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Page 8
A portion of the class last referred to is one I have hinted at as the
despair of the physician. It includes that large group of women,
especially, said to have nervous exhaustion, or who are defined as
having spinal irritation, if that be the prominent symptom. To it I must
add cases in which, besides the wasting and an�mia, emotional
manifestations predominate, and which are then called hysterical,
whether or not they exhibit ovarian or uterine disorders.
Nothing is more common in practice than to see a young woman who falls
below the health-standard, loses color and plumpness, is tired all the
time, by and by has a tender spine, and soon or late enacts the whole
varied drama of hysteria. As one or other set of symptoms is prominent
she gets the appropriate label, and sometimes she continues to exhibit
only the single phase of nervous exhaustion or of spinal irritation. Far
more often she runs the gauntlet of nerve-doctors, gyn�cologists,
plaster jackets, braces, water-treatment, and all the fantastic variety
of other cures.
It will be worth while to linger here a little and more sharply
delineate the classes of cases I have just named.
I see every week--almost every day--women who when asked what is the
matter reply, "Oh, I have nervous exhaustion." When further questioned,
they answer that everything tires them. Now, it is vain to speak of all
of these cases as hysterical, or as merely mimetic. It is quite sure
that in the graver examples exercise quickens the pulse curiously, the
tire shows in the face, or sometimes diarrhoea or nausea follows
exertion, and though while under excitement or in the presence of some
dominant motive they can do a good deal, the exhaustion which ensues is
out of proportion to the exercise used.
I have rarely seen such a case which was not more or less lacking in
color and which had not lost flesh; the exceptions being those
troublesome instances of fat an�mic people which I shall by and by speak
of more fully.
Perhaps a sketch of one of these cases will be better than any list of
symptoms. A woman, most often between twenty and thirty years of age,
undergoes a season of trial or encounters some prolonged strain. She may
have undertaken the hard task of nursing a relative, and have gone
through this severe duty with the addition of emotional excitement,
swayed by hopes and fears, and forgetful of self and of what every one
needs in the way of air and food and change when attempting this most
trying task. In another set of cases an illness is the cause, and she
never rallies entirely, or else some local uterine trouble starts the
mischief, and, although this is cured, the doctor wonders that his
patient does not get fat and ruddy again.
But, no matter how it comes about, whether from illness, anxiety, or
prolonged physical effort, the woman grows pale and thin, eats little,
or if she eats does not profit by it. Everything wearies her,--to sew,
to write, to read, to walk,--and by and by the sofa or the bed is her
only comfort. Every effort is paid for dearly, and she describes herself
as aching and sore, as sleeping ill and awaking unrefreshed, and as
needing constant stimulus and endless tonics. Then comes the mischievous
role of bromides, opium, chloral, and brandy. If the case did not begin
with uterine troubles, they soon appear, and are usually treated in vain
if the general means employed to build up the bodily health fail, as in
many of these cases they do fail. The same remark applies to the
dyspepsias and constipation which further annoy the patient and
embarrass the treatment. If such a person is by nature emotional she is
sure to become more so, for even the firmest women lose self-control at
last under incessant feebleness. Nor is this less true of men; and I
have many a time seen soldiers who had ridden boldly with Sheridan or
fought gallantly with Grant become, under the influence of painful
nerve-wounds, as irritable and hysterically emotional as the veriest
girl. If no rescue comes, the fate of women thus disordered is at last
the bed. They acquire tender spines, and furnish the most lamentable
examples of all the strange phenomena of hysteria.
The moral degradation which such cases undergo is pitiable. I have heard
a good deal of the disciplinary usefulness of sickness, and this may
well apply to brief and grave, and what I might call wholesome,
maladies. Undoubtedly I have seen a few people who were ennobled by long
sickness, but far more often the result is to cultivate self-love and
selfishness and to take away by slow degrees the healthful mastery which
all human beings should retain over their own emotions and wants.
There is one fatal addition to the weight which tends to destroy women
who suffer in the way I have described. It is the self-sacrificing love
and over-careful sympathy of a mother, a sister, or some other devoted
relative. Nothing is more curious, nothing more sad and pitiful, than
these partnerships between the sick and selfish and the sound and
over-loving. By slow but sure degrees the healthy life is absorbed by
the sick life, in a manner more or less injurious to both, until,
sometimes too late for remedy, the growth of the evil is seen by
others. Usually the individual withdrawn from wholesome duties to
minister to the caprices of hysterical sensitiveness is the person of a
household who feels most for the invalid, and who for this very reason
suffers the most. The patient has pain,--a tender spine, for example;
she is urged to give it rest. She cannot read; the self-constituted
nurse reads to her. At last light hurts her eyes; the mother or sister
remains shut up with her all day in a darkened room. A draught of air is
supposed to do harm, and the doors and windows are closed, and the
ingenuity of kindness is taxed to imagine new sources of like trouble,
until at last, as I have seen more than once, the window-cracks are
stuffed with cotton, the chimney is stopped, and even the keyhole
guarded. It is easy to see where this all leads to: the nurse falls ill,
and a new victim is found. I have seen an hysterical, an�mic girl kill
in this way three generations of nurses. If you tell the patient she is
basely selfish, she is probably amazed, and wonders at your cruelty. To
cure such a case you must morally alter as well as physically amend, and
nothing less will answer. The first step needful is to break up the
companionship, and to substitute the firm kindness of a well-trained
hired nurse.[12]
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