Sir Bulwer Lytton's renderings of a homoeopath and a water-cure specialist are open to the same charge, and could only have been successful in the hands of a master.

There are at least two doctors in Balzac's novels. Rastignac, man of fashion and science, is drawn with the master's usual skill, but he is not a doctor. His art has no prominence. It is not shown how his peculiarities influenced his work, nor how his art, and its use, altered or modified the man. "The Country Doctor," by the same strong hand, is far more near my ideal of what this portraiture should be than any other known to me in French literature. The humorous aspects of a medical life in the provinces of France are nicely handled in Jules Sandeau's "Doctor Herbeau," but the study, however neat and pleasing, is slight.

Wander where you may, in the drama or the novel, you will still find, I think, that the character of the physician awaits in its interesting varieties competent portrayal.

Shakespeare has left us no finished portrait of a doctor. Moliere caricatured him. Thackeray failed to draw him, and generally in novels he is merely a man who is labelled "Doctor." The sole exception known to me is the marvellous delineation of Lydgate in "Middlemarch." He is all over the physician, his manner, his sentiments, his modes of thought, but he stands alone in fiction. How did that great mistress of her art learn all of physicians which enabled her to leave us this amazingly truthful picture? Her life gives us no clue, and when I asked her husband, George Lewes, to explain the matter, he said that he did not know, and that she knew no more of this than of how she had acquired her strangely complete knowledge of the low turf people she has drawn in the same book, and with an almost equal skill and truth to nature.

It were easy, I fancy, to point out how the doctor's life and training differ from those of all the other professions, and how this must act on peculiar individualities for the deepening of some lines and the erasure of others; but this were too elaborate a study for my present gossiping essay, and may await another day and a less lazy mood.

If any one should be curious to see what are the modifying circumstances in a physician's life which strongly tend to weaken or to reinforce character, I recommend a delightful little address, quite too brief, by Dr. Emerson, the son of the great essayist. It is unluckily out of print and difficult to obtain. If you would see in real lives what sturdy forms of personal distinctness the doctor may assume, there is no better way than to glance over some half-dozen medical biographies. Read, for instance, delightful John Brown's sketch of Sydenham and of his own father, or George Wilson's life of John Reid, the physiologist, whom community of suffering must have made dear to that gentle intelligence, and whose days ended in tragic horror such as sensational fiction may scarcely match; or, for an individuality as well defined and more pleasing, read Pichot's life of Sir Charles Bell, or one of the most remarkable of biographies, Mr. Morley's life of Jerome Cardan.

I am reminded as I write how rare are the really good medical biographies. The autobiographies are better. Ambrose Pare's sketches of his own life, which was both eventful and varied, are scattered through his treatise on surgery, and he does not gain added interest in the hands of Malgaigne. Our own Sims's book about himself is worth reading, but is too realistic for the library table, yet what a strangely valuable story it is of the struggle of genius up to eminent success. But these are the heroes of a not unheroic profession, and I had almost forgotten to set among them, as a study of character, the life of the tranquil, high-minded Jenner, the country doctor who swept the scars of smallpox from the faces of the world of men, and beside him John Hunter, his friend, impulsive, quick of temper, enthusiastic, an intensely practical man of science. These are illustrations of men of the most varied types, whose works show their characteristics, and who would, in the end, I fancy, have been very different had fate set them other tasks in life, for if the sculptor makes the statue, we may rest quite sure that the statue he makes influences the man who made it.

These, I have said, are our heroes, but I still think there remains to be written the simple, honest, dutiful story of an intelligent, thoughtful, every-day doctor, such as will pleasantly and fitly open to laymen some true conception of the life he leads, its cares, its trials, its influences on himself and others and its varied rewards. John Brown got closest to it in that sketch of his father, and in her delicately-drawn "Country Doctor" Miss Jewett has done us gentle service. But my doctor would differ somewhat in all lands, because nationality and social conventions have their influence on us as on other men, as any one may observe who compares the clergymen of the Episcopal Church in America with those of England.

The man who deals with the physician in fiction would have to consider this class of facts, for social conventions have assigned to the physician in England, at least, a very different position from that which he holds with us, where he has no social superior, and is usually in all small communities, and in some larger ones, the most eminent personage and the man of largest influence.

In the rage for novel characters the lady doctor has of late assumed her place in fiction. Lots of wives have been picked up among hospital nurses, especially since the Crimean war, and since other women than Sisters of Charity got into the business, and so made to seem probable this pleasing termination of an illness. There was a case well known to me where a young officer simulated delirium tremens in order to get near to a Sister of Charity. If ever you had seen the lady, you would not have wondered at his madness; and should any author desire to utilize this incident, let him comprehend that the order of Sisters of Charity admits of its members leaving the ranks by marriage, theirs being a secular order; so that here are the chances for a story of the freshest kind. As for the lady doctor in fiction, her advantages would be awful to contemplate in sickness, when we are weak and fevered, and absurdly grateful for a newly-beaten pillow or a morsel of ice. But imagine the awful temptation of having your heart auscultated. Let us dismiss the subject while the vision of Beranger's Ange Gardienne flits before us as De Grandville drew her.

I have not now beside me Howells's "Doctor Breen's Practice." It is a remarkable attempt to do justice to a very difficult subject, for there are two physicians to handle, male and female, not, I think, after their kind. "Doctor Zay," by Miss Phelps, makes absurd a book which is otherwise very attractive. This young woman doctor, a homoeopath, sets a young man's leg, and falls in love with him after a therapeutic courtship, in which he wooes and she prescribes.

The woman doctor is, I suspect, still available as material for the ambitious novelist, but let him beware how he deals with her.



PAIN AND ITS CONSEQUENCES.

As I look from my window, on the lawn below are girls at play,—gay, vigorous, wholesome; they laugh, they run, and are never weary. How far from them and their abounding health seem the possibilities of such torment as nature somewhere in life reserves for most of us. As women, their lives are likely, nay, certain, to bring them a variety of physical discomforts, and perhaps pain in its gravest forms. For man, pain is accidental, and depends much on the chances of life. Certainly, many men go through existence here with but little pain. With women it is incidental, and a far more probable possibility. The most healthy will have least of it. Vigor of body is its foe. Thin blood is its ally. Speaking now, not of the physiological pain, which few escape, but of the torments of neuralgia and the like, Romberg says, "Pain is the prayer of the nerves for healthy blood." As the woman is normally less full-blooded than the man, she is relatively in more danger of becoming thin-blooded than he.

Moreover, the disturbances which come from the nature of her physiological processes subject her to larger risks of lessened blood than man, and hence, for all reasons, she is more likely than he to become anaemic, and out of this to evolve pain in some shape.

If we see that our girls are not overtasked at the age of sexual evolution, that the brain is not overtrained at bitter cost of other developments as essential, we escape a part of this peril. To discuss the question here is not my intention. To secure in our artificial life what is desirable is difficult. It involves matters of dress, exercise, proportion of lessons, diet, and other matters, of which I shall yet say something, and as to which I have elsewhere said a good deal.

But no matter how careful we may be, how thoughtful as to the true needs of these young lives, we may be sure that our daughters will be more likely to have to face at some time the grim question of pain than the lads who grow up beside them.

For both there are always the little ailments of childhood,—the hurts, the accidents, and the disorders or the diseases of youthful years. All come in for a share. Let us be careful how we deal with them. I have often watched with interest a mother beside the girl or boy in temporary pain. As a rule, she assumes from the beginning that the hurt boy is to be taught silent, patient endurance. What! you, a boy, to cry! Be a man! Among his comrades he is a "cry-baby" if he whimpers, "a regular girl," "a girl-boy." He is taught early that from him endurance is expected; the self-conquest of restrained emotion is his constant lesson.

If it be a girl who suffers, she is assumed to be weak, and it is felt that for her tears are natural and not to be sternly repressed; nor are her little aches and complaints dismissed as lightly as are her brother's. She is trained to expect sympathy, and learns that to weep is her prerogative. The first gush of tears after a hurt of body or mind is in some mysterious way a relief, and not rudely to be chidden; but, on the whole, it is wise and right to teach patience and unemotional endurance to the sex which in life is sure to have the larger share of suffering. To be of use, this education must begin reasonably early, and we may leave to the mother to make sure that it is not too severe.

As a girl grows older, we ask and expect some measure of restraint in emotional expression as regards any of the physical or moral troubles which call out tears in the child; for the woman who is wise understands that unrestrained emotion and outward expressions of pain or distress are the beginnings of that loss of self-rule which leads to habitual unrestraint, and this to more and more enfeeblement of endurance, and this, again, to worse things, of which more in the future.

We are dealing now with pain. My simple practical thesis is that pain comes to all soon or late, that the indirect consequences are most to be feared, and that endurance in the adult, rational endurance, must be won by a gradual education, which can hardly begin too early. But of what use are these stern lessonings in the bearing of what none can quite escape? Do they enable us to diminish pain or to feel it less? Indirectly, yes. One woman cries out for instant easement if in pain or distress, unschooled to endure. She claims immediate relief. Another, more resolute, submits with patience, does not give way, as we put it, tries to distract her attention, knowing that even as distinct suffering as toothache may be less felt in the presence of something which interests the mind and secures the attention. Nothing, indeed, is more instructive than to watch how women bear pain,—the tremendous calamity it is to one, the far slighter thing in life it is to another. I speak now of transient torments. When we come to consider those years of torture which cruel nature holds in store for some, no one blames the sight of the moral wreck it is apt to make of the sufferer. On the other hand, there is nothing I ever see in my profession so splendid as the way in which a few, a rare few, triumph over pain, which we know must often rise to the grade of anguish, and from which scarce a day is ever free.

I recall well one woman who for years, under my eyes, was the subject of what, with due sense of the force of the word, I call torture. At times she shut herself up in her room, and, as she said, "wrestled with it." This happened every day or two for an hour or more. The rest of the time she was out, or busy with her duties, but always in some pain. Meanwhile, although failing slowly, she was the life and joy of many, the true and gentle counsellor, the sure support of all who leaned on her for aid. At her dinner-table, in chat with friends, or over a book, no one who did not know her well could have dreamed that she was in such pain as consigns lower natures to disability. Her safeguard from utter wreck was a clear and resolute faith, a profound and unfailing interest in men and things and books, which gave strange vigor to her whole range of intellectual activities. But above all she possessed that happiest of gifts, the keen, undying sense of the humorous, the absurd, the witty. As she once said, "All life laughs for me." It followed her to death, as it has certain others as noble. When dying, she said some gay thing which disturbed a dear friend. The sufferer, well knowing her own state, looked up. "I must laugh, dear," she said; "I would not feel that the other world was the good place I think it if I did not believe I could laugh there too." She once said to me, in the midst of a storm of acute suffering, that pain seemed to her a strange sort of a joke. I hardly knew what she meant, but it shows the reigning mood of one who used to better ends a life half pain than most of us use the untroubled health of existence. Very irritable in youth, her clear brain and strong sense of duty overcame it in proportion to the growth of what in others creates it. All opiates she disliked, and could rarely be induced to take them. "If my mind gets weaker, I shall go to pieces——;" and, laughing always, "the bits would be worthless as the scattered bricks of a sound house." Surely such a life is a fruitful lesson in the uses of endurance, for be sure that both she and all around her were the better and happier, yes, and she the less a sufferer, for her mode of dealing with a life of pain.

The illustration I have given saves me from dwelling at great length on the values of all the means within a woman's control for lessening the evil consequences of suffering, and if to few is given the largest moral and mental outfit for such a struggle, none are without the power to cultivate what they have, and, in the lesser ills of life, to make use of the lesson we may hope and know few will be called on to apply to an existence such as hers.

Pain of body, hurt of mind, all the sad gamut from discomfort to anguish, depend for their influence on her life upon how nature and training enable the woman to meet them.

To endure without excess of emotion saves her from consequent nervousness, and from that feebleness of mind and body which craves at all cost instant relief. It is the spoiled child, untaught to endure, who becomes the self-pampered woman. Endurance of pain has also its side-values, and is the handmaid of courage and of a large range of duties. Tranquil endurance enables the sufferer to seek and to use all the means of distraction which this woman I have described did use. It leaves the mind free, as it never can be otherwise in the storm of unrestraint, to reason on her troubles, and to decide whether or not her pain justifies the use of drugs, for on her the physician must measurably rely for this knowledge, and as she is morally strong or weak the decision will be.

There are those, indeed, who suffer and grow strong; there are those who suffer and grow weak.

This mystery of pain is still for me the saddest of earth's disabilities. After all is said that can be said on its values as a safeguard, an indicator of the locality of disease, after the moralist has considered it from the disciplinary view, and the theologian cracked his teeth on this bitter nut, and the evolutionist accounted for its existence, it comes at last to the doctor to say what shall be done with it. I wish it came to him alone. Civilized man has ceased to torture, but nature, relentless still, has in store possibilities of utmost anguish, which seem to fall alike on the guilty and the innocent, the poor and the rich, and in largest proportion on the gentler sex. But while pain is still here with its ever-ready presence, the direct means of lessening it have multiplied so that hardly a month goes by without some new method being added of destroying for a time the power to suffer. For, bear in mind that it is not usually the cause which can be at once destroyed by drugs, but only the bodily capacity to react to it in the fashion we call pain. Ether, chloroform, cocaine, and many other drugs enable us to-day to feel sure that the mass of real pain in the world is vastly less than it was. It is, indeed, possible to prevent all pain, and pain has no real value which we need respect and desire to preserve; at least this is so from the physician's stand-point.

The temptation which comes to us out of the accumulation of anaesthetic agents is one which every tender-hearted man can understand. The temptations which it presents to the suffering they only know who have suffered. To this all that I have said leads up. To most women, even to strong women, there comes a time when pain is a grim presence in their lives. If brief, the wise physician calls upon them for that endurance, of the value of which I have spoken. On some he calls in vain. Even if it recur at intervals, as in the shape of neuralgic headaches, in the name of reason let him be the sole judge of your need to be relieved by drugs. He well knows, as you cannot know, that the frequent use of morphia seems in the end to increase, not to lessen, the whole amount of probable future pain, and that what eases for a time is a devil in angelic disguise. If you are urgent, weak of will, unable through unrestraint to comprehend him, the fault will be only half his, if you plead too eagerly for help and too constantly claim the relief he holds.

But suppose that the woman I address is a long and true sufferer, and that the physician desires to use such help often, then comes her time of peril and his day of largest responsibility. If he be weak, or too tender, or too prone to escape trouble by the easy help of some pain-lulling agent, she is soon on the evil path of the opium, chloral, or chloroform habit. Nor is prevention easy. With constant or inconstant suffering comes weakness of mind as well as body, and none but the strongest natures pass through this ordeal of character unhurt. If the woman be unenduring and unthoughtful, if the doctor fail to command her faith, and be too sympathetic, at last she gets possession herself of the drug, or the drug and the hypodermatic needle. Then there is before her one of the saddest of the many downward paths which lead to destruction of body and soul.

More often, in my experience, the opium habit is learned during an illness of limited duration, and for the consequences of which there is always some one to be blamed.

As I remember these patients, and I have seen them by the score, far on in their evil ways, such women are most often those who lack the power, even in health, to endure pain. Some defect of training or of nature has made pain, or even distress or insomnia, ills to be relieved at once regardless of cost. Let them but feel that relief for the time is possible, and self-restraint is over. They will have the thing they crave. You cure them of the vile opium habit at awful cost of suffering, and they relapse on the first new trial of endurance, and men of their type more surely than women.

I see a good many cases of opium, morphia, or chloral habit, and I am sure that these forms of intoxication are becoming more prevalent than they were a generation ago. Is this due to an increase in the disorders which are eased by such drugs? Is it not rather due to the softening influence of luxury, and the fact that we are all being constantly trained to feel that it is both easy and our right to escape pain, however brief?

I am sure, too, that a part of it lies in the readiness with which many physicians give sedatives, and their failure to feel the vast moral responsibilities of their position. But, whatever be the cause or causes, it is well in the hour of ease to learn beforehand the risks which come of too easy and too frequent appeals to agents which benumb the nerves.

When people are first given opium, it is apt to be the friend of the night and the foe of the morrow. Repeated often enough, it loses power to constipate and distress. It still soothes pain. It still gives sleep. At last it seems to be in a measure a tonic for those who take it. But after a while it does some other things less agreeable. The mind and memory suffer, but far more surely the moral nature is altered. The woman becomes indifferent, her affections dull, her sense of duty hopelessly weakened. Watchful, cunning, suspicious, deceitful,—a thief, if need be, to get the valued opiate,—she stops at nothing. It would seem as if it were a drug which directly affected the conscience. At last, before this one craving, all ties in life are slight and bind her not. Insensible to shame and dead to affection, she is happy if the alcohol habit be not added to her disorder, for if she cannot get the one drug she longs for, the other will serve her at need.

There is a popular idea that opium gives pleasant dreams, and that it takes us away into the land of poetry, to which it is supposed to have conducted Coleridge and De Quincey. As a matter of fact, there are but few persons who get more out of opium than relief of pain, sense of comfort, and next day's remorses. The opium dream is not for all. I have known only four or five cases of habitual and distinct opium dreamers. There was more of Coleridge than of opium in "Kubla Khan," and more of De Quincey than of the juice of poppies in the "Vision of Sudden Death." When it came to the telling of these immortal dreams, we may well suspect that the narrative gained in the literary appeal from the poet opium-drunk to the poet sober.

It is, I fancy, well known to physicians that opium may act on an individual differently at different times. In the case of one well known to me it usually causes sleep, and no longer gives rise to nausea the next day, as it once did. Although it leaves him sufficiently wretched, and he has taken it but rarely, the drug occasionally keeps him wide awake and delightfully indifferent to the passage of time. The striking hours are heard, and that is all. There is none of the ennui of insomnia. This effect of morphia is rare with him. He may have taken morphia a dozen times in his life to ease acute pain, but only twice has it made him thus wakeful. On these nights he saw an endless succession of visions, which he did not forget, as one does common dreams. Nearly all of the hallucinations were of the most amusing character, and were often long and connected series of ludicrous situations, over which he wondered, as he lay next day, a victim to the secondary miseries due to the soothing dose of the night before. This is one of the tricks which drugs play, and is not a thing to be anticipated. The drug is the same; the man varies, and with his variations arise peculiarities in the effects of remedies.

The excess sometimes attained in the use of opiates is almost past belief. I have seen a mere girl of seventeen years take at one dose thirty grains of morphia, and I know of a woman who took for years ninety grains a day, and ruined a weak husband, a man of small means, by the costliness of her habit.

The causes of the torment, which the cessation of the use of morphia brings about, are interesting. Agonizing pains show that the nerves, long muffled, have become more acutely sensitive than they were before the fatal drug was first employed. A host of lesser troubles—insomnia, pain, and indigestion—attend the cure. I know nothing more pitiful than such an ordeal, and, despite the most watchful care, I have seen it end more than once in suicide. When one has watched a woman from whom opium has been taken away, even with skilful tenderness, roll in agony on the floor, rend her garments, tear out her hair, or pass into a state of hysterical mania, the physician is made to feel that no suffering for which she took the drug can have been as bad as the results to which it leads. The capacity to suffer, which comes on as we remove the poison, is almost inconceivable. It lasts long, and is the true difficulty in the way of forming anew habits of wholesome endurance. The physician who imagines that his case is well, because he has enabled an opium-taker to eat, sleep, and be comfortable without use of the sedative, can have seen little of the future of such people. The oversensitiveness to pain persists for months, and is a constant temptation. The moral and mental habits formed under opium—the irresolution, the recklessness, the want of shame, in a word, the general failure of all that is womanly—need something more than time to cure. But I am not preaching to the woman just set free from this bondage to sin, and speak of her only to emphasize the horror with which I would wish to inspire the well, who yet may come some day to be the suffering.

If there be one set of women more liable than another to become victims of morphia or chloral, it is the wives of physicians. Every winter I see four or five, and always it is true that the habit has arisen out of the effort of the husband to attend medically on his wife. Physicians make good husbands, and this is in part due to the fact that their knowledge of the difficulties of feminine life causes them to be more thoughtfully tender, and more charitable as concerns the effects upon women of certain inevitable conditions as to which the layman is ignorant or indifferent. But the very fulness of the husband's appreciation of a woman's drawbacks and little moral ailments, the outcome of her womanhood, becomes dangerous when he ventures to be her medical caretaker. What he coolly decides in another's case, he cannot in hers. How can he see her suffer and not give her of the abundance of relief in his hands? She is quick to know and to profit by this, and so the worst comes of it.

"It is easy for you to sit by in your strength and see me suffer," said a woman once to me. She was on the verge of the morphia habit, and I was trying to break it off abruptly. I felt, as any gentle-hearted man must feel, the sting and hurt of her words. Next day she said to me, "Of course you were right. I used to talk that way to B——, and he never could stand it." He was her husband and a physician. She got well easily.

I do not believe that most women who sin in this way slip into it either quite so ignorantly and so unwarned as they would have you to suppose. Nearly always there is a time when some one—the physician, a friend, or their own reason—bids them pause, reflect, and choose.

"Alas I for thee, if thou from thine own soul dost turn and flee. Better the house and company of pain; Better distress; Better the stones of strife, the bread with tears; Humiliation and despair and fears; All, all the heart can suffer, the soul know, Rather than with the bestial train to go, With base rejoicings, ignorant of woe."[3]

[Footnote 3: "Sylvian, and Other Poems," by Philip Varley.]



THE MORAL MANAGEMENT OF SICK OR INVALID CHILDREN.

Not long ago a pretty little girl of ten was brought to me from a long distance to get my advice as to a slight paralysis of one leg. The trouble had existed for several years. I soon saw that the child was irritable, sensitive, and positive, and I was, therefore, careful to approach her gently. The moment it was proposed to show me the leg, she broke into a fury of rage, and no inducement I could offer enabled me to effect my purpose. An appeal to the parents, and from them to force, ended in a distressing battle. She bit, scratched, kicked, and at last won a victory, and was left sullen and sobbing on the floor. Next day the same scene was repeated. It is true that at length they were able to undress her, but neither threats nor persuasion would keep her quiet long enough to enable me to apply the simplest tests. The case was obscure, and demanded the most careful study. Their time was limited, so that at length they were obliged to take her home in despair, without any guiding opinion from me, and with no advice, except as to her moral education, concerning which I was sufficiently explicit. I have seen many such illustrations of a common evil, and have watched the growth to adult life of some of these cases of wrecked character, and observed the unpleasant results which came as they grew older. I have used an extreme case as a text, because I desire to fix attention on the error which parents and some doctors are apt to commit in cases of chronic ailments in children.

As to the miserable sufferers who pass through long illness to death I have little to say. We naturally yield to their whims, pet and indulge them, moved by pitiful desire to give them all they want of the little which life affords them. In acute illness, with long convalescence, I am pretty sure that the tender mother does no real good by over-indulgence; but the subject is difficult, and hard to handle with justice and charity without calling down upon me the indignation of the unthoughtful. It is so easy and pleasant to yield to the caprices of those we love, when they are in pain or helpless from illness,—so doubly hard at such times to say no. Yet, if in the case of a long convalescence, such as follows, perhaps, a typhoid or scarlet fever, we balance for the little one the too-easily yielded joy of to-day against the inevitable stringency of discipline, which, with recovered health, must teach the then doubly difficult lesson of self-restraint, we shall see, I think, that, on the whole, we do not add to the sum of happiness to which the child is entitled.

The mother at the sick-bed of her young child is, however, a being quite often as difficult to manage as her child. All her instinctive maternity is up in arms. Deep in the heart of many mothers there is an unconfessed and half-smothered sense of wrath at the attack which sickness has made on her dear one. Then nothing is too much to give; no sacrifice of herself or others too great to grant or demand. The irritability and feebleness of convalescence makes claims upon her love of self-sacrifice, and her prodigality of tenderness as positive and yet more baneful. That in most cases she may and does go too far, and loses for her child what it is hard to recover in health, is a thing likely enough, yet to talk to her at such times of the wrong she does the child is almost to insult her. Nevertheless the unwisdom of a course of reckless yielding to all a child's whims is plain enough, for if the little one be long ill or weak, it learns with sad swiftness to exact more and more, and to yield less and less, so that it becomes increasingly hard to do for it the many little unpleasant things which sickness demands. Character comes strongly out in the maladies of the child, as it does even less distinctly in the sickness of the adult. The spoiled, over-indulged child is a doubly unmanageable invalid, and when in illness the foolish petting of the mother continues, the doctor, at least, is to be pitied.

The ductility of childhood has its dangerous side. This is seen very well in cases which, fortunately, are rather rare, and, for some reason, are less frequent in girls than in boys. These little ones observe sharply the faces and obvious motives of those about their sick-beds, and more readily than adults are led to humor the doubts they hear expressed by the doctor or their elders as to their capacity to do this or that. Too frequent queries as to their feelings are perilously suggestive, and out of it all arises, in children of nervous or imaginative temperaments, an inexplicable tendency to fulfil the predictions they have heard, or actively to humor the ideas they acquire as to their own ailments and disabilities.

There is something profoundly human in this. With careless, unthoughtful people, who have trained a child to know that illness means absolute indulgence, and who pour out unguardedly their own fears and expectations at the bedside, the result for the child is in some cases past belief. The little one gets worse and worse. It accepts automatically the situation, with all the bribes to do so made larger by feebleness, and at last gains that extreme belief in its own inability to rise or move about which absolute convictions of this nature impose on child or man.

There is a further and worse stage possible. The child's claims increase. Its complaints gather force, and alarm those about it. Gratified in all its whims, it develops perverted tastes, or refuses all food but what it fancies. At last it becomes violent if opposed, and rules at will a scared circle of over-affectionate relatives. When all else fails, it exaggerates or invents symptoms, and so goes on, until some resolute physician sees the truth and opens the eyes of an amazed family.

Certain physicians explain these cases as due to hysteria, and in a small number of instances there are signs which justify such an explanation. But in the larger proportion the mode of origin is complex, and depends on the coincidence of a variety of evils, none of which are of hysterical character. I am not here concerned so much with the exact nature of these troubles as I am with the avoidable errors in the management of sick childhood. If I can make the mother more thoughtfully alert, less disposed to terror and exaggeration, less liable to be led by her emotions, I shall have fulfilled my purpose without such discussion as is out of place in essays like these.

To make clear, however, the possibility of the disasters I have briefly described, an illustration may answer better than any length of generalized statements. A little fellow of nine once came under my care, and was said to have inflammation of the coverings of the brain. There was a long story, which I may sum up in a few sentences. An only child; feeble in youth; indulgence to almost any degree; at the age of eight, a fall, not at all grave, but followed by some days of headache; long rest in bed, by order of a physician; much pity; many questions; half-whispered, anxious discussions at the bedside; yet more excessive indulgence, because every denial seemed to increase or cause headache. At last the slightest annoyance became cause for tears, and finally for blame, all of which a gentle, fearful mother bore as if it were part of the natural trials of disease. It took but a few months of complete non-restraint to make of a shrewd, bright, half-educated, spoiled boy a little brute, as to whose sanity there seemed to be some doubt. He was easily made well, and has lived to thank the sternness which won back the health of mind and body his parents had so foolishly helped to lose for him.

A single example may suffice, nor have I any fear that it may lead any one, least of all nature's gentlest creation, a mother, to be more severe than is reasonable. She it is who is really most responsible. She is ever beside the child when the little actor is off guard. She may have the cleverness to see through the deceit or she may not. The physician comes and goes, and must take for granted much that he has no chance to see, and for which he has to trust the more constant attendant. Moreover, the rarity of these cases is apt to help to deceive him quite as much as does the mother's affectionate trust. Nevertheless, it is his fault if soon or late he fail to see the truth; but he may well be careful how he states his doubt. The mother at the sick-bed but too often resents as a wrong any hint at the true state of the case.

Children are singularly imitative, and more or less prone to suffer from this tendency. Hence the curious cases in which a child simulates, I do not say dissimulates, the malady it sees constantly before it, as when one child has attacks of false epilepsy, owing to having seen the real attack in a sister or brother, or when St. Vitus's dance runs through a school or an asylum.

To sum up, we credit these little ones with a simplicity of moral organization which forbids us to believe that the causes which are active for mischief in their elders are not as potent for evil in them. The popular and reasonable creed of moral education, which teaches us to ask from a well child self-control, self-restraint, truth of statement, reasonable endurance of the unavoidable, good temper, is not too lightly or too entirely to be laid aside when sickness softens the rule of health and all our hearts go out in pity to the little sufferer.

Certain of the nervous and other maladies of children sometimes keep them a long while under treatments which are annoying, painful, or disabling. They often end by leaving them as strong as their fellows, but crippled, lame, disfigured, or with troubles that attract remark, or, at least, notice. Thus, a child may have hip-disease, and, after years of treatment, get well, and although vigorous enough to do all that is required in life, be more or less lame. In another case, there is disease of the bones of the spine. After a wearying treatment, it is well, but the little one has a distorted spine,—is humpbacked. Again, we have the common malady, palsy of childhood, and here, too, most probably, there is left a residue of disability, or, at all events, some loss of power.

In each case there are years of troublesome treatment, all sorts of unpleasant limitations, pain it may be, and certainly, at the best, a variety of discomforts. The joy and little pleasures of youth are gone. It makes one sorrowful to think of such cases, even when all that competent means can do to help them is at their disposal, and still more to reflect on those who have to battle for health with no more resource than is left to the needy. What shall we not do for them! The woman's whole tendency is to give them all of herself and all else that she can control. Indulgence becomes inevitable, or seems to become so, and the mother is rare who does not insist that they shall have what they desire, and that her other children shall yield to them in all things. Her answer to herself and others is, "They have so little; let them at least have what they can." As rare as the reasonable mother is the sick child who can stand this treatment and survive with those traits of character which it above all others requires to make its crippled life happy, not to say useful. The child thus unrestrained and foolishly indulged must needs become ill-tempered. It loses self-control, and yet no one will need it more. It learns to expect no disappointments, and life is to hold for it less than for others. Disease has crippled its body and the mother has crippled its character.

I have no belief that long illness is good for the mass of people, but the character of the adult sufferer is in his or her own hands to make, mar, or mend. In childhood the mother is in large measure responsible for the ductile being in her care. If she believes that unrestraint is her duty, she is laying up for the invalid a retribution which soon or late will bitterly visit on the child the sin or, if you like, the mistakes of the parent. It is her business and duty, no matter how hard may be to her the trial, to see that this child, above all others, shall be taught patience, gentleness, good temper, and self-control in all its varieties, nor should she fail to point out, as health returns and years go by, that it is not all of life to be straight and uncrippled. I need not dwell on this. Every wise woman will understand me, and be able to put in practice better than I can here state what I might more fully say.

I do not wish, however, to be understood as urging that all children long ill or crippled grow to be unamiable and spoiled. I do not quite know why it is, but, after all, children are less apt to suffer morally from long illness than adults, and very often, despite careless or thoughtless usage, these young sufferers come out as wholesome in mind and heart as if they had known no trial, or, perhaps, because of it. It is in a measure a matter of original temperament. In other words, what the sick child was as to character modified results, and this is especially true as concerns the peculiarities which attract unpleasant notice. One person who has twitching of the muscles of the face is made miserable by the attention it invites; another is indifferent.

The cases of Lord Byron and Walter Scott are to the point. The former was sensitive and morbid about his deformity. I cannot help thinking that had his mother been other than she was, he would have been brought up to more wholesome views as to what was after all no very great calamity. Walter Scott suffered from a like trouble, but healthy moral surroundings and a cheerful nature saved him from the consequences which fell so heavily upon his brother poet.

Epilepsy is a malady but too common in childhood, and as to which a few words apart are needed. Usually a child epileptic for some years will carry the disease with it for a time, the length of which no man can set. The disease may be such as to ruin mind and body, or the attacks may be rare, and not prevent courageous and resolute natures from leading useful lives. All intermediate degrees are possible. As a rule, no children need so inflexible a discipline as epileptics. Indulgence as regards them is only another name for ruin. Do as we may, they are apt to become morally perverted, and require the utmost firmness, and the most matured and educated intelligence, to train them wisely. Difficult epileptics and most idiots are best looked after, and certainly happiest, in some one of the competent training-schools for feeble-minded children.

Even the milder epileptic cases are hard to manage. I rarely see one which has been intelligently dealt with. Few mothers are able or willing to use a rule as stern, as enduring, as unyielding as they require.

As to education, I am satisfied that these children are the better for it, and yet almost invariably I find that in the cases referred to me some physician has, with too little thought, recommended entire abandonment or avoidance of mental training. I have neither space nor desire to go into my reasons for a different belief. I am, however, sure that education limited as to time, education of mind, and especially of the hands, has for these cases distinct utility, while to them also, as to the other children crippled in mind or body, all that I have already urged applies with equal force.

As to the management of sick or crippled childhood, I have said far more than I had at first meant to say, and chiefly because I have been made to feel, as I thought the matter over, how far more difficult it is in practice than in theory. But this applies to all moral lessons, and the moralist must be credited by the thoughtful mother with a full perception of the embarrassments which lie in her path.



NERVOUSNESS AND ITS INFLUENCE ON CHARACTER.

There are two questions often put to me which I desire to use as texts for the brief essay or advice of which nervousness[4] is the heading. As concerns this matter, I shall here deal with women alone, and with women as I see and know them. I have elsewhere written at some length as to nervousness in the male, for he, too, in a minor degree, and less frequently, may become the victim of this form of disability.

[Footnote 4: Neither nerves nor nervousness are words to be found in the Bible or Shakespeare. The latter uses the word nerve at least seven times in the sense of sinewy. Nervy, which is obsolete, he employs as full of nerves, sinewy, strong. It is still heard in America, but I am sure would be classed as slang. Writers, of course, still employ nerve and nervous in the old sense, as a nervous style. Bailey's dictionary, 1734, has nervous,—sinewy, strongly made. Robt. Whytte, Edin., in the preface to his work on certain maladies, 1765, says, "Of late these have also got the name of nervous," and this is the earliest use of the word in the modern meaning I have found. Richardson has it in both its modern meanings, "vigorous," or "sensitive in nerves, and consequently weak, diseased." Hysteria is not in the Bible, and is found once in Shakespeare; as, "Hysterica passio, down," Lear ii. 4. It was common in Sydenham's day,—i.e., Charles II. and Cromwell's time,—but he classified under hysteria many disorders no longer considered as of this nature.]

So much has been written on this subject by myself and others, that I should hesitate to treat it anew from a mere didactic point of view. But, perhaps, if I can bring home to the sufferer some more individualized advice, if I can speak here in a friendly and familiar way, I may be of more service than if I were to repeat, even in the fullest manner, all that is to be said or has been said of nervousness from a scientific point of view.

The two questions referred to above are these: The woman who consults you says, "I am nervous. I did not use to be. What can I do to overcome it?" Once well again, she asks you,—and the query is common enough from the thoughtful,—"What can I do to keep my girls from being nervous?"

Observe, now, that this woman has other distresses, in the way of aches and feebleness. The prominent thing in her mind, nervousness, is but one of the symptomatic results of her condition. She feels that to be the greatest evil, and that it is which she puts forward. What does she mean by nervousness, and what does it do with her which makes it so unpleasant? Remark also that this is not one of the feebler sisters who accept this ill as a natural result, and who condone for themselves the moral and social consequences as things over which they have little or no reasonable control. The person who asks this fertile question has once been well, and resents as unnatural the weaknesses and incapacities which now she feels. She wants to be helped, and will help you to help her. You have an active ally, not a passive fool who, too, desires to be made well, but can give you no potent aid. There are many kinds of fool, from the mindless fool to the fiend-fool, but for the most entire capacity to make a household wretched there is no more complete human receipt than a silly woman who is to a high degree nervous and feeble, and who craves pity and likes power. But to go back to the more helpful case. If you are wise, you ask what she means by nervousness. You soon learn that she suffers in one of two, or probably in both of two, ways. The parentage is always mental in a large sense, the results either mental or physical or both. She has become doubtful and fearful, where formerly she was ready-minded and courageous. Once decisive, she is now indecisive. When well, unemotional, she is now too readily disturbed by a sad tale or a startling newspaper-paragraph. A telegram alarms her; even an unopened letter makes her hesitate and conjure up dreams of disaster. Very likely she is irritable and recognizes the unreasonableness of her temper. Her daily tasks distress her sorely. She can no longer sit still and sew or read. Conversation no longer interests, or it even troubles her. Noises, especially sudden noises, startle her, and the cries and laughter of children have become distresses of which she is ashamed, and of which she complains or not, as her nature is weak or enduring. Perhaps, too, she is so restless as to want to be in constant motion, but that seems to tire her as it once did not. Her sense of moral proportion becomes impaired. Trifles grow large to her; the grasshopper is a burden. With all this, and in a measure out of all this, come certain bodily disabilities. The telegram or any cause of emotion sets her to shaking. She cries for no cause; the least alarm makes her hand shake, and even her writing, if she should chance to become the subject of observation when at the desk, betrays her state of tremor. What caused all this trouble? What made her, as she says, good for nothing? I have, of course, put an extreme case. We may, as a rule, be pretty sure, as to this condition, that the woman has had some sudden shock, some severe domestic trial, some long strain, or that it is the outcome of acute illness or of one of the forms of chronic disturbance of nutrition which result in what we now call general neurasthenia or nervous weakness,—a condition which has a most varied parentage. With the ultimate medical causation of these disorderly states of body I do not mean to concern myself here, except to add also that the great physiological revolutions of a woman's life are often responsible for the physical failures which create nervousness.

If she is at the worst she becomes a ready victim of hysteria. The emotions so easily called into activity give rise to tears. Too weak for wholesome restraint, she yields. The little convulsive act we call crying brings uncontrollable, or what seems to her to be uncontrollable, twitching of the face. The jaw and hands get rigid, and she has a hysterical convulsion, and is on the way to worse perils. The intelligent despotism of self-control is at an end, and every new attack upon its normal prerogatives leaves her less and less able to resist.

Let us return to the causes of this sad condition. It is a common mistake to suppose that the well and strong are not liable to onsets which cause nervousness. As a rule, they rarely suffer; but we are neatly ballasted, and some well people are nearer to the chance of being so overturned than it is pleasant to believe. Thus it is that what for lack of a better name we call "shock" is at times and in some people capable of inflicting very lasting evil in the way of nervousness.

We see this illustrated in war in the effects of even slight injuries on certain people. I have known a trivial wound to make a brave man suddenly timid and tremulous for months, or to disorder remote organs and functions in a fashion hard to understand. In the same way, a moral wound for which we are not prepared may bring about abrupt and prolonged consequences, from which the most robust health does not always protect us; and which is in proportion disastrous if the person on whom it falls is by temperament excitable or nervous. I have over and over seen such shocks cause lasting nervousness. I knew a stout young clerk who was made tremulous, cowardly, sleepless, and, in the end, feeble, from having at a funeral fallen by mishap into an open grave. I have seen a strong woman made exquisitely nervous owing to the fall of a wall which did her no material damage. Earthquakes cause many such cases, and bad ones, as we have had of late sad occasion to know. The sudden news of calamity, as of a death or financial disaster, has in my experience made vigorous people nervous for months. A friend of mine once received a telegram which rather brutally announced the disgrace of one dear to him. He had a sense of explosion in his head, and for weeks was in a state of nervousness from which he but slowly recovered. There is something in cases like his to think about. The least preparation would have saved him, and we may be sure that there is wisdom in the popular idea that ill news should be gently and guardedly broken to such as must bear it. To be forewarned is to be forearmed we say with true wisdom.

Prolonged strain of mind and body, or of both, is another cause apt to result in health failures and in nervousness as one attendant evil. The worst one I know is to nurse some person through a long disease. Women are apt to think that no one can so well care for their sick as they. Intrusion on this duty is resented as a wrong done to their sense of right. The friend who would help is thrust aside. The trained nurse excites jealous indignation. The volunteer gives herself soul and body to the hardest of tasks, and is rather proud of the folly of self-sacrifice. How often do we hear a woman say with pride, "I have not slept nor had my clothes off for a week." She does not see that her very affection unfits her for the calm control of the sick-room, and that her inevitable anxiety is incompatible with tranquil judgment. If you tell her that nursing is a profession, and that the amateur can never truly fill the place of the regular, she smiles proudly, and thinks that affection is capable of all things, and that what may be lost in skill will be made up in thoroughness and compensated by watchfulness, such as she believes fondly only love can command. It is hard to convince such a woman.

It rarely chances that women are called upon to suffer in their common lives emotional strains through very long periods, and at the same time to sustain an excess of mental and physical labor. In days of financial trouble this combination is sometimes fatal to the health of the strongest men. When a loving relative undertakes to nurse one dear to her through a protracted illness, she subjects herself to just such conditions of peril as fall upon the man staggering under financial adversity.

The analogy to which I have referred is curiously complete. In both there is the combination of anxiety with physical and mental overwork, and in both alike the hurtfulness of the trial is masked by the excitement which furnishes for a while the means of waging unequal battle, and prevents the sufferer from knowing or feeling the extent of the too constant effort he or she is making. This is one of the evils of all work done under excessive moral stimulus, and when the excitation comes from the emotions the expenditure of nerve-force becomes doubly dangerous, because in this case not only is the governing power taken away from the group of faculties which make up what we call common sense, but also because in women overtaxing the emotional centres is apt to result in the development of some form of breakdown, and in the secondary production of nervousness or hysteria.

If she cannot afford a nurse, or will not, let her at least share her duties with some one. Above all, let her know that every competent doctor watches even the best of his trained nurses, and insists that they shall be in the open air daily. Your good wife or mother thinks in her heart that when she has sickness at home she should not be seen out of doors, and that to eat, sleep, or care for herself is then wicked or something like that.

If you can make a woman change her dress, eat often, bathe as usual, and take the air, even if it must be so at night, she can stand a great deal, especially if you insist that she shall sleep her usual length of time. If she will not listen or obey, she runs a large risk, and is very apt to collapse as the patient recovers, and to furnish her family with a new case of illness, and the doctor and herself with some variety of disorder of mind or body arising out of this terrible strain on both.

If physical tire, without chance for rest, with anxiety and incessant vigilance, is thus apt to cause wrecks in the nurse of ordinary illness, far more apt is it to involve breakdowns when a loving mother or sister endeavors to care for a protracted case of insanity. Unless the man of the house interferes, this effort is sure to bring disaster. And the more sensitive, imaginative, and loving is the self-appointed nurse, the more certain is she to suffer. There are no cases in which it is so hard to advise, none in which it is so difficult to get people to follow your advice. The morbid view of insanity, the vague sense of its being a stain, the horror of the hospital, all combine to perplex and trouble us. Yet here, if at any time, it is wise to cast the whole weight on the physician and to abide by his decision.

Families see this peril, and can be often made to understand the unwisdom of this sacrifice; but, in cases of prolonged disease, such as hysteria in a bedridden sister or mother, it is hard to make them hear reason, and still more hard to make the nursing relation understand that she is of necessity the worst of nurses, and may share the wreck she helps to make.

These old and happily rare cases of chronic nervous invalids are simply fatal to loving nurses. I have said, perhaps too often, that invalidism is for most of us a moral poison. Given a nervous, hysterical, feeble woman, shut out from the world, and if she does not in time become irritable, exacting, hungry for sympathy and petty power, she is one of nature's noblest. A mother or sister gives herself up to caring for her. She is in the grip of an octopus. Every fine quality of her nature helps to hurt her, and at last she breaks down utterly and can do no more. She, too, is become nervous, unhappy, and feeble. Then every one wonders that nobody had the sense to see what was going on. I can count many examples of nervousness which have arisen in this fashion. Perhaps my warning may not be without good results. Over and over I have made like statements in one or another form, and the increasing experience of added years only contributes force to my belief that, in still urging the matter, I am doing a serious duty. I ought to say also that the care of these invalids is, even to the well-trained and thoughtful nurse, one of the most severe of moral and physical trials, and that, in the effort to satisfy the cravings of these sick people, I have seen the best nurses crumble as it were in health, and at last give up, worn out and disheartened. A part of the responsibility of such disasters falls on the physician who forgets that it should be a portion of his duty to look sharply after the health of too devoted nurses as well as that of selfish patients.

I have now said all that I need to say of the causes which, directly or indirectly, evoke the condition we call nervousness. Many of these are insidious in their growth. Too often the husband, if she be married, is immersed in his own cares, and fails to see what is going on. "I am not ill enough to see a doctor," she says, and waits until she has needlessly increased the difficulties of his task. Let us suppose, however, that, soon or late, she is doing, in a merely medical way, all that he insists upon, what more can she do for herself? She has before her very likely a long trial, severe in its exactions in proportion to her previous activity of mind and body. She most probably needs rest, and now that physicians have learned its value, and that not all ills are curable by exertion, she is told to lie down some hours each day. If she cannot get rid of her home duties, let her try at least to secure to herself despotically her times of real and true rest. To lie down is not enough. What she needs is undisturbed repose, and not to have to expect every few minutes to hear at her door the knocks and voices of servants or children. It is difficult to secure these most needful times of silent security even in health, as most women too well know. Very often the after-meal hours are the most available and the more desirable as times of repose, because in the weak digestion goes on better when they are at rest. She will find, too, that some light food between meals and at bedtime is useful, but this is within the doctor's province, and I am either desirous to avoid that or to merely help him. Air, too, she wants rather than any such great exertion as wearies; and, as regards this latter, let her understand that letter-writing, of which many women are fond, must be altogether set aside.

It is, however, the moral aspects of life which will trouble her most. The cares which once were easily shaken off stick to her like burrs, and she carries them to bed with her. I have heard women say that men little know the moral value to women of sewing. It becomes difficult when people are nervous, but this or some other light handiwork is then invaluable.

By this time she has learned that her minor, every-day duties trouble her, and when about to meet them, if wise, she will put herself, as we all can do, in an attitude of calmness. This applies still more forcibly to the larger decisions she must so often have to make as to children, house, and servants. Worry, as I have elsewhere said, is as sand in the mental and moral machinery, and easily becomes a mischievous habit. We can stand an immense deal of work, and can, even if weak, bear much, if only we learn to dismiss small questions without worry or unreasonable reconsiderations. As concerns temper, we constantly prepare ourselves to meet even just causes of anger, and thus by degrees learn more and more easily, and with less and less preparation, to encounter tranquilly even the most serious vexations. In health, when not nervous, a woman well knows that there are seasons when she must predetermine not to be nervous; and when ill-health has made her emotional, she must learn to be still, more constantly on guard. Above all, it is the small beginnings of nervousness which she has to fear.

Tears are, for the nervous woman, the seed of trouble. Let her resolutely shun this commencement of disaster. The presence of others is apt to insure failure of self-control. A word of pity, the touch of affection, the face of sympathy, double her danger. When at her worst, let her seek to be alone and in silence and solitude to fight her battle. Fresh air, a bath (if she can bear that), even the act of undressing, will often help her. I once quoted a valued friend as saying that "we never take out of a cold bath the thoughts we take into it," and the phrase is useful and true.

Above all, let such a woman avoid all forms of emotion. Her former standards of resistance apply no longer, and what once did not disturb will now shake her to the centre. A time comes, however, when she will do well to meet and relearn to bear calmly all the little emotional trials of life. I know a nervous woman—and no coward, either—who for months, and wisely, read no newspapers, and who asked another to open and read all her letters and telegrams. The day came when she was able to resume the habits of health, but for a long time the telegram at least was a sore distress, and she could only meet it by a resolute putting of herself in the attitude of tranquillity of which I have spoken. To say more should be needless. For the nervous strong emotions are bad or risky, and from violent mirth to anger all are to be sedulously set aside. Calm of mind and quiet of body are what she most needs to aid the more potent measures of the physician.

The woman in the situation I have described has probably a variety of symptoms on which her condition causes her to dwell. A great many of them are of little practical moment. If she is irresolute and weak, she yields where she should not, and finds for inactivity or for fears ample excuses in the state of her own feelings. An unwholesome crop of disabilities grows out of these conditions. It then becomes the business of her physician to tell her what is real, what is unreal, what must be respected, what must be overcome or fought. She has acquired within herself a host of enemies. Some are strong, some are feeble. The hour for absolute trust has arrived, and she must now believe in her adviser, or, if she cannot, she must acquire one in whom her belief will be entire and unquestioning.

Let us take an illustration. Such a woman is apt enough to suffer from vertigo or giddiness. "If I walk out," she says, "I become giddy. I am rarely free from this unless I am in bed, and it terrifies me." You know in this case that she is still strong enough to exercise in moderation. You say, "Walk so much daily. When you fall we will think about stopping. Talk to some one when you go out; have a friend with you, but walk." She must believe you to succeed. This is a form of faith-cure which has other illustrations. You tell her that she must disregard her own feelings. She credits you with knowing, and so wins her fight.

There is a sense of fatigue which at some time she should learn to treat with disrespect, especially when disuse of her powers has made their exercise difficult, and yet when returning health makes it wise to employ them. To think, and at last to feel sure that she cannot walk is fatal. And above all, and at all times, close attention to her own motions is a great evil. We cannot swallow a pill because we think of what, as regards the larger morsels of food, we do automatically. Moreover, attention intensifies fatigue. Walk a mile, carefully willing each leg-motion, and you will be tired. The same evil results of attention are observed in disease as regards other functions over which we seem in health to be without direct power of control.

"Mind-cure," so called, has, in some shape, its legitimate sphere in the hands of men who know their profession. It is not rare to find among nervous women a few in whom you can cause a variety of odd symptoms by pressing on a tender spine and suggesting to the woman that now she is going to feel certain pains in breast, head, or limbs. Nervous women have, more or less, a like capacity to create or intensify pains and aches, but when a woman is assured that she only seems to have such ailments she is apt, if she be one kind of woman, to be vexed. These dreamed pains—I hardly know what else to call them—are, to her, real enough. If she be another kind of woman, if she believes you, she sets herself to disregard these aches and to escape their results by ceasing to attend to them. You may call this mind-cure or what you will, but it succeeds. Now and then you meet with cases in which, from sudden shock or accident, a woman is led to manufacture a whole train of disabling symptoms, and if in these instances you can convince her that she is well and can walk, eat, etc., like others, you make one of those singular cures which at times fall to the luck of mind-or faith-cures when the patient has not had the happy fortune to meet with a physician who is intelligent, sagacious as to character, and has the courage of his opinions. I could relate many such cases if this were the place to do so, but all I desire here is to win the well woman and the nervously-sick woman to the side of the physician. If she flies from him to seek aid from the ignorant fanatic, she may, in rare cases, get what her trained adviser ought to give her and she be willing to use, while in unskilful hands she runs sad risks of having her too morbid attention riveted to her many symptoms; for to think too much about their disorders is, on the whole, one of the worst things which can happen to man or woman, and wholesome self-attention is difficult, nay, impossible, to command without help from a personally-uninterested mind outside of oneself.

I cannot leave this subject without a further word of solemn warning. In my youth we had mesmerism with its cures, then we had and have spiritualism with its like pretensions. From time to time we have had faith-cures. They come and they go, and have no stable life. The evil they do lives after them in the many mental wrecks they leave. When the charlatan Newton was ordering every class of the sick to get well, I was called upon to see case after case of the most calamitous results on mind and body. Now and then he had the luck to meet some one who was merely idea-sick,—a class of cases we know well. Then he made a cure which would have been as easy to me as to him. I made much inquiry, but could never find a case of organic disease with distinct tissue-changes which he had cured. A man with hopeless rheumatic alterations of joints was made to walk a few steps without crutches. This he did at sore cost of pain, and then came to me to tell me his tale with a new set of crutches, the healer having kept the old set as evidence of the cure. And now we have the mind-cure, Christian science and the like,—a muddle of mystical statements, backed by a medley of the many half-examined facts, which show the influence of mental and moral states over certain forms of disorder. The rarity of these makes them to be suspected. Hardly any have the solid base of a thorough medical study, and we lose sight of them at the moment of cure and learn nothing as to their future.

The books on mind-cure are calculated to make much and serious evil. I have read them with care, and have always risen from them with the sense of confusion which one would have if desired to study a pattern from the back of a piece of embroidery. There is, however, a class of minds which delight in the fogs of mystery, and, when a book puzzles them, accept this as evidence of depth of thought. I have been bewildered at times by the positiveness and reasoning folly of the insane, and I think most trained intelligences will feel that books like these mystical volumes require an amount of care and thinking to avoid bewilderment of which the mass of men and women are not possessed. In a few years they will be the rarely read and dusty volumes, hid away in libraries, and consulted only by those who undertake the sad task of writing the history of credulity. Their creed will die with them, and what is best of it and true will continue to be used by the thoughtful physician, as it has been in all ages. But, meanwhile, it is doing much harm and little good. Every neurologist sees already some of its consequences, and I, myself, have over and over had to undo some of the evil it had done.

Our nervous woman is well. Slowly, very slowly, she has won flesh and color, which means gain in quality and quantity of blood. By degrees, too, she has been able to return to the habits and endurances of health. And now she asks that other question, "I have daughters who are yet young, but how shall I guard them against nervousness?" and again puts forward this single complex symptom in disregard of the states of body which usually accompany it, and are to us matters quite as grave. She knows well that the mass of women are by physiological nature more liable to be nervous than are men. It is a sad drawback in the face of the duties of life, that a very little emotional disturbance will suffice to overcome the woman as it does not do the man, and that the same disease which makes him irritable makes her nervous. Says Romanes, in an admirable and impartial article on the mental differences of men and women, "She is pre-eminent for affection, sympathy, devotion, self-denial, modesty, long-suffering or patience under pain, disappointment, and adversity, for reverence, veneration, religious feeling, and general morality." I accept his statement to add that these very virtues do many of them lead to the automatic development of emotion, which, in its excesses and its uncontrolled states, is the parent of much of the nervousness not due to the enfeeblement of disease.[5]

[Footnote 5: Journal of Popular Science, July, 1887.]

With the intellectual differences between man and woman I have here little to do. That there is difference, both quantitative and in a measure qualitative, I believe, nor do I think any educational change in generations of women will ever set her, as to certain mental and moral qualifications, as an equal beside the man. It would be as impossible as to make him morally and physically, by any educational or other training, what the woman now is, his true superior in much that is as high, and as valuable as any mental capacities he may possess; nor does my creed involve for woman any refusal of the loftiest educational attainments. I would only insist on selection and certain limitations as to age of training and methods of work, concerning which I shall by and by have something more to say. Neither would I forbid to her any profession or mode of livelihood. This is a human right. I do not mean to discuss it here either as citizen or physician; but, as man, I like to state for my fellow-man that there are careers now sought and won and followed by her which for him inevitably lessen her true attractiveness, and to my mind make her less fit to be the "friendly lover and the loving friend."[7] AEsthetic and other sacrifices in this direction are, however, her business, not mine, and do not influence my practical judgments as to what freedom to act is or should be hers in common with men. For most men, when she seizes the apple, she drops the rose. I am a little afraid that Mrs. Lynn Linton is right as to this, but it took some courage to say what she said,[6] and she looks at the matter from a more practical point of view, and deserves to be read at length rather than quoted in fragments.

[Footnote 6: One would like to know how many women truly want the suffrage, and how, when it was won, the earnest anti-tariff wife would construe the marriage service in the face of the husband's belief in high tariff. The indirect influence of women in politics is worth a thought. We felt it sorely in 1861, and thence on to the war's end, and to-day it is the woman who is making the general prohibition laws probable. For ill or good she is still a power in the state.]

[Footnote 7: Fortnightly, 1886.]

I return to the subject. We want our young girl to be all that Romanes says she is. We desire, too, that she shall be as thoroughly educated in relation to her needs as her brothers, and that in so training her we shall not forget that my ideal young person is to marry or not, and, at all events, is to have a good deal of her life in her home with others, and should have some resources for minor or self-culture and occupation besides the larger ones which come of more distinctively intellectual acquirements.

I turn now to the mother who asks this question, and say, "What of your boys? Why are you not concerned as to them?" "Oh, boys are never nervous. One couldn't stand that; but they never are. Girls are so different." My answer is a long one. I wish I could think that it might be so fresh and so attractive as to secure a hearing; but the preacher goes on, Sunday after Sunday, saying over and over the same old truths, and, like him, with some urgency within me to speak, I can only hope that I may be able so to restate certain ancient verities as to win for them a novel respect and a generous acceptation.

The strong animal is, as a rule, the least liable to damaging emotion and its consequences. Train your girls physically, and, up to the age of adolescence, as you train your boys. Too many mothers make haste to recognize the sexual difference. To run, to climb, to swim, to ride, to play violent games, ought to be as natural to the girl as to the boy. All this is fast changing for us, and for the better. When I see young girls sweating from a good row or the tennis-field, I know that it is preventive medicine. I wish I saw how to widen these useful habits so as to give like chances to the poor, and I trust the time will come when the mechanic and the laborer shall insist on public play-grounds as the right of his little ones.[8]

[Footnote 8: The demagogue urges his rights to much that he cannot have in any conceivable form of society. Let him ask for free libraries, free baths, free music, and, above all, free and ample play-grounds within easy reach. I wonder that the rich who endow colleges do not ever think of creating play-grounds. I wish I could open some large pockets by an appeal to hearts at large.]

The tender mother, who hates dirt and loves neatness, and does not like to hear her girls called tom-boys, may and does find it hard to cultivate this free out-door life for her girls even when easy means make the matter less difficult than it is for the caged dweller in cities during a large portion or the whole of a year.

I may leave her to see that delicacy and modesty find place enough in her educational trainings, but let her also make sure that her girls have whatever chance she can afford to live out of doors, and to use the sports which develop the muscles and give tone and vigor. Even in our winters and in-doors, she can try to encourage active games such as shuttlecock and graces. I know of homes where the girls put on the gloves, and stand up with their brothers, and take gallantly the harmless blows which are so valuable a training in endurance and self-control.

I am reminded as I write that what I say applies and must apply chiefly to the leisure class; but in others there is a good deal of manual work done of necessity, and, after all, the leisure class is one which is rapidly increasing in America, and which needs, especially among its new recruits, the very kind of advice I am now giving. Severer games, such as cricket, which I see girls playing with their brothers, tennis, fencing, and even boxing, have for both sexes moral values. They teach, or some of them teach, endurance, contempt of little hurts, obedience to laws, control of temper, in a word, much that under ordinary circumstances growing girls do not get out of their gentler games. These are worth some risks, and such as they are need not trouble seriously the most careful mother. Neither need she fear for girls up to the age of puberty that they are any more liable to serious damage than are her boys.

When for her young daughters this time of change comes near, she may rest assured that their thorough physical training will have good results. Beyond this point it is hard to generalize, and, of course, the more violent games, in which girl and boy are or may be as one, must cease But each case must stand alone, and so be judged. There are plenty of healthy girls who may continue to row, to ride, to swim, to walk as before, but there are individual cases as to which advice is needed, although, as to all girls, it should be the rule that at certain times temperate exercise, lessened walks, and no dancing, riding, rowing, skating, or swimming should be allowed. Girls feel these restrictions less if they are so stringently taught from the outset as to become habits, and this is all I care to say.

Once past the critical years, and there is no reason why the mass of women should not live their own lives as men live theirs, except that always, in my opinion, the prudent woman will at certain times save herself. It is still true that even healthy women exercise too little. Our climate makes walking unpleasant, and to get in a good sweat in summer, or to wade through slush in winter, is hateful to the female soul. The English reproach us with this defect, and rightly, but do not estimate the difficulties of climate. Australian women walk little, and the English dame who comes to this country to live soon succumbs to the despotism of climate and abandons her habits of ample exercise afoot.

The in-door resources of women for chest and arm exertion are sadly few, and I think it fortunate when they are so situated as to have to do things in the household which exact vigorous use of the upper extremities. Nothing is a better ally against nervousness or irritability in any one than either out-door exercise or pretty violent use of the muscles. I knew a nervously-inclined woman who told me that when she was losing self-control she was accustomed to seek her own room, and see how long she could keep up a shuttlecock without a failure. As to weather, again, I should say the worse the weather the better the exercise of a brisk walk; and my wise mother shall see that her girls do not dawdle about in-doors, but get a good tramp under all skies as a part of the habits of life. A sturdy struggle with a rough day blows the irritability and nervousness of the hour out of any but the truly sick, and I know as to some folks that the more they are out of doors the better they are morally as well as physically.

My ideal mother has looked on and seen her daughters grow up to be strong and vigorous. When the time came, she has not forgotten that she has had and has to deal with one of her own sex. During the years of their childhood she should understand, as concerns her girls, that to differentiate too largely their moral lessons from those of their brothers is unwise. Something as to this I have said in a former chapter as concerns the training of invalid children. It applies also to the well. The boy is taught self-control, repression of emotion, not to cry when hurt. Teach your girls these things, and you will in the end assure to them that habitual capacity to suffer moral and physical ill without exterior show of emotion, which is so true an aid to the deeper interior control which subdues emotion at its sources, or robs it of its power to harm. Physical strength and an out-door life will make this lesson easy and natural. Be certain that weakness of body fosters and excuses emotional non-restraint, and that under long illness the most hardy man may become as nervously foolish as a spoiled child. Crave, then, for your girls strength and bodily power of endurance, and with this insist that the boy's code of emotional control shall be also theirs. But to do all this you must begin with them young, and not have to make each year undo the failure of the last. A dog-trainer once told me that it was a good thing to whip the smallest pups with a straw, and to teach them good habits, or try to do so, from birth. He put it strongly; but be sure that if we wish to build habits thoroughly into the mental and physical structure of childhood, we shall do well to begin early. As regards the out-door life, I shall have something more to say in another place, for much is within the reach of the thoughtful, which, with reasonable means, they can get for girls and women, and which yet they do not get; and there are many ways in which also we can so train our girls as to create for them constant and lasting bribes to be in the air.

The question of education is a more difficult one to handle. In childhood I do not see that our wise mother need be anxious; but there comes a day when her girl is entering womanhood, when she will have to think of it. I have dealt with this question so fully of late that I have little here to add.[9] Our public schools are so organized that there is small place or excuse for indulgence, although, under wise management, this has been shown to be possible.[10] But there is a vast and growing class which is so situated that the mother can more largely control the studies and hours of her girls than can the parents of those who frequent our municipal schools.

[Footnote 9: "Wear and Tear," 6th ed., 1887.]

[Footnote 10: Ibid., p. 54.]

A great change is on her child. Let her watch its evolution, and not with such apparent watchfulness as shall suggest the perils she is to look out for. We are all organized with a certain capital of nerve-force, and we cannot spend it with equal recklessness in all directions. If the girl bears well her gathering work,—that is, as one could wish,—we may let her alone, except that the wise mother will insist on lighter tasks and some rest of body at the time when nature is making her largest claim upon the vital powers. The least sign of physical failure should ring a graver alarm, and make the mother insist, at every cost, upon absence of lessons and reasonable repose. The matter is simple, and I have no more to say.

I am dealing now so entirely with the moral and physical aspects of a woman's life, and so distinctly from the medical point of view, that I do not feel called upon to discuss, in all its aspects, the mooted question of the values and the perils of the higher education. At one time it was not open to women at all. Now it is within her reach. Our girl is well, and has passed, happily, over her time of development. Will the larger education which she so often craves subject her to risks such as are not present to the man,—risks of broken health and of its consequences? I wish to speak with care to the mother called upon to decide this grave question. I most honestly believe that the woman is the better in mind and morals for the larger training, better if she marries, and far better and happier if it chances that she does not. If we take the mass of girls, even of mature age, and give them the training commonly given to men, they run, I think, grave risks of being injured by it, and in larger proportion than do their brothers. Where it seems for other reasons desirable, it should be, I think, a question of individual selection. The majority of healthy young women ought to be able to bear the strain. Once in a female college, the woman goes on, and it is my own experience that, on the whole, she exhibits a far larger list of disastrous results from such work than do young men. If she be in the least degree nervous or not well, I, for one, should resolutely say no to all such claims; for let us bear in mind that the higher education is rarely to be used as men use it, to some definite end, and is therefore not, on the whole, so essential to her as to him. Few women mean it as a way towards medicine, or even the upper ranks of teaching; and if they do, the least doubt as to health ought to make us especially unwilling to start an unseaworthy or uninsurable vessel upon an ocean of perilous possibilities. I wish that every woman could attain to the best that men have. I wish for her whatever in the loftiest training helps to make her as mother more capable, as wife more helpful; but I would on no account let the healthiest woman thus task her brain until she is at least nineteen. If she is to marry, and this puts it off until twenty-three, I consider that a gain not counted by the advocates of the higher education. I leave to others to survey the broad question of whether or not it will be well for the community that the mass of women should have a collegiate training. It is a wide and wrathful question, and has of late been very well discussed in Romanes's paper, and by Mrs. Lynn Linton. I think the conclusions of the former, on the whole, are just; but now, whatever be my views as to the larger interests of the commonwealth and the future mothers of our race, I must not forget that I am giving, or trying to give, what I may call individualized advice, from the physician's view, as to what is wisest.

Let us suppose that circumstances make it seem proper to consider an ambitious young woman's wish, and to let her go to a college for women. We presume that she has average health. But let no prudent mother suppose that in these collections of persons of one sex her child will be watched as she has been at home. At no time will she more need the vigilant insight of a mother, and yet this can only be had through letters and in the holiday seasons. Nor can the mother always rely upon the girl to put forward what may cause doubt as to her power to go on with her work. I utterly distrust the statistics of these schools and their graduates as to health, and my want of reliance arises out of the fact that this whole question is in a condition which makes the teachers, scholars, and graduates of such colleges antagonistic to masculine disbelievers in a way and to a degree fatal to truth. I trust far more what I hear from the women who have broken down under the effort to do more than they were fit to do, for always, say what you may, it is the man's standard of endurance which is set before them, and up to which they try to live with all the energy which a woman's higher sense of duty imposes upon the ambitious ones of her sex. I have often asked myself what should be done to make sure that these schools shall produce the minimum amount of evil; what can be done to avoid the penalties inflicted by over-study and class competitions, and by the emotional stimulus which women carry into all forms of work. Even if the doctor says this girl is sound and strong, her early months of college labor should be carefully watched. Above all, her eyes should be seen to, because in my experience some unsuspected disorder of vision has been fruitful of headaches and overstrain of brain, nor is it enough to know that at the beginning her eyes are good. Extreme use often evolves practical evils from visual difficulties at first so slight as to need or seem to need no correction.

The period of examinations is, too, of all others, the time of danger, and I know of many sad breakdowns due to the exaction and emotional anxieties of these days of competition and excitement.

Let me once for all admit that many girls improve in health at these colleges, and that in some of them the machinery of organization for care of the mental and physical health of their students seems to be all that is desirable. That it does not work satisfactorily I am sure, from the many cases I have seen of women who have told me their histories of defeat and broken health. The reason is clear. The general feeling (shall I say prejudices?) of such groups of women is bitterly opposed to conceding the belief held by physicians, that there are in the woman's physiological life disqualifications for such continuous labor of mind as is easy and natural to man. The public sentiment of these great schools is against any such creed, and every girl feels called upon to sustain the general view, so that this acts as a constant goad for such as are at times unfit to use their fullest possibility of energy. Modest girls, caught in the stern mechanism of a system, hesitate to admit reasons for lessened work or to exhibit signals of failure, and this I know to be the case. The practical outcome of it all is that the eyes of home can never be too thoughtfully busy with those of their girls who have won consent to pursue, away from maternal care, the higher education of female colleges. I must have wearied that wise mother by this time, but, perhaps, I have given her more than enough to make her dread these trials.