CHAPTER I.

THE MODERN MALADY.

THE MODERN MALADY;

Or, Sufferers from “Nerves.”

BY

CYRIL BENNETT,

AUTHOR OF “THE MASSAGE CASE,” ETC.

_WITH A PREFACE_

BY

HERBERT TIBBITS, M.D., F.R.C.P.E.,

FOUNDER OF THE WEST END HOSPITAL FOR DISEASES OF THE NERVOUS

SYSTEM, ETC.

“Absence of knowledge has for its inevitable fruit this result; that

the right exercise of our faculties leads, at first, not to true, but to false

conclusions. The only means whereby our progress in knowledge can

be made harmonious is in frankly recognising and accepting this law of

our life.”--JAMES HINTON.

LONDON:

EDWARD ARNOLD.

1890.

[_All rights reserved._]

PREFACE.

BY DR. TIBBITS.

I have been requested to write a Preface to the “Modern Malady,” and I

have pleasure in doing so, as it seems to me that the author, with whose

views I am in general agreement, has adequately and successfully carried

out a work, not over easy, but certainly wanted--_i.e._, an introduction

to public consideration, from a non-medical point of view, of a

condition of ill-health which is increasingly prevalent in all ranks of

society; which is as common in the slums of the East End as in the

mansions of the West; which incapacitates innumerable people (both men

and women) from the efficient discharge of the duties, and from the

proper enjoyment of the pleasures, of life; which undoubtedly often

owes its origin to injudicious medication; which is quite capable of

cure in certain ways which are not those generally adopted; and which is

still more capable of prevention.

The condition is technically called “Neurasthenia,” or “nerve-weakness.”

This is but a generic word, a convenient designation for a condition of

the nervous system, the symptoms of which vary widely; but beneath all

these symptoms, various as they may be, there is as their foundation a

condition of nerve-prostration and fatigue; and a permanent removal of

this condition is only brought about by keeping in mind a recollection

of its origin and directing treatment to the _fons et origo mali_; by

repairing, if only slightly damaged, by building up, if shattered, this

unfortunate nervous system. This state of ill-health used to be called

“Hysteria,” a name derived from an erroneous idea that there is a

special connection between the disease and a particular organ of the

body. It was even once thought that this organ moved about to various

parts of the body, and so caused the local symptoms; and various

nauseous drugs were given for centuries, on the theory that by their

offensive taste they would drive the wanderer back to its proper place.

It is also popularly supposed that “hysterical” people simulate their

symptoms and can control them if they wish. Both of these views are

quite wrong. The disease is a real disease, as truly a disease as is a

fever or an attack of bronchitis, and it is found in men as well as

women. In this connection I would ask, with Cyril Bennett, “Do the

majority of people know that they possess a nervous system at all? We

still hear educated persons talk of their nerves as if they were

something _spiritual_, as though nervous disorder were not a physical

disease.”

We should remember that the nervous system is one continuous structure,

and it is only the necessities of nomenclature and the ingenuity of

anatomists that have divided it into so many parts. It is as continuous

as is an oak tree with its various branches. The spinal cord and the

nerves are composed in varying proportions of the same materials as is

that part of the system which we call the brain: injury and disease

with them give rise to symptoms analogous to similar injury or disease

to the brain. Indeed, there are several brains,--some in the cord

itself, one in relation with the stomach and called the “abdominal

brain,”--but the intellect and perception reside only in that portion of

nervous material which is confined within the skull; injury there--in

addition to the symptoms common to injury in other parts--influencing

intellect, perception, and memory; and this is the only distinction.

Neurasthenia is especially prevalent, not only with members of certain

families (we all know people peculiarly liable to suffer from the

“nerves”), but certain races are more prone to it than others--the

French and American more than ourselves; and this fact must not be lost

sight of, nor the fact that the relatives of many of these

patients--probably afflicted themselves with a latent form of the same

condition--are frequently but ill-fitted to help the patient to

recovery, so that a temporary removal from their care is sometimes

advisable.

But prevention is better than cure, and this is best secured by healthy

hygienic, physical, mental, and moral surroundings,--by bestowing upon

the growing human plant a share of as intelligent a care as the gardener

bestows upon his grapes and his peaches; by no undue forcing, by no

undue straining, and by no undue school pressure; but by bodily

exercises in proportion to the strength of the body, and progressively

increased as the strength of the body increases, and by mental exercises

equally proportioned to the increasing mental strength, and not forced

beyond it; for the exercise of nerve-power is as fatiguing as that of

muscle-power, brings on the same feeling of exhaustion, and requires the

same recuperation by adequate food and rest.

So much for prevention: but when the nervous system _has_ broken

down--when the symptoms may vary from extreme mental and physical

exhaustion to that condition of what has been called “Death-trance,”

where the patient is apparently dead; that condition which has furnished

the theme for many a sensational story (but the most ghastly incidents

of fiction have been paralleled by authenticated facts)--then treatment

comes in. The less physic-drinking the better. As the late Sir William

Gull said, “Medicine was once given even for fractures. Disease is not

cured by drugs. It is the power of Nature that cures disease, and the

duty of the medical man is--not to give drugs--but to assist Nature.” So

spoke Sir William Gull; and Lord Coleridge, deciding a law case not long

since, said, “If you give a man drugs, you make him the arena of a

conflict of opposing poisons.”

The first thing to do, is to try to remove whatever defect in the

general health can be discovered. Then local treatment should be had

recourse to. One method of such treatment is that perfected by Weir

Mitchell of Philadelphia, and extensively carried out in this country

by Playfair, myself, and others. Stated generally, it consists, in

severe cases, in keeping the patient absolutely at rest in bed,

and obtaining the tonic influence of exercise by daily massage and

electricity,--_i.e._, skilled rubbing and kneading of the muscles, and

putting them in action by electricity. At the same time abundant food is

given in an easily digestible form. By this method the wearying effects

of fatigue are avoided and patients often recover rapidly. Skilled

massage and electrisation are essential. Without these, rest in bed will

probably convert the patient into a helpless invalid. This method has

been carried out extensively, and with marked success, for several years

past, at the West End School of Massage and Electricity, 67 Welbeck

Street, some of whose students have been sent to the Continent, India,

and the Colonies, there training other nurses, and becoming new centres

of usefulness.

But while upon this subject of massage, I would enter my earnest protest

against what is called “_isolation_,” and especially against any attempt

to “manage” a patient. As Cyril Bennett wrote in a former work, when a

doctor and a nurse think they are “managing” an invalid, nervous,

suffering woman, you may depend upon it that in nine cases out of ten

they are mis-managing her. The best physicians of the day are

remarkable, not more for their medical knowledge and skill, than for

their charm of manner, their human kindness, their warm sympathy with

suffering. The wise physician is the family friend, the trusted adviser,

the counsellor and comforter in many a trouble and anxiety: and so also

with the nurse. She should possess the _sensitive_ rather than the

_strong_ hand, and refinement, patience, tact, and sympathy.

In certain cases of nervous disease, great benefit is derived from the

use alone, and without massage, of the variety of electricity called

“Franklinism,” after the illustrious philosopher and statesman who so

carefully studied it. We have all heard the story of the thunder-cloud,

the kite, the key tied to the kite-string; Franklin’s disappointment

that he obtained no electricity; its coming on to rain, and by wetting

the string making it a conductor; and his delight at being able to draw

sparks--real miniature flashes of lightning--from the key with his

knuckles. This form of electricity has been little used until a short

time since, owing to certain inconveniences in its application; but

recent improvements in the manufacture of instruments have largely

removed these inconveniences, and placed at our service a remedy of

great promise, and in some cases of unequalled value.

The thanks of the medical profession are due to “Cyril Bennett” for a

sagacious, though not unkindly, criticism upon the more common methods

of treatment of that distressing affection, the “Modern Malady;” and in

indicating from a medical standpoint the opinions of a neurologist, I

venture to hope that the views of the author, who has so skilfully

sketched its salient features, may have received some support.

Finally, I would say that the day for the routine treatment of disease

has gone by, and progress of the most important character is being made

in the study of diet, exercise, sleep, rest, the application of water,

cold and hot, and many other agencies; and it has been well said that if

in the future, as in the past, nervous diseases are to be the measure of

our civilisation; if every increase in the illuminating power of the

mind is but an increase of surface to be eclipsed; if all new modes of

action of nerve-force are to be so many added pathways to sorrow; if

each fresh discovery or invention is to be matched by some new malady of

the nerves; we yet have this assurance, that science, with keen eyes and

steps that are not slow, is seeking and is finding means of prevention

and relief.

HERBERT TIBBITS.

AUTHOR’S PREFACE.

In the first part of this work I have dwelt on the errors in our mode of

treating Neurasthenia, consequent on the wide ignorance of the subject

which still prevails; in the second part, I have drawn attention to the

principal causes of the malady. The allegory forming the Introduction to

Part I. gives a brief history of nervous exhaustion and the modes of

treatment which have at various times been thought suitable to this most

painful and trying disease.

A friend, to whom I read the Introduction, criticised the quotation with

which I have concluded it. She objected that I thereby gave too high a

place to mere knowledge. I replied that I referred to the highest kind

of knowledge. This argument, however, fails to satisfy those who

persistently remind one of Eve’s transgression. In my humble opinion,

the point of that great and instructive history has always been missed.

Adam and Eve were cast out of Eden for eating of the tree of knowledge,

but if they had not been cast out of Eden, how could they have been

received into heaven? It was necessary to eat of the tree of knowledge

in order to desire to eat of the tree of life.

Again, before we can even desire to eat of the tree of knowledge, we

must be ignorant; and thus we see our ignorance itself to be a needed

stage in our upward evolution. We see in a glass darkly; we must become

fools that we may be wise. In our imperfect condition we do but catch

brief glimpses and fleeting shadows of the one mighty Truth. Just as our

nervous system must waste that it may be nourished, as the pendulum must

fall on the one side that it may rise on the other,[1] so must our

ignorance precede our half-knowledge, and our half-knowledge precede the

fuller revelation.

It is almost needless to add that I am oppressed with a sense of my own

incapacity for the task which I have here undertaken. But the most

ignorant may teach something to the most learned, if he go through life

by a different path. My only hope is that, in dealing with a subject

about which so little is known, even my observations--conscientious as

they are, however faulty--may be of some slight use to the community to

which I owe so much.

In preparing this work for the press, I have had the advantage of Mr.

Horace Hutchinson’s kind and generous assistance.

C. B.

CONTENTS.

_PART I._

Our Nerves and their Ill-Treatment.

CHAP. PAGE

I. INTRODUCTION 23

II. A THIEF IN THE NIGHT 37

III. INEFFECTUAL TREATMENT 47

IV. ERRONEOUS NOTIONS 70

V. OBSERVATION 85

_PART II._

The Causes of Neurasthenia.

VI. INTRODUCTION 101

VII. HEREDITY 104

VIII. IMPERFECTIONS OF OUR SOCIAL SYSTEM 121

IX. AN IMPERFECT SYSTEM OF EDUCATION 142

X. SECONDARY CAUSES OF NERVE-DETERIORATION 161

_PART I._

Our Nerves and their Ill-Treatment.

“None shall rule but the humble.”--EMERSON.

Dedicated

TO THE

_MEDICAL MEN, NURSES, AND OTHERS_,

WHO, BY THEIR GENEROUS ASSISTANCE,

HAVE SO LARGELY CONDUCED TO THE SUCCESS OF THE AUTHOR’S

LABOURS

AMONGST OUR EPILEPTIC AND NEURASTHENIC POOR.

CHAPTER I.

_INTRODUCTORY._

Once there lived a race of men blest with very strong eyesight--so

strong that they were unconscious of possessing sight at all, but

accepted their marvellous endowment as a matter of course. These men

were hunters, who lived on the birds and beasts they shot with their

bows and arrows.

After a time our hunters learnt other arts besides that of the chase;

various implements were invented; industries such as spinning and

weaving were established; the primitive huts and sheds were discarded,

and commodious dwellings rose in their place. But their progress was not

unattended by serious disadvantages. For instance, the weavers, who

passed a great deal of their time indoors, began to lose the strength

and keenness of eyesight enjoyed by those who followed the chase.

At first little attention was paid to this calamity, but when some of

the weavers went blind and became a burden on the rest of the community,

a meeting was convened in the council-chamber called Public Opinion, the

most influential members of the tribe were consulted, and certain

conclusions were arrived at.

To be brief, it was decided that the malady in question was nothing more

nor less than a special manifestation of the Evil One, and that the

prompt execution of the sufferers was the only sure means of preventing

the spread of his power. It was therefore decreed that these uncanny and

mischievous weavers should at once be put to death. To ensure the

conviction of all suspected parties, a mode of trial was ordered which

had the advantage of being as efficacious as it was painful. So

everything seemed to be made quite safe and comfortable, and the spirits

of the tribe improved.

In spite of these excellent arrangements, however, some of the invalids

contrived to escape the doom thus thoughtfully prepared for them. It so

happened that certain of the community, who had not been invited to vote

at the meeting, held firmly to the belief that, so far from being

possessed by the Evil One, these dreaded weavers were divinely inspired.

Just because those whose sight was impaired could not see to do the work

which was close to their eyes, their advocates credited them with the

ability to discern things which were beyond the range of the most

powerful vision. They therefore protected the sufferers from trial and

honoured them with superstitious awe.

The disabled weavers had themselves done much to promote the conflicting

beliefs concerning them. When forced by growing blindness to abandon

their trade, they had been glad enough to make a livelihood by seemingly

exercising their supposed supernatural vision, and thus to escape from

reproach on the score of idleness; not anticipating that they would but

lay themselves open to suspicion of demon-fostering. In fact, they were

often self-deceived, for the disease exercised a peculiar effect on the

optic nerve, causing them, when they closed their eyes, to see before

them a variety of colours and forms which had no objective existence,

but which they frequently mistook for Divine revelation.

Time passed on. Notwithstanding the extreme measures taken to extirpate

the malady, it spread widely and increased in severity. Again the matter

was investigated, and again a meeting was convened.

This august assembly took a different view of the state of affairs from

that which had decreed the death of the sufferers. The former enactments

were repealed. Indeed, they were declared to be barbarous and unworthy

of the community which had so long tolerated them. With singular

unanimity it was agreed that the sufferers were really afflicted with

some incapacitating disease, the nature of which it was impossible to

discover, and for which it was vain to seek a cure. It was supposed to

originate in obscure injuries to the arms and legs, but on this point

there was difference of opinion. It never occurred to anybody that the

malady could have anything to do with impairment of the sight.

The ultimate decision of the court was to the effect that the suffering

weavers were to be relieved from the necessity of working for their

bread; that they should be permitted to remain a burden on the

community; that they should be kept within doors and tended as cripples,

and that surgeons should visit them and bandage their legs and arms.

These changes met with universal approval. The more humane members of

the tribe, who had shuddered at the former barbarities, were convinced

that the millennium had arrived, while the sufferers themselves accepted

their fate willingly enough. For though it was dull work to be kept

indoors with bandaged limbs, it was infinitely preferable to the hatred

and scorn of those around them, to say nothing of a violent and painful

death; and though many of them at first wished to use their limbs and

to take exercise in the open air on the days when there was no glare to

hurt their weak eyes, inactivity was less irksome than constant and

futile efforts to fulfil their tasks.

So, at first, every one was contented with the new decisions. True, all

the sufferers died sooner or later in a crippled condition, after a more

or less miserable and monotonous existence; but this unhappy result was

regarded as inevitable, and no further cure was sought for. Even the

invalids themselves came to attribute their bodily helplessness to their

original complaint, and not to the total disuse and tight bandaging

prescribed by the court.

Years went by, and brought no relief either to the disabled weavers or

to those who maintained them. On the contrary, the disease continued to

increase with frightful rapidity. All classes of the community--which

had, for the most part, abandoned its outdoor pursuits--were attacked in

turn. Further investigations were made as to the cause of the calamity;

a third meeting was convened, and definite conclusions were arrived at.

These, in some respects, showed more knowledge than the conclusions of

the second meeting. At the same time they showed less humanity. It

seemed as though the pendulum of human feeling had swung violently in

the direction of intolerance, then in the direction of tolerance,

returning once more, not quite to its former position, but to one far

beyond the mean of wisdom and moderation. Possibly the pendulum, in its

oscillations, would repeatedly pass and repass this mean point, till its

range should grow more and more limited, and it should at length find

repose.

The third meeting fully recognised many of the follies and absurdities

of its predecessors. Powerful speakers and keen investigators argued

with great force and clearness that the incapacity of the sufferers

arose entirely from disuse of the limbs, and not from disease. By some

of the speakers, this disuse was attributed--with a singular momentary

forgetfulness of past decrees--to the wicked deceit of the idle, and of

the friends who had solicited public charity in their behalf. The whole

community--so these excellent, well-meaning members insisted--had been

systematically gulled by the devices of impostors. There was nothing in

the world the matter with the disabled weavers and those whom they had

infected by their example. They must be forced to behave as if they were

well, and well they would become. No doubt their eyes were weak. Whose

eyes would not be weak after years of confinement within doors? Blazing

sunlight and constant use of eyes and limbs would soon cure their

fancies, and these infallible remedies must be prescribed for them at

once.

Such cogent common-sense arguments could not but meet with the approval

they deserved to meet with in the minds of the common-sense people who

heard them. The recommendations of the speakers were promptly adopted.

And now ensued a very singular state of affairs. By command of the

court, all invalids disabled by no visible and well-known disorder, were

forced to rise from their couches, to drag themselves about in the

blazing sunlight, and even to resume their former occupations. Some of

them, however, succeeded in simulating well-known disorders of the limbs

so cleverly, that they were considered, even by skilled investigators,

to be victims of chronic disease, and were mercifully left alone. Others

had already been partially cured by the complete rest from their labours

they had long enjoyed, and though the rough treatment they received, and

the trying effects of sudden exposure to light, caused them great

discomfort, they now learnt for the first time that they had recovered

the use of their eyes--long incarceration in dark rooms having prevented

their discovering the fact sooner. This result, however satisfactory to

themselves, was a source of infinite misery to their companions in

affliction, for it was hastily assumed that a mode of procedure which

had proved in the main efficacious with a few, must prove equally

efficacious with all.

True, some of the patients went altogether blind the moment they were

interfered with, and had to be conveyed to the blind asylum--in

accordance with the custom of the country--to be kept there for the rest

of their lives at the public expense. Some even developed real diseases

of the limbs, in consequence of their unaccustomed efforts to take

violent exercise. But these occasional failures by no means daunted the

resolution of philanthropic legislators. How could there be such a thing

as disease of the eyes while their own eyes were strong? With blindness

they were unhappily too well acquainted, even though they had never been

blind themselves; for when a man could not see at all, the fact could

readily be ascertained. But it was evident that so long as a man could

see, he was not blind, and therefore to treat him for loss of sight

would be absurd.

The larger number of those for whom work and sunlight were prescribed

neither lost their sight completely nor recovered it sufficiently to

perform their allotted tasks in even the most perfunctory manner. The

existence led by these unhappy people was miserable in the extreme.

Every effort to use the eyes was painful. The glare of the sunlight was

a torture baffling description. And their sufferings were not physical

only. Their fellow-men, including their nearest and dearest friends, did

their utmost to convince them of the illusory nature of their disease,

and continually implored them to exert their wills to overcome

temptations to imposture. By the more unfeeling, sneers and reproaches

were not spared. In sheer despair the less courageous of these

unfortunates died by their own hand.

Oddly enough, those who were the most uncompromising in their

discouragement of supposed impostors had themselves recently become

painfully conscious of impairment of vision. Fear of discovery made them

loud in denouncing others; ignorance of the nature of the malady gave

them hope that work and sunlight might conduce to their own cure. In

time, there were in that eccentric community an abundance of deceivers

of two different orders: the first pretending an illness other than that

which afflicted them; the second pretending to be well when they were

ill. It is said that the second class was larger than the first, and

that recruits were continually swelling its ranks.

Altogether, in spite of the well-intentioned efforts of the

investigators, the state of that tribe with regard to eye-disease was

very much worse than it had been while the regulations of the second

meeting were in force.

But, as the night is darkest immediately before the dawn, so, just as

things looked blackest, there came a change for the better. It chanced

that certain patients suffering from injuries to the limbs found their

eyesight much affected by the illness, and were rashly credited with

imposture. The injuries were declared to be wholly imaginary, and the

usual moral discipline was resorted to in order to cure the patients of

their delusion. Consequently, some of them were hopelessly crippled,

while others, who ultimately recovered the use of their limbs, were

blind for the rest of their days.

And now there was a panic in that hitherto contented community. Fears

were entertained that real disease (eye-weakness was not yet regarded

as actual illness) should frequently be overlooked in the midst of the

general craze for extirpating imposture. The continued increase in the

number of mysterious invalids occasioned anxious questioning on all

sides. The crippled patients seized the opportunity to complain loudly

of the usage they had received. Notwithstanding the remonstrances of the

more fortunate, they insisted on repeating, to all who would hear them,

the whole category of their woes. They never tired of declaring that

they had been cruelly and unjustly crippled, and that the eye-weakness

with which they had been temporarily afflicted was a terrible and

unmistakable malady, more painful even than injuries to the limbs, and

more urgently needing rational treatment.

So overwhelming was this evidence, so vehement were the witnesses, that

public attention was perforce called to their grievances. Further

investigations were made; further inquiries were diligently prosecuted;

and a fourth meeting was convened.

That meeting is still going on. Day after day the discussions are

resumed; day after day final judgment is deferred. The causes, nature,

and cure of the alarmingly prevalent eye-disease are all earnestly

debated. The ultimate decision of the court cannot be doubted. Sooner or

later it will be recognised that the great epidemic is a disease like

any other, to be treated with kindly consideration--to be cured, to be

prevented. Learned investigators, while admitting that their

examinations can discover no trace of disease in the eyes of the

sufferers, admit likewise that their failure is no argument whatever

against its existence. Pending the final judgment of the court, all

former cruel enactments have been repealed, and over the door of the

council-chamber have been inscribed these words, “Ignorance is the curse

of God. Knowledge is the wing on which we fly to heaven.”