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CHAPTER 4.  Diseases Of The Digestive System

   1--Diseases of the Mouth
      A--Stomatitis
         1--Acute Stomatitis
         2--Ulcerative Stomatitis
         3--Eczema of Tongue
   2--Diseases of the Salivary Glands
      A--Hypersecretion (Ptyalism)
      B--Xerostomia (Dry Mouth)
      C--Inflammation of Salivary Glands
   3--Diseases of the Pharynx
      A--Circulatory disturbances
      B--Acute Pharyngitis
      C--Chronic
      D--Ulceration of the Pharynx
      E--Tuberculosis of the Pharynx
   4--Diseases of the Tonsils
      A--Acute Tonsilitis
      B--Chronic
   5--Diseases of the Esophogas
      A--Acute Esophagitis
      B--Spasms of Esophagitis
   6--Diseases of the Stomach
      A--Acute Gastritis
      B--Chronic
      C--Dilation of Stomach
      D--Peptic Ulcers
      E--Cancer of Stomach
      F--Hemorrhage from Stomach
      G--Neurosis of Stomach
   7--Diseases of the Intestines
      A--Diarrhea
         1--Chronic Diarrhea
         2--Dysentery
         3--Chronic dysentery
         4--Amebic disentery
      B--Constipation
      C--Appendicitis
      D--Enteroptosis
   8--Diseases of the Liver
      A--Jaundice
      B--Gallstones
      C--Cirrhosis of the Liver
   9-Diseases of the Pancreas
      A--Hemorrhage
      B--Acute Pancreatitis
   10--Diseases of the Peritoneum
      A--Peritonitis
      B--Chronic Peritonitis
      C-Ascites

A. DISEASES OF THE MOUTH
STOMATITIS
(1) Acute Stomatitis

   This is a disease of the mouth--the commonest disease of this organ. It may be caused by gum-chewing, or by eating anything that is pungent or irritating. Mustard may bring it on. Where these sores appear in the mouth frequently, it shows a run-down state of the system, and it always points to more or less derangment of the digestion. The irritation may be confined to the gums; in fact, any part of the mouth, including the tongue, may be affected. First there is redness. Where the irritation extends over a considerable surface, the tongue, gums, or cheeks may be swollen. If the tongue is swollen, the prints of the teeth will be seen on the side. An acid state of the stomach is more inclined to favor the development of this disease than any other cause. The acid referred to is not the normal hydrochloric acid of the stomach; it is the acid of fermentation, always indicating an excessive intake of food, particularly carbohydrates.

   Treatment.--Change the style of eating: Eat more fruit and vegetables, less starch--especially white bread--and see to it that the bowels move regularly every day. Those who so desire may use a little chlorate of potash water as a wash for the mouth; but washes and medication generally are not necessary. Remove the cause--improper eating.

(2) Ulcerative Stomatitis

   The ulcerative form of this, disease is found in many grown people. 'Those with decomposition in the stomach and bowels, and fetid breath, and who have bad teeth and a coated tongue, will often have white ulcers appearing on the margin of the tongue, on the gums, inside of the cheek, or in other parts of the mouth. In severe derangements of this kind there will be several ulcers at one time; but the disease always means improper eating and constipation--eating of food that is potentially acid, often made so by cooking and dressing.

   Treatment.--The bowels should be kept open with enemas. It is best to stop eating until the bowels are well emptied; then fruit for two meals a day, and one meal of meat, combination salad, and cooked, non-starchy vegetables. This diet should be continued until the bad breath, coated tongue, and every other indication of perverted digestion have been righted; then add bread to one of the fruit meals.

(3) Geographical Tongue (Eczema of the Tongue)

   As the name implies, the surface of the tongue gives the impression of a map; or the tongue may be described as being figured--some parts denuded of epithelium and other parts coated. This condition is accompanied by itching, and sometimes a burning sensation.

   According to the best writers, the etiology is not known. In my practice I have found that this state of the tongue is always accompanied by obstinate constipation, with the usual toxin poisoning characteristic of putrefaction in the large intestine.

   Treatment.--Correct the condition of the alimentary canal by overcoming constipation and having the patient live on fruit for a week or two. If the patient is thin, about one week without food, except fruit, is enough. The prunes and fresh fruit should be taken for breakfast; uncooked apples for lunch, and oranges and figs for the evening meal. No water or other fluid is to be drunk until the bowels are normal. If the bowels are obstinate, an enema may be taken in the evening.

   The second week, fruit may be given twice a day, and then a dinner of meat, cooked, non-starchy vegetables, and a salad. This diet should be kept up until the tongue is normal.

 

B. DISEASES OF THE SALIVARY GLANDS

(1) Hypersecretion (Ptyalism)

   The amount of saliva secreted in twenty-four hours is from two to three pints. Most of this is secreted while eating. When there is a hypersecretion, it is called ptyalism. This is met with in nervous derangements--in some cases of mental disease in those who are starch-poisoned. It is sometimes found in fevers and in smallpox. Where the motility of the stomach is disturbed from adhesions, etc., plyalism is liable to be present. Mental states of fear--fear of sickness, fear of taking an epidemic disease that is raging in a community--will often create ptyalism. The patient, if a lady, will have a handkerchief and spit into it every few seconds, Ordinary ptyalism, that has not been brought on from mental derangement or poisoning by mercury, is usually an indication of an excessive intake of starch; and the treatment, of course, is to stop the use of starch until fully recovered. Where the disease is caused by mental excitement, the cause must be removed.

(2) Xerostomia (Dry Mouth)

   This condition is brought on by anger, hate, envy, and spite. Waking up at night with a dry mouth usually indicates mouth-breathing--a bad habit that should be controlled. Tobacco-users often are troubled with dry mouth on awakening of a morning, and the tongue will be red and furrowed. Excessive starch-eating is sometimes indicated by a fissured tongue. The cause must be discovered and removed.

(3) Inflammation of the Salivary Glands

   Mumps come under this head. This disease has been treated elsewhere.

   Symptomatic Parotitis, or Parotid Bubo, is often a metastasis of disease from elsewhere--a septic inflammation transferred from some other part of the body. Septic inflammation developing in any part of the body is liable to start up this condition. It has shown itself in typhus, typhoid, pneumonia, pyemia, septicemia, etc. A slight infection following abortion may sometimes prove fatal by starting up septic inflammation of the parotid glands. Sometimes this condition accompanies so-called syphilitic infection. This disease has been set up by injuries of different parts of the body--diseases of the urinary tract, alimentary canal, and injuries to the abdominal wall, or peritoneum. The cause is an infection.

   The treatment should be cloths wrung out of hot water, frequently changed. When suppuration takes place, the abscess should be given a free opening and not allowed to close too soon. Where the infection is due to pelvic peritonitis, the chances of recovery are very slim. This has been my experience running over a number of years.

   Chronic enlargement of these glands may develop from the same causes that develop enlargement of other glands. They may become tubercular, cancerous, or fibrous. A strict letting-alone is the best treatment, along with careful living--careful dieting. Where the glands remain large and show no tendency for growing larger--seem to have arrived at a standstill--they should be left alone.

   Enlargement of the salivary, lachrymal, and buccal glands sometimes occurs. In such cases I should expect to find a stomach derangement. If this is corrected, the swelling of the glands will soon pass away.

 

C. DISEASES OF THE PHARYNX

(1) Circulatory Disturbances

   Hyperemia is common with smokers, or those who eat excessively and have acid fermentation in the stomach. The fermentation causes gas, and the gas eructations into the throat keep it in a sensitive state. Constant use of the voice will produce irritation of this kind. Sometimes this condition of the throat will develop in heart disease. Young children will often be made hoarse, their throats being made sensitive by the gas coming up from the stomach, causing irritation and edema. This may be severe enough to cause a husky voice, persistent cough, and often a croupy cough. Where the irritation comes from deranged digestion, this must be corrected by proper feeding. Where it is caused by the use of tobacco, alcoholics, etc., the cause must be stopped.

   A cough from pharyngeal irritation often precedes pulmonary tuberculosis.

   Hemorrhage is sometimes found. This is associated with a tendency for bleeding of the mucous membranes of other parts of the body. In vicarious menstruation the pharynx will sometimes bleed. Bleeding of the nose, where the blood passes down into the throat, is sometimes taken for bleeding of the pharynx. An enlargement and elongation of the uvula will sometimes be developed, with intense redness, and there will be a certain amount of oozing of blood from it. This is the case where the throat is decidedly abused by wrong eating; it is also found where either hot water or hot coffee is taken, and where tobacco is used to excess.

(2) Acute Pharyngitis

   This derangement is frequently met with in epidemics of scarlet fever. In some epidemics there will be fifteen to twenty cases of scarlatinal angina to every marked case of scarlet fever.

   Colds are supposed to cause this sore throat. The disease is said to be associated with rheumatism and gout. The reason is that rheumatism and gout are always associated with digestive disorders. Digestive disorders are the primary cause of all these diseases. No one can develop acute pharyngitis without a deranged digestion, unless it should happen to be brought on from accidentally scalding the throat. The cure for this disease is to correct the stomach derangement by feeding properly. The patient should go without food until better, and wash out the bowels. If this is done, it will not take more than three or four days to cure the worst type of the disease.

(3) Chronic Pharyngitis

   This may develop in tuberculous subjects after several acute attacks. It is very liable to develop in those who use tobacco, alcoholics, and gum. Clergymen, hucksters, and others are liable to develop this disease from loud talking. It is often a sequel of nasal catarrh--or, rather, an accompaniment. It is accompanied by a dropping-down in the back of the throat. It is strictly a catarrhal derangement.

   For treatment, the diet must be corrected. The bowels should move every day.

   Until the severe symptoms are overcome, two meals of fruit a day, one meal of buttermilk, and no starch, should be taken.

(4) Ulceration of the Pharynx

   On looking into the throat, the follicles will be found inflamed. The ulceration will not be very deep, and there will be other symptoms of catarrh. Syphilitic sore throat is usually confined to the pharynx. Sometimes it goes to the larynx.

(5) Tuberculous Pharynx

   This disease is not infrequent. It is very intractable--presumably because the throat is used so much. However, when tuberculosis develops in the throat or the air-passages of the lungs, it means that wrong life is the cause to such an extent that nutrition is pushed very far from the normal. In the tuberculous diathesis it requires a very great deal of painstaking care to bring patients back to normal.

 

D. DISEASES OF THE TONSILS

I. ACUTE TONSILITIS

   Etiology.--This is a disease of childhood. It is, however, not infrequently met with in grown people. An attack of this disease is supposed to be precipitated by wet and cold weather, and bad hygienic surroundings. The weather and surroundings will have little to do with bringing on a disease of this character until nutrition is very much impaired. Some of our leading writers declare that sewer gas is regarded as a common exciting cause. I agree in full that this is true, but I do not agree with them as to the location of the sewer. In all the cases that I have ever been called upon to treat, the sewer has been below the diaphragm. Unless there is a sewer there, the outside sewer--city drains, grease traps, etc.--will have little to do with developing the disease. According to our best authorities, one attack renders a patient more liable to subsequent attacks. Why? Because these patients will be treated for sewer-gas poisoning, instead of correcting the cess-pools under their diaphragms; and so long as they know nothing about proper living, and continue to generate sewer gas in their own stomachs and bowels, they will be subject to frequent attacks of this disease. The disease prevails more in the fall. Why? Because the first cold weather is accompanied by chilly winds. The throat already being sensitive from imprudent eating all summer, the cold air creates irritation. The patients put on heavy underwear just as soon as the weather turns cold, the body is over-heated, and they are thrown into a cold.

   The cold is often repeated quite frequently during the fall and winter. There is nothing peculiarly wrong with the weather in the fall, so that anyone need be affected by it, indeed, it is usually delightful; but for years I have noticed that tonsilitis is a very common disease following within a week after the people start fires in their homes and put on their heavy underwear. It is worth while to know that after Thanksgiving, Christmas, New Year, and other feast-days, there is always an epidemic of tonsilitis, la grippe, colds, pneumonia, etc. Where conditions are favorable, diphtheria is developed, which is nothing more or less than a septic development or infection of ordinary tonsilitis. Most authorities look upon it as epidemic and contagious. It is so only in appearance, however; for people generally have much the same habits of eating, housing, clothing, etc., and there is nothing strange in the fact that all enervated people should be affected alike. When the habits of the people are analyzed, they will be found to live in much the same way; then it would be unnatural if physical agencies did not act on all alike.

   Symptoms.--Chill and fever, with aching all over, but particularly in the back and legs, are the symptoms with which this disease is ushered in. In children the temperature often runs to 105 F. Accompanying the disease there is always more or less gastritis; for the origin of the disease is gas poisoning from the gastro-intestinal canal.

   The first symptoms may be a soreness in the throat; if not, this will come soon after the fever starts. On examination after the angina has commenced, the throat will be found intensely red, and the mucous membrance engorged, congested, and much swollen; the tongue is usually coated, and the breath very foul; the urine, as in all cases of fever, is highly colored and filled with mineral elements. Children frequently breathe very heavily, the pulse is quite rapid, and swallowing in some cases almost impossible. The fever is somewhat self-limited, usually lasting about a week. Then the patient will be almost well, unless there is a complication of quinsy setting in. That means that the tonsilar inflammation has extended to the soft palate, and an abscess will form. This form of tonsilitis is what is known as quinsy. It is an infection from an ordinary tonsilitis. The tonsils remain enlarged after this disease for quite a while, but will gradually shrink to their normal size, if the patient is properly fed; if not--if the patient continues the ordinary haphazard living--other attacks of tonsilitis will follow, a few weeks or months apart, until a time comes when the tonsils will be very much diseased. The constitutional derangement is great. Rheumatism will develop in some, and pulmonary tuberculosis in others.

   Treatment.--Inasmuch as tonsilitis always comes from gastro-intestinal fermentation, the first, last, and about the only consideration in the line of treatment should be given to clearing out the intestinal tract and fasting until the disease is controlled. Copious enemas should be given two or three times the first twenty-four hours, and after that every night before bedtime. Positively no food should be taken until the inflammation in the throat has entirely subsided, but all water desired may be taken. Then the eating should be confined to fruit for the first twenty-four hours; the second twenty-four hours, fruit moming and night, with a combination salad and cooked, non-starchy vegetables for the noon meal. The third day a little meat may be used if desired, or a soft-boiled egg, with a salad or a grapefruit. At the end of the fourth or fifth day, toasted bread and butter, with uncooked fruit, may be taken for breakfast; meat and salad, with cooked, non-starchy vegetables, for the second meal; and fruit for the third meal.

 

II. CHRONIC TONSILITIS

   This is a catarrhal state of the pharynx and posterior nasal passages. Sometimes the eustachian tube, and even the middle ear, are involved. This disease is often accompanied by adenoids. By the best authorities, enlargement of the tonsils is given credit for being the cause of mental derangements and lack of bodily development in some children, It is too bad that extraordinarily smart teachers sometimes hook up the cart before the horse. The cause of the tonsilitis is the cause of the mental and bodily derangement. As soon as the improper habits of life, practiced daily, which cause this disease, are corrected, the disease will gradually decline, and the tonsils will grow smaller from month to month, until they entirely disappear. The adenoids will disappear in much less time. Operations are not necessary--and, in fact, are injurious, because they give the patient hope of a cure without removing the cause. The cause is wrong eating, and wrong care of the body generally. Children that are fed on a diet lacking in raw fruit and raw vegetables develop a catarrhal state early; and so long as the bad habits are practiced, the condition grows worse. The children most afflicted in this way are those inheriting the scrofulous diathesis. Then, when they arrive at puberty, a large percentage are taken off with tuberculosis.

   Children who have very large tonsils are mouth-breathers. They are not bright in school; their general health is, very much impaired. But, as stated before, this is not due altogether to the enlarged tonsils. The majority of children who do not breathe well through the nose will be entirely relieved of this symptom in one week, if confined to fruit morning, noon, and night. Possibly there may be cases so severe that they will require ten days on a fruit fast; but if the children are started on the fruit diet, they should be kept on it until their breathing is natural. By that time the redness, swelling, puffiness in the throat, and a great deal of the enlargement of the tonsils, will have vanished, and the adenoids will no longer interfere with breathing.

   Treatment.--See to it that the bowels move every day. In pronounced cases the child should be kept away from food for three days. Then this should be followed with three fruit meals each day--moming, noon, and night--for three days. If all the symptoms are improving by that time, two meals of fruit, with one of toasted bread and butter, followed with an apple or an orange, may be given. This can continue for three days. At the end of that time, toasted bread in the morning may be given, followed with an apple. An egg, or a small bit of lamb, chicken, or fish, with cooked, non-starchy vegetables and a salad may be taken for dinner every other day. The alternate days, baked potatoes may be given, with vegetables and salad. The third meal for the day may be fruit and nothing else.

 

E. DISEASES OF THE ESOPHAGUS
I. ACUTE ESOPHAGITIS

   Etiology.--Inflammation of this passage may be of a catarrhal nature, but the rule is that it comes from injuries, such as scalding, accidentally swallowing acids, swallowing a fish-bone, or any other kind of bone that will cut, scratch, or denude, and start up irritation, inflammation, and ulceration.

   Some authors describe a pseudo-membranous inflammation of a diphtheritic nature. I see no reason why a putrid sore throat or a tonsilitis could not be extended down the esophagus, and even to the stomach, but if these cases are treated as they should be, and controlled in regard to swelling, the disease need not be extended to this passage. Cancer has been described in this location, but in all probability it was first a wound to the walls of the passage, and the irritation ended in ulceration, and eventually ulceration merged into a cancer.

   Symptoms.--Pain in swallowing is always present in severe inflammations of the esophagus. A dull pain beneath the sternum is felt. The presence of foreign substances in the esophagus may The suspected when the food regurgitates. In scalds and injuries of a severe character the inflammation may be great enough to end in stricture. This will interfere with swallowing.

   Treatment.--Acute inflammation of this organ should be treated the same as acute inflammation anywhere. A fast of sufficient duration to overcome discomfort, and then fluid food of the proper character, should be taken until all the symptoms have vanished. Orange juice, milk, broths, and soups are in order. In case of stricture, it is not possible to eat food that has to be swallowed in a bolus, because it cannot get by. It is necessary to give fluid foods, and bougies will be required to enlarge the stricture. Begin with a small bougie, and gradually work up to one large enough to fit the caliber of the esophagus.

 

II. SPASM OF THE ESOPHAGUS

   This disease is met with in hysterical women and hypochondriacal men, It is also a symptom in chorea, epilepsy, and certain other convulsions. It is sometimes associated with the lodgment of foreign substances in the passage. We find it in those of nervous temperamentthose of the neurotic temperament. To prove that there is no stricture, all that is necessary is to pass an ordinary esophageal bougie. If it passes readily into the stomach, this is positive proof that there is no obstruction, and that the apparent obstruction is simply of a nervous character.

   Treatment.--The treatment must be the correcting of the general condition of the patient. Whatever these symptoms depend upon must be corrected. In chorea the patient should be put to bed until all symptoms have disappeared, and then the eating should be very light for the first week. In cases of epilepsy the basic derangement must be treated. It may be due to decomposition of food in the gastro-intestinal canal. Many times there will be colitis, accompanied by distressing constipation. These symptoms must be overcome before any relief will be experienced to the disagreeable sensations in the esophagus.

 

F. DISEASES OF THE STOMACH
1. ACUTE GASTRITIS

   Etiology.--Anything that will irritate the stomach may be a cause: overeating; eating improper food; improper combinations; swallowing chemicals of any kind, accidentally or with suicidal intent.

   Symptoms.--As a rule, an attack is brought on from imprudence in eating. Fermentation takes place, with so much irritation that the food is expelled by vomiting. The patient complains of pain and nausea; the tongue is coated, the breath is bad, and vomiting is severe. The thirst is great. If satisfied, the vomiting increases until a small amount of water will not stay on the stomach any length of time before it is rejected. When the vomiting is severe, the thirst is very great. There is a little fever-seldom above 102 F. Sometimes there are diarrhea and pain like colic. The duration of the attack will not be longer than twenty-four hours, if the patient is treated properly from the start.

   Treatment.--Stop drinking entirely, or taking anything into the stomach. Nothing is to go into the stomach until the nausea and vomiting are all gone. The bowels should be washed out by an enema. If the symptoms are very severe, enemas may be used three times the first day. If the nausea is gone within six to twelve hours, then all the water that the patient wants may be taken, beginning with a few sips at a time, and increasing as desired. If the nausea is severe and thirst is great, water should not be taken by mouth, but a cup of water may be put into the bowels with a fountain syringe and allowed to remain. This may be repeated frequently enough to satisfy the thirst, In cases which have been abused by feeding and water-drinking the vomiting may be so severe as to bring on congestion and a trace of blood in the ejected fluid.

   Within twenty-four hours after the patient is able to take water without nausea, feeding may begin; but it should be buttermilk, or fruit if the fruit is thoroughly masticated. If the fruit and buttermilk are tolerated, the second day buttermilk may be given in the morning; lamb broth with grapefruit, or any fresh fruit or combination vegetable salad, at noon; and fresh fruit in the evening. The third day the same breakfast; meat at noon, with cooked, nonstarchy vegetables, and a salad; in the evening, toasted bread and butter, followed with an apple. After this the patient may be given his freedom.

 

II. CHRONIC GASTRITIS

   Etiology.--This disease is the culmination of a number of attacks of acute gastritis, with a continuous abuse to the stomach between attacks. Those who build this state of the stomach are very imprudent in eating. As a rule they overeat, and they always eat improperly. Other sensual habits are practiced.

   Symptoms.--The mucous membrane will become more or less thickened. This takes place especially near the pyloric orifice. This opening frequently becomes thickened and hardened, so that the contents of the stomach do not pass out readily. A very common symptom is a feeling of discomfort midway between meals--sometimes, in the early stages, starting up an hour before the regular meal-time. This discomfort is described as a hunger pain. If these symptoms are relieved by eating, the patient grows worse; the desire for food becomes more urgent, and occurs at shorter intervals, until a time arrives when the patient is suffering great distress constantly, due to decomposition, and the irritation, inflammation, and congestion that follow. The tongue is often red; sometimes broad and pallid. This disease produces symptoms, reflex and otherwise, paralleling symptoms of almost every other disease. Indeed, the reflex derangements due to this condition of the stomach are very numerous, and are often treated as primary diseases. Such ailments as piles, headache, nervous irritation, and migraine are almost entirely due to derangement of the stomach; yet unfortunately they are treated as independent diseases, instead of as simply symptomatic.

   Treatment.--Chronic gastritis is brought on from overeating, improper eating, hasty eating, or improper mastication; gum chewing; the use of tobacco--chewing or smoking; the use of alcoholics, and the drug habit generally. Many people use drastic drugs in securing a movement from the bowels; and, if they are not already constipated, they soon will be, after treating this disease in this way. Following the use of cathartics will be established the cathartic habit, which is a constant source of irritation in the stomach and bowels. The state of the mind will have much to do with digestion. Those who worry, or give way to their emotions, will always be troubled with chronic gastric indigestion.

   Venereal abuse, the lascivious habit, breaks down resistance and produces chronic gastritis in those who are predisposed to stomach trouble. It is superfluous to say that the first thing necessary is to find out what the cause is, and to remove it; then nature will do the rest. Whatever bad habit is causing the disease, that bad habit must be stopped.

   Constipation should be palliated by the use of laxative foods and enemas.

   The eating habits should be corrected. A safe plan in all cases is to stop eating for one to three days, and then follow with fruit for three days. After that, fruit in the morning; dinner at noon of meat, cooked, non-starchy vegetables, and a salad. The salad will agree with these cases, provided they will masticate thoroughly. Then fruit should be taken for the evening meal for a few days; after which starch may be taken for one meal each day.

   The Golden Rule has to be observed in every case, or there will be no progress made. No food--not even fruit--is to be taken unless the patient is comfortable from one meal-time to the other. These patients must be given to understand, when they are brought back to health, that they can never return to their old eating habits without suffering a relapse in a very short time. It should be generally known that after forty-five years of age the amount of food should be reduced very decidedly every decade. There is very little waste after men give up their active life; hence to eat heartily is to burden the system, bring on indigestion, lower nutrition, and pen up in the body waste matter that will harden the tissues, prematurely age the subject, and in many cases bring on arteriosclerosis.

   It should be understood that chronic gastritis--or, as far as that is concerned, any disease--cannot per se be successfully treated. Disease is the sum-total of the effects of wrong life; hence, to cure any disease, it is necessary to correct the living habits, whatever they are. To undertake to cure this disease by any special form of treatment, without paying any attention to the physical and mental habits of the patient, is the height of folly. Some undertake to correct this disease with the milk diet. The majority of patients who take the milk diet will be benefited; but they must go off this diet some time, and, if they know nothing about proper eating, they will return to their old style of eating--and soon the disease will be brought back.

   Drugs are of no benefit in this disease. In those cases which are troubled much with fermentation--acid stomach--there can be no objection to using a little alkaline mineral water; but, as this is not always convenient, a half teaspoonful of soda may be put dry on the tongue, and followed with a glass of hot water. This will neutralize the acid, as will be evidenced by the throwing-off of gas. The patient will rest, and get up refreshed in the morning; whereas, if nothing is done, the tongue will be coated, there will be a bad taste in the mouth, and the patient will get up heavy, dull, and tired. One great objection, however, to palliatives is that they license the patient to continue in his evil eating habits. When a condition requiring soda develops, it should be a hint to change the eating a little--eat a little less or combine more rationally. This disease will get well, and stay well, if the patient is willing to make a little personal sacrifice. There is no question but that the stomach can take care of the food necessary, but it cannot take care of all kinds of food at one meal.

 

III. DILATION OF THE STOMACH (Gastrectasis)

   Etiology.--Dilation of the stomach is not a common disease; yet in a large general practice a physician will see a case occasionally. It is characterized by nausea; vomiting sometimes coming on suddenly, and surprising the patient by the amount of material thrown out. The reason for the amount is that there is an accumulation. In all cases there is a certain amount of stricture of the pylorus. In all chronic cases of this disease (and all cases worth mentioning or being classed as cases of dilation of the stomach are chronic), there has been chronic irritation for years perhaps, due to overeating and the formation of acid. The acid in time creates more or less ulceration, and it is the hardening of the tissues that follows the ulceration which produces a strictured condition of the pylorus. When patients who have a diathesis become run down and enervated, they have more tendency to develop the disease which is in keeping with their diathesis, and after that they may take on malignancy.

   Symptoms.--On percussing over the region of the stomach, the experienced physician will readily detect dilation, and, on palpating from side to side, there will usually be a splashing of the fluids, or contents of the stomach. Where dilation is suspected, the hands should be placed, one on each side of the abdomen, and then brought toward each other suddenly; or one is to be pushed suddenly toward the other, and then immediately the hand that has been kept quiet will go through the same motion toward the other. In this way there will be a splashing sound elicited, which is almost positively diagnostic.

   Then, if a hard lump is found a little to the right and above the umbilicus, this will confirm the diagnosis, which is that the patient has dilation of the stomach, with enlargement or thickening, with stricture or cancer, of the pylorus.

   If there is blood in the vomitus from any of the vomiting spells, or if the ejecta have the appearance of coffee grounds, this will be a strong indication that the patient has cancer. Then, if cancerous cachexia be added, the diagnosis is without question cancer of the pylorus of the stomach. When there is a failure to pass out the liquefied or digested material, and it is retained, fermenation, with bad breath, will be common. At first the fermentation produces alcohol; later, acetic acid. At this stage there will be little digestion of food. If much butter is eaten , there will be butyric-acid fermentation. One of the most pronounced symptoms of butyric fermentation is a pungent eructation from the stomach, which will scald and make the throat feel very uncomfortable. This is an indication of a lack of hydrochloric acid. Where dilation is found to exist, chemical analysis of the stomach shows a deficiency in hydrochloric acid; lemons, or sour fruits of any kind, will assist the stomach in digesting foods, but the amount of food taken must be limited. Surgery is seldom, if ever, necessary.

   Treatment--Try out first the stomach-pump once or twice a day, and fruit for the morning meal; for the evening meal, meat and fresh fruit or salad. Thirst should be controlled by enemas. No water or other table beverages should be used. The stomach-pump will give great relief if used daily, and only solid food given. If the disease of the pylorus proves to be simply a hyperplasia due to irritation, congestion, and inflammation, by removing the irritation with the stomach-pump, feeding nothing but solid nourishment, and keeping the stomach cleaned out, there is a possibility of reducing the inflammation and hardening, gradually reducing the thickened state of the mucous membrane, and restoring the opening of the pylorus to sufficient caliber to allow the food to pass out normally. In these cases an operation for enlargement of the opening, followed by proper care in eating and care of the body generally, may end in perfect recovery, and good health may follow for years to come. The operation should be simply one of enlarging the mouth of the pylorus.

   If the case proves to be cancer of the pylorus, an operation may lengthen life or prolong the patient's misery. However, by making an opening from the stomach into the bowels below, the patient will be relieved, but not cured. Some will live one or two months; others may live a year or so. The diet should be raw fruit and raw vegetables.

 

IV. PEPTIC ULCER (Ulceration of the Stomach)

   Symptoms.--This is a small ulcer. When located in the first portion of the duodenum, or in the pyloric extremity of the stomach, it creates very few symptoms. The patient may complain of indigestion at times, but often not more than people in very good health will suffer from occasionally. I have known quite a good many cases where there was no particular warning until perforation came. Again, there are other victims of this disease who will have frequent attacks of indigestion.

   Treatment.--It is said that post-mortems have shown that a very large number of ulcers heal. My experience has been that the chances of recovery are very good. In the first place, there will be no erosions or ulcers unless the patient has been living in such a manner as to favor the development of these diseases. All the cases I have been called to treat have shown a decreased alkalinity, caused by eating foods that are potentially acid. Indeed, these erosions are only one form of scurvy or acidosis; hence it is obvious that the proper treatment for all such diseases is to restore the blood to its normal alkalinity. When disease has been suspected, or if suspected and not properly treated until hemorrhage has taken place, the patient must be kept quiet in bed, without any food, for at least forty-eight hours after the hemorrhage ceases. Then the eating must be confined to fluid foods for at least two weeks--buttermilk and orange juice, or the juice of the grapefruit. If in the berry season, blackberries may be run through a colander--one with meshes small enough to exclude the seeds. After the first week a combination salad may be finely chopped or run through a vegetable-mill, dressed with salt and olive oil, and given for one meal. The other two meals may be a breakfast of orange juice, and in the evening either buttermilk or lamb or chicken broth,

   Beginning with the third week, mastication must positively be thorough. Fruit may be taken for breakfast--any kind desired; and for the noon meal, thoroughly cooked rice dressed with a little salt. This must be eaten very carefully. Insalivation must be perfect, because starch is hard to digest unless it is thoroughly mixed with saliva. Those who value quick recovery, without relapses, should certainly do their part in mouthing their food. The evening meal may be stewed meat, with the juice of a grapefruit. In the course of one or two weeks after this the eating may be of almost any foods desired, but they must be properly combined: fruit in the morning, starch at noon, and in the evening meat, combination salad, and a couple of cooked, non-starchy vegetables.

 

V. CANCER OF THE STOMACH

   Symptoms.--It is rather hard to distinguish the turning-point from chronic irritation, inflammation, and ulceration to a state of malignancy. Those who have deranged digestion, and continue to abuse the stomach, bringing on symptoms such as have been described under gastritis, gastric ulcer, gastric erosions, chronic gastritis, etc., should not be surprised if their disease degenerates into malignancy. Nature is very kind to those who are unfortunate in developing cancer; for she gives a great deal of warning. Cancer of the stomach will not develop without the patient being conscious of having abused the organ for months, and sometimes for years, preceding, No one has any assurance that a small stomach derangement, repeated and forced to recur by imprudence in eating, may not eventually end in cancer. Hence the early symptoms of cancer may be looked upon as all those symptoms that are peculiar to stomach derangements.

   When the disease has developed to the point where the stomach is hindered in emptying itself, and there is sufficient retention to create vomiting, it will be necessary to distinguish between a simple thickening of the pylorus and a hardening from the development of cancerous tissue. There will be a sensitive point to the right of and just above the umbilicus, such as was described under ulceration. To distinguish between a simple disease and the malignant, the constitutional derangement must be watched; for in cancer there will be a cancerous cachexia, while in a simple closing from chronic inflammation the patient will not develop this particular symptom.

   Treatment--The usual treatment for both is the same--namely, surgery; but surgery offers nothing in cancerous cases. It may be that there will be a little respite and a prolongation of life for a few weeks or a few months; but even this is doubtful.

 

VI. HEMORRHAGE FROM THE STOMACH
(Hematemesis)

   Etiology.--This symptom may result from cancer, ulcer, disease of the blood-vessels as described under the head of erosions, dilated blood-vessels such as are described as miliary aneurisms, varicose veins, acute congestion, acute gastritis, and the aftermath of wounds in the stomach. There is also hemorrhage from passive congestion due to liver derangements; also from cancer of the liver.

   Symptoms.--Sometimes cases will occur where the first symptoms will be fainting; indeed, fatal syncope has been known to result from hemorrhage of the stomach, the hemorrhage coming on suddenly from the giving-way of a large blood-vessel. In fatal hemorrhages the stomach will sometimes fill with blood without any warning by way of vomiting. These fatal hemorrhages occur in ulcer and cancer, or in cases where an aneurism ruptures in the stomach or in the esophagus.

   In hemorrhage from the stomach the amount of blood lost is variable. This is a symptom that frightens all concerned. The rule is that patients exaggerate the amount of blood vomited. However, a half-pint to a pint is an ordinary hemorrhage from the stomach, except in those cases where there is just a slight oozing of blood from an erosion. The straining at vomiting may cause the ejected matter to be streaked with blood.

   Diagnosis.--As a rule, there is no question as to the origin of the blood. Occasionally, when the amount is small, there may be a question as to whether it is a hemorrhage from the nose, where the blood has passed into the throat--possibly been swallowed during sleep; and again there may occasionally be a patient who is morbid, and who will practice deception by swallowing blood for the purpose of being able to vomit it. Morbid, hysterical women may go to this trouble to elicit the sympathy and attention which they imagine they are not getting. It is not difficult to distinguish between hematemesis and hemoptysis; yet both are often preceded and accompanied by coughing. Irritation of the stomach produces coughing, and irritation from blood in the bronchial tubes and trachea may cause coughing. It is necessary to cough to raise blood from the lungs. In case of stomach hemorrhage the irritation that causes coughing is reflex. In bleeding from the lungs, the blood comes with the cough. In bleeding from the stomach, the blood does not necessarily come with the cough; it will precede or follow the cough, showing a sick condition of the stomach. The previous history will usually point to a difference. In hemorrhage from the stomach there is, usually a history of stomach trouble; besides, the blood is brought up in the act of vomiting, is clotted and mixed with food, and has an acid reaction. If the blood has been retained in the stomach for any length of time, it will be dark; if retained in the stomach for some time, it will have the appearance of coffee grounds. Where the blood has passed into the intestine, the patient will have stools that look like tar. Furthermore, there will be indications of derangement of the stomach and intestine. In bleeding from the lungs, on the other hand, there is an excited pulse, the blood-pressure is high, the patient brings up blood when coughing, the blood is bright red in color--rather inclined to be frothy, because the air is mixed with it--and the reaction is alkaline.

   Treatment.--Perfect quiet in bed; positively no food until the symptoms have disappeared. In bleeding from the lungs, the pulse must come down to the normal in number of beats and in volume. If feeding is persisted in when the pulse is high, it will be almost impossible to stop a hemorrhage from the lungs. In stomach hemorrhage the tendency is for the pulse to be very weak. At the beginning of the vomiting the pulse may be higher, but the tendency is for the pulse-rate to go down and the volume to sink much more rapidly in this hemorrhage than in hemorrhage from the lungs. The treatment should be perfect quiet, and liquid food for at least a week before solid food is eaten; always the mastication must be thorough.

 

VII. NEUROSIS OF THE STOMACH
(Nervous Dyspepsia)

   Etiology.--Nervous derangements of the stomach may be divided into three classes: (1) Motor, (2) Secretory, and (3) Sensory Neurosis. These are the distinctions given by some of our best authorities, but certainly are distinctions without very much difference, because one type runs into another, and there is always a reason for an organ developing a condition of neurosis.

   A nervous dyspepsia may be found in all types, from those who are quite stout--those who carry more than a normal amount of flesh--to those who are emaciated; indeed, some cases become skeleton-like and at the same time have more desire for food than those who carry more flesh. Many very healthy-looking people will have a neurosis of the stomach. An hour before meal-time there will be a feeling of discomfort, which food relieves. The layman usually jumps to the conclusion that it is a hunger pain, which should be relieved by taking food. The more it is relieved, however, the more it must be relieved and the oftener the symptoms will present themselves. The cause of this primary condition is rapid eating, overeating, using alcoholics, tobacco, and drugs of various kinds. This condition is also brought about by overworked emotions--jealousy, envy, spite, and anger.

   Again, this condition may be brought on by exhausting the nerve energy in seeking pleasure--wearing out the nervous system enjoying, so to speak. Instead of taking a moderate amount of pleasure in going to the theater or picture shows, dancing, etc., the nerve energy is worn out taking these pleasures in excess. These symptoms are often covered by the blanket term "neurasthenia," but there is no more reason for labeling these patients neurasthenics than there formerly was for calling them hysterical or hypochondriacal. This nervous state cannot exist without a cause, and the causes are as enumerated above, Patients of a very imaginative turn of mind, and others who are idealistic, take their little ailments too seriously, and build upon them, making them larger than they are. The idealist thinks that people should have perfect health; because he happens to feel uncomfortable, he becomes introspective, and soon he is making mountains out of mole-hills.

   Nearly all uterine diseases have a certain reflex influence on the stomach. Many cases of stomach neurosis can be traced to painful menstruation, catarrhal inflammation of the neck and body of the womb, misplacements of the womb, or acute and chronic inflammations of the ovaries.

   Symptoms.--Many of these patients will complain of acid eructations--belching of acid fluids-and gases. These attacks of acid eructation follow each other day after day, and, as the disease becomes better established, the inconvenience from these symptoms lasts longer. Patients who at first have experienced simply a little eructation of sour fluids in the throat an hour or two or three after eating, will in time develop such a nervous state that sleep will be disturbed, and perhaps vomiting will be produced.

   Many cases of this disorder will manifest as periodic headache. Migraine rests upon this kind of basis; for it is purely a nervous disease, and is one symptom of nervous dyspepsia. Quite a large percentage of patients with this disease are troubled with gas soon after eating, which they expel from the stomach frequently. As the disease grows more chronic, intestinal indigestion joins with the stomach indigestion, and the bowels fill with gas. Enlargement of the stomach results after months and years of indiscreet eating; rapid eating--neglect of thorough mastication. When the stomach and intestine are very greatly distended, the diaphragm is pressed upon and the heart action is interfered with. This can be pushed to such an extent that even kidney trouble will develop. An overworked heart from this cause will soon be accompanied by albuminous urine.

   Nervous vomiting of spitting-out of food is common. An hour or two after a meal the patient will eructate a mouthful of partially digested food, which he will spit out. This condition may develop to such an extent that a certain percentage of these patients spit out everything they eat before the next meal-time, and they become more and more emaciated. Others find it difficult to go through the digestive act without vomiting once or twice, getting rid of the previous meal. It such patients could understand the "modus operandi" of their condition, they could save themselves great discomfort by eating one-half or one-third the amount to which they are accustomed, and soon evolve into first-class health. But too often they attribute their disagreeable symptoms to a disease of the stomach--a real entity, so to speak; when in reality overeating and eating wrong combinations are the source. Often physicians will treat patients according to this idea, and it is no wonder that such cases never recover. Nearly all the symptoms named for every other disease of the stomach may be found in this disease. The truth of the matter is that nomenclature is rather superfluous; and that is not the worst part of it; unfortunately it is confusing. It has a tendency to make laymen and young physicians really believe that, when a name is given to a disease, the cause is understood. Nothing, however, could be more erroneous than this conclusion; for ordinary diagnosing throws no light on the real cause.

   Treatment.--It should be obvious to anyone who has studied the symptoms that this disease cannot be treated in a cut-and-dried fashion. The real cause must be discovered and corrected. If the disease is produced by reflex irritations--irritation from the uterus, or reflex irritation from fibroid or ovarian tumor; or it is the result of over-worked emotions, or any of the causes set forth under the head of etiology and symptomatology, such condition must be sought out and corrected. But the disease will return if the patient returns to former habits. In cases of disagreeable acid eructations, temporary relief may be had by taking a little bicarbonate of soda. The most reliable relief, however, is to find one's limitations in regard to the amount of food that can be taken and digested, and then confine the eating within those limitations. This will give full relief until the disease on which the reflex irritation depends can be corrected. Indeed, the majority of people suffering from stomach derangement cause themselves a great deal of unnecessary suffering from imprudent eating. The neurotic state is brought on from whatever exhausts the nerve energy and produces reflex irritation of the stomach; but no particular suffering will be experienced until more work is put upon the stomach than it can take care of. When this is persisted in, patients will suffer very greatly from discomfort as well as from perverted nutrition.

 

G. DISEASES OF THE INTESTINE
I. DIARRHEA (Catarrhal Enteritis)

   It is purely arbitrary to diagnose an intestinal derangement as duodenitis, jejunitis, typhlitis, ileitis, colitis, or proctitis; for diarrhea--or, rather, its cause or causes--will not be confined to one particular section of the intestinal tract. Indeed, when there is a serious derangement of this organ, the entire tract is more or less involved. The derangement oftenest met with in civilized life is colitis. Yet this derangement is not absolutely confined to the colon; for, as a rule, the rectum is more or less involved, and, either directly or sympathetically, the small intestine plays its part. In established derangements of the large bowel there is almost invariably sympathetic derangement of the stomach; hence, to my mind, it is exceedingly foolish to separate the intestinal tract into special locations for the development of the derangement known as catarrhal diarrhea.

   Etiology.--First, last, and all the time, the most important cause of all diarrheacal derangements of the intestine is improper feeding or improper eating. Foods vary in their influence on the stomach and bowels. A persistent use of the laxative foods--such as prunes, figs, spinach, onions, mutton, lamb, and others which I might mention--will keep the bowels of those in normal health quite regular, while in those who have a sensitive state of the mucous membrane it develops a diarrheacal condition. Strange to say, there are more people who are inclined to constipation than to diarrhea, and foods that prove laxative to some will appear to produce constipation in others. Young children will be forced into a diarrheacal state by being overfed on milk. At first they are severely constipated, but the constipation eventually creates inflammation of the mucous membrane, and from this time on diarrhea supplants constipation, This is very largely true with grown people. Those who eat excessively will be troubled with constipation and bloating of the bowels. Constipation grows more confirmed from year to year, until a catarrhal state is set up in the large intestine. This we call colitis; when it extends to the rectum it is called proctitis. As the disease advances, the patient becomes more and more toxin-poisoned, and the catarrh becomes more intense. Local inflammations start up, on the order of appendicitis or typhlitis, with periodic diarrhea and constipation.

   If the patient is not carried off by a typhlitic abscess or an appendiceal abscess, it will be because the abscess opens into the bowel. The real cause of this diarrhea is toxin poisoning and the irritation produced by the hardened fecal accumulations from constipation. The influence of polyuria in causing constipation must not be overlooked.

   The exanthematous skin diseases, when there is a retrocession of the rash from the surface to the mucous membrane, may set up a diarrhea that is very intractable.

   Such diseases as dysentery, cholera, typhoid fever, pyemia, septicemia, tuberculosis, etc., are often accompanied or followed by a state of catarrh of the intestine--colitis. This is according to the leading authorities. I should like, however, to put in a few words of explanation. When those diseases leave in their wake a catarrhal diarrhea, it is more often due to the treatment than to the natural evolution of the disease. In the first place, dysentery cannot end in anything but health, unless it is maltreated. This is true of all the other diseases named above; hence all the causes that are listed as inclined to produce catarrhal diarrhea will fall short of any such effect if they are treated in the most simple, but the most effective manner-namely, by removing their causes.

   Treatment.--When a diarrhea begins, what is the probable cause? Indigestion. What causes indigestion? Improper combinations of food, on the one hand; on the other hand, nerve exhaustion. Those who eat when tired--when pronouncedly enervated--do not have the power to take care of food; but if they eat heartily under such circumstances, fermentation is set up instead of digestion. In other words, the system, on account of being enervated, does not furnish enough digestive fluid to finish physiological fermentation; hence, as germs are always present, pathological fermentation is set up, resulting in diarrhea.

   If the condition is understood and properly treated, the attack will end as soon as the gastro-intestinal canal is emptied of its contents. The diarrhea washes the offending material out of the bowels. If no food is taken, and the efforts of nature are seconded by copious enemas of hot water within twenty-four to forty-eight hours the intestinal canal will be cleaned out; and if proper rest--bodily rest and rest from food--is given, after all symptoms have passed away--say twenty-four hours with no nourishment except hot water--the disease will end, never to return unless some imprudence in eating is practiced. If, however, this disease is met with opiates to relieve pain, locking up the decomposition in the intestine, producing a sluggish state of the liver, locking up secretions and excretions, and the patient is fed for the purpose of keeping up. his strength, instead of the case being entirely free of disease within seventy-two hours, those hours will be spent in laying the foundation for chronic diarrhea; for be it known that, if eating is continued before there has been a reestablishment of normal secretions and excretions, digestion will be imperfect and diarrhea will continue.

(1) Chronic Diarrhea

   In tubercular subjects, maltreatment will often transform an acute case of diarrhea into one of so-called chronic diarrhea, or intestinal tuberculosis. In these cases there is a glandular involvement, and there will be general symptoms pointing to the tubercular character of the disease. An increase in temperature of the body, with high pulse-rate and diarrhea, will cause a breaking down that will be very much on the order of the breaking-down of patients who suffer from pulmonary tuberculosis. The disease, when once thoroughly established, will be as difficult to relieve and cure as pulmonary tuberculosis. It will have to be treated on general principles. The eating must be watched, and the digestive power consulted regarding the kinds of food administered. Fats, oils, sweets, and starches will not be taken care of well in such cases. Only foods that are well taken care of in the stomach will agree. These are the cases in which animal foods and products act best. They are truly types of disease that can be handled best by using meat and milk, with fruit and vegetable juices.

(2) Dysentery

   This is a disease that is strictly a type of constipation.

   Symptoms.--The patient has frequent desire to evacuate the bowels. The first symptoms are those of a slight diarrhea, with a great deal of bearing-down. The patient leaves the stool unsatisfied, feeling that there must be more to pass; but this will be the sensation almost continually, no matter how frequent the attempts to evacuate the bowels. In the acute state the disease is really a proctitis--an acute inflammation of the rectum. The cause is constipation of the large intestine.

   Treatment.--No food should be eaten. Copious enemas--two quarts of hot water--should be given at first to cleanse the bowels. If the first enema does not bring good results, a second should be tried immediately. The patient should lie on the left side, with the hips well elevated on a pillow, and then introduce as much water into the bowels as possible. On account of the sensitive state of the rectum, it may be impossible to get a very large enema into the bowels. In that case the bowels must be moved from above by using two or three tablespoonfuls of castor oil, with the juice of half a lemon, every three hours until the bowels are thoroughly cleared out. Between the doses the patient should have lemon juice and water once or twice--the juice of half a lemon in a glass of water. If ideal treatment is desired, and the patient will accept it; perfect quiet, hot cloths bound on the abdomen, changed every three hours, and no food, no oil, but enough hot water in the bowels to supply thirst, will in a reasonable time bring about a perfect cure.

   As soon as the bowels are cleared out, the tendency for going to stool should be relieved. If, however, the bearing-down continues, and the patient is not contented except when sitting on stool, the indications are that the bowels are still loaded with material and the constipation has not been overcome. Under those conditions, perhaps it would be well to take copious doses of olive oil--half a teacupful with a little lemon juice, using olive oil in place of the castor oil. The patient may be sure that he will get full relief as soon as the bowels are cleared out. No food should be taken, except a little orange juice or some other fruit juice, for at least two days after the disease is controlled, and certainly no starch is to be used for at least a week. Lamb broth may be used in a day or two after the symptoms have passed away, with a little grapefruit or orange juice, or any other fruit juice.

(3) Chronic Dysentery

   'This is the remains of a badly treated case of acute dysentery,

   'Treatment.--The treatment should not be very different. Copious enemas must be given to unload the bowels. No food should be given until. the symptoms are entirely overcome, which may be a week or ten days. Then the feeding must be very carefully done for several months. Foods that irritate the large intestine should not be eaten--those containing seeds, such as strawberries, blackberries, grapes, etc. All starchy foods must be thoroughly masticated, and prepared for eating by the second baking. Bread should always be baked twice, or thoroughly toasted. The animal albuminoids, with grapefruit or vegetable salads, can be depended upon as the best food for such patients, Rest in bed and fasting are the best remedies until the disease is controlled.

(4) Amebic Dysentery

   Etiology.--Colitis, acute or chronic, caused by amebic dysentery, is not very frequently met with, yet often enough to be noticed in this place. It is said that in these cases there is a strong tendency for abscesses to form in the liver. This is a disease that prevails in the eastern countries, Egypt, and Europe. It is in reality a tropical disease; yet we do occasionally run across cases of it in this country. I believe I have not seen more than two. It is very intractable, and when it is once thoroughly established, and the patient highly enervated, the prognosis is doubtful. I have been favorably located for the practice of my profession, so far as not having many cases of this disease to treat is concerned. It belongs to the warmer countries, and is more inclined to develop in the southern states of this country than in the northern and western.

   Morbid Anatomy.--These cases present lesions on the order of ulcerations. The mucous membrane is very edematous, and there is more or less sloughing. This may even be seen in the mucous stools which the patient passes. It is said that the disease is inclined to be wholly confined to the large intestine, and to the cecum more than any other part of the intestinal canal except the sigmoid flexure of the colon.

   Symptoms.--In mild cases the disease may exist for several months before a patient is aware of it. There are vague symptoms of headache, tired feeling, weakness, slight pain in the intestines, occasionally diarrhea. There is but one way to be absolutely sure of the existence of this disease, and that is by having the stools examined with the microscope, when the ameba will be found. Patients suffer very greatly and become very much emaciated. They will spend hours out of each twenty-four on the stool. They know that they can have very little action from the bowels, notwithstanding a great desire; yet they are compelled to prepare and get into position for soliciting a stool, and try to have a movement, even if the trying is injurious. Where the bearing down is very great, a pint of hot water should be introduced into the rectum before attempting to have the bowels move, and always bear down as little as possible.

   In all such cases it would be well, if possible, to induce the patient not to wear out the nervous system by going to the closet seat. Use either a bed-pan or cloths; for there will seldom be an amount beyond a tablespoonful of mucous. Of course, occasionally there will be a movement of the bowels; but in the majority of instances when the patient is called upon to have a movement there will be nothing to pass, except a small amount of mucous and the necrosed tissue.

   Treatment--Patients should be kept in bed. When a person finds he has this disease--it matters not how much strength he has left, it matters not if he has strength to go and attend to his business--he should make his business that of getting rid of this disease; for, when it is once established and the constitution is broken, the chances for recovery are very slight, as stated before.

   The feeding should be fruit juices, vegetable juices, lamb or chicken broth, or coddled eggs; fruit juices for breakfast, lamb or chicken broth, with fruit juices, for dinner, and buttermilk for the evening meal. But if the patient is in good flesh, he should fast for one or more weeks, depending upon the severity of the symptoms. THERE IS NOTHING THAT DRUGS CAN DO. It would be well to use copious enemas. The object of treatment should be to restore the patient's health to the normal standard--to the point of being able to furnish enough of the digestive secretions--enzymes--to digest the ameba.

   It should not be forgotten that parasites will not find lodgment in the intestinal tract of normally healthy people. To find anyone troubled with any kind of parasitic disease is proof positive that his nerve energies have been broken down, and, as a consequence, his digestive power is below normal; hence everything must be done to restore his resistance. While he should be kept in bed, he should go through a course of exercise daily. Everything should be done for him that is done to restore people suffering from any other disease. Exhaustion from exercise must be avoided.

 

II. CONSTIPATION; OBSTIPATION; FECAL IMPACTION

   Definition of Peristalsis.--Peristalsis means rolling. It is a vermicular motion or movement of the bowels--a contraction of the transverse or circular muscular fibers of the muscular coat of the intestine. When the contraction takes place, the movement starts at the head of a section of intestine with a circular contraction--perhaps constriction would be a better term. No sooner does the constriction begin than it starts, wave-like, to descend, rapidly passing to the end of that particular section of the bowel. If it starts at the head of the small intestine, the wave-like contraction ends at the ileo-cecal valve (a valve that guards the passage between the ileum and cecum). This contraction may be likened in effect to stopping a rubber tube with the thumb and finger; whatever the content of the tube, it is forced ahead of the stripping. The peristaltic movement produces the same effect; it forces the contents of the intestine onward.

   Definition of Constipation.--Constipation is the opposite of diarrhea. In constipation there is a lack of normal secretion into the bowels; in diarrhea there is an abnormal amount secreted into the bowels, Anatomical malformation, stricture, adhesions, obstructions from tumors, and malposition of organs, or telescoping or twisting of the intestine, are forms of constipation that come under the head of mechanical obstruction, and are not to be considered under the head of constipation proper. There are many causes for constipation due to functional derangement.

   Etiology of Constipation.--The commonest predisposing causes for constipation are neglect in answering nature's calls, and the unnatural position at stool that custom and modem bathroom equipment enforce. The position deprives the bowels of the thigh support and pressure that squatting gives. Postponing a desire tends to blunt sensation and educate a toleration for rectal accumulation. It is no uncommon thing to find, in obstinately constipated people , very large, pouchy rectums, which have become enlarged and made senseless from being allowed to pack with waste matter. It is not uncommon for physicians to be called to see patients with fecal impaction of the rectum requiring mechanical measures for unloading.

   One of the causes of this state is spasmodic stricture of the anus. Spasmodic stricture is not a real stricture; hence it can be overcome very readily. Organized stricture means a thickening up, due to such derangements as fissure. and ulceration of the lower part of the rectum and unnecessary operations for piles.

   Next to neglect--not answering the demands of the bowels to evacuate--is overeating. More food is eaten than can be digested, and it must decompose. As a result of this decomposition, the gastro-intestinal tract is overstimulated from the toxins. The irritation from toxin stimulation brings on enervation and catarrhal inflammation. The catarrhal secretions interfere with perfect digestion. The stomach derangements resulting are many. The diseases that develop because of the influence of fermentation on the stomach, small intestine, and auxiliary organs are many; namely: irritation, inflammation, and ulceration of the stomach and duodenum; catarrh of the gall-bladder and eventually gall-stones, pancreatitis, diabetes, albuminuria, etc. The irritation caused by decomposition in the large bowels becomes the exciting cause of constipation, colitis, ulceration, typhlitic ulceration, appendicitis, and, directly and indirectly, other affections of the colon, rectum, bladder, and the abdominal and pelvic organs.

   The decomposition causes gas to form, and the distention from gas is a mechanical cause of pain and constipation. The distention causes pain, because the inflamed and ulcerated mucous membrane is put on the stretch. The distention and pain tend to fix the parts by putting the muscles. on guard to keep the inflamed and sensitive. parts quiet. This, of course, means inactivity--constipation.

   When putrefaction is an established habit, toxin poisoning keeps the abdominal and pelvic viscera in a sensitive state, The sensitive state is made up of irritation and catarrhal inflammation. There is catarrh of the bowels and uterus, and an irritable state of the abdominal arid pelvic lymphatic glands; for these are worked overtime in keeping the blood from being overwhelmed with toxins.

   This sensitive state favors fixation, because any movement is uncomfortable--even the moving of gas. The peristaltic motion necessary to pass the intestinal contents on to the outlet is painful. The consequence is that stasis--which means a standing still--is cultivated. Because of this stasis and gas distention, fecal matter and debris accumulate and cause ptosis (dragging down). The affections appearing as a consequence are dilation of the stomach, with retarded digestion, irritation, inflammation, ulceration, cancer; duodenitis with ulceration--perforating ulcer of the duodenum--gall-bladder diseases, pancreatic diseases, diseases of the cecum, colon, and rectum, diseases of the pelvic organs and bladder. These are a few of the affections of the alimentary tract and auxiliary organs caused by constipation, and are amenable to a plan of treatment that will cure gastro-intestinal fermentation and decomposition.

   To be able to correct a disease, it is necessary to know its causes. Attention has been worked overtime in finding remedies which cause the bowels to move. It is an error to apply the name "remedy" to the thousand-and-one inventions and contrivances made to force the bowels to move. All so-called remedies are causes of constipation.

   We have seen that overeating leads to decomposition, that decomposition (putrefaction) evolves toxins, and that toxins poison the entire organism. Certainly one of the most important things to do in overcoming constipation is to stop overeating and improper eating. Unless this is done, all arrangements, devices, drugs, waters, enemas, peculiar foods, etc., must continue to fail as they have done in the past.

The So-Called Remedies and Why They Must Fail.--Cellulose. Rough food containing much cellulose is the first thing thought of when the physician's mind turns from cathartics and all kinds of drug stimulation, enemas, suppositories, rectal dilators, etc.

   Bran bread, graham bread, whole-wheat bread, bread with flax-seed in it, oils, agar-agar, water-drinking, and many other bowel persuaders, are in daily use by the people and prescribed by the profession.

   The use of bran in constipation marks the early stages of dietetic evolution. When a physician begins to talk bran, eat bran, prescribe bran, insist on bran, and can expatiate for hours on the virtues of bran, it is safe to say that he is in the prehistoric age of dietetics. His next evolution will bring him to the calories and protein age, where he will spend his idle hours figuring out menus with an eye single to the correct number of calories (heat units) and protein contained therein. If heat units and protein were all that is necessary for a correct dietetic blend, then butter, oil, or sugar, and eggs or cheese, would be the only food required. One may know, or think he knows how many heat units, and how much protein, are required by a man of so many pounds' weight; and he may know how to figure out and properly blend menus which will contain just the required heat units, and the proper weight of protein; yet he is many years removed from a successful dietetic physician. Indeed, any layman may have all this knowledge, but it takes the dexterity of a physician to apply the knowledge successfully.

   All dieticians must go through these stages of development; and they all go through them in the same way--namely, with the mental horizons fastened down tight, so as to prevent the knowledge they think they have from slipping away. But they do not know that when the horizon fits too tight, it keeps knowledge out as well as keeps ignorance in.

   It is not necessary to take up bran and other rough foods for a separate study, for all can come under one head, The object of rough foods is to prick and prod the bowels into activity. The effect is the same as prodding a jaded horse, or giving strychnine to a flaggering heart; namely, it hastens to prostration.

   It is only a question of time when bowels that are forced to act will cease to act, except by the use of more and more powerful stimulation.

   No one has ever been cured of constipation by the use of rough food--by bran or whole-wheat or graham bread. These breads, like laxatives, will keep the bowels regular for a time; but the end of their laxative effect comes, and then a change in bowel stimulants must be had.

   A very serious objection to eating rough bread to keep the bowels moving is that too much is used-more bread is eaten than should be, and starch poisoning is developed. Those who are most constipated are often the very people who have the least power to digest starch in this from; and, as a consequence, they are often injured more than benefited by the use of bran.

   It should not be forgotten that the gastro-intestinal tract is a pleasure resort for bacteria. The food eaten serves to feed them. But the reason why they are there in great abundance is because they are needed. They are a conservative necessity. They are as necessary as enzymes (unorganized ferments); for when enzymic power is unavailing for liquefying ingested aliments, the microbes (organized ferments) lend a hand and bring the refractory ingesta to a liquid form for expulsion. It is not so much for refractory aliments that microbes are needed as for liquefying the superabundance of the supply taken in beyond the enzymic power.

   Enzymes are limited, and the power of the organism to manufacture the unorganized ferments is limited; hence, when the food intake is beyond the enzymic power, organized ferments, the germs--bacteria or microbes--start up fermentation in carbohydrate foods, and decomposition--putrefaction--in the proteins. The bacterial fermentation cannot be exhausted; for the bacteria are organized as needed. The organized ferments are dispersed when they are no longer necessary.

   So much more food is taken than is required by the average person that it is not strange that the alimentary canal becomes the mecca for germs.

   The estimated number of microbes in the digestive tract is 411,000, 000,000; a few billions more or less cannot matter. It is obvious that the number must vary from millions to billions. Large numbers are not necessary, if we admit overeating is not necessary. A hibernating animal will have few, and perhaps none, unless the slight distintegration calls for a few. In hibernation enzymes are not needed and are not secreted. Where the least food is taken there will be fewer bacteria, and obviously less enzymic secretion.

   Bowels that are abused by converting them into veritable gehennas require rapid developing of microbes to meet the demand for organized ferment. If an unusual meal be eaten of fish, meat, or sausage, and the enzymes are unequal to the task, in from twelve to fifteen hours, or less time, vomiting may occur, and a fetid diarrhea starts up and relieves the system of the poisoning.

   Imported sausage is liable to start up botulism or allantiasis--sausage poisoning. Ptomain (cadaver poisoning) brings on great enervation. Besides vomiting and diarrhea, there may be skin and kidney enervation, great nervousness, dizziness, and double vision; the temperature drops, cold sweat appears, and the patient dies in a collapse. This is the severest type of food poisoning.

   Chronic subacute food poisoning, ending in constipation, is what concerns us most. As time runs on, the intensity of food-poisoning symptoms grows less and less, until there are scarcely any symptoms of decomposition, except gas in the bowels, which is ill-smelling, a chronic tired feeling, constipation, with catarrhal mucus passing with most bowel movements, which are scybalous (hard and lumpy in character) and often coated with catarrhal matters, giving them a grayish, glazed appearance. This state of the bowels. is called colitis, and proctitis often accompanies it. This condition is brought on from years of abuse in over-eating, and the catarrh is a conservative measure.

   The symptom complex may be stated as follows: decomposition, intestinal irritation, diarrhea, alternating with constipation, inflammation, ulceration, confirmed constipation. The systemic symptoms are chronic toxin poisoning, lymphatic involvement, pelvic diseases, appendicitis, ovaritis, sexual neurosis, liver and kidney diseases, tuberculosis, arteritis, arteriosclerosis, cancer, and others.

   Those with chronic constipation and its accompanying toxin poisoning must necessarily grow old rapidly and develop old-age diseases, such as cirrhosis, sclerosis, or cancer.

   Constipation is a conservative measure. Nature is always marshaling her forces in such a way as to strengthen all weak points, and, when necessary, the various organs of the body are made to do vicarious work--work for others.

   In constipation of this character the kidneys eliminate for the bowels. At first the fluid intake is diverted to the kidneys to prevent dilution and ready absorption of toxins; and, secondly, the toxin irritation of the nucous membrane of the bowels causes an exudation of mucus which coats the membrane and renders absorption slow and difficult. In confirmed constipation almost the entire fluid intake is diverted kidneyward, leaving the bowels with a Saharian dryness. This vicarious habit becomes so firmly established that a cure for constipation means a cure for polyuria (excessive urination). A true etiology of all affections of the body must give, as the leading factor, confirmed, chronic constipation, with more or less colitis, and more or less malnutrition, with greater or less poverty of flesh, or more or less waterlogging of the tissues of the body, which is a form of obesity.

   Excessive weight, with anemic complexion, often means polyuria diverted into the tissues of the body--in common language, urinating in one's body. The subject may be young, and the average person may mistake rotundity for robust health; but the true physician will not be mistaken.

   Nature works and schemes in various ways to save us. The fecal waste is made to dry up by diverting the fluid to the kidneys. If the kidneys are failing, the water will be retained in the tissued of the body--the cellular tissues become waterlogged, or a diarrhea may relieve the waterlogged tissues. This is the true explanation of many intractable diarrheas.

   The leading etiological factor, then, in constipation is toxin infection, which first stimulates, then irritates, then inflames, then ulcerates, then hardens and strictures, and finally degenerates into cancer. Add to this all the vicarious and auxiliary affections, including every constitutional derangement that is caused by toxemia, and we have, as a leading etiological factor in all the diseases of the body, constipation. Toxin causes constipation, bacterial fermentation causes toxins, and eating beyond enzymic power leaves no alternative but to get rid of the surplus intake of food by decomposition.

   Intestinal fermentation and gas distention, with intestinal putrefaction and excruciating colics, diarrhea and nauseous evacuations, bad breath, malodorous skin, lassitude, dizziness, headache, are the first developments, which recur, or come and go with irregularity, until constipation is established; then come reabsorption, chronic, systemic toxin poisoning, and the development of conservative affections--namely, any intercurrent affection, fevers, etc. --which should be looked upon as crises in chronic toxemia from constipation. The lighter affections that come and go are periodic attacks of dizziness, headache, fatigue, coated tongue, fetid breath, insomnia, eczemas, acne, and other skin diseases, as well as night sweats. Add to this state intercurrent affections from unusual causes, and we have a picture of chronic constipation.

   The latter half of the nineteenth century built many fortunes out of pills. Pills, squills, and opium have built a financial nobility unequaled by that of beer and whisky. The financial world may boast of the colossal fortunes which it has built on trafficking in human health and life, but esthetism and ethics certainly cannot be proud of the mutilation and wrecked lives which represent the graduates from our sanatoria, hospitals, and "surgical plants."

   As a result of medical wisdom (?), constipation is universal; and the McLeans and Beachams have taken the lion's share of glory and filthy lucre for the benefaction. But it is the elite of the medical profession that popularizes quackery by making drugs popular.

   Treatment of Constipation.--Constipation is an affection--it is not a disease; hence, whatever the cause is, it must be sought out and removed. To use anything--any one remedy or any hundred remedies--is equivalent to limiting cause, and that shows a fallacious understanding of what constipation is. No cure can come from a treatment based on a false conception of cause.

   Constipation is one prominent symptom in a syndrome represented as follows: indigestion; catarrhal inflammation of the throat, nasal passages, stomach and intestine; diarrhea, alternating with constipation; intestinal indigestion; gas distention; headaches; heart palpitation; chilliness; cold hands and feet; dizziness; fermentation of starches; decomposition of proteins; constitutional toxemia; colitis; and ending in obstinate constipation and many collateral affections.

   As to cause, it is as impossible to find a single cause as it is to find a single effect or a single remedy. The causes and effects become a tangled web, as we see causes becoming effects and effects becoming causes; but order comes out of chaos when we think of fermentation standing at the head of organization and disorganization--when we think of ferment, enzyme, and bacteria as cause and effect in every process of being. Causes that pervert the normal action of the ferments may be enumerated as follows: excessive eating; imprudent eating; eating wrong combinations, causing indigestion, fermentation, and decomposition, acidosis and toxin poisoning, which totals catarrhal inflammations of vulnerable parts; water-drinking, causing polyuria, diabetes, or Bright's disease; eating foods that are artificially prepared, or which are changed in their chemical constituents in preparing them for the table; overwork; worry; anything that uses up nerve energy; overworked emotions; lack of discipline; the use of stimulants of all kinds; neglect in the care of the skin; carelessness in looking after the functions of the body; in fact, any influences that will produce overstimulation, intoxication, enervation, imperfect elimination, etc., may be looked upon as so many causes making up the syndrome above mentioned. But without fermentation the named causes become meaningless.

   It should be obvious to the discerning that if constipation is a prominent link in the chain of affections above described. it would be foolish to undertake to isolate that particular symptom and give it special treatment. The idea of finding a specific remedy for constipation is as absurd as it would be to discover a single remedy for catarrh, or a single remedy for toxin poisoning. Constipation should be looked upon as a leading symptom of a constitutional derangement for which the blanket term, chronic toxic poisoning, is quite fitting. And when the disease is cured, it will have to be cured by righting the errors of life, so as to bring the general health back to the normal. This we shall endeavor to describe in the following.

   Before making any suggestions regarding cures, it shall be my endeavor to give a frank and honest criticism of the remedies usually resorted to.

   Looking back over medical history for the past hundred years, what do we see regarding the bowels? Drugs and all manner of devices for compelling the bowels to move. What are the results from the various schemes of cure? Failure--always failure--and constipation everywhere , and increasing.

   The fountain syringe, and the thousand-and-one oth er devices for getting water into the alimentary canal, constitute the second of a trinity of illogical plans for overcoming constipation. The first of these is pills, or drugs; the second is the fountain syringe, and other devices for waterlogging the bowels; and the third and last is water-drinking.

   Physic for overcoming constipation should be thrown to the dogs; and, so far as intelligence is concerned, it has been. But there will always be mental slackers and stragglers on the road to reform; and this is true of drugs and physic in the treatment of constipation. As well undertake to cure inebriety without sobriety, as to cure constipation without curing toxin poisoning.

   The plan of washing out the bowels is perhaps one of the most pronounced palliations ever introduced for constipation. How could it be more than palliative, when no causes are removed? Confirmed constipation will be the ultimate reward for a close attention to flushing out the bowels. Of course, there are a few who appear to be benefited; yes, there are a few who boast of breaking every health law and continue to live to tell the story. That fact, however, does not annul the law, nor remove the penalty for breaking it. None but the foolhardy or foolish will be governed by an apparent exception to a rule.

   Enemas wash away natural mucus, and in time paralyze the bowels--leave them dead, so to speak.

   On account of physic and enemas being unsatisfactory, excessive water-drinking has been pretty generally adopted. As in the case of all cure-alls, there has been an unthinking acceptance of the suggestion that water, drunk in sufficient quantities, will overcome constipation. This is one of the great medical mistakes of this century.

   As stated before, nature works out many conservative schemes; and the scheme of routing all water intake out of the body by way of the kidneys is a conservative measure. If the water is allowed to be absorbed by the bowels, it carries toxins with it, and extra intoxication takes place; hence it is railroaded out by way of the kidneys. When these vicarious or auxiliary activities are established, any interference by way of forcing measures will end in failure, and the ending is worse than the beginning. When the bowels are constipated for any length of time, the constipation causes colitis; then the more water drunk, the more the kidneys act, and the drier and more constipated the bowels become, because nature is endeavoring to sidestep being overcome by toxin absorption. It is safe to say that the constipation accompanying colitis cannot be cured--not even relieved--by water-drinking. This constipation is often confirmed by bran-bread eating. Petroleum oil gives a questionable relief, and certainly will do harm when its use is continued over a long period. All :such remedies are miserable failures.

   The capping climax of all medical and surgical inanities is the removing of a part of the colon to cure constipation, epilepsy, or ptosis.

   Those who desire to overcome constipation must first stop overeating, and, when eating begins, eat properly.

   The tensing exercise should be practiced twice daily --about fifteen to twenty minutes before getting up in the morning, and the same length of time after getting ready for bed at night. This is necessary to re-establish the normal tone to the muscular system and help to re-establish peristaltic action of the bowels. At the end of each exercise period the abdomen should be given firm and fairly deep massage. This massage should be clockwise around the navel--in other words, from left to right below the navel and from right to left above the navel. This brings the movement down on the left side and up on the right side of the abdomen.

   In cases of prolapsus of the uterus in women, and in enlarged prostate in men, much time should be spent in the knee shoulder position.

   There should be absolutely no straining at stool--straining brings on piles. If there is a desire for a movement, but the muscular effort amounts to a real strain, always use a little water in the form of a small enema, not more than a pint of water. That will start the movement and prevent development of prolapsus of the rectum or piles.

   If one is eating little in an effort to overcome constipation, there will be much less fecal matter to be thrown out than normal, and under those circumstances a movement every other day should be sufficient to keep the bowels cleared. A person who is taking ordinary meals should find one good movement a day sufficient. If the bowels fail to move, however, don't worry--forget it--in all probability the movement will come the next morning. Don't be in too great a hurry to use artificial means to secure a movement. If it is necessary to use an enema to assist the bowels, it should be a small enema, about a pint of water or less. If a movement is not secured with the first pint of water, repeat, using another pint of water. This is better than using large quantities of water in one enema. One should always avoid large enemas. It washes the mucus out of the colon and is conducive to constipation.

   In any case of sickness where there is reason to believe that the bowels have not been cleared out by enemas, then one should not hesitate to use a laxative. Castor oil is the safest laxative. The tasteless variety may be used with lemon juice to make it more pleasant. In cases of fever, the temperature will not come to normal until the bowels are cleared. This should be the sign that the bowels have not been cleared, and one should not hesitate to continue with the efforts to empty the bowels, because it means the end of whatever disease is threatening.

   In extreme cases there is suffering from sensitiveness to touch over the bowels, caused by gas distention. Toxin infection is marked by tired feeling, headaches, heart palpitation, chilliness, cold hands and feet, dizziness, etc. When these symptoms are pronounced there may be obstinate constipation, and there may be vomiting with diarrhea. Where there is much gas distention the pain is great. These cases are usually operated upon for appendicitis. The proper treatment is: Send the patient to bed to stay; feed an apple, or its equivalent in any fresh fruit , three times a day. He should drink no water, but use an enema, every other night, of a pint of water, hold it in the bowels for ten or fifteen minutes, and then try to have a movement. This is a routine which I follow to stimulate the rectum for a short time at the beginning of treatment, and stop it as soon as possible. If thirst is driving and must be relieved, use a half-pint of water in the rectum with a syringe. Thirst should be endured until secretions are established in the intestines. This is necessary for a cure, and the end cannot be accomplished until polyuria or excessive urination is overcome. Excessive waterdrinking under these circumstances forces excessive flow of water by way of the kidneys, but depuration is not increased; indeed, retention of excretions is favored, and, instead of water-drinking being a benefit, it furthers toxemia.

   Those who have not the will-power to eat carefully, and to go without drinking until cured of constipation, need never expect to be cured of this or any other disease.

   I have seen obstinate constipation overcome by this plan, so that the patient was getting a movement almost daily within a month or six weeks. Overeating must be given up forever; for as soon as a cured case returns to the old style of eating, the bowel trouble will return.

   These patients complain of gas distention. Fruit does often cause trouble of this kind. There is but one way to correct it--namely, eat less and less, or fast until the gas is gone; then eat; and if the gas or other ill feelings return, fast again.

   It should be understood that there is a price that must be paid, by victims of bad habits, before they can be restored to the normal; namely, stop the bad habits. No one can give up inebriating habits--drunkenness--withouit paying the price of much discomfort, and those of very sensitive natures have great pain and suffering.

   It must be understood that poisoning by alcohol or any other drug, and poisoning by retained excretions, or by the toxin of decomposition of protein (animal or vegetable), or fermentation of carbohydrates (sugar and starch), are all the, same. The nervous system is gradually broken down, and general weakness, or enervation, is brought on to such a degree that when the habit is broken off the victim suffers greatly. The whole organism feels the effect of the suspended stimulation. The whole body cries out its displeasure at being robbed of its stimulation. To stop any habit shocks the nervous system; but it is nonsense to think of curing in any other way.

   People of no self-discipline--those who have been in the habit of indulging every desire, who dance immediate attendance on every impulse and whim--not only have to give up their stimulating habits, but are compelled to cultivate discipline. For the first time in their lives they are compelled to say no to their desire. They suffer fully as much from being forced to say no to a desire--a whim--as their nervous systems suffer from lack of the effect of the poison--stimulation--which they have given up.

   'Those who are self-disciplined--those who have the control that a business training gives, or the self-control that must be developed in filling any responsible position--do not find it so hard to come under rules that are rigid enough to bring about a cure of chronic disease.

   There are many disciplined people who have unwittingly brought upon themselves diseases from overeating and the use of stimulants, because they have been advised by reputable professional men to "eat good, nourishing food," "eat to keep up the strength," and "smoke or drink in moderation"; and they have looked upon medical men, of good standing in medical societies, as oracles of wisdom. When their attention has been called to the probable falsity of their teachings in this matter, they are slow--indeed, reluctant--to believe that the self-professed ethical profession is not more reliable in matters medical than someone who appears to be thinking thoughts that the school-men ignore or reject--someone with "peculiar views."

   It is obvious, then, that the people are divided into two classes. The first class is composed of those of no discipline--those who are self-indulgent, and who are hard to discipline because they have a "right" to self-indulgence. "What are people on earth for? to make ascetics of themselves? I would rather have five years and freedom than ten years with restrictions." Which means five years of license, and enough suffering to kill the body in half the time that might be had with a discipline which gives peace, comfort, and the feeling of well-being that always accompanied self-control and full efficiency.

   The other class are indulgent from advice--from authority. This class pride themselves on discipline to authority. Indeed, they are disciplinarians, and, to serve authority, they do not mind becoming ascetics when required to do so.

   The first class are sensual and self-indulgent. And their reasoning is on a par with their lives. They believe that a system of cure which restricts them is an infringement on their personal rights. It is hard to impart enough knowledge to save them. Such people have knowledge, but no wisdom. Man must live his knowledge; then it becomes his own--it becomes wisdom!

   The second class have the discipline that enables them to follow instructions, if they can be persuaded to give up their: conventional teachings--if they can be convinced that they have been taught wrong.

   To cure colitis (which is another name for chronic constipation) means reforming the life of the patient. No, there can be no cure as long as one continues to smoke, to drink, to eat too much, to live sensually.

   Those with great nervous prostration must go to bed for a few weeks. The eating at first must be as suggested above: nothing but a little fruit until comfort has been secured. If not too weakening, a two- or three-minutes' hot bath may be taken every morning, followed with a quick cold sponge-bath in summer time. The sponging should be followed with dry towel-rubbing. Friction mittins may be used to advantage in these cases.

   When comfort has come, the eating may change a little.

   For Breakfast.--Fruit in summer time, fresh fruits and prunes, in the winter time. Apples for winter may be had by almost anyone. With an apple, or its equivalent in other fresh fruit, 6 or 8 prunes.

   For lunch: Two ounces of thoroughly toasted bread, whole-wheat, and not more than one-fourth ounce of unsalted butter, Each morsel is to be masticated until it turns sweet in the mouth; then take another bite, and treat it the same; and so on until the two ounces have been eaten. Then apples, or any other fresh fruit desired, may be eaten in reasonable amounts. Overeating must end if constipation is to be permanently cured.

   If desired, the food suggested for the morning meal may be taken at noon and the suggestions given for the noon meal may be used for breakfast.

   Those who are opposed to losing weight need not look for a cure. To cure means the complete renovation of the system--the renewal of digestion and assimilation, and the reestablishing and bringing-back to the normal of all secretions and excretions. All idea of eating up to the profession's standard amount must be given up; for a cure means eating properly, but not enough to keep the standard weight.

   The morning and noon meals have been given. For dinner: Meat--lamb, chicken, and fish are the best meats--the lamb and chicken are to be cooked very tender; the fish should be baked and served with salt, lemon, and very little, if any, butter. In cold weather, a roast or a stew of pork may be eaten twice a week. With the meat or fish, one or two of the succulent cooked vegetables, and a combination salad made by combining lettuce, tomatoes, cucumber (or celery), and a very small bit of onion. A large dinner-plate of these vegetables, after they have been cut up, is the quantity required by grown-ups. The salad should be seasoned with salt and olive oil, or a mayonnaise made with lemon--not vinegar.

   During the winter, grapefruit or cabbage slaw may be used in place of the salad.

   On account of its laxative influence, spinach should be used as one of the cooked nonstarchy vegetables as often as possible. Do not overcook the spinach. It should be cooked just enough to thoroughly wilt the leaves.

   Never eat unless comfortable from the preceding mealtime. Then eat deliberately, masticating thoroughly, and eat all desired short of discomfort. If enough is eaten to cause discomfort, the next meal should be omitted, and another, and others, until comfort is secured. Always try to eat in quantities short of enough to bring discomfort. What kind of discomfort? Any discomfort, either of mind or body. When gas is troublesome, stop eating until comfortable, then eat less; when gas reappears, then miss a meal; etc.

   Many will worry about losing flesh and looking haggard. Losing flesh cannot be avoided. It is the price that must be paid to recover health. Looking haggard can be overcome, or rather prevented, by taking exercise. The faint-hearted, the self-indulgent--the babes and boobies of humanity--will make a fuss, stew and fret, and either fail to follow instructions closely enough to get well, or cause themselves a lot more trouble than necessary.

   Hopefulness, and a determination to have health at the sacrifice of any comfort, will soon put any case on the highroad to health.

   Getting well quickly, or in a reasonable time, depends much upon the mental attitude. Those who have no object in life, who live with nothing higher to hope for, or look for, than the indulging of sensual appetites, are hard, if not impossible to cure; for when their indulgences are cut off to bring health, they have nothing worth while to live for, and they become mentally depressed. They want to be cured, but they do not want to stop self-indulgence--they do not want the cause of their disease removed. Hence those who can reason should see how utterly impossible it is to cure them. They must drift from one palliative to another palliative to secure a little relief; but a cure that means the giving up of any habit will not he looked upon with favor, and will not be adopted,

   Those who are looking for a remedy for constipation--those who wish to have a formula which they can have filled at the corner drug store, and take it, and have their constipation cured--will not appreciate my treatment. But, as stated above, there is no such thing as a specific remedy for this affection, any more than there is for any other affection. There is but on cure, and that is to right the life. Those who are unwilling to go through a routine of treatment that will evolve into full health need never expect to overcome constipation, and its many causes and consequences. If there is one organic change, more constant than another, accompanying confirmed constipation, it is sclerosis. A well-known type is arteriosclerosis.

   Those who are looking for quick cures are doomed to disappointment; for the usual quick remedies are nothing more than palliation.

 

III. APPENDICITIS, COLITIS, AND OBSTRUCTION

   Appendicitis.--There never was a case of appendicitis that was not preceded by constipation and colitis. Indeed, appendicitis is sequential to these two affections. It will be necessary to consider them as different stages of one disease.

   Bowel obstruction in appendicitis is not so complete as in the disease known as complete obstruction, the difference being a lack of intensity, The pain is not so great. Yet, after the first clearing-out of the bowels from drugs, enemas, or perhaps a slight diarrhea, enemas fail to bring anything more than mucus. The same is true of complete obstruction. If food of any kind, even liquid food or milk, is taken, vomiting will take place, and intense pain will follow almost immediately after the ingestion of a very small quantity. This is due to the stimulating effects of the food, creating peristalsis. If food is withheld, these patients become very comfortable. There will be a dullness on percussion in the lower anterior right side of the abdomen, to the right of, and two inches below, the umbilicus. This part will be sensitive on pressure. But, indeed, an experienced physician will use no pressure; he will diagnose his case from what subjective symptoms the patient describes, and the objective symptoms that he himself can see, without submitting his patient to the dangerous procedure of deep bimanual examination. Nearly every case of rupture of the appendiceal abscess has been brought about by the surgeon in his zeal to diagnose the disease and determine if the usual tumor-like development--pus sac--can be found. The obstruction in appendicitis is due more to muscular fixation than to accumulation in the intestine; indeed, most of the obstruction is caused by the inflammatory process--irritation, determination of blood, swelling, and the exudation which is for the purpose of walling in the forming abscess. Muscle fixation guards the intestine and secures quiet. Motion is dangerous; there is danger in using physic, or doing anything that will stimulate peristaltic action, because of a possibility of a rupture or perforation of a necrosed bowel.

   The highly sensitive state of the bowels obtaining in this disease puts the muscles in the region on guard, and the parts are fixed for the very definite purpose of conserving the life of the patient. If nature is not meddled with, the abscess will form and rupture will take place along the line of least resistance, which will be into the bowel. In this way the abscess will empty, and in a very short time after the pus has gained entrance into the bowel, inflammation, swelling, and obstruction will subside, and within twenty-four hours the patient may be given fluid nourishment.

Colitis.--Discomfort in the lower bowels and pelvic region, sometimes amounting to distress. The discomfort of this disease is so great and so constant that thousands have been subjected to operations for appendicitis, ovaritis, and other diseases, without the least suspicion that the real disease was nothing more than gaseous distention of a chronically inflamed colon. Many more have been subjected to ovariotomy--in fact, all the operations peculiar to the pelvic region--because of this discomfort in the lower bowels. Patients frequently complain of pain in the lower right frontal region of the abdomen. At first they are suspicious of appendicitis, and too often the medical man is willing to confirm this suspicion and recommend an unnecessary operation.

   Obstruction.--Distressing pain in the lower bowels, with inability to secure a movement. The taking of laxatives or physic creates great nausea and vomiting, but fails to cause the bowels to move. Large enemas may be used, which return without carrying with them any fecal matter, after the rectum, and perhaps the signioid flexure, are cleared of their contents. If the obstruction is complete, the symptoms become very grave, the stomach will not tolerate anything, not even water, and the distress caused by taking food, or even taking water, is so great that everything by way of the mouth has to be suspended. The pulse increases in frequency, the breathing is hurried, the skin clammy, all the symptoms of collapse gradually set in, and within forty-eight to seventy-two hours death relieves the sufferer.

   Treatment.--In colitis anything that has a tendency to create inflammation of the mucous membrane must be overcome. The bowels must be emptied every day--constipation must be overcome. This can be temporarily relieved by a very light saline laxative, or laxative foods, or small enemas--not more than a pint of water placed in the rectum and left there for five or ten minutes; then solicit a movement. This should be carried out regularly every night. On account of the great tendency for carbohydrate foods to cause gas in the bowels, these foods should be either proscribed entirely or given in very limited quantities. Meat, non-starchy vegetables, and fresh fruits are the proper foods for those who have chronic colitis. For chronic colitis very little starch should be used--none whatever by the obese. Until all the symptoms are under control, no food should be given except fruit three times a day. When the patient is better, the noon meal may be meat, one or two cooked, non-starchy vegetables, and a combination salad. This should be kept up for weeks, if necessary, to overcome the disease. The stools should be watched. If there is much catarrhal discharge, this is evidence that the disease is not yet under control. No starch should be given until the bowels are moving without any mucus in the stools; in fact, the mucous discharge must be overcome before a cure can be accomplished. Then white-flour bread thoroughly toasted, is the best form of starch to be given at first. The coarse bread has a tendency to irritate the bowels, and should not be used until the patient is quite well. During the time when the symptoms are most intense the seeded fruits should not be eaten; or, if they are, they should be run through a sieve or colander that will exclude the seeds.

   For complete obstruction, a surgical operation at once is the only remedy. In this matter there must be no delay. Yet those interested in the case should not lose their head. Unfortunately, surgical insanity is so, general that it is a very difficult matter to find professional men who will not fly off at a tangent and recommend an operation for almost any severe pain in the bowels. But there is a great difference between obstruction caused by appendicitis and complete obstruction, which latter may be due to invagination, or telescoping of the bowels, or to a twist, or to mesenteric, mesocolic, omental, or any visceral hernia.

   The treatment for appendicitis amounts to a wise letting-alone. The patient should be put to bed, with hot-water bottles to his feet. If in great pain, and running a temperature above 103 F., ice should be put over the region of the appendix. If the temperature is below 103 F., heat should be put to the abdomen. The mouth must be closed to everything, even water, until comfort is established, which will be within about three days. Then the patient may have all the water desired. A copious enema, or as much as can be introduced into the bowels, should be used every day, either morning or evening; but positively nothing else needs to be done until the bowels move without assistance, except for the enema which is used daily to wash out the lower bowels. There will be a large amount of accumulated fecal matter, blood, and pus above the portion of the bowels involved. The movement will be copious, because it will not take place within seven to twenty-seven days. Of course, the longer the patient lingers before the bowels do move, the greater the accumulation will be above the cut-off. Then, within three or four hours after the first copious evacuation, the patient will have another movement, which will show more or less pus. It will be well to wash out the bowels once or twice with simply warm water. Let the patient alone. He may have fluid nourishment for four or five days; and, to be really safe, he should confine his eating to fluid foods for the first week after the evacuation. Then gradually return to the accustomed style of eating. However, if a permanent cure is desired, such patients should live correctly ever after, having one meal of fruit, one of starch, and one of meat and vegetables.

 

IV. ENTEROPTOSIS

   Definition.--Dropping down of the contents of the abdominal cavity, but particularly a dropping of the stomach and large intestine, transverse colon, kidneys, spleen, and pelvic organs.

   Etiology.--What can cause falling of the organs within the cavity of the abdomen? Weight, causing relaxation of the attachments. Anything that will distend the stomach and intestine has a tendency to cause a dropping-down or a sagging below the normal position. The stomach is distended with food. Those who eat too rapidly will always eat more than they should. After they are through eating, the food swells and distends the stomach beyond its normal capacity. In time this brings on a dilated and a relaxed state of the stomach and intestine. Indigestion will accompany this state, and more or less gas will be evolved, which pulls up or distends the organs. We not only have a dropping-down of the stomach, but we also have a puffed or an enlarged state. This interferes with the mechanism; the muscularity of the organ is put out of commission; the stomach does not empty well; digestion becomes slow, and there is more or less retention of food, This favors the development of still more indigestion and distention with gas, until the entire intestinal canal becomes more or less involved with the stomach, and from the same causes. The individual will have what is called a "high stomach;" that is, a distended, enlarged abdomen. There is always enervation accompanying such a state of the stomach and bowels. Enervation always means relaxation of muscles, and, if the cause is continued, a dropping-down of the entire contents of the abdominal cavity sooner or later follows. Some people are more inclined to take on this state of the stomach than others. Those of a relaxed, flabby habit--those whose muscles are soft and inclined to gravitate--take on the disease sooner than others.

   The attachments of the kidneys partake of this same relaxation; and then, from gas distention and the ordinary affairs of life, the pressure on the loosened kidney has a tendency to pull down and elongate the normal attachments. Those who carry a great deal of fat in the abdomen--who have heavy omentums--will in time cultivate the dropping-down of the entire contents of the abdominal cavity. This intra-abdominal pressure frequently creates more or less bladder trouble, urethral trouble, and, in women, a prolapsus of the womb and ovaries--especially the left ovary, which is often pressed below the uterus into the cul-de-sac of Douglas. Then, if the intra-abdominal pressure is not overcome and constipation follows, the woman will suffer a very great deal from the pressure on the ovary; for it is crowded, so to speak, between a constipated rectum and an intra-abdominal pressure from fat and gas. Many patients will be troubled with prolapsus of the rectum. At each evacuation of the bowels the rectum will prolapse, and, unless replaced, will remain out until a night of rest allows it to resume its proper place within the body. However, when the prolapsus is very extensive it never gets back to the proper location. This same intra-abdominal pressure, and the relaxed state of the muscular system generally, favor the development of all kinds of hernias, especially inguinal and femoral. Those who are of a relaxed habit should take warning and never do any lifting without thinking of the possibility of creating a rupture. If at any time there is a sensitiveness in either flank, one hand should press upon and support it while the other does the lifting. No lifting should be done without the muscles of the abdomen being placed on guard, preventing a rupture. If people generally understood this, and would be mindful of it, they could avoid developing hernia.

   Enteroptosis, then, is a dropping-down of any of the organs in the cavity of the abdomen; but, as a rule, when that word is used it is intended to convey the idea that the patient has a falling of the stomach or transverse colon. I see no reason, however, for dividing these subjects. The treatment for one is the same as for the other.

   Treatment.--The first and most important thing to undertake is to remove all causes that lead to intra-abdominal pressure. The cause of dilation of the stomach was given as improper eating, rapid eating, and overeating; consequently this must be controlled. All cases where there is dropping of the stomach and transverse colon must be treated in such a manner as to get rid of the fermentation. The first week the patient should be put on a fast; the second week, fruit morning and night; and the third week, two meals of fruit, and a dinner consisting of meat, two cooked, non-starchy vegetables, and a combination salad, every other day; the alternate days, potatoes, rice, or any of the decidedly starchy foods, with a cooked, non-starchy vegetable and salad. Every case must be treated according to its special needs. It is very difficult to give an exact treatment for any derangement of the body, because the individual must be treated and not the disease. All bad habits must be stopped. No tobacco, alcoholics, coffee, or tea is to be allowed.

   In cases of floating kidney, the same treatment must be given for correcting the indigestion and getting rid of the gas distention, and also an excessive amount of adipose tissue in the intestine. Those who are quite stout must be fasted long enough to overcome, and cause an absorption of, unnecessary fat deposits in the abdomen. Those who are thin should be fed in such a way as to overcome gaseous distention. All cases must be exercised properly. Lying on the back and going through the movements of bicycle-riding is one of the most important exercises that can be taken for any of the diseases named under the head of enteroptosis. All hernias that have been of long duration can be cured in the same way.

   This disease will require a good deal of exercise to the bowels, also manipulation of the abdomen, and the knee shoulder position should be practiced fifteen minutes twice a day if possible--in the morning and in the evening preceded by the Irish mail movement. Grasping hold of some object in front of one and squatting to almost complete bending of the knees is an excellent exercise. Directions for the different exercise and massage are explained in Toxemia.

   Prolapsus of the rectum can be entirely overcome. The ligaments will shorten under the influence of the exercise recommended. The entire body should be exercised lying down. Patients should be taught to practice the tensing exercise, according to the instructions given elsewhere. Is it ever necessary to shorten the ligaments and cable the kidneys, or operate on the stomach and transverse colon? Never, unless the patient is unwilling to take upon himself the amount of work that will be necessary to restore him to his normal condition. Anyone can be restored to an absolutely normal condition without an operation; but, of course, those who are too shiftless, too indifferent to their best interests, will have to submit to questionable surgical operations. I say "questionable" advisedly; for I have never seen many people derive any great benefit from any of these operations, and, indeed, I have seen many injured by them.

 

H. DISEASES OF THE LIVER
I. JAUNDICE

   Definition.--Jaundice is known by the name of icterus. It is characterized by a yellow coloring of the skin of the body; also the mucous membrane and the fluids of the body are tinged with bile pigment. Jaundice is a symptom depending upon a great variety of causes, and the causes are obstructive.

   Etiology.--A foreign body, such as a gallstone, may lodge in the gall-duct, or parasites may pass from the duodenum into the duct. Catarrhal inflammation may cause enough closing of the duct to impede the flow of bile and become a cause of jaundice. Inflammation may also cause stricture of the duct. Tumors may press upon the duct. Tumors of the liver, stomach, pancreas, kidneys, and omentum may, by pressure, cause obstruction; occasionally an enlarged gland. Such enlargements as pregnancy, ovarian cysts, and even fecal accumulations have been described as causes of jaundice. It is barely possible that this may be true, but not very probable. Constipation might be the cause of toxin poisoning, and in this way cause jaundice.

   General Symptoms.--Yellow tinting of the skin; itching of the surface of the body; yellowing of the sclerotic coat of the eye. The tinting of the skin will vary from a very slight yellow to a deep brown or bronze. The exceedingly dark coloring comes from complete obstruction. Under such circumstances the urine is also very dark. The tissues of the entire body are involved in the coloring. In the chronic form of this disease, pruritis, or itching, becomes a very distressing symptom. Sweating is another symptom. The clothing of such patients has the appearance of having been dyed yellow. Skin troubles are not uncommon where there is obstruction of the bile. Piles often occur.

   Where no bile whatever passes into the intestine, the stools are very light-colored--sometimes of a grayish coloring--and the odor is pronounced. The clay-colored stools are common in those who are troubled with inactivity of the liver. This may occur in cases where there is very little coloring of the skin. It cannot, however, exist for any great length of time without the urine showing that the bile is failing to pass into the intestine.

   Constipation is common; yet, on account of the decomposition taking place when the bile fails to enter the bowels, diarrhea may be a constant symptom. Bile is, so to speak, an antiseptic. It has a tendency to prevent decomposition. Where the stools are offensive, and there is hearty eating or overeating to account for it, the probable cause is a lack of the secretion of bile. Many of these cases present irritability and depression of spirits. One of the peculiar influences of bile on the system is to produce melancholia. In acute derangements of the liver, brought on from excessive eating or debauch, the debauchee will have great depression of spirits and gloomy forebodings of the future. While the patient is in this state, the world is all going wrong, his business is going to smash, and he is ready to sell out for a song and get away from the smash-up; but within twenty-four to forty-eight hours after this depression--this influence of bile in his blood--everything is lovely, the goose hangs high, and you could not buy him for one hundred and fifty cents on the dollar.

   In low forms of fever there is a toxemic jaundice which augurs badly. Indeed, it is a symptom that might be avoided by preventing the disease from taking on a septic state. Such fevers as typhoid, if not medicated and fed, will fail to develop septicemia; hence the complications, such as jaundice, will never develop. This is not only true of typhoid, but it is true of every disease. These symptoms are secondary, and are possible only in malpractice. The word "malpractice," as used in this sense, includes the malpractice supposed to be scientific medicine.

   There is said to be a hereditary icterus. In all probability it is due to some anatomical defect, or to some peculiar style of eating, on the part of the families of the various progenitors, all of them having the tendency to eat in such a manner as to bring on liver derangements--to develop a hepatic diathesis, if you please. Why should not this be true when families for several generations live in such a way as to produce engorgement of the liver? Why should not the tendency for developing this derangement become so fixed that it is transmissible? The true definition of heredity is a tendency to take on certain forms of disease. There is no such thing as inheriting a disease.

   lcterus Neonatorum.--New-born children often develop a jaundiced condition within the first week after birth. As a rule, this needs no special attention, even when so pronounced that the urine will dye the diapers an orange yellow. Fatal cases, however, have been known. It is my opinion that such cases come from obstruction of the biliary duct. Where the condition is purely functional, it is aggravated by too frequent and excessive eating. If the error is not suspected, the child may be driven into a fatal illness.

   Anemia of the Liver.--Anemia of the liver cannot be thought of in these days of much starch-eating; for starch, sugar, and fat have a tendency to produce hyperemia. Possibly, after the hyperemia has been developing for years, a hardening may take place that in time will end in anemia. Then the disease would be of a secondary character and come under the head of sclerosis. Hyperemia is divided into two classes--active and passive congestion.

   Active.--After a meal the liver will always be found engorged because of the absorbed food. All the vessels are filled. This state passes away in a few hours--as fast as the food material can be absorbed and utilized by the body. Where the engorgement is excessive there may be a feeling of weight and heaviness in the region of the liver, and, if eating is frequent and excessive, the hyperemia becomes a fixed state. The border of the liver may come down much below the ribs. This state is diagnosed as enlargement of the liver. It is found in those who are steady imbibers of alcoholics, as well as in those who eat excessively.

   Passive.--Passive hyperemia is more common. it is said to result from pressure on the efferent vessels. This affection is found in valvular diseases of the heart, emphysema, sclerosis of the lungs, and thoracic tumors. The skin of patients in this state often has the appearance of having been smoked; or their faces may seem cyanotic or flushed. This affection is brought on more frequently from heart derangement than from liver derangement, but these two conditions are often found together.

   General Treatment.--The treatment for obstructive icterus must be the removal of the obstruction. This may require surgery, and it may be a derangement that surgery cannot remedy. In gallstone obstruction the feeding of eliminating foods, such as fruit and raw vegetables, will in a reasonable time bring about a disintegration of the stone in the gall-bladder. Then there will be a passing into the bowels of the sand that results from the disintegration; and, if this style of eating is persisted in, the patient will make a complete recovery. Where the obstruction is due to a catarrhal inflammation of the gallduct, proper feeding will overcome it. What is proper feeding? Any normal style of eating that will include the necessary amount of eliminating foods, such as fresh, uncooked fruit and vegetables. In severe cases of this character the patient should fast for a week or two, and then live on fruit for a week or two, depending upon the severity of the symptoms and the rapidity of relief. In all these cases--it matters not how severe they are or what the character of the obstruction is--the patient should be kept away from sugar, starch, and fat. That will give the liver--the portal system--rest; and rest is the foundation on which all curative therapeutics must be based. Physiological rest is of more importance than all other forms of rest. Physical and mental rest are also needed, however; for these are allies of physiological rest.

   In the jaundice of children, no hesitancy should be felt about taking the child off its mother's breast and giving nothing but water until the severe symptoms have passed. Then the feeding should be light enough to prevent a return of the icterus.

   Hot baths should not be neglected in the treatment of any of these diseases. Where the symptoms are urgent, the bath water should be as hot as the patient can bear, and the duration of the bath should be in keeping with the patient's resistance. Where patients weaken quickly, the bath should be of short duration; but where they can stand it for fifteen to twenty, and even thirty, minutes, there should be no hesitation in extending it until complete relaxation is secured. Then a bath of from five to ten minutes' duration should be given daily. Absolute rest in bed, and no feeding until it is justified by a decided betterment of all symptoms, should be the treatment in any of these cases.

 

II. GALLSTONES

   Etiology.--There are many causes given by authorities on the subject. According to my way of thinking, the simplest and most correct explanation is that, as a necessary condition for the formation of gallstone, there must first be a primary period of catarrh of the gall-duct and gall-bladder. This must be aided by the gouty diathesis, and then by the habit, on the part of the patient, of eating too much of foods that carry mineral into the system, and too little of foods that eliminate. Excessive eating of starchy foods, sugar, and fat, and overstimulation with alcoholics, cause a sluggishness of the liver. First, the liver becomes hyperemic from an oversupply. This interferes with the nutrition of the organ, and enervation is established. Then we have retention of waste products. In those who eat foods that are potentially acid, to the neglect of those that are potentially alkaline, and then, as stated before, add a gouty diathesis, there is developed a condition that favors the building of stone in the gallbladder. This is further aided by a catarrhal thickening of the gall-duct, which to a certain extent impedes the passage of bile. With partial obstruction of the gall-duct, the gallbladder is inhibited in its housecleaning, so to speak. Every canal and cavity of the body will become diseased, if the process of natural cleaning is interfered with; and, as the flow of bile is somewhat inhibited by the catarrhal thickening of the mucous membrane of the gall-duct, this favors the retention of gall in the gall-bladder, and this again favors concentration. The thinner fluid will find an exit through the gall-duct, while the heavier will be retained. This gives a start for the formation of gallstones. It is said that experimenters have succeeded in producing gallstones by injecting micro-organisms into the gall-bladder of animals. Another experiment has been successfully tried, within my professional experience--that of introducing a small bit of chewing gum into the male bladder, after which a stone as large as a hen's egg was taken out. It required only about three years for the stone to reach that size. Hence--this being positively true--chewing gum must be the cause of stone in the urinary bladder, if micro-organisms injected into the gall-bladder produce gallstones in that cavity.

   Without joking and without irony, any foreign substance finding lodgment, accidentally or otherwise, in closed cavities, especially the gall-bladder and the urinary bladder, has a tendency to become the nucleus around which stone forms into calculi of varying size. In some cases the gallbladder may be filled with one stone; in other cases there will be numerous stones. I have heard of as many as sixty to sixty-five being taken out of one gall-bladder.

   It stands to reason that the food and water which carry the greatest amount of mineral will be most favorable to the development of stones in the body.

   Symptoms.--In many cases there are no symptoms further than attacks of indigestion, and at times a slight jaundiced yellowness of the skin; but in many cases of fully developed stone in the gall-bladder there will be no decided symptoms whatever. To the educated eye, patients who have this disease will always present symptoms of deranged digestion.

   No one will develop gallstones and at the same time have the appearance of perfect health. The first symptom to arrest the attention of the patient is a feeling of fullness or weight, or a feeling of oppression, in the region over the stomach. The majority of cases will not be suspicious of anything wrong until they are taken with a pain so severe that it doubles them up. This they ascribe to indigestion. They will think that something they have eaten has thrown them into a colic. The disease is called gallstone colic. Previous to these attacks of severe pain there will be attacks of indigestion, weeks, and sometimes months, apart. When indigestion is accompanied by urticaria, or nettle-rash, it is well to be suspicious enough to investigate in the line of gallstones. It may be that the skin trouble has been produced by a sluggish state of the liver; but certainly, if there is much pain over the stomach, and a sensitiveness to pressure to the right of and a little above the umbilicus, the probabilities are that the disease is gallstones. Some cases will suffer very greatly, and remain sore for one or two days after they get over the gallstone colic. Patients recover from this affection, and sometimes run along for months--or, again, may not run along for more than a week--before they have another attack. It depends altogether upon how soon another stone will become lodged in the gall-duct. It is the passage of the gallstone from the gall-bladder into the duodenum that creates the suffering. These stones are usually rough and jagged, and cause great pain as they are forced through the passage.

   It is not necessary, in going over the symptoms, to take up the various complications, such as ulceration, suppuration, and the dangerous perforation that follows these complications; for such cases must be put into the hands of physicians. Nothing short of an operation will prevent death in case of peritonitis from perforation. In complete obstruction of the gall-duct it may be that surgery will be the only procedure which promises relief. Such extreme symptoms are exceptional and belong to the province of the surgical specialist.

   Treatment.--No treatment whatever should be given to gallstones--the patient must be treated. It matters not what the deviation is from the normal, he must be brought back. Hence, to treat a case of gallstone successfully, the patient must be examined, habits must be inquired into, and everything necessary to correct the eating and care of the body must be done.

   Constipation must be overcome by laxative foods. If the patient is suffering, and has been suffering a great deal, a fast must be insisted upon. No definite length of time can be given. It should, however, be prolonged until all pain and discomfort have passed away. During the fast, hot water should be taken freely--a pint every three hours, or even more. As soon as all discomfort has vanished, the patient should live for one week on fruit--any kind of fresh fruit--morning, noon, and night. No eating should be permitted between meals. Fruit must be eaten at the regular mealtime, and nothing at all between meals. The second week: fruit in the morning, and a combination salad, with one or two cooked, non-starchy vegetables, at noon. One of these vegetables should be spinach or onions, and they should be cooked properly--in very little water, so that there will be none to drain off. Spinach should be one of the raw vegetables in the salad. Lettuce, tomatoes, cucumbers, and spinach, with a small piece of onion for flavoring, makes a nice salad. Dress with salt, oil, and lemon juice. The evening meal should be one or two glasses of buttermilk. This should be the style of eating for the first month. The second month: fruit in the morning; toasted bread and fruit at noon, or rice dressed with salt only, and any kind of fresh, uncooked fruit; occasionally biscuit, butter, and honey, if so desired. If any drink is taken at the mealtime, it should be teakettle tea with the starch meal and fruit meal. Milk is not to be taken with meat.

   The dinners may be meat every other day, with two cooked, non-starchy vegetables and a combination salad. The alternate days have potatoes, navy beans, corn bread, or any of the decidedly starchy foods in place of meat. Patients must give their bodies thorough attention by way of bathing, dry towel rubbing, etc. A hot bath of three to five minutes' duration should be taken every morning, with a quick cold sponge bath, to be followed with dry towel rubbing, and then dry towel rubbing at night before going to bed. This should be done daily. The skin must be put into good condition, so as to prevent catching cold; for the gallstones depend upon catarrh of the gall-duct and gallbladder. Unless the constitutional derangement that should be known as catarrh is cured, it will be impossible to relieve the patient permanently of gallstone formation.

   Exercise regularly. Passive exercise should be practiced daily, besides being in the open air and sunshineeither walking, driving, or just enjoying the freedom of the out-of-doors. Old habits must be given up--such as eating between meals, eating candy, desserts, etc.

 

III. CIRRHOSIS OF THE LIVER

   Etiology.--This disease is the ending of a life of debauchery. It comes from indulging the senses by way of eating and drinking, and gratifying lust. Lust enters into this derangement as a factor by bringing on enervation and helping to derange digestion and nutrition. There are several leading etiological factors given by medical authorities: the toxic, coming from the use of alcoholics; the infectious, which is said to come from specific fevers, syphilis, etc.; a type that comes from the congestion following heart disease, known as cardiac liver; and one that comes from obstruction of the bile-duct. There is a vascular cirrhosis, which is brought on from irritation, engorgement, and the developing of new tissue because of an oversupply of nutritive material in the organ. There are many other etiological factors given, but I think it unnecessary to mention them. The causes most commonly met with are overeating and alcohol-drinking.

   Symptoms.--Like many other diseases of the liver, this disease often progresses to full development without presenting many symptoms--this is what authorities on the subject say. I, however, incline to the belief that the premonitory or primary symptoms have been present for years, but have been ignored or not even noticed. It would be impossible for anyone to tipple for years without showing symptoms of irritation of the stomach and tumefaction of the liver; so these symptoms are primary, and it should be the duty of every physician to inform victims of this derangement of what they are bringing upon themselves. Unfortunately the medical profession has never considered it its duty to take the attitude toward patients of being "my brother's keeper;" indeed, too many supposed-to-be teachers of health have encouraged these victims in taking into the system the material that builds disease. For years the blood vessels in the region of the stomach and liver have been engorged because of the irritation produced by alcoholics. The tongue is furred in the morning; the bowels are irregular. Sometimes there is vomiting or mucus. In alcohol gastritis great quantities of this mucus will be thrown out at times; even hemorrhage from the stomach is not uncommon. Occasionally the hemorrhage is profuse, and liable to recur so long as the habit of drinking is continued. Hemorrhage from the bowels may take place in this disease before there is any blood thrown out of the stomach. The bleeding is often from the veins in the esophagus, because of the disturbed portal circulation. Indeed, there is not very much difference, except in degree, between this state of the liver, caused by alcohol poisoning, and the chronic state brought on from years of imprudence in the eating of starch, sugar, and fat. The alcoholic variety is always more intense, there is greater enervation, and the circulatory system throughout the body is more involved than in those varieties produced by imprudence in eating. In advanced cases, patients become dropsical--show general dropsy. Ascites is common.

   Diagnosis.--With a dropsical state of the peritoneum, the well-marked history of alcoholism, light-colored feces from the bowels, and hemorrhage from the stomach and bowels, the diagnosis is made.

   Treatment.--There is not much to be done. Patients may be tapped and water taken off, which will give relief for a short time; but the water certainly will return. The time for curing the case has passed, perhaps many years ago. When the liver is so organically disorganized and the auxiliary organs of the body are so deranged as in these cases, there is nothing to be done, except whatever palliation may be required to give the patient temporary relief.

 

I. DISEASES OF THE PANCREAS

   When speaking of derangements of the pancreas, we necessarily, in this connection, think of digestion of the starches. If the mouthing of food is neglected, the whole work of digesting the starches falls on the alkaline secretions of the intestine. The pancreas stands at the head of this secretion. When there is difficulty in taking care of fat, we also think of a deranged secretion of the pancreas. The indication of deranged functioning of the pancreas is a changed appearance of the character of the stools. There is an excess of fat, which in some cases runs very high--even to one hundred per cent of the intake. The pancreatic secretion is necessary for the emulsifying of fat. When fats are not emulsified, they do not pass through the walls of the intestine; or, in other words, they are not absorbed and not utilized as food. The carbohydrates also fail of digestion, and the stools show a waste of these foods. When there is a failure in intestinal digestion, there is, accompanying this failure, colitis, because, if these foods are not digested, they go through an acetous and putrefactive change, which develops toxins, which are absorbed, and create irritation and inflammation of the mucous membrane of the intestine. Hence the importance of the pancreatic secretion may be seen in warding off the primary cause, not only of inflammation of the intestinal mucous membrane, but also of the diseases created by the absorbed toxins, as well as those that come from imperfect digestion of sugar, such as diabetes.

 

I. HEMORRHAGE

   Hemorrhage into the pancreas has been reported by the leading authorities. F. W. Draper, of Boston, reported that in four thousand autopsies he met with nineteen cases, in half of which no other disease was found. At this point I wish to state that that is one of the failures of postmortems and autopsies. They show organic disease, for they cannot show a functional disease, even if it is pronounced. Such examinations give no clue whatever to causation, They give no hint of perverted nutrition, and many of the lighter forms of organic derangement that may be the real cause of death; hence the fact that one-half of the subjects met with in the autopsies reported by Professor Draper presented no other cause for death than hemorrhage into the pancreas does not prove that there were no other causes; and post-mortems fail to reveal any cause of the hemorrhage into the pancreas. Those who inquire into the cause of death by autopsic examinations really find nothing except the effects of long-existing derangements in nutrition, caused by toxin poisoning. This being true, it is safe to give, as the principal etiological factor in the development of diseases of the pancreatic gland, any cause that deranges digestion and nutrition.

   Treatment.--The treatment should be preventive; for, after the disease is once established, there is no cure. Palliation is all that can be given. Just what the palliation should be depends upon the necessities of the case.

 

II. ACUTE PANCREATITIS

   This disease may be started by septic infection. it may be caused by an injury--a blow on the abdomen. As toxins are the principal cause, inebriety, and the use of other stimulants, such as coffee, tea, tobacco, etc., must be considered as so many causes.

   Symptoms.--This disease is said to begin very suddenly, with violent pains, on the order of colic, in the upper part of the abdomen. Nausea and vomiting follow. One of the pronounced cases that I have ever met with came into my hands after it had been developing for two weeks. The patient was a man forty-seven years of age. He was vomiting continually. The principal material ejected from the stomach was bile. Food could not be retained on the stomach at all. There was nothing that gave relief. At last I recommended an operation, which was performed, revealing the true cause of the trouble--namely, acute inflammation of the pancreas, with hemorrhagic spots throughout the entire organ. There was nothing to be done, and the patient died within a few hours after the surgical exploration.

   Acute pancreatitis may end in suppuration--an abscess. The symptoms will be on the order of dyspepsia. Severe pains, with vomiting, will be the principal symptom. Then palpation, or bimanual examination, must do the rest. It requires surgical skill in differential diagnosis, as a tumor, swelling, or mass will be felt in the region of the pancreas.

   Treatment.--The treatment for inflammation of this organ must be directed to correcting the digestion and assimilation. So long as there is pain and discomfort, the patient should be fasted. After that the eating should be fruit juice, and nothing else until all the symptoms have subsided; then a very light diet for a week or two. The diet should be fruit, raw vegetables, and cooked, nonstarchy vegetables, avoiding fats, starches, and sugars. In abscess of the pancreas there is no relief except by surgical operation.

   Tumors of the pancreas belong to surgical practice, the same as calculi of this organ. The treatment is strictly surgical. I will say, however, that those who are living a normal life will not develop such diseases,

 

J. DISEASES OF THE PERITONEUM
I. PERITONITIS

   Definition.--Inflammation of the peritoneum.

   Etiology.--It may be primary or secondary.

   Primary Peritonitis.-This is of very rare occurrence. When it does occur, it probably develops from cold or exposure, or from a rheumatic state of the body. Not having seen a case of the kind, I can do no more than mention the fact that primary inflammation is recognized by most authorities. I have seen a great many cases of peritonitis, but always of secondary origin.

   Secondary Peritonitis.--This inflammation is an extension of other inflammations. Diseases of any of the viscera--of the chest, abdominal cavity, and pelvis--may end in peritonitis. Diseases of the liver, with abscess or simple inflammation, may extend to the peritoneum. Gallbladder diseases, malignant diseases of any part of the abdominal cavity, or of the thoracic or pelvic region, may extend to the peritoneum. Ulceration of the stomach, ulceration of the bowels, colitis, muco-colitis, appendicitis, typhlitis, ovarian and uterine inflammations, septic inflammation of the uterus following childbirth or abortion, may extend to the peritoneum. External wounds of the abdomen may by ulceration perforate the peritoneum. Abscesses in the cecal region, or the region of the appendix, will sometimes break into the peritoneum. This means fatal peritonitis, unless the case is operated upon at once, and the cavity thoroughly cleansed and drained. Perforating ulcer of the stomach and duodenum will cause fatal peritonitis. There is no hope for such cases, unless the peritoneum is opened, and thoroughly cleansed and drained.

   Symptoms.--Inflammation of the peritoneum is ushered in by a chill or chilly feeling. In severe cases the chill amounts to a rigor, with intense pain in the abdomen and aching in the back; in fact, aching all over the body.

   In low forms of typhoid fever, where the perforation has occurred after the system has become thoroughly toxemic and the brain dulled by the toxins, the symptoms may develop so insidiously that a fatal state will be evolved before the dangerous condition of the patient will be suspected. However, the watchful physician will observe a swelling of the abdomen, which is a distention of the peritoneal cavity. In other words, tympanitis must be distinguished from gas in the bowels. Both of these distend the abdomen, but there is a vast difference in the two cases. Where tympanitis exists, it means infection of the peritoneum, and, if it is the result of perforation, death will result very soon--within a few hours. In septicemia, following childbirth or abortion, intense pain in the abdomen, quick pulse, flushed face, preceded by a rigor, mean a fatal case, unless it is quickly comprehended and the right treatment used immediately.

   Treatment.--Inasmuch as peritonitis is secondary to a primary disease, it is necessary to know what the primary disease is. The treatment must be directed to the correction of that disease. Of course, in cases that are rapidly fatal, like perforating ulcer, it is too late to do anything for the primary disease, and all the remedies that can be used must be directed to correcting the secondary disease, which is, peritonitis, As suggested before, if there has been a perforation, the peritoneum must be opened, cleansed, and drained.

 

II. CHRONIC PERITONITIS

   This is a slight affection at the start. There may be a slight infection of the peritoneum from an extension of the disease in the pelvis. There may be a slight infection following an operation which opens the peritoneum. This disease often ends in adhesions--by adhesive inflammation. In that case the treatment must be for the removal of the adhesions. Following the removal of ovarian and fibroid tumors, normal ovariotomy, and operations for appendicitis, we hear of a great deal of trouble caused by adhesions. In many cases there are no adhesions, the pain and discomfort complained of by patients being due to intestinal indigestion and a distention from gas; but in these days we are having a great many patients sent to the hospital for secondary operations, for the purpose of breaking up old adhesions, etc. Every case must be a law unto itself, and whatever is necessary should be done. I have not met with so many adhesions as one would suppose in an active practice in a country where this derangement is heard of often, following the numerous operations to which people are subjected.

 

III. ASCITES

   Definition.--Accumulation of serous fluid in the peritoneal cavity.

   Etiology.--This affection is secondary to inflammations, or slight extension of inflammations from other organs. It may be due to cancer extending to the peritoneum, tuberculosis of the peritoneum, or portal obstruction or cancer extending from the liver to the peritoneum. Pyemia may be a cause of this affection; also tumors in the abdomen, large fibroids or ovarian tumors, or hydatid disease of the liver.

   Ascites becomes a part of the general dropsy brought on from heart enervation. Lung affections, such as emphysema or sclerosis of the lungs, cause dropsy. Ascites occurs also in dropsy brought on from Bright's disease of the kidneys.

   Symptoms.--Gradual enlargement of the abdomen, sometimes starting with puffiness of the feet and ankles. The history of the case will throw some light upon it and aid in differentiating between ovarian tumor and ascites.

   In percussing over an ovarian tumor, the resonant sound peculiar to percussing over the intestine is entirely eliminated. The sound is dull over the lower abdomen, and when the percussing extends above the umbilicus, if there begins to be a resonant sound it will be known that that is the upper part of the tumor. Then, going laterally on each side down into the small of the back, there will be more resonance on both sides, showing that the tumor rests upon the intestine. Sometimes a loop of intestine will rise between the tumor and the wall of the abdomen. In that event it requires a little more skill in diagnosing to determine whether it is a case of ovarian cyst or ascites. The experienced diagnostician, however, will not have much trouble; for, by introducing the finger into the vagina and passing up in front of the neck of the womb with one hand, and then having the other hand placed on the abdomen, the sensations of the two palpating hands or fingers will be carried to each other, showing a continuation of a fluid medium; whereas, if the hand can be placed upon the top of the swelling, above the umbilicus, and pressed down, and, with the finger in the vagina and to the anterior of the neck of the womb, nothing can be felt between--if the percussion wave does not extend to the finger in the vagina--then it will be known that the disease is ascites.

   Treatment.--For ascites, where the symptom is very distressing, a little palliation may be secured by tapping and drawing off the water; but it will fill up very soon again, and the patient will have to be tapped again and again, until he is worn out and dies from exhaustion. If the affection has not evolved into such a desperate type, fasting will give relief; and, in fact, this is the only hope of carrying a patient back to a reasonable state of health. If the ascites is due to a cancerous extension, there is no hope. If the disease is due to a pyemic infection from, say, liver abscess, if the abscess can be drained there is hope of a betterment, and possibly a cure. In acute peritonitis from extension of pelvic inflammation, the pelvic disease must be corrected as quickly as possible; and if the peritonitis is extensive, there is a possible hope in opening the peritoneum and washing it out, and then draining. These cases are never very promising.


 

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