Of course to say that the stomach is well prepared chemically, muscularly, and by its nerve supply to handle any combination of ordinary food in ordinary amounts is not the same thing as saying that we may devour with impunity any amount of anything. It is a good thing for every one to know when he has reached his limit, and a person with organic heart disease should avoid eating large quant.i.ties at one time, or when he is extraordinarily fatigued or emotionally disturbed, lest at such a time he may put a fatal strain on the pneumogastric nerve that controls both stomach and heart.
The Fear of Certain Foods
Physical Idiosyncrasies. Most of our false fears on food subjects come from some tradition-either a social tradition or a little private, pet tradition of one"s own. Some one once was ill after eating strawberries and cream. What more natural than to look back to those little curdles in the dish and to start the tradition that such mixtures are dangerous? The worst of it is that the taboo habit is very likely to grow. One after another, innocent foods are thrown out until one wonders what is left. A patient of mine, Mr. G., told me that he had a short time before gone to a physician with a tale of woe about his sour stomach. "What are you eating?" asked the doctor. "Bran crackers and prunes." "Then," said the learned doctor, "you will have to cut out the prunes!" Needless to say, this man ate everything at my table, and flourished accordingly.
There may be such a thing as physical idiosyncrasies for certain foods. I have often heard of them, but I have never seen one. I have often challenged my patients to show me some of the "spells" which they say invariably follow the eating of certain foods, but I have almost never been given an exhibition. The man who couldn"t eat eggs did throw up once, but he couldn"t do it a second time. Many people have threatened to break out with hives after strawberries. One woman triumphantly brought me what looked like a nice eruption, but which proved to be the after-results of a hungry flea! After that she ate strawberries,-without the flea and without the hives.
Not Miracles but Ideas. Conversions on food subjects are so common at my table that I should have difficulty in remembering the individual stories. Scores of them run together in my mind and make a sort of composite narrative something like this: "Oh, no, thank you, I don"t eat this. You really must excuse me. I have tried many times and it is invariably disastrous." Then a reluctant yielding and a day or two later some talk about miracles. "It really is wonderful. I don"t understand," etc. Experiences like these only go to show the power of the subconscious mind, both in building up wrong habit-reactions and in quickly subst.i.tuting healthy ones, once the false idea is removed.
Among my stomach-patients there were two men, brothers-in-law, immigrants from the Austrian Tyrol, and now resident in one of the cow-boy states. Leonardo spoke little English, and though Giovanni understood a very little, he spoke only Italian.
Several years before I knew them, Giovanni had developed a severe case of stomach trouble and had finally gone to a medical center for operation. The disturbance, however, was not relieved by the operation and before long his brother-in-law fell into the same kind of trouble. For several years the two had spent much of their time dieting, vomiting, and worrying over their sour stomachs. Giovanni finally became so ill that his sick-benefit society had actually a.s.sessed its members to pay for his funeral expenses. About this time a business man of their town, impressed by the cure of a former patient who had made a quick recovery after seven years of invalidism, persuaded the two men to take their little savings and come to California to be under my care. The evening meal and breakfast went smoothly enough, although the menu included articles which they had been taught to avoid. However, as I left the house on a necessary absence soon after breakfast, I saw Leonardo weeping in the garden and Giovanni spitting up his breakfast, out at the entrance gate. On my return, I found one of "the family" literally sitting on the coat-tails of Leonardo, while Giovanni hovered at a distance, safe from capture. Leonardo upbraided me bitterly for having undone all the gain they had made in the long months of rigid dieting, for now the vomiting had returned, because they had eaten sugar on their oatmeal at breakfast! I made Leonardo drink an egg-nog, took him into the consultation-room and held my hand on his knee to keep him in his chair, while explaining to him as best I could the physiologic action of the hydrochloric acid on the digestive juice, which he feared as a sour stomach, the sign of indigestion.
During the conversation I said, "I suppose Giovanni imitated you in this mistaken fear about your health." The reply was, "No, I got it off him!" Nearly two hours later he exclaimed in astonishment: "Why, that milk hasn"t come up! Maybe I am cured!" "Of course you are cured," I answered; "there never was anything really the matter with your stomach, so you are cured as soon as you think you are."
Later Giovanni was inveigled into the house by the promise that he would have to eat nothing more than milk soup. All was smooth sailing after this. For my own part I feared for the permanency of the cure, for they were returning to the old environment. But more than three years have pa.s.sed, and grateful letters still come telling of their continued health.
Another patient, a teacher of domestic science in a big Eastern university, had lived on skimmed milk and lime-water from Easter to Thanksgiving. Several attempts to enlarge the dietary by adding cream or white of egg had only served to increase the sense of discomfort. Finding nothing in the history of the case to warrant a diagnosis of organic disease of the stomach, I served her plate with the regular dinner, bidding her have no hesitancy even over the pork chops and potato chips. She gained nine pounds in weight the first week, and in two and a half months was forty pounds to the good.
When Re-education Failed. But there is one patient who has had to have his lesson repeated at intervals. This man laughingly calls himself a disgrace to his doctor because he is a "repeater." His story ill.u.s.trates the power of an autosuggestion and the disastrous effect of attention to a physiological function. When Mr. T. came first to me he weighed only 120 pounds, although he is over six feet tall and of large frame. From the age of sixteen he had followed fads in eating and thought he had a weak stomach. I treated his "weak stomach" to everything there was in the market, including mince-pies, cabbage, cheese, and all the other so-called indigestibles. He gained 16-1/2 pounds the first week and 31 pounds in five weeks. One would think that the idea about the weak stomach would have died a natural death, but it did not. Again and again he came back to me like a living skeleton, the last time weighing only 105 pounds, and again and again he has gone back to his home in the Middle West plump and well. Twice while he was at home he underwent unnecessary operations, once for an ulcer that was not there and once for supposed chronic spasm of the pylorus. Needless to say, the operations did not help. You cannot cut out an idea with a knife. Neither can you wash it out with a stomach-pump; else would Mr. T. long ago have been cured! This particular idea of his seems to be proof against all my best efforts at re-education. Psycho-a.n.a.lysis is impracticable, partly because of the duration of the habit of repression, but the history, and certain symbolic symptoms, indicate the Freudian mechanisms at work. All I can do is to feed him up, bully him along, and keep him from starving to death. Just now he is doing very well at home, although he has moved to California so as not to be too far away from "the miracle-worker."
If Mr. T."s case had been typical, I should long ago have lost my faith in psychotherapy. Keeping people from starving is worth while, but is less satisfactory than curing them of what ails them. The nervous patient who has a relapse is no credit to his doctor. It is only when the origin of his trouble is not removed that the bond of transference tends to become permanent. The neurotic who is well only while under the influence of his physician is still a neurotic. However, as most people"s complexes are neither so deeply buried nor so obstinate as this, a simple explanation or a single demonstration is usually enough to loose the fettering hold of old misconceptions.
Common Ailments
"Gas on the Stomach." We all know people who suffer from "gas." Indeed, very few of us escape an occasional desire to belch after a hearty meal. But the person with nervous indigestion rolls out the "gas" with such force that the noise can sometimes be heard all over the house. He may keep this up for hours at a time, under the conviction that he is freeing himself from the products of fermenting food. He may exhibit a well-bloated stomach as proof of the disastrous effect of certain articles of diet. The gas and the bloating are supposed to be the sign and the seal of indigestion, a positive evidence that undigested food is fermenting in the stomach.
But what is fermentation? It is, necessarily, a question of the growth of bacteria and is a process which we may easily watch in our own kitchens. Bread rises when the yeast-cells have multiplied and acted on the starch of the flour, producing enough gas to raise the whole ma.s.s. Potatoes ferment because bacteria have multiplied within them. Canned fruit blows up because enough bacteria have developed inside to produce sufficient gas to blow open the can. Every housewife knows that it takes time for each of these processes. Bread has to stand several hours before it will rise; potatoes do not ferment under twelve hours, and canned fruit is not considered safe from the fermenting process under three days. Evidently there is some mistake when a person begins to belch forth "gas" within an hour or two after a meal. As a matter of fact, it is not gas at all but merely air that is swallowed with the food or that was present in the empty stomach.
When the food enters the stomach it necessarily displaces air, which normally comes out automatically and noiselessly. But if, through fear or attention, a certain set of muscles contract, the pent-up air may come forth awkwardly and noisily or it may stay imprisoned until we take measures to let it out. A hearty laugh is as good as anything, but if that cannot be managed, we may have to resort to a cup of hot water which gives the stomach a slap and makes it let go. Two belches are enough to relieve the pressure. After that we merely go on swallowing air and letting it out again, a habit both awkward and useless.
If the emotion which ties the muscle-knot is very intense, and the stomach refuses to let go under ordinary measures, the pain may be severe. But a quant.i.ty of hot water or a dose of ipecac is sure to relieve the situation. If the person is able to give himself a good moral slap and relax his unruly muscles, he reaches the same end by a much pleasanter road.
Some people are fond of the popular remedy of hot water and soda. Their faith in its efficacy is likely to be increased by the good display of gas which is sure to follow. As any cook knows, soda and acid always fizz. The soda is broken up by the hydrochloric acid of the stomach and forms salt and carbon dioxid, a gas. However, as the avowed aim of the remedy is the relief of gas rather than its manufacture, and as the soda uses up the hydrochloric acid needed in digestion, the practice cannot be recommended as reasonable.
Gastritis. I once knew a woman who went to a big city to consult a fashionable doctor. When she returned she told with great satisfaction that the doctor had p.r.o.nounced her case gastritis. "It must be true," she added, "because I have so much gas on my stomach!" The diagnosis of gastritis used to be very common. The ending itis means inflammation,-gastritis, enteritis, colitis, each meaning inflammation of the corresponding organ. An inflammation implies an irritant. There can be no kind of itis without the presence of something which irritates the membrane of the affected part. If we get unusual and irritating bacteria in some spoiled food, we are likely to have an acute inflammation until the offending bacteria are expelled. But an inflammation of this kind never lasts. People who have had ptomaine poisoning sometimes a.s.sert that they are afterwards susceptible to poisoning by the kind of food which first made them ill. Such a susceptibility is not so much a hold-over effect from the poison as a hold-over fear which tends to repeat the physical reaction whenever that food is eaten. I, myself, have had ptomaine poisoning from canned salmon, but I have never since had any trouble about eating salmon.
Sour Stomach. Sometimes when a person lies down an hour or so after a meal, some of the contents of his stomach comes up in his throat. Then if he be ignorant of physiology, he may be very much alarmed because his stomach is "sour." Not knowing that he would have far greater cause for alarm if his stomach were not sour, he may, if the idea is interesting to him, begin to restrict his diet, to take digestive tablets, and to develop a regular case of nervous dyspepsia. Sometimes when the specialists measure the amount of hydrochloric acid in the stomach, they do find too much or too little acid; but this merely means that an emotion has made the glands work overtime or has stopped their action for a little while. The functions of the body are so very, very old that there is little likelihood of permanent disturbance.
Biliousness. The stomach is not the only part of the body concerning which we lack proper confidence. Next to it the liver is the most maligned organ in the whole body. Although the liver is about as likely to be upset in its process of secreting bile as the ocean is likely to be lacking in salt, many an intelligent person labels every little disturbance "biliousness" and lays it at the door of his faithful, dependable liver.
As a matter of fact, the liver is liable to injury from virtually but three sources-alcohol, bacterial infection, and cancer-and even a liver hardened by alcohol goes on secreting bile as usual. The patient dies of dropsy but not of "liver complaint."
Some people act as if they thought bile were a poison. On the contrary, it is a very useful digestant; it aids in keeping down the number of harmful bacteria and helps to carry the food from intestines to blood. Every day the liver manufactures at least a pint of this important fluid. The body uses what it needs and stores the surplus for reserve in the gall-bladder. The flow is continuous and, despite all appearances to the contrary, there is no such thing as a torpid or an over-active liver.
It is true that after a "bilious" person has vomited for a few minutes he is likely to throw up a certain amount of bile, which is supposed to have been lying in his stomach and causing the nausea. In fact, however, this bile is merely a part of the usual supply stored away in the gall-bladder. By the very act of retching, the bile is forced out of the bile channels into the stomach and thence up into the mouth. Anybody can throw up bile at any time if he only tries hard enough.
One of the favorite habits of certain people is the taking of calomel and salts. After such a dose they view with satisfaction the green character of the stools and conclude that they have rid themselves of a great amount of harmful matter. As a matter of fact, the greater part of the coloring in the stools is from the calomel itself, changed in the intestines from one salt of mercury to another. Any excess bile is the result of the irritating action of the calomel on the intestinal wall, an irritation which makes the bowel hurry to cast out this foreign substance without waiting for the bile to be absorbed as usual.
A patient once told me that he had bought medicine from a street fakir and by his direction had followed it with a dose of salts. He saved the bowel movement, washed it in a sieve, and discovered a great number of "gall-stones," which the medicine had so effectively washed from his system. He was much astonished when I told him that his gall-stones were merely pieces of soap. He did not know that everybody manufactures soap in his body every day, and that by taking an extra quant.i.ty of oil in the shape of the fakir"s medicine and an extra quant.i.ty of potash in the salts, he had merely augmented a normal physiological process. The supposed action of calomel belongs to the same cla.s.s of phenomena, and has no slightest effect on the liver or on real gall-stones, which are the precipitate of bile-salts in the gall-bladder, and which cannot be reached by any medicine.
If the popular notions about biliousness are ill founded, what then causes the disturbances which undoubtedly do occur and which show themselves in attacks of nausea or sick headache? The answer can be given in a word of four letters; a coated tongue, a bilious attack and a sick headache are all the outcome of a mood. Stocks have gone down or the wife is cranky or the neighbors are hateful. Adrenalin and thyroid secretions are poured out as the result of emotion; digestion is stopped, circulation disturbed, and the whole apparatus thrown out of gear.
Sick-Headache. Sick-headache is primarily a circulatory disturbance; and although the disturbance may have been inaugurated by some chemical unbalance, the sum total of the force that makes a sick-headache is emotional. The emotion, of course, need not be conscious in order to be effective. If we picture the arteries all over the body as being supplied with, among other things, a wall of circular muscles, and then imagine messages of emotion being flashed to the nerves controlling this muscle wall, we may get an idea of what happens just before a sick-headache. Some parts of the arteries contract too much and other parts relax. The arteries to the head tighten up at the extremities and become loose lower down. The force of the blood-stream against the constricted portion can hardly fail to cause pain. The sick part of the headache is merely a sympathetic strike of the nerves which control circulation and stomach.
The moral of all this is plain. If a sick-headache is the result of an emotional spasm of the blood-vessels, the obvious cure is a change of the emotion. Some people manage it by going to a party or a picnic, others by ignoring the symptoms and keeping on with their work. A woman physician whom I know was in the midst of a violent headache when called out on an obstetrical case. She felt sorry for herself, but went on the case. In the strenuous work which followed, she quite forgot the headache, which disappeared as if by magic.
Sometimes it happens that a headache recurs periodically or at regular intervals. It is easy to see that in such cases the exciting cause is fear and expectation. At some time in the past, headaches have occurred at an interval of, say, fourteen days; as the next fourteenth day approaches the sufferer says to himself: "It is about time for another headache. I am afraid it will come to-morrow," and of course it comes. One man told me that if he ate Sunday-night supper he inevitably had a headache on Monday morning. We were about to sit down to a simple Sunday supper and he refused very positively to join us. I told him he could stay all night and that I would take care of him if the Monday sickness appeared. He accepted my challenge but was unable to produce a headache. In fact, he felt so unusually flourishing the next morning that he insisted on frying the bacon for my entire family. That was the end of the Monday headaches.
A Few Examples. As sick-headache has always been considered a rather stubborn difficulty, not amenable to most forms of treatment, it may be well to cite a few cases which were helped by educational methods. A patient came home from a walk one day and announced that he was going to bed. When questioned, be said: "I am tired and I have a sick-headache. Isn"t it logical to go to bed?" To which I answered that it would be far more logical to put some food into his stomach and change the circulation than to lie in bed and think about his pain. This man was completely cured. I have had patients throw up one meal, and very rarely two, but I have never had to supply more than three meals at a time. The waste of food I consider amply justified by the benefit to the patient.
There once came to me an elderly woman, the wife of a poor minister. She was suffering from attacks of nausea, which recurred every five to ten days with intense pain through the eyes, and with photo-phobia or fear of light. I found that she had by dint of heroic efforts raised a large and promising family on the salary of an itinerant minister-from four hundred to six hundred a year! All the time she had been feeling sorry for herself because her husband did not appreciate her. One day, after reading one of his letters which seemed to show an utter lack of appreciation of all that she was doing, she fell down in the field beside her plow, paralyzed. From that time on she had been more or less of an invalid, continually nursing her grudge and complaining that she ought not to have been made to bear so many children.
After I had heard this plaint over and over for about a week, I said: "Perhaps you ought not to have had that little daughter, the little ewe-lamb. Maybe she was one too many." "Oh, no," came the quick response. "I couldn"t have spared her." Then I went down the line of the fine stalwart sons. Perhaps she could have spared John or Tom or Fred? Finally she saw the whole matter in a different light,-saw herself as a queen among women, the mother of such a family.
As to the husband, I tried to show her that she was not very clever to live with a man all those years without discovering that he was not likely to change. "You can"t change him but you can change your reaction to him. If something keeps hurting your hand, you don"t keep on being sore. You grow callous. Isn"t it about time you grew a moral callous, too?"
I put her on the roof to sleep, on account of her fear of light. Only once did she start a headache, which I quickly nipped in the bud by making her get up and dress. She had come to stay "three months or four,-if I get along well." At the end of four weeks she left, an apparently well woman. The last I heard of her she was stumping the state for temperance, the oldest of an automobile party of speakers, and the st.u.r.diest physically. With the emotional grievance, disappeared also the physical effects in stomach and head.
Miss S., a very brilliant woman, ambitious to make the most of her life, had been shelved for twenty-five years because of violent sick-headaches which made it impossible for her to undertake any kind of work. She had not been able to read a half-hour a day without bringing on a terrible headache. I insisted on her reading, and very soon she was so deep in psychological literature that I had difficulty in making her go to bed at all. After learning the cause of her headaches and gaining greater emotional control, she succeeded so well in freeing herself from the old habit, that she now leads the busiest kind of useful life with only an occasional headache, perhaps once in six months.
A certain minister suffered constantly from a dull pain in his head, besides having violent headaches every few days. He started in to have a bad spell the day after his arrival at my house. As I was going out of the door, he caught my sleeve. "Doctor," he said, "would it be bad manners to run away?" "Manners?" I answered. "They don"t count, but morals, yes." He stayed-and that was his last bad headache. Both chronic and periodic pains disappeared for good.
One woman who had suffered from bad headaches for eighteen years lost them completely under a process of re-education. On the other hand, I have had patients who were not helped at all. The principles held good in their cases, but they were simply not able to lose the old habit of tightening up the body under emotion.
Hysterical Nausea. Sometimes nausea is merely the physical symbol of a subconscious moral disgust. We have already told the stories of "the woman with the nausea" (Chapter V) and of Mrs. Y. (Chapter VII). These cases are typical of many others. Their bodies were perfectly normal, and when, through psycho-a.n.a.lysis and re-education, they were helped to make over their childish att.i.tudes toward the s.e.x-life, the nausea disappeared.
Loss of Appet.i.te. A nervous patient with a good appet.i.te is "the exception that proves the rule." The neurotic is usually under weight and often complains that he feels satiated almost as soon as he begins to eat. Loss of appet.i.te may, of course, mean that the body is busy combating toxins in the blood, but in a nervous person it usually means a symbolic loss of appet.i.te for something in life, a struggle of the personality against something for which he has "no stomach." Psycho-a.n.a.lysis often reveals the source of the trouble, and a little bullying helps along the good work. By simply taking away a harmful means of expression, we may often force the subconscious mind to find a better language.
Summary
Since the stomach seems to be an organ which is much better fitted to care for food than to care for a depressing emotion or a false idea, it seems far more sensible to change our minds than to keep enlarging our list of eatables which are taboo.
And since most indigestion is in very truth nothing more nor less than an emotional disturbance, worked up by fear, anger, discontent, worry, ignorance, suggestion, attention to bodily functions which are meant to be ignored, love of notice and the conversion of moral distress into physical distress, the best diet list which can be furnished to Mr. Everyman in search of health must read something like this:
MENU
Monday, Tuesday, Wednesday, Thursday, Friday, Sat.u.r.day, Sunday
A Calm Spirit Plenty of Good Cheer A Varied Diet Commonsense Good Cooking Judicious Neglect of Symptoms Forgetfulness of the Digestive Process A Little Accurate Knowledge A Determination to BE LIKE FOLKS
CHAPTER XI
In which we relearn an old trick