Health Through Will Power

by James J. Walsh

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 [{152}] 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 [{153}] 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 [{154}] 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 [{155}] 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 [{156}] 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 [{157}] 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 [{158}] 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.

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 [{159}] 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 [{160}] 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 [{161}] stomachs are empty. Children are the typical examples. We are all only children of a larger growth in this regard.