Religion And Health

"This at all events is certain: if death is to end all alike for the righteous and for the unrighteous, for those who have been blessings and for those who have been curses to their kind, the Power which rules the universe cannot be just in any sense of the word which we can understand."

Doctor Carroll, in "The Mastery of Nervousness"[10 - Macmillan, New York, 1918.] has summed up the value of suffering as a revealer of power and a bracer of strength in words that are worth remembering. "None knows his real strength till he has faced failure and tasted the bitterness of defeat. Physical and mental suffering and soul pain come to all that endurance may be developed, for without this the strength which conquers can never be. The master man laughs in the face of personal hurts; offenses fail to offend, insults fail to embitter; he turns with shame from the so-called depths of suffering; for him honor and majesty of soul are found upon the heights of suffering." In a word the really brave man does not let himself sink under the burden of suffering but maintains his place and stands up firmly under it. Under these circumstances suffering, instead of being an evil, is a good. After the showing of mercy, man is likest to God when he stands suffering bravely and brings good out of evil even as Providence does.

CHAPTER XV

PAIN

Pain is one of the very hard things of life which most people find it extremely difficult to bear with equanimity. I suppose that the majority of human beings, especially when they are young, do not feel nearly so much dread of death as they do of the possibility of years of discomfort preceding it or even a short period of very acute pain when nature is preparing for dissolution. Older folks learn to bear physical pain better and come to appreciate how much harder to stand is mental anguish. Modern life, with its cultivation of comforts and conveniences and the elimination of discomforts of all kinds, has greatly fostered the dread of pain. We hear much of the progress of humanity founded on the increase of comfort, but that way lies degeneracy and failure to take life seriously. Human character develops under the stress of pain and even the body acquires self-control through it and is trained under the discipline of pain not to react so disturbingly as is the case when there has been no experience with it or but very little.

We find it almost impossible to understand, now that we have cultivated the comforts of life so sedulously, how men and women stood the discomforts to which they were subjected in the ordinary run of life practically every day two generations ago. A great many of them slept in little stuffy attics with scarcely any chance for the free movement of air on the hot days of summer, often immediately underneath a roof which had been exposed to the direct rays of the sun all day long. In the winter not infrequently they broke the ice in their pitchers to secure water for washing. Their heating arrangements were so imperfect that in the colder months at least there was very little possibility of comfort. A grate fire makes a very charming ornamental addition to a room which is heated by steam or some other modern heating arrangement, but when it is the only means of heating it is not very efficacious except in milder weather. On very cold days an open fire will heat one side of the individual, but not the whole person, and at best the feet are likely to be cold because the open fire must be fed with an abundance of air and the draft runs along the floor in order to get to it. The story is told of an English public school in the old days where the head master met one of the smaller boys crying because of the cold; on being told what was the matter, the head master simply remarked that "this was no young ladies' seminary, and young gentlemen are expected to stand things without tears." Twenty years later in India, during the Mutiny, just before that boy who had cried from the cold led a forlorn hope of a charge with the idea of saving the lives of women and children, he remarked to his commanding officer who was himself also from that same public school, "This is what old… "—naming the head master—"would have said is no young ladies' seminary." And then he went out without more ado to accept death in a great cause.

It is extremely difficult for us to understand how the people of the older time, young and old, endured all these trials and hardships, though it is not difficult to comprehend that if one were exercised daily in standing things of this kind it would be much easier to bear pain and even serious discomfort than it is at the present time, when many people can bear only the touch of silk on the skin and the sybarite's complaint of his utter inability to sleep because there was a crushed rose leaf underneath him has become almost a literal reality. More and more we are eliminating discomforts from life and making things as comfortable and easy as possible. From the carefully tempered water of the morning bath to the warm foot bath just before sleep, in a bedroom where the temperature makes it possible to undress for bed without a shiver, all is arranged for the avoidance of the slightest discomfort.

Pain has become a veritable nightmare to most people as a consequence of the lack of the necessity to stand things in life, and it is therefore all the more interesting to see what an effect religion can have in enabling people to stand pain. In my volume "Health through Will Power" I have told the story of the second last General of the Jesuits and the very serious and intensely painful operation which he insisted on standing without an anaesthetic. The story is worth repeating here as showing what a habit of prayer and practice of self-control can do for a man in the face of some of the severest pain a human being is asked to stand. Generals of the Jesuits have usually found their way into literature for very different reasons from this.

He had developed a sarcoma of his upper arm and was advised to submit to an amputation at the shoulder joint. As he was well on in the sixties the operation presented an extremely serious problem. The surgeons suggested that he should be ready for the anaesthetic at a given hour the next morning and then they would proceed to operate. He replied that he would be ready for the operation at the time appointed, but that he would not take an anaesthetic. They argued with him that it would be quite impossible for him to stand unanaesthetized the elaborate cutting and dissection necessary to complete an operation of this kind in a most important part of the body, where large nerves and arteries would have to be cut through and where the slightest disturbance on the part of the patient might easily lead to serious or even fatal results. Above all, he could not hope to stand the exaggerated pain that would surely be produced in the tissues rendered more sensitive than normal by the increased circulation to the part, due to the growth of the tumor.

He insisted, however, that he would not take an anaesthetic, for surely here seemed a chance to welcome suffering voluntarily as his Lord and Master had done. I believe that the head surgeon said at first that he would not operate. He felt sure that the operation would have to be interrupted after it had been begun, because the patient would not be able to stand the pain, and there would then be the danger from bleeding as well as from infection which might occur as the result of the delay. The General of the Jesuits, however, was so calm and firm that at last it was determined to permit him at least to try to stand it.

The event was most interesting. The patient not only underwent the operation without a murmur, but absolutely without wincing. The surgeon who performed the operation said afterwards, "It was like cutting wax and not human flesh, so far as any reaction was concerned, though of course it bled very freely."

Professor William James has noted this same power with regard to that most painful of all diseases in which pain seems so much harder to stand because it is hopeless, and there is no possibility that the endurance of it can lead eventually to any improvement. The patient must just stand being racked to pieces until the end comes. No wonder then that the professor of psychology should note with commendation the effect of religion in bringing about a sense of well-being in spite of the constantly progressive physical condition which was so painfully eating life away. He said:

"The most genuinely saintly person I have ever known is a friend of mine now suffering from cancer of the breast—I hope that she may pardon my citing her here as an example of what ideas can do. Her ideas have kept her a practically well woman for months after she should have given up and gone to bed. They have annulled all pain and weakness and given her a cheerful active life, unusually beneficent to others to whom she has afforded help. Her doctors, acquiescing in results they could not understand, have had the good sense to let her go her own way."

Many physicians, I am sure, have had the opportunity to witness instances very like that which is thus recorded with whole-hearted sympathy by Professor James. I count it as one of the precious privileges of life to have known rather well a distinguished professor of anatomy at Professor James' own university. He suffered from incurable cancer and two years before the end knew that nothing could be done for him and that it was just a question of time and pain and the most poignant discomfort until the end would come. He continued his lessons at the university; he finished up a book that he had long wished to write and had begun several times; he maintained his simple, social relations with friends in such a gracious spirit that none of them suspected his condition and continued until the very end bravely to go on with his work quite as if there were nothing the matter.

I shall never forget how shocked I was when I once presumed to invite an addition to his labors by asking him to make a public address, and he told me, as a brother physician, just how much he had to be in the trained nurse's hands every day so as to keep himself from being offensive to others. I had met him at lunch in the bosom of his family and spent several pleasant hours with him afterward without ever a thought of the possibility of the hideous malignant neoplasm which was constantly at work making a wreck of his tissues and which no one knew better than he would never be appeased with less than his death.

He himself would have said that whatever there was of courage in his conduct was due to the strength that came to him from prayer. It was his consolation and the sources of the energy which enabled him to stand not only the pain he had to suffer but to suppress any manifestations with regard to it and keep on with his work.

There is an impression in many minds that as time goes on and medicine and surgery advance and science scores further triumphs, pain and ill health generally will decrease, and there will not be nearly so much necessity for standing pain as there is even at the present time. Besides, it is thought that the discovery of new modes of stilling pain will still further eliminate the necessity for patience. As a matter of fact, all our advance in hygiene and sanitation and scientific medicine has served rather to increase than lessen the amount of pain. People now live longer than they used to. They live on to die of the degenerative diseases which are slow running and often involve a great deal of pain over a prolonged period. One reason, probably the most important one, for the great increase of the number of deaths from cancer in recent years is the fact that ever so many more people now live on to the cancer age than before. Every year beyond forty which a human being lives increases the liability of death from cancer in that individual. There are some enthusiasts in the field of medicine who are inclined to think that we may discover the cause of cancer and eliminate the disease, but after a generation of special effort in that direction with absolutely no hopeful outlook, this is at least a dubious prospect. Indeed, there are many good authorities on the subject, who are inclined to feel that cancer more often represents an embryologic or developmental defect than almost anything else and that in so far as it does we can scarcely hope ever to eliminate it.

While the death rate from other acute diseases has been decreasing in recent years and especially from the infectious diseases, the mortality from affections of the kidneys, heart and brain has been increasing. Almost needless to say, these affections are practically always chronic, involve definite discomfort when not positively acute suffering, and not infrequently produce bodily states in which people must bear patiently a great deal of discomfort, sometimes for years. When people live beyond middle life they become more and more liable to be affected by these diseases, so that instead of needing less consolation for pain, our generation and the immediately succeeding generations at least are going to need more. It is particularly the people who are stricken with chronic disease who need the consolation afforded by religion, above all when they know that their affection is essentially incurable and that the only absolute relief they can have will come from death.

It is with this as with regard to hospitals and charity. The greater the advance in medicine and the longer people are kept in life, the more need there will be for hospital care and consequently for the exercise of charity in the best sense of that word and also for patience in pain and suffering. In these matters, as with regard to knowledge, science, instead of lessening the need of religion and its influence, is multiplying it. There is not the slightest reason for thinking that a man will ever make here on earth a heaven in which he may be perfectly happy, and even those enthusiastic advocates of modern progress who are inclined to think of the possibility of this set the date of it so far forward in the future, especially since the disillusionizing process of the Great War, that even the fulfillment of their prophecy is not likely to do very much good for our generation or for many subsequent generations. We are going to need the consolations afforded by religion even more than our forefathers did in the past, now that physicians are able to prolong life and yet cannot entirely do away with suffering.

Above all it must not be forgotten that the cult of comfort and convenience and what may well be called the habit of luxury in the modern time has greatly increased sensitiveness to pain. There are two elements that enter into suffering, as we have said in the chapter on that subject. The one is the irritation of a sensitive nerve and the other is the reaction to it in the mind of the sufferer. If, for any reason, the nerve has been rendered insensitive, or the mind put in a condition where it cannot receive the irritation, the subject will not feel the pain. If anything has happened to increase the irritability of a nerve, as happens, for instance, when continued irritation has brought more blood to the part than usual and the affected area is hyperemic and swollen, the pain will be greater because the nerve is more sensitive. If anything happens to make the mind more receptive of pain, and especially if the pain message that comes up along a nerve is diffused over a large part of the brain because there is a concentration of attention on it, then too the pain will be ever so much worse. We are, in various ways, adding to this subjective element of pain and therefore increasing it. We are going to need then all the possible consolation that can be afforded by religious motives.

In an article written for the International Clinics,[11 - Series 23, Vol. IV.] on "Neurotic Discomfort and the Law of Avalanche", I called attention to how much even comparatively mild pains can be increased by concentration of attention.

The law of avalanche is a term employed by Ramón y Cajal to indicate the mode by which very simple sensations at the periphery of the body may be multiplied into an avalanche of sensations within the brain. In a lecture of his for International Clinics[12 - Series 11, Vol. II.] Professor Ramon y Cajal said: "Impressions are made upon single cells at the periphery. As the result of the disturbance of the single cell, an ever-increasing number of cells are affected as the nervous impulse travels toward the nerve-center. Finally the nervous impulses reach the brain and are spread over a considerable group of pyramidal cells in the cortex."

In his paragraphs on attention he says that if conscious attention is paid to the sensation a great many other cells throughout the brain become affected by it. It may be that every cell which subtends consciousness will at a given moment of intense attention be tingling from a single sensation. If it is unpleasant, the unpleasantness is multiplied to a very serious degree. The "law of avalanche" has a very large place in disturbing the lives of those people who have much time on their hands to think about themselves and who are always solicitous lest some serious condition should be developing.

Our self-conscious generation, as religious impressions have been diminished in recent years, is making its pains ever so much more difficult to bear than they were before. Paying attention to slight discomfort will quite literally turn it into a veritable torment. Prayer of itself, by distracting the attention, will act in an actual physical manner to reduce the pain, and the habit of prayer could accomplish very much in that direction. The feeling that somehow the pain that is being borne is not merely a useless torment but has a dual beneficial effect in strengthening character and storing up merit for the hereafter, as the religious minded believe, will do a very great deal to make the pain more bearable. As we are not going to have less pain for humanity, and suffering and death are to be always with us, not even the most roseate dreams of medical scientists contemplating their elimination, it is easy to understand how valuable religious motives will continue to be. Meantime physicians have abundance of experience of how much religion can do to make life, even under the most trying circumstances, not only useful for self and others, but even satisfying for those who would otherwise find it an almost intolerable burden.

Probably the most fruitful source of consolation to be found in life is contained in the profound conviction that the Lord and Master said to those who would come after Him that if they would be His disciples they must take up their cross and follow Him. One of the very great books of world literature is "The Imitation of Christ", the keynote of which is contained in its title.

This little book, which has chapters bearing such titles as "That a Man Must not be over Eager about his Affairs" and "That a Man has Nothing Good of Himself" and which suggests "That True Comfort must be Sought in God Alone" and "That All care Should be Cast upon God" and "That Worldly Honor must be Held in Contempt" and "That All Things, however Grievous, are to be Borne for the Sake of Eternal Life" and "That a Man ought to Consider Himself more Worthy of Chastisement than of Consolation", has been the favorite reading of more of the men and women whose opinions are worth while in the world's history than probably any other, with the exception of the Bible itself. It has been placed next to Homer and Dante and Shakespeare among the books which scholars would preserve if, by a cataclysm, all the other books in the world were to be destroyed. When, some years ago, there was a spirited discussion in the English newspapers and magazines as to the ten books which should be selected if one were to be on a desert island for the rest of life with only these ten books for company, the "Imitation of Christ" almost invariably found its way into the list and usually among the first five.

If the little book which emphasizes the pain and suffering of life has come to be looked upon as one of the greatest books of the world, by the very fact of its profound treatment of this subject in lofty poetry, then it is easy to understand the place that pain bears in life. It is at the very heart of it. Nothing so reveals its meaning and makes it so bearable as religion. Just as it is true with regard to suffering, as stated in the chapter on that subject, that the five poets who at long-separated intervals in the world's history dared to take the mystery of suffering in the world for the subject of their poems, made by that very fact the greatest dramatic poetry that has ever been made, so this humble member of the Brethren of the Common Life, Thomas à Kempis, working just as the Renaissance was beginning, and writing the spiritual conferences for "those humble-minded patient teachers and thinkers" as Hamilton Mabie said, "whose devotion and fire of soul for a century and a half made the choice treasures of Italian palaces and convents and universities a common possession along the low-lying shores of the Netherlands", composed what his contemporaries called "ecclesiastical music", and what all subsequent generations have agreed in thinking the most wonderful expression of the significance of life in terms of Christianity that has ever been written.

CHAPTER XVI

SUICIDE AND HOMICIDE

No book on religion and health would be complete without a discussion of the effect of religious influence on these two very important factors in modern mortality statistics, especially in our own country,—suicide and homicide. One of the most disturbing features of public health work is the occurrence of such a large number of deaths every year in our great city life from murder and self-murder. It is discouraging to have the death rate from nearly every form of disease coming down while these are going up. Any factor which promises, however modestly, to remove even to a slight degree this stigma from our modern civilization is worthy of consideration. The moral factors in life are most important in this regard and over these religion has the most direct and potent influence.

One of the most disturbing features of our modern life is the fact that in spite of the notable progressive increase of comfort in life far beyond what people enjoyed in the past, there has been a steadily mounting growth in the number of suicides every year in civilized countries. Comforts and conveniences have become widely diffused, so that the luxuries of the rich in the older time have become the everyday commonplaces of the poor or the simple necessities of the middle class, and life would seem to be ever so much more easy than it used to be. Yet more and more people find it so hard that they are willing to go out of life by their own hands to meet untimely the dark mystery of the future. It has become quite manifest that comfort of body and peace of mind are by no means in such direct ratio to one another as is usually thought, but rather the contrary. Our suicides take place more frequently among the better-to-do classes than among the poor who might possibly be expected to find life so hard that they could not stand it any longer. Even chronic suffering does not cause so many suicides as the various disappointments of life, most of which are only transitory in their effect.

Perhaps the most disturbing feature of the suicide situation lies in the fact that the average age of those who commit suicide every year is constantly becoming younger. Suicide used to be the resort particularly of the discouraged beyond middle life, but now it is becoming ever more and more the mode of escape from an immediate future of unhappiness which ever younger and younger folk foresee for themselves. Disappointments in love have always been occasions for suicide, but other causes have multiplied in recent years to an alarming degree, and now high-school children with the suggestion of sensational newspaper accounts of suicide in their minds turn to self-murder over failures in examination or setbacks in school work or over a scolding at home. Even below the age of fifteen suicides are reported rather frequently, because children have been punished or have been refused something that they had set their hearts on. The generation is engaged in producing many oversensitive young folk who cannot stand being disturbed in their hopes and aspirations.

Suicides have increased just in proportion to the decrease of attention to religion and the absence of religious teaching and above all of religious training, that is, of such practice of self-denial and of mortification for religious motives as leads to formation of character. When children and young folks are always given their own way and are not taught that denying themselves is of itself a virtue because it leads to strength of will power and enables one to stand the inevitable hardships of later life, no wonder that their first serious disappointments come to them as such disturbing misfortunes that they can scarcely picture to themselves a time when they shall be happy again. Above all a great many of them have no real belief in immortality and therefore face the future life with no feeling as to its mystery and no proper sense of their obligation toward a Creator who gave them life to use to the best advantage possible and who wants them to play the game of life fair, taking the ill with the good and "carrying on." The lack of religious feeling has left them with nothing to cling to in the midst of their trials, and though they may have friends, all human beings are eminently alone, and we must go through what is hard in life by ourselves. We never feel our loneliness more than when some severe trial comes. We almost resent the pity of others, and Emerson's phrase that we are "infinitely repellent particles" becomes a very grave reality.

It is the easy custom of our time to blame nearly all the social ills on what is called our present-day strenuous existence. There are a great many people who seem to think that men never worked so hard as they do now, though as a matter of fact in what concerns the accomplishment of things worth while our generation is sadly backward. He unfortunately grows preoccupied with trivial narrow concerns and keeps on working at them so continuously that we have become very fussy folk because we have no variety of occupation to relieve the strain of daily life. It must not be forgotten in this regard that some of the men who have lived the longest have been extremely hard workers, accomplishing so much in a number of lines of thought and endeavor that it has seemed almost impossible to understand how they did it, yet they have been healthy and hearty in mind and body until fourscore years, and sometimes, like Ranke, the great German historian, and Pope Leo XIII and Chevreul, the distinguished French chemist, even beyond ninety years of age and more. The strenuous existence is a good excuse, however, and a great many people are sure that it is the overtiredness and the disturbance of health and the depression which comes in connection with this that causes suicide or at least contributes greatly to the increase of it in our time.

Only a little analysis of suicide statistics, however, is necessary to make it very clear that it is not physical factors which contribute most to the increase of suicide, but that it is the state of mind of the individual. If the physical counted for much then it would be confidently expected that suicides would be commonest in the winter and least frequent in the summer, particularly in the pleasanter months of the summer time. The statistics show, however, that the month which has the most suicides is June. June is probably the pleasantest month of the year in most ways in our climate. July is likely to be very hot. May often has cold and rainy days at the beginning, but June has often a succession of almost perfect days. James Russell Lowell sang, and it has been reechoed many times, "What is so rare as a day in June", yet this is the month which more people take to put themselves out of existence than any other. Brides have chosen it as the favorite month for marriage because all nature looks so lovely and in sympathy with their own joy and because there are fewer rainy days in it than any other. Happy hearts are beginning a new existence with the brightest possible prospects just when so many others are voluntarily getting out of what seems a hopeless life.

December, which has so many gloomy days and which naturally is likely to be so much more depressing than the succeeding months of the winter, for the clear, cold days of January and February are bracing, might on physical grounds be expected to be the month with most suicides in it. Christmas with its celebrations and the announcement of peace and joy to men of good will might be expected to lower the number of suicides for the latter third of the month, but even the joy of that occasion could scarcely be hoped to neutralize completely the depressing effect of the weather. Just exactly the contradiction of these anticipations is what happens. Suicides are least frequent in December of any month in the year, and the last ten days of the month have the most of them because it is not so much the individual's own sense of hopelessness in life, complicated by physical suffering and material trials of various kinds, that tempts to suicide, as the contrast of the joy of those around him with his own feelings which emphasize his depressed state of mind until he feels that he can stand it no longer. June's gayety with its happy brides adds to the number of suicides and the Christmas festivities have a like unfortunate tendency. Gloomy weather has exactly the opposite effect from what would surely have been expected on the general principle that the physical plays the most important rôle in the production of suicides.

This is brought out still more clearly by the careful review of the effect of the weather on suicide which was made some years ago by Professor Edmund T. Dexter[13 - Popular Science Monthly, April, 1901.] of the University of Illinois.

He followed out the records of nearly two thousand cases of suicides reported to the police in the City of New York and placed beside them the records of the weather bureau of the same city for the days on which these suicides occurred. According to this, which represents not any preconceived notions but the realities of the relationship of the weather to self-murder, the tendency to suicide is highest in spring and summer, and the deed is accomplished in the great majority of cases on the sunniest days of these seasons. It is not at all a case of heat disturbance of mind or tendency to heat stroke, for as has been seen June is the month of most suicides and while it often has some hot days it does not compare in this regard with July and August or even September as a rule.

His conclusions are carefully drawn, and there is no doubt that they must be accepted as representing the actual facts. All the world feels depressed on rainy days and in dark, cloudy weather, but suicides react well, as a rule, against this physical depression, yet allow their mental depression to get the better of them on the finest days of the year. Professor Dexter said:

"The clear, dry days show the greatest number of suicides, and the wet, partly cloudy days the least; and with differences too great to be attributed to accident or chance. In fact there are nearly one in three (31%) more suicides on dry than on wet days and more than one in five (21%) more on clear days than on days that are partly cloudy."

In reviewing the subject of suicide in my book on "Psychotherapy"[14 - D. Appleton & Co., New York, 1912.] I suggested that this subject of depressed weather conditions as the contributing cause of suicide might be carried still further and the lack of the dispiriting influence of dark, damp weather, as a suicide factor, could be seen very strikingly from the suicide statistics of various climates.

The suicide rate is not highest in the torrid or in the frigid zones, but in the temperate zones. In the north temperate zone it is much more marked than in the south temperate zone. Civilization and culture, diffused to a much greater extent in the north temperate zone than in the south, seem to be the main reason for this difference. We make people capable of feeling pain more poignantly, but do not add to their power to stand trials or train character by self-control to make the best of life under reasonably severe conditions.

Severe physical suffering of any kind, provided it is shared by a whole people, reduces the suicide rate. Famine, for instance, though it might be expected that people facing starvation would surely take the easier way, rather reduces the tendency to suicide. Earthquakes followed by loss of life and intense suffering have the same effect. It might possibly be thought that this would be true only among less well educated people, the orientals or perhaps certain of the South Americans where lack of education made them less poignantly sensitive to physical suffering than among the more refined people in our western civilization, but the earthquake at San Francisco demonstrated very clearly the effect upon average Californians who, I suppose, must be considered to have been rather a little above than below the general run of Americans in what we are accustomed to call civilization and education. Before the catastrophe, suicides were occurring in that city on an average of twelve a week. After the earthquake, when, if physical sufferings had anything to do with suicide, it might be expected that the self-murder rate would go up, there was so great a reduction that only three suicides were reported in two months. Some of this reduction was due to inadequate records, but there can be no doubt that literally a hundred lives were saved from suicide by the awful catastrophe that leveled the city. Men and women were homeless, destitute and exposed to every kind of hardship, yet because all those around them were suffering in the same way, every one seemed to be reasonably satisfied. Evidently a comparison with the conditions in which others are has much to do with deciding the would-be suicide not to make away with himself, for by dwelling too much on his own state he is prone to think that he is ever so much worse off than others.

If life were always vividly interesting, as it was in San Francisco after the earthquake, and if all men worked and suffered as the San Franciscans did for a few weeks, suicide would not end more than ten thousand American lives every year, as it does now. The one hope for the man who is contemplating suicide is to get him interested in others, to arouse him to the realization of the fact that there are others suffering even more than himself, but above all to get him to feel that he can relieve the suffering of others. Selfishness is the root of suicide, usually pathological in its utter preoccupation with self as the most important thing in the universe, but often only the result of a fostering of self-interest and a failure to train the mind to think of other people, which is of the very essence of religion.

It is not when things are made easy for mankind, but on the contrary when they are passing through times of difficulty and severe stress that the suicide rate goes down. War always brings a striking reduction in the number of suicides. Our Spanish-American War reduced the death rate from suicide in this country over forty per cent throughout the country and over fifty per cent in Washington itself, where there was most excitement with regard to the war. This was true also during the Civil War. Our minimum annual death rate from suicide from 1805 (when statistics on this subject began to be kept) to the present time was one suicide to about twenty-four thousand people, which occurred in 1864, when our Civil War was in its severest phase. There had been constant increase in our suicide rate every year until the Civil War began, then there was a drop at once and this continued until the end of the war. In New York City the average rate of suicide for the five years of the Civil War was nearly forty-five per cent lower than the average for the five following years. In Massachusetts, where the statistics were gathered very carefully, the number of suicides for the five-year period before 1860 was nearly twenty per cent greater than for the five-year period immediately following, which represents the preliminary excitement over the war and the actual year of the war. This experience in America is only in accordance with what happens everywhere. Mr. George Kennan in his article on "The Problems of Suicide"[15 - McClure's Magazine, June, 1908.] has a paragraph which brings this out very well. He says:

"In Europe the restraining influence of war upon the suicidal impulse is equally marked. The war between Austria and Italy in 1866 decreased the suicide rate for each country about fourteen per cent. The Franco-German War of 1870-1871 lowered the suicide rate of Saxony eight per cent, that of Prussia 11.4 per cent, and that of France 18.7 per cent. The reduction was greatest in France, because the German invasion of that country made the war excitement there much more general and intense than it was in Saxony or Prussia."

Above all the sense of patriotic duty, the recognition of the fact that there are things in life worth more than life itself, lifts men out of the depression into which they have permitted themselves to be plunged as a consequence of their utter absorption in themselves and their own narrow interests.

Old-fashioned religion has a distinct effect in the reduction of the suicide rate, and all over the world the orthodox Jews who cling to their old-time belief and above all to their orthodox practices and mode of life have undoubtedly the lowest suicide rate of any people in the world. This is true, though almost needless to say a great many Jews, not only in the foreign countries but here in our own great cities, have to live under circumstances that are the most trying that it is possible to imagine. A great many of them live in slums, doing intensely hard work in sweat shops—though, thank God, these are fewer now than they used to be—and yet the Jews cling to life in the midst of trials that would seem almost impossible for human nature to bear. The Jewish suicide rate is the lowest everywhere in spite of racial differences, for after all there are German Jews and Portuguese Jews and Russian Jews who have lived among the respective peoples after whom they are called for centuries and who might therefore be expected to take on the characteristics which their environments have brought. There is a very great difference in the suicide rate between the orthodox and unorthodox Jews, that is, those who have given up the beliefs and religious practices of their forefathers. It is in favor of the orthodox Jews, though of course the record is complicated by the prosperity of those who have given up their religion. Wealth and speculation greatly favor the occurrence of suicide.

It is well known that Roman Catholics the world over have much less tendency to suicide than their Protestant neighbors living in the same communities. It is true that where the national suicide rate is high, many Catholics also commit suicide, but there is a distinct disproportion between them and their neighbors. The suicide rate of Protestants in the northern part of Ireland, as pointed out by Mr. George Kennan, is twice that of Roman Catholics in the southern part. He discusses certain factors that would seem to modify the breadth of the conclusion that might be drawn from this, but in the end he confesses that their faith probably has most to do with it and that, above all, the practice of sacramental confession must be considered as tending to lessen the suicide rate materially. It is the readiness to give their confidence to some one on the part of these patients, for that is what they really are, that seems to the physician the best hope of helping them to combat their impulse, and Mr. Kennan's opinion is worth recalling for therapeutic purposes:

"In view of the fact that the suicide rate of the Protestant canton in Switzerland is nearly four times that of Catholic cantons, it seems probable that Catholicism, as a form of religious belief, does restrain the suicidal impulse. The efficient cause may be the Catholic practice of confessing to priests, which probably gives much encouragement and consolation to unhappy but devout believers and thus induces many of them to struggle on in spite of misfortune and depression."