,,wear ,,and ,,tear1 ,,or ,,hints ,,for ,,the ,,overworked4 ,,by ,s4 ,,weir ,,mitchell1 ,m4,d41 ,,ll4,d4 ,,harv41 ,,member ,,of ,,the ,,national ,,academy ,,of ,,sciences1 ,,president ,,of ,,the ,,college ,,of ,,physicians ,,of ,,philadelphia1 ,,etc4 ,,fifth ,,edition1 ,,thoroughly ,,revised4 ,,philadelphia3 ,j4,b4 ,,lippincott ,,company4 ,,london3 #aj ,,henrietta ,,street1 ,,covent ,,garden4 ,entered according to ,act of ,congress1 in the year #ahga1 by ,j4,b4 ,,lippincott ,,co41 ,in the ,office of the ,librarian of ,congress at ,washington4 ,,printed ,,by ,j4,b4 ,,lippincott ,,company1 ,,philadelphia4 ,,preface4 ,the rate of change in this country in education1 in dress1 and in diet and habits of daily life surprises even the most watchful ,american observer4 ,it is now but fifteen years since this little book was written as a warning to a restless nation possessed of an energy tempted to its largest uses by unsurpassed opportunities4 ,there is still need to repeat and reinforce my former remonstrance1 but ,i am glad to add that since ,i first wrote on these subjects they have not only grown into importance as questions of public hygiene1 but vast changes for the better have come about in many of our ways of living1 and everywhere common sense is beginning to rule in matters of dress1 diet1 and education4 ,the ,american of the ,eastern ,states and of the comfortable classes#a is becoming notably more ruddy and more stout4 ,the alteration in women as to these conditions is most striking1 and1 if ,i am not mistaken1 in ,england there is a lessening tendency towards that excess of adipose matter which is still a surprise to the ,american visiting ,england for the first time4 ,i should scarcely venture to assert so positively that ,americans had obviously taken on flesh within a generation if what ,i see had not been observed by many others4 ,it would1 ,i think1 be interesting to enter at length upon a study of these remarkable changes1 but that were scarcely within the scope of this little book4 ,footnote #a3 ,happily1 a large class with us4 ,,wear ,,and ,,tear4 ,,or ,,hints ,,for ,,the ,,overworked4 ,many years ago#a ,i found occasion to set before the readers of ,lippincott's ,magazine certain thoughts concerning work in ,america1 and its results4 ,somewhat to my surprise1 the article attracted more notice than usually falls to the share of such papers1 and since then1 from numerous sources1 ,i have had the pleasure to learn that my words of warning have been of good service to many thoughtless sinners against the laws of labor and of rest4 ,i have found1 also1 that the views then set forth as to the peculiar difficulties of mental and physical work in this country are in strict accordance with the personal experience of foreign scholars who have cast their lots among us2 while some of our best teachers have thanked me for stating1 from a doctor's stand-point1 the evils which their own experience had taught them to see in our present mode of tasking the brains of the younger girls4 ,footnote #a3 ,in #ahga4 ,i hope1 therefore1 that ,i am justified in the belief that in its new and larger form my little tract may again claim attention from such as need its lessons4 ,since it was meant only for these1 ,i need not excuse myself to physicians for its simplicity2 while ,i trust that certain of my brethren may find in it enough of original thought to justify its reappearance1 as its statistics were taken from manuscript notes and have been printed in no scientific journal4 ,i have called these ,hints ,,wear and ,,tear1 because this title clearly and briefly points out my meaning4 ,wear is a natural and legitimate result of lawful use1 and is what we all have to put up with as the result of years of activity of brain and body4 ,tear is another matter3 it comes of hard or evil usage of body or engine1 of putting things to wrong purposes1 using a chisel for a screw-driver1 a penknife for a gimlet4 ,long strain1 or the sudden demand of strength from weakness1 causes tear4 ,wear comes of use2 tear1 of abuse4 ,the sermon of which these words are the text has been preached many times in many ways to congregations for whom the ,dollar ,devil had always a more winning eloquence4 ,like many another man who has talked wearily to his fellows with an honest sense of what they truly need1 ,i feel how vain it is to hope for many earnest listeners4 ,yet here and there may be men and women1 ignorantly sinning against the laws by which they should live or should guide the lives of others1 who will perhaps be willing to heed what one unbiased thinker has to say in regard to the dangers of the way they are treading with so little knowledge as to where it is leading4 ,the man who lives an out-door life--who sleeps with the stars visible above him--who wins his bodily subsistence at first hand from the earth and waters--is a being who defies rain and sun1 has a strange sense of elastic strength1 may drink if he likes1 and may smoke all day long1 and feel none the worse for it4 ,some such return to the earth for the means of life is what gives vigor and developing power to the colonist of an older race cast on a land like ours4 ,a few generations of men living in such fashion store up a capital of vitality which accounts largely for the prodigal activity displayed by their descendants1 and made possible only by the sturdy contest with ,nature which their ancestors have waged4 ,that such a life is still led by multitudes of our countrymen is what alone serves to keep up our pristine force and energy4 ,are we not merely using the interest on these accumulations of power1 but also wastefully spending the capital8 ,from a few we have grown to millions1 and already in many ways the people of the ,atlantic coast present the peculiarities of an old nation4 ,have we lived too fast8 ,the settlers here1 as elsewhere1 had ample room1 and lived sturdily by their own hands1 little troubled for the most part with those intense competitions which make it hard to live nowadays and embitter the daily bread of life4 ,neither had they the thousand intricate problems to solve which perplex those who struggle to-day in our teeming city hives4 ,above all1 educational wants were limited in kind and in degree1 and the physical man and woman were what the growing state most needed4 ,how much and what kind of good came of the gradual change in all these matters we well enough know4 ,that in one and another way the cruel competition for the dollar1 the new and exacting habits of business1 the racing speed which the telegraph and railway have introduced into commercial life1 the new value which great fortunes have come to possess as means towards social advancement1 and the overeducation and overstraining of our young people1 have brought about some great and growing evils1 is what is now beginning to be distinctly felt4 ,i should like1 therefore1 at the risk of being tedious1 to re-examine this question--to see if it be true that the nervous system of certain classes of ,americans is being sorely overtaxed--and to ascertain how much our habits1 our modes of work1 and1 haply1 climatic peculiarities1 may have to do with this state of things4 ,but before venturing anew upon a subject which may possibly excite controversy and indignant comment1 let me premise that ,i am talking chiefly of the crowded portions of our country1 of our great towns1 and especially of their upper classes1 and am dealing with those higher questions of mental hygiene of which in general we hear but too little4 ,if the strictures ,i have to make applied as fully throughout the land--to ,oregon as to ,new ,england1 to the farmer as to the business man1 to the women of the artisan class as to those socially above them--then indeed ,i should cry1 ,god help us and those that are to come after us6 ,owing to causes which are obvious enough1 the physical worker is being better and better paid and less and less hardly tasked1 while just the reverse obtains in increasing ratios for those who live by the lower form of brain-work2 so that the bribe to use the hand is growing daily1 and pure mechanical labor1 as opposed to that of the clerk1 is being levelled upward with fortunate celerity4 ,before attempting to indicate certain ways in which we as a people are overtaxing and misusing the organs of thought1 ,i should be glad to have the privilege of explaining the terms which it is necessary to use1 and of pointing out some of the conditions under which mental labor is performed4 ,the human body carries on several kinds of manufacture1 two of which--the evolution of muscular force or motion1 and intellection with all moral activities--alone concern us here4 ,we are somewhat apt to antagonize these two sets of functions1 and to look upon the latter1 or brain-labor1 as alone involving the use or abuse of the nervous system4 ,but every blow on the anvil is as distinctly an act of the nerve centres as are the highest mental processes4 ,if this be so1 how or why is it that excessive muscular exertion--,i mean such as is violent and continued--does not cause the same appalling effects as may be occasioned by a like abuse of the nerve-organs in mental actions of various kinds8 ,this is not an invariable rule1 for1 as ,i may point out in the way of illustration hereafter1 the centres which originate or evolve muscular power do sometimes suffer from undue taxation2 but it is certainly true that when this happens1 the evil result is rarely as severe or as lasting as when it is the organs of mental power that have suffered4 ,in either form of work1 physical or mental1 the will acts to start the needed processes1 and afterwards is chiefly regulative4 ,in the case of bodily labor1 the spinal nerve-centres are most largely called into action4 ,where mental or moral processes are involved1 the active organs lie within the cranium4 ,as ,i said just now1 when we talk of an overtaxed nervous system it is usually the brain we refer to1 and not the spine2 and the question therefore arises1 ,why is it that an excess of physical labor is better borne than a like excess of mental labor8 ,the simple answer is1 that mental overwork is harder1 because as a rule it is closet or counting-room or at least in-door work--sedentary1 in a word4 ,the man who is intensely using his brain is not collaterally employing any other organs1 and the more intense his application the less locomotive does he become4 ,on the other hand1 however a man abuses his powers of motion in the way of work1 he is at all events encouraging that collateral functional activity which mental labor discourages3 he is quickening the heart1 driving the blood through unused channels1 hastening the breathing and increasing the secretions of the skin--all excellent results1 and1 even if excessive1 better than a too incomplete use of these functions4 ,but there is more than this in the question4 ,we do not know as yet what is the cost in expended material of mental acts as compared with motor manifestations1 and here1 therefore1 are at fault2 because1 although it seems so much slighter a thing to think a little than to hit out with the power of an athlete1 it may prove that the expenditure of nerve material is in the former case greater than in the latter4 ,when a man uses his muscles1 after a time comes the feeling called fatigue--a sensation always referred to the muscles1 and due most probably to the deposit in the tissues of certain substances formed during motor activity4 ,warned by this weariness1 the man takes rest--may indeed be forced to do so2 but1 unless ,i am mistaken1 he who is intensely using the brain does not feel in the common use of it any sensation referable to the organ itself which warns him that he has taxed it enough4 ,it is apt1 like a well-bred creature1 to get into a sort of exalted state under the stimulus of need1 so that its owner feels amazed at the ease of its processes and at the sense of wide-awakefulness and power that accompanies them4 ,it is only after very long misuse that the brain begins to have means of saying1 ,i have done enough2 and at this stage the warning comes too often in the shape of some one of the many symptoms which indicate that the organ is already talking with the tongue of disease4 ,i do not know how these views will be generally received1 but ,i am sure that the personal experience of many scholars will decide them to be correct2 and they serve to make clear why it is that men may not know they are abusing the organ of thought until it is already suffering deeply1 and also wherefore the mind may not be as ruthlessly overworked as the legs or arms4 ,whenever ,i have closely questioned patients or men of studious habits as to this matter1 ,i have found that most of them1 when in health1 recognized no such thing as fatigue in mental action1 or else ,i learned that what they took for this was merely that physical sense of being tired1 which arises from prolonged writing or constrained positions4 ,the more1 ,i fancy1 any healthy student reflects on this matter the more clearly will he recognize this fact1 that very often when his brain is at its clearest1 he pauses only because his back is weary1 his eyes aching1 or his fingers tired4 ,this most important question1 as to how a man shall know when he has sufficiently tasked his brain1 demands a longer answer than ,i can give it here2 and1 unfortunately1 there is no popular book since ,ray's clever and useful ,mental ,hygiene1 and ,feuchtersleben's ,dietetics of the ,soul1 both out of print1 which deals in a readable fashion with this or kindred topics4#a ,many men are warned by some sense of want of clearness or ease in their intellectual processes4 ,others are checked by a feeling of surfeit or disgust1 which they obey or not as they are wise or unwise4 ,here1 for example1 is in substance the evidence of a very attentive student of his own mental mechanism1 whom we have to thank for many charming products of his brain4 ,like most scholars1 he can scarcely say that he ever has a sense of brain-tire1 because cold hands and feet and a certain restlessness of the muscular system drive him to take exercise4 ,especially when working at night1 he gets after a time a sense of disgust at the work he is doing4 ,but sometimes1 he adds1 my brain gets going1 and is to be stopped by none of the common plans of counting1 repeating ,french verbs1 or the like4 ,a well-known poet describes to me the curious condition of excitement into which his brain is cast by the act of composing verse1 and thinks that the happy accomplishment of his task is followed by a feeling of relief1 which shows that there has been high tension4 ,footnote #a3 ,see1 now1 ,brain-,work and ,overwork1 by ,h4,c4 ,wood1 ,m4,d42 also1 ,mental ,overwork and ,premature ,disease among ,public and ,professional ,men1 by ,ch4 ,k4 ,mills1 ,m4,d42 also1 ,overwork and ,sanitation in ,public ,schools1 with ,remarks on the ,production of ,nervous ,disease and ,insanity1 by ,ch4 ,k4 ,mills1 ,m4,d41--,annals of ,hygiene1 ,september1 #ahhf4 ,one of our ablest medical scholars reports himself to me as having never been aware of any sensation in the head1 by which he could tell that he had worked enough1 up to a late period of his college career1 when1 having overtaxed his brain1 he was restricted by his advisers to two or three hours of daily study4 ,he thus learned to study hard1 and ever since has been accustomed to execute all mental tasks at high pressure under intense strain and among the cares of a great practice4 ,all his mind-work is1 however1 forced labor1 and it always results in a distinct sense of cerebral fatigue1--a feeling of pressure1 which is eased by clasping his hands over his head2 and also there is desire to lie down and rest4 ,i am not aware1 writes a physician of distinction1 that1 until a few years ago1 ,i ever felt any sense of fatigue from brain-work which ,i could refer to the organ employed4 ,the longer ,i worked the clearer and easier my mental processes seemed to be1 until1 during a time of great sorrow and anxiety1 ,i pushed my thinking organs rather too hard4 ,as a result1 ,i began to have headache after every period of intellectual exertion4 ,then ,i lost power to sleep4 ,although ,i have partially recovered1 ,i am now always warned when ,i have done enough1 by lessening ease in my work1 and by a sense of fulness and tension in the head4 ,the indications of brain-tire1 therefore1 differ in different people1 and are more and more apt to be referred to the thinking organ as it departs more and more from a condition of health4 ,surely a fuller record of the conditions under which men of note are using their mental machinery would be everyway worthy of attention4 ,another reason why too prolonged use of the brain is so mischievous is seen in a peculiarity1 which is of itself a proof of the auto-activity of the vital acts of the various organs concerned in intellection4 ,we sternly concentrate attention on our task1 whatever it be2 we do this too long1 or under circumstances which make labor difficult1 such as during digestion or when weighted by anxiety4 ,at last we stop and propose to find rest in bed4 ,not so1 says the ill-used brain1 now morbidly wide awake2 and whether we will or not1 the mind keeps turning over and over the work of the day1 the business or legal problem1 or mumbling1 so to speak1 some wearisome question in a fashion made useless by the denial of full attention4 ,or else the imagination soars away with the unrestful energy of a demon1 conjuring up an endless procession of broken images and disconnected thoughts1 so that sleep is utterly banished4 ,i have chosen here as examples men whose brains are engaged constantly in the higher forms of mental labor2 but the difficulty of arresting at will the overtasked brain belongs more or less to every man who overuses this organ1 and is the well-known initial symptom of numerous morbid states4 ,i have instanced scholars and men of science chiefly1 because they1 more than others1 are apt to study the conditions under which their thinking organs prosper or falter in their work1 and because from them have we had the clearest accounts of this embarrassing condition of automatic activity of the cerebral organs4 ,few thinkers have failed1 ,i fancy1 to suffer in this way at some time1 and with many the annoyance is only too common4 ,i do not think the subject has received the attention it deserves1 even from such thorough believers in unconscious cerebration as ,maudsley4 ,as this state of brain is fatal to sleep1 and therefore to needful repose of brain1 every sufferer has a remedy which he finds more or less available4 ,this usually consists in some form of effort to throw the thoughts off the track upon which they are moving4 ,almost every literary biography has some instance of this difficulty1 and some hint as to the sufferer's method of freeing his brain from the despotism of a ruling idea or a chain of thought4 ,many years ago ,i heard ,mr4 ,thackeray say that he was sometimes haunted1 when his work was over1 by the creatures he himself had summoned into being1 and that it was a good corrective to turn over the pages of a dictionary4 ,sir ,walter ,scott is said to have been troubled in a similar way4 ,a great lawyer1 whom ,i questioned lately as to this matter1 told me that his cure was a chapter or two of a novel1 with a cold bath before going to bed2 for1 said he1 quaintly1 ,you never take out of a cold bath the thoughts you take into it4 ,it would be easy to multiply such examples4 ,looking broadly at the question of the influence of excessive and prolonged use of the brain upon the health of the nervous system1 we learn1 first1 that cases of cerebral exhaustion in people who live wisely are rare4 ,eat regularly and exercise freely1 and there is scarce a limit to the work you may get out of the thinking organs4 ,but if into the life of a man whose powers are fully taxed we bring the elements of great anxiety or worry1 or excessive haste1 the whole machinery begins at once to work1 as it were1 with a dangerous amount of friction4 ,add to this such constant fatigue of body as some forms of business bring about1 and you have all the means needed to ruin the man's power of useful labor4 ,i have been careful here to state that combined overwork of mind and body is doubly mischievous1 because nothing is now more sure in hygienic science than that a proper alternation of physical and mental labor is best fitted to insure a lifetime of wholesome and vigorous intellectual exertion4 ,this is probably due to several causes1 but principally to the fact that during active exertion of the body the brain cannot be employed intensely1 and therefore has secured to it a state of repose which even sleep is not always competent to supply4 ,there is a ,turkish proverb which occurs to me here1 like most proverbs1 more or less true3 ,dreaming goes afoot1 but who can think on horseback8 ,perhaps1 too1 there is concerned a physiological law1 which1 though somewhat mysterious1 ,i may again have to summon to my aid in the way of explanation4 ,it is known as the law of ,treviranus1 its discoverer1 and may thus be briefly stated3 ,each organ is to every other as an excreting organ4 ,in other words1 to insure perfect health1 every tissue1 bone1 nerve1 tendon1 or muscle should take from the blood certain materials and return to it certain others4 ,to do this every organ must or ought to have its period of activity and of rest1 so as to keep the vital fluid in a proper state to nourish every other part4 ,this process in perfect health is a system of mutual assurance1 and is probably essential to a condition of entire vigor of both mind and body4 ,it has long been believed that maladies of the nervous system are increasing rapidly in the more crowded portions of the ,united ,states2 but ,i am not aware that any one has studied the death-records to make sure of the accuracy of this opinion4 ,there can be no doubt1 ,i think1 that the palsy of children becomes more frequent in cities just in proportion to their growth in population4 ,i mention it here because1 as it is a disease which does not kill but only cripples1 it has no place in the mortuary tables4 ,neuralgia is another malady which has no record there1 but is1 ,i suspect1 increasing at a rapid rate wherever our people are crowded together in towns4 ,perhaps no other form of sickness is so sure an indication of the development of the nervous temperament1 or that condition in which there are both feebleness and irritability of the nervous system4 ,but the most unquestionable proof of the increase of nervous disease is to be looked for in the death statistics of cities4 ,there1 if anywhere1 we shall find evidence of the fact1 because there we find in exaggerated shapes all the evils ,i have been defining4 ,the best mode of testing the matter is to take the statistics of some large city which has grown from a country town to a vast business hive within a very few years4 ,chicago fulfils these conditions precisely4 ,in #aheb it numbered #di1djg souls4 ,at the close of #ahfh it had reached to #beb1jed4 ,within these years it has become the keenest and most wide-awake business centre in ,america4 ,i owe to the kindness of ,dr4 ,j4,h4 ,rauch1 ,sanitary ,superintendent of ,chicago1 manuscript records1 hitherto unpublished1 of its deaths from nervous disease1 as well as the statement of each year's total mortality2 so that ,i have it in my power to show the increase of deaths from nerve disorders relatively to the annual loss of life from all causes4 ,i possess similar details as to ,philadelphia1 which seem to admit of the same conclusions as those drawn from the figures ,i have used4 ,but here the evil has increased more slowly4 ,let us see what story these figures will tell us for the ,western city4 ,unluckily1 they are rather dry tale-tellers4 ,the honest use of the mortuary statistics of a large town is no easy matter1 and ,i must therefore ask that ,i may be supposed to have taken every possible precaution in order not to exaggerate the reality of a great evil4 ,certain diseases1 such as apoplexy1 palsy1 epilepsy1 ,st4 ,vitus's dance1 and lockjaw or tetanus1 we all agree to consider as nervous maladies2 convulsions1 and the vast number of cases known in the death-lists as dropsy of the brain1 effusion on the brain1 etc41 are to be looked upon with more doubt4 ,the former1 as every doctor knows1 are1 in a vast proportion of instances1 due to direct disease of the nerve-centres2 or1 if not to this1 then to such a condition of irritability of these parts as makes them too ready to originate spasms in response to causes which disturb the extremities of the nerves1 such as teething and the like4 ,this tendency seems to be fostered by the air and habits of great towns1 and by all the agencies which in these places depress the health of a community4 ,the other class of diseases1 as dropsy of the brain or effusion1 probably includes a number of maladies1 due some of them to scrofula1 and to the predisposing causes of that disease2 others1 to the kind of influences which seem to favor convulsive disorders4 ,less surely than the former class can these be looked upon as true nervous diseases2 so that in speaking of them ,i am careful to make separate mention of their increase1 while thinking it right on the whole to include in the general summary of this growth of nerve disorders this partially doubtful class4 ,taking the years #aheb to #ahfh1 inclusive1 it will be found that the population of ,chicago has increased #e4a times and the deaths from all causes #c4g times2 while the nerve deaths1 including the doubtful class labelled in the reports as dropsy of the brain and convulsions1 have risen to #bj4d times what they were in #aheb4 ,thus in #aheb1 '#ec1 and '#ee1 leaving out the cholera year '#ed1 the deaths from nerve disorders were respectively to the whole population as #a in #aadi1 #a in #iec1 and #a in #ida2 whilst in #ahff1 '#fg1 and '#fh1 they were #a in #eje1 #a in #dae4g1 and #a in #bhg4h4 ,still omitting #ahed1 the average proportion of neural deaths to the total mortality was1 in the five years beginning with #aheb1 #a in #bf4a4 ,in the five latter years studied--that is1 from #ahfd to #ahfh1 inclusive--the proportion was #a nerve death to every #i4i of all deaths4 ,i have alluded above to a class of deaths included in my tables1 but containing1 no doubt1 instances of mortality due to other causes than disease of the nerve-organs4 ,thus many which are stated to have been owing to convulsions ought to be placed to the credit of tubercular disease of the brain or to heart maladies2 but even in the practice of medicine the distinction as to cause cannot always be made2 and as a large proportion of this loss of life is really owing to brain affections1 ,i have thought best to include the whole class in my statement4 ,a glance at the individual diseases which are indubitably nervous is more instructive and less perplexing4 ,for example1 taking the extreme years1 the recent increase in apoplexy is remarkable1 even when we remember that it is a malady of middle and later life1 and that ,chicago1 a new city1 is therefore entitled to a yearly increasing quantity of this form of death4 ,in #ahfh the number was #h4f times greater than in #aheb4 ,convulsions as a death cause had in #ahfh risen to #bb times as many as in the year #aheb4 ,epilepsy1 one of the most marked of all nervous maladies1 is more free from the difficulties which belong to the last-mentioned class4 ,in #aheb and '#ec there were but two deaths from this disease2 in the next four years there were none4 ,from #aheh to '#fd1 inclusive1 there were in all #f epileptic deaths3 then we have in the following years1 #e1 #c1 #aa2 and in #ahfh the number had increased to #ag4 ,passing over palsy1 which1 like apoplexy1 increases in #ahfh1--h4f times as compared with #aheb2 and #bf times as compared with the four years following #aheb1--we come to lockjaw1 an unmistakable nerve malady4 ,six years out of the first eleven give us no death from this painful disease2 the others1 up to #ahfd1 offer each one only1 and the last-mentioned year has but two4 ,then the number rises to #c each year1 to #e in #ahfg1 and to #ab in #ahfh4 ,at first sight1 this record of mortality from lockjaw would seem to be conclusive1 yet it is perhaps1 of all the maladies mentioned1 the most deceptive as a means of determining the growth of neural diseases4 ,to make this clear to the general reader1 he need only be told that tetanus is nearly always caused by mechanical injuries1 and that the natural increase of these in a place like ,chicago may account for a large part of the increase4 ,yet1 taking the record as a whole1 and viewing it only with a calm desire to get at the truth1 it is not possible to avoid seeing that the growth of nerve maladies has been inordinate4 ,the industry and energy which have built this great city on a morass1 and made it a vast centre of insatiate commerce1 are now at work to undermine the nervous systems of its restless and eager people1#a with what result ,i have here tried to point out1 chiefly because it is an illustration in the most concentrated form of causes which are at work elsewhere throughout the land4 ,footnote #a3 ,i asked two citizens of this uneasy town--on the same day--what was their business4 ,both replied tranquilly that they were speculators6 ,the facts ,i have given establish the disproportionate increase in one great city of those diseases which are largely produced by the strain on the nervous system resulting from the toils and competitions of a community growing rapidly and stimulated to its utmost capacity4 ,probably the same rule would be found to apply to other large towns1 but ,i have not had time to study the statistics of any of them fully2 and1 for reasons already given1 ,chicago may be taken as a typical illustration4 ,it were interesting to-day to question the later statistics of this great business-centre2 to see if the answers would weaken or reinforce the conclusions drawn in #ahga4 ,i have seen it anew of late with its population of #gjj1jjj souls4 ,it is a place to-day to excite wonder1 and pity1 and fear4 ,all the tides of its life move with bustling swiftness4 ,nowhere else are the streets more full1 and nowhere else are the faces so expressive of preoccupation1 of anxiety1 of excitement4 ,it is making money fast and accumulating a physiological debt of which that bitter creditor1 the future1 will one day demand payment4 ,if ,i have made myself understood1 we are now prepared to apply some of our knowledge to the solution of certain awkward questions which force themselves daily upon the attention of every thoughtful and observant physician1 and have thus opened a way to the discussion of the causes which1 as ,i believe1 are deeply affecting the mental and physical health of working ,americans4 ,some of these are due to the climatic conditions under which all work must be done in this country1 some are out-growths of our modes of labor1 and some go back to social habitudes and defective methods of early educational training4 ,in studying this subject1 it will not answer to look only at the causes of sickness and weakness which affect the male sex4 ,if the mothers of a people are sickly and weak1 the sad inheritance falls upon their offspring1 and this is why ,i must deal first1 however briefly1 with the health of our girls1 because it is here1 as the doctor well knows1 that the trouble begins4 ,ask any physician of your acquaintance to sum up thoughtfully the young girls he knows1 and to tell you how many in each score are fit to be healthy wives and mothers1 or in fact to be wives and mothers at all4 ,i have been asked this question myself very often1 and ,i have heard it asked of others4 ,the answers ,i am not going to give1 chiefly because ,i should not be believed--a disagreeable position1 in which ,i shall not deliberately place myself4 ,perhaps ,i ought to add that the replies ,i have heard given by others were appalling4 ,next1 ,i ask you to note carefully the expression and figures of the young girls whom you may chance to meet in your walks1 or whom you may observe at a concert or in the ball-room4 ,you will see many very charming faces1 the like of which the world cannot match--figures somewhat too spare of flesh1 and1 especially south of ,rhode ,island1 a marvellous littleness of hand and foot4 ,but look further1 and especially among ,new ,england young girls3 you will be struck with a certain hardness of line in form and feature which should not be seen between thirteen and eighteen1 at least2 and if you have an eye which rejoices in the tints of health1 you will too often miss them on the cheeks we are now so daringly criticising4 ,i do not want to do more than is needed of this ungracious talk3 suffice it to say that multitudes of our young girls are merely pretty to look at1 or not that2 that their destiny is the shawl and the sofa1 neuralgia1 weak backs1 and the varied forms of hysteria1--that domestic demon which has produced untold discomfort in many a household1 and1 ,i am almost ready to say1 as much unhappiness as the husband's dram4 ,my phrase may seem outrageously strong1 but only the doctor knows what one of these self-made invalids can do to make a household wretched4 ,mrs4 ,gradgrind is1 in fiction1 the only successful portrait of this type of misery1 of the woman who wears out and destroys generations of nursing relatives1 and who1 as ,wendell ,holmes has said1 is like a vampire1 sucking slowly the blood of every healthy1 helpful creature within reach of her demands4 ,if any reader doubts my statement as to the physical failure of our city-bred women to fulfil all the natural functions of mothers1 let him contrast the power of the recently imported ,irish or ,germans to nurse their babies a full term or longer1 with that of the native women even of our mechanic classes4 ,it is difficult to get at full statistics as to those a higher social degree1 but ,i suspect that not over one-half are competent to nurse their children a full year without themselves suffering gravely4 ,i ought to add that our women1 unlike ladies abroad1 are usually anxious to nurse their own children1 and merely cannot4 ,the numerous artificial infant foods now for sale singularly prove the truth of this latter statement4 ,many physicians1 with whom ,i have talked of this matter1 believe that ,i do not overstate the evil2 others think that two-thirds may be found reliable as nurses2 while the rural doctors1 who have replied to my queries1 state that only from one-tenth to three-tenths of farmers' wives are unequal to this natural demand4 ,there is indeed little doubt that the mass of our women possess that peculiar nervous organization which is associated with great excitability1 and1 unfortunately1 with less physical vigor than is to be found1 for example1 in the sturdy ,english dames at whom ,hawthorne sneered so bitterly4 ,and what are the causes to which these peculiarities are to be laid8 ,there are many who will say that late hours1 styles of dress1 prolonged dancing1 etc41 are to blame2 while really1 with rare exceptions1 the newer fashions have been more healthy than those they superseded1 people are better clad and better warmed than ever1 and1 save in rare cases1 late hours and overexertion in the dance are utterly incapable of alone explaining the mischief4 ,i am far more inclined to believe that climatic peculiarities have formed the groundwork of the evil1 and enabled every injurious agency to produce an effect which would not in some other countries be so severe4 ,i am quite persuaded1 indeed1 that the development of a nervous temperament is one of the many race-changes which are also giving us facial1 vocal1 and other peculiarities derived from none of our ancestral stocks4 ,if1 as ,i believe1 this change of temperament in a people coming largely from the phlegmatic races is to be seen most remarkably in the more nervous sex1 it will not surprise us that it should be fostered by many causes which are fully within our own control4 ,given such a tendency1 disease will find in it a ready prey1 want of exercise will fatally increase it1 and all the follies of fashion will aid in the work of ruin4 ,while a part of the mischief lies with climatic conditions which are utterly mysterious1 the obstacles to physical exercise1 arising from extremes of temperature1 constitute at least one obvious cause of ill health among women in our country4 ,the great heat of summer1 and the slush and ice of winter1 interfere with women who wish to take exercise1 but whose arrangements to go out-of-doors involve wonderful changes of dress and an amount of preparation appalling to the masculine creature4 ,the time taken for the more serious instruction of girls extends to the age of nineteen1 and rarely over this4 ,during some of these years they are undergoing such organic development as renders them remarkably sensitive4 ,at seventeen ,i presume that healthy girls are as well able to study1 with proper precautions1 as men2 but before this time overuse1 or even a very steady use1 of the brain is in many dangerous to health and to every probability of future womanly usefulness4 ,in most of our schools the hours are too many1 for both girls and boys4 ,from nine until two is1 with us1 the common school-time in private seminaries4 ,the usual recess is twenty minutes or half an hour1 and it is not as a rule filled by enforced exercise4 ,in certain schools--would it were common6--ten minutes' recess is given after every hour2 and in the ,blind ,asylum of ,philadelphia this time is taken up by light gymnastics1 which are obligatory4 ,to these hours we must add the time spent in study out of school4 ,this1 for some reason1 nearly always exceeds the time stated by teachers to be necessary2 and most girls of our common schools and normal schools between the ages of thirteen and seventeen thus expend two or three hours4 ,does any physician believe that it is good for a growing girl to be so occupied seven or eight hours a day8 or that it is right for her to use her brains as long a time as the mechanic employs his muscles8 ,but this is only a part of the evil4 ,the multiplicity of studies1 the number of teachers1--each eager to get the most he can out of his pupil1 the severer drill of our day1 and the greater intensity of application demanded1 produce effects on the growing brain which1 in a vast number of cases1 can be only disastrous4 ,my remarks apply of course chiefly to public school life4 ,i am glad to say that of late in all of our best school ,states more thought is now being given to this subject1 but we have much to do before an evil which is partly a school difficulty and partly a home difficulty shall have been fully provided against4 ,careful reading of our ,pennsylvania reports and of those of ,massachusetts convinces me that while in the country schools overwork is rare1 in those of the cities it is more common1 and that the system of pushing1--of competitive examinations1--of ranking1 etc41 is in a measure responsible for that worry which adds a dangerous element to work4 ,the following remarks as to the influence of home life in ,massachusetts are not out of place here1 and will be reinforced by what is to be said farther on by a competent authority as to ,philadelphia3 ,the danger of overwork1 ,i believe1 exists mainly1 if not wholly1 in graded schools1 where large numbers are taught together1 where there is greater competition than in ungraded schools1 and where the work of each pupil cannot be so easily adjusted to his capacity and needs4 ,and what are the facts in these schools8 ,i am prepared to agree with a recent ,london ,school ,board ,report so far as to say that in some of our graded schools there are pupils who are overworked4 ,the number in any school is1 ,i believe1 small who are stimulated beyond their strength1 and the schools are few in which such extreme stimulation is encouraged4 ,when1 with a large class of children whose minds are naturally quick and active1 the teacher resorts to the daily marking of recitations1 to the giving of extra credits for extra work done1 to ranking1 and to holding up the danger of non-promotion before the pupils2 and when1 added to those extra inducements to work1 there are given by committees and superintendents examinations for promotion at regular intervals1 it would be very strange if there were not some pupils so weak and so susceptible as to be encouraged to work beyond their strength4 ,there is another occasion of overwork which ,i have found in a few schools1 and that is the spending of nearly all of the school time in recitation and putting off study to extra time at home4 ,when1 in a school of forty or more1 pupils belong to the same class1 and are not separated into divisions for recitation and study1 there is a temptation to spend the greater part of the time in recitation which few teachers can resist2 and if tasks are given1 they have to be learned out of school or not at all4 ,pupils of grammar schools are known to feel obliged to study two or three hours daily from this cause at a time when they should be sleeping1 or exercising in the open air4 ,frequently1 however1 it is not so much overwork as overworry that most affects the health of the child1--that worry which may not always be traced to any fault of system or teacher1 but which1 it must be admitted1 is too often induced by encouraging wrong motives to study4 ,in making up the verdict we must not forget that others besides the teacher may be responsible for overwork and overworry4 ,the parents and pupils themselves are quite as often to blame as are the teachers4 ,an unwillingness on the part of pupils to review work imperfectly done1 and a desire on the part of parents to have their children get into a higher class1 or to graduate1 frequently cause pupils to cram for examinations and to work unduly at a time when the body is least able to bear the extra strain4 ,again1 children are frequently required to take extra lessons in music or some other study at home1 thus depriving them of needed exercise and recreation1 or exhausting nervous energy which is needed for their regular school work4 ,it will be observed that in this charge against parents ,i do not speak of those causes of ill health which really have nothing to do with overwork1 but which are oftentimes forgotten when a school-boy or girl breaks down4 ,i allude to the eating of improper and unwholesome food1 to irregularity of eating and sleeping1 to attendance upon parties and other places of amusement late at night1 to smoking1 and to the indulgence of other habits which tend to unduly excite the nervous system4 ,for very obvious reasons these causes of disease are not brought prominently forward by the attending physician1 who doubtless thinks it safer and more flattering to his patrons to say that the child has broken down from hard study1 rather than from excesses which are somewhat discreditable4 ,while parents are clearly to blame for endangering health in the ways indicated1 it may be a question whether the work required to be done in school should not be regulated accordingly2 whether1 in designating the studies to be taken1 and in assigning lessons1 there should not be taken into consideration all the circumstances of the pupil's life which can be conveniently ascertained1 even though those circumstances are most unfavorable to school work and are brought about mainly through the ignorance or folly of parents4 ,of course there is a limit to such an adjustment of work in school1 but with proper caution and a good understanding with the parents there need be little danger of advantage being taken by an indolent child2 nor need the school be affected when it is understood to be a sign of weakness rather than of favor to any particular pupil to lessen his work4 ,not unfrequently there are found other causes of ill health than those which ,i have mentioned2 such1 for instance1 as poor ventilation1 overheating of the school-room1 draughts of cold air1 and the like2 not to speak of the annual public exhibition1 with the possible nervous excitement attending it4 ,all of these things are mentioned1 not because they belong directly to the question of overwork1 but because it is well1 in considering the question1 to keep in mind all possible causes of ill health1 that no one cause may be unduly emphasized4#a ,footnote #a3 ,forty-ninth ,annual ,report of the ,massachusetts ,board of ,education1 p4 #bjd 7,john ,t4 ,prince74 ,in private schools the same kind of thing goes on1 with the addition of foreign languages1 and under the dull spur of discipline1 without the aid of any such necessities as stimulate the pupils of what we are pleased to call a normal 767 school4 ,in private schools for girls of what ,i may call the leisure class of society overwork is of course much more rare than in our normal schools for girls1 but the precocious claims of social life and the indifference of parents as to hours and systematic living needlessly add to the ever-present difficulties of the school-teacher1 whose control ceases when the pupil passes out of her house4 ,as to the school in which both sexes are educated together a word may be said4 ,surely no system can be worse than that which complicates a difficult problem by taking two sets of beings of different gifts1 and of unlike physiological needs and construction1 and forcing them into the same educational mould4 ,it is a wrong for both sexes4 ,not much unlike the boy in childhood1 there comes a time when in the rapid evolution of puberty the girl becomes for a while more than the equal of the lad1 and1 owing to her conscientiousness1 his moral superior1 but at this era of her life she is weighted by periodical disabilities which become needlessly hard to consider in a school meant to be both home and school for both sexes4 ,finally1 there comes a time when the matured man certainly surpasses the woman in persistent energy and capacity for unbroken brain-work4 ,if then she matches herself against him1 it will be1 with some exceptions1 at bitter cost4 ,it is sad to think that the demands of civilized life are making this contest almost unavoidable4 ,even if we admit equality of intellect1 the struggle with man is cruelly unequal and is to be avoided whenever it is possible4 ,the colleges for women1 such as ,vassar1 are nowadays more careful than they were4 ,indeed1 their machinery for guarding health while education of a high class goes on is admirable4 ,what they still lack is a correct public feeling4 ,the standard for health and endurance is too much that which would be normal for young men1 and the sentiment of these groups of women is silently opposed to admitting that the feminine life has necessities which do not cumber that of man4 ,thus the unwritten code remains in a measure hostile to the accepted laws which are supposed to rule4 ,as concerns our colleges for young men ,i have little to say4 ,the cases ,i see of breakdown among women between sixteen and nineteen who belong to normal schools or female colleges are out of all proportion larger than the number of like failures among young men of the same ages1 and yet1 as ,i have hinted1 the arrangements for watching the health of these groups of women are usually better than such as the colleges for young men provide4 ,the system of professional guardianship at ,johns ,hopkins is an admirable exception1 and at some other institutions the physical examination on matriculation becomes of the utmost value1 when followed up as it is in certain of these schools by compulsory physical training and occasional re-examinations of the state of health4 ,i do not see why the whole matter could not in all colleges be systematically made part of the examinations on entry upon studies4 ,it would at least point out to the thoughtful student his weak points1 and enable him to do his work and take his exercise with some regard to consequences4 ,i have over and over seen young men with weak hearts or unsuspected valvular troubles who had suffered from having been allowed to play foot-ball4 ,cases of cerebral trouble in students1 due to the use of defective eyes1 are common1 and ,i have known many valuable lives among male and female students crippled hopelessly owing to the fact that no college pre-examination of their state had taught them their true condition1 and that no one had pointed out to them the necessity of such correction by glasses as would have enabled them as workers to compete on even terms with their fellows4 ,in a somewhat discursive fashion ,i have dwelt upon the mischief which is pressing to-day upon our girls of every class in life4 ,the doctor knows how often and how earnestly he is called upon to remonstrate against this growing evil4 ,he is1 of course1 well enough aware that many sturdy girls stand the strain1 but he knows also that very many do not1 and that the brain1 sick with multiplied studies and unwholesome home life1 plods on1 doing poor work1 until somebody wonders what is the matter with that girl2 or she is left to scramble through1 or break down with weak eyes1 headaches1 neuralgias1 or what not4 ,i am perfectly confident that ,i shall be told here that girls ought to be able to study hard between fourteen and eighteen years without injury1 if boys can do it4 ,practically1 however1 the boys of to-day are getting their toughest education later and later in life1 while girls leave school at the same age as they did thirty years ago4 ,it used to be common for boys to enter college at fourteen3 at present1 eighteen is a usual age of admission at ,harvard or ,yale4 ,now1 let any one compare the scale of studies for both sexes employed half a century ago with that of to-day4 ,he will find that its demands are vastly more exacting than they were1--a difference fraught with no evil for men1 who attack the graver studies later in life1 but most perilous for girls1 who are still expected to leave school at eighteen or earlier4#a ,footnote #a3 ,witness ,richardson's heroine1 who was perfect mistress of the four rules of arithmetic6 ,i firmly believe--and ,i am not alone in this opinion--that as concerns the physical future of women they would do far better if the brain were very lightly tasked and the school hours but three or four a day until they reach the age of seventeen at least4 ,anything1 indeed1 were better than loss of health2 and if it be in any case a question of doubt1 the school should be unhesitatingly abandoned or its hours lessened1 as at least in part the source of very many of the nervous maladies with which our women are troubled4 ,i am almost ashamed to defend a position which is held by many competent physicians1 but an intelligent friend1 who has read this page1 still asks me why it is that overwork of brain should be so serious an evil to women at the age of womanly development4 ,my best reply would be the experience and opinions of those of us who are called upon to see how many school-girls are suffering in health from confinement1 want of exercise at the time of day when they most incline to it1 bad ventilation1#a and too steady occupation of mind4 ,at no other time of life is the nervous system so sensitive1--so irritable1 ,i might say1--and at no other are abundant fresh air and exercise so important4 ,to show more precisely how the growing girl is injured by the causes just mentioned would lead me to speak of subjects unfit for full discussion in these pages1 but no thoughtful reader can be much at a loss as to my meaning4 ,footnote #a3 ,in the city where this is written there is1 so far as ,i know1 not one private girls' school in a building planned for a school-house4 ,as a consequence1 we hear endless complaints from young ladies of overheated or chilly rooms4 ,if the teacher be old1 the room is kept too warm2 if she be young1 and much afoot about her school1 the apartment is apt to be cold4 ,the following remarks ,i owe to the experience of a friend1#a a woman1 who kindly permits me to use them in full4 ,they complete what ,i have space to add as to the matter of education1 and deserve to be read with care by every parent and by every one concerned in our public schools4 ,footnote #a3 ,miss ,pendleton4 ,there can be no question that the health of growing girls is overtaxed2 but1 in my opinion1 this is a vice of the age1 and not primarily of the schools4 ,i have found teachers more alive to it than parents or the general public4 ,upon interrogating a class of forty girls1 of ages varying from twelve to fourteen1 ,i found that more than half the number were conscious of loss of sleep and nervous apprehension before examinations2 but ,i discovered1 upon further inquiry1 that nearly one-half of this class received instruction in one or two branches outside of the school curriculum1 with the intention of qualifying to become teachers4 ,i could get no information as to appetite or diet2 all of the class1 as the teacher informed me1 being ashamed to give information on questions of the table4 ,in the opinion of this teacher1 nervousness and sleeplessness are somewhat due to studies and in-door social amusements in addition to regular school work2 but chiefly to ignorance in the home as to the simplest rules of healthy living4 ,nearly all the girls in this class drink a cup of tea before leaving home1 eat a sweet biscuit as they walk1 hurried and late1 to school1 and nothing else until they go home to their dinners at two o'clock4 ,all their brain-work in the school-room is done before eating any nourishing food4 ,the teacher realized the injurious effects of the present forcing system1 and suggested withdrawing the girls from school for one year between the grammar- and high-school grades4 ,when ,i asked whether a better result would not be obtained by keeping the girls in school during this additional year1 but relieving the pressure of purely mental work by the introduction throughout all the grades of branches in household economy1 she said this seemed to her ideal1 but1 she feared1 impracticable1 not from the nature of schools1 but from the nature of boards4 ,a ,latin graduating class of seven girls1 aged seventeen and eighteen years1 stated that they do their work without nervousness1 restlessness1 or apprehension4 ,this1 with other statistics1 would seem to bear out your theory that after seventeen girls may study with much less risk to health4 ,so far as ,i have observed1 the strain or tear is chiefly in the case of girls studying to become teachers4 ,these girls often press forward too rapidly for the purpose of becoming self-supporting at the age of eighteen4 ,the bait of a salary1 and a good salary for one entering upon a profession1 lures them on2 and a false sympathy in members of boards and committees lends itself to this injurious cramming4 ,our own normal school1#a which is doing a great1 an indispensable1 work in preparing a trained body of faithful1 intelligent teachers1 has succumbed to this injurious tendency4 ,we have here the high and normal grades merged into one1 the period of adolescence stricken out of the girl's school life1 and many hundreds of girls hurried annually forward beyond their physical or mental capacity1 in advance of their physical growth1 for the sake of those who cannot afford to remain in school one or two years longer4 ,i say this notwithstanding the fact that this school is1 in my opinion1 one of the most potent agencies for good in the community4 ,footnote #a3 ,philadelphia4 ,overpressure in school appears to me to be a disease of the body politic from which this member suffers2 but it also seems to me that this vast school system is the most powerful agency for the correction of the evil4 ,in the case of girls1 the first principle to be recognized is that the education of women is a problem by itself2 that1 in all its lower grades at all events1 it is not to be laid down exactly upon the lines of education for boys4 ,the school system may be made a forceful agency for building up the family1 and the integrity of the home is without doubt the vital question of the age4 ,edward ,everett ,hale1 with his far spiritual sight1 has discerned the necessity for restoring home training1 and advocates1 to this end1 short school terms of a few weeks annually4 ,it is probable that in the future many school departments will be relegated to the home1 but the homes are not now prepared to assume these duties4 ,when it was discovered that citizens must be prepared for their political duties the schools were opened2 but the means so far became an end that even women were educated only in the directions which bear upon public and not upon household economy4 ,the words of ,stein1 that 'what we put into the schools will come out in the manhood of the nation afterward1' cannot be too often quoted4 ,let branches in household economy be connected with all the general as distinguished from normal-school grades1 and we not only relieve the girl immediately of the strain of working with insufficient food1 and of acquiring skill in household duties in addition to the school curriculum1 we not only simplify and harmonize her work1 but we send out in every case a woman prepared to carry this new influence into all her future life1 even if a large number of these women should eventually pursue special or higher technical branches2 for we are women before we are teachers1 lawyers1 physicians1 etc41 and if we are to add anything of distinctive value to the world by entering upon the fields of work hitherto pre-empted by men1 it will be by the essential quality of this new feminine element4 ,the strain in all work comes chiefly from lack of qualification by training or nature for the work in hand1--tear in place of wear4 ,the schools can restore the ideal of quiet work4 ,they have an immense advantage in regularity1 discipline1 time4 ,this vast system gives an opportunity1 such as no private schools offer1 for ascertaining the average work which is healthful for growing girls4 ,it is quite possible to ascertain1 whether by women medical officers appointed to this end1 or by the teachers themselves1 the physical capacity of each girl1 and to place her where this will not be exceeded4 ,girls trained in school under such wise supervision would go out into life qualified to guard the children of the future4 ,the chief cause of overwork of children at present is the ignorance of parents as to the injurious effects of overwork1 and of the signs of its influence4 ,the first step toward the relief of over-pressure and false stimulus is to discard the pernicious idea that it is the function of the normal school to offer to every girl in the community the opportunity for becoming a teacher4 ,this unwholesome feature is the one distinctive strain which must be removed from the system4 ,it can be done provided public and political sentiment approve4 ,the normal school should be only a device for securing the best possible body of teachers4 ,it should be technical4 ,every teacher knows that the average girl of seventeen has not reached the physical1 mental1 or moral development necessary to enter upon this severe and high professional course of studies1 and that one year is insufficient for such a course4 ,lengthen the time given to normal instruction1--make it two years2 give in this school instruction purely in the science of education2 relegate all general instruction to a good high school covering a term of four years4 ,in this as in all other progressive formative periods the way out is ahead4 ,it will be time enough to talk of doing away with a portion of the girls' school year when the schools have fulfilled their high mission1 when they have sent out a large body of ,american women prepared1 not for a single profession1 even the high feminine vocation of pedagogy1 but equipped for her highest1 most general and congenial functions as the source and centre of the home4 ,i am unwilling to leave this subject without a few words as to our remedy1 especially as concerns our public schools and normal schools for girls4 ,what seems to me to be needed most is what the woman would bring into our school boards4 ,surely it is also possible for female teachers to talk frankly to that class of girls who learn little of the demands of health from uneducated or busy or careless mothers1 and it would be as easy1 if school boards were what they should be1 to insist on such instruction1 and to make sure that the claims of maturing womanhood are considered and attended to4 ,should ,i be told that this is impracticable1 ,i reply that as high an authority as ,samuel ,eliot1 of ,massachusetts1 has shown in large schools that it is both possible and valuable4 ,as concerns the home life1 it is also easy to get at the parents by annual circulars enforcing good counsel as to some of the simplest hygienic needs in the way of sleep1 hours of study1 light1 and meals4 ,it were better not to educate girls at all between the ages of fourteen and eighteen1 unless it can be done with careful reference to their bodily health4 ,to-day1 the ,american woman is1 to speak plainly1 too often physically unfit for her duties as woman1 and is perhaps of all civilized females the least qualified to undertake those weightier tasks which tax so heavily the nervous system of man4 ,she is not fairly up to what nature asks from her as wife and mother4 ,how will she sustain herself under the pressure of those yet more exacting duties which nowadays she is eager to share with the man8 ,while making these stringent criticisms1 ,i am anxious not to be misunderstood4 ,the point which above all others ,i wish to make is this1 that owing chiefly to peculiarities of climate1 our growing girls are endowed with organizations so highly sensitive and impressionable that we expose them to needless dangers when we attempt to overtax them mentally4 ,in any country the effects of such a course must be evil1 but in ,america ,i believe it to be most disastrous4 ,as ,i have spoken of climate in the broad sense as accountable for some peculiarities of the health of our women1 so also would ,i admit it as one of the chief reasons why work among men results so frequently in tear as well as wear4 ,i believe that something in our country makes intellectual work of all kinds harder to do than it is in ,europe2 and since we do it with a terrible energy1 the result shows in wear very soon1 and almost always in the way of tear also4 ,perhaps few persons who look for evidence of this fact at our national career alone will be willing to admit my proposition1 but among the higher intellectual workers1 such as astronomers1 physicists1 and naturalists1 ,i have frequently heard this belief expressed1 and by none so positively as those who have lived on both continents4 ,since this paper was first written ,i have been at some pains to learn directly from ,europeans who have come to reside in ,america how this question has been answered by their experience4 ,for obvious reasons1 ,i do not name my witnesses1 who are numerous2 but1 although they vary somewhat in the proportion of the effects which they ascribe to climate and to such domestic peculiarities as the overheating of our houses1 they are at one as regards the simple fact that1 for some reason1 mental work is more exhausting here than in ,europe2 while1 as a rule1 such ,americans as have worked abroad are well aware that in ,france and in ,england intellectual labor is less trying than it is with us4 ,a great physiologist1 well known among us1 long ago expressed to me the same opinion2 and one of the greatest of living naturalists1 who is honored alike on both continents1 is positive that brain-work is harder and more hurtful here than abroad1 an opinion which is shared by ,oliver ,wendell ,holmes and other competent observers4 ,certain it is that our thinkers of the classes named are apt to break down with what the doctor knows as cerebral exhaustion1--a condition in which the mental organs become more or less completely incapacitated for labor1--and that this state of things is very much less common among the savans of ,europe4 ,a share in the production of this evil may perhaps be due to certain general habits of life which fall with equal weight of mischief upon many classes of busy men1 as ,i shall presently point out4 ,still1 these will not altogether account for the fact1 nor is it to my mind explained by any of the more obvious faults in our climate1 nor yet by our habits of life1 such as furnace-warmed houses1 hasty meals1 bad cooking1 or neglect of exercise4 ,let a man live as he may1 ,i believe he will still discover that mental labor is with us more exhausting than we could wish it to be4 ,why this is ,i cannot say1 but it is not more mysterious than the fact that agents which1 as sedatives or excitants1 affect the great nerve-centres1 do this very differently in different climates4 ,there is some evidence to show that this is also the case with narcotics2 and perhaps a partial explanation may be found in the manner in which the excretions are controlled by external temperatures1 as well as by the fact which ,dr4 ,brown-,squard discovered1 and which ,i have frequently corroborated1 that many poisons are retarded in their action by placing the animal affected in a warm atmosphere4 ,it is possible to drink with safety in ,england quantities of wine which here would be disagreeable in their first effect and perilous in their ultimate results4 ,the ,cuban who takes coffee enormously at home1 and smokes endlessly1 can do here neither the one nor the other to the same degree4 ,and so also the amount of excitation from work which the brain will bear varies exceedingly with variations of climatic influences4 ,we are all of us familiar with the fact that physical work is more or less exhausting in different climates1 and as ,i am dealing1 or about to deal1 with the work of business men1 which involves a certain share of corporal exertion1 as well as with that of mere scholars1 ,i must ask leave to digress1 in order to show that in this part of the country at least the work of the body probably occasions more strain than in ,europe1 and is followed by greater sense of fatigue4 ,the question is certainly a large one1 and should include a consideration of matters connected with food and stimulants1 on which ,i can but touch4 ,i have carefully questioned a number of master-mechanics who employ both foreigners and native ,americans1 and ,i am assured that the ,british workman finds labor more trying here than at home2 while perhaps the eight-hour movement may be looked upon as an instinctive expression of the main fact as regards our working class in general4 ,a distinguished ,english scholar informs me that since he has resided among us the same complaints1 as to the depressing effects of physical labor in ,america1 have come to him from skilled ,english mechanics4 ,what share change of diet and the like may have in the matter ,i have not space to discuss4#a ,footnote #a3 ,the new emigrant suffers in a high degree from the same evils as to cookery which affect only less severely the mass of our people1 and this1 no doubt1 helps to enfeeble him4 ,the frying-pan has1 ,i fear1 a better right to be called our national emblem than the eagle1 and ,i grieve to say it reigns supreme west of the ,alleghanies4 ,i well remember that a party of friends about to camp out were unable to buy a gridiron in two ,western towns1 each numbering over four thousand eaters of fried meats4 ,although1 from what ,i have seen1 ,i should judge that overtasked men of science are especially liable to the trouble which ,i have called cerebral exhaustion1 all classes of men who use the brain severely1 and who have also--and this is important--seasons of excessive anxiety or of grave responsibility1 are subject to the same form of disease2 and this ,i presume is why we meet with numerous instances of nervous exhaustion among merchants and manufacturers4 ,the lawyer and clergyman offer examples1 but ,i do not remember to have seen many bad cases among physicians4 ,dismissing the easy jest which the latter statement will surely suggest1 the reason for this we may presently encounter4 ,my note-books seem to show that manufacturers and certain classes of railway officials are the most liable to suffer from neural exhaustion4 ,next to these come merchants in general1 brokers1 etc42 then less frequently clergymen2 still less often lawyers2 and more rarely doctors2 while distressing cases are apt to occur among the overschooled young of both sexes4 ,the worst instances to be met with are among young men suddenly cast into business positions involving weighty responsibility4 ,i can recall several cases of men under or just over twenty-one who have lost health while attempting to carry the responsibilities of great manufactories4 ,excited and stimulated by the pride of such a charge1 they have worked with a certain exaltation of brain1 and1 achieving success1 have been stricken down in the moment of triumph4 ,this too frequent practice of immature men going into business1 especially with borrowed capital1 is a serious evil4 ,the same person1 gradually trained to naturally and slowly increasing burdens1 would have been sure of healthy success4 ,in individual cases ,i have found it so often vain to remonstrate or to point out the various habits which collectively act for mischief on our business class that ,i may well despair of doing good by a mere general statement4 ,as ,i have noted them1 connected with cases of overwork1 they are these3 late hours of work1 irregular meals bolted in haste away from home1 the want of holidays and of pursuits outside of business1 and the consequent practice of carrying home1 as the only subject of talk1 the cares and successes of the counting-house and the stock-board4 ,most of these evil habits require no comment4 ,what1 indeed1 can be said8 ,the man who has worked hard all day1 and lunched or dined hastily1 comes home or goes to the club to converse--save the mark6--about goods and stocks4 ,holidays1 except in summer1 he knows not1 and it is then thought time enough taken from work if the man sleeps in the country and comes into a hot city daily1 or at the best has a week or two at the sea-shore4 ,this incessant monotony tells in the end4 ,men have confessed to me that for twenty years they had worked every day1 often travelling at night or on ,sundays to save time1 and that in all this period they had not taken one day for play4 ,these are extreme instances1 but they are also in a measure representative of a frightfully general social evil4 ,is it any wonder if asylums for the insane gape for such men8 ,there comes to them at last a season of business embarrassment2 or1 when they get to be fifty or thereabouts1 the brain begins to feel the strain1 and just as they are thinking1 ,now we will stop and enjoy ourselves1 the brain1 which1 slave-like1 never murmurs until it breaks out into open insurrection1 suddenly refuses to work1 and the mischief is done4 ,there are therefore two periods of existence especially prone to those troubles1--one when the mind is maturing2 another at the turning-point of life1 when the brain has attained its fullest power1 and has left behind it accomplished the larger part of its best enterprise and most active labor4 ,i am disposed to think that the variety of work done by lawyers1 their long summer holiday1 their more general cultivation1 their usual tastes for literary or other objects out of their business walks1 may1 to some extent1 save them1 as well as the fact that they can rarely be subject to the sudden and fearful responsibilities of business men4 ,moreover1 like the doctor1 the lawyer gets his weight upon him slowly1 and is thirty at least before it can be heavy enough to task him severely4 ,the business man's only limitation is need of money1 and few young mercantile men will hesitate to enter trade on their own account if they can command capital4 ,with the doctor1 as with the lawyer1 a long intellectual education1 a slowly-increasing strain1 and responsibilities of gradual growth tend1 with his out-door life1 to save him from the form of disease ,i have been alluding to4 ,this element of open-air life1 ,i suspect1 has a share in protecting men who in many respects lead a most unhealthy existence4 ,the doctor1 who is supposed to get a large share of exercise1 in reality gets very little after he grows too busy to walk1 and has then only the incidental exposure to out-of-door air4 ,when this is associated with a fair share of physical exertion1 it is an immense safeguard against the ills of anxiety and too much brain-work4 ,for these reasons ,i do not doubt that the effects of our great civil war were far more severely felt by the ,secretary of ,war and ,president ,lincoln than by ,grant or ,sherman4 ,the wearing1 incessant cares of overwork1 of business anxiety1 and the like1 produce directly diseases of the nervous system1 and are also the fertile parents of dyspepsia1 consumption1 and maladies of the heart4 ,how often we can trace all the forms of the first-named protean disease to such causes is only too well known to every physician1 and their connection with cardiac troubles is also well understood4 ,happily1 functional troubles of heart or stomach are far from unfrequent precursors of the graver mischief which finally falls upon the nerve-centres if the lighter warnings have been neglected2 and for this reason no man who has to use his brain energetically and for long periods can afford to disregard the hints which he gets from attacks of palpitation of heart or from a disordered stomach4 ,in many instances these are the only expressions of the fact that he is abusing the machinery of mind or body2 and the sufferer may think himself fortunate that this is the case1 since even the least serious degrees of direct exhaustion of the centres with which he feels and thinks are more grave and are less open to ready relief4 ,when affections of the outlying organs are neglected1 and even in many cases where these have not suffered at all1 we are apt to witness1 as a result of too prolonged anxiety combined with business cares1 or even of mere overwork alone1 with want of proper physical habits as to exercise1 amusement1 and diet1 that form of disorder of which ,i have already spoken as cerebral exhaustion2 and before closing this paper ,i am tempted to describe briefly the symptoms which warn of its approach or tell of its complete possession of the unhappy victim4 ,why it should be so difficult of relief is hard to comprehend1 until we remember that the brain is apt to go on doing its weary work automatically and despite the will of the unlucky owner2 so that it gets no thorough rest1 and is in the hapless position of a broken limb which is expected to knit while still in use4 ,where physical overwork has worn out the spinal or motor centres1 it is1 on the other hand1 easy to enforce repose1 and so to place them in the best condition for repair4 ,this was often and happily illustrated during the late war4 ,severe marches1 bad food1 and other causes which make war exhausting1 were constantly in action1 until certain men were doing their work with too small a margin of reserve-power4 ,then came such a crisis as the last days of ,mc,clellan's retreat to the ,james ,river1 or the forced march of the ,sixth ,army ,corps to ,gettysburg1 and at once these men succumbed with palsy of the legs4 ,a few months of absolute rest1 good diet1 ale1 fresh beef and vegetables restored them to perfect health4 ,in all probability incessant use of a part flushes with blood the nerve-centres which furnish it with motor energy1 so that excessive work may bring about a state of congestion1 owing to which the nerve-centre becomes badly nourished1 and at last strikes work4 ,in civil life we sometimes meet with such cases among certain classes of artisans3 paralysis of the legs as a result of using the treadle of the sewing-machine ten hours a day is a good example1 and1 ,i am sorry to add1 not a very rare one1 among the overtasked women who slave at such labor4 ,now let us see what happens when the intellectual organs are put over-long on the stretch1 and when moral causes1 such as heavy responsibilities and over-anxiety1 are at work4 ,when in active use1 the thinking organs become full of blood1 and1 as has been shown1 rise in temperature1 while the feet and hands become cold4 ,nature meant that1 for their work1 they should be1 in the first place1 supplied with food2 next1 that they should have certain intervals of rest to rid themselves of the excess of blood accumulated during their periods of activity1 and this is to be done by sleep1 and also by bringing into play the physical machinery of the body1 such as the muscles1--that is to say1 by exercise which flushes the parts engaged in it and so depletes the brain4 ,she meant1 also1 that the various brain-organs should aid in the relief1 by being used in other directions than mere thought2 and lastly1 she desired that1 during digestion1 all the surplus blood of the body should go to the stomach1 intestines1 and liver1 and that neither blood nor nerve-power should be then misdirected upon the brain3 in other words1 she did not mean that we should try to carry on1 with equal energy1 two kinds of important functional business at once4 ,if1 then1 the brain-user wishes to be healthy1 he must limit his hours of work according to rules which will come of experience1 and which no man can lay down for him4 ,above all1 let him eat regularly and not at too long intervals4 ,i well remember the amazement of a distinguished naturalist when told that his sleeplessness and irregular pulse were due to his fasting from nine until six4 ,a biscuit and a glass of porter1 at one o'clock1 effected a ready and pleasant cure4 ,as to exercise in the fresh air1 ,i need say little1 except that if the exercise can be made to have a distinct object1 not in the way of business1 so much the better4 ,nor should ,i need to add that we may relieve the thinking and worrying mechanisms by light reading and other amusements1 or enforce the lesson that no hard work should be attempted during digestion4 ,the wise doctor may haply smile at the commonplace of such directions1 but woe be to the man who neglects them6 ,when an overworked and worried victim has sufficiently sinned against these simple laws1 if he does not luckily suffer from disturbances of heart or stomach1 he begins to have certain signs of nervous exhaustion4 ,as a rule1 one of two symptoms appears first1 though sometimes both come together4 ,work gets to be a little less facile2 this astonishes the subject1 especially if he has been under high pressure and doing his tasks with that ease which comes of excitement4 ,with this1 or a little later1 he discovers that he sleeps badly1 and that the thoughts of the day infest his dreams1 or so possess him as to make slumber difficult4 ,unrefreshed1 he rises and plunges anew into the labor for which he is no longer competent4 ,let him stop here2 he has had his warning4 ,day after day the work grows more trying1 but the varied stimulants to exertion come into play1 the mind1 aroused1 forgets in the cares of the day the weariness of the night season1 and so1 with lessening power and growing burden1 he pursues his purpose4 ,at last come certain new symptoms1 such as giddiness1 dimness of sight1 neuralgia of the face or scalp1 with entire nights of insomnia and growing difficulty in the use of the mental powers2 so that to attempt a calculation1 or any form of intellectual labor1 is to insure a sense of distress in the head1 or such absolute pain as proves how deeply the organs concerned have suffered4 ,even to read is sometimes almost impossible2 and there still remains the perilous fact that under enough of moral stimulus the man may be able1 for a few hours1 to plunge into business cares1 without such pain as completely to incapacitate him for immediate activity4 ,night1 however1 never fails to bring the punishment2 and at last the slightest prolonged exertion of mind becomes impossible4 ,in the worst cases the scalp itself grows sore1 and a sudden jar hurts the brain1 or seems to do so1 while the mere act of stepping from a curb-stone produces positive pain4 ,strange as it may seem1 much of all this may happen to a man1 and he may still struggle onward1 ignorant of the terrible demands he is making upon an exhausted brain4 ,usually1 by this time he has sought advice1 and1 if his doctor be worthy of the title1 has learned that while there are certain aids for his symptoms in the shape of drugs1 there is only one real remedy4 ,happy he if not too late in discovering that complete and prolonged cessation from work is the one thing needful4 ,not a week of holiday1 or a month1 but probably a year or more of utter idleness may be absolutely essential4 ,only this will answer in cases so extreme as that which ,i have tried to depict1 and even this will not always insure a return to a state of active working health4 ,i am very far from conceding that the vehement energy with which we do our work is due altogether to greed4 ,we probably idle less and play less than any other race1 and the absence of national habits of sport1 especially in the ,west1 leaves the man of business with no inducement to abandon that unceasing labor in which at last he finds his sole pleasure4 ,he does not ride1 or shoot1 or fish1 or play any game but euchre4 ,business absorbs him utterly1 and at last he finds neither time nor desire for books4 ,the newspaper is his sole literature2 he has never had time to acquire a taste for any reading save his ledger4 ,honest friendship for books comes with youth or1 as a rule1 not at all4 ,at last his hour of peril arrives4 ,then you may separate him from business1 but you will find that to divorce his thoughts from it is impossible4 ,the fiend of work he raised no man can lay4 ,as to foreign travel1 it wearies him4 ,he has not the culture which makes it available or pleasant4 ,notwithstanding the plasticity of the ,american1 he is now without resources4 ,what then to advise ,i have asked myself countless times4 ,let him at least look to it that his boys go not the same evil road4 ,the best business men are apt to think that their own successful careers represent the lives their children ought to follow1 and that the four years of college spoil a lad for business4 ,in reality these years1 be they idle or well filled with work1 give young men the custom of play1 and surround them with an atmosphere of culture which leaves them with bountiful resources for hours of leisure1 while they insure to them in these years of growth wholesome1 unworried freedom from such business pressure as the successful parent is so apt to put on too youthful shoulders4 ,somewhat distracted by the desire to be brief1 and yet to tell the whole story1 ,i have sought1 in what ,i fear is a very loose and disconnected way1 to put in a new light some of the evils which are hurting the mothers of our race1 and those which every day's experience teaches the doctor are gravely affecting the working capacity of numberless men4 ,i trust ,i have succeeded in satisfying my readers that we dwell in a climate where work of all kinds demands greater precautions as to health than is the case abroad4 ,we cannot improve our climate1 but it is quite possible that we have not sufficiently learned to modify the conditions of labor in accordance with those of the sky under which we live4 ,no student of the nervous maladies of ,american men and women will think ,i have overdrawn any part of the foregoing sketch4 ,it would have been as easy1 had such a course been proper1 to tell the individual stories of youth1 vigorous1 eager1 making haste to be rich1 wrecked and made unproductive and dependent for years or forever2 and of middle age1 unable or unwilling to pause in the career of dollar-getting1 crushed to earth in the hour of fruition1 or made powerless to labor longer at any cost for those who were dearest4 ,,the ,,end4