diff options
Diffstat (limited to '14901-8.txt')
| -rw-r--r-- | 14901-8.txt | 5309 |
1 files changed, 5309 insertions, 0 deletions
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. Briggs + +*** END OF THIS PROJECT GUTENBERG EBOOK EPILEPSY, HYSTERIA, AND NEURASTHENIA *** + +***** This file should be named 14901-8.txt or 14901-8.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/4/9/0/14901/ + +Produced by Martin Agren, Keith Edkins and the PG Online Distributed +Proofreading Team. + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +https://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +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 + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at https://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +https://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at https://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit https://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including including checks, online payments and credit card +donations. To donate, please visit: https://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart was the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. |