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The present series, entitled ‘“‘ Smithsonian Miscellaneous Col- lections,” is intended to embrace all the publications issued di- rectly by the Smithsonian Institution in octavo form; those in quarto constituting the “Smithsonian Contributions to Knowl- edge.” The quarto series includes memoirs, embracing the records of extended original investigations and researches, re- sulting in what are believed to be new truths, and constituting positive additions to the sum of human knowledge. The octavo series is designed to contain reports on the present state of our knowledge of particular branches of science ; instructions for collecting and digesting facts and materials for research ; lists and synopses of species of the organic and inorganic world ; mu- seum catalogues ; reports of explorations ; aids to bibliographical investigations, etc., generally prepared at the express request of the Institution, and at its expense.

In the Smithsonian Contributions to Knowledge, as well as in the present series, each article is separately paged and indexed, and the actual date of its publication is that given on its special title-page, and not that of the volume in which it is placed. In many cases works have been published and largely distributed, years before their combination into volumes.

S. P. LANGLEY Secretary S. I


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The following slip has been prepared for insertion in library catalogues :

Smithsonian Institution.

Smithsonian Miscellaneous Collections. Vol- ume xxxiv. Washington city, published by the Smithsonian Institution, 1893. 8v°. [1084

pp. ] (Number 849). Contents : The Toner lectures : lecture ix, mental overwork and premature disease among public and professional men. By Charles K. Mills, M. D. Washington, 1885. Transactions of the Anthropological Society of Wash- ——— ington, vol. iii. Washington, 1885. Index to the literature of columbium : 1801-1887. By Frank W. Traphagen, Ph. D. Washington, 1888. Rese pbRon tp oy of astronomy, for the year 1887, By William C. Winlock. Washington, 1888. Bibliography of chemistry, for the year 1887. By H. Carrington Bolton. Washington, 1888. The ‘Toner lectures: lecture x, a clinical study of the skull. By Harrison Allen, M. D. Washington, 1890. Index to the literature of thermodynamics. By Aifred Tuckerman, Ph.D. Washington, 189go. The correction of sextants, for errors of eccentricity and graduation. By J.A. Rogers. Washington, 1890. Bibliography of the Chemical influence of light. By Alfred Tuckerman, Ph. D. Washington, 1891. oe mechanics of the earth’s atmosphere. A collec- ~ tion of translations. By Cleveland Abbe. Wash- ington, I8gI.

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ARTICLE aye Articte III. ArticteE IY.


Articte VI.

Articte VIL.

ArricLe VIII.

ArtictE IX.


(594.) Tue Toner Lectures. Lecture IX. Mevy- TAL OvER-woRK AND PREMATURE DISEASE AMONG Pusuic AND ProressionaL Men. By Cuartss K. Mitts, M. D. January. 1885. Pp. 34.

(630.) TRANSACTIONS OF THE ANTHROPOLOGICAL So- ciETY OF WasHINGTON. VotuMEIII. Novremser, 6, 1883-May 19, 1885. 1886. Pp. 226.

(663.) InpEx to THE LitrraTuRE oF CoLUMBIUM, 1801-1887. By Frank W. Trapuacen, Pa. D. 1888. Pp. 27.

(664.) BrpiiogkapHy oF ASTRONOMY, FOR THE YEAR 1887. By Wiru1am C. Wintock. 1888. Pp. 63.

(665.) A BrpiioGRaPpHy OF CHEMISTRY, FOR THE YEAR 1887. By H. Carrineron Boiron. 1888. Pp. £3:

(708.) THe Toner Lectures. Lecture X. A Crin- ICAL STupY OF THE SKuLL. By Harrison ALLEN, MO DS Marcu, 1890). Bp:79.

(741.) InpEx To THE LirERATURE OF THERMODYNAMICS. By Aurrep Tuckrrman, Px. D. 1890. Pp. 2438.

(764.) THE CorrECTION OF SEXTANTS FOR ERRORS OF Eccentriciry and Grapuation. By Josrpn A. Rocers. 1890. Pp. 33. :

(785.) Bre~ioGRAPHy OF THE CHEMICAL INFLUENCE OF Lieut. By Atrrep Tuckerman, Px. D. 1891. Ppa22:

Article X. (843.) Tar Mecuanics or THE Earru’s ATMOSPHERE.

A CotxecTion oF TRANSLATIONS. By CLEVELAND AsBE. 1891. Pp. 324.


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Tue “Toner Lectures” have been instituted at Washington, D. C., by JoserH M. Toner, M. D., of this city, for the promotion of medical science. With this object the founder has placed in charge of a Board of Trustees, consisting of the Secretary of the Smithsonian Institution, the Surgeon-General of the United States Army, the Surgeon-General of the United States Navy, and the President of the Medical Society of the District of Columbia, a fund, “the interest of which is to be applied for memoirs or essavs relative to some branch of medical science, and containing some new truth fully established by experiment or observation.”

The publication of these Lectures has been undertaken by the Smithsonian Institution, as falling legitimately within its funda- mental purpose, “the increase and diffusion of knowledge among men.” ‘The series of “Toner Lectures,” published by the Institu- tion in pamphlet form, is as follows; and they are also included in

the “Smithsonian Miscellaneous Collections.”

I. “On the Structure of Cancerous Tumors and the mode in which adjacent parts are invaded.” By Dr. J.J. Woopwarp. De- livered March 28, 1873. Published November, 1873. 8vo., 42 pp.

II. “Dual Character of the Brain.” By Dr. C. E. Browny- SEquaRD. Delivered April 22,1874. Published January, 1877. 8vo., 23 pp.

Ill. “On Strain and Over-Action of the Heart.” By Dr. J. M. Da Costa. Delivered May 14, 1874. Published August, 1874. 8vo., 30 pp.

IV. “A Study of the Nature and Mechanism of Fever.” By Dr. H. C. Woop. Delivered January 20, 1875. Published Feb- ruary, 1875. 8vo., 47 pp.



V. “On the Surgical Complications and Sequels of the Continued Fevers.” By Dr. Witt1am W. Keren. Delivered February 17, 1876. Published March, 1877. 8vo., 70 pp.

VI. “Sub-cutaneous Surgery.” By Dr. Witttam Apams. De- livered September 15, 1876. Published April, 1877. 8vo., 17 pp.

VIL. “The Nature of Reparatory Inflammation in Arteries after Ligatures, Acupressure, and Torsion.” By Epwarp O. SHAKE- SPEARE. Delivered June 27,1878. Published March, 1879. 8vo., 70 pp. and 7 plates.

VIII. “Suggestions for the Sanitary Drainage of Washington City.” By Grorce E. Wartne, Jr. Delivered May 26, 1880. Published June, 1880. 8vo., 24 pp.

IX. “Mental Over-Work and Premature Disease among Public and Professional Men.” By Dr. Caarutes K. Mtuns. Delivered March 19, 1884. Published January, 1885. 8vo., 36 pp.

As it has been found quite impossible to supply gratuitously the large demand from medical men and others for these Lectures, (in addition to the liberal grant to the leading public Libraries and other Institutions in this and foreign countries,) the uniform price of 25 cents has been fixed for each, by which probably their more

equitable personal distribution is secured.


Secretary Smithsonian Institution.


WASHINGTON, January, 1885


Delivered March 19, 1884.


By CHarLes K. Mitts, M. D.

For my subject this evening I am indebted to the suggestion of the public-spirited founder of the “Toner Lectures,” who, during his long residence in Washington, having seen many striking in- stances of break-down among public and professional men, had been led to feel that a study of the causes and the earliest indications of over brain work in these walks of life might prove an interesting investigation, and assist in the development of some new facts.

Extreme mental activity, overstrain, and excitement must be re- garded as characteristics of American civilization. In this country every one feels that he is an important possibility in polities, law, medicine, theology, business, science, or literature, so that our very liberties and opportunities become sources of peril to health and life. From the cradle to the grave the American too often lives in an atmosphere of unnatural emulation, while, in other countries, the traditional usages and the more absolute divisions of society into grades and castes prevent so fierce a struggle among the many for high position.

Mr. Herbert Spencer, whom all admit to be entitled to consid- eration as a close observer of human nature, during his visit to this country, was everywhere struck with the number of faces he met which spoke in strong lines of the burdens that had to

i (1)


be borne. In every circle he saw the sufferers from nervous col- lapse, or heard of the victims of over-work. Mitchell, Beard, Jewell, and others have dwelt upon the same fact, and have shown that brain work and brain strain are, in this country, the not in- frequent cause of the downfall of health. .

That intellectual work per se does not injure health or shorten life may, I think, at once be admitted. The longevity of intel- lectual workers is a subject that has frequently claimed the atten- tion of statisticians, psychologists, and alienists. Madden! gives a series of tables showing the relative longevity of medical authors, philologists, authors on revealed and natural religion, and on law and jurisprudence, miscellaneous and novel writers, moral philoso- phers, dramatists, natural philosophers, poets, artists, and musical composers. The general average age at death for the whole list is 66 years.

Tuke’ has collected from various sources the ages at death of fifty-four men who were distinguished for intellectual achievements. These ages gave an average of 80 years.

Caspar (quoted by Tuke) gives the average age of clergymen at 65; merchants, 62; clerks and farmers, 61 each; military men, 59; lawyers, 58; artists, 57; medical men, 56.

Beard? ascertained the longevity of five hundred of the greatest men of history—poets, philosophers, authors, scientists, lawyers, statesmen, generals, physicians, inventors, musicians, actors, orators, and philanthropists. His list was prepared impartially, and in- cluded those who, like Byron, Raphael, Pascal, Mozart, Keats, ete., died young. The average age was found to be 64.20 years. Sher- wood (quoted by Beard) ascertained at great labor the ages at death

of ten thousand clergymen, the average being 64 years. The average

1Infirmities of Genius. * Illustrations of the Influence of the Mind upon the Body in Health and Disease. By Daniel Hack Tuke, M. D., ete. Second Edition. 1884.

$A Practical Treatise on Nervous Exhaustion (Neurasthenia). By George M. Beard, A. M., M. D. Second and Revised Edition. 1880.




age at death of all classes of those who live over twenty is about 50 years.

Statistics of this kind, which could be multiplied without limit, are decisive as to the beneficial rather than injurious effects of pure mental labor, conducted upon a proper basis, upon longevity. In our public and professional classes, nevertheless, every physician of experience has seen instances of premature break-down from causes peculiar to these largely intellectual vocations. Even if the in- stances were few, as claimed by some, their discussion would still be of interest, because any sources of peril to those in the front ranks of society must always demand earnest attention.

In all I have collected a series of sixty cases in which loss of health or life has been largely attributable to excessive brain work and brain strain incident to the callings of those considered. ‘These cases may be arranged into two classes: (1,) Men in political and official life, including cabinet officers, senators, representatives, de- partment officials, governors, and candidates for office; (2,) Pro- fessional men, including physicians, lawyers, clergymen, journalists, scientists, and teachers. I have drawn not alone from my own experience, but have obtained the records of cases and corrobora- tive facts from professional friends.’ The inferences and conclusions of this paper are largely based upon a study of these cases, although time will permit details to be given in but a few instances.

With a subject go wide in scope, limitations must be set, in order to arrive at any practical conclusions in a single lecture. In the first place, then, will be considered some of the causes which lead to mental over-work and break-down in American publie and _ pro- fessional life; and, secondly, the early warnings of such over-work, and the forms of disease most likely to result.

Men engaged in commerce and speculation have not been in-

cluded in the present study, although, by including them, the list

1 Kspecial obligations are due to Drs. S. Weir Mitchell, W. A. Hammond J. M. Toner, A. Y. P. Garnett, D. L. Huntington,, J. H. Baxter, H. C. Yarrow, and J. T. Johnson.


of cases could have been largely increased. Premature failure of health, and especially sudden and severe collapse are quite as likely to occur in business life as in any other sphere of action, owing to the protracted labors, and great anxieties and excitements attendant upon pursuits involving the getting and losing of wealth. Brain work and brain strain of a peculiarly destructive kind attend upon the devotees of the counting-house and the exchange; but our pres- ent design is to deal only with those whose vocations are in major part intellectual, in the higher meaning which is given to the word inteilectual—the men of affairs, of books, and of the laboratory.

The actual occupations embraced within my study were cabinet officer, 1; senators, 8; representatives in Congress, 10; department officials, 5; governors, 2; candidates for important offices, 2; phy- sicians, 6; lawyers, 7; clergymen, 2; journalists, 4; scientists, 6 ; teachers, 7.

Twenty-eight of the sixty, therefore, were men in political and official life, and eighteen of these were members of Congress.

The average longevity of men in the higher walks of political life in this country is, I am inclined to believe, considerably below the average of those who occupy similar positions in England. Comparing, so far as information was available, the ages at death of United States Congressmen and members of the English Parlia- ment, who have died since 1860, I obtained the following results :’

Fifty-nine United States Senators gave an average of 61 years ; one hundred and forty-six United States Representatives an aver- age of 55 years; the average for both being, therefore, 58 years. One hundred and twenty-one members of Parliament gave the re- markable average age at death of 68 years.

Taking twenty-five of those that might be regarded as the most

eminent American statesmen of the last one hundred years and

1The sources of information for these statistics were chiefly, as follows: Lanman’s Biographical Annals of the United States Civil Government; Ben Perley Poore’s Registry of the United States Government; the Congres- sional Directories; Foster’s Collectanea Genealogica; the British Almanac and Companion; and the Statesman’s Year Book.


comparing their ages at death with those of the same number of the most distinguished English statesmen, the United States gave an average of 69 years, and Great Britain of 70—no practical dif- ference. It is noticeable, however, that much of the best work of the great English statesmen—of Palmerston, Derby, and Beacons- field, for instance—has been done at an advanced age, when most of our American public men have ceased to do anything important.

A little searching will show, in the first place, some general causes for these differences. While politics in America may, in the spoils- man’s sense, be regarded by many as a business, it is not, as in England, a true vocation followed in the main by those prepared by inheritance, education, and training.

In England we not infrequently see men entering on public careers, usually by a seat in the House of Commons, shortly after attaining their majority, or, at least, at a comparatively early age. Pitt, the elder, for instance, came into Parliament at 27, Pitt, the younger, at 21, Palmerston and Gladstone at 23, and Disraeli, after several attempts, at 32. They come, however, at these early ages to Parliament, usually well-endowed mentally, and as to a training school for their life work. By a gradual process they become ac- customed to their duties and their labors, and their responsibilities in- crease with their years and mental strength. Great responsibilities are not, as a rule, entrusted to them until their powers are matured. In the few instances in which English statesmen have assumed the highest positions early in life, as in the cases, for example, of the younger Pitt, and of Fox, they have usually paid the penalty of pre- mature death. An American, because of constitutional restrictions, cannot reach the lower house of Congress until twenty-five years old, and the Senate until thirty. This ought to be to our advantage, but there are many counterbalancing drawbacks. Many Americans who enter the public arena comparatively young have made and finished their public careers at an age when the British statesman is beginning to reap his reward.

Others come to high political and official position at or after the


meridian of life, and find themselves confronted with brain work, and with duties and responsibilities to which they are unequal, be- cause for them they have had no preparation at all.

The occupations of the members of the Forty-Eighth Congress, as given by the Congressional Directory, were as follows: Lawyers, 197 ; manufacturers, 24; journalists, 22; farmers or planters, 19 ; merchants, 16; bankers, 11; physicians, 6; mining capitalists, 5; mining engineers, 3; railroad managers, 3; clergymen, 2; army officers, 2; stenographers, 2; architect, 1; pharmacist, 1; railroad ticket agent, 1; hatter, 1; zoologist, 1; and unclassified, 8.

The legal profession furnishes by far the largest number of Sen- ators and Representatives, and of others holding public places; and among these are to be found our brightest political luminaries. Even legal studies, however, do not necessarily fit men for public position ; in special instances, they rather unfit them. It must be borne in mind also that the term “lawyer,” as applied to those in political station, is often a mere fiction, those holding it often being men half-trained, or not trained at all, who have assumed the legal role by the easy methods which prevail throughout our land. <A lawyer or editor, a banker or merchant, a farmer or planter, a manu- facturer or railway magnate, a physician or preacher, finds himself in Congressional halls by virtue of wealth, or local fame, or fortuit- ous circumstances, and absolutely without any appreciation of or fitness for the labors and responsibilities of his new calling. Am- bition, self-esteem, and the instinct for praise impel him to strenuous exertion to compensate for his deficiencies, an effort which leaves him sometimes a mental and physical wreck.

Whether they have entered public life in youth or middle age, and whether prepared or not, mental overwork is particularly dan- gerous to men beyond the prime of life. Of the sixty cases, break- down occurred between twenty-five and thirty years in 2 cases; between thirty and forty in 14 cases; between forty and fifty in 18 cases; between fifty and sixty in 17 cases; between sixty and seventy in 9 cases.


Thirteen of the seventeen cases between fifty and sixty, and eight of the nine cases between sixty and seventy, were in political or official life. It is premature decay for the man who should live to eighty or ninety to die at seventy, or for one who should die at seventy to pass away at fifty-five or sixty. It is a question of po- tential longevity. In the cases before us, sudden or unusual brain work or strain terminated the careers of those destined apparently to live from five to twenty years longer.

Vice-President Wilson died prematurely at sixty-three, without doubt the victim of extreme over-work. The death of a distin- guished Senator at the same age was precipitated by overwork both inside and outside of the Senate,and by worry and excitement grow- ing out of the opposition and censure of the Legislature of the State which he represented. A Representative in Congress, and one high in judicial position, subjected to special causes of work and worry, died at sixty-five of cerebral hemorrhage. Another Rep- resentative, overwhelmed with labors and anxieties of a peculiarly harassing character, contracted diabetes, of which he eventually died between sixty and seventy.

Men may live for many years in comparative comfort, and able to do a reasonable amount of work, with organic disease of the kidneys, liver, heart, or other organs, as long as they are not sub- jected to any unusual physical or mental strain. One of America’s most distinguished physicians died a few years ago at the age of eighty-two, and was found after death to have advanced disease of the kidneys which had not been suspected; but the last twenty years of his life were free from strain.

The history of many old hemiplegies is confirmative of this point. At the Philadelphia Hospital, I usually have under observation a score or more of hemiplegies, the victims of thrombosis, embolism, or hemorrhage. These cases, some advanced in years, with brittle, atheromatous vessels, and (as numerous autopsies show) with disease in almost every organ of the body, live on year after year without


change, because their absolute pauperism has its compensation in that they are no longer subjected to the strain and friction of life.

The contrast to such cases is found in the histories of some of those who form the subject of the present study.

One died at the age of sixty-six, holding a position of high rank and responsibility at the time of his death. He was of good hered- ity and physique, and had been thoroughly educated. In early life his habits of eating and drinking had been irregular, and at one period he suffered from gouty symptoms. For fifteen or twenty years before his death, however, he had been careful and systematic in his habits, mental and physical, and enjoyed fair health, when suddenly he was subjected to unusual labor and anxiety, because of a great public catastrophe. He could not escape the suddenly- imposed strain. His health failed rapidly in a few months, and he died of Bright’s disease.

Another, also in high official position, died at fifty-eight He also was of good heredity, used alcohol moderately, and tobacco freely. Mentally he had been through life a fair but not unusual worker. Twenty-seven years before his decease he had suffered severely from scurvy. After this he was not sick until his fatal illness. Mental work, and cares and anxieties, to which he was unaccustomed, crowded upon him during the last three years of his life. Worn out, he took a sudden cold, was attacked with a local inflammatory trouble, and died.

Some of those who have been lifted from the ordinary walks of life into high official position by appointment, find themselves entirely unfitted for the tasks before them, and yet from these tasks they are unable to escape. If too old, or without sufficient fundamental education to learn, and if unable to do their work by proxy, failure in health, as well as in reputation, is sometimes the result. In England, so severe are some of the competitive examinations for positions in the public service that many are injured in health by the strain which they undergo in prepar- ing for these examinations. With us, it is often the other way;


the strain and pressure come afterward. The positions acquired solely by favor are themselves the hard examiners. In one case, reported to me by a Washington physician, temporary glycosuria was developed in a man fifty-nine years old, largely as the result of anxiety induced by the fact that he was mentally unfit to make the annual report called for by his high position.

If ambitious and conscientious, the real mental labor connected with the position of a man high in public position is often very great. Pressing and perplexing committee work, attention to a large correspondence, the preparation of reports, bills, speeches, and points for debate, make incessant demands upon the time and strength of the Senator or Representative. A well-educated lawyer, coming to Congress at thirty-four, rapidly rose to promi- nence. He did a prodigious amount of work on the floor of the House of Representatives, and by correspondence, but especially on committees. He was taken seriously ill at the close of a session during which his labors had been unusually great even for him, because of the excessive extra work thrown on him by the sickness of another member of one of the important committees on which he was serving. He died at the beginning of the next session of Con- gress. Another reached the speakership of the House of Repre- sentatives, only to succumb at forty-nine to the brain work and multifarious cares of his high position. An abstemious New Eng- land Senator, an indefatigable worker, after suffering for long time from dyspepsia, and from insomnia and other nervous symptoms, was suddenly taken down with enteritis, of which he died.

A special cause of sudden failure in health among public men is the mental over-work, physical fatigue, and excessive emotional excitement attendant upon our political campaigns. In recent years a presidential aspirant was suddenly and seriously stricken during the meeting of the nominating convention. Horace Greeley died insane from brain disease at the conclusion of his unsuccessful campaign. A successful candidate for a high public position de-


veloped pneumonia after a campaign of toil and excitement. Simi- lar instances could be given were it worth while.

Although perhaps not as important a factor in the causation of disease in political as in commercial life, the emotional element plays a large part. It is, as has just been shown, often a life of clamor and excitement. It is one too often of uncertainty, disap- pointment, and yain longing. Even to the man who is compara- tively well fitted for his work, the political vocation in this country is never assured. The new Representative, for instance, feels that it is imperative for him to speedily make a career. Others aspire to his place, which can only be held by hard work, and too often also by low arts. The faults and foibles of a public man are laid bare, his mistakes are magnified, and his best efforts are sometimes mis- interpreted by a thoughtless or merciless press. The tremendous sense of responsibility which important positions impose is a con- stant strain, particularly upon the higher orders of mind. This burden of responsibility, conjoined with Herculean labors, mental and physical, destroyed some of our greatest statesmen during the Civil War.

To such causes as these must be added the lack of recreation, and che excesses, excitements, and irregularities of social life at the National Capital, although it does not come within my purpose to consider either these, or the abuse of aleohol and tobacco, in the present paper.

Leaving the political and official circles, let us next glance at some of the conditions which lead to mental over-work and its con- sequences among the professional classes.

Defects in our system both of medical and legal education are at the root of failure in health, no less than of professional failure, in many cases. The physician or lawyer, half-educated and _half- trained in youth, and yet ambitious and naturally able, is com- pelled to put forth efforts doubly tasking and straining because his mind has not been systematically developed for his life-work.

Physicians ordinarily do not afford many illustrations of pre-


mature disease from mental overstrain and over-work. Some lose their health from broken rest, irregular meals, physical fatigue, and the continual incurrence of the responsibilities of life and death; but the variety in their lives, the alternation between in-door and out-door existence, and the knowledge of health and disease which they are able to apply for their own behoof, serve in some measure to counterbalance these injurious influences. The physicians who succumb to mental over-work are usually those who, not content with the ordinary labors and rewards of an arduous profession, strive, in addition, for literary, scientific, or professorial honors. In this country # is the rule, rather than the exception, to find the professorships and the subordinate teaching positions in our medical colleges filled by men actively engaged in practice. We have not here, as abroad, scientific physicians in well-endowed professor- ships, or comfortably quartered on the Government in positions, the routine duties of which can be performed by deputy. The young American physician who, without means, influence, or friends, sets out for the high places of his profession, has before him a prospect which only fails to appall, because it is veiled by his ambition. In- tellectual labor must be prolonged, encroaching upon intervals which should be given to rest or recreation; special appointments must be kept, no matter what the cost; the brain must be forced to constantly augmenting and multiplying tasks. Besides all this, he has, to a greater or less extent, the responsibility, the physical fatigue, and the irregularity in eating and sleeping, which belong to medical practice. Science and literature may be made instru- ments of health and happiness to the working physician ; but when turned to for the purposes of ambition by those already sufficiently taxed by practical work, great care must be taken, or they will assist in sowing the seeds of disease and death. Five of six physi- cians in my list were engaged both in teaching and in literary or scientific work, besides attending to private and hospital practice. In the case of two of them, valuable contributions, the result of much labor, appeared about the time their health gave way.


Many lawyers are among the cases collected from those in political and official life; but, in addition, three judges and four lawyers in active practice, and not in political careers, are included in my notes. The temporary but severe break-down of two judges was attributable to the habit long persisted in of examining papers, comparing authorities, and preparing opinions at night—a form of mental labor taxing to the highest powers. Successful lawyers are often subjected to sudden, prolonged, and severe mental work and strain. Cases must be prepared with great rapidity, important prin- ciples of law must be mastered in a short time, and exhausting efforts must be made in courts under conditions of excitement and bad hygiene. With lawyers, as with physicians, self-imposed tasks, in addition to their necessary labors, are sometimes the cause of their downfall in health. A young lawyer, with a decided taste for philo- sophical pursuits, wrote an able scientific monograph, and developed insanity directly as the result of continuous mental work, legal and scientific. Another succumbed while editing a legal work.

Before success is assured the mental effects of pecuniary pressure are often felt with great force and intensity by men in the profes- sions of medicine and law. Such men, waiting for business until reputation is acquired, and, in the meantime, often doing unre- quited work that calls for an immense output of mental energy, have both their intellectual and emotional natures under constant tension. Both work and worry do their parts.

In attributing impairment of health to worry rather than to work, it is sometimes forgotten that a man with an over-worked brain often worries about small matters which would otherwise be met with fortitude. Worry, in such cases, is begotten of over-work. “When,” says Blaikie," “a celebrated editor complained of being—

Over-worked, over-worried,

Over-Croker’d, over-Murray’d,

the first word of his lamentation explained all the rest.” Worry,

1 Maecmillan’s Magazine.



morcover, is in itself a form of brain work; to worry means to cerebrate intensely.

Two clergymen, both of whom were compelled to do severe mental work, and at the same time sustain grave responsibilities, were the only representatives of theology in my list of cases. Chance may not have thrown a fair proportion of mentally over- worked clergymen within my reach, but this small number is prob- ably not entirely accidental. Many clergymen suffer from the symptoms of a mild but annoying form of neurasthenia, but com- paratively few succumb completely to mental over-work. Their un- usual longevity is well known. Sherwood’s statistics have already been quoted. Their variety of toil, their comparative freedom from financial anxiety, their superior mental endowments, and their tem- perance and morality are the reasons assigned by Beard, and I believe correctly, for the greater longevity of clergymen than of other brain workers.

Of the four journalists, three were engaged upon the highest order of journalistic work. The work done by editors and leader- writers often calls for the severest intellectual effort under pressure. The writer of leading articles will probably average two or more columns daily. His matter must be interesting and forcible; facts must be rapidly obtained and marshalled; judgments on important topics must be formed instantaneously. Often the brain must be goaded to do work against the mental grain. The work must be done, and must be done on time; there is no putting off to a more convenient season. [iditors, moreover, often do their work under bad hygienic conditions—at night, in the glare and heat of gas, sometimes in badly ventilated rooms. One of my patients suffered so much from in- somnia, cervico-occipital pain, nervous dyspepsia, and other symp- toms, distinctly traceable to his work and mode of life, that he finally left journalism entirely. Two others were forced tempo- rarily to quit their labors.

Scientific work is, as a rule, conservative rather than destructive of health. The scientist, unlike the journalist, is not usually com-


pelled to do severe intellectual work under pressure for time. His danger, as noted in the six cases that have come under observation in the preparation of the present paper, is from sedentary habits, and from intense and prolonged activity of the mind in certain limited grooves. To some minds scientific work has a fascination which becomes a source of peril ; the worker becomes a willing slave to tasks which are often of his own making. The six cases were all men who labored beyond the requirements of the positions held by them. Assiduous work with the microscope, steady concentration upon mathematical and engineering problems, and the laborious collection and comparison of data, produced, after a time, states of mental and nervous hyperesthia and exhaustion, which led to albuminuria in one case, to insanity In two, and to temporary nery- ous collapse in three cases.

One of these cases, a man highly distinguished in the professional and scientifie world, devoted himself with rare enthusiasm to scien- tific work under Governmental auspices. His method was simply one of intense and incessant application by day and by night, Sunday and week-day. Warnings in the shape of insomnia, great irritability, mental and physical weariness, oxaluria, and marked loss of weight came and went unheeded. Melancholia de- veloped. Rest and travel twice restored him to mental health, but only to have the same history repeated, and to end with a third and complete mental collapse. Another, a young man who had educated himself scientifically, at the same time earning a living, frequently worked fourteen hours a day at tasks requiring close mental concentration. The tendency to over-work is greater among men who have, without the training of schools, raised themselves to honorable rank in science and literature than among those who have had the advantage of a systematic education.

The teachers that have fallen under my notice have been, with one exception (a college professor), principals of male grammar schools in Philadelphia. Five of them broke down completely from mental over-work, and the worry which went with and grew

nuk ve ee es




out of this over-work. These cases were observed a few years ago when the system of competitive examinations prevailed in its worst form in Philadelphia public schools. The Boys’ High School and Girls’ Normal School had accommodations only for a fixed number of pupils. Any school of a certain grade could send pupils to the examinations ; but those to be admitted were selected from the com- petitors absolutely in the order of the averages obtained. Twenty- five might be accepted from the grammar school of one section, and only five, or perhaps not one, from another school of an equal grade. Cramming was at the highest premium. A teacher’s repu- tation, and even his position sometimes, depended upon the success of his pupils at these examinations. Teachers and pupils both fre- quently gave way under the terrible mental pressure to which they were subjected. One grammar school principal, just before his last illness, sueceeded by extraordinary efforts in getting the highest general average of xny school in the city, and also had in his sue- cessful class the boy who attained the highest average among all who competed. These were dearly bought honors. It was no un- common thing for teacher and pupil to begin werk at seven o’clock in the morning, to invade the dinner hour, and to continue their labors until ten or later in the evening. Happily, a quota system has taken the place of the murderous method here outlined—a method to which, I trust, Philadelphia will never return.

Not long since, in some of our newspapers, was noted the case of a colored girl who was in attendance at the same school with white children, and who died from “brain fever” brought on by over- work, in her efforts to compete with her more favored schoolmates. Scores of children whose skins are fair, differ as widely from each other in capacity and helpful surroundings as she differed from those with whom she vainly endeavored to compete.

Our children are too largely in the hands of those educationalists to whom Clouston’ refers, who go on the theory that there is an un-

1 Clinical Lectures on Mental Diseases.


limited capacity in every individual brain for education to any ex- tent, in any direction, and that after you have strained the power of the mental medium to its utmost there is plenty of energy left for growth, nutrition, and reproduction, while nothing is more cer- tain than that every brain has at starting just a certain potentiality of education in any one direction and of power generally, and that it is far better not to exhaust that potentiality.

Children varying in age and original capacity, in previous prepa- ration and in home surroundings, are forced to the same molds and grooves. The slow must keep pace with the fleet, the frail with the sturdy, the children of toil and deprivation with the sons and daughters of wealth and luxury.

A child is always liable to suffer from mental over-work when the effort is made to force its education beyond its receptive powers. Edueation is not individualized enough. The mind of the child is often confused by a multitude of ill-assorted studies. Recreation is neglected and unhealthy emulation is too much cultivated. Some account has been given of the method in vogue at one time in Phila- delphia, and which some are unwise enough to wish to revive. In many communities, outside of Philadelphia, admissions to the vari- ous grades of public schools are regulated entirely by the averages obtained at examinations, instead of on the general record of the pupils in connection with proper, but not too severe, examinations. In consequence, often after the campaign of over-work and confu- sion, called an examination, we see children developing serious dis- turbances of health, or even organic disease—paroxysmal fever, loss of appetite, headache or neckache, disturbed sleep, temporary albuminuria, chorea, hysteria, and hystero-epilepsy.

Premature disease, even in the medical profession, sometimes has its origin in student days. Such education as medical students re- ceive is often obtained under the most trying circumstances. In some of our most celebrated medical schools many of the students are expected to attend lectures or do laboratory work for seven

hours in the day-time, and in addition to dissect in the evening.


When to this is superadded attendance upon private examining associations and text-book cramming, the only wonder is that so many survive. Young men finish with credit and honor their medical course not unfrequently only to become invalids or to pass to their graves in a few months, victims of the mental over-work and bad hygiene of the colleges where they sought instruction in health and healing.

The symptom-groups and diseases represented by the series of sixty cases may be summarized as follows: Acute neurasthenia, 18 cases ; insanity, 10; phthisis, 9; diabetes, 4; cerebral hemorrhage, 4; Bright’s disease, 3: posterior spinal sclerosis, 3; pneumonia, 3; bulbar paralysis, 1; angina pectoris, 1; erysipelas, 1; hepatitis, 1 ; enteritis, 1; glossitis, 1.