Kitabı oku: «Health Through Will Power», sayfa 7

CHAPTER IX
THE WILL AND AIR AND EXERCISE

 
"And wishes fall out as they are willed."
 

Pericles

Very probably the most important function of the will in its relation to health is that which concerns its power to control the habits of mankind as regards air and exercise. It is surprising to what an extent people neglect both of these essentials of healthy living in the midst of our modern sophisticated life, unless the will power is consciously used for the purpose of forming and then maintaining habits with regard to these requisites for health. It is a very fortunate thing that instinct urges the child, particularly the infant, to almost constant movement during its waking hours. Children that are healthy and that are growing rapidly, boys somewhat more than girls, are so constantly in movement that one would almost think that they must be on springs. Whenever they discover that they can make a new movement, they proceed to make it over and over again until they can do it with facility. There is no lolling around for them; as soon as they wake, they want to be up and doing, no matter what the habits of the household may be. They are constantly on the move. We know that this is absolutely essential for growth as well as for the proper training of their muscles, but it is a very fortunate thing that children do it for themselves, for if their mothers were compelled to train them, the task would be indeed difficult. All mother has to do is to control them to some extent and keep them from venturing too far, lest they should hurt themselves.

When the control of instinct over life is gradually replaced by reason, this tendency to exercise gradually diminishes until it is often surprising to find how little people are taking. As it is mainly the need for exercise that forces people out into the air, indoor life comes to be the main portion of existence. This is all contrary to nature, and so it is not surprising that disease, in its original etymological sense of discomfort, develops rather readily. The lack of exercise in the air permits a great many people to drift into all sorts of morbid conditions in which they are quite miserable. This is, of course, particularly true as regards nervous ailments of various kinds; only under the term nervous ailments should be included not alone direct affections of the nervous system or functional disturbances of nerves, but also a number of other conditions. Nervous indigestion, insomnia, neurotic constipation and many of the symptomatic affections associated with these conditions, tired feelings that interfere with activities, headache, various feelings of discomfort in the muscles and around the joints, inability to control the emotions and other such common complaints—if that is the proper word for them—all these are fostered by a sedentary life indoors. They frequently make not only the patient himself—or oftener herself—miserable, but also all those who come in contact with her.

Above all, it must not be forgotten that lack of exercise in the open air has a very definite tendency to make people extremely sensitive to discomforts of all kinds, mental as well as physical. Many a man or woman whose life seems full of worries, sometimes without any adequate cause at all, who goes from one dread to another, who wakes in the morning with a sense of depression, find that most of these feelings and sometimes all of them, disappear promptly when they begin to exercise more in the open.

Nothing dispels the gloom and depressions consequent upon an accumulation of cares and worries of various kinds like a few weeks in the woods, where every moment is passed in the fresh outdoor air, which actually seems to blow the cobwebs of ill feelings away and leaves the individual with a freedom of mind and a comfort of body that he almost expected never to enjoy again.

Undoubtedly the most important factor for the preservation of health is an abundance of fresh air. At certain seasons of the year this is not only easy and agreeable, but to do anything else imposes hardship. In our climate, however, there are about six months of the year in which it requires some exercise of will power to secure as much open air life as is required for health. There are weeks when it is too hot, there are many weeks when it is too cold. The cold air particularly is important, because it produces a stimulating vital reaction than which nothing is more precious for health. We have no tonic among all the drugs of the pharmacopeia that is equal to the effect of a brisk walk in the bracing air of a dry cold day. After a long morning and perhaps a whole day in the house, even half an hour outdoors will enable us to throw off the sluggishness consequent upon confinement to the indoor air and the lack of appetite and the general feeling of physical lassitude which has followed living in an absolutely equable temperature for twenty-four hours. Sometimes it requires no little effort of the will to secure this, and to continue it day after day without missing it or letting it be crowded out by claims that are partly real and partly excuses, because we do not care to make the special effort required.

What humanity needs is regular exercise in the open air every day. As it is, between the trolley car and the automobile, very few people get what they need. Any one who has to go a mile takes a car or some other conveyance and between waiting for the car and certain inevitable delays it will probably take ten minutes or more to go the mile. In five minutes more one could walk that distance and secure precious exercise besides such diversion of mind as inevitably comes from walking on busy city streets and which makes an excellent recreation in the midst of one's work. For it is quite impossible in our day to walk along city streets absorbed in abstract mental occupations. One of the objections to walking is that after a while it can be accomplished as a matter of routine without necessarily taking one's mind away from subjects in which it has been absorbed. It is quite impossible for this to happen, however, on modern city streets. "The outside of a horse", it used to be said, "is good for the inside of a man." The main reason for this was because it is impossible for a man to ride horseback, unless his mount is a veritable old Dobbin, without paying strict attention to the animal. The same thing is true as regards city pedestrianism, especially since the coming of the auto has made it necessary to watch our steps and look where we go.

A great many people would be ever so much better in health if they walked to business or to school every morning instead of riding, for the young need it even more than the older people. Especially is this true for all those who follow sedentary occupations. Clerks in lawyers' offices, typewriters and stenographers, secretaries—all those who have to sit down much during the day—need the brisk walking and need it not merely of a Sunday or a Saturday afternoon, but every day in the year. Many of them, if they walked two and three miles to the office, would probably require only fifteen minutes, at most half an hour, more than if they took a train or trolley, but they would have secured a good hour of exercise in the open air.

On the other hand the unfortunate crowding of trolley and elevated and subway trains in the busy hours when people go to and from their work makes an extremely uncomfortable and often rather depressing commencement and completion of the day's work. I know of nothing that makes a worse beginning for the day than to have to stand for half an hour or longer in a swaying, bumping car, hanging to a strap, crushed and crowded by people getting in and out. The effect of coming home under such circumstances after a reasonably long day's work is even more serious, and any little sacrifice that will enable people to avoid it will do them a great deal of good. Fifteen or twenty minutes of extra time morning and evening would often suffice for this and would at the same time add a bracing walk in the open air to the day's routine.

When first begun, such a practice would make one tired and sore, but that condition would pass in the course of a few days and be replaced by a healthy feeling of satisfaction that would be well worth all the effort required. We should need ever so much less medicine for appetite and for constipation if this were true. A great many people who stand during the day would probably deem it quite out of the question for them to walk three miles or more to and from their business, for their feet get so tired that they feel that they could not endure it. What they need more than anything else, however, is exercise that will bring about a stimulation of the circulation in their feet. Standing is very depressing to the circulation. It leads to compression of the veins and hence interference with the return circulation, with lowered nutrition which often predisposes to flat foot or yielding arch and tends to create corns and callouses: walking in reasonably well fitting shoes on the contrary tends to make the feet ever so much less sensitive Our soldiers have had that experience and have learned some very precious lessons with regard to the care of their feet, the principal one being that the best possible remedy for foot troubles is to exercise the feet vigorously in walking and running, provided the shoes permit proper foot use.

I have often known clerks and floorwalkers who have to stand all day or move but a few steps at intervals, who were so tired at night that they felt the one thing they could do was to sit down for a while after dinner and then go to bed, but who came to feel ever so much better after a brisk walk home. It was rather hard to persuade them that, exhausted as they felt, they would actually get rested and not more tired from vigorous walking, but once they tried it, they knew the exercise was what they needed. The air in stores is often dry and uncomfortable for those who are in them all day. It is usually and quite properly regulated for the customers who come in from the streets expecting to get warm without delay. In dry, cold weather particularly, an evening walk home sets the blood in circulation until it gets thoroughly oxidized and the whole body feels better. Such a brisk walk will often prevent the development of flat foot, especially if care is taken to spring properly from the ball of the foot, in the good, old-fashioned heel and toe method of walking. Once flat foot has developed, walking probably is more difficult, but even then, with properly fitting shoes, the patients will be the better for a good walk after their work is over. It requires some will power to acquire the habit, but once formed, the benefit and pleasure derived make it easy to keep up the practice.

Those who walk thus regularly will often find that their evening tiredness is not so marked, and they will feel much more like going out for some diversion than they otherwise would. Probably nothing is more dispiriting in the course of time than to come home merely to eat dinner, sit down after dinner and grow sleepy on one's chair until one feels quite miserable, and then go to bed. There should be always, unless in very inclement weather, an outing before bedtime, and this should be looked forward to. It will often forestall the feeling that the day is over after dinner and so keep the individual from settling down into the dozy discomfort of an after-dinner nap as the closing scene of the day. Good habits in this matter require an effort of the will to form; bad habits almost seem to form of themselves and then require a special effort to break.

It is surprising how many of the dreads and anxiety neuroses and psycho-neurotic solicitudes and neurasthenic disquietudes and other more or less morbid mental states disappear under the influence of a brisk walk for three or four miles or more every day. I have tried this prescription on all sorts of people, including particularly myself, and I know for certain that when troubles are accumulating the thing to do is to get outdoors more, especially for walking; then the incubus begins to lift. Clergymen, university professors, members of religious orders, school teachers, as well as bankers, clerks and business people of various kinds, have been subjected to the influence of this prescription with decided benefit. Some of them assert that they never felt so well as since they have formed the habit of walking every day. It must, however, be every day, and it must not merely be a mile or so but it must be at least three miles. That means for a good many people about an hour spent in actual walking, but it is well worth the time and effort. Above all, it repays not only in health and in better feelings but in the increased amount of work that can be done on the day itself. A whole day passed indoors will often contain many wasted hours, while if a walk of a couple of miles is planned for the morning and one for a couple of miles more in the afternoon, very satisfactory study or other work can be done in the intervals. Almost needless to say, a brisk walk in the cooler weather will create an appetite where it did not exist before. Women often need counsel in this matter more than men, and regular walking for them is indeed a counsel of health. Very few women in these modern times walk much, and to walk more than a mile seems to them a hardship. This is responsible for more of the supersensitiveness and nervous complaints of all kinds to which women are liable than anything else that I know of. It is also one important factor in the production of the constipation to which women are so much more liable than men. We see many advertisements with regard to the jolts to which the body is subjected every time the heel is put down and of the means that should be taken to prevent them, but it must not be forgotten that men and women were meant by nature to walk erect and that this recurring jolt has a very definite effect in stimulating peristalsis and favoring the movement of the contents of the intestines. Besides, if the walking is brisk, the breathing is deeper and there is some massage of the liver, as also of the other abdominal viscera, while other organs are affected favorably. Walking for women—regular, everyday walking—would be indeed a precious habit, but now that women have occupations more and more outside of the house, this is one of the things they must make up their minds to do, if they are to maintain health, remembering that making up the mind is really making up the will.

Over and over again I have seen a great many of the troubles of the menopause or change of life in women disappear or become ever so much less bothersome as the result of the formation of regular habits of walking out of doors every day. Unfortunately, there is a definite tendency about this time for women to withdraw more and more from public appearances and to live to a considerable extent in retirement at home. Nothing could be much worse for them. They need, above all, to get out and to have a number of interests, and if these interests can only be so arranged as to demand rather prolonged walks, so much the better. This is more particularly true for the unmarried woman who is going through this critical time, and the question of walking regularly every day for three or four miles must be proposed to her. It will require a considerable effort of the will. More than two miles at the beginning will probably be too tiring, but the amount can be gradually increased until at least four miles on the average is covered every day. Above all, for the feelings of discomfort in the cardiac region so often noticed at this time, regular walking is the best remedy in most cases, always of course presupposing that there is no organic heart condition, for in that case only a physician can give the proper direction for each case. By the exercise of the lungs that it requires, it will probably save most people from colds and coughs which they have had to endure every winter. Lastly be it said that practically all men and women, though more particularly the men who have lived well beyond the Psalmist's limit of threescore and ten, have been regular daily walkers, or else they have taken exercise in some form in the open air which is the equivalent of walking. One of the most distinguished of English physicians, Sir Hermann Weber, who died just after the end of the war in London, was in his ninety-fifth year. He had practised medicine regularly until the age of eighty and continued in excellent health and vigor until just before his death. During the last year of life, he contributed an interesting article to the British Medical Journal on the "Influence of Muscular Exercise on Longevity." He attributed his vigor at the age of ninety-five as well as the prolongation of his life to his practice of spending every day two or three hours in the open air. He walked, as a rule, forty to fifty miles a week. Even in the most inclement weather he rarely did less than thirty miles a week. Many another octogenarian and nonagenarian has attributed his good health and long life to the habit of regular daily exercise in the open.

Instead of using up energy, the will so used brings out latent stores of energy that would not otherwise be employed and thus adds to the available amount of vitality for the individual. Doctor Thomas Addis Emmet, only just dead, over ninety, in his younger years as a busy medical practitioner never kept a horse. It would not be difficult to cite many other examples among men who lived to advanced old age and who considered that they owed their good health and long life to daily habits of outdoor exercise.

CHAPTER X
THE WILL TO EAT

 
"If your will want not, time and place will be fruitfully added."
 

King Lear

Eating is usually supposed to be entirely a matter of appetite which instinct directs to the best possible advantage of the individual. This is quite true for those who are living the outdoor life that is normal or at least most healthy for men, and when they are getting an abundance of exercise, and may I add also have not too great a variety of food materials in tempting form presented to them. Under the artificial not to say unnatural conditions which men have to a great extent created for themselves in city life, confined at indoor sedentary occupations, some of them—and they are much more numerous than is usually imagined—eat too little, while a great many, owing to stimulation of appetite in various ways, eat too much.

Eating therefore for health's sake has to be done through the will and as a rule by the formation of deliberate habits. It is easy to form habits either of defect or excess in the matter of eating and indeed a great deal of the ill health to which mankind is liable is due to errors in either of these directions. Having disturbed nature's instincts for food in modifying the mode of life to suit modern conveniences, we have now to learn from experience and scientific observations what we should eat and then make up our minds to eat such quantity and variety as is necessary to maintain health and strength in the particular circumstances in which we are placed.

While the greatest emphasis has been placed on the dangers to health in overeating, the number of people who, for one reason or another, eat too little is, as has been said, quite surprising. A very large proportion of those under normal weight are so merely because they have wrong habits of eating. Indeed, it may be laid down as a practical rule of health that wherever there is no organic disease the condition of being underweight is a symptom of undereating. A great many thin people insist that the reason why they are underweight is that it is a family trait and that father and mother, or at least one of them, and some of their grandparents exhibited this peculiarity; and thus it is not surprising that they should have it. A careful analysis of the family eating in such cases has shown me in a large number of instances, indeed almost without exception, that what my patients had inherited was not a constitutional tendency to thinness, but a family habit of undereating. This accrued to them not from nature but from nurture, and was acquired in their bringing up. Most of them were eating one quite abundant meal a day and perhaps a pretty good second meal, but practically all of them were skimping at least one meal very much. In some way or other, a family habit of eating very little at this meal had become established and was now an almost inviolable custom.

A great many thin individuals, that is persons who are somewhat more than ten per cent. under the average normal weight for their height, either do not eat breakfast at all or eat a very small one. It is not unusual for the physician analyzing their day's dietary to be told that the meal consists of a cup of coffee and a piece of bread. Sometimes there is a roll, but more often only part of a roll, though occasionally in recent years there may be some fruit and some cereal; the fruit will usually be a half of one of the citrus fruits which contains practically no nutrition and is only a pleasant appetizer, while more often than not the cereal will be one of the dry, ready-to-eat varieties which, apart from the milk or cream that may be served with them, contain in the usual small helpings very little nutriment. Such breakfasts are particularly the rule among women who are under weight. Sometimes lunch is comparatively light so that there are two daily apologies for meals. To make up for these, the third meal may be very hearty. City folk often eat at dinner more than is good for them. This may produce a sense of uncomfortable distention and overfulness followed by sleepiness which may be set down as due to indigestion, though it is just a question of overeating for the nonce.

It would be much more conducive to health to distribute the eating over the three meals of the day, but it requires a special effort of the will to break the unfortunate habits that have been formed. Particularly it seems hard for many people to eat a substantial breakfast and a determined effort is required to secure this. It would seem almost as though their wills had not yet waked up and that it was harder for them to do things at this time of day. It is especially important for working women, that is, those who have such regular occupations as school-teacher, secretary, clerk and the like, to eat a hearty breakfast. They can get a warm properly chosen meal at home at this hour, while very often in the middle of the day they have to eat a lunch that is not nearly so suitable. As a consequence of neglecting breakfast then, it is twenty-four hours between their warm, hearty meals. Even when they eat a rather good lunch, some eighteen hours elapse since the last hearty meal was taken, and one half the day's work has to be done on the gradually decreasing energy secured from the evening meal of the day before. With this unfortunate habit of eating, most of that was used up during the night in repairing the tissue losses of the day before, so that the morning's work has to be done largely "on the will" rather than on the normal store of bodily energy.

It is surprising how many patients who are admitted to tuberculosis sanatoria have been underweight for years as a consequence of unfortunate habits of eating. Not infrequently it is found that they have a number of prejudices with regard to the simple and most nutritious foods that mankind is accustomed to. Not a few of the younger ones who develop tuberculosis have been laboring under the impression that they could not digest milk or eggs or in some way they had acquired a distaste for them and so had eliminated them from their diet; some of them had also stopped eating butter or used it very sparingly. At the sanatoria, as a rule, very little attention is paid to the supposed difficulty of digestion of milk and eggs and perhaps butter. The patients are at once put on the regular diet containing these articles and the nurse sees that they take them even between meals, and unless there is actual vomiting or some very definite objective—not merely subjective—sign of indigestion, the patients are required to continue the diet.

It is almost an invariable rule for the patients of such institutions to come to the physician in charge after a couple of weeks and ask how it was that they could have thought that these simple articles of food disagreed with them. They have begun to like them now and are surprised at their former refusal to take them, which they begin to suspect, as the physician very well knows, to have been the principal reason for the development of their tuberculosis.

There are people who are up to weight or slightly above it who develop tuberculosis, but they do not represent one in five of the patients who suffer from the affection. In probably three fourths of all the cases of tuberculosis the predisposing factor which allowed the tubercle bacillus to grow in the tissues was the loss of weight or the being underweight. There is a good biological reason for this, for there are certain elements in the make-up of the tubercle bacillus which favor its growth at a time when fat is being lost from the tissues rather than deposited, for at that time more fat for the growth of the tubercle bacillus is available in the lungs than at other times. Often among the poor the loss in weight is due to lack of food because of poverty, or failure to eat because of alcoholism, but not infrequently among all classes it is just a question of certain bad habits of eating that might readily have been corrected by the will. It is surprising how many people who complain of various nervous symptoms—meaning by that term symptoms for which no definite physical basis can be found, or for which only that extremely indefinite basis of a vague reflex, real or supposed, from the abdominal organs—are underweight and will be found to be eating much less than the average of humanity. These nervous symptoms include above all discomforts of various kinds in the abdominal region; sense of gone-ness; at times a feeling of fullness because of the presence of gas; grumblings, acid eructations, bitter taste in the mouth, and above all, constipation. As is said in the chapter on "The Will and the Intestinal Functions," the most potent and frequent cause of constipation is insufficient eating, either in quantity or in variety. It is especially in the digestive tract of those who do not eat as much as they should that gas accumulates. This gas is usually thought to be due to fermentation, but as fermentation is a very slow gas producer and nervous patients not infrequently belch up large quantities, it is evident that another source for it must be sought. Any one who has seen a number of hysterical patients with gaseous distention of the abdomen and attacks of belching in which immense quantities of gas are eructated, will be forced to the conclusion that in such nervous crises gas leaks out of the blood vessels of the walls of the digestive tract and that this is the principal source of the gas noted. What is true in the severe nervous attacks is also true in nervous symptoms of other kinds, and neurotic indigestion so called is always accompanied by the presence of gas.

Apparently the old maxim of the physicist of past centuries has an application here. "Nature abhors a vacuum" and as the stomach and intestines are not as full as they ought to be, nor given as much work to do as they should have, nature proceeds to occupy them with gas which finds its way in from the very vascular gastrointestinal walls. This is of course an explanation that would not have been popular a few years ago when the chemistry of digestion seemed so extremely important, but in recent years, medical science has brought us back rather to the physics of digestion, and I think that most physicians who have seen many functional nervous patients would now agree with these suggestions as to the origin of gaseous disturbance in the gastrointestinal tract in a great many of these cases.

Besides the physical symptoms, there are a whole series of psychic or psycho-neurotic symptoms, the basis of which undoubtedly lies in the condition of underweight as a consequence of undereating. Over and over again I have seen the feeling of inability to do things which had come over men, and particularly women, disappear by adding to and regulating the diet until an increase in weight came. Extreme tiredness is a frequent symptom in those under weight, and this often leads to their having no recreation after their work because they have not enough energy for it; as every human being needs diversion, a vicious circle of influence which adds to their nervous tired condition is formed. I have seen in so many cases the eating of a good breakfast and a good lunch supply working people with the energy hitherto lacking that enabled them to go out of an evening to the theater or to entertainments of one kind or another, that it has become a routine practice to treat these people by adding to their dietary unless there are direct contra-indications.

Dreads are much more common among people who are underweight than among those who eat enough to keep themselves in proper physical condition. I have had a series of cases, unfortunately only a small one in number, in which the craving for alcoholic liquor disappeared before an increase in diet and a gain in weight. I shall never forget the first case in which this happened. The patient was a man of nearly sixty years of age who held a rather important political office in a small neighboring town. He was on the point of losing it because periodical sprees were becoming more frequent and it was impossible for him to maintain his position. He was over six feet in height and he weighed less than a hundred and fifty pounds. I had tried to get him to gain in weight by advice and suggestion without avail. Finally, I had to make a last effort to use whatever influence I had to save his political position for him, and then I succeeded in making him understand that he would have to do as I told him in the matter of eating, or else I would have nothing more to do with him.