Wear and Tear; Or, Hints for the Overworked

by S. Weir Mitchell

I have been careful here to state that combined overwork of mind and body is doubly mischievous, because nothing is now more sure in hygienic science than that a proper alternation of physical and mental labor is best fitted to insure a lifetime of wholesome and vigorous intellectual exertion. This is probably due to several causes, but principally to the fact that during active exertion of the body the brain cannot be employed intensely, and therefore has secured to it a state of repose which even sleep is not always competent to supply. There is a Turkish proverb which occurs to me here, like most proverbs, more or less true: "Dreaming goes afoot, but who can think on horseback?" Perhaps, too, there is concerned a physiological law, which, though somewhat mysterious, I may again have to summon to my aid in the way of explanation. It is known as the law of Treviranus, its discoverer, and may thus be briefly stated: Each organ is to every other as an excreting organ. In other words, to insure perfect health, every tissue, bone, nerve, tendon, or muscle should take from the blood certain materials and return to it certain others. To do this every organ must or ought to have its period of activity and of rest, so as to keep the vital fluid in a proper state to nourish every other part. This process in perfect health is a system of mutual assurance, and is probably essential to a condition of entire vigor of both mind and body.

It has long been believed that maladies of the nervous system are increasing rapidly in the more crowded portions of the United States; but I am not aware that any one has studied the death-records to make sure of the accuracy of this opinion. There can be no doubt, I think, that the palsy of children becomes more frequent in cities just in proportion to their growth in population. I mention it here because, as it is a disease which does not kill but only cripples, it has no place in the mortuary tables. Neuralgia is another malady which has no record there, but is, I suspect, increasing at a rapid rate wherever our people are crowded together in towns. Perhaps no other form of sickness is so sure an indication of the development of the nervous temperament, or that condition in which there are both feebleness and irritability of the nervous system. But the most unquestionable proof of the increase of nervous disease is to be looked for in the death statistics of cities.

There, if anywhere, we shall find evidence of the fact, because there we find in exaggerated shapes all the evils I have been defining. The best mode of testing the matter is to take the statistics of some large city which has grown from a country town to a vast business hive within a very few years. Chicago fulfils these conditions precisely. In 1852 it numbered 49,407 souls. At the close of 1868 it had reached to 252,054. Within these years it has become the keenest and most wide-awake business centre in America. I owe to the kindness of Dr. J.H. Rauch, Sanitary Superintendent of Chicago, manuscript records, hitherto unpublished, of its deaths from nervous disease, as well as the statement of each year's total mortality; so that I have it in my power to show the increase of deaths from nerve disorders relatively to the annual loss of life from all causes. I possess similar details as to Philadelphia, which seem to admit of the same conclusions as those drawn from the figures I have used. But here the evil has increased more slowly. Let us see what story these figures will tell us for the Western city. Unluckily, they are rather dry tale-tellers.

The honest use of the mortuary statistics of a large town is no easy matter, and I must therefore ask that I may be supposed to have taken every possible precaution in order not to exaggerate the reality of a great evil. Certain diseases, such as apoplexy, palsy, epilepsy, St. Vitus's dance, and lockjaw or tetanus, we all agree to consider as nervous maladies; convulsions, and the vast number of cases known in the death-lists as dropsy of the brain, effusion on the brain, etc., are to be looked upon with more doubt. The former, as every doctor knows, are, in a vast proportion of instances, due to direct disease of the nerve-centres; or, if not to this, then to such a condition of irritability of these parts as makes them too ready to originate spasms in response to causes which disturb the extremities of the nerves, such as teething and the like. This tendency seems to be fostered by the air and habits of great towns, and by all the agencies which in these places depress the health of a community. The other class of diseases, as dropsy of the brain or effusion, probably includes a number of maladies, due some of them to scrofula, and to the predisposing causes of that disease; others, to the kind of influences which seem to favor convulsive disorders. Less surely than the former class can these be looked upon as true nervous diseases; so that in speaking of them I am careful to make separate mention of their increase, while thinking it right on the whole to include in the general summary of this growth of nerve disorders this partially doubtful class.

Taking the years 1852 to 1868, inclusive, it will be found that the population of Chicago has increased 5.1 times and the deaths from all causes 3.7 times; while the nerve deaths, including the doubtful class labelled in the reports as dropsy of the brain and convulsions, have risen to 20.4 times what they were in 1852. Thus in 1852, '53, and '55, leaving out the cholera year '54, the deaths from nerve disorders were respectively to the whole population as 1 in 1149, 1 in 953, and 1 in 941; whilst in 1866, '67, and '68, they were 1 in 505, 1 in 415.7, and 1 in 287.8. Still omitting 1854, the average proportion of neural deaths to the total mortality was, in the five years beginning with 1852, 1 in 26.1. In the five latter years studied--that is, from 1864 to 1868, inclusive--the proportion was 1 nerve death to every 9.9 of all deaths.

I have alluded above to a class of deaths included in my tables, but containing, no doubt, instances of mortality due to other causes than disease of the nerve-organs. Thus many which are stated to have been owing to convulsions ought to be placed to the credit of tubercular disease of the brain or to heart maladies; but even in the practice of medicine the distinction as to cause cannot always be made; and as a large proportion of this loss of life is really owing to brain affections, I have thought best to include the whole class in my statement.

A glance at the individual diseases which are indubitably nervous is more instructive and less perplexing. For example, taking the extreme years, the recent increase in apoplexy is remarkable, even when we remember that it is a malady of middle and later life, and that Chicago, a new city, is therefore entitled to a yearly increasing quantity of this form of death. In 1868 the number was 8.6 times greater than in 1852. Convulsions as a death cause had in 1868 risen to 22 times as many as in the year 1852. Epilepsy, one of the most marked of all nervous maladies, is more free from the difficulties which belong to the last-mentioned class. In 1852 and '53 there were but two deaths from this disease; in the next four years there were none. From 1858 to '64, inclusive, there were in all 6 epileptic deaths: then we have in the following years, 5, 3, 11; and in 1868 the number had increased to 17. Passing over palsy, which, like apoplexy, increases in 1868,--8.6 times as compared with 1852; and 26 times as compared with the four years following 1852,--we come to lockjaw, an unmistakable nerve malady. Six years out of the first eleven give us no death from this painful disease; the others, up to 1864, offer each one only, and the last-mentioned year has but two. Then the number rises to 3 each year, to 5 in 1867, and to 12 in 1868. At first sight, this record of mortality from lockjaw would seem to be conclusive, yet it is perhaps, of all the maladies mentioned, the most deceptive as a means of determining the growth of neural diseases. To make this clear to the general reader, he need only be told that tetanus is nearly always caused by mechanical injuries, and that the natural increase of these in a place like Chicago may account for a large part of the increase. Yet, taking the record as a whole, and viewing it only with a calm desire to get at the truth, it is not possible to avoid seeing that the growth of nerve maladies has been inordinate.

The industry and energy which have built this great city on a morass, and made it a vast centre of insatiate commerce, are now at work to undermine the nervous systems of its restless and eager people,[^[4]] with what result I have here tried to point out, chiefly because it is an illustration in the most concentrated form of causes which are at work elsewhere throughout the land.

The facts I have given establish the disproportionate increase in one great city of those diseases which are largely produced by the strain on the nervous system resulting from the toils and competitions of a community growing rapidly and stimulated to its utmost capacity. Probably the same rule would be found to apply to other large towns, but I have not had time to study the statistics of any of them fully; and, for reasons already given, Chicago may be taken as a typical illustration.

It were interesting to-day to question the later statistics of this great business-centre; to see if the answers would weaken or reinforce the conclusions drawn in 1871. I have seen it anew of late with its population of 700,000 souls. It is a place to-day to excite wonder, and pity, and fear. All the tides of its life move with bustling swiftness. Nowhere else are the streets more full, and nowhere else are the faces so expressive of preoccupation, of anxiety, of excitement. It is making money fast and accumulating a physiological debt of which that bitter creditor, the future, will one day demand payment.