Project Gutenberg's Epilepsy, Hysteria, and Neurasthenia, by Isaac G. Briggs

This eBook is for the use of anyone anywhere at no cost and with
almost no restrictions whatsoever.  You may copy it, give it away or
re-use it under the terms of the Project Gutenberg License included
with this eBook or online at www.gutenberg.net


Title: Epilepsy, Hysteria, and Neurasthenia

Author: Isaac G. Briggs

Release Date: February 4, 2005 [EBook #14901]

Language: English

Character set encoding: ISO-8859-1

*** START OF THIS PROJECT GUTENBERG EBOOK EPILEPSY, HYSTERIA, AND NEURASTHENIA ***




Produced by Martin Agren, Keith Edkins and the PG Online Distributed
Proofreading Team.





              EPILEPSY, HYSTERIA,
               AND NEURASTHENIA

      THEIR CAUSES, SYMPTOMS, & TREATMENT

                      BY
               ISAAC G. BRIGGS
                   A.R.S.I.

              METHUEN & CO. LTD.
             36 ESSEX STREET W.C.
                   LONDON

          _First Published in 1921_

       *       *       *       *       *

                      TO
               ALBERT E. WOODRUFF
                OF STOKE PRIOR
                NR. BROMSGROVE
                   MY OLD
                 SCHOOLMASTER

       *       *       *       *       *

                 CONTENTS

  CHAPTER                             PAGE

           PREFACE                      ix

       I. MAJOR AND MINOR EPILEPSY      1

      II. RARER TYPES OF EPILEPSY       7

     III. GENERAL REMARKS               15

      IV. CAUSES OF EPILEPSY            20

       V. PREVENTION OF ATTACKS         25

      VI. FIRST-AID TO VICTIMS          28

     VII. NEURASTHENIA                  30

    VIII. HYSTERIA                      39

      IX. ADVICE TO NEUROPATHS          46

       X. FIRST STEPS TOWARD HEALTH     53

      XI. DIGESTION                     56

     XII. INDIGESTION                   60

    XIII. DIETING                       63

     XIV. CONSTIPATION                  67

      XV. GENERAL HYGIENE               71

     XVI. SLEEPLESSNESS                 76

    XVII. THE EFFECTS OF IMAGINATION    79

   XVIII. SUGGESTION TREATMENT          82

     XIX. MEDICINES                     86

     XX.  PATENT MEDICINES              90

    XXI.  TRAINING THE NERVOUS CHILD    98

   XXII.  DANGERS AT AND AFTER PUBERTY 109

  XXIII.  WORK AND PLAY                115

   XXIV.  HEREDITY                     118

    XXV.  CHARACTER                    123

   XXVI.  MARRIAGE                     131

  XXVII.  SUMMARY                      140

          BIBLIOGRAPHY                 142

          INDEX                        145

       *       *       *       *       *

PREFACE

I hope this book will meet a real need, for when one considers how
prevalent epilepsy, hysteria and neurasthenia are, among all ranks and ages
of both sexes, it seems remarkable some such popular book was not written
long ago.

I add nothing to our knowledge of these ills, my object being to put what
we know into simple words, and to insist on the necessity for personal
discipline being allied to expert aid. The book aims at helping, not
ousting, the doctor, who may find it of use in getting his patient to
see--and to act on--the obvious.

"Nervous Disease", as here used, includes only the three diseases treated
of; "Neuropath"--victims of them.

"Advice" to a neuropath is usually a very depressing decalogue of "Thou
Shalt Nots!" If it be made clear _why_ he must _not_ do so-and-so, the
patient endeavours to obey; peremptorily ordered to obey, he rebels. Much
sound advice is wasted for lack of an interesting, convincing, "Reason
Why!" which would ensure the hearty and very helpful co-operation of a
patient who had been taught that writing prescriptions is not the limit of
a doctor's activities.

Many folk, with touching belief in his own claims, regard the quack as a
hoary-headed sage, who from disinterested motives devotes his life to
curing ailments, by methods of which he alone has the secret, at low fees.
To fight this dangerous idea I have tried to show in an interesting way how
science deals with nerve ills, and to prove that qualified aid is needed.
Suggestions and criticisms will be welcomed.

                  I. G. BRIGGS
  THE UNIVERSITY,
      BIRMINGHAM,
          _June_, 1921

       *       *       *       *       *

"Lette than clerkes enditen in Latin, for they have the propertie of
science, and the knowing in that facultie: and lette Frenchmen in their
Frenche also enditen their queinte termes, for it is kyndely to their
mouthes; and let us showe our fantasies in soche wordes as we lerneden of
our dames tongue."

--Chaucer.

       *       *       *       *       *

EPILEPSY, HYSTERIA,
AND NEURASTHENIA

       *       *       *       *       *

CHAPTER I

MAJOR AND MINOR EPILEPSY

(_Grand and Petit Mal_)

"My son is sore vexed, for ofttimes he falleth into the fire, and ofttimes
into the water."--Matthew xvii, 15.

  "Oft, too, some wretch before our startled sight,
  Struck as with lightning with some keen disease,
  Drops sudden: By the dread attack o'erpowered
  He foams, he groans, he trembles, and he faints;
  Now rigid, now convuls'd, his labouring lungs
  Heave quick, and quivers each exhausted limb.

       *       *       *       *       *

  "He raves, since Soul and Spirit are alike
  Disturbed throughout, and severed each from each
  As urged above, distracted by the bane;
  But when at length the morbid cause declines,
  And the fermenting humours from the heart
  Flow back--with staggering foot first treads
  Led gradual on to intellect and strength."--Lucretius.

Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervous
system, evinced by attacks of _alteration of consciousness_, usually
accompanied by convulsions.

It attacks men of every race, as well as domesticated animals, and has been
known since the earliest times, the ancients imputing it to demons, the
anger of the gods, or a blow from a star.

It often attacks men in crowds, when excited by oratory or sport, hence the
Roman name: _morbus comitialis_ (crowd sickness).

In mediæval times, sufferers were regarded with awe, as being possessed by
a spirit. Witch doctors among savages, and founders and expounders of
differing creeds among more civilized peoples, have taken advantage of this
infirmity to claim divine inspiration, and the power of "seeing visions"
and prophesying.

Epilepsy has always interested medical men because of its frequency, the
difficulty of tracing its cause, and its obstinacy to treatment, while it
has appealed to popular imagination by the appalling picture of bodily
overthrow it presents, so that many gross superstitions have grown up
around it.

The description in Mark ix. 17-29, is interesting:

    "Master, I have brought Thee my son, which hath a dumb spirit. And
    wheresoever he taketh him, he teareth him: and he foameth, and gnasheth
    with his teeth, and pineth away: ... straightway the spirit tare him;
    and he fell on the ground, and wallowed foaming.

    "And He asked his father, How long is it ago since this came unto him?
    And he said, Of a child. And ofttimes it hath cast him into the fire,
    and into the waters, to destroy him.

    "And he said unto them, This kind can come forth by nothing, but by
    prayer and fasting."

Up to the present, epilepsy can be ascribed to no specific disease of the
brain, the symptoms being due to some morbid disturbance in its action.
Epilepsy is a "functional" disease.

GRAND MAL ("_Great Evil_")

An unusual feeling called an _aura_ (Latin--vapour), sometimes warns a
patient of an impending fit, commonly lasting long enough to permit him to
sit or lie down. This is followed by giddiness, a roaring in the ears, or
some unusual sensation, and merciful unconsciousness. In many cases this
stage is instantaneous; in others it lasts some seconds--but an eternity to
the sufferer. This stage is all that victims can recall (and this only
after painful effort) of an attack.

As unconsciousness supervenes, the patient becomes pale, and gives a cry,
which varies from a low moan to a loud, inhuman shriek. The head and eyes
turn to one side, or up or down, the pupils of the eyes enlarge and become
fixed in a set stare, and the patient drops as if shot, making no effort to
guard his fall, being often slightly and sometimes severely injured.

The whole body then becomes stiff. The hands are clenched, with thumbs
inside the palms, the legs are extended, the arms stiffly bent, and the
head thrown back, or twisted to one side. The muscles of the chest and
heart are impeded in their action, breathing ceases, the heart is slowed,
and the face becomes pale, and then a livid, dusky blue.

The skin is cold and clammy, the eyebrows knit; the tongue may be
protruded, and bitten between the teeth. The eyeballs seem starting from
their sockets, the eyes are fixed or turned up, so that only the sclerotic
("whites") can be seen, and they may be touched or pressed without causing
blinking. The stomach, bladder, and bowels may involuntarily be emptied.

This _tonic_ stage only lasts a few seconds, and is followed by
convulsions. The head turns from side to side, the jaws snap, the eyes
roll, saliva and blood mingle as foam on the lips, the face is contorted in
frightful grimaces, the arms and legs are twisted and jerked about, the
breathing is deep and irregular, the whole body writhes violently, and is
bathed in sweat.

The spasms become gradually less severe, and finally cease. Deep breathing
continues for some seconds; then the victim becomes semi-conscious, looks
around bewildered, and sinks into coma or deep sleep.

  "...As one that falls,
  He knows not how, by force demoniac dragg'd
  To earth, and through obstruction fettering up
  In chains invisible the powers of Man;
  Who, risen from his trance, gazeth around
  Bewilder'd with the monstrous agony
  He hath indured, and, wildly staring, sighs:
  ..."

In a few hours he wakes, with headache and mental confusion, not knowing he
has been ill until told, and having no recollection of events just
preceding the seizure, until reminded of them when they are slowly, and
with painful effort, brought to mind. He is exhausted, and often vomits. In
severe cases he may be deaf, dumb, blind, or paralysed for some hours,
while purple spots (the result of internal hemorrhage) may appear on the
head and neck. Victims often pass large quantities of colourless urine
after an attack, and, as a rule, are quite well again within twenty-four
hours.

This is the usual type, but seizures vary in different patients, and in the
same sufferer at different times. The cry and the biting of the tongue may
be absent, the first spasm brief, and the convulsions mild. Epilepsy of all
kinds is characterized by an _alteration_ (not necessarily a _loss_) of
consciousness, followed by loss of memory for events that occurred during
the time that alteration of consciousness lasted.

Attacks may occur by day only, by day and by night, or by night only,
though in so-called nocturnal epilepsy, it is _sleep_ and not night that
induces the fit, for night-workers have fits when they go to sleep during
the day.

Victims of nocturnal epilepsy may not be awakened by the seizure, but pass
into deeper sleep. Intermittent wetting of the bed, occasional temporary
mental stupor in the morning, irritability, temporary but well-marked
lapses of memory, sleep-walking, and causeless outbursts of ungovernable
temper all suggest nocturnal epilepsy.

Such a victim awakes confused, but imputes his mental sluggishness to a
hearty supper or "a bad night". A swollen tongue, blood-stained pillow, and
urinated bed arouse suspicion as to the real cause, suspicion which is
confirmed by a seizure during the day. He is more fortunate (if such a term
can rightly be used of any sufferer from this malady) than his fellow
victim whose attacks occur during the day, often under circumstances which,
to a sensitive nature, are very mortifying.

Epileptic attacks are of every degree of violence, varying from a moment's
unconsciousness, from which the patient recovers so quickly that he cannot
be convinced he has been ill, to that awful state which terrifies every
beholder, and seems to menace the hapless victim with instant death. Every
degree of frequency, too, is known, from one attack in a lifetime, down
through one in a year, a month, a week, or a day; several in the same
periods, to _hundreds_ in four-and-twenty hours.

PETIT MAL ("_Little Evil_")

This is incomplete _grand mal_, the starting stages only of a fit, recovery
occurring before convulsions.

_Petit mal_ often occurs in people who do not suffer from _grand mal_, the
symptoms consisting of a loss of consciousness for _a few seconds_, the
seizure being so brief that the victim never realizes he has been
unconscious. He suddenly stops what he is doing, turns pale, and his eyes
become fixed in a glassy stare. He may give a slight jerk, sway, and make
some slight sound, smack his lips, try to speak, or moan. He recovers with
a start, and is confused, the attack usually being over ere he has had time
to fall.

If talking when attacked, he hesitates, stares in an absent-minded manner,
and then completes his interrupted sentence, unaware that he has acted
strangely. Whatever act he is engaged in is interrupted for a second or
two, and then resumed.

A mild type of _petit mal_ consists of a temporary _blurring_ of
consciousness, with muscular weakness. The victim drops what he is holding,
and is conscious of a strange, extremely unpleasant sensation, a sensation
which he is usually quite unable to describe to anyone else. The view in
front is clear, he understands what it is--a house here, a tree there, and
so on--yet he does not _grasp_ the vista as usual. Other victims have short
spells of giddiness, while some are unable to realize "where they are" for
a few moments.

Frequent _petit mal_ impairs the intellect more than _grand mal_, for
convulsions calm the patient as a good cry calms hysterical people. After a
number of attacks of _petit mal, grand mal_ usually supervenes, and most
epileptics suffer from attacks of both types. Some precocious, perverse
children are victims of unrecognized _petit mal_, and when pushed at school
run grave risks of developing symptoms of true epilepsy. The "Little Evil"
is a serious complaint.

       *       *       *       *       *

CHAPTER II

RARER TYPES OF EPILEPSY

    If it be true that: "One half the world does not know how the other
    half lives", how true also is it that one half the world does not know,
    and does not care, what the other half suffers.

Epilepsy shows every gradation, from symptoms which cannot be described in
language, to severe _grand mal_. Gowers says: "The elements of an epileptic
attack may be extended, and thereby be made less intense, though not less
distressing. If we conceive a minor attack that is extended, and its
elements protracted, with no loss of consciousness, it would be so
different that its epileptic nature would not be suspected. Swiftness is an
essential element of ordinary epilepsy, but this does not prevent the
possibility of deliberation."

In Serial Epilepsy, a number of attacks of _grand mal_ follow one another,
with but very brief intervals between. Serial epilepsy often ends in

_Status Epilepticus_, in which a series of _grand mal_ attacks follow one
another with no conscious interval. The temperature rises slowly, the pulse
becomes rapid and feeble, the breathing rapid, shallow and irregular, and
death usually occurs from exhaustion or heart-failure. Though not
invariably fatal, the condition is so very grave that a doctor must
instantly be summoned. Nearly all victims of severe, confirmed epilepsy (25
per cent of all epileptics) die in _status epilepticus_.

Jacksonian Epilepsy, named after Hughlings Jackson, who in 1861 traced its
symptoms to their cause, is not a true epilepsy, being due to a local
irritation of the cortex (the outermost layer) of the brain.

There is usually an _aura_ before the attack, often a tingling or stabbing
pain. The chief symptoms are convulsions of certain limbs or areas of the
body, which, save in very severe cases, are confined to one side, and are
not attended by loss of consciousness.

The irritation spreads to adjacent areas, as wavelets spread from a stone
thrown into a pond, with the result that convulsions of other limbs follow
in sequence, all confined to one side.

As every part of the brain is connected to every other part by "association
fibres", in very violent attacks of Jacksonian epilepsy the irritation
spreads to the other side of the brain also, consciousness is lost, the
convulsions become general and bilateral, and the patient presents exactly
the same picture as if the attack were due to _grand mal_.

All degrees of violence are seen. The convulsions may consist only of a
rapid trembling, or the limb or limbs may be flung about like a flail.

Jackson said: "The convulsion is a brutal development of a man's own
movements, a sudden and excessive contention of many of the patient's
familiar motions, like winking, speaking, singing, moving, etc." These acts
are learned after many attempts, and leave a memory in certain groups of
brain cells; irritate those cells, and the memorized acts are performed
with convulsive violence.

The convulsions are followed by temporary paralysis of the involved
muscles, but power finally returns. As we should expect, this paralysis
lasts longest in the muscles first involved, and is slightest in the
muscles whose brain-centres were irritated by the nearly exhausted waves.
If the disease be untreated, the muscles in time may become totally
paralysed, wasted, and useless.

Friends should very carefully note exactly where and how the attack begins,
the exact part first involved, and the precise order in which the spasms
appear, as this is the only way the doctor can localize the brain injury.
The importance of this cannot be overrated.

The consulting surgeon will say if operation is, or is not, advisable, but
_operation is the sole remedy for Jacksonian epilepsy_, for the causes that
underly its symptoms cannot be reached by medicines.

Patients must consult a good surgeon; other courses are _useless_.

Psychic or Mental Epilepsy is a trance-state often occurring after attacks
of _grand_ or _petit mal_, in which the patient performs unusual acts. The
epileptic feature is the patient's inability to recall these actions. The
complaint is fortunately rare.

The face is usually pale, the eyes staring, and there may be a "dream
state". Without warning, the victim performs certain actions.

These may be automatic, and not seriously embarrassing--he may tug his
beard, scratch his head, hide things, enter into engagements, find the
presence of others annoying and hide himself, or take a long journey. Such
a journey is often reported in the papers as a "mysterious disappearance".
Yet, had he committed a crime during this time, he would probably have been
held "fully responsible" and sentenced.

The actions may be more embarrassing: breaking something, causing pain,
exhibiting the sexual organs; the patient may be transported by violent
rage, and abuse relatives, friends or even perfect strangers; he may spit
carelessly, or undress himself--possibly with a vague idea that he is
unwell, and would be better in bed.

Finally the acts may be criminal: sexual or other assault, murder, arson,
theft, or suicide.

In this state, the patient is dazed, and though he appreciates to some
extent his surroundings, and may be able to answer questions more or less
rationally, he is really in a profound reverie. The attack soon ends with
exhaustion; the victim falls asleep, and a few moments later wakes,
ignorant of having done or said anything peculiar.

We usually think of our _mind_ as the aggregate of the various emotions of
which we are actually _conscious_, when, in reality, consciousness forms
but a small portion of our mentality, the _subconscious_--which is composed
of all our past experiences filed away below consciousness--directing every
thought and act. Inconceivably delicate and intricate mind-machinery
directs us, and our idlest fancy arises, _not by chance_ as most people
surmise, but through endless associations of subconscious mental processes,
which can often be laid bare by skilful psycho-analysis.

Our subconscious mind does not let the past jar with the present, for life
would be made bitter by the eternal vivid recollection of incidents best
forgotten. Every set of ideas, as it is done with, is locked up separately
in the dungeons of subconsciousness, and these imprisoned ideas form the
basis of memory. _Nothing is ever forgotten_, though we may never again
"remember" it this side the grave.

In a few cases we can unlock the cell-door and release the prisoner--we
"remember"; in some, we mislay the key for awhile; in many, the wards of
the lock have rusted, and we cannot open the door although we have the
key--we "forget"; finally, our prisoner may pick the lock, and make us
attend to him whether we wish to or not--something "strikes us".

Normally, only one set of ideas (a complex) can hold the stage of
consciousness at any one time. When two sets get on the boards together,
double-consciousness occurs, but even then they cannot try to shout each
other down; one set plays "leading lady", the other set the "chorus belle"
and so life is rendered bearable.

This "dissociation of consciousness" occurs in all of us. A skilled pianist
plays a piece "automatically" while talking to a friend; we often read a
book and think of other things at the same time: our full attention is
devoted to neither action; neither is done perfectly, yet both are done
sufficiently well to escape comment.

Day-dreaming is dissociation carried further. "Leading lady" and "chorus
belle" change places for a while--imaginary success keeps us from worrying
about real failure. Dissociation, day-dreaming, and mental epilepsy are but
few of the many milestones on a road, the end of which is insanity, or
complete and permanent dissociation, instead of the partial and fleeting
dissociation from which we all suffer. The lunatic never "comes to", but in
a world of dreams dissociates himself forever from realities he is not
mentally strong enough to face.

The writing of "spirits" through a "medium" is an example of dissociation,
and though shown at its best in neuropaths, is common enough in normal men,
as can be proved by anyone with a planchette and some patience.

If the experimenter puts his hands on the toy, and a friend talks to him,
while another whispers questions, he may write more or less coherent
answers, though all the time he goes on talking, and does not know what his
hand is writing. His mind is split into two smaller minds, each ignorant of
the other, each busily liberating memory-prisoners from its own block of
cells in the gaol of the subconscious. The writing often refers to
long-forgotten incidents, the experiment sometimes being of real use in
cases of lost memory.

Dreams are dissociations in sleep, while the scenes conjured up by
crystal-gazing are only waking dreams, in which the dissociation is caused
by gazing at a bright surface and so tiring the brain centres, whereupon
impressions of past life emerge from the subconscious, to surprise, not
only the onlookers to whom they are related, but also the gazer herself,
who has long "forgotten them".

It is childish to attach supernatural significance to either dreams or
crystal-gazing, both of which mirror, not the future, but only the past,
the subject's own past.

It is noteworthy that women dream more frequently and vividly than men.
When a dreamer has few worries, he usually dreams but forgets his dream on
waking; when greatly worried, he often carries his problems to bed with
him, and recent "representative dreams" are merely unprofitable overtime
work done by the brain. Occasionally, dreams have a purely physical basis
as when palpitation becomes transformed in a dream into a scene wherein a
horse is struggling violently, or where an uncovered foot originates a
dream of polar-exploration; in this latter type the dream is protective, in
that it is an effort to side-track some irritation without breaking sleep.

Since Freud has traced a sex-basis in all our dreams, many worthy people
have been much worried about the things they see or do in dreams. Let them
remember that virtue is not an inability to conceive of misconduct, so much
as the determination to refrain from it, and it may well be that the
centres which so determinedly inhibit sexual or unsocial thoughts in the
day, are tired by the very vigour of their resistance, and so in sleep
allow the thoughts they have so stoutly opposed when waking to slip by. The
man who is long-suffering and slow to wrath when awake, may surely be
excused if he murders a few of his tormentors during sleep.

Epileptiform Seizures are convulsions due to causes other than epilepsy,
and only a doctor can tell if an attack be epileptic or not and prescribe
appropriate treatment. To give "patent" medicines for "fits", to a man who
may be suffering from lead poisoning or heart disease, is criminal.

Convulsions in Children often occur before or after some other ailment.
Such children need careful training, but less than 10 per cent of children
who have convulsions become epileptic. Epilepsy should only be suspected if
the first attack occurs in a previously healthy child of over two years of
age. There are many possible causes for infantile convulsions, and but one
treatment; call in a doctor _at once_, and, while waiting for him, put the
child in a warm bath (not over 100° F.) in a quiet, darkened room, and hold
a sponge wrung out of hot water to the throat at intervals of five minutes.
Never give "soothing syrups" or "teething powders".

The "soothing" portion of such preparations is some essential oil, like
aniseed, caraway or dill, and there are often present strong drugs
unsuitable for children. According to the analyses made by the British
Medical Association, the following are the _essential_ ingredients of some
well-known preparations for children:

  Mrs. Winslow's Soothing  Potassium Bromide,
  Syrup.                   Aniseed, and Syrup
                           (sugar and water).

  Woodward's Gripe         Sodium Bicarbonate,
  Water.                   Caraway, and Syrup.

  Atkinson and Barker's    Pot. and Magnesium
  Royal Infant             Bicarbonate, several
  Preservative.            Oils, and Syrup.

  Mrs. Johnson's American  Spirits of Salt, Common
  Soothing Syrup.          Salt, and Honey.

Convulsions During Pregnancy. Send for a doctor instantly.

Feigned Epilepsy is an all-too-common "ailment". The false fit, as a rule,
is very much overdone. The face is red from exertion instead of livid from
heart and lung embarrassment, the spasms are too vigorous but not jerky
enough, the skin is hot and dry instead of hot and clammy, the hands may be
clenched, but the thumb will be _outside_ instead of _inside_ the palm,
foam comes in volumes but is unmixed with blood, and the whole thing is
kept up far too long. Almost before a crowd can gather an epileptic seizure
is over, whereas the sham sufferer does not begin seriously to exhibit his
questionable talents until a crowd has appeared.

Pressure on the eye, which will blink while the "sufferer" will swear;
bending back the thumb and pressing in the end of the nail, when the hand
will be withdrawn in feigned but not in true epilepsy; blowing snuff up the
nose, which induces sneezing in the sham fit alone, or using a cold douche
will all expose the miserable trick.

It is, unfortunately, far easier to suggest than to apply these tests, for
anyone foolish enough to try experiments within reach of the wildly-waving
arms will probably get such a buffet as will damp his ardour for amateur
diagnosis for some time.

       *       *       *       *       *

CHAPTER III

GENERAL REMARKS

  "Do not muse at me, my most worthy friends;
  I have a strange infirmity, which is nothing
  To those that know me."
                           "Macbeth," Act III.

Starr's table shows that combinations of all types of epilepsy are
possible, and that mental epilepsy is rare:

  Grand mal                        1150
  Grand and petit mal               589
  Petit mal                         179
  Jacksonian                         37
  Mental                             16
  Grand mal and Jacksonian           10
  Grand mal, petit mal and Jacksonian 8
  Grand mal and mental                3
  Grand mal, petit mal and mental     6
  Petit mal and mental                2
  Fits by day only                  660
  Fits day and night                880
  Fits by night only                380

The majority of victims have attacks both by day and by night. Of 115,000
seizures tabulated by Clark, 55,000 occurred during the day (6 a.m. to 6
p.m.) and 60,000 by night.

The _usual course_ of a case of epilepsy is somewhat as follows: the
disease begins in childhood, the first convulsion, about the age of three,
being followed some twelve months later by a second, and this again by a
third within a few months. Then attacks occur more frequently until a
regular periodicity--from one a day to one a year--is reached after about
five years, and this frequently persists throughout life.

The effect of epilepsy on the general health is not serious, but it has a
more serious effect on the mind, for epileptic children cannot go to school
(though special schools are now doing something towards removing this
serious disability), and grow up with an imperfect mental training. They
become moody, fretful, ill-tempered, unmanageable, and at puberty fall
victims to self-abuse, which helps to lead to neurasthenia. Then they may
drift slowly into a state of mental weakness, and often require as much
care as imbeciles. If the fits are severe from an early age, arrest of
mental development and imbecility follow. If the disease be very mild in
character, and especially if it be _petit mal_, the victim may be very
precocious, get "pushed" at school, and later become eccentric or insane.

Adult victims necessarily lead a semi-invalid life, often cut off from
wholesome work and from the pleasures of life, and become hypersensitive,
timid, impulsive, forgetful, irritable, incapable of concentration,
suspicious, show evidences of a weakened mind, have few interests, and are
difficult to manage.

About 10 per cent--the very severe cases--go on to insanity; either
temporary attacks of mania, calling for restraint, or permanent epileptic
dementia with progressive loss of mind. Some victims are accidentally
killed in, or die as a result of a fit; about 25 per cent--severe cases
again--die in _status epilepticus_, but the majority after being sufferers
throughout life are finally carried off by some other disease.

There are many exceptions to this general course. Some patients have
attacks very infrequently, and are possessed of brilliant talent, though
apt to be eccentric. Others may have a number of seizures in youth, and
then "outgrow" the complaint.

A few victims are attacked only after excessive alcoholic or sexual
indulgence, some women only during their menses, while other women are free
from attacks during pregnancy, which state, however (contrary to popular
belief), commonly aggravates the trouble. Victims may be free from attacks
during the duration of, and for some time after, an infectious disease;
while Spratling says that a consumptive epileptic may have no fits for
months, or even years.

Some epileptics are normal in appearance, but many show signs of
degeneration. This is common in the insane, but less frequent and
pronounced in neurasthenics. An abnormal shape of the head or curvature of
the skull, a high, arched palate, peculiarly-shaped ears, unusually large
hands and feet, irregular teeth from narrow jaws, a small mouth, unequal
length and size of the limbs, a projecting occiput, and poor physical
development may be noted.

These are most pronounced in intractable cases, in whom mental
peculiarities are most frequently seen--either dullness, stupidity and
ungovernable temper, or very marked talent in one direction with as marked
an incapacity in others. In all epileptics, the pupils of the eye are
larger than normal, and, after contracting to bright light soon enlarge
again.

The facial expression of most epileptics indicates abnormal mentality. When
the seizures have been so frequent and severe as to cause mental decay, the
actions are awkward, and the gait slouching and irregular. Progressive poor
memory is one of the first signs of intellectual damage consequent upon
severe epilepsy.

Though the disease may occur at any age, most cases occur before the age of
twenty, there being good reason to look for other causes (often syphilis)
in cases which occur after that age. Of 1,450 of Gowers' cases, 30 per cent
commenced before the age of ten; 75 per cent before twenty. In Starr's
2,000 cases, 68 per cent commenced before the patient was twenty-one.

According to Turner, the first epoch is from birth to the age of six,
during which 25 per cent of all cases commence, usually associated with
mental backwardness, and some due to organic brain trouble. The second
epoch is ten to twenty-two, the time of puberty and adolescence, during
which time no less than 54 per cent of all cases commence. This is, _par
excellence_, the age of onset of genuine epilepsy, the mean age of maximum
onset being fourteen in men and sixteen in women. The remaining 21 per cent
of cases occur after the age of twenty-two.

In 430 cases of epilepsy in children, Osler found that 230 were attacked
before they reached the age of five, 100 between five and ten, and 100
between ten and fifteen.

Epilepsy, then, is a disease of early youth, coming on when the development
and growth of the nervous and reproductive systems is taking place. During
this period, causes, insignificant for stable people, may light up the
disease in those of unstable, nervous constitution, a fact which explains
the importance of training the child.

Both sexes are attacked. If we consider only cases of true idiopathic
epilepsy female patients are probably in excess, but in epilepsy in adults,
from all causes, males predominate. In females, the menopause may arrest
the disease.

In days gone by, epilepsy more rarely commenced after the age of twenty,
but in these days of nerve stress it commences more frequently than
formerly in people of mature age. A victim who has a fit for the first time
after the age of twenty, however, should consult a nerve specialist
immediately.

In its early stages there are no changes of the brain due to, or the cause
of, epilepsy, but in long-standing, severe cases, well-marked, morbid
changes may be found. These are the effects, not the cause, of the disease,
and they vary in intensity according to the manner of death and the length
and severity of the malady. They probably cause the mental decay and
slouching gait mentioned before.

Fits may suddenly cease for a long time, but they usually recur, and most
patients have them more or less regularly through life.

The fact that recovery is rare should not be hidden from patients and
friends. Perhaps 8 per cent of all classes recover--and "recovery" may only
be a long interval--but 4 per cent of these are Jacksonian, syphilitic or
accident cases. Only one victim in every thirty recovers from true
epilepsy; and these are very mild cases, in which the fits are infrequent,
there is no mental impairment, and bromides are well borne. The earlier the
onset, the more severe and frequent the attacks, the deeper the coma, and
the worse the mental decay, the poorer the outlook.

_Cure is exceptional_, but by vigorous treatment the severity of the malady
may be much abated. _Petit mal_ is no more hopeful than _grand mal_; less
so in cases with severe giddiness; in all cases, the better the physical
condition and digestive powers of the patient, the brighter the outlook.

To sum up, epilepsy is a chronic abnormality of the higher nervous system,
characterized by periodic attacks of alteration of consciousness, often
accompanied by spasms of varying violence, affecting primarily the brain
and secondarily the body, based on an abnormal readiness for action of the
motor cells, occurring in persons with congenital nerve weakness, and
leading to mental decay of various types and degrees of severity.

       *       *       *       *       *

CHAPTER IV

CAUSES OF EPILEPSY

  "Find out the cause of this effect,
  Or rather say, the cause of this defect,
  For this effect defective comes by cause."
                  "Hamlet," Act II.

THE MECHANISM OF THE FIT

The brain consists of cells of _grey matter_, grouped together to form
centres for thought, action or sensation, and _white matter_, consisting of
nerve strands, which act as lines of communication between different parts
of brain and body. The wrinkled surface (_cortex_) of the brain, is covered
with grey matter, which dips into the fissures. There are also islands of
grey matter embedded in the white.

The front part of the brain is supposed, with some probability, to be the
seat of intelligence, while a ribbon three inches wide stretched over the
head from ear to ear would roughly cover the Rolandic area, in which are
contained the _motor cells_ through which impulse is translated to action.
These motor cells are controlled by _inhibitory cells_, which act as brakes
and release nerve energy in a gentle stream; otherwise our movements would
be convulsive in their violence, and life would be impossible through
inability usefully to direct our energy.

That is how inhibition acts physically; mentally it is the power to
restrain impulses until reason has suggested the wisest course.

Irritation of the cortex, especially the motor area, causes convulsions,
and experiment has shown that epilepsy may be due to a disease or
instability of certain inhibitory cells of the cortex. The motor cells of
epileptics are restrained, with some difficulty, by these cells in normal
times. When irritation from any cause throws additional strain on the motor
cells, the defective brakes fail, and the uncontrolled energy, instead of
flowing in a gentle stream through the usual channels, bursts forth in a
tidal wave through other areas of the brain, causes unconsciousness, and
exhausts itself in those violent convulsions of the limbs which we term a
fit.

The Primary Cause of epilepsy is an inherent instability of the nervous
system.

Secondary Causes are factors which cause the first fit in a person with
predisposing nervous instability; later, the brain gets the _fit habit_,
and attacks recur independently of the secondary cause. In most cases no
secondary causes can be discovered, and the disease is then termed
_idiopathic_, for want of an explanation.

Injuries to the brain may cause epilepsy, and many cases date from birth, a
difficult labour having caused a minute injury to the brain.

Some accident is often wrongly alleged as the cause of fits, for most
victims come of a bad stock, and when the first fit occurs, their relatives
recollect an injury or a fright in the past, which is said to be the cause.

Great fright may cause epilepsy, as in the case of a nervous girl whose
brother entered her room, covered with a sheet, as a "ghost", a "joke" that
was followed by a fit within an hour.

Sunstroke may cause fits, and a few cases follow infectious diseases.

Alcoholism is a strong secondary factor, fits often occurring during a
drinking-bout and in topers, but in many cases, drunkenness, instead of
being the cause, is only the result of a lack of self-control following
epilepsy.

Pregnancy may be a secondary cause of the malady: it may lead to more
frequent and severe seizures in women who are already victims; bring on a
recurrence of the malady after it has apparently been cured; or, very
rarely, induce a temporary or permanent cure.

Epilepsy may be due to abortives. These drugs wreck the constitution of the
undesired children, who contract epilepsy from causes which would not so
have affected them had they started fairly. In many families, the first
child, who was wanted, is normal; some or all the others, who were not
desired and on whom attempts were probably made to prevent birth, are
neuropaths, as are many illegitimate children. It cannot too emphatically
be stated that there is no drug known which will procure abortion without
putting the woman's life in so grave a danger as to prevent medical men
using it; legal abortion is always procured surgically. Dealing in
abortifacients would be a capital offence under the laws of a rational
community.

Self-abuse may perhaps play some part in epilepsy commencing or recurring
after the age of ten.

The onset of menstruation often coincides with the onset of epilepsy, and
in some cases irregularity of the menses seems to be a secondary or
exciting cause.

Exciting Causes aggravate the trouble when present, causing more frequent
and severe seizures. The chief are irritation of stomach and bowels (from
decaying teeth, unchewed, unsuitable, or indigestible food, constipation,
or diarrhoea), exhaustion, work immediately after a meal, passion or
excitement, fright, worry, mental work, alcoholism, sexual excess, nasal
growths, eye-strain; in short, anything that irritates brain or body.

Theories as to Cause. Epilepsy is usually classed as a _functional
disorder_; that is, the brain cells are physically normal, but, for some
unknown reason, they act abnormally at certain times. This term is a very
loose one, and there is reason to believe that the basis of epilepsy is
some obscure disease of the brain which has not been detected by present
methods.

The new school of psychologists regard the malady as a mental _complex_--a
system of ideas strongly influenced by the emotions--the convulsions being
but minor symptoms.

Fits are most frequent between 9-10 p.m. the hours of deepest repose. One
school says this is due to anæmia of the brain during sleep. Clark traces
the cause to lessened inhibitory powers owing to the higher brain centres
being at rest, while Haig claims to have explained the high incidence at
this hour by the fact that uric acid is present in the system in the
greatest amount at this time.

Some doctors have thought, on the contrary, that _excess_ of blood in the
head was the cause, but results of treatment so directed did not bear out
the sanguine hopes built on the theory.

The fact that convulsions occur in diabetes and alcoholism, suggested that
epilepsy was due to poisons circulating in the blood, and thus irritating
the brain. Every act uses up cell material and leaves waste products,
exactly as the production of steam uses up coal and leaves ashes. Various
waste products have been found in more than normal quantities in the blood
of epileptics, but it is uncertain whether accumulation of waste products
causes the seizure.

A convincing theory must satisfactorily account for all the widely diverse
phenomena seen in epilepsy, and the problem must remain largely a matter of
speculation, until research work has given us a far deeper insight into the
biochemistry of both the brain cells, and the germ-plasm than we have at
present.

       *       *       *       *       *

CHAPTER V

PREVENTION OF ATTACKS

    In health matters, prevention is nine points of the law.

Some patients are obsessed by a peculiar sensation (the "aura") just before
a fit. This warning takes many forms, the two most common being a "sinking"
or feeling of distress in the stomach, and giddiness. The character of the
aura is very variable--terror, excitement, numbness, tingling,
irritability, twitching, a feeling of something passing up from the toes to
the head, delusions of sight, smell, taste, or hearing (ringing, or
buzzing, etc.), palpitation, throbbing in the head, an impulse to run or
spin around--any of these may warn a victim that a fit is at hand. Some
patients "lose themselves" and make curious mistakes in talking.

The warning is nearly always the same each time with the same patient, and
is more common in mild than in severe cases. Rarely, the attack does not go
beyond this stage.

When the patient becomes conscious of the aura he should sit in a large
chair, or lie down on the floor, well away from fire, and from anything
that can be capsized. He must never try to go upstairs to bed. Some one
should draw the blind, as light is irritating.

If the warning lasts some minutes, the patient should carry with him, a
bottle of uncoated one-hundredth-grain tabloids of

Nitroglycerin, replacing the screw cap with a cork, so that they can
quickly be extracted. When the warning occurs, one--or two--should be
taken, and the head bent forward. The arteries are dilated, the
blood-pressure thus lowered, and the attack _may_ be averted.

The use of nitroglycerin is based on the theory that seizures are caused by
anæmia due to vasomotor constriction. Success is only occasional, but this
is so welcome as to justify the habitual use of the method.

If the aura be brief, buy a few "pearls" of Amyl Nitrite, crush one in your
handkerchief, and sniff the vapour. This has the same affect as
nitroglycerin, but the action occurs in 15 seconds and only persists 7
minutes. A headache occasionally follows the use of these drugs, and they
should not be employed without professional advice.

When the warning is felt in the hand or foot, a strap should be worn round
the ankle or wrist, and pulled tight when the aura commences. This
sometimes aborts a fit, as biting a finger in which the aura commences may
also do.

If a victim feels unwell after a meal, he must never eat the next meal at
the usual time, simply because it _is_ the usual time.

Should a patient feel unwell between, say, dinner and tea, instead of
eating his tea he must empty his bowels by an enema, or croton oil (see
chemist), and his stomach by drinking a pint of warm water in which has
been stirred a tablespoonful of mustard powder and a teaspoonful of salt.
After vomiting, drink warm water.

_Never attempt to empty the stomach at the onset of a definite aura_, for
if the seizure occurs, the vomit will probably obstruct the trachea, and
suffocate the victim.

After the stomach has been empty ten minutes, the patient should take a
double dose of bromides (Chapter XIX) and go to bed. Next morning he will
be well, whereas if he eats but a single piece of bread-and-butter he will
probably have a fit within five minutes.

Unfortunately, in 60 per cent of cases, there is no warning at all, while
in those cases which do exhibit an aura, the measures mentioned above more
often fail than succeed.

       *       *       *       *       *

CHAPTER VI

FIRST-AID TO VICTIMS

    "First-aid is the assistance which can be given in case of emergency by
    those who, with certain easily acquired knowledge are in a position,
    not only to relieve the sufferer, but also to prevent further mischief
    being done pending the arrival of a doctor."--Dickey.

_Never try to cut short a fit_. Placing smelling-salts beneath the nose,
together with all other remedies for people who have "fainted", are useless
in epilepsy.

Lay the patient on his back, with head slightly raised; admit air freely;
remove scarf or collar and tie, unfasten waistcoat, shirt, stays or other
tight garments, and if it be known or observed that the victim wears
artificial teeth, remove them.

If five people are at hand, let two persons grasp each a leg of the victim,
holding it above the ankle and above the knee; two others should each hold
a hand and the shoulder; the fifth supports the head. Do not kneel opposite
the feet or you may receive a severe kick. Prevent the limbs from striking
the floor, but _allow them full play_. If the victim rolls on his face
gently turn him on his back.

Roll a large handkerchief up _from the side_ (not diagonally) and holding
one end firmly, tie a knot in the other end, and place it between the teeth
to protect the tongue; or slide the handle of a spoon or a piece of smooth
wood between the teeth, and thus hold the tongue down. Soft articles like
cork and indiarubber should not be used, for if they are bitten through,
the rear portion will fall down the throat and choke the victim.

After the fit, lower the head to one side to clear any vomitus which, if
left, might be drawn into the windpipe, lift the patient on to a couch,
cover him warmly, and let him sleep. An epileptic's bed should be placed on
the ground floor; if his bed be upstairs, it is difficult to get him there
after an attack, while he may at any time fall downstairs and be killed.

Any effort to rouse him will only make the post-epileptic stupor more
severe, but whether he sleeps or not, he must carefully be watched, for
patients in this state are apt to slip away, often half-clothed, and travel
towards nowhere in particular at a wonderfully rapid rate.

If several fits follow one another, or if one is very long or severe, send
for a doctor.

When a seizure occurs in public, a constable should be summoned, who, being
a "St. John" man, will be of far more use than bystanders brimming over
with sympathy--_and ignorance_. If some kindly householder near by will
allow the victim to sleep for an hour or two--a boon usually denied more
from fear of recurrence than lack of sympathy, it is better than taking him
home. If not, let someone call a cab, and deliver the victim safely to his
friends.

Every epileptic should carry always with him a card stating his full name
and address, with a request that some one present at any seizure will
escort him home.

If the victim wakes with a headache, give him a 10-grain Aspirin powder, or
a 5-grain Phenalgin tablet; _never patent "cures"_.

If possible, the patient should lie abed the day after a fit, undisturbed,
taking only soda-and-milk and eggs beaten up in _hot_ milk.

       *       *       *       *       *

CHAPTER VII

NEURASTHENIA

  "Some of your hurts you have cured,
    And the worst you still have survived;
  But what torments of mind you endured
    From evils which never arrived."
                  --Lowell.

To-day, the need to eat forces even sensible men to live--and die--at a
feverish rate. In bygone days the world was a peaceful place, in which our
forefathers were denied the chance of combining exercise with amusement
dodging murderous taxis; knew not the blessings of "Bile Beans", nor the
biliousness they blessed either; they did not fall victims to
"advert-diseases"; and they left the waters beneath to the fishes, and the
skies above to the birds.

Withal they were sound trenchermen, who called their few ailments "humours"
or "vapours" and knew what peace of mind meant. Sixty years ago there was
one lunatic in every six hundred people; to-day there is one in every two
hundred.

At the same time, the "neurasthenic temperament" is not altogether a modern
product, for Plato described it with great precision, and declared such
people to be "undesirable citizens" for his ideal republic.

Neurasthenia is due to exhaustion and poisoning of the nervous system, the
chief symptoms of which is persistent _neuro-muscular fatigue with general
irritability_. Its minor symptoms are almost as numerous as the various
activities possible in mind and body.

The Predisposing Cause of neurasthenia is inherited nervous instability,
but among nervous diseases, neurasthenia seems the least dependent on
heredity, this factor playing a less important part than

Exciting Causes which are the sparks that fire explosive trains laid by the
living, and often by the dead.

  Worry in any form (especially when accompanied by excess of brain-work),
  Accident-shock,
  Sexual abuse,
  Abuse of drink, drugs or tobacco,
  Lack of exercise,
  Exhausting diseases,
  Menopause, and diseases of the womb,
  "Society life",
  Retirement,

are the commonest exciting causes of neurasthenia; hard brain-work, unless
accompanied by worry, not being injurious.

The disease is more common in men than women (because of the more active
part played by them in the struggle for existence), in cities than in the
country, in mental than in manual workers, in the "idle rich", and in races
which live feverishly, like the Americans. It is rare in old age.

Ambition, the race for "success", the struggle to carry out projects beyond
the reasonable capacity of one man, and the ceaseless work and worry with
little sleep and no real rest which mark life to-day are responsible for
this disease.

Competition has increased in all conditions of life; free course is given
to ambition, individuals impose on their brains a work beyond their
strength; and then comes care and perhaps reverse of fortune; and the
nervous system, under the wear and tear of incessant excitation, at last
becomes exhausted,

The basic symptom is an inability to stand a normal amount of mental or
physical strain, and shows itself in seven marked ways:

1.  Muscular Fatigue, which is often most marked in the morning. The
patient rises reluctantly, feeling as if he had not slept, is listless and
"lazy", and can neither work nor play much without getting unduly tired.
This weariness may pass off as the day wears on.

2. Backache is often constant and annoying. It may be a pain, or a general
discomfort, and may be felt anywhere in the back, the nape of the neck and
down the spine being common places. The legs often "give way", and, in
severe cases, patients believe they cannot stand, and become bed-ridden.
Under sudden excitement they may walk again, becoming "miracles of
healing". These _spinal symptoms_ are common in neurasthenia following
accident.

3.  Headache is more often an abnormal sensation than an intense pain.
Pulsations, feelings of distress, of lightness, fullness, heaviness and
pressure are common, or a band may seem to be drawn tightly round the head
across the forehead.

The sensations are usually located in the back of the head, and may be
accompanied by dizziness, noises in the ears, or dimness of sight. There
may be a feeling of unsteadiness when walking, or a sense of being in
motion when at rest. The headache varies in intensity; it is worst in the
morning, is increased by thinking, diminished after eating, often improves
at night, and never keeps the patient awake.

4. Stomach and Bowel Disorders. The victim is indifferent to food, though
dainties often tempt him, when he cannot face a square meal. He has a
feeling of general well-being after a meal, but within an hour signs of
imperfect digestion arise; he feels oppressed, and has flatulence. Later,
there are flushes of heat, palpitation, drowsiness, and a craving for food.
Constipation is usually obstinate, while diarrhoea may cause great
weakness.

5. Sleeplessness. Some patients go to sleep readily, but after some
instants wake suddenly, in a state of excitement that persists despite
their efforts to calm themselves, and only at an early hour in the morning
do they sleep again. Other patients go to bed with the conviction they will
not sleep, and are kept awake by incessant cogitation, their minds being
harassed by a rapid flow of images, ideas and memories. In some cases the
person is calm, his mind is at rest, yet he cannot sleep.

6. Circulatory Disturbances. More blood flows to an organ at work than to
one at rest. In health we do not notice these changes, but in neurasthenia
these internal tides are exaggerated as rushes of blood to the head,
flushings of various parts, and coldness of hands and feet.

Heart palpitation is alarming but not dangerous, and the distended
blood-vessels of the ears may set up vibrations in the drum, so that at
night when the head is on the pillow, every beat of the heart is heard as a
thump, which banishes sleep, and works the victim into a state of high
tension. A pain in the chest, arms and elbows is often felt, limbs may
swell (shown by the tightness of rings, collars, etc.) while the hands and
feet are usually moist and clammy. The patient may have to empty the
bladder every half-hour.  Disorders of menstruation are common.

7. Mental Fatigue. Hundreds of pages would be needed to describe all the
symptoms due to mental fatigue, the morbid belief that the victim has a
fatal disease being very common, though his "disease" rarely makes him lie
up; in the day he works, at night describes his symptoms to the home
circle.

The inability of most men to apply themselves steadfastly to any one set of
ideas is seen in the immense popularity of music halls, cinemas, and
short-story magazines, which offer a change of interest every few minutes.

In normal people there is a slight consciousness of mental processes, but
the mind rarely watches itself work; the neurasthenic is unable to
concentrate, and gets charged with inconstancy and shiftlessness.

His ideas are restive, continuous thought is impossible, and when talking
he has to be "brought back to the point" many times. Memory and attention
flag, and he listens to a long conversation, or reads pages of a book
without grasping its import, and consequently he readily "forgets" what in
reality he never laboured to learn. Trembling of limbs is common.

He lacks initiative, and whatever course he is forced to take--after much
indecision--he is convinced, a moment later, it would have been wiser to
have taken the opposite one.

All his acts are done inattentively. He goes to his room for something, but
has forgotten what when he gets there; later, he wonders if he locked the
drawer, and goes back to see. At night he gets up to make sure he bolted
the door, put out the gas, and damped the fire.

Regret for the past, dissatisfaction with the present, and anxiety for the
future are plagues common to most people, but they become acute in a
neurasthenic, who reproaches himself with past shortcomings of no moment,
infuriates himself over to-day's trivialities, and frets himself over evils
yet unborn.

Such a patient is often greatly upset by a trifle, yet little affected by a
real shock, which by its very severity arouses his reactive faculties which
lay dormant and left him at the mercy of the minor event. He will fret over
a farthing increase in the price of a loaf, but if his bank fails he sets
manfully to.

Duty that should be done to-day he leaves to be shirked to-morrow; he is
easily discouraged, timid, and vacillating. Extremely self-conscious, he
thinks himself the observed of all observers. If others are indifferent
toward him, he is depressed; if interested, they have some deep motive; if
grave, he has annoyed them; if gay, they are laughing at him; the truth,
that they are minding their own business, never occurs to him, and if it
did, the thought that other people were _not_ interested in him, would only
vex him.

He is extremely irritable (slight noises make him start violently),
childishly unreasonable, wants to be left alone, rejects efforts to rouse
him, but is disappointed if such efforts be not made, broods, and fears
insanity. The true melancholic is convinced he himself is to blame for his
misery; it is a just punishment for some unpardonable sin, and there is no
hope for him in this world or the next. The neurasthenic, on the contrary,
ascribes his distress to every conceivable cause save his own personal
hygienic errors.

A neurasthenic, if epileptic, fears a fit will occur at an untoward moment.
He dreads confined or, maybe, open spaces, or being in a crowd. When he
reaches an open space (after walking miles through tortuous byways in an
endeavour to avoid it) he becomes paralysed by an undefinable fear, and
stops, or gets near to the wall.

He fears trains, theatres, churches, social gatherings, or the office.

Other victims fear knives, canals, firearms, gas, high places, and railway
tracks, when the basic fear is of suicide. Many patients have sudden
impulses--on which the attention is focussed with abnormal intensity--to
perform useless, eccentric, or even criminal actions; to count objects, to
touch lamp-posts, to continually reiterate certain words, and so on.

The victim is fully aware that there are no grounds for his panic or
impulse, but though his reason ridicules, it cannot disperse, his fear, and
the wretched man finds relief in sleep alone, which adds to his woes by
being a coy lover.

An almost invariable stage is that wherein the patient studies a
patent-medicine advertisement and finds that a disease, or collection of
diseases, is the root of his troubles. This alarms but interests him; he
studies other advertisements, sends for pamphlets, and so becomes familiar
with a few medical terms. He then takes a "treatment", and talks of his
"complaint" and how he "diagnosed" it. He has become hypochondriac.

He borrows a book on anatomy from the public library to discover in what
part of the body his ailment is located.

He draws up (or copies) a special diet-sheet, and talks of "proteids",
notices a slight cloudiness in his urine, and underlines "The Uric-Acid
Diathesis" in one of his pamphlets. Then his heart bumps, he diagnoses
anew, and so goes on, usually ending by taking phosphorus for his "brain
fag". Then he finds he has a disease unknown to the faculty, which
discovery interests him as intensely as it irritates his unfortunate
friends.

This prince of pessimists has a conviction that, compared with him, Job was
a happy man, and that he will go insane. He does not know that it is only
when there are flaws in the brain from inheritance or organic disease that
mental worry leads to lunacy; a sound brain never becomes unhinged from
intellectual stress alone.

Books and friends are daily questioned about his "diseases", and in spite
of reassuring replies, he continues to doubt, re-question and cross-examine
endlessly, feeding his hopes on the same assurances, consoling himself with
the same sympathies, and worrying himself with the same fears.

Other folk may be "nervy", he is seriously ill; he _knows_ it because he
_feels_ it. He expects the greatest consideration himself, denies it to
others, and then complains he is "misunderstood".

"Every symptom becomes magnified; the trifling ache or pain, the trivial
flatulence, the disinclination or mere hesitation of the bowels to adhere
to a strict schedule, all minor events such as occur to the majority of
healthy men from time to time unheeded, come to be of vast importance to
the psychasthenic individual."

He keeps a record of hourly changes in his condition, and pesters his
family doctor to death. He goes from physician to physician, from hospital
to hospital. Having been induced by his friends to see a specialist, he
bores that good man--who knows him all too well--with a minute description
of his symptoms, presenting for inspection carefully preserved
prescriptions, urinary examination records, differential blood counts, and
the like. Coming away with precious advice, he feels he omitted to describe
all his symptoms, begins to doubt if the specialist really understands
_his_ case, and so the pitiful farce goes on--for years.

The extraordinary fact is that while he is suffering (_sic_) from cancer,
or heart disease, or Bright's disease, and spasmodically from minor
affections like tuberculosis, arterio-sclerosis, and liver-fluke, he is
probably running a successful business. While making money he forgets his
ills; the moment his attention is diverted from the "root of evil" he
proceeds to further "diagnosis".

In the end, he makes a pleasant hobby of his imaginary maladies, trying
each patent nostrum, and giving herbalists, electric-belt men, Christian
Scientists, and dozens of other weird "specialists" a chance to cure him.

Sexual Neurasthenia occurs chiefly in young men given to self-abuse or
sexual excesses. Erections and emissions are frequent, first at night with
amorous dreams, then in the day as a result of sexual thoughts; weakness
and pain in the back follow, and the sexual act may become impossible. The
patient usually studies a quack advertisement, and passes into the hands of
men who make a living by bleeding such wretches dry. Cold baths and the
treatment outlined in Chapter IX will cure him.

Course and Outlook. Neurasthenia is very curable. If the cause be removed,
and vigorous treatment instituted, the victim may be well in a couple of
months, but in most cases there are obstacles to radical treatment, and the
disease drags on indefinitely.

Egoism, moral cowardice, and sexual excess play a part in much
neurasthenia, but relatives must not forget, in their indignation at these
laxities, that the patient really _is_ ill; it is unkind, unjust and
useless to tell an ailing man the unpalatable truth that it is his own
fault.

       *       *       *       *       *

CHAPTER VIII

HYSTERIA

  "Diseased nature oftentimes breaks forth
  In strange eruptions; ..."
                  "King Henry IV."

Hysteria, recorded in legend and law, in manuscript and marble, in
folk-lore and chronicle, right from history's dawn, is still a puzzle of
personality, and only equalled by syphilis in the protean nature of its
manifestations.

The sacred books of the East said delayed menstruation due to a devil was
its cause; the thrashing-out of the devil its cure. Chinese legends
describe it, and its symptoms were ascribed by the Inquisition to
witchcraft and sorcery.

Old Egyptian papyri tell how to dislodge the devil from the stomach, and
there were hysteria specialists in 450 B.C. All old theories fix on the
womb as the seat of the disease. The name hysteria is the Greek word for
womb, and 97 per cent of patients are women.

A few of the very numerous modern theories may be noticed.

The unconscious (or the subconscious) and the conscious are only parts of
one whole. Our "conscious" activities are those which have developed late
in the history of the race, and which develop comparatively late in the
history of the individual. The "conscious" is the product of the racial
education of the "unconscious"; the first is the man, the modern, the
civilized; the last is the child, the primitive, the savage. Between the
two there is no gulf fixed, and the Oxford metaphysician need not go to
Timbuctoo to seek a superstitious savage; he may find one within himself.

In hysteria, Janet says, the field of consciousness is narrowed, and the
patient lives through subconscious experiences, which she forgets when she
again "comes to". She journeys back into the past, back a few years
individually, back centuries or æons racially, and becomes a savage child
again.

Normally, when anything goes wrong, or we suffer from excessive emotion, we
give vent to our feelings by tears, abuse, anger, or impulsive action; in
some way we "hit back", and relieve ourselves of the feeling of oppression.
Then we forget, which heals the sore, and closes the experience.

If, at the moment, we bottle up our emotions, they obtrude later at
inconvenient times until we "get them off our mind" by confiding in some
one, when we get peace of mind. Open confession _is_ good for the soul, and
it is better to "cry your eyes out" than to "eat your heart out".

There are some experiences, however, to which we cannot react by anger or
confidence, and so we imprison our emotions, and try to obtain peace of
mind by forgetting the irritation.

Freud thinks perverted sex ideas are thus repressed, and cause hysteria by
coming into conflict with the normal sex life. If these old sores can be
laid bare by psycho-analysis, and the mental abscess drained by confession
and contrition, cure follows.

The biologists consider hysteria as an adult childishness, a primitive mode
of dodging difficulties. Victims cannot live up to the complicated
emotional standard of modern life, and so act on a standard which to us
seems natural only in children and uncivilized races.

Savill gives the following differences between neurasthenia and hysteria:

                  NEURASTHENIA             HYSTERIA

  Sex             Both sexes equally.      97 per cent females.

  Age             Any age.                 First attack before
                                             page of 25.

  Mental          Intellectual weakness;   Deficient will power,
    peculiarities   bad memory               Want of control
                    and attention.           over emotions.

  Causes          Overwork; dyspepsia;     Emotional upset or
                     accident;               shock.
                     nervous shock.

  Course          Fairly even.             Paroxysms. Vary
                                             from hour to hour.

  Mental          Mental exhaustion;       Emotional; wayward;
    Symptoms        unable to study;         no  self-analysis,
                    restless; sad;           living by
                    irritable; not           rule  or reading
                    equal to                 medical books;
                    amusement.  May          Fond of gaiety;
                    be suicidal.             sad and joyous by
                                             turns. Never
                                             suicidal.

  General         Occasional giddiness;    Flushing;  convulsions
    Symptoms        fainting rare;           and fainting
                    convulsions;             common; no
                    headache; backache;      symptoms between
                    sleeplessness; no        attacks; local
                    loss of feeling.         anæsthesia or
                                             hyperæsthesia.

  Termination     Lasts weeks or           Lasts lifetime in
                    months.                  spasms.
                    CURABLE.                 TEMPORARILY
                                             CURABLE.

Hysteria is a disease of youth, usually ceasing at the climacteric. Social,
financial and domestic worries are exciting causes, a happy marriage often
curing, and an unhappy one greatly aggravating the complaint. It is most
common among the races we usually deem "excitable", the Slavs, Latin races
and Jews, and is often associated with anæmia and pelvic disorders.

Symptoms. Changeability of mood is striking. "All is caprice. They love
without measure those they will soon hate without reason."

Sensationalism is manna to them. They _must_ occupy the limelight. Pains
are magnified or manufactured to attract sympathy; they pose as
martyrs--refusing food at table, and eating sweets in their room, or
stealing down to the larder at night--to the same end. If mild measures
fail, then self-mutilation, half-hearted attempts at suicide, and baseless
accusations against others are brought into play to focus attention on
them.

Minor attacks usually commence with palpitation and a "rising" in the
stomach or a lump in the throat, the _globus hystericus_, which the patient
tries to dislodge by repeated swallowing. This is followed by a feeling of
suffocation, the patient drags at her neck-band, throws herself into a
chair, pants for breath, calls for help, and is generally in a state of
great agitation. She may tear her hair, wring her hands, laugh or weep
immoderately, and finally swoon. The recovery is gradual, is accompanied by
eructations of gas, and a large quantity of pale, limpid, urine may be
passed later.

Major attacks have attracted attention through all ages, ancient statues
showing the same poses as modern photographs. The beginning stage--which
may last a few moments or a few days--is one of mental unrest, the victim
being irritable and depressed. In some cases a warning aura then occurs;
clutchings at the throat, or the _globus hystericus_, palpitation,
dizziness, sounds in the ears, spots dancing before the eyes, or feelings
of intense "_tightness_" as if the skin is about to tear or the stomach to
burst.

The victim throws herself on a chair or couch, from which she slides to the
floor, apparently senseless, the head being thrown back, the arms extended,
the legs held straight and stiff. The face is that of a dreamer, and the
crucifix position is not uncommon. This stage is a gigantic sexual stretch.

Next comes the convulsive stage, but the convulsions are not the true jerky
movements of epilepsy, but are bilateral tossing, kicking, and rolling
movements, interspersed with various irregular passionate attitudes. There
is great alteration but _not loss_ of consciousness. The patient struggles
with those about her, bites them, but never her own tongue, shrieks and
fights, but never passes urine, throws things about, and arches the back
until the body rests on head and feet (_opisthotonos_). The stretching and
convulsive stages alternate, and the attack lasts a long time, being
stopped by pain or by the departure of onlookers. During this stage the
face may reflect the various emotions passing through the mind--with a
fidelity that would rouse the envy of an Irving.

The patient gradually calms down, and a fit of tears or a scream ends the
attack, after which the worn-out victim is depressed but not confused,
though memory for the events of the attack may only be partial. The patient
sometimes passes into the "dream state", described in Chapter II, for some
hours or occasionally for far longer; these are the women described with
much gusto in the local Press as being in a trance--"the living dead".

The victim of these attacks _is_ suffering from a disease, for she shows
many temporary mental symptoms which could not possibly be feigned, while
there is often a genuine partial forgetfulness of the incidents of an
attack. She says she cannot help it; candid friends say she will not. The
truth is that she cannot _will_ not to help it; for though intelligence and
memory are often good and sometimes abnormal, the judgment and will are
always weak--indecision, obstinacy, and doubt being common.

Treatment. A thorough examination by a doctor is _absolutely essential_, to
prove that the patient is merely hysterical, and not the victim of
unrecognized organic disease. In a few cases, skilled attention to some
minor ailment will result in an apparently miraculous cure.

Many who habitually "go into hysterics", are merely grown-up "spoiled
children", and in all cases, the basic factor is a lack of control and
self-discipline.

Unfortunately, these tainted individuals who are so exquisitely sensitive
that any reproof brings floods of tears, turn with mercurial rapidity from
passionate fury to passionate self-reproach, and assuage by impassioned
protestations of affection the distress they have carelessly inflicted,
and, as a consequence of their momentary but undoubtedly sincere
contrition, escape blame and punishment.

Harmful sympathy is thus substituted for helpful discipline, and the more
stable members of the family are often made slaves to the whims and
caprices of the hysterical member.

The usual home treatment of the victim passes through various stages, and
lacks persistence. Violent methods are succeeded by studied indifference;
and that again by reproaches and recriminations.

Greene's remarks are very pertinent: "The condition must be regarded as an
acquired psycho-neurosis to be ameliorated, and perhaps removed, by
suggestion and a complete control, which, though kind, is firm, persistent,
insistent, and _lacking in every element that enters into the upbuilding of
the hysterical temperament_."

For anæmic patients, the following is a useful prescription:

  R.
  Quininæ valerianatis       gr. xx
  Ferri valerianatis         gr. xx
  Ammon. valerianatis        gr. xx
  Misce et fiant pilulæ no.      xx
  Sig.: One or two three times a day, after meals.

As far as the minor symptoms are concerned, the disease is usually chronic,
for as soon as one symptom has been overcome another takes its place, and
there is little hope of cure save when the case is taken vigorously in hand
in childhood, treatment being best given in a home or hospital. Home
treatment consists in an attempt to inculcate the lost or never-acquired
habit of self-control, and in the hygienic measures laid down for
neuropaths in general in the rest of this book.

In a major attack, _show no sympathy_. Let every one leave the room, save
one attendant, whom the victim knows to be of firm character, and calm but
determined disposition. This attendant should get a jug of water, and
threaten to douche the victim unless she makes vigorous efforts to control
herself. If she cannot, or will not, _douche her_, then hold a towel over
her nose and mouth, and she will perforce cease her gymnastics to breathe,
though the attendant must be prepared for an outburst of abuse when she has
recovered her breath. Between attacks, all who are brought into contact
with the victim, must adopt a tolerant but unsympathetic attitude, while
efforts are made to inculcate habits of control.

       *       *       *       *       *

CHAPTER IX

ADVICE TO NEUROPATHS

  "Great temperance, open air,
  Easy labour, little care."

The above quotation epitomizes the cure for neurasthenia, for as Huxley
said:

    "Our life, fortune, and happiness depend on our knowing something of
    the rules of a game far more complicated than chess, which has been
    played since Creation; every man, woman and child of us being one of
    the players in a game of our own. The board is the world, the pieces
    the phenomena of the universe, while the rules of the game are the laws
    of nature. Though our opponent is hidden, we know his play is fair,
    just and patient, but we also know to our sorrow that he never
    overlooks a mistake or makes the slightest allowance for ignorance. To
    the man who plays well, the highest stakes are paid with that
    overflowing generosity with which the strong show their delight in
    strength. The one who plays badly is checkmated; without haste, but
    without remorse. Ignorance is visited as sharply a as wilful
    disobedience; incapacity meets with the same punishment as crime."

In many cases some real trouble is the best medicine for a neurasthenic,
for though disaster may crush him, it is more likely to act as a spur, by
diverting his thoughts from his woes, and making him fight instead of fret.

Since such blessings in disguise cannot be booked to order, first see a
doctor. Though little be physically wrong, the sense of comfort and relief
from fear, which a clear idea of what _is_ wrong brings, goes a long way
towards cure by giving the patient hope and confidence.

Having seen the doctor, assist him by carrying out the following advice as
far as real limitations--not lazy inclinations--permit. Do not say after
reading this chapter, "I know all that"; you have to _do_ "all that", for
medicine alone, whether patent or prescribed, is useless.

       *       *       *       *       *

Go for a long sea voyage, if possible.

If not, get a long holiday in a quiet farmhouse, or, better still, get to
the country for good, be it in never so humble a capacity, for a healthy
cowman is happier than a neurasthenic clerk. The rural worker has no
theatres, but he can walk miles without meeting another; he has woods to
roam in, hills to climb, trees to muse under: he has ample light and air,
and his is a far happier lot than that of a vainglorious but miserable,
sedentary machine in a great city.

The rural districts round Braemar, the Channel Islands, Cromer, Deal,
Droitwich, Scarborough, and Weston-super-Mare are, in general, suitable
holiday resorts for neuropaths.

Avoid alcohol, tea, coffee, much meat, all excitement, anger and _worry_.
Take tickets only for comedy at the theatre, and leave lectures, social
gatherings and dances alone.

Nerve-starvation needs generous feeding with easily digested food. Drink
milk in gradually increasing amounts up to half a gallon per day. If more
food is needed, add eggs, custard, fruit, spinach, chicken, or fish, but do
not forgo any milk. Avoid starchy foods and sweets.

Eat only what you can digest, and digest all you eat. Chew every mouthful a
hundred times. This is one of the few sensible food fads.

Drink water copiously between meals, and take no liquid (save the milk)
with them. Keep the bowels open.

If you _must_ "occupy your mind", take up some very simple, quiet hobby.
Gardening, fretwork, photography and gymnastics are not necessarily quiet
hobbies. Chess, billiards, and contortions with gymnastic apparatus are not
to be recommended.

If you _must_ read, peruse only humorous novels. Never study, and leave
exciting fiction and medical work alone. Symptoms are the most misleading
things in a most misleading world.

After your evening meal, take a quiet walk, go to bed _and sleep_. You
should occasionally spend from Saturday midday to Monday morning in bed,
with blinds drawn, living on milk, seeing nobody and doing _nothing_. The
deepest degradation of the Sabbath is to fill it with odd jobs which have
accumulated through the week.

Do not get out of bed too early in the morning, but rise in time to eat
your breakfast slowly, attend to the toilet, and catch the car without
haste. If your occupation be an indoor one, rise an hour earlier, and walk
or cycle quietly to work.

Take a warm bath followed by a cold douche on rising. If no warm after-glow
follows, use tepid water. Keep your body warm; your head cool.

Be continent. Nerve-tone and sexual delights are not compatible. Matrimony,
while a convenient cloak, is no excuse for lust.

Try suggestion for fears and impulses (see Chapter XVIII), for it is
useless to try to "reason them out", though it is useful for a brief period
each day to try deliberately to turn the mind away from the obsession, by
singing or whistling, gradually prolonging the attempts.

Rest, to prevent the manufacture of more waste products, the elimination of
those present, and the generation of nerve-strength from nourishing food
are the things that cure. Chapters XIX and XX deal with the drug treatment.

Do not Worry. Whatever your trouble is, it is useless to

    "Look before and after, and sigh for what is not"

for the future cannot be rushed nor the past remedied. All patients reply
promptly that they "can't help" worrying, when in truth they do not try.

Work never hurt anyone, but harassing preoccupation with problems which no
amount of thought will solve drives many thousands to early graves. Anger
exhausts itself in a few minutes, fatigue in a few hours, and real overwork
with a week's rest, but worry grows ever worse. Ponder Meredith's lines:

  "I _will_ endure; I will not strive to peep
  Behind the barrier of the days to come."

"Look on the bright side!" said an optimist to a melancholy friend.

"But there is no bright side."

"Then polish up the dull one!" was the sound advice tendered.

_Learn to forget_!

One cannot open a periodical without being exhorted to train one's memory
for a variety of reasons. The neuropath needs a system of forgetfulness.
Lethe is often a greater friend than Mnemosyne.

To brood on disappointments, failures and griefs only wastes energy, sours
temper, and upsets the general health. Resolve _beforehand_ that when
unhappy ideas arise you will _not_ dwell on them, but turn your thoughts to
pleasant trifles; take up a humorous book, or take a turn in the fresh air,
and you will soon acquire the habit of laughing instead of whining at Fate.

To sum up: Go slow! Your neurons have been exhausted in your foolish
attempt to "live this day as if thy last" in a wrong sense; feverish
activity and unnecessary work must be abandoned to enable the nerves to
recuperate.

When the doctor says "rest", he means "_rest_", not change your bustle from
work to what you are pleased to regard as play.

So much is _absolute rest_ recognized as the foundation of treatment, that
severe cases undergo the "Weir-Mitchell Treatment". The patient is _utterly
secluded_; letters, reading, talking, smoking and visits from friends are
forbidden. He is put to bed, not allowed even to sit up, sees no one save
nurse and doctor, is massaged, treated electrically, grossly overfed,
fattened up, and freed from every care.

In leaving his habitual circle, the patient escapes the too-attentive care
of his relatives, and the incessant questions about his complaint with
which they overwhelm him. The results of this régime with semi-insane
wrecks are marvellous. It is a very drastic but very successful
"rest-cure", and while it cannot be undergone at home, neurasthenics will
benefit by following its principles as far as they can in their own homes.

High-frequency or static electricity sometimes works wonders in the hands
of a specialist, but the electric batteries, medical coils, finger-rings
and body-belts so persistently advertised are _useless_.

When the patient has in some measure recuperated, he may try the following
exercises in mental concentration. Vittoz claims good results from them,
but they must be done quite seriously.

    1. Walk a few steps with the definite idea that you are putting forward
    right and left feet alternately. Go on by easy stages until you
    concentrate on the movement of the whole body.

    2. Take any object in your hand, and note its exact form, weight,
    colour, etc.

    3. Look in a shop-window while you count ten, and as you walk on, try
    to recall all the objects therein exhibited.

    4. Accustom yourself to defining the sounds you hear, and concentrating
    on a special one, as that of a passing tram, or a ticking watch.

    5. Make a rapid examination several times daily of your feelings and
    thoughts, and try to express them definitely.

    6. Concentrate on the mental reproduction of a regular curve: a figure
    8 placed on its side.

    7. Listen to a metronome, and, a friend having stopped it, mentally
    repeat the ticking to time.

    8. Whenever you handle anything, try to retain the impression of that
    object and its properties for several minutes, to the exclusion of
    other ideas.

    9. Concentrate on ideas of calm, and of energy controlled.

    10. Place three objects on a sheet of white paper. Remove them one by
    one, at the same time effacing the impression of each one as it is
    removed, until the mind, like the paper, is blank.

    11. Efface two of the objects, and retain the impression of one only.

    12. Replace the impressions in your mind, but not the objects on the
    paper, one by one.

The object of these exercises is to get your wandering mind daily a little
more under control; do not exhaust yourself.

After some months of treatment, ask yourself--

Am I able to walk ten miles with ease? when introduced to a stranger of
either sex or any age, to converse agreeably, profitably and without
embarrassment? to entertain visitors so that all enjoy themselves? to read
essays or poetry with as much pleasure as a novel? to listen to a lecture,
and be able afterwards to rehearse the main points? to be good company for
myself on a rainy day? to submit to insult, injustice or petulance with
dignity and patience, and to answer them wisely and calmly? When you are
able to answer, "Yes!" to these queries, your nerves are sound.

       *       *       *       *       *

CHAPTER X

FIRST STEPS TOWARDS HEALTH

    "All sick people want to get well, but rarely in the best way. A 'jolly
    good fellow' said: 'Strike at the root of the disease, Doctor!' And
    smash went the whisky bottle under the faithful physician's cane."

In neuropaths, all irritation to the nervous system is dangerous, and must
be eliminated, and to this end, eyes, ears, nose and teeth, all in close
touch with nerves and brain, must be put and kept in perfect order.

The Eye. Only 4 per cent, of people have _perfect_ sight. Errors in
refraction--common in neuropaths--mean that the unstable brain-cells are
constantly irritated. Dodd corrected eye-errors in 52 epileptics, 36 of
whom showed improvement.

You take your watch to a watchmaker, not a chemist; take your eyes to an
oculist, and if you cannot afford to see one privately, get an eye-hospital
note. (To allow a chemist or "optician" to try lenses until he finds a pair
through which you "see better" is very dangerous.)

Then you go to a qualified optician, who makes a proper frame, and inserts
the lenses prescribed. Patients should inquire if the glasses are to be
worn continually, or only when doing close work or reading.

The Ears. Giddiness and other unpleasant symptoms may be due to ear
trouble. If there is any discharge, buzzing or ringing, see a doctor, for
if ear disease gains a firm hold it is usually incurable.

The Nose. Neuropaths often suffer from moist nasal catarrh, or from a dry
type in which crusts of offensive mucus form, the disagreeable odour of
which is not apparent to the patient himself. He must pay careful attention
to the general health, take nourishing food, and wash out the nose three
times a day with:

  1 oz. Bicarbonate of Soda,
  1 oz. Common Salt,
  1 oz. Borax,
  Dissolved in 1 pint hot water.

For obstinate nasal trouble, consult an aural surgeon.

The Teeth.

    "Most men dig their graves with their teeth."--Chinese Proverb.

Serious ills are caused by defective teeth, for microbes decompose the food
left in the crevices to acid substances which dissolve the lime salts from
the teeth, and this process continues until the tooth is lost.

Faulty teeth are common in neuropaths, and at the risk of being
wearisome--and good advice is wearisome to people--patients must get proper
aid, privately or at a dental hospital, from a _registered dentist_, who,
like a doctor, does not advertise.

Teeth gone beyond recall will be painlessly extracted, those going,
"stopped", and tartar or scale scraped off. If necessary, have artificial
teeth, but remember that the comfort of a plate depends upon skilled
workmanship, not on gold or platinum. Everyone should visit the dentist as
a matter of routine once a year.

  Buy 3 ozs. Precipitated Chalk,
  1 oz. Chlorate of Potash,

and brush the teeth with this mixture ere going to bed; use tepid water
after meals. Do not brush across, but, holding the brush horizontally,
brush with a circular motion, cleaning top and bottom teeth at once. Use a
moderately hard brush with a curved surface which fits the teeth.

After each meal, it is essential to cleanse the interstices between the
teeth with a quill toothpick or dental floss, never with a pin, for it is
the decomposition of tiny particles that starts decay; _a tooth never
decays from within_.

     1½ fl. oz. Glycerine,
      1 fl. oz. Carbolic Acid,
      ½ fl. oz. Methylated Chloroform.

With ten drops of this mixture in a wineglassful of tepid water, wash out
your mouth and gargle your throat after every meal, sending vigorous waves
between the teeth, and so removing any particles left by toothpick and
brush.

Children should be taught these habits as soon as they can eat, for the
custom of a lifetime is easy.

       *       *       *       *       *

CHAPTER XI

DIGESTION

  "We may live without poetry, music and art;
  We may live without conscience, and live without heart;
  We may live without friends, we may live without books,
  But civilized man cannot live without cooks."

The human digestive system consists of a long tube, in which food is
received, nutriment taken from it as it passes slowly downwards, and from
which waste is discharged, in from sixteen to thirty hours afterwards.

Six glands pour saliva into the mouth, where it should be--but how rarely
is--mixed with the food, causing chemical changes, and moistening the bolus
to pass easily down.

The acid Gastric Juice, of which a quart is secreted daily, stops the
action of the saliva, and commences to digest the proteins, which pass
through several stages, each a little more assimilable than the last.

The lower end of the stomach contracts regularly and violently, churning
the food with the juice, and gradually squirting it, when liquified to
Chyme, into the small intestine. If food is not chewed until almost
liquified, the gastric juice cannot act normally, but has to attack as much
of the surface of the food-lump as possible, leaving the interior to
decompose, causing dyspepsia and flatulence.

Most people suppose the stomach finishes digestion, but it only initiates
the digestion of those foodstuffs which contain nitrogen, leaving fats,
starches and sugars untouched.

By an obscure process, the acid chyme stimulates the walls of the bowel to
send a chemical messenger, a Hormone through the blood to the liver and
pancreas, warning them their help is needed, whereupon they actively
secrete their ferments.

The secretion of the pancreas is very complex. It carries on the work of
the saliva, and also splits insoluble fats into a soluble milky emulsion.

Fats are unaffected in the mouth and stomach, which explains why hot,
buttered toast, and other hot, greasy dishes are so indigestible. The
butter on plain bread is quickly cleared off, and the bread attacked by the
gastric juice, but in toast or fatty dishes, the fat is intimately mixed
with other ingredients, none of which can properly be dealt with. Always
butter toast when cold.

To continue: The secretion of the pancreas also contains a very active
ferment, which, on entering the bowel, meets and mixes with another ferment
four times as powerful as gastric juice, which completes the digestion of
the proteids.

Meantime, the secretions of Lieberkühn's glands (of which there are immense
numbers in the small intestine) are further aiding the digestion of the
chyme, while the liver (the largest and most important gland in the body)
sends its ferments, and the gall-bladder its bile, which further emulsifies
the fatty acids and glycerin until they are ready to be absorbed.

The chemically-changed chyme is now termed Chyle, and is ready to be
absorbed by the minute, projecting Villi.

The fatty portion of the chyle is absorbed by minute capillaries and
ultimately mingles with the blood, which may look quite milky after a fatty
meal.

The remaining food is absorbed by the blood capillaries in the villi, and
passes to the liver for filtration and storage.

The large bowel has Lieberkühn's glands, but not villi, and is relatively
unimportant, though most of the water the body needs is absorbed from here.

How food becomes energy and tissue we do not know. The tissues are
continually being built up from assimilated food, and as constantly being
burnt away, oxygen for this purpose being extracted from the air we inhale,
and carried via the blood to every corner of the body. The ashes of this
burning are expelled into the blood and lymph, and carried out of the body
by the kidneys, lungs, skin and bowels. The product of the burning is the
marvel--Life; the extinction of the fire is the terror--Death.

Energy is obtained almost solely from the combustion of fats and sugars,
proteids being reconverted into albumin, and then broken down to obtain
their carbon for combustion, the nitrogen being expelled, but proteids are
essential for the building of the tissues themselves, the stones of the
furnaces which burn up carbohydrates and fats.

The time taken in the digestion of foods was first studied through a wound
in the stomach of St. Martin, a Canadian. Experiments were made with
various well-masticated foods, and with similar foods placed unchewed, into
the stomach through the wound, the latter experiment being carried out by
millions of people at every meal, by a slightly different route.

Boiled food is more easily digested than fried or roasted (the frying pan
should be anathema to a neuropath); lean meat than fat; fresh than salt;
hot meat than cold; full-grown than young animals, though the latter are
more tender; white flesh than red; while lean meat is made less, and fat
meat more digestible, by salting or broiling. Oily dishes, hashes, stews,
pastries and sweetmeats are hard to digest. Bread should be stale, and
toasted crisply _right through_. The time, compared with the thoroughness
of digestion, is of little importance, as it varies widely within
physiologic bounds.

Most people fancy that the more they eat the stronger they become, whereas
the digestion of all food beyond that actually needed to repair the waste
due to physical and mental effort consumes priceless nerve energy, and
weakens one. The greater part of excessive food has literally to be _burnt
away_ by the body, which causes great strain, mainly on the muscles. The
question is not: "How much can I eat?" but: "How much do I need?"

       *       *       *       *       *

CHAPTER XII

INDIGESTION

    "We know how dismal the world looks during a fit of indigestion, and
    what a host of evils disappear as the abused stomach regains its tone.
    Indigestion has lead to the loss of battles; it has caused many crimes,
    and inspired much sulphurous theology, gloomy poetry and bitter
    satire."--Hollander.

The nervous dyspeptic suffers no marked pain, but often feels a "sinking",
has no appetite, and cannot enjoy life because his stomach, though sound,
does not get enough nerve-force to run it properly.

A great deal of nerve-force is required for digestion, and if a man comes
to the table exhausted, bolts his food, uses nerve-force scheming while he
is bolting, and, immediately he has bolted a given amount, rushes off to
work, digestion is imperfectly performed, nutriment is not assimilated, the
nerve-force supply becomes deficient. He continues to overdraw his account
in spite of the doctor's warning, and stomachic bankruptcy occurs, followed
by a host of ills.

Nervous dyspepsia is a very obstinate complaint, but if tackled resolutely,
it can to a great extent be mitigated; but let it be emphasized at once,
that medicines, patent or otherwise, are useless. If dyspepsia be
aggravated by other complaints, these should receive appropriate treatment,
but the assertions so unblushingly made in patent-pill advertisements are
unfounded. The very variety of the advertised remedies is proof of the
uselessness of all.

Set aside certain periods three times a day for meals. Fifteen minutes
before meal times, sit in a comfortable chair, relax all your muscles,
close the eyes, and try to make the mind a blank. _Rest_!

Then eat the meal slowly and thoroughly. Conversation may lighten and
lengthen a meal, but avoid politics, "shop" and topics of that type. What
is wanted at table is wit, not wisdom.

Water may be drunk with meals, provided it is drunk between eating, and not
while masticating, for it has decidedly beneficial effects upon the
digestive functions. Water is usually forbidden with meals because if
patients drink while eating, the water usurps the functions of saliva, and
moistens the bolus, which is then swallowed with little or no mastication.
If you cannot drink between mouthfuls, then drink only between meals.
_Never drink while food is in the mouth!_

After the meal, lie down on the right side for half an hour, _resting_, and
so directing all available nerve-energy to getting digestion well under
way.

Indifferent appetites must be tempted by wholesome dishes made up in a
variety of enticing ways. Fats are good, but must be taken in a tasty form.
Eat fruit deluged with cream.

The crux of digestion is to

"_Chew_! CHEW!! and KEEP ON CHEWING!!!" for until food is thoroughly
masticated there will be no relief. The only part of the whole digestive
process placed under the control of consciousness is mastication, and,
paradoxically, it is the only part that consciousness usually ignores.

A healthy man never knows he has a stomach; a dyspeptic never knows he has
anything else, because he will not _eat_ his food, but throws it into his
stomach as the average bachelor throws his belongings into a trunk.

A varied, tasty diet, thoroughly chewed and salivated, with rest before and
after meals, is the only means of curing dyspepsia, for no medicine can
supply and properly distribute nerve-energy.

Digestive pills are all purgatives, with a bitter to increase appetite, and
occasionally a stomachic, bound together with syrup or soap. Practically
all contain aloes, and very rarely a minute quantity of a digestive ferment
like pepsin. Taken occasionally as purges, most digestive pills would be
useful, but none are suited to continuous use, and the price is, as a rule,
out of all proportion to the primary cost, while one or two are, frankly,
barefaced swindles.

The analyses of the British Medical Association give the following as the
probable formulæ for some well-known preparations:

  Beecham's Pills.............................Aloes; ginger.
  Holloway's Pills............................Aloes; ginger.
  Page Woodcock's ............................Aloes; ginger; capsicum;
                                                cinnamon and oil of
                                                peppermint.
  Carter's Little Liver.......................Aloes; podophyllin;
    Pills                                       liquorice.
  Burgess' Lion Pills.........................Aloes; ipecacuanha; rhubarb;
                                                jalap; peppermint.
  Cockle's Pills..............................Aloes; colocynth; jalap.
  Barclay's Pills.............................Aloes; colocynth; jalap.
  Whelpton's Pills............................Ginger; colocynth; gentian.
  Bile Beans..................................Cascara; rhubarb; liquorice;
                                                peppermint.
  Cicfa.......................................Cascara; capsicum; pepsin;
                                                diastase; maltose.

       *       *       *       *       *

CHAPTER XIII

DIETING

  "Simple diet is best; many dishes bring many diseases,"
                  --Pliny.

  "Alas! what things I dearly love--
    puddings and preserves--
  Are sure to rouse the vengeance of
    All pneumogastric nerves!"
                  --Field.

The man who pores over a book to discover the exact number of calories
(heat units) of carbohydrates, proteins and fats his body needs, means
well, but is wasting time.

In theory it is excellent, for it should ensure maximum work-energy with
minimum use of digestive-energy, but in practice it breaks down badly, a
weakness to which theories are prone. One man divided four raw eggs, an
ounce of olive oil, and a pound of rice into three meals a day.
Theoretically, such a diet is ideal, and for a short time the experimenter
gained weight, but malnutrition and dyspepsia set in, and he had to give
up. The best diet-calculator is a normal appetite, and fancy aids digestion
more than a pair of scales.

In spite of rabid veget- and other "arians", most foods are good (making
allowances for personal idiosyncrasy) if thoroughly masticated. The
oft-quoted analogy of the cow is incorrect, for herbivora are able to
digest cellulose; but even cows masticate most laboriously.

Meat juices are the most digestion-compelling substances in existence, and
a little meat soup, "Oxo" or "Bovril" is an excellent first course.

No one needs more than three meals per day, while millions thrive on one or
two only, which should be ready at fixed hours; for the stomach when
habituated becomes congested and secretes gastric juice at those hours
without the impulse of the will, is ready to digest food, and gets that
rest between-times which is essential to sound digestion. The man who has
snacks between meals, and chocolates and biscuits between snacks can never
hope to get well.

To eat the largest meal at midday, as is the custom of working-men, is
best, provided one can take half an hour's rest afterwards.

Drink a pint of tepid water half an hour before every meal. If the stomach
be very foul, add a teaspoonful of bicarbonate of soda to the water.

The question of alcohol is a vexed one, but Paul's "Take a little wine for
thy stomach's sake," is undoubtedly sound advice, though had Paul been
trained at a London hospital, he would have added "after meals".
Unfortunately, moderation is usually beyond the ability of the neuropath,
and consequently he should be forbidden to take alcohol at all. Spirits
must be avoided.

Moderately strong, freshly made tea or coffee may be consumed in reasonable
quantity.

Vegetable salads are excellent if compounded with liquids other than
vinegar or salad oil, and of ingredients other than cucumbers, radishes,
and the like.

Take little starchy food and sweetmeats. It may surprise those with "a
sweet tooth" to learn that, to the end of the Middle Ages, sugar was used
only as a medicine. Meat must be eaten--if at all--in the very strictest
moderation, and never more than once a day. Eggs, fish and poultry--in
moderation too--take its place.

Healthy children need very little meat, while it is a moot point if
children of unstable, nervous build need any at all. The diet at homes for
epileptics is usually vegetarian, and gives excellent results.

Never swallow skin, core, seeds or kernels of fruits, many of which,
excellent otherwise, are forbidden because of the irritation caused to
stomach and bowels by their seeds or skins.

Bromides are said to give better results if salt is not taken. A little may
be used in cooking, if, as is usually the case, the patient has to eat at
the common table, but condiments are unnecessary and often irritating to
delicate stomachs.

The diet of nervous dyspeptics must be very simple, and though it is trying
and monotonous to forgo harmful dainties in favour of wholesome dishes, it
is but one of the many limitations Nature inflicts on neuropaths. Many an
epileptic, after believing himself cured, has brought on a severe attack by
an imprudent meal. La Rochefoucauld says: "Preserving the health by too
strict a regimen is a wearisome malady", but it is open to all men to
choose whether they will endure the remedy or the disease.

Most men eat six times the minimum and twice the optimum quantity of food
per day. For every one who starves, hundreds gorge themselves to death.
"Food kills more than famine", and the poor, who eat sparsely from
necessity, suffer far less from gout, cancer, rheumatism and other
food-aggravated diseases than the rich.

Most books give detailed lists of foods to be eaten and to be avoided, but
this we believe is productive of little good.

Let the patient eat a mixed diet, well and suitably cooked, taking what he
fancies in reason, masticating everything thoroughly, and gradually
eliminating foods which experience teaches him are difficult for him to
digest.

       *       *       *       *       *

CHAPTER XIV

CONSTIPATION

  "Causing a symptom to disappear is seldom the cure of
  any ill; the true course is to _prevent_ the symptom."

Rings of muscle cause wormlike movements of the bowels, and so propel
forward food and waste. Weakening of these muscles or their nerve controls
from any cause, results in a "condition of the bowels in which motions
occur only when provoked by medicines or injections". In some cases though
motions occur freely, food ingested is retained too long in the digestive
tract.

The blood extracts what water it needs from the fluid waste in the large
bowel, but when the weak muscles allow this to remain too long, an excess
of moisture is removed, leaving hard, dry masses, painful to pass.

When the fæces reach the anus, they cause an uneasy feeling, which directs
us to seek relief, but if we neglect this impulse the bowel may become so
insensitive that it ceases to warn its owner of the need to evacuate.
Meantime, the muscles which expel the fæces get weak, so that every motion
needs a strong effort of will, and much harmful straining.

Much misery is caused by false modesty in the presence of others. It can
never be immodest to attend to the calls of Nature, and such
hypersensitiveness is dangerous, for rupture, piles, fissure, prolapse,
fistula, are often due to straining.

Lack of exercise weakens the intestinal and abdominal muscles. Unsuitable
or imprudent foods or drinks, indigestion, excessive worry, and anything
that lowers the general health tend to produce constipation.

Bacteria flourish freely in fæces, and though it is doubtful whether the
"Auto-intoxication" so freely ascribed to them, is supported by facts, it
cannot be doubted that, whatever the precise mechanism by which the effects
are produced, constipation does result in a lowering of the resistance to
disease. More frequent fits, colic, foul breath, headache right across the
forehead, lost appetite, drowsiness, skin eruptions, irritability,
insomnia, melancholia and anæmia (especially the "green sickness" of women,
usually connected with menstrual irregularities) are but a few of many ills
partly or wholly due to or consequent upon constipation.

The symptoms of constipation of the small bowel are dry stools, usually
light in colour.

To cure this type, more water should be drunk, so that the waste may pass
to the large bowel in a fluid state. Drink freely between meals, especially
in summer, when profuse perspiration often causes obstinate constipation.

The symptoms of constipation of the large bowel are furred tongue, foetid
breath, sallow or jaundiced complexion, and mottled stools of round, hard
balls, the first portion being very firm, and the remainder nearly liquid.
There are occasional attacks of colic.

The first step towards cure is to form regular habits. At a suitable time,
say shortly after breakfast, or after supper if you suffer from
hæmorrhoids, go to the lavatory, whether you feel uncomfortable or not.
Wait patiently, do not try to hasten matters by violent straining, and if
for some weeks there is little improvement, do not despair, for the habits
of a lifetime are not overcome in five minutes, just because you have
decided to amend your careless ways. A short, brisk walk beforehand often
helps.

If necessary, use a chamber and "squat" as savages do. In this position,
the thighs support the abdomen, and force is exerted without straining.
Massaging the abdomen by firmly rubbing it round and round, clockwise, with
the hand, often does good, as does pressure with a finger on the flesh
between the end of the backbone and the anus. Try every method before
taking purgatives, for with patience and determination these are rarely
necessary.

Carefully cooked and "concentrated", easily digested and "pre-digested"
foods contain little residue; every meal should contain some indigestible
matter to stimulate the intestines. Brown bread, porridge, lettuce, cress,
apples and coarse vegetables are all good for this purpose, but if taken
too freely may cause heartburn and flatulence. Meat, milk, fish, eggs and
most patent foods have not enough waste. Boiled milk is very constipating.

Purgatives, injections and medicines, alone, are useless, for the bowel
becomes still more insensitive to natural calls under the artificial
stimulation of drugs, on which it becomes so entirely dependent that
without their aid it will not act.

It may be necessary to clean out the bowel by an enema.

Make a lather with clean warm water and plain soap, and fill the enema
syringe (a half-pint size is useful). Smear the nozzle with vaseline, lean
forward and insert into the anus, pointing a little to the left. Press the
bulb, withdraw the nozzle, retain the liquid a few moments and a desire to
go to stool will be felt.

A simpler plan is to buy glycerin suppositories. One is inserted into the
anus and acts like an injection. It must be clearly understood that these
are emergency measures.

If internal piles come down at stool, do not allow them to remain and get
engorged with blood. See that your hands are scrupulously clean, and your
nails closely cut and free from dirt; then moisten the middle finger with a
little vaseline taken to the lavatory for the purpose, and gently return
the hæmorrhoids, sitting down for a few minutes to retain them.

A mild purge may be taken once a week with advantage. Glauber's Salts
(Sodium Sulphate), Cascara Sagrada, and liquid paraffin are all good, while
Castor Oil Globules are suited for children.

For flatulence, take a 10-minim capsule of Terebine after meals, or
charcoal, either as French Rusks ("Biscols Fraudin") or a teaspoonful of
powdered charcoal between meals. One drop of creosote on a lump of sugar,
peppermint water, and sal volatile may also be used. Sufferers should toast
bread, and use sugar sparingly.

Patent medicines almost invariably contain a brisk aperient.

       *       *       *       *       *

CHAPTER XV

GENERAL HYGIENE

  "Better to hunt in fields for health unbought,
  Than fee the doctor for a nauseous draught."
                  --Dryden.

If men but realized what complicated machines they were, they would use
themselves better. In the body are 240 bones and hundreds of muscles. The
heart, no bigger than the clenched fist, beats 100,000 times a day; the
aerating surface of the lungs is equal in area to the floors of a
six-roomed house, and by means of its minute blood-vessels which would
stretch across the Atlantic, 500 gallons of blood are brought into contact
with over 3,000 gallons of air every day.

Seven million sweat-glands, 30 miles long, get rid of a pint of liquid and
an ounce of solid waste each day while it takes a tube 30 feet long, with
millions of glands, to deal with a sip of milk.

Man's finest steam engine turns one-eighth of the energy supplied into
work; nature's engine, muscle, turns one-third into work. The body contains
9 gallons of water, enough carbon to make 9,000 lead pencils, phosphorus
for 8,000 boxes of matches, iron for 5 tacks, and salt enough to fill half
a dozen salt-cellars.

Over 40 food-ferments have been found in the liver; there are 5,000,000 red
and 30,000 white blood corpuscles in a space as big as a pin's head, each
one of which travels a mile a day and lives but a fortnight, millions of
new ones being built up in the bone-marrow every second; a flash of light
lasting only one eight-millionth of a second, will stimulate the eye, which
can discriminate half a million tints. The ear can distinguish 11,000
tones, and is so sensitive that we hear waves of air less than one
sixty-thousandth of an inch long; a mass of almost liquid jelly--for 81 per
cent of the brain is water, and Aristotle thought it was a wet sponge to
cool the hot heart--sends out impulses ordering our every thought and act,
and stores up memory, we know not how or where.

There are 10,000,000,000 of cells in the brain cortex alone, and 560,000
fibres pass from the brain down the spinal cord.

A clear, watery cell, no larger than the dot on an "i" encloses factors
causing genius or stupidity, honesty or roguery, pride or humility,
patience or impulsiveness, coldness or ardour, tallness or shortness, form
of head or hands, colour of eyes and hair, male or female sex, and the
thousand details that make a man.

Yet man uses this marvellous mechanism but carelessly, and the widespread
poverty, the worry and discord in the lives of the happiest, our ignorance,
the evil habits we contract, and the vice, miseries, diseases and labours
to which most expectant mothers are too often exposed, explain why one baby
in every eight never walks; why but four of them live to manhood; why less
than 40 years is now man's average span; and why this brief space is filled
with suffering and misery, from which many escape by self-destruction.

Sound children do not come from unclean air, surroundings, habits,
pursuits, passions and parents. Children conceived in unsuitable
surroundings by unsuitable parents, die; must die; ought to die. They are
not built for the stern battle of life.

       *       *       *       *       *

  "Where the sun does not enter, the doctor does!"
                  --Italian proverb.

Plenty of fresh, clean air is essential to health.

In all rooms a block of wood nine inches high should be inserted beneath
the whole length of the bottom sash of the window. This leaves a space
between the top and bottom sashes through which fresh air passes freely,
without draught, both night and day, for it should never be closed. A handy
man will fit a simple device to prevent the windows being forced at night,
but better let in a burglar than keep out air.

If it be cold or draughty in the bedroom, hang a sheet a foot from the
window, put more blankets or an overcoat on the bed, or put layers of brown
paper above the sheets, _but never close the window_.

You can take too much of many good things, but never too much pure air.

Cleanliness. Keep the body clean by taking at least one hot bath per week;
per day if possible. Much filth is excreted by your sweat-pores; why let it
cake on skin and underlinen, and silently silt up your thirty miles of skin
canals, thus overworking the other excretory organs, and gradually
poisoning yourself?

Neuropaths always suffer from sluggish circulation of the extremities, and
to improve this, hot and cold baths, spinal douches and massage are
excellent. A hot bath (98-110° F.) ensures a thorough cleansing, but it
brings the blood to the surface, where its heat is quickly lost, enervating
one, and causing a bout of shivering which increases the production of heat
by stimulating the heat-regulating centre in the brain. Baths above 110° F.
induce faintness. To prevent shivering, take a cold douche after the hot
bath, and have a brisk rub down with a coarse towel, when a delightful,
warm glow will result. Do not freeze yourself, or the reaction will not
occur; what is wanted is a short, sharp shock, which sends the blood racing
from the skin, to which it returns in tingling pulsations, which brace up
the whole system. The douche is over in a few seconds, and may be enjoyed
the year round, commencing in late Spring.

The cold bath must not be made a fetish. If the glow is not felt, give it
up, and bathe in tepid (85-92° F.) or warm (93-98° F.) water. When started
in the vigour of youth, the cold bath may often be continued through life,
but it is unwise to commence in middle life. Parents should never force
their children to take cold baths, to "harden them".

Other Hygienic Points. Tobacco is undesirable for neuropaths, save in
moderation.

Clothes should be light, loose, and warm. Epileptics should wear low, stiff
collars, half a size too large, with clip ties. Such a combination does not
form a tight band round the neck, and can quickly be removed if necessary.
Wear thick, woollen socks, and square-toed, low-heeled, double-soled boots.
Hats should be large, light, and of soft material. Woollen underwear is
best. Change as often as possible, and aim at health, not appearance.

Let all rooms be well lighted, well ventilated, moderately heated, and
sparsely furnished with necessities. Shun draperies, have no window boxes,
cut climbing plants ruthlessly away from the windows, and never obstruct
chimneys.

Buy Muller's "My System", which gives a course of physical exercises
without apparatus, which only take fifteen minutes a day. The patient must
conscientiously perform the exercises each morning, not for a week, nor for
a month, but for an indefinite period, or throughout life.

Finally, remember that so few die a natural death from senile decay because
so few live a natural life.

       *       *       *       *       *

CHAPTER XVI

SLEEPLESSNESS

  "O magic sleep! O comfortable bird
  That broodest o'er the troubled sea of the mind
  Till it is hushed and smooth."
                  --Keats.

Some men need only a few hours' sleep, but no one ever overslept himself in
natural slumber. There are anecdotes of great men taking little sleep, but
their power usually consisted in going without sleep for some days when
necessary, and making up for it in one long, deep sleep. Neuropaths require
from 10-13 hours to prepare the brain for the stress of the next day, but
quality is more important than quantity.

Patients go to bed tired, but cannot sleep; fall asleep, and wake every
other hour the night through; sleep till the small hours, and then wake, to
get no more rest that night; only fall asleep when they should be rising;
or have their slumber disturbed by nightmare, terrifying dreams, heart
palpitation, and so on.

Noise often prevents sleep. A clock that chimes the quarters, or a watch
that in the silence ticks with sledge-hammer beats, has invoked many a
malediction. Traffic and other intermittent noises are very trying, as the
victim waits for them to recur. Townsmen who seek rural quiet have got so
used to town clatter, that barking dogs, rippling streams, lowing cows,
rustling leaves, singing birds or chirruping insects keep them awake. Too
much light, eating a heavy supper, all tend to banish repose, as do also
violent emotions which produce toxins, torturing the brain and causing
gruesome nightmares.

Grief and worry--especially business and domestic cares--constipation,
indigestion, bad ventilation, stimulants, excitement and a hearty supper
are a few of the many causes of insomnia.

In children sleeplessness is often due to the bad habit of picking a child
up whenever it cries, usually from the pain of indigestion due to having
been given unsuitable food. Feed children properly, and train them to
regular retiring hours. School home-work may cause insomnia; if so, forbid
it.

Man spends a third of his life in the bedroom, which should be furnished
and used for no other purpose. Pictures, drapery above or below the bed,
and wallpaper with weird designs in glaring colours are undesirable. The
wall should be distempered a quiet green or blue tint, and the ceiling
cream. A bedroom should never be made a storeroom for odds and ends, nor is
the space beneath the bed suitable for trunks; least of all for a
soiled-linen basket.

Some time before retiring, excitement and mental work should be avoided.
The patient should take a quiet walk after supper, drink no fluid, empty
bladder and bowels, and take a hot foot-bath.

Retire and rise punctually, for the brain, like most other organs, may be
trained to definite habits with patience.

If sleeplessness be ascribed, rightly or wrongly, to an empty stomach, a
glass of hot milk and two plain biscuits should be taken in bed; dyspeptics
should take no food for three hours before retiring. If the patient wakes
in the early morning he may find a glass of milk (warmed on a spirit-stove
by the bedside) and a few plain biscuits of value.

A victim of insomnia should lie on his side on a firm bed with warm, light
coverings, open the window, close the door, and endeavour to fix his
attention on some monotonous idea; such as watching a flock of white sheep
jump a hedge. Think of trifles to avoid thinking of troubles.

How often do we hear people complain that they suffer from insomnia, when
in fact they get a reasonable amount of sleep, and indeed often keep others
awake by their snoring.

When you wake, _get up_, for a second sleep does no good. When some one, on
seeing the narrow camp-bed in which Wellington slept, said: "There is no
room to turn about in it," the Iron Duke replied: "When a man begins to
turn about in his bed it is time he turned out of it."

The only safe narcotic is a day's hard work. For severe insomnia consult a
doctor; do not take drugs--that way lies ruin. By taking narcotics, or
patent remedies containing powerful drugs, you will easily get sleep--for a
time only--and then fall a slave to the drug. Such victims may be seen in
dozens in any large asylum.

       *       *       *       *       *

CHAPTER XVII

THE EFFECTS OF IMAGINATION

  "The surest way to health, say what they will
  Is never to suppose we shall be ill;
  Most of the ailments we poor mortals know
  From doctors and imagination flow."
                  --Churchill.

      "Men may die of imagination,
      So depe may impression be take."
                  --Chaucer.

    "Suggestion is the introduction into the mind of a practical belief
    that works out its own fulfilment."--Guyau.

Man suffers from no purely imaginary ills, for mental ills are as real as
physical ills, and though an individual be ailing simply because he
persuades himself he is ailing, his mind so affects his body that he is
actually unwell physically, though the cause of his trouble is purely
mental.

The suffering of this world is out of all proportion to its actual disease,
many people being tortured by fancied ills. Some dread a certain complaint
because a relative has died of it.

Others are unwell, but while taking proper treatment they brood gloomily,
and get worse instead of better as they should and _could do_.

Cheap medical and pseudo-medical works are not an unmixed blessing, for
many a person who knows, and needs to know, nothing about disease, gets
hold of one, and soon has most of the ills known to the faculty and some
which are not.

If a patient be an optimist and persuades himself he is improving, he
_does_ improve. This is the explanation of "Faith moving mountains", for
the curative power of prayer, Christian Science, laying-on of hands,
suggestion treatment and patent medicine, depends on man's own faith, not
on the supernatural.

A doctor in whom a patient has perfect confidence, will do him far more
good with the same medicines, or even with no medicines at all, than one of
riper experience in whose skill he has no faith.

Eloquent, though often inaccurate accounts of the benefits derived from
patent medicines are persistently advertised until the mind is so
influenced by the constant reiteration of miraculous cures, that, either
because the healing forces of the body are thereby stimulated, or because
the disease is curable by suggestion, the patient is benefited by such
medicines.

Thinking of pain makes it worse and vice versa.

The curative effects of auto-suggestion were demonstrated at the Siege of
Breda in 1625. The garrison was on the point of surrender when a learned
doctor eluded the besiegers, and got in with some minute phials of an
extraordinary Eastern Elixir, one drop of which taken after each meal cured
all the ills flesh was heir to; two drops were fatal.

The "learned doctor" was a quick-witted soldier, and the elixir was
_coloured water_ sold by order of the commander. Its potency was due to the
faith of all, who persuaded each other they were getting better, and an
epidemic of infectious wellness followed ills due to depressed spirits.

One man after reading a list of symptoms said in great alarm: "Good
Heavens. I have got that disease!" and, on turning the page, found it
was... _pregnancy_.

As the great Scotch physiologist, Reid, said seventy years ago:

    "Hope and joy promote the surface circulation of the body, and the
    elimination of waste matter and thus make the body capable of
    withstanding the causes which lead to disease, and of resisting it when
    formed. Grief, anguish and despair enfeeble the circulation, diminish
    or vitiate the secretions, favour the causes which induce disease, and
    impede the action of the mechanism by which the body may get rid of its
    maladies. An army when flushed with victory and elated with hope
    maintains a comparative immunity from disease under physical privations
    and sufferings which, under the opposite circumstances of defeat and
    despair, produce the most frightful ravages."

The classic description of the woeful effects of imagination is in Jerome's
"Three Men in a Boat". Harris, having a little time on his hands, strolls
into a public library, picks up a medical work, and discovers he has every
affliction therein mentioned, save housemaid's knee. He consults a doctor
friend and is given a prescription. After an argument with an