Dedicated
TO THE
MEDICAL MEN, NURSES, AND OTHERS,
WHO, BY THEIR GENEROUS ASSISTANCE,
HAVE SO LARGELY CONDUCED TO THE SUCCESS OF THE AUTHOR’S
LABOURS
AMONGST OUR EPILEPTIC AND NEURASTHENIC POOR.

CHAPTER I.
INTRODUCTORY.

ONCE there lived a race of men blest with very strong eyesight—so strong that they were unconscious of possessing sight at all, but accepted their marvellous endowment as a matter of course. These men were hunters, who lived on the birds and beasts they shot with their bows and arrows.

After a time our hunters learnt other arts besides that of the chase; various implements were invented; industries such as spinning and weaving were established; the primitive huts and sheds were discarded, and commodious dwellings rose in their place. But their progress was not unattended by serious disadvantages. For instance, the weavers, who passed a great deal of their time indoors, began to lose the strength and keenness of eyesight enjoyed by those who followed the chase.

At first little attention was paid to this calamity, but when some of the weavers went blind and became a burden on the rest of the community, a meeting was convened in the council-chamber called Public Opinion, the most influential members of the tribe were consulted, and certain conclusions were arrived at.

To be brief, it was decided that the malady in question was nothing more nor less than a special manifestation of the Evil One, and that the prompt execution of the sufferers was the only sure means of preventing the spread of his power. It was therefore decreed that these uncanny and mischievous weavers should at once be put to death. To ensure the conviction of all suspected parties, a mode of trial was ordered which had the advantage of being as efficacious as it was painful. So everything seemed to be made quite safe and comfortable, and the spirits of the tribe improved.

In spite of these excellent arrangements, however, some of the invalids contrived to escape the doom thus thoughtfully prepared for them. It so happened that certain of the community, who had not been invited to vote at the meeting, held firmly to the belief that, so far from being possessed by the Evil One, these dreaded weavers were divinely inspired. Just because those whose sight was impaired could not see to do the work which was close to their eyes, their advocates credited them with the ability to discern things which were beyond the range of the most powerful vision. They therefore protected the sufferers from trial and honoured them with superstitious awe.

The disabled weavers had themselves done much to promote the conflicting beliefs concerning them. When forced by growing blindness to abandon their trade, they had been glad enough to make a livelihood by seemingly exercising their supposed supernatural vision, and thus to escape from reproach on the score of idleness; not anticipating that they would but lay themselves open to suspicion of demon-fostering. In fact, they were often self-deceived, for the disease exercised a peculiar effect on the optic nerve, causing them, when they closed their eyes, to see before them a variety of colours and forms which had no objective existence, but which they frequently mistook for Divine revelation.

Time passed on. Notwithstanding the extreme measures taken to extirpate the malady, it spread widely and increased in severity. Again the matter was investigated, and again a meeting was convened.

This august assembly took a different view of the state of affairs from that which had decreed the death of the sufferers. The former enactments were repealed. Indeed, they were declared to be barbarous and unworthy of the community which had so long tolerated them. With singular unanimity it was agreed that the sufferers were really afflicted with some incapacitating disease, the nature of which it was impossible to discover, and for which it was vain to seek a cure. It was supposed to originate in obscure injuries to the arms and legs, but on this point there was difference of opinion. It never occurred to anybody that the malady could have anything to do with impairment of the sight.

The ultimate decision of the court was to the effect that the suffering weavers were to be relieved from the necessity of working for their bread; that they should be permitted to remain a burden on the community; that they should be kept within doors and tended as cripples, and that surgeons should visit them and bandage their legs and arms.

These changes met with universal approval. The more humane members of the tribe, who had shuddered at the former barbarities, were convinced that the millennium had arrived, while the sufferers themselves accepted their fate willingly enough. For though it was dull work to be kept indoors with bandaged limbs, it was infinitely preferable to the hatred and scorn of those around them, to say nothing of a violent and painful death; and though many of them at first wished to use their limbs and to take exercise in the open air on the days when there was no glare to hurt their weak eyes, inactivity was less irksome than constant and futile efforts to fulfil their tasks.

So, at first, every one was contented with the new decisions. True, all the sufferers died sooner or later in a crippled condition, after a more or less miserable and monotonous existence; but this unhappy result was regarded as inevitable, and no further cure was sought for. Even the invalids themselves came to attribute their bodily helplessness to their original complaint, and not to the total disuse and tight bandaging prescribed by the court.

Years went by, and brought no relief either to the disabled weavers or to those who maintained them. On the contrary, the disease continued to increase with frightful rapidity. All classes of the community—which had, for the most part, abandoned its outdoor pursuits—were attacked in turn. Further investigations were made as to the cause of the calamity; a third meeting was convened, and definite conclusions were arrived at.

These, in some respects, showed more knowledge than the conclusions of the second meeting. At the same time they showed less humanity. It seemed as though the pendulum of human feeling had swung violently in the direction of intolerance, then in the direction of tolerance, returning once more, not quite to its former position, but to one far beyond the mean of wisdom and moderation. Possibly the pendulum, in its oscillations, would repeatedly pass and repass this mean point, till its range should grow more and more limited, and it should at length find repose.

The third meeting fully recognised many of the follies and absurdities of its predecessors. Powerful speakers and keen investigators argued with great force and clearness that the incapacity of the sufferers arose entirely from disuse of the limbs, and not from disease. By some of the speakers, this disuse was attributed—with a singular momentary forgetfulness of past decrees—to the wicked deceit of the idle, and of the friends who had solicited public charity in their behalf. The whole community—so these excellent, well-meaning members insisted—had been systematically gulled by the devices of impostors. There was nothing in the world the matter with the disabled weavers and those whom they had infected by their example. They must be forced to behave as if they were well, and well they would become. No doubt their eyes were weak. Whose eyes would not be weak after years of confinement within doors? Blazing sunlight and constant use of eyes and limbs would soon cure their fancies, and these infallible remedies must be prescribed for them at once.

Such cogent common-sense arguments could not but meet with the approval they deserved to meet with in the minds of the common-sense people who heard them. The recommendations of the speakers were promptly adopted.

And now ensued a very singular state of affairs. By command of the court, all invalids disabled by no visible and well-known disorder, were forced to rise from their couches, to drag themselves about in the blazing sunlight, and even to resume their former occupations. Some of them, however, succeeded in simulating well-known disorders of the limbs so cleverly, that they were considered, even by skilled investigators, to be victims of chronic disease, and were mercifully left alone. Others had already been partially cured by the complete rest from their labours they had long enjoyed, and though the rough treatment they received, and the trying effects of sudden exposure to light, caused them great discomfort, they now learnt for the first time that they had recovered the use of their eyes—long incarceration in dark rooms having prevented their discovering the fact sooner. This result, however satisfactory to themselves, was a source of infinite misery to their companions in affliction, for it was hastily assumed that a mode of procedure which had proved in the main efficacious with a few, must prove equally efficacious with all.

True, some of the patients went altogether blind the moment they were interfered with, and had to be conveyed to the blind asylum—in accordance with the custom of the country—to be kept there for the rest of their lives at the public expense. Some even developed real diseases of the limbs, in consequence of their unaccustomed efforts to take violent exercise. But these occasional failures by no means daunted the resolution of philanthropic legislators. How could there be such a thing as disease of the eyes while their own eyes were strong? With blindness they were unhappily too well acquainted, even though they had never been blind themselves; for when a man could not see at all, the fact could readily be ascertained. But it was evident that so long as a man could see, he was not blind, and therefore to treat him for loss of sight would be absurd.

The larger number of those for whom work and sunlight were prescribed neither lost their sight completely nor recovered it sufficiently to perform their allotted tasks in even the most perfunctory manner. The existence led by these unhappy people was miserable in the extreme. Every effort to use the eyes was painful. The glare of the sunlight was a torture baffling description. And their sufferings were not physical only. Their fellow-men, including their nearest and dearest friends, did their utmost to convince them of the illusory nature of their disease, and continually implored them to exert their wills to overcome temptations to imposture. By the more unfeeling, sneers and reproaches were not spared. In sheer despair the less courageous of these unfortunates died by their own hand.

Oddly enough, those who were the most uncompromising in their discouragement of supposed impostors had themselves recently become painfully conscious of impairment of vision. Fear of discovery made them loud in denouncing others; ignorance of the nature of the malady gave them hope that work and sunlight might conduce to their own cure. In time, there were in that eccentric community an abundance of deceivers of two different orders: the first pretending an illness other than that which afflicted them; the second pretending to be well when they were ill. It is said that the second class was larger than the first, and that recruits were continually swelling its ranks.

Altogether, in spite of the well-intentioned efforts of the investigators, the state of that tribe with regard to eye-disease was very much worse than it had been while the regulations of the second meeting were in force.

But, as the night is darkest immediately before the dawn, so, just as things looked blackest, there came a change for the better. It chanced that certain patients suffering from injuries to the limbs found their eyesight much affected by the illness, and were rashly credited with imposture. The injuries were declared to be wholly imaginary, and the usual moral discipline was resorted to in order to cure the patients of their delusion. Consequently, some of them were hopelessly crippled, while others, who ultimately recovered the use of their limbs, were blind for the rest of their days.

And now there was a panic in that hitherto contented community. Fears were entertained that real disease (eye-weakness was not yet regarded as actual illness) should frequently be overlooked in the midst of the general craze for extirpating imposture. The continued increase in the number of mysterious invalids occasioned anxious questioning on all sides. The crippled patients seized the opportunity to complain loudly of the usage they had received. Notwithstanding the remonstrances of the more fortunate, they insisted on repeating, to all who would hear them, the whole category of their woes. They never tired of declaring that they had been cruelly and unjustly crippled, and that the eye-weakness with which they had been temporarily afflicted was a terrible and unmistakable malady, more painful even than injuries to the limbs, and more urgently needing rational treatment.

So overwhelming was this evidence, so vehement were the witnesses, that public attention was perforce called to their grievances. Further investigations were made; further inquiries were diligently prosecuted; and a fourth meeting was convened.

That meeting is still going on. Day after day the discussions are resumed; day after day final judgment is deferred. The causes, nature, and cure of the alarmingly prevalent eye-disease are all earnestly debated. The ultimate decision of the court cannot be doubted. Sooner or later it will be recognised that the great epidemic is a disease like any other, to be treated with kindly consideration—to be cured, to be prevented. Learned investigators, while admitting that their examinations can discover no trace of disease in the eyes of the sufferers, admit likewise that their failure is no argument whatever against its existence. Pending the final judgment of the court, all former cruel enactments have been repealed, and over the door of the council-chamber have been inscribed these words, “Ignorance is the curse of God. Knowledge is the wing on which we fly to heaven.”

CHAPTER II.
A THIEF IN THE NIGHT.

OUR life and progress may be aptly compared to the passage of collections of particles through a fine sieve. The particles that will not crumble are inevitably cast out, while those that succeed in passing through it are rendered finer in the process. It would perhaps be apter still to say, that we are passing continually through a series of sieves, some coarse, some fine, and that the particles which survive the ordeal, though refined in their passage, are perpetually losing something they possessed before. Whether this be an advantage or a disadvantage to them depends on the nature of that which is lost. Those who survive the longest, in spite of constant paring and shaping, fitting them for still finer passages, must have had their sieves carefully graduated for them, each preceding sieve fitting them for the next in order of progression.

Just as it is not the loudest things that have the most substance, so it is not the largest things that contain the most power. We are told that there is sufficient force holding together the particles composing a single drop of water to make a whole flash of lightning. In the same way, there may be more force concentrated in a small portion of the nervous system than is diffused throughout all the rest of the body. And our progress through the sieves may be a condensation of great forces into our small compass. Leaving the matter of mere size of body out of the question, one man of coarse organisation (A) may possess more physical strength than a man of fine organisation (B). But B may rule the world while A is a nonentity. B may, by means of his superior mental capacity, subdue the powers of Nature to his will, and thus be master of a force compared to which A’s physical strength is as a drop in the ocean. B’s complex nervous system is the storehouse of a tremendous energy.

Now, though we have been shaped in the past by sieves over which we have had no control, we are nevertheless conscious of having acquired some power of selecting and shaping the sieves of the future. Whether or no our action in the matter is predetermined by the shape already given us, the fact that we possess this power is indubitable.

In our age it would seem that we have arrived at a sieve that is either exceptionally small or of an exceptional shape. Numbers of particles are just now being rejected, not necessarily suddenly, but often subsequent to unusually protracted, painful, and futile efforts at forcing a passage through.

The question arises, Is this state of affairs inevitable? Have we not power to graduate our sieves more effectually? And granting this power of selection and modification, is it not possible that the sieve through which we are endeavouring to force ourselves may be ill-shapen, and calculated therefore to occasion needless destruction and deformity?

In some mode or other, we are all of us constantly considering this problem. Pass through the sieves we must, if we would survive. The process seems never-ending. We may be able to select or modify our sieves, hurry our progress or retard it, but we can neither stand still nor turn back. If we cannot or will not fit ourselves to the sieve, or if mankind, by their combined action, cannot or will not fit the sieve to us, then we must be cast out.

This casting out, if sudden, we term death; if slow, disease and death. We have habituated ourselves to regard life and health as natural—death and disease as unnatural if premature; but for our mode of thought in the latter case there seems little justification. The process of disintegration that we call disease is wholly natural. The result of two opposing forces is the path of our planet in space; the result of two opposing forces is our life. Let either force gain the ascendancy, and our life goes, or begins to go.

Sooner or later, then, we must be rejected from a sieve. But our early rejection and our late rejection are two very different matters. Our sudden rejection or our slow rejection are two very different matters also. Disintegration is always going on, but if we absorb sufficient nutriment to repair the waste adequately, we are in health. If, owing to disease of any part, the waste is more than we can repair, one of the opposing forces has gained the ascendancy, and death has begun.

We justly regard this slow death in life as a most terrible fate: we will do anything to avert it. To death itself we may be resigned; to some it is an escape from suffering; by some it is regarded as the entrance to a higher life. But all alike shrink from the prospect of dragging out long years of pain and hopeless misery in the sick-room. And just as we are becoming better acquainted with the causes and prevention of disease in various forms, one form of it has recently spread in our midst to an alarming extent, our ignorance of its nature and origin rendering us powerless against its incursions.

Nervous prostration encounters us on all sides. It finds victims in all classes of life. It has come amongst us like a thief in the night.

Disease, like any other adversary, finds out the most vulnerable part. The most vulnerable part of our machinery is that about which we are most ignorant. We are lamentably ignorant about our nervous systems; our adversary, repulsed in other quarters, effects an entrance there. It is far more difficult to expel him when once he has made his abode with us, than to fortify the stronghold against him. Prevalent as this particular form of disease is at the present moment, that is not the worst of the evil. It is alarming and disheartening to be told that it is still on the increase; but such is nevertheless the fact.

Professor Huxley very wisely says, that Nature gives us a blow and leaves us to find out its meaning. More than that, she never stops giving us blows until we have succeeded in doing so. It must be candidly admitted that we are inexpressibly dull and require many very hard knocks, and that when some one else is knocked and not ourselves, we are apt to be extremely heartless.

It is only lately that the majority of non-medical people have become conscious of possessing a nervous system at all. We still hear even educated persons talk of their nerves as though they were something spiritual—as though nervous disorder were not a physical disease. Such inexcusable ignorance leads to shadowy, pernicious ideas about the impossibility of curing the malady, or, supposing it to be regarded as curable, to the adoption of cruel and fantastic methods of treatment. If only we were forced to have all our remedies tried on ourselves before trying them on others, patients would henceforth have a better time of it. Unfortunately, many supposed remedies which are not unpleasant to the healthy are torture to the diseased.

I regret to say, that I still come across people who regard nervous prostration as sheer wickedness and obstinacy on the part of the sufferer. Indeed, I have even heard the grace of God and a change of heart talked about by excellent women as the only cure for cases that had come under their notice. Far be it from me to underrate the power of any good influence; but you have only to suggest that asthma shall be treated by spiritual influence, and you will find that the good folks regard you as a lunatic or as a profane person. Asthma being undoubtedly a nervous disease, these distinctions are a little puzzling. I have even heard of church-going being suggested as a remedy for nervous excitability, regardless of the ventilation of the building, the length of the sermon, and the tunefulness of the singing. Now, with all due respect for church-going, I sometimes cannot help regretting that the friends and advisers of the nervous do not believe in charms, like the Neapolitans. If charms do no good, at all events they do no harm; and if ignorant superstition must find vent, it is well if we can, at least, render it innocuous.

The spiritual treatment of the diseased is nothing new; on the contrary, it is hallowed by ancient custom. Anna of Saxony, the insane wife of William the Silent, was shut up by her father in a miserable room, and by his orders preached to daily, through a hole in the door, by a minister of religion. But perhaps the poor lady suffered from insomnia! Unfortunately the preaching proved ineffectual, for she died raving mad.

An intelligent Italian gentleman, interested in the case of an English friend suffering from nervous prostration, once endeavoured to console him by saying that, in his opinion, it was only clever people who suffered from nerves. Stupid people had the same things the matter with them, he said, but they were too stupid to find it out. An original notion, certainly. Unhappily, however true it may be that we lack the wits to diagnose our ills, I know of many persons belonging to the labouring classes who could scarcely be considered clever even by their best friends, yet who are not only afflicted with the universal malady, but are painfully conscious of the fact. Indeed, no rank or occupation secures immunity from the visitations of our modern foe. In these days of ready communication and rapid rise and fall of families, influences affecting one part of the community quickly affect the whole. True, certain conditions may be more fatal to fine organisations—to the noblest and the best, to the most useful and the most intelligent—than to the ill-developed; but of this more hereafter.

When I see people dropping out of the ranks one after another, each probably having been confident that to him, at any rate, the disease would never come, I am reminded of De Quincey’s “Klosterheim,” where citizen after citizen was stolen away by the unseen foe. We understand so little of the causes of these break-downs, that we will not be warned in time; our partial but growing weakness is so gradual, that we become accustomed to it, and think that nothing worse will befall us; and yet the final collapse is often so sudden, that it at last comes upon us unawares, and our total prostration is a surprise to ourselves. Perhaps some shock or accident is blamed for the disaster, the long period of weakness preceding it being ignored; or we fall a victim to some well-known illness, and regard it as the judgment of Heaven, which we were powerless to avoid, instead of telling ourselves that we might have avoided it, and ought to have avoided it, by acting wisely in the first instance, and fortifying ourselves against its inroads.

CHAPTER III.
INEFFECTUAL TREATMENT.

WE are most of us so far enlightened concerning our nervous systems as to regard our nerves as a very useful means of communication between the various parts of our machinery. The network of telegraph wires in this country, with their chief offices, have frequently been compared to our network of nerves with their chief offices, the brain and the spinal centres. Yet this comparison gives a totally inadequate conception of the functions of the nervous system. Many of us fail to realise that not only do the nerves bear messages from one part of the machinery to another, but that, without their co-operation, we can receive no impressions from the outside world at all, and can perform no function whatever. Without their aid, the eyes and ears are valueless, the muscles refuse to do their work, the digestive and respiratory processes cannot be carried on. If the nerve-centres are seriously injured, we become paralysed or die. If they be impaired, the whole body is enfeebled, and disease or incapacity of some particular organ may be occasioned.

But, we may ask, how does it come about that, without external injury of any kind, the nervous systems of good people, leading good lives and given to good works, become impaired wholesale, and often remain impaired in spite of all efforts to restore them?

Medical men tell us that, in such cases, the waste in the body exceeds the nutritive supply; but this assertion may be made with equal truth in regard to diseases of a different order, and, unfortunately, increase of the nutritive supply does not necessarily cure nervous exhaustion; it is the actual nerve-waste that we have to put a stop to. Even where a patient has purposely starved herself, mere feeding up does but bring her back to the point at which she began to starve. And if we could know the truth (if we would even try to know it), we should probably find that loathing of the food, and incapability to assimilate it, were the beginning of the seeming craze which, singularly enough, seems to afford so much amusement to the average nurse. We therefore still have the original disease to tackle. A long series of observations have convinced me, that though this original disease is not often satisfactorily cured, it can be cured, and ought to be cured. The reasons of so much failure seem to me to be evident enough, and later on I hope to state them fully.

Let me give some interesting and instructive instances of failure.

A few months ago I was told that a remarkable cure had been effected by means of a well-known treatment, in which isolation, massage, and electricity were the chief agents. I accepted an invitation to meet the patient—a lady—at a friend’s house, and on asking for details of the case, I was told that she had been for years prostrate on her couch, but had been entirely restored to health and activity by the above treatment.

At the time appointed, I went to my friend’s house and was introduced to this “show-case.” What I saw was a lady manifestly suffering from severe nervous exhaustion. The strained expression of her face was sufficient evidence of mental fatigue; her attitude indicated bodily fatigue. Her voice and manner betrayed a total lack of the energy and elasticity that distinguish persons of her sanguine temperament when in good health, and it was evident that continuous conversation was trying to her in the extreme.

I talked with her for a few minutes, refraining from asking direct questions. She readily informed me that she was undoubtedly cured by the treatment she had recently undergone; that, though the massage was very painful, she had greatly benefited by it; that she had been unable to stir off her couch before undergoing it, but that she had now returned to ordinary life, and was doing in all things as ordinary people did. All I can say is, I am very sorry for ordinary people. She seemed anxious to impress upon me the fact of her having had a real illness, and not a fanciful illness; little knowing that at that moment I was wondering at the strange fancies of those who could imagine such a miserable invalid to be well. She ended by informing me triumphantly that she was able to walk—how far do you think? Ten miles? Five miles? No, not even one mile. This supposed convalescent—this “show-case”—was able to drag herself exactly half-a-mile; that is to say, if she rested on a seat half-way—and she was unmistakably done up at the end of it.

And this was the result of paying from ten to twenty guineas a week for a couple of months!

I ascertained afterwards, on closer inquiry, that the poor lady was still weak and poorly in the opinion of unbiassed friends, but that her doctor and nurse had treated her as if she were very fussy, and as if the thing to be done was to cure her of her fancies. But there was little need to tell me so: she was so evidently ashamed of ever having been ill at all.

Why can it not be honestly recognised that a young woman who is too weak to walk five miles, and chat with her friends afterwards without over-fatigue, is in an unsatisfactory state of health; and that a young lady who cannot walk half-a-mile without betraying, in spite of herself, symptoms of nervous exhaustion, is in a most dangerous and alarming state of health, and should at once be prevented from fatiguing herself further, lest she should either die of nervous prostration (failure of the heart’s action is, I believe, the polite name for this mode of making our exit), or lest she should fall a prey to one or other of the many forms of disease which are apt to attack weak women?

To a person of common-sense, the bodily fatigue of painful massage, and the mental fatigue of being regarded as an imbecile, would hardly seem conducive to cure in cases where repose of mind and body are urgently needed; but in terror of that foe to our progress, the fixed idea, one is careful to leave a corner for even the remotest of possibilities.

How this poor lady originally became a victim to the modern malady I do not know. What happened after it had developed itself is easy enough to comprehend. She had dragged herself about in misery till she could drag herself about no more, and then she had taken to her couch. Want of fresh air and exercise soon started a whole host of minor ills, which, though painful and annoying, were less dangerous than continued over-fatigue. These ailments were ineffectually doctored, one after another, in a variety of ways. Then came a physician who carried her bodily off to town, cured all the small ailments at once, and by means of the strong moral influence brought to bear upon the patient, persuaded her that lying in bed and having ailments was exceedingly selfish and sinful, besides being inhuman to those about her. It was then impressed upon her that she was cured, and she was warned against falling into sin any more. The patient actually found some of her ills cured, and persuaded herself that the remainder would yield in time.

It is a matter of fact that the intellectually weak are readily wrought upon by those about them. In like manner, those who are suffering from nervous prostration are often mere reflectors of their companions, and their strength of character on recovery is a surprise to persons who have only known them during illness. Our powers of will and judgment depend not only on the number and correctness of the impressions collected and combined in the storehouse of the nervous system, but on the physical strength we have at command with which to put our machinery in motion. Nervous weakness cannot but impair the needful connection between its highly specialised parts.

So the patient is entered in the doctor’s book as cured, and goes home to lead an ordinary life. The supposed success causes other ladies to be treated in a similar manner. If the doctor refrains from telling them how fanciful Miss So-and-so was, the nurse repairs the omission. In the meantime Miss So-and-so, little suspecting that she is being held up as a warning and an example,—perhaps even by name,—finds that her small stock of strength has not been sufficiently increased to enable her to bear the strain of an active existence. Perhaps she will break down under some well-known disease, in which case her friends will say, “How very unfortunate, just as Dr. —— had cured her of her nervousness!” Perhaps she will give in and take to her bed again, and then the nurses will say to their patients, “She was all right as long as we had her, but after she went home she took to her messy ways again, and now you see what she’s come to.”

If I have heard this sort of thing said once, I have heard it a hundred times. In the days when I was even more ignorant than I am now, I used to argue with these worthy, misguided folks; but I have since realised the futility of trying to reason with people whose sieves have not pared and shaped them into a capability for reasoning correctly.

Now you and I, and all cultured men and women in our community, have a voice in the meetings at the council-chamber of Public Opinion, and have power to modify the sieves through which these nurses pass. In fact, we are always modifying them in one way or another, whether we recognise the fact or not. And if we so far shirk our responsibilities as to allow the sieves to be formed badly, then we are very selfish, and that is infinitely worse than being ignorant and stupid. We shall not advance matters a single stage by throwing mud at individuals who have conscientiously done their best in very difficult circumstances.

Here is another case of failure which ought to commend itself to our sense of humour.

I recently met a young lady who showed the ordinary symptoms of nervous exhaustion. She had not collapsed entirely, but was forcing herself by sheer strength of will to undergo the painful dragging-about process. She informed me that she had just been consulting a physician who had labelled her “hysteria.”[2] How delighted we all are when we get hold of a label! I am, for one. Now this particular label is the concise and technical mode of saying, “Disease unknown;” and in these days of hurry, it is a great advantage to be concise.

But excellent as the label is in this respect, edifying as it is as an example of candour, it is, unfortunately, peculiarly discouraging to the patient, and therefore encouraging to the disease. So we are glad to learn that it has at length been respectfully put to its long, last sleep by our kind friend Dr. Tibbits; and, though we are willing to admit that refuges for our half-knowledge are necessary landing-places in our upward evolutionary climb, we must also regard this service rendered by Dr. Tibbits as by no means the least with which he has benefited humanity.

In “Massage and its Applications,” pp. 20-21, we read as follows:—

“I would ask you to allow me to enter my protest against that refuge of destitute physicians and surgeons—the word ‘Hysteria!’ What does it mean? What do you understand by it? I have looked up many definitions of it from all writers of repute, and I will not give you any one of them. The thing is non-existent. The word is, as I have said, a refuge for destitute medical practitioners, who, having to do with dreadfully harassing cases of functional nervous disorder, take ‘Hysteria’ as their motto and their shield, and retire—or do not retire—from the case under its shelter.”[3]

To go on with the story. The young lady was shut up and treated for fussiness, though the wrong party would seem to have been under treatment. And when the fuss was over, and the lady—with lightened purse—was mercifully let loose again, she stoutly maintained that she was no better than before. Her doctor, however, declared her to be cured, and attributed her want of recognition of the fact to “hysteria.” But then hysteria was the supposed disease for which the lady had been treated!

So in this case the doctor had cured a disease which had no existence, while the lady, in consequence of the disease which had no existence and which had been cured, continued to consider herself as ill as before.

Unfortunately, some cases of failure are less amusing than this one, and have a more tragic ending. I have on record several instances in which patients were treated as if a morbid craving for sympathy were the cause of their illness, whereas it was in one case merely a symptom of the disorder; in another, it was induced by the withholding on the part of others the helpful sympathy with suffering which we all of us need, and which we should all of us be ready to give; and in other cases there was no proof at all of its existence. The results were extremely sad. One lady, who had been treated to isolation and the interference of incompetent nurses, became insane. A young man who had been forced to exert himself became epileptic; another became partially paralysed. These are solemn warnings. Those who have lain for a length of time in bed are often more easy to cure than those who have long dragged themselves about in pain and weakness. This is the interpretation, I suspect, of the saying that it is the half-ill who are most difficult to relieve. By the half-ill is meant those who are still dragging themselves about, though they are often more ill than those who are lying in bed.

Nervous exhaustion, as has been abundantly proved, is not usually difficult to cure. Even epilepsy, if taken in time, yields satisfactorily to rational treatment.[4] And if only nervous exhaustion were better understood, the numbers of our insane and epileptic patients would at once be marvellously reduced. Unhappily, the fantastic means too often resorted to in order to cure supposed hysteria destroys the patients’ faith in medical men, and renders them unwilling to submit to further experiments. If only one could get hold of them in the early stages of the disease, much suffering might be saved in the future. When this is done, it sometimes happens that the patient does not realise how much misery he has been spared, and is not proportionately grateful.

The other day a lady in a sadly overworked condition consulted a very well-known medical man. He informed her that she was suffering from “hysteria,” and recommended her to seek active employment. The lady, not being a homoeopath, objected to the proposed treatment. Since she was suffering from fatigue, of what use could it be to prescribe fatigue as a cure? The inexorable doctor took refuge in the imperative mood,—a very favourite refuge when the patient has been labelled “disease unknown,”—and she was overruled. With misplaced confidence and reprehensible docility, she forced herself back to her work. Shortly afterwards she had to be placed under care.

A worthy great-uncle of mine was one morning engaged in doctoring the out-patients at the hospital he attended, when a poor woman addressed him in pathetic tones, begging him to cure the malady in consequence of which she endured unutterable things.

“Certainly, my good woman,” he said cheeringly. “What’s the matter?”

“I have a newt, sir,” was the unexpected response.

“A what?”

“A newt, sir, inside me.”

My uncle then recognised the case as being what he called “hysterical.”

People in those days were more sympathetic and less contemptuous in their treatment of such unfortunates than most of us are now, so he said in a kindly, soothing manner—

“Poor thing! Well, well, we’ll soon set that right. Now don’t you distress yourself, my good woman. I’ll soon settle the newt for you!”

Thereupon he gave her a bottle of coloured water and some bread-pills, directing her to take them steadily for a few days and then return to show herself to him. He fully expected, he added, that she would then be quite restored to health.

Away went the sufferer.

At the time appointed she again visited the hospital.

“Well,” said my uncle cheerfully, “how are you? Newt’s quite done for, I suppose?”

“Oh no, sir,” she replied piteously. “A terrible thing’s happened.”

“Indeed! Sorry for that. What is it?”

“The newt’s had young ones!”

My uncle gave that case up. I have no doubt he thenceforth regarded “hysteria” as incurable in confirmed cases.

It is really surprising that so successful a practitioner should have been short-sighted enough to treat a mere symptom instead of the disease in which it originated. He appeared to think that his patient was suffering from hallucination, from a morbid idea, and that if he could remove the idea, she would be well. Had he realised that morbid ideas argue a morbid condition of the nerves, and that the mere removal of one hallucination after another would not suffice to repair actual nerve-waste, he would certainly have refrained from expending his own nerve-force in a vain endeavour. But I am glad to know that he at any rate refrained from dissipating still further the poor woman’s small capital of strength by frightening her and discouraging her. In this respect his method compares favourably with that now in vogue at many hospitals.

Here are three instances of more modern usage.

A woman of the labouring class presented herself at a country hospital for treatment. She declared herself to be afflicted with severe pain in one leg, rendering it almost helpless, and preventing her from accomplishing her daily work. The medical gentlemen to whom she addressed herself could find nothing wrong with the limb, and harshly told her that her complaint was “hysteria.” One would have thought that having discovered the disease and given it a name, they would have done something to cure it. Not at all. The woman was sent away unrelieved, to be a burden on her unhappy family or on the community, as the case might be. Yet these gentlemen had probably heard of such things as nerves, and knew them to be an even more essential part of the body than the legs. Their refusal to treat the patient in question would have been excusable had they systematically excluded all nervous cases, but this does not appear to have been their practice. The poor woman went home and struggled to do her work, but failed from weakness. In despair she consulted a quack, who put her on an efficacious course of treatment and cured her triumphantly. A member of the Hospital Committee, having these facts brought under his notice, attended the next meeting, and moved that that quack should at once be taken on to the staff to assist the medical gentlemen with his valuable advice. The motion was lost.

Another woman, suffering from severe nervous exhaustion, applied for relief at a large hospital in London, and received the same answer—“Only hysteria.” One would really have thought that a disease so widely recognised, and causing so much perplexity, would be a bad enough thing to have without more being expected of one. However, the woman was told that her complaint was all sham and nonsense, and she was sent about her business. She went in despondency, for she was in a fearfully exhausted condition. Soon afterwards a painful malady made its appearance of the description usually considered “interesting,” and the same hospital, which had closed its doors on the invalid, now opened them wide, received her with kindness, and studied the disease diligently. They failed to cure it, but that is a detail. Indeed, I think they would have cured it if they could, but perhaps it was incurable. This hospital admits itself to have been mistaken. It says it was wrong in crediting the patient with “hysteria;” she was really suffering, the doctors say, from the exhaustion preceding this particular form of disease. In short, if they could have cured the neurasthenia, which was the woman’s sole disease when she went to the hospital in the first instance, she need never have contracted the disease which was found so interesting. Lower the vitality of the whole organism, and the part originally weakest breaks down; or the patient may be exposed to some malign influence,—such as blood-poisoning, for example,—which, in health, she would have been able to withstand, but to which, in an enfeebled condition, she falls an easy prey. I had watched this patient become ill. I had even tried to arrest her downward progress; but my hands being tied, I could accomplish very little. She was of neurasthenic inheritance, and was put in unfavourable conditions. A hospital, taking entire possession of her at the right moment, might have done a good deal.

At another hospital a young probationer began to break down from overwork. She fell a victim to neurasthenia, and a very painful and distressing malady she found it. She consulted one of the medical staff, who rebuked her, told her she was suffering from “hysteria,” and ordered her to go and work. Her health would have been destroyed, and she would have been forced to abandon her career, had not a kindly, sensible physician—such as, happily, abound in the much-tried medical profession—come to the rescue, set her feet upon a rock, and ordered her goings. She is still leading an active, useful life.

There have probably been many cases in which the patient has become neurasthenic from monotony and want of occupation, and in which her cure has seemingly been effected by her being forced to exertion. As a matter of fact, the good results have been obtained chiefly by the patient being placed in better conditions, and I have seen many such cases, who have been entered in the doctor’s book as cured, relapse again on the smallest provocation. Yet, as I have said before, neurasthenia can be cured, and ought to be cured; and if we fail in our efforts, there must be a screw loose in our mode of treatment.

One more instance of failure may be given here, out of a very large number that might be recorded.

A young lady, rendered justly anxious by increasing nerve-weakness, consulted a well-known physician. He asked what ailed her. She described her symptoms, the most usual symptoms of neurasthenia. His comment on her report was singular. He wondered that she should have come to him at all, having no more than that the matter with her. One is again tempted to ask what more one can be expected to have the matter? Surely, continued languor, depression, neuralgia, and weakness are a sufficiently heavy burden for anybody to bear, to say nothing of want of comprehension on the part of others. Did the good gentleman wish the lady to wait until she had developed something more “interesting”? Not at all. We should wrong him by entertaining any such idea. He merely believed neurasthenia to be three parts fuss and nonsense, and he thought he was proving himself a kind friend to the young lady by rousing her to a sense of her duty—the duty of dragging herself about and saying nothing of her ailments. It is odd how very ready we all are to preach duty—to somebody else. Nevertheless, let us honour the conscientious physician for his honesty. Unfortunately, he failed to cure the young lady, and for anything I know to the contrary, she may by this time have developed something extremely interesting.

CHAPTER IV.
ERRONEOUS NOTIONS.

IT will be readily conceded that in order to treat nervous disease successfully, we must have some special qualifications for our task. We need not only learning, but experience and powers of ready observation. Indeed, mere learning will avail us little in a still undiscovered country, or in one where the observations of our predecessors have been so frequently and unavoidably erroneous. But if it be true that all disease is in a sense nervous disease—an affection of the nerves of some particular part of the organism—the importance of the study of neurasthenia cannot be overrated, provided that we study it from Nature, and do not rely wholly on prevalent teaching concerning the mode of treatment required.

Mr. Francis Galton, in his able work, “Natural Inheritance,” shows that tendencies to certain maladies may lie latent in families tainted with them in the past, and that, on the other hand, these may be increased in severity by inheritance, and may even bring the family to an end. With some complaints the rule would seem to be that they are either very largely inherited by the offspring or not at all. Making some allowance for difference in circumstance and mode of life of a given generation, it will be found that where the nervous system has been strengthened, the family malady has been successfully defied, and that where it has been enfeebled, the enemy has made his appearance. As regards consumption especially, it would be easy to give a large number of cases in point. In the early stages of this terrible malady, when the enemy had already effected an entrance and was clearly recognised by physicians, I have known him to be summarily expelled, not by treating the disease itself, not by sending the patient to warm climates, but by adopting the very methods which are so effectual in neurasthenia. Bracing air, frequent nourishment, cold water to the neck and spine, mild tonics continued for a length of time, and freedom from worry—in some cases massage and electricity also,—these are the true remedies so long as remedies are of any use at all. I have known instances where such a rÉgime has entirely banished the hereditary evil, and the patient has resumed an ordinary existence.

Almost too much stress has recently been laid on the necessity for moral treatment of the neurasthenic. Though it is impossible to lay too much stress on the importance of good surroundings, the term “moral treatment” has come to be employed in a wrong sense. Doctors and nurses usually mean by it (not always) keeping the patient in order, making her forget herself, rousing her, and—too often—irritating her; whereas good moral treatment should before all things mean gentleness, cheerfulness, patience, the encouragement of the growth of the patient’s will—not the enforcement of abject submission to the will of somebody else,—total freedom from all noise, fatigue, and irritation, and the constant presence of an improving influence and example. Special attention must be called to this latter point. Jean Paul Richter tells us:—

“The first rule to be observed by any one who will give something is, that he must himself have it.”

In other words, it is useless to attempt to light the fire with an unlighted match.

Now, the notion that a woman less refined, less highly educated than the patient, and originally of inferior mental and moral endowment, is to be permitted to thwart and control her, is one that must, and does, work an incalculable amount of harm. It is not by saying, “Be unselfish,” “Don’t think of your ailments,” “Be self-controlled,” &c., that we can do any good to a suffering invalid. If we have not built up our own organisations—our characters—impression by impression, in the path of right reason and true sanity, so that we can benefit others by our unconscious influence, we had far better let the neurasthenic alone.

I have, moreover, come across neurasthenic patients who were far more fitted to teach me endurance and sweet temper than I was to teach them. Even in cases where we justly lament the absence of these virtues, we should consider what strength of mind it must require to refrain from irritability of temper, from yielding to constant pain and fatigue, and from sinking into a state of complete inactivity. The efforts of neurasthenics in this latter direction are often mistaken; Nature is indicating the pressing need of rest; but we must nevertheless admire the vigour of at least one portion of their nervous systems, though realising that the health of the whole organism should not be sacrificed to the demands of that one portion. Looking at the matter in this light, we feel our self-righteousness to be misplaced, and our ready interference to be an impertinence.

A patient suffering from neurasthenia was once lying ill at a small nursing home, undergoing massage. A visitor at the house inquired of its owner, a trained nurse, what ailed the lady.

“Oh, there’s nothing the matter with her,” replied the trained attendant glibly. “She is only a little odd.”

What a vista of ignorance was opened up by this remark! How could a patient who was ill enough to be subjected to the Weir Mitchell treatment have nothing the matter with her, unless indeed she had simply been condemned to imprisonment for the sake of the loaves and fishes she would thereby be forced to dispense?

Two nurses at a hospital were once puzzling over the case of a neurasthenic woman then under treatment there. They were perplexed, with reason, because the woman appeared to be in pain, although the harsh medical verdict was to the effect that she had no disease. They were nice, kindly women, and were sorry for the patient. So they found a middle course between the rival evidences by coming to the conclusion that, though there was nothing the matter with her, her pains were “real to her,” and they ought to treat her with gentleness. All I can say is, if I ever get ill, may I be nursed by those two women. There is something genuinely heroic about people who refuse to follow powerful superiors to do evil.

Nevertheless, though their resolution was right and praiseworthy, their conclusion was wrong. If we are unduly conscious of any part of our bodies, that part is not in a healthy state. Wherever there is pain, there is disintegration—disease, and because the medical advisers in this instance could not find the disease, it by no means followed that it was not there. “The fact is, we know very little about nerves,” said a medical man the other day. His candour merits our respect. To say that a patient can fancy pain is absurd. Pain is but a condition of the nerves. If it is not there, we cannot feel it. It is objected that, if we take a patient’s thoughts off her aches and pains, she ceases to feel them, consequently the pain must be imaginary. But if we cut a finger while in a state of excitement, we feel no pain. Not because the pain is there and we are unconscious of it, but that while nervous energy is diverted into another channel, there can be no pain. Read the account of the burning of the martyrs of Valenciennes at the time of the Spanish persecution in the Netherlands.[5] Those brave people were in a state of ecstasy in which pain was impossible. If there is one thing certain in past history, it is that they suffered absolutely nothing. The contemporary evidence on the subject is overwhelming.

But, as far as the neurasthenic are concerned, the practice of taking their attention off their pains has its dangers. The process is apt to be fatiguing, so that the patients only have more pain as soon as the distraction ceases. This fact is very exasperating to the more ignorant of their attendants. “She was well enough as long as she was thinking of something else,” the disappointed folks will tell you with an aggrieved air. One woman, possessing many good qualities, informed me that what such patients wanted was a “thrashing.” This nurse was a masseuse in the habit of “Weir Mitchelling” patients. Without supposing that her views ever took a practical form, their existence could hardly conduce to a kindly consideration for suffering invalids.

One very favourite notion about the nervous is, that they ought not to be sympathised with. If any one will try this treatment for a little while himself, even in health, he will find it necessary to fly pretty quickly to people possessing natural human feeling, in order to avoid drifting into permanent lunacy. In disease the danger is still greater. I have always found that when I sympathised cordially with real causes of distress, and simply disregarded unmistakably simulated ones, the simulated ones died a natural death without more ado.

But which symptoms are real and which are simulated? Here the tough or toughened organisation is usually hopelessly at sea. Here no information will enlighten, no rules will guide. If we are by nature incapable of making simple observations correctly, we had better give the whole thing up and go into another line of business. Even the so-called simulated symptoms are in a sense real symptoms of a morbid condition of brain; so, however good observers we may be, if we have not the wisdom and the patience to deal with these wisely and gently, we are still disqualified. “But nervous patients are so trying!” Why, of course they are. “Trying” is not the word. They are sometimes maddening. And nurses who are overworked, which they ought not to be, will be saints if they always contrive to keep their temper with them. We must remember, however, that lunatics and delirious people are trying also, and why should it be criminal to mismanage one kind of nervous disorder and not another?

I was once travelling in a railway carriage in France. The stuffiness of the place was poisonous, and I ventured to lower one of the windows a few inches. Instantly a French gentleman, seated opposite to me, well out of the draught, reared himself up and descended upon me with indignation and with a positive sense of injury. He could not stand the cold. Why had I opened the window? He must really be permitted to shut it.

An English gentleman explained that we wished for air. The Frenchman was amazed.

“It surely cannot hurt you,” he said, with violent gesticulation, “to have the windows shut. But I, when they are open, I suffer.”

It would have been impossible to convince him of the fact that I suffered when the window was shut as much as he did when it was open.

Some of our nurses are very like this French gentleman. Let the patient have a cold, and they are quite pleased for her to put her feet in mustard and water. Let her have a shattered nervous system, and nine out of ten of them feel injured if they are told to stop their chatter. I have known women who were in many respects capable nurses rendered useless, as far as nervous patients were concerned, by the erroneous notions with which they had been impregnated. One nurse told me seriously that the proper way to manage a nervous invalid was to make her afraid of you. She had had no personal experience in the matter, and the little prattling monkey was hardly likely to inspire much terror; but that was what she had been taught.

Doctors, too, sometimes indulge in whimsical ideas about these cases. A nurse, who had recently “Weir Mitchelled” a neurasthenic patient, told me that the lady, like many others suffering from disorder of the medulla, had a difficulty in swallowing, and could not take the pills that were ordered for her. I inquired what happened. She replied that the doctor, evidently impressed with the belief that the difficulty was all sham, insisted that she should get those pills down somehow. It was done. But the nurse informed me that, in the effort, the poor lady swallowed a whole bottle of water every day, and it was very bad for her.

A gentleman once asked me if I knew what Beau Brummell was then employed in doing in the other world. Much surprised at the question, I replied that I could not imagine.

“Eating raw onions with a steel knife,” he said solemnly. “By and bye, he will get to cabbage. For a long time he will be allowed no other food.”

On this principle, what will happen to that doctor who made a sick person swallow a whole bottle of water daily? But perhaps Beau Brummell is not suffering merely for having spoken contemptuously of the “creature” who ate cabbage, but for his indifference to the needs of others throughout his life. As to the doctor, let us hope he will be able to show a counterbalancing array of kind actions as a set-off against his misdemeanour, and so escape penance.

After all, it requires little skill to find fault. The thing is to do better. Unfortunately, it is just those medical men who have recognised nervous exhaustion and done their best to treat it who, in the nature of things, have made the most blunders and have been most blamed. This was inevitable. It is by failure that we learn. There is all the more need to draw attention to our failures and to point the moral. We have often tried hard to treat the person and not the disease; we have even tried to treat the disease and not the person. We must accustom ourselves to attacking the enemy on all sides at once. We must realise that not only the food that we eat and the air we breathe act upon the nervous system, but every impression conveyed to it through our senses. We may think it is of little consequence whether we say certain words to a patient or not. We think they will soon be forgotten, or the damage done by them be repaired. But no impression on anything in nature can be done away, not even the impression of the faintest particle of light. The whole universe throughout eternity is altered by our uttering one sentence or leaving it unsaid.

Supposing we put a photographic plate into the camera and expose it, then take it to the dark room and look at it. Can we see any change? None whatever. But immerse it in the developing solution, and the change it has undergone becomes apparent,—there is a picture on our plate. If we take it out into the light without first fixing it, the picture fades away. Is the plate therefore the same as it was before we took our picture? No, it is entirely different, and nothing in the world can ever restore the film on the plate precisely to its former condition.

In like manner outer impressions are every moment altering our nervous structure, and life’s clock cannot be put back.

CHAPTER V.
OBSERVATION.

WE must bear in mind the fact that all observation is difficult, not only because of our lack of perception, but because impressions already received project themselves, so to speak, on to the objects to be observed, and prevent our seeing these as they really are. Here lies the true interpretation of the “fixed idea,” and the “subjective” order of mind. The mind must not only be large enough and elastic enough to receive new impressions, but must also combine them with the old, so as to modify the former idea; for that which can only receive a new impression at the cost of casting out former and equally truthful impressions is deficient in retentiveness, and must always be wanting in thoroughness. We see examples of this order of mind in persons who eagerly take up one subject after another, but who permanently assimilate nothing. Mental growth is manifestly of little advantage to us if, while gaining on the one side, we are continually losing on the other. Again, if we cut ourselves off from outer impressions we lose mental power, for it is only by use of a part that nutriment can be attracted to it; and if our impressions are too exclusively of one particular order, our minds become ill-balanced.

Before we can be of special use as observers, therefore, education must have meant for us “the harmonious development of all the faculties.” We need to have our sense perceptions in good order that we may perceive quickly and accurately; we need the retentive power to enable us to store the impressions received; and we need the faculty of combining these impressions in our minds—the lower manifestation of which process we call imagination, and the higher, reasoning faculty.

Probably, in the cases where we generally attribute erroneous observations to excess of imagination, the fault really lies in the defective perceptive power. Either the nervous structure lacks sufficient sensitiveness to respond readily to the stimulus, or it lacks the strength to retain the impression. In these respects we commonly note improvement with the amelioration of the general health. It is a question, however, whether, if the stimulus were to make an adequate impression, the impression would not be more effectually retained. Be that as it may, we find persons who observe isolated facts readily enough, and who remember them well, but who learn little thereby, because they lack combining power. Isolated facts are facts to them and nothing more. The notion of law is a thing beyond them, and each fact has to be observed separately.

These are just the persons who are unfit to have the charge of nervous invalids, but for some mysterious reason they are just the persons into whose hands nervous invalids most often fall. Perhaps the explanation is, that ready combining power can exist only with a certain amount of sensitiveness of nervous structure, and that the sieves through which we pass our nurses may cast out those who would be of the greatest value in nervous illness, besides tending to lessen the sensitiveness of those that remain.[6] At all events, I have been disappointed to find that women from whom I hoped great things as nurses—women of good organisation, and certainly not of delicate constitution—have broken down completely in the course of their hospital training; whilst women whom I consider positively injurious to any kind of invalid have passed through it triumphantly. The question arises, Are we not unwise so to shape our sieves as to exclude the very people by whom we ourselves would most prefer to be tended in sickness? Will any mere knowledge atone for the loss of that keen intelligence which we recognise in persons of so-called sympathetic disposition?

On inquiring the reason why so many highly desirable persons have been cast out from the sieve of their hospital training, I have been told that the fact causes no concern to the authorities, so numerous are the women pressing in to take the place of the defeated strugglers for existence. If this is no answer to the inquiries, it is at least as good as most of the replies one gets when seeking for information on this unsatisfactory subject. Supposing it to be true, we may well ask further whether a too great narrowing of the spaces of the sieve in a particular direction, combined probably with an extreme elongation in another direction, does not tend to produce ill-shapen and one-sided nurses? I say tend, because the present system is still new, and though it may have immediate advantages, we should not blind ourselves to its possible disadvantages in the future. We need always to remember that a process of selection which ensures the survival of the toughest does not necessarily ensure the survival of the fittest. There is such a thing as evolving backwards, like the cave-fish who have lost their sight during their long residence in the dark. The best things in life are not machine-made.

But correct observation being such a complicated performance, we should be very indulgent to people who make mistakes; especially so if we have ever made a mistake ourselves. In our plentiful abuse of individuals, we merely display our inability to recognise the limitations and imperfections of “the thing called human nature.” We have reached a certain landing-place in our upward climb by means of paying attention to our sieves, but we have a long way still to go.

A few very simple experiments will suffice to show us how hard a thing it is to see even what lies right under our very noses. We may then perhaps realise how rash it is to form hasty opinions about the complicated and invisible nervous systems of our suffering fellow-creatures. Having got thus far, it may even dawn upon us that to make our fanciful and erroneous theories (fanciful because founded on insufficient knowledge, and erroneous because founded on the defective observations of others) the excuse for ill-treating other people’s nerves by showing a want of consideration for their sufferings, by tormenting them with painful and fantastic tricks, and by indulging our own tyranny and self-righteousness, is to manifest to the world an extremely primeval species of childishness.

I once drew a character called “Dr. Broadley,” who, excellent man though he was in some respects, put on a “stalk” when he came in contact with a nervous patient. Now, three different people thought they recognised Dr. Broadley, and informed me of the fact. They were all wrong. Not one of their three supposed models had sat to me for his portrait. I am forced, against my will, to the conclusion that there are in existence a superfluous number of persons who make the proximity of an invalid the excuse for displaying unnecessary airs. Surely it is not by such an influence, such an example, that the morals of our patients are to be improved.

I once put together two small prayer-books, so that the coloured edges of the leaves were divided only by the edge of the thin cover of each book. The leaves of one were of a bright golden colour; those of the other had been tinted a dull red. The books were momentarily held up for observation, with this interesting result. The leaves of the one book were seen correctly, so far, at least, as their colour was concerned; for they were unhesitatingly declared to be tinted with bright gold. The leaves of the other, however, were with equal readiness declared to be of a golden red colour.

It is easy to understand how this mistake arose. The golden colour was the first perceived, and the impression made by the dull red was not strong enough in comparison to be correctly seen and retained in a brief moment. The bright gold of the one book had so powerfully affected the retina that the colour was cast, so to speak, on to the leaves of the other book. These therefore appeared to be golden red in tint, instead of the dull red they were in reality.

On another occasion a small smooth cake was placed in a dish together with several large almond-cakes. When attention was attracted to it, it was mistaken for a cocoanut cake.

Here a rapid inspection had sufficed to show that one cake was smaller than the others. It had not sufficed to show the great difference in its construction. The large cakes had been first perceived, and their roughness was erroneously seen to be shared by the small cake.

Some people go through life with their minds so completely lined by a series of crystallised impressions, that no aftercomers have the smallest chance of even combining with them to produce a half-truth, to say nothing of overcoming them to a sufficient extent to drive out the errors and replace approximate truths by others still truer.

It may be objected that the above failures in perception of differences (a much more difficult thing than perception of similarities[7]) was occasioned solely by the speed with which the observations were made. I entertained a contrary belief, and my belief was confirmed by the following example of my own capacity for disgraceful blundering.

Shortly after the publication of “The Massage Case,” a friend asked me how I could have made such a mistake as to attribute to Elfie during her convalescence the strength to walk twenty miles in one day. I asked her to show me the passage wherein I had erred. She did so; and I read that Elfie really did walk twenty miles in the desert. I was amazed at my own stupidity, for, considering the length of time required for complete recovery from severe nervous exhaustion, it is evident that even the charm of Dr. Risedale’s society could not be expected to inspire her even temporarily with nerve-power for such a feat. I had looked steadily at the passage for a few seconds before the idea occurred to me that I might be seeing wrong. Then I scrutinised each word by the light of this suspicion, and having hit upon a correct theory, I found out the truth. It turned out that Elfie walked in the desert for twenty minutes, not miles. An erroneous impression had been conveyed to my brain through the ear; and by its disproportionate tenacity—disproportionate to my perceptive power at the moment—had prevented my receiving a new and truer impression through the eye.

I was overdone at the time, and took the warning; that is to say, I rested. But many of our doctors and nurses, whose observations are of the extremest importance, are supposed to do their work in a fatigued condition, and are considered fit objects of abuse if they do it badly. Why then do they overwork themselves? The answer to this question is that they are underpaid. The butcher and the baker must always receive the reward of their labours; the doctor and the nurse must often toil for nothing, though we are aware that, in order to obtain efficiency in any profession, it is essential that that profession should be well paid. The community may object that it cannot afford to pay more than it pays at present. Can it then afford to be kept ill or made ill by ignorant interference or by erroneous notions? It would surely be cheaper in the long-run to pay to get well or to learn how not to get ill.

To be dogmatic about that which is least known would appear to be an ineradicable characteristic of human nature in its present imperfect state. “Fools rush in where angels fear to tread” is still a true saying. In the treatment of nervous disease it is amply exemplified. Where we are most ignorant, there we are most uncompromising in our dealings. When we understood absolutely nothing of insanity, seeing little connection between madness and disease, we resorted to the whip and the chain. On waking to some conception of nervous disorder, we perceive similarities more readily than differences, and proceed to lump together all diseases of the nerves in the earlier stages under the name of “hysteria.” Having already some vague foolish fixed idea in our heads about “hysteria” being synonymous with idleness and general depravity, we drag our patients about, beat them with wet towels, give them frightful shocks, galvanic or otherwise, and then get rid of them as quickly as possible, so as not to have the burden of remote consequences.

But when more serious mischief is set up, what then? Why, then comes tardily a perception of differences, and we divide nervous disorders into hard and fast diseases, concluding that all had been different from the very first. The later perception of underlying similarity has as yet scarcely dawned. Some of these maladies are considered curable; others, without rhyme or reason, are considered incurable.

With regard to the curability of nervous disease, let us consider what happens when we travel by train from Eastbourne to London, and again from Eastbourne to Brighton. In each case we pass through Willingdon and Polegate, and stop at Lewes. We can get out at Lewes or at either of the previous stations and return to Eastbourne, but if we proceed as far as Lewes, our return journey will be longer than if we had got out at Polegate. In the same way nervous disease is more quickly cured in the early stages than in the later stages. Now, suppose that we are in a train which does not stop between Lewes and London. It is evident in this case that, if we have missed our chance of alighting at Lewes, we must go on to the final goal; no return being possible. Thus, there is a point in certain nervous diseases beyond which recovery is impossible. On the other hand, in travelling from Eastbourne to Brighton, we have several chances of retracing our steps even after leaving Lewes, where the ways diverge; and so we find that, in some cases of nervous disease, incurability is reached sooner than in others. And just as we must be content to take longer to return from Lewes than from Polegate, so we must be content with a slow cure in advanced nervous disorders, and remember that, in administering nerve-tonics, the weaker the patient, the weaker should be the dose; all attempts to hurry the cure being fatal to success. Moreover, just as, in journeying from Eastbourne to London, and from Eastbourne to Brighton, we travel along the same road as far as Lewes, so all nervous diseases have a common origin in nerve-deterioration which may be repaired.

Defective powers of observation bring with them this great evil,—we not only fail to reduce a terrible malady to a minimum, but we mete out unjust censure to those who seem to be responsible for the failure. Whereas the really responsible party is the community at large—in short, ourselves. We blame the doctor; but doctors are after all a small minority, and the minority can only expand and take shape in the direction in which the least pressure is put upon it by the majority. The grotesque modes of treatment resorted to in past times evidently gave satisfaction to all but the enlightened few, just as bad Governments have been tolerated in the countries fitted only to be governed badly.

But to be dissatisfied, to mete out blame, to expect a cure, are healthier symptoms than a passive acceptance of the evil and a lazy belief in incurability.

Medical science is unlimited. The law of our universe is progress.