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+The essays which compose this volume deal chiefly with a variety of
+subjects to which every physician must have given more or less thought.
+Some of them touch on matters concerning the mutual relation of
+physician and patient, but are meant to interest and instruct the laity
+rather than the medical attendant. The larger number have from their
+nature a closer relation to the needs of women than of men.
+
+It has been my fate of late years to have in my medical care very many
+women who, from one or another cause, were what is called nervous. Few
+of them were so happily constituted as to need from me neither counsel
+nor warnings. Very often such were desired, more commonly they were
+given unsought, as but a part of that duty which the physician feels, a
+duty which is but half fulfilled when we think of the body as our only
+province.
+
+Many times I have been asked if there were no book that helpfully dealt
+with some of the questions which a weak or nervous woman, or a woman who
+has been these, would wish to have answered. I knew of none, nor can I
+flatter myself that the parts of this present little volume, in which I
+have sought to aid this class of patients, are fully adequate to the
+purpose.
+
+I was tempted when I wrote these essays to call them lay sermons, so
+serious did some of their subjects seem to me. They touch, indeed, on
+matters involving certain of the most difficult problems in human life,
+and involve so much that goes to mar or make character, that no man
+could too gravely approach such a task. Not all, however, of these
+chapters are of this nature, and I have, therefore, contented myself
+with a title which does not so clearly suggest the preacher.
+
+It would be scarcely correct to state that their substance or advice was
+personally addressed to those still actually nervous. To them a word or
+two of sustaining approval, a smiling remonstrance, or a few phrases of
+definite explanation, are all that the wise and patient doctor should
+then wish to use. Constant inquiries and a too great appearance of what
+must be at times merely acted interest, are harmful.
+
+When I was a small boy, my father watched me one day hoeing in my little
+garden. In reply to a question, I said I was digging up my potatoes to
+see if they were growing. He laughed, and returned, "When you are a man,
+you will find it unwise to dig up your potatoes every day to see if they
+are growing." Nor has the moral of his remark been lost on me. It is as
+useless to be constantly digging up a person's symptoms to see if they
+are better, and still greater folly to preach long sermons of advice to
+such as are under the despotism of ungoverned emotion, or whirled on the
+wayward currents of hysteria. To read the riot act to a mob of emotions
+is valueless, and he who is wise will choose a more wholesome hour for
+his exhortations. Before and after are the preacher's hopeful occasions,
+not the moment when excitement is at its highest, and the self-control
+we seek to get help from at its lowest ebb.
+
+There are, as I have said, two periods when such an effort is wise,--the
+days of health, or of the small beginnings of nervousness, and of the
+uncontrol which is born of it, and the time when, after months or years
+of sickness, you have given back to the patient physical vigor, and with
+it a growing capacity to cultivate anew those lesser morals which
+fatally wither before the weariness of pain and bodily weakness.
+
+When you sit beside a woman you have saved from mournful years of
+feebleness, and set afoot to taste anew the joy of wholesome life,
+nothing seems easier than with hope at your side, and a chorus of
+gratitude in the woman's soul, to show her how she has failed, and to
+make clear to her how she is to regain and preserve domination over her
+emotions; nor is it then less easy to point out how the moral failures,
+which were the outcome of sickness, may be atoned for in the future, now
+that she has been taught to see their meaning, their evils for herself,
+and their sad influence on the lives of others.
+
+To preach to a mass of unseen people is quite another and a less easy
+matter. I approach it with a strong sense that it may have far less
+certain utility than the advice and exhortation addressed to the
+individual with such force as personal presence, backed by a knowledge
+of their peculiar needs, may give. I am now, then, for the first time,
+in the position of the higher class of teachers, who lay before a
+multitude what will be usefully assimilated by the few.
+
+If my power to say what is best fitted to help my readers were as large
+as the experience that guides my speech, I should feel more assured of
+its value. But sometimes the very excess of the material from which one
+is to deduce formulas and to draw remembrances is an embarrassment, for
+I think I may say without lack of modesty in statement, that perhaps
+scarce any one can have seen more of women who have been made by
+disease, disorder, outward circumstance, temperament, or some
+combination of these, morbid in mind, or been tormented out of just
+relation to the world about them.
+
+The position of the physician who deals with this class of ailments,
+with the nervous and feeble, the painworn, the hysterical, is one of the
+utmost gravity. It demands the kindliest charity. It exacts the most
+temperate judgments. It requires active, good temper. Patience,
+firmness, and discretion are among its necessities. Above all, the man
+who is to deal with such cases must carry with him that earnestness
+which wins confidence. None other can learn all that should be learned
+by a physician of the lives, habits, and symptoms of the different
+people whose cases he has to treat. From the rack of sickness sad
+confessions come to him, more, indeed, than he may care to hear. To
+confess is, for mysterious reasons, most profoundly human, and in weak
+and nervous women this tendency is sometimes exaggerated to the actual
+distortion of facts. The priest hears the crime or folly of the hour,
+but to the physician are oftener told the long, sad tales of a whole
+life, its far-away mistakes, its failures, and its faults. None may be
+quite foreign to his purpose or needs. The causes of breakdowns and
+nervous disaster, and consequent emotional disturbances and their bitter
+fruit, are often to be sought in the remote past. He may dislike the
+quest, but he cannot avoid it. If he be a student of character, it will
+have for him a personal interest as well as the relative value of its
+applicative side. The moral world of the sick-bed explains in a measure
+some of the things that are strange in daily life, and the man who does
+not know sick women does not know women.
+
+I have been often asked by ill women if my contact with the nervous
+weaknesses, the petty moral deformities of nervous feminine natures, had
+not lessened my esteem for woman. I say, surely, no! So much of these is
+due to educational errors, so much to false relationships with husbands,
+so much is born out of that which healthfully dealt with, or fortunately
+surrounded, goes to make all that is sincerely charming in the best of
+women. The largest knowledge finds the largest excuses, and therefore no
+group of men so truly interprets, comprehends, and sympathizes with
+woman as do physicians, who know how near to disorder and how close to
+misfortune she is brought by the very peculiarities of her nature, which
+evolve in health the flower and fruitage of her perfect life.
+
+With all her weakness, her unstable emotionality, her tendency to
+morally warp when long nervously ill, she is then far easier to deal
+with, far more amenable to reason, far more sure to be comfortable as a
+patient, than the man who is relatively in a like position. The reasons
+for this are too obvious to delay me here, and physicians accustomed to
+deal with both sexes as sick people will be apt to justify my position.
+
+It would be easy, and in some sense valuable, could a man of large
+experience and intelligent sympathies write a book for women, in which
+he would treat plainly of the normal circle of their physiological
+lives; but this would be a method of dealing with the whole matter which
+would be open to criticism, and for me, at least, a task difficult to
+the verge of the impossible. I propose a more superficial plan as on the
+whole the most useful. The man who desires to write in a popular way of
+nervous women and of her who is to be taught how not to become that
+sorrowful thing, a nervous woman, must acknowledge, like the Anglo-Saxon
+novelist, certain reputable limitations. The best readers are, however,
+in a measure co-operative authors, and may be left to interpolate the
+unsaid. A true book is the author, the book and the reader. And this is
+so not only as to what is left for the reader to fill in, but also has
+larger applications. All this may be commonplace enough, but naturally
+comes back to one who is making personal appeals without the aid of
+personal presence.
+
+Because what I shall write is meant for popular use rather than for my
+own profession, I have made my statements as simple as possible.
+Scarcely a fact I state, or a piece of advice I give, might not be
+explained or justified by physiological reasoning which would carry me
+far beyond the depth of those for whom I wrote. All this I have
+sedulously avoided.
+
+What I shall have to say in these pages will trench but little on the
+mooted ground of the differences between men and women. I take women as
+they are to my experience. For me the grave significance of sexual
+difference controls the whole question, and, if I say little of it in
+words, I cannot exclude it from my thought of them and their
+difficulties. The woman's desire to be on a level of competition with
+man and to assume his duties is, I am sure, making mischief, for it is
+my belief that no length of generations of change in her education and
+modes of activity will ever really alter her characteristics. She is
+physiologically other than the man. I am concerned with her now as she
+is, only desiring to help her in my small way to be in wiser and more
+healthful fashion what I believe her Maker meant her to be, and to teach
+her how not to be that with which her physiological construction and the
+strong ordeals of her sexual life threaten her as no contingencies of
+man's career threaten in like measure or like number the feeblest of the
+masculine sex.
+
+
+
+THE PHYSICIAN.
+
+
+I have long had in mind to write from a physician's point of view
+something in regard to the way in which the well-trained man of my
+profession does his work. My inclination to justify the labors and
+sentiments of an often misunderstood body of men was lately reinforced
+by remarks made to me by a very intelligent patient. I found him, when I
+entered my room, standing before an admirable copy of the famous
+portrait of the great William Harvey, the original of which is in the
+Royal College of Physicians. After asking of whom it was a likeness, he
+said, "I should be a little curious to know how he would have treated my
+case."
+
+I had to confess that of Harvey's modes of practice we know little, but
+I took down from a shelf those odd and most interesting letters of
+Howell's, clerk of council to James I., and turned to his account of
+having consulted Harvey on returning home from Spain. Only too briefly
+he tells what was done for him, but was naturally most concerned about
+himself and thus missed a chance for us, because it so happens that we
+know little of Harvey. At this page of Howelliana was a yellow
+paper-marker. Once the book was Walpole's, and after him was
+Thackeray's, and I like to fancy that Walpole left the marker, and that
+Thackeray saw it and left it, too, as I did.
+
+My patient, who liked books, was interested, and went on to say that he
+had seen several physicians in Europe and America. That in France they
+always advised spas and water-cure, and that at least three physicians
+in America and one in London had told him there was nothing the matter
+with him, and that finally a shrewd country doctor had remarked bluntly
+that he would not give him any medicine, because he was overdosed
+already with work and worries, which was true.
+
+At last he came back to Harvey. "He looks ill," he said, which is true.
+His honestly-painted knuckles make diagnosis easy. My friend thought
+that this great man would probably have dosed him well, and, as he
+added, would not have bothered him about too much sugar, nor forbidden
+champágne. I had to reply that whatever ills were in the England of that
+day,--and there was much dyspepsia and much gout,--sugar was the luxury
+of the rich, and anything but as abundant as it is to-day, when we
+consume annually fifty-six pounds per head or per stomach. I told him
+that in all ages the best of us would have dwelt most on diet and habits
+of living, and that Harvey was little likely to have been less wise than
+his peers, and he has had but few. Then he said it would be curious to
+put on paper a case, and to add just what a doctor in each century would
+have ordered. The idea struck me as ingenious and fertile. I could wish
+that some one would do this thing. It would, I think, be found that the
+best men of every time were most apt to consider with care the general
+habits of their patients as to exercise and diet, and to rely less than
+others on mere use of drugs. As to this matter, one learns more from
+men's lives than from their books, but nowadays care as to matters of
+hygiene has become in a valuable degree the common wisdom of a large
+part of my profession. Surveying our vast gains, we are a little apt to
+undervalue the men of older days, and no lesson is wiser than sometimes
+to go back and see how the best of them thought and acted amidst the
+embarrassments of imperfect knowledge.
+
+There is a charming life by Henry Morley, of Cardan, the great Italian
+physician and algebraist, which gives us in accurate detail the daily
+routine of a doctor's days in the sixteenth century. In it is an account
+of Cardan's professional visit in 1551 to John Hamilton, archbishop of
+St. Andrew's, Scotland, and practically the ruler of that turbulent
+realm. Cardan's scientific opinion as to his patient is queer enough,
+but, as Morley remarks, it is probably not more amusing to us than will
+be our opinion in a like case to the smiling brother of our guild who
+may chance to read it at some remote future day. The physician of whom I
+now write was one who already dreaded bleeding, thought less of
+medicines than his fellows, and was, in fact, exceptionally acute. He
+did some droll things for the sick prelate, and had reasons yet more
+droll for what he did, but his practice was, as may happen on the whole,
+wiser than his reasons for its use. His patient was a man once bulky,
+but now thin, overworked, worried, subject to asthma, troubled with a
+bad stomach, prone to eat largely of coarse food, but indisposed to
+physical exercise. Cardan advised that the full, heated head, of which
+his patient much complained, should be washed night and morning with hot
+water in a warm room, and then subjected to a cold shower-bath. Next was
+to come a thorough dry rubbing, and rest for two hours. As to his
+asthma, he forbade him to subject himself to night air or rainy weather.
+He must sleep on silk, not feathers, and use a dry pillow of chopped
+straw or sea-weed, but by no means of feathers. He forbade suppers if
+too late, and asked the reverend lord to sleep ten hours, and even to
+take time from study or business and give it to bed. He was to avoid
+purgatives, to breakfast lightly, and to drink slowly at intervals four
+pints a day of new asses' milk. As to other matters, he was to walk some
+time in the shade at an early hour, and, discussing the time for the
+fullest meal, Cardan remarks that established habits as to this point
+are not to be lightly considered. His directions as to diet are many,
+reasonable, and careful. His patient, once stout, had become perilously
+thin. Turtle-soup and snail-broth would help him. Cardan insisted also
+on the sternest rules as to hours of work, need for complete rest, daily
+exercise, and was lucky enough to restore his patient to health and
+vigor. The great churchman was grateful, and seems to have well
+understood the unusual mental qualities of his physician. Nothing on the
+whole could be better than the advice Cardan gave, and the story is well
+worth reading as an illustration of the way in which a man of genius
+rises above the level of the routine of his day.
+
+I might go farther back in time, and show by examples that the great
+fathers of medicine have usually possessed a like capacity, and learned
+much from experience of that which, emphasized by larger use and
+explained by scientific knowledge, has found its way into the text-books
+of our own day and become common property.
+
+It appears to me from a large mental survey of the gains of my
+profession, that the English have above all other races contributed the
+most towards enforcing the fact that on the whole dietetics, what a man
+shall eat and drink, and also how he shall live as to rest, exercise,
+and work, are more valuable than drugs, and do not exclude their use.[1]
+
+[Footnote 1: By this I mean that the physician, if forced to choose
+between absolute control of the air, diet, exercise, work, and general
+habits of a patient, and use of drugs without these, would choose the
+former, and yet there are cases where this decision would be a
+death-warrant to the patient.]
+
+The active physician has usually little time nowadays to give to the
+older books, but it is still a valuable lesson in common sense to read,
+not so much the generalizations as the cases of Whytt, Willis, Sydenham,
+and others. Nearer our own day, Sir John Forbes, Bigelow, and Flint
+taught us the great lesson that many diseases are self-limited, and need
+only the great physician, Time, and reasonable dietetic care to get well
+without other aid.
+
+There is a popular belief that we have learned this from homoeopathy,
+for the homoeopath, without knowing it, made for us on this matter ample
+experiments, and was as confident he was giving powerful medicines as we
+are that he was giving practically none. "He builded better than he
+knew," and certainly his results aided our ablest thinkers to reach the
+truth.
+
+I have named one of the most illustrious of physicians, Sydenham, as
+among the great Englishmen who brought to their work the clearest
+perception of how nature was to be best aided. He will answer admirably
+to exemplify my meaning.
+
+Sydenham was born in 1624, and lived in and through the wild periods of
+Charles I. and Cromwell, and was himself a stanch republican. He more
+than any other in his century decisively taught caution as to mere
+medication, and sedulously brought the clear light of common sense to
+bear upon the practice of his time. It is interesting to note, as his
+biographer remarks, that his theories were often as worthless as his
+practice was good. Experience taught him to do that for which he felt
+forced to find a reason, and the reason was often enough absurd. "The
+contrast gives a fine light and shadow effect in his biography."[2]
+
+[Footnote 2: R.G. Latham, p. xxxvi.]
+
+His systematic beliefs were ofttimes worthless, but great acuteness in
+observation was apt to lead him to do wisely in individual cases what
+was at variance with his creed. Speaking of Hippocrates, he says, "His
+system led him to assist nature, to support her when enfeebled and to
+the coercion of her when she was outrageous."
+
+As to mere drugs, Sydenham used them in what was for his day an
+extremely moderate fashion, and sagaciously limited in the old and young
+his practice as to bleeding, which was then immensely in vogue. The
+courage required to treat smallpox, measles, and even other fevered
+states by cooling methods, must have been of the highest, as it was
+boldly in opposition to the public and private sentiment of his day. He
+had, too, the intelligence to learn and teach that the Jesuit bark,
+cinchona, was a tonic as well as the master of the agues, so common in
+the England of his time.
+
+He is at his best, however, in his statement of how he treated
+individual cases, for then his written theories are given to the winds,
+or the practice is far beyond the creed in its clear common-sense value.
+
+Thus, horseback exercise he constantly speaks of. He tells you of a
+friend who had been much dosed by many for dyspepsia, and how he bade
+him ride, and abandon drugs, and how, after a thousand miles of such
+riding, he regained health and vigor. See how this wise man touches the
+matter of gout: "For years a man has feasted; has omitted his usual
+exercises; has grown slow and sluggish; has been overstudious or
+overanxious, etc." Then he reasons about "smothering the animal spirits,
+which are the primary instruments of concoction," and so on, but at last
+he says, "We must look beyond medicines. Wise men do this in gout and in
+all other chronic diseases." And what does he advise? Here is the
+substance of what he says. A gouty man must be moderate, not too
+abstinent, so as to get weak. One meat is best; mixtures are bad. A milk
+diet "has prevailed," only bread being added, but it must be rigid and
+has its risks. He seems to have kept a nobleman on milk a year. Also
+there must be total abstinence from wine and all fermented liquors.
+Early bed hours and early rising are for the gouty. Then there come wise
+words as to worry and overwork. But, above all, the gouty must ride on
+horseback and exercise afoot. As to the wilder passions of men, he makes
+this strangely interesting remark, "All such the old man should avoid,
+for," he says, "by their indulgence he thus denies himself the privilege
+of enjoying that jubilee which by the special and kind gift of nature is
+conceded to old men: of whom it is the natural and happy lot to be
+emancipated from the control of those lusts which during youth attacked
+them."
+
+This is a fair specimen of a master at his best. I would rather have
+trusted Sydenham, with all his queer theories, than many a man with the
+ampler resources of to-day; for his century may aid but does not make
+the true physician, who is not the slave, but the master, of opinions.
+
+To enforce again the fact that the greater men of my art, even in days
+of the most extreme theories, were more sensible in their daily practice
+than in their dogmatic statements, I would like to quote a letter of
+Rush, which for several reasons is interesting and valuable. No man was
+more positive in his beliefs and in the assertion of them than he. His
+name is still associated with bleeding and purging, and if we considered
+only some of his written assertions, made with the violence which
+opposition always aroused in his positive nature, we should pause in
+wonder at his great reputation. But what a man says or writes, and what
+he does, are often far apart. We are apt to take his most decisive
+statements as representative, and thus may seriously err. I have known a
+number of men who were really trustworthy physicians, and who yet were
+credited by us with a fondness for absurd ideas, which, in fact,
+influenced their writings far more than their practice. Rush was to some
+extent one of this class. His book on insanity is far in advance of his
+time, and his descriptions of disease one of our best tests, most
+admirable. Let us see how this physician who bled and dosed heavily
+could think and act when face to face with a hopeless case. The letter
+to which I have referred was given to the College of Physicians of
+Philadelphia at my request by one of its associate fellows, Dr. Hunter
+Maguire, of Richmond, Virginia. It is written to Rush's cousin, Dr.
+Thornton, in 1789, and has an added interest from the fact that it is a
+letter of advice in the case of the aged mother of Washington, who had a
+cancer of the breast.
+
+
+                                            "PHILADELPHIA, July 6, 1789.
+
+MY DEAR KINSMAN:
+
+The respectable age and character of your venerable patient leads me to
+regret that it is not in my power to suggest a remedy for the cure of
+the disorder you have described in her breast. I know nothing of the
+root that you mention as found in Carolina and Georgia, but, from a
+variety of inquiries and experiments, I am disposed to believe that
+there does not exist in the vegetable kingdom an antidote to cancers.
+All the vegetable remedies I have heard of are composed of some mineral
+caustics. The arsenic is the most powerful of any of them. It is the
+basis of Dr. Martin's powder. I have used it in many cases with some
+success, but have failed in some. From your account of Mrs. Washington's
+breast, I am afraid no great good can be expected from the use of it.
+Perhaps it may cleanse it, and thereby retard its spreading. You may try
+it diluted in water. Continue the application of opium and camphor, and
+wash it frequently with a decoction of red clover. Give anodynes when
+necessary, and support the system with bark and wine. Under this
+treatment she may live comfortably many years, and finally die of old
+age."
+
+He had here to deal with cancer, a disease which he knew to be
+incurable. His experience taught him, however, that in the very old this
+malady is slow and measured in its march, and that he could only aid and
+not cure. What he says might with slight change have been penned to-day.
+We have gone no further in helpfulness as regards this sad disease.
+
+If what I write now is to have for the laity any value, it will be in
+correcting certain of their judgments as to physicians, and in
+suggesting to them some of the tests which will enable them to exercise
+a reasonable judgment as to those in whose hands they place so often
+without a thought the issues of life and death and the earthly fates of
+their dearest.
+
+I began, somewhat discursively, by showing how much care the masters of
+my art gave even in past days to matters of diet and modes of life. This
+is still to-day a test of larger applicability. There are those of my
+profession who have a credulity about the action of drugs, a belief in
+their supreme control and exactness of effect which amounts to
+superstition, and fills many of us with amazement. This form of idolatry
+is at times the dull-witted child of laziness, or it is a queer form of
+self-esteem, which sets the idol of self-made opinion on too firm a base
+to be easily shaken by the rudeness of facts. But, if you watched these
+men, you would find them changing their idols. Such too profound belief
+in mere drugs is apt, especially in the lazy thinker, to give rise to
+neglect of more natural aids, and these tendencies are strengthened and
+helped by the dislike of most patients to follow a schedule of life, and
+by the comfort they seem to find in substituting three pills a day for a
+troublesome obedience to strict rules of diet, of exercise, and of work.
+
+The doctor who gives much medicine and many medicines, who is
+continually changing them, and who does not insist with care on knowing
+all about your habits as to diet, mealtimes, sleep, modes of work, and
+hours of recreation, is, on the whole, one to avoid. The family doctor
+is most of all apt to fail as to these details, especially if he be an
+overworked victim of routine, and have not that habitual vigilance of
+duty which should be an essential part of his value. He is supposed to
+have some mysterious knowledge of your constitution, and yet may not
+have asked you a medical question in months or years. Too much is taken
+for granted, and inefficient opinions are the outcome of carelessness.
+Every new case in a household should be dealt with as if it were a
+stranger's, and outside familiarity should not be allowed to breed
+contempt of caution in study or lead to half measures. Every consultant
+will agree with me that this kind of social nearness of the doctor to
+his patient is a common cause of inert advice, and nowhere more
+distinctly so than when unwise physicians attempt to practise in their
+own households on those they love.
+
+There are very few instances of chronic ailments, however slight, which
+should not be met by advice as to modes of living, in the full breadth
+of this term; and only by a competent union of such, with reasonable use
+of drugs, can all be done most speedily that should be done. I have said
+"with use of drugs," for I am far from wishing to make any one believe
+that medicines are valueless. Nor do I think that the most extreme
+dosing employed nowadays by any one is as really hurtful as the neglect
+to urge efficiently the value of definite hygienic means. There are,
+indeed, diseases which can only be helped by heroic measures; but, in
+this case, were I the patient, I should like to be pretty certain as to
+the qualifications of my hero.
+
+The popular view of the great hurtfulness of drugs is curiously
+fallacious. I have spoken above more of their relative usefulness, as
+compared to other means of relief, than with any desire to convince my
+readers that they are such terrible things as some kinds of
+practitioners would have us to believe. The dread of their employment is
+a relic of the time of reaction against the senseless and excessive
+dosing with calomel and strong purges, and nowadays, even as regards
+bleeding, once wholly abandoned, it is clear that it still has at times
+its uses, and valuable ones, too. As medicines are now employed, even by
+the thoughtless, it must be rarely that they give rise to permanent
+injury. Let any physician who reads these lines pause and reflect how
+many times in his life he has seen lasting or serious evil results from
+drugs.
+
+Accidents happen, but they are the offspring of carelessness. Sometimes,
+also, unexpected and temporary extreme results surprise us, as when an
+opiate purges, or five grains of an iodide prove to be gravely
+poisonous. These occurrences are due to individual peculiarities, which
+we can as yet neither explain nor anticipate. One man can take opium
+with almost the impunity which belongs naturally to birds. Another is
+put to sleep by the dose you give a baby. All this teaches caution, but
+it is not a matter for blame when it gives rise to alarming
+consequences, and happily these cases of what we call idiosyncrasies are
+exceptionally uncommon.
+
+Physicians are often enough tempted to give a simple placebo to patients
+who are impatient, and ask instant treatment when we know that time is
+what we want, either for study of present symptoms or to enable the
+growing disorder to spell itself out for us, as it were, letter by
+letter, until its nature becomes clear. The practice is harmless, but
+there is, of course, a better way, if we possess the entire confidence
+of the patient or his friends. But sometimes it is undesirable to give
+explanations until they can be securely correct, or haply the sick man
+is too ill to receive them. Then we are apt, and wisely, to treat some
+dominant symptom, and to wait until the disease assumes definite shape.
+So it is that much of what we thus give is mild enough. The restless
+mother is the cause with some doctors of much of this use of mere
+harmless medicines. I once expressed surprise in a consultation that an
+aged physician, who had called me in, should be so desirous of doing
+something, when I as earnestly wished to wait. At last he said, "Doctor,
+it is not the child I want to dose; it is the mother's mind." Perhaps
+the anecdote may not be lost on some too solicitous woman, who naturally
+desires that the doctor should be doing something just when he is most
+anxious to be doing nothing.
+
+Men yet live who can remember when all of our knowledge of disease was
+acquired by the unaided use of the eye, the ear, and the touch. The
+physician felt the pulse, and judged of fever by the sense of warmth. He
+looked at the skin and tongue and the secretions, and formed
+conclusions, more or less just in proportion to the educated acuteness
+of his senses and the use he made of these accumulations of experience.
+The shrewdness of the judgments thus formed shows us, to our wonder, how
+sharply he must have trained his senses, and has led some to suspect
+that our easier and more exact methods and means may have led us to
+bestow less care in observation than did these less aided and less
+fortunate students. The conclusion is, I am sure, erroneous, and I am
+confident that the more refined the means the more do they train us to
+exactness in all directions, so that even what we now do with the eye,
+ear, or hand alone is better and more carefully done than when the
+senses had none of the training due to the use of instruments of
+precision. I may add that the results of their employment have also made
+it easy in many cases to dispense with them, and to interpret readily
+what has been won by the unassisted sense.
+
+The history of precision in medicine is worth the telling, if only to
+teach the lay reader something of that vast struggle to know the truths
+of disease, which is little understood beyond the ranks of the most
+scholarly of my profession. The first step was due to Galileo. In 1585
+he used his pendulum to record the pulse, in a fashion at which we smile
+to-day, and yet what he tried to do was the birth of precision in
+medicine. Keeping a finger on the pulse, he set a pendulum in motion. If
+it went faster than the pulse, he put the weight a little lower, or as I
+may state it to make it clearer, he lengthened the pendulum. At last
+when it moved so as to beat equal time with the pulse, he measured the
+length of the swinging bar, and set down the pulse as, say ten inches;
+next day it might be set at six, and so a record was made. He was soon
+lost to medicine, but in 1625, Santorini, known to science as
+Sanctorius, published a curious book, called "Commentaries on Avicenna,"
+in which he figured a variety of similar instruments, called
+"pulsilograms." We owe to him some of the first accurate studies of
+diet, and also the discovery of the insensible perspiration, but his
+pulsilogram was soon forgotten.
+
+I think that Harvey but once or twice mentions the number of the pulse
+even in his physiological books. In the case descriptions of his time
+and of Sydenham's it is rare to find it noted, and this is true as a
+rule all through the next century. The exceptions are interesting. In
+Whytte's works, _circa_ 1745, he not rarely mentions the pulse number in
+connection with his primary delineation of a case, but after that does
+not often speak of its subsequent changes in number. The force and other
+characters of the pulse receive, however, immense attention, and are on
+the whole more valuable aids than mere numeration; but that cannot
+nowadays be left out of our calculations, yet as early as the reign of
+Anne, about 1710, an English physician, Sir John Floyer, wrote an able
+and now half-forgotten book, quaintly called the "Pulse Watch." I am
+pretty sure that he was the first to put a minute-hand on a watch to
+enable him to time the pulse-beat, but nowhere in any English collection
+have I been able to find one of his watches. Thus aided, he was the
+first to count the minute's pulse, which is now a sort of recognized and
+accepted matter as standard of comparison, so that we say merely, the
+pulse was 60 or 90, as may chance, and do not even speak of the minute.
+It is as true as strange that this convenient method was practically
+lost to habitual use in medicine for quite a hundred years. It
+reappeared in the writings of the time of the great teachers who arose
+in France and Germany about 1825. To-day, in case of need, we have
+instruments which write in instructive curves the form of the
+pulse-wave, and enable us to settle questions which sometimes could not
+be settled without this delicate means.
+
+The study of the temperature of the body was, as I have said, a mere
+matter of the touch until our same Galileo applied a thermometer to
+learn more accurately its changes. Sanctorius again followed in his
+steps, and has left us in his works curious drawings of forms of
+thermometer applicable to medical uses. Our profession is, however,
+inapt to hold on to useless things, and our knowledge of fever, its
+risks and its remedies, was for many a day far behind any need for the
+delicate appreciations of the thermometer.
+
+Hence it is that very few physicians did more in the last three
+centuries as regards the temperature of the body than speak of it as
+high or low. Sanctorius was too far ahead of his time to teach us the
+true value of medical thermometry. It was forgotten for many a day. In
+the last century, in Dehaen and Hunter, it again receives some notice,
+and again drops out of use. At last we are ripe for it, and Wunderlich,
+in a classical book, about twenty-five years ago, puts it in a position
+of permanent utility. The physician of to-day knows more both of fever
+and of its consequences, and finds in his thermometer an indispensable
+ally.
+
+Within but a few years the instruments of precision have so multiplied
+that a well-trained consultant may be called on to know and handle as
+many tools as a mechanic. Their use, the exactness they teach and
+demand, the increasing refinement in drugs, and our ability to give them
+in condensed forms, all tend towards making the physician more accurate,
+and by overtaxing him, owing to the time all such methodical studies
+require, have made his work such that only the patient and the dutiful
+can do it justice.
+
+Primary examinations of chest, heart, and other viscera are long and
+troublesome, and the first study of a case which is at all difficult,
+demands such time as it is increasingly hard for the busy to find. A
+good test for laymen in acute cases is the methodical manner in which a
+physician of modern training goes over the case, nor is his preciseness
+as to doses and medicines less worthy of note. I used to watch with
+interest the late Professor P. at a sick-bed. The grave and tranquil
+interest, the pauses for thought, the swift thoroughness of examination,
+and then the delay, with, "Please, nurse, let me taste that last
+medicine," were full of good lessons. Any consultant could tell you what
+a rare quality is this union of precision and thoroughness.
+
+Our profession has in its work enough of true difficulties, but we still
+owe many of our worst errors to want of absolutely complete study of our
+cases, and with the careless these slips are obvious enough to enable
+any one who is watchful to sit in judgment on the failures. The more
+delicate illustrations of the fine union of qualities which attain the
+highest triumphs are, of course, only seen and comprehended by
+physicians, whose general opinion on their fellows is in the end almost
+always a just one. There is a potent combination of alertness in
+observation, with a never-satisfied desire to know even the trifles of a
+case, which, with sagacity, gives a medical mental character as rare as
+it is valuable.
+
+For such men there are no trifles, and, on entering a sick-room, they
+seem to absorb at a glance matters which escape others, and yet to the
+end are still so quietly observant and searching that they seem never to
+be quite content with what they have learned. Not to know surely is to
+them a form of unhappiness.
+
+I remember well a consultation in a case of great obscurity, into which,
+many years ago, the late Dr. G. was called, after three of his
+colleagues had failed to reach a conclusion. It was suspected that
+poisoning by lead was the cause of a singular and unusual train of
+symptoms. Now, in such cases, a blue line around the junction of the
+teeth and gums is a certain sign of the presence of that poisonous
+metal. The patient, a man of seventy-five years, was known by his own
+physician to wear full sets of artificial teeth, and he so said. This
+having been stated no one looked at the gums. At the close of the second
+meeting Dr. G. turned back unsatisfied. "Let me see your gums. Ah!" he
+said. There was the stump of one incisor left, and around it the blue
+line told a tale which ended all doubt.
+
+On another occasion, a young physician well known to me, fell by a
+chance into a consultation with Dr. P., the physician I have mentioned,
+and the late Professor P. The case was one of a young man who several
+times had been found at morning in a stupor. The attacks were rare, and
+what caused them was unknown. The young physician, much embarrassed, was
+civilly asked to examine the case, and did so with a thoroughness which
+rather wearied the two older men. When they retired to an adjoining
+room, he was asked, as our custom is, to give, as the youngest, the
+first opinion. He said, "It is a case of epilepsy. He has bitten his
+cheek in the fit." Dr. P. rose without a word and went out. Returning in
+a few moments, he said, "You are right. I did not look far enough back.
+You will reach, sir, a high rank in our profession." The case was
+thenceforward plain enough. These are rare illustrations of my meaning,
+and may suffice, with one which has a more humorous aspect. Meeting the
+late Professor C. D. M. on the steps of a house where, the day before,
+we had seen together a woman critically ill, he said to me, "Mrs. B. is
+better, doctor, much better." "And how do you know that?" I returned.
+"Her windows are open, my dear doctor. She wants more light. She must be
+better, much better." And so she was, as it proved.
+
+A final result of the multiplication of the means of research, and the
+increasing difficulty in becoming expert in the use of the many and
+delicate instruments they require, is the growth of what we call
+specialties in medicine. The best of us learn to use the ophthalmoscope
+to look into the eye, to use the laryngoscope for the larynx, and can at
+need examine the urine and the blood, but the men must be rare who are
+as competent to use each and all of these means as persons who devote
+themselves to single branches of our work. Moreover, the element of time
+comes in, as well as the element of such constant familiar practice as
+makes for one man commonplace and easy what for another, who is more
+generally occupied, is uncommon and unfamiliar. The specialist profits
+by the fact that his experience becomes enormous and his work advantaged
+by its definite limitations. On the other hand, and nowadays especially,
+he is too apt to be one who, after brief hospital work of general
+character, or without this, takes up, as we say, the eye, ear, throat,
+or uterine organs. Unless he has had at some time a larger and more
+varied experience, or unless he is a most unusual man, he is prone at
+last to lose sight in his practice of the fact that eye, ear, and womb
+are parts of a complicated mechanism, and suffer through its general or
+local disorders. Hence the too common neglect of constitutional
+conditions, to which are often due the apparent maladies of the organs
+to which he devotes himself. Moreover, in certain of the organs of
+sense, as the eye, are frequently seen the very first signals of spinal
+or other maladies, and if, as too often happens, he sees in some such
+sign or symptom only the evidence of a local trouble, and neglects to
+look or reason beyond it, he may inflict on his patient the gravest
+penalties, by depriving him of the chance of early treatment of some
+serious disease, involving lifelong, or even fatal, consequences. This
+is a criticism on the man and his training, not on the system of
+specialties which has become invaluable.
+
+A reasonable desire to seek aid from physicians of usefully limited
+values is another test of the good family physician. I know of men who
+are in the habit of saying that they dislike consultations and get
+little good from them. As compared to those who too commonly subject
+people to the expense of fresh advisers, they are the more dangerous
+class. Apt enough in cases of acute disease to bring into the case some
+one to share responsibilities which seem grave because near at hand,
+they continue to treat chronic cases they do not understand, because
+there is no crisis of pain, disability, or danger to bring them to
+reason.
+
+Hitherto I have dealt most with the intellectual outfit needed for the
+best practice of medicine, but the criticism I have just made brings me
+on more delicate ground. The man who feels himself so competent that his
+self-esteem forbids him to seek advice when he knows and must know he
+has come to the end of his reasonable resources, lacks the humility
+which belongs to larger natures, and he, too, is a man to avoid.
+
+Be sure that the physician cannot he a mere intellectual machine. None
+know that better than we. Through all ages we have insisted that he
+shall feel himself bound by a code of moral law, to which, on the whole,
+he has held without question, while creeds of more serious nature were
+shifting and changing. What the Greek fathers of medicine asked of him
+we still ask of him to-day. He must guard the secrets wrung from you on
+the rack of disease. He is more often than he likes a confessor, and
+while the priest hears, as I have once said, the sins and foibles of
+to-day, he is as like as not to have to hear the story of a life. He
+must be what About calls him, "Le tombeau des secrets,"--the grave of
+secrets. How can he be too prudent or too close-mouthed? Honor you must
+ask of him, for you must feel free to speak. Charity you should expect
+from him, for the heart is open to him as it is to no other, and
+knowledge, large knowledge, is the food which nourishes charity in the
+tender-hearted. In the tender-hearted? How can he be that? All his days
+he has walked amidst misery, anguish, bodily and mental suffering. Be
+careful when you come to test him by his ability to feel what you call
+sympathy. In its loftiest meaning this is the capacity to enter into, to
+realize, and hence to feel with and for you. There is a mystery about
+this matter. I know men who have never suffered gravely in mind or body,
+who yet have some dramatic power to enter into the griefs of others, and
+to comprehend, as if by intuition, just what others feel, and hence how
+best to say and do the things which heal or help. I know others,
+seemingly as tender, who, with sad experience to aid them, appear to
+lack the imaginative insight needed to make their education in sorrow of
+use to their fellows. There are times when all that men can give of
+sympathetic tenderness is of use. There are others when what you crave
+is but the outcome of morbid desires for some form of interested
+attention. You may ask too much, and every doctor knows how curiously
+this persistent claim for what you call sympathy does, as the nurses
+say, "take it out of a doctor." The selfishness of nervous women
+sometimes exceeds belief in its capacity to claim pity and constancy of
+expressed sympathy.
+
+In times of more serious peril and suffering, be assured that the best
+sympathy is that which calmly translates itself into the desire to be of
+practical use, and that the extreme of capacity to feel your woes would
+be in a measure enfeebling to energetic utility. This it is which makes
+a man unfit to attend those who are dear to him, or, to emphasize the
+illustration, to medically treat himself. He goes to extremes, loses
+judgment, and does too much; fears to hurt, and does too little. I once
+saw a very young physician burst into tears at sight of a burnt child, a
+charming little girl. He was practically useless for the time. And I
+have known men who had to abandon their profession on account of too
+great sensibility to suffering.
+
+There is a measure of true sympathy which comes of kindness and insight,
+which has its value, and but one. Does it help you over the hard places?
+Does it aid you to see clearly and to bear patiently? Does it truly
+nourish character, and tenderly but, firmly set you where you can gain a
+larger view of the uses of pain and distress? That is the truest
+sympathy. Does it leave you feebler with mere pity? Does it accentuate
+pain and grief by simply dwelling on it with barren words? I leave you
+to say what that is. We have a certain gentle disrespect among us for
+the doctor who is described as, oh! so sympathetic,--the man who goes
+about his work with a pocket-full of banal phrases calculated to soothe
+and comfort the cravings of the wretched. The sick and feeble take
+gladly these imitation crumbs cast from the full table of the strong.
+But sometimes people of firm character revolt at such petty and
+economical charity. I heard a vigorous old Quaker lady say once, after a
+consultation, "Thee will do me a kindness not to ask me to see that man
+again. Thee knows that I don't like my feelings poulticed."
+
+The question of the truthfulness of physicians is one often raised. It
+troubles the consultant far more than it does the family doctor, and
+perhaps few who are not of us understand our difficulties in this
+direction. Every patient has his or her standard of truth, and by it is
+apt to try the perplexed physician. Some of the cases which arise are
+curiously interesting, and perhaps nowhere better than in the
+physician's office or at the bedside do we see sharply developed the
+peculiarities of character as to this matter of truth in many of its
+aspects. There is the patient who asks you to tell him the whole truth
+as to his case. Does he really want to know? Very often he does not. If
+you tell him, you sentence him. You do not shorten his life, you only
+add to its misery. Or perhaps his wife has written to you, "On no
+account tell my husband that he cannot get well. He dwells now on every
+sign of failing health, and you will make him wretched." You parry his
+question and try to help him. If he is resolute, he returns on you with
+a query so positive that you must answer frankly. His wife was right.
+You have done him an injury. There is the other man who insists at the
+start that you must on no account tell him if he cannot get well. You
+inform some relative of his condition. But perhaps he ought to know. He
+contemplates some work or travel which he should not undertake. You say
+so, and he replies, "But you have not told me that I am seriously ill."
+Such is sick human nature.
+
+The people who really want to know if they will die of some given
+disease are few in number. Those who pretend they want to know are more
+common. Those who should not know are frequent enough, and among them
+one is troubled to do what seems right and to say in answer to their
+questions what is true.
+
+Wise women choose their doctors and trust them. The wisest ask the
+fewest questions. The terrible patients are nervous women with long
+memories, who question much where answers are difficult, and who put
+together one's answers from time to time and torment themselves and the
+physician with the apparent inconsistencies they detect. Another form of
+trouble arises with the woman whose standards are of unearthly altitude.
+This is the woman who thinks herself deceived if she does not know what
+you are giving her, or who, if without telling her you substitute an
+innocent drug for a hurtful one which she may have learned to take too
+largely, thinks that you are untruthful in the use of such a method. And
+you would indeed be wrong if you were of opinion that to tell her the
+whole truth, and invite her to break the habit by her own act, were
+available means. I certainly do not think that you have any right
+(indeed, I would not even discuss this) to take active means to make her
+think she is taking, say opium, when you are only giving her something
+which tastes like it. If she asks, you must answer. But she may not, or
+does not, and yet when she is well again and learns that the physician
+preferred to act without her knowledge because he distrusted her power
+to help, she is very likely, if she chance to be a certain kind of
+woman, to say that he has been untruthful. Happily, such cases must be
+rare, and yet I know of some which have been the source of much
+annoyance to sensitive men. Thorough trust and full understanding is the
+way to avoid such difficulties. A nervous woman should be made to
+comprehend at the outset that the physician means to have his way
+unhampered by the subtle distinctions with which bedridden women are apt
+to trouble those who most desire to help them.
+
+I omitted above an allusion to the most unpleasant inquirers, those who
+are either on the verge of insanity or are victims of that singular
+malady, hypochrondriasis. A patient clearly staggering to and fro on the
+border line of sanity consults you. Here is a wilful, terrified being,
+eager to know the truth. "Am I becoming insane? Will I end in an
+asylum?" How can you answer? You see clearly, are sure the worst is
+coming. What shall you do with this morbid, scared, obstinate child-man?
+You put aside his questions, but you have here a person quite or nearly
+sane to-day, resolute to hear, afraid to learn the truth he dreads. I
+leave my reader with this patient, and my stated knowledge and my
+shifted responsibility. "Doctor, if I am going to be insane, I will kill
+myself." Good reader, pray dispose of this case. Or take the ease of a
+confirmed hypochondriac. He is miserable, has a hundred ailments,
+watches the weather, studies the barometer, has queer delusions as to
+diets, clothes, and his own inability to walk. The least hint of a
+belief that he is not as well as he was a week ago, or even a too close
+examination, leaves him with a new malady, and he, too, is a sharp
+questioner. As a rule, he has no perceptible changes in his tissues. But
+if he has some real malady,--it may be a grave one on which he has built
+a larger sense of misery than there was need for, and the case is common
+enough,--how shall you answer him? It is a less difficult case than the
+other, and I gladly leave him also to my consultant reader's acquired
+knowledge and to his personal sense of the value of truth.
+
+Physicians are often blamed for not sooner warning a family of the fact
+that, in some case he and it are anxiously watching, death is
+inevitable. As to this the doctor has very mingled feelings. Sometimes
+he lacks courage, sometimes he is not sure enough to speak. A weak man
+fears that he will lose his patient and some quack be called in, and
+thus lessen the little chance yet left. Most of us can recall painful
+interviews in which a relative insisted on a definite opinion, which we
+were unable to give. As to cases where there is little or no doubt left,
+perfect frankness should be, and is, I think, our rule, but no one knows
+better, or as well as we, how numberless are the chances of escape for
+cases which seem to be at their worst. Hence a part of the reluctance
+the physician has to pronounce a verdict of fatal character.
+
+There is another matter of moment as to cases known to be hastening to a
+fatal conclusion. The responsibility of withholding this knowledge from
+the patient is usually shifted on to the shoulders of relatives or
+friends. The medical adviser reports to them his opinion and leaves with
+them the power to act.
+
+He is often asked if to know that death seems certain makes less the
+chance of recovery or shortens the lessening number of the days of life
+yet left. It has often fallen to my sad lot, as to that of many of my
+medical brothers, to have to tell a patient that he is to die. Some
+isolated man asks it. Some lonely hospital patient has just reasons for
+knowing early or late in his disease the truth as the doctor sees it. I
+have never been able to feel certain that in any case of acute or
+hopeless illness to know surely what lay before a sick man did
+distinctly shorten his life. I have seen many people in apparent health
+made ill by the shock of emotion,--by fear, grief, anger, jealousy.
+Diseased persons feel less, or show less in a physical way, the results
+we might expect to see from even the most rudely conveyed intelligence
+as to their probable future.
+
+It was not my wish to enter into a long discussion of all the qualities
+which go to make up the ideal physician. I desired chiefly to consider
+his principal needs, to point out in big defence certain of his
+embarrassments, and to leave the reader with some sense of help towards
+knowing whether his adviser was such as he should be in the more
+important qualities which go to make the true physician. There are other
+and minor matters which are not without their relative gravity in his
+life. Some are desirable but not truly essential, and yet help or hurt
+him much. Whether he is gentle and well-mannered, is socially agreeable,
+or as to this negative, influences much the choice of the woman on whom,
+as a rule, comes finally the decision of who her family physician shall
+be. Too often she is caught by the outside show of manners, and sets
+aside an abler and plainer man, who has more really the true manners of
+the heart, yet lacks the power to make himself pleasant. Desirable it
+is, of course, to be what so many of the best physicians have been,
+refined and tactful gentlemen, and also charming companions. But a man
+may be a most competent, clear-headed, honest, scrupulously careful
+doctor, and yet be plain, ill-dressed, and uninteresting, and all this
+it is as well to understand. The mass of professional opinion is not so
+easily pleased as are individual patients. It decides pretty early in
+any large community, and classifies its members accurately, reversing
+very often the verdict of the juries of matrons, who do so much to make
+or mar our early fates. Soon or late it sifts the mass, knows who are
+the thorough, trustworthy, competent, hard-headed practitioners, who are
+the timid, who the too daring, who ride hobbies, and who trust too much
+to drugs. Soon, too, it distinguishes those on whom it can call in
+emergencies, and the highest class of men who have the great gift of
+discovery and the genius of observation.
+
+From the public we can look for no such justice, and our professional
+manners forbid us to speak of our brethren, save among ourselves, with
+perfect freedom. As a profession, it is my sincere conviction that in
+our adherence to a high code of moral law, and in the general honesty
+with which we do our work, no other profession can be compared with
+ours. Our temptations, small and large, negative and positive, are many
+and constant, and yet I am quite sure that no like group of men affords
+as few illustrations of grave moral weaknesses. It is commonplace to say
+that our lives are one long training in charity, self-abandonment, all
+forms of self-restraint. The doctor will smile at my thinking it needful
+to even state the fact. He begins among the poor; all his life, in or
+out of hospitals, he keeps touch of them always. He sells that which men
+can neither weigh nor measure, and this sets him over all professions,
+save one, and far above all forms of mere business. He is bound in honor
+to profit by no patent, to disclose all he has learned, and to give
+freely and without reward of his best care to all others of his
+profession who may be sick. What such a life makes of a man is largely a
+question of original character, but in no other form of occupation is
+there such constant food useful to develop all that is best and noblest.
+
+Popular opinion has been prone to decide that the physician who is
+anything else than this is a person not to be trusted. The old axiom is
+too often quoted as concerns us, "Jack of all trades, master of none."
+But there are enough men who have the power to be master of many trades
+and passed master of one. It is a question of applicative energy. Few
+men in early life can do much more than is needed to learn our art and
+its sister sciences; but, as time goes on, there are many who can add to
+it other pursuits which greatly benefit them in a wide sense, and
+enlarge and strengthen their mental powers, or pleasantly contribute to
+the joys of life, and so even to the growth of a man's moral nature. The
+wise physician, who is fond of etching or botany, the brush, or the
+chisel or the pen, or who is given to science, does well to keep these
+things a little in the background until he is securely seated in the
+saddle of professional success. Then usually he may feel free to
+reasonably follow out his tastes, and to write, or in any other way
+insist on freedom to use or make public his results. If only he has the
+competent fund of persistent industry to draw upon, he will be not the
+worse, but the better, physician for such enlargement of his pursuits as
+I refer to, for we may feel sure that in my profession there is room for
+the direct or indirect use of every possible accomplishment.
+
+
+
+CONVALESCENCE.
+
+
+To my mind, there is nothing more pleasant than the gradual return to
+health after some revolutionary disease which has removed a goodly
+portion of the material out of which is formed our bodily frame. Nature
+does this happy work deftly in most cases, where, at least, no grave
+organic mischief has been left by the malady; and in the process we get
+such pleasantness as comes always from the easy exercise of healthy
+function. The change from good to better day by day is in itself
+delightful, and if you have been so happy, when well, as to have loved
+and served many, now is the good time when bun and biscuit come back to
+you,--shapely loaves of tenderness and gracious service. Flowers and
+books, and folks good and cheery to talk to, arrive day after day, and
+have for you a new zest which they had not in fuller health. Old tastes
+return and mild delights become luxuries, as if the new tissues in nerve
+and brain were not sated, like those of the older body in which they are
+taking their places.
+
+When you are acutely ill, the doctor is business-like and gravely kind;
+you want him in a way, are even anxious to see him for the relief he may
+bring, or the reassurance. But when you begin to feel as if you were a
+creature reborn, when you are safe and keenly enjoying the return of
+health, then it is that the morning visit is so delightful. You look for
+his coming and count on the daily chat. Should he chance to be what many
+of my medical brothers are,--educated, accomplished, with wide artistic
+and mental sympathies,--he brings a strong, breezy freshness of the
+outer world with him into the monastic life of the sick-room. One does
+not escape from being a patient because of being also a physician, and
+for my part I am glad to confess my sense of enjoyment in such visits,
+and how I have longed to keep my doctor at my side and to decoy him into
+a protracted stay. The convalescence he observes is for him, too, a
+pleasant thing. He has and should have pride in some distinct rescue, or
+in the fact that he has been able to stand by, with little interference,
+and see the disease run its normal course. I once watched a famous
+surgeon just after he had done a life-saving operation by dim
+candle-light. He stood smiling as the child's breath came back, and kept
+nodding his head with pleasant sense of his own competence. He was most
+like a Newfoundland dog I once had the luck to see pull out a small
+child from the water and on to a raft. When we came up, the dog was
+wagging his tail and standing beside the child with sense of
+self-approval in every hair. The man wagged his head; the dog wagged his
+tail. Each liked well what he had done.
+
+Thus it is that these half-hours by the convalescent's couch are full of
+subtle flattery for the doctor, and are apt to evolve the social best of
+him, as he notes the daily gain in strength and color, and listens, a
+tranquil despot, to one's pleas for this freedom or that indulgence. He
+turns over your books, suggests others, and, trained by a thousand such
+interviews, is likely enough a man interesting on many sides.
+
+You selfishly enjoy his visit, not suspecting that you, too, are
+ignorantly helpful. He has been in sadder homes to-day, has been sorely
+tried, has had to tell grim truths, is tired, mind and body. The visit
+he makes you is for him a pleasant oasis: not all convalescents are
+agreeable. He goes away refreshed.
+
+Most doctors have their share, and more, of illness, and are not, as I
+have seen stated, exempt from falling a prey to contagious maladies.
+Indeed, our records sadly show that this is not the case. Perhaps there
+is value for them and their future patients in the fact that they have
+been in turn patient and doctor and have served in both camps. Like
+other sick folks, the physician, as I know, looks forward, when ill, to
+the "morning visits" quite as anxiously as do any of those who have at
+times awaited his own coming.
+
+That medical poet who has the joyous art of sending a ripple of mirth
+across the faces of the Anglo-Saxon world recognizes this fact in a
+cheerful poem, called "The Morning Visit," and to which I gladly refer
+any of my readers who would like to know from the lips of Oliver Wendell
+Holmes what manner of delightful patient he must have been. I can fancy
+that he lost for his doctor many a pleasant hour.
+
+It has seemed to me as if this wonderful remaking and regrowing of the
+tissues might be likened to a swift change from the weak childhood of
+disease to a sudden manhood of mind and body, in which is something of
+mysterious development elsewhere unmatched in life. Death has been
+minutely busy with your tissues, and millions of dead molecules are
+being restored in such better condition that not only are you become new
+in the best sense,--renewed, as we say,--but have gotten power to grow
+again, and, after your terrible typhoid or yellow fever, may win a
+half-inch or so in the next six months,--a doubtful advantage for some
+of us, but a curious and sure sign of great integral change.
+
+The Greeks had a notion that once in seven years we are totally changed,
+the man of seven years back having in this time undergone an entire
+reconstruction. We know now that life is a constant death and a
+renewing,--that our every-day nutrition involves millions of molecular
+deaths and as many millions of births,--although to liken that which is
+so exquisitely managed, so undisturbingly done, to the coarser phenomena
+of death and birth is in a measure misleading.
+
+Diseases such as typhoid fever, or a sharp local lung-trouble like
+pneumonia, really do make these minute changes approximate in abruptness
+to death. You weigh, let us say, one hundred and eighty pounds, and you
+drop in three weeks of a fever to one hundred and thirty pounds. The
+rest of you is dead. You have lost, as men say, fifty pounds, but your
+debt to disease, or to the blunders of civilization, for it is a case of
+creditor behind creditor, is paid. Your capital is much diminished, but
+you have come out of the trial with an amazing renovation of energy.
+This is the happy convalescence of the wholesome man. The other, the
+unlucky, fellow, does not get as safely through the cleansing bankruptcy
+of disease. The vicious, unlucky, or gouty grandfather appears on the
+books of that court in mysterious ways; his sins are pathologically
+visited on his child's child in this time of testing strain.
+
+In the happy rush towards useful health, of a convalescence undisturbed
+by drawbacks, it is pleasant to think, as one lies mending, of the good
+day to come when my friend, recovering from typhoid or smallpox, shall
+send for his legal adviser and desire him as usual to bring suit against
+the city for damages and loss of time.
+
+A little girl coughed in my face a hideous breath of membraneous decay.
+I felt at once a conviction of having been hit. Two days later I was
+down with her malady. She herself and two more of her family owed their
+disease to the overflow of a neighbor's cesspool, and to them--poor,
+careless folk--Death dealt out a yet sterner retribution. There was a
+semi-civilized community beyond both. Should one go to law about it and
+test the matter of ultimate responsibility?
+
+The amiability of convalescence is against it. One feels at peace with
+all the world, and so lies still, and reflects, "like souls that balance
+joy and pain," as to whether, on the whole, the matter has not had its
+valuable side. Certainly it has brought experiences not otherwise
+attainable.
+
+Of the deeper and more serious insights a man gathers in the close
+approach of death and the swift, delicious return to safety and
+enlarging powers I hardly care to speak. To a physician, it is simply
+invaluable to have known in his own person pain, and to have been at
+close quarters with his constant enemy, and come off only wounded from
+the contest. In the anxiety about you is read anew what you look upon in
+other households every day, and perhaps with a too accustomed eye. And
+as to pain, I am almost ready to say that the physician who has not felt
+it is imperfectly educated. It were easy to dwell on this aspect of
+convalescence, but the mental state of one on the way to health is not
+favorable to connected thought. It is more grateful to lie in the sun,
+at the window, and watch the snow-birds on the ice-clad maples across
+the way, and now and then, day after day, to jot down the thoughts that
+hop about one's brain like the friendly birds on the mail-clad twigs.
+
+I make no apology for the disconnectedness of my reflections, but turn
+gladly to my records of the joyous and less grave observations which the
+passing hours brought me. Much as I have seen of disease and recoveries
+in all manner of men and women, the chance to observe them in my own
+person presented me with many little novel facts of interest. I find in
+my brief notes of this well-remembered time many records of the
+extraordinary acuteness won for a while by the senses.
+
+Not dubious, but, alas! brief, is the gain which the sensorium acquires
+in this delightfully instructive passage out of death's shadow into
+certain sunshine. In my own case there was a rapid exfoliation, as we
+call it, of the skin, a loss and renewal of the outer layer of the
+cuticle. As a result of this, the sense of touch became for a while more
+acute, and was at times unpleasantly delicate. This seemed to me, as I
+first thought of its cause, a mere mechanical result, but I incline to
+suspect now that it was in a measure due to a true increase in capacity
+to feel, because I found also that the sister sense of pain was
+heightened. Slight things hurt me, and a rather gentle pinch gave undue
+discomfort. No doubt a part of this was owing to my having taken a good
+deal of opium, and then abruptly laid it aside. As I have elsewhere
+stated, this is apt to leave the nerves oversensitive for a season. The
+sense of hearing seemed to me to be less wide awake. I did not hear
+better, but high notes were for a while most unpleasant. The sense of
+taste grew singularly appreciative for a time, and made every meal a
+joyful occasion. The simplest food had distinct flavors. As for a glass
+of old Madeira,--a demijohned veteran of many ripening summers,--I
+recall to this day with astonishment the wonderful thing it was, and how
+it went over the tongue in a sort of procession of tastes, and what
+changeful bouquets it left in my mouth,--a strange variety of varying
+impressions, like the play of colors. In these days of more unspiritual
+health and coarser sense I am almost ashamed to say what pleasure I
+found in a dish of terrapin.
+
+The function of smell became for me a source both of annoyance and,
+later on, of pleasure. I smelt things no one else could, and more things
+than I now can. The spring came early, and once out of doors the
+swiftly-flitting hours of sensory acuteness brought to me on every
+breeze nameless odors which have no being to the common sense,--a sweet,
+faint confusion of scents, some slight, some too intense,--a gamut of
+odors. Usually I have an imperfect capacity to apprehend smells, unless
+they are very positive, and it was a curious lesson to learn how intense
+for the time a not perfect function may become. Recent researches have
+shown that a drug like mercaptan may be used to test the limit of
+olfactory appreciation. We have thus come to know that the capacity to
+perceive an odor is more delicate than our ability to recognize light.
+Probably it is an inconceivable delicacy of the sense of smell more than
+anything else which enables animals to find their way in the manner
+which seems to us so utterly mysterious. Yet, even in human beings, and
+not alone in a fortunate convalescence, do we see startling
+illustrations of the possibilities of this form of sensorial acuteness.
+I know of a woman who can by the smell at once tell the worn gloves of
+the several people with whom she is most familiar, and I also recall a
+clever choreic lad of fourteen who could distinguish when blindfold the
+handkerchiefs of his mother, his father, or himself, just after they
+have been washed and ironed. This test has been made over and over, to
+my satisfaction and surprise.
+
+If a man could possess in the highest degree and in combination all of
+the possible extremes of sensory appreciativeness seen in disease, in
+hysteria, and in the hypnotic state, we should have a being of
+extraordinary capacities for observation. Taylor, in his "Physical
+Theory of Another World," a singular and half-forgotten book, has set
+this forth as conceivable of the beings of a world to come, and dwelt
+upon it in an ingenious and interesting way. For a long time even the
+inhalation of tobacco-smoke from a friend's cigar disturbed my heart,
+but one day, and it was, I fear, long before my physician, and he was
+wise, thought it prudent, I suddenly fell a prey to our lady Nicotia. I
+had been reading listlessly a cruel essay in the _Atlantic_ on the
+wickedness of smoking, and was presently seized with a desire to look at
+King James's famous "counterblast" against the weed. One is like a
+spoiled child at these times, and I sent off at once for the royal
+fulmination, which I found dull enough. It led to results the monarch
+could not have dreamed of. I got a full-flavored cigar, and had a
+half-hour of worshipful incense-product at the shrine of the
+brown-cheeked lady,--a thing to remember,--and which I had leisure
+enough to repent of in the sleepless night it cost me.
+
+This new keenness of perception, of taste and touch, of smell and sound,
+belongs also, in the splendid rally which the body makes toward health,
+to the intellectual and imaginative sphere of activities. Something of
+the lost gifts of the fairy-land of childhood returns to us in fresh
+aptitude for strange, sweet castle-building, as we lie open-eyed, or in
+power to see, as the child sees, what we will when the eyes are
+closed,--
+
+  Pictures of love and hate,
+  Grim battles where no death is. Tournaments,
+  Tall castles fair and garden terraces,
+  Where the stiff peacock mocks the sunset light,
+  And man and maiden whisper tenderly
+  A shadowy love where no heart ever breaks,--
+  Love whose to-morrow shall be as to-day.
+
+With the increase of intellectual clearness, within a certain range,
+come, as with the brightened senses, certain drawbacks, arising out of
+the fastidiousness which belongs to the changing man just at this time.
+Let him, therefore, be careful what novels he chooses, for of all times
+this is the one for fiction, when we are away from the contradictions of
+the fierce outer world, and are in an atmosphere all sun and flowers,
+and pleasant with generous service and thankful joy. Be careful what
+Scheherezade you invite to your couch. By an awful rule of this world's
+life, in all its phases, the sharper the zest of enjoyment, the keener
+the possible disgusts may be. I recommend Dumas's books at this crisis,
+but they should be read with acceptance; as stories, their value lying
+largely in this, that no matter who is murdered or what horror occurs,
+you somehow feel no more particular call upon your compassion than is
+made when you read afresh the terrible catastrophes of Jack the
+Giant-Killer.
+
+A delightful master of style, Robert Louis Stevenson, in a recent
+enumeration of the books which have influenced him in life, mentions, as
+among the most charming of characterizations, the older Artagnan of the
+Vicomte de Bragelonne. I feel sure that on the sick-bed, of which he
+does not hesitate to speak, he must have learned, as I did, to
+appreciate this charming book. I made acquaintance then, also, with what
+seems to me, however, the most artistic of Dumas's works, and one so
+little known that to name it is a benefit, or may be, the Chevalier
+d'Harmenthal.
+
+In the long road towards working health, I must have found, as my
+note-books show, immense leisure, and equal capacity to absorb a
+quantity of fiction, good and bad, and to find in some of it things
+about my own art which excited amused comment, and but for that would
+long ago have been forgotten. Among the stuff which I more or less
+listlessly read was an astonishing book called "Norwood." It set me to
+thinking, because in this book are recounted many things concerning sick
+or wounded folk, and those astonishing surgeons and nurses who are
+supposed to have helped them on to their feet again.
+
+The ghastly amusement which came to me out of the young lady in this
+volume, who amputates a man's leg, made me reflect a little about the
+mode in which writers of fiction have dealt with sick people and
+doctors. I lay half awake, and thought over this in no unkindly critical
+mood,
+
+  "With now and then a merry thought,
+  And now and then a sad one,"
+
+until I built myself a great literary hospital, such as would delight
+Miss Nightingale. For in it I had a Scott ward, and a Dickens ward, and
+a Bulwer ward, and a Thackeray ward, with a very jolly lot of doctors,
+such as Drs. Goodenough and Firmin, with the Little Sister (out of
+Philip) and Miss Evangeline to take care of the patients, besides cells
+for Charles Reade's heroes and heroines, and the apothecary (out of
+Romeo and Juliet) to mix more honest doses than he gave to luckless
+Romeo.
+
+Should you wander with a critical doctor through those ghostly wards,
+you would see some queerer results of battle and fray than ever the
+doctors observe nowadays,--cases I should like to report, it might be:
+poisonings that would have bewildered Orfila, heart-diseases that would
+have astounded Corvisart, and those wonderful instances of consumption
+which render that most painful of diseases so delightful to die of--in
+novels. I have no present intention to weary my readers with a clinic in
+those crowded wards, but it will ease my soul a little if I may say my
+say in a general fashion about the utter absurdities of most of these
+pictures of disease and death-beds. In older times the sickness of a
+novel was merely a feint to gain time in the story or account for a
+non-appearance, and the doctor made very brief show upon the stage.
+Since, however, the growth of realism in literary art, the temptation to
+delineate exactly the absolute facts of disease has led authors to dwell
+too freely on the details of sickness. So long as they dealt in
+generalities their way was clear enough. Of old a man was poisoned and
+done for. Today we deal in symptoms, and follow science closely in our
+use of poisons. Mr. Trollope's "Gemma" is an instance in point, where
+every one will feel that the spectacle of the heroine going seasick to
+death, owing to the administration of tartar emetic, is as disgusting
+and inartistic a method as fiction presents. Why not have made it croton
+oil? More and worse of this hideous realism is to be found in About's
+books, such, for instance, as "Germaine"; but from which censure I like
+to exclude the rollicking fun of "Le Nez d'un Notaire." As to the recent
+realistic atrocities of Zola, and even of Tolstoi, a more rare sinner,
+if we exclude his disgusting drama of peasant life, I prefer to say
+little.
+
+As to blunders in the science of poisons I say little. The novelist is a
+free lance, and chooses his own weapons; but I cannot help remarking
+that, if recent investigators are to be trusted, one unlucky female, at
+least, must be still alive, for a novelist relates that she was done to
+death by the internal taking of a dose of rattlesnake venom. I hope when
+I am to be poisoned this mode may be employed. She might as well have
+drunk a glass of milk. That book was a queer one to me after this
+catastrophe: the woman ought to be dead and could not be.
+
+The difficulty of the modern novelist in giving symptoms and preserving
+the entire decorum of his pages has amused me a little. Depend upon it,
+he had best fight shy of these chronic illnesses: they make queer
+reading to a doctor who knows what sick people are; and above all does
+this advice apply to death-beds. As a rule, folks get very horrible at
+such times, and are a long while in dying, with few of their wits about
+them at the last. But in novels people die marvellously possessed of
+their faculties; or, if they are shot, always jump into the air exactly
+as men never do in fact.
+
+Just here, concerning wounds, a question occurs to me: The heroes who
+have to lose a limb--a common thing in novels since the war--always come
+back with one arm, and never with a lost leg. Is it more romantic to get
+rid of one than of the other?--considering also that a one-armed embrace
+of the weeping waiting lady-love must be so utterly unsatisfactory.
+
+But enough of the patients. Among them I think I like Pendennis the
+best, and consider little Dombey and Nell the most delightfully absurd.
+And as to the doctors. Some of them have absolutely had the high
+promotion to be the heroes of a whole book. Had not one, nay, two, a
+novel to themselves? There is delightful Dr. Antonio, not enough of a
+doctor to call down on him my professional wrath. As to Dr. Goodenough,
+he has been in our family a long while,--on the shelf (God bless
+him!),--and attended, we remember, our friend Colonel Newcome in that
+death-bed matchless in art since Falstaff babbled life away. Yet, after
+all, he is not a doctor so much as a man charmingly drawn.
+
+There are in novels many good portraits of lawyers, from Pleydell to
+Tulkinghorn. Whether fair or unjust as pictures, I am scarce able to
+judge, although I believe that some of them have been recognized by our
+legal brethren as sufficiently exact. While, however, we have plenty of
+characters which for his purpose the novelist labels M.D., there seems
+to have been some insuperable difficulty in evolving for artistic use a
+doctor who shall seem at home, as such, among the other characters of
+the novel,--one, at least, who shall appear to any reasonable degree
+like a doctor to those who really know the genus doctor thoroughly. Save
+Lydgate, no doctor in fiction answers this critical demand, or seems
+anything to me but a very stiff lay figure from the moment he is called
+upon to bring his art into the story, or to figure, except as an
+unprofessional personage.
+
+Nor does this arise from poverty of types in the tribe of physicians.
+The training of a doctor's life produces the most varied effects for
+good or evil, as may chance, upon the human natures submitted to its
+discipline, so that I think any thoughtful medical man will tell you
+that there is a more notable individuality among his brethren in middle
+life than among most of the people he encounters. As for the novelist's
+effort--an inartistic one, it seems to me--to bring on his stage
+representations of some especial kind of doctor, I have only a grim
+smile to give, remembering Mr. Reade's grewsome medico in "Hard
+Cash,"--a personation meant, I suppose, to present to the public a
+certain irregular London doctor, but which, to the minds of most
+physicians, reads like an elaborate advertisement of the man in
+question.
+
+Sir Bulwer Lytton's renderings of a homoeopath and a water-cure
+specialist are open to the same charge, and could only have been
+successful in the hands of a master.
+
+There are at least two doctors in Balzac's novels. Rastignac, man of
+fashion and science, is drawn with the master's usual skill, but he is
+not a doctor. His art has no prominence. It is not shown how his
+peculiarities influenced his work, nor how his art, and its use, altered
+or modified the man. "The Country Doctor," by the same strong hand, is
+far more near my ideal of what this portraiture should be than any other
+known to me in French literature. The humorous aspects of a medical life
+in the provinces of France are nicely handled in Jules Sandeau's "Doctor
+Herbeau," but the study, however neat and pleasing, is slight.
+
+Wander where you may, in the drama or the novel, you will still find, I
+think, that the character of the physician awaits in its interesting
+varieties competent portrayal.
+
+Shakespeare has left us no finished portrait of a doctor. Molière
+caricatured him. Thackeray failed to draw him, and generally in novels
+he is merely a man who is labelled "Doctor." The sole exception known to
+me is the marvellous delineation of Lydgate in "Middlemarch." He is all
+over the physician, his manner, his sentiments, his modes of thought,
+but he stands alone in fiction. How did that great mistress of her art
+learn all of physicians which enabled her to leave us this amazingly
+truthful picture? Her life gives us no clue, and when I asked her
+husband, George Lewes, to explain the matter, he said that he did not
+know, and that she knew no more of this than of how she had acquired her
+strangely complete knowledge of the low turf people she has drawn in the
+same book, and with an almost equal skill and truth to nature.
+
+It were easy, I fancy, to point out how the doctor's life and training
+differ from those of all the other professions, and how this must act on
+peculiar individualities for the deepening of some lines and the erasure
+of others; but this were too elaborate a study for my present gossiping
+essay, and may await another day and a less lazy mood.
+
+If any one should be curious to see what are the modifying circumstances
+in a physician's life which strongly tend to weaken or to reinforce
+character, I recommend a delightful little address, quite too brief, by
+Dr. Emerson, the son of the great essayist. It is unluckily out of print
+and difficult to obtain. If you would see in real lives what sturdy
+forms of personal distinctness the doctor may assume, there is no better
+way than to glance over some half-dozen medical biographies. Read, for
+instance, delightful John Brown's sketch of Sydenham and of his own
+father, or George Wilson's life of John Reid, the physiologist, whom
+community of suffering must have made dear to that gentle intelligence,
+and whose days ended in tragic horror such as sensational fiction may
+scarcely match; or, for an individuality as well defined and more
+pleasing, read Pichot's life of Sir Charles Bell, or one of the most
+remarkable of biographies, Mr. Morley's life of Jerome Cardan.
+
+I am reminded as I write how rare are the really good medical
+biographies. The autobiographies are better. Ambrose Paré's sketches of
+his own life, which was both eventful and varied, are scattered through
+his treatise on surgery, and he does not gain added interest in the
+hands of Malgaigne. Our own Sims's book about himself is worth reading,
+but is too realistic for the library table, yet what a strangely
+valuable story it is of the struggle of genius up to eminent success.
+But these are the heroes of a not unheroic profession, and I had almost
+forgotten to set among them, as a study of character, the life of the
+tranquil, high-minded Jenner, the country doctor who swept the scars of
+smallpox from the faces of the world of men, and beside him John Hunter,
+his friend, impulsive, quick of temper, enthusiastic, an intensely
+practical man of science. These are illustrations of men of the most
+varied types, whose works show their characteristics, and who would, in
+the end, I fancy, have been very different had fate set them other tasks
+in life, for if the sculptor makes the statue, we may rest quite sure
+that the statue he makes influences the man who made it.
+
+These, I have said, are our heroes, but I still think there remains to
+be written the simple, honest, dutiful story of an intelligent,
+thoughtful, every-day doctor, such as will pleasantly and fitly open to
+laymen some true conception of the life he leads, its cares, its trials,
+its influences on himself and others and its varied rewards. John Brown
+got closest to it in that sketch of his father, and in her
+delicately-drawn "Country Doctor" Miss Jewett has done us gentle
+service. But my doctor would differ somewhat in all lands, because
+nationality and social conventions have their influence on us as on
+other men, as any one may observe who compares the clergymen of the
+Episcopal Church in America with those of England.
+
+The man who deals with the physician in fiction would have to consider
+this class of facts, for social conventions have assigned to the
+physician in England, at least, a very different position from that
+which he holds with us, where he has no social superior, and is usually
+in all small communities, and in some larger ones, the most eminent
+personage and the man of largest influence.
+
+In the rage for novel characters the lady doctor has of late assumed her
+place in fiction. Lots of wives have been picked up among hospital
+nurses, especially since the Crimean war, and since other women than
+Sisters of Charity got into the business, and so made to seem probable
+this pleasing termination of an illness. There was a case well known to
+me where a young officer simulated delirium tremens in order to get near
+to a Sister of Charity. If ever you had seen the lady, you would not
+have wondered at his madness; and should any author desire to utilize
+this incident, let him comprehend that the order of Sisters of Charity
+admits of its members leaving the ranks by marriage, theirs being a
+secular order; so that here are the chances for a story of the freshest
+kind. As for the lady doctor in fiction, her advantages would be awful
+to contemplate in sickness, when we are weak and fevered, and absurdly
+grateful for a newly-beaten pillow or a morsel of ice. But imagine the
+awful temptation of having your heart auscultated. Let us dismiss the
+subject while the vision of Béranger's Ange Gardienne flits before us as
+De Grandville drew her.
+
+I have not now beside me Howells's "Doctor Breen's Practice." It is a
+remarkable attempt to do justice to a very difficult subject, for there
+are two physicians to handle, male and female, not, I think, after their
+kind. "Doctor Zay," by Miss Phelps, makes absurd a book which is
+otherwise very attractive. This young woman doctor, a homoeopath, sets a
+young man's leg, and falls in love with him after a therapeutic
+courtship, in which he wooes and she prescribes.
+
+The woman doctor is, I suspect, still available as material for the
+ambitious novelist, but let him beware how he deals with her.
+
+
+
+PAIN AND ITS CONSEQUENCES.
+
+
+As I look from my window, on the lawn below are girls at play,--gay,
+vigorous, wholesome; they laugh, they run, and are never weary. How far
+from them and their abounding health seem the possibilities of such
+torment as nature somewhere in life reserves for most of us. As women,
+their lives are likely, nay, certain, to bring them a variety of
+physical discomforts, and perhaps pain in its gravest forms. For man,
+pain is accidental, and depends much on the chances of life. Certainly,
+many men go through existence here with but little pain. With women it
+is incidental, and a far more probable possibility. The most healthy
+will have least of it. Vigor of body is its foe. Thin blood is its ally.
+Speaking now, not of the physiological pain, which few escape, but of
+the torments of neuralgia and the like, Romberg says, "Pain is the
+prayer of the nerves for healthy blood." As the woman is normally less
+full-blooded than the man, she is relatively in more danger of becoming
+thin-blooded than he.
+
+Moreover, the disturbances which come from the nature of her
+physiological processes subject her to larger risks of lessened blood
+than man, and hence, for all reasons, she is more likely than he to
+become anæmic, and out of this to evolve pain in some shape.
+
+If we see that our girls are not overtasked at the age of sexual
+evolution, that the brain is not overtrained at bitter cost of other
+developments as essential, we escape a part of this peril. To discuss
+the question here is not my intention. To secure in our artificial life
+what is desirable is difficult. It involves matters of dress, exercise,
+proportion of lessons, diet, and other matters, of which I shall yet say
+something, and as to which I have elsewhere said a good deal.
+
+But no matter how careful we may be, how thoughtful as to the true needs
+of these young lives, we may be sure that our daughters will be more
+likely to have to face at some time the grim question of pain than the
+lads who grow up beside them.
+
+For both there are always the little ailments of childhood,--the hurts,
+the accidents, and the disorders or the diseases of youthful years. All
+come in for a share. Let us be careful how we deal with them. I have
+often watched with interest a mother beside the girl or boy in temporary
+pain. As a rule, she assumes from the beginning that the hurt boy is to
+be taught silent, patient endurance. What! you, a boy, to cry! Be a man!
+Among his comrades he is a "cry-baby" if he whimpers, "a regular girl,"
+"a girl-boy." He is taught early that from him endurance is expected;
+the self-conquest of restrained emotion is his constant lesson.
+
+If it be a girl who suffers, she is assumed to be weak, and it is felt
+that for her tears are natural and not to be sternly repressed; nor are
+her little aches and complaints dismissed as lightly as are her
+brother's. She is trained to expect sympathy, and learns that to weep is
+her prerogative. The first gush of tears after a hurt of body or mind is
+in some mysterious way a relief, and not rudely to be chidden; but, on
+the whole, it is wise and right to teach patience and unemotional
+endurance to the sex which in life is sure to have the larger share of
+suffering. To be of use, this education must begin reasonably early, and
+we may leave to the mother to make sure that it is not too severe.
+
+As a girl grows older, we ask and expect some measure of restraint in
+emotional expression as regards any of the physical or moral troubles
+which call out tears in the child; for the woman who is wise understands
+that unrestrained emotion and outward expressions of pain or distress
+are the beginnings of that loss of self-rule which leads to habitual
+unrestraint, and this to more and more enfeeblement of endurance, and
+this, again, to worse things, of which more in the future.
+
+We are dealing now with pain. My simple practical thesis is that pain
+comes to all soon or late, that the indirect consequences are most to be
+feared, and that endurance in the adult, rational endurance, must be won
+by a gradual education, which can hardly begin too early. But of what
+use are these stern lessonings in the bearing of what none can quite
+escape? Do they enable us to diminish pain or to feel it less?
+Indirectly, yes. One woman cries out for instant easement if in pain or
+distress, unschooled to endure. She claims immediate relief. Another,
+more resolute, submits with patience, does not give way, as we put it,
+tries to distract her attention, knowing that even as distinct suffering
+as toothache may be less felt in the presence of something which
+interests the mind and secures the attention. Nothing, indeed, is more
+instructive than to watch how women bear pain,--the tremendous calamity
+it is to one, the far slighter thing in life it is to another. I speak
+now of transient torments. When we come to consider those years of
+torture which cruel nature holds in store for some, no one blames the
+sight of the moral wreck it is apt to make of the sufferer. On the other
+hand, there is nothing I ever see in my profession so splendid as the
+way in which a few, a rare few, triumph over pain, which we know must
+often rise to the grade of anguish, and from which scarce a day is ever
+free.
+
+I recall well one woman who for years, under my eyes, was the subject of
+what, with due sense of the force of the word, I call torture. At times
+she shut herself up in her room, and, as she said, "wrestled with it."
+This happened every day or two for an hour or more. The rest of the time
+she was out, or busy with her duties, but always in some pain.
+Meanwhile, although failing slowly, she was the life and joy of many,
+the true and gentle counsellor, the sure support of all who leaned on
+her for aid. At her dinner-table, in chat with friends, or over a book,
+no one who did not know her well could have dreamed that she was in such
+pain as consigns lower natures to disability. Her safeguard from utter
+wreck was a clear and resolute faith, a profound and unfailing interest
+in men and things and books, which gave strange vigor to her whole range
+of intellectual activities. But above all she possessed that happiest of
+gifts, the keen, undying sense of the humorous, the absurd, the witty.
+As she once said, "All life laughs for me." It followed her to death, as
+it has certain others as noble. When dying, she said some gay thing
+which disturbed a dear friend. The sufferer, well knowing her own state,
+looked up. "I must laugh, dear," she said; "I would not feel that the
+other world was the good place I think it if I did not believe I could
+laugh there too." She once said to me, in the midst of a storm of acute
+suffering, that pain seemed to her a strange sort of a joke. I hardly
+knew what she meant, but it shows the reigning mood of one who used to
+better ends a life half pain than most of us use the untroubled health
+of existence. Very irritable in youth, her clear brain and strong sense
+of duty overcame it in proportion to the growth of what in others
+creates it. All opiates she disliked, and could rarely be induced to
+take them. "If my mind gets weaker, I shall go to pieces----;" and,
+laughing always, "the bits would be worthless as the scattered bricks of
+a sound house." Surely such a life is a fruitful lesson in the uses of
+endurance, for be sure that both she and all around her were the better
+and happier, yes, and she the less a sufferer, for her mode of dealing
+with a life of pain.
+
+The illustration I have given saves me from dwelling at great length on
+the values of all the means within a woman's control for lessening the
+evil consequences of suffering, and if to few is given the largest moral
+and mental outfit for such a struggle, none are without the power to
+cultivate what they have, and, in the lesser ills of life, to make use
+of the lesson we may hope and know few will be called on to apply to an
+existence such as hers.
+
+Pain of body, hurt of mind, all the sad gamut from discomfort to
+anguish, depend for their influence on her life upon how nature and
+training enable the woman to meet them.
+
+To endure without excess of emotion saves her from consequent
+nervousness, and from that feebleness of mind and body which craves at
+all cost instant relief. It is the spoiled child, untaught to endure,
+who becomes the self-pampered woman. Endurance of pain has also its
+side-values, and is the handmaid of courage and of a large range of
+duties. Tranquil endurance enables the sufferer to seek and to use all
+the means of distraction which this woman I have described did use. It
+leaves the mind free, as it never can be otherwise in the storm of
+unrestraint, to reason on her troubles, and to decide whether or not her
+pain justifies the use of drugs, for on her the physician must
+measurably rely for this knowledge, and as she is morally strong or weak
+the decision will be.
+
+There are those, indeed, who suffer and grow strong; there are those who
+suffer and grow weak.
+
+This mystery of pain is still for me the saddest of earth's
+disabilities. After all is said that can be said on its values as a
+safeguard, an indicator of the locality of disease, after the moralist
+has considered it from the disciplinary view, and the theologian cracked
+his teeth on this bitter nut, and the evolutionist accounted for its
+existence, it comes at last to the doctor to say what shall be done with
+it. I wish it came to him alone. Civilized man has ceased to torture,
+but nature, relentless still, has in store possibilities of utmost
+anguish, which seem to fall alike on the guilty and the innocent, the
+poor and the rich, and in largest proportion on the gentler sex. But
+while pain is still here with its ever-ready presence, the direct means
+of lessening it have multiplied so that hardly a month goes by without
+some new method being added of destroying for a time the power to
+suffer. For, bear in mind that it is not usually the cause which can be
+at once destroyed by drugs, but only the bodily capacity to react to it
+in the fashion we call pain. Ether, chloroform, cocaine, and many other
+drugs enable us to-day to feel sure that the mass of real pain in the
+world is vastly less than it was. It is, indeed, possible to prevent all
+pain, and pain has no real value which we need respect and desire to
+preserve; at least this is so from the physician's stand-point.
+
+The temptation which comes to us out of the accumulation of anæsthetic
+agents is one which every tender-hearted man can understand. The
+temptations which it presents to the suffering they only know who have
+suffered. To this all that I have said leads up. To most women, even to
+strong women, there comes a time when pain is a grim presence in their
+lives. If brief, the wise physician calls upon them for that endurance,
+of the value of which I have spoken. On some he calls in vain. Even if
+it recur at intervals, as in the shape of neuralgic headaches, in the
+name of reason let him be the sole judge of your need to be relieved by
+drugs. He well knows, as you cannot know, that the frequent use of
+morphia seems in the end to increase, not to lessen, the whole amount of
+probable future pain, and that what eases for a time is a devil in
+angelic disguise. If you are urgent, weak of will, unable through
+unrestraint to comprehend him, the fault will be only half his, if you
+plead too eagerly for help and too constantly claim the relief he holds.
+
+But suppose that the woman I address is a long and true sufferer, and
+that the physician desires to use such help often, then comes her time
+of peril and his day of largest responsibility. If he be weak, or too
+tender, or too prone to escape trouble by the easy help of some
+pain-lulling agent, she is soon on the evil path of the opium, chloral,
+or chloroform habit. Nor is prevention easy. With constant or inconstant
+suffering comes weakness of mind as well as body, and none but the
+strongest natures pass through this ordeal of character unhurt. If the
+woman be unenduring and unthoughtful, if the doctor fail to command her
+faith, and be too sympathetic, at last she gets possession herself of
+the drug, or the drug and the hypodermatic needle. Then there is before
+her one of the saddest of the many downward paths which lead to
+destruction of body and soul.
+
+More often, in my experience, the opium habit is learned during an
+illness of limited duration, and for the consequences of which there is
+always some one to be blamed.
+
+As I remember these patients, and I have seen them by the score, far on
+in their evil ways, such women are most often those who lack the power,
+even in health, to endure pain. Some defect of training or of nature has
+made pain, or even distress or insomnia, ills to be relieved at once
+regardless of cost. Let them but feel that relief for the time is
+possible, and self-restraint is over. They will have the thing they
+crave. You cure them of the vile opium habit at awful cost of suffering,
+and they relapse on the first new trial of endurance, and men of their
+type more surely than women.
+
+I see a good many cases of opium, morphia, or chloral habit, and I am
+sure that these forms of intoxication are becoming more prevalent than
+they were a generation ago. Is this due to an increase in the disorders
+which are eased by such drugs? Is it not rather due to the softening
+influence of luxury, and the fact that we are all being constantly
+trained to feel that it is both easy and our right to escape pain,
+however brief?
+
+I am sure, too, that a part of it lies in the readiness with which many
+physicians give sedatives, and their failure to feel the vast moral
+responsibilities of their position. But, whatever be the cause or
+causes, it is well in the hour of ease to learn beforehand the risks
+which come of too easy and too frequent appeals to agents which benumb
+the nerves.
+
+When people are first given opium, it is apt to be the friend of the
+night and the foe of the morrow. Repeated often enough, it loses power
+to constipate and distress. It still soothes pain. It still gives sleep.
+At last it seems to be in a measure a tonic for those who take it. But
+after a while it does some other things less agreeable. The mind and
+memory suffer, but far more surely the moral nature is altered. The
+woman becomes indifferent, her affections dull, her sense of duty
+hopelessly weakened. Watchful, cunning, suspicious, deceitful,--a thief,
+if need be, to get the valued opiate,--she stops at nothing. It would
+seem as if it were a drug which directly affected the conscience. At
+last, before this one craving, all ties in life are slight and bind her
+not. Insensible to shame and dead to affection, she is happy if the
+alcohol habit be not added to her disorder, for if she cannot get the
+one drug she longs for, the other will serve her at need.
+
+There is a popular idea that opium gives pleasant dreams, and that it
+takes us away into the land of poetry, to which it is supposed to have
+conducted Coleridge and De Quincey. As a matter of fact, there are but
+few persons who get more out of opium than relief of pain, sense of
+comfort, and next day's remorses. The opium dream is not for all. I have
+known only four or five cases of habitual and distinct opium dreamers.
+There was more of Coleridge than of opium in "Kubla Khan," and more of
+De Quincey than of the juice of poppies in the "Vision of Sudden Death."
+When it came to the telling of these immortal dreams, we may well
+suspect that the narrative gained in the literary appeal from the poet
+opium-drunk to the poet sober.
+
+It is, I fancy, well known to physicians that opium may act on an
+individual differently at different times. In the case of one well known
+to me it usually causes sleep, and no longer gives rise to nausea the
+next day, as it once did. Although it leaves him sufficiently wretched,
+and he has taken it but rarely, the drug occasionally keeps him wide
+awake and delightfully indifferent to the passage of time. The striking
+hours are heard, and that is all. There is none of the ennui of
+insomnia. This effect of morphia is rare with him. He may have taken
+morphia a dozen times in his life to ease acute pain, but only twice has
+it made him thus wakeful. On these nights he saw an endless succession
+of visions, which he did not forget, as one does common dreams. Nearly
+all of the hallucinations were of the most amusing character, and were
+often long and connected series of ludicrous situations, over which he
+wondered, as he lay next day, a victim to the secondary miseries due to
+the soothing dose of the night before. This is one of the tricks which
+drugs play, and is not a thing to be anticipated. The drug is the same;
+the man varies, and with his variations arise peculiarities in the
+effects of remedies.
+
+The excess sometimes attained in the use of opiates is almost past
+belief. I have seen a mere girl of seventeen years take at one dose
+thirty grains of morphia, and I know of a woman who took for years
+ninety grains a day, and ruined a weak husband, a man of small means, by
+the costliness of her habit.
+
+The causes of the torment, which the cessation of the use of morphia
+brings about, are interesting. Agonizing pains show that the nerves,
+long muffled, have become more acutely sensitive than they were before
+the fatal drug was first employed. A host of lesser troubles--insomnia,
+pain, and indigestion--attend the cure. I know nothing more pitiful than
+such an ordeal, and, despite the most watchful care, I have seen it end
+more than once in suicide. When one has watched a woman from whom opium
+has been taken away, even with skilful tenderness, roll in agony on the
+floor, rend her garments, tear out her hair, or pass into a state of
+hysterical mania, the physician is made to feel that no suffering for
+which she took the drug can have been as bad as the results to which it
+leads. The capacity to suffer, which comes on as we remove the poison,
+is almost inconceivable. It lasts long, and is the true difficulty in
+the way of forming anew habits of wholesome endurance. The physician who
+imagines that his case is well, because he has enabled an opium-taker to
+eat, sleep, and be comfortable without use of the sedative, can have
+seen little of the future of such people. The oversensitiveness to pain
+persists for months, and is a constant temptation. The moral and mental
+habits formed under opium--the irresolution, the recklessness, the want
+of shame, in a word, the general failure of all that is womanly--need
+something more than time to cure. But I am not preaching to the woman
+just set free from this bondage to sin, and speak of her only to
+emphasize the horror with which I would wish to inspire the well, who
+yet may come some day to be the suffering.
+
+If there be one set of women more liable than another to become victims
+of morphia or chloral, it is the wives of physicians. Every winter I see
+four or five, and always it is true that the habit has arisen out of the
+effort of the husband to attend medically on his wife. Physicians make
+good husbands, and this is in part due to the fact that their knowledge
+of the difficulties of feminine life causes them to be more thoughtfully
+tender, and more charitable as concerns the effects upon women of
+certain inevitable conditions as to which the layman is ignorant or
+indifferent. But the very fulness of the husband's appreciation of a
+woman's drawbacks and little moral ailments, the outcome of her
+womanhood, becomes dangerous when he ventures to be her medical
+caretaker. What he coolly decides in another's case, he cannot in hers.
+How can he see her suffer and not give her of the abundance of relief in
+his hands? She is quick to know and to profit by this, and so the worst
+comes of it.
+
+"It is easy for you to sit by in your strength and see me suffer," said
+a woman once to me. She was on the verge of the morphia habit, and I was
+trying to break it off abruptly. I felt, as any gentle-hearted man must
+feel, the sting and hurt of her words. Next day she said to me, "Of
+course you were right. I used to talk that way to B----, and he never
+could stand it." He was her husband and a physician. She got well
+easily.
+
+I do not believe that most women who sin in this way slip into it either
+quite so ignorantly and so unwarned as they would have you to suppose.
+Nearly always there is a time when some one--the physician, a friend, or
+their own reason--bids them pause, reflect, and choose.
+
+  "Alas I for thee, if thou from thine own soul dost turn and flee.
+  Better the house and company of pain;
+  Better distress;
+  Better the stones of strife, the bread with tears;
+  Humiliation and despair and fears;
+  All, all the heart can suffer, the soul know,
+  Rather than with the bestial train to go,
+  With base rejoicings, ignorant of woe."[3]
+
+[Footnote 3: "Sylvian, and Other Poems," by Philip Varley.]
+
+
+
+THE MORAL MANAGEMENT OF SICK OR INVALID CHILDREN.
+
+
+Not long ago a pretty little girl of ten was brought to me from a long
+distance to get my advice as to a slight paralysis of one leg. The
+trouble had existed for several years. I soon saw that the child was
+irritable, sensitive, and positive, and I was, therefore, careful to
+approach her gently. The moment it was proposed to show me the leg, she
+broke into a fury of rage, and no inducement I could offer enabled me to
+effect my purpose. An appeal to the parents, and from them to force,
+ended in a distressing battle. She bit, scratched, kicked, and at last
+won a victory, and was left sullen and sobbing on the floor. Next day
+the same scene was repeated. It is true that at length they were able to
+undress her, but neither threats nor persuasion would keep her quiet
+long enough to enable me to apply the simplest tests. The case was
+obscure, and demanded the most careful study. Their time was limited, so
+that at length they were obliged to take her home in despair, without
+any guiding opinion from me, and with no advice, except as to her moral
+education, concerning which I was sufficiently explicit. I have seen
+many such illustrations of a common evil, and have watched the growth to
+adult life of some of these cases of wrecked character, and observed the
+unpleasant results which came as they grew older. I have used an extreme
+case as a text, because I desire to fix attention on the error which
+parents and some doctors are apt to commit in cases of chronic ailments
+in children.
+
+As to the miserable sufferers who pass through long illness to death I
+have little to say. We naturally yield to their whims, pet and indulge
+them, moved by pitiful desire to give them all they want of the little
+which life affords them. In acute illness, with long convalescence, I am
+pretty sure that the tender mother does no real good by over-indulgence;
+but the subject is difficult, and hard to handle with justice and
+charity without calling down upon me the indignation of the
+unthoughtful. It is so easy and pleasant to yield to the caprices of
+those we love, when they are in pain or helpless from illness,--so
+doubly hard at such times to say no. Yet, if in the case of a long
+convalescence, such as follows, perhaps, a typhoid or scarlet fever, we
+balance for the little one the too-easily yielded joy of to-day against
+the inevitable stringency of discipline, which, with recovered health,
+must teach the then doubly difficult lesson of self-restraint, we shall
+see, I think, that, on the whole, we do not add to the sum of happiness
+to which the child is entitled.
+
+The mother at the sick-bed of her young child is, however, a being quite
+often as difficult to manage as her child. All her instinctive maternity
+is up in arms. Deep in the heart of many mothers there is an unconfessed
+and half-smothered sense of wrath at the attack which sickness has made
+on her dear one. Then nothing is too much to give; no sacrifice of
+herself or others too great to grant or demand. The irritability and
+feebleness of convalescence makes claims upon her love of
+self-sacrifice, and her prodigality of tenderness as positive and yet
+more baneful. That in most cases she may and does go too far, and loses
+for her child what it is hard to recover in health, is a thing likely
+enough, yet to talk to her at such times of the wrong she does the child
+is almost to insult her. Nevertheless the unwisdom of a course of
+reckless yielding to all a child's whims is plain enough, for if the
+little one be long ill or weak, it learns with sad swiftness to exact
+more and more, and to yield less and less, so that it becomes
+increasingly hard to do for it the many little unpleasant things which
+sickness demands. Character comes strongly out in the maladies of the
+child, as it does even less distinctly in the sickness of the adult. The
+spoiled, over-indulged child is a doubly unmanageable invalid, and when
+in illness the foolish petting of the mother continues, the doctor, at
+least, is to be pitied.
+
+The ductility of childhood has its dangerous side. This is seen very
+well in cases which, fortunately, are rather rare, and, for some reason,
+are less frequent in girls than in boys. These little ones observe
+sharply the faces and obvious motives of those about their sick-beds,
+and more readily than adults are led to humor the doubts they hear
+expressed by the doctor or their elders as to their capacity to do this
+or that. Too frequent queries as to their feelings are perilously
+suggestive, and out of it all arises, in children of nervous or
+imaginative temperaments, an inexplicable tendency to fulfil the
+predictions they have heard, or actively to humor the ideas they acquire
+as to their own ailments and disabilities.
+
+There is something profoundly human in this. With careless, unthoughtful
+people, who have trained a child to know that illness means absolute
+indulgence, and who pour out unguardedly their own fears and
+expectations at the bedside, the result for the child is in some cases
+past belief. The little one gets worse and worse. It accepts
+automatically the situation, with all the bribes to do so made larger by
+feebleness, and at last gains that extreme belief in its own inability
+to rise or move about which absolute convictions of this nature impose
+on child or man.
+
+There is a further and worse stage possible. The child's claims
+increase. Its complaints gather force, and alarm those about it.
+Gratified in all its whims, it develops perverted tastes, or refuses all
+food but what it fancies. At last it becomes violent if opposed, and
+rules at will a scared circle of over-affectionate relatives. When all
+else fails, it exaggerates or invents symptoms, and so goes on, until
+some resolute physician sees the truth and opens the eyes of an amazed
+family.
+
+Certain physicians explain these cases as due to hysteria, and in a
+small number of instances there are signs which justify such an
+explanation. But in the larger proportion the mode of origin is complex,
+and depends on the coincidence of a variety of evils, none of which are
+of hysterical character. I am not here concerned so much with the exact
+nature of these troubles as I am with the avoidable errors in the
+management of sick childhood. If I can make the mother more thoughtfully
+alert, less disposed to terror and exaggeration, less liable to be led
+by her emotions, I shall have fulfilled my purpose without such
+discussion as is out of place in essays like these.
+
+To make clear, however, the possibility of the disasters I have briefly
+described, an illustration may answer better than any length of
+generalized statements. A little fellow of nine once came under my care,
+and was said to have inflammation of the coverings of the brain. There
+was a long story, which I may sum up in a few sentences. An only child;
+feeble in youth; indulgence to almost any degree; at the age of eight, a
+fall, not at all grave, but followed by some days of headache; long rest
+in bed, by order of a physician; much pity; many questions;
+half-whispered, anxious discussions at the bedside; yet more excessive
+indulgence, because every denial seemed to increase or cause headache.
+At last the slightest annoyance became cause for tears, and finally for
+blame, all of which a gentle, fearful mother bore as if it were part of
+the natural trials of disease. It took but a few months of complete
+non-restraint to make of a shrewd, bright, half-educated, spoiled boy a
+little brute, as to whose sanity there seemed to be some doubt. He was
+easily made well, and has lived to thank the sternness which won back
+the health of mind and body his parents had so foolishly helped to lose
+for him.
+
+A single example may suffice, nor have I any fear that it may lead any
+one, least of all nature's gentlest creation, a mother, to be more
+severe than is reasonable. She it is who is really most responsible. She
+is ever beside the child when the little actor is off guard. She may
+have the cleverness to see through the deceit or she may not. The
+physician comes and goes, and must take for granted much that he has no
+chance to see, and for which he has to trust the more constant
+attendant. Moreover, the rarity of these cases is apt to help to deceive
+him quite as much as does the mother's affectionate trust. Nevertheless,
+it is his fault if soon or late he fail to see the truth; but he may
+well be careful how he states his doubt. The mother at the sick-bed but
+too often resents as a wrong any hint at the true state of the case.
+
+Children are singularly imitative, and more or less prone to suffer from
+this tendency. Hence the curious cases in which a child simulates, I do
+not say dissimulates, the malady it sees constantly before it, as when
+one child has attacks of false epilepsy, owing to having seen the real
+attack in a sister or brother, or when St. Vitus's dance runs through a
+school or an asylum.
+
+To sum up, we credit these little ones with a simplicity of moral
+organization which forbids us to believe that the causes which are
+active for mischief in their elders are not as potent for evil in them.
+The popular and reasonable creed of moral education, which teaches us to
+ask from a well child self-control, self-restraint, truth of statement,
+reasonable endurance of the unavoidable, good temper, is not too lightly
+or too entirely to be laid aside when sickness softens the rule of
+health and all our hearts go out in pity to the little sufferer.
+
+Certain of the nervous and other maladies of children sometimes keep
+them a long while under treatments which are annoying, painful, or
+disabling. They often end by leaving them as strong as their fellows,
+but crippled, lame, disfigured, or with troubles that attract remark,
+or, at least, notice. Thus, a child may have hip-disease, and, after
+years of treatment, get well, and although vigorous enough to do all
+that is required in life, be more or less lame. In another case, there
+is disease of the bones of the spine. After a wearying treatment, it is
+well, but the little one has a distorted spine,--is humpbacked. Again,
+we have the common malady, palsy of childhood, and here, too, most
+probably, there is left a residue of disability, or, at all events, some
+loss of power.
+
+In each case there are years of troublesome treatment, all sorts of
+unpleasant limitations, pain it may be, and certainly, at the best, a
+variety of discomforts. The joy and little pleasures of youth are gone.
+It makes one sorrowful to think of such cases, even when all that
+competent means can do to help them is at their disposal, and still more
+to reflect on those who have to battle for health with no more resource
+than is left to the needy. What shall we not do for them! The woman's
+whole tendency is to give them all of herself and all else that she can
+control. Indulgence becomes inevitable, or seems to become so, and the
+mother is rare who does not insist that they shall have what they
+desire, and that her other children shall yield to them in all things.
+Her answer to herself and others is, "They have so little; let them at
+least have what they can." As rare as the reasonable mother is the sick
+child who can stand this treatment and survive with those traits of
+character which it above all others requires to make its crippled life
+happy, not to say useful. The child thus unrestrained and foolishly
+indulged must needs become ill-tempered. It loses self-control, and yet
+no one will need it more. It learns to expect no disappointments, and
+life is to hold for it less than for others. Disease has crippled its
+body and the mother has crippled its character.
+
+I have no belief that long illness is good for the mass of people, but
+the character of the adult sufferer is in his or her own hands to make,
+mar, or mend. In childhood the mother is in large measure responsible
+for the ductile being in her care. If she believes that unrestraint is
+her duty, she is laying up for the invalid a retribution which soon or
+late will bitterly visit on the child the sin or, if you like, the
+mistakes of the parent. It is her business and duty, no matter how hard
+may be to her the trial, to see that this child, above all others, shall
+be taught patience, gentleness, good temper, and self-control in all its
+varieties, nor should she fail to point out, as health returns and years
+go by, that it is not all of life to be straight and uncrippled. I need
+not dwell on this. Every wise woman will understand me, and be able to
+put in practice better than I can here state what I might more fully
+say.
+
+I do not wish, however, to be understood as urging that all children
+long ill or crippled grow to be unamiable and spoiled. I do not quite
+know why it is, but, after all, children are less apt to suffer morally
+from long illness than adults, and very often, despite careless or
+thoughtless usage, these young sufferers come out as wholesome in mind
+and heart as if they had known no trial, or, perhaps, because of it. It
+is in a measure a matter of original temperament. In other words, what
+the sick child was as to character modified results, and this is
+especially true as concerns the peculiarities which attract unpleasant
+notice. One person who has twitching of the muscles of the face is made
+miserable by the attention it invites; another is indifferent.
+
+The cases of Lord Byron and Walter Scott are to the point. The former
+was sensitive and morbid about his deformity. I cannot help thinking
+that had his mother been other than she was, he would have been brought
+up to more wholesome views as to what was after all no very great
+calamity. Walter Scott suffered from a like trouble, but healthy moral
+surroundings and a cheerful nature saved him from the consequences which
+fell so heavily upon his brother poet.
+
+Epilepsy is a malady but too common in childhood, and as to which a few
+words apart are needed. Usually a child epileptic for some years will
+carry the disease with it for a time, the length of which no man can
+set. The disease may be such as to ruin mind and body, or the attacks
+may be rare, and not prevent courageous and resolute natures from
+leading useful lives. All intermediate degrees are possible. As a rule,
+no children need so inflexible a discipline as epileptics. Indulgence as
+regards them is only another name for ruin. Do as we may, they are apt
+to become morally perverted, and require the utmost firmness, and the
+most matured and educated intelligence, to train them wisely. Difficult
+epileptics and most idiots are best looked after, and certainly
+happiest, in some one of the competent training-schools for
+feeble-minded children.
+
+Even the milder epileptic cases are hard to manage. I rarely see one
+which has been intelligently dealt with. Few mothers are able or willing
+to use a rule as stern, as enduring, as unyielding as they require.
+
+As to education, I am satisfied that these children are the better for
+it, and yet almost invariably I find that in the cases referred to me
+some physician has, with too little thought, recommended entire
+abandonment or avoidance of mental training. I have neither space nor
+desire to go into my reasons for a different belief. I am, however, sure
+that education limited as to time, education of mind, and especially of
+the hands, has for these cases distinct utility, while to them also, as
+to the other children crippled in mind or body, all that I have already
+urged applies with equal force.
+
+As to the management of sick or crippled childhood, I have said far more
+than I had at first meant to say, and chiefly because I have been made
+to feel, as I thought the matter over, how far more difficult it is in
+practice than in theory. But this applies to all moral lessons, and the
+moralist must be credited by the thoughtful mother with a full
+perception of the embarrassments which lie in her path.
+
+
+
+NERVOUSNESS AND ITS INFLUENCE ON CHARACTER.
+
+
+There are two questions often put to me which I desire to use as texts
+for the brief essay or advice of which nervousness[4] is the heading. As
+concerns this matter, I shall here deal with women alone, and with women
+as I see and know them. I have elsewhere written at some length as to
+nervousness in the male, for he, too, in a minor degree, and less
+frequently, may become the victim of this form of disability.
+
+[Footnote 4: Neither _nerves_ nor _nervousness_ are words to be found in
+the Bible or Shakespeare. The latter uses the word nerve at least seven
+times in the sense of sinewy. _Nervy_, which is obsolete, he employs as
+full of nerves, sinewy, strong. It is still heard in America, but I am
+sure would be classed as slang. Writers, of course, still employ nerve
+and nervous in the old sense, as a nervous style. Bailey's dictionary,
+1734, has nervous,--sinewy, strongly made. Robt. Whytte, Edin., in the
+preface to his work on certain maladies, 1765, says, "Of late these have
+also got the name of nervous," and this is the earliest use of the word
+in the modern meaning I have found. Richardson has it in both its modern
+meanings, "vigorous," or "sensitive in nerves, and consequently weak,
+diseased." Hysteria is not in the Bible, and is found once in
+Shakespeare; as, "Hysterica passio, down," Lear ii. 4. It was common in
+Sydenham's day,--_i.e._, Charles II. and Cromwell's time,--but he
+classified under hysteria many disorders no longer considered as of this
+nature.]
+
+So much has been written on this subject by myself and others, that I
+should hesitate to treat it anew from a mere didactic point of view.
+But, perhaps, if I can bring home to the sufferer some more
+individualized advice, if I can speak here in a friendly and familiar
+way, I may be of more service than if I were to repeat, even in the
+fullest manner, all that is to be said or has been said of nervousness
+from a scientific point of view.
+
+The two questions referred to above are these: The woman who consults
+you says, "I am nervous. I did not use to be. What can I do to overcome
+it?" Once well again, she asks you,--and the query is common enough from
+the thoughtful,--"What can I do to keep my girls from being nervous?"
+
+Observe, now, that this woman has other distresses, in the way of aches
+and feebleness. The prominent thing in her mind, nervousness, is but one
+of the symptomatic results of her condition. She feels that to be the
+greatest evil, and that it is which she puts forward. What does she
+mean by nervousness, and what does it do with her which makes it so
+unpleasant? Remark also that this is not one of the feebler sisters who
+accept this ill as a natural result, and who condone for themselves the
+moral and social consequences as things over which they have little or
+no reasonable control. The person who asks this fertile question has
+once been well, and resents as unnatural the weaknesses and incapacities
+which now she feels. She wants to be helped, and will help you to help
+her. You have an active ally, not a passive fool who, too, desires to be
+made well, but can give you no potent aid. There are many kinds of fool,
+from the mindless fool to the fiend-fool, but for the most entire
+capacity to make a household wretched there is no more complete human
+receipt than a silly woman who is to a high degree nervous and feeble,
+and who craves pity and likes power. But to go back to the more helpful
+case. If you are wise, you ask what she means by nervousness. You soon
+learn that she suffers in one of two, or probably in both of two, ways.
+The parentage is always mental in a large sense, the results either
+mental or physical or both. She has become doubtful and fearful, where
+formerly she was ready-minded and courageous. Once decisive, she is now
+indecisive. When well, unemotional, she is now too readily disturbed by
+a sad tale or a startling newspaper-paragraph. A telegram alarms her;
+even an unopened letter makes her hesitate and conjure up dreams of
+disaster. Very likely she is irritable and recognizes the
+unreasonableness of her temper. Her daily tasks distress her sorely. She
+can no longer sit still and sew or read. Conversation no longer
+interests, or it even troubles her. Noises, especially sudden noises,
+startle her, and the cries and laughter of children have become
+distresses of which she is ashamed, and of which she complains or not,
+as her nature is weak or enduring. Perhaps, too, she is so restless as
+to want to be in constant motion, but that seems to tire her as it once
+did not. Her sense of moral proportion becomes impaired. Trifles grow
+large to her; the grasshopper is a burden. With all this, and in a
+measure out of all this, come certain bodily disabilities. The telegram
+or any cause of emotion sets her to shaking. She cries for no cause; the
+least alarm makes her hand shake, and even her writing, if she should
+chance to become the subject of observation when at the desk, betrays
+her state of tremor. What caused all this trouble? What made her, as
+she says, good for nothing? I have, of course, put an extreme case. We
+may, as a rule, be pretty sure, as to this condition, that the woman has
+had some sudden shock, some severe domestic trial, some long strain, or
+that it is the outcome of acute illness or of one of the forms of
+chronic disturbance of nutrition which result in what we now call
+general neurasthenia or nervous weakness,--a condition which has a most
+varied parentage. With the ultimate medical causation of these
+disorderly states of body I do not mean to concern myself here, except
+to add also that the great physiological revolutions of a woman's life
+are often responsible for the physical failures which create
+nervousness.
+
+If she is at the worst she becomes a ready victim of hysteria. The
+emotions so easily called into activity give rise to tears. Too weak for
+wholesome restraint, she yields. The little convulsive act we call
+crying brings uncontrollable, or what seems to her to be uncontrollable,
+twitching of the face. The jaw and hands get rigid, and she has a
+hysterical convulsion, and is on the way to worse perils. The
+intelligent despotism of self-control is at an end, and every new attack
+upon its normal prerogatives leaves her less and less able to resist.
+
+Let us return to the causes of this sad condition. It is a common
+mistake to suppose that the well and strong are not liable to onsets
+which cause nervousness. As a rule, they rarely suffer; but we are
+neatly ballasted, and some well people are nearer to the chance of being
+so overturned than it is pleasant to believe. Thus it is that what for
+lack of a better name we call "shock" is at times and in some people
+capable of inflicting very lasting evil in the way of nervousness.
+
+We see this illustrated in war in the effects of even slight injuries on
+certain people. I have known a trivial wound to make a brave man
+suddenly timid and tremulous for months, or to disorder remote organs
+and functions in a fashion hard to understand. In the same way, a moral
+wound for which we are not prepared may bring about abrupt and prolonged
+consequences, from which the most robust health does not always protect
+us; and which is in proportion disastrous if the person on whom it falls
+is by temperament excitable or nervous. I have over and over seen such
+shocks cause lasting nervousness. I knew a stout young clerk who was
+made tremulous, cowardly, sleepless, and, in the end, feeble, from
+having at a funeral fallen by mishap into an open grave. I have seen a
+strong woman made exquisitely nervous owing to the fall of a wall which
+did her no material damage. Earthquakes cause many such cases, and bad
+ones, as we have had of late sad occasion to know. The sudden news of
+calamity, as of a death or financial disaster, has in my experience made
+vigorous people nervous for months. A friend of mine once received a
+telegram which rather brutally announced the disgrace of one dear to
+him. He had a sense of explosion in his head, and for weeks was in a
+state of nervousness from which he but slowly recovered. There is
+something in cases like his to think about. The least preparation would
+have saved him, and we may be sure that there is wisdom in the popular
+idea that ill news should be gently and guardedly broken to such as must
+bear it. To be forewarned is to be forearmed we say with true wisdom.
+
+Prolonged strain of mind and body, or of both, is another cause apt to
+result in health failures and in nervousness as one attendant evil. The
+worst one I know is to nurse some person through a long disease. Women
+are apt to think that no one can so well care for their sick as they.
+Intrusion on this duty is resented as a wrong done to their sense of
+right. The friend who would help is thrust aside. The trained nurse
+excites jealous indignation. The volunteer gives herself soul and body
+to the hardest of tasks, and is rather proud of the folly of
+self-sacrifice. How often do we hear a woman say with pride, "I have not
+slept nor had my clothes off for a week." She does not see that her very
+affection unfits her for the calm control of the sick-room, and that her
+inevitable anxiety is incompatible with tranquil judgment. If you tell
+her that nursing is a profession, and that the amateur can never truly
+fill the place of the regular, she smiles proudly, and thinks that
+affection is capable of all things, and that what may be lost in skill
+will be made up in thoroughness and compensated by watchfulness, such as
+she believes fondly only love can command. It is hard to convince such a
+woman.
+
+It rarely chances that women are called upon to suffer in their common
+lives emotional strains through very long periods, and at the same time
+to sustain an excess of mental and physical labor. In days of financial
+trouble this combination is sometimes fatal to the health of the
+strongest men. When a loving relative undertakes to nurse one dear to
+her through a protracted illness, she subjects herself to just such
+conditions of peril as fall upon the man staggering under financial
+adversity.
+
+The analogy to which I have referred is curiously complete. In both
+there is the combination of anxiety with physical and mental overwork,
+and in both alike the hurtfulness of the trial is masked by the
+excitement which furnishes for a while the means of waging unequal
+battle, and prevents the sufferer from knowing or feeling the extent of
+the too constant effort he or she is making. This is one of the evils of
+all work done under excessive moral stimulus, and when the excitation
+comes from the emotions the expenditure of nerve-force becomes doubly
+dangerous, because in this case not only is the governing power taken
+away from the group of faculties which make up what we call common
+sense, but also because in women overtaxing the emotional centres is apt
+to result in the development of some form of breakdown, and in the
+secondary production of nervousness or hysteria.
+
+If she cannot afford a nurse, or will not, let her at least share her
+duties with some one. Above all, let her know that every competent
+doctor watches even the best of his trained nurses, and insists that
+they shall be in the open air daily. Your good wife or mother thinks in
+her heart that when she has sickness at home she should not be seen out
+of doors, and that to eat, sleep, or care for herself is then wicked or
+something like that.
+
+If you can make a woman change her dress, eat often, bathe as usual, and
+take the air, even if it must be so at night, she can stand a great
+deal, especially if you insist that she shall sleep her usual length of
+time. If she will not listen or obey, she runs a large risk, and is very
+apt to collapse as the patient recovers, and to furnish her family with
+a new case of illness, and the doctor and herself with some variety of
+disorder of mind or body arising out of this terrible strain on both.
+
+If physical tire, without chance for rest, with anxiety and incessant
+vigilance, is thus apt to cause wrecks in the nurse of ordinary illness,
+far more apt is it to involve breakdowns when a loving mother or sister
+endeavors to care for a protracted case of insanity. Unless the man of
+the house interferes, this effort is sure to bring disaster. And the
+more sensitive, imaginative, and loving is the self-appointed nurse, the
+more certain is she to suffer. There are no cases in which it is so hard
+to advise, none in which it is so difficult to get people to follow your
+advice. The morbid view of insanity, the vague sense of its being a
+stain, the horror of the hospital, all combine to perplex and trouble
+us. Yet here, if at any time, it is wise to cast the whole weight on the
+physician and to abide by his decision.
+
+Families see this peril, and can be often made to understand the
+unwisdom of this sacrifice; but, in cases of prolonged disease, such as
+hysteria in a bedridden sister or mother, it is hard to make them hear
+reason, and still more hard to make the nursing relation understand that
+she is of necessity the worst of nurses, and may share the wreck she
+helps to make.
+
+These old and happily rare cases of chronic nervous invalids are simply
+fatal to loving nurses. I have said, perhaps too often, that invalidism
+is for most of us a moral poison. Given a nervous, hysterical, feeble
+woman, shut out from the world, and if she does not in time become
+irritable, exacting, hungry for sympathy and petty power, she is one of
+nature's noblest. A mother or sister gives herself up to caring for her.
+She is in the grip of an octopus. Every fine quality of her nature helps
+to hurt her, and at last she breaks down utterly and can do no more.
+She, too, is become nervous, unhappy, and feeble. Then every one wonders
+that nobody had the sense to see what was going on. I can count many
+examples of nervousness which have arisen in this fashion. Perhaps my
+warning may not be without good results. Over and over I have made like
+statements in one or another form, and the increasing experience of
+added years only contributes force to my belief that, in still urging
+the matter, I am doing a serious duty. I ought to say also that the care
+of these invalids is, even to the well-trained and thoughtful nurse, one
+of the most severe of moral and physical trials, and that, in the effort
+to satisfy the cravings of these sick people, I have seen the best
+nurses crumble as it were in health, and at last give up, worn out and
+disheartened. A part of the responsibility of such disasters falls on
+the physician who forgets that it should be a portion of his duty to
+look sharply after the health of too devoted nurses as well as that of
+selfish patients.
+
+I have now said all that I need to say of the causes which, directly or
+indirectly, evoke the condition we call nervousness. Many of these are
+insidious in their growth. Too often the husband, if she be married, is
+immersed in his own cares, and fails to see what is going on. "I am not
+ill enough to see a doctor," she says, and waits until she has
+needlessly increased the difficulties of his task. Let us suppose,
+however, that, soon or late, she is doing, in a merely medical way, all
+that he insists upon, what more can she do for herself? She has before
+her very likely a long trial, severe in its exactions in proportion to
+her previous activity of mind and body. She most probably needs rest,
+and now that physicians have learned its value, and that not all ills
+are curable by exertion, she is told to lie down some hours each day. If
+she cannot get rid of her home duties, let her try at least to secure to
+herself despotically her times of real and true rest. To lie down is not
+enough. What she needs is undisturbed repose, and not to have to expect
+every few minutes to hear at her door the knocks and voices of servants
+or children. It is difficult to secure these most needful times of
+silent security even in health, as most women too well know. Very often
+the after-meal hours are the most available and the more desirable as
+times of repose, because in the weak digestion goes on better when they
+are at rest. She will find, too, that some light food between meals and
+at bedtime is useful, but this is within the doctor's province, and I am
+either desirous to avoid that or to merely help him. Air, too, she wants
+rather than any such great exertion as wearies; and, as regards this
+latter, let her understand that letter-writing, of which many women are
+fond, must be altogether set aside.
+
+It is, however, the moral aspects of life which will trouble her most.
+The cares which once were easily shaken off stick to her like burrs, and
+she carries them to bed with her. I have heard women say that men little
+know the moral value to women of sewing. It becomes difficult when
+people are nervous, but this or some other light handiwork is then
+invaluable.
+
+By this time she has learned that her minor, every-day duties trouble
+her, and when about to meet them, if wise, she will put herself, as we
+all can do, in an attitude of calmness. This applies still more forcibly
+to the larger decisions she must so often have to make as to children,
+house, and servants. Worry, as I have elsewhere said, is as sand in the
+mental and moral machinery, and easily becomes a mischievous habit. We
+can stand an immense deal of work, and can, even if weak, bear much, if
+only we learn to dismiss small questions without worry or unreasonable
+reconsiderations. As concerns temper, we constantly prepare ourselves to
+meet even just causes of anger, and thus by degrees learn more and more
+easily, and with less and less preparation, to encounter tranquilly even
+the most serious vexations. In health, when not nervous, a woman well
+knows that there are seasons when she must predetermine not to be
+nervous; and when ill-health has made her emotional, she must learn to
+be still, more constantly on guard. Above all, it is the small
+beginnings of nervousness which she has to fear.
+
+Tears are, for the nervous woman, the seed of trouble. Let her
+resolutely shun this commencement of disaster. The presence of others is
+apt to insure failure of self-control. A word of pity, the touch of
+affection, the face of sympathy, double her danger. When at her worst,
+let her seek to be alone and in silence and solitude to fight her
+battle. Fresh air, a bath (if she can bear that), even the act of
+undressing, will often help her. I once quoted a valued friend as saying
+that "we never take out of a cold bath the thoughts we take into it,"
+and the phrase is useful and true.
+
+Above all, let such a woman avoid all forms of emotion. Her former
+standards of resistance apply no longer, and what once did not disturb
+will now shake her to the centre. A time comes, however, when she will
+do well to meet and relearn to bear calmly all the little emotional
+trials of life. I know a nervous woman--and no coward, either--who for
+months, and wisely, read no newspapers, and who asked another to open
+and read all her letters and telegrams. The day came when she was able
+to resume the habits of health, but for a long time the telegram at
+least was a sore distress, and she could only meet it by a resolute
+putting of herself in the attitude of tranquillity of which I have
+spoken. To say more should be needless. For the nervous strong emotions
+are bad or risky, and from violent mirth to anger all are to be
+sedulously set aside. Calm of mind and quiet of body are what she most
+needs to aid the more potent measures of the physician.
+
+The woman in the situation I have described has probably a variety of
+symptoms on which her condition causes her to dwell. A great many of
+them are of little practical moment. If she is irresolute and weak, she
+yields where she should not, and finds for inactivity or for fears ample
+excuses in the state of her own feelings. An unwholesome crop of
+disabilities grows out of these conditions. It then becomes the business
+of her physician to tell her what is real, what is unreal, what must be
+respected, what must be overcome or fought. She has acquired within
+herself a host of enemies. Some are strong, some are feeble. The hour
+for absolute trust has arrived, and she must now believe in her adviser,
+or, if she cannot, she must acquire one in whom her belief will be
+entire and unquestioning.
+
+Let us take an illustration. Such a woman is apt enough to suffer from
+vertigo or giddiness. "If I walk out," she says, "I become giddy. I am
+rarely free from this unless I am in bed, and it terrifies me." You know
+in this case that she is still strong enough to exercise in moderation.
+You say, "Walk so much daily. When you fall we will think about
+stopping. Talk to some one when you go out; have a friend with you, but
+walk." She must believe you to succeed. This is a form of faith-cure
+which has other illustrations. You tell her that she must disregard her
+own feelings. She credits you with knowing, and so wins her fight.
+
+There is a sense of fatigue which at some time she should learn to treat
+with disrespect, especially when disuse of her powers has made their
+exercise difficult, and yet when returning health makes it wise to
+employ them. To think, and at last to feel sure that she cannot walk is
+fatal. And above all, and at all times, close attention to her own
+motions is a great evil. We cannot swallow a pill because we think of
+what, as regards the larger morsels of food, we do automatically.
+Moreover, attention intensifies fatigue. Walk a mile, carefully willing
+each leg-motion, and you will be tired. The same evil results of
+attention are observed in disease as regards other functions over which
+we seem in health to be without direct power of control.
+
+"Mind-cure," so called, has, in some shape, its legitimate sphere in the
+hands of men who know their profession. It is not rare to find among
+nervous women a few in whom you can cause a variety of odd symptoms by
+pressing on a tender spine and suggesting to the woman that now she is
+going to feel certain pains in breast, head, or limbs. Nervous women
+have, more or less, a like capacity to create or intensify pains and
+aches, but when a woman is assured that she only seems to have such
+ailments she is apt, if she be one kind of woman, to be vexed. These
+dreamed pains--I hardly know what else to call them--are, to her, real
+enough. If she be another kind of woman, if she believes you, she sets
+herself to disregard these aches and to escape their results by ceasing
+to attend to them. You may call this mind-cure or what you will, but it
+succeeds. Now and then you meet with cases in which, from sudden shock
+or accident, a woman is led to manufacture a whole train of disabling
+symptoms, and if in these instances you can convince her that she is
+well and can walk, eat, etc., like others, you make one of those
+singular cures which at times fall to the luck of mind-or faith-cures
+when the patient has not had the happy fortune to meet with a physician
+who is intelligent, sagacious as to character, and has the courage of
+his opinions. I could relate many such cases if this were the place to
+do so, but all I desire here is to win the well woman and the
+nervously-sick woman to the side of the physician. If she flies from him
+to seek aid from the ignorant fanatic, she may, in rare cases, get what
+her trained adviser ought to give her and she be willing to use, while
+in unskilful hands she runs sad risks of having her too morbid attention
+riveted to her many symptoms; for to think too much about their
+disorders is, on the whole, one of the worst things which can happen to
+man or woman, and wholesome self-attention is difficult, nay,
+impossible, to command without help from a personally-uninterested mind
+outside of oneself.
+
+I cannot leave this subject without a further word of solemn warning. In
+my youth we had mesmerism with its cures, then we had and have
+spiritualism with its like pretensions. From time to time we have had
+faith-cures. They come and they go, and have no stable life. The evil
+they do lives after them in the many mental wrecks they leave. When the
+charlatan Newton was ordering every class of the sick to get well, I was
+called upon to see case after case of the most calamitous results on
+mind and body. Now and then he had the luck to meet some one who was
+merely idea-sick,--a class of cases we know well. Then he made a cure
+which would have been as easy to me as to him. I made much inquiry, but
+could never find a case of organic disease with distinct tissue-changes
+which he had cured. A man with hopeless rheumatic alterations of joints
+was made to walk a few steps without crutches. This he did at sore cost
+of pain, and then came to me to tell me his tale with a new set of
+crutches, the healer having kept the old set as evidence of the cure.
+And now we have the mind-cure, Christian science and the like,--a muddle
+of mystical statements, backed by a medley of the many half-examined
+facts, which show the influence of mental and moral states over certain
+forms of disorder. The rarity of these makes them to be suspected.
+Hardly any have the solid base of a thorough medical study, and we lose
+sight of them at the moment of cure and learn nothing as to their
+future.
+
+The books on mind-cure are calculated to make much and serious evil. I
+have read them with care, and have always risen from them with the sense
+of confusion which one would have if desired to study a pattern from the
+back of a piece of embroidery. There is, however, a class of minds which
+delight in the fogs of mystery, and, when a book puzzles them, accept
+this as evidence of depth of thought. I have been bewildered at times by
+the positiveness and reasoning folly of the insane, and I think most
+trained intelligences will feel that books like these mystical volumes
+require an amount of care and thinking to avoid bewilderment of which
+the mass of men and women are not possessed. In a few years they will be
+the rarely read and dusty volumes, hid away in libraries, and consulted
+only by those who undertake the sad task of writing the history of
+credulity. Their creed will die with them, and what is best of it and
+true will continue to be used by the thoughtful physician, as it has
+been in all ages. But, meanwhile, it is doing much harm and little good.
+Every neurologist sees already some of its consequences, and I, myself,
+have over and over had to undo some of the evil it had done.
+
+Our nervous woman is well. Slowly, very slowly, she has won flesh and
+color, which means gain in quality and quantity of blood. By degrees,
+too, she has been able to return to the habits and endurances of health.
+And now she asks that other question, "I have daughters who are yet
+young, but how shall I guard them against nervousness?" and again puts
+forward this single complex symptom in disregard of the states of body
+which usually accompany it, and are to us matters quite as grave. She
+knows well that the mass of women are by physiological nature more
+liable to be nervous than are men. It is a sad drawback in the face of
+the duties of life, that a very little emotional disturbance will
+suffice to overcome the woman as it does not do the man, and that the
+same disease which makes him irritable makes her nervous. Says Romanes,
+in an admirable and impartial article on the mental differences of men
+and women, "She is pre-eminent for affection, sympathy, devotion,
+self-denial, modesty, long-suffering or patience under pain,
+disappointment, and adversity, for reverence, veneration, religious
+feeling, and general morality." I accept his statement to add that these
+very virtues do many of them lead to the automatic development of
+emotion, which, in its excesses and its uncontrolled states, is the
+parent of much of the nervousness not due to the enfeeblement of
+disease.[5]
+
+[Footnote 5: _Journal of Popular Science_, July, 1887.]
+
+With the intellectual differences between man and woman I have here
+little to do. That there is difference, both quantitative and in a
+measure qualitative, I believe, nor do I think any educational change in
+generations of women will ever set her, as to certain mental and moral
+qualifications, as an equal beside the man. It would be as impossible as
+to make him morally and physically, by any educational or other
+training, what the woman now is, his true superior in much that is as
+high, and as valuable as any mental capacities he may possess; nor does
+my creed involve for woman any refusal of the loftiest educational
+attainments. I would only insist on selection and certain limitations as
+to age of training and methods of work, concerning which I shall by and
+by have something more to say. Neither would I forbid to her any
+profession or mode of livelihood. This is a human right. I do not mean
+to discuss it here either as citizen or physician; but, as man, I like
+to state for my fellow-man that there are careers now sought and won and
+followed by her which for him inevitably lessen her true attractiveness,
+and to my mind make her less fit to be the "friendly lover and the
+loving friend."[7] Æsthetic and other sacrifices in this direction are,
+however, her business, not mine, and do not influence my practical
+judgments as to what freedom to act is or should be hers in common with
+men. For most men, when she seizes the apple, she drops the rose. I am a
+little afraid that Mrs. Lynn Linton is right as to this, but it took
+some courage to say what she said,[6] and she looks at the matter from a
+more practical point of view, and deserves to be read at length rather
+than quoted in fragments.
+
+[Footnote 6: One would like to know how many women truly want the
+suffrage, and how, when it was won, the earnest anti-tariff wife would
+construe the marriage service in the face of the husband's belief in
+high tariff. The indirect influence of women in politics is worth a
+thought. We felt it sorely in 1861, and thence on to the war's end, and
+to-day it is the woman who is making the general prohibition laws
+probable. For ill or good she is still a power in the state.]
+
+[Footnote 7: _Fortnightly_, 1886.]
+
+I return to the subject. We want our young girl to be all that Romanes
+says she is. We desire, too, that she shall be as thoroughly educated in
+relation to her needs as her brothers, and that in so training her we
+shall not forget that my ideal young person is to marry or not, and, at
+all events, is to have a good deal of her life in her home with others,
+and should have some resources for minor or self-culture and occupation
+besides the larger ones which come of more distinctively intellectual
+acquirements.
+
+I turn now to the mother who asks this question, and say, "What of your
+boys? Why are you not concerned as to them?" "Oh, boys are never
+nervous. One couldn't stand that; but they never are. Girls are so
+different." My answer is a long one. I wish I could think that it might
+be so fresh and so attractive as to secure a hearing; but the preacher
+goes on, Sunday after Sunday, saying over and over the same old truths,
+and, like him, with some urgency within me to speak, I can only hope
+that I may be able so to restate certain ancient verities as to win for
+them a novel respect and a generous acceptation.
+
+The strong animal is, as a rule, the least liable to damaging emotion
+and its consequences. Train your girls physically, and, up to the age of
+adolescence, as you train your boys. Too many mothers make haste to
+recognize the sexual difference. To run, to climb, to swim, to ride, to
+play violent games, ought to be as natural to the girl as to the boy.
+All this is fast changing for us, and for the better. When I see young
+girls sweating from a good row or the tennis-field, I know that it is
+preventive medicine. I wish I saw how to widen these useful habits so as
+to give like chances to the poor, and I trust the time will come when
+the mechanic and the laborer shall insist on public play-grounds as the
+right of his little ones.[8]
+
+[Footnote 8: The demagogue urges his rights to much that he cannot have
+in any conceivable form of society. Let him ask for free libraries, free
+baths, free music, and, above all, free and ample play-grounds within
+easy reach. I wonder that the rich who endow colleges do not ever think
+of creating play-grounds. I wish I could open some large pockets by an
+appeal to hearts at large.]
+
+The tender mother, who hates dirt and loves neatness, and does not like
+to hear her girls called tom-boys, may and does find it hard to
+cultivate this free out-door life for her girls even when easy means
+make the matter less difficult than it is for the caged dweller in
+cities during a large portion or the whole of a year.
+
+I may leave her to see that delicacy and modesty find place enough in
+her educational trainings, but let her also make sure that her girls
+have whatever chance she can afford to live out of doors, and to use the
+sports which develop the muscles and give tone and vigor. Even in our
+winters and in-doors, she can try to encourage active games such as
+shuttlecock and graces. I know of homes where the girls put on the
+gloves, and stand up with their brothers, and take gallantly the
+harmless blows which are so valuable a training in endurance and
+self-control.
+
+I am reminded as I write that what I say applies and must apply chiefly
+to the leisure class; but in others there is a good deal of manual work
+done of necessity, and, after all, the leisure class is one which is
+rapidly increasing in America, and which needs, especially among its new
+recruits, the very kind of advice I am now giving. Severer games, such
+as cricket, which I see girls playing with their brothers, tennis,
+fencing, and even boxing, have for both sexes moral values. They teach,
+or some of them teach, endurance, contempt of little hurts, obedience to
+laws, control of temper, in a word, much that under ordinary
+circumstances growing girls do not get out of their gentler games. These
+are worth some risks, and such as they are need not trouble seriously
+the most careful mother. Neither need she fear for girls up to the age
+of puberty that they are any more liable to serious damage than are her
+boys.
+
+When for her young daughters this time of change comes near, she may
+rest assured that their thorough physical training will have good
+results. Beyond this point it is hard to generalize, and, of course, the
+more violent games, in which girl and boy are or may be as one, must
+cease But each case must stand alone, and so be judged. There are plenty
+of healthy girls who may continue to row, to ride, to swim, to walk as
+before, but there are individual cases as to which advice is needed,
+although, as to all girls, it should be the rule that at certain times
+temperate exercise, lessened walks, and no dancing, riding, rowing,
+skating, or swimming should be allowed. Girls feel these restrictions
+less if they are so stringently taught from the outset as to become
+habits, and this is all I care to say.
+
+Once past the critical years, and there is no reason why the mass of
+women should not live their own lives as men live theirs, except that
+always, in my opinion, the prudent woman will at certain times save
+herself. It is still true that even healthy women exercise too little.
+Our climate makes walking unpleasant, and to get in a good sweat in
+summer, or to wade through slush in winter, is hateful to the female
+soul. The English reproach us with this defect, and rightly, but do not
+estimate the difficulties of climate. Australian women walk little, and
+the English dame who comes to this country to live soon succumbs to the
+despotism of climate and abandons her habits of ample exercise afoot.
+
+The in-door resources of women for chest and arm exertion are sadly few,
+and I think it fortunate when they are so situated as to have to do
+things in the household which exact vigorous use of the upper
+extremities. Nothing is a better ally against nervousness or
+irritability in any one than either out-door exercise or pretty violent
+use of the muscles. I knew a nervously-inclined woman who told me that
+when she was losing self-control she was accustomed to seek her own
+room, and see how long she could keep up a shuttlecock without a
+failure. As to weather, again, I should say the worse the weather the
+better the exercise of a brisk walk; and my wise mother shall see that
+her girls do not dawdle about in-doors, but get a good tramp under all
+skies as a part of the habits of life. A sturdy struggle with a rough
+day blows the irritability and nervousness of the hour out of any but
+the truly sick, and I know as to some folks that the more they are out
+of doors the better they are morally as well as physically.
+
+My ideal mother has looked on and seen her daughters grow up to be
+strong and vigorous. When the time came, she has not forgotten that she
+has had and has to deal with one of her own sex. During the years of
+their childhood she should understand, as concerns her girls, that to
+differentiate too largely their moral lessons from those of their
+brothers is unwise. Something as to this I have said in a former chapter
+as concerns the training of invalid children. It applies also to the
+well. The boy is taught self-control, repression of emotion, not to cry
+when hurt. Teach your girls these things, and you will in the end assure
+to them that habitual capacity to suffer moral and physical ill without
+exterior show of emotion, which is so true an aid to the deeper interior
+control which subdues emotion at its sources, or robs it of its power to
+harm. Physical strength and an out-door life will make this lesson easy
+and natural. Be certain that weakness of body fosters and excuses
+emotional non-restraint, and that under long illness the most hardy man
+may become as nervously foolish as a spoiled child. Crave, then, for
+your girls strength and bodily power of endurance, and with this insist
+that the boy's code of emotional control shall be also theirs. But to do
+all this you must begin with them young, and not have to make each year
+undo the failure of the last. A dog-trainer once told me that it was a
+good thing to whip the smallest pups with a straw, and to teach them
+good habits, or try to do so, from birth. He put it strongly; but be
+sure that if we wish to build habits thoroughly into the mental and
+physical structure of childhood, we shall do well to begin early. As
+regards the out-door life, I shall have something more to say in another
+place, for much is within the reach of the thoughtful, which, with
+reasonable means, they can get for girls and women, and which yet they
+do not get; and there are many ways in which also we can so train our
+girls as to create for them constant and lasting bribes to be in the
+air.
+
+The question of education is a more difficult one to handle. In
+childhood I do not see that our wise mother need be anxious; but there
+comes a day when her girl is entering womanhood, when she will have to
+think of it. I have dealt with this question so fully of late that I
+have little here to add.[9] Our public schools are so organized that
+there is small place or excuse for indulgence, although, under wise
+management, this has been shown to be possible.[10] But there is a vast
+and growing class which is so situated that the mother can more largely
+control the studies and hours of her girls than can the parents of those
+who frequent our municipal schools.
+
+[Footnote 9: "Wear and Tear," 6th ed., 1887.]
+
+[Footnote 10: Ibid., p. 54.]
+
+A great change is on her child. Let her watch its evolution, and not
+with such apparent watchfulness as shall suggest the perils she is to
+look out for. We are all organized with a certain capital of
+nerve-force, and we cannot spend it with equal recklessness in all
+directions. If the girl bears well her gathering work,--that is, as one
+could wish,--we may let her alone, except that the wise mother will
+insist on lighter tasks and some rest of body at the time when nature is
+making her largest claim upon the vital powers. The least sign of
+physical failure should ring a graver alarm, and make the mother insist,
+at every cost, upon absence of lessons and reasonable repose. The matter
+is simple, and I have no more to say.
+
+I am dealing now so entirely with the moral and physical aspects of a
+woman's life, and so distinctly from the medical point of view, that I
+do not feel called upon to discuss, in all its aspects, the mooted
+question of the values and the perils of the higher education. At one
+time it was not open to women at all. Now it is within her reach. Our
+girl is well, and has passed, happily, over her time of development.
+Will the larger education which she so often craves subject her to risks
+such as are not present to the man,--risks of broken health and of its
+consequences? I wish to speak with care to the mother called upon to
+decide this grave question. I most honestly believe that the woman is
+the better in mind and morals for the larger training, better if she
+marries, and far better and happier if it chances that she does not. If
+we take the mass of girls, even of mature age, and give them the
+training commonly given to men, they run, I think, grave risks of being
+injured by it, and in larger proportion than do their brothers. Where it
+seems for other reasons desirable, it should be, I think, a question of
+individual selection. The majority of healthy young women ought to be
+able to bear the strain. Once in a female college, the woman goes on,
+and it is my own experience that, on the whole, she exhibits a far
+larger list of disastrous results from such work than do young men. If
+she be in the least degree nervous or not well, I, for one, should
+resolutely say no to all such claims; for let us bear in mind that the
+higher education is rarely to be used as men use it, to some definite
+end, and is therefore not, on the whole, so essential to her as to him.
+Few women mean it as a way towards medicine, or even the upper ranks of
+teaching; and if they do, the least doubt as to health ought to make us
+especially unwilling to start an unseaworthy or uninsurable vessel upon
+an ocean of perilous possibilities. I wish that every woman could attain
+to the best that men have. I wish for her whatever in the loftiest
+training helps to make her as mother more capable, as wife more helpful;
+but I would on no account let the healthiest woman thus task her brain
+until she is at least nineteen. If she is to marry, and this puts it off
+until twenty-three, I consider that a gain not counted by the advocates
+of the higher education. I leave to others to survey the broad question
+of whether or not it will be well for the community that the mass of
+women should have a collegiate training. It is a wide and wrathful
+question, and has of late been very well discussed in Romanes's paper,
+and by Mrs. Lynn Linton. I think the conclusions of the former, on the
+whole, are just; but now, whatever be my views as to the larger
+interests of the commonwealth and the future mothers of our race, I must
+not forget that I am giving, or trying to give, what I may call
+individualized advice, from the physician's view, as to what is wisest.
+
+Let us suppose that circumstances make it seem proper to consider an
+ambitious young woman's wish, and to let her go to a college for women.
+We presume that she has average health. But let no prudent mother
+suppose that in these collections of persons of one sex her child will
+be watched as she has been at home. At no time will she more need the
+vigilant insight of a mother, and yet this can only be had through
+letters and in the holiday seasons. Nor can the mother always rely upon
+the girl to put forward what may cause doubt as to her power to go on
+with her work. I utterly distrust the statistics of these schools and
+their graduates as to health, and my want of reliance arises out of the
+fact that this whole question is in a condition which makes the
+teachers, scholars, and graduates of such colleges antagonistic to
+masculine disbelievers in a way and to a degree fatal to truth. I trust
+far more what I hear from the women who have broken down under the
+effort to do more than they were fit to do, for always, say what you
+may, it is the man's standard of endurance which is set before them, and
+up to which they try to live with all the energy which a woman's higher
+sense of duty imposes upon the ambitious ones of her sex. I have often
+asked myself what should be done to make sure that these schools shall
+produce the minimum amount of evil; what can be done to avoid the
+penalties inflicted by over-study and class competitions, and by the
+emotional stimulus which women carry into all forms of work. Even if the
+doctor says this girl is sound and strong, her early months of college
+labor should be carefully watched. Above all, her eyes should be seen
+to, because in my experience some unsuspected disorder of vision has
+been fruitful of headaches and overstrain of brain, nor is it enough to
+know that at the beginning her eyes are good. Extreme use often evolves
+practical evils from visual difficulties at first so slight as to need
+or seem to need no correction.
+
+The period of examinations is, too, of all others, the time of danger,
+and I know of many sad breakdowns due to the exaction and emotional
+anxieties of these days of competition and excitement.
+
+Let me once for all admit that many girls improve in health at these
+colleges, and that in some of them the machinery of organization for
+care of the mental and physical health of their students seems to be all
+that is desirable. That it does not work satisfactorily I am sure, from
+the many cases I have seen of women who have told me their histories of
+defeat and broken health. The reason is clear. The general feeling
+(shall I say prejudices?) of such groups of women is bitterly opposed to
+conceding the belief held by physicians, that there are in the woman's
+physiological life disqualifications for such continuous labor of mind
+as is easy and natural to man. The public sentiment of these great
+schools is against any such creed, and every girl feels called upon to
+sustain the general view, so that this acts as a constant goad for such
+as are at times unfit to use their fullest possibility of energy. Modest
+girls, caught in the stern mechanism of a system, hesitate to admit
+reasons for lessened work or to exhibit signals of failure, and this I
+know to be the case. The practical outcome of it all is that the eyes of
+home can never be too thoughtfully busy with those of their girls who
+have won consent to pursue, away from maternal care, the higher
+education of female colleges. I must have wearied that wise mother by
+this time, but, perhaps, I have given her more than enough to make her
+dread these trials.
+
+I should say something as to the home-life of girls who go through the
+ordinary curriculum of city day schools were it not that I have of late
+so very fully reconsidered and rewritten my views as to this interesting
+question. I beg to refer my unsatisfied reader to a little book which, I
+am glad to know, has been helpful to many people in the last few
+years.[11]
+
+[Footnote 11: "Wear and Tear," pp. 30 to 60. J.B. Lippincott Company,
+Philadelphia, 1887.]
+
+
+
+OUT-DOOR AND CAMP-LIFE FOR WOMEN.
+
+
+A good many years ago I wrote a short paper, meant to capture popular
+attention, under the title of "Camp Cure." I have reason to think that
+it was of use, but I have been led to regret that I did not see when it
+was written that what I therein urged as desirable for men was not also
+in a measure attainable by many women. I wish now to correct my error of
+omission, and to show not only that in our climate camp-life in some
+shape can be readily had, but also what are its joys and what its
+peculiar advantages.[12] My inclination to write anew on this subject is
+made stronger by two illustrations which recur to my mind, and which
+show how valuable may be an entire out-door life, and how free from
+risks even for the invalid. The lessons of the great war were not lost
+upon some of us, who remember the ease with which recoveries were made
+in tents, but single cases convince more than any statement of these
+large and generalized remembrances.
+
+[Footnote 12: "Nurse and Patient," and "Camp Cure," by S. Weir Mitchell.
+J.B. Lippincott Company Philadelphia.]
+
+I knew a sick and very nervous woman who had failed in many hands to
+regain health of mind. I had been able to restore to her all she needed
+in the way of blood and tissue, but she remained, as before, almost
+helplessly nervous. Wealth made all resources easy, and yet I had been
+unable to help her. At last I said to her, "If you were a man I think I
+could cure you." I then told her how in that case I would ask a man to
+live. "I will do anything you desire," she said, and this was what she
+did. With an intelligent companion, she secured two well-known, trusty
+guides, and pitched her camp by the lonely waters of a Western lake in
+May, as soon as the weather allowed of the venture. With two good
+wall-tents for sleeping-and sitting-rooms, with a log hut for her men a
+hundred yards away and connected by a wire telephone, she began to make
+her experiment.
+
+A little stove warmed her sitting-room at need, and once a fortnight a
+man went to the nearest town and brought her books. Letters she avoided,
+and her family agreed to notify her at once of any real occasion for her
+presence. Even newspapers were shut out, and thus she began her new
+life. Her men shot birds and deer, and the lake gave her black bass, and
+with these and well-chosen canned vegetables and other stores she did
+well enough as to food. The changing seasons brought her strange
+varieties of flowers, and she and her friend took industriously to
+botany, and puzzled out their problems unaided save by books. Very soon
+rowing, fishing, and, at last, shooting were added to her resources.
+Before August came she could walk for miles with a light gun, and could
+stand for hours in wait for a deer. Then she learned to swim, and found
+also refined pleasure in what I call word-sketching, as to which I shall
+by and by speak. Photography was a further gain, taken up at my
+suggestion. In a word, she led a man's life until the snow fell in the
+fall and she came back to report, a thoroughly well woman.
+
+A more notable case was that of a New England lady, who was sentenced to
+die of consumption by at least two competent physicians. Her husband,
+himself a doctor, made for her exactly the same effort at relief which
+was made in the case I have detailed, except that when snow fell he had
+built a warm log cabin, and actually spent the winter in the woods,
+teaching her to live out in the air and to walk on snow-shoes. She has
+survived at least one of her doctors, and is, I believe, to this day a
+wholesome and vigorous wife and mother.
+
+What large wealth did to help in these two cases may be managed with
+much smaller means. All through the White Mountains, in summer, you may
+see people, a whole family often, with a wagon, going from place to
+place, pitching their tents, eating at farm-houses or hotels, or
+managing to cook at less cost the food they buy. Our sea-coast presents
+like chances. With a good tent or two, which costs little, you may go to
+unoccupied beaches, or by inlet or creek, and live for little. I very
+often counsel young people to hire a safe open or decked boat, and, with
+a good tent, to live in the sounds along the Jersey coast, going hither
+and thither, and camping where it is pleasant, for, with our easy
+freedom as to land, none object. When once a woman--and I speak now of
+the healthy--has faced and overcome her dread of sun and mosquitoes, the
+life becomes delightful. The Adirondacks, the Alleghanies, and the
+Virginia mountains afford like chances, for which, as these are in a
+measure remote, there must be a somewhat more costly organization. I
+knew well a physician who every summer deserted his house and pitched
+tents on an island not over three miles from home, and there spent the
+summer with his family, so that there are many ways of doing the same
+thing.
+
+As to the question of expense, there is no need to say much. All over
+our sparsely-inhabited land places wild enough are within easy reach,
+and the journey to reach them need not be long. Beyond this, tent-life
+is, of course, less costly than the hotel or boarding-house, in which
+such numbers of people swelter through their summers. As to food, it is
+often needful to be within reach of farm-houses or hotels, and all kind
+of modifications of the life I advise are possible.
+
+As to inconveniences, they are, of course, many, but, with a little
+ingenuity, it is easy to make tent-life comfortable, and none need dread
+them. Any book on camp-life will tell how to meet or avoid them, and to
+such treatises I beg to refer the reader who wishes to experiment on
+this delightful mode of gypsying.
+
+The class of persons who find it easy to reach the most charming sites
+and to secure the help of competent guides is, as I have said in another
+place, increasing rapidly. The desire also for such a life is also
+healthfully growing, so that this peculiarly American mode of getting an
+outing is becoming more and more familiar. It leads to our young folks
+indulging in all sorts of strengthening pursuits. It takes them away
+from less profitable places, and the good it does need not be confined
+to the boys. Young women may swim, fish, and row like their brothers,
+but the life has gains and possibilities, as to which I would like to
+say something more. In a well-ordered camp you may be sure of good food
+and fair cooking. To sleep and live in the air is an insurance against
+what we call taking cold. Where nature makes the atmospheric changes,
+they are always more gradual and kindly than those we make at any season
+when we go from street to house or house to street.
+
+My brothers during the war always got colds when at home on leave, and
+those who sleep in a chinky cabin or tent soon find that they do not
+suffer and that they have an increasing desire for air and openness.
+
+To live out of doors seems to be a little matter in the way of change,
+and that it should have remarkable moral and intellectual values does
+not appear credible to such as have not had this experience.
+
+Yet, in fact, nothing so dismisses the host of little nervousnesses with
+which house-caged women suffer as this free life. Cares, frets, worries,
+and social annoyances disappear, and in the woods and by the waters we
+lose, as if they were charmed away, our dislikes or jealousies, all the
+base, little results of the struggle for bread or place. At home, in
+cities, they seem so large; here, in the gentle company of constant sky
+and lake and stream, they seem trivial, and we cast them away as easily
+as we throw aside some piece of worn-out and useless raiment.
+
+The man who lives out of doors awhile acquires better sense of moral
+proportions, and thinks patiently and not under stress, making tranquil
+companions of his worthy thoughts. This is a great thing, not to be
+hurried. There seems to me always more time out of doors than in houses,
+and if you have intellectual problems to settle, the cool quiet of the
+woods or the lounging comfort of the canoe, or to be out under "the huge
+and thoughtful night," has many times seemed to me helpful. One gets
+near realities out of doors. Thought is more sober; one becomes a better
+friend to one's self.
+
+As to the effect of out-door life on the imaginative side of us, much
+may be said. Certainly some books get fresh flavors out of doors, and
+you see men or women greedily turn to reading and talking over verse who
+never dream of it when at home. I am tempted to mention the poets, and
+even the other authors who gain a kindly rubric for their work from the
+gentle company of lake and wood and stream. I should frankly name Walt
+Whitman and Thoreau, and pause pretty soon in wonder at the small number
+of poets who suggest out-door life as their source of inspiration. A
+good many of them--read as you lie in a birch canoe or seated on a stump
+in the woods--shrink to well-bred, comfortable parlor bards, who seem to
+you to have gotten their nature-lessons through plate-glass windows. The
+test is a sharp one, and will leave out some great names and let in some
+hardly known, or almost forgotten. Books to be read out of doors would
+make a curious catalogue, and would vary, as such lists must, with every
+thoughtful reader, while some would smile, perhaps with reason, at the
+idea of any such classification. Certainly all would name Wordsworth,
+and a few would add Clough, whilst the out-door plays of Shakespeare
+would come in, and we should soon be called on to feel that for this
+sort of congenial open-air poetic company we have still to fall back on
+the vast resources of English verse. Somehow, as yet, our own poets have
+not gotten fully into imaginative relation with what is peculiar in our
+own flowers, trees, and skies. This does not lessen our joy in the
+masters of English verse, because, of course, much of what they have
+sung has liberal application in all lands; yet is there something which
+we lose in them for lack of familiar knowledge of English lanes and
+woods, of English flowers and trees. A book of the essentially American
+nature--poems found here and there in many volumes--would be pleasant,
+for surely we have had no one poet as to whom it is felt that he is
+absolutely desirable as the interpretive poetic observer who has
+positive claims to go with us as a friendly bookmate in our wood or
+water wanderings. I have shrunk, as will have been seen, from the
+dangerous venture of enlarging my brief catalogue. What I have just now
+spoken of as one's bookmates will appear in very different lights
+according to the surroundings in which we seek to enjoy their society.
+If, as to this matter, any one doubts me, and has the good luck to camp
+out long, and to have a variety of books of verse and prose, very soon,
+if dainty of taste, he will find that the artificial flavoring of some
+books is unpleasantly felt; but, after all, one does not read very much
+when living thus outside of houses. Books are then, of course, well to
+have, but rather as giving one texts for thoughts and talk than as
+preachers, counsellors, jesters, or friends.
+
+In my own wood-life or canoe journeys I used to wonder how little I read
+or cared to read. One has nowadays many resources. If you sketch, no
+matter how badly, it teaches and even exacts that close observation of
+nature which brings in its train much that is to be desired. Photography
+is a means of record, now so cheaply available as to be at the disposal
+of all, and there is a great charm of a winter evening in turning over
+sketch or photograph to recall anew the pleasant summer days. Beyond all
+this, there is botany. I knew a lady who combined it happily and
+ingeniously with photography, and so preserved pictures of plants in
+their flowering state. When you are out under starry skies with breadth
+of heaven in view, astronomy with an opera-glass--and Galileo's
+telescope was no better--is an agreeable temptation which the cheap and
+neat charts of the skies now to be readily obtained make very
+interesting.
+
+I should advise any young woman, indeed, any one who has the good chance
+to live a camp-life, or to be much in the country, to keep a diary, not
+of events but of things. I find myself that I go back to my old
+note-books with increasing pleasure.
+
+To make this resource available something more than the will to do it is
+necessary. Take any nice young girl, who is reasonably educated, afloat
+in your canoe with you, and ask her what she sees. As a rule she has a
+general sense that yonder yellow bank, tree-crowned above the rippled
+water, is pleasant. The sky is blue, the sun falling behind you. She
+says it is beautiful and has a vague sense of enjoyment, and will carry
+away with her little more than this. Point out to her that the trees
+above are some of them deciduous poplars, or maples, and others sombre
+groups of pines and silky tamarack with a wonder of delicate tracery.
+Show her that the sun against the sloped yellow bank has covered the
+water with a shining changeful orange light, through which gleam the
+mottled stones below, and that the concave curve of every wave which
+faces us concentrates for the eye an unearthly sapphire the reflex of
+the darkening blue above us. Or a storm is on us at the same place. She
+is fearless as to the ducking from which even her waterproof will hardly
+protect. The clouds gather, the mists trail on the hills, ragged mosses
+on the trees hang in wet festoons of gray, and look in the misty
+distance like numberless cascades. It rains at last, a solid down-pour;
+certain tree-trunks grow black, and the shining beech and birch and
+poplar get a more vivid silver on their wet boles. The water is black
+like ink. It is no longer even translucent, and overhead the red
+scourges of the lightning fly, and the great thunder-roar of smitten
+clouds rolls over us from hill to hill.
+
+All these details you teach her and more, and paddle home with a mental
+cargo of fresh joys and delicious memories. My young friend is
+intelligent and clever, but she has never learned to observe. If she
+wants to know how, there is a book will help her. Let her take with her
+Ruskin's "Modern Painters." It will teach her much, not all. Nor do I
+know of any other volume which will tell her more.[13] Despite its
+faults, it has so many lessons in the modes of minute study of outside
+nature that it becomes a valuable friend. Although ostensibly written to
+aid artistic criticism, it does far more than this and yet not all.
+Other books which might seem desirable are less so because they are
+still more distinctly meant to teach or assist artists or amateurs. What
+is yet wanted is a little treatise on the methods of observing exterior
+nature. Above all it should be adapted to our own woods, skies, and
+waters. What to look for as a matter of pleasure, and how to see and
+record it, is a thing apart from such observation as leads to
+classification, and is scientific in its aims. It is somewhat remote
+also from the artist's study, which is a more complex business, and
+tends to learn what can be rendered by pencil or brush and what cannot.
+Its object at first is merely to give intelligent joy to the senses, to
+cultivate them into acuteness, and to impress on the mind such records
+as they ought to give us at their best.
+
+[Footnote 13: "Frondes Agrestes," Ruskin, is a more handy book than
+"Modern Painters," but is only selections from the greater volumes
+recommended. "Deucalion" is yet harder reading, but will repay the
+careful reader.]
+
+Presuming the pupil to be like myself, powerless to use the pencil, she
+is to learn how to put on paper in words what she sees. The result will
+be what I may call _word-sketches_. Observe these are not to be for
+other eyes. They make her diary of things seen and worthy of note.
+Neither are they to be efforts to give elaborate descriptions. In the
+hands of a master, such use of words makes a picture in which often he
+sacrifices something, as the artist does, to get something else, and
+strives chiefly to leave on the mind one dominant emotion just as did
+the scene thus portrayed. A few words may do this or it may be an
+elaborate work. The gift is a rare and great one. The word-paintings of
+Ruskin hang forever in one's mental gallery, strong, true, poetical, and
+capable of stirring you as the scenes described would have done, nay,
+even more, for a great word-master has stood interpretative between you
+and nature.
+
+Miss Brontë was mistress of this art. Blackmore has it also. In some
+writers it is so lightly managed as to approach the sketch, and is more
+suggestive than fully descriptive. To see what I mean read the first few
+chapters of "Miss Angel," by Anna Thackeray. But a sketch by a trained
+and poetical observer is one thing; a sketch by a less gifted person is
+quite another. My pupil must be content with the simplest, most honest,
+unadorned record of things seen. Her training must look to this only.
+
+What she should first seek to do is to be methodical and accurate and by
+and by fuller. If wise she will first limit herself to small scenes, and
+try to get notes of them somewhat in this fashion. She is, we suppose,
+on the bank of a stream. Her notes run as follows:
+
+Date, time of day, place. Hills to either side and their character; a
+guess at their height; a river below, swift, broken, or placid; the
+place of the sun, behind, in front, or overhead. Then the nature of the
+trees and how the light falls on them or in them, according to their
+kind. Next come color of wave and bank and sky, with questions as to
+water-tints and their causes. Last of all, and here she must be simple
+and natural, what mood of mind does it all bring to her, for every
+landscape has its capacity to leave you with some general sense of its
+awe, its beauty, its sadness, or its joyfulness.
+
+Try this place again at some other hour, or in a storm, or under early
+morning light, and make like notes. If she should go on at this pleasant
+work, and one day return to the same spot, she will wonder how much more
+she has now learned to see.
+
+Trees she will find an enchanting study. Let her take a group of them
+and endeavor to say on paper what makes each species so peculiar. The
+form, color, and expression of the boles are to be noted. A reader may
+smile at the phrase "expression," but look at a tattered old birch, or a
+silvery young beech-hole, "modest and maidenly, clean of limb," or a
+lightning-scarred pine. Tree-study has advantages because it is always
+within reach. The axe has been so ruthlessly wielded that you must go
+far into the woods to get the best specimens of the pine, and the
+forests about our Maine lakes and in the Adirondacks have been sadly
+despoiled of their aristocrats. To see trees at their savage best one
+must go South, and seek the white-oaks of Carolina, the cypress of
+Florida, but the parks of Philadelphia and Baltimore afford splendid
+studies, and so also do the mountains of Virginia. Private taste and
+enterprise is saving already much that will be a joy to our children. A
+noble instance is the great wild park with which Colonel Parsons has
+protected the Natural Bridge in Virginia. I saw there an arbor-vitæ said
+by botanists to be not less than nine hundred years old, a chestnut
+twenty-six feet in girth at the height of my shoulders, and oaks past
+praise. But trees are everywhere, and if my observant pupil likes them,
+let her next note the mode in which the branches spread and their
+proportion to the trunk. State it all in the fewest words. It is to be
+only a help to memory. Then she comes to the leaf forms and the mode in
+which they are massed, their dulness or translucency, how sunshine
+affects their brilliancy, as it is above or falls laterally at morn or
+eve. Perhaps she will note, too, on which the gray moss grows, and just
+in what forms, and how the mosses or lichens gather on the north side of
+trees and on what trees.
+
+I may help my pupil if, like an artist teacher, I give one or two
+illustrations, copied _verbatim_ from my note-books. The first was
+written next morning, as it is a brief record of a night scene.
+
+Time, July 21, 1887, 9 P.M. Ristigouche River, New Brunswick, Canada.
+Black darkness. Hill outlines nearly lost in sky. River black, with
+flashing bits of white rapid; banks have grayish rocks, and so seem to
+be nearer than the dark stream limits. Sky looks level with hill-tops.
+Water seems to come up close. Effect of being in a concave valley of
+water, and all things draw in on me. Sense of awe. Camp-fire's red glare
+on water. Sudden opening lift of sky. Hills recede. Water-level falls.
+This is a barren, unadorned sketch, but it seems to tell the thing.
+
+Or this, for a change. Newport. A beach. Time, August 1, 1887; 4 P.M.
+About me cleft rocks, cleavage straight through the embedded pebbles.
+Tones ruddy browns and grays. Gray beach. Sea-weed in heaps, deep pinks
+and purples. Boisterous waves, loaded with reddish seaweed, blue, with
+white crests, torn off in long ribbons by wind. Curious reds and blues
+as waves break, carrying sea-weed. Fierce gale off land. Dense fog, sun
+above it and to right. Everywhere yellow light. Sea strange dingy
+yellow. Leaves an unnatural green. Effect weird. Sense of unusualness.
+
+Of course, such study of nature leads the intelligent to desire to know
+why the cleaved rock shows its sharp divisions as if cut by a knife, why
+yellow light gives such strangeness of tints, and thus draws on my pupil
+to larger explanatory studies. So much the better.
+
+If when she bends over a foot-square area of mouldered tree-trunk, deep
+in the silence of a Maine wood, she has a craving to know the names and
+ways of the dozen mosses she notes, of the minute palm-like growths, of
+the odd toadstools, it will not lessen the joy this liliputian
+representation of a tropical jungle gives to her. Nor will she like less
+the splendor of sunset tints on water to know the secrets of the
+pleasant tricks of refraction and reflection.
+
+I do not want to make too much of a small matter. No doubt many people
+do this kind of thing, but in most volumes of travel it is easy to see
+that the descriptions lack method, and show such want of training in
+observation as would not be noticeable had their authors gone through
+the modest studies I am now inviting my pupil to make.
+
+Her temptation will be to note most the large, the grotesque, or the
+startling aspects of nature. In time these will be desirable as studies,
+but at first she must try smaller and limited sketches. They are as
+difficult, but do not change as do the grander scenes and objects. I
+knew a sick girl, who, bedfast for years, used to amuse herself with
+what her windows and an opera-glass commanded in the way of sky and
+foliage. The buds in spring-time, especially the horse-chestnuts, were
+the subject of quite curious notes, and cloud-forms an endless source of
+joy and puzzle to describe. One summer a great effort was made, and she
+was taken to the country, and a day or two later carried down near a
+brook, where they swung her hammock. I found her quite busy a week
+later, and happy in having discovered that the wave-curves over a rock
+were like the curves of some shells. My pupil will soon learn, as she
+did, that a good opera-glass is indispensable. Let any one who has not
+tried it look with such a glass at sunset-decked water in motion. I am
+sure they will be startled by its beauty, and this especially if the
+surface be seen from a boat, because merely to look down on water is to
+make no acquaintance with its loveliness. A scroll of paper to limit the
+view and cut out side-lights also intensifies color. The materials my
+pupil is to use are words, and words only. Constant dissatisfaction with
+the little they can tell us is the fate of all who use them. The
+sketcher, the great word-painter, and even the poet feels this when,
+like Browning, he seems so to suffer from their weakness as to be
+troubled into audacious employment of the words that will not obey his
+will, torment them as he may. Yet, as my pupil goes on, she will find
+her vocabulary growing, and will become more and more accurate in her
+use and more ingenious in her combination of words to give her meaning.
+As she learns to feel strongly--for she will in time--her love will give
+her increasing power both to see and to state what she sees, because
+this gentle passion for nature in all her moods is like a true-love
+affair, and grows by what it feeds upon.
+
+When we come to sketch in words the rare and weird effects, the storm,
+the sunsets that seem not of earth, the cascade, or the ravage of the
+"windfall," it is wise not to be lured into fanciful word-painting, and
+the temptation is large. Yet the simplest expression of facts is then
+and for such rare occasions the best, and often by far the most
+forceful.
+
+I venture, yet again, to give from a note-book of last year a few lines
+as to a sunset. I was on a steam-yacht awaiting the yachts which were
+racing for the Newport cup.
+
+August 6, time, sunset; level sea; light breeze; fire-red sun on
+horizon; vast masses of intensely-lighted scarlet clouds; a broad track
+of fiery red on water; three yachts, with all sail set, coming over this
+sea of red towards us. Their sails are a vivid green. The vast mass of
+reds and scarlets give one a strange sense of terror as if something
+would happen. I could go on to expand upon "this color such as shall be
+in heaven," and on the sails which seemed to be green, but for the
+purpose of a sketch and to refresh the traitor memory in the future, the
+lines I wrote are enough and are yet baldly simple.
+
+Out of this practice grow, as I have said, love of accuracy, larger
+insights, careful valuation of words, and also an increasing and more
+intelligent love of art in all its forms; nor will all these gains in
+the power to observe be without practical value in life.
+
+I trust that I have said enough to tempt others to try each in their way
+to do what has been for me since boyhood a constant summer amusement.