Part 35

Hypochlorhydria is a diminution in the amount of hydrochloric acid. Physicians often administer hydrochloric acid about one half hour to an hour after the meal.

Many advocate a diet omitting protein, but since protein foods stimulate the flow of gastric juices, they should not be omitted, but used a little less freely.

Achlorhydria. Where there is an entire absence of hydrochloric acid, as in Achlorhydria, the stomach, of course, cannot digest proteins and this digestion must be done entirely by the trypsin of the pancreatic juice. The presence of liquified protein as beef juice in the stomach, however, acts as a stimulus to the gastric juice and is an agency in again starting its flow.

The foods should be liquid, so as to pass through the stomach without irritation. Clear milk must be excluded, because of the action of the rennin in coagulating the casein. This would irritate the stomach.

Peptonized milk, described on page 245 may be used as an article of diet,—also milk with limewater, gelatin, cream, olive oil, gruels, and any foods which would pass through the stomach in a liquid state. Any cereals must exclude the bran and must be masticated to a pulp, so that they may readily pass into the small intestine.

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=Dilation of the Stomach= results from continued overeating, (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.

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=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.

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=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.

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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.

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=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.