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The Cuases Of Nervousness (Environment)

( Originally Published 1908 )

NERVOUSNESS in its manifold forms is often called a disease of civilization. "Without civilization there can be no nervousness; there is no race, no climate, no environment that can make nervousness and nervous disease possible and common, save when reinforced by man's work and worry and indoor life." While there is a large element of truth in this saying, it is certain that the severer forms of nervous disease, epilepsy, melancholia, mania, and idiocy, are and have been well known to barbaric and savage life. Civilization has unquestionably enhanced longevity, yet the vaster and the more complex the environment to which we must adjust ourselves, the greater are the demands made upon our nervous system. In this sense nervousness is the child of civilization, and the more life demands of us the more nervousness is destined to spread both by the creation of new types and by the transmission of old ones. Unless we find some better means than we possess at present to calm and simplify our lives, the 'end of our civilization is in sight, for we cannot continue to use up our forces faster than those forces are generated. Humanity, however, has a wonderful capacity for renewing itself. When the disease be-comes pressing the cure comes. In this case the relief is already in sight. It will come in the discovery and use of those inexhaustible subconscious powers which have their roots in the Infinite. As a runner exhausts his "first wind" and then taps a new source of energy which carries him indefinitely on, so humanity will not falter in its race. Soon it will learn the great lesson of "hitching its wagon to a star," and then it will no longer faint and stagger on its way as it does now while it childishly insists on carrying its burden on the weak shoulders of flesh. Moreover it is to be remembered that work seldom injures, it is worry which undermines the health. Much has been written on this subject of the highest value by the so-called Metaphysical School, to which I am glad at last to pay my respects.' Here I shall only attempt to review some of the prevailing conditions of our social and moral life which act unfavorably upon our nervous system.

Among all the predisposing causes of nervousness, the first place must be assigned to drunkenness. No other source of mental and nervous disease can be pointed to with anything like the same certainty. Alcoholic poisoning is believed by many eminent physiologists to infect the reproductive germs, in opposition to Weissmann's theory which certainly finds no support in the history of nervous disease. Von Bunge, arguing this question, calls attention to the fact that the daughters of drunkards are seldom able to nurse their babies, their milk being deficient in quantity and in nourishing elements. Be this as it may, it is certain that the posterity of drunkards suffers to an almost incredible extent from the milder and the severer forms of mental and nervous disease. For this reason the great neurologists, e.g., Forel, Möbius, and Weir Mitchell, have been great advocates of temperance. Möbius goes so far as to say, "In my opinion the wide-spread conditions of weakness which we call nervousness, neurasthenia, etc., in the majority of cases are due to the intemperate habits of parents. People are apt to think that the strenuousness of life, the demands of business and other influences, create nervous weakness. But it is very probable that the telephone, railroads, and the demands of business have no injurious effect upon well people. They may rack their nerves for awhile, but they certainly do not create the conditions which we encounter daily in our office hours. Examination reveals the fact that the majority of these patients have never been really well, that their maladies began in childhood."' Of course the more seriously the father has injured his brain and nervous system through alcoholic indulgence, the more serious the disorders he is likely to bequeath to his children. But it would be a great mistake to imagine that the habits of so-called moderate drinkers have no effect on posterity. To this cause as much as to any other is due the short life of so many prosperous American families, which frequently become extinct in the third or fourth generation. The founder of the family's affluence makes his way by intelligence, sobriety, and hard work, but he desires a different life for his son whom he brings up in luxury and pleasure. The son spends his time in enjoying and perhaps dissipating what his father earned and he frequently bequeaths a diminished fortune and an exhausted nervous system to his children. During the past ten years, thanks to the influence of our fine boys' schools and to the example of our great President, there has been a marked improvement in the ideals of our young men who are doomed to wealth. But this melancholy drama has been enacted so often as to be typical of a certain phase of American life. Luxury tears down the house which self-denial has built. Nor is this spectacle peculiar to America. P. Buchner in his interesting examination of the conditions of life in Hamburg comes to the same conclusion. He says : " Generally the third generation (of affluent families) sinks back into the great impoverished mass out of which the founder of a commercial house arose. Hence there are few Hamburg families which have been able to maintain themselves for more than a hundred years. Of the old patrician families which established the Hanseatic League, not one remains to-day. Only new names figure on the Ham-burg exchange."

One of the most ominous signs of the times is the Iarge amount of alcohol consumed by business men, not for pleasure, but as a stimulus to flagging powers or to stimulate digestion. In this way a man who regards himself as quite temperate will consume from four to six cocktails or other alcoholic beverages daily without suspecting that he is undermining his nervous system or that of his children. Yet we are constantly confronted with defective and hysterical boys and girls who owe their enfeebled constitutions in no slight degree to their father's habit of moderate but constant tippling. Nervousness is regarded as peculiarly a disease of girls and women, but a nervous system which requires frequent alcoholic stimulation in order to function is certainly diseased. No nervousness is worse than alcoholic nervousness, and a man who can maintain himself only with the assistance of alcohol will not maintain himself long. Unfortunately, if he has children he will not suffer alone. Our civilization, as Môbius remarks, is built on alcohol, and as the flood of alcohol rises the prevalence of neurotic weakness rises with it.' To this rule as to all other generalizations on mankind, the Jews form an exception, as they are both sober and nervous. On the other hand, Americans on account of their peculiarly nervous temperament are less able to resist alcoholic poisoning than other peoples.

After alcoholism perhaps the most general cause of nervous affection is venereal disease and the moral and physical consequences of illicit sexual relations. The memorial presented to the diocesan convention of the Episcopal Church in Massachusetts in 19o7 on the state of morals reveals the alarming extent to which virtuous married women are inoculated with venereal disease by their husbands, and our hospital reports tell the same story. From these infected unions when they are not sterile springs a race of infirm, debilitated children who frequently bear on the body and soul the imprint of their father's sins. Apart from its corroding action on the mucous membranes, the epidermis, and the bones, the poison of syphilis not infrequently attacks the brain, the spinal cord and the nerves. Even those from whose systems the actual virus of syphilis has been eliminated continue to suffer from general debility and from a nervous dread of a fresh outbreak of the disease.

As the conditions of life grow more complex and the craving for luxurious living becomes more universal, marriage becomes more difficult and tends constantly to be postponed to a later period of life. The result of this is a constant increase of sexual vice. Prostitution is the cancer' of our civilization, and apparently it is inseparable from it. It is the penalty we pay for our ideal of monogamy, which in the present state of humanity can never be perfectly realized. The result is the existence of a large class of sad and degenerate beings which polygamous countries hardly know, a class branded by every infamy, preyed upon by every brutal passion and by the foulest disease. That women of this class suffer from every form of nervous, mental, and moral disease, that their lives are short and that they are frequently shortened by suicide, goes without saying. No human being suffers so disproportionately for human frailty as the fallen woman.

Apart from recognized prostitution, many tendencies of contemporary society encourage temporary and irresponsible unions to an extent hitherto unknown in our American life. Among these tendencies I should include the increasing difficulty of marriage and the frequency of divorce, the loss of religious faith with its attending relaxation of ethical standards, the increasing love of pleasure, and above all the industrial conditions as they affect woman. Girls and young women who were formerly brought up in the privacy of the home and under parental control are now found in large stores and factories, and in offices where, freed from all moral restraint, they work side by side with men, often for wages which barely suffice for subsistence. The result is an immense increase in irregular or temporary sexual connections. Nor do I imagine for a moment that such relations are peculiar to the working classes. One of the revelations of our work has been the large number of men and women, frequently of the highest station, who are suffering from disturbances originating in the sexual life.

The effects of a "double life" upon the nervous system are unmistakable. "He who lives more lives than one, More deaths than one must die," says Oscar Wilde. Probably women, who have more at stake and whose moral sensibility is greater, suffer more from this cause than men. The intense excitement which attends such experiences, the remorse they frequently inspire, the burden of a guilty conscience, the element of falsehood and secrecy which they introduce into life, fear of discovery, dread of consequences, and the horror which attends the discovery of pregnancy all react powerfully upon the nervous system and they may lead to insanity. Goethe has depicted the depth of woe and guilt into which an innocent girl may be plunged through her affections, and in Margaret's madness and death he has given the tragic ending of these crooked paths. Balzac in the wonderful trilogy which describes the utter ruin of Lucien de Rubempré, and in his terrible Cousine Bette, has laid an even more unsparing finger upon this open sore of our civilization. Frequently more dangerous than the moral emotions I have mentioned is the deep-rooted dissociation of personality which results from the attempt to lead two lives. On the other hand it ought to be remembered that sexual perversions and outbreaks are often the effect and not the cause of nervous conditions. The first duty of one so affected is to seek the advice and assistance of an experienced neurologist, and to avoid as he would the devil those dangerous so-called "specialists" who batten upon sexual vice and upon the morbid fears of their victims. Of sexual perversions I shall not speak except to say that they are recognized forms of mental and nervous disease which can frequently be removed by suggestion.

One of the most certain causes of nervousness is the overtaxing of the mental powers in childhood. It is well known that the human brain at birth is quite embryonic. Many of the nerve fibers have not received their medullary sheaths, the higher centers of speech, of word and visual memory, are not yet formed. The brain is not yet organized by habit.' In short the most important work of life is performed during the first six years. Man is born with a brain and nervous system differing but slightly from that of the anthropoid apes, but the modifications which take place in the former during these years separate him from the animal kingdom as a star is separate from the earth (Thomson). Every day is a voyage of discovery into an unknown world. The child's powers of observation, of attention and of memory are taxed to a degree which it is difficult for us to comprehend, and these difficult feats of memory, of imitation, of co-ordination and self-direction are performed through the instrumentality of organs which are yet imperfect, which are easily exhausted, and which require long and frequent periods of complete repose. In the face of these facts it is hardly necessary to say that during these tender years no additional burdens ought to be imposed, unless it be the acquisition of a second language which can then be acquired with the least difficulty. Above all things, the child's nervous system ought to be protected from all shocks and unnecessary stimulation. Those who care for it should be mild and free from nervousness. During this period an excess of mental application not only injures the brain, but checks growth and induces morbid precocities, e.g., premature sexual development (Möbius).

The beginning of school life, therefore, before the age of seven or eight is neither desirable, nor in the long run profitable. At an earlier period, if any instruction beyond normal development and the moral training of the home be thought necessary, the Kindergarten which trains the senses and which teaches useful lessons without fatiguing the attention is the best school for the young child. In fact it is the concentration of attention which is most difficult to a child. The child's powers of observation and of imitation are keen, but the attention is very volatile, and the attempt to fix the mind for any length of time on one thing produces a sense of fatigue which is the chief cause of the child's aversion to school and study.

The American school system has often been compared with the German to the distinct detriment of the former in respect to thoroughness and comprehensiveness and as regards sound scientific method. No doubt the principles of pedagogics have been studied and applied in Germany more successfully than elsewhere, and it is certain that German school-teachers as a class are far more learned than ours, but on the other hand our American schools are not responsible for the wrecking of nervous systems, the almost universal defects of vision, and the not infrequent suicides of children which are produced by the severity of the German school system, against which German physicians and men of science continually protest. The educational problems presented in the two countries are very different. The German school undertakes the training of a homogeneous people in a country where specialized knowledge is the chief avenue to success. Upon the American school is laid the duty and responsibility of transforming the off-spring of the most diverse races into American citizens, and of preparing its pupils for a life in which talent, moral character, and initiative play a larger part than learning. The first of these tasks it performs in a manner above all praise. No aspect of our civilization is more remarkable than our power of assimilating the various peoples of the earth and of transforming them into good and enthusiastic Americans full of love for our institutions. This miracle is performed for the most part by our public schools, which of late years have taken a far more liberal view of their moral and social duties and opportunities. Studies of public school life like those of Myra Kelly are full of interest from this point of view.

One injurious element in the early life of our rich children is its extreme complexity. The young children of well-to-do people have as many engagements as their fathers and mothers. As soon as one task is ended they are hurried to another. Then come children's parties, dances, rich food, late hours, etc. All this excitement and confusion and distraction of attention unquestionably react injuriously upon the nervous system and upon character. For this reason it is often best for boys to leave homes where there is really no place for them and to enter schools where life is simple and wholesome and where they will be thrown under the influence of manly men. As humanity rises higher the labors imposed upon youth become more severe, but it is a poor preparation for life to overtax and cripple these faculties and powers on which our happiness and our usefulness depend.

A frequent source of nervous debility in boys, less frequently in girls, is the habit of self-abuse, a vice that is shared with mankind by dogs and monkeys. Pernicious as are the effects of this wide-spread evil on body and mind, they are by no means so terrible as interested and mercenary persons pretend. Victims of this sad habit should know the truth in regard to it, for the morbid apprehension and fears created by the wilful misrepresentations of charlatans often produce in them nervous conditions which are more harmful than the effects of the vice itself. The "Incurable spinal disease" of which one hears never proceeds from this cause (Mains), weak-mindedness and imbecility very rarely. On the other hand no one can deny that serious moral and nervous affections follow the habitual practice of masturbation, and these are more serious in early life, and when, as is often the case, the victim is temporarily nervous and delicate. The physical symptoms are weakness, pallor and backache, and general debility. The effects on the brain and nervous system are more serious. They may dull the intellect, weaken the memory and the affections, produce listlessness, apathy, moroseness and morbid irritability, in short a general perversion of character. This habit may arise through a variety of causes, some of which are in themselves morbid. Parents owe it to their children, especially to their boys, to be sincere with them on these subjects. They may take it for granted that their reticence only exposes their children to revelations from impure sources. There is something morbid and base in our attitude toward the great mysteries of life which in themselves are pure and wonderful. Truth can never harm us. It is the lie long meditated in secret that corrupts us. I have heard many a young man who had fallen low exclaim, " If my father had only told me when I was a boy." In conclusion I would say that the wide-spread notion that sexual activity is necessary to the health of man at any age is a fallacy. Balzac, who knew human nature as well as another, speaks frequently of the great surplus of moral and physical power possessed by virgins. Neither are occasional losses to be regarded as dangerous or as indications of disease provided they are not too frequent. These, however, and the habit of masturbation and in general a tendency to impure and evil thoughts can in the majority of cases be removed by suggestion, and parents whose children are so afflicted ought not to hesitate to employ it.

We come now to the more general causes of nervousness in our environment and these may almost be said to be coextensive with our civilization. The well-nigh universal conditions of nervous weakness which confront us on every hand proclaim the fact that life as it is organized at present is too difficult for us. The brain and nervous system of man are capable of responding to an incalculable yet limited variety of stimulation, and it begins to look as if for us the limit had been reached and in many cases exceeded. This is the situation which confronts us to-day, and theoretically two courses are possible; either the reduction of the nervous tension under which we are living, or an increase of moral and nervous energy to meet life's demands. Accordingly Pastor Wagner and others have issued a powerful appeal for the Simple Life, but just as these lessons seemed likely to be heeded, our President drowned their gentle voices with his loud roar for the Strenuous Life, and it is easy to see in which direction the tide is turning. Here, however, we are not concerned with remedies but with symptoms.

The health and well-being of any animal organism depends upon its adjustment to its environment. After this adjustment is made, it perpetuates itself by the trans-mission of acquired faculties. A kind of equilibrium is established between the nervous system and the normal demands made upon it, which permits the formation of habits and innumerable unconscious acts. But every change of environment disturbs this equilibrium and demands new adjustments in the course of which innumerable individuals and sometimes whole species perish. During the past century the general conditions of human life have changed more profoundly than during any corresponding period since the dawn of civilization, and one general cause of the prevailing nervous irritability which we observe at present is the heavy task imposed upon the nervous system in adjusting itself to a new environment and in meeting new demands.

But our environment has not merely changed, it has become more complex. It is true the world presents far fewer natural obstacles to us than it presented to our forefathers. The difficulty of maintaining this country in peace and affluence is slight in comparison with the difficulty of wresting it from stubborn Nature and from implacable savages. Our present embarrassments would not seem serious to a generation which had beheld our soil drenched with the blood of citizens. And yet the critical hour for every nation occurs after its struggle with Nature and for its own existence ceases to be pressing. Man carries his conquest of the world to a certain point : he overcomes its hard obstacles, but its soft seductions usually in the end overcome him. Our fathers wrestled against flesh and blood and to virile men this struggle is the easiest. We must wrestle against effeminating luxury, against corrupting materialism, against our own debilitated nervous systems, against the vastest doubts which have ever dismayed the minds of men, against the very richness and complexity of the life we have inherited. Perhaps never, except in the years following the birth of Christ, has the world aged so perceptibly as during the century just ended. As we look back to the lives of our fathers and grandfathers, what charms us most is their simplicity, and as we look forward to our own lives, what terrifies us most is their complexity, and this complexity no Pastor Wagner can reduce. Knowledge has become so vast that the human brain can no longer contain a fraction of what a man may legitimately desire to know, and with this infinite expansion of knowledge, the old faith, which did not rest on knowledge but largely on ignorance, becomes more difficult. Every path of knowledge ends in doubt. We build our theories and our explanations of things up to the skies, yet over every explanation towers a gigantic question-mark. Who is able to follow all these paths through doubt to final reconciliation and peace? What eye but the eye of omniscience can trace all the infinite radii of truth to the point where they converge in God?

If the world of thought has become too great for our minds to grasp, the life we lead threatens to become too manifold in its interests, too exacting in its demands, for our weak organisms. In the early deaths and suicides of many of our ablest men, in the alarming increase of insanity and nervousness, in the diminishing and vanishing offspring of the cultured classes, in the general use of alcoholic stimulants and dangerous drugs, we already see a limit set to the dissipation of man's energies. These are the conditions under which life presents itself to the more favored classes. The less favored suffer from grievances which cry louder to Heaven. Without an uncharitable thought we may admit that the same system which has made one portion of society rich has made a large portion poor. One of the problems, therefore, with which the twentieth century is confronted is the problem of human happiness. It has taken us a long time to admit that there is such a problem, or if there be such a one that there is a possibility of its solution. But we are slowly learning that it is impossible for anyone to be happy in this world so long as he is obliged to lower his eyes in the presence of the misery of his fellow men. The noble already perceive that the highest and most satisfactory use which can be made of wealth is to expend it during life in the improvement of man. After a while we shall learn that it is better to leave our children pure examples and high ideals than abnormal fortunes. Fathers who have seen the melancholy experiment tried sufficiently often will not be anxious to corrupt and ruin their sons by leaving them too rich.

The whole tendency of the age in which we live may be summed up in two words, mechanical and material. We have not succeeded in making life more beautiful, indeed much of beauty is gone out of life. It may be doubted whether on the whole we have made life better or happier, but it cannot be doubted that we have made life more effective. Our planet supports a far greater number of inhabitants than ever before, and those in-habitants are better nourished, better clad, and better educated than in the past. All this has come about through the discovery and control of the immeasurable and inexhaustible mechanical energies of nature, first of steam and then of electricity. But these gigantic forces have not only enhanced incalculably the effectiveness of human life, they have shortened all its processes. The supreme end to which all practical inventions look is economy, economy of time, economy of effort, economy in the cost of production. Of the two great functions of steam, manufacture and transportation, the latter is of more importance than the former. And when steam proved too slow, the light wings of electricity were employed to bring distant human beings into instantaneous communication and to flash man's messages from one end of the, world to another.

All this is wonderful, but to him who sees in man more than an acquiring animal, it cannot appear as an unmixed blessing. These mighty servants have ended by en-slaving their masters. They have introduced an element of haste and of feverish unrest into human life which amounts to a disease. All our labor-saving devices have not procured for us either rest or peace, they act only as an incentive to new effort. The very processes of acquisition are so vast, so complex and so pitiless that a man once launched in them becomes part of a machine. He is hurried on in spite of himself and as soon as he be-comes ineffective he is cast aside as so much scrap iron. Moreover the purely material complexion of our civilization has reacted unfavorably upon us, for man, strange as the phrase sounds to-day, is essentially a moral and spiritual being and he can never find his permanent rest in material things. Were the tendencies which have prevailed for the past century to prevail and to accelerate for another hundred years, they would then cease through sheer exhaustion. Nervous disorders propagate them-selves with such fatal facility, they increase in severity so rapidly, that when a civilization becomes thoroughly neurotic, unless the causes of nervousness are removed its end is in sight. The great problem of our age as of all ages is the problem of the spiritual life, but never since the downfall of Rome was that problem more pressing than it is today. Christianity arrived too late on the scene to save the Roman Empire, but it showed what a spiritual religion can do by creating a new world out of its ruins. Only Christ is strong enough to save the world to-day, but to do this He must be allowed to free Himself from the iron fetters with which human tradition has bound Him. He must be permitted to confront humanity with all His divine reasonableness, His pity, His sense of God's nearness. Salvation will come not in a return to a world that has passed away forever, in an ineffective milk and water existence, but in an enlargement of spiritual power through the recognition and appropriation of spiritual energies which surround us, as we have already recognized and employed the mechanical energies of the universe. We have learned that in the little world every spiritual event is attended by a mechanical event and vice versa. We may be sure that the same holds true of the great world. The unfailing characteristic of nervous debility is weakness, the secret of health is peace.

There can be no doubt that the decline of practical religion has had an injurious effect on the moral life and sanity of every people which has undergone this experience, nor is the reason far to seek. The morality and standards of living of every civilized nation are built on the foundations of religion, and when this is withdrawn or weakened the superstructure collapses. Religion, therefore, cannot be regarded as an illusion, as a temporary phase of human culture through which men and nations pass, and then are done with it forever. If this were true the downfall of religion would be the harbinger of new and higher life. As a matter of fact in the history of the nations it has been the precursor of spiritual night and death. The cause of the downfall of religion has been the same through all ages. Religion has identified itself so exclusively with the Traditional Motive as to be inaccessible to the other great motives of faith, the Practical and the Rational. As a result it has largely ceased to be useful, and it no longer represents truth. The Traditional Motive, believing because one has been taught to believe (Fechner), is very powerful, but it is not strong enough to hold the faith of the better portion of mankind forever. A religion exclusively of the past cannot dominate the present or represent reality to minds which have outgrown it. Hence it is repudiated.

On the practical effects of the weakening of religious faith as a cause of nervous and mental disease I would prefer to quote the words of some recognized neurologist and man of science. Mobus says: "We reckon the downfall of religion as one of the causes of mental and nervous disease. Religion is essentially a comforter. It builds for the man who stands amid the misery and evil of the world another and fairer world. Besides his daily care-full life it lets him lead a second, purer life. The consciousness of being within the hand of Providence, confident hope of future righteousness and redemption is a support to the believer in his work, his care and need for which unbelief has no compensation. In comparison with the Last Things the incidents of this life seem small, and his outlook on eternity sustains him in passion and in sorrow. Meditation calms and refreshes him like a healing bath. In the congregation one member sustains an-other. Worship breaks in upon the daily drudgery with days of rest and of meeting, and orders the life of the individual and of the community by the establishment of fixed customs. The more religion descends into life, the more it remains at man's side early and late, the more it affects our daily life, the more powerful is its consoling influence. In proportion as it disappears out of the human life, and as the individual and the nation become irreligious, the more comfortless and irritating life becomes. If one disregards the few who make of speculation or of art a kind of religion, the people, with its religion, loses the ideal altogether, and there remains nothing but unsatisfying reality. The best comfort in sorrow and in-ward peace disappear. Then the highest good consists in worldly possessions, and the struggle for these becomes man's first and last. For the people, however, as Kant says, religion is the public standard of virtue, and when this standard falls, even if the morality which rests on natural goodness of the heart does not directly suffer, formal morality (legalitat) receives the severest injury.

The morality of a nation suffers most seriously through the downfall of its religion, as experience has everywhere and always proved. To speak of the present, materialism, or, as it shamefacedly calls itself, the mechanical theory of the world expresses itself in the masses as brutality. The pure ethical impulses are too weak to control the massive egoistical instincts of men. Let us eat and drink for to-morrow we die is the logical watchword. Struggle of all against all, and the conscienceless subjection of the weak, must prevail in exact proportion as the mechanical theory of the world prevails.

"If we consider the effect of irreligion as increasing our helplessness to resist the storms of life, and as favoring dissipation and crime, its relation to nervousness cannot be doubted. For if chronic moral disturbances con-tribute to nervousness, these conditions must be regarded as causes."'

Another unquestionable cause is the strenuousness of our American life with its ups and downs, its incessant changes, its large element of uncertainty and the restless energy which it demands as the price of success. Many of our higher positions of trust are deliberately planned with the knowledge that no man will hold them long. Responsibility and anxiety remove their occupants in the course of a few years. Of late the vast combinations and aggregations of capital have introduced an element of uncertainty into business life which increases its moral strain. A man may labor successfully for years only to see the results of his labor swept away by causes over which he has no control. The swift transitions from wealth to poverty and from poverty to wealth with the intense emotional crises which attend them are also very harmful in their effects on the nervous system. Men who live habitually on these emotions, e.g., stock-brokers and gamblers who make and lose fortunes every day, naturally suffer most and exhibit many of the phenomena of in-sanity. The floor of a stock exchange, e.g., on a day when values are fluctuating rapidly, might readily be mistaken for Bedlam. But even in the most legitimate and conservative business there is an element of uncertainty, a swiftness of change, a degree of fluctuation which does not exist in other countries.

The effect of the conditions of American life is plainly perceptible in the Jew, who is far more subject to nervous diseases in this country than elsewhere. I have discussed this question with Hebrew practitioners and the views they have expressed coincide with my own. The Jew, however humble may be the beginning of his business career, is too intelligent not to perceive the great opportunities for the acquisition of wealth which this country affords him. Accordingly he works unsparingly, he denies himself almost the necessities of life. He is frequently ill-nourished and in a state of constant fatigue. But he bends his whole energy to lifting himself out of his humble circumstances into affluence. He works all day and he schemes and plans at night, with the result that in spite of his magnificent vitality, his sobriety and freedom from venereal disease, he suffers greatly from insanity and other forms of mental and nervous weakness.

I would like here to call the attention of business men to the great importance of a secondary aim or interest in life. In fact I scarcely know of anything so conducive to longevity, the preservation of one's powers and capacity for enjoyment, as a variety of interest and occupation. The most incurable and impossible patients we have encountered have been business men who had con-fined themselves exclusively to business and who had never learned to play. When such men find themselves incapacitated for business they are the most helpless and unhappy of human beings, for the reason that they do not know what to do with themselves. Hence they easily fall victims to hypochondria, melancholia, and other nervous disorders. A man frequently looks for-ward for years to retiring from business, and he does so only to find himself restless and unhappy and perhaps to fall into an early grave. A radical change of habits and occupation is apt to be a dangerous experiment after fifty, and before a man attempts it he should be sure of something to occupy his thought and his time and to take him outside himself. Some men find such an interest when their own work is done in living for others. On the other hand a man can do a prodigious amount of work if he varies that work with play which really amuses him, or if he substitutes for mental toil occupations which involve muscle exercise. By such judicious habits men like President Roosevelt and Dr. Mitchell have per-formed an incredible amount of labor without injury to their health. But even more important than a change of occupation is a real secondary interest in life which keeps the heart young. Some men find such an interest in sport, in hunting and fishing, in sailing the seas and in exploring wild nature. Others find it in the cultivation of the soil, in breeding fine cattle, horses, dogs, sheep and fowls, others in art, music, literature, science, or travel. But some such avocation is almost indispensable to men whose main interest in life is absorbing and whose duties are exhausting. Over against the increasing strenuousness of life and concentration in cities, we may point to the return to nature and the soil, the revival of sport, the passion for games and out-of-door exercises which have added perceptibly to the stature of both men and, women and are among the most encouraging signs of the times.

Although those whom we are accustomed to call "business men," i.e., merchants, financiers, manufacturers, officers of corporations, etc., are the most heavily burdened, the duties of professional men, physicians, jurists, clergy-men, actors, etc., are not slight and each of these callings makes its own demands on the nervous system. Few greater mental efforts can be imagined than are involved in preparing and pleading an important and difficult case in court. The exercise of memory, of rapid judgment, in short of all our higher faculties employed by great lawyers on such occasions, together with the power of sustained and convincing argument, tax the resources of the most gifted man and are frequently followed by utter exhaustion. The physician feels the burden of the gravest responsibilities. He cannot minister to his patients without to a certain degree taking their sicknesses upon him. Nor can he forget that human lives are constantly staked on his judgment and skill. If he is able and brilliant he is apt to be overworked. He suffers from mental and physical over-exertion and from almost constant anxiety. The actor and the singer stake their reputations every time they appear on the stage. Beside the incredible feats of memory they are constantly called on to perform, they must preserve an inward calm and repose in order to do their best work. Every art requires a long and wearisome technical preparation and an amount of labor of which the uninitiated can form no conception. Clergymen, if they are rectors or ministers of great and highly organized parishes, must be leaders of thought, organizers, financiers, scholars, able preachers. In other words, they must labor in constantly recurring tasks and duties, which are always the same and yet must always be done differently. Addressing the same audience week by week, they must not repeat themselves. Speaking on the oldest theme known to man, they must be able to make it ever fresh and new. Their working week consists of seven days, and their working day, if they are really interested in their work, ends at midnight or when they are too weary to write, to speak, to think or to act any longer, and then they go to bed with the sad consciousness of having left many tasks undone. In short, if we are really alive and awake to our opportunities, life demands of us all that we are able to give and to do. But such activity, unless we have the constitution of a rhinoceros or an incentive and enthusiasm which never flag, exhausts us and gives rise to insomnia, depression, brain fag, and every other form of nervous weakness.

Neurasthenia and nervousness in all its forms are frequently thought to be affections of the rich and of the great brain workers. This, however, is a mistake. There are other circumstances which act quite as unfavorably upon our nervous systems as those which I have enumerated. I now refer to the restrictions of a narrow lot, to loneliness and isolation, to the frequent repetition of uninteresting tasks, to the burdens of maternity and domestic cares and worries. These, like the constant dripping of water which wears away stone, are frequently the causes of mental and nervous diseases and disorders. Persons who live much alone are apt to become peculiar." The wives of farmers, especially in sparsely settled regions where life is hard and barren, are peculiarly subject to insanity. Bookkeepers and accountants whose days are passed in performing simple operations on meaningless numbers are also apt to suffer from mental disease. Telegraph operators and mail sorters whose duties demand protracted close attention also suffer frequently from nervous disorders. In our practice the two classes of persons which most frequently seek our aid are unmarried women teachers and married women, mostly mothers, of moderate or restricted means. Among the former neurasthenia, nervous exhaustion, insomnia, mild melancholia, and psychasthenia are of common occurrence. The complaints I hear most frequently from such teachers are of the monotonous repetition of tasks, loneliness and sadness, of the difficulty of the moral control of their charges, of fears of growing old and helpless, of failure, of insanity, etc. The causes of nervousness among the married women above mentioned are more complex and they cannot so readily be distinguished. Sometimes this nervous condition is due to marital incompatibility, to the intemperance or bad conduct of their husbands, to shock, or to some painful moral experience. Frequently it is present simply because these women are unequal to the tasks and responsibilities imposed upon them and their nervous systems have succumbed to the strain. Perhaps they were always more or less delicate, and marriage, child-bearing, and family cares have resulted in further enfeebling them. The latter patients are among those most benefited by rest and change, although reorganization of the home life is frequently necessary. Many husbands are selfish towards their wives without intending to be. They are so accustomed to see the latter weak and hear their complaints that it does not occur to them that there may be a cause for such weakness and complaining. Domestic servants over forty years of age are quite frequently slightly demented. This is probably due to somewhat the same causes as those which affect teachers and to the performance of hard manual labor during menstruation. The nervousness frequently discoverable among students in women's colleges is also due largely to the latter cause, in this case to the overtaxing of the brain and nervous system during the menstrual period. Dr. Mitchell has written judiciously on this subject.'

Among the general psychical causes of nervousness intellectual over-exertion is probably the most fruitful. No element of our system needs rest more than the brain and certainly none suffers equally from excessive fatigue. When brain fatigue is attended by intense excitement, as is frequently the case in the lives of business and professional men, the injury to the brain and nervous system is severe and more permanent. All the depressing emotions, anger, fear, moral shock, anxiety, worry, sorrow, have a very unfavorable effect upon our nervous system and upon all our physical functions, and when as sometimes hap-pens these sad feelings persist for years, their effect upon temperament and character may be permanent. We know to-day that every psychical event is attended by a corresponding nervous event. Joy, happiness, a sense of well-being, are invariably healthful and health-bringing. Grief, pain, anger, and anxiety have also their concomitants in the brain and nervous system and these are injurious or destructive in character. It is to be remembered, however, that such emotions are frequently not voluntary in the sense that they are wilful. They are often symptoms of a more general disease in which body and soul suffer together (Môbius). The psychical causes of nervousness, as we have seen, may also be of a different character. The effect of our environment in-stead of overtaxing our' moral and intellectual powers may depress and starve us by its barrenness and monotony. This is frequently the effect of life on the prairie, especially on those who come from mountainous or hill countries. In the west there is a form of mental disease known as "prairie insanity."

The physical causes of nervousness are very numerous and can only here be alluded to. Whether mere physical labor, however hard in itself, produces nervousness may be doubted, although protracted labor which robs us of our sleep or rest is undoubtedly injurious. I have seen the experiment tried of causing men to work seven days in the week with very bad results. After a couple of weeks the men have become demoralized, weak, and inefficient, and the work (loading freight cases) was badly done. If, as von Jhering believes, the Sabbath rest originated to meet the necessities of the laboring men in Babylon, we have an ancient precedent for its scrupulous observance which modern physiology fully endorses. In general, any employment which robs us of the needful modicum of sleep must be regarded as injurious. Dr. Weir Mitchell has proved abundantly the great value of rest and isolation in many of the functional and organic neuroses. There can be no doubt that the over-stimulation of our senses has an exhausting effect upon the nervous system. The tumult and uproar of our cities unquestionably has an irritating influence upon those who are inclined to nervousness. Schopenhauer has written an eloquent tract on the Din of Cities which ought to be reprinted and widely circulated.' Elevated railways running through the principal thoroughfares of cities are the cause of untold sufferings. Beside torturing the sick and weak with their infernal uproar, they injure the eyes of thousands by the tiny filaments of steel which the brakes constantly shave from the wheels. Many of our street noises could be abolished or mitigated with great benefit to the public health.

Intense heat also has an irritating and depressing effect upon the nervous system. The extraordinary series of atrocious crimes against young children which occurred in New York last summer (1907) has given rise to many curious theories on the subject. In this outbreak suggestion was a far more potent factor than the heat of the sun. It is known, however, that summer is favorable to crimes of violence and also to suicide. The most marked effect of intense heat on the nervous system is in heat prostration and so-called sunstrokes which are attended by marked elevation of temperature, insensibility, intense headache, and convulsions, and which is frequently followed by a long period of nervous weakness.

Physical shock is also a common cause of nervous debility, and in these days of frequent railway and auto-mobile accidents the so-called traumatic neuroses are of constant occurrence. In damage suits against railway companies injuries of this nature frequently receive slight consideration, yet they may be far more serious in their subsequent effect than broken bones. I know a young man of splendid physique who underwent a railway accident with apparently no effect beyond that which is generally termed "a good shaking-up." Within a year he became a nervous wreck unable to attend to his business and a burden to himself and to his family. This condition lasted for four or five years when it gradually improved, yet he obtained but trifling compensation be-cause he had no wounds to show.

Other physical diseases such as heart disease, phthisis, and affections of the reproductive organs, especially in women, produce nervous conditions. In tuberculosis nervous disturbances are frequently present at the inception of the disease, but as the latter progresses irritability and depression give place to the unconquerable optimism which is characteristic of consumption. The association between affections of the female organs and nervousness is preserved in the word hysteria, but this relation is very general as many hysterical women have no organic disease, and many sufferers from uterine affections are not hysterical. Fevers through the modifications they effect in cerebral circulation and through the inflammation of the brain and its membranes give rise to mental disturbances and to delirium which resembles the raving of insanity. Anaemia, whether due to a deficiency of red blood corpuscles or to actual loss of blood, is a certain cause of nervousness. Pale and ill-nourished girls pre-sent typical cases, yet it is not true that all nervous sufferers are anaemic. When the volume and constitution of the blood become normal, the nervous symptoms usually disappear. The same may be said of nervousness which is caused or complicated by digestional disturbances. In all such cases it is best to attack the physical symptoms first. My friend and associate, Dr. J. Warren Achorn, the well-known stomach specialist of Boston, has succeeded in innumerable instances in con-trolling severe nervous disorders by re-establishing the equilibrium of digestion and assimilation.

Toxic substances, whether they are retained through defective elimination, or are introduced into the system from without, have a marked effect on our brain and nerve life and upon our states of consciousness. Of these the most important is alcohol. This may be so highly diluted that the action is very slight, but intoxication as the word implies is a poisoning of the higher centers of the brain, which causes a temporary delirium corresponding to the delirium of insanity, and which affects sensibility, loco-motion, and speech. The result of so violent a stimulation of the nervous system, especially on one inclined to nervousness, is profoundly depressing. The intoxicated person, as Möbius says, is, for the time being, an invalid.

Not only does he suffer from acute physical and nervous symptoms such as nausea, headache, nervous tremblings, prostration, intense irritability, apathy, etc., but he is far more susceptible than he would otherwise be to other forms of disease and less likely to recover from them.

Acuter forms of alcoholism may cause the dis-eased condition of the nervous system known as delirium tremens which not infrequently results in death itself, or in permanent insanity, in epilepsy or paralysis. I am speaking here on the effects of alcohol on civilized man; its effect on savages is different. Alcohol makes savages drunk; it does not make them nervous.

Among Byron's trifling and immoral sayings, one for which the world has never forgiven him runs thus: "Man, being reasonable, must get drunk." Offensive as these words are, as we look around the world, the power to be-come intoxicated seems to constitute one of the striking differences between rational men and irrational brutes. Whither should we go to find a people ignorant of the art of distilling alcohol and of concocting drinks which rob them of their reason? When the barbaric German tribes first came into civilization they were already a beer-drinking people. Their capacity for their national beverage struck the Romans, who themselves were no mean drinkers, with astonishment. What beer is in Germany, wine is in France, Italy, and Spain, and whisky in Scotland and Ireland. The English, who like ourselves have no one national beverage, welcome with joy the in-toxicants of every civilized people. The inhabitants of Kamschatka consume a kind of mushroom which induces a protracted delirium. The descendants of the Incas have their greasy chica prepared from corn which has been chewed by mules. The Tartars intoxicate them-selves with a fermentation of mutton, rice, and other vegetables, or with their beloved kumiss, made of fermented mare's milk. In the East opium is freely eaten and smoked, a vice which has penetrated every part of the world. In South America coca is the favorite narcotic, which of late years in the form of cocaine has become popular with all nations. If there is a people on earth so primitive as not to have learned how to poison itself with alcohol or narcotics, civilization no sooner finds that people than it teaches them these deadly arts.

What is the reason why the whole human race with scarce an exception has so willingly yielded itself to the dangerous pleasures of alcoholic and narcotic poisoning? Undoubtedly because of their effects. There is nothing which man dreads so much as the dulness and monotony of a barren existence. A life of suffering is hardly so dreadful as a life of ennui. Now in intoxication man finds the longed-for escape from a monotonous existence, and the more barren life is of vital interest, the greater the temptation to this relief. Especially noticeable is this cause in our western states and territories, where men regard a prolonged debauch almost in the light of an innocent recreation, a refuge from the deadly monotony of their daily lives. Intoxication is a form of delirium in which all the forces of the nervous system are temporarily exalted. Of course, the reaction of profound depression follows quickly on the heels of enjoyment, but this is a consideration few men have strength enough to weigh, or if they do take it into account they dismiss it as a lesser evil. We rightly think that intoxication de-grades a man, but that is not what the drunkard thinks, at least when he is drunk. Drunken men are almost always optimists: nothing troubles them. Listening to their conversation one would suppose them to be kings and princes, superior to their fellows, able to do what they will. The first effect of alcoholic intoxication seems to be an exaltation of self-consciousness, an elevation of feeling, a sense of importance which in a sober man would be foolish egotism. This feeling may rise to madness and give birth to crime, in fact the, larger proportion of all crimes is directly inspired by alcohol. The forces of the mind, goaded to unwonted activity, break their uniting bond and fall into a wild whirl of anarchy, in which thoughts and emotions, joy and sorrow, good and evil, stretch out their hands to one another in a furious dance, and the whole soul is given to unbridled license, not, how-ever, untroubled by remorse.

As intoxication becomes profounder its effects are more overwhelming. The whole mind and body, with the exception of the medulla oblongata, become drunk together. The muscles relax and cease to obey the will. The senses are obscured and the mind cut off from its usual means of communication with the external world, and madly stimulated is plunged into a sea of gloomy and delirious thought. The will vainly struggles to preserve its autonomy against the overwhelming flood of physiological disturbances which threaten to engulf it on every side. The flashes of intelligence grow faint and intermittent. Then they cease, and night, spiritual night, the night of death, throws its sable pall over all. That physical death does not instantly follow is due to the fact that in the strange dispensation of things, the palsied hand is no longer able to carry to the lips the poison which would next overthrow that watchful guardian which pre-sides over the beating heart and the function of respiration. Were some kind friend to perform this office, the drunkard's troubles would end then and there. That such a state is sinful, degrading to manhood, destructive to soul and body, goes without saying. Only a man of the lowest instincts can find pleasure in so brutal an indulgence. We may lose ourselves thus once and find ourselves again, yet not as before. The soul lost in the darkness of flesh and sin does not bring all its spirituality back with it, nor does the brain recover quickly from so gross an injury. On the other hand, the nervous system is wonderfully plastic, it learns its lessons quickly and retains its habits with fatal tenacity. The man who has been intoxicated only once is not without danger of becoming a drunkard.

"From drinking fiery poison in a den,
Crowded with tawdry girls and squalid men,
Who hoarsely laugh and brawl and curse and fight;
I wake from day-dreams to this real night."

The effects of narcotic poisoning differ radically from those of alcohol and vary with the substances employed. The subjective effect of opium differs widely in different persons and races and in different stages of its habitual use. The Chinese, for example, regard the use of opium very much as we do the use of tobacco, i.e., as mildly deleterious. At first, according to the accounts of educated white men who have carefully observed their sensations, there is a sense of well-being; not, however, the expansive and boisterous happiness of alcoholism, which demands outward expression, but rather an inward state of untroubled peace which the Chinese call "a flame which burns far from the wind." The subject of opium or of morphia is for the time being calmly happy, for the sorrows of life cannot penetrate the veil behind which he slumbers. He is not bored by his environment, for a fine, intense organic cerebral activity supplies him with an unending series of mental images. No fancy is so bold, no pencil so accomplished, as to be able to depict the visions which rise out of the chaos of his brain and which display themselves to his closed eyes. Alcohol draws men together. Its votaries must have companions to laugh with, to drink with, to talk with. The victim of opium goes his way alone for the reason that no other human being can accompany him. No other eye can see what he sees, no other heart can know what he enjoys and suffers.

The effects of the habitual use of opium and morphia is even more injurious to the brain and nervous system than the use of alcohol, and the habit also is more difficult to control. The moral effect of opium is the erection of a veil between its victim and the world. At first this veil is of such diaphanous texture as to be scarcely perceptible. A man dimly feels that his relations with the world have undergone a change, a change for the better, he thinks, since now he has a refuge from every ill of life. Only when he attempts to rend this slight tissue of illusions does he discover that it is composed of finest steel. His inner life may be a Heaven, or it may be a Hell; the fact remains that he cannot escape from it. The veil between him and the world thickens. He looks out on life as one sees a light through an alabaster vase. He feels the world as one feels a piece of glass through a silk glove. In time his thoughts are apt to become of a darker complexion, and his moral vision is wholly obscured. The only truth to him is what he experiences on his mysterious journeys to the land of nothingness. The one thing needful in life is the means of prolonging his slumber. To obtain this he would betray his best friend, rob the fatherless, make dominoes of his parents' bones. For the thing which he dreads most is awakening. So every tie which binds the opium-eater to his fellow men gives way. The victim of opium has but one tie — that which binds him to his drug. If alcohol drowns the soul, opium immures it. Its votaries continue to live in their prison, but it is a life which dreams of death.'

"From wandering through many a solemn scene,
Of opium vision with a heart serene,
And intellect miraculously bright,
I wake from day-dreams to this real night."

—.James Thomson.

No etiology of nervousness would be complete which did not call attention to the extraordinary prevalence of nervous disorders on this continent, and which did not deal specifically with the problem of American nervousness. So far as nervousness is to be regarded as the disease of civilization, it is to be expected that America, in which the processes of civilization are most accelerated, should be the land in which this disease would most plainly reveal itself. Fortunately for us, however, our peculiar national tendency to nervousness is in the direction of the lighter functional neuroses. The severer organic forms of nervous disease are by no means unusual, but there is nothing to show that they are more prevalent in America than in other civilized countries, nor do the milder nervous disorders tend to pass into severer organic nervous diseases.

The causes and symptoms of American nervousness have been treated comprehensively by Dr. George M. Beard. His book 1 is now old, but it remains the best popular treatise on the subject with which I am acquainted. Dr. Beard, as we have already seen, regards nervousness as a direct outcome of modern civilization. He emphatically asserts that without civilization there can be no nervousness, and that neither bad habits, climate, race, nor environment can make nervous disease possible and common except when reinforced by brain-work, worry, and an indoor life. He recognizes the hereditary factor in nervous disorders, but he does not give it sufficient weight. Seventy-five years ago, Dr. Beard affirms, nervousness was unknown to America and to the world. Today (1881) there are more than fifty thousand cases in this country alone. (If Dr. Beard were writing now he would have to multiply these figures by ten.) What is the cause of this unexampled spread of a new disease? In attempting to answer this question, Dr. Beard enumerates many of the characteristics of American nervousness, and then states what he believes to be their causes. Among the former he mentions the fine organization so characteristic of the native-born American, which is marked by fine soft hair, delicate skin, nicely chiseled features, small bones, and which is frequently accompanied by a slight physical and muscular system. This, as he observes, accompanies the true nervous temperament. Such a constitution can only be produced by a high form of civilization, and in Dr. Beard's opinion it protects us from ordinary fevers and inflammatory diseases. Among other physical indications of nervous weakness Beard notices the fragility of American teeth, an early baldness of American men, increasing sensitiveness to pain and to heat and cold, and digestional weakness. Irregularities of teeth, like their decay, are the product primarily of civilization, and secondarily of climate. The only races which have poor teeth are those that clean them. I submit, however, that as long as American women are distinguished by their long and abundant hair, nervousness can hardly be regarded as the cause of baldness in our men. Dr. Beard also calls attention to the growing disability of American women to sustain the burdens of the marriage relation and to perform the functions of maternity. In speaking of the increasing sensitiveness of the digestive organs, Dr. Beard calls attention to the fact that a generation or two ago pork and Indian meal formed the chief staples of life in America, as they are still in many parts of the South and West. This diet could no longer be tolerated by people who live in cities. "In America pork, like the Indian, flees before civilization." Americans eat better and more carefully prepared foods than any other people in the world and suffer most from indigestion. The first of these propositions is, I think, open to question. The well-to-do and intelligent in America, who after all form but an insignificant fraction of our whole population, unquestionably live better than any class of the same numerical strength in other lands. But when we pass into the homes of the poor and uneducated, we find ignorance of the simplest principles of dietetics, a vast amount of waste, and the ruin of good food by bad cooking. Moreover, as regards our public eating houses, apart from the fine hotels of our larger cities, there is no other country in the civilized world where it is so difficult to obtain a decent meal as it is in America.

Dr. Beard comments very interestingly on our increased susceptibility to alcohol and narcotics and also to drugs and medicines. "Among Americans of the higher order, those who live indoors, drinking is a lost art. A European coming to America sees a sight which no other civilized nation can show him — greater than Niagara — an immense body of intelligent people voluntarily and habitually abstaining from alcoholic liquors, females almost universally so, and males temperate if not totally abstinent. There is, perhaps, no single fact in sociology more instructive and far-reaching than this, and this is but the fraction of the general and sweeping fact that the heightened sensitiveness of Americans forces them to abstain entirely, or use in incredible and amusing moderation, not only the stronger alcoholic liquors, whether pure or impure, but also the milder wines, ales, and beers, and even tea and coffee." This is not altogether the impression of our habits which intelligent visitors from abroad have received on visiting America, nor does this statement coincide with the fact that a vaster quantity of malt and spirituous liquors is manufactured and sold in America than in any other country on earth. In all human probability this is drunk by some one. No doubt the Germans and Irish to whom Dr. Beard assigns the whole amount get their share, but it is improbable that they consume it all. Still Dr. Beard is unquestionably right in his assertion that a growing susceptibility to the effects of alcohol is characteristic of the higher type of American and that this is a sign of nervous weakness. It is also certain that climate has a marked effect on man's craving for alcohol and on his ability to endure it. Englishmen, Scotchmen, and Germans visiting this country have frequently commented upon the fact that they neither desired nor could endure their usual quantity of stimulating liquor.' The large daily ration of whisky of which the Scotch and Irish partake, apparently with impunity at home would be destructive to them in this country. The same may be said of tea and coffee, and of tobacco. Their effects on persons of nervous temperament in this country are unquestionably injurious. As Beard puts it, "Our fathers could smoke, our mothers could smoke, but their children must ofttimes be cautious, and chewing is very rapidly going out of custom, and will soon, like snuff-taking, become a historic curiosity while cigars give way to cigarettes."

Dr. Beard, speaking as a physician of experience, also asserts that Americans are far more sensitive to the action of medicines than other peoples, and that this sensitiveness is increasing. While fonder of drugs than any other people, they are least able to endure them. This is shown among other instances in the effect of cathartic remedies which are administered in constantly decreasing doses. "Where two or three powerful pills were formerly required for a strong cathartic effect, now one or two, perhaps half a pill, suffices." Physicians who have both hospital and private practice constantly observe how temperament modifies physiological action of drugs. Coarse and phlegmatic natures can endure far more powerful medicines than the nervous and sensitive. This is brought home to those of our people who come under the care of foreign physicians, whether in England or on the continent, and they have learned by bitter experience that they cannot tolerate the powerful medicines which those physicians are accustomed to administer. A friend of mine, a delicate and sensitive woman, almost lost her life as a result of taking sixty grains of phenacetine which were prescribed for her as a single dose by a celebrated German physician. Among other symptoms of American nervousness, Dr. Beard cites the wide-spread prevalence of hay-fever and catarrh, the tendency to abbreviate speech, and the high-pitched American voice and our nasal intonation.

The causes of American nervousness Dr. Beard finds in the high pressure of American life, re-enforced by the stimulating and depressing effects of our climate. The latter cause in itself could never produce nervousness, since the American Indians, who were far more exposed to climatic changes than ourselves, are among the least nervous of mankind. Working in conjunction with our intense mental activity, our indoor life, and with all the nervous tension to which we are exposed, climate unquestionably is an important factor in the creation of nervous diseases and disorders. The influence of climate and environment together is shown in the fact that a new and distinct type of humanity has been evolved in the course of a few hundred years on these shores, a type that differs perceptibly from its English prototype. The American is taller, sparer, less ruddy than the Englishman. Both American men and women are less inclined to become corpulent with advancing years, partly because they eat less and drink less.' The moist skin of our English ancestors in our climate has become dry, their curly hair straight and silken. Especially does the American differ from the Englishman in excess of nervous energy and in the rapidity of his mental operations. This is shown especially in our rapidity of speech and in our great facility in public speaking.

The characteristics of our climate which have done most to accentuate our tendency to nervousness in Beard's opinion are its extreme dryness, the immense variation of its summer and winter temperatures, and its rapid fluctuations. I am, however, by no means sure of the correctness of the first of these causes. No part of this country suffers so much from nervousness in all its forms as New England, whose climate can hardly be called dry, but on the other hand the very dry climate of Colorado, Montana, Arizona, and Wyoming has already developed a very marked tendency to nervousness. Beard's observations on the effects of extreme heat and cold and of rapid changes of temperature are very interesting. He reminds us of the powerfully stimulating effect on the system obtained by the alternation of ice and hot water and by the Turkish bath. This intense stimulation, how-ever, soon gives rise to exhaustion. The American is stimulated to greater activity by his climate, but its permanent effect is to exhaust him. Foreigners visiting this country have frequently observed this. They feel more energetic but they tire sooner than at home. "The in-habitants of the northern and eastern portions of the United States are subjected to severer and more sudden and frequent alternations of heat and cold than the in-habitants of any other civilized country. Our climate is a union of the tropics and the poles : half the year we freeze, the other half roast, and at all seasons a day of painful cold is liable to be followed by a day of painful warmth. Apart from the direct effect of these conditions on the nervous system, they confine us too much to our houses. During a large part of the year, either because it is too warm or too cold, we are disinclined to go abroad or to take much exercise. The extreme cold compels us to maintain a temperature in our houses which Europeans find oppressive and intolerable. The effect of the degrees of our climate is to accelerate all the vital changes of our organism, with the result that we actually live faster than other peoples and wear out earlier." As one travels south in this country one sees nervousness steadily diminish. Boston, as a city, is more nervous than New York, New York more nervous than Philadelphia and Baltimore, and further south the tendency to nervousness is not wide-spread. This is probably due partly to inherited tendencies in regard to the conduct of life, partly to the effect of a warm and too enervating climate in relaxing the restless activities of man. As the conditions of Northern life are introduced into the South, they can hardly fail to be followed by increasing nervousness.

In general it is to be remembered that the functional nervousness we have been describing has no perceptible affect upon longevity. Americans suffer more than any other people from these disorders, but they excel all nations but the Jews in the average length of life. This is shown particularly in the longevity of brain-workers which here as elsewhere exceeds that of manual laborers and indeed the longevity of any other class. Dr. Beard's discussion of this subject forms the ablest and most interesting chapter of his book. As an offset to the deleterious influences of our civilization, we see many healthful influences at work to check and neutralize the effects of over-exertion. I allude here to such tendencies as longer vacations for all, general relaxation of all interests during the heated term, the disposition of well-to-do families to live in the country for the larger portion of the year, a renewed love of out-of-door life and sport, the athletic spirit cultivated by our colleges, and physical activity and prowess of our young women. These tendencies, if they persist for a generation, cannot fail to be productive of great good. By this means, and by the cultivation of the spiritual life, we may escape from the flood of nervous disorders which threatens to overwhelm us.

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