All of these may be due to local conditions which need to be corrected, but in most cases nothing is found locally, or at most there is some functional disturbance so slight that, though it is shared by a great many people in our climate, others do not complain of it at all. It seems evident, therefore, that the discomfort must result from the sensitiveness of the individual emphasizing the significance of some slight disturbance.
Every portion of the body may suffer from these discomforts. The upper part of the back, especially below the base of the neck, is a favorite location in men, and particularly in those who bend over a desk. The lower part of the back is affected in such men as tailors and cutters who stoop incessantly at their work. In women, the lower part of the back is likely to suffer, and this is usually attributed to genital conditions, but constipation may play quite as large a role as the genital organs. Some of the stooping occupations of women, at the sewing machine or dressmaking, or even harder occupations, as sweeping, washing, and the like, may also be responsible. The commonest source of discomfort is, perhaps, the upper left-hand quadrant of the abdomen. This seems to be due to the distention of the stomach, either by gas or by liquid. Vague discomforts may occur around the umbilicus, often due to the presence of gas, with or without borborygmi.
Generally the local condition is only an occasion, and the real cause of the complaint is the lack of occupation of mind and consequent concentration of attention on any organ whose function happens to be disturbed sufficiently to make one conscious of its action.
Lack of Occupation.—For all of these cases the most important therapeutic factor is occupation of mind and diversion of attention. In our time, social conditions allow a large number of people to have very little occupation. For instance, many women of the well-to-do classes have absolutely nothing that they must do. Various phases of this are discussed in previous sections.
As a rule, it is useless to try to relieve these discomforts by anodynes. Many an opium habit has been formed by a turning to opium in such cases. The coal tar products are greatly abused here, for they do not bring relief to queer feelings nor to a sense of pressure or discomfort; they rather add to depression. What they are efficacious for is acute pain. The coal tar products relieve even toothache or neuralgia, as well as a real headache, but I have had patients tell me over and over again that the continuous headaches from which they suffered were not relieved in the slightest degree by phenacetin or acetanilid. Occasionally one hears of hyoscine or hyoscyamus suggested for these conditions, but they are quite as useless and as much contraindicated as opium or the coal tar products. As a rule, these headaches are relieved by lying down; they disappear during sleep. The real indication for treatment, however, is found in the fact that all of these vague discomforts are much better or even disappear when the patient is intensely occupied, or at least pleasurably engaged.
What these people need is occupation that really catches their interest and takes attention from themselves. One of the most striking expressions of this truth that we have comes from the poor, sad, mad poet, Cowper:
Absence of occupation is not rest;
A mind quite vacant is a mind distressed.
And surely poor Cowper, himself the victim of depression, saved from himself only by the suggestion that he should put into poetic form the thoughts that came so abundantly to him, could well understand the depth of wisdom in his couplet. The story of Cowper's life is enough of itself to encourage physician and patient to persevere in the effort to lift depression by occupation, since the fruits of that occupation may prove so valuable.