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GENERAL NERVE	SENSITIVENESS.

EVOLUTION OF NERVOUSNESS.

AMERICAN NERVOUSNESS

ITS CAUSES AND CONSEQUENCES

A SUPPLEMENT TO NERVOUS EXHAUSTION (NEURASTHENIA)

BY

GEORGE M. BEAUD, A.M.M.D.

FELLOW OF THE NEW TOKK ACADEMY OF MEDICINE, MEMBEB OF THE NEW YORK

NEUROLOGICAL SOCIETY, EX-VICE-PRESIDENT OF THE AMERICAN

ACADEMY OF MEDICINE, MEMBER OF THE NEW YORK

ACADEMY OF SCIENCES, OF THE AMERICAN

NEUROLOGICAL ASSOCIATION.

t^

KEW YORK

G. P. PUTNAM'S SONS

27 & 29 West 23d Street 1881

^ n

COPTKIGHT, 1881, BY G. P. PUTNAm's SOSS.

1

PEEFACE

This work is designed as a supplement to my lately published work on Neurasthenia (Nervous Exhaustion).

That work, though it appeared but one year ago, speedily passed to a second edition in this country, and has already been translated into German. It is just to infer that at last, after long delay, an audi- ence has been found for a scientific discussion of this class of subjects.

In the preface to Nervous Exhaustion it was stated that the chapter on the causes was designedly omitted, inasmuch as a thorough elucidation of that side of the subject, in all its relations and depen- dencies, would be of so complex a character as to re- quire a special volume of itself. The present work' is, therefore, to be regarded as a chapter on causes for the treatise on Nervous Exhaustion, with these qualifications — that it embraces the whole domain of nerve sensitiveness and nerve susceptibility, that lead to the more definite condition of nervous ex- haustion, and that it is of a more distinctly philo-

IV PREFACE.

sophical and popular character than that treatise, which was specially addressed to the professional and scientific reader.

The various subjects discussed in this work have occupied my mind from the time when I first began to think ; in the form in which they now appear they represent not far from a quarter of a century of research and toil ; many of the sections having been so often re- written and re-cast, that they bear little resemblance to their original form. The criti- cism which will be given to the philosophy of this work has been to a considerable degree anticipated, since the researches, and generalizations based on the researches, have been published by me, in various ways, during the last fifteen years ; and most of them have been extensively published and republished in England and Germany; and thus have repeatedly, and in various forms, received the attention of some of the strongest critics of our generation. Replies to these critics and improvements in the mode of state- ment inspired by their suggestions, will be found in the present volume. Among these criticisms, espe- cially noteworthy are those of the London Times^ London Spectator^ and Saturday Review ; in Germany there has been endorsement rather than criticism. jlB Although the general philosophy of this work is, in substance, the same as that contained in my earlier writings on the same subject, yet, in details and

PREFACE. V

illustrations, and in the arrangement and methods of argumentation, very many additions have been made which are here published for the first time. Many of tiie distinctive thoughts of this work are found in my lecture on American. Nervousness given before the Medical and Surgical Society of Baltimore, and subsequently published in the Virginia Medical Jouimal^ and in pamphlet form, and in papers on "English and American Physique," in the North AmeHcan Review^ on " The Future of the Ameri- can People," in the Atlantic Monthly and on " The Consolations of the Kervous," in AppletorCs Jour- nal^ and in a series of articles in the Yale College Courant, More recently I lectured on the general subject before the Philosophical Society of Chicago.

Some of the points have also been touched upon in a series of papers recently given through the New York Medical Record^ in my paper on Writer's Cramp ; also in my work on " Hay- Fever," and on " Neurasthenia " (Nervous Exhaustion), and in Beard and Rockwell's " Medical and Surgical Electricity." In a paper read before the British Medical Associa- tion, in Cork, 1879, and Cambridge in 1880, I also discussed the problems raised in this volume and the one that it supplements.

Throughout this book references and foot notes are resorted to but occasionally, since to make the list of authorities of sources of facts complete

VI PREFACE.

would require another volume at least half the size of the present one.

To those who are beginning the study of this interesting theme the following epitome of the philosophy of this work may be of assistance, as a ' preliminary to a detailed examination.

First. Nervousness is strictly deficiency or lack of nerve-force. This condition, together with all the symptoms of diseases that are evolved from it, has developed mainly within the nineteenth cen- tury, and is especially frequent and severe in the Northern and Eastern portions of the United States. ISTervousness, in the sense here used, is to be distin- guished rigidly and systematically from simple ex- cess of emotion and from organic_disease.

Secondly, The chief and primary cause of this development and very rapid increase of nervousness is modern civilization, which is distinguished from the ancient by these five characteristics : steam- power, the periodical press, the telegraph, the sciences, and the mental activity of women.

Civilization is the one constant factor without which there can be little or no nervousness, and under which in its modern form nervousness in its m^ny va- fll rieties must arise inevitably. Among the secondary and tertiary causes of nervousness are, climate, institu- tions— civil, political, and religious, social and business — personal habits, indulgence of appetites and passions.

PREFACE. vii

Third. These secondary and tertiary causes are of themselves without power to induce nervousness, save when they supplement and are interwoven with the modern forms of civilization.

Fourth. The sign and type of functional ner- vous diseases that are evolved out of this general nerve sensitiveness is, neurasthenia (nervous exhaus- tion), which is in close and constant relation with such functional nerve maladies as certain physical forms of hysteria, hay-fever, sick-headache, inebriety, and some phases of insanity ; is, indeed, a branch whence at early or later stages of growth these dis- eases may take their origin.

Fifth. The greater prevalence of nervousness in America is a complex resultant of a number of in- fluences, the chief of which are dryness of tho air, extremes of heat and cold, civil and religious liberty, and the great mental activity made necessary and possible in a new and productive country under such climatic conditions.

A new crop of diseases has sprung up in America, of which Great Britain until lately knew nothing, or but little. A class of functional diseases of the ner- vous system, now beginning to be known everywhere in civilization, seem to have first taken root under an American sky, whence their seed is being distributed.

All this is modern, and originally American ; and no age, no country, and no form of civilization,

vill PREFACE.

not Greece, nor Rome, nor Spain, nor the Nether- lands, in the days of their glory, possessed such maladies. Of all the facts of modern sociology, this rise and growth of functional nervous disease in the northern part of America is one of the most stu- pendous, complex, and suggestive ; to solve it in all its interlacings, to unfold its marvellous phe- nomena and trace them back to their sources and forward to their future developments, is to solve the problem of sociology itself.

But although nervousness, and the functional nervous diseases derived from it, are most frequent in America, and were here first observed and first systematically studied, they are now and for some time have been, becoming more and more frequent in E '.e.

Sixth. Among the signs of American nervous- ness specially worthy of attention are the following: The nervous diathesis ; susceptibility to stimulants and narcotics and various drugs, and consequent necessity of temperance ; increase of the nervous diseases inebriety and neurasthenia (nervous exhaus- tion), hay-fever, neuralgia, nervous dyspepsia, as- thenopia and allied diseases and symptoms ; early and rapid decay of teeth ; premature baldness ; sen- sitiveness to cold and heat ; increase of diseases not exclusively nervous, as diabetes and certain forms of Bright's disease of the kidneys and chronic ca-

I I

PREFACE. IX

tarrhs ; unprecedented beauty of American women ; ^ frequency of trance and muscle-reading ; the strain of dentition, puberty, and change of life ; American oratory, humor, speech, and language ; change in type of disease during the past half century, and the greater intensity of animal life on this continent.

Seventh. Side by side with this increase of ner- vousness, and partly as a result of it, longevity has increased, and in all ages brain- workers have, on the average, been long-lived, the very greatest gen- iuses being tlie longest-lived of all. In connection with this fact of the longevity of brain-workers is to be noted also, the law of the relation of age to work, by which it is shown that original brain-work is done mostly in youth and early and middle life, the latter decades being reserved for work requir- ing simply experience and routine.

Eighth. The evil of American nervousness, like^ all other evils, tends, within certain limits, to correct itself ; and the physical future of the American people has a bright as well as a dark side; increas- ing wealth will bring increasing calm and repose ; the friction of nervousness shall be diminished by various inventions ; social customs with the needs of the times, shall be modified, and as a consequence strength and vigor shall be developed at the same time with, and b}^ the side of debility and ner- vousness.

■-J

X PREFACE.

Some of the views herein contained have passed long since through the three stages through which all new truths must pass before they enter into the fel- lowship of science ; the stage of indifference, the stage of denial, the stage of contests of priority ; others are passing out of the second and third of these stages, and others still have not yet passed, or are but be- ginning to pass out of the era of indifference. It is worthy of comment that some of the most icon- oclastic of the truths here announced, those which, when first made known, years since, were believed to indicate insanity on the part of the author, and were felt to threaten the stability of the science to which they belong, have already become so inter- woven with our medical literature, that their pliil- osophy and their terminology are met with every day and every hour in reading and in conversation ; out of these researches a number of bookig have been published, in Europe and America, and numbers more, as I learn, are in preparation ; in this new and immense field, there is room for an army of workers.

But despite all this rq.pid adoption and popular- ization of these facts, their reception is yet, and for a long future must remain, very far from being unanimous ; indeed, only among the leading experts can they be said to have gained complete and unwavering acceptance ; with the great body of

PREFACE. XI

science young and old, these truths are as though they had never been ; in all our cyclopedias of med- icine, the terms hysteria, somnambulism, ecstasy, catalepsy, mimicry of disease, spinal congestion, in- cipient ataxy, epilepsy, spasms and congestions, an- emias and hyperemias alcoholism, spinal irritation, spinal exhaustion, cerebral paresis, cerebral exhaus- tion and irritation, nervousness and imagination are thrown together recklessly, confusedly, hopelessly as in a witches caldron; and in all, and through all, one shall look vainly — save here and there, for an intelligent and differential description of neuras- thenia, the most frequent, the most important, the most interesting nervous disease of our time, or of any time ; still hay-fever is classed as parasitic or infectious, although as justly insanity or epilepsy or neuralgia might be similarly classed ; still inebriety or dipsomania, is either not mentioned at all or grotesquely confounded with alcoholism or epilepsy ; still our medical graduates, after years spent in lis- tening to lectures, must wait for their diploma be- fore they are even ready to begin the study of this side of the nervous system. Meantime the literature of ataxia, which is but an atom compared with the world of functional nervous diseases, has risen and yet rising with infinite repetitions and revolutions to volumes and volumes.

The researches on the longevity of brain-work-

Xli PREFACE.

ers have a history which, at this stage, as an en- couragement to young men who are giving them- selves to original work, may properly be given here. The investigations on this subject were made by me while a student of medicine, were given as a lecture before an association of army and navy surgeons in New Orleans, w^ere then put in a gradu- ating thesis, which not only received no prize, but not even an honorable mention. A popular essay based on these researches, after being rejected by one magazine was finally published in the " Hours at Home," when all its statistics and reasonings were called in question ; after being put in a somewhat different form the same was published in the first volume of the " Transactions of the American Health Association," and there for the first time, through the transactions and through the reprint, was fairly brought before the scientific w^orld, and for the first time began to have .an audience. The essay was reprinted in England in the London Journal of Science, and a full abstract was published in Germany, with the statement, that it w^as an evi- dence of the progress of science in the United States that such researches could be made here. Within the last few years the views of that essay have been passing into general acceptance in the scientific world ; some of them having been used of late as a base line wlience to attack other

I

PREFACE. XUl

researches contained in this book. The philosophy and the facts which have met with so complete an endorsement, were in substance those contained in that graduating thesis which now rests in peace in the archives of ray alma mater.

The philosophy of the work of neurasthenia of which the present work is a supplement, after a long period of indifference — has passed in the mind of many, if not the majority of experts on nervous diseases, through the three stages which new truths are destined to pass — so that, now we hear little but the dying away echoes of the contest of priority which always attends the latter part of the last stage in the evolution of ideas.

At the late meeting of the British Medical As- sociation Dr. Crichton-Browne gave an address on this subject accurately stating and confirming my conclusions in regard to the increase of nervous diseases, and advocating throughout much of the philosophy embraced in that portion of this work which is devoted to the signs and causes of ner- vous exhaustion ; and he also added some very sug- gestive and well-stated observations of his own ; even going so far as to assert that the English are growing thinner, that they weigh less than their ancestors of a century ago.

The law of the relation of age to work which is announced and demonstrated in the chapter on

XIV PREFACE.

longevity of brain-workers has not yet been ac- cepted by any considerable number of human beings so far as known to me, and it is scarcely probable that it will be accepted, although it is easier of . demonstration and absolute verification than any of the facts that are contained in these researches ; men feel as though this discovery were an attack upon the human race, and by the instincts of self-preser- vation every one is enlisted to oppose it. It is probable, therefore, although any one with a cyclo- pedia can confirm all that I claim to have discov- ered on this subject, that a yet higher and wider development of the scientific sense will be required before even experts in pyschology shall be ready to receive a scientific truth so opposed to the al- most universal convictions of mankind.

When, a number of years ago, I formulated some of the signs and proofs of this increasing nervous- ness, there was scarcely a responsive voice in any country; but the strongest, most numerous and com- prehensive endorsements these views have obtained have thus far been in Germany and England more than in the United States, which is the nervous country by pre-eminence. So far as I know, there has been no hostile criticism of this philosophy in^l Germany, but in England, even now, these views are not unanimously sustained. At the time that Dr. Crich ton- Browne gave his essay in w^hich he

I

PREFACE. XV

not only asserted all that I had claimed on the in- crease of nervousness, but went even farther than I should have dared to go, on their increase in England, the distinguished microscopist, Dr. Lionel Beale, published a work on " Slight Ailments," in which he had occasion to refer to nervousness and to my researches in that subject, and he denies that there has been any increase; and implies that if our fathers had observed properly, they would have found as much as their descendants. Philos- ophy of this kind comes partly from defective observation ; but more, it is to be feared, from defective reasoning; from conjoined inability and unwillingness to trace detailed facts back to the general laws Avhence they flow, or to take a wide survey of intricate and difficult problems. If this philosophy be driven to its logical conclusion, it must assert that, on the banks of the Nile and the Amazon, among the fading-away Indian tribes of our continent, in Greenland, in Iceland, in Lapland, in Russia, in China, in Turkey, in Australia, in India, in Japan, and in the Cannibal Islands there is just as much hay-fever, just as much epilepsy, just as much inebriety and insanity, just as much neurasthenia, as many phases of insomnia, of head- ache, just as much near-sightedness, as much hypo- chondria, hysteria, chorea, and as much mental and physical debility as there is in London and New

XVI PREFACE.

York. A conclusion so unscientific and non-ac- cordant with general — to say nothing of special — observation, is a thousand times over refuted by facts contained in this volume; and that at this late hour, this delusion survives in scientific society is an argument more potent than all others I know, for such a re-construction of our system of education as shall make reasoning of that kind among edu- cated men impossible.

The London Times in commenting on some of the views here brought forth has assumed and stated that I deplore the necessity of stating them. An inference so erroneous I trust may not be drawn from the present volume. Science fears not, nor does it hope — it does not even expect ; but takes all that it finds in nature and makes it its own, trusting all, receiving all, and witli equal welcome.

It has been said, it will be said here, that these subjects are unworthy of science, and that the time and force of scientific men expended upon them might have been more wisely used in other realms ; and it will be urged, as it has been urged, upon those who would make the wisest use of their powers, to give little heed to the scientific study of this side of psychology and sociology.

As compared with politics, a topic like this must seem, and especially in a land like ours, very small indeed ; so that only when we fix our eyes

PREFACE. XVI 1

most closely upon it, is it possible to see it at all ; but it is the office, the nature, the essence and the life of science to ennoble the ignoble, and out of sraallness and meanness to ev^olve greatness and beauty ; all science that is now known is but the organization of phenomena of nature that men have thought to be too trifling for the solemn attention of the human mind.

The philosophic study of the several branches of sociology, politics, charities, history, education, shall never be even in the direction of scientific precision or completeness until it shall have ab- sorbed some, at least, of the suggestions of this problem of American Nervousness. We are, there- fore, called to its study by the very presence in our minds of the seemingly weightier matters that would drive it out of sight ; we are called to it by politics itself, which American youth are taught is the only theme worthy the attention of an ambitious nature ; by the problems of merchandise, of inven- tion, of property, and of social order. This subject also calls us to its study by the chance it gives through widely-opened doors for original, creative, pioneering, and producti\'e work that shall make Europe follow us, instead of our following Europe. Long enough this babjdand of science has fed on the crumbs that fall from Germany's table ; corn and fruits we are carrying to the old country; let

xvni PREFACE.

new ideas, and crops of fresh discoveries go with them. Better to criticise and confirm than to be idle ; but wiser far to make others criticise and confirm. If we will cease to cross the sea in our search of materials for thought, and take those that fall in full showers at our doorsteps, we shall do our best service for other lands as well as for our own.

The hope may be expressed — that this theme may not be judged by the imperfectness and in- expertness of its representative ; the insignificance of the author may weaken, but cannot destroy his cause ; for, as little children sometimes return homeward from their play so laden and covered over with wreaths and flowers that they themselves are hidden, so this subject by its richness and import- ance quite conceals and overshadows its advocate.

G. M. B.

New York, May 1 — 161 Madison Avenue.

1

I

OOlSTTEll^rTS.

CHAPTER I.

NATURE AND DEFINITION OP NERVOUSNESS.

What it is not — The Maine Jumpers — Nervousness is Nerve- lessness — A lack of Nerve-force — Symptoms of Nervous Exhaustion — Nervous Bankruptcy — Reserve Force needed — Why American Nervousness — Nervousness dis- tinguished from Organic Disease 1-1 7

CHAPTER II.

SIGNS OF AMERICAN NERVOUSNESS.

Principles of evidence to be applied in the study of this sub- ject— Statistics of little value — Functional Diseases not fatal — Nervousness vs. Longevity — Increase of the Ner- vous Diathesis — The Nervous Diathesis — Increased Sus- ceptibility to Stimulants and Narcotics — English vs. American Drinking — English Drinking Capacity — Tem- perance a Modern Virtue — Inebriety — Smoking — Sensi- tiveness to Drugs — Thirstlessness — Indigestion — Rela- tion of Indigestion to Nervousness — Sensitiveness of Digestion — Near-Sightedness — Weak Eyes — Americans Moderate Eaters — Increase of Near-Sightedness and Weakness of the Eyes — Early and Rapid Decay of the Teeth — Teeth of Savages — Premature Baldness — Sensi- tiveness to Heat and Cold — Evolution of Nervousness — Nervous Exhaustion (Neurasthenia) — Increase of Dis- eases not Distinctively Nervous — Diabetes and Bright's Disease — Chronic Catarrhs — Catarrh of Nose and Throat — Sensitiveness to Medicines — Habit of taking Drugs — Re- lation of Nervousness to Beauty — American Beauty — American vs. English Female Beauty — American Muscle- Reading — Relation of Dress to Nervousness — Dentition,

XX CONTENTS.

Puberty, and Change of Life — Panurition, Nursing — Diseases of Women, Lacerations of the Womb and Perineum — Relation of American Oratory to American Nervousness — Nervousness and Humor — Philosophy of American Humor — The American Language — Nervous- ness and Language — Rapidity of Speech and Pitch of Voice— Greater Susceptibility to Trance in America — Change in Type of Disease — Diseases of Savages — Syphilis growing Milder — Nervousness Increased by Inheritance — Intensity of Animal Life in America 18-95

CHAPTER IIL

CAUSES OP AMERICAN NERVOUSNESS.

Civilization very limited in extent — Analogy of the Electric Light — Analogy of the Steam Engine — Necessary Evils of Specialization — Clocks and Watches — Necessity of Punctuality — The Telegraph — Effect of Noise on the Nerves — Disagreeable Odors — New York Elevated Road — Railway Travelling and Nervousness — Rapid Devel- opment and Acceptance of New Ideas — Increase in Amount of Business in Modern Times — Buying on a Margin vs. Gambling — Increased Capacity for Sorrow — Love and Philanthropy — Repression of Emotion — Do- mestic and Financial Trouble — Politics and Religion — Liberty as a Cause of Nervousness — Elections — Protes- tantisms— Anxiety and Insanity — Evils of Forethought — Indian Indifference — Comparative Size of the Ancient and Modern World — Activity of the Modern World — Life in Ancient Athens and New York Contrasted— Greece m. America — Climate — Extremes of Heat and Cold — No Summer in England — Mildness of the English Winter — Dryness of the Air — Rocky Mountain Region — Dryness and Electricity — High Temperature of Houses— How Dry Air Causes Nervousness — Moisture of England — Out-door Life of English — The Late Season — Chorographic Map of the United States — Less Nervousness Soutii — Climate of America Compared with that of Japan — Differences in American Climate — Nervousness in the West — Climates Contrasted — Tropical and Sub-Tropical Climate Con-

I

CONTENTS. XXI

trasted with the Climate of the United States — Caprice of Southern Climate — Severity of this Season — Recapitula- tion of Causes of Nervous Exhaustion— Modem Civiliza- tion— Climate — Race — The Nervous Diathesis — Exciting Causes — Nervousness and Civilization — Tobacco and Eye Disease — Opium Eating in China — Opium Eating not always Injurious to the Chinese — Health and Habits of North American Indians — Physique of Woman in the Savage State — North vs. South — The Problem can be Solved by Studying this Continent alone — A Study of Soutliern Negroes — Comparative Physique of East and West— East vs. West— Australia 96-192

CHAPTER IV.

LONGEVITY OP BRAIN-WORKERS, AND THE RELATION OP AGE TO WORK.

The Popular Belief a Delusion — Longevity of Brain-Workers — DiflBculties in the Investigation — Great Longevity of Great Men — Comparative Longevity — Causes of Great Longevity of Brain-Workers — Brain-Workers have less Worry — Brain-workers have more Comforts — Nervous- ness favors Longevity — Brain- Workers Easier in Old Age— Relation of Age to Work, Reputation, and Ability — Force vs. Results of Force— Original and Routine Work — Replies to Criticisms — Method of Investigation — Num- ber and Quality of Biographies Consulted — Results of tlie Investigation — The Golden Decade — Apparent and Real Exceptions to the Average — Old Age of Artists — Old Age Imitates Itself — Childhood and Old Age but Imitators — Application of the Law to Animals and Plants — Unpopu- larity of these Truths — Moral Decline and Happiness in Old Age — Compensations of Age — Comparative Longevity of the Professions — Longevity of the Precocious — Moral vs. Morbid Precocity — The Great Longevity of Clergymen — Causes of the Exceptional Longevity of Clergymen — Consolation for the Nervous — Natural History of the Nervous — Cycles of Debility — Nervousness a Constant Warning — Healthy Old Age — Recent Progress in the Treatment of Nervous Diseases 193-291

XXll CONTENTS.

CHAPTER V.

PHYSICAL FUTURE OF THE AMERICAN PEOPLE.

Relation of Health to Wealth and Poverty — Comparative Healthf ulness of Different Orders of Brain- Work — Pros- pective Increase of Nervous Diseases — Inebriety a Type of all — Increase of Opium Habit— Increased Susceptibility to Muscular Exercise — Reconstruction of the Systems of Education demanded — Why Education is Behind other Sciences and Arts — The Gospel of Rest — Ignorance a Necessity — The Art of Reasoning — Senses to be Chiefly Used — Lectures and Languages — Psychological Object Teaching — Authors' Experience — Competitive Examina- tions— Recent Improvement in the American Physique — Germanization of America — Americanization of Europe — The Omnistic Philosophy applied to this Subject. . .292-345

^

AMERICAN NERVOUSNESS

CHAPTER I.

NATURE AND DEFINITION OF NERVOUSNESS.

If our fathers in medicine of tlie last century could be told of the subject of this work, their first question would be, "What is meant by the term nervousness ? " They would say, and very truly, that the Greeks had no w^ord for nervousness as we now understand that term; and that even down to the eighteenth century, nervousness was supposed to mean i irritability of temper, disposition to anger, excitabil- ity— a mental quality, and not a physical disease. sy

The first step, therefore, in the study of nervous- ness is to define it. First of all, what does it not \/ mean ?

^Nervousness does not mean unbalanced mental organization ; a predominance of the emotional, with a relative inferiority of intellectual nature. Relative excess of the emotions may produce symptoms which appear to be precisely similar to those which come from nervousness, and have been, and usually are, classed as nervous symptoms; and from a want of

2 WHAT IT IS NOT.

knowledge of this distinction, confusion without limit has resulted in the minds of many in regard to this whole subject. This dual meaning of the word "ner- vous " has been an important obstruction in the study of nervousness in general and of many special nervous diseases.

Whatever our philosophy of the relation of mind to body may be, practically we are compelled to study the mental as well as the physical side of the nervous system both in health and disease. Psychology may be but physiology out of sight, but psychology, as we know it, and physiology as we know it, are not iden- tical. Mental strength may coexist with physical weak- ness, and physical strength may coexist with mental weakness.

A few illustrations familiar to all will make clear, better than any quantity of abstract reasoning, this distinction. The performers in the Middle- Age epi- demics— those who were attacked with the various symptoms of anaesthesia or paralysis, or with chorea or hysteria in vast crowds, sometimes in large popu- lations— these were not nervous, they were simply unbalanced, that is, they had but little intellectual strength and very much emotion, so that when these psychical phenomena, as hysteria or chorea, once got a start among them, it spread like fire on a prairie. Trance, with its numerous, interesting and intricate phenomena, a condition that has been known in all

I

DEFINITION OF NERVOUSNESS. 3

ages, and among almost all people, is not nervousness, albeit nervous people are sometimes subject to it ; it is more likely to be psychological than physical in its origin, and it is a condition that can only be studied satisfactorily by psychological methods.*

In the religious revivals of Kentucky, in the beginning of the present century, the phenomena of " The Jerkers," so called, were not manifestations of nervousness, but were in all respects similar to the Middle- Age epidemics. To the same order belong the performances of the " Holy Rollers," who, in certain parts of ]N^ew Hampshire and Vermont, it is said, were wont to roll on the floor in the phrenzy of religious excitement. The "Jumpers," of Maine — the pheno- mena which I have recently studied, are not nervous, although they are called so by many of those who see them. As stated in my paper giving an account of my experiments with these remarkable people, none of them have tLs symptoms of nervous exhaustion, even in a mild form; they come from stalwart and hard-working ancestry, and they can themselves toil, and do toil systematically in the woods, and hold their own, side by side with their companions — they are not sleepless or neuralgic, nor do they suffer from morbid fears, or any of the various sensations of neurasthenics ;

* See my work on Trance, in which this distinction between physiology and psychology is discussed more fully and variously illustrated.

* THE MAINE JUMPERS.

some of them are among the best examples of physical hardness and endurance ; but, despite all this muscular vigor, and all this broad margin of nerve-force which they certainly possess, they can no more help jumping, when suddenly struck, or on hearing a sharp sound, or throwing, or striking, or repeating automatically what is suddenly communicated, than they can avoid breathing. This interesting sur\rival of the Middle Ages that we have right here with us to-day, is the most forcible single illustration that I know of, of the distinction between unbalanced mental organization and nervousness.

These Jumpers are precious curiosities, relics or antiques that the fourteenth century has, as it were, dropped right into the middle of the nineteenth. The phenomena of the Jumpers* are as interesting, sci- entifically, as any phenomena can be, but they are^i not contributions to American nervousness. H

Brainlessness (excess of emotion over intellect) is, indeed, to nervousness, what idiocy is to insanity ; and, like insanity and idiocy, the two are very often con- founded. Insanity is a disease of the brain in which mental co-ordination is seriously impaired ; but idiocy does not necessarily come from disease, but from defi-

* In the December number of Popular Science Monthly (1880), I described the phenomena of these Jumpers, and g-ave the re- sults of my experiments with them, and showed their rela- tions to mental and physical disorders more in detail than I can do here.

DEFINITION OF NERVOUSNESS. 6

cient brain, or a brain unbalanced or badly organized ; asV these psychical or mental disorder, like those of the IJoly Rollers, the Jumpers, etc., do not come from disease, but from ill-balanced brains — a preponderance of emotioii : and such mental disorders may appear, and usually dO -appear, in those who have an abun- dance of nerve-force, and can never become neuras- thenic, or nervously exhausted*

Idiocy and insanity may sometimes run together ; so an emotional nature may sometimes become ex- cessively nervous.

Nervousness is not passionateness. A person who easily gets excited or angry, is often called nervous. One of the signs, and in some cases, one of the first signs of real nervousness, is mental irritability, a dis- position to become fretted over trifles ; but in a major- ity of instances, passionate persons are healthy — their exhibitions of anger are the expression of normal emotions, and not in any sense evidences of disease, although they may be made worse by disease, either functional or organic.

Nervousness is nervelessness — a lack of nerve- force.

If it be asked why I do not use the term nerveless- ness in preference to nervousness, the reply is, that nervousness already has the floor, and will hold it, and, with the above explanations, need not mislead. It is difficult, and sometimes beyond our power to drive out

LACK OF NERVE-FORGE.

an old term, even althougli it be but partially correct- In medical science we are forced to retain terminology that is in the last degree unscientific, for the 'game reason that we retain our orthography, whicli in the English language is, as all know, very .bad indeed. Such terms as Writer's Cramp, which gives but little idea of the condition to which it is applied, and Hay- Fever — one of the most unscientific and least expres- sive terms in medicine — we are compelled to adopt in scientific literature. Similarly, such common terms as hysteria and epilepsy are as strong in their positions as ever, although scientific men use them under re- served protest. It is, therefore, unwise to attempt to displace the term nervousness by nervelessness, or by any other word that might be framed. An attempt of this kind would doubly fail ; it would not be under, stood, and would, therefore, bring confusion ; and would not succeed in driving out the old and familiar term which has so long been growing in popular and professional literature.

Nervousness manifests itself by some one or many of a very large number of symptoms of functional de- bility and irritability, the majority of which symptoms are not found in those who have simply unbalanced mental organizations, and among these symptoms — which are described or illustrated in detail in my work on Nervous Exhaustion (Neurasthenia) — are the following :

1

I

DEFINITION OF NERVOUSNESS. 7

Insomnia, flushing, drowsiness, bad dreams, cere- ^ bral irritation, dilated pupils, pain, pressure and heavi- ness in the head, changes in the expression of the eye, neurasthenic asthenopia, noises in the ears, atonic voice, mental irritability, tenderness of the teeth and gums, nervous dyspepsia, desire for stimulants and narcotics, abnormal dryness of the skin, joints and mucous membranes, sweating hands and feet with redness, fear of lightning, or fear of responsibility, of open places or of closed places, fear of society, fear of being alone, fear of fears, fear of contamina- tion, fear of everything, deficient mental control, lack of decision in trifling matters, hopelessness, deficient thirst and capacity for assimilating fluids, abnormal- ities of the secretions, salivation, tenderness of the spine, and of the whole body, sensitiveness to cold or hot water, sensitiveness to changes in the weather, coccyodynia, pains in the back, heaviness of the loins and limbs, shooting pains simulating those of ataxia, cold hands and feet, pain in the feet, localized per- ipheral numbness and hypersesthesia, tremulous and variable pulse and palpitation of the heart, special idiosyncrasies in regard to food, medicines, and ex- ternal irritants, local spasms of muscles, difficulty of swallowing, convulsive movements, especially on go- ing to sleep, cramps, a feeling of profound exhaus- tion unaccompanied by positive pain, coming and going, ticklishness, vague, pains and flying neuralgias,

8 SYMPTOMS OF NERVOUS EXHAUSTION.

general or local itching, g^eneral and local chills and flashes of heat, cold feet and hands, attacks of tem- porary paralysis, pain in the perineum, involuntary emissions, partial or complete impotence, irritability of the prostatic urethra, certain functional diseases of women, excessive gaping and yawning, rapid decay and irregularities of the teeth, oxalates, urates, phos- phates and spermatozoa in the urine, vertigo or dizzi- ness, explosions in the brain at the back of the neck, dribbling and incontinence of urine, frequent urina- tion, choreic movements of different parts of the body, trembling of the muscles or portions of the muscles in different parts of the body, exhaustion after defecation and urination, dryness of the hair, falling away of the hair and beard, slow reaction of the skin, etc. Dr. Neisser, of Breslau, while translat- ing my work on l^ervous Exhaustion into German, wrote me that the list of symptoms was not exhaust- ive. This criticism is at once accepted, and was long ago anticipated. An absolutely exhaustive catalogue of the manifestations of the nervously exhausted state / cannot be prepared, since every case differs somewhat from every other case. The above list is not supposed to be complete,* but only representative and typical.

* Other symptoms of Neurastlienia have been described by me in a series of papers in the New York Medical Record, on Nervous Diseases connected with the male genital functions, published during the last two years, ending February 19,1881. It is quite true, as Dr. Neisser states, that certain chronic catarrhs of the

I

DEFINITION OF NERV0U8NE8S. 9

Nervous Bankruptcy.

A nervous person suffering from any number of the above-named symptoms is one who has a narrow margin of nerve-force.

In finance, a man is rich who always lives within his income. A millionnaire may draw very heavily on his funds and yet keep a large surplus ; but a man with very small resources — a hundred dollars in the bank — can easily overdraw his account; it may be months or years before he will be able to make him- self square. There are millionnaires of nerve-force — those who never know what it is to be tired out, or feel that their energies are expended, who can write, preach, or work with their hands many hours, with- out ever becoming fatigued, who do not know by per- sonal experience what the term exhaustion means; and there are those — and their numbers are increasing daily — who, without being absolutely sick, without being, perhaps for a lifetime, ever confined to the bed a day with acute disorder, are yet very poor in nerve-force ; their inheritance is small, and they have been able to increase it but slightly, if at all ; and if from overtoil, or sorrow, or injury, they overdraw their little surplus, they may find that it will require months or perhaps years to make up the deficiency,

nasal passages, pharynx and eyelids are of a neurasthenic char- acter, and are maintained by a depressed state of the nervous system.

10 NERVOUS BANKRUPTCY.

if, indeed^ they ever accomplish the task. The man with a small income is really rich, as long as there is no overdraft ■ on the account ; so the nervous man may be really well and in fair working order as long as he does not draw on his limited store of nerve-force. But a slight mental disturbance, unwonted toil or ex- posure, anything out of and beyond his usual routine, even a sleepless night, may sweep away that narrow margin, and leave him in nervous bankruptcy, from which he finds it as hard to rise as from financial bankruptcy.

A man is not well and strong and properly or- ganized and equipped for life, who has not a large amount of reserve force, much more than is needed in his ordinary duties. An electric battery that does not supply very much more electric force than is needful for the use to which the battery is put, is a failure, since, by the wasting away of the elements and the chemical changes that take place in the fluid, the force will tend to diminish, and unless there be originally a great reserve in excess of what is needed for the purpose — either medical or other use — there will be necessary frequent cleaning and overhauling. Scores of batteries of all sorts have been brought to me by hopeful and earnest inventors, which I have been obliged to condemn simply for this : that while, perhaps, they have every other desirable element in an instrument for medical use, they are deficient in

I

DEFINITION OF NERVOUSNESS. 11

reserve force. When in perfect order, with new fluid, the elements clean, all the connections per- fectly bright, they will give, perchance, all the elec- tricity that is needed, and thus deceive the inventor, the manufacturer, and the one who purchases ; but in a few days the reserve is so drawn upon that they are useless, and in time become too feeble for the whole range of medical purposes, even after being thoroughly cleaned. I have been compelled to make myself very unpopular with inventors and manufacturers for giv- ing this opinion in regard to their instruments. Men, like batteries, need a reserve force, and men, like bat- teries, need to be measured by the amount of this re- serve, and not by what they are compelled to expend in ordinary daily life. Prof. Erb, of Leipsic, in his brief but very appreciative, scientific and suggestive chapter on " Neurasthenia," in Zimmsen's Cyclopedia of Medicine, emphasizes the fact that unusual exertion, out of the ordinary line of toil, is especially exhaust- ing to neurasthenics. This is a fact which I ob- served for years in all my study of the subject, and it is an instructive and important fact in our study of the pathology of neurasthenia and of nervous- ness in general. The greater exhaustion that comes from unusual and unwonted exertion, has this two- fold explanation, which is quite clear to those w^ho are familiar with modern physics : First, unusual ex- ertion, along the untravelled pathways of the nerves.

12

RESERVE FORGE NEEDED.

meets with greater resistance, just as the electric force meets with greater resistance in a badly conducting circuit. Routine labor requires the evolution and transfer of force along well worn pathway?, where the resistance is brought down to a minimum ; hence a very slight evolution of force is sufficient to produce the result, just as a very slight amount of electricity will pass through a good conductor, like a large cop- per wire. To overcome this resistance of these un- worn pathways, more nerve-force is required : the re- serve is drawn upon ; the man becomes tired. Hence we see that neurasthenics who can pursue without any special difficulty the callings of their lives, even those callings requiring great and prolonged activity, amid perhaps very considerable excitement, as that of statesmanship, politics, business, commercial life, or in overworked professions, are prostrated at once when they are called upon to do something outside of their line, where their force must travel by paths

(that have never been opened and in which the ob- structions are numerous and can only be overcome by greater energy than they can supply. In the presence of unusual exertion, these persons are like men with moderate incomes, who, having long been accustomed to live within those incomes with ease, and who are therefore relatively rich, are called upon suddenly and unexpectedly to meet an unusual drain, and so become insolvent. .

DEFINITION OF NERVOUSNESS. 1 3

The purpose of treatment in cases of nervous exhaustion is of a twofold character — to widen the margin of nerve-force, and to teach the patient how to keep from slipping over the edge.

Why American Nervousness ?

The very title of this work, *^ American !N'ervous- ness," may seem to some a giving away of this question ; to others, perhaps, an insult. It is asked why not English, French, German, or Irish nervous- ness ? Our answer is, that while modern nervousness is not peculiar to America, yet there are special ex- pressions of this nervousness that are found here only; and the relative quantity of nervousness and of ner- vous diseases that spring out of nervousness, are far greater here than in any other nation of history, and it has a special quality. American nervousness, like American invention or agriculture, is at once peculiar and pre-eminent. Our title is justified by this, that if once we understand the causes and consequences of American nervousness, the problems connected with the nervousness of other lands speedily solve them- selves.

He who has ascended the summit of Mont Blanc looks easily down on all the other mountains of the Alps, none of which he cares to ascend, for already he is higher than they ; he who has solved the problem of nervousness as it appears in America, shall find its

14 WHY AMERICAN NERVOUSNESS.

problems in other lands already solved for him ; for as the greater includes the less, so the history of the rise and growth of the nerve maladies of the United States embraces all of a similar or allied nature that have arisen in other lands.

I have before me a most valuable book by Karl Hillebrand, on German Thought.

Neither by the title of this book nor by the treat- ment of the subject does the author imply that there is no thought outside of Germany. He does, how- ever, imply, and directly state, that in modern times, up to a recent day, Geraiany has done the thinking in philosophy for all nations, and that there are pecu- liarities of German thought that entitle it to special study, and make it legitimate and proper to prepare a work on that subject and with that title. For the same reasons, American nervousness is a subject wor- thy of distinct and special study.

The philosophy of Germany has penetrated to all civilized nations; in all directions we are becoming Germanized. Similarly, the nervousness of America is extending over Europe, which, in certain countries, at least, is becoming rapidly Americanized. Just as it is impossible to treat of German thought without in- telligent reference to the thought of other nationali- ties, ancient or modern, so is it impossible to solve the problem of American nervousness without taking into our estimate the nervousness of other lands and ages.

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DEFINITION OF NERVOUSNESS. 1 5

Nervousness distinguished from organic disease, E'ervousness is to be distinguished from nervous diseases of an organic or structural character. There is no evidence — certainly no evidence of a satisfactory character — that such serious diseases, for example, as locomotor ataxia, spinal paralysis, and various organic diseases of the brain, paralysis of a cerebral origin, with rupture of the arteries, have so very much in- creased in modern times, and there is certainly no evidence that diseases of this kind are any more com- mon in America than in any other country. Indeed, so far as I have been able to estimate from informa- tion I have been able to obtain and from my own personal observation in the hospitals of Europe and of this country, I should say that locomotor ataxia and other diseases of the spinal cord are really more common in Europe than in America. Sufferers from ataxia and spinal meningitis and interior spinal scle- rosis, are not usually very nervous people, certainly not exceedingly so. Indeed, nervousness, in its ex- treme manifestations, seems to save one from these organic incurable diseases of the brain and of the cord; with some exceptions here and there, the neur- asthenic does not go into or die of nervous disease. A certain degree of nervousness may be necessary for the development of these structural diseases of the brain and cord, but not the extreme phases of nervousness. It is undeniable that these structural

16 DISTINGUISHED FUOM ORGANIG DISEASE.

diseases — some of them at least, are much more common in civilized countries than in barbarian, but they are not so common among the very nervous as among those who are but moderately so ; they may be regarded as stopping- places between the strength of the barbarian and the sensitiveness of the highly civilized. A point which I always make in dealing with neurasthenic patients is, that their very frequent fear of dying of some organic disease of the brain and cord, is usually not well grounded, and that their very nervousness is likely to save them from what they so intensely fear. They may become in- sane— some of them do ; they may become bed-con fined invalids; they may be forced, as they often are, to resign their occupations, but they do not, as rule, develop the structural maladies to which here refer.

Some of the nervous symptoms above mentioned may be found in organic or structural disease, but when so found they can be distinguished from the same symptoms occurring in neurasthenia or the neurasthenic state, by tests — as described in my work on Neurasthenia — that need not often mis- lead us.

Although nervousness sometimes leads to insanity, especially of the melancholic form, and to the types known as inebriety and general paralysis of the insane, just as it may lead to epilepsy or hysteria, yet there

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DEFINITION OF NERVOUSNESS. 17

is no necessary correlation between simple nervous- ness and the extreme or special manifestation of it in the form of insanity. Thousands and thousands are nervous who are not and never will be insane.

To compress all in one sentence ; nervousness is a physical not a mental state, and its phenomena do not come from emotional excess or excitability or from organic disease but from nervous debility and irritability.

CHAPTEK 11.

SIGNS OF AMERICAN NEEYOUSNESS.

Foe years, the philosophers of both continents have been asking, and in various and inconsistent ways have been answering, this question, Are ner- vous diseases increasing ? and they have gone to the most distant regions and to the far away ages for arguments which, when found, did not aid them on either side. There is no need of this search, the proofs are all about us ; we are overloaded, weighed down with excess of evidence ; the proof shines so strong that our eyes are blinded by its light ; it irri- tates and teases us until we are benumbed, and can feel no more.

Just as, in recent and famous trials in court, of persons accused of crime, there have been many escapes, from the very excess of evidence against the prisoner, whereby the overburdened jury have been compelled to give up the hope of finding the truth, so the magnitude, multiplicity and imminence of the phenomena of American nervousness overawe and weary us ; the problem becomes harder to solve than if there were fewer facts to help us in the solution.

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SIGNS OF AMERICAN NERVOUSNESS. 19

Just as, according to the old story, the passengers of a ship that had been long out of her calculations, being in danger of death from thirst, on saluting another passing vessel, and asking for water, were told to dip it up, for they were in tlie Amazon ; — so philosophers wandering in unknown regions, eager for informa- tion on this theme, may well pause where they are, and dip up facts enough all about them to solve the problem for all time.

Principles of evidence to he ajpjplied in the study of this suhject.

Exact statistics in regard to the relative frequency of functional nervous diseases in ancient and modern times, or even comparing the last with the present century, cannot be secured, for the reason mainly, that persons do not die, or at least are not reported to have died of those diseases — even when death is a result directly or indirectly of neurasthenia, for example, it does not appear so in the death records ; consequently, the tables of mortality are of no use in the study of this subject. The attempts that have been made to make comparison of the relative number of deaths that result from paralysis of cerebral origin in present and past times have failed in aiding the solution of this question, and partly for this — that rupture and other diseases of the blood-vessels are not, strictly speaking, nervous diseases ; they are really vascular

20 STATISTICS OF LITTLE VALUE,

A

diseases ; but as rupture or lesion takes place in the vessels that go through the brain, the nervous system suffers. Diseases of this kind depending upon rup- ture in the brain or the breaking of the arteries are very old ; and, although they may have increased in modern times, they certainly have not increased as rapidly as functional diseases of the nervous system. Functional nervous disorders, which are an evolution of nervous diathesis, belong to a different order of disease ; tliey may increase, while structural diseases, such as some forms of paralysis, may decrease or re- main stationary.

The development of nervousness and the increase of functional nervous diseases, under whatever names they may be known, have been so great in modern times, especially in the Northern portions of the United States, that there is no need of statistics — the facts can be demonstrated by the general observa- tion of those who have opportunities to observe, and improve those opportunities so as to be able to draw correct conclusions. There is as much evidence that nervous diseases have increased in this country dur- ing the past fifty years as there is that the population has increased during the same time. Every ten years we have a census, but even if no census were taken, we should know that our population had increased largely; and that fact is no more certain after a census than * before, although it has greater preci

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SIGNS OF AMERICAN NERVOUSNESS. 21

eion. A person visiting Chicago does not need to go through every house and count every inhabitant to know that it is a city of several hundred thousand, and that this population has multiplied from almost nothing in 1830 to half a million or more in 1880. Before the last census the citizens of Chicago esti- mated the population by general observation, and such estimates were not far from the truth. The citizens of St. Louis made estimates in the same way, and did not get so near to the truth. Both cities were influ- enced somewhat in their judgment by feelings of local pride, but both, in spite of this local bias, were correct in their conclusion that their respective cities had very materially augmented in population.

The evidence that nervous diseases have increased in the past century is quite as satisfactory ; and even if statistics on this subject could be gathered as exact and particular as those of our census in regard to our population, such statistics, like those of the census, would merely give precision and confirmation to what we already know, and in regard to which our knowl- edge at present is practically sufficient.

Dr. Althaus, of London, has recently published a series of statistics which prove, or seem to prove, that organic or structural diseases of the nervous system have not increased in Great Britain during the past decade. These statistics are based on mortality reports, and are undoubtedly as correct as, in the nature of

22 FUNCTIONAL DISEASES NOT FATAL.

things, they can be ; but for the reasons above given on the general subject of the increase of nervous dis- eases they shed absolutely no light. I^ervous diseases or symptoms of the functional type, do not usually kill patients. IS'o one dies of spinal irritation ; no one dies of cerebral irritation ; no one dies of hay-fever ; rarely one dies of hysteria; no one dies of general neural- gia ; no one dies of sick-headache ; no one dies of ner- vous dyspepsia ; quite rarely does one die of nervous exhaustion ; and even when these conditions are the cause of death they are not noted as such in the tables of mortality ; and yet a fleet of Great Easterns might be filled with our hay-fever sufferers alone ; not Great Britain, nor all Europe, nor all the world, could as- semble so large an army of sufferers from this dis- tinguished malady; while our cases of nervous ex- haustion would make a standing army as large as that of Russia. Even inebriety, as such, does not kill, or necessarily shorten life ; it is the alcoholism and other effects of alcohol on the body that destroys inebriates, and not the disease inebriety. That these functional nervous diseases are multiplying on every hand, par- ticularly in this country, is proved by the facts and reasonings here presented. But the tables of mortal- ity give on this subject no information ; these mala- dies might increase a hundred-fold and the death-rate would not be unfavorably affected by such increase. Take sick-headache, for example ; in nearly every

11

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SIGNS OF AMERICAN NERVOUSNESS 23

family of our brain- working, indoor-living classes there are cases ; yet who dies of sick-headache ? Seventy- five years ago hay-fever was almost unknown in this country or the world ; now there are probably 50,000 cases in the United States alone, but who would sus- pect this increase from our tables of mortality ? Per- sons may and do die with these diseases, but they do not die of them. Indeed, as I have elsewhere and often urged, these diseases favor longevity, and in a variety of ways ; they make it necessary to be cau- tious, to avoid protracted over-exertion ; they make it difficult or impossible to acquire destructive habits, and positively protect the system against febrile and inflammatory diseases. Hence the explanation of the apparent paradox that while there are more of these diseases in the United States than in all the rest of the world combined, there is no country where the lon- gevity is greater than here.

Nervousness of constitution is, indeed, an aid to longevity, and in various ways; it compels caution, makes imperative the avoidance of evil habits, and early warns us of the approach of peril. Bulwer wisely says that it needs a strong constitution to be dissipated. Probably no great class of people in the world live longer than the professional and business men of America — the very class among whom these nervous disorders are so often found, the class that supplies the victims for our inebriate asylums.

24 NERVOUSNESS VS. LONGEVITY.

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I know not where to find a better demonstration of the lack of logical and scientific training among educated men, than in the published reports of the discussion on this question of the increase of nervous diseases, at the recent meeting of the International Medical Congress in Philadelphia. While the weight of opinion, so far as that goes, was in favor of the views advocated by this paper, yet the speakers— men of ability and distinction — nearly all illustrated the very common habit — and with the laity quite excusa- ble— of looking at one side of a subject. Thus, one declared that there were no new diseases ; another that nervous diseases had only appeared to increase through the mistaken observations of specialists. One said that alcohol did not produce insanity; another declared that it did, and that in connection with it, tea, coffee, and tobacco caused more disease than brain work. " Wickedness " was solemnly assigned as the cause of the increase of nervous diseases, as though wickedness were a modern discovery. One man wildly declared that " the idea that a man could hurt himself over books, was preposterous." But one of the strong- est objections made was, that longevity had increased, and that intellectual men are generally long-lived. To me this objection was of special interest, from the fact that when a number of years ago I first published my investigations on the longevity of brain-workers, showing that they lived longer than muscle-workers,

SIGNS OF AMERICAN NERVOUSNESS 25

and that great men, on the average, lived longer than ordinary men, and that longevity had clearly increased with the progress of civilization, I stated that nervous diseases of the functional variety had increased pari passu with this increase of longevity, and that the facts, so far from being inconsistent, really explained each other, and for the reasons above noted.

Increase of the Nervous Diathesis.

It is observed that nearly all the sufferers from nervous exhaustion are those in whom the nervous diathesis temperament predominates. It is observed that the majority of these cases have what I have termed the nervous diathesis — an evolution of the nervous temperament.

I may quote here my remarks on the nervous diathesis as published originally in the first edition of Beard and Rockwell's "Medical and Surgical Elec- tricity," p. 286 :

By the term nervous diathesis we design to ex- press a constitutional tendency to diseases of the ner- vous system. It includes those temperaments, com- monly designated as nervous, in whom there exists a predisposition to neuralgia, dyspepsia, chorea, sick- headache, functional paralysis, hysteria, hypochon- driasis, insanity, or other of the many symptoms of disease of the central or peripheral nervous sys- tem. What the gouty and scrofulous diathesis is

THE NERVOUS DIATHESIS.

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to the blood, such is the nervous diathesis to the nerves.

The characteristic features of the nervous dia-J thesis are :

1. A fine organization. The fine organization is distinguished from the coarse by fine, soft hair, deli- cate skin, nicely chiselled features, small bones, taper- ing extremities, and frequently by a muscular system comparatively small and feeble. It is frequently asso- ciated with superior intellect, and with a strong and active emotional nature. By these general features the fine organization is so positively distinguished from one of an opposite character that it is most readily recognized even by those least accustomed tdB I the study of temperaments. It is the organization of the civilized, refined, and educated, rather than of the barbarous and low-born and untrained — of women more than of men. It is developed, fostered, and per- petuated with the progress of civilization, with the advance of culture and refinement, and the corre- sponding preponderance of labor of the brain over that

of the muscles. As would logically be expected, it is oftener met with in cities than in the country, is more marked and more frequent at the desk, the pulpit, and in the counting-room than in the shop or on the farm.

2. Liability to varied and recurring attacks of dis- eases of the nervous system. The nature of these attacks and the frequency of their repetition will be

4

SIGNS OF AMERICAN NERVOUSNESS. 27

variously modified by climate, tlie seasons, and other external conditions ; by the personal habits and man- ner of life, and especially by sex and age. The typical manifestations of the nervous diathesis in infancy are convulsions, irritability, and sometimes grave cerebral disorder; of childhood, chorea, and analogous symp- toms ; of puberty, headache, chlorosis, spermatorrhoea, and occasionally ej^ilepsy ; of maturity, sick-headache, neuralgia, dyspepsia, with its accompaniments, consti- pation, insomnia, nervousness, and emaciation, func- tional and reflex and occasionally organic paralysis, hypochondriasis, neurasthenia, and, in women, hys- teria, spinal irritation, and the long train of nervous conditions associated with diseases of the organs of reproduction; of old age, " softening of the brain," and slow paralysis. A child born with nervous dia- thesis may suffer in infancy from attacks of spasms of the glottis ; in childhood, from chorea ; at puberty, from spermatorrhoea ; between the age of twenty and fifty or sixty, from the different grades and forms of dyspepsia, sick-headache, and neuralgia; and, in old age, may gradually fail beneath the slow advance of cerebral degeneration.

3. Comparative immunity from ordinary febrile and inflammatory diseases. The nervous diathesis appears, within certain limits, to ^protect the system against attacks of fever and inflammation.

There seems, indeed, to be something in the ner-

28 THE NERVOUS DIATHESIS.

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vous diathesis which is antagonistic to the febrile con- ditions, or at least to those forms which are developed by ordinary malaria, for it is certain that on the av- erage (with numerous exceptions, of course, on both sides) fevers and inflammations are less fatal arriong brain-workers than among muscle-workers, even when subjected to the same exposure. Now, it is among the brain-working class that the nervous diathesis is most distinctly marked and most frequently observed.

This great law also applies to races and nations. Although the question is so complicated by differences of external conditions that it is impossible to establish by statistics the relative quantity and quality of dis- ease in civilized and barbarous lands, yet history and general observation seem to show that nearly all sav- age tribes are more liable to fatal attacks of certain forms of inflammatory and febrile disease than the civilized. The history of the North American Indians seems to point to this fact with considerable conclu- siveness. Making all proper allowance for the better sanitary conditions, the higher prudence, and the V stronger force of will of the civilized man, it would appear that he is less liable to contract certain forms of inflammatory disease than the barbarian, even when exposed to the same influences.' Vl

The nervous is the prevailing diathesis in the United States.

The nervous diathesis should be distinguished from

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SIGNS OF AMERICAN NERVOUSNESS. 29

the tuberculous, with which it is frequently combined, and with which also it is liable to be confounded. The external appearances of the two are not very dissimi- lar, but their symptoms and their behavior under ex- posure, and especially their prognosis when existing separately, are radically different. The tuberculous diathesis frequently accompanies a fine organization ; but fine organizations only in a certain proportion of cases have a tuberculous diathesis. The nervous dia- thesis is frequently not only not susceptible to tuber- culosis, but apparently much less so than the average, and sometimes, indeed, seems to be antagonistic to it, for there are many nervous patients in whom no amount of exposure or hardship or imprudence seems to be able to develop phthisis, although they may ap- pear to suffer intensely and constantly from the vari- ous phases of nervous disease. The tuberculous dia- thesis frequently appears in the coarsely organized, the plethoric, and the muscular. It develops most rap- idly and perhaps commits its greatest ravages among the poor, the oppressed, and degraded. On the con- trary, the nervous diathesis, though found more or less among all classes of civilized lands, is chiefly found among the higher orders. Both of these dia- theses are the results and concomitants of depressed vitality ; but the nervous is peculiar to brain- workers and civilization, while the tuberculous also afflicts the day-laborer and the savage. The one is perhaps an

30 SUSCEPTIBILITY TO STIMULANTS.

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II

impoverishment of the blood, the other an impover- ishment of the nervous force.

The distinction between the nervous and the tuber- culous diathesis is seen a^ain in the contrast in their prognosis. The nervous diathesis in many of its H manifestations is speedily relieved, but rarely perma- nently eradicated; the tuberculous diathesis is less susceptible to actual relief, but in occasional instances may be absolutely cured. The nervous diathesis, by protecting the system against inflammations, seems to lengthen life ; the tuberculous, by attacking and de- stroying a vital organ, most fearfully shortens it. In both the conflict between the remedies and the disease is always hard and sometimes long ; in the nervous diathesis it is a guerrilla warfare, in which there are frequent skirmishes, with continual fightings and re- treatings, where the enemy is disinclined to concen- trate his forces or allow himself to be drawn into a decisive encounter. In the tuberculous diathesis it is a pitched battle for the possession of a vital organ, where the enemy fights behind intrenchments, and usually obtains the mastery.

Increased suscej[>tihility to stimulants and nar cotics.

Among the signs of nervousness is increased sen- sitiveness to stimulants and narcotics. This is itself proof enough of the heightened nerve sensitiveness of

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SIGNS OF AMERICAN NERVOUSNESS. 31

the age. It is not only a fact demonstrated every day and every hour, but it is as unprecedented a fact as the telegraph, the railway, or the telephone. Until within twenty-five or thirty years, man, civilized or uncivilized, was an animal of tremendous alcohol power, organized for bearing, with only transient dis- turbance, enormous and repeated quantities not only of strong liquors, but also of other narcotics and stim- ulants of the various families.

Among Americans of the higher orders, those who | live in-doors, drinking is becoming a lost art ; among these classes drinking customs are now historic, must be searched for, read or talked about, like extinct or dying-away species.

A European coming to America sees a sight that no other civilized nation can show him — greater than IN^iagara — an immense body of intelligent people vol- untarily and habitually abstaining from alcoholic liquors, females almost universally so, and males ab- stinent, if not totally abstinent. There is, perhaps, no single fact in sociology more insti-uctive and far reach- ing than this, and this is but a fraction of the general and sweeping fact that the heightened sensitiveness of Americans forces them to abstain entirely, or to use in incredible and amusing moderation, not only the stronger alcoholic liquors, whether pure or impure, but also the milder wines, ales, and beers, and even tea and coffee. Half of my nervous patients give up

32 ENGLISH VS. AMEBIGAN DRINKING.

1

coffee before I see them, and very many abandon tea — ^next to chocolate the mildest of all table drinks.

Under the title of "The National Yice," Mr. Richard Grant White has recently published in The Atlantic Monthly what is a most accurate photograph of the drinking customs of England as seen to-day. Mr. White's observations are in harmony with my own, among the very same classes, and in the same districts. .^1

Kote the fact, also, that England is growing ner- vous, and that both her men and women drink far less than formerly; and on all those subjects they are passing through the stage in which we were thirty or forty years ago. Every year the higher orders of Great Britain are drinking less and less of strong liquors ; a simple substitute, a mild drink of a popular sort, is having there a most extensive patronage. If Mr. White had carried his studies into Germany he would have found that the English, with all their indulgence in alcoholic liquors, were but pupils and beginners — amateurs, compared with the hahitues of the beer-gardens of Munich, Dresden, and Yienna. Gallons upon gallons of their summer beer these Ger- mans will drink day after day or in a single evening, a quantity of fluid, considered merely as water, that would suffice a brain- working, in-door living Ameri- can for a week or month. An English physician of much experience in nervous diseases asked me once

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JSIONS OF AMERICAN NERVOUSNESS. 33

if it were true, as stated in one of my books, that my American patients could not bear smoking. I replied that there were very few nervous patients who were not injured by it, and very few who would not find it out without the aid of any physician. Our fathers could smoke, our mothers could smoke, but their chil- dren must ofttimes be cautious ; and chewing is very rapidly going out of custom, and will soon, like snuff- ^ taking, become a historic curiosity ; while cigars give way to cigarettes. From the cradle to the grave the Chinese empire smokes, and when a sick man in China has grown so weak that he no longer asks for his pipe, they give up hope, and expect him to die. Savage tribes without number drink most of the time when not sleeping or fighting, and without suffering alcohol- f 7 ism, or without ever becoming inebriates ; they have the vice of drinking, but not the nervous-disease in- ebriety.

It is much less than a century ago, that a man who could not carry many bottles of wine was thought of as effeminate — but a fraction of a man. But fifty years ago opium produced sleep ; now the same dose keeps us awake, like coffee or tea ; — susceptibility to this dnig has been revolutionized.

The enormous quantity of alcoholic liquors, includ- ing beer, used in the United States, is used to a large extent by Germans and Irish, and those who live in the distant West and So nth.

34 ENGLISH DRINKING CAPACITY.

n

Through all the E'orthern States the brain- work- ing classes find coffee more poisonous than whiskey or tobacco, and thousands are made wakeful by even a mild cup of tea. The incapacity for bearing the gentlest wines and beers is for thousands of our youth ■■ the only salvation against the demon inebriety. Thus the united forces of climate and civilization are pres- sing us back from one stimulant to another, until, like babes, we find no safe retreat save in chocolate and milk and water. In the South, for climatic reasons, jl| these substances are far better endured than in the North ; but the very day on which this page is com- posed, I am called to see a Southerner paralyzed, to all appearance, through tobacco alone. m I

To see how an Englishman can drink is alone worthy the ocean voyage. On the steamer with me a prominent clergyman of the Established Church sat down beside me, poured out half a tumblerful of whiskey, added some water, and drank it almost at one swallow. He was an old gentleman, sturdy, vig- orous, energetic, whose health was an object of com- ment and envy. I said to him : " How can you stand that ? In America, we of your class cannot drink that way." He replied, " I have done it all my life, and I am not aware that I was ever injured by it."

A number of years since I was present in Liverpool at an ecclesiastical gathering composed of leading members of the Established Church, from the bishops

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SIGNS OF AMERICAN NERVOUSNESS. 35

and archbishops through all the gradations ; at lunch- eon, alcoholic liquors were served in a quantity that no assembly of any profession, except politicians, in this country could have tolerated.

Capacity to bear stimulants is a measure of nerve ; the English are men of more bottle-power than the Americans.

This capacity for drinking measures the force of this stalwart people : long hours of brain-toil are better endured in Great Britain than in America ; there is less exhaustion from the strain of overwork. This fact is observed by men in public life, as parliamen- tary leaders, etc., in England, that they can do more speaking, more sitting up late at night, as well as more eating and more drinking, than the politicians of America.

It has been said that the strength of a nation is the strength of the thighs rather than that of the brain ; and, as an English physician of eminence has observed, the best population of the cities of Great Britain renews its strength from the large-limbed High- landers of the north, but for whom there would be a constant degeneracy. It would appear, then, that the qualities which are necessary to make a good, strong nation are precisely the qualities which make a good horseman, and that he who can ride well makes a good founder of states. The English, as a people, have that balance and harmony of temperament, that

36 TEMPERANCE A MODERN VIRTUE.

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always breed well. Large families are commanded by unrecorded law, and this little island has become the spawning-ground of empires.

The progress of total abstinence in both countries, is due, in part, no doubt, to the special efforts of re- formers, but mainly to the general progress of culture, and perhaps, most of all, to that heightened nervous sensitiveness that makes it impossible for many to fl partake, even moderately, of wine without showing, instantaneously or speedily, the evil effects there- from.

Temperance, indeed, is mostly a nineteenth cen- tury vii*tne, and the vice of intemperance is a survival of savagery in civilization. Going back yet farther, Tve find that with certain savage tribes, drunkenness is the rule, sobriety the exception. In these tribes every event of real or supposed importance, a birth, a fu- neral, the going to or return frOm battle, is celebrated ■! by hard drinking. Reprove an Angola negro for being drunk and he will reply, " My mother is dead," as though that were excuse enough. Even as recently as the beginning of the present century, the custom of drinking at funerals yet survived with our fathere. At the present time both culture and conscience are opposed to such habits. It is among the depressed classes, who yet retain the habits, and the constitutions of the last century, that intemperance abounds ; they drink as everybody drank, in the eighteenth century.

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SlOIfS OF AMERICA]^ NERVOUSNESS. 37

It is often claimed that we, of this generation, are more injured by drinking than our fathers, because of the adulterations of liquors. The reply to this is, that analyses show that most of the adulterations are, so far as their effect on the nervous system is concerned, comparatively harmless, and that few or none of them produce intoxication or inebriety. It is through the alcohol, and not the adulterations, that excessive di'inking injures.

•Inebriety.

This functional malady of the nervous system which we call inebriety, as distinguished from the vice or habit of drunkenness, may be said to have been born in America, has here developed sooner and far more rapidly than elsewhere, and here also has received earlier and more successful attention from men of science. The increase of the disorder has forced us to study it and to devise plans for it relief.

Like other nerve maladies, it is especially fre- quent here. It is for this reason mainly that asylums for inebriates were first organized in this country. England, however, is feeling the same need, and is beginning to follow our example.

In certain countries and climates where the ner- vous system is strong and the temperature more equable than with us, in what I sometimes call the temperate belt of the world, including Spain, Italy,

38 INEBRIETY— SMOKING.

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Southern France, Syria, and Persia, tlie habitual use of wine rarely leads to drunkenness, and never, or almost never, to inebriety; but in the intemperate belt, where we live, and which includes Northern Europe and the United States, with a cold and vio- lently changeable climate, the habit of drinking either wines or stronger liquors is liable to develop in some cases a habit of intemperance. Kotably in our coun- ■I try, where nervous sensitiveness is seen in its extreme manifestations, the majority of brain- workers are not entirely safe so long as they are in the habit of even moderate drinking. I admit that this was not the case one hundred years ago — and the reasons I give vl in this work — it is not the case to-day in Continental Europe ; even in England it is not so markedly the case as in the northern part of the United States.

For those individuals who inherit a tendency to inebriety, the only safe course is absolute abstinence, especially in early life ; and in certain cases treatment of the nervous system, on the exhaustion of which the inebriety depends.

The use of tobacco in the form of smoking cigars and cigarettes, is probably more common in America to-day than it was a quarter of a century ago, but smoking pipes and chewing and snuff-taking, are habits which are passing away, among the better classes. Thus is harmonized the paradox that while there are more persons, perhaps, who make some

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SIGNS OF AMERICAN NERVOUSNESS. 39

use of tobacco, there are fewer persons of the same classes who make an excessive use of it than for- merly ; and of those who do use it, even but lightly, there is an increasing number who are perceptibly injured by it.

Sensitiveness to drugs.

The increasing nerve susceptibility of our time and country is excellently illustrated by the effect of cathartic remedies. It took stronger doses to affect the bowels in the last generation than in the present — where formerly two or three powerful pills were required for a strong cathartic effect, now, one or two, or perhaps half a pill, suffices. This differen- tial action of the same remedy on different tempera- ments can be well studied by those who have both hospital and private practice; the coarse and phleg- matic temperaments will require, in some cases, sev- eral-fold more powerful remedies to give a strong cathartic effect than the nervous and sensitive.

I am constantly obliged, in my practice, to pre- scribe half a pill for a cathartic, where for an old fash- ioned constitution, such as we sometimes see, even now, two or three, or perhaps even more, are needed.

One very eminent physician finds that even choc- olate, one of the mildest beverages, is a poison to him; and another experienced physician w^ho con- sulted me one time in regard to himself, could not.

40 TEIR8TLES8NESS— INDIGESTION.

J he said, bear anything that I prescribed. I spoke of iron : he said iron, even in small doses, made his head ache ; and when I tried it, even with other medicines, it produced that effect. I suggested quinine : he said quinine made him crazy. I tried a zinc combina- tion ; it disturbed his stomach. And yet this man, so variously sensitive, was actively engaged in one of our most laborious professions.

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Thirstlessness.

Thirstlessness — a lack of desire for water, and the difficulty of assimilating it — is as common among the upper classes of Americans as lack of desire for solid food, and is a most serious symptom, expressive of a lower grade of nerve exhaustion. No people in the world drink so little fluid as we, either with or be-Jj tween meals. To see how other nations drink, and to learn how our fathers, half a century ago, used to drink, is, to a philosophic nature, worth a trip to Europe, though nothing else be seen ; since one may live here for a lifetime and never take the pains tafll study the habits of recently-imported foreigners in our midst, or the habits of American-born citizens in the far distant West.

delation of Indigestion to Nervousness.

Dr. Lauder Brunton, editor of The PractitioneTy has lately published a very thoughtful and instructive paper on "Indigestion as a Cause of Nervous De-

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SIGNS OF AMERICAN NERVOUSNESS. 41

pression," the leading point of which is, that in the digestive track and particularly the intestines, various gases are formed, as sulphuret of hydrogen, marsh gas, etc., which, being absorbed into the circulation, have a paralyzing influence on the nerve centres. Dr. J. H. Salisbury, of Cleveland, has for years inculcated this same doctrine, and has treated his patients in ac- cordance with it. Dr. Brunton argues, logically and truthfully, that much of nervous depression results from indigestion and from liver disorder, and that the old belief that hypocondria had its origin in the liver has thus a scientific explanation. While all this is quite true, it is also true, that, without special reference to digestion there may be impoverishment of nerve energy; the digestion even may be strong or tolerably so, while the individual is very weak, and, on the other hand, the pei*son may be very strong, while the digestion is far from perfect; in a word, indigestion may excite and maintain neurasthenia and may result from it, but neurasthenia is none the less a condition of itself, though necessarily modified by the state of digestion. If, in an electric battery, however well constructed, the fluids are made impure by the products of chemical decomposition, the amount of force generated for use will be very much reduced, though the metals are new and the conduction is good; so in the body, though there may be much force in the nerve centres, yet if digestion be clogged

42 SENSITIVENESS OF DIGESTION.

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and the waste matters are suffered to accumulate in the digestive apparatus and gases, and waste products circulate througli the nerve system, the amount of force generated and usable will be very much dimin- ished. When the fluid of a battery is filled with impurities by chemical decomposition, we may pour in acids as much as we will, but the battery will be weak, and the force you will get from it will be small ; when the body is clogged with waste products, y we may supply food, and the best of food, in any

amount, and the person will be still feeble ; hence it is that we so often find not only epileptics, but neu- rasthenics and nervous persons with other symptoms, are free and sometimes excessive eaters. They say their food does not give them strength, and it does not, for the same reason that the acid poured into the impure fluid of the battery does not give us electric force. There are those who all their lives are habit4Bl ually small eaters and yet are great workers, and there are those who, though all their lives great eaters, are never strong; their food is either not digested or thoroughly assimilated, and so a much smaller fraction than should be is converted into nerve-force.

51

Sensitiveness of the Digestion,

Delicacy of digestion is one of the best known first observed effects of civilization upon the nervous system. The history of the rise and fall of pork as an

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SIGNS OF AMERICAN NERVOUSNESS. 43

article of food is itself, without any re-enforcing fact, most insti-uctive on this point. In America pork, like tlie Indian, flees before civilization. In all the great cities of the East, among the brain- working classes of our large cities everywhere, pork, in all its varieties and preparations, has taken a subordinate place among the meats upon onr tables, for the reason that the stomach of the brain- worker cannot digest it. Three times a day, and every day in the year almost, the flesh of swine in some form was, in the last generation, the dependence of our fathers, who could eat it freely without ever asking themselves whether it was easy or hard to be digested. This dethronement of pork has had, and is still having on one side, a disastrous eflect upon the American people ; for, as yet, no article of food with a sufiicient amount of fat has been generally substituted ; and fat in our dietaries is, if it can be assimilated, one of the imperative needs.

The demand for the pork of America is exten- sive in Europe, the exports reaching annually the value of one hundred millions, and the attempt made this very year to stop this exportation was an alarm to an immense body of capitalists. In our own coun- try, pork is yet freely and in some districts almost ex- clusively employed, but chiefly in farming districts, and especially in the sparsely settled region of the South and West.

44 NEAH-SIOHTEDNESS—WEAK EYES.

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Americans moderate eaters.

Compared with Europeans, Americans of the middle and higher orders are, or have been, but moderate eaters. The bulk of our daily food is less than that of the English or Germans. With material for food in unlimited variety, we have made less use — certainly less frequent use of it at the table than any other nation of modern times. Four and five meals a day is, or has been, the English and, notably, the German custom. Foreigners have greatly sur- passed us in the taking of solid as well as liquid food.

Twenty-five years ago nervous dyspepsia was di- agnosed in Germany as the "American disease." This pre-eminence we deserve no longer — at least not as fully as then — for not only is it frequent in England, but Germany itself is a sufferer from this malady, ii J

Increase of Near-sightedness and Weakness of the Eyes. ^1

The eyes also are good barometers of our nervous civilization. The increase of asthenopia and short- sightedness, and, in general, of the functional disor- ders of the eye, are demonstrated facts and are most instructive. The great skill and great number of our oculists are constant proof and suggestions of the nervousness of our age.

The savage can usually see well ; myopia is a v/ measure of civilization. "Well known German investi-

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SIGNS OF AMERICAN- NERVOUSNESS 45

gators have shown that near-sightedness increases in schools, from class to class, the proportion of near- sighted persons in the advanced classes being much greater than with those who have just entered. Near- sightedness, however, is but one of many maladies of the eye that civilization excites ; the muscles are oftentimes weakened by excessive use, and in some cases where apparently there has not been over-use. And this muscular weakness is accompanied by great pain in the eye, and frequently by inability to read, sew, or do any work that requires close vision. The number of persons of both sexes who suffer in this way is very large indeed, and is certainly on the increase.

The special cause of this increase of near-sighted- ness in modern times is so apparent, that there has been but little dispute in regard to it — the over-use of the eyes for looking at minute objects, as in writing and reading.

In this form of local nervous and muscular de- bility, Germany has, it would appear, seemed to lead the world, and probably for these two reasons :

First. In the German schools and in the student life of certain classes of Germans, severe demand is made on the eyes by the illegible type and manu- script.

Secondly. The Germans, being less nervous than the Americans, excess in the use of any organ is more

46 NEAR-SIGHTEDNESS {MYOPIA).

likely to induce in them local than constitutional ease, in accordance with the general law that in strong persons abuse of any function produces local disease and in the weak constitutional disease. An American breaks down all over — becomes neurasthenic before his eyes give out ; he cannot work long enough to injure his vision, but must give up while it is yet good. Constitutional diseases prevent local diseases and vice versa.

Dr. Hasket Derby, of Boston, in a recent article asserts that, in the United States there is about oneJ[l third as much near-sightedness as in Europe, but that' in New England, about one person in every ten who consults the oculist is near-sighted. In regard to the development of near-sightedness with civilization and through the use of the eyes in schools, these propo- sitions seem to be pretty clearly supported.

First, that among savages everywhere, near-sight- edness is very rare, just as insanity, neurasthenia, hay- fever, the nervous disease inebriety, sick-headache epilepsy, hysteria, chorea, and nervous dyspepsia are very rare.

Macnamara declares that he took every oppor- tunity of examining the eyes of Southall aborigines of Bengal, for the purpose of discovering whether near-sightedness and diseases of like character existed among them, and he asserts that he never saw a young Southall whose eyes were not perfect.

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SIGNS OF AMERICAN NERVOUSNESS. 47

Secondly. Near-sightedness is rare in cliildren who have not been to school.

Thirdly. Among the school-children of this coun- try, between the ages of six and seven, three out of a hundred are found to be near-siglited.

Fourthly. This percentage increases with age, and at the age of twenty, twenty-six out of one hundred Americans are near-sighted. In Russia, forty-two out of a hundred, and in Germany, sixty-two out of a hundred are near-sighted.

Dr. Derby believes that spasm or cramp of the ciliary muscle, produced by over-use, is one of the lirst causes of near-sightedness.

Dr. Loring, of this city, in an excellent paper on this subject, avers that near-sightedness has a reactive effect on the mind, of an injurious character, and for that reason alone, should, if possible, be prevented.

At the recent Congress of German Naturalists, at Dantzic, Prof. Cohn delivered an address on " The Kelation of School Hygiene to Myopia." He claims that it is rarely congenital, he having never met with it in children below ^n^ years of age. In rural schools but few myopes are found, the number increasing with the grade of the school. The figures in the Geneva high schools are alarming. In the *' Mal- schulen " (corresponding to the scientific course of the high school) there were from twenty to forty per cent. ; in the elementary schools from ten to twenty-

48 RAPID DECAY OF TEETH.

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four per cent. ; in the village schools five to eleven per cent. ; and in the " Gymnasien," or classical high school, from thirty to fifty-five per cent. — a regular increase from the lowest school to the highest ; show- ing clearly that over-use of the eyes in study is the one exciting cause of this malady. He forms his conclusion from the examination of over 10,000 school children.

Early and rapid Decay of the Teeth

Teeth decay among other peoples, and the pain called toothache is probably a thousand years old ; nor is man the only animal that suffers in this way. There is no class of peo]3le of any race or color who lose their teeth so early through decay, and so rapidly, and need to keep themselves so constantly under the den- tist's eye as the better class of Americans. American dentists are the best in the world, because American teeth are the worst in the world.

Necessity has been the parent of inventive skill. Dr. J. I^. Farrar, of E'ew York, estimates that $500,000 in pure gold is each year put into the mouths of Americans, and four times as much cheaper material, such as silver and platina ; that each year millions of artificial teeth are mounted, and that but little more than one person in a hundred, take peo- ple as they are, has perfect teeth. All this is modem, and, in this extreme manifestation, American.

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SIGNS OF AMERICAN NERVOUSNESS. 49

This quick decay of teeth in America, and the various forms of nervous diseases that go with this decay, are the results not of climate alone, but of climate combined with civilization : the confluence of these two streams is necessary. Irregularities of teeth, like their decay, are the product primarily of civiliza- tion, secondarily of climate. These are rarely found among the Indians or the Chinese ; and, according to Dr. Kingsley, are rare even in idiots ; the cretins of Switzerland, the same authority states, have " broad jaws and well-developed teeth."

Special investigations have been made in order to determine whether negroes and Indians are troubled with decayed teeth. Judging from all the sources of information, it is within the facts to assert that while the Indians, especially in advanced life, are liable to have the teeth decay, and while negroes, even in middle life, are similarly affected, yet, as compared with sensitive, nervous whites, they suffer but little in this way. It is probable that negroes are troubled earlier than Indians. The popular impression that negroes always have good teeth is erroneous — the contrast between the whiteness of the teeth and the blackness of the face tending not a little to flatter them. Those who have sought to prove that the teeth decayed among savages, hundreds of years ago, just as rapidly, just as early, and just as badly as they decay now, among nervous, susceptible whites of this

60 THE TEETH OF SAVAGES.

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country, because they succeed in finding proofs of decay in skulls which they have examined, are guilty of reasoning quite the reverse of expert.

Another fact of much instructiveness is, that de- cayed teeth in Indians and negroes are less likely to annoy and irritate than the same amount of decay in sensitive, nervous, and finely organized whites of any race.

Coarse races and peoples, and coarse individuals can go with teeth badly broken down without being aware of it from any pain ; whereas, in a finely or- ganized constitution, the very slightest decay in the teeth excites pain which renders filling or extracting imperative. The coarse races and coarse individuals are less disturbed by the bites of mosquitoes, by the presence of flies or of dirt on the body, than those in |jl whom the nervous diathesis prevails, l^ervous force travels more slowly, the reflex irritation is less per- ceptible by far, in the dark races and those who live out-doors, than in those who live in-doors, and are of a nervous diathesis. In the strong and coarsely built local irritation remains local, and does not reverberate through the body ; while, on the other hand, in the feeble, the sensitive, and the highly and finely organ- ized, any local irritation is speedily transmitted and puts the whole system into disturbance. The simple operation of sneezing illustrates this law in a most interesting and significant manner. It is said, for

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SIGNS OF AMERICAN NERVOUSNESS. 51

example, of the negroes of the South, that they rarely if ever sneeze. It is certain that the nervous, feeble, sensitive, and impressible of any race are far more likely to be provoked into sneezing from slight irrita- tion of the nasal passages than those of an opposite temperament. In hay-fever, sneezing is one of the leading symptoms, and is provoked by irritations in themselves of the most trilling character, which those not victims of the disease can only be forced to believe by a personal battle with this enemy of the race.

Special explanations without number have been offered for this long-observed phenomenon — the early and rapid decay of American teeth — such as the use of sweets, the use of acids, neglect of cleanliness, and the use of food that requires little mastication. But they who urge these special facts to account for the decay of teeth of our civilization would, by proper inquiry, learn that the savages and negroes, and semi- barbarians everywhere, in many cases use sweets far more than we, and never clean their mouths, and never suffer, except in old age. The cause of the de- cay of teeth is subjective far more than objective — in the constitution of the modern civilized man. The young are early cautioned to clean their teeth, and properly so ; but the only races that have poor teeth are those who clean them.

52 PREMATURE BALDNESS.

Bald/ness. ^ The increasing popularity of baldness is one of tlie

minor but most instructive expressions of nerve sen- sitiveness. Among savages in all parts of the earth baldness is unusual, except in extreme age, and gray hairs come much later than with us. So common is mok baldness in otir large cities that what was once a de- formity and exception is now almost the rule, and an element of beauty. One may be bald without being very nervous ; but the general prevalence of baldness comes from the general prevalence of nervousness. The beard and hair, accurately studied, are measures of nutrition of high delicacy and power.

A sudden emotional disturbance, as of grief, or the exhaustion of acute illness, or an exacerbation of chronic debility, may in a few days, or even in a ^1 few hours, cause the hair to fall or turn white and make it excessively dry.

Although woman is more nervous than man, yet she is less afflicted with baldness; the reason being that she has on her head more and longer hair, a greater proportion of her force being expended in that direction ; hence, when she becomes nervous, she breaks down in other directions sooner than in this,

Sensitiveness to Heat and Cold. Increased sensitiveness to both heat and cold is a noteworthy sign of nervousness. We must have the

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SIGNS OF AMERICAN NERVOUSNESS. 63

temperature of our rooms at least ten or twelve, if not fifteen degrees higher than our fathers desired, and at least ten degrees higher than the English, French, or Germans of the present day desire. Dr. Bucknill, of England, when visiting the asylums of this country, noticed that the temperature was kept not less than ten or fifteen degrees higher than that of the asylums of Europe. In the winter we must dress warmer than our ancestors, we wear more under as well as over clothing ; we cannot endure wet feet as they could, nor bear with impunity the same exposure. India-nibbers are far less used in Europe than here, although, on account of the abundant rains, they are more needed there. In America rubbers are for sale at every shoe-store; in Paris and in London I have hunted for hours looking for a pair. The heat of summer is not well tolerated ; sunstrokes are, rela- tively, more frequent, or heat prostrations that sug- gest sunstroke, and which are followed in some cases by years of nervous disorders and symptoms. The months of July and August bear so heavily on our brain-working classes as to slow down or suspend business everywhere ; a visitation of prolonged heat is more fatal than yellow fever or cholera ; we are driven to the mountains or the sea as by the march of an invading army.

Cold bathing is not borne as well as formerly. When the water system first became popular in the

SENSITIVENESS TO GOLD.

treatment of disease, great benefit was in many cases obtained by the use of very cold water, and the inju- rious effects arising from such treatment were not so ^i common as now. O

At present, in America at least, cold water is not used in hydropathic establishments as universally as when these institutions were first started ; and one reason, among man}^ others, why the hydropathic treatment declined in popularity among English- speaking people is, that nervous people (who were most likely to frequent these places) were also most in danger of being injured by the use of cold water. What their ancestors could not only bear, but be bene- fited by, they cannot bear at all. In ordinary bath- fli ing, not only in this country, but in England, it has been found of late years, that it is necessary to have water warmed somewhat, before applying it to the body — the old habit of cutting holes in the ice and plunging in is passing away; and the recently pub- fll lished protests in the Lancet, against the use of cold water in the morning bath, were wise and timely.

A large number of the nervous patients whom I treat professionally cannot bear the Turkish and Rus- sian baths, as they are generally given ; in many cases they are injured by them, and in some cases per- manently injured, even for years.

In France, where the treatment of nervous dis- eases is very little understood, scarcely anything is

I

i

SIGNS OF AMERICAN NERVOUSNESS. 55

advised by the best neurologists except the use of water, with a result, in the ca^e of many of our American patients, of working serious injury. Two cases illustrating this have been brought to my at- tention this past month. Even while this paragraph is being written, I have received a letter from an American physician studying in Germany, in which he informs me that one of his patients — a Russian lady, I believe — was nearly killed by immersion in a deep tub of very cold water.

Water treatment is as good for some forms of nervous disease as it ever was ; but it must be adapt- ed to the constitution of the patient, and adapted also to the peculiar needs of each case.

Involution of Nervousness. — Nervous Exhaustion {Neurasthenia).

More specifically, and to the eye of some, perhaps, more interesting than all, is the increase of neu- rasthenia, or nervous exhaustion, and effects allied to and correlated with it. Out of the soil of nerve-sen- sitiveness springs the nervous diathesis which runs into neurasthenia, or nervous exhaustion. Among the many branches of this neurological tree are, in the order in which they are very likely to develop in many cases — nervous dyspepsia, sick-headache, near- sightedness, chorea, insomnia, asthenopia, hay-fever, hypochondria, hysteria, nervous exhaustion in its

56 EVOLUTION OF NERVOUSNESS.

varieties, and in the extreme cases — epilepsy, inebri- ety, insanity. (See Frontispiece). The disease, state, or condition to which the term neurasthenia is ap- plied is subdivisible, just as insanity is subdivided into general paresis or general paralysis of the insane, epileptic insanity, hysterical, climatic, and puerperal insanity ; just as the disease or condition that we call trance is subdivided into clinical varieties, such as intellectual trance, induced trance, cataleptic trance, somnambulistic trance, emotional trance, ecstatic trance, etc. ; just so neurasthenia has sub-varieties, or clinical varieties, the cerebral, the spinal, the sexual, the digestive varieties, and so forth. These varieties of nervous exhaustion are nowhere experienced, no^H| where known, as they are here ; and even here they have been known in great abundance only within the past quarter of a century ; and they are even now but just beginning to be scientifically and discrimi- nately recognized and differentiated. The fathers and mothers — the grandfathers and grandmothers — of our neurasthenic parents of both sexes suffered from rheu- matism, from gout, from lung fever, from all forms of colds, from insanity now and then, and from epi- lepsy quite often ; but they were not neurasthenic. ^U\

The influences and conditions that excite the gout in the phlegmatic and strong develop to ner- vousness in the sensitive and weak ; neurasthenia is more abundant in America, gout and rheumatism

I

SIGNS OF AMERICAN NERVOUSNESS 57

in Europe. Lately I was consulted by a very ner- vous patient who comes from a line of gouty ances- tors reaching back through several generations, the morbitic force in his case having changed to the symptoms of insomnia, mental depression, and neu- ralgia.

The excessive nervousness of Americans seems to act as an antidote and preventive of gout and rheumatism, as well as of other inflammatory diseases. Many of the gouty and rheumatic patients in Europe are troubled with indigestion, and it happens very often indeed that attacks of rheumatism and gout — such as are familiar to the English and Germans — are preceded by so-called " bilious attacks," that is, symp- toms of indigestion. The antagonism of disease to disease, and the force and value of disease in the treatment of disease, are illustrated very well by the frequency of functional nervous diseases in America, and the infrequency of gout and rheumatic troubles ; and it would be most interesting to know whether as Europe becomes Americanized, and neurasthenia, w^ith its train of symptoms invades Great Britain and the Continent, there shall take place a corre- sponding diminution in the frequency and severity of gout and rheumatism.

The purpose of the drawing (Frontispiece) should not be misunderstood ; it is not to give a mathemati- cal statement or history of the development of ner-

58 E VOL UTION OF NEB VO USNESS.

I

vous symptoms as applicable to any one case, but a general view of the way in which, these nervous symptoms develop, no two cases being precisely alike in this respect, or in any other respect. For clearness and convenience I use familiar terms rather than technical terms — those which are symptoms of disease rather than, strictly speaking, disease itself, such, for example, as hypochondria and insomnia.

The drawing gives a general view of the order in which these nervous symptoms are very likely to appear, although there is no uniformity.

Nervous dyspepsia is one of the iirst, then fol- lows sick-headache — sometimes these come together, while the other symptoms of neurasthenia or ner- vous exhaustion are much later ; and yet, hay-fever may come very early, even in babyhood ; and near- sightedness and chorea in childhood, and neurasthenia or nervous exhaustion itself, in any of its varieties, may appear without many of the conditions which ■I in this drawing seem to precede it; for many of these conditions are themselves symptoms of nervous exhaustion.

There is, it will be observed, no mathematical line between nervous diathesis and nervous exhaus- sl tion, the object being to represent what is truly the case, a growth and evolution ; a passing from one state into another by successive increments.

Insanity and epilepsy are, occasionally, results of

i

SIGNS OF AMERICAN NERVOUSNESS. 59

protracted nervous exhaustion ; but epileptics do not, as a rule, pass through this stage of neurasthenia before they become epileptics; indeed, neurasthenia saves us, in some cases, from insanity, although it may lead to insanity ; on the other hand, inebriety (or dipsomania) may occur in those who are not neu- rasthenic, but simply of a nervous diathesis ; or, it may be one of the sequels of neurasthenia, just like insanity in general.

One very important fact suggested by this draw- ing, that is, that many of the cases of nervous exhaus- tion and many of the cases of spinal trouble of va- rious kinds, had in early life, nervous dyspepsia and sick-headache, from which, perhaps, they have either partially or wholly recovered, and which, indeed, they may have forgotten.

Increase of diseases not distinctively nervous.

Kot only purely nervous diseases, such as are above described, but also diseases in which there is an important nerve element, have increased with the ad- vance of civilization. Types of maladies of this class are diabetes and the so-called Bright's disease of the kidneys in its different varieties. The severe forms of Bright's disease do not, as a rule, occur in the very nervous, but oftentimes in those of fair if not firm con- stitution, and very frequently indeed in those of great apparent vigor — the class that suffer from locomotor

II

US

is-

4

60 DIABETES AND BRIGHT8 DISEASE.

ataxia and cerebral paralysis — but the milder more chronic, and intermitting and relievable forms occur in those who are quite nervous and sensitive even in the positively neurasthenic.

That diabetes is largely if not mainly a nervous disease is becoming more and more the conviction of all medical thinkers, and that, like Bri£:ht's dis- ease, it has increased of late, can be proved by sti tistics that in this respect are in harmony with ol servation.

A single branch of our neurological tree, hay-fever, has in it the material for years of study ; he who un- derstands that understands the whole problem. In theW] history of nervous disease I know not where to look for anything more extraordinary or more instructive than the rise and growth of hay-fever in the United States of America. Straggling cases of this disease are found in Germany and France — possibly, also, in Italy and Spain ; it is somewhat more frequent in Great Britain : but in the state of Illinois alone there are probably more cases every year, in its earlier, later, and middle forms, than in all the rest of the world, excepting the other States of the Union.

Hay-fever, as I have demonstrated in my work on that subject, is a nervous disease ; it is subjective raore^^ than objective, though excited and maintained bj^^|| invading objective irritations ; it is simply the sign of susceptibility, the peculiar idiosyncrasy of the nervous

SIGNS OF AMERICAN NERVOUSNESS. 61

system to one or many irritants. Where can we find a more completely unprecedented fact than this, that for many years there has been here a large and powerful body called " The United States Hay- Fever Association," with a not unimportant branch in the AVest, and with a new branch projected in !New York city ? The fall or autumnal form of hay-fever is peculiarly American, and was but little known, if known at all, in this country seventy-five years ago. A just estimate on these matters is always impos- sible ; but that there are in this country, crowded together mostly in the northern and western sec- tions, diminishing in number as we go south, like all other nervous diseases, an army of fifty thousand (a respectable city in population) sufferers from this dis- ease, is very probable. As I have myself studied or known of not less than one thousand cases, this esti- mate cannot be very excessive.

Chronic Catarrhs.

Catarrh of the nose and nasal pharyngeal states — so-called nasal and pharyngeal catarrh — is not a nervous disease, in the strict sense of the term, but there is often a nervous element in it ; and in the marked and obstinate forms it is, like decay of the teeth and irregularities of the teeth, one of the signs or one of the nerve symptoms of impairment of nu- trition and decrease erf vital force which make us

i J

62 CATABRH OF NOSE AND THROAT.

unable to resist change of climate and extremes of temperature. JM\

That there has been an increase in nasal and^' pharyngeal catarrh in America during the last half century, seems to be pretty clearly established by the recorded experiences of large numbers of phy- sicians in general and special practice ; and it would seem that these catarrhs are more obstinate and diffi- cult to yield to the most judicious treatment known to our modern art. Quite true it is that catarrh is but a symptom, and a symptom of various and differ- ing diseased states of the nasal passages and the nasal and pharyngeal spaces ; and quite true it is that bulging of the septum and hypertrophy of the tur- binated bones are common pathological conditions in the disease known as nasal catarrh. But these hypertrophies and bulgings of the septum are them- selves oftentimes a result of imperfect nutrition ; and true also it is that, of themselves, they might not cause annoyance of an important character ; but when acted upon by cold and damp they become sources of great and life-long distress.

There is every reason for the belief that, fifty years ago, catarrh was relatively more infrequent than now; that is, the number of cases, according to the population was not so large. Indeed, this malady is now so common that each city or locality in the northern and eastern portions of the country is ask-

i

SIOI^S OF AMERICAN NERVOUSNESS. 63

ing itself whether there is anything in its location or climate to account for the frequency and severity of the catarrhs with which it is infested.*

It is certain, also, that the greatest sufferers from chronic catarrh are not those who are most constantly exposed to the dangers of out-door life — cold and damp — but those who live mostly in-doors ; who have only intei-mittent or occasional exposure ; many ladies, whose lives all the year are passed under cover are the most severe sufferers. All these statements are in no way inconsistent with these two facts ; first, that cold and damp are exciting causes of catarrh, when acting on the predisposed constitution ; and, secondly, that the greater attention which physicians of late years — general practitioners as well as laryngologists — have given to the treatment of catarrh has forced the subject more constantly and impressively upon our notice ; but to reason, therefore, that catarrh has not increased, is to imitate the illogical and unscientific example of those who have, until lately, contended that insanity and neurasthenia have not increased in modern times. To my own mind, there is no doubt that catarrh is much more frequent in the northern and eastern portions of the United States than in any portion of Europe.

* Very recently a committee of the Kings County Medical Society in Brooklyn have been investigating the question, whether residents of Brooklyn are more liable to suffer from catarrh than residents of New York city.

Q4: SENSITIVENESS TO MEDICINES

Habit of tahing Drugs.

A

\f - America is a nation of drug-takers. JS'owhere else shall we find sucli extensive, gorgeous, and richly supplied chemical establishments as here ; nowhere else is there such general patronage of such establish- ments. ]^ot only in proprietary medicines, but in physicians' prescriptions, as well as in self-doctoring, this continent leads the world ; a physician can live here on half the number of families that w^ould be needed to support him in Europe, on the same terms. But with all our drug-taking we are, as a people, sensitive to medicine. The difference between Amer- ican and European constitutions, on the side of the nervous system, is illustrated in the different treat- ment that our nervous patients receive when they consult European physicians of distinction and skill. American physicians whose patients go abroad are astonished at the powerful medicines and the large- ness of the doses ordered by the best authorities in Great Britain and on the Continent ; and on the other hand, English and Continental physicians are astonished at the sensitiveness of Americans to strong remedies given in ordinary doses.

An American physician, long afflicted with severe neurasthenia, who for some time had been under my professional care, on reaching London, consulted a medical gentleman whom I knew to be familiar with those conditions as they exist in Europe, and

A

SlOIfS OF AMERICAN NERVOUSNESS. 65

who is judicious in their treatment. In this case he ordered a combination, such as he was accustomed constantly to give in his own practice in London, which produced not only a powerful but poisonous, and almost fatal effect ; so that, indeed, for some hours it was a question whether the patient would survive.

I remarked to the London physician, when I saw him, not long after, that I should not have dared to have given such a dose to that patient in America ; he said, however, that it was a very common draught with him. When my patient returned, I put him on drop doses of Fowler's Solution and Tincture of Cantharides, with most excellent results.

Helation of Nervousness to Beauty.

The phenomenal beauty of the American girl of the highest type, is a subject of the greatest interest both to the psychologist and the sociologist, since it has no precedent, in recorded history, at least; and it is very instructive in its relation to the char- acter and the diseases of America.

This entrancing beauty, remarkable at once for its intensity and its extent among the comfortable classes of America, appears to be a resultant of two factors ; the peculiarities of climate, to be hereafter referred to, and the unusual social position of women in America.

6Q AMERICAN BEAUTY.

1

The same climatic peculiarities that make us ner- vous also make us handsome ; for fineness of organ- ization is the first element in all human beauty, iu™« either sex. ^|

In no other country are the daughters pushed forward so rapidly, so early sent to school, so quickly admitted into society ; the yoke of social observance (if it may be called such), nmst be borne by them much sooner than by their transatlantic sisters — long before marriage they have had much experience in conversation and in entertainment, and have served as queens in social life, and assumed many of the responsibilities and activities connected therewith. Their mental faculties in the middle range being thus drawn upon, constantly from childhood, they develop rapidly a cerebral activity both of an emotional and an intellectual nature, that speaks in the eyes and forms the countenance ; thus, fineness of organization, the first element of beauty, is supplemented by ^x-al pressiveness of features — which is its second element ; by the union of these two, human beauty reaches its highest.

Among the higher classes of America, the dim- inution of the friction of daily life, by avoiding the responsibility of housekeeping, united with gen- erous living and all comforts, have assisted in adding the third element of beauty — that is, a moderate degree of embonpoint, a feature which, in the ex-

I

SIGJ^JS OF AMERICAN NERVOUSNESS. 67

treme, and not re-enforced by these preceding ele- ments— fineness of type and spriglitlines& of counte- nance, becomes the worst element of ugliness.

Handsome women are found here and there in Great Britain, and rarely in Germany; more fre- quently in France and in Austria, in Italy and Spain ; and in all these countries one may find individuals that approximate the highest type of American beauty ; but in America, it is the extent — the commonness of this beauty, which is so remark- ably, unprecedentedly, and scientifically interesting. It is not possible to go to an opera in any of our large cities without seeing more of the representa- tives of the highest type of female beauty than can be found in months of travel in any part of Europe.

Among the middle and lower orders of the old world, beauty is kept down by labor. A woman who works all day in the field is not likely to be very handsome, nor to be the mother of handsome daughters ; for, while mental and intellectual ac- tivity in the middle range heightens beauty, muscu- lar toil, out-doors or in-doors, destroys it.

One cause, perhaps, of the almost universal home- liness of female faces among European works of art is, the fact that the best of the masters never saw a handsome woman. One can scarcely believe that Eubens, had he lived in America, or even in England, at the present time, would have given us such im-

rS AMERICAN VS. ENGLISH BEA UTY.

posing and terrible types of female coantenances. If Raphael had been wont to see every day in Eome or Naples what he would now see every day in Kew York, Baltimore, or Chicago, it would seem probable that, in his Sistine Madonna he would have preferred a face of, at least, moderate beauty, to the neurasthenic and anemic type that is there repre- sented.

To the first and inevitable objection that will be made to all here said — namely, that beauty is a relative thing, the standard of which varies with age, race, and individual — the answer is found in the fact that the American type is to/day more adored in Europe than in America ; that American girls are more in demand for foreign marriages than any other nationality ; and that the professional beauties of London that stand highest are those who, in ap- pearance and in character have come nearest the American type.

American vs. English Female Beauty.

While the beauty of the English girl may perhaps in some cases endure longer than that of her Ameri- can sister, yet American beauty has this sovereign advantage — that it best bears close observation. The English beauty is most beautiful at a distance, and grows homely as we approach her : the typical Ameri- can beauty appears most attractive near at hand ; in

I

SIGNS OF AMERICAN NERVOUSNESS. 69

lier case, nearness brings enchantment. The American face bears the microscope mainly by reason of its delicacy, fineness, and mobility of expression — quali- ties that are only appreciated on inspection. The ruddiness or freshness, the health-suggesting and health-sustaining face of the English girl seem in- comparable when partially veiled, or when a few rods away ; but, as they come nearer, these excelling characteristics retreat behind the irregularities of the skin, the thickness of the lip, the size of the nose ; and the observer is mildly stunned by the disappoint- ment at not finding the nimble and automatic play of emotion in the eyes and features, without which female beauty must always fall below the line of supreme authority. The English beauties of national and international fame, at whose feet the empire of Great Britain is now kneeling, in this country w^ould be held simply as of average rather than exceptional excellence.

It is no hard task for one travelling in Great Britain or on the Continent to distinguish American ladies from those of any other nationality, by the finely cut features and mobility of expression ; the practised observer would make a mistake but rarely. At the great watering-places, as Homburg and Baden- Baden, on the lines where travel is thickest, as on the Rhine and through Switzerland, we may often see a face which, far away, seems to be purely American,

70 AMERICAN VS. ENGLISH BEAUTY.

but which, as we gain a closer view, is found to be all English ; should there be a doubt, the voice — tlie speaking of a single word — often solves the problem.

Hiding once from Paris to Calais, there stepped into the coach a lady whom, for various reasons I assumed to be English, although her whole appear- ance— her voice, her manner, her conversation — were completely American. I concluded that at last I had found a case where it was impossible to make a differential diagnosis between an American and an English woman ; and I very soon found that my reasons for believing her English were not well founded — that she was an American, and a typical American, in her face, expression, gait, and bearing, and even in the functional nervous disease which she had long endured. d|l

It were well if these two extremes could be united ; an American beauty slowly approaching, an English beauty slowly vanishing, present together a picture of human beauty the fairest that could fall on mortal vision. An American lady who unites the American qualities of intellect, of manners, and of physique^ and who at one period lived for years in English territory, compresses it all in one sentence : *' The English face is molded, the American is chis- elled."

The superior fineness and delicacy of organiza-

^

SIGNS OF AMERICAN NERVOUSNESS 71

tion of the American woman, as compared with the women of Great Britain, Germany, and Switzerland, is shown in every organ and function— revealing it- self in the -play of the eyes, in the voice, in tlie re- sponse of the facial muscles, in gait, and dress, and gesturje. The European woman steps wuth a firmer tread than the American, and with not so much light- ness, pliancy, and grace. In a multitude, where both nations are represented, this difference is impressive. In the hourly operation of shaking hands one can tell, in some cases, the American woman of the higher order from a European, Swiss, or German, in the same rank. The grasp of the European woman is firmer and harder, as though on account of greater strength and firmness of muscle. In the touch of the hand of the American woman there is a nicety and tenderness that the English woman destroys by the force of the impact. It is probable that the inter- esting and remarkable feat of muscle-reading, pop- ularly called " mind-reading," would not be so skill- fully and successfully performed by English as by American ladies, for the reason that they are physi- cally more delicate and nimble, and their suscepti- bility to external impressions far greater.

There is, perhaps, no one test of both muscular and nervous susceptibility so delicate as this test of muscle-reading ; for in these experiments the operator — the so-called "mind-reader" — is blindfolded, takes

72 AMERICAN MUSGLE.READING.

the subject to be operated upon by the hand, and leads him to some minute spot or locality on which the subject's mind is concentrated ; and this is done oftentimes with a rapidity, a facility and a precision of movement that are almost beyond credence. In these experiments the operator's nervous system must be so susceptible as to detect the exceedingly minute and unconscious tension of the arm of the subject on whom he operates in the direction of the object on which his mind is concentrated ; and he must also detect the unconscious muscular relaxation when the locality is reached. All persons cannot attain this pre- cision ; but of the female sex there are many who by practice, perform at the seances with a success almost unfailing. This delusion of "mind-reading" was born in this country, and within the past few years. It may be rationally claimed that it could not have originated, or at least have attained so wide popular- ity in England, Germany, or Switzerland, since not enough could be found there who were capable of performing it to the amusement and astonishment of large audiences.*

The physiological problem, whether the surface of the eye alone, independent of the muscles that cover and surround it, can express emotion, a near study of the American girl seems to answer quite in theJI

* See my paper, " Physiology of Mind-Reading," Popular Science Monthly, February, 1877.

SIGNS OF AMERICAN NERVOUSNESS. 73

affirmative. The time that nerve-force takes in trav- ersing the fibres from centre to extremity is now mathematically measured, and it is known to vary with the individual, the temperament, and the sea- son ; with race, and climate, and sex it must also vary; in the brain of the American girl thoughts travel by the express, in that of her European sister by accommodation.

America, if archa3ology is to be trusted, is a mod- ern Etruria, the delicate features and fine forms of prehistoric Italy emerging from the entombment of ages and reappearing in a higher evolution in the Western hemisphere.

•

Belation of Dress to Net^ousness.

The dress is the woman : all of female character is in the clothes for him who can read their lan- guage. The American girl of the higher order is ex- quisitely susceptible, is impressed by mild irritation acting upon any of the senses; she dresses in taste, and, where the means are at hand, with elegance, in colors that are quite subdued, and noticeable only at a short distance.

A psychologist once asked me, " "Why are bright colors beautiful in sunset, but out of taste in dress ? Why should it be a sign of coarse taste to dress one's self in the most brilliant colors, when all go to see an imposing sunset ? "

1

T4 NERVOUSNESS AND DRESS.

The answer is, that higher culture and sensitive nerves react to slight irritation; while low culture and insensitive nerves require strong irritation. Loudness of dress is, therefore, justly regarded as proof of coarseness of nerve-fibre.

If we could clothe ourselves in sunsets ; if all this resplendency of crimson and scarlet and gold, and all these variations in hue and form could descend upon the delicate maiden, and fall about her in palj)itating folds like a rich garment, the eye of that maiden and of those who gaze upon her would soon weary ; the irritation of such splendor would become a pang, and only be worn as a badge and sign of a nature in the lower stages of evolution. Bright-colored scarlet and red, so common in Switzerland and in certain parts of Germany, are never seen in America in any class. And, among men, the custom of wearing gorgeous and jewelled apparel in public assemblies, as at courts or on occasions of state, is a survival of the barbarian period through which all Europe with the rest of the modern world has passed, or is now passing.

There is a fable that one day the most powerful of the fairies concluded to assist at the birth of women and assign to them the gifts which it was in the power of each fairy to bestow upon each one of the new born. The English woman received her bril- liant color, the Italian woman her eyes, the Spanish her figure, the German woman her beautiful hair.

«

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SIGNS OF AMERICAN NERVOUSNESS. 75

the French woman her little foot and her chio. The fairies were going to leave, when a little thin voice wjis heard, and a little woman whom nobody had seen came and demanded her share. "Who are you ? " asked the queen of the fairies.

" I am the Parisienne."

"You will not have any special gift like your sisters, but something from all the gifts of all the others." This was before the discovery of America. For the Parisienne can now be substituted the Ameri- can.

Dentition, Puberty and Change of Life.

Another evidence of the nervousness of our time is the difficulty which we experience in teething, at puberty, and change of life. These normal physio- logical processes in recent times, make so important a draft upon the nervous system that various sorts of illness result therefrom. During dentition, stomach and bowel difficulties arise ; at puberty chorea, chloro- sis, sick-headache and hysteria oftentimes appear ; and at change of life, a vast array of cerebral symp- toms, and many of the above described symptoms of neurasthenia appear, and cause great disturbance, continuing sometimes for years. The system has an insufficient quantity of nervous force, and the draft which is made upon it by these processes ex- hausts it.

76 PARTURITION AND NURSING.

Cholera infantum has a nervous factor in its causation, and it is pre-eminently an American dis- ease and is most prevalent during the excessive heats of our summer.

Parturition^ Nursing^ cmd Diseases of Women.

The process of parturition is everywhere the measure of nerve-strength. Had we no other barom- eter than this, we should know that civilization was paid for by nervousness, and that our cities are build- ed out of the life-force of their populations.

I was consulted, not long ago, by a Spanish lady of middle life, who had children to the number of fourteen, and always was up and about on the fol- lowing day. '^M I

A case of this kind, in private practice, I have never before seen ; certainly not among our in-door living classes.

For our savage ancestors, parturition was but a trifle more exhausting, either in time or expenditure of nerve-force than an attack of vomiting. On the march, an Indian woman, when taken with the pains of labor, would delay the company but half an hour.

All modern civilization demands prolonged rest for the parturient female ; and how many there are in our own land, for whom the conventional nine days is extended to double that time ; how many, also, to whom the simple act of giving birth to a child

SIGNS OF AMERICA]!^ NERVOUSNESS. 77

opens the door to unnumbered woes ; beginning with lacerations and relaxations, extending to displace- ments and ovarian imprisonments, and ending by setting the whole system on fire with neuralgias, tremors, etc., and compelling a life-long slavery to sleeplessness, hysteria, or insanity.

One of the most amazing of all sights on the Con- tinent of Europe and Ireland is that of the women toiling in the fields — mowing, raking, digging, driv- ing carts, chopping wood, carrying water, which the same class on landing in this country rarely if ever do. Custom, which is the resultant of many and hard- to-be-traced influences, in part explains this difference ; but in the second and third generations, the force of climate is potent and imperious. Our women cannot endure such exposure to heat or to cold, and soon become unable to bear the muscular strain that such labor makes necessary. The direst straits of poverty American women, even of direct German and English descent, will endure rather than labor at the hard, muscular employments of men. Subject a part of the year to the tyranny of heat, and a part to the tyranny of cold, they grow unused to -leaving the house ; to live in-doors is the rule ; it is a rarity to go out, as with those of Continental Europe it is to go in.

How many thousands of mothers there are who cannot, if they would, nurse their own infants, who have not sufficient milk for them, and who cannot

T8 DISEASES OF WOMEN.

I

bear the fatigue and drain upon the nervous system that nursing causes. It is not so much the dislike as the impossibility of nursing that makes wet nurses in such demand. So also the processes of gestation and child-bearing are borne in a most unsatisfactory way by large numbers in American society. In a state of perfect or almost perfect health, these processes are physiological; but for the last half century, among the upper classes of this country, they have become pathological ; they have become signs of disease.

Lacerations of the Womh and Perineum,

The large numbers of cases of laceration in child- birth, and the prolonged, and sometimes even life- enduring illnesses resulting from them, are good rea- son for the terror which the process of parturition inspires in the minds of many American women to- day.

The wornb and jperineum tear at childbirth he- cause they have jpreviously been reduced to the tearing point by general nervous exhaustion.

When Dr. Fallen and Dr. Sims discussed this sub- ject of the laceration of the cervix at the last meet- ing of the British Medical Association, in Cambridge, and spoke of the operations of Emmet for the cure of that condition, the European surgeons expressed astonishment and doubt in regard to the frequency if not the existence or importance of the disease.

SIGNS OF AMERICAN NERVOUSNESS. 79

Allowing for imperfect observation — the confounding of ulceration with laceration, it is probable that the disease is more frequent in American women, and also more likely to cause reflex constitutional disturbance among them.

The difference between an average of a half- dozen children in a family, which obtained fifty yeai-s ago, and an average of less than four which obtains now, is very great, and, abating certain obvious quali- fying facts, pretty accurately measures the child-bear- ing and child-rearing power of the woman of the past and the woman of to-day. But on this subject statis- tics are scarcely needed. Consider the large number of childless households, the many families that have but two or three children, or but one, and with them contrast the families that prevailed at the beginning of this century. The contrast, also, between the higher and lower orders in this respect, cannot, it would seem, be entirely explained by excess of pru- dence on the one hand, or want of it on the other.

American children cry more than other children — they are more nervous, more fretful, more easily annoyed by heat, or by irritating clothing, by indiges- tible food, as well as by nervous and emotional influ- ences. The generalization that children in civilization cry and worry more than children in savagery seems to be sustained by the experiences of all travellers who are trustworthy reporters on these matters. Thus

80 NERVOUSNESS AND ORATORY.

I

Miss Bird — whose observations are always worthy of attention, and in the main, in harmony with facts — states in her work on " Unbeaten Tracks in Japan," that the children are more calm and quiet, and Icsaul troublesome than the children of higher civilizations.

Travellers in Brazil make the same report in re- gard to the children of the dark or mixed races in that country. In our own land the contrast be- tween the black and the white children in this respect is very noticeable indeed ; and that Indian children are cold, phlegmatic, and enduring is well known to aU who have studied Indian life.

Relation of American Oratory to American ^ Nervousness,

American oratory is partly the product of Ameri- can nervousness. For success in the loftier phases of oratory, fineness of organization, a touch of the nervous diathesis are essential; the masters in the oratorical art are always nervous; the same suscep- tibility that makes them eloquent, subtile, and per- suasive causes them to be timid, distrustful, and sometimes cowardly. "We blame Cicero for the pusil- lanimity of his old age, and for his terror in the presence of death, and praise him for his spirit and force and grace in the presence of audiences, not . thinking that the two opposite piodes of conduct flowed from a single source. A nature wholly coarse

SJOJ^S OF AMERICAN NERVOUSNESS. 81

and hard, with no thread or vein of nerve sensitive- ness, must always fail in the higher realms of the oratorio art, just as it must fail in all arts; every- where it is the fine organization that conquers.

Jefferson, after acting his Rip Yan Winkle for years, even now enters upon the stage at each per- formance with a feeling of responsibility ; and of more than one orator has it been affirmed that he always dreaded to speak. I know a clergyman of exceptional power, who has preached thousands of times, and yet who confesses to me that he can never eat at a dinner where he is announced to make one of his speeches.

" Give me an army of cowards," said Wellington ; it is the man who turns pale in the face of the enemy that will fight to the death. This delicacy of organization, united with Saxon force, makes America a nation of orators. The preacher whom all will allow to be the greatest and boldest we have ever had in these States, admits that when he sees one whom he knows to be his enemy in his audience, the fire of his eloquence is at once extinguished ; and Gough, who has delivered eight thousand lectures, whose life has been spent in the presence of crowded assemblages, declares that he never goes on the plat- form without a certain anxiety lest he fail : he has not yet outgrown the school-boy's timidity.

At a banquet in England I once sat next to a well-

82 NERVOUSNESS AND HUMOR.

known man of science, who had been appointed to respond to one of the most important and difficult toasts of the occasion. We conversed on many themes, but I noticed a deepening anxiety in his manner, and before his turn came he confessed to me that he would give one hundred pounds if he could be excused from speaking ; and knowing my interest in psychological studies he admitted that all the day long he had been apprehensive of the even- ing, and had even taken, without avail, a solitary row on a stream near-by, to divert and calm his mind. When he rose to respond, his manner was absolutely easy, and he spoke most elegantly and eloquently. ]^ear us, also, there sat one of the speakers who is justly honored for his eloquence, and who is wont to prepare himself for important efforts by months of thought. This man likewise, it was easy to see, was nervous and anxious up to the moment that he was called upon, and only appeared collected and at home when he was doing that which he somewhat dreaded to do. The two best speeches of the even- ing were made by those who were most afraid of speaking.

JPhilosophy of American Humor.

The power to create or to appreciate humor re- quires a fine organization. American humor, both iu its peculiarities and in its abundance, takes its origin,

SIGNS OF AMERICAN Nj^RVOUSNESS. 83

ill part, in American nervousness. It is an inevit- able reaction from the excessive strain of mental and physical life; people who toil and worry less have less need than we for abandonment — of nonsense, exaggeration, and fun. Both the supply of and de- mand for humor of a grotesque and exaggerated form are maintained by this increasing requirement for recreation ; not the vulgar, the untrained alone, but the disciplined, the intellectual, the finely organized man and woman of position, dignity, responsibility and genius, of strong and solid acquisitions, enjoy and follow up and sustain those amusements which are in our land so very common, and which are looked upon, and rightly so, as American — such as the negro minstrels or experiments in induced or mes- meric trance.

"The Gilded Age," the most popular play ever written on this continent, owes its success to those elements of exaggeration and nonsense, of absurd- ity and grotesquesness, that made it fail in Great Britain. Pinafore, popular as it was in Great Brit- ain, was incomparably more so in America, where great numbers of troupes were playing it simulta- neously, and in 'New York five theatres kept it run- ning for weeks and months : its success at home was partly a reflex of its success here. In this country at present, no lecturer can attract very large crowds unless he be a humorist and makes his hearers

84 THE AMERICAN LANGUAGE.

laugh as well as cry ; and the lectures of the humor- ists— now a class by themselves — are more required than those of philosophers or men of science, or of fame in literature. Americans, who are themselves capable of originating thought in science or letters, scholarly, sober, and mature, prefer nonsense to science for an evening's employment ; and so, w^ith the in- crease of our nervousness and intelligence there has been a fading away in the popularity of the instruc- tive and dignified lecturers for whom our lyceums were first organized.

The American Language. . A new language is being evolved in this new world. It was once held — perhaps is held even now, in England, by some — as a certain reproach against Americans, that they spoke a different lan- guage from that of their mother country.

Criticism of this kind must come only from those who have studied but fractionally the psychology of language, and the philosophy of its development. The American language is as necessary as the Ameri- can flag. As the English of England to-day differs from the English of England in the past, so must the American language differ from the language of England, and continue to diverge along certain lines, at least — more and more, with time and devel- opment.

I

SIGNS OF AMERICAN NERVOUSNESS. 85

Language is a resultant of very numerous factors working simultaneously or successively ; and among these factors, climate, races, institutions, general and special, accidents of situation and of travel, of class, of war and peace, of industry and inventions, of wealth and the lack of it, are pre-eminent. Only by violating natural laws could Americans speak the English language as it is spoken in England. Every decade marks differences, subtractions, altera- tions — qualitive and quantitive — to the language which our fathers brought to these shores ; and with heightening sensitiveness there are at the same time changes in pronunciation, in articulation, in phraseology, as well as in the choice and handling of terms. Treatises and criticisms on Americanisms we have perhaps enough — and not without a con- siderable value ; but none of them would seem to give sufficient force to the study of the relation of language to nervousness, that is, to the effect of the nervous organization on our idioms, articulation, or lack or want of articulation.

Nervousness causes us to clip words, to leave off or slide endings of words like iiig, the full and clear enunciation of which makes severe draughts on time and force. Yoltaire said of the English that in conversation of a day they would gain two hours over the French, because they used fewer vowels and more consonants, vowels requiring more

I

86 NERVOUSNESS AND LANGUAGE.

time than consonants for their distinct articulation; and an American can surely gain as mnch over the English as the English over the French by tjie use of compressed idioms, elisions, and the simple rapid- ity of utterance. The Americans effect much sav- ing of force, also, by allowing the voice to fall at the end of sentences, although those who listen must ex- pend more force if they would hear correctly.

I once attended, in company with Mr. A. Oj "Wheeler (Nim Crinkle), a matinee performance of our leading American actress, Clara Morris, in the powerful and emotional play of Camille. It is well known on this side of the Atlantic, and not en-^ tirely unknown abroad, that this actress is a repre- sentative of American female nervousness, and that she has suffered, and I believe still suffers at times, severe depressions and pains, so that only by stimu- lation and care and long rests is it possible for her to fulfil her parts. W\

In studying her acting, at the performance re- ferred to, we both observed — as indeed w^e had both observed before, that while in the expression of strong emotion through the vowel sounds she was remarkable, even surpassing Bernhardt, she was very much inferior to the French actress in her average elocution, disregarding in a most wonderful way the consonant sounds, and so making it a difficult task to hear the lines. For an actress so famous and

SIGJS'S OF AMERICAN NERVOUSNESS. 87

successful her elocution is phenomenally bad, and it is a result, in part, of her extreme deficiency in nerve-force ; unconsciously, no doubt, she expends the nervous energy that other actresses give to ar- ticulation in the spasmodic expression of feeling through the vowel sounds, and were she a better rhetorician she would be a less powerful actress, since her success is entirely in emotional characters, and it consists more of spontaneous and piercing out- bursts of emotion than in a uniform manifestation of art. In this respect this actress is a type of her sex in America, on and off the stage — a type, to a degree, of both sexes.

The condition described by Mr. Eichard Grant White, as heterophemy (saying the opposite of what we mean), is probably more common in America than in Europe, although instances of it have been pointed out in the waitings of some of the leaders of English literature; as a symptom of disease and a result of brain exhaustion I have observed it in a number of cases ; coming on or growing worse as the patient's brain-force diminishes.

Rapidity of Speech and Pitch of Voice.

The American speaks more rapidly than the European ; he makes more muscular movements of the larynx in a minute : in his nervousness he clips words, articulating indistinctly, and allowing his

II

TRANCE IN AMERICA.

YOiQB to fall at the end of a sentence, sometimes so as to be inaudible. The Englishman speaks more slowly, enunciates more clearly, says fewer words to a minute, and, as is well known, keeps the voice up, where an American would let it fall. The American fli woman says more than the Englishwoman, is easier and more alert for converse, quicker to seize a deli- cate irony, more facile to respond to a suggestion, than the English lady in the same walk of life. I' believe, also, that the English, Germans, and Swiss cannot hear as many words in a minute as Ameri- cans ; the auditory nerve and the brain behind it being incapable of receiving and co-ordinating as many sounds in a given time. Hence it is necessary to speak to them with more calmness and clearness, whatever language may be employed.

The American voice is pitched higher than that of the European ; and it would appear that the pitch has been gradually rising during the past century. Our musical instruments, according to some authorities, are keyed higher than those of European manufacture.

Greater susGeptibility to Trance in America. 9\

Americans are, without question, more suscepti- ble to certain forms of trance than any other civil- ized people. As I have indicated in my writings on trance, the special variety known as induced

I

ST0N8 OF AMERICAN NERVOUSNESS. 89

trance is very much affected bj the state of the atmosphere as well as by the general condition of the nervous system. Those who are very strong physically, are easily entranced, oftentimes ; but the influence of the weather is very apparent to any one who studies the subject thoroughly, and makes experiments on large numbers of human beings at different times and seasons. I have ob- served, myself, that in dull, heavy, rainy, unpleasant weather, the phenomena of induced trance appear far more slowly, require more effort to develop them, are capricious, tricky, and uncertain ; and the subjects are more disposed to slide out of the conditions in which they are placed in the trance state, than when the weather is sparkling and clear. A dry atmosphere is favorable to the induction of trance states ; and a sensitive, nervous temperament — provided the psychology be favorable — is more likely to develop the higher manifestations of trance than the heavy and the dull. Hence it is that in the I^orth-western sections of our country — in Minnesota and Iowa — where the air is not only ex- cessively dry, but frequently very cold, the propor- tion of persons who go into trance through the or- dinary manipulations and manoeuvrings employed is greater than on the sea-board, and greater, probably, than in the South.

America is the only country, ancient or modern,

90 CHANGE IN TYPE OF DISEASE.

I

in whicli large numbers of people make it a life- business to amuse people by trance exhibitions ; and those who have studied these exhibitions, as they are given by the best experts, well know that there is no form of evening amusement that can in any way be compared with them. All these phe- nomena are, it is true, known in Europe, and they have been known all over the world, some of them for centuries ! but what is here claimed is, that they are more easily obtained here, and the manifelsta- tions are more certain and more interesting, partly because this trance has been studied in America more thoroughly than in Europe.

I

Change in Type of Disease.

The question often agitated is. Whether diseases have changed their type in modern times? This is a question which so far as chronic disease is con- cerned should not be discussed ; to raise it, is to an- swer it. There is no doubt that chronic diseases have changed their type in the last half century. The only question is. What are the degrees of the change, and what are the causes which produce these results? Acute diseases, like pneumonia, may per- haps have been but little changed in type, but it is easily demonstrable that chronic nervous diseases have increased in recent periods, and that, with this increase of nervous symptoms, there has been

SIGIiS OF AMERICAN NERVOUSNESS. 91

also an increase in the asthenic forms of disease, and a decrease in the sthenic forms ; and, corre- spondingly, that there has been a change in the methods of treatment of diseases ; neurasthenia — nervous susceptibility — has affected all, or nearly all, diseases, so that nearly all illnesses occurring among the better class of people — the brain- workers — require a different kind of treatment from that which our fathei-s employed for the same diseases.

Tlie four ways by which we determine these facts 2LrQ— first, by studying the literature of medi- cine of the past centuries ; secondly, by conversation with very old and experienced pi-actitioners — men between the ages of seventy and ninety — who link the past with the present generation, and remember their own personal experience and the practice of medicine as it w^as fifty years ago ; thirdly, from our own individual experience and observation ; fourthly, by studying the habits and diseases of savages and barbarians of all climes and ages, and of the lower orders about us. Statistics on this subject are of very little value, for reasons that will be clear to those who are used to statistics, and who know how they can be handled.

We do not bear blood-letting now as our fathers did, for the same reasons that we do not bear alco- hol, tobacco, coffee, opium, as they could. The chauge in the treatment of disease is a necessary

DISEASES OF SAVAGES.

I

result of the change in the modern constitution. The old-fashioned constitution yet survives in num- bers of people; and in such cases, the old treatment is oftentimes better than the modern treatment.

The diseases of savages can be learned from books of travel and from conversations with travel- lers. Many of these books, it is true, are of a non- expert character, but some of them are written by physicians and scientific men of various degrees of eminence, whose observations, on a large scale, com- pared together, enable us to arrive at the approxi- mate truth. In the study of this subject, I have compared a very large number of books of travel, and I have arrived at this fact, in regard to which there can be no doubt whatever, namely, that nervous dis- ease of a physical character, scarcely exists among savages or barbarians, or semi-barbarians or partially civilized people. Likewise, in the lower orders in our great cities, and among the peasantry in the rural districts, muscle-workers, as distinguished from brain-workers — those who represent the habits and mode of life and diseases of our ancestors of the last century — functional nervous diseases, except those of a malarial or syphilitic character, are about as rare as they were among all classes during the last century. These people frequently need more vio- lent and severe purging, more blood-letting, more frequent blistering than the higher orders would

SIGNS OF AMERICAN NERVOUSNESS 93

endure. If we would compare the nervous dis- eases of our time with those of the past, we have only to look about us among those classes of people whose temperaments take us back a half or three- quarters of a century ; in these classes such diseases as neurasthenia, heavy fever, sick-headache are very rare indeed; so that it is very difficult for a hospi- tal for nervous diseases to succeed in getting a suffi- cient number of patients of this character. On the other hand, hospitals for inflammatory and febrile diseases are enormously patronized among them. It is partly for this reason that the literature for ner- vous functional diseases is so poor and unsatisfac- tory ; our medical books and lectures are made up far too often of hospital, charity, and dispensary practice. In regard to the incapacity for observing, which has been so often charged upon all the physicians who were so unfortunate as to be born prior to the last half century, I may say, that even conceding the general truth of the charge, as applied to the mass of the profession, it certainly does not apply to all the great leaders in medical thought. The greatest medical minds of the last century were, to use the most measured language, the equals of those who lead the profession of our day, and were capable of observing, and did observe, and they recorded their observations; some of the grandest discoveries of all time were made by them.

1/

INHERITANCE OF NERVOUSNESS.

Syphilis growing milder.

One reason, thongli not perhaps the only reason, why syphilis is growing milder with civilization, is, without much question, as it seems to me, the in- creasing nervousness of our time. This disease, dreadful as it is and must always be, is not so hid- eous and revolting in its symptoms as it once was; independent of the treatment, before any treatment is used, its manifestations are less repulsive than formerly, and they are less violent and obstinate among the higher than among the lower classes ; syphilis, plus a nervous constitution, is a different disease from syphilis plus a strong phlegtoatic con- stitution ; it has less to feed on, and like febrile and inflammatory diseases, is not so furious and dangerous in a sensitive organism as in a strong one.

Nervous syphilis is apparently more common than it was ; indeed, it simulates in very many of its mani- festations the symptoms of neurasthenia, so that with- out the history of the case, it would be almost im- possible to make a sure differential diagnosis.*

I^ervousness increased hy Inheritance. Nervousness develops very rapidly in our cli- mate, and, by the remorseless law of inheritance

* Tlie very able and original prize essay of Dr. C. L. Dana, of this city, on " The Benignity of Syphilis," is worthy of careful study in relation to this question. (See New York Medical Record, February 5, 1881.)

SIGNS OF AMERICAN NERVOUSNESS. 95

soon becomes an element in the family history of recent importations.

A very considerable portion of those whom I see professionally for nervous diseases of a functional character are descendants of parents who were born in Germany, or some portion of Europe — descend- ants of ancestors who, in the old country, never knew what nervousness meant. I have never seen more severe cases of neurasthenia than some of this class. Some patients who were born in Europe, after a long residence here, themselves develop the full symptoms of nervous exhaustion.

Intensity of Animal Life in America. *

In a paper of much interest on the Cosmopoli- tan Butterfly, a naturalist of Cambridge, Samuel Y. Scudder, has shown that among all the butterflies properly comparable on the two continents, there is no single instance where the European butterfly » has more broods than the American.

This author, speaking of the species of butter- fly called the Y. Cardui, asserts that "all observ- ers in Switzerland and Germany agree that it is single- brooded ; whereas, in Kew England it is double- brooded ; " and, on comparing the histories of several other and different species also, he derives the gen- eral law that animal life on this continent is more intense than in Europe.

CHAPTER III.

CAUSES OF AMERICAN NEEV0TJSNE8S.

The causes of American nervousness are compli- cated, but are not beyond analysis: First of all modern civilization. The phrase modern civilization is used with emphasis, for civilization alone does not cause nervousness. The Greeks were certainly civilized, but they were not nervous, and in the Greek language there is no word for that term. The ancient Romans were civilized, as judged by any standard. Civilization is therefore a relative term, and as such is employed throughout this trea- tise. The modern differ from the ancient civiliza- tions mainly in these five elements — steam power, the periodical press, the telegraph, the sciences, and the mental activity of women. When civilization, plus these five factors, invades any nation, it must carry nervousness and nervous diseases along with it.

•I

Civilization very limited in extent. All that is said here of American nervousness refers only to a fraction of American society ; for

A

CAUSES OF AMERICAN NERVOUSNESS. 97

in America, as in all lands, the majority of the peo- ple are muscle- workers rather than brain- workers ; have little education, and are not striving for honor, or expecting eminence or w^ealth. All our civiliza- tion hangs by a thread; the activity and force of the very few make us what w^e are as a nation ; and if, through degeneracy, the descendants of these few revert to the condition of their not very re- mote ancestors, all our haughty civilization would be wiped away. With all our numerous colleges, such as they are, it is a rarity and surprise to meet in business relations with a college-educated man.

A late writer. Dr. Arthur Mitchell, has shown that if, of the population of Scotland, a few thou- sands were destroyed or degenerated and their places unsupplied, the nation would fall downward to bar- barism. To a somewhat less degree this is true of all lands, including our own land. Of our fifty millions of population, but a few millions have reached that elevation where they are likely to be nervous. In the lower orders, the classes that sup- port our dispensaries and hospitals, in the tenements of our crowded cities, and even on farms in the country, by the mountain side — among the health- iest regions, we iind, now and then, here and there cases of special varieties of nervous disease, such as hay-fever, neurasthenia, etc. ; but the proportion of

98 ANALOGY OF THE ELECTRIC LIGHT.

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II

diseases of this kind among these people is much smaller than among the in-dooF-ljying and brain- working classes, although insanity of the incurable kind is more common among the lower or the middle than in the very highest classes.

Edison's electric light is now sufficiently advanced in an experimental direction to give us the best possible illustration of the effects of modern civil- ization on the nervous system. An electric machine of definite horse-power, situated at some central point, is to supply the electricity needed to run a certain number of lamps — say one thousand, more or less. If an extra number of lamps should bo in- terposed in the circuit, then the power of the engine must be increased ; else the light of the lamps would be decreased, or give out. This ha^, been mathematically calculated, so that it is known, §■ or believed to be known, by those in charge, just how much increase of horse-power is needed for each increase in the number of lamps. In all the calculations, however widely they may differ, it is assumed that the force supplied by any central machine is limited, and cannot be pushed beyond a certain point ; and if the number of lamps inter- posed in the circuit be increased, there must be a corresponding increase in the force of the machine. The nervous system of man is the centre of the nerve-force supplying all the organs of the body.

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CAUSES OF AMERICAN NERVOUSNESS. 99

Like the steam engine, its force is limited, although it cannot be mathematically measured — and, unlike the steam engine, varies in amount of force with tlie food, the state of health and external conditions, varies with age, nutrition, occupation, and number- less factors. The force in tliis nervous system 1 can, therefore, be increased or diminished by good or evil influences, medical or hygienic, or by the natural evolutions — growth, disease and decline ; but none the less it is limited ; and when new functions are interposed in the circuit, as modern civilization is constantly requiring us to do, there comes a period, sooner or later, varying in different individuals, and at different times of life, when the amount of force is insufficient to keep all the lamps acti^^ely burn- ing ; those that are weakest go out entirely, or, as more frequently happens, burn faint and feebly — they do not expire, but give an insufficient and un- stable light — this is the philosophy of modern ner- >f vousness.

The invention of printing, the extension of steam power into manufacturing interests and into means of conveyance, the telegraph, the periodical press, the political machinery of free countries, the religious excitements that are the sequels of Protes- tantism— the activities of j)hilanthropy, made neces- sary by the increase of civilization, and of poverty, and certain forms of disease — and, more than all.

100 ANALOGY OF THE STEAM ENGINE.

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perhaps, the heightening and extending complexity of modern education in and out of schools and universities, the inevitable efiect of the rise of modern science and the expansion of history in all its branches — all these are so many additional lamps interposed in the circuit, and are supplied at the expense of the nervous system, the dynamic power of which has not correspondingly increased."^

II

* The London Times, in an editorial article of much ability and interest, giving a resume of my researches in American ner- vousness, illustrates the philosophy here advocated very appro- priately, by the analogy of the steam engine.

" The nervous system, as a whole, is the immediate motor power of the human machine ; and in this machine it may be very roughly said that the steam generated in a single boiler works through the agency of scattered engines, technically called special nerve-centres, or ganglia, which are charged with the maintenance of particular functions. If one such engine is hard at work, and is therefore using a great deal of steam, so much the less will be available to support the activity of the rest. For all functions of primary importance to the existence of the human race there are engines coeval with the race itself in antiquity, which have been perfected by long exercise, and handed down from generation to generation in a state of gradually acquired stability and aptitude. Such, for example, are the nerve-centres which combine in harmonious action the very large number of muscles that are collectively subservient to the maintenance of the erect posture, or the smaller but very distinct group that governs the conjoined movements of the eyes.

" When the progress of civilization calls for the performance of a new function, whether it be of body or mind, a new engine must be gradually provided for the purpose ; and this which be- comes developed in individuals long before it can be considered the common property of the race, will for a long period be infe- rior to move established centres in its power of endurance. Dr.

Jt

CAUSES OF AMERICAN NERVOUSNESS. 101

Necessary Evils of Specialization,

One evil, and hardly looked for effect of the introduction of steam, together with the improved methods of manufacturing of recent times, has been the training in special departments or duties — so that artisans, instead of doing or preparing to do, all the varieties of the manipulations needed in the making of any article, are restricted to a few simple exiguous movements, to which they give their whole lives — in the making of a rifle, or a watch,

Buzzard lias felicitously used these principles in explaining one of the causes of the disease called writer's palsy. The art of writing-, measured by the antiquity of man, is only a thing of yesterday, and the special nervous engine which controls it is liable to de- rangements from which those of older formation are compara- tively exempt. In our own day, even when compared with quite recent times, there has been an enormous increase of brain-work, of education, of competition between educated people ; and there can be no doubt that we are living in the midst of a consequently greatly increased development of nervous tissue and of nervous force, a large share of which, in very many people, is applied to intellectual or other purposes which are more or less novel in their nature. In a certain number of such people, to continue the illustration, the engines most in use are those which are deficient in stability, while, at the same time, the individuals have no ex- cess of power for the maintenance of the activity of others. A man whose thinking centres are exerted to the full measure of their capabilities has no reserve of force to enable him to dis- pose of more food than he requires ; and he has either to find out how little he should live upon, and to live upon that little, or to pay a penalty in the shape of indigestion. He has no reserv^e of force with which to burn off fat for the maintenance of his animal heat, and it is sound economy for him to live in a warm room, and to devote his energies to higher uses than those of a perambulat-

102 EVILS OF SPECIALIZATION.

each part is constructed by experts on that part. The effect of this exclusive concentration of mind and muscle to one mode of action, through months and years, is both negatively and positively perni- cious, and notably so, when re-enforced, as it almost universally is, by the bad air of overheated and ill- ventilated establishments. Plerein is one unantici- pated cause of the increase of insanity and other diseases of the nervous system among the laboring and poorer classes. The steam engine, which would relieve work, as it was hoped, and allow us to be idle, has increased the amount of work done a thousand fold; and with that increase in quantity

II

ing furnace. If he fails to surround himself by a sufficient external temperature, he will suffer from cold. In this way cer- tain forms of nervous disorder have been brought into what may be described as unnecessary prominence, and at the same time their relative prominence has been increased by the diminished frequency of many of the diseases which are caused by the neg- lect of obvious precautions or by the prevalence of unwholesome habits of living. There are fewer epidemics because, in spite of many shortcomings in our sanitary arrangements, the spreading of infectious diseases is hindered to a very real extent. There is less inflammation because people have learned, partially at least, the wisdom of taking proper care of their bodies.

" Lastly, it must not be forgotten that the increase of nerve-force to which we have referred is an increase of the '.' boiler " power itself, and is therefore originally capable of being applied to any or all of the demands of the organism. When compared with our ancestors, we are athletes, and we may be physical or intellectual athletes, as we please.

"It is not given to ordinary humanity to reach a summit of ambition in more than one direction at once."

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CAUSES OF AMERICAN NERVOUSNESS. 103

tliere has been a differentiation of quality and specialization of function which, so far forth, is depressing both to mind and body. In the profes- sions — the constringing power of specialization is neutralized very successfully by general culture and observation, out of which specialties spring, and by which they are supported ; but for the artisan there is no time, or chance, or hope, for such re- deeming and antidotal influences.

Clocks and Watches. — Necessity of Punctuality.

The perfection of clocks and the invention of watches have something to do with modern ner- ^ vousness, since they compel us to be on time, and excite the habit of looking to see the exact moment, so as not to be late for trains or appointments. Before the general use of these instmments of pre- cision in time, there was a wider margin for all appointments ; a longer period was required and prepared for, especially in trav*elling — coaches of the olden period were not expected to start like steamers or trains, on the instant — men judged of the time by probabilities, by looking at the sun, and needed not, as a rule, to be nervous about the loss of a moment, and had incomparably fewer expe- riences wherein a delay of a few moments might destroy the hopes of a lifetime. A nervous man cannot take out his watch and look at it when the

104 NECESSITY OF PUNCTUALITY.

time for an appointment or train is near, without affecting his pulse, and the effect on that pulse, if we could but measure and weigh it, w^ould be found to be correlated to a loss to the nervous system. Punctuality is a greater thief of nervous force than is procrastination of time. We are under constant strain, mostly unconscious, oftentimes iufll sleeping as well as in waking hours, to get some-^™' where or do something at some definite moment. Those who would relieve their nervousness may well study the manners of the Turks, who require two weeks to execute a promise that the Anglo- Saxon would fulfil in a moment. In Constantinople indolence is the ideal, as work is the ideal in London and New York ; the follower of the Prophet is ashamed to be in haste, and would apologize for keeping a promise. There are those who prefer, or fancy they prefer, the sensations of movement and activity to the sensations of repose ; but from the standpoint only of economy of nerve- force all our civilization is a mistake ; every mile of advance into the domain of ideas, brings a conflict that knows no rest, and all conquests are to be paid for, before delivery often, in blood and nerve and life. We cannot have civilization and have anything else, the price at which nature disposes of this luxury being all the rest of her domain.

rf

CAUSES OF AMERICAN NERVOUSNESS. 105

The Telegraph.

The telegraph is a cause of nervousness the po- tency of which is little understood. Before the days of Morse and his rivals, merchants were far less worried than now, aud less business was trans- acted in a given time ; prices fluctuated far less rapidly, and the fluctuations which now are trans- mitted instantaneously over the world were only known then by the slow communication of sailing vessels or steamships ; hence we might wait for weeks or months for a cargo of tea from China, trusting for profit to prices that should follow their arrival ; w^hereas, now, prices at each port are known at once all over the globe. This continual fluctua- tion of values, and the constant knowledge of those fluctuations in every part of the world, are the scourges of business men, the tyrants of trade — every cut in prices in wholesale lines in the smallest of any of the Western cities, becomes know^n in less than an hour all over the Union ; thus competition is both diffused and intensified. Within but thirty years the telegraphs of the world have grown to half a million miles of line, and over a million miles of wire — or more than forty times the circuit of the globe. In the United States there were, in 1880, 170,103 miles of line, and in that year 33,155,991 messages w^ere sent over them.

106 NOISE AND NERVES.

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Effect of Noise on the Nerves.

The relation of noise to nervousness and ner- vous diseases is a subject of not a little interest: but one which seems to have been but incidentally studied.

The noises that nature is constantly producing — the moans and roar of the wind, the rustling and trembling of the leaves and swaying of the branches, the roar of the sea and of waterfalls, the singing of birds, and even the cries of some wild animals — are mostly rhythmical to a greater or less degree, and always varying if not intermittent ; to a savage or to a refined ear, on cultured or uncultured brains, they are rarely distressing, often pleasing, sometimeaM I delightful and inspiring. Even the loudest sounds in nature, the roll of thunder, the howling of storms, and the roar of a cataract like Niagara — save in the exceptional cases of idiosyncrasy — are the occasions not of pain but of pleasure, and to observe them atfll their best men will compass the globe.

Many of the appliances and accompaniments of civilization, on the other hand, are the causes of noises that are unrhythmical, unmelodious and there- fore annoying, if not injurious ; manufactures, loco- motion, travel, housekeeping even, are noise-pro- ducing factors, and when all these elements are concentred, as in great cities, they maintain through all the waking and some of the sleeping hours, an

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CAUSES OF AMERICAN NERVOUSNESS. 107

unintermittent vibration in the air that is more or less disagreeable to all, and in the case of an idio- syncrasy or severe illness may be unbearable and harmful. Ehythmical. melodious, musical sounds are not only agreeable, but when not too long main- tained are beneficial, and may be ranked among our therapeutical agencies.

Unrhythmical, harsh, jarring sounds, to which we apply the term noise, are, on the contrary, to a greater or less degree, harmful or liable to be harm- ful ; they cause severe molecular disturbance.

In regard to this general subject of the relation of noises to the nerves these three general princi- ples are to be recognized ;

1. That what is disagreeable may not of neces- sity be especially injurious to the health.

2. That it is possible to adapt the system to noises that are at first disagreeable, so that they cease to have any appreciable or at least demon- strable effect.

3. That there may be idiosyncrasies against noises as against all other forms of irritation — as there may be idiosyncrasies against certain articles of food or drink, or against the various stimulants and narcotics or different articles on the materia medica.

Although it is usually assumed that the dis- agreeable and the unhealthful are identical, although offensive odors in large cities have been regarded as

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108 DISAOBEBABL'E ODORS.

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nuisances in the eye of modern law, yet there is no scientific proof that there is any such necessary cor- relation. The odor of a tanyard is not only un- pleasant, but enormously so ; one, at first, wonders that any human being could live, even for a day, in such an atmosphere; and yet investigations that Jl I made a number of years ago convinced me that those who regularly worked in these yards were not in any perceptible way injured in health, and that their longevity compared favorably with that of other muscle-workers in the various trades.

Likewise there are many vile odors in all our cities that are legislated against as nuisances, and for permitting which the members of the Board of Health of the city of New York were lately indict- ed, but which certainly cannot be proved to be in- jurious to health ; there is no evidence that they directly excite either acute or chronic disease, or that they tend to shorten life, although they are so disagreeable as to subtract largely from the comfort of those who are exposed to them. On the other hand, it is well established that the sewer gas and other poisons that give rise to most serious disease have little or no odor, and only make their presence felt by their effects. i^lj

With disagreeable sounds the same principle, up ^' to a certain point at least, applies ; the rumble of omnibuses, the jangling of car-bells, and the clatter

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CAUSES OF AMERICAN NERVOUSNESS. 109

of many carriages, with the tramping and shuffling of vast multitudes in our crowded streets, all jar on a sensitive frame; but whether the}^ excite, in any considerable number of people, symptoms of either acute or chronic disorder, must be regarded as doubt- ful. That in connection with the bad air of cities and the coniinement, they do tend to increase the nervousness of civilization is quite probable, but any ^ claim more deiinite than that cannot well be main- tained.

In case of illness or idiosyncrasy, however, it is quite different, for the evil effects of noise on those confined with grave or debilitating disease are often- times so speedy, direct, and severe that no doubt can be raised, and the cessation of the nuisance or the removal of the sufferer is an urgent need.

This must without dispute be allowed, that one may have an idiosyncrasy against a certain form of sound just as against a certain odor, taste, or action of food or medicine. How painful the noise of filing a saw may be is well known ; but it is not so well known that this is but one of many noises that are specially offensive to individuals. The scraping of the foot on a corn cob or rubber mat is to some as painful as though a pin were stuck into the skin ; and at one time, when somewhat ex- hausted by overwork, the noise of the tearing of a newspaper was to myself unpleasant in the extreme.

HO JVBW YORK ELEVATED ROAD.

T

These peculiarities, however, are not necessarily the result of disease or symptomatic of any recognizable state ; they are found in the strongest and hardiest. One who for a number of years has been my guide in the White Mountains, a man of rare endurance and vigor, who in a long and laborious life has never known a day of real illness, tells me that the noise of the filing of a saw has always been exceed- ingly distressing. A professional gentleman whom I know, says that the noise of the elevated railway trains in New York city are so harassing to him that he never goes on the avenue where these trains run unless compelled to do so; the effect he declares is rasping, exasperating, amounting to posi- tive pain ; and yet this man is not only well, but is remarkably tough and wiry, capable of bearing confinement and long and severe application.

This elevated railroad, it may be observed, has been a convenient means of illustrating all the principles here brought forward in regard to the relation of noise to nerves. When first organized, during the heat of summer, while people lived with doors and windows open for the admission of air, the noise of the trains was a source of distress to all or nearly all, w^ho lived on or very near the avenue and streets through which it passed; a new structure usually makes more noise than an old one, and this fact not being understood caused

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CAUSES OF AMERICAN NERVOUSNESS. HI

the complaints to be almost as loud as the noise. Those who were so unfortunate as to . be confined to the house by any form of sickness in some cases suffered so severely that it was feared their lives would be sacrificed ; and some were obliged to dispose of their property and move away.

The majority of the residents, however, in the course of a few months became so used to the din that, except when tlieir attention was specially di- rected to it, it ceased to be painfully annoying ; they had adapted themselves to their environment ; the nervous system had become in a degree be- numbed, so that the vibrations striking on the ear gave rise to no conscious or rememberable sensation. This process of the moulding of the internal to the external was made much easier and shorter by the coming of cold weather, which closed the doors and windows; and by the fact that the structure of the road had been so affected by use that its vibra- tions were less rasping to the nerves. It would appear that the vibrations were both changed in quality and diminished in loudness, although so far as I know no scientific proof of this has ever been offered.

In some cases of idiosyncrasy it is probable that instead of adaptation to environment directly the reverse will take place, and the more the noise is heard the more distressing it will become. The

112 BAIL WAY TRAVELLING.

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analogy of hay-fever gives us a suggestion of truth on this subject. In this malady there is usually an idiosyncrasy against some one or a number of vege- table or other irritants, as dust or roses, or certain fruits, as strawberries, or peaches, or grapes, or water- melons ; and this idiosyncrasy cannot be overcome by any effort of the will, and the sufferer, instead of getting used to any of these irritants by long dwelling among them, becomes thereby w^orse and worse ; and the only relief is to run away and escape the irritation ; the effect of a long ab- sence being in some cases to make the sensitive- ness less; avoidance of the irritant doing for them just what long subjection to it does for others. To sum up briefly, any irritation constantly or re- peatedly acting, may have two precisely opposite effects — it may benumb or it may increase the sensitiveness — this latter effect occurring chiefly in cases of idiosyncrasy.

Railway Travelling and Nervousness.

Whether railway travelling is directly the cause of nervous disease is a question of not a little in- terest. Reasoning deductively, without any special facts, it would seem that the molecular disturbance caused by travelling long distances, or living on trains as an employe, would have an unfavorable influence on the nervous system.

CAUSES OF AMERICAN NERVOUSNESS. 113

In practice this seems to be found ; that in some cases — probably a minority of those who live on the road — functional nervous symptoms are excited, and there are some who are compelled to give up this mode of life.

A German physician has given the name " Fear of Eailway Travelling," to a symptom that is ob- served in some who have become nervously ex- hausted by long residence on trains; they become fearful of taking a journey on the cars, mainly from the unpleasant sensations caused by the vibrat- ing motions of the train.

That railway travel, though beneficial to some, is sometimes injurious to the nerve system of the ner- vous, is demonstrable all the time in my patients ; many while travelling by rail suffer from the symp- toms of sea-sickness and with increase of nervousness.*

Bapid Development and Acceptance of New Ideas, The rapidity with which new truths are discov- ered, accepted and popularized in modern times is a proof and result of the extravagance of our civiliza- tion.

Philosophies and discoveries as well as inventions

which in the Middle Ages would have been passed

by or dismissed with the murder of the author, are

in our time — and notably in our country — taken up

* See my work on Sea-sickness, last edition.

114 RAPID ACCEPTANCE OF NEW IDEAS.

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and adopted, in innumerable wajs made practical — modiiied, developed, actively opposed, possibly over- thrown and displaced within a few years, and all of necessity at a great expenditure of force. t

The experiments, inventions, and discoveries of Edison alone have made and are now making con- stant and exhausting draughts on the nervous forces of America and Europe, and have multiplied in very many w^ays, and made more complex and ex- dl tensive, the tasks and agonies not only of practical men, but of professors and teachers and students everywhere ; the simple attempt to master the multitudinous directions and details of the labors of this one young man with all his thousands and thousands of experiments and hundreds of patents and with all the soluble and insoluble physical prob- ^ lems suggested by his discoveries would itself be ^1 a sufficient task for even a genius in science; and any high school or college in which his labors were Si not recognized and the results of his labors were ^' not taught would be patronized only for those who prefer the eighteenth century to the twentieth. 1U\

On the mercantile or practical side the promised discoveries and inventions of this one man have kept millions of capital and thousand of capitalists in suspense and distress on both sides of the sea. In contrast with the gradualness of thought move- ment in the Middle Ages, consider the dazzling

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CAUSES OF AMERICAN NERVOUSNESS. 115

swiftness with which the theory of evolution and the agnostic philosophy have extended and solidified their conquests until the whole world of thought seems hopelessly subjected to their autocracy. I once met in society a young man just entering the sil- ver decade, but whose hair was white enough for one of sixty, and he said that the color changed in a single day, as a sign and result of a mental con- flict in giving up his religion for science. Many are they who have passed, or are yet to pass through such conflict, and at far greater damage to the nerve centres.

Increase in Amount of Business in Modern Times,

The increase in the amount of business of nearly all kinds in modern times, especially in the last half century, is a fact that comes right before us when we ask the question. Why nervousness is so much on the increase ?

Of business, as we moderns understand the term, the ancient world knew almost nothing ; the com- merce of the Greeks, of which classical histories talk so much, was more like play — like our summer yachting trips — than like the work or commerce of to-day.

Manufacturers, under the impulses of steam- power and invention, have multiplied the burdens

I

116 INCREASED QUANTITY OF BUSINESS.

of mankind ; and railways, telegraphs, canals, steam- ships, and the utilization of steam-power in agri- culture, and in handling and preparing materials for transportation, have made it possible to transact a hundred-fold more business in a limited time than even in the eighteenth century ; but with an in- crease rather tlian a decrease in business transac- tions. Increased facilities for agriculture, manufac- tures, and trades have developed sources of anxiety and of loss as well as profit, and have enhanced the risks of business ; machinery has been increased in quantity and complexity, some parts, it is true, being lubricated by late inventions, others having the friction still more increased.

Dr. Mosso, of Turin, Italy, has invented an ap- paratus, of simple construction, by which it is pos- sible to prove that even a slight excitement of the brain causes increased circulation in it. The instru- ment consists in glass vessels large enough to hold a man's outstretched hand, in which there is an|H orifice in whfch the arm of the person to be experi- ^mented on is placed, so that the warm water with which the vessel is filled cannot escape, the water being connected with a thin glass tube like a ther- mometer, which shows the least rising or falling in the circulation of the arm. Experiments show that when a person has his attention attracted even slightly — as by the reading of a book or paper — the

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CAUSES OF AMERICAN NERVOUSNESS 117

bulk of the blood in his arm diminishes ; and the inference is that correspondingly the bulk of the blood in the brain increases.

With this experiment before us, let us consider the heightened activity of the cerebral circulation which is made necessary for a business man since the introduction of steam-power, the telegraph, the telephone, and the morning newspaper.

Buying on a Margin vs. Gambling.

The custom of buying on a margin that has late- ly grown so much in popularity is more exciting to the nervous system than ordinary gambling, which it in a measure displaces, in these two re spects —

First, the gambler risks usually all that he has; while the stock buyer risks very much more than he has.

Secondly. The stock buyer usually has a certain commercial, social, and religious position, which is thrown into the risk, in all his ventures ; whereas, the ordinary gambler has nothing to lose but his money.

For these reasons it is quite clear that gambling — formerly far more prevalent than now — is less per- nicious in its action on the nervous system, than buying stocks oiv a margin.

118 INCREASED CAPACITY FOR SORROW.

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Increased capacitf/ for Sorrow — Love and Phi- lanthropy. .

Capacity for disappointment and sorrow lias in- ^ creased with the advance of civilization. Fineness of organization, which is essential to the develop- ment of the civilization of modern times, is accom- I v' panied by intensified mental susceptibility.

In savagery, life is mostly sensual, with much mental force held in reserve, as with I^orth Ameri- can Indians, while the intellect has but slight strength ; in a highly civilized people, some of the senses and all the emotions are quickly excited, and are attended with higher, sweeter, and more com- plex and rapturous pleasure than in savagery, and but for the controlling and inhibiting force of a better trained reason, would make progress, and even existence, in civilization, impossible. Eelatively to the intellect, the savage has more emotion than the civilized man, but in absolute quantity and quality of emotion, the civilized man very far surpasses the savage; although, as the civilized man is constantly kept in check by the inhibitory power of the intellect, he appears to be far less emotional than the savage, who, as a rule, with some exceptions, acts out his feelings witli com- paratively little restraint. The civilized man enjoys his food better than the barbarian; has vastly more complex modes of cookery, and appreciates, when

CAUSES OF AMERICAN NERVOUSNESS. 119

in health, nice distinctions in what he eats, far more than is possible to the savage.

Of the poetry of love, as distinct from the physi- cal type, the lower savages know nothing — their friendships, their married life, their home life with their offspring, show but fugitive traces of that enormous and tyrannous emotion out of which all our novels, romances, and dramas are builded. This potency of loving, including not only sexual, but filial, brotherly and sisterly affection, in all its ranges and ramifications, is a later evolution of human nature ; like all other emotions, it is matched by a capacity for sorrow corresponding to its capacity for joy. Love, even when gratified, is a costly emo- tion ; when disappointed, as it is so often likely to be, it costs still more, drawing largely, in the grow- ing years of both sexes, on the margin of nerve- force, and thus becomes the channel through which not a few are carried on to neurasthenia, hysteria, epilepsy, or insanity.

Jealousy is the shadow of love and like other shadows greater than the original ; it deepens and widens and lengthens with increasing refinement.

Organized philanthropy is wholly modern, and is the offspring of a higher evolved sympathy wedded to a form of poverty that could only arise out of the inequalities of civilization. Philanthropy that is sincere suffers more than those it hopes to save;

120 REPBES8I0N OF EMOTION.

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for while " charity creates much of the misery that it relieves, it does not relieve all the misery that it creates."

J

II

Hepression of Emotion.

One cause of the increase of nervous diseases is that the conventionalities of society require the emotions to be repressed, while the activity of our civilization gives an unprecedented freedom and opportunity for the expression of the intellect; theBl more we feel the more we must restrain our feel- ings. This expression of emotion and expression of reason, when carried to a high degree, as in the most active nations, tend to exhaustion, the one by excessive toil and friction, the other by restraining and shutting up within the mind those feelings which are best relieved by expression. Laughter and tears are safety-valves ; the savage and the child laugh or cry when they feel like it — and it takes but little to make them feel like it ; in .afll high civilization like the present, it is not polite either to laugh or to cry in public ; the emotions which would lead us to do either the one or the other, thus turn in on the brain and expend them- selves on its substance; the relief which should come from the movements of muscles in laughter and from the escape of tears in crying is denied us ; nature will not, however, be robbed ; her lose

CAUSES OF AMERICAN NERVOUSNESS. 121

must be paid and the force which might be ex- pended in muscular actions of the face in laugh- ter and on the whole body in various movements reverberates on the brain and dies awaj in the cerebral cells.

Constant inhibition, restraining normal feelings, keeping back, covering, holding in check atomic forces, of the mind and body, is an exhausting pro- cess, and to this process all civilization is constantly subjected.

A modern philosopher of the most liberal school, states that he hates to hear one laugh aloud, re- garding the habit, as he declares, a survival of bar- barism.

Domestic and Financial Trouble.

Family and financial sorrows, and secret griefs of various kinds, are very commonly indeed the exciting cause of neurasthenia. In very many cases where overwork is the assigned cause — and . where it is brought prominently into notice, the true cause, philosophically, is to be found in family broils or disappointments, business failures or mishaps, or some grief that comes very near to one, and, rightly or wrongly, is felt to be very serious.

The savage has no property and cannot fail; he has so little to win of wealth or possessions, that he has no need to be anxious. If his wife does not

122 LIBERTY AND NERVOUSNESS.

suit he divorces or murders her ; and if all things seem to go wrong he kills himself.

Politics and Religion.

There are two institutions that are almost dis- tinctively American — political elections and relig- ious revivals ; for although in other countries both these institutions exist, yet they are far less numer- ous and far less exacting, and have far less influ- ence than in America. Politics and religion appeal mostly to the emotional nature of men, and have little to do with the intellect, save among the lead- ers ; and in consequence, the whole land is at times agitated by both these influences, to a degree which, however needful it may be, is most exciting to the nervous temperament.

Liberty as a Cause of Nervousness,

A factor in producing American nervousness is, beyond dispute, the liberty allowed, and the stimulus given, to Americans to rise out of the posi- tion in which they were born, whatever that may be, and to aspire to the highest possibilities of for- tune and glory. In the older countries, the exist- ence of classes and of nobility, and the general con- texture and mechanism of society, make necessary so much strenuous eflort to rise from poverty and paltriness and obscurity, that the majority do not

CAUSES OF AMERICAN NERVOVSNESS. 123

attempt or even tliink of doing anything that their fathers did not do : thns trades, employments, and professions become the inheritance of families, save where great ambition is combined with great powers. There is a spirit of routine and spontaneous con- tentment and repose, which in America is only found among the extremely unambitious. In travel- ling in Europe one is often amazed to find indi- viduals serving in menial, or at least most undig- nilied positions, whose appearance and conversation show that they are capable of nobler things than they will ever accomplish. In this land, men of that order, their ambition once aroused, are far more likely to ascend in the social scale. Thus it is that in all classes there is a constant friction and unrest — a painful striving to see who shall be high- est ; and, as those who are at the bottom may soon be at the very top, there is almost as much stress and agony and excitement among some of the lowest orders as among the very highest.

Consider how much nerve-force the American people have expended in carrying through our late nominations and elections.

Last June, just after the nominations were made, I was in Cleveland, assisting in organizing a na- tional association for the protection of the insane, and in my address I referred to the campaign for the nominations as one of the reasons why we

124 POLITICS-ELECTIONS.

needed such an organization. To-day, just after the inauguration, those whose minds are philosophically bent, may well occupy themselves with making an estimate of the cost in brain and nerve of these months of excitement and disappointment ; for it is the very essence of politics to disappoint those who have to do with it, and disappointment, like love, is one of the most expensive of human emotions.

Before the late election one of my patients in-rfll formed me, to my alarm, that he w^as getting inter- ested in politics. He had been treated most suc- cessfully for nerve troubles, two years ago, and had been put into Vorking order, and had been able to work hard ; but I knew that, like most of his class, he was living on a small reserve of nerve-force. He said that great issues were before us, and the neg- lect of politics on the part of intelligent men was the ruin of their nation. J said to him : " My friend, presidents and politicians are chips and foam on the surface of the sea ; they are not the sea ; tossed up by the tide and left on the shore, but they are not the tide ; fold your arms and go to bed, and most of the evils of this world will correct themselves, and, of those that remain, few will be modified by anything that you or I can do." To this advice he, of coui-se, paid no heed, and a day or two before the election came to my office, entirely prostrated, and confessed a most interesting: fact — that five minutes' conversa-

CA USES OF AMERICAN NER YO USNESS. 125

tion on politics had taken all his nerve from him, doing more to exhaust him than months of steady work. * He was a Hancock man, and the unpleasant- ness of defeat supplemented the discussions and elec- tioneerings of a long campaign, doing more of evil for him than he had done of good to his country.

Take that case, which is not an exception, but a type of others in varying degrees; multiply it by thousands and thousands of thousands ; add to it a million of our citizens whose existence depends, near or remotely, on the victory or failure of par- ties, and who must work all through their lives on the treacherous edge of precipices ; pile on the infinite wranglings and controversies, public and family, of these months that the nation believed to be a crisis in its life : throw in the concentrated agony of half our population on the morning fol- lowing election and the long-drawn-out disappoint- ments of the coming yeai-s; then need we ask if there is any mystery in American nervousness, even to those who reject every other accredited cause? The experiment attempted on this continent of making every man, every child, and every woman an expert in politics and theology is one of the costliest of experiments with living human beings, and has been drawing on our surplus energies with cruel extravagance for one hundred years.

Protestantism, with the subdivision into sects

126 PROTESTANTISM.

I

which has sprung from it, is an element in the causation of the nervous diseases of our time.

No Catholic country is very nervous, and partly for this — that in a Catholic nation the burden of religion is carried by the church. In Protestant countries this burden is borne by each individual for himself ; hence the doubts, bickerings, and an- tagonisms between individuals of the same sect and between churches, most noticeable in this land, where millions of excellent people are in constant disagree- ment about the way to heaven.

The difference between Canadians and Ameri- cans is observed as soon as we cross the border, the Catholic church and a limited monarchy acting as antidotes to neurasthenia and allied affections. Prot- estant England has imitated Catholicism, in a mea- sure, by concentrating the machinery of religion and taking away the burden from the people. It is stated — although it is supposed that this kind of statistics (^re) unreliable — that in Italy insanity has been on the increase during these few years in which there has been civil and religious liberty in that country.

If this statement could be mathematically proved — as probably it cannot, in the face of so many sources of error to complicate the calculations — it would be a vigorous illustration of