suffer to almost any degree from injury. In none of these cases need there be any previous nervous weakness or overstrain; the effect is purely physical. If, therefore, we note in the neighborhood of Donnybrook Fair a great increase in nervous diseases, such increase may be due, not to the greater demand which the conditions of modern life make upon the human brain, but to the shillalagh. Another very large proportion of cases of nervous disease is due directly or indirectly to the action of different forms of bacteria, or disease germs. Nearly all the forms of meningitis, or brain fever, are due to the direct action of different forms of bacteria upon the membranes that cover the brain. Other forms of nervous disease are now thought to be of infectious nature, due to some specific organism. Others still are due to the action of poisons produced by the germs of other diseases. There is, for example, a form of paralysis which not infrequently follows diphtheria, which is due, not to any weakness of the nervous system, but to the action of the diphtheritic poison upon the peripheral nerves. Similar forms of paralysis may follow smallpox, typhoid fever, pneumonia, or influenza. Many of the diseases of the spinal cord are of similar origin. Locomotor ataxia and general paresis, two common and fatal diseases, are in most cases the result of one of these infectious diseases.

Other poisons, not of bacterial origin, may also cause various forms of nervous disease. The so-called lead palsy, from which painters are apt to suffer, is the most familiar of these; but arsenic, alcohol, absinthe, mercury, and other substances, also give rise to disease.

The number of such cases of nervous disease must, therefore, vary with the number of cases of infectious disease and the amount of poisoning from other causes. A wide-spread epidemic of diphtheria or influenza might increase the amount of nervous disease in a given community. The whole amount of infectious disease is probably diminishing; but at the same time the number of cases of any one infectious disease, as we have recently seen with regard to influenza, may increase. With the decrease in the amount of infectious disease, there ought also to be a decrease in the amount of nervous disease due to this cause. Some writers, however, have claimed that the nervous system has become more vulnerable, and that, therefore, it is more often affected by the poison of infectious disease. Concerning this point no definite opinion can at present be expressed. One form of nervous disease, general paresis, has

in several countries become relatively and absolutely more common. This may be due to an increased vulnerability of the nervous system, or it may be due to an increase in the predisposing infectious disease, the statistics of which are altogether indefinite in comparison with the statistics of acute infectious diseases, like scarlet fever or diphtheria. If we could compare the percentage of cases of this disease who have later developed general paresis with the percentage of similar cases fifty or a hundred years ago, we might speak definitely; but such statistics do not exist.

Finally, there are a large number of cases of nervous disease due directly to overwork, or rather overworry, and to the inability of the brain to meet the demands upon it. The affections most frequently due to such cases. are nervous prostration, hysteria, and some of the forms of insanity. The liability to these troubles is increased by bad heredity and poor nutrition; they are often developed. in those who are weak and broken down from other diseases; they may be caused, like other forms of nervous disease, by injury or poisoning: but they are very often due to too great nervous strain, such as may arise from the defective social conditions previously enumerated.1

The increased nervousness of our age, therefore, is not proved; but even if it exist, we cannot attribute the increase to the greater demands which the conditions of modern life make upon the human brain until we have shown what forms of nervous disease actually have increased. If there be a great increase in hysteria, nervous prostration, and similar disorders, the conditions of modern life may well be at fault; but if there be a great increase in broken heads and broken backs and other traumatic nervous affections, or in diphtheritic paralysis, locomotor ataxia, and meningitis, other conditions are to blame, and the special conditions above enumerated have nothing to do with the case; and if there be an increase in apoplexy, it shows only an increase in disease of the bloodvessels, without any disease in the brain itself.

The argument thus far has been general. It may be perfectly true that there has been no increase in the amount of nervous disease in the world at large, and possibly no increase

1 A bad heredity plays, of course, a very important part in the production of certain forms of nervous disease. It is possible that this factor may also be on the increase; but in the absence of any data I have omitted considering it, in order to avoid unnecessary complication of the main argument. It would, of course, have little influence in the cases due to injury or poison.

in this country; but the question of chief interest to us must necessarily be, Is there not a much greater amount of nervousness in America, and do not the conditions of American life tend to cause an increase in that nervousness and in the amount of nervous disease?

Once again we must deplore the lack of conclusive statistics. The belief in the greater nervousness of the American seems very widespread. The late Dr. Beard of New York was one of the first to describe nervous prostration, and to give it its medical name of neurasthenia, so that it has often been spoken of as "the American disease.» In his work on « American Nervousness » he treats chiefly of the causes of the nervousness, and its symptoms, accepting almost as an axiom the statement that Americans are more nervous than any other race, and that there is a vastly greater amount of nervous disease in this country than in Europe. He admits, however, that the severer forms of organic nervous disease, such as locomotor ataxia and apoplexy, are probably less frequent, the increase being in the so-called functional conditions, neurasthenia, hysteria, and the like. It is probable that the majority of educated people not physicians in this country would admit without a murmur that as a people we are peculiarly subject to nervous disease.

Although, as I have said, the statistics are not conclusive, nevertheless such statistics as we have, and the conclusions drawn from various general impressions, absolutely contradict this belief. It is only since the War of 1812 that the American has acquired his reputation for restless energy; before that he was denounced as indolent and sluggish. Up to the period of the Civil War he was also denounced as physically degenerate, inferior in bulk, strength, and endurance to his English cousin. The Civil War put an end to such talk. No armies endured more than ours in the field; no people endured more than those who stayed behind waiting and helping. The record of the first Kentucky brigade in the Confederate army, almost continuously in action or on the march for a hundred days in 1864; retreating from their homes, with the hope of success steadily fading away; 1140 strong at the beginning, suffering 1860 fatal or hospital wounds, with only 50 left unwounded, yet mustering 240 at the end, with less than 10 desertions-such a record has never been surpassed. These men were of the purest American stock.

1 For these and other data, compare the first chapter of the third volume of Rhodes's « History of the United

At about the same time Dr. Brown-Séquard found that the American mammals survived injuries that were inevitably fatal to the European, and our surgeons found a surprising percentage of recovery from severe gunshot wounds, greater probably than had ever been observed in Europe. Dr. B. A. Gould found that the American soldier was physically as well developed as the European, and Dr. H. P. Bowditch found that the American school-boy was the equal in measurement of the boys of Eton and Rugby. American life-insurance underwriters, too, have found that the longevity in this country is as great as it is in Europe, or greater. The rise of the South since the Civil War, and the prompt recovery of individual communities, such as Chicago, Boston, and Portland, after great conflagrations, are further instances of the great recuperative power of our people.

Since the Civil War our physical condition has greatly improved. The greater interest in athletics, and better cooking, have probably had something to do with this improvement. We have held the America's cup for nearly fifty years. In shooting, cricket, rowing, and tennis we have not been inferior in international contests. In track athletics Yale has recently shown her superiority to Cambridge, and the New York athletes have not only surpassed their London rivals, but have established new world's records in more than one event. In the famous ride a few years ago between Berlin and Vienna the picked riders and horses of the Austrian and German armies were used up, yet our cavalrymen and express messengers on the plains, with ordinary mounts, have made better records both for time and distance, without the slightest injury to horses or men.1

These, and many similar facts that might be collected, show very conclusively that neither in size, strength, skill, endurance, nor recuperative power is the American inferior to the European. These are, to be sure, physical qualities; but endurance and recuperative power such as our people have shown time and again in these last fifty years, cannot exist without a sound nervous system. The one thing that the victim of nervous disease is, as a rule, incapable of is steady and persistent effort.

The American is energetic, pushing, restless, impatient; he may move more briskly, his apprehension may be quicker, he may have a keener wit, and he certainly is in more of a hurry, and perhaps lives under a greater States,» Shaler's Nature and Man in America,» and Colonel T. A. Dodge's « Riders of Many Lands.»

strain and with less ease, than the European. This, however, is not being nervous, in the sense of having a weaker or a diseased nervous system. Though nervous in manner, he is distinctly not as neurotic, he much less frequently shows signs of nervous degeneracy, and he probably is less frequently the victim of severe nervous disease.

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Such a statement, so at variance with the popular belief, demands further proof. One of the affections which is indicative of nervous degeneracy and bad heredity, and is often the direct result of breakdown from overwork, an affection on which Nordau has recently laid much stress in treating of the alleged increased nervousness of our age,-is hysteria. Now hysteria, although common in France and by no means rare in Germany, is not very common in America. It is seen most frequently among the Russian and Polish Jews; in patients of American stock it is distinctly rare. Gilles de la Tourette, the author of the best recent French treatise on hysteria, has claimed that hysteria is a wide-spread disease, and he implies that it is as frequent in England and America as in France. The opinion given above is based, not merely upon personal experience, but upon statements made to me by many of the leading specialists in nervous diseases in our large cities; statements in the American treatises on nervous diseases; and the following table. This table shows the relative frequency of hysteria and neurasthenia in a number of the large clinics in different cities:

The statistics of insanity in Massachusetts and Scotland-1 in 369 in the former in 1885, and 1 in 345 in the latter in 1888-show no greater amount of insanity in Massachusetts. We note, too, much less of that much-discussed degeneracy in literature in America than in England or on the Continent. It would seem, therefore, as if the burden of proof rested upon those who claim that the American is peculiarly subject to nervous affections. It seems to be a mere vulgar error, with as little to recommend it as the error that once obtained as to our physical degeneracy.

Apart from all questions as to the increased nervousness of our age in general, or as to American nervousness in particular, it is certainly a fair question to ask whether these much-discussed conditions of modern life do, after all, make so much greater demands upon the human brain, and whether our modern civilization has made the world so much harder to live in. This article, however, is already too long to discuss such a question in detail; but there are some conditions, well within the knowledge of the average man, which may fitly be compared with those of the past.

There are, of course, many injurious conditions in our modern civilization which may cause nervous affections; but the question is whether these conditions, taken as a whole, are more or less detrimental than the social conditions of the past.

In the first place, we must recognize that human life and liberty are far more secure

Nervous prostration, or neurasthenia, is very common in all large clinics for nervous diseases, but the table shows no special preponderance in this country. Bouveret and Löwenfeld, two of the ablest recent writers on the subject in France and Germany, utterly scout the idea that it is exclusively or chiefly an American disease. Less than one half the cases in my own clinic in Boston in the last four years have been born in the United States. A year or two ago I selected five cases for a clinical lecture on neurasthenia as illustrating typical varieties of the disease. One could not speak English, another dropped her h's, and on inquiry I found that only one was of American birth, and he was a Nova Scotian.

to-day than in the past. The civilized world suffers less and less from great epidemics; the plague has not entered Europe since the middle of the last century; the last cholera epidemic, a few years ago, was of merely local significance as compared with the epidemics early in the century; yellow fever never enters our Northern cities, and is becoming less and less the scourge of the South; a journal of the influenza year in London or New York would be jovial in comparison with Defoe's grisly story of the plague. The dangers from war and oppression are less. Non-combatants do not suffer as they did at Magdeburg. The Red Prince's Uhlans were missionaries compared to Tilly's troopers. No Frenchman is to-day hurried to the Bastille by lettres de cachet.

No Italian patriot is immured in an Austrian prison. The press-gang no longer travels the streets of English seaports. The criminal on trial for his life in England can now have counsel, and in America can testify in his own behalf. Imprisonment for debt is disappearing. The New England farmer plows his field without dread of the red man's arrow. Alva's autos da fe no longer smoke in the Netherlands. All these things mean greater security to life, lessened anxiety and mental strain, and inevitably sounder mental health.

With this the material comforts of life have increased. With easy transportation and abundant food supply, few communities in this country, except remote and isolated regions, are reduced to the straits of the early Plymouth settlers, and we thus know nothing of the horrors of famine. Bad as our American cooking is (and it is still the worst in the civilized world), saleratus and the frying-pan are less dominant. Our churches, schools, and sleeping-rooms are less of an arctic temperature in winter. We have more fresh air, purer water, and cleaner houses. The athletic craze is giving us sounder bodies. In a thousand ways life is made easier and more comfortable at home and abroad.

The novelist may not rank as a scientific authority in comparison with tables of vital statistics, but there is a curious and suggestive contrast between the maiden up to date and the heroine of the old novelists, which in some ways, as far as physical health and nervous stability go, is in favor of the former, although Sophia Western would never have sunk to the moral level of Gallia or Mildred Lawson. The bicycling, golfing, tennis-playing young woman of the day seldom complains of the vapors and megrims of which we heard a good deal in the last century. I once tried to keep a record of the number of times that Miss Clarissa Harlowe swooned in her sad career, but the task was too great. One thing is certain, that the modern girl does not swoon, either in ordinary life or in novels. Does she still, even when she meets unexpectedly a long-absent lover, « utter a fearful shriek, and faint in the arms of her companion, like Narcissa? All these differences indicate that the girl of to-day has greater control over her emotions, which is one indication of a more stable nervous system.

Such conditions of greater security, greater material comfort, better nutrition, a diminution of infectious diseases, sounder bodies, and greater self-control, all imply a better standard of physical health, and with it a higher standard of nervous health, and, nat

urally, a diminution in the amount of nervous disease.

Property has also become more secure. Taxation, although often excessive, usually follows some definite rule, and is not so extortionate, in the literal sense, as in the days of King John. A man's goods are not taken from him without due process of law, which means much to the ordinary man. Possibly a greater portion of our wealth to-day is in securities, which have a more fluctuating value, and afford a somewhat uncertain income; but income has always been somewhat uncertain, whether derived from crops, rents, or interest on bonds. We do business, perhaps, on different methods; but there has always been a tendency toward speculation and gambling. The victims of Erie, Reading, and the Cordage Trust were fewer in number, and lost less money, than the victims of the Mississippi Scheme or the South Sea Bubble.

The railway undoubtedly claims many victims, because more people travel to-day than ever before; but in comparison to the number of passengers carried, the railway is the safest mode of travel yet discovered. A trip from Boston to New York to-day may cause a headache from the heat and bad air of the car. A hundred and fifty years ago the man who made that journey took a solemn leave of his wife and family before he started, and requested the prayers of the congregation. The telegraph may give us a sudden shock, but it also adds to our security by assuring us that no disaster can happen to distant friends without instant warning. Other new inventions have their drawbacks, they sometimes do harm, they often try our tempers; but on the whole, they make life smoother, and add to our comfort.

With the decay of faith have come doubt and pessimism. Schopenhauer, Leopardi, and Thomson are all of this century, but they are descended from Omar and Ecclesiastes. With the decay of faith have come the extinguishing of the fires of Smithfield, the vanishing of a personal devil and his witches and wizards, and a hope for unbaptized infants. The dread of hellfire has played a greater part in the delusions of the insane than any doubt as to theological doctrines.

Life has always been a struggle, and to-day the struggle seems to be more toward social advancement, since democracy has made it. possible for any one to attain preferment. In many cases the struggle is a failure, with all the despair that that implies. With that evil, however, has come the hope of success, which in the past was far less possible. The struggle

for advancement may be greater, but the struggle for life and for the means of living against wild nature, wild beasts, and wild men has grown less.

We may be burdened with the necessity of a knowledge of too many things; yet I question whether many people are in danger from too much knowledge. There are people who, by some vice of constitution, have brains which are unequal to the task of steady or protracted work, and they succumb under the effort of even a moderate education. People with healthy brains, however, although they may succumb to worry and anxiety, are not broken down by ordinary brain-work. We see, of course, many a child of an unstable, nervous organization who breaks down, especially at the period of adolescence, under an absurd curriculum of a public school; yet, in looking over the records of a large number of cases of nervous disease in children of the school age, I have been surprised to find that overwork in school was in only a small percentage of the cases responsible for the trouble. The average child is, after all, capable of absorbing just so much; then he grows weary, and he will take no more until he has assimilated or forgotten what he has already been taught. It is much the same with the brain of the adult; we can learn only a little. If we try to do more, we must either forget the old or give up the attempt from fatigue. We must, therefore, if we can, choose. If we prefer to fill our minds with Ibsen and Tolstoi, there will be so much less room for Shakspere and Dante, and those who to the average man still shine amid the «gross darkness of English fiction.»

I have compared only a few of the condi

VOL. LII.-20.

tions of life at the present day with those of the past. The task would be too great, even if my knowledge were sufficient, to strike the balance between all those conditions, and to determine which were the most detrimental. Some conditions are undoubtedly better and others worse than they were five, or two, or one century ago. Many of us, especially here in America, as is apparent to the most superficial observer, live in too much of a hurry and under too great a strain. We should undoubtedly be better off if we led quieter lives, if we relaxed the tension under which we work, and if we went more slowly and took life more easily and comfortably. Our life to-day is certainly more complex, but there is no reason for condemning it wholly in comparison with the past. The golden age is, after all, a mere superstition; and there is good reason for asking whether, on the whole, our social conditions are not to-day more favorable for mental and nervous health than they ever have been before.

We should not, then, chatter glibly about the increased nervousness of our age, due to the greater demands which the conditions of modern life make upon the human brain. It is not a matter to be settled by a few phrases, or by tables of very general and questionable statistics. We are by no means certain that there is any increased nervousness; and even if it do exist, we do not know whether it is due to these greater demands, or to injury or infection. It is also doubtful whether the conditions of modern life make as great demands upon the brain as did the conditions of life in the past. Finally, without more evidence in its favor, we must regard the belief in the greater nervousness of Americans as an error.

Philip Coombs Knapp.

Arlo Bates.