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.