Doctor and Patient

by S. Weir Mitchell

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.