( Originally Published 1936 )
A failure of any portion of the digestive tract to function in a normal manner in changing food, may be referred to as indigestion. Irregular conditions in certain organs, for example, the small intestine, may be observed more than in others. Faulty digestion of starch in the mouth is not accompanied by symptoms. Insufficient or arrested flow of any juice may upset the orderly sequence of the digestive process. Also nervous strain or excitement may influence the muscular tone of the stomach and intestine to such a degree that food is not moved as it should be or is moved along too rapidly. With changed function we may have abnormal gas accumulations, in-creased irritability of the bowel wall or spasms of the organs with actual pain and griping.
In studies of the activity of digestive glands it has been shown that violent nervous strain or emotional stress such as accompanies a keen disappointment, may lead to the production of a gastric juice reduced in amount and largely devoid of digestive elements. One who is sick may eat quite well of food served in small portions, in pretty dishes, on a decorated tray, yet the same food served in large portions in plain dishes would most likely be repulsive. Also physical tire or exhaustion is frequently accompanied by changes in the muscular activity of the intestines. Worry, whether based on fact or fancy, lessens the appetite; and depression of glandular and muscular activity follows. Occasionally a different reaction is observed, and following these severe strains of the nervous system, an abnormal rate of intestinal and colon activity results with distress due to food reaching the lower bowel before it is properly prepared.
In debilitated states of health, or in acute diseases, the digestive tract may lack its normal tone. Peristalsis may be reduced in activity so that gas and undigested residue accumulate in abnormal amounts. Similarly with the wasting seen in senility and advanced age, the production of digestive juices is lessened and the vigor of muscles in the digestive tract and about the' abdominal space is diminished. This disturbed function of the organs is annoying.
Many persons who are abnormally underweight complain of widespread soreness in the abdomen, and yet on handling the abdomen no pain or tenderness is located. They describe their feelings as a kind of aching or dragging. Some of these persons are suffering from physical tension in the abdomen such as comes with dropped organs or adhesions. Often they are relieved by wearing a supporting belt or better still, by restoring the body nutrition which strengthens the muscles and deposits fat about the intestines and colon, thus restoring the organs to their natural positions.
Normally, in digestion, some gas is produced. Much of this is carbon dioxide, which is easily absorbed by the blood and eliminated through the lungs. In certain states, fermentation may be present, or bacteria of certain types may enter the digestive tract and cause decomposition of proteins with the liberation of certain toxic substances and the production of a variety of gases, some of which are decidedly offensive. Auto-intoxication is -a term that is commonly wrongly used. Only when bacilli are present which break protein substances into toxic fractions is there a justification for its use. This does not occur as often as has been thought; and further, the products known as indole, skatol, and phenol are very quickly eliminated from the body when their production ceases. We prefer to avoid using a term which is so loosely applied, and which at best tends to confuse.
Digestion may be upset in a greater or lesser degree by mechanical agents. Frequently there are symptoms of distress in the presence of a maturing pregnancy. These should be regarded as physiological and should have sensible care. If masses due to growths in the walI of the digestive tract, or in other organs which lie adjacent to the intestines, are found, the fundamental pathology needs treatment rather than the digestive tract itself. Operations are sometimes followed by some degree of complications which may produce adhesions; or similarly, the irritation of an ulcer may cause spasms delaying the emptying of the stomach or the production of adhesions about its outlet and the duodenum. Here again, the in-digestion experienced is corrected by caring for the accompanying physical abnormality.
Before beginning the treatment of any form of indigestion we urge that a careful physical and laboratory examination of the patient be made. This may make the cause of his complaint clear—whether it is due to states such as those mentioned above, or whether it is due to a disturbance or irregularity in the production of digestive juices. This discussion presents only -a brief reference to the former group, as it is our purpose to discuss more fully those forms of indigestion where a deficiency in the flow of digestive juices is found. It is not unlikely that this cause exists in many instances where it has not been recognized or suspected in the past.