Prevention And Correction

The important rule with regard to the mental attitude of the patient

toward uncomfortable feelings due to digestion must be, first to

correct all other possible sources of the trouble, and only after

these have been proved not to be factors in the case, should there be

any question of modification of diet. This is just the opposite rule

from that which obtains, and by which patients begin to meddle with

their diet at the slightest symptom, or supposed symptom, of

indigestion. My custom is to tell patients at once that there is

probably something else besides their diet at fault. It is not that

they eat too much, nor too great a variety, but that perhaps they eat

too rapidly. Without reducing their diet, and above all without

eliminating supposedly indigestible things from it, there should be

formed a habit of eating more slowly. This will usually result in the

reduction of the quantity eaten, but the variety of food should be the

same, and the patient should not be permitted to limit his diet to a

few supposedly bland, unirritating materials. In that event,

constipation will assert itself, particularly if there is limitation

of the amount of fluid taken.

Longevity of Dyspeptics.--There is one consolation that may be given

to nervous dyspeptics, though in the midst of their worst symptoms

they may not be sure whether it is a genuine consolation or not. It

has been noted that many of those who live to extreme age tell the

story of having suffered from nervous dyspepsia in middle-life. Their

solicitude about themselves makes them safe against over-indulgences

of many kinds in food or drink that might prove hurtful to them. Much

of their discomfort is indeed due to the fact that they do not eat

quite enough. If they succeed in avoiding the pitfalls of the

infectious diseases, and especially tuberculosis during their earlier

years, and most of them are likely to because of the great care they

take of themselves, they often live to old age. Certainly of two men,

one of whom eats very heartily and the other very sparingly, the

latter is much the more likely to attain old age. There are those who

declare that the valetudinarian life, "half dead and alive," which

even Plato satirized nearly 2,500 years ago, ever renews the question

as to whether life is worth living or not. It is particularly

dyspeptics who seriously discuss this question--yet with all their

complaints, they actually do live longer lives.

Pharmaceutic Remedies.--This insistence on the importance of mind in

the treatment of indigestion does not imply that tonic remedies, and

especially such substances as strychnin, which stimulate appetite and

add tone to the muscles of the stomach, should not be used when duly

indicated. They are always helpful. Alone, these remedies give but

temporary relief and after a short time the system becomes accustomed

to them. If prescribed in connection with changes in the patient's

habits, and especially such as divert his attention from his digestive

tract, and from wrong persuasions as to food taking, the good they

accomplish will be lasting. Nervous people usually have an increase of

acidity. They are liable to overdo everything, and even the stomach

overdoes its acid forming function. For this, alkaline remedies such

as rhubarb and soda will do good. But, just as with strychnin, the

benefit is but temporary unless the patient's habits and attitude of

mind are modified so as to eliminate their solicitude as a constantly

disturbing factor.

Circumstantial Suggestions.--There are many changes of habits that are

of great value in the treatment of nervous and allied forms of

indigestion. These changes often make a great difference in the

general health of the patient and thus help to improve digestion.

Besides their influence as alteratives, they are valuable from the

mental influence which they exercise. It requires a definite exertion

of will many times, perhaps, each day to bring about the omission or

performance of certain actions, and this act of the will is

accompanied by the repeated suggestion that this will cause

improvement in the digestion. Many of the cures effected by special

diet. Habits of exercise, health resort regimes and the like, owe

their efficacy to this accompanying repeated suggestion of acts for

the formation of new habits or the breaking of old ones.

Physiological Measures.--There are, of course, certain details with

regard to digestion in which the patient's mental attitude needs to be

changed by instruction rather than persuasion, by knowledge of

physiology rather than by psychology. In the taking of food itself,

chewing is, of course, the most important consideration after its good

preparation by the cook. If patients are told to chew their food

carefully, however, without further directions than this, it will

usually be found that they begin to chew their meat a great deal and

their vegetables scarcely more than before. It is, however, vegetables

that must be chewed particularly. The meat-eating animals bolt their

food. They have only cutting and tearing teeth. Their instinct is

correct, for the saliva has nothing to do with the digestion of meat,

and therefore no chewing is necessary. On the other hand, the

vegetable-eating, and especially the grain-eating animals, chew

carefully. Most of them are ruminants, that is, after a preliminary

thorough chewing of their food, they swallow it, and then

afterwards at their leisure bring it up once more into the mouth and

chew it again.

Mastication and the Stomach.--If food is not chewed well, and occurs

in large masses in the stomach, not only is it not dissolved easily,

but the work of passing it out to the intestine is delayed. The reflex

which brings about the opening of the stomach and the ejection of food

into the intestine is best brought about by the liquefaction of the

stomach contents. During the mixing process all the food, as far as

possible, becomes fluid and then is passed on. Large pieces of any

kind are delayed, however, hamper the emptying of the stomach and

interfere with stomach motility. The stomach is only a thin-walled

membranous viscus which finds difficulty in dealing with food in

lumps. It is different from the stomach of the hen, which, having no

teeth, swallows grains of all kinds without chewing, but also by

instinct swallows small stones which, in its thick-walled, muscular

gizzard, are used for grinding up the food.

Exercise.--The taking of exercise is an important habit that needs

to be changed in the case of dyspeptics. Many of those who live a

sedentary life, and are much occupied with intellectual or business

matters, are almost sure to take little or no exercise. If earlier in

life they were accustomed to take much, the lack of it leads to

serious disturbances of nutrition. They have formed certain habits as

to the amount of food they eat, and these continue, so that they

consume more heat-making material than they can use. In the process of

dissipating it, there is likely to be much nervous energy wasted,

usually to the discomfort of the patient. This is likely to be

eventually reflected back to the stomach, with disturbance of appetite

and digestion.

We now know that the motor function of the stomach is much more

important than its secretory function. Its main purpose is to mix the

food and pass it on in small quantities, at intervals, to the

intestines. When patients have a sense of uncomfortable fullness in

the gastric region after a hearty meal, or of discomfort after the

taking of food, especially if much liquid is taken with it, they are

prone to attribute these feelings to imperfect secretion not

completing digestion as it should, and permitting fermentation with a

production of gas and consequent stomach distention. The real reason

for their discomfort is not secretory, but motor. It is due to a delay

in passing on the food and to stomach distention because the gastric

muscle is not in good tone.

People who have been used to taking exercises have their muscular

system in good tonic condition. This includes the involuntary muscles,

as well as the voluntary, and if they are neglecting air and exercise,

the whole muscular system becomes flabby. Hence the uncomfortable

sense of distention, because the stomach walls do not contract readily

for the expulsion of food. A second important factor is also

present--the muscles of the abdomen. Ordinarily they support the

abdominal organs without any sense of effort. If by lack of exercise

they have diminished in tone, however, when a hearty meal is eaten,

the abdominal muscles have to support this additional weight since the

stomach itself sags, and the consequence is a feeling of pressure on

the left side of the abdomen about the level of the umbilicus. To

relieve this feeling the tendency of the patient is almost always to

lessen the amount eaten. If he is not distinctly overweight this will

do harm rather than good. Instead he needs to take sufficient

exercise to tone abdominal muscles and reflexly also tone even

involuntary muscles, and with them the gastric muscularis.

Air.--Almost more important than exercise is an abundance of fresh

air, and without this muscles soon fail to respond to voluntary or

involuntary impulses. If people do not spend two or three hours in the

air every day, they are likely to develop an over-sensitive condition

in which all nervous sensations are exaggerated. The reason men and

women differ so markedly in their reaction to pains, aches and

discomforts, is mainly that their habits of being out in the air

differ correspondingly. Men are out much and, as a rule, stand

discomfort better. Women are out little and are more sensitive to

pains and aches. The more a man is out, the less is he likely to

notice discomforts and aches that he would otherwise complain about.

Sleep.--Another important factor is the amount of sleep. Over and

over again I have found that patients who were beginning to complain

of discomfort, which they associated with the word indigestion, were

taking too little sleep, and as soon as I persuaded them to add an

hour or more to their sleep their gastric symptoms began to improve.

It is easy in our large cities to acquire the habit of shortening the

hours of rest. This is sometimes done so gradually that the individual

scarcely realizes how much he has cut into his sleeping period. Some

people who have to get up at seven or half-past seven in the morning

go to bed about twelve, but really do not get settled for sleep until

nearly one o'clock. Sometimes people read interesting books just

before going to bed, or while in bed, and it is nearly two o'clock

when they get to sleep.

Many people have the habit of reading themselves to sleep. This may be

an excellent way to get rid of bothersome thoughts, provided the

reading selected is not of too absorbing a character, and provided

also as soon as sleepiness comes its call is heeded. Some write

letters late at night. Writing always keeps one awake, though reading

may be helpful for sleep. If this abbreviation of sleep becomes

habitual, the first organs in the body to set up an objection is the

digestive tract. It is one of the hardest worked systems in the body,

having to dispose of its quantum of food three times every day, and if

the organism does not receive due rest, the digestive tract suffers

first. People who get insufficient sleep often have no appetite in the

morning, and suffer from uncomfortable feelings in the gastric region.

What they are too prone to do is to meddle with their diet, and this

practice always does harm.

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