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.