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by Willard Grosvenor Bleyer

The arts and crafts shops being the basic principle of the "occupation and exercise cure," the capitalist was introduced to an efficient and businesslike young woman, the instructress, who explained to him the nature of the avocations in which he might choose to interest himself. Here he found his fellow-patients busily and apparently congenially employed. In one of the shops a recent alumnus of one of the leading universities, who had undergone a nervous breakdown after graduation, was patiently hammering a sheet of brass with a view to converting it into a lampshade; a matron of nearly sixty, who had previously spent eight years in sanatoriums, practically bedridden, was setting type in the printing office with greater activity than she had known before for two decades; two girls, one sixteen and the other twelve, the latter inclined to hysteria and the former once subject to acute nervous attacks, taking the cure in charge of trained nurses, were chattering gayly over a loom in the construction of a silk rug; a prominent business man from a Western city, like the New York capitalist broken down from overwork, was earnestly modeling in clay what he hoped might eventually become a jardiniere; one of last season's debutantes among the fashionables, who had been leading a life of too strenuous gayety that had told on her nerves, was constructing a stamped leather portfolio with entire absorption; and half a dozen others, mostly young women, were engaged at wood-carving, bookbinding, block-printing, tapestry weaving, or basket-making, each one of them under treatment for some nervous derangement.

The new patient decided to try his hand at basket-making; and, although he figured out that it would take him about four days to turn out a product that might sell for ten cents, he was soon so much interested in mastering the manual details of the craft that he was disinclined to put the work aside when the medical superintendent suggested a horseback ride. When, at the advice of the specialist, the capitalist had decided to try the occupation and exercise cure, he did so with little faith that it would restore him to health, though he felt that there was perhaps a slight chance that it might help him. The remedy seemed to him too simple to overcome a disease that was paralyzing his energies. To his great surprise, he began to improve at once; and though for the first week he got little sleep, and his dizziness, with the pain in the back of his neck and his apprehensions, continued to recur for weeks, they did so at always increasing intervals.

He learned bookbinding, and sent to his library for some favorite volumes, and put them into new dress; he made elaborate waste-paper baskets, and beat brass into ornamental desk-trays, which he proudly presented to his friends in the city as specimens of his skill. Work with him, as with the others of the patients, was continually varied by recreation. In the summer months there were lawn-tennis, golf, croquet, canoeing, rowing, fishing, riding, and driving. In winter, such outdoor sports as skating, tobogganing, coasting, skeeing, snowshoeing, and lacrosse were varied by billiards, bowling, squash, the medicine ball, and basket and tether ball. The capitalist was astonished to discover that he could take an interest in games. The specialist, who called upon his patient at intervals, told him that a point of great importance in the cure was that exercise that is enjoyed is almost twice as effective in the good accomplished as exercise which is a mere mechanical routine of movements made as a matter of duty.

The net result was that, after four months of the "occupation and exercise cure," the capitalist returned to New York sound in mind and body, and feeling younger than he had before in years. Complete cures were effected in the cases of the other patients also, which is the less remarkable when the circumstance is taken into consideration that only patients capable of entire recovery are recommended to take the treatment.

Of course the institution that has been described is only for the well-to-do, and physicians are endeavoring to bring the "occupation and exercise cure" within the reach of the poor, and to interest philanthropists in the establishment of "colony sanatoriums," such as already exist in different parts of Europe, for those suffering from functional nervous disorders who are without means. Contrary to the general opinion, neurasthenia, particularly among women, is not confined to the moneyed and leisure class; but, owing to the fact that women have taken up the work of men in offices and trades as well as in many of the professions, working-women are continually breaking down under nervous strain, and many, under present conditions, have little chance for recovery, because they cannot afford the proper treatment. As a speaker at the last annual meeting of the American Medical Association declared, "Idiots and epileptics and lunatics are many; but all together they are less numerous than the victims of nervousness—the people afflicted with lesser grades of psychasthenic and neurasthenic inadequacy, who become devoted epicures of their own emotions, and who claim a large share of the attention of every general practitioner and of every specialist."

Scientists declare that this premature collapse of nerve force is increasing to such an extent as to become a positive menace to the general welfare. The struggle for existence among the conditions of modern life, especially among those found in the large centers of industrial and scientific activity, and the steady, persistent work, with its attendant sorrows, deprivations, and over-anxiety for success, are among the most prolific causes—causes which are the results of conditions from which, for the large mass of people, according to a leading New York alienist, there has been no possibility of escape.

"Especially here in America are people forced into surroundings for which they have never been fitted," the alienist asserts, "and especially here are premature demands made upon their nervous systems before they are mature and properly qualified. The lack of proper training deprives many of the workers, in all branches, of the best protection against functional nervous diseases which any person can have, namely, a well-trained nervous system. This struggle for existence by the congenital neuropath or the educationally unfit forces many to the use, and then to the abuse, of stimulants and excitants, and herein we have another important exciting cause. This early and excessive use of coffee, tea, alcohol, and tobacco is especially deleterious in its action upon the nervous system of those very ones who are most prone to go to excess in their use.

"Therefore, predisposition, aided by the storm and stress of active competition and abetted by the use of stimulants, must be looked upon as the main cause for the premature collapse of nerve force which we call neurasthenia; so it will be found that the majority of neurasthenics are between twenty-five and fifty years of age, and that their occupations are those which are attended by worry, undue excitement, uncertainty, excessive wear and tear, and thus we find mentally active persons more easily affected than those whose occupation is solely physical. Authors, actors, school-teachers, governesses, telegraph and telephone operators, are among those most frequently affected, and the increase of neurasthenia among women dates from the modern era which has opened to them new channels of work and has admitted them more generally into the so-called learned professions. But whatever may be the occupation in which persons have broken down, it is never the occupation alone which has been the cause.

"This cannot be too often repeated. The emotional fitness or unfitness of an individual for his occupation is of the utmost importance as a causative factor, and overwork alone, without any emotional cause and without any errors in mode of life, will never act to produce such a collapse. It is therefore not astonishing that this class of functional nervous diseases is not confined to the wealthy, and that the rich and the poor are indiscriminately affected. But certain causes are of greater influence in the one class, while different ones obtain in the other. Poverty in itself, with its limitations of proper rest and recuperation, is a very positive cause. Years of neurological dispensary work among the poor have convinced me that nervousness, neurasthenia, hysteria, etc., are quite as prevalent among the indigent as among the well-to-do."

Physicians agree that the prime requisite in the treatment of these disorders is the removal of the patient from his or her habitual surroundings, where recognition of the existence of actual disease is generally wanting, where the constant admonitions of well-meaning friends to "brace up" and to "exert your will power" force the sick man or woman to bodily and mental over-exertion, and where the worries about a livelihood are always dominant. Such a change alone, however, the experts say, will help but few, for it is being recognized more and more that these functional diseases of the nervous system can receive satisfactory treatment only in institutions, where constant attention may be had, with expert supervision and trained attendants.