THE WILL IN INTESTINAL FUNCTION
"Ill will never said well."
_Henry V_.
During the past generation, the appreciation of the relative part
played by the stomach and intestines in digestion has completely
changed. Our forefathers considered the stomach the all-important
organ of digestion and the intestines as scarcely more than a long
tube to facilitate absorption and deal properly with waste materials.
Their relative values are now exactly reversed in our estimation. The
stomach has come to be looked upon as scarcely more than a thin-walled
bag meant to hold the food that we take at each meal and then pass it
on by degrees to be digested, prepared for absorption and finally
absorbed in the intestines. It has comparatively little to do with
such alteration of the food as prepares it to be absorbed. Its motor
function is much more important than its secretory function and
serious stomach troubles are {216} dependent on disturbances of
stomach motility. Contractions at the pyloric orifice, that is the
passageway from the stomach into the intestines, will cause the
retention of food and seriously interfere with health. The dilatation
of the stomach for any reason may produce a like result and these are
the stomach affections that need special care.
If the stomach will only pass the food on properly, the intestines
will do the rest. A number of people have been found in the course of
routine stomach examinations who proved to have no secretory function
of the stomach and yet suffered no symptoms at all attributable to
this fact. The condition is well known and is called _achylia
gastrica_, that is, failure of the stomach to manufacture chyle, the
scientific term for food changed by stomach secretions. Our stomachs
are only meant, apparently, to provide a reservoir for food that will
save us the necessity of eating frequently during the day, as the
herbivorous and graminivorous animals have to do, and enable us to
store away enough food to provide nutrition for five or six hours. We
thus have the leisure to occupy ourselves with other things besides
eating and drinking.
This conclusion as to the relative {217} significance of the stomach
and digestion is confirmed by the fact that removal of the whole
stomach or practically all of it for cancer has in a number of well
known cases been followed by gain in weight and general improvement in
health. Schlatter's case, the very first one in which nearly the whole
stomach was removed, proved a typical instance of this, for the
patient proceeded to gain some forty pounds in weight. She had lost
this during the course of the growth of a cancer and its interference
with stomach motility. It was necessary, however, for her to be fed,
rather carefully, well-chosen foods usually in liquid form, and every
hour and a half instead of at longer intervals. Her intestines were
thus spared from overloading and proceeded to do the work of digestion
for which they are so well provided by abundant secretion poured into
them from the large glands, the liver and the pancreas, as well as the
series of small glands in their own walls all of which were manifestly
meant to do extremely important work.
In the increased estimation of the significance of the digestive
functions of the intestines which has come in recent years, there has
been a tendency, as always in human {218} affairs, for the pendulum to
swing too far. Above all, certain phases of intestinal function have
come to occupy too much attention and to be the subject of
oversolicitude. Whenever this happens, whatever function it concerns
is sure to be interfered with. Attention has been concentrated to a
great extent on evacuation of the bowels and the consequences have
been rather serious. A great many people whose intestinal functions
were proceeding quite regularly have had their attention called to the
fact that any sluggishness of the intestines may be the source of
disturbing symptoms and the beginning of even serious morbid
conditions. As a consequence, they pay a great deal of attention to
the matter and before long become so solicitous that the elimination
of waste materials from the intestines is interfered with. Above all,
they may be led to pick and choose their foods so delicately that
there is not the necessary waste material left to encourage
peristalsis.
The result is that to some extent at least, intestinal function would
almost seem to have broken down in our day. Everywhere one sees
advertisements of medicines and remedies and treatments of various
kinds that will aid in the evacuation of the bowels. {219} Most of
them are guaranteed to be perfectly harmless and all of them are
pleasant to take, they work while you are doing nothing else and are
just engaged in saving mankind not only suffering but complications of
various kinds that may lead to serious results. Some years ago, when
Matthew Arnold was in this country, he declared in one of his lectures
that what the world needed was "leading and light," but a well known
American physician who is closely in touch with American life declared
not long since that what we needed in America manifestly, if
advertisements were any index of the needs of a people, was laxatives
and more laxatives. Advertisements cost money; it is said that at
least four times as much as the advertising costs must be spent by the
public on any object advertised in order to make it pay, so that very
probably nearly a billion of dollars a year is spent in this country
on laxatives. Only whiskey and tobacco present a higher bill to the
American people annually.
Practically all of the laxative medicines do harm if taken over a
prolonged period. Over and over again physicians have found that
laxative remedies introduced even by scientists, with the assurance
that they were quite {220} harmless and had no undesirable after
effects proved the source of annoying or even serious symptoms after a
while. It is true that when constipation has become habitual, it may
be necessary to give laxative medicines for a prolonged period, but
this is only another instance of the necessity that is often presented
to the physician of choosing between two evils and trying to find the
lesser one. Even the heavy oil that has become so popular in recent
years has been found on careful investigation and prolonged
observation to have certain undesirable effects and it must not be
forgotten that it has not been used generally for a sufficiently long
time for us to be absolutely sure what its sequelae may be.
This breakdown of intestinal activity is not the fault of nature but
of men and women who have been thinking to improve on the natural laws
of living. As the result of improvements in diet and refinements in
cooking and the preparation of foods, less and less of their roughage
is left in our articles of food when sent to the table. It is on this
roughage or waste material that intestinal movement or peristalsis
depends. If we eat perfectly white bread, cut all the gristle and
fatty materials from our meat, carefully eliminating {221} the
connective tissue bundles that may occur in it, eat our vegetables
mainly in the shape of purees and avoid to a great extent all the
coarser varieties, such as parsnips and carrots and beets, we provide
very little material for the intestines to carry on and aid them in
the elimination of other wastes. If, besides, we always ride and do
not walk, and so have none of that precious jolting which occurs every
time the heel comes down, and if we have no bending movements in our
lives, no wonder that intestinal movement becomes sluggish and we have
to supply stimulants and irritants to get it to do its work.
Intestinal evacuation is very largely a matter of will. There are very
few people so constituted by nature that they will not have regular
movements sufficient to maintain their digestive tracts in excellent
health, if they form the right habits. They must, however, make up
their minds, that is their wills, to restore coarse materials to their
diet. They must eat whole wheat or graham bread, must eat fruit
regularly and usually eat the skins of the fruit with it, that is as
far as apples, pears, peaches, apricots, plums and the like are
concerned. Even as regards oranges, it is probable that the eating of
occasional {222} pieces of orange peel is an excellent means of
helping intestinal functions and providing waste material. [Footnote
6 ]
[Footnote 6: A curious discovery has been made in recent years that
orange skin contains a very precious element essential for bodily
health, belonging to the class of substances known as the vitamines
and contains more of it than any other food material that we have.
The instinct which tempted so many of us as children to eat orange
skin, in spite of the fact that we were discouraged from the
practice, was founded on something much more than mere childish
caprice. Orange skin is after all the basis of marmalade which has
been so commonly used by the English people at breakfast and which
is at once a tasty and healthful material.]
When baked potatoes are taken, the skin should be eaten, mainly
because of the waste material it provides, but also because just
underneath the skin and sure to be removed with it if it is taken off,
there are certain salts and other substances that are excellent for
health and particularly for digestion. Besides, the carbonized
material which so often occurs on baked potatoes is of itself a good
thing. It represents some of that charcoal which in recent years
French physicians particularly have found very valuable as a remedy
for certain disturbances of intestinal digestion. The removal of
parings from fruit and vegetables and the careful trimming of meat,
have taken out of human diet the materials which meant most for
intestinal movements for former generations, and they {223} have to be
supplied artificially by means of irritant drugs, salts, oils and the
like, to the detriment of function.
The other element in the modern situation as regards the failure of
intestinal function is the lack of fluids. People who live indoors are
not tempted to take so much water as those who work outside and yet in
our modern, steam-heated houses they often need more. Our heating
systems take much more water from us than the former methods of
heating. The result is seen in our furniture that comes apart from
dryness and in our books and other things which crack and deteriorate.
Something of the same thing happens to human beings unless they supply
sufficient fluids. For this it is necessary deliberately to make up
the mind, which always means the will, to consume five or six glasses
of water between meals and especially to take one on rising in the
morning and another on going to bed. This should _not_ be hot and
above all not lukewarm water, but fresh cold water which stimulates
peristalsis. The creation of a habit is needed in the matter or it
will be neglected. I have sometimes given patients some harmless drug,
like a lithium salt, that was to be taken three or four times a day in
a full glass of {224} water, in order to be sure that they would take
the water. They were willing to take the medicine but I could not be
assured that without it they would drink the amount of water that I
counselled.
Above all, a regular habit of going to the toilet at a definite time
every day must be created. Nothing is so important. In little
children, even from their very early years, such a habit can be
established; it is only necessary to put them on their chairs at
certain times in the day and the desired result will follow. Adults
are merely children of a larger growth in this matter, and the habit
of going regularly is all-important. A little patience is needed,
though there should be no forcing, and after a time, a very
satisfactory habit can be established in this manner. It seems almost
impossible to many people that anything so simple should prove to be
remedial for what to them for a time seemed so serious a disturbance
of health, but only a comparatively short trial of the method will be
sufficient to demonstrate its value. A book or newspaper may be taken
with one, or Lord Chesterfield's advice to learn a page of Horace
which may afterwards be sent down as an offering to Libitina, the
goddess of secret {225} places, may be followed, but the mind must not
be diverted too much from the business in hand, and the will must be
afforded an opportunity to exert its power.
It is true that the muscular elements of the intestines consist of
unstriped muscles and that they are involuntary, and yet experience
and observation have shown that the will has a certain indirect
influence even over involuntary muscle. The heart, though entirely
involuntary in its regular activities, can be deeply influenced by the
will and the emotions, as the words encouraging and discouraging, or
the equivalent Saxon words heartening and disheartening, make very
clear. Undoubtedly the peristaltic functions of the intestines can be
encouraged by a favorable attitude of the will towards them.
Above all, it is important that the anxious solicitude which a great
many people have and foster sedulously with regard to the effect of
even slight disturbances of intestinal functions should be overcome.
We have discussed this question in the chapter on dreads and need only
say here that the delay of a few hours in the evacuation of the bowels
or even the missing entirely of an intestinal movement for a full day
occasionally, will {226} usually not disturb the general health to any
notable extent, and that the symptoms so often attributed to these
slight disturbances of intestinal function are much more due to the
solicitude about them than to any physical effect. There are a great
many people whose intestinal functions are quite sluggish and whose
movements occur only every second day or so, who are in perfectly good
health and strength and have no symptoms attributable to any
absorption of supposed toxic materials from the intestines. Indeed, in
recent years, the idea of intestinal auto-toxemia has lost more and
more in popularity for it has come to be recognized that the symptoms
attributed to this condition are due in a number of cases to serious
organic disease in other parts of the body, and in a great many cases
to functional nervous troubles and to the psycho-neuroses, especially
the oversolicitude with regard to the intestines. The will is needed
then for intestinal function to regulate the diet, to increase the
quantity of fluid, to secure regular habits and to eliminate worry and
anxiety which interferes with intestinal peristalsis. There are but
very few cases that will not yield to this discipline of the will when
properly and persistently tried.
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