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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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Previous: Mental Influence In Dyspepsia And Indigestion

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