James Walsh - Psychotherapy

Personal Hygiene.—Expert Advice.—For many men who are much occupied with business, the best possible safeguard for health, as well as the best guarantee against nervous or physical breakdown, would be a detailed consultation once a year with a physician regarding their habits of life and their business in relation to their health, present and future. In recent years many a business firm has found it not only expedient but profitable to turn to an expert accountant or auditing company and ask advice with regard to the management of its business. It is often found that certain business customs are causing serious drains, and that there are newer ways of doing things that save time and money. Sometimes a reorganization of the accounting system, or of the method of dealing with credits and debits, or the receiving or shipping department, proves advantageous to the business. Sometimes it is found that the capital invested will not justify the extension of business that is proposed, and not infrequently it is shown that a proposed extension adds to business movement but does not add to profits. Sometimes there are departments that can be dropped to advantage, though they seem to be adding to both business and profit.

All of this may well be transferred to the question of health in its relation to business. Not infrequently it is found that the capital of strength of the business man is not sufficient to justify the extension that he is planning or has already attempted. Sometimes suggestions can be made with regard to the mode of doing business, the hours employed and the hours of relaxation, that will make business less of a drain on the system. Occasionally arrangements for sleep and exercise, as well as for afternoons or special times of diversion, may save a man from that concentration of attention on one thing which frequently leads to nervous breakdown. Not infrequently business men who are of neurotic habit have customs of doing business which add to their nervous irritability, and these might be modified so as to lessen the call on nervous energy. There is need that the physician be looked to as an expert in personal health and its relation to business, just as the expert accountant or auditing firm is looked to for advice with regard to business methods.

Information regarding the mid-day meal will be of value to the physician in many cases. In cities, luncheon, likely to be rather an apology for a meal, is taken rapidly, and immediately there is a return to work. As a medical student in Vienna, I was much interested in the mid-day meal of the bankers and merchants of the old Austrian capital. At that time—I hope they have not changed the good custom since—the banks closed at 12 o'clock and did not open again until 3 o'clock. This gave time for taking the mid-day meal in comfort, and for a proper interval for digestion. In all the southern countries of Europe, for seven or eight months in the year at least, little is done during the two or three hours in the middle of the day. The people get up earlier and rest at mid-day as a break between the afternoon and morning. It is quite beyond expectation that anything like this will ever again be possible in the great commercial cities. The fact that this was the custom of our European forefathers, however, shows how business has obtruded itself on the habits that man would naturally form for himself. Business men hurry to luncheon, or if they take any time over it, it is because they have invited some one to lunch with them with whom they wish to talk over important matters. This means of saving time recalls the well-known expression of James Jeffrey Roche: "Time is money. Every second saved from your dinner now is a sequin in your doctor's pocket later on in life!"

Hurried Lunch.—The seeds of our frequent American dyspepsia are sown partly at the hurried breakfast and then at the hurried mid-day lunch. When a physician finds this to be the case, then the patient's habits must be reformed. Otherwise there is little prospect of relief from neurotic digestive symptoms, or from those uncomfortable feelings so often supposed to refer to the heart, or other important organ, when digestion is interfered with. There should be pleasant company at luncheon if possible; it should be preceded by fifteen or twenty minutes in the open air, with, as far as possible, complete seclusion from business thoughts so as to allow the stomach to secure its share of blood, and it should be followed by at least half an hour of pleasant occupation that does not call for serious mental work. This may not be possible for every one, and many will complain that this is asking too much in our busy time. We physicians are not here to make the nice customs of medicine courtesy to great kings of finance or to the busy tyrants of the professions, but to tell them what we think should be done in order that nature may not be abused. Men should be advised to take their luncheon in some building different from that in which their offices are located, or, if they eat in the same building, to go out on the street for a while before the meal. In the old days men used to call on one another in order to transact business, and these little trips were often made just before or after luncheons.

Now the telephone and the messenger boy have done away with this, with a great saving of time, but with an increase of intensity of labor that makes for nervous exhaustion. Luncheon clubs are excellent things when men do not talk shop, but they have one fatal defect. Almost invariably they lack simplicity of menu, and, because of the variety supplied and the example of others, there is a tendency to eat to excess. A game of billiards after eating is often excellent, because, when standing, digestion is accomplished with more comfort than when seated. A walk after the lighter midday meal is a good thing, though the old saw said "after dinner sit a while," but that was in reference to the largest meal of the day, and may still hold good for the evening meal, which is likely to be the heaviest one.

Women's Lunch.—Women are very likely to take their mid-day meal, when it is their luncheon, very irregularly. If they have to get it for themselves they are likely to be satisfied with almost anything. If they get it outside the house they are likely to take it rather late, so that if they have breakfast before eight o'clock, this putting off of the next meal causes some disturbance of the economy. When the stomach gets to be empty, either there is a tendency to swallow air, or there is a rumbling sense of fullness that disturbs the appetite, or the appetite itself is capricious, and a headache develops. How many headaches are due to missed meals it would be hard to say, but this is one of the most fruitful causes of the ordinary passing headache. Delicate women, and especially those who work, are likely not to eat enough luncheon. All the details with regard to this meal must be known or the physician will find it hard to get rid of many neurotic symptoms, particularly in working women. The same thing is true for the so-called society woman, since she is likely to have a late breakfast and then skip her mid-day meal. This is permissible if she is so stout as to be able to spare it, but it is all wrong if she is thin and needs every ounce of weight.

Nature of the Noon Meal.—During the last two generations fashion, custom and the increasing demands of business have pushed the hour of taking the principal meal farther and farther away from mid-day. There are, however, cases in which it seems better that the principal meal should be taken in accordance with the old custom, about noon time. For tuberculous patients this is especially important. They often have fever in the afternoon that seriously disturbs appetite. They may eat with comfort and relish a couple of hours before the fever is due. For delicate persons, especially those who have not much appetite for breakfast and who can not be persuaded to eat a sufficient amount early in the morning, a hearty meal at noon is almost a necessity. They should be shown how low their nutrition is during working hours. Their principal meal of the day before was taken between six and seven o'clock. They have had a light breakfast, a meager lunch, and naturally have little reserve force during the afternoon hours. As a consequence they become overtired, this lessens the appetite, they do not eat properly, and, above all, they do not digest as well as they would if their last good meal were not so far away. They are suffering from inanition, and, as is well known, starving people cannot be allowed to eat heartily, because their stomachs have not enough vitality to digest well.