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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/37109-8.txt b/37109-8.txt new file mode 100644 index 0000000..27693ef --- /dev/null +++ b/37109-8.txt @@ -0,0 +1,6614 @@ +The Project Gutenberg EBook of Health Through Will Power, by James J. Walsh + +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: Health Through Will Power + +Author: James J. Walsh + +Release Date: August 17, 2011 [EBook #37109] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK HEALTH THROUGH WILL POWER *** + + + + +Produced by Don Kostuch + + + + +[Transcriber's Notes] + Page numbers in this book are indicated by numbers enclosed in curly + braces, e.g. {99}. They have been located where page breaks occurred + in the original book. + + This book is derived from a copy on the Internet Archive: + http://www.archive.org/details/cu31924012175505 + + Obvious spelling or typographical errors have been corrected. + Inconsistent spelling of names and inventive and alternative + spelling is left as printed. + + Extended quotations and citations are indented such as reports, + letters and interviews. +[End Transcriber's Notes] + + +HEALTH THROUGH WILL POWER + + +BY + +JAMES J. WALSH, M.D., Ph.D., Sc.D., Etc. + +MEDICAL DIRECTOR OF FORDHAM UNIVERSITY SCHOOL OF SOCIOLOGY; +PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY +AT CATHEDRAL COLLEGE; LECTURER ON PSYCHOLOGY, +MARYWOOD COLLEGE, ETC. + + + + + BOSTON + + LITTLE, BROWN, AND COMPANY + + 1919 + + + + _Copyright, 1919,_ + + By Little, Brown, and Company. + + + + _All rights reserve_ + + Published, November, 1919 + + + + _Norwood Press_ + + Set up and electrotyped by J. S. Cushing Co., + + Norwood, Mass., U.S.A. + + + +_To_ +J. H. W. + +EX ANIMO ET CORDE + +J. J. W. + + +{vii} + + +PREFACE + +A French surgeon to whom the remark was made in the third year of the +War that France was losing an immense number of men replied: "Yes, we +are losing enormously, but for every man that we lose we are making +two men." What he meant, of course, was that the War was bringing out +the latent powers of men to such an extent that every one of those who +were left now counted for two. The expression is much more than a mere +figure of speech. It is quite literally true that a man who has had +the profound experience of a war like this becomes capable of doing +ever so much more than he could before. He has discovered his own +power. He has tapped layers of energy that he did not know he +possessed. Above all, he has learned that his will is capable of +enabling him to do things that he would have hesitated about and +probably thought quite impossible before this revelation of himself to +himself had been made. + +{viii} + +In a word, the War has proved a revival of appreciation of the place +of the human will in life. Marshal Foch, the greatest character of the +War, did not hesitate even to declare that "A battle is the struggle +of two wills. It is never lost until defeat is accepted. They only are +vanquished who confess themselves to be." + +Our generation has been intent on the development of the intellect. We +have been neglecting the will. "Shell shock" experiences have shown us +that the intellect is largely the source of unfavorable suggestion. +The will is the controlling factor in the disease. Many another +demonstration of the power of will has been furnished by the War. This +volume is meant to help in the restoration of the will to its place as +the supreme faculty in life, above all the one on whose exercise, more +than any other single factor, depends health and recovery from +disease. The time seems opportune for its appearance and it is +commended to the attention of those who have recognized how much the +modern cult of intellect left man unprepared for the ruder trails of +life yet could not see clearly what the remedy might be. + +{ix} + +CONTENTS + + + PAGE + + Preface vii + +CHAPTER + +I The Will in Life 1 + +II Dreads 19 + +III Habits 42 + +IV Sympathy 57 + +V Self-Pity 69 + +VI Avoidance of Conscious Use of the Will 80 + +VII What the Will Can Do 102 + +VIII Pain and the Will 112 + +IX The Will and Air and Exercise 133 + +X The Will to Eat 148 + +XI The Place of the Will in Tuberculosis 167 + +XII The Will in Pneumonia 187 + +XIII Coughs and Colds 196 + +XIV Neurotic Asthma and the Will 207 + +XV The Will in Intestinal Function 215 + +XVI The Will and the Heart 227 + +XVII The Will in So-Called Chronic Rheumatism 240 + +XVII Psycho-Neuroses 258 + +XIX Feminine Ills and the Will 270 + + Index 285 + + +{1} + + +HEALTH THROUGH WILL POWER + + + +CHAPTER I + +THE WILL IN LIFE + + + "What he will he does and does so much + That proof is called impossibility." + + _Troilus and Cressida._ + + +The place of the will in its influence upon health and vitality has +long been recognized, not only by psychologists and those who pay +special attention to problems of mental healing, but also, as a rule, +by physicians and even by the general public. It is, for instance, a +well-established practice, when two older folk, near relatives, are +ill at the same time, or even when two younger persons are injured +together and one of them dies, or perhaps has a serious turn for the +worse, carefully to keep all knowledge of it from the other one. The +reason is a very definite conviction that in the revulsion of feeling +caused by learning of the fatality, or as {2} a result of the +solicitude consequent upon hearing that there has been a turn for the +worse, the other patient's chances for recovery would probably be +seriously impaired. The will to get better, even to live on, is +weakened, with grave consequences. This is no mere popular impression +due to an exaggeration of sympathetic feeling for the patient. It has +been noted over and over again, so often that it evidently represents +some rule of life, that whenever by inadvertence the serious condition +or death of the other was made known, there was an immediate +unfavorable development in the case which sometimes ended fatally, +though all had been going well up to that time. This was due not +merely to the shock, but largely to the "giving up", as it is called, +which left the surviving patient without that stimulus from the will +to get well which means so much. + +It is surprising to what an extent the will may affect the body, even +under circumstances where it would seem impossible that physical +factors could any longer have any serious influence. We often hear it +said that certain people are "living on their wills", and when they +are of the kind who take comparatively little food and yet succeed in +accomplishing {3} a great deal of work, the truth of the expression +comes home to us rather strikingly. The expression is usually +considered, however, to be scarcely more than a formula of words +elaborated in order to explain certain of these exceptional cases that +seem to need some special explanation. The possibility of the human +will of itself actually prolonging existence beyond the time when, +according to all reason founded on physical grounds, life should end, +would seem to most people to be quite out of the question. And yet +there are a number of striking cases on record in which the only +explanation of the continuance of life would seem to be that the will +to live has been so strongly aroused that life was prolonged beyond +even expert expectation. That the will was the survival factor in the +case is clear from the fact that as soon as this active willing +process ceased, because the reason that had aroused it no longer +existed, the individuals in question proceeded to reach the end of +life rapidly from the physical factors already at work and which +seemed to portend inevitably an earlier dissolution than that which +happened. Probably a great many physicians know of striking examples +of patients who have lived beyond the time when ordinarily death would +{4} be expected, because they were awaiting the arrival of a friend +from a distance who was known to be coming and whom the patient wanted +very much to see. Dying mothers have lived on to get a last embrace of +a son or daughter, and wives have survived to see their husbands for a +last parting--though it seemed impossible that they should do so, so +far as their physical condition was concerned--and then expired +within a short time. Of course there are any number of examples in +which this has not been true, but then that is only a proof of the +fact that the great majority of mankind do not use their wills, or +perhaps, having appealed to them for help during life never or but +slightly, are not prepared to make a definite serious call on them +toward the end. I am quite sure, however, that a great many country +physicians particularly can tell stories of incidents that to them +were proofs that the will can resist even the approach of death for +some time, though just as soon as the patients give up, death comes to +them. + +Professor Stokes, the great Irish clinician of the nineteenth century, +to whom we owe so much of our knowledge of the diseases of the heart +and lungs, and whose name is enshrined in terms commonly used in +medicine in {5} connection with these diseases, has told a striking +story of his experiences in a Dublin hospital that illustrates this +very well. An old Irishman, who had been a soldier in his younger +years and had been wounded many times, was in the hospital ill and +manifestly dying. Professor Stokes, after a careful investigation of +his condition, declared that he could not live a week, though at the +end of that time the old soldier was still hanging on to life, ever +visibly sinking. Stokes assured the students who were making the +rounds of his wards with him that the old man had at most a day or two +more to live, and yet at the end of some days he was still there to +greet them on their morning visits. After the way of medical students +the world over, though without any of that hard-heartedness that would +be supposed ordinarily to go with such a procedure, for they were +interested in the case as a medical problem, the students began to bet +how long the old man would live. + +Finally, one day the old man said to Stokes in his broadest brogue: +"Docther, you must keep me alive until the first of the month, because +me pension for the quarther is then due, and unless the folks have it, +shure they won't have anything to bury me with." + +{6} + +The first of the month was some ten days away. Stokes said to his +students, though of course not in the hearing of the patient, that +there was not a chance in the world, considering the old soldier's +physical condition, that he would live until the first of the month. +Every morning, in spite of this, when they came in, the old man was +still alive and there was even no sign of the curtains being drawn +around his bed as if the end were approaching. Finally on the morning +of the first of the month, when Stokes came in, the old pensioner said +to him feebly, "Docther, the papers are there. Sign them! Then they'll +get the pension. I am glad you kept me alive, for now they'll surely +have the money to bury me." And then the old man, having seen the +signature affixed, composed himself for death and was dead in the +course of a few hours. He had kept himself alive on his will because +he had a purpose in it, and once that purpose was fulfilled, death was +welcome and it came without any further delay. + +There is a story which comes to us from one of the French prisons +about the middle of the nineteenth century which illustrates forcibly +the same power of the will to maintain life after it seemed sure, +beyond peradventure, {7} that death must come. It was the custom to +bury in quicklime in the prison yard the bodies of all the prisoners +who died while in custody. The custom still survives, or did but +twenty years ago, even in English prisons, for those who were +executed, as readers of Oscar Wilde's "Ballad of Reading Gaol" will +recall. Irish prisons still keep up the barbarism, and one of the +reasons for the bitterness of the Irish after the insurrection of 1916 +in Dublin was the burial of the executed in quicklime in the prison +yard. The Celtic mind particularly revolts at the idea, and it +happened that one of the prisoners in a certain French prison, a +Breton, a Celt of the Celts, was deeply affected by the thought that +something like this might happen to him. He was suffering from +tuberculosis at a time when very little attention was paid to such +ailments in prisoners, for the sooner the end came, the less bother +there was with them; but he was horrified at the thought that if he +died in prison his body would disappear in the merciless fire of the +quicklime. + +So far as the prison physician could foresee, the course of his +disease would inevitably reach its fatal termination long before the +end of his sentence. In spite of its advance. {8} however, the +prisoner himself declared that he would never permit himself to die in +prison and have his body face such a fate. His declaration was +dismissed by the physician with a shrug and the feeling that after all +it would not make very much difference to the man, since he would not +be there to see or feel it. When, however, he continued to live, +manifestly in the last throes of consumption, for weeks and even +months after death seemed inevitable, some attention was paid to his +declaration in the matter and the doctors began to give special +attention to his case. He lived for many months after the time when, +according to all ordinary medical knowledge, it would seem he must +surely have died. He actually outlived the end of his sentence, had +arrangements made to move him to a house just beyond the prison gate +as soon as his sentence had expired, and according to the story, was +dead within twenty-four hours after the time he got out of prison and +thus assured his Breton soul of the fact that his body would be given, +like that of any Christian, to the bosom of mother earth. + +But there are other and even more important phases of the prolongation +of life by the will that still better illustrates its power. {9} It +has often been noted that men who have had extremely busy lives, +working long hours every day, often sleeping only a few hours at +night, turning from one thing to another and accomplishing so much +that it seemed almost impossible that one man could do all they did, +have lived very long lives. Men like Alexander Humboldt, for instance, +distinguished in science in his younger life, a traveler for many +years in that hell-hole of the tropics, the region around Panama and +Central America, a great writer whose books deeply influenced his +generation in middle age. Prime Minister of Prussia as an older man, +lived to be past ninety, though he once confessed that in his forties +he often slept but two or three hours a night and sometimes took even +that little rest on a sofa instead of a bed. Leo XIII at the end of +the nineteenth century was just such another man. Frail of body, +elected Pope at sixty-four, it was thought that there would soon be +occasion for another election; he did an immense amount of work, +assumed successfully the heaviest responsibilities, and outlived the +years of Peter in the Papal chair, breaking all the prophecies in that +regard and not dying till he was ninety-three. + +Many other examples might be cited. {10} Gladstone, always at work, +probably the greatest statesman of the nineteenth century in the +better sense of that word, was a scholar almost without a peer in the +breadth of his scholarly attainments, a most interesting writer on +multitudinous topics, keen of interest for everything human and always +active, and yet he lived well on into the eighties. Bismarck and Von +Moltke, who assumed heavier responsibilities than almost any other men +of the nineteenth century, saw their fourscore years pass over them a +good while before the end came. Bismarck remarked on his eighty-first +birthday that he used to think all the good things of life were +confined to the first eighty years of life, but now he knew that there +were a great many good things reserved for the second eighty years. I +shall never forget sitting beside Thomas Dunn English, the American +poet, at a banquet of the Alumni of the University of Pennsylvania, +when he repeated this expression for us; at the time he himself was +well past eighty. He too had been a busy man and yet rejoiced to be +with the younger alumni at the dinner. + +My dear old teacher, Virchow, of whom they said when he died that four +men died, for he was distinguished not only as a pathologist, {11} +which was the great life-work for which he was known, but as an +anthropologist, a historian of medicine and a sanitarian, was at +seventy-five actively accomplishing the work of two or three men. He +died at eighty-one, as the result of a trolley injury, or I could +easily imagine him alive even yet. Von Ranke, the great historian of +the popes, began a universal history at the age of ninety which was +planned to be complete in twelve volumes, one volume a year to be +issued. I believe that he lived to finish half a dozen of them. I have +some dear friends among the medical profession in America who are in +their eighties and nineties, and all of them were extremely busy men +in their middle years and always lived intensely active lives. Stephen +Smith and Thomas Addis Emmet, John W. Gouley, William Hanna Thompson, +not long dead, and S. Weir Mitchell, who lived to be past eighty-five, +are typical examples of extremely busy men, yet of extremely long +lives. + +All of these men had the will power to keep themselves busily at work, +and their exercise of that will power, far from wearing them out, +actually seemed to enable them to tap reservoirs of energy that might +have remained {12} latent in them. The very intensiveness of their +will to do seemed to exert an extensive influence over their lives, +and so they not only accomplished more but actually lived longer. Hard +work, far from exhausting, has just the opposite effect. We often hear +of hard work killing people, but as a physician I have carefully +looked into a number of these cases and have never found one which +satisfied me as representing exhaustion due to hard work. Insidious +kidney disease, rheumatic heart disease, the infections of which +pneumonia is a typical example, all these have been the causes of +death and not hard work, and they may come to any of us. They are just +as much accidents as any other of the mischances of life, for it is as +dangerous to be run into by a microbe as by a trolley car. Using the +will in life to do all the work possible only gives life and gives it +more abundantly, and people may rust out, that is be hurt by rest, +much sooner than they will wear out. + +Here, then, is a wellspring of vitality that checks for a time at +least even lethal changes in the body and undoubtedly is one of the +most important factors for the prolongation of life. It represents the +greatest force for health and power of accomplishment that we have. +{13} Unfortunately, in recent years, it has been neglected to a great +extent for a number of reasons. One of these has been the discussions +as to the freedom of the will and the very common teaching of +determinism which seemed to eliminate the will as an independent +faculty in life. While this affected only the educated classes who had +received the higher education, their example undoubtedly was pervasive +and influenced a great many other people. Besides, newspaper and +magazine writers emphasized for popular dissemination the ideas as to +absence of the freedom of the will which created at least an +unfortunate attitude of mind as regards the use of the will at its +best and tended to produce the feeling that we are the creatures of +circumstances rather than the makers of our destiny in any way, or +above all, the rulers of ourselves, including even to a great extent +our bodily energies. + +Even more significant than this intellectual factor, in sapping will +power has been the comfortable living of the modern time with its +tendency to eliminate from life everything that required any exercise +of the will. The progress which our generation is so prone to boast of +concerns mainly this making of people {14} more comfortable than they +were before. The luxuries of life of a few centuries ago have now +become practically the necessities of life of to-day. We are not asked +to stand cold to any extent, we do not have to tire ourselves walking, +and bodily labor is reserved for a certain number of people whom we +apparently think of as scarcely counting in the scheme of humanity. +Making ourselves comfortable has included particularly the removal of +nearly all necessity for special exertion, and therefore of any +serious exercise of the will. We have saved ourselves the necessity +for expending energy, apparently with the idea that thus it would +accumulate and be available for higher and better purposes. + +The curious thing with regard to animal energy, however, is that it +does not accumulate in the body beyond a certain limited extent, and +all energy that is manufactured beyond that seems to have a definite +tendency to dissipate itself throughout the body, producing discomfort +of various kinds instead of doing useful work. The process is very +like what is called short-circuiting in electrical machinery, and this +enables us to understand how much harm may be done. Making ourselves +comfortable, therefore, may in the {15} end have just exactly the +opposite effect, and often does. This is not noted at first, and may +escape notice entirely unless there is an analysis of the mode of life +which is directed particularly to finding out the amount of exertion +of will and energy that there is in the daily round of existence. + +The will, like so many other faculties of the human organism, grows in +power not by resting but by use and exercise. There have been very few +calls for serious exercise of the will left in modern life and so it +is no wonder that it has dwindled in power. As a consequence, a good +deal of the significance of the will in life has been lost sight of. +This is unfortunate, for the will can enable us to tap sources of +energy that might otherwise remain concealed from us. Professor +William James particularly called attention to the fact, in his +well-known essay on "The Energies of Men", that very few people live +up to their _maximum_ of accomplishment or their _optimum_ of conduct, +and that indeed "_as a rule men habitually use only a small part of +the powers which they actually possess and which they might use under +appropriate conditions._" + +It is with the idea of pointing out how much the will can accomplish +in changing things for {16} the better that this volume is written. +Professor James quoted with approval Prince Pueckler-Muskau's +expression, "I find something very satisfactory in the thought that +man has the power of framing such props and weapons out of the most +trivial materials, indeed out of nothing, merely by the force of his +will, which thereby truly deserves the name of omnipotent." +[Footnote 1] + + [Footnote 1: "Tour in England, Ireland and France."] + +It is this power, thus daringly called omnipotent, that men have not +been using to the best advantage to maintain health and even to help +in the cure of disease, which needs to be recalled emphatically to +attention. The war has shown us in the persons of our young soldiers +that the human will has not lost a single bit of its pristine power to +enable men to accomplish what might almost have seemed impossible. One +of the heritages from the war should be the continuance of that fine +use of the will which military discipline and war's demands so well +brought into play. Men can do and stand ever so much more than they +realize, and in the very doing and standing find a satisfaction that +surpasses all the softer pleasant feelings that come from mere comfort +and lack of necessity for physical and {17} psychical exertion. Their +exercise of tolerance and their strenuous exertion, instead of +exhausting, only makes them more capable and adds to instead of +detracting from their powers. + +How much this discipline and training of the will meant for our young +American soldiers, some of whom were raised in the lap of luxury and +almost without the necessity of ever having had to do or stand hard +things previously in their lives, is very well illustrated by a letter +quoted by Miss Agnes Repplier in the _Century_ for December. It is by +no means unique or even exceptional. There were literally thousands of +such letters written by young officers similarly circumstanced, and it +is only because it is typical and characteristic of the spirit of all +of these young men that I quote it here. Miss Repplier says that it +came from "a young American lieutenant for whom the world had been +from infancy a perilously pleasant place." He wrote home in the early +spring of 1918: + +"It has rained and rained and rained. I am as much at home in a mud +puddle as any frog in France, and I have clean forgotten what a dry +bed is like. But I am as fit as a fiddle and as hard as nails. I can +eat scrap iron and sleep standing. Aren't there things {18} called +umbrellas, which you pampered civilians carry about in showers?" If we +can secure the continuance of this will exertion, life will be ever so +much heartier and healthier and happier than it was before, so that +the war shall have its compensations. + + +{19} + +CHAPTER II + +DREADS + + "O, know he is the bridle of your will. + There's none but asses will be bridled so." + _A Comedy of Errors._ + + +It must be a surprise to most people, after the demonstration of the +power of the will in the preceding chapter, that so many fail to make +use of it. Indeed, the majority of mankind are quite unable to realize +the store of energy for their health and strength and well-being which +is thus readily available, though so often unused or called upon but +feebly. The reason why the will is not used more is comparatively easy +to understand, however, once its activity in ordinary conditions of +humanity is analyzed a little more carefully. The will is +unfortunately seldom permitted to act freely. Brakes are put on its +energies by mental states of doubt and hesitation, by contrary +suggestion, and above all by the dreads which humanity has allowed to +fasten {20} themselves on us until now a great many activities are +hampered. There is the feeling that many things cannot be done, or may +be accomplished only at the cost of so much effort and even hardship +that it would be hopeless for any but those who are gifted with +extremely strong wills to attempt them. People grow afraid to commit +themselves to any purpose lest they should not be able to carry it +out. Many feel that they would never be able to stand what others have +stood without flinching and are persuaded that if ever they were +placed in the position where they had to withstand some of the trials +that they have heard of they would inevitably break down under the +strain. + +Just as soon as a human being loses confidence that he or she may be +able to accomplish a certain thing, that of itself is enough to make +the will ever so much less active than it would otherwise be. It is +like breaking a piece of strong string: those who know how wrap it +around their fingers, then jerk confidently and the string is broken. +Those who fear that they may not be able to break it hesitate lest +they should hurt themselves and give a half-hearted twitch which does +not break the string; the only thing they succeed {21} in doing is in +hurting themselves ever so much more than does the person who really +breaks it. After that abortive effort, they feel that they must be +different from the others whose fingers were strong enough to break +the string, and they hesitate about it and will probably refuse to +make the attempt again. + +It is a very old story,--this of dreads hampering the activities of +mankind with lack of confidence, and the fear of failure keeping +people from doing things. One of his disciples, according to a very +old tradition, once asked St. Anthony the Hermit what had been the +hardest obstacle that he found on the road to sanctity. The story has +all the more meaning for us here if we recall that health and holiness +are in etymology the same. St. Anthony, whose temptations have made +him famous, was over a hundred at the time and had spent some seventy +years in the desert, almost always alone, and probably knew as much +about the inner workings of human nature from the opportunities for +introspection which he had thus enjoyed as any human being who ever +lived. His young disciple, like all young disciples, wanted a short +cut on the pathway that they were both traveling. The old man said to +him, "Well, {22} I am an old man and I have had many troubles, but +most of them never happened." + +Many a nightmare of doubt and hesitation disappears at once if the +dread of it is overcome. The troubles that never happen, if dwelt +upon, paralyze the will until health and holiness become extremely +difficult of attainment. + +There is the secret of the failure of a great many people in life in a +great many ways. They fear the worst, dread failure, dampen their own +confidence, and therefore fritter away their own energy. Anything that +will enable them to get rid of the dreads of life will add greatly to +their power to accomplish things inside as well as outside their +bodies. Well begun is half done, and tackling a thing confidently +means almost surely that it will be accomplished. If the dread of +failure, the dread of possible pain in its performance, the dread of +what may happen as a result of activity,--if all these or any of them +are allowed to obtrude themselves, then energy is greatly lessened, +the power to do things hampered and success becomes almost impossible. +This is as true in matters of health and strength as it is with regard +to various external accomplishments. It takes a great {23} deal of +experience for mankind to learn the lesson that their dreads are often +without reality, and some men never learn it. + +Usually when the word dreads is used, it is meant to signify a series +of psychic or psychoneurotic conditions from which sensitive, nervous +people suffer a great deal. There is, for instance, the dread of dirt +called learnedly misophobia, that exaggerated fear that dirt may cling +to the hands and prove in some way deleterious which sends its victims +to wash their hands from twenty to forty times a day. Not infrequently +they wash the skin pretty well off or at least produce annoying skin +irritation as the result of their feeling. There are many other dreads +of this kind. Some of them seem ever so much more absurd even than +this dread of dirt. Most of us have a dread of heights, that is, we +cannot stand on the edge of a height and look down without trembling +and having such uncomfortable feelings that it is impossible for us to +stay there any length of time. Some people also are unable to sit in +the front row of the balcony of a theater or even to kneel in the +front row of a gallery at church without having the same dread of +heights that comes to others at the edge of a high precipice. I have +among my {24} patients some clergymen who find it extremely difficult +to stand up on a high altar, though, almost needless to say, the whole +height is at most five or six ordinary steps. + +Then there are people who have an exaggerated dread of the dark, so +that it is quite impossible for them to sleep without a light or to +sleep alone. Sometimes such a dread is the result of some terrifying +incident, as the case in my notes in which the treasurer of a +university developed an intense dread of the dark which made sleep +impossible without a light, after he had been shot at by a burglar who +came into his room and who answered his demand, "Who is that?" by a +bullet which passed through the head of the bed. Most of the +skotophobists, the technical name for dark-dreaders, have no such +excuse as this one. Victims of nervous dreads have as a rule developed +their dread by permitting some natural feeling of minor importance to +grow to such an extent that it makes them very miserable. + +Some cannot abide a shut-in place. Philip Gilbert Hamerton, the +English writer and painter, often found a railroad compartment in the +English cars an impossible situation and had to break his journey in +order to get over {25} the growing feeling of claustrophobia, the +dread of shut-in places, which would steal over him. + +There are any number of these dreads and, almost needless to say, all +of them may interfere with health and the pursuit of happiness. I have +seen men and women thrown into a severe nervous state with chilly +feelings and cold sweat as the result of trying to overcome one of +these dreads. They make it impossible for their victims to do a great +many things that other people do readily, and sadly hamper their +wills. There is only one way to overcome these dreads, and that is by +a series of acts in the contrary direction until a habit of +self-control with regard to these haunting ideas is secured. All +mankind, almost without exception, has a dread of heights, and yet +many thousands of men have in recent years learned to work on high +buildings without very much inconvenience from the dread. The wages +are good, they _want_ to work this way, and the result is they take +themselves in hand and gradually acquire self-control. I have had many +of them tell me that at first they were sure they would never be able +to do it, but the gradual ascent of the building as the work proceeded +accustomed them to height, {26} and after a while it became almost as +natural to work high up in the air as on the first or second story of +a building or even on the level ground. + +The overcoming of these dreads is not easy unless some good reason +releases the will and sets it to exerting its full power. When this is +the case, however, the dread is overcome and the brake lifted after +some persistence, with absolute assurance. Men who became brave +soldiers have been known to have had a great dread of blood in early +life. Some of our best surgeons have had to leave the first operation +that they ever saw or they would have fainted, and yet after repeated +effort they have succeeded in overcoming this sensitiveness. As a +matter of fact, most people suffer so much from dreads because they +yielded to a minor dread and allowed a bad habit to be formed. It is a +question of breaking a bad habit by contrary acts rather than of +overcoming a natural disposition. Many of those who are victims have +the feeling that they cannot be expected to conquer nature this way. +As a result, they are so discouraged at the very idea that success is +dubious and practically impossible from their very attitude of mind; +but it is only the {27} second nature of a habit that they have to +overcome, and this is quite another matter, for exactly contrary acts +to these which formed a habit will break it. + +Some of these dreads seem to be purely physical in origin or character +yet prove to be merely or to a great degree only psychic states. +Insomnia itself is more a dread than anything else. In writing for the +International Clinics some years ago (Volume IV, Series XXVI) I dwelt +on the fact that insomnia as a dread was probably responsible for more +discomfort and complaints from mankind than almost anything else. +Insomniaphobia is just such a dread as agoraphobia, the dread of open +spaces; or akrophobia, the dread of heights; or skotophobia, the dread +of the dark, and other phobias which afflict mankind. It is perfectly +possible in most cases to cure such phobias by direct training against +them, and this can be done also with regard to insomnia. + +Some people, particularly those who have not been out much during the +day and who have suffered from wakefulness a few times, get it on +their mind that if this state keeps up they will surely lose their +reason or their bodily health, and they begin to worry about {28} it. +They commence wondering about five in the afternoon whether they are +going to be awake that night or not. It becomes a haunt, and no matter +what they do during the evening every now and then the thought recurs +that they will not sleep. By the time they actually lie down they have +become so thoroughly occupied with that thought that it serves to keep +them awake. Some of them avoid the solicitude before they actually get +to bed, but begin to worry after that, and if after ten minutes they +are not asleep, above all if they hear a clock strike somewhere, they +are sure they are going to be awake, they worry about it, get +themselves thoroughly aroused, and then they will not go to sleep for +hours. It is quite useless to give such people drugs, just as useless +as to attempt to give a man a drug to overcome the dread of heights or +the dread of the dark or of a narrow street through which he has to +pass. They must use their wills to help them out of a condition in +which their dreads have placed them. + +Apart from these neurotic dreads, quite unreasoning as most of them +are, there are a series of what may be called intellectual dreads. +These are due to false notions that have come to be accepted and that +serve to {29} keep people from doing things that they ought to do for +the sake of their health, or set them performing acts that are +injurious instead of beneficial. The dread of loss of sleep has often +caused people to take somnifacients which eventually proved ever so +much more harmful than would the loss of sleep they were meant to +overcome. Many a person dreading a cold has taken enough quinine and +whisky to make him more miserable the next day than the cold would +have, had it actually made its appearance, as it often does not. The +quinine and whisky did not prevent it, but the expectation was founded +on false premises. There are a great many other floating ideas that +prove the source of disturbing dreads for many people. A discussion of +a few typical examples will show how much health may be broken by the +dreads associated with various ills, for they often interfere with +normal, healthy living. + +"A little knowledge is a dangerous thing" applies particularly in this +matter. There are many morbid fears that disturb mankind and keep us +from accomplishing what might otherwise be comparatively easy. A great +many people become convinced that they have some diseased condition, +or morbid elements at least, {30} in them which make it impossible for +them to do as much as other people. Sometimes this morbid persuasion +takes the form of hypochrondia and the individuals feel that they have +a constitution that unfits them for prolonged and strenuous effort of +any kind, so they avoid it. The number of valetudinarians, that is of +those who live their lives mainly engaged in caring for their health, +though their physicians have never been able to find anything +organically wrong with them, is much larger than might be imagined. +This state of mind has been with us for many centuries, for the word +which describes it, hypochondria, came to us originally from Greece +and is an attempt to localize the affection in connection with its +principal symptom, which is usually one of discomfort in the stomach +region or to one side or the other of it, that is, in the hypochondria +or beneath the ribs. + +Such a state of mind, in which the patient is constantly complaining +of one symptom or another, quite paralyzes the will. The individual +may be able to do some routine work but he will not be able to have +any initiative or energy for special developments of his occupation, +and of course, when any real affection occurs, he will feel that he is +quite {31} unable to bear this additional burden of disease. +Hypochondriacs, however, sometimes fairly enjoy their ill health and +therefore have been known not infrequently to live on to a good, round +old age, ever complaining more and more. It is their dread of disease +that keeps them from getting better and prevents their wills from +throwing off whatever symptoms there are and becoming perfectly well. +Until something comes along and rouses their wills, there is no hope +of affecting them favorably, and it is surprising how long the state +may continue without any one ever having found any organic affection +to justify all the discomforts of which they complain. Quite +literally, they are suffering from complaints and not from disease in +the ordinary sense of the word. + +Sometimes these dreads of disease are dependent on some word which has +taken on an exaggerated significance in people's minds. A word that in +recent years has been the source of a great deal of unfavorable +suggestion is "catarrh", and a mistaken notion of its meaning has been +productive of a serious hampering of their will to be well in a number +of persons. In itself, both according to its derivation and its +accepted scientific {32} significance, the word means only that first +stage of inflammatory irritation of mucous membranes which causes +secretion to flow more freely than normally. _Catarrhein_ in Greek +means only to flow down. [Footnote 2] + + [Footnote 2: The word has, by the way, the same meaning as + rheumatism, which is also from the Greek verb, to flow, though its + application is usually limited to the serous membranes of the joints + or the serous surfaces of the intermuscular planes. By derivation, + catarrh is the same word also as gout, which comes from _gutta_ in + Latin, meaning a drop and implying secretory disturbances. These + three words--catarrh, rheumatism, gout--have been applied to all + sorts of affections and are so general in meaning as to be quite + hard to define exactly. They have for this very reason, their + vagueness, become a prolific source of unfortunate suggestion and of + all kinds of dreads that disturb health.] + +By abuse, however, the word _catarrh_ has come to mean in the minds of +a great many people in our time a very serious inflammation of the +mucous membranes, almost inevitably progressive and very often +resulting in fetid diseased conditions of internal or external mucous +membranes, very unpleasant for the patient and his friends and the +source of serious complications and _sequelae_. This idea has been +fostered sedulously by the advertisers of proprietary remedies and the +ingenious exploiters of various modes of treatment. As a result, a +great many people who for one reason or another--usually because of +some slight increase of secretion in the nose and {33} throat--become +convinced they have catarrh begin to feel that they cannot be expected +to have as much resistive vitality as others, since they are the +subjects of this serious progressive disease. As a matter of fact, +very few people in America, especially those living in the northern or +eastern States, are without some tendency to mild chronic catarrh. The +violent changes of temperature and the damp, dark days predispose to +it; but it produces very few symptoms except in certain particularly +sensitive individuals whose minds become centered on slight +discomforts in the throat and nose and who feel that they must +represent some serious and probably progressive condition. + +As a matter of fact, catarrh has almost nothing of the significance +attributed to it so often in magazine and newspaper advertisements. +Simple catarrh decreases without producing any serious result, and +indeed it is an index of a purely catarrhal condition that there is a +complete return to normal. Sometimes microbes are associated with its +causation, but when this is so, they are bacteria of mild pathological +virulence that do not produce deep changes. As for catarrh developing +fetid, foul-smelling discharges or odors, that {34} is out of the +question. There are certain affections, notably diphtheria, that may +produce such serious changes in the mucous membranes that there will +always even long after complete recovery be an unpleasant odorous +condition, but it is probable that even in these cases there exists a +special form of microbe quite rare in occurrence which produces the +state known as _ozena_. + +As to catarrh spreading from the nose and throat to the other mucous +membranes, that is also quite out of the question if it is supposed to +occur in the way that the advertising specialist likes to announce. +Catarrhal conditions may occur in the stomach, but like those of the +nose and throat they are not serious, heal completely, and produce no +definite changes. A pinch of snuff may cause a catarrhal condition of +the nose, that is an increase of secretion due to hyperaemia of the +mucous membrane; the eating of condiments, of Worcestershire sauce, +peppers, and horse-radish may cause it in the stomach. It may be due +to microbic action or to irritant or decomposing food, but it is not a +part of a serious, wide-spreading pathological condition that will +finally make the patient miserable. It is surprising, however, how +many people say with an air of finality {35} that they have catarrh, +as if it should be perfectly clear that as a result they cannot be +expected at any time to be in sufficiently good health to be called on +for any special work, and of course if any affection should attack +them, their natural immunity to disease has been so lowered by this +chronic affection, of which they are the victims, that no strong +resistance could be expected from them. + +All this is merely a dread induced by paying too much attention to +medical advertisements. It is better not to know as much as some +people know, or think they know about themselves, than to know so many +things that are not so. Their dreads seriously impair their power to +work and leave them ill disposed to resist affections of any kind that +may attack them. It is a sad confession to make, but not a little of +the enforced study of physiology in our schools has become the source +of a series of dreads and solicitudes rather than of helpful +knowledge. We have as a result a generation who know a little about +their internal economy, but only enough to make them worry about it +and not quite enough to make them understand how thoroughly capable +our organisms are of caring for themselves successfully and with +resultant good health, if we will only {36} refrain from putting +brakes on their energies and disturbing their functions by our worries +and anxieties. + +Another such word as catarrh in its unfavorable suggestiveness in +recent years has been auto-intoxication. It is a mouth-filling word, +and therefore very probably it has occupied the minds of the better +educated classes. Usually the form of auto-intoxication that is most +spoken of is intestinal auto-intoxication, and this combination has +for many people a very satisfying polysyllabic length that makes it of +special significance. Its meaning is taken to be that whenever the +contents of the intestines are delayed more than twenty hours or +perhaps a little longer, or whenever certain irritant materials find +their way into the intestinal tract, there is an absorption of toxic +matter which produces a series of constitutional symptoms. These +include such vague symptomatic conditions as sleepiness, torpor after +meals, an uncomfortable sense of fullness--though when we were young +we rather liked to have that feeling of fullness--and sometimes a +feeling of heat in the skin with other sensations of discomfort in +various parts of the body. At times there is headache, but this is +rather rare; lassitude and a feeling of {37} inability to do things is +looked upon as almost characteristic of the condition. Usually there +are nervous symptoms of one kind or another associated with the other +complaints and there may be distinctly hysterical or psycho-neurotic +manifestations. + +Auto-intoxication as just described has become a sort of fetish for a +great many people who bow down and worship at its shrine and give some +of the best of their energies and not a little of their time to +meditation before it. As a matter of fact, in the last few years it +has come to be recognized that auto-intoxication is a much abused word +employed very often when there are serious organic conditions in +existence elsewhere in the body and still more frequently when the +symptoms are due merely to functional nervous troubles. These are +usually consequent upon a sedentary life, lack of fresh air and +exercise, insufficient attention to the diet in the direction of +taking simple and coarse food, and generally passing disturbances that +can be rather readily catalogued under much simpler affections than a +supposed absorption of toxic materials from the intestines. Reflexes +from the intestinal tract, emphasized by worries about the condition, +are much more responsible for the feelings {38} complained of--which +are often not in any sense symptoms--than any physical factors +present. + +As Doctor Walter C. Alvarez said in a paper on the "Origin of the +So-called Auto-intoxicational Symptoms" published from the George +Williams Hooper Foundation for Medical Research of the University of +California Medical School, [Footnote 3] as the conclusion of his +investigation of the subject: + + [Footnote 3: _Journal of the American Medical Association_, + January 4, 1919.] + + "Auto-intoxication is commonly diagnosed when a physical examination + would show other more definite causes for the symptoms. Those who + believe that intestinal stasis can account for a long list of + disease conditions have little proof to offer for their views. Many + of the assumptions on which they rest their case have proved to be + wrong. + + "The usual symptoms of the constipated disappear so promptly after a + bowel movement that they cannot be due to absorbed toxins. They must + be produced mechanically by distension and irritation of the colon. + They occur in nervous, sensitive people. It has been shown that + various activities of the digestive tract can profoundly affect the + sensorium and the vasomotor nerves. The {39} old ideas of insidious + poisoning led to the formation of hypochrondriacs; the new + explanation helps to cure many of them." + +There are many other terms in common use that have unfortunate +suggestions and make people feel, if they once get the habit of +applying them to themselves, that they are the subject of rather +serious illness. I suppose that one of the most used and most abused +of these is uric acid and the uric acid diathesis. Scientific +physicians have nearly given up these terms, but a great many people +are still intent on making themselves miserable. All sorts of symptoms +usually due to insufficient exercise and air, inadequate diversion of +mind and lack of interests are attributed to these conditions. Some +time or other a physician or perhaps some one who is supposed to be a +friend suggested them and they continue to hamper the will to be well +by baseless worries founded on false notions for years afterwards. +What is needed is a definite effort of the will to throw off these +nightmares of disease that are so disturbing and live without them. + +It is surprising how much vital energy may be wasted in connection +with such dreads. Unfortunately, too, medicines of various kinds are +taken to relieve the symptoms connected {40} with them and the +medicine does ever so much more harm than good. Oliver Wendell Holmes +declared a generation ago that if all the medicines that had ever been +taken by mankind were thrown into the sea it would be much better for +mankind and much worse for the fishes. The expression still has a +great truth in it, especially as regards that habit of self-drugging +so common among the American people. In the course of lecture +engagements, I stay with very intelligent friends on a good many +occasions each year, and it is surprising how many of them have +medicine bottles around, indicating that they are subject to dreads of +various kinds with regard to themselves for which they feel medicine +should be taken. These dreads unfortunately often serve to lessen +resistive vitality to real affections when they occur and therefore +become a source of real danger. + +All these various dreads, then, have the definite effect of lessening +the power of the will to enable people to do their work and remain +well. They represent serious brakes upon the flow of nerve impulses +from the spiritual side of man's nature to the physical. This is much +more serious in its results than would usually be thought; and one of +the {41} things that a physician has to find out from a great many +patients is what sources of dread they are laboring under so as to +neutralize them or at least correct them as far as possible. It is +surprising how much good can be accomplished by a deliberate quest +after dreads and the direct discussion of them, for they are always +much less significant when brought out of the purlieus of the mind +directly into the open. Many a neurotic patient, particularly, will +not be improved until his dreads are relieved. This form of +psycho-analysis rather than the search for sex insults, as they are +called, or sexual incidents of early life, is the hopeful phase of +modern psychological contribution to therapeutics. + + +{42} + +CHAPTER III + +HABITS + + + "Why, will shall break it; will and nothing else." + _Love's Labor's Lost_. + + +Dreads are brakes on the will, inhibitions which prevent its exercise +and make accomplishment very difficult and sometimes impossible. They +represent mainly a state of mind, yet often they contain physical +elements, and the disposition counts for much. Their counterpart in +the opposite direction is represented by habits which are acquired +facilities of action for good or for ill. Habits not only make +activities easy but they even produce such a definite tendency to the +performance of certain actions as to make it difficult not to do them. +They may become so strong as to be tyrants for ill, though it must not +be forgotten that properly directed they may master what is worst in +us and help us up the hill of life. Acts that are entirely voluntary +and very difficult at first may become by habit so {43} natural that +it is extremely difficult to do otherwise than follow the ingrained +tendency. Nature's activities are imperative. Habitual actions may +become equally so. When some one once remarked to the Duke of +Wellington that habit was second nature, he replied: + +"Oh, ever so much more than that! Habit may be ten times as strong as +nature." + +The function of the will in health is mainly to prevent the formation +of bad habits or break those that have been formed, but above all, to +bring about the formation of habits that will prevent as far as is +possible the development of tendencies to disease in the body, Man +probably faces no more difficult problem in life than the breaking of +a bad habit. Usually it requires the exercise of all his will power +applied to its fullest extent. If there is a more difficult problem +than the breaking of a bad habit it is the formation of a good one +late in life because of the persistency of advertence and effort that +is required. It is comparatively easy to prevent the formation of bad +habits and also easy to form good habits in the earlier years. The +organism is then plastic and yields itself readily and thus becomes +grooved to the habit or hardened against it by the performance of even +a few acts. + +{44} + +All the psychologists insist that after the period of the exercise of +instinct as the basis of life passes, habit becomes the great force +for good or for ill. We become quite literally a bundle of habits, and +the success of life largely depends on whether these habits are +favorable or unfavorable to the accomplishment of what is best in us. +More than anything else health depends on habit. We begin by doing +things more or less casually, and after a time a tendency to do them +is created; then almost before we know it, we find that we have a +difficult task before us, if we try not to do them. + +To begin with, the activity which becomes the subject of a habit may +be distinctly unpleasant and require considerable effort to +accomplish. Practically every one who has learned to smoke recalls +more or less vividly the physical disturbance caused by the first +attempt and how even succeeding smokes for some time, far from being +pleasant, required distinct effort and no little self-control. After a +time, the desire to smoke becomes so ingrained that a man is literally +made quite miserable by the lack of it and finds himself almost +incapable of doing anything else until he has had his smoke. + +{45} + +Even more of an effort is required to establish the habit of chewing +tobacco, and it is even more difficult to break when once it has been +formed. Any one who has seen the discomfort and even torments endured +by a man who, after he had chewed tobacco for many years, tried to +stop will appreciate fully what a firm hold the habit has obtained. I +have known a serious business man who almost had to give up business, +who lost his sleep and his appetite and went through a nervous crisis +merely by trying to break the habit of chewing tobacco. + +In the Orient they chew betel nut. It is an extremely hot material +which burns the tongue and which a man can stand for only a very short +time when he first tries it. After a while, however, he finds a +pleasant stimulation of sensation in the constant presence of the +biting betel nut in his mouth; he craves it and cannot do his work so +well without it. He will ever advert to its use and will be restless +without it. He continues to use it in spite of the fact that the +intense irritation set up by the biting qualities of the substance +causes cancer of the tongue to occur ten times as frequently among +those who chew betel nut as among the rest of the population. Not all +{46} those who chew it get cancer, for some die from other causes +before there is time for the cancer to develop, and some seem to +possess immunity against the irritation. The betel nut chewer ignores +all this, proceeds to form the habit, urged thereto by the force of +example, and then lets himself drift along, hoping that it will have +no bad effects. + +The alcohol and drug habits are quite as significant in shortening +life as betel nut and yet men take them up quite confident in the +beginning that _they_ will not fall victims, and then find themselves +enmeshed. It is probable that the direct physical effects of none of +these substances shorten life to a marked degree unless they are +indulged in to very great excess, but the moral hazards which they +produce, accidents, injuries of various kinds, exposure to disease, +all these shorten life. Men know this very well, and yet persist in +the formation of these habits. + +Any habit, no matter how strong, can be broken if the individual +really wishes to break it, provided the subject of it is not actually +insane or on the way to the insane asylum. He need only get a motive +strong enough to rouse his will, secure a consciousness of his own +power, and then the habit can be broken. {47} After all, it must never +be forgotten that the only thing necessary in order to break a habit +effectively is to refuse to perform a single act of it, the next time +one is tempted. That breaks the habit and makes refusal easier and one +need only continue the refusal until the temptation ceases. + +Men who have not drawn a sober breath for years have sometimes come to +the realization of the fools that they were making of themselves, the +injury they were doing their relatives, or perhaps have been touched +by a child's words or some religious motive, and after that they have +never touched liquor again. Father Theobald Mathew's wonderful work in +this regard among the Irish in the first half of the nineteenth +century has been repeated by many temperance or total abstinence +advocates in more recent generations. I have known a confirmed +drunkard reason himself into a state of mind from which he was able to +overcome his habit very successfully, though his reasoning consisted +of nothing more than the recognition of the fact that suggestion was +the root of his craving for alcohol. His father had been a drunkard +and he had received so many warnings from all his older relatives and +had himself so come to dwell on {48} the possible danger of his own +formation of the habit that he had suggested himself into the frame of +mind in which he took to drink. I have known a physician on whom some +half a dozen different morphine cures had been tried--always followed +by a relapse--cure himself by an act of his own will and stay cured +ever since because of an incident that stirred him deeply enough to +arouse his will properly to activity. One day his little boy of about +four was in his office when father prepared to give himself one of his +usual injections of morphine. The little boy gave very close attention +to all his father's manipulations, and as the doctor was hurrying to +keep an appointment, he did not notice the intent eye witness of the +proceedings. Just as the needle was pushed home and the piston shot +down in the barrel, the little boy rushed over to his father and said, +"Oh, Daddy, do that to me." Apparently this close childish observer +had noted something of the look of satisfaction that came over his +father's face as he felt the fluid sink into his tissues. It is almost +needless to say that the shock the father received was enough to break +his morphine habit for good and all. It simply released his will and +then he found that if he {49} really wanted to, he could accomplish +what the various cures for the morphine habit only lead up to--and in +his case unsuccessfully--the exercise of his own will power. + +The word "habit" suggests nearly always, unfortunately, the thought of +bad habits, just as the word "passion" implies, with many people, evil +tendencies. But it must not be forgotten that there are good passions +and good habits that are as helpful for the accomplishment of what is +best in life as bad passions and bad habits are harmful. A repetition +of acts is needed for the formation of good habits just as for the +establishment of customs of evil. Usually, however, and this must not +be forgotten, the beginning of a good habit is easier than the +beginning of a bad habit. Once formed, the good habits are even more +beneficial than the bad habits are harmful. It is almost as hard to +break a good habit as a bad one, provided that it has been continued +for a sufficient length of time to make that groove in the nervous +system which underlies all habit. We cannot avoid forming habits and +the question is, shall we form good or bad habits? Good habits +preserve health, make life easier and happier; bad habits have the +opposite effect, though {50} there is some countervailing personal +element that tempts to their formation and persistence. + +Every failure to do what we should has its unfortunate effect upon us. +We get into a state in which it is extremely difficult for us to do +the right things. We have to overcome not only the original inertia of +nature, but also a contrary habit. If we do not follow our good +impulses, the worse ones get the upper hand. As Professor James said, +for we must always recur to him when we want to have the clear +expression of many of these ideas: + + "Just as, if we let our emotions evaporate, they get into a way of + evaporating; so there is reason to suppose that if we often flinch + from making an effort, before we know it the effort-making capacity + will be gone; and that, if we suffer the wandering of our attention, + presently it will wander all the time. Attention and effort are but + two names for the same psychic fact. To what brain-processes they + correspond we do not know. The strongest reason for believing that + they do depend on brain processes at all and are not pure acts of + the spirit, is just this fact, that they seem in some degree subject + to the law of habit, which is a material law." + +It must not be forgotten that we mold not {51} alone what we call +character, but that we manifestly produce effects upon our tissues +that are lasting. Indeed it is these that count the most, for health +at least. It is the physical basis of will and intellect that is +grooved by what we call habit. As Doctor Carpenter says: + + "Our nervous systems have grown to the way in which they have been + exercised, just as a sheet of paper or a coat, once creased or + folded, tends to fall forever afterwards into the same identical + fold." + +Permitting exceptions to occur when we are forming a habit is almost +necessarily disturbing. The classical figure is that it is like +letting fall a ball of string which we have been winding. It undoes in +a moment all that we have accomplished in a long while. As Professor +Bain has said it so much better than I could, I prefer to quote him: + + "The peculiarity of the moral habits, contradistinguishing them from + the intellectual acquisitions, is the presence of two hostile + powers, one to be gradually raised into the ascendant over the + other. It is necessary, above all things, in such a situation never + to lose a battle. Every gain on the wrong side undoes the effect of + many conquests on the {52} right. The essential precaution, + therefore, is so to regulate the two opposing powers that the one + may have a series of uninterrupted successes, until repetition has + fortified it to such a degree as to enable it to cope with the + opposition under any circumstances." + +This means training the will by a series of difficult acts, +accomplished in spite of the effort they require, but which gradually +become easier from repeated performance until habit replaces nature +and dominates the situation. + +Serious thinkers who faced humanity's problems squarely and devoted +themselves to finding solutions for them had worked out this formula +of the need of will training long ago, and it was indeed a principal +characteristic of medieval education. The old monastic schools were +founded on the idea that training of the will and the formation of +good habits was ever so much more important than the accumulation of +information. They frankly called the human will the highest faculty of +mankind and felt that to neglect it would be a serious defect in +education. The will can only be trained by the accomplishment of +difficult things day after day until its energies are aroused and the +man becomes conscious of his own powers and the {53} ability to use +them whenever he really wishes. There was a time not so long since, +and there are still voices raised to that purport, when it was the +custom to scoff at the will training of the older time and above all +the old-fashioned suggestion that mortifications of various +kinds--that is, the doing of unpleasant things just for the sake of +doing them--should be practiced because of the added will power thus +acquired. The failure of our modern education which neglected this +special attention to the will is now so patent as to make everyone +feel that there must be a recurrence to old time ideas once more. + +The formation of proper habits should, then, be the main occupation of +the early years. This will assure health as well as happiness, barring +the accidents that may come to any human being. Good habits make +proper living easy and after a time even pleasant, though there may +have been considerable difficulty in the performance of the acts +associated with them at the beginning. Indeed, the organism becomes so +accustomed to their performance after a time that it becomes actually +something of a trial to omit them, and they are missed. + +Education consists much more in such {54} training of the will than in +storing the intellect with knowledge, though the latter idea has been +unfortunately the almost exclusive policy in our education in recent +generations. We are waking up to the fact that diminution of power has +been brought about by striving for information instead of for the +increase of will energy. + +Professor Conklin of Princeton, in his volume on "Heredity and +Environment", emphasized the fact that "Will is indeed the supreme +human faculty, the whole mind in action, the internal stimulus which +may call forth all the capacities and powers." He had said just before +this: "It is one of the most serious indictments against modern +systems of education that they devote so much attention to the +training of the memory and intellect and so little attention to the +training of the will, upon the proper development of which so much +depends." + +Nor must it be thought that the idea behind this training of the will +is in any sense medievally ascetic and old-fashioned and that it does +not apply to our modern conditions and modes of thinking. Professor +Huxley would surely be the one man above all whom any one in our times +would be least likely to think of {55} as mystical in his ways or +medieval in his tendencies. In his address on "A Liberal Education and +Where to Find It", delivered before the South London Workingmen's +College some forty years ago, in emphasizing what he thought was the +real purpose of education, he dwelt particularly on the training of +the will. He defined a liberal education not as so many people might +think of it in terms of the intellect, but rather in terms of the +will. He said that a liberal education was one "which has not only +prepared a man to escape the great evils of disobedience to natural +laws, but has trained him to appreciate and to seize upon the rewards +which nature scatters with as free a hand as her penalties." And then +he added: + + "That man, I think, has had a liberal education who has been so + trained in youth that his body is the ready servant of his will, and + does with ease and pleasure all the work that, as a mechanism, it is + capable of; whose intellect is a clear, cold, logic engine, with all + its parts of equal strength, and in smooth working order, ready, + like a steam engine, to be turned to any kind of work, and spin the + gossamers as well as forge the anchors of the mind; whose mind is + stored with a knowledge of the great {56} and fundamental truths of + nature and of the laws of her operations; one who is no stunted + ascetic but who is full of life and fire, but whose passions are + trained to come to heel by a vigorous will, the servant of a tender + conscience; who has learned to love all beauty, whether of nature or + of art, to hate all vileness, and to respect others as himself. + + "Such an one and no other, I conceive, has had a liberal education; + for he is, completely as a man can be, in harmony with nature." + +This is the liberal education in habits of order and power that every +one must strive for, so that all possible energies may be available +for the rewards of good health. Details of the habits that mean much +for health must be reserved for subsequent chapters, but it must be +appreciated in any consideration of the relation of the will to health +that good habits formed as early as possible in life and maintained +conservatively as the years advance are the mainstay of health and the +power to do work. + + +{57} + +CHAPTER IV + +SYMPATHY + + + "Never could maintain his part but in the force of his will." + _Much Ado about Nothing_. + +A great French physician once combined in the same sentence two +expressions that to most people of the modern time would seem utter +paradoxes. "Rest," he said, "is the most dangerous of remedies, never +to be employed for the treatment of disease, except in careful doses, +under the direction of a physician and rarely for any but sufferers +from organic disease"; while "sympathy", he added, "is the most +insidiously harmful of anodynes, seldom doing any good except for the +passing moment, and often working a deal of harm to the patient." + +With the first of these expressions, we have nothing to do here, but +the second is extremely important in any consideration of the place of +the will in human life. Nothing is so prone {58} to weaken the will, +to keep it from exerting its full influence in maintaining vital +resistance, and as a result, to relax not only the moral but the +physical fiber of men and women as misplaced sympathy. It has almost +exactly the same place in the moral life that narcotics have in the +physical, and it must be employed with quite as much nicety of +judgment and discrimination. + +Sympathy of itself is a beautiful thing in so far as it implies that +_suffering with_ another which its Greek etymology signifies. In so +far as it is pity, however, it tends to lessen our power to stand up +firmly under the trials that are sure to come, and is just to that +extent harmful rather than helpful. There is a definite reaction +against it in all normal individuals. No one wants to be pitied. We +feel naturally a little degraded by it. In so far as it creates a +feeling of self-pity, it is particularly to be deprecated, and indeed +this is so important a subject in all that concerns the will to be +well and to get well that it has been reserved for a special chapter. +What we would emphasize here is the harm that is almost invariably +done by the well-meant but so often ill-directed sympathy of friends +and relatives which proves relaxing of moral {59} purpose and hampers +the will in its activities, physical as well as ethical. + +Human nature has long recognized this and has organized certain +customs of life with due reference to it. We all know that when +children fall and even hurt themselves, the thing to do is not to +express our sympathy and sorrow for them, even though we feel it +deeply, but unless their injury is severe, to let them pick themselves +up and divert their minds from their hurts by suggesting that they +have broken the floor, or hurt it. For the less sympathy expressed, +the shorter will be the crying, and the sooner the child will learn to +take the hard knocks of life without feeling that it is especially +abused or suffering any more than comes to most people. Unfortunately, +it is not always the custom to do the same thing with the children of +a larger growth. This is particularly true when there is but a single +child in the family, or perhaps two, when a good deal of sympathy is +likely to be wasted on their ills which are often greatly increased by +their self-consciousness and their dwelling on them. Diversion of +mind, not pity, is needed. The advice to do the next thing and not cry +over spilt milk is ever so much better than sentimental recalling of +the past. + +{60} + +Many a young man who went to war learned the precious lesson that +sympathy, though he might crave it, instead of doing him good would do +harm. Many a manly character was rounded out into firm self-control +and independence by military discipline and the lack of anything like +sentimentality in camp and military life. A good many mothers whose +boys had been the objects of their special solicitude felt very sorry +to think that they would have to submit to the hardships and trials +involved in military discipline. Most of them who were solicitous in +this way were rather inclined to feel that their boy might not be able +to stand up under the rigidities of military life and hoped at most +that he would not be seriously harmed. They could not think that early +rising, hard work, severe physical tasks, tiring almost to exhaustion, +with plain, hearty, yet rather coarse food, eaten in slapdash fashion, +would be quite the thing for their boy of whom they had taken so much +care. Not a few of them were surprised to find how the life under +these difficult circumstances proved practically always beneficial. + +I remember distinctly that when the soldiers were sent to the Mexican +border the mother of {61} a soldier from a neighboring State remarked +rather anxiously to me that she did not know what would happen to Jack +under the severe discipline incident to military life. He had always +gone away for five or six weeks in the summer either to the mountains +or to the seashore, and the Mexican border, probably the most trying +summer climate in the United States, represented the very opposite of +this. Besides, there was the question of the army rations; Jack was an +only son with five sisters. Most of them were older than he, and so +Jack had been coddled as though by half a dozen mothers. He was +underweight, he had a rather finicky appetite, he was capricious in +his eating both as to quantity and quality, and was supposed to be a +sufferer from some form of nervous indigestion. Personally, I felt +that what Jack needed was weight, but I had found it very hard to +increase his weight. He was particularly prone to eat a very small +breakfast, and his mother once told me that whenever he was at home, +she always prepared his breakfast for him with her own hands. This did +not improve matters much, however, for Jack was likely to take a small +portion of the meat cooked for him, refuse to touch the potatoes, and +eat marmalade and toast with {62} his coffee and nothing more. No +wonder that he was twenty pounds underweight or that his mother should +be solicitous as to what might happen to her Jack in army life at the +Border. + +I agreed with her in that but there were some things that I knew would +not happen to Jack. His breakfast, for instance, would not be +particularly cooked for him, and he might take or leave exactly what +was prepared for every one else. Neither would the Government cook +come out and sit beside Jack while he was at breakfast and tempt him +to eat, as his mother had always done. I knew, too, that at other +meals, while the food would be abundant, it would usually be rather +coarse, always plain, and there would be nothing very tempting about +it unless you had your appetite with you. If ever there is a place +where appetite is the best sauce, it is surely where one is served +with army food. + +I need scarcely tell what actually happened to Jack, for it was +exactly what happened to a good many Jacks whose mothers were equally +afraid of the effects of camp life on them. Amid the temptations of +home food, Jack had remained persistently underweight. Eating an army +ration with the sauce of appetite due to prolonged physical efforts in +the outdoor {63} air every day, Jack gained more than twenty pounds in +weight, in spite of the supposedly insalubrious climate of the Border +and the difficult conditions under which he had to live. It was +literally the best summer vacation that Jack had ever spent, though if +the suggestion had ever been made that this was the sort of summer +vacation that would do him good, the idea would have been scoffed at +as impractical, if not absolutely impossible. + +Homer suggested that a mollycoddle character whom he introduces into +the "Iliad" owed something of his lack of manly stamina to the fact +that he had six sisters at home, and an Irish friend once translated +the passage by saying that the young man in question was "one of seven +sisters." This had been something of Jack's trouble. He had been asked +always whether he changed his underwear at the different seasons, +whether he wore the wristlets that sisterly care provided for him, +whether he put on his rubbers when he went out in damp weather and +carried his umbrella when it was threatening rain, and all the rest. +He got away from all this sympathetic solicitude in army life and was +ever so much better for it. + +It is extremely difficult to draw the line {64} where the sympathy +that is helpful because it is encouraging ends, and sentimental pity +which discourages begins. There is always danger of overdoing and it +is extremely important that growing young folks particularly should be +allowed to bear their ills without help and learn to find resources +within themselves that will support them. The will can thus be +buttressed to withstand the difficulties of life, make them much +easier to bear, and actually lessen their effect. Ten growing young +folks have been seriously hurt by ill-judged sympathy for every one +that has been discouraged by the absence of sympathy or by being made +to feel that he must take the things of life as they come and stand +them without grouchy complaint or without looking for sympathy. + +This is particularly true as regards those with any nervous or +hysterical tendencies, for they readily learn to look for sympathy. +The most precious lesson of the war for physicians has been that which +is emphasized in the chapter on "The Will and the War Psychoneuroses." +There was an immense amount of so-called "shell-shock" which really +represented functional neurotic conditions such as in women used to be +called hysteria. At the {65} beginning of the war there was a good +deal of hearty sympathy with it, and patients were encouraged by the +physicians and then by the nurses and other patients in the hospital +to tell over and over again how their condition developed. It was +found after a time that the sympathy thus manifested always did harm. +The frequent repetition of their stories added more and more +suggestive elements to the patients' condition, and they grew worse +instead of better. It was found that the proper curative treatment was +to make just as little as possible of their condition, to treat them +firmly but with assurance--once it had been definitely determined that +no organic nervous trouble was present--and to bring about a cure of +whatever symptoms they had at a single sitting by changing their +attitude of mind towards themselves. + +Some of the patients proved refractory and for these isolation and +rather severe discipline were occasionally necessary. The isolation +was so complete as to deprive them not only of companionship but also +of reading and writing materials and the solace of their tobacco. +Severe cases were sometimes treated by strong faradic currents of +electricity which were extremely painful. Patients who insisted that +{66} they could not move their muscles were simply made to jump by an +electric shock, thus proving to them that they could use the muscles, +and then they were required to continue their use. + +Those suffering from shell-shock deafness and muteness were told that +an electrode would be applied to their larynx or the neighborhood of +their ear and when they felt pain from it, that was a sign that they +were able to talk and to hear if they wished, and that they must do +so. Relapses had to be guarded against by suggestion, and where +relapses became refractory and stronger currents of electricity to ear +and larynx were deemed inadvisable, the strict isolation treatment +usually proved effective. + +In a word, discipline and not sympathy was the valuable mode of +treating them. Sympathy did them harm as it invariably does. The world +has recognized this truism always, but we need to learn the lesson +afresh, or the will power is undermined. Character is built up by +standing the difficult things of life without looking for the narcotic +of sympathy or any other anaesthetizing material. These are "hard +sayings," to use a Scriptural expression, but they represent the +accumulation of wisdom of human experience. Sympathy can be {67} +almost as destructive of individual morale as the dreads, and it is +extremely important that it should not be allowed to sap will energy. +In our time above all, when the training of the will has been +neglected, though it is by far the most important factor in education, +this lesson with regard to the harmful effect of sympathy needs to be +emphasized. + +For nervous people, that is, for those who have, either from +inheritance or so much oftener from environment, yielded to +circumstances rather than properly opposed them, sympathy is quite as +dangerous as opium. George Eliot once replied to a friend who asked +her what was duty, that duty consisted in facing the hard things in +life without taking opium. + +Healthy living to a great extent depends on standing what has to be +borne from the bodies that we carry around with us without looking for +sympathy. It has often been emphasized that human beings are eminently +lonely. The great experiences of life and above all, death and +suffering, we have to face by ourselves and no one can help us. We may +not be, as Emerson suggested, "infinitely repellent particles", but at +all the profoundest moments of life we feel our alone-ness. The more +{68} that we learn to depend bravely on ourselves and the less we seek +outside support for our characters, the better for us and our power to +stand whatever comes to us in life. + +Physical ills are always lessened by courageously facing them and are +always increased by cringing before them. The one who dreads suffers +both before and during the time of the pain and thus doubles his +discomfort. We must stand alone in the matter and sympathy is prone to +unman us. Looking for sympathy is a tendency to that self-pity which +is treated in a subsequent chapter and which does more to increase +discomfort in illness, exaggerate symptoms, and lower resistive +vitality than anything else, in the psychic order at least. + +Suffering is always either constructive or destructive of character. +It is constructive when the personal reaction suffices to lessen and +make it bearable. It is destructive whenever there is a looking for +sympathy or a leaning on some one else. Character counts in +withstanding disease, and even in the midst of epidemics, according to +many well-grounded traditions, those who are afraid contract the +disease sooner than others and usually suffer more severely. Sympathy +must not be allowed to produce any such effect as this. + +{69} + +CHAPTER V + +SELF-PITY + + + "The will dotes that is attributive + To what infectiously itself affects." + _Troilus and Cressida_. + + +The worst brake on the will to be well is undoubtedly the habit that +some people have of pitying themselves and feeling that they are +eminently deserving of the pity of others because of the trials, real +or supposed, which they have to undergo. Instead of realizing how much +better off they are than the great majority of people--for most of the +typical self-pitiers are not real subjects for pity--they keep looking +at those whom they fondly suppose to be happier than themselves and +then proceed to get into a mood of commiseration with themselves +because of their ill health--real or imaginary--or uncomfortable +surroundings. Just as soon as men or women assume this state of mind, +it becomes extremely difficult for them to stand any real {70} trials +that appear, and above all, it becomes even more difficult for them to +react properly against the affections of one kind or another that are +almost sure to come. Self-pity is ever a serious hamperer of resistive +vitality. + +A great many things in modern life have distinctly encouraged this +practice of self-pity and conscious commiseration of one's state until +it has become almost a commonplace of modern life for those who feel +that they are suffering, especially if they belong to what may be +called the sophisticated classes. We have become extremely sensitive +as a consequence about contact with suffering. Editors of magazines +and readers for publishing houses often refuse in our time to accept +stories that have unhappy endings, because people do not care to read +them, it is said. The story may have some suffering in it and even +severe hardships, especially if these can be used for purposes of +dramatic climax, but by the end of the story everything must have +turned out "just lovely", and it must be understood that suffering is +only a passing matter and merely a somewhat unpleasant prelude to +inevitable happiness. + +Almost needless to say, this is not the way of life as it must be +lived in what many {71} generations of men have agreed in calling +"this vale of tears." For a great many people have to suffer severely +and without any prospect of relief--none of us quite escape the +necessity of suffering--and as some one has said, all human life, +inasmuch as there is death in it, must be considered a tragedy. The +old Greeks did not hesitate, in spite of their deep appreciation of +the beauty of nature and cordial enthusiasm for the joy of living, +even to emphasize the tragedy in life. They were perhaps inclined to +think that the sense of contrast produced by tragedy heightened the +actual enjoyment of life and that indeed all pleasure was founded +rather on contrast than positive enjoyment. One may not be ready to +agree with the saying that the only thing that makes life worth while +is contrast, but certainly suffering as a background enhances +happiness as nothing else can. + +Aristotle declared that tragedy purges life, that is, that only +through the lens of death and misfortune could one see life free from +the dross of the sordid and merely material to which it was attached. +His meaning was that tragedy lifted man above the selfishness of mere +individualism, and by showing him the misfortunes of others prepared +him to struggle {72} for himself when misfortune might come, as it +almost inevitably would; and at the same time lifted him above the +trifles of daily life into a higher, broader sphere of living, where +he better realized himself and his powers. + +For man is distinctly prone to forget about death and suffering, and +when he does, to become eminently selfish and forgetful of the rights +of others and his duties towards them. The French have a saying, +consisting of but four words and an intervening shrug of the +shoulders, that is extremely illuminating. They quote as the +expression of the usual thought of men when brought face to face with +the fact that people are dying all around them, "_On meurt--les +autres!_" "People die--Oh, yes (with an expressive shrug of the +shoulders), other people!" We refuse to recognize the fact that we too +must go until that is actually forced upon us by advancing years or by +some incurable disease. As for suffering, a great many people have +come almost to resent that they should be asked to suffer, and +character dissolves in self-pity as a result. + +Instead of the constant, continuous reading of what may be called +Sybaritic literature--for it is said that the Sybarite finds it +impossible to sleep if there is a crushed rose leaf next {73} his +skin--instead of being absorbed in the literature which emphasizes the +pleasures of life and pushes its pains into the background, young +people, and especially those of the better-to-do classes, should be +taught from their early years to read the lives of those who have +endured successfully hardships of various kinds and have succeeded in +getting satisfaction out of their accomplishment in life, despite all +the suffering that was involved. These are human beings like +ourselves, and what mortal has done, other mortals can do. + +There was a school of American psychologists before the war who had +come to recognize the value of that old-fashioned means of +self-discipline of mind, the reading of the lives of the saints. For +those to whom that old-fashioned practice may seem too reactionary, +there are the lives and adventures of our African and Asiatic +travelers and our polar explorers as a resource. + +War books have been a godsend for our generation in this regard. They +have led people to contemplate the hardest kind of suffering--and very +often in connection with those who are nearest and dearest to them-- +and thus made them understand something of the possibilities of human +nature to withstand {74} trials and sufferings. As a result they have +been trained not to make too much of their own trivial trials, as they +soon learned to recognize them in the face of the awful hardships that +this war involved. What Belgium endured was bad enough, while the +experiences of Poland, Servia, Armenia were an ascending scale of +horrors, but also of humanity's power to stand suffering. + +Life in the larger families of the olden times afforded more +opportunities for the proper teaching of the place of suffering than +in the smaller families of the modern time. Older children, as they +grew up, had before them the example of mother's trials and hardships +in bearing and rearing children, and so came to understand better the +place of hard things in life. In a large family it was very rare when +one or more of the members did not die, and thus growing youth was +brought in contact with the greatest mystery in life, that of death. +Very frequently at least one of the household and sometimes more, had +to go through a period of severe suffering with which the others were +brought in daily contact. It is sometimes thought in modern times that +such intimacy with those who are suffering takes the joy out of life +for those who {75} are young, but any one who thinks so should consult +a person who has had the actual experience; while occasionally it may +be found that some one with a family history of this kind may think +that he or she was rendered melancholy by it, nine out of ten or even +more will frankly say that they feel sure that they were benefited. +There is nothing in the world that broadens and deepens the +significance of life like intimate contact with suffering, if not in +person, then in those who are near and dear to us. + +As a physician, I have often felt that I should like to take people +who are constantly complaining of their little sorrows and trials, who +are downhearted over some minor ailment, who sometimes suffer from +fits of depression precipitated by nothing more, perhaps, than a dark +day or a little humid weather, or possibly even a petty social +disappointment, and put them in contact with cancer patients or others +who are suffering severely day by day, yes, hour by hour, night and +day, and yet who are joyful and often a source of joy to others. Let +us not forget that nearly one hundred thousand people die every year +from cancer in this country alone. + +As a physician, I have often found that a {76} chronic invalid in a +house became the center of attraction for the whole household, and +that particularly when it was a woman, whether mother or elder sister, +all of the other members brought their troubles to her and went away +feeling better for what she said to them. I have seen this not in a +few exceptional instances, but so often as to know that it is a rule +of life. Chronic invalids often radiate joy and happiness, while +perfectly well people who suffer from minor ills of the body and mind +are frequently a source of grumpiness, utterly lack sympathy, and are +impossible as companions. An American woman, bedridden for over thirty +years, has organized by correspondence one of the most beautiful +charities of our time. + +Pity properly restricted to practical helpfulness without any +sentimentality is a beautiful thing. There is always a danger, +however, of its arousing in its object that self-pity which is so +eminently unlovely and which has so often the direct tendency to +increase rather than decrease whatever painful conditions are present. + +Crying over oneself is always to be considered at least hysterical. +Crying, except over a severe loss, is almost unpardonable. {77} It is +often said that a good cry, like a rainstorm, clears the atmosphere of +murk and the dark elements of life, but it is dangerous to have +recourse to it. It is a sign of lack of character almost invariably +and when indulged in to any extent will almost surely result in +deterioration of the power to withstand the trials of life, whatever +they may be. + +Professor William James has suggested that not only should men and +women stand the things that come to them in the natural course of +events, but they should even go out and seek certain things hard to +bear with the idea of increasing their power to withstand the +unpleasant things of life. This is, of course, a very old idea in +humanity, and the ascetics from the earliest days of Christianity +taught the doctrine of self-inflicted suffering in order to increase +the power of resistance. + +It is usually said that the principal idea which the hermits and +anchorites and the saintly personages of the early Middle Ages, of +whose mortifications we have heard so much, had in inflicting pain on +themselves was to secure merit for the hereafter. Something of that +undoubtedly was in their minds, but their main purpose was quite +literally ascetic. _Ascesis_, from the Greek, means in its strict {78} +etymology just exercise. They were exercising their power to stand +trials and even sufferings, so that when these events came, as +inevitably they would, seeing that we carry round with us what St. +Paul called "this body of our death," they would be prepared for them. + +Practically any psychologist of modern times who has given this +subject any serious thought will recognize, as did Professor James, +the genuine psychology of human nature that lies behind these ascetic +practices. Nothing that I know is so thoroughgoing a remedy for +self-pity as the actual seeking at times of painful things in order to +train oneself to bear them. The old-fashioned use of disciplines, that +is, little whips which were used so vigorously sometimes over the +shoulders as to draw blood, or the wearing of chains which actually +penetrated the skin and produced quite serious pain no longer seems +absurd, once it is appreciated that this may be a means of bracing up +character and making the real trials and hardships of life much easier +than would otherwise be the case. + +Not that human nature must not be expected to yield a little under +severe trials and bend before the blasts of adverse fortune, but {79} +that there should not be that tendency to exaggerate one's personal +feelings which has unfortunately become characteristic of at least the +better-to-do classes in our time. Not that we would encourage stony +grief, but that sorrow must be restrained and, above all, must not be +so utterly selfish as to be forgetful of others. + +Tears should, to a large extent, be reserved, as they are in most +perfectly normal individuals, for joyous rather than sad occasions, +for no one ever was supremely joyful without having tears in the eyes. +It is when we feel most sympathetic to humanity that the gift of tears +comes to us, and no feeling is quite so completely satisfying as comes +from the tears of joy. Mothers who have heard of their boy's bravery, +its recognition by those above him, and its reward by proper symbols, +have had tears come welling to their eyes, while their hearts were +stirred so deeply with sensations of joy and pride that probably they +have never before felt quite so happy. + +{80} + +CHAPTER VI + +AVOIDANCE OF CONSCIOUS USE OF THE WILL + + + "Our bodies are our gardens to which our wills are gardeners." + _Othello_. + + +Doctor Austin O'Malley, in his little volume, "Keystones of Thought", +says: "When you are conscious of your stomach or your will you are +ill." We all appreciate thoroughly, as the result of modern progress +in the knowledge of the influences of the mind on the body, how true +is the first part of this saying, but comparatively few people realize +the truth of the second part. The latter portion of this maxim is most +important for our consideration. It should always be in the minds of +those who want to use their own wills either for the purpose of making +themselves well, or keeping themselves healthy, but above all, should +never be forgotten by those who want to help others get over various +ills that are manifestly due in whole or in part to the failure to use +the vital energies in the body as they should be employed. + +{81} + +Conscious use of the will, except at the beginning of a series of +activities, is always a mistake. It is extremely wasteful of internal +energy. It adds greatly to the difficulty of accomplishing whatever is +undertaken. It includes, above all, watching ourselves do things, +constantly calculating how much we are accomplishing and whether we +are doing all that we should be doing, and thus makes useless demands +on power partly by diversion of attention, partly by impairment of +concentration, but above all by adding to the friction because of the +inspection that is at work. + +The old kitchen saw is "a watched kettle never boils." The real +significance of the expression is of course that it seems to take so +long for the water to boil that we become impatient while watching and +it looks to us as though the boiling process would really never occur. +This is still more strikingly evident when we are engaged in watching +our own activities and wondering whether they are as efficient as they +should be. The lengthening of time under these circumstances is an +extremely important factor in bringing about tiredness. Ask any human +being unaccustomed to note the passage of time to tell you when two +minutes have elapsed; {82} inevitably he will suggest at the end of +thirty to forty seconds that the two minutes must be up. Only by +counting his pulse or by going through some regular mechanical process +will he be enabled to appreciate the passage of time in anything like +its proper course. When watched thus, time seems to pass ever so much +more slowly than it would otherwise. + +It is extremely important then that people should not acquire the +impression that they must be consciously using their will to bring +themselves into good health and keep themselves there, for that will +surely defeat their purpose. What is needed is a training of the will +to do things by a succession of harder and harder tasks until the +ordinary acts of life seem comparatively easy. Intellectual persuasion +as to the efficiency of the will in this matter means very little. The +ordinary feeling that reasoning means much in such matters is a +fallacy. Much thinking about them is only disturbing of action as a +rule and Hamlet's expression that the "native hue of resolution is +sicklied o'er with the pale cast of thought" is a striking bit of +psychology. + +Shakespeare had no illusions with regard to the place of the will in +life and more than any English author has emphasized it. I have {83} +ventured to illustrate this by quotations from him under each chapter +heading, but there are many more quite as applicable that might +readily be found. He knew above all how easy it was for human beings +to lessen the power of their wills and has told us of "the cloy'd will +that satiateth unsatisfied desire" and "the bridles of our wills", and +has given us such adjectives as "benumbed" and "neutral" and "doting", +which demonstrates his recognition of how men weaken their wills by +over-deliberation. + +The mode of training in the army is of course founded on this mode of +thinking. The young men in the United States Army want to accomplish +every iota of their duty and are not only willing but anxious to do +everything that is expected of them. There were some mighty difficult +tasks ahead of them over in Europe and our method of preparing the men +was not by emphasizing their duty and dinning into their ears and +minds how great the difficulty would be and how they must nerve +themselves for the task. Such a mode of preparation would probably +have been discouraging rather than helpful. But they were trained in +exercises of various kinds in an absolutely regular life under plain +living in the {84} midst of hard work until their wills responded to +the word of command quite unconsciously and immediately without any +need of further prompting. Their bodies were trained until every +available source of energy was at command, so that when they _wanted_ +to do things they set about them without more ado, and as they were +used to being fatigued they were not constantly engaged in dreading +lest they should hurt themselves, or fostering fears that they might +exhaust their energies or that their tiredness, even when apparently +excessive, would mean anything more than a passing state that rest +would repair completely. + +If at every emergency of their life at war soldiers had to go through +a series of conscious persuasions to wake up their will and set their +energies at work, and if they had to occupy themselves every time in +presenting motives why this activity should not be delayed, then +military discipline, at least in so far as it involves prompt +obedience, would almost inevitably be considerable of a joke. What is +needed is unthinking, immediate obedience, and this can be secured +only by the formation of deeply graven habits which enable a man to +set about the next thing that duty calls for at once. + +{85} + +Every action that we perform is the result of an act of the will, but +we do not have to advert to that as a rule; whenever any one gets into +a state of mind where it is necessary to be constantly adverting to +it, then, as was said at the beginning of this chapter, there is +something the matter with the will. The faculty is being hampered in +its action by consciousness, and such hampering leads to a great waste +of energy. + +The will is the great, unconscious faculty in us. By far the greater +part of what has come unfortunately to be called the unconscious and +the subconscious and that has occupied so much of the attention of +modern writers on psychological subjects is really the will at work. +It attains its results we know not how, and it is prompted to their +accomplishment in ways that are often very difficult for us to +understand. Its effects are often spoken of as due to the submerged +self or the subliminal self or the other self, but it is only in rare +and pathological cases as a rule that such expressions are justified +once the place of the will is properly recognized. + +It is often said, for instance, that the power some people have of +waking after a certain {86} period of sleep at night or after a short +nap during the daytime, a power that a great many more people would +possess if only they deliberately practised it, is due to the +subconsciousness or the subliminal personality of the individual which +wakes him up at the determined time. Why those terms should be used +when other things are accomplished by the human will just as +mysteriously is rather difficult to understand. It is well recognized +that if an individual in the ordinary waking state wants to do +something after the lapse of an hour or so he will do it, provided his +will is really awake to the necessity of accomplishing it. It is true +that he may become so absorbed in his current occupation as to miss +the time, but such abstraction usually means that he was not +sufficiently interested in the duty that was to be performed as to +keep the engagement with himself, or else that he is an individual in +whom the intellectual over-shadows the voluntary life. We speak of him +as an impractical man. + +We all know the danger there is in putting off calling some one by +telephone on being told that "the line is busy", for not infrequently +it will happen that several hours will elapse before we think of the +matter again {87} and then perhaps it may be too late. If we set a +definite time limit with ourselves, however, then our will will prompt +us quite as effectively, though quite as inexplicably, at the +expiration of that time as it awakes those who have resolved to be +aroused at a predetermined moment. We may miss our telephone +engagement with ourselves, but we practically never miss an important +train, because having deeply impressed upon ourselves the necessity +for not missing this, our will arouses us to activity in good time. +There is not the slightest necessity, however, for appealing to the +unconscious or the subconscious in this. It is true that there is a +wonderful sentinel within us that awakes us from daydreams or disturbs +the ordinary course of some occupation to turn our attention to the +next important duty that we should perform. We know that this sentinel +is quite apart from our consciousness; but the power we have of +setting ourselves to doing anything is exemplified in very much the +same way. When I want a book, I do not know what it is that sets my +muscles in motion and brings me to a shelf and then directs my +attention to choosing the one I shall take down and consult. It is an +unconscious activity, but not the activity of {88} unconsciousness, +which is only a contradiction in terms. [Footnote 4] + + [Footnote 4: It is true that there is a particular phase of our + intellectual effort included under the modern terms unconscious or + subconscious that is mysterious enough to deserve a special name, + but we already have an excellent term for this quality which is not + vague but thoroughly descriptive of its activity. This is + intuition,--a word that has been in use for nearly a thousand years + now and signifies the immediate perception of a truth,--by a flash + as it were. We may know nothing about a subject and may have only + begun to think about it, when there flashes on us a truth that has + perhaps never occurred to any one else and certainly has never been + in our minds before. It has been suggested in recent years that such + flashes of intelligence are due to the secondary personality or the + subliminal self or the other self, and it is often added that it is + the development of our knowledge of these phases of psychology that + represents modern progress in the science of mind. Only the term for + it is new, however, for intuition has been the subject of special + intensive study for a long while. Indeed, the reason why the + old-time poet appealed to the muses for aid and the modern poet + suggests inspiration as the source of his poetic thought, is because + both of them knew that their best thoughts flash on them, not as the + result of long and hard thinking, but by some process in which with + the greatest facility come perceptions that even they themselves are + surprised to learn that they have. To say that such things come from + the unconscious is simply to ignore this wonderful power of original + thought, that is, primary perception. Emerson suggested that + intuition represented all the knowledge that came without tuition, + as if this were the etymology, and the hint is excellent for the + meaning, though the real derivation of the word has no relation to + tuition. To attribute these original thoughts to the unconscious or + any partly conscious faculty in us is to ignore a great deal of + careful study of psychology before our time. It is besides to + entangle oneself in the absurdity of discussing an unconscious + consciousness.] + +While many people are inclined to feel almost helpless in the presence +of the idea that it is their unconscious selves that enable them {89} +to do things or initiate modes of activity, the feeling is quite +different when we substitute for that the word "will." All of us +recognize that our wills can be trained to do things, and while at +first it may require a conscious effort, we can by the formation of +habits not only make them easy, but often delightful and sometimes +quite indispensable to our sense of well being. Walking is extremely +difficult at the beginning, when its movements are consciously +performed, but it becomes a very satisfying sort of exercise after a +while and then almost literally a facile, nearly indispensable +activity of daily life, so that we feel the need for it, if we are +deprived of it. + +This has to be done with regard to the activities that make for +health. We have to form habits that render them easy, pleasant, and +even necessary for our good feelings. This can be done, as has been +suggested in the chapter on habits, but we have to avoid any such +habit as that of consciously using the will. That is a bad habit that +some people let themselves drop into but it should be corrected. +Having set our activities to work we must, as far as possible, forget +about them and let them go on for themselves. It is not only possible +but even easy and above all almost {90} necessary that we should do +this. Hence at the beginning people must not expect that they will +find the use of their will easy in suppressing pain, lessening +tiredness, and facilitating accomplishment, but they must look forward +to the time quite confidently when it will be so. In the meantime the +less attention paid to the process of training, the better and more +easily will the needed habits be formed. + +Failure to secure results is almost inevitable when conscious use of +the will comes into the problem. As a rule a direct appeal should not +be made to people to use their wills, but they should be aroused and +stimulated in various ways and particularly by the force of example. +What has made it so comparatively easy for our young soldiers to use +their wills and train their bodies and get into a condition where they +are capable of accomplishing what they would have thought quite +impossible before, has been above all the influence of example. A lot +of other young men of their own age are standing these things +exemplarily. They are seen performing what is expected of them without +complaint, or at least without refusal, and so every effort is put +forth to do likewise without any time spent on reflection as to how +{91} difficult it all is or how hard to bear or how much they are to +be pitied. It is not long before what was hard at first becomes under +repetition even easy and a source of fine satisfaction. Getting up at +five in the morning and working for sixteen hours with only +comparatively brief intervals for relaxation now and then, and often +being burdened with additional duties of various kinds which must be +worked in somehow or other, seems a very difficult matter until one +has done it for a while. Then one finds everything gets done almost +without conscious effort. Will power flows through the body and lends +hitherto unexpected energy, but of this there is no consciousness; +indeed, conscious reflection on it would hamper action. No wonder that +as a result of the facility acquired, one comes to readily credit the +assumption that the will is a spiritual power and that some source of +energy apart from the material is supplying the initiative and the +resources of vitality that have made accomplishment so much easier +than would have been imagined beforehand. This is quite literally what +training of the will means: training ourselves to use all our powers +to the best advantage, not putting obstacles in their way nor brakes +on their exertion, but {92} also not thinking very much about them or +making resolutions. The way to do things is to do them, not think +about them. + +Professor James is, as always, particularly happy in his mode of +expressing this great truth. He insists that the way to keep the will +active is not by constantly thinking about it and supplying new +motives and furbishing up old motives for its activity, but by +cultivating the faculty of effort. His paragraph in this regard is of +course well known, and yet it deserves to be repeated here because it +represents the essence of what is needed to make the will ready to do +its best work. He says: + + "As a fine practical maxim, relative to these habits of the will, we + may, then, offer something like this: _Keep the faculty of effort + alive in you by a little gratuitous exercise every day_. That is, be + systematically ascetic or heroic in little unnecessary points, do + every day or two something for no other reason than that you would + rather not do it, so that when the hour of dire need draws nigh, it + may find you not unnerved and untrained to stand the test. + Asceticism of this sort is like the insurance which a man pays on + his house and goods. The tax does him no good at the time and {93} + possibly may never bring him a return. But if the fire _does_ come, + his having paid it will be his salvation from ruin. So with the man + who has daily inured himself to habits of concentrated attention, + energetic volition, and self-denial in unnecessary things. He will + stand like a tower when everything rocks around him, and when his + softer fellow mortals are winnowed like chaff in the blast." + +To do things on one's will without very special interest is an +extremely difficult matter. It can be done more readily when one is +young and when certain secondary aims are in view besides the mere +training of the will, but to do things merely for will training +becomes so hard eventually that some excuse is found and the task is +almost inevitably given up. Exercising for instance in a gymnasium +just for the sake of taking exercise or keeping in condition becomes +so deadly dull after a while that unless there is a trainer to keep a +man up to the mark, his exercise dwindles from day to day until it +amounts to very little. Men who are growing stout about middle life +will take up the practice of a cold bath after ten minutes or more of +morning exercises with a good deal of enthusiasm, but they will not +keep it up long, or if they do continue for several months, any {94} +change in the daily routine will provide an excuse to drop it. +Companionship and above all competition in any way greatly helps, but +it takes too much energy of the will to make the effort alone. +Besides, when the novelty has worn off and routine has replaced +whatever interest existed in the beginning in watching the effect of +exercise on the muscles, the lack of interest makes the exercise of +much less value than before. If there is not a glow of satisfaction +with it, the circulation, especially to the periphery to the body, is +not properly stimulated and some of the best effect of the exercise is +lost. Athletes often say of solitary exercise that it leaves them +cold, which is quite a literal description of the effect produced on +them. The circulation of the surface is not stimulated as it is when +there is interest in what is being done and so the same warmth is not +produced at the surface of the body. + +It is comparatively easy to persuade men who need outdoor exercise to +walk home from their offices in the afternoon when the distance is not +too far, but it is difficult to get them to keep it up. The walk +becomes so monotonous a routine after a time that all sorts of excuses +serve to interrupt the habit, and then it is not long before it is +done so irregularly as to lose {95} most of its value. Here as in all +exercise, companionship which removes conscious attention from +advertence to the will greatly aids. On the other hand, as has been so +clearly demonstrated in recent years, it is very easy to induce men to +go out and follow a little ball over the hills in the country, an +ideal form of exercise, merely because they are interested in their +score or in beating an opponent. Any kind of a game that involves +competition makes people easily capable of taking all sorts of +trouble. Instead of being tired by their occupation in this way and +not wanting to repeat it, they become more and more interested and +spend more and more time at it. The difference between gymnastics and +sport in this regard is very marked. + +In sport the extraneous interest adds to the value of the exercise and +makes it ever so much easier to continue; when it sets every nerve +tingling with the excitement of the game, it is doing all the more +good. Gymnastics grow harder unless in some way associated with +competition, or with the effort to outdo oneself, while indulgence in +sport becomes ever easier. Many a young man would find it an +intolerable bore and an increasingly difficult task if asked to give +as much time and energy {96} to some form of hard work as he does to +some sport. He feels tired after sport, but not exhausted, and becomes +gradually able to stand more and more before he need give up, thus +showing that he is constantly increasing his muscular capacity. + +Conscious training of the will is then practically always a mistake. +It is an extremely difficult thing to do, and the amount of inhibition +which accumulates to oppose it serves after a time to neutralize the +benefit to be derived. Good habits should be formed, but not merely +for the sake of forming them. There should be some ulterior purpose +and if possible some motive that lifts men up to the performance of +duty, no matter how difficult it is. + +Our young men who went to the camps demonstrated how much can be +accomplished in this manner. They were asked to get up early in the +morning, to work hard for many hours in the day, or take long walks, +sometimes carrying heavy burdens, and were so occupied that they had +but very little time to themselves. They were encouraged to take +frequent cold baths, which implied further waste of heat energy, and +then were very plainly fed, though of course with a good, rounded +diet, {97} well-balanced, but without any frills and with very little +in it that would tempt any appetite except that of a hungry man. They +learned the precious lesson that hunger is the best sauce for food. + +Most of these men were pushed so hard that only an army officer +perfectly confident of what he was doing and well aware that all of +his men had been thoroughly examined by a physician and had nothing +organically wrong with them would have dared to do it. A good many of +us had the chance to see how university men took the military regime. +Long hours of drilling and of hard work in the open made them so tired +that in the late afternoon they could just lie down anywhere and go to +sleep. I have seen young fellows asleep on porches or in the late +spring on the grass and once saw a number of them who found excellent +protection from the sun in what to them seemed nice soft beds--at +least they slept well in them--inside a series of large earthen-ware +pipes that were about to be put down for a sewer. Some of them were +pushed so hard, considering how little physical exercise they had +taken before, that they fainted while on drill. Quite a few of them +were in such a state of nervous tension that they fainted on {98} +being vaccinated. Almost needless to say, had they been at home, any +such effect would have been a signal for the prompt cessation of such +work as they were doing, for the home people would have been quite +sure that serious injury would be done to their boys. These young +fellows themselves did not think so. Their physicians were confident +that with no organic lesion present the faint was a neurotic +derangement and not at all a symptom of exhaustion. The young soldiers +would have felt ashamed if there had been any question of their +stopping training. They felt that they could make good as well as +their fellows. They would have resented sympathy and much more pity. +They went on with their work because they were devoted to a great +cause. After a time, it became comparatively easy for them to +accomplish things that would hitherto have been quite impossible and +for which they themselves had no idea that they possessed the energy. +It was this high purpose that inspired them to let more and more of +their internal energy loose without putting a brake on, until finally +the habit of living up to this new maximum of accomplishment became +second nature and therefore natural and easy of accomplishment. + +{99} + +Here is the defect in systems which promise to help people to train +their wills by talking much about it, and by persuading them that it +can be done, that all they have to do is to set about it. Unless one +has some fine satisfying purpose in doing things, their doing is +difficult and fails to accomplish as much good for the doer as would +otherwise be the case. Conscious will activity requires, to use +old-fashioned psychological terms, the exercise of two faculties at +the same time, the consciousness and the will. This adds to the +difficulty of willing. What is needed is a bait of interest held up +before the will, constantly tempting it to further effort but without +any continuing consciousness on the part of the individual that he +must will it and keep on willing it. That must ever be a hampering +factor in the case. Human nature does not like imperatives and writhes +and wastes energy under them. On the contrary, optatives are pleasant +and give encouragement without producing a contrary reaction; and it +is this state of mind and will that is by far the best for the +individual. + +Above all, it is important that the person forming new habits should +feel that there is nothing else to be done except the hard things +{100} that have been outlined. If there is any mode of escape from the +fulfillment of hard tasks, human nature will surely find it. If our +young soldiers had felt that they did not have to perform their +military duties and that there was some way to avoid them, the taking +of the training would have proved extremely difficult. They just _had_ +to take it; there was no way out, so they pushed themselves through +the difficulties and then after a time they found that they were +tapping unsuspected sources of energy in themselves. For when people +_have_ to do things, they find that they can do ever so much more than +they thought they could, and in the doing, instead of exhausting +themselves, they actually find it easier to accomplish more and more +with ever less difficulty. The will must by habit be made so prompt to +obey that obedience will anticipate thought in the matter and +sometimes contravene what reason would dictate if it had a chance to +act. The humorous story of the soldier who, carrying his dinner on a +plate preparatory to eating it, was greeted by a wag with the word +"Attention!" in martial tones, and dropped his dinner to assume the +accustomed attitude, is well known. Similar practical jokes are said +to have been played, on a certain number {101} of occasions in this +war, with the thoroughly trained young soldier. + +The help of the will to the highest degree is obtained not by a series +of resolutions but by doing whatever one wishes to do a number of +times until it becomes easy and the effort to accomplish it is quite +unconscious. Reason does not help conduct much, but a trained will is +of the greatest possible service. It can only be secured, however, by +will action. The will is very like the muscles. There is little use in +showing people how to accomplish muscle feats; they must do them for +themselves. The less consciousness there is involved in this, the +better. + +{102} + +CHAPTER VII + +WHAT THE WILL CAN DO + + + "I can with ease translate it to my will." + _King John_. + + +It should be well understood from the beginning just what the will can +do in the matter of the cure or, to use a much better word, the relief +of disease, not forgetting that disease means etymologically and also +literally discomfort rather than anything else. The will cannot cure +organic disease in the ordinary sense of that term. It is just as +absurd to say that the will can bring about the cure of Bright's +disease as it is to suggest that one can by will power replace a +finger that has been lost. When definite changes have taken place in +tissues, above all when connective tissue cells have by inflammatory +processes come to take the place of organic tissue cells, then it is +idle to talk of bringing about a cure, though sometimes relief of +symptoms may be secured; above all the compensatory powers of the body +{103} may be called upon and will often bring relief, for a time, at +least. What is true of kidney changes applies also to corresponding +changes in other organs, and there can be no question of any amount of +will power bringing about the redintegration of organs that have been +seriously damaged by disease or replacing cells that have been +destroyed. + +There are however a great many organic diseases in which the will may +serve an extremely useful purpose in the relief of symptoms and +sometimes in producing such a release of vital energy previously +hampered by discouragement as will enable the patient to react +properly against the disease. This is typically exemplified in +tuberculosis of the lungs. Nothing is so important in this disease, as +we shall see, as the patient's attitude of mind and his will to get +well. Without that there is very little hope. With that strongly +aroused, all sorts of remedies, many of them even harmful in +themselves, have enabled patients to get better merely because the +taking of them adds suggestion after suggestion of assurance of cure. +The cells of the lungs that have been destroyed by the disease are not +reborn, much less recreated, but nature walls off the diseased parts, +and the rest of {104} the lungs learn to do their work in spite of the +hampering effect of the diseased tissues. When fresh air and good food +are readily available for the patient, then the will power is the one +other thing absolutely necessary to bring about not only relief from +symptoms, but such a betterment in the tissues as will prevent further +development of the disease and enable the lungs to do their work. The +disease is not cured, but, as physicians say, it is arrested, and the +patient may and often does live for many years to do extremely useful +work. + +In a disease like pneumonia the will to get well, coupled with the +confidence that should accompany this, will do more than anything else +to carry the patient over the critical stage of the affection. +Discouragement, which is after all by etymology only disheartenment, +represents a serious effect upon the heart through depression. The +fullest power of the heart is needed in pneumonia and discouragement +puts a brake on it. As we shall see it is probably because whiskey +took off this brake and lifted the scare that it acquired a reputation +as a remedy in pneumonia and also in tuberculosis. In spite of what +was probably an unfavorable physical effect, whiskey {105} actually +benefited the patient by its production of a sense of well being and +absence of regard for consequences. Hence its former reputation. This +extended also to its use in a continued fever where the same +disheartenment was likely to occur with unfortunate consequences on +the general condition and above all with disturbance of appetite and +of sleep. Worry often made the patients much more restless than they +would otherwise have been and they thus wasted vital energy needed to +bring about the cure of the affection under which they were laboring. + +In all of these cases solicitude led to surveillance of processes +within the body and interfered with their proper performance. It is +perfectly possible to hamper the lungs by watching their action, and +the same thing may be done for the heart. Whenever involuntary +activities in the body are watched, their proper functioning is almost +sure to be disturbed. We have emphasized that in the chapter on +"Avoidance of Conscious Use of the Will," and so it need not be dwelt +on further here. + +Even apart from over-consciousness there occur some natural dreads +that may disturb nature's vital reactions, and these can be {106} +overcome through the will. There is a whole series of inhibitions +consequent upon fears of various kinds that sadly interfere with +nature's reaction against disease. To secure the neutralization of +these the will must be brought into action, and this is probably +better secured by suggestion, that is, by placing some special motive +before the individual, than by any direct appeal. Particularly is this +true if patients have not been accustomed before this to use their +wills strenuously, for they will probably be disturbed by such an +appeal. + +What will power when properly released can do above all is to bring +the relief of discomfort. In a great many cases the greater part of +the discomfort is due to over-sensitization and over-attention. Even +in such severe organic diseases as cancer, the awakening of the will +may accomplish very much to bring decided relief. This is why we have +had so many "cancer cures" that have failed. They made the patient +feel better at first, and they relieved pain to some extent and +therefore were thought to be direct remedial agents for the cancer +itself. The malignant condition however has progressed without +remission, though sometimes, possibly as the result of the new courage +given flowing as surplus vitality into {107} the tissues, perhaps the +progress of the lesion has been retarded. The patient sometimes has +felt so much better as to proclaim himself cured. What is thus true of +cancer will be found to occur in any very serious organic condition, +such as severe injury, chronic disease involving important organs, and +even such nutritional diseases as anemia or diabetes. The awakening in +the patient of the feeling that there is hope and the maintenance of +that hope in any way will always bring relief and usually some +considerable remission in the disease. + +It is in convalescence above all, however, that the will power +manifests its greatest helpfulness. When patients are hopeful and +anxious to get well they are tempted to eat properly, to get out into +the air; they thus sleep better and recovery is rapid. Whenever they +are disheartened, as for instance when husband and wife have been +together in an injury, or both have contracted a disease and one of +them dies, the survivor is likely to have a slow and lingering +convalescence. The reason is obvious: there is literal lack of will +power or at least unwillingness to face the new conditions of life, +and vitality is spent in vain regret for the companionship that has +been {108} lost. This depression can only be lifted by motives that +appeal to the inner self and by such an awakening of the will for +further interests in life as will set vital energies flowing freely +again. + +In convalescence from injuries received after middle life or from +affections that have been accompanied by incapacity to use muscles +there is particular need of the will. A great many older people refuse +to go through the pain and discomfort, soreness and tenderness as the +younger folk who are training their muscles call them, which must be +borne in order to bring about redevelopment of muscles, after they +have once become atrophic from disuse. The refusal to push through a +period of what is often rather serious discomfort leads many people to +foster disabilities and use their muscles in wrong ways sometimes even +for years. Something occurs then to arouse their wills and they get +better. Anything that will do this will cure them. Sometimes it is a +new liniment, sometimes a new mode of manipulation or massage, +sometimes some supposed electrical or magnetic discovery and sometimes +the touch of a presumed healer. Anything at all will be effective +provided it wakens their wills into such activity {109} as will enable +them to persist in the use of their muscles through the period of +soreness and tenderness necessary to restore proper muscular +functions. + +It is quite surprising to see what can be accomplished in this way, +and the quacks and charlatans of the world have made their fortunes +out of such patients always, while their cure has been the greatest +possible advertisement and has attracted ever so many other patients +to these so-called healers. Nothing that can be done for these +patients will have any good results unless their own wills are +aroused, new hope given them and they themselves made to tap the +layers of energy in them that can restore them to health. To tell them +that they were to be cured by their own will, however, would probably +inhibit utterly this energy that is needed, so that somehow they have +to be brought to the state of mind in which they will accomplish the +purpose demanded of them by indirection. + +The will is particularly capable of removing obstacles to nutrition +that have often hampered the activities and sometimes seriously +impaired the health of patients. Many people are not eating enough for +one reason or another and need to have their diet regulated, not in +{110} the direction of a limitation or selection of food, though this +appeals to so many people under the term dieting, but so that they +shall eat enough and of the proper variety to maintain their health +and bodily functions. A great many nervous diseases are dependent on +lack of sufficient food. Eating in those who lead sedentary lives much +indoors is ever so much more a matter of will than of appetite. When +people say that they eat all they want to, what they mean, as a rule, +is that they eat all that they have formed the habit of eating. Other +habits can readily be formed and will often do them good. For a great +many of the less serious symptoms which make people valetudinarians, +nervous indigestion, insomnia, tendencies to headache, queer feelings +in the head, constipation, the proper habit secured by will power, of +eating so as to secure sufficient food, is the most important single +factor. This the will must be trained to accomplish. + +Now that disease prevention has become even more important than cure, +the will is an extremely efficient element. Air, food, exercise are +important factors for healthy living. A great many people are +neglecting them and then seem surprised that they should suffer from +various symptoms of impaired {111} functioning of bodily organs. Many +men and a still greater number of women are staying in the house so +much that their oxidation within the body is at a low ebb, and it is +no wonder that vital processes are not carried on to the best +advantage. Our generation has eliminated exercise from life to a great +extent, and now that the auto and the trolley car limit walking, not +only the feet of mankind suffer severely, but all the organs in the +body work at a disadvantage for lack of the exercise that they should +have. No wonder that under the circumstances appetite is impaired and +other functions of the body suffer. Instead of simple foods various +artificial stimulants are employed--such as alcohol, spices, and the +like--to provoke appetite, often with serious consequences for the +digestive organs. The will to be well includes the willing of the +means proper to that purpose, and particularly regular exercise, +several hours a day in the air, good simple food taken in sufficient +quantity at three regular intervals and the avoidance of such sources +of worry as will disturb physical functions. + +{112} + + +CHAPTER VIII + +PAIN AND THE WILL + + + "That the will is infinite and the execution confined." + _Troilus and Cressida_. + + +The symptom of disease that humanity dreads the most is pain. +Fortunately, it is also the symptom which is most under the control of +the will, and which can be greatly relieved by being bravely faced +and, to as great an extent as possible, ignored. It requires courage +and usually persistent training to succeed in the relief of severe +pain in this way, but men have done it, and women too, and men and +women _can_ do it, if they really want to, though unfortunately all of +the trend of modern life has been in the opposite direction, of +avoiding pain at whatever cost instead of bravely facing it. The +American Indian, trained from his youth to stand severe pain, scoffed +at even the almost ingeniously diabolical tortures of his enemy +captors. After they had pushed slivers beneath his nails or {113} +slowly crushed the end of a finger, or put salt in long, superficial +wounds that had bared a whole series of sensitive cutaneous nerves, he +has been known to laugh at them, and ask them proudly, without giving +a sign of the pain that he was enduring, whether that was all that +they could do. It was just a question of the human will overcoming +even the worst sensations that the body could send up to the brain and +deliberately refusing to permit any reactions that would reveal the +reflex torment that was actually taking place. + +The war has done much to bring back the recognition of that +diminution--to a great extent at least--or even almost entire +suppression of pain which may occur, indeed almost constantly does +occur, as a consequence of a man facing it bravely. We have been +accustomed to think of the early martyrs as probably divinely helped +in their power to withstand pain. Whatever of celestial aid they had, +we know that martyrs for all sorts of causes, some of them certainly +not divine, have exhibited some degree of this same steadfastness. +Their behavior makes it reasonably clear that as the result of making +up their minds to stand the pain involved, they have actually suffered +so little that it was not {114} difficult to suppress external +manifestations of their sufferings. It is not merely a suppression of +the reflexes that has occurred but a minimizing to a very striking +degree of the actual sensations felt. We have many stories of the +older time before the modern use of anaesthetics, which tell how +bravely men endured pain and at the same time retained their power to +do things. Indeed, some of them accomplished purposes in the midst of +what would seem like supreme agony which made it very clear that pain +alone has nothing like the prostrating effect that it is often +supposed to have. + +For we have well authenticated tales of physicians performing +amputations on themselves at times when no other assistance was +available, and accomplishing the task so well that they recovered +without complications. A blacksmith in the distant West, whose leg had +been crushed by the fall of a huge beam, actually had himself carried +into his shop and amputated his own limb above the knee, searing the +blood vessels with hot irons as he proceeded. Such a manifestation of +will power is, of course, exceptional to a degree, and yet it +illustrates what men can do in the face of conditions that are usually +supposed {115} to be overwhelming. Many a man in lumber camps or in +distant island fisheries or on board fishing vessels, far beyond the +hope of reaching a physician in time for him to be of service, has +done things of this kind. We can be quite sure that the will to +accomplish for himself what seemed necessary to save his life lessened +his pain, made it ever so much more bearable and generally proved the +power of the human will over even these physical manifestations in the +body that are commonly supposed to be quite beyond any interference +from the psychical part of nature. The spirit can still dominate the +flesh, even in matters of pain, and dictate how much it shall be +affected. It is a hard lesson to learn, but it is one that can be +learned by proper persistence. + +In the early part of the war particularly many a young man had to face +even serious operations without an anaesthetic. The awful carnage of +the first six weeks of the war had not been anticipated and therefore +there were not sufficient stores of anaesthetics available to permit +of their use in every case. Besides, many operations had to be +performed so close to the front and under such circumstances that +there could not be anaesthetics for all of them; and it was a +never-ending source of {116} surprise to those who witnessed the +details to see how bravely and uncomplainingly the young men took +their enforced suffering. Many a one, when his turn came to be +operated on, quietly asked for a cigarette and then bore unflinchingly +painful manipulations that the surgeon was extremely sorry to have to +inflict. Over and over again, when there was question of the regular +succession of patients, young soldiers in severe pain suggested that +some one else who seemed in worse condition than they, or who perhaps +was not quite so well able to stand pain and control himself, should +be attended to before they were. There is no doubt at all that this +very power of self-control lessened their pain and made it ever so +much easier to bear and less of a torment than it would have been +otherwise. + +Any great diversion of mind that turns the attention completely to +something else will lessen even severe pain so much as to make it +quite negligible for the moment. Headaches disappear promptly when +there is an alarm of fire, and toothaches have been known to vanish, +for the time at least, as the result of a burglar scare. Much less +than this is needed, however, and there are many familiar examples +{117} which illustrate the fact that the turning of the attention to +something else will greatly diminish or even abolish pain. + +The well known story of the French surgeon about to set a dislocation +is a typical demonstration. His patient was a woman of the nobility, +her dislocation was of the shoulder and it was necessary for him to +inflict very severe pain in order to replace it. Besides, as the +result of the reflex of that pain, he was certain to meet with great +resistance from spasm in the surrounding muscles. It was before the +days of anaesthetics, which relieve all of these inconveniences, and +above all, relax the muscles. The surgeon got ready to do the ultimate +manipulation that would replace the joint in its proper relation, and +necessarily inflicted no little pain in his preparations. The lady +complained very much, so he turned on her angrily, told her that she +must stand it, slapped her in the face, and before she had recovered +from the shock, the dislocation had been restored to the normal +condition. It was rather heroic treatment, and it is to be hoped that +she understood it, but it is easy to understand how much the procedure +lessened her physical pain. + +When the mind is very much preoccupied {118} and the will intent on +accomplishing some immediate purpose, even severe pain will not be +felt at all. Instances of this are not rare, and men who are advancing +in a charge on a battlefield will often be wounded rather severely, +and yet continue to advance without knowing anything about their +wounds until a friend calls attention to their bleeding, or they +themselves notice it; or perhaps even loss of blood may make them +faint. The late President Roosevelt furnished a magnificent +illustration of this principle when he was wounded some years ago in +the midst of a political campaign. A crank shot at him, in one of the +Western cities, and though the bullet penetrated four inches of muscle +on his chest wall, and then flattened itself against a rib, he did not +know that he was wounded. The flattening of the bullet must have +represented at least as much force as would be exerted by a heavy blow +on the chest, and yet the Colonel never felt it. His friends +congratulated him on his escape from injury until it was noted that +blood was oozing through a hole that had been made in his coat. The +intense will activity of the President simply kept him from noticing +either the shock or the pain. + +{119} + +Not long before the war a striking example was given of how a man may +stand suffering in spite of long years of the refining influences of a +sedentary scholarly life, most of it spent indoors. The second last +General of the Jesuits developed a sarcoma on his upper arm and was +advised to submit to an amputation of the arm at the shoulder joint. +He was a man well on in the sixties and the operation presented an +extremely serious problem. The surgeons suggested that he should be +ready for the anaesthetic at a given hour the next morning and then +they would proceed to operate. He replied that he would be ready for +the operation at the time suggested, but that he would not take an +anaesthetic. They argued with him that it would be quite impossible +for him to stand unanaesthetized the extensive cutting and dissection +necessary to complete an operation of this kind in an extremely +important part of the body, where large nerves and arteries would have +to be cut through and where the slightest disturbance on the part of +the patient might easily lead to serious or even fatal results. Above +all, he could not hope to stand it in tissues that had been rendered +more sensitive than before by the enlarged circulation to the part, +due to {120} the growth of the tumor, and the consequent hyperaemic +condition of most of the tissues through which the cutting would have +to be done and which were thus hypersensitized. + +He insisted, however, that he would not take an anaesthetic, for +surely here seemed a chance to welcome suffering voluntarily as his +Lord and Master had done. I believe that the head surgeon said at +first that he would not operate. He felt sure that the operation would +have to be interrupted after it had been begun, because the patient +would not be able to stand the pain and there would then be the danger +from bleeding as well as from infection which might occur. The General +of the Jesuits, however, was so calm and firm that at last it was +determined to permit him to try at least to stand it, though most of +the surgeons were sure that he would probably have to give up and +allow himself to be anaesthetized before they were through. + +The event then was most interesting. The patient not only underwent +the operation without a murmur, but absolutely without wincing. The +surgeon who performed the operation said afterwards, "It was like +cutting wax and not human flesh, so far as any reaction was concerned, +though of course it bled." + +{121} + +The story carries its lesson of the power of a brave man to face even +such awful pain as this and probably actually overcome it to such an +extent that he scarcely felt it, simply because he willed that he +would do so and occupied himself with other thoughts during the +process. + +Such an example as that of this General of the Jesuits will seem to +most people a reversion to that mystical attitude of mind of the +medieval period, when somehow or other people were able to stand ever +so much more pain than any one in our time could possibly think of +enduring. We hear of saints of the Middle Ages who inflicted what now +seem hideous self-tortures on themselves and not only bore them +bravely but went about life smiling and doing good to others while +they were under the influence of them. It would seem quite impossible, +however, for people of the modern time to get into any such state of +mind. Our discoveries for the prevention of pain have made it +unnecessary to stand much suffering, and as a result mankind would +seem to have lost some if not most of the faculty of standing pain. So +little of truth is there in any such thought that any number of the +young men of the present generation between {122} twenty and thirty, +that is, during the very years when mankind most resents pain and +therefore reacts most to it, and by the same token feels it the most, +have shown during this war that they possessed all the old-fashioned +faculty of standing pain without a whimper and thinking of others +while they did it. + +Lack of advertence always lessens pain and may even nullify it until +it becomes exceedingly severe. In his little volume, "A Journey around +My Room", Xavier de Maistre dwells particularly on the fact that his +body, when his spirit was wandering, would occasionally pick up the +fire tongs and burn itself before his _alter ego_ could rescue it. +Concentration of attention on some subject that attracts may +neutralize pain and make it utterly unnoticed until physical +consequences develop. Undoubtedly dwelling on pain, anticipating it, +noting the first sensations that occur, multiplies the painful +feeling. The physical reasons for this are to be found in the +increased blood supply consequent upon conscious attention to any +part, which sensitizes the nerves of the area and the added number of +nerve fibers that are at once put into association with the area by +the act of concentration of the attention. These serve to render +sensation {123} much more acute than it would otherwise be. It might +seem impossible to control the attention, but this has been done over +and over again, even in the midst of severe pain, until there is no +doubt that it is quite possible. As for the increase of pain by +deliberate attention, that is so familiar an experience that +practically every one has had it at some time. + +The reason for it has become very clear as the result of our +generation's investigations into the constitution of the nervous +system. The central nervous system, instead of being a _continuum_, or +series of nerve elements which are directly connected with each other, +consists of a very large number of separate individual cells which +only make contacts with each other, the nerve impulses flowing over +across the contact. The demonstration of these we owe originally to +Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was +awarded some years ago the Nobel Prize as well as the Prize of the +City of Paris for his researches. + +In connection with his surprising discoveries as to the neurons which +make up the brain, he suggested the Law of Avalanche, which would +serve to explain the supersensitiveness of parts to which concentrated +attention is paid. {124} According to this law, pain felt in any small +area of the body may be multiplied very greatly if the sensation from +it is distributed over a considerable part of the brain, as happens +when attention is centered upon it. A pain message that comes from a +localized area of the body disturbs under normal conditions at most a +few thousand cells in the brain, because the area is directly +represented only by these cells. They are connected however by +dendrites and cell branches of various kinds with a great many other +cells in different parts of the brain. A pain message that comes up +will ordinarily produce only disturbance of the directly connected +cells, but it may be transmitted and diffused over a great many of the +cells of the cortex of the brain if the attention is focused strongly +on it. The area at first affected, but a few thousand cells, may +spread to many millions or perhaps even some hundreds of millions of +them, if the centering of attention causes them to be "connected up", +as the electricians say, with the originally affected small group of +cells. + +It is just what happens in high mountains when a few stones loosened +somewhere near the top by the wind or by melting processes begin their +course down the mountain side. {125} On the way they disturb ever more +and more of the loose pieces of ice and the shifting snows as well as +the rocks near them, until, gathering force, what was at the beginning +only a minor movement of small particles becomes a dreaded avalanche, +capable not only of sweeping away men in its path but even of +obliterating houses and sometimes of changing the whole face of a +mountain area. Hence the expression suggested by Ramon y Cajal of the +Law of Avalanche for this wide diffusion of sensation, which spreads +from a few thousand to millions or billions of cells, and from a +rather bearable pain becomes intolerable torture, as a consequence of +the brain's complete occupation with it. + +Now it is possible for most people, indeed for all who have not some +organic morbid condition, to control this spread of pain beyond its +original connections, provided only they will to do so, refuse to be +ruled by their dreads and proceed to divert attention from the painful +condition to other subjects. Here is why the man who bravely faces +pain actually lessens the amount that he has to bear. There is no pain +in the part affected. That we know, because any interruption of the +nerve tract leading from the affected part to the brain {126} +eliminates the pain. In the same way, the obtunding of the nerve cells +in the cortex by anaesthetics or of the conducting nerve apparatus on +the way to the brain by local anaesthesia, will have a like effect. +Anything then that will interfere with the further conduction of the +pain sensation and the cortical cells directly affected will lessen +the sense of pain, and this is what happens when a man settles himself +firmly to the thought that he will not allow himself to be affected +beyond what is the actual reaction of the nerve tissues to the part. + +As a matter of fact, the anticipation of pain due to the dread of it +predisposes the part to be much more sensitive than it was before. We +can all of us readily make experiments which show this very clearly. +Ordinarily we have a stream of sensations flowing up from the surface +of the body to the brain, consequent upon the fact that the skin +surface is touched by garments over most of the body, and that our +nerves of touch respond to their usually rather rough surface. We have +learned to pay no attention to these because we have grown accustomed +to them, though any one who thinks that they are negligible should +witness the writhings of a poor Indian under the stress {127} of being +civilized when he is required to wear a starched shirt for the first +time. Ordinarily Indians have learned to suppress their feelings, but +the shirt with its myriad points of contact, all of them starchily +scraping, usually proves too much for his equanimity, and he wiggles +and twists to such an extent as shows very clearly that he is +extremely uncomfortable. Most people have something of the same +feeling the first day that they change into woolen underclothes after +they have been wearing cotton for months, and the sensation is by no +means easy to bear with equanimity. + +Ordinarily from custom and habit in the suppression of feelings we +notice none of these contact sensations with their almost inevitable +itchy and ticklish feelings, though they are constantly there, but we +can reveal them to ourselves by thinking definitely about any part of +the body. Such concentration of attention at once brings that part of +the body above the threshold of consciousness, and we have distinct +feelings there that we did not notice before. If for instance we think +about the big toe on the left foot, immediately our attention is +turned to it and we note sensations in it that were quite unnoticed +before. We can feel the stocking touching any part of it {128} that we +think of. Not only that, but if we concentrate attention on a part +most uncomfortable sensations develop. If anything calls our attention +even to the middle of our backs, we find at once that there is a +distinct sensation there, and this may become so insistent as to +demand relief. + +It is well understood now what happens in these cases. As we have +said, the attention given to a part leads to a widening of the minute +blood vessels located there so that the nerve endings to the part are +supplied with more blood and therefore become more sensitive. We know +from experience in cold windy weather that when the cheek is +hyperaemic the drawing of a leaf or even of a piece of paper across it +may produce a very acute painful sensation. Hyperaemia always makes +parts of the body much more sensitive than before. Attention has just +this effect over all the surface of the body, as we can demonstrate to +ourselves. We can actually, though only gradually, make our feet warm +by thinking about them, because the active attention to them sends +more blood to them. The dread of pain then, by concentrating attention +on the part beforehand, actually increases the pain that has to be +suffered and makes the subject {129} ever so much more sensitive. +Sensitiveness is of course dependent on other factors, as for instance +lack of outdoor air and of oxygenization, which actually seems to +hypersensitize people so that even very slight pain becomes extremely +difficult to bear, but the question of attention, which is after all +almost entirely a voluntary matter, has more to do with making pain +harder to bear than anything else. + +In the preanaesthetic days, men have been known to sit and watch +calmly an amputation of one of their limbs without wincing and +apparently without undergoing very much pain. Many are the incidents +in history of a favorite general who showed his men how to bear pain +by calmly smoking a cigar while a surgeon amputated an arm or a leg or +performed some other rather important surgery. Pain is after all like +the sense of danger and may be suppressed practically to as great a +degree. Once during the present war, when long columns of soldiers +going to the front had to pass by the open market place of a town that +was being shelled by the Germans, there was danger of the troops +losing something of their morale at this point and of confusion +ensuing. It would have been disturbing both to discipline and the +{130} ordered movement of the troops to divert them by narrower +streets, and the shells, though dangerous, were not falling frequently +and not working serious havoc. Every one knew, however, that the +German gunners had the range, and a shell might land square in the +market place at any time; thus there was a feeling of uneasiness and a +tendency to nervous lack of self-control, with the inevitable +confusion of movement afterwards. One of the French generals ordered +an armchair to be brought out of one of the houses near by, took a +position in the center of the square, with a little wand in his hand, +and calmly joked with the soldiers as they went by about the +temperature of the day mentioning occasionally something about a shell +that happened to strike not far away. According to the story he was an +immense man weighing nearly three hundred pounds, and so provided a +very good-sized target for shells, but he was never touched and, +almost needless to say, the line of soldiers never wavered while their +general sat there joking at the danger. + +It is sometimes thought that men in the older, less refined times +could stand pain and suffering generally much better than our +generation which is supposed to have {131} degenerated in that +respect. We have found, however, during the war that the soldiers who +could stand supreme suffering the best were very often those who came +from better-to-do families, who had been subjected to the most highly +refining influences of civilization, but also to that discipline of +the repression of the emotions which is recognized as an important +phase of civilization. Strange as it may seem, the city boys stood the +hardships and the trials of trench life better than the country boys +and not only withstood the physical trials but were calmer under fire +and ever so much less complaining under injury. After all it is what +might be expected, once serious thought is given to the subject, and +yet somehow it comes as a surprise, as if the country boy ought to be +less sensitive,--as indeed he probably is; but he lacks that training +in self-control which enables the city boy to stand suffering. + +All our feeling that human nature has degenerated in physical +constitution has been completely contradicted by the reaction of our +young soldiers to camp and trench life. They have gone back to the +lack of comforts and conveniences of the pioneer days and have had to +submit to the outdoor life and the {132} hardships that their pioneer +grandfathers went through and have not failed under them. The boys +have come out of it all demonstrating not only that their courage was +capable of supporting them, but with their physical being bettered by +the conditions and their power to stand suffering revealed in a way +that would scarcely have been believed possible beforehand. + + +{133} + +CHAPTER IX + +THE WILL AND AIR AND EXERCISE + + + "And wishes fall out as they are willed." + _Pericles_ + + +Very probably the most important function of the will in its relation +to health is that which concerns its power to control the habits of +mankind as regards air and exercise. It is surprising to what an +extent people neglect both of these essentials of healthy living in +the midst of our modern sophisticated life, unless the will power is +consciously used for the purpose of forming and then maintaining +habits with regard to these requisites for health. It is a very +fortunate thing that instinct urges the child, particularly the +infant, to almost constant movement during its waking hours. Children +that are healthy and that are growing rapidly, boys somewhat more than +girls, are so constantly in movement that one would almost think that +they must be on springs. Whenever they discover that they can make a +{134} new movement, they proceed to make it over and over again until +they can do it with facility. There is no lolling around for them; as +soon as they wake, they want to be up and doing, no matter what the +habits of the household may be. They are constantly on the move. We +know that this is absolutely essential for growth as well as for the +proper training of their muscles, but it is a very fortunate thing +that children do it for themselves, for if their mothers were +compelled to train them, the task would be indeed difficult. All +mother has to do is to control them to some extent and keep them from +venturing too far, lest they should hurt themselves. + +When the control of instinct over life is gradually replaced by +reason, this tendency to exercise gradually diminishes until it is +often surprising to find how little people are taking. As it is mainly +the need for exercise that forces people out into the air, indoor life +comes to be the main portion of existence. This is all contrary to +nature, and so it is not surprising that _disease_, in its original +etymological sense of discomfort, develops rather readily. The lack of +exercise in the air permits a great many people to drift into all +sorts of morbid conditions in which they are quite miserable. This +{135} is, of course, particularly true as regards nervous ailments of +various kinds; only under the term nervous ailments should be included +not alone direct affections of the nervous system or functional +disturbances of nerves, but also a number of other conditions. Nervous +indigestion, insomnia, neurotic constipation and many of the +symptomatic affections associated with these conditions, tired +feelings that interfere with activities, headache, various feelings of +discomfort in the muscles and around the joints, inability to control +the emotions and other such common complaints--if that is the proper +word for them--all these are fostered by a sedentary life indoors. +They frequently make not only the patient himself--or oftener +herself--miserable, but also all those who come in contact with her. + +Above all, it must not be forgotten that lack of exercise in the open +air has a very definite tendency to make people extremely sensitive to +discomforts of all kinds, mental as well as physical. Many a man or +woman whose life seems full of worries, sometimes without any adequate +cause at all, who goes from one dread to another, who wakes in the +morning with a sense of depression, find that most of these feelings +and sometimes all of them, {136} disappear promptly when they begin to +exercise more in the open. + +Nothing dispels the gloom and depressions consequent upon an +accumulation of cares and worries of various kinds like a few weeks in +the woods, where every moment is passed in the fresh outdoor air, +which actually seems to blow the cobwebs of ill feelings away and +leaves the individual with a freedom of mind and a comfort of body +that he almost expected never to enjoy again. + +Undoubtedly the most important factor for the preservation of health +is an abundance of fresh air. At certain seasons of the year this is +not only easy and agreeable, but to do anything else imposes hardship. +In our climate, however, there are about six months of the year in +which it requires some exercise of will power to secure as much open +air life as is required for health. There are weeks when it is too +hot, there are many weeks when it is too cold. The cold air +particularly is important, because it produces a stimulating vital +reaction than which nothing is more precious for health. We have no +tonic among all the drugs of the pharmacopeia that is equal to the +effect of a brisk walk in the bracing air of a dry cold day. After a +long morning and {137} perhaps a whole day in the house, even half an +hour outdoors will enable us to throw off the sluggishness consequent +upon confinement to the indoor air and the lack of appetite and the +general feeling of physical lassitude which has followed living in an +absolutely equable temperature for twenty-four hours. Sometimes it +requires no little effort of the will to secure this, and to continue +it day after day without missing it or letting it be crowded out by +claims that are partly real and partly excuses, because we do not care +to make the special effort required. + +What humanity needs is regular exercise in the open air every day. As +it is, between the trolley car and the automobile, very few people get +what they need. Any one who has to go a mile takes a car or some other +conveyance and between waiting for the car and certain inevitable +delays it will probably take ten minutes or more to go the mile. In +five minutes more one could walk that distance and secure precious +exercise besides such diversion of mind as inevitably comes from +walking on busy city streets and which makes an excellent recreation +in the midst of one's work. For it is quite impossible in our day to +walk along city streets absorbed in abstract mental {138} occupations. +One of the objections to walking is that after a while it can be +accomplished as a matter of routine without necessarily taking one's +mind away from subjects in which it has been absorbed. It is quite +impossible for this to happen, however, on modern city streets. "The +outside of a horse", it used to be said, "is good for the inside of a +man." The main reason for this was because it is impossible for a man +to ride horseback, unless his mount is a veritable old Dobbin, without +paying strict attention to the animal. The same thing is true as +regards city pedestrianism, especially since the coming of the auto +has made it necessary to watch our steps and look where we go. + +A great many people would be ever so much better in health if they +walked to business or to school every morning instead of riding, for +the young need it even more than the older people. Especially is this +true for all those who follow sedentary occupations. Clerks in +lawyers' offices, typewriters and stenographers, secretaries--all +those who have to sit down much during the day--need the brisk walking +and need it not merely of a Sunday or a Saturday afternoon, but every +day in the year. Many of them, if they walked two and three miles to +{139} the office, would probably require only fifteen minutes, at most +half an hour, more than if they took a train or trolley, but they +would have secured a good hour of exercise in the open air. + +On the other hand the unfortunate crowding of trolley and elevated and +subway trains in the busy hours when people go to and from their work +makes an extremely uncomfortable and often rather depressing +commencement and completion of the day's work. I know of nothing that +makes a worse beginning for the day than to have to stand for half an +hour or longer in a swaying, bumping car, hanging to a strap, crushed +and crowded by people getting in and out. The effect of coming home +under such circumstances after a reasonably long day's work is even +more serious, and any little sacrifice that will enable people to +avoid it will do them a great deal of good. Fifteen or twenty minutes +of extra time morning and evening would often suffice for this and +would at the same time add a bracing walk in the open air to the day's +routine. + +When first begun, such a practice would make one tired and sore, but +that condition would pass in the course of a few days and be replaced +by a healthy feeling of satisfaction {140} that would be well worth +all the effort required. We should need ever so much less medicine for +appetite and for constipation if this were true. A great many people +who stand during the day would probably deem it quite out of the +question for them to walk three miles or more to and from their +business, for their feet get so tired that they feel that they could +not endure it. What they need more than anything else, however, is +exercise that will bring about a stimulation of the circulation in +their feet. Standing is very depressing to the circulation. It leads +to compression of the veins and hence interference with the return +circulation, with lowered nutrition which often predisposes to flat +foot or yielding arch and tends to create corns and callouses: walking +in reasonably well fitting shoes on the contrary tends to make the +feet ever so much less sensitive Our soldiers have had that experience +and have learned some very precious lessons with regard to the care of +their feet, the principal one being that the best possible remedy for +foot troubles is to exercise the feet vigorously in walking and +running, provided the shoes permit proper foot use. + +I have often known clerks and floorwalkers {141} who have to stand all +day or move but a few steps at intervals, who were so tired at night +that they felt the one thing they could do was to sit down for a while +after dinner and then go to bed, but who came to feel ever so much +better after a brisk walk home. It was rather hard to persuade them +that, exhausted as they felt, they would actually get rested and not +more tired from vigorous walking, but once they tried it, they knew +the exercise was what they needed. The air in stores is often dry and +uncomfortable for those who are in them all day. It is usually and +quite properly regulated for the customers who come in from the +streets expecting to get warm without delay. In dry, cold weather +particularly, an evening walk home sets the blood in circulation until +it gets thoroughly oxidized and the whole body feels better. Such a +brisk walk will often prevent the development of flat foot, especially +if care is taken to spring properly from the ball of the foot, in the +good, old-fashioned heel and toe method of walking. Once flat foot has +developed, walking probably is more difficult, but even then, with +properly fitting shoes, the patients will be the better for a good +walk after their work is over. It requires some will power to acquire +the {142} habit, but once formed, the benefit and pleasure derived +make it easy to keep up the practice. + +Those who walk thus regularly will often find that their evening +tiredness is not so marked, and they will feel much more like going +out for some diversion than they otherwise would. Probably nothing is +more dispiriting in the course of time than to come home merely to eat +dinner, sit down after dinner and grow sleepy on one's chair until one +feels quite miserable, and then go to bed. There should be always, +unless in very inclement weather, an outing before bedtime, and this +should be looked forward to. It will often forestall the feeling that +the day is over after dinner and so keep the individual from settling +down into the dozy discomfort of an after-dinner nap as the closing +scene of the day. Good habits in this matter require an effort of the +will to form; bad habits almost seem to form of themselves and then +require a special effort to break. + +It is surprising how many of the dreads and anxiety neuroses and +psycho-neurotic solicitudes and neurasthenic disquietudes and other +more or less morbid mental states disappear under the influence of a +brisk walk for three or {143} four miles or more every day. I have +tried this prescription on all sorts of people, including particularly +myself, and I know for certain that when troubles are accumulating the +thing to do is to get outdoors more, especially for walking; then the +incubus begins to lift. Clergymen, university professors, members of +religious orders, school teachers, as well as bankers, clerks and +business people of various kinds, have been subjected to the influence +of this prescription with decided benefit. Some of them assert that +they never felt so well as since they have formed the habit of walking +every day. It must, however, be _every_ day, and it must not merely be +a mile or so but it must be at least three miles. That means for a +good many people about an hour spent in actual walking, but it is well +worth the time and effort. Above all, it repays not only in health and +in better feelings but in the increased amount of work that can be +done on the day itself. A whole day passed indoors will often contain +many wasted hours, while if a walk of a couple of miles is planned for +the morning and one for a couple of miles more in the afternoon, very +satisfactory study or other work can be done in the intervals. Almost +needless to say, a brisk walk in the {144} cooler weather will create +an appetite where it did not exist before. Women often need counsel in +this matter more than men, and regular walking for them is indeed a +counsel of health. Very few women in these modern times walk much, and +to walk more than a mile seems to them a hardship. This is responsible +for more of the supersensitiveness and nervous complaints of all kinds +to which women are liable than anything else that I know of. It is +also one important factor in the production of the constipation to +which women are so much more liable than men. We see many +advertisements with regard to the jolts to which the body is subjected +every time the heel is put down and of the means that should be taken +to prevent them, but it must not be forgotten that men and women were +meant by nature to walk erect and that this recurring jolt has a very +definite effect in stimulating peristalsis and favoring the movement +of the contents of the intestines. Besides, if the walking is brisk, +the breathing is deeper and there is some massage of the liver, as +also of the other abdominal viscera, while other organs are affected +favorably. Walking for women--regular, everyday walking--would be +indeed a precious habit, but now {145} that women have occupations +more and more outside of the house, this is one of the things they +must make up their minds to do, if they are to maintain health, +remembering that making up the mind is really making up the will. + +Over and over again I have seen a great many of the troubles of the +menopause or change of life in women disappear or become ever so much +less bothersome as the result of the formation of regular habits of +walking out of doors every day. Unfortunately, there is a definite +tendency about this time for women to withdraw more and more from +public appearances and to live to a considerable extent in retirement +at home. Nothing could be much worse for them. They need, above all, +to get out and to have a number of interests, and if these interests +can only be so arranged as to demand rather prolonged walks, so much +the better. This is more particularly true for the unmarried woman who +is going through this critical time, and the question of walking +regularly every day for three or four miles must be proposed to her. +It will require a considerable effort of the will. More than two miles +at the beginning will probably be too tiring, but the amount can be +gradually increased {146} until at least four miles on the average is +covered every day. Above all, for the feelings of discomfort in the +cardiac region so often noticed at this time, regular walking is the +best remedy in most cases, always of course presupposing that there is +no organic heart condition, for in that case only a physician can give +the proper direction for each case. By the exercise of the lungs that +it requires, it will probably save most people from colds and coughs +which they have had to endure every winter. Lastly be it said that +practically all men and women, though more particularly the men who +have lived well beyond the Psalmist's limit of threescore and ten, +have been regular daily walkers, or else they have taken exercise in +some form in the open air which is the equivalent of walking. One of +the most distinguished of English physicians, Sir Hermann Weber, who +died just after the end of the war in London, was in his ninety-fifth +year. He had practised medicine regularly until the age of eighty and +continued in excellent health and vigor until just before his death. +During the last year of life, he contributed an interesting article to +the _British Medical Journal_ on the "Influence of Muscular Exercise +on Longevity." He attributed his vigor at the age of {147} ninety-five +as well as the prolongation of his life to his practice of spending +every day two or three hours in the open air. He walked, as a rule, +forty to fifty miles a week. Even in the most inclement weather he +rarely did less than thirty miles a week. Many another octogenarian +and nonagenarian has attributed his good health and long life to the +habit of regular daily exercise in the open. + +Instead of using up energy, the will so used brings out latent stores +of energy that would not otherwise be employed and thus adds to the +available amount of vitality for the individual. Doctor Thomas Addis +Emmet, only just dead, over ninety, in his younger years as a busy +medical practitioner never kept a horse. It would not be difficult to +cite many other examples among men who lived to advanced old age and +who considered that they owed their good health and long life to daily +habits of outdoor exercise. + + + +{148} + +CHAPTER X + +THE WILL TO EAT + + + "If your will want not, time and place will be fruitfully added." + _King Lear_. + + +Eating is usually supposed to be entirely a matter of appetite which +instinct directs to the best possible advantage of the individual. +This is quite true for those who are living the outdoor life that is +normal or at least most healthy for men, and when they are getting an +abundance of exercise, and may I add also have not too great a variety +of food materials in tempting form presented to them. Under the +artificial not to say unnatural conditions which men have to a great +extent created for themselves in city life, confined at indoor +sedentary occupations, some of them--and they are much more numerous +than is usually imagined--eat too little, while a great many, owing to +stimulation of appetite in various ways, eat too much. + +Eating therefore for health's sake has to be done through the will and +as a rule by the {149} formation of deliberate habits. It is easy to +form habits either of defect or excess in the matter of eating and +indeed a great deal of the ill health to which mankind is liable is +due to errors in either of these directions. Having disturbed nature's +instincts for food in modifying the mode of life to suit modern +conveniences, we have now to learn from experience and scientific +observations what we should eat and then make up our minds to eat such +quantity and variety as is necessary to maintain health and strength +in the particular circumstances in which we are placed. + +While the greatest emphasis has been placed on the dangers to health +in overeating, the number of people who, for one reason or another, +eat too little is, as has been said, quite surprising. A very large +proportion of those under normal weight are so merely because they +have wrong habits of eating. Indeed, it may be laid down as a +practical rule of health that wherever there is no organic disease the +condition of being underweight is a symptom of undereating. A great +many thin people insist that the reason why they are underweight is +that it is a family trait and that father and mother, or at least one +of them, and some of their grandparents exhibited this {150} +peculiarity; and thus it is not surprising that they should have it. A +careful analysis of the family eating in such cases has shown me in a +large number of instances, indeed almost without exception, that what +my patients had inherited was not a constitutional tendency to +thinness, but a family habit of undereating. This accrued to them not +from nature but from nurture, and was acquired in their bringing up. +Most of them were eating one quite abundant meal a day and perhaps a +pretty good second meal, but practically all of them were skimping at +least one meal very much. In some way or other, a family habit of +eating very little at this meal had become established and was now an +almost inviolable custom. + +A great many thin individuals, that is persons who are somewhat more +than ten per cent. under the average normal weight for their height, +either do not eat breakfast at all or eat a very small one. It is not +unusual for the physician analyzing their day's dietary to be told +that the meal consists of a cup of coffee and a piece of bread. +Sometimes there is a roll, but more often only part of a roll, though +occasionally in recent years there may be some fruit and some cereal; +the fruit will usually be a half of one of the citrus fruits {151} +which contains practically no nutrition and is only a pleasant +appetizer, while more often than not the cereal will be one of the +dry, ready-to-eat varieties which, apart from the milk or cream that +may be served with them, contain in the usual small helpings very +little nutriment. Such breakfasts are particularly the rule among +women who are under weight. Sometimes lunch is comparatively light so +that there are two daily apologies for meals. To make up for these, +the third meal may be very hearty. City folk often eat at dinner more +than is good for them. This may produce a sense of uncomfortable +distention and overfulness followed by sleepiness which may be set +down as due to indigestion, though it is just a question of overeating +for the nonce. + +It would be much more conducive to health to distribute the eating +over the three meals of the day, but it requires a special effort of +the will to break the unfortunate habits that have been formed. +Particularly it seems hard for many people to eat a substantial +breakfast and a determined effort is required to secure this. It would +seem almost as though their wills had not yet waked up and that it was +harder for them to do things at this time of day. It is especially +important for working {152} women, that is, those who have such +regular occupations as school-teacher, secretary, clerk and the like, +to eat a hearty breakfast. They can get a warm properly chosen meal at +home at this hour, while very often in the middle of the day they have +to eat a lunch that is not nearly so suitable. As a consequence of +neglecting breakfast then, it is twenty-four hours between their warm, +hearty meals. Even when they eat a rather good lunch, some eighteen +hours elapse since the last hearty meal was taken, and one half the +day's work has to be done on the gradually decreasing energy secured +from the evening meal of the day before. With this unfortunate habit +of eating, most of that was used up during the night in repairing the +tissue losses of the day before, so that the morning's work has to be +done largely "on the will" rather than on the normal store of bodily +energy. + +It is surprising how many patients who are admitted to tuberculosis +sanatoria have been underweight for years as a consequence of +unfortunate habits of eating. Not infrequently it is found that they +have a number of prejudices with regard to the simple and most +nutritious foods that mankind is accustomed to. Not a few of the +younger ones who {153} develop tuberculosis have been laboring under +the impression that they could not digest milk or eggs or in some way +they had acquired a distaste for them and so had eliminated them from +their diet; some of them had also stopped eating butter or used it +very sparingly. At the sanatoria, as a rule, very little attention is +paid to the supposed difficulty of digestion of milk and eggs and +perhaps butter. The patients are at once put on the regular diet +containing these articles and the nurse sees that they take them even +between meals, and unless there is actual vomiting or some very +definite objective--not merely subjective--sign of indigestion, the +patients are required to continue the diet. + +It is almost an invariable rule for the patients of such institutions +to come to the physician in charge after a couple of weeks and ask how +it was that they could have thought that these simple articles of food +disagreed with them. They have begun to like them now and are +surprised at their former refusal to take them, which they begin to +suspect, as the physician very well knows, to have been the principal +reason for the development of their tuberculosis. + +There are people who are up to weight or {154} slightly above it who +develop tuberculosis, but they do not represent one in five of the +patients who suffer from the affection. In probably three fourths of +all the cases of tuberculosis the predisposing factor which allowed +the tubercle bacillus to grow in the tissues was the loss of weight or +the being underweight. There is a good biological reason for this, for +there are certain elements in the make-up of the tubercle bacillus +which favor its growth at a time when fat is being lost from the +tissues rather than deposited, for at that time more fat for the +growth of the tubercle bacillus is available in the lungs than at +other times. Often among the poor the loss in weight is due to lack of +food because of poverty, or failure to eat because of alcoholism, but +not infrequently among all classes it is just a question of certain +bad habits of eating that might readily have been corrected by the +will. It is surprising how many people who complain of various nervous +symptoms--meaning by that term symptoms for which no definite physical +basis can be found, or for which only that extremely indefinite basis +of a vague reflex, real or supposed, from the abdominal organs--are +underweight and will be found to be eating much less than the average +of {155} humanity. These nervous symptoms include above all +discomforts of various kinds in the abdominal region; sense of +gone-ness; at times a feeling of fullness because of the presence of +gas; grumblings, acid eructations, bitter taste in the mouth, and +above all, constipation. As is said in the chapter on "The Will and +the Intestinal Functions," the most potent and frequent cause of +constipation is insufficient eating, either in quantity or in variety. +It is especially in the digestive tract of those who do not eat as +much as they should that gas accumulates. This gas is usually thought +to be due to fermentation, but as fermentation is a very slow gas +producer and nervous patients not infrequently belch up large +quantities, it is evident that another source for it must be sought. +Any one who has seen a number of hysterical patients with gaseous +distention of the abdomen and attacks of belching in which immense +quantities of gas are eructated, will be forced to the conclusion that +in such nervous crises gas leaks out of the blood vessels of the walls +of the digestive tract and that this is the principal source of the +gas noted. What is true in the severe nervous attacks is also true in +nervous symptoms of other kinds, and neurotic indigestion so called +{156} is always accompanied by the presence of gas. + +Apparently the old maxim of the physicist of past centuries has an +application here. "Nature abhors a vacuum" and as the stomach and +intestines are not as full as they ought to be, nor given as much work +to do as they should have, nature proceeds to occupy them with gas +which finds its way in from the very vascular gastrointestinal walls. +This is of course an explanation that would not have been popular a +few years ago when the chemistry of digestion seemed so extremely +important, but in recent years, medical science has brought us back +rather to the physics of digestion, and I think that most physicians +who have seen many functional nervous patients would now agree with +these suggestions as to the origin of gaseous disturbance in the +gastrointestinal tract in a great many of these cases. + +Besides the physical symptoms, there are a whole series of psychic or +psycho-neurotic symptoms, the basis of which undoubtedly lies in the +condition of underweight as a consequence of undereating. Over and +over again I have seen the feeling of inability to do things which had +come over men, and {157} particularly women, disappear by adding to +and regulating the diet until an increase in weight came. Extreme +tiredness is a frequent symptom in those under weight, and this often +leads to their having no recreation after their work because they have +not enough energy for it; as every human being needs diversion, a +vicious circle of influence which adds to their nervous tired +condition is formed. I have seen in so many cases the eating of a good +breakfast and a good lunch supply working people with the energy +hitherto lacking that enabled them to go out of an evening to the +theater or to entertainments of one kind or another, that it has +become a routine practice to treat these people by adding to their +dietary unless there are direct contra-indications. + +Dreads are much more common among people who are underweight than +among those who eat enough to keep themselves in proper physical +condition. I have had a series of cases, unfortunately only a small +one in number, in which the craving for alcoholic liquor disappeared +before an increase in diet and a gain in weight. I shall never forget +the first case in which this happened. The patient was a man of nearly +sixty years of age who held a {158} rather important political office +in a small neighboring town. He was on the point of losing it because +periodical sprees were becoming more frequent and it was impossible +for him to maintain his position. He was over six feet in height and +he weighed less than a hundred and fifty pounds. I had tried to get +him to gain in weight by advice and suggestion without avail. Finally, +I had to make a last effort to use whatever influence I had to save +his political position for him, and then I succeeded in making him +understand that he would have to do as I told him in the matter of +eating, or else I would have nothing more to do with him. + +It was not without some misgivings that I thus undertook to make a man +of nearly sixty change his lifelong habits of eating. That is +something which I consider no physician has a right to do unless there +is some very imperative reason for it. Here was, however, a desperate +case. It was in the late afternoon particularly that this patient +craved drink so much that he could not deny himself. As he ate but +very little breakfast and had a hasty scanty lunch, he was at the very +bottom of his physical resources at that time, and at the end of a +rather demanding day's work. We had {159} to break up his other habits +in the hope of getting at the craving. He had taken coffee and a roll +for breakfast. I dictated a cereal, two eggs and several rashers of +bacon and several rolls. I insisted on fifteen minutes in the open +before lunch and then a hearty lunch with some substantial dessert at +the end of it. This man proceeded to gain at the rate of a little more +than three pounds a week. By the end of two months, he weighed about +one hundred and eighty pounds and had not touched a drop of liquor in +that time and felt that he had no craving for it. That is some ten +years ago, and there has been no trouble with his alcoholic cravings +since. He has maintained his weight; he says that he never felt so +well and that above all he now has no more of that intense tiredness +that used to come to him at the end of the day. Every now and then he +says to me in musing mood,--"And to think that I had never learned to +eat enough!" + +For these very tired feelings so often complained of by nervous +patients, once it has been decided that there is no organic +trouble--for of course kidney or heart or blood pressure affections +may readily cause them--there are just two things to be considered: +These are {160} flat-foot or yielding arch, and undereating. When +there is a combination of these two, then tiredness may well seem +excessive and yet be readily amenable to treatment. Persons with +occupations which require standing are especially liable to suffer in +this way. + +Undereating in the evening is especially important for many nervous +people and is often the source of wakefulness. It is the cause of +insomnia, not so much at the beginning of the night, as a rule, as in +the early morning. Many a person who wakes at four or five and cannot +go to sleep again is hungry. There is a sense of gone-ness in the +stomach region in these cases, which the patients are prone to +attribute to their nerves in general, or some of them who have had +unfortunate suggestions from their physicians may talk of their +abdominal brain; but it is surprising how often their feelings are due +simply to emptiness. Any thin person particularly who has his last +meal before seven and does not go to bed until after eleven should +always take something to eat before retiring. A glass of milk or a cup +of cocoa and some crackers or a piece of simple cake may be +sufficient, but it is important to eat enough. Animals and men +naturally get sleepy after eating and do not sleep well if their {161} +stomachs are empty. Children are the typical examples. We are all only +children of a larger growth in this regard. + +When the last meal is taken before seven and people do not go to bed +until nearly twelve, as is frequently the case in large cities, the +custom of having something to eat just before bed is excellent for +sleep. I have known the establishment of this habit to afford marked +relief in cases of insomnia that had extended over years. The people +in my experience who sleep the worst are those who, having taken a +little cambric tea and some toast and preserves with perhaps a piece +of cake for supper, think that this virtuous self-control in eating +ought to assure them good rest. It has just the opposite effect. +Disturbed sleep, full of dreams and waking moments, is oftener due to +insufficient eating than to overeating. The people whom I know who +sleep the best and from whom there are no complaints of insomnia, are +those who, having eaten so heartily at dinner that they get to the +theater a little late, attend the Follies or some late show for a +while and then go round to one of the Broadway restaurants and chase a +Welsh rarebit or some lobster a la Newburg, with a biscuit Tortoni or +a Pêche Melba down {162} to their stomachs and then go home to sleep +the sleep of the just. + +Just as there are bad habits of eating too little that are dangerous +and must be corrected by the will so there are bad habits of eating +too much that can only be corrected in the same way. While it is +dangerous to be under weight in the early years of life, it is at +least as dangerous to be overweight in middle life. With the variety +and abundance of food now supplied at a great many tables, it is +comparatively easy for people in our time to eat too much. The result +is that among the better-to-do classes a great many people suffer from +obesity, sometimes to such an extent that life is made a burden to +them. There is only one way to correct this and that is to eat less +and of course to exercise more. Reduction in diet means the breaking +of a long established habit and that of course is often hard. The +whole family may have to set a good example of abstinence from too +great a variety of food and especially from the richer foods, in order +that a parent may be helped to prevent further development of obesity +and to lose gently and gradually some of the overweight that is being +put on, and which now, by conserving heat and slowing up metabolism +{163} generally within the body, makes it so easy for even reduced +quantities of food to maintain the former habit of adding weight. + +In this matter of obesity, however, just exactly as in the case of +tuberculosis for those who are underweight, prevention is much better +than cure. The people who know that they inherit such tendencies +should be particularly careful not to form habits of eating that will +add considerably to their weight. After all, it is not nearly so +difficult a matter as is often imagined. There is no need, unless in +very exceptional cases, of denying one's self anything that is liked +in the ordinary foods, only less of each article must be eaten. Even +desserts need not be entirely eliminated, for ices may be taken +instead of ice cream; sour fruits and especially those of the citrus +variety--oranges and grapefruit--and the gelatine desserts may be +eaten almost with impunity. The phrase "eat and grow thin" has +deservedly become popular in recent years because as a matter of fact +it is perfectly possible to eat heartily and above all to satisfaction +without putting on weight. It is, of course, harder to lose weight, +but even that may be accomplished gradually under proper direction if +there is the persistent will to do it. + +{164} + +In recent years another disease has come to attract attention which +represents the result of an overindulgence in food materials that can +be limited without much difficulty. This is diabetes which used to be +comparatively rare but has now become rather frequent. An authority on +the disease declared not long since that there are over half a million +people in this country now who either have or will have diabetes as +the result of the breaking down of their sugar metabolism. It is not +surprising that the disease should be on the increase, for the +consumption of sugar has multiplied to a very serious degree during +the last few generations. A couple of centuries ago, those who wanted +sugar went not to the grocery store, but to the apothecary shop. It +was kept as a flavoring material for children's food, as a welcome +addition to the dietary of invalids and the old, and quite literally +as a drug, for it was considered to have, as it actually has, to a +slight extent at least, some diuretic qualities that made it valuable. +A little more than a century ago, a thousand tons of sugar sufficed +for the whole world's needs, while the year before the war, the world +consumed some twenty-two million of tons of sugar. It is said that +every man, woman, and {165} child in the United States consumed on the +average every day a quarter of a pound of sugar. + +Our candy stores have multiplied, and while two generations ago the +little candy stores sold candies practically entirely for children, +eking out their trade with stationery and newspapers and school +supplies, now candy stores dealing exclusively in confectionery are +very common. There are several hundred stores in the United States +that pay more than $25,000 a year rent, though they sell nothing but +candy and ice-cream sodas. Corresponding with the increase in the sale +of candy has come also the consumption of very sweet materials of +various kinds. French pastries, Vienna tarts, Oriental sweetmeats, +Turkish fig paste, Arabian date conserves, and West Indian guava +jelly, are all familiar products on our tables. Chocolate has become +one of the important articles of world commerce, though almost unknown +beyond a very narrow circle a little more than a century ago. Tea and +coffee have been introduced from the near and the far East and by a +Western abuse consumed with such an amount of sweetening as make them +the medium of an immense consumption of sugar. + +There is no doubt that unless good habits {166} of self-denial in this +regard are formed, diabetes, which is an extremely serious disease, +especially for those under middle life, will continue to increase in +frequency. The candy and sugar habit is rather easy to form; every one +realizes that it is a habit, but it is sometimes almost as hard to +break as the tobacco habit. We were meant to get our sugar by the +personal manufacture of it from starch substances. If a crust of bread +is chewed vigorously until it swallows itself, that is, dissolves in +the secretions and gradually disappears, it will be noted that there +is a distinctly sweetish taste in the mouth. This is the starch of the +bread being changed into sugar. We were expected by nature to make our +own sugar in this way, but this has proved too slow and laborious a +way for human nature to get all the sugar it cared for, so most people +prefer to secure it ready made. Sugar is almost as artificial a +product as alcohol and is actually capable of doing almost as much +harm as its not distantly related chemical neighbor. It is rather +important that good habits in the matter should be formed and we have +been letting ourselves drift into very unfortunate habits in recent +years. + + +{167} + +CHAPTER XI + +THE PLACE OF THE WILL IN TUBERCULOSIS + + + "And like a neutral to his will and matter + Did nothing." + _Hamlet_. + + +Probably the very best illustration in the whole range of medicine of +the place of the will in the cure of disease is afforded by +tuberculosis. This used to be the most fatal of all human affections +until displaced from its "bad eminence" within the last few years by +pneumonia, which now carries off more victims. As it is, however, +about one in nine or perhaps a few more of all those who die are +victims of tuberculosis. This high mortality would seem to indicate +that the disease must be very little amenable to the influence of the +will, since surely under ordinary circumstances a good many people +might be expected to have the desire and the will to resist the +affection if that were possible. In spite of the large death rate this +is exactly what is true. + +{168} + +Tuberculous infections are extremely common, much commoner even than +their high mortality reveals. After long and critical discussion with +a number of persistent denials, it is now generally conceded by +authorities in the disease that the old maxim "after all, all of us +are a little tuberculous" is substantially correct. Very few human +beings entirely escape infection from the tubercle bacillus at some +time in life. The great majority of us never become aware of the +presence of the disease and succeed in conquering it, though the +traces of it may be found subsequently in our bodies. Careful +autopsies reveal, however, that very few even of those who did not die +directly from tuberculosis fail to show tuberculous lesions, usually +healed and well shut off from the healthy tissues, in their bodies. +One in eight of those who become infected have not the resistive +vitality to throw off the disease or the courage to face it and take +such precautions as will prevent its advance. All those, however, who +give themselves any reasonable chance for the development of +resistance survive the disease though they remain always liable to +attack from it subsequently if they should run down in health and +strength. + +{169} + +Heredity, which used to be supposed to play so important a rôle in the +affection, is now known to have almost nothing to do with the spread +of the disease. Family tendencies are probably represented by nothing +more than a proneness to underweight which makes one more liable to +infection, and this is due as a rule to family habits in the matter of +undernourishment from ill-advised consumption of food. Probably a +certain lack of courage to face the disease boldly and do what is +necessary to develop bodily resistance against it may also be an +hereditary family trait, but environment means ever so much more than +heredity. + +There is a well known expression current among those who have had most +experience in the treatment of patients suffering from tuberculosis +that "tuberculosis takes only the quitters", that is to say that only +those succumb to consumption who have not the strength of will to face +the issue bravely and without discouragement to push through with the +measures necessary for the treatment of their disease. In a word it is +only those who lack the firmness of purpose to persist in the mode of +life outlined for them who eventually die from their affection of the +{170} lungs. No specific remedy has been found that gives any promise +of being helpful, much less of affording assured recovery, though a +great many have been tried and not a few are still in hopeful use. +Recent experience has only served to emphasize the fact that the one +thing absolutely indispensable for any successful treatment of +tuberculosis of the lungs is that the patient should regain weight and +strength and with them resistive vitality so as to be able to overcome +the disease and get better. + +To secure this favorable result two conditions of living are necessary +but they must be above all persisted in for a considerable period. +First there must be an abundance of fresh air with rest during the +advancing stage or whenever there are acute symptoms present, and +secondly an abundance of good food which will provide a store of +nutritive energy and make the resistive vitality as high as possible. +Curiously enough this "fresh air and good food" treatment for the +disease was recognized as the sheet anchor of the therapeutics of +consumption as long ago as Galen's time, the end of the second +century, when that distinguished Greek physician was practising at +Rome. Nearly eighteen hundred {171} years ago Galen suggested that he +had tried many remedies for what he called phthisis, the Greek +equivalent of our word consumption or wasting away, and had often +thought that he had noted a remedial value in them, but after further +experience he felt that the all-important factors for cure were fresh +air and good food. He even went so far as to say that he thought the +best food of the consumptive or the phthisical, as he called them, was +milk and eggs. A great deal of water has flowed under the bridge of +medical advance since his time and at many periods since physicians +have been sure that they had valuable remedies for consumption; yet +here we are practically back at Galen's conclusion more than fifty +generations after his time, and we are even inclined to think of this +mode of treatment as comparatively new, as it is in modern history. + +The influence on consumption of the will to get well when once aroused +was typically exemplified in the career of the well-known London quack +of the beginning of the nineteenth century, St. John Long. He set +himself up as having a sure cure for consumption. He was a charlatan +of the deepest dye whose one idea was to make money, and who knew +{172} nothing at all about medicine in any way. He took a large house +in Harley Street and fitted it up for the reception of people anxious +to consult him. For some seasons every morning and afternoon the +public way was blocked up with carriages pressing to his door. Nine +out of ten of his patients were ladies and many of them were of the +highest rank; fashion and wealth hastened to place themselves and +their daughters at the mercy of the pretender's ignorance. His mode of +treatment was by inhalation. He assured his patients that the +breathing in of this medicated vapor would surely cure their pulmonary +disease, and because others were intent on going they went; many of +them were greatly benefited for a time and these so-called cures +proved a bait for many other patients. + +J. Cordy Jeaffreson in his volume "A Book about Doctors", written two +generations ago, has told the story of St. John Long's successful +application of the principle of community of treatment and its +effectiveness upon his patient. Like Mesmer he realized that treating +people in groups led them mutually to influence each other and to +bring about improvement. St. John Long {173} had in one of the rooms +in Harley Street "two enormous inhalers, with flexible tubes running +outward in all directions and surrounded by dozens of excited women-- +ladies of advanced years and young girls giddy with the excitement of +their first London season--puffing from their lips the medicated vapor +or waiting until a mouthpiece should be at liberty for their pink +lips." In our generation of course we had various phases of similar +treatment, including nebulizers and compressed air apparatus and +medicated vapor, all working wonders for a while, and then proving to +have no physical beneficial effect. + +What is surprising is to find the number of cures that were worked. +St. John Long had so many applicants for attention that he was +literally unable to give heed to all of them. The news of the +wonderful remedy flew to every part of the United Kingdom and from +every quarter sick persons, wearied of a vain search after an +alleviation of their sufferings, flocked to London with hope renewed +once more. This enabled St. John Long to select for treatment only +such cases as gave ready promise of cure. He made it a great +preliminary of his treatment that his {174} patients should eat well +as a rule and on one occasion when he was called into the country to +see a man suffering in the last stages of consumption he said quite +frankly, "Sir, you are so ill that I cannot take you under my charge +at present. You want stamina. Take hearty meals of beefsteak and +strong beer; and if you are better in ten days I will do my best for +you and cure you." + +It is easy to understand that if he made it a rule for his consumptive +patients that they should eat well or not expect relief from his +medicine he would secure a great many good results. Especially would +this be true in many cases that came up to him from the country, had +the advantage of a change of climate, and of environment and very soon +found that they had much more strength than they thought they had. +They had been dreading the worst, they were now led to hope for the +best; they took the brake off their will, they fed well and it was not +long then before they proceeded to get well. + +As even a little experience with consumptive patients shows it is +often difficult for them to follow directions--and keep it up--in the +matter of fresh air and good food and here is where the question of +the will in the {175} treatment is all important. Many a consumptive +has in early life formed bad habits with regard to eating, especially +in the direction of eating too little and refusing for some reason or +other to take what are known to be the especially nutritious foods. +Not infrequently indeed it is their neglect of nutrition in this +regard that has been the principal predisposing factor toward the +development of the disease. This bad habit must be overcome and often +proves refractory. + +Then it is never easy to give up the pursuit of a chosen vocation and +pursue faithfully for a suitable period the humdrum monotonous +existence of prolonged rest every day in the open air with eating and +sleeping as almost the only serious interests, if indeed they can be +called such, permitted in life. It is only those who have the will +power to follow directions faithfully, whole-heartedly and +persistently who have a reasonable prospect of getting ahead of their +disease and eventually securing such a conquest of it as will enable +them to return to their ordinary life as it was before the development +of tuberculosis. + +Unless patients are ready to follow directions as regards outdoor air +and good food the {176} cure, or as specialists in tuberculosis prefer +to call it the arrest of symptoms in the disease, is almost out of the +question. Above all it is extremely important that those who suffer +from pulmonary tuberculosis should be ready to follow directions at an +early stage of their disease, before any serious symptoms develop, for +it is then that most can be done for them. Many a sufferer from +tuberculosis makes his or her cure extremely difficult, certainly ever +so much more difficult than it would otherwise have been, because the +dread of going to see a physician--lest they should be told that their +affection is really consumption and demands immediate strenuous +treatment--causes them to put off consultation with some one whose +opinion in the matter is reliable. + +This is indeed one of the principal reasons why tuberculosis of the +lungs still continues to carry off so many victims every year,-- +because people are afraid to learn the truth. They dare not put the +question to a definite issue and refuse to believe the possibility +that certain disturbing symptoms represent developing tuberculosis. +They defer seeing an expert; they take this and that suggestion from +friends; they buy cough remedies which {177} they see advertised, +sometimes they tinker with so-called "consumption cures." After a +while an advance of their symptoms makes it absolutely necessary to +see a physician but often by this time their disease has progressed +from an incipient case rather easy to be treated and with an excellent +prognosis to a more advanced stage at which cure is ever so much more +difficult; or by this time it may even prove that their strength has +been seriously sapped and they have not enough resistive vitality left +to bring about reaction toward the cure. + +The all-important thing for all those who have at any time lived near +consumptives, whether relatives or others--for the disease is almost +invariably acquired and not hereditary--or who have worked for any +prolonged period in more or less intimate contact with those who had a +chronic cough or who subsequently developed tuberculosis, is that on +the first symptom that is at all suspicious they should make up their +minds to have the question as to whether they have tuberculosis or not +definitely settled and that they should be ready to do what they are +told in the matter. The first symptom is not a persistent cough as so +many think, nor continued loss of {178} weight, which is an advanced +sign as a rule, but a continued rapidity of pulse for which no +non-pulmonary reason can be found. + +The old idea that consumptives should not be told what their affection +was, lest it should disturb their minds and discourage them so much as +to do them harm, has now been abandoned by practically all those of +large experience in the care of the tuberculous. The opposite policy +of being perfectly candid and making the patients understand their +serious condition and the importance of taking all the measures +necessary for cure, yet without permitting them to be unnecessarily +scared, has been adopted. Their will to get well must be thoroughly +aroused. After all, it must be recalled that tuberculosis is an +extremely curable disease. It is now definitely known that more than +ninety per cent. of humanity have at some time had a tuberculosis +process, that is to say a focus of tuberculosis active within their +tissues. Only about one in nine of the deaths in civilized countries +is from tuberculosis. That means that at least eight other people who +have not died from the disease but from something else have had the +affection, yet have recovered from it. Instead of the old shadow of +{179} heredity with its supposedly almost inevitable fatality, so that +young people who saw their brothers and sisters or other relatives +around them die from the disease felt that they were doomed, we now +know that the hereditary factor plays an extremely minor role if +indeed it plays any serious rôle at all in the development of the +disease. + +No affection is so amenable to the state of mind and the will to be +well as tuberculosis. That is exactly the reason why so many remedies +have come into vogue and apparently been very successful in its +treatment and then after a while have proved to be of no particular +service or even perhaps actually harmful so far as their physical +effect is concerned. It cannot be too often repeated that anything +whatever that a patient takes that will arouse new hope and give new +courage and reawaken the will will actually benefit these patients. No +wonder then that scarcely a year passes without some new remedy for +tuberculosis being proposed. All that is needed to affect favorably +patients suffering from the disease is to have some good reason +presented which makes them feel that they ought to get better and then +at once they eat better and proceed to increase {180} their resistive +vitality. The despondency that comes with the lack of the will to be +well hurts their appetite particularly and no tuberculosis patient can +ever hope to recover health unless he is eating heartily. With better +eating there is always a temptation to be more outdoors and the +ability to stand cooler air which always means that the lungs are +given their opportunity to breathe fresh cool air which constitutes +absolutely the best tonic that we have for the affection. + +It has been recognized in recent years that the only climates which +give reasonable hope of being helpful for the tuberculous are those +which present a variation of some thirty degrees in their temperature +every day. Whenever this is the case chilly feelings are always +produced in those who are exposed to the change, even though the lower +temperature curve may not go down to anywhere near freezing. If for +instance the temperature at the hottest hour of the day, say three +o'clock in the afternoon, is 90° F. and that of the later evening or +middle of the night is 60° F., chilly feelings will be produced. Just +the same thing is true if the temperature is between 30° F. and 40° F. +shortly after the middle of the day and then goes down to {181} near +zero at night. These chilly feelings are uncomfortable, but they +produce an excellent reaction in the circulation and set the blood +coursing from the heart to the tissues better than any medicine that +we have. In the midst of this the lungs have their resistive vitality +raised so as to throw off the disease. + +This is probably one of the principal reasons why mountain climates +have been found so much more helpful for the treatment of tuberculosis +than regions of lower elevations. Whenever the elevation is more than +fifteen hundred feet there will almost invariably be a variation of +thirty degrees between the day and the night temperature. There are of +course still greater variations, even sixty or seventy degrees +sometimes where the altitudes are very high, but this is often too +great for the tuberculous patients to react properly to, in their +rundown conditions. Besides, the air is much rarer at the higher +elevations, breathing is more difficult, because the lungs have to +breathe more rapidly and more deeply in order to secure the amount of +oxygen that is needed for bodily necessities from the rarified air. +The middle elevations then, between fifteen hundred and twenty-five +{182} hundred feet, have been found the best for tuberculosis +patients, and they are very pleasant during the summer time, though +never without the chilly discomfort of the drop in temperature. During +the fall and winter, however, many patients become tired out trying to +react to these variations of temperature and want to seek other +climates where they will not have to submit to the discomfort and the +chilly feelings. If they come down to more comfortable quarters before +their tuberculosis has been brought to a standstill by the increase of +their resistive vitality, it is very probable that they will lose most +of the benefit that they derived from their mountain experience. Here +is where the will comes in. Those who have the will to do it and the +persistence to stick at it and the character that keeps them in good +humor in spite of the discouraging circumstances which almost +inevitably develop from time to time, will almost without exception +recover from their tuberculosis with comparatively little difficulty, +if they have only taken up the treatment before the disease is so far +advanced as to be beyond cure. + +In the older days consumptives used to be sent to the Riviera and to +Algiers and to {183} other places where the climate was comparatively +equable, with the idea that if they could only avoid the chilly +feelings consequent upon variations of temperature it would be better +for them. Many of the disturbing symptoms of tuberculosis are rendered +less troublesome in such a climate, but the disease itself is likely +to remain quiescent at best or perhaps even to get insidiously worse, +as tuberculosis is so prone to do. These milder climates require much +less exercise of the will, but that very fact leaves them without the +all-important therapeutic quality which the lower altitudes possess. + +For many people the outdoor life and the sight of nature in the +variations produced in scenery during the course of the days and the +seasons are satisfying enough to be helpful in making their cure of +tuberculosis easy. They are extremely fortunate if they have this +strong factor in their favor. It is very probable that we owe the +discovery of the value of the Adirondacks and other such medium +altitudes in the treatment of tuberculosis to the fact that Doctor +Trudeau liked the outdoors so much and was indeed so charmed with the +Adirondack region that when death from tuberculosis seemed {184} +inevitable, he preferred the Saranac region as a place to die in, in +spite of the hardships and the bitter cold from which at that time +there was so little adequate protection, to the comforts of the city. +He scarcely hoped for the miracle of cure from a disease which he as a +doctor knew had carried off so many people, but if he were to die he +felt that he would rather die in the face of nature with his beloved +mountains all around him than in the shut-in spaces of the city. + +His resolution to go to the Adirondacks seemed to many of those who +heard of it scarcely more than the caprice of a man whom death had +marked for itself. His physicians surely had no hope of his journey +benefiting him but they felt very probably that in the conditions he +might be allowed to have this last desire since there were so few +other desires of life that he was likely to have fulfilled. His will +to live outdoors in spite of the bitter cold of that first winter +undoubtedly saved his life and then he evolved the system of outdoor +treatment which has in the past fifty years saved so many lives and is +now the recognized treatment for the disease. It is easy to +understand, however, how much of firm determination was required {185} +on his part forty years ago, when there were no comfortable ways of +getting into the Adirondacks, when the last stage of the journey had +to be made for forty miles on a mattress in a rough wagon, when water +for washing had to be secured by breaking the ice in the pitcher or on +the lake and when the bitter climate must have been the source of +almost poignant torture to a man constantly running a slight +temperature. He had the courage and the will power to do it and the +result was not only his own survival but a great benefit secured for +others. + +Unfortunately many a consumptive patient who during his first period +of treatment keeps to the letter the regulations for outdoor air and +abundant food fails to do so if it is necessary to come back a second +time. Persistency is here a jewel indeed and only the persistent win +out. Many an arrested case fails to keep the rules of living that may +be necessary for years afterwards and runs upon relapse. The will to +do what is necessary is all-important. Trudeau himself, after securing +the arrest of his disease in the Adirondacks, though he lived and +worked successfully to almost seventy years of age, found it quite +impossible to live out of them {186} and often had to hurry back from +even comparatively brief visits to the lowlands. Besides, every now +and then during some forty years he had the will power to take his own +prescription of outdoor air and absolute rest. It was the faculty to +do this that gave him length of life far beyond the average of +humanity and the power to accomplish so much in spite of the invasion +of the disease which had rendered large parts of both lungs +inoperative. Not only did he live on, however, but he succeeded in +doing so much valuable work that few men in the medical profession of +America have stamped their name deeper on modern medical science than +this consumptive who had constantly to use his will to keep himself +from letting go. + + +{187} + +CHAPTER XII + +THE WILL IN PNEUMONIA + + + "Who shall stay you?--My will, not all the world." + _Hamlet_. + + +What is true of tuberculosis and the influence of the will has proved +to be still more true, if possible, of pneumonia. Clinical experience +with the disease in recent years has not brought to us any remedy that +is of special value, nor least of all of specific significance, but it +has enabled us to understand how individual must be the treatment of +patients suffering from pneumonia. We have recognized above all that +mentally disturbing factors which lessen the patient's courage and +will to live may prove extremely serious. We hesitate about letting an +older person suffering from pneumonia learn any bad news and +particularly any announcement of the death of a near relative, above +all, a husband or wife. The shock and depression consequent upon any +such announcement may {188} prove serious or even fatal. The heart +needs all its power to accomplish its difficult task of forcing blood +through the limited space left free in the unaffected lung tissue, and +anything which lessens that, that is anything which _disheartens_ the +patient, to use our expressive English phrase, must be avoided as far +as possible. + +When a man of fifty or beyond, one or more of whose friends has died +of pneumonia about his age, comes down with the disease and learns, as +he often will in spite of the best directed effort to the contrary, +that he is suffering from the affection, if he is seriously disturbed +by the knowledge, we realize that it bodes ill for the course of the +disease. If a pneumonia patient, especially beyond middle life, early +in the case expresses the thought that perhaps this may be the end and +clings at all insistently to that idea, the physician is almost sure +to feel little confidence of pulling him through the illness. In +probably no disease is it more important that the patient's courage +should be kept up and that his will should help rather than hamper. + +Courage is above all necessary in pneumonia because the organs that +are most affected and have most to do with his recovery are so much +{189} under the control of the emotions. Any emotional disturbance +will cause the heart to be affected to some extent and the respiration +to be altered in some way. When a pneumonia patient has to lie for +days watching his respirations at forty to the minute, though probably +he has never noticed them before, and feels how his heart is laboring, +no wonder that he gets scared, and yet his scare is the very worst +thing that can happen to him. It will further disturb both his heart +and his respiration and leave him with less energy to overcome the +affection. He may be tempted to make conscious efforts to help his +lungs in their work, though any such attempt will almost surely do +more harm than good. He must just face the inevitable for some five to +nine days, hope for the best all the time and keep up his courage so +as not to disturb his heart. After middle life only the patients who +are capable of doing that will survive the trial that pneumonia gives. +The super-abounding energy of the young man will carry him through it +much better; and besides, the young man usually has much less +solicitude as to the future and much less depending on his recovery. + +A generation ago or even less, whiskey or {190} brandy or some form of +strong, alcoholic stimulant, as it was called, was looked upon as the +sheet anchor in pneumonia. For a generation or more at that time, the +same remedy had been looked upon by a great many physicians as an +extremely precious resource in the treatment of tuberculosis. The +therapeutic theory behind the practice was that in affections of the +lungs a particular strain was placed upon the heart and therefore this +organ needed to be stimulated just as far as could be done with +safety. As alcohol increases the rapidity of the heart beat, it was +considered to be surely a stimulant and came to be looked upon as the +safest of heart stimulants, because, except when used over very long +periods, direct bad effects had not been noticed. In pneumonia, above +all, the heart needed to be stimulated because it had to pump blood +through the portion of the lungs unaffected by the pneumonia, usually +congested and offering special hindrances to the circulation; besides, +a much larger amount of blood than usual had to be pumped through +these portions of the lungs in order to compensate for the solidified +portions. + +A number of very experienced physicians came to be quite sure that +alcoholic stimulants {191} were the most valuable remedy that we had +for this special purpose of cardiac stimulation; some of them went so +far as to say, with a well known New York clinician, that if they were +to be offered all the drugs of the pharmacopeia without alcoholic +stimulant for the treatment of pneumonia on the one hand, or whiskey +or brandy on the other without all the pharmacals, they would prefer +to take the alcohol, confident that it would save more patients for +them. They were quite sure that they had made observations which +justified them in this conclusion. + +We know at the present time that alcohol is not a stimulant but always +a narcotic. It increases the rapidity of the heart beat, though not by +direct stimulation, but by disturbing the inhibitory nerve apparatus +of the heart and thus permitting the heart to beat faster. Just as +there is a governor on a steam engine, to keep it from going too fast +and regulate its speed to a definite range, so there is a similar +governing apparatus or mechanism in connection with the heart. It is +by affecting this that alcohol makes the heart go faster. Blood +pressure is not raised, but on the contrary lowered, and the effect of +alcohol is depression and not stimulation. {192} In spite of this, +good observers seemed to note favorable effects from the use of +alcohol in both pneumonia and tuberculosis. This appears to be a +paradox until one analyzes the psychic effects of alcohol and places +them alongside the physical, in order to determine the ultimate +equation of the influence of the substance. + +Alcohol has a very definite tendency to produce a state of euphoria, +that is, of well-being. The patient's mind is brought to where it +dismisses solicitude with regard to himself. This neutralizes directly +the anxiety which so often acts as a definite brake upon resistive +vitality. The alcoholic stimulant, in so far as it has any physical +effect, probably does a little harm, but its influence on the mind of +the patient not only serves to neutralize this, but adds distinctly to +the patient's prospects of recovery. Without it, the dread which comes +over him paralyzes to some extent at least his heart activity and +interferes with lung action. Under the influence of alcohol, he gains +courage--artificial, it is true--but still enough to put _heart_ in +him, and this is the stimulation that the older clinical observers +noted. The patient can, with the scare lifted, use his will to be well +{193} ever so much more effectively and psychic factors are +neutralized that were hampering his resistive vitality. + +This illustrates very well indeed the place of dilute alcohol in some +of the usual forms in therapeutics about the middle of the nineteenth +century. Practically all the textbooks of medicine at that time +recommended alcohol for many of the continued fevers. In sepsis, in +child-bed fever, in typhoid, in typhus, as well as in tuberculosis and +pneumonia and other less common affections, whiskey or brandy was +recommended highly and usually given in considerable quantities. All +of these affections are likely to be accompanied by considerable +anxiety and solicitude with a series of recurring dreads that sadly +interfere with nature's efforts toward recovery. Under certain +circumstances, the scare, to use the plain, simple word, was +sufficient to turn the scale against the patient. The giving of +whiskey at least lifted the scare [Footnote 5] {194} and enabled the +patient to use his vital resources to best advantage. + + [Footnote 5: The use of whiskey for snake-bite probably has no other + significance than this lifting of the scare. It used to be said that + the alcoholic stimulation neutralized the depressant effect of snake + poisoning on the heart. Now we know that this is not true, and in + addition, we know of no effect that alcohol in the system might have + in neutralizing the presence of the toxic albumin which constitutes + the danger in snake poisoning. It is only rarely that the bite of a + rattlesnake will be fatal. Experts declare that the snake must be a + large one, its sting must be inflicted on the bare skin, it must not + have stung any one so as to empty its poison glands for more than + twenty-four hours, and the full dose of the poison must be injected + beneath the skin for the bite to be fatal. Very rarely are all these + conditions fulfilled. When a person is bitten by a snake, however, + the terror which ensues is quite sufficient of itself to hurt the + patient seriously and he may scare himself to death, though the + snake poison would not have killed him. The whiskey lifts the scare + and gives nature a chance to neutralize the poison which she can + usually do successfully.] + +It is extremely important, then, first to be sure that the patient's +will to be well is not hampered by unfortunate psychic factors and +secondly, that his courage shall be stimulated to the greatest +possible degree. Fresh air is the most important adjuvant for this +that we have. The outdoor air gives a man the courage to dissipate +dreads and makes him feel that he can accomplish what seemed +impossible before. Undoubtedly this is one of the favorable effects of +the fresh-air treatment of pneumonia, for it makes people mentally +ever so much less morbid. The patient's surroundings must be made as +encouraging as possible and there must be no signs of anxious +solicitude, no long faces, no weeping, and as far as possible, no +disturbance about business affairs that might make him think that a +fatal termination was {195} feared. His will to get well must be +fostered in every possible way and obstacles removed. This is why it +has been so well said in recent years that good nursing is the most +important part of the treatment of pneumonia. This does not mean that +a good nurse can replace a physician, but that both must coordinate +their efforts to making the patient just as comfortable as possible, +so that he will feel assured that everything that should be, is being +done for him, and that it is only a question of being somewhat +uncomfortable for a few days and he will surely get well. + +Sunny rooms, smiling faces, flowers at his bedside, cheerful +greetings, all these, by adding to the patient's euphoria, bolster up +his will and make him feel that after all, thousands of people have +suffered from pneumonia and recovered from it, and there is no reason +why he should not, provided that he will not interfere with his own +recovery. + + +{196} + +CHAPTER XIII + +COUGHS AND COLDS + + + "The power and corrigible authority of this lies in our wills." + _Othello_. + + +It might seem as though the will had nothing to do with such very +material ailments as coughs and colds, and yet the more one knows +about them, the clearer it becomes that their symptoms can be +lessened, their duration shortened, their tendencies to complications +modified, and to some extent at least, they can be almost literally +thrown off by the will to be well. The idea of a little more than a +generation ago that coughs and colds would be most benefited by +confinement to the house and as far as possible to a room of an +absolutely equable temperature has gradually given way before the +success of the open-air treatment for tuberculosis and the meaning of +fresh air in the management of pneumonia cases. Fresh, cold air is +always beneficial to the lungs, no matter what the conditions present +in them, though it requires {197} no little courage and will power to +face the practical application of that conclusion in many cases. When +it is bravely faced, however, the results are most satisfactory, and +the respiratory condition, if amenable to therapeutics, is relieved or +proceeds to get better. Of course it is well understood that any and +every patient who has a rise in temperature, that is whose temperature +is above 100° F. in the later afternoon hours, should be in bed. Under +no circumstances must a person with any degree of fever move around. +This does not mean, however, that such patients should not be +subjected to fresh, cold air. The windows in their room or the ward in +which they are treated should be open, and if the condition is at all +prolonged, arrangements should be made for wheeling their beds out on +the balcony or placing them close to a window. The cold air gives them +distinctly chilly feelings and sometimes they complain of this, but +they must be asked to stand it. Of course if the cold disturbs their +circulation, if the feet and hands get cold and the lips blue, the +patients are not capable of properly reacting against the cold and +must not be subjected to it. Their subjective feelings of chilliness, +however, must {198} not be sufficient to keep them from the ordeal of +cold, fresh air; on the contrary, they must be told of the benefit +they will receive from it and asked to exert their wills to stand the +discomfort with just as little disturbance as possible. + +People suffering from coughs, no matter how severe, should get out +into the air regularly, if they have no fever, and should go on with +their regular occupation unless that occupation is very confining or +is necessarily conducted in dusty air. Keeping to the house only +prolongs the affection and makes it much more liable to complications +than would otherwise be the case. Sufferers from these affections +should not go into crowds, should avoid the theaters and crowded cars, +partly for the sake of others--because they can readily convey their +affection to them--but also for their own sake, because they are more +susceptible to other forms of bacteria than those already implanted in +their own systems and they are much more liable to pick up foreign +bacteria in crowds than anywhere else. They should be out in the open +air, particularly in the sunlight, and this will do more to shorten +the course of a cough and cold than anything else. + +{199} + +They need more sleep than before and should be in bed at least ten or +eleven hours in the day, though if they should not sleep during all of +that time, they need not feel disturbed but may read or knit or do +something else that will occupy them while they retain a recumbent +position. They should not indulge in long, tiresome walks and in +special exertion, but should postpone these until the cough has given +definite signs of beginning to remit. + +With regard to the cough itself, it must not be forgotten that the +action of coughing is for the special purpose of removing material +that needs to be cleared from the lungs and the throat and larynx. It +should not be indulged in except for that purpose. It requires a +special effort, and while the lungs and other respiratory passages are +the subject of a cold, these extra efforts should not be demanded of +them unless they are absolutely necessary. Almost needless to say, +people indulge in a great deal of unnecessary coughing. Some of this +is a sort of habit and some of it is due to that tendency to imitate, +so common in mankind. Every one has surely heard during religious +services, in a pause just after heads have been bowed in prayer or for +a {200} benediction, a single cough from a distant part of the church +which seemed to be almost the signal for a whole battery of coughs +that followed immediately from every portion of the edifice. If some +one begins coughing during a sermon or discourse, others will almost +inevitably follow. Coughing, like yawning, is very liable to +imitation. + +The famous rule of an old-time German physician was that no one was +justified in coughing or scratching the head unless these activities +were productive. Unless you get something as the result of the +coughing, it should not be indulged in. There are a great many people +who cough much more than necessary and who delay the progress of their +betterment in that way. Whenever material is present to be coughed up, +coughing is not only proper but almost indispensable. It is the +imitative cough, the coughs which indicate overconsciousness of one's +affection, the coughs that so often almost unconsciously are meant to +catch the sympathy of those around, which must be repressed by the +will, and when the patient finds that he really has to cough less than +he thinks, he will be quite sure that he is getting better and will +actually improve as a consequence of this feeling. + +{201} + +Coughs need an abundance of fluid much more than medicine, and warm +fluids are better than cold; the will must be exercised so as to +secure the taking of these regularly. At least a quart of warm liquid, +milk if one is not already overweight, should be taken between meals +during the existence of a cough. Hot milk taken at night will very +often secure much better rest with ever so much less coughing than +would otherwise be the case. The tendency to take cough remedies which +lessen the cough by their narcotic effect always does harm. Coughing +is a necessary evil in connection with coughs, and whatever +suppression there is should be accomplished by means of the will. +Remedies that lessen the coughing also lock up the secretions and +disturb the system generally and therefore prolong the affection and +do the patient harm. Most of the remedies that are supposed to choke +off a cough have the same effect. Quinine and whiskey have been very +popular in this regard but always do harm rather than good. Their use +is a relic of the time when whiskey was employed for almost every form +of continued fever and when quinine was supposed to be good for every +febrile affection. We know now that quinine has no effect {202} except +upon malarial fevers, and then only by killing the malarial organism, +and that whiskey is a narcotic and not a stimulant and does harm +rather than good. Those who did not take the familiar Q. and W. have +in recent years had the habit of administering to themselves or to +their friends various laxative or anodyne or antiphlogistic remedies +that are supposed to abort a cough or cold and above all, prevent +complications. All of these remedies do harm. Every single one of +them, even if it makes the patient a little more comfortable for the +time, produces a condition that prevents the system from throwing off +the infection which the cold represents as well and as promptly as it +otherwise would. + +It requires a good deal of will power to keep from taking the many +remedies which friends and sometimes relatives insist on offering us +whenever a cold is developing, but the thing to do is to summon the +will power and bravely refuse them. Medicine knows no remedies that +will abort a cold. The use of brisk purgatives, sometimes to an extent +which weakens the patient very much the next day, is simply a relic of +the time when every patient was treated with antimony {203} or calomel +and free purgation was supposed to be almost as much of a cure-all as +blood-letting. There is no reason in the world to think that the +emptying of food out of the bowels will do any particular good, unless +there is some definite indication that the food material present there +should be removed because it is producing some deleterious effect. + +The longer a physician is in the practice of medicine the less he +tries to abort infectious diseases, and coughs and colds are, of +course, just infections. They must run their course, and the one thing +essential is to put the patient in as good condition as possible so +that his resistive vitality will enable him to throw off the infection +as quickly as possible. It requires a good deal of exercise of will +power on the part of the physician to keep from running after the many +will-o'-the-wisps of treatment that are supposed to be so effective in +shortening the course of disease, but any physician who looks back at +the end of twenty years will know that his patients have reason to be +thankful to him just in proportion as he has avoided running after the +fads and fancies of current medicine and conservatively tried to treat +his patients rather than cure their diseases. The patient is ever so +much {204} more important than his disease, no matter what the disease +may be. + +Above all, for the cure and prevention of coughs and colds people must +not be afraid of cold, fresh air. A good many seem to fear that any +exposure to cold air while one has a cough may bring about pneumonia +or some other serious complication. It must not be forgotten, however, +that the pneumonia months in the year occur in the fall and the +spring, October and November and March and April producing most deaths +from the disease, and not December, January and February. The large +city in this country which may be said to have the fewest deaths from +pneumonia is Montreal, where the temperature during December and +January is often almost continuously below zero for weeks at a time +and where there is snow on the ground for three or four months in +succession. The highest death rate from pneumonia is to be found in +some of our southern cities which have rather mild winters and rather +equable temperature,--that is, no considerable variation in the daily +temperature range. Cold air is bracing and tonic for the lungs and +enables them to resist the microbe of pneumonia, and it is now +recognized {205} by physicians that personal immunity is a much more +important factor in the prevention of the disease than anything else. + +Coughs and colds and bronchitis and pneumonia, the respiratory +diseases generally, are much less frequent in very cold climates than +in variable regions. Arctic explorers are but rarely troubled by them, +even though they may be exposed to extremely low temperatures for +months. Men subjected to blizzards at thirty and forty degrees below +zero may have fingers and toes frozen but do not have respiratory +affections. Some years ago, it was noted that one of these Arctic +expeditions had spent nearly two years within the Arctic Circle +without suffering from bronchial or throat disease and within a month +after their return in the spring most of them had had colds. Nansen +and his men actually returned from the Arctic regions where they had +been in excellent health during two severe winters to be confined to +their beds with grippy colds within a week of their restoration to +civilization, with its warm comfortable homes and that absolute +absence of chill which is connected in so many people's minds with the +thought of coughs and colds. + +The principal reason why colds are so {206} frequent in the winter +time in our cities and that pneumonia has increased so much is mainly +because people are afraid of standing a little cold. Office buildings +are now heated up to seventy degrees to make the personnel absolutely +comfortable even on the coldest days, and as a consequence the air is +so dry that it is more arid--that is more lacking in water vapor, as +the United States Public Health Service pointed out--than Death +Valley, Arizona, in summer. People dress too warmly, anticipating +wintry days and often getting milder weather and thus making +themselves susceptible to chilling because the skin is so warm that +the blood is attracted to the surface. Will power to stand cold, even +though at a little cost of discomfort, is the best preventive of +coughs and colds and their complications and the best remedy for them, +once the acute febrile stage has passed. + + + +{207} + +CHAPTER XIV + +NEUROTIC ASTHMA AND THE WILL + + + "Great minds of partial indulgence + To their benumbed wills." + _Troilus and Cressida_. + + +In closing a clinical lecture on bronchial asthma at the University of +Marburg some years ago, Professor Friedrich Müller, who afterwards +became professor at Berlin, said, "Each asthmatic patient is a problem +by himself and must be studied as such; meantime, it must not be +forgotten what an important rôle suggestion plays in the treatment of +the disease." This represents very probably the reason why so many +remedies have been recommended for asthma and have proved very +successful in the hands of their inventors or discoverers as regards +the first certain number of patients who use them, and yet on +subsequent investigation have turned out to be of no special +therapeutic value and sometimes indeed to have no physical effect of +any significance. + +{208} + +Of course this is said with regard to neurotic asthma only, and must +not be applied too particularly to other forms of the affection, +though there is no doubt at all that the symptoms of even the most +severe cases of organic asthma can be very much modified and often +very favorably, by suggestive methods. + +The principal feature of asthma is a special form of severe difficulty +in breathing. It is known now that the beginning of the affection is +always as Strumpell said, "an extensive and quite rapid contraction of +the smaller and smallest bronchial branches, that is the terminal +twigs of the bronchial tubes." It is not so much air hunger, though +there is, of course, an element of that because the lungs are not +functioning properly, as an inability to empty the lungs of air +already there and get more for respiratory purposes. The spasm in +asthma has a tendency to hold the lungs too full of air and produce +the feeling of their getting ever fuller and fuller. What the old sea +captain said in the midst of his attack of asthma, when somebody +sympathized with him because he had so much difficulty in getting his +breath, was that he had lots of breath and would like to get rid of +some of it. {209} He added, "If I ever get all this breath that's in +me now out of me, I'll never draw another breath so long as I live, so +help me." The respiration spasm is usually at full inspiration and the +effort is mainly directed toward expiration and expulsion of air +present using the accessory respiratory muscles for that purpose. + +The picture of a man suffering from asthma is that of a patient so +severely ill as to be very disturbing to one not accustomed to seeing +it. It would be almost impossible for any one not used to the attacks +to think that in an hour or two at the most the patient would be quite +comfortable and if he is accustomed to the attacks, that he will be +walking around the next day almost as if nothing had happened. All +that the affection consists in is a spasm of the bronchioles and as +soon as that lets up, the patient will be himself again. Some material +may have accumulated during the time when the spasm was on which will +still need to be disposed of, and there will be, of course, tiredness +of muscles unaccustomed to be used in that special way, but that will +be all. + +We are still in the dark as to what causes the spasms but undoubtedly +psychic factors {210} play an important etiological rôle. For a good +many people, there is a distinct element of dread as the immediate +cause of their asthmatic attacks. Some people have it only when they +have gone through some disturbing neurotic experience. Occasionally it +is the result of physical factors combined with some psychic element. +Cat asthma is not very uncommon and occurs as a consequence of some +contact by the individual with a specimen of the cat tribe though +usually the large cats, the lions and tigers, do not cause it. There +is nearly always, in those who are liable to this form of asthma, a +special detestation of cats. There is probably some emanation from the +animal which produces the asthmatic fever, just as is true also of +horses in those cases where horse asthma occurs. In a few of these +latter cases, however, it was noted that the horse asthma did not +begin until after there had been some terrifying experience in +connection with the horse, as a runaway, a collision, or something of +that kind. + +Any one who sees many asthmatic cases inevitably gets the impression +after a time that their very dread of the attacks has not a little to +do with predisposing them. {211} Occasionally the dread is associated +with some other organic disturbance, either of heart or kidneys, or +oftener still, with some solicitude with regard to these organs and +the persuasion that there is something serious the matter with them, +though there is at most only some functional disturbance. This is +particularly true of cases of palpitation of the heart where there has +been considerable dread of organic heart disease. In a certain number +of these cases, there is some emphysema present, that is, +overdistention of the lungs, such as is seen in high-chested people. +Owing to the long anterio-posterior diameter of the chest and the fact +that as a consequence it is nearly as thick through as it is wide, +this form of chest is sometimes spoken of as barrel-chest. Patients +who have it are particularly likely to suffer from asthma if they have +any dread of heart trouble or if they are of a nervous constitution. + +I have known people with the dread of the dark to get an attack of +asthma if they were asked to sleep alone after having been accustomed +for years to sleep with somebody in the room. I have known even a +physician to have attacks of asthma of quite typical character as the +result of a dread of being {212} out after dark which had gradually +come over him. I have had a physician patient who was very +uncomfortable if alone on the streets of New York, even during the +day, and whose symptoms at their worst were distinctly dyspneic or +asthmatic. He used to have to bring his wife with him whenever he came +to see me for he lived out in one of the neighboring towns, because he +was so afraid that he might get an asthmatic attack that would +overcome him and he would feel helpless without some one to aid him. + +In practically all these cases, the treatment of asthma becomes +largely that of treating the accompanying dread. Once the acute +symptoms of the attack itself manifest themselves, they have to be +treated in any way that experience has shown will relieve the patient. +The general condition, however, needs very often an awakening of the +will to regulate the life, to get out into the air more than before, +to avoid disturbing neurotic elements, and worrying conditions of +various kinds. Thin people need to be made to gain in weight, using +their will for that purpose; stout people who eat too much and take +too little exercise need to have their lives {213} regulated in the +opposite direction. In the meantime, anything that arouses the patient +to believe firmly that his condition will be improved by some remedy +or mode of treatment, will help him to make the intervals between +attacks longer and the attacks themselves less disturbing. The will +undoubtedly plays a distinct role in this matter which patients who +have been through a series of asthmatic attacks recognize very +clearly. + +The many remedies for asthma which have been lauded highly even by +physicians, and that have cured or relieved a great many patients and +yet after a while have proved to be without much beneficial effect, +make it very clear how much the affection depends on the will power to +face it and throw it off. Nothing will be curative in asthma unless +the patient has confidence in his power and uses his own will energy +to help it. He must overcome the element of dread which occurs in +connection with all asthmatic attacks, even those due to organic +disease of heart or kidneys. No matter how frequent the attacks have +been, there is always an element of fright that enters into an +affection which interferes with the respiration. This must {214} be +overcome by psychic means to help out the physical remedies that are +employed. Sometimes the psychic remedies will succeed of themselves +where more material means have failed completely. + + +{215} + +CHAPTER XV + +THE WILL IN INTESTINAL FUNCTION + + + "Ill will never said well." + _Henry V_. + + +During the past generation, the appreciation of the relative part +played by the stomach and intestines in digestion has completely +changed. Our forefathers considered the stomach the all-important +organ of digestion and the intestines as scarcely more than a long +tube to facilitate absorption and deal properly with waste materials. +Their relative values are now exactly reversed in our estimation. The +stomach has come to be looked upon as scarcely more than a thin-walled +bag meant to hold the food that we take at each meal and then pass it +on by degrees to be digested, prepared for absorption and finally +absorbed in the intestines. It has comparatively little to do with +such alteration of the food as prepares it to be absorbed. Its motor +function is much more important than its secretory function and +serious stomach troubles are {216} dependent on disturbances of +stomach motility. Contractions at the pyloric orifice, that is the +passageway from the stomach into the intestines, will cause the +retention of food and seriously interfere with health. The dilatation +of the stomach for any reason may produce a like result and these are +the stomach affections that need special care. + +If the stomach will only pass the food on properly, the intestines +will do the rest. A number of people have been found in the course of +routine stomach examinations who proved to have no secretory function +of the stomach and yet suffered no symptoms at all attributable to +this fact. The condition is well known and is called _achylia +gastrica_, that is, failure of the stomach to manufacture chyle, the +scientific term for food changed by stomach secretions. Our stomachs +are only meant, apparently, to provide a reservoir for food that will +save us the necessity of eating frequently during the day, as the +herbivorous and graminivorous animals have to do, and enable us to +store away enough food to provide nutrition for five or six hours. We +thus have the leisure to occupy ourselves with other things besides +eating and drinking. + +This conclusion as to the relative {217} significance of the stomach +and digestion is confirmed by the fact that removal of the whole +stomach or practically all of it for cancer has in a number of well +known cases been followed by gain in weight and general improvement in +health. Schlatter's case, the very first one in which nearly the whole +stomach was removed, proved a typical instance of this, for the +patient proceeded to gain some forty pounds in weight. She had lost +this during the course of the growth of a cancer and its interference +with stomach motility. It was necessary, however, for her to be fed, +rather carefully, well-chosen foods usually in liquid form, and every +hour and a half instead of at longer intervals. Her intestines were +thus spared from overloading and proceeded to do the work of digestion +for which they are so well provided by abundant secretion poured into +them from the large glands, the liver and the pancreas, as well as the +series of small glands in their own walls all of which were manifestly +meant to do extremely important work. + +In the increased estimation of the significance of the digestive +functions of the intestines which has come in recent years, there has +been a tendency, as always in human {218} affairs, for the pendulum to +swing too far. Above all, certain phases of intestinal function have +come to occupy too much attention and to be the subject of +oversolicitude. Whenever this happens, whatever function it concerns +is sure to be interfered with. Attention has been concentrated to a +great extent on evacuation of the bowels and the consequences have +been rather serious. A great many people whose intestinal functions +were proceeding quite regularly have had their attention called to the +fact that any sluggishness of the intestines may be the source of +disturbing symptoms and the beginning of even serious morbid +conditions. As a consequence, they pay a great deal of attention to +the matter and before long become so solicitous that the elimination +of waste materials from the intestines is interfered with. Above all, +they may be led to pick and choose their foods so delicately that +there is not the necessary waste material left to encourage +peristalsis. + +The result is that to some extent at least, intestinal function would +almost seem to have broken down in our day. Everywhere one sees +advertisements of medicines and remedies and treatments of various +kinds that will aid in the evacuation of the bowels. {219} Most of +them are guaranteed to be perfectly harmless and all of them are +pleasant to take, they work while you are doing nothing else and are +just engaged in saving mankind not only suffering but complications of +various kinds that may lead to serious results. Some years ago, when +Matthew Arnold was in this country, he declared in one of his lectures +that what the world needed was "leading and light," but a well known +American physician who is closely in touch with American life declared +not long since that what we needed in America manifestly, if +advertisements were any index of the needs of a people, was laxatives +and more laxatives. Advertisements cost money; it is said that at +least four times as much as the advertising costs must be spent by the +public on any object advertised in order to make it pay, so that very +probably nearly a billion of dollars a year is spent in this country +on laxatives. Only whiskey and tobacco present a higher bill to the +American people annually. + +Practically all of the laxative medicines do harm if taken over a +prolonged period. Over and over again physicians have found that +laxative remedies introduced even by scientists, with the assurance +that they were quite {220} harmless and had no undesirable after +effects proved the source of annoying or even serious symptoms after a +while. It is true that when constipation has become habitual, it may +be necessary to give laxative medicines for a prolonged period, but +this is only another instance of the necessity that is often presented +to the physician of choosing between two evils and trying to find the +lesser one. Even the heavy oil that has become so popular in recent +years has been found on careful investigation and prolonged +observation to have certain undesirable effects and it must not be +forgotten that it has not been used generally for a sufficiently long +time for us to be absolutely sure what its sequelae may be. + +This breakdown of intestinal activity is not the fault of nature but +of men and women who have been thinking to improve on the natural laws +of living. As the result of improvements in diet and refinements in +cooking and the preparation of foods, less and less of their roughage +is left in our articles of food when sent to the table. It is on this +roughage or waste material that intestinal movement or peristalsis +depends. If we eat perfectly white bread, cut all the gristle and +fatty materials from our meat, carefully eliminating {221} the +connective tissue bundles that may occur in it, eat our vegetables +mainly in the shape of purees and avoid to a great extent all the +coarser varieties, such as parsnips and carrots and beets, we provide +very little material for the intestines to carry on and aid them in +the elimination of other wastes. If, besides, we always ride and do +not walk, and so have none of that precious jolting which occurs every +time the heel comes down, and if we have no bending movements in our +lives, no wonder that intestinal movement becomes sluggish and we have +to supply stimulants and irritants to get it to do its work. + +Intestinal evacuation is very largely a matter of will. There are very +few people so constituted by nature that they will not have regular +movements sufficient to maintain their digestive tracts in excellent +health, if they form the right habits. They must, however, make up +their minds, that is their wills, to restore coarse materials to their +diet. They must eat whole wheat or graham bread, must eat fruit +regularly and usually eat the skins of the fruit with it, that is as +far as apples, pears, peaches, apricots, plums and the like are +concerned. Even as regards oranges, it is probable that the eating of +occasional {222} pieces of orange peel is an excellent means of +helping intestinal functions and providing waste material. [Footnote +6 ] + + [Footnote 6: A curious discovery has been made in recent years that + orange skin contains a very precious element essential for bodily + health, belonging to the class of substances known as the vitamines + and contains more of it than any other food material that we have. + The instinct which tempted so many of us as children to eat orange + skin, in spite of the fact that we were discouraged from the + practice, was founded on something much more than mere childish + caprice. Orange skin is after all the basis of marmalade which has + been so commonly used by the English people at breakfast and which + is at once a tasty and healthful material.] + +When baked potatoes are taken, the skin should be eaten, mainly +because of the waste material it provides, but also because just +underneath the skin and sure to be removed with it if it is taken off, +there are certain salts and other substances that are excellent for +health and particularly for digestion. Besides, the carbonized +material which so often occurs on baked potatoes is of itself a good +thing. It represents some of that charcoal which in recent years +French physicians particularly have found very valuable as a remedy +for certain disturbances of intestinal digestion. The removal of +parings from fruit and vegetables and the careful trimming of meat, +have taken out of human diet the materials which meant most for +intestinal movements for former generations, and they {223} have to be +supplied artificially by means of irritant drugs, salts, oils and the +like, to the detriment of function. + +The other element in the modern situation as regards the failure of +intestinal function is the lack of fluids. People who live indoors are +not tempted to take so much water as those who work outside and yet in +our modern, steam-heated houses they often need more. Our heating +systems take much more water from us than the former methods of +heating. The result is seen in our furniture that comes apart from +dryness and in our books and other things which crack and deteriorate. +Something of the same thing happens to human beings unless they supply +sufficient fluids. For this it is necessary deliberately to make up +the mind, which always means the will, to consume five or six glasses +of water between meals and especially to take one on rising in the +morning and another on going to bed. This should _not_ be hot and +above all not lukewarm water, but fresh cold water which stimulates +peristalsis. The creation of a habit is needed in the matter or it +will be neglected. I have sometimes given patients some harmless drug, +like a lithium salt, that was to be taken three or four times a day in +a full glass of {224} water, in order to be sure that they would take +the water. They were willing to take the medicine but I could not be +assured that without it they would drink the amount of water that I +counselled. + +Above all, a regular habit of going to the toilet at a definite time +every day must be created. Nothing is so important. In little +children, even from their very early years, such a habit can be +established; it is only necessary to put them on their chairs at +certain times in the day and the desired result will follow. Adults +are merely children of a larger growth in this matter, and the habit +of going regularly is all-important. A little patience is needed, +though there should be no forcing, and after a time, a very +satisfactory habit can be established in this manner. It seems almost +impossible to many people that anything so simple should prove to be +remedial for what to them for a time seemed so serious a disturbance +of health, but only a comparatively short trial of the method will be +sufficient to demonstrate its value. A book or newspaper may be taken +with one, or Lord Chesterfield's advice to learn a page of Horace +which may afterwards be sent down as an offering to Libitina, the +goddess of secret {225} places, may be followed, but the mind must not +be diverted too much from the business in hand, and the will must be +afforded an opportunity to exert its power. + +It is true that the muscular elements of the intestines consist of +unstriped muscles and that they are involuntary, and yet experience +and observation have shown that the will has a certain indirect +influence even over involuntary muscle. The heart, though entirely +involuntary in its regular activities, can be deeply influenced by the +will and the emotions, as the words encouraging and discouraging, or +the equivalent Saxon words heartening and disheartening, make very +clear. Undoubtedly the peristaltic functions of the intestines can be +encouraged by a favorable attitude of the will towards them. + +Above all, it is important that the anxious solicitude which a great +many people have and foster sedulously with regard to the effect of +even slight disturbances of intestinal functions should be overcome. +We have discussed this question in the chapter on dreads and need only +say here that the delay of a few hours in the evacuation of the bowels +or even the missing entirely of an intestinal movement for a full day +occasionally, will {226} usually not disturb the general health to any +notable extent, and that the symptoms so often attributed to these +slight disturbances of intestinal function are much more due to the +solicitude about them than to any physical effect. There are a great +many people whose intestinal functions are quite sluggish and whose +movements occur only every second day or so, who are in perfectly good +health and strength and have no symptoms attributable to any +absorption of supposed toxic materials from the intestines. Indeed, in +recent years, the idea of intestinal auto-toxemia has lost more and +more in popularity for it has come to be recognized that the symptoms +attributed to this condition are due in a number of cases to serious +organic disease in other parts of the body, and in a great many cases +to functional nervous troubles and to the psycho-neuroses, especially +the oversolicitude with regard to the intestines. The will is needed +then for intestinal function to regulate the diet, to increase the +quantity of fluid, to secure regular habits and to eliminate worry and +anxiety which interferes with intestinal peristalsis. There are but +very few cases that will not yield to this discipline of the will when +properly and persistently tried. + + +{227} + +CHAPTER XVI + +THE WILL AND THE HEART + + + "For what I will, I will, and there an end." + _Two Gentlemen of Verona_. + + +The heart is the _primum movens_, the first tissue of the body that +moves of itself in the animal organism, doing so rhythmically and of +course continuously before the nervous system develops in the embryo. +This spontaneous activity would seem to place it quite beyond the +control of the will, as of course it is, so far as the continuance of +its essential activity goes, but there is probably no organ that is so +much influenced by the emotions and comes indirectly under the +influence of the will as the heart. There are a series of expressions +in practically all languages which chronicle this fact. We talk about +the encouragement and discouragement or in Saxon terms that are +exactly equivalent to the French words, heartening and disheartening +of the individual. At moments of panic the {228} heart can be felt to +be depressed, while at times when resolve is high there is a sense of +well-being in connection with the firm action of the heart that flows +over into the organism and makes everything seem easy of +accomplishment. + +There are a number of heart conditions that depend for their existence +and continuance on a sense of discouragement, that is oversolicitude +with regard to the heart. If something calls attention to that organ, +the fact that it is so important for life and health and that anything +the matter with it may easily prove serious, will sometimes +precipitate a feeling of panic that is reflected in the heart and adds +to the symptoms noted. The original disturbing heart sensation may be +due to nothing more than some slight distention of the stomach by gas, +or by a rather heavy meal, but once the dread of the presence of a +heart condition of some kind comes over the individual, all the +subjective feelings in the cardiac region are emphasized and the +discouragement that results further disturbs both heart and patient. + +Palpitation of the heart is scarcely more than a solicitous noting of +the fact that the heart is beating. In certain cases, under the {229} +stress of emotion, the heart beat-rate may be faster than normal, but +in a number of people who complain of palpitation, no rapid heart +action is noted. What has happened is that something having called +particular attention to the heart, the beating of the organ gets above +the threshold of consciousness and then continues to be noted whenever +attention is given it. This is of itself quite sufficient to cause a +sense of discomfort in the heart region and there may be, owing to the +solicitude about the organ, a great deal of complaint. + +Just one thing is absolutely necessary in the treatment of these +cases, once it is found that there is no organic condition present. +The patient's will must be stimulated to divert the attention from the +heart and to keep solicitude from disturbing both that organ and the +patient himself. It is not always easy to accomplish this, but where +the patient has confidence in the diagnosis and the assurance that +nothing serious is the matter, a contrary habit that will overcome the +worry with regard to the heart can be formed. For it must not be +forgotten that in these cases a series of acts of solicitous attention +has been performed which has created a habit that can only be overcome +by the opposite habit. {230} It is surprising how much discomfort this +simple affection, due to a functional disturbance of the heart and +overattention to it, may produce and how much it may interfere with +the usual occupation. It is a case, however, simply of willing to be +better, and nothing else will accomplish the desired result. At times +the mistake is made of giving such patients a heart remedy, perhaps +digitalis, but this only emphasizes the unfavorable suggestion and +besides, by stimulating heart action, sometimes brings it more into +the sphere of consciousness than before and actually does harm. + +There is a form of this functional disturbance of the heart which +reaches a climax of power to disturb and then is sometimes spoken of +as spurious _angina pectoris_. In these cases the patient complains +not only of a sense of discomfort but of actual pain over the heart +region and this pain is sometimes spoken of as excruciating. +Occasionally the pain will be reflected down the left arm which used +to be considered the pathognomic sign of true _angina pectoris_ but is +not. Sometimes the pain is reflected in the neck on the left side or +at times is noted at the angle of the scapula behind. When these +symptoms occur {231} in young persons and particularly in young women, +there is no reason to think for a moment of their being due to true +_angina pectoris_, which is a spasm of the heart muscle consequent +upon the degeneration of the coronary arteries, the blood vessels +which feed the heart itself, and occurs almost exclusively in the old, +and much more commonly in old men. + +The pain of true _angina pectoris_ is often said to be perhaps the +worst torture that humanity has to bear. As a rule, however, it is +very prostrating and so genuine sufferers from it are not loud in +their complaints. Their suffering is more evident in their faces than +in their voices. Indeed, it has come to be looked upon as a rule by +the English clinicians and heart experts that the more fuss there is +made, the less likelihood there is of the affection being true _angina +pectoris_. When there is pain in the heart region then, especially in +young or comparatively young women, of which great complaint is made, +it is almost surely to be considered spurious _angina_, even though +there may be reflex pain down the arm as well as the impending sense +of death which used to be considered distinctive of the genuine +_angina pectoris_. + +{232} + +The treatment of true _angina_ depends to some extent on inspiring the +patient with courage, for it is needed to carry him through the very +serious condition to which he is subjected. The psychic element is +important, though the drug treatment by the nitrites and especially +amyl nitrite is often very effective. In spurious _angina_, the will +is the all-important element. There is some irritation of the heart +muscle but it is mainly fright that exaggerates the pain and then +concentration of attention on it makes it seem very serious. The one +thing that is all important is to relieve patients from the solicitude +which comes upon them with regard to their hearts and which prevents +them from suppressing their feelings and diverting their minds to +other things. Sometimes the will is needed to bring about such a +change in the habits of the individual as will furnish proper +nutrition for the heart. Very often these patients are under weight, +not infrequently they have been staying a great deal in the house, and +both of these bad habits of living need to be corrected. Good habits +of eating and exercise are above all important for the relief of the +condition. + +For functional heart trouble, gentle exercise {233} in the open air +generally must be taken, for it acts as a tonic stimulant to the heart +muscle. Almost as a rule, when patients suffer from symptoms from +their hearts, they are inclined to consider them a signal that they +must rest and above all must not exercise to such an extent as to make +the heart go faster. Rest, if indulged in to too great an extent, has +a very unfavorable effect upon the heart, for the heart, like all +muscles, needs exercise to keep it in good condition. One of the most +important developments of heart therapeutics in our generation was the +Nauheim treatment. In this, exercise is an important feature. The +exercise is graduated and is pushed so as to make a definite call upon +the heart's muscular power. Nauheim is situated in a little cup-shaped +valley and patients are directed to walk a certain distance on one of +the various roads, distances being marked by signposts every quarter +of a mile or so. The walk outward, when the patient is fresh, is +slightly uphill, and the return home is always downhill, which saves +the patient from any undue strain. + +The experience at Nauheim was so favorable that many physicians took +up the practice of having their heart patients exercise {234} +regularly and found that it was decidedly to their benefit. If this is +true for organic heart conditions, it is even more valuable for +neurotic heart cases, though it often requires a good deal of exercise +of will on the part of patients suffering from these affections to +control their feelings and take such exercise as is needed. In men, it +will often be found that the discomfort in the heart region, +particularly in muscular, well-built men who have no organic +condition, is due more to lack of exercise than to any other factor. +This is particularly true whenever the men have taken considerable +vigorous exercise when they were young and then tried to settle down +to the inactive habits of a sedentary life. Athletes who have been on +the teams at college, self-made men who have been hard manual laborers +when they were young, even sons of farmers who take up city life are +likely to suffer in this way. Their successful treatment depends more +on getting exercise in the open back into their lives than on anything +else, and for this a call upon the individual's will power for the +establishment of the needed new habits is the essential. + +Former athletes who try to settle down to a very inactive life are +almost sure to have {235} uncomfortable feelings in their heart +region. At times it will be hard to persuade them that they have not +some serious affection consequent upon some overstrain at athletics. +In a few cases, this will be found to be true, but in the great +majority the root of the trouble is that the heart craves exercise. A +good many functional heart cases, like the neurotic indigestions, so +called--are due to the fact that the heart and the stomach are not +given enough to do. The renewal of exercise in the daily life--and it +should be the daily life as a rule and not merely once or twice a +week--will do more than anything else to relieve these cases and +restore the patient's confidence. We saw during the war that a number +of young men, officers even more than privates--that is, the better +educated more than the less educated--suffered from shell shock so +called. A good many university men may suffer from what might be +termed heart shock if they find any reason to be solicitous about +their hearts. These neurotic conditions can only be relieved by the +will and diversion of attention. + +A certain number of people who suffer from missed beats of their +hearts become very much perturbed about the condition of that organ. +{236} Irregular heart action, and especially what has been called the +irregularly irregular heart, may prove to be a serious condition. +There are a number of regular irregularities of heart action, however, +consisting particularly of the missed beat at shorter or longer +intervals, which may have almost no significance at all. I know two +physicians, both athletes when they were at college, who have suffered +from a missed heartbeat since their early twenties. In one case it has +lasted now for thirty-five years and the physician is still vigorous +and hearty, capable even of running up an elevated stairway after a +train without any inconvenience. Some twenty years ago there was +question of his taking out a twenty-year life insurance policy and the +insurance company's physician at first hesitated to accept the risk +because of the missed beat. An examination made by three physicians at +the home office was followed by his acceptance and he has outlived the +maturity of the policy in good health and been given a renewal of it, +in spite of the fact that his missed beat still persists. + +There is often likely to be a good deal of solicitude as to the +eventual prognosis in these cases, that is as to what the prospect of +{237} prolonged life is. The regularly irregular heart does not seem +to make for an unfavorable prognosis. Young patients particularly who +have learned that they have a missed heartbeat need to have this fact +emphasized. We have the story of an important official of an American +university in whom a missed beat was discovered when he was under +forty. This was many years ago, and the prognosis of his condition was +considered to be rather serious. The patient actually lived, however, +for a little more than fifty years after the discovery of his missed +beat. It is easy to understand what a favorable effect on a patient +solicitous about a missed beat such a story as this will have. It +heartens a patient and gives him the will power to throw off his +anxieties and to keep from watching his heart and thus further +interfering with its activities. There is even a possibility of life +to the eighties or, as I have known at least one case, to the +nineties, where the irregular heart was first noted under thirty. + +But it is well recognized that close concentration of attention on the +heart will hamper its action. It has been demonstrated that it is +possible by will power to cause the missing of heartbeats and while +only those who have {238} practised the phenomenon can demonstrate it, +there are a number of well-authenticated examples of it. There is no +doubt, however, that anxiety about the heart will quicken or slow the +pulse rate. When a patient comes to be examined for suspected heart +trouble the pulse rate is almost sure to be higher than normal, even +though there may be nothing the matter with the heart; the increase or +decrease of the pulse beat is due to the anxiety lest some heart +lesion should be discovered. This makes it necessary as a rule not to +take too seriously the pulse rate that is discovered on a first +consultation and makes it always advisable to wait until the patient +has been reassured to some extent before the pulse rate is definitely +taken. + +It is easy to see, then, what a large place there is for the will in +heart therapeutics. Courage is an extremely important element in +keeping the heart from being disturbed and maintaining it properly +under control. Scares of various kinds with regard to this +all-important organ are prone to get hold of people and then to +disturb it. Many a heart that is actually interfered with in its +activities by drugs of various kinds would respond to the awakening of +the will of the patient {239} so as to control solicitudes, anxieties, +dreads and the like that are acting as disturbing factors on the +heart. When taken in conjunction with the will to eat and to exercise +properly so often necessary in these cases, the will becomes the +therapeutic agent whose power must never be forgotten, because it can +always be an adjuvant even when it is not curative and can produce +excellent auxiliary effects for every form of heart treatment that we +have. + + + +{240} + +CHAPTER XVII + +THE WILL IN SO-CALLED CHRONIC RHEUMATISM + + "I should do it + With much more ease; for my good will is to it." + _The Tempest_. + + +In popular estimation, rheumatism is one of the commonest of +affections. When a physician asks a patient, especially if the patient +is over forty years of age, "Have you ever suffered from rheumatism?" +the almost invariable response is, "Yes", though but little further +inquiry is needed to show that what the patient means is that he has +suffered from some painful conditions in the neighborhood of his +joints, or that his muscles have been sore or inclined to ache in +rainy weather, or that he has undergone some other vague discomforts +connected with dampness. Chronic rheumatism is a term that includes a +great many of the most varied conditions. True rheumatism, that is, +acute articular rheumatism, is now recognized as an infectious disease +which runs a definite course, usually with {241} fever, for some ten +days to ten weeks, and requires confinement to bed usually for a month +or more. Very rarely will any connection be found between this +affection, which presents always Galen's four classic symptoms of +inflammation, swelling, redness, heat and pain (_tumor, rubor, color, +et dolor_), and the usual conditions which are broadly characterized +as rheumatism. Just as soon as patients are asked if their rheumatism +included these symptoms there is denial, yet the idea of their having +had rheumatism remains. + +As a matter of fact, there are a number of sore and painful conditions +in connection with muscles and particularly in and around joints that +have, without any scientific justification at least, been called +chronic rheumatism. Any painful condition that is worse in rainy +weather is sure to be so named. As old dislocations, sprains and +wrenches of joints, broken bones, as well as muscular conditions of +all kinds, including flat foot and other yielding of joints, all +produce this effect, it is easy to understand that there is an immense +jumble of all sorts of painful conditions included under the term +"chronic rheumatism." Some of them, particularly in older people, +produce lameness or at least inability to walk {242} distances without +showing the disability; a great many of them produce distinct painful +conditions during the night following the use of muscles and often +disturb patients very much, because they arouse the dread that they +are going to be crippled as they grow older. + +Indeed, one of the most serious effects of these recurring painful +conditions is the dread produced lest they should cause such +progressive affections in and around joints as would eventually make +the patients bed-ridden. There are a certain number of cases of +so-called rheumatoid arthritis which produce very serious changes in +joints with inevitable crippling and quite beyond all possibility of +repair. These cases are often spoken of as chronic rheumatism and it +is the solicitude produced by the dread of them that makes the worst +part of the discomfort in many a so-called chronic rheumatic case. If +their affection is to be progressive, then the patients foresee a +prolonged confinement to bed in the midst of severe pain, hopeless of +ultimate cure. It may be said at once that these cases of rheumatoid +arthritis have nothing to do with rheumatism, represent a special +acute infection, are never a sequela of any of the rheumatic +conditions and are {243} fortunately very rare. This assurance of +itself is quite sufficient to make ever so much better a great many +patients who feel that they suffer from rheumatism. + +The painful conditions that are described under the term chronic +rheumatism would seem to be quite beyond any power of the will to +affect. They are at least supposed to represent very definite changes +in the tissues, usually of chronic character and therefore not +amenable to any remedies except those of physical influence. Besides, +they are so frequent that surely if there were any question of the +will being able to control them or bring relief for them, most +sufferers would discover this fact for themselves and apply the remedy +from within. It is not to be expected that a very great many people +would suffer pains and aches that are worse in rainy weather if all +that was needed was the exertion of their will power either to throw +off the affection or to perform such exercises and activities as would +gradually make their conditions better. In general it is felt that +painful conditions of this kind cannot be affected by the will and +that distinctly material and not psychic therapeutics must be looked +to for their relief. + +Now it so happens that the best illustration {244} of the power of the +will to "cure" people, that is, to relieve them completely of their +affections and start them afresh in life with the feeling that they +are no longer handicapped by disease, is to be found exactly in the +group of cases that have almost from time immemorial been called +chronic rheumatisms. We have had more "cures" of various kinds +announced for these--chemical, electrical, physical, hydriatic, +movement therapy and so forth--than for almost any other group of +diseases. More irregular practitioners of medicine all down the ages +have made a reputation by curing these affections than have won renown +by treating any other set of ills to which humanity is heir. Like the +poor, these ills are still with us, in spite of all the "cures" and +probably nowhere is the expression of the old French physician that +"the therapeutics of any generation is always absurd to the second +succeeding generation" better illustrated than in regard to them. +These cases serve to emphasize very clearly, however, the fact that +the pains and aches of mankind are largely under the control of the +will. + +The more one studies these cases of so-called chronic rheumatism the +easier it is to {245} understand how they become the signal "cures" +which attract attention to the quacks and charlatans who promise much, +but do nothing in particular, though they may give medicines or +treatment of some kind or another. They only arouse the patient's will +to be better and the determination to use his will with confidence, +now that the much praised treatment is doing something which will +surely make him better. Cases of this kind have constituted a goodly +part of the clientele of the great historic impostors who succeeded in +making large sums of money out of curing people by methods that in +themselves had no curative power. A review of some of the chapters of +that very interesting department of human history, the history of +quackery, is extremely suggestive in that regard. The only way to get +a good idea of the basic significance of these cases is to realize by +what they were cured and by whom they were cured. + +One of the most interesting illustrations of that phase of human +credulity is the story of Greatrakes, the Irish adventurer who had +been a soldier in Flanders, and who when his campaigns were over set +up to be a healer of mankind. He chose his opportunity during {246} +the time while Cromwell, as Lord Protector of Great Britain, had +refused to continue the practice of touching the ailing which the +Kings of England had pursued for hundreds of years since the +Confessor's time. Cromwell did not impugn the efficacy of the Royal +Touch but he refused to have anything to do with it himself. +Greatrakes found it an opportune moment to announce that for three +nights in succession he had been told in a dream by the Holy Spirit +that in the absence of the King he was to touch people and cure them. + +One might possibly think that with no better credentials than this and +no testimony except his own claim in the matter Greatrakes would +receive but scant attention. Any one who thinks so, however, does not +understand human nature. It was not long before some of the people who +had been sufferers for longer or shorter periods went to Greatrakes +and allowed him to try his hand at healing them. They argued that at +least if it did them no good it could do them no harm, and it was not +long before some of them declared that they had been benefited by his +ministrations. Very soon then he was able to furnish what seemed to be +abundant evidence of Divine Mission in the cures {247} that were +worked by his more than magic touch. Above all, people who had been +sufferers for prolonged periods, who had gone the rounds of +physicians, who had tried all sorts of popular remedies, and some of +whom had been declared incurable were healed of their ills after a +series of visits to Greatrakes. No wonder then that patients came more +and more frequently, until his name went abroad in all the country and +in spite of the difficulties of travel people came from long distances +just to be treated by him. + +All that he did was to ask the patient to expose the affected part and +then Greatrakes would stroke it with his hand, assure the patient that +a wonderful new vitality would go into them because of his Mission +from on High and promise them that they would surely get better, +explaining of course that betterment would be progressive and that it +would start from this very moment. The stroking was the important part +of the cure and so he is known in history as "Greatrakes the Stroker." +It may be said in passing that while those who were touched by the +English kings in the exercise of the prerogative of the Royal Touch +were usually presented with a gold coin which had been particularly +{248} coined for that purpose as a memorial, a corresponding gold +piece, a sovereign as a rule, in Greatrakes' method of treatment +passed from the patient to the healer. It was a case of metallotherapy +with extraction of the precious metal from the patient, as is always +the case under such circumstances. + +Here in America we had a similar experience, though ours had science +as the basis of the superstition in the case instead of religion. The +interest aroused by Galvani's experience with the twitching of frogs' +legs when exposed nerve and muscle were touched by different metals +led Doctor Elisha Perkins to invent a pair of tractors which would +presumedly apply Galvani's discovery to therapeutics. These were just +plain pieces of metal four or five inches long, shaped more or less +like a lead pencil and tapering to a blunt point. With these, as +Thatcher, one of our earlier historians of medicine, tells us, Perkins +succeeded in curing all sorts of ailments, but particularly many +different kinds of painful conditions. He was most successful in the +treatment of "pains in the head, face, teeth, breast, side, stomach, +back, rheumatism and so forth." In a word, he cured the neuralgias and +the rheumatic pains and the chronic {249} rheumatisms which are the +source of so much trouble--and especially complaint--for the old, and +which so often physicians, in any time of the world's history, have +been unable to cure. + +For a time his success was supposed to be due to some curious +electrical power that he was using. Learned pamphlets were issued to +show that animal magnetism or animal electricity or Galvanism was at +work. Professors at no less than three universities in America gave +attestations in favor of its efficacy. Time has of course shown that +there was absolutely no physical influence of any kind at work. The +only appeal was to the mind. Elisha Perkins was a Yale man of +education and impressive personality, "possessing by nature uncommon +endowments both bodily and mental ", and he succeeded in impressing on +his patients the idea that they would surely be cured; he thus +overcame the dreads, released the will power, gave new hope and a +tonic stimulus to appetite, created a desire for exercise, and then +the will kept this up and before long the patient was cured. + +When animal magnetism, as it was called about the middle of the +nineteenth century, {250} was practised without apparatus, one of its +most important claims to the consideration of physicians was founded +on its power to heal chronic painful affections which had previously +resisted all therapeutic efforts. The power of neuro-hypnotism, as it +came to be designated, to accomplish this, will be best appreciated +from the fact that this state was being used as a mode of anaesthesia +for surgical operations. When the news of the use of ether to produce +narcosis for surgical purposes at the Massachusetts General Hospital +first came to England, it did not attract so much attention as would +otherwise have been the case, because English physicians and surgeons +were just then preoccupied with the discussion of neuro-hypnotic +anaesthesia, and those who believed in it thought that ether would not +be necessary, while those who refused to believe thought the report +with regard to ether just another of these curious self-delusions to +which physicians seemed to be so liable. + +Perkins' declarations of the curative value of his tractors were, +after all, only a succeeding phase of what Mesmer had called to the +attention of the medical profession and the public in Paris not quite +a generation before. Mesmer seated his patients around a tub {251} +containing bottles filled with metallic materials out of which wires +were conducted and placed in the hands of patients seated in a circle +around it. Mesmer called this apparatus a _baquet_ or battery and it +was thought to have some wonderful electric properties. A great many +people who received the treatment were cured of chronic pains and +aches that had sometimes lasted for years. So many prominent people +were involved that the Government finally ordered an investigation to +be made by French scientists with whom, because he was the Minister +from the colonies at the time, our own Benjamin Franklin was +associated. They declared that there was not a trace of electricity or +any other physical force in Mesmer's apparatus. He was forbidden to +continue the treatment and there was a great scandal about the affair, +because a large number of people felt that he was doing a great deal +of good. + +When hypnotism came in vogue again at the end of the nineteenth +century, it was a case of chronic rheumatism that gave it its first +impetus in scientific circles. Professor Bernheim of Nancy had tried +in vain all of his remedies in the treatment of a patient suffering +from lumbago. The patient disappeared {252} for a time and when +Bernheim next saw him, he was cured. Bernheim had treated him futilely +for months and was curious to know how he had been cured. The patient +told him that he had been cured by hypnotism as practised by Liebault. +This brought Bernheim to investigate Liebault's method of hypnotism +and made him a convert to its practice. It was the interest of the +school of Nancy in the subject that finally aroused Charcot's +attention and gave us the phase of interest in hypnotism which +attracted so much public attention some thirty years ago. Many other +cases of those very refractory affections--lumbago and sciatica--have +been cured by hypnotism when they have resisted the best directed +treatment of other kinds over very long periods. + +It is these chronic rheumatisms, so called, the chronic pains and +aches in muscles in the neighborhood of joints, that were cured by the +Viennese astronomer, Father Maximilian Höll, in the eighteenth +century. He simply applied the magnet and saw the result, and felt +sure that there must be some physical effect, though there was none. +His work was taken up by Pfarrer Gassner of Elwangen who, after using +the magnets for a time, found {253} that there was no need of their +application, provided the patients could by prayer and other religious +means be brought into a state of mind where they were sure that they +were going to get better. They then proceeded to use their muscles +properly in spite of the pain that might result for a time, and as a +result it was not long before they were cured of their affections. The +Church forbade his further practise because of his expressed idea that +pain came from the power of evil and dropped from men when they turned +to God, which was the eighteenth-century anticipation of Eddyism. +Dowie's cures were largely of similar affections, and patients +sometimes dropped their crutches and walked straight who could not +walk before. + +A great many of the so-called chronic rheumatisms are really the +result of dreads to use muscles in the proper way because for the +moment something has happened to make their use painful. A direct +injury, a wrench, or some incident causes a joint for a time to be +painful when used. In sparing it, the muscles around it are used +differently than before and as a consequence become sensitive and +painful. It is quite easy, then, for people to form bad habits which +they cannot break {254} because they have not the strength of will to +endure the sore and tender condition which develops when they try to +use muscles properly once more. The young athlete who wants to get his +muscles in good condition knows that he must pass through a period of +soreness and tenderness, sometimes of almost excruciatingly painful +character. He does so, however, and does not speak of his condition as +involving pains and aches but only soreness and tenderness. + +Older people, however, who have to get their muscles back into good +condition after a period of disuse following an injury or some +inflammatory disturbance, find this period of discomfort very +difficult to bear and so keep on using their muscles somewhat +abnormally and at mechanical disadvantage. As a consequence, these +muscles remain tender, are likely to ache in rainy weather and often +give a good deal of discomfort. Until the sufferers can be brought to +use their wills properly, so as to win back their muscles to normal +use, they will not get well. An application of magnets or a Leyden jar +or Mesmer's battery of the eighteenth century, or Perkins' tractors, +or neuro-hypnotism, or animal magnetism, or later hypnotism, or {255} +Dowie's declaration of their cure, enables them to use their will in +this regard and then they proceed to recover. It is surprising how +many presumedly intelligent people--at least they have received +considerable education--have been cured of conditions that they have +endured for years by some remedy or mode of treatment that actually +had no physical effect. + +St. John Long, the English charlatan who has been mentioned in the +chapter on tuberculosis, also succeeded in making a name for himself +in connection with the chronic rheumatisms and the so-called rheumatic +pains and aches of older people. Between consumption and these +conditions, he caught both the young and the old, and thus rounded out +his clientele. For consumption he provided an inhalant; for rheumatic +conditions, a liniment. This liniment became very famous in that +generation for its power to relieve the pains and aches, both acute +and chronic, of mankind. So many people were cured by it and above +all, so many of them were people of distinction--lords and ladies and +the relatives of the nobility--that Parliament was finally petitioned +in the interests of suffering humanity to buy the secret of the {256} +liniment from its inventor and publish it for the benefit of the +world. I believe that a substantial sum, representing many, many +thousands of dollars in our time, was actually voted to St. John Long +and the recipe for his liniment was published in the British +pharmacopeia. In composition, it was, I believe, only a commonplace +turpentine liniment made up with yolks of eggs instead of oil, as had +been the custom before. Just as soon as this fact became known, the +wonderful cures which had occurred in connection with its use ceased +to a great extent, for distinguished members of the nobility and their +relatives would not be cured by so common-place a medium as an +ordinary turpentine liniment. St. John Long was even accused of not +having sold his real secret to the Government, but there was no reason +at all to think that. He had been producing his cures not by his +liniment but by the strong effect of his prestige and reputation as a +healer upon the minds of his patients and the consequent release of +will power which enabled them to do things which they thought they +could not do before. We have had many wonderful curative oils of +various kinds since then, with all sorts of names from Alpha to Omega +and {257} very often called after a saint,--though St. John Long was +as far as possible from being a saint in the ordinary acceptance of +that word. These modern curative oils and liniments have been merely +counter-irritants, but at times, owing to a special reputation +acquired, they have been counter-irritants for the mind and stimulants +for the will which have enabled old people to persist through the +periods of soreness and tiredness until they reacquired the proper use +of their muscles. + + +{258} + +CHAPTER XVIII + +PSYCHO-NEUROSES + + + "Look, what I will not, that I cannot do." + _Measure for Measure_. + + +The psycho-neuroses, that is, the various perversions of nervous +energy and inability to supply and conduct nervous impulses properly, +consequent upon a mental persuasion which interferes with these +activities, have come to occupy an ever larger and larger place in the +field of medicine. The war has been illuminating in this matter. A +psycho-neurosis is, after all, a hysterical manifestation and it might +very well be expected that very few of these would be encountered in +armies which took only the _men_ of early adult life and from among +those, only persons who had been demonstrated to be physically and, as +far as could be determined, mentally normal. Neurologists would seem +scarcely to have a place in the war except for wounds of nerves {259} +and the cerebral location of missiles and lesions. Certainly none of +the army medical departments had the slightest premonition that +neurology would bulk larger in their war work than any other +department except surgery. That proved to be the case, however. + +The surprise was to have, from very early in the war, literally +thousands of cases of psycho-neuroses, "shell shock" as unfortunately +they came to be called, which included hysterical symptoms of all +kinds, mutism, deafness, blindness, paralysis, and contractures. +France and England after some time actually had to maintain some fifty +thousand beds in their war hospitals mainly for functional nervous +diseases, the war neuroses of many kinds. During the first half of the +war, one seventh of all the discharges from the British army or +actually one third of all the discharges, if those from wounds were +not included, were for these war neuroses. They attacked particularly +the better educated among the men and were four times as prevalent +among officers as among the privates. In proportion to the whole +number of those exposed to shells and "war's alarms and dangers" +generally, these war neuroses were {260} more common among the men +than among the women. Nurses occasionally suffered from them, but not +so frequently as the men who shared their dangers in the hospitals and +stations for wounded not far from the firing line. + +In the treatment of this immense number of cases, a very large amount +of the most valuable therapeutic experience for psychoneuroses was +accumulated. It was found that suggestion played a very large role in +making the cases worse. If these patients were placed in general +hospitals where there was much talk of wounds and injuries and the +severe trials of battle life they grew progressively worse. They +talked of their own experiences, constantly enlarging them; they +repeated what they had heard from others as if these represented their +own war incidents and auto-suggested themselves into ever worse and +worse symptomatic conditions. This was, after all, only the familiar +_pseudologia hysterica_ which occurs in connection with hysteria, and +which is so much better called by the straightforward name of +pathological self-deception or perhaps even just frankly hysterical +lying. If these patients were examined frequently by physicians, their +{261} symptoms became more and more varied and disabling and their +psycho-neurosis involved more external symptoms. + +In a word, it was found that their minds were the source of extremely +unfavorable factors in their cases. The original shock or the severe +trials of war life had unbalanced their self-control and suggestions +of various kinds made them still worse. Much attention to their +condition from themselves and others simply proved to be constantly +disturbing. As was pointed out by Doctor Pearce Bailey, who had the +opportunity as United States Chief of the Division of Neurology and +Psychiatry attached to the Surgeon General's office to visit France +and England officially to make observations on the war neuroses, the +experience of the war has amply confirmed Babinski's position with +regard to hysteria. The distinguished French neurologist has shown +that the classic symptoms of hysteria are the results of suggestion +originating in medical examinations or from misapplied medical or +surgical treatment. He differs entirely from Charcot in the matter and +points out that it was unfortunate misdirected attention to hysterical +patients which led to the creation of the many cases of _grande +hystérie_ which {262} used to be seen so commonly in clinics in France +and have now practically disappeared. They were not genuine +pathological conditions in any sense of the word, but merely the +reflection of the exaggerated interest shown in them by those +interested in neurology, who came to see certain symptoms and were, of +course, gratified in this regard by the patients, always anxious to be +the center of attention and, above all, the focus of special interest. + +The successful treatment of the war neuroses was all founded on the +will and not on the mind. Once a careful examination had determined +absolutely that no organic morbid condition was present, the patient +was given to understand that his case was of no special significance +but on the contrary was well understood and had nothing exceptional in +it. The unfortunate frequent demonstration of these patients at the +beginning of the war as subjects of special interest had been the +worst possible thing for them. After experience had cleared the way, +they were made to feel that just as soon as the attending physician +had the time to give them, he would be able to remove their symptoms +without delay. This was almost the only appeal to the mind {263} that +was made. It represented the suggestive element of the treatment. + +The two other elements were reeducation and discipline. Once +suggestion had brought the patient to believe firmly that he would be +cured, he was made to understand that his cure would be permanent. +Then reeducation was instituted to overcome the bad habit of lack of +confidence that had been formed, while discipline broke down the +psychic resistance of the patient to the idea of recovery. In such +symptoms as mutism or deafness, the patient was told that electricity +would cure him and that as soon as he felt the current when the +electrode was applied, his power of speech or of hearing would be +restored, _pari passu_, with sensation. The same method was used for +blindness and other sensory symptoms. Paralyses were favorably +affected the same way, though tremors were harder to deal with. A cure +in a single treatment was the best method, for the patient readily +relapsed unless he was made to feel that he had recovered his powers +completely and that it would be his own fault if he permitted his +symptoms to recur. + +The most interesting phase of the successful treatment of these war +neuroses for us was {264} the fact that the ultimate dependence was +placed by the French on a system of management which was called +_torpillage_. _Torpillage_ consists in the brusque application of +faradic currents strong enough to be extremely painful in hysterical +conditions, and the continuance of the procedure to the point at which +the deaf hear, the dumb speak, or those who believe themselves +incapable of moving certain groups of muscles come to move them +freely. The method has proved highly effective and requires but little +time and practically no personnel except the medical officer who +applies the treatment and the non-commissioned officer who takes the +patient at the end of the treatment and continues the exercise of the +afflicted parts. One treatment suffices. The apparatus is of the +simplest, the only accessory to the electric supply and the electrodes +consisting of an overhead trolley which carries the long connecting +wires the whole length of the room, thus making it impossible for the +patient to get away from the current which is destined to cure him. + +In a word, the man who would insist on maintaining a false attitude of +mind towards himself, though that attitude of mind was not {265} +deliberate, and least of all not malingering, was simply made to give +it up. Sufficient pain was inflicted on him so that he was willing to +accept instead of his own false opinion the opinion of his physician +that he could accomplish certain functions. _Torpillage_ was, in other +words, simply "a method of treatment which gave authority to a medical +officer to inflict pain on a patient up to the point at which the +patient yields up his neurosis." As a rule, the infliction of very +little suffering is needed, for once the demonstration is made that he +will have to suffer or give in, it does not take him very long to give +in. There is no doubt at all that the method is eminently effective, +particularly in those cases which were entirely refractory to other +modes of treatment. + +It would remind us of some old modes of treatment which were in +popular use long ago, but which had gone out entirely in our milder +generation because we thought their use almost unjustified. It was not +an unusual thing three or four generations ago to rouse a young woman +out of an hysterical tantrum, once it was perfectly clear from +previous experiences that it _was_ really an hysterical tantrum, by +dashing a pitcher of cold water {266} over her. Sir Thomas More +relates that he saw a number of people suffering from various forms of +possession--and any neurologist will confess that some hysterics must +have a devil--who were cured by being roundly whipped. Certain men +and women who complained that they were unable to walk or to work and +thus became a care for relatives or for the community, were cured by +this, as it seemed to later generations, heartless mode of treatment. +Now, we have turned to curing the war hysterias by punishment, that +is, by the infliction of severe pain, in just the same way. A great +many of these patients who suffer from neuroses and psycho-neuroses, +and especially from hysterical inhibitions so that they cannot hear or +cannot walk or cannot talk, represent inabilities similar to many +which are seen in civil life. Patients complain that they cannot do +things; their friends say that they will not do them; and the +physician sees that the root of the trouble is that they cannot +_will_. Now, however, that war has permitted the use of such remedies, +physicians have found that they can, to advantage, force the patients +to will and that once the will has been recalled into action, its +energy can be maintained. + +{267} + +Of course the compulsory mode of treatment was not represented as a +punishment, but on the contrary it was always presented as a form of +treatment which was extremely painful but necessary for the condition. +Presented as punishment, it would have been resented, and the patient +would probably have set about sympathizing with himself and perhaps +seek the sympathy of others, and this would prevent the effectiveness +of the treatment. It is very evident that as the result of compulsory +methods of treatment, and of the recognition of the fact that major +hysterical conditions are largely the result of suggestion and must be +cured by enabling the patient to secure control over himself again, +the outlook for the treatment of the psychoneuroses will be very +different as a consequence of the experience that has been gained. +Above all, the place of the will will be recognized, and there will no +longer be that coddling of patients and that analysis of their minds +for long distant psychic insults of various kinds which will explain +their condition, that has done so much harm in a great many ways in +recent years. + +Another feature of the French treatment was that the neurotic patients +should be {268} isolated. This isolation was complete. It had been +found that association with other patients, the opportunity to tell +their troubles and be sympathized with, did them harm invariably and +inevitably, so that those whose neurotic symptoms continued were taken +absolutely away from all association with others. Not only this, but +all other modes of diversion of mind were denied them. They were +placed in rooms without reading or writing materials and even without +tobacco. This solitary confinement would remind one of the enforced +privacy of the old-fashioned rest cure in which the patient was +absolutely secluded from all association with relatives or others who +might in any way sympathize with them. The soldier patients were kept +in this complete isolation until such time as they showed themselves +amenable to treatment. This was usually not very long. + +As a matter of fact, the isolation rooms had to be used very little +but were found necessary and especially effective in the management of +relapsed cases. Just as soon as soldier patients learned that such +isolating rooms were available, they became much more ready to give up +their neuroses, and as a consequence, in most places, the isolating +department did {269} not have to be used, and in some places they +could even be given over to the lodgment of attendants. It was quite +sufficient, however, that they had fulfilled their purpose of changing +patients' attitude of mind towards themselves and giving their will +control over them. + +As Colonel Pearce Bailey, M.C., says, in most of these patients, +persuasive measures and contrary suggestion were quite sufficient, but +when they failed, disciplinary measures proved effective. How are we +going to be able to make such disciplinary measures available in civil +life is another question, but at least the war has made clear that +neurotic patients who claim that they cannot do something and actually +will not do it, _must be made to do it_, for this will prove the +beginning of their cure. It seems probable, as Doctor Bailey adds, +that the reason why the treatment of officers was more difficult--and +it must not be forgotten that in proportion to their numbers, four +times as many officers suffered from so-called shell shock as +privates--was exactly because these modes of discipline, amounting +practically to compulsion, were not used with them. + + +{270} + +CHAPTER XIX + +FEMININE ILLS AND THE WILL + + + "Oh, undistinguished space of woman's will!" + _King Lear_. + + +It is probable that the largest field for the employment of the will +for the cure of conditions that are a source of serious discomfort or +at least of complaint is to be found among the special ills of +womankind. The reason for this is that the personal reaction has so +much to do with the amount of complaint in these affections. Not +infrequently the individual is ever so much more important than the +condition from which she is suffering. Women who have regular +occupation with plenty to do, especially if they are interested in it +and take their duties seriously, who get sufficient exercise and are +out of doors several hours each day and whose appetites are as a +consequence reasonably good, suffer very little from feminine ills, as +a rule. If an infection of some kind attacks them, they will, of {271} +course, have the usual reaction to it, and this may involve a good +deal of pain and even eventually require operation. Apart from this, +however, there is an immense number of feminine ills dependent almost +entirely on the exaggerated tendency to react to even minor +discomforts which characterizes women who have no occupation in which +they are really interested, who have very little to do, almost no +exercise, and whose appetite and sleep as a consequence are almost +inevitably disturbed. + +Above all, it must not be forgotten that whenever women do not get out +into the air regularly every day--and this means for a time both +morning and afternoon--they are likely to become extremely sensitive +to pains and aches. This is true of all human beings. Those who are +much in the open air complain very little of injuries and bodily +conditions that would seem extremely painful to those living sedentary +lives and who are much indoors. Riding in the open air is better than +not being in the open air at all, but it does not compare in its power +to desensitize people with active exercise in the open air. In the +older days, when women occupied themselves very much indoors with +{272} sewing, knitting and other feminine work, and with reading in +the evenings, and when it was considered quite undignified for them to +take part in sports, neurotic conditions were even more common than +they are at the present time, and young women were supposed to faint +readily and were quite expected to have attacks of the "vapors" and +the "tantrums." + +The interest of young women in sports in recent years and the practice +of walking has done a great deal to make them ever so much healthier +and has had not a little to do with decreasing the number and +intensity of the so-called feminine ills, the special "women's +diseases" of the patent medicine advertisements. Much remains to be +done in this regard, however, and there are still a great many young +women who need to be encouraged to take more exercise in the open than +they do and thus to live more natural lives. It is particularly, +however, the women of middle age, around forty and beyond it, who need +to be encouraged to use their wills for the establishment of habits of +regular exercise in the open air as well as the creation of interests +of one kind or another that will keep them from thinking too much +about {273} themselves and dwelling on their discomforts. These are +thus exaggerated until often a woman who has only some of the feelings +that are almost normally connected with physiological processes +persuades herself that she is the victim of a malady or maladies that +make her a pitiable object, deserving of the sympathy of her friends. + +A great many of the operations that have been performed on women +during the past generation have been quite unnecessary, but have been +performed because women felt themselves so miserable that they kept +insisting that something must be done to relieve them, until finally +it was felt that an operation might do them some good. It would surely +do them no harm or at least make them no worse, and there was always +the possibility that the rest in the hospital, the firm persuasion +that the operation was to do them good, the inculcation of proper +habits of eating during convalescence might produce such an effect on +their minds as would give them a fresh start in life. Undoubtedly a +great many women who were distinctly improved after operations owed +their improvement much more to the quiet seclusion of their hospital +life, their own strong expectancy {274} and the care bestowed upon +them under the hospital discipline without exaggerated sympathy which +brought about the formation of good habits of life, than to their +operation. Many a woman gained weight after an operation simply +because her eating was properly directed, and this was the main part +of the improvement which took place. + +Operations are sometimes needed and when they are the patient will +probably not get well without one; but as a distinguished neurologist, +Doctor Dercum of Philadelphia, said in a paper read before the +American Medical Association last year, the neurologist is constantly +finding patients on whom one or several operations have been +performed, some of them rather serious abdominal operations, the +source of whose complaints is a neurosis and not any morbid condition +of the female or other organs. Occasionally one sees something like +this in men, and I shall never forget seeing at Professor Koenig's +clinic in Berlin a sufferer from an abdominal neurotic condition on +whom no less than three operations for the removal of his appendix had +been performed, until finally Professor Koenig felt that he would be +justified in tattooing over the right iliac region the words "No +Appendix {275} Here." The condition developed in a young soldier as +the result of a fall from a horse and his affection resembled very +much some of the neuroses that came to be called, unfortunately, +"shell shock" during the present war. + +The principal trouble in securing such occupation of mind as will +prevent exaggerated neurotic reactions to even slight discomforts in +women is the creation for them of definite interests in life. The war +taught a notable lesson in this regard. Many a physician saw patients +whose complaints had been a great source of annoyance to them--and +their friends--proceed to get ever so much better as the result of war +interests. In one women's prison in an Eastern State, just before the +war, a series of crises of major hysteria was proving almost +unmanageable. By psychic contagion it had spread among the prisoners +until scarcely a day passed without some prisoner "throwing a fit" +with screaming and tearing of clothes and breaking of articles that +might be near. Prominent neurologists had been consulted and could +suggest nothing. When the war began, the prisoners were set to rolling +bandages, knitting socks and sweaters and making United States flags +for the army. As if by magic, the neurotic {276} crises disappeared. +For months there were none of them. The prisoners had an abiding +interest that occupied them deeply in other things besides themselves. + +The reduction of nervous complaints of various kinds among +better-to-do women was very striking. As might be expected, their +rather strenuous occupation with war activities kept them from +thinking about themselves, though it is true that now they complain +about all the details that they had to care for and the lack of +coöperation on the part of certain people. It would seem as though +many of them had so much to do that they would surely exhaust their +energies and so be in worse condition than before, but this very +seldom proved to be the case. Literally many thousands of women +improved in health because they became interested in other people's +troubles instead of their own. David Harum once said that "It is a +mighty good thing for a dog to have fleas because it keeps him from +thinking too much about the fact that he is a dog." That seems a +rather unsympathetic way of putting the case, but there is no doubt at +all that what many women need is serious interests apart from +themselves in order to prevent the law of {277} avalanche from making +minor ills appear serious troubles. + +What most women need above all are heart interests rather than +intellectual occupations. That was why occupation with war activities +did so much good. That is the reason, too, that club life and reading +and other similar pursuits often fail to be helpful to women in their +ills to the extent that might possibly be expected. Above all, women +need interests in children and the ailing, and these can be supplied +by visits to hospitals or by taking an active interest in nurseries, +though this is often not personal enough in its appeal to catch a +woman's deepest attention. One of the great reasons why there are more +nervous diseases among women in our time than in the past is because +children are fewer, and because so many women are without children and +the calls that they inevitably make on their mothers. Unfortunately, +the traditions of the present day are to a great extent in opposition +to that family life with a number of children, which means not only +the deepest interests for woman but also such inevitable occupations +in the care of them that she has very little time to think about +herself. It may seem quixotic, that is, {278} demanding unnecessary +magnanimity to suggest that these modern ideas should be discarded by +those who wish to assure themselves such interests in middle life as +will prove definitely preventive of many neurotic conditions, but it +is manifestly the physician's duty to make such suggestions. + +Life has really become full of dreads for many women in this regard. A +gradual reduction in the birth rate which has deprived so many women +of the heart interests that were particularly valuable at and after +middle life; has been the source of a great deal more suffering +without any satisfaction, than would be associated in any way with the +care of children. It is extremely unfortunate, then, that this phase +of social evolution should have taken place, for the quest of ease and +pleasure has proved a prolific source of feminine ills. It is well +recognized now that the reason for this reduction in the birth rate is +not physical but ethical. It is a matter of choice and not necessity. +There is a conscious limitation of the number of children in the +family accomplished deliberately, and as a rule the women consider +that they are justified in the procedure because they thus conserve +their own health and provide such {279} few children as they have with +healthier bodies than would otherwise have been the case. + +Indeed, child-bearing beyond one or two or perhaps three children has +become a source of dread in modern times, a dread that supposedly +centers around the health of the children, as well as the mother +herself. The mother of a few children is supposed to be healthier and +the children of small families to be heartier and more vigorous than +when there are half a dozen or more children in the family. A woman is +actually supposed by many to seriously imperil her life and her health +if she has more than two or three children, though as a matter of +fact, the history of the older times when families were larger shows +us that women were then healthier on the average than they are now, in +spite of all the progress that medicine and surgery have since made in +relieving serious ills. Above all, it was often the mother of numerous +children who lived long and in good health to be a blessing to those +around her, and not the old maids nor the childless wives, for +longevity is not a special trait of these latter classes of women. The +modern dread of deterioration of vitality as the result of frequent +child-bearing is quite without {280} foundation in the realities of +human experience. + +Some rather carefully made statistics demonstrate that the old +tradition in the matter is not merely an impression but a veritable +truth as to human nature's reaction to a great natural call. While the +mothers of large families born in the slums with all the handicaps of +poverty as well as hard work against them, die on the average much +younger than the generality of women in the population, careful study +of the admirable vital statistics of New South Wales show that the +mothers who lived longest were those who under reasonably good +conditions bore from five to seven children. Here in America, a study +of more favored families shows that the healthiest children come from +the large families, and it is in the small families particularly that +the delicate, neurotic and generally weakly children are found. +Alexander Graham Bell, in his investigation of the Hyde family here in +America, discovered that it was in the families of ten or more +children that the greatest longevity occurred. So far from mothers +being exhausted by the number of children that were born, and thus +endowing their children with less vitality than if they {281} had +fewer children, it was to the numerous offspring that the highest +vitality and physical fitness were given. One special consequence of +these is longevity. + +In a word, the dread so commonly fostered that the mothers of large +families will weaken themselves in the process of child-bearing and +unfortunately pass on to their offspring weakling natures by the very +fact that they have to repeat the process of giving life and +nourishment to them at comparatively short intervals, is as groundless +as other dreads, for exactly the opposite is true. It is when nature +is called upon to exert her amplest power that she responds most +bountifully and dowers both children and mother with better health in +return. + +Something of the same thing is true with regard to the age of mothers +when their children are born. The infant mortality is lowest among the +children of young mothers between twenty and twenty-five years of age, +though it has been found out that "delay in child-bearing after that +age penalizes the children." This is, of course, true particularly for +first children. The successive children of young mothers are known by +observation and statistics as being constantly in {282} better +condition up to the seventh. There is on the average nearly a half a +pound difference in weight at birth between succeeding children of the +same mother, so that each infant is born sturdier and more vigorous +than its predecessor. + +These recently collated facts remove entirely the supposed foundations +of a series of dreads which were having an unfortunate effect upon our +population, for the natives were disappearing before the foreigners +because of the higher birth rate among the latter. Birth control has +been producing a set of unfortunate conditions for both mothers and +children. The one child in the family is sure to be spoiled, not only +as a social being but often as regards health, and conditions are +scarcely better when there are but two, especially if they are of +opposite sexes. If anything happens to them, the mother has nothing to +live for, and a little later in life the selfish beings that have been +raised under the self-centered conditions of a small family are almost +sure to be a source of anxiety and worry. Many a woman owes the +valetudinarianism of her later years to the fact that she dreaded +maternal obligations and avoided them, and so the latter part of her +life is {283} empty of most of what makes life worth living. + +The will to make life useful for others rather than to follow a +selfish, comfortable, easy existence is the secret of health and +happiness for a great many women who are almost invalids or at least +constantly complaining in the midst of idle lives. A woman who has +nothing better to occupy her time than the care of a dog or two cannot +expect to have any interests deep enough to divert her attention from +the pains and aches of life that are more or less inevitable. The +opportunity to dwell on them will heighten their intensity until they +are almost torments. Many more of the feminine ills can be explained +in this way than by learned pathological disquisitions. Every +physician has seen the bitterest complaints disappear before some +change of life that necessitated occupation and gave the patient other +things to think about besides self. + +The will to face nature's obligations of maternity straightforwardly +is probably the greatest preventive against the psycho-neuroses that +prove so seriously disturbing to a great many women. Their affections, +given a proper opportunity to develop, impel their {284} wills to such +activity as prevents the development of morbid states. The dreads for +themselves and their children, which so often make the excuse for a +different policy in life than this, have proved unfounded on more +careful study. Now that war activities no longer call women, it must +not be forgotten that home duties are the only ones that can serve as +a universal antidote for the poison of self-indulgence, which is much +more productive of symptoms of disease than the autointoxications of +which we have heard so much, but for which there is so little +justification in our advancing science. The assumption of serious +duties is the best possible panacea for the ills of mankind as well as +womankind, only unfortunately in recent years women have succeeded in +shirking duties more and have paid the inevitable price which nature +always demands under such circumstances, when the dissatisfaction in +life is much harder to bear than the work and trials involved in the +pursuit of duty. + + +{285} + +INDEX + + A + + Achylia Gastrica, 216 + Activity, intestinal, 220 + Adirondacks, 183 + Agoraphobia, 27 + Akrophobia, 27 + Alcohol, + narcotics, 191; + in pneumonia, 190; + in snake bite, 193 + Alcoholic craving and food, 159 + Algiers, 182 + Angina pectoris, 230 + Anthony, Saint, the Hermit, 21 + Arctic regions, 205 + Aridity, office building, 206 + Aristotle, 71 + Arnold, Matthew, 219 + Arthritis, rheumatoid, 242 + Ascesis, 77 + Asceticism, 92 + Asthma dread, 211 + Attention, concentration of, 127 + Auto-intoxication, 36 + Autotoxemia, 226 + Avalanche, Law of, 123 + + B + + Babinski, 261 + Bailey, Dr. Pearce, 261, 269 + Bain, Professor, 51 + Bell, Alexander Graham, 280 + Bernheim, 252 + Betel nut, 45 + Birth control, 282 + Bismarck, 10 + Brakes on energies, 19 + Bright's disease, 102 + + C + + Cancer, 75 + Cancer cures, 106 + Carpenter, Doctor, 51 + Cat asthma, 210 + Catarrh, 31 + Character, 66 + Charcot, Professor, 252 + Chesterfield, Lord, 224 + Child bearing, 279 + Chilliness, 197 + Claustrophobia, 25 + Coddling, 267 + Conklin, Professor, 54 + Consciousness, + sphere of, 230; + threshold of, 127 + Consumption cures, 177 + Cough remedies, 201 + Coughing, + unnecessary, 199; + productive, 200 + Coughs and cold air, 204 + Cures, so-called, 244 + + D + + Danger, sense of, 129 + "David Harum", 276 + Death Valley, 206 + Dercum, Doctor, 274 + Diabetes, 164 + Disheartenment, 104 + Dowie, John A., 253 + Dreads, 278 + + {286} + + E + + "Eat and grow thin", 163 + Eating, 149 + Eddyism, 253 + Education, liberal, 55 + Effort, faculty of, 92 + Eliot, George, 67 + Emerson, Ralph Waldo, 67 + Emmet, Thomas Addis, 11, 147 + Energies of men, 15 + English, Thomas Dunn, 10 + Euphoria, 192 + Evacuation, intestinal, 221 + + F + + Family, + large, 74; + eating, 160 + Fermentation, 155 + Flat foot, 141 + Food and alcoholic craving, 159 + Food prejudices, 152 + Franklin, Benjamin, 251 + Function, intestinal, 218 + + G + + Galen, 170, 241 + Galvani, 248 + Gas formation, 155 + Gassner, Pfarrer, 252 + Giving up, 2 + Gouley, John W., 11 + Greatrakes, 245 + + H + + Habits, 149 + Hamerton, Philip Gilbert, 24 + Hamlet, 82 + Hard sayings, 66 + Health, secret of, 283 + Heart + craves exercise, 235; + interests, 277; + irregular, 236: + missed beats, 235; + regularly irregular, 237 + Heredity, 169; + and environment, 54 + Höll, Father Maximilian, 252 + Holmes, Oliver Wendell, 40 + Horace, 224 + "Horse, the outside of a", 138 + Humboldt, Alexander von, 9 + Huxley, Thomas Henry, 54 + Hyde family, 280 + Hypnotism, 251 + Hypochondria, 30 + Hysteria, major, 275 + + I + + Imperatives, 99 + Insomniaphobia, 27 + Instinct, 149 + Insults, psychic, 267 + Interests, feminine, 277 + Intestinal stasis, 38 + Intuition, 88 + Invalids, chronic, 76 + Isolation, 268 + + J + + James, William, Professor, 15, 60, 77, 92 + Jesuits, General of, 119 + + K + + Koenig, Professor, 274 + + L + + Laxatives, 219 + Leo XIII, 9 + Libitina, 224 + Long, St. John, 171, 255 + + {287} + + Longevity, 146 + Lying, hysterical, 260 + + M + + Maistre, Xavier De, 122 + Marmalade, 222 + Matthew, Father, 47 + Mesmer, Friedrich Anton, 172, 250 + Metallotherapy, 248 + Mexican border, 60 + Misophobia, 23 + Mitchell, S. Weir, 11 + Mollycoddle, 63 + Moltke, 10 + Montreal, 204 + More, Sir Thomas, 266 + Mothers, young, 281 + Mutism, 259 + + N + + Nansen, Fridtjof, 205 + Nauheim, 233 + Neuro-hypnotism, 250 + New South Wales, 280 + + O + + Obesity, 162 + O'Malley, Austin, 80 + Optatives, 99 + Orange skin, 222 + + P + + Pain and Refinement, 131 + Pain, + control, 116; + dread of, 128 + Palpitation, 228 + Perkins, Elisha, 248 + Personality, secondary, 88 + Phthisis, 171 + Physiology, study of, 35 + Pneumonia, 104; + alcohol in, 190 + Possession, 266 + Pseudologia hysterica, 260 + Psychic contagion, 275 + Psycho-analysis, 41 + Pueckler-Muskau, Prince, 16 + + Q + + Quackery, History of, 245 + Quinine and whisky, 201 + Quitters, 169 + + R + + Ramon y Cajal, 123 + Ranke, Leopold von, 11 + Repplier, Agnes, 17 + Resolution, 82 + Respiration spasm, 209 + Rest, 57 + Rheumatism, chronic, 240 + Rheumatoid arthritis, 242 + Riviera, 182 + Roosevelt, Theodore, 118 + Roughage, 220 + Royal touch, 246 + + S + + Saranac, 184 + Scare, lifted, 193 + Schlatter's case, 217 + Self-drugging, 40 + Self-pity, practice of, 70 + Self-subliminal, 88 + Sensation, diffusion of, 125 + Sensitization, 135 + Shell-shock, 64, 259 + Skotophobia, 24 + Smith, Stephen, 11 + Snake bite, 193 + + {288} + + Stokes, Professor, 5 + Stomach functions, 215 + Subconscious, 85 + Suffering, 68 + Sybarite, 72 + + T + + Tantrum, 265, 272 + Temperature variations, 181 + Thatcher, 248 + Therapeutics, absurd, 244 + Thompson, William Hanna, 11 + Torpillage, 264, 265 + Tragedy, 71 + Trait, family, 149 + Trudeau, Doctor, 183 + Tuberculosis, 103; + curable, 178; + early, 176; + frequency, 168; + takes quitters, 169 + + U + + Undereating, 160 + Underweight, 149 + + V + + Valetudinarianism, 282 + Vapors, 272 + Virchow, Rudolf, 10 + + W + + Weber, Sir Hermann, 146 + Wellington, Duke of, 43 + Wilde, Oscar, 7 + Will, + and survival, 4; + conscious use, 81; + living on, 2; + omnipotent, 16; + sapping, 13 + Women's diseases, 272 + + +-------------------------- + +MIND AND HEALTH SERIES + + +A Series of Medical Handbooks written by eminent specialists and +edited by H. Addington Bruce, A.M., and designed to present the +results of recent research and clinical experience in a form +intelligible to the lay public and medical profession. + + + +1. HUMAN MOTIVES. By James Jackson Putnam, M.D., Professor Emeritus, +Diseases of the Nervous System, Harvard University; Consulting +Neurologist, Massachusetts General Hospital, Boston. 179 pages. 12mo. +$1.35 _net_. + + A study of human conduct, using both the philosophical and the + Freudian psychoanalytic methods of approach, with most attention to + the latter method.--_A. L. A. Booklist_. + + +2. THE MEANING OF DREAMS. By Isador H. Coriat, M.D., First Assistant +Visiting Physician, Nervous Diseases, Boston City Hospital. 194 pages. +12mo. $1.35 _net_. + + The many examples that are analyzed and explained are taken from + cases that have come under the author's observations.--_A. L. A. + Booklist_. + + +3. SLEEP AND SLEEPLESSNESS. By H. 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Walsh +</title> + +<style type="text/css"> + +h1 {font-size: 160%; text-align:center;} + +h2 {font-size: 120%; text-align:center;} + +i { font-weight: bold; } + +pre { font-family: Serif; } + +.font80 { font-size: 80%; } + +.right { text-align:right; } + +.cite { margin-left: 5%; } + +.footnote { margin-left: 10%; margin-right: 10%;} + +.center { text-align: center; } + +</style> + +</head> + +<body> + + +<pre> + +The Project Gutenberg EBook of Health Through Will Power, by James J. Walsh + +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: Health Through Will Power + +Author: James J. Walsh + +Release Date: August 17, 2011 [EBook #37109] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK HEALTH THROUGH WILL POWER *** + + + + +Produced by Don Kostuch + + + + + +</pre> + + +<p class="cite"> +[Transcriber's Notes]<br> + Page numbers in this book are indicated by numbers enclosed in curly + braces, e.g. {99}. They have been located where page breaks occurred + in the original book. +<br><br> + This book is derived from a copy on the Internet Archive:<br> + http://www.archive.org/details/cu31924012175505 +<br><br> + Obvious spelling or typographical errors have been corrected. + Inconsistent spelling of names and inventive and alternative + spelling is left as printed. +<br><br> + Extended quotations and citations are indented such as reports, + letters and interviews.<br> +[End Transcriber's Notes] +</p> +<br><br> +<h1>HEALTH THROUGH WILL POWER</h1> + +<p align=center> +BY +<br><br> +JAMES J. WALSH, M.D., Ph.D., Sc.D., Etc. +<br><br> +MEDICAL DIRECTOR OF FORDHAM UNIVERSITY SCHOOL OF SOCIOLOGY; +PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY +AT CATHEDRAL COLLEGE; LECTURER ON PSYCHOLOGY, +MARYWOOD COLLEGE, ETC. +<br><br><br> + + + + BOSTON +<br><br> + LITTLE, BROWN, AND COMPANY +<br><br> + 1919 +<br><br><br> + + + <i>Copyright, 1919, </i> +<br> + By Little, Brown, and Company. +<br><br><br> + + + <i>All rights reserve</i> +<br><br> + Published, November, 1919 +<br><br><br> + + + <i>Norwood Press</i> +<br><br> + Set up and electrotyped by J. S. Cushing Co., +<br><br> + Norwood, Mass., U.S.A. +<br><br><br> + + +<i>To</i> +<br> +J. H. W. +<br><br> +EX ANIMO ET CORDE +<br><br> +J. J. W. +</p> + +{vii} + + +<h2>PREFACE</h2> +<p> +A French surgeon to whom the remark was made in the third year of the +War that France was losing an immense number of men replied: "Yes, we +are losing enormously, but for every man that we lose we are making +two men." What he meant, of course, was that the War was bringing out +the latent powers of men to such an extent that every one of those who +were left now counted for two. The expression is much more than a mere +figure of speech. It is quite literally true that a man who has had +the profound experience of a war like this becomes capable of doing +ever so much more than he could before. He has discovered his own +power. He has tapped layers of energy that he did not know he +possessed. Above all, he has learned that his will is capable of +enabling him to do things that he would have hesitated about and +probably thought quite impossible before this revelation of himself to +himself had been made. +</p> +{viii} +<p> +In a word, the War has proved a revival of appreciation of the place +of the human will in life. Marshal Foch, the greatest character of the +War, did not hesitate even to declare that "A battle is the struggle +of two wills. It is never lost until defeat is accepted. They only are +vanquished who confess themselves to be." +</p> +<p> +Our generation has been intent on the development of the intellect. We +have been neglecting the will. "Shell shock" experiences have shown us +that the intellect is largely the source of unfavorable suggestion. +The will is the controlling factor in the disease. Many another +demonstration of the power of will has been furnished by the War. This +volume is meant to help in the restoration of the will to its place as +the supreme faculty in life, above all the one on whose exercise, more +than any other single factor, depends health and recovery from +disease. The time seems opportune for its appearance and it is +commended to the attention of those who have recognized how much the +modern cult of intellect left man unprepared for the ruder trails of +life yet could not see clearly what the remedy might be. +</p> +{ix} + +<h2>CONTENTS</h2> + +<table width="100%" border="0" cellpadding="2" cellspacing="2"> +<tr><td><br></td><td><br></td><td>PAGE</td></tr> +<tr><td><br></td><td>Preface</td><td>vii</td></tr> +<tr><td><br></td><td>CHAPTER</td></tr> +<tr><td>I</td><td>The Will in Life</td><td><a href="#1">1</a></td></tr> +<tr><td>II</td><td>Dreads</td><td> <a href="#19">19</a></td></tr> +<tr><td>III</td><td>Habits</td><td> <a href="#42">42</a></td></tr> +<tr><td>IV</td><td>Sympathy</td><td> <a href="#57">57</a></td></tr> +<tr><td>V</td><td>Self-Pity</td><td><a href="#69">69</a></td></tr> +<tr><td>VI </td><td>Avoidance of Conscious Use of the Will</td><td> <a href="#80">80</a></td></tr> +<tr><td>VII </td><td> What the Will Can Do</td><td><a href="#102">102</a></td></tr> +<tr><td>VIII </td><td>Pain and the Will</td><td><a href="#112">112</a></td></tr> +<tr><td>IX </td><td>The Will and Air and Exercise</td><td> <a href="#133">133</a></td></tr> +<tr><td>X </td><td>The Will to Eat</td><td><a href="#148">148</a></td></tr> +<tr><td>XI </td><td>The Place of the Will in Tuberculosis</td><td><a href="#167">167</a></td></tr> +<tr><td>XII </td><td>The Will in Pneumonia</td><td><a href="#187">187</a></td></tr> +<tr><td>XIII </td><td>Coughs and Colds</td><td> <a href="#196">196</a></td></tr> +<tr><td>XIV </td><td>Neurotic Asthma and the Will</td><td><a href="#207">207</a></td></tr> +<tr><td>XV </td><td>The Will in Intestinal Function</td><td> <a href="#215">215</a></td></tr> +<tr><td>XVI </td><td>The Will and the Heart</td><td><a href="#227">227</a></td></tr> +<tr><td>XVII </td><td>The Will in So-Called Chronic Rheumatism</td><td> <a href="#240">240</a></td></tr> +<tr><td>XVII </td><td>Psycho-Neuroses</td><td><a href="#258">258</a></td></tr> +<tr><td>XIX </td><td>Feminine Ills and the Will</td><td><a href="#270">270</a></td></tr> +<tr><td><br></td><td>Index </td><td><a href="#285">285</a></td></tr> +</table> + + +<a name="1">{1}</a> + + +<h1>HEALTH THROUGH WILL POWER</h1> +<br><br> + + +<h2>CHAPTER I +<br><br> +THE WILL IN LIFE</h2> + +<table class="center"> +<tr><td align="left"> + "What he will he does and does so much<br> + That proof is called impossibility." +</td></tr> +<tr><td align="right"> +<i>Troilus and Cressida.</i> +</td></tr> +</table> + +<p> +The place of the will in its influence upon health and vitality has +long been recognized, not only by psychologists and those who pay +special attention to problems of mental healing, but also, as a rule, +by physicians and even by the general public. It is, for instance, a +well-established practice, when two older folk, near relatives, are +ill at the same time, or even when two younger persons are injured +together and one of them dies, or perhaps has a serious turn for the +worse, carefully to keep all knowledge of it from the other one. The +reason is a very definite conviction that in the revulsion of feeling +caused by learning of the fatality, or as <a name="2">{2}</a> a result of the +solicitude consequent upon hearing that there has been a turn for the +worse, the other patient's chances for recovery would probably be +seriously impaired. The will to get better, even to live on, is +weakened, with grave consequences. This is no mere popular impression +due to an exaggeration of sympathetic feeling for the patient. It has +been noted over and over again, so often that it evidently represents +some rule of life, that whenever by inadvertence the serious condition +or death of the other was made known, there was an immediate +unfavorable development in the case which sometimes ended fatally, +though all had been going well up to that time. This was due not +merely to the shock, but largely to the "giving up", as it is called, +which left the surviving patient without that stimulus from the will +to get well which means so much. +</p> +<p> +It is surprising to what an extent the will may affect the body, even +under circumstances where it would seem impossible that physical +factors could any longer have any serious influence. We often hear it +said that certain people are "living on their wills", and when they +are of the kind who take comparatively little food and yet succeed in +accomplishing <a name="3">{3}</a> a great deal of work, the truth of the expression +comes home to us rather strikingly. The expression is usually +considered, however, to be scarcely more than a formula of words +elaborated in order to explain certain of these exceptional cases that +seem to need some special explanation. The possibility of the human +will of itself actually prolonging existence beyond the time when, +according to all reason founded on physical grounds, life should end, +would seem to most people to be quite out of the question. And yet +there are a number of striking cases on record in which the only +explanation of the continuance of life would seem to be that the will +to live has been so strongly aroused that life was prolonged beyond +even expert expectation. That the will was the survival factor in the +case is clear from the fact that as soon as this active willing +process ceased, because the reason that had aroused it no longer +existed, the individuals in question proceeded to reach the end of +life rapidly from the physical factors already at work and which +seemed to portend inevitably an earlier dissolution than that which +happened. Probably a great many physicians know of striking examples +of patients who have lived beyond the time when ordinarily death would +<a name="4">{4}</a> be expected, because they were awaiting the arrival of a friend +from a distance who was known to be coming and whom the patient wanted +very much to see. Dying mothers have lived on to get a last embrace of +a son or daughter, and wives have survived to see their husbands for a +last parting—though it seemed impossible that they should do so, so +far as their physical condition was concerned—and then expired +within a short time. Of course there are any number of examples in +which this has not been true, but then that is only a proof of the +fact that the great majority of mankind do not use their wills, or +perhaps, having appealed to them for help during life never or but +slightly, are not prepared to make a definite serious call on them +toward the end. I am quite sure, however, that a great many country +physicians particularly can tell stories of incidents that to them +were proofs that the will can resist even the approach of death for +some time, though just as soon as the patients give up, death comes to +them. +</p> +<p> +Professor Stokes, the great Irish clinician of the nineteenth century, +to whom we owe so much of our knowledge of the diseases of the heart +and lungs, and whose name is enshrined in terms commonly used in +medicine in <a name="5">{5}</a> connection with these diseases, has told a striking +story of his experiences in a Dublin hospital that illustrates this +very well. An old Irishman, who had been a soldier in his younger +years and had been wounded many times, was in the hospital ill and +manifestly dying. Professor Stokes, after a careful investigation of +his condition, declared that he could not live a week, though at the +end of that time the old soldier was still hanging on to life, ever +visibly sinking. Stokes assured the students who were making the +rounds of his wards with him that the old man had at most a day or two +more to live, and yet at the end of some days he was still there to +greet them on their morning visits. After the way of medical students +the world over, though without any of that hard-heartedness that would +be supposed ordinarily to go with such a procedure, for they were +interested in the case as a medical problem, the students began to bet +how long the old man would live. +</p> +<p> +Finally, one day the old man said to Stokes in his broadest brogue: +"Docther, you must keep me alive until the first of the month, because +me pension for the quarther is then due, and unless the folks have it, +shure they won't have anything to bury me with." +</p> +<a name="6">{6}</a> +<p> +The first of the month was some ten days away. Stokes said to his +students, though of course not in the hearing of the patient, that +there was not a chance in the world, considering the old soldier's +physical condition, that he would live until the first of the month. +Every morning, in spite of this, when they came in, the old man was +still alive and there was even no sign of the curtains being drawn +around his bed as if the end were approaching. Finally on the morning +of the first of the month, when Stokes came in, the old pensioner said +to him feebly, "Docther, the papers are there. Sign them! Then they'll +get the pension. I am glad you kept me alive, for now they'll surely +have the money to bury me." And then the old man, having seen the +signature affixed, composed himself for death and was dead in the +course of a few hours. He had kept himself alive on his will because +he had a purpose in it, and once that purpose was fulfilled, death was +welcome and it came without any further delay. +</p> +<p> +There is a story which comes to us from one of the French prisons +about the middle of the nineteenth century which illustrates forcibly +the same power of the will to maintain life after it seemed sure, +beyond peradventure, <a name="7">{7}</a> that death must come. It was the custom to +bury in quicklime in the prison yard the bodies of all the prisoners +who died while in custody. The custom still survives, or did but +twenty years ago, even in English prisons, for those who were +executed, as readers of Oscar Wilde's "Ballad of Reading Gaol" will +recall. Irish prisons still keep up the barbarism, and one of the +reasons for the bitterness of the Irish after the insurrection of 1916 +in Dublin was the burial of the executed in quicklime in the prison +yard. The Celtic mind particularly revolts at the idea, and it +happened that one of the prisoners in a certain French prison, a +Breton, a Celt of the Celts, was deeply affected by the thought that +something like this might happen to him. He was suffering from +tuberculosis at a time when very little attention was paid to such +ailments in prisoners, for the sooner the end came, the less bother +there was with them; but he was horrified at the thought that if he +died in prison his body would disappear in the merciless fire of the +quicklime. +</p> +<p> +So far as the prison physician could foresee, the course of his +disease would inevitably reach its fatal termination long before the +end of his sentence. In spite of its advance. <a name="8">{8}</a> however, the +prisoner himself declared that he would never permit himself to die in +prison and have his body face such a fate. His declaration was +dismissed by the physician with a shrug and the feeling that after all +it would not make very much difference to the man, since he would not +be there to see or feel it. When, however, he continued to live, +manifestly in the last throes of consumption, for weeks and even +months after death seemed inevitable, some attention was paid to his +declaration in the matter and the doctors began to give special +attention to his case. He lived for many months after the time when, +according to all ordinary medical knowledge, it would seem he must +surely have died. He actually outlived the end of his sentence, had +arrangements made to move him to a house just beyond the prison gate +as soon as his sentence had expired, and according to the story, was +dead within twenty-four hours after the time he got out of prison and +thus assured his Breton soul of the fact that his body would be given, +like that of any Christian, to the bosom of mother earth. +</p> +<p> +But there are other and even more important phases of the prolongation +of life by the will that still better illustrates its power. <a name="9">{9}</a> It +has often been noted that men who have had extremely busy lives, +working long hours every day, often sleeping only a few hours at +night, turning from one thing to another and accomplishing so much +that it seemed almost impossible that one man could do all they did, +have lived very long lives. Men like Alexander Humboldt, for instance, +distinguished in science in his younger life, a traveler for many +years in that hell-hole of the tropics, the region around Panama and +Central America, a great writer whose books deeply influenced his +generation in middle age. Prime Minister of Prussia as an older man, +lived to be past ninety, though he once confessed that in his forties +he often slept but two or three hours a night and sometimes took even +that little rest on a sofa instead of a bed. Leo XIII at the end of +the nineteenth century was just such another man. Frail of body, +elected Pope at sixty-four, it was thought that there would soon be +occasion for another election; he did an immense amount of work, +assumed successfully the heaviest responsibilities, and outlived the +years of Peter in the Papal chair, breaking all the prophecies in that +regard and not dying till he was ninety-three. +</p> +<p> +Many other examples might be cited. <a name="10">{10}</a> Gladstone, always at work, +probably the greatest statesman of the nineteenth century in the +better sense of that word, was a scholar almost without a peer in the +breadth of his scholarly attainments, a most interesting writer on +multitudinous topics, keen of interest for everything human and always +active, and yet he lived well on into the eighties. Bismarck and Von +Moltke, who assumed heavier responsibilities than almost any other men +of the nineteenth century, saw their fourscore years pass over them a +good while before the end came. Bismarck remarked on his eighty-first +birthday that he used to think all the good things of life were +confined to the first eighty years of life, but now he knew that there +were a great many good things reserved for the second eighty years. I +shall never forget sitting beside Thomas Dunn English, the American +poet, at a banquet of the Alumni of the University of Pennsylvania, +when he repeated this expression for us; at the time he himself was +well past eighty. He too had been a busy man and yet rejoiced to be +with the younger alumni at the dinner. +</p> +<p> +My dear old teacher, Virchow, of whom they said when he died that four +men died, for he was distinguished not only as a pathologist, <a name="11">{11}</a> +which was the great life-work for which he was known, but as an +anthropologist, a historian of medicine and a sanitarian, was at +seventy-five actively accomplishing the work of two or three men. He +died at eighty-one, as the result of a trolley injury, or I could +easily imagine him alive even yet. Von Ranke, the great historian of +the popes, began a universal history at the age of ninety which was +planned to be complete in twelve volumes, one volume a year to be +issued. I believe that he lived to finish half a dozen of them. I have +some dear friends among the medical profession in America who are in +their eighties and nineties, and all of them were extremely busy men +in their middle years and always lived intensely active lives. Stephen +Smith and Thomas Addis Emmet, John W. Gouley, William Hanna Thompson, +not long dead, and S. Weir Mitchell, who lived to be past eighty-five, +are typical examples of extremely busy men, yet of extremely long +lives. +</p> +<p> +All of these men had the will power to keep themselves busily at work, +and their exercise of that will power, far from wearing them out, +actually seemed to enable them to tap reservoirs of energy that might +have remained <a name="12">{12}</a> latent in them. The very intensiveness of their +will to do seemed to exert an extensive influence over their lives, +and so they not only accomplished more but actually lived longer. Hard +work, far from exhausting, has just the opposite effect. We often hear +of hard work killing people, but as a physician I have carefully +looked into a number of these cases and have never found one which +satisfied me as representing exhaustion due to hard work. Insidious +kidney disease, rheumatic heart disease, the infections of which +pneumonia is a typical example, all these have been the causes of +death and not hard work, and they may come to any of us. They are just +as much accidents as any other of the mischances of life, for it is as +dangerous to be run into by a microbe as by a trolley car. Using the +will in life to do all the work possible only gives life and gives it +more abundantly, and people may rust out, that is be hurt by rest, +much sooner than they will wear out. +</p> +<p> +Here, then, is a wellspring of vitality that checks for a time at +least even lethal changes in the body and undoubtedly is one of the +most important factors for the prolongation of life. It represents the +greatest force for health and power of accomplishment that we have. +<a name="13">{13}</a> Unfortunately, in recent years, it has been neglected to a great +extent for a number of reasons. One of these has been the discussions +as to the freedom of the will and the very common teaching of +determinism which seemed to eliminate the will as an independent +faculty in life. While this affected only the educated classes who had +received the higher education, their example undoubtedly was pervasive +and influenced a great many other people. Besides, newspaper and +magazine writers emphasized for popular dissemination the ideas as to +absence of the freedom of the will which created at least an +unfortunate attitude of mind as regards the use of the will at its +best and tended to produce the feeling that we are the creatures of +circumstances rather than the makers of our destiny in any way, or +above all, the rulers of ourselves, including even to a great extent +our bodily energies. +</p> +<p> +Even more significant than this intellectual factor, in sapping will +power has been the comfortable living of the modern time with its +tendency to eliminate from life everything that required any exercise +of the will. The progress which our generation is so prone to boast of +concerns mainly this making of people <a name="14">{14}</a> more comfortable than they +were before. The luxuries of life of a few centuries ago have now +become practically the necessities of life of to-day. We are not asked +to stand cold to any extent, we do not have to tire ourselves walking, +and bodily labor is reserved for a certain number of people whom we +apparently think of as scarcely counting in the scheme of humanity. +Making ourselves comfortable has included particularly the removal of +nearly all necessity for special exertion, and therefore of any +serious exercise of the will. We have saved ourselves the necessity +for expending energy, apparently with the idea that thus it would +accumulate and be available for higher and better purposes. +</p> +<p> +The curious thing with regard to animal energy, however, is that it +does not accumulate in the body beyond a certain limited extent, and +all energy that is manufactured beyond that seems to have a definite +tendency to dissipate itself throughout the body, producing discomfort +of various kinds instead of doing useful work. The process is very +like what is called short-circuiting in electrical machinery, and this +enables us to understand how much harm may be done. Making ourselves +comfortable, therefore, may in the <a name="15">{15}</a> end have just exactly the +opposite effect, and often does. This is not noted at first, and may +escape notice entirely unless there is an analysis of the mode of life +which is directed particularly to finding out the amount of exertion +of will and energy that there is in the daily round of existence. +</p> +<p> +The will, like so many other faculties of the human organism, grows in +power not by resting but by use and exercise. There have been very few +calls for serious exercise of the will left in modern life and so it +is no wonder that it has dwindled in power. As a consequence, a good +deal of the significance of the will in life has been lost sight of. +This is unfortunate, for the will can enable us to tap sources of +energy that might otherwise remain concealed from us. Professor +William James particularly called attention to the fact, in his +well-known essay on "The Energies of Men", that very few people live +up to their <i>maximum</i> of accomplishment or their <i>optimum</i> of conduct, +and that indeed "<i>as a rule men habitually use only a small part of +the powers which they actually possess and which they might use under +appropriate conditions.</i>" +</p> +<p> +It is with the idea of pointing out how much the will can accomplish +in changing things for <a name="16">{16}</a> the better that this volume is written. +Professor James quoted with approval Prince Pueckler-Muskau's +expression, "I find something very satisfactory in the thought that +man has the power of framing such props and weapons out of the most +trivial materials, indeed out of nothing, merely by the force of his +will, which thereby truly deserves the name of omnipotent." +[Footnote 1] +</p> +<p class="footnote"> + [Footnote 1: "Tour in England, Ireland and France."] +</p> +<p> +It is this power, thus daringly called omnipotent, that men have not +been using to the best advantage to maintain health and even to help +in the cure of disease, which needs to be recalled emphatically to +attention. The war has shown us in the persons of our young soldiers +that the human will has not lost a single bit of its pristine power to +enable men to accomplish what might almost have seemed impossible. One +of the heritages from the war should be the continuance of that fine +use of the will which military discipline and war's demands so well +brought into play. Men can do and stand ever so much more than they +realize, and in the very doing and standing find a satisfaction that +surpasses all the softer pleasant feelings that come from mere comfort +and lack of necessity for physical and <a name="17">{17}</a> psychical exertion. Their +exercise of tolerance and their strenuous exertion, instead of +exhausting, only makes them more capable and adds to instead of +detracting from their powers. +</p> +<p> +How much this discipline and training of the will meant for our young +American soldiers, some of whom were raised in the lap of luxury and +almost without the necessity of ever having had to do or stand hard +things previously in their lives, is very well illustrated by a letter +quoted by Miss Agnes Repplier in the <i>Century</i>  for December. It is by +no means unique or even exceptional. There were literally thousands of +such letters written by young officers similarly circumstanced, and it +is only because it is typical and characteristic of the spirit of all +of these young men that I quote it here. Miss Repplier says that it +came from "a young American lieutenant for whom the world had been +from infancy a perilously pleasant place." He wrote home in the early +spring of 1918: +</p> +<p> +"It has rained and rained and rained. I am as much at home in a mud +puddle as any frog in France, and I have clean forgotten what a dry +bed is like. But I am as fit as a fiddle and as hard as nails. I can +eat scrap iron and sleep standing. Aren't there things <a name="18">{18}</a> called +umbrellas, which you pampered civilians carry about in showers?" If we +can secure the continuance of this will exertion, life will be ever so +much heartier and healthier and happier than it was before, so that +the war shall have its compensations. +</p> + +<a name="19">{19}</a> + +<h2>CHAPTER II +<br><br> +DREADS</h2> + +<table class="center"> +<tr><td align="left"> + "O, know he is the bridle of your will.<br> + There's none but asses will be bridled so." +</td></tr> +<tr><td align="right"> +<i>A Comedy of Errors.</i> +</td></tr> +</table> + +<p> +It must be a surprise to most people, after the demonstration of the +power of the will in the preceding chapter, that so many fail to make +use of it. Indeed, the majority of mankind are quite unable to realize +the store of energy for their health and strength and well-being which +is thus readily available, though so often unused or called upon but +feebly. The reason why the will is not used more is comparatively easy +to understand, however, once its activity in ordinary conditions of +humanity is analyzed a little more carefully. The will is +unfortunately seldom permitted to act freely. Brakes are put on its +energies by mental states of doubt and hesitation, by contrary +suggestion, and above all by the dreads which humanity has allowed to +fasten <a name="20">{20}</a> themselves on us until now a great many activities are +hampered. There is the feeling that many things cannot be done, or may +be accomplished only at the cost of so much effort and even hardship +that it would be hopeless for any but those who are gifted with +extremely strong wills to attempt them. People grow afraid to commit +themselves to any purpose lest they should not be able to carry it +out. Many feel that they would never be able to stand what others have +stood without flinching and are persuaded that if ever they were +placed in the position where they had to withstand some of the trials +that they have heard of they would inevitably break down under the +strain. +</p> +<p> +Just as soon as a human being loses confidence that he or she may be +able to accomplish a certain thing, that of itself is enough to make +the will ever so much less active than it would otherwise be. It is +like breaking a piece of strong string: those who know how wrap it +around their fingers, then jerk confidently and the string is broken. +Those who fear that they may not be able to break it hesitate lest +they should hurt themselves and give a half-hearted twitch which does +not break the string; the only thing they succeed <a name="21">{21}</a> in doing is in +hurting themselves ever so much more than does the person who really +breaks it. After that abortive effort, they feel that they must be +different from the others whose fingers were strong enough to break +the string, and they hesitate about it and will probably refuse to +make the attempt again. +</p> +<p> +It is a very old story,—this of dreads hampering the activities of +mankind with lack of confidence, and the fear of failure keeping +people from doing things. One of his disciples, according to a very +old tradition, once asked St. Anthony the Hermit what had been the +hardest obstacle that he found on the road to sanctity. The story has +all the more meaning for us here if we recall that health and holiness +are in etymology the same. St. Anthony, whose temptations have made +him famous, was over a hundred at the time and had spent some seventy +years in the desert, almost always alone, and probably knew as much +about the inner workings of human nature from the opportunities for +introspection which he had thus enjoyed as any human being who ever +lived. His young disciple, like all young disciples, wanted a short +cut on the pathway that they were both traveling. The old man said to +him, "Well, <a name="22">{22}</a> I am an old man and I have had many troubles, but +most of them never happened." +</p> +<p> +Many a nightmare of doubt and hesitation disappears at once if the +dread of it is overcome. The troubles that never happen, if dwelt +upon, paralyze the will until health and holiness become extremely +difficult of attainment. +</p> +<p> +There is the secret of the failure of a great many people in life in a +great many ways. They fear the worst, dread failure, dampen their own +confidence, and therefore fritter away their own energy. Anything that +will enable them to get rid of the dreads of life will add greatly to +their power to accomplish things inside as well as outside their +bodies. Well begun is half done, and tackling a thing confidently +means almost surely that it will be accomplished. If the dread of +failure, the dread of possible pain in its performance, the dread of +what may happen as a result of activity,—if all these or any of them +are allowed to obtrude themselves, then energy is greatly lessened, +the power to do things hampered and success becomes almost impossible. +This is as true in matters of health and strength as it is with regard +to various external accomplishments. It takes a great <a name="23">{23}</a> deal of +experience for mankind to learn the lesson that their dreads are often +without reality, and some men never learn it. +</p> +<p> +Usually when the word dreads is used, it is meant to signify a series +of psychic or psychoneurotic conditions from which sensitive, nervous +people suffer a great deal. There is, for instance, the dread of dirt +called learnedly misophobia, that exaggerated fear that dirt may cling +to the hands and prove in some way deleterious which sends its victims +to wash their hands from twenty to forty times a day. Not infrequently +they wash the skin pretty well off or at least produce annoying skin +irritation as the result of their feeling. There are many other dreads +of this kind. Some of them seem ever so much more absurd even than +this dread of dirt. Most of us have a dread of heights, that is, we +cannot stand on the edge of a height and look down without trembling +and having such uncomfortable feelings that it is impossible for us to +stay there any length of time. Some people also are unable to sit in +the front row of the balcony of a theater or even to kneel in the +front row of a gallery at church without having the same dread of +heights that comes to others at the edge of a high precipice. I have +among my <a name="24">{24}</a> patients some clergymen who find it extremely difficult +to stand up on a high altar, though, almost needless to say, the whole +height is at most five or six ordinary steps. +</p> +<p> +Then there are people who have an exaggerated dread of the dark, so +that it is quite impossible for them to sleep without a light or to +sleep alone. Sometimes such a dread is the result of some terrifying +incident, as the case in my notes in which the treasurer of a +university developed an intense dread of the dark which made sleep +impossible without a light, after he had been shot at by a burglar who +came into his room and who answered his demand, "Who is that?" by a +bullet which passed through the head of the bed. Most of the +skotophobists, the technical name for dark-dreaders, have no such +excuse as this one. Victims of nervous dreads have as a rule developed +their dread by permitting some natural feeling of minor importance to +grow to such an extent that it makes them very miserable. +</p> +<p> +Some cannot abide a shut-in place. Philip Gilbert Hamerton, the +English writer and painter, often found a railroad compartment in the +English cars an impossible situation and had to break his journey in +order to get over <a name="25">{25}</a> the growing feeling of claustrophobia, the +dread of shut-in places, which would steal over him. +</p> +<p> +There are any number of these dreads and, almost needless to say, all +of them may interfere with health and the pursuit of happiness. I have +seen men and women thrown into a severe nervous state with chilly +feelings and cold sweat as the result of trying to overcome one of +these dreads. They make it impossible for their victims to do a great +many things that other people do readily, and sadly hamper their +wills. There is only one way to overcome these dreads, and that is by +a series of acts in the contrary direction until a habit of +self-control with regard to these haunting ideas is secured. All +mankind, almost without exception, has a dread of heights, and yet +many thousands of men have in recent years learned to work on high +buildings without very much inconvenience from the dread. The wages +are good, they <i>want</i> to work this way, and the result is they take +themselves in hand and gradually acquire self-control. I have had many +of them tell me that at first they were sure they would never be able +to do it, but the gradual ascent of the building as the work proceeded +accustomed them to height, <a name="26">{26}</a> and after a while it became almost as +natural to work high up in the air as on the first or second story of +a building or even on the level ground. +</p> +<p> +The overcoming of these dreads is not easy unless some good reason +releases the will and sets it to exerting its full power. When this is +the case, however, the dread is overcome and the brake lifted after +some persistence, with absolute assurance. Men who became brave +soldiers have been known to have had a great dread of blood in early +life. Some of our best surgeons have had to leave the first operation +that they ever saw or they would have fainted, and yet after repeated +effort they have succeeded in overcoming this sensitiveness. As a +matter of fact, most people suffer so much from dreads because they +yielded to a minor dread and allowed a bad habit to be formed. It is a +question of breaking a bad habit by contrary acts rather than of +overcoming a natural disposition. Many of those who are victims have +the feeling that they cannot be expected to conquer nature this way. +As a result, they are so discouraged at the very idea that success is +dubious and practically impossible from their very attitude of mind; +but it is only the <a name="27">{27}</a> second nature of a habit that they have to +overcome, and this is quite another matter, for exactly contrary acts +to these which formed a habit will break it. +</p> +<p> +Some of these dreads seem to be purely physical in origin or character +yet prove to be merely or to a great degree only psychic states. +Insomnia itself is more a dread than anything else. In writing for the +International Clinics some years ago (Volume IV, Series XXVI) I dwelt +on the fact that insomnia as a dread was probably responsible for more +discomfort and complaints from mankind than almost anything else. +Insomniaphobia is just such a dread as agoraphobia, the dread of open +spaces; or akrophobia, the dread of heights; or skotophobia, the dread +of the dark, and other phobias which afflict mankind. It is perfectly +possible in most cases to cure such phobias by direct training against +them, and this can be done also with regard to insomnia. +</p> +<p> +Some people, particularly those who have not been out much during the +day and who have suffered from wakefulness a few times, get it on +their mind that if this state keeps up they will surely lose their +reason or their bodily health, and they begin to worry about <a name="28">{28}</a> it. +They commence wondering about five in the afternoon whether they are +going to be awake that night or not. It becomes a haunt, and no matter +what they do during the evening every now and then the thought recurs +that they will not sleep. By the time they actually lie down they have +become so thoroughly occupied with that thought that it serves to keep +them awake. Some of them avoid the solicitude before they actually get +to bed, but begin to worry after that, and if after ten minutes they +are not asleep, above all if they hear a clock strike somewhere, they +are sure they are going to be awake, they worry about it, get +themselves thoroughly aroused, and then they will not go to sleep for +hours. It is quite useless to give such people drugs, just as useless +as to attempt to give a man a drug to overcome the dread of heights or +the dread of the dark or of a narrow street through which he has to +pass. They must use their wills to help them out of a condition in +which their dreads have placed them. +</p> +<p> +Apart from these neurotic dreads, quite unreasoning as most of them +are, there are a series of what may be called intellectual dreads. +These are due to false notions that have come to be accepted and that +serve to <a name="29">{29}</a> keep people from doing things that they ought to do for +the sake of their health, or set them performing acts that are +injurious instead of beneficial. The dread of loss of sleep has often +caused people to take somnifacients which eventually proved ever so +much more harmful than would the loss of sleep they were meant to +overcome. Many a person dreading a cold has taken enough quinine and +whisky to make him more miserable the next day than the cold would +have, had it actually made its appearance, as it often does not. The +quinine and whisky did not prevent it, but the expectation was founded +on false premises. There are a great many other floating ideas that +prove the source of disturbing dreads for many people. A discussion of +a few typical examples will show how much health may be broken by the +dreads associated with various ills, for they often interfere with +normal, healthy living. +</p> +<p> +"A little knowledge is a dangerous thing" applies particularly in this +matter. There are many morbid fears that disturb mankind and keep us +from accomplishing what might otherwise be comparatively easy. A great +many people become convinced that they have some diseased condition, +or morbid elements at least, <a name="30">{30}</a> in them which make it impossible for +them to do as much as other people. Sometimes this morbid persuasion +takes the form of hypochrondia and the individuals feel that they have +a constitution that unfits them for prolonged and strenuous effort of +any kind, so they avoid it. The number of valetudinarians, that is of +those who live their lives mainly engaged in caring for their health, +though their physicians have never been able to find anything +organically wrong with them, is much larger than might be imagined. +This state of mind has been with us for many centuries, for the word +which describes it, hypochondria, came to us originally from Greece +and is an attempt to localize the affection in connection with its +principal symptom, which is usually one of discomfort in the stomach +region or to one side or the other of it, that is, in the hypochondria +or beneath the ribs. +</p> +<p> +Such a state of mind, in which the patient is constantly complaining +of one symptom or another, quite paralyzes the will. The individual +may be able to do some routine work but he will not be able to have +any initiative or energy for special developments of his occupation, +and of course, when any real affection occurs, he will feel that he is +quite <a name="31">{31}</a> unable to bear this additional burden of disease. +Hypochondriacs, however, sometimes fairly enjoy their ill health and +therefore have been known not infrequently to live on to a good, round +old age, ever complaining more and more. It is their dread of disease +that keeps them from getting better and prevents their wills from +throwing off whatever symptoms there are and becoming perfectly well. +Until something comes along and rouses their wills, there is no hope +of affecting them favorably, and it is surprising how long the state +may continue without any one ever having found any organic affection +to justify all the discomforts of which they complain. Quite +literally, they are suffering from complaints and not from disease in +the ordinary sense of the word. +</p> +<p> +Sometimes these dreads of disease are dependent on some word which has +taken on an exaggerated significance in people's minds. A word that in +recent years has been the source of a great deal of unfavorable +suggestion is "catarrh", and a mistaken notion of its meaning has been +productive of a serious hampering of their will to be well in a number +of persons. In itself, both according to its derivation and its +accepted scientific <a name="32">{32}</a> significance, the word means only that first +stage of inflammatory irritation of mucous membranes which causes +secretion to flow more freely than normally. <i>Catarrhein</i> in Greek +means only to flow down. [Footnote 2] +</p> +<p class="footnote"> + [Footnote 2: The word has, by the way, the same meaning as + rheumatism, which is also from the Greek verb, to flow, though its + application is usually limited to the serous membranes of the joints + or the serous surfaces of the intermuscular planes. By derivation, + catarrh is the same word also as gout, which comes from <i>gutta</i> in + Latin, meaning a drop and implying secretory disturbances. These + three words—catarrh, rheumatism, gout—have been applied to all + sorts of affections and are so general in meaning as to be quite + hard to define exactly. They have for this very reason, their + vagueness, become a prolific source of unfortunate suggestion and of + all kinds of dreads that disturb health.] +</p> +<p> +By abuse, however, the word <i>catarrh</i> has come to mean in the minds of +a great many people in our time a very serious inflammation of the +mucous membranes, almost inevitably progressive and very often +resulting in fetid diseased conditions of internal or external mucous +membranes, very unpleasant for the patient and his friends and the +source of serious complications and <i>sequelae</i>. This idea has been +fostered sedulously by the advertisers of proprietary remedies and the +ingenious exploiters of various modes of treatment. As a result, a +great many people who for one reason or another—usually because of +some slight increase of secretion in the nose and <a name="33">{33}</a> throat—become +convinced they have catarrh begin to feel that they cannot be expected +to have as much resistive vitality as others, since they are the +subjects of this serious progressive disease. As a matter of fact, +very few people in America, especially those living in the northern or +eastern States, are without some tendency to mild chronic catarrh. The +violent changes of temperature and the damp, dark days predispose to +it; but it produces very few symptoms except in certain particularly +sensitive individuals whose minds become centered on slight +discomforts in the throat and nose and who feel that they must +represent some serious and probably progressive condition. +</p> +<p> +As a matter of fact, catarrh has almost nothing of the significance +attributed to it so often in magazine and newspaper advertisements. +Simple catarrh decreases without producing any serious result, and +indeed it is an index of a purely catarrhal condition that there is a +complete return to normal. Sometimes microbes are associated with its +causation, but when this is so, they are bacteria of mild pathological +virulence that do not produce deep changes. As for catarrh developing +fetid, foul-smelling discharges or odors, that <a name="34">{34}</a> is out of the +question. There are certain affections, notably diphtheria, that may +produce such serious changes in the mucous membranes that there will +always even long after complete recovery be an unpleasant odorous +condition, but it is probable that even in these cases there exists a +special form of microbe quite rare in occurrence which produces the +state known as <i>ozena</i>. +</p> +<p> +As to catarrh spreading from the nose and throat to the other mucous +membranes, that is also quite out of the question if it is supposed to +occur in the way that the advertising specialist likes to announce. +Catarrhal conditions may occur in the stomach, but like those of the +nose and throat they are not serious, heal completely, and produce no +definite changes. A pinch of snuff may cause a catarrhal condition of +the nose, that is an increase of secretion due to hyperaemia of the +mucous membrane; the eating of condiments, of Worcestershire sauce, +peppers, and horse-radish may cause it in the stomach. It may be due +to microbic action or to irritant or decomposing food, but it is not a +part of a serious, wide-spreading pathological condition that will +finally make the patient miserable. It is surprising, however, how +many people say with an air of finality <a name="35">{35}</a> that they have catarrh, +as if it should be perfectly clear that as a result they cannot be +expected at any time to be in sufficiently good health to be called on +for any special work, and of course if any affection should attack +them, their natural immunity to disease has been so lowered by this +chronic affection, of which they are the victims, that no strong +resistance could be expected from them. +</p> +<p> +All this is merely a dread induced by paying too much attention to +medical advertisements. It is better not to know as much as some +people know, or think they know about themselves, than to know so many +things that are not so. Their dreads seriously impair their power to +work and leave them ill disposed to resist affections of any kind that +may attack them. It is a sad confession to make, but not a little of +the enforced study of physiology in our schools has become the source +of a series of dreads and solicitudes rather than of helpful +knowledge. We have as a result a generation who know a little about +their internal economy, but only enough to make them worry about it +and not quite enough to make them understand how thoroughly capable +our organisms are of caring for themselves successfully and with +resultant good health, if we will only <a name="36">{36}</a> refrain from putting +brakes on their energies and disturbing their functions by our worries +and anxieties. +</p> +<p> +Another such word as catarrh in its unfavorable suggestiveness in +recent years has been auto-intoxication. It is a mouth-filling word, +and therefore very probably it has occupied the minds of the better +educated classes. Usually the form of auto-intoxication that is most +spoken of is intestinal auto-intoxication, and this combination has +for many people a very satisfying polysyllabic length that makes it of +special significance. Its meaning is taken to be that whenever the +contents of the intestines are delayed more than twenty hours or +perhaps a little longer, or whenever certain irritant materials find +their way into the intestinal tract, there is an absorption of toxic +matter which produces a series of constitutional symptoms. These +include such vague symptomatic conditions as sleepiness, torpor after +meals, an uncomfortable sense of fullness—though when we were young +we rather liked to have that feeling of fullness—and sometimes a +feeling of heat in the skin with other sensations of discomfort in +various parts of the body. At times there is headache, but this is +rather rare; lassitude and a feeling of <a name="37">{37}</a> inability to do things is +looked upon as almost characteristic of the condition. Usually there +are nervous symptoms of one kind or another associated with the other +complaints and there may be distinctly hysterical or psycho-neurotic +manifestations. +</p> +<p> +Auto-intoxication as just described has become a sort of fetish for a +great many people who bow down and worship at its shrine and give some +of the best of their energies and not a little of their time to +meditation before it. As a matter of fact, in the last few years it +has come to be recognized that auto-intoxication is a much abused word +employed very often when there are serious organic conditions in +existence elsewhere in the body and still more frequently when the +symptoms are due merely to functional nervous troubles. These are +usually consequent upon a sedentary life, lack of fresh air and +exercise, insufficient attention to the diet in the direction of +taking simple and coarse food, and generally passing disturbances that +can be rather readily catalogued under much simpler affections than a +supposed absorption of toxic materials from the intestines. Reflexes +from the intestinal tract, emphasized by worries about the condition, +are much more responsible for the feelings <a name="38">{38}</a> complained of—which +are often not in any sense symptoms—than any physical factors +present. +</p> +<p> +As Doctor Walter C. Alvarez said in a paper on the "Origin of the +So-called Auto-intoxicational Symptoms" published from the George +Williams Hooper Foundation for Medical Research of the University of +California Medical School, [Footnote 3] as the conclusion of his +investigation of the subject: +</p> +<p class="footnote"> + [Footnote 3: <i>Journal of the American Medical Association</i>, + January 4, 1919.] +</p> +<p class="cite"> + "Auto-intoxication is commonly diagnosed when a physical examination + would show other more definite causes for the symptoms. Those who + believe that intestinal stasis can account for a long list of + disease conditions have little proof to offer for their views. Many + of the assumptions on which they rest their case have proved to be + wrong. +<br><br> + "The usual symptoms of the constipated disappear so promptly after a + bowel movement that they cannot be due to absorbed toxins. They must + be produced mechanically by distension and irritation of the colon. + They occur in nervous, sensitive people. It has been shown that + various activities of the digestive tract can profoundly affect the + sensorium and the vasomotor nerves. The <a name="39">{39}</a> old ideas of insidious + poisoning led to the formation of hypochrondriacs; the new + explanation helps to cure many of them." +</p> +<p> +There are many other terms in common use that have unfortunate +suggestions and make people feel, if they once get the habit of +applying them to themselves, that they are the subject of rather +serious illness. I suppose that one of the most used and most abused +of these is uric acid and the uric acid diathesis. Scientific +physicians have nearly given up these terms, but a great many people +are still intent on making themselves miserable. All sorts of symptoms +usually due to insufficient exercise and air, inadequate diversion of +mind and lack of interests are attributed to these conditions. Some +time or other a physician or perhaps some one who is supposed to be a +friend suggested them and they continue to hamper the will to be well +by baseless worries founded on false notions for years afterwards. +What is needed is a definite effort of the will to throw off these +nightmares of disease that are so disturbing and live without them. +</p> +<p> +It is surprising how much vital energy may be wasted in connection +with such dreads. Unfortunately, too, medicines of various kinds are +taken to relieve the symptoms connected <a name="40">{40}</a> with them and the +medicine does ever so much more harm than good. Oliver Wendell Holmes +declared a generation ago that if all the medicines that had ever been +taken by mankind were thrown into the sea it would be much better for +mankind and much worse for the fishes. The expression still has a +great truth in it, especially as regards that habit of self-drugging +so common among the American people. In the course of lecture +engagements, I stay with very intelligent friends on a good many +occasions each year, and it is surprising how many of them have +medicine bottles around, indicating that they are subject to dreads of +various kinds with regard to themselves for which they feel medicine +should be taken. These dreads unfortunately often serve to lessen +resistive vitality to real affections when they occur and therefore +become a source of real danger. +</p> +<p> +All these various dreads, then, have the definite effect of lessening +the power of the will to enable people to do their work and remain +well. They represent serious brakes upon the flow of nerve impulses +from the spiritual side of man's nature to the physical. This is much +more serious in its results than would usually be thought; and one of +the <a name="41">{41}</a> things that a physician has to find out from a great many +patients is what sources of dread they are laboring under so as to +neutralize them or at least correct them as far as possible. It is +surprising how much good can be accomplished by a deliberate quest +after dreads and the direct discussion of them, for they are always +much less significant when brought out of the purlieus of the mind +directly into the open. Many a neurotic patient, particularly, will +not be improved until his dreads are relieved. This form of +psycho-analysis rather than the search for sex insults, as they are +called, or sexual incidents of early life, is the hopeful phase of +modern psychological contribution to therapeutics. +</p> + +<a name="42">{42}</a> + +<h2>CHAPTER III +<br><br> +HABITS</h2> + +<table class="center"> +<tr><td align="left"> + "Why, will shall break it; will and nothing else." +</td></tr> +<tr><td align="right"> +<i>Love's Labor's Lost</i> +</td></tr> +</table> + +<p> +Dreads are brakes on the will, inhibitions which prevent its exercise +and make accomplishment very difficult and sometimes impossible. They +represent mainly a state of mind, yet often they contain physical +elements, and the disposition counts for much. Their counterpart in +the opposite direction is represented by habits which are acquired +facilities of action for good or for ill. Habits not only make +activities easy but they even produce such a definite tendency to the +performance of certain actions as to make it difficult not to do them. +They may become so strong as to be tyrants for ill, though it must not +be forgotten that properly directed they may master what is worst in +us and help us up the hill of life. Acts that are entirely voluntary +and very difficult at first may become by habit so <a name="43">{43}</a> natural that +it is extremely difficult to do otherwise than follow the ingrained +tendency. Nature's activities are imperative. Habitual actions may +become equally so. When some one once remarked to the Duke of +Wellington that habit was second nature, he replied: +</p> +<p> +"Oh, ever so much more than that! Habit may be ten times as strong as +nature." +</p> +<p> +The function of the will in health is mainly to prevent the formation +of bad habits or break those that have been formed, but above all, to +bring about the formation of habits that will prevent as far as is +possible the development of tendencies to disease in the body, Man +probably faces no more difficult problem in life than the breaking of +a bad habit. Usually it requires the exercise of all his will power +applied to its fullest extent. If there is a more difficult problem +than the breaking of a bad habit it is the formation of a good one +late in life because of the persistency of advertence and effort that +is required. It is comparatively easy to prevent the formation of bad +habits and also easy to form good habits in the earlier years. The +organism is then plastic and yields itself readily and thus becomes +grooved to the habit or hardened against it by the performance of even +a few acts. +</p> +<a name="44">{44}</a> +<p> +All the psychologists insist that after the period of the exercise of +instinct as the basis of life passes, habit becomes the great force +for good or for ill. We become quite literally a bundle of habits, and +the success of life largely depends on whether these habits are +favorable or unfavorable to the accomplishment of what is best in us. +More than anything else health depends on habit. We begin by doing +things more or less casually, and after a time a tendency to do them +is created; then almost before we know it, we find that we have a +difficult task before us, if we try not to do them. +</p> +<p> +To begin with, the activity which becomes the subject of a habit may +be distinctly unpleasant and require considerable effort to +accomplish. Practically every one who has learned to smoke recalls +more or less vividly the physical disturbance caused by the first +attempt and how even succeeding smokes for some time, far from being +pleasant, required distinct effort and no little self-control. After a +time, the desire to smoke becomes so ingrained that a man is literally +made quite miserable by the lack of it and finds himself almost +incapable of doing anything else until he has had his smoke. +</p> +<a name="45">{45}</a> +<p> +Even more of an effort is required to establish the habit of chewing +tobacco, and it is even more difficult to break when once it has been +formed. Any one who has seen the discomfort and even torments endured +by a man who, after he had chewed tobacco for many years, tried to +stop will appreciate fully what a firm hold the habit has obtained. I +have known a serious business man who almost had to give up business, +who lost his sleep and his appetite and went through a nervous crisis +merely by trying to break the habit of chewing tobacco. +</p> +<p> +In the Orient they chew betel nut. It is an extremely hot material +which burns the tongue and which a man can stand for only a very short +time when he first tries it. After a while, however, he finds a +pleasant stimulation of sensation in the constant presence of the +biting betel nut in his mouth; he craves it and cannot do his work so +well without it. He will ever advert to its use and will be restless +without it. He continues to use it in spite of the fact that the +intense irritation set up by the biting qualities of the substance +causes cancer of the tongue to occur ten times as frequently among +those who chew betel nut as among the rest of the population. Not all +<a name="46">{46}</a> those who chew it get cancer, for some die from other causes +before there is time for the cancer to develop, and some seem to +possess immunity against the irritation. The betel nut chewer ignores +all this, proceeds to form the habit, urged thereto by the force of +example, and then lets himself drift along, hoping that it will have +no bad effects. +</p> +<p> +The alcohol and drug habits are quite as significant in shortening +life as betel nut and yet men take them up quite confident in the +beginning that <i>they</i>  will not fall victims, and then find themselves +enmeshed. It is probable that the direct physical effects of none of +these substances shorten life to a marked degree unless they are +indulged in to very great excess, but the moral hazards which they +produce, accidents, injuries of various kinds, exposure to disease, +all these shorten life. Men know this very well, and yet persist in +the formation of these habits. +</p> +<p> +Any habit, no matter how strong, can be broken if the individual +really wishes to break it, provided the subject of it is not actually +insane or on the way to the insane asylum. He need only get a motive +strong enough to rouse his will, secure a consciousness of his own +power, and then the habit can be broken. <a name="47">{47}</a> After all, it must never +be forgotten that the only thing necessary in order to break a habit +effectively is to refuse to perform a single act of it, the next time +one is tempted. That breaks the habit and makes refusal easier and one +need only continue the refusal until the temptation ceases. +</p> +<p> +Men who have not drawn a sober breath for years have sometimes come to +the realization of the fools that they were making of themselves, the +injury they were doing their relatives, or perhaps have been touched +by a child's words or some religious motive, and after that they have +never touched liquor again. Father Theobald Mathew's wonderful work in +this regard among the Irish in the first half of the nineteenth +century has been repeated by many temperance or total abstinence +advocates in more recent generations. I have known a confirmed +drunkard reason himself into a state of mind from which he was able to +overcome his habit very successfully, though his reasoning consisted +of nothing more than the recognition of the fact that suggestion was +the root of his craving for alcohol. His father had been a drunkard +and he had received so many warnings from all his older relatives and +had himself so come to dwell on <a name="48">{48}</a> the possible danger of his own +formation of the habit that he had suggested himself into the frame of +mind in which he took to drink. I have known a physician on whom some +half a dozen different morphine cures had been tried—always followed +by a relapse—cure himself by an act of his own will and stay cured +ever since because of an incident that stirred him deeply enough to +arouse his will properly to activity. One day his little boy of about +four was in his office when father prepared to give himself one of his +usual injections of morphine. The little boy gave very close attention +to all his father's manipulations, and as the doctor was hurrying to +keep an appointment, he did not notice the intent eye witness of the +proceedings. Just as the needle was pushed home and the piston shot +down in the barrel, the little boy rushed over to his father and said, +"Oh, Daddy, do that to me." Apparently this close childish observer +had noted something of the look of satisfaction that came over his +father's face as he felt the fluid sink into his tissues. It is almost +needless to say that the shock the father received was enough to break +his morphine habit for good and all. It simply released his will and +then he found that if he <a name="49">{49}</a> really wanted to, he could accomplish +what the various cures for the morphine habit only lead up to—and in +his case unsuccessfully—the exercise of his own will power. +</p> +<p> +The word "habit" suggests nearly always, unfortunately, the thought of +bad habits, just as the word "passion" implies, with many people, evil +tendencies. But it must not be forgotten that there are good passions +and good habits that are as helpful for the accomplishment of what is +best in life as bad passions and bad habits are harmful. A repetition +of acts is needed for the formation of good habits just as for the +establishment of customs of evil. Usually, however, and this must not +be forgotten, the beginning of a good habit is easier than the +beginning of a bad habit. Once formed, the good habits are even more +beneficial than the bad habits are harmful. It is almost as hard to +break a good habit as a bad one, provided that it has been continued +for a sufficient length of time to make that groove in the nervous +system which underlies all habit. We cannot avoid forming habits and +the question is, shall we form good or bad habits? Good habits +preserve health, make life easier and happier; bad habits have the +opposite effect, though <a name="50">{50}</a> there is some countervailing personal +element that tempts to their formation and persistence. +</p> +<p> +Every failure to do what we should has its unfortunate effect upon us. +We get into a state in which it is extremely difficult for us to do +the right things. We have to overcome not only the original inertia of +nature, but also a contrary habit. If we do not follow our good +impulses, the worse ones get the upper hand. As Professor James said, +for we must always recur to him when we want to have the clear +expression of many of these ideas: +</p> +<p class="cite"> + "Just as, if we let our emotions evaporate, they get into a way of + evaporating; so there is reason to suppose that if we often flinch + from making an effort, before we know it the effort-making capacity + will be gone; and that, if we suffer the wandering of our attention, + presently it will wander all the time. Attention and effort are but + two names for the same psychic fact. To what brain-processes they + correspond we do not know. The strongest reason for believing that + they do depend on brain processes at all and are not pure acts of + the spirit, is just this fact, that they seem in some degree subject + to the law of habit, which is a material law." +</p> +<p> +It must not be forgotten that we mold not <a name="51">{51}</a> alone what we call +character, but that we manifestly produce effects upon our tissues +that are lasting. Indeed it is these that count the most, for health +at least. It is the physical basis of will and intellect that is +grooved by what we call habit. As Doctor Carpenter says: +</p> +<p class="cite"> + "Our nervous systems have grown to the way in which they have been + exercised, just as a sheet of paper or a coat, once creased or + folded, tends to fall forever afterwards into the same identical + fold." +</p> +<p> +Permitting exceptions to occur when we are forming a habit is almost +necessarily disturbing. The classical figure is that it is like +letting fall a ball of string which we have been winding. It undoes in +a moment all that we have accomplished in a long while. As Professor +Bain has said it so much better than I could, I prefer to quote him: +</p><p class="cite"> + "The peculiarity of the moral habits, contradistinguishing them from + the intellectual acquisitions, is the presence of two hostile + powers, one to be gradually raised into the ascendant over the + other. It is necessary, above all things, in such a situation never + to lose a battle. Every gain on the wrong side undoes the effect of + many conquests on the <a name="52">{52}</a> right. The essential precaution, + therefore, is so to regulate the two opposing powers that the one + may have a series of uninterrupted successes, until repetition has + fortified it to such a degree as to enable it to cope with the + opposition under any circumstances." +</p> +<p> +This means training the will by a series of difficult acts, +accomplished in spite of the effort they require, but which gradually +become easier from repeated performance until habit replaces nature +and dominates the situation. +</p> +<p> +Serious thinkers who faced humanity's problems squarely and devoted +themselves to finding solutions for them had worked out this formula +of the need of will training long ago, and it was indeed a principal +characteristic of medieval education. The old monastic schools were +founded on the idea that training of the will and the formation of +good habits was ever so much more important than the accumulation of +information. They frankly called the human will the highest faculty of +mankind and felt that to neglect it would be a serious defect in +education. The will can only be trained by the accomplishment of +difficult things day after day until its energies are aroused and the +man becomes conscious of his own powers and the <a name="53">{53}</a> ability to use +them whenever he really wishes. There was a time not so long since, +and there are still voices raised to that purport, when it was the +custom to scoff at the will training of the older time and above all +the old-fashioned suggestion that mortifications of various +kinds—that is, the doing of unpleasant things just for the sake of +doing them—should be practiced because of the added will power thus +acquired. The failure of our modern education which neglected this +special attention to the will is now so patent as to make everyone +feel that there must be a recurrence to old time ideas once more. +</p> +<p> +The formation of proper habits should, then, be the main occupation of +the early years. This will assure health as well as happiness, barring +the accidents that may come to any human being. Good habits make +proper living easy and after a time even pleasant, though there may +have been considerable difficulty in the performance of the acts +associated with them at the beginning. Indeed, the organism becomes so +accustomed to their performance after a time that it becomes actually +something of a trial to omit them, and they are missed. +</p> +<p> +Education consists much more in such <a name="54">{54}</a> training of the will than in +storing the intellect with knowledge, though the latter idea has been +unfortunately the almost exclusive policy in our education in recent +generations. We are waking up to the fact that diminution of power has +been brought about by striving for information instead of for the +increase of will energy. +</p> +<p> +Professor Conklin of Princeton, in his volume on "Heredity and +Environment", emphasized the fact that "Will is indeed the supreme +human faculty, the whole mind in action, the internal stimulus which +may call forth all the capacities and powers." He had said just before +this: "It is one of the most serious indictments against modern +systems of education that they devote so much attention to the +training of the memory and intellect and so little attention to the +training of the will, upon the proper development of which so much +depends." +</p> +<p> +Nor must it be thought that the idea behind this training of the will +is in any sense medievally ascetic and old-fashioned and that it does +not apply to our modern conditions and modes of thinking. Professor +Huxley would surely be the one man above all whom any one in our times +would be least likely to think of <a name="55">{55}</a> as mystical in his ways or +medieval in his tendencies. In his address on "A Liberal Education and +Where to Find It", delivered before the South London Workingmen's +College some forty years ago, in emphasizing what he thought was the +real purpose of education, he dwelt particularly on the training of +the will. He defined a liberal education not as so many people might +think of it in terms of the intellect, but rather in terms of the +will. He said that a liberal education was one "which has not only +prepared a man to escape the great evils of disobedience to natural +laws, but has trained him to appreciate and to seize upon the rewards +which nature scatters with as free a hand as her penalties." And then +he added: +</p> +<p class="cite"> + "That man, I think, has had a liberal education who has been so + trained in youth that his body is the ready servant of his will, and + does with ease and pleasure all the work that, as a mechanism, it is + capable of; whose intellect is a clear, cold, logic engine, with all + its parts of equal strength, and in smooth working order, ready, + like a steam engine, to be turned to any kind of work, and spin the + gossamers as well as forge the anchors of the mind; whose mind is + stored with a knowledge of the great <a name="56">{56}</a> and fundamental truths of + nature and of the laws of her operations; one who is no stunted + ascetic but who is full of life and fire, but whose passions are + trained to come to heel by a vigorous will, the servant of a tender + conscience; who has learned to love all beauty, whether of nature or + of art, to hate all vileness, and to respect others as himself. +<br><br> + "Such an one and no other, I conceive, has had a liberal education; + for he is, completely as a man can be, in harmony with nature." +</p> +<p> +This is the liberal education in habits of order and power that every +one must strive for, so that all possible energies may be available +for the rewards of good health. Details of the habits that mean much +for health must be reserved for subsequent chapters, but it must be +appreciated in any consideration of the relation of the will to health +that good habits formed as early as possible in life and maintained +conservatively as the years advance are the mainstay of health and the +power to do work. +</p> + +<a name="57">{57}</a> + +<h2>CHAPTER IV +<br><br> +SYMPATHY</h2> + +<table class="center"> +<tr><td align="left"> + "Never could maintain his part but in the force of his will." +</td></tr> +<tr><td align="right"> +<i>Much Ado about Nothing</i> +</td></tr> +</table> + +<p> +A great French physician once combined in the same sentence two +expressions that to most people of the modern time would seem utter +paradoxes. "Rest," he said, "is the most dangerous of remedies, never +to be employed for the treatment of disease, except in careful doses, +under the direction of a physician and rarely for any but sufferers +from organic disease"; while "sympathy", he added, "is the most +insidiously harmful of anodynes, seldom doing any good except for the +passing moment, and often working a deal of harm to the patient." +</p> +<p> +With the first of these expressions, we have nothing to do here, but +the second is extremely important in any consideration of the place of +the will in human life. Nothing is so prone <a name="58">{58}</a> to weaken the will, +to keep it from exerting its full influence in maintaining vital +resistance, and as a result, to relax not only the moral but the +physical fiber of men and women as misplaced sympathy. It has almost +exactly the same place in the moral life that narcotics have in the +physical, and it must be employed with quite as much nicety of +judgment and discrimination. +</p> +<p> +Sympathy of itself is a beautiful thing in so far as it implies that +<i>suffering with</i> another which its Greek etymology signifies. In so +far as it is pity, however, it tends to lessen our power to stand up +firmly under the trials that are sure to come, and is just to that +extent harmful rather than helpful. There is a definite reaction +against it in all normal individuals. No one wants to be pitied. We +feel naturally a little degraded by it. In so far as it creates a +feeling of self-pity, it is particularly to be deprecated, and indeed +this is so important a subject in all that concerns the will to be +well and to get well that it has been reserved for a special chapter. +What we would emphasize here is the harm that is almost invariably +done by the well-meant but so often ill-directed sympathy of friends +and relatives which proves relaxing of moral <a name="59">{59}</a> purpose and hampers +the will in its activities, physical as well as ethical. +</p> +<p> +Human nature has long recognized this and has organized certain +customs of life with due reference to it. We all know that when +children fall and even hurt themselves, the thing to do is not to +express our sympathy and sorrow for them, even though we feel it +deeply, but unless their injury is severe, to let them pick themselves +up and divert their minds from their hurts by suggesting that they +have broken the floor, or hurt it. For the less sympathy expressed, +the shorter will be the crying, and the sooner the child will learn to +take the hard knocks of life without feeling that it is especially +abused or suffering any more than comes to most people. Unfortunately, +it is not always the custom to do the same thing with the children of +a larger growth. This is particularly true when there is but a single +child in the family, or perhaps two, when a good deal of sympathy is +likely to be wasted on their ills which are often greatly increased by +their self-consciousness and their dwelling on them. Diversion of +mind, not pity, is needed. The advice to do the next thing and not cry +over spilt milk is ever so much better than sentimental recalling of +the past. +</p> +<a name="60">{60}</a> +<p> +Many a young man who went to war learned the precious lesson that +sympathy, though he might crave it, instead of doing him good would do +harm. Many a manly character was rounded out into firm self-control +and independence by military discipline and the lack of anything like +sentimentality in camp and military life. A good many mothers whose +boys had been the objects of their special solicitude felt very sorry +to think that they would have to submit to the hardships and trials +involved in military discipline. Most of them who were solicitous in +this way were rather inclined to feel that their boy might not be able +to stand up under the rigidities of military life and hoped at most +that he would not be seriously harmed. They could not think that early +rising, hard work, severe physical tasks, tiring almost to exhaustion, +with plain, hearty, yet rather coarse food, eaten in slapdash fashion, +would be quite the thing for their boy of whom they had taken so much +care. Not a few of them were surprised to find how the life under +these difficult circumstances proved practically always beneficial. +</p> +<p> +I remember distinctly that when the soldiers were sent to the Mexican +border the mother of <a name="61">{61}</a> a soldier from a neighboring State remarked +rather anxiously to me that she did not know what would happen to Jack +under the severe discipline incident to military life. He had always +gone away for five or six weeks in the summer either to the mountains +or to the seashore, and the Mexican border, probably the most trying +summer climate in the United States, represented the very opposite of +this. Besides, there was the question of the army rations; Jack was an +only son with five sisters. Most of them were older than he, and so +Jack had been coddled as though by half a dozen mothers. He was +underweight, he had a rather finicky appetite, he was capricious in +his eating both as to quantity and quality, and was supposed to be a +sufferer from some form of nervous indigestion. Personally, I felt +that what Jack needed was weight, but I had found it very hard to +increase his weight. He was particularly prone to eat a very small +breakfast, and his mother once told me that whenever he was at home, +she always prepared his breakfast for him with her own hands. This did +not improve matters much, however, for Jack was likely to take a small +portion of the meat cooked for him, refuse to touch the potatoes, and +eat marmalade and toast with <a name="62">{62}</a> his coffee and nothing more. No +wonder that he was twenty pounds underweight or that his mother should +be solicitous as to what might happen to her Jack in army life at the +Border. +</p> +<p> +I agreed with her in that but there were some things that I knew would +not happen to Jack. His breakfast, for instance, would not be +particularly cooked for him, and he might take or leave exactly what +was prepared for every one else. Neither would the Government cook +come out and sit beside Jack while he was at breakfast and tempt him +to eat, as his mother had always done. I knew, too, that at other +meals, while the food would be abundant, it would usually be rather +coarse, always plain, and there would be nothing very tempting about +it unless you had your appetite with you. If ever there is a place +where appetite is the best sauce, it is surely where one is served +with army food. +</p> +<p> +I need scarcely tell what actually happened to Jack, for it was +exactly what happened to a good many Jacks whose mothers were equally +afraid of the effects of camp life on them. Amid the temptations of +home food, Jack had remained persistently underweight. Eating an army +ration with the sauce of appetite due to prolonged physical efforts in +the outdoor <a name="63">{63}</a> air every day, Jack gained more than twenty pounds in +weight, in spite of the supposedly insalubrious climate of the Border +and the difficult conditions under which he had to live. It was +literally the best summer vacation that Jack had ever spent, though if +the suggestion had ever been made that this was the sort of summer +vacation that would do him good, the idea would have been scoffed at +as impractical, if not absolutely impossible. +</p> +<p> +Homer suggested that a mollycoddle character whom he introduces into +the "Iliad" owed something of his lack of manly stamina to the fact +that he had six sisters at home, and an Irish friend once translated +the passage by saying that the young man in question was "one of seven +sisters." This had been something of Jack's trouble. He had been asked +always whether he changed his underwear at the different seasons, +whether he wore the wristlets that sisterly care provided for him, +whether he put on his rubbers when he went out in damp weather and +carried his umbrella when it was threatening rain, and all the rest. +He got away from all this sympathetic solicitude in army life and was +ever so much better for it. +</p> +<p> +It is extremely difficult to draw the line <a name="64">{64}</a> where the sympathy +that is helpful because it is encouraging ends, and sentimental pity +which discourages begins. There is always danger of overdoing and it +is extremely important that growing young folks particularly should be +allowed to bear their ills without help and learn to find resources +within themselves that will support them. The will can thus be +buttressed to withstand the difficulties of life, make them much +easier to bear, and actually lessen their effect. Ten growing young +folks have been seriously hurt by ill-judged sympathy for every one +that has been discouraged by the absence of sympathy or by being made +to feel that he must take the things of life as they come and stand +them without grouchy complaint or without looking for sympathy. +</p> +<p> +This is particularly true as regards those with any nervous or +hysterical tendencies, for they readily learn to look for sympathy. +The most precious lesson of the war for physicians has been that which +is emphasized in the chapter on "The Will and the War Psychoneuroses." +There was an immense amount of so-called "shell-shock" which really +represented functional neurotic conditions such as in women used to be +called hysteria. At the <a name="65">{65}</a> beginning of the war there was a good +deal of hearty sympathy with it, and patients were encouraged by the +physicians and then by the nurses and other patients in the hospital +to tell over and over again how their condition developed. It was +found after a time that the sympathy thus manifested always did harm. +The frequent repetition of their stories added more and more +suggestive elements to the patients' condition, and they grew worse +instead of better. It was found that the proper curative treatment was +to make just as little as possible of their condition, to treat them +firmly but with assurance—once it had been definitely determined that +no organic nervous trouble was present—and to bring about a cure of +whatever symptoms they had at a single sitting by changing their +attitude of mind towards themselves. +</p> +<p> +Some of the patients proved refractory and for these isolation and +rather severe discipline were occasionally necessary. The isolation +was so complete as to deprive them not only of companionship but also +of reading and writing materials and the solace of their tobacco. +Severe cases were sometimes treated by strong faradic currents of +electricity which were extremely painful. Patients who insisted that +<a name="66">{66}</a> they could not move their muscles were simply made to jump by an +electric shock, thus proving to them that they could use the muscles, +and then they were required to continue their use. +</p> +<p> +Those suffering from shell-shock deafness and muteness were told that +an electrode would be applied to their larynx or the neighborhood of +their ear and when they felt pain from it, that was a sign that they +were able to talk and to hear if they wished, and that they must do +so. Relapses had to be guarded against by suggestion, and where +relapses became refractory and stronger currents of electricity to ear +and larynx were deemed inadvisable, the strict isolation treatment +usually proved effective. +</p> +<p> +In a word, discipline and not sympathy was the valuable mode of +treating them. Sympathy did them harm as it invariably does. The world +has recognized this truism always, but we need to learn the lesson +afresh, or the will power is undermined. Character is built up by +standing the difficult things of life without looking for the narcotic +of sympathy or any other anaesthetizing material. These are "hard +sayings," to use a Scriptural expression, but they represent the +accumulation of wisdom of human experience. Sympathy can be <a name="67">{67}</a> +almost as destructive of individual morale as the dreads, and it is +extremely important that it should not be allowed to sap will energy. +In our time above all, when the training of the will has been +neglected, though it is by far the most important factor in education, +this lesson with regard to the harmful effect of sympathy needs to be +emphasized. +</p> +<p> +For nervous people, that is, for those who have, either from +inheritance or so much oftener from environment, yielded to +circumstances rather than properly opposed them, sympathy is quite as +dangerous as opium. George Eliot once replied to a friend who asked +her what was duty, that duty consisted in facing the hard things in +life without taking opium. +</p> +<p> +Healthy living to a great extent depends on standing what has to be +borne from the bodies that we carry around with us without looking for +sympathy. It has often been emphasized that human beings are eminently +lonely. The great experiences of life and above all, death and +suffering, we have to face by ourselves and no one can help us. We may +not be, as Emerson suggested, "infinitely repellent particles", but at +all the profoundest moments of life we feel our alone-ness. The more +<a name="68">{68}</a> that we learn to depend bravely on ourselves and the less we seek +outside support for our characters, the better for us and our power to +stand whatever comes to us in life. +</p> +<p> +Physical ills are always lessened by courageously facing them and are +always increased by cringing before them. The one who dreads suffers +both before and during the time of the pain and thus doubles his +discomfort. We must stand alone in the matter and sympathy is prone to +unman us. Looking for sympathy is a tendency to that self-pity which +is treated in a subsequent chapter and which does more to increase +discomfort in illness, exaggerate symptoms, and lower resistive +vitality than anything else, in the psychic order at least. +</p> +<p> +Suffering is always either constructive or destructive of character. +It is constructive when the personal reaction suffices to lessen and +make it bearable. It is destructive whenever there is a looking for +sympathy or a leaning on some one else. Character counts in +withstanding disease, and even in the midst of epidemics, according to +many well-grounded traditions, those who are afraid contract the +disease sooner than others and usually suffer more severely. Sympathy +must not be allowed to produce any such effect as this. +</p> +<a name="69">{69}</a> + +<h2>CHAPTER V +<br><br> +SELF-PITY</h2> + +<table class="center"> +<tr><td align="left"> + "The will dotes that is attributive<br> + To what infectiously itself affects." +</td></tr> +<tr><td align="right"> +<i>Troilus and Cressida</i> +</td></tr> +</table> + +<p> +The worst brake on the will to be well is undoubtedly the habit that +some people have of pitying themselves and feeling that they are +eminently deserving of the pity of others because of the trials, real +or supposed, which they have to undergo. Instead of realizing how much +better off they are than the great majority of people—for most of the +typical self-pitiers are not real subjects for pity—they keep looking +at those whom they fondly suppose to be happier than themselves and +then proceed to get into a mood of commiseration with themselves +because of their ill health—real or imaginary—or uncomfortable +surroundings. Just as soon as men or women assume this state of mind, +it becomes extremely difficult for them to stand any real <a name="70">{70}</a> trials +that appear, and above all, it becomes even more difficult for them to +react properly against the affections of one kind or another that are +almost sure to come. Self-pity is ever a serious hamperer of resistive +vitality. +</p> +<p> +A great many things in modern life have distinctly encouraged this +practice of self-pity and conscious commiseration of one's state until +it has become almost a commonplace of modern life for those who feel +that they are suffering, especially if they belong to what may be +called the sophisticated classes. We have become extremely sensitive +as a consequence about contact with suffering. Editors of magazines +and readers for publishing houses often refuse in our time to accept +stories that have unhappy endings, because people do not care to read +them, it is said. The story may have some suffering in it and even +severe hardships, especially if these can be used for purposes of +dramatic climax, but by the end of the story everything must have +turned out "just lovely", and it must be understood that suffering is +only a passing matter and merely a somewhat unpleasant prelude to +inevitable happiness. +</p> +<p> +Almost needless to say, this is not the way of life as it must be +lived in what many <a name="71">{71}</a> generations of men have agreed in calling +"this vale of tears." For a great many people have to suffer severely +and without any prospect of relief—none of us quite escape the +necessity of suffering—and as some one has said, all human life, +inasmuch as there is death in it, must be considered a tragedy. The +old Greeks did not hesitate, in spite of their deep appreciation of +the beauty of nature and cordial enthusiasm for the joy of living, +even to emphasize the tragedy in life. They were perhaps inclined to +think that the sense of contrast produced by tragedy heightened the +actual enjoyment of life and that indeed all pleasure was founded +rather on contrast than positive enjoyment. One may not be ready to +agree with the saying that the only thing that makes life worth while +is contrast, but certainly suffering as a background enhances +happiness as nothing else can. +</p> +<p> +Aristotle declared that tragedy purges life, that is, that only +through the lens of death and misfortune could one see life free from +the dross of the sordid and merely material to which it was attached. +His meaning was that tragedy lifted man above the selfishness of mere +individualism, and by showing him the misfortunes of others prepared +him to struggle <a name="72">{72}</a> for himself when misfortune might come, as it +almost inevitably would; and at the same time lifted him above the +trifles of daily life into a higher, broader sphere of living, where +he better realized himself and his powers. +</p> +<p> +For man is distinctly prone to forget about death and suffering, and +when he does, to become eminently selfish and forgetful of the rights +of others and his duties towards them. The French have a saying, +consisting of but four words and an intervening shrug of the +shoulders, that is extremely illuminating. They quote as the +expression of the usual thought of men when brought face to face with +the fact that people are dying all around them, "<i>On meurt—les +autres!</i>" "People die—Oh, yes (with an expressive shrug of the +shoulders), other people!" We refuse to recognize the fact that we too +must go until that is actually forced upon us by advancing years or by +some incurable disease. As for suffering, a great many people have +come almost to resent that they should be asked to suffer, and +character dissolves in self-pity as a result. +</p> +<p> +Instead of the constant, continuous reading of what may be called +Sybaritic literature—for it is said that the Sybarite finds it +impossible to sleep if there is a crushed rose leaf next <a name="73">{73}</a> his +skin—instead of being absorbed in the literature which emphasizes the +pleasures of life and pushes its pains into the background, young +people, and especially those of the better-to-do classes, should be +taught from their early years to read the lives of those who have +endured successfully hardships of various kinds and have succeeded in +getting satisfaction out of their accomplishment in life, despite all +the suffering that was involved. These are human beings like +ourselves, and what mortal has done, other mortals can do. +</p> +<p> +There was a school of American psychologists before the war who had +come to recognize the value of that old-fashioned means of +self-discipline of mind, the reading of the lives of the saints. For +those to whom that old-fashioned practice may seem too reactionary, +there are the lives and adventures of our African and Asiatic +travelers and our polar explorers as a resource. +</p> +<p> +War books have been a godsend for our generation in this regard. They +have led people to contemplate the hardest kind of suffering—and very +often in connection with those who are nearest and dearest to them— +and thus made them understand something of the possibilities of human +nature to withstand <a name="74">{74}</a> trials and sufferings. As a result they have +been trained not to make too much of their own trivial trials, as they +soon learned to recognize them in the face of the awful hardships that +this war involved. What Belgium endured was bad enough, while the +experiences of Poland, Servia, Armenia were an ascending scale of +horrors, but also of humanity's power to stand suffering. +</p> +<p> +Life in the larger families of the olden times afforded more +opportunities for the proper teaching of the place of suffering than +in the smaller families of the modern time. Older children, as they +grew up, had before them the example of mother's trials and hardships +in bearing and rearing children, and so came to understand better the +place of hard things in life. In a large family it was very rare when +one or more of the members did not die, and thus growing youth was +brought in contact with the greatest mystery in life, that of death. +Very frequently at least one of the household and sometimes more, had +to go through a period of severe suffering with which the others were +brought in daily contact. It is sometimes thought in modern times that +such intimacy with those who are suffering takes the joy out of life +for those who <a name="75">{75}</a> are young, but any one who thinks so should consult +a person who has had the actual experience; while occasionally it may +be found that some one with a family history of this kind may think +that he or she was rendered melancholy by it, nine out of ten or even +more will frankly say that they feel sure that they were benefited. +There is nothing in the world that broadens and deepens the +significance of life like intimate contact with suffering, if not in +person, then in those who are near and dear to us. +</p> +<p> +As a physician, I have often felt that I should like to take people +who are constantly complaining of their little sorrows and trials, who +are downhearted over some minor ailment, who sometimes suffer from +fits of depression precipitated by nothing more, perhaps, than a dark +day or a little humid weather, or possibly even a petty social +disappointment, and put them in contact with cancer patients or others +who are suffering severely day by day, yes, hour by hour, night and +day, and yet who are joyful and often a source of joy to others. Let +us not forget that nearly one hundred thousand people die every year +from cancer in this country alone. +</p> +<p> +As a physician, I have often found that a <a name="76">{76}</a> chronic invalid in a +house became the center of attraction for the whole household, and +that particularly when it was a woman, whether mother or elder sister, +all of the other members brought their troubles to her and went away +feeling better for what she said to them. I have seen this not in a +few exceptional instances, but so often as to know that it is a rule +of life. Chronic invalids often radiate joy and happiness, while +perfectly well people who suffer from minor ills of the body and mind +are frequently a source of grumpiness, utterly lack sympathy, and are +impossible as companions. An American woman, bedridden for over thirty +years, has organized by correspondence one of the most beautiful +charities of our time. +</p> +<p> +Pity properly restricted to practical helpfulness without any +sentimentality is a beautiful thing. There is always a danger, +however, of its arousing in its object that self-pity which is so +eminently unlovely and which has so often the direct tendency to +increase rather than decrease whatever painful conditions are present. +</p> +<p> +Crying over oneself is always to be considered at least hysterical. +Crying, except over a severe loss, is almost unpardonable. <a name="77">{77}</a> It is +often said that a good cry, like a rainstorm, clears the atmosphere of +murk and the dark elements of life, but it is dangerous to have +recourse to it. It is a sign of lack of character almost invariably +and when indulged in to any extent will almost surely result in +deterioration of the power to withstand the trials of life, whatever +they may be. +</p> +<p> +Professor William James has suggested that not only should men and +women stand the things that come to them in the natural course of +events, but they should even go out and seek certain things hard to +bear with the idea of increasing their power to withstand the +unpleasant things of life. This is, of course, a very old idea in +humanity, and the ascetics from the earliest days of Christianity +taught the doctrine of self-inflicted suffering in order to increase +the power of resistance. +</p> +<p> +It is usually said that the principal idea which the hermits and +anchorites and the saintly personages of the early Middle Ages, of +whose mortifications we have heard so much, had in inflicting pain on +themselves was to secure merit for the hereafter. Something of that +undoubtedly was in their minds, but their main purpose was quite +literally ascetic. <i>Ascesis</i>, from the Greek, means in its strict <a name="78">{78}</a> +etymology just exercise. They were exercising their power to stand +trials and even sufferings, so that when these events came, as +inevitably they would, seeing that we carry round with us what St. +Paul called "this body of our death," they would be prepared for them. +</p> +<p> +Practically any psychologist of modern times who has given this +subject any serious thought will recognize, as did Professor James, +the genuine psychology of human nature that lies behind these ascetic +practices. Nothing that I know is so thoroughgoing a remedy for +self-pity as the actual seeking at times of painful things in order to +train oneself to bear them. The old-fashioned use of disciplines, that +is, little whips which were used so vigorously sometimes over the +shoulders as to draw blood, or the wearing of chains which actually +penetrated the skin and produced quite serious pain no longer seems +absurd, once it is appreciated that this may be a means of bracing up +character and making the real trials and hardships of life much easier +than would otherwise be the case. +</p> +<p> +Not that human nature must not be expected to yield a little under +severe trials and bend before the blasts of adverse fortune, but <a name="79">{79}</a> +that there should not be that tendency to exaggerate one's personal +feelings which has unfortunately become characteristic of at least the +better-to-do classes in our time. Not that we would encourage stony +grief, but that sorrow must be restrained and, above all, must not be +so utterly selfish as to be forgetful of others. +</p> +<p> +Tears should, to a large extent, be reserved, as they are in most +perfectly normal individuals, for joyous rather than sad occasions, +for no one ever was supremely joyful without having tears in the eyes. +It is when we feel most sympathetic to humanity that the gift of tears +comes to us, and no feeling is quite so completely satisfying as comes +from the tears of joy. Mothers who have heard of their boy's bravery, +its recognition by those above him, and its reward by proper symbols, +have had tears come welling to their eyes, while their hearts were +stirred so deeply with sensations of joy and pride that probably they +have never before felt quite so happy. +</p> +<a name="80">{80}</a> + +<h2>CHAPTER VI +<br><br> +AVOIDANCE OF CONSCIOUS USE OF THE WILL</h2> + +<table class="center"> +<tr><td align="left"> + "Our bodies are our gardens to which our wills are gardeners." +</td></tr> +<tr><td align="right"> +<i>Othello</i> +</td></tr> +</table> + +<p> +Doctor Austin O'Malley, in his little volume, "Keystones of Thought", +says: "When you are conscious of your stomach or your will you are +ill." We all appreciate thoroughly, as the result of modern progress +in the knowledge of the influences of the mind on the body, how true +is the first part of this saying, but comparatively few people realize +the truth of the second part. The latter portion of this maxim is most +important for our consideration. It should always be in the minds of +those who want to use their own wills either for the purpose of making +themselves well, or keeping themselves healthy, but above all, should +never be forgotten by those who want to help others get over various +ills that are manifestly due in whole or in part to the failure to use +the vital energies in the body as they should be employed. +</p> +<a name="81">{81}</a> +<p> +Conscious use of the will, except at the beginning of a series of +activities, is always a mistake. It is extremely wasteful of internal +energy. It adds greatly to the difficulty of accomplishing whatever is +undertaken. It includes, above all, watching ourselves do things, +constantly calculating how much we are accomplishing and whether we +are doing all that we should be doing, and thus makes useless demands +on power partly by diversion of attention, partly by impairment of +concentration, but above all by adding to the friction because of the +inspection that is at work. +</p> +<p> +The old kitchen saw is "a watched kettle never boils." The real +significance of the expression is of course that it seems to take so +long for the water to boil that we become impatient while watching and +it looks to us as though the boiling process would really never occur. +This is still more strikingly evident when we are engaged in watching +our own activities and wondering whether they are as efficient as they +should be. The lengthening of time under these circumstances is an +extremely important factor in bringing about tiredness. Ask any human +being unaccustomed to note the passage of time to tell you when two +minutes have elapsed; <a name="82">{82}</a> inevitably he will suggest at the end of +thirty to forty seconds that the two minutes must be up. Only by +counting his pulse or by going through some regular mechanical process +will he be enabled to appreciate the passage of time in anything like +its proper course. When watched thus, time seems to pass ever so much +more slowly than it would otherwise. +</p> +<p> +It is extremely important then that people should not acquire the +impression that they must be consciously using their will to bring +themselves into good health and keep themselves there, for that will +surely defeat their purpose. What is needed is a training of the will +to do things by a succession of harder and harder tasks until the +ordinary acts of life seem comparatively easy. Intellectual persuasion +as to the efficiency of the will in this matter means very little. The +ordinary feeling that reasoning means much in such matters is a +fallacy. Much thinking about them is only disturbing of action as a +rule and Hamlet's expression that the "native hue of resolution is +sicklied o'er with the pale cast of thought" is a striking bit of +psychology. +</p> +<p> +Shakespeare had no illusions with regard to the place of the will in +life and more than any English author has emphasized it. I have <a name="83">{83}</a> +ventured to illustrate this by quotations from him under each chapter +heading, but there are many more quite as applicable that might +readily be found. He knew above all how easy it was for human beings +to lessen the power of their wills and has told us of "the cloy'd will +that satiateth unsatisfied desire" and "the bridles of our wills", and +has given us such adjectives as "benumbed" and "neutral" and "doting", +which demonstrates his recognition of how men weaken their wills by +over-deliberation. +</p> +<p> +The mode of training in the army is of course founded on this mode of +thinking. The young men in the United States Army want to accomplish +every iota of their duty and are not only willing but anxious to do +everything that is expected of them. There were some mighty difficult +tasks ahead of them over in Europe and our method of preparing the men +was not by emphasizing their duty and dinning into their ears and +minds how great the difficulty would be and how they must nerve +themselves for the task. Such a mode of preparation would probably +have been discouraging rather than helpful. But they were trained in +exercises of various kinds in an absolutely regular life under plain +living in the <a name="84">{84}</a> midst of hard work until their wills responded to +the word of command quite unconsciously and immediately without any +need of further prompting. Their bodies were trained until every +available source of energy was at command, so that when they <i>wanted</i> +to do things they set about them without more ado, and as they were +used to being fatigued they were not constantly engaged in dreading +lest they should hurt themselves, or fostering fears that they might +exhaust their energies or that their tiredness, even when apparently +excessive, would mean anything more than a passing state that rest +would repair completely. +</p> +<p> +If at every emergency of their life at war soldiers had to go through +a series of conscious persuasions to wake up their will and set their +energies at work, and if they had to occupy themselves every time in +presenting motives why this activity should not be delayed, then +military discipline, at least in so far as it involves prompt +obedience, would almost inevitably be considerable of a joke. What is +needed is unthinking, immediate obedience, and this can be secured +only by the formation of deeply graven habits which enable a man to +set about the next thing that duty calls for at once. +</p> +<a name="85">{85}</a> +<p> +Every action that we perform is the result of an act of the will, but +we do not have to advert to that as a rule; whenever any one gets into +a state of mind where it is necessary to be constantly adverting to +it, then, as was said at the beginning of this chapter, there is +something the matter with the will. The faculty is being hampered in +its action by consciousness, and such hampering leads to a great waste +of energy. +</p> +<p> +The will is the great, unconscious faculty in us. By far the greater +part of what has come unfortunately to be called the unconscious and +the subconscious and that has occupied so much of the attention of +modern writers on psychological subjects is really the will at work. +It attains its results we know not how, and it is prompted to their +accomplishment in ways that are often very difficult for us to +understand. Its effects are often spoken of as due to the submerged +self or the subliminal self or the other self, but it is only in rare +and pathological cases as a rule that such expressions are justified +once the place of the will is properly recognized. +</p> +<p> +It is often said, for instance, that the power some people have of +waking after a certain <a name="86">{86}</a> period of sleep at night or after a short +nap during the daytime, a power that a great many more people would +possess if only they deliberately practised it, is due to the +subconsciousness or the subliminal personality of the individual which +wakes him up at the determined time. Why those terms should be used +when other things are accomplished by the human will just as +mysteriously is rather difficult to understand. It is well recognized +that if an individual in the ordinary waking state wants to do +something after the lapse of an hour or so he will do it, provided his +will is really awake to the necessity of accomplishing it. It is true +that he may become so absorbed in his current occupation as to miss +the time, but such abstraction usually means that he was not +sufficiently interested in the duty that was to be performed as to +keep the engagement with himself, or else that he is an individual in +whom the intellectual over-shadows the voluntary life. We speak of him +as an impractical man. +</p> +<p> +We all know the danger there is in putting off calling some one by +telephone on being told that "the line is busy", for not infrequently +it will happen that several hours will elapse before we think of the +matter again <a name="87">{87}</a> and then perhaps it may be too late. If we set a +definite time limit with ourselves, however, then our will will prompt +us quite as effectively, though quite as inexplicably, at the +expiration of that time as it awakes those who have resolved to be +aroused at a predetermined moment. We may miss our telephone +engagement with ourselves, but we practically never miss an important +train, because having deeply impressed upon ourselves the necessity +for not missing this, our will arouses us to activity in good time. +There is not the slightest necessity, however, for appealing to the +unconscious or the subconscious in this. It is true that there is a +wonderful sentinel within us that awakes us from daydreams or disturbs +the ordinary course of some occupation to turn our attention to the +next important duty that we should perform. We know that this sentinel +is quite apart from our consciousness; but the power we have of +setting ourselves to doing anything is exemplified in very much the +same way. When I want a book, I do not know what it is that sets my +muscles in motion and brings me to a shelf and then directs my +attention to choosing the one I shall take down and consult. It is an +unconscious activity, but not the activity of <a name="88">{88}</a> unconsciousness, +which is only a contradiction in terms. [Footnote 4] +</p> +<p class="footnote"> + [Footnote 4: It is true that there is a particular phase of our + intellectual effort included under the modern terms unconscious or + subconscious that is mysterious enough to deserve a special name, + but we already have an excellent term for this quality which is not + vague but thoroughly descriptive of its activity. This is + intuition,—a word that has been in use for nearly a thousand years + now and signifies the immediate perception of a truth,—by a flash + as it were. We may know nothing about a subject and may have only + begun to think about it, when there flashes on us a truth that has + perhaps never occurred to any one else and certainly has never been + in our minds before. It has been suggested in recent years that such + flashes of intelligence are due to the secondary personality or the + subliminal self or the other self, and it is often added that it is + the development of our knowledge of these phases of psychology that + represents modern progress in the science of mind. Only the term for + it is new, however, for intuition has been the subject of special + intensive study for a long while. Indeed, the reason why the + old-time poet appealed to the muses for aid and the modern poet + suggests inspiration as the source of his poetic thought, is because + both of them knew that their best thoughts flash on them, not as the + result of long and hard thinking, but by some process in which with + the greatest facility come perceptions that even they themselves are + surprised to learn that they have. To say that such things come from + the unconscious is simply to ignore this wonderful power of original + thought, that is, primary perception. Emerson suggested that + intuition represented all the knowledge that came without tuition, + as if this were the etymology, and the hint is excellent for the + meaning, though the real derivation of the word has no relation to + tuition. To attribute these original thoughts to the unconscious or + any partly conscious faculty in us is to ignore a great deal of + careful study of psychology before our time. It is besides to + entangle oneself in the absurdity of discussing an unconscious + consciousness.] +</p> +<p> +While many people are inclined to feel almost helpless in the presence +of the idea that it is their unconscious selves that enable them <a name="89">{89}</a> +to do things or initiate modes of activity, the feeling is quite +different when we substitute for that the word "will." All of us +recognize that our wills can be trained to do things, and while at +first it may require a conscious effort, we can by the formation of +habits not only make them easy, but often delightful and sometimes +quite indispensable to our sense of well being. Walking is extremely +difficult at the beginning, when its movements are consciously +performed, but it becomes a very satisfying sort of exercise after a +while and then almost literally a facile, nearly indispensable +activity of daily life, so that we feel the need for it, if we are +deprived of it. +</p> +<p> +This has to be done with regard to the activities that make for +health. We have to form habits that render them easy, pleasant, and +even necessary for our good feelings. This can be done, as has been +suggested in the chapter on habits, but we have to avoid any such +habit as that of consciously using the will. That is a bad habit that +some people let themselves drop into but it should be corrected. +Having set our activities to work we must, as far as possible, forget +about them and let them go on for themselves. It is not only possible +but even easy and above all almost <a name="90">{90}</a> necessary that we should do +this. Hence at the beginning people must not expect that they will +find the use of their will easy in suppressing pain, lessening +tiredness, and facilitating accomplishment, but they must look forward +to the time quite confidently when it will be so. In the meantime the +less attention paid to the process of training, the better and more +easily will the needed habits be formed. +</p> +<p> +Failure to secure results is almost inevitable when conscious use of +the will comes into the problem. As a rule a direct appeal should not +be made to people to use their wills, but they should be aroused and +stimulated in various ways and particularly by the force of example. +What has made it so comparatively easy for our young soldiers to use +their wills and train their bodies and get into a condition where they +are capable of accomplishing what they would have thought quite +impossible before, has been above all the influence of example. A lot +of other young men of their own age are standing these things +exemplarily. They are seen performing what is expected of them without +complaint, or at least without refusal, and so every effort is put +forth to do likewise without any time spent on reflection as to how +<a name="91">{91}</a> difficult it all is or how hard to bear or how much they are to +be pitied. It is not long before what was hard at first becomes under +repetition even easy and a source of fine satisfaction. Getting up at +five in the morning and working for sixteen hours with only +comparatively brief intervals for relaxation now and then, and often +being burdened with additional duties of various kinds which must be +worked in somehow or other, seems a very difficult matter until one +has done it for a while. Then one finds everything gets done almost +without conscious effort. Will power flows through the body and lends +hitherto unexpected energy, but of this there is no consciousness; +indeed, conscious reflection on it would hamper action. No wonder that +as a result of the facility acquired, one comes to readily credit the +assumption that the will is a spiritual power and that some source of +energy apart from the material is supplying the initiative and the +resources of vitality that have made accomplishment so much easier +than would have been imagined beforehand. This is quite literally what +training of the will means: training ourselves to use all our powers +to the best advantage, not putting obstacles in their way nor brakes +on their exertion, but <a name="92">{92}</a> also not thinking very much about them or +making resolutions. The way to do things is to do them, not think +about them. +</p> +<p> +Professor James is, as always, particularly happy in his mode of +expressing this great truth. He insists that the way to keep the will +active is not by constantly thinking about it and supplying new +motives and furbishing up old motives for its activity, but by +cultivating the faculty of effort. His paragraph in this regard is of +course well known, and yet it deserves to be repeated here because it +represents the essence of what is needed to make the will ready to do +its best work. He says: +</p> +<p class="cite"> + "As a fine practical maxim, relative to these habits of the will, we + may, then, offer something like this: <i>Keep the faculty of effort + alive in you by a little gratuitous exercise every day</i>. That is, be + systematically ascetic or heroic in little unnecessary points, do + every day or two something for no other reason than that you would + rather not do it, so that when the hour of dire need draws nigh, it + may find you not unnerved and untrained to stand the test. + Asceticism of this sort is like the insurance which a man pays on + his house and goods. The tax does him no good at the time and <a name="93">{93}</a> + possibly may never bring him a return. But if the fire <i>does</i> come, + his having paid it will be his salvation from ruin. So with the man + who has daily inured himself to habits of concentrated attention, + energetic volition, and self-denial in unnecessary things. He will + stand like a tower when everything rocks around him, and when his + softer fellow mortals are winnowed like chaff in the blast." +</p> +<p> +To do things on one's will without very special interest is an +extremely difficult matter. It can be done more readily when one is +young and when certain secondary aims are in view besides the mere +training of the will, but to do things merely for will training +becomes so hard eventually that some excuse is found and the task is +almost inevitably given up. Exercising for instance in a gymnasium +just for the sake of taking exercise or keeping in condition becomes +so deadly dull after a while that unless there is a trainer to keep a +man up to the mark, his exercise dwindles from day to day until it +amounts to very little. Men who are growing stout about middle life +will take up the practice of a cold bath after ten minutes or more of +morning exercises with a good deal of enthusiasm, but they will not +keep it up long, or if they do continue for several months, any <a name="94">{94}</a> +change in the daily routine will provide an excuse to drop it. +Companionship and above all competition in any way greatly helps, but +it takes too much energy of the will to make the effort alone. +Besides, when the novelty has worn off and routine has replaced +whatever interest existed in the beginning in watching the effect of +exercise on the muscles, the lack of interest makes the exercise of +much less value than before. If there is not a glow of satisfaction +with it, the circulation, especially to the periphery to the body, is +not properly stimulated and some of the best effect of the exercise is +lost. Athletes often say of solitary exercise that it leaves them +cold, which is quite a literal description of the effect produced on +them. The circulation of the surface is not stimulated as it is when +there is interest in what is being done and so the same warmth is not +produced at the surface of the body. +</p> +<p> +It is comparatively easy to persuade men who need outdoor exercise to +walk home from their offices in the afternoon when the distance is not +too far, but it is difficult to get them to keep it up. The walk +becomes so monotonous a routine after a time that all sorts of excuses +serve to interrupt the habit, and then it is not long before it is +done so irregularly as to lose <a name="95">{95}</a> most of its value. Here as in all +exercise, companionship which removes conscious attention from +advertence to the will greatly aids. On the other hand, as has been so +clearly demonstrated in recent years, it is very easy to induce men to +go out and follow a little ball over the hills in the country, an +ideal form of exercise, merely because they are interested in their +score or in beating an opponent. Any kind of a game that involves +competition makes people easily capable of taking all sorts of +trouble. Instead of being tired by their occupation in this way and +not wanting to repeat it, they become more and more interested and +spend more and more time at it. The difference between gymnastics and +sport in this regard is very marked. +</p> +<p> +In sport the extraneous interest adds to the value of the exercise and +makes it ever so much easier to continue; when it sets every nerve +tingling with the excitement of the game, it is doing all the more +good. Gymnastics grow harder unless in some way associated with +competition, or with the effort to outdo oneself, while indulgence in +sport becomes ever easier. Many a young man would find it an +intolerable bore and an increasingly difficult task if asked to give +as much time and energy <a name="96">{96}</a> to some form of hard work as he does to +some sport. He feels tired after sport, but not exhausted, and becomes +gradually able to stand more and more before he need give up, thus +showing that he is constantly increasing his muscular capacity. +</p> +<p> +Conscious training of the will is then practically always a mistake. +It is an extremely difficult thing to do, and the amount of inhibition +which accumulates to oppose it serves after a time to neutralize the +benefit to be derived. Good habits should be formed, but not merely +for the sake of forming them. There should be some ulterior purpose +and if possible some motive that lifts men up to the performance of +duty, no matter how difficult it is. +</p> +<p> +Our young men who went to the camps demonstrated how much can be +accomplished in this manner. They were asked to get up early in the +morning, to work hard for many hours in the day, or take long walks, +sometimes carrying heavy burdens, and were so occupied that they had +but very little time to themselves. They were encouraged to take +frequent cold baths, which implied further waste of heat energy, and +then were very plainly fed, though of course with a good, rounded +diet, <a name="97">{97}</a> well-balanced, but without any frills and with very little +in it that would tempt any appetite except that of a hungry man. They +learned the precious lesson that hunger is the best sauce for food. +</p> +<p> +Most of these men were pushed so hard that only an army officer +perfectly confident of what he was doing and well aware that all of +his men had been thoroughly examined by a physician and had nothing +organically wrong with them would have dared to do it. A good many of +us had the chance to see how university men took the military regime. +Long hours of drilling and of hard work in the open made them so tired +that in the late afternoon they could just lie down anywhere and go to +sleep. I have seen young fellows asleep on porches or in the late +spring on the grass and once saw a number of them who found excellent +protection from the sun in what to them seemed nice soft beds—at +least they slept well in them—inside a series of large earthen-ware +pipes that were about to be put down for a sewer. Some of them were +pushed so hard, considering how little physical exercise they had +taken before, that they fainted while on drill. Quite a few of them +were in such a state of nervous tension that they fainted on <a name="98">{98}</a> +being vaccinated. Almost needless to say, had they been at home, any +such effect would have been a signal for the prompt cessation of such +work as they were doing, for the home people would have been quite +sure that serious injury would be done to their boys. These young +fellows themselves did not think so. Their physicians were confident +that with no organic lesion present the faint was a neurotic +derangement and not at all a symptom of exhaustion. The young soldiers +would have felt ashamed if there had been any question of their +stopping training. They felt that they could make good as well as +their fellows. They would have resented sympathy and much more pity. +They went on with their work because they were devoted to a great +cause. After a time, it became comparatively easy for them to +accomplish things that would hitherto have been quite impossible and +for which they themselves had no idea that they possessed the energy. +It was this high purpose that inspired them to let more and more of +their internal energy loose without putting a brake on, until finally +the habit of living up to this new maximum of accomplishment became +second nature and therefore natural and easy of accomplishment. +</p> +<a name="99">{99}</a> +<p> +Here is the defect in systems which promise to help people to train +their wills by talking much about it, and by persuading them that it +can be done, that all they have to do is to set about it. Unless one +has some fine satisfying purpose in doing things, their doing is +difficult and fails to accomplish as much good for the doer as would +otherwise be the case. Conscious will activity requires, to use +old-fashioned psychological terms, the exercise of two faculties at +the same time, the consciousness and the will. This adds to the +difficulty of willing. What is needed is a bait of interest held up +before the will, constantly tempting it to further effort but without +any continuing consciousness on the part of the individual that he +must will it and keep on willing it. That must ever be a hampering +factor in the case. Human nature does not like imperatives and writhes +and wastes energy under them. On the contrary, optatives are pleasant +and give encouragement without producing a contrary reaction; and it +is this state of mind and will that is by far the best for the +individual. +</p> +<p> +Above all, it is important that the person forming new habits should +feel that there is nothing else to be done except the hard things +<a name="100">{100}</a> that have been outlined. If there is any mode of escape from the +fulfillment of hard tasks, human nature will surely find it. If our +young soldiers had felt that they did not have to perform their +military duties and that there was some way to avoid them, the taking +of the training would have proved extremely difficult. They just <i>had</i> +to take it; there was no way out, so they pushed themselves through +the difficulties and then after a time they found that they were +tapping unsuspected sources of energy in themselves. For when people +<i>have</i> to do things, they find that they can do ever so much more than +they thought they could, and in the doing, instead of exhausting +themselves, they actually find it easier to accomplish more and more +with ever less difficulty. The will must by habit be made so prompt to +obey that obedience will anticipate thought in the matter and +sometimes contravene what reason would dictate if it had a chance to +act. The humorous story of the soldier who, carrying his dinner on a +plate preparatory to eating it, was greeted by a wag with the word +"Attention!" in martial tones, and dropped his dinner to assume the +accustomed attitude, is well known. Similar practical jokes are said +to have been played, on a certain number <a name="101">{101}</a> of occasions in this +war, with the thoroughly trained young soldier. +</p> +<p> +The help of the will to the highest degree is obtained not by a series +of resolutions but by doing whatever one wishes to do a number of +times until it becomes easy and the effort to accomplish it is quite +unconscious. Reason does not help conduct much, but a trained will is +of the greatest possible service. It can only be secured, however, by +will action. The will is very like the muscles. There is little use in +showing people how to accomplish muscle feats; they must do them for +themselves. The less consciousness there is involved in this, the +better. +</p> +<a name="102">{102}</a> + +<h2>CHAPTER VII +<br><br> +WHAT THE WILL CAN DO</h2> + +<table class="center"> +<tr><td align="left"> + "I can with ease translate it to my will." +</td></tr> +<tr><td align="right"> +<i>King John</i> +</td></tr> +</table> + +<p> +It should be well understood from the beginning just what the will can +do in the matter of the cure or, to use a much better word, the relief +of disease, not forgetting that disease means etymologically and also +literally discomfort rather than anything else. The will cannot cure +organic disease in the ordinary sense of that term. It is just as +absurd to say that the will can bring about the cure of Bright's +disease as it is to suggest that one can by will power replace a +finger that has been lost. When definite changes have taken place in +tissues, above all when connective tissue cells have by inflammatory +processes come to take the place of organic tissue cells, then it is +idle to talk of bringing about a cure, though sometimes relief of +symptoms may be secured; above all the compensatory powers of the body +<a name="103">{103}</a> may be called upon and will often bring relief, for a time, at +least. What is true of kidney changes applies also to corresponding +changes in other organs, and there can be no question of any amount of +will power bringing about the redintegration of organs that have been +seriously damaged by disease or replacing cells that have been +destroyed. +</p> +<p> +There are however a great many organic diseases in which the will may +serve an extremely useful purpose in the relief of symptoms and +sometimes in producing such a release of vital energy previously +hampered by discouragement as will enable the patient to react +properly against the disease. This is typically exemplified in +tuberculosis of the lungs. Nothing is so important in this disease, as +we shall see, as the patient's attitude of mind and his will to get +well. Without that there is very little hope. With that strongly +aroused, all sorts of remedies, many of them even harmful in +themselves, have enabled patients to get better merely because the +taking of them adds suggestion after suggestion of assurance of cure. +The cells of the lungs that have been destroyed by the disease are not +reborn, much less recreated, but nature walls off the diseased parts, +and the rest of <a name="104">{104}</a> the lungs learn to do their work in spite of the +hampering effect of the diseased tissues. When fresh air and good food +are readily available for the patient, then the will power is the one +other thing absolutely necessary to bring about not only relief from +symptoms, but such a betterment in the tissues as will prevent further +development of the disease and enable the lungs to do their work. The +disease is not cured, but, as physicians say, it is arrested, and the +patient may and often does live for many years to do extremely useful +work. +</p> +<p> +In a disease like pneumonia the will to get well, coupled with the +confidence that should accompany this, will do more than anything else +to carry the patient over the critical stage of the affection. +Discouragement, which is after all by etymology only disheartenment, +represents a serious effect upon the heart through depression. The +fullest power of the heart is needed in pneumonia and discouragement +puts a brake on it. As we shall see it is probably because whiskey +took off this brake and lifted the scare that it acquired a reputation +as a remedy in pneumonia and also in tuberculosis. In spite of what +was probably an unfavorable physical effect, whiskey <a name="105">{105}</a> actually +benefited the patient by its production of a sense of well being and +absence of regard for consequences. Hence its former reputation. This +extended also to its use in a continued fever where the same +disheartenment was likely to occur with unfortunate consequences on +the general condition and above all with disturbance of appetite and +of sleep. Worry often made the patients much more restless than they +would otherwise have been and they thus wasted vital energy needed to +bring about the cure of the affection under which they were laboring. +</p> +<p> +In all of these cases solicitude led to surveillance of processes +within the body and interfered with their proper performance. It is +perfectly possible to hamper the lungs by watching their action, and +the same thing may be done for the heart. Whenever involuntary +activities in the body are watched, their proper functioning is almost +sure to be disturbed. We have emphasized that in the chapter on +"Avoidance of Conscious Use of the Will," and so it need not be dwelt +on further here. +</p> +<p> +Even apart from over-consciousness there occur some natural dreads +that may disturb nature's vital reactions, and these can be <a name="106">{106}</a> +overcome through the will. There is a whole series of inhibitions +consequent upon fears of various kinds that sadly interfere with +nature's reaction against disease. To secure the neutralization of +these the will must be brought into action, and this is probably +better secured by suggestion, that is, by placing some special motive +before the individual, than by any direct appeal. Particularly is this +true if patients have not been accustomed before this to use their +wills strenuously, for they will probably be disturbed by such an +appeal. +</p> +<p> +What will power when properly released can do above all is to bring +the relief of discomfort. In a great many cases the greater part of +the discomfort is due to over-sensitization and over-attention. Even +in such severe organic diseases as cancer, the awakening of the will +may accomplish very much to bring decided relief. This is why we have +had so many "cancer cures" that have failed. They made the patient +feel better at first, and they relieved pain to some extent and +therefore were thought to be direct remedial agents for the cancer +itself. The malignant condition however has progressed without +remission, though sometimes, possibly as the result of the new courage +given flowing as surplus vitality into <a name="107">{107}</a> the tissues, perhaps the +progress of the lesion has been retarded. The patient sometimes has +felt so much better as to proclaim himself cured. What is thus true of +cancer will be found to occur in any very serious organic condition, +such as severe injury, chronic disease involving important organs, and +even such nutritional diseases as anemia or diabetes. The awakening in +the patient of the feeling that there is hope and the maintenance of +that hope in any way will always bring relief and usually some +considerable remission in the disease. +</p> +<p> +It is in convalescence above all, however, that the will power +manifests its greatest helpfulness. When patients are hopeful and +anxious to get well they are tempted to eat properly, to get out into +the air; they thus sleep better and recovery is rapid. Whenever they +are disheartened, as for instance when husband and wife have been +together in an injury, or both have contracted a disease and one of +them dies, the survivor is likely to have a slow and lingering +convalescence. The reason is obvious: there is literal lack of will +power or at least unwillingness to face the new conditions of life, +and vitality is spent in vain regret for the companionship that has +been <a name="108">{108}</a> lost. This depression can only be lifted by motives that +appeal to the inner self and by such an awakening of the will for +further interests in life as will set vital energies flowing freely +again. +</p> +<p> +In convalescence from injuries received after middle life or from +affections that have been accompanied by incapacity to use muscles +there is particular need of the will. A great many older people refuse +to go through the pain and discomfort, soreness and tenderness as the +younger folk who are training their muscles call them, which must be +borne in order to bring about redevelopment of muscles, after they +have once become atrophic from disuse. The refusal to push through a +period of what is often rather serious discomfort leads many people to +foster disabilities and use their muscles in wrong ways sometimes even +for years. Something occurs then to arouse their wills and they get +better. Anything that will do this will cure them. Sometimes it is a +new liniment, sometimes a new mode of manipulation or massage, +sometimes some supposed electrical or magnetic discovery and sometimes +the touch of a presumed healer. Anything at all will be effective +provided it wakens their wills into such activity <a name="109">{109}</a> as will enable +them to persist in the use of their muscles through the period of +soreness and tenderness necessary to restore proper muscular +functions. +</p> +<p> +It is quite surprising to see what can be accomplished in this way, +and the quacks and charlatans of the world have made their fortunes +out of such patients always, while their cure has been the greatest +possible advertisement and has attracted ever so many other patients +to these so-called healers. Nothing that can be done for these +patients will have any good results unless their own wills are +aroused, new hope given them and they themselves made to tap the +layers of energy in them that can restore them to health. To tell them +that they were to be cured by their own will, however, would probably +inhibit utterly this energy that is needed, so that somehow they have +to be brought to the state of mind in which they will accomplish the +purpose demanded of them by indirection. +</p> +<p> +The will is particularly capable of removing obstacles to nutrition +that have often hampered the activities and sometimes seriously +impaired the health of patients. Many people are not eating enough for +one reason or another and need to have their diet regulated, not in +<a name="110">{110}</a> the direction of a limitation or selection of food, though this +appeals to so many people under the term dieting, but so that they +shall eat enough and of the proper variety to maintain their health +and bodily functions. A great many nervous diseases are dependent on +lack of sufficient food. Eating in those who lead sedentary lives much +indoors is ever so much more a matter of will than of appetite. When +people say that they eat all they want to, what they mean, as a rule, +is that they eat all that they have formed the habit of eating. Other +habits can readily be formed and will often do them good. For a great +many of the less serious symptoms which make people valetudinarians, +nervous indigestion, insomnia, tendencies to headache, queer feelings +in the head, constipation, the proper habit secured by will power, of +eating so as to secure sufficient food, is the most important single +factor. This the will must be trained to accomplish. +</p> +<p> +Now that disease prevention has become even more important than cure, +the will is an extremely efficient element. Air, food, exercise are +important factors for healthy living. A great many people are +neglecting them and then seem surprised that they should suffer from +various symptoms of impaired <a name="111">{111}</a> functioning of bodily organs. Many +men and a still greater number of women are staying in the house so +much that their oxidation within the body is at a low ebb, and it is +no wonder that vital processes are not carried on to the best +advantage. Our generation has eliminated exercise from life to a great +extent, and now that the auto and the trolley car limit walking, not +only the feet of mankind suffer severely, but all the organs in the +body work at a disadvantage for lack of the exercise that they should +have. No wonder that under the circumstances appetite is impaired and +other functions of the body suffer. Instead of simple foods various +artificial stimulants are employed—such as alcohol, spices, and the +like—to provoke appetite, often with serious consequences for the +digestive organs. The will to be well includes the willing of the +means proper to that purpose, and particularly regular exercise, +several hours a day in the air, good simple food taken in sufficient +quantity at three regular intervals and the avoidance of such sources +of worry as will disturb physical functions. +</p> +<a name="112">{112}</a> + + +<h2>CHAPTER VIII +<br><br> +PAIN AND THE WILL</h2> + +<table class="center"> +<tr><td align="left"> + "That the will is infinite and the execution confined." +</td></tr> +<tr><td align="right"> +<i> Troilus and Cressida</i> +</td></tr> +</table> + +<p> +The symptom of disease that humanity dreads the most is pain. +Fortunately, it is also the symptom which is most under the control of +the will, and which can be greatly relieved by being bravely faced +and, to as great an extent as possible, ignored. It requires courage +and usually persistent training to succeed in the relief of severe +pain in this way, but men have done it, and women too, and men and +women <i>can</i> do it, if they really want to, though unfortunately all of +the trend of modern life has been in the opposite direction, of +avoiding pain at whatever cost instead of bravely facing it. The +American Indian, trained from his youth to stand severe pain, scoffed +at even the almost ingeniously diabolical tortures of his enemy +captors. After they had pushed slivers beneath his nails or <a name="113">{113}</a> +slowly crushed the end of a finger, or put salt in long, superficial +wounds that had bared a whole series of sensitive cutaneous nerves, he +has been known to laugh at them, and ask them proudly, without giving +a sign of the pain that he was enduring, whether that was all that +they could do. It was just a question of the human will overcoming +even the worst sensations that the body could send up to the brain and +deliberately refusing to permit any reactions that would reveal the +reflex torment that was actually taking place. +</p> +<p> +The war has done much to bring back the recognition of that +diminution—to a great extent at least—or even almost entire +suppression of pain which may occur, indeed almost constantly does +occur, as a consequence of a man facing it bravely. We have been +accustomed to think of the early martyrs as probably divinely helped +in their power to withstand pain. Whatever of celestial aid they had, +we know that martyrs for all sorts of causes, some of them certainly +not divine, have exhibited some degree of this same steadfastness. +Their behavior makes it reasonably clear that as the result of making +up their minds to stand the pain involved, they have actually suffered +so little that it was not <a name="114">{114}</a> difficult to suppress external +manifestations of their sufferings. It is not merely a suppression of +the reflexes that has occurred but a minimizing to a very striking +degree of the actual sensations felt. We have many stories of the +older time before the modern use of anaesthetics, which tell how +bravely men endured pain and at the same time retained their power to +do things. Indeed, some of them accomplished purposes in the midst of +what would seem like supreme agony which made it very clear that pain +alone has nothing like the prostrating effect that it is often +supposed to have. +</p> +<p> +For we have well authenticated tales of physicians performing +amputations on themselves at times when no other assistance was +available, and accomplishing the task so well that they recovered +without complications. A blacksmith in the distant West, whose leg had +been crushed by the fall of a huge beam, actually had himself carried +into his shop and amputated his own limb above the knee, searing the +blood vessels with hot irons as he proceeded. Such a manifestation of +will power is, of course, exceptional to a degree, and yet it +illustrates what men can do in the face of conditions that are usually +supposed <a name="115">{115}</a> to be overwhelming. Many a man in lumber camps or in +distant island fisheries or on board fishing vessels, far beyond the +hope of reaching a physician in time for him to be of service, has +done things of this kind. We can be quite sure that the will to +accomplish for himself what seemed necessary to save his life lessened +his pain, made it ever so much more bearable and generally proved the +power of the human will over even these physical manifestations in the +body that are commonly supposed to be quite beyond any interference +from the psychical part of nature. The spirit can still dominate the +flesh, even in matters of pain, and dictate how much it shall be +affected. It is a hard lesson to learn, but it is one that can be +learned by proper persistence. +</p> +<p> +In the early part of the war particularly many a young man had to face +even serious operations without an anaesthetic. The awful carnage of +the first six weeks of the war had not been anticipated and therefore +there were not sufficient stores of anaesthetics available to permit +of their use in every case. Besides, many operations had to be +performed so close to the front and under such circumstances that +there could not be anaesthetics for all of them; and it was a +never-ending source of <a name="116">{116}</a> surprise to those who witnessed the +details to see how bravely and uncomplainingly the young men took +their enforced suffering. Many a one, when his turn came to be +operated on, quietly asked for a cigarette and then bore unflinchingly +painful manipulations that the surgeon was extremely sorry to have to +inflict. Over and over again, when there was question of the regular +succession of patients, young soldiers in severe pain suggested that +some one else who seemed in worse condition than they, or who perhaps +was not quite so well able to stand pain and control himself, should +be attended to before they were. There is no doubt at all that this +very power of self-control lessened their pain and made it ever so +much easier to bear and less of a torment than it would have been +otherwise. +</p> +<p> +Any great diversion of mind that turns the attention completely to +something else will lessen even severe pain so much as to make it +quite negligible for the moment. Headaches disappear promptly when +there is an alarm of fire, and toothaches have been known to vanish, +for the time at least, as the result of a burglar scare. Much less +than this is needed, however, and there are many familiar examples +<a name="117">{117}</a> which illustrate the fact that the turning of the attention to +something else will greatly diminish or even abolish pain. +</p> +<p> +The well known story of the French surgeon about to set a dislocation +is a typical demonstration. His patient was a woman of the nobility, +her dislocation was of the shoulder and it was necessary for him to +inflict very severe pain in order to replace it. Besides, as the +result of the reflex of that pain, he was certain to meet with great +resistance from spasm in the surrounding muscles. It was before the +days of anaesthetics, which relieve all of these inconveniences, and +above all, relax the muscles. The surgeon got ready to do the ultimate +manipulation that would replace the joint in its proper relation, and +necessarily inflicted no little pain in his preparations. The lady +complained very much, so he turned on her angrily, told her that she +must stand it, slapped her in the face, and before she had recovered +from the shock, the dislocation had been restored to the normal +condition. It was rather heroic treatment, and it is to be hoped that +she understood it, but it is easy to understand how much the procedure +lessened her physical pain. +</p> +<p> +When the mind is very much preoccupied <a name="118">{118}</a> and the will intent on +accomplishing some immediate purpose, even severe pain will not be +felt at all. Instances of this are not rare, and men who are advancing +in a charge on a battlefield will often be wounded rather severely, +and yet continue to advance without knowing anything about their +wounds until a friend calls attention to their bleeding, or they +themselves notice it; or perhaps even loss of blood may make them +faint. The late President Roosevelt furnished a magnificent +illustration of this principle when he was wounded some years ago in +the midst of a political campaign. A crank shot at him, in one of the +Western cities, and though the bullet penetrated four inches of muscle +on his chest wall, and then flattened itself against a rib, he did not +know that he was wounded. The flattening of the bullet must have +represented at least as much force as would be exerted by a heavy blow +on the chest, and yet the Colonel never felt it. His friends +congratulated him on his escape from injury until it was noted that +blood was oozing through a hole that had been made in his coat. The +intense will activity of the President simply kept him from noticing +either the shock or the pain. +</p> +<a name="119">{119}</a> +<p> +Not long before the war a striking example was given of how a man may +stand suffering in spite of long years of the refining influences of a +sedentary scholarly life, most of it spent indoors. The second last +General of the Jesuits developed a sarcoma on his upper arm and was +advised to submit to an amputation of the arm at the shoulder joint. +He was a man well on in the sixties and the operation presented an +extremely serious problem. The surgeons suggested that he should be +ready for the anaesthetic at a given hour the next morning and then +they would proceed to operate. He replied that he would be ready for +the operation at the time suggested, but that he would not take an +anaesthetic. They argued with him that it would be quite impossible +for him to stand unanaesthetized the extensive cutting and dissection +necessary to complete an operation of this kind in an extremely +important part of the body, where large nerves and arteries would have +to be cut through and where the slightest disturbance on the part of +the patient might easily lead to serious or even fatal results. Above +all, he could not hope to stand it in tissues that had been rendered +more sensitive than before by the enlarged circulation to the part, +due to <a name="120">{120}</a> the growth of the tumor, and the consequent hyperaemic +condition of most of the tissues through which the cutting would have +to be done and which were thus hypersensitized. +</p> +<p> +He insisted, however, that he would not take an anaesthetic, for +surely here seemed a chance to welcome suffering voluntarily as his +Lord and Master had done. I believe that the head surgeon said at +first that he would not operate. He felt sure that the operation would +have to be interrupted after it had been begun, because the patient +would not be able to stand the pain and there would then be the danger +from bleeding as well as from infection which might occur. The General +of the Jesuits, however, was so calm and firm that at last it was +determined to permit him to try at least to stand it, though most of +the surgeons were sure that he would probably have to give up and +allow himself to be anaesthetized before they were through. +</p> +<p> +The event then was most interesting. The patient not only underwent +the operation without a murmur, but absolutely without wincing. The +surgeon who performed the operation said afterwards, "It was like +cutting wax and not human flesh, so far as any reaction was concerned, +though of course it bled." +</p> +<a name="121">{121}</a> +<p> +The story carries its lesson of the power of a brave man to face even +such awful pain as this and probably actually overcome it to such an +extent that he scarcely felt it, simply because he willed that he +would do so and occupied himself with other thoughts during the +process. +</p> +<p> +Such an example as that of this General of the Jesuits will seem to +most people a reversion to that mystical attitude of mind of the +medieval period, when somehow or other people were able to stand ever +so much more pain than any one in our time could possibly think of +enduring. We hear of saints of the Middle Ages who inflicted what now +seem hideous self-tortures on themselves and not only bore them +bravely but went about life smiling and doing good to others while +they were under the influence of them. It would seem quite impossible, +however, for people of the modern time to get into any such state of +mind. Our discoveries for the prevention of pain have made it +unnecessary to stand much suffering, and as a result mankind would +seem to have lost some if not most of the faculty of standing pain. So +little of truth is there in any such thought that any number of the +young men of the present generation between <a name="122">{122}</a> twenty and thirty, +that is, during the very years when mankind most resents pain and +therefore reacts most to it, and by the same token feels it the most, +have shown during this war that they possessed all the old-fashioned +faculty of standing pain without a whimper and thinking of others +while they did it. +</p> +<p> +Lack of advertence always lessens pain and may even nullify it until +it becomes exceedingly severe. In his little volume, "A Journey around +My Room", Xavier de Maistre dwells particularly on the fact that his +body, when his spirit was wandering, would occasionally pick up the +fire tongs and burn itself before his <i>alter ego</i> could rescue it. +Concentration of attention on some subject that attracts may +neutralize pain and make it utterly unnoticed until physical +consequences develop. Undoubtedly dwelling on pain, anticipating it, +noting the first sensations that occur, multiplies the painful +feeling. The physical reasons for this are to be found in the +increased blood supply consequent upon conscious attention to any +part, which sensitizes the nerves of the area and the added number of +nerve fibers that are at once put into association with the area by +the act of concentration of the attention. These serve to render +sensation <a name="123">{123}</a> much more acute than it would otherwise be. It might +seem impossible to control the attention, but this has been done over +and over again, even in the midst of severe pain, until there is no +doubt that it is quite possible. As for the increase of pain by +deliberate attention, that is so familiar an experience that +practically every one has had it at some time. +</p> +<p> +The reason for it has become very clear as the result of our +generation's investigations into the constitution of the nervous +system. The central nervous system, instead of being a <i>continuum</i>, or +series of nerve elements which are directly connected with each other, +consists of a very large number of separate individual cells which +only make contacts with each other, the nerve impulses flowing over +across the contact. The demonstration of these we owe originally to +Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was +awarded some years ago the Nobel Prize as well as the Prize of the +City of Paris for his researches. +</p> +<p> +In connection with his surprising discoveries as to the neurons which +make up the brain, he suggested the Law of Avalanche, which would +serve to explain the supersensitiveness of parts to which concentrated +attention is paid. <a name="124">{124}</a> According to this law, pain felt in any small +area of the body may be multiplied very greatly if the sensation from +it is distributed over a considerable part of the brain, as happens +when attention is centered upon it. A pain message that comes from a +localized area of the body disturbs under normal conditions at most a +few thousand cells in the brain, because the area is directly +represented only by these cells. They are connected however by +dendrites and cell branches of various kinds with a great many other +cells in different parts of the brain. A pain message that comes up +will ordinarily produce only disturbance of the directly connected +cells, but it may be transmitted and diffused over a great many of the +cells of the cortex of the brain if the attention is focused strongly +on it. The area at first affected, but a few thousand cells, may +spread to many millions or perhaps even some hundreds of millions of +them, if the centering of attention causes them to be "connected up", +as the electricians say, with the originally affected small group of +cells. +</p> +<p> +It is just what happens in high mountains when a few stones loosened +somewhere near the top by the wind or by melting processes begin their +course down the mountain side. <a name="125">{125}</a> On the way they disturb ever more +and more of the loose pieces of ice and the shifting snows as well as +the rocks near them, until, gathering force, what was at the beginning +only a minor movement of small particles becomes a dreaded avalanche, +capable not only of sweeping away men in its path but even of +obliterating houses and sometimes of changing the whole face of a +mountain area. Hence the expression suggested by Ramon y Cajal of the +Law of Avalanche for this wide diffusion of sensation, which spreads +from a few thousand to millions or billions of cells, and from a +rather bearable pain becomes intolerable torture, as a consequence of +the brain's complete occupation with it. +</p> +<p> +Now it is possible for most people, indeed for all who have not some +organic morbid condition, to control this spread of pain beyond its +original connections, provided only they will to do so, refuse to be +ruled by their dreads and proceed to divert attention from the painful +condition to other subjects. Here is why the man who bravely faces +pain actually lessens the amount that he has to bear. There is no pain +in the part affected. That we know, because any interruption of the +nerve tract leading from the affected part to the brain <a name="126">{126}</a> +eliminates the pain. In the same way, the obtunding of the nerve cells +in the cortex by anaesthetics or of the conducting nerve apparatus on +the way to the brain by local anaesthesia, will have a like effect. +Anything then that will interfere with the further conduction of the +pain sensation and the cortical cells directly affected will lessen +the sense of pain, and this is what happens when a man settles himself +firmly to the thought that he will not allow himself to be affected +beyond what is the actual reaction of the nerve tissues to the part. +</p> +<p> +As a matter of fact, the anticipation of pain due to the dread of it +predisposes the part to be much more sensitive than it was before. We +can all of us readily make experiments which show this very clearly. +Ordinarily we have a stream of sensations flowing up from the surface +of the body to the brain, consequent upon the fact that the skin +surface is touched by garments over most of the body, and that our +nerves of touch respond to their usually rather rough surface. We have +learned to pay no attention to these because we have grown accustomed +to them, though any one who thinks that they are negligible should +witness the writhings of a poor Indian under the stress <a name="127">{127}</a> of being +civilized when he is required to wear a starched shirt for the first +time. Ordinarily Indians have learned to suppress their feelings, but +the shirt with its myriad points of contact, all of them starchily +scraping, usually proves too much for his equanimity, and he wiggles +and twists to such an extent as shows very clearly that he is +extremely uncomfortable. Most people have something of the same +feeling the first day that they change into woolen underclothes after +they have been wearing cotton for months, and the sensation is by no +means easy to bear with equanimity. +</p> +<p> +Ordinarily from custom and habit in the suppression of feelings we +notice none of these contact sensations with their almost inevitable +itchy and ticklish feelings, though they are constantly there, but we +can reveal them to ourselves by thinking definitely about any part of +the body. Such concentration of attention at once brings that part of +the body above the threshold of consciousness, and we have distinct +feelings there that we did not notice before. If for instance we think +about the big toe on the left foot, immediately our attention is +turned to it and we note sensations in it that were quite unnoticed +before. We can feel the stocking touching any part of it <a name="128">{128}</a> that we +think of. Not only that, but if we concentrate attention on a part +most uncomfortable sensations develop. If anything calls our attention +even to the middle of our backs, we find at once that there is a +distinct sensation there, and this may become so insistent as to +demand relief. +</p> +<p> +It is well understood now what happens in these cases. As we have +said, the attention given to a part leads to a widening of the minute +blood vessels located there so that the nerve endings to the part are +supplied with more blood and therefore become more sensitive. We know +from experience in cold windy weather that when the cheek is +hyperaemic the drawing of a leaf or even of a piece of paper across it +may produce a very acute painful sensation. Hyperaemia always makes +parts of the body much more sensitive than before. Attention has just +this effect over all the surface of the body, as we can demonstrate to +ourselves. We can actually, though only gradually, make our feet warm +by thinking about them, because the active attention to them sends +more blood to them. The dread of pain then, by concentrating attention +on the part beforehand, actually increases the pain that has to be +suffered and makes the subject <a name="129">{129}</a> ever so much more sensitive. +Sensitiveness is of course dependent on other factors, as for instance +lack of outdoor air and of oxygenization, which actually seems to +hypersensitize people so that even very slight pain becomes extremely +difficult to bear, but the question of attention, which is after all +almost entirely a voluntary matter, has more to do with making pain +harder to bear than anything else. +</p> +<p> +In the preanaesthetic days, men have been known to sit and watch +calmly an amputation of one of their limbs without wincing and +apparently without undergoing very much pain. Many are the incidents +in history of a favorite general who showed his men how to bear pain +by calmly smoking a cigar while a surgeon amputated an arm or a leg or +performed some other rather important surgery. Pain is after all like +the sense of danger and may be suppressed practically to as great a +degree. Once during the present war, when long columns of soldiers +going to the front had to pass by the open market place of a town that +was being shelled by the Germans, there was danger of the troops +losing something of their morale at this point and of confusion +ensuing. It would have been disturbing both to discipline and the +<a name="130">{130}</a> ordered movement of the troops to divert them by narrower +streets, and the shells, though dangerous, were not falling frequently +and not working serious havoc. Every one knew, however, that the +German gunners had the range, and a shell might land square in the +market place at any time; thus there was a feeling of uneasiness and a +tendency to nervous lack of self-control, with the inevitable +confusion of movement afterwards. One of the French generals ordered +an armchair to be brought out of one of the houses near by, took a +position in the center of the square, with a little wand in his hand, +and calmly joked with the soldiers as they went by about the +temperature of the day mentioning occasionally something about a shell +that happened to strike not far away. According to the story he was an +immense man weighing nearly three hundred pounds, and so provided a +very good-sized target for shells, but he was never touched and, +almost needless to say, the line of soldiers never wavered while their +general sat there joking at the danger. +</p> +<p> +It is sometimes thought that men in the older, less refined times +could stand pain and suffering generally much better than our +generation which is supposed to have <a name="131">{131}</a> degenerated in that +respect. We have found, however, during the war that the soldiers who +could stand supreme suffering the best were very often those who came +from better-to-do families, who had been subjected to the most highly +refining influences of civilization, but also to that discipline of +the repression of the emotions which is recognized as an important +phase of civilization. Strange as it may seem, the city boys stood the +hardships and the trials of trench life better than the country boys +and not only withstood the physical trials but were calmer under fire +and ever so much less complaining under injury. After all it is what +might be expected, once serious thought is given to the subject, and +yet somehow it comes as a surprise, as if the country boy ought to be +less sensitive,—as indeed he probably is; but he lacks that training +in self-control which enables the city boy to stand suffering. +</p> +<p> +All our feeling that human nature has degenerated in physical +constitution has been completely contradicted by the reaction of our +young soldiers to camp and trench life. They have gone back to the +lack of comforts and conveniences of the pioneer days and have had to +submit to the outdoor life and the <a name="132">{132}</a> hardships that their pioneer +grandfathers went through and have not failed under them. The boys +have come out of it all demonstrating not only that their courage was +capable of supporting them, but with their physical being bettered by +the conditions and their power to stand suffering revealed in a way +that would scarcely have been believed possible beforehand. +</p> + +<a name="133">{133}</a> + +<h2>CHAPTER IX +<br><br> +THE WILL AND AIR AND EXERCISE</h2> + +<table class="center"> +<tr><td align="left"> + "And wishes fall out as they are willed." +</td></tr> +<tr><td align="right"> +<i>Pericles</i> +</td></tr> +</table> + +<p> +Very probably the most important function of the will in its relation +to health is that which concerns its power to control the habits of +mankind as regards air and exercise. It is surprising to what an +extent people neglect both of these essentials of healthy living in +the midst of our modern sophisticated life, unless the will power is +consciously used for the purpose of forming and then maintaining +habits with regard to these requisites for health. It is a very +fortunate thing that instinct urges the child, particularly the +infant, to almost constant movement during its waking hours. Children +that are healthy and that are growing rapidly, boys somewhat more than +girls, are so constantly in movement that one would almost think that +they must be on springs. Whenever they discover that they can make a +<a name="134">{134}</a> new movement, they proceed to make it over and over again until +they can do it with facility. There is no lolling around for them; as +soon as they wake, they want to be up and doing, no matter what the +habits of the household may be. They are constantly on the move. We +know that this is absolutely essential for growth as well as for the +proper training of their muscles, but it is a very fortunate thing +that children do it for themselves, for if their mothers were +compelled to train them, the task would be indeed difficult. All +mother has to do is to control them to some extent and keep them from +venturing too far, lest they should hurt themselves. +</p> +<p> +When the control of instinct over life is gradually replaced by +reason, this tendency to exercise gradually diminishes until it is +often surprising to find how little people are taking. As it is mainly +the need for exercise that forces people out into the air, indoor life +comes to be the main portion of existence. This is all contrary to +nature, and so it is not surprising that <i>disease</i>, in its original +etymological sense of discomfort, develops rather readily. The lack of +exercise in the air permits a great many people to drift into all +sorts of morbid conditions in which they are quite miserable. This +<a name="135">{135}</a> is, of course, particularly true as regards nervous ailments of +various kinds; only under the term nervous ailments should be included +not alone direct affections of the nervous system or functional +disturbances of nerves, but also a number of other conditions. Nervous +indigestion, insomnia, neurotic constipation and many of the +symptomatic affections associated with these conditions, tired +feelings that interfere with activities, headache, various feelings of +discomfort in the muscles and around the joints, inability to control +the emotions and other such common complaints—if that is the proper +word for them—all these are fostered by a sedentary life indoors. +They frequently make not only the patient himself—or oftener +herself—miserable, but also all those who come in contact with her. +</p> +<p> +Above all, it must not be forgotten that lack of exercise in the open +air has a very definite tendency to make people extremely sensitive to +discomforts of all kinds, mental as well as physical. Many a man or +woman whose life seems full of worries, sometimes without any adequate +cause at all, who goes from one dread to another, who wakes in the +morning with a sense of depression, find that most of these feelings +and sometimes all of them, <a name="136">{136}</a> disappear promptly when they begin to +exercise more in the open. +</p> +<p> +Nothing dispels the gloom and depressions consequent upon an +accumulation of cares and worries of various kinds like a few weeks in +the woods, where every moment is passed in the fresh outdoor air, +which actually seems to blow the cobwebs of ill feelings away and +leaves the individual with a freedom of mind and a comfort of body +that he almost expected never to enjoy again. +</p> +<p> +Undoubtedly the most important factor for the preservation of health +is an abundance of fresh air. At certain seasons of the year this is +not only easy and agreeable, but to do anything else imposes hardship. +In our climate, however, there are about six months of the year in +which it requires some exercise of will power to secure as much open +air life as is required for health. There are weeks when it is too +hot, there are many weeks when it is too cold. The cold air +particularly is important, because it produces a stimulating vital +reaction than which nothing is more precious for health. We have no +tonic among all the drugs of the pharmacopeia that is equal to the +effect of a brisk walk in the bracing air of a dry cold day. After a +long morning and <a name="137">{137}</a> perhaps a whole day in the house, even half an +hour outdoors will enable us to throw off the sluggishness consequent +upon confinement to the indoor air and the lack of appetite and the +general feeling of physical lassitude which has followed living in an +absolutely equable temperature for twenty-four hours. Sometimes it +requires no little effort of the will to secure this, and to continue +it day after day without missing it or letting it be crowded out by +claims that are partly real and partly excuses, because we do not care +to make the special effort required. +</p> +<p> +What humanity needs is regular exercise in the open air every day. As +it is, between the trolley car and the automobile, very few people get +what they need. Any one who has to go a mile takes a car or some other +conveyance and between waiting for the car and certain inevitable +delays it will probably take ten minutes or more to go the mile. In +five minutes more one could walk that distance and secure precious +exercise besides such diversion of mind as inevitably comes from +walking on busy city streets and which makes an excellent recreation +in the midst of one's work. For it is quite impossible in our day to +walk along city streets absorbed in abstract mental <a name="138">{138}</a> occupations. +One of the objections to walking is that after a while it can be +accomplished as a matter of routine without necessarily taking one's +mind away from subjects in which it has been absorbed. It is quite +impossible for this to happen, however, on modern city streets. "The +outside of a horse", it used to be said, "is good for the inside of a +man." The main reason for this was because it is impossible for a man +to ride horseback, unless his mount is a veritable old Dobbin, without +paying strict attention to the animal. The same thing is true as +regards city pedestrianism, especially since the coming of the auto +has made it necessary to watch our steps and look where we go. +</p> +<p> +A great many people would be ever so much better in health if they +walked to business or to school every morning instead of riding, for +the young need it even more than the older people. Especially is this +true for all those who follow sedentary occupations. Clerks in +lawyers' offices, typewriters and stenographers, secretaries—all +those who have to sit down much during the day—need the brisk walking +and need it not merely of a Sunday or a Saturday afternoon, but every +day in the year. Many of them, if they walked two and three miles to +<a name="139">{139}</a> the office, would probably require only fifteen minutes, at most +half an hour, more than if they took a train or trolley, but they +would have secured a good hour of exercise in the open air. +</p> +<p> +On the other hand the unfortunate crowding of trolley and elevated and +subway trains in the busy hours when people go to and from their work +makes an extremely uncomfortable and often rather depressing +commencement and completion of the day's work. I know of nothing that +makes a worse beginning for the day than to have to stand for half an +hour or longer in a swaying, bumping car, hanging to a strap, crushed +and crowded by people getting in and out. The effect of coming home +under such circumstances after a reasonably long day's work is even +more serious, and any little sacrifice that will enable people to +avoid it will do them a great deal of good. Fifteen or twenty minutes +of extra time morning and evening would often suffice for this and +would at the same time add a bracing walk in the open air to the day's +routine. +</p> +<p> +When first begun, such a practice would make one tired and sore, but +that condition would pass in the course of a few days and be replaced +by a healthy feeling of satisfaction <a name="140">{140}</a> that would be well worth +all the effort required. We should need ever so much less medicine for +appetite and for constipation if this were true. A great many people +who stand during the day would probably deem it quite out of the +question for them to walk three miles or more to and from their +business, for their feet get so tired that they feel that they could +not endure it. What they need more than anything else, however, is +exercise that will bring about a stimulation of the circulation in +their feet. Standing is very depressing to the circulation. It leads +to compression of the veins and hence interference with the return +circulation, with lowered nutrition which often predisposes to flat +foot or yielding arch and tends to create corns and callouses: walking +in reasonably well fitting shoes on the contrary tends to make the +feet ever so much less sensitive Our soldiers have had that experience +and have learned some very precious lessons with regard to the care of +their feet, the principal one being that the best possible remedy for +foot troubles is to exercise the feet vigorously in walking and +running, provided the shoes permit proper foot use. +</p> +<p> +I have often known clerks and floorwalkers <a name="141">{141}</a> who have to stand all +day or move but a few steps at intervals, who were so tired at night +that they felt the one thing they could do was to sit down for a while +after dinner and then go to bed, but who came to feel ever so much +better after a brisk walk home. It was rather hard to persuade them +that, exhausted as they felt, they would actually get rested and not +more tired from vigorous walking, but once they tried it, they knew +the exercise was what they needed. The air in stores is often dry and +uncomfortable for those who are in them all day. It is usually and +quite properly regulated for the customers who come in from the +streets expecting to get warm without delay. In dry, cold weather +particularly, an evening walk home sets the blood in circulation until +it gets thoroughly oxidized and the whole body feels better. Such a +brisk walk will often prevent the development of flat foot, especially +if care is taken to spring properly from the ball of the foot, in the +good, old-fashioned heel and toe method of walking. Once flat foot has +developed, walking probably is more difficult, but even then, with +properly fitting shoes, the patients will be the better for a good +walk after their work is over. It requires some will power to acquire +the <a name="142">{142}</a> habit, but once formed, the benefit and pleasure derived +make it easy to keep up the practice. +</p> +<p> +Those who walk thus regularly will often find that their evening +tiredness is not so marked, and they will feel much more like going +out for some diversion than they otherwise would. Probably nothing is +more dispiriting in the course of time than to come home merely to eat +dinner, sit down after dinner and grow sleepy on one's chair until one +feels quite miserable, and then go to bed. There should be always, +unless in very inclement weather, an outing before bedtime, and this +should be looked forward to. It will often forestall the feeling that +the day is over after dinner and so keep the individual from settling +down into the dozy discomfort of an after-dinner nap as the closing +scene of the day. Good habits in this matter require an effort of the +will to form; bad habits almost seem to form of themselves and then +require a special effort to break. +</p> +<p> +It is surprising how many of the dreads and anxiety neuroses and +psycho-neurotic solicitudes and neurasthenic disquietudes and other +more or less morbid mental states disappear under the influence of a +brisk walk for three or <a name="143">{143}</a> four miles or more every day. I have +tried this prescription on all sorts of people, including particularly +myself, and I know for certain that when troubles are accumulating the +thing to do is to get outdoors more, especially for walking; then the +incubus begins to lift. Clergymen, university professors, members of +religious orders, school teachers, as well as bankers, clerks and +business people of various kinds, have been subjected to the influence +of this prescription with decided benefit. Some of them assert that +they never felt so well as since they have formed the habit of walking +every day. It must, however, be <i>every</i> day, and it must not merely be +a mile or so but it must be at least three miles. That means for a +good many people about an hour spent in actual walking, but it is well +worth the time and effort. Above all, it repays not only in health and +in better feelings but in the increased amount of work that can be +done on the day itself. A whole day passed indoors will often contain +many wasted hours, while if a walk of a couple of miles is planned for +the morning and one for a couple of miles more in the afternoon, very +satisfactory study or other work can be done in the intervals. Almost +needless to say, a brisk walk in the <a name="144">{144}</a> cooler weather will create +an appetite where it did not exist before. Women often need counsel in +this matter more than men, and regular walking for them is indeed a +counsel of health. Very few women in these modern times walk much, and +to walk more than a mile seems to them a hardship. This is responsible +for more of the supersensitiveness and nervous complaints of all kinds +to which women are liable than anything else that I know of. It is +also one important factor in the production of the constipation to +which women are so much more liable than men. We see many +advertisements with regard to the jolts to which the body is subjected +every time the heel is put down and of the means that should be taken +to prevent them, but it must not be forgotten that men and women were +meant by nature to walk erect and that this recurring jolt has a very +definite effect in stimulating peristalsis and favoring the movement +of the contents of the intestines. Besides, if the walking is brisk, +the breathing is deeper and there is some massage of the liver, as +also of the other abdominal viscera, while other organs are affected +favorably. Walking for women—regular, everyday walking—would be +indeed a precious habit, but now <a name="145">{145}</a> that women have occupations +more and more outside of the house, this is one of the things they +must make up their minds to do, if they are to maintain health, +remembering that making up the mind is really making up the will. +</p> +<p> +Over and over again I have seen a great many of the troubles of the +menopause or change of life in women disappear or become ever so much +less bothersome as the result of the formation of regular habits of +walking out of doors every day. Unfortunately, there is a definite +tendency about this time for women to withdraw more and more from +public appearances and to live to a considerable extent in retirement +at home. Nothing could be much worse for them. They need, above all, +to get out and to have a number of interests, and if these interests +can only be so arranged as to demand rather prolonged walks, so much +the better. This is more particularly true for the unmarried woman who +is going through this critical time, and the question of walking +regularly every day for three or four miles must be proposed to her. +It will require a considerable effort of the will. More than two miles +at the beginning will probably be too tiring, but the amount can be +gradually increased <a name="146">{146}</a> until at least four miles on the average is +covered every day. Above all, for the feelings of discomfort in the +cardiac region so often noticed at this time, regular walking is the +best remedy in most cases, always of course presupposing that there is +no organic heart condition, for in that case only a physician can give +the proper direction for each case. By the exercise of the lungs that +it requires, it will probably save most people from colds and coughs +which they have had to endure every winter. Lastly be it said that +practically all men and women, though more particularly the men who +have lived well beyond the Psalmist's limit of threescore and ten, +have been regular daily walkers, or else they have taken exercise in +some form in the open air which is the equivalent of walking. One of +the most distinguished of English physicians, Sir Hermann Weber, who +died just after the end of the war in London, was in his ninety-fifth +year. He had practised medicine regularly until the age of eighty and +continued in excellent health and vigor until just before his death. +During the last year of life, he contributed an interesting article to +the <i>British Medical Journal</i> on the "Influence of Muscular Exercise +on Longevity." He attributed his vigor at the age of <a name="147">{147}</a> ninety-five +as well as the prolongation of his life to his practice of spending +every day two or three hours in the open air. He walked, as a rule, +forty to fifty miles a week. Even in the most inclement weather he +rarely did less than thirty miles a week. Many another octogenarian +and nonagenarian has attributed his good health and long life to the +habit of regular daily exercise in the open. +</p> +<p> +Instead of using up energy, the will so used brings out latent stores +of energy that would not otherwise be employed and thus adds to the +available amount of vitality for the individual. Doctor Thomas Addis +Emmet, only just dead, over ninety, in his younger years as a busy +medical practitioner never kept a horse. It would not be difficult to +cite many other examples among men who lived to advanced old age and +who considered that they owed their good health and long life to daily +habits of outdoor exercise. +</p> + + +<a name="148">{148}</a> + +<h2>CHAPTER X +<br><br> +THE WILL TO EAT</h2> + +<table class="center"> +<tr><td align="left"> + "If your will want not, time and place will be fruitfully added." +</td></tr> +<tr><td align="right"> +<i>King Lear</i> +</td></tr> +</table> + +<p> +Eating is usually supposed to be entirely a matter of appetite which +instinct directs to the best possible advantage of the individual. +This is quite true for those who are living the outdoor life that is +normal or at least most healthy for men, and when they are getting an +abundance of exercise, and may I add also have not too great a variety +of food materials in tempting form presented to them. Under the +artificial not to say unnatural conditions which men have to a great +extent created for themselves in city life, confined at indoor +sedentary occupations, some of them—and they are much more numerous +than is usually imagined—eat too little, while a great many, owing to +stimulation of appetite in various ways, eat too much. +</p> +<p> +Eating therefore for health's sake has to be done through the will and +as a rule by the <a name="149">{149}</a> formation of deliberate habits. It is easy to +form habits either of defect or excess in the matter of eating and +indeed a great deal of the ill health to which mankind is liable is +due to errors in either of these directions. Having disturbed nature's +instincts for food in modifying the mode of life to suit modern +conveniences, we have now to learn from experience and scientific +observations what we should eat and then make up our minds to eat such +quantity and variety as is necessary to maintain health and strength +in the particular circumstances in which we are placed. +</p> +<p> +While the greatest emphasis has been placed on the dangers to health +in overeating, the number of people who, for one reason or another, +eat too little is, as has been said, quite surprising. A very large +proportion of those under normal weight are so merely because they +have wrong habits of eating. Indeed, it may be laid down as a +practical rule of health that wherever there is no organic disease the +condition of being underweight is a symptom of undereating. A great +many thin people insist that the reason why they are underweight is +that it is a family trait and that father and mother, or at least one +of them, and some of their grandparents exhibited this <a name="150">{150}</a> +peculiarity; and thus it is not surprising that they should have it. A +careful analysis of the family eating in such cases has shown me in a +large number of instances, indeed almost without exception, that what +my patients had inherited was not a constitutional tendency to +thinness, but a family habit of undereating. This accrued to them not +from nature but from nurture, and was acquired in their bringing up. +Most of them were eating one quite abundant meal a day and perhaps a +pretty good second meal, but practically all of them were skimping at +least one meal very much. In some way or other, a family habit of +eating very little at this meal had become established and was now an +almost inviolable custom. +</p> +<p> +A great many thin individuals, that is persons who are somewhat more +than ten per cent. under the average normal weight for their height, +either do not eat breakfast at all or eat a very small one. It is not +unusual for the physician analyzing their day's dietary to be told +that the meal consists of a cup of coffee and a piece of bread. +Sometimes there is a roll, but more often only part of a roll, though +occasionally in recent years there may be some fruit and some cereal; +the fruit will usually be a half of one of the citrus fruits <a name="151">{151}</a> +which contains practically no nutrition and is only a pleasant +appetizer, while more often than not the cereal will be one of the +dry, ready-to-eat varieties which, apart from the milk or cream that +may be served with them, contain in the usual small helpings very +little nutriment. Such breakfasts are particularly the rule among +women who are under weight. Sometimes lunch is comparatively light so +that there are two daily apologies for meals. To make up for these, +the third meal may be very hearty. City folk often eat at dinner more +than is good for them. This may produce a sense of uncomfortable +distention and overfulness followed by sleepiness which may be set +down as due to indigestion, though it is just a question of overeating +for the nonce. +</p> +<p> +It would be much more conducive to health to distribute the eating +over the three meals of the day, but it requires a special effort of +the will to break the unfortunate habits that have been formed. +Particularly it seems hard for many people to eat a substantial +breakfast and a determined effort is required to secure this. It would +seem almost as though their wills had not yet waked up and that it was +harder for them to do things at this time of day. It is especially +important for working <a name="152">{152}</a> women, that is, those who have such +regular occupations as school-teacher, secretary, clerk and the like, +to eat a hearty breakfast. They can get a warm properly chosen meal at +home at this hour, while very often in the middle of the day they have +to eat a lunch that is not nearly so suitable. As a consequence of +neglecting breakfast then, it is twenty-four hours between their warm, +hearty meals. Even when they eat a rather good lunch, some eighteen +hours elapse since the last hearty meal was taken, and one half the +day's work has to be done on the gradually decreasing energy secured +from the evening meal of the day before. With this unfortunate habit +of eating, most of that was used up during the night in repairing the +tissue losses of the day before, so that the morning's work has to be +done largely "on the will" rather than on the normal store of bodily +energy. +</p> +<p> +It is surprising how many patients who are admitted to tuberculosis +sanatoria have been underweight for years as a consequence of +unfortunate habits of eating. Not infrequently it is found that they +have a number of prejudices with regard to the simple and most +nutritious foods that mankind is accustomed to. Not a few of the +younger ones who <a name="153">{153}</a> develop tuberculosis have been laboring under +the impression that they could not digest milk or eggs or in some way +they had acquired a distaste for them and so had eliminated them from +their diet; some of them had also stopped eating butter or used it +very sparingly. At the sanatoria, as a rule, very little attention is +paid to the supposed difficulty of digestion of milk and eggs and +perhaps butter. The patients are at once put on the regular diet +containing these articles and the nurse sees that they take them even +between meals, and unless there is actual vomiting or some very +definite objective—not merely subjective—sign of indigestion, the +patients are required to continue the diet. +</p> +<p> +It is almost an invariable rule for the patients of such institutions +to come to the physician in charge after a couple of weeks and ask how +it was that they could have thought that these simple articles of food +disagreed with them. They have begun to like them now and are +surprised at their former refusal to take them, which they begin to +suspect, as the physician very well knows, to have been the principal +reason for the development of their tuberculosis. +</p> +<p> +There are people who are up to weight or <a name="154">{154}</a> slightly above it who +develop tuberculosis, but they do not represent one in five of the +patients who suffer from the affection. In probably three fourths of +all the cases of tuberculosis the predisposing factor which allowed +the tubercle bacillus to grow in the tissues was the loss of weight or +the being underweight. There is a good biological reason for this, for +there are certain elements in the make-up of the tubercle bacillus +which favor its growth at a time when fat is being lost from the +tissues rather than deposited, for at that time more fat for the +growth of the tubercle bacillus is available in the lungs than at +other times. Often among the poor the loss in weight is due to lack of +food because of poverty, or failure to eat because of alcoholism, but +not infrequently among all classes it is just a question of certain +bad habits of eating that might readily have been corrected by the +will. It is surprising how many people who complain of various nervous +symptoms—meaning by that term symptoms for which no definite physical +basis can be found, or for which only that extremely indefinite basis +of a vague reflex, real or supposed, from the abdominal organs—are +underweight and will be found to be eating much less than the average +of <a name="155">{155}</a> humanity. These nervous symptoms include above all +discomforts of various kinds in the abdominal region; sense of +gone-ness; at times a feeling of fullness because of the presence of +gas; grumblings, acid eructations, bitter taste in the mouth, and +above all, constipation. As is said in the chapter on "The Will and +the Intestinal Functions," the most potent and frequent cause of +constipation is insufficient eating, either in quantity or in variety. +It is especially in the digestive tract of those who do not eat as +much as they should that gas accumulates. This gas is usually thought +to be due to fermentation, but as fermentation is a very slow gas +producer and nervous patients not infrequently belch up large +quantities, it is evident that another source for it must be sought. +Any one who has seen a number of hysterical patients with gaseous +distention of the abdomen and attacks of belching in which immense +quantities of gas are eructated, will be forced to the conclusion that +in such nervous crises gas leaks out of the blood vessels of the walls +of the digestive tract and that this is the principal source of the +gas noted. What is true in the severe nervous attacks is also true in +nervous symptoms of other kinds, and neurotic indigestion so called +<a name="156">{156}</a> is always accompanied by the presence of gas. +</p> +<p> +Apparently the old maxim of the physicist of past centuries has an +application here. "Nature abhors a vacuum" and as the stomach and +intestines are not as full as they ought to be, nor given as much work +to do as they should have, nature proceeds to occupy them with gas +which finds its way in from the very vascular gastrointestinal walls. +This is of course an explanation that would not have been popular a +few years ago when the chemistry of digestion seemed so extremely +important, but in recent years, medical science has brought us back +rather to the physics of digestion, and I think that most physicians +who have seen many functional nervous patients would now agree with +these suggestions as to the origin of gaseous disturbance in the +gastrointestinal tract in a great many of these cases. +</p> +<p> +Besides the physical symptoms, there are a whole series of psychic or +psycho-neurotic symptoms, the basis of which undoubtedly lies in the +condition of underweight as a consequence of undereating. Over and +over again I have seen the feeling of inability to do things which had +come over men, and <a name="157">{157}</a> particularly women, disappear by adding to +and regulating the diet until an increase in weight came. Extreme +tiredness is a frequent symptom in those under weight, and this often +leads to their having no recreation after their work because they have +not enough energy for it; as every human being needs diversion, a +vicious circle of influence which adds to their nervous tired +condition is formed. I have seen in so many cases the eating of a good +breakfast and a good lunch supply working people with the energy +hitherto lacking that enabled them to go out of an evening to the +theater or to entertainments of one kind or another, that it has +become a routine practice to treat these people by adding to their +dietary unless there are direct contra-indications. +</p> +<p> +Dreads are much more common among people who are underweight than +among those who eat enough to keep themselves in proper physical +condition. I have had a series of cases, unfortunately only a small +one in number, in which the craving for alcoholic liquor disappeared +before an increase in diet and a gain in weight. I shall never forget +the first case in which this happened. The patient was a man of nearly +sixty years of age who held a <a name="158">{158}</a> rather important political office +in a small neighboring town. He was on the point of losing it because +periodical sprees were becoming more frequent and it was impossible +for him to maintain his position. He was over six feet in height and +he weighed less than a hundred and fifty pounds. I had tried to get +him to gain in weight by advice and suggestion without avail. Finally, +I had to make a last effort to use whatever influence I had to save +his political position for him, and then I succeeded in making him +understand that he would have to do as I told him in the matter of +eating, or else I would have nothing more to do with him. +</p> +<p> +It was not without some misgivings that I thus undertook to make a man +of nearly sixty change his lifelong habits of eating. That is +something which I consider no physician has a right to do unless there +is some very imperative reason for it. Here was, however, a desperate +case. It was in the late afternoon particularly that this patient +craved drink so much that he could not deny himself. As he ate but +very little breakfast and had a hasty scanty lunch, he was at the very +bottom of his physical resources at that time, and at the end of a +rather demanding day's work. We had <a name="159">{159}</a> to break up his other habits +in the hope of getting at the craving. He had taken coffee and a roll +for breakfast. I dictated a cereal, two eggs and several rashers of +bacon and several rolls. I insisted on fifteen minutes in the open +before lunch and then a hearty lunch with some substantial dessert at +the end of it. This man proceeded to gain at the rate of a little more +than three pounds a week. By the end of two months, he weighed about +one hundred and eighty pounds and had not touched a drop of liquor in +that time and felt that he had no craving for it. That is some ten +years ago, and there has been no trouble with his alcoholic cravings +since. He has maintained his weight; he says that he never felt so +well and that above all he now has no more of that intense tiredness +that used to come to him at the end of the day. Every now and then he +says to me in musing mood,—"And to think that I had never learned to +eat enough!" +</p> +<p> +For these very tired feelings so often complained of by nervous +patients, once it has been decided that there is no organic +trouble—for of course kidney or heart or blood pressure affections +may readily cause them—there are just two things to be considered: +These are <a name="160">{160}</a> flat-foot or yielding arch, and undereating. When +there is a combination of these two, then tiredness may well seem +excessive and yet be readily amenable to treatment. Persons with +occupations which require standing are especially liable to suffer in +this way. +</p> +<p> +Undereating in the evening is especially important for many nervous +people and is often the source of wakefulness. It is the cause of +insomnia, not so much at the beginning of the night, as a rule, as in +the early morning. Many a person who wakes at four or five and cannot +go to sleep again is hungry. There is a sense of gone-ness in the +stomach region in these cases, which the patients are prone to +attribute to their nerves in general, or some of them who have had +unfortunate suggestions from their physicians may talk of their +abdominal brain; but it is surprising how often their feelings are due +simply to emptiness. Any thin person particularly who has his last +meal before seven and does not go to bed until after eleven should +always take something to eat before retiring. A glass of milk or a cup +of cocoa and some crackers or a piece of simple cake may be +sufficient, but it is important to eat enough. Animals and men +naturally get sleepy after eating and do not sleep well if their <a name="161">{161}</a> +stomachs are empty. Children are the typical examples. We are all only +children of a larger growth in this regard. +</p> +<p> +When the last meal is taken before seven and people do not go to bed +until nearly twelve, as is frequently the case in large cities, the +custom of having something to eat just before bed is excellent for +sleep. I have known the establishment of this habit to afford marked +relief in cases of insomnia that had extended over years. The people +in my experience who sleep the worst are those who, having taken a +little cambric tea and some toast and preserves with perhaps a piece +of cake for supper, think that this virtuous self-control in eating +ought to assure them good rest. It has just the opposite effect. +Disturbed sleep, full of dreams and waking moments, is oftener due to +insufficient eating than to overeating. The people whom I know who +sleep the best and from whom there are no complaints of insomnia, are +those who, having eaten so heartily at dinner that they get to the +theater a little late, attend the Follies or some late show for a +while and then go round to one of the Broadway restaurants and chase a +Welsh rarebit or some lobster a la Newburg, with a biscuit Tortoni or +a Pêche Melba down <a name="162">{162}</a> to their stomachs and then go home to sleep +the sleep of the just. +</p> +<p> +Just as there are bad habits of eating too little that are dangerous +and must be corrected by the will so there are bad habits of eating +too much that can only be corrected in the same way. While it is +dangerous to be under weight in the early years of life, it is at +least as dangerous to be overweight in middle life. With the variety +and abundance of food now supplied at a great many tables, it is +comparatively easy for people in our time to eat too much. The result +is that among the better-to-do classes a great many people suffer from +obesity, sometimes to such an extent that life is made a burden to +them. There is only one way to correct this and that is to eat less +and of course to exercise more. Reduction in diet means the breaking +of a long established habit and that of course is often hard. The +whole family may have to set a good example of abstinence from too +great a variety of food and especially from the richer foods, in order +that a parent may be helped to prevent further development of obesity +and to lose gently and gradually some of the overweight that is being +put on, and which now, by conserving heat and slowing up metabolism +<a name="163">{163}</a> generally within the body, makes it so easy for even reduced +quantities of food to maintain the former habit of adding weight. +</p> +<p> +In this matter of obesity, however, just exactly as in the case of +tuberculosis for those who are underweight, prevention is much better +than cure. The people who know that they inherit such tendencies +should be particularly careful not to form habits of eating that will +add considerably to their weight. After all, it is not nearly so +difficult a matter as is often imagined. There is no need, unless in +very exceptional cases, of denying one's self anything that is liked +in the ordinary foods, only less of each article must be eaten. Even +desserts need not be entirely eliminated, for ices may be taken +instead of ice cream; sour fruits and especially those of the citrus +variety—oranges and grapefruit—and the gelatine desserts may be +eaten almost with impunity. The phrase "eat and grow thin" has +deservedly become popular in recent years because as a matter of fact +it is perfectly possible to eat heartily and above all to satisfaction +without putting on weight. It is, of course, harder to lose weight, +but even that may be accomplished gradually under proper direction if +there is the persistent will to do it. +</p> +<a name="164">{164}</a> +<p> +In recent years another disease has come to attract attention which +represents the result of an overindulgence in food materials that can +be limited without much difficulty. This is diabetes which used to be +comparatively rare but has now become rather frequent. An authority on +the disease declared not long since that there are over half a million +people in this country now who either have or will have diabetes as +the result of the breaking down of their sugar metabolism. It is not +surprising that the disease should be on the increase, for the +consumption of sugar has multiplied to a very serious degree during +the last few generations. A couple of centuries ago, those who wanted +sugar went not to the grocery store, but to the apothecary shop. It +was kept as a flavoring material for children's food, as a welcome +addition to the dietary of invalids and the old, and quite literally +as a drug, for it was considered to have, as it actually has, to a +slight extent at least, some diuretic qualities that made it valuable. +A little more than a century ago, a thousand tons of sugar sufficed +for the whole world's needs, while the year before the war, the world +consumed some twenty-two million of tons of sugar. It is said that +every man, woman, and <a name="165">{165}</a> child in the United States consumed on the +average every day a quarter of a pound of sugar. +</p> +<p> +Our candy stores have multiplied, and while two generations ago the +little candy stores sold candies practically entirely for children, +eking out their trade with stationery and newspapers and school +supplies, now candy stores dealing exclusively in confectionery are +very common. There are several hundred stores in the United States +that pay more than $25,000 a year rent, though they sell nothing but +candy and ice-cream sodas. Corresponding with the increase in the sale +of candy has come also the consumption of very sweet materials of +various kinds. French pastries, Vienna tarts, Oriental sweetmeats, +Turkish fig paste, Arabian date conserves, and West Indian guava +jelly, are all familiar products on our tables. Chocolate has become +one of the important articles of world commerce, though almost unknown +beyond a very narrow circle a little more than a century ago. Tea and +coffee have been introduced from the near and the far East and by a +Western abuse consumed with such an amount of sweetening as make them +the medium of an immense consumption of sugar. +</p> +<p> +There is no doubt that unless good habits <a name="166">{166}</a> of self-denial in this +regard are formed, diabetes, which is an extremely serious disease, +especially for those under middle life, will continue to increase in +frequency. The candy and sugar habit is rather easy to form; every one +realizes that it is a habit, but it is sometimes almost as hard to +break as the tobacco habit. We were meant to get our sugar by the +personal manufacture of it from starch substances. If a crust of bread +is chewed vigorously until it swallows itself, that is, dissolves in +the secretions and gradually disappears, it will be noted that there +is a distinctly sweetish taste in the mouth. This is the starch of the +bread being changed into sugar. We were expected by nature to make our +own sugar in this way, but this has proved too slow and laborious a +way for human nature to get all the sugar it cared for, so most people +prefer to secure it ready made. Sugar is almost as artificial a +product as alcohol and is actually capable of doing almost as much +harm as its not distantly related chemical neighbor. It is rather +important that good habits in the matter should be formed and we have +been letting ourselves drift into very unfortunate habits in recent +years. +</p> + +<a name="167">{167}</a> + +<h2>CHAPTER XI +<br><br> +THE PLACE OF THE WILL IN TUBERCULOSIS</h2> + +<table> +<tr><td align="left"> +<pre> +"And like a neutral to his will and matter +Did nothing." +</pre> +</td></tr> +<tr><td align="right"> +<i>Hamlet</i> +</td></tr> +</table> + +<p> +Probably the very best illustration in the whole range of medicine of +the place of the will in the cure of disease is afforded by +tuberculosis. This used to be the most fatal of all human affections +until displaced from its "bad eminence" within the last few years by +pneumonia, which now carries off more victims. As it is, however, +about one in nine or perhaps a few more of all those who die are +victims of tuberculosis. This high mortality would seem to indicate +that the disease must be very little amenable to the influence of the +will, since surely under ordinary circumstances a good many people +might be expected to have the desire and the will to resist the +affection if that were possible. In spite of the large death rate this +is exactly what is true. +</p> +<a name="168">{168}</a> +<p> +Tuberculous infections are extremely common, much commoner even than +their high mortality reveals. After long and critical discussion with +a number of persistent denials, it is now generally conceded by +authorities in the disease that the old maxim "after all, all of us +are a little tuberculous" is substantially correct. Very few human +beings entirely escape infection from the tubercle bacillus at some +time in life. The great majority of us never become aware of the +presence of the disease and succeed in conquering it, though the +traces of it may be found subsequently in our bodies. Careful +autopsies reveal, however, that very few even of those who did not die +directly from tuberculosis fail to show tuberculous lesions, usually +healed and well shut off from the healthy tissues, in their bodies. +One in eight of those who become infected have not the resistive +vitality to throw off the disease or the courage to face it and take +such precautions as will prevent its advance. All those, however, who +give themselves any reasonable chance for the development of +resistance survive the disease though they remain always liable to +attack from it subsequently if they should run down in health and +strength. +</p> +<a name="169">{169}</a> +<p> +Heredity, which used to be supposed to play so important a rôle in the +affection, is now known to have almost nothing to do with the spread +of the disease. Family tendencies are probably represented by nothing +more than a proneness to underweight which makes one more liable to +infection, and this is due as a rule to family habits in the matter of +undernourishment from ill-advised consumption of food. Probably a +certain lack of courage to face the disease boldly and do what is +necessary to develop bodily resistance against it may also be an +hereditary family trait, but environment means ever so much more than +heredity. +</p> +<p> +There is a well known expression current among those who have had most +experience in the treatment of patients suffering from tuberculosis +that "tuberculosis takes only the quitters", that is to say that only +those succumb to consumption who have not the strength of will to face +the issue bravely and without discouragement to push through with the +measures necessary for the treatment of their disease. In a word it is +only those who lack the firmness of purpose to persist in the mode of +life outlined for them who eventually die from their affection of the +<a name="170">{170}</a> lungs. No specific remedy has been found that gives any promise +of being helpful, much less of affording assured recovery, though a +great many have been tried and not a few are still in hopeful use. +Recent experience has only served to emphasize the fact that the one +thing absolutely indispensable for any successful treatment of +tuberculosis of the lungs is that the patient should regain weight and +strength and with them resistive vitality so as to be able to overcome +the disease and get better. +</p> +<p> +To secure this favorable result two conditions of living are necessary +but they must be above all persisted in for a considerable period. +First there must be an abundance of fresh air with rest during the +advancing stage or whenever there are acute symptoms present, and +secondly an abundance of good food which will provide a store of +nutritive energy and make the resistive vitality as high as possible. +Curiously enough this "fresh air and good food" treatment for the +disease was recognized as the sheet anchor of the therapeutics of +consumption as long ago as Galen's time, the end of the second +century, when that distinguished Greek physician was practising at +Rome. Nearly eighteen hundred <a name="171">{171}</a> years ago Galen suggested that he +had tried many remedies for what he called phthisis, the Greek +equivalent of our word consumption or wasting away, and had often +thought that he had noted a remedial value in them, but after further +experience he felt that the all-important factors for cure were fresh +air and good food. He even went so far as to say that he thought the +best food of the consumptive or the phthisical, as he called them, was +milk and eggs. A great deal of water has flowed under the bridge of +medical advance since his time and at many periods since physicians +have been sure that they had valuable remedies for consumption; yet +here we are practically back at Galen's conclusion more than fifty +generations after his time, and we are even inclined to think of this +mode of treatment as comparatively new, as it is in modern history. +</p> +<p> +The influence on consumption of the will to get well when once aroused +was typically exemplified in the career of the well-known London quack +of the beginning of the nineteenth century, St. John Long. He set +himself up as having a sure cure for consumption. He was a charlatan +of the deepest dye whose one idea was to make money, and who knew +<a name="172">{172}</a> nothing at all about medicine in any way. He took a large house +in Harley Street and fitted it up for the reception of people anxious +to consult him. For some seasons every morning and afternoon the +public way was blocked up with carriages pressing to his door. Nine +out of ten of his patients were ladies and many of them were of the +highest rank; fashion and wealth hastened to place themselves and +their daughters at the mercy of the pretender's ignorance. His mode of +treatment was by inhalation. He assured his patients that the +breathing in of this medicated vapor would surely cure their pulmonary +disease, and because others were intent on going they went; many of +them were greatly benefited for a time and these so-called cures +proved a bait for many other patients. +</p> +<p> +J. Cordy Jeaffreson in his volume "A Book about Doctors", written two +generations ago, has told the story of St. John Long's successful +application of the principle of community of treatment and its +effectiveness upon his patient. Like Mesmer he realized that treating +people in groups led them mutually to influence each other and to +bring about improvement. St. John Long <a name="173">{173}</a> had in one of the rooms +in Harley Street "two enormous inhalers, with flexible tubes running +outward in all directions and surrounded by dozens of excited women— +ladies of advanced years and young girls giddy with the excitement of +their first London season—puffing from their lips the medicated vapor +or waiting until a mouthpiece should be at liberty for their pink +lips." In our generation of course we had various phases of similar +treatment, including nebulizers and compressed air apparatus and +medicated vapor, all working wonders for a while, and then proving to +have no physical beneficial effect. +</p> +<p> +What is surprising is to find the number of cures that were worked. +St. John Long had so many applicants for attention that he was +literally unable to give heed to all of them. The news of the +wonderful remedy flew to every part of the United Kingdom and from +every quarter sick persons, wearied of a vain search after an +alleviation of their sufferings, flocked to London with hope renewed +once more. This enabled St. John Long to select for treatment only +such cases as gave ready promise of cure. He made it a great +preliminary of his treatment that his <a name="174">{174}</a> patients should eat well +as a rule and on one occasion when he was called into the country to +see a man suffering in the last stages of consumption he said quite +frankly, "Sir, you are so ill that I cannot take you under my charge +at present. You want stamina. Take hearty meals of beefsteak and +strong beer; and if you are better in ten days I will do my best for +you and cure you." +</p> +<p> +It is easy to understand that if he made it a rule for his consumptive +patients that they should eat well or not expect relief from his +medicine he would secure a great many good results. Especially would +this be true in many cases that came up to him from the country, had +the advantage of a change of climate, and of environment and very soon +found that they had much more strength than they thought they had. +They had been dreading the worst, they were now led to hope for the +best; they took the brake off their will, they fed well and it was not +long then before they proceeded to get well. +</p> +<p> +As even a little experience with consumptive patients shows it is +often difficult for them to follow directions—and keep it up—in the +matter of fresh air and good food and here is where the question of +the will in the <a name="175">{175}</a> treatment is all important. Many a consumptive +has in early life formed bad habits with regard to eating, especially +in the direction of eating too little and refusing for some reason or +other to take what are known to be the especially nutritious foods. +Not infrequently indeed it is their neglect of nutrition in this +regard that has been the principal predisposing factor toward the +development of the disease. This bad habit must be overcome and often +proves refractory. +</p> +<p> +Then it is never easy to give up the pursuit of a chosen vocation and +pursue faithfully for a suitable period the humdrum monotonous +existence of prolonged rest every day in the open air with eating and +sleeping as almost the only serious interests, if indeed they can be +called such, permitted in life. It is only those who have the will +power to follow directions faithfully, whole-heartedly and +persistently who have a reasonable prospect of getting ahead of their +disease and eventually securing such a conquest of it as will enable +them to return to their ordinary life as it was before the development +of tuberculosis. +</p> +<p> +Unless patients are ready to follow directions as regards outdoor air +and good food the <a name="176">{176}</a> cure, or as specialists in tuberculosis prefer +to call it the arrest of symptoms in the disease, is almost out of the +question. Above all it is extremely important that those who suffer +from pulmonary tuberculosis should be ready to follow directions at an +early stage of their disease, before any serious symptoms develop, for +it is then that most can be done for them. Many a sufferer from +tuberculosis makes his or her cure extremely difficult, certainly ever +so much more difficult than it would otherwise have been, because the +dread of going to see a physician—lest they should be told that their +affection is really consumption and demands immediate strenuous +treatment—causes them to put off consultation with some one whose +opinion in the matter is reliable. +</p> +<p> +This is indeed one of the principal reasons why tuberculosis of the +lungs still continues to carry off so many victims every year,— +because people are afraid to learn the truth. They dare not put the +question to a definite issue and refuse to believe the possibility +that certain disturbing symptoms represent developing tuberculosis. +They defer seeing an expert; they take this and that suggestion from +friends; they buy cough remedies which <a name="177">{177}</a> they see advertised, +sometimes they tinker with so-called "consumption cures." After a +while an advance of their symptoms makes it absolutely necessary to +see a physician but often by this time their disease has progressed +from an incipient case rather easy to be treated and with an excellent +prognosis to a more advanced stage at which cure is ever so much more +difficult; or by this time it may even prove that their strength has +been seriously sapped and they have not enough resistive vitality left +to bring about reaction toward the cure. +</p> +<p> +The all-important thing for all those who have at any time lived near +consumptives, whether relatives or others—for the disease is almost +invariably acquired and not hereditary—or who have worked for any +prolonged period in more or less intimate contact with those who had a +chronic cough or who subsequently developed tuberculosis, is that on +the first symptom that is at all suspicious they should make up their +minds to have the question as to whether they have tuberculosis or not +definitely settled and that they should be ready to do what they are +told in the matter. The first symptom is not a persistent cough as so +many think, nor continued loss of <a name="178">{178}</a> weight, which is an advanced +sign as a rule, but a continued rapidity of pulse for which no +non-pulmonary reason can be found. +</p> +<p> +The old idea that consumptives should not be told what their affection +was, lest it should disturb their minds and discourage them so much as +to do them harm, has now been abandoned by practically all those of +large experience in the care of the tuberculous. The opposite policy +of being perfectly candid and making the patients understand their +serious condition and the importance of taking all the measures +necessary for cure, yet without permitting them to be unnecessarily +scared, has been adopted. Their will to get well must be thoroughly +aroused. After all, it must be recalled that tuberculosis is an +extremely curable disease. It is now definitely known that more than +ninety per cent. of humanity have at some time had a tuberculosis +process, that is to say a focus of tuberculosis active within their +tissues. Only about one in nine of the deaths in civilized countries +is from tuberculosis. That means that at least eight other people who +have not died from the disease but from something else have had the +affection, yet have recovered from it. Instead of the old shadow of +<a name="179">{179}</a> heredity with its supposedly almost inevitable fatality, so that +young people who saw their brothers and sisters or other relatives +around them die from the disease felt that they were doomed, we now +know that the hereditary factor plays an extremely minor role if +indeed it plays any serious rôle at all in the development of the +disease. +</p> +<p> +No affection is so amenable to the state of mind and the will to be +well as tuberculosis. That is exactly the reason why so many remedies +have come into vogue and apparently been very successful in its +treatment and then after a while have proved to be of no particular +service or even perhaps actually harmful so far as their physical +effect is concerned. It cannot be too often repeated that anything +whatever that a patient takes that will arouse new hope and give new +courage and reawaken the will will actually benefit these patients. No +wonder then that scarcely a year passes without some new remedy for +tuberculosis being proposed. All that is needed to affect favorably +patients suffering from the disease is to have some good reason +presented which makes them feel that they ought to get better and then +at once they eat better and proceed to increase <a name="180">{180}</a> their resistive +vitality. The despondency that comes with the lack of the will to be +well hurts their appetite particularly and no tuberculosis patient can +ever hope to recover health unless he is eating heartily. With better +eating there is always a temptation to be more outdoors and the +ability to stand cooler air which always means that the lungs are +given their opportunity to breathe fresh cool air which constitutes +absolutely the best tonic that we have for the affection. +</p> +<p> +It has been recognized in recent years that the only climates which +give reasonable hope of being helpful for the tuberculous are those +which present a variation of some thirty degrees in their temperature +every day. Whenever this is the case chilly feelings are always +produced in those who are exposed to the change, even though the lower +temperature curve may not go down to anywhere near freezing. If for +instance the temperature at the hottest hour of the day, say three +o'clock in the afternoon, is 90° F. and that of the later evening or +middle of the night is 60° F., chilly feelings will be produced. Just +the same thing is true if the temperature is between 30° F. and 40° F. +shortly after the middle of the day and then goes down to <a name="181">{181}</a> near +zero at night. These chilly feelings are uncomfortable, but they +produce an excellent reaction in the circulation and set the blood +coursing from the heart to the tissues better than any medicine that +we have. In the midst of this the lungs have their resistive vitality +raised so as to throw off the disease. +</p> +<p> +This is probably one of the principal reasons why mountain climates +have been found so much more helpful for the treatment of tuberculosis +than regions of lower elevations. Whenever the elevation is more than +fifteen hundred feet there will almost invariably be a variation of +thirty degrees between the day and the night temperature. There are of +course still greater variations, even sixty or seventy degrees +sometimes where the altitudes are very high, but this is often too +great for the tuberculous patients to react properly to, in their +rundown conditions. Besides, the air is much rarer at the higher +elevations, breathing is more difficult, because the lungs have to +breathe more rapidly and more deeply in order to secure the amount of +oxygen that is needed for bodily necessities from the rarified air. +The middle elevations then, between fifteen hundred and twenty-five +<a name="182">{182}</a> hundred feet, have been found the best for tuberculosis +patients, and they are very pleasant during the summer time, though +never without the chilly discomfort of the drop in temperature. During +the fall and winter, however, many patients become tired out trying to +react to these variations of temperature and want to seek other +climates where they will not have to submit to the discomfort and the +chilly feelings. If they come down to more comfortable quarters before +their tuberculosis has been brought to a standstill by the increase of +their resistive vitality, it is very probable that they will lose most +of the benefit that they derived from their mountain experience. Here +is where the will comes in. Those who have the will to do it and the +persistence to stick at it and the character that keeps them in good +humor in spite of the discouraging circumstances which almost +inevitably develop from time to time, will almost without exception +recover from their tuberculosis with comparatively little difficulty, +if they have only taken up the treatment before the disease is so far +advanced as to be beyond cure. +</p> +<p> +In the older days consumptives used to be sent to the Riviera and to +Algiers and to <a name="183">{183}</a> other places where the climate was comparatively +equable, with the idea that if they could only avoid the chilly +feelings consequent upon variations of temperature it would be better +for them. Many of the disturbing symptoms of tuberculosis are rendered +less troublesome in such a climate, but the disease itself is likely +to remain quiescent at best or perhaps even to get insidiously worse, +as tuberculosis is so prone to do. These milder climates require much +less exercise of the will, but that very fact leaves them without the +all-important therapeutic quality which the lower altitudes possess. +</p> +<p> +For many people the outdoor life and the sight of nature in the +variations produced in scenery during the course of the days and the +seasons are satisfying enough to be helpful in making their cure of +tuberculosis easy. They are extremely fortunate if they have this +strong factor in their favor. It is very probable that we owe the +discovery of the value of the Adirondacks and other such medium +altitudes in the treatment of tuberculosis to the fact that Doctor +Trudeau liked the outdoors so much and was indeed so charmed with the +Adirondack region that when death from tuberculosis seemed <a name="184">{184}</a> +inevitable, he preferred the Saranac region as a place to die in, in +spite of the hardships and the bitter cold from which at that time +there was so little adequate protection, to the comforts of the city. +He scarcely hoped for the miracle of cure from a disease which he as a +doctor knew had carried off so many people, but if he were to die he +felt that he would rather die in the face of nature with his beloved +mountains all around him than in the shut-in spaces of the city. +</p> +<p> +His resolution to go to the Adirondacks seemed to many of those who +heard of it scarcely more than the caprice of a man whom death had +marked for itself. His physicians surely had no hope of his journey +benefiting him but they felt very probably that in the conditions he +might be allowed to have this last desire since there were so few +other desires of life that he was likely to have fulfilled. His will +to live outdoors in spite of the bitter cold of that first winter +undoubtedly saved his life and then he evolved the system of outdoor +treatment which has in the past fifty years saved so many lives and is +now the recognized treatment for the disease. It is easy to +understand, however, how much of firm determination was required <a name="185">{185}</a> +on his part forty years ago, when there were no comfortable ways of +getting into the Adirondacks, when the last stage of the journey had +to be made for forty miles on a mattress in a rough wagon, when water +for washing had to be secured by breaking the ice in the pitcher or on +the lake and when the bitter climate must have been the source of +almost poignant torture to a man constantly running a slight +temperature. He had the courage and the will power to do it and the +result was not only his own survival but a great benefit secured for +others. +</p> +<p> +Unfortunately many a consumptive patient who during his first period +of treatment keeps to the letter the regulations for outdoor air and +abundant food fails to do so if it is necessary to come back a second +time. Persistency is here a jewel indeed and only the persistent win +out. Many an arrested case fails to keep the rules of living that may +be necessary for years afterwards and runs upon relapse. The will to +do what is necessary is all-important. Trudeau himself, after securing +the arrest of his disease in the Adirondacks, though he lived and +worked successfully to almost seventy years of age, found it quite +impossible to live out of them <a name="186">{186}</a> and often had to hurry back from +even comparatively brief visits to the lowlands. Besides, every now +and then during some forty years he had the will power to take his own +prescription of outdoor air and absolute rest. It was the faculty to +do this that gave him length of life far beyond the average of +humanity and the power to accomplish so much in spite of the invasion +of the disease which had rendered large parts of both lungs +inoperative. Not only did he live on, however, but he succeeded in +doing so much valuable work that few men in the medical profession of +America have stamped their name deeper on modern medical science than +this consumptive who had constantly to use his will to keep himself +from letting go. +</p> + +<a name="187">{187}</a> + +<h2>CHAPTER XII +<br><br> +THE WILL IN PNEUMONIA</h2> + +<table class="center"> +<tr><td align="left"> + "Who shall stay you?—My will, not all the world." +</td></tr> +<tr><td align="right"> +<i>Hamlet</i> +</td></tr> +</table> + +<p> +What is true of tuberculosis and the influence of the will has proved +to be still more true, if possible, of pneumonia. Clinical experience +with the disease in recent years has not brought to us any remedy that +is of special value, nor least of all of specific significance, but it +has enabled us to understand how individual must be the treatment of +patients suffering from pneumonia. We have recognized above all that +mentally disturbing factors which lessen the patient's courage and +will to live may prove extremely serious. We hesitate about letting an +older person suffering from pneumonia learn any bad news and +particularly any announcement of the death of a near relative, above +all, a husband or wife. The shock and depression consequent upon any +such announcement may <a name="188">{188}</a> prove serious or even fatal. The heart +needs all its power to accomplish its difficult task of forcing blood +through the limited space left free in the unaffected lung tissue, and +anything which lessens that, that is anything which <i>disheartens</i> the +patient, to use our expressive English phrase, must be avoided as far +as possible. +</p> +<p> +When a man of fifty or beyond, one or more of whose friends has died +of pneumonia about his age, comes down with the disease and learns, as +he often will in spite of the best directed effort to the contrary, +that he is suffering from the affection, if he is seriously disturbed +by the knowledge, we realize that it bodes ill for the course of the +disease. If a pneumonia patient, especially beyond middle life, early +in the case expresses the thought that perhaps this may be the end and +clings at all insistently to that idea, the physician is almost sure +to feel little confidence of pulling him through the illness. In +probably no disease is it more important that the patient's courage +should be kept up and that his will should help rather than hamper. +</p> +<p> +Courage is above all necessary in pneumonia because the organs that +are most affected and have most to do with his recovery are so much +<a name="189">{189}</a> under the control of the emotions. Any emotional disturbance +will cause the heart to be affected to some extent and the respiration +to be altered in some way. When a pneumonia patient has to lie for +days watching his respirations at forty to the minute, though probably +he has never noticed them before, and feels how his heart is laboring, +no wonder that he gets scared, and yet his scare is the very worst +thing that can happen to him. It will further disturb both his heart +and his respiration and leave him with less energy to overcome the +affection. He may be tempted to make conscious efforts to help his +lungs in their work, though any such attempt will almost surely do +more harm than good. He must just face the inevitable for some five to +nine days, hope for the best all the time and keep up his courage so +as not to disturb his heart. After middle life only the patients who +are capable of doing that will survive the trial that pneumonia gives. +The super-abounding energy of the young man will carry him through it +much better; and besides, the young man usually has much less +solicitude as to the future and much less depending on his recovery. +</p> +<p> +A generation ago or even less, whiskey or <a name="190">{190}</a> brandy or some form of +strong, alcoholic stimulant, as it was called, was looked upon as the +sheet anchor in pneumonia. For a generation or more at that time, the +same remedy had been looked upon by a great many physicians as an +extremely precious resource in the treatment of tuberculosis. The +therapeutic theory behind the practice was that in affections of the +lungs a particular strain was placed upon the heart and therefore this +organ needed to be stimulated just as far as could be done with +safety. As alcohol increases the rapidity of the heart beat, it was +considered to be surely a stimulant and came to be looked upon as the +safest of heart stimulants, because, except when used over very long +periods, direct bad effects had not been noticed. In pneumonia, above +all, the heart needed to be stimulated because it had to pump blood +through the portion of the lungs unaffected by the pneumonia, usually +congested and offering special hindrances to the circulation; besides, +a much larger amount of blood than usual had to be pumped through +these portions of the lungs in order to compensate for the solidified +portions. +</p> +<p> +A number of very experienced physicians came to be quite sure that +alcoholic stimulants <a name="191">{191}</a> were the most valuable remedy that we had +for this special purpose of cardiac stimulation; some of them went so +far as to say, with a well known New York clinician, that if they were +to be offered all the drugs of the pharmacopeia without alcoholic +stimulant for the treatment of pneumonia on the one hand, or whiskey +or brandy on the other without all the pharmacals, they would prefer +to take the alcohol, confident that it would save more patients for +them. They were quite sure that they had made observations which +justified them in this conclusion. +</p> +<p> +We know at the present time that alcohol is not a stimulant but always +a narcotic. It increases the rapidity of the heart beat, though not by +direct stimulation, but by disturbing the inhibitory nerve apparatus +of the heart and thus permitting the heart to beat faster. Just as +there is a governor on a steam engine, to keep it from going too fast +and regulate its speed to a definite range, so there is a similar +governing apparatus or mechanism in connection with the heart. It is +by affecting this that alcohol makes the heart go faster. Blood +pressure is not raised, but on the contrary lowered, and the effect of +alcohol is depression and not stimulation. <a name="192">{192}</a> In spite of this, +good observers seemed to note favorable effects from the use of +alcohol in both pneumonia and tuberculosis. This appears to be a +paradox until one analyzes the psychic effects of alcohol and places +them alongside the physical, in order to determine the ultimate +equation of the influence of the substance. +</p> +<p> +Alcohol has a very definite tendency to produce a state of euphoria, +that is, of well-being. The patient's mind is brought to where it +dismisses solicitude with regard to himself. This neutralizes directly +the anxiety which so often acts as a definite brake upon resistive +vitality. The alcoholic stimulant, in so far as it has any physical +effect, probably does a little harm, but its influence on the mind of +the patient not only serves to neutralize this, but adds distinctly to +the patient's prospects of recovery. Without it, the dread which comes +over him paralyzes to some extent at least his heart activity and +interferes with lung action. Under the influence of alcohol, he gains +courage—artificial, it is true—but still enough to put <i>heart</i> in +him, and this is the stimulation that the older clinical observers +noted. The patient can, with the scare lifted, use his will to be well +<a name="193">{193}</a> ever so much more effectively and psychic factors are +neutralized that were hampering his resistive vitality. +</p> +<p> +This illustrates very well indeed the place of dilute alcohol in some +of the usual forms in therapeutics about the middle of the nineteenth +century. Practically all the textbooks of medicine at that time +recommended alcohol for many of the continued fevers. In sepsis, in +child-bed fever, in typhoid, in typhus, as well as in tuberculosis and +pneumonia and other less common affections, whiskey or brandy was +recommended highly and usually given in considerable quantities. All +of these affections are likely to be accompanied by considerable +anxiety and solicitude with a series of recurring dreads that sadly +interfere with nature's efforts toward recovery. Under certain +circumstances, the scare, to use the plain, simple word, was +sufficient to turn the scale against the patient. The giving of +whiskey at least lifted the scare [Footnote 5] <a name="194">{194}</a> and enabled the +patient to use his vital resources to best advantage. +</p> +<p class="footnote"> + [Footnote 5: The use of whiskey for snake-bite probably has no other + significance than this lifting of the scare. It used to be said that + the alcoholic stimulation neutralized the depressant effect of snake + poisoning on the heart. Now we know that this is not true, and in + addition, we know of no effect that alcohol in the system might have + in neutralizing the presence of the toxic albumin which constitutes + the danger in snake poisoning. It is only rarely that the bite of a + rattlesnake will be fatal. Experts declare that the snake must be a + large one, its sting must be inflicted on the bare skin, it must not + have stung any one so as to empty its poison glands for more than + twenty-four hours, and the full dose of the poison must be injected + beneath the skin for the bite to be fatal. Very rarely are all these + conditions fulfilled. When a person is bitten by a snake, however, + the terror which ensues is quite sufficient of itself to hurt the + patient seriously and he may scare himself to death, though the + snake poison would not have killed him. The whiskey lifts the scare + and gives nature a chance to neutralize the poison which she can + usually do successfully.] +</p> +<p> +It is extremely important, then, first to be sure that the patient's +will to be well is not hampered by unfortunate psychic factors and +secondly, that his courage shall be stimulated to the greatest +possible degree. Fresh air is the most important adjuvant for this +that we have. The outdoor air gives a man the courage to dissipate +dreads and makes him feel that he can accomplish what seemed +impossible before. Undoubtedly this is one of the favorable effects of +the fresh-air treatment of pneumonia, for it makes people mentally +ever so much less morbid. The patient's surroundings must be made as +encouraging as possible and there must be no signs of anxious +solicitude, no long faces, no weeping, and as far as possible, no +disturbance about business affairs that might make him think that a +fatal termination was <a name="195">{195}</a> feared. His will to get well must be +fostered in every possible way and obstacles removed. This is why it +has been so well said in recent years that good nursing is the most +important part of the treatment of pneumonia. This does not mean that +a good nurse can replace a physician, but that both must coordinate +their efforts to making the patient just as comfortable as possible, +so that he will feel assured that everything that should be, is being +done for him, and that it is only a question of being somewhat +uncomfortable for a few days and he will surely get well. +</p> +<p> +Sunny rooms, smiling faces, flowers at his bedside, cheerful +greetings, all these, by adding to the patient's euphoria, bolster up +his will and make him feel that after all, thousands of people have +suffered from pneumonia and recovered from it, and there is no reason +why he should not, provided that he will not interfere with his own +recovery. +</p> + +<a name="196">{196}</a> + +<h2>CHAPTER XIII +<br><br> +COUGHS AND COLDS</h2> + +<table class="center"> +<tr><td align="left"> + "The power and corrigible authority of this lies in our wills." +</td></tr> +<tr><td align="right"> +<i>Othello</i> +</td></tr> +</table> + +<p> +It might seem as though the will had nothing to do with such very +material ailments as coughs and colds, and yet the more one knows +about them, the clearer it becomes that their symptoms can be +lessened, their duration shortened, their tendencies to complications +modified, and to some extent at least, they can be almost literally +thrown off by the will to be well. The idea of a little more than a +generation ago that coughs and colds would be most benefited by +confinement to the house and as far as possible to a room of an +absolutely equable temperature has gradually given way before the +success of the open-air treatment for tuberculosis and the meaning of +fresh air in the management of pneumonia cases. Fresh, cold air is +always beneficial to the lungs, no matter what the conditions present +in them, though it requires <a name="197">{197}</a> no little courage and will power to +face the practical application of that conclusion in many cases. When +it is bravely faced, however, the results are most satisfactory, and +the respiratory condition, if amenable to therapeutics, is relieved or +proceeds to get better. Of course it is well understood that any and +every patient who has a rise in temperature, that is whose temperature +is above 100° F. in the later afternoon hours, should be in bed. Under +no circumstances must a person with any degree of fever move around. +This does not mean, however, that such patients should not be +subjected to fresh, cold air. The windows in their room or the ward in +which they are treated should be open, and if the condition is at all +prolonged, arrangements should be made for wheeling their beds out on +the balcony or placing them close to a window. The cold air gives them +distinctly chilly feelings and sometimes they complain of this, but +they must be asked to stand it. Of course if the cold disturbs their +circulation, if the feet and hands get cold and the lips blue, the +patients are not capable of properly reacting against the cold and +must not be subjected to it. Their subjective feelings of chilliness, +however, must <a name="198">{198}</a> not be sufficient to keep them from the ordeal of +cold, fresh air; on the contrary, they must be told of the benefit +they will receive from it and asked to exert their wills to stand the +discomfort with just as little disturbance as possible. +</p> +<p> +People suffering from coughs, no matter how severe, should get out +into the air regularly, if they have no fever, and should go on with +their regular occupation unless that occupation is very confining or +is necessarily conducted in dusty air. Keeping to the house only +prolongs the affection and makes it much more liable to complications +than would otherwise be the case. Sufferers from these affections +should not go into crowds, should avoid the theaters and crowded cars, +partly for the sake of others—because they can readily convey their +affection to them—but also for their own sake, because they are more +susceptible to other forms of bacteria than those already implanted in +their own systems and they are much more liable to pick up foreign +bacteria in crowds than anywhere else. They should be out in the open +air, particularly in the sunlight, and this will do more to shorten +the course of a cough and cold than anything else. +</p> +<a name="199">{199}</a> +<p> +They need more sleep than before and should be in bed at least ten or +eleven hours in the day, though if they should not sleep during all of +that time, they need not feel disturbed but may read or knit or do +something else that will occupy them while they retain a recumbent +position. They should not indulge in long, tiresome walks and in +special exertion, but should postpone these until the cough has given +definite signs of beginning to remit. +</p> +<p> +With regard to the cough itself, it must not be forgotten that the +action of coughing is for the special purpose of removing material +that needs to be cleared from the lungs and the throat and larynx. It +should not be indulged in except for that purpose. It requires a +special effort, and while the lungs and other respiratory passages are +the subject of a cold, these extra efforts should not be demanded of +them unless they are absolutely necessary. Almost needless to say, +people indulge in a great deal of unnecessary coughing. Some of this +is a sort of habit and some of it is due to that tendency to imitate, +so common in mankind. Every one has surely heard during religious +services, in a pause just after heads have been bowed in prayer or for +a <a name="200">{200}</a> benediction, a single cough from a distant part of the church +which seemed to be almost the signal for a whole battery of coughs +that followed immediately from every portion of the edifice. If some +one begins coughing during a sermon or discourse, others will almost +inevitably follow. Coughing, like yawning, is very liable to +imitation. +</p> +<p> +The famous rule of an old-time German physician was that no one was +justified in coughing or scratching the head unless these activities +were productive. Unless you get something as the result of the +coughing, it should not be indulged in. There are a great many people +who cough much more than necessary and who delay the progress of their +betterment in that way. Whenever material is present to be coughed up, +coughing is not only proper but almost indispensable. It is the +imitative cough, the coughs which indicate overconsciousness of one's +affection, the coughs that so often almost unconsciously are meant to +catch the sympathy of those around, which must be repressed by the +will, and when the patient finds that he really has to cough less than +he thinks, he will be quite sure that he is getting better and will +actually improve as a consequence of this feeling. +</p> +<a name="201">{201}</a> +<p> +Coughs need an abundance of fluid much more than medicine, and warm +fluids are better than cold; the will must be exercised so as to +secure the taking of these regularly. At least a quart of warm liquid, +milk if one is not already overweight, should be taken between meals +during the existence of a cough. Hot milk taken at night will very +often secure much better rest with ever so much less coughing than +would otherwise be the case. The tendency to take cough remedies which +lessen the cough by their narcotic effect always does harm. Coughing +is a necessary evil in connection with coughs, and whatever +suppression there is should be accomplished by means of the will. +Remedies that lessen the coughing also lock up the secretions and +disturb the system generally and therefore prolong the affection and +do the patient harm. Most of the remedies that are supposed to choke +off a cough have the same effect. Quinine and whiskey have been very +popular in this regard but always do harm rather than good. Their use +is a relic of the time when whiskey was employed for almost every form +of continued fever and when quinine was supposed to be good for every +febrile affection. We know now that quinine has no effect <a name="202">{202}</a> except +upon malarial fevers, and then only by killing the malarial organism, +and that whiskey is a narcotic and not a stimulant and does harm +rather than good. Those who did not take the familiar Q. and W. have +in recent years had the habit of administering to themselves or to +their friends various laxative or anodyne or antiphlogistic remedies +that are supposed to abort a cough or cold and above all, prevent +complications. All of these remedies do harm. Every single one of +them, even if it makes the patient a little more comfortable for the +time, produces a condition that prevents the system from throwing off +the infection which the cold represents as well and as promptly as it +otherwise would. +</p> +<p> +It requires a good deal of will power to keep from taking the many +remedies which friends and sometimes relatives insist on offering us +whenever a cold is developing, but the thing to do is to summon the +will power and bravely refuse them. Medicine knows no remedies that +will abort a cold. The use of brisk purgatives, sometimes to an extent +which weakens the patient very much the next day, is simply a relic of +the time when every patient was treated with antimony <a name="203">{203}</a> or calomel +and free purgation was supposed to be almost as much of a cure-all as +blood-letting. There is no reason in the world to think that the +emptying of food out of the bowels will do any particular good, unless +there is some definite indication that the food material present there +should be removed because it is producing some deleterious effect. +</p> +<p> +The longer a physician is in the practice of medicine the less he +tries to abort infectious diseases, and coughs and colds are, of +course, just infections. They must run their course, and the one thing +essential is to put the patient in as good condition as possible so +that his resistive vitality will enable him to throw off the infection +as quickly as possible. It requires a good deal of exercise of will +power on the part of the physician to keep from running after the many +will-o'-the-wisps of treatment that are supposed to be so effective in +shortening the course of disease, but any physician who looks back at +the end of twenty years will know that his patients have reason to be +thankful to him just in proportion as he has avoided running after the +fads and fancies of current medicine and conservatively tried to treat +his patients rather than cure their diseases. The patient is ever so +much <a name="204">{204}</a> more important than his disease, no matter what the disease +may be. +</p> +<p> +Above all, for the cure and prevention of coughs and colds people must +not be afraid of cold, fresh air. A good many seem to fear that any +exposure to cold air while one has a cough may bring about pneumonia +or some other serious complication. It must not be forgotten, however, +that the pneumonia months in the year occur in the fall and the +spring, October and November and March and April producing most deaths +from the disease, and not December, January and February. The large +city in this country which may be said to have the fewest deaths from +pneumonia is Montreal, where the temperature during December and +January is often almost continuously below zero for weeks at a time +and where there is snow on the ground for three or four months in +succession. The highest death rate from pneumonia is to be found in +some of our southern cities which have rather mild winters and rather +equable temperature,—that is, no considerable variation in the daily +temperature range. Cold air is bracing and tonic for the lungs and +enables them to resist the microbe of pneumonia, and it is now +recognized <a name="205">{205}</a> by physicians that personal immunity is a much more +important factor in the prevention of the disease than anything else. +</p> +<p> +Coughs and colds and bronchitis and pneumonia, the respiratory +diseases generally, are much less frequent in very cold climates than +in variable regions. Arctic explorers are but rarely troubled by them, +even though they may be exposed to extremely low temperatures for +months. Men subjected to blizzards at thirty and forty degrees below +zero may have fingers and toes frozen but do not have respiratory +affections. Some years ago, it was noted that one of these Arctic +expeditions had spent nearly two years within the Arctic Circle +without suffering from bronchial or throat disease and within a month +after their return in the spring most of them had had colds. Nansen +and his men actually returned from the Arctic regions where they had +been in excellent health during two severe winters to be confined to +their beds with grippy colds within a week of their restoration to +civilization, with its warm comfortable homes and that absolute +absence of chill which is connected in so many people's minds with the +thought of coughs and colds. +</p> +<p> +The principal reason why colds are so <a name="206">{206}</a> frequent in the winter +time in our cities and that pneumonia has increased so much is mainly +because people are afraid of standing a little cold. Office buildings +are now heated up to seventy degrees to make the personnel absolutely +comfortable even on the coldest days, and as a consequence the air is +so dry that it is more arid—that is more lacking in water vapor, as +the United States Public Health Service pointed out—than Death +Valley, Arizona, in summer. People dress too warmly, anticipating +wintry days and often getting milder weather and thus making +themselves susceptible to chilling because the skin is so warm that +the blood is attracted to the surface. Will power to stand cold, even +though at a little cost of discomfort, is the best preventive of +coughs and colds and their complications and the best remedy for them, +once the acute febrile stage has passed. +</p> + + +<a name="207">{207}</a> + +<h2>CHAPTER XIV +<br><br> +NEUROTIC ASTHMA AND THE WILL</h2> + +<table class="center"> +<tr><td align="left"> + "Great minds of partial indulgence<br> + To their benumbed wills." +</td></tr> +<tr><td align="right"> +<i>Troilus and Cressida</i> +</td></tr> +</table> + +<p> +In closing a clinical lecture on bronchial asthma at the University of +Marburg some years ago, Professor Friedrich Müller, who afterwards +became professor at Berlin, said, "Each asthmatic patient is a problem +by himself and must be studied as such; meantime, it must not be +forgotten what an important rôle suggestion plays in the treatment of +the disease." This represents very probably the reason why so many +remedies have been recommended for asthma and have proved very +successful in the hands of their inventors or discoverers as regards +the first certain number of patients who use them, and yet on +subsequent investigation have turned out to be of no special +therapeutic value and sometimes indeed to have no physical effect of +any significance. +</p> +<a name="208">{208}</a> +<p> +Of course this is said with regard to neurotic asthma only, and must +not be applied too particularly to other forms of the affection, +though there is no doubt at all that the symptoms of even the most +severe cases of organic asthma can be very much modified and often +very favorably, by suggestive methods. +</p> +<p> +The principal feature of asthma is a special form of severe difficulty +in breathing. It is known now that the beginning of the affection is +always as Strumpell said, "an extensive and quite rapid contraction of +the smaller and smallest bronchial branches, that is the terminal +twigs of the bronchial tubes." It is not so much air hunger, though +there is, of course, an element of that because the lungs are not +functioning properly, as an inability to empty the lungs of air +already there and get more for respiratory purposes. The spasm in +asthma has a tendency to hold the lungs too full of air and produce +the feeling of their getting ever fuller and fuller. What the old sea +captain said in the midst of his attack of asthma, when somebody +sympathized with him because he had so much difficulty in getting his +breath, was that he had lots of breath and would like to get rid of +some of it. <a name="209">{209}</a> He added, "If I ever get all this breath that's in +me now out of me, I'll never draw another breath so long as I live, so +help me." The respiration spasm is usually at full inspiration and the +effort is mainly directed toward expiration and expulsion of air +present using the accessory respiratory muscles for that purpose. +</p> +<p> +The picture of a man suffering from asthma is that of a patient so +severely ill as to be very disturbing to one not accustomed to seeing +it. It would be almost impossible for any one not used to the attacks +to think that in an hour or two at the most the patient would be quite +comfortable and if he is accustomed to the attacks, that he will be +walking around the next day almost as if nothing had happened. All +that the affection consists in is a spasm of the bronchioles and as +soon as that lets up, the patient will be himself again. Some material +may have accumulated during the time when the spasm was on which will +still need to be disposed of, and there will be, of course, tiredness +of muscles unaccustomed to be used in that special way, but that will +be all. +</p> +<p> +We are still in the dark as to what causes the spasms but undoubtedly +psychic factors <a name="210">{210}</a> play an important etiological rôle. For a good +many people, there is a distinct element of dread as the immediate +cause of their asthmatic attacks. Some people have it only when they +have gone through some disturbing neurotic experience. Occasionally it +is the result of physical factors combined with some psychic element. +Cat asthma is not very uncommon and occurs as a consequence of some +contact by the individual with a specimen of the cat tribe though +usually the large cats, the lions and tigers, do not cause it. There +is nearly always, in those who are liable to this form of asthma, a +special detestation of cats. There is probably some emanation from the +animal which produces the asthmatic fever, just as is true also of +horses in those cases where horse asthma occurs. In a few of these +latter cases, however, it was noted that the horse asthma did not +begin until after there had been some terrifying experience in +connection with the horse, as a runaway, a collision, or something of +that kind. +</p> +<p> +Any one who sees many asthmatic cases inevitably gets the impression +after a time that their very dread of the attacks has not a little to +do with predisposing them. <a name="211">{211}</a> Occasionally the dread is associated +with some other organic disturbance, either of heart or kidneys, or +oftener still, with some solicitude with regard to these organs and +the persuasion that there is something serious the matter with them, +though there is at most only some functional disturbance. This is +particularly true of cases of palpitation of the heart where there has +been considerable dread of organic heart disease. In a certain number +of these cases, there is some emphysema present, that is, +overdistention of the lungs, such as is seen in high-chested people. +Owing to the long anterio-posterior diameter of the chest and the fact +that as a consequence it is nearly as thick through as it is wide, +this form of chest is sometimes spoken of as barrel-chest. Patients +who have it are particularly likely to suffer from asthma if they have +any dread of heart trouble or if they are of a nervous constitution. +</p> +<p> +I have known people with the dread of the dark to get an attack of +asthma if they were asked to sleep alone after having been accustomed +for years to sleep with somebody in the room. I have known even a +physician to have attacks of asthma of quite typical character as the +result of a dread of being <a name="212">{212}</a> out after dark which had gradually +come over him. I have had a physician patient who was very +uncomfortable if alone on the streets of New York, even during the +day, and whose symptoms at their worst were distinctly dyspneic or +asthmatic. He used to have to bring his wife with him whenever he came +to see me for he lived out in one of the neighboring towns, because he +was so afraid that he might get an asthmatic attack that would +overcome him and he would feel helpless without some one to aid him. +</p> +<p> +In practically all these cases, the treatment of asthma becomes +largely that of treating the accompanying dread. Once the acute +symptoms of the attack itself manifest themselves, they have to be +treated in any way that experience has shown will relieve the patient. +The general condition, however, needs very often an awakening of the +will to regulate the life, to get out into the air more than before, +to avoid disturbing neurotic elements, and worrying conditions of +various kinds. Thin people need to be made to gain in weight, using +their will for that purpose; stout people who eat too much and take +too little exercise need to have their lives <a name="213">{213}</a> regulated in the +opposite direction. In the meantime, anything that arouses the patient +to believe firmly that his condition will be improved by some remedy +or mode of treatment, will help him to make the intervals between +attacks longer and the attacks themselves less disturbing. The will +undoubtedly plays a distinct role in this matter which patients who +have been through a series of asthmatic attacks recognize very +clearly. +</p> +<p> +The many remedies for asthma which have been lauded highly even by +physicians, and that have cured or relieved a great many patients and +yet after a while have proved to be without much beneficial effect, +make it very clear how much the affection depends on the will power to +face it and throw it off. Nothing will be curative in asthma unless +the patient has confidence in his power and uses his own will energy +to help it. He must overcome the element of dread which occurs in +connection with all asthmatic attacks, even those due to organic +disease of heart or kidneys. No matter how frequent the attacks have +been, there is always an element of fright that enters into an +affection which interferes with the respiration. This must <a name="214">{214}</a> be +overcome by psychic means to help out the physical remedies that are +employed. Sometimes the psychic remedies will succeed of themselves +where more material means have failed completely. +</p> + +<a name="215">{215}</a> + +<h2>CHAPTER XV +<br><br> +THE WILL IN INTESTINAL FUNCTION</h2> + +<table class="center"> +<tr><td align="left"> + "Ill will never said well." +</td></tr> +<tr><td align="right"> +<i>Henry V</i> +</td></tr> +</table> + +<p> +During the past generation, the appreciation of the relative part +played by the stomach and intestines in digestion has completely +changed. Our forefathers considered the stomach the all-important +organ of digestion and the intestines as scarcely more than a long +tube to facilitate absorption and deal properly with waste materials. +Their relative values are now exactly reversed in our estimation. The +stomach has come to be looked upon as scarcely more than a thin-walled +bag meant to hold the food that we take at each meal and then pass it +on by degrees to be digested, prepared for absorption and finally +absorbed in the intestines. It has comparatively little to do with +such alteration of the food as prepares it to be absorbed. Its motor +function is much more important than its secretory function and +serious stomach troubles are <a name="216">{216}</a> dependent on disturbances of +stomach motility. Contractions at the pyloric orifice, that is the +passageway from the stomach into the intestines, will cause the +retention of food and seriously interfere with health. The dilatation +of the stomach for any reason may produce a like result and these are +the stomach affections that need special care. +</p> +<p> +If the stomach will only pass the food on properly, the intestines +will do the rest. A number of people have been found in the course of +routine stomach examinations who proved to have no secretory function +of the stomach and yet suffered no symptoms at all attributable to +this fact. The condition is well known and is called <i>achylia +gastrica</i>, that is, failure of the stomach to manufacture chyle, the +scientific term for food changed by stomach secretions. Our stomachs +are only meant, apparently, to provide a reservoir for food that will +save us the necessity of eating frequently during the day, as the +herbivorous and graminivorous animals have to do, and enable us to +store away enough food to provide nutrition for five or six hours. We +thus have the leisure to occupy ourselves with other things besides +eating and drinking. +</p> +<p> +This conclusion as to the relative <a name="217">{217}</a> significance of the stomach +and digestion is confirmed by the fact that removal of the whole +stomach or practically all of it for cancer has in a number of well +known cases been followed by gain in weight and general improvement in +health. Schlatter's case, the very first one in which nearly the whole +stomach was removed, proved a typical instance of this, for the +patient proceeded to gain some forty pounds in weight. She had lost +this during the course of the growth of a cancer and its interference +with stomach motility. It was necessary, however, for her to be fed, +rather carefully, well-chosen foods usually in liquid form, and every +hour and a half instead of at longer intervals. Her intestines were +thus spared from overloading and proceeded to do the work of digestion +for which they are so well provided by abundant secretion poured into +them from the large glands, the liver and the pancreas, as well as the +series of small glands in their own walls all of which were manifestly +meant to do extremely important work. +</p> +<p> +In the increased estimation of the significance of the digestive +functions of the intestines which has come in recent years, there has +been a tendency, as always in human <a name="218">{218}</a> affairs, for the pendulum to +swing too far. Above all, certain phases of intestinal function have +come to occupy too much attention and to be the subject of +oversolicitude. Whenever this happens, whatever function it concerns +is sure to be interfered with. Attention has been concentrated to a +great extent on evacuation of the bowels and the consequences have +been rather serious. A great many people whose intestinal functions +were proceeding quite regularly have had their attention called to the +fact that any sluggishness of the intestines may be the source of +disturbing symptoms and the beginning of even serious morbid +conditions. As a consequence, they pay a great deal of attention to +the matter and before long become so solicitous that the elimination +of waste materials from the intestines is interfered with. Above all, +they may be led to pick and choose their foods so delicately that +there is not the necessary waste material left to encourage +peristalsis. +</p> +<p> +The result is that to some extent at least, intestinal function would +almost seem to have broken down in our day. Everywhere one sees +advertisements of medicines and remedies and treatments of various +kinds that will aid in the evacuation of the bowels. <a name="219">{219}</a> Most of +them are guaranteed to be perfectly harmless and all of them are +pleasant to take, they work while you are doing nothing else and are +just engaged in saving mankind not only suffering but complications of +various kinds that may lead to serious results. Some years ago, when +Matthew Arnold was in this country, he declared in one of his lectures +that what the world needed was "leading and light," but a well known +American physician who is closely in touch with American life declared +not long since that what we needed in America manifestly, if +advertisements were any index of the needs of a people, was laxatives +and more laxatives. Advertisements cost money; it is said that at +least four times as much as the advertising costs must be spent by the +public on any object advertised in order to make it pay, so that very +probably nearly a billion of dollars a year is spent in this country +on laxatives. Only whiskey and tobacco present a higher bill to the +American people annually. +</p> +<p> +Practically all of the laxative medicines do harm if taken over a +prolonged period. Over and over again physicians have found that +laxative remedies introduced even by scientists, with the assurance +that they were quite <a name="220">{220}</a> harmless and had no undesirable after +effects proved the source of annoying or even serious symptoms after a +while. It is true that when constipation has become habitual, it may +be necessary to give laxative medicines for a prolonged period, but +this is only another instance of the necessity that is often presented +to the physician of choosing between two evils and trying to find the +lesser one. Even the heavy oil that has become so popular in recent +years has been found on careful investigation and prolonged +observation to have certain undesirable effects and it must not be +forgotten that it has not been used generally for a sufficiently long +time for us to be absolutely sure what its sequelae may be. +</p> +<p> +This breakdown of intestinal activity is not the fault of nature but +of men and women who have been thinking to improve on the natural laws +of living. As the result of improvements in diet and refinements in +cooking and the preparation of foods, less and less of their roughage +is left in our articles of food when sent to the table. It is on this +roughage or waste material that intestinal movement or peristalsis +depends. If we eat perfectly white bread, cut all the gristle and +fatty materials from our meat, carefully eliminating <a name="221">{221}</a> the +connective tissue bundles that may occur in it, eat our vegetables +mainly in the shape of purees and avoid to a great extent all the +coarser varieties, such as parsnips and carrots and beets, we provide +very little material for the intestines to carry on and aid them in +the elimination of other wastes. If, besides, we always ride and do +not walk, and so have none of that precious jolting which occurs every +time the heel comes down, and if we have no bending movements in our +lives, no wonder that intestinal movement becomes sluggish and we have +to supply stimulants and irritants to get it to do its work. +</p> +<p> +Intestinal evacuation is very largely a matter of will. There are very +few people so constituted by nature that they will not have regular +movements sufficient to maintain their digestive tracts in excellent +health, if they form the right habits. They must, however, make up +their minds, that is their wills, to restore coarse materials to their +diet. They must eat whole wheat or graham bread, must eat fruit +regularly and usually eat the skins of the fruit with it, that is as +far as apples, pears, peaches, apricots, plums and the like are +concerned. Even as regards oranges, it is probable that the eating of +occasional <a name="222">{222}</a> pieces of orange peel is an excellent means of +helping intestinal functions and providing waste material. [Footnote +6 ] +</p> +<p class="footnote"> + [Footnote 6: A curious discovery has been made in recent years that + orange skin contains a very precious element essential for bodily + health, belonging to the class of substances known as the vitamines + and contains more of it than any other food material that we have. + The instinct which tempted so many of us as children to eat orange + skin, in spite of the fact that we were discouraged from the + practice, was founded on something much more than mere childish + caprice. Orange skin is after all the basis of marmalade which has + been so commonly used by the English people at breakfast and which + is at once a tasty and healthful material.] +</p> +<p> +When baked potatoes are taken, the skin should be eaten, mainly +because of the waste material it provides, but also because just +underneath the skin and sure to be removed with it if it is taken off, +there are certain salts and other substances that are excellent for +health and particularly for digestion. Besides, the carbonized +material which so often occurs on baked potatoes is of itself a good +thing. It represents some of that charcoal which in recent years +French physicians particularly have found very valuable as a remedy +for certain disturbances of intestinal digestion. The removal of +parings from fruit and vegetables and the careful trimming of meat, +have taken out of human diet the materials which meant most for +intestinal movements for former generations, and they <a name="223">{223}</a> have to be +supplied artificially by means of irritant drugs, salts, oils and the +like, to the detriment of function. +</p> +<p> +The other element in the modern situation as regards the failure of +intestinal function is the lack of fluids. People who live indoors are +not tempted to take so much water as those who work outside and yet in +our modern, steam-heated houses they often need more. Our heating +systems take much more water from us than the former methods of +heating. The result is seen in our furniture that comes apart from +dryness and in our books and other things which crack and deteriorate. +Something of the same thing happens to human beings unless they supply +sufficient fluids. For this it is necessary deliberately to make up +the mind, which always means the will, to consume five or six glasses +of water between meals and especially to take one on rising in the +morning and another on going to bed. This should <i>not</i> be hot and +above all not lukewarm water, but fresh cold water which stimulates +peristalsis. The creation of a habit is needed in the matter or it +will be neglected. I have sometimes given patients some harmless drug, +like a lithium salt, that was to be taken three or four times a day in +a full glass of <a name="224">{224}</a> water, in order to be sure that they would take +the water. They were willing to take the medicine but I could not be +assured that without it they would drink the amount of water that I +counselled. +</p> +<p> +Above all, a regular habit of going to the toilet at a definite time +every day must be created. Nothing is so important. In little +children, even from their very early years, such a habit can be +established; it is only necessary to put them on their chairs at +certain times in the day and the desired result will follow. Adults +are merely children of a larger growth in this matter, and the habit +of going regularly is all-important. A little patience is needed, +though there should be no forcing, and after a time, a very +satisfactory habit can be established in this manner. It seems almost +impossible to many people that anything so simple should prove to be +remedial for what to them for a time seemed so serious a disturbance +of health, but only a comparatively short trial of the method will be +sufficient to demonstrate its value. A book or newspaper may be taken +with one, or Lord Chesterfield's advice to learn a page of Horace +which may afterwards be sent down as an offering to Libitina, the +goddess of secret <a name="225">{225}</a> places, may be followed, but the mind must not +be diverted too much from the business in hand, and the will must be +afforded an opportunity to exert its power. +</p> +<p> +It is true that the muscular elements of the intestines consist of +unstriped muscles and that they are involuntary, and yet experience +and observation have shown that the will has a certain indirect +influence even over involuntary muscle. The heart, though entirely +involuntary in its regular activities, can be deeply influenced by the +will and the emotions, as the words encouraging and discouraging, or +the equivalent Saxon words heartening and disheartening, make very +clear. Undoubtedly the peristaltic functions of the intestines can be +encouraged by a favorable attitude of the will towards them. +</p> +<p> +Above all, it is important that the anxious solicitude which a great +many people have and foster sedulously with regard to the effect of +even slight disturbances of intestinal functions should be overcome. +We have discussed this question in the chapter on dreads and need only +say here that the delay of a few hours in the evacuation of the bowels +or even the missing entirely of an intestinal movement for a full day +occasionally, will <a name="226">{226}</a> usually not disturb the general health to any +notable extent, and that the symptoms so often attributed to these +slight disturbances of intestinal function are much more due to the +solicitude about them than to any physical effect. There are a great +many people whose intestinal functions are quite sluggish and whose +movements occur only every second day or so, who are in perfectly good +health and strength and have no symptoms attributable to any +absorption of supposed toxic materials from the intestines. Indeed, in +recent years, the idea of intestinal auto-toxemia has lost more and +more in popularity for it has come to be recognized that the symptoms +attributed to this condition are due in a number of cases to serious +organic disease in other parts of the body, and in a great many cases +to functional nervous troubles and to the psycho-neuroses, especially +the oversolicitude with regard to the intestines. The will is needed +then for intestinal function to regulate the diet, to increase the +quantity of fluid, to secure regular habits and to eliminate worry and +anxiety which interferes with intestinal peristalsis. There are but +very few cases that will not yield to this discipline of the will when +properly and persistently tried. +</p> + +<a name="227">{227}</a> + +<h2>CHAPTER XVI +<br><br> +THE WILL AND THE HEART</h2> + +<table class="center"> +<tr><td align="left"> + "For what I will, I will, and there an end." +</td></tr> +<tr><td align="right"> +<i>Two Gentlemen of Verona</i> +</td></tr> +</table> + +<p> +The heart is the <i>primum movens</i>, the first tissue of the body that +moves of itself in the animal organism, doing so rhythmically and of +course continuously before the nervous system develops in the embryo. +This spontaneous activity would seem to place it quite beyond the +control of the will, as of course it is, so far as the continuance of +its essential activity goes, but there is probably no organ that is so +much influenced by the emotions and comes indirectly under the +influence of the will as the heart. There are a series of expressions +in practically all languages which chronicle this fact. We talk about +the encouragement and discouragement or in Saxon terms that are +exactly equivalent to the French words, heartening and disheartening +of the individual. At moments of panic the <a name="228">{228}</a> heart can be felt to +be depressed, while at times when resolve is high there is a sense of +well-being in connection with the firm action of the heart that flows +over into the organism and makes everything seem easy of +accomplishment. +</p> +<p> +There are a number of heart conditions that depend for their existence +and continuance on a sense of discouragement, that is oversolicitude +with regard to the heart. If something calls attention to that organ, +the fact that it is so important for life and health and that anything +the matter with it may easily prove serious, will sometimes +precipitate a feeling of panic that is reflected in the heart and adds +to the symptoms noted. The original disturbing heart sensation may be +due to nothing more than some slight distention of the stomach by gas, +or by a rather heavy meal, but once the dread of the presence of a +heart condition of some kind comes over the individual, all the +subjective feelings in the cardiac region are emphasized and the +discouragement that results further disturbs both heart and patient. +</p> +<p> +Palpitation of the heart is scarcely more than a solicitous noting of +the fact that the heart is beating. In certain cases, under the <a name="229">{229}</a> +stress of emotion, the heart beat-rate may be faster than normal, but +in a number of people who complain of palpitation, no rapid heart +action is noted. What has happened is that something having called +particular attention to the heart, the beating of the organ gets above +the threshold of consciousness and then continues to be noted whenever +attention is given it. This is of itself quite sufficient to cause a +sense of discomfort in the heart region and there may be, owing to the +solicitude about the organ, a great deal of complaint. +</p> +<p> +Just one thing is absolutely necessary in the treatment of these +cases, once it is found that there is no organic condition present. +The patient's will must be stimulated to divert the attention from the +heart and to keep solicitude from disturbing both that organ and the +patient himself. It is not always easy to accomplish this, but where +the patient has confidence in the diagnosis and the assurance that +nothing serious is the matter, a contrary habit that will overcome the +worry with regard to the heart can be formed. For it must not be +forgotten that in these cases a series of acts of solicitous attention +has been performed which has created a habit that can only be overcome +by the opposite habit. <a name="230">{230}</a> It is surprising how much discomfort this +simple affection, due to a functional disturbance of the heart and +overattention to it, may produce and how much it may interfere with +the usual occupation. It is a case, however, simply of willing to be +better, and nothing else will accomplish the desired result. At times +the mistake is made of giving such patients a heart remedy, perhaps +digitalis, but this only emphasizes the unfavorable suggestion and +besides, by stimulating heart action, sometimes brings it more into +the sphere of consciousness than before and actually does harm. +</p> +<p> +There is a form of this functional disturbance of the heart which +reaches a climax of power to disturb and then is sometimes spoken of +as spurious <i>angina pectoris</i>. In these cases the patient complains +not only of a sense of discomfort but of actual pain over the heart +region and this pain is sometimes spoken of as excruciating. +Occasionally the pain will be reflected down the left arm which used +to be considered the pathognomic sign of true <i>angina pectoris</i> but is +not. Sometimes the pain is reflected in the neck on the left side or +at times is noted at the angle of the scapula behind. When these +symptoms occur <a name="231">{231}</a> in young persons and particularly in young women, +there is no reason to think for a moment of their being due to true +<i>angina pectoris</i>, which is a spasm of the heart muscle consequent +upon the degeneration of the coronary arteries, the blood vessels +which feed the heart itself, and occurs almost exclusively in the old, +and much more commonly in old men. +</p> +<p> +The pain of true <i>angina pectoris</i> is often said to be perhaps the +worst torture that humanity has to bear. As a rule, however, it is +very prostrating and so genuine sufferers from it are not loud in +their complaints. Their suffering is more evident in their faces than +in their voices. Indeed, it has come to be looked upon as a rule by +the English clinicians and heart experts that the more fuss there is +made, the less likelihood there is of the affection being true <i>angina +pectoris</i>. When there is pain in the heart region then, especially in +young or comparatively young women, of which great complaint is made, +it is almost surely to be considered spurious <i>angina</i>, even though +there may be reflex pain down the arm as well as the impending sense +of death which used to be considered distinctive of the genuine +<i>angina pectoris</i>. +</p> +<a name="232">{232}</a> +<p> +The treatment of true <i>angina</i> depends to some extent on inspiring the +patient with courage, for it is needed to carry him through the very +serious condition to which he is subjected. The psychic element is +important, though the drug treatment by the nitrites and especially +amyl nitrite is often very effective. In spurious <i>angina</i>, the will +is the all-important element. There is some irritation of the heart +muscle but it is mainly fright that exaggerates the pain and then +concentration of attention on it makes it seem very serious. The one +thing that is all important is to relieve patients from the solicitude +which comes upon them with regard to their hearts and which prevents +them from suppressing their feelings and diverting their minds to +other things. Sometimes the will is needed to bring about such a +change in the habits of the individual as will furnish proper +nutrition for the heart. Very often these patients are under weight, +not infrequently they have been staying a great deal in the house, and +both of these bad habits of living need to be corrected. Good habits +of eating and exercise are above all important for the relief of the +condition. +</p> +<p> +For functional heart trouble, gentle exercise <a name="233">{233}</a> in the open air +generally must be taken, for it acts as a tonic stimulant to the heart +muscle. Almost as a rule, when patients suffer from symptoms from +their hearts, they are inclined to consider them a signal that they +must rest and above all must not exercise to such an extent as to make +the heart go faster. Rest, if indulged in to too great an extent, has +a very unfavorable effect upon the heart, for the heart, like all +muscles, needs exercise to keep it in good condition. One of the most +important developments of heart therapeutics in our generation was the +Nauheim treatment. In this, exercise is an important feature. The +exercise is graduated and is pushed so as to make a definite call upon +the heart's muscular power. Nauheim is situated in a little cup-shaped +valley and patients are directed to walk a certain distance on one of +the various roads, distances being marked by signposts every quarter +of a mile or so. The walk outward, when the patient is fresh, is +slightly uphill, and the return home is always downhill, which saves +the patient from any undue strain. +</p> +<p> +The experience at Nauheim was so favorable that many physicians took +up the practice of having their heart patients exercise <a name="234">{234}</a> +regularly and found that it was decidedly to their benefit. If this is +true for organic heart conditions, it is even more valuable for +neurotic heart cases, though it often requires a good deal of exercise +of will on the part of patients suffering from these affections to +control their feelings and take such exercise as is needed. In men, it +will often be found that the discomfort in the heart region, +particularly in muscular, well-built men who have no organic +condition, is due more to lack of exercise than to any other factor. +This is particularly true whenever the men have taken considerable +vigorous exercise when they were young and then tried to settle down +to the inactive habits of a sedentary life. Athletes who have been on +the teams at college, self-made men who have been hard manual laborers +when they were young, even sons of farmers who take up city life are +likely to suffer in this way. Their successful treatment depends more +on getting exercise in the open back into their lives than on anything +else, and for this a call upon the individual's will power for the +establishment of the needed new habits is the essential. +</p> +<p> +Former athletes who try to settle down to a very inactive life are +almost sure to have <a name="235">{235}</a> uncomfortable feelings in their heart +region. At times it will be hard to persuade them that they have not +some serious affection consequent upon some overstrain at athletics. +In a few cases, this will be found to be true, but in the great +majority the root of the trouble is that the heart craves exercise. A +good many functional heart cases, like the neurotic indigestions, so +called—are due to the fact that the heart and the stomach are not +given enough to do. The renewal of exercise in the daily life—and it +should be the daily life as a rule and not merely once or twice a +week—will do more than anything else to relieve these cases and +restore the patient's confidence. We saw during the war that a number +of young men, officers even more than privates—that is, the better +educated more than the less educated—suffered from shell shock so +called. A good many university men may suffer from what might be +termed heart shock if they find any reason to be solicitous about +their hearts. These neurotic conditions can only be relieved by the +will and diversion of attention. +</p> +<p> +A certain number of people who suffer from missed beats of their +hearts become very much perturbed about the condition of that organ. +<a name="236">{236}</a> Irregular heart action, and especially what has been called the +irregularly irregular heart, may prove to be a serious condition. +There are a number of regular irregularities of heart action, however, +consisting particularly of the missed beat at shorter or longer +intervals, which may have almost no significance at all. I know two +physicians, both athletes when they were at college, who have suffered +from a missed heartbeat since their early twenties. In one case it has +lasted now for thirty-five years and the physician is still vigorous +and hearty, capable even of running up an elevated stairway after a +train without any inconvenience. Some twenty years ago there was +question of his taking out a twenty-year life insurance policy and the +insurance company's physician at first hesitated to accept the risk +because of the missed beat. An examination made by three physicians at +the home office was followed by his acceptance and he has outlived the +maturity of the policy in good health and been given a renewal of it, +in spite of the fact that his missed beat still persists. +</p> +<p> +There is often likely to be a good deal of solicitude as to the +eventual prognosis in these cases, that is as to what the prospect of +<a name="237">{237}</a> prolonged life is. The regularly irregular heart does not seem +to make for an unfavorable prognosis. Young patients particularly who +have learned that they have a missed heartbeat need to have this fact +emphasized. We have the story of an important official of an American +university in whom a missed beat was discovered when he was under +forty. This was many years ago, and the prognosis of his condition was +considered to be rather serious. The patient actually lived, however, +for a little more than fifty years after the discovery of his missed +beat. It is easy to understand what a favorable effect on a patient +solicitous about a missed beat such a story as this will have. It +heartens a patient and gives him the will power to throw off his +anxieties and to keep from watching his heart and thus further +interfering with its activities. There is even a possibility of life +to the eighties or, as I have known at least one case, to the +nineties, where the irregular heart was first noted under thirty. +</p> +<p> +But it is well recognized that close concentration of attention on the +heart will hamper its action. It has been demonstrated that it is +possible by will power to cause the missing of heartbeats and while +only those who have <a name="238">{238}</a> practised the phenomenon can demonstrate it, +there are a number of well-authenticated examples of it. There is no +doubt, however, that anxiety about the heart will quicken or slow the +pulse rate. When a patient comes to be examined for suspected heart +trouble the pulse rate is almost sure to be higher than normal, even +though there may be nothing the matter with the heart; the increase or +decrease of the pulse beat is due to the anxiety lest some heart +lesion should be discovered. This makes it necessary as a rule not to +take too seriously the pulse rate that is discovered on a first +consultation and makes it always advisable to wait until the patient +has been reassured to some extent before the pulse rate is definitely +taken. +</p> +<p> +It is easy to see, then, what a large place there is for the will in +heart therapeutics. Courage is an extremely important element in +keeping the heart from being disturbed and maintaining it properly +under control. Scares of various kinds with regard to this +all-important organ are prone to get hold of people and then to +disturb it. Many a heart that is actually interfered with in its +activities by drugs of various kinds would respond to the awakening of +the will of the patient <a name="239">{239}</a> so as to control solicitudes, anxieties, +dreads and the like that are acting as disturbing factors on the +heart. When taken in conjunction with the will to eat and to exercise +properly so often necessary in these cases, the will becomes the +therapeutic agent whose power must never be forgotten, because it can +always be an adjuvant even when it is not curative and can produce +excellent auxiliary effects for every form of heart treatment that we +have. +</p> + + +<a name="240">{240}</a> + +<h2>CHAPTER XVII +<br><br> +THE WILL IN SO-CALLED CHRONIC RHEUMATISM</h2> + +<table class="center"> +<tr><td align="right"> + "I should do it<br> + With much more ease; for my good will is to it." +</td></tr> +<tr><td align="right"> +<i>The Tempest</i> +</td></tr> +</table> + +<p> +In popular estimation, rheumatism is one of the commonest of +affections. When a physician asks a patient, especially if the patient +is over forty years of age, "Have you ever suffered from rheumatism?" +the almost invariable response is, "Yes", though but little further +inquiry is needed to show that what the patient means is that he has +suffered from some painful conditions in the neighborhood of his +joints, or that his muscles have been sore or inclined to ache in +rainy weather, or that he has undergone some other vague discomforts +connected with dampness. Chronic rheumatism is a term that includes a +great many of the most varied conditions. True rheumatism, that is, +acute articular rheumatism, is now recognized as an infectious disease +which runs a definite course, usually with <a name="241">{241}</a> fever, for some ten +days to ten weeks, and requires confinement to bed usually for a month +or more. Very rarely will any connection be found between this +affection, which presents always Galen's four classic symptoms of +inflammation, swelling, redness, heat and pain (<i>tumor, rubor, color, +et dolor</i>), and the usual conditions which are broadly characterized +as rheumatism. Just as soon as patients are asked if their rheumatism +included these symptoms there is denial, yet the idea of their having +had rheumatism remains. +</p> +<p> +As a matter of fact, there are a number of sore and painful conditions +in connection with muscles and particularly in and around joints that +have, without any scientific justification at least, been called +chronic rheumatism. Any painful condition that is worse in rainy +weather is sure to be so named. As old dislocations, sprains and +wrenches of joints, broken bones, as well as muscular conditions of +all kinds, including flat foot and other yielding of joints, all +produce this effect, it is easy to understand that there is an immense +jumble of all sorts of painful conditions included under the term +"chronic rheumatism." Some of them, particularly in older people, +produce lameness or at least inability to walk <a name="242">{242}</a> distances without +showing the disability; a great many of them produce distinct painful +conditions during the night following the use of muscles and often +disturb patients very much, because they arouse the dread that they +are going to be crippled as they grow older. +</p> +<p> +Indeed, one of the most serious effects of these recurring painful +conditions is the dread produced lest they should cause such +progressive affections in and around joints as would eventually make +the patients bed-ridden. There are a certain number of cases of +so-called rheumatoid arthritis which produce very serious changes in +joints with inevitable crippling and quite beyond all possibility of +repair. These cases are often spoken of as chronic rheumatism and it +is the solicitude produced by the dread of them that makes the worst +part of the discomfort in many a so-called chronic rheumatic case. If +their affection is to be progressive, then the patients foresee a +prolonged confinement to bed in the midst of severe pain, hopeless of +ultimate cure. It may be said at once that these cases of rheumatoid +arthritis have nothing to do with rheumatism, represent a special +acute infection, are never a sequela of any of the rheumatic +conditions and are <a name="243">{243}</a> fortunately very rare. This assurance of +itself is quite sufficient to make ever so much better a great many +patients who feel that they suffer from rheumatism. +</p> +<p> +The painful conditions that are described under the term chronic +rheumatism would seem to be quite beyond any power of the will to +affect. They are at least supposed to represent very definite changes +in the tissues, usually of chronic character and therefore not +amenable to any remedies except those of physical influence. Besides, +they are so frequent that surely if there were any question of the +will being able to control them or bring relief for them, most +sufferers would discover this fact for themselves and apply the remedy +from within. It is not to be expected that a very great many people +would suffer pains and aches that are worse in rainy weather if all +that was needed was the exertion of their will power either to throw +off the affection or to perform such exercises and activities as would +gradually make their conditions better. In general it is felt that +painful conditions of this kind cannot be affected by the will and +that distinctly material and not psychic therapeutics must be looked +to for their relief. +</p> +<p> +Now it so happens that the best illustration <a name="244">{244}</a> of the power of the +will to "cure" people, that is, to relieve them completely of their +affections and start them afresh in life with the feeling that they +are no longer handicapped by disease, is to be found exactly in the +group of cases that have almost from time immemorial been called +chronic rheumatisms. We have had more "cures" of various kinds +announced for these—chemical, electrical, physical, hydriatic, +movement therapy and so forth—than for almost any other group of +diseases. More irregular practitioners of medicine all down the ages +have made a reputation by curing these affections than have won renown +by treating any other set of ills to which humanity is heir. Like the +poor, these ills are still with us, in spite of all the "cures" and +probably nowhere is the expression of the old French physician that +"the therapeutics of any generation is always absurd to the second +succeeding generation" better illustrated than in regard to them. +These cases serve to emphasize very clearly, however, the fact that +the pains and aches of mankind are largely under the control of the +will. +</p> +<p> +The more one studies these cases of so-called chronic rheumatism the +easier it is to <a name="245">{245}</a> understand how they become the signal "cures" +which attract attention to the quacks and charlatans who promise much, +but do nothing in particular, though they may give medicines or +treatment of some kind or another. They only arouse the patient's will +to be better and the determination to use his will with confidence, +now that the much praised treatment is doing something which will +surely make him better. Cases of this kind have constituted a goodly +part of the clientele of the great historic impostors who succeeded in +making large sums of money out of curing people by methods that in +themselves had no curative power. A review of some of the chapters of +that very interesting department of human history, the history of +quackery, is extremely suggestive in that regard. The only way to get +a good idea of the basic significance of these cases is to realize by +what they were cured and by whom they were cured. +</p> +<p> +One of the most interesting illustrations of that phase of human +credulity is the story of Greatrakes, the Irish adventurer who had +been a soldier in Flanders, and who when his campaigns were over set +up to be a healer of mankind. He chose his opportunity during <a name="246">{246}</a> +the time while Cromwell, as Lord Protector of Great Britain, had +refused to continue the practice of touching the ailing which the +Kings of England had pursued for hundreds of years since the +Confessor's time. Cromwell did not impugn the efficacy of the Royal +Touch but he refused to have anything to do with it himself. +Greatrakes found it an opportune moment to announce that for three +nights in succession he had been told in a dream by the Holy Spirit +that in the absence of the King he was to touch people and cure them. +</p> +<p> +One might possibly think that with no better credentials than this and +no testimony except his own claim in the matter Greatrakes would +receive but scant attention. Any one who thinks so, however, does not +understand human nature. It was not long before some of the people who +had been sufferers for longer or shorter periods went to Greatrakes +and allowed him to try his hand at healing them. They argued that at +least if it did them no good it could do them no harm, and it was not +long before some of them declared that they had been benefited by his +ministrations. Very soon then he was able to furnish what seemed to be +abundant evidence of Divine Mission in the cures <a name="247">{247}</a> that were +worked by his more than magic touch. Above all, people who had been +sufferers for prolonged periods, who had gone the rounds of +physicians, who had tried all sorts of popular remedies, and some of +whom had been declared incurable were healed of their ills after a +series of visits to Greatrakes. No wonder then that patients came more +and more frequently, until his name went abroad in all the country and +in spite of the difficulties of travel people came from long distances +just to be treated by him. +</p> +<p> +All that he did was to ask the patient to expose the affected part and +then Greatrakes would stroke it with his hand, assure the patient that +a wonderful new vitality would go into them because of his Mission +from on High and promise them that they would surely get better, +explaining of course that betterment would be progressive and that it +would start from this very moment. The stroking was the important part +of the cure and so he is known in history as "Greatrakes the Stroker." +It may be said in passing that while those who were touched by the +English kings in the exercise of the prerogative of the Royal Touch +were usually presented with a gold coin which had been particularly +<a name="248">{248}</a> coined for that purpose as a memorial, a corresponding gold +piece, a sovereign as a rule, in Greatrakes' method of treatment +passed from the patient to the healer. It was a case of metallotherapy +with extraction of the precious metal from the patient, as is always +the case under such circumstances. +</p> +<p> +Here in America we had a similar experience, though ours had science +as the basis of the superstition in the case instead of religion. The +interest aroused by Galvani's experience with the twitching of frogs' +legs when exposed nerve and muscle were touched by different metals +led Doctor Elisha Perkins to invent a pair of tractors which would +presumedly apply Galvani's discovery to therapeutics. These were just +plain pieces of metal four or five inches long, shaped more or less +like a lead pencil and tapering to a blunt point. With these, as +Thatcher, one of our earlier historians of medicine, tells us, Perkins +succeeded in curing all sorts of ailments, but particularly many +different kinds of painful conditions. He was most successful in the +treatment of "pains in the head, face, teeth, breast, side, stomach, +back, rheumatism and so forth." In a word, he cured the neuralgias and +the rheumatic pains and the chronic <a name="249">{249}</a> rheumatisms which are the +source of so much trouble—and especially complaint—for the old, and +which so often physicians, in any time of the world's history, have +been unable to cure. +</p> +<p> +For a time his success was supposed to be due to some curious +electrical power that he was using. Learned pamphlets were issued to +show that animal magnetism or animal electricity or Galvanism was at +work. Professors at no less than three universities in America gave +attestations in favor of its efficacy. Time has of course shown that +there was absolutely no physical influence of any kind at work. The +only appeal was to the mind. Elisha Perkins was a Yale man of +education and impressive personality, "possessing by nature uncommon +endowments both bodily and mental ", and he succeeded in impressing on +his patients the idea that they would surely be cured; he thus +overcame the dreads, released the will power, gave new hope and a +tonic stimulus to appetite, created a desire for exercise, and then +the will kept this up and before long the patient was cured. +</p> +<p> +When animal magnetism, as it was called about the middle of the +nineteenth century, <a name="250">{250}</a> was practised without apparatus, one of its +most important claims to the consideration of physicians was founded +on its power to heal chronic painful affections which had previously +resisted all therapeutic efforts. The power of neuro-hypnotism, as it +came to be designated, to accomplish this, will be best appreciated +from the fact that this state was being used as a mode of anaesthesia +for surgical operations. When the news of the use of ether to produce +narcosis for surgical purposes at the Massachusetts General Hospital +first came to England, it did not attract so much attention as would +otherwise have been the case, because English physicians and surgeons +were just then preoccupied with the discussion of neuro-hypnotic +anaesthesia, and those who believed in it thought that ether would not +be necessary, while those who refused to believe thought the report +with regard to ether just another of these curious self-delusions to +which physicians seemed to be so liable. +</p> +<p> +Perkins' declarations of the curative value of his tractors were, +after all, only a succeeding phase of what Mesmer had called to the +attention of the medical profession and the public in Paris not quite +a generation before. Mesmer seated his patients around a tub <a name="251">{251}</a> +containing bottles filled with metallic materials out of which wires +were conducted and placed in the hands of patients seated in a circle +around it. Mesmer called this apparatus a <i>baquet</i> or battery and it +was thought to have some wonderful electric properties. A great many +people who received the treatment were cured of chronic pains and +aches that had sometimes lasted for years. So many prominent people +were involved that the Government finally ordered an investigation to +be made by French scientists with whom, because he was the Minister +from the colonies at the time, our own Benjamin Franklin was +associated. They declared that there was not a trace of electricity or +any other physical force in Mesmer's apparatus. He was forbidden to +continue the treatment and there was a great scandal about the affair, +because a large number of people felt that he was doing a great deal +of good. +</p> +<p> +When hypnotism came in vogue again at the end of the nineteenth +century, it was a case of chronic rheumatism that gave it its first +impetus in scientific circles. Professor Bernheim of Nancy had tried +in vain all of his remedies in the treatment of a patient suffering +from lumbago. The patient disappeared <a name="252">{252}</a> for a time and when +Bernheim next saw him, he was cured. Bernheim had treated him futilely +for months and was curious to know how he had been cured. The patient +told him that he had been cured by hypnotism as practised by Liebault. +This brought Bernheim to investigate Liebault's method of hypnotism +and made him a convert to its practice. It was the interest of the +school of Nancy in the subject that finally aroused Charcot's +attention and gave us the phase of interest in hypnotism which +attracted so much public attention some thirty years ago. Many other +cases of those very refractory affections—lumbago and sciatica—have +been cured by hypnotism when they have resisted the best directed +treatment of other kinds over very long periods. +</p> +<p> +It is these chronic rheumatisms, so called, the chronic pains and +aches in muscles in the neighborhood of joints, that were cured by the +Viennese astronomer, Father Maximilian Höll, in the eighteenth +century. He simply applied the magnet and saw the result, and felt +sure that there must be some physical effect, though there was none. +His work was taken up by Pfarrer Gassner of Elwangen who, after using +the magnets for a time, found <a name="253">{253}</a> that there was no need of their +application, provided the patients could by prayer and other religious +means be brought into a state of mind where they were sure that they +were going to get better. They then proceeded to use their muscles +properly in spite of the pain that might result for a time, and as a +result it was not long before they were cured of their affections. The +Church forbade his further practise because of his expressed idea that +pain came from the power of evil and dropped from men when they turned +to God, which was the eighteenth-century anticipation of Eddyism. +Dowie's cures were largely of similar affections, and patients +sometimes dropped their crutches and walked straight who could not +walk before. +</p> +<p> +A great many of the so-called chronic rheumatisms are really the +result of dreads to use muscles in the proper way because for the +moment something has happened to make their use painful. A direct +injury, a wrench, or some incident causes a joint for a time to be +painful when used. In sparing it, the muscles around it are used +differently than before and as a consequence become sensitive and +painful. It is quite easy, then, for people to form bad habits which +they cannot break <a name="254">{254}</a> because they have not the strength of will to +endure the sore and tender condition which develops when they try to +use muscles properly once more. The young athlete who wants to get his +muscles in good condition knows that he must pass through a period of +soreness and tenderness, sometimes of almost excruciatingly painful +character. He does so, however, and does not speak of his condition as +involving pains and aches but only soreness and tenderness. +</p> +<p> +Older people, however, who have to get their muscles back into good +condition after a period of disuse following an injury or some +inflammatory disturbance, find this period of discomfort very +difficult to bear and so keep on using their muscles somewhat +abnormally and at mechanical disadvantage. As a consequence, these +muscles remain tender, are likely to ache in rainy weather and often +give a good deal of discomfort. Until the sufferers can be brought to +use their wills properly, so as to win back their muscles to normal +use, they will not get well. An application of magnets or a Leyden jar +or Mesmer's battery of the eighteenth century, or Perkins' tractors, +or neuro-hypnotism, or animal magnetism, or later hypnotism, or +<a name="255">{255}</a> +Dowie's declaration of their cure, enables them to use their will in +this regard and then they proceed to recover. It is surprising how +many presumedly intelligent people—at least they have received +considerable education—have been cured of conditions that they have +endured for years by some remedy or mode of treatment that actually +had no physical effect. +</p> +<p> +St. John Long, the English charlatan who has been mentioned in the +chapter on tuberculosis, also succeeded in making a name for himself +in connection with the chronic rheumatisms and the so-called rheumatic +pains and aches of older people. Between consumption and these +conditions, he caught both the young and the old, and thus rounded out +his clientele. For consumption he provided an inhalant; for rheumatic +conditions, a liniment. This liniment became very famous in that +generation for its power to relieve the pains and aches, both acute +and chronic, of mankind. So many people were cured by it and above +all, so many of them were people of distinction—lords and ladies and +the relatives of the nobility—that Parliament was finally petitioned +in the interests of suffering humanity to buy the secret of the +<a name="256">{256}</a> +liniment from its inventor and publish it for the benefit of the +world. I believe that a substantial sum, representing many, many +thousands of dollars in our time, was actually voted to St. John Long +and the recipe for his liniment was published in the British +pharmacopeia. In composition, it was, I believe, only a commonplace +turpentine liniment made up with yolks of eggs instead of oil, as had +been the custom before. Just as soon as this fact became known, the +wonderful cures which had occurred in connection with its use ceased +to a great extent, for distinguished members of the nobility and their +relatives would not be cured by so common-place a medium as an +ordinary turpentine liniment. St. John Long was even accused of not +having sold his real secret to the Government, but there was no reason +at all to think that. He had been producing his cures not by his +liniment but by the strong effect of his prestige and reputation as a +healer upon the minds of his patients and the consequent release of +will power which enabled them to do things which they thought they +could not do before. We have had many wonderful curative oils of +various kinds since then, with all sorts of names from Alpha to Omega +and <a name="257">{257}</a> very often called after a saint,—though St. John Long was +as far as possible from being a saint in the ordinary acceptance of +that word. These modern curative oils and liniments have been merely +counter-irritants, but at times, owing to a special reputation +acquired, they have been counter-irritants for the mind and stimulants +for the will which have enabled old people to persist through the +periods of soreness and tiredness until they reacquired the proper use +of their muscles. +</p> + +<a name="258">{258}</a> + +<h2>CHAPTER XVIII +<br><br> +PSYCHO-NEUROSES</h2> + +<table class="center"> +<tr><td align="left"> + "Look, what I will not, that I cannot do." +</td></tr> +<tr><td align="right"> +<i>Measure for Measure</i> +</td></tr> +</table> + +<p> +The psycho-neuroses, that is, the various perversions of nervous +energy and inability to supply and conduct nervous impulses properly, +consequent upon a mental persuasion which interferes with these +activities, have come to occupy an ever larger and larger place in the +field of medicine. The war has been illuminating in this matter. A +psycho-neurosis is, after all, a hysterical manifestation and it might +very well be expected that very few of these would be encountered in +armies which took only the <i>men</i> of early adult life and from among +those, only persons who had been demonstrated to be physically and, as +far as could be determined, mentally normal. Neurologists would seem +scarcely to have a place in the war except for wounds of nerves <a name="259">{259}</a> +and the cerebral location of missiles and lesions. Certainly none of +the army medical departments had the slightest premonition that +neurology would bulk larger in their war work than any other +department except surgery. That proved to be the case, however. +</p> +<p> +The surprise was to have, from very early in the war, literally +thousands of cases of psycho-neuroses, "shell shock" as unfortunately +they came to be called, which included hysterical symptoms of all +kinds, mutism, deafness, blindness, paralysis, and contractures. +France and England after some time actually had to maintain some fifty +thousand beds in their war hospitals mainly for functional nervous +diseases, the war neuroses of many kinds. During the first half of the +war, one seventh of all the discharges from the British army or +actually one third of all the discharges, if those from wounds were +not included, were for these war neuroses. They attacked particularly +the better educated among the men and were four times as prevalent +among officers as among the privates. In proportion to the whole +number of those exposed to shells and "war's alarms and dangers" +generally, these war neuroses were <a name="260">{260}</a> more common among the men +than among the women. Nurses occasionally suffered from them, but not +so frequently as the men who shared their dangers in the hospitals and +stations for wounded not far from the firing line. +</p> +<p> +In the treatment of this immense number of cases, a very large amount +of the most valuable therapeutic experience for psychoneuroses was +accumulated. It was found that suggestion played a very large role in +making the cases worse. If these patients were placed in general +hospitals where there was much talk of wounds and injuries and the +severe trials of battle life they grew progressively worse. They +talked of their own experiences, constantly enlarging them; they +repeated what they had heard from others as if these represented their +own war incidents and auto-suggested themselves into ever worse and +worse symptomatic conditions. This was, after all, only the familiar +<i>pseudologia hysterica</i> which occurs in connection with hysteria, and +which is so much better called by the straightforward name of +pathological self-deception or perhaps even just frankly hysterical +lying. If these patients were examined frequently by physicians, their +<a name="261">{261}</a> symptoms became more and more varied and disabling and their +psycho-neurosis involved more external symptoms. +</p> +<p> +In a word, it was found that their minds were the source of extremely +unfavorable factors in their cases. The original shock or the severe +trials of war life had unbalanced their self-control and suggestions +of various kinds made them still worse. Much attention to their +condition from themselves and others simply proved to be constantly +disturbing. As was pointed out by Doctor Pearce Bailey, who had the +opportunity as United States Chief of the Division of Neurology and +Psychiatry attached to the Surgeon General's office to visit France +and England officially to make observations on the war neuroses, the +experience of the war has amply confirmed Babinski's position with +regard to hysteria. The distinguished French neurologist has shown +that the classic symptoms of hysteria are the results of suggestion +originating in medical examinations or from misapplied medical or +surgical treatment. He differs entirely from Charcot in the matter and +points out that it was unfortunate misdirected attention to hysterical +patients which led to the creation of the many cases of <i>grande +hystérie</i> which <a name="262">{262}</a> +used to be seen so commonly in clinics in France +and have now practically disappeared. They were not genuine +pathological conditions in any sense of the word, but merely the +reflection of the exaggerated interest shown in them by those +interested in neurology, who came to see certain symptoms and were, of +course, gratified in this regard by the patients, always anxious to be +the center of attention and, above all, the focus of special interest. +</p> +<p> +The successful treatment of the war neuroses was all founded on the +will and not on the mind. Once a careful examination had determined +absolutely that no organic morbid condition was present, the patient +was given to understand that his case was of no special significance +but on the contrary was well understood and had nothing exceptional in +it. The unfortunate frequent demonstration of these patients at the +beginning of the war as subjects of special interest had been the +worst possible thing for them. After experience had cleared the way, +they were made to feel that just as soon as the attending physician +had the time to give them, he would be able to remove their symptoms +without delay. This was almost the only appeal to the mind <a name="263">{263}</a> that +was made. It represented the suggestive element of the treatment. +</p> +<p> +The two other elements were reeducation and discipline. Once +suggestion had brought the patient to believe firmly that he would be +cured, he was made to understand that his cure would be permanent. +Then reeducation was instituted to overcome the bad habit of lack of +confidence that had been formed, while discipline broke down the +psychic resistance of the patient to the idea of recovery. In such +symptoms as mutism or deafness, the patient was told that electricity +would cure him and that as soon as he felt the current when the +electrode was applied, his power of speech or of hearing would be +restored, <i>pari passu</i>, with sensation. The same method was used for +blindness and other sensory symptoms. Paralyses were favorably +affected the same way, though tremors were harder to deal with. A cure +in a single treatment was the best method, for the patient readily +relapsed unless he was made to feel that he had recovered his powers +completely and that it would be his own fault if he permitted his +symptoms to recur. +</p> +<p> +The most interesting phase of the successful treatment of these war +neuroses for us was <a name="264">{264}</a> the fact that the ultimate dependence was +placed by the French on a system of management which was called +<i>torpillage</i>. <i>Torpillage</i> consists in the brusque application of +faradic currents strong enough to be extremely painful in hysterical +conditions, and the continuance of the procedure to the point at which +the deaf hear, the dumb speak, or those who believe themselves +incapable of moving certain groups of muscles come to move them +freely. The method has proved highly effective and requires but little +time and practically no personnel except the medical officer who +applies the treatment and the non-commissioned officer who takes the +patient at the end of the treatment and continues the exercise of the +afflicted parts. One treatment suffices. The apparatus is of the +simplest, the only accessory to the electric supply and the electrodes +consisting of an overhead trolley which carries the long connecting +wires the whole length of the room, thus making it impossible for the +patient to get away from the current which is destined to cure him. +</p> +<p> +In a word, the man who would insist on maintaining a false attitude of +mind towards himself, though that attitude of mind was not <a name="265">{265}</a> +deliberate, and least of all not malingering, was simply made to give +it up. Sufficient pain was inflicted on him so that he was willing to +accept instead of his own false opinion the opinion of his physician +that he could accomplish certain functions. <i>Torpillage</i> was, in other +words, simply "a method of treatment which gave authority to a medical +officer to inflict pain on a patient up to the point at which the +patient yields up his neurosis." As a rule, the infliction of very +little suffering is needed, for once the demonstration is made that he +will have to suffer or give in, it does not take him very long to give +in. There is no doubt at all that the method is eminently effective, +particularly in those cases which were entirely refractory to other +modes of treatment. +</p> +<p> +It would remind us of some old modes of treatment which were in +popular use long ago, but which had gone out entirely in our milder +generation because we thought their use almost unjustified. It was not +an unusual thing three or four generations ago to rouse a young woman +out of an hysterical tantrum, once it was perfectly clear from +previous experiences that it <i>was</i> really an hysterical tantrum, by +dashing a pitcher of cold water <a name="266">{266}</a> over her. Sir Thomas More +relates that he saw a number of people suffering from various forms of +possession—and any neurologist will confess that some hysterics must +have a devil—who were cured by being roundly whipped. Certain men +and women who complained that they were unable to walk or to work and +thus became a care for relatives or for the community, were cured by +this, as it seemed to later generations, heartless mode of treatment. +Now, we have turned to curing the war hysterias by punishment, that +is, by the infliction of severe pain, in just the same way. A great +many of these patients who suffer from neuroses and psycho-neuroses, +and especially from hysterical inhibitions so that they cannot hear or +cannot walk or cannot talk, represent inabilities similar to many +which are seen in civil life. Patients complain that they cannot do +things; their friends say that they will not do them; and the +physician sees that the root of the trouble is that they cannot +<i>will</i>. Now, however, that war has permitted the use of such remedies, +physicians have found that they can, to advantage, force the patients +to will and that once the will has been recalled into action, its +energy can be maintained. +</p> +<a name="267">{267}</a> +<p> +Of course the compulsory mode of treatment was not represented as a +punishment, but on the contrary it was always presented as a form of +treatment which was extremely painful but necessary for the condition. +Presented as punishment, it would have been resented, and the patient +would probably have set about sympathizing with himself and perhaps +seek the sympathy of others, and this would prevent the effectiveness +of the treatment. It is very evident that as the result of compulsory +methods of treatment, and of the recognition of the fact that major +hysterical conditions are largely the result of suggestion and must be +cured by enabling the patient to secure control over himself again, +the outlook for the treatment of the psychoneuroses will be very +different as a consequence of the experience that has been gained. +Above all, the place of the will will be recognized, and there will no +longer be that coddling of patients and that analysis of their minds +for long distant psychic insults of various kinds which will explain +their condition, that has done so much harm in a great many ways in +recent years. +</p> +<p> +Another feature of the French treatment was that the neurotic patients +should be <a name="268">{268}</a> isolated. This isolation was complete. It had been +found that association with other patients, the opportunity to tell +their troubles and be sympathized with, did them harm invariably and +inevitably, so that those whose neurotic symptoms continued were taken +absolutely away from all association with others. Not only this, but +all other modes of diversion of mind were denied them. They were +placed in rooms without reading or writing materials and even without +tobacco. This solitary confinement would remind one of the enforced +privacy of the old-fashioned rest cure in which the patient was +absolutely secluded from all association with relatives or others who +might in any way sympathize with them. The soldier patients were kept +in this complete isolation until such time as they showed themselves +amenable to treatment. This was usually not very long. +</p> +<p> +As a matter of fact, the isolation rooms had to be used very little +but were found necessary and especially effective in the management of +relapsed cases. Just as soon as soldier patients learned that such +isolating rooms were available, they became much more ready to give up +their neuroses, and as a consequence, in most places, the isolating +department did <a name="269">{269}</a> not have to be used, and in some places they +could even be given over to the lodgment of attendants. It was quite +sufficient, however, that they had fulfilled their purpose of changing +patients' attitude of mind towards themselves and giving their will +control over them. +</p> +<p> +As Colonel Pearce Bailey, M.C., says, in most of these patients, +persuasive measures and contrary suggestion were quite sufficient, but +when they failed, disciplinary measures proved effective. How are we +going to be able to make such disciplinary measures available in civil +life is another question, but at least the war has made clear that +neurotic patients who claim that they cannot do something and actually +will not do it, <i>must be made to do it</i>, for this will prove the +beginning of their cure. It seems probable, as Doctor Bailey adds, +that the reason why the treatment of officers was more difficult—and +it must not be forgotten that in proportion to their numbers, four +times as many officers suffered from so-called shell shock as +privates—was exactly because these modes of discipline, amounting +practically to compulsion, were not used with them. +</p> + +<a name="270">{270}</a> + +<h2>CHAPTER XIX +<br><br> +FEMININE ILLS AND THE WILL</h2> + +<table class="center"> +<tr><td align="left"> + "Oh, undistinguished space of woman's will!" +</td></tr> +<tr><td align="right"> +<i>King Lear</i> +</td></tr> +</table> + +<p> +It is probable that the largest field for the employment of the will +for the cure of conditions that are a source of serious discomfort or +at least of complaint is to be found among the special ills of +womankind. The reason for this is that the personal reaction has so +much to do with the amount of complaint in these affections. Not +infrequently the individual is ever so much more important than the +condition from which she is suffering. Women who have regular +occupation with plenty to do, especially if they are interested in it +and take their duties seriously, who get sufficient exercise and are +out of doors several hours each day and whose appetites are as a +consequence reasonably good, suffer very little from feminine ills, as +a rule. If an infection of some kind attacks them, they will, of <a name="271">{271}</a> +course, have the usual reaction to it, and this may involve a good +deal of pain and even eventually require operation. Apart from this, +however, there is an immense number of feminine ills dependent almost +entirely on the exaggerated tendency to react to even minor +discomforts which characterizes women who have no occupation in which +they are really interested, who have very little to do, almost no +exercise, and whose appetite and sleep as a consequence are almost +inevitably disturbed. +</p> +<p> +Above all, it must not be forgotten that whenever women do not get out +into the air regularly every day—and this means for a time both +morning and afternoon—they are likely to become extremely sensitive +to pains and aches. This is true of all human beings. Those who are +much in the open air complain very little of injuries and bodily +conditions that would seem extremely painful to those living sedentary +lives and who are much indoors. Riding in the open air is better than +not being in the open air at all, but it does not compare in its power +to desensitize people with active exercise in the open air. In the +older days, when women occupied themselves very much indoors with +<a name="272">{272}</a> sewing, knitting and other feminine work, and with reading in +the evenings, and when it was considered quite undignified for them to +take part in sports, neurotic conditions were even more common than +they are at the present time, and young women were supposed to faint +readily and were quite expected to have attacks of the "vapors" and +the "tantrums." +</p> +<p> +The interest of young women in sports in recent years and the practice +of walking has done a great deal to make them ever so much healthier +and has had not a little to do with decreasing the number and +intensity of the so-called feminine ills, the special "women's +diseases" of the patent medicine advertisements. Much remains to be +done in this regard, however, and there are still a great many young +women who need to be encouraged to take more exercise in the open than +they do and thus to live more natural lives. It is particularly, +however, the women of middle age, around forty and beyond it, who need +to be encouraged to use their wills for the establishment of habits of +regular exercise in the open air as well as the creation of interests +of one kind or another that will keep them from thinking too much +about <a name="273">{273}</a> themselves and dwelling on their discomforts. These are +thus exaggerated until often a woman who has only some of the feelings +that are almost normally connected with physiological processes +persuades herself that she is the victim of a malady or maladies that +make her a pitiable object, deserving of the sympathy of her friends. +</p> +<p> +A great many of the operations that have been performed on women +during the past generation have been quite unnecessary, but have been +performed because women felt themselves so miserable that they kept +insisting that something must be done to relieve them, until finally +it was felt that an operation might do them some good. It would surely +do them no harm or at least make them no worse, and there was always +the possibility that the rest in the hospital, the firm persuasion +that the operation was to do them good, the inculcation of proper +habits of eating during convalescence might produce such an effect on +their minds as would give them a fresh start in life. Undoubtedly a +great many women who were distinctly improved after operations owed +their improvement much more to the quiet seclusion of their hospital +life, their own strong expectancy <a name="274">{274}</a> and the care bestowed upon +them under the hospital discipline without exaggerated sympathy which +brought about the formation of good habits of life, than to their +operation. Many a woman gained weight after an operation simply +because her eating was properly directed, and this was the main part +of the improvement which took place. +</p> +<p> +Operations are sometimes needed and when they are the patient will +probably not get well without one; but as a distinguished neurologist, +Doctor Dercum of Philadelphia, said in a paper read before the +American Medical Association last year, the neurologist is constantly +finding patients on whom one or several operations have been +performed, some of them rather serious abdominal operations, the +source of whose complaints is a neurosis and not any morbid condition +of the female or other organs. Occasionally one sees something like +this in men, and I shall never forget seeing at Professor Koenig's +clinic in Berlin a sufferer from an abdominal neurotic condition on +whom no less than three operations for the removal of his appendix had +been performed, until finally Professor Koenig felt that he would be +justified in tattooing over the right iliac region the words "No +Appendix <a name="275">{275}</a> Here." The condition developed in a young soldier as +the result of a fall from a horse and his affection resembled very +much some of the neuroses that came to be called, unfortunately, +"shell shock" during the present war. +</p> +<p> +The principal trouble in securing such occupation of mind as will +prevent exaggerated neurotic reactions to even slight discomforts in +women is the creation for them of definite interests in life. The war +taught a notable lesson in this regard. Many a physician saw patients +whose complaints had been a great source of annoyance to them—and +their friends—proceed to get ever so much better as the result of war +interests. In one women's prison in an Eastern State, just before the +war, a series of crises of major hysteria was proving almost +unmanageable. By psychic contagion it had spread among the prisoners +until scarcely a day passed without some prisoner "throwing a fit" +with screaming and tearing of clothes and breaking of articles that +might be near. Prominent neurologists had been consulted and could +suggest nothing. When the war began, the prisoners were set to rolling +bandages, knitting socks and sweaters and making United States flags +for the army. As if by magic, the neurotic <a name="276">{276}</a> crises disappeared. +For months there were none of them. The prisoners had an abiding +interest that occupied them deeply in other things besides themselves. +</p> +<p> +The reduction of nervous complaints of various kinds among +better-to-do women was very striking. As might be expected, their +rather strenuous occupation with war activities kept them from +thinking about themselves, though it is true that now they complain +about all the details that they had to care for and the lack of +coöperation on the part of certain people. It would seem as though +many of them had so much to do that they would surely exhaust their +energies and so be in worse condition than before, but this very +seldom proved to be the case. Literally many thousands of women +improved in health because they became interested in other people's +troubles instead of their own. David Harum once said that "It is a +mighty good thing for a dog to have fleas because it keeps him from +thinking too much about the fact that he is a dog." That seems a +rather unsympathetic way of putting the case, but there is no doubt at +all that what many women need is serious interests apart from +themselves in order to prevent the law of <a name="277">{277}</a> avalanche from making +minor ills appear serious troubles. +</p> +<p> +What most women need above all are heart interests rather than +intellectual occupations. That was why occupation with war activities +did so much good. That is the reason, too, that club life and reading +and other similar pursuits often fail to be helpful to women in their +ills to the extent that might possibly be expected. Above all, women +need interests in children and the ailing, and these can be supplied +by visits to hospitals or by taking an active interest in nurseries, +though this is often not personal enough in its appeal to catch a +woman's deepest attention. One of the great reasons why there are more +nervous diseases among women in our time than in the past is because +children are fewer, and because so many women are without children and +the calls that they inevitably make on their mothers. Unfortunately, +the traditions of the present day are to a great extent in opposition +to that family life with a number of children, which means not only +the deepest interests for woman but also such inevitable occupations +in the care of them that she has very little time to think about +herself. It may seem quixotic, that is, <a name="278">{278}</a> demanding unnecessary +magnanimity to suggest that these modern ideas should be discarded by +those who wish to assure themselves such interests in middle life as +will prove definitely preventive of many neurotic conditions, but it +is manifestly the physician's duty to make such suggestions. +</p> +<p> +Life has really become full of dreads for many women in this regard. A +gradual reduction in the birth rate which has deprived so many women +of the heart interests that were particularly valuable at and after +middle life; has been the source of a great deal more suffering +without any satisfaction, than would be associated in any way with the +care of children. It is extremely unfortunate, then, that this phase +of social evolution should have taken place, for the quest of ease and +pleasure has proved a prolific source of feminine ills. It is well +recognized now that the reason for this reduction in the birth rate is +not physical but ethical. It is a matter of choice and not necessity. +There is a conscious limitation of the number of children in the +family accomplished deliberately, and as a rule the women consider +that they are justified in the procedure because they thus conserve +their own health and provide such <a name="279">{279}</a> few children as they have with +healthier bodies than would otherwise have been the case. +</p> +<p> +Indeed, child-bearing beyond one or two or perhaps three children has +become a source of dread in modern times, a dread that supposedly +centers around the health of the children, as well as the mother +herself. The mother of a few children is supposed to be healthier and +the children of small families to be heartier and more vigorous than +when there are half a dozen or more children in the family. A woman is +actually supposed by many to seriously imperil her life and her health +if she has more than two or three children, though as a matter of +fact, the history of the older times when families were larger shows +us that women were then healthier on the average than they are now, in +spite of all the progress that medicine and surgery have since made in +relieving serious ills. Above all, it was often the mother of numerous +children who lived long and in good health to be a blessing to those +around her, and not the old maids nor the childless wives, for +longevity is not a special trait of these latter classes of women. The +modern dread of deterioration of vitality as the result of frequent +child-bearing is quite without <a name="280">{280}</a> foundation in the realities of +human experience. +</p> +<p> +Some rather carefully made statistics demonstrate that the old +tradition in the matter is not merely an impression but a veritable +truth as to human nature's reaction to a great natural call. While the +mothers of large families born in the slums with all the handicaps of +poverty as well as hard work against them, die on the average much +younger than the generality of women in the population, careful study +of the admirable vital statistics of New South Wales show that the +mothers who lived longest were those who under reasonably good +conditions bore from five to seven children. Here in America, a study +of more favored families shows that the healthiest children come from +the large families, and it is in the small families particularly that +the delicate, neurotic and generally weakly children are found. +Alexander Graham Bell, in his investigation of the Hyde family here in +America, discovered that it was in the families of ten or more +children that the greatest longevity occurred. So far from mothers +being exhausted by the number of children that were born, and thus +endowing their children with less vitality than if they <a name="281">{281}</a> had +fewer children, it was to the numerous offspring that the highest +vitality and physical fitness were given. One special consequence of +these is longevity. +</p> +<p> +In a word, the dread so commonly fostered that the mothers of large +families will weaken themselves in the process of child-bearing and +unfortunately pass on to their offspring weakling natures by the very +fact that they have to repeat the process of giving life and +nourishment to them at comparatively short intervals, is as groundless +as other dreads, for exactly the opposite is true. It is when nature +is called upon to exert her amplest power that she responds most +bountifully and dowers both children and mother with better health in +return. +</p> +<p> +Something of the same thing is true with regard to the age of mothers +when their children are born. The infant mortality is lowest among the +children of young mothers between twenty and twenty-five years of age, +though it has been found out that "delay in child-bearing after that +age penalizes the children." This is, of course, true particularly for +first children. The successive children of young mothers are known by +observation and statistics as being constantly in <a name="282">{282}</a> better +condition up to the seventh. There is on the average nearly a half a +pound difference in weight at birth between succeeding children of the +same mother, so that each infant is born sturdier and more vigorous +than its predecessor. +</p> +<p> +These recently collated facts remove entirely the supposed foundations +of a series of dreads which were having an unfortunate effect upon our +population, for the natives were disappearing before the foreigners +because of the higher birth rate among the latter. Birth control has +been producing a set of unfortunate conditions for both mothers and +children. The one child in the family is sure to be spoiled, not only +as a social being but often as regards health, and conditions are +scarcely better when there are but two, especially if they are of +opposite sexes. If anything happens to them, the mother has nothing to +live for, and a little later in life the selfish beings that have been +raised under the self-centered conditions of a small family are almost +sure to be a source of anxiety and worry. Many a woman owes the +valetudinarianism of her later years to the fact that she dreaded +maternal obligations and avoided them, and so the latter part of her +life is <a name="283">{283}</a> empty of most of what makes life worth living. +</p> +<p> +The will to make life useful for others rather than to follow a +selfish, comfortable, easy existence is the secret of health and +happiness for a great many women who are almost invalids or at least +constantly complaining in the midst of idle lives. A woman who has +nothing better to occupy her time than the care of a dog or two cannot +expect to have any interests deep enough to divert her attention from +the pains and aches of life that are more or less inevitable. The +opportunity to dwell on them will heighten their intensity until they +are almost torments. Many more of the feminine ills can be explained +in this way than by learned pathological disquisitions. Every +physician has seen the bitterest complaints disappear before some +change of life that necessitated occupation and gave the patient other +things to think about besides self. +</p> +<p> +The will to face nature's obligations of maternity straightforwardly +is probably the greatest preventive against the psycho-neuroses that +prove so seriously disturbing to a great many women. Their affections, +given a proper opportunity to develop, impel their <a name="284">{284}</a> wills to such +activity as prevents the development of morbid states. The dreads for +themselves and their children, which so often make the excuse for a +different policy in life than this, have proved unfounded on more +careful study. Now that war activities no longer call women, it must +not be forgotten that home duties are the only ones that can serve as +a universal antidote for the poison of self-indulgence, which is much +more productive of symptoms of disease than the autointoxications of +which we have heard so much, but for which there is so little +justification in our advancing science. The assumption of serious +duties is the best possible panacea for the ills of mankind as well as +womankind, only unfortunately in recent years women have succeeded in +shirking duties more and have paid the inevitable price which nature +always demands under such circumstances, when the dissatisfaction in +life is much harder to bear than the work and trials involved in the +pursuit of duty. +</p> + +<a name="285">{285}</a> + +<h2>INDEX</h2> + +<pre> +A + +Achylia Gastrica, <a href="#216">216</a> +Activity, intestinal, <a href="#220">220</a> +Adirondacks, <a href="#183">183</a> +Agoraphobia, <a href="#27">27</a> +Akrophobia, <a href="#27">27</a> +Alcohol, + narcotics, <a href="#191">191</a>; + in pneumonia, <a href="#190">190</a>; + in snake bite, <a href="#193">193</a> +Alcoholic craving and food, <a href="#159">159</a> +Algiers, <a href="#182">182</a> +Angina pectoris, <a href="#230">230</a> +Anthony, Saint, the Hermit, <a href="#21">21</a> +Arctic regions, <a href="#205">205</a> +Aridity, office building, <a href="#206">206</a> +Aristotle, <a href="#71">71</a> +Arnold, Matthew, <a href="#219">219</a> +Arthritis, rheumatoid, <a href="#242">242</a> +Ascesis, <a href="#77">77</a> +Asceticism, <a href="#92">92</a> +Asthma dread, <a href="#211">211</a> +Attention, concentration of, <a href="#127">127</a> +Auto-intoxication, <a href="#36">36</a> +Autotoxemia, <a href="#226">226</a> +Avalanche, Law of, <a href="#123">123</a> + +B + +Babinski, <a href="#261">261</a> +Bailey, Dr. Pearce, <a href="#261">261</a>, <a href="#269">269</a> +Bain, Professor, <a href="#51">51</a> +Bell, Alexander Graham, <a href="#280">280</a> +Bernheim, <a href="#252">252</a> +Betel nut, <a href="#45">45</a> +Birth control, <a href="#282">282</a> +Bismarck, <a href="#10">10</a> +Brakes on energies, <a href="#19">19</a> +Bright's disease, <a href="#102">102</a> + +C + +Cancer, <a href="#75">75</a> +Cancer cures, <a href="#106">106</a> +Carpenter, Doctor, <a href="#51">51</a> +Cat asthma, <a href="#210">210</a> +Catarrh, <a href="#31">31</a> +Character, <a href="#66">66</a> +Charcot, Professor, <a href="#252">252</a> +Chesterfield, Lord, <a href="#224">224</a> +Child bearing, <a href="#279">279</a> +Chilliness, <a href="#197">197</a> +Claustrophobia, <a href="#25">25</a> +Coddling, <a href="#267">267</a> +Conklin, Professor, <a href="#54">54</a> +Consciousness, + sphere of, <a href="#230">230</a>; + threshold of, <a href="#127">127</a> +Consumption cures, <a href="#177">177</a> +Cough remedies, <a href="#201">201</a> +Coughing, + unnecessary, <a href="#199">199</a>; + productive, <a href="#200">200</a> +Coughs and cold air, <a href="#204">204</a> +Cures, so-called, <a href="#244">244</a> + +D + +Danger, sense of, <a href="#129">129</a> +"David Harum", <a href="#276">276</a> +Death Valley, <a href="#206">206</a> +Dercum, Doctor, <a href="#274">274</a> +Diabetes, <a href="#164">164</a> +Disheartenment, <a href="#104">104</a> +Dowie, John A., <a href="#253">253</a> +Dreads, <a href="#278">278</a> + +<a name="286">{286}</a> + +E + +"Eat and grow thin", <a href="#163">163</a> +Eating, <a href="#149">149</a> +Eddyism, <a href="#253">253</a> +Education, liberal, <a href="#55">55</a> +Effort, faculty of, <a href="#92">92</a> +Eliot, George, <a href="#67">67</a> +Emerson, Ralph Waldo, <a href="#67">67</a> +Emmet, Thomas Addis, <a href="#11">11</a>, <a href="#147">147</a> +Energies of men, <a href="#15">15</a> +English, Thomas Dunn, <a href="#10">10</a> +Euphoria, <a href="#192">192</a> +Evacuation, intestinal, <a href="#221">221</a> + +F + +Family, + large, <a href="#74">74</a>; + eating, <a href="#160">160</a> +Fermentation, <a href="#155">155</a> +Flat foot, <a href="#141">141</a> +Food and alcoholic craving, <a href="#159">159</a> +Food prejudices, <a href="#152">152</a> +Franklin, Benjamin, <a href="#251">251</a> +Function, intestinal, <a href="#218">218</a> + +G + +Galen, <a href="#170">170</a>, <a href="#241">241</a> +Galvani, <a href="#248">248</a> +Gas formation, <a href="#155">155</a> +Gassner, Pfarrer, <a href="#252">252</a> +Giving up, <a href="#2">2</a> +Gouley, John W., <a href="#11">11</a> +Greatrakes, <a href="#245">245</a> + +H + +Habits, <a href="#149">149</a> +Hamerton, Philip Gilbert, <a href="#24">24</a> +Hamlet, <a href="#82">82</a> +Hard sayings, <a href="#66">66</a> +Health, secret of, <a href="#283">283</a> +Heart + craves exercise, <a href="#235">235</a>; + interests, <a href="#277">277</a>; + irregular, <a href="#236">236:</a> + missed beats, <a href="#235">235</a>; + regularly irregular, <a href="#237">237</a> +Heredity, <a href="#169">169</a>; + and environment, <a href="#54">54</a> +Höll, Father Maximilian, <a href="#252">252</a> +Holmes, Oliver Wendell, <a href="#40">40</a> +Horace, <a href="#224">224</a> +"Horse, the outside of a", <a href="#138">138</a> +Humboldt, Alexander von, <a href="#9">9</a> +Huxley, Thomas Henry, <a href="#54">54</a> +Hyde family, <a href="#280">280</a> +Hypnotism, <a href="#251">251</a> +Hypochondria, <a href="#30">30</a> +Hysteria, major, <a href="#275">275</a> + +I + +Imperatives, <a href="#99">99</a> +Insomniaphobia, <a href="#27">27</a> +Instinct, <a href="#149">149</a> +Insults, psychic, <a href="#267">267</a> +Interests, feminine, <a href="#277">277</a> +Intestinal stasis, <a href="#38">38</a> +Intuition, <a href="#88">88</a> +Invalids, chronic, <a href="#76">76</a> +Isolation, <a href="#268">268</a> + +J + +James, William, Professor, <a href="#15">15</a>, <a href="#60">60</a>, <a href="#77">77</a>, <a href="#92">92</a> +Jesuits, General of, <a href="#119">119</a> + +K + +Koenig, Professor, <a href="#274">274</a> + +L + +Laxatives, <a href="#219">219</a> +Leo XIII, <a href="#9">9</a> +Libitina, <a href="#224">224</a> +Long, St. John, <a href="#171">171</a>, <a href="#255">255</a> + +<a name="287">{287}</a> + +Longevity, <a href="#146">146</a> +Lying, hysterical, <a href="#260">260</a> + +M + +Maistre, Xavier De, <a href="#122">122</a> +Marmalade, <a href="#222">222</a> +Matthew, Father, <a href="#47">47</a> +Mesmer, Friedrich Anton, <a href="#172">172</a>, <a href="#250">250</a> +Metallotherapy, <a href="#248">248</a> +Mexican border, <a href="#60">60</a> +Misophobia, <a href="#23">23</a> +Mitchell, S. Weir, <a href="#11">11</a> +Mollycoddle, <a href="#63">63</a> +Moltke, <a href="#10">10</a> +Montreal, <a href="#204">204</a> +More, Sir Thomas, <a href="#266">266</a> +Mothers, young, <a href="#281">281</a> +Mutism, <a href="#259">259</a> + +N + +Nansen, Fridtjof, <a href="#205">205</a> +Nauheim, <a href="#233">233</a> +Neuro-hypnotism, <a href="#250">250</a> +New South Wales, <a href="#280">280</a> + +O + +Obesity, <a href="#162">162</a> +O'Malley, Austin, <a href="#80">80</a> +Optatives, <a href="#99">99</a> +Orange skin, <a href="#222">222</a> + +P + +Pain and Refinement, <a href="#131">131</a> +Pain, + control, <a href="#116">116</a>; + dread of, <a href="#128">128</a> +Palpitation, <a href="#228">228</a> +Perkins, Elisha, <a href="#248">248</a> +Personality, secondary, <a href="#88">88</a> +Phthisis, <a href="#171">171</a> +Physiology, study of, <a href="#35">35</a> +Pneumonia, <a href="#104">104</a>; + alcohol in, <a href="#190">190</a> +Possession, <a href="#266">266</a> +Pseudologia hysterica, <a href="#260">260</a> +Psychic contagion, <a href="#275">275</a> +Psycho-analysis, <a href="#41">41</a> +Pueckler-Muskau, Prince, <a href="#16">16</a> + +Q + +Quackery, History of, <a href="#245">245</a> +Quinine and whisky, <a href="#201">201</a> +Quitters, <a href="#169">169</a> + +R + +Ramon y Cajal, <a href="#123">123</a> +Ranke, Leopold von, <a href="#11">11</a> +Repplier, Agnes, <a href="#17">17</a> +Resolution, <a href="#82">82</a> +Respiration spasm, <a href="#209">209</a> +Rest, <a href="#57">57</a> +Rheumatism, chronic, <a href="#240">240</a> +Rheumatoid arthritis, <a href="#242">242</a> +Riviera, <a href="#182">182</a> +Roosevelt, Theodore, <a href="#118">118</a> +Roughage, <a href="#220">220</a> +Royal touch, <a href="#246">246</a> + +S + +Saranac, <a href="#184">184</a> +Scare, lifted, <a href="#193">193</a> +Schlatter's case, <a href="#217">217</a> +Self-drugging, <a href="#40">40</a> +Self-pity, practice of, <a href="#70">70</a> +Self-subliminal, <a href="#88">88</a> +Sensation, diffusion of, <a href="#125">125</a> +Sensitization, <a href="#135">135</a> +Shell-shock, <a href="#64">64</a>, <a href="#259">259</a> +Skotophobia, <a href="#24">24</a> +Smith, Stephen, <a href="#11">11</a> +Snake bite, <a href="#193">193</a> + +<a name="288">{288}</a> + +Stokes, Professor, <a href="#5">5</a> +Stomach functions, <a href="#215">215</a> +Subconscious, <a href="#85">85</a> +Suffering, <a href="#68">68</a> +Sybarite, <a href="#72">72</a> + +T + +Tantrum, <a href="#265">265</a>, <a href="#272">272</a> +Temperature variations, <a href="#181">181</a> +Thatcher, <a href="#248">248</a> +Therapeutics, absurd, <a href="#244">244</a> +Thompson, William Hanna, <a href="#11">11</a> +Torpillage, <a href="#264">264</a>, <a href="#265">265</a> +Tragedy, <a href="#71">71</a> +Trait, family, <a href="#149">149</a> +Trudeau, Doctor, <a href="#183">183</a> +Tuberculosis, <a href="#103">103</a>; + curable, <a href="#178">178</a>; + early, <a href="#176">176</a>; + frequency, <a href="#168">168</a>; + takes quitters, <a href="#169">169</a> + +U + +Undereating, <a href="#160">160</a> +Underweight, <a href="#149">149</a> + +V + +Valetudinarianism, <a href="#282">282</a> +Vapors, <a href="#272">272</a> +Virchow, Rudolf, <a href="#10">10</a> + +W + +Weber, Sir Hermann, <a href="#146">146</a> +Wellington, Duke of, <a href="#43">43</a> +Wilde, Oscar, <a href="#7">7</a> +Will, + and survival, <a href="#4">4</a>; + conscious use, <a href="#81">81</a>; + living on, <a href="#2">2</a>; + omnipotent, <a href="#16">16</a>; + sapping, <a href="#13">13</a> +Women's diseases, <a href="#272">272</a> +</pre> +<hr> + +<h2>MIND AND HEALTH SERIES</h2> + +<p> +A Series of Medical Handbooks written by eminent specialists and +edited by H. Addington Bruce, A.M., and designed to present the +results of recent research and clinical experience in a form +intelligible to the lay public and medical profession. +</p> +<p> +1. HUMAN MOTIVES. By James Jackson Putnam, M.D., Professor Emeritus, +Diseases of the Nervous System, Harvard University; Consulting +Neurologist, Massachusetts General Hospital, Boston. 179 pages. 12mo. +$1.35 <i>net</i>. +</p> +<p class="cite"> + A study of human conduct, using both the philosophical and the + Freudian psychoanalytic methods of approach, with most attention to + the latter method.—<i>A. L. A. Booklist</i>. +</p> +<p> +2. THE MEANING OF DREAMS. By Isador H. Coriat, M.D., First Assistant +Visiting Physician, Nervous Diseases, Boston City Hospital. 194 pages. +12mo. $1.35 <i>net</i>. +</p> +<p class="cite"> + The many examples that are analyzed and explained are taken from + cases that have come under the author's observations.—<i>A. L. A. + Booklist</i>. +</p> +<p> +3. SLEEP AND SLEEPLESSNESS. By H. Addington +Bruce, A.M. 219 pages. 12mo. $1.35 <i>net</i>. +</p> +<p class="cite"> + Popular chapters on the various theories of sleep and dreams; + disorders of sleep, dreams and the supernatural; and on the causes + and treatment of sleeplessness.—<i>A. L. A. Booklist</i>. +</p> +<p> +4. THE INFLUENCE OF JOY. By George Van Ness +Dearborn, A.M., Ph.D., M.D. 223 pages. 12mo. $1.35 <i>net</i>. +</p> +<p class="cite"> + Presents the latest findings as to the effects of joy on the human + organism. The writer gives sensible, easily understood suggestions + to students and teachers and something of the psychology underlying + the suggestions.—<i>A. L. A. Booklist</i>. +</p> +<p> +5. NERVOUSNESS: ITS CAUSES, TREATMENT AND PREVENTION. +By L. E. Emerson, Ph.D.. 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You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Health Through Will Power + +Author: James J. Walsh + +Release Date: August 17, 2011 [EBook #37109] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK HEALTH THROUGH WILL POWER *** + + + + +Produced by Don Kostuch + + + + +[Transcriber's Notes] + Page numbers in this book are indicated by numbers enclosed in curly + braces, e.g. {99}. They have been located where page breaks occurred + in the original book. + + This book is derived from a copy on the Internet Archive: + http://www.archive.org/details/cu31924012175505 + + Obvious spelling or typographical errors have been corrected. + Inconsistent spelling of names and inventive and alternative + spelling is left as printed. + + Extended quotations and citations are indented such as reports, + letters and interviews. +[End Transcriber's Notes] + + +HEALTH THROUGH WILL POWER + + +BY + +JAMES J. WALSH, M.D., Ph.D., Sc.D., Etc. + +MEDICAL DIRECTOR OF FORDHAM UNIVERSITY SCHOOL OF SOCIOLOGY; +PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY +AT CATHEDRAL COLLEGE; LECTURER ON PSYCHOLOGY, +MARYWOOD COLLEGE, ETC. + + + + + BOSTON + + LITTLE, BROWN, AND COMPANY + + 1919 + + + + _Copyright, 1919,_ + + By Little, Brown, and Company. + + + + _All rights reserve_ + + Published, November, 1919 + + + + _Norwood Press_ + + Set up and electrotyped by J. S. Cushing Co., + + Norwood, Mass., U.S.A. + + + +_To_ +J. H. W. + +EX ANIMO ET CORDE + +J. J. W. + + +{vii} + + +PREFACE + +A French surgeon to whom the remark was made in the third year of the +War that France was losing an immense number of men replied: "Yes, we +are losing enormously, but for every man that we lose we are making +two men." What he meant, of course, was that the War was bringing out +the latent powers of men to such an extent that every one of those who +were left now counted for two. The expression is much more than a mere +figure of speech. It is quite literally true that a man who has had +the profound experience of a war like this becomes capable of doing +ever so much more than he could before. He has discovered his own +power. He has tapped layers of energy that he did not know he +possessed. Above all, he has learned that his will is capable of +enabling him to do things that he would have hesitated about and +probably thought quite impossible before this revelation of himself to +himself had been made. + +{viii} + +In a word, the War has proved a revival of appreciation of the place +of the human will in life. Marshal Foch, the greatest character of the +War, did not hesitate even to declare that "A battle is the struggle +of two wills. It is never lost until defeat is accepted. They only are +vanquished who confess themselves to be." + +Our generation has been intent on the development of the intellect. We +have been neglecting the will. "Shell shock" experiences have shown us +that the intellect is largely the source of unfavorable suggestion. +The will is the controlling factor in the disease. Many another +demonstration of the power of will has been furnished by the War. This +volume is meant to help in the restoration of the will to its place as +the supreme faculty in life, above all the one on whose exercise, more +than any other single factor, depends health and recovery from +disease. The time seems opportune for its appearance and it is +commended to the attention of those who have recognized how much the +modern cult of intellect left man unprepared for the ruder trails of +life yet could not see clearly what the remedy might be. + +{ix} + +CONTENTS + + + PAGE + + Preface vii + +CHAPTER + +I The Will in Life 1 + +II Dreads 19 + +III Habits 42 + +IV Sympathy 57 + +V Self-Pity 69 + +VI Avoidance of Conscious Use of the Will 80 + +VII What the Will Can Do 102 + +VIII Pain and the Will 112 + +IX The Will and Air and Exercise 133 + +X The Will to Eat 148 + +XI The Place of the Will in Tuberculosis 167 + +XII The Will in Pneumonia 187 + +XIII Coughs and Colds 196 + +XIV Neurotic Asthma and the Will 207 + +XV The Will in Intestinal Function 215 + +XVI The Will and the Heart 227 + +XVII The Will in So-Called Chronic Rheumatism 240 + +XVII Psycho-Neuroses 258 + +XIX Feminine Ills and the Will 270 + + Index 285 + + +{1} + + +HEALTH THROUGH WILL POWER + + + +CHAPTER I + +THE WILL IN LIFE + + + "What he will he does and does so much + That proof is called impossibility." + + _Troilus and Cressida._ + + +The place of the will in its influence upon health and vitality has +long been recognized, not only by psychologists and those who pay +special attention to problems of mental healing, but also, as a rule, +by physicians and even by the general public. It is, for instance, a +well-established practice, when two older folk, near relatives, are +ill at the same time, or even when two younger persons are injured +together and one of them dies, or perhaps has a serious turn for the +worse, carefully to keep all knowledge of it from the other one. The +reason is a very definite conviction that in the revulsion of feeling +caused by learning of the fatality, or as {2} a result of the +solicitude consequent upon hearing that there has been a turn for the +worse, the other patient's chances for recovery would probably be +seriously impaired. The will to get better, even to live on, is +weakened, with grave consequences. This is no mere popular impression +due to an exaggeration of sympathetic feeling for the patient. It has +been noted over and over again, so often that it evidently represents +some rule of life, that whenever by inadvertence the serious condition +or death of the other was made known, there was an immediate +unfavorable development in the case which sometimes ended fatally, +though all had been going well up to that time. This was due not +merely to the shock, but largely to the "giving up", as it is called, +which left the surviving patient without that stimulus from the will +to get well which means so much. + +It is surprising to what an extent the will may affect the body, even +under circumstances where it would seem impossible that physical +factors could any longer have any serious influence. We often hear it +said that certain people are "living on their wills", and when they +are of the kind who take comparatively little food and yet succeed in +accomplishing {3} a great deal of work, the truth of the expression +comes home to us rather strikingly. The expression is usually +considered, however, to be scarcely more than a formula of words +elaborated in order to explain certain of these exceptional cases that +seem to need some special explanation. The possibility of the human +will of itself actually prolonging existence beyond the time when, +according to all reason founded on physical grounds, life should end, +would seem to most people to be quite out of the question. And yet +there are a number of striking cases on record in which the only +explanation of the continuance of life would seem to be that the will +to live has been so strongly aroused that life was prolonged beyond +even expert expectation. That the will was the survival factor in the +case is clear from the fact that as soon as this active willing +process ceased, because the reason that had aroused it no longer +existed, the individuals in question proceeded to reach the end of +life rapidly from the physical factors already at work and which +seemed to portend inevitably an earlier dissolution than that which +happened. Probably a great many physicians know of striking examples +of patients who have lived beyond the time when ordinarily death would +{4} be expected, because they were awaiting the arrival of a friend +from a distance who was known to be coming and whom the patient wanted +very much to see. Dying mothers have lived on to get a last embrace of +a son or daughter, and wives have survived to see their husbands for a +last parting--though it seemed impossible that they should do so, so +far as their physical condition was concerned--and then expired +within a short time. Of course there are any number of examples in +which this has not been true, but then that is only a proof of the +fact that the great majority of mankind do not use their wills, or +perhaps, having appealed to them for help during life never or but +slightly, are not prepared to make a definite serious call on them +toward the end. I am quite sure, however, that a great many country +physicians particularly can tell stories of incidents that to them +were proofs that the will can resist even the approach of death for +some time, though just as soon as the patients give up, death comes to +them. + +Professor Stokes, the great Irish clinician of the nineteenth century, +to whom we owe so much of our knowledge of the diseases of the heart +and lungs, and whose name is enshrined in terms commonly used in +medicine in {5} connection with these diseases, has told a striking +story of his experiences in a Dublin hospital that illustrates this +very well. An old Irishman, who had been a soldier in his younger +years and had been wounded many times, was in the hospital ill and +manifestly dying. Professor Stokes, after a careful investigation of +his condition, declared that he could not live a week, though at the +end of that time the old soldier was still hanging on to life, ever +visibly sinking. Stokes assured the students who were making the +rounds of his wards with him that the old man had at most a day or two +more to live, and yet at the end of some days he was still there to +greet them on their morning visits. After the way of medical students +the world over, though without any of that hard-heartedness that would +be supposed ordinarily to go with such a procedure, for they were +interested in the case as a medical problem, the students began to bet +how long the old man would live. + +Finally, one day the old man said to Stokes in his broadest brogue: +"Docther, you must keep me alive until the first of the month, because +me pension for the quarther is then due, and unless the folks have it, +shure they won't have anything to bury me with." + +{6} + +The first of the month was some ten days away. Stokes said to his +students, though of course not in the hearing of the patient, that +there was not a chance in the world, considering the old soldier's +physical condition, that he would live until the first of the month. +Every morning, in spite of this, when they came in, the old man was +still alive and there was even no sign of the curtains being drawn +around his bed as if the end were approaching. Finally on the morning +of the first of the month, when Stokes came in, the old pensioner said +to him feebly, "Docther, the papers are there. Sign them! Then they'll +get the pension. I am glad you kept me alive, for now they'll surely +have the money to bury me." And then the old man, having seen the +signature affixed, composed himself for death and was dead in the +course of a few hours. He had kept himself alive on his will because +he had a purpose in it, and once that purpose was fulfilled, death was +welcome and it came without any further delay. + +There is a story which comes to us from one of the French prisons +about the middle of the nineteenth century which illustrates forcibly +the same power of the will to maintain life after it seemed sure, +beyond peradventure, {7} that death must come. It was the custom to +bury in quicklime in the prison yard the bodies of all the prisoners +who died while in custody. The custom still survives, or did but +twenty years ago, even in English prisons, for those who were +executed, as readers of Oscar Wilde's "Ballad of Reading Gaol" will +recall. Irish prisons still keep up the barbarism, and one of the +reasons for the bitterness of the Irish after the insurrection of 1916 +in Dublin was the burial of the executed in quicklime in the prison +yard. The Celtic mind particularly revolts at the idea, and it +happened that one of the prisoners in a certain French prison, a +Breton, a Celt of the Celts, was deeply affected by the thought that +something like this might happen to him. He was suffering from +tuberculosis at a time when very little attention was paid to such +ailments in prisoners, for the sooner the end came, the less bother +there was with them; but he was horrified at the thought that if he +died in prison his body would disappear in the merciless fire of the +quicklime. + +So far as the prison physician could foresee, the course of his +disease would inevitably reach its fatal termination long before the +end of his sentence. In spite of its advance. {8} however, the +prisoner himself declared that he would never permit himself to die in +prison and have his body face such a fate. His declaration was +dismissed by the physician with a shrug and the feeling that after all +it would not make very much difference to the man, since he would not +be there to see or feel it. When, however, he continued to live, +manifestly in the last throes of consumption, for weeks and even +months after death seemed inevitable, some attention was paid to his +declaration in the matter and the doctors began to give special +attention to his case. He lived for many months after the time when, +according to all ordinary medical knowledge, it would seem he must +surely have died. He actually outlived the end of his sentence, had +arrangements made to move him to a house just beyond the prison gate +as soon as his sentence had expired, and according to the story, was +dead within twenty-four hours after the time he got out of prison and +thus assured his Breton soul of the fact that his body would be given, +like that of any Christian, to the bosom of mother earth. + +But there are other and even more important phases of the prolongation +of life by the will that still better illustrates its power. {9} It +has often been noted that men who have had extremely busy lives, +working long hours every day, often sleeping only a few hours at +night, turning from one thing to another and accomplishing so much +that it seemed almost impossible that one man could do all they did, +have lived very long lives. Men like Alexander Humboldt, for instance, +distinguished in science in his younger life, a traveler for many +years in that hell-hole of the tropics, the region around Panama and +Central America, a great writer whose books deeply influenced his +generation in middle age. Prime Minister of Prussia as an older man, +lived to be past ninety, though he once confessed that in his forties +he often slept but two or three hours a night and sometimes took even +that little rest on a sofa instead of a bed. Leo XIII at the end of +the nineteenth century was just such another man. Frail of body, +elected Pope at sixty-four, it was thought that there would soon be +occasion for another election; he did an immense amount of work, +assumed successfully the heaviest responsibilities, and outlived the +years of Peter in the Papal chair, breaking all the prophecies in that +regard and not dying till he was ninety-three. + +Many other examples might be cited. {10} Gladstone, always at work, +probably the greatest statesman of the nineteenth century in the +better sense of that word, was a scholar almost without a peer in the +breadth of his scholarly attainments, a most interesting writer on +multitudinous topics, keen of interest for everything human and always +active, and yet he lived well on into the eighties. Bismarck and Von +Moltke, who assumed heavier responsibilities than almost any other men +of the nineteenth century, saw their fourscore years pass over them a +good while before the end came. Bismarck remarked on his eighty-first +birthday that he used to think all the good things of life were +confined to the first eighty years of life, but now he knew that there +were a great many good things reserved for the second eighty years. I +shall never forget sitting beside Thomas Dunn English, the American +poet, at a banquet of the Alumni of the University of Pennsylvania, +when he repeated this expression for us; at the time he himself was +well past eighty. He too had been a busy man and yet rejoiced to be +with the younger alumni at the dinner. + +My dear old teacher, Virchow, of whom they said when he died that four +men died, for he was distinguished not only as a pathologist, {11} +which was the great life-work for which he was known, but as an +anthropologist, a historian of medicine and a sanitarian, was at +seventy-five actively accomplishing the work of two or three men. He +died at eighty-one, as the result of a trolley injury, or I could +easily imagine him alive even yet. Von Ranke, the great historian of +the popes, began a universal history at the age of ninety which was +planned to be complete in twelve volumes, one volume a year to be +issued. I believe that he lived to finish half a dozen of them. I have +some dear friends among the medical profession in America who are in +their eighties and nineties, and all of them were extremely busy men +in their middle years and always lived intensely active lives. Stephen +Smith and Thomas Addis Emmet, John W. Gouley, William Hanna Thompson, +not long dead, and S. Weir Mitchell, who lived to be past eighty-five, +are typical examples of extremely busy men, yet of extremely long +lives. + +All of these men had the will power to keep themselves busily at work, +and their exercise of that will power, far from wearing them out, +actually seemed to enable them to tap reservoirs of energy that might +have remained {12} latent in them. The very intensiveness of their +will to do seemed to exert an extensive influence over their lives, +and so they not only accomplished more but actually lived longer. Hard +work, far from exhausting, has just the opposite effect. We often hear +of hard work killing people, but as a physician I have carefully +looked into a number of these cases and have never found one which +satisfied me as representing exhaustion due to hard work. Insidious +kidney disease, rheumatic heart disease, the infections of which +pneumonia is a typical example, all these have been the causes of +death and not hard work, and they may come to any of us. They are just +as much accidents as any other of the mischances of life, for it is as +dangerous to be run into by a microbe as by a trolley car. Using the +will in life to do all the work possible only gives life and gives it +more abundantly, and people may rust out, that is be hurt by rest, +much sooner than they will wear out. + +Here, then, is a wellspring of vitality that checks for a time at +least even lethal changes in the body and undoubtedly is one of the +most important factors for the prolongation of life. It represents the +greatest force for health and power of accomplishment that we have. +{13} Unfortunately, in recent years, it has been neglected to a great +extent for a number of reasons. One of these has been the discussions +as to the freedom of the will and the very common teaching of +determinism which seemed to eliminate the will as an independent +faculty in life. While this affected only the educated classes who had +received the higher education, their example undoubtedly was pervasive +and influenced a great many other people. Besides, newspaper and +magazine writers emphasized for popular dissemination the ideas as to +absence of the freedom of the will which created at least an +unfortunate attitude of mind as regards the use of the will at its +best and tended to produce the feeling that we are the creatures of +circumstances rather than the makers of our destiny in any way, or +above all, the rulers of ourselves, including even to a great extent +our bodily energies. + +Even more significant than this intellectual factor, in sapping will +power has been the comfortable living of the modern time with its +tendency to eliminate from life everything that required any exercise +of the will. The progress which our generation is so prone to boast of +concerns mainly this making of people {14} more comfortable than they +were before. The luxuries of life of a few centuries ago have now +become practically the necessities of life of to-day. We are not asked +to stand cold to any extent, we do not have to tire ourselves walking, +and bodily labor is reserved for a certain number of people whom we +apparently think of as scarcely counting in the scheme of humanity. +Making ourselves comfortable has included particularly the removal of +nearly all necessity for special exertion, and therefore of any +serious exercise of the will. We have saved ourselves the necessity +for expending energy, apparently with the idea that thus it would +accumulate and be available for higher and better purposes. + +The curious thing with regard to animal energy, however, is that it +does not accumulate in the body beyond a certain limited extent, and +all energy that is manufactured beyond that seems to have a definite +tendency to dissipate itself throughout the body, producing discomfort +of various kinds instead of doing useful work. The process is very +like what is called short-circuiting in electrical machinery, and this +enables us to understand how much harm may be done. Making ourselves +comfortable, therefore, may in the {15} end have just exactly the +opposite effect, and often does. This is not noted at first, and may +escape notice entirely unless there is an analysis of the mode of life +which is directed particularly to finding out the amount of exertion +of will and energy that there is in the daily round of existence. + +The will, like so many other faculties of the human organism, grows in +power not by resting but by use and exercise. There have been very few +calls for serious exercise of the will left in modern life and so it +is no wonder that it has dwindled in power. As a consequence, a good +deal of the significance of the will in life has been lost sight of. +This is unfortunate, for the will can enable us to tap sources of +energy that might otherwise remain concealed from us. Professor +William James particularly called attention to the fact, in his +well-known essay on "The Energies of Men", that very few people live +up to their _maximum_ of accomplishment or their _optimum_ of conduct, +and that indeed "_as a rule men habitually use only a small part of +the powers which they actually possess and which they might use under +appropriate conditions._" + +It is with the idea of pointing out how much the will can accomplish +in changing things for {16} the better that this volume is written. +Professor James quoted with approval Prince Pueckler-Muskau's +expression, "I find something very satisfactory in the thought that +man has the power of framing such props and weapons out of the most +trivial materials, indeed out of nothing, merely by the force of his +will, which thereby truly deserves the name of omnipotent." +[Footnote 1] + + [Footnote 1: "Tour in England, Ireland and France."] + +It is this power, thus daringly called omnipotent, that men have not +been using to the best advantage to maintain health and even to help +in the cure of disease, which needs to be recalled emphatically to +attention. The war has shown us in the persons of our young soldiers +that the human will has not lost a single bit of its pristine power to +enable men to accomplish what might almost have seemed impossible. One +of the heritages from the war should be the continuance of that fine +use of the will which military discipline and war's demands so well +brought into play. Men can do and stand ever so much more than they +realize, and in the very doing and standing find a satisfaction that +surpasses all the softer pleasant feelings that come from mere comfort +and lack of necessity for physical and {17} psychical exertion. Their +exercise of tolerance and their strenuous exertion, instead of +exhausting, only makes them more capable and adds to instead of +detracting from their powers. + +How much this discipline and training of the will meant for our young +American soldiers, some of whom were raised in the lap of luxury and +almost without the necessity of ever having had to do or stand hard +things previously in their lives, is very well illustrated by a letter +quoted by Miss Agnes Repplier in the _Century_ for December. It is by +no means unique or even exceptional. There were literally thousands of +such letters written by young officers similarly circumstanced, and it +is only because it is typical and characteristic of the spirit of all +of these young men that I quote it here. Miss Repplier says that it +came from "a young American lieutenant for whom the world had been +from infancy a perilously pleasant place." He wrote home in the early +spring of 1918: + +"It has rained and rained and rained. I am as much at home in a mud +puddle as any frog in France, and I have clean forgotten what a dry +bed is like. But I am as fit as a fiddle and as hard as nails. I can +eat scrap iron and sleep standing. Aren't there things {18} called +umbrellas, which you pampered civilians carry about in showers?" If we +can secure the continuance of this will exertion, life will be ever so +much heartier and healthier and happier than it was before, so that +the war shall have its compensations. + + +{19} + +CHAPTER II + +DREADS + + "O, know he is the bridle of your will. + There's none but asses will be bridled so." + _A Comedy of Errors._ + + +It must be a surprise to most people, after the demonstration of the +power of the will in the preceding chapter, that so many fail to make +use of it. Indeed, the majority of mankind are quite unable to realize +the store of energy for their health and strength and well-being which +is thus readily available, though so often unused or called upon but +feebly. The reason why the will is not used more is comparatively easy +to understand, however, once its activity in ordinary conditions of +humanity is analyzed a little more carefully. The will is +unfortunately seldom permitted to act freely. Brakes are put on its +energies by mental states of doubt and hesitation, by contrary +suggestion, and above all by the dreads which humanity has allowed to +fasten {20} themselves on us until now a great many activities are +hampered. There is the feeling that many things cannot be done, or may +be accomplished only at the cost of so much effort and even hardship +that it would be hopeless for any but those who are gifted with +extremely strong wills to attempt them. People grow afraid to commit +themselves to any purpose lest they should not be able to carry it +out. Many feel that they would never be able to stand what others have +stood without flinching and are persuaded that if ever they were +placed in the position where they had to withstand some of the trials +that they have heard of they would inevitably break down under the +strain. + +Just as soon as a human being loses confidence that he or she may be +able to accomplish a certain thing, that of itself is enough to make +the will ever so much less active than it would otherwise be. It is +like breaking a piece of strong string: those who know how wrap it +around their fingers, then jerk confidently and the string is broken. +Those who fear that they may not be able to break it hesitate lest +they should hurt themselves and give a half-hearted twitch which does +not break the string; the only thing they succeed {21} in doing is in +hurting themselves ever so much more than does the person who really +breaks it. After that abortive effort, they feel that they must be +different from the others whose fingers were strong enough to break +the string, and they hesitate about it and will probably refuse to +make the attempt again. + +It is a very old story,--this of dreads hampering the activities of +mankind with lack of confidence, and the fear of failure keeping +people from doing things. One of his disciples, according to a very +old tradition, once asked St. Anthony the Hermit what had been the +hardest obstacle that he found on the road to sanctity. The story has +all the more meaning for us here if we recall that health and holiness +are in etymology the same. St. Anthony, whose temptations have made +him famous, was over a hundred at the time and had spent some seventy +years in the desert, almost always alone, and probably knew as much +about the inner workings of human nature from the opportunities for +introspection which he had thus enjoyed as any human being who ever +lived. His young disciple, like all young disciples, wanted a short +cut on the pathway that they were both traveling. The old man said to +him, "Well, {22} I am an old man and I have had many troubles, but +most of them never happened." + +Many a nightmare of doubt and hesitation disappears at once if the +dread of it is overcome. The troubles that never happen, if dwelt +upon, paralyze the will until health and holiness become extremely +difficult of attainment. + +There is the secret of the failure of a great many people in life in a +great many ways. They fear the worst, dread failure, dampen their own +confidence, and therefore fritter away their own energy. Anything that +will enable them to get rid of the dreads of life will add greatly to +their power to accomplish things inside as well as outside their +bodies. Well begun is half done, and tackling a thing confidently +means almost surely that it will be accomplished. If the dread of +failure, the dread of possible pain in its performance, the dread of +what may happen as a result of activity,--if all these or any of them +are allowed to obtrude themselves, then energy is greatly lessened, +the power to do things hampered and success becomes almost impossible. +This is as true in matters of health and strength as it is with regard +to various external accomplishments. It takes a great {23} deal of +experience for mankind to learn the lesson that their dreads are often +without reality, and some men never learn it. + +Usually when the word dreads is used, it is meant to signify a series +of psychic or psychoneurotic conditions from which sensitive, nervous +people suffer a great deal. There is, for instance, the dread of dirt +called learnedly misophobia, that exaggerated fear that dirt may cling +to the hands and prove in some way deleterious which sends its victims +to wash their hands from twenty to forty times a day. Not infrequently +they wash the skin pretty well off or at least produce annoying skin +irritation as the result of their feeling. There are many other dreads +of this kind. Some of them seem ever so much more absurd even than +this dread of dirt. Most of us have a dread of heights, that is, we +cannot stand on the edge of a height and look down without trembling +and having such uncomfortable feelings that it is impossible for us to +stay there any length of time. Some people also are unable to sit in +the front row of the balcony of a theater or even to kneel in the +front row of a gallery at church without having the same dread of +heights that comes to others at the edge of a high precipice. I have +among my {24} patients some clergymen who find it extremely difficult +to stand up on a high altar, though, almost needless to say, the whole +height is at most five or six ordinary steps. + +Then there are people who have an exaggerated dread of the dark, so +that it is quite impossible for them to sleep without a light or to +sleep alone. Sometimes such a dread is the result of some terrifying +incident, as the case in my notes in which the treasurer of a +university developed an intense dread of the dark which made sleep +impossible without a light, after he had been shot at by a burglar who +came into his room and who answered his demand, "Who is that?" by a +bullet which passed through the head of the bed. Most of the +skotophobists, the technical name for dark-dreaders, have no such +excuse as this one. Victims of nervous dreads have as a rule developed +their dread by permitting some natural feeling of minor importance to +grow to such an extent that it makes them very miserable. + +Some cannot abide a shut-in place. Philip Gilbert Hamerton, the +English writer and painter, often found a railroad compartment in the +English cars an impossible situation and had to break his journey in +order to get over {25} the growing feeling of claustrophobia, the +dread of shut-in places, which would steal over him. + +There are any number of these dreads and, almost needless to say, all +of them may interfere with health and the pursuit of happiness. I have +seen men and women thrown into a severe nervous state with chilly +feelings and cold sweat as the result of trying to overcome one of +these dreads. They make it impossible for their victims to do a great +many things that other people do readily, and sadly hamper their +wills. There is only one way to overcome these dreads, and that is by +a series of acts in the contrary direction until a habit of +self-control with regard to these haunting ideas is secured. All +mankind, almost without exception, has a dread of heights, and yet +many thousands of men have in recent years learned to work on high +buildings without very much inconvenience from the dread. The wages +are good, they _want_ to work this way, and the result is they take +themselves in hand and gradually acquire self-control. I have had many +of them tell me that at first they were sure they would never be able +to do it, but the gradual ascent of the building as the work proceeded +accustomed them to height, {26} and after a while it became almost as +natural to work high up in the air as on the first or second story of +a building or even on the level ground. + +The overcoming of these dreads is not easy unless some good reason +releases the will and sets it to exerting its full power. When this is +the case, however, the dread is overcome and the brake lifted after +some persistence, with absolute assurance. Men who became brave +soldiers have been known to have had a great dread of blood in early +life. Some of our best surgeons have had to leave the first operation +that they ever saw or they would have fainted, and yet after repeated +effort they have succeeded in overcoming this sensitiveness. As a +matter of fact, most people suffer so much from dreads because they +yielded to a minor dread and allowed a bad habit to be formed. It is a +question of breaking a bad habit by contrary acts rather than of +overcoming a natural disposition. Many of those who are victims have +the feeling that they cannot be expected to conquer nature this way. +As a result, they are so discouraged at the very idea that success is +dubious and practically impossible from their very attitude of mind; +but it is only the {27} second nature of a habit that they have to +overcome, and this is quite another matter, for exactly contrary acts +to these which formed a habit will break it. + +Some of these dreads seem to be purely physical in origin or character +yet prove to be merely or to a great degree only psychic states. +Insomnia itself is more a dread than anything else. In writing for the +International Clinics some years ago (Volume IV, Series XXVI) I dwelt +on the fact that insomnia as a dread was probably responsible for more +discomfort and complaints from mankind than almost anything else. +Insomniaphobia is just such a dread as agoraphobia, the dread of open +spaces; or akrophobia, the dread of heights; or skotophobia, the dread +of the dark, and other phobias which afflict mankind. It is perfectly +possible in most cases to cure such phobias by direct training against +them, and this can be done also with regard to insomnia. + +Some people, particularly those who have not been out much during the +day and who have suffered from wakefulness a few times, get it on +their mind that if this state keeps up they will surely lose their +reason or their bodily health, and they begin to worry about {28} it. +They commence wondering about five in the afternoon whether they are +going to be awake that night or not. It becomes a haunt, and no matter +what they do during the evening every now and then the thought recurs +that they will not sleep. By the time they actually lie down they have +become so thoroughly occupied with that thought that it serves to keep +them awake. Some of them avoid the solicitude before they actually get +to bed, but begin to worry after that, and if after ten minutes they +are not asleep, above all if they hear a clock strike somewhere, they +are sure they are going to be awake, they worry about it, get +themselves thoroughly aroused, and then they will not go to sleep for +hours. It is quite useless to give such people drugs, just as useless +as to attempt to give a man a drug to overcome the dread of heights or +the dread of the dark or of a narrow street through which he has to +pass. They must use their wills to help them out of a condition in +which their dreads have placed them. + +Apart from these neurotic dreads, quite unreasoning as most of them +are, there are a series of what may be called intellectual dreads. +These are due to false notions that have come to be accepted and that +serve to {29} keep people from doing things that they ought to do for +the sake of their health, or set them performing acts that are +injurious instead of beneficial. The dread of loss of sleep has often +caused people to take somnifacients which eventually proved ever so +much more harmful than would the loss of sleep they were meant to +overcome. Many a person dreading a cold has taken enough quinine and +whisky to make him more miserable the next day than the cold would +have, had it actually made its appearance, as it often does not. The +quinine and whisky did not prevent it, but the expectation was founded +on false premises. There are a great many other floating ideas that +prove the source of disturbing dreads for many people. A discussion of +a few typical examples will show how much health may be broken by the +dreads associated with various ills, for they often interfere with +normal, healthy living. + +"A little knowledge is a dangerous thing" applies particularly in this +matter. There are many morbid fears that disturb mankind and keep us +from accomplishing what might otherwise be comparatively easy. A great +many people become convinced that they have some diseased condition, +or morbid elements at least, {30} in them which make it impossible for +them to do as much as other people. Sometimes this morbid persuasion +takes the form of hypochrondia and the individuals feel that they have +a constitution that unfits them for prolonged and strenuous effort of +any kind, so they avoid it. The number of valetudinarians, that is of +those who live their lives mainly engaged in caring for their health, +though their physicians have never been able to find anything +organically wrong with them, is much larger than might be imagined. +This state of mind has been with us for many centuries, for the word +which describes it, hypochondria, came to us originally from Greece +and is an attempt to localize the affection in connection with its +principal symptom, which is usually one of discomfort in the stomach +region or to one side or the other of it, that is, in the hypochondria +or beneath the ribs. + +Such a state of mind, in which the patient is constantly complaining +of one symptom or another, quite paralyzes the will. The individual +may be able to do some routine work but he will not be able to have +any initiative or energy for special developments of his occupation, +and of course, when any real affection occurs, he will feel that he is +quite {31} unable to bear this additional burden of disease. +Hypochondriacs, however, sometimes fairly enjoy their ill health and +therefore have been known not infrequently to live on to a good, round +old age, ever complaining more and more. It is their dread of disease +that keeps them from getting better and prevents their wills from +throwing off whatever symptoms there are and becoming perfectly well. +Until something comes along and rouses their wills, there is no hope +of affecting them favorably, and it is surprising how long the state +may continue without any one ever having found any organic affection +to justify all the discomforts of which they complain. Quite +literally, they are suffering from complaints and not from disease in +the ordinary sense of the word. + +Sometimes these dreads of disease are dependent on some word which has +taken on an exaggerated significance in people's minds. A word that in +recent years has been the source of a great deal of unfavorable +suggestion is "catarrh", and a mistaken notion of its meaning has been +productive of a serious hampering of their will to be well in a number +of persons. In itself, both according to its derivation and its +accepted scientific {32} significance, the word means only that first +stage of inflammatory irritation of mucous membranes which causes +secretion to flow more freely than normally. _Catarrhein_ in Greek +means only to flow down. [Footnote 2] + + [Footnote 2: The word has, by the way, the same meaning as + rheumatism, which is also from the Greek verb, to flow, though its + application is usually limited to the serous membranes of the joints + or the serous surfaces of the intermuscular planes. By derivation, + catarrh is the same word also as gout, which comes from _gutta_ in + Latin, meaning a drop and implying secretory disturbances. These + three words--catarrh, rheumatism, gout--have been applied to all + sorts of affections and are so general in meaning as to be quite + hard to define exactly. They have for this very reason, their + vagueness, become a prolific source of unfortunate suggestion and of + all kinds of dreads that disturb health.] + +By abuse, however, the word _catarrh_ has come to mean in the minds of +a great many people in our time a very serious inflammation of the +mucous membranes, almost inevitably progressive and very often +resulting in fetid diseased conditions of internal or external mucous +membranes, very unpleasant for the patient and his friends and the +source of serious complications and _sequelae_. This idea has been +fostered sedulously by the advertisers of proprietary remedies and the +ingenious exploiters of various modes of treatment. As a result, a +great many people who for one reason or another--usually because of +some slight increase of secretion in the nose and {33} throat--become +convinced they have catarrh begin to feel that they cannot be expected +to have as much resistive vitality as others, since they are the +subjects of this serious progressive disease. As a matter of fact, +very few people in America, especially those living in the northern or +eastern States, are without some tendency to mild chronic catarrh. The +violent changes of temperature and the damp, dark days predispose to +it; but it produces very few symptoms except in certain particularly +sensitive individuals whose minds become centered on slight +discomforts in the throat and nose and who feel that they must +represent some serious and probably progressive condition. + +As a matter of fact, catarrh has almost nothing of the significance +attributed to it so often in magazine and newspaper advertisements. +Simple catarrh decreases without producing any serious result, and +indeed it is an index of a purely catarrhal condition that there is a +complete return to normal. Sometimes microbes are associated with its +causation, but when this is so, they are bacteria of mild pathological +virulence that do not produce deep changes. As for catarrh developing +fetid, foul-smelling discharges or odors, that {34} is out of the +question. There are certain affections, notably diphtheria, that may +produce such serious changes in the mucous membranes that there will +always even long after complete recovery be an unpleasant odorous +condition, but it is probable that even in these cases there exists a +special form of microbe quite rare in occurrence which produces the +state known as _ozena_. + +As to catarrh spreading from the nose and throat to the other mucous +membranes, that is also quite out of the question if it is supposed to +occur in the way that the advertising specialist likes to announce. +Catarrhal conditions may occur in the stomach, but like those of the +nose and throat they are not serious, heal completely, and produce no +definite changes. A pinch of snuff may cause a catarrhal condition of +the nose, that is an increase of secretion due to hyperaemia of the +mucous membrane; the eating of condiments, of Worcestershire sauce, +peppers, and horse-radish may cause it in the stomach. It may be due +to microbic action or to irritant or decomposing food, but it is not a +part of a serious, wide-spreading pathological condition that will +finally make the patient miserable. It is surprising, however, how +many people say with an air of finality {35} that they have catarrh, +as if it should be perfectly clear that as a result they cannot be +expected at any time to be in sufficiently good health to be called on +for any special work, and of course if any affection should attack +them, their natural immunity to disease has been so lowered by this +chronic affection, of which they are the victims, that no strong +resistance could be expected from them. + +All this is merely a dread induced by paying too much attention to +medical advertisements. It is better not to know as much as some +people know, or think they know about themselves, than to know so many +things that are not so. Their dreads seriously impair their power to +work and leave them ill disposed to resist affections of any kind that +may attack them. It is a sad confession to make, but not a little of +the enforced study of physiology in our schools has become the source +of a series of dreads and solicitudes rather than of helpful +knowledge. We have as a result a generation who know a little about +their internal economy, but only enough to make them worry about it +and not quite enough to make them understand how thoroughly capable +our organisms are of caring for themselves successfully and with +resultant good health, if we will only {36} refrain from putting +brakes on their energies and disturbing their functions by our worries +and anxieties. + +Another such word as catarrh in its unfavorable suggestiveness in +recent years has been auto-intoxication. It is a mouth-filling word, +and therefore very probably it has occupied the minds of the better +educated classes. Usually the form of auto-intoxication that is most +spoken of is intestinal auto-intoxication, and this combination has +for many people a very satisfying polysyllabic length that makes it of +special significance. Its meaning is taken to be that whenever the +contents of the intestines are delayed more than twenty hours or +perhaps a little longer, or whenever certain irritant materials find +their way into the intestinal tract, there is an absorption of toxic +matter which produces a series of constitutional symptoms. These +include such vague symptomatic conditions as sleepiness, torpor after +meals, an uncomfortable sense of fullness--though when we were young +we rather liked to have that feeling of fullness--and sometimes a +feeling of heat in the skin with other sensations of discomfort in +various parts of the body. At times there is headache, but this is +rather rare; lassitude and a feeling of {37} inability to do things is +looked upon as almost characteristic of the condition. Usually there +are nervous symptoms of one kind or another associated with the other +complaints and there may be distinctly hysterical or psycho-neurotic +manifestations. + +Auto-intoxication as just described has become a sort of fetish for a +great many people who bow down and worship at its shrine and give some +of the best of their energies and not a little of their time to +meditation before it. As a matter of fact, in the last few years it +has come to be recognized that auto-intoxication is a much abused word +employed very often when there are serious organic conditions in +existence elsewhere in the body and still more frequently when the +symptoms are due merely to functional nervous troubles. These are +usually consequent upon a sedentary life, lack of fresh air and +exercise, insufficient attention to the diet in the direction of +taking simple and coarse food, and generally passing disturbances that +can be rather readily catalogued under much simpler affections than a +supposed absorption of toxic materials from the intestines. Reflexes +from the intestinal tract, emphasized by worries about the condition, +are much more responsible for the feelings {38} complained of--which +are often not in any sense symptoms--than any physical factors +present. + +As Doctor Walter C. Alvarez said in a paper on the "Origin of the +So-called Auto-intoxicational Symptoms" published from the George +Williams Hooper Foundation for Medical Research of the University of +California Medical School, [Footnote 3] as the conclusion of his +investigation of the subject: + + [Footnote 3: _Journal of the American Medical Association_, + January 4, 1919.] + + "Auto-intoxication is commonly diagnosed when a physical examination + would show other more definite causes for the symptoms. Those who + believe that intestinal stasis can account for a long list of + disease conditions have little proof to offer for their views. Many + of the assumptions on which they rest their case have proved to be + wrong. + + "The usual symptoms of the constipated disappear so promptly after a + bowel movement that they cannot be due to absorbed toxins. They must + be produced mechanically by distension and irritation of the colon. + They occur in nervous, sensitive people. It has been shown that + various activities of the digestive tract can profoundly affect the + sensorium and the vasomotor nerves. The {39} old ideas of insidious + poisoning led to the formation of hypochrondriacs; the new + explanation helps to cure many of them." + +There are many other terms in common use that have unfortunate +suggestions and make people feel, if they once get the habit of +applying them to themselves, that they are the subject of rather +serious illness. I suppose that one of the most used and most abused +of these is uric acid and the uric acid diathesis. Scientific +physicians have nearly given up these terms, but a great many people +are still intent on making themselves miserable. All sorts of symptoms +usually due to insufficient exercise and air, inadequate diversion of +mind and lack of interests are attributed to these conditions. Some +time or other a physician or perhaps some one who is supposed to be a +friend suggested them and they continue to hamper the will to be well +by baseless worries founded on false notions for years afterwards. +What is needed is a definite effort of the will to throw off these +nightmares of disease that are so disturbing and live without them. + +It is surprising how much vital energy may be wasted in connection +with such dreads. Unfortunately, too, medicines of various kinds are +taken to relieve the symptoms connected {40} with them and the +medicine does ever so much more harm than good. Oliver Wendell Holmes +declared a generation ago that if all the medicines that had ever been +taken by mankind were thrown into the sea it would be much better for +mankind and much worse for the fishes. The expression still has a +great truth in it, especially as regards that habit of self-drugging +so common among the American people. In the course of lecture +engagements, I stay with very intelligent friends on a good many +occasions each year, and it is surprising how many of them have +medicine bottles around, indicating that they are subject to dreads of +various kinds with regard to themselves for which they feel medicine +should be taken. These dreads unfortunately often serve to lessen +resistive vitality to real affections when they occur and therefore +become a source of real danger. + +All these various dreads, then, have the definite effect of lessening +the power of the will to enable people to do their work and remain +well. They represent serious brakes upon the flow of nerve impulses +from the spiritual side of man's nature to the physical. This is much +more serious in its results than would usually be thought; and one of +the {41} things that a physician has to find out from a great many +patients is what sources of dread they are laboring under so as to +neutralize them or at least correct them as far as possible. It is +surprising how much good can be accomplished by a deliberate quest +after dreads and the direct discussion of them, for they are always +much less significant when brought out of the purlieus of the mind +directly into the open. Many a neurotic patient, particularly, will +not be improved until his dreads are relieved. This form of +psycho-analysis rather than the search for sex insults, as they are +called, or sexual incidents of early life, is the hopeful phase of +modern psychological contribution to therapeutics. + + +{42} + +CHAPTER III + +HABITS + + + "Why, will shall break it; will and nothing else." + _Love's Labor's Lost_. + + +Dreads are brakes on the will, inhibitions which prevent its exercise +and make accomplishment very difficult and sometimes impossible. They +represent mainly a state of mind, yet often they contain physical +elements, and the disposition counts for much. Their counterpart in +the opposite direction is represented by habits which are acquired +facilities of action for good or for ill. Habits not only make +activities easy but they even produce such a definite tendency to the +performance of certain actions as to make it difficult not to do them. +They may become so strong as to be tyrants for ill, though it must not +be forgotten that properly directed they may master what is worst in +us and help us up the hill of life. Acts that are entirely voluntary +and very difficult at first may become by habit so {43} natural that +it is extremely difficult to do otherwise than follow the ingrained +tendency. Nature's activities are imperative. Habitual actions may +become equally so. When some one once remarked to the Duke of +Wellington that habit was second nature, he replied: + +"Oh, ever so much more than that! Habit may be ten times as strong as +nature." + +The function of the will in health is mainly to prevent the formation +of bad habits or break those that have been formed, but above all, to +bring about the formation of habits that will prevent as far as is +possible the development of tendencies to disease in the body, Man +probably faces no more difficult problem in life than the breaking of +a bad habit. Usually it requires the exercise of all his will power +applied to its fullest extent. If there is a more difficult problem +than the breaking of a bad habit it is the formation of a good one +late in life because of the persistency of advertence and effort that +is required. It is comparatively easy to prevent the formation of bad +habits and also easy to form good habits in the earlier years. The +organism is then plastic and yields itself readily and thus becomes +grooved to the habit or hardened against it by the performance of even +a few acts. + +{44} + +All the psychologists insist that after the period of the exercise of +instinct as the basis of life passes, habit becomes the great force +for good or for ill. We become quite literally a bundle of habits, and +the success of life largely depends on whether these habits are +favorable or unfavorable to the accomplishment of what is best in us. +More than anything else health depends on habit. We begin by doing +things more or less casually, and after a time a tendency to do them +is created; then almost before we know it, we find that we have a +difficult task before us, if we try not to do them. + +To begin with, the activity which becomes the subject of a habit may +be distinctly unpleasant and require considerable effort to +accomplish. Practically every one who has learned to smoke recalls +more or less vividly the physical disturbance caused by the first +attempt and how even succeeding smokes for some time, far from being +pleasant, required distinct effort and no little self-control. After a +time, the desire to smoke becomes so ingrained that a man is literally +made quite miserable by the lack of it and finds himself almost +incapable of doing anything else until he has had his smoke. + +{45} + +Even more of an effort is required to establish the habit of chewing +tobacco, and it is even more difficult to break when once it has been +formed. Any one who has seen the discomfort and even torments endured +by a man who, after he had chewed tobacco for many years, tried to +stop will appreciate fully what a firm hold the habit has obtained. I +have known a serious business man who almost had to give up business, +who lost his sleep and his appetite and went through a nervous crisis +merely by trying to break the habit of chewing tobacco. + +In the Orient they chew betel nut. It is an extremely hot material +which burns the tongue and which a man can stand for only a very short +time when he first tries it. After a while, however, he finds a +pleasant stimulation of sensation in the constant presence of the +biting betel nut in his mouth; he craves it and cannot do his work so +well without it. He will ever advert to its use and will be restless +without it. He continues to use it in spite of the fact that the +intense irritation set up by the biting qualities of the substance +causes cancer of the tongue to occur ten times as frequently among +those who chew betel nut as among the rest of the population. Not all +{46} those who chew it get cancer, for some die from other causes +before there is time for the cancer to develop, and some seem to +possess immunity against the irritation. The betel nut chewer ignores +all this, proceeds to form the habit, urged thereto by the force of +example, and then lets himself drift along, hoping that it will have +no bad effects. + +The alcohol and drug habits are quite as significant in shortening +life as betel nut and yet men take them up quite confident in the +beginning that _they_ will not fall victims, and then find themselves +enmeshed. It is probable that the direct physical effects of none of +these substances shorten life to a marked degree unless they are +indulged in to very great excess, but the moral hazards which they +produce, accidents, injuries of various kinds, exposure to disease, +all these shorten life. Men know this very well, and yet persist in +the formation of these habits. + +Any habit, no matter how strong, can be broken if the individual +really wishes to break it, provided the subject of it is not actually +insane or on the way to the insane asylum. He need only get a motive +strong enough to rouse his will, secure a consciousness of his own +power, and then the habit can be broken. {47} After all, it must never +be forgotten that the only thing necessary in order to break a habit +effectively is to refuse to perform a single act of it, the next time +one is tempted. That breaks the habit and makes refusal easier and one +need only continue the refusal until the temptation ceases. + +Men who have not drawn a sober breath for years have sometimes come to +the realization of the fools that they were making of themselves, the +injury they were doing their relatives, or perhaps have been touched +by a child's words or some religious motive, and after that they have +never touched liquor again. Father Theobald Mathew's wonderful work in +this regard among the Irish in the first half of the nineteenth +century has been repeated by many temperance or total abstinence +advocates in more recent generations. I have known a confirmed +drunkard reason himself into a state of mind from which he was able to +overcome his habit very successfully, though his reasoning consisted +of nothing more than the recognition of the fact that suggestion was +the root of his craving for alcohol. His father had been a drunkard +and he had received so many warnings from all his older relatives and +had himself so come to dwell on {48} the possible danger of his own +formation of the habit that he had suggested himself into the frame of +mind in which he took to drink. I have known a physician on whom some +half a dozen different morphine cures had been tried--always followed +by a relapse--cure himself by an act of his own will and stay cured +ever since because of an incident that stirred him deeply enough to +arouse his will properly to activity. One day his little boy of about +four was in his office when father prepared to give himself one of his +usual injections of morphine. The little boy gave very close attention +to all his father's manipulations, and as the doctor was hurrying to +keep an appointment, he did not notice the intent eye witness of the +proceedings. Just as the needle was pushed home and the piston shot +down in the barrel, the little boy rushed over to his father and said, +"Oh, Daddy, do that to me." Apparently this close childish observer +had noted something of the look of satisfaction that came over his +father's face as he felt the fluid sink into his tissues. It is almost +needless to say that the shock the father received was enough to break +his morphine habit for good and all. It simply released his will and +then he found that if he {49} really wanted to, he could accomplish +what the various cures for the morphine habit only lead up to--and in +his case unsuccessfully--the exercise of his own will power. + +The word "habit" suggests nearly always, unfortunately, the thought of +bad habits, just as the word "passion" implies, with many people, evil +tendencies. But it must not be forgotten that there are good passions +and good habits that are as helpful for the accomplishment of what is +best in life as bad passions and bad habits are harmful. A repetition +of acts is needed for the formation of good habits just as for the +establishment of customs of evil. Usually, however, and this must not +be forgotten, the beginning of a good habit is easier than the +beginning of a bad habit. Once formed, the good habits are even more +beneficial than the bad habits are harmful. It is almost as hard to +break a good habit as a bad one, provided that it has been continued +for a sufficient length of time to make that groove in the nervous +system which underlies all habit. We cannot avoid forming habits and +the question is, shall we form good or bad habits? Good habits +preserve health, make life easier and happier; bad habits have the +opposite effect, though {50} there is some countervailing personal +element that tempts to their formation and persistence. + +Every failure to do what we should has its unfortunate effect upon us. +We get into a state in which it is extremely difficult for us to do +the right things. We have to overcome not only the original inertia of +nature, but also a contrary habit. If we do not follow our good +impulses, the worse ones get the upper hand. As Professor James said, +for we must always recur to him when we want to have the clear +expression of many of these ideas: + + "Just as, if we let our emotions evaporate, they get into a way of + evaporating; so there is reason to suppose that if we often flinch + from making an effort, before we know it the effort-making capacity + will be gone; and that, if we suffer the wandering of our attention, + presently it will wander all the time. Attention and effort are but + two names for the same psychic fact. To what brain-processes they + correspond we do not know. The strongest reason for believing that + they do depend on brain processes at all and are not pure acts of + the spirit, is just this fact, that they seem in some degree subject + to the law of habit, which is a material law." + +It must not be forgotten that we mold not {51} alone what we call +character, but that we manifestly produce effects upon our tissues +that are lasting. Indeed it is these that count the most, for health +at least. It is the physical basis of will and intellect that is +grooved by what we call habit. As Doctor Carpenter says: + + "Our nervous systems have grown to the way in which they have been + exercised, just as a sheet of paper or a coat, once creased or + folded, tends to fall forever afterwards into the same identical + fold." + +Permitting exceptions to occur when we are forming a habit is almost +necessarily disturbing. The classical figure is that it is like +letting fall a ball of string which we have been winding. It undoes in +a moment all that we have accomplished in a long while. As Professor +Bain has said it so much better than I could, I prefer to quote him: + + "The peculiarity of the moral habits, contradistinguishing them from + the intellectual acquisitions, is the presence of two hostile + powers, one to be gradually raised into the ascendant over the + other. It is necessary, above all things, in such a situation never + to lose a battle. Every gain on the wrong side undoes the effect of + many conquests on the {52} right. The essential precaution, + therefore, is so to regulate the two opposing powers that the one + may have a series of uninterrupted successes, until repetition has + fortified it to such a degree as to enable it to cope with the + opposition under any circumstances." + +This means training the will by a series of difficult acts, +accomplished in spite of the effort they require, but which gradually +become easier from repeated performance until habit replaces nature +and dominates the situation. + +Serious thinkers who faced humanity's problems squarely and devoted +themselves to finding solutions for them had worked out this formula +of the need of will training long ago, and it was indeed a principal +characteristic of medieval education. The old monastic schools were +founded on the idea that training of the will and the formation of +good habits was ever so much more important than the accumulation of +information. They frankly called the human will the highest faculty of +mankind and felt that to neglect it would be a serious defect in +education. The will can only be trained by the accomplishment of +difficult things day after day until its energies are aroused and the +man becomes conscious of his own powers and the {53} ability to use +them whenever he really wishes. There was a time not so long since, +and there are still voices raised to that purport, when it was the +custom to scoff at the will training of the older time and above all +the old-fashioned suggestion that mortifications of various +kinds--that is, the doing of unpleasant things just for the sake of +doing them--should be practiced because of the added will power thus +acquired. The failure of our modern education which neglected this +special attention to the will is now so patent as to make everyone +feel that there must be a recurrence to old time ideas once more. + +The formation of proper habits should, then, be the main occupation of +the early years. This will assure health as well as happiness, barring +the accidents that may come to any human being. Good habits make +proper living easy and after a time even pleasant, though there may +have been considerable difficulty in the performance of the acts +associated with them at the beginning. Indeed, the organism becomes so +accustomed to their performance after a time that it becomes actually +something of a trial to omit them, and they are missed. + +Education consists much more in such {54} training of the will than in +storing the intellect with knowledge, though the latter idea has been +unfortunately the almost exclusive policy in our education in recent +generations. We are waking up to the fact that diminution of power has +been brought about by striving for information instead of for the +increase of will energy. + +Professor Conklin of Princeton, in his volume on "Heredity and +Environment", emphasized the fact that "Will is indeed the supreme +human faculty, the whole mind in action, the internal stimulus which +may call forth all the capacities and powers." He had said just before +this: "It is one of the most serious indictments against modern +systems of education that they devote so much attention to the +training of the memory and intellect and so little attention to the +training of the will, upon the proper development of which so much +depends." + +Nor must it be thought that the idea behind this training of the will +is in any sense medievally ascetic and old-fashioned and that it does +not apply to our modern conditions and modes of thinking. Professor +Huxley would surely be the one man above all whom any one in our times +would be least likely to think of {55} as mystical in his ways or +medieval in his tendencies. In his address on "A Liberal Education and +Where to Find It", delivered before the South London Workingmen's +College some forty years ago, in emphasizing what he thought was the +real purpose of education, he dwelt particularly on the training of +the will. He defined a liberal education not as so many people might +think of it in terms of the intellect, but rather in terms of the +will. He said that a liberal education was one "which has not only +prepared a man to escape the great evils of disobedience to natural +laws, but has trained him to appreciate and to seize upon the rewards +which nature scatters with as free a hand as her penalties." And then +he added: + + "That man, I think, has had a liberal education who has been so + trained in youth that his body is the ready servant of his will, and + does with ease and pleasure all the work that, as a mechanism, it is + capable of; whose intellect is a clear, cold, logic engine, with all + its parts of equal strength, and in smooth working order, ready, + like a steam engine, to be turned to any kind of work, and spin the + gossamers as well as forge the anchors of the mind; whose mind is + stored with a knowledge of the great {56} and fundamental truths of + nature and of the laws of her operations; one who is no stunted + ascetic but who is full of life and fire, but whose passions are + trained to come to heel by a vigorous will, the servant of a tender + conscience; who has learned to love all beauty, whether of nature or + of art, to hate all vileness, and to respect others as himself. + + "Such an one and no other, I conceive, has had a liberal education; + for he is, completely as a man can be, in harmony with nature." + +This is the liberal education in habits of order and power that every +one must strive for, so that all possible energies may be available +for the rewards of good health. Details of the habits that mean much +for health must be reserved for subsequent chapters, but it must be +appreciated in any consideration of the relation of the will to health +that good habits formed as early as possible in life and maintained +conservatively as the years advance are the mainstay of health and the +power to do work. + + +{57} + +CHAPTER IV + +SYMPATHY + + + "Never could maintain his part but in the force of his will." + _Much Ado about Nothing_. + +A great French physician once combined in the same sentence two +expressions that to most people of the modern time would seem utter +paradoxes. "Rest," he said, "is the most dangerous of remedies, never +to be employed for the treatment of disease, except in careful doses, +under the direction of a physician and rarely for any but sufferers +from organic disease"; while "sympathy", he added, "is the most +insidiously harmful of anodynes, seldom doing any good except for the +passing moment, and often working a deal of harm to the patient." + +With the first of these expressions, we have nothing to do here, but +the second is extremely important in any consideration of the place of +the will in human life. Nothing is so prone {58} to weaken the will, +to keep it from exerting its full influence in maintaining vital +resistance, and as a result, to relax not only the moral but the +physical fiber of men and women as misplaced sympathy. It has almost +exactly the same place in the moral life that narcotics have in the +physical, and it must be employed with quite as much nicety of +judgment and discrimination. + +Sympathy of itself is a beautiful thing in so far as it implies that +_suffering with_ another which its Greek etymology signifies. In so +far as it is pity, however, it tends to lessen our power to stand up +firmly under the trials that are sure to come, and is just to that +extent harmful rather than helpful. There is a definite reaction +against it in all normal individuals. No one wants to be pitied. We +feel naturally a little degraded by it. In so far as it creates a +feeling of self-pity, it is particularly to be deprecated, and indeed +this is so important a subject in all that concerns the will to be +well and to get well that it has been reserved for a special chapter. +What we would emphasize here is the harm that is almost invariably +done by the well-meant but so often ill-directed sympathy of friends +and relatives which proves relaxing of moral {59} purpose and hampers +the will in its activities, physical as well as ethical. + +Human nature has long recognized this and has organized certain +customs of life with due reference to it. We all know that when +children fall and even hurt themselves, the thing to do is not to +express our sympathy and sorrow for them, even though we feel it +deeply, but unless their injury is severe, to let them pick themselves +up and divert their minds from their hurts by suggesting that they +have broken the floor, or hurt it. For the less sympathy expressed, +the shorter will be the crying, and the sooner the child will learn to +take the hard knocks of life without feeling that it is especially +abused or suffering any more than comes to most people. Unfortunately, +it is not always the custom to do the same thing with the children of +a larger growth. This is particularly true when there is but a single +child in the family, or perhaps two, when a good deal of sympathy is +likely to be wasted on their ills which are often greatly increased by +their self-consciousness and their dwelling on them. Diversion of +mind, not pity, is needed. The advice to do the next thing and not cry +over spilt milk is ever so much better than sentimental recalling of +the past. + +{60} + +Many a young man who went to war learned the precious lesson that +sympathy, though he might crave it, instead of doing him good would do +harm. Many a manly character was rounded out into firm self-control +and independence by military discipline and the lack of anything like +sentimentality in camp and military life. A good many mothers whose +boys had been the objects of their special solicitude felt very sorry +to think that they would have to submit to the hardships and trials +involved in military discipline. Most of them who were solicitous in +this way were rather inclined to feel that their boy might not be able +to stand up under the rigidities of military life and hoped at most +that he would not be seriously harmed. They could not think that early +rising, hard work, severe physical tasks, tiring almost to exhaustion, +with plain, hearty, yet rather coarse food, eaten in slapdash fashion, +would be quite the thing for their boy of whom they had taken so much +care. Not a few of them were surprised to find how the life under +these difficult circumstances proved practically always beneficial. + +I remember distinctly that when the soldiers were sent to the Mexican +border the mother of {61} a soldier from a neighboring State remarked +rather anxiously to me that she did not know what would happen to Jack +under the severe discipline incident to military life. He had always +gone away for five or six weeks in the summer either to the mountains +or to the seashore, and the Mexican border, probably the most trying +summer climate in the United States, represented the very opposite of +this. Besides, there was the question of the army rations; Jack was an +only son with five sisters. Most of them were older than he, and so +Jack had been coddled as though by half a dozen mothers. He was +underweight, he had a rather finicky appetite, he was capricious in +his eating both as to quantity and quality, and was supposed to be a +sufferer from some form of nervous indigestion. Personally, I felt +that what Jack needed was weight, but I had found it very hard to +increase his weight. He was particularly prone to eat a very small +breakfast, and his mother once told me that whenever he was at home, +she always prepared his breakfast for him with her own hands. This did +not improve matters much, however, for Jack was likely to take a small +portion of the meat cooked for him, refuse to touch the potatoes, and +eat marmalade and toast with {62} his coffee and nothing more. No +wonder that he was twenty pounds underweight or that his mother should +be solicitous as to what might happen to her Jack in army life at the +Border. + +I agreed with her in that but there were some things that I knew would +not happen to Jack. His breakfast, for instance, would not be +particularly cooked for him, and he might take or leave exactly what +was prepared for every one else. Neither would the Government cook +come out and sit beside Jack while he was at breakfast and tempt him +to eat, as his mother had always done. I knew, too, that at other +meals, while the food would be abundant, it would usually be rather +coarse, always plain, and there would be nothing very tempting about +it unless you had your appetite with you. If ever there is a place +where appetite is the best sauce, it is surely where one is served +with army food. + +I need scarcely tell what actually happened to Jack, for it was +exactly what happened to a good many Jacks whose mothers were equally +afraid of the effects of camp life on them. Amid the temptations of +home food, Jack had remained persistently underweight. Eating an army +ration with the sauce of appetite due to prolonged physical efforts in +the outdoor {63} air every day, Jack gained more than twenty pounds in +weight, in spite of the supposedly insalubrious climate of the Border +and the difficult conditions under which he had to live. It was +literally the best summer vacation that Jack had ever spent, though if +the suggestion had ever been made that this was the sort of summer +vacation that would do him good, the idea would have been scoffed at +as impractical, if not absolutely impossible. + +Homer suggested that a mollycoddle character whom he introduces into +the "Iliad" owed something of his lack of manly stamina to the fact +that he had six sisters at home, and an Irish friend once translated +the passage by saying that the young man in question was "one of seven +sisters." This had been something of Jack's trouble. He had been asked +always whether he changed his underwear at the different seasons, +whether he wore the wristlets that sisterly care provided for him, +whether he put on his rubbers when he went out in damp weather and +carried his umbrella when it was threatening rain, and all the rest. +He got away from all this sympathetic solicitude in army life and was +ever so much better for it. + +It is extremely difficult to draw the line {64} where the sympathy +that is helpful because it is encouraging ends, and sentimental pity +which discourages begins. There is always danger of overdoing and it +is extremely important that growing young folks particularly should be +allowed to bear their ills without help and learn to find resources +within themselves that will support them. The will can thus be +buttressed to withstand the difficulties of life, make them much +easier to bear, and actually lessen their effect. Ten growing young +folks have been seriously hurt by ill-judged sympathy for every one +that has been discouraged by the absence of sympathy or by being made +to feel that he must take the things of life as they come and stand +them without grouchy complaint or without looking for sympathy. + +This is particularly true as regards those with any nervous or +hysterical tendencies, for they readily learn to look for sympathy. +The most precious lesson of the war for physicians has been that which +is emphasized in the chapter on "The Will and the War Psychoneuroses." +There was an immense amount of so-called "shell-shock" which really +represented functional neurotic conditions such as in women used to be +called hysteria. At the {65} beginning of the war there was a good +deal of hearty sympathy with it, and patients were encouraged by the +physicians and then by the nurses and other patients in the hospital +to tell over and over again how their condition developed. It was +found after a time that the sympathy thus manifested always did harm. +The frequent repetition of their stories added more and more +suggestive elements to the patients' condition, and they grew worse +instead of better. It was found that the proper curative treatment was +to make just as little as possible of their condition, to treat them +firmly but with assurance--once it had been definitely determined that +no organic nervous trouble was present--and to bring about a cure of +whatever symptoms they had at a single sitting by changing their +attitude of mind towards themselves. + +Some of the patients proved refractory and for these isolation and +rather severe discipline were occasionally necessary. The isolation +was so complete as to deprive them not only of companionship but also +of reading and writing materials and the solace of their tobacco. +Severe cases were sometimes treated by strong faradic currents of +electricity which were extremely painful. Patients who insisted that +{66} they could not move their muscles were simply made to jump by an +electric shock, thus proving to them that they could use the muscles, +and then they were required to continue their use. + +Those suffering from shell-shock deafness and muteness were told that +an electrode would be applied to their larynx or the neighborhood of +their ear and when they felt pain from it, that was a sign that they +were able to talk and to hear if they wished, and that they must do +so. Relapses had to be guarded against by suggestion, and where +relapses became refractory and stronger currents of electricity to ear +and larynx were deemed inadvisable, the strict isolation treatment +usually proved effective. + +In a word, discipline and not sympathy was the valuable mode of +treating them. Sympathy did them harm as it invariably does. The world +has recognized this truism always, but we need to learn the lesson +afresh, or the will power is undermined. Character is built up by +standing the difficult things of life without looking for the narcotic +of sympathy or any other anaesthetizing material. These are "hard +sayings," to use a Scriptural expression, but they represent the +accumulation of wisdom of human experience. Sympathy can be {67} +almost as destructive of individual morale as the dreads, and it is +extremely important that it should not be allowed to sap will energy. +In our time above all, when the training of the will has been +neglected, though it is by far the most important factor in education, +this lesson with regard to the harmful effect of sympathy needs to be +emphasized. + +For nervous people, that is, for those who have, either from +inheritance or so much oftener from environment, yielded to +circumstances rather than properly opposed them, sympathy is quite as +dangerous as opium. George Eliot once replied to a friend who asked +her what was duty, that duty consisted in facing the hard things in +life without taking opium. + +Healthy living to a great extent depends on standing what has to be +borne from the bodies that we carry around with us without looking for +sympathy. It has often been emphasized that human beings are eminently +lonely. The great experiences of life and above all, death and +suffering, we have to face by ourselves and no one can help us. We may +not be, as Emerson suggested, "infinitely repellent particles", but at +all the profoundest moments of life we feel our alone-ness. The more +{68} that we learn to depend bravely on ourselves and the less we seek +outside support for our characters, the better for us and our power to +stand whatever comes to us in life. + +Physical ills are always lessened by courageously facing them and are +always increased by cringing before them. The one who dreads suffers +both before and during the time of the pain and thus doubles his +discomfort. We must stand alone in the matter and sympathy is prone to +unman us. Looking for sympathy is a tendency to that self-pity which +is treated in a subsequent chapter and which does more to increase +discomfort in illness, exaggerate symptoms, and lower resistive +vitality than anything else, in the psychic order at least. + +Suffering is always either constructive or destructive of character. +It is constructive when the personal reaction suffices to lessen and +make it bearable. It is destructive whenever there is a looking for +sympathy or a leaning on some one else. Character counts in +withstanding disease, and even in the midst of epidemics, according to +many well-grounded traditions, those who are afraid contract the +disease sooner than others and usually suffer more severely. Sympathy +must not be allowed to produce any such effect as this. + +{69} + +CHAPTER V + +SELF-PITY + + + "The will dotes that is attributive + To what infectiously itself affects." + _Troilus and Cressida_. + + +The worst brake on the will to be well is undoubtedly the habit that +some people have of pitying themselves and feeling that they are +eminently deserving of the pity of others because of the trials, real +or supposed, which they have to undergo. Instead of realizing how much +better off they are than the great majority of people--for most of the +typical self-pitiers are not real subjects for pity--they keep looking +at those whom they fondly suppose to be happier than themselves and +then proceed to get into a mood of commiseration with themselves +because of their ill health--real or imaginary--or uncomfortable +surroundings. Just as soon as men or women assume this state of mind, +it becomes extremely difficult for them to stand any real {70} trials +that appear, and above all, it becomes even more difficult for them to +react properly against the affections of one kind or another that are +almost sure to come. Self-pity is ever a serious hamperer of resistive +vitality. + +A great many things in modern life have distinctly encouraged this +practice of self-pity and conscious commiseration of one's state until +it has become almost a commonplace of modern life for those who feel +that they are suffering, especially if they belong to what may be +called the sophisticated classes. We have become extremely sensitive +as a consequence about contact with suffering. Editors of magazines +and readers for publishing houses often refuse in our time to accept +stories that have unhappy endings, because people do not care to read +them, it is said. The story may have some suffering in it and even +severe hardships, especially if these can be used for purposes of +dramatic climax, but by the end of the story everything must have +turned out "just lovely", and it must be understood that suffering is +only a passing matter and merely a somewhat unpleasant prelude to +inevitable happiness. + +Almost needless to say, this is not the way of life as it must be +lived in what many {71} generations of men have agreed in calling +"this vale of tears." For a great many people have to suffer severely +and without any prospect of relief--none of us quite escape the +necessity of suffering--and as some one has said, all human life, +inasmuch as there is death in it, must be considered a tragedy. The +old Greeks did not hesitate, in spite of their deep appreciation of +the beauty of nature and cordial enthusiasm for the joy of living, +even to emphasize the tragedy in life. They were perhaps inclined to +think that the sense of contrast produced by tragedy heightened the +actual enjoyment of life and that indeed all pleasure was founded +rather on contrast than positive enjoyment. One may not be ready to +agree with the saying that the only thing that makes life worth while +is contrast, but certainly suffering as a background enhances +happiness as nothing else can. + +Aristotle declared that tragedy purges life, that is, that only +through the lens of death and misfortune could one see life free from +the dross of the sordid and merely material to which it was attached. +His meaning was that tragedy lifted man above the selfishness of mere +individualism, and by showing him the misfortunes of others prepared +him to struggle {72} for himself when misfortune might come, as it +almost inevitably would; and at the same time lifted him above the +trifles of daily life into a higher, broader sphere of living, where +he better realized himself and his powers. + +For man is distinctly prone to forget about death and suffering, and +when he does, to become eminently selfish and forgetful of the rights +of others and his duties towards them. The French have a saying, +consisting of but four words and an intervening shrug of the +shoulders, that is extremely illuminating. They quote as the +expression of the usual thought of men when brought face to face with +the fact that people are dying all around them, "_On meurt--les +autres!_" "People die--Oh, yes (with an expressive shrug of the +shoulders), other people!" We refuse to recognize the fact that we too +must go until that is actually forced upon us by advancing years or by +some incurable disease. As for suffering, a great many people have +come almost to resent that they should be asked to suffer, and +character dissolves in self-pity as a result. + +Instead of the constant, continuous reading of what may be called +Sybaritic literature--for it is said that the Sybarite finds it +impossible to sleep if there is a crushed rose leaf next {73} his +skin--instead of being absorbed in the literature which emphasizes the +pleasures of life and pushes its pains into the background, young +people, and especially those of the better-to-do classes, should be +taught from their early years to read the lives of those who have +endured successfully hardships of various kinds and have succeeded in +getting satisfaction out of their accomplishment in life, despite all +the suffering that was involved. These are human beings like +ourselves, and what mortal has done, other mortals can do. + +There was a school of American psychologists before the war who had +come to recognize the value of that old-fashioned means of +self-discipline of mind, the reading of the lives of the saints. For +those to whom that old-fashioned practice may seem too reactionary, +there are the lives and adventures of our African and Asiatic +travelers and our polar explorers as a resource. + +War books have been a godsend for our generation in this regard. They +have led people to contemplate the hardest kind of suffering--and very +often in connection with those who are nearest and dearest to them-- +and thus made them understand something of the possibilities of human +nature to withstand {74} trials and sufferings. As a result they have +been trained not to make too much of their own trivial trials, as they +soon learned to recognize them in the face of the awful hardships that +this war involved. What Belgium endured was bad enough, while the +experiences of Poland, Servia, Armenia were an ascending scale of +horrors, but also of humanity's power to stand suffering. + +Life in the larger families of the olden times afforded more +opportunities for the proper teaching of the place of suffering than +in the smaller families of the modern time. Older children, as they +grew up, had before them the example of mother's trials and hardships +in bearing and rearing children, and so came to understand better the +place of hard things in life. In a large family it was very rare when +one or more of the members did not die, and thus growing youth was +brought in contact with the greatest mystery in life, that of death. +Very frequently at least one of the household and sometimes more, had +to go through a period of severe suffering with which the others were +brought in daily contact. It is sometimes thought in modern times that +such intimacy with those who are suffering takes the joy out of life +for those who {75} are young, but any one who thinks so should consult +a person who has had the actual experience; while occasionally it may +be found that some one with a family history of this kind may think +that he or she was rendered melancholy by it, nine out of ten or even +more will frankly say that they feel sure that they were benefited. +There is nothing in the world that broadens and deepens the +significance of life like intimate contact with suffering, if not in +person, then in those who are near and dear to us. + +As a physician, I have often felt that I should like to take people +who are constantly complaining of their little sorrows and trials, who +are downhearted over some minor ailment, who sometimes suffer from +fits of depression precipitated by nothing more, perhaps, than a dark +day or a little humid weather, or possibly even a petty social +disappointment, and put them in contact with cancer patients or others +who are suffering severely day by day, yes, hour by hour, night and +day, and yet who are joyful and often a source of joy to others. Let +us not forget that nearly one hundred thousand people die every year +from cancer in this country alone. + +As a physician, I have often found that a {76} chronic invalid in a +house became the center of attraction for the whole household, and +that particularly when it was a woman, whether mother or elder sister, +all of the other members brought their troubles to her and went away +feeling better for what she said to them. I have seen this not in a +few exceptional instances, but so often as to know that it is a rule +of life. Chronic invalids often radiate joy and happiness, while +perfectly well people who suffer from minor ills of the body and mind +are frequently a source of grumpiness, utterly lack sympathy, and are +impossible as companions. An American woman, bedridden for over thirty +years, has organized by correspondence one of the most beautiful +charities of our time. + +Pity properly restricted to practical helpfulness without any +sentimentality is a beautiful thing. There is always a danger, +however, of its arousing in its object that self-pity which is so +eminently unlovely and which has so often the direct tendency to +increase rather than decrease whatever painful conditions are present. + +Crying over oneself is always to be considered at least hysterical. +Crying, except over a severe loss, is almost unpardonable. {77} It is +often said that a good cry, like a rainstorm, clears the atmosphere of +murk and the dark elements of life, but it is dangerous to have +recourse to it. It is a sign of lack of character almost invariably +and when indulged in to any extent will almost surely result in +deterioration of the power to withstand the trials of life, whatever +they may be. + +Professor William James has suggested that not only should men and +women stand the things that come to them in the natural course of +events, but they should even go out and seek certain things hard to +bear with the idea of increasing their power to withstand the +unpleasant things of life. This is, of course, a very old idea in +humanity, and the ascetics from the earliest days of Christianity +taught the doctrine of self-inflicted suffering in order to increase +the power of resistance. + +It is usually said that the principal idea which the hermits and +anchorites and the saintly personages of the early Middle Ages, of +whose mortifications we have heard so much, had in inflicting pain on +themselves was to secure merit for the hereafter. Something of that +undoubtedly was in their minds, but their main purpose was quite +literally ascetic. _Ascesis_, from the Greek, means in its strict {78} +etymology just exercise. They were exercising their power to stand +trials and even sufferings, so that when these events came, as +inevitably they would, seeing that we carry round with us what St. +Paul called "this body of our death," they would be prepared for them. + +Practically any psychologist of modern times who has given this +subject any serious thought will recognize, as did Professor James, +the genuine psychology of human nature that lies behind these ascetic +practices. Nothing that I know is so thoroughgoing a remedy for +self-pity as the actual seeking at times of painful things in order to +train oneself to bear them. The old-fashioned use of disciplines, that +is, little whips which were used so vigorously sometimes over the +shoulders as to draw blood, or the wearing of chains which actually +penetrated the skin and produced quite serious pain no longer seems +absurd, once it is appreciated that this may be a means of bracing up +character and making the real trials and hardships of life much easier +than would otherwise be the case. + +Not that human nature must not be expected to yield a little under +severe trials and bend before the blasts of adverse fortune, but {79} +that there should not be that tendency to exaggerate one's personal +feelings which has unfortunately become characteristic of at least the +better-to-do classes in our time. Not that we would encourage stony +grief, but that sorrow must be restrained and, above all, must not be +so utterly selfish as to be forgetful of others. + +Tears should, to a large extent, be reserved, as they are in most +perfectly normal individuals, for joyous rather than sad occasions, +for no one ever was supremely joyful without having tears in the eyes. +It is when we feel most sympathetic to humanity that the gift of tears +comes to us, and no feeling is quite so completely satisfying as comes +from the tears of joy. Mothers who have heard of their boy's bravery, +its recognition by those above him, and its reward by proper symbols, +have had tears come welling to their eyes, while their hearts were +stirred so deeply with sensations of joy and pride that probably they +have never before felt quite so happy. + +{80} + +CHAPTER VI + +AVOIDANCE OF CONSCIOUS USE OF THE WILL + + + "Our bodies are our gardens to which our wills are gardeners." + _Othello_. + + +Doctor Austin O'Malley, in his little volume, "Keystones of Thought", +says: "When you are conscious of your stomach or your will you are +ill." We all appreciate thoroughly, as the result of modern progress +in the knowledge of the influences of the mind on the body, how true +is the first part of this saying, but comparatively few people realize +the truth of the second part. The latter portion of this maxim is most +important for our consideration. It should always be in the minds of +those who want to use their own wills either for the purpose of making +themselves well, or keeping themselves healthy, but above all, should +never be forgotten by those who want to help others get over various +ills that are manifestly due in whole or in part to the failure to use +the vital energies in the body as they should be employed. + +{81} + +Conscious use of the will, except at the beginning of a series of +activities, is always a mistake. It is extremely wasteful of internal +energy. It adds greatly to the difficulty of accomplishing whatever is +undertaken. It includes, above all, watching ourselves do things, +constantly calculating how much we are accomplishing and whether we +are doing all that we should be doing, and thus makes useless demands +on power partly by diversion of attention, partly by impairment of +concentration, but above all by adding to the friction because of the +inspection that is at work. + +The old kitchen saw is "a watched kettle never boils." The real +significance of the expression is of course that it seems to take so +long for the water to boil that we become impatient while watching and +it looks to us as though the boiling process would really never occur. +This is still more strikingly evident when we are engaged in watching +our own activities and wondering whether they are as efficient as they +should be. The lengthening of time under these circumstances is an +extremely important factor in bringing about tiredness. Ask any human +being unaccustomed to note the passage of time to tell you when two +minutes have elapsed; {82} inevitably he will suggest at the end of +thirty to forty seconds that the two minutes must be up. Only by +counting his pulse or by going through some regular mechanical process +will he be enabled to appreciate the passage of time in anything like +its proper course. When watched thus, time seems to pass ever so much +more slowly than it would otherwise. + +It is extremely important then that people should not acquire the +impression that they must be consciously using their will to bring +themselves into good health and keep themselves there, for that will +surely defeat their purpose. What is needed is a training of the will +to do things by a succession of harder and harder tasks until the +ordinary acts of life seem comparatively easy. Intellectual persuasion +as to the efficiency of the will in this matter means very little. The +ordinary feeling that reasoning means much in such matters is a +fallacy. Much thinking about them is only disturbing of action as a +rule and Hamlet's expression that the "native hue of resolution is +sicklied o'er with the pale cast of thought" is a striking bit of +psychology. + +Shakespeare had no illusions with regard to the place of the will in +life and more than any English author has emphasized it. I have {83} +ventured to illustrate this by quotations from him under each chapter +heading, but there are many more quite as applicable that might +readily be found. He knew above all how easy it was for human beings +to lessen the power of their wills and has told us of "the cloy'd will +that satiateth unsatisfied desire" and "the bridles of our wills", and +has given us such adjectives as "benumbed" and "neutral" and "doting", +which demonstrates his recognition of how men weaken their wills by +over-deliberation. + +The mode of training in the army is of course founded on this mode of +thinking. The young men in the United States Army want to accomplish +every iota of their duty and are not only willing but anxious to do +everything that is expected of them. There were some mighty difficult +tasks ahead of them over in Europe and our method of preparing the men +was not by emphasizing their duty and dinning into their ears and +minds how great the difficulty would be and how they must nerve +themselves for the task. Such a mode of preparation would probably +have been discouraging rather than helpful. But they were trained in +exercises of various kinds in an absolutely regular life under plain +living in the {84} midst of hard work until their wills responded to +the word of command quite unconsciously and immediately without any +need of further prompting. Their bodies were trained until every +available source of energy was at command, so that when they _wanted_ +to do things they set about them without more ado, and as they were +used to being fatigued they were not constantly engaged in dreading +lest they should hurt themselves, or fostering fears that they might +exhaust their energies or that their tiredness, even when apparently +excessive, would mean anything more than a passing state that rest +would repair completely. + +If at every emergency of their life at war soldiers had to go through +a series of conscious persuasions to wake up their will and set their +energies at work, and if they had to occupy themselves every time in +presenting motives why this activity should not be delayed, then +military discipline, at least in so far as it involves prompt +obedience, would almost inevitably be considerable of a joke. What is +needed is unthinking, immediate obedience, and this can be secured +only by the formation of deeply graven habits which enable a man to +set about the next thing that duty calls for at once. + +{85} + +Every action that we perform is the result of an act of the will, but +we do not have to advert to that as a rule; whenever any one gets into +a state of mind where it is necessary to be constantly adverting to +it, then, as was said at the beginning of this chapter, there is +something the matter with the will. The faculty is being hampered in +its action by consciousness, and such hampering leads to a great waste +of energy. + +The will is the great, unconscious faculty in us. By far the greater +part of what has come unfortunately to be called the unconscious and +the subconscious and that has occupied so much of the attention of +modern writers on psychological subjects is really the will at work. +It attains its results we know not how, and it is prompted to their +accomplishment in ways that are often very difficult for us to +understand. Its effects are often spoken of as due to the submerged +self or the subliminal self or the other self, but it is only in rare +and pathological cases as a rule that such expressions are justified +once the place of the will is properly recognized. + +It is often said, for instance, that the power some people have of +waking after a certain {86} period of sleep at night or after a short +nap during the daytime, a power that a great many more people would +possess if only they deliberately practised it, is due to the +subconsciousness or the subliminal personality of the individual which +wakes him up at the determined time. Why those terms should be used +when other things are accomplished by the human will just as +mysteriously is rather difficult to understand. It is well recognized +that if an individual in the ordinary waking state wants to do +something after the lapse of an hour or so he will do it, provided his +will is really awake to the necessity of accomplishing it. It is true +that he may become so absorbed in his current occupation as to miss +the time, but such abstraction usually means that he was not +sufficiently interested in the duty that was to be performed as to +keep the engagement with himself, or else that he is an individual in +whom the intellectual over-shadows the voluntary life. We speak of him +as an impractical man. + +We all know the danger there is in putting off calling some one by +telephone on being told that "the line is busy", for not infrequently +it will happen that several hours will elapse before we think of the +matter again {87} and then perhaps it may be too late. If we set a +definite time limit with ourselves, however, then our will will prompt +us quite as effectively, though quite as inexplicably, at the +expiration of that time as it awakes those who have resolved to be +aroused at a predetermined moment. We may miss our telephone +engagement with ourselves, but we practically never miss an important +train, because having deeply impressed upon ourselves the necessity +for not missing this, our will arouses us to activity in good time. +There is not the slightest necessity, however, for appealing to the +unconscious or the subconscious in this. It is true that there is a +wonderful sentinel within us that awakes us from daydreams or disturbs +the ordinary course of some occupation to turn our attention to the +next important duty that we should perform. We know that this sentinel +is quite apart from our consciousness; but the power we have of +setting ourselves to doing anything is exemplified in very much the +same way. When I want a book, I do not know what it is that sets my +muscles in motion and brings me to a shelf and then directs my +attention to choosing the one I shall take down and consult. It is an +unconscious activity, but not the activity of {88} unconsciousness, +which is only a contradiction in terms. [Footnote 4] + + [Footnote 4: It is true that there is a particular phase of our + intellectual effort included under the modern terms unconscious or + subconscious that is mysterious enough to deserve a special name, + but we already have an excellent term for this quality which is not + vague but thoroughly descriptive of its activity. This is + intuition,--a word that has been in use for nearly a thousand years + now and signifies the immediate perception of a truth,--by a flash + as it were. We may know nothing about a subject and may have only + begun to think about it, when there flashes on us a truth that has + perhaps never occurred to any one else and certainly has never been + in our minds before. It has been suggested in recent years that such + flashes of intelligence are due to the secondary personality or the + subliminal self or the other self, and it is often added that it is + the development of our knowledge of these phases of psychology that + represents modern progress in the science of mind. Only the term for + it is new, however, for intuition has been the subject of special + intensive study for a long while. Indeed, the reason why the + old-time poet appealed to the muses for aid and the modern poet + suggests inspiration as the source of his poetic thought, is because + both of them knew that their best thoughts flash on them, not as the + result of long and hard thinking, but by some process in which with + the greatest facility come perceptions that even they themselves are + surprised to learn that they have. To say that such things come from + the unconscious is simply to ignore this wonderful power of original + thought, that is, primary perception. Emerson suggested that + intuition represented all the knowledge that came without tuition, + as if this were the etymology, and the hint is excellent for the + meaning, though the real derivation of the word has no relation to + tuition. To attribute these original thoughts to the unconscious or + any partly conscious faculty in us is to ignore a great deal of + careful study of psychology before our time. It is besides to + entangle oneself in the absurdity of discussing an unconscious + consciousness.] + +While many people are inclined to feel almost helpless in the presence +of the idea that it is their unconscious selves that enable them {89} +to do things or initiate modes of activity, the feeling is quite +different when we substitute for that the word "will." All of us +recognize that our wills can be trained to do things, and while at +first it may require a conscious effort, we can by the formation of +habits not only make them easy, but often delightful and sometimes +quite indispensable to our sense of well being. Walking is extremely +difficult at the beginning, when its movements are consciously +performed, but it becomes a very satisfying sort of exercise after a +while and then almost literally a facile, nearly indispensable +activity of daily life, so that we feel the need for it, if we are +deprived of it. + +This has to be done with regard to the activities that make for +health. We have to form habits that render them easy, pleasant, and +even necessary for our good feelings. This can be done, as has been +suggested in the chapter on habits, but we have to avoid any such +habit as that of consciously using the will. That is a bad habit that +some people let themselves drop into but it should be corrected. +Having set our activities to work we must, as far as possible, forget +about them and let them go on for themselves. It is not only possible +but even easy and above all almost {90} necessary that we should do +this. Hence at the beginning people must not expect that they will +find the use of their will easy in suppressing pain, lessening +tiredness, and facilitating accomplishment, but they must look forward +to the time quite confidently when it will be so. In the meantime the +less attention paid to the process of training, the better and more +easily will the needed habits be formed. + +Failure to secure results is almost inevitable when conscious use of +the will comes into the problem. As a rule a direct appeal should not +be made to people to use their wills, but they should be aroused and +stimulated in various ways and particularly by the force of example. +What has made it so comparatively easy for our young soldiers to use +their wills and train their bodies and get into a condition where they +are capable of accomplishing what they would have thought quite +impossible before, has been above all the influence of example. A lot +of other young men of their own age are standing these things +exemplarily. They are seen performing what is expected of them without +complaint, or at least without refusal, and so every effort is put +forth to do likewise without any time spent on reflection as to how +{91} difficult it all is or how hard to bear or how much they are to +be pitied. It is not long before what was hard at first becomes under +repetition even easy and a source of fine satisfaction. Getting up at +five in the morning and working for sixteen hours with only +comparatively brief intervals for relaxation now and then, and often +being burdened with additional duties of various kinds which must be +worked in somehow or other, seems a very difficult matter until one +has done it for a while. Then one finds everything gets done almost +without conscious effort. Will power flows through the body and lends +hitherto unexpected energy, but of this there is no consciousness; +indeed, conscious reflection on it would hamper action. No wonder that +as a result of the facility acquired, one comes to readily credit the +assumption that the will is a spiritual power and that some source of +energy apart from the material is supplying the initiative and the +resources of vitality that have made accomplishment so much easier +than would have been imagined beforehand. This is quite literally what +training of the will means: training ourselves to use all our powers +to the best advantage, not putting obstacles in their way nor brakes +on their exertion, but {92} also not thinking very much about them or +making resolutions. The way to do things is to do them, not think +about them. + +Professor James is, as always, particularly happy in his mode of +expressing this great truth. He insists that the way to keep the will +active is not by constantly thinking about it and supplying new +motives and furbishing up old motives for its activity, but by +cultivating the faculty of effort. His paragraph in this regard is of +course well known, and yet it deserves to be repeated here because it +represents the essence of what is needed to make the will ready to do +its best work. He says: + + "As a fine practical maxim, relative to these habits of the will, we + may, then, offer something like this: _Keep the faculty of effort + alive in you by a little gratuitous exercise every day_. That is, be + systematically ascetic or heroic in little unnecessary points, do + every day or two something for no other reason than that you would + rather not do it, so that when the hour of dire need draws nigh, it + may find you not unnerved and untrained to stand the test. + Asceticism of this sort is like the insurance which a man pays on + his house and goods. The tax does him no good at the time and {93} + possibly may never bring him a return. But if the fire _does_ come, + his having paid it will be his salvation from ruin. So with the man + who has daily inured himself to habits of concentrated attention, + energetic volition, and self-denial in unnecessary things. He will + stand like a tower when everything rocks around him, and when his + softer fellow mortals are winnowed like chaff in the blast." + +To do things on one's will without very special interest is an +extremely difficult matter. It can be done more readily when one is +young and when certain secondary aims are in view besides the mere +training of the will, but to do things merely for will training +becomes so hard eventually that some excuse is found and the task is +almost inevitably given up. Exercising for instance in a gymnasium +just for the sake of taking exercise or keeping in condition becomes +so deadly dull after a while that unless there is a trainer to keep a +man up to the mark, his exercise dwindles from day to day until it +amounts to very little. Men who are growing stout about middle life +will take up the practice of a cold bath after ten minutes or more of +morning exercises with a good deal of enthusiasm, but they will not +keep it up long, or if they do continue for several months, any {94} +change in the daily routine will provide an excuse to drop it. +Companionship and above all competition in any way greatly helps, but +it takes too much energy of the will to make the effort alone. +Besides, when the novelty has worn off and routine has replaced +whatever interest existed in the beginning in watching the effect of +exercise on the muscles, the lack of interest makes the exercise of +much less value than before. If there is not a glow of satisfaction +with it, the circulation, especially to the periphery to the body, is +not properly stimulated and some of the best effect of the exercise is +lost. Athletes often say of solitary exercise that it leaves them +cold, which is quite a literal description of the effect produced on +them. The circulation of the surface is not stimulated as it is when +there is interest in what is being done and so the same warmth is not +produced at the surface of the body. + +It is comparatively easy to persuade men who need outdoor exercise to +walk home from their offices in the afternoon when the distance is not +too far, but it is difficult to get them to keep it up. The walk +becomes so monotonous a routine after a time that all sorts of excuses +serve to interrupt the habit, and then it is not long before it is +done so irregularly as to lose {95} most of its value. Here as in all +exercise, companionship which removes conscious attention from +advertence to the will greatly aids. On the other hand, as has been so +clearly demonstrated in recent years, it is very easy to induce men to +go out and follow a little ball over the hills in the country, an +ideal form of exercise, merely because they are interested in their +score or in beating an opponent. Any kind of a game that involves +competition makes people easily capable of taking all sorts of +trouble. Instead of being tired by their occupation in this way and +not wanting to repeat it, they become more and more interested and +spend more and more time at it. The difference between gymnastics and +sport in this regard is very marked. + +In sport the extraneous interest adds to the value of the exercise and +makes it ever so much easier to continue; when it sets every nerve +tingling with the excitement of the game, it is doing all the more +good. Gymnastics grow harder unless in some way associated with +competition, or with the effort to outdo oneself, while indulgence in +sport becomes ever easier. Many a young man would find it an +intolerable bore and an increasingly difficult task if asked to give +as much time and energy {96} to some form of hard work as he does to +some sport. He feels tired after sport, but not exhausted, and becomes +gradually able to stand more and more before he need give up, thus +showing that he is constantly increasing his muscular capacity. + +Conscious training of the will is then practically always a mistake. +It is an extremely difficult thing to do, and the amount of inhibition +which accumulates to oppose it serves after a time to neutralize the +benefit to be derived. Good habits should be formed, but not merely +for the sake of forming them. There should be some ulterior purpose +and if possible some motive that lifts men up to the performance of +duty, no matter how difficult it is. + +Our young men who went to the camps demonstrated how much can be +accomplished in this manner. They were asked to get up early in the +morning, to work hard for many hours in the day, or take long walks, +sometimes carrying heavy burdens, and were so occupied that they had +but very little time to themselves. They were encouraged to take +frequent cold baths, which implied further waste of heat energy, and +then were very plainly fed, though of course with a good, rounded +diet, {97} well-balanced, but without any frills and with very little +in it that would tempt any appetite except that of a hungry man. They +learned the precious lesson that hunger is the best sauce for food. + +Most of these men were pushed so hard that only an army officer +perfectly confident of what he was doing and well aware that all of +his men had been thoroughly examined by a physician and had nothing +organically wrong with them would have dared to do it. A good many of +us had the chance to see how university men took the military regime. +Long hours of drilling and of hard work in the open made them so tired +that in the late afternoon they could just lie down anywhere and go to +sleep. I have seen young fellows asleep on porches or in the late +spring on the grass and once saw a number of them who found excellent +protection from the sun in what to them seemed nice soft beds--at +least they slept well in them--inside a series of large earthen-ware +pipes that were about to be put down for a sewer. Some of them were +pushed so hard, considering how little physical exercise they had +taken before, that they fainted while on drill. Quite a few of them +were in such a state of nervous tension that they fainted on {98} +being vaccinated. Almost needless to say, had they been at home, any +such effect would have been a signal for the prompt cessation of such +work as they were doing, for the home people would have been quite +sure that serious injury would be done to their boys. These young +fellows themselves did not think so. Their physicians were confident +that with no organic lesion present the faint was a neurotic +derangement and not at all a symptom of exhaustion. The young soldiers +would have felt ashamed if there had been any question of their +stopping training. They felt that they could make good as well as +their fellows. They would have resented sympathy and much more pity. +They went on with their work because they were devoted to a great +cause. After a time, it became comparatively easy for them to +accomplish things that would hitherto have been quite impossible and +for which they themselves had no idea that they possessed the energy. +It was this high purpose that inspired them to let more and more of +their internal energy loose without putting a brake on, until finally +the habit of living up to this new maximum of accomplishment became +second nature and therefore natural and easy of accomplishment. + +{99} + +Here is the defect in systems which promise to help people to train +their wills by talking much about it, and by persuading them that it +can be done, that all they have to do is to set about it. Unless one +has some fine satisfying purpose in doing things, their doing is +difficult and fails to accomplish as much good for the doer as would +otherwise be the case. Conscious will activity requires, to use +old-fashioned psychological terms, the exercise of two faculties at +the same time, the consciousness and the will. This adds to the +difficulty of willing. What is needed is a bait of interest held up +before the will, constantly tempting it to further effort but without +any continuing consciousness on the part of the individual that he +must will it and keep on willing it. That must ever be a hampering +factor in the case. Human nature does not like imperatives and writhes +and wastes energy under them. On the contrary, optatives are pleasant +and give encouragement without producing a contrary reaction; and it +is this state of mind and will that is by far the best for the +individual. + +Above all, it is important that the person forming new habits should +feel that there is nothing else to be done except the hard things +{100} that have been outlined. If there is any mode of escape from the +fulfillment of hard tasks, human nature will surely find it. If our +young soldiers had felt that they did not have to perform their +military duties and that there was some way to avoid them, the taking +of the training would have proved extremely difficult. They just _had_ +to take it; there was no way out, so they pushed themselves through +the difficulties and then after a time they found that they were +tapping unsuspected sources of energy in themselves. For when people +_have_ to do things, they find that they can do ever so much more than +they thought they could, and in the doing, instead of exhausting +themselves, they actually find it easier to accomplish more and more +with ever less difficulty. The will must by habit be made so prompt to +obey that obedience will anticipate thought in the matter and +sometimes contravene what reason would dictate if it had a chance to +act. The humorous story of the soldier who, carrying his dinner on a +plate preparatory to eating it, was greeted by a wag with the word +"Attention!" in martial tones, and dropped his dinner to assume the +accustomed attitude, is well known. Similar practical jokes are said +to have been played, on a certain number {101} of occasions in this +war, with the thoroughly trained young soldier. + +The help of the will to the highest degree is obtained not by a series +of resolutions but by doing whatever one wishes to do a number of +times until it becomes easy and the effort to accomplish it is quite +unconscious. Reason does not help conduct much, but a trained will is +of the greatest possible service. It can only be secured, however, by +will action. The will is very like the muscles. There is little use in +showing people how to accomplish muscle feats; they must do them for +themselves. The less consciousness there is involved in this, the +better. + +{102} + +CHAPTER VII + +WHAT THE WILL CAN DO + + + "I can with ease translate it to my will." + _King John_. + + +It should be well understood from the beginning just what the will can +do in the matter of the cure or, to use a much better word, the relief +of disease, not forgetting that disease means etymologically and also +literally discomfort rather than anything else. The will cannot cure +organic disease in the ordinary sense of that term. It is just as +absurd to say that the will can bring about the cure of Bright's +disease as it is to suggest that one can by will power replace a +finger that has been lost. When definite changes have taken place in +tissues, above all when connective tissue cells have by inflammatory +processes come to take the place of organic tissue cells, then it is +idle to talk of bringing about a cure, though sometimes relief of +symptoms may be secured; above all the compensatory powers of the body +{103} may be called upon and will often bring relief, for a time, at +least. What is true of kidney changes applies also to corresponding +changes in other organs, and there can be no question of any amount of +will power bringing about the redintegration of organs that have been +seriously damaged by disease or replacing cells that have been +destroyed. + +There are however a great many organic diseases in which the will may +serve an extremely useful purpose in the relief of symptoms and +sometimes in producing such a release of vital energy previously +hampered by discouragement as will enable the patient to react +properly against the disease. This is typically exemplified in +tuberculosis of the lungs. Nothing is so important in this disease, as +we shall see, as the patient's attitude of mind and his will to get +well. Without that there is very little hope. With that strongly +aroused, all sorts of remedies, many of them even harmful in +themselves, have enabled patients to get better merely because the +taking of them adds suggestion after suggestion of assurance of cure. +The cells of the lungs that have been destroyed by the disease are not +reborn, much less recreated, but nature walls off the diseased parts, +and the rest of {104} the lungs learn to do their work in spite of the +hampering effect of the diseased tissues. When fresh air and good food +are readily available for the patient, then the will power is the one +other thing absolutely necessary to bring about not only relief from +symptoms, but such a betterment in the tissues as will prevent further +development of the disease and enable the lungs to do their work. The +disease is not cured, but, as physicians say, it is arrested, and the +patient may and often does live for many years to do extremely useful +work. + +In a disease like pneumonia the will to get well, coupled with the +confidence that should accompany this, will do more than anything else +to carry the patient over the critical stage of the affection. +Discouragement, which is after all by etymology only disheartenment, +represents a serious effect upon the heart through depression. The +fullest power of the heart is needed in pneumonia and discouragement +puts a brake on it. As we shall see it is probably because whiskey +took off this brake and lifted the scare that it acquired a reputation +as a remedy in pneumonia and also in tuberculosis. In spite of what +was probably an unfavorable physical effect, whiskey {105} actually +benefited the patient by its production of a sense of well being and +absence of regard for consequences. Hence its former reputation. This +extended also to its use in a continued fever where the same +disheartenment was likely to occur with unfortunate consequences on +the general condition and above all with disturbance of appetite and +of sleep. Worry often made the patients much more restless than they +would otherwise have been and they thus wasted vital energy needed to +bring about the cure of the affection under which they were laboring. + +In all of these cases solicitude led to surveillance of processes +within the body and interfered with their proper performance. It is +perfectly possible to hamper the lungs by watching their action, and +the same thing may be done for the heart. Whenever involuntary +activities in the body are watched, their proper functioning is almost +sure to be disturbed. We have emphasized that in the chapter on +"Avoidance of Conscious Use of the Will," and so it need not be dwelt +on further here. + +Even apart from over-consciousness there occur some natural dreads +that may disturb nature's vital reactions, and these can be {106} +overcome through the will. There is a whole series of inhibitions +consequent upon fears of various kinds that sadly interfere with +nature's reaction against disease. To secure the neutralization of +these the will must be brought into action, and this is probably +better secured by suggestion, that is, by placing some special motive +before the individual, than by any direct appeal. Particularly is this +true if patients have not been accustomed before this to use their +wills strenuously, for they will probably be disturbed by such an +appeal. + +What will power when properly released can do above all is to bring +the relief of discomfort. In a great many cases the greater part of +the discomfort is due to over-sensitization and over-attention. Even +in such severe organic diseases as cancer, the awakening of the will +may accomplish very much to bring decided relief. This is why we have +had so many "cancer cures" that have failed. They made the patient +feel better at first, and they relieved pain to some extent and +therefore were thought to be direct remedial agents for the cancer +itself. The malignant condition however has progressed without +remission, though sometimes, possibly as the result of the new courage +given flowing as surplus vitality into {107} the tissues, perhaps the +progress of the lesion has been retarded. The patient sometimes has +felt so much better as to proclaim himself cured. What is thus true of +cancer will be found to occur in any very serious organic condition, +such as severe injury, chronic disease involving important organs, and +even such nutritional diseases as anemia or diabetes. The awakening in +the patient of the feeling that there is hope and the maintenance of +that hope in any way will always bring relief and usually some +considerable remission in the disease. + +It is in convalescence above all, however, that the will power +manifests its greatest helpfulness. When patients are hopeful and +anxious to get well they are tempted to eat properly, to get out into +the air; they thus sleep better and recovery is rapid. Whenever they +are disheartened, as for instance when husband and wife have been +together in an injury, or both have contracted a disease and one of +them dies, the survivor is likely to have a slow and lingering +convalescence. The reason is obvious: there is literal lack of will +power or at least unwillingness to face the new conditions of life, +and vitality is spent in vain regret for the companionship that has +been {108} lost. This depression can only be lifted by motives that +appeal to the inner self and by such an awakening of the will for +further interests in life as will set vital energies flowing freely +again. + +In convalescence from injuries received after middle life or from +affections that have been accompanied by incapacity to use muscles +there is particular need of the will. A great many older people refuse +to go through the pain and discomfort, soreness and tenderness as the +younger folk who are training their muscles call them, which must be +borne in order to bring about redevelopment of muscles, after they +have once become atrophic from disuse. The refusal to push through a +period of what is often rather serious discomfort leads many people to +foster disabilities and use their muscles in wrong ways sometimes even +for years. Something occurs then to arouse their wills and they get +better. Anything that will do this will cure them. Sometimes it is a +new liniment, sometimes a new mode of manipulation or massage, +sometimes some supposed electrical or magnetic discovery and sometimes +the touch of a presumed healer. Anything at all will be effective +provided it wakens their wills into such activity {109} as will enable +them to persist in the use of their muscles through the period of +soreness and tenderness necessary to restore proper muscular +functions. + +It is quite surprising to see what can be accomplished in this way, +and the quacks and charlatans of the world have made their fortunes +out of such patients always, while their cure has been the greatest +possible advertisement and has attracted ever so many other patients +to these so-called healers. Nothing that can be done for these +patients will have any good results unless their own wills are +aroused, new hope given them and they themselves made to tap the +layers of energy in them that can restore them to health. To tell them +that they were to be cured by their own will, however, would probably +inhibit utterly this energy that is needed, so that somehow they have +to be brought to the state of mind in which they will accomplish the +purpose demanded of them by indirection. + +The will is particularly capable of removing obstacles to nutrition +that have often hampered the activities and sometimes seriously +impaired the health of patients. Many people are not eating enough for +one reason or another and need to have their diet regulated, not in +{110} the direction of a limitation or selection of food, though this +appeals to so many people under the term dieting, but so that they +shall eat enough and of the proper variety to maintain their health +and bodily functions. A great many nervous diseases are dependent on +lack of sufficient food. Eating in those who lead sedentary lives much +indoors is ever so much more a matter of will than of appetite. When +people say that they eat all they want to, what they mean, as a rule, +is that they eat all that they have formed the habit of eating. Other +habits can readily be formed and will often do them good. For a great +many of the less serious symptoms which make people valetudinarians, +nervous indigestion, insomnia, tendencies to headache, queer feelings +in the head, constipation, the proper habit secured by will power, of +eating so as to secure sufficient food, is the most important single +factor. This the will must be trained to accomplish. + +Now that disease prevention has become even more important than cure, +the will is an extremely efficient element. Air, food, exercise are +important factors for healthy living. A great many people are +neglecting them and then seem surprised that they should suffer from +various symptoms of impaired {111} functioning of bodily organs. Many +men and a still greater number of women are staying in the house so +much that their oxidation within the body is at a low ebb, and it is +no wonder that vital processes are not carried on to the best +advantage. Our generation has eliminated exercise from life to a great +extent, and now that the auto and the trolley car limit walking, not +only the feet of mankind suffer severely, but all the organs in the +body work at a disadvantage for lack of the exercise that they should +have. No wonder that under the circumstances appetite is impaired and +other functions of the body suffer. Instead of simple foods various +artificial stimulants are employed--such as alcohol, spices, and the +like--to provoke appetite, often with serious consequences for the +digestive organs. The will to be well includes the willing of the +means proper to that purpose, and particularly regular exercise, +several hours a day in the air, good simple food taken in sufficient +quantity at three regular intervals and the avoidance of such sources +of worry as will disturb physical functions. + +{112} + + +CHAPTER VIII + +PAIN AND THE WILL + + + "That the will is infinite and the execution confined." + _Troilus and Cressida_. + + +The symptom of disease that humanity dreads the most is pain. +Fortunately, it is also the symptom which is most under the control of +the will, and which can be greatly relieved by being bravely faced +and, to as great an extent as possible, ignored. It requires courage +and usually persistent training to succeed in the relief of severe +pain in this way, but men have done it, and women too, and men and +women _can_ do it, if they really want to, though unfortunately all of +the trend of modern life has been in the opposite direction, of +avoiding pain at whatever cost instead of bravely facing it. The +American Indian, trained from his youth to stand severe pain, scoffed +at even the almost ingeniously diabolical tortures of his enemy +captors. After they had pushed slivers beneath his nails or {113} +slowly crushed the end of a finger, or put salt in long, superficial +wounds that had bared a whole series of sensitive cutaneous nerves, he +has been known to laugh at them, and ask them proudly, without giving +a sign of the pain that he was enduring, whether that was all that +they could do. It was just a question of the human will overcoming +even the worst sensations that the body could send up to the brain and +deliberately refusing to permit any reactions that would reveal the +reflex torment that was actually taking place. + +The war has done much to bring back the recognition of that +diminution--to a great extent at least--or even almost entire +suppression of pain which may occur, indeed almost constantly does +occur, as a consequence of a man facing it bravely. We have been +accustomed to think of the early martyrs as probably divinely helped +in their power to withstand pain. Whatever of celestial aid they had, +we know that martyrs for all sorts of causes, some of them certainly +not divine, have exhibited some degree of this same steadfastness. +Their behavior makes it reasonably clear that as the result of making +up their minds to stand the pain involved, they have actually suffered +so little that it was not {114} difficult to suppress external +manifestations of their sufferings. It is not merely a suppression of +the reflexes that has occurred but a minimizing to a very striking +degree of the actual sensations felt. We have many stories of the +older time before the modern use of anaesthetics, which tell how +bravely men endured pain and at the same time retained their power to +do things. Indeed, some of them accomplished purposes in the midst of +what would seem like supreme agony which made it very clear that pain +alone has nothing like the prostrating effect that it is often +supposed to have. + +For we have well authenticated tales of physicians performing +amputations on themselves at times when no other assistance was +available, and accomplishing the task so well that they recovered +without complications. A blacksmith in the distant West, whose leg had +been crushed by the fall of a huge beam, actually had himself carried +into his shop and amputated his own limb above the knee, searing the +blood vessels with hot irons as he proceeded. Such a manifestation of +will power is, of course, exceptional to a degree, and yet it +illustrates what men can do in the face of conditions that are usually +supposed {115} to be overwhelming. Many a man in lumber camps or in +distant island fisheries or on board fishing vessels, far beyond the +hope of reaching a physician in time for him to be of service, has +done things of this kind. We can be quite sure that the will to +accomplish for himself what seemed necessary to save his life lessened +his pain, made it ever so much more bearable and generally proved the +power of the human will over even these physical manifestations in the +body that are commonly supposed to be quite beyond any interference +from the psychical part of nature. The spirit can still dominate the +flesh, even in matters of pain, and dictate how much it shall be +affected. It is a hard lesson to learn, but it is one that can be +learned by proper persistence. + +In the early part of the war particularly many a young man had to face +even serious operations without an anaesthetic. The awful carnage of +the first six weeks of the war had not been anticipated and therefore +there were not sufficient stores of anaesthetics available to permit +of their use in every case. Besides, many operations had to be +performed so close to the front and under such circumstances that +there could not be anaesthetics for all of them; and it was a +never-ending source of {116} surprise to those who witnessed the +details to see how bravely and uncomplainingly the young men took +their enforced suffering. Many a one, when his turn came to be +operated on, quietly asked for a cigarette and then bore unflinchingly +painful manipulations that the surgeon was extremely sorry to have to +inflict. Over and over again, when there was question of the regular +succession of patients, young soldiers in severe pain suggested that +some one else who seemed in worse condition than they, or who perhaps +was not quite so well able to stand pain and control himself, should +be attended to before they were. There is no doubt at all that this +very power of self-control lessened their pain and made it ever so +much easier to bear and less of a torment than it would have been +otherwise. + +Any great diversion of mind that turns the attention completely to +something else will lessen even severe pain so much as to make it +quite negligible for the moment. Headaches disappear promptly when +there is an alarm of fire, and toothaches have been known to vanish, +for the time at least, as the result of a burglar scare. Much less +than this is needed, however, and there are many familiar examples +{117} which illustrate the fact that the turning of the attention to +something else will greatly diminish or even abolish pain. + +The well known story of the French surgeon about to set a dislocation +is a typical demonstration. His patient was a woman of the nobility, +her dislocation was of the shoulder and it was necessary for him to +inflict very severe pain in order to replace it. Besides, as the +result of the reflex of that pain, he was certain to meet with great +resistance from spasm in the surrounding muscles. It was before the +days of anaesthetics, which relieve all of these inconveniences, and +above all, relax the muscles. The surgeon got ready to do the ultimate +manipulation that would replace the joint in its proper relation, and +necessarily inflicted no little pain in his preparations. The lady +complained very much, so he turned on her angrily, told her that she +must stand it, slapped her in the face, and before she had recovered +from the shock, the dislocation had been restored to the normal +condition. It was rather heroic treatment, and it is to be hoped that +she understood it, but it is easy to understand how much the procedure +lessened her physical pain. + +When the mind is very much preoccupied {118} and the will intent on +accomplishing some immediate purpose, even severe pain will not be +felt at all. Instances of this are not rare, and men who are advancing +in a charge on a battlefield will often be wounded rather severely, +and yet continue to advance without knowing anything about their +wounds until a friend calls attention to their bleeding, or they +themselves notice it; or perhaps even loss of blood may make them +faint. The late President Roosevelt furnished a magnificent +illustration of this principle when he was wounded some years ago in +the midst of a political campaign. A crank shot at him, in one of the +Western cities, and though the bullet penetrated four inches of muscle +on his chest wall, and then flattened itself against a rib, he did not +know that he was wounded. The flattening of the bullet must have +represented at least as much force as would be exerted by a heavy blow +on the chest, and yet the Colonel never felt it. His friends +congratulated him on his escape from injury until it was noted that +blood was oozing through a hole that had been made in his coat. The +intense will activity of the President simply kept him from noticing +either the shock or the pain. + +{119} + +Not long before the war a striking example was given of how a man may +stand suffering in spite of long years of the refining influences of a +sedentary scholarly life, most of it spent indoors. The second last +General of the Jesuits developed a sarcoma on his upper arm and was +advised to submit to an amputation of the arm at the shoulder joint. +He was a man well on in the sixties and the operation presented an +extremely serious problem. The surgeons suggested that he should be +ready for the anaesthetic at a given hour the next morning and then +they would proceed to operate. He replied that he would be ready for +the operation at the time suggested, but that he would not take an +anaesthetic. They argued with him that it would be quite impossible +for him to stand unanaesthetized the extensive cutting and dissection +necessary to complete an operation of this kind in an extremely +important part of the body, where large nerves and arteries would have +to be cut through and where the slightest disturbance on the part of +the patient might easily lead to serious or even fatal results. Above +all, he could not hope to stand it in tissues that had been rendered +more sensitive than before by the enlarged circulation to the part, +due to {120} the growth of the tumor, and the consequent hyperaemic +condition of most of the tissues through which the cutting would have +to be done and which were thus hypersensitized. + +He insisted, however, that he would not take an anaesthetic, for +surely here seemed a chance to welcome suffering voluntarily as his +Lord and Master had done. I believe that the head surgeon said at +first that he would not operate. He felt sure that the operation would +have to be interrupted after it had been begun, because the patient +would not be able to stand the pain and there would then be the danger +from bleeding as well as from infection which might occur. The General +of the Jesuits, however, was so calm and firm that at last it was +determined to permit him to try at least to stand it, though most of +the surgeons were sure that he would probably have to give up and +allow himself to be anaesthetized before they were through. + +The event then was most interesting. The patient not only underwent +the operation without a murmur, but absolutely without wincing. The +surgeon who performed the operation said afterwards, "It was like +cutting wax and not human flesh, so far as any reaction was concerned, +though of course it bled." + +{121} + +The story carries its lesson of the power of a brave man to face even +such awful pain as this and probably actually overcome it to such an +extent that he scarcely felt it, simply because he willed that he +would do so and occupied himself with other thoughts during the +process. + +Such an example as that of this General of the Jesuits will seem to +most people a reversion to that mystical attitude of mind of the +medieval period, when somehow or other people were able to stand ever +so much more pain than any one in our time could possibly think of +enduring. We hear of saints of the Middle Ages who inflicted what now +seem hideous self-tortures on themselves and not only bore them +bravely but went about life smiling and doing good to others while +they were under the influence of them. It would seem quite impossible, +however, for people of the modern time to get into any such state of +mind. Our discoveries for the prevention of pain have made it +unnecessary to stand much suffering, and as a result mankind would +seem to have lost some if not most of the faculty of standing pain. So +little of truth is there in any such thought that any number of the +young men of the present generation between {122} twenty and thirty, +that is, during the very years when mankind most resents pain and +therefore reacts most to it, and by the same token feels it the most, +have shown during this war that they possessed all the old-fashioned +faculty of standing pain without a whimper and thinking of others +while they did it. + +Lack of advertence always lessens pain and may even nullify it until +it becomes exceedingly severe. In his little volume, "A Journey around +My Room", Xavier de Maistre dwells particularly on the fact that his +body, when his spirit was wandering, would occasionally pick up the +fire tongs and burn itself before his _alter ego_ could rescue it. +Concentration of attention on some subject that attracts may +neutralize pain and make it utterly unnoticed until physical +consequences develop. Undoubtedly dwelling on pain, anticipating it, +noting the first sensations that occur, multiplies the painful +feeling. The physical reasons for this are to be found in the +increased blood supply consequent upon conscious attention to any +part, which sensitizes the nerves of the area and the added number of +nerve fibers that are at once put into association with the area by +the act of concentration of the attention. These serve to render +sensation {123} much more acute than it would otherwise be. It might +seem impossible to control the attention, but this has been done over +and over again, even in the midst of severe pain, until there is no +doubt that it is quite possible. As for the increase of pain by +deliberate attention, that is so familiar an experience that +practically every one has had it at some time. + +The reason for it has become very clear as the result of our +generation's investigations into the constitution of the nervous +system. The central nervous system, instead of being a _continuum_, or +series of nerve elements which are directly connected with each other, +consists of a very large number of separate individual cells which +only make contacts with each other, the nerve impulses flowing over +across the contact. The demonstration of these we owe originally to +Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was +awarded some years ago the Nobel Prize as well as the Prize of the +City of Paris for his researches. + +In connection with his surprising discoveries as to the neurons which +make up the brain, he suggested the Law of Avalanche, which would +serve to explain the supersensitiveness of parts to which concentrated +attention is paid. {124} According to this law, pain felt in any small +area of the body may be multiplied very greatly if the sensation from +it is distributed over a considerable part of the brain, as happens +when attention is centered upon it. A pain message that comes from a +localized area of the body disturbs under normal conditions at most a +few thousand cells in the brain, because the area is directly +represented only by these cells. They are connected however by +dendrites and cell branches of various kinds with a great many other +cells in different parts of the brain. A pain message that comes up +will ordinarily produce only disturbance of the directly connected +cells, but it may be transmitted and diffused over a great many of the +cells of the cortex of the brain if the attention is focused strongly +on it. The area at first affected, but a few thousand cells, may +spread to many millions or perhaps even some hundreds of millions of +them, if the centering of attention causes them to be "connected up", +as the electricians say, with the originally affected small group of +cells. + +It is just what happens in high mountains when a few stones loosened +somewhere near the top by the wind or by melting processes begin their +course down the mountain side. {125} On the way they disturb ever more +and more of the loose pieces of ice and the shifting snows as well as +the rocks near them, until, gathering force, what was at the beginning +only a minor movement of small particles becomes a dreaded avalanche, +capable not only of sweeping away men in its path but even of +obliterating houses and sometimes of changing the whole face of a +mountain area. Hence the expression suggested by Ramon y Cajal of the +Law of Avalanche for this wide diffusion of sensation, which spreads +from a few thousand to millions or billions of cells, and from a +rather bearable pain becomes intolerable torture, as a consequence of +the brain's complete occupation with it. + +Now it is possible for most people, indeed for all who have not some +organic morbid condition, to control this spread of pain beyond its +original connections, provided only they will to do so, refuse to be +ruled by their dreads and proceed to divert attention from the painful +condition to other subjects. Here is why the man who bravely faces +pain actually lessens the amount that he has to bear. There is no pain +in the part affected. That we know, because any interruption of the +nerve tract leading from the affected part to the brain {126} +eliminates the pain. In the same way, the obtunding of the nerve cells +in the cortex by anaesthetics or of the conducting nerve apparatus on +the way to the brain by local anaesthesia, will have a like effect. +Anything then that will interfere with the further conduction of the +pain sensation and the cortical cells directly affected will lessen +the sense of pain, and this is what happens when a man settles himself +firmly to the thought that he will not allow himself to be affected +beyond what is the actual reaction of the nerve tissues to the part. + +As a matter of fact, the anticipation of pain due to the dread of it +predisposes the part to be much more sensitive than it was before. We +can all of us readily make experiments which show this very clearly. +Ordinarily we have a stream of sensations flowing up from the surface +of the body to the brain, consequent upon the fact that the skin +surface is touched by garments over most of the body, and that our +nerves of touch respond to their usually rather rough surface. We have +learned to pay no attention to these because we have grown accustomed +to them, though any one who thinks that they are negligible should +witness the writhings of a poor Indian under the stress {127} of being +civilized when he is required to wear a starched shirt for the first +time. Ordinarily Indians have learned to suppress their feelings, but +the shirt with its myriad points of contact, all of them starchily +scraping, usually proves too much for his equanimity, and he wiggles +and twists to such an extent as shows very clearly that he is +extremely uncomfortable. Most people have something of the same +feeling the first day that they change into woolen underclothes after +they have been wearing cotton for months, and the sensation is by no +means easy to bear with equanimity. + +Ordinarily from custom and habit in the suppression of feelings we +notice none of these contact sensations with their almost inevitable +itchy and ticklish feelings, though they are constantly there, but we +can reveal them to ourselves by thinking definitely about any part of +the body. Such concentration of attention at once brings that part of +the body above the threshold of consciousness, and we have distinct +feelings there that we did not notice before. If for instance we think +about the big toe on the left foot, immediately our attention is +turned to it and we note sensations in it that were quite unnoticed +before. We can feel the stocking touching any part of it {128} that we +think of. Not only that, but if we concentrate attention on a part +most uncomfortable sensations develop. If anything calls our attention +even to the middle of our backs, we find at once that there is a +distinct sensation there, and this may become so insistent as to +demand relief. + +It is well understood now what happens in these cases. As we have +said, the attention given to a part leads to a widening of the minute +blood vessels located there so that the nerve endings to the part are +supplied with more blood and therefore become more sensitive. We know +from experience in cold windy weather that when the cheek is +hyperaemic the drawing of a leaf or even of a piece of paper across it +may produce a very acute painful sensation. Hyperaemia always makes +parts of the body much more sensitive than before. Attention has just +this effect over all the surface of the body, as we can demonstrate to +ourselves. We can actually, though only gradually, make our feet warm +by thinking about them, because the active attention to them sends +more blood to them. The dread of pain then, by concentrating attention +on the part beforehand, actually increases the pain that has to be +suffered and makes the subject {129} ever so much more sensitive. +Sensitiveness is of course dependent on other factors, as for instance +lack of outdoor air and of oxygenization, which actually seems to +hypersensitize people so that even very slight pain becomes extremely +difficult to bear, but the question of attention, which is after all +almost entirely a voluntary matter, has more to do with making pain +harder to bear than anything else. + +In the preanaesthetic days, men have been known to sit and watch +calmly an amputation of one of their limbs without wincing and +apparently without undergoing very much pain. Many are the incidents +in history of a favorite general who showed his men how to bear pain +by calmly smoking a cigar while a surgeon amputated an arm or a leg or +performed some other rather important surgery. Pain is after all like +the sense of danger and may be suppressed practically to as great a +degree. Once during the present war, when long columns of soldiers +going to the front had to pass by the open market place of a town that +was being shelled by the Germans, there was danger of the troops +losing something of their morale at this point and of confusion +ensuing. It would have been disturbing both to discipline and the +{130} ordered movement of the troops to divert them by narrower +streets, and the shells, though dangerous, were not falling frequently +and not working serious havoc. Every one knew, however, that the +German gunners had the range, and a shell might land square in the +market place at any time; thus there was a feeling of uneasiness and a +tendency to nervous lack of self-control, with the inevitable +confusion of movement afterwards. One of the French generals ordered +an armchair to be brought out of one of the houses near by, took a +position in the center of the square, with a little wand in his hand, +and calmly joked with the soldiers as they went by about the +temperature of the day mentioning occasionally something about a shell +that happened to strike not far away. According to the story he was an +immense man weighing nearly three hundred pounds, and so provided a +very good-sized target for shells, but he was never touched and, +almost needless to say, the line of soldiers never wavered while their +general sat there joking at the danger. + +It is sometimes thought that men in the older, less refined times +could stand pain and suffering generally much better than our +generation which is supposed to have {131} degenerated in that +respect. We have found, however, during the war that the soldiers who +could stand supreme suffering the best were very often those who came +from better-to-do families, who had been subjected to the most highly +refining influences of civilization, but also to that discipline of +the repression of the emotions which is recognized as an important +phase of civilization. Strange as it may seem, the city boys stood the +hardships and the trials of trench life better than the country boys +and not only withstood the physical trials but were calmer under fire +and ever so much less complaining under injury. After all it is what +might be expected, once serious thought is given to the subject, and +yet somehow it comes as a surprise, as if the country boy ought to be +less sensitive,--as indeed he probably is; but he lacks that training +in self-control which enables the city boy to stand suffering. + +All our feeling that human nature has degenerated in physical +constitution has been completely contradicted by the reaction of our +young soldiers to camp and trench life. They have gone back to the +lack of comforts and conveniences of the pioneer days and have had to +submit to the outdoor life and the {132} hardships that their pioneer +grandfathers went through and have not failed under them. The boys +have come out of it all demonstrating not only that their courage was +capable of supporting them, but with their physical being bettered by +the conditions and their power to stand suffering revealed in a way +that would scarcely have been believed possible beforehand. + + +{133} + +CHAPTER IX + +THE WILL AND AIR AND EXERCISE + + + "And wishes fall out as they are willed." + _Pericles_ + + +Very probably the most important function of the will in its relation +to health is that which concerns its power to control the habits of +mankind as regards air and exercise. It is surprising to what an +extent people neglect both of these essentials of healthy living in +the midst of our modern sophisticated life, unless the will power is +consciously used for the purpose of forming and then maintaining +habits with regard to these requisites for health. It is a very +fortunate thing that instinct urges the child, particularly the +infant, to almost constant movement during its waking hours. Children +that are healthy and that are growing rapidly, boys somewhat more than +girls, are so constantly in movement that one would almost think that +they must be on springs. Whenever they discover that they can make a +{134} new movement, they proceed to make it over and over again until +they can do it with facility. There is no lolling around for them; as +soon as they wake, they want to be up and doing, no matter what the +habits of the household may be. They are constantly on the move. We +know that this is absolutely essential for growth as well as for the +proper training of their muscles, but it is a very fortunate thing +that children do it for themselves, for if their mothers were +compelled to train them, the task would be indeed difficult. All +mother has to do is to control them to some extent and keep them from +venturing too far, lest they should hurt themselves. + +When the control of instinct over life is gradually replaced by +reason, this tendency to exercise gradually diminishes until it is +often surprising to find how little people are taking. As it is mainly +the need for exercise that forces people out into the air, indoor life +comes to be the main portion of existence. This is all contrary to +nature, and so it is not surprising that _disease_, in its original +etymological sense of discomfort, develops rather readily. The lack of +exercise in the air permits a great many people to drift into all +sorts of morbid conditions in which they are quite miserable. This +{135} is, of course, particularly true as regards nervous ailments of +various kinds; only under the term nervous ailments should be included +not alone direct affections of the nervous system or functional +disturbances of nerves, but also a number of other conditions. Nervous +indigestion, insomnia, neurotic constipation and many of the +symptomatic affections associated with these conditions, tired +feelings that interfere with activities, headache, various feelings of +discomfort in the muscles and around the joints, inability to control +the emotions and other such common complaints--if that is the proper +word for them--all these are fostered by a sedentary life indoors. +They frequently make not only the patient himself--or oftener +herself--miserable, but also all those who come in contact with her. + +Above all, it must not be forgotten that lack of exercise in the open +air has a very definite tendency to make people extremely sensitive to +discomforts of all kinds, mental as well as physical. Many a man or +woman whose life seems full of worries, sometimes without any adequate +cause at all, who goes from one dread to another, who wakes in the +morning with a sense of depression, find that most of these feelings +and sometimes all of them, {136} disappear promptly when they begin to +exercise more in the open. + +Nothing dispels the gloom and depressions consequent upon an +accumulation of cares and worries of various kinds like a few weeks in +the woods, where every moment is passed in the fresh outdoor air, +which actually seems to blow the cobwebs of ill feelings away and +leaves the individual with a freedom of mind and a comfort of body +that he almost expected never to enjoy again. + +Undoubtedly the most important factor for the preservation of health +is an abundance of fresh air. At certain seasons of the year this is +not only easy and agreeable, but to do anything else imposes hardship. +In our climate, however, there are about six months of the year in +which it requires some exercise of will power to secure as much open +air life as is required for health. There are weeks when it is too +hot, there are many weeks when it is too cold. The cold air +particularly is important, because it produces a stimulating vital +reaction than which nothing is more precious for health. We have no +tonic among all the drugs of the pharmacopeia that is equal to the +effect of a brisk walk in the bracing air of a dry cold day. After a +long morning and {137} perhaps a whole day in the house, even half an +hour outdoors will enable us to throw off the sluggishness consequent +upon confinement to the indoor air and the lack of appetite and the +general feeling of physical lassitude which has followed living in an +absolutely equable temperature for twenty-four hours. Sometimes it +requires no little effort of the will to secure this, and to continue +it day after day without missing it or letting it be crowded out by +claims that are partly real and partly excuses, because we do not care +to make the special effort required. + +What humanity needs is regular exercise in the open air every day. As +it is, between the trolley car and the automobile, very few people get +what they need. Any one who has to go a mile takes a car or some other +conveyance and between waiting for the car and certain inevitable +delays it will probably take ten minutes or more to go the mile. In +five minutes more one could walk that distance and secure precious +exercise besides such diversion of mind as inevitably comes from +walking on busy city streets and which makes an excellent recreation +in the midst of one's work. For it is quite impossible in our day to +walk along city streets absorbed in abstract mental {138} occupations. +One of the objections to walking is that after a while it can be +accomplished as a matter of routine without necessarily taking one's +mind away from subjects in which it has been absorbed. It is quite +impossible for this to happen, however, on modern city streets. "The +outside of a horse", it used to be said, "is good for the inside of a +man." The main reason for this was because it is impossible for a man +to ride horseback, unless his mount is a veritable old Dobbin, without +paying strict attention to the animal. The same thing is true as +regards city pedestrianism, especially since the coming of the auto +has made it necessary to watch our steps and look where we go. + +A great many people would be ever so much better in health if they +walked to business or to school every morning instead of riding, for +the young need it even more than the older people. Especially is this +true for all those who follow sedentary occupations. Clerks in +lawyers' offices, typewriters and stenographers, secretaries--all +those who have to sit down much during the day--need the brisk walking +and need it not merely of a Sunday or a Saturday afternoon, but every +day in the year. Many of them, if they walked two and three miles to +{139} the office, would probably require only fifteen minutes, at most +half an hour, more than if they took a train or trolley, but they +would have secured a good hour of exercise in the open air. + +On the other hand the unfortunate crowding of trolley and elevated and +subway trains in the busy hours when people go to and from their work +makes an extremely uncomfortable and often rather depressing +commencement and completion of the day's work. I know of nothing that +makes a worse beginning for the day than to have to stand for half an +hour or longer in a swaying, bumping car, hanging to a strap, crushed +and crowded by people getting in and out. The effect of coming home +under such circumstances after a reasonably long day's work is even +more serious, and any little sacrifice that will enable people to +avoid it will do them a great deal of good. Fifteen or twenty minutes +of extra time morning and evening would often suffice for this and +would at the same time add a bracing walk in the open air to the day's +routine. + +When first begun, such a practice would make one tired and sore, but +that condition would pass in the course of a few days and be replaced +by a healthy feeling of satisfaction {140} that would be well worth +all the effort required. We should need ever so much less medicine for +appetite and for constipation if this were true. A great many people +who stand during the day would probably deem it quite out of the +question for them to walk three miles or more to and from their +business, for their feet get so tired that they feel that they could +not endure it. What they need more than anything else, however, is +exercise that will bring about a stimulation of the circulation in +their feet. Standing is very depressing to the circulation. It leads +to compression of the veins and hence interference with the return +circulation, with lowered nutrition which often predisposes to flat +foot or yielding arch and tends to create corns and callouses: walking +in reasonably well fitting shoes on the contrary tends to make the +feet ever so much less sensitive Our soldiers have had that experience +and have learned some very precious lessons with regard to the care of +their feet, the principal one being that the best possible remedy for +foot troubles is to exercise the feet vigorously in walking and +running, provided the shoes permit proper foot use. + +I have often known clerks and floorwalkers {141} who have to stand all +day or move but a few steps at intervals, who were so tired at night +that they felt the one thing they could do was to sit down for a while +after dinner and then go to bed, but who came to feel ever so much +better after a brisk walk home. It was rather hard to persuade them +that, exhausted as they felt, they would actually get rested and not +more tired from vigorous walking, but once they tried it, they knew +the exercise was what they needed. The air in stores is often dry and +uncomfortable for those who are in them all day. It is usually and +quite properly regulated for the customers who come in from the +streets expecting to get warm without delay. In dry, cold weather +particularly, an evening walk home sets the blood in circulation until +it gets thoroughly oxidized and the whole body feels better. Such a +brisk walk will often prevent the development of flat foot, especially +if care is taken to spring properly from the ball of the foot, in the +good, old-fashioned heel and toe method of walking. Once flat foot has +developed, walking probably is more difficult, but even then, with +properly fitting shoes, the patients will be the better for a good +walk after their work is over. It requires some will power to acquire +the {142} habit, but once formed, the benefit and pleasure derived +make it easy to keep up the practice. + +Those who walk thus regularly will often find that their evening +tiredness is not so marked, and they will feel much more like going +out for some diversion than they otherwise would. Probably nothing is +more dispiriting in the course of time than to come home merely to eat +dinner, sit down after dinner and grow sleepy on one's chair until one +feels quite miserable, and then go to bed. There should be always, +unless in very inclement weather, an outing before bedtime, and this +should be looked forward to. It will often forestall the feeling that +the day is over after dinner and so keep the individual from settling +down into the dozy discomfort of an after-dinner nap as the closing +scene of the day. Good habits in this matter require an effort of the +will to form; bad habits almost seem to form of themselves and then +require a special effort to break. + +It is surprising how many of the dreads and anxiety neuroses and +psycho-neurotic solicitudes and neurasthenic disquietudes and other +more or less morbid mental states disappear under the influence of a +brisk walk for three or {143} four miles or more every day. I have +tried this prescription on all sorts of people, including particularly +myself, and I know for certain that when troubles are accumulating the +thing to do is to get outdoors more, especially for walking; then the +incubus begins to lift. Clergymen, university professors, members of +religious orders, school teachers, as well as bankers, clerks and +business people of various kinds, have been subjected to the influence +of this prescription with decided benefit. Some of them assert that +they never felt so well as since they have formed the habit of walking +every day. It must, however, be _every_ day, and it must not merely be +a mile or so but it must be at least three miles. That means for a +good many people about an hour spent in actual walking, but it is well +worth the time and effort. Above all, it repays not only in health and +in better feelings but in the increased amount of work that can be +done on the day itself. A whole day passed indoors will often contain +many wasted hours, while if a walk of a couple of miles is planned for +the morning and one for a couple of miles more in the afternoon, very +satisfactory study or other work can be done in the intervals. Almost +needless to say, a brisk walk in the {144} cooler weather will create +an appetite where it did not exist before. Women often need counsel in +this matter more than men, and regular walking for them is indeed a +counsel of health. Very few women in these modern times walk much, and +to walk more than a mile seems to them a hardship. This is responsible +for more of the supersensitiveness and nervous complaints of all kinds +to which women are liable than anything else that I know of. It is +also one important factor in the production of the constipation to +which women are so much more liable than men. We see many +advertisements with regard to the jolts to which the body is subjected +every time the heel is put down and of the means that should be taken +to prevent them, but it must not be forgotten that men and women were +meant by nature to walk erect and that this recurring jolt has a very +definite effect in stimulating peristalsis and favoring the movement +of the contents of the intestines. Besides, if the walking is brisk, +the breathing is deeper and there is some massage of the liver, as +also of the other abdominal viscera, while other organs are affected +favorably. Walking for women--regular, everyday walking--would be +indeed a precious habit, but now {145} that women have occupations +more and more outside of the house, this is one of the things they +must make up their minds to do, if they are to maintain health, +remembering that making up the mind is really making up the will. + +Over and over again I have seen a great many of the troubles of the +menopause or change of life in women disappear or become ever so much +less bothersome as the result of the formation of regular habits of +walking out of doors every day. Unfortunately, there is a definite +tendency about this time for women to withdraw more and more from +public appearances and to live to a considerable extent in retirement +at home. Nothing could be much worse for them. They need, above all, +to get out and to have a number of interests, and if these interests +can only be so arranged as to demand rather prolonged walks, so much +the better. This is more particularly true for the unmarried woman who +is going through this critical time, and the question of walking +regularly every day for three or four miles must be proposed to her. +It will require a considerable effort of the will. More than two miles +at the beginning will probably be too tiring, but the amount can be +gradually increased {146} until at least four miles on the average is +covered every day. Above all, for the feelings of discomfort in the +cardiac region so often noticed at this time, regular walking is the +best remedy in most cases, always of course presupposing that there is +no organic heart condition, for in that case only a physician can give +the proper direction for each case. By the exercise of the lungs that +it requires, it will probably save most people from colds and coughs +which they have had to endure every winter. Lastly be it said that +practically all men and women, though more particularly the men who +have lived well beyond the Psalmist's limit of threescore and ten, +have been regular daily walkers, or else they have taken exercise in +some form in the open air which is the equivalent of walking. One of +the most distinguished of English physicians, Sir Hermann Weber, who +died just after the end of the war in London, was in his ninety-fifth +year. He had practised medicine regularly until the age of eighty and +continued in excellent health and vigor until just before his death. +During the last year of life, he contributed an interesting article to +the _British Medical Journal_ on the "Influence of Muscular Exercise +on Longevity." He attributed his vigor at the age of {147} ninety-five +as well as the prolongation of his life to his practice of spending +every day two or three hours in the open air. He walked, as a rule, +forty to fifty miles a week. Even in the most inclement weather he +rarely did less than thirty miles a week. Many another octogenarian +and nonagenarian has attributed his good health and long life to the +habit of regular daily exercise in the open. + +Instead of using up energy, the will so used brings out latent stores +of energy that would not otherwise be employed and thus adds to the +available amount of vitality for the individual. Doctor Thomas Addis +Emmet, only just dead, over ninety, in his younger years as a busy +medical practitioner never kept a horse. It would not be difficult to +cite many other examples among men who lived to advanced old age and +who considered that they owed their good health and long life to daily +habits of outdoor exercise. + + + +{148} + +CHAPTER X + +THE WILL TO EAT + + + "If your will want not, time and place will be fruitfully added." + _King Lear_. + + +Eating is usually supposed to be entirely a matter of appetite which +instinct directs to the best possible advantage of the individual. +This is quite true for those who are living the outdoor life that is +normal or at least most healthy for men, and when they are getting an +abundance of exercise, and may I add also have not too great a variety +of food materials in tempting form presented to them. Under the +artificial not to say unnatural conditions which men have to a great +extent created for themselves in city life, confined at indoor +sedentary occupations, some of them--and they are much more numerous +than is usually imagined--eat too little, while a great many, owing to +stimulation of appetite in various ways, eat too much. + +Eating therefore for health's sake has to be done through the will and +as a rule by the {149} formation of deliberate habits. It is easy to +form habits either of defect or excess in the matter of eating and +indeed a great deal of the ill health to which mankind is liable is +due to errors in either of these directions. Having disturbed nature's +instincts for food in modifying the mode of life to suit modern +conveniences, we have now to learn from experience and scientific +observations what we should eat and then make up our minds to eat such +quantity and variety as is necessary to maintain health and strength +in the particular circumstances in which we are placed. + +While the greatest emphasis has been placed on the dangers to health +in overeating, the number of people who, for one reason or another, +eat too little is, as has been said, quite surprising. A very large +proportion of those under normal weight are so merely because they +have wrong habits of eating. Indeed, it may be laid down as a +practical rule of health that wherever there is no organic disease the +condition of being underweight is a symptom of undereating. A great +many thin people insist that the reason why they are underweight is +that it is a family trait and that father and mother, or at least one +of them, and some of their grandparents exhibited this {150} +peculiarity; and thus it is not surprising that they should have it. A +careful analysis of the family eating in such cases has shown me in a +large number of instances, indeed almost without exception, that what +my patients had inherited was not a constitutional tendency to +thinness, but a family habit of undereating. This accrued to them not +from nature but from nurture, and was acquired in their bringing up. +Most of them were eating one quite abundant meal a day and perhaps a +pretty good second meal, but practically all of them were skimping at +least one meal very much. In some way or other, a family habit of +eating very little at this meal had become established and was now an +almost inviolable custom. + +A great many thin individuals, that is persons who are somewhat more +than ten per cent. under the average normal weight for their height, +either do not eat breakfast at all or eat a very small one. It is not +unusual for the physician analyzing their day's dietary to be told +that the meal consists of a cup of coffee and a piece of bread. +Sometimes there is a roll, but more often only part of a roll, though +occasionally in recent years there may be some fruit and some cereal; +the fruit will usually be a half of one of the citrus fruits {151} +which contains practically no nutrition and is only a pleasant +appetizer, while more often than not the cereal will be one of the +dry, ready-to-eat varieties which, apart from the milk or cream that +may be served with them, contain in the usual small helpings very +little nutriment. Such breakfasts are particularly the rule among +women who are under weight. Sometimes lunch is comparatively light so +that there are two daily apologies for meals. To make up for these, +the third meal may be very hearty. City folk often eat at dinner more +than is good for them. This may produce a sense of uncomfortable +distention and overfulness followed by sleepiness which may be set +down as due to indigestion, though it is just a question of overeating +for the nonce. + +It would be much more conducive to health to distribute the eating +over the three meals of the day, but it requires a special effort of +the will to break the unfortunate habits that have been formed. +Particularly it seems hard for many people to eat a substantial +breakfast and a determined effort is required to secure this. It would +seem almost as though their wills had not yet waked up and that it was +harder for them to do things at this time of day. It is especially +important for working {152} women, that is, those who have such +regular occupations as school-teacher, secretary, clerk and the like, +to eat a hearty breakfast. They can get a warm properly chosen meal at +home at this hour, while very often in the middle of the day they have +to eat a lunch that is not nearly so suitable. As a consequence of +neglecting breakfast then, it is twenty-four hours between their warm, +hearty meals. Even when they eat a rather good lunch, some eighteen +hours elapse since the last hearty meal was taken, and one half the +day's work has to be done on the gradually decreasing energy secured +from the evening meal of the day before. With this unfortunate habit +of eating, most of that was used up during the night in repairing the +tissue losses of the day before, so that the morning's work has to be +done largely "on the will" rather than on the normal store of bodily +energy. + +It is surprising how many patients who are admitted to tuberculosis +sanatoria have been underweight for years as a consequence of +unfortunate habits of eating. Not infrequently it is found that they +have a number of prejudices with regard to the simple and most +nutritious foods that mankind is accustomed to. Not a few of the +younger ones who {153} develop tuberculosis have been laboring under +the impression that they could not digest milk or eggs or in some way +they had acquired a distaste for them and so had eliminated them from +their diet; some of them had also stopped eating butter or used it +very sparingly. At the sanatoria, as a rule, very little attention is +paid to the supposed difficulty of digestion of milk and eggs and +perhaps butter. The patients are at once put on the regular diet +containing these articles and the nurse sees that they take them even +between meals, and unless there is actual vomiting or some very +definite objective--not merely subjective--sign of indigestion, the +patients are required to continue the diet. + +It is almost an invariable rule for the patients of such institutions +to come to the physician in charge after a couple of weeks and ask how +it was that they could have thought that these simple articles of food +disagreed with them. They have begun to like them now and are +surprised at their former refusal to take them, which they begin to +suspect, as the physician very well knows, to have been the principal +reason for the development of their tuberculosis. + +There are people who are up to weight or {154} slightly above it who +develop tuberculosis, but they do not represent one in five of the +patients who suffer from the affection. In probably three fourths of +all the cases of tuberculosis the predisposing factor which allowed +the tubercle bacillus to grow in the tissues was the loss of weight or +the being underweight. There is a good biological reason for this, for +there are certain elements in the make-up of the tubercle bacillus +which favor its growth at a time when fat is being lost from the +tissues rather than deposited, for at that time more fat for the +growth of the tubercle bacillus is available in the lungs than at +other times. Often among the poor the loss in weight is due to lack of +food because of poverty, or failure to eat because of alcoholism, but +not infrequently among all classes it is just a question of certain +bad habits of eating that might readily have been corrected by the +will. It is surprising how many people who complain of various nervous +symptoms--meaning by that term symptoms for which no definite physical +basis can be found, or for which only that extremely indefinite basis +of a vague reflex, real or supposed, from the abdominal organs--are +underweight and will be found to be eating much less than the average +of {155} humanity. These nervous symptoms include above all +discomforts of various kinds in the abdominal region; sense of +gone-ness; at times a feeling of fullness because of the presence of +gas; grumblings, acid eructations, bitter taste in the mouth, and +above all, constipation. As is said in the chapter on "The Will and +the Intestinal Functions," the most potent and frequent cause of +constipation is insufficient eating, either in quantity or in variety. +It is especially in the digestive tract of those who do not eat as +much as they should that gas accumulates. This gas is usually thought +to be due to fermentation, but as fermentation is a very slow gas +producer and nervous patients not infrequently belch up large +quantities, it is evident that another source for it must be sought. +Any one who has seen a number of hysterical patients with gaseous +distention of the abdomen and attacks of belching in which immense +quantities of gas are eructated, will be forced to the conclusion that +in such nervous crises gas leaks out of the blood vessels of the walls +of the digestive tract and that this is the principal source of the +gas noted. What is true in the severe nervous attacks is also true in +nervous symptoms of other kinds, and neurotic indigestion so called +{156} is always accompanied by the presence of gas. + +Apparently the old maxim of the physicist of past centuries has an +application here. "Nature abhors a vacuum" and as the stomach and +intestines are not as full as they ought to be, nor given as much work +to do as they should have, nature proceeds to occupy them with gas +which finds its way in from the very vascular gastrointestinal walls. +This is of course an explanation that would not have been popular a +few years ago when the chemistry of digestion seemed so extremely +important, but in recent years, medical science has brought us back +rather to the physics of digestion, and I think that most physicians +who have seen many functional nervous patients would now agree with +these suggestions as to the origin of gaseous disturbance in the +gastrointestinal tract in a great many of these cases. + +Besides the physical symptoms, there are a whole series of psychic or +psycho-neurotic symptoms, the basis of which undoubtedly lies in the +condition of underweight as a consequence of undereating. Over and +over again I have seen the feeling of inability to do things which had +come over men, and {157} particularly women, disappear by adding to +and regulating the diet until an increase in weight came. Extreme +tiredness is a frequent symptom in those under weight, and this often +leads to their having no recreation after their work because they have +not enough energy for it; as every human being needs diversion, a +vicious circle of influence which adds to their nervous tired +condition is formed. I have seen in so many cases the eating of a good +breakfast and a good lunch supply working people with the energy +hitherto lacking that enabled them to go out of an evening to the +theater or to entertainments of one kind or another, that it has +become a routine practice to treat these people by adding to their +dietary unless there are direct contra-indications. + +Dreads are much more common among people who are underweight than +among those who eat enough to keep themselves in proper physical +condition. I have had a series of cases, unfortunately only a small +one in number, in which the craving for alcoholic liquor disappeared +before an increase in diet and a gain in weight. I shall never forget +the first case in which this happened. The patient was a man of nearly +sixty years of age who held a {158} rather important political office +in a small neighboring town. He was on the point of losing it because +periodical sprees were becoming more frequent and it was impossible +for him to maintain his position. He was over six feet in height and +he weighed less than a hundred and fifty pounds. I had tried to get +him to gain in weight by advice and suggestion without avail. Finally, +I had to make a last effort to use whatever influence I had to save +his political position for him, and then I succeeded in making him +understand that he would have to do as I told him in the matter of +eating, or else I would have nothing more to do with him. + +It was not without some misgivings that I thus undertook to make a man +of nearly sixty change his lifelong habits of eating. That is +something which I consider no physician has a right to do unless there +is some very imperative reason for it. Here was, however, a desperate +case. It was in the late afternoon particularly that this patient +craved drink so much that he could not deny himself. As he ate but +very little breakfast and had a hasty scanty lunch, he was at the very +bottom of his physical resources at that time, and at the end of a +rather demanding day's work. We had {159} to break up his other habits +in the hope of getting at the craving. He had taken coffee and a roll +for breakfast. I dictated a cereal, two eggs and several rashers of +bacon and several rolls. I insisted on fifteen minutes in the open +before lunch and then a hearty lunch with some substantial dessert at +the end of it. This man proceeded to gain at the rate of a little more +than three pounds a week. By the end of two months, he weighed about +one hundred and eighty pounds and had not touched a drop of liquor in +that time and felt that he had no craving for it. That is some ten +years ago, and there has been no trouble with his alcoholic cravings +since. He has maintained his weight; he says that he never felt so +well and that above all he now has no more of that intense tiredness +that used to come to him at the end of the day. Every now and then he +says to me in musing mood,--"And to think that I had never learned to +eat enough!" + +For these very tired feelings so often complained of by nervous +patients, once it has been decided that there is no organic +trouble--for of course kidney or heart or blood pressure affections +may readily cause them--there are just two things to be considered: +These are {160} flat-foot or yielding arch, and undereating. When +there is a combination of these two, then tiredness may well seem +excessive and yet be readily amenable to treatment. Persons with +occupations which require standing are especially liable to suffer in +this way. + +Undereating in the evening is especially important for many nervous +people and is often the source of wakefulness. It is the cause of +insomnia, not so much at the beginning of the night, as a rule, as in +the early morning. Many a person who wakes at four or five and cannot +go to sleep again is hungry. There is a sense of gone-ness in the +stomach region in these cases, which the patients are prone to +attribute to their nerves in general, or some of them who have had +unfortunate suggestions from their physicians may talk of their +abdominal brain; but it is surprising how often their feelings are due +simply to emptiness. Any thin person particularly who has his last +meal before seven and does not go to bed until after eleven should +always take something to eat before retiring. A glass of milk or a cup +of cocoa and some crackers or a piece of simple cake may be +sufficient, but it is important to eat enough. Animals and men +naturally get sleepy after eating and do not sleep well if their {161} +stomachs are empty. Children are the typical examples. We are all only +children of a larger growth in this regard. + +When the last meal is taken before seven and people do not go to bed +until nearly twelve, as is frequently the case in large cities, the +custom of having something to eat just before bed is excellent for +sleep. I have known the establishment of this habit to afford marked +relief in cases of insomnia that had extended over years. The people +in my experience who sleep the worst are those who, having taken a +little cambric tea and some toast and preserves with perhaps a piece +of cake for supper, think that this virtuous self-control in eating +ought to assure them good rest. It has just the opposite effect. +Disturbed sleep, full of dreams and waking moments, is oftener due to +insufficient eating than to overeating. The people whom I know who +sleep the best and from whom there are no complaints of insomnia, are +those who, having eaten so heartily at dinner that they get to the +theater a little late, attend the Follies or some late show for a +while and then go round to one of the Broadway restaurants and chase a +Welsh rarebit or some lobster a la Newburg, with a biscuit Tortoni or +a Peche Melba down {162} to their stomachs and then go home to sleep +the sleep of the just. + +Just as there are bad habits of eating too little that are dangerous +and must be corrected by the will so there are bad habits of eating +too much that can only be corrected in the same way. While it is +dangerous to be under weight in the early years of life, it is at +least as dangerous to be overweight in middle life. With the variety +and abundance of food now supplied at a great many tables, it is +comparatively easy for people in our time to eat too much. The result +is that among the better-to-do classes a great many people suffer from +obesity, sometimes to such an extent that life is made a burden to +them. There is only one way to correct this and that is to eat less +and of course to exercise more. Reduction in diet means the breaking +of a long established habit and that of course is often hard. The +whole family may have to set a good example of abstinence from too +great a variety of food and especially from the richer foods, in order +that a parent may be helped to prevent further development of obesity +and to lose gently and gradually some of the overweight that is being +put on, and which now, by conserving heat and slowing up metabolism +{163} generally within the body, makes it so easy for even reduced +quantities of food to maintain the former habit of adding weight. + +In this matter of obesity, however, just exactly as in the case of +tuberculosis for those who are underweight, prevention is much better +than cure. The people who know that they inherit such tendencies +should be particularly careful not to form habits of eating that will +add considerably to their weight. After all, it is not nearly so +difficult a matter as is often imagined. There is no need, unless in +very exceptional cases, of denying one's self anything that is liked +in the ordinary foods, only less of each article must be eaten. Even +desserts need not be entirely eliminated, for ices may be taken +instead of ice cream; sour fruits and especially those of the citrus +variety--oranges and grapefruit--and the gelatine desserts may be +eaten almost with impunity. The phrase "eat and grow thin" has +deservedly become popular in recent years because as a matter of fact +it is perfectly possible to eat heartily and above all to satisfaction +without putting on weight. It is, of course, harder to lose weight, +but even that may be accomplished gradually under proper direction if +there is the persistent will to do it. + +{164} + +In recent years another disease has come to attract attention which +represents the result of an overindulgence in food materials that can +be limited without much difficulty. This is diabetes which used to be +comparatively rare but has now become rather frequent. An authority on +the disease declared not long since that there are over half a million +people in this country now who either have or will have diabetes as +the result of the breaking down of their sugar metabolism. It is not +surprising that the disease should be on the increase, for the +consumption of sugar has multiplied to a very serious degree during +the last few generations. A couple of centuries ago, those who wanted +sugar went not to the grocery store, but to the apothecary shop. It +was kept as a flavoring material for children's food, as a welcome +addition to the dietary of invalids and the old, and quite literally +as a drug, for it was considered to have, as it actually has, to a +slight extent at least, some diuretic qualities that made it valuable. +A little more than a century ago, a thousand tons of sugar sufficed +for the whole world's needs, while the year before the war, the world +consumed some twenty-two million of tons of sugar. It is said that +every man, woman, and {165} child in the United States consumed on the +average every day a quarter of a pound of sugar. + +Our candy stores have multiplied, and while two generations ago the +little candy stores sold candies practically entirely for children, +eking out their trade with stationery and newspapers and school +supplies, now candy stores dealing exclusively in confectionery are +very common. There are several hundred stores in the United States +that pay more than $25,000 a year rent, though they sell nothing but +candy and ice-cream sodas. Corresponding with the increase in the sale +of candy has come also the consumption of very sweet materials of +various kinds. French pastries, Vienna tarts, Oriental sweetmeats, +Turkish fig paste, Arabian date conserves, and West Indian guava +jelly, are all familiar products on our tables. Chocolate has become +one of the important articles of world commerce, though almost unknown +beyond a very narrow circle a little more than a century ago. Tea and +coffee have been introduced from the near and the far East and by a +Western abuse consumed with such an amount of sweetening as make them +the medium of an immense consumption of sugar. + +There is no doubt that unless good habits {166} of self-denial in this +regard are formed, diabetes, which is an extremely serious disease, +especially for those under middle life, will continue to increase in +frequency. The candy and sugar habit is rather easy to form; every one +realizes that it is a habit, but it is sometimes almost as hard to +break as the tobacco habit. We were meant to get our sugar by the +personal manufacture of it from starch substances. If a crust of bread +is chewed vigorously until it swallows itself, that is, dissolves in +the secretions and gradually disappears, it will be noted that there +is a distinctly sweetish taste in the mouth. This is the starch of the +bread being changed into sugar. We were expected by nature to make our +own sugar in this way, but this has proved too slow and laborious a +way for human nature to get all the sugar it cared for, so most people +prefer to secure it ready made. Sugar is almost as artificial a +product as alcohol and is actually capable of doing almost as much +harm as its not distantly related chemical neighbor. It is rather +important that good habits in the matter should be formed and we have +been letting ourselves drift into very unfortunate habits in recent +years. + + +{167} + +CHAPTER XI + +THE PLACE OF THE WILL IN TUBERCULOSIS + + + "And like a neutral to his will and matter + Did nothing." + _Hamlet_. + + +Probably the very best illustration in the whole range of medicine of +the place of the will in the cure of disease is afforded by +tuberculosis. This used to be the most fatal of all human affections +until displaced from its "bad eminence" within the last few years by +pneumonia, which now carries off more victims. As it is, however, +about one in nine or perhaps a few more of all those who die are +victims of tuberculosis. This high mortality would seem to indicate +that the disease must be very little amenable to the influence of the +will, since surely under ordinary circumstances a good many people +might be expected to have the desire and the will to resist the +affection if that were possible. In spite of the large death rate this +is exactly what is true. + +{168} + +Tuberculous infections are extremely common, much commoner even than +their high mortality reveals. After long and critical discussion with +a number of persistent denials, it is now generally conceded by +authorities in the disease that the old maxim "after all, all of us +are a little tuberculous" is substantially correct. Very few human +beings entirely escape infection from the tubercle bacillus at some +time in life. The great majority of us never become aware of the +presence of the disease and succeed in conquering it, though the +traces of it may be found subsequently in our bodies. Careful +autopsies reveal, however, that very few even of those who did not die +directly from tuberculosis fail to show tuberculous lesions, usually +healed and well shut off from the healthy tissues, in their bodies. +One in eight of those who become infected have not the resistive +vitality to throw off the disease or the courage to face it and take +such precautions as will prevent its advance. All those, however, who +give themselves any reasonable chance for the development of +resistance survive the disease though they remain always liable to +attack from it subsequently if they should run down in health and +strength. + +{169} + +Heredity, which used to be supposed to play so important a role in the +affection, is now known to have almost nothing to do with the spread +of the disease. Family tendencies are probably represented by nothing +more than a proneness to underweight which makes one more liable to +infection, and this is due as a rule to family habits in the matter of +undernourishment from ill-advised consumption of food. Probably a +certain lack of courage to face the disease boldly and do what is +necessary to develop bodily resistance against it may also be an +hereditary family trait, but environment means ever so much more than +heredity. + +There is a well known expression current among those who have had most +experience in the treatment of patients suffering from tuberculosis +that "tuberculosis takes only the quitters", that is to say that only +those succumb to consumption who have not the strength of will to face +the issue bravely and without discouragement to push through with the +measures necessary for the treatment of their disease. In a word it is +only those who lack the firmness of purpose to persist in the mode of +life outlined for them who eventually die from their affection of the +{170} lungs. No specific remedy has been found that gives any promise +of being helpful, much less of affording assured recovery, though a +great many have been tried and not a few are still in hopeful use. +Recent experience has only served to emphasize the fact that the one +thing absolutely indispensable for any successful treatment of +tuberculosis of the lungs is that the patient should regain weight and +strength and with them resistive vitality so as to be able to overcome +the disease and get better. + +To secure this favorable result two conditions of living are necessary +but they must be above all persisted in for a considerable period. +First there must be an abundance of fresh air with rest during the +advancing stage or whenever there are acute symptoms present, and +secondly an abundance of good food which will provide a store of +nutritive energy and make the resistive vitality as high as possible. +Curiously enough this "fresh air and good food" treatment for the +disease was recognized as the sheet anchor of the therapeutics of +consumption as long ago as Galen's time, the end of the second +century, when that distinguished Greek physician was practising at +Rome. Nearly eighteen hundred {171} years ago Galen suggested that he +had tried many remedies for what he called phthisis, the Greek +equivalent of our word consumption or wasting away, and had often +thought that he had noted a remedial value in them, but after further +experience he felt that the all-important factors for cure were fresh +air and good food. He even went so far as to say that he thought the +best food of the consumptive or the phthisical, as he called them, was +milk and eggs. A great deal of water has flowed under the bridge of +medical advance since his time and at many periods since physicians +have been sure that they had valuable remedies for consumption; yet +here we are practically back at Galen's conclusion more than fifty +generations after his time, and we are even inclined to think of this +mode of treatment as comparatively new, as it is in modern history. + +The influence on consumption of the will to get well when once aroused +was typically exemplified in the career of the well-known London quack +of the beginning of the nineteenth century, St. John Long. He set +himself up as having a sure cure for consumption. He was a charlatan +of the deepest dye whose one idea was to make money, and who knew +{172} nothing at all about medicine in any way. He took a large house +in Harley Street and fitted it up for the reception of people anxious +to consult him. For some seasons every morning and afternoon the +public way was blocked up with carriages pressing to his door. Nine +out of ten of his patients were ladies and many of them were of the +highest rank; fashion and wealth hastened to place themselves and +their daughters at the mercy of the pretender's ignorance. His mode of +treatment was by inhalation. He assured his patients that the +breathing in of this medicated vapor would surely cure their pulmonary +disease, and because others were intent on going they went; many of +them were greatly benefited for a time and these so-called cures +proved a bait for many other patients. + +J. Cordy Jeaffreson in his volume "A Book about Doctors", written two +generations ago, has told the story of St. John Long's successful +application of the principle of community of treatment and its +effectiveness upon his patient. Like Mesmer he realized that treating +people in groups led them mutually to influence each other and to +bring about improvement. St. John Long {173} had in one of the rooms +in Harley Street "two enormous inhalers, with flexible tubes running +outward in all directions and surrounded by dozens of excited women-- +ladies of advanced years and young girls giddy with the excitement of +their first London season--puffing from their lips the medicated vapor +or waiting until a mouthpiece should be at liberty for their pink +lips." In our generation of course we had various phases of similar +treatment, including nebulizers and compressed air apparatus and +medicated vapor, all working wonders for a while, and then proving to +have no physical beneficial effect. + +What is surprising is to find the number of cures that were worked. +St. John Long had so many applicants for attention that he was +literally unable to give heed to all of them. The news of the +wonderful remedy flew to every part of the United Kingdom and from +every quarter sick persons, wearied of a vain search after an +alleviation of their sufferings, flocked to London with hope renewed +once more. This enabled St. John Long to select for treatment only +such cases as gave ready promise of cure. He made it a great +preliminary of his treatment that his {174} patients should eat well +as a rule and on one occasion when he was called into the country to +see a man suffering in the last stages of consumption he said quite +frankly, "Sir, you are so ill that I cannot take you under my charge +at present. You want stamina. Take hearty meals of beefsteak and +strong beer; and if you are better in ten days I will do my best for +you and cure you." + +It is easy to understand that if he made it a rule for his consumptive +patients that they should eat well or not expect relief from his +medicine he would secure a great many good results. Especially would +this be true in many cases that came up to him from the country, had +the advantage of a change of climate, and of environment and very soon +found that they had much more strength than they thought they had. +They had been dreading the worst, they were now led to hope for the +best; they took the brake off their will, they fed well and it was not +long then before they proceeded to get well. + +As even a little experience with consumptive patients shows it is +often difficult for them to follow directions--and keep it up--in the +matter of fresh air and good food and here is where the question of +the will in the {175} treatment is all important. Many a consumptive +has in early life formed bad habits with regard to eating, especially +in the direction of eating too little and refusing for some reason or +other to take what are known to be the especially nutritious foods. +Not infrequently indeed it is their neglect of nutrition in this +regard that has been the principal predisposing factor toward the +development of the disease. This bad habit must be overcome and often +proves refractory. + +Then it is never easy to give up the pursuit of a chosen vocation and +pursue faithfully for a suitable period the humdrum monotonous +existence of prolonged rest every day in the open air with eating and +sleeping as almost the only serious interests, if indeed they can be +called such, permitted in life. It is only those who have the will +power to follow directions faithfully, whole-heartedly and +persistently who have a reasonable prospect of getting ahead of their +disease and eventually securing such a conquest of it as will enable +them to return to their ordinary life as it was before the development +of tuberculosis. + +Unless patients are ready to follow directions as regards outdoor air +and good food the {176} cure, or as specialists in tuberculosis prefer +to call it the arrest of symptoms in the disease, is almost out of the +question. Above all it is extremely important that those who suffer +from pulmonary tuberculosis should be ready to follow directions at an +early stage of their disease, before any serious symptoms develop, for +it is then that most can be done for them. Many a sufferer from +tuberculosis makes his or her cure extremely difficult, certainly ever +so much more difficult than it would otherwise have been, because the +dread of going to see a physician--lest they should be told that their +affection is really consumption and demands immediate strenuous +treatment--causes them to put off consultation with some one whose +opinion in the matter is reliable. + +This is indeed one of the principal reasons why tuberculosis of the +lungs still continues to carry off so many victims every year,-- +because people are afraid to learn the truth. They dare not put the +question to a definite issue and refuse to believe the possibility +that certain disturbing symptoms represent developing tuberculosis. +They defer seeing an expert; they take this and that suggestion from +friends; they buy cough remedies which {177} they see advertised, +sometimes they tinker with so-called "consumption cures." After a +while an advance of their symptoms makes it absolutely necessary to +see a physician but often by this time their disease has progressed +from an incipient case rather easy to be treated and with an excellent +prognosis to a more advanced stage at which cure is ever so much more +difficult; or by this time it may even prove that their strength has +been seriously sapped and they have not enough resistive vitality left +to bring about reaction toward the cure. + +The all-important thing for all those who have at any time lived near +consumptives, whether relatives or others--for the disease is almost +invariably acquired and not hereditary--or who have worked for any +prolonged period in more or less intimate contact with those who had a +chronic cough or who subsequently developed tuberculosis, is that on +the first symptom that is at all suspicious they should make up their +minds to have the question as to whether they have tuberculosis or not +definitely settled and that they should be ready to do what they are +told in the matter. The first symptom is not a persistent cough as so +many think, nor continued loss of {178} weight, which is an advanced +sign as a rule, but a continued rapidity of pulse for which no +non-pulmonary reason can be found. + +The old idea that consumptives should not be told what their affection +was, lest it should disturb their minds and discourage them so much as +to do them harm, has now been abandoned by practically all those of +large experience in the care of the tuberculous. The opposite policy +of being perfectly candid and making the patients understand their +serious condition and the importance of taking all the measures +necessary for cure, yet without permitting them to be unnecessarily +scared, has been adopted. Their will to get well must be thoroughly +aroused. After all, it must be recalled that tuberculosis is an +extremely curable disease. It is now definitely known that more than +ninety per cent. of humanity have at some time had a tuberculosis +process, that is to say a focus of tuberculosis active within their +tissues. Only about one in nine of the deaths in civilized countries +is from tuberculosis. That means that at least eight other people who +have not died from the disease but from something else have had the +affection, yet have recovered from it. Instead of the old shadow of +{179} heredity with its supposedly almost inevitable fatality, so that +young people who saw their brothers and sisters or other relatives +around them die from the disease felt that they were doomed, we now +know that the hereditary factor plays an extremely minor role if +indeed it plays any serious role at all in the development of the +disease. + +No affection is so amenable to the state of mind and the will to be +well as tuberculosis. That is exactly the reason why so many remedies +have come into vogue and apparently been very successful in its +treatment and then after a while have proved to be of no particular +service or even perhaps actually harmful so far as their physical +effect is concerned. It cannot be too often repeated that anything +whatever that a patient takes that will arouse new hope and give new +courage and reawaken the will will actually benefit these patients. No +wonder then that scarcely a year passes without some new remedy for +tuberculosis being proposed. All that is needed to affect favorably +patients suffering from the disease is to have some good reason +presented which makes them feel that they ought to get better and then +at once they eat better and proceed to increase {180} their resistive +vitality. The despondency that comes with the lack of the will to be +well hurts their appetite particularly and no tuberculosis patient can +ever hope to recover health unless he is eating heartily. With better +eating there is always a temptation to be more outdoors and the +ability to stand cooler air which always means that the lungs are +given their opportunity to breathe fresh cool air which constitutes +absolutely the best tonic that we have for the affection. + +It has been recognized in recent years that the only climates which +give reasonable hope of being helpful for the tuberculous are those +which present a variation of some thirty degrees in their temperature +every day. Whenever this is the case chilly feelings are always +produced in those who are exposed to the change, even though the lower +temperature curve may not go down to anywhere near freezing. If for +instance the temperature at the hottest hour of the day, say three +o'clock in the afternoon, is 90 deg. F. and that of the later evening or +middle of the night is 60 deg. F., chilly feelings will be produced. Just +the same thing is true if the temperature is between 30 deg. F. and 40 deg. F. +shortly after the middle of the day and then goes down to {181} near +zero at night. These chilly feelings are uncomfortable, but they +produce an excellent reaction in the circulation and set the blood +coursing from the heart to the tissues better than any medicine that +we have. In the midst of this the lungs have their resistive vitality +raised so as to throw off the disease. + +This is probably one of the principal reasons why mountain climates +have been found so much more helpful for the treatment of tuberculosis +than regions of lower elevations. Whenever the elevation is more than +fifteen hundred feet there will almost invariably be a variation of +thirty degrees between the day and the night temperature. There are of +course still greater variations, even sixty or seventy degrees +sometimes where the altitudes are very high, but this is often too +great for the tuberculous patients to react properly to, in their +rundown conditions. Besides, the air is much rarer at the higher +elevations, breathing is more difficult, because the lungs have to +breathe more rapidly and more deeply in order to secure the amount of +oxygen that is needed for bodily necessities from the rarified air. +The middle elevations then, between fifteen hundred and twenty-five +{182} hundred feet, have been found the best for tuberculosis +patients, and they are very pleasant during the summer time, though +never without the chilly discomfort of the drop in temperature. During +the fall and winter, however, many patients become tired out trying to +react to these variations of temperature and want to seek other +climates where they will not have to submit to the discomfort and the +chilly feelings. If they come down to more comfortable quarters before +their tuberculosis has been brought to a standstill by the increase of +their resistive vitality, it is very probable that they will lose most +of the benefit that they derived from their mountain experience. Here +is where the will comes in. Those who have the will to do it and the +persistence to stick at it and the character that keeps them in good +humor in spite of the discouraging circumstances which almost +inevitably develop from time to time, will almost without exception +recover from their tuberculosis with comparatively little difficulty, +if they have only taken up the treatment before the disease is so far +advanced as to be beyond cure. + +In the older days consumptives used to be sent to the Riviera and to +Algiers and to {183} other places where the climate was comparatively +equable, with the idea that if they could only avoid the chilly +feelings consequent upon variations of temperature it would be better +for them. Many of the disturbing symptoms of tuberculosis are rendered +less troublesome in such a climate, but the disease itself is likely +to remain quiescent at best or perhaps even to get insidiously worse, +as tuberculosis is so prone to do. These milder climates require much +less exercise of the will, but that very fact leaves them without the +all-important therapeutic quality which the lower altitudes possess. + +For many people the outdoor life and the sight of nature in the +variations produced in scenery during the course of the days and the +seasons are satisfying enough to be helpful in making their cure of +tuberculosis easy. They are extremely fortunate if they have this +strong factor in their favor. It is very probable that we owe the +discovery of the value of the Adirondacks and other such medium +altitudes in the treatment of tuberculosis to the fact that Doctor +Trudeau liked the outdoors so much and was indeed so charmed with the +Adirondack region that when death from tuberculosis seemed {184} +inevitable, he preferred the Saranac region as a place to die in, in +spite of the hardships and the bitter cold from which at that time +there was so little adequate protection, to the comforts of the city. +He scarcely hoped for the miracle of cure from a disease which he as a +doctor knew had carried off so many people, but if he were to die he +felt that he would rather die in the face of nature with his beloved +mountains all around him than in the shut-in spaces of the city. + +His resolution to go to the Adirondacks seemed to many of those who +heard of it scarcely more than the caprice of a man whom death had +marked for itself. His physicians surely had no hope of his journey +benefiting him but they felt very probably that in the conditions he +might be allowed to have this last desire since there were so few +other desires of life that he was likely to have fulfilled. His will +to live outdoors in spite of the bitter cold of that first winter +undoubtedly saved his life and then he evolved the system of outdoor +treatment which has in the past fifty years saved so many lives and is +now the recognized treatment for the disease. It is easy to +understand, however, how much of firm determination was required {185} +on his part forty years ago, when there were no comfortable ways of +getting into the Adirondacks, when the last stage of the journey had +to be made for forty miles on a mattress in a rough wagon, when water +for washing had to be secured by breaking the ice in the pitcher or on +the lake and when the bitter climate must have been the source of +almost poignant torture to a man constantly running a slight +temperature. He had the courage and the will power to do it and the +result was not only his own survival but a great benefit secured for +others. + +Unfortunately many a consumptive patient who during his first period +of treatment keeps to the letter the regulations for outdoor air and +abundant food fails to do so if it is necessary to come back a second +time. Persistency is here a jewel indeed and only the persistent win +out. Many an arrested case fails to keep the rules of living that may +be necessary for years afterwards and runs upon relapse. The will to +do what is necessary is all-important. Trudeau himself, after securing +the arrest of his disease in the Adirondacks, though he lived and +worked successfully to almost seventy years of age, found it quite +impossible to live out of them {186} and often had to hurry back from +even comparatively brief visits to the lowlands. Besides, every now +and then during some forty years he had the will power to take his own +prescription of outdoor air and absolute rest. It was the faculty to +do this that gave him length of life far beyond the average of +humanity and the power to accomplish so much in spite of the invasion +of the disease which had rendered large parts of both lungs +inoperative. Not only did he live on, however, but he succeeded in +doing so much valuable work that few men in the medical profession of +America have stamped their name deeper on modern medical science than +this consumptive who had constantly to use his will to keep himself +from letting go. + + +{187} + +CHAPTER XII + +THE WILL IN PNEUMONIA + + + "Who shall stay you?--My will, not all the world." + _Hamlet_. + + +What is true of tuberculosis and the influence of the will has proved +to be still more true, if possible, of pneumonia. Clinical experience +with the disease in recent years has not brought to us any remedy that +is of special value, nor least of all of specific significance, but it +has enabled us to understand how individual must be the treatment of +patients suffering from pneumonia. We have recognized above all that +mentally disturbing factors which lessen the patient's courage and +will to live may prove extremely serious. We hesitate about letting an +older person suffering from pneumonia learn any bad news and +particularly any announcement of the death of a near relative, above +all, a husband or wife. The shock and depression consequent upon any +such announcement may {188} prove serious or even fatal. The heart +needs all its power to accomplish its difficult task of forcing blood +through the limited space left free in the unaffected lung tissue, and +anything which lessens that, that is anything which _disheartens_ the +patient, to use our expressive English phrase, must be avoided as far +as possible. + +When a man of fifty or beyond, one or more of whose friends has died +of pneumonia about his age, comes down with the disease and learns, as +he often will in spite of the best directed effort to the contrary, +that he is suffering from the affection, if he is seriously disturbed +by the knowledge, we realize that it bodes ill for the course of the +disease. If a pneumonia patient, especially beyond middle life, early +in the case expresses the thought that perhaps this may be the end and +clings at all insistently to that idea, the physician is almost sure +to feel little confidence of pulling him through the illness. In +probably no disease is it more important that the patient's courage +should be kept up and that his will should help rather than hamper. + +Courage is above all necessary in pneumonia because the organs that +are most affected and have most to do with his recovery are so much +{189} under the control of the emotions. Any emotional disturbance +will cause the heart to be affected to some extent and the respiration +to be altered in some way. When a pneumonia patient has to lie for +days watching his respirations at forty to the minute, though probably +he has never noticed them before, and feels how his heart is laboring, +no wonder that he gets scared, and yet his scare is the very worst +thing that can happen to him. It will further disturb both his heart +and his respiration and leave him with less energy to overcome the +affection. He may be tempted to make conscious efforts to help his +lungs in their work, though any such attempt will almost surely do +more harm than good. He must just face the inevitable for some five to +nine days, hope for the best all the time and keep up his courage so +as not to disturb his heart. After middle life only the patients who +are capable of doing that will survive the trial that pneumonia gives. +The super-abounding energy of the young man will carry him through it +much better; and besides, the young man usually has much less +solicitude as to the future and much less depending on his recovery. + +A generation ago or even less, whiskey or {190} brandy or some form of +strong, alcoholic stimulant, as it was called, was looked upon as the +sheet anchor in pneumonia. For a generation or more at that time, the +same remedy had been looked upon by a great many physicians as an +extremely precious resource in the treatment of tuberculosis. The +therapeutic theory behind the practice was that in affections of the +lungs a particular strain was placed upon the heart and therefore this +organ needed to be stimulated just as far as could be done with +safety. As alcohol increases the rapidity of the heart beat, it was +considered to be surely a stimulant and came to be looked upon as the +safest of heart stimulants, because, except when used over very long +periods, direct bad effects had not been noticed. In pneumonia, above +all, the heart needed to be stimulated because it had to pump blood +through the portion of the lungs unaffected by the pneumonia, usually +congested and offering special hindrances to the circulation; besides, +a much larger amount of blood than usual had to be pumped through +these portions of the lungs in order to compensate for the solidified +portions. + +A number of very experienced physicians came to be quite sure that +alcoholic stimulants {191} were the most valuable remedy that we had +for this special purpose of cardiac stimulation; some of them went so +far as to say, with a well known New York clinician, that if they were +to be offered all the drugs of the pharmacopeia without alcoholic +stimulant for the treatment of pneumonia on the one hand, or whiskey +or brandy on the other without all the pharmacals, they would prefer +to take the alcohol, confident that it would save more patients for +them. They were quite sure that they had made observations which +justified them in this conclusion. + +We know at the present time that alcohol is not a stimulant but always +a narcotic. It increases the rapidity of the heart beat, though not by +direct stimulation, but by disturbing the inhibitory nerve apparatus +of the heart and thus permitting the heart to beat faster. Just as +there is a governor on a steam engine, to keep it from going too fast +and regulate its speed to a definite range, so there is a similar +governing apparatus or mechanism in connection with the heart. It is +by affecting this that alcohol makes the heart go faster. Blood +pressure is not raised, but on the contrary lowered, and the effect of +alcohol is depression and not stimulation. {192} In spite of this, +good observers seemed to note favorable effects from the use of +alcohol in both pneumonia and tuberculosis. This appears to be a +paradox until one analyzes the psychic effects of alcohol and places +them alongside the physical, in order to determine the ultimate +equation of the influence of the substance. + +Alcohol has a very definite tendency to produce a state of euphoria, +that is, of well-being. The patient's mind is brought to where it +dismisses solicitude with regard to himself. This neutralizes directly +the anxiety which so often acts as a definite brake upon resistive +vitality. The alcoholic stimulant, in so far as it has any physical +effect, probably does a little harm, but its influence on the mind of +the patient not only serves to neutralize this, but adds distinctly to +the patient's prospects of recovery. Without it, the dread which comes +over him paralyzes to some extent at least his heart activity and +interferes with lung action. Under the influence of alcohol, he gains +courage--artificial, it is true--but still enough to put _heart_ in +him, and this is the stimulation that the older clinical observers +noted. The patient can, with the scare lifted, use his will to be well +{193} ever so much more effectively and psychic factors are +neutralized that were hampering his resistive vitality. + +This illustrates very well indeed the place of dilute alcohol in some +of the usual forms in therapeutics about the middle of the nineteenth +century. Practically all the textbooks of medicine at that time +recommended alcohol for many of the continued fevers. In sepsis, in +child-bed fever, in typhoid, in typhus, as well as in tuberculosis and +pneumonia and other less common affections, whiskey or brandy was +recommended highly and usually given in considerable quantities. All +of these affections are likely to be accompanied by considerable +anxiety and solicitude with a series of recurring dreads that sadly +interfere with nature's efforts toward recovery. Under certain +circumstances, the scare, to use the plain, simple word, was +sufficient to turn the scale against the patient. The giving of +whiskey at least lifted the scare [Footnote 5] {194} and enabled the +patient to use his vital resources to best advantage. + + [Footnote 5: The use of whiskey for snake-bite probably has no other + significance than this lifting of the scare. It used to be said that + the alcoholic stimulation neutralized the depressant effect of snake + poisoning on the heart. Now we know that this is not true, and in + addition, we know of no effect that alcohol in the system might have + in neutralizing the presence of the toxic albumin which constitutes + the danger in snake poisoning. It is only rarely that the bite of a + rattlesnake will be fatal. Experts declare that the snake must be a + large one, its sting must be inflicted on the bare skin, it must not + have stung any one so as to empty its poison glands for more than + twenty-four hours, and the full dose of the poison must be injected + beneath the skin for the bite to be fatal. Very rarely are all these + conditions fulfilled. When a person is bitten by a snake, however, + the terror which ensues is quite sufficient of itself to hurt the + patient seriously and he may scare himself to death, though the + snake poison would not have killed him. The whiskey lifts the scare + and gives nature a chance to neutralize the poison which she can + usually do successfully.] + +It is extremely important, then, first to be sure that the patient's +will to be well is not hampered by unfortunate psychic factors and +secondly, that his courage shall be stimulated to the greatest +possible degree. Fresh air is the most important adjuvant for this +that we have. The outdoor air gives a man the courage to dissipate +dreads and makes him feel that he can accomplish what seemed +impossible before. Undoubtedly this is one of the favorable effects of +the fresh-air treatment of pneumonia, for it makes people mentally +ever so much less morbid. The patient's surroundings must be made as +encouraging as possible and there must be no signs of anxious +solicitude, no long faces, no weeping, and as far as possible, no +disturbance about business affairs that might make him think that a +fatal termination was {195} feared. His will to get well must be +fostered in every possible way and obstacles removed. This is why it +has been so well said in recent years that good nursing is the most +important part of the treatment of pneumonia. This does not mean that +a good nurse can replace a physician, but that both must coordinate +their efforts to making the patient just as comfortable as possible, +so that he will feel assured that everything that should be, is being +done for him, and that it is only a question of being somewhat +uncomfortable for a few days and he will surely get well. + +Sunny rooms, smiling faces, flowers at his bedside, cheerful +greetings, all these, by adding to the patient's euphoria, bolster up +his will and make him feel that after all, thousands of people have +suffered from pneumonia and recovered from it, and there is no reason +why he should not, provided that he will not interfere with his own +recovery. + + +{196} + +CHAPTER XIII + +COUGHS AND COLDS + + + "The power and corrigible authority of this lies in our wills." + _Othello_. + + +It might seem as though the will had nothing to do with such very +material ailments as coughs and colds, and yet the more one knows +about them, the clearer it becomes that their symptoms can be +lessened, their duration shortened, their tendencies to complications +modified, and to some extent at least, they can be almost literally +thrown off by the will to be well. The idea of a little more than a +generation ago that coughs and colds would be most benefited by +confinement to the house and as far as possible to a room of an +absolutely equable temperature has gradually given way before the +success of the open-air treatment for tuberculosis and the meaning of +fresh air in the management of pneumonia cases. Fresh, cold air is +always beneficial to the lungs, no matter what the conditions present +in them, though it requires {197} no little courage and will power to +face the practical application of that conclusion in many cases. When +it is bravely faced, however, the results are most satisfactory, and +the respiratory condition, if amenable to therapeutics, is relieved or +proceeds to get better. Of course it is well understood that any and +every patient who has a rise in temperature, that is whose temperature +is above 100 deg. F. in the later afternoon hours, should be in bed. Under +no circumstances must a person with any degree of fever move around. +This does not mean, however, that such patients should not be +subjected to fresh, cold air. The windows in their room or the ward in +which they are treated should be open, and if the condition is at all +prolonged, arrangements should be made for wheeling their beds out on +the balcony or placing them close to a window. The cold air gives them +distinctly chilly feelings and sometimes they complain of this, but +they must be asked to stand it. Of course if the cold disturbs their +circulation, if the feet and hands get cold and the lips blue, the +patients are not capable of properly reacting against the cold and +must not be subjected to it. Their subjective feelings of chilliness, +however, must {198} not be sufficient to keep them from the ordeal of +cold, fresh air; on the contrary, they must be told of the benefit +they will receive from it and asked to exert their wills to stand the +discomfort with just as little disturbance as possible. + +People suffering from coughs, no matter how severe, should get out +into the air regularly, if they have no fever, and should go on with +their regular occupation unless that occupation is very confining or +is necessarily conducted in dusty air. Keeping to the house only +prolongs the affection and makes it much more liable to complications +than would otherwise be the case. Sufferers from these affections +should not go into crowds, should avoid the theaters and crowded cars, +partly for the sake of others--because they can readily convey their +affection to them--but also for their own sake, because they are more +susceptible to other forms of bacteria than those already implanted in +their own systems and they are much more liable to pick up foreign +bacteria in crowds than anywhere else. They should be out in the open +air, particularly in the sunlight, and this will do more to shorten +the course of a cough and cold than anything else. + +{199} + +They need more sleep than before and should be in bed at least ten or +eleven hours in the day, though if they should not sleep during all of +that time, they need not feel disturbed but may read or knit or do +something else that will occupy them while they retain a recumbent +position. They should not indulge in long, tiresome walks and in +special exertion, but should postpone these until the cough has given +definite signs of beginning to remit. + +With regard to the cough itself, it must not be forgotten that the +action of coughing is for the special purpose of removing material +that needs to be cleared from the lungs and the throat and larynx. It +should not be indulged in except for that purpose. It requires a +special effort, and while the lungs and other respiratory passages are +the subject of a cold, these extra efforts should not be demanded of +them unless they are absolutely necessary. Almost needless to say, +people indulge in a great deal of unnecessary coughing. Some of this +is a sort of habit and some of it is due to that tendency to imitate, +so common in mankind. Every one has surely heard during religious +services, in a pause just after heads have been bowed in prayer or for +a {200} benediction, a single cough from a distant part of the church +which seemed to be almost the signal for a whole battery of coughs +that followed immediately from every portion of the edifice. If some +one begins coughing during a sermon or discourse, others will almost +inevitably follow. Coughing, like yawning, is very liable to +imitation. + +The famous rule of an old-time German physician was that no one was +justified in coughing or scratching the head unless these activities +were productive. Unless you get something as the result of the +coughing, it should not be indulged in. There are a great many people +who cough much more than necessary and who delay the progress of their +betterment in that way. Whenever material is present to be coughed up, +coughing is not only proper but almost indispensable. It is the +imitative cough, the coughs which indicate overconsciousness of one's +affection, the coughs that so often almost unconsciously are meant to +catch the sympathy of those around, which must be repressed by the +will, and when the patient finds that he really has to cough less than +he thinks, he will be quite sure that he is getting better and will +actually improve as a consequence of this feeling. + +{201} + +Coughs need an abundance of fluid much more than medicine, and warm +fluids are better than cold; the will must be exercised so as to +secure the taking of these regularly. At least a quart of warm liquid, +milk if one is not already overweight, should be taken between meals +during the existence of a cough. Hot milk taken at night will very +often secure much better rest with ever so much less coughing than +would otherwise be the case. The tendency to take cough remedies which +lessen the cough by their narcotic effect always does harm. Coughing +is a necessary evil in connection with coughs, and whatever +suppression there is should be accomplished by means of the will. +Remedies that lessen the coughing also lock up the secretions and +disturb the system generally and therefore prolong the affection and +do the patient harm. Most of the remedies that are supposed to choke +off a cough have the same effect. Quinine and whiskey have been very +popular in this regard but always do harm rather than good. Their use +is a relic of the time when whiskey was employed for almost every form +of continued fever and when quinine was supposed to be good for every +febrile affection. We know now that quinine has no effect {202} except +upon malarial fevers, and then only by killing the malarial organism, +and that whiskey is a narcotic and not a stimulant and does harm +rather than good. Those who did not take the familiar Q. and W. have +in recent years had the habit of administering to themselves or to +their friends various laxative or anodyne or antiphlogistic remedies +that are supposed to abort a cough or cold and above all, prevent +complications. All of these remedies do harm. Every single one of +them, even if it makes the patient a little more comfortable for the +time, produces a condition that prevents the system from throwing off +the infection which the cold represents as well and as promptly as it +otherwise would. + +It requires a good deal of will power to keep from taking the many +remedies which friends and sometimes relatives insist on offering us +whenever a cold is developing, but the thing to do is to summon the +will power and bravely refuse them. Medicine knows no remedies that +will abort a cold. The use of brisk purgatives, sometimes to an extent +which weakens the patient very much the next day, is simply a relic of +the time when every patient was treated with antimony {203} or calomel +and free purgation was supposed to be almost as much of a cure-all as +blood-letting. There is no reason in the world to think that the +emptying of food out of the bowels will do any particular good, unless +there is some definite indication that the food material present there +should be removed because it is producing some deleterious effect. + +The longer a physician is in the practice of medicine the less he +tries to abort infectious diseases, and coughs and colds are, of +course, just infections. They must run their course, and the one thing +essential is to put the patient in as good condition as possible so +that his resistive vitality will enable him to throw off the infection +as quickly as possible. It requires a good deal of exercise of will +power on the part of the physician to keep from running after the many +will-o'-the-wisps of treatment that are supposed to be so effective in +shortening the course of disease, but any physician who looks back at +the end of twenty years will know that his patients have reason to be +thankful to him just in proportion as he has avoided running after the +fads and fancies of current medicine and conservatively tried to treat +his patients rather than cure their diseases. The patient is ever so +much {204} more important than his disease, no matter what the disease +may be. + +Above all, for the cure and prevention of coughs and colds people must +not be afraid of cold, fresh air. A good many seem to fear that any +exposure to cold air while one has a cough may bring about pneumonia +or some other serious complication. It must not be forgotten, however, +that the pneumonia months in the year occur in the fall and the +spring, October and November and March and April producing most deaths +from the disease, and not December, January and February. The large +city in this country which may be said to have the fewest deaths from +pneumonia is Montreal, where the temperature during December and +January is often almost continuously below zero for weeks at a time +and where there is snow on the ground for three or four months in +succession. The highest death rate from pneumonia is to be found in +some of our southern cities which have rather mild winters and rather +equable temperature,--that is, no considerable variation in the daily +temperature range. Cold air is bracing and tonic for the lungs and +enables them to resist the microbe of pneumonia, and it is now +recognized {205} by physicians that personal immunity is a much more +important factor in the prevention of the disease than anything else. + +Coughs and colds and bronchitis and pneumonia, the respiratory +diseases generally, are much less frequent in very cold climates than +in variable regions. Arctic explorers are but rarely troubled by them, +even though they may be exposed to extremely low temperatures for +months. Men subjected to blizzards at thirty and forty degrees below +zero may have fingers and toes frozen but do not have respiratory +affections. Some years ago, it was noted that one of these Arctic +expeditions had spent nearly two years within the Arctic Circle +without suffering from bronchial or throat disease and within a month +after their return in the spring most of them had had colds. Nansen +and his men actually returned from the Arctic regions where they had +been in excellent health during two severe winters to be confined to +their beds with grippy colds within a week of their restoration to +civilization, with its warm comfortable homes and that absolute +absence of chill which is connected in so many people's minds with the +thought of coughs and colds. + +The principal reason why colds are so {206} frequent in the winter +time in our cities and that pneumonia has increased so much is mainly +because people are afraid of standing a little cold. Office buildings +are now heated up to seventy degrees to make the personnel absolutely +comfortable even on the coldest days, and as a consequence the air is +so dry that it is more arid--that is more lacking in water vapor, as +the United States Public Health Service pointed out--than Death +Valley, Arizona, in summer. People dress too warmly, anticipating +wintry days and often getting milder weather and thus making +themselves susceptible to chilling because the skin is so warm that +the blood is attracted to the surface. Will power to stand cold, even +though at a little cost of discomfort, is the best preventive of +coughs and colds and their complications and the best remedy for them, +once the acute febrile stage has passed. + + + +{207} + +CHAPTER XIV + +NEUROTIC ASTHMA AND THE WILL + + + "Great minds of partial indulgence + To their benumbed wills." + _Troilus and Cressida_. + + +In closing a clinical lecture on bronchial asthma at the University of +Marburg some years ago, Professor Friedrich Mueller, who afterwards +became professor at Berlin, said, "Each asthmatic patient is a problem +by himself and must be studied as such; meantime, it must not be +forgotten what an important role suggestion plays in the treatment of +the disease." This represents very probably the reason why so many +remedies have been recommended for asthma and have proved very +successful in the hands of their inventors or discoverers as regards +the first certain number of patients who use them, and yet on +subsequent investigation have turned out to be of no special +therapeutic value and sometimes indeed to have no physical effect of +any significance. + +{208} + +Of course this is said with regard to neurotic asthma only, and must +not be applied too particularly to other forms of the affection, +though there is no doubt at all that the symptoms of even the most +severe cases of organic asthma can be very much modified and often +very favorably, by suggestive methods. + +The principal feature of asthma is a special form of severe difficulty +in breathing. It is known now that the beginning of the affection is +always as Strumpell said, "an extensive and quite rapid contraction of +the smaller and smallest bronchial branches, that is the terminal +twigs of the bronchial tubes." It is not so much air hunger, though +there is, of course, an element of that because the lungs are not +functioning properly, as an inability to empty the lungs of air +already there and get more for respiratory purposes. The spasm in +asthma has a tendency to hold the lungs too full of air and produce +the feeling of their getting ever fuller and fuller. What the old sea +captain said in the midst of his attack of asthma, when somebody +sympathized with him because he had so much difficulty in getting his +breath, was that he had lots of breath and would like to get rid of +some of it. {209} He added, "If I ever get all this breath that's in +me now out of me, I'll never draw another breath so long as I live, so +help me." The respiration spasm is usually at full inspiration and the +effort is mainly directed toward expiration and expulsion of air +present using the accessory respiratory muscles for that purpose. + +The picture of a man suffering from asthma is that of a patient so +severely ill as to be very disturbing to one not accustomed to seeing +it. It would be almost impossible for any one not used to the attacks +to think that in an hour or two at the most the patient would be quite +comfortable and if he is accustomed to the attacks, that he will be +walking around the next day almost as if nothing had happened. All +that the affection consists in is a spasm of the bronchioles and as +soon as that lets up, the patient will be himself again. Some material +may have accumulated during the time when the spasm was on which will +still need to be disposed of, and there will be, of course, tiredness +of muscles unaccustomed to be used in that special way, but that will +be all. + +We are still in the dark as to what causes the spasms but undoubtedly +psychic factors {210} play an important etiological role. For a good +many people, there is a distinct element of dread as the immediate +cause of their asthmatic attacks. Some people have it only when they +have gone through some disturbing neurotic experience. Occasionally it +is the result of physical factors combined with some psychic element. +Cat asthma is not very uncommon and occurs as a consequence of some +contact by the individual with a specimen of the cat tribe though +usually the large cats, the lions and tigers, do not cause it. There +is nearly always, in those who are liable to this form of asthma, a +special detestation of cats. There is probably some emanation from the +animal which produces the asthmatic fever, just as is true also of +horses in those cases where horse asthma occurs. In a few of these +latter cases, however, it was noted that the horse asthma did not +begin until after there had been some terrifying experience in +connection with the horse, as a runaway, a collision, or something of +that kind. + +Any one who sees many asthmatic cases inevitably gets the impression +after a time that their very dread of the attacks has not a little to +do with predisposing them. {211} Occasionally the dread is associated +with some other organic disturbance, either of heart or kidneys, or +oftener still, with some solicitude with regard to these organs and +the persuasion that there is something serious the matter with them, +though there is at most only some functional disturbance. This is +particularly true of cases of palpitation of the heart where there has +been considerable dread of organic heart disease. In a certain number +of these cases, there is some emphysema present, that is, +overdistention of the lungs, such as is seen in high-chested people. +Owing to the long anterio-posterior diameter of the chest and the fact +that as a consequence it is nearly as thick through as it is wide, +this form of chest is sometimes spoken of as barrel-chest. Patients +who have it are particularly likely to suffer from asthma if they have +any dread of heart trouble or if they are of a nervous constitution. + +I have known people with the dread of the dark to get an attack of +asthma if they were asked to sleep alone after having been accustomed +for years to sleep with somebody in the room. I have known even a +physician to have attacks of asthma of quite typical character as the +result of a dread of being {212} out after dark which had gradually +come over him. I have had a physician patient who was very +uncomfortable if alone on the streets of New York, even during the +day, and whose symptoms at their worst were distinctly dyspneic or +asthmatic. He used to have to bring his wife with him whenever he came +to see me for he lived out in one of the neighboring towns, because he +was so afraid that he might get an asthmatic attack that would +overcome him and he would feel helpless without some one to aid him. + +In practically all these cases, the treatment of asthma becomes +largely that of treating the accompanying dread. Once the acute +symptoms of the attack itself manifest themselves, they have to be +treated in any way that experience has shown will relieve the patient. +The general condition, however, needs very often an awakening of the +will to regulate the life, to get out into the air more than before, +to avoid disturbing neurotic elements, and worrying conditions of +various kinds. Thin people need to be made to gain in weight, using +their will for that purpose; stout people who eat too much and take +too little exercise need to have their lives {213} regulated in the +opposite direction. In the meantime, anything that arouses the patient +to believe firmly that his condition will be improved by some remedy +or mode of treatment, will help him to make the intervals between +attacks longer and the attacks themselves less disturbing. The will +undoubtedly plays a distinct role in this matter which patients who +have been through a series of asthmatic attacks recognize very +clearly. + +The many remedies for asthma which have been lauded highly even by +physicians, and that have cured or relieved a great many patients and +yet after a while have proved to be without much beneficial effect, +make it very clear how much the affection depends on the will power to +face it and throw it off. Nothing will be curative in asthma unless +the patient has confidence in his power and uses his own will energy +to help it. He must overcome the element of dread which occurs in +connection with all asthmatic attacks, even those due to organic +disease of heart or kidneys. No matter how frequent the attacks have +been, there is always an element of fright that enters into an +affection which interferes with the respiration. This must {214} be +overcome by psychic means to help out the physical remedies that are +employed. Sometimes the psychic remedies will succeed of themselves +where more material means have failed completely. + + +{215} + +CHAPTER XV + +THE WILL IN INTESTINAL FUNCTION + + + "Ill will never said well." + _Henry V_. + + +During the past generation, the appreciation of the relative part +played by the stomach and intestines in digestion has completely +changed. Our forefathers considered the stomach the all-important +organ of digestion and the intestines as scarcely more than a long +tube to facilitate absorption and deal properly with waste materials. +Their relative values are now exactly reversed in our estimation. The +stomach has come to be looked upon as scarcely more than a thin-walled +bag meant to hold the food that we take at each meal and then pass it +on by degrees to be digested, prepared for absorption and finally +absorbed in the intestines. It has comparatively little to do with +such alteration of the food as prepares it to be absorbed. Its motor +function is much more important than its secretory function and +serious stomach troubles are {216} dependent on disturbances of +stomach motility. Contractions at the pyloric orifice, that is the +passageway from the stomach into the intestines, will cause the +retention of food and seriously interfere with health. The dilatation +of the stomach for any reason may produce a like result and these are +the stomach affections that need special care. + +If the stomach will only pass the food on properly, the intestines +will do the rest. A number of people have been found in the course of +routine stomach examinations who proved to have no secretory function +of the stomach and yet suffered no symptoms at all attributable to +this fact. The condition is well known and is called _achylia +gastrica_, that is, failure of the stomach to manufacture chyle, the +scientific term for food changed by stomach secretions. Our stomachs +are only meant, apparently, to provide a reservoir for food that will +save us the necessity of eating frequently during the day, as the +herbivorous and graminivorous animals have to do, and enable us to +store away enough food to provide nutrition for five or six hours. We +thus have the leisure to occupy ourselves with other things besides +eating and drinking. + +This conclusion as to the relative {217} significance of the stomach +and digestion is confirmed by the fact that removal of the whole +stomach or practically all of it for cancer has in a number of well +known cases been followed by gain in weight and general improvement in +health. Schlatter's case, the very first one in which nearly the whole +stomach was removed, proved a typical instance of this, for the +patient proceeded to gain some forty pounds in weight. She had lost +this during the course of the growth of a cancer and its interference +with stomach motility. It was necessary, however, for her to be fed, +rather carefully, well-chosen foods usually in liquid form, and every +hour and a half instead of at longer intervals. Her intestines were +thus spared from overloading and proceeded to do the work of digestion +for which they are so well provided by abundant secretion poured into +them from the large glands, the liver and the pancreas, as well as the +series of small glands in their own walls all of which were manifestly +meant to do extremely important work. + +In the increased estimation of the significance of the digestive +functions of the intestines which has come in recent years, there has +been a tendency, as always in human {218} affairs, for the pendulum to +swing too far. Above all, certain phases of intestinal function have +come to occupy too much attention and to be the subject of +oversolicitude. Whenever this happens, whatever function it concerns +is sure to be interfered with. Attention has been concentrated to a +great extent on evacuation of the bowels and the consequences have +been rather serious. A great many people whose intestinal functions +were proceeding quite regularly have had their attention called to the +fact that any sluggishness of the intestines may be the source of +disturbing symptoms and the beginning of even serious morbid +conditions. As a consequence, they pay a great deal of attention to +the matter and before long become so solicitous that the elimination +of waste materials from the intestines is interfered with. Above all, +they may be led to pick and choose their foods so delicately that +there is not the necessary waste material left to encourage +peristalsis. + +The result is that to some extent at least, intestinal function would +almost seem to have broken down in our day. Everywhere one sees +advertisements of medicines and remedies and treatments of various +kinds that will aid in the evacuation of the bowels. {219} Most of +them are guaranteed to be perfectly harmless and all of them are +pleasant to take, they work while you are doing nothing else and are +just engaged in saving mankind not only suffering but complications of +various kinds that may lead to serious results. Some years ago, when +Matthew Arnold was in this country, he declared in one of his lectures +that what the world needed was "leading and light," but a well known +American physician who is closely in touch with American life declared +not long since that what we needed in America manifestly, if +advertisements were any index of the needs of a people, was laxatives +and more laxatives. Advertisements cost money; it is said that at +least four times as much as the advertising costs must be spent by the +public on any object advertised in order to make it pay, so that very +probably nearly a billion of dollars a year is spent in this country +on laxatives. Only whiskey and tobacco present a higher bill to the +American people annually. + +Practically all of the laxative medicines do harm if taken over a +prolonged period. Over and over again physicians have found that +laxative remedies introduced even by scientists, with the assurance +that they were quite {220} harmless and had no undesirable after +effects proved the source of annoying or even serious symptoms after a +while. It is true that when constipation has become habitual, it may +be necessary to give laxative medicines for a prolonged period, but +this is only another instance of the necessity that is often presented +to the physician of choosing between two evils and trying to find the +lesser one. Even the heavy oil that has become so popular in recent +years has been found on careful investigation and prolonged +observation to have certain undesirable effects and it must not be +forgotten that it has not been used generally for a sufficiently long +time for us to be absolutely sure what its sequelae may be. + +This breakdown of intestinal activity is not the fault of nature but +of men and women who have been thinking to improve on the natural laws +of living. As the result of improvements in diet and refinements in +cooking and the preparation of foods, less and less of their roughage +is left in our articles of food when sent to the table. It is on this +roughage or waste material that intestinal movement or peristalsis +depends. If we eat perfectly white bread, cut all the gristle and +fatty materials from our meat, carefully eliminating {221} the +connective tissue bundles that may occur in it, eat our vegetables +mainly in the shape of purees and avoid to a great extent all the +coarser varieties, such as parsnips and carrots and beets, we provide +very little material for the intestines to carry on and aid them in +the elimination of other wastes. If, besides, we always ride and do +not walk, and so have none of that precious jolting which occurs every +time the heel comes down, and if we have no bending movements in our +lives, no wonder that intestinal movement becomes sluggish and we have +to supply stimulants and irritants to get it to do its work. + +Intestinal evacuation is very largely a matter of will. There are very +few people so constituted by nature that they will not have regular +movements sufficient to maintain their digestive tracts in excellent +health, if they form the right habits. They must, however, make up +their minds, that is their wills, to restore coarse materials to their +diet. They must eat whole wheat or graham bread, must eat fruit +regularly and usually eat the skins of the fruit with it, that is as +far as apples, pears, peaches, apricots, plums and the like are +concerned. Even as regards oranges, it is probable that the eating of +occasional {222} pieces of orange peel is an excellent means of +helping intestinal functions and providing waste material. [Footnote +6 ] + + [Footnote 6: A curious discovery has been made in recent years that + orange skin contains a very precious element essential for bodily + health, belonging to the class of substances known as the vitamines + and contains more of it than any other food material that we have. + The instinct which tempted so many of us as children to eat orange + skin, in spite of the fact that we were discouraged from the + practice, was founded on something much more than mere childish + caprice. Orange skin is after all the basis of marmalade which has + been so commonly used by the English people at breakfast and which + is at once a tasty and healthful material.] + +When baked potatoes are taken, the skin should be eaten, mainly +because of the waste material it provides, but also because just +underneath the skin and sure to be removed with it if it is taken off, +there are certain salts and other substances that are excellent for +health and particularly for digestion. Besides, the carbonized +material which so often occurs on baked potatoes is of itself a good +thing. It represents some of that charcoal which in recent years +French physicians particularly have found very valuable as a remedy +for certain disturbances of intestinal digestion. The removal of +parings from fruit and vegetables and the careful trimming of meat, +have taken out of human diet the materials which meant most for +intestinal movements for former generations, and they {223} have to be +supplied artificially by means of irritant drugs, salts, oils and the +like, to the detriment of function. + +The other element in the modern situation as regards the failure of +intestinal function is the lack of fluids. People who live indoors are +not tempted to take so much water as those who work outside and yet in +our modern, steam-heated houses they often need more. Our heating +systems take much more water from us than the former methods of +heating. The result is seen in our furniture that comes apart from +dryness and in our books and other things which crack and deteriorate. +Something of the same thing happens to human beings unless they supply +sufficient fluids. For this it is necessary deliberately to make up +the mind, which always means the will, to consume five or six glasses +of water between meals and especially to take one on rising in the +morning and another on going to bed. This should _not_ be hot and +above all not lukewarm water, but fresh cold water which stimulates +peristalsis. The creation of a habit is needed in the matter or it +will be neglected. I have sometimes given patients some harmless drug, +like a lithium salt, that was to be taken three or four times a day in +a full glass of {224} water, in order to be sure that they would take +the water. They were willing to take the medicine but I could not be +assured that without it they would drink the amount of water that I +counselled. + +Above all, a regular habit of going to the toilet at a definite time +every day must be created. Nothing is so important. In little +children, even from their very early years, such a habit can be +established; it is only necessary to put them on their chairs at +certain times in the day and the desired result will follow. Adults +are merely children of a larger growth in this matter, and the habit +of going regularly is all-important. A little patience is needed, +though there should be no forcing, and after a time, a very +satisfactory habit can be established in this manner. It seems almost +impossible to many people that anything so simple should prove to be +remedial for what to them for a time seemed so serious a disturbance +of health, but only a comparatively short trial of the method will be +sufficient to demonstrate its value. A book or newspaper may be taken +with one, or Lord Chesterfield's advice to learn a page of Horace +which may afterwards be sent down as an offering to Libitina, the +goddess of secret {225} places, may be followed, but the mind must not +be diverted too much from the business in hand, and the will must be +afforded an opportunity to exert its power. + +It is true that the muscular elements of the intestines consist of +unstriped muscles and that they are involuntary, and yet experience +and observation have shown that the will has a certain indirect +influence even over involuntary muscle. The heart, though entirely +involuntary in its regular activities, can be deeply influenced by the +will and the emotions, as the words encouraging and discouraging, or +the equivalent Saxon words heartening and disheartening, make very +clear. Undoubtedly the peristaltic functions of the intestines can be +encouraged by a favorable attitude of the will towards them. + +Above all, it is important that the anxious solicitude which a great +many people have and foster sedulously with regard to the effect of +even slight disturbances of intestinal functions should be overcome. +We have discussed this question in the chapter on dreads and need only +say here that the delay of a few hours in the evacuation of the bowels +or even the missing entirely of an intestinal movement for a full day +occasionally, will {226} usually not disturb the general health to any +notable extent, and that the symptoms so often attributed to these +slight disturbances of intestinal function are much more due to the +solicitude about them than to any physical effect. There are a great +many people whose intestinal functions are quite sluggish and whose +movements occur only every second day or so, who are in perfectly good +health and strength and have no symptoms attributable to any +absorption of supposed toxic materials from the intestines. Indeed, in +recent years, the idea of intestinal auto-toxemia has lost more and +more in popularity for it has come to be recognized that the symptoms +attributed to this condition are due in a number of cases to serious +organic disease in other parts of the body, and in a great many cases +to functional nervous troubles and to the psycho-neuroses, especially +the oversolicitude with regard to the intestines. The will is needed +then for intestinal function to regulate the diet, to increase the +quantity of fluid, to secure regular habits and to eliminate worry and +anxiety which interferes with intestinal peristalsis. There are but +very few cases that will not yield to this discipline of the will when +properly and persistently tried. + + +{227} + +CHAPTER XVI + +THE WILL AND THE HEART + + + "For what I will, I will, and there an end." + _Two Gentlemen of Verona_. + + +The heart is the _primum movens_, the first tissue of the body that +moves of itself in the animal organism, doing so rhythmically and of +course continuously before the nervous system develops in the embryo. +This spontaneous activity would seem to place it quite beyond the +control of the will, as of course it is, so far as the continuance of +its essential activity goes, but there is probably no organ that is so +much influenced by the emotions and comes indirectly under the +influence of the will as the heart. There are a series of expressions +in practically all languages which chronicle this fact. We talk about +the encouragement and discouragement or in Saxon terms that are +exactly equivalent to the French words, heartening and disheartening +of the individual. At moments of panic the {228} heart can be felt to +be depressed, while at times when resolve is high there is a sense of +well-being in connection with the firm action of the heart that flows +over into the organism and makes everything seem easy of +accomplishment. + +There are a number of heart conditions that depend for their existence +and continuance on a sense of discouragement, that is oversolicitude +with regard to the heart. If something calls attention to that organ, +the fact that it is so important for life and health and that anything +the matter with it may easily prove serious, will sometimes +precipitate a feeling of panic that is reflected in the heart and adds +to the symptoms noted. The original disturbing heart sensation may be +due to nothing more than some slight distention of the stomach by gas, +or by a rather heavy meal, but once the dread of the presence of a +heart condition of some kind comes over the individual, all the +subjective feelings in the cardiac region are emphasized and the +discouragement that results further disturbs both heart and patient. + +Palpitation of the heart is scarcely more than a solicitous noting of +the fact that the heart is beating. In certain cases, under the {229} +stress of emotion, the heart beat-rate may be faster than normal, but +in a number of people who complain of palpitation, no rapid heart +action is noted. What has happened is that something having called +particular attention to the heart, the beating of the organ gets above +the threshold of consciousness and then continues to be noted whenever +attention is given it. This is of itself quite sufficient to cause a +sense of discomfort in the heart region and there may be, owing to the +solicitude about the organ, a great deal of complaint. + +Just one thing is absolutely necessary in the treatment of these +cases, once it is found that there is no organic condition present. +The patient's will must be stimulated to divert the attention from the +heart and to keep solicitude from disturbing both that organ and the +patient himself. It is not always easy to accomplish this, but where +the patient has confidence in the diagnosis and the assurance that +nothing serious is the matter, a contrary habit that will overcome the +worry with regard to the heart can be formed. For it must not be +forgotten that in these cases a series of acts of solicitous attention +has been performed which has created a habit that can only be overcome +by the opposite habit. {230} It is surprising how much discomfort this +simple affection, due to a functional disturbance of the heart and +overattention to it, may produce and how much it may interfere with +the usual occupation. It is a case, however, simply of willing to be +better, and nothing else will accomplish the desired result. At times +the mistake is made of giving such patients a heart remedy, perhaps +digitalis, but this only emphasizes the unfavorable suggestion and +besides, by stimulating heart action, sometimes brings it more into +the sphere of consciousness than before and actually does harm. + +There is a form of this functional disturbance of the heart which +reaches a climax of power to disturb and then is sometimes spoken of +as spurious _angina pectoris_. In these cases the patient complains +not only of a sense of discomfort but of actual pain over the heart +region and this pain is sometimes spoken of as excruciating. +Occasionally the pain will be reflected down the left arm which used +to be considered the pathognomic sign of true _angina pectoris_ but is +not. Sometimes the pain is reflected in the neck on the left side or +at times is noted at the angle of the scapula behind. When these +symptoms occur {231} in young persons and particularly in young women, +there is no reason to think for a moment of their being due to true +_angina pectoris_, which is a spasm of the heart muscle consequent +upon the degeneration of the coronary arteries, the blood vessels +which feed the heart itself, and occurs almost exclusively in the old, +and much more commonly in old men. + +The pain of true _angina pectoris_ is often said to be perhaps the +worst torture that humanity has to bear. As a rule, however, it is +very prostrating and so genuine sufferers from it are not loud in +their complaints. Their suffering is more evident in their faces than +in their voices. Indeed, it has come to be looked upon as a rule by +the English clinicians and heart experts that the more fuss there is +made, the less likelihood there is of the affection being true _angina +pectoris_. When there is pain in the heart region then, especially in +young or comparatively young women, of which great complaint is made, +it is almost surely to be considered spurious _angina_, even though +there may be reflex pain down the arm as well as the impending sense +of death which used to be considered distinctive of the genuine +_angina pectoris_. + +{232} + +The treatment of true _angina_ depends to some extent on inspiring the +patient with courage, for it is needed to carry him through the very +serious condition to which he is subjected. The psychic element is +important, though the drug treatment by the nitrites and especially +amyl nitrite is often very effective. In spurious _angina_, the will +is the all-important element. There is some irritation of the heart +muscle but it is mainly fright that exaggerates the pain and then +concentration of attention on it makes it seem very serious. The one +thing that is all important is to relieve patients from the solicitude +which comes upon them with regard to their hearts and which prevents +them from suppressing their feelings and diverting their minds to +other things. Sometimes the will is needed to bring about such a +change in the habits of the individual as will furnish proper +nutrition for the heart. Very often these patients are under weight, +not infrequently they have been staying a great deal in the house, and +both of these bad habits of living need to be corrected. Good habits +of eating and exercise are above all important for the relief of the +condition. + +For functional heart trouble, gentle exercise {233} in the open air +generally must be taken, for it acts as a tonic stimulant to the heart +muscle. Almost as a rule, when patients suffer from symptoms from +their hearts, they are inclined to consider them a signal that they +must rest and above all must not exercise to such an extent as to make +the heart go faster. Rest, if indulged in to too great an extent, has +a very unfavorable effect upon the heart, for the heart, like all +muscles, needs exercise to keep it in good condition. One of the most +important developments of heart therapeutics in our generation was the +Nauheim treatment. In this, exercise is an important feature. The +exercise is graduated and is pushed so as to make a definite call upon +the heart's muscular power. Nauheim is situated in a little cup-shaped +valley and patients are directed to walk a certain distance on one of +the various roads, distances being marked by signposts every quarter +of a mile or so. The walk outward, when the patient is fresh, is +slightly uphill, and the return home is always downhill, which saves +the patient from any undue strain. + +The experience at Nauheim was so favorable that many physicians took +up the practice of having their heart patients exercise {234} +regularly and found that it was decidedly to their benefit. If this is +true for organic heart conditions, it is even more valuable for +neurotic heart cases, though it often requires a good deal of exercise +of will on the part of patients suffering from these affections to +control their feelings and take such exercise as is needed. In men, it +will often be found that the discomfort in the heart region, +particularly in muscular, well-built men who have no organic +condition, is due more to lack of exercise than to any other factor. +This is particularly true whenever the men have taken considerable +vigorous exercise when they were young and then tried to settle down +to the inactive habits of a sedentary life. Athletes who have been on +the teams at college, self-made men who have been hard manual laborers +when they were young, even sons of farmers who take up city life are +likely to suffer in this way. Their successful treatment depends more +on getting exercise in the open back into their lives than on anything +else, and for this a call upon the individual's will power for the +establishment of the needed new habits is the essential. + +Former athletes who try to settle down to a very inactive life are +almost sure to have {235} uncomfortable feelings in their heart +region. At times it will be hard to persuade them that they have not +some serious affection consequent upon some overstrain at athletics. +In a few cases, this will be found to be true, but in the great +majority the root of the trouble is that the heart craves exercise. A +good many functional heart cases, like the neurotic indigestions, so +called--are due to the fact that the heart and the stomach are not +given enough to do. The renewal of exercise in the daily life--and it +should be the daily life as a rule and not merely once or twice a +week--will do more than anything else to relieve these cases and +restore the patient's confidence. We saw during the war that a number +of young men, officers even more than privates--that is, the better +educated more than the less educated--suffered from shell shock so +called. A good many university men may suffer from what might be +termed heart shock if they find any reason to be solicitous about +their hearts. These neurotic conditions can only be relieved by the +will and diversion of attention. + +A certain number of people who suffer from missed beats of their +hearts become very much perturbed about the condition of that organ. +{236} Irregular heart action, and especially what has been called the +irregularly irregular heart, may prove to be a serious condition. +There are a number of regular irregularities of heart action, however, +consisting particularly of the missed beat at shorter or longer +intervals, which may have almost no significance at all. I know two +physicians, both athletes when they were at college, who have suffered +from a missed heartbeat since their early twenties. In one case it has +lasted now for thirty-five years and the physician is still vigorous +and hearty, capable even of running up an elevated stairway after a +train without any inconvenience. Some twenty years ago there was +question of his taking out a twenty-year life insurance policy and the +insurance company's physician at first hesitated to accept the risk +because of the missed beat. An examination made by three physicians at +the home office was followed by his acceptance and he has outlived the +maturity of the policy in good health and been given a renewal of it, +in spite of the fact that his missed beat still persists. + +There is often likely to be a good deal of solicitude as to the +eventual prognosis in these cases, that is as to what the prospect of +{237} prolonged life is. The regularly irregular heart does not seem +to make for an unfavorable prognosis. Young patients particularly who +have learned that they have a missed heartbeat need to have this fact +emphasized. We have the story of an important official of an American +university in whom a missed beat was discovered when he was under +forty. This was many years ago, and the prognosis of his condition was +considered to be rather serious. The patient actually lived, however, +for a little more than fifty years after the discovery of his missed +beat. It is easy to understand what a favorable effect on a patient +solicitous about a missed beat such a story as this will have. It +heartens a patient and gives him the will power to throw off his +anxieties and to keep from watching his heart and thus further +interfering with its activities. There is even a possibility of life +to the eighties or, as I have known at least one case, to the +nineties, where the irregular heart was first noted under thirty. + +But it is well recognized that close concentration of attention on the +heart will hamper its action. It has been demonstrated that it is +possible by will power to cause the missing of heartbeats and while +only those who have {238} practised the phenomenon can demonstrate it, +there are a number of well-authenticated examples of it. There is no +doubt, however, that anxiety about the heart will quicken or slow the +pulse rate. When a patient comes to be examined for suspected heart +trouble the pulse rate is almost sure to be higher than normal, even +though there may be nothing the matter with the heart; the increase or +decrease of the pulse beat is due to the anxiety lest some heart +lesion should be discovered. This makes it necessary as a rule not to +take too seriously the pulse rate that is discovered on a first +consultation and makes it always advisable to wait until the patient +has been reassured to some extent before the pulse rate is definitely +taken. + +It is easy to see, then, what a large place there is for the will in +heart therapeutics. Courage is an extremely important element in +keeping the heart from being disturbed and maintaining it properly +under control. Scares of various kinds with regard to this +all-important organ are prone to get hold of people and then to +disturb it. Many a heart that is actually interfered with in its +activities by drugs of various kinds would respond to the awakening of +the will of the patient {239} so as to control solicitudes, anxieties, +dreads and the like that are acting as disturbing factors on the +heart. When taken in conjunction with the will to eat and to exercise +properly so often necessary in these cases, the will becomes the +therapeutic agent whose power must never be forgotten, because it can +always be an adjuvant even when it is not curative and can produce +excellent auxiliary effects for every form of heart treatment that we +have. + + + +{240} + +CHAPTER XVII + +THE WILL IN SO-CALLED CHRONIC RHEUMATISM + + "I should do it + With much more ease; for my good will is to it." + _The Tempest_. + + +In popular estimation, rheumatism is one of the commonest of +affections. When a physician asks a patient, especially if the patient +is over forty years of age, "Have you ever suffered from rheumatism?" +the almost invariable response is, "Yes", though but little further +inquiry is needed to show that what the patient means is that he has +suffered from some painful conditions in the neighborhood of his +joints, or that his muscles have been sore or inclined to ache in +rainy weather, or that he has undergone some other vague discomforts +connected with dampness. Chronic rheumatism is a term that includes a +great many of the most varied conditions. True rheumatism, that is, +acute articular rheumatism, is now recognized as an infectious disease +which runs a definite course, usually with {241} fever, for some ten +days to ten weeks, and requires confinement to bed usually for a month +or more. Very rarely will any connection be found between this +affection, which presents always Galen's four classic symptoms of +inflammation, swelling, redness, heat and pain (_tumor, rubor, color, +et dolor_), and the usual conditions which are broadly characterized +as rheumatism. Just as soon as patients are asked if their rheumatism +included these symptoms there is denial, yet the idea of their having +had rheumatism remains. + +As a matter of fact, there are a number of sore and painful conditions +in connection with muscles and particularly in and around joints that +have, without any scientific justification at least, been called +chronic rheumatism. Any painful condition that is worse in rainy +weather is sure to be so named. As old dislocations, sprains and +wrenches of joints, broken bones, as well as muscular conditions of +all kinds, including flat foot and other yielding of joints, all +produce this effect, it is easy to understand that there is an immense +jumble of all sorts of painful conditions included under the term +"chronic rheumatism." Some of them, particularly in older people, +produce lameness or at least inability to walk {242} distances without +showing the disability; a great many of them produce distinct painful +conditions during the night following the use of muscles and often +disturb patients very much, because they arouse the dread that they +are going to be crippled as they grow older. + +Indeed, one of the most serious effects of these recurring painful +conditions is the dread produced lest they should cause such +progressive affections in and around joints as would eventually make +the patients bed-ridden. There are a certain number of cases of +so-called rheumatoid arthritis which produce very serious changes in +joints with inevitable crippling and quite beyond all possibility of +repair. These cases are often spoken of as chronic rheumatism and it +is the solicitude produced by the dread of them that makes the worst +part of the discomfort in many a so-called chronic rheumatic case. If +their affection is to be progressive, then the patients foresee a +prolonged confinement to bed in the midst of severe pain, hopeless of +ultimate cure. It may be said at once that these cases of rheumatoid +arthritis have nothing to do with rheumatism, represent a special +acute infection, are never a sequela of any of the rheumatic +conditions and are {243} fortunately very rare. This assurance of +itself is quite sufficient to make ever so much better a great many +patients who feel that they suffer from rheumatism. + +The painful conditions that are described under the term chronic +rheumatism would seem to be quite beyond any power of the will to +affect. They are at least supposed to represent very definite changes +in the tissues, usually of chronic character and therefore not +amenable to any remedies except those of physical influence. Besides, +they are so frequent that surely if there were any question of the +will being able to control them or bring relief for them, most +sufferers would discover this fact for themselves and apply the remedy +from within. It is not to be expected that a very great many people +would suffer pains and aches that are worse in rainy weather if all +that was needed was the exertion of their will power either to throw +off the affection or to perform such exercises and activities as would +gradually make their conditions better. In general it is felt that +painful conditions of this kind cannot be affected by the will and +that distinctly material and not psychic therapeutics must be looked +to for their relief. + +Now it so happens that the best illustration {244} of the power of the +will to "cure" people, that is, to relieve them completely of their +affections and start them afresh in life with the feeling that they +are no longer handicapped by disease, is to be found exactly in the +group of cases that have almost from time immemorial been called +chronic rheumatisms. We have had more "cures" of various kinds +announced for these--chemical, electrical, physical, hydriatic, +movement therapy and so forth--than for almost any other group of +diseases. More irregular practitioners of medicine all down the ages +have made a reputation by curing these affections than have won renown +by treating any other set of ills to which humanity is heir. Like the +poor, these ills are still with us, in spite of all the "cures" and +probably nowhere is the expression of the old French physician that +"the therapeutics of any generation is always absurd to the second +succeeding generation" better illustrated than in regard to them. +These cases serve to emphasize very clearly, however, the fact that +the pains and aches of mankind are largely under the control of the +will. + +The more one studies these cases of so-called chronic rheumatism the +easier it is to {245} understand how they become the signal "cures" +which attract attention to the quacks and charlatans who promise much, +but do nothing in particular, though they may give medicines or +treatment of some kind or another. They only arouse the patient's will +to be better and the determination to use his will with confidence, +now that the much praised treatment is doing something which will +surely make him better. Cases of this kind have constituted a goodly +part of the clientele of the great historic impostors who succeeded in +making large sums of money out of curing people by methods that in +themselves had no curative power. A review of some of the chapters of +that very interesting department of human history, the history of +quackery, is extremely suggestive in that regard. The only way to get +a good idea of the basic significance of these cases is to realize by +what they were cured and by whom they were cured. + +One of the most interesting illustrations of that phase of human +credulity is the story of Greatrakes, the Irish adventurer who had +been a soldier in Flanders, and who when his campaigns were over set +up to be a healer of mankind. He chose his opportunity during {246} +the time while Cromwell, as Lord Protector of Great Britain, had +refused to continue the practice of touching the ailing which the +Kings of England had pursued for hundreds of years since the +Confessor's time. Cromwell did not impugn the efficacy of the Royal +Touch but he refused to have anything to do with it himself. +Greatrakes found it an opportune moment to announce that for three +nights in succession he had been told in a dream by the Holy Spirit +that in the absence of the King he was to touch people and cure them. + +One might possibly think that with no better credentials than this and +no testimony except his own claim in the matter Greatrakes would +receive but scant attention. Any one who thinks so, however, does not +understand human nature. It was not long before some of the people who +had been sufferers for longer or shorter periods went to Greatrakes +and allowed him to try his hand at healing them. They argued that at +least if it did them no good it could do them no harm, and it was not +long before some of them declared that they had been benefited by his +ministrations. Very soon then he was able to furnish what seemed to be +abundant evidence of Divine Mission in the cures {247} that were +worked by his more than magic touch. Above all, people who had been +sufferers for prolonged periods, who had gone the rounds of +physicians, who had tried all sorts of popular remedies, and some of +whom had been declared incurable were healed of their ills after a +series of visits to Greatrakes. No wonder then that patients came more +and more frequently, until his name went abroad in all the country and +in spite of the difficulties of travel people came from long distances +just to be treated by him. + +All that he did was to ask the patient to expose the affected part and +then Greatrakes would stroke it with his hand, assure the patient that +a wonderful new vitality would go into them because of his Mission +from on High and promise them that they would surely get better, +explaining of course that betterment would be progressive and that it +would start from this very moment. The stroking was the important part +of the cure and so he is known in history as "Greatrakes the Stroker." +It may be said in passing that while those who were touched by the +English kings in the exercise of the prerogative of the Royal Touch +were usually presented with a gold coin which had been particularly +{248} coined for that purpose as a memorial, a corresponding gold +piece, a sovereign as a rule, in Greatrakes' method of treatment +passed from the patient to the healer. It was a case of metallotherapy +with extraction of the precious metal from the patient, as is always +the case under such circumstances. + +Here in America we had a similar experience, though ours had science +as the basis of the superstition in the case instead of religion. The +interest aroused by Galvani's experience with the twitching of frogs' +legs when exposed nerve and muscle were touched by different metals +led Doctor Elisha Perkins to invent a pair of tractors which would +presumedly apply Galvani's discovery to therapeutics. These were just +plain pieces of metal four or five inches long, shaped more or less +like a lead pencil and tapering to a blunt point. With these, as +Thatcher, one of our earlier historians of medicine, tells us, Perkins +succeeded in curing all sorts of ailments, but particularly many +different kinds of painful conditions. He was most successful in the +treatment of "pains in the head, face, teeth, breast, side, stomach, +back, rheumatism and so forth." In a word, he cured the neuralgias and +the rheumatic pains and the chronic {249} rheumatisms which are the +source of so much trouble--and especially complaint--for the old, and +which so often physicians, in any time of the world's history, have +been unable to cure. + +For a time his success was supposed to be due to some curious +electrical power that he was using. Learned pamphlets were issued to +show that animal magnetism or animal electricity or Galvanism was at +work. Professors at no less than three universities in America gave +attestations in favor of its efficacy. Time has of course shown that +there was absolutely no physical influence of any kind at work. The +only appeal was to the mind. Elisha Perkins was a Yale man of +education and impressive personality, "possessing by nature uncommon +endowments both bodily and mental ", and he succeeded in impressing on +his patients the idea that they would surely be cured; he thus +overcame the dreads, released the will power, gave new hope and a +tonic stimulus to appetite, created a desire for exercise, and then +the will kept this up and before long the patient was cured. + +When animal magnetism, as it was called about the middle of the +nineteenth century, {250} was practised without apparatus, one of its +most important claims to the consideration of physicians was founded +on its power to heal chronic painful affections which had previously +resisted all therapeutic efforts. The power of neuro-hypnotism, as it +came to be designated, to accomplish this, will be best appreciated +from the fact that this state was being used as a mode of anaesthesia +for surgical operations. When the news of the use of ether to produce +narcosis for surgical purposes at the Massachusetts General Hospital +first came to England, it did not attract so much attention as would +otherwise have been the case, because English physicians and surgeons +were just then preoccupied with the discussion of neuro-hypnotic +anaesthesia, and those who believed in it thought that ether would not +be necessary, while those who refused to believe thought the report +with regard to ether just another of these curious self-delusions to +which physicians seemed to be so liable. + +Perkins' declarations of the curative value of his tractors were, +after all, only a succeeding phase of what Mesmer had called to the +attention of the medical profession and the public in Paris not quite +a generation before. Mesmer seated his patients around a tub {251} +containing bottles filled with metallic materials out of which wires +were conducted and placed in the hands of patients seated in a circle +around it. Mesmer called this apparatus a _baquet_ or battery and it +was thought to have some wonderful electric properties. A great many +people who received the treatment were cured of chronic pains and +aches that had sometimes lasted for years. So many prominent people +were involved that the Government finally ordered an investigation to +be made by French scientists with whom, because he was the Minister +from the colonies at the time, our own Benjamin Franklin was +associated. They declared that there was not a trace of electricity or +any other physical force in Mesmer's apparatus. He was forbidden to +continue the treatment and there was a great scandal about the affair, +because a large number of people felt that he was doing a great deal +of good. + +When hypnotism came in vogue again at the end of the nineteenth +century, it was a case of chronic rheumatism that gave it its first +impetus in scientific circles. Professor Bernheim of Nancy had tried +in vain all of his remedies in the treatment of a patient suffering +from lumbago. The patient disappeared {252} for a time and when +Bernheim next saw him, he was cured. Bernheim had treated him futilely +for months and was curious to know how he had been cured. The patient +told him that he had been cured by hypnotism as practised by Liebault. +This brought Bernheim to investigate Liebault's method of hypnotism +and made him a convert to its practice. It was the interest of the +school of Nancy in the subject that finally aroused Charcot's +attention and gave us the phase of interest in hypnotism which +attracted so much public attention some thirty years ago. Many other +cases of those very refractory affections--lumbago and sciatica--have +been cured by hypnotism when they have resisted the best directed +treatment of other kinds over very long periods. + +It is these chronic rheumatisms, so called, the chronic pains and +aches in muscles in the neighborhood of joints, that were cured by the +Viennese astronomer, Father Maximilian Hoell, in the eighteenth +century. He simply applied the magnet and saw the result, and felt +sure that there must be some physical effect, though there was none. +His work was taken up by Pfarrer Gassner of Elwangen who, after using +the magnets for a time, found {253} that there was no need of their +application, provided the patients could by prayer and other religious +means be brought into a state of mind where they were sure that they +were going to get better. They then proceeded to use their muscles +properly in spite of the pain that might result for a time, and as a +result it was not long before they were cured of their affections. The +Church forbade his further practise because of his expressed idea that +pain came from the power of evil and dropped from men when they turned +to God, which was the eighteenth-century anticipation of Eddyism. +Dowie's cures were largely of similar affections, and patients +sometimes dropped their crutches and walked straight who could not +walk before. + +A great many of the so-called chronic rheumatisms are really the +result of dreads to use muscles in the proper way because for the +moment something has happened to make their use painful. A direct +injury, a wrench, or some incident causes a joint for a time to be +painful when used. In sparing it, the muscles around it are used +differently than before and as a consequence become sensitive and +painful. It is quite easy, then, for people to form bad habits which +they cannot break {254} because they have not the strength of will to +endure the sore and tender condition which develops when they try to +use muscles properly once more. The young athlete who wants to get his +muscles in good condition knows that he must pass through a period of +soreness and tenderness, sometimes of almost excruciatingly painful +character. He does so, however, and does not speak of his condition as +involving pains and aches but only soreness and tenderness. + +Older people, however, who have to get their muscles back into good +condition after a period of disuse following an injury or some +inflammatory disturbance, find this period of discomfort very +difficult to bear and so keep on using their muscles somewhat +abnormally and at mechanical disadvantage. As a consequence, these +muscles remain tender, are likely to ache in rainy weather and often +give a good deal of discomfort. Until the sufferers can be brought to +use their wills properly, so as to win back their muscles to normal +use, they will not get well. An application of magnets or a Leyden jar +or Mesmer's battery of the eighteenth century, or Perkins' tractors, +or neuro-hypnotism, or animal magnetism, or later hypnotism, or {255} +Dowie's declaration of their cure, enables them to use their will in +this regard and then they proceed to recover. It is surprising how +many presumedly intelligent people--at least they have received +considerable education--have been cured of conditions that they have +endured for years by some remedy or mode of treatment that actually +had no physical effect. + +St. John Long, the English charlatan who has been mentioned in the +chapter on tuberculosis, also succeeded in making a name for himself +in connection with the chronic rheumatisms and the so-called rheumatic +pains and aches of older people. Between consumption and these +conditions, he caught both the young and the old, and thus rounded out +his clientele. For consumption he provided an inhalant; for rheumatic +conditions, a liniment. This liniment became very famous in that +generation for its power to relieve the pains and aches, both acute +and chronic, of mankind. So many people were cured by it and above +all, so many of them were people of distinction--lords and ladies and +the relatives of the nobility--that Parliament was finally petitioned +in the interests of suffering humanity to buy the secret of the {256} +liniment from its inventor and publish it for the benefit of the +world. I believe that a substantial sum, representing many, many +thousands of dollars in our time, was actually voted to St. John Long +and the recipe for his liniment was published in the British +pharmacopeia. In composition, it was, I believe, only a commonplace +turpentine liniment made up with yolks of eggs instead of oil, as had +been the custom before. Just as soon as this fact became known, the +wonderful cures which had occurred in connection with its use ceased +to a great extent, for distinguished members of the nobility and their +relatives would not be cured by so common-place a medium as an +ordinary turpentine liniment. St. John Long was even accused of not +having sold his real secret to the Government, but there was no reason +at all to think that. He had been producing his cures not by his +liniment but by the strong effect of his prestige and reputation as a +healer upon the minds of his patients and the consequent release of +will power which enabled them to do things which they thought they +could not do before. We have had many wonderful curative oils of +various kinds since then, with all sorts of names from Alpha to Omega +and {257} very often called after a saint,--though St. John Long was +as far as possible from being a saint in the ordinary acceptance of +that word. These modern curative oils and liniments have been merely +counter-irritants, but at times, owing to a special reputation +acquired, they have been counter-irritants for the mind and stimulants +for the will which have enabled old people to persist through the +periods of soreness and tiredness until they reacquired the proper use +of their muscles. + + +{258} + +CHAPTER XVIII + +PSYCHO-NEUROSES + + + "Look, what I will not, that I cannot do." + _Measure for Measure_. + + +The psycho-neuroses, that is, the various perversions of nervous +energy and inability to supply and conduct nervous impulses properly, +consequent upon a mental persuasion which interferes with these +activities, have come to occupy an ever larger and larger place in the +field of medicine. The war has been illuminating in this matter. A +psycho-neurosis is, after all, a hysterical manifestation and it might +very well be expected that very few of these would be encountered in +armies which took only the _men_ of early adult life and from among +those, only persons who had been demonstrated to be physically and, as +far as could be determined, mentally normal. Neurologists would seem +scarcely to have a place in the war except for wounds of nerves {259} +and the cerebral location of missiles and lesions. Certainly none of +the army medical departments had the slightest premonition that +neurology would bulk larger in their war work than any other +department except surgery. That proved to be the case, however. + +The surprise was to have, from very early in the war, literally +thousands of cases of psycho-neuroses, "shell shock" as unfortunately +they came to be called, which included hysterical symptoms of all +kinds, mutism, deafness, blindness, paralysis, and contractures. +France and England after some time actually had to maintain some fifty +thousand beds in their war hospitals mainly for functional nervous +diseases, the war neuroses of many kinds. During the first half of the +war, one seventh of all the discharges from the British army or +actually one third of all the discharges, if those from wounds were +not included, were for these war neuroses. They attacked particularly +the better educated among the men and were four times as prevalent +among officers as among the privates. In proportion to the whole +number of those exposed to shells and "war's alarms and dangers" +generally, these war neuroses were {260} more common among the men +than among the women. Nurses occasionally suffered from them, but not +so frequently as the men who shared their dangers in the hospitals and +stations for wounded not far from the firing line. + +In the treatment of this immense number of cases, a very large amount +of the most valuable therapeutic experience for psychoneuroses was +accumulated. It was found that suggestion played a very large role in +making the cases worse. If these patients were placed in general +hospitals where there was much talk of wounds and injuries and the +severe trials of battle life they grew progressively worse. They +talked of their own experiences, constantly enlarging them; they +repeated what they had heard from others as if these represented their +own war incidents and auto-suggested themselves into ever worse and +worse symptomatic conditions. This was, after all, only the familiar +_pseudologia hysterica_ which occurs in connection with hysteria, and +which is so much better called by the straightforward name of +pathological self-deception or perhaps even just frankly hysterical +lying. If these patients were examined frequently by physicians, their +{261} symptoms became more and more varied and disabling and their +psycho-neurosis involved more external symptoms. + +In a word, it was found that their minds were the source of extremely +unfavorable factors in their cases. The original shock or the severe +trials of war life had unbalanced their self-control and suggestions +of various kinds made them still worse. Much attention to their +condition from themselves and others simply proved to be constantly +disturbing. As was pointed out by Doctor Pearce Bailey, who had the +opportunity as United States Chief of the Division of Neurology and +Psychiatry attached to the Surgeon General's office to visit France +and England officially to make observations on the war neuroses, the +experience of the war has amply confirmed Babinski's position with +regard to hysteria. The distinguished French neurologist has shown +that the classic symptoms of hysteria are the results of suggestion +originating in medical examinations or from misapplied medical or +surgical treatment. He differs entirely from Charcot in the matter and +points out that it was unfortunate misdirected attention to hysterical +patients which led to the creation of the many cases of _grande +hysterie_ which {262} used to be seen so commonly in clinics in France +and have now practically disappeared. They were not genuine +pathological conditions in any sense of the word, but merely the +reflection of the exaggerated interest shown in them by those +interested in neurology, who came to see certain symptoms and were, of +course, gratified in this regard by the patients, always anxious to be +the center of attention and, above all, the focus of special interest. + +The successful treatment of the war neuroses was all founded on the +will and not on the mind. Once a careful examination had determined +absolutely that no organic morbid condition was present, the patient +was given to understand that his case was of no special significance +but on the contrary was well understood and had nothing exceptional in +it. The unfortunate frequent demonstration of these patients at the +beginning of the war as subjects of special interest had been the +worst possible thing for them. After experience had cleared the way, +they were made to feel that just as soon as the attending physician +had the time to give them, he would be able to remove their symptoms +without delay. This was almost the only appeal to the mind {263} that +was made. It represented the suggestive element of the treatment. + +The two other elements were reeducation and discipline. Once +suggestion had brought the patient to believe firmly that he would be +cured, he was made to understand that his cure would be permanent. +Then reeducation was instituted to overcome the bad habit of lack of +confidence that had been formed, while discipline broke down the +psychic resistance of the patient to the idea of recovery. In such +symptoms as mutism or deafness, the patient was told that electricity +would cure him and that as soon as he felt the current when the +electrode was applied, his power of speech or of hearing would be +restored, _pari passu_, with sensation. The same method was used for +blindness and other sensory symptoms. Paralyses were favorably +affected the same way, though tremors were harder to deal with. A cure +in a single treatment was the best method, for the patient readily +relapsed unless he was made to feel that he had recovered his powers +completely and that it would be his own fault if he permitted his +symptoms to recur. + +The most interesting phase of the successful treatment of these war +neuroses for us was {264} the fact that the ultimate dependence was +placed by the French on a system of management which was called +_torpillage_. _Torpillage_ consists in the brusque application of +faradic currents strong enough to be extremely painful in hysterical +conditions, and the continuance of the procedure to the point at which +the deaf hear, the dumb speak, or those who believe themselves +incapable of moving certain groups of muscles come to move them +freely. The method has proved highly effective and requires but little +time and practically no personnel except the medical officer who +applies the treatment and the non-commissioned officer who takes the +patient at the end of the treatment and continues the exercise of the +afflicted parts. One treatment suffices. The apparatus is of the +simplest, the only accessory to the electric supply and the electrodes +consisting of an overhead trolley which carries the long connecting +wires the whole length of the room, thus making it impossible for the +patient to get away from the current which is destined to cure him. + +In a word, the man who would insist on maintaining a false attitude of +mind towards himself, though that attitude of mind was not {265} +deliberate, and least of all not malingering, was simply made to give +it up. Sufficient pain was inflicted on him so that he was willing to +accept instead of his own false opinion the opinion of his physician +that he could accomplish certain functions. _Torpillage_ was, in other +words, simply "a method of treatment which gave authority to a medical +officer to inflict pain on a patient up to the point at which the +patient yields up his neurosis." As a rule, the infliction of very +little suffering is needed, for once the demonstration is made that he +will have to suffer or give in, it does not take him very long to give +in. There is no doubt at all that the method is eminently effective, +particularly in those cases which were entirely refractory to other +modes of treatment. + +It would remind us of some old modes of treatment which were in +popular use long ago, but which had gone out entirely in our milder +generation because we thought their use almost unjustified. It was not +an unusual thing three or four generations ago to rouse a young woman +out of an hysterical tantrum, once it was perfectly clear from +previous experiences that it _was_ really an hysterical tantrum, by +dashing a pitcher of cold water {266} over her. Sir Thomas More +relates that he saw a number of people suffering from various forms of +possession--and any neurologist will confess that some hysterics must +have a devil--who were cured by being roundly whipped. Certain men +and women who complained that they were unable to walk or to work and +thus became a care for relatives or for the community, were cured by +this, as it seemed to later generations, heartless mode of treatment. +Now, we have turned to curing the war hysterias by punishment, that +is, by the infliction of severe pain, in just the same way. A great +many of these patients who suffer from neuroses and psycho-neuroses, +and especially from hysterical inhibitions so that they cannot hear or +cannot walk or cannot talk, represent inabilities similar to many +which are seen in civil life. Patients complain that they cannot do +things; their friends say that they will not do them; and the +physician sees that the root of the trouble is that they cannot +_will_. Now, however, that war has permitted the use of such remedies, +physicians have found that they can, to advantage, force the patients +to will and that once the will has been recalled into action, its +energy can be maintained. + +{267} + +Of course the compulsory mode of treatment was not represented as a +punishment, but on the contrary it was always presented as a form of +treatment which was extremely painful but necessary for the condition. +Presented as punishment, it would have been resented, and the patient +would probably have set about sympathizing with himself and perhaps +seek the sympathy of others, and this would prevent the effectiveness +of the treatment. It is very evident that as the result of compulsory +methods of treatment, and of the recognition of the fact that major +hysterical conditions are largely the result of suggestion and must be +cured by enabling the patient to secure control over himself again, +the outlook for the treatment of the psychoneuroses will be very +different as a consequence of the experience that has been gained. +Above all, the place of the will will be recognized, and there will no +longer be that coddling of patients and that analysis of their minds +for long distant psychic insults of various kinds which will explain +their condition, that has done so much harm in a great many ways in +recent years. + +Another feature of the French treatment was that the neurotic patients +should be {268} isolated. This isolation was complete. It had been +found that association with other patients, the opportunity to tell +their troubles and be sympathized with, did them harm invariably and +inevitably, so that those whose neurotic symptoms continued were taken +absolutely away from all association with others. Not only this, but +all other modes of diversion of mind were denied them. They were +placed in rooms without reading or writing materials and even without +tobacco. This solitary confinement would remind one of the enforced +privacy of the old-fashioned rest cure in which the patient was +absolutely secluded from all association with relatives or others who +might in any way sympathize with them. The soldier patients were kept +in this complete isolation until such time as they showed themselves +amenable to treatment. This was usually not very long. + +As a matter of fact, the isolation rooms had to be used very little +but were found necessary and especially effective in the management of +relapsed cases. Just as soon as soldier patients learned that such +isolating rooms were available, they became much more ready to give up +their neuroses, and as a consequence, in most places, the isolating +department did {269} not have to be used, and in some places they +could even be given over to the lodgment of attendants. It was quite +sufficient, however, that they had fulfilled their purpose of changing +patients' attitude of mind towards themselves and giving their will +control over them. + +As Colonel Pearce Bailey, M.C., says, in most of these patients, +persuasive measures and contrary suggestion were quite sufficient, but +when they failed, disciplinary measures proved effective. How are we +going to be able to make such disciplinary measures available in civil +life is another question, but at least the war has made clear that +neurotic patients who claim that they cannot do something and actually +will not do it, _must be made to do it_, for this will prove the +beginning of their cure. It seems probable, as Doctor Bailey adds, +that the reason why the treatment of officers was more difficult--and +it must not be forgotten that in proportion to their numbers, four +times as many officers suffered from so-called shell shock as +privates--was exactly because these modes of discipline, amounting +practically to compulsion, were not used with them. + + +{270} + +CHAPTER XIX + +FEMININE ILLS AND THE WILL + + + "Oh, undistinguished space of woman's will!" + _King Lear_. + + +It is probable that the largest field for the employment of the will +for the cure of conditions that are a source of serious discomfort or +at least of complaint is to be found among the special ills of +womankind. The reason for this is that the personal reaction has so +much to do with the amount of complaint in these affections. Not +infrequently the individual is ever so much more important than the +condition from which she is suffering. Women who have regular +occupation with plenty to do, especially if they are interested in it +and take their duties seriously, who get sufficient exercise and are +out of doors several hours each day and whose appetites are as a +consequence reasonably good, suffer very little from feminine ills, as +a rule. If an infection of some kind attacks them, they will, of {271} +course, have the usual reaction to it, and this may involve a good +deal of pain and even eventually require operation. Apart from this, +however, there is an immense number of feminine ills dependent almost +entirely on the exaggerated tendency to react to even minor +discomforts which characterizes women who have no occupation in which +they are really interested, who have very little to do, almost no +exercise, and whose appetite and sleep as a consequence are almost +inevitably disturbed. + +Above all, it must not be forgotten that whenever women do not get out +into the air regularly every day--and this means for a time both +morning and afternoon--they are likely to become extremely sensitive +to pains and aches. This is true of all human beings. Those who are +much in the open air complain very little of injuries and bodily +conditions that would seem extremely painful to those living sedentary +lives and who are much indoors. Riding in the open air is better than +not being in the open air at all, but it does not compare in its power +to desensitize people with active exercise in the open air. In the +older days, when women occupied themselves very much indoors with +{272} sewing, knitting and other feminine work, and with reading in +the evenings, and when it was considered quite undignified for them to +take part in sports, neurotic conditions were even more common than +they are at the present time, and young women were supposed to faint +readily and were quite expected to have attacks of the "vapors" and +the "tantrums." + +The interest of young women in sports in recent years and the practice +of walking has done a great deal to make them ever so much healthier +and has had not a little to do with decreasing the number and +intensity of the so-called feminine ills, the special "women's +diseases" of the patent medicine advertisements. Much remains to be +done in this regard, however, and there are still a great many young +women who need to be encouraged to take more exercise in the open than +they do and thus to live more natural lives. It is particularly, +however, the women of middle age, around forty and beyond it, who need +to be encouraged to use their wills for the establishment of habits of +regular exercise in the open air as well as the creation of interests +of one kind or another that will keep them from thinking too much +about {273} themselves and dwelling on their discomforts. These are +thus exaggerated until often a woman who has only some of the feelings +that are almost normally connected with physiological processes +persuades herself that she is the victim of a malady or maladies that +make her a pitiable object, deserving of the sympathy of her friends. + +A great many of the operations that have been performed on women +during the past generation have been quite unnecessary, but have been +performed because women felt themselves so miserable that they kept +insisting that something must be done to relieve them, until finally +it was felt that an operation might do them some good. It would surely +do them no harm or at least make them no worse, and there was always +the possibility that the rest in the hospital, the firm persuasion +that the operation was to do them good, the inculcation of proper +habits of eating during convalescence might produce such an effect on +their minds as would give them a fresh start in life. Undoubtedly a +great many women who were distinctly improved after operations owed +their improvement much more to the quiet seclusion of their hospital +life, their own strong expectancy {274} and the care bestowed upon +them under the hospital discipline without exaggerated sympathy which +brought about the formation of good habits of life, than to their +operation. Many a woman gained weight after an operation simply +because her eating was properly directed, and this was the main part +of the improvement which took place. + +Operations are sometimes needed and when they are the patient will +probably not get well without one; but as a distinguished neurologist, +Doctor Dercum of Philadelphia, said in a paper read before the +American Medical Association last year, the neurologist is constantly +finding patients on whom one or several operations have been +performed, some of them rather serious abdominal operations, the +source of whose complaints is a neurosis and not any morbid condition +of the female or other organs. Occasionally one sees something like +this in men, and I shall never forget seeing at Professor Koenig's +clinic in Berlin a sufferer from an abdominal neurotic condition on +whom no less than three operations for the removal of his appendix had +been performed, until finally Professor Koenig felt that he would be +justified in tattooing over the right iliac region the words "No +Appendix {275} Here." The condition developed in a young soldier as +the result of a fall from a horse and his affection resembled very +much some of the neuroses that came to be called, unfortunately, +"shell shock" during the present war. + +The principal trouble in securing such occupation of mind as will +prevent exaggerated neurotic reactions to even slight discomforts in +women is the creation for them of definite interests in life. The war +taught a notable lesson in this regard. Many a physician saw patients +whose complaints had been a great source of annoyance to them--and +their friends--proceed to get ever so much better as the result of war +interests. In one women's prison in an Eastern State, just before the +war, a series of crises of major hysteria was proving almost +unmanageable. By psychic contagion it had spread among the prisoners +until scarcely a day passed without some prisoner "throwing a fit" +with screaming and tearing of clothes and breaking of articles that +might be near. Prominent neurologists had been consulted and could +suggest nothing. When the war began, the prisoners were set to rolling +bandages, knitting socks and sweaters and making United States flags +for the army. As if by magic, the neurotic {276} crises disappeared. +For months there were none of them. The prisoners had an abiding +interest that occupied them deeply in other things besides themselves. + +The reduction of nervous complaints of various kinds among +better-to-do women was very striking. As might be expected, their +rather strenuous occupation with war activities kept them from +thinking about themselves, though it is true that now they complain +about all the details that they had to care for and the lack of +cooperation on the part of certain people. It would seem as though +many of them had so much to do that they would surely exhaust their +energies and so be in worse condition than before, but this very +seldom proved to be the case. Literally many thousands of women +improved in health because they became interested in other people's +troubles instead of their own. David Harum once said that "It is a +mighty good thing for a dog to have fleas because it keeps him from +thinking too much about the fact that he is a dog." That seems a +rather unsympathetic way of putting the case, but there is no doubt at +all that what many women need is serious interests apart from +themselves in order to prevent the law of {277} avalanche from making +minor ills appear serious troubles. + +What most women need above all are heart interests rather than +intellectual occupations. That was why occupation with war activities +did so much good. That is the reason, too, that club life and reading +and other similar pursuits often fail to be helpful to women in their +ills to the extent that might possibly be expected. Above all, women +need interests in children and the ailing, and these can be supplied +by visits to hospitals or by taking an active interest in nurseries, +though this is often not personal enough in its appeal to catch a +woman's deepest attention. One of the great reasons why there are more +nervous diseases among women in our time than in the past is because +children are fewer, and because so many women are without children and +the calls that they inevitably make on their mothers. Unfortunately, +the traditions of the present day are to a great extent in opposition +to that family life with a number of children, which means not only +the deepest interests for woman but also such inevitable occupations +in the care of them that she has very little time to think about +herself. It may seem quixotic, that is, {278} demanding unnecessary +magnanimity to suggest that these modern ideas should be discarded by +those who wish to assure themselves such interests in middle life as +will prove definitely preventive of many neurotic conditions, but it +is manifestly the physician's duty to make such suggestions. + +Life has really become full of dreads for many women in this regard. A +gradual reduction in the birth rate which has deprived so many women +of the heart interests that were particularly valuable at and after +middle life; has been the source of a great deal more suffering +without any satisfaction, than would be associated in any way with the +care of children. It is extremely unfortunate, then, that this phase +of social evolution should have taken place, for the quest of ease and +pleasure has proved a prolific source of feminine ills. It is well +recognized now that the reason for this reduction in the birth rate is +not physical but ethical. It is a matter of choice and not necessity. +There is a conscious limitation of the number of children in the +family accomplished deliberately, and as a rule the women consider +that they are justified in the procedure because they thus conserve +their own health and provide such {279} few children as they have with +healthier bodies than would otherwise have been the case. + +Indeed, child-bearing beyond one or two or perhaps three children has +become a source of dread in modern times, a dread that supposedly +centers around the health of the children, as well as the mother +herself. The mother of a few children is supposed to be healthier and +the children of small families to be heartier and more vigorous than +when there are half a dozen or more children in the family. A woman is +actually supposed by many to seriously imperil her life and her health +if she has more than two or three children, though as a matter of +fact, the history of the older times when families were larger shows +us that women were then healthier on the average than they are now, in +spite of all the progress that medicine and surgery have since made in +relieving serious ills. Above all, it was often the mother of numerous +children who lived long and in good health to be a blessing to those +around her, and not the old maids nor the childless wives, for +longevity is not a special trait of these latter classes of women. The +modern dread of deterioration of vitality as the result of frequent +child-bearing is quite without {280} foundation in the realities of +human experience. + +Some rather carefully made statistics demonstrate that the old +tradition in the matter is not merely an impression but a veritable +truth as to human nature's reaction to a great natural call. While the +mothers of large families born in the slums with all the handicaps of +poverty as well as hard work against them, die on the average much +younger than the generality of women in the population, careful study +of the admirable vital statistics of New South Wales show that the +mothers who lived longest were those who under reasonably good +conditions bore from five to seven children. Here in America, a study +of more favored families shows that the healthiest children come from +the large families, and it is in the small families particularly that +the delicate, neurotic and generally weakly children are found. +Alexander Graham Bell, in his investigation of the Hyde family here in +America, discovered that it was in the families of ten or more +children that the greatest longevity occurred. So far from mothers +being exhausted by the number of children that were born, and thus +endowing their children with less vitality than if they {281} had +fewer children, it was to the numerous offspring that the highest +vitality and physical fitness were given. One special consequence of +these is longevity. + +In a word, the dread so commonly fostered that the mothers of large +families will weaken themselves in the process of child-bearing and +unfortunately pass on to their offspring weakling natures by the very +fact that they have to repeat the process of giving life and +nourishment to them at comparatively short intervals, is as groundless +as other dreads, for exactly the opposite is true. It is when nature +is called upon to exert her amplest power that she responds most +bountifully and dowers both children and mother with better health in +return. + +Something of the same thing is true with regard to the age of mothers +when their children are born. The infant mortality is lowest among the +children of young mothers between twenty and twenty-five years of age, +though it has been found out that "delay in child-bearing after that +age penalizes the children." This is, of course, true particularly for +first children. The successive children of young mothers are known by +observation and statistics as being constantly in {282} better +condition up to the seventh. There is on the average nearly a half a +pound difference in weight at birth between succeeding children of the +same mother, so that each infant is born sturdier and more vigorous +than its predecessor. + +These recently collated facts remove entirely the supposed foundations +of a series of dreads which were having an unfortunate effect upon our +population, for the natives were disappearing before the foreigners +because of the higher birth rate among the latter. Birth control has +been producing a set of unfortunate conditions for both mothers and +children. The one child in the family is sure to be spoiled, not only +as a social being but often as regards health, and conditions are +scarcely better when there are but two, especially if they are of +opposite sexes. If anything happens to them, the mother has nothing to +live for, and a little later in life the selfish beings that have been +raised under the self-centered conditions of a small family are almost +sure to be a source of anxiety and worry. Many a woman owes the +valetudinarianism of her later years to the fact that she dreaded +maternal obligations and avoided them, and so the latter part of her +life is {283} empty of most of what makes life worth living. + +The will to make life useful for others rather than to follow a +selfish, comfortable, easy existence is the secret of health and +happiness for a great many women who are almost invalids or at least +constantly complaining in the midst of idle lives. A woman who has +nothing better to occupy her time than the care of a dog or two cannot +expect to have any interests deep enough to divert her attention from +the pains and aches of life that are more or less inevitable. The +opportunity to dwell on them will heighten their intensity until they +are almost torments. Many more of the feminine ills can be explained +in this way than by learned pathological disquisitions. Every +physician has seen the bitterest complaints disappear before some +change of life that necessitated occupation and gave the patient other +things to think about besides self. + +The will to face nature's obligations of maternity straightforwardly +is probably the greatest preventive against the psycho-neuroses that +prove so seriously disturbing to a great many women. Their affections, +given a proper opportunity to develop, impel their {284} wills to such +activity as prevents the development of morbid states. The dreads for +themselves and their children, which so often make the excuse for a +different policy in life than this, have proved unfounded on more +careful study. Now that war activities no longer call women, it must +not be forgotten that home duties are the only ones that can serve as +a universal antidote for the poison of self-indulgence, which is much +more productive of symptoms of disease than the autointoxications of +which we have heard so much, but for which there is so little +justification in our advancing science. The assumption of serious +duties is the best possible panacea for the ills of mankind as well as +womankind, only unfortunately in recent years women have succeeded in +shirking duties more and have paid the inevitable price which nature +always demands under such circumstances, when the dissatisfaction in +life is much harder to bear than the work and trials involved in the +pursuit of duty. + + +{285} + +INDEX + + A + + Achylia Gastrica, 216 + Activity, intestinal, 220 + Adirondacks, 183 + Agoraphobia, 27 + Akrophobia, 27 + Alcohol, + narcotics, 191; + in pneumonia, 190; + in snake bite, 193 + Alcoholic craving and food, 159 + Algiers, 182 + Angina pectoris, 230 + Anthony, Saint, the Hermit, 21 + Arctic regions, 205 + Aridity, office building, 206 + Aristotle, 71 + Arnold, Matthew, 219 + Arthritis, rheumatoid, 242 + Ascesis, 77 + Asceticism, 92 + Asthma dread, 211 + Attention, concentration of, 127 + Auto-intoxication, 36 + Autotoxemia, 226 + Avalanche, Law of, 123 + + B + + Babinski, 261 + Bailey, Dr. Pearce, 261, 269 + Bain, Professor, 51 + Bell, Alexander Graham, 280 + Bernheim, 252 + Betel nut, 45 + Birth control, 282 + Bismarck, 10 + Brakes on energies, 19 + Bright's disease, 102 + + C + + Cancer, 75 + Cancer cures, 106 + Carpenter, Doctor, 51 + Cat asthma, 210 + Catarrh, 31 + Character, 66 + Charcot, Professor, 252 + Chesterfield, Lord, 224 + Child bearing, 279 + Chilliness, 197 + Claustrophobia, 25 + Coddling, 267 + Conklin, Professor, 54 + Consciousness, + sphere of, 230; + threshold of, 127 + Consumption cures, 177 + Cough remedies, 201 + Coughing, + unnecessary, 199; + productive, 200 + Coughs and cold air, 204 + Cures, so-called, 244 + + D + + Danger, sense of, 129 + "David Harum", 276 + Death Valley, 206 + Dercum, Doctor, 274 + Diabetes, 164 + Disheartenment, 104 + Dowie, John A., 253 + Dreads, 278 + + {286} + + E + + "Eat and grow thin", 163 + Eating, 149 + Eddyism, 253 + Education, liberal, 55 + Effort, faculty of, 92 + Eliot, George, 67 + Emerson, Ralph Waldo, 67 + Emmet, Thomas Addis, 11, 147 + Energies of men, 15 + English, Thomas Dunn, 10 + Euphoria, 192 + Evacuation, intestinal, 221 + + F + + Family, + large, 74; + eating, 160 + Fermentation, 155 + Flat foot, 141 + Food and alcoholic craving, 159 + Food prejudices, 152 + Franklin, Benjamin, 251 + Function, intestinal, 218 + + G + + Galen, 170, 241 + Galvani, 248 + Gas formation, 155 + Gassner, Pfarrer, 252 + Giving up, 2 + Gouley, John W., 11 + Greatrakes, 245 + + H + + Habits, 149 + Hamerton, Philip Gilbert, 24 + Hamlet, 82 + Hard sayings, 66 + Health, secret of, 283 + Heart + craves exercise, 235; + interests, 277; + irregular, 236: + missed beats, 235; + regularly irregular, 237 + Heredity, 169; + and environment, 54 + Hoell, Father Maximilian, 252 + Holmes, Oliver Wendell, 40 + Horace, 224 + "Horse, the outside of a", 138 + Humboldt, Alexander von, 9 + Huxley, Thomas Henry, 54 + Hyde family, 280 + Hypnotism, 251 + Hypochondria, 30 + Hysteria, major, 275 + + I + + Imperatives, 99 + Insomniaphobia, 27 + Instinct, 149 + Insults, psychic, 267 + Interests, feminine, 277 + Intestinal stasis, 38 + Intuition, 88 + Invalids, chronic, 76 + Isolation, 268 + + J + + James, William, Professor, 15, 60, 77, 92 + Jesuits, General of, 119 + + K + + Koenig, Professor, 274 + + L + + Laxatives, 219 + Leo XIII, 9 + Libitina, 224 + Long, St. John, 171, 255 + + {287} + + Longevity, 146 + Lying, hysterical, 260 + + M + + Maistre, Xavier De, 122 + Marmalade, 222 + Matthew, Father, 47 + Mesmer, Friedrich Anton, 172, 250 + Metallotherapy, 248 + Mexican border, 60 + Misophobia, 23 + Mitchell, S. Weir, 11 + Mollycoddle, 63 + Moltke, 10 + Montreal, 204 + More, Sir Thomas, 266 + Mothers, young, 281 + Mutism, 259 + + N + + Nansen, Fridtjof, 205 + Nauheim, 233 + Neuro-hypnotism, 250 + New South Wales, 280 + + O + + Obesity, 162 + O'Malley, Austin, 80 + Optatives, 99 + Orange skin, 222 + + P + + Pain and Refinement, 131 + Pain, + control, 116; + dread of, 128 + Palpitation, 228 + Perkins, Elisha, 248 + Personality, secondary, 88 + Phthisis, 171 + Physiology, study of, 35 + Pneumonia, 104; + alcohol in, 190 + Possession, 266 + Pseudologia hysterica, 260 + Psychic contagion, 275 + Psycho-analysis, 41 + Pueckler-Muskau, Prince, 16 + + Q + + Quackery, History of, 245 + Quinine and whisky, 201 + Quitters, 169 + + R + + Ramon y Cajal, 123 + Ranke, Leopold von, 11 + Repplier, Agnes, 17 + Resolution, 82 + Respiration spasm, 209 + Rest, 57 + Rheumatism, chronic, 240 + Rheumatoid arthritis, 242 + Riviera, 182 + Roosevelt, Theodore, 118 + Roughage, 220 + Royal touch, 246 + + S + + Saranac, 184 + Scare, lifted, 193 + Schlatter's case, 217 + Self-drugging, 40 + Self-pity, practice of, 70 + Self-subliminal, 88 + Sensation, diffusion of, 125 + Sensitization, 135 + Shell-shock, 64, 259 + Skotophobia, 24 + Smith, Stephen, 11 + Snake bite, 193 + + {288} + + Stokes, Professor, 5 + Stomach functions, 215 + Subconscious, 85 + Suffering, 68 + Sybarite, 72 + + T + + Tantrum, 265, 272 + Temperature variations, 181 + Thatcher, 248 + Therapeutics, absurd, 244 + Thompson, William Hanna, 11 + Torpillage, 264, 265 + Tragedy, 71 + Trait, family, 149 + Trudeau, Doctor, 183 + Tuberculosis, 103; + curable, 178; + early, 176; + frequency, 168; + takes quitters, 169 + + U + + Undereating, 160 + Underweight, 149 + + V + + Valetudinarianism, 282 + Vapors, 272 + Virchow, Rudolf, 10 + + W + + Weber, Sir Hermann, 146 + Wellington, Duke of, 43 + Wilde, Oscar, 7 + Will, + and survival, 4; + conscious use, 81; + living on, 2; + omnipotent, 16; + sapping, 13 + Women's diseases, 272 + + +-------------------------- + +MIND AND HEALTH SERIES + + +A Series of Medical Handbooks written by eminent specialists and +edited by H. Addington Bruce, A.M., and designed to present the +results of recent research and clinical experience in a form +intelligible to the lay public and medical profession. + + + +1. HUMAN MOTIVES. By James Jackson Putnam, M.D., Professor Emeritus, +Diseases of the Nervous System, Harvard University; Consulting +Neurologist, Massachusetts General Hospital, Boston. 179 pages. 12mo. +$1.35 _net_. + + A study of human conduct, using both the philosophical and the + Freudian psychoanalytic methods of approach, with most attention to + the latter method.--_A. L. A. Booklist_. + + +2. THE MEANING OF DREAMS. By Isador H. Coriat, M.D., First Assistant +Visiting Physician, Nervous Diseases, Boston City Hospital. 194 pages. +12mo. $1.35 _net_. + + The many examples that are analyzed and explained are taken from + cases that have come under the author's observations.--_A. L. A. + Booklist_. + + +3. SLEEP AND SLEEPLESSNESS. By H. 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