EPILEPSY, HYSTERIA, AND NEURASTHENIA

 THEIR CAUSES, SYMPTOMS, & TREATMENT

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

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

 _First Published in 1921_

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

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 CONTENTS

 CHAPTER PAGE

 PREFACE ix

 I. MAJOR AND MINOR EPILEPSY 1

 II. RARER TYPES OF EPILEPSY 7

 III. GENERAL REMARKS 15

 IV. CAUSES OF EPILEPSY 20

 V. PREVENTION OF ATTACKS 25

 VI. FIRST-AID TO VICTIMS 28

 VII. NEURASTHENIA 30

 VIII. HYSTERIA 39

 IX. ADVICE TO NEUROPATHS 46

 X. FIRST STEPS TOWARD HEALTH 53

 XI. DIGESTION 56

 XII. INDIGESTION 60

 XIII. DIETING 63

 XIV. CONSTIPATION 67

 XV. GENERAL HYGIENE 71

 XVI. SLEEPLESSNESS 76

 XVII. THE EFFECTS OF IMAGINATION 79

 XVIII. SUGGESTION TREATMENT 82

 XIX. MEDICINES 86

 XX. PATENT MEDICINES 90

 XXI. TRAINING THE NERVOUS CHILD 98

 XXII. DANGERS AT AND AFTER PUBERTY 109

 XXIII. WORK AND PLAY 115

 XXIV. HEREDITY 118

 XXV. CHARACTER 123

 XXVI. MARRIAGE 131

 XXVII. SUMMARY 140

 BIBLIOGRAPHY 142

 INDEX 145

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PREFACE

I hope this book will meet a real need, for when one considers howprevalent epilepsy, hysteria and neurasthenia are, among all ranks and agesof both sexes, it seems remarkable some such popular book was not writtenlong ago. 

I add nothing to our knowledge of these ills, my object being to put whatwe know into simple words, and to insist on the necessity for personaldiscipline being allied to expert aid. The book aims at helping, notousting, the doctor, who may find it of use in getting his patient tosee--and to act on--the obvious. 

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

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

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

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

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

--Chaucer. 

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EPILEPSY, HYSTERIA, AND NEURASTHENIA

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CHAPTER I

MAJOR AND MINOR EPILEPSY

(_Grand and Petit Mal_)

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

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

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

Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervoussystem, evinced by attacks of _alteration of consciousness_, usuallyaccompanied by convulsions. 

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

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

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

Epilepsy has always interested medical men because of its frequency, thedifficulty of tracing its cause, and its obstinacy to treatment, while ithas appealed to popular imagination by the appalling picture of bodilyoverthrow it presents, so that many gross superstitions have grown uparound it. 

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

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

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

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

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

GRAND MAL ("_Great Evil_")

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

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

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

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

This _tonic_ stage only lasts a few seconds, and is followed byconvulsions. The head turns from side to side, the jaws snap, the eyesroll, saliva and blood mingle as foam on the lips, the face is contorted infrightful grimaces, the arms and legs are twisted and jerked about, thebreathing is deep and irregular, the whole body writhes violently, and isbathed in sweat. 

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

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

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

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

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

Victims of nocturnal epilepsy may not be awakened by the seizure, but passinto deeper sleep. Intermittent wetting of the bed, occasional temporarymental stupor in the morning, irritability, temporary but well-markedlapses of memory, sleep-walking, and causeless outbursts of ungovernabletemper all suggest nocturnal epilepsy. 

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

Epileptic attacks are of every degree of violence, varying from a moment'sunconsciousness, from which the patient recovers so quickly that he cannotbe convinced he has been ill, to that awful state which terrifies everybeholder, and seems to menace the hapless victim with instant death. Everydegree of frequency, too, is known, from one attack in a lifetime, downthrough one in a year, a month, a week, or a day; several in the sameperiods, to _hundreds_ in four-and-twenty hours. 

PETIT MAL ("_Little Evil_")

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

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

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

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

Frequent _petit mal_ impairs the intellect more than _grand mal_, forconvulsions calm the patient as a good cry calms hysterical people. After anumber of attacks of _petit mal, grand mal_ usually supervenes, and mostepileptics suffer from attacks of both types. Some precocious, perversechildren are victims of unrecognized _petit mal_, and when pushed at schoolrun grave risks of developing symptoms of true epilepsy. The "Little Evil"is a serious complaint. 

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CHAPTER II

RARER TYPES OF EPILEPSY

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

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

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

_Status Epilepticus_, in which a series of _grand mal_ attacks follow oneanother with no conscious interval. The temperature rises slowly, the pulsebecomes rapid and feeble, the breathing rapid, shallow and irregular, anddeath usually occurs from exhaustion or heart-failure. Though notinvariably fatal, the condition is so very grave that a doctor mustinstantly be summoned. Nearly all victims of severe, confirmed epilepsy (25per cent of all epileptics) die in _status epilepticus_. 

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

There is usually an _aura_ before the attack, often a tingling or stabbingpain. The chief symptoms are convulsions of certain limbs or areas of thebody, which, save in very severe cases, are confined to one side, and arenot attended by loss of consciousness. 

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

As every part of the brain is connected to every other part by "associationfibres", in very violent attacks of Jacksonian epilepsy the irritationspreads to the other side of the brain also, consciousness is lost, theconvulsions become general and bilateral, and the patient presents exactlythe same picture as if the attack were due to _grand mal_. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Day-dreaming is dissociation carried further. "Leading lady" and "chorusbelle" change places for a while--imaginary success keeps us from worryingabout real failure. Dissociation, day-dreaming, and mental epilepsy are butfew of the many milestones on a road, the end of which is insanity, orcomplete and permanent dissociation, instead of the partial and fleetingdissociation from which we all suffer. The lunatic never "comes to", but ina world of dreams dissociates himself forever from realities he is notmentally strong enough to face. 

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

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

Dreams are dissociations in sleep, while the scenes conjured up bycrystal-gazing are only waking dreams, in which the dissociation is causedby gazing at a bright surface and so tiring the brain centres, whereuponimpressions of past life emerge from the subconscious, to surprise, notonly the onlookers to whom they are related, but also the gazer herself, who has long "forgotten them". 

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

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

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

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

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

The "soothing" portion of such preparations is some essential oil, likeaniseed, caraway or dill, and there are often present strong drugsunsuitable for children. According to the analyses made by the BritishMedical Association, the following are the _essential_ ingredients of somewell-known preparations for children:

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

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

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

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

Convulsions During Pregnancy. Send for a doctor instantly. 

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

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

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

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CHAPTER III

GENERAL REMARKS

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

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

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

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

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

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

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

About 10 per cent--the very severe cases--go on to insanity; eithertemporary attacks of mania, calling for restraint, or permanent epilepticdementia with progressive loss of mind. Some victims are accidentallykilled in, or die as a result of a fit; about 25 per cent--severe casesagain--die in _status epilepticus_, but the majority after being sufferersthroughout life are finally carried off by some other disease. 

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

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

Some epileptics are normal in appearance, but many show signs ofdegeneration. This is common in the insane, but less frequent andpronounced in neurasthenics. An abnormal shape of the head or curvature ofthe skull, a high, arched palate, peculiarly-shaped ears, unusually largehands and feet, irregular teeth from narrow jaws, a small mouth, unequallength and size of the limbs, a projecting occiput, and poor physicaldevelopment may be noted. 

These are most pronounced in intractable cases, in whom mentalpeculiarities are most frequently seen--either dullness, stupidity andungovernable temper, or very marked talent in one direction with as markedan incapacity in others. In all epileptics, the pupils of the eye arelarger than normal, and, after contracting to bright light soon enlargeagain. 

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

Though the disease may occur at any age, most cases occur before the age oftwenty, there being good reason to look for other causes (often syphilis)in cases which occur after that age. Of 1, 450 of Gowers' cases, 30 per centcommenced before the age of ten; 75 per cent before twenty. In Starr's2, 000 cases, 68 per cent commenced before the patient was twenty-one. 

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

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

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

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

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

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

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

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

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

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

 * * * * *

CHAPTER IV

CAUSES OF EPILEPSY

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

THE MECHANISM OF THE FIT

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

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

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

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

The Primary Cause of epilepsy is an inherent instability of the nervoussystem. 

Secondary Causes are factors which cause the first fit in a person withpredisposing nervous instability; later, the brain gets the _fit habit_, and attacks recur independently of the secondary cause. In most cases nosecondary causes can be discovered, and the disease is then termed_idiopathic_, for want of an explanation. 

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

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

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

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

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

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

Epilepsy may be due to abortives. These drugs wreck the constitution of theundesired children, who contract epilepsy from causes which would not sohave affected them had they started fairly. In many families, the firstchild, who was wanted, is normal; some or all the others, who were notdesired and on whom attempts were probably made to prevent birth, areneuropaths, as are many illegitimate children. It cannot too emphaticallybe stated that there is no drug known which will procure abortion withoutputting the woman's life in so grave a danger as to prevent medical menusing it; legal abortion is always procured surgically. Dealing inabortifacients would be a capital offence under the laws of a rationalcommunity. 

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

The onset of menstruation often coincides with the onset of epilepsy, andin some cases irregularity of the menses seems to be a secondary orexciting cause. 

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

Theories as to Cause. Epilepsy is usually classed as a _functionaldisorder_; that is, the brain cells are physically normal, but, for someunknown reason, they act abnormally at certain times. This term is a veryloose one, and there is reason to believe that the basis of epilepsy issome obscure disease of the brain which has not been detected by presentmethods. 

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

Fits are most frequent between 9-10 p. M. The hours of deepest repose. Oneschool says this is due to anæmia of the brain during sleep. Clark tracesthe cause to lessened inhibitory powers owing to the higher brain centresbeing at rest, while Haig claims to have explained the high incidence atthis hour by the fact that uric acid is present in the system in thegreatest amount at this time. 

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

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

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

 * * * * *

CHAPTER V

PREVENTION OF ATTACKS

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

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

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

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

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

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

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

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

When the warning is felt in the hand or foot, a strap should be worn roundthe ankle or wrist, and pulled tight when the aura commences. Thissometimes aborts a fit, as biting a finger in which the aura commences mayalso do. 

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

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

_Never attempt to empty the stomach at the onset of a definite aura_, forif the seizure occurs, the vomit will probably obstruct the trachea, andsuffocate the victim. 

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

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

 * * * * *

CHAPTER VI

FIRST-AID TO VICTIMS

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

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

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

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

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

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

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

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

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

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

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

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

 * * * * *

CHAPTER VII

NEURASTHENIA

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

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

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

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

Neurasthenia is due to exhaustion and poisoning of the nervous system, thechief symptoms of which is persistent _neuro-muscular fatigue with generalirritability_. Its minor symptoms are almost as numerous as the variousactivities possible in mind and body. 

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

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

 Worry in any form (especially when accompanied by excess of brain-work), Accident-shock, Sexual abuse, Abuse of drink, drugs or tobacco, Lack of exercise, Exhausting diseases, Menopause, and diseases of the womb, "Society life", Retirement, are the commonest exciting causes of neurasthenia; hard brain-work, unlessaccompanied by worry, not being injurious. 

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

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

Competition has increased in all conditions of life; free course is givento ambition, individuals impose on their brains a work beyond theirstrength; and then comes care and perhaps reverse of fortune; and thenervous system, under the wear and tear of incessant excitation, at lastbecomes exhausted, The basic symptom is an inability to stand a normal amount of mental orphysical strain, and shows itself in seven marked ways:

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

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

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

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

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

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

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

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

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

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

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

His ideas are restive, continuous thought is impossible, and when talkinghe has to be "brought back to the point" many times. Memory and attentionflag, and he listens to a long conversation, or reads pages of a bookwithout grasping its import, and consequently he readily "forgets" what inreality he never laboured to learn. Trembling of limbs is common. 

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

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

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

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

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

He is extremely irritable (slight noises make him start violently), childishly unreasonable, wants to be left alone, rejects efforts to rousehim, but is disappointed if such efforts be not made, broods, and fearsinsanity. The true melancholic is convinced he himself is to blame for hismisery; it is a just punishment for some unpardonable sin, and there is nohope for him in this world or the next. The neurasthenic, on the contrary, ascribes his distress to every conceivable cause save his own personalhygienic errors. 

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

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

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

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

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

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

He draws up (or copies) a special diet-sheet, and talks of "proteids", notices a slight cloudiness in his urine, and underlines "The Uric-AcidDiathesis" in one of his pamphlets. Then his heart bumps, he diagnosesanew, and so goes on, usually ending by taking phosphorus for his "brainfag". Then he finds he has a disease unknown to the faculty, whichdiscovery interests him as intensely as it irritates his unfortunatefriends. 

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

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

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

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

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

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

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

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

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

Egoism, moral cowardice, and sexual excess play a part in muchneurasthenia, but relatives must not forget, in their indignation at theselaxities, that the patient really _is_ ill; it is unkind, unjust anduseless to tell an ailing man the unpalatable truth that it is his ownfault. 

 * * * * *

CHAPTER VIII

HYSTERIA

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

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

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

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

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

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

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

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

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

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

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

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

Savill gives the following differences between neurasthenia and hysteria:

 NEURASTHENIA HYSTERIA

 Sex Both sexes equally. 97 per cent females. 

 Age Any age. First attack before page of 25. 

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

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

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

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

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

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

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

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

Sensationalism is manna to them. They _must_ occupy the limelight. Painsare magnified or manufactured to attract sympathy; they pose asmartyrs--refusing food at table, and eating sweets in their room, orstealing down to the larder at night--to the same end. If mild measuresfail, then self-mutilation, half-hearted attempts at suicide, and baselessaccusations against others are brought into play to focus attention onthem. 

Minor attacks usually commence with palpitation and a "rising" in thestomach or a lump in the throat, the _globus hystericus_, which the patienttries to dislodge by repeated swallowing. This is followed by a feeling ofsuffocation, the patient drags at her neck-band, throws herself into achair, pants for breath, calls for help, and is generally in a state ofgreat agitation. She may tear her hair, wring her hands, laugh or weepimmoderately, and finally swoon. The recovery is gradual, is accompanied byeructations of gas, and a large quantity of pale, limpid, urine may bepassed later. 

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

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

Next comes the convulsive stage, but the convulsions are not the true jerkymovements of epilepsy, but are bilateral tossing, kicking, and rollingmovements, interspersed with various irregular passionate attitudes. Thereis great alteration but _not loss_ of consciousness. The patient struggleswith those about her, bites them, but never her own tongue, shrieks andfights, but never passes urine, throws things about, and arches the backuntil the body rests on head and feet (_opisthotonos_). The stretching andconvulsive stages alternate, and the attack lasts a long time, beingstopped by pain or by the departure of onlookers. During this stage theface may reflect the various emotions passing through the mind--with afidelity that would rouse the envy of an Irving. 

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

The victim of these attacks _is_ suffering from a disease, for she showsmany temporary mental symptoms which could not possibly be feigned, whilethere is often a genuine partial forgetfulness of the incidents of anattack. She says she cannot help it; candid friends say she will not. Thetruth is that she cannot _will_ not to help it; for though intelligence andmemory are often good and sometimes abnormal, the judgment and will arealways weak--indecision, obstinacy, and doubt being common. 

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

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

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

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

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

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

For anæmic patients, the following is a useful prescription:

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

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

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

 * * * * *

CHAPTER IX

ADVICE TO NEUROPATHS

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

The above quotation epitomizes the cure for neurasthenia, for as Huxleysaid:

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

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

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

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

 * * * * *

Go for a long sea voyage, if possible. 

If not, get a long holiday in a quiet farmhouse, or, better still, get tothe country for good, be it in never so humble a capacity, for a healthycowman is happier than a neurasthenic clerk. The rural worker has notheatres, but he can walk miles without meeting another; he has woods toroam in, hills to climb, trees to muse under: he has ample light and air, and his is a far happier lot than that of a vainglorious but miserable, sedentary machine in a great city. 

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

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

Nerve-starvation needs generous feeding with easily digested food. Drinkmilk in gradually increasing amounts up to half a gallon per day. If morefood is needed, add eggs, custard, fruit, spinach, chicken, or fish, but donot forgo any milk. Avoid starchy foods and sweets. 

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

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

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

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

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

Do not get out of bed too early in the morning, but rise in time to eatyour breakfast slowly, attend to the toilet, and catch the car withouthaste. If your occupation be an indoor one, rise an hour earlier, and walkor cycle quietly to work. 

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

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

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

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

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

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

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

Work never hurt anyone, but harassing preoccupation with problems which noamount of thought will solve drives many thousands to early graves. Angerexhausts itself in a few minutes, fatigue in a few hours, and real overworkwith a week's rest, but worry grows ever worse. Ponder Meredith's lines:

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

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

"But there is no bright side. "

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

_Learn to forget_!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

After some months of treatment, ask yourself--

Am I able to walk ten miles with ease? when introduced to a stranger ofeither sex or any age, to converse agreeably, profitably and withoutembarrassment? to entertain visitors so that all enjoy themselves? to readessays or poetry with as much pleasure as a novel? to listen to a lecture, and be able afterwards to rehearse the main points? to be good company formyself on a rainy day? to submit to insult, injustice or petulance withdignity and patience, and to answer them wisely and calmly? When you areable to answer, "Yes!" to these queries, your nerves are sound. 

 * * * * *

CHAPTER X

FIRST STEPS TOWARDS HEALTH

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

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

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

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

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

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

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

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

For obstinate nasal trouble, consult an aural surgeon. 

The Teeth. 

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

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

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

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

 Buy 3 ozs. Precipitated Chalk, 1 oz. Chlorate of Potash, and brush the teeth with this mixture ere going to bed; use tepid waterafter meals. Do not brush across, but, holding the brush horizontally, brush with a circular motion, cleaning top and bottom teeth at once. Use amoderately hard brush with a curved surface which fits the teeth. 

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

 1œ fl. Oz. Glycerine, 1 fl. Oz. Carbolic Acid, œ fl. Oz. Methylated Chloroform. 

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

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

 * * * * *

CHAPTER XI

DIGESTION

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

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

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

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

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

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

By an obscure process, the acid chyme stimulates the walls of the bowel tosend a chemical messenger, a Hormone through the blood to the liver andpancreas, warning them their help is needed, whereupon they activelysecrete their ferments. 

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

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

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

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

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

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

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

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

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

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

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

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

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

 * * * * *

CHAPTER XII

INDIGESTION

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

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

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

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

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

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

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

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

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

The crux of digestion is to

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

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

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

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

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

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

 * * * * *

CHAPTER XIII

DIETING

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

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

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

In theory it is excellent, for it should ensure maximum work-energy withminimum use of digestive-energy, but in practice it breaks down badly, aweakness to which theories are prone. One man divided four raw eggs, anounce of olive oil, and a pound of rice into three meals a day. Theoretically, such a diet is ideal, and for a short time the experimentergained weight, but malnutrition and dyspepsia set in, and he had to giveup. The best diet-calculator is a normal appetite, and fancy aids digestionmore than a pair of scales. 

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

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

No one needs more than three meals per day, while millions thrive on one ortwo only, which should be ready at fixed hours; for the stomach whenhabituated becomes congested and secretes gastric juice at those hourswithout the impulse of the will, is ready to digest food, and gets thatrest between-times which is essential to sound digestion. The man who hassnacks between meals, and chocolates and biscuits between snacks can neverhope to get well. 

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

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

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

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

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

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

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

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

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

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

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

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

Let the patient eat a mixed diet, well and suitably cooked, taking what hefancies in reason, masticating everything thoroughly, and graduallyeliminating foods which experience teaches him are difficult for him todigest. 

 * * * * *

CHAPTER XIV

CONSTIPATION

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

Rings of muscle cause wormlike movements of the bowels, and so propelforward food and waste. Weakening of these muscles or their nerve controlsfrom any cause, results in a "condition of the bowels in which motionsoccur only when provoked by medicines or injections". In some cases thoughmotions occur freely, food ingested is retained too long in the digestivetract. 

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

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

Much misery is caused by false modesty in the presence of others. It cannever be immodest to attend to the calls of Nature, and suchhypersensitiveness is dangerous, for rupture, piles, fissure, prolapse, fistula, are often due to straining. 

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

Bacteria flourish freely in fæces, and though it is doubtful whether the"Auto-intoxication" so freely ascribed to them, is supported by facts, itcannot be doubted that, whatever the precise mechanism by which the effectsare produced, constipation does result in a lowering of the resistance todisease. More frequent fits, colic, foul breath, headache right across theforehead, lost appetite, drowsiness, skin eruptions, irritability, insomnia, melancholia and anæmia (especially the "green sickness" of women, usually connected with menstrual irregularities) are but a few of many illspartly or wholly due to or consequent upon constipation. 

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

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

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

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

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

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

Purgatives, injections and medicines, alone, are useless, for the bowelbecomes still more insensitive to natural calls under the artificialstimulation of drugs, on which it becomes so entirely dependent thatwithout their aid it will not act. 

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

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

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

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

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

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

Patent medicines almost invariably contain a brisk aperient. 

 * * * * *

CHAPTER XV

GENERAL HYGIENE

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

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

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

Man's finest steam engine turns one-eighth of the energy supplied intowork; nature's engine, muscle, turns one-third into work. The body contains9 gallons of water, enough carbon to make 9, 000 lead pencils, phosphorusfor 8, 000 boxes of matches, iron for 5 tacks, and salt enough to fill halfa dozen salt-cellars. 

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

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

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

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

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

 * * * * *

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

Plenty of fresh, clean air is essential to health. 

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

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

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

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

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

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

Other Hygienic Points. Tobacco is undesirable for neuropaths, save inmoderation. 

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

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

Buy Muller's "My System", which gives a course of physical exerciseswithout apparatus, which only take fifteen minutes a day. The patient mustconscientiously perform the exercises each morning, not for a week, nor fora month, but for an indefinite period, or throughout life. 

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

 * * * * *

CHAPTER XVI

SLEEPLESSNESS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 * * * * *

CHAPTER XVII

THE EFFECTS OF IMAGINATION

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

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

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

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

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

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

Cheap medical and pseudo-medical works are not an unmixed blessing, formany a person who knows, and needs to know, nothing about disease, getshold of one, and soon has most of the ills known to the faculty and somewhich are not. 

If a patient be an optimist and persuades himself he is improving, he_does_ improve. This is the explanation of "Faith moving mountains", forthe curative power of prayer, Christian Science, laying-on of hands, suggestion treatment and patent medicine, depends on man's own faith, noton the supernatural. 

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

Eloquent, though often inaccurate accounts of the benefits derived frompatent medicines are persistently advertised until the mind is soinfluenced by the constant reiteration of miraculous cures, that, eitherbecause the healing forces of the body are thereby stimulated, or becausethe disease is curable by suggestion, the patient is benefited by suchmedicines. 

Thinking of pain makes it worse and vice versa. 

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

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

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

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

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

The classic description of the woeful effects of imagination is in Jerome's"Three Men in a Boat". Harris, having a little time on his hands, strollsinto a public library, picks up a medical work, and discovers he has everyaffliction therein mentioned, save housemaid's knee. He consults a doctorfriend and is given a prescription. After an argument with an iratechemist, he finds he has been ordered to take beefsteak and porter, and notmeddle with matters he does not understand. A sounder prescription neverwas penned. 

 * * * * *

CHAPTER XVIII

SUGGESTION TREATMENT

 "To purge the veins Of melancholy, and clear the heart Of those black fumes that make it smart; And clear the brain of misty fogs Which dull our senses, our souls clog. " --Burton. 

Hypnosis and suggestion have suffered from those people who put back everyreform many years--quacks and cranks--for while science, with open mind, was testing this new treatment, the quacks exploited it up hill and downdale. 

Yet there is nothing supernatural in suggestion, for we employ it onourselves and others every hour we live. Conscience consists only of thecountless stored-up suggestions of our education, which by opposing anycontrary suggestions, cause uneasiness. 

Many of us conform through life to the suggestions of others, affection, awe, hero-worship and fear taking the place of reason. 

The most resolute of men are influenced by tactful suggestions, whichquietly "tip-toe" on to the margin of consciousness, awaken ideas whichlink up more and more associations, until an avalanche is started whichforces itself on to the field of consciousness, the subject thinking theidea is his own. 

Author and actor try by suggestion to make us think, laugh, or weep attheir will, books are sold by suggestive titles, and many clothes are wornonly to suggest wealth or respectability. 

The best salesman is he who by artful suggestion sells us what we do notwant; the best buyer he who by equally astute suggestion makes the sellerpart at a price which makes him regret the bargain the moment it is closed. 

Suggestion treatment is of great use in curing nervous states and badhabits, and all neuropaths should practice self- or auto-suggestion. Insevere cases a specialist must give the treatment. 

The patient is taken by the neurologist to a cosy, restfully-furnished, half-lighted room, and placed in a huge easy chair facing a cheery fire. Hesinks into the depths of the chair, relaxes every muscle, allows histhoughts to wander pleasantly, and soon his brain is at rest, and his mind, undisturbed by the fears which usually harass it, is ready to receivesuggestions. 

The doctor talks quietly, soothingly, but with the conviction born ofknowledge to the patient about his trouble, assuring him that he _can_control his cravings; that he _can_ put away the doubts or fears that havegrown upon him. The true reason of his illness is pointed out, any littleorganic factors given due weight, and the idea that it is hereditary or dueto Fate dispelled. Faults of character, reasoning and living areunsparingly exposed and appropriate remedies suggested, and he is shown howunmanly his self-torturing reproaches are, and how futile is remorse unlesstransmuted into reform. 

The doctor's earnestness inspires confidence, and the patient unburdens hissecret troubles, discusses means of remedying them, and turns from pain topromise, from remorse to resolve, from introspection to action, fromdreading to doing. 

Struck by the way the psycho-analyst reads his soul and lays bare pettymeannesses, impressed by the patient thoroughness with which the doctorattends to each little symptom, confident that organic troubles--if therebe any--will receive appropriate treatment, ready to carry outinstructions, and disposed to believe the new treatment is of real value:under all these circumstances, the physician's suggestions carry very greatweight with the patient. 

The resolutions passed by the victim in this calm state sink deep intosubconsciousness, and when next temptation, impulse or fear assails him, his own resolutions and the doctor's suggestions are so vividly recalledthat he tries to control his thoughts, and, in due time he "wins out". 

Anyone may induce the calm state, and repeat suitable suggestions. Thepatient should go to a quiet room, and, reclining on a comfortable couchbefore a cheery fire, close the eyes, relax the muscles, breathe deeply, and avoid all sense of strain. 

The next step is to fix the imagination on some scene which suggeststranquility--smooth seas, autumnal landscapes, snow-clad heights, old-worldgardens, deep, shady silent pools, childhood's lullabies, secludedbackwaters, dim aisles of ancient churches. 

After a few evenings' practice, you will be able gradually to exclude allother ideas, and focus on one, inducing a state which, somewhat similaroutwardly, is free from the excitement of religious exaltation, and fromthe delusions of a medium's trance. 

In this state, an appropriate suggestion must be made, sincerely, and with_absolute faith_ in its power. Christ's miracles were the result ofsuggestive therapeutics, and He took care to inspire relatives with faith, to exclude scoffers, to surround himself by his believing Apostles, and, after treatment, said: "See thou tell no man!" well knowing that suggestioncannot withstand derision. 

In this way, a patient of limited means can do for himself exactly whatmore fortunate ones pay large fees to specialists to do for them. Thetreatment is uncommon, but sound, for the medical profession is perhaps themost conservative on earth, and when specialists of repute use a method, you may be confident it is of value. 

To cure sleeplessness, see that stomach and brain are at rest, bedcomfortable, and feet warm; calm yourself, and focus on the idea of sleep, saying:

"I shall go to sleep in a few minutes, and wake at eight o'clock in themorning. "

Repeat this a few times, persist for a few nights and you will quickly getdrowsy, and fall asleep. 

Phrases for other requirements will readily occur, as:

"I shall feel confident in open spaces!"

"I shall find no more pleasure in alcohol!" and so on. 

Suggestion will not cure epilepsy, hysteria or neurasthenia, but itovercomes many of the symptoms which make the patient so wretched. 

 "Crutches are hung on the walls of miraculous grottos, but _never a wooden leg_. "

Suggestion may move a paralysed arm, but the muscles only become healthyagain in many days by slow repair; suggestion releases the catch, but thespring must be wound up by energy suitably applied. 

 * * * * *

CHAPTER XIX

MEDICINES

 "Of simples in these groves that grow He'll learn the perfect skill; The nature of each herb, to know Which cures and which can kill. " --Dryden. 

So distressing a malady as epilepsy early attracted attention, and everytreatment superstition could devise, or science could suggest, has beentried. Culpepper in his "Herbal" (300 years old), recommends bryony; lunarcaustic (nitrate of silver) was extensively used, because silver was thecolour of the moon, which caused madness. 

The royal touch for scrofula (King's Evil) was also extended to epilepsy, the king blessing a ring, which was worn by the sufferer. 

Another old remedy was to cut off a lock of the victim's hair while in aseizure and put it in his hand, which stopped (?) the attack. In Berkshirea piece of silver collected at the communion service and made into a ringwas specific, but in Devon a ring made of three nails from an old coffinwas preferred. Lupton says: "A piece of child's navel-string borne in aring is good against falling sickness. "

Nearly every drug in the Pharmacopoeia has been tried, the drugs nowgenerally used being sodium, potassium and ammonium bromide. 

Before bromides were introduced by Locock in 1857, very strict hygienic, dietic and personal disciplinary treatment combined with the use of drugsoften effected improvement. Since the use of bromides, these personalhabits have, unfortunately, been neglected, far too much reliance beingplaced on the "three times a day after meals" formula. 

All bromides are quickly absorbed from the stomach and bowels, and enterthe blood as sodium bromide, which lowers the activity of both motor andsensory centres, and renders the brain less sensitive to disturbinginfluences. 

Unfortunately, the influence of bromides is variable, uncertain, andmarkedly good in only a small proportion of cases. 

In about 25 per cent of cases, in which mild seizures occur at longperiods, without mental impairment, the bromides arrest the seizures, either temporarily or permanently, after a short course. In another 25 percent the bromides lessen the frequency and severity of the fits, this beingthe common _temporary_ result of their use in _all cases_ in the firststages. 

In quite 50 per cent of cases, the effect of bromides diminishes as theyare continued, and they finally exert no influence at all. Many cases aretemporarily "cured", the drug is stopped, and the seizures recur. Bromidesare valuable in recent and mild cases, but no medicine exerts much effecton severe cases of long standing, which usually end in an institution. 

When these drugs are taken continuously, nausea, vomiting, sleepiness, confusion of thought and speech, lapses of memory, palpitation, furredtongue, unsteady walk, acne and other symptoms of "bromism" may arise, whereupon the patient must stop taking bromides and see a doctor, who willsubstitute other drugs for a time. 

If heart palpitation be troublesome while using bromides, take ateaspoonful of sal volatile in water. 

See a doctor if you can; _until_ you see him, get from a chemist:

 Potassii bromidi 10 grains. Sodii bromidi 10 grains. Boracis purificati 5 grains. Aquæ 1 fluid ounce. Two tablespoonfuls in water three times a day after meals. 

This prescription is for an adult. If the patient be under twenty-one, tellthe chemist his age, and he will make it up proportionately. 

Victims who have seizures with some regularity at a certain time, shouldtake the three doses in one, two hours before the attack is expected. Ifthere are long intervals between attacks, cease taking bromides after onefit and recommence three weeks before the next seizure is apprehended. Whenthere is an interval of six months or more between attacks, take no drugs. 

Bromides in solution are unpalatable, patients grow careless of regularityand dosage. 

You must learn from your doctor and your own experience the prescription, time and dose best suited to your case, and then _never miss a dose untilyou have been free from fits for two years_, for the beneficial action ofbromide depends on the tissues becoming and remaining "saturated" with thedrug. Never give up bromides suddenly after long use, but gradually reducethe dose. 

It is just when the disease has been brought under control, that patientsconsider further doctor's bills an unnecessary expense, with the resultthat a little later the fits recur, and a tedious treatment has to becommenced over again. 

No value can be placed on any specific for epilepsy until it has beenthoroughly tested for some years, and so proved that its effects arepermanent, for almost any treatment is of value for a time, possiblythrough the agency of suggestion. 

 * * * * *

CHAPTER XX

PATENT MEDICINES

 "Men who prescribe purifications and spells and other illiberal practices of like kind. "--Hippocrates. 

 "... Corrupted By spell and medicines bought of mountebanks. " "Othello. " Act I. 

Carlyle said the world consisted of "so many million people, _mostlyfools_"; and he was right, for to public credulity alone is due the immensegrowth of the patent-medicine trade. 

It was formerly thought that for each disease, a specific drug could befound, but this idea is exploded. The doctor determines the exact conditionof his patient, considers how he best may assist nature or prevent death, and selects suitable drugs. He carefully notes their action and modifieshis treatment as required. The use of set prescriptions for set diseases isobsolete; the doctor of to-day treats the patient, not the disease. 

A few patent medicines are of limited value; many are made up fromprescriptions culled from medical works, and the rest are frauds, likepotato starch. The evil lies in charging from three to four hundred times ajust price, in ascribing to a medicine which may be good for a certaindisorder, a "cure-all" virtue it does not possess, and in inducing ignorantpeople to take powerful drugs, reckless of results. 

Ephemeral patent-medicine businesses, run by charlatans, whose aim isfrankly to make money before they are exposed, spring up like mushrooms;and their cunningly worded advertisements meet the eye in the columns ofevery paper one opens for a few months; then they drop out, to reappearunder another name, at another address. These rogues buy a few gross pillsfrom a wholesale druggist, insert a small advertisement, and so lay thefoundations of a profitable business. 

The lure of the unknown is turned to account. "The discoverer went back tothe Heart of Nature--and found many rare herbs used by Native Tribes. " "The"Heart of Nature" was probably a single-room office tucked away down aFleet Street alley, and analysis proves these medicines contain only commondrugs, one "_Herbal Remedy_" being _metallic_ phosphates. 

A common procedure is to send a question form, and, after answering thequery, "What are you suffering from?" with "Neurasthenia", the company"carefully study" this, and then inform you with a gravity that would gracethe pages of "Punch", "You are the victim of a very intractable type ofNeurasthenia", so intractable in fact that it will need "additionaltreatment"--at an "additional" fee. 

The quack's advertisements are models of the skilful use of suggestion, andturn to rare account the half-knowledge of physiology most men pick up fromperiodicals. He frightens you with alarming and untrue statements, gainsyour confidence by a display of semi-true facts reinforced where weak byfalse assertions, and, having benefited himself far more than you, leavesyou to do what you should have done at first, go to a doctor or a hospital. 

Were it made compulsory for the recipe to be printed on all patentmedicines, people would lose their childlike faith in coloured water andpurges, and cease the foolish and dangerous practice of treating diseasesof which they know little with drugs of which they know less. 

The British Medical Association of 429, Strand, London, W. C. , issue two1_s_. Books--"Secret Remedies: What they cost and what they contain", "MoreSecret Remedies"--giving the ingredients and cost price of most patentmedicines. You are strongly urged to send for these books, which should bein every home. 

_The basis of every cure for epilepsy_ (not obviously fraudulent) _isbromides_. The usual method is to condemn vigorously the use of potassiumbromide, and substitute ammonium or sodium bromide for it. Some advertiserscondemn all the bromides, and prescribe a mixture of them; others condemnpotassium bromide, and shamelessly forward a pure solution of this samesalt in water as a "positive cure!"

In all cases the sale price is out of reasonable proportion to the cost, victims paying outrageous sums for very cheap drugs. 

Most epileptics are poor, because their infirmity debars them fromcontinuous or well-paid work, leaving them dependent on relatives, often inpoor circumstances also. The picture of patients, already lacking many realnecessities, still further denying themselves for weeks or months topurchase a worthless powder, is truly a pitiful one. 

Bromides are unsatisfactory drugs in the treatment of epilepsy, but theyare the best we have at present. Get them made up to the prescription of adoctor, and see him every month to report progress and be examined. In theend, this plan will be very much cheaper, and incomparably better, thanbuying crude bromides from quacks. 

 * * * * *

There is no drug treatment for either hysteria or neurasthenia, and whenthe doctor gives medicines for these complaints, it is to remedy organictroubles, or, more often because necessity forces him to pander to theirrational and pernicious habit into which the public have fallen ofexpecting a bottle of medicine whenever they visit a doctor. Osier, thefamous Professor of Medicine at Oxford, truly observed that he was the bestdoctor who knew the uselessness of medicines. But when public opiniondemands a bottle, and is unwilling either to accept or pay for advicealone, the doctor may be forced to give medicines which he feels are oflittle value, hoping that their suggestive power will be greater than istheir therapeutic value. 

Neuropaths invariably contract the habit of physicking themselves, andtaking patent foods and drugs which are valueless. 

So universal is this pernicious habit that we deem it desirable tocriticize it here at some length. 

One highly popular type consists of port wine, reinforced (?) by malt andmeat extracts, and sold under a fanciful name. It has about the same valueas a bottle of port, which costs considerably less. It is well to rememberthat many a confirmed drunkard has commenced with these "restoratives". 

Malt extracts are also popular. They contain diastase, and therefore aidthe digestion of starch, but the diastatic power of most commercialextracts is negligible. 

Meat extracts of various makes contain no nourishment, but are valuableappetisers. Meat gravy is as effective and far cheaper. 

Foods containing digestive ferments, which are widely advertised undervarious proprietary names are practically valueless, as are the fermentsthemselves sold commercially. Digestive disorders are very rarely due todeficiency of ferments, while pepsin is the only one among all the fermentsthat could act (and that only for a little while) in the digestive system. 

Some of the disadvantages of predigested foods have been noted, and theirprices are usually so exorbitant that eggs at 2_s. _ 6_d. _ each would becheaper. The remarks of Sollmann the great pharmacologist are pertinent:

 _Limitations_. The administration of food in the guise of medicine is sometimes advantageous; but medicinal foods are subject to the ordinary law of dietetics, and therefore cannot accomplish the wonders which are often claimed for them. The proprietary foods have been enormously overestimated, and have probably done more harm than good. The ultimate value of any food depends mainly on the amount of calories which it can yield, and on its supplying at least a minimum of proteins. In these respects, the medical foods are all inferior, for they cannot be administered practically in sufficient quantity to supply the needs of the body. They have a place as adjuvants to other foods, permitting the introduction of more food than the patient could otherwise be induced to take. Aside from the special diabetes foods and cod-liver oil, their value is largely psychic. 

 _Predigested Foods_. The value of these is doubtful, for digestive disturbances involve the motor functions and absorption more commonly than the chemical functions. Their continued use often produces irritation. 

 _Liquid Predigested Foods_. As sold, these are flavoured solutions containing small amounts (œ-6 per cent) of predigested proteins, œ-15 per cent of sugars and other carbohydrates, with 12-19 per cent of alcohol, and often with large quantities (up to 30 per cent) of glycerin. Their protein content averages less than that of milk, and in energy value they are vastly inferior. Their daily dose yields but 55-300 calories including their alcohol; this is only one-thirtieth to one-fifth the minimum requirements of resting patients. To increase their dose to that required to maintain nutrition would mean the ingestion of an amount of alcohol equivalent to a pint of whisky per day. 

Of recent years very expensive preparations of real or alleged organic ironcompounds have had a large sale. Iron is a component of hæmoglobin, a solidconstituent (13 per cent by weight) of the blood, which combines with theoxygen in the lungs, and is carried (as oxyhæmoglobin) all over the body, giving the oxygen up to the tissues. Hæmoglobin is an exceedingly complexsubstance, but it contains only one-third per cent by weight of iron inorganic form. 

The liver is the storehouse of iron, its reserve being depleted when thereis an extraordinary demand for iron. The minute amounts of iron in ordinaryfood are amply sufficient for all our needs; any excess is simply stored, and, later excreted, and has no effect whatever on the circulatinghæmoglobin. 

Iron is only of value in certain forms of anæmia, and the many patentmedicines purporting to contain hæmoglobin or organic iron are thereforeuseless to neuropaths. The Roman plan of drinking water in which swords hadbeen rusted, is quite as valuable as drinking expensive proprietarycompounds. When iron is indicated Blaud's Pills are perhaps the bestpreparation. 

Huge quantities of patent medicines containing phosphates in the form ofhypo-or glycerophosphates, and (or) lecithin are sold annually. 

All phosphorus compounds are reduced to inorganic phosphates in thedigestive tract, absorbed and eliminated, so that, as with iron, ifphosphates are needed, the form in which they are taken is of no moment. Why, then, pay huge sums for organic-phosphorus compounds (synthesized frominorganic phosphates) when they are immediately reduced to the sameconstituents from which they were constructed, the only value in thereduction process being seen in the immense fortunes which patent-medicineproprietors accumulate?

Lecithin is isolated from animal brain, or egg-yolk, and commerciallecithin is impure. Not only does the ordinary daily diet contain amplelecithin (5 grammes), but two eggs will double this, while liver orsweetbread, both rich in phosphorous, may be eaten. 

The much-vaunted glycerophosphates are decomposed to and excreted asphosphates. Sollmann's remarks apply to all similar proprietary articles:

 "A proprietary compound of glycerophosphates and casein has been widely and extravagantly advertised as 'Sanatogen'. It is a very costly food, and in no sense superior to ordinary casein, such as cottage cheese. "

Hypophosphites have been boomed by various people, chiefly for financialreasons. Five or six of them are usually prescribed, with the addition ofcod liver oil, and perhaps quinine, and (or) iron and strychnine, thecomplexity of the prescription being expected, apparently, to compensatefor the uselessness of its various ingredients. 

To deduce rational remedies, it is first necessary to elucidate the causesof inefficiency; and to expect a brain which is out of order to function inan orderly manner simply because it is supplied with one of the substancesnecessary to its normal functioning (regardless of whether a deficiency ofthat substance is the cause of the disorder), is as rational as it would beto expect to restart an automobile engine, the magneto of which was broken, by filling up the half-empty petrol tank. 

 * * * * *

CHAPTER XXI

TRAINING THE NERVOUS CHILD

 "When shall I begin to train my child?" said a young mother to an old doctor. "How old is the child, madam?" "Two years, sir!" "Then, madam, you have lost just two years, " answered the old physician, gravely. 

Neuropathic children are super-emotional, and from them come prodigies, geniuses, perverts and madmen. They are usually spare of build, with pale, sallow complexions, and dark rings under the eyes. 

They can never sit still, but wriggle restlessly about on their seats, picktheir nostrils, and bite their nails. They are always wanting to be doingsomething, but soon tire of it, and start something else, which is asquickly cast aside; their energy is feverish but fitful. They jump toconclusions, quickly grasp ideas; as quickly forget them. Having nocapacity for calm, reasoned judgment, they are creatures of impulse, imperative but timid, suffer from strange ideas, and worry over trifles. 

The affections are strong and vehement, likes and dislikes are takenwithout reason, while intense personal attachments--oftenunrequited--occur, but not seldom swing round to indifference, or evenbitter enmity. The passions and emotions are all abnormal, for owing todeficiency in the higher inhibitory centres, the victim is blown about byevery idle emotional wind that blows. The slightest irritation may provokean outburst of maniacal rage, or a fit. Consequently, they require the mostcareful, but firm training, right from birth, to bring them up with aminimum of nerve-strain. Twitchings, night or day terrors, sleep walking, and incontinence of urine often trouble them. They should be examined by adoctor once a year. 

These children have no _balance_, and are usually selfish, alwaysgarrulous, with a love of romancing, while a ready wit combined withfertile imagination often gains them a bubble reputation for learning theydo not possess. Invention, poetry, music, artistic taste and originalityare occasionally of a high order, and the memory is sometimes phenomenal;but desultory, half-finished work, and shiftlessness are the rule. 

Their appetite is fitful and fanciful, they like unsuitable foods, andtheir digestive system is easily upset. At puberty, sexual perversity iscommon, and the animal appetite, is as a rule, very strong, though rarely, it may be absent. During adolescence, there is excessive shyness orbravado, always introspection, and exaggerated self-consciousness. 

As they grow older, they readily contract hypochondria, neurasthenia, hysteria, alcoholism, insomnia and drug habits, and react unduly to themost trifling external causes, even to the weather, by which they areexhilarated or depressed. 

Education. Send them to school only when the law compels you, and observethem closely while there, for health is far more important to them thaneducation. "Infant prodigies" lack the mental staying power and physicalrobustness which real success demands, though they may do well for a time. Go to your old school: the successes of to-day were dunces twenty yearsago; about those whose names are proudly emblazoned in fading gold on Rollsof Honour, a discreet silence is maintained. 

Keep a keen lookout for symptoms of over-effort. Sleepiness, languor, avacant expression, forehead wrinkled, eyebrows knit, eyes dull, sunken andsurrounded by dark rings, twitchings, restlessness, or loss of appetite areall warnings that the pace is too strong for the child. 

 "These are the cases in which the School Board--who ordain that if children are well enough to play or run errands, they are well enough to attend school--should be defied. "

This defiance must of course be reinforced by a doctor's certificate. 

To the healthy, the strain of preparing for and enduring an examination istremendous; to highly strung children it is dangerous. Home-work should beforbidden in spite of the authorities. Let the child join in the sports ofthe school as much as possible. 

School misdemeanours form a thorny problem, for discipline must bemaintained, and a stern but just discipline is very wholesome for thistype, who are too apt to assume that because they are abnormal, they can beidle and refractory. On the other hand, parents should promptly andvigorously object to their children being punished for errors in lessons, or struck on the head. 

Diet. Food, while being nourishing, and easily digested, must not bestimulating or "pappy". Meat, condiments, tea, coffee and alcohol arehighly undesirable, a child's beverage being milk and water. 

Meals should be ready at regular hours, and capricious appetites shouldfreely be humoured among suitable foods, served in appetizing form to temptthe palate. Let them chatter, but see they do not get the time to talk bybolting their food. 

Most children can chew properly soon after they are two, but they are nevertaught. Their food is "mushy", or is carefully cut, and gives them noincentive to masticate. So long as food is digestible, the harder it is thebetter, and plain biscuits, raw fruits, and foods like "Grape Nuts", aresplendid. Mastication helps digestion; it also prevents nasal troubles. 

The desire for food at odd moments causes trouble, which is aggravated ifthe meals are not ready at stated hours. Gently but firmly refuse the pieceof bread-and-butter they crave, explain why you do so, and though theyweep, or fly into a passion, do not lose your own temper, or beat, or giveway to them. When accustomed to regular hours and firm refusals they willnot crave for titbits between meals. 

It is very hard for them to see other members of the family freelypartaking of condiments, drinks and unsuitable foods, and be told they arethe only ones who must refrain. A little personal self-sacrifice helpsimmensely, and if your child _must_ refrain so _might_ you. 

All foods must be pure. Avoid tinned goods, and cheap jams, which containmangels and glucose. Judged by the nutriment they contain--most cheap foodsare very expensive. 

Lightly boil, poach, or scramble eggs; steam fish and vegetables; cook riceand sago in the oven for three hours. See that milk puddings are chewed, for usually they are bolted more quickly than anything else. The stomach isexpected to deal with unchewed rice pudding, because it is "nourishing". Soare walnuts, but you do not swallow them whole. 

Fruit must be fresh, ripe and raw, with skin and core removed. Brown bread, crisply toasted and buttered when cold, is best. Porridge is admirable, butmany children dislike it. Try to induce a taste by giving plenty of milk, and sugar or syrup with it. 

The starch-digesting ferments in the saliva and pancreas are not activeuntil the age of 18 months, before which infants must not be given starchyfoods like potatoes, cereals, puddings and bread. 

All greenstuffs must be thoroughly washed, or worms may pass into thesystem. Foul breath, picking the nose, restlessness, fever and startingsare often attributed to worms, when the real "worms" are mince pies, raisins, sour apples, and even beer. 

Never force fat on children in a form they do not like, for there areplenty of palatable fats, as butter, dripping, lard and milk. Cream is ascheap, as good, and far nicer than cod-liver oil. 

Decide on your children's diet, but do not discuss it with or before them. If a child _does_ dislike a dish, never force it on him, but try to inducea liking by serving it in a more appetizing way. Never mix medicines withfood. 

Worms. Various symptoms are due to intestinal worms, and a sharp lookoutshould be kept for the appearance of any in the stools, and suitabletreatment given when necessary. 

Treatment for thread and round worms:

 R. Santonini........................ Gr. Ij. Hydrarg. Chloridi mitis.......... Gr. Ij. Pulv. Aromatici.................. Gr. Iv. Mix and divide into four. 

 Take one at bedtime every other night, followed by castor oil in the morning. 

Tapeworms. These are rarer, being much more frequently talked or read aboutthan seen. A doctor should be consulted. 

Moral Training. The road to hell is broad and easy; so is that to heaven, for if bad habits are easily acquired, so are good ones. 

Example is the best moral precept, and if the conduct of parents is good, little moral exhortation is needed. "What is the moral ideal set beforechildren in most families? Not to be noisy, not to put the fingers in thenose or mouth, not to help themselves with their hands at table, not towalk in puddles when it rains, etc. To be 'good'!" To hedge in the child'slittle world, the most wonderful it will ever know, by hidebound rulesenforced by severe punishments, is to repress a child, not to train it. While the commonest error is to spoil a child, it is just as harmful tocrush it. Be firm, be kindly, and, above all, _be fair_. 

Issue no command hastily, but only if necessary, and shun prohibitionsbased on petulance or pique. Give the child what it wants if easilyobtainable and not harmful. 

If the desire is harmful, explain why, but if a child asks for a toy, donot pettishly reply: "It's nearly bedtime!" when it is not, or even if itis. 

Discipline is essential, but discipline does not consist in inconsistentnagging; harshly insisting on unquestioning obedience to some unreasonablecommand one moment, and weakly giving way--to avoid a scene--on some mattervitally affecting the child's welfare the next. 

There must be no coddling, and no inducement to self-pity. Such childrenmust be taught that they are capable of real success and real failure, andthat upon personal obedience to the laws of health of body and of mind, this success or failure largely depends. 

A child should be early accustomed to have confidence in himself. For thispurpose all about him must encourage him and receive with kindlinesswhatever he does or says out of goodwill, only giving him gently tounderstand, if necessary, that he might have done better and been moresuccessful if he had followed this or that other course. Nothing is moreapt to deprive a child of confidence in himself than to tell him brutallythat he does not understand, does not know how, cannot do this or that, orto laugh at his attempts. His educators must persuade him that he _can_understand, and that he _can_ do this thing or that, and must be pleasedwith his slightest effort. 

It seems a trifle to let a child have the run of cake plate or sweet-tray, or to stay up "just another five minutes, Mummy!" to avoid a howl, butthese are the trifles that sow acts to reap habits, habits to reapcharacter, and character to fulfil destiny. It is selfish of parents toavoid trouble by not teaching their children habits of obedience, self-restraint, order and unselfishness. Between five and ten is the age ofgreatest imitation, when habits are most readily contracted. 

Come to no decision until hearing the child's wishes or statements, andthinking the matter out; having come to it, _be inexorable_ despite thewiles, whines and wails of a subtle child. Reduce both promises and threatsto a minimum, but _rigidly_ fulfil them, for a threat which can be ignored, and a promise unfulfilled, are awful errors in training a child. 

Persuade, rather than prohibit or prevent, a child from doing harmfulactions. If it wants to touch a hot iron, say clearly it is hot, and willburn, but _do not move it_. Then, if the child persists, it will touch theiron tentatively, and the small discomfort will teach it that obediencewould have been better. Let it learn as far as possible by the hard, butwholesome, road of experience. 

Makeshift answers must never be given to a child. Awkward questions requiretruthful answers, even though these only suggest more "Whys?"

Sentimentality must be nipped promptly in the bud, and an imaginative andhumorous view of things encouraged. The child must be taught to keep thepassions under control, and to face pain (that great educator whichneurotic natures feel with exaggerated keenness) with fortitude. 

Fear must be excluded from a child's experience. "Bogies!" "Ghosts!""Robbers!" and "Black-men!" if unintroduced, will not naturally be feared. The mental harm a highly strung child does by rearing most fearsomeimaginings on small foundations is incalculable, and has led more than oneto an asylum. 

Try to train the child to go to sleep in the dark, but if it is frightenedgive it a nightlight. As Guthrie says, the comfort derived from theassurance that Unseen Powers are watching over it, is small compared tothat given by a nightlight. He mentions a child who, when told she need notfear the dark because God would be with her, said: "I wish you'd take Godaway and leave the candle. "

If the child wakes terrified, it is stupid and wicked to call upstairs: "Goto sleep!" A child cannot go to sleep in that state, and a wise mother willgo up and softly soothe the frightened eyes to sleep. 

Neuropathic children often have night terrors within an hour or two ofgoing to bed. Piercing screams cause a hasty rush upstairs, where the childis found sitting up in bed, crouching in a corner, or trying to get out ofdoor or window. His face is distorted with fear and he stares wildly at thepart of the room in which he sees the terrifying apparition. He clings tohis mother but does not know her. After some time he recovers, but is in apitiful state and has to have his hand held while he dozes fitfully off. Heoften wets the bed or passes a large amount of colourless urine. Medicaltreatment is imperative. 

Corporal punishment is unsuitable for neuropathic children, for the meresuggestion of its application usually causes such excessive dread, mentalupset and terror as make it really dangerous. Such children are often saidto be "naughty" when in reality they are unable to exercise self-control, owing to defective inhibitory power. Try patiently to inculcate obediencefrom the desire to do right, and make chastisement efficacious from itsvery exceptional character. 

"The young child is too unconscious to have a deliberately perverseintention; to ascribe to him the fixed determination to do evil, is tojudge him unjustly and often to develop in him an evil instinct. It isbetter in such a case to tell him he has made a mistake, that he did notforesee the consequences to which his action might lead, etc. " Many parentsfall into a habit of shaking, ear-boxing, and such-like harmful minorpunishments for equally minor offences, which should be overlooked. 

In all little troubles, keep _quite calm_. The child's nerve andassociation centres have not yet got "hooked up", and you cannot expect itto act reasonably instead of impulsively. This excuse does not apply toyou. One excitable person is more than enough, for if both get angry, sensible measures will certainly not result. 

The necessity for calmness cannot too strongly be urged. The treatment fora fit of temper, is to give the unfortunate child a warm bath, and put itto bed, with a few toys, when it will soon fall asleep, and awake refreshedand calm. 

Proceed gently but with absolute firmness, _start early_, and remember thatexample is better than precept. 

Religion. Offering advice on this subject is skating on very thin ice, andwe do so but to give grave warning against neuropathic youth being allowedto contract religious "mania", "ecstasy", or "exaltation". 

Neuropaths are given naturally to "see visions and dream dreams", and ifthis tendency be exaggerated an unbalanced moral type results. Jones says:

 "The epileptic is apt to be greatly influenced by the mystical or awe-inspiring, and is disposed to morbid piety. He has an outer religiousness without corresponding strictness of morals; indeed the sentiment of religious exaltation may be in great contrast to his habitual conduct, which is a mixture of irritability, vice and perverted instincts. "

Lay stress on the simple moral teaching of the New Testament, and avoidcranky creeds, cross references, or Higher Criticism. Teach them topractise the moral precepts, not to quote them by the page. 

Without this practical bent, a "Revival" meeting is apt to result in atransient but harmful "conversion"; a form of religious sentiment whichfinds outlet, not so much in works as in morbid excitement. In thesepeople, as in the insane, there is often a weird mixing-up of religious andsexual emotion. 

Teach these children that the greatest good is not to sob over theirfancied sins at "salvation" meetings, but to love the just and good, tohate the unjust and evil, and to do unto others as they would others shoulddo unto them. 

It is better for them to join one of the great churches, than becomemembers of those small sects which maintain peculiar tenets. 

A word of special warning must be given against Spiritualism. There may ormay not be a foundation for this belief, but it is highly abnormal, and hasled thousands into asylums. 

The medium and the majority of her audience are highly neurotic, and a moreunwholesome environment for an actual or potential neuropath could not beimagined. 

The educated neuropath often peruses certain agnostic works, the resultusually being deplorable, for this class are dependent on some stable baseoutside themselves, such as is found in a calm religion manifested in asteadfast attempt to overcome the weakness of the flesh, by ordering lifein accordance with the teachings of the New Testament. 

So long as abnormalities of character do not become too pronounced, friendsmust be content. 

Such children must be trained to express themselves in a practical manner, not in weaving gorgeous phantasies in which they march to imaginaryvictory. Day dreams form one of those unlatched doors of the madhouse thatswing open at a touch, the phantasy of to-day being written "emotionaldementia" on a lunacy certificate to-morrow. 

Finally, remember that above them hangs the curse:

"Unstable as water, _thou shall not excel_. "

"Go thou softly with them, all their days!" and whether your tears fall onthe ashes of a loved and loving, but weak and wilful one, or whether theirtears bedew the grave of the only friend they ever knew, you will not havelacked a rich reward. 

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CHAPTER XXII

DANGERS AT AND AFTER PUBERTY

 "Th' expense of spirit in a waste of shame Is lust in action; and till action, Lust Is perjured, murderous, bloody, full of blame, Savage, extreme, rude, cruel, not to trust; Enjoyed no sooner but despised straight; Past reason hunted; and, no sooner had, Past reason hated, as a swallow'd bait On purpose laid to make the taker mad; Mad in pursuit, and in possession so; Had, having had, and in quest to have, extreme; A bliss in proof, and proved, a very woe; Before, a joy proposed; behind, a dream; All this the world well knows; yet none knows well, To shun the Heaven that leads men to this Hell!" --Shakespeare. Sonnet 129. 

At puberty (from the age of 11-15) a boy becomes capable of paternity, agirl of maternity; during adolescence (from puberty to 25) the body ingeneral, and the reproductive organs in particular, grow and mature. 

In the boy, semen is secreted, the voice breaks, the genitals enlarge, hairgrows on the pubes, face and armpits, and there is a rapid increase inheight owing to growth of bone. In the girl menstruation commences, thepelvis is enlarged, bust and breasts develop, the complexion brightens, thehair becomes glossy, and the eyes bright and attractive. 

In both, the sexual instinct awakens, and the mental, like the physical, changes are profound. There is great general instability, the child, at onetime shy and reticent, is at another, boisterous and self-assertive. 

Parents rarely realize the importance and trying nature of this period when"there awakes an appetite which in all ages has debased the weak, wrestledfiercely with the strong and overwhelmed too often even the noble". Adolescents suffer more from the lack of understanding, sympathy, appreciation and wise guidance shown by their blind parents, than they dofrom their own ignorance and perfervid imagination. 

The transitions from radiant joy and confident expectation, reared on aflimsy basis of supposition, to dire despair consequent on a wrong readingof physical and mental changes, are rapid. Friends, lovers and heroesquickly succeed one another, play their parts, and give place to others. 

The awakening of the sexual appetite is usually ignored, and children areleft to gain knowledge of man's noblest power from companions, casualreferences in the Bible and other books, and unguarded references inconversation. Under such conditions not one in a thousand--and _your_ childis _not_ that one--escapes impurity and degraded sex ideas. 

Wherever youth congregate, this subject crops up, and those who talk mostfreely to the others are just those with the most distorted and viciousideas, whose discourse abounds in obscene detail and ribald jest. Yourchild must learn either from ignorant, unclean minds, or be taught in aclean, sacred way, which will rob sex of secrecy and obscenity; _learn hewill_; if you will not teach your child, his pet rabbit will. 

When children ask awkward questions, say quietly that such matters are notdiscussed with children, but promise to tell them all about it when theyare ten years old; delay no longer, for most children learn self-abusebetween ten and twelve. 

Self-abuse is a bad habit, and no more a "sin" than is biting the nails. Unfortunately, people with no other qualification than a desire to do good, wrongly harp on the "sin" of it and draw lurid pictures of physical andmental wreck as the end of such "sinners", ignorant that if allmasturbators went mad the world would be one huge asylum. 

Exaggeration never pays in teaching youth. Tell the truth, which is badenough without adding "white lies" with an eye to effect. 

Coitus causes slight prostration, Nature's device to remind man to keepsexual intercourse within bounds, for while in moderation it is harmless, in excess it causes great prostration. _Exactly the same applies toself-abuse_, for, paradoxical as it seems, the real harm is done by the_fear_ of the supposed harm. 

The masturbator first suffers from the knowledge he is indulging in apleasure he knows would be forbidden, and from fear of being found out;later he learns from friends, quack advertisements, or well-meaning booksthat self-abuse is a most deadly practice, and thereupon a tremendousstruggle occurs between desire and fear, each act ending in an agony ofremorse and dread of future consequences, which struggle does athousand-fold more harm than the loss of a little semen. 

The ill-effects of these mental struggles disappear after marriage, whichmeans greater indulgence, but indulgence free from mental stress. Inneuropaths, these mental struggles are the worst things that could occur, for they tend to make permanent the states we are trying to cure. 

The most serious results of masturbation are moral not physical. Loss ofwill-power, self-reliance, presence of mind, reasoning power, memory, courage, idealism, and self-control; mental and physical debility, laziness, a diseased fondness for the opposite sex, and in later years, some degree of impotence or sterility, are its commoner results. 

Teach _your_ child, therefore, not from fear of physical harm, but becauseyou wish him to be one of those fortunate few who live and die "gentlemenunafraid", because they had wise parents. 

Let the mother instruct a girl, the father a boy, and not leave so vital amatter to an unsuitable pamphlet. 

Buy one of the many "Knowledge for Boys or Girls" books and read itcarefully. 

Having made sure you can convey a simple account of the wonders ofreproduction, and that you have rooted out the idea that sex is somethingto be apologized for, see the child and tell him it is time he learned ofhis private parts, as manhood draws near. 

Then, speaking in a quiet, unembarrassed way, deliver your little homily, all the time insisting on the marvel, the romance, the poetry and thebeauty of the sex. Let chivalry be your text, not fear, and repeat theSquire's sound parting advice to Tom Brown:

 "Never listen to or say things you would not have your mother or sister hear. "

Give a clear and complete description in simple words of the mechanism andmarvel of reproduction, for half-knowledge generates a prurient curiosityabout the other sex, thus defeating the very end you have so earnestlystriven for. 

Purity not impurity should be your text, and you should only refer tomasturbation as a harmful habit, which should not be contracted. 

Warn them to

 "Keep the heart with all diligence, for out of it are the issues of life!"

by turning their thoughts instantly and determinedly away from sex ideaswhen they arise, as they _will_ arise, time and again. It is useless to try_not_ to think of them, the child must instantly turn its thoughts to to_something else_, for one who cannot stamp out a spark will not subdue afiercely-raging conflagration. 

Babies should not be carelessly caressed, and a fretful infant must neverbe soothed by playing with the genitals, as is done innocently by somemothers and nurses, and by others from motives more questionable. Freudshowed that there are subconscious sexual desires in infants, which die outuntil reanimated at puberty in Nature's own way. If exaggerated byexuberant fondling, they gather force in the dark corners of the mind, andare later manifested in morbid sexual or mental perversity. 

If you have good grounds for believing the habit has already beencontracted, enlist medical advice. A great factor in the successfultreatment of self-abuse is early recognition, and, after the unhygienicnature of the habit has carefully been pointed out, the child's sense ofhonour should be invoked. 

Without further reference to the matter, try to become your child'sconfidant, for he will have to fight fires within and foes without. Seethat his time is filled with healthy sport and play, and ennoble his ideaswith talk, books and plays which lay stress on chivalry and manliness. Givehim plain food, tepid douches, and a firm bed with light, fairly warmclothing. Get him up reasonably early in the morning, and let him playuntil he is "dog-tired" at night. 

Let children rub shoulders with others, keep them from highly excitingtales, let them read but little, and train them to be observant of externalobjects all the time. 

Neuropaths develop very early sexually, and contract bad habits in theendeavour to still their unruly passions; with them, the future is darkerthan with the normal child, and the parent who neglects his duty may justlybe held accountable for what happens to his child or his child's children. 

Puberty is always a critical period in epilepsy, many cases commencing atthis time, while in a number, fits commence in infancy, cease duringchildhood, and recommence at puberty, the baneful stimulus of masturbationbeing undoubtedly a factor in many of these cases. 

 * * * * *

CHAPTER XXIII

WORK AND PLAY

Although most people would assume that epileptics are unable to follow atrade, there is hardly an occupation from medicine to mining, fromagriculture to acting, that does not include epileptics among its votaries. 

Outdoor occupations involving but little mental work or responsibility arebest, but unfortunately just those which promise excitement and change arethose which appeal to the neuropath. 

A light, clean, manual trade should be chosen, and those that mean work instuffy factories, amid whirring wheels and harmful fumes, using dangeroustools, or climbing ladders, must be avoided. 

For the fairly robust, gardening or farming are good occupations, suchworkers getting pure air, continuous exercise, and little brain-work. Wood-working trades are good, if dangerous tools like circular saws areleft to others. 

For the frail neuropath with a fair education, drawing, modelling, book-keeping, and similar semi-sedentary work may do. Other patients mightbe suited as shoemakers, stonemasons, painters, plumbers or domesticservants, so long as they always work on the ground. 

Some work is essential; better an unsuitable occupation than none at all, for the downward tendency of the complaint is sufficiently marked withoutthe victim becoming an idler. Work gives stability. 

Epilepsy limits patients to a humble sphere, and though this is hard to aman of talent, it is but one of many hard lessons, the hardest being torealize clearly his own limitations. 

If seizures be frequent, the ignorant often refuse to work with a victim, who can only procure odd jobs, in which case he should strive to findhome-work, at which he can work slowly and go to bed when he feels ill. Acard in the window, a few handbills distributed in the district, judiciouscanvassing, and perhaps the patronage of the local doctor and clergy mayprocure enough work to pay expenses and leave a little over, for theessential thing is to occupy the mind and exercise the body, not to makemoney. 

Very few trades can be plied at home and many swindlers obtain money underthe pretence of finding such employment, charging an excessive price for an"outfit", and then refusing to buy the output, usually on the pretext thatit is inferior. Envelope-addressing, postcard-painting and machine-knittinghave all been abused to this end. 

An auto-knitter seems to offer possibilities, but victims must investigateoffers carefully. 

Photography is easy. A cheap outfit will make excellent postcards, modernmethods having got rid of the dark room and much of the mess, andpostcard-size prints can be pasted on various attractive mounts. 

If the work is done slowly, and in a good light, and the patient has anaptitude for it, ticket-writing is pleasant. Among small shopkeepers thereis a constant demand for good, plainly printed tickets at a reasonableprice. 

On an allotment near home vegetables and poultry might be raised, animportant contribution to the household, and one which removes the stigmaof being a non-earner. 

The mental discipline furnished by this home-work is invaluable, Neuropaths, especially if untrained, are unable to concentrate theirattention on any matter for long, and do their work hastily to get itfinished. When they find that to sell the work it must be done slowly andperfectly they have made a great advance towards training their minds toconcentrate. Their weak inhibitory power is thus strengthened with happyresults all round. 

When the work and the weather permit, work should be done outdoors, andwhen done indoors windows should be opened, and, if possible, an empty orsparsely-furnished bedroom chosen for the work. 

Recreations. These offer a freer choice, but those causing fatigue orexcitement must be avoided, for patients who have no energy to waste needonly fresh air and quiet exercise. 

Manual are better than mental relaxations. Dancing is unsuitable, swimmingdangerous, athletics too tiring and exciting. Bowls, croquet, golf, walking, quoits, billiards, parlour games and quiet gymnastics withoutapparatus are good, if played in moderation and much more gently thannormal people play them. Play is recreation only so long as a pastime isnot turned into a business. When a player is annoyed at losing, though heloses naught save his own temper, any game has ceased to be recreative. 

 * * * * *

CHAPTER XXIV

HEREDITY

 "Man is composed of characters derived from pre-existing germ-cells, over which he has no control. Be they good, bad, or indifferent, these factors are his from his ancestry; the possession of them is to him a matter of neither blame nor praise, but of necessity. They are inevitable. "--Leighton. 

The body is composed of myriads of cells of _protoplasm_, in each of which, is a _nucleus_ which contains the factors of the hereditary nature of thecell. In growth, the nucleus splits in half, a wall grows between and eachnew cell has half the original factors, Female _ovum_ and male _sperm_ (the cells concerned with reproduction)divide, thus losing half their factors, and when brought together by sexualintercourse form a _germ-cell_ having an equal number of factors frommother and father. 

How these factors are mingled--whether shuffled like two packs of cards, ormixed like two paints--we do not know. If two opposite factors are broughttogether, one must lie dormant. The offspring may be male or female, tallor short; it cannot be both, nor will there be a mixture. _This rule onlyapplies to clearly defined factors. _

We are _made by_ the _germ-plasm_ handed down to us by our ancestors; inturn we pass it on to our children, _unaltered_, but mixed with ourpartner's plasm. 

"The Dead dominate the Living" for our physical and mental inheritance is amosaic made by our ancestors. 

Variations which may or may not be inheritable do arise spontaneously, weknow not how, and by variations all living things evolve. 

A child resembles his parents more than strangers, not because they madecells "after their own image" but because both he and they got theirfactors from the same source. 

Man's physical and mental, and the _basis_ of his moral, qualities dependentirely on the types of ancestral plasm combined in marriage. Man maycontrol his environment; his heritage is immutable. To suppress anundesirable trait the germ-cell must unite with one that has never shownit--one from a sound stock. An unsuitable mating in a later generation, however, may bring it out again (for factors are indestructible), and theindividual showing it will have "reverted to ancestral type". 

To give an instance: Does the son of a drunkard inherit a tendency todrink? No! The father is alcoholic because he lacks control, consequentupon the factors which make for control having been absent from hisgerm-plasm. He passes on this lack; if the mother does the same, the defectoccurs--in a worse form--in the son. If the mother gives a control factor, the son may be unstable or _apparently_ stable, this depending entirely onchance, but if the mother's plasm contains a _strong_ control-factor, thedefect will lie dormant in her son, who will have self-control, though ifhe marries the wrong woman he will have weak-willed children. 

If the son becomes a toper, therefore, it is because he, like his fatherbefore him, was born with a defect--weak control--which might have made ofhim a drug-fiend, a tobacco-slave, a rake, or a criminal; in his home drinkwould naturally be the temptation nearest to hand, and he would show hislack of control in drunkenness. 

The way a lily-seed is treated makes a vast difference to the plant whicharises. If sown in poor soil, and neglected, a dwarf, sickly plant willresult; if sown in rich soil, and given every care that enthusiasm, moneyand skill can suggest or procure, the result will be magnificent. 

So with man. A well-nourished mother, free from care and disease, may havea finer child than a half-starved woman, crushed by worry and work, butneither starvation nor nourishment alter the inborn character of the child. 

The _body-cells_ are greatly changed by disease, poison, injury, andoverwork, but these changes are not passed on, and despite the influence ofdisease from time immemorial, the _germ-cell_ produces the same man as inancient days. Without this fixity of character, this "continuity of thegerm-plasm", "man" would cease to be, for the descendants of changeablecells would be of infinite variety, having fixity of neither form norcharacter. 

Epilepsy, hysteria and neurasthenia are all outward signs of defect in thegerm-plasm, and so they (or a predisposition to them) can be passed on, andinherited. 

If a man shows a certain character, his plasm, had, and has, the causativefactor. He may have received it from _both_ his parents, when it will be_strong_, or from one only, when it will be _normal_. If he have it not, itis absent. The same applies to the plasm of the woman he mates, so thereare six possible combinations, with results according to "Mendel's Law. "

_All_ the children will not inherit a taint unless _both_ parents possessit, but, however strong one parent be, if the other is tainted, _none_ ofthe children can be absolutely clean, but will show the taint, weak, strong, or dormant. This means that neuropathy will recur--and that it haspreviously occurred--in the same family, unless there be continual matinginto sound stocks. If there is continual mating into bad stocks, it willrecur frequently and in severe forms. All intermediate stages may occur, depending entirely on the qualities of the combining stocks. 

From this we shall expect, in the same stock, signs of neuropathic taintother than the three diseases dealt with here, and these we get; foralcoholism, criminality, chorea, deformities, insanity and other braindiseases, are not infrequent among the relatives of a neuropath, showingthat the family germ-plasm is unsound. 

Epilepsy, one symptom of taint, is more or less interchangeable with otherdefects; the taint, as a whole, is an inheritable unit whose inheritancewill appear as any one of many defects. This is shown by the fact that veryfew epileptics have an epileptic parent. Starr's analysis of 700 cases ofepilepsy emphasizes this point. 

 Epilepsy in a parent 6 Epilepsy in a near relative 136 Alcoholism in a parent 120 Nervous Diseases in family 118 Rheumatism and Tuberculosis 184 Combinations of above diseases 142

As medicine and surgery cannot add or delete plasmic factors, the only wayto stamp out neuropathy in severe forms would be to sterilize victims byX-rays. This would be painless, would protect the race and not interferewith personal or even with sexual liberty. In fifty years such diseaseswould be almost extinct, and those arising from accident or the chanceunion of dormant factors in apparently normal people could easily be dealtwith. 

There are 100, 000 epileptics in Great Britain, and as _all_ their childrencarry a taint which tends to reappear as epilepsy in a later generation_the number of epileptics doubles every forty years_. We protect theseunfortunates against others; why not posterity against them?

Neuropaths must pass on _some_ defect; therefore, though victims may marry, _no neuropath has a right to have children_. 

 * * * * *

CHAPTER XXV

CHARACTER

 "All men are not equal, either at birth or by training. Nature gives each of us the neural clay, with its properties of pliability and of receiving impressions; nurture moulds and fashions it, until a _character_ is formed, a mingling of innate disposition and acquired powers. But clay will be clay to the end; you cannot expect it to be marble. "--Thomson & Geddes. 

 "Heaven lay not my transgression to my charge. "--King John. 

It is essential that attendants, relatives, and friends carefully study thecharacter of neuropaths, and recognize clearly how abnormal it is, foruntold misery is caused by judging neuropaths by normal standards. 

Patients are often harshly treated because others regard the victim ofdefective inhibition as having gone deliberately to work, through wickedperversity and pure wilfulness, to make himself a nuisance, to persist inbeing a nuisance, and to refuse to be other than a nuisance, rather thanexercise what more fortunate men are pleased to term self-control. 

Character is usually appraised as "good" or "evil" by the nature of a man'sactions, the assumption being made that he can control his impulses if hebe so minded. 

This is not so. "Good" and "evil" are only relative terms. What one manthinks "evil", a second holds "good", while a third is not influenced. 

Now the performance of the act judged is directed by the performer's brain, the constitution of which was pre-determined by the germ-plasm from whichhe arose, so that _the basis of character is inherited_. 

The moral sense is the last evolved and least stable attribute of the lastevolved and least stable of our organs, the brain; and brains are born, notmade to order. To blame a man for having weak control--a sick will--is asunreasonable as to blame him for a cleft palate or a squint. The "good"people who jog so quietly through life little reck how much they owe theirancestors, from whom they received stability. 

These tendencies represent the total material for building character. Training and environment can only nourish good tendencies and give bad onesno encouragement to grow gigantic. 

If training and environment alone formed character, then children rearedtogether would be of similar disposition; by no means the case. Similarly, if external influences altered inborn tendencies, then, not only would theevil man be totally reformed by strong inducements to virtue, but stronginducements to vice would lead totally astray the good man, for "good" isno _stronger_ than "evil", both being attributes of mind. 

In mind as in body, from the moment he is conceived to the moment his dustrests in the tomb, man is directed by immutable laws, though he is notsimply a machine directed by impulses over which he has no control. Thereis real meaning in "strong will" and "weak will" will being a tendency todeliberate before and be steadfast in action, a tendency which variesimmensely in different people. The fallacy of "free will" lies in assumingthat every one has this tendency equally developed, making character a merematter of saying "Yes!" and "No!" without reference to the individual'smental make-up. 

Deliberate, persistent wickedness implies a strong will, just whatneuropaths lack. A man of weak will can never be a very good nor yet a verybad man. He will be very good at times, very bad at times, and neutral attimes, but neither for long; before sudden impulses, whether good or bad, neuropaths are largely powerless. 

The many perversities of a neuropath are not deliberately put forth of his"free will" to annoy both himself and others, for the neuropath inheritshis weak-control no less than his large hands. 

Friends _must_ remember they are dealing with a person whose _nature_ it isto "go off half-cock", and who cannot be normal "if he likes". Theneuropath, young or old, says what he "thinks" _without thinking_, that ishe says what he _feels_, and acts hastily without weighing consequences. 

 _Cassius_: Have you not love enough to bear with me, When that rash humour which my mother gave me Makes me forgetful?

 _Brutus_: Yes, Cassius; and, from henceforth When you are over-earnest with your Brutus, He'll think your mother chides, and leave you so. 

 * * * * *

One cannot detail the effects of neuropathy on character, when its victimsinclude madmen, sexual perverts, idiots, criminals, imbeciles, prostitutes, humble but honest citizens, common nuisances, invalids of many kinds, misanthropists, designers, enthusiasts, composers, communists, reformers, authors, artists, agitators, statesmen, poets, prophets, priests and kings. 

Very mild epilepsy--from one fit a year to one in several years--instead ofhindering, seems rather to help mentality, and many geniuses have beenepileptic. These talented victims, are less rare than the public suppose, owing to the jealous care with which symptoms of this disease are guarded. Socrates, Julius Cæsar, Mahomet, Joan of Arc, Peter the Great, Napoleon, Byron, Swinburne, and Dostoieffsky are but a few among many great names inthe world of art, religion and statecraft. Epileptic princes, kings andkinglets who have achieved unenviable notoriety might be named by scores, Wilhelm II being the most notable of modern times. 

This brilliant mentality is always accompanied by instability, and usuallyby marked disability in other ways. The success of these men often dependson an ability to view things from a new, quaint or queer standpoint, whichappeals to their more normal fellows. 

In matters that require great fertility, a quick grasp, ready wit, andbrilliant but not sustained mental effort, numerous neuropaths excel. Inthings calling for calm, well-balanced judgment, or stern effort to conquerunforseen difficulties, they fail utterly. 

Subtle in debate, they are but stumbling-blocks in council; brilliant inconception, they fail in execution; fanciful designers, they are not"builders of bridges". They are boastful, sparkling, inventive, witty, garrulous, vain and supersensitive, outraging their friends by theextravagance of their schemes; embarrassing their enemies by the subtletyof their intrigues. 

They wing on exuberant imagination from height to height, but the smallboulders of difficulty trip them up, for they are hopelessly unpractical;they have neither strength of purpose nor fortitude, and their best-laidschemes are always frustrated at the critical moment, by either theincurable blight of vacillation, or by the determination to amplify theirscheme ere it has proved successful, sacrificing probable results forvisionary improvements. 

Great and cunning strategists while fortune smiles, they are impotent todirect a retreat, but flee before the fury they ought to face. They rarelyhave personal courage, but are timid, conciliatory and vacillating justwhen bravery, sternness, and determination are needed; furious, obstinateand reckless, when gentleness, diplomacy and wisdom would carry theirpoint. 

They are ready to forgive when there is magnanimity, vainglory and probablyfolly in forgiveness, but will not overlook the most trivial affront whenthere is every reason for so doing. They have brain, but not ballast, andtheir whole life is usually a lopsided effort to "play to the gallery". 

In poetry and literature, fancy has free play, and they often succeed, sometimes rising to sublime heights; usually in the depiction of thewhimsical, the wonderful, the sardonic, the bizarre, the monstrous, or thefrankly impossible. They are not architects as much as jugglers of words, and descriptive writing from an acute angle of vision is their forte. Theysometimes succeed as artists or composers, for in these spheres they neednot elaborate their ideas in such clean-cut detail, but many who mightsucceed in these branches have not sufficient strength of purpose to do thepreliminary "spadework". 

They have too many talents, too many differing inclinations, too muchimpetuosity, too much vanity, too little concentration and will-power, andthey fail in ordinary walks of life from the lack of resolution to lay thefoundations necessary to successful mediocrity. 

No greater obstacle to progress exists than the reputation for talent whichthis class acquire on a flimsy basis of superficial brilliance inconversation or a penchant for witty repartee. They are self-opinionatedand egoistical, with a conceit and assurance out of all proportion to theirabilities. Their mental perspective is distorted and they are conspicuousfor their obstinacy. In conversation they are prolix and pretentious, andthey often contract religious mania, in which their actions by no meansaccord with their protestations, for they have very elementary notions ofright and wrong, or no notions at all. 

Often they are precocious, but untruthful, cruel, and vicious; the despairof relatives, friends, and teachers. They combine unusual frankness with anaudacity and impulsiveness that is very misleading, for below this show offire and power there is no stability. 

Their character is a tangle of mercurial moods, the neuropath beingpassionate but loving, sullen one moment, overflowing with sentimentalaffection the next, vicious a little while later, quick to unreasoninganger, and as quick to repent or forgive, obstinate but easily led, versatile but inconstant, noble and mean by turns, full of contradictionsand contrasts, at best a brilliant failure, vain, deaf to advice orreproof, having in his ailing frame the virtues and vices of a dozen normalmen. 

Mercier aptly describes him:

 "There is a large class of persons who are often of acute and nimble intelligence, in general ability equal to or above the average, of an active, bustling disposition, but who are utterly devoid of industry. For by industry we mean steady persistence in a continuous employment in spite of monotony and distastefulness; an employment that is followed at the cost of present gratification for the sake of future benefit. Of such self-sacrifice these persons are incapable. They are always busy, but their activity is recreative, in the sense that it is congenial to them, and from it they derive immediate gratification. As soon as they tire of what they are doing, as soon as their occupation ceases to be in itself attractive it is relinquished for something else, which in its turn is abandoned as soon as it becomes tedious. 

 "Such people form a well-characterized class: they are clever; they readily acquire accomplishments which do not need great application; and agreeably to the recreative character of their occupations, their natures are well developed on the artistic side. They draw, paint, sing, play, write verses and make various pretty things with easy dexterity. Their lack of industry prevents them ever mastering the technique of any art; they have artistic tastes, but are always amateurs. 

 "With the vice of busy idleness they display other vices. The same inability to forgo immediate enjoyment, at whatever cost, shows itself in other acts. They are nearly always spendthrifts, usually drunkards, often sexually dissolute. Next to their lack of industry, their most conspicuous quality is their incurable mendacity. Their readiness, their resources, their promptitude, the elaborate circumstantiality of their lies are astonishing. The copiousness and efficiency of their excuses for failing to do what they have undertaken would convince anyone who had no experience of their capabilities in this way. 

 "Withal, they are excellent company, pleasant companions, good-natured, easy-going, and urbane. Their self-conceit is inordinate, and remains undiminished in spite of repeated failures in the most important affairs of life. They see themselves fall immeasurably behind those who are admittedly their inferiors in cleverness, yet they are not only cheery and content, but their confidence in their own powers and general superiority to other people remains undiminished. 

 "_The lack of self-restraint is plainly an inborn character_, for it may show itself in but one member of the family brought up in exactly the same circumstances as other members who do not show any such peculiarity. The victim is born with one important mental faculty defective, precisely as another may be born with hare-lip. "

In neuropaths the mental mechanism of _projection_, which we all show, isoften marked. 

Any personal shortcoming, being repugnant to us causes self-reproach, whichwe avoid by "projecting" the fault (unconsciously) on some one else. 

Readers should get "The Idiot" by Fedor Dostoieffsky, an epileptic geniuswho saw that for those like him, happiness could be got through peace ofmind alone, and not in the cut-throat struggle for worldly success. Heprojected his stabler self into Prince Muishkin, the idiot, and every oneof the six hundred odd pages of this amazing description of a neuropathicnation is stamped with the hall-mark of genius. 

 * * * * *

CHAPTER XXVI

MARRIAGE

 "Between two beings so complex and so diverse as man and woman, the whole of life is not too long for them to know one another well, and to learn to love one another worthily. "--Comte. 

No neuropath should have children, but marriage is good in mild cases, forneuropaths are benefited by sympathetic companionship, and their sexualpassions are so strong that they must be gratified, by marriage, prostitution, or unnaturally. 

Bernard Shaw's sneer--

 "Marriage is popular because it combines the maximum of temptation with the maximum of opportunity"--

is justifiable, though the "maximum of opportunity" is better than amaximum of unnatural devices to satisfy and intensify normal and abnormalcravings. 

There is a popular belief that an epileptic girl is cured by pregnancy, astate that ought never to occur. 

The lack of sex-education causes millions of miserable marriages. Sexualdesire is cultivated out of all proportion to other desires, the willcannot control the desire to relieve an intolerable sense of discomfort, and men eagerly seize the first chance of being able to satisfy thesefierce cravings at pleasure. 

If sex were treated sensibly it would develop into a powerful instead of anoverpowering appetite, and reason would have some say in the choice of alife-partner. 

A neuropath needs a calm, even-tempered, "motherly" wife. For him, gentleness, self-control, sound common sense and domestic virtues aresuperior to wit or beauty. Unfortunately, contrary to public belief, peopleare attracted by their like, not by their opposites. The sensitive, refinedneuropath finds the normal person insipid and dull; the normal person isrendered uncomfortable by the morbid caprices of the neuropath. 

There must be no disparity of age, for at the menopause the woman no longerseeks the sexual embrace, and if her husband be young unfaithfulnessensues. Not only that, but she, knowing, probably to her sorrow, how rarelythe hopes of youth mature, cannot take a keen interest in his ambitionslike a younger woman, or fire his dying enthusiasm at difficult parts ofthe way. If he be his wife's senior he will be as little able to appreciateher ideas and habits. 

An excitable, volatile, garrulous, "neighbourly" woman, or one who can dolittle save strum on the piano or make embroidery as intricate as it isuseless, means divorce or murder. For him, sweetness, gentleness, self-control, sound common sense, shrewdness, and domestic virtues areincomparably superior to any mental brilliance or physical comeliness. Heneeds a "homely" woman, and should remember that no banking account canmatch a sweet, womanly personality, and no charms compare to a sunny heart, and an ability steadfastly to "see the silver lining". 

He must on no account marry a woman in indifferent health, for under thestrain of her husband's infirmity the woman, who if she were well would bea help, is a source of expense, worry and friction. 

On the other hand the woman who receives a proposal from a neuropath, be heever so gifted, has grave grounds for pausing, though it is hard to counterthe specious arguments of one who may be "a man o' pairts", a wittycompanion and an ardent lover. It is doubtful if a neuropath is everpermeated by a steadfast emotion, for all his emotions are fierce butunstable, the love of an inconsistent man being ten times more ardent thanthat of a faithful one, _while it lasts_. 

 "You can't marry a man without taking his faults with his virtues, "

and love must be strong enough to stand, not storms alone, but the minormiseries of life, the incessant pinpricks, the dreary days when the smileabroad has become the scowl at home. At best, her husband will becapricious, hard to please, and though rabidly jealous without cause, atthe same time very partial to the attractions of other women. He usuallyneeds the attention of the whole household, which his varying health andmoods keep in a mingled state of anxious solicitude and smoulderingresentment. 

His infirmity may mean a very secluded and humdrum life. She will have tomake home an ever-cheery place, an ideal that means hard work andself-sacrifice through lonesome years in which her nobility will beunrecognized and unrewarded. 

A woman fond of amusements and sport, and having many acquaintances wouldfind this unbearable. Any happiness in marriage to a neuropath is largelydependent on the self-sacrifice of the wife. 

Should marriage occur, the wife must judiciously curb her husband'spassions without driving him to other women by coldness, a problem which isoften solved by separation. The suggestion should never come from her, andthe more she can curb his ardour by tactful suggestion, the healthier willhe and the happier will she be, for nothing causes such an irritable, nervous state as excessive coitus. 

She will often have to give way in this matter, but must be firm on thenecessity for preventing conception, for she can only bear a tainted child;her responsibility is great, and she must _insist_ that her husband usethose simple methods which prevent conception, thereby ending in himselfone branch of a worthless tree. This must be done at any cost, for herhappiness is nought compared to the welfare of future generations. Bitterthough it be that no fruit of her womb may call her blessèd, it is lessbitter than hearing her children call themselves accursèd. 

 "So many severall wayes are we plagued and punished for our father's defaultes, that it is the greatest part of our felicity to be well born, and it were happy for humankind if only such parentes as are sounde of body and mind should be suffered to marry. An Husbandman will sow none but the choicest seed upon his lande; he will not reare a bull nor an horse, except he be right shapen in all his parts, or permit him to cover a mare, except he be well assured of his breed; we make choice of the neatest kine, and keep the best dogs, and how careful then should we be in begetting our children? In former tyme, some countreys have been so chary in this behalf, so stern, that if a child were crooked or deformed in body or mind, they made it away; so did the Indians of old, and many other well gouverned Commonwealths, according to the discipline of those times. Heretofore in Scotland, if any were visited with the falling sickness, madness, goute, leprosie, or any such dangerous disease, which was like to be propagated from the father to the son, he was instantly gelded; a woman kept from all company of men; and if by chance, having some such disease, she was found to be with child she with her brood were buried alive; and this was done for the common good, lest the whole nation should be injured or corrupted. A severe doom, you will say, and not to be used among Christians. Yet to be more looked into than it is. For now, by our too much facility in this kind, in giving way to all to marry that will, too much liberty and indulgence in tolerating all sorts, there is a vast confusion of hereditary diseases; no family secure, no man almost free from some grievous infirmity or other. Our generation is corrupt, we have so many weak persons, both in body and mind, many feral diseases raging among us, crazed families: our fathers bad, and we like to be worse. "

Her husband will want much petting and caressing, and she must foster hislove by lavishing on him much fondness, and ignoring amours as but themischievous results of his restless, intriguing mind. 

She must let him see in an affectionate way that she can let others enjoyhis company betimes, secure in the knowledge that she is supreme in hisaffections--cajolery that flatters his overweening vanity, and rarelyfails. 

In anger, as in every other emotion, the neuropath is as transient as he istruculent. A trivial "tiff" will make him blaze up in ungovernable rage andsay most abominable and untruthful things; even utter violent threats. Hewill not admit he is wrong, but like a spoilt child must be kissed andcoaxed into a good temper, first with himself and with others next. 

At one moment he is in a perfect paroxysm of fury; five minutes later he ispassionately embracing the luckless object of it and vowing eternaldevotion. In a further five he has forgotten all his remarks and wouldhotly deny he used the vexing statements imputed to him. 

Epileptics are morbidly sensitive, and reference to their malady must beavoided. Victims are intensely suspicious, and a pitying look will revealto them the fact that some outsider knows all about the jealously-guardedskeleton. Resentment, distrust and misery follow such an exposure, forevery innocent look is then translated into a contemptuous glance, and thevictim detects slights undreamt of in any brain save his own. 

Unless seizures are severe, no one should be called in; if they causealarm, ask a discreet male neighbour to assist when necessary, leaving whenthe convulsions abate so that the victim is not aware of his presence. Avoid the word "fit" and "epilepsy", and if reference to the attack benecessary, refer to it as a "faint" or "turn". 

Living with a man liable to have a fit at inopportune times is a tremendousstrain, and the soundest advice one can offer a woman thinking of marryingsuch a one is Punch's--"DON'T!"

We have painted the black side, but, tactfully managed, a neuropath willmerge in the kindest of husbands, the most constant of lovers. The wifeneed not be unhappy. Tactless, masterful women will fail, but no one ismore easily led, particularly in the way he should not go, than aneuropath. 

A man with definite views of his own value will not be successful foil for"mother-in-lawing", nor remain quiet under the interference of relatives, who should remember that well-meaning intentions do not justify meddlingactions. 

Many a neuropath led a useful life and gained success in a profession, solely because his wife tactfully kept him in the path, watched his health, prevented him frittering away his gifts in many pursuits or uselessrepining, and made home a real haven. 

When the yolk seems unbearably heavy, the wife should remember her husbandhas to bear the primary, she only the reflected misery, for the limitationsneuropathy puts on every activity and ambition, social and professional, are frightfully depressing. 

In spite of his peevishness her husband may be trying hard to minimize hisdefects and be a reasonable, helpful companion. 

 "Judge not the working of his brain, And of his heart thou can'st not see; What looks to thy dim eyes a stain In God's pure light may only be A scar brought from some well-fought field, Where thou would'st only faint and yield. "

Magnify his virtues and be tenderly charitable to his many frailties, forhe is "not as other men" and too well he knows it. Love at its best is socomplex that it easily goes awry, but death will one day dissolve all itscomplexity, and when, maybe after "many a weary mile"

 "The voice of him I loved is still, The restless brain is quiet, The troubled heart has ceased to beat And the tainted blood to riot"--

it will comfort you to reflect that you did your duty and, to best the ofyour ability, fulfilled your solemn pledge to love and honour him. 

To quote George Eliot:

 "What greater reward can thou desire than the proud consciousness that you have strengthened him in all labour, comforted him in all sorrow, ministered to him in all pain, and been with him in silent but unspeakably holy memories at the moment of eternal parting?"

Surely, none!

We have considered the mournful case of a wife with a neuropathic husband, and must now say a few words about the truly distressing fate of a husbandafflicted with a neuropathic wife, for neuropathy in its unpleasantconsequences to others is far worse in woman than in man. 

A man is at work all day, and his mind is perforce distracted from hiswoes, and, though he retails them at night to the home circle, they get soused to them as to disregard them, proffering a few words of agreement, sympathy or scorn quite automatically. 

With women the distraction of work is not so complete, for housework can beneglected, there are always neighbours and friends to listen to tales ofwoe and thus generate a very harmful self-pity, and women are not contentto enumerate their woes, but demand the attention and sympathy of alllisteners. 

Many of the facts in the foregoing parts of this chapter apply with equalforce to both sexes, but women being usually more patient, tactful, resigned and self-sacrificing than men, can--and often do--alleviate thelot of the male neuropath; whereas the absence of these qualities in theaverage man means that he aggravates, instead of alleviating, the lot ofany female neuropath to whom he may be wedded. 

Having taken her "for better, for worse" he will find her irritating, unreasonable, and unfitted to shoulder domestic responsibilities. Her likesand dislikes, fickle fancies, unreasonable prejudices, selfish ways willcause trouble; he must be prepared for misunderstandings and feuds withrelatives and friends, and on reaching home tired and worried, he is liketo find his house in disorder, be assailed by a tale of woe, and perhapsfind that his wife's vagaries have involved him in a tiff with neighbours. 

She will be fretful, exacting, impatient, and given to ready tears. Sensitive to the last degree, she will see slights where none are intended, and a chiding word, a reproachful look, or a weary sigh will mean a fit oftemper or depression. 

Not only are men less gifted for "managing" women than vice versa, butwomen are far less susceptible to tactful management than men; a man, likea dog, can be led almost anywhere with a little dragging at the chain andgrowling now and then; a woman, like a cat, is more likely to spit, swear, and scratch than come along. 

Consequently, it is almost impossible to suggest means of obtaining reliefto one who has been luckless enough to marry, or be married by, aneuropathic woman. 

If the husband sympathize, the condition will but be aggravated; medicinalmeasures will only increase, instead of diminishing, the number ofsymptoms; indifference will procure such an exhibition as will both proveits uselessness and ensure the attention craved. 

 * * * * *

CHAPTER XXVII

SUMMARY

To sum up: we have learnt that Epilepsy is a very ancient disease due tosome instability of the brain, in which convulsions are a common but notinvariable symptom. 

Its actual cause is unknown. Heredity plays a big part, but there aresecondary causes beside factors which excite attacks. 

Various methods and drugs to prevent seizures have a limited use. 

First-aid treatment consists solely in preventing the victim sustaining anyinjury. 

Neurasthenia is a disease due to nerve-exhaustion and poisoning fromoverwork and worry. Its symptoms are many, but fatigue and irritability arethe chief. 

Hysteria is an obstinate, functional, nervous disease in which the patientacts in an abnormal manner, which is highly provoking to other individuals. 

The cure for hysteria and neurasthenia is solely hygienic, and dependsmainly on the patient. 

The first step towards health consists in getting any slight organicdefects remedied. 

Digestion is often poorly performed. 

This must be remedied by thorough mastication and rational dieting. 

Constipation is very inimical to neuropaths, and must be remedied. 

Patients must pay careful attention to general hygiene. 

Insomnia is exhausting and must be conquered. 

The effects of imagination are profound. 

Suggestion treatment overcomes imaginary ills. 

Drug treatment is either of very limited utility, or frankly useless. 

Patent medicines are never of the slightest use. 

The rational training of neuropathic children is a very difficult butessential task. 

Puberty and adolescence are very critical times. 

Occupations and recreations must be wisely chosen. 

Heredity is the primary cause of these diseases. As it cannot be treated, sufferers must not have children. 

Character is abnormal in nervous disease. 

Marriage is very undesirable. 

As a parting injunction, whether you are an epileptic or a neurasthenic, ora friend, relative, or attendant of such a one:

"GO THOU SOFTLY ALL THY DAYS!"

 * * * * *

BIBLIOGRAPHY

 "Oh! for a booke and a shadie nooke, Eyther indoore or oute; Where I maie reade, all atte my ease Both of the newe and olde: For a jollie goode booke, whereonne to looke Is better to me than golde!"

The following books are suitable for laymen, and are most of them veryreadable. 

EPILEPSY

We know of no book suitable for laymen, NEURASTHENIA AND HYSTERIA

"Nervous Disorders of Men" (Kegan Paul) Hollander. 

"Nervous Disorders of Women" (Kegan Paul) Hollander. 

"National Degeneration" (Cornish, Birmingham) D. F. Harris. 

"Hysteria and Neurasthenia" J. M. Clarke. 

"The Management of a Nerve Patient" Schofield. 

"Confessions of a Neurasthenic" (F. A. Davis Co. , Philadelphia) Marrs. 

"Conquest of Nerves" (Macmillan) Courtney. 

GENERAL:

INDIGESTION

"Indigestion" Herschell. 

DIETING

"Dietetics" (Jack's People's Books) A. Bryce. 

"Diet in Dyspepsia" Tibbles. 

"Cookery for Common Ailments" Brown. 

CONSTIPATION

"Constipation" Bigg. 

HYGIENE

"Laws of Life and Health" A. Bryce. 

"Health" M. M. Burgess. 

INSOMNIA

"Sleep and Sleeplessness" H. A. Bruce. 

"The Meaning of Dreams" I. H. Coriat. 

IMAGINATION

"Psychology in Daily Life" Seashore. 

"Hygiene of the Mind" T. S. Clouston. 

SUGGESTION

"Hypnotism and Suggestion" Hollander. 

"How to Treat by Suggestion" Ash. 

"Hypnotism and Self-Education" (Jack's People's Books) Hutchinson. 

PATENT MEDICINES

"Patent Foods and Patent Medicines" (Bale & Davidson) Hutchinson. 

See Chapter XX for B. M. A. Books. 

THE CHILD

"Our Baby" R. D. Clark. 

"Abnormal Children" (Kegan Paul) Hollander. 

"The Baby" (Jack's People's Books) Anonymous. 

"Training the Child" (Jack's People's Books) Spiller. 

PUBERTY

"Youth and Sex" (Jack's People's Books) Scharlieb and Sibley. 

"Woman in Childhood, Wifehood, and Motherhood" M. S. Cohen. 

"The Adolescent Period" Starr. 

"Physiology" (Home Univ. Library) McKendrick. 

"Human Physiology" Leonard Hill. 

HEREDITY AND CHARACTER

"Evolution" (Home Univ. Library) Thomson and Geddes. 

"Heredity in the Light of Recent Research" (Cam. Univ. Press) Doncaster. 

"The Psychology of Insanity" (Cam. Univ. Press) Bernard Hart. 

MARRIAGE

"On Conjugal Happiness" R. G. S. Krohn

"Race Culture and Race Suicide" R. R. Rentoul. 

 * * * * *

INDEX

 ABORTIVES, Use of, as cause of epilepsy, 22 Age-incidence in epilepsy, 17, 18 Air, Fresh, Importance of, 73 Alcohol, The question of, 64 Alcoholic excess in relation to epilepsy, 16, 21-23 ---- ---- neurasthenia, 31 Amyl Nitrite, to check the aura in epilepsy, 26 Analyses of proprietary preparations for children, 13 ---- ---- purgative medicines, 62 ---- of secret remedies, British Medical Association, 13, 62, 92 Arson as manifestation of mental epilepsy, 10 Aspirin for post-epileptic headache, 29 Aura, The, 2, 3, 25 ----, ----, in Jacksonian epilepsy, 8 ----, Treatment of the, 25, 26 Auto-intoxication, 68 Auto-suggestion, Value of, 80, 83

 BACKACHE in neurasthenia, 32 Baths, Advice as to, for neuropaths, 48, 73, 74 Blaud's pills, 95 Brain, Morbid changes in, associated with epilepsy, 18, 19 ----, Structure of the, 20 Bromides, Action of, hindered by salt, 65 ---- in the prevention of epilepsy, 26 ---- ---- treatment of epilepsy, 86-88, 92 ---- the basis of every epilepsy cure, 92 Bromism, 87 Brooding, harmful to neuropaths, 49, 50

 CALM necessary in dealing with nervous children, 106 Carlyle, 90 Character, 123-30 ----, The basis of, 124 Chyle, The, 57 Chyme, The, 56 Circulation, The, in neuropaths, 73 Circulatory Disturbances in neurasthenia, 33 Clark on frequency of fits during repose, 23 Clark's statistics of epilepsy, 15 Cleanliness, 73 Climacteric, in relation to hysteria, 41 Clothing for neuropaths, 74 Coddling, Danger of, for nervous children, 103 "Complex", The, in consciousness, 10, 11 Concentration, Lack of, in neurasthenia, 34 ----, Mental, Exercises in, 51 Confession, The value of, 40 Conscious Mind, The, 10, 39 Consciousness, Alteration of, in epileptic attack, 3, 4, 6 ----, Dissociation of, 11 Constipation, 67-70 ----, Causes of, 67, 68 ----, Symptoms of, 68 ----, Treatment of, 68-70 Convulsions, Epileptic. _See_ "Fit" ---- in alcoholism, 23 ---- in children, 13 ---- in diabetes, 23 ---- in pregnancy, 14 Cooking in relation to digestibility, 58 Country resorts suitable for neuropaths, 47 Criminal acts in psychic or mental epilepsy, 9, 10 Culpepper's Herbal, 86

 DARK, Nervous children's fear of the, 105 Day-dreaming, 11, 108 Death, 58 Degeneration, Signs of, in epileptics, 17 Dementia, Epileptic, 16 Demonic Influence in relation to epilepsy, 1, 2 Dieting, 63-66 Digestion of foods, 58, 59 ---- ----, Time occupied by the, 58 ----, The process of, 56-59 Digestive troubles in relation to epilepsy, 22, 26 ---- ----, neurasthenia, 32, 33 Discipline of the nervous child, 103-106 Dissociation of consciousness, 11 Dostoieffsky's "The Idiot", a study of epilepsy, 130 Douche, The cold, for neuropaths, 74 Dreams, 12 ----, Sex-basis in, 12 Drug habit, The, in neuropaths, 93 Duties and trials of a neuropath's wife, 132-137

 EARS, Care of the, 53 Egoism in relation to neurasthenia, 38 Electrical treatment for neuropaths, 50 Emotional repression as a factor in hysteria, 40 Enema, The use of the, 69 Energy from food, 58 Epilepsy a functional disease, 2 ----, Ancient remedies for, 86 ---- as a mental complex, 23 ---- ascribed to demonic influence, 1, 2 ----, Biblical reference to, 2 ----, Causes of, 20-24 ----, Clinical course of, 15-19 ----, Cure in, 19 ----, Definition of, 1, 19 ----, Effect of, on general health, 16 ----, Feigned, 14 ----, ----, Diagnosis of, 14 ----, Historical account of, 1, 2 ---- in mediæval times, 2 ---- in neurasthenics, 35 ---- in relation to genius, 125-127 ---- ---- marriage, 131 ----, Jacksonian, 7-9 ----, ----, its relative frequency, 15 ----, Major and minor, 1-6 ----, Medicines for, 86-89 ----, Mental, 9, 10 ----, ----, Rarity of, 15 ----, Nocturnal, 4, 5 ----, ----, its relative frequency, 15 ----, Preventive treatment of, 25-27 ----, Prognosis in, 19 ----, Psychic, 9, 10 ----, Rarer types of, 7-16 ----, Serial, 7 ----, Superstitions attached to, 1, 2 Epileptic children, Care of, 16 ---- dementia, 16 ---- fit _See_ "Fit" ---- fits, Times of occurrence of, 15, 23 Epileptiform seizures, 13 Exercise for neuropaths, 48, 74, 75 Eyes, Care of the, 53

 FACIAL expression in epilepsy, 17 Fats, Digestion of, 57 Fears, Baseless, in neurasthenia, 35, 36 Feeding, Generous, needed for neuropaths, 47 Fit, Epileptic, Description of an, 3, 4 ----, ----, Mechanism of an, 20, 21 ----, ----, First-aid to victims of, 28, 29 Flatulence, Treatment of, 70 Foods, Proprietary, 94, 95 "Free will", The fallacy of, 124, 125 Freud on perverted sex-ideas as a cause of hysteria, 40 ---- ---- subconscious sexual desires in infants, 113 ---- ---- the sex-basis in dreams, 12 Fright as cause of epilepsy, 21

 GASTRIC Juice, The, 56 Genius, Epilepsy in relation to, 125-127 "Germ-plasm", The, 118 ---- in relation to neuropathic tendencies, 120, 121, 124 _Globus hystericus_, 42 Glycerin suppositories, 69 Glycerophosphates, 96 "Good" and "Evil", 123, 124 Gowers on epilepsy, 7 Gowers' statistics as to age-incidence of epilepsy, 17 _Grand mal_, 2-5 ---- ----, its relative frequency, 15 Greene on hysteria, 44

 HABIT, Importance of, in relation to constipation, 68 Haig on relation of uric acid to epilepsy, 23 Headache in neurasthenia, 32 Heredity, 118-122 Hobbies for neuropaths, 48 Hormone, The Function of a, 57 Hughlings Jackson, Dr, on the epileptic convulsion, 8 Husband of a neuropath, Advice to the, 138, 139 Huxley on the rules of the game of life, 46 Hygiene, General, 71-75 Hypochondriasis in neurasthenics, 36 Hypophosphites, 96 Hysteria, 39-45 ----, Age incidence of, 41 ----, Ancient views as to, 39 ---- and neurasthenia contrasted, 41 ---- Causes of, 40, 41 ----, Modern theories as to, 39 ----, Race incidence of, 42 ----, Sex-incidence of, 39, 41 ----, Symptoms of, 42-44 ----, Treatment of, 44 Hysterical attack, The, 42, 43

 IMAGINATION, Effects of, 79-81 Indigestion, 60-62 Infantile convulsions, 13 ---- ----, relation of to epilepsy, 13 ---- ----, Treatment of, 13 Inhibitory cells of brain, 20, 21 Injuries to brain as cause of epilepsy, 21 Insanity in relation to dissociation of consciousness, 11 ---- ---- epilepsy, 16 Insomnia _See_ "Sleeplessness" Intestinal worms, 102 Iron preparations, 95

 JACKSONIAN epilepsy, 7, 8, 9 Janet on consciousness in hysteria, 40 Jones on the religious sentiment in neuropaths, 106, 107

 KING'S evil, The, 86

 LA ROCHEFOUCAULD on health and regimen, 65 Lecithin, 96 Lieberkuhn's glands, 57, 58 Life, in relation to tissue change, 58 Locock's introduction of bromides for epilepsy, 86

 MACHINE, The human, 71, 72 Malt extracts, 93 Marriage, 131-139 ---- and neuropathy, 122, 131, 132 ---- of neuropaths should be childless, 134, 135 Mastication, Importance of thorough, 61 Masturbation, 110-112 ----, Effects of, 111, 112 ---- in relation to epilepsy, 16, 22, 114 ---- ---- neurasthenia, 38 Meals, Number and time of, 64 Meat extracts, 93 ---- juices, Value of, 64 ----, Moderation in its use necessary, 65 Memory in epilepsy, 17 ----, its subconscious basis, 10 Mendel's law of inheritance, 120, 121 Menopause in relation to neurasthenia, 31 Menstruation, Disordered, in neurasthenia, 33 ---- in relation to epilepsy, 17, 22 Mental attitude of neurasthenics, 33-38 ---- fatigue in neurasthenia, 33, 34 Mercier on the characteristics of the neuropath, 128-130 Mind in relation to consciousness, 10 Moral cowardice in relation to neurasthenia, 38 _Morbus comitialis_, 2 Motor cells of brain, 20, 21 Murder as manifestation of mental epilepsy, 10

 NARCOTICS, Use and abuse of, 78 Nervous child, Training of the, 98-108 ---- dyspepsia, 60 ---- ----, Diet in, 65 Neurasthenia, 30-38 ---- and hysteria contrasted, 41 ----, Causes of, 31, 32, 41 ----, Course and outlook in, 38, 41 ---- in relation to epilepsy, 35 ---- ---- self abuse, 16, 38 ----, Sexual, 38 ----, Symptoms of, 32-38, 41 Neuropath, The, his need of a wife, 132 Neuropathic children, Characteristics of, 98, 99 ---- ----, Diet of, 100-102 ---- ----, Education of 99, 100 ---- ----, Moral training of, 102-106 Neuropaths, Advice to, 46-52 ----, Mental characteristics of, 126-130 Neuropathy in relation to marriage, 122, 131-139 ----, The only way to eradicate, 121 Night terrors, 105 Nitroglycerine to check the epileptic aura, 25, 26 Nose, Care of the, 54

 OPISTHOTONOS, 43 Optimism, Value of, 80 Osler on age-incidence of epilepsy, 18 ---- ---- the use of medicines, 93

 PALPITATION during use of bromides, 87 ---- in neurasthenia, 33 Parentage in relation to inherited qualities, 119, 120 Patent medicines, 90-97 ---- ---- and the dyspeptic, 60, 62 ---- ---- ---- ---- neurasthenic, 36 ---- ----, explanation of their benefit, 80 Pepsin, 94 _Petit mal_, 5, 6 ---- ---- in childhood, 16 ---- ----, its relative frequency 15 Phenalgin for post-epileptic headache, 29 Phosphorus preparations, 96 Piles, 70 Port wine in proprietary preparations, 93 Predigested foods, 94, 95 Pregnancy, Convulsions during, 14 ---- in relation to epilepsy, 17, 22 Psycho-analysis in the treatment of hysteria, 40 Puberty, Bodily changes at, 109 ----, Dangers at and after, 109-114 ---- in relation to epilepsy, 16, 18, 114 Punishment, Corporal, unsuited for nervous children, 105, 106 Pupils in epilepsy, The, 17 Purgatives, The abuse of, 69 ----, Suitable, 70

 QUACK Advertisements, 91, 111

 READING for neuropaths, 48 Recovery in epilepsy, 19 Recreations for neuropaths, 117 Reid on the effect of emotions on bodily functions, 81 Religion, Question of, in nervous children, 106-108 Rest for neuropaths, 49, 50 Responsibility in relation to mental epilepsy, 9, 10

 SANATOGEN, 96 Savill on differences between neurasthenia and hysteria, 41 Self-abuse _See_ "Masturbation" Self control, how far possible to neuropaths, 123-125 Self-restraint, The neuropath's lack of, 129, 130 Sentimentality to be discouraged in nervous children, 104 Sex education, The need for, 131 Sex-incidence in epilepsy, 18 Sex instruction for children, 110, 112 Sexual development early in neuropaths, 113, 114 ---- excesses in relation to epilepsy, 16, 23 ---- ---- in relation to neurasthenia, 31, 38 ---- instinct, Awakening of, 109, 110 ---- neurasthenia, 38 ---- offences as manifestations of mental epilepsy, 9, 10 ---- rules for neuropaths, 48 Shaw, Bernard, his sneer at marriage, 131 Sleep, Relation of, to epileptic fit, 4 Sleeplessness, 76-78 ----, Causes of, 76, 77 ----, Treatment of, 77, 78, 85 ---- in neurasthenia, 33 Sollmann on proprietary foods, 94, 96 Soothing syrups, 13 "Sound nerves", 52 Spirit writing, 11, 12 Spiritualism, Danger of, for neuropaths, 107 Spratling on epilepsy in consumptives, 17 Starr's statistics as to age-incidence in epilepsy, 17 ---- ---- heredity in epileptics, 121 ---- ---- types of epilepsy, 15 _Status epilepticus_, 7 ---- ----, as final termination of epilepsy, 16 Subconscious mind, The, 10 Suggestion treatment, 82-85 Suicide in neurasthenics and hysterical subjects, 35, 41, 42 Sunstroke as cause of fits, 21 Sweetmeats, The use of, 64 Sympathy, Harm done by, in hysteria, 44, 45

 TAPE worms, 102 Tea and coffee, 64 Teeth, Care of the, 54, 55 Tobacco undesirable for neuropaths, 74 Trades for epileptics, 116 ---- ---- neuropaths, 115-117 Turner on age-incidence of epilepsy, 18

 UNCONSCIOUS activities, 39, 40 Unconsciousness in epilepsy, 3-5 Urine, Incontinence of, in epilepsy, 3-5

 VEGETABLE Foods, 64 Villi, The intestinal, 57 Vittoz's exercises in mental concentration, 51 Vomiting, Risk of, in epilepsy, 26

 WATER, When to drink, 61, 64, 68 Weir Mitchell Treatment, 50 Wife for the neuropath, The, 132-135 ---- of a neuropath, Advice to the, 132-137 Will, Neuropath's lacking in, 125 Work and play, 115-117 Worms, Intestinal, 102 Worry as cause of neurasthenia, 31 ---- to be avoided by neuropaths, 47, 49

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