Title: Health Through Will Power
Author: Walsh, James J. (James Joseph), 1865-1942
Language: English
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[End Transcriber's Notes]


HEALTH THROUGH WILL POWER


BY

JAMES J. WALSH, M.D., Ph.D., Sc.D., Etc.

MEDICAL DIRECTOR OF FORDHAM UNIVERSITY SCHOOL OF SOCIOLOGY;
PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY
AT CATHEDRAL COLLEGE; LECTURER ON PSYCHOLOGY,
MARYWOOD COLLEGE, ETC.



  BOSTON

  LITTLE, BROWN, AND COMPANY

  1919



  _Copyright, 1919,_

  By Little, Brown, and Company.



  _All rights reserve_

  Published, November, 1919



  _Norwood Press_

  Set up and electrotyped by J. S. Cushing Co.,

  Norwood, Mass., U.S.A.



_To_
J. H. W.

EX ANIMO ET CORDE

J. J. W.


{vii}


PREFACE

A French surgeon to whom the remark was made in the third year of the
War that France was losing an immense number of men replied: "Yes, we
are losing enormously, but for every man that we lose we are making
two men." What he meant, of course, was that the War was bringing out
the latent powers of men to such an extent that every one of those who
were left now counted for two. The expression is much more than a mere
figure of speech. It is quite literally true that a man who has had
the profound experience of a war like this becomes capable of doing
ever so much more than he could before. He has discovered his own
power. He has tapped layers of energy that he did not know he
possessed. Above all, he has learned that his will is capable of
enabling him to do things that he would have hesitated about and
probably thought quite impossible before this revelation of himself to
himself had been made.

{viii}

In a word, the War has proved a revival of appreciation of the place
of the human will in life. Marshal Foch, the greatest character of the
War, did not hesitate even to declare that "A battle is the struggle
of two wills. It is never lost until defeat is accepted. They only are
vanquished who confess themselves to be."

Our generation has been intent on the development of the intellect. We
have been neglecting the will. "Shell shock" experiences have shown us
that the intellect is largely the source of unfavorable suggestion.
The will is the controlling factor in the disease. Many another
demonstration of the power of will has been furnished by the War. This
volume is meant to help in the restoration of the will to its place as
the supreme faculty in life, above all the one on whose exercise, more
than any other single factor, depends health and recovery from
disease. The time seems opportune for its appearance and it is
commended to the attention of those who have recognized how much the
modern cult of intellect left man unprepared for the ruder trails of
life yet could not see clearly what the remedy might be.

{ix}

CONTENTS


                                                 PAGE

     Preface                                     vii

CHAPTER

I    The Will in Life                            1

II   Dreads                                     19

III  Habits                                     42

IV   Sympathy                                   57

V    Self-Pity                                  69

VI   Avoidance of Conscious Use of the Will     80

VII  What the Will Can Do                      102

VIII Pain and the Will                         112

IX   The Will and Air and Exercise             133

X    The Will to Eat                           148

XI   The Place of the Will in Tuberculosis     167

XII  The Will in Pneumonia                     187

XIII Coughs and Colds                          196

XIV  Neurotic Asthma and the Will              207

XV   The Will in Intestinal Function           215

XVI  The Will and the Heart                    227

XVII The Will in So-Called Chronic Rheumatism  240

XVII Psycho-Neuroses                           258

XIX  Feminine Ills and the Will                270

     Index                                     285


{1}


HEALTH THROUGH WILL POWER



CHAPTER I

THE WILL IN LIFE


  "What he will he does and does so much
   That proof is called impossibility."

                      _Troilus and Cressida._


The place of the will in its influence upon health and vitality has
long been recognized, not only by psychologists and those who pay
special attention to problems of mental healing, but also, as a rule,
by physicians and even by the general public. It is, for instance, a
well-established practice, when two older folk, near relatives, are
ill at the same time, or even when two younger persons are injured
together and one of them dies, or perhaps has a serious turn for the
worse, carefully to keep all knowledge of it from the other one. The
reason is a very definite conviction that in the revulsion of feeling
caused by learning of the fatality, or as {2} a result of the
solicitude consequent upon hearing that there has been a turn for the
worse, the other patient's chances for recovery would probably be
seriously impaired. The will to get better, even to live on, is
weakened, with grave consequences. This is no mere popular impression
due to an exaggeration of sympathetic feeling for the patient. It has
been noted over and over again, so often that it evidently represents
some rule of life, that whenever by inadvertence the serious condition
or death of the other was made known, there was an immediate
unfavorable development in the case which sometimes ended fatally,
though all had been going well up to that time. This was due not
merely to the shock, but largely to the "giving up", as it is called,
which left the surviving patient without that stimulus from the will
to get well which means so much.

It is surprising to what an extent the will may affect the body, even
under circumstances where it would seem impossible that physical
factors could any longer have any serious influence. We often hear it
said that certain people are "living on their wills", and when they
are of the kind who take comparatively little food and yet succeed in
accomplishing {3} a great deal of work, the truth of the expression
comes home to us rather strikingly. The expression is usually
considered, however, to be scarcely more than a formula of words
elaborated in order to explain certain of these exceptional cases that
seem to need some special explanation. The possibility of the human
will of itself actually prolonging existence beyond the time when,
according to all reason founded on physical grounds, life should end,
would seem to most people to be quite out of the question. And yet
there are a number of striking cases on record in which the only
explanation of the continuance of life would seem to be that the will
to live has been so strongly aroused that life was prolonged beyond
even expert expectation. That the will was the survival factor in the
case is clear from the fact that as soon as this active willing
process ceased, because the reason that had aroused it no longer
existed, the individuals in question proceeded to reach the end of
life rapidly from the physical factors already at work and which
seemed to portend inevitably an earlier dissolution than that which
happened. Probably a great many physicians know of striking examples
of patients who have lived beyond the time when ordinarily death would
{4} be expected, because they were awaiting the arrival of a friend
from a distance who was known to be coming and whom the patient wanted
very much to see. Dying mothers have lived on to get a last embrace of
a son or daughter, and wives have survived to see their husbands for a
last parting--though it seemed impossible that they should do so, so
far as their physical condition was concerned--and then expired
within a short time. Of course there are any number of examples in
which this has not been true, but then that is only a proof of the
fact that the great majority of mankind do not use their wills, or
perhaps, having appealed to them for help during life never or but
slightly, are not prepared to make a definite serious call on them
toward the end. I am quite sure, however, that a great many country
physicians particularly can tell stories of incidents that to them
were proofs that the will can resist even the approach of death for
some time, though just as soon as the patients give up, death comes to
them.

Professor Stokes, the great Irish clinician of the nineteenth century,
to whom we owe so much of our knowledge of the diseases of the heart
and lungs, and whose name is enshrined in terms commonly used in
medicine in {5} connection with these diseases, has told a striking
story of his experiences in a Dublin hospital that illustrates this
very well. An old Irishman, who had been a soldier in his younger
years and had been wounded many times, was in the hospital ill and
manifestly dying. Professor Stokes, after a careful investigation of
his condition, declared that he could not live a week, though at the
end of that time the old soldier was still hanging on to life, ever
visibly sinking. Stokes assured the students who were making the
rounds of his wards with him that the old man had at most a day or two
more to live, and yet at the end of some days he was still there to
greet them on their morning visits. After the way of medical students
the world over, though without any of that hard-heartedness that would
be supposed ordinarily to go with such a procedure, for they were
interested in the case as a medical problem, the students began to bet
how long the old man would live.

Finally, one day the old man said to Stokes in his broadest brogue:
"Docther, you must keep me alive until the first of the month, because
me pension for the quarther is then due, and unless the folks have it,
shure they won't have anything to bury me with."

{6}

The first of the month was some ten days away. Stokes said to his
students, though of course not in the hearing of the patient, that
there was not a chance in the world, considering the old soldier's
physical condition, that he would live until the first of the month.
Every morning, in spite of this, when they came in, the old man was
still alive and there was even no sign of the curtains being drawn
around his bed as if the end were approaching. Finally on the morning
of the first of the month, when Stokes came in, the old pensioner said
to him feebly, "Docther, the papers are there. Sign them! Then they'll
get the pension. I am glad you kept me alive, for now they'll surely
have the money to bury me." And then the old man, having seen the
signature affixed, composed himself for death and was dead in the
course of a few hours. He had kept himself alive on his will because
he had a purpose in it, and once that purpose was fulfilled, death was
welcome and it came without any further delay.

There is a story which comes to us from one of the French prisons
about the middle of the nineteenth century which illustrates forcibly
the same power of the will to maintain life after it seemed sure,
beyond peradventure, {7} that death must come. It was the custom to
bury in quicklime in the prison yard the bodies of all the prisoners
who died while in custody. The custom still survives, or did but
twenty years ago, even in English prisons, for those who were
executed, as readers of Oscar Wilde's "Ballad of Reading Gaol" will
recall. Irish prisons still keep up the barbarism, and one of the
reasons for the bitterness of the Irish after the insurrection of 1916
in Dublin was the burial of the executed in quicklime in the prison
yard. The Celtic mind particularly revolts at the idea, and it
happened that one of the prisoners in a certain French prison, a
Breton, a Celt of the Celts, was deeply affected by the thought that
something like this might happen to him. He was suffering from
tuberculosis at a time when very little attention was paid to such
ailments in prisoners, for the sooner the end came, the less bother
there was with them; but he was horrified at the thought that if he
died in prison his body would disappear in the merciless fire of the
quicklime.

So far as the prison physician could foresee, the course of his
disease would inevitably reach its fatal termination long before the
end of his sentence. In spite of its advance. {8} however, the
prisoner himself declared that he would never permit himself to die in
prison and have his body face such a fate. His declaration was
dismissed by the physician with a shrug and the feeling that after all
it would not make very much difference to the man, since he would not
be there to see or feel it. When, however, he continued to live,
manifestly in the last throes of consumption, for weeks and even
months after death seemed inevitable, some attention was paid to his
declaration in the matter and the doctors began to give special
attention to his case. He lived for many months after the time when,
according to all ordinary medical knowledge, it would seem he must
surely have died. He actually outlived the end of his sentence, had
arrangements made to move him to a house just beyond the prison gate
as soon as his sentence had expired, and according to the story, was
dead within twenty-four hours after the time he got out of prison and
thus assured his Breton soul of the fact that his body would be given,
like that of any Christian, to the bosom of mother earth.

But there are other and even more important phases of the prolongation
of life by the will that still better illustrates its power. {9} It
has often been noted that men who have had extremely busy lives,
working long hours every day, often sleeping only a few hours at
night, turning from one thing to another and accomplishing so much
that it seemed almost impossible that one man could do all they did,
have lived very long lives. Men like Alexander Humboldt, for instance,
distinguished in science in his younger life, a traveler for many
years in that hell-hole of the tropics, the region around Panama and
Central America, a great writer whose books deeply influenced his
generation in middle age. Prime Minister of Prussia as an older man,
lived to be past ninety, though he once confessed that in his forties
he often slept but two or three hours a night and sometimes took even
that little rest on a sofa instead of a bed. Leo XIII at the end of
the nineteenth century was just such another man. Frail of body,
elected Pope at sixty-four, it was thought that there would soon be
occasion for another election; he did an immense amount of work,
assumed successfully the heaviest responsibilities, and outlived the
years of Peter in the Papal chair, breaking all the prophecies in that
regard and not dying till he was ninety-three.

Many other examples might be cited. {10} Gladstone, always at work,
probably the greatest statesman of the nineteenth century in the
better sense of that word, was a scholar almost without a peer in the
breadth of his scholarly attainments, a most interesting writer on
multitudinous topics, keen of interest for everything human and always
active, and yet he lived well on into the eighties. Bismarck and Von
Moltke, who assumed heavier responsibilities than almost any other men
of the nineteenth century, saw their fourscore years pass over them a
good while before the end came. Bismarck remarked on his eighty-first
birthday that he used to think all the good things of life were
confined to the first eighty years of life, but now he knew that there
were a great many good things reserved for the second eighty years. I
shall never forget sitting beside Thomas Dunn English, the American
poet, at a banquet of the Alumni of the University of Pennsylvania,
when he repeated this expression for us; at the time he himself was
well past eighty. He too had been a busy man and yet rejoiced to be
with the younger alumni at the dinner.

My dear old teacher, Virchow, of whom they said when he died that four
men died, for he was distinguished not only as a pathologist, {11}
which was the great life-work for which he was known, but as an
anthropologist, a historian of medicine and a sanitarian, was at
seventy-five actively accomplishing the work of two or three men. He
died at eighty-one, as the result of a trolley injury, or I could
easily imagine him alive even yet. Von Ranke, the great historian of
the popes, began a universal history at the age of ninety which was
planned to be complete in twelve volumes, one volume a year to be
issued. I believe that he lived to finish half a dozen of them. I have
some dear friends among the medical profession in America who are in
their eighties and nineties, and all of them were extremely busy men
in their middle years and always lived intensely active lives. Stephen
Smith and Thomas Addis Emmet, John W. Gouley, William Hanna Thompson,
not long dead, and S. Weir Mitchell, who lived to be past eighty-five,
are typical examples of extremely busy men, yet of extremely long
lives.

All of these men had the will power to keep themselves busily at work,
and their exercise of that will power, far from wearing them out,
actually seemed to enable them to tap reservoirs of energy that might
have remained {12} latent in them. The very intensiveness of their
will to do seemed to exert an extensive influence over their lives,
and so they not only accomplished more but actually lived longer. Hard
work, far from exhausting, has just the opposite effect. We often hear
of hard work killing people, but as a physician I have carefully
looked into a number of these cases and have never found one which
satisfied me as representing exhaustion due to hard work. Insidious
kidney disease, rheumatic heart disease, the infections of which
pneumonia is a typical example, all these have been the causes of
death and not hard work, and they may come to any of us. They are just
as much accidents as any other of the mischances of life, for it is as
dangerous to be run into by a microbe as by a trolley car. Using the
will in life to do all the work possible only gives life and gives it
more abundantly, and people may rust out, that is be hurt by rest,
much sooner than they will wear out.

Here, then, is a wellspring of vitality that checks for a time at
least even lethal changes in the body and undoubtedly is one of the
most important factors for the prolongation of life. It represents the
greatest force for health and power of accomplishment that we have.
{13} Unfortunately, in recent years, it has been neglected to a great
extent for a number of reasons. One of these has been the discussions
as to the freedom of the will and the very common teaching of
determinism which seemed to eliminate the will as an independent
faculty in life. While this affected only the educated classes who had
received the higher education, their example undoubtedly was pervasive
and influenced a great many other people. Besides, newspaper and
magazine writers emphasized for popular dissemination the ideas as to
absence of the freedom of the will which created at least an
unfortunate attitude of mind as regards the use of the will at its
best and tended to produce the feeling that we are the creatures of
circumstances rather than the makers of our destiny in any way, or
above all, the rulers of ourselves, including even to a great extent
our bodily energies.

Even more significant than this intellectual factor, in sapping will
power has been the comfortable living of the modern time with its
tendency to eliminate from life everything that required any exercise
of the will. The progress which our generation is so prone to boast of
concerns mainly this making of people {14} more comfortable than they
were before. The luxuries of life of a few centuries ago have now
become practically the necessities of life of to-day. We are not asked
to stand cold to any extent, we do not have to tire ourselves walking,
and bodily labor is reserved for a certain number of people whom we
apparently think of as scarcely counting in the scheme of humanity.
Making ourselves comfortable has included particularly the removal of
nearly all necessity for special exertion, and therefore of any
serious exercise of the will. We have saved ourselves the necessity
for expending energy, apparently with the idea that thus it would
accumulate and be available for higher and better purposes.

The curious thing with regard to animal energy, however, is that it
does not accumulate in the body beyond a certain limited extent, and
all energy that is manufactured beyond that seems to have a definite
tendency to dissipate itself throughout the body, producing discomfort
of various kinds instead of doing useful work. The process is very
like what is called short-circuiting in electrical machinery, and this
enables us to understand how much harm may be done. Making ourselves
comfortable, therefore, may in the {15} end have just exactly the
opposite effect, and often does. This is not noted at first, and may
escape notice entirely unless there is an analysis of the mode of life
which is directed particularly to finding out the amount of exertion
of will and energy that there is in the daily round of existence.

The will, like so many other faculties of the human organism, grows in
power not by resting but by use and exercise. There have been very few
calls for serious exercise of the will left in modern life and so it
is no wonder that it has dwindled in power. As a consequence, a good
deal of the significance of the will in life has been lost sight of.
This is unfortunate, for the will can enable us to tap sources of
energy that might otherwise remain concealed from us. Professor
William James particularly called attention to the fact, in his
well-known essay on "The Energies of Men", that very few people live
up to their _maximum_ of accomplishment or their _optimum_ of conduct,
and that indeed "_as a rule men habitually use only a small part of
the powers which they actually possess and which they might use under
appropriate conditions._"

It is with the idea of pointing out how much the will can accomplish
in changing things for {16} the better that this volume is written.
Professor James quoted with approval Prince Pueckler-Muskau's
expression, "I find something very satisfactory in the thought that
man has the power of framing such props and weapons out of the most
trivial materials, indeed out of nothing, merely by the force of his
will, which thereby truly deserves the name of omnipotent."
[Footnote 1]

  [Footnote 1: "Tour in England, Ireland and France."]

It is this power, thus daringly called omnipotent, that men have not
been using to the best advantage to maintain health and even to help
in the cure of disease, which needs to be recalled emphatically to
attention. The war has shown us in the persons of our young soldiers
that the human will has not lost a single bit of its pristine power to
enable men to accomplish what might almost have seemed impossible. One
of the heritages from the war should be the continuance of that fine
use of the will which military discipline and war's demands so well
brought into play. Men can do and stand ever so much more than they
realize, and in the very doing and standing find a satisfaction that
surpasses all the softer pleasant feelings that come from mere comfort
and lack of necessity for physical and {17} psychical exertion. Their
exercise of tolerance and their strenuous exertion, instead of
exhausting, only makes them more capable and adds to instead of
detracting from their powers.

How much this discipline and training of the will meant for our young
American soldiers, some of whom were raised in the lap of luxury and
almost without the necessity of ever having had to do or stand hard
things previously in their lives, is very well illustrated by a letter
quoted by Miss Agnes Repplier in the _Century_ for December. It is by
no means unique or even exceptional. There were literally thousands of
such letters written by young officers similarly circumstanced, and it
is only because it is typical and characteristic of the spirit of all
of these young men that I quote it here. Miss Repplier says that it
came from "a young American lieutenant for whom the world had been
from infancy a perilously pleasant place." He wrote home in the early
spring of 1918:

"It has rained and rained and rained. I am as much at home in a mud
puddle as any frog in France, and I have clean forgotten what a dry
bed is like. But I am as fit as a fiddle and as hard as nails. I can
eat scrap iron and sleep standing. Aren't there things {18} called
umbrellas, which you pampered civilians carry about in showers?" If we
can secure the continuance of this will exertion, life will be ever so
much heartier and healthier and happier than it was before, so that
the war shall have its compensations.


{19}

CHAPTER II

DREADS

  "O, know he is the bridle of your will.
  There's none but asses will be bridled so."
                         _A Comedy of Errors._


It must be a surprise to most people, after the demonstration of the
power of the will in the preceding chapter, that so many fail to make
use of it. Indeed, the majority of mankind are quite unable to realize
the store of energy for their health and strength and well-being which
is thus readily available, though so often unused or called upon but
feebly. The reason why the will is not used more is comparatively easy
to understand, however, once its activity in ordinary conditions of
humanity is analyzed a little more carefully. The will is
unfortunately seldom permitted to act freely. Brakes are put on its
energies by mental states of doubt and hesitation, by contrary
suggestion, and above all by the dreads which humanity has allowed to
fasten {20} themselves on us until now a great many activities are
hampered. There is the feeling that many things cannot be done, or may
be accomplished only at the cost of so much effort and even hardship
that it would be hopeless for any but those who are gifted with
extremely strong wills to attempt them. People grow afraid to commit
themselves to any purpose lest they should not be able to carry it
out. Many feel that they would never be able to stand what others have
stood without flinching and are persuaded that if ever they were
placed in the position where they had to withstand some of the trials
that they have heard of they would inevitably break down under the
strain.

Just as soon as a human being loses confidence that he or she may be
able to accomplish a certain thing, that of itself is enough to make
the will ever so much less active than it would otherwise be. It is
like breaking a piece of strong string: those who know how wrap it
around their fingers, then jerk confidently and the string is broken.
Those who fear that they may not be able to break it hesitate lest
they should hurt themselves and give a half-hearted twitch which does
not break the string; the only thing they succeed {21} in doing is in
hurting themselves ever so much more than does the person who really
breaks it. After that abortive effort, they feel that they must be
different from the others whose fingers were strong enough to break
the string, and they hesitate about it and will probably refuse to
make the attempt again.

It is a very old story,--this of dreads hampering the activities of
mankind with lack of confidence, and the fear of failure keeping
people from doing things. One of his disciples, according to a very
old tradition, once asked St. Anthony the Hermit what had been the
hardest obstacle that he found on the road to sanctity. The story has
all the more meaning for us here if we recall that health and holiness
are in etymology the same. St. Anthony, whose temptations have made
him famous, was over a hundred at the time and had spent some seventy
years in the desert, almost always alone, and probably knew as much
about the inner workings of human nature from the opportunities for
introspection which he had thus enjoyed as any human being who ever
lived. His young disciple, like all young disciples, wanted a short
cut on the pathway that they were both traveling. The old man said to
him, "Well, {22} I am an old man and I have had many troubles, but
most of them never happened."

Many a nightmare of doubt and hesitation disappears at once if the
dread of it is overcome. The troubles that never happen, if dwelt
upon, paralyze the will until health and holiness become extremely
difficult of attainment.

There is the secret of the failure of a great many people in life in a
great many ways. They fear the worst, dread failure, dampen their own
confidence, and therefore fritter away their own energy. Anything that
will enable them to get rid of the dreads of life will add greatly to
their power to accomplish things inside as well as outside their
bodies. Well begun is half done, and tackling a thing confidently
means almost surely that it will be accomplished. If the dread of
failure, the dread of possible pain in its performance, the dread of
what may happen as a result of activity,--if all these or any of them
are allowed to obtrude themselves, then energy is greatly lessened,
the power to do things hampered and success becomes almost impossible.
This is as true in matters of health and strength as it is with regard
to various external accomplishments. It takes a great {23} deal of
experience for mankind to learn the lesson that their dreads are often
without reality, and some men never learn it.

Usually when the word dreads is used, it is meant to signify a series
of psychic or psychoneurotic conditions from which sensitive, nervous
people suffer a great deal. There is, for instance, the dread of dirt
called learnedly misophobia, that exaggerated fear that dirt may cling
to the hands and prove in some way deleterious which sends its victims
to wash their hands from twenty to forty times a day. Not infrequently
they wash the skin pretty well off or at least produce annoying skin
irritation as the result of their feeling. There are many other dreads
of this kind. Some of them seem ever so much more absurd even than
this dread of dirt. Most of us have a dread of heights, that is, we
cannot stand on the edge of a height and look down without trembling
and having such uncomfortable feelings that it is impossible for us to
stay there any length of time. Some people also are unable to sit in
the front row of the balcony of a theater or even to kneel in the
front row of a gallery at church without having the same dread of
heights that comes to others at the edge of a high precipice. I have
among my {24} patients some clergymen who find it extremely difficult
to stand up on a high altar, though, almost needless to say, the whole
height is at most five or six ordinary steps.

Then there are people who have an exaggerated dread of the dark, so
that it is quite impossible for them to sleep without a light or to
sleep alone. Sometimes such a dread is the result of some terrifying
incident, as the case in my notes in which the treasurer of a
university developed an intense dread of the dark which made sleep
impossible without a light, after he had been shot at by a burglar who
came into his room and who answered his demand, "Who is that?" by a
bullet which passed through the head of the bed. Most of the
skotophobists, the technical name for dark-dreaders, have no such
excuse as this one. Victims of nervous dreads have as a rule developed
their dread by permitting some natural feeling of minor importance to
grow to such an extent that it makes them very miserable.

Some cannot abide a shut-in place. Philip Gilbert Hamerton, the
English writer and painter, often found a railroad compartment in the
English cars an impossible situation and had to break his journey in
order to get over {25} the growing feeling of claustrophobia, the
dread of shut-in places, which would steal over him.

There are any number of these dreads and, almost needless to say, all
of them may interfere with health and the pursuit of happiness. I have
seen men and women thrown into a severe nervous state with chilly
feelings and cold sweat as the result of trying to overcome one of
these dreads. They make it impossible for their victims to do a great
many things that other people do readily, and sadly hamper their
wills. There is only one way to overcome these dreads, and that is by
a series of acts in the contrary direction until a habit of
self-control with regard to these haunting ideas is secured. All
mankind, almost without exception, has a dread of heights, and yet
many thousands of men have in recent years learned to work on high
buildings without very much inconvenience from the dread. The wages
are good, they _want_ to work this way, and the result is they take
themselves in hand and gradually acquire self-control. I have had many
of them tell me that at first they were sure they would never be able
to do it, but the gradual ascent of the building as the work proceeded
accustomed them to height, {26} and after a while it became almost as
natural to work high up in the air as on the first or second story of
a building or even on the level ground.

The overcoming of these dreads is not easy unless some good reason
releases the will and sets it to exerting its full power. When this is
the case, however, the dread is overcome and the brake lifted after
some persistence, with absolute assurance. Men who became brave
soldiers have been known to have had a great dread of blood in early
life. Some of our best surgeons have had to leave the first operation
that they ever saw or they would have fainted, and yet after repeated
effort they have succeeded in overcoming this sensitiveness. As a
matter of fact, most people suffer so much from dreads because they
yielded to a minor dread and allowed a bad habit to be formed. It is a
question of breaking a bad habit by contrary acts rather than of
overcoming a natural disposition. Many of those who are victims have
the feeling that they cannot be expected to conquer nature this way.
As a result, they are so discouraged at the very idea that success is
dubious and practically impossible from their very attitude of mind;
but it is only the {27} second nature of a habit that they have to
overcome, and this is quite another matter, for exactly contrary acts
to these which formed a habit will break it.

Some of these dreads seem to be purely physical in origin or character
yet prove to be merely or to a great degree only psychic states.
Insomnia itself is more a dread than anything else. In writing for the
International Clinics some years ago (Volume IV, Series XXVI) I dwelt
on the fact that insomnia as a dread was probably responsible for more
discomfort and complaints from mankind than almost anything else.
Insomniaphobia is just such a dread as agoraphobia, the dread of open
spaces; or akrophobia, the dread of heights; or skotophobia, the dread
of the dark, and other phobias which afflict mankind. It is perfectly
possible in most cases to cure such phobias by direct training against
them, and this can be done also with regard to insomnia.

Some people, particularly those who have not been out much during the
day and who have suffered from wakefulness a few times, get it on
their mind that if this state keeps up they will surely lose their
reason or their bodily health, and they begin to worry about {28} it.
They commence wondering about five in the afternoon whether they are
going to be awake that night or not. It becomes a haunt, and no matter
what they do during the evening every now and then the thought recurs
that they will not sleep. By the time they actually lie down they have
become so thoroughly occupied with that thought that it serves to keep
them awake. Some of them avoid the solicitude before they actually get
to bed, but begin to worry after that, and if after ten minutes they
are not asleep, above all if they hear a clock strike somewhere, they
are sure they are going to be awake, they worry about it, get
themselves thoroughly aroused, and then they will not go to sleep for
hours. It is quite useless to give such people drugs, just as useless
as to attempt to give a man a drug to overcome the dread of heights or
the dread of the dark or of a narrow street through which he has to
pass. They must use their wills to help them out of a condition in
which their dreads have placed them.

Apart from these neurotic dreads, quite unreasoning as most of them
are, there are a series of what may be called intellectual dreads.
These are due to false notions that have come to be accepted and that
serve to {29} keep people from doing things that they ought to do for
the sake of their health, or set them performing acts that are
injurious instead of beneficial. The dread of loss of sleep has often
caused people to take somnifacients which eventually proved ever so
much more harmful than would the loss of sleep they were meant to
overcome. Many a person dreading a cold has taken enough quinine and
whisky to make him more miserable the next day than the cold would
have, had it actually made its appearance, as it often does not. The
quinine and whisky did not prevent it, but the expectation was founded
on false premises. There are a great many other floating ideas that
prove the source of disturbing dreads for many people. A discussion of
a few typical examples will show how much health may be broken by the
dreads associated with various ills, for they often interfere with
normal, healthy living.

"A little knowledge is a dangerous thing" applies particularly in this
matter. There are many morbid fears that disturb mankind and keep us
from accomplishing what might otherwise be comparatively easy. A great
many people become convinced that they have some diseased condition,
or morbid elements at least, {30} in them which make it impossible for
them to do as much as other people. Sometimes this morbid persuasion
takes the form of hypochrondia and the individuals feel that they have
a constitution that unfits them for prolonged and strenuous effort of
any kind, so they avoid it. The number of valetudinarians, that is of
those who live their lives mainly engaged in caring for their health,
though their physicians have never been able to find anything
organically wrong with them, is much larger than might be imagined.
This state of mind has been with us for many centuries, for the word
which describes it, hypochondria, came to us originally from Greece
and is an attempt to localize the affection in connection with its
principal symptom, which is usually one of discomfort in the stomach
region or to one side or the other of it, that is, in the hypochondria
or beneath the ribs.

Such a state of mind, in which the patient is constantly complaining
of one symptom or another, quite paralyzes the will. The individual
may be able to do some routine work but he will not be able to have
any initiative or energy for special developments of his occupation,
and of course, when any real affection occurs, he will feel that he is
quite {31} unable to bear this additional burden of disease.
Hypochondriacs, however, sometimes fairly enjoy their ill health and
therefore have been known not infrequently to live on to a good, round
old age, ever complaining more and more. It is their dread of disease
that keeps them from getting better and prevents their wills from
throwing off whatever symptoms there are and becoming perfectly well.
Until something comes along and rouses their wills, there is no hope
of affecting them favorably, and it is surprising how long the state
may continue without any one ever having found any organic affection
to justify all the discomforts of which they complain. Quite
literally, they are suffering from complaints and not from disease in
the ordinary sense of the word.

Sometimes these dreads of disease are dependent on some word which has
taken on an exaggerated significance in people's minds. A word that in
recent years has been the source of a great deal of unfavorable
suggestion is "catarrh", and a mistaken notion of its meaning has been
productive of a serious hampering of their will to be well in a number
of persons. In itself, both according to its derivation and its
accepted scientific {32} significance, the word means only that first
stage of inflammatory irritation of mucous membranes which causes
secretion to flow more freely than normally. _Catarrhein_ in Greek
means only to flow down.   [Footnote 2]

  [Footnote 2:  The word has, by the way, the same meaning as
  rheumatism, which is also from the Greek verb, to flow, though its
  application is usually limited to the serous membranes of the joints
  or the serous surfaces of the intermuscular planes. By derivation,
  catarrh is the same word also as gout, which comes from _gutta_ in
  Latin, meaning a drop and implying secretory disturbances. These
  three words--catarrh, rheumatism, gout--have been applied to all
  sorts of affections and are so general in meaning as to be quite
  hard to define exactly. They have for this very reason, their
  vagueness, become a prolific source of unfortunate suggestion and of
  all kinds of dreads that disturb health.]

By abuse, however, the word _catarrh_ has come to mean in the minds of
a great many people in our time a very serious inflammation of the
mucous membranes, almost inevitably progressive and very often
resulting in fetid diseased conditions of internal or external mucous
membranes, very unpleasant for the patient and his friends and the
source of serious complications and _sequelae_. This idea has been
fostered sedulously by the advertisers of proprietary remedies and the
ingenious exploiters of various modes of treatment. As a result, a
great many people who for one reason or another--usually because of
some slight increase of secretion in the nose and {33} throat--become
convinced they have catarrh begin to feel that they cannot be expected
to have as much resistive vitality as others, since they are the
subjects of this serious progressive disease. As a matter of fact,
very few people in America, especially those living in the northern or
eastern States, are without some tendency to mild chronic catarrh. The
violent changes of temperature and the damp, dark days predispose to
it; but it produces very few symptoms except in certain particularly
sensitive individuals whose minds become centered on slight
discomforts in the throat and nose and who feel that they must
represent some serious and probably progressive condition.

As a matter of fact, catarrh has almost nothing of the significance
attributed to it so often in magazine and newspaper advertisements.
Simple catarrh decreases without producing any serious result, and
indeed it is an index of a purely catarrhal condition that there is a
complete return to normal. Sometimes microbes are associated with its
causation, but when this is so, they are bacteria of mild pathological
virulence that do not produce deep changes. As for catarrh developing
fetid, foul-smelling discharges or odors, that {34} is out of the
question. There are certain affections, notably diphtheria, that may
produce such serious changes in the mucous membranes that there will
always even long after complete recovery be an unpleasant odorous
condition, but it is probable that even in these cases there exists a
special form of microbe quite rare in occurrence which produces the
state known as _ozena_.

As to catarrh spreading from the nose and throat to the other mucous
membranes, that is also quite out of the question if it is supposed to
occur in the way that the advertising specialist likes to announce.
Catarrhal conditions may occur in the stomach, but like those of the
nose and throat they are not serious, heal completely, and produce no
definite changes. A pinch of snuff may cause a catarrhal condition of
the nose, that is an increase of secretion due to hyperaemia of the
mucous membrane; the eating of condiments, of Worcestershire sauce,
peppers, and horse-radish may cause it in the stomach. It may be due
to microbic action or to irritant or decomposing food, but it is not a
part of a serious, wide-spreading pathological condition that will
finally make the patient miserable. It is surprising, however, how
many people say with an air of finality {35} that they have catarrh,
as if it should be perfectly clear that as a result they cannot be
expected at any time to be in sufficiently good health to be called on
for any special work, and of course if any affection should attack
them, their natural immunity to disease has been so lowered by this
chronic affection, of which they are the victims, that no strong
resistance could be expected from them.

All this is merely a dread induced by paying too much attention to
medical advertisements. It is better not to know as much as some
people know, or think they know about themselves, than to know so many
things that are not so. Their dreads seriously impair their power to
work and leave them ill disposed to resist affections of any kind that
may attack them. It is a sad confession to make, but not a little of
the enforced study of physiology in our schools has become the source
of a series of dreads and solicitudes rather than of helpful
knowledge. We have as a result a generation who know a little about
their internal economy, but only enough to make them worry about it
and not quite enough to make them understand how thoroughly capable
our organisms are of caring for themselves successfully and with
resultant good health, if we will only {36} refrain from putting
brakes on their energies and disturbing their functions by our worries
and anxieties.

Another such word as catarrh in its unfavorable suggestiveness in
recent years has been auto-intoxication. It is a mouth-filling word,
and therefore very probably it has occupied the minds of the better
educated classes. Usually the form of auto-intoxication that is most
spoken of is intestinal auto-intoxication, and this combination has
for many people a very satisfying polysyllabic length that makes it of
special significance. Its meaning is taken to be that whenever the
contents of the intestines are delayed more than twenty hours or
perhaps a little longer, or whenever certain irritant materials find
their way into the intestinal tract, there is an absorption of toxic
matter which produces a series of constitutional symptoms. These
include such vague symptomatic conditions as sleepiness, torpor after
meals, an uncomfortable sense of fullness--though when we were young
we rather liked to have that feeling of fullness--and sometimes a
feeling of heat in the skin with other sensations of discomfort in
various parts of the body. At times there is headache, but this is
rather rare; lassitude and a feeling of {37} inability to do things is
looked upon as almost characteristic of the condition. Usually there
are nervous symptoms of one kind or another associated with the other
complaints and there may be distinctly hysterical or psycho-neurotic
manifestations.

Auto-intoxication as just described has become a sort of fetish for a
great many people who bow down and worship at its shrine and give some
of the best of their energies and not a little of their time to
meditation before it. As a matter of fact, in the last few years it
has come to be recognized that auto-intoxication is a much abused word
employed very often when there are serious organic conditions in
existence elsewhere in the body and still more frequently when the
symptoms are due merely to functional nervous troubles. These are
usually consequent upon a sedentary life, lack of fresh air and
exercise, insufficient attention to the diet in the direction of
taking simple and coarse food, and generally passing disturbances that
can be rather readily catalogued under much simpler affections than a
supposed absorption of toxic materials from the intestines. Reflexes
from the intestinal tract, emphasized by worries about the condition,
are much more responsible for the feelings {38} complained of--which
are often not in any sense symptoms--than any physical factors
present.

As Doctor Walter C. Alvarez said in a paper on the "Origin of the
So-called Auto-intoxicational Symptoms" published from the George
Williams Hooper Foundation for Medical Research of the University of
California Medical School,   [Footnote 3] as the conclusion of his
investigation of the subject:

    [Footnote 3: _Journal of the American Medical Association_,
    January 4, 1919.]

  "Auto-intoxication is commonly diagnosed when a physical examination
  would show other more definite causes for the symptoms. Those who
  believe that intestinal stasis can account for a long list of
  disease conditions have little proof to offer for their views. Many
  of the assumptions on which they rest their case have proved to be
  wrong.

  "The usual symptoms of the constipated disappear so promptly after a
  bowel movement that they cannot be due to absorbed toxins. They must
  be produced mechanically by distension and irritation of the colon.
  They occur in nervous, sensitive people. It has been shown that
  various activities of the digestive tract can profoundly affect the
  sensorium and the vasomotor nerves. The {39} old ideas of insidious
  poisoning led to the formation of hypochrondriacs; the new
  explanation helps to cure many of them."

There are many other terms in common use that have unfortunate
suggestions and make people feel, if they once get the habit of
applying them to themselves, that they are the subject of rather
serious illness. I suppose that one of the most used and most abused
of these is uric acid and the uric acid diathesis. Scientific
physicians have nearly given up these terms, but a great many people
are still intent on making themselves miserable. All sorts of symptoms
usually due to insufficient exercise and air, inadequate diversion of
mind and lack of interests are attributed to these conditions. Some
time or other a physician or perhaps some one who is supposed to be a
friend suggested them and they continue to hamper the will to be well
by baseless worries founded on false notions for years afterwards.
What is needed is a definite effort of the will to throw off these
nightmares of disease that are so disturbing and live without them.

It is surprising how much vital energy may be wasted in connection
with such dreads. Unfortunately, too, medicines of various kinds are
taken to relieve the symptoms connected {40} with them and the
medicine does ever so much more harm than good. Oliver Wendell Holmes
declared a generation ago that if all the medicines that had ever been
taken by mankind were thrown into the sea it would be much better for
mankind and much worse for the fishes. The expression still has a
great truth in it, especially as regards that habit of self-drugging
so common among the American people. In the course of lecture
engagements, I stay with very intelligent friends on a good many
occasions each year, and it is surprising how many of them have
medicine bottles around, indicating that they are subject to dreads of
various kinds with regard to themselves for which they feel medicine
should be taken. These dreads unfortunately often serve to lessen
resistive vitality to real affections when they occur and therefore
become a source of real danger.

All these various dreads, then, have the definite effect of lessening
the power of the will to enable people to do their work and remain
well. They represent serious brakes upon the flow of nerve impulses
from the spiritual side of man's nature to the physical. This is much
more serious in its results than would usually be thought; and one of
the {41} things that a physician has to find out from a great many
patients is what sources of dread they are laboring under so as to
neutralize them or at least correct them as far as possible. It is
surprising how much good can be accomplished by a deliberate quest
after dreads and the direct discussion of them, for they are always
much less significant when brought out of the purlieus of the mind
directly into the open. Many a neurotic patient, particularly, will
not be improved until his dreads are relieved. This form of
psycho-analysis rather than the search for sex insults, as they are
called, or sexual incidents of early life, is the hopeful phase of
modern psychological contribution to therapeutics.


{42}

CHAPTER III

HABITS


  "Why, will shall break it; will and nothing else."
                                      _Love's Labor's Lost_.


Dreads are brakes on the will, inhibitions which prevent its exercise
and make accomplishment very difficult and sometimes impossible. They
represent mainly a state of mind, yet often they contain physical
elements, and the disposition counts for much. Their counterpart in
the opposite direction is represented by habits which are acquired
facilities of action for good or for ill. Habits not only make
activities easy but they even produce such a definite tendency to the
performance of certain actions as to make it difficult not to do them.
They may become so strong as to be tyrants for ill, though it must not
be forgotten that properly directed they may master what is worst in
us and help us up the hill of life. Acts that are entirely voluntary
and very difficult at first may become by habit so {43} natural that
it is extremely difficult to do otherwise than follow the ingrained
tendency. Nature's activities are imperative. Habitual actions may
become equally so. When some one once remarked to the Duke of
Wellington that habit was second nature, he replied:

"Oh, ever so much more than that! Habit may be ten times as strong as
nature."

The function of the will in health is mainly to prevent the formation
of bad habits or break those that have been formed, but above all, to
bring about the formation of habits that will prevent as far as is
possible the development of tendencies to disease in the body, Man
probably faces no more difficult problem in life than the breaking of
a bad habit. Usually it requires the exercise of all his will power
applied to its fullest extent. If there is a more difficult problem
than the breaking of a bad habit it is the formation of a good one
late in life because of the persistency of advertence and effort that
is required. It is comparatively easy to prevent the formation of bad
habits and also easy to form good habits in the earlier years. The
organism is then plastic and yields itself readily and thus becomes
grooved to the habit or hardened against it by the performance of even
a few acts.

{44}

All the psychologists insist that after the period of the exercise of
instinct as the basis of life passes, habit becomes the great force
for good or for ill. We become quite literally a bundle of habits, and
the success of life largely depends on whether these habits are
favorable or unfavorable to the accomplishment of what is best in us.
More than anything else health depends on habit. We begin by doing
things more or less casually, and after a time a tendency to do them
is created; then almost before we know it, we find that we have a
difficult task before us, if we try not to do them.

To begin with, the activity which becomes the subject of a habit may
be distinctly unpleasant and require considerable effort to
accomplish. Practically every one who has learned to smoke recalls
more or less vividly the physical disturbance caused by the first
attempt and how even succeeding smokes for some time, far from being
pleasant, required distinct effort and no little self-control. After a
time, the desire to smoke becomes so ingrained that a man is literally
made quite miserable by the lack of it and finds himself almost
incapable of doing anything else until he has had his smoke.

{45}

Even more of an effort is required to establish the habit of chewing
tobacco, and it is even more difficult to break when once it has been
formed. Any one who has seen the discomfort and even torments endured
by a man who, after he had chewed tobacco for many years, tried to
stop will appreciate fully what a firm hold the habit has obtained. I
have known a serious business man who almost had to give up business,
who lost his sleep and his appetite and went through a nervous crisis
merely by trying to break the habit of chewing tobacco.

In the Orient they chew betel nut. It is an extremely hot material
which burns the tongue and which a man can stand for only a very short
time when he first tries it. After a while, however, he finds a
pleasant stimulation of sensation in the constant presence of the
biting betel nut in his mouth; he craves it and cannot do his work so
well without it. He will ever advert to its use and will be restless
without it. He continues to use it in spite of the fact that the
intense irritation set up by the biting qualities of the substance
causes cancer of the tongue to occur ten times as frequently among
those who chew betel nut as among the rest of the population. Not all
{46} those who chew it get cancer, for some die from other causes
before there is time for the cancer to develop, and some seem to
possess immunity against the irritation. The betel nut chewer ignores
all this, proceeds to form the habit, urged thereto by the force of
example, and then lets himself drift along, hoping that it will have
no bad effects.

The alcohol and drug habits are quite as significant in shortening
life as betel nut and yet men take them up quite confident in the
beginning that _they_ will not fall victims, and then find themselves
enmeshed. It is probable that the direct physical effects of none of
these substances shorten life to a marked degree unless they are
indulged in to very great excess, but the moral hazards which they
produce, accidents, injuries of various kinds, exposure to disease,
all these shorten life. Men know this very well, and yet persist in
the formation of these habits.

Any habit, no matter how strong, can be broken if the individual
really wishes to break it, provided the subject of it is not actually
insane or on the way to the insane asylum. He need only get a motive
strong enough to rouse his will, secure a consciousness of his own
power, and then the habit can be broken. {47} After all, it must never
be forgotten that the only thing necessary in order to break a habit
effectively is to refuse to perform a single act of it, the next time
one is tempted. That breaks the habit and makes refusal easier and one
need only continue the refusal until the temptation ceases.

Men who have not drawn a sober breath for years have sometimes come to
the realization of the fools that they were making of themselves, the
injury they were doing their relatives, or perhaps have been touched
by a child's words or some religious motive, and after that they have
never touched liquor again. Father Theobald Mathew's wonderful work in
this regard among the Irish in the first half of the nineteenth
century has been repeated by many temperance or total abstinence
advocates in more recent generations. I have known a confirmed
drunkard reason himself into a state of mind from which he was able to
overcome his habit very successfully, though his reasoning consisted
of nothing more than the recognition of the fact that suggestion was
the root of his craving for alcohol. His father had been a drunkard
and he had received so many warnings from all his older relatives and
had himself so come to dwell on {48} the possible danger of his own
formation of the habit that he had suggested himself into the frame of
mind in which he took to drink. I have known a physician on whom some
half a dozen different morphine cures had been tried--always followed
by a relapse--cure himself by an act of his own will and stay cured
ever since because of an incident that stirred him deeply enough to
arouse his will properly to activity. One day his little boy of about
four was in his office when father prepared to give himself one of his
usual injections of morphine. The little boy gave very close attention
to all his father's manipulations, and as the doctor was hurrying to
keep an appointment, he did not notice the intent eye witness of the
proceedings. Just as the needle was pushed home and the piston shot
down in the barrel, the little boy rushed over to his father and said,
"Oh, Daddy, do that to me." Apparently this close childish observer
had noted something of the look of satisfaction that came over his
father's face as he felt the fluid sink into his tissues. It is almost
needless to say that the shock the father received was enough to break
his morphine habit for good and all. It simply released his will and
then he found that if he {49} really wanted to, he could accomplish
what the various cures for the morphine habit only lead up to--and in
his case unsuccessfully--the exercise of his own will power.

The word "habit" suggests nearly always, unfortunately, the thought of
bad habits, just as the word "passion" implies, with many people, evil
tendencies. But it must not be forgotten that there are good passions
and good habits that are as helpful for the accomplishment of what is
best in life as bad passions and bad habits are harmful. A repetition
of acts is needed for the formation of good habits just as for the
establishment of customs of evil. Usually, however, and this must not
be forgotten, the beginning of a good habit is easier than the
beginning of a bad habit. Once formed, the good habits are even more
beneficial than the bad habits are harmful. It is almost as hard to
break a good habit as a bad one, provided that it has been continued
for a sufficient length of time to make that groove in the nervous
system which underlies all habit. We cannot avoid forming habits and
the question is, shall we form good or bad habits? Good habits
preserve health, make life easier and happier; bad habits have the
opposite effect, though {50} there is some countervailing personal
element that tempts to their formation and persistence.

Every failure to do what we should has its unfortunate effect upon us.
We get into a state in which it is extremely difficult for us to do
the right things. We have to overcome not only the original inertia of
nature, but also a contrary habit. If we do not follow our good
impulses, the worse ones get the upper hand. As Professor James said,
for we must always recur to him when we want to have the clear
expression of many of these ideas:

  "Just as, if we let our emotions evaporate, they get into a way of
  evaporating; so there is reason to suppose that if we often flinch
  from making an effort, before we know it the effort-making capacity
  will be gone; and that, if we suffer the wandering of our attention,
  presently it will wander all the time. Attention and effort are but
  two names for the same psychic fact. To what brain-processes they
  correspond we do not know. The strongest reason for believing that
  they do depend on brain processes at all and are not pure acts of
  the spirit, is just this fact, that they seem in some degree subject
  to the law of habit, which is a material law."

It must not be forgotten that we mold not {51} alone what we call
character, but that we manifestly produce effects upon our tissues
that are lasting. Indeed it is these that count the most, for health
at least. It is the physical basis of will and intellect that is
grooved by what we call habit. As Doctor Carpenter says:

  "Our nervous systems have grown to the way in which they have been
  exercised, just as a sheet of paper or a coat, once creased or
  folded, tends to fall forever afterwards into the same identical
  fold."

Permitting exceptions to occur when we are forming a habit is almost
necessarily disturbing. The classical figure is that it is like
letting fall a ball of string which we have been winding. It undoes in
a moment all that we have accomplished in a long while. As Professor
Bain has said it so much better than I could, I prefer to quote him:

  "The peculiarity of the moral habits, contradistinguishing them from
  the intellectual acquisitions, is the presence of two hostile
  powers, one to be gradually raised into the ascendant over the
  other. It is necessary, above all things, in such a situation never
  to lose a battle. Every gain on the wrong side undoes the effect of
  many conquests on the {52} right. The essential precaution,
  therefore, is so to regulate the two opposing powers that the one
  may have a series of uninterrupted successes, until repetition has
  fortified it to such a degree as to enable it to cope with the
  opposition under any circumstances."

This means training the will by a series of difficult acts,
accomplished in spite of the effort they require, but which gradually
become easier from repeated performance until habit replaces nature
and dominates the situation.

Serious thinkers who faced humanity's problems squarely and devoted
themselves to finding solutions for them had worked out this formula
of the need of will training long ago, and it was indeed a principal
characteristic of medieval education. The old monastic schools were
founded on the idea that training of the will and the formation of
good habits was ever so much more important than the accumulation of
information. They frankly called the human will the highest faculty of
mankind and felt that to neglect it would be a serious defect in
education. The will can only be trained by the accomplishment of
difficult things day after day until its energies are aroused and the
man becomes conscious of his own powers and the {53} ability to use
them whenever he really wishes. There was a time not so long since,
and there are still voices raised to that purport, when it was the
custom to scoff at the will training of the older time and above all
the old-fashioned suggestion that mortifications of various
kinds--that is, the doing of unpleasant things just for the sake of
doing them--should be practiced because of the added will power thus
acquired. The failure of our modern education which neglected this
special attention to the will is now so patent as to make everyone
feel that there must be a recurrence to old time ideas once more.

The formation of proper habits should, then, be the main occupation of
the early years. This will assure health as well as happiness, barring
the accidents that may come to any human being. Good habits make
proper living easy and after a time even pleasant, though there may
have been considerable difficulty in the performance of the acts
associated with them at the beginning. Indeed, the organism becomes so
accustomed to their performance after a time that it becomes actually
something of a trial to omit them, and they are missed.

Education consists much more in such {54} training of the will than in
storing the intellect with knowledge, though the latter idea has been
unfortunately the almost exclusive policy in our education in recent
generations. We are waking up to the fact that diminution of power has
been brought about by striving for information instead of for the
increase of will energy.

Professor Conklin of Princeton, in his volume on "Heredity and
Environment", emphasized the fact that "Will is indeed the supreme
human faculty, the whole mind in action, the internal stimulus which
may call forth all the capacities and powers." He had said just before
this: "It is one of the most serious indictments against modern
systems of education that they devote so much attention to the
training of the memory and intellect and so little attention to the
training of the will, upon the proper development of which so much
depends."

Nor must it be thought that the idea behind this training of the will
is in any sense medievally ascetic and old-fashioned and that it does
not apply to our modern conditions and modes of thinking. Professor
Huxley would surely be the one man above all whom any one in our times
would be least likely to think of {55} as mystical in his ways or
medieval in his tendencies. In his address on "A Liberal Education and
Where to Find It", delivered before the South London Workingmen's
College some forty years ago, in emphasizing what he thought was the
real purpose of education, he dwelt particularly on the training of
the will. He defined a liberal education not as so many people might
think of it in terms of the intellect, but rather in terms of the
will. He said that a liberal education was one "which has not only
prepared a man to escape the great evils of disobedience to natural
laws, but has trained him to appreciate and to seize upon the rewards
which nature scatters with as free a hand as her penalties." And then
he added:

  "That man, I think, has had a liberal education who has been so
  trained in youth that his body is the ready servant of his will, and
  does with ease and pleasure all the work that, as a mechanism, it is
  capable of; whose intellect is a clear, cold, logic engine, with all
  its parts of equal strength, and in smooth working order, ready,
  like a steam engine, to be turned to any kind of work, and spin the
  gossamers as well as forge the anchors of the mind; whose mind is
  stored with a knowledge of the great {56} and fundamental truths of
  nature and of the laws of her operations; one who is no stunted
  ascetic but who is full of life and fire, but whose passions are
  trained to come to heel by a vigorous will, the servant of a tender
  conscience; who has learned to love all beauty, whether of nature or
  of art, to hate all vileness, and to respect others as himself.

  "Such an one and no other, I conceive, has had a liberal education;
  for he is, completely as a man can be, in harmony with nature."

This is the liberal education in habits of order and power that every
one must strive for, so that all possible energies may be available
for the rewards of good health. Details of the habits that mean much
for health must be reserved for subsequent chapters, but it must be
appreciated in any consideration of the relation of the will to health
that good habits formed as early as possible in life and maintained
conservatively as the years advance are the mainstay of health and the
power to do work.


{57}

CHAPTER IV

SYMPATHY


  "Never could maintain his part but in the force of his will."
                                       _Much Ado about Nothing_.

A great French physician once combined in the same sentence two
expressions that to most people of the modern time would seem utter
paradoxes. "Rest," he said, "is the most dangerous of remedies, never
to be employed for the treatment of disease, except in careful doses,
under the direction of a physician and rarely for any but sufferers
from organic disease"; while "sympathy", he added, "is the most
insidiously harmful of anodynes, seldom doing any good except for the
passing moment, and often working a deal of harm to the patient."

With the first of these expressions, we have nothing to do here, but
the second is extremely important in any consideration of the place of
the will in human life. Nothing is so prone {58} to weaken the will,
to keep it from exerting its full influence in maintaining vital
resistance, and as a result, to relax not only the moral but the
physical fiber of men and women as misplaced sympathy. It has almost
exactly the same place in the moral life that narcotics have in the
physical, and it must be employed with quite as much nicety of
judgment and discrimination.

Sympathy of itself is a beautiful thing in so far as it implies that
_suffering with_ another which its Greek etymology signifies. In so
far as it is pity, however, it tends to lessen our power to stand up
firmly under the trials that are sure to come, and is just to that
extent harmful rather than helpful. There is a definite reaction
against it in all normal individuals. No one wants to be pitied. We
feel naturally a little degraded by it. In so far as it creates a
feeling of self-pity, it is particularly to be deprecated, and indeed
this is so important a subject in all that concerns the will to be
well and to get well that it has been reserved for a special chapter.
What we would emphasize here is the harm that is almost invariably
done by the well-meant but so often ill-directed sympathy of friends
and relatives which proves relaxing of moral {59} purpose and hampers
the will in its activities, physical as well as ethical.

Human nature has long recognized this and has organized certain
customs of life with due reference to it. We all know that when
children fall and even hurt themselves, the thing to do is not to
express our sympathy and sorrow for them, even though we feel it
deeply, but unless their injury is severe, to let them pick themselves
up and divert their minds from their hurts by suggesting that they
have broken the floor, or hurt it. For the less sympathy expressed,
the shorter will be the crying, and the sooner the child will learn to
take the hard knocks of life without feeling that it is especially
abused or suffering any more than comes to most people. Unfortunately,
it is not always the custom to do the same thing with the children of
a larger growth. This is particularly true when there is but a single
child in the family, or perhaps two, when a good deal of sympathy is
likely to be wasted on their ills which are often greatly increased by
their self-consciousness and their dwelling on them. Diversion of
mind, not pity, is needed. The advice to do the next thing and not cry
over spilt milk is ever so much better than sentimental recalling of
the past.

{60}

Many a young man who went to war learned the precious lesson that
sympathy, though he might crave it, instead of doing him good would do
harm. Many a manly character was rounded out into firm self-control
and independence by military discipline and the lack of anything like
sentimentality in camp and military life. A good many mothers whose
boys had been the objects of their special solicitude felt very sorry
to think that they would have to submit to the hardships and trials
involved in military discipline. Most of them who were solicitous in
this way were rather inclined to feel that their boy might not be able
to stand up under the rigidities of military life and hoped at most
that he would not be seriously harmed. They could not think that early
rising, hard work, severe physical tasks, tiring almost to exhaustion,
with plain, hearty, yet rather coarse food, eaten in slapdash fashion,
would be quite the thing for their boy of whom they had taken so much
care. Not a few of them were surprised to find how the life under
these difficult circumstances proved practically always beneficial.

I remember distinctly that when the soldiers were sent to the Mexican
border the mother of {61} a soldier from a neighboring State remarked
rather anxiously to me that she did not know what would happen to Jack
under the severe discipline incident to military life. He had always
gone away for five or six weeks in the summer either to the mountains
or to the seashore, and the Mexican border, probably the most trying
summer climate in the United States, represented the very opposite of
this. Besides, there was the question of the army rations; Jack was an
only son with five sisters. Most of them were older than he, and so
Jack had been coddled as though by half a dozen mothers. He was
underweight, he had a rather finicky appetite, he was capricious in
his eating both as to quantity and quality, and was supposed to be a
sufferer from some form of nervous indigestion. Personally, I felt
that what Jack needed was weight, but I had found it very hard to
increase his weight. He was particularly prone to eat a very small
breakfast, and his mother once told me that whenever he was at home,
she always prepared his breakfast for him with her own hands. This did
not improve matters much, however, for Jack was likely to take a small
portion of the meat cooked for him, refuse to touch the potatoes, and
eat marmalade and toast with {62} his coffee and nothing more. No
wonder that he was twenty pounds underweight or that his mother should
be solicitous as to what might happen to her Jack in army life at the
Border.

I agreed with her in that but there were some things that I knew would
not happen to Jack. His breakfast, for instance, would not be
particularly cooked for him, and he might take or leave exactly what
was prepared for every one else. Neither would the Government cook
come out and sit beside Jack while he was at breakfast and tempt him
to eat, as his mother had always done. I knew, too, that at other
meals, while the food would be abundant, it would usually be rather
coarse, always plain, and there would be nothing very tempting about
it unless you had your appetite with you. If ever there is a place
where appetite is the best sauce, it is surely where one is served
with army food.

I need scarcely tell what actually happened to Jack, for it was
exactly what happened to a good many Jacks whose mothers were equally
afraid of the effects of camp life on them. Amid the temptations of
home food, Jack had remained persistently underweight. Eating an army
ration with the sauce of appetite due to prolonged physical efforts in
the outdoor {63} air every day, Jack gained more than twenty pounds in
weight, in spite of the supposedly insalubrious climate of the Border
and the difficult conditions under which he had to live. It was
literally the best summer vacation that Jack had ever spent, though if
the suggestion had ever been made that this was the sort of summer
vacation that would do him good, the idea would have been scoffed at
as impractical, if not absolutely impossible.

Homer suggested that a mollycoddle character whom he introduces into
the "Iliad" owed something of his lack of manly stamina to the fact
that he had six sisters at home, and an Irish friend once translated
the passage by saying that the young man in question was "one of seven
sisters." This had been something of Jack's trouble. He had been asked
always whether he changed his underwear at the different seasons,
whether he wore the wristlets that sisterly care provided for him,
whether he put on his rubbers when he went out in damp weather and
carried his umbrella when it was threatening rain, and all the rest.
He got away from all this sympathetic solicitude in army life and was
ever so much better for it.

It is extremely difficult to draw the line {64} where the sympathy
that is helpful because it is encouraging ends, and sentimental pity
which discourages begins. There is always danger of overdoing and it
is extremely important that growing young folks particularly should be
allowed to bear their ills without help and learn to find resources
within themselves that will support them. The will can thus be
buttressed to withstand the difficulties of life, make them much
easier to bear, and actually lessen their effect. Ten growing young
folks have been seriously hurt by ill-judged sympathy for every one
that has been discouraged by the absence of sympathy or by being made
to feel that he must take the things of life as they come and stand
them without grouchy complaint or without looking for sympathy.

This is particularly true as regards those with any nervous or
hysterical tendencies, for they readily learn to look for sympathy.
The most precious lesson of the war for physicians has been that which
is emphasized in the chapter on "The Will and the War Psychoneuroses."
There was an immense amount of so-called "shell-shock" which really
represented functional neurotic conditions such as in women used to be
called hysteria. At the {65} beginning of the war there was a good
deal of hearty sympathy with it, and patients were encouraged by the
physicians and then by the nurses and other patients in the hospital
to tell over and over again how their condition developed. It was
found after a time that the sympathy thus manifested always did harm.
The frequent repetition of their stories added more and more
suggestive elements to the patients' condition, and they grew worse
instead of better. It was found that the proper curative treatment was
to make just as little as possible of their condition, to treat them
firmly but with assurance--once it had been definitely determined that
no organic nervous trouble was present--and to bring about a cure of
whatever symptoms they had at a single sitting by changing their
attitude of mind towards themselves.

Some of the patients proved refractory and for these isolation and
rather severe discipline were occasionally necessary. The isolation
was so complete as to deprive them not only of companionship but also
of reading and writing materials and the solace of their tobacco.
Severe cases were sometimes treated by strong faradic currents of
electricity which were extremely painful. Patients who insisted that
{66} they could not move their muscles were simply made to jump by an
electric shock, thus proving to them that they could use the muscles,
and then they were required to continue their use.

Those suffering from shell-shock deafness and muteness were told that
an electrode would be applied to their larynx or the neighborhood of
their ear and when they felt pain from it, that was a sign that they
were able to talk and to hear if they wished, and that they must do
so. Relapses had to be guarded against by suggestion, and where
relapses became refractory and stronger currents of electricity to ear
and larynx were deemed inadvisable, the strict isolation treatment
usually proved effective.

In a word, discipline and not sympathy was the valuable mode of
treating them. Sympathy did them harm as it invariably does. The world
has recognized this truism always, but we need to learn the lesson
afresh, or the will power is undermined. Character is built up by
standing the difficult things of life without looking for the narcotic
of sympathy or any other anaesthetizing material. These are "hard
sayings," to use a Scriptural expression, but they represent the
accumulation of wisdom of human experience. Sympathy can be {67}
almost as destructive of individual morale as the dreads, and it is
extremely important that it should not be allowed to sap will energy.
In our time above all, when the training of the will has been
neglected, though it is by far the most important factor in education,
this lesson with regard to the harmful effect of sympathy needs to be
emphasized.

For nervous people, that is, for those who have, either from
inheritance or so much oftener from environment, yielded to
circumstances rather than properly opposed them, sympathy is quite as
dangerous as opium. George Eliot once replied to a friend who asked
her what was duty, that duty consisted in facing the hard things in
life without taking opium.

Healthy living to a great extent depends on standing what has to be
borne from the bodies that we carry around with us without looking for
sympathy. It has often been emphasized that human beings are eminently
lonely. The great experiences of life and above all, death and
suffering, we have to face by ourselves and no one can help us. We may
not be, as Emerson suggested, "infinitely repellent particles", but at
all the profoundest moments of life we feel our alone-ness. The more
{68} that we learn to depend bravely on ourselves and the less we seek
outside support for our characters, the better for us and our power to
stand whatever comes to us in life.

Physical ills are always lessened by courageously facing them and are
always increased by cringing before them. The one who dreads suffers
both before and during the time of the pain and thus doubles his
discomfort. We must stand alone in the matter and sympathy is prone to
unman us. Looking for sympathy is a tendency to that self-pity which
is treated in a subsequent chapter and which does more to increase
discomfort in illness, exaggerate symptoms, and lower resistive
vitality than anything else, in the psychic order at least.

Suffering is always either constructive or destructive of character.
It is constructive when the personal reaction suffices to lessen and
make it bearable. It is destructive whenever there is a looking for
sympathy or a leaning on some one else. Character counts in
withstanding disease, and even in the midst of epidemics, according to
many well-grounded traditions, those who are afraid contract the
disease sooner than others and usually suffer more severely. Sympathy
must not be allowed to produce any such effect as this.

{69}

CHAPTER V

SELF-PITY


  "The will dotes that is attributive
  To what infectiously itself affects."
                  _Troilus and Cressida_.


The worst brake on the will to be well is undoubtedly the habit that
some people have of pitying themselves and feeling that they are
eminently deserving of the pity of others because of the trials, real
or supposed, which they have to undergo. Instead of realizing how much
better off they are than the great majority of people--for most of the
typical self-pitiers are not real subjects for pity--they keep looking
at those whom they fondly suppose to be happier than themselves and
then proceed to get into a mood of commiseration with themselves
because of their ill health--real or imaginary--or uncomfortable
surroundings. Just as soon as men or women assume this state of mind,
it becomes extremely difficult for them to stand any real {70} trials
that appear, and above all, it becomes even more difficult for them to
react properly against the affections of one kind or another that are
almost sure to come. Self-pity is ever a serious hamperer of resistive
vitality.

A great many things in modern life have distinctly encouraged this
practice of self-pity and conscious commiseration of one's state until
it has become almost a commonplace of modern life for those who feel
that they are suffering, especially if they belong to what may be
called the sophisticated classes. We have become extremely sensitive
as a consequence about contact with suffering. Editors of magazines
and readers for publishing houses often refuse in our time to accept
stories that have unhappy endings, because people do not care to read
them, it is said. The story may have some suffering in it and even
severe hardships, especially if these can be used for purposes of
dramatic climax, but by the end of the story everything must have
turned out "just lovely", and it must be understood that suffering is
only a passing matter and merely a somewhat unpleasant prelude to
inevitable happiness.

Almost needless to say, this is not the way of life as it must be
lived in what many {71} generations of men have agreed in calling
"this vale of tears." For a great many people have to suffer severely
and without any prospect of relief--none of us quite escape the
necessity of suffering--and as some one has said, all human life,
inasmuch as there is death in it, must be considered a tragedy. The
old Greeks did not hesitate, in spite of their deep appreciation of
the beauty of nature and cordial enthusiasm for the joy of living,
even to emphasize the tragedy in life. They were perhaps inclined to
think that the sense of contrast produced by tragedy heightened the
actual enjoyment of life and that indeed all pleasure was founded
rather on contrast than positive enjoyment. One may not be ready to
agree with the saying that the only thing that makes life worth while
is contrast, but certainly suffering as a background enhances
happiness as nothing else can.

Aristotle declared that tragedy purges life, that is, that only
through the lens of death and misfortune could one see life free from
the dross of the sordid and merely material to which it was attached.
His meaning was that tragedy lifted man above the selfishness of mere
individualism, and by showing him the misfortunes of others prepared
him to struggle {72} for himself when misfortune might come, as it
almost inevitably would; and at the same time lifted him above the
trifles of daily life into a higher, broader sphere of living, where
he better realized himself and his powers.

For man is distinctly prone to forget about death and suffering, and
when he does, to become eminently selfish and forgetful of the rights
of others and his duties towards them. The French have a saying,
consisting of but four words and an intervening shrug of the
shoulders, that is extremely illuminating. They quote as the
expression of the usual thought of men when brought face to face with
the fact that people are dying all around them, "_On meurt--les
autres!_" "People die--Oh, yes (with an expressive shrug of the
shoulders), other people!" We refuse to recognize the fact that we too
must go until that is actually forced upon us by advancing years or by
some incurable disease. As for suffering, a great many people have
come almost to resent that they should be asked to suffer, and
character dissolves in self-pity as a result.

Instead of the constant, continuous reading of what may be called
Sybaritic literature--for it is said that the Sybarite finds it
impossible to sleep if there is a crushed rose leaf next {73} his
skin--instead of being absorbed in the literature which emphasizes the
pleasures of life and pushes its pains into the background, young
people, and especially those of the better-to-do classes, should be
taught from their early years to read the lives of those who have
endured successfully hardships of various kinds and have succeeded in
getting satisfaction out of their accomplishment in life, despite all
the suffering that was involved. These are human beings like
ourselves, and what mortal has done, other mortals can do.

There was a school of American psychologists before the war who had
come to recognize the value of that old-fashioned means of
self-discipline of mind, the reading of the lives of the saints. For
those to whom that old-fashioned practice may seem too reactionary,
there are the lives and adventures of our African and Asiatic
travelers and our polar explorers as a resource.

War books have been a godsend for our generation in this regard. They
have led people to contemplate the hardest kind of suffering--and very
often in connection with those who are nearest and dearest to them--
and thus made them understand something of the possibilities of human
nature to withstand {74} trials and sufferings. As a result they have
been trained not to make too much of their own trivial trials, as they
soon learned to recognize them in the face of the awful hardships that
this war involved. What Belgium endured was bad enough, while the
experiences of Poland, Servia, Armenia were an ascending scale of
horrors, but also of humanity's power to stand suffering.

Life in the larger families of the olden times afforded more
opportunities for the proper teaching of the place of suffering than
in the smaller families of the modern time. Older children, as they
grew up, had before them the example of mother's trials and hardships
in bearing and rearing children, and so came to understand better the
place of hard things in life. In a large family it was very rare when
one or more of the members did not die, and thus growing youth was
brought in contact with the greatest mystery in life, that of death.
Very frequently at least one of the household and sometimes more, had
to go through a period of severe suffering with which the others were
brought in daily contact. It is sometimes thought in modern times that
such intimacy with those who are suffering takes the joy out of life
for those who {75} are young, but any one who thinks so should consult
a person who has had the actual experience; while occasionally it may
be found that some one with a family history of this kind may think
that he or she was rendered melancholy by it, nine out of ten or even
more will frankly say that they feel sure that they were benefited.
There is nothing in the world that broadens and deepens the
significance of life like intimate contact with suffering, if not in
person, then in those who are near and dear to us.

As a physician, I have often felt that I should like to take people
who are constantly complaining of their little sorrows and trials, who
are downhearted over some minor ailment, who sometimes suffer from
fits of depression precipitated by nothing more, perhaps, than a dark
day or a little humid weather, or possibly even a petty social
disappointment, and put them in contact with cancer patients or others
who are suffering severely day by day, yes, hour by hour, night and
day, and yet who are joyful and often a source of joy to others. Let
us not forget that nearly one hundred thousand people die every year
from cancer in this country alone.

As a physician, I have often found that a {76} chronic invalid in a
house became the center of attraction for the whole household, and
that particularly when it was a woman, whether mother or elder sister,
all of the other members brought their troubles to her and went away
feeling better for what she said to them. I have seen this not in a
few exceptional instances, but so often as to know that it is a rule
of life. Chronic invalids often radiate joy and happiness, while
perfectly well people who suffer from minor ills of the body and mind
are frequently a source of grumpiness, utterly lack sympathy, and are
impossible as companions. An American woman, bedridden for over thirty
years, has organized by correspondence one of the most beautiful
charities of our time.

Pity properly restricted to practical helpfulness without any
sentimentality is a beautiful thing. There is always a danger,
however, of its arousing in its object that self-pity which is so
eminently unlovely and which has so often the direct tendency to
increase rather than decrease whatever painful conditions are present.

Crying over oneself is always to be considered at least hysterical.
Crying, except over a severe loss, is almost unpardonable. {77} It is
often said that a good cry, like a rainstorm, clears the atmosphere of
murk and the dark elements of life, but it is dangerous to have
recourse to it. It is a sign of lack of character almost invariably
and when indulged in to any extent will almost surely result in
deterioration of the power to withstand the trials of life, whatever
they may be.

Professor William James has suggested that not only should men and
women stand the things that come to them in the natural course of
events, but they should even go out and seek certain things hard to
bear with the idea of increasing their power to withstand the
unpleasant things of life. This is, of course, a very old idea in
humanity, and the ascetics from the earliest days of Christianity
taught the doctrine of self-inflicted suffering in order to increase
the power of resistance.

It is usually said that the principal idea which the hermits and
anchorites and the saintly personages of the early Middle Ages, of
whose mortifications we have heard so much, had in inflicting pain on
themselves was to secure merit for the hereafter. Something of that
undoubtedly was in their minds, but their main purpose was quite
literally ascetic. _Ascesis_, from the Greek, means in its strict {78}
etymology just exercise. They were exercising their power to stand
trials and even sufferings, so that when these events came, as
inevitably they would, seeing that we carry round with us what St.
Paul called "this body of our death," they would be prepared for them.

Practically any psychologist of modern times who has given this
subject any serious thought will recognize, as did Professor James,
the genuine psychology of human nature that lies behind these ascetic
practices. Nothing that I know is so thoroughgoing a remedy for
self-pity as the actual seeking at times of painful things in order to
train oneself to bear them. The old-fashioned use of disciplines, that
is, little whips which were used so vigorously sometimes over the
shoulders as to draw blood, or the wearing of chains which actually
penetrated the skin and produced quite serious pain no longer seems
absurd, once it is appreciated that this may be a means of bracing up
character and making the real trials and hardships of life much easier
than would otherwise be the case.

Not that human nature must not be expected to yield a little under
severe trials and bend before the blasts of adverse fortune, but {79}
that there should not be that tendency to exaggerate one's personal
feelings which has unfortunately become characteristic of at least the
better-to-do classes in our time. Not that we would encourage stony
grief, but that sorrow must be restrained and, above all, must not be
so utterly selfish as to be forgetful of others.

Tears should, to a large extent, be reserved, as they are in most
perfectly normal individuals, for joyous rather than sad occasions,
for no one ever was supremely joyful without having tears in the eyes.
It is when we feel most sympathetic to humanity that the gift of tears
comes to us, and no feeling is quite so completely satisfying as comes
from the tears of joy. Mothers who have heard of their boy's bravery,
its recognition by those above him, and its reward by proper symbols,
have had tears come welling to their eyes, while their hearts were
stirred so deeply with sensations of joy and pride that probably they
have never before felt quite so happy.

{80}

CHAPTER VI

AVOIDANCE OF CONSCIOUS USE OF THE WILL


  "Our bodies are our gardens to which our wills are gardeners."
                                                              _Othello_.


Doctor Austin O'Malley, in his little volume, "Keystones of Thought",
says: "When you are conscious of your stomach or your will you are
ill." We all appreciate thoroughly, as the result of modern progress
in the knowledge of the influences of the mind on the body, how true
is the first part of this saying, but comparatively few people realize
the truth of the second part. The latter portion of this maxim is most
important for our consideration. It should always be in the minds of
those who want to use their own wills either for the purpose of making
themselves well, or keeping themselves healthy, but above all, should
never be forgotten by those who want to help others get over various
ills that are manifestly due in whole or in part to the failure to use
the vital energies in the body as they should be employed.

{81}

Conscious use of the will, except at the beginning of a series of
activities, is always a mistake. It is extremely wasteful of internal
energy. It adds greatly to the difficulty of accomplishing whatever is
undertaken. It includes, above all, watching ourselves do things,
constantly calculating how much we are accomplishing and whether we
are doing all that we should be doing, and thus makes useless demands
on power partly by diversion of attention, partly by impairment of
concentration, but above all by adding to the friction because of the
inspection that is at work.

The old kitchen saw is "a watched kettle never boils." The real
significance of the expression is of course that it seems to take so
long for the water to boil that we become impatient while watching and
it looks to us as though the boiling process would really never occur.
This is still more strikingly evident when we are engaged in watching
our own activities and wondering whether they are as efficient as they
should be. The lengthening of time under these circumstances is an
extremely important factor in bringing about tiredness. Ask any human
being unaccustomed to note the passage of time to tell you when two
minutes have elapsed; {82} inevitably he will suggest at the end of
thirty to forty seconds that the two minutes must be up. Only by
counting his pulse or by going through some regular mechanical process
will he be enabled to appreciate the passage of time in anything like
its proper course. When watched thus, time seems to pass ever so much
more slowly than it would otherwise.

It is extremely important then that people should not acquire the
impression that they must be consciously using their will to bring
themselves into good health and keep themselves there, for that will
surely defeat their purpose. What is needed is a training of the will
to do things by a succession of harder and harder tasks until the
ordinary acts of life seem comparatively easy. Intellectual persuasion
as to the efficiency of the will in this matter means very little. The
ordinary feeling that reasoning means much in such matters is a
fallacy. Much thinking about them is only disturbing of action as a
rule and Hamlet's expression that the "native hue of resolution is
sicklied o'er with the pale cast of thought" is a striking bit of
psychology.

Shakespeare had no illusions with regard to the place of the will in
life and more than any English author has emphasized it. I have {83}
ventured to illustrate this by quotations from him under each chapter
heading, but there are many more quite as applicable that might
readily be found. He knew above all how easy it was for human beings
to lessen the power of their wills and has told us of "the cloy'd will
that satiateth unsatisfied desire" and "the bridles of our wills", and
has given us such adjectives as "benumbed" and "neutral" and "doting",
which demonstrates his recognition of how men weaken their wills by
over-deliberation.

The mode of training in the army is of course founded on this mode of
thinking. The young men in the United States Army want to accomplish
every iota of their duty and are not only willing but anxious to do
everything that is expected of them. There were some mighty difficult
tasks ahead of them over in Europe and our method of preparing the men
was not by emphasizing their duty and dinning into their ears and
minds how great the difficulty would be and how they must nerve
themselves for the task. Such a mode of preparation would probably
have been discouraging rather than helpful. But they were trained in
exercises of various kinds in an absolutely regular life under plain
living in the {84} midst of hard work until their wills responded to
the word of command quite unconsciously and immediately without any
need of further prompting. Their bodies were trained until every
available source of energy was at command, so that when they _wanted_
to do things they set about them without more ado, and as they were
used to being fatigued they were not constantly engaged in dreading
lest they should hurt themselves, or fostering fears that they might
exhaust their energies or that their tiredness, even when apparently
excessive, would mean anything more than a passing state that rest
would repair completely.

If at every emergency of their life at war soldiers had to go through
a series of conscious persuasions to wake up their will and set their
energies at work, and if they had to occupy themselves every time in
presenting motives why this activity should not be delayed, then
military discipline, at least in so far as it involves prompt
obedience, would almost inevitably be considerable of a joke. What is
needed is unthinking, immediate obedience, and this can be secured
only by the formation of deeply graven habits which enable a man to
set about the next thing that duty calls for at once.

{85}

Every action that we perform is the result of an act of the will, but
we do not have to advert to that as a rule; whenever any one gets into
a state of mind where it is necessary to be constantly adverting to
it, then, as was said at the beginning of this chapter, there is
something the matter with the will. The faculty is being hampered in
its action by consciousness, and such hampering leads to a great waste
of energy.

The will is the great, unconscious faculty in us. By far the greater
part of what has come unfortunately to be called the unconscious and
the subconscious and that has occupied so much of the attention of
modern writers on psychological subjects is really the will at work.
It attains its results we know not how, and it is prompted to their
accomplishment in ways that are often very difficult for us to
understand. Its effects are often spoken of as due to the submerged
self or the subliminal self or the other self, but it is only in rare
and pathological cases as a rule that such expressions are justified
once the place of the will is properly recognized.

It is often said, for instance, that the power some people have of
waking after a certain {86} period of sleep at night or after a short
nap during the daytime, a power that a great many more people would
possess if only they deliberately practised it, is due to the
subconsciousness or the subliminal personality of the individual which
wakes him up at the determined time. Why those terms should be used
when other things are accomplished by the human will just as
mysteriously is rather difficult to understand. It is well recognized
that if an individual in the ordinary waking state wants to do
something after the lapse of an hour or so he will do it, provided his
will is really awake to the necessity of accomplishing it. It is true
that he may become so absorbed in his current occupation as to miss
the time, but such abstraction usually means that he was not
sufficiently interested in the duty that was to be performed as to
keep the engagement with himself, or else that he is an individual in
whom the intellectual over-shadows the voluntary life. We speak of him
as an impractical man.

We all know the danger there is in putting off calling some one by
telephone on being told that "the line is busy", for not infrequently
it will happen that several hours will elapse before we think of the
matter again {87} and then perhaps it may be too late. If we set a
definite time limit with ourselves, however, then our will will prompt
us quite as effectively, though quite as inexplicably, at the
expiration of that time as it awakes those who have resolved to be
aroused at a predetermined moment. We may miss our telephone
engagement with ourselves, but we practically never miss an important
train, because having deeply impressed upon ourselves the necessity
for not missing this, our will arouses us to activity in good time.
There is not the slightest necessity, however, for appealing to the
unconscious or the subconscious in this. It is true that there is a
wonderful sentinel within us that awakes us from daydreams or disturbs
the ordinary course of some occupation to turn our attention to the
next important duty that we should perform. We know that this sentinel
is quite apart from our consciousness; but the power we have of
setting ourselves to doing anything is exemplified in very much the
same way. When I want a book, I do not know what it is that sets my
muscles in motion and brings me to a shelf and then directs my
attention to choosing the one I shall take down and consult. It is an
unconscious activity, but not the activity of {88} unconsciousness,
which is only a contradiction in terms.   [Footnote 4]

  [Footnote 4: It is true that there is a particular phase of our
  intellectual effort included under the modern terms unconscious or
  subconscious that is mysterious enough to deserve a special name,
  but we already have an excellent term for this quality which is not
  vague but thoroughly descriptive of its activity. This is
  intuition,--a word that has been in use for nearly a thousand years
  now and signifies the immediate perception of a truth,--by a flash
  as it were. We may know nothing about a subject and may have only
  begun to think about it, when there flashes on us a truth that has
  perhaps never occurred to any one else and certainly has never been
  in our minds before. It has been suggested in recent years that such
  flashes of intelligence are due to the secondary personality or the
  subliminal self or the other self, and it is often added that it is
  the development of our knowledge of these phases of psychology that
  represents modern progress in the science of mind. Only the term for
  it is new, however, for intuition has been the subject of special
  intensive study for a long while. Indeed, the reason why the
  old-time poet appealed to the muses for aid and the modern poet
  suggests inspiration as the source of his poetic thought, is because
  both of them knew that their best thoughts flash on them, not as the
  result of long and hard thinking, but by some process in which with
  the greatest facility come perceptions that even they themselves are
  surprised to learn that they have. To say that such things come from
  the unconscious is simply to ignore this wonderful power of original
  thought, that is, primary perception. Emerson suggested that
  intuition represented all the knowledge that came without tuition,
  as if this were the etymology, and the hint is excellent for the
  meaning, though the real derivation of the word has no relation to
  tuition. To attribute these original thoughts to the unconscious or
  any partly conscious faculty in us is to ignore a great deal of
  careful study of psychology before our time. It is besides to
  entangle oneself in the absurdity of discussing an unconscious
  consciousness.]

While many people are inclined to feel almost helpless in the presence
of the idea that it is their unconscious selves that enable them {89}
to do things or initiate modes of activity, the feeling is quite
different when we substitute for that the word "will." All of us
recognize that our wills can be trained to do things, and while at
first it may require a conscious effort, we can by the formation of
habits not only make them easy, but often delightful and sometimes
quite indispensable to our sense of well being. Walking is extremely
difficult at the beginning, when its movements are consciously
performed, but it becomes a very satisfying sort of exercise after a
while and then almost literally a facile, nearly indispensable
activity of daily life, so that we feel the need for it, if we are
deprived of it.

This has to be done with regard to the activities that make for
health. We have to form habits that render them easy, pleasant, and
even necessary for our good feelings. This can be done, as has been
suggested in the chapter on habits, but we have to avoid any such
habit as that of consciously using the will. That is a bad habit that
some people let themselves drop into but it should be corrected.
Having set our activities to work we must, as far as possible, forget
about them and let them go on for themselves. It is not only possible
but even easy and above all almost {90} necessary that we should do
this. Hence at the beginning people must not expect that they will
find the use of their will easy in suppressing pain, lessening
tiredness, and facilitating accomplishment, but they must look forward
to the time quite confidently when it will be so. In the meantime the
less attention paid to the process of training, the better and more
easily will the needed habits be formed.

Failure to secure results is almost inevitable when conscious use of
the will comes into the problem. As a rule a direct appeal should not
be made to people to use their wills, but they should be aroused and
stimulated in various ways and particularly by the force of example.
What has made it so comparatively easy for our young soldiers to use
their wills and train their bodies and get into a condition where they
are capable of accomplishing what they would have thought quite
impossible before, has been above all the influence of example. A lot
of other young men of their own age are standing these things
exemplarily. They are seen performing what is expected of them without
complaint, or at least without refusal, and so every effort is put
forth to do likewise without any time spent on reflection as to how
{91} difficult it all is or how hard to bear or how much they are to
be pitied. It is not long before what was hard at first becomes under
repetition even easy and a source of fine satisfaction. Getting up at
five in the morning and working for sixteen hours with only
comparatively brief intervals for relaxation now and then, and often
being burdened with additional duties of various kinds which must be
worked in somehow or other, seems a very difficult matter until one
has done it for a while. Then one finds everything gets done almost
without conscious effort. Will power flows through the body and lends
hitherto unexpected energy, but of this there is no consciousness;
indeed, conscious reflection on it would hamper action. No wonder that
as a result of the facility acquired, one comes to readily credit the
assumption that the will is a spiritual power and that some source of
energy apart from the material is supplying the initiative and the
resources of vitality that have made accomplishment so much easier
than would have been imagined beforehand. This is quite literally what
training of the will means: training ourselves to use all our powers
to the best advantage, not putting obstacles in their way nor brakes
on their exertion, but {92} also not thinking very much about them or
making resolutions. The way to do things is to do them, not think
about them.

Professor James is, as always, particularly happy in his mode of
expressing this great truth. He insists that the way to keep the will
active is not by constantly thinking about it and supplying new
motives and furbishing up old motives for its activity, but by
cultivating the faculty of effort. His paragraph in this regard is of
course well known, and yet it deserves to be repeated here because it
represents the essence of what is needed to make the will ready to do
its best work. He says:

  "As a fine practical maxim, relative to these habits of the will, we
  may, then, offer something like this: _Keep the faculty of effort
  alive in you by a little gratuitous exercise every day_. That is, be
  systematically ascetic or heroic in little unnecessary points, do
  every day or two something for no other reason than that you would
  rather not do it, so that when the hour of dire need draws nigh, it
  may find you not unnerved and untrained to stand the test.
  Asceticism of this sort is like the insurance which a man pays on
  his house and goods. The tax does him no good at the time and {93}
  possibly may never bring him a return. But if the fire _does_ come,
  his having paid it will be his salvation from ruin. So with the man
  who has daily inured himself to habits of concentrated attention,
  energetic volition, and self-denial in unnecessary things. He will
  stand like a tower when everything rocks around him, and when his
  softer fellow mortals are winnowed like chaff in the blast."

To do things on one's will without very special interest is an
extremely difficult matter. It can be done more readily when one is
young and when certain secondary aims are in view besides the mere
training of the will, but to do things merely for will training
becomes so hard eventually that some excuse is found and the task is
almost inevitably given up. Exercising for instance in a gymnasium
just for the sake of taking exercise or keeping in condition becomes
so deadly dull after a while that unless there is a trainer to keep a
man up to the mark, his exercise dwindles from day to day until it
amounts to very little. Men who are growing stout about middle life
will take up the practice of a cold bath after ten minutes or more of
morning exercises with a good deal of enthusiasm, but they will not
keep it up long, or if they do continue for several months, any {94}
change in the daily routine will provide an excuse to drop it.
Companionship and above all competition in any way greatly helps, but
it takes too much energy of the will to make the effort alone.
Besides, when the novelty has worn off and routine has replaced
whatever interest existed in the beginning in watching the effect of
exercise on the muscles, the lack of interest makes the exercise of
much less value than before. If there is not a glow of satisfaction
with it, the circulation, especially to the periphery to the body, is
not properly stimulated and some of the best effect of the exercise is
lost. Athletes often say of solitary exercise that it leaves them
cold, which is quite a literal description of the effect produced on
them. The circulation of the surface is not stimulated as it is when
there is interest in what is being done and so the same warmth is not
produced at the surface of the body.

It is comparatively easy to persuade men who need outdoor exercise to
walk home from their offices in the afternoon when the distance is not
too far, but it is difficult to get them to keep it up. The walk
becomes so monotonous a routine after a time that all sorts of excuses
serve to interrupt the habit, and then it is not long before it is
done so irregularly as to lose {95} most of its value. Here as in all
exercise, companionship which removes conscious attention from
advertence to the will greatly aids. On the other hand, as has been so
clearly demonstrated in recent years, it is very easy to induce men to
go out and follow a little ball over the hills in the country, an
ideal form of exercise, merely because they are interested in their
score or in beating an opponent. Any kind of a game that involves
competition makes people easily capable of taking all sorts of
trouble. Instead of being tired by their occupation in this way and
not wanting to repeat it, they become more and more interested and
spend more and more time at it. The difference between gymnastics and
sport in this regard is very marked.

In sport the extraneous interest adds to the value of the exercise and
makes it ever so much easier to continue; when it sets every nerve
tingling with the excitement of the game, it is doing all the more
good. Gymnastics grow harder unless in some way associated with
competition, or with the effort to outdo oneself, while indulgence in
sport becomes ever easier. Many a young man would find it an
intolerable bore and an increasingly difficult task if asked to give
as much time and energy {96} to some form of hard work as he does to
some sport. He feels tired after sport, but not exhausted, and becomes
gradually able to stand more and more before he need give up, thus
showing that he is constantly increasing his muscular capacity.

Conscious training of the will is then practically always a mistake.
It is an extremely difficult thing to do, and the amount of inhibition
which accumulates to oppose it serves after a time to neutralize the
benefit to be derived. Good habits should be formed, but not merely
for the sake of forming them. There should be some ulterior purpose
and if possible some motive that lifts men up to the performance of
duty, no matter how difficult it is.

Our young men who went to the camps demonstrated how much can be
accomplished in this manner. They were asked to get up early in the
morning, to work hard for many hours in the day, or take long walks,
sometimes carrying heavy burdens, and were so occupied that they had
but very little time to themselves. They were encouraged to take
frequent cold baths, which implied further waste of heat energy, and
then were very plainly fed, though of course with a good, rounded
diet, {97} well-balanced, but without any frills and with very little
in it that would tempt any appetite except that of a hungry man. They
learned the precious lesson that hunger is the best sauce for food.

Most of these men were pushed so hard that only an army officer
perfectly confident of what he was doing and well aware that all of
his men had been thoroughly examined by a physician and had nothing
organically wrong with them would have dared to do it. A good many of
us had the chance to see how university men took the military regime.
Long hours of drilling and of hard work in the open made them so tired
that in the late afternoon they could just lie down anywhere and go to
sleep. I have seen young fellows asleep on porches or in the late
spring on the grass and once saw a number of them who found excellent
protection from the sun in what to them seemed nice soft beds--at
least they slept well in them--inside a series of large earthen-ware
pipes that were about to be put down for a sewer. Some of them were
pushed so hard, considering how little physical exercise they had
taken before, that they fainted while on drill. Quite a few of them
were in such a state of nervous tension that they fainted on {98}
being vaccinated. Almost needless to say, had they been at home, any
such effect would have been a signal for the prompt cessation of such
work as they were doing, for the home people would have been quite
sure that serious injury would be done to their boys. These young
fellows themselves did not think so. Their physicians were confident
that with no organic lesion present the faint was a neurotic
derangement and not at all a symptom of exhaustion. The young soldiers
would have felt ashamed if there had been any question of their
stopping training. They felt that they could make good as well as
their fellows. They would have resented sympathy and much more pity.
They went on with their work because they were devoted to a great
cause. After a time, it became comparatively easy for them to
accomplish things that would hitherto have been quite impossible and
for which they themselves had no idea that they possessed the energy.
It was this high purpose that inspired them to let more and more of
their internal energy loose without putting a brake on, until finally
the habit of living up to this new maximum of accomplishment became
second nature and therefore natural and easy of accomplishment.

{99}

Here is the defect in systems which promise to help people to train
their wills by talking much about it, and by persuading them that it
can be done, that all they have to do is to set about it. Unless one
has some fine satisfying purpose in doing things, their doing is
difficult and fails to accomplish as much good for the doer as would
otherwise be the case. Conscious will activity requires, to use
old-fashioned psychological terms, the exercise of two faculties at
the same time, the consciousness and the will. This adds to the
difficulty of willing. What is needed is a bait of interest held up
before the will, constantly tempting it to further effort but without
any continuing consciousness on the part of the individual that he
must will it and keep on willing it. That must ever be a hampering
factor in the case. Human nature does not like imperatives and writhes
and wastes energy under them. On the contrary, optatives are pleasant
and give encouragement without producing a contrary reaction; and it
is this state of mind and will that is by far the best for the
individual.

Above all, it is important that the person forming new habits should
feel that there is nothing else to be done except the hard things
{100} that have been outlined. If there is any mode of escape from the
fulfillment of hard tasks, human nature will surely find it. If our
young soldiers had felt that they did not have to perform their
military duties and that there was some way to avoid them, the taking
of the training would have proved extremely difficult. They just _had_
to take it; there was no way out, so they pushed themselves through
the difficulties and then after a time they found that they were
tapping unsuspected sources of energy in themselves. For when people
_have_ to do things, they find that they can do ever so much more than
they thought they could, and in the doing, instead of exhausting
themselves, they actually find it easier to accomplish more and more
with ever less difficulty. The will must by habit be made so prompt to
obey that obedience will anticipate thought in the matter and
sometimes contravene what reason would dictate if it had a chance to
act. The humorous story of the soldier who, carrying his dinner on a
plate preparatory to eating it, was greeted by a wag with the word
"Attention!" in martial tones, and dropped his dinner to assume the
accustomed attitude, is well known. Similar practical jokes are said
to have been played, on a certain number {101} of occasions in this
war, with the thoroughly trained young soldier.

The help of the will to the highest degree is obtained not by a series
of resolutions but by doing whatever one wishes to do a number of
times until it becomes easy and the effort to accomplish it is quite
unconscious. Reason does not help conduct much, but a trained will is
of the greatest possible service. It can only be secured, however, by
will action. The will is very like the muscles. There is little use in
showing people how to accomplish muscle feats; they must do them for
themselves. The less consciousness there is involved in this, the
better.

{102}

CHAPTER VII

WHAT THE WILL CAN DO


  "I can with ease translate it to my will."
                                    _King John_.


It should be well understood from the beginning just what the will can
do in the matter of the cure or, to use a much better word, the relief
of disease, not forgetting that disease means etymologically and also
literally discomfort rather than anything else. The will cannot cure
organic disease in the ordinary sense of that term. It is just as
absurd to say that the will can bring about the cure of Bright's
disease as it is to suggest that one can by will power replace a
finger that has been lost. When definite changes have taken place in
tissues, above all when connective tissue cells have by inflammatory
processes come to take the place of organic tissue cells, then it is
idle to talk of bringing about a cure, though sometimes relief of
symptoms may be secured; above all the compensatory powers of the body
{103} may be called upon and will often bring relief, for a time, at
least. What is true of kidney changes applies also to corresponding
changes in other organs, and there can be no question of any amount of
will power bringing about the redintegration of organs that have been
seriously damaged by disease or replacing cells that have been
destroyed.

There are however a great many organic diseases in which the will may
serve an extremely useful purpose in the relief of symptoms and
sometimes in producing such a release of vital energy previously
hampered by discouragement as will enable the patient to react
properly against the disease. This is typically exemplified in
tuberculosis of the lungs. Nothing is so important in this disease, as
we shall see, as the patient's attitude of mind and his will to get
well. Without that there is very little hope. With that strongly
aroused, all sorts of remedies, many of them even harmful in
themselves, have enabled patients to get better merely because the
taking of them adds suggestion after suggestion of assurance of cure.
The cells of the lungs that have been destroyed by the disease are not
reborn, much less recreated, but nature walls off the diseased parts,
and the rest of {104} the lungs learn to do their work in spite of the
hampering effect of the diseased tissues. When fresh air and good food
are readily available for the patient, then the will power is the one
other thing absolutely necessary to bring about not only relief from
symptoms, but such a betterment in the tissues as will prevent further
development of the disease and enable the lungs to do their work. The
disease is not cured, but, as physicians say, it is arrested, and the
patient may and often does live for many years to do extremely useful
work.

In a disease like pneumonia the will to get well, coupled with the
confidence that should accompany this, will do more than anything else
to carry the patient over the critical stage of the affection.
Discouragement, which is after all by etymology only disheartenment,
represents a serious effect upon the heart through depression. The
fullest power of the heart is needed in pneumonia and discouragement
puts a brake on it. As we shall see it is probably because whiskey
took off this brake and lifted the scare that it acquired a reputation
as a remedy in pneumonia and also in tuberculosis. In spite of what
was probably an unfavorable physical effect, whiskey {105} actually
benefited the patient by its production of a sense of well being and
absence of regard for consequences. Hence its former reputation. This
extended also to its use in a continued fever where the same
disheartenment was likely to occur with unfortunate consequences on
the general condition and above all with disturbance of appetite and
of sleep. Worry often made the patients much more restless than they
would otherwise have been and they thus wasted vital energy needed to
bring about the cure of the affection under which they were laboring.

In all of these cases solicitude led to surveillance of processes
within the body and interfered with their proper performance. It is
perfectly possible to hamper the lungs by watching their action, and
the same thing may be done for the heart. Whenever involuntary
activities in the body are watched, their proper functioning is almost
sure to be disturbed. We have emphasized that in the chapter on
"Avoidance of Conscious Use of the Will," and so it need not be dwelt
on further here.

Even apart from over-consciousness there occur some natural dreads
that may disturb nature's vital reactions, and these can be {106}
overcome through the will. There is a whole series of inhibitions
consequent upon fears of various kinds that sadly interfere with
nature's reaction against disease. To secure the neutralization of
these the will must be brought into action, and this is probably
better secured by suggestion, that is, by placing some special motive
before the individual, than by any direct appeal. Particularly is this
true if patients have not been accustomed before this to use their
wills strenuously, for they will probably be disturbed by such an
appeal.

What will power when properly released can do above all is to bring
the relief of discomfort. In a great many cases the greater part of
the discomfort is due to over-sensitization and over-attention. Even
in such severe organic diseases as cancer, the awakening of the will
may accomplish very much to bring decided relief. This is why we have
had so many "cancer cures" that have failed. They made the patient
feel better at first, and they relieved pain to some extent and
therefore were thought to be direct remedial agents for the cancer
itself. The malignant condition however has progressed without
remission, though sometimes, possibly as the result of the new courage
given flowing as surplus vitality into {107} the tissues, perhaps the
progress of the lesion has been retarded. The patient sometimes has
felt so much better as to proclaim himself cured. What is thus true of
cancer will be found to occur in any very serious organic condition,
such as severe injury, chronic disease involving important organs, and
even such nutritional diseases as anemia or diabetes. The awakening in
the patient of the feeling that there is hope and the maintenance of
that hope in any way will always bring relief and usually some
considerable remission in the disease.

It is in convalescence above all, however, that the will power
manifests its greatest helpfulness. When patients are hopeful and
anxious to get well they are tempted to eat properly, to get out into
the air; they thus sleep better and recovery is rapid. Whenever they
are disheartened, as for instance when husband and wife have been
together in an injury, or both have contracted a disease and one of
them dies, the survivor is likely to have a slow and lingering
convalescence. The reason is obvious: there is literal lack of will
power or at least unwillingness to face the new conditions of life,
and vitality is spent in vain regret for the companionship that has
been {108} lost. This depression can only be lifted by motives that
appeal to the inner self and by such an awakening of the will for
further interests in life as will set vital energies flowing freely
again.

In convalescence from injuries received after middle life or from
affections that have been accompanied by incapacity to use muscles
there is particular need of the will. A great many older people refuse
to go through the pain and discomfort, soreness and tenderness as the
younger folk who are training their muscles call them, which must be
borne in order to bring about redevelopment of muscles, after they
have once become atrophic from disuse. The refusal to push through a
period of what is often rather serious discomfort leads many people to
foster disabilities and use their muscles in wrong ways sometimes even
for years. Something occurs then to arouse their wills and they get
better. Anything that will do this will cure them. Sometimes it is a
new liniment, sometimes a new mode of manipulation or massage,
sometimes some supposed electrical or magnetic discovery and sometimes
the touch of a presumed healer. Anything at all will be effective
provided it wakens their wills into such activity {109} as will enable
them to persist in the use of their muscles through the period of
soreness and tenderness necessary to restore proper muscular
functions.

It is quite surprising to see what can be accomplished in this way,
and the quacks and charlatans of the world have made their fortunes
out of such patients always, while their cure has been the greatest
possible advertisement and has attracted ever so many other patients
to these so-called healers. Nothing that can be done for these
patients will have any good results unless their own wills are
aroused, new hope given them and they themselves made to tap the
layers of energy in them that can restore them to health. To tell them
that they were to be cured by their own will, however, would probably
inhibit utterly this energy that is needed, so that somehow they have
to be brought to the state of mind in which they will accomplish the
purpose demanded of them by indirection.

The will is particularly capable of removing obstacles to nutrition
that have often hampered the activities and sometimes seriously
impaired the health of patients. Many people are not eating enough for
one reason or another and need to have their diet regulated, not in
{110} the direction of a limitation or selection of food, though this
appeals to so many people under the term dieting, but so that they
shall eat enough and of the proper variety to maintain their health
and bodily functions. A great many nervous diseases are dependent on
lack of sufficient food. Eating in those who lead sedentary lives much
indoors is ever so much more a matter of will than of appetite. When
people say that they eat all they want to, what they mean, as a rule,
is that they eat all that they have formed the habit of eating. Other
habits can readily be formed and will often do them good. For a great
many of the less serious symptoms which make people valetudinarians,
nervous indigestion, insomnia, tendencies to headache, queer feelings
in the head, constipation, the proper habit secured by will power, of
eating so as to secure sufficient food, is the most important single
factor. This the will must be trained to accomplish.

Now that disease prevention has become even more important than cure,
the will is an extremely efficient element. Air, food, exercise are
important factors for healthy living. A great many people are
neglecting them and then seem surprised that they should suffer from
various symptoms of impaired {111} functioning of bodily organs. Many
men and a still greater number of women are staying in the house so
much that their oxidation within the body is at a low ebb, and it is
no wonder that vital processes are not carried on to the best
advantage. Our generation has eliminated exercise from life to a great
extent, and now that the auto and the trolley car limit walking, not
only the feet of mankind suffer severely, but all the organs in the
body work at a disadvantage for lack of the exercise that they should
have. No wonder that under the circumstances appetite is impaired and
other functions of the body suffer. Instead of simple foods various
artificial stimulants are employed--such as alcohol, spices, and the
like--to provoke appetite, often with serious consequences for the
digestive organs. The will to be well includes the willing of the
means proper to that purpose, and particularly regular exercise,
several hours a day in the air, good simple food taken in sufficient
quantity at three regular intervals and the avoidance of such sources
of worry as will disturb physical functions.

{112}


CHAPTER VIII

PAIN AND THE WILL


  "That the will is infinite and the execution confined."
                                    _Troilus and Cressida_.


The symptom of disease that humanity dreads the most is pain.
Fortunately, it is also the symptom which is most under the control of
the will, and which can be greatly relieved by being bravely faced
and, to as great an extent as possible, ignored. It requires courage
and usually persistent training to succeed in the relief of severe
pain in this way, but men have done it, and women too, and men and
women _can_ do it, if they really want to, though unfortunately all of
the trend of modern life has been in the opposite direction, of
avoiding pain at whatever cost instead of bravely facing it. The
American Indian, trained from his youth to stand severe pain, scoffed
at even the almost ingeniously diabolical tortures of his enemy
captors. After they had pushed slivers beneath his nails or {113}
slowly crushed the end of a finger, or put salt in long, superficial
wounds that had bared a whole series of sensitive cutaneous nerves, he
has been known to laugh at them, and ask them proudly, without giving
a sign of the pain that he was enduring, whether that was all that
they could do. It was just a question of the human will overcoming
even the worst sensations that the body could send up to the brain and
deliberately refusing to permit any reactions that would reveal the
reflex torment that was actually taking place.

The war has done much to bring back the recognition of that
diminution--to a great extent at least--or even almost entire
suppression of pain which may occur, indeed almost constantly does
occur, as a consequence of a man facing it bravely. We have been
accustomed to think of the early martyrs as probably divinely helped
in their power to withstand pain. Whatever of celestial aid they had,
we know that martyrs for all sorts of causes, some of them certainly
not divine, have exhibited some degree of this same steadfastness.
Their behavior makes it reasonably clear that as the result of making
up their minds to stand the pain involved, they have actually suffered
so little that it was not {114} difficult to suppress external
manifestations of their sufferings. It is not merely a suppression of
the reflexes that has occurred but a minimizing to a very striking
degree of the actual sensations felt. We have many stories of the
older time before the modern use of anaesthetics, which tell how
bravely men endured pain and at the same time retained their power to
do things. Indeed, some of them accomplished purposes in the midst of
what would seem like supreme agony which made it very clear that pain
alone has nothing like the prostrating effect that it is often
supposed to have.

For we have well authenticated tales of physicians performing
amputations on themselves at times when no other assistance was
available, and accomplishing the task so well that they recovered
without complications. A blacksmith in the distant West, whose leg had
been crushed by the fall of a huge beam, actually had himself carried
into his shop and amputated his own limb above the knee, searing the
blood vessels with hot irons as he proceeded. Such a manifestation of
will power is, of course, exceptional to a degree, and yet it
illustrates what men can do in the face of conditions that are usually
supposed {115} to be overwhelming. Many a man in lumber camps or in
distant island fisheries or on board fishing vessels, far beyond the
hope of reaching a physician in time for him to be of service, has
done things of this kind. We can be quite sure that the will to
accomplish for himself what seemed necessary to save his life lessened
his pain, made it ever so much more bearable and generally proved the
power of the human will over even these physical manifestations in the
body that are commonly supposed to be quite beyond any interference
from the psychical part of nature. The spirit can still dominate the
flesh, even in matters of pain, and dictate how much it shall be
affected. It is a hard lesson to learn, but it is one that can be
learned by proper persistence.

In the early part of the war particularly many a young man had to face
even serious operations without an anaesthetic. The awful carnage of
the first six weeks of the war had not been anticipated and therefore
there were not sufficient stores of anaesthetics available to permit
of their use in every case. Besides, many operations had to be
performed so close to the front and under such circumstances that
there could not be anaesthetics for all of them; and it was a
never-ending source of {116} surprise to those who witnessed the
details to see how bravely and uncomplainingly the young men took
their enforced suffering. Many a one, when his turn came to be
operated on, quietly asked for a cigarette and then bore unflinchingly
painful manipulations that the surgeon was extremely sorry to have to
inflict. Over and over again, when there was question of the regular
succession of patients, young soldiers in severe pain suggested that
some one else who seemed in worse condition than they, or who perhaps
was not quite so well able to stand pain and control himself, should
be attended to before they were. There is no doubt at all that this
very power of self-control lessened their pain and made it ever so
much easier to bear and less of a torment than it would have been
otherwise.

Any great diversion of mind that turns the attention completely to
something else will lessen even severe pain so much as to make it
quite negligible for the moment. Headaches disappear promptly when
there is an alarm of fire, and toothaches have been known to vanish,
for the time at least, as the result of a burglar scare. Much less
than this is needed, however, and there are many familiar examples
{117} which illustrate the fact that the turning of the attention to
something else will greatly diminish or even abolish pain.

The well known story of the French surgeon about to set a dislocation
is a typical demonstration. His patient was a woman of the nobility,
her dislocation was of the shoulder and it was necessary for him to
inflict very severe pain in order to replace it. Besides, as the
result of the reflex of that pain, he was certain to meet with great
resistance from spasm in the surrounding muscles. It was before the
days of anaesthetics, which relieve all of these inconveniences, and
above all, relax the muscles. The surgeon got ready to do the ultimate
manipulation that would replace the joint in its proper relation, and
necessarily inflicted no little pain in his preparations. The lady
complained very much, so he turned on her angrily, told her that she
must stand it, slapped her in the face, and before she had recovered
from the shock, the dislocation had been restored to the normal
condition. It was rather heroic treatment, and it is to be hoped that
she understood it, but it is easy to understand how much the procedure
lessened her physical pain.

When the mind is very much preoccupied {118} and the will intent on
accomplishing some immediate purpose, even severe pain will not be
felt at all. Instances of this are not rare, and men who are advancing
in a charge on a battlefield will often be wounded rather severely,
and yet continue to advance without knowing anything about their
wounds until a friend calls attention to their bleeding, or they
themselves notice it; or perhaps even loss of blood may make them
faint. The late President Roosevelt furnished a magnificent
illustration of this principle when he was wounded some years ago in
the midst of a political campaign. A crank shot at him, in one of the
Western cities, and though the bullet penetrated four inches of muscle
on his chest wall, and then flattened itself against a rib, he did not
know that he was wounded. The flattening of the bullet must have
represented at least as much force as would be exerted by a heavy blow
on the chest, and yet the Colonel never felt it. His friends
congratulated him on his escape from injury until it was noted that
blood was oozing through a hole that had been made in his coat. The
intense will activity of the President simply kept him from noticing
either the shock or the pain.

{119}

Not long before the war a striking example was given of how a man may
stand suffering in spite of long years of the refining influences of a
sedentary scholarly life, most of it spent indoors. The second last
General of the Jesuits developed a sarcoma on his upper arm and was
advised to submit to an amputation of the arm at the shoulder joint.
He was a man well on in the sixties and the operation presented an
extremely serious problem. The surgeons suggested that he should be
ready for the anaesthetic at a given hour the next morning and then
they would proceed to operate. He replied that he would be ready for
the operation at the time suggested, but that he would not take an
anaesthetic. They argued with him that it would be quite impossible
for him to stand unanaesthetized the extensive cutting and dissection
necessary to complete an operation of this kind in an extremely
important part of the body, where large nerves and arteries would have
to be cut through and where the slightest disturbance on the part of
the patient might easily lead to serious or even fatal results. Above
all, he could not hope to stand it in tissues that had been rendered
more sensitive than before by the enlarged circulation to the part,
due to {120} the growth of the tumor, and the consequent hyperaemic
condition of most of the tissues through which the cutting would have
to be done and which were thus hypersensitized.

He insisted, however, that he would not take an anaesthetic, for
surely here seemed a chance to welcome suffering voluntarily as his
Lord and Master had done. I believe that the head surgeon said at
first that he would not operate. He felt sure that the operation would
have to be interrupted after it had been begun, because the patient
would not be able to stand the pain and there would then be the danger
from bleeding as well as from infection which might occur. The General
of the Jesuits, however, was so calm and firm that at last it was
determined to permit him to try at least to stand it, though most of
the surgeons were sure that he would probably have to give up and
allow himself to be anaesthetized before they were through.

The event then was most interesting. The patient not only underwent
the operation without a murmur, but absolutely without wincing. The
surgeon who performed the operation said afterwards, "It was like
cutting wax and not human flesh, so far as any reaction was concerned,
though of course it bled."

{121}

The story carries its lesson of the power of a brave man to face even
such awful pain as this and probably actually overcome it to such an
extent that he scarcely felt it, simply because he willed that he
would do so and occupied himself with other thoughts during the
process.

Such an example as that of this General of the Jesuits will seem to
most people a reversion to that mystical attitude of mind of the
medieval period, when somehow or other people were able to stand ever
so much more pain than any one in our time could possibly think of
enduring. We hear of saints of the Middle Ages who inflicted what now
seem hideous self-tortures on themselves and not only bore them
bravely but went about life smiling and doing good to others while
they were under the influence of them. It would seem quite impossible,
however, for people of the modern time to get into any such state of
mind. Our discoveries for the prevention of pain have made it
unnecessary to stand much suffering, and as a result mankind would
seem to have lost some if not most of the faculty of standing pain. So
little of truth is there in any such thought that any number of the
young men of the present generation between {122} twenty and thirty,
that is, during the very years when mankind most resents pain and
therefore reacts most to it, and by the same token feels it the most,
have shown during this war that they possessed all the old-fashioned
faculty of standing pain without a whimper and thinking of others
while they did it.

Lack of advertence always lessens pain and may even nullify it until
it becomes exceedingly severe. In his little volume, "A Journey around
My Room", Xavier de Maistre dwells particularly on the fact that his
body, when his spirit was wandering, would occasionally pick up the
fire tongs and burn itself before his _alter ego_ could rescue it.
Concentration of attention on some subject that attracts may
neutralize pain and make it utterly unnoticed until physical
consequences develop. Undoubtedly dwelling on pain, anticipating it,
noting the first sensations that occur, multiplies the painful
feeling. The physical reasons for this are to be found in the
increased blood supply consequent upon conscious attention to any
part, which sensitizes the nerves of the area and the added number of
nerve fibers that are at once put into association with the area by
the act of concentration of the attention. These serve to render
sensation {123} much more acute than it would otherwise be. It might
seem impossible to control the attention, but this has been done over
and over again, even in the midst of severe pain, until there is no
doubt that it is quite possible. As for the increase of pain by
deliberate attention, that is so familiar an experience that
practically every one has had it at some time.

The reason for it has become very clear as the result of our
generation's investigations into the constitution of the nervous
system. The central nervous system, instead of being a _continuum_, or
series of nerve elements which are directly connected with each other,
consists of a very large number of separate individual cells which
only make contacts with each other, the nerve impulses flowing over
across the contact. The demonstration of these we owe originally to
Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was
awarded some years ago the Nobel Prize as well as the Prize of the
City of Paris for his researches.

In connection with his surprising discoveries as to the neurons which
make up the brain, he suggested the Law of Avalanche, which would
serve to explain the supersensitiveness of parts to which concentrated
attention is paid. {124} According to this law, pain felt in any small
area of the body may be multiplied very greatly if the sensation from
it is distributed over a considerable part of the brain, as happens
when attention is centered upon it. A pain message that comes from a
localized area of the body disturbs under normal conditions at most a
few thousand cells in the brain, because the area is directly
represented only by these cells. They are connected however by
dendrites and cell branches of various kinds with a great many other
cells in different parts of the brain. A pain message that comes up
will ordinarily produce only disturbance of the directly connected
cells, but it may be transmitted and diffused over a great many of the
cells of the cortex of the brain if the attention is focused strongly
on it. The area at first affected, but a few thousand cells, may
spread to many millions or perhaps even some hundreds of millions of
them, if the centering of attention causes them to be "connected up",
as the electricians say, with the originally affected small group of
cells.

It is just what happens in high mountains when a few stones loosened
somewhere near the top by the wind or by melting processes begin their
course down the mountain side. {125} On the way they disturb ever more
and more of the loose pieces of ice and the shifting snows as well as
the rocks near them, until, gathering force, what was at the beginning
only a minor movement of small particles becomes a dreaded avalanche,
capable not only of sweeping away men in its path but even of
obliterating houses and sometimes of changing the whole face of a
mountain area. Hence the expression suggested by Ramon y Cajal of the
Law of Avalanche for this wide diffusion of sensation, which spreads
from a few thousand to millions or billions of cells, and from a
rather bearable pain becomes intolerable torture, as a consequence of
the brain's complete occupation with it.

Now it is possible for most people, indeed for all who have not some
organic morbid condition, to control this spread of pain beyond its
original connections, provided only they will to do so, refuse to be
ruled by their dreads and proceed to divert attention from the painful
condition to other subjects. Here is why the man who bravely faces
pain actually lessens the amount that he has to bear. There is no pain
in the part affected. That we know, because any interruption of the
nerve tract leading from the affected part to the brain {126}
eliminates the pain. In the same way, the obtunding of the nerve cells
in the cortex by anaesthetics or of the conducting nerve apparatus on
the way to the brain by local anaesthesia, will have a like effect.
Anything then that will interfere with the further conduction of the
pain sensation and the cortical cells directly affected will lessen
the sense of pain, and this is what happens when a man settles himself
firmly to the thought that he will not allow himself to be affected
beyond what is the actual reaction of the nerve tissues to the part.

As a matter of fact, the anticipation of pain due to the dread of it
predisposes the part to be much more sensitive than it was before. We
can all of us readily make experiments which show this very clearly.
Ordinarily we have a stream of sensations flowing up from the surface
of the body to the brain, consequent upon the fact that the skin
surface is touched by garments over most of the body, and that our
nerves of touch respond to their usually rather rough surface. We have
learned to pay no attention to these because we have grown accustomed
to them, though any one who thinks that they are negligible should
witness the writhings of a poor Indian under the stress {127} of being
civilized when he is required to wear a starched shirt for the first
time. Ordinarily Indians have learned to suppress their feelings, but
the shirt with its myriad points of contact, all of them starchily
scraping, usually proves too much for his equanimity, and he wiggles
and twists to such an extent as shows very clearly that he is
extremely uncomfortable. Most people have something of the same
feeling the first day that they change into woolen underclothes after
they have been wearing cotton for months, and the sensation is by no
means easy to bear with equanimity.

Ordinarily from custom and habit in the suppression of feelings we
notice none of these contact sensations with their almost inevitable
itchy and ticklish feelings, though they are constantly there, but we
can reveal them to ourselves by thinking definitely about any part of
the body. Such concentration of attention at once brings that part of
the body above the threshold of consciousness, and we have distinct
feelings there that we did not notice before. If for instance we think
about the big toe on the left foot, immediately our attention is
turned to it and we note sensations in it that were quite unnoticed
before. We can feel the stocking touching any part of it {128} that we
think of. Not only that, but if we concentrate attention on a part
most uncomfortable sensations develop. If anything calls our attention
even to the middle of our backs, we find at once that there is a
distinct sensation there, and this may become so insistent as to
demand relief.

It is well understood now what happens in these cases. As we have
said, the attention given to a part leads to a widening of the minute
blood vessels located there so that the nerve endings to the part are
supplied with more blood and therefore become more sensitive. We know
from experience in cold windy weather that when the cheek is
hyperaemic the drawing of a leaf or even of a piece of paper across it
may produce a very acute painful sensation. Hyperaemia always makes
parts of the body much more sensitive than before. Attention has just
this effect over all the surface of the body, as we can demonstrate to
ourselves. We can actually, though only gradually, make our feet warm
by thinking about them, because the active attention to them sends
more blood to them. The dread of pain then, by concentrating attention
on the part beforehand, actually increases the pain that has to be
suffered and makes the subject {129} ever so much more sensitive.
Sensitiveness is of course dependent on other factors, as for instance
lack of outdoor air and of oxygenization, which actually seems to
hypersensitize people so that even very slight pain becomes extremely
difficult to bear, but the question of attention, which is after all
almost entirely a voluntary matter, has more to do with making pain
harder to bear than anything else.

In the preanaesthetic days, men have been known to sit and watch
calmly an amputation of one of their limbs without wincing and
apparently without undergoing very much pain. Many are the incidents
in history of a favorite general who showed his men how to bear pain
by calmly smoking a cigar while a surgeon amputated an arm or a leg or
performed some other rather important surgery. Pain is after all like
the sense of danger and may be suppressed practically to as great a
degree. Once during the present war, when long columns of soldiers
going to the front had to pass by the open market place of a town that
was being shelled by the Germans, there was danger of the troops
losing something of their morale at this point and of confusion
ensuing. It would have been disturbing both to discipline and the
{130} ordered movement of the troops to divert them by narrower
streets, and the shells, though dangerous, were not falling frequently
and not working serious havoc. Every one knew, however, that the
German gunners had the range, and a shell might land square in the
market place at any time; thus there was a feeling of uneasiness and a
tendency to nervous lack of self-control, with the inevitable
confusion of movement afterwards. One of the French generals ordered
an armchair to be brought out of one of the houses near by, took a
position in the center of the square, with a little wand in his hand,
and calmly joked with the soldiers as they went by about the
temperature of the day mentioning occasionally something about a shell
that happened to strike not far away. According to the story he was an
immense man weighing nearly three hundred pounds, and so provided a
very good-sized target for shells, but he was never touched and,
almost needless to say, the line of soldiers never wavered while their
general sat there joking at the danger.

It is sometimes thought that men in the older, less refined times
could stand pain and suffering generally much better than our
generation which is supposed to have {131} degenerated in that
respect. We have found, however, during the war that the soldiers who
could stand supreme suffering the best were very often those who came
from better-to-do families, who had been subjected to the most highly
refining influences of civilization, but also to that discipline of
the repression of the emotions which is recognized as an important
phase of civilization. Strange as it may seem, the city boys stood the
hardships and the trials of trench life better than the country boys
and not only withstood the physical trials but were calmer under fire
and ever so much less complaining under injury. After all it is what
might be expected, once serious thought is given to the subject, and
yet somehow it comes as a surprise, as if the country boy ought to be
less sensitive,--as indeed he probably is; but he lacks that training
in self-control which enables the city boy to stand suffering.

All our feeling that human nature has degenerated in physical
constitution has been completely contradicted by the reaction of our
young soldiers to camp and trench life. They have gone back to the
lack of comforts and conveniences of the pioneer days and have had to
submit to the outdoor life and the {132} hardships that their pioneer
grandfathers went through and have not failed under them. The boys
have come out of it all demonstrating not only that their courage was
capable of supporting them, but with their physical being bettered by
the conditions and their power to stand suffering revealed in a way
that would scarcely have been believed possible beforehand.


{133}

CHAPTER IX

THE WILL AND AIR AND EXERCISE


  "And wishes fall out as they are willed."
                             _Pericles_


Very probably the most important function of the will in its relation
to health is that which concerns its power to control the habits of
mankind as regards air and exercise. It is surprising to what an
extent people neglect both of these essentials of healthy living in
the midst of our modern sophisticated life, unless the will power is
consciously used for the purpose of forming and then maintaining
habits with regard to these requisites for health. It is a very
fortunate thing that instinct urges the child, particularly the
infant, to almost constant movement during its waking hours. Children
that are healthy and that are growing rapidly, boys somewhat more than
girls, are so constantly in movement that one would almost think that
they must be on springs. Whenever they discover that they can make a
{134} new movement, they proceed to make it over and over again until
they can do it with facility. There is no lolling around for them; as
soon as they wake, they want to be up and doing, no matter what the
habits of the household may be. They are constantly on the move. We
know that this is absolutely essential for growth as well as for the
proper training of their muscles, but it is a very fortunate thing
that children do it for themselves, for if their mothers were
compelled to train them, the task would be indeed difficult. All
mother has to do is to control them to some extent and keep them from
venturing too far, lest they should hurt themselves.

When the control of instinct over life is gradually replaced by
reason, this tendency to exercise gradually diminishes until it is
often surprising to find how little people are taking. As it is mainly
the need for exercise that forces people out into the air, indoor life
comes to be the main portion of existence. This is all contrary to
nature, and so it is not surprising that _disease_, in its original
etymological sense of discomfort, develops rather readily. The lack of
exercise in the air permits a great many people to drift into all
sorts of morbid conditions in which they are quite miserable. This
{135} is, of course, particularly true as regards nervous ailments of
various kinds; only under the term nervous ailments should be included
not alone direct affections of the nervous system or functional
disturbances of nerves, but also a number of other conditions. Nervous
indigestion, insomnia, neurotic constipation and many of the
symptomatic affections associated with these conditions, tired
feelings that interfere with activities, headache, various feelings of
discomfort in the muscles and around the joints, inability to control
the emotions and other such common complaints--if that is the proper
word for them--all these are fostered by a sedentary life indoors.
They frequently make not only the patient himself--or oftener
herself--miserable, but also all those who come in contact with her.

Above all, it must not be forgotten that lack of exercise in the open
air has a very definite tendency to make people extremely sensitive to
discomforts of all kinds, mental as well as physical. Many a man or
woman whose life seems full of worries, sometimes without any adequate
cause at all, who goes from one dread to another, who wakes in the
morning with a sense of depression, find that most of these feelings
and sometimes all of them, {136} disappear promptly when they begin to
exercise more in the open.

Nothing dispels the gloom and depressions consequent upon an
accumulation of cares and worries of various kinds like a few weeks in
the woods, where every moment is passed in the fresh outdoor air,
which actually seems to blow the cobwebs of ill feelings away and
leaves the individual with a freedom of mind and a comfort of body
that he almost expected never to enjoy again.

Undoubtedly the most important factor for the preservation of health
is an abundance of fresh air. At certain seasons of the year this is
not only easy and agreeable, but to do anything else imposes hardship.
In our climate, however, there are about six months of the year in
which it requires some exercise of will power to secure as much open
air life as is required for health. There are weeks when it is too
hot, there are many weeks when it is too cold. The cold air
particularly is important, because it produces a stimulating vital
reaction than which nothing is more precious for health. We have no
tonic among all the drugs of the pharmacopeia that is equal to the
effect of a brisk walk in the bracing air of a dry cold day. After a
long morning and {137} perhaps a whole day in the house, even half an
hour outdoors will enable us to throw off the sluggishness consequent
upon confinement to the indoor air and the lack of appetite and the
general feeling of physical lassitude which has followed living in an
absolutely equable temperature for twenty-four hours. Sometimes it
requires no little effort of the will to secure this, and to continue
it day after day without missing it or letting it be crowded out by
claims that are partly real and partly excuses, because we do not care
to make the special effort required.

What humanity needs is regular exercise in the open air every day. As
it is, between the trolley car and the automobile, very few people get
what they need. Any one who has to go a mile takes a car or some other
conveyance and between waiting for the car and certain inevitable
delays it will probably take ten minutes or more to go the mile. In
five minutes more one could walk that distance and secure precious
exercise besides such diversion of mind as inevitably comes from
walking on busy city streets and which makes an excellent recreation
in the midst of one's work. For it is quite impossible in our day to
walk along city streets absorbed in abstract mental {138} occupations.
One of the objections to walking is that after a while it can be
accomplished as a matter of routine without necessarily taking one's
mind away from subjects in which it has been absorbed. It is quite
impossible for this to happen, however, on modern city streets. "The
outside of a horse", it used to be said, "is good for the inside of a
man." The main reason for this was because it is impossible for a man
to ride horseback, unless his mount is a veritable old Dobbin, without
paying strict attention to the animal. The same thing is true as
regards city pedestrianism, especially since the coming of the auto
has made it necessary to watch our steps and look where we go.

A great many people would be ever so much better in health if they
walked to business or to school every morning instead of riding, for
the young need it even more than the older people. Especially is this
true for all those who follow sedentary occupations. Clerks in
lawyers' offices, typewriters and stenographers, secretaries--all
those who have to sit down much during the day--need the brisk walking
and need it not merely of a Sunday or a Saturday afternoon, but every
day in the year. Many of them, if they walked two and three miles to
{139} the office, would probably require only fifteen minutes, at most
half an hour, more than if they took a train or trolley, but they
would have secured a good hour of exercise in the open air.

On the other hand the unfortunate crowding of trolley and elevated and
subway trains in the busy hours when people go to and from their work
makes an extremely uncomfortable and often rather depressing
commencement and completion of the day's work. I know of nothing that
makes a worse beginning for the day than to have to stand for half an
hour or longer in a swaying, bumping car, hanging to a strap, crushed
and crowded by people getting in and out. The effect of coming home
under such circumstances after a reasonably long day's work is even
more serious, and any little sacrifice that will enable people to
avoid it will do them a great deal of good. Fifteen or twenty minutes
of extra time morning and evening would often suffice for this and
would at the same time add a bracing walk in the open air to the day's
routine.

When first begun, such a practice would make one tired and sore, but
that condition would pass in the course of a few days and be replaced
by a healthy feeling of satisfaction {140} that would be well worth
all the effort required. We should need ever so much less medicine for
appetite and for constipation if this were true. A great many people
who stand during the day would probably deem it quite out of the
question for them to walk three miles or more to and from their
business, for their feet get so tired that they feel that they could
not endure it. What they need more than anything else, however, is
exercise that will bring about a stimulation of the circulation in
their feet. Standing is very depressing to the circulation. It leads
to compression of the veins and hence interference with the return
circulation, with lowered nutrition which often predisposes to flat
foot or yielding arch and tends to create corns and callouses: walking
in reasonably well fitting shoes on the contrary tends to make the
feet ever so much less sensitive Our soldiers have had that experience
and have learned some very precious lessons with regard to the care of
their feet, the principal one being that the best possible remedy for
foot troubles is to exercise the feet vigorously in walking and
running, provided the shoes permit proper foot use.

I have often known clerks and floorwalkers {141} who have to stand all
day or move but a few steps at intervals, who were so tired at night
that they felt the one thing they could do was to sit down for a while
after dinner and then go to bed, but who came to feel ever so much
better after a brisk walk home. It was rather hard to persuade them
that, exhausted as they felt, they would actually get rested and not
more tired from vigorous walking, but once they tried it, they knew
the exercise was what they needed. The air in stores is often dry and
uncomfortable for those who are in them all day. It is usually and
quite properly regulated for the customers who come in from the
streets expecting to get warm without delay. In dry, cold weather
particularly, an evening walk home sets the blood in circulation until
it gets thoroughly oxidized and the whole body feels better. Such a
brisk walk will often prevent the development of flat foot, especially
if care is taken to spring properly from the ball of the foot, in the
good, old-fashioned heel and toe method of walking. Once flat foot has
developed, walking probably is more difficult, but even then, with
properly fitting shoes, the patients will be the better for a good
walk after their work is over. It requires some will power to acquire
the {142} habit, but once formed, the benefit and pleasure derived
make it easy to keep up the practice.

Those who walk thus regularly will often find that their evening
tiredness is not so marked, and they will feel much more like going
out for some diversion than they otherwise would. Probably nothing is
more dispiriting in the course of time than to come home merely to eat
dinner, sit down after dinner and grow sleepy on one's chair until one
feels quite miserable, and then go to bed. There should be always,
unless in very inclement weather, an outing before bedtime, and this
should be looked forward to. It will often forestall the feeling that
the day is over after dinner and so keep the individual from settling
down into the dozy discomfort of an after-dinner nap as the closing
scene of the day. Good habits in this matter require an effort of the
will to form; bad habits almost seem to form of themselves and then
require a special effort to break.

It is surprising how many of the dreads and anxiety neuroses and
psycho-neurotic solicitudes and neurasthenic disquietudes and other
more or less morbid mental states disappear under the influence of a
brisk walk for three or {143} four miles or more every day. I have
tried this prescription on all sorts of people, including particularly
myself, and I know for certain that when troubles are accumulating the
thing to do is to get outdoors more, especially for walking; then the
incubus begins to lift. Clergymen, university professors, members of
religious orders, school teachers, as well as bankers, clerks and
business people of various kinds, have been subjected to the influence
of this prescription with decided benefit. Some of them assert that
they never felt so well as since they have formed the habit of walking
every day. It must, however, be _every_ day, and it must not merely be
a mile or so but it must be at least three miles. That means for a
good many people about an hour spent in actual walking, but it is well
worth the time and effort. Above all, it repays not only in health and
in better feelings but in the increased amount of work that can be
done on the day itself. A whole day passed indoors will often contain
many wasted hours, while if a walk of a couple of miles is planned for
the morning and one for a couple of miles more in the afternoon, very
satisfactory study or other work can be done in the intervals. Almost
needless to say, a brisk walk in the {144} cooler weather will create
an appetite where it did not exist before. Women often need counsel in
this matter more than men, and regular walking for them is indeed a
counsel of health. Very few women in these modern times walk much, and
to walk more than a mile seems to them a hardship. This is responsible
for more of the supersensitiveness and nervous complaints of all kinds
to which women are liable than anything else that I know of. It is
also one important factor in the production of the constipation to
which women are so much more liable than men. We see many
advertisements with regard to the jolts to which the body is subjected
every time the heel is put down and of the means that should be taken
to prevent them, but it must not be forgotten that men and women were
meant by nature to walk erect and that this recurring jolt has a very
definite effect in stimulating peristalsis and favoring the movement
of the contents of the intestines. Besides, if the walking is brisk,
the breathing is deeper and there is some massage of the liver, as
also of the other abdominal viscera, while other organs are affected
favorably. Walking for women--regular, everyday walking--would be
indeed a precious habit, but now {145} that women have occupations
more and more outside of the house, this is one of the things they
must make up their minds to do, if they are to maintain health,
remembering that making up the mind is really making up the will.

Over and over again I have seen a great many of the troubles of the
menopause or change of life in women disappear or become ever so much
less bothersome as the result of the formation of regular habits of
walking out of doors every day. Unfortunately, there is a definite
tendency about this time for women to withdraw more and more from
public appearances and to live to a considerable extent in retirement
at home. Nothing could be much worse for them. They need, above all,
to get out and to have a number of interests, and if these interests
can only be so arranged as to demand rather prolonged walks, so much
the better. This is more particularly true for the unmarried woman who
is going through this critical time, and the question of walking
regularly every day for three or four miles must be proposed to her.
It will require a considerable effort of the will. More than two miles
at the beginning will probably be too tiring, but the amount can be
gradually increased {146} until at least four miles on the average is
covered every day. Above all, for the feelings of discomfort in the
cardiac region so often noticed at this time, regular walking is the
best remedy in most cases, always of course presupposing that there is
no organic heart condition, for in that case only a physician can give
the proper direction for each case. By the exercise of the lungs that
it requires, it will probably save most people from colds and coughs
which they have had to endure every winter. Lastly be it said that
practically all men and women, though more particularly the men who
have lived well beyond the Psalmist's limit of threescore and ten,
have been regular daily walkers, or else they have taken exercise in
some form in the open air which is the equivalent of walking. One of
the most distinguished of English physicians, Sir Hermann Weber, who
died just after the end of the war in London, was in his ninety-fifth
year. He had practised medicine regularly until the age of eighty and
continued in excellent health and vigor until just before his death.
During the last year of life, he contributed an interesting article to
the _British Medical Journal_ on the "Influence of Muscular Exercise
on Longevity." He attributed his vigor at the age of {147} ninety-five
as well as the prolongation of his life to his practice of spending
every day two or three hours in the open air. He walked, as a rule,
forty to fifty miles a week. Even in the most inclement weather he
rarely did less than thirty miles a week. Many another octogenarian
and nonagenarian has attributed his good health and long life to the
habit of regular daily exercise in the open.

Instead of using up energy, the will so used brings out latent stores
of energy that would not otherwise be employed and thus adds to the
available amount of vitality for the individual. Doctor Thomas Addis
Emmet, only just dead, over ninety, in his younger years as a busy
medical practitioner never kept a horse. It would not be difficult to
cite many other examples among men who lived to advanced old age and
who considered that they owed their good health and long life to daily
habits of outdoor exercise.



{148}

CHAPTER X

THE WILL TO EAT


  "If your will want not, time and place will be fruitfully added."
                                           _King Lear_.


Eating is usually supposed to be entirely a matter of appetite which
instinct directs to the best possible advantage of the individual.
This is quite true for those who are living the outdoor life that is
normal or at least most healthy for men, and when they are getting an
abundance of exercise, and may I add also have not too great a variety
of food materials in tempting form presented to them. Under the
artificial not to say unnatural conditions which men have to a great
extent created for themselves in city life, confined at indoor
sedentary occupations, some of them--and they are much more numerous
than is usually imagined--eat too little, while a great many, owing to
stimulation of appetite in various ways, eat too much.

Eating therefore for health's sake has to be done through the will and
as a rule by the {149} formation of deliberate habits. It is easy to
form habits either of defect or excess in the matter of eating and
indeed a great deal of the ill health to which mankind is liable is
due to errors in either of these directions. Having disturbed nature's
instincts for food in modifying the mode of life to suit modern
conveniences, we have now to learn from experience and scientific
observations what we should eat and then make up our minds to eat such
quantity and variety as is necessary to maintain health and strength
in the particular circumstances in which we are placed.

While the greatest emphasis has been placed on the dangers to health
in overeating, the number of people who, for one reason or another,
eat too little is, as has been said, quite surprising. A very large
proportion of those under normal weight are so merely because they
have wrong habits of eating. Indeed, it may be laid down as a
practical rule of health that wherever there is no organic disease the
condition of being underweight is a symptom of undereating. A great
many thin people insist that the reason why they are underweight is
that it is a family trait and that father and mother, or at least one
of them, and some of their grandparents exhibited this {150}
peculiarity; and thus it is not surprising that they should have it. A
careful analysis of the family eating in such cases has shown me in a
large number of instances, indeed almost without exception, that what
my patients had inherited was not a constitutional tendency to
thinness, but a family habit of undereating. This accrued to them not
from nature but from nurture, and was acquired in their bringing up.
Most of them were eating one quite abundant meal a day and perhaps a
pretty good second meal, but practically all of them were skimping at
least one meal very much. In some way or other, a family habit of
eating very little at this meal had become established and was now an
almost inviolable custom.

A great many thin individuals, that is persons who are somewhat more
than ten per cent. under the average normal weight for their height,
either do not eat breakfast at all or eat a very small one. It is not
unusual for the physician analyzing their day's dietary to be told
that the meal consists of a cup of coffee and a piece of bread.
Sometimes there is a roll, but more often only part of a roll, though
occasionally in recent years there may be some fruit and some cereal;
the fruit will usually be a half of one of the citrus fruits {151}
which contains practically no nutrition and is only a pleasant
appetizer, while more often than not the cereal will be one of the
dry, ready-to-eat varieties which, apart from the milk or cream that
may be served with them, contain in the usual small helpings very
little nutriment. Such breakfasts are particularly the rule among
women who are under weight. Sometimes lunch is comparatively light so
that there are two daily apologies for meals. To make up for these,
the third meal may be very hearty. City folk often eat at dinner more
than is good for them. This may produce a sense of uncomfortable
distention and overfulness followed by sleepiness which may be set
down as due to indigestion, though it is just a question of overeating
for the nonce.

It would be much more conducive to health to distribute the eating
over the three meals of the day, but it requires a special effort of
the will to break the unfortunate habits that have been formed.
Particularly it seems hard for many people to eat a substantial
breakfast and a determined effort is required to secure this. It would
seem almost as though their wills had not yet waked up and that it was
harder for them to do things at this time of day. It is especially
important for working {152} women, that is, those who have such
regular occupations as school-teacher, secretary, clerk and the like,
to eat a hearty breakfast. They can get a warm properly chosen meal at
home at this hour, while very often in the middle of the day they have
to eat a lunch that is not nearly so suitable. As a consequence of
neglecting breakfast then, it is twenty-four hours between their warm,
hearty meals. Even when they eat a rather good lunch, some eighteen
hours elapse since the last hearty meal was taken, and one half the
day's work has to be done on the gradually decreasing energy secured
from the evening meal of the day before. With this unfortunate habit
of eating, most of that was used up during the night in repairing the
tissue losses of the day before, so that the morning's work has to be
done largely "on the will" rather than on the normal store of bodily
energy.

It is surprising how many patients who are admitted to tuberculosis
sanatoria have been underweight for years as a consequence of
unfortunate habits of eating. Not infrequently it is found that they
have a number of prejudices with regard to the simple and most
nutritious foods that mankind is accustomed to. Not a few of the
younger ones who {153} develop tuberculosis have been laboring under
the impression that they could not digest milk or eggs or in some way
they had acquired a distaste for them and so had eliminated them from
their diet; some of them had also stopped eating butter or used it
very sparingly. At the sanatoria, as a rule, very little attention is
paid to the supposed difficulty of digestion of milk and eggs and
perhaps butter. The patients are at once put on the regular diet
containing these articles and the nurse sees that they take them even
between meals, and unless there is actual vomiting or some very
definite objective--not merely subjective--sign of indigestion, the
patients are required to continue the diet.

It is almost an invariable rule for the patients of such institutions
to come to the physician in charge after a couple of weeks and ask how
it was that they could have thought that these simple articles of food
disagreed with them. They have begun to like them now and are
surprised at their former refusal to take them, which they begin to
suspect, as the physician very well knows, to have been the principal
reason for the development of their tuberculosis.

There are people who are up to weight or {154} slightly above it who
develop tuberculosis, but they do not represent one in five of the
patients who suffer from the affection. In probably three fourths of
all the cases of tuberculosis the predisposing factor which allowed
the tubercle bacillus to grow in the tissues was the loss of weight or
the being underweight. There is a good biological reason for this, for
there are certain elements in the make-up of the tubercle bacillus
which favor its growth at a time when fat is being lost from the
tissues rather than deposited, for at that time more fat for the
growth of the tubercle bacillus is available in the lungs than at
other times. Often among the poor the loss in weight is due to lack of
food because of poverty, or failure to eat because of alcoholism, but
not infrequently among all classes it is just a question of certain
bad habits of eating that might readily have been corrected by the
will. It is surprising how many people who complain of various nervous
symptoms--meaning by that term symptoms for which no definite physical
basis can be found, or for which only that extremely indefinite basis
of a vague reflex, real or supposed, from the abdominal organs--are
underweight and will be found to be eating much less than the average
of {155} humanity. These nervous symptoms include above all
discomforts of various kinds in the abdominal region; sense of
gone-ness; at times a feeling of fullness because of the presence of
gas; grumblings, acid eructations, bitter taste in the mouth, and
above all, constipation. As is said in the chapter on "The Will and
the Intestinal Functions," the most potent and frequent cause of
constipation is insufficient eating, either in quantity or in variety.
It is especially in the digestive tract of those who do not eat as
much as they should that gas accumulates. This gas is usually thought
to be due to fermentation, but as fermentation is a very slow gas
producer and nervous patients not infrequently belch up large
quantities, it is evident that another source for it must be sought.
Any one who has seen a number of hysterical patients with gaseous
distention of the abdomen and attacks of belching in which immense
quantities of gas are eructated, will be forced to the conclusion that
in such nervous crises gas leaks out of the blood vessels of the walls
of the digestive tract and that this is the principal source of the
gas noted. What is true in the severe nervous attacks is also true in
nervous symptoms of other kinds, and neurotic indigestion so called
{156} is always accompanied by the presence of gas.

Apparently the old maxim of the physicist of past centuries has an
application here. "Nature abhors a vacuum" and as the stomach and
intestines are not as full as they ought to be, nor given as much work
to do as they should have, nature proceeds to occupy them with gas
which finds its way in from the very vascular gastrointestinal walls.
This is of course an explanation that would not have been popular a
few years ago when the chemistry of digestion seemed so extremely
important, but in recent years, medical science has brought us back
rather to the physics of digestion, and I think that most physicians
who have seen many functional nervous patients would now agree with
these suggestions as to the origin of gaseous disturbance in the
gastrointestinal tract in a great many of these cases.

Besides the physical symptoms, there are a whole series of psychic or
psycho-neurotic symptoms, the basis of which undoubtedly lies in the
condition of underweight as a consequence of undereating. Over and
over again I have seen the feeling of inability to do things which had
come over men, and {157} particularly women, disappear by adding to
and regulating the diet until an increase in weight came. Extreme
tiredness is a frequent symptom in those under weight, and this often
leads to their having no recreation after their work because they have
not enough energy for it; as every human being needs diversion, a
vicious circle of influence which adds to their nervous tired
condition is formed. I have seen in so many cases the eating of a good
breakfast and a good lunch supply working people with the energy
hitherto lacking that enabled them to go out of an evening to the
theater or to entertainments of one kind or another, that it has
become a routine practice to treat these people by adding to their
dietary unless there are direct contra-indications.

Dreads are much more common among people who are underweight than
among those who eat enough to keep themselves in proper physical
condition. I have had a series of cases, unfortunately only a small
one in number, in which the craving for alcoholic liquor disappeared
before an increase in diet and a gain in weight. I shall never forget
the first case in which this happened. The patient was a man of nearly
sixty years of age who held a {158} rather important political office
in a small neighboring town. He was on the point of losing it because
periodical sprees were becoming more frequent and it was impossible
for him to maintain his position. He was over six feet in height and
he weighed less than a hundred and fifty pounds. I had tried to get
him to gain in weight by advice and suggestion without avail. Finally,
I had to make a last effort to use whatever influence I had to save
his political position for him, and then I succeeded in making him
understand that he would have to do as I told him in the matter of
eating, or else I would have nothing more to do with him.

It was not without some misgivings that I thus undertook to make a man
of nearly sixty change his lifelong habits of eating. That is
something which I consider no physician has a right to do unless there
is some very imperative reason for it. Here was, however, a desperate
case. It was in the late afternoon particularly that this patient
craved drink so much that he could not deny himself. As he ate but
very little breakfast and had a hasty scanty lunch, he was at the very
bottom of his physical resources at that time, and at the end of a
rather demanding day's work. We had {159} to break up his other habits
in the hope of getting at the craving. He had taken coffee and a roll
for breakfast. I dictated a cereal, two eggs and several rashers of
bacon and several rolls. I insisted on fifteen minutes in the open
before lunch and then a hearty lunch with some substantial dessert at
the end of it. This man proceeded to gain at the rate of a little more
than three pounds a week. By the end of two months, he weighed about
one hundred and eighty pounds and had not touched a drop of liquor in
that time and felt that he had no craving for it. That is some ten
years ago, and there has been no trouble with his alcoholic cravings
since. He has maintained his weight; he says that he never felt so
well and that above all he now has no more of that intense tiredness
that used to come to him at the end of the day. Every now and then he
says to me in musing mood,--"And to think that I had never learned to
eat enough!"

For these very tired feelings so often complained of by nervous
patients, once it has been decided that there is no organic
trouble--for of course kidney or heart or blood pressure affections
may readily cause them--there are just two things to be considered:
These are {160} flat-foot or yielding arch, and undereating. When
there is a combination of these two, then tiredness may well seem
excessive and yet be readily amenable to treatment. Persons with
occupations which require standing are especially liable to suffer in
this way.

Undereating in the evening is especially important for many nervous
people and is often the source of wakefulness. It is the cause of
insomnia, not so much at the beginning of the night, as a rule, as in
the early morning. Many a person who wakes at four or five and cannot
go to sleep again is hungry. There is a sense of gone-ness in the
stomach region in these cases, which the patients are prone to
attribute to their nerves in general, or some of them who have had
unfortunate suggestions from their physicians may talk of their
abdominal brain; but it is surprising how often their feelings are due
simply to emptiness. Any thin person particularly who has his last
meal before seven and does not go to bed until after eleven should
always take something to eat before retiring. A glass of milk or a cup
of cocoa and some crackers or a piece of simple cake may be
sufficient, but it is important to eat enough. Animals and men
naturally get sleepy after eating and do not sleep well if their {161}
stomachs are empty. Children are the typical examples. We are all only
children of a larger growth in this regard.

When the last meal is taken before seven and people do not go to bed
until nearly twelve, as is frequently the case in large cities, the
custom of having something to eat just before bed is excellent for
sleep. I have known the establishment of this habit to afford marked
relief in cases of insomnia that had extended over years. The people
in my experience who sleep the worst are those who, having taken a
little cambric tea and some toast and preserves with perhaps a piece
of cake for supper, think that this virtuous self-control in eating
ought to assure them good rest. It has just the opposite effect.
Disturbed sleep, full of dreams and waking moments, is oftener due to
insufficient eating than to overeating. The people whom I know who
sleep the best and from whom there are no complaints of insomnia, are
those who, having eaten so heartily at dinner that they get to the
theater a little late, attend the Follies or some late show for a
while and then go round to one of the Broadway restaurants and chase a
Welsh rarebit or some lobster a la Newburg, with a biscuit Tortoni or
a Pêche Melba down {162} to their stomachs and then go home to sleep
the sleep of the just.

Just as there are bad habits of eating too little that are dangerous
and must be corrected by the will so there are bad habits of eating
too much that can only be corrected in the same way. While it is
dangerous to be under weight in the early years of life, it is at
least as dangerous to be overweight in middle life. With the variety
and abundance of food now supplied at a great many tables, it is
comparatively easy for people in our time to eat too much. The result
is that among the better-to-do classes a great many people suffer from
obesity, sometimes to such an extent that life is made a burden to
them. There is only one way to correct this and that is to eat less
and of course to exercise more. Reduction in diet means the breaking
of a long established habit and that of course is often hard. The
whole family may have to set a good example of abstinence from too
great a variety of food and especially from the richer foods, in order
that a parent may be helped to prevent further development of obesity
and to lose gently and gradually some of the overweight that is being
put on, and which now, by conserving heat and slowing up metabolism
{163} generally within the body, makes it so easy for even reduced
quantities of food to maintain the former habit of adding weight.

In this matter of obesity, however, just exactly as in the case of
tuberculosis for those who are underweight, prevention is much better
than cure. The people who know that they inherit such tendencies
should be particularly careful not to form habits of eating that will
add considerably to their weight. After all, it is not nearly so
difficult a matter as is often imagined. There is no need, unless in
very exceptional cases, of denying one's self anything that is liked
in the ordinary foods, only less of each article must be eaten. Even
desserts need not be entirely eliminated, for ices may be taken
instead of ice cream; sour fruits and especially those of the citrus
variety--oranges and grapefruit--and the gelatine desserts may be
eaten almost with impunity. The phrase "eat and grow thin" has
deservedly become popular in recent years because as a matter of fact
it is perfectly possible to eat heartily and above all to satisfaction
without putting on weight. It is, of course, harder to lose weight,
but even that may be accomplished gradually under proper direction if
there is the persistent will to do it.

{164}

In recent years another disease has come to attract attention which
represents the result of an overindulgence in food materials that can
be limited without much difficulty. This is diabetes which used to be
comparatively rare but has now become rather frequent. An authority on
the disease declared not long since that there are over half a million
people in this country now who either have or will have diabetes as
the result of the breaking down of their sugar metabolism. It is not
surprising that the disease should be on the increase, for the
consumption of sugar has multiplied to a very serious degree during
the last few generations. A couple of centuries ago, those who wanted
sugar went not to the grocery store, but to the apothecary shop. It
was kept as a flavoring material for children's food, as a welcome
addition to the dietary of invalids and the old, and quite literally
as a drug, for it was considered to have, as it actually has, to a
slight extent at least, some diuretic qualities that made it valuable.
A little more than a century ago, a thousand tons of sugar sufficed
for the whole world's needs, while the year before the war, the world
consumed some twenty-two million of tons of sugar. It is said that
every man, woman, and {165} child in the United States consumed on the
average every day a quarter of a pound of sugar.

Our candy stores have multiplied, and while two generations ago the
little candy stores sold candies practically entirely for children,
eking out their trade with stationery and newspapers and school
supplies, now candy stores dealing exclusively in confectionery are
very common. There are several hundred stores in the United States
that pay more than $25,000 a year rent, though they sell nothing but
candy and ice-cream sodas. Corresponding with the increase in the sale
of candy has come also the consumption of very sweet materials of
various kinds. French pastries, Vienna tarts, Oriental sweetmeats,
Turkish fig paste, Arabian date conserves, and West Indian guava
jelly, are all familiar products on our tables. Chocolate has become
one of the important articles of world commerce, though almost unknown
beyond a very narrow circle a little more than a century ago. Tea and
coffee have been introduced from the near and the far East and by a
Western abuse consumed with such an amount of sweetening as make them
the medium of an immense consumption of sugar.

There is no doubt that unless good habits {166} of self-denial in this
regard are formed, diabetes, which is an extremely serious disease,
especially for those under middle life, will continue to increase in
frequency. The candy and sugar habit is rather easy to form; every one
realizes that it is a habit, but it is sometimes almost as hard to
break as the tobacco habit. We were meant to get our sugar by the
personal manufacture of it from starch substances. If a crust of bread
is chewed vigorously until it swallows itself, that is, dissolves in
the secretions and gradually disappears, it will be noted that there
is a distinctly sweetish taste in the mouth. This is the starch of the
bread being changed into sugar. We were expected by nature to make our
own sugar in this way, but this has proved too slow and laborious a
way for human nature to get all the sugar it cared for, so most people
prefer to secure it ready made. Sugar is almost as artificial a
product as alcohol and is actually capable of doing almost as much
harm as its not distantly related chemical neighbor. It is rather
important that good habits in the matter should be formed and we have
been letting ourselves drift into very unfortunate habits in recent
years.


{167}

CHAPTER XI

THE PLACE OF THE WILL IN TUBERCULOSIS


  "And like a neutral to his will and matter
   Did nothing."
                                            _Hamlet_.


Probably the very best illustration in the whole range of medicine of
the place of the will in the cure of disease is afforded by
tuberculosis. This used to be the most fatal of all human affections
until displaced from its "bad eminence" within the last few years by
pneumonia, which now carries off more victims. As it is, however,
about one in nine or perhaps a few more of all those who die are
victims of tuberculosis. This high mortality would seem to indicate
that the disease must be very little amenable to the influence of the
will, since surely under ordinary circumstances a good many people
might be expected to have the desire and the will to resist the
affection if that were possible. In spite of the large death rate this
is exactly what is true.

{168}

Tuberculous infections are extremely common, much commoner even than
their high mortality reveals. After long and critical discussion with
a number of persistent denials, it is now generally conceded by
authorities in the disease that the old maxim "after all, all of us
are a little tuberculous" is substantially correct. Very few human
beings entirely escape infection from the tubercle bacillus at some
time in life. The great majority of us never become aware of the
presence of the disease and succeed in conquering it, though the
traces of it may be found subsequently in our bodies. Careful
autopsies reveal, however, that very few even of those who did not die
directly from tuberculosis fail to show tuberculous lesions, usually
healed and well shut off from the healthy tissues, in their bodies.
One in eight of those who become infected have not the resistive
vitality to throw off the disease or the courage to face it and take
such precautions as will prevent its advance. All those, however, who
give themselves any reasonable chance for the development of
resistance survive the disease though they remain always liable to
attack from it subsequently if they should run down in health and
strength.

{169}

Heredity, which used to be supposed to play so important a rôle in the
affection, is now known to have almost nothing to do with the spread
of the disease. Family tendencies are probably represented by nothing
more than a proneness to underweight which makes one more liable to
infection, and this is due as a rule to family habits in the matter of
undernourishment from ill-advised consumption of food. Probably a
certain lack of courage to face the disease boldly and do what is
necessary to develop bodily resistance against it may also be an
hereditary family trait, but environment means ever so much more than
heredity.

There is a well known expression current among those who have had most
experience in the treatment of patients suffering from tuberculosis
that "tuberculosis takes only the quitters", that is to say that only
those succumb to consumption who have not the strength of will to face
the issue bravely and without discouragement to push through with the
measures necessary for the treatment of their disease. In a word it is
only those who lack the firmness of purpose to persist in the mode of
life outlined for them who eventually die from their affection of the
{170} lungs. No specific remedy has been found that gives any promise
of being helpful, much less of affording assured recovery, though a
great many have been tried and not a few are still in hopeful use.
Recent experience has only served to emphasize the fact that the one
thing absolutely indispensable for any successful treatment of
tuberculosis of the lungs is that the patient should regain weight and
strength and with them resistive vitality so as to be able to overcome
the disease and get better.

To secure this favorable result two conditions of living are necessary
but they must be above all persisted in for a considerable period.
First there must be an abundance of fresh air with rest during the
advancing stage or whenever there are acute symptoms present, and
secondly an abundance of good food which will provide a store of
nutritive energy and make the resistive vitality as high as possible.
Curiously enough this "fresh air and good food" treatment for the
disease was recognized as the sheet anchor of the therapeutics of
consumption as long ago as Galen's time, the end of the second
century, when that distinguished Greek physician was practising at
Rome. Nearly eighteen hundred {171} years ago Galen suggested that he
had tried many remedies for what he called phthisis, the Greek
equivalent of our word consumption or wasting away, and had often
thought that he had noted a remedial value in them, but after further
experience he felt that the all-important factors for cure were fresh
air and good food. He even went so far as to say that he thought the
best food of the consumptive or the phthisical, as he called them, was
milk and eggs. A great deal of water has flowed under the bridge of
medical advance since his time and at many periods since physicians
have been sure that they had valuable remedies for consumption; yet
here we are practically back at Galen's conclusion more than fifty
generations after his time, and we are even inclined to think of this
mode of treatment as comparatively new, as it is in modern history.

The influence on consumption of the will to get well when once aroused
was typically exemplified in the career of the well-known London quack
of the beginning of the nineteenth century, St. John Long. He set
himself up as having a sure cure for consumption. He was a charlatan
of the deepest dye whose one idea was to make money, and who knew
{172} nothing at all about medicine in any way. He took a large house
in Harley Street and fitted it up for the reception of people anxious
to consult him. For some seasons every morning and afternoon the
public way was blocked up with carriages pressing to his door. Nine
out of ten of his patients were ladies and many of them were of the
highest rank; fashion and wealth hastened to place themselves and
their daughters at the mercy of the pretender's ignorance. His mode of
treatment was by inhalation. He assured his patients that the
breathing in of this medicated vapor would surely cure their pulmonary
disease, and because others were intent on going they went; many of
them were greatly benefited for a time and these so-called cures
proved a bait for many other patients.

J. Cordy Jeaffreson in his volume "A Book about Doctors", written two
generations ago, has told the story of St. John Long's successful
application of the principle of community of treatment and its
effectiveness upon his patient. Like Mesmer he realized that treating
people in groups led them mutually to influence each other and to
bring about improvement. St. John Long {173} had in one of the rooms
in Harley Street "two enormous inhalers, with flexible tubes running
outward in all directions and surrounded by dozens of excited women--
ladies of advanced years and young girls giddy with the excitement of
their first London season--puffing from their lips the medicated vapor
or waiting until a mouthpiece should be at liberty for their pink
lips." In our generation of course we had various phases of similar
treatment, including nebulizers and compressed air apparatus and
medicated vapor, all working wonders for a while, and then proving to
have no physical beneficial effect.

What is surprising is to find the number of cures that were worked.
St. John Long had so many applicants for attention that he was
literally unable to give heed to all of them. The news of the
wonderful remedy flew to every part of the United Kingdom and from
every quarter sick persons, wearied of a vain search after an
alleviation of their sufferings, flocked to London with hope renewed
once more. This enabled St. John Long to select for treatment only
such cases as gave ready promise of cure. He made it a great
preliminary of his treatment that his {174} patients should eat well
as a rule and on one occasion when he was called into the country to
see a man suffering in the last stages of consumption he said quite
frankly, "Sir, you are so ill that I cannot take you under my charge
at present. You want stamina. Take hearty meals of beefsteak and
strong beer; and if you are better in ten days I will do my best for
you and cure you."

It is easy to understand that if he made it a rule for his consumptive
patients that they should eat well or not expect relief from his
medicine he would secure a great many good results. Especially would
this be true in many cases that came up to him from the country, had
the advantage of a change of climate, and of environment and very soon
found that they had much more strength than they thought they had.
They had been dreading the worst, they were now led to hope for the
best; they took the brake off their will, they fed well and it was not
long then before they proceeded to get well.

As even a little experience with consumptive patients shows it is
often difficult for them to follow directions--and keep it up--in the
matter of fresh air and good food and here is where the question of
the will in the {175} treatment is all important. Many a consumptive
has in early life formed bad habits with regard to eating, especially
in the direction of eating too little and refusing for some reason or
other to take what are known to be the especially nutritious foods.
Not infrequently indeed it is their neglect of nutrition in this
regard that has been the principal predisposing factor toward the
development of the disease. This bad habit must be overcome and often
proves refractory.

Then it is never easy to give up the pursuit of a chosen vocation and
pursue faithfully for a suitable period the humdrum monotonous
existence of prolonged rest every day in the open air with eating and
sleeping as almost the only serious interests, if indeed they can be
called such, permitted in life. It is only those who have the will
power to follow directions faithfully, whole-heartedly and
persistently who have a reasonable prospect of getting ahead of their
disease and eventually securing such a conquest of it as will enable
them to return to their ordinary life as it was before the development
of tuberculosis.

Unless patients are ready to follow directions as regards outdoor air
and good food the {176} cure, or as specialists in tuberculosis prefer
to call it the arrest of symptoms in the disease, is almost out of the
question. Above all it is extremely important that those who suffer
from pulmonary tuberculosis should be ready to follow directions at an
early stage of their disease, before any serious symptoms develop, for
it is then that most can be done for them. Many a sufferer from
tuberculosis makes his or her cure extremely difficult, certainly ever
so much more difficult than it would otherwise have been, because the
dread of going to see a physician--lest they should be told that their
affection is really consumption and demands immediate strenuous
treatment--causes them to put off consultation with some one whose
opinion in the matter is reliable.

This is indeed one of the principal reasons why tuberculosis of the
lungs still continues to carry off so many victims every year,--
because people are afraid to learn the truth. They dare not put the
question to a definite issue and refuse to believe the possibility
that certain disturbing symptoms represent developing tuberculosis.
They defer seeing an expert; they take this and that suggestion from
friends; they buy cough remedies which {177} they see advertised,
sometimes they tinker with so-called "consumption cures." After a
while an advance of their symptoms makes it absolutely necessary to
see a physician but often by this time their disease has progressed
from an incipient case rather easy to be treated and with an excellent
prognosis to a more advanced stage at which cure is ever so much more
difficult; or by this time it may even prove that their strength has
been seriously sapped and they have not enough resistive vitality left
to bring about reaction toward the cure.

The all-important thing for all those who have at any time lived near
consumptives, whether relatives or others--for the disease is almost
invariably acquired and not hereditary--or who have worked for any
prolonged period in more or less intimate contact with those who had a
chronic cough or who subsequently developed tuberculosis, is that on
the first symptom that is at all suspicious they should make up their
minds to have the question as to whether they have tuberculosis or not
definitely settled and that they should be ready to do what they are
told in the matter. The first symptom is not a persistent cough as so
many think, nor continued loss of {178} weight, which is an advanced
sign as a rule, but a continued rapidity of pulse for which no
non-pulmonary reason can be found.

The old idea that consumptives should not be told what their affection
was, lest it should disturb their minds and discourage them so much as
to do them harm, has now been abandoned by practically all those of
large experience in the care of the tuberculous. The opposite policy
of being perfectly candid and making the patients understand their
serious condition and the importance of taking all the measures
necessary for cure, yet without permitting them to be unnecessarily
scared, has been adopted. Their will to get well must be thoroughly
aroused. After all, it must be recalled that tuberculosis is an
extremely curable disease. It is now definitely known that more than
ninety per cent. of humanity have at some time had a tuberculosis
process, that is to say a focus of tuberculosis active within their
tissues. Only about one in nine of the deaths in civilized countries
is from tuberculosis. That means that at least eight other people who
have not died from the disease but from something else have had the
affection, yet have recovered from it. Instead of the old shadow of
{179} heredity with its supposedly almost inevitable fatality, so that
young people who saw their brothers and sisters or other relatives
around them die from the disease felt that they were doomed, we now
know that the hereditary factor plays an extremely minor role if
indeed it plays any serious rôle at all in the development of the
disease.

No affection is so amenable to the state of mind and the will to be
well as tuberculosis. That is exactly the reason why so many remedies
have come into vogue and apparently been very successful in its
treatment and then after a while have proved to be of no particular
service or even perhaps actually harmful so far as their physical
effect is concerned. It cannot be too often repeated that anything
whatever that a patient takes that will arouse new hope and give new
courage and reawaken the will will actually benefit these patients. No
wonder then that scarcely a year passes without some new remedy for
tuberculosis being proposed. All that is needed to affect favorably
patients suffering from the disease is to have some good reason
presented which makes them feel that they ought to get better and then
at once they eat better and proceed to increase {180} their resistive
vitality. The despondency that comes with the lack of the will to be
well hurts their appetite particularly and no tuberculosis patient can
ever hope to recover health unless he is eating heartily. With better
eating there is always a temptation to be more outdoors and the
ability to stand cooler air which always means that the lungs are
given their opportunity to breathe fresh cool air which constitutes
absolutely the best tonic that we have for the affection.

It has been recognized in recent years that the only climates which
give reasonable hope of being helpful for the tuberculous are those
which present a variation of some thirty degrees in their temperature
every day. Whenever this is the case chilly feelings are always
produced in those who are exposed to the change, even though the lower
temperature curve may not go down to anywhere near freezing. If for
instance the temperature at the hottest hour of the day, say three
o'clock in the afternoon, is 90° F. and that of the later evening or
middle of the night is 60° F., chilly feelings will be produced. Just
the same thing is true if the temperature is between 30° F. and 40° F.
shortly after the middle of the day and then goes down to {181} near
zero at night. These chilly feelings are uncomfortable, but they
produce an excellent reaction in the circulation and set the blood
coursing from the heart to the tissues better than any medicine that
we have. In the midst of this the lungs have their resistive vitality
raised so as to throw off the disease.

This is probably one of the principal reasons why mountain climates
have been found so much more helpful for the treatment of tuberculosis
than regions of lower elevations. Whenever the elevation is more than
fifteen hundred feet there will almost invariably be a variation of
thirty degrees between the day and the night temperature. There are of
course still greater variations, even sixty or seventy degrees
sometimes where the altitudes are very high, but this is often too
great for the tuberculous patients to react properly to, in their
rundown conditions. Besides, the air is much rarer at the higher
elevations, breathing is more difficult, because the lungs have to
breathe more rapidly and more deeply in order to secure the amount of
oxygen that is needed for bodily necessities from the rarified air.
The middle elevations then, between fifteen hundred and twenty-five
{182} hundred feet, have been found the best for tuberculosis
patients, and they are very pleasant during the summer time, though
never without the chilly discomfort of the drop in temperature. During
the fall and winter, however, many patients become tired out trying to
react to these variations of temperature and want to seek other
climates where they will not have to submit to the discomfort and the
chilly feelings. If they come down to more comfortable quarters before
their tuberculosis has been brought to a standstill by the increase of
their resistive vitality, it is very probable that they will lose most
of the benefit that they derived from their mountain experience. Here
is where the will comes in. Those who have the will to do it and the
persistence to stick at it and the character that keeps them in good
humor in spite of the discouraging circumstances which almost
inevitably develop from time to time, will almost without exception
recover from their tuberculosis with comparatively little difficulty,
if they have only taken up the treatment before the disease is so far
advanced as to be beyond cure.

In the older days consumptives used to be sent to the Riviera and to
Algiers and to {183} other places where the climate was comparatively
equable, with the idea that if they could only avoid the chilly
feelings consequent upon variations of temperature it would be better
for them. Many of the disturbing symptoms of tuberculosis are rendered
less troublesome in such a climate, but the disease itself is likely
to remain quiescent at best or perhaps even to get insidiously worse,
as tuberculosis is so prone to do. These milder climates require much
less exercise of the will, but that very fact leaves them without the
all-important therapeutic quality which the lower altitudes possess.

For many people the outdoor life and the sight of nature in the
variations produced in scenery during the course of the days and the
seasons are satisfying enough to be helpful in making their cure of
tuberculosis easy. They are extremely fortunate if they have this
strong factor in their favor. It is very probable that we owe the
discovery of the value of the Adirondacks and other such medium
altitudes in the treatment of tuberculosis to the fact that Doctor
Trudeau liked the outdoors so much and was indeed so charmed with the
Adirondack region that when death from tuberculosis seemed {184}
inevitable, he preferred the Saranac region as a place to die in, in
spite of the hardships and the bitter cold from which at that time
there was so little adequate protection, to the comforts of the city.
He scarcely hoped for the miracle of cure from a disease which he as a
doctor knew had carried off so many people, but if he were to die he
felt that he would rather die in the face of nature with his beloved
mountains all around him than in the shut-in spaces of the city.

His resolution to go to the Adirondacks seemed to many of those who
heard of it scarcely more than the caprice of a man whom death had
marked for itself. His physicians surely had no hope of his journey
benefiting him but they felt very probably that in the conditions he
might be allowed to have this last desire since there were so few
other desires of life that he was likely to have fulfilled. His will
to live outdoors in spite of the bitter cold of that first winter
undoubtedly saved his life and then he evolved the system of outdoor
treatment which has in the past fifty years saved so many lives and is
now the recognized treatment for the disease. It is easy to
understand, however, how much of firm determination was required {185}
on his part forty years ago, when there were no comfortable ways of
getting into the Adirondacks, when the last stage of the journey had
to be made for forty miles on a mattress in a rough wagon, when water
for washing had to be secured by breaking the ice in the pitcher or on
the lake and when the bitter climate must have been the source of
almost poignant torture to a man constantly running a slight
temperature. He had the courage and the will power to do it and the
result was not only his own survival but a great benefit secured for
others.

Unfortunately many a consumptive patient who during his first period
of treatment keeps to the letter the regulations for outdoor air and
abundant food fails to do so if it is necessary to come back a second
time. Persistency is here a jewel indeed and only the persistent win
out. Many an arrested case fails to keep the rules of living that may
be necessary for years afterwards and runs upon relapse. The will to
do what is necessary is all-important. Trudeau himself, after securing
the arrest of his disease in the Adirondacks, though he lived and
worked successfully to almost seventy years of age, found it quite
impossible to live out of them {186} and often had to hurry back from
even comparatively brief visits to the lowlands. Besides, every now
and then during some forty years he had the will power to take his own
prescription of outdoor air and absolute rest. It was the faculty to
do this that gave him length of life far beyond the average of
humanity and the power to accomplish so much in spite of the invasion
of the disease which had rendered large parts of both lungs
inoperative. Not only did he live on, however, but he succeeded in
doing so much valuable work that few men in the medical profession of
America have stamped their name deeper on modern medical science than
this consumptive who had constantly to use his will to keep himself
from letting go.


{187}

CHAPTER XII

THE WILL IN PNEUMONIA


  "Who shall stay you?--My will, not all the world."
                          _Hamlet_.


What is true of tuberculosis and the influence of the will has proved
to be still more true, if possible, of pneumonia. Clinical experience
with the disease in recent years has not brought to us any remedy that
is of special value, nor least of all of specific significance, but it
has enabled us to understand how individual must be the treatment of
patients suffering from pneumonia. We have recognized above all that
mentally disturbing factors which lessen the patient's courage and
will to live may prove extremely serious. We hesitate about letting an
older person suffering from pneumonia learn any bad news and
particularly any announcement of the death of a near relative, above
all, a husband or wife. The shock and depression consequent upon any
such announcement may {188} prove serious or even fatal. The heart
needs all its power to accomplish its difficult task of forcing blood
through the limited space left free in the unaffected lung tissue, and
anything which lessens that, that is anything which _disheartens_ the
patient, to use our expressive English phrase, must be avoided as far
as possible.

When a man of fifty or beyond, one or more of whose friends has died
of pneumonia about his age, comes down with the disease and learns, as
he often will in spite of the best directed effort to the contrary,
that he is suffering from the affection, if he is seriously disturbed
by the knowledge, we realize that it bodes ill for the course of the
disease. If a pneumonia patient, especially beyond middle life, early
in the case expresses the thought that perhaps this may be the end and
clings at all insistently to that idea, the physician is almost sure
to feel little confidence of pulling him through the illness. In
probably no disease is it more important that the patient's courage
should be kept up and that his will should help rather than hamper.

Courage is above all necessary in pneumonia because the organs that
are most affected and have most to do with his recovery are so much
{189} under the control of the emotions. Any emotional disturbance
will cause the heart to be affected to some extent and the respiration
to be altered in some way. When a pneumonia patient has to lie for
days watching his respirations at forty to the minute, though probably
he has never noticed them before, and feels how his heart is laboring,
no wonder that he gets scared, and yet his scare is the very worst
thing that can happen to him. It will further disturb both his heart
and his respiration and leave him with less energy to overcome the
affection. He may be tempted to make conscious efforts to help his
lungs in their work, though any such attempt will almost surely do
more harm than good. He must just face the inevitable for some five to
nine days, hope for the best all the time and keep up his courage so
as not to disturb his heart. After middle life only the patients who
are capable of doing that will survive the trial that pneumonia gives.
The super-abounding energy of the young man will carry him through it
much better; and besides, the young man usually has much less
solicitude as to the future and much less depending on his recovery.

A generation ago or even less, whiskey or {190} brandy or some form of
strong, alcoholic stimulant, as it was called, was looked upon as the
sheet anchor in pneumonia. For a generation or more at that time, the
same remedy had been looked upon by a great many physicians as an
extremely precious resource in the treatment of tuberculosis. The
therapeutic theory behind the practice was that in affections of the
lungs a particular strain was placed upon the heart and therefore this
organ needed to be stimulated just as far as could be done with
safety. As alcohol increases the rapidity of the heart beat, it was
considered to be surely a stimulant and came to be looked upon as the
safest of heart stimulants, because, except when used over very long
periods, direct bad effects had not been noticed. In pneumonia, above
all, the heart needed to be stimulated because it had to pump blood
through the portion of the lungs unaffected by the pneumonia, usually
congested and offering special hindrances to the circulation; besides,
a much larger amount of blood than usual had to be pumped through
these portions of the lungs in order to compensate for the solidified
portions.

A number of very experienced physicians came to be quite sure that
alcoholic stimulants {191} were the most valuable remedy that we had
for this special purpose of cardiac stimulation; some of them went so
far as to say, with a well known New York clinician, that if they were
to be offered all the drugs of the pharmacopeia without alcoholic
stimulant for the treatment of pneumonia on the one hand, or whiskey
or brandy on the other without all the pharmacals, they would prefer
to take the alcohol, confident that it would save more patients for
them. They were quite sure that they had made observations which
justified them in this conclusion.

We know at the present time that alcohol is not a stimulant but always
a narcotic. It increases the rapidity of the heart beat, though not by
direct stimulation, but by disturbing the inhibitory nerve apparatus
of the heart and thus permitting the heart to beat faster. Just as
there is a governor on a steam engine, to keep it from going too fast
and regulate its speed to a definite range, so there is a similar
governing apparatus or mechanism in connection with the heart. It is
by affecting this that alcohol makes the heart go faster. Blood
pressure is not raised, but on the contrary lowered, and the effect of
alcohol is depression and not stimulation. {192} In spite of this,
good observers seemed to note favorable effects from the use of
alcohol in both pneumonia and tuberculosis. This appears to be a
paradox until one analyzes the psychic effects of alcohol and places
them alongside the physical, in order to determine the ultimate
equation of the influence of the substance.

Alcohol has a very definite tendency to produce a state of euphoria,
that is, of well-being. The patient's mind is brought to where it
dismisses solicitude with regard to himself. This neutralizes directly
the anxiety which so often acts as a definite brake upon resistive
vitality. The alcoholic stimulant, in so far as it has any physical
effect, probably does a little harm, but its influence on the mind of
the patient not only serves to neutralize this, but adds distinctly to
the patient's prospects of recovery. Without it, the dread which comes
over him paralyzes to some extent at least his heart activity and
interferes with lung action. Under the influence of alcohol, he gains
courage--artificial, it is true--but still enough to put _heart_ in
him, and this is the stimulation that the older clinical observers
noted. The patient can, with the scare lifted, use his will to be well
{193} ever so much more effectively and psychic factors are
neutralized that were hampering his resistive vitality.

This illustrates very well indeed the place of dilute alcohol in some
of the usual forms in therapeutics about the middle of the nineteenth
century. Practically all the textbooks of medicine at that time
recommended alcohol for many of the continued fevers. In sepsis, in
child-bed fever, in typhoid, in typhus, as well as in tuberculosis and
pneumonia and other less common affections, whiskey or brandy was
recommended highly and usually given in considerable quantities. All
of these affections are likely to be accompanied by considerable
anxiety and solicitude with a series of recurring dreads that sadly
interfere with nature's efforts toward recovery. Under certain
circumstances, the scare, to use the plain, simple word, was
sufficient to turn the scale against the patient. The giving of
whiskey at least lifted the scare   [Footnote 5] {194} and enabled the
patient to use his vital resources to best advantage.

  [Footnote 5: The use of whiskey for snake-bite probably has no other
  significance than this lifting of the scare. It used to be said that
  the alcoholic stimulation neutralized the depressant effect of snake
  poisoning on the heart. Now we know that this is not true, and in
  addition, we know of no effect that alcohol in the system might have
  in neutralizing the presence of the toxic albumin which constitutes
  the danger in snake poisoning. It is only rarely that the bite of a
  rattlesnake will be fatal. Experts declare that the snake must be a
  large one, its sting must be inflicted on the bare skin, it must not
  have stung any one so as to empty its poison glands for more than
  twenty-four hours, and the full dose of the poison must be injected
  beneath the skin for the bite to be fatal. Very rarely are all these
  conditions fulfilled. When a person is bitten by a snake, however,
  the terror which ensues is quite sufficient of itself to hurt the
  patient seriously and he may scare himself to death, though the
  snake poison would not have killed him. The whiskey lifts the scare
  and gives nature a chance to neutralize the poison which she can
  usually do successfully.]

It is extremely important, then, first to be sure that the patient's
will to be well is not hampered by unfortunate psychic factors and
secondly, that his courage shall be stimulated to the greatest
possible degree. Fresh air is the most important adjuvant for this
that we have. The outdoor air gives a man the courage to dissipate
dreads and makes him feel that he can accomplish what seemed
impossible before. Undoubtedly this is one of the favorable effects of
the fresh-air treatment of pneumonia, for it makes people mentally
ever so much less morbid. The patient's surroundings must be made as
encouraging as possible and there must be no signs of anxious
solicitude, no long faces, no weeping, and as far as possible, no
disturbance about business affairs that might make him think that a
fatal termination was {195} feared. His will to get well must be
fostered in every possible way and obstacles removed. This is why it
has been so well said in recent years that good nursing is the most
important part of the treatment of pneumonia. This does not mean that
a good nurse can replace a physician, but that both must coordinate
their efforts to making the patient just as comfortable as possible,
so that he will feel assured that everything that should be, is being
done for him, and that it is only a question of being somewhat
uncomfortable for a few days and he will surely get well.

Sunny rooms, smiling faces, flowers at his bedside, cheerful
greetings, all these, by adding to the patient's euphoria, bolster up
his will and make him feel that after all, thousands of people have
suffered from pneumonia and recovered from it, and there is no reason
why he should not, provided that he will not interfere with his own
recovery.


{196}

CHAPTER XIII

COUGHS AND COLDS


  "The power and corrigible authority of this lies in our wills."
                                       _Othello_.


It might seem as though the will had nothing to do with such very
material ailments as coughs and colds, and yet the more one knows
about them, the clearer it becomes that their symptoms can be
lessened, their duration shortened, their tendencies to complications
modified, and to some extent at least, they can be almost literally
thrown off by the will to be well. The idea of a little more than a
generation ago that coughs and colds would be most benefited by
confinement to the house and as far as possible to a room of an
absolutely equable temperature has gradually given way before the
success of the open-air treatment for tuberculosis and the meaning of
fresh air in the management of pneumonia cases. Fresh, cold air is
always beneficial to the lungs, no matter what the conditions present
in them, though it requires {197} no little courage and will power to
face the practical application of that conclusion in many cases. When
it is bravely faced, however, the results are most satisfactory, and
the respiratory condition, if amenable to therapeutics, is relieved or
proceeds to get better. Of course it is well understood that any and
every patient who has a rise in temperature, that is whose temperature
is above 100° F. in the later afternoon hours, should be in bed. Under
no circumstances must a person with any degree of fever move around.
This does not mean, however, that such patients should not be
subjected to fresh, cold air. The windows in their room or the ward in
which they are treated should be open, and if the condition is at all
prolonged, arrangements should be made for wheeling their beds out on
the balcony or placing them close to a window. The cold air gives them
distinctly chilly feelings and sometimes they complain of this, but
they must be asked to stand it. Of course if the cold disturbs their
circulation, if the feet and hands get cold and the lips blue, the
patients are not capable of properly reacting against the cold and
must not be subjected to it. Their subjective feelings of chilliness,
however, must {198} not be sufficient to keep them from the ordeal of
cold, fresh air; on the contrary, they must be told of the benefit
they will receive from it and asked to exert their wills to stand the
discomfort with just as little disturbance as possible.

People suffering from coughs, no matter how severe, should get out
into the air regularly, if they have no fever, and should go on with
their regular occupation unless that occupation is very confining or
is necessarily conducted in dusty air. Keeping to the house only
prolongs the affection and makes it much more liable to complications
than would otherwise be the case. Sufferers from these affections
should not go into crowds, should avoid the theaters and crowded cars,
partly for the sake of others--because they can readily convey their
affection to them--but also for their own sake, because they are more
susceptible to other forms of bacteria than those already implanted in
their own systems and they are much more liable to pick up foreign
bacteria in crowds than anywhere else. They should be out in the open
air, particularly in the sunlight, and this will do more to shorten
the course of a cough and cold than anything else.

{199}

They need more sleep than before and should be in bed at least ten or
eleven hours in the day, though if they should not sleep during all of
that time, they need not feel disturbed but may read or knit or do
something else that will occupy them while they retain a recumbent
position. They should not indulge in long, tiresome walks and in
special exertion, but should postpone these until the cough has given
definite signs of beginning to remit.

With regard to the cough itself, it must not be forgotten that the
action of coughing is for the special purpose of removing material
that needs to be cleared from the lungs and the throat and larynx. It
should not be indulged in except for that purpose. It requires a
special effort, and while the lungs and other respiratory passages are
the subject of a cold, these extra efforts should not be demanded of
them unless they are absolutely necessary. Almost needless to say,
people indulge in a great deal of unnecessary coughing. Some of this
is a sort of habit and some of it is due to that tendency to imitate,
so common in mankind. Every one has surely heard during religious
services, in a pause just after heads have been bowed in prayer or for
a {200} benediction, a single cough from a distant part of the church
which seemed to be almost the signal for a whole battery of coughs
that followed immediately from every portion of the edifice. If some
one begins coughing during a sermon or discourse, others will almost
inevitably follow. Coughing, like yawning, is very liable to
imitation.

The famous rule of an old-time German physician was that no one was
justified in coughing or scratching the head unless these activities
were productive. Unless you get something as the result of the
coughing, it should not be indulged in. There are a great many people
who cough much more than necessary and who delay the progress of their
betterment in that way. Whenever material is present to be coughed up,
coughing is not only proper but almost indispensable. It is the
imitative cough, the coughs which indicate overconsciousness of one's
affection, the coughs that so often almost unconsciously are meant to
catch the sympathy of those around, which must be repressed by the
will, and when the patient finds that he really has to cough less than
he thinks, he will be quite sure that he is getting better and will
actually improve as a consequence of this feeling.

{201}

Coughs need an abundance of fluid much more than medicine, and warm
fluids are better than cold; the will must be exercised so as to
secure the taking of these regularly. At least a quart of warm liquid,
milk if one is not already overweight, should be taken between meals
during the existence of a cough. Hot milk taken at night will very
often secure much better rest with ever so much less coughing than
would otherwise be the case. The tendency to take cough remedies which
lessen the cough by their narcotic effect always does harm. Coughing
is a necessary evil in connection with coughs, and whatever
suppression there is should be accomplished by means of the will.
Remedies that lessen the coughing also lock up the secretions and
disturb the system generally and therefore prolong the affection and
do the patient harm. Most of the remedies that are supposed to choke
off a cough have the same effect. Quinine and whiskey have been very
popular in this regard but always do harm rather than good. Their use
is a relic of the time when whiskey was employed for almost every form
of continued fever and when quinine was supposed to be good for every
febrile affection. We know now that quinine has no effect {202} except
upon malarial fevers, and then only by killing the malarial organism,
and that whiskey is a narcotic and not a stimulant and does harm
rather than good. Those who did not take the familiar Q. and W. have
in recent years had the habit of administering to themselves or to
their friends various laxative or anodyne or antiphlogistic remedies
that are supposed to abort a cough or cold and above all, prevent
complications. All of these remedies do harm. Every single one of
them, even if it makes the patient a little more comfortable for the
time, produces a condition that prevents the system from throwing off
the infection which the cold represents as well and as promptly as it
otherwise would.

It requires a good deal of will power to keep from taking the many
remedies which friends and sometimes relatives insist on offering us
whenever a cold is developing, but the thing to do is to summon the
will power and bravely refuse them. Medicine knows no remedies that
will abort a cold. The use of brisk purgatives, sometimes to an extent
which weakens the patient very much the next day, is simply a relic of
the time when every patient was treated with antimony {203} or calomel
and free purgation was supposed to be almost as much of a cure-all as
blood-letting. There is no reason in the world to think that the
emptying of food out of the bowels will do any particular good, unless
there is some definite indication that the food material present there
should be removed because it is producing some deleterious effect.

The longer a physician is in the practice of medicine the less he
tries to abort infectious diseases, and coughs and colds are, of
course, just infections. They must run their course, and the one thing
essential is to put the patient in as good condition as possible so
that his resistive vitality will enable him to throw off the infection
as quickly as possible. It requires a good deal of exercise of will
power on the part of the physician to keep from running after the many
will-o'-the-wisps of treatment that are supposed to be so effective in
shortening the course of disease, but any physician who looks back at
the end of twenty years will know that his patients have reason to be
thankful to him just in proportion as he has avoided running after the
fads and fancies of current medicine and conservatively tried to treat
his patients rather than cure their diseases. The patient is ever so
much {204} more important than his disease, no matter what the disease
may be.

Above all, for the cure and prevention of coughs and colds people must
not be afraid of cold, fresh air. A good many seem to fear that any
exposure to cold air while one has a cough may bring about pneumonia
or some other serious complication. It must not be forgotten, however,
that the pneumonia months in the year occur in the fall and the
spring, October and November and March and April producing most deaths
from the disease, and not December, January and February. The large
city in this country which may be said to have the fewest deaths from
pneumonia is Montreal, where the temperature during December and
January is often almost continuously below zero for weeks at a time
and where there is snow on the ground for three or four months in
succession. The highest death rate from pneumonia is to be found in
some of our southern cities which have rather mild winters and rather
equable temperature,--that is, no considerable variation in the daily
temperature range. Cold air is bracing and tonic for the lungs and
enables them to resist the microbe of pneumonia, and it is now
recognized {205} by physicians that personal immunity is a much more
important factor in the prevention of the disease than anything else.

Coughs and colds and bronchitis and pneumonia, the respiratory
diseases generally, are much less frequent in very cold climates than
in variable regions. Arctic explorers are but rarely troubled by them,
even though they may be exposed to extremely low temperatures for
months. Men subjected to blizzards at thirty and forty degrees below
zero may have fingers and toes frozen but do not have respiratory
affections. Some years ago, it was noted that one of these Arctic
expeditions had spent nearly two years within the Arctic Circle
without suffering from bronchial or throat disease and within a month
after their return in the spring most of them had had colds. Nansen
and his men actually returned from the Arctic regions where they had
been in excellent health during two severe winters to be confined to
their beds with grippy colds within a week of their restoration to
civilization, with its warm comfortable homes and that absolute
absence of chill which is connected in so many people's minds with the
thought of coughs and colds.

The principal reason why colds are so {206} frequent in the winter
time in our cities and that pneumonia has increased so much is mainly
because people are afraid of standing a little cold. Office buildings
are now heated up to seventy degrees to make the personnel absolutely
comfortable even on the coldest days, and as a consequence the air is
so dry that it is more arid--that is more lacking in water vapor, as
the United States Public Health Service pointed out--than Death
Valley, Arizona, in summer. People dress too warmly, anticipating
wintry days and often getting milder weather and thus making
themselves susceptible to chilling because the skin is so warm that
the blood is attracted to the surface. Will power to stand cold, even
though at a little cost of discomfort, is the best preventive of
coughs and colds and their complications and the best remedy for them,
once the acute febrile stage has passed.



{207}

CHAPTER XIV

NEUROTIC ASTHMA AND THE WILL


  "Great minds of partial indulgence
  To their benumbed wills."
                                      _Troilus and Cressida_.


In closing a clinical lecture on bronchial asthma at the University of
Marburg some years ago, Professor Friedrich Müller, who afterwards
became professor at Berlin, said, "Each asthmatic patient is a problem
by himself and must be studied as such; meantime, it must not be
forgotten what an important rôle suggestion plays in the treatment of
the disease." This represents very probably the reason why so many
remedies have been recommended for asthma and have proved very
successful in the hands of their inventors or discoverers as regards
the first certain number of patients who use them, and yet on
subsequent investigation have turned out to be of no special
therapeutic value and sometimes indeed to have no physical effect of
any significance.

{208}

Of course this is said with regard to neurotic asthma only, and must
not be applied too particularly to other forms of the affection,
though there is no doubt at all that the symptoms of even the most
severe cases of organic asthma can be very much modified and often
very favorably, by suggestive methods.

The principal feature of asthma is a special form of severe difficulty
in breathing. It is known now that the beginning of the affection is
always as Strumpell said, "an extensive and quite rapid contraction of
the smaller and smallest bronchial branches, that is the terminal
twigs of the bronchial tubes." It is not so much air hunger, though
there is, of course, an element of that because the lungs are not
functioning properly, as an inability to empty the lungs of air
already there and get more for respiratory purposes. The spasm in
asthma has a tendency to hold the lungs too full of air and produce
the feeling of their getting ever fuller and fuller. What the old sea
captain said in the midst of his attack of asthma, when somebody
sympathized with him because he had so much difficulty in getting his
breath, was that he had lots of breath and would like to get rid of
some of it. {209} He added, "If I ever get all this breath that's in
me now out of me, I'll never draw another breath so long as I live, so
help me." The respiration spasm is usually at full inspiration and the
effort is mainly directed toward expiration and expulsion of air
present using the accessory respiratory muscles for that purpose.

The picture of a man suffering from asthma is that of a patient so
severely ill as to be very disturbing to one not accustomed to seeing
it. It would be almost impossible for any one not used to the attacks
to think that in an hour or two at the most the patient would be quite
comfortable and if he is accustomed to the attacks, that he will be
walking around the next day almost as if nothing had happened. All
that the affection consists in is a spasm of the bronchioles and as
soon as that lets up, the patient will be himself again. Some material
may have accumulated during the time when the spasm was on which will
still need to be disposed of, and there will be, of course, tiredness
of muscles unaccustomed to be used in that special way, but that will
be all.

We are still in the dark as to what causes the spasms but undoubtedly
psychic factors {210} play an important etiological rôle. For a good
many people, there is a distinct element of dread as the immediate
cause of their asthmatic attacks. Some people have it only when they
have gone through some disturbing neurotic experience. Occasionally it
is the result of physical factors combined with some psychic element.
Cat asthma is not very uncommon and occurs as a consequence of some
contact by the individual with a specimen of the cat tribe though
usually the large cats, the lions and tigers, do not cause it. There
is nearly always, in those who are liable to this form of asthma, a
special detestation of cats. There is probably some emanation from the
animal which produces the asthmatic fever, just as is true also of
horses in those cases where horse asthma occurs. In a few of these
latter cases, however, it was noted that the horse asthma did not
begin until after there had been some terrifying experience in
connection with the horse, as a runaway, a collision, or something of
that kind.

Any one who sees many asthmatic cases inevitably gets the impression
after a time that their very dread of the attacks has not a little to
do with predisposing them. {211} Occasionally the dread is associated
with some other organic disturbance, either of heart or kidneys, or
oftener still, with some solicitude with regard to these organs and
the persuasion that there is something serious the matter with them,
though there is at most only some functional disturbance. This is
particularly true of cases of palpitation of the heart where there has
been considerable dread of organic heart disease. In a certain number
of these cases, there is some emphysema present, that is,
overdistention of the lungs, such as is seen in high-chested people.
Owing to the long anterio-posterior diameter of the chest and the fact
that as a consequence it is nearly as thick through as it is wide,
this form of chest is sometimes spoken of as barrel-chest. Patients
who have it are particularly likely to suffer from asthma if they have
any dread of heart trouble or if they are of a nervous constitution.

I have known people with the dread of the dark to get an attack of
asthma if they were asked to sleep alone after having been accustomed
for years to sleep with somebody in the room. I have known even a
physician to have attacks of asthma of quite typical character as the
result of a dread of being {212} out after dark which had gradually
come over him. I have had a physician patient who was very
uncomfortable if alone on the streets of New York, even during the
day, and whose symptoms at their worst were distinctly dyspneic or
asthmatic. He used to have to bring his wife with him whenever he came
to see me for he lived out in one of the neighboring towns, because he
was so afraid that he might get an asthmatic attack that would
overcome him and he would feel helpless without some one to aid him.

In practically all these cases, the treatment of asthma becomes
largely that of treating the accompanying dread. Once the acute
symptoms of the attack itself manifest themselves, they have to be
treated in any way that experience has shown will relieve the patient.
The general condition, however, needs very often an awakening of the
will to regulate the life, to get out into the air more than before,
to avoid disturbing neurotic elements, and worrying conditions of
various kinds. Thin people need to be made to gain in weight, using
their will for that purpose; stout people who eat too much and take
too little exercise need to have their lives {213} regulated in the
opposite direction. In the meantime, anything that arouses the patient
to believe firmly that his condition will be improved by some remedy
or mode of treatment, will help him to make the intervals between
attacks longer and the attacks themselves less disturbing. The will
undoubtedly plays a distinct role in this matter which patients who
have been through a series of asthmatic attacks recognize very
clearly.

The many remedies for asthma which have been lauded highly even by
physicians, and that have cured or relieved a great many patients and
yet after a while have proved to be without much beneficial effect,
make it very clear how much the affection depends on the will power to
face it and throw it off. Nothing will be curative in asthma unless
the patient has confidence in his power and uses his own will energy
to help it. He must overcome the element of dread which occurs in
connection with all asthmatic attacks, even those due to organic
disease of heart or kidneys. No matter how frequent the attacks have
been, there is always an element of fright that enters into an
affection which interferes with the respiration. This must {214} be
overcome by psychic means to help out the physical remedies that are
employed. Sometimes the psychic remedies will succeed of themselves
where more material means have failed completely.


{215}

CHAPTER XV

THE WILL IN INTESTINAL FUNCTION


  "Ill will never said well."
                           _Henry V_.


During the past generation, the appreciation of the relative part
played by the stomach and intestines in digestion has completely
changed. Our forefathers considered the stomach the all-important
organ of digestion and the intestines as scarcely more than a long
tube to facilitate absorption and deal properly with waste materials.
Their relative values are now exactly reversed in our estimation. The
stomach has come to be looked upon as scarcely more than a thin-walled
bag meant to hold the food that we take at each meal and then pass it
on by degrees to be digested, prepared for absorption and finally
absorbed in the intestines. It has comparatively little to do with
such alteration of the food as prepares it to be absorbed. Its motor
function is much more important than its secretory function and
serious stomach troubles are {216} dependent on disturbances of
stomach motility. Contractions at the pyloric orifice, that is the
passageway from the stomach into the intestines, will cause the
retention of food and seriously interfere with health. The dilatation
of the stomach for any reason may produce a like result and these are
the stomach affections that need special care.

If the stomach will only pass the food on properly, the intestines
will do the rest. A number of people have been found in the course of
routine stomach examinations who proved to have no secretory function
of the stomach and yet suffered no symptoms at all attributable to
this fact. The condition is well known and is called _achylia
gastrica_, that is, failure of the stomach to manufacture chyle, the
scientific term for food changed by stomach secretions. Our stomachs
are only meant, apparently, to provide a reservoir for food that will
save us the necessity of eating frequently during the day, as the
herbivorous and graminivorous animals have to do, and enable us to
store away enough food to provide nutrition for five or six hours. We
thus have the leisure to occupy ourselves with other things besides
eating and drinking.

This conclusion as to the relative {217} significance of the stomach
and digestion is confirmed by the fact that removal of the whole
stomach or practically all of it for cancer has in a number of well
known cases been followed by gain in weight and general improvement in
health. Schlatter's case, the very first one in which nearly the whole
stomach was removed, proved a typical instance of this, for the
patient proceeded to gain some forty pounds in weight. She had lost
this during the course of the growth of a cancer and its interference
with stomach motility. It was necessary, however, for her to be fed,
rather carefully, well-chosen foods usually in liquid form, and every
hour and a half instead of at longer intervals. Her intestines were
thus spared from overloading and proceeded to do the work of digestion
for which they are so well provided by abundant secretion poured into
them from the large glands, the liver and the pancreas, as well as the
series of small glands in their own walls all of which were manifestly
meant to do extremely important work.

In the increased estimation of the significance of the digestive
functions of the intestines which has come in recent years, there has
been a tendency, as always in human {218} affairs, for the pendulum to
swing too far. Above all, certain phases of intestinal function have
come to occupy too much attention and to be the subject of
oversolicitude. Whenever this happens, whatever function it concerns
is sure to be interfered with. Attention has been concentrated to a
great extent on evacuation of the bowels and the consequences have
been rather serious. A great many people whose intestinal functions
were proceeding quite regularly have had their attention called to the
fact that any sluggishness of the intestines may be the source of
disturbing symptoms and the beginning of even serious morbid
conditions. As a consequence, they pay a great deal of attention to
the matter and before long become so solicitous that the elimination
of waste materials from the intestines is interfered with. Above all,
they may be led to pick and choose their foods so delicately that
there is not the necessary waste material left to encourage
peristalsis.

The result is that to some extent at least, intestinal function would
almost seem to have broken down in our day. Everywhere one sees
advertisements of medicines and remedies and treatments of various
kinds that will aid in the evacuation of the bowels. {219} Most of
them are guaranteed to be perfectly harmless and all of them are
pleasant to take, they work while you are doing nothing else and are
just engaged in saving mankind not only suffering but complications of
various kinds that may lead to serious results. Some years ago, when
Matthew Arnold was in this country, he declared in one of his lectures
that what the world needed was "leading and light," but a well known
American physician who is closely in touch with American life declared
not long since that what we needed in America manifestly, if
advertisements were any index of the needs of a people, was laxatives
and more laxatives. Advertisements cost money; it is said that at
least four times as much as the advertising costs must be spent by the
public on any object advertised in order to make it pay, so that very
probably nearly a billion of dollars a year is spent in this country
on laxatives. Only whiskey and tobacco present a higher bill to the
American people annually.

Practically all of the laxative medicines do harm if taken over a
prolonged period. Over and over again physicians have found that
laxative remedies introduced even by scientists, with the assurance
that they were quite {220} harmless and had no undesirable after
effects proved the source of annoying or even serious symptoms after a
while. It is true that when constipation has become habitual, it may
be necessary to give laxative medicines for a prolonged period, but
this is only another instance of the necessity that is often presented
to the physician of choosing between two evils and trying to find the
lesser one. Even the heavy oil that has become so popular in recent
years has been found on careful investigation and prolonged
observation to have certain undesirable effects and it must not be
forgotten that it has not been used generally for a sufficiently long
time for us to be absolutely sure what its sequelae may be.

This breakdown of intestinal activity is not the fault of nature but
of men and women who have been thinking to improve on the natural laws
of living. As the result of improvements in diet and refinements in
cooking and the preparation of foods, less and less of their roughage
is left in our articles of food when sent to the table. It is on this
roughage or waste material that intestinal movement or peristalsis
depends. If we eat perfectly white bread, cut all the gristle and
fatty materials from our meat, carefully eliminating {221} the
connective tissue bundles that may occur in it, eat our vegetables
mainly in the shape of purees and avoid to a great extent all the
coarser varieties, such as parsnips and carrots and beets, we provide
very little material for the intestines to carry on and aid them in
the elimination of other wastes. If, besides, we always ride and do
not walk, and so have none of that precious jolting which occurs every
time the heel comes down, and if we have no bending movements in our
lives, no wonder that intestinal movement becomes sluggish and we have
to supply stimulants and irritants to get it to do its work.

Intestinal evacuation is very largely a matter of will. There are very
few people so constituted by nature that they will not have regular
movements sufficient to maintain their digestive tracts in excellent
health, if they form the right habits. They must, however, make up
their minds, that is their wills, to restore coarse materials to their
diet. They must eat whole wheat or graham bread, must eat fruit
regularly and usually eat the skins of the fruit with it, that is as
far as apples, pears, peaches, apricots, plums and the like are
concerned. Even as regards oranges, it is probable that the eating of
occasional {222} pieces of orange peel is an excellent means of
helping intestinal functions and providing waste material.   [Footnote
6 ]

  [Footnote 6: A curious discovery has been made in recent years that
  orange skin contains a very precious element essential for bodily
  health, belonging to the class of substances known as the vitamines
  and contains more of it than any other food material that we have.
  The instinct which tempted so many of us as children to eat orange
  skin, in spite of the fact that we were discouraged from the
  practice, was founded on something much more than mere childish
  caprice. Orange skin is after all the basis of marmalade which has
  been so commonly used by the English people at breakfast and which
  is at once a tasty and healthful material.]

When baked potatoes are taken, the skin should be eaten, mainly
because of the waste material it provides, but also because just
underneath the skin and sure to be removed with it if it is taken off,
there are certain salts and other substances that are excellent for
health and particularly for digestion. Besides, the carbonized
material which so often occurs on baked potatoes is of itself a good
thing. It represents some of that charcoal which in recent years
French physicians particularly have found very valuable as a remedy
for certain disturbances of intestinal digestion. The removal of
parings from fruit and vegetables and the careful trimming of meat,
have taken out of human diet the materials which meant most for
intestinal movements for former generations, and they {223} have to be
supplied artificially by means of irritant drugs, salts, oils and the
like, to the detriment of function.

The other element in the modern situation as regards the failure of
intestinal function is the lack of fluids. People who live indoors are
not tempted to take so much water as those who work outside and yet in
our modern, steam-heated houses they often need more. Our heating
systems take much more water from us than the former methods of
heating. The result is seen in our furniture that comes apart from
dryness and in our books and other things which crack and deteriorate.
Something of the same thing happens to human beings unless they supply
sufficient fluids. For this it is necessary deliberately to make up
the mind, which always means the will, to consume five or six glasses
of water between meals and especially to take one on rising in the
morning and another on going to bed. This should _not_ be hot and
above all not lukewarm water, but fresh cold water which stimulates
peristalsis. The creation of a habit is needed in the matter or it
will be neglected. I have sometimes given patients some harmless drug,
like a lithium salt, that was to be taken three or four times a day in
a full glass of {224} water, in order to be sure that they would take
the water. They were willing to take the medicine but I could not be
assured that without it they would drink the amount of water that I
counselled.

Above all, a regular habit of going to the toilet at a definite time
every day must be created. Nothing is so important. In little
children, even from their very early years, such a habit can be
established; it is only necessary to put them on their chairs at
certain times in the day and the desired result will follow. Adults
are merely children of a larger growth in this matter, and the habit
of going regularly is all-important. A little patience is needed,
though there should be no forcing, and after a time, a very
satisfactory habit can be established in this manner. It seems almost
impossible to many people that anything so simple should prove to be
remedial for what to them for a time seemed so serious a disturbance
of health, but only a comparatively short trial of the method will be
sufficient to demonstrate its value. A book or newspaper may be taken
with one, or Lord Chesterfield's advice to learn a page of Horace
which may afterwards be sent down as an offering to Libitina, the
goddess of secret {225} places, may be followed, but the mind must not
be diverted too much from the business in hand, and the will must be
afforded an opportunity to exert its power.

It is true that the muscular elements of the intestines consist of
unstriped muscles and that they are involuntary, and yet experience
and observation have shown that the will has a certain indirect
influence even over involuntary muscle. The heart, though entirely
involuntary in its regular activities, can be deeply influenced by the
will and the emotions, as the words encouraging and discouraging, or
the equivalent Saxon words heartening and disheartening, make very
clear. Undoubtedly the peristaltic functions of the intestines can be
encouraged by a favorable attitude of the will towards them.

Above all, it is important that the anxious solicitude which a great
many people have and foster sedulously with regard to the effect of
even slight disturbances of intestinal functions should be overcome.
We have discussed this question in the chapter on dreads and need only
say here that the delay of a few hours in the evacuation of the bowels
or even the missing entirely of an intestinal movement for a full day
occasionally, will {226} usually not disturb the general health to any
notable extent, and that the symptoms so often attributed to these
slight disturbances of intestinal function are much more due to the
solicitude about them than to any physical effect. There are a great
many people whose intestinal functions are quite sluggish and whose
movements occur only every second day or so, who are in perfectly good
health and strength and have no symptoms attributable to any
absorption of supposed toxic materials from the intestines. Indeed, in
recent years, the idea of intestinal auto-toxemia has lost more and
more in popularity for it has come to be recognized that the symptoms
attributed to this condition are due in a number of cases to serious
organic disease in other parts of the body, and in a great many cases
to functional nervous troubles and to the psycho-neuroses, especially
the oversolicitude with regard to the intestines. The will is needed
then for intestinal function to regulate the diet, to increase the
quantity of fluid, to secure regular habits and to eliminate worry and
anxiety which interferes with intestinal peristalsis. There are but
very few cases that will not yield to this discipline of the will when
properly and persistently tried.


{227}

CHAPTER XVI

THE WILL AND THE HEART


  "For what I will, I will, and there an end."
                               _Two Gentlemen of Verona_.


The heart is the _primum movens_, the first tissue of the body that
moves of itself in the animal organism, doing so rhythmically and of
course continuously before the nervous system develops in the embryo.
This spontaneous activity would seem to place it quite beyond the
control of the will, as of course it is, so far as the continuance of
its essential activity goes, but there is probably no organ that is so
much influenced by the emotions and comes indirectly under the
influence of the will as the heart. There are a series of expressions
in practically all languages which chronicle this fact. We talk about
the encouragement and discouragement or in Saxon terms that are
exactly equivalent to the French words, heartening and disheartening
of the individual. At moments of panic the {228} heart can be felt to
be depressed, while at times when resolve is high there is a sense of
well-being in connection with the firm action of the heart that flows
over into the organism and makes everything seem easy of
accomplishment.

There are a number of heart conditions that depend for their existence
and continuance on a sense of discouragement, that is oversolicitude
with regard to the heart. If something calls attention to that organ,
the fact that it is so important for life and health and that anything
the matter with it may easily prove serious, will sometimes
precipitate a feeling of panic that is reflected in the heart and adds
to the symptoms noted. The original disturbing heart sensation may be
due to nothing more than some slight distention of the stomach by gas,
or by a rather heavy meal, but once the dread of the presence of a
heart condition of some kind comes over the individual, all the
subjective feelings in the cardiac region are emphasized and the
discouragement that results further disturbs both heart and patient.

Palpitation of the heart is scarcely more than a solicitous noting of
the fact that the heart is beating. In certain cases, under the {229}
stress of emotion, the heart beat-rate may be faster than normal, but
in a number of people who complain of palpitation, no rapid heart
action is noted. What has happened is that something having called
particular attention to the heart, the beating of the organ gets above
the threshold of consciousness and then continues to be noted whenever
attention is given it. This is of itself quite sufficient to cause a
sense of discomfort in the heart region and there may be, owing to the
solicitude about the organ, a great deal of complaint.

Just one thing is absolutely necessary in the treatment of these
cases, once it is found that there is no organic condition present.
The patient's will must be stimulated to divert the attention from the
heart and to keep solicitude from disturbing both that organ and the
patient himself. It is not always easy to accomplish this, but where
the patient has confidence in the diagnosis and the assurance that
nothing serious is the matter, a contrary habit that will overcome the
worry with regard to the heart can be formed. For it must not be
forgotten that in these cases a series of acts of solicitous attention
has been performed which has created a habit that can only be overcome
by the opposite habit. {230} It is surprising how much discomfort this
simple affection, due to a functional disturbance of the heart and
overattention to it, may produce and how much it may interfere with
the usual occupation. It is a case, however, simply of willing to be
better, and nothing else will accomplish the desired result. At times
the mistake is made of giving such patients a heart remedy, perhaps
digitalis, but this only emphasizes the unfavorable suggestion and
besides, by stimulating heart action, sometimes brings it more into
the sphere of consciousness than before and actually does harm.

There is a form of this functional disturbance of the heart which
reaches a climax of power to disturb and then is sometimes spoken of
as spurious _angina pectoris_. In these cases the patient complains
not only of a sense of discomfort but of actual pain over the heart
region and this pain is sometimes spoken of as excruciating.
Occasionally the pain will be reflected down the left arm which used
to be considered the pathognomic sign of true _angina pectoris_ but is
not. Sometimes the pain is reflected in the neck on the left side or
at times is noted at the angle of the scapula behind. When these
symptoms occur {231} in young persons and particularly in young women,
there is no reason to think for a moment of their being due to true
_angina pectoris_, which is a spasm of the heart muscle consequent
upon the degeneration of the coronary arteries, the blood vessels
which feed the heart itself, and occurs almost exclusively in the old,
and much more commonly in old men.

The pain of true _angina pectoris_ is often said to be perhaps the
worst torture that humanity has to bear. As a rule, however, it is
very prostrating and so genuine sufferers from it are not loud in
their complaints. Their suffering is more evident in their faces than
in their voices. Indeed, it has come to be looked upon as a rule by
the English clinicians and heart experts that the more fuss there is
made, the less likelihood there is of the affection being true _angina
pectoris_. When there is pain in the heart region then, especially in
young or comparatively young women, of which great complaint is made,
it is almost surely to be considered spurious _angina_, even though
there may be reflex pain down the arm as well as the impending sense
of death which used to be considered distinctive of the genuine
_angina pectoris_.

{232}

The treatment of true _angina_ depends to some extent on inspiring the
patient with courage, for it is needed to carry him through the very
serious condition to which he is subjected. The psychic element is
important, though the drug treatment by the nitrites and especially
amyl nitrite is often very effective. In spurious _angina_, the will
is the all-important element. There is some irritation of the heart
muscle but it is mainly fright that exaggerates the pain and then
concentration of attention on it makes it seem very serious. The one
thing that is all important is to relieve patients from the solicitude
which comes upon them with regard to their hearts and which prevents
them from suppressing their feelings and diverting their minds to
other things. Sometimes the will is needed to bring about such a
change in the habits of the individual as will furnish proper
nutrition for the heart. Very often these patients are under weight,
not infrequently they have been staying a great deal in the house, and
both of these bad habits of living need to be corrected. Good habits
of eating and exercise are above all important for the relief of the
condition.

For functional heart trouble, gentle exercise {233} in the open air
generally must be taken, for it acts as a tonic stimulant to the heart
muscle. Almost as a rule, when patients suffer from symptoms from
their hearts, they are inclined to consider them a signal that they
must rest and above all must not exercise to such an extent as to make
the heart go faster. Rest, if indulged in to too great an extent, has
a very unfavorable effect upon the heart, for the heart, like all
muscles, needs exercise to keep it in good condition. One of the most
important developments of heart therapeutics in our generation was the
Nauheim treatment. In this, exercise is an important feature. The
exercise is graduated and is pushed so as to make a definite call upon
the heart's muscular power. Nauheim is situated in a little cup-shaped
valley and patients are directed to walk a certain distance on one of
the various roads, distances being marked by signposts every quarter
of a mile or so. The walk outward, when the patient is fresh, is
slightly uphill, and the return home is always downhill, which saves
the patient from any undue strain.

The experience at Nauheim was so favorable that many physicians took
up the practice of having their heart patients exercise {234}
regularly and found that it was decidedly to their benefit. If this is
true for organic heart conditions, it is even more valuable for
neurotic heart cases, though it often requires a good deal of exercise
of will on the part of patients suffering from these affections to
control their feelings and take such exercise as is needed. In men, it
will often be found that the discomfort in the heart region,
particularly in muscular, well-built men who have no organic
condition, is due more to lack of exercise than to any other factor.
This is particularly true whenever the men have taken considerable
vigorous exercise when they were young and then tried to settle down
to the inactive habits of a sedentary life. Athletes who have been on
the teams at college, self-made men who have been hard manual laborers
when they were young, even sons of farmers who take up city life are
likely to suffer in this way. Their successful treatment depends more
on getting exercise in the open back into their lives than on anything
else, and for this a call upon the individual's will power for the
establishment of the needed new habits is the essential.

Former athletes who try to settle down to a very inactive life are
almost sure to have {235} uncomfortable feelings in their heart
region. At times it will be hard to persuade them that they have not
some serious affection consequent upon some overstrain at athletics.
In a few cases, this will be found to be true, but in the great
majority the root of the trouble is that the heart craves exercise. A
good many functional heart cases, like the neurotic indigestions, so
called--are due to the fact that the heart and the stomach are not
given enough to do. The renewal of exercise in the daily life--and it
should be the daily life as a rule and not merely once or twice a
week--will do more than anything else to relieve these cases and
restore the patient's confidence. We saw during the war that a number
of young men, officers even more than privates--that is, the better
educated more than the less educated--suffered from shell shock so
called. A good many university men may suffer from what might be
termed heart shock if they find any reason to be solicitous about
their hearts. These neurotic conditions can only be relieved by the
will and diversion of attention.

A certain number of people who suffer from missed beats of their
hearts become very much perturbed about the condition of that organ.
{236} Irregular heart action, and especially what has been called the
irregularly irregular heart, may prove to be a serious condition.
There are a number of regular irregularities of heart action, however,
consisting particularly of the missed beat at shorter or longer
intervals, which may have almost no significance at all. I know two
physicians, both athletes when they were at college, who have suffered
from a missed heartbeat since their early twenties. In one case it has
lasted now for thirty-five years and the physician is still vigorous
and hearty, capable even of running up an elevated stairway after a
train without any inconvenience. Some twenty years ago there was
question of his taking out a twenty-year life insurance policy and the
insurance company's physician at first hesitated to accept the risk
because of the missed beat. An examination made by three physicians at
the home office was followed by his acceptance and he has outlived the
maturity of the policy in good health and been given a renewal of it,
in spite of the fact that his missed beat still persists.

There is often likely to be a good deal of solicitude as to the
eventual prognosis in these cases, that is as to what the prospect of
{237} prolonged life is. The regularly irregular heart does not seem
to make for an unfavorable prognosis. Young patients particularly who
have learned that they have a missed heartbeat need to have this fact
emphasized. We have the story of an important official of an American
university in whom a missed beat was discovered when he was under
forty. This was many years ago, and the prognosis of his condition was
considered to be rather serious. The patient actually lived, however,
for a little more than fifty years after the discovery of his missed
beat. It is easy to understand what a favorable effect on a patient
solicitous about a missed beat such a story as this will have. It
heartens a patient and gives him the will power to throw off his
anxieties and to keep from watching his heart and thus further
interfering with its activities. There is even a possibility of life
to the eighties or, as I have known at least one case, to the
nineties, where the irregular heart was first noted under thirty.

But it is well recognized that close concentration of attention on the
heart will hamper its action. It has been demonstrated that it is
possible by will power to cause the missing of heartbeats and while
only those who have {238} practised the phenomenon can demonstrate it,
there are a number of well-authenticated examples of it. There is no
doubt, however, that anxiety about the heart will quicken or slow the
pulse rate. When a patient comes to be examined for suspected heart
trouble the pulse rate is almost sure to be higher than normal, even
though there may be nothing the matter with the heart; the increase or
decrease of the pulse beat is due to the anxiety lest some heart
lesion should be discovered. This makes it necessary as a rule not to
take too seriously the pulse rate that is discovered on a first
consultation and makes it always advisable to wait until the patient
has been reassured to some extent before the pulse rate is definitely
taken.

It is easy to see, then, what a large place there is for the will in
heart therapeutics. Courage is an extremely important element in
keeping the heart from being disturbed and maintaining it properly
under control. Scares of various kinds with regard to this
all-important organ are prone to get hold of people and then to
disturb it. Many a heart that is actually interfered with in its
activities by drugs of various kinds would respond to the awakening of
the will of the patient {239} so as to control solicitudes, anxieties,
dreads and the like that are acting as disturbing factors on the
heart. When taken in conjunction with the will to eat and to exercise
properly so often necessary in these cases, the will becomes the
therapeutic agent whose power must never be forgotten, because it can
always be an adjuvant even when it is not curative and can produce
excellent auxiliary effects for every form of heart treatment that we
have.



{240}

CHAPTER XVII

THE WILL IN SO-CALLED CHRONIC RHEUMATISM

                                         "I should do it
  With much more ease; for my good will is to it."
                                       _The Tempest_.


In popular estimation, rheumatism is one of the commonest of
affections. When a physician asks a patient, especially if the patient
is over forty years of age, "Have you ever suffered from rheumatism?"
the almost invariable response is, "Yes", though but little further
inquiry is needed to show that what the patient means is that he has
suffered from some painful conditions in the neighborhood of his
joints, or that his muscles have been sore or inclined to ache in
rainy weather, or that he has undergone some other vague discomforts
connected with dampness. Chronic rheumatism is a term that includes a
great many of the most varied conditions. True rheumatism, that is,
acute articular rheumatism, is now recognized as an infectious disease
which runs a definite course, usually with {241} fever, for some ten
days to ten weeks, and requires confinement to bed usually for a month
or more. Very rarely will any connection be found between this
affection, which presents always Galen's four classic symptoms of
inflammation, swelling, redness, heat and pain (_tumor, rubor, color,
et dolor_), and the usual conditions which are broadly characterized
as rheumatism. Just as soon as patients are asked if their rheumatism
included these symptoms there is denial, yet the idea of their having
had rheumatism remains.

As a matter of fact, there are a number of sore and painful conditions
in connection with muscles and particularly in and around joints that
have, without any scientific justification at least, been called
chronic rheumatism. Any painful condition that is worse in rainy
weather is sure to be so named. As old dislocations, sprains and
wrenches of joints, broken bones, as well as muscular conditions of
all kinds, including flat foot and other yielding of joints, all
produce this effect, it is easy to understand that there is an immense
jumble of all sorts of painful conditions included under the term
"chronic rheumatism." Some of them, particularly in older people,
produce lameness or at least inability to walk {242} distances without
showing the disability; a great many of them produce distinct painful
conditions during the night following the use of muscles and often
disturb patients very much, because they arouse the dread that they
are going to be crippled as they grow older.

Indeed, one of the most serious effects of these recurring painful
conditions is the dread produced lest they should cause such
progressive affections in and around joints as would eventually make
the patients bed-ridden. There are a certain number of cases of
so-called rheumatoid arthritis which produce very serious changes in
joints with inevitable crippling and quite beyond all possibility of
repair. These cases are often spoken of as chronic rheumatism and it
is the solicitude produced by the dread of them that makes the worst
part of the discomfort in many a so-called chronic rheumatic case. If
their affection is to be progressive, then the patients foresee a
prolonged confinement to bed in the midst of severe pain, hopeless of
ultimate cure. It may be said at once that these cases of rheumatoid
arthritis have nothing to do with rheumatism, represent a special
acute infection, are never a sequela of any of the rheumatic
conditions and are {243} fortunately very rare. This assurance of
itself is quite sufficient to make ever so much better a great many
patients who feel that they suffer from rheumatism.

The painful conditions that are described under the term chronic
rheumatism would seem to be quite beyond any power of the will to
affect. They are at least supposed to represent very definite changes
in the tissues, usually of chronic character and therefore not
amenable to any remedies except those of physical influence. Besides,
they are so frequent that surely if there were any question of the
will being able to control them or bring relief for them, most
sufferers would discover this fact for themselves and apply the remedy
from within. It is not to be expected that a very great many people
would suffer pains and aches that are worse in rainy weather if all
that was needed was the exertion of their will power either to throw
off the affection or to perform such exercises and activities as would
gradually make their conditions better. In general it is felt that
painful conditions of this kind cannot be affected by the will and
that distinctly material and not psychic therapeutics must be looked
to for their relief.

Now it so happens that the best illustration {244} of the power of the
will to "cure" people, that is, to relieve them completely of their
affections and start them afresh in life with the feeling that they
are no longer handicapped by disease, is to be found exactly in the
group of cases that have almost from time immemorial been called
chronic rheumatisms. We have had more "cures" of various kinds
announced for these--chemical, electrical, physical, hydriatic,
movement therapy and so forth--than for almost any other group of
diseases. More irregular practitioners of medicine all down the ages
have made a reputation by curing these affections than have won renown
by treating any other set of ills to which humanity is heir. Like the
poor, these ills are still with us, in spite of all the "cures" and
probably nowhere is the expression of the old French physician that
"the therapeutics of any generation is always absurd to the second
succeeding generation" better illustrated than in regard to them.
These cases serve to emphasize very clearly, however, the fact that
the pains and aches of mankind are largely under the control of the
will.

The more one studies these cases of so-called chronic rheumatism the
easier it is to {245} understand how they become the signal "cures"
which attract attention to the quacks and charlatans who promise much,
but do nothing in particular, though they may give medicines or
treatment of some kind or another. They only arouse the patient's will
to be better and the determination to use his will with confidence,
now that the much praised treatment is doing something which will
surely make him better. Cases of this kind have constituted a goodly
part of the clientele of the great historic impostors who succeeded in
making large sums of money out of curing people by methods that in
themselves had no curative power. A review of some of the chapters of
that very interesting department of human history, the history of
quackery, is extremely suggestive in that regard. The only way to get
a good idea of the basic significance of these cases is to realize by
what they were cured and by whom they were cured.

One of the most interesting illustrations of that phase of human
credulity is the story of Greatrakes, the Irish adventurer who had
been a soldier in Flanders, and who when his campaigns were over set
up to be a healer of mankind. He chose his opportunity during {246}
the time while Cromwell, as Lord Protector of Great Britain, had
refused to continue the practice of touching the ailing which the
Kings of England had pursued for hundreds of years since the
Confessor's time. Cromwell did not impugn the efficacy of the Royal
Touch but he refused to have anything to do with it himself.
Greatrakes found it an opportune moment to announce that for three
nights in succession he had been told in a dream by the Holy Spirit
that in the absence of the King he was to touch people and cure them.

One might possibly think that with no better credentials than this and
no testimony except his own claim in the matter Greatrakes would
receive but scant attention. Any one who thinks so, however, does not
understand human nature. It was not long before some of the people who
had been sufferers for longer or shorter periods went to Greatrakes
and allowed him to try his hand at healing them. They argued that at
least if it did them no good it could do them no harm, and it was not
long before some of them declared that they had been benefited by his
ministrations. Very soon then he was able to furnish what seemed to be
abundant evidence of Divine Mission in the cures {247} that were
worked by his more than magic touch. Above all, people who had been
sufferers for prolonged periods, who had gone the rounds of
physicians, who had tried all sorts of popular remedies, and some of
whom had been declared incurable were healed of their ills after a
series of visits to Greatrakes. No wonder then that patients came more
and more frequently, until his name went abroad in all the country and
in spite of the difficulties of travel people came from long distances
just to be treated by him.

All that he did was to ask the patient to expose the affected part and
then Greatrakes would stroke it with his hand, assure the patient that
a wonderful new vitality would go into them because of his Mission
from on High and promise them that they would surely get better,
explaining of course that betterment would be progressive and that it
would start from this very moment. The stroking was the important part
of the cure and so he is known in history as "Greatrakes the Stroker."
It may be said in passing that while those who were touched by the
English kings in the exercise of the prerogative of the Royal Touch
were usually presented with a gold coin which had been particularly
{248} coined for that purpose as a memorial, a corresponding gold
piece, a sovereign as a rule, in Greatrakes' method of treatment
passed from the patient to the healer. It was a case of metallotherapy
with extraction of the precious metal from the patient, as is always
the case under such circumstances.

Here in America we had a similar experience, though ours had science
as the basis of the superstition in the case instead of religion. The
interest aroused by Galvani's experience with the twitching of frogs'
legs when exposed nerve and muscle were touched by different metals
led Doctor Elisha Perkins to invent a pair of tractors which would
presumedly apply Galvani's discovery to therapeutics. These were just
plain pieces of metal four or five inches long, shaped more or less
like a lead pencil and tapering to a blunt point. With these, as
Thatcher, one of our earlier historians of medicine, tells us, Perkins
succeeded in curing all sorts of ailments, but particularly many
different kinds of painful conditions. He was most successful in the
treatment of "pains in the head, face, teeth, breast, side, stomach,
back, rheumatism and so forth." In a word, he cured the neuralgias and
the rheumatic pains and the chronic {249} rheumatisms which are the
source of so much trouble--and especially complaint--for the old, and
which so often physicians, in any time of the world's history, have
been unable to cure.

For a time his success was supposed to be due to some curious
electrical power that he was using. Learned pamphlets were issued to
show that animal magnetism or animal electricity or Galvanism was at
work. Professors at no less than three universities in America gave
attestations in favor of its efficacy. Time has of course shown that
there was absolutely no physical influence of any kind at work. The
only appeal was to the mind. Elisha Perkins was a Yale man of
education and impressive personality, "possessing by nature uncommon
endowments both bodily and mental ", and he succeeded in impressing on
his patients the idea that they would surely be cured; he thus
overcame the dreads, released the will power, gave new hope and a
tonic stimulus to appetite, created a desire for exercise, and then
the will kept this up and before long the patient was cured.

When animal magnetism, as it was called about the middle of the
nineteenth century, {250} was practised without apparatus, one of its
most important claims to the consideration of physicians was founded
on its power to heal chronic painful affections which had previously
resisted all therapeutic efforts. The power of neuro-hypnotism, as it
came to be designated, to accomplish this, will be best appreciated
from the fact that this state was being used as a mode of anaesthesia
for surgical operations. When the news of the use of ether to produce
narcosis for surgical purposes at the Massachusetts General Hospital
first came to England, it did not attract so much attention as would
otherwise have been the case, because English physicians and surgeons
were just then preoccupied with the discussion of neuro-hypnotic
anaesthesia, and those who believed in it thought that ether would not
be necessary, while those who refused to believe thought the report
with regard to ether just another of these curious self-delusions to
which physicians seemed to be so liable.

Perkins' declarations of the curative value of his tractors were,
after all, only a succeeding phase of what Mesmer had called to the
attention of the medical profession and the public in Paris not quite
a generation before. Mesmer seated his patients around a tub {251}
containing bottles filled with metallic materials out of which wires
were conducted and placed in the hands of patients seated in a circle
around it. Mesmer called this apparatus a _baquet_ or battery and it
was thought to have some wonderful electric properties. A great many
people who received the treatment were cured of chronic pains and
aches that had sometimes lasted for years. So many prominent people
were involved that the Government finally ordered an investigation to
be made by French scientists with whom, because he was the Minister
from the colonies at the time, our own Benjamin Franklin was
associated. They declared that there was not a trace of electricity or
any other physical force in Mesmer's apparatus. He was forbidden to
continue the treatment and there was a great scandal about the affair,
because a large number of people felt that he was doing a great deal
of good.

When hypnotism came in vogue again at the end of the nineteenth
century, it was a case of chronic rheumatism that gave it its first
impetus in scientific circles. Professor Bernheim of Nancy had tried
in vain all of his remedies in the treatment of a patient suffering
from lumbago. The patient disappeared {252} for a time and when
Bernheim next saw him, he was cured. Bernheim had treated him futilely
for months and was curious to know how he had been cured. The patient
told him that he had been cured by hypnotism as practised by Liebault.
This brought Bernheim to investigate Liebault's method of hypnotism
and made him a convert to its practice. It was the interest of the
school of Nancy in the subject that finally aroused Charcot's
attention and gave us the phase of interest in hypnotism which
attracted so much public attention some thirty years ago. Many other
cases of those very refractory affections--lumbago and sciatica--have
been cured by hypnotism when they have resisted the best directed
treatment of other kinds over very long periods.

It is these chronic rheumatisms, so called, the chronic pains and
aches in muscles in the neighborhood of joints, that were cured by the
Viennese astronomer, Father Maximilian Höll, in the eighteenth
century. He simply applied the magnet and saw the result, and felt
sure that there must be some physical effect, though there was none.
His work was taken up by Pfarrer Gassner of Elwangen who, after using
the magnets for a time, found {253} that there was no need of their
application, provided the patients could by prayer and other religious
means be brought into a state of mind where they were sure that they
were going to get better. They then proceeded to use their muscles
properly in spite of the pain that might result for a time, and as a
result it was not long before they were cured of their affections. The
Church forbade his further practise because of his expressed idea that
pain came from the power of evil and dropped from men when they turned
to God, which was the eighteenth-century anticipation of Eddyism.
Dowie's cures were largely of similar affections, and patients
sometimes dropped their crutches and walked straight who could not
walk before.

A great many of the so-called chronic rheumatisms are really the
result of dreads to use muscles in the proper way because for the
moment something has happened to make their use painful. A direct
injury, a wrench, or some incident causes a joint for a time to be
painful when used. In sparing it, the muscles around it are used
differently than before and as a consequence become sensitive and
painful. It is quite easy, then, for people to form bad habits which
they cannot break {254} because they have not the strength of will to
endure the sore and tender condition which develops when they try to
use muscles properly once more. The young athlete who wants to get his
muscles in good condition knows that he must pass through a period of
soreness and tenderness, sometimes of almost excruciatingly painful
character. He does so, however, and does not speak of his condition as
involving pains and aches but only soreness and tenderness.

Older people, however, who have to get their muscles back into good
condition after a period of disuse following an injury or some
inflammatory disturbance, find this period of discomfort very
difficult to bear and so keep on using their muscles somewhat
abnormally and at mechanical disadvantage. As a consequence, these
muscles remain tender, are likely to ache in rainy weather and often
give a good deal of discomfort. Until the sufferers can be brought to
use their wills properly, so as to win back their muscles to normal
use, they will not get well. An application of magnets or a Leyden jar
or Mesmer's battery of the eighteenth century, or Perkins' tractors,
or neuro-hypnotism, or animal magnetism, or later hypnotism, or {255}
Dowie's declaration of their cure, enables them to use their will in
this regard and then they proceed to recover. It is surprising how
many presumedly intelligent people--at least they have received
considerable education--have been cured of conditions that they have
endured for years by some remedy or mode of treatment that actually
had no physical effect.

St. John Long, the English charlatan who has been mentioned in the
chapter on tuberculosis, also succeeded in making a name for himself
in connection with the chronic rheumatisms and the so-called rheumatic
pains and aches of older people. Between consumption and these
conditions, he caught both the young and the old, and thus rounded out
his clientele. For consumption he provided an inhalant; for rheumatic
conditions, a liniment. This liniment became very famous in that
generation for its power to relieve the pains and aches, both acute
and chronic, of mankind. So many people were cured by it and above
all, so many of them were people of distinction--lords and ladies and
the relatives of the nobility--that Parliament was finally petitioned
in the interests of suffering humanity to buy the secret of the {256}
liniment from its inventor and publish it for the benefit of the
world. I believe that a substantial sum, representing many, many
thousands of dollars in our time, was actually voted to St. John Long
and the recipe for his liniment was published in the British
pharmacopeia. In composition, it was, I believe, only a commonplace
turpentine liniment made up with yolks of eggs instead of oil, as had
been the custom before. Just as soon as this fact became known, the
wonderful cures which had occurred in connection with its use ceased
to a great extent, for distinguished members of the nobility and their
relatives would not be cured by so common-place a medium as an
ordinary turpentine liniment. St. John Long was even accused of not
having sold his real secret to the Government, but there was no reason
at all to think that. He had been producing his cures not by his
liniment but by the strong effect of his prestige and reputation as a
healer upon the minds of his patients and the consequent release of
will power which enabled them to do things which they thought they
could not do before. We have had many wonderful curative oils of
various kinds since then, with all sorts of names from Alpha to Omega
and {257} very often called after a saint,--though St. John Long was
as far as possible from being a saint in the ordinary acceptance of
that word. These modern curative oils and liniments have been merely
counter-irritants, but at times, owing to a special reputation
acquired, they have been counter-irritants for the mind and stimulants
for the will which have enabled old people to persist through the
periods of soreness and tiredness until they reacquired the proper use
of their muscles.


{258}

CHAPTER XVIII

PSYCHO-NEUROSES


  "Look, what I will not, that I cannot do."
                           _Measure for Measure_.


The psycho-neuroses, that is, the various perversions of nervous
energy and inability to supply and conduct nervous impulses properly,
consequent upon a mental persuasion which interferes with these
activities, have come to occupy an ever larger and larger place in the
field of medicine. The war has been illuminating in this matter. A
psycho-neurosis is, after all, a hysterical manifestation and it might
very well be expected that very few of these would be encountered in
armies which took only the _men_ of early adult life and from among
those, only persons who had been demonstrated to be physically and, as
far as could be determined, mentally normal. Neurologists would seem
scarcely to have a place in the war except for wounds of nerves {259}
and the cerebral location of missiles and lesions. Certainly none of
the army medical departments had the slightest premonition that
neurology would bulk larger in their war work than any other
department except surgery. That proved to be the case, however.

The surprise was to have, from very early in the war, literally
thousands of cases of psycho-neuroses, "shell shock" as unfortunately
they came to be called, which included hysterical symptoms of all
kinds, mutism, deafness, blindness, paralysis, and contractures.
France and England after some time actually had to maintain some fifty
thousand beds in their war hospitals mainly for functional nervous
diseases, the war neuroses of many kinds. During the first half of the
war, one seventh of all the discharges from the British army or
actually one third of all the discharges, if those from wounds were
not included, were for these war neuroses. They attacked particularly
the better educated among the men and were four times as prevalent
among officers as among the privates. In proportion to the whole
number of those exposed to shells and "war's alarms and dangers"
generally, these war neuroses were {260} more common among the men
than among the women. Nurses occasionally suffered from them, but not
so frequently as the men who shared their dangers in the hospitals and
stations for wounded not far from the firing line.

In the treatment of this immense number of cases, a very large amount
of the most valuable therapeutic experience for psychoneuroses was
accumulated. It was found that suggestion played a very large role in
making the cases worse. If these patients were placed in general
hospitals where there was much talk of wounds and injuries and the
severe trials of battle life they grew progressively worse. They
talked of their own experiences, constantly enlarging them; they
repeated what they had heard from others as if these represented their
own war incidents and auto-suggested themselves into ever worse and
worse symptomatic conditions. This was, after all, only the familiar
_pseudologia hysterica_ which occurs in connection with hysteria, and
which is so much better called by the straightforward name of
pathological self-deception or perhaps even just frankly hysterical
lying. If these patients were examined frequently by physicians, their
{261} symptoms became more and more varied and disabling and their
psycho-neurosis involved more external symptoms.

In a word, it was found that their minds were the source of extremely
unfavorable factors in their cases. The original shock or the severe
trials of war life had unbalanced their self-control and suggestions
of various kinds made them still worse. Much attention to their
condition from themselves and others simply proved to be constantly
disturbing. As was pointed out by Doctor Pearce Bailey, who had the
opportunity as United States Chief of the Division of Neurology and
Psychiatry attached to the Surgeon General's office to visit France
and England officially to make observations on the war neuroses, the
experience of the war has amply confirmed Babinski's position with
regard to hysteria. The distinguished French neurologist has shown
that the classic symptoms of hysteria are the results of suggestion
originating in medical examinations or from misapplied medical or
surgical treatment. He differs entirely from Charcot in the matter and
points out that it was unfortunate misdirected attention to hysterical
patients which led to the creation of the many cases of _grande
hystérie_ which {262} used to be seen so commonly in clinics in France
and have now practically disappeared. They were not genuine
pathological conditions in any sense of the word, but merely the
reflection of the exaggerated interest shown in them by those
interested in neurology, who came to see certain symptoms and were, of
course, gratified in this regard by the patients, always anxious to be
the center of attention and, above all, the focus of special interest.

The successful treatment of the war neuroses was all founded on the
will and not on the mind. Once a careful examination had determined
absolutely that no organic morbid condition was present, the patient
was given to understand that his case was of no special significance
but on the contrary was well understood and had nothing exceptional in
it. The unfortunate frequent demonstration of these patients at the
beginning of the war as subjects of special interest had been the
worst possible thing for them. After experience had cleared the way,
they were made to feel that just as soon as the attending physician
had the time to give them, he would be able to remove their symptoms
without delay. This was almost the only appeal to the mind {263} that
was made. It represented the suggestive element of the treatment.

The two other elements were reeducation and discipline. Once
suggestion had brought the patient to believe firmly that he would be
cured, he was made to understand that his cure would be permanent.
Then reeducation was instituted to overcome the bad habit of lack of
confidence that had been formed, while discipline broke down the
psychic resistance of the patient to the idea of recovery. In such
symptoms as mutism or deafness, the patient was told that electricity
would cure him and that as soon as he felt the current when the
electrode was applied, his power of speech or of hearing would be
restored, _pari passu_, with sensation. The same method was used for
blindness and other sensory symptoms. Paralyses were favorably
affected the same way, though tremors were harder to deal with. A cure
in a single treatment was the best method, for the patient readily
relapsed unless he was made to feel that he had recovered his powers
completely and that it would be his own fault if he permitted his
symptoms to recur.

The most interesting phase of the successful treatment of these war
neuroses for us was {264} the fact that the ultimate dependence was
placed by the French on a system of management which was called
_torpillage_. _Torpillage_ consists in the brusque application of
faradic currents strong enough to be extremely painful in hysterical
conditions, and the continuance of the procedure to the point at which
the deaf hear, the dumb speak, or those who believe themselves
incapable of moving certain groups of muscles come to move them
freely. The method has proved highly effective and requires but little
time and practically no personnel except the medical officer who
applies the treatment and the non-commissioned officer who takes the
patient at the end of the treatment and continues the exercise of the
afflicted parts. One treatment suffices. The apparatus is of the
simplest, the only accessory to the electric supply and the electrodes
consisting of an overhead trolley which carries the long connecting
wires the whole length of the room, thus making it impossible for the
patient to get away from the current which is destined to cure him.

In a word, the man who would insist on maintaining a false attitude of
mind towards himself, though that attitude of mind was not {265}
deliberate, and least of all not malingering, was simply made to give
it up. Sufficient pain was inflicted on him so that he was willing to
accept instead of his own false opinion the opinion of his physician
that he could accomplish certain functions. _Torpillage_ was, in other
words, simply "a method of treatment which gave authority to a medical
officer to inflict pain on a patient up to the point at which the
patient yields up his neurosis." As a rule, the infliction of very
little suffering is needed, for once the demonstration is made that he
will have to suffer or give in, it does not take him very long to give
in. There is no doubt at all that the method is eminently effective,
particularly in those cases which were entirely refractory to other
modes of treatment.

It would remind us of some old modes of treatment which were in
popular use long ago, but which had gone out entirely in our milder
generation because we thought their use almost unjustified. It was not
an unusual thing three or four generations ago to rouse a young woman
out of an hysterical tantrum, once it was perfectly clear from
previous experiences that it _was_ really an hysterical tantrum, by
dashing a pitcher of cold water {266} over her. Sir Thomas More
relates that he saw a number of people suffering from various forms of
possession--and any neurologist will confess that some hysterics must
have a devil--who were cured by being roundly whipped. Certain men
and women who complained that they were unable to walk or to work and
thus became a care for relatives or for the community, were cured by
this, as it seemed to later generations, heartless mode of treatment.
Now, we have turned to curing the war hysterias by punishment, that
is, by the infliction of severe pain, in just the same way. A great
many of these patients who suffer from neuroses and psycho-neuroses,
and especially from hysterical inhibitions so that they cannot hear or
cannot walk or cannot talk, represent inabilities similar to many
which are seen in civil life. Patients complain that they cannot do
things; their friends say that they will not do them; and the
physician sees that the root of the trouble is that they cannot
_will_. Now, however, that war has permitted the use of such remedies,
physicians have found that they can, to advantage, force the patients
to will and that once the will has been recalled into action, its
energy can be maintained.

{267}

Of course the compulsory mode of treatment was not represented as a
punishment, but on the contrary it was always presented as a form of
treatment which was extremely painful but necessary for the condition.
Presented as punishment, it would have been resented, and the patient
would probably have set about sympathizing with himself and perhaps
seek the sympathy of others, and this would prevent the effectiveness
of the treatment. It is very evident that as the result of compulsory
methods of treatment, and of the recognition of the fact that major
hysterical conditions are largely the result of suggestion and must be
cured by enabling the patient to secure control over himself again,
the outlook for the treatment of the psychoneuroses will be very
different as a consequence of the experience that has been gained.
Above all, the place of the will will be recognized, and there will no
longer be that coddling of patients and that analysis of their minds
for long distant psychic insults of various kinds which will explain
their condition, that has done so much harm in a great many ways in
recent years.

Another feature of the French treatment was that the neurotic patients
should be {268} isolated. This isolation was complete. It had been
found that association with other patients, the opportunity to tell
their troubles and be sympathized with, did them harm invariably and
inevitably, so that those whose neurotic symptoms continued were taken
absolutely away from all association with others. Not only this, but
all other modes of diversion of mind were denied them. They were
placed in rooms without reading or writing materials and even without
tobacco. This solitary confinement would remind one of the enforced
privacy of the old-fashioned rest cure in which the patient was
absolutely secluded from all association with relatives or others who
might in any way sympathize with them. The soldier patients were kept
in this complete isolation until such time as they showed themselves
amenable to treatment. This was usually not very long.

As a matter of fact, the isolation rooms had to be used very little
but were found necessary and especially effective in the management of
relapsed cases. Just as soon as soldier patients learned that such
isolating rooms were available, they became much more ready to give up
their neuroses, and as a consequence, in most places, the isolating
department did {269} not have to be used, and in some places they
could even be given over to the lodgment of attendants. It was quite
sufficient, however, that they had fulfilled their purpose of changing
patients' attitude of mind towards themselves and giving their will
control over them.

As Colonel Pearce Bailey, M.C., says, in most of these patients,
persuasive measures and contrary suggestion were quite sufficient, but
when they failed, disciplinary measures proved effective. How are we
going to be able to make such disciplinary measures available in civil
life is another question, but at least the war has made clear that
neurotic patients who claim that they cannot do something and actually
will not do it, _must be made to do it_, for this will prove the
beginning of their cure. It seems probable, as Doctor Bailey adds,
that the reason why the treatment of officers was more difficult--and
it must not be forgotten that in proportion to their numbers, four
times as many officers suffered from so-called shell shock as
privates--was exactly because these modes of discipline, amounting
practically to compulsion, were not used with them.


{270}

CHAPTER XIX

FEMININE ILLS AND THE WILL


  "Oh, undistinguished space of woman's will!"
                                     _King Lear_.


It is probable that the largest field for the employment of the will
for the cure of conditions that are a source of serious discomfort or
at least of complaint is to be found among the special ills of
womankind. The reason for this is that the personal reaction has so
much to do with the amount of complaint in these affections. Not
infrequently the individual is ever so much more important than the
condition from which she is suffering. Women who have regular
occupation with plenty to do, especially if they are interested in it
and take their duties seriously, who get sufficient exercise and are
out of doors several hours each day and whose appetites are as a
consequence reasonably good, suffer very little from feminine ills, as
a rule. If an infection of some kind attacks them, they will, of {271}
course, have the usual reaction to it, and this may involve a good
deal of pain and even eventually require operation. Apart from this,
however, there is an immense number of feminine ills dependent almost
entirely on the exaggerated tendency to react to even minor
discomforts which characterizes women who have no occupation in which
they are really interested, who have very little to do, almost no
exercise, and whose appetite and sleep as a consequence are almost
inevitably disturbed.

Above all, it must not be forgotten that whenever women do not get out
into the air regularly every day--and this means for a time both
morning and afternoon--they are likely to become extremely sensitive
to pains and aches. This is true of all human beings. Those who are
much in the open air complain very little of injuries and bodily
conditions that would seem extremely painful to those living sedentary
lives and who are much indoors. Riding in the open air is better than
not being in the open air at all, but it does not compare in its power
to desensitize people with active exercise in the open air. In the
older days, when women occupied themselves very much indoors with
{272} sewing, knitting and other feminine work, and with reading in
the evenings, and when it was considered quite undignified for them to
take part in sports, neurotic conditions were even more common than
they are at the present time, and young women were supposed to faint
readily and were quite expected to have attacks of the "vapors" and
the "tantrums."

The interest of young women in sports in recent years and the practice
of walking has done a great deal to make them ever so much healthier
and has had not a little to do with decreasing the number and
intensity of the so-called feminine ills, the special "women's
diseases" of the patent medicine advertisements. Much remains to be
done in this regard, however, and there are still a great many young
women who need to be encouraged to take more exercise in the open than
they do and thus to live more natural lives. It is particularly,
however, the women of middle age, around forty and beyond it, who need
to be encouraged to use their wills for the establishment of habits of
regular exercise in the open air as well as the creation of interests
of one kind or another that will keep them from thinking too much
about {273} themselves and dwelling on their discomforts. These are
thus exaggerated until often a woman who has only some of the feelings
that are almost normally connected with physiological processes
persuades herself that she is the victim of a malady or maladies that
make her a pitiable object, deserving of the sympathy of her friends.

A great many of the operations that have been performed on women
during the past generation have been quite unnecessary, but have been
performed because women felt themselves so miserable that they kept
insisting that something must be done to relieve them, until finally
it was felt that an operation might do them some good. It would surely
do them no harm or at least make them no worse, and there was always
the possibility that the rest in the hospital, the firm persuasion
that the operation was to do them good, the inculcation of proper
habits of eating during convalescence might produce such an effect on
their minds as would give them a fresh start in life. Undoubtedly a
great many women who were distinctly improved after operations owed
their improvement much more to the quiet seclusion of their hospital
life, their own strong expectancy {274} and the care bestowed upon
them under the hospital discipline without exaggerated sympathy which
brought about the formation of good habits of life, than to their
operation. Many a woman gained weight after an operation simply
because her eating was properly directed, and this was the main part
of the improvement which took place.

Operations are sometimes needed and when they are the patient will
probably not get well without one; but as a distinguished neurologist,
Doctor Dercum of Philadelphia, said in a paper read before the
American Medical Association last year, the neurologist is constantly
finding patients on whom one or several operations have been
performed, some of them rather serious abdominal operations, the
source of whose complaints is a neurosis and not any morbid condition
of the female or other organs. Occasionally one sees something like
this in men, and I shall never forget seeing at Professor Koenig's
clinic in Berlin a sufferer from an abdominal neurotic condition on
whom no less than three operations for the removal of his appendix had
been performed, until finally Professor Koenig felt that he would be
justified in tattooing over the right iliac region the words "No
Appendix {275} Here." The condition developed in a young soldier as
the result of a fall from a horse and his affection resembled very
much some of the neuroses that came to be called, unfortunately,
"shell shock" during the present war.

The principal trouble in securing such occupation of mind as will
prevent exaggerated neurotic reactions to even slight discomforts in
women is the creation for them of definite interests in life. The war
taught a notable lesson in this regard. Many a physician saw patients
whose complaints had been a great source of annoyance to them--and
their friends--proceed to get ever so much better as the result of war
interests. In one women's prison in an Eastern State, just before the
war, a series of crises of major hysteria was proving almost
unmanageable. By psychic contagion it had spread among the prisoners
until scarcely a day passed without some prisoner "throwing a fit"
with screaming and tearing of clothes and breaking of articles that
might be near. Prominent neurologists had been consulted and could
suggest nothing. When the war began, the prisoners were set to rolling
bandages, knitting socks and sweaters and making United States flags
for the army. As if by magic, the neurotic {276} crises disappeared.
For months there were none of them. The prisoners had an abiding
interest that occupied them deeply in other things besides themselves.

The reduction of nervous complaints of various kinds among
better-to-do women was very striking. As might be expected, their
rather strenuous occupation with war activities kept them from
thinking about themselves, though it is true that now they complain
about all the details that they had to care for and the lack of
coöperation on the part of certain people. It would seem as though
many of them had so much to do that they would surely exhaust their
energies and so be in worse condition than before, but this very
seldom proved to be the case. Literally many thousands of women
improved in health because they became interested in other people's
troubles instead of their own. David Harum once said that "It is a
mighty good thing for a dog to have fleas because it keeps him from
thinking too much about the fact that he is a dog." That seems a
rather unsympathetic way of putting the case, but there is no doubt at
all that what many women need is serious interests apart from
themselves in order to prevent the law of {277} avalanche from making
minor ills appear serious troubles.

What most women need above all are heart interests rather than
intellectual occupations. That was why occupation with war activities
did so much good. That is the reason, too, that club life and reading
and other similar pursuits often fail to be helpful to women in their
ills to the extent that might possibly be expected. Above all, women
need interests in children and the ailing, and these can be supplied
by visits to hospitals or by taking an active interest in nurseries,
though this is often not personal enough in its appeal to catch a
woman's deepest attention. One of the great reasons why there are more
nervous diseases among women in our time than in the past is because
children are fewer, and because so many women are without children and
the calls that they inevitably make on their mothers. Unfortunately,
the traditions of the present day are to a great extent in opposition
to that family life with a number of children, which means not only
the deepest interests for woman but also such inevitable occupations
in the care of them that she has very little time to think about
herself. It may seem quixotic, that is, {278} demanding unnecessary
magnanimity to suggest that these modern ideas should be discarded by
those who wish to assure themselves such interests in middle life as
will prove definitely preventive of many neurotic conditions, but it
is manifestly the physician's duty to make such suggestions.

Life has really become full of dreads for many women in this regard. A
gradual reduction in the birth rate which has deprived so many women
of the heart interests that were particularly valuable at and after
middle life; has been the source of a great deal more suffering
without any satisfaction, than would be associated in any way with the
care of children. It is extremely unfortunate, then, that this phase
of social evolution should have taken place, for the quest of ease and
pleasure has proved a prolific source of feminine ills. It is well
recognized now that the reason for this reduction in the birth rate is
not physical but ethical. It is a matter of choice and not necessity.
There is a conscious limitation of the number of children in the
family accomplished deliberately, and as a rule the women consider
that they are justified in the procedure because they thus conserve
their own health and provide such {279} few children as they have with
healthier bodies than would otherwise have been the case.

Indeed, child-bearing beyond one or two or perhaps three children has
become a source of dread in modern times, a dread that supposedly
centers around the health of the children, as well as the mother
herself. The mother of a few children is supposed to be healthier and
the children of small families to be heartier and more vigorous than
when there are half a dozen or more children in the family. A woman is
actually supposed by many to seriously imperil her life and her health
if she has more than two or three children, though as a matter of
fact, the history of the older times when families were larger shows
us that women were then healthier on the average than they are now, in
spite of all the progress that medicine and surgery have since made in
relieving serious ills. Above all, it was often the mother of numerous
children who lived long and in good health to be a blessing to those
around her, and not the old maids nor the childless wives, for
longevity is not a special trait of these latter classes of women. The
modern dread of deterioration of vitality as the result of frequent
child-bearing is quite without {280} foundation in the realities of
human experience.

Some rather carefully made statistics demonstrate that the old
tradition in the matter is not merely an impression but a veritable
truth as to human nature's reaction to a great natural call. While the
mothers of large families born in the slums with all the handicaps of
poverty as well as hard work against them, die on the average much
younger than the generality of women in the population, careful study
of the admirable vital statistics of New South Wales show that the
mothers who lived longest were those who under reasonably good
conditions bore from five to seven children. Here in America, a study
of more favored families shows that the healthiest children come from
the large families, and it is in the small families particularly that
the delicate, neurotic and generally weakly children are found.
Alexander Graham Bell, in his investigation of the Hyde family here in
America, discovered that it was in the families of ten or more
children that the greatest longevity occurred. So far from mothers
being exhausted by the number of children that were born, and thus
endowing their children with less vitality than if they {281} had
fewer children, it was to the numerous offspring that the highest
vitality and physical fitness were given. One special consequence of
these is longevity.

In a word, the dread so commonly fostered that the mothers of large
families will weaken themselves in the process of child-bearing and
unfortunately pass on to their offspring weakling natures by the very
fact that they have to repeat the process of giving life and
nourishment to them at comparatively short intervals, is as groundless
as other dreads, for exactly the opposite is true. It is when nature
is called upon to exert her amplest power that she responds most
bountifully and dowers both children and mother with better health in
return.

Something of the same thing is true with regard to the age of mothers
when their children are born. The infant mortality is lowest among the
children of young mothers between twenty and twenty-five years of age,
though it has been found out that "delay in child-bearing after that
age penalizes the children." This is, of course, true particularly for
first children. The successive children of young mothers are known by
observation and statistics as being constantly in {282} better
condition up to the seventh. There is on the average nearly a half a
pound difference in weight at birth between succeeding children of the
same mother, so that each infant is born sturdier and more vigorous
than its predecessor.

These recently collated facts remove entirely the supposed foundations
of a series of dreads which were having an unfortunate effect upon our
population, for the natives were disappearing before the foreigners
because of the higher birth rate among the latter. Birth control has
been producing a set of unfortunate conditions for both mothers and
children. The one child in the family is sure to be spoiled, not only
as a social being but often as regards health, and conditions are
scarcely better when there are but two, especially if they are of
opposite sexes. If anything happens to them, the mother has nothing to
live for, and a little later in life the selfish beings that have been
raised under the self-centered conditions of a small family are almost
sure to be a source of anxiety and worry. Many a woman owes the
valetudinarianism of her later years to the fact that she dreaded
maternal obligations and avoided them, and so the latter part of her
life is {283} empty of most of what makes life worth living.

The will to make life useful for others rather than to follow a
selfish, comfortable, easy existence is the secret of health and
happiness for a great many women who are almost invalids or at least
constantly complaining in the midst of idle lives. A woman who has
nothing better to occupy her time than the care of a dog or two cannot
expect to have any interests deep enough to divert her attention from
the pains and aches of life that are more or less inevitable. The
opportunity to dwell on them will heighten their intensity until they
are almost torments. Many more of the feminine ills can be explained
in this way than by learned pathological disquisitions. Every
physician has seen the bitterest complaints disappear before some
change of life that necessitated occupation and gave the patient other
things to think about besides self.

The will to face nature's obligations of maternity straightforwardly
is probably the greatest preventive against the psycho-neuroses that
prove so seriously disturbing to a great many women. Their affections,
given a proper opportunity to develop, impel their {284} wills to such
activity as prevents the development of morbid states. The dreads for
themselves and their children, which so often make the excuse for a
different policy in life than this, have proved unfounded on more
careful study. Now that war activities no longer call women, it must
not be forgotten that home duties are the only ones that can serve as
a universal antidote for the poison of self-indulgence, which is much
more productive of symptoms of disease than the autointoxications of
which we have heard so much, but for which there is so little
justification in our advancing science. The assumption of serious
duties is the best possible panacea for the ills of mankind as well as
womankind, only unfortunately in recent years women have succeeded in
shirking duties more and have paid the inevitable price which nature
always demands under such circumstances, when the dissatisfaction in
life is much harder to bear than the work and trials involved in the
pursuit of duty.


{285}

INDEX

  A

  Achylia Gastrica, 216
  Activity, intestinal, 220
  Adirondacks, 183
  Agoraphobia, 27
  Akrophobia, 27
  Alcohol,
    narcotics, 191;
    in pneumonia, 190;
    in snake bite, 193
  Alcoholic craving and food, 159
  Algiers, 182
  Angina pectoris, 230
  Anthony, Saint, the Hermit, 21
  Arctic regions, 205
  Aridity, office building, 206
  Aristotle, 71
  Arnold, Matthew, 219
  Arthritis, rheumatoid, 242
  Ascesis, 77
  Asceticism, 92
  Asthma dread, 211
  Attention, concentration of, 127
  Auto-intoxication, 36
  Autotoxemia, 226
  Avalanche, Law of, 123

  B

  Babinski, 261
  Bailey, Dr. Pearce, 261, 269
  Bain, Professor, 51
  Bell, Alexander Graham, 280
  Bernheim, 252
  Betel nut, 45
  Birth control, 282
  Bismarck, 10
  Brakes on energies, 19
  Bright's disease, 102

  C

  Cancer, 75
  Cancer cures, 106
  Carpenter, Doctor, 51
  Cat asthma, 210
  Catarrh, 31
  Character, 66
  Charcot, Professor, 252
  Chesterfield, Lord, 224
  Child bearing, 279
  Chilliness, 197
  Claustrophobia, 25
  Coddling, 267
  Conklin, Professor, 54
  Consciousness,
    sphere of, 230;
    threshold of, 127
  Consumption cures, 177
  Cough remedies, 201
  Coughing,
    unnecessary, 199;
    productive, 200
  Coughs and cold air, 204
  Cures, so-called, 244

  D

  Danger, sense of, 129
  "David Harum", 276
  Death Valley, 206
  Dercum, Doctor, 274
  Diabetes, 164
  Disheartenment, 104
  Dowie, John A., 253
  Dreads, 278

  {286}

  E

  "Eat and grow thin", 163
  Eating, 149
  Eddyism, 253
  Education, liberal, 55
  Effort, faculty of, 92
  Eliot, George, 67
  Emerson, Ralph Waldo, 67
  Emmet, Thomas Addis, 11, 147
  Energies of men, 15
  English, Thomas Dunn, 10
  Euphoria, 192
  Evacuation, intestinal, 221

  F

  Family,
    large, 74;
    eating, 160
  Fermentation, 155
  Flat foot, 141
  Food and alcoholic craving, 159
  Food prejudices, 152
  Franklin, Benjamin, 251
  Function, intestinal, 218

  G

  Galen, 170, 241
  Galvani, 248
  Gas formation, 155
  Gassner, Pfarrer, 252
  Giving up, 2
  Gouley, John W., 11
  Greatrakes, 245

  H

  Habits, 149
  Hamerton, Philip Gilbert, 24
  Hamlet, 82
  Hard sayings, 66
  Health, secret of, 283
  Heart
    craves exercise, 235;
    interests, 277;
    irregular, 236:
    missed beats, 235;
    regularly irregular, 237
  Heredity, 169;
    and environment, 54
  Höll, Father Maximilian, 252
  Holmes, Oliver Wendell, 40
  Horace, 224
  "Horse, the outside of a", 138
  Humboldt, Alexander von, 9
  Huxley, Thomas Henry, 54
  Hyde family, 280
  Hypnotism, 251
  Hypochondria, 30
  Hysteria, major, 275

  I

  Imperatives, 99
  Insomniaphobia, 27
  Instinct, 149
  Insults, psychic, 267
  Interests, feminine, 277
  Intestinal stasis, 38
  Intuition, 88
  Invalids, chronic, 76
  Isolation, 268

  J

  James, William, Professor, 15, 60, 77, 92
  Jesuits, General of, 119

  K

  Koenig, Professor, 274

  L

  Laxatives, 219
  Leo XIII, 9
  Libitina, 224
  Long, St. John, 171, 255

  {287}

  Longevity, 146
  Lying, hysterical, 260

  M

  Maistre, Xavier De, 122
  Marmalade, 222
  Matthew, Father, 47
  Mesmer, Friedrich Anton, 172, 250
  Metallotherapy, 248
  Mexican border, 60
  Misophobia, 23
  Mitchell, S. Weir, 11
  Mollycoddle, 63
  Moltke, 10
  Montreal, 204
  More, Sir Thomas, 266
  Mothers, young, 281
  Mutism, 259

  N

  Nansen, Fridtjof, 205
  Nauheim, 233
  Neuro-hypnotism, 250
  New South Wales, 280

  O

  Obesity, 162
  O'Malley, Austin, 80
  Optatives, 99
  Orange skin, 222

  P

  Pain and Refinement, 131
  Pain,
    control, 116;
    dread of, 128
  Palpitation, 228
  Perkins, Elisha, 248
  Personality, secondary, 88
  Phthisis, 171
  Physiology, study of, 35
  Pneumonia, 104;
    alcohol in, 190
  Possession, 266
  Pseudologia hysterica, 260
  Psychic contagion, 275
  Psycho-analysis, 41
  Pueckler-Muskau, Prince, 16

  Q

  Quackery, History of, 245
  Quinine and whisky, 201
  Quitters, 169

  R

  Ramon y Cajal, 123
  Ranke, Leopold von, 11
  Repplier, Agnes, 17
  Resolution, 82
  Respiration spasm, 209
  Rest, 57
  Rheumatism, chronic, 240
  Rheumatoid arthritis, 242
  Riviera, 182
  Roosevelt, Theodore, 118
  Roughage, 220
  Royal touch, 246

  S

  Saranac, 184
  Scare, lifted, 193
  Schlatter's case, 217
  Self-drugging, 40
  Self-pity, practice of, 70
  Self-subliminal, 88
  Sensation, diffusion of, 125
  Sensitization, 135
  Shell-shock, 64, 259
  Skotophobia, 24
  Smith, Stephen, 11
  Snake bite, 193

  {288}

  Stokes, Professor, 5
  Stomach functions, 215
  Subconscious, 85
  Suffering, 68
  Sybarite, 72

  T

  Tantrum, 265, 272
  Temperature variations, 181
  Thatcher, 248
  Therapeutics, absurd, 244
  Thompson, William Hanna, 11
  Torpillage, 264, 265
  Tragedy, 71
  Trait, family, 149
  Trudeau, Doctor, 183
  Tuberculosis, 103;
    curable, 178;
    early, 176;
    frequency, 168;
    takes quitters, 169

  U

  Undereating, 160
  Underweight, 149

  V

  Valetudinarianism, 282
  Vapors, 272
  Virchow, Rudolf, 10

  W

  Weber, Sir Hermann, 146
  Wellington, Duke of, 43
  Wilde, Oscar, 7
  Will,
    and survival, 4;
    conscious use, 81;
    living on, 2;
    omnipotent, 16;
    sapping, 13
  Women's diseases, 272


--------------------------

MIND AND HEALTH SERIES


A Series of Medical Handbooks written by eminent specialists and
edited by H. Addington Bruce, A.M., and designed to present the
results of recent research and clinical experience in a form
intelligible to the lay public and medical profession.



1. HUMAN MOTIVES. By James Jackson Putnam, M.D., Professor Emeritus,
Diseases of the Nervous System, Harvard University; Consulting
Neurologist, Massachusetts General Hospital, Boston. 179 pages. 12mo.
$1.35 _net_.

  A study of human conduct, using both the philosophical and the
  Freudian psychoanalytic methods of approach, with most attention to
  the latter method.--_A. L. A. Booklist_.


2. THE MEANING OF DREAMS. By Isador H. Coriat, M.D., First Assistant
Visiting Physician, Nervous Diseases, Boston City Hospital. 194 pages.
12mo. $1.35 _net_.

  The many examples that are analyzed and explained are taken from
  cases that have come under the author's observations.--_A. L. A.
  Booklist_.


3. SLEEP AND SLEEPLESSNESS. By H. Addington
Bruce, A.M. 219 pages. 12mo. $1.35 _net_.

  Popular chapters on the various theories of sleep and dreams;
  disorders of sleep, dreams and the supernatural; and on the causes
  and treatment of sleeplessness.--_A. L. A. Booklist_.


4. THE INFLUENCE OF JOY. By George Van Ness
Dearborn, A.M., Ph.D., M.D. 223 pages. 12mo. $1.35 _net_.

  Presents the latest findings as to the effects of joy on the human
  organism. The writer gives sensible, easily understood suggestions
  to students and teachers and something of the psychology underlying
  the suggestions.--_A. L. A. Booklist_.


5. NERVOUSNESS: ITS CAUSES, TREATMENT AND PREVENTION.
By L. E. Emerson, Ph.D.. Psychologist, Massachusetts General Hospital,
Boston. 184 pages. 12mo. $1.35 _net_.

  A popular, psychological discussion of nervousness, and its
  treatment by psychoanalysis and mental readjustment. It should be of
  help to the nervous sufferer. A good introduction to the Freudian
  theory.--_A. L. A. Booklist_.


6. THE MENTAL HYGIENE OF CHILDHOOD. By William A. White, M.D.,
Superintendent of St. Elizabeths Hospital, Washington, D. C. 193
pages. 12mo. $1.35 _net_.

  A brilliant study of the psychology of childhood that analyzes the
  mental life of the child and shows parents how it may best be
  cultivated.


_IN PREPARATION_


FEAR AND ITS CONSEQUENCES. By Boris Sidis, M.D., Director
of the Sidis Psychotherapeutic Institute, Portsmouth, N. H.


INSANITY AND ITS PREVENTION. By M. S. Gregory, M.D.,
Resident Alienist, Bellevue Hospital, New York.


DREADS AND OBSESSIONS. By Dr. J. W. Courtney,
Physician-in-Chief,
Department of the Diseases of the Mind and Nervous System,
Carney Hospital, Boston.


THE CONQUEST OF LAZINESS. By Arthur Holmes, Dean of
Pennsylvania State College.

------------------

  LITTLE, BROWN & CO., Publishers
  34 Beacon Street, Boston





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