meiou 0.1.8 → 0.1.9

data/_books/Doctor_and_Patient.txt

@@ -1,3261 +0,0 @@
-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.