Wear and Tear; Or, Hints for the Overworked

by S. Weir Mitchell

I am disposed to think that the variety of work done by lawyers, their long summer holiday, their more general cultivation, their usual tastes for literary or other objects out of their business walks, may, to some extent, save them, as well as the fact that they can rarely be subject to the sudden and fearful responsibilities of business men. Moreover, like the doctor, the lawyer gets his weight upon him slowly, and is thirty at least before it can be heavy enough to task him severely. The business man's only limitation is need of money, and few young mercantile men will hesitate to enter trade on their own account if they can command capital. With the doctor, as with the lawyer, a long intellectual education, a slowly-increasing strain, and responsibilities of gradual growth tend, with his out-door life, to save him from the form of disease I have been alluding to. This element of open-air life, I suspect, has a share in protecting men who in many respects lead a most unhealthy existence. The doctor, who is supposed to get a large share of exercise, in reality gets very little after he grows too busy to walk, and has then only the incidental exposure to out-of-door air. When this is associated with a fair share of physical exertion, it is an immense safeguard against the ills of anxiety and too much brain-work. For these reasons I do not doubt that the effects of our great civil war were far more severely felt by the Secretary of War and President Lincoln than by Grant or Sherman.

The wearing, incessant cares of overwork, of business anxiety, and the like, produce directly diseases of the nervous system, and are also the fertile parents of dyspepsia, consumption, and maladies of the heart. How often we can trace all the forms of the first-named protean disease to such causes is only too well known to every physician, and their connection with cardiac troubles is also well understood. Happily, functional troubles of heart or stomach are far from unfrequent precursors of the graver mischief which finally falls upon the nerve-centres if the lighter warnings have been neglected; and for this reason no man who has to use his brain energetically and for long periods can afford to disregard the hints which he gets from attacks of palpitation of heart or from a disordered stomach. In many instances these are the only expressions of the fact that he is abusing the machinery of mind or body; and the sufferer may think himself fortunate that this is the case, since even the least serious degrees of direct exhaustion of the centres with which he feels and thinks are more grave and are less open to ready relief.

When affections of the outlying organs are neglected, and even in many cases where these have not suffered at all, we are apt to witness, as a result of too prolonged anxiety combined with business cares, or even of mere overwork alone, with want of proper physical habits as to exercise, amusement, and diet, that form of disorder of which I have already spoken as cerebral exhaustion; and before closing this paper I am tempted to describe briefly the symptoms which warn of its approach or tell of its complete possession of the unhappy victim. Why it should be so difficult of relief is hard to comprehend, until we remember that the brain is apt to go on doing its weary work automatically and despite the will of the unlucky owner; so that it gets no thorough rest, and is in the hapless position of a broken limb which is expected to knit while still in use. Where physical overwork has worn out the spinal or motor centres, it is, on the other hand, easy to enforce repose, and so to place them in the best condition for repair. This was often and happily illustrated during the late war. Severe marches, bad food, and other causes which make war exhausting, were constantly in action, until certain men were doing their work with too small a margin of reserve-power. Then came such a crisis as the last days of McClellan's retreat to the James River, or the forced march of the Sixth Army Corps to Gettysburg, and at once these men succumbed with palsy of the legs. A few months of absolute rest, good diet, ale, fresh beef and vegetables restored them to perfect health.

In all probability incessant use of a part flushes with blood the nerve-centres which furnish it with motor energy, so that excessive work may bring about a state of congestion, owing to which the nerve-centre becomes badly nourished, and at last strikes work. In civil life we sometimes meet with such cases among certain classes of artisans: paralysis of the legs as a result of using the treadle of the sewing-machine ten hours a day is a good example, and, I am sorry to add, not a very rare one, among the overtasked women who slave at such labor.

Now let us see what happens when the intellectual organs are put over-long on the stretch, and when moral causes, such as heavy responsibilities and over-anxiety, are at work.

When in active use, the thinking organs become full of blood, and, as has been shown, rise in temperature, while the feet and hands become cold. Nature meant that, for their work, they should be, in the first place, supplied with food; next, that they should have certain intervals of rest to rid themselves of the excess of blood accumulated during their periods of activity, and this is to be done by sleep, and also by bringing into play the physical machinery of the body, such as the muscles,--that is to say, by exercise which flushes the parts engaged in it and so depletes the brain. She meant, also, that the various brain-organs should aid in the relief, by being used in other directions than mere thought; and lastly, she desired that, during digestion, all the surplus blood of the body should go to the stomach, intestines, and liver, and that neither blood nor nerve-power should be then misdirected upon the brain: in other words, she did not mean that we should try to carry on, with equal energy, two kinds of important functional business at once.

If, then, the brain-user wishes to be healthy, he must limit his hours of work according to rules which will come of experience, and which no man can lay down for him. Above all, let him eat regularly and not at too long intervals. I well remember the amazement of a distinguished naturalist when told that his sleeplessness and irregular pulse were due to his fasting from nine until six. A biscuit and a glass of porter, at one o'clock, effected a ready and pleasant cure. As to exercise in the fresh air, I need say little, except that if the exercise can be made to have a distinct object, not in the way of business, so much the better. Nor should I need to add that we may relieve the thinking and worrying mechanisms by light reading and other amusements, or enforce the lesson that no hard work should be attempted during digestion. The wise doctor may haply smile at the commonplace of such directions, but woe be to the man who neglects them!

When an overworked and worried victim has sufficiently sinned against these simple laws, if he does not luckily suffer from disturbances of heart or stomach, he begins to have certain signs of nervous exhaustion.

As a rule, one of two symptoms appears first, though sometimes both come together. Work gets to be a little less facile; this astonishes the subject, especially if he has been under high pressure and doing his tasks with that ease which comes of excitement. With this, or a little later, he discovers that he sleeps badly, and that the thoughts of the day infest his dreams, or so possess him as to make slumber difficult. Unrefreshed, he rises and plunges anew into the labor for which he is no longer competent. Let him stop here; he has had his warning. Day after day the work grows more trying, but the varied stimulants to exertion come into play, the mind, aroused, forgets in the cares of the day the weariness of the night season, and so, with lessening power and growing burden, he pursues his purpose. At last come certain new symptoms, such as giddiness, dimness of sight, neuralgia of the face or scalp, with entire nights of insomnia and growing difficulty in the use of the mental powers; so that to attempt a calculation, or any form of intellectual labor, is to insure a sense of distress in the head, or such absolute pain as proves how deeply the organs concerned have suffered. Even to read is sometimes almost impossible; and there still remains the perilous fact that under enough of moral stimulus the man may be able, for a few hours, to plunge into business cares, without such pain as completely to incapacitate him for immediate activity. Night, however, never fails to bring the punishment; and at last the slightest prolonged exertion of mind becomes impossible. In the worst cases the scalp itself grows sore, and a sudden jar hurts the brain, or seems to do so, while the mere act of stepping from a curb-stone produces positive pain.

Strange as it may seem, much of all this may happen to a man, and he may still struggle onward, ignorant of the terrible demands he is making upon an exhausted brain. Usually, by this time he has sought advice, and, if his doctor be worthy of the title, has learned that while there are certain aids for his symptoms in the shape of drugs, there is only one real remedy. Happy he if not too late in discovering that complete and prolonged cessation from work is the one thing needful. Not a week of holiday, or a month, but probably a year or more of utter idleness may be absolutely essential. Only this will answer in cases so extreme as that which I have tried to depict, and even this will not always insure a return to a state of active working health.