Health Through Will Power Part 5

The event then was most interesting. The patient not only underwent the operation without a murmur, but absolutely without wincing. The surgeon who performed the operation said afterwards, "It was like cutting wax and not human flesh, so far as any reaction was concerned, though of course it bled."

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The story carries its lesson of the power of a brave man to face even such awful pain as this and probably actually overcome it to such an extent that he scarcely felt it, simply because he willed that he would do so and occupied himself with other thoughts during the process.

Such an example as that of this General of the Jesuits will seem to most people a reversion to that mystical att.i.tude of mind of the medieval period, when somehow or other people were able to stand ever so much more pain than any one in our time could possibly think of enduring. We hear of saints of the Middle Ages who inflicted what now seem hideous self-tortures on themselves and not only bore them bravely but went about life smiling and doing good to others while they were under the influence of them. It would seem quite impossible, however, for people of the modern time to get into any such state of mind. Our discoveries for the prevention of pain have made it unnecessary to stand much suffering, and as a result mankind would seem to have lost some if not most of the faculty of standing pain. So little of truth is there in any such thought that any number of the young men of the present generation between {122} twenty and thirty, that is, during the very years when mankind most resents pain and therefore reacts most to it, and by the same token feels it the most, have shown during this war that they possessed all the old-fashioned faculty of standing pain without a whimper and thinking of others while they did it.

Lack of advertence always lessens pain and may even nullify it until it becomes exceedingly severe. In his little volume, "A Journey around My Room", Xavier de Maistre dwells particularly on the fact that his body, when his spirit was wandering, would occasionally pick up the fire tongs and burn itself before his _alter ego_ could rescue it.

Concentration of attention on some subject that attracts may neutralize pain and make it utterly unnoticed until physical consequences develop. Undoubtedly dwelling on pain, antic.i.p.ating it, noting the first sensations that occur, multiplies the painful feeling. The physical reasons for this are to be found in the increased blood supply consequent upon conscious attention to any part, which sensitizes the nerves of the area and the added number of nerve fibers that are at once put into a.s.sociation with the area by the act of concentration of the attention. These serve to render sensation {123} much more acute than it would otherwise be. It might seem impossible to control the attention, but this has been done over and over again, even in the midst of severe pain, until there is no doubt that it is quite possible. As for the increase of pain by deliberate attention, that is so familiar an experience that practically every one has had it at some time.

The reason for it has become very clear as the result of our generation's investigations into the const.i.tution of the nervous system. The central nervous system, instead of being a _continuum_, or series of nerve elements which are directly connected with each other, consists of a very large number of separate individual cells which only make contacts with each other, the nerve impulses flowing over across the contact. The demonstration of these we owe originally to Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was awarded some years ago the n.o.bel Prize as well as the Prize of the City of Paris for his researches.

In connection with his surprising discoveries as to the neurons which make up the brain, he suggested the Law of Avalanche, which would serve to explain the supersensitiveness of parts to which concentrated attention is paid. {124} According to this law, pain felt in any small area of the body may be multiplied very greatly if the sensation from it is distributed over a considerable part of the brain, as happens when attention is centered upon it. A pain message that comes from a localized area of the body disturbs under normal conditions at most a few thousand cells in the brain, because the area is directly represented only by these cells. They are connected however by dendrites and cell branches of various kinds with a great many other cells in different parts of the brain. A pain message that comes up will ordinarily produce only disturbance of the directly connected cells, but it may be transmitted and diffused over a great many of the cells of the cortex of the brain if the attention is focused strongly on it. The area at first affected, but a few thousand cells, may spread to many millions or perhaps even some hundreds of millions of them, if the centering of attention causes them to be "connected up", as the electricians say, with the originally affected small group of cells.

It is just what happens in high mountains when a few stones loosened somewhere near the top by the wind or by melting processes begin their course down the mountain side. {125} On the way they disturb ever more and more of the loose pieces of ice and the shifting snows as well as the rocks near them, until, gathering force, what was at the beginning only a minor movement of small particles becomes a dreaded avalanche, capable not only of sweeping away men in its path but even of obliterating houses and sometimes of changing the whole face of a mountain area. Hence the expression suggested by Ramon y Cajal of the Law of Avalanche for this wide diffusion of sensation, which spreads from a few thousand to millions or billions of cells, and from a rather bearable pain becomes intolerable torture, as a consequence of the brain's complete occupation with it.

Now it is possible for most people, indeed for all who have not some organic morbid condition, to control this spread of pain beyond its original connections, provided only they will to do so, refuse to be ruled by their dreads and proceed to divert attention from the painful condition to other subjects. Here is why the man who bravely faces pain actually lessens the amount that he has to bear. There is no pain in the part affected. That we know, because any interruption of the nerve tract leading from the affected part to the brain {126} eliminates the pain. In the same way, the obtunding of the nerve cells in the cortex by anaesthetics or of the conducting nerve apparatus on the way to the brain by local anaesthesia, will have a like effect.

Anything then that will interfere with the further conduction of the pain sensation and the cortical cells directly affected will lessen the sense of pain, and this is what happens when a man settles himself firmly to the thought that he will not allow himself to be affected beyond what is the actual reaction of the nerve tissues to the part.

As a matter of fact, the antic.i.p.ation of pain due to the dread of it predisposes the part to be much more sensitive than it was before. We can all of us readily make experiments which show this very clearly.

Ordinarily we have a stream of sensations flowing up from the surface of the body to the brain, consequent upon the fact that the skin surface is touched by garments over most of the body, and that our nerves of touch respond to their usually rather rough surface. We have learned to pay no attention to these because we have grown accustomed to them, though any one who thinks that they are negligible should witness the writhings of a poor Indian under the stress {127} of being civilized when he is required to wear a starched shirt for the first time. Ordinarily Indians have learned to suppress their feelings, but the shirt with its myriad points of contact, all of them starchily sc.r.a.ping, usually proves too much for his equanimity, and he wiggles and twists to such an extent as shows very clearly that he is extremely uncomfortable. Most people have something of the same feeling the first day that they change into woolen underclothes after they have been wearing cotton for months, and the sensation is by no means easy to bear with equanimity.

Ordinarily from custom and habit in the suppression of feelings we notice none of these contact sensations with their almost inevitable itchy and ticklish feelings, though they are constantly there, but we can reveal them to ourselves by thinking definitely about any part of the body. Such concentration of attention at once brings that part of the body above the threshold of consciousness, and we have distinct feelings there that we did not notice before. If for instance we think about the big toe on the left foot, immediately our attention is turned to it and we note sensations in it that were quite unnoticed before. We can feel the stocking touching any part of it {128} that we think of. Not only that, but if we concentrate attention on a part most uncomfortable sensations develop. If anything calls our attention even to the middle of our backs, we find at once that there is a distinct sensation there, and this may become so insistent as to demand relief.

It is well understood now what happens in these cases. As we have said, the attention given to a part leads to a widening of the minute blood vessels located there so that the nerve endings to the part are supplied with more blood and therefore become more sensitive. We know from experience in cold windy weather that when the cheek is hyperaemic the drawing of a leaf or even of a piece of paper across it may produce a very acute painful sensation. Hyperaemia always makes parts of the body much more sensitive than before. Attention has just this effect over all the surface of the body, as we can demonstrate to ourselves. We can actually, though only gradually, make our feet warm by thinking about them, because the active attention to them sends more blood to them. The dread of pain then, by concentrating attention on the part beforehand, actually increases the pain that has to be suffered and makes the subject {129} ever so much more sensitive.

Sensitiveness is of course dependent on other factors, as for instance lack of outdoor air and of oxygenization, which actually seems to hypersensitize people so that even very slight pain becomes extremely difficult to bear, but the question of attention, which is after all almost entirely a voluntary matter, has more to do with making pain harder to bear than anything else.

In the preanaesthetic days, men have been known to sit and watch calmly an amputation of one of their limbs without wincing and apparently without undergoing very much pain. Many are the incidents in history of a favorite general who showed his men how to bear pain by calmly smoking a cigar while a surgeon amputated an arm or a leg or performed some other rather important surgery. Pain is after all like the sense of danger and may be suppressed practically to as great a degree. Once during the present war, when long columns of soldiers going to the front had to pa.s.s by the open market place of a town that was being sh.e.l.led by the Germans, there was danger of the troops losing something of their morale at this point and of confusion ensuing. It would have been disturbing both to discipline and the {130} ordered movement of the troops to divert them by narrower streets, and the sh.e.l.ls, though dangerous, were not falling frequently and not working serious havoc. Every one knew, however, that the German gunners had the range, and a sh.e.l.l might land square in the market place at any time; thus there was a feeling of uneasiness and a tendency to nervous lack of self-control, with the inevitable confusion of movement afterwards. One of the French generals ordered an armchair to be brought out of one of the houses near by, took a position in the center of the square, with a little wand in his hand, and calmly joked with the soldiers as they went by about the temperature of the day mentioning occasionally something about a sh.e.l.l that happened to strike not far away. According to the story he was an immense man weighing nearly three hundred pounds, and so provided a very good-sized target for sh.e.l.ls, but he was never touched and, almost needless to say, the line of soldiers never wavered while their general sat there joking at the danger.

It is sometimes thought that men in the older, less refined times could stand pain and suffering generally much better than our generation which is supposed to have {131} degenerated in that respect. We have found, however, during the war that the soldiers who could stand supreme suffering the best were very often those who came from better-to-do families, who had been subjected to the most highly refining influences of civilization, but also to that discipline of the repression of the emotions which is recognized as an important phase of civilization. Strange as it may seem, the city boys stood the hardships and the trials of trench life better than the country boys and not only withstood the physical trials but were calmer under fire and ever so much less complaining under injury. After all it is what might be expected, once serious thought is given to the subject, and yet somehow it comes as a surprise, as if the country boy ought to be less sensitive,--as indeed he probably is; but he lacks that training in self-control which enables the city boy to stand suffering.

All our feeling that human nature has degenerated in physical const.i.tution has been completely contradicted by the reaction of our young soldiers to camp and trench life. They have gone back to the lack of comforts and conveniences of the pioneer days and have had to submit to the outdoor life and the {132} hardships that their pioneer grandfathers went through and have not failed under them. The boys have come out of it all demonstrating not only that their courage was capable of supporting them, but with their physical being bettered by the conditions and their power to stand suffering revealed in a way that would scarcely have been believed possible beforehand.

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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 {134} 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 {135} 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 a.s.sociated 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, {136} disappear promptly when they begin to exercise more in the open.

Nothing dispels the gloom and depressions consequent upon an acc.u.mulation of cares and worries of various kinds like a few weeks in the woods, where every moment is pa.s.sed 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 {137} 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 appet.i.te and the general feeling of physical la.s.situde 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 {138} 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 Sat.u.r.day afternoon, but every day in the year. Many of them, if they walked two and three miles to {139} 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, b.u.mping car, hanging to a strap, crushed and crowded by people getting in and out. The effect of coming home under such circ.u.mstances 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 pa.s.s in the course of a few days and be replaced by a healthy feeling of satisfaction {140} that would be well worth all the effort required. We should need ever so much less medicine for appet.i.te 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 princ.i.p.al 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 {141} 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 {142} 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 {143} 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 acc.u.mulating 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 a.s.sert 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 pa.s.sed 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 {144} cooler weather will create an appet.i.te 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 advertis.e.m.e.nts 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 ma.s.sage 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 {145} 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 {146} 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 {147} 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 pract.i.tioner 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.

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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 appet.i.te 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 appet.i.te 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 {149} 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 quant.i.ty and variety as is necessary to maintain health and strength in the particular circ.u.mstances 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 {150} peculiarity; and thus it is not surprising that they should have it. A careful a.n.a.lysis 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 const.i.tutional 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.