"A little knowledge is a dangerous thing" applies particularly in this matter. There are many morbid fears that disturb mankind and keep us from accomplishing what might otherwise be comparatively easy. A great many people become convinced that they have some diseased condition, or morbid elements at least, in them which make it impossible for them to do as much as other people. Sometimes this morbid persuasion takes the form of hypochrondia and the individuals feel that they have a constitution that unfits them for prolonged and strenuous effort of any kind, so they avoid it. The number of valetudinarians, that is of those who live their lives mainly engaged in caring for their health, though their physicians have never been able to find anything organically wrong with them, is much larger than might be imagined. This state of mind has been with us for many centuries, for the word which describes it, hypochondria, came to us originally from Greece and is an attempt to localize the affection in connection with its principal symptom, which is usually one of discomfort in the stomach region or to one side or the other of it, that is, in the hypochondria or beneath the ribs.

Such a state of mind, in which the patient is constantly complaining of one symptom or another, quite paralyzes the will. The individual may be able to do some routine work but he will not be able to have any initiative or energy for special developments of his occupation, and of course, when any real affection occurs, he will feel that he is quite unable to bear this additional burden of disease. Hypochondriacs, however, sometimes fairly enjoy their ill health and therefore have been known not infrequently to live on to a good, round old age, ever complaining more and more. It is their dread of disease that keeps them from getting better and prevents their wills from throwing off whatever symptoms there are and becoming perfectly well. Until something comes along and rouses their wills, there is no hope of affecting them favorably, and it is surprising how long the state may continue without any one ever having found any organic affection to justify all the discomforts of which they complain. Quite literally, they are suffering from complaints and not from disease in the ordinary sense of the word.

Sometimes these dreads of disease are dependent on some word which has taken on an exaggerated significance in people's minds. A word that in recent years has been the source of a great deal of unfavorable suggestion is "catarrh", and a mistaken notion of its meaning has been productive of a serious hampering of their will to be well in a number of persons. In itself, both according to its derivation and its accepted scientific significance, the word means only that first stage of inflammatory irritation of mucous membranes which causes secretion to flow more freely than normally. Catarrhein in Greek means only to flow down.²

By abuse, however, the word catarrh has come to mean in the minds of a great many people in our time a very serious inflammation of the mucous membranes, almost inevitably progressive and very often resulting in fetid diseased conditions of internal or external mucous membranes, very unpleasant for the patient and his friends and the source of serious complications and sequelae. This idea has been fostered sedulously by the advertisers of proprietary remedies and the ingenious exploiters of various modes of treatment. As a result, a great many people who for one reason or another—usually because of some slight increase of secretion in the nose and throat—become convinced they have catarrh begin to feel that they cannot be expected to have as much resistive vitality as others, since they are the subjects of this serious progressive disease. As a matter of fact, very few people in America, especially those living in the northern or eastern States, are without some tendency to mild chronic catarrh. The violent changes of temperature and the damp, dark days predispose to it; but it produces very few symptoms except in certain particularly sensitive individuals whose minds become centered on slight discomforts in the throat and nose and who feel that they must represent some serious and probably progressive condition.

As a matter of fact, catarrh has almost nothing of the significance attributed to it so often in magazine and newspaper advertisements. Simple catarrh decreases without producing any serious result, and indeed it is an index of a purely catarrhal condition that there is a complete return to normal. Sometimes microbes are associated with its causation, but when this is so, they are bacteria of mild pathological virulence that do not produce deep changes. As for catarrh developing fetid, foul-smelling discharges or odors, that is out of the question. There are certain affections, notably diphtheria, that may produce such serious changes in the mucous membranes that there will always even long after complete recovery be an unpleasant odorous condition, but it is probable that even in these cases there exists a special form of microbe quite rare in occurrence which produces the state known as ozena.

As to catarrh spreading from the nose and throat to the other mucous membranes, that is also quite out of the question if it is supposed to occur in the way that the advertising specialist likes to announce. Catarrhal conditions may occur in the stomach, but like those of the nose and throat they are not serious, heal completely, and produce no definite changes. A pinch of snuff may cause a catarrhal condition of the nose, that is an increase of secretion due to hyperaemia of the mucous membrane; the eating of condiments, of Worcestershire sauce, peppers, and horse-radish may cause it in the stomach. It may be due to microbic action or to irritant or decomposing food, but it is not a part of a serious, wide-spreading pathological condition that will finally make the patient miserable. It is surprising, however, how many people say with an air of finality that they have catarrh, as if it should be perfectly clear that as a result they cannot be expected at any time to be in sufficiently good health to be called on for any special work, and of course if any affection should attack them, their natural immunity to disease has been so lowered by this chronic affection, of which they are the victims, that no strong resistance could be expected from them.

All this is merely a dread induced by paying too much attention to medical advertisements. It is better not to know as much as some people know, or think they know about themselves, than to know so many things that are not so. Their dreads seriously impair their power to work and leave them ill disposed to resist affections of any kind that may attack them. It is a sad confession to make, but not a little of the enforced study of physiology in our schools has become the source of a series of dreads and solicitudes rather than of helpful knowledge. We have as a result a generation who know a little about their internal economy, but only enough to make them worry about it and not quite enough to make them understand how thoroughly capable our organisms are of caring for themselves successfully and with resultant good health, if we will only refrain from putting brakes on their energies and disturbing their functions by our worries and anxieties.

Another such word as catarrh in its unfavorable suggestiveness in recent years has been auto-intoxication. It is a mouth-filling word, and therefore very probably it has occupied the minds of the better educated classes. Usually the form of auto-intoxication that is most spoken of is intestinal auto-intoxication, and this combination has for many people a very satisfying polysyllabic length that makes it of special significance. Its meaning is taken to be that whenever the contents of the intestines are delayed more than twenty hours or perhaps a little longer, or whenever certain irritant materials find their way into the intestinal tract, there is an absorption of toxic matter which produces a series of constitutional symptoms. These include such vague symptomatic conditions as sleepiness, torpor after meals, an uncomfortable sense of fullness—though when we were young we rather liked to have that feeling of fullness—and sometimes a feeling of heat in the skin with other sensations of discomfort in various parts of the body. At times there is headache, but this is rather rare; lassitude and a feeling of inability to do things is looked upon as almost characteristic of the condition. Usually there are nervous symptoms of one kind or another associated with the other complaints and there may be distinctly hysterical or psycho-neurotic manifestations.

Auto-intoxication as just described has become a sort of fetish for a great many people who bow down and worship at its shrine and give some of the best of their energies and not a little of their time to meditation before it. As a matter of fact, in the last few years it has come to be recognized that auto-intoxication is a much abused word employed very often when there are serious organic conditions in existence elsewhere in the body and still more frequently when the symptoms are due merely to functional nervous troubles. These are usually consequent upon a sedentary life, lack of fresh air and exercise, insufficient attention to the diet in the direction of taking simple and coarse food, and generally passing disturbances that can be rather readily catalogued under much simpler affections than a supposed absorption of toxic materials from the intestines. Reflexes from the intestinal tract, emphasized by worries about the condition, are much more responsible for the feelings complained of—which are often not in any sense symptoms—than any physical factors present.

As Doctor Walter C. Alvarez said in a paper on the "Origin of the So-called Auto-intoxicational Symptoms" published from the George Williams Hooper Foundation for Medical Research of the University of California Medical School,³ as the conclusion of his investigation of the subject:

"Auto-intoxication is commonly diagnosed when a physical examination would show other more definite causes for the symptoms. Those who believe that intestinal stasis can account for a long list of disease conditions have little proof to offer for their views. Many of the assumptions on which they rest their case have proved to be wrong.

"The usual symptoms of the constipated disappear so promptly after a bowel movement that they cannot be due to absorbed toxins. They must be produced mechanically by distension and irritation of the colon. They occur in nervous, sensitive people. It has been shown that various activities of the digestive tract can profoundly affect the sensorium and the vasomotor nerves. The old ideas of insidious poisoning led to the formation of hypochrondriacs; the new explanation helps to cure many of them."

There are many other terms in common use that have unfortunate suggestions and make people feel, if they once get the habit of applying them to themselves, that they are the subject of rather serious illness. I suppose that one of the most used and most abused of these is uric acid and the uric acid diathesis. Scientific physicians have nearly given up these terms, but a great many people are still intent on making themselves miserable. All sorts of symptoms usually due to insufficient exercise and air, inadequate diversion of mind and lack of interests are attributed to these conditions. Some time or other a physician or perhaps some one who is supposed to be a friend suggested them and they continue to hamper the will to be well by baseless worries founded on false notions for years afterwards. What is needed is a definite effort of the will to throw off these nightmares of disease that are so disturbing and live without them.

It is surprising how much vital energy may be wasted in connection with such dreads. Unfortunately, too, medicines of various kinds are taken to relieve the symptoms connected with them and the medicine does ever so much more harm than good. Oliver Wendell Holmes declared a generation ago that if all the medicines that had ever been taken by mankind were thrown into the sea it would be much better for mankind and much worse for the fishes. The expression still has a great truth in it, especially as regards that habit of self-drugging so common among the American people. In the course of lecture engagements, I stay with very intelligent friends on a good many occasions each year, and it is surprising how many of them have medicine bottles around, indicating that they are subject to dreads of various kinds with regard to themselves for which they feel medicine should be taken. These dreads unfortunately often serve to lessen resistive vitality to real affections when they occur and therefore become a source of real danger.

All these various dreads, then, have the definite effect of lessening the power of the will to enable people to do their work and remain well. They represent serious brakes upon the flow of nerve impulses from the spiritual side of man's nature to the physical. This is much more serious in its results than would usually be thought; and one of the things that a physician has to find out from a great many patients is what sources of dread they are laboring under so as to neutralize them or at least correct them as far as possible. It is surprising how much good can be accomplished by a deliberate quest after dreads and the direct discussion of them, for they are always much less significant when brought out of the purlieus of the mind directly into the open. Many a neurotic patient, particularly, will not be improved until his dreads are relieved. This form of psycho-analysis rather than the search for sex insults, as they are called, or sexual incidents of early life, is the hopeful phase of modern psychological contribution to therapeutics.