PREVENTION OF NERVOUS AND MENTAL DISEASES 251
pecially prejudicial to the nerves. The same may be said
of sexual excess. The long engagement is to be tabooed,
and a simple wedding and wholesome honeymoon in the
country (and not a tiresome journey) are indicated (see
page 197). In the case of the woman, rest, quiet, and
freedom from anxiety are peculiarly necessary during
menstruation, pregnancy, and following childbirth. Early
consultation with a physician in suspected pregnancy will
bften give relief and a feeling of security. Prevention of
neurasthenia in the adult is usually only attempted, after
an attack has been experienced. Treatment of local
troubles will often relieve the general neurasthenia, and in
no cases is a thorough physical examination from head to
foot more essential to discover a local trouble masquerad-
ing as nervous prostration.
Nervous prostration, to those who have never experi-
enced it, often seems an inexcusable and incomprehensible
mental state which could be prevented by exercise of will
power and common sense. It is as real a condition as a
toothache to the patient, and his will power is so weakened
that trying to exert it is much like trying to lift himself by
his own bootr-straps.
There is loss of self-reliance, and little everyday tasks
and responsibilities become overwhelming burdens. The
patient neglects his business, procrastinates, and often
shuns society. The nervous system has no resistance and
is peculiarly susceptible to every influence or irritation.
Women are often emotional, cry and throw themselves
about, and have suicidal ideas. There is usually mental
depression. A feeling of pressure or constriction in the
back of the head or neck, and sometimes in other parts of
the head, is the most common symptom. The patient
easily tires and sometimes is so exhausted as to be unable
to walk. Special fears are characteristic, as fear of being
252 THE PREVENTION OF DISEASE
alone, of being in a crowd or open place, of being in the
cars, of lightning, etc. The memory is poor. Sleepless-
ness is the rule. Pains may occur in almost any organ and
part of the body and simulate organic disease, and this is
why a thorough physical examination is required to surely
determine that the neurasthenia is not secondary to some
local trouble. Correction of local sources of irritation, as
stated above, may wholly cure neurasthenia, especially if
it is of the acquired and not of the inherited variety:
Local disease of the sexual organs in man is a most frequent
cause, as has been already noted and emphasized. Since
abdominal surgery has made the diagnosis of abdominal
troubles often possible in diseases formerly subject to
guesswork, it has been found that many of the so-called
cases of nervous dyspepsia were, in reality, due to ulcer of
the stomach, chronic appendicitis, etc. On the other hand,
many persons with neurasthenia have been subjected to
much surgery for suppositious organic diseases which never
existed except in the mind of more or less ignorant or
mercenary operators. The leading surgeons are always
on their guard against falling into such errors.
The prevention of neurasthenia means practically proper
living. Cabot regards four elements as essential to proper
living, and has recently written a book ("What Men Live
By") in which he amplifies his ideas on the practical appli-
cation of these work, play, love, and worship. All are
necessary in proper proportion for preserving the normal
moral, mental, and physical state we denote as "mens
sana in corpore sano," a healthy mind in a healthy body.
The older methods of treatment of neurasthenia included
largely the Weir-Mitchell rest cure, in which the patient
remained in bed for three to six weeks in a sanatorium away
from home, in the hands of a doctor and nurse, and was
stuffed with food, given massage and electricity, and kept
PREVENTION OF NERVOUS AND MENTAL DISEASES 253
away from cares and worries. This treatment no man
would stand, and it is usually inadvisable except in women
who are much emaciated and who suffer from malnutrition.
The more modern method is that by which the patient is
gradually directed into a normal manner of living by find-
ing some sort of work which will interest him or her, so that
it will not be drudgery, and combining this with a proper
amount of recreation. Such treatment sounds very simple,
but it requires all the tact and wisdom of an experienced
physician to guide a neurasthenic person back to health,
and there will be required many mental boosts from the
doctor and many relapses on the part of the patient before
the end is secured. This re-education is best accomplished
when the patient can put himself in the hands of the
physician specializing in this matter, and having all the
facilities of a sanatorium in the country, with its various
outdoor and indoor arrangements for work and play.
Modern society is responsible for much neurasthenia, es-
pecially among women, owing to the unhealthy life which
results from excitement, late hours, the use of alcohol, and
lack of restful occupation. The "coming out" of the young
woman is attended by so much gaiety and late hours that
only the unusually strong female can stand the ordeal, and
when this is combined with a prolonged round of enter-
tainments prior to marriage and its attendant demands for
extra exertion and excitement, the whole culminating in a
final burst of social pyrotechnics at the wedding, we have
all the ingredients for producing a beautiful case of nervous
exhaustion at the worst possible time.
Insanity may be defined as the sudden or gradual devel-
opment in a person of more or less permanent peculiarities
in thought, feeling, and action. This definition indicates
a decided change in the normal character of the person,
whatever that may have been. Unfortunately, heredity is
254 THE PREVENTION OF DISEASE
here a more unquestionable and paramount cause than in
the case of any other disease In asylums it has been
found that the history of mental trouble can be traced in
the forebears of half the inmates, and it is estimated that
from 50 to 70 per cent, of cases of mental trouble owe their
origin to inherited mental defects. The brain develop-
ment of the child is imperfect owing to the defective
germ material from the parents (egg of the mother, sperm
cell of the father). Observers have noted diminution in
the number, together with imperfect development and
irregularity, of the brain cells in mental defectives. Such
conditions are also produced by the influence of alcohol
on the parents at the time of conception of the child, or bad
health of the mother while she is carrying the child, or dis-
eases of the subject in childhood, such as convulsions,
scarlet fever, influenza, and meningitis. The care and
surroundings of the child and method of its upbringing as
to diet, food, habits, work, play, diseases, schooling, and
home life have naturally an important bearing in favoring
or hindering the advent of mental breakdowns. If the
conditions are bad they may be sufficient in themselves to
cause insanity, and with an added inherited taint, would be
pretty certain to do so.
Many immigrants become insane probably from their
unfavorable environment alone.
Causes of Insanity. Bad habits are the cause of about
one-quarter of all cases of insanity, and these include the
abuse of alcohol, morphin, cocain, and self-abuse, but the
chief of these is alcohol. Alcohol, in the report of the Mas-
sachusetts Commission of 19 10 on the reason for the increase
of criminal and mental defectives, was found the essential
cause "Indeed it is the belief of this commission, based
upon long personal observation, that the abuse of alcohol
directly and indirectly does more to fill our prisons, insane
PREVENTION OF NERVOUS AND MENTAL DISEASES 255
hospitals, institutions for the feeble minded, and alms-
houses than all other causes combined. We are unable to
formulate any recommendations as to legislation which we
believe would materially modify this deplorable condition.
It is probable that long-continued education of the young
as to the mental, moral, physical, and economic results of
the abuse of alcohol will be the most effective method of
dealing with the subject."
It is hard for persons living in refined and comfortable
circumstances to realize the full meaning of this opinion,
but if one actually sees the innumerable cases of delirium
tremens which enter large city hospitals every day of the
year, and follows them into the courts and thence into the
asylums (those who do not stop at the morgue), its true
impressiveness becomes very poignant. During holiday
seasons, as about Christmas and New Years, the number
of such cases is sickening and appalling.
Alcohol is the cause of 20 per cent, of all cases of insanity
according to a well-known alienist.
Another fruitful but preventable cause of insanity is
syphilis, which we have stated elsewhere (see page 183) is
practically the sole cause of locomotor ataxia and paresis
(or general paralysis of the insane, or softening of the
brain). Paresis occurs in middle life and terminates in
death in three to five years. About 14 per cent, of the
inmates of New York State hospitals have this disease,
and there are probably about 10,000 deaths in the United
States annually from this cause, if the same rate prevails
as in New York State. Locomotor ataxia is syphilis of
the spinal cord. Paresis is syphilis of the brain.
Certain epochs are favorable for the development of
insanity. In women the age of puberty (twelve to four-
teen), pregnancy and childbirth, and the period of change
of life (forty-five to fifty-five) are danger periods; while in
256 THE PREVENTION OF DISEASE
men middle life (thirty-five to fifty) is the more frequent
age at which insanity appears.
Forms of Insanity. During youth one of the com-
monest forms of insanity, known as precocious dementia
(dementia praecox), begins. This is seen especially in
those with hereditary tendencies to mental or nervous
disease or in the progeny of alcoholic forebears. Suf-
ferers from this form of mental impairment are long lived
and accumulate in institutions, so that they comprise
about 40 per cent, of the inmates. The forming of proper
mental habits is to a considerable extent possible, and
may avert such types of precocious mental breakdown.
One must not permit worries, cares, anxieties, and desires
to become obsessions by brooding over them, but use will
and self-control in banishing them by directing the
thoughts into other channels, by work, by interest in
others, and by confessing one's troubles to a sympathetic
friend which will often clear the mental atmosphere and
aid in establishing mental equilibrium. Then, again,
oversensitiveness to fancied slights and offense may lead
in the susceptible to the actual delusions of the insane that
the subject is being persecuted by imaginary persons, or
the constant mental warfare with the obsessing thoughts or
desires may result in perversions of the senses so that the
patient hears imaginary voices or sees imaginary objects
(hallucinations).
While the intellect, will, and memory are so impaired in
dementia that the patient's mental condition is patent to
all, yet in another less common form of insanity, paranoia,
the subject may show no mental deterioration. These
are the persons who commit crimes, while their apparent
mental acuteness deceives juries, and they escape com-
mitment to institutions for the criminal insane notwith-
standing the absolute certainty as to diagnosis in the
PREVENTION OF NERVOUS AND MENTAL DISEASES 257
opinion of unbiased experts. The latter are rarely called
in such cases, however. One notable example is that of
a paranoiac who murdered a leading professional man of
this country and, constantly trying to escape incarcer-
ation for years, has recently succeeded owing to the
influence of money. In every community there are
lamentable instances of miscarriage of justice in the case of
criminal paranoiacs. They are frequent litigants and
difficult to convict. The paranoiac imagines he is being
persecuted and deprived of his property, business, or pro-
fessional rights, or that some one is alienating the affections
of his wife or fiancee. It is for this reason that he is
dangerous and is apt to make sudden murderous assaults
upon his fancied enemies. Paranoiacs are often able to
attend to their business, talk quietly and well upon current
topics, and thus commonly delude the casual observer.
They are, however, born with a defective nervous anatomy
and show faulty development and peculiarities in child-
hood, and though bright in school, are self-conceited, sus-
picious, and morbid.
Later the paranoiac discovers that he is an exalted char-
acter of noble birth, a prophet, or Christ. In killing
prominent persons the paranoiac believes himself a public
benefactor. Being impressionable, paranoiacs are ready
tools for anarchists and unprincipled men.
There is a large class of cases comprising the type of
manic-depressive insanity. This is peculiarly an inherit-
ance which curses many families. In the form of mania
the patient may be noisy, restless, and violent, destroying
furniture. But often in this phase he is only in an excited
and pleasurable state of mind. He thinks he is rich and
gives money away in an absurd fashion, talks constantly,
makes friends without discrimination, and sleeps poorly.
In the depressive form, or melancholia, there is the opposite
17
258 THE PREVENTION OF DISEASE
condition. Here the patient may sit motionless and
brooding in gloom and despondency. He imagines he is
worthless or has committed the unpardonable crime; or
there may be signs of deep distress, restlessness, the subject
moving back and forth and wringing his hands and moan-
ing. The tendency to suicide is common. Sometimes
periods of exaltation alternate with those of depression
after an intervening period of normality (circular insanity).
Victims of the manic-depressive insanity tend to recover in
a variable time from weeks to a year or so. Finally,
there is the senile dementia, in which degenerative changes
occur in the brain cells and narrowing of the blood-vessels
in the brain as a part of old age.
Treatment of Insanity. The laity have extraordinary
ideas about the insane. They think that they may be
argued out of delusions, depression, etc. It is useless to
argue and combat imaginary fixed ideas or delusions, and
may cause the patient to become violent. In a general
way the insane should be treated like anybody else, so far
as is compatible with safety regarding themselves and
others. Individuals who show great depression should,
however, be carefully watched to prevent them from com-
mitting suicide, and those laboring under the delusion that
they are being persecuted or wronged should be put under
restraint lest they become guilty of homicide.
The sanatorium or hospital is the only place for persons
with disordered minds, as the chances of recovery are much
better away from their ordinary environment, and they are
thus protected from doing violence to themselves or others.
There are probably 250,000 insane people in the United
States today, and, including the feeble-minded, epileptics,
and mental defectives, there are some 750,000 patients
afflicted with mental defects and disease who should be
in institutions in this country (Mullan). A large percent-
PREVENTION OF NERVOUS AND MENTAL DISEASES 259
age of these cases might be prevented if the various causes
enumerated were removed and if proper living and mental
and physical training were taught and practised.
There is great interest in this subject at present, and
State societies for mental hygiene are being established to
protect the mental health of the public, to study and spread
abroad knowledge of the causes, prevention, and treatment
of mental disorders, and to better the conditions of the
mentally defective. We have made a similar brief attempt
in the foregoing pages in reference to individual prevention
of mental diseases.
CHAPTER XIV
THE PREVENTION OF DISEASES OF DIGESTION
Constipation, Ulcer, Gastritis, Gall-stones, Appendicitis, Stone in
the Kidney, Nervous Indigestion, Visceroptosis
CONSTIPATION
CONSTIPATION is the most common and radical diges-
tive disorder. It is impossible to say precisely how much
harm may be accomplished by habitual constipation, but
a large part of known diseases has been attributed by
authorities to it. We do know positively that mental
depression, physical weakness and loss of energy, headache,
foul tongue, taste, and breath are often immediate results
of constipation. Also that inflammation of the bowels,
diarrhea, and piles result from long-continued stagnation
of the bowel contents.
Many of the common abdominal diseases, as gall-
stones, appendicitis, etc., are thought to originate in
chronic constipation by leading medical authorities, while
from constant absorption of poisons due to bacterial
growth or putrefaction of delayed intestinal contents all
kinds of constitutional diseases may arise. The chronic
joint troubles known as chronic rheumatism or rheumatic
gout, and even hardening of arteries and premature old
age, are commonly believed by noted physicians to be
caused by chronic constipation. It is an unfortunate fact
that we are continually taking one-sided views of all
sorts of matters, so that each specialist, medical or other-
260
CONSTIPATION 261
wise, is apt to exaggerate his own specialty and attribute
to it all possible effects, to the exclusion of all others.
In chronic constipation it is the colon or large intestine
which is at fault, and the taking of buttermilk has been
much in vogue, with the idea, originated by Metchnikoff,
that its sour-milk germs (lactobacilli) would destroy the
germs in the bowels which were thought to bring about the
changes in old age. Osier thus characterizes the fad, which
is now waning, as follows, "Captivated by the theories
of Metchnikoff, we have been for some years on the crest
of a colonic wave, and intestinal toxemia (poisoning) has
been held responsible for many of the worst of the ills that
flesh is heir to, more particularly arteriosclerosis and old
age. The seniles and preseniles of two continents have
been taking sour milk and lactobacillary compounds, to
the great benefit of the manufacturing chemists. But the
fad is passing, not, as I hope, to be replaced by one even
more serious, in which operation is advised for every case
of intestinal stasis (stagnation)."
Without going into further discussion as to the possi-
bilities of remote harm from constipation, it seems reason-
able to believe that there is no other disorder which is so
generally preventable and at the same time so common
and so likely to be provocative of serious local and remote
diseases. By constipation is meant retention of the intes-
tinal contents. This may be due either to infrequent
action of the bowels or to insufficient action; that is, the
bowels may move daily, but not sufficiently, so that
material may remain for months in the intestines while a
part of the contents is passing through or around that left
behind. The natural action occurs owing to the contrac-
tions and secretions of the bowels.
In constipation one or both are deficient. The contrac-
tions may fail for lack of the stimulus of sufficient coarse
262 THE PREVENTION OF DISEASE
residue and too good digestion, or sometimes from too
much residue in overeating. In many cases too little water
is taken. Constipation is growing more common because
of the increase of sedentary lives in cities, and because we
eat too little coarse food, such as is still used by the peas-
antry of many countries.
The constipating foods are the digestible foods which
leave little residue in the bowels. Thus, meat, fish, and
eggs are notably constipating. Among other causes of
constipation is failure in attending to nature's needs at a
regular time each day. The school girl is too hurried or
modest to make her wants known ; the business man is too
busy to attend to such a trifling matter as nature's most
imperative requirement, he must catch a train or perform
some other important act. Persons may be so interested
in reading while in the closet that the bowels become in-
sensitive.
Frequently the taking of powerful pills establishes con-
stipation as a habit, because the intestines come to rely
on unnatural stimulation.
In the milder forms of constipation simple measures
may remedy the trouble. Thus, drinking a glass of hot
or cold water containing a pinch of salt on rising and at
bedtime, taking exercise on horseback ("the outside of a
horse is the best thing for the inside of a man"), in tennis,
swimming, baseball, golf, and eating stewed or raw fruit at
each meal may be sufficient. Cooked fruit is more di-
gestible, as apple-sauce, baked apples, stewed prunes. An
attempt should be made at a regular hour each day, and
no alarm need be felt if for two or three days there is no
bowel movement after beginning treatment.
Proper diet will cure most cases of constipation. This
treatment depends upon the fact that certain articles of
food tend to overcome constipation in different ways.
CONSTIPATION 263
Fruits and some vegetables contain cathartic principles,
and other vegetables act chiefly because they leave a coarse
residue to stimulate the bowels. Among the fruits and
vegetables containing cathartic principles may be included
oranges, grapefruit, apples, grapes, peaches, pears, prunes,
melons, tomatoes, cucumbers, onions, beets, carrots, pota-
toes, and spinach; while turnips and squash, Brussel
sprouts, string beans, green peas, and oyster plant stimu-
late the bowels by their residue. In addition, acids are
laxative, so that pickles, vinegar, and acid fruits and
buttermilk act through their acidity. Oils, as in salad,
lubricate the contents of the bowels and are laxative, to-
gether with butter, cream, and bacon. Coarse bread
containing the hulls of grain is perhaps the most effective
laxative in stimulating the coats of the bowels.
If a person can eat six slices of rye, whole wheat, graham,
or "brown" bread daily, that in itself is often sufficient to
cure constipation.
The constipating articles of food include milk, eggs,
cheese, meat, fish, tea (tannin), cocoa, chocolate, red wine,
macaroni, spaghetti, etc. It is not possible to eliminate
these wholly from the diet, but they should be eaten in
moderation, while there should be a corresponding increase
in the amount of coarse bread, fruit, and vegetables.
Sweets are also laxative.
We may give a sample diet list as follows. It is not
intended that a person should eat every article included
under each meal, but he can vary his diet according to the
dishes recommended.
On rising, a glass of cold or hot water, according to pref-
erence, containing a pinch of salt.
264 THE PREVENTION OF DISEASE
Breakfast
Oatmeal with syrup or cream and sugar, one or two slices
of graham, rye, wheat bread, corn bread, or Boston
brown bread. Cracked wheat, hominy grits, or graham
meal may be used in place of oatmeal.
Fruit raw or cooked, or marmalade, or honey. Eggs
with bacon or omelet with apple-sauce (which is excellent).
Coffee, cream, and sugar.
Luncheon
Fish, as mackerel, salmon, halibut, herring, or sardines.
One of the coarse breads, as at breakfast, or gingerbread.
Two green vegetables or salad. Jam or marmalade.
Fruit, as stewed apples, figs, or apricots, etc. Cider,
lemonade, or weak Oolong tea with cream and sugar, or a
glass or two of buttermilk.
Dinner
Thick or thin vegetable soups. Green vegetables and
potatoes, fish or meat, and salad and pickles. Two slices
of coarse bread. Desserts of fruit or puddings of coarse
meals, as Indian meal, or fruit puddings, as apple Char-
lotte, brown Betty, etc.
At bedtime a glass of buttermilk, or figs, seedless
raisins, or stewed prunes.
The only objection to this diet is that some persons are
unable to take it because the coarse food gives them flatu-
lence and pain and the acid fruits occasion heart-burn.
Then, again, if an individual is traveling or not living at
home it may be impossible for him to obtain such a diet.
In these cases the patient should take a diet as near that
described as he can secure or digest, and, in addition, one
of the remedies which 1 am about to recommend. Heart-
CONSTIPATION 265
burn from acid may be relieved by Husband's magnesia,