CHAPTER VI
DIGESTIVE TRACT
CHAPTER VI
DIGESTIVE TRACT
GASTRITIS
Incoördinations of the stomach alone are less frequent in infancy than are those of the intestines. Usually the stomach and intestines are involved at the same time and it becomes impossible to differentiate the two. The greater part of digestion during infancy takes place in the intestinal tract, the stomach acting more as a receptacle for the milk from which food passes slowly into the intestinal tract to be properly digested. In an infant one month old the stomach will be empty one and one-half hours after nursing; in bottle-fed babies it will take a little longer. From two to eight months of age the time is about two hours for breast-fed babies and from two and a half to three hours for those taking cow’s milk.
Symptoms
The symptoms of gastritis come on very suddenly with pain and tenderness in the epigastric region, and with a high temperature which after the onset decreases. There is thirst, loss of appetite, and vomiting. The vomited matter is usually sour and may be streaked with blood. If there is an excessive amount of blood it indicates ulcers. This is rather unusual, however, in small children. Vomiting is excited by anything taken into the stomach. The thirst is intense, although the water will be vomited as soon as taken. The tongue is heavily coated and the breath is foul. If these symptoms continue intestinal symptoms will soon develop.
The different kinds of gastritis are given as: catarrhal, ulcerative, membranous and corrosive; but the symptoms are all very much the same and from a chiropractic standpoint a knowledge of the particular pathology would be of no value as the adjustment would be the same. In these cases the difference, or rather specific diagnosis, cannot be made, medically, until after the autopsy. In the ulcerative type the condition is more prolonged and there is a greater tendency to hemorrhage which results in a greater amount of blood in the material vomited. Corrosive gastritis is the result of a corrosive poison being taken into the stomach, such as carbolic acid.
Major Adjustment
From a chiropractic standpoint it is immaterial what form of gastritis the child may be suffering from with the exception of the corrosive type which may require the administration of an antidote. In this event the condition passes out of the realm of Chiropractic the same as any other traumatic condition. The adjustment in all cases of gastritis the same as in any other incoördination of the stomach is S.P. If there are symptoms which indicate that the poison family is involved the combination would include K.P.
If adjustments are given at the onset results will be obtained almost instantly. The temperature will soon be reduced, the pain will be relieved and in a remarkably short time the symptoms will all disappear.
CHRONIC GASTRITIS
There are no characteristic peculiarities associated with gastritis when it becomes chronic. There is no advantage in differentiating the chronic from the acute. The symptoms are somewhat less severe, and run a longer course. There is vomiting following meals. Between meals there will be a regurgitation of the food. This form of indigestion is not common among infants but may be found with older children. The most prominent symptom is that of malnutrition. There is restlessness at night, loss of appetite, constant loss of weight and anemia.
Major Adjustment
The adjustment in the case of chronic gastritis is the same as in the acute attacks. Stomach place is the condition of the stomach with kidney place for the elimination of the waste products which result from the lack of digestion. The kidney place adjustment is also to correct any abnormality in the serous circulation resulting from faulty digestion.
STOMATITIS
Dr. James N. Firth, in his “Chiropractic Symptomatology,” states that “There are five forms of stomatitis, viz.: simple, ulcerative, follicular, thrush and gangrenous.” It is not our thought to cover this subject in detail as he has done, but only to point out that which is characteristic of stomatitis in infants and small children. In this incoördination the mucous membrane lining the mouth becomes inflamed and swollen. The mouth is hot and the lips dry. The child is fretful and even though hungry refuses to nurse or will cry while trying to nurse. There is quite an increase in the secretion of saliva.
Stomatitis in infants often accompanies the acute febrile dis-eases or may appear alone. There will be more or less indigestion with possibly some diarrhea. If the condition remains for a great length of time the child becomes emaciated from the lack of food ingestion.
It is not necessary for us to take up the different forms of stomatitis since the adjustment is the same in all cases. Upon the first indication of stomatitis or the slightest symptom of sore mouth, the infant should receive prompt attention. Strict hygienic measures should be used, especially if the child is being bottle fed.
Equation
In stomatitis the equation is C+ for the simple form; for the suppurative form it is N.C.R.
Family
Simple stomatitis is classified in the fever family. The other forms involve the poison and degeneration families.
Major Adjustment
The adjustment for simple stomatitis is S.P. in combination with M.C.P. If there is any suppuration involving the poison and degenerations family the major will include K.P.
GLOSSITIS
Glossitis is not very common among infants. It is an inflammatory condition of the tongue with hyperemia and swelling. There is usually a slight temperature and the swelling may involve the mucous membrane of the mouth. The tongue may be so greatly swollen that it becomes very difficult for the child to take food. Glossitis is often associated with stomatitis or any involvement of the mucous membrane of the mouth.
Equation
The equation for glossitis is C+ with T+ for the hyperemia. If there is suppuration it is N.C.R.
Family
This condition is in the fever family overlapping the degenerations family in case of suppuration.
Major Adjustment
The major adjustment for glossitis is S.P. and in cases involving suppuration K.P.
STENOSIS OF THE PYLORUS
There are two types of stenosis of the pylorus in infancy. One is a stenosis due to a muscular spasm of the pylorus called a pylorospasm. The other is a stenosis due to a hypertrophy of the pylorus known as hypertrophic stenosis of the pylorus. It is possible for both conditions to be present at the same time. The stenosis may be congenital and is usually called stenosis of infancy. It is considered a serious condition and the mortality is very high.
This incoördination is characterized by constipation, persistent wasting, projectile vomiting, and a marked visible tumor.
Symptoms
The symptoms begin to appear during the first or second week of life. Up to this time the child may have been gaining and showing all signs of perfect health. Vomiting is usually the first symptom to appear and this may be at irregular times but without apparent cause. It soon becomes very forcible and later projectile. The symptoms of indigestion are absent; there is no eructations of gas; the breath is sweet and the appetite is good. There is no evidence of pain and there is no fever, yet the child steadily wastes and loses in weight.
The contests of the stomach are sometimes expelled with such force that the food will be thrown a distance of two or three feet. The food sometimes comes through the nose. The vomiting takes place immediately after feeding and sometimes while the child is nursing. The fact that the child will nurse after vomiting and sometimes will leave the breast only while the food contents of the stomach are being ejected shows that the vomiting is not the result of indigestion; the fact that the food is all expelled at one time and not regurgitated at intervals is further proof. The food seldom remains in the stomach long enough for gastric digestion to take place, therefore the vomited food is not digested but it is just about in the same stage as it was when taken into the stomach. In some cases, however, the vomiting may not take place immediately; in some cases the food may even be retained for two or three feedings, although this is unusual.
The constipation is very obstinate from the fact that the food is vomited and does not pass into the intestinal tract. In the severe cases the stools resemble meconium. There is very little fecal matter in the stool. In the severe cases there is persistent loss of weight which may amount to two or three ounces per day. The constipation is very marked and the urine is scanty.
In the mild cases the symptoms are all less marked. The vomiting may be only occasional, the loss of weight is not so great, fecal matter is passed in the stools and there may even be a gain in weight at times.
Due to the character of the vomiting which is projectile the symptoms are sometimes mistaken for cerebral symptoms. The scanty urine and the vomiting confuse the condition with renal dis-ease. It is not difficult to distinguish stenosis of the pylorus from gastric indigestion. The latter rarely develops suddenly, but is very common in infants. The vomiting usually occurs shortly after feeding.
Equation
If the condition is the result of hypertrophy of the pylorus the equation is X+. If it is a case of pylorospasm the equation would be M+. The equation for the loss of weight and wasting is N-.
Family
The family of the hypertrophic condition of the pylorus would be tumor family while the pylorospasm would come in the spasms family.
Major Adjustment
The adjustment for this condition would be stomach place in combination with kidney place. The adjustment results in a relaxation of the muscular fibers of the pylorus and permits the food to pass from the stomach. In case of hypertrophic stenosis of the pylorus there is not only a relaxation of the muscular fibers, but Innate Intelligence removes the hypertrophy and thus enables the food to pass from the stomach. Excellent results are obtained in these cases. Care should be exercised in making the analysis and the adjustments should be given as early in the progress of the condition as possible.
ACUTE INTESTINAL INDIGESTION
This is quite a common incoördination and is very much more prevalent in hot weather. It is found often in very young infants, but more often in children during their second summer. There are many forms and degrees of acute intestinal indigestion among infants and small children. The attacks come on usually very abruptly and may be severe from the beginning. The most outstanding feature of the incoördination is the characteristic diarrhea. In the mild form the symptoms develop suddenly with marked gastric disturbances. At the beginning there is colicky pain and tympanites. There is great restlessness and typical symptoms of colic. The diarrhea appears in a very short time. The color of the stool is at first yellow, then it becomes a yellowish green and finally a grass green. It will usually contain undigested foods. The odor is very foul, grass green, and very much thinner than normal. This mild form may develop into the more severe type or the more severe form may develop suddenly from the very beginning. The temperature rises rapidly. The skin is hot and dry. At the beginning the child is very restless and cries a great deal, but later he lies in a stupor, the eyes are sunken, pulse is weak and there is all the appearance of an attack of serious illness. There may be anorexia. There is usually great thirst and nausea and vomiting. In a few hours there is marked diarrhea. The stools are yellow and of a thin consistency with a very offensive odor. There is usually much gas expelled. There may be as many as four or five stools an hour. This incoördination is responsible for a great many deaths among children. They respond, however, very quickly to chiropractic adjustments.
Major Adjustment
The subluxation responsible for intestinal indigestion will be found in the lumbar region, usually upper lumbar. It may be necessary to include kidney place for the elimination of the products of the indigestion. This condition is in the fever family overlapping the poison family.
CHOLERA INFANTUM
When the severe type of intestinal indigestion is accompanied with gastric disturbances and severe vomiting, it is known as cholera infantum. In this form the temperature rises rapidly and the symptoms develop quickly and become very severe in a remarkably short time. The vomiting is very severe and usually appears simultaneously with the diarrhea. After the stomach has been emptied of food the vomitus becomes serum and mucous. The contents of the small intestines may regurgitate into the stomach and be vomited up. Vomiting may be induced by taking water into the stomach. The stools are frequent, are of a pale green, yellow or brownish color at the beginning, but later become almost entirely serous. In the severe cases the bowels may be evacuated every few minutes. This type differs from that previously described in that the stools are practically odorless. In rare cases, however, they may be exceedingly offensive. There is probably no other incoördination during childhood in which there is such a rapid loss of weight. The picture which the patient presents is characteristic. There is great weakness and prostration from the very beginning. The fontanel is depressed and in some cases there may even be an overlapping of the cranial bones. The features become sharp, the eyes are deeply sunken and the angle of the mouth is drawn down. The nose is pinched, the skin over the forehead is tense and dry, the temples are sunken. There is pallor, stupor, marked relaxation of the lips and there will be convulsions and collapse. Statistics show that under medical treatment fully three-fourths of the cases die.
Major Adjustment
Most excellent results are obtained in these cases under chiropractic adjustments. In the severe attacks it will be found necessary to adjust the child as often as once every six hours. The subluxations will be found at stomach place and kidney place and middle lumbar. Some very severe cases have come under our personal observation and in the cases that we have handled personally the results have been 100%. Such cases must be analyzed very carefully, and must have the very best care in every way.
CHRONIC INTESTINAL INDIGESTION
Chronic intestinal indigestion is a very common incoördination affecting children. It is more likely to be found among children who are artificially fed. Intestinal indigestion is responsible for a great variety of symptoms that are sometimes considered separate dis-eases.
Symptoms
Children suffering with intestinal indigestion usually present symptoms of malnutrition. They are anemic, the extremities being usually very small. The most striking feature of such a case will be the extremely large abdomen. The colon is usually dilated as are also the small intestines. There is marked tympanites, which usually increases during the daytime but diminishes during the night. This is one of the principal symptoms which differentiate intestinal indigestion from tubercular peritonitis. Such children are easily fatigued, have a very sallow complexion with dark rings under the eyes. They are usually very much below the average weight and are very cross and irritable. They do not sleep well, often grinding their teeth and crying out in their sleep. There is usually alternating constipation and diarrhea, the odor of the stools being very offensive. In extreme cases there may be convulsions and other cerebral symptoms. There is seldom any fever.
Major Adjustment
The local major subluxation will be found in the lumbar region with the combination at kidney place. Kidney place is used only when there has been an accumulation of products of indigestion which makes it necessary to increase elimination to take care of these products. In many of these cases the liver is involved and therefore will call for liver place in combination with kidney place and the local lumbar. These cases will respond very readily to chiropractic adjustments.
COLIC
Colic is a common incoördination of infancy and is very prevalent during the first three months. Colic is a symptom rather than a dis-ease and usually indicates intestinal indigestion or some inflammatory condition of the intestines. It is characterized by sharp paroxysmal pains in the intestines. A child who is subject to colic will usually be suffering also from constipation. The crying of a colicky child is characteristic, being very violent and paroxysmal, which presently subsides only to be followed with another attack. During these spells the lower extremities will be drawn up and the abdomen will be tense from the accumulation of gas. In mild cases the child will not cry out but will be fretful. This may be wrongly construed to be the result of hunger. When the attacks of colic come on the child will show a desire to nurse and will take the breast as though very hungry. This may be followed by relief from the pain, but this relief is only temporary and when the pain returns it is usually more severe. There is probably no incoördination of childhood that is quite so trying to a chiropractor as an acute attack of colic, due to the violent crying of the child and the eager desire on the part of the chiropractor and the attendants to relieve the pain. It is often quite hard to obtain a correct analysis in such cases because of the difficulty experienced in getting the child into a proper position for palpation. In making the palpation the chiropractor should take plenty of time and should never endeavor to force the child to be still, rather he should adapt himself to the constant moving about of the infant.
Major Adjustment
The major varies somewhat in these cases so far as a specific vertebra is concerned, but the local will always be found in the lumbar region, usually the first or second lumbar vertebra. Kidney place should be used as a combination.
VOMITING
During nursing the infant swallows quite a little air and not infrequently this is the cause of vomiting immediately following feeding. It is not uncommon for an infant to vomit without effort after overfilling the stomach. This is a natural thing among healthy children and needs no attention from a corrective standpoint. In such cases the milk is but little changed.
In gastric indigestion and gastritis vomiting is always present, but in these cases it does not take place until some time after feeding, perhaps several hours. In gastritis the vomiting is more constant. In the more severe cases there will be not only the partially digested food but also bile and mucus and sometimes traces of blood.
Obstructive vomiting is sometimes found among infants and may be due to intestinal obstruction or to an obstruction of the pyloris. The obstruction may be congenital or it may develop after birth. Obstruction of the pyloris may be the result of hypertrophic stenosis. In this condition the child vomits immediately following feeding and with great force. This is thoroughly described in the article on Hypertrophic Stenosis of the Pylorus. If the obstruction is in the intestinal tract it may be the result of a congenital malformation or due to intussusception. The vomiting is forceful and the vomitus may contain fecal matter.
Vomiting is often associated with peritonitis and appendicitis. In these conditions there is distention of the abdomen with abdominal pains which may be localized. There may also be a slight temperature. Vomiting is purely adaptative on the part of Innate Intelligence. The food cannot be digested and carried through the digestive tract so Innate realizes that the best thing to do is to free the body from it in the quickest manner.
Vomiting often precedes such incoördinations as pneumonia, scarlet fever and malaria and may precede any of the febrile dis-eases. Vomiting may be produced by the accumulation and absorption of toxines in the body.
Infants suffering with nervous disorders such as acute meningitis, tumors of the brain and other central conditions will often have cerebral vomiting. In this event the vomiting is spontaneous and does not necessarily occur at feeding time. Other cerebral symptoms present will aid in determining the analysis.
Vomiting may be produced by the presence of worms that come up into the throat from the stomach and intestinal tract. Hunger may occasionally bring on an attack of vomiting. This is more common in older children than in infants.
RECURRENT VOMITING
This is also known as cyclic vomiting and periodical vomiting. It is characterized by recurrent attacks which may be weeks or months apart. They come on without any apparent cause and from the descriptions and explanations given in medical science very little can be done medically to control the vomiting which at the end of two or three days will cease spontaneously. The attacks recur at different intervals, usually less often, gradually decreasing until they cease altogether when the patient is about the age of ten or twelve years.
Symptoms
There is loss of appetite and malaise. The pulse becomes rapid and in some cases there is slight temperature. There is usually headache and excessive thirst. During the attack of vomiting there is extreme retching and great distress. The symptoms are similar to migraine in adults. This condition must be differentiated from tubercular meningitis in which there is vomiting without apparent cause. The course of the symptoms will soon enable a positive differentiation. In acute indigestion there is vomiting, but the history of the case reveals the fact that the attack was brought on by undigested food. It is very easy to distinguish this type of vomiting from that of appendicitis, since in appendicitis there is marked tenderness at McBurney’s point, also pain and the characteristic rigidity and muscular contraction. In intussusception the symptoms are usually more severe and there is blood and mucus in the stool.
Major Adjustment
Since there seems to be no particular indication of indigestion or impaired functions, and no pathological changes, it is evident that the function involved is that of motor. But regardless of the primary function that is interfered with a subluxation will be found at S. P. and in most cases there will be a hot box during the acute attack. The vertebra most commonly subluxated is the sixth dorsal. In most cases there is no combination and results will be obtained in a very short time by adjusting nothing but the S.P. subluxation. In the severe cases it may be necessary to adjust as often as once every six hours until the vomiting ceases. Ordinarily the vomiting will cease in a short time and in most cases marked improvement will be noted after the first adjustment.
Vomiting occurs in gastric indigestion, intussusception, meningitis, peritonitis, pyloric stenosis, uremic poisoning, and in many other acute incoördinations.
CONSTIPATION
The first bowel movement after birth is known as meconium and is a dark brownish-green color, and of a semi-solid consistency. During the first two or three days the bowels move from four to six times daily. On the third day the character of the stools begin to change and by the fourth day the feces has become normal.
The normal stool of a normal nursing infant is about the color of the yolk of an egg, and may be slightly green. The average amount is about two ounces daily. The stools should never be watery, but of a butter-like consistency. During the first few weeks the infant’s bowels will move on an average of four times daily. After about six weeks the average will be two a day. The stool changes in character as soon as the child is placed upon a mixed diet. It then becomes more like that of an adult but remains softer.
Constipation is one of the most common incoördinations of infancy and childhood. There are many factors to be considered and many things that contribute to the condition. In older children habit plays no small part in aggravating constipation. For this reason the child should be very carefully trained early in life to obey the first call on Nature in this respect.
Normally the infant should have two bowel movements a day, although some have more while others may have only one. Frequent movements do not, however, mean that the child is not constipated or costive. With two or three dry hard stools per day the child would be costive. Constipation is the result of a lack of motor function in the muscular walls of the intestines while costiveness is the result of a lack of secretion due to interference with transmission of secretory mental impulses. The two conditions are often associated. When there is a lack of motor function in the muscular walls the fecal matter will not be forced out of the intestinal tract fast enough and much of the moisture will be absorbed, thus leaving the fecal matter dry and hard. This is not a true costiveness and should not be mistaken for such.
In costiveness there may be colicky pains which may be increased, and may at times be quite severe, when the hard dry fecal matter is passed. The general health of the child may be seemingly normal. In severe cases hemorrhoids and even hernia may be developed from the constant straining.
Major Adjustment
These cases are simple and respond readily to chiropractic adjustments. The combination varies somewhat in different cases. In constipation the major will be a lumbar vertebra. In costiveness, where secretions are involved, the combination will include a Li.P. and K. P. In some cases excellent results are obtained by adjusting ninth dorsal.
INTUSSUSCEPTION
Intussusception is a condition wherein there is a telescoping of the intestines in which one portion passes into the adjacent portion and produces an obstruction.
This condition occurs most often in early infancy, although not very commonly. The most frequent site is at the ileocecal valve. It may, however, occur at any point in the intestinal tract. When it occurs in the small intestine it is known as enteric intussusception; in the colon as colic; and at the ileocecal valve as ilecocecal.
Intussusception may be chronic or acute. In the chronic cases there may be adhesions which will make it very difficult for Innate to accomplish a reduction.
Symptoms
The onset is usually accompanied with paroxysmals of pains and vomiting. The pains may be very severe and the vomiting projectile. The pain may be mistaken for that of ordinary colic, but it is much more severe and may continue through the entire attack.
The vomiting is persistent, especially at the onset, and occurs as soon as food enters the stomach. In older children it may be stercoraceous after the third or fourth day. It never occurs, however, in infancy. The vomiting is the result of the intestinal obstruction and is adaptative on the part of Innate Intelligence. It is quite obvious that it is better not to have food in the stomach than it is to have it and not be able to complete the process of intestinal digestion.
The character of the stools is of importance. At first the bowel movements may be diarrheal and later there will be no fecal matter, but the stool will contain nothing but blood and mucus. A paroxysm of colicky pain may be followed by a mucous and bloody stool several times daily. At the onset the abdominal walls are soft and relaxed, or may even be retracted. Tympanites may occur about the second or third day.
The symptoms in the acute cases are those of shock. There is an extremely anxious look on the face which is pallid, cold extremities, subnormal temperature and cold perspiration. There is restlessness and in many cases convulsions. Later there will be stupor. A sudden rise in temperature indicates a turn for the worse and may mean death in a short time. In the chronic cases there is marked inanition which progresses very rapidly.
Major Adjustment
The subluxation interfering with the transmission of mental impulses causing intussusception will be found in the lumbar region, the specific vertebra depending upon the location of the intussusception, whether in the upper or lower intestinal tract. Most excellent results have been obtained in these cases, and there should be no hesitancy in adjusting. The function involved is motor, which prevents a coördinate action of the muscular walls of the intestines. As soon as this action becomes normal Innate Intelligence will correct the condition and all symptoms will subside.
ICTERUS
Icterus is a rather common incoördination of infancy. It is characterized by yellowish discoloration of the skin produced by the accumulation of bile pigment. This is the result of an occlusion usually of the common bile duct, which prevents the bile from passing into the duodenum. There are two forms: the physiological and the pathological. In the physiological there is an inflammation in the mucous membrane lining the common bile duct. This causes a decrease in the size of the lumen, which obstructs the flow of bile. In the pathological there may be a complete obstruction due to malformation or there may be a congenital absence of the bile duct. While the common bile duct is the most common seat of the pathological type, yet the hepatic and cystic ducts may also be involved.
Symptoms
The most prominent symptoms is the discoloration of the skin. In the severe obstructive jaundice the stools are white, the urine dark brown and bile-stained and the liver and spleen often enlarged. There may be severe convulsions. In the more common and less exaggerated cases the foregoing symptoms are present but in a milder form. There is typical jaundiced discoloration which in some cases will appear soon after birth. This will continue for a few days and may become quite marked. The stools will be colorless, while the urine will be highly colored.
Equation and Family
The equation is secretion plus (T+) and excretion minus (E-) for the accumulation of the bile. The family is the poison family. In case of temperature it overlaps the fever family.
Major Adjustment
The chiropractor must not conclude that the case is one of congenital malformation or absence of the bile duct merely because of the extreme discoloration of the infant. Cases have come under our observation in which the symptoms would all indicate that the case was hopeless, but under chiropractic adjustments they have recovered. It must be recognized, of course, that if there is a congenital absence of the bile duct the case is hopeless, but since there is no way of determining whether it is a mere obstruction or congenital absence, the case should by no means be considered hopeless. Every effort should be made to locate and adjust the subluxation. The subluxation will be found at liver place which must be adjusted in combination with kidney place. Kidney place is required for the elimination of the accumulated bile. These cases will respond very quickly and satisfactorily under chiropractic adjustments.