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.
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.