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.





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