This article was written in response to a request from the recent editor of the Proceedings, after he had heard me express myself on the subject of exercise for middle-aged naval officers. In its preparation I am indebted to a number of authors for the ideas I have set forth. I have taken the liberty of quoting some of them almost verbatim because no words of mine could impress as forcibly the truths as they have expressed them. Added to this has been my experience for thirty years as a physician, most of which has been spent in contact with officers of the naval profession. My sole purpose is to help my brother-officers, especially of the middle age, to carry on physically fit as long as possible.
It is entirely pertinent to ask ourselves “What is middle life?” However, it is difficult to be precise in answering. As a general statement let us call it,
that time of life when one realizes the initial appearance of those maladies which influence an individual’s length of life and bear upon the efficiency and well-being of old age.
It is a purely artificial division of life and begins when the organism as a whole has practically completed its development. Numerically we shall make the fortieth year the beginning of middle age and the sixtieth year the end. To be exact in establishing this period is not necessary and I fully realize that some of my friends reading this will feel most upset to think I could class them at forty years of age as middle-agers. Whether they believe it or not the fact remains that they are being ushered into it and it is most important they appreciate that during this age nearly all of the maladies referred to in this article as developing later on in life may be ameliorated or even absolutely prevented if taken care of upon the initial appearance of symptoms in early middle life. Too often, when you neglect these, well-established conditions develop which your medical adviser can only check in progress or perhaps may be restricted solely to bending his efforts at counteracting disastrous effects.
Unless accidents interrupt we shall all grow old and it should be the aim of each one of us so logically and rationally to supervise our middle lives that we render our old age an enjoyable existence instead of chronic invalidism.
I am not forgetting that heredity and environment as factors are somewhat beyond our control, but the good or ill of both can be seriously influenced by our mode of life—ours to regulate to a great degree.
The annual physical examination has as its mission the early detection of disease and, failing in this, the definite establishment of no disease. I do not feel that I “turn traitor to my corps” when I say that not all medical officers take this annual physical examination as seriously as it should be considered. On the other hand many of you who are being examined are even more guilty because you lock within yourselves certain symptoms of which you are definitely conscious. There are several reasons for your neglect but probably the chief one is that bugbear of all eligibles, the selection board. It is commonly accepted that selection boards consider entries in health records very seriously. In consequence, in my opinion, officers’ health records have become a serious detriment to the promotion of good health in the Navy. Of all of my intimate friends in the service I know not one who will not take a chance with any and all symptoms, unless unbearable, to keep off the sick list when the question of selection is considered, unless you include those occasional cases who have retirement as their goal and are willing to stress ailments to satisfy their desire for civil life. I strongly urge a change in this phase of selection board activities and have a suggestion to offer that is only partly original with me. A ranking Medical officer of recognized excellent professional ability should be placed on each selection board whose sole duty shall be to evaluate for the board the medical history of each candidate for selection. Needless to say, the medical officer selected for such duty should be a non-voting member of the board and I also am of the opinion that, where the exigencies of the service will permit, he should be acceptable to the board and his medical report on each individual case respected without controversy. With this foreword I shall now emphasize some of the pitfalls to be avoided.
Exercise—The exercise enthusiast is as much of a nuisance and menace as the bleacherite. It is the duty of each officer properly to evaluate his exercise requirements. The exercise you have been accustomed to in the earlier life has to be weighed, but you must realize that individuals over forty need less physical exercise than under forty. It is also equally important to realize that definite types of exercise are even more necessary at the later Period. There is a strong tendency in the Navy to either overdo or underdo exercise. Many of us exercise mainly to build up muscles and I am quite sure do not appreciate that the real muscular good derived is to those muscles over which you have no control. I refer to those situated in the walls of your intestines, arteries, etc., whose tone is necessary for good health. It would be foolish of me if I aimed to convey the idea that I consider a man over forty ready to settle down to volley ball and horseshoe pitching, but I do urge that soon after reaching the age you look ahead and realize that you must gradually accustom yourself to less strenuous exercise or else start on regular, moderate exercise, if you have in the past been content to sit on the sidelines. If you have been a hard singles player in tennis, a long-distance swimmer, a handball enthusiast who plays the game hard and fast, I urge you to start tapering off. Some day you will have to give up these strenuous forms of exercise and, if in the meanwhile you have not interested yourself in golf, hunting, gardening, or some other less strenuous exercise, you are going to regret it.
In regard to the amount of exercise in which you should indulge I can only give you one rule. At the conclusion of any exercise in the period of your middle life you should as a maximum be left with a comfortable sense of fatigue. Beyond this you are treading on dangerous ground for one in middle life. Many a normal heart has been changed to a diseased organ by a single overtaxing.
Food.—It is not within the province of this article to discuss calories, vitamins, or the complex molecules that make up various foodstuffs. It is in regard to diet that some of us need instruction. Too little food is just as harmful as too much food and there are entirely too many persons of middle age (particularly women) today wrecking their health by extremes in diet to maintain a slim figure. Where you are excessive in weight you should reduce, but such reduction should be gradual and can be effected satisfactorily by eating a balanced ration in slowly decreasing quantities. The great fault is that most reducers aim to lose many pounds in just a few weeks. A certain percentage of individuals have an idiosyncrasy to one or more articles of food and, what is a near kin to this, practically all sane persons of middle age realize what articles of food give them digestive disturbances when eaten. Taboo all of these articles from your diet and do not gorge those you do eat, regardless of their degree of compatibility.
It is a common belief that you should not drink water with your meals. I wish to assure you that water drunk at such times is in no way unfavorable to digestion. Water drinking has been blamed for a lot of symptoms which unsuitable and improperly cooked foods have caused. Unless you exercise sufficiently to perspire freely the average person of middle age drinks a very small amount of water. Get the habit of drinking water regularly throughout the day. Mineralized and so-called crystal waters improve or even cure many conditions chiefly by reason of the amount of water they cause an individual to consume. Again, let me warn you not to carry water drinking to an extreme. I know of an officer who was advised to drink a quart of water on arising and then wondered why he suffered from an intestinal upset. Water drinking on arising is excellent, but moderate it to not more than two glasses. It is not necessary to drink hot water for soon after reaching the stomach it conforms to the temperature of that organ; on the other hand very cold water at this time is not to be advised.
Overindulgence in coffee and tea are just about as harmful as overindulgence in alcohol. There are many naval officers who recall that when they were younger they could imbibe without limit from the constantly active coffee percolator on the wardroom table and apparently suffer no ill effects. Having reached middle age it may be worth your while to realize that the average cup of coffee contains about two grains of caffeine, one of the most powerful heart, brain, and kidney stimulants, and do not fool yourself that tea is a good substitute without the ill effects of coffee; a cup of fairly strong tea contains from one to one and a half grains of caffeine. Is it reasonable to suppose that as time goes on your resistance to such overstimulation will be lessened and less damage to your vital organs result?
Work and play.—I honestly believe that as a class you will find a larger percentage of naval officers indulging in hard work without play than any other one class of persons. In youth those of you so inclined may not have appreciated any inroad into your health, but when you reach the age we are discussing it is high time you take stock of your reserve. One of the causes of high blood pressure is hard work with its worry, nervous tension, and insufficient relaxation. And let me impress on you that you cannot correct this cause of trouble by adding to the play hour; you must start at the source and cut down the expenditure of reserve. I refer to the routine day-by-day performance of duty and not the demands thrown on us from time to time to solve certain problems that might arise. I still insist on proper exercise but do not reason that play is always exercise. In the category of play I include such pursuits as bridge, pool, chess, and the modern popular dances.
Sleep.—This has been defined as the “all-important rest period for the nervous system." As youngsters you may have wanted more sleep than you got but at that age you could get by with lack of sleep a good deal more than you can from now on. Each hour you go after midnight without sleep the less value each hour has from the standpoint of peacefulness of the function.
I am willing to admit that most of us middle-agers get tangled in the wee small hours of contract bridge or modern poker and, while I honestly believe these games may prove excellent recreation for many of us, I would honor that member of our clan who would be bold enough to eliminate from these games the "one more rubber" and "final rounds." These are the chief robbers, in my opinion, of the proper time to start the evening's rest period.
Mental state.—Many of you probably have never weighed carefully the influence certain variations from even temper exert on an individual's health. You worry over the pay cut, domestic affairs, or even the job placed before you; you fear the approach of certain events in your life and are apprehensive as to the outcome; some act on the part of another or perhaps a blunder of your own making renders you irritable; you lose control of your temper as the outcome of someone's misstep. These moods continue and then sooner or later you suffer with certain ailments, you become introspective (neurasthenia) or actually suffer with symptoms referable to almost any organ. You do not appreciate that even more than poisons the mental state I refer to set up diseased conditions in your body. I could cite you any number of cases that bear out the above statement and several that I have had the happy pleasure of curing without any therapeutic measure other than a willingness on the part of the patients to cut out the worry and apply the brakes to the abnormal brain activities. These evils are common causes of high blood pressure. They affect that class of officers who "have had many troubles, most of which never happened."
As I continue writing this article I find myself wondering where I can stop. There are so many "do's and don't's" that could be emphasized and yet I must remember I am not writing a treatise. I shall point out a few of the more important conditions that may arise in our middle age and which should be weighed by you and not neglected with the tendency of youth.
The field is too broad to cover in this article so that what follows from here on might well be labeled "examples of ills which may be prevented."
Eye conditions.—I have been surprised at the number of friends in the Navy, in the middle-aged class, who are peculiarly sensitive regarding the wearing of glasses. They cannot appreciate that an individual with absolutely normal eyes will at or about forty years of age notice that he has difficulty in reading telephone numbers out of a telephone book or that he must hold a printed page farther from his eye to see it as clearly as he has been accustomed to. They fool themselves by resorting to all kinds of aids, as, for instance, adjusting their reading lights and thus only further straining their eyes by faulty illumination. Please understand that in most cases this is a pure physiological change and it is definitely a signal for you to consult an eye specialist with the idea of at least being fitted for reading glasses. If perchance it is a pathological condition it is all the more important that your eyes be examined. Then remember not to neglect further examination of your eyes as you proceed along the path of middle life. This purely physiological condition continues to change and glasses normally need readjusting, the progress depending upon the individual. Neglect all of this and you only further strain your eyes with a possible resulting serious eye condition.
Infected teeth.—I can recall in my professional career a very large number of middle-aged officers who have developed various serious ailments from diseased areas about the roots of teeth. It is the czar of all those various conditions which we as doctors name “foci of infection.” The absorption at times from one little pocket about a diseased root is out of all proportion to what you would imagine. I want it understood that I am most conservative regarding the wholesale removal of teeth. I shall be taken to task by some of my dental friends for saying that if the sole reason for taking out a tooth is that it is not alive then I prefer to leave it in place. If a tooth is shown, generally by X-ray, to be abscessed about any root or there is a loss of bony substance about a root (rarefaction) and you are suffering with symptoms persistently pointing generally to a nerve, joint, or some organ, I unhesitatingly advise the extraction of the offending tooth or teeth whether it be dead or alive. This tooth is a good bit inferior to a store tooth. Whether from fear of pain or just plain procrastination many of us are apt to evade the dentist oftener than we should and I urge you, regardless of your pride in your teeth, to make such consultations a regular habit wherever possible.
Sinus trouble.—This is a fairly common complaint in middle age. Never treat it lightly. It is one of the most common causes of headache and if untreated may lead to diseases of the heart, kidneys, and other structures. It may prove easy to cure if taken early and you learn to take certain preventative measures. In my own case I had an attack fifteen years ago, was cured, thought it was caused by swimming and, fool-like, tested my professional diagnostic ability by swimming again, got another attack, was cured, then came to my senses and gave up swimming. There are several contributing causes to sinus trouble and chief among these is a deviated septum in the nose. A specialist will tell you whether or not your deviated septum should be corrected and, if he tells you this and you have faith in him, then do not delay having it corrected.
Diseased tonsils.—The absorption from diseased tonsils is just as much a menace to good health in middle age as any other diseased condition. I am most conservative where the removal of tonsils is concerned. If they are not diseased do not have them removed. Healthy tonsils have a function to perform and if they act like perfect gentlemen “let them be.” If, on the other hand, you suffer from attacks of tonsillitis and your tonsils are shown to be definitely diseased the sooner they are removed the quicker you will notice an improvement in your general health.
Heart disease.—More persons die annually of heart disease than of any other one ailment and the most common cause of disease in this organ is infection. To specify all the infections is impossible, but the most common are rheumatic fever, diphtheria, syphilis, scarlet fever, blood poisoning, gonorrhea, sinus trouble, abscessed teeth, diseased tonsils. Do not reason that any of these diseases will surely be followed by a heart ailment because many sufferers with these diseases recover without a single complication. However, should you develop any disease of an infectious nature do not treat it lightly and blame your doctor should he confine you to bed when you feel like “a fighting cock and raring to go.” Frequently he will be thinking of such a complication and prescribing further rest for you as a prophylactic measure. If you cannot see it this way get some one else to treat you and help raise his percentage of unimprovements.
High blood pressure.—At least once each year the most of us are cognizant of the blood pressure readings found in ourselves at the annual physical examination. If above the normal limit we are usually told and advised regarding the care of ourselves to reduce such hypertensions. No age is immune from high blood pressures but they are comparatively rare before forty years of age. As a matter of interest let me state here that from my own experience I find increased blood pressures existing more commonly in the Navy personnel below forty than formerly and add that I believe the modern strain of life the chief causative factor.
I cannot deny that heredity may be a factor causing high blood pressures, but this is rather insignificant when placed beside other causative agents like “work without play,” disregarded infectious processes, and intemperate food and drink. Medical officers do not diagnose high blood pressure from one blood pressure reading because we realize that often these high registrations are transient, but we do aim when finding at any one time a high blood pressure in an individual to follow up and determine definitely whether or not it is a true condition.
I hope what I have said in this article will be sufficiently clear so that you may at least appreciate some of the simple things you can do to affect your blood pressure. It should also explain to you why medical officers, particularly with middle-aged officers under treatment, exercise even greater care than with younger men when such are convalescing from infections of any nature; also why we go thoroughly into your teeth, tonsils, sinuses, mode of life, etc., when you present yourself for physical examination and suggestive abnormal conditions are presented.
Various gastro-intestinal symptoms.—I shall not discuss these except to advise that any symptoms you may have referable to the inside of your abdomen which persist arid for which you can ascribe no cause should not make you hesitate about consulting a medical officer. It may be simple or it may be nature's warning to you that you must have the cause attended to at once. Allow it to smolder and you may be playing with fire in this your dangerous age.
Various skin lesions.—These are mentioned but no description is necessary except to invite your attention to those scaly patches seen usually on the face and hands which appear frequently in the middle-age period. They may be innocent or on the other hand forerunners of a malignant condition. Do not let them run along too great a length of time. An electric needle may cause complete disappearance and radium may be found to be indicated with equally good results.
Neurasthenia.—Some old man was quoted as saying "I am an old man and have had many troubles but most of them never happened." The best definition I know for neurasthenia is nerve exhaustion and I warn you it is none too good to develop it in middle life. You rarely, if ever, see it in our naval life in individuals who work properly, exercise properly, eat properly, cultivate self-control, and do not abuse alcohol, tobacco, and the like. It’s hard luck to have a family history injected with nervous diseases but I would advise you to just forget that or better still let it spur you on to religiously adhering to the preventative measures outlined above. It is going to harm you a lot more than you think if as middle life progresses you magnify any nervous or mental ailments in your progenitors.
There are other hurdles for you to take clearly but these will be sufficient in this limited article.
It is going to be difficult for you early middle-agers to believe what I have written is applicable to you. Some of you are too darned set in your ways, others will possibly reason I do not know what I am talking about, and some few, I fear, will take a gambler’s chance and live on as you have always done. So be it. I have given you an honest opinion in a brotherly way and the decision is yours. I have purposely written in the first person and thus avoid any reader classing this article other than a heart-to-heart talk in a personal way.
In closing I want to finally advise you fellow-middle-agers somewhere in the period of middle life (and preferably as near the beginning as possible) to develop a hobby. Procrastinate until you retire for age and you will hardly develop one. You know and I know many of the old retired fellows and, if you will just carefully analyze them, you will find the most delightful are those who have something to do and are happy at doing it. It may be golf, books, stamp collecting, gardening, or a thousand other things, but however insignificant if you give yourselves time to develop an intense interest and keep it up it is going to make you a much happier and much healthier old man.