Preventable Diseases

by Woods Hutchinson

Worry, in fact, is a sign of disease instead of a cause. To put it very crudely, whenever the blood and fluids of a body become impoverished below a certain degree, or become loaded with fatigue poisons, or other waste products above a certain point, then the nervous system proceeds to make itself felt. Either the perceptive end-organs become color-blind and read yellow for blue, or are astigmatic and report oval for round; or the conducting nerve-strands tangle up the messages, or deliver them to the wrong centre; or the central clearing-house, puzzled by the crooked messages, loses its head, and begins to throw the inkstands about, or goes down in a sulk. In other words, the nervous system goes on a strike. But it is perfectly idle to endeavor to treat it with cheering words, or kindly meant falsehoods, to the effect that "nothing is really the matter." Like any other strike, it can be rationally dealt with only by improving the conditions under which the operatives have to work, and meeting their demands for higher wages, or shorter hours.

We were accustomed at one time to divide diseases into two great classes, organic and functional. By the former, we meant those in which there was some positive defect of structure, which could be recognized by the eye or the microscope; by the latter, those diseases in which this could not be discovered, in which, so to speak, the machine was all right, but simply wouldn't work. It goes without saying that the latter class was simply a confession of our ignorance, and one which is steadily and rapidly diminishing as science progresses.

If the machine won't work, there is a reason for it somewhere, and our business is to find it out, and not loftily to assure our patients that there is nothing much the matter, and all they need is rest, or a little cheerful occupation. Furthermore, the most inane thing that a sympathizing friend or kindly physician can do to a neurasthenic, is to advise him to take his mind off himself or his symptoms. The utter inability to do that very thing is one of the chief symptoms of the disease, which will not disappear until the underlying cause has been carefully studied out and removed.

"Nerves," "neurasthenia," "psychasthenia," and "hysteria," are all the names of symptoms of definite bodily disease. The modern physician regards it as his duty to study out and discover the nature of this disease, and, if possible, remove it, rather than to give high-sounding, soul-satisfying names to the symptoms, and advise the patient to "cheer up"; which advice costs nothing—and is worth just what it costs.

"But," some one will say at once, "if nervous diseases are simply the reflection of general bodily states, as sanitary conditions improve under civilization, should they not become less frequent? And yet, any newspaper will tell you that nervous diseases are rapidly on the increase." This is a widespread belief, not only on the part of the public, but of many scientists and a considerable number of physicians; but it is, I believe, unfounded.

In the first place, we have no reliable statistical basis for a positive statement, either one way or another. Our ignorance of the precise prevalence of disease in savagery, in barbarism, and even under civilization up to fifty years ago, is absolute and profound. It is only since 1840 that vital statistics of any value, except as to gross deaths and births, began to be kept. So far as we are able to judge from our study of savage tribes by the explorer, the army surgeon, and the medical missionary, the savage nervous system is far less well balanced and adjustable than that of civilized man. Hysteria, instead of occurring only in individual instances, attacks whole villages and tribes. In fact, the average savage lives in a state alternating between naïve and childish self-satisfaction and panic-stricken terror, with their resultant cowardice and cruelty on the one hand, and unbridled lust and delusions of grandeur on the other. The much-vaunted strain of civilization upon the nervous system is not one-fifth that of savagery.

Think of living in a state when any night might see your village raided, your hut burned, yourself killed or tortured at the stake, and your wife and children carried into slavery. Read the old hymns and see how devoutly thankful our pious ancestors were every day at finding themselves alive in the morning,—"Safely through another night,"—and fancy the nerve-strain of never knowing, when you lay down to sleep, whether some one of the djinns, or voodoos, or vampires would swoop down upon you before morning. Think of facing death by famine every winter, by drought or cyclone every summer, and by open war or secret scalp-raid every month in the year; and then say that the racking nerve-strain of the commuter's time-table, the deadly clash of the wheat-pit, or the rasping grind of office-hours, would be ruinous to the uncivilized nervous system. Certainly, in those belated savages, the dwellers in our slums, hysteria, diseases of the imagination, enjoyment of ill health, and the whole brood of functional nervous disturbances are just as common as they are on Fifth Avenue.

It is not even certain that insanity is increasing. Insanity is quite common among savages; just how common is difficult to say, on account of their peculiar methods of treating it. The stupid and the dangerous forms are very apt to be simply knocked on the head, while the more harmless and fantastic varieties are turned into priests and prophets and become the founders of the earlier religions. A somewhat similar state of affairs of course prevailed among civilized races up to within the last three-quarters of a century. The idiot and the harmless lunatic were permitted to run at large, and the latter, as court and village fools, furnished no small part of popular entertainment, since organized into vaudeville. Only the dangerous or violent maniacs were actually shut up; consequently, the number of insane in a community a century ago refers solely to this class. Hence, in every country where statistics have been kept, as larger and larger percentages of these unfortunates have been gathered into hospitals, where they can be kindly cared for and intelligently treated, the number of the registered insane has steadily increased up to a certain point. This was reached some fifteen years ago in Great Britain, in Germany, in Sweden, and in other countries which have taken the lead in asylum reform, and has remained practically stationary since, at the comparatively low rate of from two to three per thousand living. This limit shows signs of having been reached in the United States already; and this gradual increase of recognition and registration is the only basis for the alleged increase of insanity under modern conditions.

It is also a significant fact that the lower and less favorably situated stratum of our population furnishes not only the largest number of inmates, but the largest percentage of insanity in proportion to their numbers, while the most highly educated and highly civilized classes furnish the lowest. Immigrants furnish nearly three times as many inmates per thousand to our American asylums as the native born.

It is, however, true that in each succeeding census a steadily increasing number and percentage of the deaths is attributed to diseases of the nervous system. This, however, does not yet exceed fifteen or twenty per cent of the whole, which would be, so to speak, the natural probable percentage of deaths due to failure of one of the five great systems of the body: the digestive, the respiratory, the circulatory, the glandular, the nervous. Two elements may certainly be counted upon as contributing in very large degree to this apparent increase. One is the enormous saving of life which has been accomplished by sanitation and medical progress during the first five years of life, infant mortality having been reduced in many instances fifty to sixty per cent, thus of course leaving a larger number of individuals to die later in life by the diseases especially of the blood-vessels, kidneys, and nervous system, which are most apt to occur after middle life. The other is the great increase in medical knowledge, resulting in the more accurate discovery of the causes of death, and a more correct reporting and classifying of the same.