Kitabı oku: «Health Through Will Power», sayfa 8

It was not without some misgivings that I thus undertook to make a man of nearly sixty change his lifelong habits of eating. That is something which I consider no physician has a right to do unless there is some very imperative reason for it. Here was, however, a desperate case. It was in the late afternoon particularly that this patient craved drink so much that he could not deny himself. As he ate but very little breakfast and had a hasty scanty lunch, he was at the very bottom of his physical resources at that time, and at the end of a rather demanding day's work. We had to break up his other habits in the hope of getting at the craving. He had taken coffee and a roll for breakfast. I dictated a cereal, two eggs and several rashers of bacon and several rolls. I insisted on fifteen minutes in the open before lunch and then a hearty lunch with some substantial dessert at the end of it. This man proceeded to gain at the rate of a little more than three pounds a week. By the end of two months, he weighed about one hundred and eighty pounds and had not touched a drop of liquor in that time and felt that he had no craving for it. That is some ten years ago, and there has been no trouble with his alcoholic cravings since. He has maintained his weight; he says that he never felt so well and that above all he now has no more of that intense tiredness that used to come to him at the end of the day. Every now and then he says to me in musing mood,—"And to think that I had never learned to eat enough!"

For these very tired feelings so often complained of by nervous patients, once it has been decided that there is no organic trouble—for of course kidney or heart or blood pressure affections may readily cause them—there are just two things to be considered: These are flat-foot or yielding arch, and undereating. When there is a combination of these two, then tiredness may well seem excessive and yet be readily amenable to treatment. Persons with occupations which require standing are especially liable to suffer in this way.

Undereating in the evening is especially important for many nervous people and is often the source of wakefulness. It is the cause of insomnia, not so much at the beginning of the night, as a rule, as in the early morning. Many a person who wakes at four or five and cannot go to sleep again is hungry. There is a sense of gone-ness in the stomach region in these cases, which the patients are prone to attribute to their nerves in general, or some of them who have had unfortunate suggestions from their physicians may talk of their abdominal brain; but it is surprising how often their feelings are due simply to emptiness. Any thin person particularly who has his last meal before seven and does not go to bed until after eleven should always take something to eat before retiring. A glass of milk or a cup of cocoa and some crackers or a piece of simple cake may be sufficient, but it is important to eat enough. Animals and men naturally get sleepy after eating and do not sleep well if their stomachs are empty. Children are the typical examples. We are all only children of a larger growth in this regard.

When the last meal is taken before seven and people do not go to bed until nearly twelve, as is frequently the case in large cities, the custom of having something to eat just before bed is excellent for sleep. I have known the establishment of this habit to afford marked relief in cases of insomnia that had extended over years. The people in my experience who sleep the worst are those who, having taken a little cambric tea and some toast and preserves with perhaps a piece of cake for supper, think that this virtuous self-control in eating ought to assure them good rest. It has just the opposite effect. Disturbed sleep, full of dreams and waking moments, is oftener due to insufficient eating than to overeating. The people whom I know who sleep the best and from whom there are no complaints of insomnia, are those who, having eaten so heartily at dinner that they get to the theater a little late, attend the Follies or some late show for a while and then go round to one of the Broadway restaurants and chase a Welsh rarebit or some lobster a la Newburg, with a biscuit Tortoni or a Pêche Melba down to their stomachs and then go home to sleep the sleep of the just.

Just as there are bad habits of eating too little that are dangerous and must be corrected by the will so there are bad habits of eating too much that can only be corrected in the same way. While it is dangerous to be under weight in the early years of life, it is at least as dangerous to be overweight in middle life. With the variety and abundance of food now supplied at a great many tables, it is comparatively easy for people in our time to eat too much. The result is that among the better-to-do classes a great many people suffer from obesity, sometimes to such an extent that life is made a burden to them. There is only one way to correct this and that is to eat less and of course to exercise more. Reduction in diet means the breaking of a long established habit and that of course is often hard. The whole family may have to set a good example of abstinence from too great a variety of food and especially from the richer foods, in order that a parent may be helped to prevent further development of obesity and to lose gently and gradually some of the overweight that is being put on, and which now, by conserving heat and slowing up metabolism generally within the body, makes it so easy for even reduced quantities of food to maintain the former habit of adding weight.

In this matter of obesity, however, just exactly as in the case of tuberculosis for those who are underweight, prevention is much better than cure. The people who know that they inherit such tendencies should be particularly careful not to form habits of eating that will add considerably to their weight. After all, it is not nearly so difficult a matter as is often imagined. There is no need, unless in very exceptional cases, of denying one's self anything that is liked in the ordinary foods, only less of each article must be eaten. Even desserts need not be entirely eliminated, for ices may be taken instead of ice cream; sour fruits and especially those of the citrus variety—oranges and grapefruit—and the gelatine desserts may be eaten almost with impunity. The phrase "eat and grow thin" has deservedly become popular in recent years because as a matter of fact it is perfectly possible to eat heartily and above all to satisfaction without putting on weight. It is, of course, harder to lose weight, but even that may be accomplished gradually under proper direction if there is the persistent will to do it.

In recent years another disease has come to attract attention which represents the result of an overindulgence in food materials that can be limited without much difficulty. This is diabetes which used to be comparatively rare but has now become rather frequent. An authority on the disease declared not long since that there are over half a million people in this country now who either have or will have diabetes as the result of the breaking down of their sugar metabolism. It is not surprising that the disease should be on the increase, for the consumption of sugar has multiplied to a very serious degree during the last few generations. A couple of centuries ago, those who wanted sugar went not to the grocery store, but to the apothecary shop. It was kept as a flavoring material for children's food, as a welcome addition to the dietary of invalids and the old, and quite literally as a drug, for it was considered to have, as it actually has, to a slight extent at least, some diuretic qualities that made it valuable. A little more than a century ago, a thousand tons of sugar sufficed for the whole world's needs, while the year before the war, the world consumed some twenty-two million of tons of sugar. It is said that every man, woman, and child in the United States consumed on the average every day a quarter of a pound of sugar.

Our candy stores have multiplied, and while two generations ago the little candy stores sold candies practically entirely for children, eking out their trade with stationery and newspapers and school supplies, now candy stores dealing exclusively in confectionery are very common. There are several hundred stores in the United States that pay more than $25,000 a year rent, though they sell nothing but candy and ice-cream sodas. Corresponding with the increase in the sale of candy has come also the consumption of very sweet materials of various kinds. French pastries, Vienna tarts, Oriental sweetmeats, Turkish fig paste, Arabian date conserves, and West Indian guava jelly, are all familiar products on our tables. Chocolate has become one of the important articles of world commerce, though almost unknown beyond a very narrow circle a little more than a century ago. Tea and coffee have been introduced from the near and the far East and by a Western abuse consumed with such an amount of sweetening as make them the medium of an immense consumption of sugar.

There is no doubt that unless good habits of self-denial in this regard are formed, diabetes, which is an extremely serious disease, especially for those under middle life, will continue to increase in frequency. The candy and sugar habit is rather easy to form; every one realizes that it is a habit, but it is sometimes almost as hard to break as the tobacco habit. We were meant to get our sugar by the personal manufacture of it from starch substances. If a crust of bread is chewed vigorously until it swallows itself, that is, dissolves in the secretions and gradually disappears, it will be noted that there is a distinctly sweetish taste in the mouth. This is the starch of the bread being changed into sugar. We were expected by nature to make our own sugar in this way, but this has proved too slow and laborious a way for human nature to get all the sugar it cared for, so most people prefer to secure it ready made. Sugar is almost as artificial a product as alcohol and is actually capable of doing almost as much harm as its not distantly related chemical neighbor. It is rather important that good habits in the matter should be formed and we have been letting ourselves drift into very unfortunate habits in recent years.

CHAPTER XI
THE PLACE OF THE WILL IN TUBERCULOSIS

 
"And like a neutral to his will and matter
Did nothing."
 

Hamlet

Probably the very best illustration in the whole range of medicine of the place of the will in the cure of disease is afforded by tuberculosis. This used to be the most fatal of all human affections until displaced from its "bad eminence" within the last few years by pneumonia, which now carries off more victims. As it is, however, about one in nine or perhaps a few more of all those who die are victims of tuberculosis. This high mortality would seem to indicate that the disease must be very little amenable to the influence of the will, since surely under ordinary circumstances a good many people might be expected to have the desire and the will to resist the affection if that were possible. In spite of the large death rate this is exactly what is true.

Tuberculous infections are extremely common, much commoner even than their high mortality reveals. After long and critical discussion with a number of persistent denials, it is now generally conceded by authorities in the disease that the old maxim "after all, all of us are a little tuberculous" is substantially correct. Very few human beings entirely escape infection from the tubercle bacillus at some time in life. The great majority of us never become aware of the presence of the disease and succeed in conquering it, though the traces of it may be found subsequently in our bodies. Careful autopsies reveal, however, that very few even of those who did not die directly from tuberculosis fail to show tuberculous lesions, usually healed and well shut off from the healthy tissues, in their bodies. One in eight of those who become infected have not the resistive vitality to throw off the disease or the courage to face it and take such precautions as will prevent its advance. All those, however, who give themselves any reasonable chance for the development of resistance survive the disease though they remain always liable to attack from it subsequently if they should run down in health and strength.

Heredity, which used to be supposed to play so important a rôle in the affection, is now known to have almost nothing to do with the spread of the disease. Family tendencies are probably represented by nothing more than a proneness to underweight which makes one more liable to infection, and this is due as a rule to family habits in the matter of undernourishment from ill-advised consumption of food. Probably a certain lack of courage to face the disease boldly and do what is necessary to develop bodily resistance against it may also be an hereditary family trait, but environment means ever so much more than heredity.

There is a well known expression current among those who have had most experience in the treatment of patients suffering from tuberculosis that "tuberculosis takes only the quitters", that is to say that only those succumb to consumption who have not the strength of will to face the issue bravely and without discouragement to push through with the measures necessary for the treatment of their disease. In a word it is only those who lack the firmness of purpose to persist in the mode of life outlined for them who eventually die from their affection of the lungs. No specific remedy has been found that gives any promise of being helpful, much less of affording assured recovery, though a great many have been tried and not a few are still in hopeful use. Recent experience has only served to emphasize the fact that the one thing absolutely indispensable for any successful treatment of tuberculosis of the lungs is that the patient should regain weight and strength and with them resistive vitality so as to be able to overcome the disease and get better.

To secure this favorable result two conditions of living are necessary but they must be above all persisted in for a considerable period. First there must be an abundance of fresh air with rest during the advancing stage or whenever there are acute symptoms present, and secondly an abundance of good food which will provide a store of nutritive energy and make the resistive vitality as high as possible. Curiously enough this "fresh air and good food" treatment for the disease was recognized as the sheet anchor of the therapeutics of consumption as long ago as Galen's time, the end of the second century, when that distinguished Greek physician was practising at Rome. Nearly eighteen hundred years ago Galen suggested that he had tried many remedies for what he called phthisis, the Greek equivalent of our word consumption or wasting away, and had often thought that he had noted a remedial value in them, but after further experience he felt that the all-important factors for cure were fresh air and good food. He even went so far as to say that he thought the best food of the consumptive or the phthisical, as he called them, was milk and eggs. A great deal of water has flowed under the bridge of medical advance since his time and at many periods since physicians have been sure that they had valuable remedies for consumption; yet here we are practically back at Galen's conclusion more than fifty generations after his time, and we are even inclined to think of this mode of treatment as comparatively new, as it is in modern history.

The influence on consumption of the will to get well when once aroused was typically exemplified in the career of the well-known London quack of the beginning of the nineteenth century, St. John Long. He set himself up as having a sure cure for consumption. He was a charlatan of the deepest dye whose one idea was to make money, and who knew nothing at all about medicine in any way. He took a large house in Harley Street and fitted it up for the reception of people anxious to consult him. For some seasons every morning and afternoon the public way was blocked up with carriages pressing to his door. Nine out of ten of his patients were ladies and many of them were of the highest rank; fashion and wealth hastened to place themselves and their daughters at the mercy of the pretender's ignorance. His mode of treatment was by inhalation. He assured his patients that the breathing in of this medicated vapor would surely cure their pulmonary disease, and because others were intent on going they went; many of them were greatly benefited for a time and these so-called cures proved a bait for many other patients.

J. Cordy Jeaffreson in his volume "A Book about Doctors", written two generations ago, has told the story of St. John Long's successful application of the principle of community of treatment and its effectiveness upon his patient. Like Mesmer he realized that treating people in groups led them mutually to influence each other and to bring about improvement. St. John Long had in one of the rooms in Harley Street "two enormous inhalers, with flexible tubes running outward in all directions and surrounded by dozens of excited women— ladies of advanced years and young girls giddy with the excitement of their first London season—puffing from their lips the medicated vapor or waiting until a mouthpiece should be at liberty for their pink lips." In our generation of course we had various phases of similar treatment, including nebulizers and compressed air apparatus and medicated vapor, all working wonders for a while, and then proving to have no physical beneficial effect.

What is surprising is to find the number of cures that were worked. St. John Long had so many applicants for attention that he was literally unable to give heed to all of them. The news of the wonderful remedy flew to every part of the United Kingdom and from every quarter sick persons, wearied of a vain search after an alleviation of their sufferings, flocked to London with hope renewed once more. This enabled St. John Long to select for treatment only such cases as gave ready promise of cure. He made it a great preliminary of his treatment that his patients should eat well as a rule and on one occasion when he was called into the country to see a man suffering in the last stages of consumption he said quite frankly, "Sir, you are so ill that I cannot take you under my charge at present. You want stamina. Take hearty meals of beefsteak and strong beer; and if you are better in ten days I will do my best for you and cure you."

It is easy to understand that if he made it a rule for his consumptive patients that they should eat well or not expect relief from his medicine he would secure a great many good results. Especially would this be true in many cases that came up to him from the country, had the advantage of a change of climate, and of environment and very soon found that they had much more strength than they thought they had. They had been dreading the worst, they were now led to hope for the best; they took the brake off their will, they fed well and it was not long then before they proceeded to get well.

As even a little experience with consumptive patients shows it is often difficult for them to follow directions—and keep it up—in the matter of fresh air and good food and here is where the question of the will in the treatment is all important. Many a consumptive has in early life formed bad habits with regard to eating, especially in the direction of eating too little and refusing for some reason or other to take what are known to be the especially nutritious foods. Not infrequently indeed it is their neglect of nutrition in this regard that has been the principal predisposing factor toward the development of the disease. This bad habit must be overcome and often proves refractory.

Then it is never easy to give up the pursuit of a chosen vocation and pursue faithfully for a suitable period the humdrum monotonous existence of prolonged rest every day in the open air with eating and sleeping as almost the only serious interests, if indeed they can be called such, permitted in life. It is only those who have the will power to follow directions faithfully, whole-heartedly and persistently who have a reasonable prospect of getting ahead of their disease and eventually securing such a conquest of it as will enable them to return to their ordinary life as it was before the development of tuberculosis.

Unless patients are ready to follow directions as regards outdoor air and good food the cure, or as specialists in tuberculosis prefer to call it the arrest of symptoms in the disease, is almost out of the question. Above all it is extremely important that those who suffer from pulmonary tuberculosis should be ready to follow directions at an early stage of their disease, before any serious symptoms develop, for it is then that most can be done for them. Many a sufferer from tuberculosis makes his or her cure extremely difficult, certainly ever so much more difficult than it would otherwise have been, because the dread of going to see a physician—lest they should be told that their affection is really consumption and demands immediate strenuous treatment—causes them to put off consultation with some one whose opinion in the matter is reliable.

This is indeed one of the principal reasons why tuberculosis of the lungs still continues to carry off so many victims every year,– because people are afraid to learn the truth. They dare not put the question to a definite issue and refuse to believe the possibility that certain disturbing symptoms represent developing tuberculosis. They defer seeing an expert; they take this and that suggestion from friends; they buy cough remedies which they see advertised, sometimes they tinker with so-called "consumption cures." After a while an advance of their symptoms makes it absolutely necessary to see a physician but often by this time their disease has progressed from an incipient case rather easy to be treated and with an excellent prognosis to a more advanced stage at which cure is ever so much more difficult; or by this time it may even prove that their strength has been seriously sapped and they have not enough resistive vitality left to bring about reaction toward the cure.

The all-important thing for all those who have at any time lived near consumptives, whether relatives or others—for the disease is almost invariably acquired and not hereditary—or who have worked for any prolonged period in more or less intimate contact with those who had a chronic cough or who subsequently developed tuberculosis, is that on the first symptom that is at all suspicious they should make up their minds to have the question as to whether they have tuberculosis or not definitely settled and that they should be ready to do what they are told in the matter. The first symptom is not a persistent cough as so many think, nor continued loss of weight, which is an advanced sign as a rule, but a continued rapidity of pulse for which no non-pulmonary reason can be found.

The old idea that consumptives should not be told what their affection was, lest it should disturb their minds and discourage them so much as to do them harm, has now been abandoned by practically all those of large experience in the care of the tuberculous. The opposite policy of being perfectly candid and making the patients understand their serious condition and the importance of taking all the measures necessary for cure, yet without permitting them to be unnecessarily scared, has been adopted. Their will to get well must be thoroughly aroused. After all, it must be recalled that tuberculosis is an extremely curable disease. It is now definitely known that more than ninety per cent. of humanity have at some time had a tuberculosis process, that is to say a focus of tuberculosis active within their tissues. Only about one in nine of the deaths in civilized countries is from tuberculosis. That means that at least eight other people who have not died from the disease but from something else have had the affection, yet have recovered from it. Instead of the old shadow of heredity with its supposedly almost inevitable fatality, so that young people who saw their brothers and sisters or other relatives around them die from the disease felt that they were doomed, we now know that the hereditary factor plays an extremely minor role if indeed it plays any serious rôle at all in the development of the disease.

No affection is so amenable to the state of mind and the will to be well as tuberculosis. That is exactly the reason why so many remedies have come into vogue and apparently been very successful in its treatment and then after a while have proved to be of no particular service or even perhaps actually harmful so far as their physical effect is concerned. It cannot be too often repeated that anything whatever that a patient takes that will arouse new hope and give new courage and reawaken the will will actually benefit these patients. No wonder then that scarcely a year passes without some new remedy for tuberculosis being proposed. All that is needed to affect favorably patients suffering from the disease is to have some good reason presented which makes them feel that they ought to get better and then at once they eat better and proceed to increase their resistive vitality. The despondency that comes with the lack of the will to be well hurts their appetite particularly and no tuberculosis patient can ever hope to recover health unless he is eating heartily. With better eating there is always a temptation to be more outdoors and the ability to stand cooler air which always means that the lungs are given their opportunity to breathe fresh cool air which constitutes absolutely the best tonic that we have for the affection.

It has been recognized in recent years that the only climates which give reasonable hope of being helpful for the tuberculous are those which present a variation of some thirty degrees in their temperature every day. Whenever this is the case chilly feelings are always produced in those who are exposed to the change, even though the lower temperature curve may not go down to anywhere near freezing. If for instance the temperature at the hottest hour of the day, say three o'clock in the afternoon, is 90° F. and that of the later evening or middle of the night is 60° F., chilly feelings will be produced. Just the same thing is true if the temperature is between 30° F. and 40° F. shortly after the middle of the day and then goes down to near zero at night. These chilly feelings are uncomfortable, but they produce an excellent reaction in the circulation and set the blood coursing from the heart to the tissues better than any medicine that we have. In the midst of this the lungs have their resistive vitality raised so as to throw off the disease.

This is probably one of the principal reasons why mountain climates have been found so much more helpful for the treatment of tuberculosis than regions of lower elevations. Whenever the elevation is more than fifteen hundred feet there will almost invariably be a variation of thirty degrees between the day and the night temperature. There are of course still greater variations, even sixty or seventy degrees sometimes where the altitudes are very high, but this is often too great for the tuberculous patients to react properly to, in their rundown conditions. Besides, the air is much rarer at the higher elevations, breathing is more difficult, because the lungs have to breathe more rapidly and more deeply in order to secure the amount of oxygen that is needed for bodily necessities from the rarified air. The middle elevations then, between fifteen hundred and twenty-five hundred feet, have been found the best for tuberculosis patients, and they are very pleasant during the summer time, though never without the chilly discomfort of the drop in temperature. During the fall and winter, however, many patients become tired out trying to react to these variations of temperature and want to seek other climates where they will not have to submit to the discomfort and the chilly feelings. If they come down to more comfortable quarters before their tuberculosis has been brought to a standstill by the increase of their resistive vitality, it is very probable that they will lose most of the benefit that they derived from their mountain experience. Here is where the will comes in. Those who have the will to do it and the persistence to stick at it and the character that keeps them in good humor in spite of the discouraging circumstances which almost inevitably develop from time to time, will almost without exception recover from their tuberculosis with comparatively little difficulty, if they have only taken up the treatment before the disease is so far advanced as to be beyond cure.

In the older days consumptives used to be sent to the Riviera and to Algiers and to other places where the climate was comparatively equable, with the idea that if they could only avoid the chilly feelings consequent upon variations of temperature it would be better for them. Many of the disturbing symptoms of tuberculosis are rendered less troublesome in such a climate, but the disease itself is likely to remain quiescent at best or perhaps even to get insidiously worse, as tuberculosis is so prone to do. These milder climates require much less exercise of the will, but that very fact leaves them without the all-important therapeutic quality which the lower altitudes possess.

For many people the outdoor life and the sight of nature in the variations produced in scenery during the course of the days and the seasons are satisfying enough to be helpful in making their cure of tuberculosis easy. They are extremely fortunate if they have this strong factor in their favor. It is very probable that we owe the discovery of the value of the Adirondacks and other such medium altitudes in the treatment of tuberculosis to the fact that Doctor Trudeau liked the outdoors so much and was indeed so charmed with the Adirondack region that when death from tuberculosis seemed inevitable, he preferred the Saranac region as a place to die in, in spite of the hardships and the bitter cold from which at that time there was so little adequate protection, to the comforts of the city. He scarcely hoped for the miracle of cure from a disease which he as a doctor knew had carried off so many people, but if he were to die he felt that he would rather die in the face of nature with his beloved mountains all around him than in the shut-in spaces of the city.