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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

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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