Kitabı oku: «Health Through Will Power», sayfa 10

CHAPTER XIV
NEUROTIC ASTHMA AND THE WILL

 
"Great minds of partial indulgence
To their benumbed wills."
 

Troilus and Cressida

In closing a clinical lecture on bronchial asthma at the University of Marburg some years ago, Professor Friedrich Müller, who afterwards became professor at Berlin, said, "Each asthmatic patient is a problem by himself and must be studied as such; meantime, it must not be forgotten what an important rôle suggestion plays in the treatment of the disease." This represents very probably the reason why so many remedies have been recommended for asthma and have proved very successful in the hands of their inventors or discoverers as regards the first certain number of patients who use them, and yet on subsequent investigation have turned out to be of no special therapeutic value and sometimes indeed to have no physical effect of any significance.

Of course this is said with regard to neurotic asthma only, and must not be applied too particularly to other forms of the affection, though there is no doubt at all that the symptoms of even the most severe cases of organic asthma can be very much modified and often very favorably, by suggestive methods.

The principal feature of asthma is a special form of severe difficulty in breathing. It is known now that the beginning of the affection is always as Strumpell said, "an extensive and quite rapid contraction of the smaller and smallest bronchial branches, that is the terminal twigs of the bronchial tubes." It is not so much air hunger, though there is, of course, an element of that because the lungs are not functioning properly, as an inability to empty the lungs of air already there and get more for respiratory purposes. The spasm in asthma has a tendency to hold the lungs too full of air and produce the feeling of their getting ever fuller and fuller. What the old sea captain said in the midst of his attack of asthma, when somebody sympathized with him because he had so much difficulty in getting his breath, was that he had lots of breath and would like to get rid of some of it. He added, "If I ever get all this breath that's in me now out of me, I'll never draw another breath so long as I live, so help me." The respiration spasm is usually at full inspiration and the effort is mainly directed toward expiration and expulsion of air present using the accessory respiratory muscles for that purpose.

The picture of a man suffering from asthma is that of a patient so severely ill as to be very disturbing to one not accustomed to seeing it. It would be almost impossible for any one not used to the attacks to think that in an hour or two at the most the patient would be quite comfortable and if he is accustomed to the attacks, that he will be walking around the next day almost as if nothing had happened. All that the affection consists in is a spasm of the bronchioles and as soon as that lets up, the patient will be himself again. Some material may have accumulated during the time when the spasm was on which will still need to be disposed of, and there will be, of course, tiredness of muscles unaccustomed to be used in that special way, but that will be all.

We are still in the dark as to what causes the spasms but undoubtedly psychic factors play an important etiological rôle. For a good many people, there is a distinct element of dread as the immediate cause of their asthmatic attacks. Some people have it only when they have gone through some disturbing neurotic experience. Occasionally it is the result of physical factors combined with some psychic element. Cat asthma is not very uncommon and occurs as a consequence of some contact by the individual with a specimen of the cat tribe though usually the large cats, the lions and tigers, do not cause it. There is nearly always, in those who are liable to this form of asthma, a special detestation of cats. There is probably some emanation from the animal which produces the asthmatic fever, just as is true also of horses in those cases where horse asthma occurs. In a few of these latter cases, however, it was noted that the horse asthma did not begin until after there had been some terrifying experience in connection with the horse, as a runaway, a collision, or something of that kind.

Any one who sees many asthmatic cases inevitably gets the impression after a time that their very dread of the attacks has not a little to do with predisposing them. Occasionally the dread is associated with some other organic disturbance, either of heart or kidneys, or oftener still, with some solicitude with regard to these organs and the persuasion that there is something serious the matter with them, though there is at most only some functional disturbance. This is particularly true of cases of palpitation of the heart where there has been considerable dread of organic heart disease. In a certain number of these cases, there is some emphysema present, that is, overdistention of the lungs, such as is seen in high-chested people. Owing to the long anterio-posterior diameter of the chest and the fact that as a consequence it is nearly as thick through as it is wide, this form of chest is sometimes spoken of as barrel-chest. Patients who have it are particularly likely to suffer from asthma if they have any dread of heart trouble or if they are of a nervous constitution.

I have known people with the dread of the dark to get an attack of asthma if they were asked to sleep alone after having been accustomed for years to sleep with somebody in the room. I have known even a physician to have attacks of asthma of quite typical character as the result of a dread of being out after dark which had gradually come over him. I have had a physician patient who was very uncomfortable if alone on the streets of New York, even during the day, and whose symptoms at their worst were distinctly dyspneic or asthmatic. He used to have to bring his wife with him whenever he came to see me for he lived out in one of the neighboring towns, because he was so afraid that he might get an asthmatic attack that would overcome him and he would feel helpless without some one to aid him.

In practically all these cases, the treatment of asthma becomes largely that of treating the accompanying dread. Once the acute symptoms of the attack itself manifest themselves, they have to be treated in any way that experience has shown will relieve the patient. The general condition, however, needs very often an awakening of the will to regulate the life, to get out into the air more than before, to avoid disturbing neurotic elements, and worrying conditions of various kinds. Thin people need to be made to gain in weight, using their will for that purpose; stout people who eat too much and take too little exercise need to have their lives regulated in the opposite direction. In the meantime, anything that arouses the patient to believe firmly that his condition will be improved by some remedy or mode of treatment, will help him to make the intervals between attacks longer and the attacks themselves less disturbing. The will undoubtedly plays a distinct role in this matter which patients who have been through a series of asthmatic attacks recognize very clearly.

The many remedies for asthma which have been lauded highly even by physicians, and that have cured or relieved a great many patients and yet after a while have proved to be without much beneficial effect, make it very clear how much the affection depends on the will power to face it and throw it off. Nothing will be curative in asthma unless the patient has confidence in his power and uses his own will energy to help it. He must overcome the element of dread which occurs in connection with all asthmatic attacks, even those due to organic disease of heart or kidneys. No matter how frequent the attacks have been, there is always an element of fright that enters into an affection which interferes with the respiration. This must be overcome by psychic means to help out the physical remedies that are employed. Sometimes the psychic remedies will succeed of themselves where more material means have failed completely.

CHAPTER XV
THE WILL IN INTESTINAL FUNCTION

 
"Ill will never said well."
 

Henry V

During the past generation, the appreciation of the relative part played by the stomach and intestines in digestion has completely changed. Our forefathers considered the stomach the all-important organ of digestion and the intestines as scarcely more than a long tube to facilitate absorption and deal properly with waste materials. Their relative values are now exactly reversed in our estimation. The stomach has come to be looked upon as scarcely more than a thin-walled bag meant to hold the food that we take at each meal and then pass it on by degrees to be digested, prepared for absorption and finally absorbed in the intestines. It has comparatively little to do with such alteration of the food as prepares it to be absorbed. Its motor function is much more important than its secretory function and serious stomach troubles are dependent on disturbances of stomach motility. Contractions at the pyloric orifice, that is the passageway from the stomach into the intestines, will cause the retention of food and seriously interfere with health. The dilatation of the stomach for any reason may produce a like result and these are the stomach affections that need special care.

If the stomach will only pass the food on properly, the intestines will do the rest. A number of people have been found in the course of routine stomach examinations who proved to have no secretory function of the stomach and yet suffered no symptoms at all attributable to this fact. The condition is well known and is called achylia gastrica, that is, failure of the stomach to manufacture chyle, the scientific term for food changed by stomach secretions. Our stomachs are only meant, apparently, to provide a reservoir for food that will save us the necessity of eating frequently during the day, as the herbivorous and graminivorous animals have to do, and enable us to store away enough food to provide nutrition for five or six hours. We thus have the leisure to occupy ourselves with other things besides eating and drinking.

This conclusion as to the relative significance of the stomach and digestion is confirmed by the fact that removal of the whole stomach or practically all of it for cancer has in a number of well known cases been followed by gain in weight and general improvement in health. Schlatter's case, the very first one in which nearly the whole stomach was removed, proved a typical instance of this, for the patient proceeded to gain some forty pounds in weight. She had lost this during the course of the growth of a cancer and its interference with stomach motility. It was necessary, however, for her to be fed, rather carefully, well-chosen foods usually in liquid form, and every hour and a half instead of at longer intervals. Her intestines were thus spared from overloading and proceeded to do the work of digestion for which they are so well provided by abundant secretion poured into them from the large glands, the liver and the pancreas, as well as the series of small glands in their own walls all of which were manifestly meant to do extremely important work.

In the increased estimation of the significance of the digestive functions of the intestines which has come in recent years, there has been a tendency, as always in human affairs, for the pendulum to swing too far. Above all, certain phases of intestinal function have come to occupy too much attention and to be the subject of oversolicitude. Whenever this happens, whatever function it concerns is sure to be interfered with. Attention has been concentrated to a great extent on evacuation of the bowels and the consequences have been rather serious. A great many people whose intestinal functions were proceeding quite regularly have had their attention called to the fact that any sluggishness of the intestines may be the source of disturbing symptoms and the beginning of even serious morbid conditions. As a consequence, they pay a great deal of attention to the matter and before long become so solicitous that the elimination of waste materials from the intestines is interfered with. Above all, they may be led to pick and choose their foods so delicately that there is not the necessary waste material left to encourage peristalsis.

The result is that to some extent at least, intestinal function would almost seem to have broken down in our day. Everywhere one sees advertisements of medicines and remedies and treatments of various kinds that will aid in the evacuation of the bowels. Most of them are guaranteed to be perfectly harmless and all of them are pleasant to take, they work while you are doing nothing else and are just engaged in saving mankind not only suffering but complications of various kinds that may lead to serious results. Some years ago, when Matthew Arnold was in this country, he declared in one of his lectures that what the world needed was "leading and light," but a well known American physician who is closely in touch with American life declared not long since that what we needed in America manifestly, if advertisements were any index of the needs of a people, was laxatives and more laxatives. Advertisements cost money; it is said that at least four times as much as the advertising costs must be spent by the public on any object advertised in order to make it pay, so that very probably nearly a billion of dollars a year is spent in this country on laxatives. Only whiskey and tobacco present a higher bill to the American people annually.

Practically all of the laxative medicines do harm if taken over a prolonged period. Over and over again physicians have found that laxative remedies introduced even by scientists, with the assurance that they were quite harmless and had no undesirable after effects proved the source of annoying or even serious symptoms after a while. It is true that when constipation has become habitual, it may be necessary to give laxative medicines for a prolonged period, but this is only another instance of the necessity that is often presented to the physician of choosing between two evils and trying to find the lesser one. Even the heavy oil that has become so popular in recent years has been found on careful investigation and prolonged observation to have certain undesirable effects and it must not be forgotten that it has not been used generally for a sufficiently long time for us to be absolutely sure what its sequelae may be.

This breakdown of intestinal activity is not the fault of nature but of men and women who have been thinking to improve on the natural laws of living. As the result of improvements in diet and refinements in cooking and the preparation of foods, less and less of their roughage is left in our articles of food when sent to the table. It is on this roughage or waste material that intestinal movement or peristalsis depends. If we eat perfectly white bread, cut all the gristle and fatty materials from our meat, carefully eliminating the connective tissue bundles that may occur in it, eat our vegetables mainly in the shape of purees and avoid to a great extent all the coarser varieties, such as parsnips and carrots and beets, we provide very little material for the intestines to carry on and aid them in the elimination of other wastes. If, besides, we always ride and do not walk, and so have none of that precious jolting which occurs every time the heel comes down, and if we have no bending movements in our lives, no wonder that intestinal movement becomes sluggish and we have to supply stimulants and irritants to get it to do its work.

Intestinal evacuation is very largely a matter of will. There are very few people so constituted by nature that they will not have regular movements sufficient to maintain their digestive tracts in excellent health, if they form the right habits. They must, however, make up their minds, that is their wills, to restore coarse materials to their diet. They must eat whole wheat or graham bread, must eat fruit regularly and usually eat the skins of the fruit with it, that is as far as apples, pears, peaches, apricots, plums and the like are concerned. Even as regards oranges, it is probable that the eating of occasional pieces of orange peel is an excellent means of helping intestinal functions and providing waste material.⁶

When baked potatoes are taken, the skin should be eaten, mainly because of the waste material it provides, but also because just underneath the skin and sure to be removed with it if it is taken off, there are certain salts and other substances that are excellent for health and particularly for digestion. Besides, the carbonized material which so often occurs on baked potatoes is of itself a good thing. It represents some of that charcoal which in recent years French physicians particularly have found very valuable as a remedy for certain disturbances of intestinal digestion. The removal of parings from fruit and vegetables and the careful trimming of meat, have taken out of human diet the materials which meant most for intestinal movements for former generations, and they have to be supplied artificially by means of irritant drugs, salts, oils and the like, to the detriment of function.

The other element in the modern situation as regards the failure of intestinal function is the lack of fluids. People who live indoors are not tempted to take so much water as those who work outside and yet in our modern, steam-heated houses they often need more. Our heating systems take much more water from us than the former methods of heating. The result is seen in our furniture that comes apart from dryness and in our books and other things which crack and deteriorate. Something of the same thing happens to human beings unless they supply sufficient fluids. For this it is necessary deliberately to make up the mind, which always means the will, to consume five or six glasses of water between meals and especially to take one on rising in the morning and another on going to bed. This should not be hot and above all not lukewarm water, but fresh cold water which stimulates peristalsis. The creation of a habit is needed in the matter or it will be neglected. I have sometimes given patients some harmless drug, like a lithium salt, that was to be taken three or four times a day in a full glass of water, in order to be sure that they would take the water. They were willing to take the medicine but I could not be assured that without it they would drink the amount of water that I counselled.

Above all, a regular habit of going to the toilet at a definite time every day must be created. Nothing is so important. In little children, even from their very early years, such a habit can be established; it is only necessary to put them on their chairs at certain times in the day and the desired result will follow. Adults are merely children of a larger growth in this matter, and the habit of going regularly is all-important. A little patience is needed, though there should be no forcing, and after a time, a very satisfactory habit can be established in this manner. It seems almost impossible to many people that anything so simple should prove to be remedial for what to them for a time seemed so serious a disturbance of health, but only a comparatively short trial of the method will be sufficient to demonstrate its value. A book or newspaper may be taken with one, or Lord Chesterfield's advice to learn a page of Horace which may afterwards be sent down as an offering to Libitina, the goddess of secret places, may be followed, but the mind must not be diverted too much from the business in hand, and the will must be afforded an opportunity to exert its power.

It is true that the muscular elements of the intestines consist of unstriped muscles and that they are involuntary, and yet experience and observation have shown that the will has a certain indirect influence even over involuntary muscle. The heart, though entirely involuntary in its regular activities, can be deeply influenced by the will and the emotions, as the words encouraging and discouraging, or the equivalent Saxon words heartening and disheartening, make very clear. Undoubtedly the peristaltic functions of the intestines can be encouraged by a favorable attitude of the will towards them.

Above all, it is important that the anxious solicitude which a great many people have and foster sedulously with regard to the effect of even slight disturbances of intestinal functions should be overcome. We have discussed this question in the chapter on dreads and need only say here that the delay of a few hours in the evacuation of the bowels or even the missing entirely of an intestinal movement for a full day occasionally, will usually not disturb the general health to any notable extent, and that the symptoms so often attributed to these slight disturbances of intestinal function are much more due to the solicitude about them than to any physical effect. There are a great many people whose intestinal functions are quite sluggish and whose movements occur only every second day or so, who are in perfectly good health and strength and have no symptoms attributable to any absorption of supposed toxic materials from the intestines. Indeed, in recent years, the idea of intestinal auto-toxemia has lost more and more in popularity for it has come to be recognized that the symptoms attributed to this condition are due in a number of cases to serious organic disease in other parts of the body, and in a great many cases to functional nervous troubles and to the psycho-neuroses, especially the oversolicitude with regard to the intestines. The will is needed then for intestinal function to regulate the diet, to increase the quantity of fluid, to secure regular habits and to eliminate worry and anxiety which interferes with intestinal peristalsis. There are but very few cases that will not yield to this discipline of the will when properly and persistently tried.