Health Through Will Power

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

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

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

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

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

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

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

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

CHAPTER XVII

THE WILL IN SO-CALLED CHRONIC RHEUMATISM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAPTER XVIII

PSYCHO-NEUROSES

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

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

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

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

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

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

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

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

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

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

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

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

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

CHAPTER XIX

FEMININE ILLS AND THE WILL

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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