How to keep fit : a series of special lectures to young men delivered at the Central Y.M.C.A., London

Front matter

SIR DYCE DUCKWORTH, Bart., M.D., F.R.C.P.

SIR R. DOUGLAS POWELL, Bart.. K.C.V.O., M.D. SIR GEORGE HENRY SAVAGE* M.D., F.R.C.P. JAMES CANTLIE, M.A., M.B., F.R.C.S., D.P.H.

LONDON

Preface

This volume- contains a series of Lectures delivered at the Central Y.M.C.A., London, by the seven eminent doctors whose names appear under the various subjects. Through their individual permission, and through the kindly courtesy of Mr. Clarence Hooper, we are enabled to produce them in volume form, and at a price which we trust will finally widen their publicity and consequently their influence. Our thanks are also due to the Society for Promoting Christian Knowledge for the sanction to use the address on Chastity by Sir Francis H. Champneys.

It will be noticed that the style is informal and conversational throughout, and it has been deemed best to publish them in this form.

Jarrold & Sons.

Contents

NO. PAGE

1. Alcohol in Relation to Health ... 9

W. McAdam Ecci.es, M.S., M.B., F.R.C.S.

II Diet

By Sir Robert William Burnet, M.D., F.R.C.P., J.P.

Mr. Chairman and Gentlemen, — When your Secretary asked me to give one lecture of this medical course in relation to the subject of how to keep fit, it occurred to me that some points as practical as possible in connection with the subject of Diet might be useful. In asking me to undertake this, he intimated that a set lecture was not required — in fact, I understand, was not desired — and that it should be informal and conversational. I have taken full advantage of that condition, and I hope, therefore, that you will not expect the subject to be presented in exact, systematic ways, and that you will bear with any repetitions that must necessarily occur under the circumstances.

The subject of this course of lectures, “How to keep fit,” implies good digestion, and, first of all, I will ask you to go back in thought to your physiological studies, and I will enumerate a very few points in regard to foods. We may define food as everything that contributes to the maintenance of the body in life and in health. That must necessarily include water and air. The use of food opens up a very complex subject. The chemistry of the body is very complex, and the processes are very subtle. Some of these processes are gradually opening up to us year by year, and progress is being made in that direction; but still, many of them, as I say, are complex, some of them elusive. We have to take into consideration much more than the mechanical processes. There is the individuality, the environment, the action of the nervous system, and the influences that the surroundings of a man have upon him. It is very easy in the laboratory to follow some of the processes in a test tube. The test tube has no nervous system ; the test tube is not subject to outside influences. But when we come to the individual we have to remember that there are many more things than the mere mechanical processes.

The uses of food may be said to be first of all the formation of tissue. That is chiefly in youth, when building up of the body takes place. Next, there is the renewal of tissue. That, of course, takes place throughout all our lives, but is very active in youth, active in middle age, less active in old age.

Secondly, the food is necessary for the supply of force. All functions of the body, voluntary and involuntary, mean an expenditure of force. Food, certain portions of the food, are necessary for the supply of the energy for these functions. And, thirdly, there is the production of heat. Man, as a warm-blooded animal, has to keep up a certain temperature. It is very remarkable how little that temperature actually varies. We may feel hot, we may feel cold, but if we are well no fever process is going on, and if no depressing influence is at work, the temperature of the body remains practically, as

DIET you know, about 98J degrees. That means, of course, that there are, in some circumstances, methods of getting rid of the superfluous heat, and all along it means that there is a process of combustion going on in the body; that the oxygen of the air in combination with the tissues of the body is producing this combustion, and that means waste, waste graduated and different under different circumstances — excessive under certain conditions, slow and slight under other conditions. Thus, without going into any deep discussion about foods we may divide them into four classes — first of all, the nitrogenous, or albuminoid foods — meat, chiefly, also found in all cereals and grain ; secondly, carbohydrates, or starches and sugars — potatoes, bread, sago, tapioca, all the farinaceous foods we eat; thirdly, the hydrocarbons, as they are called, that is chiefly fats, oils, and so on ; and fourthly and lastly, salts, and water. By salts we mean not only minerals that are found separate, but salts found in vegetables, and in many other foods.

Now, what we would call a well-balanced dietary, means that these elements are in proportion, in due and proper proportion, with regard to the age, the circumstances, and the surroundings of the individual. An unbalanced, or expensive, wasteful dietary contains some of these elements in too large proportion, and others in very reduced proportions ; but a well-balanced, suitable dietary of health means that the requirements of the system are met by a due proportion of these different elements of food, varying again, we must admit, under the

HOW ro KEEP FIT conditions of life. In active life the waste-repairing food is more needed; in sedentary life less needed, in youth much needed, in old age much less required. Now for the building up of the tissues of the body, chiefly for the repairing of the waste material, the albuminoid foods, that is to say, meat, grains, and all those foods containing a large proportion of nitrogenous matter, are necessary. These albuminoid foods are, as I said before, much more required during the process of growth. It is when growth and activity are at their highest, in the early years of youth, that these foods come in most usefully. In youth it is not only the building up of the body that requires it, but it is the activity, the constant activity, which gradually lessens as life goes on. Life cannot be sustained for any length of time without these nitrogenous or albuminoid elements in the food. A non-nitrogenous diet will not sustain life, but, on the other hand, the non-nitrogenous elements are valuable for the production of force, and for the maintenance of heat.

We will take an extreme instance in relation to the maintenance of heat. Take the food of those who live in very cold climes. In the Arctic regions, we will say, they chiefly live on meat and fats, whereas the natives and the inhabitants altogether of tropical climates require next to no meat, and little fat, but live on grain, chiefly rice and other grain. For the supply of force the combined elements of the food are necessary and desirable, not one food only; and for heat, as I said already, the fats. We have ample evidence from investigations, I think, that a mixed diet is, on the whole, by

DIET far the best for man. A vegetarian diet will support life, but it is an expensive diet in some ways. That is to say, there are large proportions of some kinds of food in it, and too small proportions of others. At the same time, a vegetarian diet admittedly will not only sustain life, but admit of a great deal of energy ; and, in passing, I would say that I think we, as a people, probably eat far more meat than is necessary. But meat is a rather inviting dietary. It gives a feeling of well-being, a sustaining feeling, a feeling of exhilaration compared to other foods, and therefore it is a somewhat tempting thing for us, as a nation, to consume a larger quantity of meat than is really necessary for the requirements of the body. I am not speaking now of the conditions of the body when an individual is out of health, or I would point out to you that a dietary consisting largely of meat is often not only unnecessary, but dangerous. That is to say, when the eliminative processes of the body are defective, then waste material comes to choke up many of our organs. But meat is not only a stimulating diet, it is a satisfying diet ; the feeling of well-being lasts some time, and the appetite does not return so soon after a meal consisting largely of meat as it does after a meal consisting of farinaceous or other foods.

Then I would offer a few observations on the question of digestion. You cannot keep fit unless your digestion is right. There are many ways in which we may make mistakes about our food. Observations that were able to be taken many years ago in the case of a man who had a gunshot wound, and whose stomach never quite healed up.

led to the discovery of a good many points in relation to the length of time that foods take to digest. The observations were most carefully made by a Canadian doctor and have stood the test of time. They only show, of course, how long it took the stomach to deal with certain foods, but that was an important point, though, at the same time, he could not follow out the secondary processes, namely, what took place after the food left the stomach, and, of course, we could not be told what share the other juices of the body had in the effects.

Four essential points may be mentioned as being necessary for the healthy action of the stomach. First of all, it must be implied that the coating of the stomach, the mucous membrane of the stomach, is healthy ; secondly, that there is a due supply of healthy gastric secretion — gastric juice we call it; thirdly, that the nervous system is not overwrought, that there is sufficient nerve power ; and fourthly, that there is muscular power of the stomach sufficient to create movements required for the complete digestion of the food. As regards the healthy mucous membrane, that goes without saying in health. I mean that we cannot be fit without the mucous membrane, throughout the body, being healthy. A due supply of gastric juice is also assumed in all healthy individuals of ordinary calibre. If these four conditions are present, the comparative digestibility of food depends largely on mechanical conditions which promote or retard the action of the secretions.

That brings us first to the subject of cooking.

DIET

Cooking, bad cooking, is responsible not only for a lot of indigestion, but for a lot of unfitness in many individuals. Cooking alters the meat in some way; bad cooking alters it in a wrong direction. That is to say, it retards the action of the juices of the stomach upon it ; whereas, when meat is properly cooked, it is more digestible, and better fitted for the action of the gastric juice.

Next to cooking I should put mastication as an important point in regard to digestibility. Unless the food is thoroughly masticated it takes much longer to digest. Mastication implies the breaking up of the food — not only the breaking up in the mouth, but it implies the mixing of the food with the saliva, which itself has an important action upon all the starchy and sugary portions of the food. The meat portions of the food are also finely divided. Now we know perfectly well if we take a solid piece of meat and put it in a test tube with a certain amount of hydrochloric acid and a certain amount of pepsin, we will get the surface of that piece of meat quickly affected by the acid and the pepsin, but it will take a long time, a very long time to penetrate to the centre of that portion of meat, whereas, if the meat is put into the test tube in finely divided particles, the surface area exposed to the reaction of the acid and of the gastric juice, or pepsin, is immensely increased, and the rate of digestion is thereby very largely improved ; it digests very quickly. So it is with the stomach. Unless the food is finely broken up, finely triturated by the teeth, it takes a much longer time; in fact, in some cases it does not digest at all, and that is why many substances which are wholesome enough in themselves are very slow and difficult of digestion. All substances that tehd to clog, to make masses, such as badly baked pastry, tough meat, gristle, all those things take a very long time for the gastric secretions to act upon them.

Next I would put mental conditions. We all know that cheerfulness is an immense help towards good digestion. Solitary meals are bad, and reading at meals is a bad thing, and cheerfulness with meals is an immense help towards good and easy digestion; also regularity of meals. We are not meant to go too long without food, especially those of us who have to work in cities. You must have all noticed — we all, I think, have observed it in ourselves — that in the country on a holiday, or when in the open air continuously, we do not get exhausted soon. You may be hungry. We are hungry, as a rule, because we have got more oxygen, and more ease, and so on, but there is not the same exhaustion that there is in the life in town ; and the town life, looking at it as we have to do, requires, if we are going to keep fit, regularity, as far as possible, with meals.

We are very much, in regard to diet, creatures of habit. Some people, however, can go much longer without food than others, without feeling any faintness or sinking; others cannot. But, as a general rule, the old-fashioned plan of three meals a day is not a bad one. That is to say, an interval of four to five hours between meals. That allows for the digestion of most foods. It has been calculated from the observations already mentioned, and

DIET from other observations, that an ordinary meal is digested, liquefied, and passes from the stomach in about three hours and a half. Then there comes a short period of rest, and at the end of four and a half to five hours we are ready, ought to be in health ready, for the next meal.

Now we are apt, as I said, to make mistakes about our diet, more from ignorance and carelessness than from wilfulness, but we do make many mistakes about diet. One common mistake is that whereas in boyhood we were able to consume an almost unlimited amount of plain food, we are apt to carry that on. Appetite remains. We are apt to carry it on, without thinking perhaps, into middle life, whereas our activity is very much lessened, our growth has ceased, and our needs, especially for the same portions of the food, are very much less than they were in youth. I have seen many cases in which bad effects have followed the change from a country life to city life without modifying the diet. I do not mean to say that we do not require very regular meals, and very sufficient food in doing the work we have to do in cities, but we do not require the same amount of the nitrogenous foods that we did. We have not the same activity, the same open-air life, the same opportunity of oxygenation. We are not bodily active as we were then, and many a man suffers from the change — and the young man especially — from the change of a hard, activeexercise life to a more or less sedentary one, unless he is on his guard to somewhat simplify his diet, and to be particularly careful that he does not bolt his food, c

I have in my mind instances of men who, having gone through a hard training (say for rowing, or for other sports) did not recognise the fact that they did not require the amount of food, of meat especially, that they had been taking these days of training, did not lessen the quantity, and they did not suffer primarily from indigestion, but suffered from other conditions which led to a comparative failure of health for a time at least. There is always a margin. Nature is long-suffering, but she is implacable, and in the end we pay for carelessness by disorganised health. So I would say here to you — how to keep fit is to pay careful attention to diet, to regularity of meals, to simple food, to slow eating, to full mastication of food, and other points that I will come to presently. We make mistakes very often, too, in the selection of our food. If we would bear this in mind — I am speaking again to myself and to all of you who have to lead a life in the city, and not in the country : if we selected the simple foods, the well-nourishing foods, the plainly cooked foods without sauces, without condiments, without things that create an artificial appetite, but kept to the plain, simple, wholesome foods, and ate them slowly, we should keep our digestions in much better condition.

That implies also that the hurrying of meals is very bad. For two reasons. First of all that it means imperfect mastication of food — swallowing the food in, more or less, large pieces — and that the mental attitude is wrong. Then, as far as possible, we should endeavour to always ease off a little before meals. A very few minutes may make all

DIET the difference, but a man sometimes rushes straight from his work and sits down and expects to digest a full meal. Without the slightest pause or rest he will come down in a hurry and attack his food. And standing up lunches are very bad. Another thing that I have found in experience in my work is that people make a great mistake in taking too much liquid with meals. We require in the twenty-four hours a certain amount of liquid to keep in solution the waste material, and to aid in the excretion of the waste material, constantly accumulating in the body, but we do not want much of that liquid at meal-times. If you will think for one moment what it means, the common sense of it is this. We have got a certain amount of gastric juice at each meal. It varies in individuals, and varies in the same individual at different times, in different circumstances ; but, take it as a whole, we have a certain amount of gastric juice secreted that is capable of acting upon our food fairly well, but if you dilute that gastric juice, say a hundred times by copious draughts of water, or of any fluid, tea, coffee, any thing you like, dilute it too much, and you immediately get very slow digestion, imperfect digestion, fermentation of the food, acidity, and all the troubles of flatulence and discomfort, constipation and other evils.

So that with many people who are leading, more or less, a sedentary life it is a very useful protection to drop soup at the beginning of a meal, especially those who want to keep hard and fit. Soup is an ideal beginning to a meal, theoretically, because it presupposes an active condition of the stomach — that is, the mucous membrane is like a sponge, ready to absorb any wholesome liquid food that is given to it — and that thus, by taking a small quantity of soup, you stimulate the stomach to more active secretion of gastric juice. That is very well in theory, and it is well enough in practice in many people, but those who are not ideally strong in digestion, and who are not leading;^an active, open-air life, very often find that they are infinitely more comfortable by what I call dry meals. That is to say, very little liquid, and the liquid taken only towards the close of the meal ; and for any who are, more or less, in training, or wanting to keep very hard and fit, dry meals, comparatively dry meals — I do not mean necessarily exclusive altogether of liquid — are of very great help. I was met by an answer once when I advised that to a man. He looked at me, and he said, “I never was a dry feeder,” and I am afraid he had not been, but his liquids were not quite always of the most simple kind.

Of course, in coming to the question of, more or less, keeping fit, of training, of getting into training, we must presuppose the four essential conditions of digestion that I have already mentioned, and in addition to that I think the avoidance of much fluid with meals, and not attempting to do too much, or much at all, before breakfast in the morning will be a very great help in training. Men often make a very great mistake by beginning the day with hard exercise before having food. Very few people can stand that. There are a few who seem to be better for it, can do a hard run, or

DIET a long walk, or a row, or something strenuous, with no food in the morning, but, as a general rule, taking the average man, a good English breakfast before hard work is not at all a bad thing; in fact, it is a necessary thing.

I think another mistake that we make is that we have very much dropped two simple articles of diet — I mean wholemeal bread and porridge. I know quite well that many people cannot, or think they cannot, eat oatmeal porridge; but for growing youths and for young men well-boiled oatmeal porridge is an excellent article of breakfast diet. The custom has been lately to have nearly all very refined flour made into bread. That is a mistake. To get the very finest colour, the flour is not always free from adulteration, and, on the other hand, the less-refined flours contain a great many elements that are extremely useful, both stimulating to the stomach and to the mucous membrane of the bowels, that tend to obviate constipation, that tend to increase the nourishment of the food, and that altogether act in a helpful way in the processes of digestion.

Another thing, I think, that we make a mistake in very often is having next to no lunch. Many men make a mistake in that way. It is quite true that men who are busy cannot well digest a heavy meal in the middle of the day, but there ought to be something substantial — especially for young men. A bun and a cup of coffee is hardly sufficient for the young man to go on from breakfast till evening. At the same time, I think many would be better to confine that meal to one course. Let it be fish, or meat and vegetables, without attempting to add a second course, or a third course to that, but let it be something substantial, and let it not be hurried, let it not be bolted, let it be masticated carefully, and let there be a small interval before the meal, and, if possible, after the meal, before active, mental, and bodily exertion are resumed.

Another caution I give in regard to keeping fit, is to avoid meat teas. That is to say, tea with the evening meal. It is against all reason. It is rather a popular meal in some quarters, but it is against all principles of dietetics. The tea with meat delays the digestion. I am not going into the question of the action of tannin on meat, but we know that there is in all tea, however good, a certain proportion of tannin, and we know that tannin is useful in the making of leather.

Another point, I think, that we are very apt to make a mistake about is the want of sufficient fruit and vegetables in our diet. Variety tends not only to the improvement of appetite, but by the use of fruit and vegetables a great many elements are introduced, that cannot otherwise be had in our diet, and, I think, on the whole, we are, as a people, apt rather to neglect the use of fruit, especially cooked fruits, and also vegetables.

Another point is that, of course, it is absolutely fatal to take any stimulant between meals. That is the most fatal mistake that anybody can make. I am saying nothing on the temperance question. But I would only say one thing — that the man who begins taking stimulants between his meals, or American drinks before his meals, is in a very bad

DIET way, and is certain to suffer badly from the habit. I said before, and I will say again, I think our faults are not so much due to the condition really of our digestive organs, as to our want of thought. It is not that the stomach suggests to us unwholesome foods, but we do not think about them, perhaps rather like them, and we take them, whereas we have to consider carefully what we are going to get most nourishment out of, with least trouble, always provided in keeping ourselves fit that we are having plenty of air, and a sufficiency of exercise.

With these precautions, and with a simple diet, without hurrying meals, without drinking much at meals, all ordinary men ought to keep themselves fit. And I would only say, in conclusion, that it is not so much the kind of food, so long as it is wholesome and simple, as the way the food is taken, the circumstances under which it is taken, the extraordinary combinations made, that upset the digestion, and keep the individual from being “fit.”

Ill

By Sir Dyce Duckworth, Bart., M.D., F.R.C.P.

I REGARD it as a privilege to be asked to address you this evening. I know something of the value of this Association, although this is the first occasion on which I have had anything to do with it.

My life-work has Iain in several other lines of duty for the benefit both of the bodies and souls of my fellow-countrymen, and I know that it has been a very full life, the events of which few are aware. My standpoint in such duties as I am engaged in here have been conducted from that of an Anglican Churchman, aloof from all parties, and with such a measure of comprehensiveness as is natural to members of my calling which leads us to deal with all sorts and conditions of men. If I had to choose a title for this address I should best find it in St. Paul’s words — “To the pure, all things are pure.” Here, surely, we are on, ground that all good men and all Christians may stand securely wherever they may be. For those who now listen to me, it may be declared that you have already stepped out into the world and are facing everything that is around you.

In this wilderness of London you see every phase of life amidst the rush and pressure of strenuous lives. Very interesting and engaging, seductive and tempting. It is hard to face it, and for any young man to find his proper place and lead a wholesome, unstained life in it, especially for those who come from smaller and quieter environments. You come here to varying spheres of occupation, and many of you leave happy and innocent homes behind you, and find yourselves much alone, a mere unit in the hurrying crowd of millions of your fellow-creatures. I know by experience what this means. If you have joined this Association, you have certainly done well, and must have been relieved of much of this depressing loneliness. Yes, we have all at one time of our lives to go right out into the busy world, and much depends upon the start we make. A wrong start may at last spell ruin for us. It is hard, and sometimes impossible, to begin afresh after once being involved in going wrong, and there are many ways, alas ! of going wrong.

This evening I am to speak more particularly of one very common way of falling away from the high moral line of conduct which is imperative for every young man in every line of duty which he may take up wherever he is placed. The clean mind is, we shall find, the great safeguard against the evils we are to discuss. Now it is largely the duty of doctors to come to the help of young men who are starting on their life career. It is so because we know more of the real inwardness of matters which tend to render the mind unclean than most people. I am speaking of impurity, and of no other sins (of which there are many, that are both degrading and soul-staining), a sin which is sadly frequent, and one that is, apparently, in the sight of man of much less consequence than other more flagrant sins, such as lying, stealing and other breaches of God’s laws, which are open and more readily recognised than impurity. Sins of impurity appear to go undiscovered, and are often not found out. Men tend often to commit them in secret, and keep them from the knowledge of all whom they love. If there is a hardened conscience, little or nothing of this evil seems to trouble the evil doer. If there is still a sensitive conscience — and thank God if there is — there will remain a sense of shame and disgrace which will eat at the heart of the impure man and embitter his life till he at last mends his way.