professions. This has changed her attitude toward her original occupation of housewife and is a psychological fact of great importance. She has become more industrial and individualized, and as a result has declined to live in unsatisfactory relations with man, so that divorce has become more frequent. In part this is also caused by her inability to give up petty irresponsibility while claiming equality. Finally, the declining birth rate is still further evidence of her individualization and is in a sense her denial of mere femaleness and an affirmation of freedom.

CHAPTER II

The Nature Of "nervousness"

Preliminary to our discussion of the nervousness of the housewife we must take up without great regard to details the subject of nervousness in general.

Nervousness, like many another word of common speech, has no place whatever in medicine. Indeed, no term indicating an abnormal condition is so loosely used as this one.

People say a man is nervous when they mean he is subject to attacks of anger, an emotional state. Likewise he is nervous when he is a victim of fear, a state literally the opposite of the first. Or, if he is restless, is given to little tricks like pulling at his hair, or biting his nails, he is nervous. The mother excuses her spoiled child on the ground of his nervousness, and I have seen a thoroughly bad boy who branded his baby sister with a heated spoon called "nervous." A "nervous breakdown" is a familiar verbal disguise for one or other of the sinister faces of insanity itself.

It should be made clear that what we are dealing with in the nervous housewife is not a special form of nervous disorder. It conforms to the general types found in single women and also in men. It differs in the intensity of symptoms, in the way they group themselves, and in the causes.

Physicians use the term psychoneuroses to include a group of nervous disorders of so-called functional nature. That is to say, there is no alteration that can be found in the brain, the spinal cord, or any part of the nervous system. In this, these conditions differ from such diseases as locomotor ataxia, tumor of the brain, cerebral hemorrhage, etc., because there are marked changes in the structure in the latter troubles. One might compare the psychoneuroses to a watch which needed oiling or cleaning, or merely a winding up,—as against one in which a vital part was broken.

The most important of the psychoneuroses, in so far as the housewife is concerned, is the condition called neurasthenia, although two other diseases, psychasthenia and hysteria, are of importance.

It is interesting that neurasthenia is considered by many physicians as a disease of modern times. Indeed, it was first described in 1869 by the eminent neurologist Beard, who thought it was entirely caused by the stress and strain of American life. That not only America, but every part of the whole civilized world has its neurasthenia is now an accepted fact. Knowing what we do of its causes we infer that it is probably as old as mankind; but there exists no reasonable doubt that modern life, with its hurry, its tensions, its widespread and ever present excitement, has increased the proportion of people involved.

Particularly the increase in the size and number of the cities, as compared with the country, is a great factor in the spread of neurasthenia. Then, too, the introduction of so-called time-saving, i.e. distance-annihilating instruments, such as the telephone, telegraph, railroad, etc., have acted not so much to save time as to increase the number of things done, seen, and heard. The busy man with his telephone close at hand may be saving time on each transaction, but by enormously increasing the number of his transactions he is not saving himself.

The keynote of neurasthenia is increased liability to fatigue. The tired feeling that comes on with a minimum of exertion, worse on arising than on going to bed, is its distinguishing mark. Sleep, which should remove the fatigue of the day, does not; the victim takes half of his day to get going; and at night, when he should have the delicious drowsiness of bedtime, he is wide-awake and disinclined to go to bed or sleep. This fatigue enters into all functions of the mind and body. Fatigue of mind brings about lack of concentration, an inattention; and this brings about an inefficiency that worries the patient beyond words as portending a mental breakdown. Fatigue of purpose brings a listlessness of effort, a shirking of the strenuous, the more distressing because the victim is often enough an idealist with over-lofty purposes. Fatigue of mood is marked by depression of a mild kind, a liability to worry, an unenthusiasm for those one loves or for the things formerly held dearest. And finally the fatigue is often marked by a lack of control over the emotional expression, so that anger blazes forth more easily over trifles, and the tears come upon even a slight vexation. To be neurasthenic is to magnify the pins and pricks of life into calamities, and to be the victim of an abnormal state that is neither health nor disease.

The more purely physical symptoms constitute almost everything imaginable.

1. Pains and aches of all kinds stand out prominently; headache, backache, pains in the shoulders and arms, pains in the feet and legs, pains that flit here and there, dull weary pains, disagreeable feelings rather than true pains. These pains are frequently related to disagreeable experiences and thoughts, but it is probable that fatigue plays the principal part in evoking them.

2. Changes in the appetite, in the condition of the stomach and bowels, are prominent. Loss of appetite is complained of, or more often a capricious appetite, vanishing quickly, or else too easily satisfied. The capriciousness of appetite is undoubtedly emotional, for disagreeable emotions, such as worry, fear, vexation, have long been known as the chief enemies of appetite.

With this change of appetite goes a host of disorders manifested by "belching", "sour stomach", "logy feelings", etc. What is back of these lay terms is that the tone, movement, and secreting activity of the stomach is impaired in neurasthenia. When we consider later on the nature of emotion, we shall find these changes to be part of the disorder of emotion.

3. So, too, there is constipation. In how far the constipation is primary and in how far it is secondary is a question. At any rate, once it is established, it interferes with all the functions of the organism by its interference with the mood.

The following story of Voltaire bluntly illustrates a fact of widespread knowledge. Voltaire and an Englishman, after an intimate philosophical discussion, decided that the aches and pains of life outnumbered the agreeable sensations, and that to live was to endure unhappiness. Therefore, they decided that jointly they would commit suicide and named the time and the place. On the day appointed the Englishman appeared with a revolver ready to blow out his brains, but no Voltaire was to be seen. He looked high and low and then went to the sage's home. There he found him seated before a table groaning with the good things of life and reading a naughty novel with an expression of utmost enjoyment. Said the Englishman to Voltaire, "This was the day upon which we were to commit suicide." "Ah, yes," said Voltaire, "so we were, but to-day my bowels moved well."

4. The disturbed sleep, either as insomnia or an unrestful, dream-disturbed slumber, is a distressing symptom. For we look to the bed as a refuge from our troubles, as a sanctuary wherein is rebuilded our strength. We may link work and sleep as the two complementary functions necessary for happiness. If sleep is disturbed, so is work, and with that our purposes are threatened. So disturbed sleep has