m NERVE WASTE NERVE WASTE PRACTICAL INFORMATION CONCERNING NERVOUS IMPAIRMENT IN MODERN LIFE ITS CAUSES, PHASES AND REMEDIES, WITH ADVICE ON THE HYGIENE OF THE NERVOUS CONSTITUTION BY H. C. SAWYEft, M.D. SECOND EDITION SAN FRANCISCO THE BANCROFT COMPANY 1889 H S3 WOLOGt UBRARV Entered according to Act of Congress in the Year 1889, by H. C. SAWYER In the office of the Librarian of Congress at Washington PREFACE TO THE SECOND EDITION The second edition of this little book has been wholly re-written and considerably enlarged in an effort to make it more practically useful. The author shall be glad if this effort to improve upon his first work will be considered, in one sense, a grateful response to the kind words of the press and to the appre- ciation of the public toward the earlier edition. BAN FRANCISCO, JAOTARY, 1889. 1320 MARKET STREET. 260169 INTRODUCTION The true scope as well as the powers and the limita- tions of the medical man are often imperfectly under- stood ; the various functions of the physician cure, alle- viation, prevention, teaching are better defined by the L,atin cura, care, than by its derivative, cure, in its modern sense. To care for the health of the whole community is a far wider field of usefulness than to cure the sick in- dividuals in it. In his work of curing, the physician is too often viewed as a kind of sorcerer, and he is invoked to use the mys- terious chemical substances which he is supposed to have, or which he ought to have ; many persons imagine that if they could get hold of the doctor's prescription-book, they could do without the doctor. There are drugs whose action is so sure, and surgical and other procedures whose results are so radical, that they appear almost magical, but, in the large proportion of cases, the physician is far from being a magician, and has no absolute power over disease. He is simply one learned in the science, and experienced in the manage- ment of sickness ; he is one factor, the chief of all the forces operating for life and against death ; the patient, his surroundings, his friends sometimes his ancestors influence the result for good or for evil. The power of the physician against disease and death lies in his trained faculty of observation, in his superior insight, in his comprehensive grasp of principles, in his (vii) VIII INTRODUCTION. profound knowledge of all the conditions which are for and against life, in his wiser judgment, and in the author- ity or the influence which he is able to excercise in any particular case. These qualities often enable him to nurse the flickering flame of life into health and strength where a less skillful hand would extinguish it forever. lyike the architect, the ship-master and the general, the doctor is a director of forces, a supervisor, an exerciser of good judgment; his equipment is intellectual more than physical; his power to cure is oftener in his head than in his satchel. It is to be feared that the physician has sometimes per- mitted or encouraged an exaggerated estimate of his power; he is human, and when the case gets well he has not the heart to dispel the illusion which inspires such grateful praises. Perhaps he feels that these are, in some measure, his due to offset the unjust criticism which all physicians receive. But, in the end, any mistaken idea of his power is apt to react upon the physician. When he fails to save a case, which no power on earth could save, he is at fault; he did not understand the case; he did not know, as he ought, the specific for this particular disease. The interests of both the physician and his clients are best served by an intelligent compre- hension of the scope, the powers and the limitations of medical science. The cure of disease will always be an important ele- ment of the physician's work, and in the incurable sick, the alleviation of pain, the prolonging of life, the affording of euthanasia are priceless services; but the most valuable services which scientific medicine is capable of rendering, lie in the direction of disease-prevention in the family, in the state and in the nation. At this time the policy of preventing disease rather than curing it is not generally understood nor appre- ciated, but the world is rapidly growing too wise to neg- INTRODUCTION. IX \V r . lect a great conservative power in its midst, and in the future this function of the medical profession will be more and more utilized. A ship drifts under full sail upon a tropic sea, a glimmering cloud appears upon the horizon, nothing is done; the cloud grows, but is still unheeded; soon the storm bursts with terrible fury, a wild rush is made to take in sail, but it is too late. This would be criminally bad seamanship, but it is an illustration of what occurs every day upon the uncertain sea of life. The efficiency of medical men will be immensely in- creased when their relation to their families is more or less constant, instead of intermittent and irregular. The doctor should come and go like the clergyman and the priest. Instead of being a necessary evil whose visits are avoided as long as possible, and which are a source of uneasiness when necessarily multiplied, he should be a minister and guardian of health, an officer of the family upon whose special wisdom free, early and constant reliance is placed. His counsel should have great weight in a hundred personal and family questions which influ- ence the most symmetrical development of the child and the preservation of the man. The eradiction of inherited tendencies to disease, the direct improvement of the physical and mental measure of stocks, the development of a hardy constitution in weak children, the recognition and arrest of many fatal organic diseases in their incipiency, before they are too old to be controlled, the arrest of acute inflammations at a time when this is possible, the insuring of longevity and a sound old age these are some of the things which the physician of to-day is able, but which he is not often permitted, to do. Teaching is an important function of the physician; every earnest medical man is ' 'doctor' ' in deed as well as in name. Medical advice in the abstract is often barren of influence; medical teaching, which conveys clear ideas X INTRODUCTION. of pertinent physiological and scientific facts, is far more impressive and fruitful. As in all teaching, the living voice is effective in a greater degree than the printed page can ever be; the talent which some physicians have for clearly illustrating a subject or emphasizing a fact is an important element in their success. Most medical men, according to their tastes and ex- periences, come to have a peculiar interest in certain diseases; such an interest the author has long felt toward functional diseases of the nervous system. Nervous impairment is one of the most common de- partures from health; it is a subject upon which consider- able teaching has been expended, some of it true, much of it false. The experience of the author is that the popular ideas at least upon the subject of remedies are frequently vague or erroneous; he is constantly meeting with persons, in the field of his daily work, to whom a realization of some of the facts attempted to be explained herein would be priceless; and he has thought that this short statement from the point of view of a working phy- sician might, in some degree, serve a useful purpose. SAN FRANCISCO, DECEMBER, 1887. 1320 MA.RK.ET STREET. CONTENTS Page I. THE PHYSIOLOGY OF NERVE FORCE I II. THE CAUSES OF NERVOUS IMPAIRMENT 6 III. THE CAUSES OF NERVOUS IMPAIRMENT ( Conj'cT) 1 6 IV. TYPES OF NERVOUS IMPAIRMENT 21 V. SURFACE SIGNS 27 VI. MENTAL SIGNS 32 VII. CIRCULATION SIGNS 37 VIII. SENSATION SIGNS 4! IX. MUSCULAR SIGNS WRITER'S CRAMP 49 X. MUSCULAR SIGNS THE CONVULSIVE DISORDERS 53 XI. RESPIRATORY SIGNS HAY FEVER AND ASTHMA 58 XII. ABDOMINAL SIGNS NERVOUS INDIGESTION.... 6l XIII. RECTAL SIGNS CHRONIC CONSTIPATION 67 XIV. REPRODUCTIVE SIGNS SEXUAL NEURASTHENIA 69 XV. SEXUAL NEURASTHENIA IN THE FEMALE .... 78 XVI. NERVE WASTE AND LONGEVITY 8 1 fxi) XII CONTENTS. Page XVII. THE CURE OF NERVOUS IMPAIRMENT 84 XVIII. REST AS A REMEDY 90 XIX. THE OUTING CURE 98 XX. BRAIN AND NERVE FOODS IO6 XXI. TEA, COFFEE, TOBACCO AND ALCOHOL 115 XXII. NERVINES AND NERVE TONICS 119 XXIII. DRUG VICE AND MEDICINE HABIT 129 XXIV. ELECTRICITY AS A REMEDY 140 XXV. SURFACE REMEDIES BATHS, HEAT AND COLD, COUNTER-IRRITATION, MASSAGE, CLOTHING. . 145 XXVI. THE SURGICAL TREATMENT OF NERVOUS IM- PAIRMENT 155 XXVII. APHORISMS IN NERVOUS IMPAIRMENT.. 158 THE PHYSIOLOGY OP NERVE FORCE THE NERVOUS SYSTEM. The central nervous system consists of the brain, a soft mass of gray and white tissue, which fills the cavity of the skull, and the spinal cord, a white cord* sixteen inches in length and about the thick- ness of a lead pencil, which is enclosed in the bony spine. To the anatomist and microscopist this nerve tissue ap- pears exactly alike in all human beings, but the invisible physical differences which undoubtedly exist constitute the difference between the mind of a Napoleon or a Crom- well and that of some contemporary simpleton. This central nervous system communicates with every other part of the body by means of long, white conducting nerves of varying thickness. The term ' 'nerve-cell' ' is used quite frequently in this book and it is important to understand what it means. The cell is the anatomical basis of human flesh ; it is a minute mass, spheroidal, ovoid, cylindrical, sometimes shapeless. A typical cell consists of an outside membrane, and an enclosed mass of protoplasm, which may or may not include certain germinal spots, the nu- cleus and the nucleolus. These cells are extremely small ; it is estimated that the spinal cord alone contains many millions of them. An aggregation of these cells is called a nerve-center, and these nerve-cells and nerve-centers, bound and woven together by fibres, and the crevices packed with fat and connective tissue, make up the structure known as the brain and spinal cord. Besides this central nervous system, a vast number of nerve-cells and nerve- (i) * 2 NERVE WASTE. centers have been placed in the head, in the neck, and in the cavities of the chest, abdomen and pelvis ; these cells are independent of the will but are dependent upon the central nervous system for their vitality. They control, regulate, and supply power to the vital organs within the body ; they act as reservoirs of nerve-force, and with their connecting nerves make up what is known as the sympa- thetic nervous system. THE FUNCTIONS OF THE NERVOUS SYSTEM are: i. Mind, Perception, Intelligence, Bmotion, Will. 2. Instinctive Action^ inherited ability; a new-born in- fant almost without mind does many acts instinctively. 3. Automatic or habitual action. Many acts come by repetition to be automatic, done without the consciousness of the individual, or participation of mind; thus, in writing, the mind of an adult is not often concerned in the spelling of the words, nor in the penmanship they have become automatic acts; or, one may play correctly a tune upon a musical instrument while the mind is absorbed in some other subject. This principle of habitual action has an important bearing in nervous diseases. Every repetition of any act makes a certain impression upon the nerve- centers in the brain or cord which renders subsequent acts, more and more easy; this is the history of all skill, from learning to walk to the most difficult performances of the musician or the professional gymnast. Thus by repetition bad habits as well as good ones become established or fastened upon us, and certain diseases, as epileptic fits or St. Vitus' dance in children, tend to become more and more a habit, or easily per- formed act of the nervous system. 4> Reflex Action. By this we mean that a sensation in any part is carried to the spinal cord or brain by the nerves, and thence reflected to some other organ or part by instinctive action or otherwise. A man touches a hot iron and draws his hand away almost before he is con- THE PHYSIOLOGY OF NERVE FORCE. 3 scious that the iron is hot; the painful impression is telegraphed to certain nerve-centers in the spinal cord, and instantly they telegraph back to certain muscles, which withdraw the hand from the iron. The mind may not be concerned at all in this process; when a person is tickled during sound sleep he may make a great variety of reflex motions, without being at all conscious of them. 5. The Nutrition and Growth of every tissue and organ is under the direct control of certain nerve-centers in the brain and spinal cord; every tissue is believed to have its "tropic center" and, if this becomes diseased, the nutrition of the parts dependent upon it suffers, partial or complete atrophy results. Many obstinate diseases of the skin and of the joints depend upon disease of their nourishing nerve-centers. 6. Certain areas of the nervous system directly control and regulate the circulation of the blood; this vaso- motor function of the nervous system will be more fully described in a future chapter. 7. The processes of secretion and excretion are directly maintained and regulated by the nervous system; this excito-secretory function explains why the mouth of a hungry man waters at sight or thought of savory food, how tears well up under the stimulus of emotion, and why the secretion of the digested juices, and the conse- quent appetite and digestion, is influenced by good or bad news, or why the skin and mouth sometimes become dry and parched under the influence of any intense emotional excitement. 8. The nervous system acts as a battery to gener- ate and give out force to every part where there are muscular fibres ; the muscles, arteries and veins, stomach and bowel walls, and every organ that contains muscular fibres, gets that quality which we call tone, from the steady, gentle force-supply from the nervous system. Muscular exertion involves the expenditure of nerve-force; 4 NERVE WASTE. the power is manifested in the muscles, but it comes from the nerve-cells, just as the power which is manifested in the ringing of an electric bell comes from the cells of the galvanic battery ; the champion oarsman is not the man with the largest or hardest muscles, but he whose nervous system can supply the largest amount of force and main- tain it the longest in the race. 9. The brain receives, assorts, distributes to its differ- ent parts, and registers, impressions and sensations from every part of the body, but although the brain feels for the whole body, it cannot feel for itself; surgical operations upon the brain-tissue cause no pain. When a pin is thrust into the finger the pain is really felt in the brain ; the proof being that if the nerve which connects the finger with the brain be cut, the pin can cause no pain ; the finger is numb and paralyzed. The nerves may be com- pared to telegraph wires; they transmit nervous impulses from, and impressions to, the brain and spinal cord. THE SOURCES OF NERVE-FORCE. The power that is expended with every thought and movement comes from food and oxygen. The blood liquefied and digested food circulates through every tissue and brings to every cell and fibre the chemical materials with which it may renew itself; it also brings oxygen in little red sacs, which unites chemically with the worn-out elements of the tissues, burns them up, or oxidizes them ; in this body- combustion heat is evolved, and this heat, by a mysterious vital process, is converted into force, with which every brain and nerve-cell is more or less charged. This force may be cempared to electricity and the nerve- cell to a Leyden jar. THE RELATION OF SLEEP TO NERVE FORCE. During the day the expenditure of brain and nerve force in thinking, moving, working, is greater than the capacity of the nervous system to store it from the blood, so, after sunset, a halt is called for sleep. During sleep the ex- THE PHYSIOLOGY OF NERVE FORCE. 5 penditure of nerve- force is reduced to a minimum, and income is far in excess of outgo; man awakens after a good night's sleep with his nerve-cells charged with an abun- dance of force for the labors of the day. Sleepless nights quickly exhaust the reserve force and a time comes when the individual must sleep. A young, strong person quickly recuperates from the effects of prolonged loss of sleep because his vigorous young brain and nerve-cells have the power of rapidly absorbing new force; in the old or enfeebled, this power of creating nerve-force is slow, and recuperation correspondingly so. CONSEQUENCES OP EXCESSIVE NERVE-WASTE. Thus the nerve-cells are constantly the seat of two processes nerve-waste and nerve-repair. When these two processes are proportionate in the individual, all goes well. But when nerve-waste habitually, or for a time, exceeds repair certain changes take place within the nerve-cell; it be- comes weakened, not only in its capacity to put out force, but also in its capacity to attract nourishment and create force from the blood; it becomes irritable ', over-sensitive to impressions, its power of enduring is diminished. When these two conditions of weakness and irritability become established in the nerve-cells, other parts of the body suffer ; the whole physiology of the individual may become disordered, weakened, unsteady. Nervousness, nervous debility, nervous prostration or exhaustion, are names in common, used to describe the consequences of a continued predominance of nerve- waste over nerve-repair. II THE CAUSES OP NERVOUS IMPAIRMENT The causes of nervous impairment are of two kinds : those which originate without, and those which are de- veloped within the individual. In the first class may be placed Environment and Heredity ; in the second class all those countless forms of nerve- waste which are so common in modern life, and which may be pretty completely sum- med up in two words, Overwork and Dissipation. THE EPOCH. Modern life is hard upon the nervous system. The age of electricity, of complicated machin- ery, of intricate business methods, is upon us. ' * The rail- road brain ' ' and ' ' the railroad spine ' ' are beginning to be talked of in medical meetings. The roar, the jar, the ceaseless eye and ear stimulation, the tyranny of~"the clock, and the increasing sunlessness of cities did not act upon the fathers. The endiess memory-weakening suc- cession of ideas in newspaper and review tittillates rather than exercises, superficially burnishes rather than solidly strengthens the organ of mind. The factors which pro- duce nervousness are probably more numerous and ac- tive among Americans than among any other people the ^American diathesis is becoming more and more distinctly jieryous. The possibilities of man in America are great and they excite ambition to become rich, to rise in the social scale, to accomplish objects which involve struggle , sacrifice, anxiety. The American is new, unsettled, unlo- cated, in a state of insecurity and unrest, which is unfavor- able to health. The climate of much of the United States (6) THE CAUSES OF NERVOUS IMPAIRMENT. 7 is bracing, and permits and encourages a greater amount of nervous expenditure than is possible in any other part of the civilized world. The American is not yet used to his environment; many a man overboard has sunk in strug- gling, who, with less exertion, could have kept afloat. THE NERVOUS CONSTITUTION In the nervous temper- ament of the old writers, strength and endurance of the nervous system was the salient feature. By reason of this very strength and endurance the nervous tempera- ment, in the stimulating environment of modern life, is apt to undertake too much, to work unceasingly or to dissipate to excess. Thus it conies about that the nervous temperament develops an irritable and weakened con- dition of the nervous system instead of the endurance which was one of its original characteristics. "Neurotic' ' is a word which has come into common use in modern medical literature to designate this state of more or less nervous weakness, and susceptibility to some form of nervous disorder. OVERWORK. The elements of overwork which involve excessive nerve-waste are over- activity, tension, over- excitement and monotony. Full exercise of the brain is favorable to health and longevity; it inhibits the emotions, strengthens the will and acts as a moral, mental and physical tonic. Kven prolonged brain-work is not necessarily injurious when unattended by hurry, anxiety or excitement, a fact which is illustrated in the biographies of innumerable long-lived brain-workers, and mental idleness, plus the dissipation which it is apt to engender, is one common cause of ner- vous impairment. An incessant mental and nervous over-activity seems to be inseparable from many vocations. Some men are habitually stimulated or goaded by circumstances into working beyond their strength; they regularly work at high-pressure. 8 NERVE WASTE. The exigencies of life often necessitate spurts of work; the lawyer works almost night and day for weeks on an important case; the inventor pursues some promising idea for days, neglecting sleep and even food. In many com- mercial houses there are periodically recurring busy times, when the closure of the doors at evening does not end the day's toil, the wear and tear goes on by gaslight till late at night or early morning. The young and the strong have a large reserve fund of nerve-force and pass through these periods of excessive work without permanent injury. But the individual whose nervous system is his weak part is subject to laws that do not apply to others, just as the man in straightened pecuniary circumstances is obliged to forego expenditures r that are scarcely felt by his well-to-do neighbors. The relation of over-activity to nervous disease is as simple as suFtractionr The man puts out more than he takes in, and sooner or later, according to the extent of_hjs nerve- capital, he becomes embarrassed, crippled or fails j^njirely in his vital power. Many occupations, for example type-setting, sewing machine running, or vocations which require prolonged standing, involve an over-activity of certain muscles; as a result a worn and iritable condition of that portion of the spinal cord which controls the nutrition of, and sup- plies the power to these muscles may be established. The spinal cord is a highly important part of the nervous system, having many similarities of structure and function to the brain; it is in fact a continuation of the brain, and some physiologists look upon it and the brain together as a single complex organ. When local irritation is once established in the spine it may irritate and depress the whole nervous system and give rise to many distress- ing symptoms. The tenison of anxiety so common among manu- facturers, merchants and men holding responsible THE CAUSES OP NERVOUS IMPAIRMENT. 9 positions, is an element of work that is in some respects worse than mere over- activity, and the two often go together. If a long, flexible finely tempered sword be supported at its extremities and subjected to a moderate weight at its middle, it will bend, and, as often as the weight is lifted from it, will fly back to its natural shape, though this act be repeated a million times; if an excessive weight be brought to bear upon the steel it is snapped in twain; if the blade be subjected to the strain of a lesser but still too heavy weight, it will yet respond up to a certain point of strain; if the too heavy weight is maintained during months and years, the resiliency and elasticity of the blade is impaired, the sword becomes crooked, inelastic, lifeless. So it is with human vitality; a man may sustain heavy day strain throughout a long life, if the succeeding night hours are periods of true relaxation; it is the carrying of business cares and worriments over night that impairs the fibre of the delicate and high-strung nervous organization of the nervous constitution. With certain workers, as locomotive engineers, bank tellers, dentists, the largest experience and the most practised skill can never dispense with an abnormal vigi- lance, an over-alertness, which kept up day after day, and year after year, is wearing in the extreme, and which not unfrequently proves a strain that breaks. Over-excitement is excessively rapid nerve-waste; it is tying down the safety valve and burning lard in the fur- nace. A measure of excitement is good for the brain and nerves, it stirs up the nutritive processes, cleans out the cobwebs, and leaves the mind clearer and stronger for it. But excessive excitement has burned the youth out of many a brain and left its possessor an old man at forty. The stock-boat d and the street are notorious fields of shattered nerves and softened brains, and every year the IO NERVE WASTE. excitement of political campaigns makes overdrafts upon the vitality of thousands. There are men whose work involves no great over- activity nor anxiety nor excitement, and yet they suffer from the monotonous repetition of one set of acts and im- pressions. The whole brain is not uniformly exercised by any act nor set of acts, but only certain parts of it. So certain impressions, as sights and sounds, do not impress the whole brain, but only small areas of it whose function it is to receive and take cognizance of this class of impres- sions. By a constant harping on one string it wears out before the others. By a continuous exercise of one set of brain-cells to the comparative exclusion of others, they become tired, then exhausted and incapable of further con- tinuance in this particular groove without suffering to the individual, Thus the book-keeper, dealing with figures and nothing but figures year after year, becomes tired, listless, inelastic and finally incapable of work. A vaca- tion trip to the seaside or the mountains benefits him immensely, partly by the power of pure air and exercise, but largely because the overworked areas of the brain are rested, and because a new set of acts and impressions ex- ercises other brain-cells that needed exercising. The physiological history of every man is that he grad- ually matures, then for a few years is at the maximum of his strength, then gradually fails to old age. The time when a man is at his best, is limited to a few years champion athletes seldom maintain their supremacy ten years. Such men may appear to be as strong or stronger than ever before, but the invisible fountains of power, deep in the nervous structures, have begun their retrograde change, their day is passed, and in the race some fresher man wins the prize. The amount of work which a man can easily do between thirty and forty should not be his standard of achievement in later years; when he has started to descend the hill of life, his work should become easier THE CAUSES OF NERVOUS IMPAIRMENT. II and his holidays and vacations should become more and more frequent. Unfortunately this is not often possible; sometimes an acquired inability to enjoy anything else in life but work is one of the bitter elements in the cup of success, but more often stern duty to others, and the grind- ing competition of young and tireless rivals keep the older man to a pace beyond his failing strength. At this stage of our national development overwork seems to be an inevitable condition of existence, but it is to be hoped that increasing prosperity and increasing wisdom will reduce the exactions and lessen the often terrible price which men pay for decent success, and that the "gospel of relaxation," preached by Herbert Spencer, may become fashionable in the land. SOCIAL NERVE-WASTE. Nervous men and women are apt to be fond of amusements, and of the excitements of social life; these seem like recreation after a day of toil, and, in some degree, they are such. But when they are carried to excess, or when they involve undue excitement, or encroach upon the hours of sleep, in a person whose nervous system is weakened, they draw steadily upon the diminished fund of vitality. There are many forms of social duty, as those incident to church, lodge and politics which require night work without being in any degree recreative, and which become auxilliary causes of nervous impairment. WORRY. There are minds that no trouble can injure it glides off as water does from a duck's back ; it does not sink in and corrode ; but nervous people are seldom phil- osophical or phlegmatic enough for this. Domestic trou- ble often aggravates nervous weakness, and instances where the thinning and rapidly ageing face are the only signs of silently borne grief are within the range of every- one's experience ; the skeleton in the closet is oftener re- vealed to the physician than to any other, and his skill to heal often stand helpless before its power to wreck. 12 NERVE WASTE. Success or failure in life, whether accident or sequence, has much to do with the health of the individual. Suc- cess brings friends, favors and pleasant words, a thousand little amenities that smooth the road of life. The con- sciousness of being somebody, of cutting a good figure in the world, is exalting and sustaining ; it buoys and enables many a weak man to accomplish a long life journey that he never could have accomplished had the way been rougher. Failure depresses and irritates ; the sensitive mind of the man who has failed poorly withstands the rebuffs, the harsh words, the neglect or the scarcely concealed con- tempt of his fellows. The depressing influence of disap- pointed ambitions and a hopeless future is sometimes a powerful obstacle to recovery. SCHOOL-LIFE Anyone who is often abroad at the hours when the children are going to and from school, must have noticed that a certain proportion of them are very thin, pallid, and as far as possible from the normal standard of plump, rosy, healthful childhood. During the past twenty years there has been no lack of protest against what Hux- ley vigorously designated "precocious mental debauchery" and ' 'book gluttony and lesson bibbing, ' ' but it would seem that the teacher and the parent can not often be made to see this subject from the point of view of the physiologist. Over-pressure and over-application are relative terms what is overwork for one child may be easy work for another. From the standpoint of the physician, the routine method of teaching which goads every one of fifty children, of widely varying physical and mental strength, to a high standard of accomplishment, under penalty of a certain disgrace at school and at home, is pernicious in the extreme. The idea that exercise strengthens the brain and mind is true up to the boundary line in the individual where exercise becomes overwork. The long lessons, the struggle to keep up, the cramming for examinations, all THE CAUSES OF NERVOUS IMPAIRMENT. 13 mean the expenditure of brain-force. This force must come from somewhere ; the brain draws upon the blood-current to a greater extent than the physiological economy of the child provides for ; the result is that certain chemical elements of the blood, which ought to be, and naturally would be, converted into bone, muscle and nerve tissue, are diverted from this course, by the demands of the brain ; the bones and muscles are poorly nourished, and the child is stunted in growth and never becomes the man, physical or mental, that he might have become. This is the story of the undeveloped muscles, the short stature, the physical insignificance of thousands, whose parents before them were large and handsome specimens of humanity. Many intelligent educators recognize these facts, but the teacher is no more able than other men, to work a revolution within the sphere of his duty ; the unwise ambition of parents is as often responsible as the zeal of the teacher for the nervous disorders arising out of school- life. The father who has begotten a nervous child owes it to that child to exercise more than ordinary care in its education ; school honors and study must be subordinated to physical development, which includes the physical brain and nerve tissues as well as bone and muscle tissues. If such a child cannot keep up with other children who have inherited strong nervous systems, without abnormal thinness, headaches, " nervousness, " then let him stay behind. The parent should never encourage such a child, by rewards or by reproaches, to become first in his class. Many nervous children are extremely bright; they learn quickly and with an apparent ease which gains them praises and honors, and leads the parents to expect and to exact great things; unfortunately, experience shows that this mental precocity is not often maintained in after life. 14 NERVE WASTE. Instead of ( ' The mind is the measure of the man, ' ' it might be said in these days that nerve-force is the measure of the man, so important a part does this quality play in the battles of life. The man who at thirty finds himself with a strong nervous system has in it a possession of appreciable coin value. Modern life demands not only fine work but a quantity of it, and many a fine worker has been obliged to abandon a lucrative position to some one less skillful, for lack of the necessary staying powers. SEDENTARY HABITS. A principle of physiology is that "a functional act is a nutritive act;" in other words, an organ is nourished, within certain limits, in proportion as it is used. An organ to be healthy must be used, but not over-used. Sedentary man over- uses one organ the brain- and-spine and under-uses all the others. This dispropor- tionate activity or strain upon the organ of vitality is one effect of sedentary habits. The overworked city man be- comes indolent and luxurious in his hour of ease. He rides rather than walks, he seeks to habitually breathe a warmed air, chews succulent food, wears hard hats, glazed shirt- fronts and garments which fulfil his idea of elegance and dignity of appearance rather than permit grace and sup- pleness. Suppleness scarcely exists among us, and if an Olympian athlete could see a hundred average Americans in running costume, it is to be feared that their partially bald heads, filled teeth, flat chests, thin limbs, stiff joints, and deformed feet, would excite his derision or his pity. LUXURY e-nervates as effectually as overwork and strain. That combination of indolence, self-indulgence, over-eating, jinder-breathing and nervous excitement, which may be observed in certain sons and daughters of wealth, leads to nervous impairment^ An under-used brain-and-spine comes to be poorly nourished, to have a flabby fibre, and to seek stimulants to c 'pull itself together. ' ' A brain-and-spine whose activity takes the form of excite- ment rather than of work, becomes irritable and craves THE CAUSES OF NERVOUS IMPAIRMENT. 15 the soothing influence of narcotics. No observation of medical practice is more constant or more striking than that those who persistently seek comfort and pleasure are the very ones who find annoyance and pain. L,ike the princess in the fairy tale whose tender flesh was irritated by a crumpled rose-leaf under twenty mattresses, self- indulgence acquires sources of suffering of which hardier mortals are ignorant. The clergyman can teach more eloquently than the phy- sician how excess of comfort makes us selfish ; how men who have never striven , and women who have never suffer- ed, have lacked the most potent force in human character ; how luxury and moral hebetude go hand in hand, and how those who have been given every opportunity for symmet- rical growth and instructive example, are commissioned, and ignobly, if at all, neglect their chances in the circean isle. But the physician, with his records of cases, and his offensive specimens gathered from the dead-house can more forcibly, if rudely, demonstrate how sloth and sensuality lead to decay and death. Ill CAUSES OF NERVOUS IMPAIRMENT (Continued) OCULAR DEFECTS, near-sight, and far-sight causing imperfect perception, and astigmatism (corneal asymme- try) causing faulty refraction, are common unsuspect- ed exciting or aggravating causes of nervous symptoms in school children, students and others. No phase of nervous disorder is more pathetic than that in which a child is held to its work, spite of headache, eye- tire, incompetency and strange feelings which it cannot itself describe and which are not understood by others. Dr. H. P. Allen of Columbus, O., was recently appointed by the Board of Education to examine the eyes of the children in the public schools of that city. His report states that of 4, 700 children examined i , 1 75 were found to have defective vision in one or both eyes. Near-sight- edness increased from none at all in the primary schools to 13 per cent in boys, and 17 per cent in girls in the senior class of the high school ; according to age it increased from none at six years to i i T s ff per cent at 17 years. Of all chil- dren who needed correcting glasses, only about 10 per cent had them. In the Polytechnic school of France, the pro- portion of myopia has increased from 30 to 50 per cent, and 80 per cent of all the students have to wear glasses. In view of the wide-spread and great increase of myopia in all civilized countries, it becomes the duty of parents to give their children's eyes the same watchful care that they now do their teeth. Dr. Dennett of New York has made the excellent suggestion that a test-type placard be hung in every class-room in the land; the card which he proposes is simple, consisting of a series of letters and (16) CAUSES OF NERVOUS IMPAIRMENT. 17 characters with directions concerning the distance at which each size should be read by the normal eye. The muscles of the orbit which control the movements of the eye-ball may become weakened, asthenic, and the disagreement between these and the internal accommo- dating muscles of the eye maintains a constant eye-strain. These eye-strains are very wearing upon the brain, and are capable of causing a high degree of nervous impair- ment, persistent headaches, and even epilepsy. Some re- markable results in the cure or alleviation of epilepsy, by the operator of ocular tenotomy, thus removing hurtful eye tension, have lately been obtained. The manner in which eye-muscle weakness and eye-ball defect harass and injure the brain may be thus stated. When a visual impression strikes the eye-ball, it is refracted through the various media within and focused upon the sensitive membrane (the retina) which lines its posterior wall. Thence it is transmitted along the optic nerve to the great central receptive ganglion of the brain (the central home-office for sensation) the optic thalamus, which lies near the bottom of me brain. Thence it is radiated to, and received by those brain-cells in the surface of the brain which are concerned in the particular impression. (This outer gra}' substance of the brain the cortex, or peeling, bears a similar quantitative relation to the rest of the brain that a three-quarter section of a peach does to its stone.) With a normal visual apparatus a clear impression is received at the central home-office and distributed to the out-lying brain-cells with facility. With a faulty appara- tus, the image formed upon the optic thalamus is not distinct; it is blurred; the higher brain-cells recognize it with an effort, and here lies the strain. What should be an automatic act is converted into a voluntary one. So, in our great post-offices the immense effort and strain of re- ceiving and distributing letters is largely due to the fact that so many of them are illegibly addressed. 1 8 NERVE WASTE. Ear-strains may cause or aggravate nerve-weakness in the same way that eye-strains do. A plug of wax in the external ear, a chronic inflammatory condition of the mid- dle ear, and other conditions may impair hearing and cause an indistinct auditory impression to be received at the optic thalamus, the recognition of which puts a strain upon the brain. REPRODUCTIVE MISFORTUNES AND MALPRACTICES are active and powerful causes of nervous impairment. Ex- cessive child-bearing or prolonged nursing, combined with household drudgery, reduces many a mother to a serious condition of nerve-weakness. On the other hand, those parents who refuse to accept the trials of parentage are often injured by such a course. All those ingenious perversions of the natural physiological relations of mar- riage, aimed at the prevention of conception, which, judging from my observations, are by no means rare, prove a dangerous strain, and make serious overdraft upon the vitality of thousands. Worse still, the practice of criminal abortion, or induced "miscarriage," when it does not cause death, may bleed out a woman's vitality beyond the power of nature to restore it, or it may leave scars and disease in the delicate reproductive tissues, which, acting backwards, persistently harass and weaken the nervous system. Sexual abuse and excess are to be expected in our American life. We have noted that the American, by reason of his constitution, his climate, the transition period in which he lives, is essentially nervous, his brain- and-spine over-active, over-sensitive, unstable, loving ex- citement, craving new things. Especially the city boy and man, under-using all extra-neural tissues and over- using the brain-and-spine, deteriorates in hair, teeth, muscle, skeleton, and develops a morbid sensibility in nerve-tissue everywhere. 'This state of nervous erythism craves all sorts of morbid excitementTand quickly responds CAUSES OF NERVOUS IMPAIRMENT. 19 to erotic suggestion, and becomes the victim of sexual vice^ Sexual vice has operated against health since the beginning of history, but probably it has never been so injurious to vitality as it is in the nineteenth century American. I am constantly obliged to note how the neurotic diathesis', sedentary habits, erotic suggestion and igSonmceTb'f fiienaws~or^exjial^hy^ien^^ct together to produce mental and nervous disease. REFLEX IRRITATION. The central nervous system, within its bony case of skull and spine, communicates with every other part of the body by means of nerves. These nerves constantly conduct nervous impulses from the brain- and-spine to other parts of the body, and con- stantly transmit nervous sensations from every other part of the body, generally through the spine to the brain. An impression made upon one part of the body may influence some distant part by influencing nerve-centers which are common to both. Thus, a hot application to the abdomen relieves intestinal colic, not by ' ' striking in, ' ' but by producing a relaxing influence upon the bowel through the spine and sympathetic. Slight, persistent morbid impressions are capable, by their cumulative action, of producing very serious diseases. Thus, the back-acting irritations of teething, of indigestible food and of worms are frequent causes of convulsions in infants. The irri- tating impression of a tight foreskin has often caused con- vulsions or paralysis in children. The irritating presence of dried secretions in the nose or throat, reflected upon an over-sensitive nervous system, is a common cause of asthma, hay-fever and deafness. The principle of reflex action is the basis of a certain proportion of cases of nervous impairment which might be described as back-acting, reflex, afferent or inverse neurasthenia. In this form the nerve-weakness is second- ary to local disease in some other part of the body. A long series of irritating morbid impressions reacting upon 2O NERVE WASTE. brain-and-spine, harass, irritate, depress these parts, and ultimately impair their nutrition and lessen their capacity for creating and supplying vital force. Nasal catarrh may be instanced as a purely local dis- ease which often develops a high degree of secondary mental and nervous disorder. ' ' Spinal irritation ' ' is often maintained by disorder of womb or rectum. Kpilepsy, St. Vitus' dance, lock-jaw and every form of persistent convulsive disorder may result from such apparently inadequate irritations as eye or ear strains, from hardened wax in the ear, or from chronic constipation. The first thing an expert in nervous diseases does with a new case of "fits," of which the cause is not obvious, is to over- haul the patient from head to heel in the search for possi- ble sources of reflex irritation. The mental symptoms of chronic dyspepsia may be studied in almost any house- hold. Diseases of the womb and ovaries in the female, diseases of the male reproductive organs, and rectal diseases, all develop a long train of mental and nervous symptoms in certain cases. In many cases of chronic local disease, the secondary impairment of the brain-and-spine comes to be by far the most important element. As between two crippled organs, the nose or the rectum, on the one hand, and the brain- and-spine on the other, the latter is certainly by far the most important, even though the former is the primary disease. Thus, the physician who fixes his attention nar- rowly upon a disease-process in eye, ear, nose, stomach, womb, prostate, or rectum, and ignores the secondary brain-and-spine complications, greatly limits his use/ul- ness. This is a danger to which the specialist, who comes to his work without broad training, is liable. In a purely local interest in the physical or mechanical problems of a case, it is possible to neglect the often graver second- ary mental and nervous symptoms; one may forget the patient in studying the disease. IV TYPES OF NERVOUS IMPAIRMENT THE NEUROTIC DIATHESIS. A diathesis is an inher- ited morbid tendency; thus we notice the gouty, the scrofulous and the tuberculous diatheses. The neurotic diathesis is the foundation of a large proportion of cases of nervous impairment. It becomes established in ner- vous stocks as a result of the nervous strain and over- draft of civilized life ; city Americans of the second and third generation are apt to be more or less neurotic. Persons of this diathesis live and work with a very small reserve fund of nerve-force. They are like a mer- chant doing business upon limited capital; every little loss and waste embarrasses them and a large one threatens to bankrupt them completely. They are always trying to keep even. On those days in which they live within their nervous income they may be pretty well, but when they exceed it they suffer to some extent ; a slight indiscretion may precipitate very disagreeable symptoms. A man in a strange land with a hundred dollars in his purse may be very happy in expending ninety-nine dol- lars and very miserable in expending one hundred and one. Such men and women may be ' ' all broken up, ' ' as they say, by an indigestible supper, a bad night's sleep, a piece of bad news, a seminal loss, or a few days of over- work. They envy persons of great vital resources, whose large reserve fund of nerve-force enables them to expend in every direction with impunity, and which seems to exempt them for a time from obedience to the laws of health. The nervous diathesis is not always a misfortune ; in many cases it is a blessing in disguise. The nervously (21) 22 NERVE WASTE. poor come early to understand the science of vital econ- omy and to be obedient subjects of the goddess Hygeia, and so are rewarded by fairly long life. The fact of limited vital-surplus keeps many a man in the straight and narrow path of virtue who would otherwise stray. Neurotic men are apt to beget bright, beautiful and interesting children and to make the best parents. Much of the world's work is being done to-day by men who are more or less crippled in their vital resources. Altogether I believe that neurotic persons who are not too unfortu- nate, or too reckless, perceive more, feel more, accomplish more, enjoy more and get more out of life than those of any other diathesis. NERVOUSNESS is only the manifestation of a greater or less degree of nerve-weakness, inherited or acquired. In some persons any emotional perturbance or excite- ment, or any mental effort which rapidly uses up a large amount of force, leaves the whole muscular system weak and trembling, and periods of activity and vivacity are apt to be followed by periods of depression and wretched- ness ; these phenomena indicate the smallness of the nervous resources, and the inconstant, unstable out-flow of nerve-force. So the intolerable annoyance which some persons feel at certain creaking noises, the sudden starting at slight, unexpected sounds, the excessive peevishness, the lack of self-control, the losing presence of mind at nothing "going all to pieces" are signs of the abnor- mal susceptibility and lessened endurance of the nervous tissues. PROSTRATIONS is an abrupt failure of the life- forces ; it may be partially recovered from in a few days, or it may keep the patient hovering between life and death for weeks, according to the degree of the vital over- draft. A serious case of nervous prostration is as impressive a health lesson as can be imagined. The active man of a TYPES OF NERVOUS IMPAIRMENT. 23 few days before is now a helpless inert mass ; in his face every vestige of youth, health, and mental power is replaced by a worn, prematurely aged appearance painful to look upon. The strong, quick intelligence familiar to his friends is degraded to a stupid indifference, or inco- herence ; in some cases visions or delirium occur ; the pulse beats quickly and feebly, thin as a thread under the finger, and almost feels as though it might at any moment die away forever. Muscular strength is at its lowest ebb ; slight exertion causes trembling ; the subject is unable to rise ; he is forced by outraged nature to permit a remedy that was long ago her due rest. Fever, persistent sleep- lessness, headache, vertigo, congestion of the brain, alarming sinking sensations are common symptoms. In some cases the sick man never reacts from this col- lapse, but after lingering for days or weeks, dies a real suicide ; but the larger proportion of cases slowly respond to rest, judicious medication and feeding. A careful nursing of the remnants of life recalls the subject from his graveward course ; although, after passing through such an experience, the patient is seldom or never again the man he was. J -The symptoms of uncomplicated nerve-weakness have been long familiar to physicians, but it is only in late years that their full import has come to be well understood. The comprehensive mental vision of Dr. George F. Beard collected the straggling objective and subjective signs of nervous impairment, classified them, appraised them, and practically created them into a new disease, which he called Neurasthenia literally, nerve- weakness. The scientific propriety of recognizing neurasthenia as a distinct disease has been denied, but in practice there is no other disorder, whose history is more clear and symmetrical, and none whose treatment is more clearly indicated. The neurasthenic is a nervous cripple. If the history of this disorder were 24 NERVE WASTE. required to be written in three words, these would be weakness, irritability, unsteadiness. (CEREBRAL NEURASTHENIA^ Cerebrasthenia, Brain Kx- Brain Fag, is most often seen in men be- tween the ages of thirty and sixty, whose duties and responsibilities are greater than they can bear and the strain of whose work falls chiefly or wholly upon the brain. Politicians, manufacturers, professional men and merchants contribute yearly a certain number to the list of those who are killed or crippled by this form of neur- asthenia. Mental symptoms of irritability or weak- ness are generally marked in these cases. The sleepless- ness and circulation derangements of acute brain exhaus- tion are capable of developing insanity . SPINAL NEURASTHENIA is the type most likely to be developed when strain has been brought to bear upon the spinal cord more than upon the brain. Telegraphers, compositors, type- writers, penmen, railroad men and house-wives may be instanced among those liable to this form of nerve- weakness. There is no clear-cut difference between cere oral and spinal neurasthenia ; their symptoms are much the same, but are apt to present certain differ- ences in degree. SEXUAL NEURASTHENIA is a term used to describe those cases in which nerve-weakness is partially or entirely manifested, and, in many cases, originated, in the repro- ductive apparatus. This class of cases has been variously designatea by the names Spermatorrhoea, Seminal Weak- ness, Irritable Prostate, Impotency, Sexual Hypochon- driasis, according as different physicians fixed their atten- tion upon one or another of the symptoms which char- acterize it. NERVE-WEAKNESS MANIFESTED BY OTHER ORGANS THAN THE BRAIN AND SPINE. A common phase of city life is a large family whose only resource is a moderate salary earned by the father. The daughters approaching TYPES OF NERVOUS IMPAIRMENT. 25 womanhood, the sons at college, or a sick child have the most pressing needs and absorb an undue share of the slender income. There is not enough to go round, and some one, too often the mother, must manifest poverty for the whole family. So it often is with the central nervous system the great vital source and the other organs and tissues of the body, which, as we have seen, are dependent upon it for vitality. Many men and women have some organ or tissue that is, by inheritance or by acquisition, weaker than the others it is their vulnerable point. When excessive brain or muscle work or strain uses up a disproportionate amount of the available nerve-force the supply is not enough to go round, and the weak part is very apt to suffer. When the brain and spinal impoverish- ment is manifested principally in the digestive apparatus we have the type gastric neurasthenia, to the various symptoms of which the names oxaluria, lithaemia, lithiasis, liver insufficiency, enteroptosis (falling of the bowels), nervous indigestion, nervous chills and cramps are applied. In other cases the muscular system is chiefly or solely affected in the form of tremor, or of writer's cramp, while in still others the eye, the voice, the heart or the reproduc- tive organs suffer most. THE FUNCTIONAL NERVOUS DISORDERS a large fam- ily are manifestations of insufficiency or impairment of the brain-and-spine. Mental Disorders of every degree of severity from simple crankiness to violent mania or profound melancholia or dementia often consist, or begin in, brain-and-spine weakness. In certain stocks the brain is an organ of less resistance than the spine and nervous over-draft or nervous strain may result in mental aliena- tion; the "insane neurosis" is the great predisposing cause of insanity. Inebriety, the diseased appetite for alcoholic liquors, uncontrollable because of enfeebled will- power, is now distinguished from the vice drunkenness and treated as a mental and nervous disease. Insomnia r?6 NERVE WASTE. is one of the most constant symptoms of nervous impair- ment. The Convulsive Disorders, Kpilepsy, St. Vitus' Dance, Hysteria and others, which are manifested by paroxysmal and irregular discharge of nerve-force, depend upon instability (one element of weakness) of the central nervous system, and are only radically cured by improv- ing the vitality and stability of this part of the body. Spermatorrhoea is often a symptom of cerebro-spinal insta- bility as of local reproductive disorder. Over-sensitive- ness of nerve-centres (another element of weakness,) is the predisposing cause of many forms of Headache and of Neuralgia. As in the convulsive disorders, the great aim in the radical treatment of these pains is to improve the integrity of the nervous structures Hay-fever, in a large proportion of cases consists in an over-sensibility oi the nervous centres connected with the nerve-ends in the upper air-passages, plus the excitant or irritant, whatever it may happen to be. Spasmodic Asthma has a similar condition of the respiratory nerve-centres for its primary causation. SURFACE SIGNS Some years since a distinguished English visitor, Her- bert Spencer, in the course of a New York address, said: " Everywhere I have been struck with the number of faces which told in strong lines of the burdens which had to be borne. I have been struck, too, with the large proportion of gray-haired men, and inquiries have brought out the fact, that with you the hair commonly begins to turn some ten years earlier than with us. Moreover, in every circle, I have met men who had themselves suffered from nervous collapse due to stress of business, or named friends who had either killed themselves by over-work, or had been permanently incapacitated, or had wasted long periods in endeav- ors to recover health. The changes which excessive nerve-waste produces on the surface of the body may be studied everywhere in American business and social life. Good looks depend more upon health than upon symmetry. Every sound, wholesome, fresh country boy and girl is good looking, but many society beauties will not bear inspection in the morning. The difference between the plump, firm, rosy cheek of youth and the withered flabby one of age is fundamentally a difference of vitality of nerve-force. EXTREME THINNESSS, sometimes even to emaciation often occurs because the fatty tissues are not sustained by the blood the excessive demands of brain and nerve lead them to appropriate the fat-forming elements of the blood for force creation, and thus leave little or none to be deposited ds fat. This thinness is sometimes limited to certain parts of the body, as the face; in other cases 28 NERVE WASTE. the face remains the only plump part. A peculiar sunken and aged appearance of the tissues lying immediately about the eye is a sign which I have frequently noted in victims of overwork and of sexual excesses. BALDNESS, which is said to be increasing among Amer- icans, is one of the most common results of over-activity of the nervous system. The three conditions of hair-growing are a blood-cur- rent containing a sufficiency of certain chemical sub- stances, its free circulation in the vessels of the scalp and sufficient vigor in the hair-follicle to attract the blood-stream and assimilate from it. In cases of excessive nerve-waste the demands of other organs upon the blood are imperative; they tax its nourishing and force-supplying capacity to the utmost molecule. Thus when the hair follicles are, hereditarily or otherwise, somewhat weak organs, they are robbed of their food. In sedentary man the lazily acting heart does not freely pump the blood as far as the hair follicle, and the blood which is pumped there is often obstructed for hours at a time by the pressure of hard hats upon the nutrient arteries of the scalp. Non-exercise of the scalp is one great cause of bald- ness. "A functional act is a nutritive act; " that is, exer- cise of an organ calls the blood into it and thus the organ is nourished, within certain limits, in proportion as it is used. The function of the hair is to protect the scalp. In animals the hair follicles are active; they erect the hairs in hot weather and apply them closely to the skin in cold. Sedentary man covers his head with hats, keeps the scalp at a hot-house temperature, or subjects it to the enervating climate of rooms. He relieves his hair follicles from all duty in protecting the head, and so they degenerate or perish as any other organ would from non-use. In extreme thinness the absorption or the absence of the layer of fat which naturally lies between the scalp and SURFACE SIGNS. 29 the bony skull subjects the hair follicle to pressure and thus favors atrophy. An impaired nervous system poorly innervates or vitalizes its dependent organs; the hair folli- cles become unable to attract the blood current or to assimilate from it as it circulates through their tissues; thus they become enfeebled beyond the power of stimulus to rouse them, or die altogether. These ideas accord with the natural history of baldness. This defect is rare among non-sedentary peoples as the Indian to whom nervousness is unknown, and in women who do not interfere with the circulation of the scalp, nor maintain it at a debilitating temperature, by their head-gear, and who are not often subjected to the same degree of nervous strain that men are. Thus, too, we may understand the inefficiency of all the popular methods of treating baldness. It is easy to bring the blood into the scalp by friction or by stimulating lotions, but an enfeebled hair-follicle cannot use this blood more than a dyspeptic's stomach can use food. We may lead a horse to water but we cannot make him drink. The treatment of the baldness of nervous insufficiency consists chiefly in improving the vigor and resources of the nervous system, as advised in the later chapters of this work, more than in the use of local measures. THE TEETH of civilized man are not very enduring; there are comparatively few Americans who are not com- pelled to seek the services of the dentist to rescue some of these organs from premature decay. The teeth, like the hair follicles, often deteriorate because they are not used sufficiently. Teeth were meant for biting, but civilized man does but little real biting. His food is soft, succu- lent, soaked in liquids, and the dental roots do not receive that nutritive stimulus which frequent firm pressure in their sockets provides. Impoverished blood is another cause of decay in teeth. There is only a certain available quantity of phosphates in the blood-stream, and if these 3O NERVE WASTE. are appropriated by an overworked brain, little is left with which the teeth may nourish themselves. Debility of the tegumentary trophic nerve-centres those centres which vitalize teeth, skin and nails, and enable them to attract the blood stream and to assimilate from it the chemical substances which they require is still another element in dental caries. Brittleness and slow growth of the nails is a sign of which the causation is similar to that of decay in teeth. ATONY. The firmness of muscle, of artery and vein, and to some extent of surface flesh depends upon a steady stream of nerve-force from the central nervous system. When this nervous outflow is limited the tissues may become lax and more or less flabby; the flesh lacks tone; the veins may be relaxed and dilated, even to the degree of varicosity or of varicocele, the face develops hard lines or wrinkles, and a general atony may prevail at a time of life when the tissues should be firm and solid. ANOMALOUS APPEARANCE. While nervous impairment is very apt to leave its mark upon the surface, it does not always do so, and it is a fact that a high degree of brain- and-spine weakness may exist in persons who are, to a casual observer, the healthiest of men. This is most strikingly exemplified in individuals of a mixed nervo- sanguine temperament, having fine thin skins and plenty of red blood. Such persons are sometimes pictures of rosy health, their digesting and blood-making organs being perfect while the central nervous system is weak and irritable in the extreme. These persons have a rather uncomfortable time of it. Their sufferings are alto- gether subjective and cannot be demonstrated. They are often unable to make any one believe that they are sick, and finally cease to try and learn to bear their troubles in silence. Relatives who would overflow with compassion for a cut finger have no sympathy at all for a lame brain-and-spine because they cannot see it. It SURFACE SIGNS. 31 sometimes happens that such persons are unjustly blamed for laziness or mental irritability or moral delinquency when they should be cured (i. e., cared for). The youthful appearance of many nervous invalids is a phenomenon which I have repeatedly noted; one is sur- prised to hear a patient who looks not more than twenty- five state his age at thirty-five or forty. THE NEURASTHENIC VOICE is an objective symptom which may be noted here. The quality and quantity of the voice is apt to be temporarily enfeebled after fevers, or any acute disease which seriously involves the nervous system. In chronic nervous impairment the voice may become permanently altered. A huskiness or hoarseness, a soft quality, a lack of timbre and of power, and especially unsteadiness or unreliability, make up what is called the neurasthenic voice. These changes are caused by a flabbiness or lack of tone in the vocal cords and their adjacent muscles, and in some cases by a re- laxed congested state of the mucous lining of the larynx. The nerves which run to these muscles, as well as the nerve-centers or batteries in the brain which supply them with force, are in a state of chronic depression, either as a part of a general brain depression, or as a result of per- sistent reflex irritation from the stomach, reproductive organs or elsewhere. The neurasthenic voice is sometimes supposed to be due to chronic laryngitis or some other condition of the larnyx, but purely local treatment never cures it. It may seem strange to treat a husky voice by medicating the stomach or womb; but as I write I recall a case of per- sistent huskiness of voice in a young lady, which com- pletely disappeared as soon as a displacement of the womb was cured. She had been a fine singer and her husband had spent considerable money upon specialists in diseases of the throat without any great benefit. VI MENTAL SIGNS The central nervous system is trie seat and source of character. The difference between a chief-justice and a sneak-thief consists in the changes which heredity and discipline have wrought in the plastic brain-and- spine. And the physical condition and the blood supply of "the organ of mind" largely determine those traits and char- acteristics which make up a man's individuality. MENTAL IRRITABILITY is a frequent manifestation of the physical irritability and weakness within. A fretful, peevish manner, an increasing irascibility, a tendency to become angered at slight provocation or without provoca- tion, an abnormal suspiciousness or jealousy; in woman, an abnormal emotional sensitiveness, sometimes approach- ing hysteria these are trouble-creating traits which may be developed in the most amiable individual as a result of nervous impairment. These exhibitions are apt to be looked upon as moral failings, and met with reproach and censure, when medical advice or treatment is what is needed. DEPRESSION OF SPIRITS is a common phase. Poorly nourished brain-cells cannot be expected to put forth a strong, hopeful, joyous quality of mind. The gloomy forebodings and the morbid fears of nervous impairment become in some cases a true insanity, and may even lead to suicide, but more often this phase takes the form of repeated fits of the blues, or of hypochondria. In this latter condition the subject feels that he is sick, and his attention once fixed upon his condition, develops into a morbid habit of introspection; he exaggerates the mean- ing of all his symptoms and fears the worst consequences. (32) MENTAL SIGNS. 33 Thousands of medical vampires deliberately do all in their power to cultivate this wretchedness, and derive large incomes by playing upon this phase of nervous impairment. PATHOPHOBIA means "fear of disease." An irritated, over-sensitive, or impoverished brain-and-spine is apt to be uneasy about itself. It watches, notes symptoms, worries. This morbid sensitiveness about health has become an American trait. No other people swallow so much medicine, nor support so many physicians, nor become the prey of charlatans to such an extent as Americans. This trait is not wholly imagination; it is a sign manifested by nervous systems irritated by the rest- less, disproportionate activity of American life. IMPAIRMENT OF MEMORY. The process by which ex- ternal impressions become fixed forever in the mind has been compared to photography the highly sensitive particles of brain matter corresponding to the highly sensi- tized plate in the camera. Every impression is brought to the brain through the special senses of sight, hearing, taste, touch and smell; and every thought and imagina- tion of the mind is supposed to be registered that is, to produce certain molecular changes in the brain-cells. But, since these brain-cells are being constantly worn out and destroyed, and the life of the individual cell is transient, how is it that this registration is permanent ? This is explained by applying the law of heredity to cell- life. Within every cell is a spot or germ, which, as the cell itself is passing through the various terms of its existence, gradually develops, and eventually takes the place of the parent cell, carrying on all the molecular peculiarities of the parent cell. The vigor of the memory is apt to be in direct pro- portion to the vigor of the brain-cell. In youth, memory is keen, and many of the impressions registered in the substance of the brain during that period of life are 34 NERVE WASTE. remembered vividly in extreme old age, while impres- sions brought to the comparatively blunted and enfeebled brain-cells of old age are forgotten in a week or a day. This illustrates how it is that an enfeebled condition of the brain-centers is apt to be manifested by a failing mem- ory. The cells, poorly nourished by thin blood, or impoverished by an excessive expenditure of their reserve force, become sluggish, blunted, unimpressionable at any age, just as they do in the natural failing power of extreme old age. Many degrees of impairment of mem- ory are met with. Of course, the capacity of the brain to register impressions has its limits. A three weeks' tour of Kurope is apt to leave indistinct and confused memories. A man whose business involves the remem- brance of a vast number of details, may have a very poor memory for things outside the range of that business, without having any degree of brain or nerve impairment. Closely related to this impairment of memory is an IMPAIRMENT OF THE FACULTY OF SPEECH. The power of speech requires a more or less normal condition of the vocal organ in the throat the larynx, of the mus- cles concerned in articulation those of the tongue and lips, and of the resounding chambers or cavities in and adjacent to the throat and nose. But, in addition, it requires the more or less healthful condition of certain brain-cells, the speech-centers, in which reside the faculty of language, or that part of intelligence which associates certain words with certain ideas. A fluent speaker is one in whom the speech-center in the brain is, by heredity or by cultivation, highly devel- oped. This instinct for words may be extraordinary in persons who are not fluent talkers ; some of the most famous authors have been comparatively stupid compan- ions, or have been totally unable to make a speech in public. Children born deaf, or becoming deaf from early sickness, remain dumb, not because the vocal organs MENTAL SIGNS. 35 are at fault, but because the speech-center in the brain cannot be sufficiently educated without hearing. When, as a result of over brain-work, the vigor of the cells of the speech center, in common with other parts of the brain, becomes impaired, the subject may be noticed to fre- quently mis-use words, or syllables, or even single letters, generally the initial letter of words ; and he may be often at a loss for a familiar word. This impaired fluency of speech is not constant ; the individual may be a strong and eloquent speaker under the stimulus of certain sur- roundings, but in his enervated, listless moments, when the brain is more or less off duty, this phase may be very conspicuous. IMPAIRMENT OF WILL POWER. Volition is the rarest and most valuable quality of mind. There are a hun- dred men who are wise for one who is strong, and the man with a strong will is apt to control his fellows. In many cases of nervous impairment, weakening of the will power is very noticeable. A patient lately informed me that he had left home immediately after breakfast to have an aching tooth drawn, but, though he had fully decided that the tooth must be removed, he could not bring himself to enter the dentist's office ; he passed and repassed the door innumerable times, and it was noon be- fore he could force himself to enter and submit to the momentary operation. This incident by itself is not proof of an impaired will, but when such a peculiarity developes, as it did in this case, in a man to whose known character it is utterly foreign, then it is so. My patient had visited the dentist many times before without shrink- ing, and his acquired enfeeblement of will was manifested in other directions. Fickleness, inconstancy, wavering, and inability to concentrate the mind, or to long apply it to study or work, are often the manifestations of an acquired enfeeblement of will, and may seriously affect the business or social interests of the individual. The 36 NERVE WASTE. patriarch's "Unstable as water, thou shalt not excel" well describes some of these cases. This impairment of will power is not unfrequently exhibited in old and wealthy families, where the stock is retrograding from a lack of earnest work, combined with dissipation, and it is one of the serious consequences of several of the drug habits, notably of morphine and of chloral addiction. UNEVENNESS is one of the characteristic phases of ner- vous impairment, which often renders the subject an enigma to his friends. Not only the state of mind, but all the subjective sensations of the disorder are liable to sudden and frequent changes. One day such a man may be active and enthusiastic, the next fatigued and de- pressed. One day he may be cheerful, or even vivacious; the next silent, inelastic, listless. The functions of digestion and reproduction are liable to sudden break- downs, or to periods of enfeeblement. Thus the neu- rasthenic invalid is apt to be in business and in society a noticeably uneven man. VII CIRCULATION SIGNS The vessels, by means of which the blood circulates through every part of the body, are not rigid and unyield- ing tubes, but have the property of dilating and contract- ing. These changes of calibre occur under a great variety of circumstances. In the moment of sudden fear the blood recedes from the skin and rallies around the vital organs within as if to protect them the face is <( blanched with terror ;" under the stimulus of another emotion the ves- sels of the skin dilate, and the blood rushing in to fill them causes the blush of shame ; when the body is exposed to cold, the blood-vessels of the skin contract and the blood is partially withdrawn from the surface, in order that it may be kept hot, and not radiate its heat too rapidly into the cold air ; under the influence of heat the blood is led into the skin, that, by radiation and by evap- oration of sweat, the body may lose part of its super- fluous heat ; during study or earnest thought the blood- wave is attracted to the brain ; during and after digestion to the stomach and other digestive organs. The duty of managing these complicated circulation changes belongs to a certain part of the nervous system of organs known as the vaso-motor system. This system consists of central collections of nerve -cells and innumer- able thread-like nerves which run along in the walls of every blood-vessel in the body. In health all goes well, but when the nerve-cells of the central nervous system become weakened or irritable, the action of the dependent vaso-motor nerves is apt to become deranged and un- steady, the abnormally susceptible blood-tubes are not I 37) 38 NERVE WASTE. properly controlled, and certain circulation derangements result. One of the most common of these is partial con- gestion of the brain. Brain exercise attracts a large quantity of blood into the brain-vessels, which, when the brain exercise is at an end, should be made to recede from the brain by the contraction of the blood-vessels ; but if the supply of nerve-force to these blood-vessels is insufficient, they are sluggish, lack tone, and cannot con- tract; the brain remains engorged with blood, and we may have a Congestive Headache, or perhaps a persistent Sleep- lessness. Or, the blood-flow to the brain may be too small, causing An