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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/14901-8.txt b/14901-8.txt new file mode 100644 index 0000000..2866ee7 --- /dev/null +++ b/14901-8.txt @@ -0,0 +1,5309 @@ +Project Gutenberg's Epilepsy, Hysteria, and Neurasthenia, by Isaac G. Briggs + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Epilepsy, Hysteria, and Neurasthenia + +Author: Isaac G. Briggs + +Release Date: February 4, 2005 [EBook #14901] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK EPILEPSY, HYSTERIA, AND NEURASTHENIA *** + + + + +Produced by Martin Agren, Keith Edkins and the PG Online Distributed +Proofreading Team. + + + + + + EPILEPSY, HYSTERIA, + AND NEURASTHENIA + + THEIR CAUSES, SYMPTOMS, & TREATMENT + + BY + ISAAC G. BRIGGS + A.R.S.I. + + METHUEN & CO. LTD. + 36 ESSEX STREET W.C. + LONDON + + _First Published in 1921_ + + * * * * * + + TO + ALBERT E. WOODRUFF + OF STOKE PRIOR + NR. BROMSGROVE + MY OLD + SCHOOLMASTER + + * * * * * + + CONTENTS + + CHAPTER PAGE + + PREFACE ix + + I. MAJOR AND MINOR EPILEPSY 1 + + II. RARER TYPES OF EPILEPSY 7 + + III. GENERAL REMARKS 15 + + IV. CAUSES OF EPILEPSY 20 + + V. PREVENTION OF ATTACKS 25 + + VI. FIRST-AID TO VICTIMS 28 + + VII. NEURASTHENIA 30 + + VIII. HYSTERIA 39 + + IX. ADVICE TO NEUROPATHS 46 + + X. FIRST STEPS TOWARD HEALTH 53 + + XI. DIGESTION 56 + + XII. INDIGESTION 60 + + XIII. DIETING 63 + + XIV. CONSTIPATION 67 + + XV. GENERAL HYGIENE 71 + + XVI. SLEEPLESSNESS 76 + + XVII. THE EFFECTS OF IMAGINATION 79 + + XVIII. SUGGESTION TREATMENT 82 + + XIX. MEDICINES 86 + + XX. PATENT MEDICINES 90 + + XXI. TRAINING THE NERVOUS CHILD 98 + + XXII. DANGERS AT AND AFTER PUBERTY 109 + + XXIII. WORK AND PLAY 115 + + XXIV. HEREDITY 118 + + XXV. CHARACTER 123 + + XXVI. MARRIAGE 131 + + XXVII. SUMMARY 140 + + BIBLIOGRAPHY 142 + + INDEX 145 + + * * * * * + +PREFACE + +I hope this book will meet a real need, for when one considers how +prevalent epilepsy, hysteria and neurasthenia are, among all ranks and ages +of both sexes, it seems remarkable some such popular book was not written +long ago. + +I add nothing to our knowledge of these ills, my object being to put what +we know into simple words, and to insist on the necessity for personal +discipline being allied to expert aid. The book aims at helping, not +ousting, the doctor, who may find it of use in getting his patient to +see--and to act on--the obvious. + +"Nervous Disease", as here used, includes only the three diseases treated +of; "Neuropath"--victims of them. + +"Advice" to a neuropath is usually a very depressing decalogue of "Thou +Shalt Nots!" If it be made clear _why_ he must _not_ do so-and-so, the +patient endeavours to obey; peremptorily ordered to obey, he rebels. Much +sound advice is wasted for lack of an interesting, convincing, "Reason +Why!" which would ensure the hearty and very helpful co-operation of a +patient who had been taught that writing prescriptions is not the limit of +a doctor's activities. + +Many folk, with touching belief in his own claims, regard the quack as a +hoary-headed sage, who from disinterested motives devotes his life to +curing ailments, by methods of which he alone has the secret, at low fees. +To fight this dangerous idea I have tried to show in an interesting way how +science deals with nerve ills, and to prove that qualified aid is needed. +Suggestions and criticisms will be welcomed. + + I. G. BRIGGS + THE UNIVERSITY, + BIRMINGHAM, + _June_, 1921 + + * * * * * + +"Lette than clerkes enditen in Latin, for they have the propertie of +science, and the knowing in that facultie: and lette Frenchmen in their +Frenche also enditen their queinte termes, for it is kyndely to their +mouthes; and let us showe our fantasies in soche wordes as we lerneden of +our dames tongue." + +--Chaucer. + + * * * * * + +EPILEPSY, HYSTERIA, +AND NEURASTHENIA + + * * * * * + +CHAPTER I + +MAJOR AND MINOR EPILEPSY + +(_Grand and Petit Mal_) + +"My son is sore vexed, for ofttimes he falleth into the fire, and ofttimes +into the water."--Matthew xvii, 15. + + "Oft, too, some wretch before our startled sight, + Struck as with lightning with some keen disease, + Drops sudden: By the dread attack o'erpowered + He foams, he groans, he trembles, and he faints; + Now rigid, now convuls'd, his labouring lungs + Heave quick, and quivers each exhausted limb. + + * * * * * + + "He raves, since Soul and Spirit are alike + Disturbed throughout, and severed each from each + As urged above, distracted by the bane; + But when at length the morbid cause declines, + And the fermenting humours from the heart + Flow back--with staggering foot first treads + Led gradual on to intellect and strength."--Lucretius. + +Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervous +system, evinced by attacks of _alteration of consciousness_, usually +accompanied by convulsions. + +It attacks men of every race, as well as domesticated animals, and has been +known since the earliest times, the ancients imputing it to demons, the +anger of the gods, or a blow from a star. + +It often attacks men in crowds, when excited by oratory or sport, hence the +Roman name: _morbus comitialis_ (crowd sickness). + +In mediæval times, sufferers were regarded with awe, as being possessed by +a spirit. Witch doctors among savages, and founders and expounders of +differing creeds among more civilized peoples, have taken advantage of this +infirmity to claim divine inspiration, and the power of "seeing visions" +and prophesying. + +Epilepsy has always interested medical men because of its frequency, the +difficulty of tracing its cause, and its obstinacy to treatment, while it +has appealed to popular imagination by the appalling picture of bodily +overthrow it presents, so that many gross superstitions have grown up +around it. + +The description in Mark ix. 17-29, is interesting: + + "Master, I have brought Thee my son, which hath a dumb spirit. And + wheresoever he taketh him, he teareth him: and he foameth, and gnasheth + with his teeth, and pineth away: ... straightway the spirit tare him; + and he fell on the ground, and wallowed foaming. + + "And He asked his father, How long is it ago since this came unto him? + And he said, Of a child. And ofttimes it hath cast him into the fire, + and into the waters, to destroy him. + + "And he said unto them, This kind can come forth by nothing, but by + prayer and fasting." + +Up to the present, epilepsy can be ascribed to no specific disease of the +brain, the symptoms being due to some morbid disturbance in its action. +Epilepsy is a "functional" disease. + +GRAND MAL ("_Great Evil_") + +An unusual feeling called an _aura_ (Latin--vapour), sometimes warns a +patient of an impending fit, commonly lasting long enough to permit him to +sit or lie down. This is followed by giddiness, a roaring in the ears, or +some unusual sensation, and merciful unconsciousness. In many cases this +stage is instantaneous; in others it lasts some seconds--but an eternity to +the sufferer. This stage is all that victims can recall (and this only +after painful effort) of an attack. + +As unconsciousness supervenes, the patient becomes pale, and gives a cry, +which varies from a low moan to a loud, inhuman shriek. The head and eyes +turn to one side, or up or down, the pupils of the eyes enlarge and become +fixed in a set stare, and the patient drops as if shot, making no effort to +guard his fall, being often slightly and sometimes severely injured. + +The whole body then becomes stiff. The hands are clenched, with thumbs +inside the palms, the legs are extended, the arms stiffly bent, and the +head thrown back, or twisted to one side. The muscles of the chest and +heart are impeded in their action, breathing ceases, the heart is slowed, +and the face becomes pale, and then a livid, dusky blue. + +The skin is cold and clammy, the eyebrows knit; the tongue may be +protruded, and bitten between the teeth. The eyeballs seem starting from +their sockets, the eyes are fixed or turned up, so that only the sclerotic +("whites") can be seen, and they may be touched or pressed without causing +blinking. The stomach, bladder, and bowels may involuntarily be emptied. + +This _tonic_ stage only lasts a few seconds, and is followed by +convulsions. The head turns from side to side, the jaws snap, the eyes +roll, saliva and blood mingle as foam on the lips, the face is contorted in +frightful grimaces, the arms and legs are twisted and jerked about, the +breathing is deep and irregular, the whole body writhes violently, and is +bathed in sweat. + +The spasms become gradually less severe, and finally cease. Deep breathing +continues for some seconds; then the victim becomes semi-conscious, looks +around bewildered, and sinks into coma or deep sleep. + + "...As one that falls, + He knows not how, by force demoniac dragg'd + To earth, and through obstruction fettering up + In chains invisible the powers of Man; + Who, risen from his trance, gazeth around + Bewilder'd with the monstrous agony + He hath indured, and, wildly staring, sighs: + ..." + +In a few hours he wakes, with headache and mental confusion, not knowing he +has been ill until told, and having no recollection of events just +preceding the seizure, until reminded of them when they are slowly, and +with painful effort, brought to mind. He is exhausted, and often vomits. In +severe cases he may be deaf, dumb, blind, or paralysed for some hours, +while purple spots (the result of internal hemorrhage) may appear on the +head and neck. Victims often pass large quantities of colourless urine +after an attack, and, as a rule, are quite well again within twenty-four +hours. + +This is the usual type, but seizures vary in different patients, and in the +same sufferer at different times. The cry and the biting of the tongue may +be absent, the first spasm brief, and the convulsions mild. Epilepsy of all +kinds is characterized by an _alteration_ (not necessarily a _loss_) of +consciousness, followed by loss of memory for events that occurred during +the time that alteration of consciousness lasted. + +Attacks may occur by day only, by day and by night, or by night only, +though in so-called nocturnal epilepsy, it is _sleep_ and not night that +induces the fit, for night-workers have fits when they go to sleep during +the day. + +Victims of nocturnal epilepsy may not be awakened by the seizure, but pass +into deeper sleep. Intermittent wetting of the bed, occasional temporary +mental stupor in the morning, irritability, temporary but well-marked +lapses of memory, sleep-walking, and causeless outbursts of ungovernable +temper all suggest nocturnal epilepsy. + +Such a victim awakes confused, but imputes his mental sluggishness to a +hearty supper or "a bad night". A swollen tongue, blood-stained pillow, and +urinated bed arouse suspicion as to the real cause, suspicion which is +confirmed by a seizure during the day. He is more fortunate (if such a term +can rightly be used of any sufferer from this malady) than his fellow +victim whose attacks occur during the day, often under circumstances which, +to a sensitive nature, are very mortifying. + +Epileptic attacks are of every degree of violence, varying from a moment's +unconsciousness, from which the patient recovers so quickly that he cannot +be convinced he has been ill, to that awful state which terrifies every +beholder, and seems to menace the hapless victim with instant death. Every +degree of frequency, too, is known, from one attack in a lifetime, down +through one in a year, a month, a week, or a day; several in the same +periods, to _hundreds_ in four-and-twenty hours. + +PETIT MAL ("_Little Evil_") + +This is incomplete _grand mal_, the starting stages only of a fit, recovery +occurring before convulsions. + +_Petit mal_ often occurs in people who do not suffer from _grand mal_, the +symptoms consisting of a loss of consciousness for _a few seconds_, the +seizure being so brief that the victim never realizes he has been +unconscious. He suddenly stops what he is doing, turns pale, and his eyes +become fixed in a glassy stare. He may give a slight jerk, sway, and make +some slight sound, smack his lips, try to speak, or moan. He recovers with +a start, and is confused, the attack usually being over ere he has had time +to fall. + +If talking when attacked, he hesitates, stares in an absent-minded manner, +and then completes his interrupted sentence, unaware that he has acted +strangely. Whatever act he is engaged in is interrupted for a second or +two, and then resumed. + +A mild type of _petit mal_ consists of a temporary _blurring_ of +consciousness, with muscular weakness. The victim drops what he is holding, +and is conscious of a strange, extremely unpleasant sensation, a sensation +which he is usually quite unable to describe to anyone else. The view in +front is clear, he understands what it is--a house here, a tree there, and +so on--yet he does not _grasp_ the vista as usual. Other victims have short +spells of giddiness, while some are unable to realize "where they are" for +a few moments. + +Frequent _petit mal_ impairs the intellect more than _grand mal_, for +convulsions calm the patient as a good cry calms hysterical people. After a +number of attacks of _petit mal, grand mal_ usually supervenes, and most +epileptics suffer from attacks of both types. Some precocious, perverse +children are victims of unrecognized _petit mal_, and when pushed at school +run grave risks of developing symptoms of true epilepsy. The "Little Evil" +is a serious complaint. + + * * * * * + +CHAPTER II + +RARER TYPES OF EPILEPSY + + If it be true that: "One half the world does not know how the other + half lives", how true also is it that one half the world does not know, + and does not care, what the other half suffers. + +Epilepsy shows every gradation, from symptoms which cannot be described in +language, to severe _grand mal_. Gowers says: "The elements of an epileptic +attack may be extended, and thereby be made less intense, though not less +distressing. If we conceive a minor attack that is extended, and its +elements protracted, with no loss of consciousness, it would be so +different that its epileptic nature would not be suspected. Swiftness is an +essential element of ordinary epilepsy, but this does not prevent the +possibility of deliberation." + +In Serial Epilepsy, a number of attacks of _grand mal_ follow one another, +with but very brief intervals between. Serial epilepsy often ends in + +_Status Epilepticus_, in which a series of _grand mal_ attacks follow one +another with no conscious interval. The temperature rises slowly, the pulse +becomes rapid and feeble, the breathing rapid, shallow and irregular, and +death usually occurs from exhaustion or heart-failure. Though not +invariably fatal, the condition is so very grave that a doctor must +instantly be summoned. Nearly all victims of severe, confirmed epilepsy (25 +per cent of all epileptics) die in _status epilepticus_. + +Jacksonian Epilepsy, named after Hughlings Jackson, who in 1861 traced its +symptoms to their cause, is not a true epilepsy, being due to a local +irritation of the cortex (the outermost layer) of the brain. + +There is usually an _aura_ before the attack, often a tingling or stabbing +pain. The chief symptoms are convulsions of certain limbs or areas of the +body, which, save in very severe cases, are confined to one side, and are +not attended by loss of consciousness. + +The irritation spreads to adjacent areas, as wavelets spread from a stone +thrown into a pond, with the result that convulsions of other limbs follow +in sequence, all confined to one side. + +As every part of the brain is connected to every other part by "association +fibres", in very violent attacks of Jacksonian epilepsy the irritation +spreads to the other side of the brain also, consciousness is lost, the +convulsions become general and bilateral, and the patient presents exactly +the same picture as if the attack were due to _grand mal_. + +All degrees of violence are seen. The convulsions may consist only of a +rapid trembling, or the limb or limbs may be flung about like a flail. + +Jackson said: "The convulsion is a brutal development of a man's own +movements, a sudden and excessive contention of many of the patient's +familiar motions, like winking, speaking, singing, moving, etc." These acts +are learned after many attempts, and leave a memory in certain groups of +brain cells; irritate those cells, and the memorized acts are performed +with convulsive violence. + +The convulsions are followed by temporary paralysis of the involved +muscles, but power finally returns. As we should expect, this paralysis +lasts longest in the muscles first involved, and is slightest in the +muscles whose brain-centres were irritated by the nearly exhausted waves. +If the disease be untreated, the muscles in time may become totally +paralysed, wasted, and useless. + +Friends should very carefully note exactly where and how the attack begins, +the exact part first involved, and the precise order in which the spasms +appear, as this is the only way the doctor can localize the brain injury. +The importance of this cannot be overrated. + +The consulting surgeon will say if operation is, or is not, advisable, but +_operation is the sole remedy for Jacksonian epilepsy_, for the causes that +underly its symptoms cannot be reached by medicines. + +Patients must consult a good surgeon; other courses are _useless_. + +Psychic or Mental Epilepsy is a trance-state often occurring after attacks +of _grand_ or _petit mal_, in which the patient performs unusual acts. The +epileptic feature is the patient's inability to recall these actions. The +complaint is fortunately rare. + +The face is usually pale, the eyes staring, and there may be a "dream +state". Without warning, the victim performs certain actions. + +These may be automatic, and not seriously embarrassing--he may tug his +beard, scratch his head, hide things, enter into engagements, find the +presence of others annoying and hide himself, or take a long journey. Such +a journey is often reported in the papers as a "mysterious disappearance". +Yet, had he committed a crime during this time, he would probably have been +held "fully responsible" and sentenced. + +The actions may be more embarrassing: breaking something, causing pain, +exhibiting the sexual organs; the patient may be transported by violent +rage, and abuse relatives, friends or even perfect strangers; he may spit +carelessly, or undress himself--possibly with a vague idea that he is +unwell, and would be better in bed. + +Finally the acts may be criminal: sexual or other assault, murder, arson, +theft, or suicide. + +In this state, the patient is dazed, and though he appreciates to some +extent his surroundings, and may be able to answer questions more or less +rationally, he is really in a profound reverie. The attack soon ends with +exhaustion; the victim falls asleep, and a few moments later wakes, +ignorant of having done or said anything peculiar. + +We usually think of our _mind_ as the aggregate of the various emotions of +which we are actually _conscious_, when, in reality, consciousness forms +but a small portion of our mentality, the _subconscious_--which is composed +of all our past experiences filed away below consciousness--directing every +thought and act. Inconceivably delicate and intricate mind-machinery +directs us, and our idlest fancy arises, _not by chance_ as most people +surmise, but through endless associations of subconscious mental processes, +which can often be laid bare by skilful psycho-analysis. + +Our subconscious mind does not let the past jar with the present, for life +would be made bitter by the eternal vivid recollection of incidents best +forgotten. Every set of ideas, as it is done with, is locked up separately +in the dungeons of subconsciousness, and these imprisoned ideas form the +basis of memory. _Nothing is ever forgotten_, though we may never again +"remember" it this side the grave. + +In a few cases we can unlock the cell-door and release the prisoner--we +"remember"; in some, we mislay the key for awhile; in many, the wards of +the lock have rusted, and we cannot open the door although we have the +key--we "forget"; finally, our prisoner may pick the lock, and make us +attend to him whether we wish to or not--something "strikes us". + +Normally, only one set of ideas (a complex) can hold the stage of +consciousness at any one time. When two sets get on the boards together, +double-consciousness occurs, but even then they cannot try to shout each +other down; one set plays "leading lady", the other set the "chorus belle" +and so life is rendered bearable. + +This "dissociation of consciousness" occurs in all of us. A skilled pianist +plays a piece "automatically" while talking to a friend; we often read a +book and think of other things at the same time: our full attention is +devoted to neither action; neither is done perfectly, yet both are done +sufficiently well to escape comment. + +Day-dreaming is dissociation carried further. "Leading lady" and "chorus +belle" change places for a while--imaginary success keeps us from worrying +about real failure. Dissociation, day-dreaming, and mental epilepsy are but +few of the many milestones on a road, the end of which is insanity, or +complete and permanent dissociation, instead of the partial and fleeting +dissociation from which we all suffer. The lunatic never "comes to", but in +a world of dreams dissociates himself forever from realities he is not +mentally strong enough to face. + +The writing of "spirits" through a "medium" is an example of dissociation, +and though shown at its best in neuropaths, is common enough in normal men, +as can be proved by anyone with a planchette and some patience. + +If the experimenter puts his hands on the toy, and a friend talks to him, +while another whispers questions, he may write more or less coherent +answers, though all the time he goes on talking, and does not know what his +hand is writing. His mind is split into two smaller minds, each ignorant of +the other, each busily liberating memory-prisoners from its own block of +cells in the gaol of the subconscious. The writing often refers to +long-forgotten incidents, the experiment sometimes being of real use in +cases of lost memory. + +Dreams are dissociations in sleep, while the scenes conjured up by +crystal-gazing are only waking dreams, in which the dissociation is caused +by gazing at a bright surface and so tiring the brain centres, whereupon +impressions of past life emerge from the subconscious, to surprise, not +only the onlookers to whom they are related, but also the gazer herself, +who has long "forgotten them". + +It is childish to attach supernatural significance to either dreams or +crystal-gazing, both of which mirror, not the future, but only the past, +the subject's own past. + +It is noteworthy that women dream more frequently and vividly than men. +When a dreamer has few worries, he usually dreams but forgets his dream on +waking; when greatly worried, he often carries his problems to bed with +him, and recent "representative dreams" are merely unprofitable overtime +work done by the brain. Occasionally, dreams have a purely physical basis +as when palpitation becomes transformed in a dream into a scene wherein a +horse is struggling violently, or where an uncovered foot originates a +dream of polar-exploration; in this latter type the dream is protective, in +that it is an effort to side-track some irritation without breaking sleep. + +Since Freud has traced a sex-basis in all our dreams, many worthy people +have been much worried about the things they see or do in dreams. Let them +remember that virtue is not an inability to conceive of misconduct, so much +as the determination to refrain from it, and it may well be that the +centres which so determinedly inhibit sexual or unsocial thoughts in the +day, are tired by the very vigour of their resistance, and so in sleep +allow the thoughts they have so stoutly opposed when waking to slip by. The +man who is long-suffering and slow to wrath when awake, may surely be +excused if he murders a few of his tormentors during sleep. + +Epileptiform Seizures are convulsions due to causes other than epilepsy, +and only a doctor can tell if an attack be epileptic or not and prescribe +appropriate treatment. To give "patent" medicines for "fits", to a man who +may be suffering from lead poisoning or heart disease, is criminal. + +Convulsions in Children often occur before or after some other ailment. +Such children need careful training, but less than 10 per cent of children +who have convulsions become epileptic. Epilepsy should only be suspected if +the first attack occurs in a previously healthy child of over two years of +age. There are many possible causes for infantile convulsions, and but one +treatment; call in a doctor _at once_, and, while waiting for him, put the +child in a warm bath (not over 100° F.) in a quiet, darkened room, and hold +a sponge wrung out of hot water to the throat at intervals of five minutes. +Never give "soothing syrups" or "teething powders". + +The "soothing" portion of such preparations is some essential oil, like +aniseed, caraway or dill, and there are often present strong drugs +unsuitable for children. According to the analyses made by the British +Medical Association, the following are the _essential_ ingredients of some +well-known preparations for children: + + Mrs. Winslow's Soothing Potassium Bromide, + Syrup. Aniseed, and Syrup + (sugar and water). + + Woodward's Gripe Sodium Bicarbonate, + Water. Caraway, and Syrup. + + Atkinson and Barker's Pot. and Magnesium + Royal Infant Bicarbonate, several + Preservative. Oils, and Syrup. + + Mrs. Johnson's American Spirits of Salt, Common + Soothing Syrup. Salt, and Honey. + +Convulsions During Pregnancy. Send for a doctor instantly. + +Feigned Epilepsy is an all-too-common "ailment". The false fit, as a rule, +is very much overdone. The face is red from exertion instead of livid from +heart and lung embarrassment, the spasms are too vigorous but not jerky +enough, the skin is hot and dry instead of hot and clammy, the hands may be +clenched, but the thumb will be _outside_ instead of _inside_ the palm, +foam comes in volumes but is unmixed with blood, and the whole thing is +kept up far too long. Almost before a crowd can gather an epileptic seizure +is over, whereas the sham sufferer does not begin seriously to exhibit his +questionable talents until a crowd has appeared. + +Pressure on the eye, which will blink while the "sufferer" will swear; +bending back the thumb and pressing in the end of the nail, when the hand +will be withdrawn in feigned but not in true epilepsy; blowing snuff up the +nose, which induces sneezing in the sham fit alone, or using a cold douche +will all expose the miserable trick. + +It is, unfortunately, far easier to suggest than to apply these tests, for +anyone foolish enough to try experiments within reach of the wildly-waving +arms will probably get such a buffet as will damp his ardour for amateur +diagnosis for some time. + + * * * * * + +CHAPTER III + +GENERAL REMARKS + + "Do not muse at me, my most worthy friends; + I have a strange infirmity, which is nothing + To those that know me." + "Macbeth," Act III. + +Starr's table shows that combinations of all types of epilepsy are +possible, and that mental epilepsy is rare: + + Grand mal 1150 + Grand and petit mal 589 + Petit mal 179 + Jacksonian 37 + Mental 16 + Grand mal and Jacksonian 10 + Grand mal, petit mal and Jacksonian 8 + Grand mal and mental 3 + Grand mal, petit mal and mental 6 + Petit mal and mental 2 + Fits by day only 660 + Fits day and night 880 + Fits by night only 380 + +The majority of victims have attacks both by day and by night. Of 115,000 +seizures tabulated by Clark, 55,000 occurred during the day (6 a.m. to 6 +p.m.) and 60,000 by night. + +The _usual course_ of a case of epilepsy is somewhat as follows: the +disease begins in childhood, the first convulsion, about the age of three, +being followed some twelve months later by a second, and this again by a +third within a few months. Then attacks occur more frequently until a +regular periodicity--from one a day to one a year--is reached after about +five years, and this frequently persists throughout life. + +The effect of epilepsy on the general health is not serious, but it has a +more serious effect on the mind, for epileptic children cannot go to school +(though special schools are now doing something towards removing this +serious disability), and grow up with an imperfect mental training. They +become moody, fretful, ill-tempered, unmanageable, and at puberty fall +victims to self-abuse, which helps to lead to neurasthenia. Then they may +drift slowly into a state of mental weakness, and often require as much +care as imbeciles. If the fits are severe from an early age, arrest of +mental development and imbecility follow. If the disease be very mild in +character, and especially if it be _petit mal_, the victim may be very +precocious, get "pushed" at school, and later become eccentric or insane. + +Adult victims necessarily lead a semi-invalid life, often cut off from +wholesome work and from the pleasures of life, and become hypersensitive, +timid, impulsive, forgetful, irritable, incapable of concentration, +suspicious, show evidences of a weakened mind, have few interests, and are +difficult to manage. + +About 10 per cent--the very severe cases--go on to insanity; either +temporary attacks of mania, calling for restraint, or permanent epileptic +dementia with progressive loss of mind. Some victims are accidentally +killed in, or die as a result of a fit; about 25 per cent--severe cases +again--die in _status epilepticus_, but the majority after being sufferers +throughout life are finally carried off by some other disease. + +There are many exceptions to this general course. Some patients have +attacks very infrequently, and are possessed of brilliant talent, though +apt to be eccentric. Others may have a number of seizures in youth, and +then "outgrow" the complaint. + +A few victims are attacked only after excessive alcoholic or sexual +indulgence, some women only during their menses, while other women are free +from attacks during pregnancy, which state, however (contrary to popular +belief), commonly aggravates the trouble. Victims may be free from attacks +during the duration of, and for some time after, an infectious disease; +while Spratling says that a consumptive epileptic may have no fits for +months, or even years. + +Some epileptics are normal in appearance, but many show signs of +degeneration. This is common in the insane, but less frequent and +pronounced in neurasthenics. An abnormal shape of the head or curvature of +the skull, a high, arched palate, peculiarly-shaped ears, unusually large +hands and feet, irregular teeth from narrow jaws, a small mouth, unequal +length and size of the limbs, a projecting occiput, and poor physical +development may be noted. + +These are most pronounced in intractable cases, in whom mental +peculiarities are most frequently seen--either dullness, stupidity and +ungovernable temper, or very marked talent in one direction with as marked +an incapacity in others. In all epileptics, the pupils of the eye are +larger than normal, and, after contracting to bright light soon enlarge +again. + +The facial expression of most epileptics indicates abnormal mentality. When +the seizures have been so frequent and severe as to cause mental decay, the +actions are awkward, and the gait slouching and irregular. Progressive poor +memory is one of the first signs of intellectual damage consequent upon +severe epilepsy. + +Though the disease may occur at any age, most cases occur before the age of +twenty, there being good reason to look for other causes (often syphilis) +in cases which occur after that age. Of 1,450 of Gowers' cases, 30 per cent +commenced before the age of ten; 75 per cent before twenty. In Starr's +2,000 cases, 68 per cent commenced before the patient was twenty-one. + +According to Turner, the first epoch is from birth to the age of six, +during which 25 per cent of all cases commence, usually associated with +mental backwardness, and some due to organic brain trouble. The second +epoch is ten to twenty-two, the time of puberty and adolescence, during +which time no less than 54 per cent of all cases commence. This is, _par +excellence_, the age of onset of genuine epilepsy, the mean age of maximum +onset being fourteen in men and sixteen in women. The remaining 21 per cent +of cases occur after the age of twenty-two. + +In 430 cases of epilepsy in children, Osler found that 230 were attacked +before they reached the age of five, 100 between five and ten, and 100 +between ten and fifteen. + +Epilepsy, then, is a disease of early youth, coming on when the development +and growth of the nervous and reproductive systems is taking place. During +this period, causes, insignificant for stable people, may light up the +disease in those of unstable, nervous constitution, a fact which explains +the importance of training the child. + +Both sexes are attacked. If we consider only cases of true idiopathic +epilepsy female patients are probably in excess, but in epilepsy in adults, +from all causes, males predominate. In females, the menopause may arrest +the disease. + +In days gone by, epilepsy more rarely commenced after the age of twenty, +but in these days of nerve stress it commences more frequently than +formerly in people of mature age. A victim who has a fit for the first time +after the age of twenty, however, should consult a nerve specialist +immediately. + +In its early stages there are no changes of the brain due to, or the cause +of, epilepsy, but in long-standing, severe cases, well-marked, morbid +changes may be found. These are the effects, not the cause, of the disease, +and they vary in intensity according to the manner of death and the length +and severity of the malady. They probably cause the mental decay and +slouching gait mentioned before. + +Fits may suddenly cease for a long time, but they usually recur, and most +patients have them more or less regularly through life. + +The fact that recovery is rare should not be hidden from patients and +friends. Perhaps 8 per cent of all classes recover--and "recovery" may only +be a long interval--but 4 per cent of these are Jacksonian, syphilitic or +accident cases. Only one victim in every thirty recovers from true +epilepsy; and these are very mild cases, in which the fits are infrequent, +there is no mental impairment, and bromides are well borne. The earlier the +onset, the more severe and frequent the attacks, the deeper the coma, and +the worse the mental decay, the poorer the outlook. + +_Cure is exceptional_, but by vigorous treatment the severity of the malady +may be much abated. _Petit mal_ is no more hopeful than _grand mal_; less +so in cases with severe giddiness; in all cases, the better the physical +condition and digestive powers of the patient, the brighter the outlook. + +To sum up, epilepsy is a chronic abnormality of the higher nervous system, +characterized by periodic attacks of alteration of consciousness, often +accompanied by spasms of varying violence, affecting primarily the brain +and secondarily the body, based on an abnormal readiness for action of the +motor cells, occurring in persons with congenital nerve weakness, and +leading to mental decay of various types and degrees of severity. + + * * * * * + +CHAPTER IV + +CAUSES OF EPILEPSY + + "Find out the cause of this effect, + Or rather say, the cause of this defect, + For this effect defective comes by cause." + "Hamlet," Act II. + +THE MECHANISM OF THE FIT + +The brain consists of cells of _grey matter_, grouped together to form +centres for thought, action or sensation, and _white matter_, consisting of +nerve strands, which act as lines of communication between different parts +of brain and body. The wrinkled surface (_cortex_) of the brain, is covered +with grey matter, which dips into the fissures. There are also islands of +grey matter embedded in the white. + +The front part of the brain is supposed, with some probability, to be the +seat of intelligence, while a ribbon three inches wide stretched over the +head from ear to ear would roughly cover the Rolandic area, in which are +contained the _motor cells_ through which impulse is translated to action. +These motor cells are controlled by _inhibitory cells_, which act as brakes +and release nerve energy in a gentle stream; otherwise our movements would +be convulsive in their violence, and life would be impossible through +inability usefully to direct our energy. + +That is how inhibition acts physically; mentally it is the power to +restrain impulses until reason has suggested the wisest course. + +Irritation of the cortex, especially the motor area, causes convulsions, +and experiment has shown that epilepsy may be due to a disease or +instability of certain inhibitory cells of the cortex. The motor cells of +epileptics are restrained, with some difficulty, by these cells in normal +times. When irritation from any cause throws additional strain on the motor +cells, the defective brakes fail, and the uncontrolled energy, instead of +flowing in a gentle stream through the usual channels, bursts forth in a +tidal wave through other areas of the brain, causes unconsciousness, and +exhausts itself in those violent convulsions of the limbs which we term a +fit. + +The Primary Cause of epilepsy is an inherent instability of the nervous +system. + +Secondary Causes are factors which cause the first fit in a person with +predisposing nervous instability; later, the brain gets the _fit habit_, +and attacks recur independently of the secondary cause. In most cases no +secondary causes can be discovered, and the disease is then termed +_idiopathic_, for want of an explanation. + +Injuries to the brain may cause epilepsy, and many cases date from birth, a +difficult labour having caused a minute injury to the brain. + +Some accident is often wrongly alleged as the cause of fits, for most +victims come of a bad stock, and when the first fit occurs, their relatives +recollect an injury or a fright in the past, which is said to be the cause. + +Great fright may cause epilepsy, as in the case of a nervous girl whose +brother entered her room, covered with a sheet, as a "ghost", a "joke" that +was followed by a fit within an hour. + +Sunstroke may cause fits, and a few cases follow infectious diseases. + +Alcoholism is a strong secondary factor, fits often occurring during a +drinking-bout and in topers, but in many cases, drunkenness, instead of +being the cause, is only the result of a lack of self-control following +epilepsy. + +Pregnancy may be a secondary cause of the malady: it may lead to more +frequent and severe seizures in women who are already victims; bring on a +recurrence of the malady after it has apparently been cured; or, very +rarely, induce a temporary or permanent cure. + +Epilepsy may be due to abortives. These drugs wreck the constitution of the +undesired children, who contract epilepsy from causes which would not so +have affected them had they started fairly. In many families, the first +child, who was wanted, is normal; some or all the others, who were not +desired and on whom attempts were probably made to prevent birth, are +neuropaths, as are many illegitimate children. It cannot too emphatically +be stated that there is no drug known which will procure abortion without +putting the woman's life in so grave a danger as to prevent medical men +using it; legal abortion is always procured surgically. Dealing in +abortifacients would be a capital offence under the laws of a rational +community. + +Self-abuse may perhaps play some part in epilepsy commencing or recurring +after the age of ten. + +The onset of menstruation often coincides with the onset of epilepsy, and +in some cases irregularity of the menses seems to be a secondary or +exciting cause. + +Exciting Causes aggravate the trouble when present, causing more frequent +and severe seizures. The chief are irritation of stomach and bowels (from +decaying teeth, unchewed, unsuitable, or indigestible food, constipation, +or diarrhoea), exhaustion, work immediately after a meal, passion or +excitement, fright, worry, mental work, alcoholism, sexual excess, nasal +growths, eye-strain; in short, anything that irritates brain or body. + +Theories as to Cause. Epilepsy is usually classed as a _functional +disorder_; that is, the brain cells are physically normal, but, for some +unknown reason, they act abnormally at certain times. This term is a very +loose one, and there is reason to believe that the basis of epilepsy is +some obscure disease of the brain which has not been detected by present +methods. + +The new school of psychologists regard the malady as a mental _complex_--a +system of ideas strongly influenced by the emotions--the convulsions being +but minor symptoms. + +Fits are most frequent between 9-10 p.m. the hours of deepest repose. One +school says this is due to anæmia of the brain during sleep. Clark traces +the cause to lessened inhibitory powers owing to the higher brain centres +being at rest, while Haig claims to have explained the high incidence at +this hour by the fact that uric acid is present in the system in the +greatest amount at this time. + +Some doctors have thought, on the contrary, that _excess_ of blood in the +head was the cause, but results of treatment so directed did not bear out +the sanguine hopes built on the theory. + +The fact that convulsions occur in diabetes and alcoholism, suggested that +epilepsy was due to poisons circulating in the blood, and thus irritating +the brain. Every act uses up cell material and leaves waste products, +exactly as the production of steam uses up coal and leaves ashes. Various +waste products have been found in more than normal quantities in the blood +of epileptics, but it is uncertain whether accumulation of waste products +causes the seizure. + +A convincing theory must satisfactorily account for all the widely diverse +phenomena seen in epilepsy, and the problem must remain largely a matter of +speculation, until research work has given us a far deeper insight into the +biochemistry of both the brain cells, and the germ-plasm than we have at +present. + + * * * * * + +CHAPTER V + +PREVENTION OF ATTACKS + + In health matters, prevention is nine points of the law. + +Some patients are obsessed by a peculiar sensation (the "aura") just before +a fit. This warning takes many forms, the two most common being a "sinking" +or feeling of distress in the stomach, and giddiness. The character of the +aura is very variable--terror, excitement, numbness, tingling, +irritability, twitching, a feeling of something passing up from the toes to +the head, delusions of sight, smell, taste, or hearing (ringing, or +buzzing, etc.), palpitation, throbbing in the head, an impulse to run or +spin around--any of these may warn a victim that a fit is at hand. Some +patients "lose themselves" and make curious mistakes in talking. + +The warning is nearly always the same each time with the same patient, and +is more common in mild than in severe cases. Rarely, the attack does not go +beyond this stage. + +When the patient becomes conscious of the aura he should sit in a large +chair, or lie down on the floor, well away from fire, and from anything +that can be capsized. He must never try to go upstairs to bed. Some one +should draw the blind, as light is irritating. + +If the warning lasts some minutes, the patient should carry with him, a +bottle of uncoated one-hundredth-grain tabloids of + +Nitroglycerin, replacing the screw cap with a cork, so that they can +quickly be extracted. When the warning occurs, one--or two--should be +taken, and the head bent forward. The arteries are dilated, the +blood-pressure thus lowered, and the attack _may_ be averted. + +The use of nitroglycerin is based on the theory that seizures are caused by +anæmia due to vasomotor constriction. Success is only occasional, but this +is so welcome as to justify the habitual use of the method. + +If the aura be brief, buy a few "pearls" of Amyl Nitrite, crush one in your +handkerchief, and sniff the vapour. This has the same affect as +nitroglycerin, but the action occurs in 15 seconds and only persists 7 +minutes. A headache occasionally follows the use of these drugs, and they +should not be employed without professional advice. + +When the warning is felt in the hand or foot, a strap should be worn round +the ankle or wrist, and pulled tight when the aura commences. This +sometimes aborts a fit, as biting a finger in which the aura commences may +also do. + +If a victim feels unwell after a meal, he must never eat the next meal at +the usual time, simply because it _is_ the usual time. + +Should a patient feel unwell between, say, dinner and tea, instead of +eating his tea he must empty his bowels by an enema, or croton oil (see +chemist), and his stomach by drinking a pint of warm water in which has +been stirred a tablespoonful of mustard powder and a teaspoonful of salt. +After vomiting, drink warm water. + +_Never attempt to empty the stomach at the onset of a definite aura_, for +if the seizure occurs, the vomit will probably obstruct the trachea, and +suffocate the victim. + +After the stomach has been empty ten minutes, the patient should take a +double dose of bromides (Chapter XIX) and go to bed. Next morning he will +be well, whereas if he eats but a single piece of bread-and-butter he will +probably have a fit within five minutes. + +Unfortunately, in 60 per cent of cases, there is no warning at all, while +in those cases which do exhibit an aura, the measures mentioned above more +often fail than succeed. + + * * * * * + +CHAPTER VI + +FIRST-AID TO VICTIMS + + "First-aid is the assistance which can be given in case of emergency by + those who, with certain easily acquired knowledge are in a position, + not only to relieve the sufferer, but also to prevent further mischief + being done pending the arrival of a doctor."--Dickey. + +_Never try to cut short a fit_. Placing smelling-salts beneath the nose, +together with all other remedies for people who have "fainted", are useless +in epilepsy. + +Lay the patient on his back, with head slightly raised; admit air freely; +remove scarf or collar and tie, unfasten waistcoat, shirt, stays or other +tight garments, and if it be known or observed that the victim wears +artificial teeth, remove them. + +If five people are at hand, let two persons grasp each a leg of the victim, +holding it above the ankle and above the knee; two others should each hold +a hand and the shoulder; the fifth supports the head. Do not kneel opposite +the feet or you may receive a severe kick. Prevent the limbs from striking +the floor, but _allow them full play_. If the victim rolls on his face +gently turn him on his back. + +Roll a large handkerchief up _from the side_ (not diagonally) and holding +one end firmly, tie a knot in the other end, and place it between the teeth +to protect the tongue; or slide the handle of a spoon or a piece of smooth +wood between the teeth, and thus hold the tongue down. Soft articles like +cork and indiarubber should not be used, for if they are bitten through, +the rear portion will fall down the throat and choke the victim. + +After the fit, lower the head to one side to clear any vomitus which, if +left, might be drawn into the windpipe, lift the patient on to a couch, +cover him warmly, and let him sleep. An epileptic's bed should be placed on +the ground floor; if his bed be upstairs, it is difficult to get him there +after an attack, while he may at any time fall downstairs and be killed. + +Any effort to rouse him will only make the post-epileptic stupor more +severe, but whether he sleeps or not, he must carefully be watched, for +patients in this state are apt to slip away, often half-clothed, and travel +towards nowhere in particular at a wonderfully rapid rate. + +If several fits follow one another, or if one is very long or severe, send +for a doctor. + +When a seizure occurs in public, a constable should be summoned, who, being +a "St. John" man, will be of far more use than bystanders brimming over +with sympathy--_and ignorance_. If some kindly householder near by will +allow the victim to sleep for an hour or two--a boon usually denied more +from fear of recurrence than lack of sympathy, it is better than taking him +home. If not, let someone call a cab, and deliver the victim safely to his +friends. + +Every epileptic should carry always with him a card stating his full name +and address, with a request that some one present at any seizure will +escort him home. + +If the victim wakes with a headache, give him a 10-grain Aspirin powder, or +a 5-grain Phenalgin tablet; _never patent "cures"_. + +If possible, the patient should lie abed the day after a fit, undisturbed, +taking only soda-and-milk and eggs beaten up in _hot_ milk. + + * * * * * + +CHAPTER VII + +NEURASTHENIA + + "Some of your hurts you have cured, + And the worst you still have survived; + But what torments of mind you endured + From evils which never arrived." + --Lowell. + +To-day, the need to eat forces even sensible men to live--and die--at a +feverish rate. In bygone days the world was a peaceful place, in which our +forefathers were denied the chance of combining exercise with amusement +dodging murderous taxis; knew not the blessings of "Bile Beans", nor the +biliousness they blessed either; they did not fall victims to +"advert-diseases"; and they left the waters beneath to the fishes, and the +skies above to the birds. + +Withal they were sound trenchermen, who called their few ailments "humours" +or "vapours" and knew what peace of mind meant. Sixty years ago there was +one lunatic in every six hundred people; to-day there is one in every two +hundred. + +At the same time, the "neurasthenic temperament" is not altogether a modern +product, for Plato described it with great precision, and declared such +people to be "undesirable citizens" for his ideal republic. + +Neurasthenia is due to exhaustion and poisoning of the nervous system, the +chief symptoms of which is persistent _neuro-muscular fatigue with general +irritability_. Its minor symptoms are almost as numerous as the various +activities possible in mind and body. + +The Predisposing Cause of neurasthenia is inherited nervous instability, +but among nervous diseases, neurasthenia seems the least dependent on +heredity, this factor playing a less important part than + +Exciting Causes which are the sparks that fire explosive trains laid by the +living, and often by the dead. + + Worry in any form (especially when accompanied by excess of brain-work), + Accident-shock, + Sexual abuse, + Abuse of drink, drugs or tobacco, + Lack of exercise, + Exhausting diseases, + Menopause, and diseases of the womb, + "Society life", + Retirement, + +are the commonest exciting causes of neurasthenia; hard brain-work, unless +accompanied by worry, not being injurious. + +The disease is more common in men than women (because of the more active +part played by them in the struggle for existence), in cities than in the +country, in mental than in manual workers, in the "idle rich", and in races +which live feverishly, like the Americans. It is rare in old age. + +Ambition, the race for "success", the struggle to carry out projects beyond +the reasonable capacity of one man, and the ceaseless work and worry with +little sleep and no real rest which mark life to-day are responsible for +this disease. + +Competition has increased in all conditions of life; free course is given +to ambition, individuals impose on their brains a work beyond their +strength; and then comes care and perhaps reverse of fortune; and the +nervous system, under the wear and tear of incessant excitation, at last +becomes exhausted, + +The basic symptom is an inability to stand a normal amount of mental or +physical strain, and shows itself in seven marked ways: + +1. Muscular Fatigue, which is often most marked in the morning. The +patient rises reluctantly, feeling as if he had not slept, is listless and +"lazy", and can neither work nor play much without getting unduly tired. +This weariness may pass off as the day wears on. + +2. Backache is often constant and annoying. It may be a pain, or a general +discomfort, and may be felt anywhere in the back, the nape of the neck and +down the spine being common places. The legs often "give way", and, in +severe cases, patients believe they cannot stand, and become bed-ridden. +Under sudden excitement they may walk again, becoming "miracles of +healing". These _spinal symptoms_ are common in neurasthenia following +accident. + +3. Headache is more often an abnormal sensation than an intense pain. +Pulsations, feelings of distress, of lightness, fullness, heaviness and +pressure are common, or a band may seem to be drawn tightly round the head +across the forehead. + +The sensations are usually located in the back of the head, and may be +accompanied by dizziness, noises in the ears, or dimness of sight. There +may be a feeling of unsteadiness when walking, or a sense of being in +motion when at rest. The headache varies in intensity; it is worst in the +morning, is increased by thinking, diminished after eating, often improves +at night, and never keeps the patient awake. + +4. Stomach and Bowel Disorders. The victim is indifferent to food, though +dainties often tempt him, when he cannot face a square meal. He has a +feeling of general well-being after a meal, but within an hour signs of +imperfect digestion arise; he feels oppressed, and has flatulence. Later, +there are flushes of heat, palpitation, drowsiness, and a craving for food. +Constipation is usually obstinate, while diarrhoea may cause great +weakness. + +5. Sleeplessness. Some patients go to sleep readily, but after some +instants wake suddenly, in a state of excitement that persists despite +their efforts to calm themselves, and only at an early hour in the morning +do they sleep again. Other patients go to bed with the conviction they will +not sleep, and are kept awake by incessant cogitation, their minds being +harassed by a rapid flow of images, ideas and memories. In some cases the +person is calm, his mind is at rest, yet he cannot sleep. + +6. Circulatory Disturbances. More blood flows to an organ at work than to +one at rest. In health we do not notice these changes, but in neurasthenia +these internal tides are exaggerated as rushes of blood to the head, +flushings of various parts, and coldness of hands and feet. + +Heart palpitation is alarming but not dangerous, and the distended +blood-vessels of the ears may set up vibrations in the drum, so that at +night when the head is on the pillow, every beat of the heart is heard as a +thump, which banishes sleep, and works the victim into a state of high +tension. A pain in the chest, arms and elbows is often felt, limbs may +swell (shown by the tightness of rings, collars, etc.) while the hands and +feet are usually moist and clammy. The patient may have to empty the +bladder every half-hour. Disorders of menstruation are common. + +7. Mental Fatigue. Hundreds of pages would be needed to describe all the +symptoms due to mental fatigue, the morbid belief that the victim has a +fatal disease being very common, though his "disease" rarely makes him lie +up; in the day he works, at night describes his symptoms to the home +circle. + +The inability of most men to apply themselves steadfastly to any one set of +ideas is seen in the immense popularity of music halls, cinemas, and +short-story magazines, which offer a change of interest every few minutes. + +In normal people there is a slight consciousness of mental processes, but +the mind rarely watches itself work; the neurasthenic is unable to +concentrate, and gets charged with inconstancy and shiftlessness. + +His ideas are restive, continuous thought is impossible, and when talking +he has to be "brought back to the point" many times. Memory and attention +flag, and he listens to a long conversation, or reads pages of a book +without grasping its import, and consequently he readily "forgets" what in +reality he never laboured to learn. Trembling of limbs is common. + +He lacks initiative, and whatever course he is forced to take--after much +indecision--he is convinced, a moment later, it would have been wiser to +have taken the opposite one. + +All his acts are done inattentively. He goes to his room for something, but +has forgotten what when he gets there; later, he wonders if he locked the +drawer, and goes back to see. At night he gets up to make sure he bolted +the door, put out the gas, and damped the fire. + +Regret for the past, dissatisfaction with the present, and anxiety for the +future are plagues common to most people, but they become acute in a +neurasthenic, who reproaches himself with past shortcomings of no moment, +infuriates himself over to-day's trivialities, and frets himself over evils +yet unborn. + +Such a patient is often greatly upset by a trifle, yet little affected by a +real shock, which by its very severity arouses his reactive faculties which +lay dormant and left him at the mercy of the minor event. He will fret over +a farthing increase in the price of a loaf, but if his bank fails he sets +manfully to. + +Duty that should be done to-day he leaves to be shirked to-morrow; he is +easily discouraged, timid, and vacillating. Extremely self-conscious, he +thinks himself the observed of all observers. If others are indifferent +toward him, he is depressed; if interested, they have some deep motive; if +grave, he has annoyed them; if gay, they are laughing at him; the truth, +that they are minding their own business, never occurs to him, and if it +did, the thought that other people were _not_ interested in him, would only +vex him. + +He is extremely irritable (slight noises make him start violently), +childishly unreasonable, wants to be left alone, rejects efforts to rouse +him, but is disappointed if such efforts be not made, broods, and fears +insanity. The true melancholic is convinced he himself is to blame for his +misery; it is a just punishment for some unpardonable sin, and there is no +hope for him in this world or the next. The neurasthenic, on the contrary, +ascribes his distress to every conceivable cause save his own personal +hygienic errors. + +A neurasthenic, if epileptic, fears a fit will occur at an untoward moment. +He dreads confined or, maybe, open spaces, or being in a crowd. When he +reaches an open space (after walking miles through tortuous byways in an +endeavour to avoid it) he becomes paralysed by an undefinable fear, and +stops, or gets near to the wall. + +He fears trains, theatres, churches, social gatherings, or the office. + +Other victims fear knives, canals, firearms, gas, high places, and railway +tracks, when the basic fear is of suicide. Many patients have sudden +impulses--on which the attention is focussed with abnormal intensity--to +perform useless, eccentric, or even criminal actions; to count objects, to +touch lamp-posts, to continually reiterate certain words, and so on. + +The victim is fully aware that there are no grounds for his panic or +impulse, but though his reason ridicules, it cannot disperse, his fear, and +the wretched man finds relief in sleep alone, which adds to his woes by +being a coy lover. + +An almost invariable stage is that wherein the patient studies a +patent-medicine advertisement and finds that a disease, or collection of +diseases, is the root of his troubles. This alarms but interests him; he +studies other advertisements, sends for pamphlets, and so becomes familiar +with a few medical terms. He then takes a "treatment", and talks of his +"complaint" and how he "diagnosed" it. He has become hypochondriac. + +He borrows a book on anatomy from the public library to discover in what +part of the body his ailment is located. + +He draws up (or copies) a special diet-sheet, and talks of "proteids", +notices a slight cloudiness in his urine, and underlines "The Uric-Acid +Diathesis" in one of his pamphlets. Then his heart bumps, he diagnoses +anew, and so goes on, usually ending by taking phosphorus for his "brain +fag". Then he finds he has a disease unknown to the faculty, which +discovery interests him as intensely as it irritates his unfortunate +friends. + +This prince of pessimists has a conviction that, compared with him, Job was +a happy man, and that he will go insane. He does not know that it is only +when there are flaws in the brain from inheritance or organic disease that +mental worry leads to lunacy; a sound brain never becomes unhinged from +intellectual stress alone. + +Books and friends are daily questioned about his "diseases", and in spite +of reassuring replies, he continues to doubt, re-question and cross-examine +endlessly, feeding his hopes on the same assurances, consoling himself with +the same sympathies, and worrying himself with the same fears. + +Other folk may be "nervy", he is seriously ill; he _knows_ it because he +_feels_ it. He expects the greatest consideration himself, denies it to +others, and then complains he is "misunderstood". + +"Every symptom becomes magnified; the trifling ache or pain, the trivial +flatulence, the disinclination or mere hesitation of the bowels to adhere +to a strict schedule, all minor events such as occur to the majority of +healthy men from time to time unheeded, come to be of vast importance to +the psychasthenic individual." + +He keeps a record of hourly changes in his condition, and pesters his +family doctor to death. He goes from physician to physician, from hospital +to hospital. Having been induced by his friends to see a specialist, he +bores that good man--who knows him all too well--with a minute description +of his symptoms, presenting for inspection carefully preserved +prescriptions, urinary examination records, differential blood counts, and +the like. Coming away with precious advice, he feels he omitted to describe +all his symptoms, begins to doubt if the specialist really understands +_his_ case, and so the pitiful farce goes on--for years. + +The extraordinary fact is that while he is suffering (_sic_) from cancer, +or heart disease, or Bright's disease, and spasmodically from minor +affections like tuberculosis, arterio-sclerosis, and liver-fluke, he is +probably running a successful business. While making money he forgets his +ills; the moment his attention is diverted from the "root of evil" he +proceeds to further "diagnosis". + +In the end, he makes a pleasant hobby of his imaginary maladies, trying +each patent nostrum, and giving herbalists, electric-belt men, Christian +Scientists, and dozens of other weird "specialists" a chance to cure him. + +Sexual Neurasthenia occurs chiefly in young men given to self-abuse or +sexual excesses. Erections and emissions are frequent, first at night with +amorous dreams, then in the day as a result of sexual thoughts; weakness +and pain in the back follow, and the sexual act may become impossible. The +patient usually studies a quack advertisement, and passes into the hands of +men who make a living by bleeding such wretches dry. Cold baths and the +treatment outlined in Chapter IX will cure him. + +Course and Outlook. Neurasthenia is very curable. If the cause be removed, +and vigorous treatment instituted, the victim may be well in a couple of +months, but in most cases there are obstacles to radical treatment, and the +disease drags on indefinitely. + +Egoism, moral cowardice, and sexual excess play a part in much +neurasthenia, but relatives must not forget, in their indignation at these +laxities, that the patient really _is_ ill; it is unkind, unjust and +useless to tell an ailing man the unpalatable truth that it is his own +fault. + + * * * * * + +CHAPTER VIII + +HYSTERIA + + "Diseased nature oftentimes breaks forth + In strange eruptions; ..." + "King Henry IV." + +Hysteria, recorded in legend and law, in manuscript and marble, in +folk-lore and chronicle, right from history's dawn, is still a puzzle of +personality, and only equalled by syphilis in the protean nature of its +manifestations. + +The sacred books of the East said delayed menstruation due to a devil was +its cause; the thrashing-out of the devil its cure. Chinese legends +describe it, and its symptoms were ascribed by the Inquisition to +witchcraft and sorcery. + +Old Egyptian papyri tell how to dislodge the devil from the stomach, and +there were hysteria specialists in 450 B.C. All old theories fix on the +womb as the seat of the disease. The name hysteria is the Greek word for +womb, and 97 per cent of patients are women. + +A few of the very numerous modern theories may be noticed. + +The unconscious (or the subconscious) and the conscious are only parts of +one whole. Our "conscious" activities are those which have developed late +in the history of the race, and which develop comparatively late in the +history of the individual. The "conscious" is the product of the racial +education of the "unconscious"; the first is the man, the modern, the +civilized; the last is the child, the primitive, the savage. Between the +two there is no gulf fixed, and the Oxford metaphysician need not go to +Timbuctoo to seek a superstitious savage; he may find one within himself. + +In hysteria, Janet says, the field of consciousness is narrowed, and the +patient lives through subconscious experiences, which she forgets when she +again "comes to". She journeys back into the past, back a few years +individually, back centuries or æons racially, and becomes a savage child +again. + +Normally, when anything goes wrong, or we suffer from excessive emotion, we +give vent to our feelings by tears, abuse, anger, or impulsive action; in +some way we "hit back", and relieve ourselves of the feeling of oppression. +Then we forget, which heals the sore, and closes the experience. + +If, at the moment, we bottle up our emotions, they obtrude later at +inconvenient times until we "get them off our mind" by confiding in some +one, when we get peace of mind. Open confession _is_ good for the soul, and +it is better to "cry your eyes out" than to "eat your heart out". + +There are some experiences, however, to which we cannot react by anger or +confidence, and so we imprison our emotions, and try to obtain peace of +mind by forgetting the irritation. + +Freud thinks perverted sex ideas are thus repressed, and cause hysteria by +coming into conflict with the normal sex life. If these old sores can be +laid bare by psycho-analysis, and the mental abscess drained by confession +and contrition, cure follows. + +The biologists consider hysteria as an adult childishness, a primitive mode +of dodging difficulties. Victims cannot live up to the complicated +emotional standard of modern life, and so act on a standard which to us +seems natural only in children and uncivilized races. + +Savill gives the following differences between neurasthenia and hysteria: + + NEURASTHENIA HYSTERIA + + Sex Both sexes equally. 97 per cent females. + + Age Any age. First attack before + page of 25. + + Mental Intellectual weakness; Deficient will power, + peculiarities bad memory Want of control + and attention. over emotions. + + Causes Overwork; dyspepsia; Emotional upset or + accident; shock. + nervous shock. + + Course Fairly even. Paroxysms. Vary + from hour to hour. + + Mental Mental exhaustion; Emotional; wayward; + Symptoms unable to study; no self-analysis, + restless; sad; living by + irritable; not rule or reading + equal to medical books; + amusement. May Fond of gaiety; + be suicidal. sad and joyous by + turns. Never + suicidal. + + General Occasional giddiness; Flushing; convulsions + Symptoms fainting rare; and fainting + convulsions; common; no + headache; backache; symptoms between + sleeplessness; no attacks; local + loss of feeling. anæsthesia or + hyperæsthesia. + + Termination Lasts weeks or Lasts lifetime in + months. spasms. + CURABLE. TEMPORARILY + CURABLE. + +Hysteria is a disease of youth, usually ceasing at the climacteric. Social, +financial and domestic worries are exciting causes, a happy marriage often +curing, and an unhappy one greatly aggravating the complaint. It is most +common among the races we usually deem "excitable", the Slavs, Latin races +and Jews, and is often associated with anæmia and pelvic disorders. + +Symptoms. Changeability of mood is striking. "All is caprice. They love +without measure those they will soon hate without reason." + +Sensationalism is manna to them. They _must_ occupy the limelight. Pains +are magnified or manufactured to attract sympathy; they pose as +martyrs--refusing food at table, and eating sweets in their room, or +stealing down to the larder at night--to the same end. If mild measures +fail, then self-mutilation, half-hearted attempts at suicide, and baseless +accusations against others are brought into play to focus attention on +them. + +Minor attacks usually commence with palpitation and a "rising" in the +stomach or a lump in the throat, the _globus hystericus_, which the patient +tries to dislodge by repeated swallowing. This is followed by a feeling of +suffocation, the patient drags at her neck-band, throws herself into a +chair, pants for breath, calls for help, and is generally in a state of +great agitation. She may tear her hair, wring her hands, laugh or weep +immoderately, and finally swoon. The recovery is gradual, is accompanied by +eructations of gas, and a large quantity of pale, limpid, urine may be +passed later. + +Major attacks have attracted attention through all ages, ancient statues +showing the same poses as modern photographs. The beginning stage--which +may last a few moments or a few days--is one of mental unrest, the victim +being irritable and depressed. In some cases a warning aura then occurs; +clutchings at the throat, or the _globus hystericus_, palpitation, +dizziness, sounds in the ears, spots dancing before the eyes, or feelings +of intense "_tightness_" as if the skin is about to tear or the stomach to +burst. + +The victim throws herself on a chair or couch, from which she slides to the +floor, apparently senseless, the head being thrown back, the arms extended, +the legs held straight and stiff. The face is that of a dreamer, and the +crucifix position is not uncommon. This stage is a gigantic sexual stretch. + +Next comes the convulsive stage, but the convulsions are not the true jerky +movements of epilepsy, but are bilateral tossing, kicking, and rolling +movements, interspersed with various irregular passionate attitudes. There +is great alteration but _not loss_ of consciousness. The patient struggles +with those about her, bites them, but never her own tongue, shrieks and +fights, but never passes urine, throws things about, and arches the back +until the body rests on head and feet (_opisthotonos_). The stretching and +convulsive stages alternate, and the attack lasts a long time, being +stopped by pain or by the departure of onlookers. During this stage the +face may reflect the various emotions passing through the mind--with a +fidelity that would rouse the envy of an Irving. + +The patient gradually calms down, and a fit of tears or a scream ends the +attack, after which the worn-out victim is depressed but not confused, +though memory for the events of the attack may only be partial. The patient +sometimes passes into the "dream state", described in Chapter II, for some +hours or occasionally for far longer; these are the women described with +much gusto in the local Press as being in a trance--"the living dead". + +The victim of these attacks _is_ suffering from a disease, for she shows +many temporary mental symptoms which could not possibly be feigned, while +there is often a genuine partial forgetfulness of the incidents of an +attack. She says she cannot help it; candid friends say she will not. The +truth is that she cannot _will_ not to help it; for though intelligence and +memory are often good and sometimes abnormal, the judgment and will are +always weak--indecision, obstinacy, and doubt being common. + +Treatment. A thorough examination by a doctor is _absolutely essential_, to +prove that the patient is merely hysterical, and not the victim of +unrecognized organic disease. In a few cases, skilled attention to some +minor ailment will result in an apparently miraculous cure. + +Many who habitually "go into hysterics", are merely grown-up "spoiled +children", and in all cases, the basic factor is a lack of control and +self-discipline. + +Unfortunately, these tainted individuals who are so exquisitely sensitive +that any reproof brings floods of tears, turn with mercurial rapidity from +passionate fury to passionate self-reproach, and assuage by impassioned +protestations of affection the distress they have carelessly inflicted, +and, as a consequence of their momentary but undoubtedly sincere +contrition, escape blame and punishment. + +Harmful sympathy is thus substituted for helpful discipline, and the more +stable members of the family are often made slaves to the whims and +caprices of the hysterical member. + +The usual home treatment of the victim passes through various stages, and +lacks persistence. Violent methods are succeeded by studied indifference; +and that again by reproaches and recriminations. + +Greene's remarks are very pertinent: "The condition must be regarded as an +acquired psycho-neurosis to be ameliorated, and perhaps removed, by +suggestion and a complete control, which, though kind, is firm, persistent, +insistent, and _lacking in every element that enters into the upbuilding of +the hysterical temperament_." + +For anæmic patients, the following is a useful prescription: + + R. + Quininæ valerianatis gr. xx + Ferri valerianatis gr. xx + Ammon. valerianatis gr. xx + Misce et fiant pilulæ no. xx + Sig.: One or two three times a day, after meals. + +As far as the minor symptoms are concerned, the disease is usually chronic, +for as soon as one symptom has been overcome another takes its place, and +there is little hope of cure save when the case is taken vigorously in hand +in childhood, treatment being best given in a home or hospital. Home +treatment consists in an attempt to inculcate the lost or never-acquired +habit of self-control, and in the hygienic measures laid down for +neuropaths in general in the rest of this book. + +In a major attack, _show no sympathy_. Let every one leave the room, save +one attendant, whom the victim knows to be of firm character, and calm but +determined disposition. This attendant should get a jug of water, and +threaten to douche the victim unless she makes vigorous efforts to control +herself. If she cannot, or will not, _douche her_, then hold a towel over +her nose and mouth, and she will perforce cease her gymnastics to breathe, +though the attendant must be prepared for an outburst of abuse when she has +recovered her breath. Between attacks, all who are brought into contact +with the victim, must adopt a tolerant but unsympathetic attitude, while +efforts are made to inculcate habits of control. + + * * * * * + +CHAPTER IX + +ADVICE TO NEUROPATHS + + "Great temperance, open air, + Easy labour, little care." + +The above quotation epitomizes the cure for neurasthenia, for as Huxley +said: + + "Our life, fortune, and happiness depend on our knowing something of + the rules of a game far more complicated than chess, which has been + played since Creation; every man, woman and child of us being one of + the players in a game of our own. The board is the world, the pieces + the phenomena of the universe, while the rules of the game are the laws + of nature. Though our opponent is hidden, we know his play is fair, + just and patient, but we also know to our sorrow that he never + overlooks a mistake or makes the slightest allowance for ignorance. To + the man who plays well, the highest stakes are paid with that + overflowing generosity with which the strong show their delight in + strength. The one who plays badly is checkmated; without haste, but + without remorse. Ignorance is visited as sharply a as wilful + disobedience; incapacity meets with the same punishment as crime." + +In many cases some real trouble is the best medicine for a neurasthenic, +for though disaster may crush him, it is more likely to act as a spur, by +diverting his thoughts from his woes, and making him fight instead of fret. + +Since such blessings in disguise cannot be booked to order, first see a +doctor. Though little be physically wrong, the sense of comfort and relief +from fear, which a clear idea of what _is_ wrong brings, goes a long way +towards cure by giving the patient hope and confidence. + +Having seen the doctor, assist him by carrying out the following advice as +far as real limitations--not lazy inclinations--permit. Do not say after +reading this chapter, "I know all that"; you have to _do_ "all that", for +medicine alone, whether patent or prescribed, is useless. + + * * * * * + +Go for a long sea voyage, if possible. + +If not, get a long holiday in a quiet farmhouse, or, better still, get to +the country for good, be it in never so humble a capacity, for a healthy +cowman is happier than a neurasthenic clerk. The rural worker has no +theatres, but he can walk miles without meeting another; he has woods to +roam in, hills to climb, trees to muse under: he has ample light and air, +and his is a far happier lot than that of a vainglorious but miserable, +sedentary machine in a great city. + +The rural districts round Braemar, the Channel Islands, Cromer, Deal, +Droitwich, Scarborough, and Weston-super-Mare are, in general, suitable +holiday resorts for neuropaths. + +Avoid alcohol, tea, coffee, much meat, all excitement, anger and _worry_. +Take tickets only for comedy at the theatre, and leave lectures, social +gatherings and dances alone. + +Nerve-starvation needs generous feeding with easily digested food. Drink +milk in gradually increasing amounts up to half a gallon per day. If more +food is needed, add eggs, custard, fruit, spinach, chicken, or fish, but do +not forgo any milk. Avoid starchy foods and sweets. + +Eat only what you can digest, and digest all you eat. Chew every mouthful a +hundred times. This is one of the few sensible food fads. + +Drink water copiously between meals, and take no liquid (save the milk) +with them. Keep the bowels open. + +If you _must_ "occupy your mind", take up some very simple, quiet hobby. +Gardening, fretwork, photography and gymnastics are not necessarily quiet +hobbies. Chess, billiards, and contortions with gymnastic apparatus are not +to be recommended. + +If you _must_ read, peruse only humorous novels. Never study, and leave +exciting fiction and medical work alone. Symptoms are the most misleading +things in a most misleading world. + +After your evening meal, take a quiet walk, go to bed _and sleep_. You +should occasionally spend from Saturday midday to Monday morning in bed, +with blinds drawn, living on milk, seeing nobody and doing _nothing_. The +deepest degradation of the Sabbath is to fill it with odd jobs which have +accumulated through the week. + +Do not get out of bed too early in the morning, but rise in time to eat +your breakfast slowly, attend to the toilet, and catch the car without +haste. If your occupation be an indoor one, rise an hour earlier, and walk +or cycle quietly to work. + +Take a warm bath followed by a cold douche on rising. If no warm after-glow +follows, use tepid water. Keep your body warm; your head cool. + +Be continent. Nerve-tone and sexual delights are not compatible. Matrimony, +while a convenient cloak, is no excuse for lust. + +Try suggestion for fears and impulses (see Chapter XVIII), for it is +useless to try to "reason them out", though it is useful for a brief period +each day to try deliberately to turn the mind away from the obsession, by +singing or whistling, gradually prolonging the attempts. + +Rest, to prevent the manufacture of more waste products, the elimination of +those present, and the generation of nerve-strength from nourishing food +are the things that cure. Chapters XIX and XX deal with the drug treatment. + +Do not Worry. Whatever your trouble is, it is useless to + + "Look before and after, and sigh for what is not" + +for the future cannot be rushed nor the past remedied. All patients reply +promptly that they "can't help" worrying, when in truth they do not try. + +Work never hurt anyone, but harassing preoccupation with problems which no +amount of thought will solve drives many thousands to early graves. Anger +exhausts itself in a few minutes, fatigue in a few hours, and real overwork +with a week's rest, but worry grows ever worse. Ponder Meredith's lines: + + "I _will_ endure; I will not strive to peep + Behind the barrier of the days to come." + +"Look on the bright side!" said an optimist to a melancholy friend. + +"But there is no bright side." + +"Then polish up the dull one!" was the sound advice tendered. + +_Learn to forget_! + +One cannot open a periodical without being exhorted to train one's memory +for a variety of reasons. The neuropath needs a system of forgetfulness. +Lethe is often a greater friend than Mnemosyne. + +To brood on disappointments, failures and griefs only wastes energy, sours +temper, and upsets the general health. Resolve _beforehand_ that when +unhappy ideas arise you will _not_ dwell on them, but turn your thoughts to +pleasant trifles; take up a humorous book, or take a turn in the fresh air, +and you will soon acquire the habit of laughing instead of whining at Fate. + +To sum up: Go slow! Your neurons have been exhausted in your foolish +attempt to "live this day as if thy last" in a wrong sense; feverish +activity and unnecessary work must be abandoned to enable the nerves to +recuperate. + +When the doctor says "rest", he means "_rest_", not change your bustle from +work to what you are pleased to regard as play. + +So much is _absolute rest_ recognized as the foundation of treatment, that +severe cases undergo the "Weir-Mitchell Treatment". The patient is _utterly +secluded_; letters, reading, talking, smoking and visits from friends are +forbidden. He is put to bed, not allowed even to sit up, sees no one save +nurse and doctor, is massaged, treated electrically, grossly overfed, +fattened up, and freed from every care. + +In leaving his habitual circle, the patient escapes the too-attentive care +of his relatives, and the incessant questions about his complaint with +which they overwhelm him. The results of this régime with semi-insane +wrecks are marvellous. It is a very drastic but very successful +"rest-cure", and while it cannot be undergone at home, neurasthenics will +benefit by following its principles as far as they can in their own homes. + +High-frequency or static electricity sometimes works wonders in the hands +of a specialist, but the electric batteries, medical coils, finger-rings +and body-belts so persistently advertised are _useless_. + +When the patient has in some measure recuperated, he may try the following +exercises in mental concentration. Vittoz claims good results from them, +but they must be done quite seriously. + + 1. Walk a few steps with the definite idea that you are putting forward + right and left feet alternately. Go on by easy stages until you + concentrate on the movement of the whole body. + + 2. Take any object in your hand, and note its exact form, weight, + colour, etc. + + 3. Look in a shop-window while you count ten, and as you walk on, try + to recall all the objects therein exhibited. + + 4. Accustom yourself to defining the sounds you hear, and concentrating + on a special one, as that of a passing tram, or a ticking watch. + + 5. Make a rapid examination several times daily of your feelings and + thoughts, and try to express them definitely. + + 6. Concentrate on the mental reproduction of a regular curve: a figure + 8 placed on its side. + + 7. Listen to a metronome, and, a friend having stopped it, mentally + repeat the ticking to time. + + 8. Whenever you handle anything, try to retain the impression of that + object and its properties for several minutes, to the exclusion of + other ideas. + + 9. Concentrate on ideas of calm, and of energy controlled. + + 10. Place three objects on a sheet of white paper. Remove them one by + one, at the same time effacing the impression of each one as it is + removed, until the mind, like the paper, is blank. + + 11. Efface two of the objects, and retain the impression of one only. + + 12. Replace the impressions in your mind, but not the objects on the + paper, one by one. + +The object of these exercises is to get your wandering mind daily a little +more under control; do not exhaust yourself. + +After some months of treatment, ask yourself-- + +Am I able to walk ten miles with ease? when introduced to a stranger of +either sex or any age, to converse agreeably, profitably and without +embarrassment? to entertain visitors so that all enjoy themselves? to read +essays or poetry with as much pleasure as a novel? to listen to a lecture, +and be able afterwards to rehearse the main points? to be good company for +myself on a rainy day? to submit to insult, injustice or petulance with +dignity and patience, and to answer them wisely and calmly? When you are +able to answer, "Yes!" to these queries, your nerves are sound. + + * * * * * + +CHAPTER X + +FIRST STEPS TOWARDS HEALTH + + "All sick people want to get well, but rarely in the best way. A 'jolly + good fellow' said: 'Strike at the root of the disease, Doctor!' And + smash went the whisky bottle under the faithful physician's cane." + +In neuropaths, all irritation to the nervous system is dangerous, and must +be eliminated, and to this end, eyes, ears, nose and teeth, all in close +touch with nerves and brain, must be put and kept in perfect order. + +The Eye. Only 4 per cent, of people have _perfect_ sight. Errors in +refraction--common in neuropaths--mean that the unstable brain-cells are +constantly irritated. Dodd corrected eye-errors in 52 epileptics, 36 of +whom showed improvement. + +You take your watch to a watchmaker, not a chemist; take your eyes to an +oculist, and if you cannot afford to see one privately, get an eye-hospital +note. (To allow a chemist or "optician" to try lenses until he finds a pair +through which you "see better" is very dangerous.) + +Then you go to a qualified optician, who makes a proper frame, and inserts +the lenses prescribed. Patients should inquire if the glasses are to be +worn continually, or only when doing close work or reading. + +The Ears. Giddiness and other unpleasant symptoms may be due to ear +trouble. If there is any discharge, buzzing or ringing, see a doctor, for +if ear disease gains a firm hold it is usually incurable. + +The Nose. Neuropaths often suffer from moist nasal catarrh, or from a dry +type in which crusts of offensive mucus form, the disagreeable odour of +which is not apparent to the patient himself. He must pay careful attention +to the general health, take nourishing food, and wash out the nose three +times a day with: + + 1 oz. Bicarbonate of Soda, + 1 oz. Common Salt, + 1 oz. Borax, + Dissolved in 1 pint hot water. + +For obstinate nasal trouble, consult an aural surgeon. + +The Teeth. + + "Most men dig their graves with their teeth."--Chinese Proverb. + +Serious ills are caused by defective teeth, for microbes decompose the food +left in the crevices to acid substances which dissolve the lime salts from +the teeth, and this process continues until the tooth is lost. + +Faulty teeth are common in neuropaths, and at the risk of being +wearisome--and good advice is wearisome to people--patients must get proper +aid, privately or at a dental hospital, from a _registered dentist_, who, +like a doctor, does not advertise. + +Teeth gone beyond recall will be painlessly extracted, those going, +"stopped", and tartar or scale scraped off. If necessary, have artificial +teeth, but remember that the comfort of a plate depends upon skilled +workmanship, not on gold or platinum. Everyone should visit the dentist as +a matter of routine once a year. + + Buy 3 ozs. Precipitated Chalk, + 1 oz. Chlorate of Potash, + +and brush the teeth with this mixture ere going to bed; use tepid water +after meals. Do not brush across, but, holding the brush horizontally, +brush with a circular motion, cleaning top and bottom teeth at once. Use a +moderately hard brush with a curved surface which fits the teeth. + +After each meal, it is essential to cleanse the interstices between the +teeth with a quill toothpick or dental floss, never with a pin, for it is +the decomposition of tiny particles that starts decay; _a tooth never +decays from within_. + + 1½ fl. oz. Glycerine, + 1 fl. oz. Carbolic Acid, + ½ fl. oz. Methylated Chloroform. + +With ten drops of this mixture in a wineglassful of tepid water, wash out +your mouth and gargle your throat after every meal, sending vigorous waves +between the teeth, and so removing any particles left by toothpick and +brush. + +Children should be taught these habits as soon as they can eat, for the +custom of a lifetime is easy. + + * * * * * + +CHAPTER XI + +DIGESTION + + "We may live without poetry, music and art; + We may live without conscience, and live without heart; + We may live without friends, we may live without books, + But civilized man cannot live without cooks." + +The human digestive system consists of a long tube, in which food is +received, nutriment taken from it as it passes slowly downwards, and from +which waste is discharged, in from sixteen to thirty hours afterwards. + +Six glands pour saliva into the mouth, where it should be--but how rarely +is--mixed with the food, causing chemical changes, and moistening the bolus +to pass easily down. + +The acid Gastric Juice, of which a quart is secreted daily, stops the +action of the saliva, and commences to digest the proteins, which pass +through several stages, each a little more assimilable than the last. + +The lower end of the stomach contracts regularly and violently, churning +the food with the juice, and gradually squirting it, when liquified to +Chyme, into the small intestine. If food is not chewed until almost +liquified, the gastric juice cannot act normally, but has to attack as much +of the surface of the food-lump as possible, leaving the interior to +decompose, causing dyspepsia and flatulence. + +Most people suppose the stomach finishes digestion, but it only initiates +the digestion of those foodstuffs which contain nitrogen, leaving fats, +starches and sugars untouched. + +By an obscure process, the acid chyme stimulates the walls of the bowel to +send a chemical messenger, a Hormone through the blood to the liver and +pancreas, warning them their help is needed, whereupon they actively +secrete their ferments. + +The secretion of the pancreas is very complex. It carries on the work of +the saliva, and also splits insoluble fats into a soluble milky emulsion. + +Fats are unaffected in the mouth and stomach, which explains why hot, +buttered toast, and other hot, greasy dishes are so indigestible. The +butter on plain bread is quickly cleared off, and the bread attacked by the +gastric juice, but in toast or fatty dishes, the fat is intimately mixed +with other ingredients, none of which can properly be dealt with. Always +butter toast when cold. + +To continue: The secretion of the pancreas also contains a very active +ferment, which, on entering the bowel, meets and mixes with another ferment +four times as powerful as gastric juice, which completes the digestion of +the proteids. + +Meantime, the secretions of Lieberkühn's glands (of which there are immense +numbers in the small intestine) are further aiding the digestion of the +chyme, while the liver (the largest and most important gland in the body) +sends its ferments, and the gall-bladder its bile, which further emulsifies +the fatty acids and glycerin until they are ready to be absorbed. + +The chemically-changed chyme is now termed Chyle, and is ready to be +absorbed by the minute, projecting Villi. + +The fatty portion of the chyle is absorbed by minute capillaries and +ultimately mingles with the blood, which may look quite milky after a fatty +meal. + +The remaining food is absorbed by the blood capillaries in the villi, and +passes to the liver for filtration and storage. + +The large bowel has Lieberkühn's glands, but not villi, and is relatively +unimportant, though most of the water the body needs is absorbed from here. + +How food becomes energy and tissue we do not know. The tissues are +continually being built up from assimilated food, and as constantly being +burnt away, oxygen for this purpose being extracted from the air we inhale, +and carried via the blood to every corner of the body. The ashes of this +burning are expelled into the blood and lymph, and carried out of the body +by the kidneys, lungs, skin and bowels. The product of the burning is the +marvel--Life; the extinction of the fire is the terror--Death. + +Energy is obtained almost solely from the combustion of fats and sugars, +proteids being reconverted into albumin, and then broken down to obtain +their carbon for combustion, the nitrogen being expelled, but proteids are +essential for the building of the tissues themselves, the stones of the +furnaces which burn up carbohydrates and fats. + +The time taken in the digestion of foods was first studied through a wound +in the stomach of St. Martin, a Canadian. Experiments were made with +various well-masticated foods, and with similar foods placed unchewed, into +the stomach through the wound, the latter experiment being carried out by +millions of people at every meal, by a slightly different route. + +Boiled food is more easily digested than fried or roasted (the frying pan +should be anathema to a neuropath); lean meat than fat; fresh than salt; +hot meat than cold; full-grown than young animals, though the latter are +more tender; white flesh than red; while lean meat is made less, and fat +meat more digestible, by salting or broiling. Oily dishes, hashes, stews, +pastries and sweetmeats are hard to digest. Bread should be stale, and +toasted crisply _right through_. The time, compared with the thoroughness +of digestion, is of little importance, as it varies widely within +physiologic bounds. + +Most people fancy that the more they eat the stronger they become, whereas +the digestion of all food beyond that actually needed to repair the waste +due to physical and mental effort consumes priceless nerve energy, and +weakens one. The greater part of excessive food has literally to be _burnt +away_ by the body, which causes great strain, mainly on the muscles. The +question is not: "How much can I eat?" but: "How much do I need?" + + * * * * * + +CHAPTER XII + +INDIGESTION + + "We know how dismal the world looks during a fit of indigestion, and + what a host of evils disappear as the abused stomach regains its tone. + Indigestion has lead to the loss of battles; it has caused many crimes, + and inspired much sulphurous theology, gloomy poetry and bitter + satire."--Hollander. + +The nervous dyspeptic suffers no marked pain, but often feels a "sinking", +has no appetite, and cannot enjoy life because his stomach, though sound, +does not get enough nerve-force to run it properly. + +A great deal of nerve-force is required for digestion, and if a man comes +to the table exhausted, bolts his food, uses nerve-force scheming while he +is bolting, and, immediately he has bolted a given amount, rushes off to +work, digestion is imperfectly performed, nutriment is not assimilated, the +nerve-force supply becomes deficient. He continues to overdraw his account +in spite of the doctor's warning, and stomachic bankruptcy occurs, followed +by a host of ills. + +Nervous dyspepsia is a very obstinate complaint, but if tackled resolutely, +it can to a great extent be mitigated; but let it be emphasized at once, +that medicines, patent or otherwise, are useless. If dyspepsia be +aggravated by other complaints, these should receive appropriate treatment, +but the assertions so unblushingly made in patent-pill advertisements are +unfounded. The very variety of the advertised remedies is proof of the +uselessness of all. + +Set aside certain periods three times a day for meals. Fifteen minutes +before meal times, sit in a comfortable chair, relax all your muscles, +close the eyes, and try to make the mind a blank. _Rest_! + +Then eat the meal slowly and thoroughly. Conversation may lighten and +lengthen a meal, but avoid politics, "shop" and topics of that type. What +is wanted at table is wit, not wisdom. + +Water may be drunk with meals, provided it is drunk between eating, and not +while masticating, for it has decidedly beneficial effects upon the +digestive functions. Water is usually forbidden with meals because if +patients drink while eating, the water usurps the functions of saliva, and +moistens the bolus, which is then swallowed with little or no mastication. +If you cannot drink between mouthfuls, then drink only between meals. +_Never drink while food is in the mouth!_ + +After the meal, lie down on the right side for half an hour, _resting_, and +so directing all available nerve-energy to getting digestion well under +way. + +Indifferent appetites must be tempted by wholesome dishes made up in a +variety of enticing ways. Fats are good, but must be taken in a tasty form. +Eat fruit deluged with cream. + +The crux of digestion is to + +"_Chew_! CHEW!! and KEEP ON CHEWING!!!" for until food is thoroughly +masticated there will be no relief. The only part of the whole digestive +process placed under the control of consciousness is mastication, and, +paradoxically, it is the only part that consciousness usually ignores. + +A healthy man never knows he has a stomach; a dyspeptic never knows he has +anything else, because he will not _eat_ his food, but throws it into his +stomach as the average bachelor throws his belongings into a trunk. + +A varied, tasty diet, thoroughly chewed and salivated, with rest before and +after meals, is the only means of curing dyspepsia, for no medicine can +supply and properly distribute nerve-energy. + +Digestive pills are all purgatives, with a bitter to increase appetite, and +occasionally a stomachic, bound together with syrup or soap. Practically +all contain aloes, and very rarely a minute quantity of a digestive ferment +like pepsin. Taken occasionally as purges, most digestive pills would be +useful, but none are suited to continuous use, and the price is, as a rule, +out of all proportion to the primary cost, while one or two are, frankly, +barefaced swindles. + +The analyses of the British Medical Association give the following as the +probable formulæ for some well-known preparations: + + Beecham's Pills.............................Aloes; ginger. + Holloway's Pills............................Aloes; ginger. + Page Woodcock's ............................Aloes; ginger; capsicum; + cinnamon and oil of + peppermint. + Carter's Little Liver.......................Aloes; podophyllin; + Pills liquorice. + Burgess' Lion Pills.........................Aloes; ipecacuanha; rhubarb; + jalap; peppermint. + Cockle's Pills..............................Aloes; colocynth; jalap. + Barclay's Pills.............................Aloes; colocynth; jalap. + Whelpton's Pills............................Ginger; colocynth; gentian. + Bile Beans..................................Cascara; rhubarb; liquorice; + peppermint. + Cicfa.......................................Cascara; capsicum; pepsin; + diastase; maltose. + + * * * * * + +CHAPTER XIII + +DIETING + + "Simple diet is best; many dishes bring many diseases," + --Pliny. + + "Alas! what things I dearly love-- + puddings and preserves-- + Are sure to rouse the vengeance of + All pneumogastric nerves!" + --Field. + +The man who pores over a book to discover the exact number of calories +(heat units) of carbohydrates, proteins and fats his body needs, means +well, but is wasting time. + +In theory it is excellent, for it should ensure maximum work-energy with +minimum use of digestive-energy, but in practice it breaks down badly, a +weakness to which theories are prone. One man divided four raw eggs, an +ounce of olive oil, and a pound of rice into three meals a day. +Theoretically, such a diet is ideal, and for a short time the experimenter +gained weight, but malnutrition and dyspepsia set in, and he had to give +up. The best diet-calculator is a normal appetite, and fancy aids digestion +more than a pair of scales. + +In spite of rabid veget- and other "arians", most foods are good (making +allowances for personal idiosyncrasy) if thoroughly masticated. The +oft-quoted analogy of the cow is incorrect, for herbivora are able to +digest cellulose; but even cows masticate most laboriously. + +Meat juices are the most digestion-compelling substances in existence, and +a little meat soup, "Oxo" or "Bovril" is an excellent first course. + +No one needs more than three meals per day, while millions thrive on one or +two only, which should be ready at fixed hours; for the stomach when +habituated becomes congested and secretes gastric juice at those hours +without the impulse of the will, is ready to digest food, and gets that +rest between-times which is essential to sound digestion. The man who has +snacks between meals, and chocolates and biscuits between snacks can never +hope to get well. + +To eat the largest meal at midday, as is the custom of working-men, is +best, provided one can take half an hour's rest afterwards. + +Drink a pint of tepid water half an hour before every meal. If the stomach +be very foul, add a teaspoonful of bicarbonate of soda to the water. + +The question of alcohol is a vexed one, but Paul's "Take a little wine for +thy stomach's sake," is undoubtedly sound advice, though had Paul been +trained at a London hospital, he would have added "after meals". +Unfortunately, moderation is usually beyond the ability of the neuropath, +and consequently he should be forbidden to take alcohol at all. Spirits +must be avoided. + +Moderately strong, freshly made tea or coffee may be consumed in reasonable +quantity. + +Vegetable salads are excellent if compounded with liquids other than +vinegar or salad oil, and of ingredients other than cucumbers, radishes, +and the like. + +Take little starchy food and sweetmeats. It may surprise those with "a +sweet tooth" to learn that, to the end of the Middle Ages, sugar was used +only as a medicine. Meat must be eaten--if at all--in the very strictest +moderation, and never more than once a day. Eggs, fish and poultry--in +moderation too--take its place. + +Healthy children need very little meat, while it is a moot point if +children of unstable, nervous build need any at all. The diet at homes for +epileptics is usually vegetarian, and gives excellent results. + +Never swallow skin, core, seeds or kernels of fruits, many of which, +excellent otherwise, are forbidden because of the irritation caused to +stomach and bowels by their seeds or skins. + +Bromides are said to give better results if salt is not taken. A little may +be used in cooking, if, as is usually the case, the patient has to eat at +the common table, but condiments are unnecessary and often irritating to +delicate stomachs. + +The diet of nervous dyspeptics must be very simple, and though it is trying +and monotonous to forgo harmful dainties in favour of wholesome dishes, it +is but one of the many limitations Nature inflicts on neuropaths. Many an +epileptic, after believing himself cured, has brought on a severe attack by +an imprudent meal. La Rochefoucauld says: "Preserving the health by too +strict a regimen is a wearisome malady", but it is open to all men to +choose whether they will endure the remedy or the disease. + +Most men eat six times the minimum and twice the optimum quantity of food +per day. For every one who starves, hundreds gorge themselves to death. +"Food kills more than famine", and the poor, who eat sparsely from +necessity, suffer far less from gout, cancer, rheumatism and other +food-aggravated diseases than the rich. + +Most books give detailed lists of foods to be eaten and to be avoided, but +this we believe is productive of little good. + +Let the patient eat a mixed diet, well and suitably cooked, taking what he +fancies in reason, masticating everything thoroughly, and gradually +eliminating foods which experience teaches him are difficult for him to +digest. + + * * * * * + +CHAPTER XIV + +CONSTIPATION + + "Causing a symptom to disappear is seldom the cure of + any ill; the true course is to _prevent_ the symptom." + +Rings of muscle cause wormlike movements of the bowels, and so propel +forward food and waste. Weakening of these muscles or their nerve controls +from any cause, results in a "condition of the bowels in which motions +occur only when provoked by medicines or injections". In some cases though +motions occur freely, food ingested is retained too long in the digestive +tract. + +The blood extracts what water it needs from the fluid waste in the large +bowel, but when the weak muscles allow this to remain too long, an excess +of moisture is removed, leaving hard, dry masses, painful to pass. + +When the fæces reach the anus, they cause an uneasy feeling, which directs +us to seek relief, but if we neglect this impulse the bowel may become so +insensitive that it ceases to warn its owner of the need to evacuate. +Meantime, the muscles which expel the fæces get weak, so that every motion +needs a strong effort of will, and much harmful straining. + +Much misery is caused by false modesty in the presence of others. It can +never be immodest to attend to the calls of Nature, and such +hypersensitiveness is dangerous, for rupture, piles, fissure, prolapse, +fistula, are often due to straining. + +Lack of exercise weakens the intestinal and abdominal muscles. Unsuitable +or imprudent foods or drinks, indigestion, excessive worry, and anything +that lowers the general health tend to produce constipation. + +Bacteria flourish freely in fæces, and though it is doubtful whether the +"Auto-intoxication" so freely ascribed to them, is supported by facts, it +cannot be doubted that, whatever the precise mechanism by which the effects +are produced, constipation does result in a lowering of the resistance to +disease. More frequent fits, colic, foul breath, headache right across the +forehead, lost appetite, drowsiness, skin eruptions, irritability, +insomnia, melancholia and anæmia (especially the "green sickness" of women, +usually connected with menstrual irregularities) are but a few of many ills +partly or wholly due to or consequent upon constipation. + +The symptoms of constipation of the small bowel are dry stools, usually +light in colour. + +To cure this type, more water should be drunk, so that the waste may pass +to the large bowel in a fluid state. Drink freely between meals, especially +in summer, when profuse perspiration often causes obstinate constipation. + +The symptoms of constipation of the large bowel are furred tongue, foetid +breath, sallow or jaundiced complexion, and mottled stools of round, hard +balls, the first portion being very firm, and the remainder nearly liquid. +There are occasional attacks of colic. + +The first step towards cure is to form regular habits. At a suitable time, +say shortly after breakfast, or after supper if you suffer from +hæmorrhoids, go to the lavatory, whether you feel uncomfortable or not. +Wait patiently, do not try to hasten matters by violent straining, and if +for some weeks there is little improvement, do not despair, for the habits +of a lifetime are not overcome in five minutes, just because you have +decided to amend your careless ways. A short, brisk walk beforehand often +helps. + +If necessary, use a chamber and "squat" as savages do. In this position, +the thighs support the abdomen, and force is exerted without straining. +Massaging the abdomen by firmly rubbing it round and round, clockwise, with +the hand, often does good, as does pressure with a finger on the flesh +between the end of the backbone and the anus. Try every method before +taking purgatives, for with patience and determination these are rarely +necessary. + +Carefully cooked and "concentrated", easily digested and "pre-digested" +foods contain little residue; every meal should contain some indigestible +matter to stimulate the intestines. Brown bread, porridge, lettuce, cress, +apples and coarse vegetables are all good for this purpose, but if taken +too freely may cause heartburn and flatulence. Meat, milk, fish, eggs and +most patent foods have not enough waste. Boiled milk is very constipating. + +Purgatives, injections and medicines, alone, are useless, for the bowel +becomes still more insensitive to natural calls under the artificial +stimulation of drugs, on which it becomes so entirely dependent that +without their aid it will not act. + +It may be necessary to clean out the bowel by an enema. + +Make a lather with clean warm water and plain soap, and fill the enema +syringe (a half-pint size is useful). Smear the nozzle with vaseline, lean +forward and insert into the anus, pointing a little to the left. Press the +bulb, withdraw the nozzle, retain the liquid a few moments and a desire to +go to stool will be felt. + +A simpler plan is to buy glycerin suppositories. One is inserted into the +anus and acts like an injection. It must be clearly understood that these +are emergency measures. + +If internal piles come down at stool, do not allow them to remain and get +engorged with blood. See that your hands are scrupulously clean, and your +nails closely cut and free from dirt; then moisten the middle finger with a +little vaseline taken to the lavatory for the purpose, and gently return +the hæmorrhoids, sitting down for a few minutes to retain them. + +A mild purge may be taken once a week with advantage. Glauber's Salts +(Sodium Sulphate), Cascara Sagrada, and liquid paraffin are all good, while +Castor Oil Globules are suited for children. + +For flatulence, take a 10-minim capsule of Terebine after meals, or +charcoal, either as French Rusks ("Biscols Fraudin") or a teaspoonful of +powdered charcoal between meals. One drop of creosote on a lump of sugar, +peppermint water, and sal volatile may also be used. Sufferers should toast +bread, and use sugar sparingly. + +Patent medicines almost invariably contain a brisk aperient. + + * * * * * + +CHAPTER XV + +GENERAL HYGIENE + + "Better to hunt in fields for health unbought, + Than fee the doctor for a nauseous draught." + --Dryden. + +If men but realized what complicated machines they were, they would use +themselves better. In the body are 240 bones and hundreds of muscles. The +heart, no bigger than the clenched fist, beats 100,000 times a day; the +aerating surface of the lungs is equal in area to the floors of a +six-roomed house, and by means of its minute blood-vessels which would +stretch across the Atlantic, 500 gallons of blood are brought into contact +with over 3,000 gallons of air every day. + +Seven million sweat-glands, 30 miles long, get rid of a pint of liquid and +an ounce of solid waste each day while it takes a tube 30 feet long, with +millions of glands, to deal with a sip of milk. + +Man's finest steam engine turns one-eighth of the energy supplied into +work; nature's engine, muscle, turns one-third into work. The body contains +9 gallons of water, enough carbon to make 9,000 lead pencils, phosphorus +for 8,000 boxes of matches, iron for 5 tacks, and salt enough to fill half +a dozen salt-cellars. + +Over 40 food-ferments have been found in the liver; there are 5,000,000 red +and 30,000 white blood corpuscles in a space as big as a pin's head, each +one of which travels a mile a day and lives but a fortnight, millions of +new ones being built up in the bone-marrow every second; a flash of light +lasting only one eight-millionth of a second, will stimulate the eye, which +can discriminate half a million tints. The ear can distinguish 11,000 +tones, and is so sensitive that we hear waves of air less than one +sixty-thousandth of an inch long; a mass of almost liquid jelly--for 81 per +cent of the brain is water, and Aristotle thought it was a wet sponge to +cool the hot heart--sends out impulses ordering our every thought and act, +and stores up memory, we know not how or where. + +There are 10,000,000,000 of cells in the brain cortex alone, and 560,000 +fibres pass from the brain down the spinal cord. + +A clear, watery cell, no larger than the dot on an "i" encloses factors +causing genius or stupidity, honesty or roguery, pride or humility, +patience or impulsiveness, coldness or ardour, tallness or shortness, form +of head or hands, colour of eyes and hair, male or female sex, and the +thousand details that make a man. + +Yet man uses this marvellous mechanism but carelessly, and the widespread +poverty, the worry and discord in the lives of the happiest, our ignorance, +the evil habits we contract, and the vice, miseries, diseases and labours +to which most expectant mothers are too often exposed, explain why one baby +in every eight never walks; why but four of them live to manhood; why less +than 40 years is now man's average span; and why this brief space is filled +with suffering and misery, from which many escape by self-destruction. + +Sound children do not come from unclean air, surroundings, habits, +pursuits, passions and parents. Children conceived in unsuitable +surroundings by unsuitable parents, die; must die; ought to die. They are +not built for the stern battle of life. + + * * * * * + + "Where the sun does not enter, the doctor does!" + --Italian proverb. + +Plenty of fresh, clean air is essential to health. + +In all rooms a block of wood nine inches high should be inserted beneath +the whole length of the bottom sash of the window. This leaves a space +between the top and bottom sashes through which fresh air passes freely, +without draught, both night and day, for it should never be closed. A handy +man will fit a simple device to prevent the windows being forced at night, +but better let in a burglar than keep out air. + +If it be cold or draughty in the bedroom, hang a sheet a foot from the +window, put more blankets or an overcoat on the bed, or put layers of brown +paper above the sheets, _but never close the window_. + +You can take too much of many good things, but never too much pure air. + +Cleanliness. Keep the body clean by taking at least one hot bath per week; +per day if possible. Much filth is excreted by your sweat-pores; why let it +cake on skin and underlinen, and silently silt up your thirty miles of skin +canals, thus overworking the other excretory organs, and gradually +poisoning yourself? + +Neuropaths always suffer from sluggish circulation of the extremities, and +to improve this, hot and cold baths, spinal douches and massage are +excellent. A hot bath (98-110° F.) ensures a thorough cleansing, but it +brings the blood to the surface, where its heat is quickly lost, enervating +one, and causing a bout of shivering which increases the production of heat +by stimulating the heat-regulating centre in the brain. Baths above 110° F. +induce faintness. To prevent shivering, take a cold douche after the hot +bath, and have a brisk rub down with a coarse towel, when a delightful, +warm glow will result. Do not freeze yourself, or the reaction will not +occur; what is wanted is a short, sharp shock, which sends the blood racing +from the skin, to which it returns in tingling pulsations, which brace up +the whole system. The douche is over in a few seconds, and may be enjoyed +the year round, commencing in late Spring. + +The cold bath must not be made a fetish. If the glow is not felt, give it +up, and bathe in tepid (85-92° F.) or warm (93-98° F.) water. When started +in the vigour of youth, the cold bath may often be continued through life, +but it is unwise to commence in middle life. Parents should never force +their children to take cold baths, to "harden them". + +Other Hygienic Points. Tobacco is undesirable for neuropaths, save in +moderation. + +Clothes should be light, loose, and warm. Epileptics should wear low, stiff +collars, half a size too large, with clip ties. Such a combination does not +form a tight band round the neck, and can quickly be removed if necessary. +Wear thick, woollen socks, and square-toed, low-heeled, double-soled boots. +Hats should be large, light, and of soft material. Woollen underwear is +best. Change as often as possible, and aim at health, not appearance. + +Let all rooms be well lighted, well ventilated, moderately heated, and +sparsely furnished with necessities. Shun draperies, have no window boxes, +cut climbing plants ruthlessly away from the windows, and never obstruct +chimneys. + +Buy Muller's "My System", which gives a course of physical exercises +without apparatus, which only take fifteen minutes a day. The patient must +conscientiously perform the exercises each morning, not for a week, nor for +a month, but for an indefinite period, or throughout life. + +Finally, remember that so few die a natural death from senile decay because +so few live a natural life. + + * * * * * + +CHAPTER XVI + +SLEEPLESSNESS + + "O magic sleep! O comfortable bird + That broodest o'er the troubled sea of the mind + Till it is hushed and smooth." + --Keats. + +Some men need only a few hours' sleep, but no one ever overslept himself in +natural slumber. There are anecdotes of great men taking little sleep, but +their power usually consisted in going without sleep for some days when +necessary, and making up for it in one long, deep sleep. Neuropaths require +from 10-13 hours to prepare the brain for the stress of the next day, but +quality is more important than quantity. + +Patients go to bed tired, but cannot sleep; fall asleep, and wake every +other hour the night through; sleep till the small hours, and then wake, to +get no more rest that night; only fall asleep when they should be rising; +or have their slumber disturbed by nightmare, terrifying dreams, heart +palpitation, and so on. + +Noise often prevents sleep. A clock that chimes the quarters, or a watch +that in the silence ticks with sledge-hammer beats, has invoked many a +malediction. Traffic and other intermittent noises are very trying, as the +victim waits for them to recur. Townsmen who seek rural quiet have got so +used to town clatter, that barking dogs, rippling streams, lowing cows, +rustling leaves, singing birds or chirruping insects keep them awake. Too +much light, eating a heavy supper, all tend to banish repose, as do also +violent emotions which produce toxins, torturing the brain and causing +gruesome nightmares. + +Grief and worry--especially business and domestic cares--constipation, +indigestion, bad ventilation, stimulants, excitement and a hearty supper +are a few of the many causes of insomnia. + +In children sleeplessness is often due to the bad habit of picking a child +up whenever it cries, usually from the pain of indigestion due to having +been given unsuitable food. Feed children properly, and train them to +regular retiring hours. School home-work may cause insomnia; if so, forbid +it. + +Man spends a third of his life in the bedroom, which should be furnished +and used for no other purpose. Pictures, drapery above or below the bed, +and wallpaper with weird designs in glaring colours are undesirable. The +wall should be distempered a quiet green or blue tint, and the ceiling +cream. A bedroom should never be made a storeroom for odds and ends, nor is +the space beneath the bed suitable for trunks; least of all for a +soiled-linen basket. + +Some time before retiring, excitement and mental work should be avoided. +The patient should take a quiet walk after supper, drink no fluid, empty +bladder and bowels, and take a hot foot-bath. + +Retire and rise punctually, for the brain, like most other organs, may be +trained to definite habits with patience. + +If sleeplessness be ascribed, rightly or wrongly, to an empty stomach, a +glass of hot milk and two plain biscuits should be taken in bed; dyspeptics +should take no food for three hours before retiring. If the patient wakes +in the early morning he may find a glass of milk (warmed on a spirit-stove +by the bedside) and a few plain biscuits of value. + +A victim of insomnia should lie on his side on a firm bed with warm, light +coverings, open the window, close the door, and endeavour to fix his +attention on some monotonous idea; such as watching a flock of white sheep +jump a hedge. Think of trifles to avoid thinking of troubles. + +How often do we hear people complain that they suffer from insomnia, when +in fact they get a reasonable amount of sleep, and indeed often keep others +awake by their snoring. + +When you wake, _get up_, for a second sleep does no good. When some one, on +seeing the narrow camp-bed in which Wellington slept, said: "There is no +room to turn about in it," the Iron Duke replied: "When a man begins to +turn about in his bed it is time he turned out of it." + +The only safe narcotic is a day's hard work. For severe insomnia consult a +doctor; do not take drugs--that way lies ruin. By taking narcotics, or +patent remedies containing powerful drugs, you will easily get sleep--for a +time only--and then fall a slave to the drug. Such victims may be seen in +dozens in any large asylum. + + * * * * * + +CHAPTER XVII + +THE EFFECTS OF IMAGINATION + + "The surest way to health, say what they will + Is never to suppose we shall be ill; + Most of the ailments we poor mortals know + From doctors and imagination flow." + --Churchill. + + "Men may die of imagination, + So depe may impression be take." + --Chaucer. + + "Suggestion is the introduction into the mind of a practical belief + that works out its own fulfilment."--Guyau. + +Man suffers from no purely imaginary ills, for mental ills are as real as +physical ills, and though an individual be ailing simply because he +persuades himself he is ailing, his mind so affects his body that he is +actually unwell physically, though the cause of his trouble is purely +mental. + +The suffering of this world is out of all proportion to its actual disease, +many people being tortured by fancied ills. Some dread a certain complaint +because a relative has died of it. + +Others are unwell, but while taking proper treatment they brood gloomily, +and get worse instead of better as they should and _could do_. + +Cheap medical and pseudo-medical works are not an unmixed blessing, for +many a person who knows, and needs to know, nothing about disease, gets +hold of one, and soon has most of the ills known to the faculty and some +which are not. + +If a patient be an optimist and persuades himself he is improving, he +_does_ improve. This is the explanation of "Faith moving mountains", for +the curative power of prayer, Christian Science, laying-on of hands, +suggestion treatment and patent medicine, depends on man's own faith, not +on the supernatural. + +A doctor in whom a patient has perfect confidence, will do him far more +good with the same medicines, or even with no medicines at all, than one of +riper experience in whose skill he has no faith. + +Eloquent, though often inaccurate accounts of the benefits derived from +patent medicines are persistently advertised until the mind is so +influenced by the constant reiteration of miraculous cures, that, either +because the healing forces of the body are thereby stimulated, or because +the disease is curable by suggestion, the patient is benefited by such +medicines. + +Thinking of pain makes it worse and vice versa. + +The curative effects of auto-suggestion were demonstrated at the Siege of +Breda in 1625. The garrison was on the point of surrender when a learned +doctor eluded the besiegers, and got in with some minute phials of an +extraordinary Eastern Elixir, one drop of which taken after each meal cured +all the ills flesh was heir to; two drops were fatal. + +The "learned doctor" was a quick-witted soldier, and the elixir was +_coloured water_ sold by order of the commander. Its potency was due to the +faith of all, who persuaded each other they were getting better, and an +epidemic of infectious wellness followed ills due to depressed spirits. + +One man after reading a list of symptoms said in great alarm: "Good +Heavens. I have got that disease!" and, on turning the page, found it +was... _pregnancy_. + +As the great Scotch physiologist, Reid, said seventy years ago: + + "Hope and joy promote the surface circulation of the body, and the + elimination of waste matter and thus make the body capable of + withstanding the causes which lead to disease, and of resisting it when + formed. Grief, anguish and despair enfeeble the circulation, diminish + or vitiate the secretions, favour the causes which induce disease, and + impede the action of the mechanism by which the body may get rid of its + maladies. An army when flushed with victory and elated with hope + maintains a comparative immunity from disease under physical privations + and sufferings which, under the opposite circumstances of defeat and + despair, produce the most frightful ravages." + +The classic description of the woeful effects of imagination is in Jerome's +"Three Men in a Boat". Harris, having a little time on his hands, strolls +into a public library, picks up a medical work, and discovers he has every +affliction therein mentioned, save housemaid's knee. He consults a doctor +friend and is given a prescription. After an argument with an irate +chemist, he finds he has been ordered to take beefsteak and porter, and not +meddle with matters he does not understand. A sounder prescription never +was penned. + + * * * * * + +CHAPTER XVIII + +SUGGESTION TREATMENT + + "To purge the veins + Of melancholy, and clear the heart + Of those black fumes that make it smart; + And clear the brain of misty fogs + Which dull our senses, our souls clog." + --Burton. + +Hypnosis and suggestion have suffered from those people who put back every +reform many years--quacks and cranks--for while science, with open mind, +was testing this new treatment, the quacks exploited it up hill and down +dale. + +Yet there is nothing supernatural in suggestion, for we employ it on +ourselves and others every hour we live. Conscience consists only of the +countless stored-up suggestions of our education, which by opposing any +contrary suggestions, cause uneasiness. + +Many of us conform through life to the suggestions of others, affection, +awe, hero-worship and fear taking the place of reason. + +The most resolute of men are influenced by tactful suggestions, which +quietly "tip-toe" on to the margin of consciousness, awaken ideas which +link up more and more associations, until an avalanche is started which +forces itself on to the field of consciousness, the subject thinking the +idea is his own. + +Author and actor try by suggestion to make us think, laugh, or weep at +their will, books are sold by suggestive titles, and many clothes are worn +only to suggest wealth or respectability. + +The best salesman is he who by artful suggestion sells us what we do not +want; the best buyer he who by equally astute suggestion makes the seller +part at a price which makes him regret the bargain the moment it is closed. + +Suggestion treatment is of great use in curing nervous states and bad +habits, and all neuropaths should practice self- or auto-suggestion. In +severe cases a specialist must give the treatment. + +The patient is taken by the neurologist to a cosy, restfully-furnished, +half-lighted room, and placed in a huge easy chair facing a cheery fire. He +sinks into the depths of the chair, relaxes every muscle, allows his +thoughts to wander pleasantly, and soon his brain is at rest, and his mind, +undisturbed by the fears which usually harass it, is ready to receive +suggestions. + +The doctor talks quietly, soothingly, but with the conviction born of +knowledge to the patient about his trouble, assuring him that he _can_ +control his cravings; that he _can_ put away the doubts or fears that have +grown upon him. The true reason of his illness is pointed out, any little +organic factors given due weight, and the idea that it is hereditary or due +to Fate dispelled. Faults of character, reasoning and living are +unsparingly exposed and appropriate remedies suggested, and he is shown how +unmanly his self-torturing reproaches are, and how futile is remorse unless +transmuted into reform. + +The doctor's earnestness inspires confidence, and the patient unburdens his +secret troubles, discusses means of remedying them, and turns from pain to +promise, from remorse to resolve, from introspection to action, from +dreading to doing. + +Struck by the way the psycho-analyst reads his soul and lays bare petty +meannesses, impressed by the patient thoroughness with which the doctor +attends to each little symptom, confident that organic troubles--if there +be any--will receive appropriate treatment, ready to carry out +instructions, and disposed to believe the new treatment is of real value: +under all these circumstances, the physician's suggestions carry very great +weight with the patient. + +The resolutions passed by the victim in this calm state sink deep into +subconsciousness, and when next temptation, impulse or fear assails him, +his own resolutions and the doctor's suggestions are so vividly recalled +that he tries to control his thoughts, and, in due time he "wins out". + +Anyone may induce the calm state, and repeat suitable suggestions. The +patient should go to a quiet room, and, reclining on a comfortable couch +before a cheery fire, close the eyes, relax the muscles, breathe deeply, +and avoid all sense of strain. + +The next step is to fix the imagination on some scene which suggests +tranquility--smooth seas, autumnal landscapes, snow-clad heights, old-world +gardens, deep, shady silent pools, childhood's lullabies, secluded +backwaters, dim aisles of ancient churches. + +After a few evenings' practice, you will be able gradually to exclude all +other ideas, and focus on one, inducing a state which, somewhat similar +outwardly, is free from the excitement of religious exaltation, and from +the delusions of a medium's trance. + +In this state, an appropriate suggestion must be made, sincerely, and with +_absolute faith_ in its power. Christ's miracles were the result of +suggestive therapeutics, and He took care to inspire relatives with faith, +to exclude scoffers, to surround himself by his believing Apostles, and, +after treatment, said: "See thou tell no man!" well knowing that suggestion +cannot withstand derision. + +In this way, a patient of limited means can do for himself exactly what +more fortunate ones pay large fees to specialists to do for them. The +treatment is uncommon, but sound, for the medical profession is perhaps the +most conservative on earth, and when specialists of repute use a method, +you may be confident it is of value. + +To cure sleeplessness, see that stomach and brain are at rest, bed +comfortable, and feet warm; calm yourself, and focus on the idea of sleep, +saying: + +"I shall go to sleep in a few minutes, and wake at eight o'clock in the +morning." + +Repeat this a few times, persist for a few nights and you will quickly get +drowsy, and fall asleep. + +Phrases for other requirements will readily occur, as: + +"I shall feel confident in open spaces!" + +"I shall find no more pleasure in alcohol!" and so on. + +Suggestion will not cure epilepsy, hysteria or neurasthenia, but it +overcomes many of the symptoms which make the patient so wretched. + + "Crutches are hung on the walls of miraculous grottos, but _never a + wooden leg_." + +Suggestion may move a paralysed arm, but the muscles only become healthy +again in many days by slow repair; suggestion releases the catch, but the +spring must be wound up by energy suitably applied. + + * * * * * + +CHAPTER XIX + +MEDICINES + + "Of simples in these groves that grow + He'll learn the perfect skill; + The nature of each herb, to know + Which cures and which can kill." + --Dryden. + +So distressing a malady as epilepsy early attracted attention, and every +treatment superstition could devise, or science could suggest, has been +tried. Culpepper in his "Herbal" (300 years old), recommends bryony; lunar +caustic (nitrate of silver) was extensively used, because silver was the +colour of the moon, which caused madness. + +The royal touch for scrofula (King's Evil) was also extended to epilepsy, +the king blessing a ring, which was worn by the sufferer. + +Another old remedy was to cut off a lock of the victim's hair while in a +seizure and put it in his hand, which stopped (?) the attack. In Berkshire +a piece of silver collected at the communion service and made into a ring +was specific, but in Devon a ring made of three nails from an old coffin +was preferred. Lupton says: "A piece of child's navel-string borne in a +ring is good against falling sickness." + +Nearly every drug in the Pharmacopoeia has been tried, the drugs now +generally used being sodium, potassium and ammonium bromide. + +Before bromides were introduced by Locock in 1857, very strict hygienic, +dietic and personal disciplinary treatment combined with the use of drugs +often effected improvement. Since the use of bromides, these personal +habits have, unfortunately, been neglected, far too much reliance being +placed on the "three times a day after meals" formula. + +All bromides are quickly absorbed from the stomach and bowels, and enter +the blood as sodium bromide, which lowers the activity of both motor and +sensory centres, and renders the brain less sensitive to disturbing +influences. + +Unfortunately, the influence of bromides is variable, uncertain, and +markedly good in only a small proportion of cases. + +In about 25 per cent of cases, in which mild seizures occur at long +periods, without mental impairment, the bromides arrest the seizures, +either temporarily or permanently, after a short course. In another 25 per +cent the bromides lessen the frequency and severity of the fits, this being +the common _temporary_ result of their use in _all cases_ in the first +stages. + +In quite 50 per cent of cases, the effect of bromides diminishes as they +are continued, and they finally exert no influence at all. Many cases are +temporarily "cured", the drug is stopped, and the seizures recur. Bromides +are valuable in recent and mild cases, but no medicine exerts much effect +on severe cases of long standing, which usually end in an institution. + +When these drugs are taken continuously, nausea, vomiting, sleepiness, +confusion of thought and speech, lapses of memory, palpitation, furred +tongue, unsteady walk, acne and other symptoms of "bromism" may arise, +whereupon the patient must stop taking bromides and see a doctor, who will +substitute other drugs for a time. + +If heart palpitation be troublesome while using bromides, take a +teaspoonful of sal volatile in water. + +See a doctor if you can; _until_ you see him, get from a chemist: + + Potassii bromidi 10 grains. + Sodii bromidi 10 grains. + Boracis purificati 5 grains. + Aquæ 1 fluid ounce. + Two tablespoonfuls in water three times a + day after meals. + +This prescription is for an adult. If the patient be under twenty-one, tell +the chemist his age, and he will make it up proportionately. + +Victims who have seizures with some regularity at a certain time, should +take the three doses in one, two hours before the attack is expected. If +there are long intervals between attacks, cease taking bromides after one +fit and recommence three weeks before the next seizure is apprehended. When +there is an interval of six months or more between attacks, take no drugs. + +Bromides in solution are unpalatable, patients grow careless of regularity +and dosage. + +You must learn from your doctor and your own experience the prescription, +time and dose best suited to your case, and then _never miss a dose until +you have been free from fits for two years_, for the beneficial action of +bromide depends on the tissues becoming and remaining "saturated" with the +drug. Never give up bromides suddenly after long use, but gradually reduce +the dose. + +It is just when the disease has been brought under control, that patients +consider further doctor's bills an unnecessary expense, with the result +that a little later the fits recur, and a tedious treatment has to be +commenced over again. + +No value can be placed on any specific for epilepsy until it has been +thoroughly tested for some years, and so proved that its effects are +permanent, for almost any treatment is of value for a time, possibly +through the agency of suggestion. + + * * * * * + +CHAPTER XX + +PATENT MEDICINES + + "Men who prescribe purifications and spells and other illiberal + practices of like kind."--Hippocrates. + + "...Corrupted + By spell and medicines bought of mountebanks." + "Othello." Act I. + +Carlyle said the world consisted of "so many million people, _mostly +fools_"; and he was right, for to public credulity alone is due the immense +growth of the patent-medicine trade. + +It was formerly thought that for each disease, a specific drug could be +found, but this idea is exploded. The doctor determines the exact condition +of his patient, considers how he best may assist nature or prevent death, +and selects suitable drugs. He carefully notes their action and modifies +his treatment as required. The use of set prescriptions for set diseases is +obsolete; the doctor of to-day treats the patient, not the disease. + +A few patent medicines are of limited value; many are made up from +prescriptions culled from medical works, and the rest are frauds, like +potato starch. The evil lies in charging from three to four hundred times a +just price, in ascribing to a medicine which may be good for a certain +disorder, a "cure-all" virtue it does not possess, and in inducing ignorant +people to take powerful drugs, reckless of results. + +Ephemeral patent-medicine businesses, run by charlatans, whose aim is +frankly to make money before they are exposed, spring up like mushrooms; +and their cunningly worded advertisements meet the eye in the columns of +every paper one opens for a few months; then they drop out, to reappear +under another name, at another address. These rogues buy a few gross pills +from a wholesale druggist, insert a small advertisement, and so lay the +foundations of a profitable business. + +The lure of the unknown is turned to account. "The discoverer went back to +the Heart of Nature--and found many rare herbs used by Native Tribes." "The +"Heart of Nature" was probably a single-room office tucked away down a +Fleet Street alley, and analysis proves these medicines contain only common +drugs, one "_Herbal Remedy_" being _metallic_ phosphates. + +A common procedure is to send a question form, and, after answering the +query, "What are you suffering from?" with "Neurasthenia", the company +"carefully study" this, and then inform you with a gravity that would grace +the pages of "Punch", "You are the victim of a very intractable type of +Neurasthenia", so intractable in fact that it will need "additional +treatment"--at an "additional" fee. + +The quack's advertisements are models of the skilful use of suggestion, and +turn to rare account the half-knowledge of physiology most men pick up from +periodicals. He frightens you with alarming and untrue statements, gains +your confidence by a display of semi-true facts reinforced where weak by +false assertions, and, having benefited himself far more than you, leaves +you to do what you should have done at first, go to a doctor or a hospital. + +Were it made compulsory for the recipe to be printed on all patent +medicines, people would lose their childlike faith in coloured water and +purges, and cease the foolish and dangerous practice of treating diseases +of which they know little with drugs of which they know less. + +The British Medical Association of 429, Strand, London, W.C., issue two +1_s_. books--"Secret Remedies: What they cost and what they contain", "More +Secret Remedies"--giving the ingredients and cost price of most patent +medicines. You are strongly urged to send for these books, which should be +in every home. + +_The basis of every cure for epilepsy_ (not obviously fraudulent) _is +bromides_. The usual method is to condemn vigorously the use of potassium +bromide, and substitute ammonium or sodium bromide for it. Some advertisers +condemn all the bromides, and prescribe a mixture of them; others condemn +potassium bromide, and shamelessly forward a pure solution of this same +salt in water as a "positive cure!" + +In all cases the sale price is out of reasonable proportion to the cost, +victims paying outrageous sums for very cheap drugs. + +Most epileptics are poor, because their infirmity debars them from +continuous or well-paid work, leaving them dependent on relatives, often in +poor circumstances also. The picture of patients, already lacking many real +necessities, still further denying themselves for weeks or months to +purchase a worthless powder, is truly a pitiful one. + +Bromides are unsatisfactory drugs in the treatment of epilepsy, but they +are the best we have at present. Get them made up to the prescription of a +doctor, and see him every month to report progress and be examined. In the +end, this plan will be very much cheaper, and incomparably better, than +buying crude bromides from quacks. + + * * * * * + +There is no drug treatment for either hysteria or neurasthenia, and when +the doctor gives medicines for these complaints, it is to remedy organic +troubles, or, more often because necessity forces him to pander to the +irrational and pernicious habit into which the public have fallen of +expecting a bottle of medicine whenever they visit a doctor. Osier, the +famous Professor of Medicine at Oxford, truly observed that he was the best +doctor who knew the uselessness of medicines. But when public opinion +demands a bottle, and is unwilling either to accept or pay for advice +alone, the doctor may be forced to give medicines which he feels are of +little value, hoping that their suggestive power will be greater than is +their therapeutic value. + +Neuropaths invariably contract the habit of physicking themselves, and +taking patent foods and drugs which are valueless. + +So universal is this pernicious habit that we deem it desirable to +criticize it here at some length. + +One highly popular type consists of port wine, reinforced (?) by malt and +meat extracts, and sold under a fanciful name. It has about the same value +as a bottle of port, which costs considerably less. It is well to remember +that many a confirmed drunkard has commenced with these "restoratives". + +Malt extracts are also popular. They contain diastase, and therefore aid +the digestion of starch, but the diastatic power of most commercial +extracts is negligible. + +Meat extracts of various makes contain no nourishment, but are valuable +appetisers. Meat gravy is as effective and far cheaper. + +Foods containing digestive ferments, which are widely advertised under +various proprietary names are practically valueless, as are the ferments +themselves sold commercially. Digestive disorders are very rarely due to +deficiency of ferments, while pepsin is the only one among all the ferments +that could act (and that only for a little while) in the digestive system. + +Some of the disadvantages of predigested foods have been noted, and their +prices are usually so exorbitant that eggs at 2_s._ 6_d._ each would be +cheaper. The remarks of Sollmann the great pharmacologist are pertinent: + + _Limitations_. The administration of food in the guise of medicine is + sometimes advantageous; but medicinal foods are subject to the ordinary + law of dietetics, and therefore cannot accomplish the wonders which are + often claimed for them. The proprietary foods have been enormously + overestimated, and have probably done more harm than good. The ultimate + value of any food depends mainly on the amount of calories which it can + yield, and on its supplying at least a minimum of proteins. In these + respects, the medical foods are all inferior, for they cannot be + administered practically in sufficient quantity to supply the needs of + the body. They have a place as adjuvants to other foods, permitting the + introduction of more food than the patient could otherwise be induced + to take. Aside from the special diabetes foods and cod-liver oil, their + value is largely psychic. + + _Predigested Foods_. The value of these is doubtful, for digestive + disturbances involve the motor functions and absorption more commonly + than the chemical functions. Their continued use often produces + irritation. + + _Liquid Predigested Foods_. As sold, these are flavoured solutions + containing small amounts (½-6 per cent) of predigested proteins, ½-15 + per cent of sugars and other carbohydrates, with 12-19 per cent of + alcohol, and often with large quantities (up to 30 per cent) of + glycerin. Their protein content averages less than that of milk, and in + energy value they are vastly inferior. Their daily dose yields but + 55-300 calories including their alcohol; this is only one-thirtieth to + one-fifth the minimum requirements of resting patients. To increase + their dose to that required to maintain nutrition would mean the + ingestion of an amount of alcohol equivalent to a pint of whisky per + day. + +Of recent years very expensive preparations of real or alleged organic iron +compounds have had a large sale. Iron is a component of hæmoglobin, a solid +constituent (13 per cent by weight) of the blood, which combines with the +oxygen in the lungs, and is carried (as oxyhæmoglobin) all over the body, +giving the oxygen up to the tissues. Hæmoglobin is an exceedingly complex +substance, but it contains only one-third per cent by weight of iron in +organic form. + +The liver is the storehouse of iron, its reserve being depleted when there +is an extraordinary demand for iron. The minute amounts of iron in ordinary +food are amply sufficient for all our needs; any excess is simply stored, +and, later excreted, and has no effect whatever on the circulating +hæmoglobin. + +Iron is only of value in certain forms of anæmia, and the many patent +medicines purporting to contain hæmoglobin or organic iron are therefore +useless to neuropaths. The Roman plan of drinking water in which swords had +been rusted, is quite as valuable as drinking expensive proprietary +compounds. When iron is indicated Blaud's Pills are perhaps the best +preparation. + +Huge quantities of patent medicines containing phosphates in the form of +hypo-or glycerophosphates, and (or) lecithin are sold annually. + +All phosphorus compounds are reduced to inorganic phosphates in the +digestive tract, absorbed and eliminated, so that, as with iron, if +phosphates are needed, the form in which they are taken is of no moment. +Why, then, pay huge sums for organic-phosphorus compounds (synthesized from +inorganic phosphates) when they are immediately reduced to the same +constituents from which they were constructed, the only value in the +reduction process being seen in the immense fortunes which patent-medicine +proprietors accumulate? + +Lecithin is isolated from animal brain, or egg-yolk, and commercial +lecithin is impure. Not only does the ordinary daily diet contain ample +lecithin (5 grammes), but two eggs will double this, while liver or +sweetbread, both rich in phosphorous, may be eaten. + +The much-vaunted glycerophosphates are decomposed to and excreted as +phosphates. Sollmann's remarks apply to all similar proprietary articles: + + "A proprietary compound of glycerophosphates and casein has been widely + and extravagantly advertised as 'Sanatogen'. It is a very costly food, + and in no sense superior to ordinary casein, such as cottage cheese." + +Hypophosphites have been boomed by various people, chiefly for financial +reasons. Five or six of them are usually prescribed, with the addition of +cod liver oil, and perhaps quinine, and (or) iron and strychnine, the +complexity of the prescription being expected, apparently, to compensate +for the uselessness of its various ingredients. + +To deduce rational remedies, it is first necessary to elucidate the causes +of inefficiency; and to expect a brain which is out of order to function in +an orderly manner simply because it is supplied with one of the substances +necessary to its normal functioning (regardless of whether a deficiency of +that substance is the cause of the disorder), is as rational as it would be +to expect to restart an automobile engine, the magneto of which was broken, +by filling up the half-empty petrol tank. + + * * * * * + +CHAPTER XXI + +TRAINING THE NERVOUS CHILD + + "When shall I begin to train my child?" said a young mother to an old + doctor. + "How old is the child, madam?" + "Two years, sir!" + "Then, madam, you have lost just two years," answered the old + physician, gravely. + +Neuropathic children are super-emotional, and from them come prodigies, +geniuses, perverts and madmen. They are usually spare of build, with pale, +sallow complexions, and dark rings under the eyes. + +They can never sit still, but wriggle restlessly about on their seats, pick +their nostrils, and bite their nails. They are always wanting to be doing +something, but soon tire of it, and start something else, which is as +quickly cast aside; their energy is feverish but fitful. They jump to +conclusions, quickly grasp ideas; as quickly forget them. Having no +capacity for calm, reasoned judgment, they are creatures of impulse, +imperative but timid, suffer from strange ideas, and worry over trifles. + +The affections are strong and vehement, likes and dislikes are taken +without reason, while intense personal attachments--often +unrequited--occur, but not seldom swing round to indifference, or even +bitter enmity. The passions and emotions are all abnormal, for owing to +deficiency in the higher inhibitory centres, the victim is blown about by +every idle emotional wind that blows. The slightest irritation may provoke +an outburst of maniacal rage, or a fit. Consequently, they require the most +careful, but firm training, right from birth, to bring them up with a +minimum of nerve-strain. Twitchings, night or day terrors, sleep walking, +and incontinence of urine often trouble them. They should be examined by a +doctor once a year. + +These children have no _balance_, and are usually selfish, always +garrulous, with a love of romancing, while a ready wit combined with +fertile imagination often gains them a bubble reputation for learning they +do not possess. Invention, poetry, music, artistic taste and originality +are occasionally of a high order, and the memory is sometimes phenomenal; +but desultory, half-finished work, and shiftlessness are the rule. + +Their appetite is fitful and fanciful, they like unsuitable foods, and +their digestive system is easily upset. At puberty, sexual perversity is +common, and the animal appetite, is as a rule, very strong, though rarely, +it may be absent. During adolescence, there is excessive shyness or +bravado, always introspection, and exaggerated self-consciousness. + +As they grow older, they readily contract hypochondria, neurasthenia, +hysteria, alcoholism, insomnia and drug habits, and react unduly to the +most trifling external causes, even to the weather, by which they are +exhilarated or depressed. + +Education. Send them to school only when the law compels you, and observe +them closely while there, for health is far more important to them than +education. "Infant prodigies" lack the mental staying power and physical +robustness which real success demands, though they may do well for a time. +Go to your old school: the successes of to-day were dunces twenty years +ago; about those whose names are proudly emblazoned in fading gold on Rolls +of Honour, a discreet silence is maintained. + +Keep a keen lookout for symptoms of over-effort. Sleepiness, languor, a +vacant expression, forehead wrinkled, eyebrows knit, eyes dull, sunken and +surrounded by dark rings, twitchings, restlessness, or loss of appetite are +all warnings that the pace is too strong for the child. + + "These are the cases in which the School Board--who ordain that if + children are well enough to play or run errands, they are well enough + to attend school--should be defied." + +This defiance must of course be reinforced by a doctor's certificate. + +To the healthy, the strain of preparing for and enduring an examination is +tremendous; to highly strung children it is dangerous. Home-work should be +forbidden in spite of the authorities. Let the child join in the sports of +the school as much as possible. + +School misdemeanours form a thorny problem, for discipline must be +maintained, and a stern but just discipline is very wholesome for this +type, who are too apt to assume that because they are abnormal, they can be +idle and refractory. On the other hand, parents should promptly and +vigorously object to their children being punished for errors in lessons, +or struck on the head. + +Diet. Food, while being nourishing, and easily digested, must not be +stimulating or "pappy". Meat, condiments, tea, coffee and alcohol are +highly undesirable, a child's beverage being milk and water. + +Meals should be ready at regular hours, and capricious appetites should +freely be humoured among suitable foods, served in appetizing form to tempt +the palate. Let them chatter, but see they do not get the time to talk by +bolting their food. + +Most children can chew properly soon after they are two, but they are never +taught. Their food is "mushy", or is carefully cut, and gives them no +incentive to masticate. So long as food is digestible, the harder it is the +better, and plain biscuits, raw fruits, and foods like "Grape Nuts", are +splendid. Mastication helps digestion; it also prevents nasal troubles. + +The desire for food at odd moments causes trouble, which is aggravated if +the meals are not ready at stated hours. Gently but firmly refuse the piece +of bread-and-butter they crave, explain why you do so, and though they +weep, or fly into a passion, do not lose your own temper, or beat, or give +way to them. When accustomed to regular hours and firm refusals they will +not crave for titbits between meals. + +It is very hard for them to see other members of the family freely +partaking of condiments, drinks and unsuitable foods, and be told they are +the only ones who must refrain. A little personal self-sacrifice helps +immensely, and if your child _must_ refrain so _might_ you. + +All foods must be pure. Avoid tinned goods, and cheap jams, which contain +mangels and glucose. Judged by the nutriment they contain--most cheap foods +are very expensive. + +Lightly boil, poach, or scramble eggs; steam fish and vegetables; cook rice +and sago in the oven for three hours. See that milk puddings are chewed, +for usually they are bolted more quickly than anything else. The stomach is +expected to deal with unchewed rice pudding, because it is "nourishing". So +are walnuts, but you do not swallow them whole. + +Fruit must be fresh, ripe and raw, with skin and core removed. Brown bread, +crisply toasted and buttered when cold, is best. Porridge is admirable, but +many children dislike it. Try to induce a taste by giving plenty of milk, +and sugar or syrup with it. + +The starch-digesting ferments in the saliva and pancreas are not active +until the age of 18 months, before which infants must not be given starchy +foods like potatoes, cereals, puddings and bread. + +All greenstuffs must be thoroughly washed, or worms may pass into the +system. Foul breath, picking the nose, restlessness, fever and startings +are often attributed to worms, when the real "worms" are mince pies, +raisins, sour apples, and even beer. + +Never force fat on children in a form they do not like, for there are +plenty of palatable fats, as butter, dripping, lard and milk. Cream is as +cheap, as good, and far nicer than cod-liver oil. + +Decide on your children's diet, but do not discuss it with or before them. +If a child _does_ dislike a dish, never force it on him, but try to induce +a liking by serving it in a more appetizing way. Never mix medicines with +food. + +Worms. Various symptoms are due to intestinal worms, and a sharp lookout +should be kept for the appearance of any in the stools, and suitable +treatment given when necessary. + +Treatment for thread and round worms: + + R. + Santonini........................gr. ij. + Hydrarg. chloridi mitis..........gr. ij. + Pulv. aromatici..................gr. iv. + Mix and divide into four. + + Take one at bedtime every other night, + followed by castor oil in the morning. + +Tapeworms. These are rarer, being much more frequently talked or read about +than seen. A doctor should be consulted. + +Moral Training. The road to hell is broad and easy; so is that to heaven, +for if bad habits are easily acquired, so are good ones. + +Example is the best moral precept, and if the conduct of parents is good, +little moral exhortation is needed. "What is the moral ideal set before +children in most families? Not to be noisy, not to put the fingers in the +nose or mouth, not to help themselves with their hands at table, not to +walk in puddles when it rains, etc. To be 'good'!" To hedge in the child's +little world, the most wonderful it will ever know, by hidebound rules +enforced by severe punishments, is to repress a child, not to train it. +While the commonest error is to spoil a child, it is just as harmful to +crush it. Be firm, be kindly, and, above all, _be fair_. + +Issue no command hastily, but only if necessary, and shun prohibitions +based on petulance or pique. Give the child what it wants if easily +obtainable and not harmful. + +If the desire is harmful, explain why, but if a child asks for a toy, do +not pettishly reply: "It's nearly bedtime!" when it is not, or even if it +is. + +Discipline is essential, but discipline does not consist in inconsistent +nagging; harshly insisting on unquestioning obedience to some unreasonable +command one moment, and weakly giving way--to avoid a scene--on some matter +vitally affecting the child's welfare the next. + +There must be no coddling, and no inducement to self-pity. Such children +must be taught that they are capable of real success and real failure, and +that upon personal obedience to the laws of health of body and of mind, +this success or failure largely depends. + +A child should be early accustomed to have confidence in himself. For this +purpose all about him must encourage him and receive with kindliness +whatever he does or says out of goodwill, only giving him gently to +understand, if necessary, that he might have done better and been more +successful if he had followed this or that other course. Nothing is more +apt to deprive a child of confidence in himself than to tell him brutally +that he does not understand, does not know how, cannot do this or that, or +to laugh at his attempts. His educators must persuade him that he _can_ +understand, and that he _can_ do this thing or that, and must be pleased +with his slightest effort. + +It seems a trifle to let a child have the run of cake plate or sweet-tray, +or to stay up "just another five minutes, Mummy!" to avoid a howl, but +these are the trifles that sow acts to reap habits, habits to reap +character, and character to fulfil destiny. It is selfish of parents to +avoid trouble by not teaching their children habits of obedience, +self-restraint, order and unselfishness. Between five and ten is the age of +greatest imitation, when habits are most readily contracted. + +Come to no decision until hearing the child's wishes or statements, and +thinking the matter out; having come to it, _be inexorable_ despite the +wiles, whines and wails of a subtle child. Reduce both promises and threats +to a minimum, but _rigidly_ fulfil them, for a threat which can be ignored, +and a promise unfulfilled, are awful errors in training a child. + +Persuade, rather than prohibit or prevent, a child from doing harmful +actions. If it wants to touch a hot iron, say clearly it is hot, and will +burn, but _do not move it_. Then, if the child persists, it will touch the +iron tentatively, and the small discomfort will teach it that obedience +would have been better. Let it learn as far as possible by the hard, but +wholesome, road of experience. + +Makeshift answers must never be given to a child. Awkward questions require +truthful answers, even though these only suggest more "Whys?" + +Sentimentality must be nipped promptly in the bud, and an imaginative and +humorous view of things encouraged. The child must be taught to keep the +passions under control, and to face pain (that great educator which +neurotic natures feel with exaggerated keenness) with fortitude. + +Fear must be excluded from a child's experience. "Bogies!" "Ghosts!" +"Robbers!" and "Black-men!" if unintroduced, will not naturally be feared. +The mental harm a highly strung child does by rearing most fearsome +imaginings on small foundations is incalculable, and has led more than one +to an asylum. + +Try to train the child to go to sleep in the dark, but if it is frightened +give it a nightlight. As Guthrie says, the comfort derived from the +assurance that Unseen Powers are watching over it, is small compared to +that given by a nightlight. He mentions a child who, when told she need not +fear the dark because God would be with her, said: "I wish you'd take God +away and leave the candle." + +If the child wakes terrified, it is stupid and wicked to call upstairs: "Go +to sleep!" A child cannot go to sleep in that state, and a wise mother will +go up and softly soothe the frightened eyes to sleep. + +Neuropathic children often have night terrors within an hour or two of +going to bed. Piercing screams cause a hasty rush upstairs, where the child +is found sitting up in bed, crouching in a corner, or trying to get out of +door or window. His face is distorted with fear and he stares wildly at the +part of the room in which he sees the terrifying apparition. He clings to +his mother but does not know her. After some time he recovers, but is in a +pitiful state and has to have his hand held while he dozes fitfully off. He +often wets the bed or passes a large amount of colourless urine. Medical +treatment is imperative. + +Corporal punishment is unsuitable for neuropathic children, for the mere +suggestion of its application usually causes such excessive dread, mental +upset and terror as make it really dangerous. Such children are often said +to be "naughty" when in reality they are unable to exercise self-control, +owing to defective inhibitory power. Try patiently to inculcate obedience +from the desire to do right, and make chastisement efficacious from its +very exceptional character. + +"The young child is too unconscious to have a deliberately perverse +intention; to ascribe to him the fixed determination to do evil, is to +judge him unjustly and often to develop in him an evil instinct. It is +better in such a case to tell him he has made a mistake, that he did not +foresee the consequences to which his action might lead, etc." Many parents +fall into a habit of shaking, ear-boxing, and such-like harmful minor +punishments for equally minor offences, which should be overlooked. + +In all little troubles, keep _quite calm_. The child's nerve and +association centres have not yet got "hooked up", and you cannot expect it +to act reasonably instead of impulsively. This excuse does not apply to +you. One excitable person is more than enough, for if both get angry, +sensible measures will certainly not result. + +The necessity for calmness cannot too strongly be urged. The treatment for +a fit of temper, is to give the unfortunate child a warm bath, and put it +to bed, with a few toys, when it will soon fall asleep, and awake refreshed +and calm. + +Proceed gently but with absolute firmness, _start early_, and remember that +example is better than precept. + +Religion. Offering advice on this subject is skating on very thin ice, and +we do so but to give grave warning against neuropathic youth being allowed +to contract religious "mania", "ecstasy", or "exaltation". + +Neuropaths are given naturally to "see visions and dream dreams", and if +this tendency be exaggerated an unbalanced moral type results. Jones says: + + "The epileptic is apt to be greatly influenced by the mystical or + awe-inspiring, and is disposed to morbid piety. He has an outer + religiousness without corresponding strictness of morals; indeed the + sentiment of religious exaltation may be in great contrast to his + habitual conduct, which is a mixture of irritability, vice and + perverted instincts." + +Lay stress on the simple moral teaching of the New Testament, and avoid +cranky creeds, cross references, or Higher Criticism. Teach them to +practise the moral precepts, not to quote them by the page. + +Without this practical bent, a "Revival" meeting is apt to result in a +transient but harmful "conversion"; a form of religious sentiment which +finds outlet, not so much in works as in morbid excitement. In these +people, as in the insane, there is often a weird mixing-up of religious and +sexual emotion. + +Teach these children that the greatest good is not to sob over their +fancied sins at "salvation" meetings, but to love the just and good, to +hate the unjust and evil, and to do unto others as they would others should +do unto them. + +It is better for them to join one of the great churches, than become +members of those small sects which maintain peculiar tenets. + +A word of special warning must be given against Spiritualism. There may or +may not be a foundation for this belief, but it is highly abnormal, and has +led thousands into asylums. + +The medium and the majority of her audience are highly neurotic, and a more +unwholesome environment for an actual or potential neuropath could not be +imagined. + +The educated neuropath often peruses certain agnostic works, the result +usually being deplorable, for this class are dependent on some stable base +outside themselves, such as is found in a calm religion manifested in a +steadfast attempt to overcome the weakness of the flesh, by ordering life +in accordance with the teachings of the New Testament. + +So long as abnormalities of character do not become too pronounced, friends +must be content. + +Such children must be trained to express themselves in a practical manner, +not in weaving gorgeous phantasies in which they march to imaginary +victory. Day dreams form one of those unlatched doors of the madhouse that +swing open at a touch, the phantasy of to-day being written "emotional +dementia" on a lunacy certificate to-morrow. + +Finally, remember that above them hangs the curse: + +"Unstable as water, _thou shall not excel_." + +"Go thou softly with them, all their days!" and whether your tears fall on +the ashes of a loved and loving, but weak and wilful one, or whether their +tears bedew the grave of the only friend they ever knew, you will not have +lacked a rich reward. + + * * * * * + +CHAPTER XXII + +DANGERS AT AND AFTER PUBERTY + + "Th' expense of spirit in a waste of shame + Is lust in action; and till action, Lust + Is perjured, murderous, bloody, full of blame, + Savage, extreme, rude, cruel, not to trust; + Enjoyed no sooner but despised straight; + Past reason hunted; and, no sooner had, + Past reason hated, as a swallow'd bait + On purpose laid to make the taker mad; + Mad in pursuit, and in possession so; + Had, having had, and in quest to have, extreme; + A bliss in proof, and proved, a very woe; + Before, a joy proposed; behind, a dream; + All this the world well knows; yet none knows well, + To shun the Heaven that leads men to this Hell!" + --Shakespeare. Sonnet 129. + +At puberty (from the age of 11-15) a boy becomes capable of paternity, a +girl of maternity; during adolescence (from puberty to 25) the body in +general, and the reproductive organs in particular, grow and mature. + +In the boy, semen is secreted, the voice breaks, the genitals enlarge, hair +grows on the pubes, face and armpits, and there is a rapid increase in +height owing to growth of bone. In the girl menstruation commences, the +pelvis is enlarged, bust and breasts develop, the complexion brightens, the +hair becomes glossy, and the eyes bright and attractive. + +In both, the sexual instinct awakens, and the mental, like the physical, +changes are profound. There is great general instability, the child, at one +time shy and reticent, is at another, boisterous and self-assertive. + +Parents rarely realize the importance and trying nature of this period when +"there awakes an appetite which in all ages has debased the weak, wrestled +fiercely with the strong and overwhelmed too often even the noble". +Adolescents suffer more from the lack of understanding, sympathy, +appreciation and wise guidance shown by their blind parents, than they do +from their own ignorance and perfervid imagination. + +The transitions from radiant joy and confident expectation, reared on a +flimsy basis of supposition, to dire despair consequent on a wrong reading +of physical and mental changes, are rapid. Friends, lovers and heroes +quickly succeed one another, play their parts, and give place to others. + +The awakening of the sexual appetite is usually ignored, and children are +left to gain knowledge of man's noblest power from companions, casual +references in the Bible and other books, and unguarded references in +conversation. Under such conditions not one in a thousand--and _your_ child +is _not_ that one--escapes impurity and degraded sex ideas. + +Wherever youth congregate, this subject crops up, and those who talk most +freely to the others are just those with the most distorted and vicious +ideas, whose discourse abounds in obscene detail and ribald jest. Your +child must learn either from ignorant, unclean minds, or be taught in a +clean, sacred way, which will rob sex of secrecy and obscenity; _learn he +will_; if you will not teach your child, his pet rabbit will. + +When children ask awkward questions, say quietly that such matters are not +discussed with children, but promise to tell them all about it when they +are ten years old; delay no longer, for most children learn self-abuse +between ten and twelve. + +Self-abuse is a bad habit, and no more a "sin" than is biting the nails. +Unfortunately, people with no other qualification than a desire to do good, +wrongly harp on the "sin" of it and draw lurid pictures of physical and +mental wreck as the end of such "sinners", ignorant that if all +masturbators went mad the world would be one huge asylum. + +Exaggeration never pays in teaching youth. Tell the truth, which is bad +enough without adding "white lies" with an eye to effect. + +Coitus causes slight prostration, Nature's device to remind man to keep +sexual intercourse within bounds, for while in moderation it is harmless, +in excess it causes great prostration. _Exactly the same applies to +self-abuse_, for, paradoxical as it seems, the real harm is done by the +_fear_ of the supposed harm. + +The masturbator first suffers from the knowledge he is indulging in a +pleasure he knows would be forbidden, and from fear of being found out; +later he learns from friends, quack advertisements, or well-meaning books +that self-abuse is a most deadly practice, and thereupon a tremendous +struggle occurs between desire and fear, each act ending in an agony of +remorse and dread of future consequences, which struggle does a +thousand-fold more harm than the loss of a little semen. + +The ill-effects of these mental struggles disappear after marriage, which +means greater indulgence, but indulgence free from mental stress. In +neuropaths, these mental struggles are the worst things that could occur, +for they tend to make permanent the states we are trying to cure. + +The most serious results of masturbation are moral not physical. Loss of +will-power, self-reliance, presence of mind, reasoning power, memory, +courage, idealism, and self-control; mental and physical debility, +laziness, a diseased fondness for the opposite sex, and in later years, +some degree of impotence or sterility, are its commoner results. + +Teach _your_ child, therefore, not from fear of physical harm, but because +you wish him to be one of those fortunate few who live and die "gentlemen +unafraid", because they had wise parents. + +Let the mother instruct a girl, the father a boy, and not leave so vital a +matter to an unsuitable pamphlet. + +Buy one of the many "Knowledge for Boys or Girls" books and read it +carefully. + +Having made sure you can convey a simple account of the wonders of +reproduction, and that you have rooted out the idea that sex is something +to be apologized for, see the child and tell him it is time he learned of +his private parts, as manhood draws near. + +Then, speaking in a quiet, unembarrassed way, deliver your little homily, +all the time insisting on the marvel, the romance, the poetry and the +beauty of the sex. Let chivalry be your text, not fear, and repeat the +Squire's sound parting advice to Tom Brown: + + "Never listen to or say things you would not have your mother or sister + hear." + +Give a clear and complete description in simple words of the mechanism and +marvel of reproduction, for half-knowledge generates a prurient curiosity +about the other sex, thus defeating the very end you have so earnestly +striven for. + +Purity not impurity should be your text, and you should only refer to +masturbation as a harmful habit, which should not be contracted. + +Warn them to + + "Keep the heart with all diligence, for out of it are the issues of + life!" + +by turning their thoughts instantly and determinedly away from sex ideas +when they arise, as they _will_ arise, time and again. It is useless to try +_not_ to think of them, the child must instantly turn its thoughts to to +_something else_, for one who cannot stamp out a spark will not subdue a +fiercely-raging conflagration. + +Babies should not be carelessly caressed, and a fretful infant must never +be soothed by playing with the genitals, as is done innocently by some +mothers and nurses, and by others from motives more questionable. Freud +showed that there are subconscious sexual desires in infants, which die out +until reanimated at puberty in Nature's own way. If exaggerated by +exuberant fondling, they gather force in the dark corners of the mind, and +are later manifested in morbid sexual or mental perversity. + +If you have good grounds for believing the habit has already been +contracted, enlist medical advice. A great factor in the successful +treatment of self-abuse is early recognition, and, after the unhygienic +nature of the habit has carefully been pointed out, the child's sense of +honour should be invoked. + +Without further reference to the matter, try to become your child's +confidant, for he will have to fight fires within and foes without. See +that his time is filled with healthy sport and play, and ennoble his ideas +with talk, books and plays which lay stress on chivalry and manliness. Give +him plain food, tepid douches, and a firm bed with light, fairly warm +clothing. Get him up reasonably early in the morning, and let him play +until he is "dog-tired" at night. + +Let children rub shoulders with others, keep them from highly exciting +tales, let them read but little, and train them to be observant of external +objects all the time. + +Neuropaths develop very early sexually, and contract bad habits in the +endeavour to still their unruly passions; with them, the future is darker +than with the normal child, and the parent who neglects his duty may justly +be held accountable for what happens to his child or his child's children. + +Puberty is always a critical period in epilepsy, many cases commencing at +this time, while in a number, fits commence in infancy, cease during +childhood, and recommence at puberty, the baneful stimulus of masturbation +being undoubtedly a factor in many of these cases. + + * * * * * + +CHAPTER XXIII + +WORK AND PLAY + +Although most people would assume that epileptics are unable to follow a +trade, there is hardly an occupation from medicine to mining, from +agriculture to acting, that does not include epileptics among its votaries. + +Outdoor occupations involving but little mental work or responsibility are +best, but unfortunately just those which promise excitement and change are +those which appeal to the neuropath. + +A light, clean, manual trade should be chosen, and those that mean work in +stuffy factories, amid whirring wheels and harmful fumes, using dangerous +tools, or climbing ladders, must be avoided. + +For the fairly robust, gardening or farming are good occupations, such +workers getting pure air, continuous exercise, and little brain-work. +Wood-working trades are good, if dangerous tools like circular saws are +left to others. + +For the frail neuropath with a fair education, drawing, modelling, +book-keeping, and similar semi-sedentary work may do. Other patients might +be suited as shoemakers, stonemasons, painters, plumbers or domestic +servants, so long as they always work on the ground. + +Some work is essential; better an unsuitable occupation than none at all, +for the downward tendency of the complaint is sufficiently marked without +the victim becoming an idler. Work gives stability. + +Epilepsy limits patients to a humble sphere, and though this is hard to a +man of talent, it is but one of many hard lessons, the hardest being to +realize clearly his own limitations. + +If seizures be frequent, the ignorant often refuse to work with a victim, +who can only procure odd jobs, in which case he should strive to find +home-work, at which he can work slowly and go to bed when he feels ill. A +card in the window, a few handbills distributed in the district, judicious +canvassing, and perhaps the patronage of the local doctor and clergy may +procure enough work to pay expenses and leave a little over, for the +essential thing is to occupy the mind and exercise the body, not to make +money. + +Very few trades can be plied at home and many swindlers obtain money under +the pretence of finding such employment, charging an excessive price for an +"outfit", and then refusing to buy the output, usually on the pretext that +it is inferior. Envelope-addressing, postcard-painting and machine-knitting +have all been abused to this end. + +An auto-knitter seems to offer possibilities, but victims must investigate +offers carefully. + +Photography is easy. A cheap outfit will make excellent postcards, modern +methods having got rid of the dark room and much of the mess, and +postcard-size prints can be pasted on various attractive mounts. + +If the work is done slowly, and in a good light, and the patient has an +aptitude for it, ticket-writing is pleasant. Among small shopkeepers there +is a constant demand for good, plainly printed tickets at a reasonable +price. + +On an allotment near home vegetables and poultry might be raised, an +important contribution to the household, and one which removes the stigma +of being a non-earner. + +The mental discipline furnished by this home-work is invaluable, +Neuropaths, especially if untrained, are unable to concentrate their +attention on any matter for long, and do their work hastily to get it +finished. When they find that to sell the work it must be done slowly and +perfectly they have made a great advance towards training their minds to +concentrate. Their weak inhibitory power is thus strengthened with happy +results all round. + +When the work and the weather permit, work should be done outdoors, and +when done indoors windows should be opened, and, if possible, an empty or +sparsely-furnished bedroom chosen for the work. + +Recreations. These offer a freer choice, but those causing fatigue or +excitement must be avoided, for patients who have no energy to waste need +only fresh air and quiet exercise. + +Manual are better than mental relaxations. Dancing is unsuitable, swimming +dangerous, athletics too tiring and exciting. Bowls, croquet, golf, +walking, quoits, billiards, parlour games and quiet gymnastics without +apparatus are good, if played in moderation and much more gently than +normal people play them. Play is recreation only so long as a pastime is +not turned into a business. When a player is annoyed at losing, though he +loses naught save his own temper, any game has ceased to be recreative. + + * * * * * + +CHAPTER XXIV + +HEREDITY + + "Man is composed of characters derived from pre-existing germ-cells, + over which he has no control. Be they good, bad, or indifferent, these + factors are his from his ancestry; the possession of them is to him a + matter of neither blame nor praise, but of necessity. They are + inevitable."--Leighton. + +The body is composed of myriads of cells of _protoplasm_, in each of which, +is a _nucleus_ which contains the factors of the hereditary nature of the +cell. In growth, the nucleus splits in half, a wall grows between and each +new cell has half the original factors, + +Female _ovum_ and male _sperm_ (the cells concerned with reproduction) +divide, thus losing half their factors, and when brought together by sexual +intercourse form a _germ-cell_ having an equal number of factors from +mother and father. + +How these factors are mingled--whether shuffled like two packs of cards, or +mixed like two paints--we do not know. If two opposite factors are brought +together, one must lie dormant. The offspring may be male or female, tall +or short; it cannot be both, nor will there be a mixture. _This rule only +applies to clearly defined factors._ + +We are _made by_ the _germ-plasm_ handed down to us by our ancestors; in +turn we pass it on to our children, _unaltered_, but mixed with our +partner's plasm. + +"The Dead dominate the Living" for our physical and mental inheritance is a +mosaic made by our ancestors. + +Variations which may or may not be inheritable do arise spontaneously, we +know not how, and by variations all living things evolve. + +A child resembles his parents more than strangers, not because they made +cells "after their own image" but because both he and they got their +factors from the same source. + +Man's physical and mental, and the _basis_ of his moral, qualities depend +entirely on the types of ancestral plasm combined in marriage. Man may +control his environment; his heritage is immutable. To suppress an +undesirable trait the germ-cell must unite with one that has never shown +it--one from a sound stock. An unsuitable mating in a later generation, +however, may bring it out again (for factors are indestructible), and the +individual showing it will have "reverted to ancestral type". + +To give an instance: Does the son of a drunkard inherit a tendency to +drink? No! The father is alcoholic because he lacks control, consequent +upon the factors which make for control having been absent from his +germ-plasm. He passes on this lack; if the mother does the same, the defect +occurs--in a worse form--in the son. If the mother gives a control factor, +the son may be unstable or _apparently_ stable, this depending entirely on +chance, but if the mother's plasm contains a _strong_ control-factor, the +defect will lie dormant in her son, who will have self-control, though if +he marries the wrong woman he will have weak-willed children. + +If the son becomes a toper, therefore, it is because he, like his father +before him, was born with a defect--weak control--which might have made of +him a drug-fiend, a tobacco-slave, a rake, or a criminal; in his home drink +would naturally be the temptation nearest to hand, and he would show his +lack of control in drunkenness. + +The way a lily-seed is treated makes a vast difference to the plant which +arises. If sown in poor soil, and neglected, a dwarf, sickly plant will +result; if sown in rich soil, and given every care that enthusiasm, money +and skill can suggest or procure, the result will be magnificent. + +So with man. A well-nourished mother, free from care and disease, may have +a finer child than a half-starved woman, crushed by worry and work, but +neither starvation nor nourishment alter the inborn character of the child. + +The _body-cells_ are greatly changed by disease, poison, injury, and +overwork, but these changes are not passed on, and despite the influence of +disease from time immemorial, the _germ-cell_ produces the same man as in +ancient days. Without this fixity of character, this "continuity of the +germ-plasm", "man" would cease to be, for the descendants of changeable +cells would be of infinite variety, having fixity of neither form nor +character. + +Epilepsy, hysteria and neurasthenia are all outward signs of defect in the +germ-plasm, and so they (or a predisposition to them) can be passed on, and +inherited. + +If a man shows a certain character, his plasm, had, and has, the causative +factor. He may have received it from _both_ his parents, when it will be +_strong_, or from one only, when it will be _normal_. If he have it not, it +is absent. The same applies to the plasm of the woman he mates, so there +are six possible combinations, with results according to "Mendel's Law." + +_All_ the children will not inherit a taint unless _both_ parents possess +it, but, however strong one parent be, if the other is tainted, _none_ of +the children can be absolutely clean, but will show the taint, weak, +strong, or dormant. This means that neuropathy will recur--and that it has +previously occurred--in the same family, unless there be continual mating +into sound stocks. If there is continual mating into bad stocks, it will +recur frequently and in severe forms. All intermediate stages may occur, +depending entirely on the qualities of the combining stocks. + +From this we shall expect, in the same stock, signs of neuropathic taint +other than the three diseases dealt with here, and these we get; for +alcoholism, criminality, chorea, deformities, insanity and other brain +diseases, are not infrequent among the relatives of a neuropath, showing +that the family germ-plasm is unsound. + +Epilepsy, one symptom of taint, is more or less interchangeable with other +defects; the taint, as a whole, is an inheritable unit whose inheritance +will appear as any one of many defects. This is shown by the fact that very +few epileptics have an epileptic parent. Starr's analysis of 700 cases of +epilepsy emphasizes this point. + + Epilepsy in a parent 6 + Epilepsy in a near relative 136 + Alcoholism in a parent 120 + Nervous Diseases in family 118 + Rheumatism and Tuberculosis 184 + Combinations of above diseases 142 + +As medicine and surgery cannot add or delete plasmic factors, the only way +to stamp out neuropathy in severe forms would be to sterilize victims by +X-rays. This would be painless, would protect the race and not interfere +with personal or even with sexual liberty. In fifty years such diseases +would be almost extinct, and those arising from accident or the chance +union of dormant factors in apparently normal people could easily be dealt +with. + +There are 100,000 epileptics in Great Britain, and as _all_ their children +carry a taint which tends to reappear as epilepsy in a later generation +_the number of epileptics doubles every forty years_. We protect these +unfortunates against others; why not posterity against them? + +Neuropaths must pass on _some_ defect; therefore, though victims may marry, +_no neuropath has a right to have children_. + + * * * * * + +CHAPTER XXV + +CHARACTER + + "All men are not equal, either at birth or by training. Nature gives + each of us the neural clay, with its properties of pliability and of + receiving impressions; nurture moulds and fashions it, until a + _character_ is formed, a mingling of innate disposition and acquired + powers. But clay will be clay to the end; you cannot expect it to be + marble."--Thomson & Geddes. + + "Heaven lay not my transgression to my charge."--King John. + +It is essential that attendants, relatives, and friends carefully study the +character of neuropaths, and recognize clearly how abnormal it is, for +untold misery is caused by judging neuropaths by normal standards. + +Patients are often harshly treated because others regard the victim of +defective inhibition as having gone deliberately to work, through wicked +perversity and pure wilfulness, to make himself a nuisance, to persist in +being a nuisance, and to refuse to be other than a nuisance, rather than +exercise what more fortunate men are pleased to term self-control. + +Character is usually appraised as "good" or "evil" by the nature of a man's +actions, the assumption being made that he can control his impulses if he +be so minded. + +This is not so. "Good" and "evil" are only relative terms. What one man +thinks "evil", a second holds "good", while a third is not influenced. + +Now the performance of the act judged is directed by the performer's brain, +the constitution of which was pre-determined by the germ-plasm from which +he arose, so that _the basis of character is inherited_. + +The moral sense is the last evolved and least stable attribute of the last +evolved and least stable of our organs, the brain; and brains are born, not +made to order. To blame a man for having weak control--a sick will--is as +unreasonable as to blame him for a cleft palate or a squint. The "good" +people who jog so quietly through life little reck how much they owe their +ancestors, from whom they received stability. + +These tendencies represent the total material for building character. +Training and environment can only nourish good tendencies and give bad ones +no encouragement to grow gigantic. + +If training and environment alone formed character, then children reared +together would be of similar disposition; by no means the case. Similarly, +if external influences altered inborn tendencies, then, not only would the +evil man be totally reformed by strong inducements to virtue, but strong +inducements to vice would lead totally astray the good man, for "good" is +no _stronger_ than "evil", both being attributes of mind. + +In mind as in body, from the moment he is conceived to the moment his dust +rests in the tomb, man is directed by immutable laws, though he is not +simply a machine directed by impulses over which he has no control. There +is real meaning in "strong will" and "weak will" will being a tendency to +deliberate before and be steadfast in action, a tendency which varies +immensely in different people. The fallacy of "free will" lies in assuming +that every one has this tendency equally developed, making character a mere +matter of saying "Yes!" and "No!" without reference to the individual's +mental make-up. + +Deliberate, persistent wickedness implies a strong will, just what +neuropaths lack. A man of weak will can never be a very good nor yet a very +bad man. He will be very good at times, very bad at times, and neutral at +times, but neither for long; before sudden impulses, whether good or bad, +neuropaths are largely powerless. + +The many perversities of a neuropath are not deliberately put forth of his +"free will" to annoy both himself and others, for the neuropath inherits +his weak-control no less than his large hands. + +Friends _must_ remember they are dealing with a person whose _nature_ it is +to "go off half-cock", and who cannot be normal "if he likes". The +neuropath, young or old, says what he "thinks" _without thinking_, that is +he says what he _feels_, and acts hastily without weighing consequences. + + _Cassius_: Have you not love enough to bear with me, + When that rash humour which my mother gave me + Makes me forgetful? + + _Brutus_: Yes, Cassius; and, from henceforth + When you are over-earnest with your Brutus, + He'll think your mother chides, and leave you so. + + * * * * * + +One cannot detail the effects of neuropathy on character, when its victims +include madmen, sexual perverts, idiots, criminals, imbeciles, prostitutes, +humble but honest citizens, common nuisances, invalids of many kinds, +misanthropists, designers, enthusiasts, composers, communists, reformers, +authors, artists, agitators, statesmen, poets, prophets, priests and kings. + +Very mild epilepsy--from one fit a year to one in several years--instead of +hindering, seems rather to help mentality, and many geniuses have been +epileptic. These talented victims, are less rare than the public suppose, +owing to the jealous care with which symptoms of this disease are guarded. +Socrates, Julius Cæsar, Mahomet, Joan of Arc, Peter the Great, Napoleon, +Byron, Swinburne, and Dostoieffsky are but a few among many great names in +the world of art, religion and statecraft. Epileptic princes, kings and +kinglets who have achieved unenviable notoriety might be named by scores, +Wilhelm II being the most notable of modern times. + +This brilliant mentality is always accompanied by instability, and usually +by marked disability in other ways. The success of these men often depends +on an ability to view things from a new, quaint or queer standpoint, which +appeals to their more normal fellows. + +In matters that require great fertility, a quick grasp, ready wit, and +brilliant but not sustained mental effort, numerous neuropaths excel. In +things calling for calm, well-balanced judgment, or stern effort to conquer +unforseen difficulties, they fail utterly. + +Subtle in debate, they are but stumbling-blocks in council; brilliant in +conception, they fail in execution; fanciful designers, they are not +"builders of bridges". They are boastful, sparkling, inventive, witty, +garrulous, vain and supersensitive, outraging their friends by the +extravagance of their schemes; embarrassing their enemies by the subtlety +of their intrigues. + +They wing on exuberant imagination from height to height, but the small +boulders of difficulty trip them up, for they are hopelessly unpractical; +they have neither strength of purpose nor fortitude, and their best-laid +schemes are always frustrated at the critical moment, by either the +incurable blight of vacillation, or by the determination to amplify their +scheme ere it has proved successful, sacrificing probable results for +visionary improvements. + +Great and cunning strategists while fortune smiles, they are impotent to +direct a retreat, but flee before the fury they ought to face. They rarely +have personal courage, but are timid, conciliatory and vacillating just +when bravery, sternness, and determination are needed; furious, obstinate +and reckless, when gentleness, diplomacy and wisdom would carry their +point. + +They are ready to forgive when there is magnanimity, vainglory and probably +folly in forgiveness, but will not overlook the most trivial affront when +there is every reason for so doing. They have brain, but not ballast, and +their whole life is usually a lopsided effort to "play to the gallery". + +In poetry and literature, fancy has free play, and they often succeed, +sometimes rising to sublime heights; usually in the depiction of the +whimsical, the wonderful, the sardonic, the bizarre, the monstrous, or the +frankly impossible. They are not architects as much as jugglers of words, +and descriptive writing from an acute angle of vision is their forte. They +sometimes succeed as artists or composers, for in these spheres they need +not elaborate their ideas in such clean-cut detail, but many who might +succeed in these branches have not sufficient strength of purpose to do the +preliminary "spadework". + +They have too many talents, too many differing inclinations, too much +impetuosity, too much vanity, too little concentration and will-power, and +they fail in ordinary walks of life from the lack of resolution to lay the +foundations necessary to successful mediocrity. + +No greater obstacle to progress exists than the reputation for talent which +this class acquire on a flimsy basis of superficial brilliance in +conversation or a penchant for witty repartee. They are self-opinionated +and egoistical, with a conceit and assurance out of all proportion to their +abilities. Their mental perspective is distorted and they are conspicuous +for their obstinacy. In conversation they are prolix and pretentious, and +they often contract religious mania, in which their actions by no means +accord with their protestations, for they have very elementary notions of +right and wrong, or no notions at all. + +Often they are precocious, but untruthful, cruel, and vicious; the despair +of relatives, friends, and teachers. They combine unusual frankness with an +audacity and impulsiveness that is very misleading, for below this show of +fire and power there is no stability. + +Their character is a tangle of mercurial moods, the neuropath being +passionate but loving, sullen one moment, overflowing with sentimental +affection the next, vicious a little while later, quick to unreasoning +anger, and as quick to repent or forgive, obstinate but easily led, +versatile but inconstant, noble and mean by turns, full of contradictions +and contrasts, at best a brilliant failure, vain, deaf to advice or +reproof, having in his ailing frame the virtues and vices of a dozen normal +men. + +Mercier aptly describes him: + + "There is a large class of persons who are often of acute and nimble + intelligence, in general ability equal to or above the average, of an + active, bustling disposition, but who are utterly devoid of industry. + For by industry we mean steady persistence in a continuous employment + in spite of monotony and distastefulness; an employment that is + followed at the cost of present gratification for the sake of future + benefit. Of such self-sacrifice these persons are incapable. They are + always busy, but their activity is recreative, in the sense that it is + congenial to them, and from it they derive immediate gratification. As + soon as they tire of what they are doing, as soon as their occupation + ceases to be in itself attractive it is relinquished for something + else, which in its turn is abandoned as soon as it becomes tedious. + + "Such people form a well-characterized class: they are clever; they + readily acquire accomplishments which do not need great application; + and agreeably to the recreative character of their occupations, their + natures are well developed on the artistic side. They draw, paint, + sing, play, write verses and make various pretty things with easy + dexterity. Their lack of industry prevents them ever mastering the + technique of any art; they have artistic tastes, but are always + amateurs. + + "With the vice of busy idleness they display other vices. The same + inability to forgo immediate enjoyment, at whatever cost, shows itself + in other acts. They are nearly always spendthrifts, usually drunkards, + often sexually dissolute. Next to their lack of industry, their most + conspicuous quality is their incurable mendacity. Their readiness, + their resources, their promptitude, the elaborate circumstantiality of + their lies are astonishing. The copiousness and efficiency of their + excuses for failing to do what they have undertaken would convince + anyone who had no experience of their capabilities in this way. + + "Withal, they are excellent company, pleasant companions, good-natured, + easy-going, and urbane. Their self-conceit is inordinate, and remains + undiminished in spite of repeated failures in the most important + affairs of life. They see themselves fall immeasurably behind those who + are admittedly their inferiors in cleverness, yet they are not only + cheery and content, but their confidence in their own powers and + general superiority to other people remains undiminished. + + "_The lack of self-restraint is plainly an inborn character_, for it + may show itself in but one member of the family brought up in exactly + the same circumstances as other members who do not show any such + peculiarity. The victim is born with one important mental faculty + defective, precisely as another may be born with hare-lip." + +In neuropaths the mental mechanism of _projection_, which we all show, is +often marked. + +Any personal shortcoming, being repugnant to us causes self-reproach, which +we avoid by "projecting" the fault (unconsciously) on some one else. + +Readers should get "The Idiot" by Fedor Dostoieffsky, an epileptic genius +who saw that for those like him, happiness could be got through peace of +mind alone, and not in the cut-throat struggle for worldly success. He +projected his stabler self into Prince Muishkin, the idiot, and every one +of the six hundred odd pages of this amazing description of a neuropathic +nation is stamped with the hall-mark of genius. + + * * * * * + +CHAPTER XXVI + +MARRIAGE + + "Between two beings so complex and so diverse as man and woman, the + whole of life is not too long for them to know one another well, and to + learn to love one another worthily."--Comte. + +No neuropath should have children, but marriage is good in mild cases, for +neuropaths are benefited by sympathetic companionship, and their sexual +passions are so strong that they must be gratified, by marriage, +prostitution, or unnaturally. + +Bernard Shaw's sneer-- + + "Marriage is popular because it combines the maximum of temptation with + the maximum of opportunity"-- + +is justifiable, though the "maximum of opportunity" is better than a +maximum of unnatural devices to satisfy and intensify normal and abnormal +cravings. + +There is a popular belief that an epileptic girl is cured by pregnancy, a +state that ought never to occur. + +The lack of sex-education causes millions of miserable marriages. Sexual +desire is cultivated out of all proportion to other desires, the will +cannot control the desire to relieve an intolerable sense of discomfort, +and men eagerly seize the first chance of being able to satisfy these +fierce cravings at pleasure. + +If sex were treated sensibly it would develop into a powerful instead of an +overpowering appetite, and reason would have some say in the choice of a +life-partner. + +A neuropath needs a calm, even-tempered, "motherly" wife. For him, +gentleness, self-control, sound common sense and domestic virtues are +superior to wit or beauty. Unfortunately, contrary to public belief, people +are attracted by their like, not by their opposites. The sensitive, refined +neuropath finds the normal person insipid and dull; the normal person is +rendered uncomfortable by the morbid caprices of the neuropath. + +There must be no disparity of age, for at the menopause the woman no longer +seeks the sexual embrace, and if her husband be young unfaithfulness +ensues. Not only that, but she, knowing, probably to her sorrow, how rarely +the hopes of youth mature, cannot take a keen interest in his ambitions +like a younger woman, or fire his dying enthusiasm at difficult parts of +the way. If he be his wife's senior he will be as little able to appreciate +her ideas and habits. + +An excitable, volatile, garrulous, "neighbourly" woman, or one who can do +little save strum on the piano or make embroidery as intricate as it is +useless, means divorce or murder. For him, sweetness, gentleness, +self-control, sound common sense, shrewdness, and domestic virtues are +incomparably superior to any mental brilliance or physical comeliness. He +needs a "homely" woman, and should remember that no banking account can +match a sweet, womanly personality, and no charms compare to a sunny heart, +and an ability steadfastly to "see the silver lining". + +He must on no account marry a woman in indifferent health, for under the +strain of her husband's infirmity the woman, who if she were well would be +a help, is a source of expense, worry and friction. + +On the other hand the woman who receives a proposal from a neuropath, be he +ever so gifted, has grave grounds for pausing, though it is hard to counter +the specious arguments of one who may be "a man o' pairts", a witty +companion and an ardent lover. It is doubtful if a neuropath is ever +permeated by a steadfast emotion, for all his emotions are fierce but +unstable, the love of an inconsistent man being ten times more ardent than +that of a faithful one, _while it lasts_. + + "You can't marry a man without taking his faults with his virtues," + +and love must be strong enough to stand, not storms alone, but the minor +miseries of life, the incessant pinpricks, the dreary days when the smile +abroad has become the scowl at home. At best, her husband will be +capricious, hard to please, and though rabidly jealous without cause, at +the same time very partial to the attractions of other women. He usually +needs the attention of the whole household, which his varying health and +moods keep in a mingled state of anxious solicitude and smouldering +resentment. + +His infirmity may mean a very secluded and humdrum life. She will have to +make home an ever-cheery place, an ideal that means hard work and +self-sacrifice through lonesome years in which her nobility will be +unrecognized and unrewarded. + +A woman fond of amusements and sport, and having many acquaintances would +find this unbearable. Any happiness in marriage to a neuropath is largely +dependent on the self-sacrifice of the wife. + +Should marriage occur, the wife must judiciously curb her husband's +passions without driving him to other women by coldness, a problem which is +often solved by separation. The suggestion should never come from her, and +the more she can curb his ardour by tactful suggestion, the healthier will +he and the happier will she be, for nothing causes such an irritable, +nervous state as excessive coitus. + +She will often have to give way in this matter, but must be firm on the +necessity for preventing conception, for she can only bear a tainted child; +her responsibility is great, and she must _insist_ that her husband use +those simple methods which prevent conception, thereby ending in himself +one branch of a worthless tree. This must be done at any cost, for her +happiness is nought compared to the welfare of future generations. Bitter +though it be that no fruit of her womb may call her blessèd, it is less +bitter than hearing her children call themselves accursèd. + + "So many severall wayes are we plagued and punished for our father's + defaultes, that it is the greatest part of our felicity to be well + born, and it were happy for humankind if only such parentes as are + sounde of body and mind should be suffered to marry. An Husbandman will + sow none but the choicest seed upon his lande; he will not reare a bull + nor an horse, except he be right shapen in all his parts, or permit him + to cover a mare, except he be well assured of his breed; we make choice + of the neatest kine, and keep the best dogs, and how careful then + should we be in begetting our children? In former tyme, some countreys + have been so chary in this behalf, so stern, that if a child were + crooked or deformed in body or mind, they made it away; so did the + Indians of old, and many other well gouverned Commonwealths, according + to the discipline of those times. Heretofore in Scotland, if any were + visited with the falling sickness, madness, goute, leprosie, or any + such dangerous disease, which was like to be propagated from the father + to the son, he was instantly gelded; a woman kept from all company of + men; and if by chance, having some such disease, she was found to be + with child she with her brood were buried alive; and this was done for + the common good, lest the whole nation should be injured or corrupted. + A severe doom, you will say, and not to be used among Christians. Yet + to be more looked into than it is. For now, by our too much facility in + this kind, in giving way to all to marry that will, too much liberty + and indulgence in tolerating all sorts, there is a vast confusion of + hereditary diseases; no family secure, no man almost free from some + grievous infirmity or other. Our generation is corrupt, we have so many + weak persons, both in body and mind, many feral diseases raging among + us, crazed families: our fathers bad, and we like to be worse." + +Her husband will want much petting and caressing, and she must foster his +love by lavishing on him much fondness, and ignoring amours as but the +mischievous results of his restless, intriguing mind. + +She must let him see in an affectionate way that she can let others enjoy +his company betimes, secure in the knowledge that she is supreme in his +affections--cajolery that flatters his overweening vanity, and rarely +fails. + +In anger, as in every other emotion, the neuropath is as transient as he is +truculent. A trivial "tiff" will make him blaze up in ungovernable rage and +say most abominable and untruthful things; even utter violent threats. He +will not admit he is wrong, but like a spoilt child must be kissed and +coaxed into a good temper, first with himself and with others next. + +At one moment he is in a perfect paroxysm of fury; five minutes later he is +passionately embracing the luckless object of it and vowing eternal +devotion. In a further five he has forgotten all his remarks and would +hotly deny he used the vexing statements imputed to him. + +Epileptics are morbidly sensitive, and reference to their malady must be +avoided. Victims are intensely suspicious, and a pitying look will reveal +to them the fact that some outsider knows all about the jealously-guarded +skeleton. Resentment, distrust and misery follow such an exposure, for +every innocent look is then translated into a contemptuous glance, and the +victim detects slights undreamt of in any brain save his own. + +Unless seizures are severe, no one should be called in; if they cause +alarm, ask a discreet male neighbour to assist when necessary, leaving when +the convulsions abate so that the victim is not aware of his presence. +Avoid the word "fit" and "epilepsy", and if reference to the attack be +necessary, refer to it as a "faint" or "turn". + +Living with a man liable to have a fit at inopportune times is a tremendous +strain, and the soundest advice one can offer a woman thinking of marrying +such a one is Punch's--"DON'T!" + +We have painted the black side, but, tactfully managed, a neuropath will +merge in the kindest of husbands, the most constant of lovers. The wife +need not be unhappy. Tactless, masterful women will fail, but no one is +more easily led, particularly in the way he should not go, than a +neuropath. + +A man with definite views of his own value will not be successful foil for +"mother-in-lawing", nor remain quiet under the interference of relatives, +who should remember that well-meaning intentions do not justify meddling +actions. + +Many a neuropath led a useful life and gained success in a profession, +solely because his wife tactfully kept him in the path, watched his health, +prevented him frittering away his gifts in many pursuits or useless +repining, and made home a real haven. + +When the yolk seems unbearably heavy, the wife should remember her husband +has to bear the primary, she only the reflected misery, for the limitations +neuropathy puts on every activity and ambition, social and professional, +are frightfully depressing. + +In spite of his peevishness her husband may be trying hard to minimize his +defects and be a reasonable, helpful companion. + + "Judge not the working of his brain, + And of his heart thou can'st not see; + What looks to thy dim eyes a stain + In God's pure light may only be + A scar brought from some well-fought field, + Where thou would'st only faint and yield." + +Magnify his virtues and be tenderly charitable to his many frailties, for +he is "not as other men" and too well he knows it. Love at its best is so +complex that it easily goes awry, but death will one day dissolve all its +complexity, and when, maybe after "many a weary mile" + + "The voice of him I loved is still, + The restless brain is quiet, + The troubled heart has ceased to beat + And the tainted blood to riot"-- + +it will comfort you to reflect that you did your duty and, to best the of +your ability, fulfilled your solemn pledge to love and honour him. + +To quote George Eliot: + + "What greater reward can thou desire than the proud consciousness that + you have strengthened him in all labour, comforted him in all sorrow, + ministered to him in all pain, and been with him in silent but + unspeakably holy memories at the moment of eternal parting?" + +Surely, none! + +We have considered the mournful case of a wife with a neuropathic husband, +and must now say a few words about the truly distressing fate of a husband +afflicted with a neuropathic wife, for neuropathy in its unpleasant +consequences to others is far worse in woman than in man. + +A man is at work all day, and his mind is perforce distracted from his +woes, and, though he retails them at night to the home circle, they get so +used to them as to disregard them, proffering a few words of agreement, +sympathy or scorn quite automatically. + +With women the distraction of work is not so complete, for housework can be +neglected, there are always neighbours and friends to listen to tales of +woe and thus generate a very harmful self-pity, and women are not content +to enumerate their woes, but demand the attention and sympathy of all +listeners. + +Many of the facts in the foregoing parts of this chapter apply with equal +force to both sexes, but women being usually more patient, tactful, +resigned and self-sacrificing than men, can--and often do--alleviate the +lot of the male neuropath; whereas the absence of these qualities in the +average man means that he aggravates, instead of alleviating, the lot of +any female neuropath to whom he may be wedded. + +Having taken her "for better, for worse" he will find her irritating, +unreasonable, and unfitted to shoulder domestic responsibilities. Her likes +and dislikes, fickle fancies, unreasonable prejudices, selfish ways will +cause trouble; he must be prepared for misunderstandings and feuds with +relatives and friends, and on reaching home tired and worried, he is like +to find his house in disorder, be assailed by a tale of woe, and perhaps +find that his wife's vagaries have involved him in a tiff with neighbours. + +She will be fretful, exacting, impatient, and given to ready tears. +Sensitive to the last degree, she will see slights where none are intended, +and a chiding word, a reproachful look, or a weary sigh will mean a fit of +temper or depression. + +Not only are men less gifted for "managing" women than vice versa, but +women are far less susceptible to tactful management than men; a man, like +a dog, can be led almost anywhere with a little dragging at the chain and +growling now and then; a woman, like a cat, is more likely to spit, swear, +and scratch than come along. + +Consequently, it is almost impossible to suggest means of obtaining relief +to one who has been luckless enough to marry, or be married by, a +neuropathic woman. + +If the husband sympathize, the condition will but be aggravated; medicinal +measures will only increase, instead of diminishing, the number of +symptoms; indifference will procure such an exhibition as will both prove +its uselessness and ensure the attention craved. + + * * * * * + +CHAPTER XXVII + +SUMMARY + +To sum up: we have learnt that Epilepsy is a very ancient disease due to +some instability of the brain, in which convulsions are a common but not +invariable symptom. + +Its actual cause is unknown. Heredity plays a big part, but there are +secondary causes beside factors which excite attacks. + +Various methods and drugs to prevent seizures have a limited use. + +First-aid treatment consists solely in preventing the victim sustaining any +injury. + +Neurasthenia is a disease due to nerve-exhaustion and poisoning from +overwork and worry. Its symptoms are many, but fatigue and irritability are +the chief. + +Hysteria is an obstinate, functional, nervous disease in which the patient +acts in an abnormal manner, which is highly provoking to other individuals. + +The cure for hysteria and neurasthenia is solely hygienic, and depends +mainly on the patient. + +The first step towards health consists in getting any slight organic +defects remedied. + +Digestion is often poorly performed. + +This must be remedied by thorough mastication and rational dieting. + +Constipation is very inimical to neuropaths, and must be remedied. + +Patients must pay careful attention to general hygiene. + +Insomnia is exhausting and must be conquered. + +The effects of imagination are profound. + +Suggestion treatment overcomes imaginary ills. + +Drug treatment is either of very limited utility, or frankly useless. + +Patent medicines are never of the slightest use. + +The rational training of neuropathic children is a very difficult but +essential task. + +Puberty and adolescence are very critical times. + +Occupations and recreations must be wisely chosen. + +Heredity is the primary cause of these diseases. As it cannot be treated, +sufferers must not have children. + +Character is abnormal in nervous disease. + +Marriage is very undesirable. + +As a parting injunction, whether you are an epileptic or a neurasthenic, or +a friend, relative, or attendant of such a one: + +"GO THOU SOFTLY ALL THY DAYS!" + + * * * * * + +BIBLIOGRAPHY + + "Oh! for a booke and a shadie nooke, + Eyther indoore or oute; + Where I maie reade, all atte my ease + Both of the newe and olde: + For a jollie goode booke, whereonne to looke + Is better to me than golde!" + +The following books are suitable for laymen, and are most of them very +readable. + +EPILEPSY + +We know of no book suitable for laymen, + +NEURASTHENIA AND HYSTERIA + +"Nervous Disorders of Men" (Kegan Paul) Hollander. + +"Nervous Disorders of Women" (Kegan Paul) Hollander. + +"National Degeneration" (Cornish, Birmingham) D.F. Harris. + +"Hysteria and Neurasthenia" J.M. Clarke. + +"The Management of a Nerve Patient" Schofield. + +"Confessions of a Neurasthenic" (F.A. Davis Co., Philadelphia) Marrs. + +"Conquest of Nerves" (Macmillan) Courtney. + +GENERAL: + +INDIGESTION + +"Indigestion" Herschell. + +DIETING + +"Dietetics" (Jack's People's Books) A. Bryce. + +"Diet in Dyspepsia" Tibbles. + +"Cookery for Common Ailments" Brown. + +CONSTIPATION + +"Constipation" Bigg. + +HYGIENE + +"Laws of Life and Health" A. Bryce. + +"Health" M.M. Burgess. + +INSOMNIA + +"Sleep and Sleeplessness" H.A. Bruce. + +"The Meaning of Dreams" I.H. Coriat. + +IMAGINATION + +"Psychology in Daily Life" Seashore. + +"Hygiene of the Mind" T.S. Clouston. + +SUGGESTION + +"Hypnotism and Suggestion" Hollander. + +"How to Treat by Suggestion" Ash. + +"Hypnotism and Self-Education" (Jack's People's Books) Hutchinson. + +PATENT MEDICINES + +"Patent Foods and Patent Medicines" (Bale & Davidson) Hutchinson. + +See Chapter XX for B.M.A. Books. + +THE CHILD + +"Our Baby" R.D. Clark. + +"Abnormal Children" (Kegan Paul) Hollander. + +"The Baby" (Jack's People's Books) Anonymous. + +"Training the Child" (Jack's People's Books) Spiller. + +PUBERTY + +"Youth and Sex" (Jack's People's Books) Scharlieb and Sibley. + +"Woman in Childhood, Wifehood, and Motherhood" M.S. Cohen. + +"The Adolescent Period" Starr. + +"Physiology" (Home Univ. Library) McKendrick. + +"Human Physiology" Leonard Hill. + +HEREDITY AND CHARACTER + +"Evolution" (Home Univ. Library) Thomson and Geddes. + +"Heredity in the Light of Recent Research" (Cam. Univ. Press) Doncaster. + +"The Psychology of Insanity" (Cam. Univ. Press) Bernard Hart. + +MARRIAGE + +"On Conjugal Happiness" R.G.S. Krohn + +"Race Culture and Race Suicide" R.R. Rentoul. + + * * * * * + +INDEX + + ABORTIVES, Use of, as cause of epilepsy, 22 + Age-incidence in epilepsy, 17, 18 + Air, Fresh, Importance of, 73 + Alcohol, The question of, 64 + Alcoholic excess in relation to epilepsy, 16, 21-23 + ---- ---- neurasthenia, 31 + Amyl Nitrite, to check the aura in epilepsy, 26 + Analyses of proprietary preparations for children, 13 + ---- ---- purgative medicines, 62 + ---- of secret remedies, British Medical Association, 13, 62, 92 + Arson as manifestation of mental epilepsy, 10 + Aspirin for post-epileptic headache, 29 + Aura, The, 2, 3, 25 + ----, ----, in Jacksonian epilepsy, 8 + ----, Treatment of the, 25, 26 + Auto-intoxication, 68 + Auto-suggestion, Value of, 80, 83 + + BACKACHE in neurasthenia, 32 + Baths, Advice as to, for neuropaths, 48, 73, 74 + Blaud's pills, 95 + Brain, Morbid changes in, associated with epilepsy, 18, 19 + ----, Structure of the, 20 + Bromides, Action of, hindered by salt, 65 + ---- in the prevention of epilepsy, 26 + ---- ---- treatment of epilepsy, 86-88, 92 + ---- the basis of every epilepsy cure, 92 + Bromism, 87 + Brooding, harmful to neuropaths, 49, 50 + + CALM necessary in dealing with nervous children, 106 + Carlyle, 90 + Character, 123-30 + ----, The basis of, 124 + Chyle, The, 57 + Chyme, The, 56 + Circulation, The, in neuropaths, 73 + Circulatory Disturbances in neurasthenia, 33 + Clark on frequency of fits during repose, 23 + Clark's statistics of epilepsy, 15 + Cleanliness, 73 + Climacteric, in relation to hysteria, 41 + Clothing for neuropaths, 74 + Coddling, Danger of, for nervous children, 103 + "Complex", The, in consciousness, 10, 11 + Concentration, Lack of, in neurasthenia, 34 + ----, Mental, Exercises in, 51 + Confession, The value of, 40 + Conscious Mind, The, 10, 39 + Consciousness, Alteration of, in epileptic attack, 3, 4, 6 + ----, Dissociation of, 11 + Constipation, 67-70 + ----, Causes of, 67, 68 + ----, Symptoms of, 68 + ----, Treatment of, 68-70 + Convulsions, Epileptic. _See_ "Fit" + ---- in alcoholism, 23 + ---- in children, 13 + ---- in diabetes, 23 + ---- in pregnancy, 14 + Cooking in relation to digestibility, 58 + Country resorts suitable for neuropaths, 47 + Criminal acts in psychic or mental epilepsy, 9, 10 + Culpepper's Herbal, 86 + + DARK, Nervous children's fear of the, 105 + Day-dreaming, 11, 108 + Death, 58 + Degeneration, Signs of, in epileptics, 17 + Dementia, Epileptic, 16 + Demonic Influence in relation to epilepsy, 1, 2 + Dieting, 63-66 + Digestion of foods, 58, 59 + ---- ----, Time occupied by the, 58 + ----, The process of, 56-59 + Digestive troubles in relation to epilepsy, 22, 26 + ---- ----, neurasthenia, 32, 33 + Discipline of the nervous child, 103-106 + Dissociation of consciousness, 11 + Dostoieffsky's "The Idiot", a study of epilepsy, 130 + Douche, The cold, for neuropaths, 74 + Dreams, 12 + ----, Sex-basis in, 12 + Drug habit, The, in neuropaths, 93 + Duties and trials of a neuropath's wife, 132-137 + + EARS, Care of the, 53 + Egoism in relation to neurasthenia, 38 + Electrical treatment for neuropaths, 50 + Emotional repression as a factor in hysteria, 40 + Enema, The use of the, 69 + Energy from food, 58 + Epilepsy a functional disease, 2 + ----, Ancient remedies for, 86 + ---- as a mental complex, 23 + ---- ascribed to demonic influence, 1, 2 + ----, Biblical reference to, 2 + ----, Causes of, 20-24 + ----, Clinical course of, 15-19 + ----, Cure in, 19 + ----, Definition of, 1, 19 + ----, Effect of, on general health, 16 + ----, Feigned, 14 + ----, ----, Diagnosis of, 14 + ----, Historical account of, 1, 2 + ---- in mediæval times, 2 + ---- in neurasthenics, 35 + ---- in relation to genius, 125-127 + ---- ---- marriage, 131 + ----, Jacksonian, 7-9 + ----, ----, its relative frequency, 15 + ----, Major and minor, 1-6 + ----, Medicines for, 86-89 + ----, Mental, 9, 10 + ----, ----, Rarity of, 15 + ----, Nocturnal, 4, 5 + ----, ----, its relative frequency, 15 + ----, Preventive treatment of, 25-27 + ----, Prognosis in, 19 + ----, Psychic, 9, 10 + ----, Rarer types of, 7-16 + ----, Serial, 7 + ----, Superstitions attached to, 1, 2 + Epileptic children, Care of, 16 + ---- dementia, 16 + ---- fit _See_ "Fit" + ---- fits, Times of occurrence of, 15, 23 + Epileptiform seizures, 13 + Exercise for neuropaths, 48, 74, 75 + Eyes, Care of the, 53 + + FACIAL expression in epilepsy, 17 + Fats, Digestion of, 57 + Fears, Baseless, in neurasthenia, 35, 36 + Feeding, Generous, needed for neuropaths, 47 + Fit, Epileptic, Description of an, 3, 4 + ----, ----, Mechanism of an, 20, 21 + ----, ----, First-aid to victims of, 28, 29 + Flatulence, Treatment of, 70 + Foods, Proprietary, 94, 95 + "Free will", The fallacy of, 124, 125 + Freud on perverted sex-ideas as a cause of hysteria, 40 + ---- ---- subconscious sexual desires in infants, 113 + ---- ---- the sex-basis in dreams, 12 + Fright as cause of epilepsy, 21 + + GASTRIC Juice, The, 56 + Genius, Epilepsy in relation to, 125-127 + "Germ-plasm", The, 118 + ---- in relation to neuropathic tendencies, 120, 121, 124 + _Globus hystericus_, 42 + Glycerin suppositories, 69 + Glycerophosphates, 96 + "Good" and "Evil", 123, 124 + Gowers on epilepsy, 7 + Gowers' statistics as to age-incidence of epilepsy, 17 + _Grand mal_, 2-5 + ---- ----, its relative frequency, 15 + Greene on hysteria, 44 + + HABIT, Importance of, in relation to constipation, 68 + Haig on relation of uric acid to epilepsy, 23 + Headache in neurasthenia, 32 + Heredity, 118-122 + Hobbies for neuropaths, 48 + Hormone, The Function of a, 57 + Hughlings Jackson, Dr, on the epileptic convulsion, 8 + Husband of a neuropath, Advice to the, 138, 139 + Huxley on the rules of the game of life, 46 + Hygiene, General, 71-75 + Hypochondriasis in neurasthenics, 36 + Hypophosphites, 96 + Hysteria, 39-45 + ----, Age incidence of, 41 + ----, Ancient views as to, 39 + ---- and neurasthenia contrasted, 41 + ---- Causes of, 40, 41 + ----, Modern theories as to, 39 + ----, Race incidence of, 42 + ----, Sex-incidence of, 39, 41 + ----, Symptoms of, 42-44 + ----, Treatment of, 44 + Hysterical attack, The, 42, 43 + + IMAGINATION, Effects of, 79-81 + Indigestion, 60-62 + Infantile convulsions, 13 + ---- ----, relation of to epilepsy, 13 + ---- ----, Treatment of, 13 + Inhibitory cells of brain, 20, 21 + Injuries to brain as cause of epilepsy, 21 + Insanity in relation to dissociation of consciousness, 11 + ---- ---- epilepsy, 16 + Insomnia _See_ "Sleeplessness" + Intestinal worms, 102 + Iron preparations, 95 + + JACKSONIAN epilepsy, 7, 8, 9 + Janet on consciousness in hysteria, 40 + Jones on the religious sentiment in neuropaths, 106, 107 + + KING'S evil, The, 86 + + LA ROCHEFOUCAULD on health and regimen, 65 + Lecithin, 96 + Lieberkuhn's glands, 57, 58 + Life, in relation to tissue change, 58 + Locock's introduction of bromides for epilepsy, 86 + + MACHINE, The human, 71, 72 + Malt extracts, 93 + Marriage, 131-139 + ---- and neuropathy, 122, 131, 132 + ---- of neuropaths should be childless, 134, 135 + Mastication, Importance of thorough, 61 + Masturbation, 110-112 + ----, Effects of, 111, 112 + ---- in relation to epilepsy, 16, 22, 114 + ---- ---- neurasthenia, 38 + Meals, Number and time of, 64 + Meat extracts, 93 + ---- juices, Value of, 64 + ----, Moderation in its use necessary, 65 + Memory in epilepsy, 17 + ----, its subconscious basis, 10 + Mendel's law of inheritance, 120, 121 + Menopause in relation to neurasthenia, 31 + Menstruation, Disordered, in neurasthenia, 33 + ---- in relation to epilepsy, 17, 22 + Mental attitude of neurasthenics, 33-38 + ---- fatigue in neurasthenia, 33, 34 + Mercier on the characteristics of the neuropath, 128-130 + Mind in relation to consciousness, 10 + Moral cowardice in relation to neurasthenia, 38 + _Morbus comitialis_, 2 + Motor cells of brain, 20, 21 + Murder as manifestation of mental epilepsy, 10 + + NARCOTICS, Use and abuse of, 78 + Nervous child, Training of the, 98-108 + ---- dyspepsia, 60 + ---- ----, Diet in, 65 + Neurasthenia, 30-38 + ---- and hysteria contrasted, 41 + ----, Causes of, 31, 32, 41 + ----, Course and outlook in, 38, 41 + ---- in relation to epilepsy, 35 + ---- ---- self abuse, 16, 38 + ----, Sexual, 38 + ----, Symptoms of, 32-38, 41 + Neuropath, The, his need of a wife, 132 + Neuropathic children, Characteristics of, 98, 99 + ---- ----, Diet of, 100-102 + ---- ----, Education of 99, 100 + ---- ----, Moral training of, 102-106 + Neuropaths, Advice to, 46-52 + ----, Mental characteristics of, 126-130 + Neuropathy in relation to marriage, 122, 131-139 + ----, The only way to eradicate, 121 + Night terrors, 105 + Nitroglycerine to check the epileptic aura, 25, 26 + Nose, Care of the, 54 + + OPISTHOTONOS, 43 + Optimism, Value of, 80 + Osler on age-incidence of epilepsy, 18 + ---- ---- the use of medicines, 93 + + PALPITATION during use of bromides, 87 + ---- in neurasthenia, 33 + Parentage in relation to inherited qualities, 119, 120 + Patent medicines, 90-97 + ---- ---- and the dyspeptic, 60, 62 + ---- ---- ---- ---- neurasthenic, 36 + ---- ----, explanation of their benefit, 80 + Pepsin, 94 + _Petit mal_, 5, 6 + ---- ---- in childhood, 16 + ---- ----, its relative frequency 15 + Phenalgin for post-epileptic headache, 29 + Phosphorus preparations, 96 + Piles, 70 + Port wine in proprietary preparations, 93 + Predigested foods, 94, 95 + Pregnancy, Convulsions during, 14 + ---- in relation to epilepsy, 17, 22 + Psycho-analysis in the treatment of hysteria, 40 + Puberty, Bodily changes at, 109 + ----, Dangers at and after, 109-114 + ---- in relation to epilepsy, 16, 18, 114 + Punishment, Corporal, unsuited for nervous children, 105, 106 + Pupils in epilepsy, The, 17 + Purgatives, The abuse of, 69 + ----, Suitable, 70 + + QUACK Advertisements, 91, 111 + + READING for neuropaths, 48 + Recovery in epilepsy, 19 + Recreations for neuropaths, 117 + Reid on the effect of emotions on bodily functions, 81 + Religion, Question of, in nervous children, 106-108 + Rest for neuropaths, 49, 50 + Responsibility in relation to mental epilepsy, 9, 10 + + SANATOGEN, 96 + Savill on differences between neurasthenia and hysteria, 41 + Self-abuse _See_ "Masturbation" + Self control, how far possible to neuropaths, 123-125 + Self-restraint, The neuropath's lack of, 129, 130 + Sentimentality to be discouraged in nervous children, 104 + Sex education, The need for, 131 + Sex-incidence in epilepsy, 18 + Sex instruction for children, 110, 112 + Sexual development early in neuropaths, 113, 114 + ---- excesses in relation to epilepsy, 16, 23 + ---- ---- in relation to neurasthenia, 31, 38 + ---- instinct, Awakening of, 109, 110 + ---- neurasthenia, 38 + ---- offences as manifestations of mental epilepsy, 9, 10 + ---- rules for neuropaths, 48 + Shaw, Bernard, his sneer at marriage, 131 + Sleep, Relation of, to epileptic fit, 4 + Sleeplessness, 76-78 + ----, Causes of, 76, 77 + ----, Treatment of, 77, 78, 85 + ---- in neurasthenia, 33 + Sollmann on proprietary foods, 94, 96 + Soothing syrups, 13 + "Sound nerves", 52 + Spirit writing, 11, 12 + Spiritualism, Danger of, for neuropaths, 107 + Spratling on epilepsy in consumptives, 17 + Starr's statistics as to age-incidence in epilepsy, 17 + ---- ---- heredity in epileptics, 121 + ---- ---- types of epilepsy, 15 + _Status epilepticus_, 7 + ---- ----, as final termination of epilepsy, 16 + Subconscious mind, The, 10 + Suggestion treatment, 82-85 + Suicide in neurasthenics and hysterical subjects, 35, 41, 42 + Sunstroke as cause of fits, 21 + Sweetmeats, The use of, 64 + Sympathy, Harm done by, in hysteria, 44, 45 + + TAPE worms, 102 + Tea and coffee, 64 + Teeth, Care of the, 54, 55 + Tobacco undesirable for neuropaths, 74 + Trades for epileptics, 116 + ---- ---- neuropaths, 115-117 + Turner on age-incidence of epilepsy, 18 + + UNCONSCIOUS activities, 39, 40 + Unconsciousness in epilepsy, 3-5 + Urine, Incontinence of, in epilepsy, 3-5 + + VEGETABLE Foods, 64 + Villi, The intestinal, 57 + Vittoz's exercises in mental concentration, 51 + Vomiting, Risk of, in epilepsy, 26 + + WATER, When to drink, 61, 64, 68 + Weir Mitchell Treatment, 50 + Wife for the neuropath, The, 132-135 + ---- of a neuropath, Advice to the, 132-137 + Will, Neuropath's lacking in, 125 + Work and play, 115-117 + Worms, Intestinal, 102 + Worry as cause of neurasthenia, 31 + ---- to be avoided by neuropaths, 47, 49 + +_Printed in Great Britain by Jarrold & Sons, Ltd., Norwich_ + + + + + + +End of the Project Gutenberg EBook of Epilepsy, Hysteria, and Neurasthenia +by Isaac G. 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Briggs + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Epilepsy, Hysteria, and Neurasthenia + +Author: Isaac G. Briggs + +Release Date: February 4, 2005 [EBook #14901] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK EPILEPSY, HYSTERIA, AND NEURASTHENIA *** + + + + +Produced by Martin Agren, Keith Edkins and the PG Online Distributed +Proofreading Team. + + + + + + +</pre> + + + +<!-- Page iii --><span class="pagenum"><a name="pageiii"></a>[iii]</span> + +<h2>EPILEPSY, HYSTERIA,<br /> +AND NEURASTHENIA</h2> + +<h3>THEIR CAUSES, SYMPTOMS, & TREATMENT</h3> + +<p class="center">BY</p> + +<h2>ISAAC G. BRIGGS</h2> + +<p class="center">A.R.S.I.</p> + +<p class="center">METHUEN & CO. LTD.<br /> +36 ESSEX STREET W.C.<br /> +LONDON</p> + +<!-- Page iv --><span class="pagenum"><a name="pageiv"></a>[iv]</span> + +<p class="center"><i>First Published in 1921</i></p> + +<!-- Page v --><span class="pagenum"><a name="pagev"></a>[v]</span> + +<hr /> + +<h3>TO<br /> + +ALBERT E. WOODRUFF<br /> + +OF STOKE PRIOR<br /> +NR. BROMSGROVE<br /> + +MY OLD<br /> +SCHOOLMASTER</h3> + +<!-- Page vi blank --> + +<!-- Page vii --><span class="pagenum"><a name="pagevii"></a>[vii]</span> + +<hr /> + +<h3>CONTENTS</h3> + +<table summary="contents"> +<tr><td colspan="2">CHAPTER</td><td>PAGE</td></tr> +<tr><td class="r"></td><td>PREFACE</td><td class="r"><a href="#pageix">ix</a></td></tr> +<tr><td class="r">I.</td><td>MAJOR AND MINOR EPILEPSY</td><td class="r"><a href="#page1">1</a></td></tr> +<tr><td class="r">II.</td><td>RARER TYPES OF EPILEPSY</td><td class="r"><a href="#page7">7</a></td></tr> +<tr><td class="r">III.</td><td>GENERAL REMARKS</td><td class="r"><a href="#page15">15</a></td></tr> +<tr><td class="r">IV.</td><td>CAUSES OF EPILEPSY</td><td class="r"><a href="#page20">20</a></td></tr> +<tr><td class="r">V.</td><td>PREVENTION OF ATTACKS</td><td class="r"><a href="#page25">25</a></td></tr> +<tr><td class="r">VI.</td><td>FIRST-AID TO VICTIMS</td><td class="r"><a href="#page28">28</a></td></tr> +<tr><td class="r">VII.</td><td>NEURASTHENIA</td><td class="r"><a href="#page30">30</a></td></tr> +<tr><td class="r">VIII.</td><td>HYSTERIA</td><td class="r"><a href="#page39">39</a></td></tr> +<tr><td class="r">IX.</td><td>ADVICE TO NEUROPATHS</td><td class="r"><a href="#page46">46</a></td></tr> +<tr><td class="r">X.</td><td>FIRST STEPS TOWARD HEALTH</td><td class="r"><a href="#page53">53</a></td></tr> +<tr><td class="r">XI.</td><td>DIGESTION</td><td class="r"><a href="#page56">56</a></td></tr> +<tr><td class="r">XII.</td><td>INDIGESTION</td><td class="r"><a href="#page60">60</a></td></tr> +<tr><td class="r">XIII.</td><td>DIETING</td><td class="r"><a href="#page63">63</a></td></tr> +<tr><td class="r">XIV.</td><td>CONSTIPATION</td><td class="r"><a href="#page67">67</a></td></tr> +<tr><td class="r">XV.</td><td>GENERAL HYGIENE</td><td class="r"><a href="#page71">71</a></td></tr> +<tr><td class="r">XVI.</td><td>SLEEPLESSNESS</td><td class="r"><a href="#page76">76</a></td></tr> +<tr><td class="r">XVII.</td><td>THE EFFECTS OF IMAGINATION</td><td class="r"><a href="#page79">79</a></td></tr> +<tr><td class="r">XVIII.</td><td>SUGGESTION TREATMENT</td><td class="r"><a href="#page82">82</a></td></tr> +<tr><td class="r">XIX.</td><td>MEDICINES</td><td class="r"><a href="#page86">86</a></td></tr> +<tr><td class="r">XX.</td><td>PATENT MEDICINES </td><td class="r"><a href="#page90">90</a></td></tr> +<tr><td class="r">XXI.</td><td>TRAINING THE NERVOUS CHILD</td><td class="r"><a href="#page98">98</a></td></tr> +<tr><td class="r">XXII.</td><td>DANGERS AT AND AFTER PUBERTY</td><td class="r"><a href="#page109">109</a></td></tr> +<tr><td class="r">XXIII.</td><td>WORK AND PLAY</td><td class="r"><a href="#page115">115</a></td></tr> +<tr><td class="r">XXIV.</td><td>HEREDITY</td><td class="r"><a href="#page118">118</a></td></tr> +<tr><td class="r">XXV.</td><td>CHARACTER</td><td class="r"><a href="#page123">123</a></td></tr> +<tr><td class="r">XXVI.</td><td>MARRIAGE</td><td class="r"><a href="#page131">131</a></td></tr> +<tr><td class="r">XXVII.</td><td>SUMMARY</td><td class="r"><a href="#page140">140</a></td></tr> +<tr><td class="r"></td><td>BIBLIOGRAPHY</td><td class="r"><a href="#page142">142</a></td></tr> +<tr><td class="r"></td><td>INDEX</td><td class="r"><a href="#page145">145</a></td></tr> +</table> + +<!-- Page ix --><span class="pagenum"><a name="pageix"></a>[ix]</span> + +<hr /> + +<h3>PREFACE</h3> + + <p>I hope this book will meet a real need, for when one considers how + prevalent epilepsy, hysteria and neurasthenia are, among all ranks and + ages of both sexes, it seems remarkable some such popular book was not + written long ago.</p> + + <p>I add nothing to our knowledge of these ills, my object being to put + what we know into simple words, and to insist on the necessity for + personal discipline being allied to expert aid. The book aims at helping, + not ousting, the doctor, who may find it of use in getting his patient to + see—and to act on—the obvious.</p> + + <p>"Nervous Disease", as here used, includes only the three diseases + treated of; "Neuropath"—victims of them.</p> + + <p>"Advice" to a neuropath is usually a very depressing decalogue of + "Thou Shalt Nots!" If it be made clear <i>why</i> he must <i>not</i> do + so-and-so, the patient endeavours to obey; peremptorily ordered to obey, + he rebels. Much sound advice is wasted for lack of an interesting, + convincing, "Reason Why!" which would ensure the hearty and very helpful + co-operation of a patient who had been taught that writing prescriptions + is not the limit of a doctor's activities.</p> + + <p>Many folk, with touching belief in his own claims, regard the quack as + a hoary-headed sage, who from disinterested motives devotes his life to + curing ailments, by methods of which he alone has the secret, at low + fees. To fight this dangerous idea I have tried to <!-- Page x --><span + class="pagenum"><a name="pagex"></a>[x]</span> show in an interesting way + how science deals with nerve ills, and to prove that qualified aid is + needed. Suggestions and criticisms will be welcomed.</p> + + <div class="noflo"> + <div class="nofblk"> + <p class="i16">I. G. BRIGGS</p> + <p>THE UNIVERSITY,</p> + <p class="i4">BIRMINGHAM,</p> + <p class="i8"><i>June</i>, 1921</p> + </div> + </div> + +<!-- Page xi --><span class="pagenum"><a name="pagexi"></a>[xi]</span> + +<hr /> + + <p>"Lette than clerkes enditen in Latin, for they have the propertie of + science, and the knowing in that facultie: and lette Frenchmen in their + Frenche also enditen their queinte termes, for it is kyndely to their + mouthes; and let us showe our fantasies in soche wordes as we lerneden of + our dames tongue."</p> + + <p>—Chaucer.</p> + +<!-- Page xii blank --> + +<!-- Page 1 --><span class="pagenum"><a name="page1"></a>[pg 1]</span> + +<hr /> + +<h2>EPILEPSY, HYSTERIA, +AND NEURASTHENIA</h2> + +<hr /> + +<p class="center">CHAPTER I</p> + +<h3>MAJOR AND MINOR EPILEPSY</h3> + +<p class="center">(<i>Grand and Petit Mal</i>)</p> + + <p>"My son is sore vexed, for ofttimes he falleth into the fire, and + ofttimes into the water."—Matthew xvii, 15.</p> + + <div class="noflo"> + <div class="nofblk"> + <p>"Oft, too, some wretch before our startled sight,</p> + <p>Struck as with lightning with some keen disease,</p> + <p>Drops sudden: By the dread attack o'erpowered</p> + <p>He foams, he groans, he trembles, and he faints;</p> + <p>Now rigid, now convuls'd, his labouring lungs</p> + <p>Heave quick, and quivers each exhausted limb.</p> + </div> + + <div class="nofblk"> + <p class="i8">* * * * *</p> + </div> + + <div class="nofblk"> + <p>"He raves, since Soul and Spirit are alike</p> + <p>Disturbed throughout, and severed each from each</p> + <p>As urged above, distracted by the bane;</p> + <p>But when at length the morbid cause declines,</p> + <p>And the fermenting humours from the heart</p> + <p>Flow back—with staggering foot first treads</p> + <p>Led gradual on to intellect and strength."—Lucretius.</p> + </div> + </div> + + <p>Epilepsy, or "Falling Sickness", is a chronic abnormality of the + nervous system, evinced by attacks of <i>alteration of consciousness</i>, + usually accompanied by convulsions.</p> + + <p>It attacks men of every race, as well as domesticated animals, and has + been known since the earliest times, the ancients imputing it to demons, + the anger of the gods, or a blow from a star.</p> + + <p>It often attacks men in crowds, when excited by <!-- Page 2 --><span + class="pagenum"><a name="page2"></a>[pg 2]</span> oratory or sport, hence + the Roman name: <i>morbus comitialis</i> (crowd sickness).</p> + + <p>In mediæval times, sufferers were regarded with awe, as being + possessed by a spirit. Witch doctors among savages, and founders and + expounders of differing creeds among more civilized peoples, have taken + advantage of this infirmity to claim divine inspiration, and the power of + "seeing visions" and prophesying.</p> + + <p>Epilepsy has always interested medical men because of its frequency, + the difficulty of tracing its cause, and its obstinacy to treatment, + while it has appealed to popular imagination by the appalling picture of + bodily overthrow it presents, so that many gross superstitions have grown + up around it.</p> + + <p>The description in Mark ix. 17-29, is interesting:</p> + + <blockquote>"Master, I have brought Thee my son, which hath a dumb + spirit. And wheresoever he taketh him, he teareth him: and he foameth, + and gnasheth with his teeth, and pineth away: ... straightway the spirit + tare him; and he fell on the ground, and wallowed foaming.</blockquote> + + <blockquote>"And He asked his father, How long is it ago since this came + unto him? And he said, Of a child. And ofttimes it hath cast him into the + fire, and into the waters, to destroy him.</blockquote> + + <blockquote>"And he said unto them, This kind can come forth by nothing, + but by prayer and fasting."</blockquote> + + <p>Up to the present, epilepsy can be ascribed to no specific disease of + the brain, the symptoms being due to some morbid disturbance in its + action. Epilepsy is a "functional" disease.</p> + +<p class="center">GRAND MAL ("<i>Great Evil</i>")</p> + + <p>An unusual feeling called an <i>aura</i> (Latin—vapour), + sometimes warns a patient of an impending fit, <!-- Page 3 --><span + class="pagenum"><a name="page3"></a>[pg 3]</span> commonly lasting long + enough to permit him to sit or lie down. This is followed by giddiness, a + roaring in the ears, or some unusual sensation, and merciful + unconsciousness. In many cases this stage is instantaneous; in others it + lasts some seconds—but an eternity to the sufferer. This stage is + all that victims can recall (and this only after painful effort) of an + attack.</p> + + <p>As unconsciousness supervenes, the patient becomes pale, and gives a + cry, which varies from a low moan to a loud, inhuman shriek. The head and + eyes turn to one side, or up or down, the pupils of the eyes enlarge and + become fixed in a set stare, and the patient drops as if shot, making no + effort to guard his fall, being often slightly and sometimes severely + injured.</p> + + <p>The whole body then becomes stiff. The hands are clenched, with thumbs + inside the palms, the legs are extended, the arms stiffly bent, and the + head thrown back, or twisted to one side. The muscles of the chest and + heart are impeded in their action, breathing ceases, the heart is slowed, + and the face becomes pale, and then a livid, dusky blue.</p> + + <p>The skin is cold and clammy, the eyebrows knit; the tongue may be + protruded, and bitten between the teeth. The eyeballs seem starting from + their sockets, the eyes are fixed or turned up, so that only the + sclerotic ("whites") can be seen, and they may be touched or pressed + without causing blinking. The stomach, bladder, and bowels may + involuntarily be emptied.</p> + + <p>This <i>tonic</i> stage only lasts a few seconds, and is followed by + convulsions. The head turns from side to side, the jaws snap, the eyes + roll, saliva and blood mingle as foam on the lips, the face is contorted + in frightful grimaces, the arms and legs are twisted and jerked about, + the breathing is deep and irregular, the whole body writhes violently, + and is bathed in sweat.</p> + +<!-- Page 4 --><span class="pagenum"><a name="page4"></a>[pg 4]</span> + + <p>The spasms become gradually less severe, and finally cease. Deep + breathing continues for some seconds; then the victim becomes + semi-conscious, looks around bewildered, and sinks into coma or deep + sleep.</p> + + <div class="noflo"> + <div class="nofblk"> + <p>"...As one that falls,</p> + <p>He knows not how, by force demoniac dragg'd</p> + <p>To earth, and through obstruction fettering up</p> + <p>In chains invisible the powers of Man;</p> + <p>Who, risen from his trance, gazeth around</p> + <p>Bewilder'd with the monstrous agony</p> + <p>He hath indured, and, wildly staring, sighs:</p> + <p>..."</p> + </div> + </div> + + <p>In a few hours he wakes, with headache and mental confusion, not + knowing he has been ill until told, and having no recollection of events + just preceding the seizure, until reminded of them when they are slowly, + and with painful effort, brought to mind. He is exhausted, and often + vomits. In severe cases he may be deaf, dumb, blind, or paralysed for + some hours, while purple spots (the result of internal hemorrhage) may + appear on the head and neck. Victims often pass large quantities of + colourless urine after an attack, and, as a rule, are quite well again + within twenty-four hours.</p> + + <p>This is the usual type, but seizures vary in different patients, and + in the same sufferer at different times. The cry and the biting of the + tongue may be absent, the first spasm brief, and the convulsions mild. + Epilepsy of all kinds is characterized by an <i>alteration</i> (not + necessarily a <i>loss</i>) of consciousness, followed by loss of memory + for events that occurred during the time that alteration of consciousness + lasted.</p> + + <p>Attacks may occur by day only, by day and by night, or by night only, + though in so-called nocturnal epilepsy, it is <i>sleep</i> and not night + that induces the fit, for night-workers have fits when they go to sleep + during the day.</p> + +<!-- Page 5 --><span class="pagenum"><a name="page5"></a>[pg 5]</span> + + <p>Victims of nocturnal epilepsy may not be awakened by the seizure, but + pass into deeper sleep. Intermittent wetting of the bed, occasional + temporary mental stupor in the morning, irritability, temporary but + well-marked lapses of memory, sleep-walking, and causeless outbursts of + ungovernable temper all suggest nocturnal epilepsy.</p> + + <p>Such a victim awakes confused, but imputes his mental sluggishness to + a hearty supper or "a bad night". A swollen tongue, blood-stained pillow, + and urinated bed arouse suspicion as to the real cause, suspicion which + is confirmed by a seizure during the day. He is more fortunate (if such a + term can rightly be used of any sufferer from this malady) than his + fellow victim whose attacks occur during the day, often under + circumstances which, to a sensitive nature, are very mortifying.</p> + + <p>Epileptic attacks are of every degree of violence, varying from a + moment's unconsciousness, from which the patient recovers so quickly that + he cannot be convinced he has been ill, to that awful state which + terrifies every beholder, and seems to menace the hapless victim with + instant death. Every degree of frequency, too, is known, from one attack + in a lifetime, down through one in a year, a month, a week, or a day; + several in the same periods, to <i>hundreds</i> in four-and-twenty + hours.</p> + +<p class="center">PETIT MAL ("<i>Little Evil</i>")</p> + + <p>This is incomplete <i>grand mal</i>, the starting stages only of a + fit, recovery occurring before convulsions.</p> + + <p><i>Petit mal</i> often occurs in people who do not suffer from + <i>grand mal</i>, the symptoms consisting of a loss of consciousness for + <i>a few seconds</i>, the seizure being so brief that the victim never + realizes he has been unconscious. <!-- Page 6 --><span class="pagenum"><a + name="page6"></a>[pg 6]</span> He suddenly stops what he is doing, turns + pale, and his eyes become fixed in a glassy stare. He may give a slight + jerk, sway, and make some slight sound, smack his lips, try to speak, or + moan. He recovers with a start, and is confused, the attack usually being + over ere he has had time to fall.</p> + + <p>If talking when attacked, he hesitates, stares in an absent-minded + manner, and then completes his interrupted sentence, unaware that he has + acted strangely. Whatever act he is engaged in is interrupted for a + second or two, and then resumed.</p> + + <p>A mild type of <i>petit mal</i> consists of a temporary + <i>blurring</i> of consciousness, with muscular weakness. The victim + drops what he is holding, and is conscious of a strange, extremely + unpleasant sensation, a sensation which he is usually quite unable to + describe to anyone else. The view in front is clear, he understands what + it is—a house here, a tree there, and so on—yet he does not + <i>grasp</i> the vista as usual. Other victims have short spells of + giddiness, while some are unable to realize "where they are" for a few + moments.</p> + + <p>Frequent <i>petit mal</i> impairs the intellect more than <i>grand + mal</i>, for convulsions calm the patient as a good cry calms hysterical + people. After a number of attacks of <i>petit mal, grand mal</i> usually + supervenes, and most epileptics suffer from attacks of both types. Some + precocious, perverse children are victims of unrecognized <i>petit + mal</i>, and when pushed at school run grave risks of developing symptoms + of true epilepsy. The "Little Evil" is a serious complaint.</p> + +<!-- Page 7 --><span class="pagenum"><a name="page7"></a>[pg 7]</span> + +<hr /> + +<p class="center">CHAPTER II</p> + +<h3>RARER TYPES OF EPILEPSY</h3> + + <blockquote>If it be true that: "One half the world does not know how the + other half lives", how true also is it that one half the world does not + know, and does not care, what the other half suffers.</blockquote> + + <p>Epilepsy shows every gradation, from symptoms which cannot be + described in language, to severe <i>grand mal</i>. Gowers says: "The + elements of an epileptic attack may be extended, and thereby be made less + intense, though not less distressing. If we conceive a minor attack that + is extended, and its elements protracted, with no loss of consciousness, + it would be so different that its epileptic nature would not be + suspected. Swiftness is an essential element of ordinary epilepsy, but + this does not prevent the possibility of deliberation."</p> + + <p>In <b>Serial Epilepsy</b>, a number of attacks of <i>grand mal</i> + follow one another, with but very brief intervals between. Serial + epilepsy often ends in</p> + + <p><i>Status Epilepticus</i>, in which a series of <i>grand mal</i> + attacks follow one another with no conscious interval. The temperature + rises slowly, the pulse becomes rapid and feeble, the breathing rapid, + shallow and irregular, and death usually occurs from exhaustion or + heart-failure. Though not invariably fatal, the condition is so very + grave that a doctor must instantly be summoned. Nearly all victims of + severe, confirmed epilepsy (25 per cent of all epileptics) die in + <i>status epilepticus</i>.</p> + + <p><b>Jacksonian Epilepsy</b>, named after Hughlings Jackson, <!-- Page 8 + --><span class="pagenum"><a name="page8"></a>[pg 8]</span> who in 1861 + traced its symptoms to their cause, is not a true epilepsy, being due to + a local irritation of the cortex (the outermost layer) of the brain.</p> + + <p>There is usually an <i>aura</i> before the attack, often a tingling or + stabbing pain. The chief symptoms are convulsions of certain limbs or + areas of the body, which, save in very severe cases, are confined to one + side, and are not attended by loss of consciousness.</p> + + <p>The irritation spreads to adjacent areas, as wavelets spread from a + stone thrown into a pond, with the result that convulsions of other limbs + follow in sequence, all confined to one side.</p> + + <p>As every part of the brain is connected to every other part by + "association fibres", in very violent attacks of Jacksonian epilepsy the + irritation spreads to the other side of the brain also, consciousness is + lost, the convulsions become general and bilateral, and the patient + presents exactly the same picture as if the attack were due to <i>grand + mal</i>.</p> + + <p>All degrees of violence are seen. The convulsions may consist only of + a rapid trembling, or the limb or limbs may be flung about like a + flail.</p> + + <p>Jackson said: "The convulsion is a brutal development of a man's own + movements, a sudden and excessive contention of many of the patient's + familiar motions, like winking, speaking, singing, moving, etc." These + acts are learned after many attempts, and leave a memory in certain + groups of brain cells; irritate those cells, and the memorized acts are + performed with convulsive violence.</p> + + <p>The convulsions are followed by temporary paralysis of the involved + muscles, but power finally returns. As we should expect, this paralysis + lasts longest in the muscles first involved, and is slightest in the + muscles whose brain-centres were irritated by the nearly exhausted waves. + If the disease be untreated, the <!-- Page 9 --><span class="pagenum"><a + name="page9"></a>[pg 9]</span> muscles in time may become totally + paralysed, wasted, and useless.</p> + + <p>Friends should very carefully note exactly where and how the attack + begins, the exact part first involved, and the precise order in which the + spasms appear, as this is the only way the doctor can localize the brain + injury. The importance of this cannot be overrated.</p> + + <p>The consulting surgeon will say if operation is, or is not, advisable, + but <i>operation is the sole remedy for Jacksonian epilepsy</i>, for the + causes that underly its symptoms cannot be reached by medicines.</p> + + <p>Patients must consult a good surgeon; other courses are + <i>useless</i>.</p> + + <p><b>Psychic or Mental Epilepsy</b> is a trance-state often occurring + after attacks of <i>grand</i> or <i>petit mal</i>, in which the patient + performs unusual acts. The epileptic feature is the patient's inability + to recall these actions. The complaint is fortunately rare.</p> + + <p>The face is usually pale, the eyes staring, and there may be a "dream + state". Without warning, the victim performs certain actions.</p> + + <p>These may be automatic, and not seriously embarrassing—he may + tug his beard, scratch his head, hide things, enter into engagements, + find the presence of others annoying and hide himself, or take a long + journey. Such a journey is often reported in the papers as a "mysterious + disappearance". Yet, had he committed a crime during this time, he would + probably have been held "fully responsible" and sentenced.</p> + + <p>The actions may be more embarrassing: breaking something, causing + pain, exhibiting the sexual organs; the patient may be transported by + violent rage, and abuse relatives, friends or even perfect strangers; he + may spit carelessly, or undress himself—possibly with a vague idea + that he is unwell, and would be better in bed.</p> + +<!-- Page 10 --><span class="pagenum"><a name="page10"></a>[pg 10]</span> + + <p>Finally the acts may be criminal: sexual or other assault, murder, + arson, theft, or suicide.</p> + + <p>In this state, the patient is dazed, and though he appreciates to some + extent his surroundings, and may be able to answer questions more or less + rationally, he is really in a profound reverie. The attack soon ends with + exhaustion; the victim falls asleep, and a few moments later wakes, + ignorant of having done or said anything peculiar.</p> + + <p>We usually think of our <i>mind</i> as the aggregate of the various + emotions of which we are actually <i>conscious</i>, when, in reality, + consciousness forms but a small portion of our mentality, the + <i>subconscious</i>—which is composed of all our past experiences + filed away below consciousness—directing every thought and act. + Inconceivably delicate and intricate mind-machinery directs us, and our + idlest fancy arises, <i>not by chance</i> as most people surmise, but + through endless associations of subconscious mental processes, which can + often be laid bare by skilful psycho-analysis.</p> + + <p>Our subconscious mind does not let the past jar with the present, for + life would be made bitter by the eternal vivid recollection of incidents + best forgotten. Every set of ideas, as it is done with, is locked up + separately in the dungeons of subconsciousness, and these imprisoned + ideas form the basis of memory. <i>Nothing is ever forgotten</i>, though + we may never again "remember" it this side the grave.</p> + + <p>In a few cases we can unlock the cell-door and release the + prisoner—we "remember"; in some, we mislay the key for awhile; in + many, the wards of the lock have rusted, and we cannot open the door + although we have the key—we "forget"; finally, our prisoner may + pick the lock, and make us attend to him whether we wish to or + not—something "strikes us".</p> + + <p>Normally, only one set of ideas (a complex) can hold <!-- Page 11 + --><span class="pagenum"><a name="page11"></a>[pg 11]</span> the stage of + consciousness at any one time. When two sets get on the boards together, + double-consciousness occurs, but even then they cannot try to shout each + other down; one set plays "leading lady", the other set the "chorus + belle" and so life is rendered bearable.</p> + + <p>This "dissociation of consciousness" occurs in all of us. A skilled + pianist plays a piece "automatically" while talking to a friend; we often + read a book and think of other things at the same time: our full + attention is devoted to neither action; neither is done perfectly, yet + both are done sufficiently well to escape comment.</p> + + <p>Day-dreaming is dissociation carried further. "Leading lady" and + "chorus belle" change places for a while—imaginary success keeps us + from worrying about real failure. Dissociation, day-dreaming, and mental + epilepsy are but few of the many milestones on a road, the end of which + is insanity, or complete and permanent dissociation, instead of the + partial and fleeting dissociation from which we all suffer. The lunatic + never "comes to", but in a world of dreams dissociates himself forever + from realities he is not mentally strong enough to face.</p> + + <p>The writing of "spirits" through a "medium" is an example of + dissociation, and though shown at its best in neuropaths, is common + enough in normal men, as can be proved by anyone with a planchette and + some patience.</p> + + <p>If the experimenter puts his hands on the toy, and a friend talks to + him, while another whispers questions, he may write more or less coherent + answers, though all the time he goes on talking, and does not know what + his hand is writing. His mind is split into two smaller minds, each + ignorant of the other, each busily liberating memory-prisoners from its + own block of cells in the gaol of the subconscious. The writing often + refers <!-- Page 12 --><span class="pagenum"><a name="page12"></a>[pg + 12]</span> to long-forgotten incidents, the experiment sometimes being of + real use in cases of lost memory.</p> + + <p>Dreams are dissociations in sleep, while the scenes conjured up by + crystal-gazing are only waking dreams, in which the dissociation is + caused by gazing at a bright surface and so tiring the brain centres, + whereupon impressions of past life emerge from the subconscious, to + surprise, not only the onlookers to whom they are related, but also the + gazer herself, who has long "forgotten them".</p> + + <p>It is childish to attach supernatural significance to either dreams or + crystal-gazing, both of which mirror, not the future, but only the past, + the subject's own past.</p> + + <p>It is noteworthy that women dream more frequently and vividly than + men. When a dreamer has few worries, he usually dreams but forgets his + dream on waking; when greatly worried, he often carries his problems to + bed with him, and recent "representative dreams" are merely unprofitable + overtime work done by the brain. Occasionally, dreams have a purely + physical basis as when palpitation becomes transformed in a dream into a + scene wherein a horse is struggling violently, or where an uncovered foot + originates a dream of polar-exploration; in this latter type the dream is + protective, in that it is an effort to side-track some irritation without + breaking sleep.</p> + + <p>Since Freud has traced a sex-basis in all our dreams, many worthy + people have been much worried about the things they see or do in dreams. + Let them remember that virtue is not an inability to conceive of + misconduct, so much as the determination to refrain from it, and it may + well be that the centres which so determinedly inhibit sexual or unsocial + thoughts in the day, are tired by the very vigour of their resistance, + and so in sleep allow the thoughts they have so stoutly opposed when + waking to slip by. The man who is long-suffering and slow to wrath when + awake, may <!-- Page 13 --><span class="pagenum"><a name="page13"></a>[pg + 13]</span> surely be excused if he murders a few of his tormentors during + sleep.</p> + + <p><b>Epileptiform Seizures</b> are convulsions due to causes other than + epilepsy, and only a doctor can tell if an attack be epileptic or not and + prescribe appropriate treatment. To give "patent" medicines for "fits", + to a man who may be suffering from lead poisoning or heart disease, is + criminal.</p> + + <p><b>Convulsions in Children</b> often occur before or after some other + ailment. Such children need careful training, but less than 10 per cent + of children who have convulsions become epileptic. Epilepsy should only + be suspected if the first attack occurs in a previously healthy child of + over two years of age. There are many possible causes for infantile + convulsions, and but one treatment; call in a doctor <i>at once</i>, and, + while waiting for him, put the child in a warm bath (not over 100° F.) in + a quiet, darkened room, and hold a sponge wrung out of hot water to the + throat at intervals of five minutes. Never give "soothing syrups" or + "teething powders".</p> + + <p>The "soothing" portion of such preparations is some essential oil, + like aniseed, caraway or dill, and there are often present strong drugs + unsuitable for children. According to the analyses made by the British + Medical Association, the following are the <i>essential</i> ingredients + of some well-known preparations for children:</p> + + <table width="50%" cellpadding="5" summary="ingredients"> + <tr><td class="t">Mrs. Winslow's Soothing Syrup.</td> + <td class="t">Potassium Bromide, Aniseed, and Syrup (sugar and water).</td></tr> + <tr><td class="t">Woodward's Gripe Water.</td> + <td class="t">Sodium Bicarbonate, Caraway, and Syrup.</td></tr> + <tr><td class="t">Atkinson and Barker's Royal Infant Preservative.</td> + <td class="t">Pot. and Magnesium Bicarbonate, several Oils, and Syrup.</td></tr> + <tr><td class="t">Mrs. Johnson's American Soothing Syrup.</td> + <td class="t">Spirits of Salt, Common Salt, and Honey.</td></tr> + </table> + +<!-- Page 14 --><span class="pagenum"><a name="page14"></a>[pg 14]</span> + + <p><b>Convulsions During Pregnancy.</b> Send for a doctor instantly.</p> + + <p><b>Feigned Epilepsy</b> is an all-too-common "ailment". The false fit, + as a rule, is very much overdone. The face is red from exertion instead + of livid from heart and lung embarrassment, the spasms are too vigorous + but not jerky enough, the skin is hot and dry instead of hot and clammy, + the hands may be clenched, but the thumb will be <i>outside</i> instead + of <i>inside</i> the palm, foam comes in volumes but is unmixed with + blood, and the whole thing is kept up far too long. Almost before a crowd + can gather an epileptic seizure is over, whereas the sham sufferer does + not begin seriously to exhibit his questionable talents until a crowd has + appeared.</p> + + <p>Pressure on the eye, which will blink while the "sufferer" will swear; + bending back the thumb and pressing in the end of the nail, when the hand + will be withdrawn in feigned but not in true epilepsy; blowing snuff up + the nose, which induces sneezing in the sham fit alone, or using a cold + douche will all expose the miserable trick.</p> + + <p>It is, unfortunately, far easier to suggest than to apply these tests, + for anyone foolish enough to try experiments within reach of the + wildly-waving arms will probably get such a buffet as will damp his + ardour for amateur diagnosis for some time.</p> + +<!-- Page 15 --><span class="pagenum"><a name="page15"></a>[pg 15]</span> + +<hr /> + +<p class="center">CHAPTER III</p> + +<h3>GENERAL REMARKS</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Do not muse at me, my most worthy friends;</p> + <p>I have a strange infirmity, which is nothing</p> + <p>To those that know me."</p> + <p class="i16"> "Macbeth," Act III.</p> + </div> + </div> + + <p>Starr's table shows that combinations of all types of epilepsy are + possible, and that mental epilepsy is rare:</p> + + <table summary="statistics of epilepsy"> + <tr><td>Grand mal</td><td class="r">1150</td></tr> + <tr><td>Grand and petit mal</td><td class="r">589</td></tr> + <tr><td>Petit mal</td><td class="r">179</td></tr> + <tr><td>Jacksonian</td><td class="r">37</td></tr> + <tr><td>Mental</td><td class="r">16</td></tr> + <tr><td>Grand mal and Jacksonian</td><td class="r">10</td></tr> + <tr><td>Grand mal, petit mal and Jacksonian</td><td class="r">8</td></tr> + <tr><td>Grand mal and mental</td><td class="r">3</td></tr> + <tr><td>Grand mal, petit mal and mental</td><td class="r">6</td></tr> + <tr><td>Petit mal and mental</td><td class="r">2</td></tr> + <tr><td>Fits by day only</td><td class="r">660</td></tr> + <tr><td>Fits day and night</td><td class="r">880</td></tr> + <tr><td>Fits by night only</td><td class="r">380</td></tr> + </table> + + <p>The majority of victims have attacks both by day and by night. Of + 115,000 seizures tabulated by Clark, 55,000 occurred during the day (6 + a.m. to 6 p.m.) and 60,000 by night.</p> + + <p>The <i>usual course</i> of a case of epilepsy is somewhat as follows: + the disease begins in childhood, the first convulsion, about the age of + three, being followed some twelve months later by a second, and this + again by a third within a few months. Then attacks occur more frequently + until a regular periodicity—from one a day to one a year—is + reached after about five years, and this frequently persists throughout + life.</p> + +<!-- Page 16 --><span class="pagenum"><a name="page16"></a>[pg 16]</span> + + <p>The effect of epilepsy on the general health is not serious, but it + has a more serious effect on the mind, for epileptic children cannot go + to school (though special schools are now doing something towards + removing this serious disability), and grow up with an imperfect mental + training. They become moody, fretful, ill-tempered, unmanageable, and at + puberty fall victims to self-abuse, which helps to lead to neurasthenia. + Then they may drift slowly into a state of mental weakness, and often + require as much care as imbeciles. If the fits are severe from an early + age, arrest of mental development and imbecility follow. If the disease + be very mild in character, and especially if it be <i>petit mal</i>, the + victim may be very precocious, get "pushed" at school, and later become + eccentric or insane.</p> + + <p>Adult victims necessarily lead a semi-invalid life, often cut off from + wholesome work and from the pleasures of life, and become hypersensitive, + timid, impulsive, forgetful, irritable, incapable of concentration, + suspicious, show evidences of a weakened mind, have few interests, and + are difficult to manage.</p> + + <p>About 10 per cent—the very severe cases—go on to insanity; + either temporary attacks of mania, calling for restraint, or permanent + epileptic dementia with progressive loss of mind. Some victims are + accidentally killed in, or die as a result of a fit; about 25 per + cent—severe cases again—die in <i>status epilepticus</i>, but + the majority after being sufferers throughout life are finally carried + off by some other disease.</p> + + <p>There are many exceptions to this general course. Some patients have + attacks very infrequently, and are possessed of brilliant talent, though + apt to be eccentric. Others may have a number of seizures in youth, and + then "outgrow" the complaint.</p> + + <p>A few victims are attacked only after excessive alcoholic or sexual + indulgence, some women only during <!-- Page 17 --><span + class="pagenum"><a name="page17"></a>[pg 17]</span> their menses, while + other women are free from attacks during pregnancy, which state, however + (contrary to popular belief), commonly aggravates the trouble. Victims + may be free from attacks during the duration of, and for some time after, + an infectious disease; while Spratling says that a consumptive epileptic + may have no fits for months, or even years.</p> + + <p>Some epileptics are normal in appearance, but many show signs of + degeneration. This is common in the insane, but less frequent and + pronounced in neurasthenics. An abnormal shape of the head or curvature + of the skull, a high, arched palate, peculiarly-shaped ears, unusually + large hands and feet, irregular teeth from narrow jaws, a small mouth, + unequal length and size of the limbs, a projecting occiput, and poor + physical development may be noted.</p> + + <p>These are most pronounced in intractable cases, in whom mental + peculiarities are most frequently seen—either dullness, stupidity + and ungovernable temper, or very marked talent in one direction with as + marked an incapacity in others. In all epileptics, the pupils of the eye + are larger than normal, and, after contracting to bright light soon + enlarge again.</p> + + <p>The facial expression of most epileptics indicates abnormal mentality. + When the seizures have been so frequent and severe as to cause mental + decay, the actions are awkward, and the gait slouching and irregular. + Progressive poor memory is one of the first signs of intellectual damage + consequent upon severe epilepsy.</p> + + <p>Though the disease may occur at any age, most cases occur before the + age of twenty, there being good reason to look for other causes (often + syphilis) in cases which occur after that age. Of 1,450 of Gowers' cases, + 30 per cent commenced before the age of ten; 75 per cent before twenty. + In Starr's 2,000 cases, 68 per cent commenced before the patient was + twenty-one.</p> + +<!-- Page 18 --><span class="pagenum"><a name="page18"></a>[pg 18]</span> + + <p>According to Turner, the first epoch is from birth to the age of six, + during which 25 per cent of all cases commence, usually associated with + mental backwardness, and some due to organic brain trouble. The second + epoch is ten to twenty-two, the time of puberty and adolescence, during + which time no less than 54 per cent of all cases commence. This is, + <i>par excellence</i>, the age of onset of genuine epilepsy, the mean age + of maximum onset being fourteen in men and sixteen in women. The + remaining 21 per cent of cases occur after the age of twenty-two.</p> + + <p>In 430 cases of epilepsy in children, Osler found that 230 were + attacked before they reached the age of five, 100 between five and ten, + and 100 between ten and fifteen.</p> + + <p>Epilepsy, then, is a disease of early youth, coming on when the + development and growth of the nervous and reproductive systems is taking + place. During this period, causes, insignificant for stable people, may + light up the disease in those of unstable, nervous constitution, a fact + which explains the importance of training the child.</p> + + <p>Both sexes are attacked. If we consider only cases of true idiopathic + epilepsy female patients are probably in excess, but in epilepsy in + adults, from all causes, males predominate. In females, the menopause may + arrest the disease.</p> + + <p>In days gone by, epilepsy more rarely commenced after the age of + twenty, but in these days of nerve stress it commences more frequently + than formerly in people of mature age. A victim who has a fit for the + first time after the age of twenty, however, should consult a nerve + specialist immediately.</p> + + <p>In its early stages there are no changes of the brain due to, or the + cause of, epilepsy, but in long-standing, severe cases, well-marked, + morbid changes may be found. These are the effects, not the cause, of the + <!-- Page 19 --><span class="pagenum"><a name="page19"></a>[pg 19]</span> + disease, and they vary in intensity according to the manner of death and + the length and severity of the malady. They probably cause the mental + decay and slouching gait mentioned before.</p> + + <p>Fits may suddenly cease for a long time, but they usually recur, and + most patients have them more or less regularly through life.</p> + + <p>The fact that recovery is rare should not be hidden from patients and + friends. Perhaps 8 per cent of all classes recover—and "recovery" + may only be a long interval—but 4 per cent of these are Jacksonian, + syphilitic or accident cases. Only one victim in every thirty recovers + from true epilepsy; and these are very mild cases, in which the fits are + infrequent, there is no mental impairment, and bromides are well borne. + The earlier the onset, the more severe and frequent the attacks, the + deeper the coma, and the worse the mental decay, the poorer the + outlook.</p> + + <p><i>Cure is exceptional</i>, but by vigorous treatment the severity of + the malady may be much abated. <i>Petit mal</i> is no more hopeful than + <i>grand mal</i>; less so in cases with severe giddiness; in all cases, + the better the physical condition and digestive powers of the patient, + the brighter the outlook.</p> + + <p>To sum up, epilepsy is a chronic abnormality of the higher nervous + system, characterized by periodic attacks of alteration of consciousness, + often accompanied by spasms of varying violence, affecting primarily the + brain and secondarily the body, based on an abnormal readiness for action + of the motor cells, occurring in persons with congenital nerve weakness, + and leading to mental decay of various types and degrees of severity.</p> + +<!-- Page 20 --><span class="pagenum"><a name="page20"></a>[pg 20]</span> + +<hr /> + +<p class="center">CHAPTER IV</p> + +<h3>CAUSES OF EPILEPSY</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Find out the cause of this effect,</p> + <p>Or rather say, the cause of this defect,</p> + <p>For this effect defective comes by cause."</p> + <p class="i16">"Hamlet," Act II.</p> + </div> + </div> + +<p class="center">THE MECHANISM OF THE FIT</p> + + <p>The brain consists of cells of <i>grey matter</i>, grouped together to + form centres for thought, action or sensation, and <i>white matter</i>, + consisting of nerve strands, which act as lines of communication between + different parts of brain and body. The wrinkled surface (<i>cortex</i>) + of the brain, is covered with grey matter, which dips into the fissures. + There are also islands of grey matter embedded in the white.</p> + + <p>The front part of the brain is supposed, with some probability, to be + the seat of intelligence, while a ribbon three inches wide stretched over + the head from ear to ear would roughly cover the Rolandic area, in which + are contained the <i>motor cells</i> through which impulse is translated + to action. These motor cells are controlled by <i>inhibitory cells</i>, + which act as brakes and release nerve energy in a gentle stream; + otherwise our movements would be convulsive in their violence, and life + would be impossible through inability usefully to direct our energy.</p> + + <p>That is how inhibition acts physically; mentally it is the power to + restrain impulses until reason has suggested the wisest course.</p> + +<!-- Page 21 --><span class="pagenum"><a name="page21"></a>[pg 21]</span> + + <p>Irritation of the cortex, especially the motor area, causes + convulsions, and experiment has shown that epilepsy may be due to a + disease or instability of certain inhibitory cells of the cortex. The + motor cells of epileptics are restrained, with some difficulty, by these + cells in normal times. When irritation from any cause throws additional + strain on the motor cells, the defective brakes fail, and the + uncontrolled energy, instead of flowing in a gentle stream through the + usual channels, bursts forth in a tidal wave through other areas of the + brain, causes unconsciousness, and exhausts itself in those violent + convulsions of the limbs which we term a fit.</p> + + <p><b>The Primary Cause</b> of epilepsy is an inherent instability of the + nervous system.</p> + + <p><b>Secondary Causes</b> are factors which cause the first fit in a + person with predisposing nervous instability; later, the brain gets the + <i>fit habit</i>, and attacks recur independently of the secondary cause. + In most cases no secondary causes can be discovered, and the disease is + then termed <i>idiopathic</i>, for want of an explanation.</p> + + <p>Injuries to the brain may cause epilepsy, and many cases date from + birth, a difficult labour having caused a minute injury to the brain.</p> + + <p>Some accident is often wrongly alleged as the cause of fits, for most + victims come of a bad stock, and when the first fit occurs, their + relatives recollect an injury or a fright in the past, which is said to + be the cause.</p> + + <p>Great fright may cause epilepsy, as in the case of a nervous girl + whose brother entered her room, covered with a sheet, as a "ghost", a + "joke" that was followed by a fit within an hour.</p> + + <p>Sunstroke may cause fits, and a few cases follow infectious + diseases.</p> + + <p>Alcoholism is a strong secondary factor, fits often <!-- Page 22 + --><span class="pagenum"><a name="page22"></a>[pg 22]</span> occurring + during a drinking-bout and in topers, but in many cases, drunkenness, + instead of being the cause, is only the result of a lack of self-control + following epilepsy.</p> + + <p>Pregnancy may be a secondary cause of the malady: it may lead to more + frequent and severe seizures in women who are already victims; bring on a + recurrence of the malady after it has apparently been cured; or, very + rarely, induce a temporary or permanent cure.</p> + + <p>Epilepsy may be due to abortives. These drugs wreck the constitution + of the undesired children, who contract epilepsy from causes which would + not so have affected them had they started fairly. In many families, the + first child, who was wanted, is normal; some or all the others, who were + not desired and on whom attempts were probably made to prevent birth, are + neuropaths, as are many illegitimate children. It cannot too emphatically + be stated that there is no drug known which will procure abortion without + putting the woman's life in so grave a danger as to prevent medical men + using it; legal abortion is always procured surgically. Dealing in + abortifacients would be a capital offence under the laws of a rational + community.</p> + + <p>Self-abuse may perhaps play some part in epilepsy commencing or + recurring after the age of ten.</p> + + <p>The onset of menstruation often coincides with the onset of epilepsy, + and in some cases irregularity of the menses seems to be a secondary or + exciting cause.</p> + + <p><b>Exciting Causes</b> aggravate the trouble when present, causing + more frequent and severe seizures. The chief are irritation of stomach + and bowels (from decaying teeth, unchewed, unsuitable, or indigestible + food, constipation, or diarrhœa), exhaustion, work immediately after + a meal, passion or excitement, fright, <!-- Page 23 --><span + class="pagenum"><a name="page23"></a>[pg 23]</span> worry, mental work, + alcoholism, sexual excess, nasal growths, eye-strain; in short, anything + that irritates brain or body.</p> + + <p><b>Theories as to Cause</b>. Epilepsy is usually classed as a + <i>functional disorder</i>; that is, the brain cells are physically + normal, but, for some unknown reason, they act abnormally at certain + times. This term is a very loose one, and there is reason to believe that + the basis of epilepsy is some obscure disease of the brain which has not + been detected by present methods.</p> + + <p>The new school of psychologists regard the malady as a mental + <i>complex</i>—a system of ideas strongly influenced by the + emotions—the convulsions being but minor symptoms.</p> + + <p>Fits are most frequent between 9-10 p.m. the hours of deepest repose. + One school says this is due to anæmia of the brain during sleep. Clark + traces the cause to lessened inhibitory powers owing to the higher brain + centres being at rest, while Haig claims to have explained the high + incidence at this hour by the fact that uric acid is present in the + system in the greatest amount at this time.</p> + + <p>Some doctors have thought, on the contrary, that <i>excess</i> of + blood in the head was the cause, but results of treatment so directed did + not bear out the sanguine hopes built on the theory.</p> + + <p>The fact that convulsions occur in diabetes and alcoholism, suggested + that epilepsy was due to poisons circulating in the blood, and thus + irritating the brain. Every act uses up cell material and leaves waste + products, exactly as the production of steam uses up coal and leaves + ashes. Various waste products have been found in more than normal + quantities in the blood of epileptics, but it is uncertain whether + accumulation of waste products causes the seizure.</p> + + <p>A convincing theory must satisfactorily account for <!-- Page 24 + --><span class="pagenum"><a name="page24"></a>[pg 24]</span> all the + widely diverse phenomena seen in epilepsy, and the problem must remain + largely a matter of speculation, until research work has given us a far + deeper insight into the biochemistry of both the brain cells, and the + germ-plasm than we have at present.</p> + +<!-- Page 25 --><span class="pagenum"><a name="page25"></a>[pg 25]</span> + +<hr /> + +<p class="center">CHAPTER V</p> + +<h3>PREVENTION OF ATTACKS</h3> + + <blockquote>In health matters, prevention is nine points of the + law.</blockquote> + + <p>Some patients are obsessed by a peculiar sensation (the "aura") just + before a fit. This warning takes many forms, the two most common being a + "sinking" or feeling of distress in the stomach, and giddiness. The + character of the aura is very variable—terror, excitement, + numbness, tingling, irritability, twitching, a feeling of something + passing up from the toes to the head, delusions of sight, smell, taste, + or hearing (ringing, or buzzing, etc.), palpitation, throbbing in the + head, an impulse to run or spin around—any of these may warn a + victim that a fit is at hand. Some patients "lose themselves" and make + curious mistakes in talking.</p> + + <p>The warning is nearly always the same each time with the same patient, + and is more common in mild than in severe cases. Rarely, the attack does + not go beyond this stage.</p> + + <p>When the patient becomes conscious of the aura he should sit in a + large chair, or lie down on the floor, well away from fire, and from + anything that can be capsized. He must never try to go upstairs to bed. + Some one should draw the blind, as light is irritating.</p> + + <p>If the warning lasts some minutes, the patient should carry with him, + a bottle of uncoated one-hundredth-grain tabloids of</p> + + <p><b>Nitroglycerin</b>, replacing the screw cap with a cork, so that + they can quickly be extracted. When the <!-- Page 26 --><span + class="pagenum"><a name="page26"></a>[pg 26]</span> warning occurs, + one—or two—should be taken, and the head bent forward. The + arteries are dilated, the blood-pressure thus lowered, and the attack + <i>may</i> be averted.</p> + + <p>The use of nitroglycerin is based on the theory that seizures are + caused by anæmia due to vasomotor constriction. Success is only + occasional, but this is so welcome as to justify the habitual use of the + method.</p> + + <p>If the aura be brief, buy a few "pearls" of <b>Amyl Nitrite</b>, crush + one in your handkerchief, and sniff the vapour. This has the same affect + as nitroglycerin, but the action occurs in 15 seconds and only persists 7 + minutes. A headache occasionally follows the use of these drugs, and they + should not be employed without professional advice.</p> + + <p>When the warning is felt in the hand or foot, a strap should be worn + round the ankle or wrist, and pulled tight when the aura commences. This + sometimes aborts a fit, as biting a finger in which the aura commences + may also do.</p> + + <p>If a victim feels unwell after a meal, he must never eat the next meal + at the usual time, simply because it <i>is</i> the usual time.</p> + + <p>Should a patient feel unwell between, say, dinner and tea, instead of + eating his tea he must empty his bowels by an enema, or croton oil (see + chemist), and his stomach by drinking a pint of warm water in which has + been stirred a tablespoonful of mustard powder and a teaspoonful of salt. + After vomiting, drink warm water.</p> + + <p><i>Never attempt to empty the stomach at the onset of a definite + aura</i>, for if the seizure occurs, the vomit will probably obstruct the + trachea, and suffocate the victim.</p> + + <p>After the stomach has been empty ten minutes, the patient should take + a double dose of bromides (<a href="#page86">Chapter XIX</a>) and go to bed. Next morning he + will be well, <!-- Page 27 --><span class="pagenum"><a + name="page27"></a>[pg 27]</span> whereas if he eats but a single piece of + bread-and-butter he will probably have a fit within five minutes.</p> + + <p>Unfortunately, in 60 per cent of cases, there is no warning at all, + while in those cases which do exhibit an aura, the measures mentioned + above more often fail than succeed.</p> + +<!-- Page 28 --><span class="pagenum"><a name="page28"></a>[pg 28]</span> + +<hr /> + +<p class="center">CHAPTER VI</p> + +<h3>FIRST-AID TO VICTIMS</h3> + + <blockquote>"First-aid is the assistance which can be given in case of + emergency by those who, with certain easily acquired knowledge are in a + position, not only to relieve the sufferer, but also to prevent further + mischief being done pending the arrival of a + doctor."—Dickey.</blockquote> + + <p><i>Never try to cut short a fit</i>. Placing smelling-salts beneath + the nose, together with all other remedies for people who have "fainted", + are useless in epilepsy.</p> + + <p>Lay the patient on his back, with head slightly raised; admit air + freely; remove scarf or collar and tie, unfasten waistcoat, shirt, stays + or other tight garments, and if it be known or observed that the victim + wears artificial teeth, remove them.</p> + + <p>If five people are at hand, let two persons grasp each a leg of the + victim, holding it above the ankle and above the knee; two others should + each hold a hand and the shoulder; the fifth supports the head. Do not + kneel opposite the feet or you may receive a severe kick. Prevent the + limbs from striking the floor, but <i>allow them full play</i>. If the + victim rolls on his face gently turn him on his back.</p> + + <p>Roll a large handkerchief up <i>from the side</i> (not diagonally) and + holding one end firmly, tie a knot in the other end, and place it between + the teeth to protect the tongue; or slide the handle of a spoon or a + piece of smooth wood between the teeth, and thus hold the tongue down. + Soft articles like cork and indiarubber <!-- Page 29 --><span + class="pagenum"><a name="page29"></a>[pg 29]</span> should not be used, + for if they are bitten through, the rear portion will fall down the + throat and choke the victim.</p> + + <p>After the fit, lower the head to one side to clear any vomitus which, + if left, might be drawn into the windpipe, lift the patient on to a + couch, cover him warmly, and let him sleep. An epileptic's bed should be + placed on the ground floor; if his bed be upstairs, it is difficult to + get him there after an attack, while he may at any time fall downstairs + and be killed.</p> + + <p>Any effort to rouse him will only make the post-epileptic stupor more + severe, but whether he sleeps or not, he must carefully be watched, for + patients in this state are apt to slip away, often half-clothed, and + travel towards nowhere in particular at a wonderfully rapid rate.</p> + + <p>If several fits follow one another, or if one is very long or severe, + send for a doctor.</p> + + <p>When a seizure occurs in public, a constable should be summoned, who, + being a "St. John" man, will be of far more use than bystanders brimming + over with sympathy—<i>and ignorance</i>. If some kindly householder + near by will allow the victim to sleep for an hour or two—a boon + usually denied more from fear of recurrence than lack of sympathy, it is + better than taking him home. If not, let someone call a cab, and deliver + the victim safely to his friends.</p> + + <p>Every epileptic should carry always with him a card stating his full + name and address, with a request that some one present at any seizure + will escort him home.</p> + + <p>If the victim wakes with a headache, give him a 10-grain + <b>Aspirin</b> powder, or a 5-grain <b>Phenalgin</b> tablet; <i>never + patent "cures"</i>.</p> + + <p>If possible, the patient should lie abed the day after a fit, + undisturbed, taking only soda-and-milk and eggs beaten up in <i>hot</i> + milk.</p> + +<!-- Page 30 --><span class="pagenum"><a name="page30"></a>[pg 30]</span> + +<hr /> + +<p class="center">CHAPTER VII</p> + +<h3>NEURASTHENIA</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Some of your hurts you have cured,</p> + <p class="i2">And the worst you still have survived;</p> + <p>But what torments of mind you endured</p> + <p class="i2">From evils which never arrived."</p> + <p class="i16">—Lowell.</p> + </div> + </div> + + <p>To-day, the need to eat forces even sensible men to live—and + die—at a feverish rate. In bygone days the world was a peaceful + place, in which our forefathers were denied the chance of combining + exercise with amusement dodging murderous taxis; knew not the blessings + of "Bile Beans", nor the biliousness they blessed either; they did not + fall victims to "advert-diseases"; and they left the waters beneath to + the fishes, and the skies above to the birds.</p> + + <p>Withal they were sound trenchermen, who called their few ailments + "humours" or "vapours" and knew what peace of mind meant. Sixty years ago + there was one lunatic in every six hundred people; to-day there is one in + every two hundred.</p> + + <p>At the same time, the "neurasthenic temperament" is not altogether a + modern product, for Plato described it with great precision, and declared + such people to be "undesirable citizens" for his ideal republic.</p> + + <p>Neurasthenia is due to exhaustion and poisoning of the nervous system, + the chief symptoms of which is persistent <i>neuro-muscular fatigue with + general irritability</i>. Its minor symptoms are almost as numerous as + the various activities possible in mind and body.</p> + +<!-- Page 31 --><span class="pagenum"><a name="page31"></a>[pg 31]</span> + + <p><b>The Predisposing Cause</b> of neurasthenia is inherited nervous + instability, but among nervous diseases, neurasthenia seems the least + dependent on heredity, this factor playing a less important part than</p> + + <p><b>Exciting Causes</b> which are the sparks that fire explosive trains + laid by the living, and often by the dead.</p> + + <div class="noflo"> + <div class="nofblk"> + <p>Worry in any form (especially when accompanied by excess of brain-work),</p> + <p>Accident-shock,</p> + <p>Sexual abuse,</p> + <p>Abuse of drink, drugs or tobacco,</p> + <p>Lack of exercise,</p> + <p>Exhausting diseases,</p> + <p>Menopause, and diseases of the womb,</p> + <p>"Society life",</p> + <p>Retirement,</p> + </div> + </div> + + <p>are the commonest exciting causes of neurasthenia; hard brain-work, + unless accompanied by worry, not being injurious.</p> + + <p>The disease is more common in men than women (because of the more + active part played by them in the struggle for existence), in cities than + in the country, in mental than in manual workers, in the "idle rich", and + in races which live feverishly, like the Americans. It is rare in old + age.</p> + + <p>Ambition, the race for "success", the struggle to carry out projects + beyond the reasonable capacity of one man, and the ceaseless work and + worry with little sleep and no real rest which mark life to-day are + responsible for this disease.</p> + + <p>Competition has increased in all conditions of life; free course is + given to ambition, individuals impose on their brains a work beyond their + strength; and then comes care and perhaps reverse of fortune; and the + nervous system, under the wear and tear of incessant excitation, at last + becomes exhausted,</p> + +<!-- Page 32 --><span class="pagenum"><a name="page32"></a>[pg 32]</span> + + <p>The basic symptom is an inability to stand a normal amount of mental + or physical strain, and shows itself in seven marked ways:</p> + + <p>1. <b>Muscular Fatigue</b>, which is often most marked in the + morning. The patient rises reluctantly, feeling as if he had not slept, + is listless and "lazy", and can neither work nor play much without + getting unduly tired. This weariness may pass off as the day wears + on.</p> + + <p>2. <b>Backache</b> is often constant and annoying. It may be a pain, + or a general discomfort, and may be felt anywhere in the back, the nape + of the neck and down the spine being common places. The legs often "give + way", and, in severe cases, patients believe they cannot stand, and + become bed-ridden. Under sudden excitement they may walk again, becoming + "miracles of healing". These <i>spinal symptoms</i> are common in + neurasthenia following accident.</p> + + <p>3. <b>Headache</b> is more often an abnormal sensation than an + intense pain. Pulsations, feelings of distress, of lightness, fullness, + heaviness and pressure are common, or a band may seem to be drawn tightly + round the head across the forehead.</p> + + <p>The sensations are usually located in the back of the head, and may be + accompanied by dizziness, noises in the ears, or dimness of sight. There + may be a feeling of unsteadiness when walking, or a sense of being in + motion when at rest. The headache varies in intensity; it is worst in the + morning, is increased by thinking, diminished after eating, often + improves at night, and never keeps the patient awake.</p> + + <p>4. <b>Stomach and Bowel Disorders</b>. The victim is indifferent to + food, though dainties often tempt him, when he cannot face a square meal. + He has a feeling of general well-being after a meal, but within an hour + signs of imperfect digestion arise; he feels oppressed, and has + flatulence. Later, there are flushes of heat, palpitation, drowsiness, + and a craving for food. Constipation <!-- Page 33 --><span + class="pagenum"><a name="page33"></a>[pg 33]</span> is usually obstinate, + while diarrhœa may cause great weakness.</p> + + <p>5. <b>Sleeplessness</b>. Some patients go to sleep readily, but after + some instants wake suddenly, in a state of excitement that persists + despite their efforts to calm themselves, and only at an early hour in + the morning do they sleep again. Other patients go to bed with the + conviction they will not sleep, and are kept awake by incessant + cogitation, their minds being harassed by a rapid flow of images, ideas + and memories. In some cases the person is calm, his mind is at rest, yet + he cannot sleep.</p> + + <p>6. <b>Circulatory Disturbances</b>. More blood flows to an organ at + work than to one at rest. In health we do not notice these changes, but + in neurasthenia these internal tides are exaggerated as rushes of blood + to the head, flushings of various parts, and coldness of hands and + feet.</p> + + <p>Heart palpitation is alarming but not dangerous, and the distended + blood-vessels of the ears may set up vibrations in the drum, so that at + night when the head is on the pillow, every beat of the heart is heard as + a thump, which banishes sleep, and works the victim into a state of high + tension. A pain in the chest, arms and elbows is often felt, limbs may + swell (shown by the tightness of rings, collars, etc.) while the hands + and feet are usually moist and clammy. The patient may have to empty the + bladder every half-hour. Disorders of menstruation are common.</p> + + <p>7. <b>Mental Fatigue</b>. Hundreds of pages would be needed to + describe all the symptoms due to mental fatigue, the morbid belief that + the victim has a fatal disease being very common, though his "disease" + rarely makes him lie up; in the day he works, at night describes his + symptoms to the home circle.</p> + + <p>The inability of most men to apply themselves steadfastly to any one + set of ideas is seen in the immense <!-- Page 34 --><span + class="pagenum"><a name="page34"></a>[pg 34]</span> popularity of music + halls, cinemas, and short-story magazines, which offer a change of + interest every few minutes.</p> + + <p>In normal people there is a slight consciousness of mental processes, + but the mind rarely watches itself work; the neurasthenic is unable to + concentrate, and gets charged with inconstancy and shiftlessness.</p> + + <p>His ideas are restive, continuous thought is impossible, and when + talking he has to be "brought back to the point" many times. Memory and + attention flag, and he listens to a long conversation, or reads pages of + a book without grasping its import, and consequently he readily "forgets" + what in reality he never laboured to learn. Trembling of limbs is + common.</p> + + <p>He lacks initiative, and whatever course he is forced to + take—after much indecision—he is convinced, a moment later, + it would have been wiser to have taken the opposite one.</p> + + <p>All his acts are done inattentively. He goes to his room for + something, but has forgotten what when he gets there; later, he wonders + if he locked the drawer, and goes back to see. At night he gets up to + make sure he bolted the door, put out the gas, and damped the fire.</p> + + <p>Regret for the past, dissatisfaction with the present, and anxiety for + the future are plagues common to most people, but they become acute in a + neurasthenic, who reproaches himself with past shortcomings of no moment, + infuriates himself over to-day's trivialities, and frets himself over + evils yet unborn.</p> + + <p>Such a patient is often greatly upset by a trifle, yet little affected + by a real shock, which by its very severity arouses his reactive + faculties which lay dormant and left him at the mercy of the minor event. + He will fret over a farthing increase in the price of a loaf, but if his + bank fails he sets manfully to.</p> + +<!-- Page 35 --><span class="pagenum"><a name="page35"></a>[pg 35]</span> + + <p>Duty that should be done to-day he leaves to be shirked to-morrow; he + is easily discouraged, timid, and vacillating. Extremely self-conscious, + he thinks himself the observed of all observers. If others are + indifferent toward him, he is depressed; if interested, they have some + deep motive; if grave, he has annoyed them; if gay, they are laughing at + him; the truth, that they are minding their own business, never occurs to + him, and if it did, the thought that other people were <i>not</i> + interested in him, would only vex him.</p> + + <p>He is extremely irritable (slight noises make him start violently), + childishly unreasonable, wants to be left alone, rejects efforts to rouse + him, but is disappointed if such efforts be not made, broods, and fears + insanity. The true melancholic is convinced he himself is to blame for + his misery; it is a just punishment for some unpardonable sin, and there + is no hope for him in this world or the next. The neurasthenic, on the + contrary, ascribes his distress to every conceivable cause save his own + personal hygienic errors.</p> + + <p>A neurasthenic, if epileptic, fears a fit will occur at an untoward + moment. He dreads confined or, maybe, open spaces, or being in a crowd. + When he reaches an open space (after walking miles through tortuous + byways in an endeavour to avoid it) he becomes paralysed by an + undefinable fear, and stops, or gets near to the wall.</p> + + <p>He fears trains, theatres, churches, social gatherings, or the + office.</p> + + <p>Other victims fear knives, canals, firearms, gas, high places, and + railway tracks, when the basic fear is of suicide. Many patients have + sudden impulses—on which the attention is focussed with abnormal + intensity—to perform useless, eccentric, or even criminal actions; + to count objects, to touch lamp-posts, <!-- Page 36 --><span + class="pagenum"><a name="page36"></a>[pg 36]</span> to continually + reiterate certain words, and so on.</p> + + <p>The victim is fully aware that there are no grounds for his panic or + impulse, but though his reason ridicules, it cannot disperse, his fear, + and the wretched man finds relief in sleep alone, which adds to his woes + by being a coy lover.</p> + + <p>An almost invariable stage is that wherein the patient studies a + patent-medicine advertisement and finds that a disease, or collection of + diseases, is the root of his troubles. This alarms but interests him; he + studies other advertisements, sends for pamphlets, and so becomes + familiar with a few medical terms. He then takes a "treatment", and talks + of his "complaint" and how he "diagnosed" it. He has become + hypochondriac.</p> + + <p>He borrows a book on anatomy from the public library to discover in + what part of the body his ailment is located.</p> + + <p>He draws up (or copies) a special diet-sheet, and talks of "proteids", + notices a slight cloudiness in his urine, and underlines "The Uric-Acid + Diathesis" in one of his pamphlets. Then his heart bumps, he diagnoses + anew, and so goes on, usually ending by taking phosphorus for his "brain + fag". Then he finds he has a disease unknown to the faculty, which + discovery interests him as intensely as it irritates his unfortunate + friends.</p> + + <p>This prince of pessimists has a conviction that, compared with him, + Job was a happy man, and that he will go insane. He does not know that it + is only when there are flaws in the brain from inheritance or organic + disease that mental worry leads to lunacy; a sound brain never becomes + unhinged from intellectual stress alone.</p> + + <p>Books and friends are daily questioned about his "diseases", and in + spite of reassuring replies, he <!-- Page 37 --><span class="pagenum"><a + name="page37"></a>[pg 37]</span> continues to doubt, re-question and + cross-examine endlessly, feeding his hopes on the same assurances, + consoling himself with the same sympathies, and worrying himself with the + same fears.</p> + + <p>Other folk may be "nervy", he is seriously ill; he <i>knows</i> it + because he <i>feels</i> it. He expects the greatest consideration + himself, denies it to others, and then complains he is + "misunderstood".</p> + + <p>"Every symptom becomes magnified; the trifling ache or pain, the + trivial flatulence, the disinclination or mere hesitation of the bowels + to adhere to a strict schedule, all minor events such as occur to the + majority of healthy men from time to time unheeded, come to be of vast + importance to the psychasthenic individual."</p> + + <p>He keeps a record of hourly changes in his condition, and pesters his + family doctor to death. He goes from physician to physician, from + hospital to hospital. Having been induced by his friends to see a + specialist, he bores that good man—who knows him all too + well—with a minute description of his symptoms, presenting for + inspection carefully preserved prescriptions, urinary examination + records, differential blood counts, and the like. Coming away with + precious advice, he feels he omitted to describe all his symptoms, begins + to doubt if the specialist really understands <i>his</i> case, and so the + pitiful farce goes on—for years.</p> + + <p>The extraordinary fact is that while he is suffering (<i>sic</i>) from + cancer, or heart disease, or Bright's disease, and spasmodically from + minor affections like tuberculosis, arterio-sclerosis, and liver-fluke, + he is probably running a successful business. While making money he + forgets his ills; the moment his attention is diverted from the "root of + evil" he proceeds to further "diagnosis".</p> + + <p>In the end, he makes a pleasant hobby of his imaginary maladies, + trying each patent nostrum, and <!-- Page 38 --><span class="pagenum"><a + name="page38"></a>[pg 38]</span> giving herbalists, electric-belt men, + Christian Scientists, and dozens of other weird "specialists" a chance to + cure him.</p> + + <p><b>Sexual Neurasthenia</b> occurs chiefly in young men given to + self-abuse or sexual excesses. Erections and emissions are frequent, + first at night with amorous dreams, then in the day as a result of sexual + thoughts; weakness and pain in the back follow, and the sexual act may + become impossible. The patient usually studies a quack advertisement, and + passes into the hands of men who make a living by bleeding such wretches + dry. Cold baths and the treatment outlined in <a href="#page46">Chapter IX</a> will cure + him.</p> + + <p><b>Course and Outlook</b>. Neurasthenia is very curable. If the cause + be removed, and vigorous treatment instituted, the victim may be well in + a couple of months, but in most cases there are obstacles to radical + treatment, and the disease drags on indefinitely.</p> + + <p>Egoism, moral cowardice, and sexual excess play a part in much + neurasthenia, but relatives must not forget, in their indignation at + these laxities, that the patient really <i>is</i> ill; it is unkind, + unjust and useless to tell an ailing man the unpalatable truth that it is + his own fault.</p> + +<!-- Page 39 --><span class="pagenum"><a name="page39"></a>[pg 39]</span> + +<hr /> + +<p class="center">CHAPTER VIII</p> + +<h3>HYSTERIA</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Diseased nature oftentimes breaks forth</p> + <p>In strange eruptions; ..."</p> + <p class="i16">"King Henry IV."</p> + </div> + </div> + + <p>Hysteria, recorded in legend and law, in manuscript and marble, in + folk-lore and chronicle, right from history's dawn, is still a puzzle of + personality, and only equalled by syphilis in the protean nature of its + manifestations.</p> + + <p>The sacred books of the East said delayed menstruation due to a devil + was its cause; the thrashing-out of the devil its cure. Chinese legends + describe it, and its symptoms were ascribed by the Inquisition to + witchcraft and sorcery.</p> + + <p>Old Egyptian papyri tell how to dislodge the devil from the stomach, + and there were hysteria specialists in 450 B.C. All old theories fix on + the womb as the seat of the disease. The name hysteria is the Greek word + for womb, and 97 per cent of patients are women.</p> + + <p>A few of the very numerous modern theories may be noticed.</p> + + <p>The unconscious (or the subconscious) and the conscious are only parts + of one whole. Our "conscious" activities are those which have developed + late in the history of the race, and which develop comparatively late in + the history of the individual. The "conscious" is the product of the + racial education of the "unconscious"; the first is the man, the <!-- + Page 40 --><span class="pagenum"><a name="page40"></a>[pg 40]</span> + modern, the civilized; the last is the child, the primitive, the savage. + Between the two there is no gulf fixed, and the Oxford metaphysician need + not go to Timbuctoo to seek a superstitious savage; he may find one + within himself.</p> + + <p>In hysteria, Janet says, the field of consciousness is narrowed, and + the patient lives through subconscious experiences, which she forgets + when she again "comes to". She journeys back into the past, back a few + years individually, back centuries or æons racially, and becomes a savage + child again.</p> + + <p>Normally, when anything goes wrong, or we suffer from excessive + emotion, we give vent to our feelings by tears, abuse, anger, or + impulsive action; in some way we "hit back", and relieve ourselves of the + feeling of oppression. Then we forget, which heals the sore, and closes + the experience.</p> + + <p>If, at the moment, we bottle up our emotions, they obtrude later at + inconvenient times until we "get them off our mind" by confiding in some + one, when we get peace of mind. Open confession <i>is</i> good for the + soul, and it is better to "cry your eyes out" than to "eat your heart + out".</p> + + <p>There are some experiences, however, to which we cannot react by anger + or confidence, and so we imprison our emotions, and try to obtain peace + of mind by forgetting the irritation.</p> + + <p>Freud thinks perverted sex ideas are thus repressed, and cause + hysteria by coming into conflict with the normal sex life. If these old + sores can be laid bare by psycho-analysis, and the mental abscess drained + by confession and contrition, cure follows.</p> + + <p>The biologists consider hysteria as an adult childishness, a primitive + mode of dodging difficulties. Victims cannot live up to the complicated + emotional standard of modern life, and so act on a standard which to us + seems natural only in children and uncivilized races.</p> + +<!-- Page 41 --><span class="pagenum"><a name="page41"></a>[pg 41]</span> + + <p>Savill gives the following differences between neurasthenia and + hysteria:</p> + + <table cellpadding="5" summary="neurasthenia and hysteria"> + <tr><td></td><td>NEURASTHENIA</td><td>HYSTERIA</td></tr> + <tr><td class="t">Sex</td><td class="t">Both sexes equally.</td><td class="t">97 per cent females.</td></tr> + <tr><td class="t">Age</td><td class="t">Any age.</td><td class="t">First attack before page of 25.</td></tr> + <tr><td class="t">Mental peculiarities</td> + <td class="t">Intellectual weakness; bad memory and attention.</td> + <td class="t">Deficient will power, Want of control over emotions.</td></tr> + <tr><td class="t">Causes</td> + <td class="t">Overwork; dyspepsia; accident; nervous shock.</td> + <td class="t">Emotional upset or shock.</td></tr> + <tr><td class="t">Course</td> + <td class="t">Fairly even.</td> + <td class="t">Paroxysms. Vary from hour to hour.</td></tr> + <tr><td class="t">Mental Symptoms</td> + <td class="t">Mental exhaustion;unable to study; restless; sad; irritable; not equal to amusement. May be suicidal.</td> + <td class="t">Emotional; wayward; no self-analysis, living by rule or reading medical books; Fond of gaiety; sad and joyous by turns. Never suicidal.</td></tr> + <tr><td class="t">General Symptoms</td> + <td class="t">Occasional giddiness; fainting rare; convulsions; headache; backache; sleeplessness; no loss of feeling.</td> + <td class="t">Flushing; convulsions and fainting common; no symptoms between attacks; local anæsthesia or hyperæsthesia.</td></tr> + <tr><td class="t">Termination</td> + <td class="t">Lasts weeks or months.<br />CURABLE.</td> + <td class="t">Lasts lifetime in spasms.<br />TEMPORARILY CURABLE.</td></tr> + </table> + + <p>Hysteria is a disease of youth, usually ceasing at the climacteric. + Social, financial and domestic worries <!-- Page 42 --><span + class="pagenum"><a name="page42"></a>[pg 42]</span> are exciting causes, + a happy marriage often curing, and an unhappy one greatly aggravating the + complaint. It is most common among the races we usually deem "excitable", + the Slavs, Latin races and Jews, and is often associated with anæmia and + pelvic disorders.</p> + + <p><b>Symptoms</b>. Changeability of mood is striking. "All is caprice. + They love without measure those they will soon hate without reason."</p> + + <p>Sensationalism is manna to them. They <i>must</i> occupy the + limelight. Pains are magnified or manufactured to attract sympathy; they + pose as martyrs—refusing food at table, and eating sweets in their + room, or stealing down to the larder at night—to the same end. If + mild measures fail, then self-mutilation, half-hearted attempts at + suicide, and baseless accusations against others are brought into play to + focus attention on them.</p> + + <p>Minor attacks usually commence with palpitation and a "rising" in the + stomach or a lump in the throat, the <i>globus hystericus</i>, which the + patient tries to dislodge by repeated swallowing. This is followed by a + feeling of suffocation, the patient drags at her neck-band, throws + herself into a chair, pants for breath, calls for help, and is generally + in a state of great agitation. She may tear her hair, wring her hands, + laugh or weep immoderately, and finally swoon. The recovery is gradual, + is accompanied by eructations of gas, and a large quantity of pale, + limpid, urine may be passed later.</p> + + <p>Major attacks have attracted attention through all ages, ancient + statues showing the same poses as modern photographs. The beginning + stage—which may last a few moments or a few days—is one of + mental unrest, the victim being irritable and depressed. In some cases a + warning aura then occurs; clutchings at the throat, or the <i>globus + hystericus</i>, palpitation, dizziness, sounds in the ears, spots dancing + before the eyes, or <!-- Page 43 --><span class="pagenum"><a + name="page43"></a>[pg 43]</span> feelings of intense "<i>tightness</i>" + as if the skin is about to tear or the stomach to burst.</p> + + <p>The victim throws herself on a chair or couch, from which she slides + to the floor, apparently senseless, the head being thrown back, the arms + extended, the legs held straight and stiff. The face is that of a + dreamer, and the crucifix position is not uncommon. This stage is a + gigantic sexual stretch.</p> + + <p>Next comes the convulsive stage, but the convulsions are not the true + jerky movements of epilepsy, but are bilateral tossing, kicking, and + rolling movements, interspersed with various irregular passionate + attitudes. There is great alteration but <i>not loss</i> of + consciousness. The patient struggles with those about her, bites them, + but never her own tongue, shrieks and fights, but never passes urine, + throws things about, and arches the back until the body rests on head and + feet (<i>opisthotonos</i>). The stretching and convulsive stages + alternate, and the attack lasts a long time, being stopped by pain or by + the departure of onlookers. During this stage the face may reflect the + various emotions passing through the mind—with a fidelity that + would rouse the envy of an Irving.</p> + + <p>The patient gradually calms down, and a fit of tears or a scream ends + the attack, after which the worn-out victim is depressed but not + confused, though memory for the events of the attack may only be partial. + The patient sometimes passes into the "dream state", described in <a href="#page7">Chapter + II</a>, for some hours or occasionally for far longer; these are the women + described with much gusto in the local Press as being in a + trance—"the living dead".</p> + + <p>The victim of these attacks <i>is</i> suffering from a disease, for + she shows many temporary mental symptoms which could not possibly be + feigned, while there is often a genuine partial forgetfulness of the + incidents of an attack. She says she cannot help it; candid <!-- Page 44 + --><span class="pagenum"><a name="page44"></a>[pg 44]</span> friends say + she will not. The truth is that she cannot <i>will</i> not to help it; + for though intelligence and memory are often good and sometimes abnormal, + the judgment and will are always weak—indecision, obstinacy, and + doubt being common.</p> + + <p><b>Treatment</b>. A thorough examination by a doctor is <i>absolutely + essential</i>, to prove that the patient is merely hysterical, and not + the victim of unrecognized organic disease. In a few cases, skilled + attention to some minor ailment will result in an apparently miraculous + cure.</p> + + <p>Many who habitually "go into hysterics", are merely grown-up "spoiled + children", and in all cases, the basic factor is a lack of control and + self-discipline.</p> + + <p>Unfortunately, these tainted individuals who are so exquisitely + sensitive that any reproof brings floods of tears, turn with mercurial + rapidity from passionate fury to passionate self-reproach, and assuage by + impassioned protestations of affection the distress they have carelessly + inflicted, and, as a consequence of their momentary but undoubtedly + sincere contrition, escape blame and punishment.</p> + + <p>Harmful sympathy is thus substituted for helpful discipline, and the + more stable members of the family are often made slaves to the whims and + caprices of the hysterical member.</p> + + <p>The usual home treatment of the victim passes through various stages, + and lacks persistence. Violent methods are succeeded by studied + indifference; and that again by reproaches and recriminations.</p> + + <p>Greene's remarks are very pertinent: "The condition must be regarded + as an acquired psycho-neurosis to be ameliorated, and perhaps removed, by + suggestion and a complete control, which, though kind, is firm, + persistent, insistent, and <i>lacking in every element that enters into + the upbuilding of the hysterical temperament</i>."</p> + +<!-- Page 45 --><span class="pagenum"><a name="page45"></a>[pg 45]</span> +For anæmic patients, the following is a useful +prescription: + + <table summary="prescription for anæmics"> + <tr><td>R.</td></tr> + <tr><td>Quininæ valerianatis</td><td class="r">gr. xx</td></tr> + <tr><td>Ferri valerianatis</td><td class="r">gr. xx</td></tr> + <tr><td>Ammon. valerianatis</td><td class="r">gr. xx</td></tr> + <tr><td>Misce et fiant pilulæ no.</td><td class="r">xx</td></tr> + <tr><td colspan="2">Sig.: One or two three times a day, after + meals.</td></tr> + </table> + + <p>As far as the minor symptoms are concerned, the disease is usually + chronic, for as soon as one symptom has been overcome another takes its + place, and there is little hope of cure save when the case is taken + vigorously in hand in childhood, treatment being best given in a home or + hospital. Home treatment consists in an attempt to inculcate the lost or + never-acquired habit of self-control, and in the hygienic measures laid + down for neuropaths in general in the rest of this book.</p> + + <p>In a major attack, <i>show no sympathy</i>. Let every one leave the + room, save one attendant, whom the victim knows to be of firm character, + and calm but determined disposition. This attendant should get a jug of + water, and threaten to douche the victim unless she makes vigorous + efforts to control herself. If she cannot, or will not, <i>douche + her</i>, then hold a towel over her nose and mouth, and she will perforce + cease her gymnastics to breathe, though the attendant must be prepared + for an outburst of abuse when she has recovered her breath. Between + attacks, all who are brought into contact with the victim, must adopt a + tolerant but unsympathetic attitude, while efforts are made to inculcate + habits of control.</p> + +<!-- Page 46 --><span class="pagenum"><a name="page46"></a>[pg 46]</span> + +<hr /> + +<p class="center">CHAPTER IX</p> + +<h3>ADVICE TO NEUROPATHS</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Great temperance, open air,</p> + <p>Easy labour, little care."</p> + </div> + </div> + + <p>The above quotation epitomizes the cure for neurasthenia, for as + Huxley said:</p> + + <blockquote>"Our life, fortune, and happiness depend on our knowing + something of the rules of a game far more complicated than chess, which + has been played since Creation; every man, woman and child of us being + one of the players in a game of our own. The board is the world, the + pieces the phenomena of the universe, while the rules of the game are the + laws of nature. Though our opponent is hidden, we know his play is fair, + just and patient, but we also know to our sorrow that he never overlooks + a mistake or makes the slightest allowance for ignorance. To the man who + plays well, the highest stakes are paid with that overflowing generosity + with which the strong show their delight in strength. The one who plays + badly is checkmated; without haste, but without remorse. Ignorance is + visited as sharply a as wilful disobedience; incapacity meets with the + same punishment as crime."</blockquote> + + <p>In many cases some real trouble is the best medicine for a + neurasthenic, for though disaster may crush him, it is more likely to act + as a spur, by diverting his thoughts from his woes, and making him fight + instead of fret.</p> + +<!-- Page 47 --><span class="pagenum"><a name="page47"></a>[pg 47]</span> + + <p>Since such blessings in disguise cannot be booked to order, first see + a doctor. Though little be physically wrong, the sense of comfort and + relief from fear, which a clear idea of what <i>is</i> wrong brings, goes + a long way towards cure by giving the patient hope and confidence.</p> + + <p>Having seen the doctor, assist him by carrying out the following + advice as far as real limitations—not lazy + inclinations—permit. Do not say after reading this chapter, "I know + all that"; you have to <i>do</i> "all that", for medicine alone, whether + patent or prescribed, is useless.</p> + +<hr /> + + <p>Go for a long sea voyage, if possible.</p> + + <p>If not, get a long holiday in a quiet farmhouse, or, better still, get + to the country for good, be it in never so humble a capacity, for a + healthy cowman is happier than a neurasthenic clerk. The rural worker has + no theatres, but he can walk miles without meeting another; he has woods + to roam in, hills to climb, trees to muse under: he has ample light and + air, and his is a far happier lot than that of a vainglorious but + miserable, sedentary machine in a great city.</p> + + <p>The rural districts round Braemar, the Channel Islands, Cromer, Deal, + Droitwich, Scarborough, and Weston-super-Mare are, in general, suitable + holiday resorts for neuropaths.</p> + + <p>Avoid alcohol, tea, coffee, much meat, all excitement, anger and + <i>worry</i>. Take tickets only for comedy at the theatre, and leave + lectures, social gatherings and dances alone.</p> + + <p>Nerve-starvation needs generous feeding with easily digested food. + Drink milk in gradually increasing amounts up to half a gallon per day. + If more food is needed, add eggs, custard, fruit, spinach, chicken, or + fish, but do not forgo any milk. Avoid starchy foods and sweets.</p> + +<!-- Page 48 --><span class="pagenum"><a name="page48"></a>[pg 48]</span> + + <p>Eat only what you can digest, and digest all you eat. Chew every + mouthful a hundred times. This is one of the few sensible food fads.</p> + + <p>Drink water copiously between meals, and take no liquid (save the + milk) with them. Keep the bowels open.</p> + + <p>If you <i>must</i> "occupy your mind", take up some very simple, quiet + hobby. Gardening, fretwork, photography and gymnastics are not + necessarily quiet hobbies. Chess, billiards, and contortions with + gymnastic apparatus are not to be recommended.</p> + + <p>If you <i>must</i> read, peruse only humorous novels. Never study, and + leave exciting fiction and medical work alone. Symptoms are the most + misleading things in a most misleading world.</p> + + <p>After your evening meal, take a quiet walk, go to bed <i>and + sleep</i>. You should occasionally spend from Saturday midday to Monday + morning in bed, with blinds drawn, living on milk, seeing nobody and + doing <i>nothing</i>. The deepest degradation of the Sabbath is to fill + it with odd jobs which have accumulated through the week.</p> + + <p>Do not get out of bed too early in the morning, but rise in time to + eat your breakfast slowly, attend to the toilet, and catch the car + without haste. If your occupation be an indoor one, rise an hour earlier, + and walk or cycle quietly to work.</p> + + <p>Take a warm bath followed by a cold douche on rising. If no warm + after-glow follows, use tepid water. Keep your body warm; your head + cool.</p> + + <p>Be continent. Nerve-tone and sexual delights are not compatible. + Matrimony, while a convenient cloak, is no excuse for lust.</p> + + <p>Try suggestion for fears and impulses (see <a href="#page82">Chapter XVIII</a>), for it is + useless to try to "reason them out", though it is useful for a brief + period each day to try deliberately to turn the mind away from the + obsession, <!-- Page 49 --><span class="pagenum"><a name="page49"></a>[pg + 49]</span> by singing or whistling, gradually prolonging the + attempts.</p> + + <p>Rest, to prevent the manufacture of more waste products, the + elimination of those present, and the generation of nerve-strength from + nourishing food are the things that cure. <a href="#page86">Chapters XIX</a> and <a href="#page90">XX</a> deal with + the drug treatment.</p> + + <p><b>Do not Worry</b>. Whatever your trouble is, it is useless to</p> + + <blockquote>"Look before and after, and sigh for what is + not"</blockquote> + + <p>for the future cannot be rushed nor the past remedied. All patients + reply promptly that they "can't help" worrying, when in truth they do not + try.</p> + + <p>Work never hurt anyone, but harassing preoccupation with problems + which no amount of thought will solve drives many thousands to early + graves. Anger exhausts itself in a few minutes, fatigue in a few hours, + and real overwork with a week's rest, but worry grows ever worse. Ponder + Meredith's lines:</p> + + <div class="noflo"> + <div class="nofblk"> + <p>"I <i>will</i> endure; I will not strive to peep</p> + <p>Behind the barrier of the days to come."</p> + </div> + </div> + + <p>"Look on the bright side!" said an optimist to a melancholy + friend.</p> + + <p>"But there is no bright side."</p> + + <p>"Then polish up the dull one!" was the sound advice tendered.</p> + + <p><i>Learn to forget</i>!</p> + + <p>One cannot open a periodical without being exhorted to train one's + memory for a variety of reasons. The neuropath needs a system of + forgetfulness. Lethe is often a greater friend than Mnemosyne.</p> + + <p>To brood on disappointments, failures and griefs <!-- Page 50 --><span + class="pagenum"><a name="page50"></a>[pg 50]</span> only wastes energy, + sours temper, and upsets the general health. Resolve <i>beforehand</i> + that when unhappy ideas arise you will <i>not</i> dwell on them, but turn + your thoughts to pleasant trifles; take up a humorous book, or take a + turn in the fresh air, and you will soon acquire the habit of laughing + instead of whining at Fate.</p> + + <p>To sum up: Go slow! Your neurons have been exhausted in your foolish + attempt to "live this day as if thy last" in a wrong sense; feverish + activity and unnecessary work must be abandoned to enable the nerves to + recuperate.</p> + + <p>When the doctor says "rest", he means "<i>rest</i>", not change your + bustle from work to what you are pleased to regard as play.</p> + + <p>So much is <i>absolute rest</i> recognized as the foundation of + treatment, that severe cases undergo the "Weir-Mitchell Treatment". The + patient is <i>utterly secluded</i>; letters, reading, talking, smoking + and visits from friends are forbidden. He is put to bed, not allowed even + to sit up, sees no one save nurse and doctor, is massaged, treated + electrically, grossly overfed, fattened up, and freed from every + care.</p> + + <p>In leaving his habitual circle, the patient escapes the too-attentive + care of his relatives, and the incessant questions about his complaint + with which they overwhelm him. The results of this régime with + semi-insane wrecks are marvellous. It is a very drastic but very + successful "rest-cure", and while it cannot be undergone at home, + neurasthenics will benefit by following its principles as far as they can + in their own homes.</p> + + <p>High-frequency or static electricity sometimes works wonders in the + hands of a specialist, but the electric batteries, medical coils, + finger-rings and body-belts so persistently advertised are + <i>useless</i>.</p> + + <p>When the patient has in some measure recuperated, <!-- Page 51 + --><span class="pagenum"><a name="page51"></a>[pg 51]</span> he may try + the following exercises in mental concentration. Vittoz claims good + results from them, but they must be done quite seriously.</p> + + <blockquote>1. Walk a few steps with the definite idea that you are + putting forward right and left feet alternately. Go on by easy stages + until you concentrate on the movement of the whole body.</blockquote> + + <blockquote>2. Take any object in your hand, and note its exact form, + weight, colour, etc.</blockquote> + + <blockquote>3. Look in a shop-window while you count ten, and as you walk + on, try to recall all the objects therein exhibited.</blockquote> + + <blockquote>4. Accustom yourself to defining the sounds you hear, and + concentrating on a special one, as that of a passing tram, or a ticking + watch.</blockquote> + + <blockquote>5. Make a rapid examination several times daily of your + feelings and thoughts, and try to express them definitely.</blockquote> + + <blockquote>6. Concentrate on the mental reproduction of a regular curve: + a figure 8 placed on its side.</blockquote> + + <blockquote>7. Listen to a metronome, and, a friend having stopped it, + mentally repeat the ticking to time.</blockquote> + + <blockquote>8. Whenever you handle anything, try to retain the impression + of that object and its properties for several minutes, to the exclusion + of other ideas.</blockquote> + + <blockquote>9. Concentrate on ideas of calm, and of energy + controlled.</blockquote> + + <blockquote>10. Place three objects on a sheet of white paper. Remove + them one by one, at the same time effacing the impression of each one as + it is removed, until the mind, like the paper, is blank.</blockquote> + + <blockquote>11. Efface two of the objects, and retain the impression of + one only.</blockquote> + + <blockquote>12. Replace the impressions in your mind, but not the objects + on the paper, one by one.</blockquote> + + <p>The object of these exercises is to get your wandering <!-- Page 52 + --><span class="pagenum"><a name="page52"></a>[pg 52]</span> mind daily a + little more under control; do not exhaust yourself.</p> + + <p>After some months of treatment, ask yourself—</p> + + <p>Am I able to walk ten miles with ease? when introduced to a stranger + of either sex or any age, to converse agreeably, profitably and without + embarrassment? to entertain visitors so that all enjoy themselves? to + read essays or poetry with as much pleasure as a novel? to listen to a + lecture, and be able afterwards to rehearse the main points? to be good + company for myself on a rainy day? to submit to insult, injustice or + petulance with dignity and patience, and to answer them wisely and + calmly? When you are able to answer, "Yes!" to these queries, your nerves + are sound.</p> + +<!-- Page 53 --><span class="pagenum"><a name="page53"></a>[pg 53]</span> + +<hr /> + +<p class="center">CHAPTER X</p> + +<h3>FIRST STEPS TOWARDS HEALTH</h3> + + <blockquote>"All sick people want to get well, but rarely in the best + way. A 'jolly good fellow' said: 'Strike at the root of the disease, + Doctor!' And smash went the whisky bottle under the faithful physician's + cane."</blockquote> + + <p>In neuropaths, all irritation to the nervous system is dangerous, and + must be eliminated, and to this end, eyes, ears, nose and teeth, all in + close touch with nerves and brain, must be put and kept in perfect + order.</p> + + <p><b>The Eye</b>. Only 4 per cent, of people have <i>perfect</i> sight. + Errors in refraction—common in neuropaths—mean that the + unstable brain-cells are constantly irritated. Dodd corrected eye-errors + in 52 epileptics, 36 of whom showed improvement.</p> + + <p>You take your watch to a watchmaker, not a chemist; take your eyes to + an oculist, and if you cannot afford to see one privately, get an + eye-hospital note. (To allow a chemist or "optician" to try lenses until + he finds a pair through which you "see better" is very dangerous.)</p> + + <p>Then you go to a qualified optician, who makes a proper frame, and + inserts the lenses prescribed. Patients should inquire if the glasses are + to be worn continually, or only when doing close work or reading.</p> + + <p><b>The Ears</b>. Giddiness and other unpleasant symptoms may be due to + ear trouble. If there is any discharge, buzzing or ringing, see a doctor, + for if ear disease gains a firm hold it is usually incurable.</p> + +<!-- Page 54 --><span class="pagenum"><a name="page54"></a>[pg 54]</span> + + <p><b>The Nose</b>. Neuropaths often suffer from moist nasal catarrh, or + from a dry type in which crusts of offensive mucus form, the disagreeable + odour of which is not apparent to the patient himself. He must pay + careful attention to the general health, take nourishing food, and wash + out the nose three times a day with:</p> + + <div class="noflo"> + <div class="nofblk"> + <p>1 oz. Bicarbonate of Soda,</p> + <p>1 oz. Common Salt,</p> + <p>1 oz. Borax,</p> + <p>Dissolved in 1 pint hot water.</p> + </div> + </div> + + <p>For obstinate nasal trouble, consult an aural surgeon.</p> + + <p><b>The Teeth</b>.</p> + + <blockquote>"Most men dig their graves with their teeth."—Chinese + Proverb.</blockquote> + + <p>Serious ills are caused by defective teeth, for microbes decompose the + food left in the crevices to acid substances which dissolve the lime + salts from the teeth, and this process continues until the tooth is + lost.</p> + + <p>Faulty teeth are common in neuropaths, and at the risk of being + wearisome—and good advice is wearisome to people—patients + must get proper aid, privately or at a dental hospital, from a + <i>registered dentist</i>, who, like a doctor, does not advertise.</p> + + <p>Teeth gone beyond recall will be painlessly extracted, those going, + "stopped", and tartar or scale scraped off. If necessary, have artificial + teeth, but remember that the comfort of a plate depends upon skilled + workmanship, not on gold or platinum. Everyone should visit the dentist + as a matter of routine once a year.</p> + + <div class="noflo"> + <div class="nofblk"> + <p>Buy 3 ozs. Precipitated Chalk,</p> + <p>1 oz. Chlorate of Potash,</p> + </div> + </div> + +<!-- Page 55 --><span class="pagenum"><a name="page55"></a>[pg 55]</span> + + <p>and brush the teeth with this mixture ere going to bed; use tepid + water after meals. Do not brush across, but, holding the brush + horizontally, brush with a circular motion, cleaning top and bottom teeth + at once. Use a moderately hard brush with a curved surface which fits the + teeth.</p> + + <p>After each meal, it is essential to cleanse the interstices between + the teeth with a quill toothpick or dental floss, never with a pin, for + it is the decomposition of tiny particles that starts decay; <i>a tooth + never decays from within</i>.</p> + + <table summary="mouthwash"> + <tr><td class="r">1½ fl. oz.</td><td>Glycerine,</td></tr> + <tr><td class="r">1 fl. oz.</td><td>Carbolic Acid,</td></tr> + <tr><td class="r">½ fl. oz.</td><td>Methylated Chloroform.</td></tr> + </table> + + <p>With ten drops of this mixture in a wineglassful of tepid water, wash + out your mouth and gargle your throat after every meal, sending vigorous + waves between the teeth, and so removing any particles left by toothpick + and brush.</p> + + <p>Children should be taught these habits as soon as they can eat, for + the custom of a lifetime is easy.</p> + +<!-- Page 56 --><span class="pagenum"><a name="page56"></a>[pg 56]</span> + +<hr /> + +<p class="center">CHAPTER XI</p> + +<h3>DIGESTION</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"We may live without poetry, music and art;</p> + <p>We may live without conscience, and live without heart;</p> + <p>We may live without friends, we may live without books,</p> + <p>But civilized man cannot live without cooks."</p> + </div> + </div> + + <p>The human digestive system consists of a long tube, in which food is + received, nutriment taken from it as it passes slowly downwards, and from + which waste is discharged, in from sixteen to thirty hours + afterwards.</p> + + <p>Six glands pour saliva into the mouth, where it should be—but + how rarely is—mixed with the food, causing chemical changes, and + moistening the bolus to pass easily down.</p> + + <p>The acid <b>Gastric Juice</b>, of which a quart is secreted daily, + stops the action of the saliva, and commences to digest the proteins, + which pass through several stages, each a little more assimilable than + the last.</p> + + <p>The lower end of the stomach contracts regularly and violently, + churning the food with the juice, and gradually squirting it, when + liquified to <b>Chyme</b>, into the small intestine. If food is not + chewed until almost liquified, the gastric juice cannot act normally, but + has to attack as much of the surface of the food-lump as possible, + leaving the interior to decompose, causing dyspepsia and flatulence.</p> + + <p>Most people suppose the stomach finishes digestion, but it only + initiates the digestion of those foodstuffs which contain nitrogen, + leaving fats, starches and sugars untouched.</p> + +<!-- Page 57 --><span class="pagenum"><a name="page57"></a>[pg 57]</span> + + <p>By an obscure process, the acid chyme stimulates the walls of the + bowel to send a chemical messenger, a <b>Hormone</b> through the blood to + the liver and pancreas, warning them their help is needed, whereupon they + actively secrete their ferments.</p> + + <p>The secretion of the pancreas is very complex. It carries on the work + of the saliva, and also splits insoluble fats into a soluble milky + emulsion.</p> + + <p>Fats are unaffected in the mouth and stomach, which explains why hot, + buttered toast, and other hot, greasy dishes are so indigestible. The + butter on plain bread is quickly cleared off, and the bread attacked by + the gastric juice, but in toast or fatty dishes, the fat is intimately + mixed with other ingredients, none of which can properly be dealt with. + Always butter toast when cold.</p> + + <p>To continue: The secretion of the pancreas also contains a very active + ferment, which, on entering the bowel, meets and mixes with another + ferment four times as powerful as gastric juice, which completes the + digestion of the proteids.</p> + + <p>Meantime, the secretions of Lieberkühn's glands (of which there are + immense numbers in the small intestine) are further aiding the digestion + of the chyme, while the liver (the largest and most important gland in + the body) sends its ferments, and the gall-bladder its bile, which + further emulsifies the fatty acids and glycerin until they are ready to + be absorbed.</p> + + <p>The chemically-changed chyme is now termed <b>Chyle</b>, and is ready + to be absorbed by the minute, projecting <b>Villi</b>.</p> + + <p>The fatty portion of the chyle is absorbed by minute capillaries and + ultimately mingles with the blood, which may look quite milky after a + fatty meal.</p> + + <p>The remaining food is absorbed by the blood capillaries in the villi, + and passes to the liver for filtration and storage.</p> + +<!-- Page 58 --><span class="pagenum"><a name="page58"></a>[pg 58]</span> + + <p>The large bowel has Lieberkühn's glands, but not villi, and is + relatively unimportant, though most of the water the body needs is + absorbed from here.</p> + + <p>How food becomes energy and tissue we do not know. The tissues are + continually being built up from assimilated food, and as constantly being + burnt away, oxygen for this purpose being extracted from the air we + inhale, and carried via the blood to every corner of the body. The ashes + of this burning are expelled into the blood and lymph, and carried out of + the body by the kidneys, lungs, skin and bowels. The product of the + burning is the marvel—<b>Life</b>; the extinction of the fire is + the terror—<b>Death</b>.</p> + + <p>Energy is obtained almost solely from the combustion of fats and + sugars, proteids being reconverted into albumin, and then broken down to + obtain their carbon for combustion, the nitrogen being expelled, but + proteids are essential for the building of the tissues themselves, the + stones of the furnaces which burn up carbohydrates and fats.</p> + + <p>The time taken in the digestion of foods was first studied through a + wound in the stomach of St. Martin, a Canadian. Experiments were made + with various well-masticated foods, and with similar foods placed + unchewed, into the stomach through the wound, the latter experiment being + carried out by millions of people at every meal, by a slightly different + route.</p> + + <p>Boiled food is more easily digested than fried or roasted (the frying + pan should be anathema to a neuropath); lean meat than fat; fresh than + salt; hot meat than cold; full-grown than young animals, though the + latter are more tender; white flesh than red; while lean meat is made + less, and fat meat more digestible, by salting or broiling. Oily dishes, + hashes, stews, pastries and sweetmeats are hard to digest. Bread should + be stale, and toasted crisply <i>right through</i>. The time, compared + with the thoroughness <!-- Page 59 --><span class="pagenum"><a + name="page59"></a>[pg 59]</span> of digestion, is of little importance, + as it varies widely within physiologic bounds.</p> + + <p>Most people fancy that the more they eat the stronger they become, + whereas the digestion of all food beyond that actually needed to repair + the waste due to physical and mental effort consumes priceless nerve + energy, and weakens one. The greater part of excessive food has literally + to be <i>burnt away</i> by the body, which causes great strain, mainly on + the muscles. The question is not: "How much can I eat?" but: "How much do + I need?"</p> + +<!-- Page 60 --><span class="pagenum"><a name="page60"></a>[pg 60]</span> + +<hr /> + +<p class="center">CHAPTER XII</p> + +<h3>INDIGESTION</h3> + + <blockquote>"We know how dismal the world looks during a fit of + indigestion, and what a host of evils disappear as the abused stomach + regains its tone. Indigestion has lead to the loss of battles; it has + caused many crimes, and inspired much sulphurous theology, gloomy poetry + and bitter satire."—Hollander.</blockquote> + + <p>The nervous dyspeptic suffers no marked pain, but often feels a + "sinking", has no appetite, and cannot enjoy life because his stomach, + though sound, does not get enough nerve-force to run it properly.</p> + + <p>A great deal of nerve-force is required for digestion, and if a man + comes to the table exhausted, bolts his food, uses nerve-force scheming + while he is bolting, and, immediately he has bolted a given amount, + rushes off to work, digestion is imperfectly performed, nutriment is not + assimilated, the nerve-force supply becomes deficient. He continues to + overdraw his account in spite of the doctor's warning, and stomachic + bankruptcy occurs, followed by a host of ills.</p> + + <p>Nervous dyspepsia is a very obstinate complaint, but if tackled + resolutely, it can to a great extent be mitigated; but let it be + emphasized at once, that medicines, patent or otherwise, are useless. If + dyspepsia be aggravated by other complaints, these should receive + appropriate treatment, but the assertions so unblushingly made in + patent-pill advertisements are unfounded. The very variety of the + advertised remedies is proof of the uselessness of all.</p> + +<!-- Page 61 --><span class="pagenum"><a name="page61"></a>[pg 61]</span> + + <p>Set aside certain periods three times a day for meals. Fifteen minutes + before meal times, sit in a comfortable chair, relax all your muscles, + close the eyes, and try to make the mind a blank. <i>Rest</i>!</p> + + <p>Then eat the meal slowly and thoroughly. Conversation may lighten and + lengthen a meal, but avoid politics, "shop" and topics of that type. What + is wanted at table is wit, not wisdom.</p> + + <p>Water may be drunk with meals, provided it is drunk between eating, + and not while masticating, for it has decidedly beneficial effects upon + the digestive functions. Water is usually forbidden with meals because if + patients drink while eating, the water usurps the functions of saliva, + and moistens the bolus, which is then swallowed with little or no + mastication. If you cannot drink between mouthfuls, then drink only + between meals. <i>Never drink while food is in the mouth!</i></p> + + <p>After the meal, lie down on the right side for half an hour, + <i>resting</i>, and so directing all available nerve-energy to getting + digestion well under way.</p> + + <p>Indifferent appetites must be tempted by wholesome dishes made up in a + variety of enticing ways. Fats are good, but must be taken in a tasty + form. Eat fruit deluged with cream.</p> + + <p>The crux of digestion is to</p> + + <p>"<i>Chew</i>! CHEW!! and KEEP ON CHEWING!!!" for until food is + thoroughly masticated there will be no relief. The only part of the whole + digestive process placed under the control of consciousness is + mastication, and, paradoxically, it is the only part that consciousness + usually ignores.</p> + + <p>A healthy man never knows he has a stomach; a dyspeptic never knows he + has anything else, because he will not <i>eat</i> his food, but throws it + into his stomach as the average bachelor throws his belongings into a + trunk.</p> + +<!-- Page 62 --><span class="pagenum"><a name="page62"></a>[pg 62]</span> + + <p>A varied, tasty diet, thoroughly chewed and salivated, with rest + before and after meals, is the only means of curing dyspepsia, for no + medicine can supply and properly distribute nerve-energy.</p> + + <p>Digestive pills are all purgatives, with a bitter to increase + appetite, and occasionally a stomachic, bound together with syrup or + soap. Practically all contain aloes, and very rarely a minute quantity of + a digestive ferment like pepsin. Taken occasionally as purges, most + digestive pills would be useful, but none are suited to continuous use, + and the price is, as a rule, out of all proportion to the primary cost, + while one or two are, frankly, barefaced swindles.</p> + + <p>The analyses of the British Medical Association give the following as + the probable formulæ for some well-known preparations:</p> + + <table cellpadding="5" summary="Digestive pills"> + <tr><td class="t">Beecham's Pills</td><td class="t">Aloes; ginger.</td></tr> + <tr><td class="t">Holloway's Pills</td><td class="t">Aloes; ginger.</td></tr> + <tr><td class="t">Page Woodcock's</td> + <td class="t">Aloes; ginger; capsicum; cinnamon and oil of peppermint.</td></tr> + <tr><td class="t">Carter's Little Liver Pills</td> + <td class="t">Aloes; podophyllin; liquorice.</td></tr> + <tr><td class="t">Burgess' Lion Pills</td> + <td class="t">Aloes; ipecacuanha; rhubarb; jalap; peppermint.</td></tr> + <tr><td class="t">Cockle's Pills</td> + <td class="t">Aloes; colocynth; jalap.</td></tr> + <tr><td class="t">Barclay's Pills</td> + <td class="t">Aloes; colocynth; jalap.</td></tr> + <tr><td class="t">Whelpton's Pills</td> + <td class="t">Ginger; colocynth; gentian.</td></tr> + <tr><td class="t">Bile Beans</td> + <td class="t">Cascara; rhubarb; liquorice; peppermint.</td></tr> + <tr><td class="t">Cicfa</td> + <td class="t">Cascara; capsicum; pepsin; diastase; maltose.</td></tr> + </table> + +<!-- Page 63 --><span class="pagenum"><a name="page63"></a>[pg 63]</span> + +<hr /> + +<p class="center">CHAPTER XIII</p> + +<h3>DIETING</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Simple diet is best; many dishes bring many diseases,"</p> + <p class="i16">—Pliny.</p> + </div> + </div> + + <div class="noflo"> + <div class="nofblk"> + <p>"Alas! what things I dearly love—</p> + <p class="i2">puddings and preserves—</p> + <p>Are sure to rouse the vengeance of</p> + <p class="i2">All pneumogastric nerves!"</p> + <p class="i16">—Field.</p> + </div> + </div> + + <p>The man who pores over a book to discover the exact number of calories + (heat units) of carbohydrates, proteins and fats his body needs, means + well, but is wasting time.</p> + + <p>In theory it is excellent, for it should ensure maximum work-energy + with minimum use of digestive-energy, but in practice it breaks down + badly, a weakness to which theories are prone. One man divided four raw + eggs, an ounce of olive oil, and a pound of rice into three meals a day. + Theoretically, such a diet is ideal, and for a short time the + experimenter gained weight, but malnutrition and dyspepsia set in, and he + had to give up. The best diet-calculator is a normal appetite, and fancy + aids digestion more than a pair of scales.</p> + + <p>In spite of rabid veget- and other "arians", most foods are good + (making allowances for personal idiosyncrasy) if thoroughly masticated. + The oft-quoted analogy of the cow is incorrect, for herbivora <!-- Page + 64 --><span class="pagenum"><a name="page64"></a>[pg 64]</span> are able + to digest cellulose; but even cows masticate most laboriously.</p> + + <p>Meat juices are the most digestion-compelling substances in existence, + and a little meat soup, "Oxo" or "Bovril" is an excellent first + course.</p> + + <p>No one needs more than three meals per day, while millions thrive on + one or two only, which should be ready at fixed hours; for the stomach + when habituated becomes congested and secretes gastric juice at those + hours without the impulse of the will, is ready to digest food, and gets + that rest between-times which is essential to sound digestion. The man + who has snacks between meals, and chocolates and biscuits between snacks + can never hope to get well.</p> + + <p>To eat the largest meal at midday, as is the custom of working-men, is + best, provided one can take half an hour's rest afterwards.</p> + + <p>Drink a pint of tepid water half an hour before every meal. If the + stomach be very foul, add a teaspoonful of bicarbonate of soda to the + water.</p> + + <p>The question of alcohol is a vexed one, but Paul's "Take a little wine + for thy stomach's sake," is undoubtedly sound advice, though had Paul + been trained at a London hospital, he would have added "after meals". + Unfortunately, moderation is usually beyond the ability of the neuropath, + and consequently he should be forbidden to take alcohol at all. Spirits + must be avoided.</p> + + <p>Moderately strong, freshly made tea or coffee may be consumed in + reasonable quantity.</p> + + <p>Vegetable salads are excellent if compounded with liquids other than + vinegar or salad oil, and of ingredients other than cucumbers, radishes, + and the like.</p> + + <p>Take little starchy food and sweetmeats. It may surprise those with "a + sweet tooth" to learn that, to the end of the Middle Ages, sugar was used + only as <!-- Page 65 --><span class="pagenum"><a name="page65"></a>[pg + 65]</span> a medicine. Meat must be eaten—if at all—in the + very strictest moderation, and never more than once a day. Eggs, fish and + poultry—in moderation too—take its place.</p> + + <p>Healthy children need very little meat, while it is a moot point if + children of unstable, nervous build need any at all. The diet at homes + for epileptics is usually vegetarian, and gives excellent results.</p> + + <p>Never swallow skin, core, seeds or kernels of fruits, many of which, + excellent otherwise, are forbidden because of the irritation caused to + stomach and bowels by their seeds or skins.</p> + + <p>Bromides are said to give better results if salt is not taken. A + little may be used in cooking, if, as is usually the case, the patient + has to eat at the common table, but condiments are unnecessary and often + irritating to delicate stomachs.</p> + + <p>The diet of nervous dyspeptics must be very simple, and though it is + trying and monotonous to forgo harmful dainties in favour of wholesome + dishes, it is but one of the many limitations Nature inflicts on + neuropaths. Many an epileptic, after believing himself cured, has brought + on a severe attack by an imprudent meal. La Rochefoucauld says: + "Preserving the health by too strict a regimen is a wearisome malady", + but it is open to all men to choose whether they will endure the remedy + or the disease.</p> + + <p>Most men eat six times the minimum and twice the optimum quantity of + food per day. For every one who starves, hundreds gorge themselves to + death. "Food kills more than famine", and the poor, who eat sparsely from + necessity, suffer far less from gout, cancer, rheumatism and other + food-aggravated diseases than the rich.</p> + + <p>Most books give detailed lists of foods to be eaten and to be avoided, + but this we believe is productive of little good.</p> + +<!-- Page 66 --><span class="pagenum"><a name="page66"></a>[pg 66]</span> + + <p>Let the patient eat a mixed diet, well and suitably cooked, taking + what he fancies in reason, masticating everything thoroughly, and + gradually eliminating foods which experience teaches him are difficult + for him to digest.</p> + +<!-- Page 67 --><span class="pagenum"><a name="page67"></a>[pg 67]</span> + +<hr /> + +<p class="center">CHAPTER XIV</p> + +<h3>CONSTIPATION</h3> + + <blockquote>"Causing a symptom to disappear is seldom the cure of + any ill; the true course is to <i>prevent</i> the symptom."</blockquote> + + <p>Rings of muscle cause wormlike movements of the bowels, and so propel + forward food and waste. Weakening of these muscles or their nerve + controls from any cause, results in a "condition of the bowels in which + motions occur only when provoked by medicines or injections". In some + cases though motions occur freely, food ingested is retained too long in + the digestive tract.</p> + + <p>The blood extracts what water it needs from the fluid waste in the + large bowel, but when the weak muscles allow this to remain too long, an + excess of moisture is removed, leaving hard, dry masses, painful to + pass.</p> + + <p>When the fæces reach the anus, they cause an uneasy feeling, which + directs us to seek relief, but if we neglect this impulse the bowel may + become so insensitive that it ceases to warn its owner of the need to + evacuate. Meantime, the muscles which expel the fæces get weak, so that + every motion needs a strong effort of will, and much harmful + straining.</p> + + <p>Much misery is caused by false modesty in the presence of others. It + can never be immodest to attend to the calls of Nature, and such + hypersensitiveness is dangerous, for rupture, piles, fissure, prolapse, + fistula, are often due to straining.</p> + + <p>Lack of exercise weakens the intestinal and <!-- Page 68 --><span + class="pagenum"><a name="page68"></a>[pg 68]</span> abdominal muscles. + Unsuitable or imprudent foods or drinks, indigestion, excessive worry, + and anything that lowers the general health tend to produce + constipation.</p> + + <p>Bacteria flourish freely in fæces, and though it is doubtful whether + the "Auto-intoxication" so freely ascribed to them, is supported by + facts, it cannot be doubted that, whatever the precise mechanism by which + the effects are produced, constipation does result in a lowering of the + resistance to disease. More frequent fits, colic, foul breath, headache + right across the forehead, lost appetite, drowsiness, skin eruptions, + irritability, insomnia, melancholia and anæmia (especially the "green + sickness" of women, usually connected with menstrual irregularities) are + but a few of many ills partly or wholly due to or consequent upon + constipation.</p> + + <p>The symptoms of constipation of the small bowel are dry stools, + usually light in colour.</p> + + <p>To cure this type, more water should be drunk, so that the waste may + pass to the large bowel in a fluid state. Drink freely between meals, + especially in summer, when profuse perspiration often causes obstinate + constipation.</p> + + <p>The symptoms of constipation of the large bowel are furred tongue, + fœtid breath, sallow or jaundiced complexion, and mottled stools of + round, hard balls, the first portion being very firm, and the remainder + nearly liquid. There are occasional attacks of colic.</p> + + <p>The first step towards cure is to form regular habits. At a suitable + time, say shortly after breakfast, or after supper if you suffer from + hæmorrhoids, go to the lavatory, whether you feel uncomfortable or not. + Wait patiently, do not try to hasten matters by violent straining, and if + for some weeks there is little improvement, do not despair, for the + habits of a lifetime are not overcome in five minutes, just because <!-- + Page 69 --><span class="pagenum"><a name="page69"></a>[pg 69]</span> you + have decided to amend your careless ways. A short, brisk walk beforehand + often helps.</p> + + <p>If necessary, use a chamber and "squat" as savages do. In this + position, the thighs support the abdomen, and force is exerted without + straining. Massaging the abdomen by firmly rubbing it round and round, + clockwise, with the hand, often does good, as does pressure with a finger + on the flesh between the end of the backbone and the anus. Try every + method before taking purgatives, for with patience and determination + these are rarely necessary.</p> + + <p>Carefully cooked and "concentrated", easily digested and + "pre-digested" foods contain little residue; every meal should contain + some indigestible matter to stimulate the intestines. Brown bread, + porridge, lettuce, cress, apples and coarse vegetables are all good for + this purpose, but if taken too freely may cause heartburn and flatulence. + Meat, milk, fish, eggs and most patent foods have not enough waste. + Boiled milk is very constipating.</p> + + <p>Purgatives, injections and medicines, alone, are useless, for the + bowel becomes still more insensitive to natural calls under the + artificial stimulation of drugs, on which it becomes so entirely + dependent that without their aid it will not act.</p> + + <p>It may be necessary to clean out the bowel by an enema.</p> + + <p>Make a lather with clean warm water and plain soap, and fill the enema + syringe (a half-pint size is useful). Smear the nozzle with vaseline, + lean forward and insert into the anus, pointing a little to the left. + Press the bulb, withdraw the nozzle, retain the liquid a few moments and + a desire to go to stool will be felt.</p> + + <p>A simpler plan is to buy glycerin suppositories. One is inserted into + the anus and acts like an injection. It must be clearly understood that + these are emergency measures.</p> + +<!-- Page 70 --><span class="pagenum"><a name="page70"></a>[pg 70]</span> + + <p>If internal piles come down at stool, do not allow them to remain and + get engorged with blood. See that your hands are scrupulously clean, and + your nails closely cut and free from dirt; then moisten the middle finger + with a little vaseline taken to the lavatory for the purpose, and gently + return the hæmorrhoids, sitting down for a few minutes to retain + them.</p> + + <p>A mild purge may be taken once a week with advantage. Glauber's Salts + (Sodium Sulphate), Cascara Sagrada, and liquid paraffin are all good, + while Castor Oil Globules are suited for children.</p> + + <p>For flatulence, take a 10-minim capsule of Terebine after meals, or + charcoal, either as French Rusks ("Biscols Fraudin") or a teaspoonful of + powdered charcoal between meals. One drop of creosote on a lump of sugar, + peppermint water, and sal volatile may also be used. Sufferers should + toast bread, and use sugar sparingly.</p> + + <p>Patent medicines almost invariably contain a brisk aperient.</p> + +<!-- Page 71 --><span class="pagenum"><a name="page71"></a>[pg 71]</span> + +<hr /> + +<p class="center">CHAPTER XV</p> + +<h3>GENERAL HYGIENE</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Better to hunt in fields for health unbought,</p> + <p>Than fee the doctor for a nauseous draught."</p> + <p class="i16">—Dryden.</p> + </div> + </div> + + <p>If men but realized what complicated machines they were, they would + use themselves better. In the body are 240 bones and hundreds of muscles. + The heart, no bigger than the clenched fist, beats 100,000 times a day; + the aerating surface of the lungs is equal in area to the floors of a + six-roomed house, and by means of its minute blood-vessels which would + stretch across the Atlantic, 500 gallons of blood are brought into + contact with over 3,000 gallons of air every day.</p> + + <p>Seven million sweat-glands, 30 miles long, get rid of a pint of liquid + and an ounce of solid waste each day while it takes a tube 30 feet long, + with millions of glands, to deal with a sip of milk.</p> + + <p>Man's finest steam engine turns one-eighth of the energy supplied into + work; nature's engine, muscle, turns one-third into work. The body + contains 9 gallons of water, enough carbon to make 9,000 lead pencils, + phosphorus for 8,000 boxes of matches, iron for 5 tacks, and salt enough + to fill half a dozen salt-cellars.</p> + + <p>Over 40 food-ferments have been found in the liver; there are + 5,000,000 red and 30,000 white blood corpuscles in a space as big as a + pin's head, each one of which travels a mile a day and lives but a + fortnight, <!-- Page 72 --><span class="pagenum"><a name="page72"></a>[pg + 72]</span> millions of new ones being built up in the bone-marrow every + second; a flash of light lasting only one eight-millionth of a second, + will stimulate the eye, which can discriminate half a million tints. The + ear can distinguish 11,000 tones, and is so sensitive that we hear waves + of air less than one sixty-thousandth of an inch long; a mass of almost + liquid jelly—for 81 per cent of the brain is water, and Aristotle + thought it was a wet sponge to cool the hot heart—sends out + impulses ordering our every thought and act, and stores up memory, we + know not how or where.</p> + + <p>There are 10,000,000,000 of cells in the brain cortex alone, and + 560,000 fibres pass from the brain down the spinal cord.</p> + + <p>A clear, watery cell, no larger than the dot on an "i" encloses + factors causing genius or stupidity, honesty or roguery, pride or + humility, patience or impulsiveness, coldness or ardour, tallness or + shortness, form of head or hands, colour of eyes and hair, male or female + sex, and the thousand details that make a man.</p> + + <p>Yet man uses this marvellous mechanism but carelessly, and the + widespread poverty, the worry and discord in the lives of the happiest, + our ignorance, the evil habits we contract, and the vice, miseries, + diseases and labours to which most expectant mothers are too often + exposed, explain why one baby in every eight never walks; why but four of + them live to manhood; why less than 40 years is now man's average span; + and why this brief space is filled with suffering and misery, from which + many escape by self-destruction.</p> + + <p>Sound children do not come from unclean air, surroundings, habits, + pursuits, passions and parents. Children conceived in unsuitable + surroundings by unsuitable parents, die; must die; <!-- Page 73 --><span + class="pagenum"><a name="page73"></a>[pg 73]</span> ought to die. They + are not built for the stern battle of life.</p> + +<hr /> + + <div class="noflo"> + <div class="nofblk"> + <p>"Where the sun does not enter, the doctor does!"</p> + <p class="i16">—Italian proverb.</p> + </div> + </div> + + <p>Plenty of fresh, clean air is essential to health.</p> + + <p>In all rooms a block of wood nine inches high should be inserted + beneath the whole length of the bottom sash of the window. This leaves a + space between the top and bottom sashes through which fresh air passes + freely, without draught, both night and day, for it should never be + closed. A handy man will fit a simple device to prevent the windows being + forced at night, but better let in a burglar than keep out air.</p> + + <p>If it be cold or draughty in the bedroom, hang a sheet a foot from the + window, put more blankets or an overcoat on the bed, or put layers of + brown paper above the sheets, <i>but never close the window</i>.</p> + + <p>You can take too much of many good things, but never too much pure + air.</p> + + <p><b>Cleanliness</b>. Keep the body clean by taking at least one hot + bath per week; per day if possible. Much filth is excreted by your + sweat-pores; why let it cake on skin and underlinen, and silently silt up + your thirty miles of skin canals, thus overworking the other excretory + organs, and gradually poisoning yourself?</p> + + <p>Neuropaths always suffer from sluggish circulation of the extremities, + and to improve this, hot and cold baths, spinal douches and massage are + excellent. A hot bath (98-110° F.) ensures a thorough cleansing, but it + brings the blood to the surface, where its heat is quickly lost, + enervating one, and causing a bout of shivering which increases the + production of heat by <!-- Page 74 --><span class="pagenum"><a + name="page74"></a>[pg 74]</span> stimulating the heat-regulating centre + in the brain. Baths above 110° F. induce faintness. To prevent shivering, + take a cold douche after the hot bath, and have a brisk rub down with a + coarse towel, when a delightful, warm glow will result. Do not freeze + yourself, or the reaction will not occur; what is wanted is a short, + sharp shock, which sends the blood racing from the skin, to which it + returns in tingling pulsations, which brace up the whole system. The + douche is over in a few seconds, and may be enjoyed the year round, + commencing in late Spring.</p> + + <p>The cold bath must not be made a fetish. If the glow is not felt, give + it up, and bathe in tepid (85-92° F.) or warm (93-98° F.) water. When + started in the vigour of youth, the cold bath may often be continued + through life, but it is unwise to commence in middle life. Parents should + never force their children to take cold baths, to "harden them".</p> + + <p><b>Other Hygienic Points</b>. Tobacco is undesirable for neuropaths, + save in moderation.</p> + + <p>Clothes should be light, loose, and warm. Epileptics should wear low, + stiff collars, half a size too large, with clip ties. Such a combination + does not form a tight band round the neck, and can quickly be removed if + necessary. Wear thick, woollen socks, and square-toed, low-heeled, + double-soled boots. Hats should be large, light, and of soft material. + Woollen underwear is best. Change as often as possible, and aim at + health, not appearance.</p> + + <p>Let all rooms be well lighted, well ventilated, moderately heated, and + sparsely furnished with necessities. Shun draperies, have no window + boxes, cut climbing plants ruthlessly away from the windows, and never + obstruct chimneys.</p> + + <p>Buy Muller's "My System", which gives a course of physical exercises + without apparatus, which only take fifteen minutes a day. The patient + must conscientiously <!-- Page 75 --><span class="pagenum"><a + name="page75"></a>[pg 75]</span> perform the exercises each morning, not + for a week, nor for a month, but for an indefinite period, or throughout + life.</p> + + <p>Finally, remember that so few die a natural death from senile decay + because so few live a natural life.</p> + +<!-- Page 76 --><span class="pagenum"><a name="page76"></a>[pg 76]</span> + +<hr /> + +<p class="center">CHAPTER XVI</p> + +<h3>SLEEPLESSNESS</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"O magic sleep! O comfortable bird</p> + <p>That broodest o'er the troubled sea of the mind</p> + <p>Till it is hushed and smooth."</p> + <p class="i16">—Keats.</p> + </div> + </div> + + <p>Some men need only a few hours' sleep, but no one ever overslept + himself in natural slumber. There are anecdotes of great men taking + little sleep, but their power usually consisted in going without sleep + for some days when necessary, and making up for it in one long, deep + sleep. Neuropaths require from 10-13 hours to prepare the brain for the + stress of the next day, but quality is more important than quantity.</p> + + <p>Patients go to bed tired, but cannot sleep; fall asleep, and wake + every other hour the night through; sleep till the small hours, and then + wake, to get no more rest that night; only fall asleep when they should + be rising; or have their slumber disturbed by nightmare, terrifying + dreams, heart palpitation, and so on.</p> + + <p>Noise often prevents sleep. A clock that chimes the quarters, or a + watch that in the silence ticks with sledge-hammer beats, has invoked + many a malediction. Traffic and other intermittent noises are very + trying, as the victim waits for them to recur. Townsmen who seek rural + quiet have got so used to town clatter, that barking dogs, rippling + streams, lowing cows, rustling leaves, singing birds or chirruping + insects keep them awake. Too much light, eating a heavy supper, <!-- Page + 77 --><span class="pagenum"><a name="page77"></a>[pg 77]</span> all tend + to banish repose, as do also violent emotions which produce toxins, + torturing the brain and causing gruesome nightmares.</p> + + <p>Grief and worry—especially business and domestic + cares—constipation, indigestion, bad ventilation, stimulants, + excitement and a hearty supper are a few of the many causes of + insomnia.</p> + + <p>In children sleeplessness is often due to the bad habit of picking a + child up whenever it cries, usually from the pain of indigestion due to + having been given unsuitable food. Feed children properly, and train them + to regular retiring hours. School home-work may cause insomnia; if so, + forbid it.</p> + + <p>Man spends a third of his life in the bedroom, which should be + furnished and used for no other purpose. Pictures, drapery above or below + the bed, and wallpaper with weird designs in glaring colours are + undesirable. The wall should be distempered a quiet green or blue tint, + and the ceiling cream. A bedroom should never be made a storeroom for + odds and ends, nor is the space beneath the bed suitable for trunks; + least of all for a soiled-linen basket.</p> + + <p>Some time before retiring, excitement and mental work should be + avoided. The patient should take a quiet walk after supper, drink no + fluid, empty bladder and bowels, and take a hot foot-bath.</p> + + <p>Retire and rise punctually, for the brain, like most other organs, may + be trained to definite habits with patience.</p> + + <p>If sleeplessness be ascribed, rightly or wrongly, to an empty stomach, + a glass of hot milk and two plain biscuits should be taken in bed; + dyspeptics should take no food for three hours before retiring. If the + patient wakes in the early morning he may find a glass of milk (warmed on + a spirit-stove by the bedside) and a few plain biscuits of value.</p> + + <p>A victim of insomnia should lie on his side on a firm <!-- Page 78 + --><span class="pagenum"><a name="page78"></a>[pg 78]</span> bed with + warm, light coverings, open the window, close the door, and endeavour to + fix his attention on some monotonous idea; such as watching a flock of + white sheep jump a hedge. Think of trifles to avoid thinking of + troubles.</p> + + <p>How often do we hear people complain that they suffer from insomnia, + when in fact they get a reasonable amount of sleep, and indeed often keep + others awake by their snoring.</p> + + <p>When you wake, <i>get up</i>, for a second sleep does no good. When + some one, on seeing the narrow camp-bed in which Wellington slept, said: + "There is no room to turn about in it," the Iron Duke replied: "When a + man begins to turn about in his bed it is time he turned out of it."</p> + + <p>The only safe narcotic is a day's hard work. For severe insomnia + consult a doctor; do not take drugs—that way lies ruin. By taking + narcotics, or patent remedies containing powerful drugs, you will easily + get sleep—for a time only—and then fall a slave to the drug. + Such victims may be seen in dozens in any large asylum.</p> + +<!-- Page 79 --><span class="pagenum"><a name="page79"></a>[pg 79]</span> + +<hr /> + +<p class="center">CHAPTER XVII</p> + +<h3>THE EFFECTS OF IMAGINATION</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"The surest way to health, say what they will</p> + <p>Is never to suppose we shall be ill;</p> + <p>Most of the ailments we poor mortals know</p> + <p>From doctors and imagination flow."</p> + <p class="i16">—Churchill.</p> + </div> + + <div class="nofblk"> + <p class="i4">"Men may die of imagination,</p> + <p class="i4">So depe may impression be take."</p> + <p class="i16">—Chaucer.</p> + </div> + </div> + + <blockquote>"Suggestion is the introduction into the mind of a practical + belief that works out its own fulfilment."—Guyau.</blockquote> + + <p>Man suffers from no purely imaginary ills, for mental ills are as real + as physical ills, and though an individual be ailing simply because he + persuades himself he is ailing, his mind so affects his body that he is + actually unwell physically, though the cause of his trouble is purely + mental.</p> + + <p>The suffering of this world is out of all proportion to its actual + disease, many people being tortured by fancied ills. Some dread a certain + complaint because a relative has died of it.</p> + + <p>Others are unwell, but while taking proper treatment they brood + gloomily, and get worse instead of better as they should and <i>could + do</i>.</p> + + <p>Cheap medical and pseudo-medical works are not an unmixed blessing, + for many a person who knows, and needs to know, nothing about disease, + gets hold <!-- Page 80 --><span class="pagenum"><a name="page80"></a>[pg + 80]</span> of one, and soon has most of the ills known to the faculty and + some which are not.</p> + + <p>If a patient be an optimist and persuades himself he is improving, he + <i>does</i> improve. This is the explanation of "Faith moving mountains", + for the curative power of prayer, Christian Science, laying-on of hands, + suggestion treatment and patent medicine, depends on man's own faith, not + on the supernatural.</p> + + <p>A doctor in whom a patient has perfect confidence, will do him far + more good with the same medicines, or even with no medicines at all, than + one of riper experience in whose skill he has no faith.</p> + + <p>Eloquent, though often inaccurate accounts of the benefits derived + from patent medicines are persistently advertised until the mind is so + influenced by the constant reiteration of miraculous cures, that, either + because the healing forces of the body are thereby stimulated, or because + the disease is curable by suggestion, the patient is benefited by such + medicines.</p> + + <p>Thinking of pain makes it worse and vice versa.</p> + + <p>The curative effects of auto-suggestion were demonstrated at the Siege + of Breda in 1625. The garrison was on the point of surrender when a + learned doctor eluded the besiegers, and got in with some minute phials + of an extraordinary Eastern Elixir, one drop of which taken after each + meal cured all the ills flesh was heir to; two drops were fatal.</p> + + <p>The "learned doctor" was a quick-witted soldier, and the elixir was + <i>coloured water</i> sold by order of the commander. Its potency was due + to the faith of all, who persuaded each other they were getting better, + and an epidemic of infectious wellness followed ills due to depressed + spirits.</p> + + <p>One man after reading a list of symptoms said in great alarm: "Good + Heavens. I have got that disease!" and, on turning the page, found it + was... <i>pregnancy</i>.</p> + +<!-- Page 81 --><span class="pagenum"><a name="page81"></a>[pg 81]</span> + + <p>As the great Scotch physiologist, Reid, said seventy years ago:</p> + + <blockquote>"Hope and joy promote the surface circulation of the body, + and the elimination of waste matter and thus make the body capable of + withstanding the causes which lead to disease, and of resisting it when + formed. Grief, anguish and despair enfeeble the circulation, diminish or + vitiate the secretions, favour the causes which induce disease, and + impede the action of the mechanism by which the body may get rid of its + maladies. An army when flushed with victory and elated with hope + maintains a comparative immunity from disease under physical privations + and sufferings which, under the opposite circumstances of defeat and + despair, produce the most frightful ravages."</blockquote> + + <p>The classic description of the woeful effects of imagination is in + Jerome's "Three Men in a Boat". Harris, having a little time on his + hands, strolls into a public library, picks up a medical work, and + discovers he has every affliction therein mentioned, save housemaid's + knee. He consults a doctor friend and is given a prescription. After an + argument with an irate chemist, he finds he has been ordered to take + beefsteak and porter, and not meddle with matters he does not understand. + A sounder prescription never was penned.</p> + +<!-- Page 82 --><span class="pagenum"><a name="page82"></a>[pg 82]</span> + +<hr /> + +<p class="center">CHAPTER XVIII</p> + +<h3>SUGGESTION TREATMENT</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"To purge the veins</p> + <p>Of melancholy, and clear the heart</p> + <p>Of those black fumes that make it smart;</p> + <p>And clear the brain of misty fogs</p> + <p>Which dull our senses, our souls clog."</p> + <p class="i16">—Burton.</p> + </div> + </div> + + <p>Hypnosis and suggestion have suffered from those people who put back + every reform many years—quacks and cranks—for while science, + with open mind, was testing this new treatment, the quacks exploited it + up hill and down dale.</p> + + <p>Yet there is nothing supernatural in suggestion, for we employ it on + ourselves and others every hour we live. Conscience consists only of the + countless stored-up suggestions of our education, which by opposing any + contrary suggestions, cause uneasiness.</p> + + <p>Many of us conform through life to the suggestions of others, + affection, awe, hero-worship and fear taking the place of reason.</p> + + <p>The most resolute of men are influenced by tactful suggestions, which + quietly "tip-toe" on to the margin of consciousness, awaken ideas which + link up more and more associations, until an avalanche is started which + forces itself on to the field of consciousness, the subject thinking the + idea is his own.</p> + + <p>Author and actor try by suggestion to make us think, laugh, or weep at + their will, books are sold by suggestive titles, and many clothes are + worn only to suggest wealth or respectability.</p> + +<!-- Page 83 --><span class="pagenum"><a name="page83"></a>[pg 83]</span> + + <p>The best salesman is he who by artful suggestion sells us what we do + not want; the best buyer he who by equally astute suggestion makes the + seller part at a price which makes him regret the bargain the moment it + is closed.</p> + + <p>Suggestion treatment is of great use in curing nervous states and bad + habits, and all neuropaths should practice self- or auto-suggestion. In + severe cases a specialist must give the treatment.</p> + + <p>The patient is taken by the neurologist to a cosy, + restfully-furnished, half-lighted room, and placed in a huge easy chair + facing a cheery fire. He sinks into the depths of the chair, relaxes + every muscle, allows his thoughts to wander pleasantly, and soon his + brain is at rest, and his mind, undisturbed by the fears which usually + harass it, is ready to receive suggestions.</p> + + <p>The doctor talks quietly, soothingly, but with the conviction born of + knowledge to the patient about his trouble, assuring him that he + <i>can</i> control his cravings; that he <i>can</i> put away the doubts + or fears that have grown upon him. The true reason of his illness is + pointed out, any little organic factors given due weight, and the idea + that it is hereditary or due to Fate dispelled. Faults of character, + reasoning and living are unsparingly exposed and appropriate remedies + suggested, and he is shown how unmanly his self-torturing reproaches are, + and how futile is remorse unless transmuted into reform.</p> + + <p>The doctor's earnestness inspires confidence, and the patient + unburdens his secret troubles, discusses means of remedying them, and + turns from pain to promise, from remorse to resolve, from introspection + to action, from dreading to doing.</p> + + <p>Struck by the way the psycho-analyst reads his soul and lays bare + petty meannesses, impressed by the patient thoroughness with which the + doctor attends to each little symptom, confident that organic + troubles—if <!-- Page 84 --><span class="pagenum"><a + name="page84"></a>[pg 84]</span> there be any—will receive + appropriate treatment, ready to carry out instructions, and disposed to + believe the new treatment is of real value: under all these + circumstances, the physician's suggestions carry very great weight with + the patient.</p> + + <p>The resolutions passed by the victim in this calm state sink deep into + subconsciousness, and when next temptation, impulse or fear assails him, + his own resolutions and the doctor's suggestions are so vividly recalled + that he tries to control his thoughts, and, in due time he "wins + out".</p> + + <p>Anyone may induce the calm state, and repeat suitable suggestions. The + patient should go to a quiet room, and, reclining on a comfortable couch + before a cheery fire, close the eyes, relax the muscles, breathe deeply, + and avoid all sense of strain.</p> + + <p>The next step is to fix the imagination on some scene which suggests + tranquility—smooth seas, autumnal landscapes, snow-clad heights, + old-world gardens, deep, shady silent pools, childhood's lullabies, + secluded backwaters, dim aisles of ancient churches.</p> + + <p>After a few evenings' practice, you will be able gradually to exclude + all other ideas, and focus on one, inducing a state which, somewhat + similar outwardly, is free from the excitement of religious exaltation, + and from the delusions of a medium's trance.</p> + + <p>In this state, an appropriate suggestion must be made, sincerely, and + with <i>absolute faith</i> in its power. Christ's miracles were the + result of suggestive therapeutics, and He took care to inspire relatives + with faith, to exclude scoffers, to surround himself by his believing + Apostles, and, after treatment, said: "See thou tell no man!" well + knowing that suggestion cannot withstand derision.</p> + + <p>In this way, a patient of limited means can do for himself exactly + what more fortunate ones pay large fees to specialists to do for them. + The treatment is <!-- Page 85 --><span class="pagenum"><a + name="page85"></a>[pg 85]</span> uncommon, but sound, for the medical + profession is perhaps the most conservative on earth, and when + specialists of repute use a method, you may be confident it is of + value.</p> + + <p>To cure sleeplessness, see that stomach and brain are at rest, bed + comfortable, and feet warm; calm yourself, and focus on the idea of + sleep, saying:</p> + + <p>"I shall go to sleep in a few minutes, and wake at eight o'clock in + the morning."</p> + + <p>Repeat this a few times, persist for a few nights and you will quickly + get drowsy, and fall asleep.</p> + + <p>Phrases for other requirements will readily occur, as:</p> + + <p>"I shall feel confident in open spaces!"</p> + + <p>"I shall find no more pleasure in alcohol!" and so on.</p> + + <p>Suggestion will not cure epilepsy, hysteria or neurasthenia, but it + overcomes many of the symptoms which make the patient so wretched.</p> + + <blockquote>"Crutches are hung on the walls of miraculous grottos, but + <i>never a wooden leg</i>."</blockquote> + + <p>Suggestion may move a paralysed arm, but the muscles only become + healthy again in many days by slow repair; suggestion releases the catch, + but the spring must be wound up by energy suitably applied.</p> + +<!-- Page 86 --><span class="pagenum"><a name="page86"></a>[pg 86]</span> + +<hr /> + +<p class="center">CHAPTER XIX</p> + +<h3>MEDICINES</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Of simples in these groves that grow</p> + <p class="i2">He'll learn the perfect skill;</p> + <p>The nature of each herb, to know</p> + <p class="i2">Which cures and which can kill."</p> + <p class="i16">—Dryden.</p> + </div> + </div> + + <p>So distressing a malady as epilepsy early attracted attention, and + every treatment superstition could devise, or science could suggest, has + been tried. Culpepper in his "Herbal" (300 years old), recommends bryony; + lunar caustic (nitrate of silver) was extensively used, because silver + was the colour of the moon, which caused madness.</p> + + <p>The royal touch for scrofula (King's Evil) was also extended to + epilepsy, the king blessing a ring, which was worn by the sufferer.</p> + + <p>Another old remedy was to cut off a lock of the victim's hair while in + a seizure and put it in his hand, which stopped (?) the attack. In + Berkshire a piece of silver collected at the communion service and made + into a ring was specific, but in Devon a ring made of three nails from an + old coffin was preferred. Lupton says: "A piece of child's navel-string + borne in a ring is good against falling sickness."</p> + + <p>Nearly every drug in the Pharmacopœia has been tried, the drugs + now generally used being sodium, potassium and ammonium bromide.</p> + + <p>Before bromides were introduced by Locock in <!-- Page 87 --><span + class="pagenum"><a name="page87"></a>[pg 87]</span> 1857, very strict + hygienic, dietic and personal disciplinary treatment combined with the + use of drugs often effected improvement. Since the use of bromides, these + personal habits have, unfortunately, been neglected, far too much + reliance being placed on the "three times a day after meals" formula.</p> + + <p>All bromides are quickly absorbed from the stomach and bowels, and + enter the blood as sodium bromide, which lowers the activity of both + motor and sensory centres, and renders the brain less sensitive to + disturbing influences.</p> + + <p>Unfortunately, the influence of bromides is variable, uncertain, and + markedly good in only a small proportion of cases.</p> + + <p>In about 25 per cent of cases, in which mild seizures occur at long + periods, without mental impairment, the bromides arrest the seizures, + either temporarily or permanently, after a short course. In another 25 + per cent the bromides lessen the frequency and severity of the fits, this + being the common <i>temporary</i> result of their use in <i>all cases</i> + in the first stages.</p> + + <p>In quite 50 per cent of cases, the effect of bromides diminishes as + they are continued, and they finally exert no influence at all. Many + cases are temporarily "cured", the drug is stopped, and the seizures + recur. Bromides are valuable in recent and mild cases, but no medicine + exerts much effect on severe cases of long standing, which usually end in + an institution.</p> + + <p>When these drugs are taken continuously, nausea, vomiting, sleepiness, + confusion of thought and speech, lapses of memory, palpitation, furred + tongue, unsteady walk, acne and other symptoms of "bromism" may arise, + whereupon the patient must stop taking bromides and see a doctor, who + will substitute other drugs for a time.</p> + + <p>If heart palpitation be troublesome while using <!-- Page 88 --><span + class="pagenum"><a name="page88"></a>[pg 88]</span> bromides, take a + teaspoonful of sal volatile in water.</p> + + <p>See a doctor if you can; <i>until</i> you see him, get from a + chemist:</p> + + <table cellpadding="5" summary="bromide"> + <tr><td>Potassii bromidi</td><td class="r">10 grains.</td></tr> + <tr><td>Sodii bromidi</td><td class="r">10 grains.</td></tr> + <tr><td>Boracis purificati</td><td class="r">5 grains.</td></tr> + <tr><td>Aquæ</td><td class="r">1 fluid ounce.</td></tr> + <tr><td colspan="2">Two tablespoonfuls in water three times a<br /> + day after meals.</td></tr> + </table> + + <p>This prescription is for an adult. If the patient be under twenty-one, + tell the chemist his age, and he will make it up proportionately.</p> + + <p>Victims who have seizures with some regularity at a certain time, + should take the three doses in one, two hours before the attack is + expected. If there are long intervals between attacks, cease taking + bromides after one fit and recommence three weeks before the next seizure + is apprehended. When there is an interval of six months or more between + attacks, take no drugs.</p> + + <p>Bromides in solution are unpalatable, patients grow careless of + regularity and dosage.</p> + + <p>You must learn from your doctor and your own experience the + prescription, time and dose best suited to your case, and then <i>never + miss a dose until you have been free from fits for two years</i>, for the + beneficial action of bromide depends on the tissues becoming and + remaining "saturated" with the drug. Never give up bromides suddenly + after long use, but gradually reduce the dose.</p> + + <p>It is just when the disease has been brought under control, that + patients consider further doctor's bills an unnecessary expense, with the + result that a little later the fits recur, and a tedious treatment has to + be commenced over again.</p> + +<!-- Page 89 --><span class="pagenum"><a name="page89"></a>[pg 89]</span> + + <p>No value can be placed on any specific for epilepsy until it has been + thoroughly tested for some years, and so proved that its effects are + permanent, for almost any treatment is of value for a time, possibly + through the agency of suggestion.</p> + +<!-- Page 90 --><span class="pagenum"><a name="page90"></a>[pg 90]</span> + +<hr /> + +<p class="center">CHAPTER XX</p> + +<h3>PATENT MEDICINES</h3> + + <blockquote>"Men who prescribe purifications and spells and other + illiberal practices of like kind."—Hippocrates.</blockquote> + + <div class="noflo"> + <div class="nofblk"> + <p>"...Corrupted</p> + <p>By spell and medicines bought of mountebanks."</p> + <p class="i16">"Othello." Act I.</p> + </div> + </div> + + <p>Carlyle said the world consisted of "so many million people, <i>mostly + fools</i>"; and he was right, for to public credulity alone is due the + immense growth of the patent-medicine trade.</p> + + <p>It was formerly thought that for each disease, a specific drug could + be found, but this idea is exploded. The doctor determines the exact + condition of his patient, considers how he best may assist nature or + prevent death, and selects suitable drugs. He carefully notes their + action and modifies his treatment as required. The use of set + prescriptions for set diseases is obsolete; the doctor of to-day treats + the patient, not the disease.</p> + + <p>A few patent medicines are of limited value; many are made up from + prescriptions culled from medical works, and the rest are frauds, like + potato starch. The evil lies in charging from three to four hundred times + a just price, in ascribing to a medicine which may be good for a certain + disorder, a "cure-all" virtue it does not possess, and in inducing <!-- + Page 91 --><span class="pagenum"><a name="page91"></a>[pg 91]</span> + ignorant people to take powerful drugs, reckless of results.</p> + + <p>Ephemeral patent-medicine businesses, run by charlatans, whose aim is + frankly to make money before they are exposed, spring up like mushrooms; + and their cunningly worded advertisements meet the eye in the columns of + every paper one opens for a few months; then they drop out, to reappear + under another name, at another address. These rogues buy a few gross + pills from a wholesale druggist, insert a small advertisement, and so lay + the foundations of a profitable business.</p> + + <p>The lure of the unknown is turned to account. "The discoverer went + back to the Heart of Nature—and found many rare herbs used by + Native Tribes." "The "Heart of Nature" was probably a single-room office + tucked away down a Fleet Street alley, and analysis proves these + medicines contain only common drugs, one "<i>Herbal Remedy</i>" being + <i>metallic</i> phosphates.</p> + + <p>A common procedure is to send a question form, and, after answering + the query, "What are you suffering from?" with "Neurasthenia", the + company "carefully study" this, and then inform you with a gravity that + would grace the pages of "Punch", "You are the victim of a very + intractable type of Neurasthenia", so intractable in fact that it will + need "additional treatment"—at an "additional" fee.</p> + + <p>The quack's advertisements are models of the skilful use of + suggestion, and turn to rare account the half-knowledge of physiology + most men pick up from periodicals. He frightens you with alarming and + untrue statements, gains your confidence by a display of semi-true facts + reinforced where weak by false assertions, and, having benefited himself + far more than you, leaves you to do what you should have done at first, + go to a doctor or a hospital.</p> + +<!-- Page 92 --><span class="pagenum"><a name="page92"></a>[pg 92]</span> + + <p>Were it made compulsory for the recipe to be printed on all patent + medicines, people would lose their childlike faith in coloured water and + purges, and cease the foolish and dangerous practice of treating diseases + of which they know little with drugs of which they know less.</p> + + <p>The British Medical Association of 429, Strand, London, W.C., issue + two 1<i>s</i>. books—"Secret Remedies: What they cost and what they + contain", "More Secret Remedies"—giving the ingredients and cost + price of most patent medicines. You are strongly urged to send for these + books, which should be in every home.</p> + + <p><i>The basis of every cure for epilepsy</i> (not obviously fraudulent) + <i>is bromides</i>. The usual method is to condemn vigorously the use of + potassium bromide, and substitute ammonium or sodium bromide for it. Some + advertisers condemn all the bromides, and prescribe a mixture of them; + others condemn potassium bromide, and shamelessly forward a pure solution + of this same salt in water as a "positive cure!"</p> + + <p>In all cases the sale price is out of reasonable proportion to the + cost, victims paying outrageous sums for very cheap drugs.</p> + + <p>Most epileptics are poor, because their infirmity debars them from + continuous or well-paid work, leaving them dependent on relatives, often + in poor circumstances also. The picture of patients, already lacking many + real necessities, still further denying themselves for weeks or months to + purchase a worthless powder, is truly a pitiful one.</p> + + <p>Bromides are unsatisfactory drugs in the treatment of epilepsy, but + they are the best we have at present. Get them made up to the + prescription of a doctor, and see him every month to report progress and + be examined. In the end, this plan will be very much <!-- Page 93 + --><span class="pagenum"><a name="page93"></a>[pg 93]</span> cheaper, and + incomparably better, than buying crude bromides from quacks.</p> + +<hr /> + + <p>There is no drug treatment for either hysteria or neurasthenia, and + when the doctor gives medicines for these complaints, it is to remedy + organic troubles, or, more often because necessity forces him to pander + to the irrational and pernicious habit into which the public have fallen + of expecting a bottle of medicine whenever they visit a doctor. Osier, + the famous Professor of Medicine at Oxford, truly observed that he was + the best doctor who knew the uselessness of medicines. But when public + opinion demands a bottle, and is unwilling either to accept or pay for + advice alone, the doctor may be forced to give medicines which he feels + are of little value, hoping that their suggestive power will be greater + than is their therapeutic value.</p> + + <p>Neuropaths invariably contract the habit of physicking themselves, and + taking patent foods and drugs which are valueless.</p> + + <p>So universal is this pernicious habit that we deem it desirable to + criticize it here at some length.</p> + + <p>One highly popular type consists of port wine, reinforced (?) by malt + and meat extracts, and sold under a fanciful name. It has about the same + value as a bottle of port, which costs considerably less. It is well to + remember that many a confirmed drunkard has commenced with these + "restoratives".</p> + + <p>Malt extracts are also popular. They contain diastase, and therefore + aid the digestion of starch, but the diastatic power of most commercial + extracts is negligible.</p> + + <p>Meat extracts of various makes contain no nourishment, but are + valuable appetisers. Meat gravy is as effective and far cheaper.</p> + +<!-- Page 94 --><span class="pagenum"><a name="page94"></a>[pg 94]</span> + + <p>Foods containing digestive ferments, which are widely advertised under + various proprietary names are practically valueless, as are the ferments + themselves sold commercially. Digestive disorders are very rarely due to + deficiency of ferments, while pepsin is the only one among all the + ferments that could act (and that only for a little while) in the + digestive system.</p> + + <p>Some of the disadvantages of predigested foods have been noted, and + their prices are usually so exorbitant that eggs at 2<i>s.</i> 6<i>d.</i> + each would be cheaper. The remarks of Sollmann the great pharmacologist + are pertinent:</p> + + <blockquote><i>Limitations</i>. The administration of food in the guise + of medicine is sometimes advantageous; but medicinal foods are subject to + the ordinary law of dietetics, and therefore cannot accomplish the + wonders which are often claimed for them. The proprietary foods have been + enormously overestimated, and have probably done more harm than good. The + ultimate value of any food depends mainly on the amount of calories which + it can yield, and on its supplying at least a minimum of proteins. In + these respects, the medical foods are all inferior, for they cannot be + administered practically in sufficient quantity to supply the needs of + the body. They have a place as adjuvants to other foods, permitting the + introduction of more food than the patient could otherwise be induced to + take. Aside from the special diabetes foods and cod-liver oil, their + value is largely psychic.</blockquote> + + <blockquote><i>Predigested Foods</i>. The value of these is doubtful, for + digestive disturbances involve the motor functions and absorption more + commonly than the chemical functions. Their continued use often produces + irritation.</blockquote> + + <blockquote><i>Liquid Predigested Foods</i>. As sold, these are <!-- Page + 95 --><span class="pagenum"><a name="page95"></a>[pg 95]</span> flavoured + solutions containing small amounts (½-6 per cent) of predigested + proteins, ½-15 per cent of sugars and other carbohydrates, with 12-19 per + cent of alcohol, and often with large quantities (up to 30 per cent) of + glycerin. Their protein content averages less than that of milk, and in + energy value they are vastly inferior. Their daily dose yields but 55-300 + calories including their alcohol; this is only one-thirtieth to one-fifth + the minimum requirements of resting patients. To increase their dose to + that required to maintain nutrition would mean the ingestion of an amount + of alcohol equivalent to a pint of whisky per day.</blockquote> + + <p>Of recent years very expensive preparations of real or alleged organic + iron compounds have had a large sale. Iron is a component of hæmoglobin, + a solid constituent (13 per cent by weight) of the blood, which combines + with the oxygen in the lungs, and is carried (as oxyhæmoglobin) all over + the body, giving the oxygen up to the tissues. Hæmoglobin is an + exceedingly complex substance, but it contains only one-third per cent by + weight of iron in organic form.</p> + + <p>The liver is the storehouse of iron, its reserve being depleted when + there is an extraordinary demand for iron. The minute amounts of iron in + ordinary food are amply sufficient for all our needs; any excess is + simply stored, and, later excreted, and has no effect whatever on the + circulating hæmoglobin.</p> + + <p>Iron is only of value in certain forms of anæmia, and the many patent + medicines purporting to contain hæmoglobin or organic iron are therefore + useless to neuropaths. The Roman plan of drinking water in which swords + had been rusted, is quite as valuable as drinking expensive proprietary + compounds. When iron is indicated Blaud's Pills are perhaps the best + preparation.</p> + +<!-- Page 96 --><span class="pagenum"><a name="page96"></a>[pg 96]</span> + + <p>Huge quantities of patent medicines containing phosphates in the form + of hypo-or glycerophosphates, and (or) lecithin are sold annually.</p> + + <p>All phosphorus compounds are reduced to inorganic phosphates in the + digestive tract, absorbed and eliminated, so that, as with iron, if + phosphates are needed, the form in which they are taken is of no moment. + Why, then, pay huge sums for organic-phosphorus compounds (synthesized + from inorganic phosphates) when they are immediately reduced to the same + constituents from which they were constructed, the only value in the + reduction process being seen in the immense fortunes which + patent-medicine proprietors accumulate?</p> + + <p>Lecithin is isolated from animal brain, or egg-yolk, and commercial + lecithin is impure. Not only does the ordinary daily diet contain ample + lecithin (5 grammes), but two eggs will double this, while liver or + sweetbread, both rich in phosphorous, may be eaten.</p> + + <p>The much-vaunted glycerophosphates are decomposed to and excreted as + phosphates. Sollmann's remarks apply to all similar proprietary + articles:</p> + + <blockquote>"A proprietary compound of glycerophosphates and casein has + been widely and extravagantly advertised as 'Sanatogen'. It is a very + costly food, and in no sense superior to ordinary casein, such as cottage + cheese."</blockquote> + + <p>Hypophosphites have been boomed by various people, chiefly for + financial reasons. Five or six of them are usually prescribed, with the + addition of cod liver oil, and perhaps quinine, and (or) iron and + strychnine, the complexity of the prescription being expected, + apparently, to compensate for the uselessness of its various + ingredients.</p> + + <p>To deduce rational remedies, it is first necessary to <!-- Page 97 + --><span class="pagenum"><a name="page97"></a>[pg 97]</span> elucidate + the causes of inefficiency; and to expect a brain which is out of order + to function in an orderly manner simply because it is supplied with one + of the substances necessary to its normal functioning (regardless of + whether a deficiency of that substance is the cause of the disorder), is + as rational as it would be to expect to restart an automobile engine, the + magneto of which was broken, by filling up the half-empty petrol + tank.</p> + +<!-- Page 98 --><span class="pagenum"><a name="page98"></a>[pg 98]</span> + +<hr /> + +<p class="center">CHAPTER XXI</p> + +<h3>TRAINING THE NERVOUS CHILD</h3> + + <blockquote>"When shall I begin to train my child?" said a young mother + to an old doctor.<br /> + "How old is the child, madam?"<br /> + "Two years, sir!"<br /> + "Then, madam, you have lost just two years," answered the old + physician, gravely.</blockquote> + + <p>Neuropathic children are super-emotional, and from them come + prodigies, geniuses, perverts and madmen. They are usually spare of + build, with pale, sallow complexions, and dark rings under the eyes.</p> + + <p>They can never sit still, but wriggle restlessly about on their seats, + pick their nostrils, and bite their nails. They are always wanting to be + doing something, but soon tire of it, and start something else, which is + as quickly cast aside; their energy is feverish but fitful. They jump to + conclusions, quickly grasp ideas; as quickly forget them. Having no + capacity for calm, reasoned judgment, they are creatures of impulse, + imperative but timid, suffer from strange ideas, and worry over + trifles.</p> + + <p>The affections are strong and vehement, likes and dislikes are taken + without reason, while intense personal attachments—often + unrequited—occur, but not seldom swing round to indifference, or + even bitter enmity. The passions and emotions are all abnormal, for owing + to deficiency in the higher inhibitory centres, the victim is blown about + by every idle emotional wind that blows. The slightest irritation may + provoke <!-- Page 99 --><span class="pagenum"><a name="page99"></a>[pg + 99]</span> an outburst of maniacal rage, or a fit. Consequently, they + require the most careful, but firm training, right from birth, to bring + them up with a minimum of nerve-strain. Twitchings, night or day terrors, + sleep walking, and incontinence of urine often trouble them. They should + be examined by a doctor once a year.</p> + + <p>These children have no <i>balance</i>, and are usually selfish, always + garrulous, with a love of romancing, while a ready wit combined with + fertile imagination often gains them a bubble reputation for learning + they do not possess. Invention, poetry, music, artistic taste and + originality are occasionally of a high order, and the memory is sometimes + phenomenal; but desultory, half-finished work, and shiftlessness are the + rule.</p> + + <p>Their appetite is fitful and fanciful, they like unsuitable foods, and + their digestive system is easily upset. At puberty, sexual perversity is + common, and the animal appetite, is as a rule, very strong, though + rarely, it may be absent. During adolescence, there is excessive shyness + or bravado, always introspection, and exaggerated self-consciousness.</p> + + <p>As they grow older, they readily contract hypochondria, neurasthenia, + hysteria, alcoholism, insomnia and drug habits, and react unduly to the + most trifling external causes, even to the weather, by which they are + exhilarated or depressed.</p> + + <p><b>Education</b>. Send them to school only when the law compels you, + and observe them closely while there, for health is far more important to + them than education. "Infant prodigies" lack the mental staying power and + physical robustness which real success demands, though they may do well + for a time. Go to your old school: the successes of to-day were dunces + twenty years ago; about those whose names are proudly emblazoned in + fading gold on Rolls of Honour, a discreet silence is maintained.</p> + + <p>Keep a keen lookout for symptoms of over-effort. <!-- Page 100 + --><span class="pagenum"><a name="page100"></a>[pg 100]</span> + Sleepiness, languor, a vacant expression, forehead wrinkled, eyebrows + knit, eyes dull, sunken and surrounded by dark rings, twitchings, + restlessness, or loss of appetite are all warnings that the pace is too + strong for the child.</p> + + <blockquote>"These are the cases in which the School Board—who + ordain that if children are well enough to play or run errands, they are + well enough to attend school—should be defied."</blockquote> + + <p>This defiance must of course be reinforced by a doctor's + certificate.</p> + + <p>To the healthy, the strain of preparing for and enduring an + examination is tremendous; to highly strung children it is dangerous. + Home-work should be forbidden in spite of the authorities. Let the child + join in the sports of the school as much as possible.</p> + + <p>School misdemeanours form a thorny problem, for discipline must be + maintained, and a stern but just discipline is very wholesome for this + type, who are too apt to assume that because they are abnormal, they can + be idle and refractory. On the other hand, parents should promptly and + vigorously object to their children being punished for errors in lessons, + or struck on the head.</p> + + <p><b>Diet</b>. Food, while being nourishing, and easily digested, must + not be stimulating or "pappy". Meat, condiments, tea, coffee and alcohol + are highly undesirable, a child's beverage being milk and water.</p> + + <p>Meals should be ready at regular hours, and capricious appetites + should freely be humoured among suitable foods, served in appetizing form + to tempt the palate. Let them chatter, but see they do not get the time + to talk by bolting their food.</p> + + <p>Most children can chew properly soon after they are two, but they are + never taught. Their food is <!-- Page 101 --><span class="pagenum"><a + name="page101"></a>[pg 101]</span> "mushy", or is carefully cut, and + gives them no incentive to masticate. So long as food is digestible, the + harder it is the better, and plain biscuits, raw fruits, and foods like + "Grape Nuts", are splendid. Mastication helps digestion; it also prevents + nasal troubles.</p> + + <p>The desire for food at odd moments causes trouble, which is aggravated + if the meals are not ready at stated hours. Gently but firmly refuse the + piece of bread-and-butter they crave, explain why you do so, and though + they weep, or fly into a passion, do not lose your own temper, or beat, + or give way to them. When accustomed to regular hours and firm refusals + they will not crave for titbits between meals.</p> + + <p>It is very hard for them to see other members of the family freely + partaking of condiments, drinks and unsuitable foods, and be told they + are the only ones who must refrain. A little personal self-sacrifice + helps immensely, and if your child <i>must</i> refrain so <i>might</i> + you.</p> + + <p>All foods must be pure. Avoid tinned goods, and cheap jams, which + contain mangels and glucose. Judged by the nutriment they + contain—most cheap foods are very expensive.</p> + + <p>Lightly boil, poach, or scramble eggs; steam fish and vegetables; cook + rice and sago in the oven for three hours. See that milk puddings are + chewed, for usually they are bolted more quickly than anything else. The + stomach is expected to deal with unchewed rice pudding, because it is + "nourishing". So are walnuts, but you do not swallow them whole.</p> + + <p>Fruit must be fresh, ripe and raw, with skin and core removed. Brown + bread, crisply toasted and buttered when cold, is best. Porridge is + admirable, but many children dislike it. Try to induce a taste by giving + plenty of milk, and sugar or syrup with it.</p> + + <p>The starch-digesting ferments in the saliva and pancreas are not + active until the age of 18 months, before <!-- Page 102 --><span + class="pagenum"><a name="page102"></a>[pg 102]</span> which infants must + not be given starchy foods like potatoes, cereals, puddings and + bread.</p> + + <p>All greenstuffs must be thoroughly washed, or worms may pass into the + system. Foul breath, picking the nose, restlessness, fever and startings + are often attributed to worms, when the real "worms" are mince pies, + raisins, sour apples, and even beer.</p> + + <p>Never force fat on children in a form they do not like, for there are + plenty of palatable fats, as butter, dripping, lard and milk. Cream is as + cheap, as good, and far nicer than cod-liver oil.</p> + + <p>Decide on your children's diet, but do not discuss it with or before + them. If a child <i>does</i> dislike a dish, never force it on him, but + try to induce a liking by serving it in a more appetizing way. Never mix + medicines with food.</p> + + <p><b>Worms</b>. Various symptoms are due to intestinal worms, and a + sharp lookout should be kept for the appearance of any in the stools, and + suitable treatment given when necessary.</p> + + <p>Treatment for thread and round worms:</p> + + <table cellpadding="5" summary="Treatment for thread and round worms"> + <tr><td>R.</td></tr> + <tr><td>Santonini</td><td class="r">gr. ij.</td></tr> + <tr><td>Hydrarg. chloridi mitis</td><td class="r">gr. ij.</td></tr> + <tr><td>Pulv. aromatici</td><td class="r">gr. iv.</td></tr> + <tr><td>Mix and divide into four.</td></tr> + + <tr><td colspan="2">Take one at bedtime every other night,<br /> + followed by castor oil in the morning.</td></tr> + </table> + + <p><b>Tapeworms</b>. These are rarer, being much more frequently talked + or read about than seen. A doctor should be consulted.</p> + + <p><b>Moral Training</b>. The road to hell is broad and easy; so is that + to heaven, for if bad habits are easily acquired, so are good ones.</p> + + <p>Example is the best moral precept, and if the conduct <!-- Page 103 + --><span class="pagenum"><a name="page103"></a>[pg 103]</span> of parents + is good, little moral exhortation is needed. "What is the moral ideal set + before children in most families? Not to be noisy, not to put the fingers + in the nose or mouth, not to help themselves with their hands at table, + not to walk in puddles when it rains, etc. To be 'good'!" To hedge in the + child's little world, the most wonderful it will ever know, by hidebound + rules enforced by severe punishments, is to repress a child, not to train + it. While the commonest error is to spoil a child, it is just as harmful + to crush it. Be firm, be kindly, and, above all, <i>be fair</i>.</p> + + <p>Issue no command hastily, but only if necessary, and shun prohibitions + based on petulance or pique. Give the child what it wants if easily + obtainable and not harmful.</p> + + <p>If the desire is harmful, explain why, but if a child asks for a toy, + do not pettishly reply: "It's nearly bedtime!" when it is not, or even if + it is.</p> + + <p>Discipline is essential, but discipline does not consist in + inconsistent nagging; harshly insisting on unquestioning obedience to + some unreasonable command one moment, and weakly giving way—to + avoid a scene—on some matter vitally affecting the child's welfare + the next.</p> + + <p>There must be no coddling, and no inducement to self-pity. Such + children must be taught that they are capable of real success and real + failure, and that upon personal obedience to the laws of health of body + and of mind, this success or failure largely depends.</p> + + <p>A child should be early accustomed to have confidence in himself. For + this purpose all about him must encourage him and receive with kindliness + whatever he does or says out of goodwill, only giving him gently to + understand, if necessary, that he might have done better and been more + successful if he had followed this or that other course. Nothing is more + apt to deprive a child of confidence in himself than to tell him brutally + <!-- Page 104 --><span class="pagenum"><a name="page104"></a>[pg + 104]</span> that he does not understand, does not know how, cannot do + this or that, or to laugh at his attempts. His educators must persuade + him that he <i>can</i> understand, and that he <i>can</i> do this thing + or that, and must be pleased with his slightest effort.</p> + + <p>It seems a trifle to let a child have the run of cake plate or + sweet-tray, or to stay up "just another five minutes, Mummy!" to avoid a + howl, but these are the trifles that sow acts to reap habits, habits to + reap character, and character to fulfil destiny. It is selfish of parents + to avoid trouble by not teaching their children habits of obedience, + self-restraint, order and unselfishness. Between five and ten is the age + of greatest imitation, when habits are most readily contracted.</p> + + <p>Come to no decision until hearing the child's wishes or statements, + and thinking the matter out; having come to it, <i>be inexorable</i> + despite the wiles, whines and wails of a subtle child. Reduce both + promises and threats to a minimum, but <i>rigidly</i> fulfil them, for a + threat which can be ignored, and a promise unfulfilled, are awful errors + in training a child.</p> + + <p>Persuade, rather than prohibit or prevent, a child from doing harmful + actions. If it wants to touch a hot iron, say clearly it is hot, and will + burn, but <i>do not move it</i>. Then, if the child persists, it will + touch the iron tentatively, and the small discomfort will teach it that + obedience would have been better. Let it learn as far as possible by the + hard, but wholesome, road of experience.</p> + + <p>Makeshift answers must never be given to a child. Awkward questions + require truthful answers, even though these only suggest more "Whys?"</p> + + <p>Sentimentality must be nipped promptly in the bud, and an imaginative + and humorous view of things encouraged. The child must be taught to keep + the passions under control, and to face pain (that great <!-- Page 105 + --><span class="pagenum"><a name="page105"></a>[pg 105]</span> educator + which neurotic natures feel with exaggerated keenness) with + fortitude.</p> + + <p>Fear must be excluded from a child's experience. "Bogies!" "Ghosts!" + "Robbers!" and "Black-men!" if unintroduced, will not naturally be + feared. The mental harm a highly strung child does by rearing most + fearsome imaginings on small foundations is incalculable, and has led + more than one to an asylum.</p> + + <p>Try to train the child to go to sleep in the dark, but if it is + frightened give it a nightlight. As Guthrie says, the comfort derived + from the assurance that Unseen Powers are watching over it, is small + compared to that given by a nightlight. He mentions a child who, when + told she need not fear the dark because God would be with her, said: "I + wish you'd take God away and leave the candle."</p> + + <p>If the child wakes terrified, it is stupid and wicked to call + upstairs: "Go to sleep!" A child cannot go to sleep in that state, and a + wise mother will go up and softly soothe the frightened eyes to + sleep.</p> + + <p>Neuropathic children often have night terrors within an hour or two of + going to bed. Piercing screams cause a hasty rush upstairs, where the + child is found sitting up in bed, crouching in a corner, or trying to get + out of door or window. His face is distorted with fear and he stares + wildly at the part of the room in which he sees the terrifying + apparition. He clings to his mother but does not know her. After some + time he recovers, but is in a pitiful state and has to have his hand held + while he dozes fitfully off. He often wets the bed or passes a large + amount of colourless urine. Medical treatment is imperative.</p> + + <p>Corporal punishment is unsuitable for neuropathic children, for the + mere suggestion of its application usually causes such excessive dread, + mental upset and terror as make it really dangerous. Such children are + often said to be "naughty" when in reality they are <!-- Page 106 + --><span class="pagenum"><a name="page106"></a>[pg 106]</span> unable to + exercise self-control, owing to defective inhibitory power. Try patiently + to inculcate obedience from the desire to do right, and make chastisement + efficacious from its very exceptional character.</p> + + <p>"The young child is too unconscious to have a deliberately perverse + intention; to ascribe to him the fixed determination to do evil, is to + judge him unjustly and often to develop in him an evil instinct. It is + better in such a case to tell him he has made a mistake, that he did not + foresee the consequences to which his action might lead, etc." Many + parents fall into a habit of shaking, ear-boxing, and such-like harmful + minor punishments for equally minor offences, which should be + overlooked.</p> + + <p>In all little troubles, keep <i>quite calm</i>. The child's nerve and + association centres have not yet got "hooked up", and you cannot expect + it to act reasonably instead of impulsively. This excuse does not apply + to you. One excitable person is more than enough, for if both get angry, + sensible measures will certainly not result.</p> + + <p>The necessity for calmness cannot too strongly be urged. The treatment + for a fit of temper, is to give the unfortunate child a warm bath, and + put it to bed, with a few toys, when it will soon fall asleep, and awake + refreshed and calm.</p> + + <p>Proceed gently but with absolute firmness, <i>start early</i>, and + remember that example is better than precept.</p> + + <p><b>Religion</b>. Offering advice on this subject is skating on very + thin ice, and we do so but to give grave warning against neuropathic + youth being allowed to contract religious "mania", "ecstasy", or + "exaltation".</p> + + <p>Neuropaths are given naturally to "see visions and dream dreams", and + if this tendency be exaggerated an unbalanced moral type results. Jones + says:</p> + + <blockquote>"The epileptic is apt to be greatly influenced by the + mystical or awe-inspiring, and is disposed <!-- Page 107 --><span + class="pagenum"><a name="page107"></a>[pg 107]</span> to morbid piety. He + has an outer religiousness without corresponding strictness of morals; + indeed the sentiment of religious exaltation may be in great contrast to + his habitual conduct, which is a mixture of irritability, vice and + perverted instincts."</blockquote> + + <p>Lay stress on the simple moral teaching of the New Testament, and + avoid cranky creeds, cross references, or Higher Criticism. Teach them to + practise the moral precepts, not to quote them by the page.</p> + + <p>Without this practical bent, a "Revival" meeting is apt to result in a + transient but harmful "conversion"; a form of religious sentiment which + finds outlet, not so much in works as in morbid excitement. In these + people, as in the insane, there is often a weird mixing-up of religious + and sexual emotion.</p> + + <p>Teach these children that the greatest good is not to sob over their + fancied sins at "salvation" meetings, but to love the just and good, to + hate the unjust and evil, and to do unto others as they would others + should do unto them.</p> + + <p>It is better for them to join one of the great churches, than become + members of those small sects which maintain peculiar tenets.</p> + + <p>A word of special warning must be given against Spiritualism. There + may or may not be a foundation for this belief, but it is highly + abnormal, and has led thousands into asylums.</p> + + <p>The medium and the majority of her audience are highly neurotic, and a + more unwholesome environment for an actual or potential neuropath could + not be imagined.</p> + + <p>The educated neuropath often peruses certain agnostic works, the + result usually being deplorable, for this class are dependent on some + stable base outside themselves, such as is found in a calm religion + manifested <!-- Page 108 --><span class="pagenum"><a + name="page108"></a>[pg 108]</span> in a steadfast attempt to overcome the + weakness of the flesh, by ordering life in accordance with the teachings + of the New Testament.</p> + + <p>So long as abnormalities of character do not become too pronounced, + friends must be content.</p> + + <p>Such children must be trained to express themselves in a practical + manner, not in weaving gorgeous phantasies in which they march to + imaginary victory. Day dreams form one of those unlatched doors of the + madhouse that swing open at a touch, the phantasy of to-day being written + "emotional dementia" on a lunacy certificate to-morrow.</p> + + <p>Finally, remember that above them hangs the curse:</p> + + <p>"Unstable as water, <i>thou shall not excel</i>."</p> + + <p>"Go thou softly with them, all their days!" and whether your tears + fall on the ashes of a loved and loving, but weak and wilful one, or + whether their tears bedew the grave of the only friend they ever knew, + you will not have lacked a rich reward.</p> + +<!-- Page 109 --><span class="pagenum"><a name="page109"></a>[pg 109]</span> + +<hr /> + +<p class="center">CHAPTER XXII</p> + +<h3>DANGERS AT AND AFTER PUBERTY</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Th' expense of spirit in a waste of shame</p> + <p>Is lust in action; and till action, Lust</p> + <p>Is perjured, murderous, bloody, full of blame,</p> + <p>Savage, extreme, rude, cruel, not to trust;</p> + <p>Enjoyed no sooner but despised straight;</p> + <p>Past reason hunted; and, no sooner had,</p> + <p>Past reason hated, as a swallow'd bait</p> + <p>On purpose laid to make the taker mad;</p> + <p>Mad in pursuit, and in possession so;</p> + <p>Had, having had, and in quest to have, extreme;</p> + <p>A bliss in proof, and proved, a very woe;</p> + <p>Before, a joy proposed; behind, a dream;</p> + <p class="i2">All this the world well knows; yet none knows well,</p> + <p class="i2">To shun the Heaven that leads men to this Hell!"</p> + <p class="i16">—Shakespeare. Sonnet 129.</p> + </div> + </div> + + <p>At puberty (from the age of 11-15) a boy becomes capable of paternity, + a girl of maternity; during adolescence (from puberty to 25) the body in + general, and the reproductive organs in particular, grow and mature.</p> + + <p>In the boy, semen is secreted, the voice breaks, the genitals enlarge, + hair grows on the pubes, face and armpits, and there is a rapid increase + in height owing to growth of bone. In the girl menstruation commences, + the pelvis is enlarged, bust and breasts develop, the complexion + brightens, the hair becomes glossy, and the eyes bright and + attractive.</p> + + <p>In both, the sexual instinct awakens, and the mental, like the + physical, changes are profound. There is great general instability, the + child, at one time shy <!-- Page 110 --><span class="pagenum"><a + name="page110"></a>[pg 110]</span> and reticent, is at another, + boisterous and self-assertive.</p> + + <p>Parents rarely realize the importance and trying nature of this period + when "there awakes an appetite which in all ages has debased the weak, + wrestled fiercely with the strong and overwhelmed too often even the + noble". Adolescents suffer more from the lack of understanding, + sympathy, appreciation and wise guidance shown by their blind parents, + than they do from their own ignorance and perfervid imagination.</p> + + <p>The transitions from radiant joy and confident expectation, reared on + a flimsy basis of supposition, to dire despair consequent on a wrong + reading of physical and mental changes, are rapid. Friends, lovers and + heroes quickly succeed one another, play their parts, and give place to + others.</p> + + <p>The awakening of the sexual appetite is usually ignored, and children + are left to gain knowledge of man's noblest power from companions, casual + references in the Bible and other books, and unguarded references in + conversation. Under such conditions not one in a thousand—and + <i>your</i> child is <i>not</i> that one—escapes impurity and + degraded sex ideas.</p> + + <p>Wherever youth congregate, this subject crops up, and those who talk + most freely to the others are just those with the most distorted and + vicious ideas, whose discourse abounds in obscene detail and ribald jest. + Your child must learn either from ignorant, unclean minds, or be taught + in a clean, sacred way, which will rob sex of secrecy and obscenity; + <i>learn he will</i>; if you will not teach your child, his pet rabbit + will.</p> + + <p>When children ask awkward questions, say quietly that such matters are + not discussed with children, but promise to tell them all about it when + they are ten years old; delay no longer, for most children learn + self-abuse between ten and twelve.</p> + + <p>Self-abuse is a bad habit, and no more a "sin" than <!-- Page 111 + --><span class="pagenum"><a name="page111"></a>[pg 111]</span> is biting + the nails. Unfortunately, people with no other qualification than a + desire to do good, wrongly harp on the "sin" of it and draw lurid + pictures of physical and mental wreck as the end of such "sinners", + ignorant that if all masturbators went mad the world would be one huge + asylum.</p> + + <p>Exaggeration never pays in teaching youth. Tell the truth, which is + bad enough without adding "white lies" with an eye to effect.</p> + + <p>Coitus causes slight prostration, Nature's device to remind man to + keep sexual intercourse within bounds, for while in moderation it is + harmless, in excess it causes great prostration. <i>Exactly the same + applies to self-abuse</i>, for, paradoxical as it seems, the real harm is + done by the <i>fear</i> of the supposed harm.</p> + + <p>The masturbator first suffers from the knowledge he is indulging in a + pleasure he knows would be forbidden, and from fear of being found out; + later he learns from friends, quack advertisements, or well-meaning books + that self-abuse is a most deadly practice, and thereupon a tremendous + struggle occurs between desire and fear, each act ending in an agony of + remorse and dread of future consequences, which struggle does a + thousand-fold more harm than the loss of a little semen.</p> + + <p>The ill-effects of these mental struggles disappear after marriage, + which means greater indulgence, but indulgence free from mental stress. + In neuropaths, these mental struggles are the worst things that could + occur, for they tend to make permanent the states we are trying to + cure.</p> + + <p>The most serious results of masturbation are moral not physical. Loss + of will-power, self-reliance, presence of mind, reasoning power, memory, + courage, idealism, and self-control; mental and physical debility, + laziness, a diseased fondness for the opposite <!-- Page 112 --><span + class="pagenum"><a name="page112"></a>[pg 112]</span> sex, and in later + years, some degree of impotence or sterility, are its commoner + results.</p> + + <p>Teach <i>your</i> child, therefore, not from fear of physical harm, + but because you wish him to be one of those fortunate few who live and + die "gentlemen unafraid", because they had wise parents.</p> + + <p>Let the mother instruct a girl, the father a boy, and not leave so + vital a matter to an unsuitable pamphlet.</p> + + <p>Buy one of the many "Knowledge for Boys or Girls" books and read it + carefully.</p> + + <p>Having made sure you can convey a simple account of the wonders of + reproduction, and that you have rooted out the idea that sex is something + to be apologized for, see the child and tell him it is time he learned of + his private parts, as manhood draws near.</p> + + <p>Then, speaking in a quiet, unembarrassed way, deliver your little + homily, all the time insisting on the marvel, the romance, the poetry and + the beauty of the sex. Let chivalry be your text, not fear, and repeat + the Squire's sound parting advice to Tom Brown:</p> + + <blockquote>"Never listen to or say things you would not have your mother + or sister hear."</blockquote> + + <p>Give a clear and complete description in simple words of the mechanism + and marvel of reproduction, for half-knowledge generates a prurient + curiosity about the other sex, thus defeating the very end you have so + earnestly striven for.</p> + + <p>Purity not impurity should be your text, and you should only refer to + masturbation as a harmful habit, which should not be contracted.</p> + + <p>Warn them to</p> + + <blockquote>"Keep the heart with all diligence, for out of it are the + issues of life!"</blockquote> + + <p>by turning their thoughts instantly and determinedly <!-- Page 113 + --><span class="pagenum"><a name="page113"></a>[pg 113]</span> away from + sex ideas when they arise, as they <i>will</i> arise, time and again. It + is useless to try <i>not</i> to think of them, the child must instantly + turn its thoughts to to <i>something else</i>, for one who cannot stamp + out a spark will not subdue a fiercely-raging conflagration.</p> + + <p>Babies should not be carelessly caressed, and a fretful infant must + never be soothed by playing with the genitals, as is done innocently by + some mothers and nurses, and by others from motives more questionable. + Freud showed that there are subconscious sexual desires in infants, which + die out until reanimated at puberty in Nature's own way. If exaggerated + by exuberant fondling, they gather force in the dark corners of the mind, + and are later manifested in morbid sexual or mental perversity.</p> + + <p>If you have good grounds for believing the habit has already been + contracted, enlist medical advice. A great factor in the successful + treatment of self-abuse is early recognition, and, after the unhygienic + nature of the habit has carefully been pointed out, the child's sense of + honour should be invoked.</p> + + <p>Without further reference to the matter, try to become your child's + confidant, for he will have to fight fires within and foes without. See + that his time is filled with healthy sport and play, and ennoble his + ideas with talk, books and plays which lay stress on chivalry and + manliness. Give him plain food, tepid douches, and a firm bed with light, + fairly warm clothing. Get him up reasonably early in the morning, and let + him play until he is "dog-tired" at night.</p> + + <p>Let children rub shoulders with others, keep them from highly exciting + tales, let them read but little, and train them to be observant of + external objects all the time.</p> + + <p>Neuropaths develop very early sexually, and contract bad habits in the + endeavour to still their unruly passions; with them, the future is darker + <!-- Page 114 --><span class="pagenum"><a name="page114"></a>[pg + 114]</span> than with the normal child, and the parent who neglects his + duty may justly be held accountable for what happens to his child or his + child's children.</p> + + <p>Puberty is always a critical period in epilepsy, many cases commencing + at this time, while in a number, fits commence in infancy, cease during + childhood, and recommence at puberty, the baneful stimulus of + masturbation being undoubtedly a factor in many of these cases.</p> + +<!-- Page 115 --><span class="pagenum"><a name="page115"></a>[pg 115]</span> + +<hr /> + +<p class="center">CHAPTER XXIII</p> + +<h3>WORK AND PLAY</h3> + + <p>Although most people would assume that epileptics are unable to follow + a trade, there is hardly an occupation from medicine to mining, from + agriculture to acting, that does not include epileptics among its + votaries.</p> + + <p>Outdoor occupations involving but little mental work or responsibility + are best, but unfortunately just those which promise excitement and + change are those which appeal to the neuropath.</p> + + <p>A light, clean, manual trade should be chosen, and those that mean + work in stuffy factories, amid whirring wheels and harmful fumes, using + dangerous tools, or climbing ladders, must be avoided.</p> + + <p>For the fairly robust, gardening or farming are good occupations, such + workers getting pure air, continuous exercise, and little brain-work. + Wood-working trades are good, if dangerous tools like circular saws are + left to others.</p> + + <p>For the frail neuropath with a fair education, drawing, modelling, + book-keeping, and similar semi-sedentary work may do. Other patients + might be suited as shoemakers, stonemasons, painters, plumbers or + domestic servants, so long as they always work on the ground.</p> + + <p>Some work is essential; better an unsuitable occupation than none at + all, for the downward tendency of the complaint is sufficiently marked + without the victim becoming an idler. Work gives stability.</p> + + <p>Epilepsy limits patients to a humble sphere, and <!-- Page 116 + --><span class="pagenum"><a name="page116"></a>[pg 116]</span> though + this is hard to a man of talent, it is but one of many hard lessons, the + hardest being to realize clearly his own limitations.</p> + + <p>If seizures be frequent, the ignorant often refuse to work with a + victim, who can only procure odd jobs, in which case he should strive to + find home-work, at which he can work slowly and go to bed when he feels + ill. A card in the window, a few handbills distributed in the district, + judicious canvassing, and perhaps the patronage of the local doctor and + clergy may procure enough work to pay expenses and leave a little over, + for the essential thing is to occupy the mind and exercise the body, not + to make money.</p> + + <p>Very few trades can be plied at home and many swindlers obtain money + under the pretence of finding such employment, charging an excessive + price for an "outfit", and then refusing to buy the output, usually on + the pretext that it is inferior. Envelope-addressing, postcard-painting + and machine-knitting have all been abused to this end.</p> + + <p>An auto-knitter seems to offer possibilities, but victims must + investigate offers carefully.</p> + + <p>Photography is easy. A cheap outfit will make excellent postcards, + modern methods having got rid of the dark room and much of the mess, and + postcard-size prints can be pasted on various attractive mounts.</p> + + <p>If the work is done slowly, and in a good light, and the patient has + an aptitude for it, ticket-writing is pleasant. Among small shopkeepers + there is a constant demand for good, plainly printed tickets at a + reasonable price.</p> + + <p>On an allotment near home vegetables and poultry might be raised, an + important contribution to the household, and one which removes the stigma + of being a non-earner.</p> + + <p>The mental discipline furnished by this home-work is invaluable, + Neuropaths, especially if untrained, are <!-- Page 117 --><span + class="pagenum"><a name="page117"></a>[pg 117]</span> unable to + concentrate their attention on any matter for long, and do their work + hastily to get it finished. When they find that to sell the work it must + be done slowly and perfectly they have made a great advance towards + training their minds to concentrate. Their weak inhibitory power is thus + strengthened with happy results all round.</p> + + <p>When the work and the weather permit, work should be done outdoors, + and when done indoors windows should be opened, and, if possible, an + empty or sparsely-furnished bedroom chosen for the work.</p> + + <p><b>Recreations</b>. These offer a freer choice, but those causing + fatigue or excitement must be avoided, for patients who have no energy to + waste need only fresh air and quiet exercise.</p> + + <p>Manual are better than mental relaxations. Dancing is unsuitable, + swimming dangerous, athletics too tiring and exciting. Bowls, croquet, + golf, walking, quoits, billiards, parlour games and quiet gymnastics + without apparatus are good, if played in moderation and much more gently + than normal people play them. Play is recreation only so long as a + pastime is not turned into a business. When a player is annoyed at + losing, though he loses naught save his own temper, any game has ceased + to be recreative.</p> + +<!-- Page 118 --><span class="pagenum"><a name="page118"></a>[pg 118]</span> + +<hr /> + +<p class="center">CHAPTER XXIV</p> + +<h3>HEREDITY</h3> + + <blockquote>"Man is composed of characters derived from pre-existing + germ-cells, over which he has no control. Be they good, bad, or + indifferent, these factors are his from his ancestry; the possession of + them is to him a matter of neither blame nor praise, but of necessity. + They are inevitable."—Leighton.</blockquote> + + <p>The body is composed of myriads of cells of <i>protoplasm</i>, in each + of which, is a <i>nucleus</i> which contains the factors of the + hereditary nature of the cell. In growth, the nucleus splits in half, a + wall grows between and each new cell has half the original factors,</p> + + <p>Female <i>ovum</i> and male <i>sperm</i> (the cells concerned with + reproduction) divide, thus losing half their factors, and when brought + together by sexual intercourse form a <i>germ-cell</i> having an equal + number of factors from mother and father.</p> + + <p>How these factors are mingled—whether shuffled like two packs of + cards, or mixed like two paints—we do not know. If two opposite + factors are brought together, one must lie dormant. The offspring may be + male or female, tall or short; it cannot be both, nor will there be a + mixture. <i>This rule only applies to clearly defined factors.</i></p> + + <p>We are <i>made by</i> the <i>germ-plasm</i> handed down to us by our + ancestors; in turn we pass it on to our children, <i>unaltered</i>, but + mixed with our partner's plasm.</p> + + <p>"The Dead dominate the Living" for our physical <!-- Page 119 --><span + class="pagenum"><a name="page119"></a>[pg 119]</span> and mental + inheritance is a mosaic made by our ancestors.</p> + + <p>Variations which may or may not be inheritable do arise spontaneously, + we know not how, and by variations all living things evolve.</p> + + <p>A child resembles his parents more than strangers, not because they + made cells "after their own image" but because both he and they got their + factors from the same source.</p> + + <p>Man's physical and mental, and the <i>basis</i> of his moral, + qualities depend entirely on the types of ancestral plasm combined in + marriage. Man may control his environment; his heritage is immutable. To + suppress an undesirable trait the germ-cell must unite with one that has + never shown it—one from a sound stock. An unsuitable mating in a + later generation, however, may bring it out again (for factors are + indestructible), and the individual showing it will have "reverted to + ancestral type".</p> + + <p>To give an instance: Does the son of a drunkard inherit a tendency to + drink? No! The father is alcoholic because he lacks control, consequent + upon the factors which make for control having been absent from his + germ-plasm. He passes on this lack; if the mother does the same, the + defect occurs—in a worse form—in the son. If the mother gives + a control factor, the son may be unstable or <i>apparently</i> stable, + this depending entirely on chance, but if the mother's plasm contains a + <i>strong</i> control-factor, the defect will lie dormant in her son, who + will have self-control, though if he marries the wrong woman he will have + weak-willed children.</p> + + <p>If the son becomes a toper, therefore, it is because he, like his + father before him, was born with a defect—weak control—which + might have made of him a drug-fiend, a tobacco-slave, a rake, or a + criminal; in his home drink would naturally be the temptation nearest + <!-- Page 120 --><span class="pagenum"><a name="page120"></a>[pg + 120]</span> to hand, and he would show his lack of control in + drunkenness.</p> + + <p>The way a lily-seed is treated makes a vast difference to the plant + which arises. If sown in poor soil, and neglected, a dwarf, sickly plant + will result; if sown in rich soil, and given every care that enthusiasm, + money and skill can suggest or procure, the result will be + magnificent.</p> + + <p>So with man. A well-nourished mother, free from care and disease, may + have a finer child than a half-starved woman, crushed by worry and work, + but neither starvation nor nourishment alter the inborn character of the + child.</p> + + <p>The <i>body-cells</i> are greatly changed by disease, poison, injury, + and overwork, but these changes are not passed on, and despite the + influence of disease from time immemorial, the <i>germ-cell</i> produces + the same man as in ancient days. Without this fixity of character, this + "continuity of the germ-plasm", "man" would cease to be, for the + descendants of changeable cells would be of infinite variety, having + fixity of neither form nor character.</p> + + <p>Epilepsy, hysteria and neurasthenia are all outward signs of defect in + the germ-plasm, and so they (or a predisposition to them) can be passed + on, and inherited.</p> + + <p>If a man shows a certain character, his plasm, had, and has, the + causative factor. He may have received it from <i>both</i> his parents, + when it will be <i>strong</i>, or from one only, when it will be + <i>normal</i>. If he have it not, it is absent. The same applies to the + plasm of the woman he mates, so there are six possible combinations, with + results according to "Mendel's Law."</p> + + <p><i>All</i> the children will not inherit a taint unless <i>both</i> + parents possess it, but, however strong one parent be, if the other is + tainted, <i>none</i> of the children can be absolutely clean, but will + show the taint, weak, strong, or dormant. This means that neuropathy will + recur—and <!-- Page 121 --><span class="pagenum"><a + name="page121"></a>[pg 121]</span> that it has previously + occurred—in the same family, unless there be continual mating into + sound stocks. If there is continual mating into bad stocks, it will recur + frequently and in severe forms. All intermediate stages may occur, + depending entirely on the qualities of the combining stocks.</p> + + <p>From this we shall expect, in the same stock, signs of neuropathic + taint other than the three diseases dealt with here, and these we get; + for alcoholism, criminality, chorea, deformities, insanity and other + brain diseases, are not infrequent among the relatives of a neuropath, + showing that the family germ-plasm is unsound.</p> + + <p>Epilepsy, one symptom of taint, is more or less interchangeable with + other defects; the taint, as a whole, is an inheritable unit whose + inheritance will appear as any one of many defects. This is shown by the + fact that very few epileptics have an epileptic parent. Starr's analysis + of 700 cases of epilepsy emphasizes this point.</p> + + <table cellpadding="5" summary="analysis of epilepsy"> + <tr><td>Epilepsy in a parent</td><td class="r">6</td></tr> + <tr><td>Epilepsy in a near relative</td><td class="r">136</td></tr> + <tr><td>Alcoholism in a parent</td><td class="r">120</td></tr> + <tr><td>Nervous Diseases in family</td><td class="r">118</td></tr> + <tr><td>Rheumatism and Tuberculosis</td><td class="r">184</td></tr> + <tr><td>Combinations of above diseases</td><td class="r">142</td></tr> + </table> + + <p>As medicine and surgery cannot add or delete plasmic factors, the only + way to stamp out neuropathy in severe forms would be to sterilize victims + by X-rays. This would be painless, would protect the race and not + interfere with personal or even with sexual liberty. In fifty years such + diseases would be almost extinct, and those arising from accident or the + chance union of dormant factors in apparently normal people could easily + be dealt with.</p> + +<!-- Page 122 --><span class="pagenum"><a name="page122"></a>[pg 122]</span> + + <p>There are 100,000 epileptics in Great Britain, and as <i>all</i> their + children carry a taint which tends to reappear as epilepsy in a later + generation <i>the number of epileptics doubles every forty years</i>. We + protect these unfortunates against others; why not posterity against + them?</p> + + <p>Neuropaths must pass on <i>some</i> defect; therefore, though victims + may marry, <i>no neuropath has a right to have children</i>.</p> + +<!-- Page 123 --><span class="pagenum"><a name="page123"></a>[pg 123]</span> + +<hr /> + +<p class="center">CHAPTER XXV</p> + +<h3>CHARACTER</h3> + + <blockquote>"All men are not equal, either at birth or by training. + Nature gives each of us the neural clay, with its properties of + pliability and of receiving impressions; nurture moulds and fashions it, + until a <i>character</i> is formed, a mingling of innate disposition and + acquired powers. But clay will be clay to the end; you cannot expect it + to be marble."—Thomson & Geddes.</blockquote> + + <blockquote>"Heaven lay not my transgression to my charge."—King + John.</blockquote> + + <p>It is essential that attendants, relatives, and friends carefully + study the character of neuropaths, and recognize clearly how abnormal it + is, for untold misery is caused by judging neuropaths by normal + standards.</p> + + <p>Patients are often harshly treated because others regard the victim of + defective inhibition as having gone deliberately to work, through wicked + perversity and pure wilfulness, to make himself a nuisance, to persist in + being a nuisance, and to refuse to be other than a nuisance, rather than + exercise what more fortunate men are pleased to term self-control.</p> + + <p>Character is usually appraised as "good" or "evil" by the nature of a + man's actions, the assumption being made that he can control his impulses + if he be so minded.</p> + + <p>This is not so. "Good" and "evil" are only relative terms. What one + man thinks "evil", a second holds "good", while a third is not + influenced.</p> + +<!-- Page 124 --><span class="pagenum"><a name="page124"></a>[pg 124]</span> + + <p>Now the performance of the act judged is directed by the performer's + brain, the constitution of which was pre-determined by the germ-plasm + from which he arose, so that <i>the basis of character is + inherited</i>.</p> + + <p>The moral sense is the last evolved and least stable attribute of the + last evolved and least stable of our organs, the brain; and brains are + born, not made to order. To blame a man for having weak control—a + sick will—is as unreasonable as to blame him for a cleft palate or + a squint. The "good" people who jog so quietly through life little reck + how much they owe their ancestors, from whom they received stability.</p> + + <p>These tendencies represent the total material for building character. + Training and environment can only nourish good tendencies and give bad + ones no encouragement to grow gigantic.</p> + + <p>If training and environment alone formed character, then children + reared together would be of similar disposition; by no means the case. + Similarly, if external influences altered inborn tendencies, then, not + only would the evil man be totally reformed by strong inducements to + virtue, but strong inducements to vice would lead totally astray the good + man, for "good" is no <i>stronger</i> than "evil", both being attributes + of mind.</p> + + <p>In mind as in body, from the moment he is conceived to the moment his + dust rests in the tomb, man is directed by immutable laws, though he is + not simply a machine directed by impulses over which he has no control. + There is real meaning in "strong will" and "weak will" will being a + tendency to deliberate before and be steadfast in action, a tendency + which varies immensely in different people. The fallacy of "free will" + lies in assuming that every one has this tendency equally developed, + making character a mere matter of saying "Yes!" and "No!" without + reference to the individual's mental make-up.</p> + + <p>Deliberate, persistent wickedness implies a strong <!-- Page 125 + --><span class="pagenum"><a name="page125"></a>[pg 125]</span> will, just + what neuropaths lack. A man of weak will can never be a very good nor yet + a very bad man. He will be very good at times, very bad at times, and + neutral at times, but neither for long; before sudden impulses, whether + good or bad, neuropaths are largely powerless.</p> + + <p>The many perversities of a neuropath are not deliberately put forth of + his "free will" to annoy both himself and others, for the neuropath + inherits his weak-control no less than his large hands.</p> + + <p>Friends <i>must</i> remember they are dealing with a person whose + <i>nature</i> it is to "go off half-cock", and who cannot be normal "if + he likes". The neuropath, young or old, says what he "thinks" <i>without + thinking</i>, that is he says what he <i>feels</i>, and acts hastily + without weighing consequences.</p> + + <div class="noflo"> + <div class="nofblk"> + <p><i>Cassius</i>: Have you not love enough to bear with me,</p> + <p>When that rash humour which my mother gave me</p> + <p>Makes me forgetful?</p> + </div> + + <div class="nofblk"> + <p><i>Brutus</i>: Yes, Cassius; and, from henceforth</p> + <p>When you are over-earnest with your Brutus,</p> + <p>He'll think your mother chides, and leave you so.</p> + </div> + </div> + +<hr /> + + <p>One cannot detail the effects of neuropathy on character, when its + victims include madmen, sexual perverts, idiots, criminals, imbeciles, + prostitutes, humble but honest citizens, common nuisances, invalids of + many kinds, misanthropists, designers, enthusiasts, composers, + communists, reformers, authors, artists, agitators, statesmen, poets, + prophets, priests and kings.</p> + + <p>Very mild epilepsy—from one fit a year to one in several + years—instead of hindering, seems rather to help mentality, and + many geniuses have been epileptic. These talented victims, are less rare + than the public <!-- Page 126 --><span class="pagenum"><a + name="page126"></a>[pg 126]</span> suppose, owing to the jealous care + with which symptoms of this disease are guarded. Socrates, Julius Cæsar, + Mahomet, Joan of Arc, Peter the Great, Napoleon, Byron, Swinburne, and + Dostoieffsky are but a few among many great names in the world of art, + religion and statecraft. Epileptic princes, kings and kinglets who have + achieved unenviable notoriety might be named by scores, Wilhelm II being + the most notable of modern times.</p> + + <p>This brilliant mentality is always accompanied by instability, and + usually by marked disability in other ways. The success of these men + often depends on an ability to view things from a new, quaint or queer + standpoint, which appeals to their more normal fellows.</p> + + <p>In matters that require great fertility, a quick grasp, ready wit, and + brilliant but not sustained mental effort, numerous neuropaths excel. In + things calling for calm, well-balanced judgment, or stern effort to + conquer unforseen difficulties, they fail utterly.</p> + + <p>Subtle in debate, they are but stumbling-blocks in council; brilliant + in conception, they fail in execution; fanciful designers, they are not + "builders of bridges". They are boastful, sparkling, inventive, witty, + garrulous, vain and supersensitive, outraging their friends by the + extravagance of their schemes; embarrassing their enemies by the subtlety + of their intrigues.</p> + + <p>They wing on exuberant imagination from height to height, but the + small boulders of difficulty trip them up, for they are hopelessly + unpractical; they have neither strength of purpose nor fortitude, and + their best-laid schemes are always frustrated at the critical moment, by + either the incurable blight of vacillation, or by the determination to + amplify their scheme ere it has proved successful, sacrificing probable + results for visionary improvements.</p> + + <p>Great and cunning strategists while fortune smiles, <!-- Page 127 + --><span class="pagenum"><a name="page127"></a>[pg 127]</span> they are + impotent to direct a retreat, but flee before the fury they ought to + face. They rarely have personal courage, but are timid, conciliatory and + vacillating just when bravery, sternness, and determination are needed; + furious, obstinate and reckless, when gentleness, diplomacy and wisdom + would carry their point.</p> + + <p>They are ready to forgive when there is magnanimity, vainglory and + probably folly in forgiveness, but will not overlook the most trivial + affront when there is every reason for so doing. They have brain, but not + ballast, and their whole life is usually a lopsided effort to "play to + the gallery".</p> + + <p>In poetry and literature, fancy has free play, and they often succeed, + sometimes rising to sublime heights; usually in the depiction of the + whimsical, the wonderful, the sardonic, the bizarre, the monstrous, or + the frankly impossible. They are not architects as much as jugglers of + words, and descriptive writing from an acute angle of vision is their + forte. They sometimes succeed as artists or composers, for in these + spheres they need not elaborate their ideas in such clean-cut detail, but + many who might succeed in these branches have not sufficient strength of + purpose to do the preliminary "spadework".</p> + + <p>They have too many talents, too many differing inclinations, too much + impetuosity, too much vanity, too little concentration and will-power, + and they fail in ordinary walks of life from the lack of resolution to + lay the foundations necessary to successful mediocrity.</p> + + <p>No greater obstacle to progress exists than the reputation for talent + which this class acquire on a flimsy basis of superficial brilliance in + conversation or a penchant for witty repartee. They are self-opinionated + and egoistical, with a conceit and assurance out of all proportion to + their abilities. Their mental perspective is distorted and they are + conspicuous for their obstinacy. In conversation they are prolix and <!-- + Page 128 --><span class="pagenum"><a name="page128"></a>[pg 128]</span> + pretentious, and they often contract religious mania, in which their + actions by no means accord with their protestations, for they have very + elementary notions of right and wrong, or no notions at all.</p> + + <p>Often they are precocious, but untruthful, cruel, and vicious; the + despair of relatives, friends, and teachers. They combine unusual + frankness with an audacity and impulsiveness that is very misleading, for + below this show of fire and power there is no stability.</p> + + <p>Their character is a tangle of mercurial moods, the neuropath being + passionate but loving, sullen one moment, overflowing with sentimental + affection the next, vicious a little while later, quick to unreasoning + anger, and as quick to repent or forgive, obstinate but easily led, + versatile but inconstant, noble and mean by turns, full of contradictions + and contrasts, at best a brilliant failure, vain, deaf to advice or + reproof, having in his ailing frame the virtues and vices of a dozen + normal men.</p> + + <p>Mercier aptly describes him:</p> + + <blockquote>"There is a large class of persons who are often of acute and + nimble intelligence, in general ability equal to or above the average, of + an active, bustling disposition, but who are utterly devoid of industry. + For by industry we mean steady persistence in a continuous employment in + spite of monotony and distastefulness; an employment that is followed at + the cost of present gratification for the sake of future benefit. Of such + self-sacrifice these persons are incapable. They are always busy, but + their activity is recreative, in the sense that it is congenial to them, + and from it they derive immediate gratification. As soon as they tire of + what they are doing, as soon as their occupation ceases to be in itself + attractive it is relinquished for something else, <!-- Page 129 --><span + class="pagenum"><a name="page129"></a>[pg 129]</span> which in its turn + is abandoned as soon as it becomes tedious.</blockquote> + + <blockquote>"Such people form a well-characterized class: they are + clever; they readily acquire accomplishments which do not need great + application; and agreeably to the recreative character of their + occupations, their natures are well developed on the artistic side. They + draw, paint, sing, play, write verses and make various pretty things with + easy dexterity. Their lack of industry prevents them ever mastering the + technique of any art; they have artistic tastes, but are always + amateurs.</blockquote> + + <blockquote>"With the vice of busy idleness they display other vices. The + same inability to forgo immediate enjoyment, at whatever cost, shows + itself in other acts. They are nearly always spendthrifts, usually + drunkards, often sexually dissolute. Next to their lack of industry, + their most conspicuous quality is their incurable mendacity. Their + readiness, their resources, their promptitude, the elaborate + circumstantiality of their lies are astonishing. The copiousness and + efficiency of their excuses for failing to do what they have undertaken + would convince anyone who had no experience of their capabilities in this + way.</blockquote> + + <blockquote>"Withal, they are excellent company, pleasant companions, + good-natured, easy-going, and urbane. Their self-conceit is inordinate, + and remains undiminished in spite of repeated failures in the most + important affairs of life. They see themselves fall immeasurably behind + those who are admittedly their inferiors in cleverness, yet they are not + only cheery and content, but their confidence in their own powers and + general superiority to other people remains undiminished.</blockquote> + + <blockquote>"<i>The lack of self-restraint is plainly an inborn + character</i>, for it may show itself in but one member of the family + brought up in exactly the same circumstances as other members who do not + show any such peculiarity. The victim is born with <!-- Page 130 --><span + class="pagenum"><a name="page130"></a>[pg 130]</span> one important + mental faculty defective, precisely as another may be born with + hare-lip."</blockquote> + + <p>In neuropaths the mental mechanism of <i>projection</i>, which we all + show, is often marked.</p> + + <p>Any personal shortcoming, being repugnant to us causes self-reproach, + which we avoid by "projecting" the fault (unconsciously) on some one + else.</p> + + <p>Readers should get "The Idiot" by Fedor Dostoieffsky, an epileptic + genius who saw that for those like him, happiness could be got through + peace of mind alone, and not in the cut-throat struggle for worldly + success. He projected his stabler self into Prince Muishkin, the idiot, + and every one of the six hundred odd pages of this amazing description of + a neuropathic nation is stamped with the hall-mark of genius.</p> + +<!-- Page 131 --><span class="pagenum"><a name="page131"></a>[pg 131]</span> + +<hr /> + +<p class="center">CHAPTER XXVI</p> + +<h3>MARRIAGE</h3> + + <blockquote>"Between two beings so complex and so diverse as man and + woman, the whole of life is not too long for them to know one another + well, and to learn to love one another + worthily."—Comte.</blockquote> + + <p>No neuropath should have children, but marriage is good in mild cases, + for neuropaths are benefited by sympathetic companionship, and their + sexual passions are so strong that they must be gratified, by marriage, + prostitution, or unnaturally.</p> + + <p>Bernard Shaw's sneer—</p> + + <blockquote>"Marriage is popular because it combines the maximum of + temptation with the maximum of opportunity"—</blockquote> + + <p>is justifiable, though the "maximum of opportunity" is better than a + maximum of unnatural devices to satisfy and intensify normal and abnormal + cravings.</p> + + <p>There is a popular belief that an epileptic girl is cured by + pregnancy, a state that ought never to occur.</p> + + <p>The lack of sex-education causes millions of miserable marriages. + Sexual desire is cultivated out of all proportion to other desires, the + will cannot control the desire to relieve an intolerable sense of + discomfort, and men eagerly seize the first chance of being able to + satisfy these fierce cravings at pleasure.</p> + + <p>If sex were treated sensibly it would develop into a <!-- Page 132 + --><span class="pagenum"><a name="page132"></a>[pg 132]</span> powerful + instead of an overpowering appetite, and reason would have some say in + the choice of a life-partner.</p> + + <p>A neuropath needs a calm, even-tempered, "motherly" wife. For him, + gentleness, self-control, sound common sense and domestic virtues are + superior to wit or beauty. Unfortunately, contrary to public belief, + people are attracted by their like, not by their opposites. The + sensitive, refined neuropath finds the normal person insipid and dull; + the normal person is rendered uncomfortable by the morbid caprices of the + neuropath.</p> + + <p>There must be no disparity of age, for at the menopause the woman no + longer seeks the sexual embrace, and if her husband be young + unfaithfulness ensues. Not only that, but she, knowing, probably to her + sorrow, how rarely the hopes of youth mature, cannot take a keen interest + in his ambitions like a younger woman, or fire his dying enthusiasm at + difficult parts of the way. If he be his wife's senior he will be as + little able to appreciate her ideas and habits.</p> + + <p>An excitable, volatile, garrulous, "neighbourly" woman, or one who can + do little save strum on the piano or make embroidery as intricate as it + is useless, means divorce or murder. For him, sweetness, gentleness, + self-control, sound common sense, shrewdness, and domestic virtues are + incomparably superior to any mental brilliance or physical comeliness. He + needs a "homely" woman, and should remember that no banking account can + match a sweet, womanly personality, and no charms compare to a sunny + heart, and an ability steadfastly to "see the silver lining".</p> + + <p>He must on no account marry a woman in indifferent health, for under + the strain of her husband's infirmity the woman, who if she were well + would be a help, is a source of expense, worry and friction.</p> + + <p>On the other hand the woman who receives a proposal <!-- Page 133 + --><span class="pagenum"><a name="page133"></a>[pg 133]</span> from a + neuropath, be he ever so gifted, has grave grounds for pausing, though it + is hard to counter the specious arguments of one who may be "a man o' + pairts", a witty companion and an ardent lover. It is doubtful if a + neuropath is ever permeated by a steadfast emotion, for all his emotions + are fierce but unstable, the love of an inconsistent man being ten times + more ardent than that of a faithful one, <i>while it lasts</i>.</p> + + <blockquote>"You can't marry a man without taking his faults with his + virtues,"</blockquote> + + <p>and love must be strong enough to stand, not storms alone, but the + minor miseries of life, the incessant pinpricks, the dreary days when the + smile abroad has become the scowl at home. At best, her husband will be + capricious, hard to please, and though rabidly jealous without cause, at + the same time very partial to the attractions of other women. He usually + needs the attention of the whole household, which his varying health and + moods keep in a mingled state of anxious solicitude and smouldering + resentment.</p> + + <p>His infirmity may mean a very secluded and humdrum life. She will have + to make home an ever-cheery place, an ideal that means hard work and + self-sacrifice through lonesome years in which her nobility will be + unrecognized and unrewarded.</p> + + <p>A woman fond of amusements and sport, and having many acquaintances + would find this unbearable. Any happiness in marriage to a neuropath is + largely dependent on the self-sacrifice of the wife.</p> + + <p>Should marriage occur, the wife must judiciously curb her husband's + passions without driving him to other women by coldness, a problem which + is often solved by separation. The suggestion should never come from her, + and the more she can curb his ardour by tactful suggestion, the healthier + will he and the <!-- Page 134 --><span class="pagenum"><a + name="page134"></a>[pg 134]</span> happier will she be, for nothing + causes such an irritable, nervous state as excessive coitus.</p> + + <p>She will often have to give way in this matter, but must be firm on + the necessity for preventing conception, for she can only bear a tainted + child; her responsibility is great, and she must <i>insist</i> that her + husband use those simple methods which prevent conception, thereby ending + in himself one branch of a worthless tree. This must be done at any cost, + for her happiness is nought compared to the welfare of future + generations. Bitter though it be that no fruit of her womb may call her + blessèd, it is less bitter than hearing her children call themselves + accursèd.</p> + + <blockquote>"So many severall wayes are we plagued and punished for our + father's defaultes, that it is the greatest part of our felicity to be + well born, and it were happy for humankind if only such parentes as are + sounde of body and mind should be suffered to marry. An Husbandman will + sow none but the choicest seed upon his lande; he will not reare a bull + nor an horse, except he be right shapen in all his parts, or permit him + to cover a mare, except he be well assured of his breed; we make choice + of the neatest kine, and keep the best dogs, and how careful then should + we be in begetting our children? In former tyme, some countreys have been + so chary in this behalf, so stern, that if a child were crooked or + deformed in body or mind, they made it away; so did the Indians of old, + and many other well gouverned Commonwealths, according to the discipline + of those times. Heretofore in Scotland, if any were visited with the + falling sickness, madness, goute, leprosie, or any such dangerous + disease, which was like to be propagated from the father to the son, he + was instantly gelded; a woman kept from all company of men; and if by + chance, having some such disease, she was found to be with child <!-- + Page 135 --><span class="pagenum"><a name="page135"></a>[pg 135]</span> + she with her brood were buried alive; and this was done for the common + good, lest the whole nation should be injured or corrupted. A severe + doom, you will say, and not to be used among Christians. Yet to be more + looked into than it is. For now, by our too much facility in this kind, + in giving way to all to marry that will, too much liberty and indulgence + in tolerating all sorts, there is a vast confusion of hereditary + diseases; no family secure, no man almost free from some grievous + infirmity or other. Our generation is corrupt, we have so many weak + persons, both in body and mind, many feral diseases raging among us, + crazed families: our fathers bad, and we like to be worse."</blockquote> + + <p>Her husband will want much petting and caressing, and she must foster + his love by lavishing on him much fondness, and ignoring amours as but + the mischievous results of his restless, intriguing mind.</p> + + <p>She must let him see in an affectionate way that she can let others + enjoy his company betimes, secure in the knowledge that she is supreme in + his affections—cajolery that flatters his overweening vanity, and + rarely fails.</p> + + <p>In anger, as in every other emotion, the neuropath is as transient as + he is truculent. A trivial "tiff" will make him blaze up in ungovernable + rage and say most abominable and untruthful things; even utter violent + threats. He will not admit he is wrong, but like a spoilt child must be + kissed and coaxed into a good temper, first with himself and with others + next.</p> + + <p>At one moment he is in a perfect paroxysm of fury; five minutes later + he is passionately embracing the luckless object of it and vowing eternal + devotion. In a further five he has forgotten all his remarks and would + hotly deny he used the vexing statements imputed to him.</p> + +<!-- Page 136 --><span class="pagenum"><a name="page136"></a>[pg 136]</span> + + <p>Epileptics are morbidly sensitive, and reference to their malady must + be avoided. Victims are intensely suspicious, and a pitying look will + reveal to them the fact that some outsider knows all about the + jealously-guarded skeleton. Resentment, distrust and misery follow such + an exposure, for every innocent look is then translated into a + contemptuous glance, and the victim detects slights undreamt of in any + brain save his own.</p> + + <p>Unless seizures are severe, no one should be called in; if they cause + alarm, ask a discreet male neighbour to assist when necessary, leaving + when the convulsions abate so that the victim is not aware of his + presence. Avoid the word "fit" and "epilepsy", and if reference to the + attack be necessary, refer to it as a "faint" or "turn".</p> + + <p>Living with a man liable to have a fit at inopportune times is a + tremendous strain, and the soundest advice one can offer a woman thinking + of marrying such a one is Punch's—"DON'T!"</p> + + <p>We have painted the black side, but, tactfully managed, a neuropath + will merge in the kindest of husbands, the most constant of lovers. The + wife need not be unhappy. Tactless, masterful women will fail, but no one + is more easily led, particularly in the way he should not go, than a + neuropath.</p> + + <p>A man with definite views of his own value will not be successful foil + for "mother-in-lawing", nor remain quiet under the interference of + relatives, who should remember that well-meaning intentions do not + justify meddling actions.</p> + + <p>Many a neuropath led a useful life and gained success in a profession, + solely because his wife tactfully kept him in the path, watched his + health, prevented him frittering away his gifts in many pursuits or + useless repining, and made home a real haven.</p> + + <p>When the yolk seems unbearably heavy, the wife <!-- Page 137 --><span + class="pagenum"><a name="page137"></a>[pg 137]</span> should remember her + husband has to bear the primary, she only the reflected misery, for the + limitations neuropathy puts on every activity and ambition, social and + professional, are frightfully depressing.</p> + + <p>In spite of his peevishness her husband may be trying hard to minimize + his defects and be a reasonable, helpful companion.</p> + + <div class="noflo"> + <div class="nofblk"> + <p>"Judge not the working of his brain,</p> + <p>And of his heart thou can'st not see;</p> + <p>What looks to thy dim eyes a stain</p> + <p>In God's pure light may only be</p> + <p>A scar brought from some well-fought field,</p> + <p>Where thou would'st only faint and yield."</p> + </div> + </div> + + <p>Magnify his virtues and be tenderly charitable to his many frailties, + for he is "not as other men" and too well he knows it. Love at its best + is so complex that it easily goes awry, but death will one day dissolve + all its complexity, and when, maybe after "many a weary mile"</p> + + <div class="noflo"> + <div class="nofblk"> + <p>"The voice of him I loved is still,</p> + <p>The restless brain is quiet,</p> + <p>The troubled heart has ceased to beat</p> + <p>And the tainted blood to riot"—</p> + </div> + </div> + + <p>it will comfort you to reflect that you did your duty and, to best the + of your ability, fulfilled your solemn pledge to love and honour him.</p> + + <p>To quote George Eliot:</p> + + <blockquote>"What greater reward can thou desire than the proud + consciousness that you have strengthened him in all labour, comforted him + in all sorrow, ministered to him in all pain, and been with him in silent + but unspeakably holy memories at the moment of eternal + parting?"</blockquote> + +<!-- Page 138 --><span class="pagenum"><a name="page138"></a>[pg 138]</span> + + <p>Surely, none!</p> + + <p>We have considered the mournful case of a wife with a neuropathic + husband, and must now say a few words about the truly distressing fate of + a husband afflicted with a neuropathic wife, for neuropathy in its + unpleasant consequences to others is far worse in woman than in man.</p> + + <p>A man is at work all day, and his mind is perforce distracted from his + woes, and, though he retails them at night to the home circle, they get + so used to them as to disregard them, proffering a few words of + agreement, sympathy or scorn quite automatically.</p> + + <p>With women the distraction of work is not so complete, for housework + can be neglected, there are always neighbours and friends to listen to + tales of woe and thus generate a very harmful self-pity, and women are + not content to enumerate their woes, but demand the attention and + sympathy of all listeners.</p> + + <p>Many of the facts in the foregoing parts of this chapter apply with + equal force to both sexes, but women being usually more patient, tactful, + resigned and self-sacrificing than men, can—and often + do—alleviate the lot of the male neuropath; whereas the absence of + these qualities in the average man means that he aggravates, instead of + alleviating, the lot of any female neuropath to whom he may be + wedded.</p> + + <p>Having taken her "for better, for worse" he will find her irritating, + unreasonable, and unfitted to shoulder domestic responsibilities. Her + likes and dislikes, fickle fancies, unreasonable prejudices, selfish ways + will cause trouble; he must be prepared for misunderstandings and feuds + with relatives and friends, and on reaching home tired and worried, he is + like to find his house in disorder, be assailed by a tale of woe, and + perhaps find that his wife's vagaries have involved him in a tiff with + neighbours.</p> + + <p>She will be fretful, exacting, impatient, and given <!-- Page 139 + --><span class="pagenum"><a name="page139"></a>[pg 139]</span> to ready + tears. Sensitive to the last degree, she will see slights where none are + intended, and a chiding word, a reproachful look, or a weary sigh will + mean a fit of temper or depression.</p> + + <p>Not only are men less gifted for "managing" women than vice versa, but + women are far less susceptible to tactful management than men; a man, + like a dog, can be led almost anywhere with a little dragging at the + chain and growling now and then; a woman, like a cat, is more likely to + spit, swear, and scratch than come along.</p> + + <p>Consequently, it is almost impossible to suggest means of obtaining + relief to one who has been luckless enough to marry, or be married by, a + neuropathic woman.</p> + + <p>If the husband sympathize, the condition will but be aggravated; + medicinal measures will only increase, instead of diminishing, the number + of symptoms; indifference will procure such an exhibition as will both + prove its uselessness and ensure the attention craved.</p> + +<!-- Page 140 --><span class="pagenum"><a name="page140"></a>[pg 140]</span> + +<hr /> + +<p class="center">CHAPTER XXVII</p> + +<h3>SUMMARY</h3> + + <p>To sum up: we have learnt that Epilepsy is a very ancient disease due + to some instability of the brain, in which convulsions are a common but + not invariable symptom.</p> + + <p>Its actual cause is unknown. Heredity plays a big part, but there are + secondary causes beside factors which excite attacks.</p> + + <p>Various methods and drugs to prevent seizures have a limited use.</p> + + <p>First-aid treatment consists solely in preventing the victim + sustaining any injury.</p> + + <p>Neurasthenia is a disease due to nerve-exhaustion and poisoning from + overwork and worry. Its symptoms are many, but fatigue and irritability + are the chief.</p> + + <p>Hysteria is an obstinate, functional, nervous disease in which the + patient acts in an abnormal manner, which is highly provoking to other + individuals.</p> + + <p>The cure for hysteria and neurasthenia is solely hygienic, and depends + mainly on the patient.</p> + + <p>The first step towards health consists in getting any slight organic + defects remedied.</p> + + <p>Digestion is often poorly performed.</p> + + <p>This must be remedied by thorough mastication and rational + dieting.</p> + + <p>Constipation is very inimical to neuropaths, and must be remedied.</p> + + <p>Patients must pay careful attention to general hygiene.</p> + +<!-- Page 141 --><span class="pagenum"><a name="page141"></a>[pg 141]</span> + + <p>Insomnia is exhausting and must be conquered.</p> + + <p>The effects of imagination are profound.</p> + + <p>Suggestion treatment overcomes imaginary ills.</p> + + <p>Drug treatment is either of very limited utility, or frankly + useless.</p> + + <p>Patent medicines are never of the slightest use.</p> + + <p>The rational training of neuropathic children is a very difficult but + essential task.</p> + + <p>Puberty and adolescence are very critical times.</p> + + <p>Occupations and recreations must be wisely chosen.</p> + + <p>Heredity is the primary cause of these diseases. As it cannot be + treated, sufferers must not have children.</p> + + <p>Character is abnormal in nervous disease.</p> + + <p>Marriage is very undesirable.</p> + + <p>As a parting injunction, whether you are an epileptic or a + neurasthenic, or a friend, relative, or attendant of such a one:</p> + +<h3>"GO THOU SOFTLY ALL THY DAYS!"</h3> + +<!-- Page 142 --><span class="pagenum"><a name="page142"></a>[pg 142]</span> + +<hr /> + +<h3>BIBLIOGRAPHY</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>"Oh! for a booke and a shadie nooke,</p> + <p>Eyther indoore or oute;</p> + <p>Where I maie reade, all atte my ease</p> + <p class="i2">Both of the newe and olde:</p> + <p>For a jollie goode booke, whereonne to looke</p> + <p class="i2">Is better to me than golde!"</p> + </div> + </div> + + <p>The following books are suitable for laymen, and are most of them very + readable.</p> + +<h4>EPILEPSY</h4> + + <p>We know of no book suitable for laymen,</p> + +<h4>NEURASTHENIA AND HYSTERIA</h4> + + <p>"Nervous Disorders of Men" (Kegan Paul) Hollander.</p> + + <p>"Nervous Disorders of Women" (Kegan Paul) Hollander.</p> + + <p>"National Degeneration" (Cornish, Birmingham) D.F. Harris.</p> + + <p>"Hysteria and Neurasthenia" J.M. Clarke.</p> + + <p>"The Management of a Nerve Patient" Schofield.</p> + + <p>"Confessions of a Neurasthenic" (F.A. Davis Co., Philadelphia) + Marrs.</p> + + <p>"Conquest of Nerves" (Macmillan) Courtney.</p> + +<h4>GENERAL:</h4> + +<p class="center">INDIGESTION</p> + + <p>"Indigestion" Herschell.</p> + +<p class="center">DIETING</p> + + <p>"Dietetics" (Jack's People's Books) A. Bryce.</p> + + <p>"Diet in Dyspepsia" Tibbles.</p> + + <p>"Cookery for Common Ailments" Brown.</p> + +<!-- Page 143 --><span class="pagenum"><a name="page143"></a>[pg 143]</span> + +<p class="center">CONSTIPATION</p> + + <p>"Constipation" Bigg.</p> + +<p class="center">HYGIENE</p> + + <p>"Laws of Life and Health" A. Bryce.</p> + + <p>"Health" M.M. Burgess.</p> + +<p class="center">INSOMNIA</p> + + <p>"Sleep and Sleeplessness" H.A. Bruce.</p> + + <p>"The Meaning of Dreams" I.H. Coriat.</p> + +<p class="center">IMAGINATION</p> + + <p>"Psychology in Daily Life" Seashore.</p> + + <p>"Hygiene of the Mind" T.S. Clouston.</p> + +<p class="center">SUGGESTION</p> + + <p>"Hypnotism and Suggestion" Hollander.</p> + + <p>"How to Treat by Suggestion" Ash.</p> + + <p>"Hypnotism and Self-Education" (Jack's People's Books) + Hutchinson.</p> + +<p class="center">PATENT MEDICINES</p> + + <p>"Patent Foods and Patent Medicines" (Bale & Davidson) + Hutchinson.</p> + + <p>See Chapter XX for B.M.A. Books.</p> + +<p class="center">THE CHILD</p> + + <p>"Our Baby" R.D. Clark.</p> + + <p>"Abnormal Children" (Kegan Paul) Hollander.</p> + + <p>"The Baby" (Jack's People's Books) Anonymous.</p> + + <p>"Training the Child" (Jack's People's Books) Spiller.</p> + +<p class="center">PUBERTY</p> + + <p>"Youth and Sex" (Jack's People's Books) Scharlieb and Sibley.</p> + + <p>"Woman in Childhood, Wifehood, and Motherhood" M.S. Cohen.</p> + + <p>"The Adolescent Period" Starr.</p> + + <p>"Physiology" (Home Univ. Library) McKendrick.</p> + + <p>"Human Physiology" Leonard Hill.</p> + +<!-- Page 144 --><span class="pagenum"><a name="page144"></a>[pg 144]</span> + +<p class="center">HEREDITY AND CHARACTER</p> + + <p>"Evolution" (Home Univ. Library) Thomson and Geddes.</p> + + <p>"Heredity in the Light of Recent Research" (Cam. Univ. Press) + Doncaster.</p> + + <p>"The Psychology of Insanity" (Cam. Univ. Press) Bernard Hart.</p> + +<p class="center">MARRIAGE</p> + + <p>"On Conjugal Happiness" R.G.S. Krohn</p> + + <p>"Race Culture and Race Suicide" R.R. Rentoul.</p> + +<!-- Page 145 --><span class="pagenum"><a name="page145"></a>[pg 145]</span> + +<hr /> + +<h3>INDEX</h3> + + <div class="noflo"> + <div class="nofblk"> + <p>ABORTIVES, Use of, as cause of epilepsy, <a href="#page22">22</a></p> + <p>Age-incidence in epilepsy, <a href="#page17">17</a>, <a href="#page18">18</a></p> + <p>Air, Fresh, Importance of, <a href="#page73">73</a></p> + <p>Alcohol, The question of, <a href="#page64">64</a></p> + <p>Alcoholic excess in relation to epilepsy, <a href="#page16">16</a>, <a href="#page21">21</a>-<a href="#page23">23</a></p> + <p>—— —— neurasthenia, <a href="#page31">31</a></p> + <p>Amyl Nitrite, to check the aura in epilepsy, <a href="#page26">26</a></p> + <p>Analyses of proprietary preparations for children, <a href="#page13">13</a></p> + <p>—— —— purgative medicines, <a href="#page62">62</a></p> + <p>—— of secret remedies, British Medical Association, <a href="#page13">13</a>, <a href="#page62">62</a>, <a href="#page92">92</a></p> + <p>Arson as manifestation of mental epilepsy, <a href="#page10">10</a></p> + <p>Aspirin for post-epileptic headache, <a href="#page29">29</a></p> + <p>Aura, The, <a href="#page2">2</a>, <a href="#page3">3</a>, <a href="#page25">25</a></p> + <p>——, ——, in Jacksonian epilepsy, <a href="#page8">8</a></p> + <p>——, Treatment of the, <a href="#page25">25</a>, <a href="#page26">26</a></p> + <p>Auto-intoxication, <a href="#page68">68</a></p> + <p>Auto-suggestion, Value of, <a href="#page80">80</a>, <a href="#page83">83</a></p> + </div> + + <div class="nofblk"> + <p>BACKACHE in neurasthenia, <a href="#page32">32</a></p> + <p>Baths, Advice as to, for neuropaths, <a href="#page48">48</a>, <a href="#page73">73</a>, <a href="#page74">74</a></p> + <p>Blaud's pills, <a href="#page95">95</a></p> + <p>Brain, Morbid changes in, associated with epilepsy, <a href="#page18">18</a>, <a href="#page19">19</a></p> + <p>——, Structure of the, <a href="#page20">20</a></p> + <p>Bromides, Action of, hindered by salt, <a href="#page65">65</a></p> + <p>—— in the prevention of epilepsy, <a href="#page26">26</a></p> + <p>—— —— treatment of epilepsy, <a href="#page86">86</a>-<a href="#page88">88</a>, <a href="#page92">92</a></p> + <p>—— the basis of every epilepsy cure, <a href="#page92">92</a></p> + <p>Bromism, <a href="#page87">87</a></p> + <p>Brooding, harmful to neuropaths, <a href="#page49">49</a>, <a href="#page50">50</a></p> + </div> + + <div class="nofblk"> + <p>CALM necessary in dealing with nervous children, <a href="#page106">106</a></p> + <p>Carlyle, <a href="#page90">90</a></p> + <p>Character, <a href="#page123">123</a>-<a href="#page30">30</a></p> + <p>——, The basis of, <a href="#page124">124</a></p> + <p>Chyle, The, <a href="#page57">57</a></p> + <p>Chyme, The, <a href="#page56">56</a></p> + <p>Circulation, The, in neuropaths, <a href="#page73">73</a></p> + <p>Circulatory Disturbances in neurasthenia, <a href="#page33">33</a></p> + <p>Clark on frequency of fits during repose, <a href="#page23">23</a></p> + <p>Clark's statistics of epilepsy, <a href="#page15">15</a></p> + <p>Cleanliness, <a href="#page73">73</a></p> + <p>Climacteric, in relation to hysteria, <a href="#page41">41</a></p> + <p>Clothing for neuropaths, <a href="#page74">74</a></p> + <p>Coddling, Danger of, for nervous children, <a href="#page103">103</a></p> + <p>"Complex", The, in consciousness, <a href="#page10">10</a>, <a href="#page11">11</a></p> + <p>Concentration, Lack of, in neurasthenia, <a href="#page34">34</a></p> + <p>——, Mental, Exercises in, <a href="#page51">51</a></p> + <p>Confession, The value of, <a href="#page40">40</a></p> + <p>Conscious Mind, The, <a href="#page10">10</a>, <a href="#page39">39</a></p> + <p>Consciousness, Alteration of, in epileptic attack, <a href="#page3">3</a>, <a href="#page4">4</a>, <a href="#page6">6</a></p> + <p>——, Dissociation of, <a href="#page11">11</a></p> + <p>Constipation, <a href="#page67">67</a>-<a href="#page70">70</a></p> + <p>——, Causes of, <a href="#page67">67</a>, <a href="#page68">68</a></p> + <p>——, Symptoms of, <a href="#page68">68</a></p> + <p>——, Treatment of, <a href="#page68">68</a>-<a href="#page70">70</a></p> + <p>Convulsions, Epileptic. <i>See</i> "Fit"</p> + <p>—— in alcoholism, <a href="#page23">23</a></p> + <p>—— in children, <a href="#page13">13</a></p> + <p>—— in diabetes, <a href="#page23">23</a></p> + <p>—— in pregnancy, <a href="#page14">14</a></p> + <p>Cooking in relation to digestibility, <a href="#page58">58</a></p> + <p>Country resorts suitable for neuropaths, <a href="#page47">47</a></p> + <p>Criminal acts in psychic or mental epilepsy, <a href="#page9">9</a>, <a href="#page10">10</a></p> + <p>Culpepper's Herbal, <a href="#page86">86</a></p> + <p><!-- Page 146 --><span class="pagenum"><a name="page146"></a>[pg 146]</span></p> + </div> + + <div class="nofblk"> + <p>DARK, Nervous children's fear of the, <a href="#page105">105</a></p> + <p>Day-dreaming, <a href="#page11">11</a>, <a href="#page108">108</a></p> + <p>Death, <a href="#page58">58</a></p> + <p>Degeneration, Signs of, in epileptics, <a href="#page17">17</a></p> + <p>Dementia, Epileptic, <a href="#page16">16</a></p> + <p>Demonic Influence in relation to epilepsy, <a href="#page1">1</a>, <a href="#page2">2</a></p> + <p>Dieting, <a href="#page63">63</a>-<a href="#page66">66</a></p> + <p>Digestion of foods, <a href="#page58">58</a>, <a href="#page59">59</a></p> + <p>—— ——, Time occupied by the, <a href="#page58">58</a></p> + <p>——, The process of, <a href="#page56">56</a>-<a href="#page59">59</a></p> + <p>Digestive troubles in relation to epilepsy, <a href="#page22">22</a>, <a href="#page26">26</a></p> + <p>—— ——, neurasthenia, <a href="#page32">32</a>, <a href="#page33">33</a></p> + <p>Discipline of the nervous child, <a href="#page103">103</a>-<a href="#page106">106</a></p> + <p>Dissociation of consciousness, <a href="#page11">11</a></p> + <p>Dostoieffsky's "The Idiot", a study of epilepsy, <a href="#page130">130</a></p> + <p>Douche, The cold, for neuropaths, <a href="#page74">74</a></p> + <p>Dreams, <a href="#page12">12</a></p> + <p>——, Sex-basis in, <a href="#page12">12</a></p> + <p>Drug habit, The, in neuropaths, <a href="#page93">93</a></p> + <p>Duties and trials of a neuropath's wife, <a href="#page132">132</a>-<a href="#page137">137</a></p> + </div> + + <div class="nofblk"> + <p>EARS, Care of the, <a href="#page53">53</a></p> + <p>Egoism in relation to neurasthenia, <a href="#page38">38</a></p> + <p>Electrical treatment for neuropaths, <a href="#page50">50</a></p> + <p>Emotional repression as a factor in hysteria, <a href="#page40">40</a></p> + <p>Enema, The use of the, <a href="#page69">69</a></p> + <p>Energy from food, <a href="#page58">58</a></p> + <p>Epilepsy a functional disease, <a href="#page2">2</a></p> + <p>——, Ancient remedies for, <a href="#page86">86</a></p> + <p>—— as a mental complex, <a href="#page23">23</a></p> + <p>—— ascribed to demonic influence, <a href="#page1">1</a>, <a href="#page2">2</a></p> + <p>——, Biblical reference to, <a href="#page2">2</a></p> + <p>——, Causes of, <a href="#page20">20</a>-<a href="#page24">24</a></p> + <p>——, Clinical course of, <a href="#page15">15</a>-<a href="#page19">19</a></p> + <p>——, Cure in, <a href="#page19">19</a></p> + <p>——, Definition of, <a href="#page1">1</a>, <a href="#page19">19</a></p> + <p>——, Effect of, on general health, <a href="#page16">16</a></p> + <p>——, Feigned, <a href="#page14">14</a></p> + <p>——, ——, Diagnosis of, <a href="#page14">14</a></p> + <p>——, Historical account of, <a href="#page1">1</a>, <a href="#page2">2</a></p> + <p>—— in mediæval times, <a href="#page2">2</a></p> + <p>—— in neurasthenics, <a href="#page35">35</a></p> + <p>—— in relation to genius, <a href="#page125">125</a>-<a href="#page127">127</a></p> + <p>—— —— marriage, <a href="#page131">131</a></p> + <p>——, Jacksonian, <a href="#page7">7</a>-<a href="#page9">9</a></p> + <p>——, ——, its relative frequency, <a href="#page15">15</a></p> + <p>——, Major and minor, <a href="#page1">1</a>-<a href="#page6">6</a></p> + <p>——, Medicines for, <a href="#page86">86</a>-<a href="#page89">89</a></p> + <p>——, Mental, <a href="#page9">9</a>, <a href="#page10">10</a></p> + <p>——, ——, Rarity of, <a href="#page15">15</a></p> + <p>——, Nocturnal, <a href="#page4">4</a>, <a href="#page5">5</a></p> + <p>——, ——, its relative frequency, <a href="#page15">15</a></p> + <p>——, Preventive treatment of, <a href="#page25">25</a>-<a href="#page27">27</a></p> + <p>——, Prognosis in, <a href="#page19">19</a></p> + <p>——, Psychic, <a href="#page9">9</a>, <a href="#page10">10</a></p> + <p>——, Rarer types of, <a href="#page7">7</a>-<a href="#page16">16</a></p> + <p>——, Serial, <a href="#page7">7</a></p> + <p>——, Superstitions attached to, <a href="#page1">1</a>, <a href="#page2">2</a></p> + <p>Epileptic children, Care of, <a href="#page16">16</a></p> + <p>—— dementia, <a href="#page16">16</a></p> + <p>—— fit <i>See</i> "Fit"</p> + <p>—— fits, Times of occurrence of, <a href="#page15">15</a>, <a href="#page23">23</a></p> + <p>Epileptiform seizures, <a href="#page13">13</a></p> + <p>Exercise for neuropaths, <a href="#page48">48</a>, <a href="#page74">74</a>, <a href="#page75">75</a></p> + <p>Eyes, Care of the, <a href="#page53">53</a></p> + </div> + + <div class="nofblk"> + <p>FACIAL expression in epilepsy, <a href="#page17">17</a></p> + <p>Fats, Digestion of, <a href="#page57">57</a></p> + <p>Fears, Baseless, in neurasthenia, <a href="#page35">35</a>, <a href="#page36">36</a></p> + <p>Feeding, Generous, needed for neuropaths, <a href="#page47">47</a></p> + <p>Fit, Epileptic, Description of an, <a href="#page3">3</a>, <a href="#page4">4</a></p> + <p>——, ——, Mechanism of an, <a href="#page20">20</a>, <a href="#page21">21</a></p> + <p>——, ——, First-aid to victims of, <a href="#page28">28</a>, <a href="#page29">29</a></p> + <p>Flatulence, Treatment of, <a href="#page70">70</a></p> + <p>Foods, Proprietary, <a href="#page94">94</a>, <a href="#page95">95</a></p> + <p>"Free will", The fallacy of, <a href="#page124">124</a>, <a href="#page125">125</a></p> + <p>Freud on perverted sex-ideas as a cause of hysteria, <a href="#page40">40</a></p> + <p><!-- Page 147 --><span class="pagenum"><a name="page147"></a>[pg 147]</span></p> + <p>—— —— subconscious sexual desires in infants, <a href="#page113">113</a></p> + <p>—— —— the sex-basis in dreams, <a href="#page12">12</a></p> + <p>Fright as cause of epilepsy, <a href="#page21">21</a></p> + </div> + + <div class="nofblk"> + <p>GASTRIC Juice, The, <a href="#page56">56</a></p> + <p>Genius, Epilepsy in relation to, <a href="#page125">125</a>-<a href="#page127">127</a></p> + <p>"Germ-plasm", The, <a href="#page118">118</a></p> + <p>—— in relation to neuropathic tendencies, <a href="#page120">120</a>, <a href="#page121">121</a>, <a href="#page124">124</a></p> + <p><i>Globus hystericus</i>, <a href="#page42">42</a></p> + <p>Glycerin suppositories, <a href="#page69">69</a></p> + <p>Glycerophosphates, <a href="#page96">96</a></p> + <p>"Good" and "Evil", <a href="#page123">123</a>, <a href="#page124">124</a></p> + <p>Gowers on epilepsy, <a href="#page7">7</a></p> + <p>Gowers' statistics as to age-incidence of epilepsy, <a href="#page17">17</a></p> + <p><i>Grand mal</i>, <a href="#page2">2</a>-<a href="#page5">5</a></p> + <p>—— ——, its relative frequency, <a href="#page15">15</a></p> + <p>Greene on hysteria, <a href="#page44">44</a></p> + </div> + + <div class="nofblk"> + <p>HABIT, Importance of, in relation to constipation, <a href="#page68">68</a></p> + <p>Haig on relation of uric acid to epilepsy, <a href="#page23">23</a></p> + <p>Headache in neurasthenia, <a href="#page32">32</a></p> + <p>Heredity, <a href="#page118">118</a>-<a href="#page122">122</a></p> + <p>Hobbies for neuropaths, <a href="#page48">48</a></p> + <p>Hormone, The Function of a, <a href="#page57">57</a></p> + <p>Hughlings Jackson, Dr, on the epileptic convulsion, <a href="#page8">8</a></p> + <p>Husband of a neuropath, Advice to the, <a href="#page138">138</a>, <a href="#page139">139</a></p> + <p>Huxley on the rules of the game of life, <a href="#page46">46</a></p> + <p>Hygiene, General, <a href="#page71">71</a>-<a href="#page75">75</a></p> + <p>Hypochondriasis in neurasthenics, <a href="#page36">36</a></p> + <p>Hypophosphites, <a href="#page96">96</a></p> + <p>Hysteria, <a href="#page39">39</a>-<a href="#page45">45</a></p> + <p>——, Age incidence of, <a href="#page41">41</a></p> + <p>——, Ancient views as to, <a href="#page39">39</a></p> + <p>—— and neurasthenia contrasted, <a href="#page41">41</a></p> + <p>—— Causes of, <a href="#page40">40</a>, <a href="#page41">41</a></p> + <p>——, Modern theories as to, <a href="#page39">39</a></p> + <p>——, Race incidence of, <a href="#page42">42</a></p> + <p>——, Sex-incidence of, <a href="#page39">39</a>, <a href="#page41">41</a></p> + <p>——, Symptoms of, <a href="#page42">42</a>-<a href="#page44">44</a></p> + <p>——, Treatment of, <a href="#page44">44</a></p> + <p>Hysterical attack, The, <a href="#page42">42</a>, <a href="#page43">43</a></p> + </div> + + <div class="nofblk"> + <p>IMAGINATION, Effects of, <a href="#page79">79</a>-<a href="#page81">81</a></p> + <p>Indigestion, <a href="#page60">60</a>-<a href="#page62">62</a></p> + <p>Infantile convulsions, <a href="#page13">13</a></p> + <p>—— ——, relation of to epilepsy, <a href="#page13">13</a></p> + <p>—— ——, Treatment of, <a href="#page13">13</a></p> + <p>Inhibitory cells of brain, <a href="#page20">20</a>, <a href="#page21">21</a></p> + <p>Injuries to brain as cause of epilepsy, <a href="#page21">21</a></p> + <p>Insanity in relation to dissociation of consciousness, <a href="#page11">11</a></p> + <p>—— —— epilepsy, <a href="#page16">16</a></p> + <p>Insomnia <i>See</i> "Sleeplessness"</p> + <p>Intestinal worms, <a href="#page102">102</a></p> + <p>Iron preparations, <a href="#page95">95</a></p> + </div> + + <div class="nofblk"> + <p>JACKSONIAN epilepsy, <a href="#page7">7</a>, <a href="#page8">8</a>, <a href="#page9">9</a></p> + <p>Janet on consciousness in hysteria, <a href="#page40">40</a></p> + <p>Jones on the religious sentiment in neuropaths, <a href="#page106">106</a>, <a href="#page107">107</a></p> + </div> + + <div class="nofblk"> + <p>KING'S evil, The, <a href="#page86">86</a></p> + </div> + + <div class="nofblk"> + <p>LA ROCHEFOUCAULD on health and regimen, <a href="#page65">65</a></p> + <p>Lecithin, <a href="#page96">96</a></p> + <p>Lieberkuhn's glands, <a href="#page57">57</a>, <a href="#page58">58</a></p> + <p>Life, in relation to tissue change, <a href="#page58">58</a></p> + <p>Locock's introduction of bromides for epilepsy, <a href="#page86">86</a></p> + </div> + + <div class="nofblk"> + <p>MACHINE, The human, <a href="#page71">71</a>, <a href="#page72">72</a></p> + <p>Malt extracts, <a href="#page93">93</a></p> + <p>Marriage, <a href="#page131">131</a>-<a href="#page139">139</a></p> + <p>—— and neuropathy, <a href="#page122">122</a>, <a href="#page131">131</a>, <a href="#page132">132</a></p> + <p>—— of neuropaths should be childless, <a href="#page134">134</a>, <a href="#page135">135</a></p> + <p>Mastication, Importance of thorough, <a href="#page61">61</a></p> + <p>Masturbation, <a href="#page110">110</a>-<a href="#page112">112</a></p> + <p>——, Effects of, <a href="#page111">111</a>, <a href="#page112">112</a></p> + <p>—— in relation to epilepsy, <a href="#page16">16</a>, <a href="#page22">22</a>, <a href="#page114">114</a></p> + <p>—— —— neurasthenia, <a href="#page38">38</a></p> + <p>Meals, Number and time of, <a href="#page64">64</a></p> + <p>Meat extracts, <a href="#page93">93</a></p> + <p>—— juices, Value of, <a href="#page64">64</a></p> + <p>——, Moderation in its use necessary, <a href="#page65">65</a></p> + <p>Memory in epilepsy, <a href="#page17">17</a></p> + <p>——, its subconscious basis, <a href="#page10">10</a></p> + <p><!-- Page 148 --><span class="pagenum"><a name="page148"></a>[pg 148]</span></p> + <p>Mendel's law of inheritance, <a href="#page120">120</a>, <a href="#page121">121</a></p> + <p>Menopause in relation to neurasthenia, <a href="#page31">31</a></p> + <p>Menstruation, Disordered, in neurasthenia, <a href="#page33">33</a></p> + <p>—— in relation to epilepsy, <a href="#page17">17</a>, <a href="#page22">22</a></p> + <p>Mental attitude of neurasthenics, <a href="#page33">33</a>-<a href="#page38">38</a></p> + <p>—— fatigue in neurasthenia, <a href="#page33">33</a>, <a href="#page34">34</a></p> + <p>Mercier on the characteristics of the neuropath, <a href="#page128">128</a>-<a href="#page130">130</a></p> + <p>Mind in relation to consciousness, <a href="#page10">10</a></p> + <p>Moral cowardice in relation to neurasthenia, <a href="#page38">38</a></p> + <p><i>Morbus comitialis</i>, <a href="#page2">2</a></p> + <p>Motor cells of brain, <a href="#page20">20</a>, <a href="#page21">21</a></p> + <p>Murder as manifestation of mental epilepsy, <a href="#page10">10</a></p> + </div> + + <div class="nofblk"> + <p>NARCOTICS, Use and abuse of, <a href="#page78">78</a></p> + <p>Nervous child, Training of the, <a href="#page98">98</a>-<a href="#page108">108</a></p> + <p>—— dyspepsia, <a href="#page60">60</a></p> + <p>—— ——, Diet in, <a href="#page65">65</a></p> + <p>Neurasthenia, <a href="#page30">30</a>-<a href="#page38">38</a></p> + <p>—— and hysteria contrasted, <a href="#page41">41</a></p> + <p>——, Causes of, <a href="#page31">31</a>, <a href="#page32">32</a>, <a href="#page41">41</a></p> + <p>——, Course and outlook in, <a href="#page38">38</a>, <a href="#page41">41</a></p> + <p>—— in relation to epilepsy, <a href="#page35">35</a></p> + <p>—— —— self abuse, <a href="#page16">16</a>, <a href="#page38">38</a></p> + <p>——, Sexual, <a href="#page38">38</a></p> + <p>——, Symptoms of, <a href="#page32">32</a>-<a href="#page38">38</a>, <a href="#page41">41</a></p> + <p>Neuropath, The, his need of a wife, <a href="#page132">132</a></p> + <p>Neuropathic children, Characteristics of, <a href="#page98">98</a>, <a href="#page99">99</a></p> + <p>—— ——, Diet of, <a href="#page100">100</a>-<a href="#page102">102</a></p> + <p>—— ——, Education of <a href="#page99">99</a>, <a href="#page100">100</a></p> + <p>—— ——, Moral training of, <a href="#page102">102</a>-<a href="#page106">106</a></p> + <p>Neuropaths, Advice to, <a href="#page46">46</a>-<a href="#page52">52</a></p> + <p>——, Mental characteristics of, <a href="#page126">126</a>-<a href="#page130">130</a></p> + <p>Neuropathy in relation to marriage, <a href="#page122">122</a>, <a href="#page131">131</a>-<a href="#page139">139</a></p> + <p>——, The only way to eradicate, <a href="#page121">121</a></p> + <p>Night terrors, <a href="#page105">105</a></p> + <p>Nitroglycerine to check the epileptic aura, <a href="#page25">25</a>, <a href="#page26">26</a></p> + <p>Nose, Care of the, <a href="#page54">54</a></p> + </div> + + <div class="nofblk"> + <p>OPISTHOTONOS, <a href="#page43">43</a></p> + <p>Optimism, Value of, <a href="#page80">80</a></p> + <p>Osler on age-incidence of epilepsy, <a href="#page18">18</a></p> + <p>—— —— the use of medicines, <a href="#page93">93</a></p> + </div> + + <div class="nofblk"> + <p>PALPITATION during use of bromides, <a href="#page87">87</a></p> + <p>—— in neurasthenia, <a href="#page33">33</a></p> + <p>Parentage in relation to inherited qualities, <a href="#page119">119</a>, <a href="#page120">120</a></p> + <p>Patent medicines, <a href="#page90">90</a>-<a href="#page97">97</a></p> + <p>—— —— and the dyspeptic, <a href="#page60">60</a>, <a href="#page62">62</a></p> + <p>—— —— —— —— neurasthenic, <a href="#page36">36</a></p> + <p>—— ——, explanation of their benefit, <a href="#page80">80</a></p> + <p>Pepsin, <a href="#page94">94</a></p> + <p><i>Petit mal</i>, <a href="#page5">5</a>, <a href="#page6">6</a></p> + <p>—— —— in childhood, <a href="#page16">16</a></p> + <p>—— ——, its relative frequency <a href="#page15">15</a></p> + <p>Phenalgin for post-epileptic headache, <a href="#page29">29</a></p> + <p>Phosphorus preparations, <a href="#page96">96</a></p> + <p>Piles, <a href="#page70">70</a></p> + <p>Port wine in proprietary preparations, <a href="#page93">93</a></p> + <p>Predigested foods, <a href="#page94">94</a>, <a href="#page95">95</a></p> + <p>Pregnancy, Convulsions during, <a href="#page14">14</a></p> + <p>—— in relation to epilepsy, <a href="#page17">17</a>, <a href="#page22">22</a></p> + <p>Psycho-analysis in the treatment of hysteria, <a href="#page40">40</a></p> + <p>Puberty, Bodily changes at, <a href="#page109">109</a></p> + <p>——, Dangers at and after, <a href="#page109">109</a>-<a href="#page114">114</a></p> + <p>—— in relation to epilepsy, <a href="#page16">16</a>, <a href="#page18">18</a>, <a href="#page114">114</a></p> + <p>Punishment, Corporal, unsuited for nervous children, <a href="#page105">105</a>, <a href="#page106">106</a></p> + <p>Pupils in epilepsy, The, <a href="#page17">17</a></p> + <p>Purgatives, The abuse of, <a href="#page69">69</a></p> + <p>——, Suitable, <a href="#page70">70</a></p> + </div> + + <div class="nofblk"> + <p>QUACK Advertisements, <a href="#page91">91</a>, <a href="#page111">111</a></p> + </div> + + <div class="nofblk"> + <p>READING for neuropaths, <a href="#page48">48</a></p> + <p>Recovery in epilepsy, <a href="#page19">19</a></p> + <p><!-- Page 149 --><span class="pagenum"><a name="page149"></a>[pg 149]</span></p> + <p>Recreations for neuropaths, <a href="#page117">117</a></p> + <p>Reid on the effect of emotions on bodily functions, <a href="#page81">81</a></p> + <p>Religion, Question of, in nervous children, <a href="#page106">106</a>-<a href="#page108">108</a></p> + <p>Rest for neuropaths, <a href="#page49">49</a>, <a href="#page50">50</a></p> + <p>Responsibility in relation to mental epilepsy, <a href="#page9">9</a>, <a href="#page10">10</a></p> + </div> + + <div class="nofblk"> + <p>SANATOGEN, <a href="#page96">96</a></p> + <p>Savill on differences between neurasthenia and hysteria, <a href="#page41">41</a></p> + <p>Self-abuse <i>See</i> "Masturbation"</p> + <p>Self control, how far possible to neuropaths, <a href="#page123">123</a>-<a href="#page125">125</a></p> + <p>Self-restraint, The neuropath's lack of, <a href="#page129">129</a>, <a href="#page130">130</a></p> + <p>Sentimentality to be discouraged in nervous children, <a href="#page104">104</a></p> + <p>Sex education, The need for, <a href="#page131">131</a></p> + <p>Sex-incidence in epilepsy, <a href="#page18">18</a></p> + <p>Sex instruction for children, <a href="#page110">110</a>, <a href="#page112">112</a></p> + <p>Sexual development early in neuropaths, <a href="#page113">113</a>, <a href="#page114">114</a></p> + <p>—— excesses in relation to epilepsy, <a href="#page16">16</a>, <a href="#page23">23</a></p> + <p>—— —— in relation to neurasthenia, <a href="#page31">31</a>, <a href="#page38">38</a></p> + <p>—— instinct, Awakening of, <a href="#page109">109</a>, <a href="#page110">110</a></p> + <p>—— neurasthenia, <a href="#page38">38</a></p> + <p>—— offences as manifestations of mental epilepsy, <a href="#page9">9</a>, <a href="#page10">10</a></p> + <p>—— rules for neuropaths, <a href="#page48">48</a></p> + <p>Shaw, Bernard, his sneer at marriage, <a href="#page131">131</a></p> + <p>Sleep, Relation of, to epileptic fit, <a href="#page4">4</a></p> + <p>Sleeplessness, <a href="#page76">76</a>-<a href="#page78">78</a></p> + <p>——, Causes of, <a href="#page76">76</a>, <a href="#page77">77</a></p> + <p>——, Treatment of, <a href="#page77">77</a>, <a href="#page78">78</a>, <a href="#page85">85</a></p> + <p>—— in neurasthenia, <a href="#page33">33</a></p> + <p>Sollmann on proprietary foods, <a href="#page94">94</a>, <a href="#page96">96</a></p> + <p>Soothing syrups, <a href="#page13">13</a></p> + <p>"Sound nerves", <a href="#page52">52</a></p> + <p>Spirit writing, <a href="#page11">11</a>, <a href="#page12">12</a></p> + <p>Spiritualism, Danger of, for neuropaths, <a href="#page107">107</a></p> + <p>Spratling on epilepsy in consumptives, <a href="#page17">17</a></p> + <p>Starr's statistics as to age-incidence in epilepsy, <a href="#page17">17</a></p> + <p>—— —— heredity in epileptics, <a href="#page121">121</a></p> + <p>—— —— types of epilepsy, <a href="#page15">15</a></p> + <p><i>Status epilepticus</i>, <a href="#page7">7</a></p> + <p>—— ——, as final termination of epilepsy, <a href="#page16">16</a></p> + <p>Subconscious mind, The, <a href="#page10">10</a></p> + <p>Suggestion treatment, <a href="#page82">82</a>-<a href="#page85">85</a></p> + <p>Suicide in neurasthenics and hysterical subjects, <a href="#page35">35</a>, <a href="#page41">41</a>, <a href="#page42">42</a></p> + <p>Sunstroke as cause of fits, <a href="#page21">21</a></p> + <p>Sweetmeats, The use of, <a href="#page64">64</a></p> + <p>Sympathy, Harm done by, in hysteria, <a href="#page44">44</a>, <a href="#page45">45</a></p> + </div> + + <div class="nofblk"> + <p>TAPE worms, <a href="#page102">102</a></p> + <p>Tea and coffee, <a href="#page64">64</a></p> + <p>Teeth, Care of the, <a href="#page54">54</a>, <a href="#page55">55</a></p> + <p>Tobacco undesirable for neuropaths, <a href="#page74">74</a></p> + <p>Trades for epileptics, <a href="#page116">116</a></p> + <p>—— —— neuropaths, <a href="#page115">115</a>-<a href="#page117">117</a></p> + <p>Turner on age-incidence of epilepsy, <a href="#page18">18</a></p> + </div> + + <div class="nofblk"> + <p>UNCONSCIOUS activities, <a href="#page39">39</a>, <a href="#page40">40</a></p> + <p>Unconsciousness in epilepsy, <a href="#page3">3</a>-<a href="#page5">5</a></p> + <p>Urine, Incontinence of, in epilepsy, <a href="#page3">3</a>-<a href="#page5">5</a></p> + </div> + + <div class="nofblk"> + <p>VEGETABLE Foods, <a href="#page64">64</a></p> + <p>Villi, The intestinal, <a href="#page57">57</a></p> + <p>Vittoz's exercises in mental concentration, <a href="#page51">51</a></p> + <p>Vomiting, Risk of, in epilepsy, <a href="#page26">26</a></p> + </div> + + <div class="nofblk"> + <p>WATER, When to drink, <a href="#page61">61</a>, <a href="#page64">64</a>, <a href="#page68">68</a></p> + <p>Weir Mitchell Treatment, <a href="#page50">50</a></p> + <p>Wife for the neuropath, The, <a href="#page132">132</a>-<a href="#page135">135</a></p> + <p>—— of a neuropath, Advice to the, <a href="#page132">132</a>-<a href="#page137">137</a></p> + <p>Will, Neuropath's lacking in, <a href="#page125">125</a></p> + <p>Work and play, <a href="#page115">115</a>-<a href="#page117">117</a></p> + <p>Worms, Intestinal, <a href="#page102">102</a></p> + <p>Worry as cause of neurasthenia, <a href="#page31">31</a></p> + <p>—— to be avoided by neuropaths, <a href="#page47">47</a>, <a href="#page49">49</a></p> + </div> + </div> + +<!-- Page 150 --><span class="pagenum"><a name="page150"></a>[pg 150]</span> + + <p><i>Printed in Great Britain by Jarrold & Sons, Ltd., + Norwich</i></p> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of Epilepsy, Hysteria, and Neurasthenia +by Isaac G. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Epilepsy, Hysteria, and Neurasthenia + +Author: Isaac G. Briggs + +Release Date: February 4, 2005 [EBook #14901] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK EPILEPSY, HYSTERIA, AND NEURASTHENIA *** + + + + +Produced by Martin Agren, Keith Edkins and the PG Online Distributed +Proofreading Team. + + + + + + EPILEPSY, HYSTERIA, + AND NEURASTHENIA + + THEIR CAUSES, SYMPTOMS, & TREATMENT + + BY + ISAAC G. BRIGGS + A.R.S.I. + + METHUEN & CO. LTD. + 36 ESSEX STREET W.C. + LONDON + + _First Published in 1921_ + + * * * * * + + TO + ALBERT E. WOODRUFF + OF STOKE PRIOR + NR. BROMSGROVE + MY OLD + SCHOOLMASTER + + * * * * * + + CONTENTS + + CHAPTER PAGE + + PREFACE ix + + I. MAJOR AND MINOR EPILEPSY 1 + + II. RARER TYPES OF EPILEPSY 7 + + III. GENERAL REMARKS 15 + + IV. CAUSES OF EPILEPSY 20 + + V. PREVENTION OF ATTACKS 25 + + VI. FIRST-AID TO VICTIMS 28 + + VII. NEURASTHENIA 30 + + VIII. HYSTERIA 39 + + IX. ADVICE TO NEUROPATHS 46 + + X. FIRST STEPS TOWARD HEALTH 53 + + XI. DIGESTION 56 + + XII. INDIGESTION 60 + + XIII. DIETING 63 + + XIV. CONSTIPATION 67 + + XV. GENERAL HYGIENE 71 + + XVI. SLEEPLESSNESS 76 + + XVII. THE EFFECTS OF IMAGINATION 79 + + XVIII. SUGGESTION TREATMENT 82 + + XIX. MEDICINES 86 + + XX. PATENT MEDICINES 90 + + XXI. TRAINING THE NERVOUS CHILD 98 + + XXII. DANGERS AT AND AFTER PUBERTY 109 + + XXIII. WORK AND PLAY 115 + + XXIV. HEREDITY 118 + + XXV. CHARACTER 123 + + XXVI. MARRIAGE 131 + + XXVII. SUMMARY 140 + + BIBLIOGRAPHY 142 + + INDEX 145 + + * * * * * + +PREFACE + +I hope this book will meet a real need, for when one considers how +prevalent epilepsy, hysteria and neurasthenia are, among all ranks and ages +of both sexes, it seems remarkable some such popular book was not written +long ago. + +I add nothing to our knowledge of these ills, my object being to put what +we know into simple words, and to insist on the necessity for personal +discipline being allied to expert aid. The book aims at helping, not +ousting, the doctor, who may find it of use in getting his patient to +see--and to act on--the obvious. + +"Nervous Disease", as here used, includes only the three diseases treated +of; "Neuropath"--victims of them. + +"Advice" to a neuropath is usually a very depressing decalogue of "Thou +Shalt Nots!" If it be made clear _why_ he must _not_ do so-and-so, the +patient endeavours to obey; peremptorily ordered to obey, he rebels. Much +sound advice is wasted for lack of an interesting, convincing, "Reason +Why!" which would ensure the hearty and very helpful co-operation of a +patient who had been taught that writing prescriptions is not the limit of +a doctor's activities. + +Many folk, with touching belief in his own claims, regard the quack as a +hoary-headed sage, who from disinterested motives devotes his life to +curing ailments, by methods of which he alone has the secret, at low fees. +To fight this dangerous idea I have tried to show in an interesting way how +science deals with nerve ills, and to prove that qualified aid is needed. +Suggestions and criticisms will be welcomed. + + I. G. BRIGGS + THE UNIVERSITY, + BIRMINGHAM, + _June_, 1921 + + * * * * * + +"Lette than clerkes enditen in Latin, for they have the propertie of +science, and the knowing in that facultie: and lette Frenchmen in their +Frenche also enditen their queinte termes, for it is kyndely to their +mouthes; and let us showe our fantasies in soche wordes as we lerneden of +our dames tongue." + +--Chaucer. + + * * * * * + +EPILEPSY, HYSTERIA, +AND NEURASTHENIA + + * * * * * + +CHAPTER I + +MAJOR AND MINOR EPILEPSY + +(_Grand and Petit Mal_) + +"My son is sore vexed, for ofttimes he falleth into the fire, and ofttimes +into the water."--Matthew xvii, 15. + + "Oft, too, some wretch before our startled sight, + Struck as with lightning with some keen disease, + Drops sudden: By the dread attack o'erpowered + He foams, he groans, he trembles, and he faints; + Now rigid, now convuls'd, his labouring lungs + Heave quick, and quivers each exhausted limb. + + * * * * * + + "He raves, since Soul and Spirit are alike + Disturbed throughout, and severed each from each + As urged above, distracted by the bane; + But when at length the morbid cause declines, + And the fermenting humours from the heart + Flow back--with staggering foot first treads + Led gradual on to intellect and strength."--Lucretius. + +Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervous +system, evinced by attacks of _alteration of consciousness_, usually +accompanied by convulsions. + +It attacks men of every race, as well as domesticated animals, and has been +known since the earliest times, the ancients imputing it to demons, the +anger of the gods, or a blow from a star. + +It often attacks men in crowds, when excited by oratory or sport, hence the +Roman name: _morbus comitialis_ (crowd sickness). + +In mediaeval times, sufferers were regarded with awe, as being possessed by +a spirit. Witch doctors among savages, and founders and expounders of +differing creeds among more civilized peoples, have taken advantage of this +infirmity to claim divine inspiration, and the power of "seeing visions" +and prophesying. + +Epilepsy has always interested medical men because of its frequency, the +difficulty of tracing its cause, and its obstinacy to treatment, while it +has appealed to popular imagination by the appalling picture of bodily +overthrow it presents, so that many gross superstitions have grown up +around it. + +The description in Mark ix. 17-29, is interesting: + + "Master, I have brought Thee my son, which hath a dumb spirit. And + wheresoever he taketh him, he teareth him: and he foameth, and gnasheth + with his teeth, and pineth away: ... straightway the spirit tare him; + and he fell on the ground, and wallowed foaming. + + "And He asked his father, How long is it ago since this came unto him? + And he said, Of a child. And ofttimes it hath cast him into the fire, + and into the waters, to destroy him. + + "And he said unto them, This kind can come forth by nothing, but by + prayer and fasting." + +Up to the present, epilepsy can be ascribed to no specific disease of the +brain, the symptoms being due to some morbid disturbance in its action. +Epilepsy is a "functional" disease. + +GRAND MAL ("_Great Evil_") + +An unusual feeling called an _aura_ (Latin--vapour), sometimes warns a +patient of an impending fit, commonly lasting long enough to permit him to +sit or lie down. This is followed by giddiness, a roaring in the ears, or +some unusual sensation, and merciful unconsciousness. In many cases this +stage is instantaneous; in others it lasts some seconds--but an eternity to +the sufferer. This stage is all that victims can recall (and this only +after painful effort) of an attack. + +As unconsciousness supervenes, the patient becomes pale, and gives a cry, +which varies from a low moan to a loud, inhuman shriek. The head and eyes +turn to one side, or up or down, the pupils of the eyes enlarge and become +fixed in a set stare, and the patient drops as if shot, making no effort to +guard his fall, being often slightly and sometimes severely injured. + +The whole body then becomes stiff. The hands are clenched, with thumbs +inside the palms, the legs are extended, the arms stiffly bent, and the +head thrown back, or twisted to one side. The muscles of the chest and +heart are impeded in their action, breathing ceases, the heart is slowed, +and the face becomes pale, and then a livid, dusky blue. + +The skin is cold and clammy, the eyebrows knit; the tongue may be +protruded, and bitten between the teeth. The eyeballs seem starting from +their sockets, the eyes are fixed or turned up, so that only the sclerotic +("whites") can be seen, and they may be touched or pressed without causing +blinking. The stomach, bladder, and bowels may involuntarily be emptied. + +This _tonic_ stage only lasts a few seconds, and is followed by +convulsions. The head turns from side to side, the jaws snap, the eyes +roll, saliva and blood mingle as foam on the lips, the face is contorted in +frightful grimaces, the arms and legs are twisted and jerked about, the +breathing is deep and irregular, the whole body writhes violently, and is +bathed in sweat. + +The spasms become gradually less severe, and finally cease. Deep breathing +continues for some seconds; then the victim becomes semi-conscious, looks +around bewildered, and sinks into coma or deep sleep. + + "...As one that falls, + He knows not how, by force demoniac dragg'd + To earth, and through obstruction fettering up + In chains invisible the powers of Man; + Who, risen from his trance, gazeth around + Bewilder'd with the monstrous agony + He hath indured, and, wildly staring, sighs: + ..." + +In a few hours he wakes, with headache and mental confusion, not knowing he +has been ill until told, and having no recollection of events just +preceding the seizure, until reminded of them when they are slowly, and +with painful effort, brought to mind. He is exhausted, and often vomits. In +severe cases he may be deaf, dumb, blind, or paralysed for some hours, +while purple spots (the result of internal hemorrhage) may appear on the +head and neck. Victims often pass large quantities of colourless urine +after an attack, and, as a rule, are quite well again within twenty-four +hours. + +This is the usual type, but seizures vary in different patients, and in the +same sufferer at different times. The cry and the biting of the tongue may +be absent, the first spasm brief, and the convulsions mild. Epilepsy of all +kinds is characterized by an _alteration_ (not necessarily a _loss_) of +consciousness, followed by loss of memory for events that occurred during +the time that alteration of consciousness lasted. + +Attacks may occur by day only, by day and by night, or by night only, +though in so-called nocturnal epilepsy, it is _sleep_ and not night that +induces the fit, for night-workers have fits when they go to sleep during +the day. + +Victims of nocturnal epilepsy may not be awakened by the seizure, but pass +into deeper sleep. Intermittent wetting of the bed, occasional temporary +mental stupor in the morning, irritability, temporary but well-marked +lapses of memory, sleep-walking, and causeless outbursts of ungovernable +temper all suggest nocturnal epilepsy. + +Such a victim awakes confused, but imputes his mental sluggishness to a +hearty supper or "a bad night". A swollen tongue, blood-stained pillow, and +urinated bed arouse suspicion as to the real cause, suspicion which is +confirmed by a seizure during the day. He is more fortunate (if such a term +can rightly be used of any sufferer from this malady) than his fellow +victim whose attacks occur during the day, often under circumstances which, +to a sensitive nature, are very mortifying. + +Epileptic attacks are of every degree of violence, varying from a moment's +unconsciousness, from which the patient recovers so quickly that he cannot +be convinced he has been ill, to that awful state which terrifies every +beholder, and seems to menace the hapless victim with instant death. Every +degree of frequency, too, is known, from one attack in a lifetime, down +through one in a year, a month, a week, or a day; several in the same +periods, to _hundreds_ in four-and-twenty hours. + +PETIT MAL ("_Little Evil_") + +This is incomplete _grand mal_, the starting stages only of a fit, recovery +occurring before convulsions. + +_Petit mal_ often occurs in people who do not suffer from _grand mal_, the +symptoms consisting of a loss of consciousness for _a few seconds_, the +seizure being so brief that the victim never realizes he has been +unconscious. He suddenly stops what he is doing, turns pale, and his eyes +become fixed in a glassy stare. He may give a slight jerk, sway, and make +some slight sound, smack his lips, try to speak, or moan. He recovers with +a start, and is confused, the attack usually being over ere he has had time +to fall. + +If talking when attacked, he hesitates, stares in an absent-minded manner, +and then completes his interrupted sentence, unaware that he has acted +strangely. Whatever act he is engaged in is interrupted for a second or +two, and then resumed. + +A mild type of _petit mal_ consists of a temporary _blurring_ of +consciousness, with muscular weakness. The victim drops what he is holding, +and is conscious of a strange, extremely unpleasant sensation, a sensation +which he is usually quite unable to describe to anyone else. The view in +front is clear, he understands what it is--a house here, a tree there, and +so on--yet he does not _grasp_ the vista as usual. Other victims have short +spells of giddiness, while some are unable to realize "where they are" for +a few moments. + +Frequent _petit mal_ impairs the intellect more than _grand mal_, for +convulsions calm the patient as a good cry calms hysterical people. After a +number of attacks of _petit mal, grand mal_ usually supervenes, and most +epileptics suffer from attacks of both types. Some precocious, perverse +children are victims of unrecognized _petit mal_, and when pushed at school +run grave risks of developing symptoms of true epilepsy. The "Little Evil" +is a serious complaint. + + * * * * * + +CHAPTER II + +RARER TYPES OF EPILEPSY + + If it be true that: "One half the world does not know how the other + half lives", how true also is it that one half the world does not know, + and does not care, what the other half suffers. + +Epilepsy shows every gradation, from symptoms which cannot be described in +language, to severe _grand mal_. Gowers says: "The elements of an epileptic +attack may be extended, and thereby be made less intense, though not less +distressing. If we conceive a minor attack that is extended, and its +elements protracted, with no loss of consciousness, it would be so +different that its epileptic nature would not be suspected. Swiftness is an +essential element of ordinary epilepsy, but this does not prevent the +possibility of deliberation." + +In Serial Epilepsy, a number of attacks of _grand mal_ follow one another, +with but very brief intervals between. Serial epilepsy often ends in + +_Status Epilepticus_, in which a series of _grand mal_ attacks follow one +another with no conscious interval. The temperature rises slowly, the pulse +becomes rapid and feeble, the breathing rapid, shallow and irregular, and +death usually occurs from exhaustion or heart-failure. Though not +invariably fatal, the condition is so very grave that a doctor must +instantly be summoned. Nearly all victims of severe, confirmed epilepsy (25 +per cent of all epileptics) die in _status epilepticus_. + +Jacksonian Epilepsy, named after Hughlings Jackson, who in 1861 traced its +symptoms to their cause, is not a true epilepsy, being due to a local +irritation of the cortex (the outermost layer) of the brain. + +There is usually an _aura_ before the attack, often a tingling or stabbing +pain. The chief symptoms are convulsions of certain limbs or areas of the +body, which, save in very severe cases, are confined to one side, and are +not attended by loss of consciousness. + +The irritation spreads to adjacent areas, as wavelets spread from a stone +thrown into a pond, with the result that convulsions of other limbs follow +in sequence, all confined to one side. + +As every part of the brain is connected to every other part by "association +fibres", in very violent attacks of Jacksonian epilepsy the irritation +spreads to the other side of the brain also, consciousness is lost, the +convulsions become general and bilateral, and the patient presents exactly +the same picture as if the attack were due to _grand mal_. + +All degrees of violence are seen. The convulsions may consist only of a +rapid trembling, or the limb or limbs may be flung about like a flail. + +Jackson said: "The convulsion is a brutal development of a man's own +movements, a sudden and excessive contention of many of the patient's +familiar motions, like winking, speaking, singing, moving, etc." These acts +are learned after many attempts, and leave a memory in certain groups of +brain cells; irritate those cells, and the memorized acts are performed +with convulsive violence. + +The convulsions are followed by temporary paralysis of the involved +muscles, but power finally returns. As we should expect, this paralysis +lasts longest in the muscles first involved, and is slightest in the +muscles whose brain-centres were irritated by the nearly exhausted waves. +If the disease be untreated, the muscles in time may become totally +paralysed, wasted, and useless. + +Friends should very carefully note exactly where and how the attack begins, +the exact part first involved, and the precise order in which the spasms +appear, as this is the only way the doctor can localize the brain injury. +The importance of this cannot be overrated. + +The consulting surgeon will say if operation is, or is not, advisable, but +_operation is the sole remedy for Jacksonian epilepsy_, for the causes that +underly its symptoms cannot be reached by medicines. + +Patients must consult a good surgeon; other courses are _useless_. + +Psychic or Mental Epilepsy is a trance-state often occurring after attacks +of _grand_ or _petit mal_, in which the patient performs unusual acts. The +epileptic feature is the patient's inability to recall these actions. The +complaint is fortunately rare. + +The face is usually pale, the eyes staring, and there may be a "dream +state". Without warning, the victim performs certain actions. + +These may be automatic, and not seriously embarrassing--he may tug his +beard, scratch his head, hide things, enter into engagements, find the +presence of others annoying and hide himself, or take a long journey. Such +a journey is often reported in the papers as a "mysterious disappearance". +Yet, had he committed a crime during this time, he would probably have been +held "fully responsible" and sentenced. + +The actions may be more embarrassing: breaking something, causing pain, +exhibiting the sexual organs; the patient may be transported by violent +rage, and abuse relatives, friends or even perfect strangers; he may spit +carelessly, or undress himself--possibly with a vague idea that he is +unwell, and would be better in bed. + +Finally the acts may be criminal: sexual or other assault, murder, arson, +theft, or suicide. + +In this state, the patient is dazed, and though he appreciates to some +extent his surroundings, and may be able to answer questions more or less +rationally, he is really in a profound reverie. The attack soon ends with +exhaustion; the victim falls asleep, and a few moments later wakes, +ignorant of having done or said anything peculiar. + +We usually think of our _mind_ as the aggregate of the various emotions of +which we are actually _conscious_, when, in reality, consciousness forms +but a small portion of our mentality, the _subconscious_--which is composed +of all our past experiences filed away below consciousness--directing every +thought and act. Inconceivably delicate and intricate mind-machinery +directs us, and our idlest fancy arises, _not by chance_ as most people +surmise, but through endless associations of subconscious mental processes, +which can often be laid bare by skilful psycho-analysis. + +Our subconscious mind does not let the past jar with the present, for life +would be made bitter by the eternal vivid recollection of incidents best +forgotten. Every set of ideas, as it is done with, is locked up separately +in the dungeons of subconsciousness, and these imprisoned ideas form the +basis of memory. _Nothing is ever forgotten_, though we may never again +"remember" it this side the grave. + +In a few cases we can unlock the cell-door and release the prisoner--we +"remember"; in some, we mislay the key for awhile; in many, the wards of +the lock have rusted, and we cannot open the door although we have the +key--we "forget"; finally, our prisoner may pick the lock, and make us +attend to him whether we wish to or not--something "strikes us". + +Normally, only one set of ideas (a complex) can hold the stage of +consciousness at any one time. When two sets get on the boards together, +double-consciousness occurs, but even then they cannot try to shout each +other down; one set plays "leading lady", the other set the "chorus belle" +and so life is rendered bearable. + +This "dissociation of consciousness" occurs in all of us. A skilled pianist +plays a piece "automatically" while talking to a friend; we often read a +book and think of other things at the same time: our full attention is +devoted to neither action; neither is done perfectly, yet both are done +sufficiently well to escape comment. + +Day-dreaming is dissociation carried further. "Leading lady" and "chorus +belle" change places for a while--imaginary success keeps us from worrying +about real failure. Dissociation, day-dreaming, and mental epilepsy are but +few of the many milestones on a road, the end of which is insanity, or +complete and permanent dissociation, instead of the partial and fleeting +dissociation from which we all suffer. The lunatic never "comes to", but in +a world of dreams dissociates himself forever from realities he is not +mentally strong enough to face. + +The writing of "spirits" through a "medium" is an example of dissociation, +and though shown at its best in neuropaths, is common enough in normal men, +as can be proved by anyone with a planchette and some patience. + +If the experimenter puts his hands on the toy, and a friend talks to him, +while another whispers questions, he may write more or less coherent +answers, though all the time he goes on talking, and does not know what his +hand is writing. His mind is split into two smaller minds, each ignorant of +the other, each busily liberating memory-prisoners from its own block of +cells in the gaol of the subconscious. The writing often refers to +long-forgotten incidents, the experiment sometimes being of real use in +cases of lost memory. + +Dreams are dissociations in sleep, while the scenes conjured up by +crystal-gazing are only waking dreams, in which the dissociation is caused +by gazing at a bright surface and so tiring the brain centres, whereupon +impressions of past life emerge from the subconscious, to surprise, not +only the onlookers to whom they are related, but also the gazer herself, +who has long "forgotten them". + +It is childish to attach supernatural significance to either dreams or +crystal-gazing, both of which mirror, not the future, but only the past, +the subject's own past. + +It is noteworthy that women dream more frequently and vividly than men. +When a dreamer has few worries, he usually dreams but forgets his dream on +waking; when greatly worried, he often carries his problems to bed with +him, and recent "representative dreams" are merely unprofitable overtime +work done by the brain. Occasionally, dreams have a purely physical basis +as when palpitation becomes transformed in a dream into a scene wherein a +horse is struggling violently, or where an uncovered foot originates a +dream of polar-exploration; in this latter type the dream is protective, in +that it is an effort to side-track some irritation without breaking sleep. + +Since Freud has traced a sex-basis in all our dreams, many worthy people +have been much worried about the things they see or do in dreams. Let them +remember that virtue is not an inability to conceive of misconduct, so much +as the determination to refrain from it, and it may well be that the +centres which so determinedly inhibit sexual or unsocial thoughts in the +day, are tired by the very vigour of their resistance, and so in sleep +allow the thoughts they have so stoutly opposed when waking to slip by. The +man who is long-suffering and slow to wrath when awake, may surely be +excused if he murders a few of his tormentors during sleep. + +Epileptiform Seizures are convulsions due to causes other than epilepsy, +and only a doctor can tell if an attack be epileptic or not and prescribe +appropriate treatment. To give "patent" medicines for "fits", to a man who +may be suffering from lead poisoning or heart disease, is criminal. + +Convulsions in Children often occur before or after some other ailment. +Such children need careful training, but less than 10 per cent of children +who have convulsions become epileptic. Epilepsy should only be suspected if +the first attack occurs in a previously healthy child of over two years of +age. There are many possible causes for infantile convulsions, and but one +treatment; call in a doctor _at once_, and, while waiting for him, put the +child in a warm bath (not over 100 deg. F.) in a quiet, darkened room, and hold +a sponge wrung out of hot water to the throat at intervals of five minutes. +Never give "soothing syrups" or "teething powders". + +The "soothing" portion of such preparations is some essential oil, like +aniseed, caraway or dill, and there are often present strong drugs +unsuitable for children. According to the analyses made by the British +Medical Association, the following are the _essential_ ingredients of some +well-known preparations for children: + + Mrs. Winslow's Soothing Potassium Bromide, + Syrup. Aniseed, and Syrup + (sugar and water). + + Woodward's Gripe Sodium Bicarbonate, + Water. Caraway, and Syrup. + + Atkinson and Barker's Pot. and Magnesium + Royal Infant Bicarbonate, several + Preservative. Oils, and Syrup. + + Mrs. Johnson's American Spirits of Salt, Common + Soothing Syrup. Salt, and Honey. + +Convulsions During Pregnancy. Send for a doctor instantly. + +Feigned Epilepsy is an all-too-common "ailment". The false fit, as a rule, +is very much overdone. The face is red from exertion instead of livid from +heart and lung embarrassment, the spasms are too vigorous but not jerky +enough, the skin is hot and dry instead of hot and clammy, the hands may be +clenched, but the thumb will be _outside_ instead of _inside_ the palm, +foam comes in volumes but is unmixed with blood, and the whole thing is +kept up far too long. Almost before a crowd can gather an epileptic seizure +is over, whereas the sham sufferer does not begin seriously to exhibit his +questionable talents until a crowd has appeared. + +Pressure on the eye, which will blink while the "sufferer" will swear; +bending back the thumb and pressing in the end of the nail, when the hand +will be withdrawn in feigned but not in true epilepsy; blowing snuff up the +nose, which induces sneezing in the sham fit alone, or using a cold douche +will all expose the miserable trick. + +It is, unfortunately, far easier to suggest than to apply these tests, for +anyone foolish enough to try experiments within reach of the wildly-waving +arms will probably get such a buffet as will damp his ardour for amateur +diagnosis for some time. + + * * * * * + +CHAPTER III + +GENERAL REMARKS + + "Do not muse at me, my most worthy friends; + I have a strange infirmity, which is nothing + To those that know me." + "Macbeth," Act III. + +Starr's table shows that combinations of all types of epilepsy are +possible, and that mental epilepsy is rare: + + Grand mal 1150 + Grand and petit mal 589 + Petit mal 179 + Jacksonian 37 + Mental 16 + Grand mal and Jacksonian 10 + Grand mal, petit mal and Jacksonian 8 + Grand mal and mental 3 + Grand mal, petit mal and mental 6 + Petit mal and mental 2 + Fits by day only 660 + Fits day and night 880 + Fits by night only 380 + +The majority of victims have attacks both by day and by night. Of 115,000 +seizures tabulated by Clark, 55,000 occurred during the day (6 a.m. to 6 +p.m.) and 60,000 by night. + +The _usual course_ of a case of epilepsy is somewhat as follows: the +disease begins in childhood, the first convulsion, about the age of three, +being followed some twelve months later by a second, and this again by a +third within a few months. Then attacks occur more frequently until a +regular periodicity--from one a day to one a year--is reached after about +five years, and this frequently persists throughout life. + +The effect of epilepsy on the general health is not serious, but it has a +more serious effect on the mind, for epileptic children cannot go to school +(though special schools are now doing something towards removing this +serious disability), and grow up with an imperfect mental training. They +become moody, fretful, ill-tempered, unmanageable, and at puberty fall +victims to self-abuse, which helps to lead to neurasthenia. Then they may +drift slowly into a state of mental weakness, and often require as much +care as imbeciles. If the fits are severe from an early age, arrest of +mental development and imbecility follow. If the disease be very mild in +character, and especially if it be _petit mal_, the victim may be very +precocious, get "pushed" at school, and later become eccentric or insane. + +Adult victims necessarily lead a semi-invalid life, often cut off from +wholesome work and from the pleasures of life, and become hypersensitive, +timid, impulsive, forgetful, irritable, incapable of concentration, +suspicious, show evidences of a weakened mind, have few interests, and are +difficult to manage. + +About 10 per cent--the very severe cases--go on to insanity; either +temporary attacks of mania, calling for restraint, or permanent epileptic +dementia with progressive loss of mind. Some victims are accidentally +killed in, or die as a result of a fit; about 25 per cent--severe cases +again--die in _status epilepticus_, but the majority after being sufferers +throughout life are finally carried off by some other disease. + +There are many exceptions to this general course. Some patients have +attacks very infrequently, and are possessed of brilliant talent, though +apt to be eccentric. Others may have a number of seizures in youth, and +then "outgrow" the complaint. + +A few victims are attacked only after excessive alcoholic or sexual +indulgence, some women only during their menses, while other women are free +from attacks during pregnancy, which state, however (contrary to popular +belief), commonly aggravates the trouble. Victims may be free from attacks +during the duration of, and for some time after, an infectious disease; +while Spratling says that a consumptive epileptic may have no fits for +months, or even years. + +Some epileptics are normal in appearance, but many show signs of +degeneration. This is common in the insane, but less frequent and +pronounced in neurasthenics. An abnormal shape of the head or curvature of +the skull, a high, arched palate, peculiarly-shaped ears, unusually large +hands and feet, irregular teeth from narrow jaws, a small mouth, unequal +length and size of the limbs, a projecting occiput, and poor physical +development may be noted. + +These are most pronounced in intractable cases, in whom mental +peculiarities are most frequently seen--either dullness, stupidity and +ungovernable temper, or very marked talent in one direction with as marked +an incapacity in others. In all epileptics, the pupils of the eye are +larger than normal, and, after contracting to bright light soon enlarge +again. + +The facial expression of most epileptics indicates abnormal mentality. When +the seizures have been so frequent and severe as to cause mental decay, the +actions are awkward, and the gait slouching and irregular. Progressive poor +memory is one of the first signs of intellectual damage consequent upon +severe epilepsy. + +Though the disease may occur at any age, most cases occur before the age of +twenty, there being good reason to look for other causes (often syphilis) +in cases which occur after that age. Of 1,450 of Gowers' cases, 30 per cent +commenced before the age of ten; 75 per cent before twenty. In Starr's +2,000 cases, 68 per cent commenced before the patient was twenty-one. + +According to Turner, the first epoch is from birth to the age of six, +during which 25 per cent of all cases commence, usually associated with +mental backwardness, and some due to organic brain trouble. The second +epoch is ten to twenty-two, the time of puberty and adolescence, during +which time no less than 54 per cent of all cases commence. This is, _par +excellence_, the age of onset of genuine epilepsy, the mean age of maximum +onset being fourteen in men and sixteen in women. The remaining 21 per cent +of cases occur after the age of twenty-two. + +In 430 cases of epilepsy in children, Osler found that 230 were attacked +before they reached the age of five, 100 between five and ten, and 100 +between ten and fifteen. + +Epilepsy, then, is a disease of early youth, coming on when the development +and growth of the nervous and reproductive systems is taking place. During +this period, causes, insignificant for stable people, may light up the +disease in those of unstable, nervous constitution, a fact which explains +the importance of training the child. + +Both sexes are attacked. If we consider only cases of true idiopathic +epilepsy female patients are probably in excess, but in epilepsy in adults, +from all causes, males predominate. In females, the menopause may arrest +the disease. + +In days gone by, epilepsy more rarely commenced after the age of twenty, +but in these days of nerve stress it commences more frequently than +formerly in people of mature age. A victim who has a fit for the first time +after the age of twenty, however, should consult a nerve specialist +immediately. + +In its early stages there are no changes of the brain due to, or the cause +of, epilepsy, but in long-standing, severe cases, well-marked, morbid +changes may be found. These are the effects, not the cause, of the disease, +and they vary in intensity according to the manner of death and the length +and severity of the malady. They probably cause the mental decay and +slouching gait mentioned before. + +Fits may suddenly cease for a long time, but they usually recur, and most +patients have them more or less regularly through life. + +The fact that recovery is rare should not be hidden from patients and +friends. Perhaps 8 per cent of all classes recover--and "recovery" may only +be a long interval--but 4 per cent of these are Jacksonian, syphilitic or +accident cases. Only one victim in every thirty recovers from true +epilepsy; and these are very mild cases, in which the fits are infrequent, +there is no mental impairment, and bromides are well borne. The earlier the +onset, the more severe and frequent the attacks, the deeper the coma, and +the worse the mental decay, the poorer the outlook. + +_Cure is exceptional_, but by vigorous treatment the severity of the malady +may be much abated. _Petit mal_ is no more hopeful than _grand mal_; less +so in cases with severe giddiness; in all cases, the better the physical +condition and digestive powers of the patient, the brighter the outlook. + +To sum up, epilepsy is a chronic abnormality of the higher nervous system, +characterized by periodic attacks of alteration of consciousness, often +accompanied by spasms of varying violence, affecting primarily the brain +and secondarily the body, based on an abnormal readiness for action of the +motor cells, occurring in persons with congenital nerve weakness, and +leading to mental decay of various types and degrees of severity. + + * * * * * + +CHAPTER IV + +CAUSES OF EPILEPSY + + "Find out the cause of this effect, + Or rather say, the cause of this defect, + For this effect defective comes by cause." + "Hamlet," Act II. + +THE MECHANISM OF THE FIT + +The brain consists of cells of _grey matter_, grouped together to form +centres for thought, action or sensation, and _white matter_, consisting of +nerve strands, which act as lines of communication between different parts +of brain and body. The wrinkled surface (_cortex_) of the brain, is covered +with grey matter, which dips into the fissures. There are also islands of +grey matter embedded in the white. + +The front part of the brain is supposed, with some probability, to be the +seat of intelligence, while a ribbon three inches wide stretched over the +head from ear to ear would roughly cover the Rolandic area, in which are +contained the _motor cells_ through which impulse is translated to action. +These motor cells are controlled by _inhibitory cells_, which act as brakes +and release nerve energy in a gentle stream; otherwise our movements would +be convulsive in their violence, and life would be impossible through +inability usefully to direct our energy. + +That is how inhibition acts physically; mentally it is the power to +restrain impulses until reason has suggested the wisest course. + +Irritation of the cortex, especially the motor area, causes convulsions, +and experiment has shown that epilepsy may be due to a disease or +instability of certain inhibitory cells of the cortex. The motor cells of +epileptics are restrained, with some difficulty, by these cells in normal +times. When irritation from any cause throws additional strain on the motor +cells, the defective brakes fail, and the uncontrolled energy, instead of +flowing in a gentle stream through the usual channels, bursts forth in a +tidal wave through other areas of the brain, causes unconsciousness, and +exhausts itself in those violent convulsions of the limbs which we term a +fit. + +The Primary Cause of epilepsy is an inherent instability of the nervous +system. + +Secondary Causes are factors which cause the first fit in a person with +predisposing nervous instability; later, the brain gets the _fit habit_, +and attacks recur independently of the secondary cause. In most cases no +secondary causes can be discovered, and the disease is then termed +_idiopathic_, for want of an explanation. + +Injuries to the brain may cause epilepsy, and many cases date from birth, a +difficult labour having caused a minute injury to the brain. + +Some accident is often wrongly alleged as the cause of fits, for most +victims come of a bad stock, and when the first fit occurs, their relatives +recollect an injury or a fright in the past, which is said to be the cause. + +Great fright may cause epilepsy, as in the case of a nervous girl whose +brother entered her room, covered with a sheet, as a "ghost", a "joke" that +was followed by a fit within an hour. + +Sunstroke may cause fits, and a few cases follow infectious diseases. + +Alcoholism is a strong secondary factor, fits often occurring during a +drinking-bout and in topers, but in many cases, drunkenness, instead of +being the cause, is only the result of a lack of self-control following +epilepsy. + +Pregnancy may be a secondary cause of the malady: it may lead to more +frequent and severe seizures in women who are already victims; bring on a +recurrence of the malady after it has apparently been cured; or, very +rarely, induce a temporary or permanent cure. + +Epilepsy may be due to abortives. These drugs wreck the constitution of the +undesired children, who contract epilepsy from causes which would not so +have affected them had they started fairly. In many families, the first +child, who was wanted, is normal; some or all the others, who were not +desired and on whom attempts were probably made to prevent birth, are +neuropaths, as are many illegitimate children. It cannot too emphatically +be stated that there is no drug known which will procure abortion without +putting the woman's life in so grave a danger as to prevent medical men +using it; legal abortion is always procured surgically. Dealing in +abortifacients would be a capital offence under the laws of a rational +community. + +Self-abuse may perhaps play some part in epilepsy commencing or recurring +after the age of ten. + +The onset of menstruation often coincides with the onset of epilepsy, and +in some cases irregularity of the menses seems to be a secondary or +exciting cause. + +Exciting Causes aggravate the trouble when present, causing more frequent +and severe seizures. The chief are irritation of stomach and bowels (from +decaying teeth, unchewed, unsuitable, or indigestible food, constipation, +or diarrhoea), exhaustion, work immediately after a meal, passion or +excitement, fright, worry, mental work, alcoholism, sexual excess, nasal +growths, eye-strain; in short, anything that irritates brain or body. + +Theories as to Cause. Epilepsy is usually classed as a _functional +disorder_; that is, the brain cells are physically normal, but, for some +unknown reason, they act abnormally at certain times. This term is a very +loose one, and there is reason to believe that the basis of epilepsy is +some obscure disease of the brain which has not been detected by present +methods. + +The new school of psychologists regard the malady as a mental _complex_--a +system of ideas strongly influenced by the emotions--the convulsions being +but minor symptoms. + +Fits are most frequent between 9-10 p.m. the hours of deepest repose. One +school says this is due to anaemia of the brain during sleep. Clark traces +the cause to lessened inhibitory powers owing to the higher brain centres +being at rest, while Haig claims to have explained the high incidence at +this hour by the fact that uric acid is present in the system in the +greatest amount at this time. + +Some doctors have thought, on the contrary, that _excess_ of blood in the +head was the cause, but results of treatment so directed did not bear out +the sanguine hopes built on the theory. + +The fact that convulsions occur in diabetes and alcoholism, suggested that +epilepsy was due to poisons circulating in the blood, and thus irritating +the brain. Every act uses up cell material and leaves waste products, +exactly as the production of steam uses up coal and leaves ashes. Various +waste products have been found in more than normal quantities in the blood +of epileptics, but it is uncertain whether accumulation of waste products +causes the seizure. + +A convincing theory must satisfactorily account for all the widely diverse +phenomena seen in epilepsy, and the problem must remain largely a matter of +speculation, until research work has given us a far deeper insight into the +biochemistry of both the brain cells, and the germ-plasm than we have at +present. + + * * * * * + +CHAPTER V + +PREVENTION OF ATTACKS + + In health matters, prevention is nine points of the law. + +Some patients are obsessed by a peculiar sensation (the "aura") just before +a fit. This warning takes many forms, the two most common being a "sinking" +or feeling of distress in the stomach, and giddiness. The character of the +aura is very variable--terror, excitement, numbness, tingling, +irritability, twitching, a feeling of something passing up from the toes to +the head, delusions of sight, smell, taste, or hearing (ringing, or +buzzing, etc.), palpitation, throbbing in the head, an impulse to run or +spin around--any of these may warn a victim that a fit is at hand. Some +patients "lose themselves" and make curious mistakes in talking. + +The warning is nearly always the same each time with the same patient, and +is more common in mild than in severe cases. Rarely, the attack does not go +beyond this stage. + +When the patient becomes conscious of the aura he should sit in a large +chair, or lie down on the floor, well away from fire, and from anything +that can be capsized. He must never try to go upstairs to bed. Some one +should draw the blind, as light is irritating. + +If the warning lasts some minutes, the patient should carry with him, a +bottle of uncoated one-hundredth-grain tabloids of + +Nitroglycerin, replacing the screw cap with a cork, so that they can +quickly be extracted. When the warning occurs, one--or two--should be +taken, and the head bent forward. The arteries are dilated, the +blood-pressure thus lowered, and the attack _may_ be averted. + +The use of nitroglycerin is based on the theory that seizures are caused by +anaemia due to vasomotor constriction. Success is only occasional, but this +is so welcome as to justify the habitual use of the method. + +If the aura be brief, buy a few "pearls" of Amyl Nitrite, crush one in your +handkerchief, and sniff the vapour. This has the same affect as +nitroglycerin, but the action occurs in 15 seconds and only persists 7 +minutes. A headache occasionally follows the use of these drugs, and they +should not be employed without professional advice. + +When the warning is felt in the hand or foot, a strap should be worn round +the ankle or wrist, and pulled tight when the aura commences. This +sometimes aborts a fit, as biting a finger in which the aura commences may +also do. + +If a victim feels unwell after a meal, he must never eat the next meal at +the usual time, simply because it _is_ the usual time. + +Should a patient feel unwell between, say, dinner and tea, instead of +eating his tea he must empty his bowels by an enema, or croton oil (see +chemist), and his stomach by drinking a pint of warm water in which has +been stirred a tablespoonful of mustard powder and a teaspoonful of salt. +After vomiting, drink warm water. + +_Never attempt to empty the stomach at the onset of a definite aura_, for +if the seizure occurs, the vomit will probably obstruct the trachea, and +suffocate the victim. + +After the stomach has been empty ten minutes, the patient should take a +double dose of bromides (Chapter XIX) and go to bed. Next morning he will +be well, whereas if he eats but a single piece of bread-and-butter he will +probably have a fit within five minutes. + +Unfortunately, in 60 per cent of cases, there is no warning at all, while +in those cases which do exhibit an aura, the measures mentioned above more +often fail than succeed. + + * * * * * + +CHAPTER VI + +FIRST-AID TO VICTIMS + + "First-aid is the assistance which can be given in case of emergency by + those who, with certain easily acquired knowledge are in a position, + not only to relieve the sufferer, but also to prevent further mischief + being done pending the arrival of a doctor."--Dickey. + +_Never try to cut short a fit_. Placing smelling-salts beneath the nose, +together with all other remedies for people who have "fainted", are useless +in epilepsy. + +Lay the patient on his back, with head slightly raised; admit air freely; +remove scarf or collar and tie, unfasten waistcoat, shirt, stays or other +tight garments, and if it be known or observed that the victim wears +artificial teeth, remove them. + +If five people are at hand, let two persons grasp each a leg of the victim, +holding it above the ankle and above the knee; two others should each hold +a hand and the shoulder; the fifth supports the head. Do not kneel opposite +the feet or you may receive a severe kick. Prevent the limbs from striking +the floor, but _allow them full play_. If the victim rolls on his face +gently turn him on his back. + +Roll a large handkerchief up _from the side_ (not diagonally) and holding +one end firmly, tie a knot in the other end, and place it between the teeth +to protect the tongue; or slide the handle of a spoon or a piece of smooth +wood between the teeth, and thus hold the tongue down. Soft articles like +cork and indiarubber should not be used, for if they are bitten through, +the rear portion will fall down the throat and choke the victim. + +After the fit, lower the head to one side to clear any vomitus which, if +left, might be drawn into the windpipe, lift the patient on to a couch, +cover him warmly, and let him sleep. An epileptic's bed should be placed on +the ground floor; if his bed be upstairs, it is difficult to get him there +after an attack, while he may at any time fall downstairs and be killed. + +Any effort to rouse him will only make the post-epileptic stupor more +severe, but whether he sleeps or not, he must carefully be watched, for +patients in this state are apt to slip away, often half-clothed, and travel +towards nowhere in particular at a wonderfully rapid rate. + +If several fits follow one another, or if one is very long or severe, send +for a doctor. + +When a seizure occurs in public, a constable should be summoned, who, being +a "St. John" man, will be of far more use than bystanders brimming over +with sympathy--_and ignorance_. If some kindly householder near by will +allow the victim to sleep for an hour or two--a boon usually denied more +from fear of recurrence than lack of sympathy, it is better than taking him +home. If not, let someone call a cab, and deliver the victim safely to his +friends. + +Every epileptic should carry always with him a card stating his full name +and address, with a request that some one present at any seizure will +escort him home. + +If the victim wakes with a headache, give him a 10-grain Aspirin powder, or +a 5-grain Phenalgin tablet; _never patent "cures"_. + +If possible, the patient should lie abed the day after a fit, undisturbed, +taking only soda-and-milk and eggs beaten up in _hot_ milk. + + * * * * * + +CHAPTER VII + +NEURASTHENIA + + "Some of your hurts you have cured, + And the worst you still have survived; + But what torments of mind you endured + From evils which never arrived." + --Lowell. + +To-day, the need to eat forces even sensible men to live--and die--at a +feverish rate. In bygone days the world was a peaceful place, in which our +forefathers were denied the chance of combining exercise with amusement +dodging murderous taxis; knew not the blessings of "Bile Beans", nor the +biliousness they blessed either; they did not fall victims to +"advert-diseases"; and they left the waters beneath to the fishes, and the +skies above to the birds. + +Withal they were sound trenchermen, who called their few ailments "humours" +or "vapours" and knew what peace of mind meant. Sixty years ago there was +one lunatic in every six hundred people; to-day there is one in every two +hundred. + +At the same time, the "neurasthenic temperament" is not altogether a modern +product, for Plato described it with great precision, and declared such +people to be "undesirable citizens" for his ideal republic. + +Neurasthenia is due to exhaustion and poisoning of the nervous system, the +chief symptoms of which is persistent _neuro-muscular fatigue with general +irritability_. Its minor symptoms are almost as numerous as the various +activities possible in mind and body. + +The Predisposing Cause of neurasthenia is inherited nervous instability, +but among nervous diseases, neurasthenia seems the least dependent on +heredity, this factor playing a less important part than + +Exciting Causes which are the sparks that fire explosive trains laid by the +living, and often by the dead. + + Worry in any form (especially when accompanied by excess of brain-work), + Accident-shock, + Sexual abuse, + Abuse of drink, drugs or tobacco, + Lack of exercise, + Exhausting diseases, + Menopause, and diseases of the womb, + "Society life", + Retirement, + +are the commonest exciting causes of neurasthenia; hard brain-work, unless +accompanied by worry, not being injurious. + +The disease is more common in men than women (because of the more active +part played by them in the struggle for existence), in cities than in the +country, in mental than in manual workers, in the "idle rich", and in races +which live feverishly, like the Americans. It is rare in old age. + +Ambition, the race for "success", the struggle to carry out projects beyond +the reasonable capacity of one man, and the ceaseless work and worry with +little sleep and no real rest which mark life to-day are responsible for +this disease. + +Competition has increased in all conditions of life; free course is given +to ambition, individuals impose on their brains a work beyond their +strength; and then comes care and perhaps reverse of fortune; and the +nervous system, under the wear and tear of incessant excitation, at last +becomes exhausted, + +The basic symptom is an inability to stand a normal amount of mental or +physical strain, and shows itself in seven marked ways: + +1. Muscular Fatigue, which is often most marked in the morning. The +patient rises reluctantly, feeling as if he had not slept, is listless and +"lazy", and can neither work nor play much without getting unduly tired. +This weariness may pass off as the day wears on. + +2. Backache is often constant and annoying. It may be a pain, or a general +discomfort, and may be felt anywhere in the back, the nape of the neck and +down the spine being common places. The legs often "give way", and, in +severe cases, patients believe they cannot stand, and become bed-ridden. +Under sudden excitement they may walk again, becoming "miracles of +healing". These _spinal symptoms_ are common in neurasthenia following +accident. + +3. Headache is more often an abnormal sensation than an intense pain. +Pulsations, feelings of distress, of lightness, fullness, heaviness and +pressure are common, or a band may seem to be drawn tightly round the head +across the forehead. + +The sensations are usually located in the back of the head, and may be +accompanied by dizziness, noises in the ears, or dimness of sight. There +may be a feeling of unsteadiness when walking, or a sense of being in +motion when at rest. The headache varies in intensity; it is worst in the +morning, is increased by thinking, diminished after eating, often improves +at night, and never keeps the patient awake. + +4. Stomach and Bowel Disorders. The victim is indifferent to food, though +dainties often tempt him, when he cannot face a square meal. He has a +feeling of general well-being after a meal, but within an hour signs of +imperfect digestion arise; he feels oppressed, and has flatulence. Later, +there are flushes of heat, palpitation, drowsiness, and a craving for food. +Constipation is usually obstinate, while diarrhoea may cause great +weakness. + +5. Sleeplessness. Some patients go to sleep readily, but after some +instants wake suddenly, in a state of excitement that persists despite +their efforts to calm themselves, and only at an early hour in the morning +do they sleep again. Other patients go to bed with the conviction they will +not sleep, and are kept awake by incessant cogitation, their minds being +harassed by a rapid flow of images, ideas and memories. In some cases the +person is calm, his mind is at rest, yet he cannot sleep. + +6. Circulatory Disturbances. More blood flows to an organ at work than to +one at rest. In health we do not notice these changes, but in neurasthenia +these internal tides are exaggerated as rushes of blood to the head, +flushings of various parts, and coldness of hands and feet. + +Heart palpitation is alarming but not dangerous, and the distended +blood-vessels of the ears may set up vibrations in the drum, so that at +night when the head is on the pillow, every beat of the heart is heard as a +thump, which banishes sleep, and works the victim into a state of high +tension. A pain in the chest, arms and elbows is often felt, limbs may +swell (shown by the tightness of rings, collars, etc.) while the hands and +feet are usually moist and clammy. The patient may have to empty the +bladder every half-hour. Disorders of menstruation are common. + +7. Mental Fatigue. Hundreds of pages would be needed to describe all the +symptoms due to mental fatigue, the morbid belief that the victim has a +fatal disease being very common, though his "disease" rarely makes him lie +up; in the day he works, at night describes his symptoms to the home +circle. + +The inability of most men to apply themselves steadfastly to any one set of +ideas is seen in the immense popularity of music halls, cinemas, and +short-story magazines, which offer a change of interest every few minutes. + +In normal people there is a slight consciousness of mental processes, but +the mind rarely watches itself work; the neurasthenic is unable to +concentrate, and gets charged with inconstancy and shiftlessness. + +His ideas are restive, continuous thought is impossible, and when talking +he has to be "brought back to the point" many times. Memory and attention +flag, and he listens to a long conversation, or reads pages of a book +without grasping its import, and consequently he readily "forgets" what in +reality he never laboured to learn. Trembling of limbs is common. + +He lacks initiative, and whatever course he is forced to take--after much +indecision--he is convinced, a moment later, it would have been wiser to +have taken the opposite one. + +All his acts are done inattentively. He goes to his room for something, but +has forgotten what when he gets there; later, he wonders if he locked the +drawer, and goes back to see. At night he gets up to make sure he bolted +the door, put out the gas, and damped the fire. + +Regret for the past, dissatisfaction with the present, and anxiety for the +future are plagues common to most people, but they become acute in a +neurasthenic, who reproaches himself with past shortcomings of no moment, +infuriates himself over to-day's trivialities, and frets himself over evils +yet unborn. + +Such a patient is often greatly upset by a trifle, yet little affected by a +real shock, which by its very severity arouses his reactive faculties which +lay dormant and left him at the mercy of the minor event. He will fret over +a farthing increase in the price of a loaf, but if his bank fails he sets +manfully to. + +Duty that should be done to-day he leaves to be shirked to-morrow; he is +easily discouraged, timid, and vacillating. Extremely self-conscious, he +thinks himself the observed of all observers. If others are indifferent +toward him, he is depressed; if interested, they have some deep motive; if +grave, he has annoyed them; if gay, they are laughing at him; the truth, +that they are minding their own business, never occurs to him, and if it +did, the thought that other people were _not_ interested in him, would only +vex him. + +He is extremely irritable (slight noises make him start violently), +childishly unreasonable, wants to be left alone, rejects efforts to rouse +him, but is disappointed if such efforts be not made, broods, and fears +insanity. The true melancholic is convinced he himself is to blame for his +misery; it is a just punishment for some unpardonable sin, and there is no +hope for him in this world or the next. The neurasthenic, on the contrary, +ascribes his distress to every conceivable cause save his own personal +hygienic errors. + +A neurasthenic, if epileptic, fears a fit will occur at an untoward moment. +He dreads confined or, maybe, open spaces, or being in a crowd. When he +reaches an open space (after walking miles through tortuous byways in an +endeavour to avoid it) he becomes paralysed by an undefinable fear, and +stops, or gets near to the wall. + +He fears trains, theatres, churches, social gatherings, or the office. + +Other victims fear knives, canals, firearms, gas, high places, and railway +tracks, when the basic fear is of suicide. Many patients have sudden +impulses--on which the attention is focussed with abnormal intensity--to +perform useless, eccentric, or even criminal actions; to count objects, to +touch lamp-posts, to continually reiterate certain words, and so on. + +The victim is fully aware that there are no grounds for his panic or +impulse, but though his reason ridicules, it cannot disperse, his fear, and +the wretched man finds relief in sleep alone, which adds to his woes by +being a coy lover. + +An almost invariable stage is that wherein the patient studies a +patent-medicine advertisement and finds that a disease, or collection of +diseases, is the root of his troubles. This alarms but interests him; he +studies other advertisements, sends for pamphlets, and so becomes familiar +with a few medical terms. He then takes a "treatment", and talks of his +"complaint" and how he "diagnosed" it. He has become hypochondriac. + +He borrows a book on anatomy from the public library to discover in what +part of the body his ailment is located. + +He draws up (or copies) a special diet-sheet, and talks of "proteids", +notices a slight cloudiness in his urine, and underlines "The Uric-Acid +Diathesis" in one of his pamphlets. Then his heart bumps, he diagnoses +anew, and so goes on, usually ending by taking phosphorus for his "brain +fag". Then he finds he has a disease unknown to the faculty, which +discovery interests him as intensely as it irritates his unfortunate +friends. + +This prince of pessimists has a conviction that, compared with him, Job was +a happy man, and that he will go insane. He does not know that it is only +when there are flaws in the brain from inheritance or organic disease that +mental worry leads to lunacy; a sound brain never becomes unhinged from +intellectual stress alone. + +Books and friends are daily questioned about his "diseases", and in spite +of reassuring replies, he continues to doubt, re-question and cross-examine +endlessly, feeding his hopes on the same assurances, consoling himself with +the same sympathies, and worrying himself with the same fears. + +Other folk may be "nervy", he is seriously ill; he _knows_ it because he +_feels_ it. He expects the greatest consideration himself, denies it to +others, and then complains he is "misunderstood". + +"Every symptom becomes magnified; the trifling ache or pain, the trivial +flatulence, the disinclination or mere hesitation of the bowels to adhere +to a strict schedule, all minor events such as occur to the majority of +healthy men from time to time unheeded, come to be of vast importance to +the psychasthenic individual." + +He keeps a record of hourly changes in his condition, and pesters his +family doctor to death. He goes from physician to physician, from hospital +to hospital. Having been induced by his friends to see a specialist, he +bores that good man--who knows him all too well--with a minute description +of his symptoms, presenting for inspection carefully preserved +prescriptions, urinary examination records, differential blood counts, and +the like. Coming away with precious advice, he feels he omitted to describe +all his symptoms, begins to doubt if the specialist really understands +_his_ case, and so the pitiful farce goes on--for years. + +The extraordinary fact is that while he is suffering (_sic_) from cancer, +or heart disease, or Bright's disease, and spasmodically from minor +affections like tuberculosis, arterio-sclerosis, and liver-fluke, he is +probably running a successful business. While making money he forgets his +ills; the moment his attention is diverted from the "root of evil" he +proceeds to further "diagnosis". + +In the end, he makes a pleasant hobby of his imaginary maladies, trying +each patent nostrum, and giving herbalists, electric-belt men, Christian +Scientists, and dozens of other weird "specialists" a chance to cure him. + +Sexual Neurasthenia occurs chiefly in young men given to self-abuse or +sexual excesses. Erections and emissions are frequent, first at night with +amorous dreams, then in the day as a result of sexual thoughts; weakness +and pain in the back follow, and the sexual act may become impossible. The +patient usually studies a quack advertisement, and passes into the hands of +men who make a living by bleeding such wretches dry. Cold baths and the +treatment outlined in Chapter IX will cure him. + +Course and Outlook. Neurasthenia is very curable. If the cause be removed, +and vigorous treatment instituted, the victim may be well in a couple of +months, but in most cases there are obstacles to radical treatment, and the +disease drags on indefinitely. + +Egoism, moral cowardice, and sexual excess play a part in much +neurasthenia, but relatives must not forget, in their indignation at these +laxities, that the patient really _is_ ill; it is unkind, unjust and +useless to tell an ailing man the unpalatable truth that it is his own +fault. + + * * * * * + +CHAPTER VIII + +HYSTERIA + + "Diseased nature oftentimes breaks forth + In strange eruptions; ..." + "King Henry IV." + +Hysteria, recorded in legend and law, in manuscript and marble, in +folk-lore and chronicle, right from history's dawn, is still a puzzle of +personality, and only equalled by syphilis in the protean nature of its +manifestations. + +The sacred books of the East said delayed menstruation due to a devil was +its cause; the thrashing-out of the devil its cure. Chinese legends +describe it, and its symptoms were ascribed by the Inquisition to +witchcraft and sorcery. + +Old Egyptian papyri tell how to dislodge the devil from the stomach, and +there were hysteria specialists in 450 B.C. All old theories fix on the +womb as the seat of the disease. The name hysteria is the Greek word for +womb, and 97 per cent of patients are women. + +A few of the very numerous modern theories may be noticed. + +The unconscious (or the subconscious) and the conscious are only parts of +one whole. Our "conscious" activities are those which have developed late +in the history of the race, and which develop comparatively late in the +history of the individual. The "conscious" is the product of the racial +education of the "unconscious"; the first is the man, the modern, the +civilized; the last is the child, the primitive, the savage. Between the +two there is no gulf fixed, and the Oxford metaphysician need not go to +Timbuctoo to seek a superstitious savage; he may find one within himself. + +In hysteria, Janet says, the field of consciousness is narrowed, and the +patient lives through subconscious experiences, which she forgets when she +again "comes to". She journeys back into the past, back a few years +individually, back centuries or aeons racially, and becomes a savage child +again. + +Normally, when anything goes wrong, or we suffer from excessive emotion, we +give vent to our feelings by tears, abuse, anger, or impulsive action; in +some way we "hit back", and relieve ourselves of the feeling of oppression. +Then we forget, which heals the sore, and closes the experience. + +If, at the moment, we bottle up our emotions, they obtrude later at +inconvenient times until we "get them off our mind" by confiding in some +one, when we get peace of mind. Open confession _is_ good for the soul, and +it is better to "cry your eyes out" than to "eat your heart out". + +There are some experiences, however, to which we cannot react by anger or +confidence, and so we imprison our emotions, and try to obtain peace of +mind by forgetting the irritation. + +Freud thinks perverted sex ideas are thus repressed, and cause hysteria by +coming into conflict with the normal sex life. If these old sores can be +laid bare by psycho-analysis, and the mental abscess drained by confession +and contrition, cure follows. + +The biologists consider hysteria as an adult childishness, a primitive mode +of dodging difficulties. Victims cannot live up to the complicated +emotional standard of modern life, and so act on a standard which to us +seems natural only in children and uncivilized races. + +Savill gives the following differences between neurasthenia and hysteria: + + NEURASTHENIA HYSTERIA + + Sex Both sexes equally. 97 per cent females. + + Age Any age. First attack before + page of 25. + + Mental Intellectual weakness; Deficient will power, + peculiarities bad memory Want of control + and attention. over emotions. + + Causes Overwork; dyspepsia; Emotional upset or + accident; shock. + nervous shock. + + Course Fairly even. Paroxysms. Vary + from hour to hour. + + Mental Mental exhaustion; Emotional; wayward; + Symptoms unable to study; no self-analysis, + restless; sad; living by + irritable; not rule or reading + equal to medical books; + amusement. May Fond of gaiety; + be suicidal. sad and joyous by + turns. Never + suicidal. + + General Occasional giddiness; Flushing; convulsions + Symptoms fainting rare; and fainting + convulsions; common; no + headache; backache; symptoms between + sleeplessness; no attacks; local + loss of feeling. anaesthesia or + hyperaesthesia. + + Termination Lasts weeks or Lasts lifetime in + months. spasms. + CURABLE. TEMPORARILY + CURABLE. + +Hysteria is a disease of youth, usually ceasing at the climacteric. Social, +financial and domestic worries are exciting causes, a happy marriage often +curing, and an unhappy one greatly aggravating the complaint. It is most +common among the races we usually deem "excitable", the Slavs, Latin races +and Jews, and is often associated with anaemia and pelvic disorders. + +Symptoms. Changeability of mood is striking. "All is caprice. They love +without measure those they will soon hate without reason." + +Sensationalism is manna to them. They _must_ occupy the limelight. Pains +are magnified or manufactured to attract sympathy; they pose as +martyrs--refusing food at table, and eating sweets in their room, or +stealing down to the larder at night--to the same end. If mild measures +fail, then self-mutilation, half-hearted attempts at suicide, and baseless +accusations against others are brought into play to focus attention on +them. + +Minor attacks usually commence with palpitation and a "rising" in the +stomach or a lump in the throat, the _globus hystericus_, which the patient +tries to dislodge by repeated swallowing. This is followed by a feeling of +suffocation, the patient drags at her neck-band, throws herself into a +chair, pants for breath, calls for help, and is generally in a state of +great agitation. She may tear her hair, wring her hands, laugh or weep +immoderately, and finally swoon. The recovery is gradual, is accompanied by +eructations of gas, and a large quantity of pale, limpid, urine may be +passed later. + +Major attacks have attracted attention through all ages, ancient statues +showing the same poses as modern photographs. The beginning stage--which +may last a few moments or a few days--is one of mental unrest, the victim +being irritable and depressed. In some cases a warning aura then occurs; +clutchings at the throat, or the _globus hystericus_, palpitation, +dizziness, sounds in the ears, spots dancing before the eyes, or feelings +of intense "_tightness_" as if the skin is about to tear or the stomach to +burst. + +The victim throws herself on a chair or couch, from which she slides to the +floor, apparently senseless, the head being thrown back, the arms extended, +the legs held straight and stiff. The face is that of a dreamer, and the +crucifix position is not uncommon. This stage is a gigantic sexual stretch. + +Next comes the convulsive stage, but the convulsions are not the true jerky +movements of epilepsy, but are bilateral tossing, kicking, and rolling +movements, interspersed with various irregular passionate attitudes. There +is great alteration but _not loss_ of consciousness. The patient struggles +with those about her, bites them, but never her own tongue, shrieks and +fights, but never passes urine, throws things about, and arches the back +until the body rests on head and feet (_opisthotonos_). The stretching and +convulsive stages alternate, and the attack lasts a long time, being +stopped by pain or by the departure of onlookers. During this stage the +face may reflect the various emotions passing through the mind--with a +fidelity that would rouse the envy of an Irving. + +The patient gradually calms down, and a fit of tears or a scream ends the +attack, after which the worn-out victim is depressed but not confused, +though memory for the events of the attack may only be partial. The patient +sometimes passes into the "dream state", described in Chapter II, for some +hours or occasionally for far longer; these are the women described with +much gusto in the local Press as being in a trance--"the living dead". + +The victim of these attacks _is_ suffering from a disease, for she shows +many temporary mental symptoms which could not possibly be feigned, while +there is often a genuine partial forgetfulness of the incidents of an +attack. She says she cannot help it; candid friends say she will not. The +truth is that she cannot _will_ not to help it; for though intelligence and +memory are often good and sometimes abnormal, the judgment and will are +always weak--indecision, obstinacy, and doubt being common. + +Treatment. A thorough examination by a doctor is _absolutely essential_, to +prove that the patient is merely hysterical, and not the victim of +unrecognized organic disease. In a few cases, skilled attention to some +minor ailment will result in an apparently miraculous cure. + +Many who habitually "go into hysterics", are merely grown-up "spoiled +children", and in all cases, the basic factor is a lack of control and +self-discipline. + +Unfortunately, these tainted individuals who are so exquisitely sensitive +that any reproof brings floods of tears, turn with mercurial rapidity from +passionate fury to passionate self-reproach, and assuage by impassioned +protestations of affection the distress they have carelessly inflicted, +and, as a consequence of their momentary but undoubtedly sincere +contrition, escape blame and punishment. + +Harmful sympathy is thus substituted for helpful discipline, and the more +stable members of the family are often made slaves to the whims and +caprices of the hysterical member. + +The usual home treatment of the victim passes through various stages, and +lacks persistence. Violent methods are succeeded by studied indifference; +and that again by reproaches and recriminations. + +Greene's remarks are very pertinent: "The condition must be regarded as an +acquired psycho-neurosis to be ameliorated, and perhaps removed, by +suggestion and a complete control, which, though kind, is firm, persistent, +insistent, and _lacking in every element that enters into the upbuilding of +the hysterical temperament_." + +For anaemic patients, the following is a useful prescription: + + R. + Quininae valerianatis gr. xx + Ferri valerianatis gr. xx + Ammon. valerianatis gr. xx + Misce et fiant pilulae no. xx + Sig.: One or two three times a day, after meals. + +As far as the minor symptoms are concerned, the disease is usually chronic, +for as soon as one symptom has been overcome another takes its place, and +there is little hope of cure save when the case is taken vigorously in hand +in childhood, treatment being best given in a home or hospital. Home +treatment consists in an attempt to inculcate the lost or never-acquired +habit of self-control, and in the hygienic measures laid down for +neuropaths in general in the rest of this book. + +In a major attack, _show no sympathy_. Let every one leave the room, save +one attendant, whom the victim knows to be of firm character, and calm but +determined disposition. This attendant should get a jug of water, and +threaten to douche the victim unless she makes vigorous efforts to control +herself. If she cannot, or will not, _douche her_, then hold a towel over +her nose and mouth, and she will perforce cease her gymnastics to breathe, +though the attendant must be prepared for an outburst of abuse when she has +recovered her breath. Between attacks, all who are brought into contact +with the victim, must adopt a tolerant but unsympathetic attitude, while +efforts are made to inculcate habits of control. + + * * * * * + +CHAPTER IX + +ADVICE TO NEUROPATHS + + "Great temperance, open air, + Easy labour, little care." + +The above quotation epitomizes the cure for neurasthenia, for as Huxley +said: + + "Our life, fortune, and happiness depend on our knowing something of + the rules of a game far more complicated than chess, which has been + played since Creation; every man, woman and child of us being one of + the players in a game of our own. The board is the world, the pieces + the phenomena of the universe, while the rules of the game are the laws + of nature. Though our opponent is hidden, we know his play is fair, + just and patient, but we also know to our sorrow that he never + overlooks a mistake or makes the slightest allowance for ignorance. To + the man who plays well, the highest stakes are paid with that + overflowing generosity with which the strong show their delight in + strength. The one who plays badly is checkmated; without haste, but + without remorse. Ignorance is visited as sharply a as wilful + disobedience; incapacity meets with the same punishment as crime." + +In many cases some real trouble is the best medicine for a neurasthenic, +for though disaster may crush him, it is more likely to act as a spur, by +diverting his thoughts from his woes, and making him fight instead of fret. + +Since such blessings in disguise cannot be booked to order, first see a +doctor. Though little be physically wrong, the sense of comfort and relief +from fear, which a clear idea of what _is_ wrong brings, goes a long way +towards cure by giving the patient hope and confidence. + +Having seen the doctor, assist him by carrying out the following advice as +far as real limitations--not lazy inclinations--permit. Do not say after +reading this chapter, "I know all that"; you have to _do_ "all that", for +medicine alone, whether patent or prescribed, is useless. + + * * * * * + +Go for a long sea voyage, if possible. + +If not, get a long holiday in a quiet farmhouse, or, better still, get to +the country for good, be it in never so humble a capacity, for a healthy +cowman is happier than a neurasthenic clerk. The rural worker has no +theatres, but he can walk miles without meeting another; he has woods to +roam in, hills to climb, trees to muse under: he has ample light and air, +and his is a far happier lot than that of a vainglorious but miserable, +sedentary machine in a great city. + +The rural districts round Braemar, the Channel Islands, Cromer, Deal, +Droitwich, Scarborough, and Weston-super-Mare are, in general, suitable +holiday resorts for neuropaths. + +Avoid alcohol, tea, coffee, much meat, all excitement, anger and _worry_. +Take tickets only for comedy at the theatre, and leave lectures, social +gatherings and dances alone. + +Nerve-starvation needs generous feeding with easily digested food. Drink +milk in gradually increasing amounts up to half a gallon per day. If more +food is needed, add eggs, custard, fruit, spinach, chicken, or fish, but do +not forgo any milk. Avoid starchy foods and sweets. + +Eat only what you can digest, and digest all you eat. Chew every mouthful a +hundred times. This is one of the few sensible food fads. + +Drink water copiously between meals, and take no liquid (save the milk) +with them. Keep the bowels open. + +If you _must_ "occupy your mind", take up some very simple, quiet hobby. +Gardening, fretwork, photography and gymnastics are not necessarily quiet +hobbies. Chess, billiards, and contortions with gymnastic apparatus are not +to be recommended. + +If you _must_ read, peruse only humorous novels. Never study, and leave +exciting fiction and medical work alone. Symptoms are the most misleading +things in a most misleading world. + +After your evening meal, take a quiet walk, go to bed _and sleep_. You +should occasionally spend from Saturday midday to Monday morning in bed, +with blinds drawn, living on milk, seeing nobody and doing _nothing_. The +deepest degradation of the Sabbath is to fill it with odd jobs which have +accumulated through the week. + +Do not get out of bed too early in the morning, but rise in time to eat +your breakfast slowly, attend to the toilet, and catch the car without +haste. If your occupation be an indoor one, rise an hour earlier, and walk +or cycle quietly to work. + +Take a warm bath followed by a cold douche on rising. If no warm after-glow +follows, use tepid water. Keep your body warm; your head cool. + +Be continent. Nerve-tone and sexual delights are not compatible. Matrimony, +while a convenient cloak, is no excuse for lust. + +Try suggestion for fears and impulses (see Chapter XVIII), for it is +useless to try to "reason them out", though it is useful for a brief period +each day to try deliberately to turn the mind away from the obsession, by +singing or whistling, gradually prolonging the attempts. + +Rest, to prevent the manufacture of more waste products, the elimination of +those present, and the generation of nerve-strength from nourishing food +are the things that cure. Chapters XIX and XX deal with the drug treatment. + +Do not Worry. Whatever your trouble is, it is useless to + + "Look before and after, and sigh for what is not" + +for the future cannot be rushed nor the past remedied. All patients reply +promptly that they "can't help" worrying, when in truth they do not try. + +Work never hurt anyone, but harassing preoccupation with problems which no +amount of thought will solve drives many thousands to early graves. Anger +exhausts itself in a few minutes, fatigue in a few hours, and real overwork +with a week's rest, but worry grows ever worse. Ponder Meredith's lines: + + "I _will_ endure; I will not strive to peep + Behind the barrier of the days to come." + +"Look on the bright side!" said an optimist to a melancholy friend. + +"But there is no bright side." + +"Then polish up the dull one!" was the sound advice tendered. + +_Learn to forget_! + +One cannot open a periodical without being exhorted to train one's memory +for a variety of reasons. The neuropath needs a system of forgetfulness. +Lethe is often a greater friend than Mnemosyne. + +To brood on disappointments, failures and griefs only wastes energy, sours +temper, and upsets the general health. Resolve _beforehand_ that when +unhappy ideas arise you will _not_ dwell on them, but turn your thoughts to +pleasant trifles; take up a humorous book, or take a turn in the fresh air, +and you will soon acquire the habit of laughing instead of whining at Fate. + +To sum up: Go slow! Your neurons have been exhausted in your foolish +attempt to "live this day as if thy last" in a wrong sense; feverish +activity and unnecessary work must be abandoned to enable the nerves to +recuperate. + +When the doctor says "rest", he means "_rest_", not change your bustle from +work to what you are pleased to regard as play. + +So much is _absolute rest_ recognized as the foundation of treatment, that +severe cases undergo the "Weir-Mitchell Treatment". The patient is _utterly +secluded_; letters, reading, talking, smoking and visits from friends are +forbidden. He is put to bed, not allowed even to sit up, sees no one save +nurse and doctor, is massaged, treated electrically, grossly overfed, +fattened up, and freed from every care. + +In leaving his habitual circle, the patient escapes the too-attentive care +of his relatives, and the incessant questions about his complaint with +which they overwhelm him. The results of this regime with semi-insane +wrecks are marvellous. It is a very drastic but very successful +"rest-cure", and while it cannot be undergone at home, neurasthenics will +benefit by following its principles as far as they can in their own homes. + +High-frequency or static electricity sometimes works wonders in the hands +of a specialist, but the electric batteries, medical coils, finger-rings +and body-belts so persistently advertised are _useless_. + +When the patient has in some measure recuperated, he may try the following +exercises in mental concentration. Vittoz claims good results from them, +but they must be done quite seriously. + + 1. Walk a few steps with the definite idea that you are putting forward + right and left feet alternately. Go on by easy stages until you + concentrate on the movement of the whole body. + + 2. Take any object in your hand, and note its exact form, weight, + colour, etc. + + 3. Look in a shop-window while you count ten, and as you walk on, try + to recall all the objects therein exhibited. + + 4. Accustom yourself to defining the sounds you hear, and concentrating + on a special one, as that of a passing tram, or a ticking watch. + + 5. Make a rapid examination several times daily of your feelings and + thoughts, and try to express them definitely. + + 6. Concentrate on the mental reproduction of a regular curve: a figure + 8 placed on its side. + + 7. Listen to a metronome, and, a friend having stopped it, mentally + repeat the ticking to time. + + 8. Whenever you handle anything, try to retain the impression of that + object and its properties for several minutes, to the exclusion of + other ideas. + + 9. Concentrate on ideas of calm, and of energy controlled. + + 10. Place three objects on a sheet of white paper. Remove them one by + one, at the same time effacing the impression of each one as it is + removed, until the mind, like the paper, is blank. + + 11. Efface two of the objects, and retain the impression of one only. + + 12. Replace the impressions in your mind, but not the objects on the + paper, one by one. + +The object of these exercises is to get your wandering mind daily a little +more under control; do not exhaust yourself. + +After some months of treatment, ask yourself-- + +Am I able to walk ten miles with ease? when introduced to a stranger of +either sex or any age, to converse agreeably, profitably and without +embarrassment? to entertain visitors so that all enjoy themselves? to read +essays or poetry with as much pleasure as a novel? to listen to a lecture, +and be able afterwards to rehearse the main points? to be good company for +myself on a rainy day? to submit to insult, injustice or petulance with +dignity and patience, and to answer them wisely and calmly? When you are +able to answer, "Yes!" to these queries, your nerves are sound. + + * * * * * + +CHAPTER X + +FIRST STEPS TOWARDS HEALTH + + "All sick people want to get well, but rarely in the best way. A 'jolly + good fellow' said: 'Strike at the root of the disease, Doctor!' And + smash went the whisky bottle under the faithful physician's cane." + +In neuropaths, all irritation to the nervous system is dangerous, and must +be eliminated, and to this end, eyes, ears, nose and teeth, all in close +touch with nerves and brain, must be put and kept in perfect order. + +The Eye. Only 4 per cent, of people have _perfect_ sight. Errors in +refraction--common in neuropaths--mean that the unstable brain-cells are +constantly irritated. Dodd corrected eye-errors in 52 epileptics, 36 of +whom showed improvement. + +You take your watch to a watchmaker, not a chemist; take your eyes to an +oculist, and if you cannot afford to see one privately, get an eye-hospital +note. (To allow a chemist or "optician" to try lenses until he finds a pair +through which you "see better" is very dangerous.) + +Then you go to a qualified optician, who makes a proper frame, and inserts +the lenses prescribed. Patients should inquire if the glasses are to be +worn continually, or only when doing close work or reading. + +The Ears. Giddiness and other unpleasant symptoms may be due to ear +trouble. If there is any discharge, buzzing or ringing, see a doctor, for +if ear disease gains a firm hold it is usually incurable. + +The Nose. Neuropaths often suffer from moist nasal catarrh, or from a dry +type in which crusts of offensive mucus form, the disagreeable odour of +which is not apparent to the patient himself. He must pay careful attention +to the general health, take nourishing food, and wash out the nose three +times a day with: + + 1 oz. Bicarbonate of Soda, + 1 oz. Common Salt, + 1 oz. Borax, + Dissolved in 1 pint hot water. + +For obstinate nasal trouble, consult an aural surgeon. + +The Teeth. + + "Most men dig their graves with their teeth."--Chinese Proverb. + +Serious ills are caused by defective teeth, for microbes decompose the food +left in the crevices to acid substances which dissolve the lime salts from +the teeth, and this process continues until the tooth is lost. + +Faulty teeth are common in neuropaths, and at the risk of being +wearisome--and good advice is wearisome to people--patients must get proper +aid, privately or at a dental hospital, from a _registered dentist_, who, +like a doctor, does not advertise. + +Teeth gone beyond recall will be painlessly extracted, those going, +"stopped", and tartar or scale scraped off. If necessary, have artificial +teeth, but remember that the comfort of a plate depends upon skilled +workmanship, not on gold or platinum. Everyone should visit the dentist as +a matter of routine once a year. + + Buy 3 ozs. Precipitated Chalk, + 1 oz. Chlorate of Potash, + +and brush the teeth with this mixture ere going to bed; use tepid water +after meals. Do not brush across, but, holding the brush horizontally, +brush with a circular motion, cleaning top and bottom teeth at once. Use a +moderately hard brush with a curved surface which fits the teeth. + +After each meal, it is essential to cleanse the interstices between the +teeth with a quill toothpick or dental floss, never with a pin, for it is +the decomposition of tiny particles that starts decay; _a tooth never +decays from within_. + + 11/2 fl. oz. Glycerine, + 1 fl. oz. Carbolic Acid, + 1/2 fl. oz. Methylated Chloroform. + +With ten drops of this mixture in a wineglassful of tepid water, wash out +your mouth and gargle your throat after every meal, sending vigorous waves +between the teeth, and so removing any particles left by toothpick and +brush. + +Children should be taught these habits as soon as they can eat, for the +custom of a lifetime is easy. + + * * * * * + +CHAPTER XI + +DIGESTION + + "We may live without poetry, music and art; + We may live without conscience, and live without heart; + We may live without friends, we may live without books, + But civilized man cannot live without cooks." + +The human digestive system consists of a long tube, in which food is +received, nutriment taken from it as it passes slowly downwards, and from +which waste is discharged, in from sixteen to thirty hours afterwards. + +Six glands pour saliva into the mouth, where it should be--but how rarely +is--mixed with the food, causing chemical changes, and moistening the bolus +to pass easily down. + +The acid Gastric Juice, of which a quart is secreted daily, stops the +action of the saliva, and commences to digest the proteins, which pass +through several stages, each a little more assimilable than the last. + +The lower end of the stomach contracts regularly and violently, churning +the food with the juice, and gradually squirting it, when liquified to +Chyme, into the small intestine. If food is not chewed until almost +liquified, the gastric juice cannot act normally, but has to attack as much +of the surface of the food-lump as possible, leaving the interior to +decompose, causing dyspepsia and flatulence. + +Most people suppose the stomach finishes digestion, but it only initiates +the digestion of those foodstuffs which contain nitrogen, leaving fats, +starches and sugars untouched. + +By an obscure process, the acid chyme stimulates the walls of the bowel to +send a chemical messenger, a Hormone through the blood to the liver and +pancreas, warning them their help is needed, whereupon they actively +secrete their ferments. + +The secretion of the pancreas is very complex. It carries on the work of +the saliva, and also splits insoluble fats into a soluble milky emulsion. + +Fats are unaffected in the mouth and stomach, which explains why hot, +buttered toast, and other hot, greasy dishes are so indigestible. The +butter on plain bread is quickly cleared off, and the bread attacked by the +gastric juice, but in toast or fatty dishes, the fat is intimately mixed +with other ingredients, none of which can properly be dealt with. Always +butter toast when cold. + +To continue: The secretion of the pancreas also contains a very active +ferment, which, on entering the bowel, meets and mixes with another ferment +four times as powerful as gastric juice, which completes the digestion of +the proteids. + +Meantime, the secretions of Lieberkuehn's glands (of which there are immense +numbers in the small intestine) are further aiding the digestion of the +chyme, while the liver (the largest and most important gland in the body) +sends its ferments, and the gall-bladder its bile, which further emulsifies +the fatty acids and glycerin until they are ready to be absorbed. + +The chemically-changed chyme is now termed Chyle, and is ready to be +absorbed by the minute, projecting Villi. + +The fatty portion of the chyle is absorbed by minute capillaries and +ultimately mingles with the blood, which may look quite milky after a fatty +meal. + +The remaining food is absorbed by the blood capillaries in the villi, and +passes to the liver for filtration and storage. + +The large bowel has Lieberkuehn's glands, but not villi, and is relatively +unimportant, though most of the water the body needs is absorbed from here. + +How food becomes energy and tissue we do not know. The tissues are +continually being built up from assimilated food, and as constantly being +burnt away, oxygen for this purpose being extracted from the air we inhale, +and carried via the blood to every corner of the body. The ashes of this +burning are expelled into the blood and lymph, and carried out of the body +by the kidneys, lungs, skin and bowels. The product of the burning is the +marvel--Life; the extinction of the fire is the terror--Death. + +Energy is obtained almost solely from the combustion of fats and sugars, +proteids being reconverted into albumin, and then broken down to obtain +their carbon for combustion, the nitrogen being expelled, but proteids are +essential for the building of the tissues themselves, the stones of the +furnaces which burn up carbohydrates and fats. + +The time taken in the digestion of foods was first studied through a wound +in the stomach of St. Martin, a Canadian. Experiments were made with +various well-masticated foods, and with similar foods placed unchewed, into +the stomach through the wound, the latter experiment being carried out by +millions of people at every meal, by a slightly different route. + +Boiled food is more easily digested than fried or roasted (the frying pan +should be anathema to a neuropath); lean meat than fat; fresh than salt; +hot meat than cold; full-grown than young animals, though the latter are +more tender; white flesh than red; while lean meat is made less, and fat +meat more digestible, by salting or broiling. Oily dishes, hashes, stews, +pastries and sweetmeats are hard to digest. Bread should be stale, and +toasted crisply _right through_. The time, compared with the thoroughness +of digestion, is of little importance, as it varies widely within +physiologic bounds. + +Most people fancy that the more they eat the stronger they become, whereas +the digestion of all food beyond that actually needed to repair the waste +due to physical and mental effort consumes priceless nerve energy, and +weakens one. The greater part of excessive food has literally to be _burnt +away_ by the body, which causes great strain, mainly on the muscles. The +question is not: "How much can I eat?" but: "How much do I need?" + + * * * * * + +CHAPTER XII + +INDIGESTION + + "We know how dismal the world looks during a fit of indigestion, and + what a host of evils disappear as the abused stomach regains its tone. + Indigestion has lead to the loss of battles; it has caused many crimes, + and inspired much sulphurous theology, gloomy poetry and bitter + satire."--Hollander. + +The nervous dyspeptic suffers no marked pain, but often feels a "sinking", +has no appetite, and cannot enjoy life because his stomach, though sound, +does not get enough nerve-force to run it properly. + +A great deal of nerve-force is required for digestion, and if a man comes +to the table exhausted, bolts his food, uses nerve-force scheming while he +is bolting, and, immediately he has bolted a given amount, rushes off to +work, digestion is imperfectly performed, nutriment is not assimilated, the +nerve-force supply becomes deficient. He continues to overdraw his account +in spite of the doctor's warning, and stomachic bankruptcy occurs, followed +by a host of ills. + +Nervous dyspepsia is a very obstinate complaint, but if tackled resolutely, +it can to a great extent be mitigated; but let it be emphasized at once, +that medicines, patent or otherwise, are useless. If dyspepsia be +aggravated by other complaints, these should receive appropriate treatment, +but the assertions so unblushingly made in patent-pill advertisements are +unfounded. The very variety of the advertised remedies is proof of the +uselessness of all. + +Set aside certain periods three times a day for meals. Fifteen minutes +before meal times, sit in a comfortable chair, relax all your muscles, +close the eyes, and try to make the mind a blank. _Rest_! + +Then eat the meal slowly and thoroughly. Conversation may lighten and +lengthen a meal, but avoid politics, "shop" and topics of that type. What +is wanted at table is wit, not wisdom. + +Water may be drunk with meals, provided it is drunk between eating, and not +while masticating, for it has decidedly beneficial effects upon the +digestive functions. Water is usually forbidden with meals because if +patients drink while eating, the water usurps the functions of saliva, and +moistens the bolus, which is then swallowed with little or no mastication. +If you cannot drink between mouthfuls, then drink only between meals. +_Never drink while food is in the mouth!_ + +After the meal, lie down on the right side for half an hour, _resting_, and +so directing all available nerve-energy to getting digestion well under +way. + +Indifferent appetites must be tempted by wholesome dishes made up in a +variety of enticing ways. Fats are good, but must be taken in a tasty form. +Eat fruit deluged with cream. + +The crux of digestion is to + +"_Chew_! CHEW!! and KEEP ON CHEWING!!!" for until food is thoroughly +masticated there will be no relief. The only part of the whole digestive +process placed under the control of consciousness is mastication, and, +paradoxically, it is the only part that consciousness usually ignores. + +A healthy man never knows he has a stomach; a dyspeptic never knows he has +anything else, because he will not _eat_ his food, but throws it into his +stomach as the average bachelor throws his belongings into a trunk. + +A varied, tasty diet, thoroughly chewed and salivated, with rest before and +after meals, is the only means of curing dyspepsia, for no medicine can +supply and properly distribute nerve-energy. + +Digestive pills are all purgatives, with a bitter to increase appetite, and +occasionally a stomachic, bound together with syrup or soap. Practically +all contain aloes, and very rarely a minute quantity of a digestive ferment +like pepsin. Taken occasionally as purges, most digestive pills would be +useful, but none are suited to continuous use, and the price is, as a rule, +out of all proportion to the primary cost, while one or two are, frankly, +barefaced swindles. + +The analyses of the British Medical Association give the following as the +probable formulae for some well-known preparations: + + Beecham's Pills.............................Aloes; ginger. + Holloway's Pills............................Aloes; ginger. + Page Woodcock's ............................Aloes; ginger; capsicum; + cinnamon and oil of + peppermint. + Carter's Little Liver.......................Aloes; podophyllin; + Pills liquorice. + Burgess' Lion Pills.........................Aloes; ipecacuanha; rhubarb; + jalap; peppermint. + Cockle's Pills..............................Aloes; colocynth; jalap. + Barclay's Pills.............................Aloes; colocynth; jalap. + Whelpton's Pills............................Ginger; colocynth; gentian. + Bile Beans..................................Cascara; rhubarb; liquorice; + peppermint. + Cicfa.......................................Cascara; capsicum; pepsin; + diastase; maltose. + + * * * * * + +CHAPTER XIII + +DIETING + + "Simple diet is best; many dishes bring many diseases," + --Pliny. + + "Alas! what things I dearly love-- + puddings and preserves-- + Are sure to rouse the vengeance of + All pneumogastric nerves!" + --Field. + +The man who pores over a book to discover the exact number of calories +(heat units) of carbohydrates, proteins and fats his body needs, means +well, but is wasting time. + +In theory it is excellent, for it should ensure maximum work-energy with +minimum use of digestive-energy, but in practice it breaks down badly, a +weakness to which theories are prone. One man divided four raw eggs, an +ounce of olive oil, and a pound of rice into three meals a day. +Theoretically, such a diet is ideal, and for a short time the experimenter +gained weight, but malnutrition and dyspepsia set in, and he had to give +up. The best diet-calculator is a normal appetite, and fancy aids digestion +more than a pair of scales. + +In spite of rabid veget- and other "arians", most foods are good (making +allowances for personal idiosyncrasy) if thoroughly masticated. The +oft-quoted analogy of the cow is incorrect, for herbivora are able to +digest cellulose; but even cows masticate most laboriously. + +Meat juices are the most digestion-compelling substances in existence, and +a little meat soup, "Oxo" or "Bovril" is an excellent first course. + +No one needs more than three meals per day, while millions thrive on one or +two only, which should be ready at fixed hours; for the stomach when +habituated becomes congested and secretes gastric juice at those hours +without the impulse of the will, is ready to digest food, and gets that +rest between-times which is essential to sound digestion. The man who has +snacks between meals, and chocolates and biscuits between snacks can never +hope to get well. + +To eat the largest meal at midday, as is the custom of working-men, is +best, provided one can take half an hour's rest afterwards. + +Drink a pint of tepid water half an hour before every meal. If the stomach +be very foul, add a teaspoonful of bicarbonate of soda to the water. + +The question of alcohol is a vexed one, but Paul's "Take a little wine for +thy stomach's sake," is undoubtedly sound advice, though had Paul been +trained at a London hospital, he would have added "after meals". +Unfortunately, moderation is usually beyond the ability of the neuropath, +and consequently he should be forbidden to take alcohol at all. Spirits +must be avoided. + +Moderately strong, freshly made tea or coffee may be consumed in reasonable +quantity. + +Vegetable salads are excellent if compounded with liquids other than +vinegar or salad oil, and of ingredients other than cucumbers, radishes, +and the like. + +Take little starchy food and sweetmeats. It may surprise those with "a +sweet tooth" to learn that, to the end of the Middle Ages, sugar was used +only as a medicine. Meat must be eaten--if at all--in the very strictest +moderation, and never more than once a day. Eggs, fish and poultry--in +moderation too--take its place. + +Healthy children need very little meat, while it is a moot point if +children of unstable, nervous build need any at all. The diet at homes for +epileptics is usually vegetarian, and gives excellent results. + +Never swallow skin, core, seeds or kernels of fruits, many of which, +excellent otherwise, are forbidden because of the irritation caused to +stomach and bowels by their seeds or skins. + +Bromides are said to give better results if salt is not taken. A little may +be used in cooking, if, as is usually the case, the patient has to eat at +the common table, but condiments are unnecessary and often irritating to +delicate stomachs. + +The diet of nervous dyspeptics must be very simple, and though it is trying +and monotonous to forgo harmful dainties in favour of wholesome dishes, it +is but one of the many limitations Nature inflicts on neuropaths. Many an +epileptic, after believing himself cured, has brought on a severe attack by +an imprudent meal. La Rochefoucauld says: "Preserving the health by too +strict a regimen is a wearisome malady", but it is open to all men to +choose whether they will endure the remedy or the disease. + +Most men eat six times the minimum and twice the optimum quantity of food +per day. For every one who starves, hundreds gorge themselves to death. +"Food kills more than famine", and the poor, who eat sparsely from +necessity, suffer far less from gout, cancer, rheumatism and other +food-aggravated diseases than the rich. + +Most books give detailed lists of foods to be eaten and to be avoided, but +this we believe is productive of little good. + +Let the patient eat a mixed diet, well and suitably cooked, taking what he +fancies in reason, masticating everything thoroughly, and gradually +eliminating foods which experience teaches him are difficult for him to +digest. + + * * * * * + +CHAPTER XIV + +CONSTIPATION + + "Causing a symptom to disappear is seldom the cure of + any ill; the true course is to _prevent_ the symptom." + +Rings of muscle cause wormlike movements of the bowels, and so propel +forward food and waste. Weakening of these muscles or their nerve controls +from any cause, results in a "condition of the bowels in which motions +occur only when provoked by medicines or injections". In some cases though +motions occur freely, food ingested is retained too long in the digestive +tract. + +The blood extracts what water it needs from the fluid waste in the large +bowel, but when the weak muscles allow this to remain too long, an excess +of moisture is removed, leaving hard, dry masses, painful to pass. + +When the faeces reach the anus, they cause an uneasy feeling, which directs +us to seek relief, but if we neglect this impulse the bowel may become so +insensitive that it ceases to warn its owner of the need to evacuate. +Meantime, the muscles which expel the faeces get weak, so that every motion +needs a strong effort of will, and much harmful straining. + +Much misery is caused by false modesty in the presence of others. It can +never be immodest to attend to the calls of Nature, and such +hypersensitiveness is dangerous, for rupture, piles, fissure, prolapse, +fistula, are often due to straining. + +Lack of exercise weakens the intestinal and abdominal muscles. Unsuitable +or imprudent foods or drinks, indigestion, excessive worry, and anything +that lowers the general health tend to produce constipation. + +Bacteria flourish freely in faeces, and though it is doubtful whether the +"Auto-intoxication" so freely ascribed to them, is supported by facts, it +cannot be doubted that, whatever the precise mechanism by which the effects +are produced, constipation does result in a lowering of the resistance to +disease. More frequent fits, colic, foul breath, headache right across the +forehead, lost appetite, drowsiness, skin eruptions, irritability, +insomnia, melancholia and anaemia (especially the "green sickness" of women, +usually connected with menstrual irregularities) are but a few of many ills +partly or wholly due to or consequent upon constipation. + +The symptoms of constipation of the small bowel are dry stools, usually +light in colour. + +To cure this type, more water should be drunk, so that the waste may pass +to the large bowel in a fluid state. Drink freely between meals, especially +in summer, when profuse perspiration often causes obstinate constipation. + +The symptoms of constipation of the large bowel are furred tongue, foetid +breath, sallow or jaundiced complexion, and mottled stools of round, hard +balls, the first portion being very firm, and the remainder nearly liquid. +There are occasional attacks of colic. + +The first step towards cure is to form regular habits. At a suitable time, +say shortly after breakfast, or after supper if you suffer from +haemorrhoids, go to the lavatory, whether you feel uncomfortable or not. +Wait patiently, do not try to hasten matters by violent straining, and if +for some weeks there is little improvement, do not despair, for the habits +of a lifetime are not overcome in five minutes, just because you have +decided to amend your careless ways. A short, brisk walk beforehand often +helps. + +If necessary, use a chamber and "squat" as savages do. In this position, +the thighs support the abdomen, and force is exerted without straining. +Massaging the abdomen by firmly rubbing it round and round, clockwise, with +the hand, often does good, as does pressure with a finger on the flesh +between the end of the backbone and the anus. Try every method before +taking purgatives, for with patience and determination these are rarely +necessary. + +Carefully cooked and "concentrated", easily digested and "pre-digested" +foods contain little residue; every meal should contain some indigestible +matter to stimulate the intestines. Brown bread, porridge, lettuce, cress, +apples and coarse vegetables are all good for this purpose, but if taken +too freely may cause heartburn and flatulence. Meat, milk, fish, eggs and +most patent foods have not enough waste. Boiled milk is very constipating. + +Purgatives, injections and medicines, alone, are useless, for the bowel +becomes still more insensitive to natural calls under the artificial +stimulation of drugs, on which it becomes so entirely dependent that +without their aid it will not act. + +It may be necessary to clean out the bowel by an enema. + +Make a lather with clean warm water and plain soap, and fill the enema +syringe (a half-pint size is useful). Smear the nozzle with vaseline, lean +forward and insert into the anus, pointing a little to the left. Press the +bulb, withdraw the nozzle, retain the liquid a few moments and a desire to +go to stool will be felt. + +A simpler plan is to buy glycerin suppositories. One is inserted into the +anus and acts like an injection. It must be clearly understood that these +are emergency measures. + +If internal piles come down at stool, do not allow them to remain and get +engorged with blood. See that your hands are scrupulously clean, and your +nails closely cut and free from dirt; then moisten the middle finger with a +little vaseline taken to the lavatory for the purpose, and gently return +the haemorrhoids, sitting down for a few minutes to retain them. + +A mild purge may be taken once a week with advantage. Glauber's Salts +(Sodium Sulphate), Cascara Sagrada, and liquid paraffin are all good, while +Castor Oil Globules are suited for children. + +For flatulence, take a 10-minim capsule of Terebine after meals, or +charcoal, either as French Rusks ("Biscols Fraudin") or a teaspoonful of +powdered charcoal between meals. One drop of creosote on a lump of sugar, +peppermint water, and sal volatile may also be used. Sufferers should toast +bread, and use sugar sparingly. + +Patent medicines almost invariably contain a brisk aperient. + + * * * * * + +CHAPTER XV + +GENERAL HYGIENE + + "Better to hunt in fields for health unbought, + Than fee the doctor for a nauseous draught." + --Dryden. + +If men but realized what complicated machines they were, they would use +themselves better. In the body are 240 bones and hundreds of muscles. The +heart, no bigger than the clenched fist, beats 100,000 times a day; the +aerating surface of the lungs is equal in area to the floors of a +six-roomed house, and by means of its minute blood-vessels which would +stretch across the Atlantic, 500 gallons of blood are brought into contact +with over 3,000 gallons of air every day. + +Seven million sweat-glands, 30 miles long, get rid of a pint of liquid and +an ounce of solid waste each day while it takes a tube 30 feet long, with +millions of glands, to deal with a sip of milk. + +Man's finest steam engine turns one-eighth of the energy supplied into +work; nature's engine, muscle, turns one-third into work. The body contains +9 gallons of water, enough carbon to make 9,000 lead pencils, phosphorus +for 8,000 boxes of matches, iron for 5 tacks, and salt enough to fill half +a dozen salt-cellars. + +Over 40 food-ferments have been found in the liver; there are 5,000,000 red +and 30,000 white blood corpuscles in a space as big as a pin's head, each +one of which travels a mile a day and lives but a fortnight, millions of +new ones being built up in the bone-marrow every second; a flash of light +lasting only one eight-millionth of a second, will stimulate the eye, which +can discriminate half a million tints. The ear can distinguish 11,000 +tones, and is so sensitive that we hear waves of air less than one +sixty-thousandth of an inch long; a mass of almost liquid jelly--for 81 per +cent of the brain is water, and Aristotle thought it was a wet sponge to +cool the hot heart--sends out impulses ordering our every thought and act, +and stores up memory, we know not how or where. + +There are 10,000,000,000 of cells in the brain cortex alone, and 560,000 +fibres pass from the brain down the spinal cord. + +A clear, watery cell, no larger than the dot on an "i" encloses factors +causing genius or stupidity, honesty or roguery, pride or humility, +patience or impulsiveness, coldness or ardour, tallness or shortness, form +of head or hands, colour of eyes and hair, male or female sex, and the +thousand details that make a man. + +Yet man uses this marvellous mechanism but carelessly, and the widespread +poverty, the worry and discord in the lives of the happiest, our ignorance, +the evil habits we contract, and the vice, miseries, diseases and labours +to which most expectant mothers are too often exposed, explain why one baby +in every eight never walks; why but four of them live to manhood; why less +than 40 years is now man's average span; and why this brief space is filled +with suffering and misery, from which many escape by self-destruction. + +Sound children do not come from unclean air, surroundings, habits, +pursuits, passions and parents. Children conceived in unsuitable +surroundings by unsuitable parents, die; must die; ought to die. They are +not built for the stern battle of life. + + * * * * * + + "Where the sun does not enter, the doctor does!" + --Italian proverb. + +Plenty of fresh, clean air is essential to health. + +In all rooms a block of wood nine inches high should be inserted beneath +the whole length of the bottom sash of the window. This leaves a space +between the top and bottom sashes through which fresh air passes freely, +without draught, both night and day, for it should never be closed. A handy +man will fit a simple device to prevent the windows being forced at night, +but better let in a burglar than keep out air. + +If it be cold or draughty in the bedroom, hang a sheet a foot from the +window, put more blankets or an overcoat on the bed, or put layers of brown +paper above the sheets, _but never close the window_. + +You can take too much of many good things, but never too much pure air. + +Cleanliness. Keep the body clean by taking at least one hot bath per week; +per day if possible. Much filth is excreted by your sweat-pores; why let it +cake on skin and underlinen, and silently silt up your thirty miles of skin +canals, thus overworking the other excretory organs, and gradually +poisoning yourself? + +Neuropaths always suffer from sluggish circulation of the extremities, and +to improve this, hot and cold baths, spinal douches and massage are +excellent. A hot bath (98-110 deg. F.) ensures a thorough cleansing, but it +brings the blood to the surface, where its heat is quickly lost, enervating +one, and causing a bout of shivering which increases the production of heat +by stimulating the heat-regulating centre in the brain. Baths above 110 deg. F. +induce faintness. To prevent shivering, take a cold douche after the hot +bath, and have a brisk rub down with a coarse towel, when a delightful, +warm glow will result. Do not freeze yourself, or the reaction will not +occur; what is wanted is a short, sharp shock, which sends the blood racing +from the skin, to which it returns in tingling pulsations, which brace up +the whole system. The douche is over in a few seconds, and may be enjoyed +the year round, commencing in late Spring. + +The cold bath must not be made a fetish. If the glow is not felt, give it +up, and bathe in tepid (85-92 deg. F.) or warm (93-98 deg. F.) water. When started +in the vigour of youth, the cold bath may often be continued through life, +but it is unwise to commence in middle life. Parents should never force +their children to take cold baths, to "harden them". + +Other Hygienic Points. Tobacco is undesirable for neuropaths, save in +moderation. + +Clothes should be light, loose, and warm. Epileptics should wear low, stiff +collars, half a size too large, with clip ties. Such a combination does not +form a tight band round the neck, and can quickly be removed if necessary. +Wear thick, woollen socks, and square-toed, low-heeled, double-soled boots. +Hats should be large, light, and of soft material. Woollen underwear is +best. Change as often as possible, and aim at health, not appearance. + +Let all rooms be well lighted, well ventilated, moderately heated, and +sparsely furnished with necessities. Shun draperies, have no window boxes, +cut climbing plants ruthlessly away from the windows, and never obstruct +chimneys. + +Buy Muller's "My System", which gives a course of physical exercises +without apparatus, which only take fifteen minutes a day. The patient must +conscientiously perform the exercises each morning, not for a week, nor for +a month, but for an indefinite period, or throughout life. + +Finally, remember that so few die a natural death from senile decay because +so few live a natural life. + + * * * * * + +CHAPTER XVI + +SLEEPLESSNESS + + "O magic sleep! O comfortable bird + That broodest o'er the troubled sea of the mind + Till it is hushed and smooth." + --Keats. + +Some men need only a few hours' sleep, but no one ever overslept himself in +natural slumber. There are anecdotes of great men taking little sleep, but +their power usually consisted in going without sleep for some days when +necessary, and making up for it in one long, deep sleep. Neuropaths require +from 10-13 hours to prepare the brain for the stress of the next day, but +quality is more important than quantity. + +Patients go to bed tired, but cannot sleep; fall asleep, and wake every +other hour the night through; sleep till the small hours, and then wake, to +get no more rest that night; only fall asleep when they should be rising; +or have their slumber disturbed by nightmare, terrifying dreams, heart +palpitation, and so on. + +Noise often prevents sleep. A clock that chimes the quarters, or a watch +that in the silence ticks with sledge-hammer beats, has invoked many a +malediction. Traffic and other intermittent noises are very trying, as the +victim waits for them to recur. Townsmen who seek rural quiet have got so +used to town clatter, that barking dogs, rippling streams, lowing cows, +rustling leaves, singing birds or chirruping insects keep them awake. Too +much light, eating a heavy supper, all tend to banish repose, as do also +violent emotions which produce toxins, torturing the brain and causing +gruesome nightmares. + +Grief and worry--especially business and domestic cares--constipation, +indigestion, bad ventilation, stimulants, excitement and a hearty supper +are a few of the many causes of insomnia. + +In children sleeplessness is often due to the bad habit of picking a child +up whenever it cries, usually from the pain of indigestion due to having +been given unsuitable food. Feed children properly, and train them to +regular retiring hours. School home-work may cause insomnia; if so, forbid +it. + +Man spends a third of his life in the bedroom, which should be furnished +and used for no other purpose. Pictures, drapery above or below the bed, +and wallpaper with weird designs in glaring colours are undesirable. The +wall should be distempered a quiet green or blue tint, and the ceiling +cream. A bedroom should never be made a storeroom for odds and ends, nor is +the space beneath the bed suitable for trunks; least of all for a +soiled-linen basket. + +Some time before retiring, excitement and mental work should be avoided. +The patient should take a quiet walk after supper, drink no fluid, empty +bladder and bowels, and take a hot foot-bath. + +Retire and rise punctually, for the brain, like most other organs, may be +trained to definite habits with patience. + +If sleeplessness be ascribed, rightly or wrongly, to an empty stomach, a +glass of hot milk and two plain biscuits should be taken in bed; dyspeptics +should take no food for three hours before retiring. If the patient wakes +in the early morning he may find a glass of milk (warmed on a spirit-stove +by the bedside) and a few plain biscuits of value. + +A victim of insomnia should lie on his side on a firm bed with warm, light +coverings, open the window, close the door, and endeavour to fix his +attention on some monotonous idea; such as watching a flock of white sheep +jump a hedge. Think of trifles to avoid thinking of troubles. + +How often do we hear people complain that they suffer from insomnia, when +in fact they get a reasonable amount of sleep, and indeed often keep others +awake by their snoring. + +When you wake, _get up_, for a second sleep does no good. When some one, on +seeing the narrow camp-bed in which Wellington slept, said: "There is no +room to turn about in it," the Iron Duke replied: "When a man begins to +turn about in his bed it is time he turned out of it." + +The only safe narcotic is a day's hard work. For severe insomnia consult a +doctor; do not take drugs--that way lies ruin. By taking narcotics, or +patent remedies containing powerful drugs, you will easily get sleep--for a +time only--and then fall a slave to the drug. Such victims may be seen in +dozens in any large asylum. + + * * * * * + +CHAPTER XVII + +THE EFFECTS OF IMAGINATION + + "The surest way to health, say what they will + Is never to suppose we shall be ill; + Most of the ailments we poor mortals know + From doctors and imagination flow." + --Churchill. + + "Men may die of imagination, + So depe may impression be take." + --Chaucer. + + "Suggestion is the introduction into the mind of a practical belief + that works out its own fulfilment."--Guyau. + +Man suffers from no purely imaginary ills, for mental ills are as real as +physical ills, and though an individual be ailing simply because he +persuades himself he is ailing, his mind so affects his body that he is +actually unwell physically, though the cause of his trouble is purely +mental. + +The suffering of this world is out of all proportion to its actual disease, +many people being tortured by fancied ills. Some dread a certain complaint +because a relative has died of it. + +Others are unwell, but while taking proper treatment they brood gloomily, +and get worse instead of better as they should and _could do_. + +Cheap medical and pseudo-medical works are not an unmixed blessing, for +many a person who knows, and needs to know, nothing about disease, gets +hold of one, and soon has most of the ills known to the faculty and some +which are not. + +If a patient be an optimist and persuades himself he is improving, he +_does_ improve. This is the explanation of "Faith moving mountains", for +the curative power of prayer, Christian Science, laying-on of hands, +suggestion treatment and patent medicine, depends on man's own faith, not +on the supernatural. + +A doctor in whom a patient has perfect confidence, will do him far more +good with the same medicines, or even with no medicines at all, than one of +riper experience in whose skill he has no faith. + +Eloquent, though often inaccurate accounts of the benefits derived from +patent medicines are persistently advertised until the mind is so +influenced by the constant reiteration of miraculous cures, that, either +because the healing forces of the body are thereby stimulated, or because +the disease is curable by suggestion, the patient is benefited by such +medicines. + +Thinking of pain makes it worse and vice versa. + +The curative effects of auto-suggestion were demonstrated at the Siege of +Breda in 1625. The garrison was on the point of surrender when a learned +doctor eluded the besiegers, and got in with some minute phials of an +extraordinary Eastern Elixir, one drop of which taken after each meal cured +all the ills flesh was heir to; two drops were fatal. + +The "learned doctor" was a quick-witted soldier, and the elixir was +_coloured water_ sold by order of the commander. Its potency was due to the +faith of all, who persuaded each other they were getting better, and an +epidemic of infectious wellness followed ills due to depressed spirits. + +One man after reading a list of symptoms said in great alarm: "Good +Heavens. I have got that disease!" and, on turning the page, found it +was... _pregnancy_. + +As the great Scotch physiologist, Reid, said seventy years ago: + + "Hope and joy promote the surface circulation of the body, and the + elimination of waste matter and thus make the body capable of + withstanding the causes which lead to disease, and of resisting it when + formed. Grief, anguish and despair enfeeble the circulation, diminish + or vitiate the secretions, favour the causes which induce disease, and + impede the action of the mechanism by which the body may get rid of its + maladies. An army when flushed with victory and elated with hope + maintains a comparative immunity from disease under physical privations + and sufferings which, under the opposite circumstances of defeat and + despair, produce the most frightful ravages." + +The classic description of the woeful effects of imagination is in Jerome's +"Three Men in a Boat". Harris, having a little time on his hands, strolls +into a public library, picks up a medical work, and discovers he has every +affliction therein mentioned, save housemaid's knee. He consults a doctor +friend and is given a prescription. After an argument with an irate +chemist, he finds he has been ordered to take beefsteak and porter, and not +meddle with matters he does not understand. A sounder prescription never +was penned. + + * * * * * + +CHAPTER XVIII + +SUGGESTION TREATMENT + + "To purge the veins + Of melancholy, and clear the heart + Of those black fumes that make it smart; + And clear the brain of misty fogs + Which dull our senses, our souls clog." + --Burton. + +Hypnosis and suggestion have suffered from those people who put back every +reform many years--quacks and cranks--for while science, with open mind, +was testing this new treatment, the quacks exploited it up hill and down +dale. + +Yet there is nothing supernatural in suggestion, for we employ it on +ourselves and others every hour we live. Conscience consists only of the +countless stored-up suggestions of our education, which by opposing any +contrary suggestions, cause uneasiness. + +Many of us conform through life to the suggestions of others, affection, +awe, hero-worship and fear taking the place of reason. + +The most resolute of men are influenced by tactful suggestions, which +quietly "tip-toe" on to the margin of consciousness, awaken ideas which +link up more and more associations, until an avalanche is started which +forces itself on to the field of consciousness, the subject thinking the +idea is his own. + +Author and actor try by suggestion to make us think, laugh, or weep at +their will, books are sold by suggestive titles, and many clothes are worn +only to suggest wealth or respectability. + +The best salesman is he who by artful suggestion sells us what we do not +want; the best buyer he who by equally astute suggestion makes the seller +part at a price which makes him regret the bargain the moment it is closed. + +Suggestion treatment is of great use in curing nervous states and bad +habits, and all neuropaths should practice self- or auto-suggestion. In +severe cases a specialist must give the treatment. + +The patient is taken by the neurologist to a cosy, restfully-furnished, +half-lighted room, and placed in a huge easy chair facing a cheery fire. He +sinks into the depths of the chair, relaxes every muscle, allows his +thoughts to wander pleasantly, and soon his brain is at rest, and his mind, +undisturbed by the fears which usually harass it, is ready to receive +suggestions. + +The doctor talks quietly, soothingly, but with the conviction born of +knowledge to the patient about his trouble, assuring him that he _can_ +control his cravings; that he _can_ put away the doubts or fears that have +grown upon him. The true reason of his illness is pointed out, any little +organic factors given due weight, and the idea that it is hereditary or due +to Fate dispelled. Faults of character, reasoning and living are +unsparingly exposed and appropriate remedies suggested, and he is shown how +unmanly his self-torturing reproaches are, and how futile is remorse unless +transmuted into reform. + +The doctor's earnestness inspires confidence, and the patient unburdens his +secret troubles, discusses means of remedying them, and turns from pain to +promise, from remorse to resolve, from introspection to action, from +dreading to doing. + +Struck by the way the psycho-analyst reads his soul and lays bare petty +meannesses, impressed by the patient thoroughness with which the doctor +attends to each little symptom, confident that organic troubles--if there +be any--will receive appropriate treatment, ready to carry out +instructions, and disposed to believe the new treatment is of real value: +under all these circumstances, the physician's suggestions carry very great +weight with the patient. + +The resolutions passed by the victim in this calm state sink deep into +subconsciousness, and when next temptation, impulse or fear assails him, +his own resolutions and the doctor's suggestions are so vividly recalled +that he tries to control his thoughts, and, in due time he "wins out". + +Anyone may induce the calm state, and repeat suitable suggestions. The +patient should go to a quiet room, and, reclining on a comfortable couch +before a cheery fire, close the eyes, relax the muscles, breathe deeply, +and avoid all sense of strain. + +The next step is to fix the imagination on some scene which suggests +tranquility--smooth seas, autumnal landscapes, snow-clad heights, old-world +gardens, deep, shady silent pools, childhood's lullabies, secluded +backwaters, dim aisles of ancient churches. + +After a few evenings' practice, you will be able gradually to exclude all +other ideas, and focus on one, inducing a state which, somewhat similar +outwardly, is free from the excitement of religious exaltation, and from +the delusions of a medium's trance. + +In this state, an appropriate suggestion must be made, sincerely, and with +_absolute faith_ in its power. Christ's miracles were the result of +suggestive therapeutics, and He took care to inspire relatives with faith, +to exclude scoffers, to surround himself by his believing Apostles, and, +after treatment, said: "See thou tell no man!" well knowing that suggestion +cannot withstand derision. + +In this way, a patient of limited means can do for himself exactly what +more fortunate ones pay large fees to specialists to do for them. The +treatment is uncommon, but sound, for the medical profession is perhaps the +most conservative on earth, and when specialists of repute use a method, +you may be confident it is of value. + +To cure sleeplessness, see that stomach and brain are at rest, bed +comfortable, and feet warm; calm yourself, and focus on the idea of sleep, +saying: + +"I shall go to sleep in a few minutes, and wake at eight o'clock in the +morning." + +Repeat this a few times, persist for a few nights and you will quickly get +drowsy, and fall asleep. + +Phrases for other requirements will readily occur, as: + +"I shall feel confident in open spaces!" + +"I shall find no more pleasure in alcohol!" and so on. + +Suggestion will not cure epilepsy, hysteria or neurasthenia, but it +overcomes many of the symptoms which make the patient so wretched. + + "Crutches are hung on the walls of miraculous grottos, but _never a + wooden leg_." + +Suggestion may move a paralysed arm, but the muscles only become healthy +again in many days by slow repair; suggestion releases the catch, but the +spring must be wound up by energy suitably applied. + + * * * * * + +CHAPTER XIX + +MEDICINES + + "Of simples in these groves that grow + He'll learn the perfect skill; + The nature of each herb, to know + Which cures and which can kill." + --Dryden. + +So distressing a malady as epilepsy early attracted attention, and every +treatment superstition could devise, or science could suggest, has been +tried. Culpepper in his "Herbal" (300 years old), recommends bryony; lunar +caustic (nitrate of silver) was extensively used, because silver was the +colour of the moon, which caused madness. + +The royal touch for scrofula (King's Evil) was also extended to epilepsy, +the king blessing a ring, which was worn by the sufferer. + +Another old remedy was to cut off a lock of the victim's hair while in a +seizure and put it in his hand, which stopped (?) the attack. In Berkshire +a piece of silver collected at the communion service and made into a ring +was specific, but in Devon a ring made of three nails from an old coffin +was preferred. Lupton says: "A piece of child's navel-string borne in a +ring is good against falling sickness." + +Nearly every drug in the Pharmacopoeia has been tried, the drugs now +generally used being sodium, potassium and ammonium bromide. + +Before bromides were introduced by Locock in 1857, very strict hygienic, +dietic and personal disciplinary treatment combined with the use of drugs +often effected improvement. Since the use of bromides, these personal +habits have, unfortunately, been neglected, far too much reliance being +placed on the "three times a day after meals" formula. + +All bromides are quickly absorbed from the stomach and bowels, and enter +the blood as sodium bromide, which lowers the activity of both motor and +sensory centres, and renders the brain less sensitive to disturbing +influences. + +Unfortunately, the influence of bromides is variable, uncertain, and +markedly good in only a small proportion of cases. + +In about 25 per cent of cases, in which mild seizures occur at long +periods, without mental impairment, the bromides arrest the seizures, +either temporarily or permanently, after a short course. In another 25 per +cent the bromides lessen the frequency and severity of the fits, this being +the common _temporary_ result of their use in _all cases_ in the first +stages. + +In quite 50 per cent of cases, the effect of bromides diminishes as they +are continued, and they finally exert no influence at all. Many cases are +temporarily "cured", the drug is stopped, and the seizures recur. Bromides +are valuable in recent and mild cases, but no medicine exerts much effect +on severe cases of long standing, which usually end in an institution. + +When these drugs are taken continuously, nausea, vomiting, sleepiness, +confusion of thought and speech, lapses of memory, palpitation, furred +tongue, unsteady walk, acne and other symptoms of "bromism" may arise, +whereupon the patient must stop taking bromides and see a doctor, who will +substitute other drugs for a time. + +If heart palpitation be troublesome while using bromides, take a +teaspoonful of sal volatile in water. + +See a doctor if you can; _until_ you see him, get from a chemist: + + Potassii bromidi 10 grains. + Sodii bromidi 10 grains. + Boracis purificati 5 grains. + Aquae 1 fluid ounce. + Two tablespoonfuls in water three times a + day after meals. + +This prescription is for an adult. If the patient be under twenty-one, tell +the chemist his age, and he will make it up proportionately. + +Victims who have seizures with some regularity at a certain time, should +take the three doses in one, two hours before the attack is expected. If +there are long intervals between attacks, cease taking bromides after one +fit and recommence three weeks before the next seizure is apprehended. When +there is an interval of six months or more between attacks, take no drugs. + +Bromides in solution are unpalatable, patients grow careless of regularity +and dosage. + +You must learn from your doctor and your own experience the prescription, +time and dose best suited to your case, and then _never miss a dose until +you have been free from fits for two years_, for the beneficial action of +bromide depends on the tissues becoming and remaining "saturated" with the +drug. Never give up bromides suddenly after long use, but gradually reduce +the dose. + +It is just when the disease has been brought under control, that patients +consider further doctor's bills an unnecessary expense, with the result +that a little later the fits recur, and a tedious treatment has to be +commenced over again. + +No value can be placed on any specific for epilepsy until it has been +thoroughly tested for some years, and so proved that its effects are +permanent, for almost any treatment is of value for a time, possibly +through the agency of suggestion. + + * * * * * + +CHAPTER XX + +PATENT MEDICINES + + "Men who prescribe purifications and spells and other illiberal + practices of like kind."--Hippocrates. + + "...Corrupted + By spell and medicines bought of mountebanks." + "Othello." Act I. + +Carlyle said the world consisted of "so many million people, _mostly +fools_"; and he was right, for to public credulity alone is due the immense +growth of the patent-medicine trade. + +It was formerly thought that for each disease, a specific drug could be +found, but this idea is exploded. The doctor determines the exact condition +of his patient, considers how he best may assist nature or prevent death, +and selects suitable drugs. He carefully notes their action and modifies +his treatment as required. The use of set prescriptions for set diseases is +obsolete; the doctor of to-day treats the patient, not the disease. + +A few patent medicines are of limited value; many are made up from +prescriptions culled from medical works, and the rest are frauds, like +potato starch. The evil lies in charging from three to four hundred times a +just price, in ascribing to a medicine which may be good for a certain +disorder, a "cure-all" virtue it does not possess, and in inducing ignorant +people to take powerful drugs, reckless of results. + +Ephemeral patent-medicine businesses, run by charlatans, whose aim is +frankly to make money before they are exposed, spring up like mushrooms; +and their cunningly worded advertisements meet the eye in the columns of +every paper one opens for a few months; then they drop out, to reappear +under another name, at another address. These rogues buy a few gross pills +from a wholesale druggist, insert a small advertisement, and so lay the +foundations of a profitable business. + +The lure of the unknown is turned to account. "The discoverer went back to +the Heart of Nature--and found many rare herbs used by Native Tribes." "The +"Heart of Nature" was probably a single-room office tucked away down a +Fleet Street alley, and analysis proves these medicines contain only common +drugs, one "_Herbal Remedy_" being _metallic_ phosphates. + +A common procedure is to send a question form, and, after answering the +query, "What are you suffering from?" with "Neurasthenia", the company +"carefully study" this, and then inform you with a gravity that would grace +the pages of "Punch", "You are the victim of a very intractable type of +Neurasthenia", so intractable in fact that it will need "additional +treatment"--at an "additional" fee. + +The quack's advertisements are models of the skilful use of suggestion, and +turn to rare account the half-knowledge of physiology most men pick up from +periodicals. He frightens you with alarming and untrue statements, gains +your confidence by a display of semi-true facts reinforced where weak by +false assertions, and, having benefited himself far more than you, leaves +you to do what you should have done at first, go to a doctor or a hospital. + +Were it made compulsory for the recipe to be printed on all patent +medicines, people would lose their childlike faith in coloured water and +purges, and cease the foolish and dangerous practice of treating diseases +of which they know little with drugs of which they know less. + +The British Medical Association of 429, Strand, London, W.C., issue two +1_s_. books--"Secret Remedies: What they cost and what they contain", "More +Secret Remedies"--giving the ingredients and cost price of most patent +medicines. You are strongly urged to send for these books, which should be +in every home. + +_The basis of every cure for epilepsy_ (not obviously fraudulent) _is +bromides_. The usual method is to condemn vigorously the use of potassium +bromide, and substitute ammonium or sodium bromide for it. Some advertisers +condemn all the bromides, and prescribe a mixture of them; others condemn +potassium bromide, and shamelessly forward a pure solution of this same +salt in water as a "positive cure!" + +In all cases the sale price is out of reasonable proportion to the cost, +victims paying outrageous sums for very cheap drugs. + +Most epileptics are poor, because their infirmity debars them from +continuous or well-paid work, leaving them dependent on relatives, often in +poor circumstances also. The picture of patients, already lacking many real +necessities, still further denying themselves for weeks or months to +purchase a worthless powder, is truly a pitiful one. + +Bromides are unsatisfactory drugs in the treatment of epilepsy, but they +are the best we have at present. Get them made up to the prescription of a +doctor, and see him every month to report progress and be examined. In the +end, this plan will be very much cheaper, and incomparably better, than +buying crude bromides from quacks. + + * * * * * + +There is no drug treatment for either hysteria or neurasthenia, and when +the doctor gives medicines for these complaints, it is to remedy organic +troubles, or, more often because necessity forces him to pander to the +irrational and pernicious habit into which the public have fallen of +expecting a bottle of medicine whenever they visit a doctor. Osier, the +famous Professor of Medicine at Oxford, truly observed that he was the best +doctor who knew the uselessness of medicines. But when public opinion +demands a bottle, and is unwilling either to accept or pay for advice +alone, the doctor may be forced to give medicines which he feels are of +little value, hoping that their suggestive power will be greater than is +their therapeutic value. + +Neuropaths invariably contract the habit of physicking themselves, and +taking patent foods and drugs which are valueless. + +So universal is this pernicious habit that we deem it desirable to +criticize it here at some length. + +One highly popular type consists of port wine, reinforced (?) by malt and +meat extracts, and sold under a fanciful name. It has about the same value +as a bottle of port, which costs considerably less. It is well to remember +that many a confirmed drunkard has commenced with these "restoratives". + +Malt extracts are also popular. They contain diastase, and therefore aid +the digestion of starch, but the diastatic power of most commercial +extracts is negligible. + +Meat extracts of various makes contain no nourishment, but are valuable +appetisers. Meat gravy is as effective and far cheaper. + +Foods containing digestive ferments, which are widely advertised under +various proprietary names are practically valueless, as are the ferments +themselves sold commercially. Digestive disorders are very rarely due to +deficiency of ferments, while pepsin is the only one among all the ferments +that could act (and that only for a little while) in the digestive system. + +Some of the disadvantages of predigested foods have been noted, and their +prices are usually so exorbitant that eggs at 2_s._ 6_d._ each would be +cheaper. The remarks of Sollmann the great pharmacologist are pertinent: + + _Limitations_. The administration of food in the guise of medicine is + sometimes advantageous; but medicinal foods are subject to the ordinary + law of dietetics, and therefore cannot accomplish the wonders which are + often claimed for them. The proprietary foods have been enormously + overestimated, and have probably done more harm than good. The ultimate + value of any food depends mainly on the amount of calories which it can + yield, and on its supplying at least a minimum of proteins. In these + respects, the medical foods are all inferior, for they cannot be + administered practically in sufficient quantity to supply the needs of + the body. They have a place as adjuvants to other foods, permitting the + introduction of more food than the patient could otherwise be induced + to take. Aside from the special diabetes foods and cod-liver oil, their + value is largely psychic. + + _Predigested Foods_. The value of these is doubtful, for digestive + disturbances involve the motor functions and absorption more commonly + than the chemical functions. Their continued use often produces + irritation. + + _Liquid Predigested Foods_. As sold, these are flavoured solutions + containing small amounts (1/2-6 per cent) of predigested proteins, 1/2-15 + per cent of sugars and other carbohydrates, with 12-19 per cent of + alcohol, and often with large quantities (up to 30 per cent) of + glycerin. Their protein content averages less than that of milk, and in + energy value they are vastly inferior. Their daily dose yields but + 55-300 calories including their alcohol; this is only one-thirtieth to + one-fifth the minimum requirements of resting patients. To increase + their dose to that required to maintain nutrition would mean the + ingestion of an amount of alcohol equivalent to a pint of whisky per + day. + +Of recent years very expensive preparations of real or alleged organic iron +compounds have had a large sale. Iron is a component of haemoglobin, a solid +constituent (13 per cent by weight) of the blood, which combines with the +oxygen in the lungs, and is carried (as oxyhaemoglobin) all over the body, +giving the oxygen up to the tissues. Haemoglobin is an exceedingly complex +substance, but it contains only one-third per cent by weight of iron in +organic form. + +The liver is the storehouse of iron, its reserve being depleted when there +is an extraordinary demand for iron. The minute amounts of iron in ordinary +food are amply sufficient for all our needs; any excess is simply stored, +and, later excreted, and has no effect whatever on the circulating +haemoglobin. + +Iron is only of value in certain forms of anaemia, and the many patent +medicines purporting to contain haemoglobin or organic iron are therefore +useless to neuropaths. The Roman plan of drinking water in which swords had +been rusted, is quite as valuable as drinking expensive proprietary +compounds. When iron is indicated Blaud's Pills are perhaps the best +preparation. + +Huge quantities of patent medicines containing phosphates in the form of +hypo-or glycerophosphates, and (or) lecithin are sold annually. + +All phosphorus compounds are reduced to inorganic phosphates in the +digestive tract, absorbed and eliminated, so that, as with iron, if +phosphates are needed, the form in which they are taken is of no moment. +Why, then, pay huge sums for organic-phosphorus compounds (synthesized from +inorganic phosphates) when they are immediately reduced to the same +constituents from which they were constructed, the only value in the +reduction process being seen in the immense fortunes which patent-medicine +proprietors accumulate? + +Lecithin is isolated from animal brain, or egg-yolk, and commercial +lecithin is impure. Not only does the ordinary daily diet contain ample +lecithin (5 grammes), but two eggs will double this, while liver or +sweetbread, both rich in phosphorous, may be eaten. + +The much-vaunted glycerophosphates are decomposed to and excreted as +phosphates. Sollmann's remarks apply to all similar proprietary articles: + + "A proprietary compound of glycerophosphates and casein has been widely + and extravagantly advertised as 'Sanatogen'. It is a very costly food, + and in no sense superior to ordinary casein, such as cottage cheese." + +Hypophosphites have been boomed by various people, chiefly for financial +reasons. Five or six of them are usually prescribed, with the addition of +cod liver oil, and perhaps quinine, and (or) iron and strychnine, the +complexity of the prescription being expected, apparently, to compensate +for the uselessness of its various ingredients. + +To deduce rational remedies, it is first necessary to elucidate the causes +of inefficiency; and to expect a brain which is out of order to function in +an orderly manner simply because it is supplied with one of the substances +necessary to its normal functioning (regardless of whether a deficiency of +that substance is the cause of the disorder), is as rational as it would be +to expect to restart an automobile engine, the magneto of which was broken, +by filling up the half-empty petrol tank. + + * * * * * + +CHAPTER XXI + +TRAINING THE NERVOUS CHILD + + "When shall I begin to train my child?" said a young mother to an old + doctor. + "How old is the child, madam?" + "Two years, sir!" + "Then, madam, you have lost just two years," answered the old + physician, gravely. + +Neuropathic children are super-emotional, and from them come prodigies, +geniuses, perverts and madmen. They are usually spare of build, with pale, +sallow complexions, and dark rings under the eyes. + +They can never sit still, but wriggle restlessly about on their seats, pick +their nostrils, and bite their nails. They are always wanting to be doing +something, but soon tire of it, and start something else, which is as +quickly cast aside; their energy is feverish but fitful. They jump to +conclusions, quickly grasp ideas; as quickly forget them. Having no +capacity for calm, reasoned judgment, they are creatures of impulse, +imperative but timid, suffer from strange ideas, and worry over trifles. + +The affections are strong and vehement, likes and dislikes are taken +without reason, while intense personal attachments--often +unrequited--occur, but not seldom swing round to indifference, or even +bitter enmity. The passions and emotions are all abnormal, for owing to +deficiency in the higher inhibitory centres, the victim is blown about by +every idle emotional wind that blows. The slightest irritation may provoke +an outburst of maniacal rage, or a fit. Consequently, they require the most +careful, but firm training, right from birth, to bring them up with a +minimum of nerve-strain. Twitchings, night or day terrors, sleep walking, +and incontinence of urine often trouble them. They should be examined by a +doctor once a year. + +These children have no _balance_, and are usually selfish, always +garrulous, with a love of romancing, while a ready wit combined with +fertile imagination often gains them a bubble reputation for learning they +do not possess. Invention, poetry, music, artistic taste and originality +are occasionally of a high order, and the memory is sometimes phenomenal; +but desultory, half-finished work, and shiftlessness are the rule. + +Their appetite is fitful and fanciful, they like unsuitable foods, and +their digestive system is easily upset. At puberty, sexual perversity is +common, and the animal appetite, is as a rule, very strong, though rarely, +it may be absent. During adolescence, there is excessive shyness or +bravado, always introspection, and exaggerated self-consciousness. + +As they grow older, they readily contract hypochondria, neurasthenia, +hysteria, alcoholism, insomnia and drug habits, and react unduly to the +most trifling external causes, even to the weather, by which they are +exhilarated or depressed. + +Education. Send them to school only when the law compels you, and observe +them closely while there, for health is far more important to them than +education. "Infant prodigies" lack the mental staying power and physical +robustness which real success demands, though they may do well for a time. +Go to your old school: the successes of to-day were dunces twenty years +ago; about those whose names are proudly emblazoned in fading gold on Rolls +of Honour, a discreet silence is maintained. + +Keep a keen lookout for symptoms of over-effort. Sleepiness, languor, a +vacant expression, forehead wrinkled, eyebrows knit, eyes dull, sunken and +surrounded by dark rings, twitchings, restlessness, or loss of appetite are +all warnings that the pace is too strong for the child. + + "These are the cases in which the School Board--who ordain that if + children are well enough to play or run errands, they are well enough + to attend school--should be defied." + +This defiance must of course be reinforced by a doctor's certificate. + +To the healthy, the strain of preparing for and enduring an examination is +tremendous; to highly strung children it is dangerous. Home-work should be +forbidden in spite of the authorities. Let the child join in the sports of +the school as much as possible. + +School misdemeanours form a thorny problem, for discipline must be +maintained, and a stern but just discipline is very wholesome for this +type, who are too apt to assume that because they are abnormal, they can be +idle and refractory. On the other hand, parents should promptly and +vigorously object to their children being punished for errors in lessons, +or struck on the head. + +Diet. Food, while being nourishing, and easily digested, must not be +stimulating or "pappy". Meat, condiments, tea, coffee and alcohol are +highly undesirable, a child's beverage being milk and water. + +Meals should be ready at regular hours, and capricious appetites should +freely be humoured among suitable foods, served in appetizing form to tempt +the palate. Let them chatter, but see they do not get the time to talk by +bolting their food. + +Most children can chew properly soon after they are two, but they are never +taught. Their food is "mushy", or is carefully cut, and gives them no +incentive to masticate. So long as food is digestible, the harder it is the +better, and plain biscuits, raw fruits, and foods like "Grape Nuts", are +splendid. Mastication helps digestion; it also prevents nasal troubles. + +The desire for food at odd moments causes trouble, which is aggravated if +the meals are not ready at stated hours. Gently but firmly refuse the piece +of bread-and-butter they crave, explain why you do so, and though they +weep, or fly into a passion, do not lose your own temper, or beat, or give +way to them. When accustomed to regular hours and firm refusals they will +not crave for titbits between meals. + +It is very hard for them to see other members of the family freely +partaking of condiments, drinks and unsuitable foods, and be told they are +the only ones who must refrain. A little personal self-sacrifice helps +immensely, and if your child _must_ refrain so _might_ you. + +All foods must be pure. Avoid tinned goods, and cheap jams, which contain +mangels and glucose. Judged by the nutriment they contain--most cheap foods +are very expensive. + +Lightly boil, poach, or scramble eggs; steam fish and vegetables; cook rice +and sago in the oven for three hours. See that milk puddings are chewed, +for usually they are bolted more quickly than anything else. The stomach is +expected to deal with unchewed rice pudding, because it is "nourishing". So +are walnuts, but you do not swallow them whole. + +Fruit must be fresh, ripe and raw, with skin and core removed. Brown bread, +crisply toasted and buttered when cold, is best. Porridge is admirable, but +many children dislike it. Try to induce a taste by giving plenty of milk, +and sugar or syrup with it. + +The starch-digesting ferments in the saliva and pancreas are not active +until the age of 18 months, before which infants must not be given starchy +foods like potatoes, cereals, puddings and bread. + +All greenstuffs must be thoroughly washed, or worms may pass into the +system. Foul breath, picking the nose, restlessness, fever and startings +are often attributed to worms, when the real "worms" are mince pies, +raisins, sour apples, and even beer. + +Never force fat on children in a form they do not like, for there are +plenty of palatable fats, as butter, dripping, lard and milk. Cream is as +cheap, as good, and far nicer than cod-liver oil. + +Decide on your children's diet, but do not discuss it with or before them. +If a child _does_ dislike a dish, never force it on him, but try to induce +a liking by serving it in a more appetizing way. Never mix medicines with +food. + +Worms. Various symptoms are due to intestinal worms, and a sharp lookout +should be kept for the appearance of any in the stools, and suitable +treatment given when necessary. + +Treatment for thread and round worms: + + R. + Santonini........................gr. ij. + Hydrarg. chloridi mitis..........gr. ij. + Pulv. aromatici..................gr. iv. + Mix and divide into four. + + Take one at bedtime every other night, + followed by castor oil in the morning. + +Tapeworms. These are rarer, being much more frequently talked or read about +than seen. A doctor should be consulted. + +Moral Training. The road to hell is broad and easy; so is that to heaven, +for if bad habits are easily acquired, so are good ones. + +Example is the best moral precept, and if the conduct of parents is good, +little moral exhortation is needed. "What is the moral ideal set before +children in most families? Not to be noisy, not to put the fingers in the +nose or mouth, not to help themselves with their hands at table, not to +walk in puddles when it rains, etc. To be 'good'!" To hedge in the child's +little world, the most wonderful it will ever know, by hidebound rules +enforced by severe punishments, is to repress a child, not to train it. +While the commonest error is to spoil a child, it is just as harmful to +crush it. Be firm, be kindly, and, above all, _be fair_. + +Issue no command hastily, but only if necessary, and shun prohibitions +based on petulance or pique. Give the child what it wants if easily +obtainable and not harmful. + +If the desire is harmful, explain why, but if a child asks for a toy, do +not pettishly reply: "It's nearly bedtime!" when it is not, or even if it +is. + +Discipline is essential, but discipline does not consist in inconsistent +nagging; harshly insisting on unquestioning obedience to some unreasonable +command one moment, and weakly giving way--to avoid a scene--on some matter +vitally affecting the child's welfare the next. + +There must be no coddling, and no inducement to self-pity. Such children +must be taught that they are capable of real success and real failure, and +that upon personal obedience to the laws of health of body and of mind, +this success or failure largely depends. + +A child should be early accustomed to have confidence in himself. For this +purpose all about him must encourage him and receive with kindliness +whatever he does or says out of goodwill, only giving him gently to +understand, if necessary, that he might have done better and been more +successful if he had followed this or that other course. Nothing is more +apt to deprive a child of confidence in himself than to tell him brutally +that he does not understand, does not know how, cannot do this or that, or +to laugh at his attempts. His educators must persuade him that he _can_ +understand, and that he _can_ do this thing or that, and must be pleased +with his slightest effort. + +It seems a trifle to let a child have the run of cake plate or sweet-tray, +or to stay up "just another five minutes, Mummy!" to avoid a howl, but +these are the trifles that sow acts to reap habits, habits to reap +character, and character to fulfil destiny. It is selfish of parents to +avoid trouble by not teaching their children habits of obedience, +self-restraint, order and unselfishness. Between five and ten is the age of +greatest imitation, when habits are most readily contracted. + +Come to no decision until hearing the child's wishes or statements, and +thinking the matter out; having come to it, _be inexorable_ despite the +wiles, whines and wails of a subtle child. Reduce both promises and threats +to a minimum, but _rigidly_ fulfil them, for a threat which can be ignored, +and a promise unfulfilled, are awful errors in training a child. + +Persuade, rather than prohibit or prevent, a child from doing harmful +actions. If it wants to touch a hot iron, say clearly it is hot, and will +burn, but _do not move it_. Then, if the child persists, it will touch the +iron tentatively, and the small discomfort will teach it that obedience +would have been better. Let it learn as far as possible by the hard, but +wholesome, road of experience. + +Makeshift answers must never be given to a child. Awkward questions require +truthful answers, even though these only suggest more "Whys?" + +Sentimentality must be nipped promptly in the bud, and an imaginative and +humorous view of things encouraged. The child must be taught to keep the +passions under control, and to face pain (that great educator which +neurotic natures feel with exaggerated keenness) with fortitude. + +Fear must be excluded from a child's experience. "Bogies!" "Ghosts!" +"Robbers!" and "Black-men!" if unintroduced, will not naturally be feared. +The mental harm a highly strung child does by rearing most fearsome +imaginings on small foundations is incalculable, and has led more than one +to an asylum. + +Try to train the child to go to sleep in the dark, but if it is frightened +give it a nightlight. As Guthrie says, the comfort derived from the +assurance that Unseen Powers are watching over it, is small compared to +that given by a nightlight. He mentions a child who, when told she need not +fear the dark because God would be with her, said: "I wish you'd take God +away and leave the candle." + +If the child wakes terrified, it is stupid and wicked to call upstairs: "Go +to sleep!" A child cannot go to sleep in that state, and a wise mother will +go up and softly soothe the frightened eyes to sleep. + +Neuropathic children often have night terrors within an hour or two of +going to bed. Piercing screams cause a hasty rush upstairs, where the child +is found sitting up in bed, crouching in a corner, or trying to get out of +door or window. His face is distorted with fear and he stares wildly at the +part of the room in which he sees the terrifying apparition. He clings to +his mother but does not know her. After some time he recovers, but is in a +pitiful state and has to have his hand held while he dozes fitfully off. He +often wets the bed or passes a large amount of colourless urine. Medical +treatment is imperative. + +Corporal punishment is unsuitable for neuropathic children, for the mere +suggestion of its application usually causes such excessive dread, mental +upset and terror as make it really dangerous. Such children are often said +to be "naughty" when in reality they are unable to exercise self-control, +owing to defective inhibitory power. Try patiently to inculcate obedience +from the desire to do right, and make chastisement efficacious from its +very exceptional character. + +"The young child is too unconscious to have a deliberately perverse +intention; to ascribe to him the fixed determination to do evil, is to +judge him unjustly and often to develop in him an evil instinct. It is +better in such a case to tell him he has made a mistake, that he did not +foresee the consequences to which his action might lead, etc." Many parents +fall into a habit of shaking, ear-boxing, and such-like harmful minor +punishments for equally minor offences, which should be overlooked. + +In all little troubles, keep _quite calm_. The child's nerve and +association centres have not yet got "hooked up", and you cannot expect it +to act reasonably instead of impulsively. This excuse does not apply to +you. One excitable person is more than enough, for if both get angry, +sensible measures will certainly not result. + +The necessity for calmness cannot too strongly be urged. The treatment for +a fit of temper, is to give the unfortunate child a warm bath, and put it +to bed, with a few toys, when it will soon fall asleep, and awake refreshed +and calm. + +Proceed gently but with absolute firmness, _start early_, and remember that +example is better than precept. + +Religion. Offering advice on this subject is skating on very thin ice, and +we do so but to give grave warning against neuropathic youth being allowed +to contract religious "mania", "ecstasy", or "exaltation". + +Neuropaths are given naturally to "see visions and dream dreams", and if +this tendency be exaggerated an unbalanced moral type results. Jones says: + + "The epileptic is apt to be greatly influenced by the mystical or + awe-inspiring, and is disposed to morbid piety. He has an outer + religiousness without corresponding strictness of morals; indeed the + sentiment of religious exaltation may be in great contrast to his + habitual conduct, which is a mixture of irritability, vice and + perverted instincts." + +Lay stress on the simple moral teaching of the New Testament, and avoid +cranky creeds, cross references, or Higher Criticism. Teach them to +practise the moral precepts, not to quote them by the page. + +Without this practical bent, a "Revival" meeting is apt to result in a +transient but harmful "conversion"; a form of religious sentiment which +finds outlet, not so much in works as in morbid excitement. In these +people, as in the insane, there is often a weird mixing-up of religious and +sexual emotion. + +Teach these children that the greatest good is not to sob over their +fancied sins at "salvation" meetings, but to love the just and good, to +hate the unjust and evil, and to do unto others as they would others should +do unto them. + +It is better for them to join one of the great churches, than become +members of those small sects which maintain peculiar tenets. + +A word of special warning must be given against Spiritualism. There may or +may not be a foundation for this belief, but it is highly abnormal, and has +led thousands into asylums. + +The medium and the majority of her audience are highly neurotic, and a more +unwholesome environment for an actual or potential neuropath could not be +imagined. + +The educated neuropath often peruses certain agnostic works, the result +usually being deplorable, for this class are dependent on some stable base +outside themselves, such as is found in a calm religion manifested in a +steadfast attempt to overcome the weakness of the flesh, by ordering life +in accordance with the teachings of the New Testament. + +So long as abnormalities of character do not become too pronounced, friends +must be content. + +Such children must be trained to express themselves in a practical manner, +not in weaving gorgeous phantasies in which they march to imaginary +victory. Day dreams form one of those unlatched doors of the madhouse that +swing open at a touch, the phantasy of to-day being written "emotional +dementia" on a lunacy certificate to-morrow. + +Finally, remember that above them hangs the curse: + +"Unstable as water, _thou shall not excel_." + +"Go thou softly with them, all their days!" and whether your tears fall on +the ashes of a loved and loving, but weak and wilful one, or whether their +tears bedew the grave of the only friend they ever knew, you will not have +lacked a rich reward. + + * * * * * + +CHAPTER XXII + +DANGERS AT AND AFTER PUBERTY + + "Th' expense of spirit in a waste of shame + Is lust in action; and till action, Lust + Is perjured, murderous, bloody, full of blame, + Savage, extreme, rude, cruel, not to trust; + Enjoyed no sooner but despised straight; + Past reason hunted; and, no sooner had, + Past reason hated, as a swallow'd bait + On purpose laid to make the taker mad; + Mad in pursuit, and in possession so; + Had, having had, and in quest to have, extreme; + A bliss in proof, and proved, a very woe; + Before, a joy proposed; behind, a dream; + All this the world well knows; yet none knows well, + To shun the Heaven that leads men to this Hell!" + --Shakespeare. Sonnet 129. + +At puberty (from the age of 11-15) a boy becomes capable of paternity, a +girl of maternity; during adolescence (from puberty to 25) the body in +general, and the reproductive organs in particular, grow and mature. + +In the boy, semen is secreted, the voice breaks, the genitals enlarge, hair +grows on the pubes, face and armpits, and there is a rapid increase in +height owing to growth of bone. In the girl menstruation commences, the +pelvis is enlarged, bust and breasts develop, the complexion brightens, the +hair becomes glossy, and the eyes bright and attractive. + +In both, the sexual instinct awakens, and the mental, like the physical, +changes are profound. There is great general instability, the child, at one +time shy and reticent, is at another, boisterous and self-assertive. + +Parents rarely realize the importance and trying nature of this period when +"there awakes an appetite which in all ages has debased the weak, wrestled +fiercely with the strong and overwhelmed too often even the noble". +Adolescents suffer more from the lack of understanding, sympathy, +appreciation and wise guidance shown by their blind parents, than they do +from their own ignorance and perfervid imagination. + +The transitions from radiant joy and confident expectation, reared on a +flimsy basis of supposition, to dire despair consequent on a wrong reading +of physical and mental changes, are rapid. Friends, lovers and heroes +quickly succeed one another, play their parts, and give place to others. + +The awakening of the sexual appetite is usually ignored, and children are +left to gain knowledge of man's noblest power from companions, casual +references in the Bible and other books, and unguarded references in +conversation. Under such conditions not one in a thousand--and _your_ child +is _not_ that one--escapes impurity and degraded sex ideas. + +Wherever youth congregate, this subject crops up, and those who talk most +freely to the others are just those with the most distorted and vicious +ideas, whose discourse abounds in obscene detail and ribald jest. Your +child must learn either from ignorant, unclean minds, or be taught in a +clean, sacred way, which will rob sex of secrecy and obscenity; _learn he +will_; if you will not teach your child, his pet rabbit will. + +When children ask awkward questions, say quietly that such matters are not +discussed with children, but promise to tell them all about it when they +are ten years old; delay no longer, for most children learn self-abuse +between ten and twelve. + +Self-abuse is a bad habit, and no more a "sin" than is biting the nails. +Unfortunately, people with no other qualification than a desire to do good, +wrongly harp on the "sin" of it and draw lurid pictures of physical and +mental wreck as the end of such "sinners", ignorant that if all +masturbators went mad the world would be one huge asylum. + +Exaggeration never pays in teaching youth. Tell the truth, which is bad +enough without adding "white lies" with an eye to effect. + +Coitus causes slight prostration, Nature's device to remind man to keep +sexual intercourse within bounds, for while in moderation it is harmless, +in excess it causes great prostration. _Exactly the same applies to +self-abuse_, for, paradoxical as it seems, the real harm is done by the +_fear_ of the supposed harm. + +The masturbator first suffers from the knowledge he is indulging in a +pleasure he knows would be forbidden, and from fear of being found out; +later he learns from friends, quack advertisements, or well-meaning books +that self-abuse is a most deadly practice, and thereupon a tremendous +struggle occurs between desire and fear, each act ending in an agony of +remorse and dread of future consequences, which struggle does a +thousand-fold more harm than the loss of a little semen. + +The ill-effects of these mental struggles disappear after marriage, which +means greater indulgence, but indulgence free from mental stress. In +neuropaths, these mental struggles are the worst things that could occur, +for they tend to make permanent the states we are trying to cure. + +The most serious results of masturbation are moral not physical. Loss of +will-power, self-reliance, presence of mind, reasoning power, memory, +courage, idealism, and self-control; mental and physical debility, +laziness, a diseased fondness for the opposite sex, and in later years, +some degree of impotence or sterility, are its commoner results. + +Teach _your_ child, therefore, not from fear of physical harm, but because +you wish him to be one of those fortunate few who live and die "gentlemen +unafraid", because they had wise parents. + +Let the mother instruct a girl, the father a boy, and not leave so vital a +matter to an unsuitable pamphlet. + +Buy one of the many "Knowledge for Boys or Girls" books and read it +carefully. + +Having made sure you can convey a simple account of the wonders of +reproduction, and that you have rooted out the idea that sex is something +to be apologized for, see the child and tell him it is time he learned of +his private parts, as manhood draws near. + +Then, speaking in a quiet, unembarrassed way, deliver your little homily, +all the time insisting on the marvel, the romance, the poetry and the +beauty of the sex. Let chivalry be your text, not fear, and repeat the +Squire's sound parting advice to Tom Brown: + + "Never listen to or say things you would not have your mother or sister + hear." + +Give a clear and complete description in simple words of the mechanism and +marvel of reproduction, for half-knowledge generates a prurient curiosity +about the other sex, thus defeating the very end you have so earnestly +striven for. + +Purity not impurity should be your text, and you should only refer to +masturbation as a harmful habit, which should not be contracted. + +Warn them to + + "Keep the heart with all diligence, for out of it are the issues of + life!" + +by turning their thoughts instantly and determinedly away from sex ideas +when they arise, as they _will_ arise, time and again. It is useless to try +_not_ to think of them, the child must instantly turn its thoughts to to +_something else_, for one who cannot stamp out a spark will not subdue a +fiercely-raging conflagration. + +Babies should not be carelessly caressed, and a fretful infant must never +be soothed by playing with the genitals, as is done innocently by some +mothers and nurses, and by others from motives more questionable. Freud +showed that there are subconscious sexual desires in infants, which die out +until reanimated at puberty in Nature's own way. If exaggerated by +exuberant fondling, they gather force in the dark corners of the mind, and +are later manifested in morbid sexual or mental perversity. + +If you have good grounds for believing the habit has already been +contracted, enlist medical advice. A great factor in the successful +treatment of self-abuse is early recognition, and, after the unhygienic +nature of the habit has carefully been pointed out, the child's sense of +honour should be invoked. + +Without further reference to the matter, try to become your child's +confidant, for he will have to fight fires within and foes without. See +that his time is filled with healthy sport and play, and ennoble his ideas +with talk, books and plays which lay stress on chivalry and manliness. Give +him plain food, tepid douches, and a firm bed with light, fairly warm +clothing. Get him up reasonably early in the morning, and let him play +until he is "dog-tired" at night. + +Let children rub shoulders with others, keep them from highly exciting +tales, let them read but little, and train them to be observant of external +objects all the time. + +Neuropaths develop very early sexually, and contract bad habits in the +endeavour to still their unruly passions; with them, the future is darker +than with the normal child, and the parent who neglects his duty may justly +be held accountable for what happens to his child or his child's children. + +Puberty is always a critical period in epilepsy, many cases commencing at +this time, while in a number, fits commence in infancy, cease during +childhood, and recommence at puberty, the baneful stimulus of masturbation +being undoubtedly a factor in many of these cases. + + * * * * * + +CHAPTER XXIII + +WORK AND PLAY + +Although most people would assume that epileptics are unable to follow a +trade, there is hardly an occupation from medicine to mining, from +agriculture to acting, that does not include epileptics among its votaries. + +Outdoor occupations involving but little mental work or responsibility are +best, but unfortunately just those which promise excitement and change are +those which appeal to the neuropath. + +A light, clean, manual trade should be chosen, and those that mean work in +stuffy factories, amid whirring wheels and harmful fumes, using dangerous +tools, or climbing ladders, must be avoided. + +For the fairly robust, gardening or farming are good occupations, such +workers getting pure air, continuous exercise, and little brain-work. +Wood-working trades are good, if dangerous tools like circular saws are +left to others. + +For the frail neuropath with a fair education, drawing, modelling, +book-keeping, and similar semi-sedentary work may do. Other patients might +be suited as shoemakers, stonemasons, painters, plumbers or domestic +servants, so long as they always work on the ground. + +Some work is essential; better an unsuitable occupation than none at all, +for the downward tendency of the complaint is sufficiently marked without +the victim becoming an idler. Work gives stability. + +Epilepsy limits patients to a humble sphere, and though this is hard to a +man of talent, it is but one of many hard lessons, the hardest being to +realize clearly his own limitations. + +If seizures be frequent, the ignorant often refuse to work with a victim, +who can only procure odd jobs, in which case he should strive to find +home-work, at which he can work slowly and go to bed when he feels ill. A +card in the window, a few handbills distributed in the district, judicious +canvassing, and perhaps the patronage of the local doctor and clergy may +procure enough work to pay expenses and leave a little over, for the +essential thing is to occupy the mind and exercise the body, not to make +money. + +Very few trades can be plied at home and many swindlers obtain money under +the pretence of finding such employment, charging an excessive price for an +"outfit", and then refusing to buy the output, usually on the pretext that +it is inferior. Envelope-addressing, postcard-painting and machine-knitting +have all been abused to this end. + +An auto-knitter seems to offer possibilities, but victims must investigate +offers carefully. + +Photography is easy. A cheap outfit will make excellent postcards, modern +methods having got rid of the dark room and much of the mess, and +postcard-size prints can be pasted on various attractive mounts. + +If the work is done slowly, and in a good light, and the patient has an +aptitude for it, ticket-writing is pleasant. Among small shopkeepers there +is a constant demand for good, plainly printed tickets at a reasonable +price. + +On an allotment near home vegetables and poultry might be raised, an +important contribution to the household, and one which removes the stigma +of being a non-earner. + +The mental discipline furnished by this home-work is invaluable, +Neuropaths, especially if untrained, are unable to concentrate their +attention on any matter for long, and do their work hastily to get it +finished. When they find that to sell the work it must be done slowly and +perfectly they have made a great advance towards training their minds to +concentrate. Their weak inhibitory power is thus strengthened with happy +results all round. + +When the work and the weather permit, work should be done outdoors, and +when done indoors windows should be opened, and, if possible, an empty or +sparsely-furnished bedroom chosen for the work. + +Recreations. These offer a freer choice, but those causing fatigue or +excitement must be avoided, for patients who have no energy to waste need +only fresh air and quiet exercise. + +Manual are better than mental relaxations. Dancing is unsuitable, swimming +dangerous, athletics too tiring and exciting. Bowls, croquet, golf, +walking, quoits, billiards, parlour games and quiet gymnastics without +apparatus are good, if played in moderation and much more gently than +normal people play them. Play is recreation only so long as a pastime is +not turned into a business. When a player is annoyed at losing, though he +loses naught save his own temper, any game has ceased to be recreative. + + * * * * * + +CHAPTER XXIV + +HEREDITY + + "Man is composed of characters derived from pre-existing germ-cells, + over which he has no control. Be they good, bad, or indifferent, these + factors are his from his ancestry; the possession of them is to him a + matter of neither blame nor praise, but of necessity. They are + inevitable."--Leighton. + +The body is composed of myriads of cells of _protoplasm_, in each of which, +is a _nucleus_ which contains the factors of the hereditary nature of the +cell. In growth, the nucleus splits in half, a wall grows between and each +new cell has half the original factors, + +Female _ovum_ and male _sperm_ (the cells concerned with reproduction) +divide, thus losing half their factors, and when brought together by sexual +intercourse form a _germ-cell_ having an equal number of factors from +mother and father. + +How these factors are mingled--whether shuffled like two packs of cards, or +mixed like two paints--we do not know. If two opposite factors are brought +together, one must lie dormant. The offspring may be male or female, tall +or short; it cannot be both, nor will there be a mixture. _This rule only +applies to clearly defined factors._ + +We are _made by_ the _germ-plasm_ handed down to us by our ancestors; in +turn we pass it on to our children, _unaltered_, but mixed with our +partner's plasm. + +"The Dead dominate the Living" for our physical and mental inheritance is a +mosaic made by our ancestors. + +Variations which may or may not be inheritable do arise spontaneously, we +know not how, and by variations all living things evolve. + +A child resembles his parents more than strangers, not because they made +cells "after their own image" but because both he and they got their +factors from the same source. + +Man's physical and mental, and the _basis_ of his moral, qualities depend +entirely on the types of ancestral plasm combined in marriage. Man may +control his environment; his heritage is immutable. To suppress an +undesirable trait the germ-cell must unite with one that has never shown +it--one from a sound stock. An unsuitable mating in a later generation, +however, may bring it out again (for factors are indestructible), and the +individual showing it will have "reverted to ancestral type". + +To give an instance: Does the son of a drunkard inherit a tendency to +drink? No! The father is alcoholic because he lacks control, consequent +upon the factors which make for control having been absent from his +germ-plasm. He passes on this lack; if the mother does the same, the defect +occurs--in a worse form--in the son. If the mother gives a control factor, +the son may be unstable or _apparently_ stable, this depending entirely on +chance, but if the mother's plasm contains a _strong_ control-factor, the +defect will lie dormant in her son, who will have self-control, though if +he marries the wrong woman he will have weak-willed children. + +If the son becomes a toper, therefore, it is because he, like his father +before him, was born with a defect--weak control--which might have made of +him a drug-fiend, a tobacco-slave, a rake, or a criminal; in his home drink +would naturally be the temptation nearest to hand, and he would show his +lack of control in drunkenness. + +The way a lily-seed is treated makes a vast difference to the plant which +arises. If sown in poor soil, and neglected, a dwarf, sickly plant will +result; if sown in rich soil, and given every care that enthusiasm, money +and skill can suggest or procure, the result will be magnificent. + +So with man. A well-nourished mother, free from care and disease, may have +a finer child than a half-starved woman, crushed by worry and work, but +neither starvation nor nourishment alter the inborn character of the child. + +The _body-cells_ are greatly changed by disease, poison, injury, and +overwork, but these changes are not passed on, and despite the influence of +disease from time immemorial, the _germ-cell_ produces the same man as in +ancient days. Without this fixity of character, this "continuity of the +germ-plasm", "man" would cease to be, for the descendants of changeable +cells would be of infinite variety, having fixity of neither form nor +character. + +Epilepsy, hysteria and neurasthenia are all outward signs of defect in the +germ-plasm, and so they (or a predisposition to them) can be passed on, and +inherited. + +If a man shows a certain character, his plasm, had, and has, the causative +factor. He may have received it from _both_ his parents, when it will be +_strong_, or from one only, when it will be _normal_. If he have it not, it +is absent. The same applies to the plasm of the woman he mates, so there +are six possible combinations, with results according to "Mendel's Law." + +_All_ the children will not inherit a taint unless _both_ parents possess +it, but, however strong one parent be, if the other is tainted, _none_ of +the children can be absolutely clean, but will show the taint, weak, +strong, or dormant. This means that neuropathy will recur--and that it has +previously occurred--in the same family, unless there be continual mating +into sound stocks. If there is continual mating into bad stocks, it will +recur frequently and in severe forms. All intermediate stages may occur, +depending entirely on the qualities of the combining stocks. + +From this we shall expect, in the same stock, signs of neuropathic taint +other than the three diseases dealt with here, and these we get; for +alcoholism, criminality, chorea, deformities, insanity and other brain +diseases, are not infrequent among the relatives of a neuropath, showing +that the family germ-plasm is unsound. + +Epilepsy, one symptom of taint, is more or less interchangeable with other +defects; the taint, as a whole, is an inheritable unit whose inheritance +will appear as any one of many defects. This is shown by the fact that very +few epileptics have an epileptic parent. Starr's analysis of 700 cases of +epilepsy emphasizes this point. + + Epilepsy in a parent 6 + Epilepsy in a near relative 136 + Alcoholism in a parent 120 + Nervous Diseases in family 118 + Rheumatism and Tuberculosis 184 + Combinations of above diseases 142 + +As medicine and surgery cannot add or delete plasmic factors, the only way +to stamp out neuropathy in severe forms would be to sterilize victims by +X-rays. This would be painless, would protect the race and not interfere +with personal or even with sexual liberty. In fifty years such diseases +would be almost extinct, and those arising from accident or the chance +union of dormant factors in apparently normal people could easily be dealt +with. + +There are 100,000 epileptics in Great Britain, and as _all_ their children +carry a taint which tends to reappear as epilepsy in a later generation +_the number of epileptics doubles every forty years_. We protect these +unfortunates against others; why not posterity against them? + +Neuropaths must pass on _some_ defect; therefore, though victims may marry, +_no neuropath has a right to have children_. + + * * * * * + +CHAPTER XXV + +CHARACTER + + "All men are not equal, either at birth or by training. Nature gives + each of us the neural clay, with its properties of pliability and of + receiving impressions; nurture moulds and fashions it, until a + _character_ is formed, a mingling of innate disposition and acquired + powers. But clay will be clay to the end; you cannot expect it to be + marble."--Thomson & Geddes. + + "Heaven lay not my transgression to my charge."--King John. + +It is essential that attendants, relatives, and friends carefully study the +character of neuropaths, and recognize clearly how abnormal it is, for +untold misery is caused by judging neuropaths by normal standards. + +Patients are often harshly treated because others regard the victim of +defective inhibition as having gone deliberately to work, through wicked +perversity and pure wilfulness, to make himself a nuisance, to persist in +being a nuisance, and to refuse to be other than a nuisance, rather than +exercise what more fortunate men are pleased to term self-control. + +Character is usually appraised as "good" or "evil" by the nature of a man's +actions, the assumption being made that he can control his impulses if he +be so minded. + +This is not so. "Good" and "evil" are only relative terms. What one man +thinks "evil", a second holds "good", while a third is not influenced. + +Now the performance of the act judged is directed by the performer's brain, +the constitution of which was pre-determined by the germ-plasm from which +he arose, so that _the basis of character is inherited_. + +The moral sense is the last evolved and least stable attribute of the last +evolved and least stable of our organs, the brain; and brains are born, not +made to order. To blame a man for having weak control--a sick will--is as +unreasonable as to blame him for a cleft palate or a squint. The "good" +people who jog so quietly through life little reck how much they owe their +ancestors, from whom they received stability. + +These tendencies represent the total material for building character. +Training and environment can only nourish good tendencies and give bad ones +no encouragement to grow gigantic. + +If training and environment alone formed character, then children reared +together would be of similar disposition; by no means the case. Similarly, +if external influences altered inborn tendencies, then, not only would the +evil man be totally reformed by strong inducements to virtue, but strong +inducements to vice would lead totally astray the good man, for "good" is +no _stronger_ than "evil", both being attributes of mind. + +In mind as in body, from the moment he is conceived to the moment his dust +rests in the tomb, man is directed by immutable laws, though he is not +simply a machine directed by impulses over which he has no control. There +is real meaning in "strong will" and "weak will" will being a tendency to +deliberate before and be steadfast in action, a tendency which varies +immensely in different people. The fallacy of "free will" lies in assuming +that every one has this tendency equally developed, making character a mere +matter of saying "Yes!" and "No!" without reference to the individual's +mental make-up. + +Deliberate, persistent wickedness implies a strong will, just what +neuropaths lack. A man of weak will can never be a very good nor yet a very +bad man. He will be very good at times, very bad at times, and neutral at +times, but neither for long; before sudden impulses, whether good or bad, +neuropaths are largely powerless. + +The many perversities of a neuropath are not deliberately put forth of his +"free will" to annoy both himself and others, for the neuropath inherits +his weak-control no less than his large hands. + +Friends _must_ remember they are dealing with a person whose _nature_ it is +to "go off half-cock", and who cannot be normal "if he likes". The +neuropath, young or old, says what he "thinks" _without thinking_, that is +he says what he _feels_, and acts hastily without weighing consequences. + + _Cassius_: Have you not love enough to bear with me, + When that rash humour which my mother gave me + Makes me forgetful? + + _Brutus_: Yes, Cassius; and, from henceforth + When you are over-earnest with your Brutus, + He'll think your mother chides, and leave you so. + + * * * * * + +One cannot detail the effects of neuropathy on character, when its victims +include madmen, sexual perverts, idiots, criminals, imbeciles, prostitutes, +humble but honest citizens, common nuisances, invalids of many kinds, +misanthropists, designers, enthusiasts, composers, communists, reformers, +authors, artists, agitators, statesmen, poets, prophets, priests and kings. + +Very mild epilepsy--from one fit a year to one in several years--instead of +hindering, seems rather to help mentality, and many geniuses have been +epileptic. These talented victims, are less rare than the public suppose, +owing to the jealous care with which symptoms of this disease are guarded. +Socrates, Julius Caesar, Mahomet, Joan of Arc, Peter the Great, Napoleon, +Byron, Swinburne, and Dostoieffsky are but a few among many great names in +the world of art, religion and statecraft. Epileptic princes, kings and +kinglets who have achieved unenviable notoriety might be named by scores, +Wilhelm II being the most notable of modern times. + +This brilliant mentality is always accompanied by instability, and usually +by marked disability in other ways. The success of these men often depends +on an ability to view things from a new, quaint or queer standpoint, which +appeals to their more normal fellows. + +In matters that require great fertility, a quick grasp, ready wit, and +brilliant but not sustained mental effort, numerous neuropaths excel. In +things calling for calm, well-balanced judgment, or stern effort to conquer +unforseen difficulties, they fail utterly. + +Subtle in debate, they are but stumbling-blocks in council; brilliant in +conception, they fail in execution; fanciful designers, they are not +"builders of bridges". They are boastful, sparkling, inventive, witty, +garrulous, vain and supersensitive, outraging their friends by the +extravagance of their schemes; embarrassing their enemies by the subtlety +of their intrigues. + +They wing on exuberant imagination from height to height, but the small +boulders of difficulty trip them up, for they are hopelessly unpractical; +they have neither strength of purpose nor fortitude, and their best-laid +schemes are always frustrated at the critical moment, by either the +incurable blight of vacillation, or by the determination to amplify their +scheme ere it has proved successful, sacrificing probable results for +visionary improvements. + +Great and cunning strategists while fortune smiles, they are impotent to +direct a retreat, but flee before the fury they ought to face. They rarely +have personal courage, but are timid, conciliatory and vacillating just +when bravery, sternness, and determination are needed; furious, obstinate +and reckless, when gentleness, diplomacy and wisdom would carry their +point. + +They are ready to forgive when there is magnanimity, vainglory and probably +folly in forgiveness, but will not overlook the most trivial affront when +there is every reason for so doing. They have brain, but not ballast, and +their whole life is usually a lopsided effort to "play to the gallery". + +In poetry and literature, fancy has free play, and they often succeed, +sometimes rising to sublime heights; usually in the depiction of the +whimsical, the wonderful, the sardonic, the bizarre, the monstrous, or the +frankly impossible. They are not architects as much as jugglers of words, +and descriptive writing from an acute angle of vision is their forte. They +sometimes succeed as artists or composers, for in these spheres they need +not elaborate their ideas in such clean-cut detail, but many who might +succeed in these branches have not sufficient strength of purpose to do the +preliminary "spadework". + +They have too many talents, too many differing inclinations, too much +impetuosity, too much vanity, too little concentration and will-power, and +they fail in ordinary walks of life from the lack of resolution to lay the +foundations necessary to successful mediocrity. + +No greater obstacle to progress exists than the reputation for talent which +this class acquire on a flimsy basis of superficial brilliance in +conversation or a penchant for witty repartee. They are self-opinionated +and egoistical, with a conceit and assurance out of all proportion to their +abilities. Their mental perspective is distorted and they are conspicuous +for their obstinacy. In conversation they are prolix and pretentious, and +they often contract religious mania, in which their actions by no means +accord with their protestations, for they have very elementary notions of +right and wrong, or no notions at all. + +Often they are precocious, but untruthful, cruel, and vicious; the despair +of relatives, friends, and teachers. They combine unusual frankness with an +audacity and impulsiveness that is very misleading, for below this show of +fire and power there is no stability. + +Their character is a tangle of mercurial moods, the neuropath being +passionate but loving, sullen one moment, overflowing with sentimental +affection the next, vicious a little while later, quick to unreasoning +anger, and as quick to repent or forgive, obstinate but easily led, +versatile but inconstant, noble and mean by turns, full of contradictions +and contrasts, at best a brilliant failure, vain, deaf to advice or +reproof, having in his ailing frame the virtues and vices of a dozen normal +men. + +Mercier aptly describes him: + + "There is a large class of persons who are often of acute and nimble + intelligence, in general ability equal to or above the average, of an + active, bustling disposition, but who are utterly devoid of industry. + For by industry we mean steady persistence in a continuous employment + in spite of monotony and distastefulness; an employment that is + followed at the cost of present gratification for the sake of future + benefit. Of such self-sacrifice these persons are incapable. They are + always busy, but their activity is recreative, in the sense that it is + congenial to them, and from it they derive immediate gratification. As + soon as they tire of what they are doing, as soon as their occupation + ceases to be in itself attractive it is relinquished for something + else, which in its turn is abandoned as soon as it becomes tedious. + + "Such people form a well-characterized class: they are clever; they + readily acquire accomplishments which do not need great application; + and agreeably to the recreative character of their occupations, their + natures are well developed on the artistic side. They draw, paint, + sing, play, write verses and make various pretty things with easy + dexterity. Their lack of industry prevents them ever mastering the + technique of any art; they have artistic tastes, but are always + amateurs. + + "With the vice of busy idleness they display other vices. The same + inability to forgo immediate enjoyment, at whatever cost, shows itself + in other acts. They are nearly always spendthrifts, usually drunkards, + often sexually dissolute. Next to their lack of industry, their most + conspicuous quality is their incurable mendacity. Their readiness, + their resources, their promptitude, the elaborate circumstantiality of + their lies are astonishing. The copiousness and efficiency of their + excuses for failing to do what they have undertaken would convince + anyone who had no experience of their capabilities in this way. + + "Withal, they are excellent company, pleasant companions, good-natured, + easy-going, and urbane. Their self-conceit is inordinate, and remains + undiminished in spite of repeated failures in the most important + affairs of life. They see themselves fall immeasurably behind those who + are admittedly their inferiors in cleverness, yet they are not only + cheery and content, but their confidence in their own powers and + general superiority to other people remains undiminished. + + "_The lack of self-restraint is plainly an inborn character_, for it + may show itself in but one member of the family brought up in exactly + the same circumstances as other members who do not show any such + peculiarity. The victim is born with one important mental faculty + defective, precisely as another may be born with hare-lip." + +In neuropaths the mental mechanism of _projection_, which we all show, is +often marked. + +Any personal shortcoming, being repugnant to us causes self-reproach, which +we avoid by "projecting" the fault (unconsciously) on some one else. + +Readers should get "The Idiot" by Fedor Dostoieffsky, an epileptic genius +who saw that for those like him, happiness could be got through peace of +mind alone, and not in the cut-throat struggle for worldly success. He +projected his stabler self into Prince Muishkin, the idiot, and every one +of the six hundred odd pages of this amazing description of a neuropathic +nation is stamped with the hall-mark of genius. + + * * * * * + +CHAPTER XXVI + +MARRIAGE + + "Between two beings so complex and so diverse as man and woman, the + whole of life is not too long for them to know one another well, and to + learn to love one another worthily."--Comte. + +No neuropath should have children, but marriage is good in mild cases, for +neuropaths are benefited by sympathetic companionship, and their sexual +passions are so strong that they must be gratified, by marriage, +prostitution, or unnaturally. + +Bernard Shaw's sneer-- + + "Marriage is popular because it combines the maximum of temptation with + the maximum of opportunity"-- + +is justifiable, though the "maximum of opportunity" is better than a +maximum of unnatural devices to satisfy and intensify normal and abnormal +cravings. + +There is a popular belief that an epileptic girl is cured by pregnancy, a +state that ought never to occur. + +The lack of sex-education causes millions of miserable marriages. Sexual +desire is cultivated out of all proportion to other desires, the will +cannot control the desire to relieve an intolerable sense of discomfort, +and men eagerly seize the first chance of being able to satisfy these +fierce cravings at pleasure. + +If sex were treated sensibly it would develop into a powerful instead of an +overpowering appetite, and reason would have some say in the choice of a +life-partner. + +A neuropath needs a calm, even-tempered, "motherly" wife. For him, +gentleness, self-control, sound common sense and domestic virtues are +superior to wit or beauty. Unfortunately, contrary to public belief, people +are attracted by their like, not by their opposites. The sensitive, refined +neuropath finds the normal person insipid and dull; the normal person is +rendered uncomfortable by the morbid caprices of the neuropath. + +There must be no disparity of age, for at the menopause the woman no longer +seeks the sexual embrace, and if her husband be young unfaithfulness +ensues. Not only that, but she, knowing, probably to her sorrow, how rarely +the hopes of youth mature, cannot take a keen interest in his ambitions +like a younger woman, or fire his dying enthusiasm at difficult parts of +the way. If he be his wife's senior he will be as little able to appreciate +her ideas and habits. + +An excitable, volatile, garrulous, "neighbourly" woman, or one who can do +little save strum on the piano or make embroidery as intricate as it is +useless, means divorce or murder. For him, sweetness, gentleness, +self-control, sound common sense, shrewdness, and domestic virtues are +incomparably superior to any mental brilliance or physical comeliness. He +needs a "homely" woman, and should remember that no banking account can +match a sweet, womanly personality, and no charms compare to a sunny heart, +and an ability steadfastly to "see the silver lining". + +He must on no account marry a woman in indifferent health, for under the +strain of her husband's infirmity the woman, who if she were well would be +a help, is a source of expense, worry and friction. + +On the other hand the woman who receives a proposal from a neuropath, be he +ever so gifted, has grave grounds for pausing, though it is hard to counter +the specious arguments of one who may be "a man o' pairts", a witty +companion and an ardent lover. It is doubtful if a neuropath is ever +permeated by a steadfast emotion, for all his emotions are fierce but +unstable, the love of an inconsistent man being ten times more ardent than +that of a faithful one, _while it lasts_. + + "You can't marry a man without taking his faults with his virtues," + +and love must be strong enough to stand, not storms alone, but the minor +miseries of life, the incessant pinpricks, the dreary days when the smile +abroad has become the scowl at home. At best, her husband will be +capricious, hard to please, and though rabidly jealous without cause, at +the same time very partial to the attractions of other women. He usually +needs the attention of the whole household, which his varying health and +moods keep in a mingled state of anxious solicitude and smouldering +resentment. + +His infirmity may mean a very secluded and humdrum life. She will have to +make home an ever-cheery place, an ideal that means hard work and +self-sacrifice through lonesome years in which her nobility will be +unrecognized and unrewarded. + +A woman fond of amusements and sport, and having many acquaintances would +find this unbearable. Any happiness in marriage to a neuropath is largely +dependent on the self-sacrifice of the wife. + +Should marriage occur, the wife must judiciously curb her husband's +passions without driving him to other women by coldness, a problem which is +often solved by separation. The suggestion should never come from her, and +the more she can curb his ardour by tactful suggestion, the healthier will +he and the happier will she be, for nothing causes such an irritable, +nervous state as excessive coitus. + +She will often have to give way in this matter, but must be firm on the +necessity for preventing conception, for she can only bear a tainted child; +her responsibility is great, and she must _insist_ that her husband use +those simple methods which prevent conception, thereby ending in himself +one branch of a worthless tree. This must be done at any cost, for her +happiness is nought compared to the welfare of future generations. Bitter +though it be that no fruit of her womb may call her blessed, it is less +bitter than hearing her children call themselves accursed. + + "So many severall wayes are we plagued and punished for our father's + defaultes, that it is the greatest part of our felicity to be well + born, and it were happy for humankind if only such parentes as are + sounde of body and mind should be suffered to marry. An Husbandman will + sow none but the choicest seed upon his lande; he will not reare a bull + nor an horse, except he be right shapen in all his parts, or permit him + to cover a mare, except he be well assured of his breed; we make choice + of the neatest kine, and keep the best dogs, and how careful then + should we be in begetting our children? In former tyme, some countreys + have been so chary in this behalf, so stern, that if a child were + crooked or deformed in body or mind, they made it away; so did the + Indians of old, and many other well gouverned Commonwealths, according + to the discipline of those times. Heretofore in Scotland, if any were + visited with the falling sickness, madness, goute, leprosie, or any + such dangerous disease, which was like to be propagated from the father + to the son, he was instantly gelded; a woman kept from all company of + men; and if by chance, having some such disease, she was found to be + with child she with her brood were buried alive; and this was done for + the common good, lest the whole nation should be injured or corrupted. + A severe doom, you will say, and not to be used among Christians. Yet + to be more looked into than it is. For now, by our too much facility in + this kind, in giving way to all to marry that will, too much liberty + and indulgence in tolerating all sorts, there is a vast confusion of + hereditary diseases; no family secure, no man almost free from some + grievous infirmity or other. Our generation is corrupt, we have so many + weak persons, both in body and mind, many feral diseases raging among + us, crazed families: our fathers bad, and we like to be worse." + +Her husband will want much petting and caressing, and she must foster his +love by lavishing on him much fondness, and ignoring amours as but the +mischievous results of his restless, intriguing mind. + +She must let him see in an affectionate way that she can let others enjoy +his company betimes, secure in the knowledge that she is supreme in his +affections--cajolery that flatters his overweening vanity, and rarely +fails. + +In anger, as in every other emotion, the neuropath is as transient as he is +truculent. A trivial "tiff" will make him blaze up in ungovernable rage and +say most abominable and untruthful things; even utter violent threats. He +will not admit he is wrong, but like a spoilt child must be kissed and +coaxed into a good temper, first with himself and with others next. + +At one moment he is in a perfect paroxysm of fury; five minutes later he is +passionately embracing the luckless object of it and vowing eternal +devotion. In a further five he has forgotten all his remarks and would +hotly deny he used the vexing statements imputed to him. + +Epileptics are morbidly sensitive, and reference to their malady must be +avoided. Victims are intensely suspicious, and a pitying look will reveal +to them the fact that some outsider knows all about the jealously-guarded +skeleton. Resentment, distrust and misery follow such an exposure, for +every innocent look is then translated into a contemptuous glance, and the +victim detects slights undreamt of in any brain save his own. + +Unless seizures are severe, no one should be called in; if they cause +alarm, ask a discreet male neighbour to assist when necessary, leaving when +the convulsions abate so that the victim is not aware of his presence. +Avoid the word "fit" and "epilepsy", and if reference to the attack be +necessary, refer to it as a "faint" or "turn". + +Living with a man liable to have a fit at inopportune times is a tremendous +strain, and the soundest advice one can offer a woman thinking of marrying +such a one is Punch's--"DON'T!" + +We have painted the black side, but, tactfully managed, a neuropath will +merge in the kindest of husbands, the most constant of lovers. The wife +need not be unhappy. Tactless, masterful women will fail, but no one is +more easily led, particularly in the way he should not go, than a +neuropath. + +A man with definite views of his own value will not be successful foil for +"mother-in-lawing", nor remain quiet under the interference of relatives, +who should remember that well-meaning intentions do not justify meddling +actions. + +Many a neuropath led a useful life and gained success in a profession, +solely because his wife tactfully kept him in the path, watched his health, +prevented him frittering away his gifts in many pursuits or useless +repining, and made home a real haven. + +When the yolk seems unbearably heavy, the wife should remember her husband +has to bear the primary, she only the reflected misery, for the limitations +neuropathy puts on every activity and ambition, social and professional, +are frightfully depressing. + +In spite of his peevishness her husband may be trying hard to minimize his +defects and be a reasonable, helpful companion. + + "Judge not the working of his brain, + And of his heart thou can'st not see; + What looks to thy dim eyes a stain + In God's pure light may only be + A scar brought from some well-fought field, + Where thou would'st only faint and yield." + +Magnify his virtues and be tenderly charitable to his many frailties, for +he is "not as other men" and too well he knows it. Love at its best is so +complex that it easily goes awry, but death will one day dissolve all its +complexity, and when, maybe after "many a weary mile" + + "The voice of him I loved is still, + The restless brain is quiet, + The troubled heart has ceased to beat + And the tainted blood to riot"-- + +it will comfort you to reflect that you did your duty and, to best the of +your ability, fulfilled your solemn pledge to love and honour him. + +To quote George Eliot: + + "What greater reward can thou desire than the proud consciousness that + you have strengthened him in all labour, comforted him in all sorrow, + ministered to him in all pain, and been with him in silent but + unspeakably holy memories at the moment of eternal parting?" + +Surely, none! + +We have considered the mournful case of a wife with a neuropathic husband, +and must now say a few words about the truly distressing fate of a husband +afflicted with a neuropathic wife, for neuropathy in its unpleasant +consequences to others is far worse in woman than in man. + +A man is at work all day, and his mind is perforce distracted from his +woes, and, though he retails them at night to the home circle, they get so +used to them as to disregard them, proffering a few words of agreement, +sympathy or scorn quite automatically. + +With women the distraction of work is not so complete, for housework can be +neglected, there are always neighbours and friends to listen to tales of +woe and thus generate a very harmful self-pity, and women are not content +to enumerate their woes, but demand the attention and sympathy of all +listeners. + +Many of the facts in the foregoing parts of this chapter apply with equal +force to both sexes, but women being usually more patient, tactful, +resigned and self-sacrificing than men, can--and often do--alleviate the +lot of the male neuropath; whereas the absence of these qualities in the +average man means that he aggravates, instead of alleviating, the lot of +any female neuropath to whom he may be wedded. + +Having taken her "for better, for worse" he will find her irritating, +unreasonable, and unfitted to shoulder domestic responsibilities. Her likes +and dislikes, fickle fancies, unreasonable prejudices, selfish ways will +cause trouble; he must be prepared for misunderstandings and feuds with +relatives and friends, and on reaching home tired and worried, he is like +to find his house in disorder, be assailed by a tale of woe, and perhaps +find that his wife's vagaries have involved him in a tiff with neighbours. + +She will be fretful, exacting, impatient, and given to ready tears. +Sensitive to the last degree, she will see slights where none are intended, +and a chiding word, a reproachful look, or a weary sigh will mean a fit of +temper or depression. + +Not only are men less gifted for "managing" women than vice versa, but +women are far less susceptible to tactful management than men; a man, like +a dog, can be led almost anywhere with a little dragging at the chain and +growling now and then; a woman, like a cat, is more likely to spit, swear, +and scratch than come along. + +Consequently, it is almost impossible to suggest means of obtaining relief +to one who has been luckless enough to marry, or be married by, a +neuropathic woman. + +If the husband sympathize, the condition will but be aggravated; medicinal +measures will only increase, instead of diminishing, the number of +symptoms; indifference will procure such an exhibition as will both prove +its uselessness and ensure the attention craved. + + * * * * * + +CHAPTER XXVII + +SUMMARY + +To sum up: we have learnt that Epilepsy is a very ancient disease due to +some instability of the brain, in which convulsions are a common but not +invariable symptom. + +Its actual cause is unknown. Heredity plays a big part, but there are +secondary causes beside factors which excite attacks. + +Various methods and drugs to prevent seizures have a limited use. + +First-aid treatment consists solely in preventing the victim sustaining any +injury. + +Neurasthenia is a disease due to nerve-exhaustion and poisoning from +overwork and worry. Its symptoms are many, but fatigue and irritability are +the chief. + +Hysteria is an obstinate, functional, nervous disease in which the patient +acts in an abnormal manner, which is highly provoking to other individuals. + +The cure for hysteria and neurasthenia is solely hygienic, and depends +mainly on the patient. + +The first step towards health consists in getting any slight organic +defects remedied. + +Digestion is often poorly performed. + +This must be remedied by thorough mastication and rational dieting. + +Constipation is very inimical to neuropaths, and must be remedied. + +Patients must pay careful attention to general hygiene. + +Insomnia is exhausting and must be conquered. + +The effects of imagination are profound. + +Suggestion treatment overcomes imaginary ills. + +Drug treatment is either of very limited utility, or frankly useless. + +Patent medicines are never of the slightest use. + +The rational training of neuropathic children is a very difficult but +essential task. + +Puberty and adolescence are very critical times. + +Occupations and recreations must be wisely chosen. + +Heredity is the primary cause of these diseases. As it cannot be treated, +sufferers must not have children. + +Character is abnormal in nervous disease. + +Marriage is very undesirable. + +As a parting injunction, whether you are an epileptic or a neurasthenic, or +a friend, relative, or attendant of such a one: + +"GO THOU SOFTLY ALL THY DAYS!" + + * * * * * + +BIBLIOGRAPHY + + "Oh! for a booke and a shadie nooke, + Eyther indoore or oute; + Where I maie reade, all atte my ease + Both of the newe and olde: + For a jollie goode booke, whereonne to looke + Is better to me than golde!" + +The following books are suitable for laymen, and are most of them very +readable. + +EPILEPSY + +We know of no book suitable for laymen, + +NEURASTHENIA AND HYSTERIA + +"Nervous Disorders of Men" (Kegan Paul) Hollander. + +"Nervous Disorders of Women" (Kegan Paul) Hollander. + +"National Degeneration" (Cornish, Birmingham) D.F. Harris. + +"Hysteria and Neurasthenia" J.M. Clarke. + +"The Management of a Nerve Patient" Schofield. + +"Confessions of a Neurasthenic" (F.A. Davis Co., Philadelphia) Marrs. + +"Conquest of Nerves" (Macmillan) Courtney. + +GENERAL: + +INDIGESTION + +"Indigestion" Herschell. + +DIETING + +"Dietetics" (Jack's People's Books) A. Bryce. + +"Diet in Dyspepsia" Tibbles. + +"Cookery for Common Ailments" Brown. + +CONSTIPATION + +"Constipation" Bigg. + +HYGIENE + +"Laws of Life and Health" A. Bryce. + +"Health" M.M. Burgess. + +INSOMNIA + +"Sleep and Sleeplessness" H.A. Bruce. + +"The Meaning of Dreams" I.H. Coriat. + +IMAGINATION + +"Psychology in Daily Life" Seashore. + +"Hygiene of the Mind" T.S. Clouston. + +SUGGESTION + +"Hypnotism and Suggestion" Hollander. + +"How to Treat by Suggestion" Ash. + +"Hypnotism and Self-Education" (Jack's People's Books) Hutchinson. + +PATENT MEDICINES + +"Patent Foods and Patent Medicines" (Bale & Davidson) Hutchinson. + +See Chapter XX for B.M.A. Books. + +THE CHILD + +"Our Baby" R.D. Clark. + +"Abnormal Children" (Kegan Paul) Hollander. + +"The Baby" (Jack's People's Books) Anonymous. + +"Training the Child" (Jack's People's Books) Spiller. + +PUBERTY + +"Youth and Sex" (Jack's People's Books) Scharlieb and Sibley. + +"Woman in Childhood, Wifehood, and Motherhood" M.S. Cohen. + +"The Adolescent Period" Starr. + +"Physiology" (Home Univ. Library) McKendrick. + +"Human Physiology" Leonard Hill. + +HEREDITY AND CHARACTER + +"Evolution" (Home Univ. Library) Thomson and Geddes. + +"Heredity in the Light of Recent Research" (Cam. Univ. Press) Doncaster. + +"The Psychology of Insanity" (Cam. Univ. Press) Bernard Hart. + +MARRIAGE + +"On Conjugal Happiness" R.G.S. Krohn + +"Race Culture and Race Suicide" R.R. Rentoul. + + * * * * * + +INDEX + + ABORTIVES, Use of, as cause of epilepsy, 22 + Age-incidence in epilepsy, 17, 18 + Air, Fresh, Importance of, 73 + Alcohol, The question of, 64 + Alcoholic excess in relation to epilepsy, 16, 21-23 + ---- ---- neurasthenia, 31 + Amyl Nitrite, to check the aura in epilepsy, 26 + Analyses of proprietary preparations for children, 13 + ---- ---- purgative medicines, 62 + ---- of secret remedies, British Medical Association, 13, 62, 92 + Arson as manifestation of mental epilepsy, 10 + Aspirin for post-epileptic headache, 29 + Aura, The, 2, 3, 25 + ----, ----, in Jacksonian epilepsy, 8 + ----, Treatment of the, 25, 26 + Auto-intoxication, 68 + Auto-suggestion, Value of, 80, 83 + + BACKACHE in neurasthenia, 32 + Baths, Advice as to, for neuropaths, 48, 73, 74 + Blaud's pills, 95 + Brain, Morbid changes in, associated with epilepsy, 18, 19 + ----, Structure of the, 20 + Bromides, Action of, hindered by salt, 65 + ---- in the prevention of epilepsy, 26 + ---- ---- treatment of epilepsy, 86-88, 92 + ---- the basis of every epilepsy cure, 92 + Bromism, 87 + Brooding, harmful to neuropaths, 49, 50 + + CALM necessary in dealing with nervous children, 106 + Carlyle, 90 + Character, 123-30 + ----, The basis of, 124 + Chyle, The, 57 + Chyme, The, 56 + Circulation, The, in neuropaths, 73 + Circulatory Disturbances in neurasthenia, 33 + Clark on frequency of fits during repose, 23 + Clark's statistics of epilepsy, 15 + Cleanliness, 73 + Climacteric, in relation to hysteria, 41 + Clothing for neuropaths, 74 + Coddling, Danger of, for nervous children, 103 + "Complex", The, in consciousness, 10, 11 + Concentration, Lack of, in neurasthenia, 34 + ----, Mental, Exercises in, 51 + Confession, The value of, 40 + Conscious Mind, The, 10, 39 + Consciousness, Alteration of, in epileptic attack, 3, 4, 6 + ----, Dissociation of, 11 + Constipation, 67-70 + ----, Causes of, 67, 68 + ----, Symptoms of, 68 + ----, Treatment of, 68-70 + Convulsions, Epileptic. _See_ "Fit" + ---- in alcoholism, 23 + ---- in children, 13 + ---- in diabetes, 23 + ---- in pregnancy, 14 + Cooking in relation to digestibility, 58 + Country resorts suitable for neuropaths, 47 + Criminal acts in psychic or mental epilepsy, 9, 10 + Culpepper's Herbal, 86 + + DARK, Nervous children's fear of the, 105 + Day-dreaming, 11, 108 + Death, 58 + Degeneration, Signs of, in epileptics, 17 + Dementia, Epileptic, 16 + Demonic Influence in relation to epilepsy, 1, 2 + Dieting, 63-66 + Digestion of foods, 58, 59 + ---- ----, Time occupied by the, 58 + ----, The process of, 56-59 + Digestive troubles in relation to epilepsy, 22, 26 + ---- ----, neurasthenia, 32, 33 + Discipline of the nervous child, 103-106 + Dissociation of consciousness, 11 + Dostoieffsky's "The Idiot", a study of epilepsy, 130 + Douche, The cold, for neuropaths, 74 + Dreams, 12 + ----, Sex-basis in, 12 + Drug habit, The, in neuropaths, 93 + Duties and trials of a neuropath's wife, 132-137 + + EARS, Care of the, 53 + Egoism in relation to neurasthenia, 38 + Electrical treatment for neuropaths, 50 + Emotional repression as a factor in hysteria, 40 + Enema, The use of the, 69 + Energy from food, 58 + Epilepsy a functional disease, 2 + ----, Ancient remedies for, 86 + ---- as a mental complex, 23 + ---- ascribed to demonic influence, 1, 2 + ----, Biblical reference to, 2 + ----, Causes of, 20-24 + ----, Clinical course of, 15-19 + ----, Cure in, 19 + ----, Definition of, 1, 19 + ----, Effect of, on general health, 16 + ----, Feigned, 14 + ----, ----, Diagnosis of, 14 + ----, Historical account of, 1, 2 + ---- in mediaeval times, 2 + ---- in neurasthenics, 35 + ---- in relation to genius, 125-127 + ---- ---- marriage, 131 + ----, Jacksonian, 7-9 + ----, ----, its relative frequency, 15 + ----, Major and minor, 1-6 + ----, Medicines for, 86-89 + ----, Mental, 9, 10 + ----, ----, Rarity of, 15 + ----, Nocturnal, 4, 5 + ----, ----, its relative frequency, 15 + ----, Preventive treatment of, 25-27 + ----, Prognosis in, 19 + ----, Psychic, 9, 10 + ----, Rarer types of, 7-16 + ----, Serial, 7 + ----, Superstitions attached to, 1, 2 + Epileptic children, Care of, 16 + ---- dementia, 16 + ---- fit _See_ "Fit" + ---- fits, Times of occurrence of, 15, 23 + Epileptiform seizures, 13 + Exercise for neuropaths, 48, 74, 75 + Eyes, Care of the, 53 + + FACIAL expression in epilepsy, 17 + Fats, Digestion of, 57 + Fears, Baseless, in neurasthenia, 35, 36 + Feeding, Generous, needed for neuropaths, 47 + Fit, Epileptic, Description of an, 3, 4 + ----, ----, Mechanism of an, 20, 21 + ----, ----, First-aid to victims of, 28, 29 + Flatulence, Treatment of, 70 + Foods, Proprietary, 94, 95 + "Free will", The fallacy of, 124, 125 + Freud on perverted sex-ideas as a cause of hysteria, 40 + ---- ---- subconscious sexual desires in infants, 113 + ---- ---- the sex-basis in dreams, 12 + Fright as cause of epilepsy, 21 + + GASTRIC Juice, The, 56 + Genius, Epilepsy in relation to, 125-127 + "Germ-plasm", The, 118 + ---- in relation to neuropathic tendencies, 120, 121, 124 + _Globus hystericus_, 42 + Glycerin suppositories, 69 + Glycerophosphates, 96 + "Good" and "Evil", 123, 124 + Gowers on epilepsy, 7 + Gowers' statistics as to age-incidence of epilepsy, 17 + _Grand mal_, 2-5 + ---- ----, its relative frequency, 15 + Greene on hysteria, 44 + + HABIT, Importance of, in relation to constipation, 68 + Haig on relation of uric acid to epilepsy, 23 + Headache in neurasthenia, 32 + Heredity, 118-122 + Hobbies for neuropaths, 48 + Hormone, The Function of a, 57 + Hughlings Jackson, Dr, on the epileptic convulsion, 8 + Husband of a neuropath, Advice to the, 138, 139 + Huxley on the rules of the game of life, 46 + Hygiene, General, 71-75 + Hypochondriasis in neurasthenics, 36 + Hypophosphites, 96 + Hysteria, 39-45 + ----, Age incidence of, 41 + ----, Ancient views as to, 39 + ---- and neurasthenia contrasted, 41 + ---- Causes of, 40, 41 + ----, Modern theories as to, 39 + ----, Race incidence of, 42 + ----, Sex-incidence of, 39, 41 + ----, Symptoms of, 42-44 + ----, Treatment of, 44 + Hysterical attack, The, 42, 43 + + IMAGINATION, Effects of, 79-81 + Indigestion, 60-62 + Infantile convulsions, 13 + ---- ----, relation of to epilepsy, 13 + ---- ----, Treatment of, 13 + Inhibitory cells of brain, 20, 21 + Injuries to brain as cause of epilepsy, 21 + Insanity in relation to dissociation of consciousness, 11 + ---- ---- epilepsy, 16 + Insomnia _See_ "Sleeplessness" + Intestinal worms, 102 + Iron preparations, 95 + + JACKSONIAN epilepsy, 7, 8, 9 + Janet on consciousness in hysteria, 40 + Jones on the religious sentiment in neuropaths, 106, 107 + + KING'S evil, The, 86 + + LA ROCHEFOUCAULD on health and regimen, 65 + Lecithin, 96 + Lieberkuhn's glands, 57, 58 + Life, in relation to tissue change, 58 + Locock's introduction of bromides for epilepsy, 86 + + MACHINE, The human, 71, 72 + Malt extracts, 93 + Marriage, 131-139 + ---- and neuropathy, 122, 131, 132 + ---- of neuropaths should be childless, 134, 135 + Mastication, Importance of thorough, 61 + Masturbation, 110-112 + ----, Effects of, 111, 112 + ---- in relation to epilepsy, 16, 22, 114 + ---- ---- neurasthenia, 38 + Meals, Number and time of, 64 + Meat extracts, 93 + ---- juices, Value of, 64 + ----, Moderation in its use necessary, 65 + Memory in epilepsy, 17 + ----, its subconscious basis, 10 + Mendel's law of inheritance, 120, 121 + Menopause in relation to neurasthenia, 31 + Menstruation, Disordered, in neurasthenia, 33 + ---- in relation to epilepsy, 17, 22 + Mental attitude of neurasthenics, 33-38 + ---- fatigue in neurasthenia, 33, 34 + Mercier on the characteristics of the neuropath, 128-130 + Mind in relation to consciousness, 10 + Moral cowardice in relation to neurasthenia, 38 + _Morbus comitialis_, 2 + Motor cells of brain, 20, 21 + Murder as manifestation of mental epilepsy, 10 + + NARCOTICS, Use and abuse of, 78 + Nervous child, Training of the, 98-108 + ---- dyspepsia, 60 + ---- ----, Diet in, 65 + Neurasthenia, 30-38 + ---- and hysteria contrasted, 41 + ----, Causes of, 31, 32, 41 + ----, Course and outlook in, 38, 41 + ---- in relation to epilepsy, 35 + ---- ---- self abuse, 16, 38 + ----, Sexual, 38 + ----, Symptoms of, 32-38, 41 + Neuropath, The, his need of a wife, 132 + Neuropathic children, Characteristics of, 98, 99 + ---- ----, Diet of, 100-102 + ---- ----, Education of 99, 100 + ---- ----, Moral training of, 102-106 + Neuropaths, Advice to, 46-52 + ----, Mental characteristics of, 126-130 + Neuropathy in relation to marriage, 122, 131-139 + ----, The only way to eradicate, 121 + Night terrors, 105 + Nitroglycerine to check the epileptic aura, 25, 26 + Nose, Care of the, 54 + + OPISTHOTONOS, 43 + Optimism, Value of, 80 + Osler on age-incidence of epilepsy, 18 + ---- ---- the use of medicines, 93 + + PALPITATION during use of bromides, 87 + ---- in neurasthenia, 33 + Parentage in relation to inherited qualities, 119, 120 + Patent medicines, 90-97 + ---- ---- and the dyspeptic, 60, 62 + ---- ---- ---- ---- neurasthenic, 36 + ---- ----, explanation of their benefit, 80 + Pepsin, 94 + _Petit mal_, 5, 6 + ---- ---- in childhood, 16 + ---- ----, its relative frequency 15 + Phenalgin for post-epileptic headache, 29 + Phosphorus preparations, 96 + Piles, 70 + Port wine in proprietary preparations, 93 + Predigested foods, 94, 95 + Pregnancy, Convulsions during, 14 + ---- in relation to epilepsy, 17, 22 + Psycho-analysis in the treatment of hysteria, 40 + Puberty, Bodily changes at, 109 + ----, Dangers at and after, 109-114 + ---- in relation to epilepsy, 16, 18, 114 + Punishment, Corporal, unsuited for nervous children, 105, 106 + Pupils in epilepsy, The, 17 + Purgatives, The abuse of, 69 + ----, Suitable, 70 + + QUACK Advertisements, 91, 111 + + READING for neuropaths, 48 + Recovery in epilepsy, 19 + Recreations for neuropaths, 117 + Reid on the effect of emotions on bodily functions, 81 + Religion, Question of, in nervous children, 106-108 + Rest for neuropaths, 49, 50 + Responsibility in relation to mental epilepsy, 9, 10 + + SANATOGEN, 96 + Savill on differences between neurasthenia and hysteria, 41 + Self-abuse _See_ "Masturbation" + Self control, how far possible to neuropaths, 123-125 + Self-restraint, The neuropath's lack of, 129, 130 + Sentimentality to be discouraged in nervous children, 104 + Sex education, The need for, 131 + Sex-incidence in epilepsy, 18 + Sex instruction for children, 110, 112 + Sexual development early in neuropaths, 113, 114 + ---- excesses in relation to epilepsy, 16, 23 + ---- ---- in relation to neurasthenia, 31, 38 + ---- instinct, Awakening of, 109, 110 + ---- neurasthenia, 38 + ---- offences as manifestations of mental epilepsy, 9, 10 + ---- rules for neuropaths, 48 + Shaw, Bernard, his sneer at marriage, 131 + Sleep, Relation of, to epileptic fit, 4 + Sleeplessness, 76-78 + ----, Causes of, 76, 77 + ----, Treatment of, 77, 78, 85 + ---- in neurasthenia, 33 + Sollmann on proprietary foods, 94, 96 + Soothing syrups, 13 + "Sound nerves", 52 + Spirit writing, 11, 12 + Spiritualism, Danger of, for neuropaths, 107 + Spratling on epilepsy in consumptives, 17 + Starr's statistics as to age-incidence in epilepsy, 17 + ---- ---- heredity in epileptics, 121 + ---- ---- types of epilepsy, 15 + _Status epilepticus_, 7 + ---- ----, as final termination of epilepsy, 16 + Subconscious mind, The, 10 + Suggestion treatment, 82-85 + Suicide in neurasthenics and hysterical subjects, 35, 41, 42 + Sunstroke as cause of fits, 21 + Sweetmeats, The use of, 64 + Sympathy, Harm done by, in hysteria, 44, 45 + + TAPE worms, 102 + Tea and coffee, 64 + Teeth, Care of the, 54, 55 + Tobacco undesirable for neuropaths, 74 + Trades for epileptics, 116 + ---- ---- neuropaths, 115-117 + Turner on age-incidence of epilepsy, 18 + + UNCONSCIOUS activities, 39, 40 + Unconsciousness in epilepsy, 3-5 + Urine, Incontinence of, in epilepsy, 3-5 + + VEGETABLE Foods, 64 + Villi, The intestinal, 57 + Vittoz's exercises in mental concentration, 51 + Vomiting, Risk of, in epilepsy, 26 + + WATER, When to drink, 61, 64, 68 + Weir Mitchell Treatment, 50 + Wife for the neuropath, The, 132-135 + ---- of a neuropath, Advice to the, 132-137 + Will, Neuropath's lacking in, 125 + Work and play, 115-117 + Worms, Intestinal, 102 + Worry as cause of neurasthenia, 31 + ---- to be avoided by neuropaths, 47, 49 + +_Printed in Great Britain by Jarrold & Sons, Ltd., Norwich_ + + + + + + +End of the Project Gutenberg EBook of Epilepsy, Hysteria, and Neurasthenia +by Isaac G. 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