Doctor and Patient

by S. Weir Mitchell

NERVOUSNESS AND ITS INFLUENCE ON CHARACTER.

There are two questions often put to me which I desire to use as texts for the brief essay or advice of which nervousness[4] is the heading. As concerns this matter, I shall here deal with women alone, and with women as I see and know them. I have elsewhere written at some length as to nervousness in the male, for he, too, in a minor degree, and less frequently, may become the victim of this form of disability.

[Footnote 4: Neither nerves nor nervousness are words to be found in the Bible or Shakespeare. The latter uses the word nerve at least seven times in the sense of sinewy. Nervy, which is obsolete, he employs as full of nerves, sinewy, strong. It is still heard in America, but I am sure would be classed as slang. Writers, of course, still employ nerve and nervous in the old sense, as a nervous style. Bailey's dictionary, 1734, has nervous,—sinewy, strongly made. Robt. Whytte, Edin., in the preface to his work on certain maladies, 1765, says, "Of late these have also got the name of nervous," and this is the earliest use of the word in the modern meaning I have found. Richardson has it in both its modern meanings, "vigorous," or "sensitive in nerves, and consequently weak, diseased." Hysteria is not in the Bible, and is found once in Shakespeare; as, "Hysterica passio, down," Lear ii. 4. It was common in Sydenham's day,—i.e., Charles II. and Cromwell's time,—but he classified under hysteria many disorders no longer considered as of this nature.]

So much has been written on this subject by myself and others, that I should hesitate to treat it anew from a mere didactic point of view. But, perhaps, if I can bring home to the sufferer some more individualized advice, if I can speak here in a friendly and familiar way, I may be of more service than if I were to repeat, even in the fullest manner, all that is to be said or has been said of nervousness from a scientific point of view.

The two questions referred to above are these: The woman who consults you says, "I am nervous. I did not use to be. What can I do to overcome it?" Once well again, she asks you,—and the query is common enough from the thoughtful,—"What can I do to keep my girls from being nervous?"

Observe, now, that this woman has other distresses, in the way of aches and feebleness. The prominent thing in her mind, nervousness, is but one of the symptomatic results of her condition. She feels that to be the greatest evil, and that it is which she puts forward. What does she mean by nervousness, and what does it do with her which makes it so unpleasant? Remark also that this is not one of the feebler sisters who accept this ill as a natural result, and who condone for themselves the moral and social consequences as things over which they have little or no reasonable control. The person who asks this fertile question has once been well, and resents as unnatural the weaknesses and incapacities which now she feels. She wants to be helped, and will help you to help her. You have an active ally, not a passive fool who, too, desires to be made well, but can give you no potent aid. There are many kinds of fool, from the mindless fool to the fiend-fool, but for the most entire capacity to make a household wretched there is no more complete human receipt than a silly woman who is to a high degree nervous and feeble, and who craves pity and likes power. But to go back to the more helpful case. If you are wise, you ask what she means by nervousness. You soon learn that she suffers in one of two, or probably in both of two, ways. The parentage is always mental in a large sense, the results either mental or physical or both. She has become doubtful and fearful, where formerly she was ready-minded and courageous. Once decisive, she is now indecisive. When well, unemotional, she is now too readily disturbed by a sad tale or a startling newspaper-paragraph. A telegram alarms her; even an unopened letter makes her hesitate and conjure up dreams of disaster. Very likely she is irritable and recognizes the unreasonableness of her temper. Her daily tasks distress her sorely. She can no longer sit still and sew or read. Conversation no longer interests, or it even troubles her. Noises, especially sudden noises, startle her, and the cries and laughter of children have become distresses of which she is ashamed, and of which she complains or not, as her nature is weak or enduring. Perhaps, too, she is so restless as to want to be in constant motion, but that seems to tire her as it once did not. Her sense of moral proportion becomes impaired. Trifles grow large to her; the grasshopper is a burden. With all this, and in a measure out of all this, come certain bodily disabilities. The telegram or any cause of emotion sets her to shaking. She cries for no cause; the least alarm makes her hand shake, and even her writing, if she should chance to become the subject of observation when at the desk, betrays her state of tremor. What caused all this trouble? What made her, as she says, good for nothing? I have, of course, put an extreme case. We may, as a rule, be pretty sure, as to this condition, that the woman has had some sudden shock, some severe domestic trial, some long strain, or that it is the outcome of acute illness or of one of the forms of chronic disturbance of nutrition which result in what we now call general neurasthenia or nervous weakness,—a condition which has a most varied parentage. With the ultimate medical causation of these disorderly states of body I do not mean to concern myself here, except to add also that the great physiological revolutions of a woman's life are often responsible for the physical failures which create nervousness.

If she is at the worst she becomes a ready victim of hysteria. The emotions so easily called into activity give rise to tears. Too weak for wholesome restraint, she yields. The little convulsive act we call crying brings uncontrollable, or what seems to her to be uncontrollable, twitching of the face. The jaw and hands get rigid, and she has a hysterical convulsion, and is on the way to worse perils. The intelligent despotism of self-control is at an end, and every new attack upon its normal prerogatives leaves her less and less able to resist.

Let us return to the causes of this sad condition. It is a common mistake to suppose that the well and strong are not liable to onsets which cause nervousness. As a rule, they rarely suffer; but we are neatly ballasted, and some well people are nearer to the chance of being so overturned than it is pleasant to believe. Thus it is that what for lack of a better name we call "shock" is at times and in some people capable of inflicting very lasting evil in the way of nervousness.

We see this illustrated in war in the effects of even slight injuries on certain people. I have known a trivial wound to make a brave man suddenly timid and tremulous for months, or to disorder remote organs and functions in a fashion hard to understand. In the same way, a moral wound for which we are not prepared may bring about abrupt and prolonged consequences, from which the most robust health does not always protect us; and which is in proportion disastrous if the person on whom it falls is by temperament excitable or nervous. I have over and over seen such shocks cause lasting nervousness. I knew a stout young clerk who was made tremulous, cowardly, sleepless, and, in the end, feeble, from having at a funeral fallen by mishap into an open grave. I have seen a strong woman made exquisitely nervous owing to the fall of a wall which did her no material damage. Earthquakes cause many such cases, and bad ones, as we have had of late sad occasion to know. The sudden news of calamity, as of a death or financial disaster, has in my experience made vigorous people nervous for months. A friend of mine once received a telegram which rather brutally announced the disgrace of one dear to him. He had a sense of explosion in his head, and for weeks was in a state of nervousness from which he but slowly recovered. There is something in cases like his to think about. The least preparation would have saved him, and we may be sure that there is wisdom in the popular idea that ill news should be gently and guardedly broken to such as must bear it. To be forewarned is to be forearmed we say with true wisdom.

Prolonged strain of mind and body, or of both, is another cause apt to result in health failures and in nervousness as one attendant evil. The worst one I know is to nurse some person through a long disease. Women are apt to think that no one can so well care for their sick as they. Intrusion on this duty is resented as a wrong done to their sense of right. The friend who would help is thrust aside. The trained nurse excites jealous indignation. The volunteer gives herself soul and body to the hardest of tasks, and is rather proud of the folly of self-sacrifice. How often do we hear a woman say with pride, "I have not slept nor had my clothes off for a week." She does not see that her very affection unfits her for the calm control of the sick-room, and that her inevitable anxiety is incompatible with tranquil judgment. If you tell her that nursing is a profession, and that the amateur can never truly fill the place of the regular, she smiles proudly, and thinks that affection is capable of all things, and that what may be lost in skill will be made up in thoroughness and compensated by watchfulness, such as she believes fondly only love can command. It is hard to convince such a woman.

It rarely chances that women are called upon to suffer in their common lives emotional strains through very long periods, and at the same time to sustain an excess of mental and physical labor. In days of financial trouble this combination is sometimes fatal to the health of the strongest men. When a loving relative undertakes to nurse one dear to her through a protracted illness, she subjects herself to just such conditions of peril as fall upon the man staggering under financial adversity.

The analogy to which I have referred is curiously complete. In both there is the combination of anxiety with physical and mental overwork, and in both alike the hurtfulness of the trial is masked by the excitement which furnishes for a while the means of waging unequal battle, and prevents the sufferer from knowing or feeling the extent of the too constant effort he or she is making. This is one of the evils of all work done under excessive moral stimulus, and when the excitation comes from the emotions the expenditure of nerve-force becomes doubly dangerous, because in this case not only is the governing power taken away from the group of faculties which make up what we call common sense, but also because in women overtaxing the emotional centres is apt to result in the development of some form of breakdown, and in the secondary production of nervousness or hysteria.

If she cannot afford a nurse, or will not, let her at least share her duties with some one. Above all, let her know that every competent doctor watches even the best of his trained nurses, and insists that they shall be in the open air daily. Your good wife or mother thinks in her heart that when she has sickness at home she should not be seen out of doors, and that to eat, sleep, or care for herself is then wicked or something like that.

If you can make a woman change her dress, eat often, bathe as usual, and take the air, even if it must be so at night, she can stand a great deal, especially if you insist that she shall sleep her usual length of time. If she will not listen or obey, she runs a large risk, and is very apt to collapse as the patient recovers, and to furnish her family with a new case of illness, and the doctor and herself with some variety of disorder of mind or body arising out of this terrible strain on both.

If physical tire, without chance for rest, with anxiety and incessant vigilance, is thus apt to cause wrecks in the nurse of ordinary illness, far more apt is it to involve breakdowns when a loving mother or sister endeavors to care for a protracted case of insanity. Unless the man of the house interferes, this effort is sure to bring disaster. And the more sensitive, imaginative, and loving is the self-appointed nurse, the more certain is she to suffer. There are no cases in which it is so hard to advise, none in which it is so difficult to get people to follow your advice. The morbid view of insanity, the vague sense of its being a stain, the horror of the hospital, all combine to perplex and trouble us. Yet here, if at any time, it is wise to cast the whole weight on the physician and to abide by his decision.

Families see this peril, and can be often made to understand the unwisdom of this sacrifice; but, in cases of prolonged disease, such as hysteria in a bedridden sister or mother, it is hard to make them hear reason, and still more hard to make the nursing relation understand that she is of necessity the worst of nurses, and may share the wreck she helps to make.

These old and happily rare cases of chronic nervous invalids are simply fatal to loving nurses. I have said, perhaps too often, that invalidism is for most of us a moral poison. Given a nervous, hysterical, feeble woman, shut out from the world, and if she does not in time become irritable, exacting, hungry for sympathy and petty power, she is one of nature's noblest. A mother or sister gives herself up to caring for her. She is in the grip of an octopus. Every fine quality of her nature helps to hurt her, and at last she breaks down utterly and can do no more. She, too, is become nervous, unhappy, and feeble. Then every one wonders that nobody had the sense to see what was going on. I can count many examples of nervousness which have arisen in this fashion. Perhaps my warning may not be without good results. Over and over I have made like statements in one or another form, and the increasing experience of added years only contributes force to my belief that, in still urging the matter, I am doing a serious duty. I ought to say also that the care of these invalids is, even to the well-trained and thoughtful nurse, one of the most severe of moral and physical trials, and that, in the effort to satisfy the cravings of these sick people, I have seen the best nurses crumble as it were in health, and at last give up, worn out and disheartened. A part of the responsibility of such disasters falls on the physician who forgets that it should be a portion of his duty to look sharply after the health of too devoted nurses as well as that of selfish patients.

I have now said all that I need to say of the causes which, directly or indirectly, evoke the condition we call nervousness. Many of these are insidious in their growth. Too often the husband, if she be married, is immersed in his own cares, and fails to see what is going on. "I am not ill enough to see a doctor," she says, and waits until she has needlessly increased the difficulties of his task. Let us suppose, however, that, soon or late, she is doing, in a merely medical way, all that he insists upon, what more can she do for herself? She has before her very likely a long trial, severe in its exactions in proportion to her previous activity of mind and body. She most probably needs rest, and now that physicians have learned its value, and that not all ills are curable by exertion, she is told to lie down some hours each day. If she cannot get rid of her home duties, let her try at least to secure to herself despotically her times of real and true rest. To lie down is not enough. What she needs is undisturbed repose, and not to have to expect every few minutes to hear at her door the knocks and voices of servants or children. It is difficult to secure these most needful times of silent security even in health, as most women too well know. Very often the after-meal hours are the most available and the more desirable as times of repose, because in the weak digestion goes on better when they are at rest. She will find, too, that some light food between meals and at bedtime is useful, but this is within the doctor's province, and I am either desirous to avoid that or to merely help him. Air, too, she wants rather than any such great exertion as wearies; and, as regards this latter, let her understand that letter-writing, of which many women are fond, must be altogether set aside.

It is, however, the moral aspects of life which will trouble her most. The cares which once were easily shaken off stick to her like burrs, and she carries them to bed with her. I have heard women say that men little know the moral value to women of sewing. It becomes difficult when people are nervous, but this or some other light handiwork is then invaluable.

By this time she has learned that her minor, every-day duties trouble her, and when about to meet them, if wise, she will put herself, as we all can do, in an attitude of calmness. This applies still more forcibly to the larger decisions she must so often have to make as to children, house, and servants. Worry, as I have elsewhere said, is as sand in the mental and moral machinery, and easily becomes a mischievous habit. We can stand an immense deal of work, and can, even if weak, bear much, if only we learn to dismiss small questions without worry or unreasonable reconsiderations. As concerns temper, we constantly prepare ourselves to meet even just causes of anger, and thus by degrees learn more and more easily, and with less and less preparation, to encounter tranquilly even the most serious vexations. In health, when not nervous, a woman well knows that there are seasons when she must predetermine not to be nervous; and when ill-health has made her emotional, she must learn to be still, more constantly on guard. Above all, it is the small beginnings of nervousness which she has to fear.

Tears are, for the nervous woman, the seed of trouble. Let her resolutely shun this commencement of disaster. The presence of others is apt to insure failure of self-control. A word of pity, the touch of affection, the face of sympathy, double her danger. When at her worst, let her seek to be alone and in silence and solitude to fight her battle. Fresh air, a bath (if she can bear that), even the act of undressing, will often help her. I once quoted a valued friend as saying that "we never take out of a cold bath the thoughts we take into it," and the phrase is useful and true.

Above all, let such a woman avoid all forms of emotion. Her former standards of resistance apply no longer, and what once did not disturb will now shake her to the centre. A time comes, however, when she will do well to meet and relearn to bear calmly all the little emotional trials of life. I know a nervous woman—and no coward, either—who for months, and wisely, read no newspapers, and who asked another to open and read all her letters and telegrams. The day came when she was able to resume the habits of health, but for a long time the telegram at least was a sore distress, and she could only meet it by a resolute putting of herself in the attitude of tranquillity of which I have spoken. To say more should be needless. For the nervous strong emotions are bad or risky, and from violent mirth to anger all are to be sedulously set aside. Calm of mind and quiet of body are what she most needs to aid the more potent measures of the physician.

The woman in the situation I have described has probably a variety of symptoms on which her condition causes her to dwell. A great many of them are of little practical moment. If she is irresolute and weak, she yields where she should not, and finds for inactivity or for fears ample excuses in the state of her own feelings. An unwholesome crop of disabilities grows out of these conditions. It then becomes the business of her physician to tell her what is real, what is unreal, what must be respected, what must be overcome or fought. She has acquired within herself a host of enemies. Some are strong, some are feeble. The hour for absolute trust has arrived, and she must now believe in her adviser, or, if she cannot, she must acquire one in whom her belief will be entire and unquestioning.

Let us take an illustration. Such a woman is apt enough to suffer from vertigo or giddiness. "If I walk out," she says, "I become giddy. I am rarely free from this unless I am in bed, and it terrifies me." You know in this case that she is still strong enough to exercise in moderation. You say, "Walk so much daily. When you fall we will think about stopping. Talk to some one when you go out; have a friend with you, but walk." She must believe you to succeed. This is a form of faith-cure which has other illustrations. You tell her that she must disregard her own feelings. She credits you with knowing, and so wins her fight.

There is a sense of fatigue which at some time she should learn to treat with disrespect, especially when disuse of her powers has made their exercise difficult, and yet when returning health makes it wise to employ them. To think, and at last to feel sure that she cannot walk is fatal. And above all, and at all times, close attention to her own motions is a great evil. We cannot swallow a pill because we think of what, as regards the larger morsels of food, we do automatically. Moreover, attention intensifies fatigue. Walk a mile, carefully willing each leg-motion, and you will be tired. The same evil results of attention are observed in disease as regards other functions over which we seem in health to be without direct power of control.

"Mind-cure," so called, has, in some shape, its legitimate sphere in the hands of men who know their profession. It is not rare to find among nervous women a few in whom you can cause a variety of odd symptoms by pressing on a tender spine and suggesting to the woman that now she is going to feel certain pains in breast, head, or limbs. Nervous women have, more or less, a like capacity to create or intensify pains and aches, but when a woman is assured that she only seems to have such ailments she is apt, if she be one kind of woman, to be vexed. These dreamed pains—I hardly know what else to call them—are, to her, real enough. If she be another kind of woman, if she believes you, she sets herself to disregard these aches and to escape their results by ceasing to attend to them. You may call this mind-cure or what you will, but it succeeds. Now and then you meet with cases in which, from sudden shock or accident, a woman is led to manufacture a whole train of disabling symptoms, and if in these instances you can convince her that she is well and can walk, eat, etc., like others, you make one of those singular cures which at times fall to the luck of mind-or faith-cures when the patient has not had the happy fortune to meet with a physician who is intelligent, sagacious as to character, and has the courage of his opinions. I could relate many such cases if this were the place to do so, but all I desire here is to win the well woman and the nervously-sick woman to the side of the physician. If she flies from him to seek aid from the ignorant fanatic, she may, in rare cases, get what her trained adviser ought to give her and she be willing to use, while in unskilful hands she runs sad risks of having her too morbid attention riveted to her many symptoms; for to think too much about their disorders is, on the whole, one of the worst things which can happen to man or woman, and wholesome self-attention is difficult, nay, impossible, to command without help from a personally-uninterested mind outside of oneself.

I cannot leave this subject without a further word of solemn warning. In my youth we had mesmerism with its cures, then we had and have spiritualism with its like pretensions. From time to time we have had faith-cures. They come and they go, and have no stable life. The evil they do lives after them in the many mental wrecks they leave. When the charlatan Newton was ordering every class of the sick to get well, I was called upon to see case after case of the most calamitous results on mind and body. Now and then he had the luck to meet some one who was merely idea-sick,—a class of cases we know well. Then he made a cure which would have been as easy to me as to him. I made much inquiry, but could never find a case of organic disease with distinct tissue-changes which he had cured. A man with hopeless rheumatic alterations of joints was made to walk a few steps without crutches. This he did at sore cost of pain, and then came to me to tell me his tale with a new set of crutches, the healer having kept the old set as evidence of the cure. And now we have the mind-cure, Christian science and the like,—a muddle of mystical statements, backed by a medley of the many half-examined facts, which show the influence of mental and moral states over certain forms of disorder. The rarity of these makes them to be suspected. Hardly any have the solid base of a thorough medical study, and we lose sight of them at the moment of cure and learn nothing as to their future.

The books on mind-cure are calculated to make much and serious evil. I have read them with care, and have always risen from them with the sense of confusion which one would have if desired to study a pattern from the back of a piece of embroidery. There is, however, a class of minds which delight in the fogs of mystery, and, when a book puzzles them, accept this as evidence of depth of thought. I have been bewildered at times by the positiveness and reasoning folly of the insane, and I think most trained intelligences will feel that books like these mystical volumes require an amount of care and thinking to avoid bewilderment of which the mass of men and women are not possessed. In a few years they will be the rarely read and dusty volumes, hid away in libraries, and consulted only by those who undertake the sad task of writing the history of credulity. Their creed will die with them, and what is best of it and true will continue to be used by the thoughtful physician, as it has been in all ages. But, meanwhile, it is doing much harm and little good. Every neurologist sees already some of its consequences, and I, myself, have over and over had to undo some of the evil it had done.

Our nervous woman is well. Slowly, very slowly, she has won flesh and color, which means gain in quality and quantity of blood. By degrees, too, she has been able to return to the habits and endurances of health. And now she asks that other question, "I have daughters who are yet young, but how shall I guard them against nervousness?" and again puts forward this single complex symptom in disregard of the states of body which usually accompany it, and are to us matters quite as grave. She knows well that the mass of women are by physiological nature more liable to be nervous than are men. It is a sad drawback in the face of the duties of life, that a very little emotional disturbance will suffice to overcome the woman as it does not do the man, and that the same disease which makes him irritable makes her nervous. Says Romanes, in an admirable and impartial article on the mental differences of men and women, "She is pre-eminent for affection, sympathy, devotion, self-denial, modesty, long-suffering or patience under pain, disappointment, and adversity, for reverence, veneration, religious feeling, and general morality." I accept his statement to add that these very virtues do many of them lead to the automatic development of emotion, which, in its excesses and its uncontrolled states, is the parent of much of the nervousness not due to the enfeeblement of disease.[5]

[Footnote 5: Journal of Popular Science, July, 1887.]

With the intellectual differences between man and woman I have here little to do. That there is difference, both quantitative and in a measure qualitative, I believe, nor do I think any educational change in generations of women will ever set her, as to certain mental and moral qualifications, as an equal beside the man. It would be as impossible as to make him morally and physically, by any educational or other training, what the woman now is, his true superior in much that is as high, and as valuable as any mental capacities he may possess; nor does my creed involve for woman any refusal of the loftiest educational attainments. I would only insist on selection and certain limitations as to age of training and methods of work, concerning which I shall by and by have something more to say. Neither would I forbid to her any profession or mode of livelihood. This is a human right. I do not mean to discuss it here either as citizen or physician; but, as man, I like to state for my fellow-man that there are careers now sought and won and followed by her which for him inevitably lessen her true attractiveness, and to my mind make her less fit to be the "friendly lover and the loving friend."[7] Æsthetic and other sacrifices in this direction are, however, her business, not mine, and do not influence my practical judgments as to what freedom to act is or should be hers in common with men. For most men, when she seizes the apple, she drops the rose. I am a little afraid that Mrs. Lynn Linton is right as to this, but it took some courage to say what she said,[6] and she looks at the matter from a more practical point of view, and deserves to be read at length rather than quoted in fragments.

[Footnote 6: One would like to know how many women truly want the suffrage, and how, when it was won, the earnest anti-tariff wife would construe the marriage service in the face of the husband's belief in high tariff. The indirect influence of women in politics is worth a thought. We felt it sorely in 1861, and thence on to the war's end, and to-day it is the woman who is making the general prohibition laws probable. For ill or good she is still a power in the state.]

[Footnote 7: Fortnightly, 1886.]

I return to the subject. We want our young girl to be all that Romanes says she is. We desire, too, that she shall be as thoroughly educated in relation to her needs as her brothers, and that in so training her we shall not forget that my ideal young person is to marry or not, and, at all events, is to have a good deal of her life in her home with others, and should have some resources for minor or self-culture and occupation besides the larger ones which come of more distinctively intellectual acquirements.

I turn now to the mother who asks this question, and say, "What of your boys? Why are you not concerned as to them?" "Oh, boys are never nervous. One couldn't stand that; but they never are. Girls are so different." My answer is a long one. I wish I could think that it might be so fresh and so attractive as to secure a hearing; but the preacher goes on, Sunday after Sunday, saying over and over the same old truths, and, like him, with some urgency within me to speak, I can only hope that I may be able so to restate certain ancient verities as to win for them a novel respect and a generous acceptation.

The strong animal is, as a rule, the least liable to damaging emotion and its consequences. Train your girls physically, and, up to the age of adolescence, as you train your boys. Too many mothers make haste to recognize the sexual difference. To run, to climb, to swim, to ride, to play violent games, ought to be as natural to the girl as to the boy. All this is fast changing for us, and for the better. When I see young girls sweating from a good row or the tennis-field, I know that it is preventive medicine. I wish I saw how to widen these useful habits so as to give like chances to the poor, and I trust the time will come when the mechanic and the laborer shall insist on public play-grounds as the right of his little ones.[8]

[Footnote 8: The demagogue urges his rights to much that he cannot have in any conceivable form of society. Let him ask for free libraries, free baths, free music, and, above all, free and ample play-grounds within easy reach. I wonder that the rich who endow colleges do not ever think of creating play-grounds. I wish I could open some large pockets by an appeal to hearts at large.]

The tender mother, who hates dirt and loves neatness, and does not like to hear her girls called tom-boys, may and does find it hard to cultivate this free out-door life for her girls even when easy means make the matter less difficult than it is for the caged dweller in cities during a large portion or the whole of a year.

I may leave her to see that delicacy and modesty find place enough in her educational trainings, but let her also make sure that her girls have whatever chance she can afford to live out of doors, and to use the sports which develop the muscles and give tone and vigor. Even in our winters and in-doors, she can try to encourage active games such as shuttlecock and graces. I know of homes where the girls put on the gloves, and stand up with their brothers, and take gallantly the harmless blows which are so valuable a training in endurance and self-control.

I am reminded as I write that what I say applies and must apply chiefly to the leisure class; but in others there is a good deal of manual work done of necessity, and, after all, the leisure class is one which is rapidly increasing in America, and which needs, especially among its new recruits, the very kind of advice I am now giving. Severer games, such as cricket, which I see girls playing with their brothers, tennis, fencing, and even boxing, have for both sexes moral values. They teach, or some of them teach, endurance, contempt of little hurts, obedience to laws, control of temper, in a word, much that under ordinary circumstances growing girls do not get out of their gentler games. These are worth some risks, and such as they are need not trouble seriously the most careful mother. Neither need she fear for girls up to the age of puberty that they are any more liable to serious damage than are her boys.

When for her young daughters this time of change comes near, she may rest assured that their thorough physical training will have good results. Beyond this point it is hard to generalize, and, of course, the more violent games, in which girl and boy are or may be as one, must cease But each case must stand alone, and so be judged. There are plenty of healthy girls who may continue to row, to ride, to swim, to walk as before, but there are individual cases as to which advice is needed, although, as to all girls, it should be the rule that at certain times temperate exercise, lessened walks, and no dancing, riding, rowing, skating, or swimming should be allowed. Girls feel these restrictions less if they are so stringently taught from the outset as to become habits, and this is all I care to say.

Once past the critical years, and there is no reason why the mass of women should not live their own lives as men live theirs, except that always, in my opinion, the prudent woman will at certain times save herself. It is still true that even healthy women exercise too little. Our climate makes walking unpleasant, and to get in a good sweat in summer, or to wade through slush in winter, is hateful to the female soul. The English reproach us with this defect, and rightly, but do not estimate the difficulties of climate. Australian women walk little, and the English dame who comes to this country to live soon succumbs to the despotism of climate and abandons her habits of ample exercise afoot.

The in-door resources of women for chest and arm exertion are sadly few, and I think it fortunate when they are so situated as to have to do things in the household which exact vigorous use of the upper extremities. Nothing is a better ally against nervousness or irritability in any one than either out-door exercise or pretty violent use of the muscles. I knew a nervously-inclined woman who told me that when she was losing self-control she was accustomed to seek her own room, and see how long she could keep up a shuttlecock without a failure. As to weather, again, I should say the worse the weather the better the exercise of a brisk walk; and my wise mother shall see that her girls do not dawdle about in-doors, but get a good tramp under all skies as a part of the habits of life. A sturdy struggle with a rough day blows the irritability and nervousness of the hour out of any but the truly sick, and I know as to some folks that the more they are out of doors the better they are morally as well as physically.

My ideal mother has looked on and seen her daughters grow up to be strong and vigorous. When the time came, she has not forgotten that she has had and has to deal with one of her own sex. During the years of their childhood she should understand, as concerns her girls, that to differentiate too largely their moral lessons from those of their brothers is unwise. Something as to this I have said in a former chapter as concerns the training of invalid children. It applies also to the well. The boy is taught self-control, repression of emotion, not to cry when hurt. Teach your girls these things, and you will in the end assure to them that habitual capacity to suffer moral and physical ill without exterior show of emotion, which is so true an aid to the deeper interior control which subdues emotion at its sources, or robs it of its power to harm. Physical strength and an out-door life will make this lesson easy and natural. Be certain that weakness of body fosters and excuses emotional non-restraint, and that under long illness the most hardy man may become as nervously foolish as a spoiled child. Crave, then, for your girls strength and bodily power of endurance, and with this insist that the boy's code of emotional control shall be also theirs. But to do all this you must begin with them young, and not have to make each year undo the failure of the last. A dog-trainer once told me that it was a good thing to whip the smallest pups with a straw, and to teach them good habits, or try to do so, from birth. He put it strongly; but be sure that if we wish to build habits thoroughly into the mental and physical structure of childhood, we shall do well to begin early. As regards the out-door life, I shall have something more to say in another place, for much is within the reach of the thoughtful, which, with reasonable means, they can get for girls and women, and which yet they do not get; and there are many ways in which also we can so train our girls as to create for them constant and lasting bribes to be in the air.

The question of education is a more difficult one to handle. In childhood I do not see that our wise mother need be anxious; but there comes a day when her girl is entering womanhood, when she will have to think of it. I have dealt with this question so fully of late that I have little here to add.[9] Our public schools are so organized that there is small place or excuse for indulgence, although, under wise management, this has been shown to be possible.[10] But there is a vast and growing class which is so situated that the mother can more largely control the studies and hours of her girls than can the parents of those who frequent our municipal schools.

[Footnote 9: "Wear and Tear," 6th ed., 1887.]

[Footnote 10: Ibid., p. 54.]

A great change is on her child. Let her watch its evolution, and not with such apparent watchfulness as shall suggest the perils she is to look out for. We are all organized with a certain capital of nerve-force, and we cannot spend it with equal recklessness in all directions. If the girl bears well her gathering work,—that is, as one could wish,—we may let her alone, except that the wise mother will insist on lighter tasks and some rest of body at the time when nature is making her largest claim upon the vital powers. The least sign of physical failure should ring a graver alarm, and make the mother insist, at every cost, upon absence of lessons and reasonable repose. The matter is simple, and I have no more to say.

I am dealing now so entirely with the moral and physical aspects of a woman's life, and so distinctly from the medical point of view, that I do not feel called upon to discuss, in all its aspects, the mooted question of the values and the perils of the higher education. At one time it was not open to women at all. Now it is within her reach. Our girl is well, and has passed, happily, over her time of development. Will the larger education which she so often craves subject her to risks such as are not present to the man,—risks of broken health and of its consequences? I wish to speak with care to the mother called upon to decide this grave question. I most honestly believe that the woman is the better in mind and morals for the larger training, better if she marries, and far better and happier if it chances that she does not. If we take the mass of girls, even of mature age, and give them the training commonly given to men, they run, I think, grave risks of being injured by it, and in larger proportion than do their brothers. Where it seems for other reasons desirable, it should be, I think, a question of individual selection. The majority of healthy young women ought to be able to bear the strain. Once in a female college, the woman goes on, and it is my own experience that, on the whole, she exhibits a far larger list of disastrous results from such work than do young men. If she be in the least degree nervous or not well, I, for one, should resolutely say no to all such claims; for let us bear in mind that the higher education is rarely to be used as men use it, to some definite end, and is therefore not, on the whole, so essential to her as to him. Few women mean it as a way towards medicine, or even the upper ranks of teaching; and if they do, the least doubt as to health ought to make us especially unwilling to start an unseaworthy or uninsurable vessel upon an ocean of perilous possibilities. I wish that every woman could attain to the best that men have. I wish for her whatever in the loftiest training helps to make her as mother more capable, as wife more helpful; but I would on no account let the healthiest woman thus task her brain until she is at least nineteen. If she is to marry, and this puts it off until twenty-three, I consider that a gain not counted by the advocates of the higher education. I leave to others to survey the broad question of whether or not it will be well for the community that the mass of women should have a collegiate training. It is a wide and wrathful question, and has of late been very well discussed in Romanes's paper, and by Mrs. Lynn Linton. I think the conclusions of the former, on the whole, are just; but now, whatever be my views as to the larger interests of the commonwealth and the future mothers of our race, I must not forget that I am giving, or trying to give, what I may call individualized advice, from the physician's view, as to what is wisest.

Let us suppose that circumstances make it seem proper to consider an ambitious young woman's wish, and to let her go to a college for women. We presume that she has average health. But let no prudent mother suppose that in these collections of persons of one sex her child will be watched as she has been at home. At no time will she more need the vigilant insight of a mother, and yet this can only be had through letters and in the holiday seasons. Nor can the mother always rely upon the girl to put forward what may cause doubt as to her power to go on with her work. I utterly distrust the statistics of these schools and their graduates as to health, and my want of reliance arises out of the fact that this whole question is in a condition which makes the teachers, scholars, and graduates of such colleges antagonistic to masculine disbelievers in a way and to a degree fatal to truth. I trust far more what I hear from the women who have broken down under the effort to do more than they were fit to do, for always, say what you may, it is the man's standard of endurance which is set before them, and up to which they try to live with all the energy which a woman's higher sense of duty imposes upon the ambitious ones of her sex. I have often asked myself what should be done to make sure that these schools shall produce the minimum amount of evil; what can be done to avoid the penalties inflicted by over-study and class competitions, and by the emotional stimulus which women carry into all forms of work. Even if the doctor says this girl is sound and strong, her early months of college labor should be carefully watched. Above all, her eyes should be seen to, because in my experience some unsuspected disorder of vision has been fruitful of headaches and overstrain of brain, nor is it enough to know that at the beginning her eyes are good. Extreme use often evolves practical evils from visual difficulties at first so slight as to need or seem to need no correction.

The period of examinations is, too, of all others, the time of danger, and I know of many sad breakdowns due to the exaction and emotional anxieties of these days of competition and excitement.

Let me once for all admit that many girls improve in health at these colleges, and that in some of them the machinery of organization for care of the mental and physical health of their students seems to be all that is desirable. That it does not work satisfactorily I am sure, from the many cases I have seen of women who have told me their histories of defeat and broken health. The reason is clear. The general feeling (shall I say prejudices?) of such groups of women is bitterly opposed to conceding the belief held by physicians, that there are in the woman's physiological life disqualifications for such continuous labor of mind as is easy and natural to man. The public sentiment of these great schools is against any such creed, and every girl feels called upon to sustain the general view, so that this acts as a constant goad for such as are at times unfit to use their fullest possibility of energy. Modest girls, caught in the stern mechanism of a system, hesitate to admit reasons for lessened work or to exhibit signals of failure, and this I know to be the case. The practical outcome of it all is that the eyes of home can never be too thoughtfully busy with those of their girls who have won consent to pursue, away from maternal care, the higher education of female colleges. I must have wearied that wise mother by this time, but, perhaps, I have given her more than enough to make her dread these trials.

I should say something as to the home-life of girls who go through the ordinary curriculum of city day schools were it not that I have of late so very fully reconsidered and rewritten my views as to this interesting question. I beg to refer my unsatisfied reader to a little book which, I am glad to know, has been helpful to many people in the last few years.[11]

[Footnote 11: "Wear and Tear," pp. 30 to 60. J.B. Lippincott Company,
Philadelphia, 1887.]