The Morning Hours





In getting the history of patients for diagnostic purposes the safest

way is to begin with the getting up in the morning and then to follow

out the various actions of the day. The hour and mode of rising should

be inquired into. Practically all nervous people, and nearly all those

beyond middle life, feel less fit in the morning hours than at any

other time in the day. Apparently as a consequence of their will

having been allowed to lose its hold during sleep, it does not secure

thorough command over the organism for some time. Nervous people, as a

rule, wake up with a tired feeling, a dread of the day, wondering

whether life is worth living. They dread--for it is a real dread--to

get up and tackle the daily round of life once more.



If they have nothing very definite to do, then slight tired feelings

or discomfort, even of very minor degree, may lead them to think that

they cannot get up. Any yielding in this matter is almost sure to do

harm. When there are no objective signs, that is, when there is no

fever recognizable by the thermometer and there has been no diarrhea

or any physical weakness, nervous patients should get up promptly at a

particular hour every morning, because, as a rule, within a half hour

after getting up they feel better, and by the time they are washed and

have had their breakfast, life has grown not only quite possible but

even plausible, and the day's work does not seem such a nightmare as

it was at first. It is not advisable to tell people all this as soon

as they confess their habit of dawdling in the morning, for they must

be gradually brought to discipline themselves. The detail emphasizes

the necessity of knowing how they get up as well as when.





Mode of Awaking.--It is often valuable to know how patients awake.

Sometimes it will be found that they are anxious and solicitous to be

at work at a particular hour, or to catch a train at a particular

time, and that as a consequence their sleep is disturbed in the early

morning hours. At best it may be fitful and when they awake they fear

to go to sleep again lest they oversleep. An alarm clock will

sometimes remedy this state of affairs. Better still is an arrangement

by which someone, who can be depended on, will wake them at a

particular time. Occasionally patients cannot content themselves in

spite of the assurance that they will be waked. They dread that the

alarm clock may not go off, or that the awakener may make a mistake,

and so they go to bed with a dominant idea, which is more or less

constantly present in their mind during all their sleeping hours,

disturbing sleep and preventing complete rest. It may be necessary to

insist on a change of occupation for such persons, or a change of

residence that will do away with the necessity for early rising. When

this is done, many a neurotic condition that has before proved

intractable will disappear.





Amount of Sleep.--It is of cardinal importance to know how long

patients sleep. In our large cities most people have too little sleep.

A comparison of the hours when they get to bed with those when they

get up will often show that at least three or four nights in the week

some patients who are complaining of nervous symptoms, especially

nervous indigestion, are sleeping less than seven hours. There

are but few men, and still fewer women, who will retain their health

under such conditions. Some men have been able to do it, but they are

comparatively rare. King Alfred's rule of dividing the day into three

eight-hour periods--one for sleep, one for work, and the third for

bodily necessities and recreation, still remains the best for human

nature. Whenever people try to live the strenuous life and get along

on less than eight hours of sleep, they are almost sure, sooner or

later, to render themselves uncomfortable, to make themselves liable

to all sorts of neurotic symptoms and, above all, to detract from

their efficiency for whatever work they are engaged in. Whether they

sleep or not, they should be in bed for nearly eight hours.





Bathing.--Morning Bath.--In our larger cities at least, many of the

inhabitants begin the day with a bath. In this matter one finds all

sorts of harmful fads that need to be corrected. Many men take a cold

bath, and unless they are particularly strong and vigorous, this is

rather an exhausting experience for the beginning of the day, when the

last nutrition the body absorbed is twelve hours before. On the other

hand, large, athletic men who manufacture a great deal of heat, their

muscles--the heat-making organs--being well developed, will be

benefited by having a cold bath because of the abstraction of heat

that it involves. It is not, however, infrequent to find that the man

for whom it will be good is not taking it, while the thin, neurotic

individual, already exhausting more of his vitality by worry and

dieting and in various fads with regard to his health than is good for

him, is regularly taking his cold plunge or douche. Unless especially

asked about it, few men give particulars in this matter, yet they are

extremely important.



Women, on the other hand, are likely to take hot baths more frequently

than is good for them. Especially when they have maids to assist in

dressing and undressing, it is not unusual to find that women take

two, and sometimes even three, hot baths in a day. They take them in

the early morning when they first get up, and in the evening before

dressing for dinner. I have known cases where some took a third hot

bath before going to bed and sometimes even put in a fourth before

luncheon in case they had had any exercise in the morning

hours--tennis, or horseback riding, or the like--that made them

perspire. These are details which the physician will learn only if he

asks particularly about them. Until he has actually had the experience

of finding that they play an important role in some ailment he is

almost sure not to think of it. It is probable that even two hot baths

a day are too many. I have known women to begin at once to get better

of neurotic symptoms that before had proved quite intractable, when

their hot baths were limited or when they were changed for a single

warm bath with a cold rub after it in the morning, or sometimes just

before dinner.



Bathing is more liable to abuse than is usually thought to be

possible. While the habits of modern life call for it often, and many

people are quite sure that they would not be healthy without it, the

people who live longest, and who have had the best health far beyond

three score years and ten, have usually not been noted for bathing

proclivities. The human body is composed of nearly seven-eighths

water, and so our cells are constantly bathed in it, but the making of

the whole organism a marine animal once more, as seems to be the

definite tendency of some people, is not nearly so hygienic as

it is often thought to be. Enough bathing for thorough cleanliness,

but not for luxury, must be the rule for people who have active work

and want to retain their health.





Bathing Fads.--While such mistakes are usually made only by the

wealthy and leisure classes, the physician will sometimes be surprised

to find that women who have no maids for personal service are

indulging themselves in these over-frequent bathing practices. They

have heard that it softens the skin and renews youth, or they have

heard that the Japanese take hot baths and are revivified when they

are very fatigued, and so they go to great lengths in bathing. Often

this is the main reason for the relaxation of muscle tissue and the

sense of prostration that has come over them. Neurotic people are

constantly going to extremes. Even delicate women will sometimes be

found to take very cold baths which are surely doing them harm. Over

frequent washings of hands and face are sometimes responsible for skin

lesions, especially if the soap used is one of the varieties so

scented that the manufacturer is enabled to conceal the impurities in

its ingredients. Some women easily run into what is really a

misophobia, an exaggerated morbid fear of dirt, and need to be

restrained from washing themselves over frequently. Many a chapped

hand would be saved by avoiding unnecessary washings, and especially

in warm water just before one goes out, for it leaves the skin without

its proper oily protection.





Clothing.--Then comes the question of clothing. It is curious how

irrationally many people clothe themselves. People complain of cold

hands and feet when they are wearing thin cotton undergarments, and

who need only to have these changed for wool for their feelings to be

at once improved. In the meantime they have been persuaded that they

have a defective circulation. The usual excuse for not wearing wool is

that it produces hyperemia of the skin with itchy discomfort, but

this, as a rule, is only passing and is due to unaccustomedness. The

coarser wools should not be worn by the sensitive. A thin cotton

garment may, if absolutely necessary, be worn next the skin. There is

too little variety in the underclothing that people wear. Some change

from light to heavy weight and only that, but there should be a medium

weight worn, and occasionally, when there is a spell of mild weather

in the winter time, even during the season when heavy weight is

usually worn, medium weight should be substituted for comfort's sake.



It is even more common to find that neurotic individuals, who fear to

catch cold, wear too much clothing, especially around the chest. Very

often they alternate from this during the day to next to nothing in

the evening, and by so doing subject themselves to special risks of

internal congestions. When the skin is covered with too much clothing

it loses the habit of reacting, and the warmth and the irritation of

wool keep up an artificial hyperemia which gradually lowers the tone

of the peripheral vessels. Many people wear "chest protectors," as is

evident from the prominent display of these abominations in the

drug-store windows. By leaving certain portions of the chest

unprotected while other parts are kept over-warm, these add greatly to

the risk of such disturbances of circulatory equilibrium as predispose

to the infections grouped under the term "taking cold." It is not

heavy clothing that keeps people warm so much as the layers of

non-conducting air between the skin and the outer air. It is better,

therefore, to wear three thin garments than two heavy ones

because of the additional layers of air that are thus confined. A

paper vest, if one is driving in the wind, will probably protect

better than the heaviest woolen garment worn. The wearing of chamois

garments is not, as a rule, advisable because chamois does not permit

free access of air and it hampers transpiration.





Before Breakfast.--After dressing comes breakfast, with regard to

which it may be advisable to ask many questions. It is well to begin

with a query as to whether liquids are taken before breakfast. Many

people have taken to the fad of drinking a large quantity of warm

water, sometimes as much as a pint, before breakfast. Surely this

never does any good and, in most cases, just as surely does harm.

Plain water will not dissolve mucus that may have collected in the

stomach, and warm water merely dilates that organ, relaxes its fibers,

and renders the whole gastric digestive system atonic. If cold water

can be borne, it will often be found that a glass of cold water the

first thing in the morning stimulates peristalsis, and serves to

lessen the necessity for laxatives. Many people complain that cold

water is too much of a shock. Usually, if they are reminded that when

we want to warm our hands we rub them vigorously with cold water and

that the reaction after this gives a healthy glow, the effect of the

supposed shock, which was merely an unfavorable suggestion, will

disappear. Sometimes delicate people cannot drink cold water. If there

is any reason to suspect an accumulation of mucus in the stomach, a

small bouillon cup of very hot water, just as hot as it can be

borne, in which a pinch of salt and a pinch of bi-carbonate of soda

have been dissolved will prove an excellent aperitive for the day.

This is physiological and appropriately chemical, as well as naturally

stimulating. Mucus does not dissolve in ordinary water but dissolves

readily in an alkaline salt solution, and this is just what is thus

recommended. This drink is quite grateful to the palate. Indeed, it

tastes very much like clear soup, and, if the eyes are closed, cannot,

as a rule, be distinguished from some of the bouillon commonly served.

I have known this cup of hot water to stimulate an appetite when drug

tonics had failed.



It is better to take the glass of cold water from fifteen to twenty

minutes before the morning meal--say immediately on rising. If,

instead, the small cup of hot water is chosen, it should come

immediately before eating, and will usually prove an appetizer.





Breakfast.--The exact details of the amount of breakfast taken and how

it is eaten should be known. Nervous people eat little breakfast. When

ordered to eat, they find it difficult at first, but the habit is

easily formed, and then they want their breakfast like anyone else. It

is surprising how often physicians will find that nervous persons, who

are under weight, are not taking enough breakfast. They will

ordinarily say that they are eating breakfast about as other people do

and will, perhaps, mention eggs and rolls, but it will be found that

their ordinary breakfast consists of a roll and piece of toast and

coffee, and only occasionally do they have any of the other things

mentioned.



Breakfast is ordinarily the meal which those who work are likely to

eat too hurriedly. Those who are neurotically inclined are especially

victims of the habit. They lie abed until there is only a few minutes

left to get the train so as to reach their place of occupation in

time, and thus their breakfast is skimped. Their oatmeal or

other soft cereal is fairly shovelled in, coffee is gulped, toast is

unchewed, the coffee softening it; if they have creamed potatoes they

are swallowed in such large pieces that, as every physician knows, if

for some reason they vomit they are surprised, beyond all measure, at

the large portions they have been able to pass down into their

stomachs. A breakfast thus eaten makes a bad beginning for a nervous

man's day, and the more that is so eaten the worse for the victim.

With a habit like this, it will be utterly impossible by means of

drugs or directions as to diet to relieve the discomfort of neurotic

indigestion, or to keep the patient from suffering that stomach

discomfort so often complained of in the morning.





Working Women.--Working women are even more prone than are men to take

a hurried breakfast, and having, as a rule, less appetite than men,

their meal is likely to be deficient. It is not unusual to find that a

young woman who is under weight and who needs three meals a day, is

taking so little for the first meal that even she hesitates to regard

it as a meal. Very often her last previous meal has been taken before

seven o'clock the night before, so that she goes out ill prepared for

her day's work. Much more than men, women are annoyed in the morning

by our transportation systems, and by worry as to whether they will

get to the office on time. Suggestions as to the modification of this

unfortunate routine, the taking of an earlier train, the using of a

quiet local instead of a crowded express, a short walk at least before

taking the train, will often help in producing a marked change in the

general health.





Home Keeping Women.--For those who really have homes, the morning

duties are usually sufficient to rouse their activities and make them

begin the day well. For those who live in apartment-hotels, however,

and for those who have the luxury of many servants, the morning hours

are often a serious problem. Madame does not get up, or if she does,

it is only to lie around in dressing gown for most of the morning.

Breakfast is easily neglected or may be eaten hurriedly because the

head of the house is rushing to business. The lack of an incentive

requiring them to rise, and get outside for a time every morning, is

probably at the root of more feminine symptoms among leisure class

patients than anything else. As we grow older all of us are likely to

note the lowered physiological cycle of the morning hours, so that

unless there is some sharp reason to compel action, we are rather

prone to persuade ourselves that it is better to lie abed, or at least

to loll around. This leads to a concentration of attention on self and

on one's feelings that easily gives rise to neurotic conditions.





Interest in life.--In my special clientele I have often found that

going to church in the early morning hours was an excellent remedy for

many of these patients. It gives them a definite reason for rising

promptly, the service provides motives to rouse them to activity, they

are likely to think during it of how they shall make their life a

little bit more livable for others as the result of their trying to be

better, and so the apathy that is so fruitful of ill feeling is shaken

off. This can only serve for those who have faith in the service. For

others, the old-fashioned going out to market, or the making of

appointments at morning hours that will tempt them to regular activity

early in the day, is of special significance. It is always ominous for

health when a woman can look forward to a whole long day without any

particular duties in it until the late afternoon or evening

hours. This has become so frequently the case for the women of our

large cities, particularly those who live in apartment hotels, it is

no wonder that neuroses and psychoneuroses of various kinds have grown

in frequency. The best prophylaxis for them is occupation of mind. The

cure for them is the securing of many interests and such diversion of

mind as will prevent concentration of attention on self.





Mail Before Breakfast.--Many people receive their most important mail

in the early morning, and personal mail, in cities especially, is

likely to be placed beside the breakfast plate. Not infrequently,

letters contain serious matters that are likely to disturb people, and

occasionally even important business finds its way to the side of the

plate at breakfast time. Authors often find their rejected manuscripts

sent back in the morning's mail. Occasionally bad news of other kinds

comes in this way, and, as a rule, it is the very worst time for its

reception. The human system--it cannot be too often repeated--is at

its lowest physiological term in the morning, the temperature is lower

than during the rest of the day, all the nervous vitality is below the

normal. Half an hour after breakfast the reception of bad news, or the

coming of important matters requiring decision, would not make so much

difference. Hence, the necessity for knowing whether the mail is

ordinarily read in the early morning, in order to know something about

people, and about the consumption and digestion of their breakfast.





Company at Breakfast.--Pleasant company during meals is an important

factor that makes for good digestion. At the other meals there is much

more likelihood of having such pleasant company, while the morning

meal is often a solitary, and quite as often as not, a rather glum

quarter of an hour, preoccupied with the business cares of the day. As

may be readily understood from our discussion of this problem of

mental preoccupation during digestion, this may seriously hamper

digestive processes. Often men take refuge in their paper. The

thoughts aroused by reading the modern newspaper are not the

pleasantest in the world and consist, very often, of the following out

of details of hideous crimes and scandals. When, as is sometimes the

case, these scandals concern relatives, friends or acquaintances in

whom we are interested, and with regard to whom we feel poignantly

because of the publicity involved, nearly the same effect is produced

as when bad news is received in letters, or when business worries are

thus brought to the breakfast table.



The best conditions for the eating of breakfast are those in which it

becomes like the other meals, a family matter. When father, mother and

children eat their breakfast together, nearly always family interests

and especially the enlivening effect of the joyousness with which

children face a new day is the best possible tonic for a business man

in whom a solitary breakfast starts a day of digestive disturbance.

Sociability and sufficient time must be insisted on, whether at home

or in a boarding house, at breakfast as well as the other meals, and

it will often be surprising to find how much difference this makes

both as regards the quantity eaten and the digestion of the food.





Morbid Habits.--In matters of diet, it is important to ask for

details, for it is surprising what unexpected things may be discovered

after weeks of treatment. That was illustrated for me once by a case

of persistent acne in a young girl, which all the ordinary remedies

failed to cure. I felt sure that I had given her such explicit

directions with regard to diet that I knew exactly what she was taking

and that nothing could be hoped for from any change. As a last resort,

I asked once more with regard to all that she ate and only then

discovered that before breakfast every day she ate a baked banana. It

had been recommended to her by a friend as a sure cure for

constipation, she had formed the habit of taking it as a medicine, and

so had not spoken of it. Baked bananas agree with many people well,

but just as soon as this was eliminated from her diet her acne began

to improve and before long had disappeared almost entirely. The taking

of large amounts of warm water, already spoken of, is another of these

morbid habits. Then many people take a glass of salt water, or

laxative water, and some have curious habits with regard to the eating

to excess of salt on cereal or on fruit, or sometimes they eat too

great a variety of fruit. All this should be known, but often will not

be ascertained unless particularly inquired about.





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