(especially when the nerves are weak), or eating when over tired. The
muscular walls become so weak that they fail to contract. Peristalsis
is likewise weak and the food, failing to digest promptly, ferments and
forms gas. A dilated stomach is larger and its weight and weakness
cause it to prolapse.
In the prolapsed condition the pyloric, or lower orifice of the
stomach, is often nearly closed, partly by reason of its position and
partly by the weakened folds of the stomach walls. Because of this
obstruction to the free emptying of the contents into the duodenum, it
is imperative that the food be masticated to a pulp and thus mixed with
saliva, that the salivary digestion of starches may be complete in the
stomach; or, at least, that all foods be reduced to a liquid state in
the stomach. A chunk of food could not easily pass through the pylorus.
All liquid or semi-liquid food should be held in the mouth until it,
also, is mixed with saliva. The stomach should not be overloaded with
either food or water and for this reason six meals a day, of light
feeding, is best.
A dilated stomach does not necessarily indicate that the digestive
juices are not secreted in normal proportions and easily digested
proteins need not be avoided. It is desirable to furnish the proteins
in concentrated form, as in meats, so as to get the most nutrition with
the least bulk. Milk may be used, with limewater, if sipped slowly and
held in the mouth until mixed with saliva.
Sugar should be used very sparingly, because it ferments readily and
aggravates the distension. If it is evident that fermented products are
in the stomach, it should be washed out with a stomach pump.
A tumor near the pylorus, or constriction of the pyloric orifice, will
also cause dilation of the stomach.
Beef juice, any of the better grades of meats, well masticated and
containing no gristle, limewater and milk, soft cooked eggs, and well
cooked cereals should constitute the diet.
Avoid vegetables containing coarse fibre, fried foods, and bread baked
on the same day.
Liquid with the meal should be avoided, on account of the tendency to
overload the stomach.
Cold water, taken a swallow at a time at intervals during the day, has
a tonic effect upon the relaxed muscles. It also incites the flow of
gastric juice.
* * * * *
=Ulcer of the Stomach.= Where this condition is severe, accompanied
with severe pains and vomiting of blood, the dietetic treatment is to
give the nourishment through the rectum for from five to ten days. Then
follows a period of ten days milk diet, with bouillon, barley water, a
beaten egg, and once a day, after the third day, strained oatmeal gruel.
Limewater is added to the milk to avoid the formation of leathery curds
and to neutralize the acids of the stomach. The patient is given half
a cup of milk every hour for three days, from 7 A. M. to 9 P. M. From
the third to the tenth day increase the quantity to one cupful, then
to a cup and a half and lengthen the periods between feedings to two
hours. If the milk is brought to a boil before the limewater is added,
it digests more readily.
After ten days, for the succeeding ten days the nourishment should be
given every two hours and the diet varied by semi-liquid foods, such
as gruels, toast water, soft boiled egg (once a day) beef juice, two
softened crackers (once a day) gelatin, buttermilk and strained soups.
After twenty days the patient, if all is well, may very gradually
resume a normal diet, beginning with baked potatoes, softened toast,
lamb chops, a small piece of steak or white meat of chicken. It is
imperative that all food, liquid or solid, be thoroughly mixed with
saliva and that solids be chewed to a pulp.
Liquids must not be swallowed either hot or cold, but about body
temperature. Cold water may be taken into the mouth when more palatable
than warm and held there until about body temperature before it is
swallowed. All liquid should be sipped, not swallowed in gulps.
* * * * *
=Cancer of the Stomach.= Since the growth most often obstructs the
pylorus, the stomach is usually dilated and the general directions
for dilation of the stomach should be followed. If the food will not
digest in the stomach, one must resort to rectal feeding. Where gastric
digestion is near normal, the general principles of diet for ulceration
of the stomach should be followed.
* * * * *
[Sidenote: Intestinal Disorders]
Most cases of intestinal difficulties may traced to a clogged
condition, either due to a weakness of the nerves and of the intestinal
muscles, and a resultant weak peristalsis, which does not strongly move
the mass along its course, or to a failure of the liver to discharge
sufficient bile to lubricate the mass. If the waste is not promptly
moved through the intestines, irritation may result and the poisons
from bacterial fermentations will be absorbed by the system.
Deranged stomach digestion also interferes with the digestion in the
intestines.
* * * * *
=Constipation.= The causes of this difficulty are so varied that it can
seldom be regulated by diet alone. It can be _helped_. A large number
of cases of chronic constipation are due to the failure to respond to
Nature’s call at a regular time each day, thus establishing a regular
habit at a certain hour. Many others are due to the weakness of the
muscular walls of the intestines or to the nerves controlling them. In
this event the intestinal peristalsis is weak. Still another cause is a
failure of the liver to discharge sufficient bile into the intestines
to lubricate the foeces. Many chronic cases are due to the pill and
drug habit. Where one continues to take pills, the condition brings a
result similar to the feeding of “predigested” food,—if the work is
done for the organs they become lazy and rely upon artificial aid.
_Every part of the body requires activity for strength._
If the straight front corset cramps the intestines it may cause
constipation by restraining their normal exercise during movements
of the body in walking, etc. Every woman who wears the straight front
corset should take exercises for the intestines morning and night.
The most natural relief for constipation is exercise,—particularly
exercise directed to the muscles of the intestines and to the nerve
centers controlling them.
Such foods as are laxative in effect, with the free use of water are
helpful. Figs and raisins (due to their seeds), prunes, dates, grapes,
apples, and rhubarb are laxative, due to their acids. These have best
effect when eaten just before retiring.
Oatmeal, or any cereal containing the bran, is laxative,—such as bran
bread or green corn.
As must be inferred from the above statement, the _cause_ of the
difficulty must first be reached.
Children should be trained to attend to Nature’s call regularly _every_
day. The best time is shortly after breakfast.
* * * * *
=Enteritis.= (=Inflammation or Catarrh of the Intestines=) is similar
in its nature to Gastritis or Catarrh of the Stomach and is treated in
a similar manner.
_Acute Enteritis_, as Acute Gastritis, is usually caused by a strong
irritant,—either by some food which disagrees, or by a mass of
undigested food. A fast of two or three days is the initial dietetic
treatment. A free drinking of water not only soothes the irritated
intestines but it cleanses the intestinal tract and assists the kidneys
in eliminating elements of fermentation; if these are not eliminated,
they will absorb into the blood.
Physicians usually give a course of calomel and castor oil to eliminate
all intestinal contents.
After the fast, a liquid and semi-liquid diet is followed until
inflammation is relieved. Milk, strained gruels, broths, strained
soups, buttermilk, eggs (soft cooked or raw), beef juice, barley water,
custards, gelatines, soft puddings, etc., are the foods most nourishing
and causing least irritation.
All irritating foods as coarse vegetables, pickles, acid fruits and
fruits with coarse seeds, candies, beer, wines and salads should be
omitted.
_Chronic Enteritis_ has the same general cause as Acute Enteritis,
though its onset is slow and it takes a correspondingly longer time to
correct.
* * * * *
=Dysentery=, if acute, demands complete rest in bed. The diet in both
Acute and Chronic cases must be confined to easily digested foods, such
as peptonized milk (see page 244), boiled milk, pressed meat juice, and
the white of egg, beaten and served with milk. Blackberry brandy, and
tea made from wild cherry bark, tend to check the inflammation.
During convalescence, care must be taken not to over-feed. Begin a more
liberal diet with a more liberal allowance of beef juice, gradually
adding tender beef steak, roast beef, fish, white meat of chicken,
eggs, custards, wine jelly, dry toast, blancmange, well boiled rice and
other easily digested food. The beef and egg are particularly valuable,
because of the anaemia occasioned by the loss of blood.
* * * * *
[Sidenote: Rectal Feeding]
is sometimes necessary in cases of ulcer, cancer, or tumor, along the
digestive tract. Since food is not absorbed in the large as readily as
in the small intestine, the strength cannot be fully maintained through
rectal feeding. In cases where the stomach is not able to digest the
food, it is the best expedient, however, until the functioning of the
stomach is re-established.
The rectum should be prepared about an hour before the feeding by a
full injection of water, to thoroughly cleanse the intestine. Place the
patient on his side with the hips elevated. If for any reason he cannot
lie on his side, let him lie on his back and elevate the foot of his
bed. After the water cleansing, inject two or three ounces of water in
which a small pinch of salt (6%) has been added and let it go high up
into the rectum.
Two to three ounces four to five hours apart is the desirable quantity
of rectal nutrition for an adult. The white of egg, beef juice, and
milk, all peptonized, are the best foods. The pancreatic trypsin, sold
in preparations of “pancreatin” is best. Unless milk is peptonized the
casein will be difficult to absorb. The food should always be salted,
as salt aids the absorption.
The white of egg should be diluted with four or five times its volume
of water; to beef juice add an equal volume of water. The yolk of egg
contains too much oil to absorb readily. Fats are not absorbed through
the rectum. If egg and beef juice are used without milk, a little sugar
may be added. Milk contains sugar in proportion.
It is not advisable to inject wine as it interferes with absorption of
other foods.
The nutriment should be forced eight to ten inches up into the rectum
to insure absorption. This can be done by using a small injection point
on a rubber tube and gently and patiently turning it as it is inserted.
The tube may be oiled to prevent irritation.
* * * * *
[Sidenote: Derangements of the Liver]
The liver is not, in a strict sense. a digestive organ, but it is very
dependent upon them, as all products of digestion must pass through
it and the starches, sugars and proteins, after they enter the blood,
undergo chemical changes here.
For a fuller understanding of the reasons for the following suggestions
regarding diet for the liver, the writer would request a re-reading, at
this point, of the chapter upon the “Work of the Liver” upon pages 81
to 92.
It will be recalled that the liver acts, not only upon proteins,
sugars, and starches,—the nourishing foods, but it also stands guard
over poisonous ferments, due to putrefactions absorbed from the
intestines, rendering them harmless; to a limited extent it also
oxidizes the poisons of alcohol. The fats also pass through the liver.
Since all products of digestion must pass through this organ, it is
easy to see how it may be overworked, for it is an undisputed fact that
most people eat more food than is required to maintain the body in
nitrogenous equilibrium and to supply the necessary heat and energy.
After the gorging of a heavy meal, the overloaded blood and liver
express themselves in a sluggish brain and one feels mentally, as well
as physically, logy, or overloaded.
Since both sugar, carbohydrates and protein undergo chemical changes in
the liver, it is evident that a diet consisting of an excess of either,
must overwork the liver, not only through the nutritive food elements
absorbed, but through the toxic substances which must be absorbed,—due
to the excessive amount of food not being digested as readily as a
smaller amount. If the food remains in the intestines too long, it is
attacked by the bacteria always present there, fermentation results
and poisons are absorbed and carried to the liver, where they must be
broken down and rendered harmless, so as not to affect other parts of
the system. If for any reason the liver is diseased, overloaded, or its
action is sluggish, it will not promptly oxidize these toxins.
One of the most important corrective agencies for an inactive liver is
exercise directed to this organ, to bring a free supply of blood, and
deep breathing of fresh air. _It is apparent that the blood must carry
its full quota of oxygen to assist in oxidizing both the nitrogenous
waste and the poisons_; and it must be remembered that the liver must
oxidize the waste from its own tissues, as well as from other parts of
the system.
It is apparent, from the above, that the regulation of diet for an
abnormal liver must be more in the _quantity_ than in the _quality_ of
food and in the perfect digestion. It depends also upon the activity of
the intestines, since the poisonous products of imperfectly digested
and fermenting food, not being regularly eliminated, must be absorbed
and carried to the liver. It is to free the intestines of the waste
containing the toxins that physicians give calomel and other strong
cathartics, to work off the toxins. These cathartics also work off
foodstuffs from the intestines before they are absorbed, so that the
liver has more rest.
* * * * *
=Torpid Liver or Billiousness.= This condition is due to the sluggish
action of this organ and a consequent failure to eliminate the
bile through the bile ducts into the duodenum. It may be caused
by inactivity and a resultant sluggish circulation of blood, to
overwork of the liver, due to overeating, to breathing of impure air,
or to insufficient breathing of pure air. It may also result from
constipation and a resultant absorption of toxic matter as described
above.
Many cases of billiousness are occasioned by obstruction of the opening
of the bile ducts into the intestines, which is often occasioned by
an excess of mucus in the duodenum. In such cases exercise for the
intestines is clearly indicated.
In the bending, twisting and squirming movements which the infant in
the cradle makes, the liver is regularly squeezed and relaxed. The same
is true in the free movements of an active child at play. If during
adult life these same free movements of bending and twisting the trunk
were continued daily and correct habits of free breathing of pure air
were established, there would be little call for “liver tonics.”
The elaboration of carbohydrates in the liver is an important part of
its work and in case of inactive liver the sugars and starches should
be limited, allowing that function to rest. Yet it is a mistake to
allow a diet too rich in protein. The best method is to cut down the
quantity of a mixed diet.
Two glasses of water an hour before breakfast followed by brisk
exercise for the vital organs and deep breathing are important. The
daily action of the bowels is imperative. In extreme cases a fast
of two or three days, with a copious use of water, is recommended.
Following this fast the diet should consist of easily digested
foods, eliminating those containing starch and sugars in too great
proportions, and it should be as limited as possible, consistent with
the actual necessity for rebuilding and for energy.
Some authorities restrict fats in a diet for billiousness but the
presence of fat in the duodenum stimulates the flow of pancreatic
juice, which in turn stimulates the secretion of bile.
Lemon stimulates the action of the hepatic glands and thus tends to
increase the liver activity.
There is a prevalent thought that eggs and milk cause sluggish liver
action. There is no physiological reason for this if too much food is
not eaten. One often loses sight of the fact that milk is a food as
well as a beverage, and that when milk constitutes an appreciable part
of the diet other foods should be limited accordingly.
The =DIET= may be selected from the following:[10]
=Soups.=—Light broths and vegetable soup with a little bread toasted
in the oven.
=Fish.=—Raw oysters, fresh white fish.
=Meats.=—Mutton, lamb, chicken or game.
=Farinaceous.=—Whole wheat or graham bread and butter, toast buttered
or dry, toasted crackers, cereals in small portions.
=Vegetables.=—Fresh vegetables, plain salads of watercress, lettuce,
and celery.
=Desserts.=—Gelatins, fruits, cornstarch, ice cream, junket, simple
puddings,—all with =very little sugar=.
=Liquids.=—Hot water, lemonade, orangeade, toast water, buttermilk,
loppard milk and unfermented grape juice,—not too sweet.
=AVOID.=—All rich, highly seasoned foods, candies, cheese, pies,
pastry, pan cakes, or any fried foods, salmon, herring, mackeral,
bluefish, eels, dried fruits, nuts and liquors of all kinds.
* * * * *
[Sidenote: Gall Stones]
The diet for gall stones need have no reduction in protein nor
carbohydrates, since the oxidation, or the chemical action upon sugars
is not interfered with. The presence of fat in the duodenum increases
the flow of pancreatic juice which, in turn stimulates the flow of
bile, so olive oil is often recommended in case of gall stones.
* * * * *
[Sidenote: Diabetes]
is a serious disturbance of nutrition. It is known and tested by the
appearance of sugar in the urine. However, the conclusion should not be
drawn that one has diabetes if the urine test for a day shows sugar.
This may be due to an excess of carbohydrates, particularly of sugar
in the diet a day or two previous and all trace of it may disappear in
a day. If continued tests for some period show an excess, nutritional
disturbances are indicated.
The most usual form of diabetes is _diabetes mellitus_. It is supposed
to be due to a disturbance in the secretions from the pancreas.
Experiments have shown that the general process of putting the
carbohydrates in condition to be absorbed into the blood is controlled
by a secretion from the pancreas.
The difficulty which confronts the dietitian is to prescribe a diet
without carbohydrates which will keep up the body weight and not
disturb the nutritive equilibrium. The diet must consist of protein
and fat and one danger is in the tendency to acetic and other acids in
the blood, which involves the nervous system. The patient has a craving
for sugars and starches, but the system cannot make use of them, and
the heat and energy must be supplied by fats. While, as a rule, the
craving for certain foods is an indication that the system needs the
elements contained in it,—this is true in the craving of the diabetes
patient for carbohydrates,—yet the desire _must not_ be gratified,
because of the inability to digest them.
There is often a distaste for fat, but its use is imperative and
in large quantities, because the weight and general vitality must
be maintained. The effort of the physician is to get the system in
condition to use carbohydrates.
Fats may be supplied in the yolk of egg, cream, butter, cheese, bacon,
nuts, particularly pecans, butternuts, walnuts and Brazil nuts.
In beginning a diet, the change must not be too sudden. At least a
week’s time should be allowed for the elimination of all sugar and
starch. Begin by eliminating sugars and next bread and potatoes.
Van Noorden gives the following diet, free from carbohydrates, which
has been in general use in Europe and America.
BREAKFAST.
Tea or coffee, 6 ounces.
Lean meat (beefsteak, mutton chop, or ham), 4 ounces.
Eggs one or two.
LUNCH.
Cold roast beef, 6 ounces.
Celery, or cucumbers, or tomatoes with salad dressing.
Coffee, without milk or sugar, 2 ounces.
Whisky, drams, diluted with 13 ounces of water.
DINNER.
Bouillon, 6 ounces.
Roast beef, 7½ ounces.
Green salad, 2 ounces.
Vinegar, 2½ drams.
Butter, 2½ drams.
Olive oil, 5 drams, or spinach with mayonnaise, large portion.
Whisky, 5 drams, diluted with 13 ounces water.
SUPPER, 9 P. M.
Two eggs, raw or cooked.
Van Noorden includes alcohol, in whisky, in his diet and most
physicians follow the theory that whisky or brandy aids in the
digestion and absorption of fats; the need is recognized since fats
must be supplied in so large quantities, yet the sweet wines and
beers contain sugar while the sour wines contain acids, which disturb
digestion.
There is a grave question in regard to the advisability of including
alcohol in the diet of a young person afflicted with diabetes and
the greater activity of the young patient will insure more perfect
digestion, so that the physician may not consider alcohol necessary.
Dr. Hall gives the following as a reasonable diet for a diabetic case,
after the first week or two, allowing potatoes.
BREAKFAST.
Tea or coffee, 6 ounces.
Cream, 2 ounces.
Meat, (beefsteak, mutton chops, or ham), 4 ounces.
Bread and butter, 2 slices.
Baked potato, with butter.
LUNCH.
Cold roast beef or cold boiled ham, 6 ounces.
Bread and butter, two slices.
Salad with mayonnaise dressing, egg garniture.
Tea or coffee with cream.
4 P. M.
Egg lemonade or egg orangeade.
DINNER.
Clear soup of any kind.
Roast beef or mutton, or pork.
Potatoes, baked or boiled.
Olives, celery, or radishes.
Side dish of green vegetables.
Bread and butter.
Dessert, milk-egg custard, sweetened with saccharin.
After a week on either of the above diets, in mild cases, sugar will
disappear from the urine. In extreme cases, it may be necessary to
follow this strict regime for two weeks. When the patient begins to eat
a little starch, potatoes and bread are re-instated first. Sugar is
kept out of the diet, except the little in fruit and vegetables, until
the urine shows no trace of it.
The following is a list of foods allowable:
Fresh meat, fish, oysters, clams, lobster, turtle, meat extracts, fats
of all kinds, eggs, such fresh vegetables as peas, beans, lentils,
lettuce, celery, asparagus, cabbage, pickles, clear soups (all kinds),
cheese (all kinds), coffee, tea (without sugar), cream, butter, fruit,
acid drinks and carbonated waters.
* * * * *
[Sidenote: Derangements of the Kidneys]
In the dietetic treatment of any diseased organ, the object must be
to give that organ as much rest as consistent with keeping up the
general nutrition of the system. The stomach and intestines are so
closely allied that, where one is affected, the other is liable to
affection also, and the dietetic treatment is regulated accordingly.
Yet generally speaking, in stomach disorders the quantity of protein
is limited; in intestinal disorders the starches, sugar and fats are
limited. Since the office of the kidneys is to pass from the system the
soluble salts and the nitrogenous waste, which dissolve in water, the
work of the kidneys in most conditions is aided by a copious drinking
of water. Since uric acid is stimulated by the kidneys, the proteins
should be restricted in the diet, particularly those formed from
the glands of animals,—as liver, sweetbreads, kidneys, also brains.
Potatoes, green vegetables, stone fruits and cranberries aggravate an
acute condition.
* * * * *
=Acute Nephritis.= In case of inflammation of the kidneys the
excretions are interrupted. In this event the quantity of water should
be limited to three to four glasses a day. In the event that the
kidneys will not excrete the water, the pores of the skin must be kept
freely open by sweat baths to assist in the elimination of waste.