THE STRAIN OF MODERN CIVILISATION 465 



as slowly used. Provocation and fatigue begin to operate ; the general 

 interest has time to flag ; and the crowd disperses as the epileptic, quite 

 accustomed to the experience, rises almost apologetically to his feet and 

 walks away. The constable resumes his measured step and the mews is at 

 peace again. 



I do not suggest that this parable is inclusive of the whole position ; far 

 from it. Direct contact with men and women, and a full use of the clinical 

 method, do, undoubtedly, reveal the effects of strain. 



These are not effects which can be measured by direct and exact 

 scientific method — though the ' vital statistics ' are confirmatory — but 

 effects the indirect evidence of which is inescapable. 



In the street the trained eye detects in the physiognomy of the people 

 the early stages of that concern which, in the consulting-room and in the 

 hospital ward, shows itself so frequently as the more established picture of 

 * Anxiety neurosis ' — unloading itself upon the digestion, the circulation 

 and other bodily functions, which are really more sinned against than 

 sinning. 



' Functional ' diseases, as against ' organic,' have increased, whether in 

 the field of the nervous system proper, the heart and blood vessels or the 

 internal secreting glands. 



I must not stay to expand, or even to justify, these statements ; few, if 

 any, medical men will contest them. In case after case a tactfully conducted 

 pursuit after fundamental causes removes the screen of headache, insomnia, 

 indigestion and fatigue, and the anxiety factor is revealed. 



In the sphere of microbic infections, as I have pointed out elsewhere, we 

 have new diseases for old. Preventive medicine has freed us from many 

 of the severer epidemics, as also from many fulminant sporadic infectious 

 diseases. Tuberculosis has come largely under control. But in place of 

 such plagues as these, there is an increase in the incidence of those more 

 subtle germ diseases which we call ' sub-infections,' in which the virulence 

 of the microbe is low, whilst the susceptibility of the host is high. In 

 many of these diseases the germ comes from within and not from without : 

 ' a man's foes ' are ' they of his own household.' In short, we are becoming 

 the victims of our own saprophytes. And the only reason we can assign 

 for all this is a ' give ' on the part of our own resistance to auto-infection — 

 a ' give ' which seems to follow a lowering of the control exercised in health 

 by the nervous system. 



Such control is, in a strict scientific sense, only a postulate ; it lacks 

 proof ; but is it likely that, with nerve control of so many other functions 

 proved, we shall find that the important function of immunity is an 

 exception ? 



So much for some of the effects of nerve strain. What of the causes ? 

 It is almost platitudinous to speak of the anxiety connected with the com- 

 petition of living, and now with the equally grave and increasing sense of 

 international insecurity ; of the pace at which we live ; of the precariousness 

 of life itself in the streets, so that we seem in these days to live by accident 

 rather than to die by it ; of the monotony and drabness inherent in many 

 workers' long hours of physical and mental effort ; of the lack of air and 

 of exercise and of sleep ; of the exciting nature of our amusements, whether 

 the immediate demand for them be normal relaxation or a dope ; of noise — 

 needless, stupid, provocative, ill-mannered, selfish noise. . . . 



Platitudinous, and yet, on reflection the major premise holds good in 

 respect of all these factors. 



I would like to add another, more subtle, but none the less recognisable : 

 the slackening of the moral code in the direction of increased freedom for 



