CHAPTER VI. The Nervous System As the Balance of Power in the Body

THE NERVOUS SYSTEM AS THE BALANCE OF POWER IN THE BODY

The Brain the Master Organ of the Body; the Functions of the Brain; Habit and Automatism; the Physiology of the Brain and Nervous System; the Hygiene of Work; the Toxins of Fatigue; Overwork; Signs of Overwork; Nature’s Restoratives; Avocation; the Physiologic Necessity for Laughter; Vacations and Health; Sleep; Insomnia.

The Eyes; Eye-strain; Description of the Visual Apparatus; Optical Defects and Their Correction; the Mechanism of Eye-strain; Local Symptoms of Eye-strain; Artificial Lighting; Hygienic Precautions in Reading and Sewing; Injuries to the Eyes; Symptoms and Treatment of Conjunctivitis; Trachoma; Styes.

Functional Nervous Disorders, Headache; Neurasthenia.

=The Brain the Master Organ of the Body.=—The brain is not only the most important organ in the body, but its essential organ, for the sake of which all the other organs and tissues exist, and it is the master of the whole. It not only receives help from every other organ, but it also largely controls the working of each. By its mental action alone it can hurry the heart’s beat or slow its pace; it can make the skin shrivel or flush; it can quicken or stop digestion; it can stop or change the character of all secretions; it can arrest or improve the general nutrition. Every organ and every vital process is represented in the structure of the brain, by special centers and groups of cells that have a direct relation with such organs and processes, and through which they are controlled.

=The Functions of the Brain.=—The brain may be said to have four chief functions; the first is that of motion; it presides over and stimulates all the voluntary muscular movements of the body, regulating their force, and coördinating in their working the different groups of muscles needed to perform them. Mind and muscular movement have the closest possible connection with each other. The second function of the brain is that of feeling and sensation; the third is that of nutrition; through this its own nourishment and that of the rest of the body is regulated. While mind is the fourth and highest form of nerve force, it is not created in the brain, but is absolutely conditioned by that organ.

Different groups of brain-cells have different work assigned them; some have motion, some have sensation, some have nutrition, and some have mind. For example, special tracts of brain govern inhibition. While every group does its own work, it is related to and combined with others, influencing them, and being influenced by them.

Every kind of mental activity uses up the brain energy of the cells. To think clearly, plenty of healthy blood must be supplied to the cells. In order to make healthy blood, there must be an abundance of fresh air supplied to the lungs, and a vigorous heart to pump it up to the brain. It has been demonstrated that, during intellectual work or emotional feeling, there is an increased supply of blood to the brain, which may become more or less congested, and that there is an actual rise of temperature; whereas during periods of relaxation, rest, or fatigue, the brain is pale and anemic.

The brain-cells generally, but particularly those cells involved in mental activity, are of such a nature and constitution that they cannot rest absolutely during the waking hours. They may act slowly or with great rapidity; different brains have different capacities for energizing, both in regard to speed and force; and, further, the brain may be pushed to work greatly in excess of its normal activity, just as an engine may be allowed to go at the rate of 50 or 60 miles an hour, or may be pushed to go at the rate of 100 miles an hour. In both cases the danger resulting from speeding are greatly in excess of going at the normal rate of speed.

In any case, the continuous brain action implies the necessity for continuous repair. The only complete physiologic rest which the brain enjoys is during sleep, when the process of repair goes on most rapidly; during this period the brain-cells absorb their nourishment from the blood in excess of their needs, and so lay up a store of energy for the waking hours.

=Habit and Automatism.=—It is one of the innate qualities of every tissue and of every organ in the body, that when any vital action is performed, any vital process gone through with, it is easier to do it the second time, and the continuous exercise of the action makes the performances more and more easy, until they become automatic.

The physiologic basis of habits consists of the plasticity of the nerve substance, and in the capacity of nerve substance to receive and retain impressions. There results the certainty that the nervous system will act again more easily in those ways in which it has already acted.

On the one hand, the automatic performance of work saves an enormous amount of brain energy; on the other hand, bad habits may be formed whose effects may be most pernicious, and which are gotten rid of only with the greatest difficulty. An example of the first is the young child learning to walk; at first he accomplishes the feat only by the fixed concentration of every power of the brain on the act; whereas the healthy adult walks automatically, without paying the least regard to the movements or the manner in which they are accomplished. Hysteria and ungovernable outbursts of passion furnish good examples of the bad habits that may be formed, owing to the lack of discipline and the powers of inhibition; every time that a woman gives way to one of these outbursts, so much the harder will it be for her to prevent or control another outbreak. Inhibition is the highest and most important function of the brain.

Habits woman must have, but it is for her to choose what they shall be, provided she chooses quickly; the time limit in habits is one of the strong evidences of the close connection of body and mind. It is a startling fact to face, that a woman’s habits are largely fixed before she is twenty; that the chief lines of her future growth and acquaintance before she is twenty-five; and her professional habits before she is thirty; yet to something like this James believes that physiologic psychology points. The woman becomes a bundle of habits, and her habits settle about her like a plaster cast.

=The Physiology of the Brain and Nervous System.=—The brain, spinal cord, and spinal nerves constitute the so-called cerebrospinal nervous system. The brain is that portion of the nervous system which is contained within the cranial cavity and which it completely fills. The spinal cord is the continuation downward, from the brain through the spinal canal, of nerve substances, and from which the spinal nerves are given off. The nerves may be described as cords and threads of varying degrees of fineness, distributed to every tissue and organ in the body.

The nervous system has been likened to the electric telegraph, the brain being the central station, while, in addition to the special senses, the body is provided with numerous terminal substations in the skin and internal organs of the body, which keep the brain informed of what is going on in the world around it, as well as in the various parts of the body. The nerves simply act as conductors to transmit the messages. The body is supplied with two distinct sets of nerves or wires, one of which carries messages from the outside world and various organs to the brain, while the other set transmits orders from the brain.

The spinal cord is the center of reflex acts; that is, if the leg of a brainless frog is touched with acid, he will take the other leg to wipe it off with. There are, as we have seen, substations in the skin, hence the acid causes the sensation of a foreign body, word is telegraphed the spinal cord, where there is a large central station; from here word is sent out by another set of nerves, to move the leg away from the acid, but this being insufficient, word is telegraphed to the other leg to wipe off the offending substance. Did the same thing happen in the body, at the same time that the cord telegraphed word to the affected member to withdraw it, it would telegraph the brain, and the sensation of pain would be felt.

A message travels along a nerve at the rate of about thirty-six yards a second, or a mile a minute. This is about the time made by a lightning express train. The distance in the body being so short, the time taken is imperceptible, and we say that movement is instantaneous.

The paths traveled by nerve impulses are made passable by use; the oftener an impulse traverses a given route, the more adapted such a route becomes for future traffic.

But all of this has to do with the nerves which are under the control of the will. There is another set of telegraph wires in the body, called the sympathetic or vegetative system, so-called because it presides over the processes of nutrition and is beyond the control of the will.

=The Hygiene of Work.=—Since the motor centers are located in the brain, it is natural to expect that all definitely directed movements will directly affect the brain and the mental development, and so it is. Du Bois Réymond says that it is easy to demonstrate that such bodily exercises as gymnastics, fencing, swimming, riding, dancing, and skating are much more exercises of the central nervous system, of the brain, and spinal cord than of the muscles.

It is further urged that healthful energy of will is impossible without strong muscles, which are its organs, and that endurance, self-control, and great achievement all depend on muscle habits.

The philosophy of work consists in its necessity. The brain-cell in health cannot cease to be active, except to a partial extent during sleep. There must be some output of mind from the mind cell and of motor stimulus from the motor cell. The proper selection of work for that particular brain to do, and the physiologic regulations of the work done, is the basis of the hygiene of work. For health, for happiness, and for efficiency, right work rightly done is the most important matter in any man’s or any woman’s life.

The physiologic, as well as the moral necessity, has always been conceded for every man to have a life-work—a vocation; a work for which he should be fitted, and for which he was capable, sufficiently congenial not to sink into mere drudgery, and which would, at the same time, afford ample financial compensation to be remunerative and a stimulus to his power of endurance.

Important, from a physiologic point of view, as a vocation is for men, it is equally or even more important for women. It is highly probable that the unstable nervous system of women and their emotional extravagance and dissipations, whether of frivolity, wickedness, or grief, is largely due to lack of mental discipline and muscular development. It is a psychologic proposition that any woman who has a toothache suffers less if she keeps busy, and any one will testify that she suffers much less from the intense heat of summer if she is busily employed.

One of the great objects of a definite and fixed occupation is to turn the thoughts out from the ego. Work of some kind is indispensable to the health and happiness of every one, since it necessitates an objective instead of a subjective attitude of mind.

Experience teaches that the brain, like the muscles, is subject to training; occasional excessive efforts, with long intervals of repose, are rather injurious, while a many-sided activity, constantly repeated, interrupted by sufficient shorter rests and supported by sufficient nutrition, is strengthening. A healthy training of the brain should be as many sided as possible.

Symmetric development and training of every function of the brain is as essential for mental efficiency and sanity as the development of all the muscles of the body is for bodily vigor, and a one-sided training of the mental powers is as certain to produce eccentricities of habits of thought and actions as those occupations which call into play only the action of certain groups of muscles is to cause bodily deformities. Anything which will prove injurious to the delicate nerve substance must be avoided, as laziness, idleness, and, worst of all, any form of narcotics.

Many-sided life work, consistently carried through, not only strengthens the brain, but also its continued power of adaptation, and one’s whole life is a continuous struggle for adaptation. The more the brain works, the more capable it is of receiving new impressions and elaborating old ones, and it retains its elasticity longer.

Hurry generally implies lack of system in carrying out the routine of work, or the undertaking of more work than the individual can accomplish without injury to herself. Few things can more certainly muddle the brain and produce a sense of physical exhaustion than a sense of hurry. Without the sense of this insane driver with a lash in his hands standing over one, she can work more rapidly, with complete self-possession, and do more accurate and better work. The peculiar sense of being hurried has a direct benumbing physical effect, that can often be felt in the brain as distinctly confusing.

=The Toxins of Fatigue.=—By speeding the machinery to the utmost, a strain is placed on nerves and muscles, and they are kept keyed up to the greatest possible tension. There is a natural pace that one can keep up; force the pace, and weariness results. A man can go for hours at the rate of five miles an hour; he can run at the rate of six miles an hour for quite a long while; but if he tries to run eight miles an hour, he will drop out very soon. The powers of endurance must be gradually developed, but no machine should ever be run at its utmost speed.

By undue pressure, at any period of life, it is possible to use up energy that ought to have been spread out over long periods; and this is emphatically the case during adolescence; too heavy a drain is made on futurity, which means a serious breakdown, or, at least, premature old age.

It has long been assumed that during the activity of muscles substances were produced which exerted a poisonous influence upon the muscle tissues. Exactly what these substances were was not known, but it was supposed that they were definite products of metabolism or tissue waste. It is a well-known phenomenon, observed during the training of athletes and soldiers, that prolonged and disciplined exercise makes it possible for individuals to support easily an amount of work which would prove exhausting or even fatal to the untrained. Increased work, under any circumstances, means increased metabolism, and consequently a more rapid accumulation of its products.

A German investigator, Dr. Weichardt, has shown that if guinea-pigs were put upon a miniature treadmill and forced to run it until they dropped dead from exhaustion, a highly poisonous liquid could be pressed from their muscles, and that the injection of this liquid or extract into the veins of healthy guinea-pigs produced, when administered in small doses, rapid fatigue; whereas, larger doses caused death, accompanied by all the symptoms observed in the original animal during the process of mechanical tiring.

On the other hand, liquid taken from unworked guinea-pigs had no such effect. Further, that if these little animals were put upon a treadmill and worked to just short of exhaustion, and then were given time to recuperate, as we say, the liquid or extract from their muscles had no such effect: it was quite harmless.

From the results of these carefully carried out scientific investigations, Weichardt has come to the conclusion that fatigue is due to a definite toxin, analogous to that of diphtheria and tetanus, and he believes that the explanation of the phenomena of training lies in the fact that in the body of the athlete there must be a specific “antibody,” which neutralizes the “fatigue toxin” as soon as it is formed.

In the animals undergoing these experiments of extreme fatigue there was a fall of temperature. A practical use of this fact could be made for the individual, by noting the fact that a subnormal temperature was a grave danger-signal.

Other observers concede that fatigue is due to chemical substances, produced in the body as the result of brain and muscle activity, and find that these toxins produce a depressing effect, especially on the muscular system, and that the sensation of fatigue is in large part the manifestation of this depression. The action of toxins is not confined to the tissues in which they arise; excessive activity of one tissue can cause fatigue of others. The facts of acid intoxication are noticed as analogous to fatigue phenomena, so far as the latter are due to toxic substances. As antidotes, only rest and sleep can be relied upon.

Observations in the electric experiments on nerve-cells have shown a remarkable shrinking of the nerve-cells, and especially of their nuclei. After five hours’ continuous work, the cell nucleus was only half its normal size, and twenty-four hours of rest was necessary in order to restore it to its normal size, but half that amount of work does not require half that amount of time for its recovery.

The mental symptoms of normal fatigue are loss of memory; the sense of perception is less acute; the association centers act less spontaneously and therefore slower; the vocabulary diminishes; the emotional tone is lowered; the attention is unstable and flickering. All these are marked symptoms that the individual is far below her best. All kinds of perceptions are more acute in the morning.

Fatigue is not, therefore, merely physically uncomfortable; it is intellectually, physically, and morally dangerous.

=Overwork.=—A surplus nervous energy must be persistently aimed at—what Emerson calls “plus health.” It must be indelibly impressed on the intelligence of every one that no fatigued individual can be at her best; she is doomed to do inferior work, to be mentally depressed, and to be morally weakened. Hope and courage ooze away, and all sense of proportions and perspective are lost.

The amount of work that can be performed without fatigue is a matter of individuality, and the only safe gauge of overwork are the danger-signals sent out by nature—loss of appetite, insomnia, increasing exhaustion from day to day without increase in the amount of work done, mental depression, lack of interest and initiative. No one can afford to disregard these danger-signals.

Habitual overwork produces fag and a desire for stimulants to act as a spur to the overworked muscles during the day, and recourse to increased stimulants or sedatives to act as hypnotics at night. The inert nerve-centers have no reserve energy to give out, so it is worse than useless to stimulate them. On the other hand, the nerve-centers are at too low an ebb to react from the depressing effects of sedatives, which, to the individual, must be positively injurious. The aim must be to promote nutrition, and to give complete rest to the exhausted nerve-centers.

Brain work, to be beneficial, must be regulated with the greatest care. During the exercise of the brain there is always an increased blood-supply to it. If the exercise is continued too long, there is a tendency for the blood to remain in too great quantity, due to the exhaustion of the nerve-cells, which are no longer able to control the vessels.

During sleep the blood-supply to the brain is diminished and the cells recover themselves, but if this hyperemia be persistently kept up, sleep soon becomes impossible, the brain-cells have no opportunity to become repaired, and their activity is diminished.

Richardson says: “Making all allowances for differences, even in the prime of their mental and physical vigor, few individuals can exceed six, and for most persons prudence would direct not more than four or five hours of close mental application, without seriously endangering their health.”

No real advantage is gained by eight or ten hours of daily study, since the memory and reasoning powers become so exhausted that the assimilation of ideas becomes slower and more difficult. When in his prime, Walter Scott declared that six hours a day was all that he could profitably spend upon his literary compositions. In later years, because of his pecuniary embarrassment, he worked beyond this limit, and, as the result of excessive labor, his last years were spent in hopeless imbecility.

=Signs of Overwork.=—These show themselves in irritability, with a sense of exhaustion, the irritability being due to an exhaustion of the nerve-centers. Work becomes irksome. There are periods of depression and melancholia, which recur at shorter and shorter intervals and continue for a longer period of time. There is a slight loss of memory, together with inability to concentrate the mind upon any given subject for any considerable length of time, and the power of thought and judgment are impaired. There are sleepless nights, ringing in the ears, fatigue from the slightest exertion, an irregular action of the heart, with palpitation and a frequent desire to urinate. Various forms of pain and neuralgia occur.

There may be as yet no loss of flesh or impairment of the appetite, but this condition of cerebral anemia furnishes the possessor with a pair of blue spectacles through which the intelligence must look, and which throw their own color over everything. Distressing dreams and unrefreshing sleep allow the brain little opportunity for either rest or repair. The mind becomes as sensitive as the skin after a blister, and the calm, vigorous mental labor is superseded by feverish anxiety, wearing responsibility, and vexing chagrin.

When the brain is well supplied with a powerful circulation, and a rich blood-supply from a good digestion furnishes it with an abundance of pabulum, the cares of life are borne with equanimity and cheerfulness. One of the most unerring signs of failing health is the inability to withstand the pressure of these same daily cares. When the cares that formerly sat lightly on the shoulders become well-nigh an insupportable burden, a state has been reached where the mind reacts on the body.

Worry.—It is readily evident that worry is bred of exhaustion, and is one of the signs of overwork; but, if too often indulged in, it becomes a fixed habit, and the mind rapidly becomes settled in a state of gloom.

It is most important for overwrought business and professional women, but most especially for those women whose vocations in life combine three distinct occupations or callings—namely, wives who act in the capacity of housekeepers, ministers of finance to the household, and the bringing up of children—to realize the importance of not undertaking more than they can accomplish without fret and worry. The overconscientious woman may object that it is selfish to consider her own comfort when she has work to do for others, but to expend too freely of the nervous energy, even in a good cause, is like giving so much of our substance to charity that we ourselves are in turn obliged to lean on others for support. In properly conserving our own energies, we may ultimately be lightening the burden of others. There is a proper balance between the duty one owes to one’s self and to others.

Once bred, worry is an endless chain. Tell such a woman not to worry, and she worries for fear she may worry. She is afraid that she has decided wrongly, and regards decisions in regard to the most trivial affairs of life as though they were matters of vital importance.

The obsession “to arrive” is a fertile source of fret and worry. This habit of mind leads to frantic and incessant labor and blocks all pleasure at every point. The person who plays a game only to see who wins, loses half of the benefit of the recreation.

“The legs of the stork are long, the legs of the duck are short; you cannot make the legs of the stork short, neither can you make the legs of the duck long. Why worry?” (Chinese proverb.)

Insomnia.—This is another symptom of overwork. The mind, worried and harassed all day, retires at night to struggle in the darkness and solitude with worries, forebodings, doubts, and regrets, which now assume gigantic and fantastic shapes. In this case the insomnia is due to faulty habits of mind.

Another form of insomnia is caused by intellectual work being carried on at night until time for retiring; the mind is then so fully saturated with the subject that it is unable to throw it off on going to bed.

Whatever be the cause of the insomnia, it soon becomes a fixed habit, and, whether it is a case of laying awake a long time before sleep comes, or waking up at a regular hour toward morning,—and it is a curious fact that the habit of waking up recurs at almost precisely the same hour in the morning,—the longer this habit of insomnia is indulged in, the more difficult it is to break it up.

Nervousness.—This is a well-known sign of overwork, which shows itself in intense nervousness and irritability. Everything jars on the nerves. The woman gives way to her emotions, over which she loses control.

To keep placid when overworked to the limit of physical endurance requires a stolidity of soul and lack of nerves only known to the North American Indians, and perhaps the Japanese, and it matters not what the kind of overwork is, whether business, pleasure, or charity.

=Nature’s Restoratives.=—The proper division of the day is eight hours to be allotted to work, eight to sleep, and the remaining period of eight hours is to be divided among the various methods of refreshing body and mind—the toilet, eating, rest, and recreations.

Not only are rest, recreation, and sleep in proper proportions essential to the health of the body, but they are equally essential to the quantity and the quality of the output of work. From them result a feeling of physical well-being, an exuberance of animal spirits which go into the work. The perspective is more accurate, the judgment is clearer, and the creative power is greater. Work goes of itself with a swing. Happiness is an expansive quality, that makes itself felt throughout the entire body, but its effects are most manifest in the mental power.

The mother who so honestly works and plans for the good of her family as to give herself no time to rest after her physical efforts is in such an exhausted condition as only to be able to give them the tired and critical side of herself for daily association. There are few human achievements much finer than to make human beings happy, and this power woman is endowed with to a very large extent.

Rest, to be of value, must be systematically taken. Bearing in mind the shrinking in size of the nerve-cells after stimulation caused by work, and that they recovered their normal size in relatively less time if the shrinkage were less, it becomes obvious that, in order to accomplish the best work, whether purely mental, or of the more complex mental and physical work demanded of the mother who is at the same time the housewife, that a break in the day’s work will aid in securing the best results.

The exact time of the daily siesta must be adapted to the family régime, but a fixed hour should be set aside for this purpose, and this should be known as the mother’s hour, and nothing short of a catastrophe should be allowed to infringe on it.

The woman should retire to her bed-room, undress, and go to bed. The room should be darkened, and at the same time there must be an abundant supply of fresh air. One soon forms the habit of taking a short nap, of perhaps half an hour; one hour should be spent in bed. After this, she gets up, takes a shower or other bath, dresses, and is then ready to enjoy life and be a comfort to her family. In this way alone can absolute relaxation, rest of mind, and body be secured.

=Avocation.=—Second only to the physiologic necessity for a vocation in life, is the necessity for an avocation, and this must be in the nature of a recreation.

It is a well-known fact in farming that any one kind of crop will exhaust the very best soil, but few people recognize the necessity for a change of occupation and recreation in order to produce the best mental and physical results.

Joyless drudgery drains the springs of health. There is a mental starvation, due to the lack of recreation, as well as the physical, due to the lack of bread. The French aristocrats, noted for the gaiety of their pastimes, in spite of their dietetic and other sins, furnish a remarkable list of longevity. Persons of a cheerful disposition are generally long-lived, and anything tending to counteract the influence of worry and discontent directly contributes to the preservation of the health. Despair, which frequently results from years of overwork, can paralyze the energies of vital functions like a sudden poison, while hope fulfilled has cured many a disease.

The nature of the avocation chosen will necessarily depend upon the character of the vocation. For women whose vocations are intellectual and sedentary, as writers, teachers, stenographers, etc., some outdoor employment, which calls into activity the muscles of the body, rests the eyes and brain, and, at the same time, pleasantly occupies the mind, is the best, as walking, gardening, lawn-tennis, golf, rowing, etc.

For all women engaged in sedentary occupations, daily exercise in the open air is the first essential, and let them be assured that their feelings of fatigue and disinclination to exercise are no safe guide as to their ability to take exercise.

The first cause of the feeling of fatigue is due to the lack of oxygen in the lungs and the impure air of the room. On going out-of-doors, the woman will be surprised at how much stronger and better she feels after an hour’s brisk walk than she did on starting out.

“Fancy work” and lace-making, instead of being classed with recreations, must be classed with fine hand-sewing of the most taxing kind. It calls the same groups of muscles into play, and is productive of the same evils, with a greater tendency to produce eye-strain and a paralysis similar to writer’s cramp.

The proper avocation of the tired housewife, who has been on her feet all the time and whose vocation is manual labor, will be the diversion of the mind by reading a good book, while comfortably pillowed on a veranda chair, a drive, a visit to some congenial friend, a game of cards, or music.

Literary clubs for women should be more largely organized through the country and in country towns. In the cities women have found these clubs a great boon, not only to the health and happiness, but they are in the highest degree educational.

Further, women have found that these literary clubs were profitable, as a means of bringing their minds in contact with other educated minds, and thus they had not only the additional stimulus to study, but a broadening of their horizon, which the woman’s heretofore shut-in household life had precluded. Courses in domestic science would be a boon to the home.

The greater the number of interests which education and culture have created, the greater will be the diversity of the recreations open for the woman’s enjoyment.

Care must be taken that the avocation, which is at first an enjoyment and relaxation, is not turned into hard labor. The moment that any one strains every nerve, even to excel in a game, that moment it ceases to be a relaxation.

History shows that the laws of all nations have always provided a certain number of days of rest, or at least a change of occupation, and that these days were fixed at more or less regular intervals. This was partly from a religious and partly from a hygienic standpoint. The necessity for the interruption of the regular routine work has always been recognized, and one day out of every seven has been set aside for this purpose.

The custom that is so frequently adopted by city folk of going out of town over Sunday might very well be imitated by country folk by going into the town or city over Sunday. For not only is the too continuous application to one’s employment fraught with danger, but it has been conclusively shown that a monotonous routine of occupation, such as lived by the average farmer’s wife, is a severe tax on the sanity of the mind. Statistics show that the heaviest percentage of insanity falls on farmer’s wives, and the supposed cause of this is the monotony of their lives.

A horse cannot gallop as many hours as it can walk, and the daily task should be the sum-total of what man or beast can do compatibly with health. To combine a day of toil with a second of amusement in one twenty-four hours does not give the proper allowance for sleep, and cannot be done without injury to the individual.

Fun and laughter are the most efficacious remedies in the pharmacopeia, and tired humanity owes a debt of gratitude to the guild of humorists, be they writers, comedians, or musical composers.

=The Physiologic Necessity for Laughter.=—The attitude of the individual varies with age, temperament, and the perspective of life. Grave adults are apt to think of laughter and smiling as something occasional, a momentary lapse once in a while from the persistent attitude of seriousness. Healthy children, on the contrary, consider that a state of laughter is the normal condition of humanity, and that seriousness is a tiresome necessity, which must be tolerated from time to time. But very few people have any idea that there exists a well-defined physiologic necessity for laughter, and the greater the intellectual labor and the mental strain, the greater is this necessity.

The deep forcible chest movements increase the rapidity of the circulation, the force of the heart’s beat, and secures a more complete oxygenation of the blood.

It is not improbable that this accelerated circulation produces remote effects on the organism. One of the immediate effects of a good laugh is that it relieves the brain by the rapidity of the movements of the blood through the capillary circulation.

In addition to the immediate physiologic effects which result from laughter it is highly beneficial, by relieving the brain and nervous system from the intense strain and tension of the daily affairs and occupations of life, and gives relief to the severely congested capillaries, which otherwise involve considerable risk to the individual.

Physiologists hold that pleasurable feelings tend to further the whole group of organic functions, and that laughter produces a considerable increase of vital activity by the heightened nervous stimulation. There is a sense of increased energy, of a high tide of the fulness of the life current.

=Vacations and Health.=—The secret of success of the old Romans in conquering the world lay as much in their ability to maintain the health of their troops in their various campaigns as by the courage and organization of those troops; or, rather it may be said that courage is but the coefficient of a good physique and a general mental vigor.

A rest one day out of seven, with an occasional outing for the week-end, is good but not sufficient. If one would keep up to her highest standard of physical and mental efficiency, she must have at least one month of absolute change of environment and outdoor life in the year.

The kind of place one chooses for her vacation will depend on where her home is. To dwellers in cities, the mountains and seaside resorts are the most beneficial. August is our most trying month, and every one who can would do well to take her vacation at that time, always selecting some resort north of her own home, so that she may have the additional advantage of a more bracing climate.

Maine furnishes many of the most beneficial of our health resorts, combining as it does so many attractions—its bracing atmosphere of pine forests, its beautiful scenery with vast expanses of water, and the great variety of diversions which it affords.

It is always wise to send an advance scout to investigate the place in which you contemplate spending your vacation. Avoid low and swampy land; investigate the character of the water-supply and the nature of the plumbing, together with the sewerage system, for it is all too frequent that an attack of typhoid fever follows an outing in the country. Every good summer resort should furnish facilities for a variety of outdoor sports—golf, tennis, boating, swimming, etc.

During the vacation needless exposure to the direct rays of the sun must be avoided. There is probably nothing which lowers the vital resistance, and so prepares the way for disease as much as exhausting exposure to the hot rays of the sun.

Long hours of sleep should be indulged in. The morning air is the most beneficial; it is, therefore, a good habit to retire early and to rise early.

If the vacation is not properly spent, it may be the means of doing more harm than good. On the other hand, if properly spent, vacations prepare one as nothing else can to meet and resist the vicissitudes of the following winter. It is the people who go off on long vacations who have the least need of the doctor’s care.

=Sleep.=—During sleep all the bodily functions are in abeyance and the secretions are diminished; respiration is slow and confined to the chest, so that the amount of inspired air is only one-seventh of that during the waking hours; the temperature of the body falls; less blood circulates through the brain; and the sensibility of the nerves to external stimuli is diminished. Sleep is not only par excellence the time of repose and recuperation of the brain and nerve substance, but it is the only time when, by the diminution of waste caused by the incessant activity of the brain, that the organ can be properly nourished, the deficit in nerve force canceled, and the surplus of energy stored up.

Without this absolute remission of brain activity every twenty-four hours an actual destruction of substance would occur, which, if persisted in, would be so depressing to the nervous functions as to be inconsistent with life, and this is the case in the concluding stages of fatal diseases.

The sleepy feeling caused by fatigue is due to the circulation in the blood of toxins resulting from tissue waste, which benumb the brain-cells; while the feeling of freshness and bien-être with which one awakens in the morning is due to the elimination of the fatigue products from the blood during sleep. If the blood of a tired dog be transfused into the veins of a perfectly fresh animal, the latter will immediately show symptoms of somnolence and seek a dark corner for sleep.

The medical authorities of to-day are pretty well agreed that eight hours of sleep is the minimum required for the maintenance of health, and all concede that the brain-worker requires more sleep than the manual laborer. Every moment after the feeling of languor presents itself is a strain upon the nerves and muscles which will sooner or later invalidate for life, and finally bring the victim to a premature grave. Habitual deficiency of sleep will undermine the strongest constitution.

It is a matter of great importance to train one’s self in the habits of sleep, regularity in the hour of retiring, abstinence from active brain work for the hour immediately preceding going to bed, since, if active brain work is continued until one goes to her room for the night, the chances are that the brain will continue its activities after getting into bed, and sleep may be banished from the pillow for several hours.

A few minutes spent in breathing exercises, the vigorous use of the flesh brush or hair glove, a hot plunge or foot-bath are no mean hypnotics.

A sound sleep is dreamless. Dreams require a certain expenditure of nerve force and mental energy, so that dreamless sleep is the most restful. Disagreeable dreams and “night-mares” are generally associated with indigestion and biliousness, which also occasion a general restlessness. All this can be overcome by taking some medicine for the liver. Two grains of calomel taken just before retiring often works like a charm. The dose must not be repeated under a month. In case of tendency to insomnia, no coffee should be taken after breakfast.

=Treatment of Insomnia.=—The mechanical measures for the relief of insomnia have for their purpose the withdrawing of the blood from the brain to the surface of the skin. Hot foot-baths; general warm baths; cold douches to the spine, brisk exercise; light massage, and cold rooms. Mental work should be laid aside several hours before retiring; late suppers avoided; coffee, if taken at all, should only be taken for breakfast, and then only one cup. Reading or amusement should be selected that does not excite the nerves.

To woo sleep the woman should put herself in a position of rest, which of itself physiologically induces sleep. Avoid irritations, noises, bad air, cold feet, overloaded bowels, all of which tend to wakefulness and to prevent the proper physical rest. Then sleep usually comes of itself.

=The Eyes: Eye-strain.=—Of all the misfortunes that could befall a human being, the loss of sight is probably the greatest, and yet no organ of the body is so constantly abused as the eye.

The trouble is that the possessor of the normal eye does not take into consideration that in all near work, as in reading, writing, sewing, etc., the eye is actively engaged as well as the hands and brain, and that the eye only is at rest when looking into space or when closed.

=Description of the Visual Apparatus.=—The eyeball is contained and protected in a bony cavity, formed by the bones of the face and skull, and is supported by a cushion of fat and other tissues. It is held in place by its membranes and muscles, by which it is also moved. It is further protected by the eyelids, the eyebrows, and the eyelashes. The eyebrows protect the eyes from dust and perspiration and shade the eyes.

The eyelids are lined by a very delicate mucous membrane, called the conjunctiva. They are maintained in close apposition to the eyeball by atmospheric pressure. The tears are secreted by the lacrimal gland, which is at the upper and outer angle of the orbit. The lubrication by the tears and the mucus secreted by the conjunctiva cause them to move smoothly and without friction. An important function of the lids is to distribute the tears over the front of the eyeball, and by incessant winking to free the front of the eye from dust and to keep it moist.

The conjunctiva is continuous with the mucous membrane of the nose and mouth. Hence, in inflammation of the nasal mucous membrane, as in an ordinary cold in the head or influenza, the conjunctiva is liable to become very much congested or inflamed.

The eyeball is spherical in form, having the segment of a smaller and much more prominent sphere ingrafted on its anterior part. The segment of the larger sphere, which forms about five-sixths of the globe, is opaque, and forms the sclerotic coat, the so-called “white” of the eye. The smaller sphere, which forms the remaining sixth, is transparent, and is formed by the cornea.

The iris is a circular contracting membrane, suspended from the edges of the cornea, in front of the eye like a curtain. The iris gives color to the eye, and when we say that an eye is blue or brown, we mean that is the color of the iris. The iris is freely movable, and, according as to whether it dilates or contracts, there is an alteration in the size of the central aperture, called the pupil.

The chief function of the iris is to regulate the quantity of light admitted to the interior of the eye. In a very strong light the pupil quickly contracts, shutting out the excessive light, while in a subdued light the pupil dilates, thus allowing more light to enter. When looking at a distance or when looking languidly into space, the pupil dilates.

The Formation of the Image.—The eye is a camera, consisting of a series of lenses and media arranged in a dark chamber, the iris serving as a curtain. The object of the apparatus is to form on the retina a distinct image of external objects.

The Mechanism of Accommodation.—In the passive condition of the eye, when it is adjusted for far objects, the anterior surface of the lens is somewhat flattened. Accommodation for near objects consists in a contraction of the circular ciliary muscle and an increase in the convexity of the anterior surface of the crystalline lens.

The light enters the eyeball through the pupil, falls upon the retina, which has often been compared to the sensitive plate of a camera, is received and transmitted by the optic nerve to the visual centers of the brain. The eyeball does not see. It is only a sensitive end-organ, which receives and transmits the impressions to the higher centers of sight. The act of vision is performed in the brain.

The focusing power of the eye is the property of bending nearly parallel rays of light from distant and divergent rays or from close range so that they meet exactly on the sensitive retina; this is called refraction. In the normal eye these rays are focused exactly on the retina.

=Optical Defects and their Correction.=—In the normal eye the near limit of accommodation is from 4 to 5 inches, and the far limit may be put at an infinite distance.

Myopia or Near-sightedness.—This is one of the most common refractive defects of the eye. In this condition, because of the greater length of the eyeball or increased refractive changes of the media, rays of light from a distance are focused in front of the retina, producing an indistinct image.

The near-point is brought much nearer—from 2 to 2½ inches—and the far limit is at a very short distance.

In reading, the myope is obliged to hold her book very close to the eyes in order to see. In doing so, she strains her muscles of convergence, producing ocular congestion and compression of the eyeball.

The predisposing causes of myopia are heredity; it is said that half of myopics are descended from near-sighted parents; uncorrected astigmatism, and the effort to read very fine print or figures, entails severe strain on the eyes, which may result in myopia.

Myopia is corrected by a concave lens, which diverges the rays of light, prolonging the focal distance, so that the rays of light are focused exactly on the retina.

Not only are myopic eyes not injured by wearing suitable glasses, but, on the contrary, are often preserved from injurious pressure on the globe, due to the indulgence of the habit to nearly close the lids in order to see better, as is commonly done when glasses are not worn.

Hyperopia or Far-sightedness.—In this condition the eyeball is too short, and the rays of light from a distance are focused behind the retina. Instead of being distinct, the image is blurred. Hyperopia is corrected by a convex lens, which converges the rays of light, bringing them sooner to a focus. In the hyperopic eye the near-point of accommodation is at some distance, and a far limit of accommodation practically does not exist.

Presbyopia.—This is a loss of the power of accommodation, by which reading, writing, sewing, and other near work is accomplished. This power of accommodation is greatest in early life, and gradually diminishes until about the age of forty years, when reading at the ordinary distance becomes uncomfortable. At about seventy-five years of age the power of accommodation is practically lost.

Every person over forty-five years, with normal or far-sighted eyes, should wear glasses to perform near work.

Astigmatism.—Astigmatism does not depend on the length of the eyeball, but on the curvature of the cornea, and rarely on that of the lens. Uncorrected astigmatism necessitates the expenditure of more muscular effort in the attempt to see distinctly than is necessary when refraction is normal. This is accompanied by early fatigue and more or less congestion of the vascular tunics of the eye. Astigmatism is corrected by a cylindric lens, which has a plane surface in one axis and a concave surface in the axis at right angles to it.

In simple astigmatism, on looking at the accompanying astigmatic chart with each eye separately, certain lines in the defective meridian seem very much blurred, while those at exact right angles appear clear and black. This furnishes a test for astigmatism, since to the normal eye the lines appear of equal distinctness and clearness. Astigmatism is a very common ocular defect.

=The Mechanism of Eye-strain.=—Comparatively few eyes are perfect. Far-sighted or astigmatic eyes can secure perfect vision by means of accommodation. By constant strain on the ciliary muscle, the crystalline lens is so increased in curvature as to exactly counterbalance the optical defect of the eyes.

Healthy eyes should do their work without the consciousness of the owner, and this is a safe test as to the kind and amount of work demanded of them.

Perfect rest for the eyes is impossible in the waking state—distant vision represents rest for the eyes and near vision exertion.

Near work is the chief cause of near-sightedness. Distant vision should alternate with near work, and in near work the object should not be brought nearer to the eyes than 12 inches.

=The Local Symptoms of Eye-strain.=—There may be a sense of fatigue in the eyes after reading for a short time, and this may be followed by a constant sense of discomfort in the eyes, which is increased on using them, and which may be accompanied by severe pain in the back of the head. There is a sensitiveness to light, and inflammation of the eyelids and conjunctiva. There may be twitching of the eyelids, and in extreme cases difficulty in keeping the eyes open on account of drowsiness. The eyes may smart, itch, or burn, and continually “water.”

As the trouble becomes more pronounced, reading for a short time may be followed by a blurring of the type, and finally the lines may run together. There is a constant sense of the eyes feeling for the lines, and, perhaps one of the first things to call attention to the condition of the eyes may be the losing of the lines in reading.

The general or reflex symptom of eye-strain is headache, which frequently takes the form of migraine. This is increased on reading, sewing, riding in the cars, etc. The headache is usually over the region of the temples or just above the eyes, but it may be on the top of the head or at the base of the skull.

Vision is so fundamentally related to all the brain functions that eye-strain, or anything which interferes with normal sight, may cause the most varied disturbances of bodily functions.

The Prevention of Eye-strain.—Persons whose work necessitates much ocular labor should vary their duties with intervals of rest. In continued reading or sewing it is well to desist at short intervals and fix the gaze on some distant object, and to frequently close the lids.

Lace work, very fine needle work, working on black goods, reading very fine print, or print on an inferior quality of paper, or attempting to read in a dim light, are all a severe tax on the eyes, and should be avoided, as they are certain to cause them permanent injury.

Defective vision is so common in school-children, it is so often present without being suspected, and so much harm is done to the eyes and the general health of the individual before it is discovered, that there should be a compulsory law requiring the examination of all school-children; and, again, before boys and girls enter the normal schools and colleges.

Clear vision gives clear judgment; defective vision in its various manifestations gives different warps and bents to the mind of their unfortunate possessors.

Veils.—The wearing of veils is responsible for not a little deterioration of vision, particularly when they are thick or dotted. Unless the meshes of the veil are very large, it holds a layer of impure air close to the face, so that the wearer is breathing vitiated air. It hinders clearness of vision, because the external world is viewed through a narrow lattice.

The best veil for the eyes is one with a single mesh, either without dots, or the dots so far apart that none shall come over the eyes.

Protection of the Eyes from the Glare of the Sun.—In very hot weather the eyes should always be so protected that the rays of the sun do not shine directly into them. This protection may be afforded by the brim of the hat or by a parasol. At the sea-shore, or on an ocean voyage, where the glare of the sun is constant and particularly trying, the eyes should be protected by wearing slightly tinted smoked glasses.

=Artificial Lighting.=—The main sources of artificial lighting are kerosene, gas, and electricity. The principal questions of importance are the quantity and quality of the light, its steadiness, the vitiation of the atmosphere by the products of combustion, and the expense; also the proper arrangement of the light.

Kerosene is the most extensively used means for artificial lighting. The principal objections are—the heat, the trouble of filling and keeping the lamps in order, and the danger of explosion and fire if upset; the odor and the great vitiation of the atmosphere.

The modern lamp gives a brilliant light, and if properly shaded by a slightly bluish chimney, so as to absorb the excess of yellow rays, it is very satisfactory.

Illuminating gas, as furnished in cities, has a great excess of yellow rays, which are very injurious to the eyes, and the vitiation of the atmosphere is very considerable. Gas-light is modified by the Argand and Bunsen burners. Of these, the Bunsen burner, a patented composition burner, heated to incandescence, is the best. It gives a white light, resembling daylight, and, under proper adjustment, a far greater volume than any other burner. It is not so hot, does not consume as much gas, and so there is less vitiation of the atmosphere. It is intensely brilliant, and must be shaded by ground glass or a proper shade.

Electricity gives the very best light, with a minimum amount of heat and vitiation of the atmosphere. For individual use 16-candle power is sufficient.

The lamp-shade should be opaque, of a dark-green color, and lined with a white, reflecting surface. Transparent lamp-shades, especially when patterned, are always bad, whatever their color; because of the different degree of illumination thrown upon the work, the light is irritating to the eyes.

=Hygienic Precautions in Reading and Sewing.=—There should be free access of open daylight. Near the window is obviously the best place for working, and the seat should be so selected that the window is to the left of the worker. This prevents the work from being shaded by the hand, and protects the eyes from being fatigued by the light falling directly into them.

Any room will have too much light into which the sun shines directly. Even if the worker’s face is not turned directly toward the sun, yet the light reflected from the book or other work will be so intense as to be dazzling. The softest and most pleasant light to work by is the diffused light from the northern sky. An excess of light may be easily regulated by a shade.

Reading.—Very fine type should always be avoided, it is a very unnecessary strain on the eyes, as are also books printed on a poor quality of paper with improper spacing. The paper should be unglazed.

Length of Line.—The length of the printed line should not be more than 4 inches, nor less than 2¾ inches; that is, not more than 10 or less than 7 centimeters. If the line is too long, the effort to find the succeeding line is too great. If, on the other hand, the line is too short, the lateral movements of the eye are so frequent that the muscles concerned in these movements soon become fatigued.

The position of the reader should be sitting upright, with the back toward the light, which should fall over the left shoulder, and the book held nearly on a level with the eyes. The book should be held at a distance of about 12 inches from the eyes. The light should be on a level with the head or slightly above it. In desk work, a shade should always be worn to protect the eyes.

Reading in the recumbent position is a pernicious habit, and is particularly bad when convalescing from an illness or when very tired.

Reading in carriages or cars is injurious to all eyes, but especially so to myopic eyes; because of the constant jolting, the distance between the type and the eyes is continually changing, necessitating the frequent and abrupt adjustments of accommodation; besides, the illumination is apt to be very poor. Reading in a dim light or the twilight is also very bad for the eyes.

Sewing and embroidery require the most trying ocular labor and the best conditions for illumination. Working on black goods by artificial light should be absolutely forbidden.

=Injuries to the Eyes.=—The most common injuries to the eyes are the entrance of small particles of dust, cinders, steel filings, etc., into the conjunctival sac, or into the substance of the cornea. Frequently, with the aid of a little winking, the tears wash away these foreign substances, but if the substance lodges in the lining membrane of the upper or lower lid, or is imbedded in the cornea, it may be necessary to resort to other means in order to remove them.

The lining membrane of the lower lid is brought into view by simple tension of the lower lid downward by one finger. If the offending particle is not seen, the upper lid should be averted. This may be easily effected by the fingers alone. The patient is told to look down, the edge of the upper lid and the lashes are seized by the thumb and forefinger of the right hand, and the lid is drawn at first forward and then downward away from the eye, then upward over the point of the thumb or forefinger of the left hand, which is held stationary on the lid and acts as a fulcrum. The foreign body should be removed with the handkerchief, but, if it is imbedded, it may be necessary for a competent physician to remove it.

The habit of opening the eyes when dipping the face into a basin of water, or when diving, produces congestion and inflammation of the conjunctiva.

=Symptoms and Treatment of Conjunctivitis.=—The eyes may be blood-shot and the lining membranes of the lids intensely red. There is a sense of irritation about the eyes and an intolerance of light, with a constant sense of discomfort. The sensation produced is that of having sand in the eyes. The eyes are heavy, and tire after using them for a short time.

The best treatment for acute conjunctivitis, which is so often caused by the penetration of dust or other foreign bodies into the conjunctival sac, is the application of cold water. A folded handkerchief is wrung out of ice-water and laid on the closed lids. It must be changed every few minutes, so that it shall not become warm; two cloths are necessary. When the acute symptoms have begun to abate, the patient will no longer find these applications grateful, and they must be discontinued.

For chronic conjunctivitis hot applications are the best. For these, one teaspoonful of fine table salt may be dissolved in a pint of hot water, or two teaspoonfuls of boric acid may be used instead; the last named is a mild antiseptic. The boric acid dissolves very slowly, so that it is well to prepare enough in the morning for the entire day. One tablespoonful of boric acid may be put into a quart bottle of hot water, and be well shaken from time to time, until there is a perfect solution.

When ready for use, half a pint may be heated, poured into a tumbler, which is then placed in a basin of hot water; this latter serves as a water-bath to keep the solution in the glass hot. The application should be made with a rather thick wad of absorbent cotton or a piece of fine cheese-cloth. The absorbent cotton should be picked up with all the water it will hold, and be placed over the closed eyes just as hot as can comfortably be borne, and held there until it begins to cool, when the procedure should be repeated. The two eyes can be treated simultaneously. These hot fomentations should be kept up for ten minutes, and be repeated four times a day.

=Trachoma.=—This malady, of which so much is heard now, is another name for granular conjunctivitis or granular lids. The affection is very contagious. It comes on slowly, and is frequently accompanied by redness and an appreciable degree of secretion in the early stages. Presence of secretion or of interference of the vision should always attract attention.

Strict precautions must be taken that the patient’s handkerchief, towel, and wash-basin are not used by other members of the family. Further, the other members of the family should bathe their eyes several times a day with a solution of boric acid.

=Styes.=—Styes are a very painful species of small boils that generally form on the edges of the eyelids. They are apt to appear in succession. Certain persons are liable to them if the system is run down from general causes. Like boils in other parts of the body, they give evidence of impaired nutrition.

Hot fomentations of boric acid solution will sometimes abort them if used early. If pus has formed, the stye must be opened by an incision parallel to the edge of the lid. This should not be attempted by any one except a physician.

=Color-blindness.=—As a rule, about 4 per cent. of males and about one-half of 1 per cent. of females are color-blind. The part of the color sense that is most often deficient is that for green and red.

=Cataract.=—This is a disease in which the crystalline lens or its capsule, or both, lose their transparency and become opaque. Eventually total blindness is the result. Senile cataracts appear after the forty-eighth year. The only remedy for the disease is the surgeon’s knife.

=Functional Nervous Disorders.=—Evidences of sound health are: first, individual adaptability or capacity of the individual to easily adapt herself to extremely opposite conditions of existence; second, endurance, or the capacity to do a considerable amount of mental work for a short time without suffering fatigue, or to be able to quickly recover from the fatigue; third, to be able to control the emotions; fourth, to be able to resist morbific influence; that is, the capacity on the part of sound organs of excretion to quickly eliminate all poisons from the system.

The signs of debility are just the reverse: first, deformity, obesity, or leanness; second, personal inadaptability, that is, when physical or mental discomfort is caused by such slight provocations as change of food, clothing, or climate; third, lack of endurance, so that a long rest is required to repair the fatigue incident to slight exertion; fourth, lack of control of the emotions; fifth, a proclivity to morbific influences, so that the individual succumbs to every contagion or miasm that she encounters.

Nervousness is a disease of civilization, coupled with overwork and indoor life. The more complex the environment in which the individual finds herself, and to which she must adjust herself, the greater the demands made on the nervous system.

The extreme dryness of our climate, together with the great variations of temperature between winter and summer and the rapid fluctuations of temperature, predisposes to nervous disorders.

=Headache.=—Headache is a symptom rather than a disease, but there is no symptom which requires more careful investigation of its cause than that of headache. It occurs at all ages, but is most common from ten to twenty-five years and from thirty-five to forty-five years. Women suffer from headache more than men, in the proportion of about three to one. Headaches are most common in the spring and fall of the year and in the temperate climates.

Causes of Headache.—These may be classified into those in which the blood is at fault; reflex causes; various nervous disorders; and organic diseases.

The blood may be impoverished, as in the case of anemia, where there is a deficiency in hemoglobin; but by far the most frequent cause of headache is where the blood is disordered, as in gout, rheumatism, kidney diseases, diabetes, and the infectious fevers and malaria.

Among the more common reflex causes are eye-strain, especially errors of refraction; disorders of digestion, particularly constipation; and pelvic disorders, as in inflammation of the pelvic viscera.

Functional diseases of the nervous system causing headache are overwork, neurasthenia, hysteria, epilepsy, and neuritis.

Among the most common of the organic diseases is arteriosclerosis; other diseases are meningitis and brain tumors.

Symptoms.—The pain is often dull in character and rendered worse by stooping; the location of the pain depends on the cause of the headache. The most common variety is over the forehead or eyes. In eye-strain the pain may either be in the front or back of the head. In indigestion, the pain is most frequently over the eyes, but it may also be on the top of the head. In anemia the pain may be either frontal or diffuse. In pelvic disorders the pain is generally at the base of the brain, though it is sometimes in the top of the head.

Neuralgic headaches are generally characterized by sharp paroxysmal attacks, located in the temporal regions, and associated with pain in other parts of the body. It is perhaps most frequently caused by anemia.

In hysteria the headaches are characterized by a circumscribed pain—it has been likened to the driving of a nail into the head.

In migraine the pain is paroxysmal and intensely severe; it is frequently caused by some poison in the blood, as in autointoxication, due to failure of proper regulation of the bowels, also by pelvic disorders.

Treatment.—The treatment is constitutional, and is based on the removal of the cause. First, there should be a regulation of the diet, a free evacuation of the bowels, and their proper regulation. In every case of headache there should be an examination of the urine. Often there is some congestion of the kidneys where it is least suspected. If the headache is persistently made worse by reading or sewing, the patient should be referred to a competent oculist. An inquiry should always be made into the condition of the menstrual function, backache, and leukorrhea. Any marked disorders here will necessitate a gynecologic examination.

For the immediate relief of migraine, the patient should go at once to bed and drink a glass of hot water; sometimes a cup of hot tea gives great relief. No food should be taken for from six to twelve hours, according to the severity of the case. The room must be kept dark and quiet and the head high.

A strip of prepared mustard leaf, 5 inches wide by 8 inches long, should be cut, and a piece of cheese-cloth, 6 or 8 layers thick, should be folded the same size. The cheese-cloth is then wrung out of hot water, and the mustard leaf is quickly dipped into the same. The cheese-cloth is placed on the back of the neck, between it and the mustard leaf. The clothes should be kept dry by a folded napkin. In this way the mustard may be kept on from six to eight minutes, until it begins to burn and the skin get red. If left on too long, the mustard may produce the most painful kind of a blister. When taken off the neck, the mustard may be put on over the stomach.

The medicinal treatment must be directed by the physician, but a perfectly safe prescription, and one which may be kept on hand, is the following: Take of sodium bromid, 15 grains; of essence of peppermint, 10 drops; and of water a sufficient quantity to make 1 dram. Mix well. The dose may be repeated in three hours if necessary. This prescription should be put up by a good druggist, in a three-ounce quantity. Sometimes relief is afforded by 1 teaspoonful of the aromatic spirits of ammonia, taken in four tablespoonfuls of water, and this is about the right quantity of water to take any liquid medicine in. At night 2 grains of calomel should be taken, so that the patient shall not be disturbed through the night, and it is not so apt to cause nausea as when taken through the day.

=Neurasthenia or Nervous Prostration.=—This disease first saw light in the United States, and was christened by Beard as an American disease that was absent from no household in which the inhabitants used their brains. It is certainly much more prevalent in this than in any other country. Americans scarcely treat their bodies with more consideration than their automobiles; they put on high pressure and speed them to the utmost. Add to the high pressure under which we live that other fact of heredity, that many persons are born with unstable nerve-cells, and may be nervously bankrupt, and it is not difficult to understand that 50 per cent. of Americans are suffering in some degree from lowered nerve tone.

Causes of Neurasthenia.—All classes of men and women who use their brains severely, and who have seasons of excessive anxiety and responsibility, are subject to neurasthenia. We have seen that fatigue was caused by the accumulations of toxins in the body, due to muscular activity, but these toxins may also be caused by intellectual overwork or anxiety over domestic or business affairs.

Other causes are the intemperate amount of intellectual work which is forced on the brain, and the excessive indulgence of the emotions and the passions. Combined with the strenuousness of life is the large element of uncertainty, the intense anxiety, and the restless energy which is the price of success. Added to these may be lack of suitable and sufficient recreation and short hours of restless sleep; the restrictions of a narrow lot, loneliness, and isolation, the frequent repetitions of uninteresting tasks, added to the burdens of maternity, domestic cares, and worries.

In cities the ear-strain caused by the incessant noises of the street, the amount of work done by insufficient and improper lighting, the unsanitary mode of life, the improper diet, the monotonous and infertile work, the unhappiness and discontent bred of a life of idleness, or one given to society and gambling, whether bridge, whist or poker, the senseless bolstering of shattered nerves with alcoholic stimulants and beverages, patent medicines, and hypnotics, all add their quota to the breaking down of the nervous system.

A man can do a prodigious amount of work if he only varies it with play which really amuses him, or if he substitutes for mental occupation those which involve bodily exercises.

In so-called latent gout insomnia is a frequent symptom, or insomnia may develop as the result of bad nervous habits. Insomnia from whatever cause is followed by the impairment of nerve substance and an overloading of the body with toxins. This continued nerve exhaustion leads to oxaluria, uric acid, gout, anemia, gastric and intestinal dyspepsia, muscular insufficiency, and precordial distress.

Whatever enfeebles the body by overtaxing the nervous system the waste is in excess of the repair, in all overwork the destructive metamorphosis is greater than the reparative processes, and so there is an accumulation of toxic products and a more or less severe and permanent injury is done the nervous system.

Other causes of neurasthenia, not so generally recognized as overwork, are to be found in the pathologic conditions of the intestinal canal, which becomes a veritable culture tube, and absorption from this into the blood constantly takes place. And this condition of putrefaction has to be overcome before relief can be afforded, and in many cases this condition is associated with an insufficiency of the elimination of urine.

The large intestine is the seat of an enormous bacteriologic flora; they are not there by millions, but by billions. Some of them are harmless, but not all of them, and if these pathogenic bacteria are present in sufficient quantity, they, too, may produce symptoms of mild poisoning. So, too, may mere indigestion, or the malfunction of any other organ, torpidity of the liver, a deficiency of the excretion of bile, which is generally accompanied by constipation.

The Symptoms of Neurasthenia.—The symptoms are essentially those of chronic fatigue, which has become exaggerated and pathologic. They may be classified as sensory, motor, psychic, and somatic. The sensory symptoms first noticed are those of generalized fatigue, with such localized sensations as headache, backache, and limbache. The motor symptoms are muscular fatigue, muscular weakness, and muscular exhaustion on slight exertion. The psychic symptoms are manifested by a diminution in the capacity for sustained mental effort and the spontaneity of thought and exhaustion after slight mental effort. The somatic symptoms show themselves in atony of the digestive tract and the circulatory apparatus, with disturbances of the secretions.

Headache is one of the most common symptoms of localized fatigue, and, associated with this, may be a sense of constriction about the head, and there may be either a sense of lightness or fulness of the head.

A woman who is chronically tired loses all her personal vigor, force, aggressiveness, and, above all, will power. Associated with this lack of will power are hesitation, indecision, a marked irritability, and timidity. Neurasthenic patients are subject to spontaneous attacks of fear, causeless in origin, and generalized in character. These attacks may be accompanied by pallor of the face and palpitation of the heart, just as in normal fear. The tired woman is a cross woman. The irritability shows marked impairment of the power of inhibition.

The Rational Treatment of Neurasthenia.—First of all, there must be a removal of the cause which has produced it. There are two distinct classes of cases—the overworked and the idle. The first class, and the most important to the world, are the overworked. We may have to deal with the intellectually overworked, in which the mental overwork was combined with financial anxieties, domestic difficulties, or lack of success in their work, or the cause may have been the tremendous responsibilities of their positions, which involved the lives or fortunes of many people. Added to this great strain and overwork, has been a lack of proper intervals for rest, recreation, and sleep, and the body has become a storehouse for various toxins, and so is suffering from both acute and chronic poisoning.

This class of patients must have the most rigid rest treatment, such as was prescribed by Weir Mitchell years ago. It is most important that the patient should be removed from her old surroundings; if this is not possible, she should be isolated on the top floor of the house with a good nurse. The room selected must be bright and cheerful, with plenty of sunshine and fresh air; a window should be open practically all the time, for oxygen and sunshine are two of the best restoratives. The diet must be easily digested and very nutritious. The patient should be urged not to use her mind at all. Carefully selected short stories may be read aloud by the nurse; the reading should not be continued for more than half an hour at a time.

A great deal may be done to eliminate these toxins from the system by the proper use of electric-light baths, followed by the shampoo and the percussion douche; massage with salt water, salt rubs, and electricity.

In most cases a month of this absolute rest is as long as is beneficial to the patient. And for most of them the sea-shore is the best. There should be enough going on to be diverting without being overtaxing, and a climate should be selected which is warm enough for the patient to live out-of-doors. There should be short walks, drives, sails, etc., and this outdoor life, with a contemplation of nature, is the most powerful restorative. The grandeur of nature, whether it is the mighty forests, with their refreshing shade and quiet, or even stretched in a hammock watching the sky and trees, or the constant surging of the vast sea, bringing rest in its unceasing restlessness, with the ships sailing lazily along, until the whole fades away in the distant horizon. In the vastness of the universe, the ego becomes contemptibly unimportant and insignificant.

After several months spent in this way the body has gotten rid of its toxins, nerves and muscles are rested, and through the soothing influence of nature the neurasthenic is gradually trained back to a healthier habit of thought and a more rational frame of mind. There is substituted for the morbid emotional complex a feeling of pleasure and energy. Reason and judgment reassert their sway; outdoor life quickens the perceptions, and forms tranquilizing memory pictures on the brain that return later to solace and refresh the individual.

There is another, and a very large class, of cases among women of leisure who have suffered all their lives from a lack of a vocation; they have nothing to think of except themselves. They do not know what it is to be quite well; they travel from one part of the country to another, and from one country to another, but they never rise above a certain level of invalidism. They are self centered, and what they need is the work cure. In the majority of cases, before these patients can be restored to health, powerful habits must be eradicated, new interests in others must be supplied to supplant the most intense egotism, new paths must be hewn out in the brain, the will must be recreated, and character can only be imparted by those who possess it.