—Walter C. Alvarez, M.D. (Professor and
                                     Consultant, the Mayo Clinic). Nervousness
                                     Indigestions, and Pain, 1943


ENTER THE PATIENTS

We physicians see nowadays: mildly insane
Persons; largely eviscerated persons; mercurial
Persons—tense, eccentric, constitutionally inadequate
And ne’er-do-well:
                               A nervous, tired little seamstress;
A sensitive, somewhat neurotic, middle-aged professor;
An attractive but frail and hypersensitive little violinist.
A scrawny woman, whose tissues were evidently made
Of poor materials. (Perhaps the hand of the Potter
Slipped a bit.) A frail, nervous little minister:

He blushed inside his bowel when embarrassed!
An apathetic man still wearing his galoshes;
A stupid hypochondriac with small earning power.


THEIR COMPLAINTS

Their excitement causes them to fill with gas;
They break into a sweat, the brain tightens.
Some persons feel a snake crawling ’round the abdomen.
Waves of gooseflesh; waves running up the esophagus;
A puzzling pain in the flank, a catch in the breath.

A swishing stomach: I told her that it was not
A disease but only an accomplishment without social value.

Is it real pain? Usually it is only an ache.
A burning, or a quivering, or a picking, pricking, pulling,
Pumping, crawling, boiling, gurgling, thumping,
Throbbing, gassy or itching sensation, or
A constant ache, strongly suggests  neurosis.

A cold sweat, lumbago, cricks, wry neck.
Vertigo and feelings of uncertainty. Sometimes there
Are curious musical or squeaky or rubbing noises.


THE INTERVIEW

I like to find out how bad it is. Was there tragedy?
I like to know if the pain doubled the man up.
Did it ever cause him to get on his hands and knees?
I ask about sweating, palpitation, tingling in the legs.
Does he bloat? Does he at times feel unreal?

Has he succeeded in business? If not, why?

Is he unable to stick to any one thing?
Would he like to be a vagabond without responsibilities?

He cannot “take it.” His tale of woe, which he thinks
Is so puzzling and rare, is an old story to me.

If the patient is a woman, is she sleeping with one eye open?
Ticklishness of the abdomen is interesting in women.

Was there any weakness of muscles? Does the limb get cold?
Did the patient suffer any heartbreaking psychic shock?

Is it burning, tearing, pressing, squeezing, or binding?
Is it due to too great tenseness, working late at night,
Worrying and thinking troublous thoughts, crying children?
Was there a tantrum? A picnic or cheap restaurant?


PERSONAL COMMENTS BY THE PHYSICIAN

Many a woman must know in her heart that she
Has messed up her life. If only these people would say
Less about quivering feelings in the abdomen.


ASSORTED DIAGNOSES

A diagnosis of psychoneurosis plus scatterbrainedness.
Years of foolish living with poor mental hygiene.
Pain due to feelings of rebellion.
Worry and fretting and trying to analyze Life.

She is just at the end of her rope nervously.
Often these women shop too long and too carefully.

He is too stupid, opinionated, ever to understand.

Debauchery due to loss of moral sense.
They were half crazy, undisciplined persons to begin with.


THE TREATMENT OF NERVOUS, PSYCHOPATHIC, POORLY
ADJUSTED, MUCH TROUBLED OR OVERWORKED AND
TIRED PERSONS

The cure for all this is more thinking. The thing to do
Is jump in and work. There is nothing like work for steadying.
The prognosis in these cases is poor. All treatment
Is likely to be futile. These persons are incurable.

These persons need to learn how to use their brains
More hygienically. Occasionally a blackberry cordial.