CHAPTER X
DIET IN ABNORMAL CONDITIONS
In the dietetic treatment of any disordered organ, the object must be to give that organ as much rest from its regular work as is consistent with keeping up the general nutrition of the system. The stomach and intestines and liver are so closely allied that, when one is affected, the others are liable to affection also, and the dietetic treatment is regulated accordingly.
In abnormal conditions it is necessary to say that the food must be regulated according to the case. Yet, broadly speaking, a diet largely of protein, which is digested in the stomach, rests the intestines and stimulates the liver, and a diet largely of carbohydrates rests the stomach, because the gastric juice is not active in starch digestion.
When the body is not in normal condition, because certain elements are lacking in the blood, these elements must be supplied in larger proportions in the food, and the case is one for a food chemist, or for one who has made food conditions a study.
The better medical colleges, recognizing the importance of proper food in health and disease, have in the last few years broadened their curriculum to include the subject of dietetics. Educated physical culturists and food specialists, for the correction of deranged conditions of the system, due to poor circulation and abnormal nerve and blood conditions, are doing much of the corrective work, due to the fact that instruction has not been given in the medical colleges.
Diets for the reduction of an abnormal amount of fat must also be governed according to the individual condition.
In the early stages of various diseases, when toxins are being produced, as a rule the system is not properly eliminating the waste, and it is often advisable to abstain from food for from one to three days, according to conditions. Brisk exercise, deep breathing, and a free use of water are desirable. A laxative is often recommended.
The diets given here for abnormal conditions are to enable those in charge of an invalid to gain an intelligent understanding of the needs of the system and to supply those needs through the proper foods. In serious cases, however, special diets will be ordered by the medical attendant to suit the needs of the individual.
A chemical analysis of the blood and the excretions is often the only method of determining just the diet in the individual case.
Government chemical laboratories in charge of efficient chemists should be so located as to be accessible to every physician.
The system readily excretes an excess of vegetable products, and, as a rule, no acute difficulties result from such an excess. Such chronic difficulties as constipation, torpid liver, and indigestion, however, frequently result when an excess of starch is taken above that consumed in energy.
On account of the readiness with which putrefaction occurs in protein products, care should be taken not to consume these in too great proportion.
A study of the physical ailments of thousands of women has shown, by the constituents in the blood and the condition of the different organs of the digestive system, the habitual taste for foods. One can usually determine which food the individual has formed a habit of eating, because the system will show a lack of the elements which that patient has denied herself on account of her likes and dislikes.
It is necessary to change the mental attitude toward certain foods before the system will readily assimilate them; thus, as stated, a taste for foods which the body requires should be cultivated.
Every mother, with growing children, should be a thorough student of the chemistry of food. If the child’s bones do not increase sufficiently in size and strength after the second year, care in the selection of foods rich in protein and phosphates of lime and magnesium may correct it. Such a child should have scraped meat and whole wheat bread with milk and eggs.
If the child stores up too much fat, increase the amount of exercise and of oxygen consumed, and either cut down the proportion of sweets and starches or decrease the quantity of food and require more thorough mastication.
If one is thin and undernourished, chemical analysis of the contents of the stomach, intestines, and urine is sometimes desirable. The nerves should be relaxed, and proper food, exercise, and breathing should accompany medical treatment, if medicine is needed. Often an entire change in thought and diet are helpful.
Sometimes a torpid condition of the liver and sluggish activity of the intestines are indicated. Special exercises to stimulate this activity and to encourage correct poise and deep breathing are most essential. The mind must often be stimulated and an interest be awakened, directing the thoughts in new channels.
Worry and tensity of thought are among the chief causes in the majority of cases of lack of flesh and of a very large number of blood and digestive disorders.
In anemia there is either a decrease in the number of red blood corpuscles or an insufficient amount of blood. When there are too few red blood corpuscles, “oxygen carriers,” the necessary quantity of oxygen is not furnished the tissues and the system becomes clogged with waste. The patient easily tires and is disinclined to exercise, thus the decreased number of red corpuscles are not kept in forceful circulation and the carbon dioxid is not freely thrown off by the lungs; this further aggravates the condition.
Since the blood is made from the foods assimilated, the point is to supply food which builds blood tissue. Exercise and deep breathing will encourage the elimination of waste and promote a forceful circulation which insures nourishment to the tissues. As stated, it is the food assimilated, not always the amount eaten, that counts.
In this condition it is of vital importance that one keep up a good circulation; the stomach, intestines, liver, and spleen must be strengthened through exercise and deep breathing of pure air, for the red blood corpuscles are oxygen carriers, and the insufficient supply must do double duty or the waste of the system will not be oxidized and eliminated, and the blood-forming organs will further fail in their task.
Exercise must be graded to the case, being gentle at first so as not to overtire the easily fatigued muscular system. It should be intelligently directed to the joints and to the vital organs, particularly to the liver and intestines, that they may be kept in normal activity. The exercises must be followed with plenty of rest, and accompanied by deep breathing. The habit of full breathing is one of the most effective agencies in correction of anemia, because the red blood corpuscles must carry their full quota of oxygen or the system is clogged with waste. Oxygen also rejuvenates these corpuscles.
Unless the blood furnished to the tissues is of good quality and contains sufficient oxygen, the nutrition of the body suffers, the activity of the various organs is hindered, and the health becomes impaired. Functional derangements, particularly in the digestive tract follow, and faulty digestion and difficult absorption further impoverish the blood.
The work, therefore, in the correction of anemia, lies in foods which build blood and in daily exercise and deep breathing of fresh air, accompanied by rest.
The windows at night should admit a good circulation of air through the sleeping room, and as much time as possible should be spent in the open air.
Anemia occurs many times in growing girls, due to an improperly balanced diet, caused by a capricious appetite and by the habit of satisfying this appetite with sweets, pickles, etc.
The body, during growth, needs increased nutritive material, not only to replace the waste, but also to meet the demands for new building material for the various organs, particularly the brain and the nervous system. Overwork either in school or in industrial occupations, the hasty eating of meals, or insufficient amounts of food, also aid in reducing both the quantity and quality of the blood.
Worry is one chief cause of anemia.
Insufficient sleep, due to late hours, further increases the tension of the nerves and lowers the vitality, causing depression which interferes with digestion.
When the red blood corpuscles are decreased the oxidation of the fats is interfered with, because oxygen is necessary to burn the fat. The non-use of the fatty material causes it to be stored in the tissues so that the body often appears well nourished and plump. The muscles, however, are flabby and weak and usually the pallor of the skin shows the lack of coloring matter in the blood.
The digestive organs are often weak. They must not be overloaded or the very object of the extra feeding will be defeated. In such cases the food must be taken in less quantity and more frequently. Also a diet rich in albumin and iron must be supplied.
It will often be found that one whose blood is lacking in hemoglobin and in the proper proportion of red blood corpuscles has had a dislike for the foods rich in iron, or perhaps through poverty, or some other cause, has not been able to get the right kind of food.
The yolks of eggs, the red meats (such as steak, mutton, or the breast of wild game) and the deeply colored greens (such as spinach, chard, dandelions, etc.) contain a goodly proportion of iron. The dark leaves of lettuce, celery, and cabbage contain iron; these vegetables are apt to be bleached before being marketed.
It is better, in anemia, to take the yolks of two eggs than one whole egg, as the iron is in the yolk. A good way to take the yolks of eggs is in egg lemonade or in eggnog, with a little flavoring.
Anemia sufferers have usually formed the habit of eating starches and sweets. It will usually be found that they have no desire for vegetables containing iron, or for meats rich in albuminoids, and this habit is shown in the blood composition. They often eat the white of the egg and discard the yolk, rich in iron. Tact and persuasion will often be necessary to induce them to take the proper foods.
If constipation is present, whole wheat bread, oatmeal, stewed prunes, grapes, stewed or baked apples, and oranges, should be taken freely.
When the anemic individual is thin, he should take as much fat food as the system will assimilate. Bacon is well digested and palatable. Fat may be taken in milk, cream, and butter.
The food must be made attractive to tempt the appetite, which is usually poor, and within reason one should be allowed any wholesome food which he desires. Condiments often stimulate the stomach and intestines to better action.
Vinegars, because of their action on the blood, should not be allowed nor rich pastries and sauces.
Beef may be scraped and made into sandwiches or used in purées and meat broth, which may also have a beaten egg in it.
The following is a suggestive diet in anemic conditions:
DIET VII
One pint of milk, to be sipped slowly before arising.
Breakfast
Fruit
Broiled steak or two eggs, soft-boiled, poached, or baked, with bacon
Cereal coffee, chocolate, or cocoa
Toast, or graham, or whole wheat bread, or graham or corn muffins; butter
Middle of the Forenoon
Lemonade with a tablespoonful of beef juice (not beef extract) or with a beaten egg, or a
Glass of egg malted milk, or an
Eggnog
Lunch
Split pea or bean soup with toast and butter, or scraped beef sandwich with lettuce
Fruit or vegetable and nut salad (no vinegar)
Fruit, fresh or stewed
Bread with plenty of butter
Cake
A glass of milk, cocoa, or chocolate—preferably milk
Middle of Afternoon
Egg lemonade or eggnog of two eggs beaten in boiling milk with sugar and spices
Dinner
Bouillon
Tenderloin steak, roast beef, or lamb chops
Baked potato
Spinach, beet, or dandelion greens
Custard, fruit gelatin, or cornstarch pudding, or rice with lemon cream or butter sauce
Bread and plenty of butter
Glass of milk or weak tea
When appetite is persistently absent, attention should be paid to the eliminative organs in order to remove all clogging of the system by retained waste.
If the stomach and intestines are prolapsed as a result of improper nourishment and resultant weak tissues, rest in bed, with special exercises which will replace the organs and strengthen the supporting tissues, is required.
STOMACH DISORDERS
Most chronic cases are due to worry; to improper hygiene, such as irregular meals; fat and greasy foods; hasty eating; too much sweets; insufficient mastication, with resulting lack of saliva; wrong choice of foods; too frequent eating, giving the stomach no rest; too large an amount of food; too highly spiced foods; coffee or tea; a general run-down condition, with a weakness of muscles of the stomach, due to insufficient blood supply; to a weakened or over-strained condition of nerves controlling the stomach; and usually to insufficient exercise and fresh air.
Indigestion or dyspepsia is the broad term commonly applied to most chronic stomach and intestinal difficulties, due, not alone to structural disease or to displacements, but also to their inability to perform their normal functions. The term includes troubles arising from so many different causes that in each case the cause must be determined and remedied before definite results can be attained through diet.
The most usual is that the gastric glands are pouring out an insufficient amount of secretion; almost always there is a deficiency of hydrochloric acid. In some cases in which the food has irritated and inflamed the stomach there may be a sufficient secretion of this acid, but an inflamed stomach throws off more mucus and the extra quantity of mucus neutralizes the hydrochloric acid.
When the acid is deficient or absent, the proteins are not well digested and the food may ferment; bacteria may produce putrefactive changes and the formation of gas. The gas interferes with the movement of the diaphragm, pressing it against the heart, causing pain and even palpitation.
Indigestion is usually accompanied by constipation, or by irregular action of the intestines.
Plenty of fresh air, and exercise, directed definitely to muscles and nerves of the stomach, that it may be strengthened by a better blood supply, as well as exercises and deep breathing to build up the general health, should be systematically followed.
Easily digested food, well masticated, and regular meals served daintily, will gradually regulate digestion.
Food should not be of too great a variety at one meal. It must be simple and well prepared; when nerves and muscles are weak it should be served less in quantity but more frequently. Sometimes light food every hour or every two hours is best.
Cheerful constructive thoughts are the very best of medicine for digestive derangements.
A glass of cold water from one-half to an hour before the meal will cleanse the stomach by washing out the mucus and will promote the secretion of saliva and the gastric juices.
The intelligent medical treatment of stomach difficulties is aided by a chemical analysis of the stomach contents. If the stomach is not secreting normal proportions of pepsin or hydrochloric acid, the deficiency of either can be determined. Such chemical analysis will alone determine what elements are lacking.
Permanent relief must lie in gaining a good circulation of blood through the entire body and through the stomach, that it may be strengthened and thus enabled to secrete these elements in proper proportions.
This is due to the general depleted condition of the nerves. In such cases the entire nervous system should be regulated through exercise, breathing, rest, and a change of thought. Physicians usually recommend change of scene to cause a change of thought.
The diet should be light and laxative, and low in protein. Cream soup, bread and milk, malted milk, buttermilk, cream, fruits, crackers and milk, custards, egg lemonade, and gruels, furnish easily digested food.
Tea, coffee, much meat, fried food, highly spiced food, pastry, candies, pickles, alcohol, and tobacco should be avoided.
When the walls of the stomach are weak and distended or prolapsed, light food served in small quantities at regular but more frequent periods is preferable to a hearty meal, which further distends the stomach walls. The stomach does not secrete sufficient gastric juices to digest a meal large enough to supply the needs of the system, if food is taken only three times a day.
When a loss of weight occurs, it usually indicates a failure to assimilate rather than the failure to eat a sufficient amount of food. A good circulation, particularly through the vital organs, must be established; deep full breathing of fresh air, and regular and complete rest periods, should be observed.
Usually, in chronic cases, a dietitian, or a physician, is not called until the condition has prevailed for so long that other complications have set in and the patient has lost much flesh. It takes months to pull the system down and it takes months of following of proper hygiene to build it up.
This involves an inflammation of the mucous lining of the stomach and is a most common phase of indigestion. In acute cases the physician is called at once. He can then treat the case in its initial stage and cause a much more rapid recovery.
Acute Gastritis is accompanied by nausea and vomiting and the patient should refrain from taking food for at least two days. To allay thirst a tablespoonful of water may be held in the mouth for a few moments without swallowing it. A slice of lemon may be sucked if water excites vomiting, or cold carbonated or acidulated waters may be sipped, a teaspoonful at a time, every ten or fifteen minutes. Rest of both body and mind must be obtained.
After two days begin the nourishment with water and a small portion of liquid food (not over two ounces) every two hours. Toast tea, made by pouring hot water over toast, oatmeal, or barley gruel (thoroughly strained so that no coarse matter may irritate the stomach), limewater and milk, and egg lemonade are easily digested. Increase the quantity on the fourth day and lengthen the time between feedings to three hours. Gradually increase the diet, adding semiliquid food, noted on pages 237-238, soft-boiled eggs, moistened toast, raw oysters, etc., slowly returning to the regular bill of fare.
Avoid any food difficult of digestion and any vegetable containing coarse fiber. Care in the diet must be observed for several weeks or a relapse may occur.
Chronic Gastritis is accompanied by a thickening of the mucous lining of the stomach. It is usually caused by prolonged use of irritating foods and the regulation of the diet is of utmost importance. Alcohol is a common cause. The difficulty begins gradually and the relief will be gradual.
There is an excessive secretion of thick, tenacious mucus which prevents the gastric juices from mixing with the food. The resulting fermentation of food causes heartburn and produces much gas. Thirst may be excessive.
The stomach needs washing. The washing may be accomplished by drinking two glasses of hot water at least an hour before breakfast, followed by stomach exercises, to cause a surging of the water through the stomach. This may be followed by a glass of cold water.
This may be uncomfortable at first, causing a full feeling, and one may begin by drinking one glass, followed by stomach exercises, gradually taking another glass within a half-hour of the first. This, by means of the exercises, will wash out the mucus.
A glass of cold water half an hour before each meal is recommended here, as well as for relief of indigestion.
In many cases as much as a pint of slimy mucus collects in the stomach during the night. When the stomach cleansing by means of water drinking is impossible, the physician often uses a stomach tube.
Chronic gastritis, in any of its phases, is frequently accompanied by constipation, which reacts on the stomach, and the diet should be as laxative as possible, without irritating the lining of the stomach.
In case an acute attack occurs, which is likely in chronic cases, the diet under “Acute Gastritis” should be followed.
Pancreatinized milk is an excellent food in both chronic and acute cases especially when they are severe. This is prepared by putting “pancreatin” a pancreatic ferment (trypsin) into fresh milk. Preparations of “pancreatin” are sold in the drug stores. Pepsin may be used in the same way for making peptonized milk.
The pancreatinized milk does not form hard curds and readily passes through the stomach for digestion in the intestine. The taste is rather bitter; it may be disguised by flavoring. This may be given for a few days, followed by milk and limewater, barley and toast water, kumyss, oatmeal gruel, meat juices, scraped meat (raw, boiled, or roasted), broths thickened with thoroughly cooked cereals, ice cream, egg lemonade, gelatins and whipped cream, custards and raw oysters.
Fruit in the morning and just before retiring aid the intestines. Two prunes chopped up with one fig, or a bunch of grapes, or an apple, just before retiring may be eaten to assist the action of the intestines and the kidneys.
Almost all fruits contain acids which increase the peristalsis, and the resultant flow of gastric juice. Cooked pears, stewed or baked apples, prunes, and dates are mild fruits which may be used if they agree. The juice of an orange on arising may be used if relished.
All cereals should be thoroughly cooked.
The white meat of chicken, well masticated, is readily digested.
After an acute attack, as the solid food is resumed, it should be given regularly and in small amounts.
Thorough mastication is important. The food should be chewed until it is reduced to a pulp.
Fats and food cooked in fat must be avoided. Dried beef, lean boiled ham, and salt fish agree better with some than fresh meats. All sweets must be forbidden. Starchy foods are apt to produce “sour stomach.”
Avoid meat with tough fiber, too fat meat (pork), sausage, lobster, salmon, chicken salads, mayonnaise, cucumbers, pickles, cabbage, tea, coffee, alcohol, pastry, too much sweets, and cheese if it disagrees.
Five to six light meals a day are preferable to three heavy meals.
The flow of gastric juices is constitutional, thus the regulation of digestion depends on the general vitality as well as on foods. The circulation must be forceful, the habit of deep breathing and of regular periods of complete rest of body and mind must be established.
Since one with chronic gastritis is liable to have many idiosyncrasies, he should not be urged to eat foods for which he has a dislike. The easily digested foods should be prepared in various ways and served in an appetizing, dainty manner.
There are four special phases of chronic gastritis: Mucous Gastritis, Hyperchlorhydria, Hypochlorhydria, and Achlorhydria.
In Mucous Gastritis there is a profuse secretion of mucus in the stomach. In this case it is always well to wash out the stomach before introducing food, as suggested above.
The same general diet suggested for acute gastritis should be followed.
The condition known as hyperchlorhydria shows a liberal excess of hydrochloric acid. The condition is common, and is brought on by worry, nervous excitement, eating when overtired, irregularity of meals, imperfect mastication, and excessive use of alcohol.
The diet should be a mixed one, in about normal proportions. If anything, it should incline more to proteins than to starches.
The hydrochloric acid is necessary for the digestion of proteins and some physicians give a diet consisting almost entirely of proteins such as eggs, lean meat, etc., because hydrochloric acid reduces the protein to acid albumin, which is less irritating to the stomach than the free hydrochloric acid. However, the proteins are stimulating to the stomach and the protein proportion should not be carried to excess.
The best method is to follow a diet in which the foods have practically their normal balance—avoiding all irritating foods.
The juice of one-fourth of a lemon taken one-half hour before the meal will decrease the secretion of hydrochloric acid.
Limewater and milk may be used exclusively for two days; alkaline, effervescing mineral water may be used and then the diet should follow the general diet in chronic gastritis.
Hypochlorhydria is a diminution in the amount of hydrochloric acid. Since this acid is essential in gastric digestion of proteins, a decrease in its supply diminishes the power of the stomach to digest meat, eggs, etc. Physicians often administer hydrochloric acid about one hour after a meal. It should not immediately follow the meal consisting of part solid food, because it retards salivary digestion. Acid fruits, such as lemonade or egg lemonade, should be given half an hour after the meal instead of at the beginning.
Many advocate a diet omitting protein, but since protein foods stimulate the flow of gastric juices, they should not be omitted, but taken less freely. The meals should be at least six hours apart so as to allow time for digestion and to give the stomach rest.
When there is an entire absence of hydrochloric acid, as in achlorhydria, the stomach, of course, cannot digest proteins and this digestion must be accomplished entirely by the trypsin of the pancreatic juice. The presence of liquefied protein, as beef juice in the stomach, however acts as a stimulus to the gastric juice and is an agency in again starting its flow.
The foods should be liquid, so as to pass through the stomach without irritating it. Clear milk must be excluded, because of the action of the rennin in coagulating the casein. This would irritate the stomach.
Pancreatinized milk (see page 99) may be used as an article of diet, also milk with limewater, junket, gelatin, cream, butter, bacon, olive oil, gruels, and any foods which will pass through the stomach without change and are digested by the pancreatic juice in the intestines.
Bran must be excluded from any cereals. Cereals or any carbohydrates cooked or masticated to a liquid state will pass through the stomach without difficulty and be digested and absorbed in the small intestine.
Dilatation results from continued overeating (especially when the nerves are weak), or eating when overtired. The muscular walls become so weak that they fail to contract. Peristalsis is likewise weak, and the food, failing to digest promptly, ferments and forms gas. A dilated stomach is enlarged and its weight and weakness cause it to prolapse.
In the prolapsed condition the pyloric, or lower orifice of the stomach, is often nearly closed, partly by reason of its position and partly by the weakened folds of the stomach walls. Because of this obstruction to the free emptying of the contents into the duodenum, it is imperative that the food be of the simplest form, thoroughly masticated, and perhaps predigested and concentrated so as to be in as small an amount as possible. A chunk of food could not easily pass through the pylorus.
All liquid or semiliquid food should be subject to the chewing movements until it, also, is mixed with saliva. The stomach should not be overloaded with either food or water and for this reason six or more light meals a day, at regular intervals, is best.
A dilated stomach does not necessarily indicate that the digestive juices are not secreted in normal proportions, and easily digested proteins need not be avoided. It is desirable to furnish the proteins in concentrated form, as in meats, so as to get the most nutrition with the least bulk. They should be thoroughly masticated.
Milk may be used, with limewater, if sipped slowly and mixed with saliva.
Sugar should be used very sparingly, because it ferments readily and aggravates the distention. If it is evident that fermented products are in the stomach, it should be washed out with a stomach pump.
A tumor near the pylorus, or constriction of the pyloric orifice by prolapsus, will also cause dilatation of the stomach.
Beef juice, any of the better grades of meats, well masticated and containing no gristle, limewater and milk, soft-cooked eggs, and well-cooked cereals and vegetables should constitute the diet.
Avoid vegetables containing coarse fiber, fried foods, and freshly baked bread.
Liquid with the meal should be avoided, on account of the tendency to overload the stomach.
Cold water, taken a swallow at a time at intervals during the day, has a tonic effect on the relaxed muscles. It also incites the flow of gastric juice.
The best and quickest means of correcting a prolapsed and dilated stomach is by rest in bed for several weeks, with special exercises to raise the viscera and to strengthen all abdominal muscles, as well as the muscular coat of the stomach itself. The food must be given in small quantities every hour.
When this condition is severe, accompanied with severe pains and vomiting of blood, the nourishment is given through the rectum for from five to ten days. Then, for ten days, a milk diet with bouillon, barley water, a beaten egg, and once a day, after the third day, strained oatmeal gruel is taken.
Limewater is added to the milk to avoid the formation of large curds and to neutralize the acids of the stomach. The patient is given half a cup of milk every hour for three days, from 7 A.M. to 9 P.M. From the third to the tenth day the quantity may be increased to one cupful, then to a cup and a half, and the periods between feedings lengthened to two hours. If the milk is thoroughly heated, but not boiled, before the limewater is added, it digests more readily.
After ten days, for the succeeding ten days the nourishment should be given every two hours and the diet varied by semiliquid foods, such as gruels, toast water, soft-boiled egg (once a day), beef juice, two softened crackers (once a day), gelatin, buttermilk, and strained soups. (See page 313, Semisolid Foods.)
After twenty days the patient, if all is well, may very gradually resume a normal diet, beginning with baked potatoes, softened toast, lamb chops, a small piece of steak or white meat of chicken. It is imperative that all food, liquid or solid, be thoroughly mixed with saliva and that solids be chewed to a pulp.
Liquids must not be swallowed either hot or cold, but about body temperature. Cold water may be taken into the mouth when more palatable than warm and held there until about body temperature before it is swallowed. All liquids should be sipped, not swallowed in gulps.
When the condition of ulcer has existed for some time complete rest in bed for from six to ten weeks is advisable. Either the diet suggested above or, if it is desired to gain in weight, a diet of milk, cream, and eggs may be followed. All solid food should be avoided.
INTESTINAL DISORDERS
Most cases of intestinal difficulties may be traced to a clogged condition, either due to a weakness of the nerves and of the intestinal muscles, with resultant weak peristalsis, or to insufficient lubrication.
If the waste is not promptly moved through the intestines, irritation may result and the poisons from bacterial fermentation will be absorbed by the system.
Deranged digestion in the stomach also interferes with digestion in the intestines. Likewise delayed intestinal digestion affects digestion in the stomach.
A large number of cases of constipation become chronic because of the failure to respond to Nature’s call at a regular time each day. Many others are due to weakness of the muscular walls of the intestines or to the nerves controlling them. In this event the intestinal peristalsis is weak.
Constipation may be mechanical, due to obstruction of the intestine in some part of its course, e. g., prolapsus, tumor, or a kink in the bowel itself.
Still another cause is a failure of the liver to discharge sufficient bile into the intestines to lubricate the feces.
Many chronic cases are due to the pill and drug habit. When one continues to take pills, the condition brings a result similar to the feeding of “predigested” food—if the work is done for the organs they become lazy and rely on artificial aid. Every part of the body requires activity for strength.
If the intestines are cramped by the clothing it may cause constipation by restraining their normal exercise during movements of the body in walking, etc. Exercises for the intestines should be taken morning and night.
Constipation may exist even when there apparently is a daily movement of the bowels. Material may accumulate in the large intestine because only a part of the contents is discharged and may cause the unpleasant symptoms which accompany constipation.
It may arise from irregularity in meals, or from overeating, thus causing derangements of digestion from disturbance of the normal process.
Insufficient food may cause it, because the mass is not large enough to be acted on by the muscular movements of the intestines.
Too much strong tea, by its astringent action, lessens the secretions of mucus and causes the mass to become too dry.
Too little water may be taken and the food not sufficiently moistened; food may be concentrated and leave little residue.
Overeating, especially when the intestinal muscles are weak, furnishes a greater bulk than the intestines have the power to propel, hence a semi-paralysis and inactivity result.
Anxiety and grief or worry may inhibit the action of the nerves and thus cause a stagnation of movement on the part of the bowels.
The cause of the difficulty must be ascertained before relief can be gained.
The most natural relief for constipation, therefore, comes through exercise, particularly when directed to the muscles of the stomach and of the intestines and to the nerve centers controlling them.
The free use of water and such foods as figs and raisins, prunes, dates, grapes, apples, and rhubarb, which are laxative in effect, are helpful. These have best effect when eaten just before retiring or when the stomach is empty.
The use of vegetables which furnish a large bulk of fiber is often beneficial. Cabbage, celery, lettuce, spinach, mustard greens, oyster plant, and asparagus consist largely of residue. Onions are also laxative, especially when boiled. Tomatoes possess a special laxative effect for many individuals.
When derangements of digestion make raw fruits undesirable, they may be cooked and thus used for their laxative effect. They are not so laxative when cooked with much sugar, because much sugar may cause fermentation and gas. A little bicarbonate of soda added to acid fruits after cooking will correct the acidity and not so much sugar will be needed.
Two or three glasses of water should be taken on rising and before retiring. This cleanses the stomach as well as aids in relieving the dryness of the bowel contents.
Oatmeal, or any cereal containing the bran, is laxative. Such are bran or corn-meal bread, Boston brown bread made with molasses, and Graham bread.
Children should be trained to attend to Nature’s call regularly every day. The best time is shortly after breakfast.
Inflammation or Catarrh of the Intestines is similar in its nature to Gastritis or Catarrh of the Stomach.
Acute Enteritis, or cholera morbus, is usually caused by a strong irritant—either by some food which disagrees, by unripe fruits, or by a mass of undigested food.
A fast of two or three days is the usual initial dietetic treatment.
A free drinking of water not only soothes the irritated intestines, but it cleanses the intestinal tract and assists in eliminating elements of fermentation; if these are not eliminated, they will be absorbed into the blood.
Absolute quiet in bed is necessary.
After the fast, a liquid and semiliquid diet is followed until inflammation is relieved and diarrhea and vomiting have ceased. Milk, strained gruels, broths, strained soups, buttermilk, eggs (soft cooked or raw), beef juice, barley water, custards, junket gelatins, soft puddings, etc., are most nourishing and cause little irritation. (See page 313, Semisolid Foods.)
Milk should be mixed with limewater to prevent the formation of large curds and should be sipped. Water should not be taken, as it tends to increase the diarrhea. Ice may be held in the mouth to relieve thirst.
All irritating foods, such as coarse vegetables, pickles, acid fruits and fruits with coarse seeds, candies, beer, wines, and salads must be omitted.
Chronic Enteritis has the same general cause as acute enteritis, though its onset is slow and it takes a correspondingly longer time to correct.
A milk diet for two or three weeks may be necessary to rest the bowels.
When food is taken, if undigested particles appear in the stool, it may be necessary to use predigested foods for a while.
If acute, dysentery demands complete rest in bed. The diet, in both acute and chronic cases, must be confined to easily digested foods such as peptonized or pancreatinized milk (see pages 99 and 308), boiled milk, meat juice, and the white of egg, beaten and served with milk.
Blackberry brandy and tea made from wild cherry bark tend to check the inflammation.
During convalescence, care must be taken not to overfeed. Fruits and vegetables should be avoided. Begin a more liberal diet with an increased amount of beef juice, gradually adding tender beefsteak, roast beef, fish, white meat of chicken, eggs, custards, jelly, dry toast, blancmange, well-boiled rice, and other easily digested food. The beef and egg are particularly valuable, because of the anemia occasioned by the loss of blood.
DERANGEMENTS OF THE LIVER
The liver is not, in a strict sense, a digestive organ, but the digested food must pass through it and undergo certain chemical changes.
For a fuller understanding of the reasons for the following suggestions regarding diet in liver derangements, the chapter on the “Work of the Liver,” pages 151-152 should be reread.
It will be recalled that the liver acts not only on the foods, but it also stands on guard to neutralize poisonous ferments, due to putrefactions absorbed from the intestines, and to render them harmless. To a limited extent it also oxidizes alcohol.
After the gorging of a heavy meal, the overloaded blood and liver express themselves in a sluggishness of the brain and one feels mentally as well as physically inert.
Since both carbohydrates and protein undergo chemical changes in the liver, it is evident that a diet consisting of an excess of either, must overwork the liver, not only through the nutritive food elements absorbed, but through the toxic substances which may be produced.
The regulation of diet, when the liver is in an abnormal condition, must be more in the quantity than in the quality of food.
The condition of the liver depends also on the activity of the intestines, since the poisonous products from imperfectly digested and fermenting food, not being eliminated, will be absorbed and carried to the liver. If the food remains in the intestines too long, it is attacked by the bacteria always present there, fermentation results and poisons are absorbed and carried to the liver, which usually can render them harmless to the system. If for any reason the liver is diseased, overloaded, or its action is sluggish, these toxins are absorbed in larger quantities than the liver is able to handle, hence they reënter the blood and poison the system.
The most important corrective agencies, when the liver is inactive, is a fast for a day or two, a free drinking of water, deep breathing, and exercise so directed as to bring a free supply of blood to this organ.
It is apparent that the blood must carry its full quota of oxygen to assist in eliminating both the nitrogenous waste and the poisons. It must also be remembered that the liver must oxidize the waste from its own tissues, as well as from other parts of the system.