On Overwork and Premature Mental Decay: its Treatment
- Author:
PI. F. Kouth, M.D., M.R.C.P. London : Bailliere, Tindall,
& Cox, 1876.
Although some doubt the fact as to whether insanity is on the in- crease or not, there cannot be a question that the fierce struggle in the present day for distinction and pre-eminence among all classes, and the modern system of competitive examination for public appointments, have been fertile sources of brain-disease; and everyone must admit the truth of what Dr Routh has said on this vital subject in his valuable treatise on “Overwork.” He observes:?
” If one of our ancestors but of one hundred years ago were sud- denly resuscitated, and made to undergo the toil and mental labour of our days, he could not endure it. The life of an intellectual man who would keep on a level with his compeers of the present day would be equivalent to, at least, a dozen lives of a former age.
” In our own profession competition is carried to a fearful extent. Formerly a young man had’to pass through a very limited groove. Medical men were few and far between. Competitive examinations were unheard of. Examinations for degrees and diplomas required but a minimum of knowledge. It is within the memory of some of the profession even now, that a student might become a surgeon after one year’s study, and many others became general practitioners, before 1815, without any examination whatsoever. Places of trust in our hospitals were often family sinecures. India assistant-surgeoncies were reserved only for those who had friends in office. I well remember the time when two young men in a college, notorious only for their very unfrequent attendance on lectures and their anything but tem- perate habits, after three months’ cramming, passed the Royal College of Surgeons, were appointed Indian assistant-surgeons, and sent to minister to our brave troops in that Empire. But now how different the state of things ! A man mvst know his subjects to pass. Five years of study and hospital practice, at least, are required, and many appointments are open to honourable competition. The modern system of competitive examination is no doubt yn improvement on that ?of former days, when interest alone determined tlie election of a candi- date. Nevertheless, we think it could be clearly demonstrated that, in many instances, it not only fails to secure the best man for the public service, but that it frequently operates unjustly towards a rejected candidate. We once heard the head-master of one of our first colle- giate schools remark that his best boys?both mentally and morally? were not those who generally succeeded at competitive examinations. Is it not reasonable to infer that the system wants remodelling? ” Dr Kouth well describes the premonitory symptoms of premature mental decay from overwork. Pie observes :?
” Let us now consider what are the evidences of premature mental decay from overwork. They are, in fact, the general symptoms of exhausted nervous power?viz., general debility of the body, inability to walk even short distances without fatigue, general feeling of lan- guor, unwillingness to any active exertion ; great tendency to sweat, specially at night, but induced during the day by the slightest exertion; generally an unsteady gait. The heart’s action is weak, often irregular, accompanied with palpitation, and not unfrequently with symptoms of general indigestion.
” A change is gradually observed to come over the marts mind; nnd, generally, some peculiarity developes itself in the character, not previously noticeable in the affected person. It is not unusual in such oases to find an undue exaltation of some peculiar talent or property of the mind in a different direction, or one totally opposed to former hobbies; and what strikes one more than anything in these changes is the suddenness with which these hobbies spring up.
” A man may become intensely selfish and garrulous who was formerly generous and reticent. lie takes, without any apparent reason, likes and dislikes to those with whom he is associated, often his nearest relatives, whose motives he invariably misunderstands. He becomes subject to uncontrollable fits of moroseness or bad temper. A previously careful man becomes unusually liberal, even extravagant; a remarkably modest and prudent man puts off all reserve, and becomes intensely disagreeable in genteel society; a dull man becomes a poet; a deep, far-sighted politician will become a religious controversialist; a man who, perhaps, never turned a note of music correctly becomes a devotee to music. Sometimes the very morale of the mind is changed. For instance, there is an alternation in his manner of acting ?one moment intensely joyous and excited, now greatly depressed? one moment friendly, the next hostile. Sometimes obstinacy developes itself to an intense degree, and nothing will move his determination ; at another time he can be led as a child. Sometimes it is indecision of character, ori in his opinions, which forms the prominent symptom, often the more remarkable because occurring in one heretofore known to be ever ready and resolute. Frequently there is an utter inability to fix the attention on any one subject. In reading, the thread of the story or argument cannot be long followed. Again, sometimes not only is there an entire inability to arrange ideas in order, but the judgment is strangely perverted.”
Dr Kouth gives the following touching account of an interview he had with the late Dr Golding Bird?one of the victims of over- work?a few weeks before his death: ?
” I well remember a conversation I liad with the late Dr Golding Bird a feAV weeks before his death. He was then in the zenith of his popularity, and recognised by all as one of the ablest of our London physicians. I called upon him one morning with a relative to consult him. Several other medical men had preceded me. His rooms were full, and I had to wait three hours ere I could obtain admission into his study and consult about the case. I congratulated him on his success in practice. ‘Yes,’ he said to me, ‘ you are right; but I wish, nevertheless, to make your remark a text for a little parting advice. You see me, at little over forty, in full practice, my rooms full. I am making my several thousands per annum ‘?I think he said seven?’ and, if I die to-morrow, I do not leave as many hundreds to my family. All this I have done by sheer perseverance, increasing hard work, and no holiday. But I am to-day a wreck. I have fatal disease of the heart. I know I cannot live many months?the result of anxiety and hard work ; and my parting words of advice to you are these : Coute qui coute, and?nevermind at what loss?take your six weeks’ holiday. It may delay your success, but it will insure its development; otherwise you will find yourself at my age a prosperous- practitioner, but a dying old man.’ Six weeks after this conversation he had put off his earthly tabernacle.”
Dr Eouth’s views on the moral and physical treatment of the victims of overwork are very valuable ; but we cannot endorse all he says on the efficacy of phosphorus, though we are quite in accord with him as to the value of a fish-diet in these cases. Dr Winn published an article in the British Medical Journal, September 28, 1872, entitled ” Training for the Tripos,” in which he advocates the utility of a fish- diet. Dr Winn observed :?
” There is a common saying that fish feeds the brain, which may depend on the phosphorus it contains. Certainly, there can be no doubt that some sorts of fish, such as soles, whiting, plaice, &c., are peculiarly suitable to a weak digestion.”
Dr Eouth’s book is very instructive and well worthy of perusal.
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