Part 9 (1/2)

CHAPTER X

HISTORIES OF SOME SEVERE CASES

The cases that follow represent mainly the severe types of nervousness in the housewife. To every case that comes to the neurologist there are a hundred that explain their symptoms as ”stomach trouble”, ”backache”, etc., who remain well enough to carry on, and who think their pains and aches inevitably wrapped with the lot of woman.

It will be seen, upon reading these cases, that a rather pessimistic att.i.tude is taken toward some of them. It would be nice to present a series of cases all of which recovered, and it would be easy to do that by picking the cases. Such a series would be optimistic in its trend; it would however have the small demerit of being false to life. Though the majority of women suffering from nervousness may be relieved or cured, a number cannot be essentially benefited. Some of them have temperaments utterly incompatible with matrimony, others have husbands of the incorrigible type, others have life situations to change which would make it necessary to change society. Therefore in these cases all a doctor can do is to _relieve symptoms_, relieve some of the distress and rest content with that.

I am essentially neither pessimist nor optimist in the presentation of these cases, nor do I seek to present the man or woman's case with prejudice. In life a realistic att.i.tude is the best, for if we were to remove much of the sentimental self-deception at present so prevalent, huge reforms would occur almost overnight. Sentimentality decorates and disguises all kinds of horridness and makes us feel kindly toward evil.

Strip it away, and we would immediately break down the evil.

There is always this danger in presenting ”cases” to a lay public, that symptoms are suggested to a great many people. How deeply suggestible the ma.s.s of people can be is only appreciated when one sees the result of public health lectures and books. Many persons tend to develop all the symptoms they hear of, from pains and aches to mental failure. Even in the medical schools this is so, and every medical teacher is consulted each year by students who feel sure they have the diseases he has described.

So in presenting the following cases symptoms will be largely omitted.

What will be presented is history and to a certain extent treatment.

That part of treatment which is strictly medical can only be indicated.

It may be said that in obtaining the intimate history of a woman a difficulty is met with in the natural reluctance to telling what often seems to the patient painful and unnecessary details. To some people it seems inconceivable that fears, pains and aches, sleeplessness, etc., can arise out of difficulties like the monotony of housework, temperament, or troubles with the husband. Furthermore, though some women understand well enough the source of their conflicts, they are ashamed to tell and rest mainly on the surface of their symptoms. To obtain the truth it is necessary to see the patient over and over again, to get somewhat closer to her. This is especially easy to do after the physician has to a certain extent relieved the patient. In other words, except in the cases where the woman is quite prepared to tell of her intimate difficulties, it is best to go slowly from the medical to the social-psychological point of view.

Case I. The overworked, under-rested type of housewife.

Mrs. A.J., thirty years old, is a woman of American birth and ancestry.

Her parents were poor, her father being a mechanic in a factory town of Ma.s.sachusetts. She had several brothers and sisters, all of whom reached maturity and most of whom married.

Before marriage she was a salesgirl in a department store, worked fairly hard for rather small pay, but was strong, jolly, liked dancing and amus.e.m.e.nts, liked men and had her girl friends.

At the age of twenty-two she married a mechanic of twenty-four, a good, sober, steady man, devoted to her and very domestic. Unfortunately he was not very well for some time following a pneumonia in the third year of their marriage. They drew upon all their savings and fell seriously in debt. This meant borrowing and scrimping for several years,--a fact which had great bearing on the wife's illness later.

They had three children, born the twelfth month, the third year, and the fourth year after marriage. After the first child the mother was very well, nursed the baby successfully, and the little family flourished. Then came the unfortunate illness of the husband, which threw him out of work for six months, during which time they lived on an allowance from his union, his savings, and finally ran into debt. This greatly grieved the man and depressed the woman, but both bore up well under it until the birth of the second child, when their circ.u.mstances forced them to move to a poorer apartment. The wife was delivered by a dispensary physician, who did his duty well but allowed the woman, who protested she felt well, to get up and care for her husband and baby much earlier than she should have done.

The nursing of this baby was more difficult. The mother's b.r.e.a.s.t.s did not seem to be nearly as active as in the previous case. The baby cried a great deal and needed attention a good part of the night. The husband was unable to help as he had previously done and the fatigue of the care of child and man brought a condition where the woman was tired all the time. Still she bore up well, though when the summer came she greatly missed the little two weeks' vacation that she and her husband had yearly taken together from the days of their courts.h.i.+p.

The husband recovered, but his strength came back very slowly. He went to work as soon as possible but worked only part time for six months. At night he came home utterly exhausted and could not help his wife at all.

During the next year both children were sick, first with scarlet fever and then with whooping cough. The mother did most of the nursing, though by this time the father was able to help and did. The necessary expenses so depleted the family treasury that when the summer came neither could afford to go away.

Both noticed that the mother was getting more irritable than was natural to her. She went out very seldom and her youthful good looks had largely been replaced by a sharp-featured anxiety. Though she carried on faithfully she had to rest frequently and at night tossed restlessly, though greatly fatigued.

She became pregnant again, much to her dismay and to the great regret of her husband. At times she thought of abortion, but only in a desperate way. The last few months of her term were in the very hot months of the year and she was very uncomfortable. However, she was delivered safely, got up in a week to help in the care of her other two children and to get the house into shape again. Her milk was fairly plentiful, despite her fatigue and ”jumpy nerves.” Unfortunately at this time, when they had acc.u.mulated a little surplus and she was looking forward to better clothes for her family and more comforts, the plant at which her husband was employed suspended operations because of some ”high finance” mix-up. Coming at this time, the news struck terror into her heart; she broke down, became ”hysterical” _i.e._ had an emotional outburst. This pa.s.sed away, but now she was sleepless, had no appet.i.te, complained of headache and great fatigue.

Though she was a.s.sured that the plant would reopen soon (in fact it soon did), she made little progress. That she was suffering from a psychoneurosis was evident; what remained was to bring about treatment.

This was done by enlisting a development of recent days,--the Social Service agencies. Out of the old-time charity has come a fine successor, social service; out of the amateurish, self-consciously gracious and sweet Lady Bountiful has come the social worker. Unfortunately social service has not yet dropped the name ”Charity”, perhaps has not been able to do so, largely because the well-to-do from whom the money must come like to think of themselves as charitable, rather than as the beneficiaries of the social system giving to the unfortunates of that system.

Let me say one more word about social service and the social worker, though I feel that a volume of praise would be more fitting. The social worker has become an indispensable part of the hospital organization, an investigator to bring in facts, a social adjuster to bring about cure.

For a hospital to be without a social service department is to confess itself behind the times and inefficient.

Briefly, this is what was done for this family.

Their prejudices against social aid were removed by emphasizing that they were not recipients of charity. The husband was allowed to pay, or arrange to pay, for a six weeks' stay in the country for the mother and the new baby. The home for this purpose was found by the agency and was that of a kindly elderly couple who took the woman into their hearts as well as over their threshold. The social worker arranged with a nursing organization to send a worker to the man's house each day to clean up the home while the children stayed in a nursery. One way or another the husband and children were made comfortable, and the wife came back from her stay, made over, eager to get back to her work.