But this does not change the domestic situation of the man who is usually much more concerned with his own comfort than the mathematical possibilities of his offspring being geniuses.  Certainly such a woman as the type now considered is not a poor man’s wife, for she really needs what only the rich can have,—­servants, variety, frequent vacations, and freedom from worry.  Now worry cannot be shut out of even the richest home, for illness, old age, and death are grim visitors who ask no man’s leave.  But poverty and its worries are kept away by wealth, and poverty is perhaps the most persistent tormentor of man.

Essential in the study of “nervousness” is the physical examination, and we here pass to the physically ill housewife.

It is important to remember that the diagnosis of neurasthenia is, properly speaking, what is called by physicians a diagnosis of exclusion.  That is to say, after one has excluded all possible illnesses that give rise to symptoms like neurasthenia, then and then only is the diagnosis justified.  That is, a woman physically ill, with heart, lung, or kidney disease, or with derangements of the sexual organs, may act precisely like a nervous housewife,—­may have pains and aches, changes in mood, loss of control of emotion; in a word may be deenergized.

It is not often enough remembered that bearing children, though a natural process, is hazardous, not only in its immediate dangers but to the future health of the woman.  Injuries to the internal and external parts occur with almost every first birth, especially if that birth occurs after twenty-five years of age.  Repair of the parts immediately is indicated, but in what percentage of cases is this done?  In a very small percentage of cases, I venture to state, not only in my own small experience in this work, but on the statements of men of large experience and high authority.

In this connection I may state that the leading obstetricians believe that the woman of to-day has a harder time in labor than her predecessors.  Aside from the more or less mythical stories of the savage women who deliver themselves on the march, there seems to be no reasonable doubt that in an increasing civilization and feminization, woman becomes less able to deliver herself, especially at the first birth.

Why is this?  After all, it is a fundamental matter.  And moreover it is more often the tennis-playing, horseback-riding, athletic girl who falls short in this respect than the soft-limbed, shrinking, old-fashioned girl.  Does a strenuous existence make against easy motherhood?  It would seem so; it would seem the more masculine the occupations of woman become, the less able are they to carry out the truly female functions.  But this is a digression from our point.

A retroverted uterus, a lacerated perineum, such minor difficulties as flat feet, such major ones as valvular disease of the heart, are causes of ill health to be ruled out before “nervousness” (or its medical equivalents) is to be diagnosed.