As the means by which we are able to keep the intestines in good working order are of the same efficacy also for the stomach, all that is necessary to mention in this chapter about the intestines will apply equally to the hygiene of the stomach. The same applies also to the pancreas, so that it is unnecessary to treat of its hygiene separately. It is also our intention in this book to mention only the hygiene of those organs which are able to rid the body of toxic products, as it is mainly by their degeneration that premature old age is brought about.
There is scarcely a serious disorder of the stomach without an attendant alteration of the intestinal functions. All the different agencies that are dangerous to the stomach will also prove dangerous to the intestines. We have mentioned several of these in the chapter on food and the hygiene of eating, where we have pointed out that defective mastication is very deleterious. Food introduced into the stomach passes into the intestines, and if it reaches these insufficiently masticated it will present great difficulties for the penetration of the intestinal ferments. Not only will it not be well digested, but as the different ferments cannot well penetrate these compact masses they will putrefy, thus considerably increasing the natural fermentation, in consequence of which a great amount of toxic products and a considerable irritation of the intestinal mucous membrane will result, which may subsequently cause disease. By thoroughly masticating everything we eat, we are not only safeguarding the condition of the stomach, but also that of the intestine.
The integrity of the functions of the intestines is of supreme importance, for it is here that absorption and assimilation of most of our food occurs. If our intestines are not in perfect order we shall soon waste and dwindle away, even within a short period, and sometimes very rapidly. Thus if we wish to retain our strength we must treat the intestine with the greatest care. This is especially the case in old age, for then an atrophy of the glandular mechanism of the digestive tract, stomach, and intestines, takes place. Thus old people will not be able to assimilate nourishment to the same extent as younger ones; they will lose a portion of its nutritive value, and it will become more and more difficult for them to completely digest their food. To such people, therefore, it will be necessary to give food in a form that is easily absorbed, preferably in liquid form; it would also be desirable to give them their albuminous food in a predigested and soluble form. In Germany, especially, are used a considerable number of so-called “Nährpräparate,” a nutritive preparation which contains albumin in the form of albumose, which naturally can be assimilated easier; there are also carbohydrate preparations in which the starch is transformed into dextrin or maltose. There is a legion of such preparations, but it would lead us too far to enlarge on them by a longer description. They are produced from proteids, many of them from fish, or from blood, or from eggs; also from milk; while others consist of finely ground preparations of wheat, oatmeal, barley, rice, arrowroot, sago, tapioca, buckwheat, Indian corn, etc. As aged persons have greater difficulty in assimilating in their intestines and stomach food in its natural state, the use of the best of these predigested preparations would certainly be advisable in order to insure a healthy condition of the intestines and a prolongation of life. The last mentioned carbohydrate preparations possess also the great advantage of preventing an excessive putrefaction of the intestinal contents with its harmful consequences, which tendency is always greater with albuminous food, starchy foods in large quantity tending, as already stated, to produce acid fermentation in the intestines by which many products of albuminous digestion can be destroyed. Against these poisons formed in the intestinal tract we possess a natural defense in certain ductless glands, the thyroid and liver, which are degenerated in old people; therefore carbohydrate is the best for them.
The prevention of intestinal putrefaction is, however, equally important in younger people. As Combe proves, we can avoid this by the use of certain kinds of food, especially carbohydrates and fruit, and by other substances producing lactic acid, which is, indeed, the best disinfectant for the intestines. The great benefit of various kinds of sour milk generally has been pointed out by Metschnikoff and his disciples. Among the causes of old age this savant attributes an important rôle to the processes of putrefaction in the intestines, and to avoid this he recommends the use of a certain kind of sour milk produced by fermentation by a number of microbes, including the Bulgarian Bacillus maya.
That certain kinds of food exercise poisonous effects when introduced into the intestines is a matter of common observation. Thus, in not a few cases, fever, accompanied by cutaneous eruption, may be witnessed after partaking of strawberries or oysters, and especially after eating meats (notably sausages) which are in a state of decomposition. Severe cases of poisoning, even resulting in death, have occurred; and in Germany there have been, from time to time, regular epidemics after partaking of sausages in the above condition.
Of course everyone partaking of such poisonous food will not become poisoned as this is prevented by the action of such glands as the thyroid and liver, whose function it is to preserve us from such effects. People in possession of healthy sensory organs,—eyes, nose, and tongue,—will be enabled to tell whether meat is in a fit condition to be eaten or not; but frequently we cannot discover by our senses a state of decomposition when such is not in an advanced stage, and if such food is taken regularly and in large quantities the great number of microbes we thus introduce into the intestines will poison us slowly but surely.
Such poisonous microbes thrive and multiply very well in the alkaline contents of the intestines, but the growth of such dangerous bacteria can be greatly hindered by the introduction therein of acid substances, especially lactic acid. It has been observed by several authorities, such as Grundzach,[213] Schmitz,[214] and Singer,[215] that lactic acid decreases intestinal putrefaction, and also the conjugated ether sulphates in the urine.
Professor Metschnikoff, of the Pasteur Institute in Paris, deserves great credit for having insisted on the importance of introducing certain microbes into the intestines for the purpose of transforming the sugar of their carbohydrate contents into lactic acid, and thus causing the disinfection of the intestines by destroying the noxious germs and hindering their development. For this purpose the so-called Bulgarian bacillus can best be employed, as it is able to transform the cultures of pathologic microbes in the intestines into a beneficient growth that is quite harmless.
This Bulgarian bacillus is well known because of its action in producing the sour milk “yoghurt” of the Bulgarian population, to the use of which, according to Metschnikoff, is due the very large number of centenarians to be found in that country.
The action of the lactic bacilli has been proved by the experiments of Dr. Herter, of New York,[216] who discovered that by the introduction of large quantities of these bacilli into animals their intestinal putrefaction was diminished.
Dr. Michel Cohendy[217] has performed similar experiments on himself. After taking for twenty-five days his usual diet and subsequently noting the degree of his intestinal putrefaction, he took pure cultures of a lactic bacillus, extracted from “yoghurt.” For more than two months he continued to take large quantities of these bacilli (280 to 350 grammes a day). Not only during the course of the experiment did the urine exhibit evidences of a diminution of intestinal putrefaction, but this continued for seven weeks afterward, and he arrived at the conclusion that the lactic acid fermentation due to this bacillus was able to hinder the putrefying action of the microbes developed from the meat he had taken during his experiments. He, therefore, comes to the conclusion that it is unnecessary to discontinue meat food for the suppression of intestinal intoxication if lactic bacilli be taken therewith.
Dr. Pochon, assistant to Professor Combe, of Lausanne, continued upon himself the experiments of Dr. Cohendy. For several weeks he took sour milk (lait caillé) which was prepared from cultures of pure lactic microbes, and he found positive proofs of the checking of intestinal putrefaction thereby.[218] In those, therefore, who are able to procure and use a pure preparation of lactic bacilli, intestinal putrefaction will be greatly diminished. But even when we cannot obtain these preparations we can follow a diet that will tend to develop lactic acid fermentation. This can be brought about by taking carbohydrates in large quantities, especially those which are very rich in sugar, at the same time taking milk, particularly sour milk.
It is an absolute fact that in those who are addicted to a diet of carbohydrates, intestinal putrefaction is diminished, owing to the formation of lactic acid from the fermentation of the milk-sugar which is contained in such carbohydrates.
Intestinal putrefaction is enhanced by the alkaline contents of the intestines; it can, therefore, be checked by various agencies that diminish the alkalinity of the intestine, such, for instance, as by lactic acid, just referred to. Fatty and acetic acids also effect this; likewise fatty food, which promotes the formation of fatty acids. Cheese may produce fatty and also lactic acids; wherefore it is of value to combat putrefaction in the intestines. Of the further benefits of cheese as an article of food, we make mention in the chapter on the hygiene of food; we also state there that it is unsuitable in those cases in which the intestines are not in thorough order.
Great care should be exercised in the quality of the food. The freshness of various foods is of the greatest importance to the intestines, since the main function of the stomach is principally a mechanical one, serving to reduce the food into a convenient form and carry it to the intestines, ready to be there prepared, through the influence of the intestinal juices, into a condition fit for absorption and assimilation. During this process the food is being reduced to its simpler elements, and the more noxious substances are being freed to commence their baneful activity. These substances first of all create an inflamed condition of the intestines; then, being absorbed into the blood, they cause a general intoxication. Fortunately they are not frequently absorbed, and thus their injurious effect is limited to the intestine. Among other such injurious foods we may mention fish and oysters, sausages and meats that are in a state of decomposition; fruit that is unripe or unsound; and canned food in which certain drugs are used as preservatives, such being poisonous in varying degree, examples being salicylic boracic, and sulphuric acids, etc., and at times even the terrible poison, verdigris. Fresh food should always be preferred to canned food, or to food preserved in other forms for too long a period (see also chapter on the hygiene of food).
The stomach, and intestines also, can frequently suffer damage from ice cold drinks, especially if taken habitually and in large quantities. As already mentioned in the chapter on the hygiene of the kidneys, we should never forget that every sort of food or drink must pass a series of delicate epithelia of our noblest organs, which can be injured by sharp and poisonous substances with which they come in contact.
More injurious is the action of various kinds of noxious food, especially if putrid, which remain for a long time in the intestines, thus creating a chemical laboratory constantly preparing poisons. Even the residue of less harmful foods, especially albuminous, even if of good quality, when taken into the body, can become deleterious if it remains too long in the intestines. It will, therefore, be a part of the highest wisdom to exercise care in having these highly important organs, on which all our nutrition depends, in thoroughly good working order by keeping them clean and by removing stagnant material. We have already designated the best way to effect this in a previous chapter, and we desire here to say a few words on the abuse of, and great dangers arising from, remedies constantly prescribed for constipation.
We have insisted in the foregoing pages on the necessity of a daily bowel movement, and have stated that appropriate food is the best way to attain this. Food that leaves no residue, like meat or finely ground cereals, is incapable of producing a stool. Hence, as Schmidt has pointed out, constipation is often caused by the food being too completely absorbed. Strassberger, by analyzing and counting the number of bacteria in the stools, found that certain cases of constipation were caused by a diminished fermentation in the bowels. Lohrisch has found that in persons whose intestines possess a marked power for absorption there does not remain in them a residue sufficient for the action of the bacteria, and thus there will not be a sufficient fermentation to act as a stimulant to the intestinal walls to cause them to expel their contents. Uncooked cold milk (especially buttermilk, whey, sour milk, “yoghurt,” kefir, etc.), and dishes containing vegetables and fruit, grapes, puree of prunes, marmalade of oranges, and brown bread (Graham, Pumpernikel, etc.) should produce a movement of the bowels every day in a normal man or woman. There are, however, many exceptions to this, especially in the case of women, caused either by previous errors in diet, or by negligence in answering at once the demands of the bowels for an immediate evacuation, and also, very often, by an abuse of purgatives. All this is, of course, aggravated in those in whom the innervation of the bowels, which is controlled by the splanchnic nerves and the vagus, is altered by the degenerative condition of certain glands which influence these nerves: the sexual organs and the thyroid.
These alterations are far more common in women, as frequently mentioned before, as their sexual glands and thyroid are so often irritated by physiological and pathological processes peculiar to her sex, and which so frequently recur during the life of a woman. It is a fact that most of the diseases of the female sexual mechanism are followed by alterations in the intestines, due, in part, to their close proximity to the pelvic organs, but, in a greater degree, to the intimate relation of these regions to the nerves that control the intestines. The same is true to a lesser degree in man, so that after troubles with the prostate, or after chronic gonorrhœa, a regulation of the bowels is an important matter, constipation being usually very obstinate in such cases.
In addition to this sluggishness of the bowels in females, owing to anatomical and physiological causes, there may be associated faults arising from a bad habit. Instead of paying special regard to the innate tendency toward constipation and endeavoring to have a movement every day, many women, especially young girls, neglect this by even resisting the demand of the intestine to be evacuated, and deferring this most important function to the following day, or even later. Such a course necessarily lowers the vitality of the intestinal nerves and muscles. As soon as such a nervous impulse is felt, we must promptly act on it; should we not do so a greater nervous and muscular effort must follow, and, if even then we neglect to obey the call of Nature, after several such useless efforts the nerves and muscles of the intestines will relax, particularly if such a foolish practice be often repeated, for it is quite natural that such an intestine will not respond to the stimulation by the pressure of its contents upon the nerves, and its muscles will not contract to expel the fæcal contents, as in normal people.
Unless, therefore, from force of circumstances, it is impossible, we must at once respond to the first admonition of the intestines, and not exhaust the vitality of its nerves and muscles by exposing them to unnecessary efforts at our own expense. Some people are so impressed with the importance of immediately answering such a call that they will forego the most urgent business on that account. I know an authentic case of a member in the profession—a great surgeon—who, a few years ago, was urgently summoned to a member of the highest nobility who had met with a hunting accident. Unfortunately for the patient the call came at just such a moment as we have been speaking of; true to his principles, he did not arrive immediately, but only after having fulfilled the execution of this important part of the hygiene of his intestines, and the patient lost his life.
Happily such an instance is of the rarest occurrence in our profession, for we always ignore our own chance for a long life in favor of our patient’s, which is fully proved by the fact that, of all professions, the physician’s life is the shortest.
Corsets as worn by women contribute to develop in them ptosed bowels—gastroptosis and enteroptosis—which can easily arise after pregnancy; the strength of the intestinal muscles becomes still more diminished and constipation is the consequence.
It is not to be wondered at if women, and men also, in cases where the diet alone does not bring about an ordinary movement, should resort to drugs, several of which we have mentioned previously. At first, even the mildest drugs will act; but, unfortunately, after a time the intestine becomes accustomed to them and they cease to act. Stronger drugs are then resorted to, such as often contain aloes, which, besides injuring the stomach, act in a very irritating way on the intestines; these respond by a very strong action, causing copious stools accompanied by colicky pains. But it is in the nature of things, as we have observed holds true in any organ, that overstimulation of any function is followed by its exhaustion; thus the nerves and muscles of the intestine get over irritated and relax if obliged to overact. After a copious evacuation caused by strong drugs we, therefore, find a still more obstinate constipation than before. Stronger and stronger drugs are then used until there is a complete breakdown and ruin of the intestinal innervation and muscular action. We must, therefore, commence first with a suitable diet, then use mild drugs if necessary, with massage and electricity, as already described.
Intestinal enemata are also beneficial, but if a large amount of liquid be used the muscular walls get too greatly dilated and may lose their elasticity and vitality, particularly if strong drugs be used in such enemas.
Many women suffer from habitual constipation by reason of their drinking but little water, especially if the food they take contains little fluid; the fæcal masses become solid and coagulated, and thus their passage in the intestine toward the anal exit becomes more difficult, whereas by a sufficient quantity of liquid, such as water, this movement will be much facilitated; and that this is an important consideration is quite evident in the case of women who have a tendency to lethargic bowels. Such a thickening of the fæcal masses occurs particularly in certain parts of the intestines, such as the cæcum, the ascending colon, and the sigmoid flexure. In these parts the fæcal matters often become detached, accumulate, and easily get condensed. They may remain there sometimes for longer periods, which can easily be proved by experiments, giving bismuth by mouth and then examining the abdomen by means of the Roentgen rays.
It thus happens that people, under the impression that a good daily stool has produced a clean bowel, still have a residue, and this can instantly be seen by removing the same by purging drugs. We, therefore, recommend the weekly use of a reliable purgative, such as bitter water, thus cleaning the bowels of all residue, which frequently remains in deep haustra of the intestines, as in Barlow’s disease.
The stagnation of fæces around the cæcum may also facilitate the development of appendicitis, this being frequently due to neglect of the hygiene of the intestines. It is also one of the commonest diseases, as we will show in the succeeding chapter.