The Occupation and Exercise Cure
By Frank Marshall White
The nerve specialist leaned back in his chair behind the great mahogany desk in his consulting-room and studied the features of the capitalist as that important factor in commerce and industry explained the symptoms that had become alarming enough to drive him, against his will, to seek medical assistance. The patient was under fifty years of age, though the deep lines in his face, with his whitening hair—consequences of the assiduity with which he had devoted himself to the accumulation of his millions and his position in the Directory of Directors—made him appear ten years older. An examination had shown that he had no organic disease of any kind, but he told the physician that he was suffering from what he called “inward trembling,” with palpitation of the heart, poor sleep, occasional dizziness, pain in the back of the neck, difficulty in concentrating his attention, and, most of all, from various apprehensions, such as that of being about to fall, of losing his mind, of sudden death—he was afraid to be alone, and was continually tired, worried, and harassed.
“You present merely the ordinary signs of neurasthenia,” said the specialist. “These symptoms are distressing, but not at all serious or dangerous. You have been thinking a great deal too much about yourself and your feelings. You watch with morbid interest the perverted sensations that arise in various parts of your body. You grow apprehensive about the palpitation of your heart, which is not at all diseased, but which flutters a little from time to time because the great nerve of the heart is tired, like the other great nerves and nerve-centers of your body. You grow apprehensive over the analogous tremor which you describe as ‘inward trembling,’ and which you often feel all through your trunk and sometimes in your knees, hands, and face, particularly about the eyes and mouth and in the fingers.”
The capitalist had started at the mention of the word neurasthenia, and had seemed much relieved when the physician had declared that the symptoms were not dangerous. “I had been under the impression that neurasthenia was practically an incurable disease,” he said. “However, you have described my sensations exactly.”
“One hundred per centum of cases of neurasthenia are curable,” responded the specialist. “Neurasthenia is not, as is usually supposed, an equally diffused general exhaustion of the nervous system. In my opinion, it is rather an unequally distributed multiple fatigue. Certain more vulnerable portions of the nervous system are affected, while the remainder is normal. In the brain we have an overworked area which, irritated, gives rise to an apprehension or imperative idea. By concentration of energy in some other region of the brain, by using the normal portions, we give this affected part an opportunity to rest and recuperate. New occupations are therefore substituted for the old habitual one. A change of interests gives the tired centers rest.”
“I have heard the ‘rest cure’ advocated in cases like mine,” suggested the capitalist.
“In the treatment of neurasthenia we must take the whole man into consideration,” said the physician. “We must stimulate nutrition, feed well the tired and exhausted organism, and, above all, provide some sort of rest and distraction for the mind. The mind needs feeding as well as the body. The rest cure is a kind of passive, relaxing, sedative treatment. The field is allowed to lie fallow, and often to grow up with weeds, trusting to time to rest and enrich it. The ‘exercise and occupation cure,’ on the other hand, is an active, stimulating, and tonic prescription. You place yourself in the hands of a physician who must direct the treatment. He will lay out a scheme with a judicious admixture of exercise which will improve your general health, soothe your nervous system, induce good appetite and sleep, and of occupation which will keep your mind from morbid self-contemplation. One of the best means to this end is manual occupation—drawing, designing, carpentry, metal-work, leather-work, weaving, basket-making, bookbinding, clay-modeling, and the like—for in all these things the hands are kept busy, requiring concentration of attention, while new interests of an artistic and æsthetic nature are aroused. The outdoor exercise, taken for a part of each day, if of the right sort, also distracts by taking the attention and creating interest.”
The capitalist had called upon the specialist braced for a possible sentence of death, prepared at the least to be informed that he was suffering from a progressive mental malady. Now, while a tremendous weight was lifted from his mind with the information that he might anticipate a complete return to health, the idea of devoting his trained intelligence, accustomed to cope with great problems of trade and finance, to such trivialities as basket-making or modeling in clay appeared preposterous. Nevertheless, when the physician told him of a resort near at hand, established for the treatment of cases just such as his, where he might be under continuous medical supervision, without confinement indoors or being deprived of any of the comforts or luxuries of life, he decided to put himself in the other’s hands unreservedly. The specialist informed him that the length of time required for his cure would depend largely upon himself. He might, for instance, even keep in touch with his office and have matters of import referred to him while he was recuperating his mental and physical strength, but such a course would inevitably retard his recovery, and possibly prevent it. To get the best results from the treatment he ought to leave every business interest behind him, he was told.
The fee that the capitalist paid the specialist made his advice so valuable that the other followed it absolutely. The next evening saw the patient in the home of the “occupation and exercise cure.” He arrived just in time to sit down to dinner with a score of other patients, not one of whom showed any outward sign of illness, though all were taking the cure for some form of nervous trouble. There were no cases of insanity among them, however, none being admitted to the institution under any circumstances. The dinner was simple and abundant, and the conversation at the tables of a lively and cheerful nature. As everybody went to bed by ten o’clock—almost every one considerably before that hour, in fact—the newcomer did likewise, he having secured a suite with a bath in the main building. Somewhat to the surprise of the capitalist, who was accustomed to be made much of wherever he happened to be, no more attention was paid to him than to any other guest of the establishment, a condition of affairs that happened to please him. He was told on retiring that breakfast would be served in the dining-room from 7:30 to 8:30 in the morning, but that, if he preferred to remain in his room, it would be brought to him there at nine o’clock.
The capitalist had a bad night, and was up to breakfast early. After he had concluded that repast the medical superintendent showed him about the place, but did not encourage him to talk about his symptoms. The grounds of the “occupation and exercise cure” comprised a farm of forty acres located among the hills of northern Westchester County in the Croton watershed, with large shade trees, lawns, flower gardens, and an inexhaustible supply of pure spring water from a well three hundred feet deep in solid rock. The main building, situated on a knoll adjacent to a grove of evergreen trees, contained a great solarium, which was the favorite sitting-room of the patients, and the dining-room was also finished with two sides of glass, both apartments capable of being thrown open in warm weather, and having the advantage of all the sun there was in winter. In this building were also the medical offices, with a clinical laboratory and hydro- and electro-therapeutic equipment, and accommodations for from twelve to fifteen guests. Two bungalows under the trees of the apple orchard close at hand, one containing two separate suites with baths, and the other two living-rooms with hall and bath-room, were ideal places for quiet and repose. Situated at the entrance to the grounds was a club-house, with a big sitting-room and an open fireplace; it also contained a solarium, billiard-room, bowling alleys, a squash court, a greenhouse for winter floriculture, and the arts and crafts shops, with seven living-rooms. Every living-room in the main building, the club-house, and the bungalows was connected with the medical office by telephone, so that in case of need patients might immediately secure the services of a physician at any hour of the day or night.
The arts and crafts shops being the basic principle of the “occupation and exercise cure,” the capitalist was introduced to an efficient and businesslike young woman, the instructress, who explained to him the nature of the avocations in which he might choose to interest himself. Here he found his fellow-patients busily and apparently congenially employed. In one of the shops a recent alumnus of one of the leading universities, who had undergone a nervous breakdown after graduation, was patiently hammering a sheet of brass with a view to converting it into a lampshade; a matron of nearly sixty, who had previously spent eight years in sanatoriums, practically bedridden, was setting type in the printing office with greater activity than she had known before for two decades; two girls, one sixteen and the other twelve, the latter inclined to hysteria and the former once subject to acute nervous attacks, taking the cure in charge of trained nurses, were chattering gayly over a loom in the construction of a silk rug; a prominent business man from a Western city, like the New York capitalist broken down from overwork, was earnestly modeling in clay what he hoped might eventually become a jardiniere; one of last season’s debutantes among the fashionables, who had been leading a life of too strenuous gayety that had told on her nerves, was constructing a stamped leather portfolio with entire absorption; and half a dozen others, mostly young women, were engaged at wood-carving, bookbinding, block-printing, tapestry weaving, or basket-making, each one of them under treatment for some nervous derangement.
The new patient decided to try his hand at basket-making; and, although he figured out that it would take him about four days to turn out a product that might sell for ten cents, he was soon so much interested in mastering the manual details of the craft that he was disinclined to put the work aside when the medical superintendent suggested a horseback ride. When, at the advice of the specialist, the capitalist had decided to try the occupation and exercise cure, he did so with little faith that it would restore him to health, though he felt that there was perhaps a slight chance that it might help him. The remedy seemed to him too simple to overcome a disease that was paralyzing his energies. To his great surprise, he began to improve at once; and though for the first week he got little sleep, and his dizziness, with the pain in the back of his neck and his apprehensions, continued to recur for weeks, they did so at always increasing intervals.
He learned bookbinding, and sent to his library for some favorite volumes, and put them into new dress; he made elaborate waste-paper baskets, and beat brass into ornamental desk-trays, which he proudly presented to his friends in the city as specimens of his skill. Work with him, as with the others of the patients, was continually varied by recreation. In the summer months there were lawn-tennis, golf, croquet, canoeing, rowing, fishing, riding, and driving. In winter, such outdoor sports as skating, tobogganing, coasting, skeeing, snowshoeing, and lacrosse were varied by billiards, bowling, squash, the medicine ball, and basket and tether ball. The capitalist was astonished to discover that he could take an interest in games. The specialist, who called upon his patient at intervals, told him that a point of great importance in the cure was that exercise that is enjoyed is almost twice as effective in the good accomplished as exercise which is a mere mechanical routine of movements made as a matter of duty.
The net result was that, after four months of the “occupation and exercise cure,” the capitalist returned to New York sound in mind and body, and feeling younger than he had before in years. Complete cures were effected in the cases of the other patients also, which is the less remarkable when the circumstance is taken into consideration that only patients capable of entire recovery are recommended to take the treatment.
Of course the institution that has been described is only for the well-to-do, and physicians are endeavoring to bring the “occupation and exercise cure” within the reach of the poor, and to interest philanthropists in the establishment of “colony sanatoriums,” such as already exist in different parts of Europe, for those suffering from functional nervous disorders who are without means. Contrary to the general opinion, neurasthenia, particularly among women, is not confined to the moneyed and leisure class; but, owing to the fact that women have taken up the work of men in offices and trades as well as in many of the professions, working-women are continually breaking down under nervous strain, and many, under present conditions, have little chance for recovery, because they cannot afford the proper treatment. As a speaker at the last annual meeting of the American Medical Association declared, “Idiots and epileptics and lunatics are many; but all together they are less numerous than the victims of nervousness—the people afflicted with lesser grades of psychasthenic and neurasthenic inadequacy, who become devoted epicures of their own emotions, and who claim a large share of the attention of every general practitioner and of every specialist.”
Scientists declare that this premature collapse of nerve force is increasing to such an extent as to become a positive menace to the general welfare. The struggle for existence among the conditions of modern life, especially among those found in the large centers of industrial and scientific activity, and the steady, persistent work, with its attendant sorrows, deprivations, and over-anxiety for success, are among the most prolific causes—causes which are the results of conditions from which, for the large mass of people, according to a leading New York alienist, there has been no possibility of escape.
“Especially here in America are people forced into surroundings for which they have never been fitted,” the alienist asserts, “and especially here are premature demands made upon their nervous systems before they are mature and properly qualified. The lack of proper training deprives many of the workers, in all branches, of the best protection against functional nervous diseases which any person can have, namely, a well-trained nervous system. This struggle for existence by the congenital neuropath or the educationally unfit forces many to the use, and then to the abuse, of stimulants and excitants, and herein we have another important exciting cause. This early and excessive use of coffee, tea, alcohol, and tobacco is especially deleterious in its action upon the nervous system of those very ones who are most prone to go to excess in their use.
“Therefore, predisposition, aided by the storm and stress of active competition and abetted by the use of stimulants, must be looked upon as the main cause for the premature collapse of nerve force which we call neurasthenia; so it will be found that the majority of neurasthenics are between twenty-five and fifty years of age, and that their occupations are those which are attended by worry, undue excitement, uncertainty, excessive wear and tear, and thus we find mentally active persons more easily affected than those whose occupation is solely physical. Authors, actors, school-teachers, governesses, telegraph and telephone operators, are among those most frequently affected, and the increase of neurasthenia among women dates from the modern era which has opened to them new channels of work and has admitted them more generally into the so-called learned professions. But whatever may be the occupation in which persons have broken down, it is never the occupation alone which has been the cause.
“This cannot be too often repeated. The emotional fitness or unfitness of an individual for his occupation is of the utmost importance as a causative factor, and overwork alone, without any emotional cause and without any errors in mode of life, will never act to produce such a collapse. It is therefore not astonishing that this class of functional nervous diseases is not confined to the wealthy, and that the rich and the poor are indiscriminately affected. But certain causes are of greater influence in the one class, while different ones obtain in the other. Poverty in itself, with its limitations of proper rest and recuperation, is a very positive cause. Years of neurological dispensary work among the poor have convinced me that nervousness, neurasthenia, hysteria, etc., are quite as prevalent among the indigent as among the well-to-do.”
Physicians agree that the prime requisite in the treatment of these disorders is the removal of the patient from his or her habitual surroundings, where recognition of the existence of actual disease is generally wanting, where the constant admonitions of well-meaning friends to “brace up” and to “exert your will power” force the sick man or woman to bodily and mental over-exertion, and where the worries about a livelihood are always dominant. Such a change alone, however, the experts say, will help but few, for it is being recognized more and more that these functional diseases of the nervous system can receive satisfactory treatment only in institutions, where constant attention may be had, with expert supervision and trained attendants.
The “occupation and exercise cure” is applicable also to epilepsy, and is the therapeutic principle of the Craig Colony for Epileptics at Sonyea, in Livingston County, supported by the State, and that institution furnishes a general model for the “colony sanatoriums” suggested for indigent patients suffering from functional nervous disorders. The Craig Colony was the idea of Dr. Frederick Peterson, Professor of Psychiatry at Columbia University, and former President of the New York State Commission of Lunacy and of the New York Neurological Society, which he based upon the epileptic colony at Beilefeld, Germany, that was founded in 1867. The Craig Colony was founded in 1894, and there are now being cared for within its confines more than thirteen hundred patients, who have turned out this year agricultural products, with bricks, soap, and brooms, to the value of $60,000. The colony is named after the late Oscar Craig, of Rochester, who, with William P. Letchworth, of Buffalo, purchased the two-thousand-acre tract of land on which it is situated from the Shaker colony at Sonyea and presented it to the State, Dr. Peterson devoting several months of each year for nine years to getting the institution into working order. The first patients were housed in the old Shaker buildings, which were well constructed and fairly well arranged for the purpose, but as additional applications for admission have been made new buildings have been erected. To-day there are eighty buildings in the colony, but a thousand patients are waiting for admission, eight hundred of whom are in New York City.
Epilepsy, the “falling sickness,” is a most difficult malady to treat even in an institution for that purpose, and it is impossible to treat it anywhere else. An epileptic in a family is an almost intolerable burden to its other members, as well as to himself. The temperamental effect of the disease takes the form in the patient of making frequent and unjust complaints, and epileptics invariably charge some one with having injured them while they have been unconscious during an attack. Then, too, living at home, they are often dangerous to younger members of a family, and they are fault-finding, exacting, and irritable generally. The seizures frequently come on without warning, and the patient drops where he stands, often injuring himself severely. The last annual report of the Craig Colony records more than four hundred injuries within the year to patients during seizures which required a surgeon’s attention, the injuries varying from severe bruises to fractures of the skull.
The object of the Craig Colony is to remove the burden of the epileptic in the family from the home without subjecting the patient to the hardship of confinement with the insane. “Very few epileptics suffer permanent insanity in any form except dementia,” says the medical superintendent of the Colony. “Acute mania and maniac depressive insanity not infrequently appear as a ‘post-convulsive’ condition, that generally subsides within a few hours, or at most a few days. Rarely the state may persist a month. Melancholia is extremely infrequent. Delusions of persecution, hallucinations of sight or hearing, systematized in character, are almost never encountered in epilepsy.”
Only from six to fifteen per cent of epileptics are curable, and hence the work of the Craig Colony is largely palliative of the sufferings of the patients. Each individual case is studied with the utmost care, however, and patients are given their choice of available occupations. The Colony is not a custodial institution. There are no bars on the windows, no walls or high fences about the farm. The patients are housed in cottages, men and women in separate buildings some distance apart, about thirty to each cottage. In charge of each of these families are a man and his wife, who utilize the services of some of the patients in the performance of household work, while the others have their duties outside. Kindness to the unfortunates under their care is impressed upon every employee of the Colony, and an iron-bound rule forbids them to strike a patient even in case of assault.
Besides the agricultural work in the Craig Colony, and that in the soap and broom factories and the brick-yard, the patients are taught blacksmithing, carpentry, dressmaking, tailoring, painting, plumbing, shoemaking, laundrying, and sloyd work. It is insisted on that all patients physically capable shall find employment as a therapeutic measure. The records show that on Sundays and holidays and on rainy days, when there is a minimum of physical activity among the patients, their seizures double and sometimes treble in number. Few of the patients know how to perform any kind of labor when they enter the Colony, but many of them learn rapidly. It has been repeatedly demonstrated that boys from eighteen to twenty years of age can spend two years in the sloyd shop and leave it fully qualified as cabinet-makers, and capable of earning a journeyman’s wages.
There are about two hundred children in the colony of epileptics at Sonyea, more than half of whom are girls. As children subject to epileptic seizures are not received in the public schools of the State, the only opportunity for any education among these afflicted little ones whose parents are unable to teach them themselves or provide private tutors for them is in the schools of the Colony. Some of the children are comparatively bright scholars, while the attempt to teach others seems a hopeless task. For instance, it took one girl ninety days to learn to lay three sticks in the form of a letter A.
Every effort is made to encourage recreation among the patients in the Craig Colony, both children and adults. The men have a club of 250 members, with billiards, chess, checkers, cards, and magazines and newspapers. The boys have their baseball and football, and play match games among themselves or with visiting teams. The women and girls play croquet, tennis, and other outdoor games. There is a band composed of patients that gives a concert once a week, and there are theatricals and dancing, with occasional lectures by visiting celebrities. As the Colony, with the medical staff, nurses, and other employees, has a population of 2,000, there is always an audience for any visiting attraction. The maintenance of the Colony is costing the State $225,000 the present year.
Since the founding of the Craig Colony similar institutions have been established in Massachusetts, Texas, Michigan, Ohio, New Jersey, Pennsylvania, Illinois, and Kansas, and other States are preparing to follow their example. There are other private sanatoriums throughout the country similar to the one in Westchester County, where the nervous or neurasthenic patient who is well-to-do may obtain relaxation and supervision, but there is no place at all to-day where the man or woman suffering from curable nervous disorders who is without means can go for treatment.
(McClure’s Magazine)
Five illustrations: two wash drawings by André Castaigne showing mono-rail trains in the future, five half-tone reproductions of photographs of the car on its trial trip, and one pen-and-ink diagram of the gyroscopes.