Affections of the Digestive Organs

the hygienic system orthopathy chapter 9

AFFECTIONS OF THE MOUTH

LUDWIG'S ANGINA (Angina Ludovici)

Definition: A grave and acute phlegmonous inflammation of the tissues of the floor of the mouth and sides of the neck.

Symptoms: Painful inflammation of the floor of the mouth and neck, with difficulty in talking and swallowing, and fever, are followed by break-down and suppuration of the glands of the mouth and neck.

Etiology: It may occur in the course of various so-called "specific fevers," or it may result from traumatic injury, or it may be caused by carious processes at the roots of the teeth. It is obviously of septic (putrescent) origin.

Prognosis: Under Hygienic care practically all cases recover. Under regular care cases frequently end in abscess-formation or gangrene, and frequently lead to general septicemia.

Care of the Patient: Dr. Weger says "usually the pus must be surgically drained. It is a rather infrequent disease and the under-lying toxic state must be adequately treated." This means all causes of enervation must be corrected and all food withheld until the toxemia is eliminated.
Digestive Organs

STOMATITIS

Definition: Sore mouth, aphthae, thrush, canker stomatitis, is inflammation of the mouth and is divided into seven different kinds of stomatitis; these kinds representing degrees of severity.

Symptoms: Catarrhal stomatitis is a simple inflammation of a part or of the entire surface of the mouth. It occurs most commonly during the period of the first dentition and results from wrong feeding and uncleanliness. It may also be present in fevers, and is quite commonly present in gastro-intestinal disorders. The mouth is dry, hot and red with an Increased flow of saliva. The tongue is coated, there is constipation or diarrhea, thirst, and slight fever. Nursing is quite painful and should be omitted. The condition lasts from three or four days to a week.

Aphthous stomatitis is a little worse stage of catarrhal stomatitis. There is hyperemia (excess of blood) in the mucous membrane of the mouth, with the formation of small, yellowish-white vesicles commonly called fever-blisters. It is a self-limited affection and is caused by bad hygiene, improper feeding and lack of cleanliness.
Ulcerative stomatitis differs from the above only In that it is severe enough to produce ulceration. Ulcers may form anywhere in the mouth, but form chiefly on the gums. The gums are red and swollen and there is considerable pain. There is a profuse flow of acid, irritating and offensive saliva (salivation), a foul breath and hemorrhages from the mucous surfaces on pressure. This condition develops in scurvy and other severe types of malnutrition, and in the so-called infectious "diseases." Mercury is a potent cause, improper feeding, and uncleanliness are chief causes where mercury can be excluded.

Gangrenous stomatitis (noma, vancrum oris) is a still more severe type of the above condition and develops in greatly debilitated children and in maltreated cases of "infectious" fevers. In these cases there is gangrenous destruction of the tissues of the cheeks and perhaps also of other adjacent structures.
Gonorrheal stomatitis is a gonorrheal infection of the mouth occasionally seen in children who have been infected at birth and in adults addicted to cunnilingus.

Symptoms: The condition is marked by catarrhal inflammation and the formation of a whitish deposit on the tongue, gums and cheeks.
Cleanliness of the mouth and general care of the body are all that are required. The condition speedily clears up.

Parasitic stomatitis (Thrush) is a catarrhal inflammation of the mouth and tongue. The membrane is dotted with flake-like patches which are claimed to be due to the presence of a vegetable parasite (a mold fungi) called by such good English names as Saccharomyces albicans and oidium albicans. It is due to faulty feeding and lack of cleanliness.

Mercurial stomatitis, commonly called salivation, is inflammation of the mouth, tongue, and salivary glands, due to calomel or other forms of mercury taken internally through any channel.
Its symptoms are fetid breath, swollen and spongy gums, sore and loosened teeth, a profuse tenacious saliva, Inflammation of the membranes of the mouth, a strong metallic taste in the mouth, headache, insomnia and emaciation. Severe cases go on to ulceration of the jaw bone and the falling out of the teeth. Gangrenous stomatitis is frequently due to mercury.
Tilden says: "I began to practice my profession long enough ago to witness little children pick their own teeth out of their sloughing gums, made so by the use of calomel." He tells us that "fear of water drinking by sick people was developed in those days" and that "water was forbidden all fever patients because their systems were filled with mercury (calomel) - and when mercury is in, water must stay out if not, salivation — mercurial poisoning — takes place." All of this is the result of "curing one disease by producing another," and of the principle that "our strongest poisons are our best remedies." The destructive effects of mercury are not confined to the mouth.

Etiology: "Diseases of the mouth or any part of the gastro-intestinal tract may be looked upon as representing much more than a local condition," says Dr. Weger. "Almost invariably mouth diseases are indicative of a constitutional disturbance having its origin in the digestive tube lower down. No child or adult with a sweet stomach and healthy bowel ever developed catarrhal, aphthous, or ulcerative stomatitis. The same may be said of thrush, gangrenous, and mercurial stomatitis.
"In the latter disease we have, in addition to a disordered digestive tract a mercurial poisoning which must be considered accidental even though the drug be used for a definite purpose with -this contingency in mind."

Prognosis: Dr. Weger says: "diseases of the mouth prove to be conditions of relatively minor importance when treated rationally by withholding food for a short time and then feeding according to individual needs as determined by previous food excesses or deficiencies."

Care of the Patient: All forms of stomatitis are to be treated alike, with assurance that all cases, except perhaps many cases of the gangrenous type, will recover. Many cases of mercurial poisoning will leave the teeth permanently loosened and injured. Many cases of pyorrhea are due to mercury.
The mouth should be frequently cleansed with plain water or with diluted lemon juice. The calomel and alkaline mouth washes, boric acid and sodium salicylate, mouth washes made of salicylate of sodium or hydrogen dioxide, advised in the various stages of stomatitis should be religiously avoided, as should, also, potassium chlorate, commonly administered internally.
All, food should be withheld until the inflammation has completely subsided. In mercurial poisoning little or no water should be taken.
If there is fever or malaise, the patient should be kept in bed and made comfortable.
Follow this with a fruit diet for a few days after which, return to a normal diet. Fruit juices are the best remedies for the dyscrasia back of the sore mouth.

AFFECTIONS OF THE TONGUE

Definition: This is inflammation of the tongue.

Symptoms: Redness, swelling and painfulness with difficulty of movement of the tongue.

Etiology: Inflammation of the tongue is always associated with digestive derangements, often with such secondary conditions as pyorrhea, abscessed teeth, tonsils, sinusitis, chronic catarrh, septic bronchitis, etc. Back of all of these are enervation and toxemia.

Prognosis: Rapid recovery follows removal of the basic causes.

Care of the Patient: Local measures, mouth washes, etc., are only palliative. Attention should be directed to the removal of cause. This is comparatively easy for those who are willing to forego some of their pet table indulgencies and give proper consideration to the hygiene of the entire digestive tract. Fasting should rule until the inflammation has subsided.
LEUKOPLAKIA BUCCALIS
Definition: This is chronic glossitis marked by whitish patches on the surface.

Symptoms: There are slightly elevated, smooth, opaque, whitish plaques on the mucous membrane of the tongue and often of the mouth. There is no pain or other subjective symptoms.

Etiology: "Excessive" smoking is a common cause. It is sometimes associated with chronic affections of the skin, notably psoriasis. Digestive derangements are basic.

Complications: Epithelioma of the tongue or mouth is a not uncommon sequel.

Prognosis: This is good in the early stages.

Care of the Patient: Care must be directed toward the removal of the cause. A fast, followed by good intestinal hygiene — proper food, properly combined, eaten in moderation and under proper conditions — will result 1n recovery.
AFFECTIONS OF THE SALIVARY GLANDS
Hypersecretion of Saliva is marked by excessive flow of saliva and drooling.

Hyposecretion of Saliva is marked by a lack of saliva and dryness of the mouth.

Etiology: These conditions are never local, but are always symptomatic of conditions elsewhere in the body.
Drooling, for instance, may occur as part of the symptom-complex of Parkinson's "disease" or in other nervous affections. Dryness of the mouth may be due to emotional -or psychic conditions.

Prognosis: Recovery depends on correction of general derangements.

Care of the Patient: Dr. Weger says "a normal blood chemistry can be relied upon to effect a cure in these abnormalities which are dependent almost entirely upon conditions other than local." Blood chemistry is normalized by fasting, rest, natural food, exercise and sunshine.
AFFECTIONS OF THE PHARYNX AND TONSILS
ACUTE PHARYNGITIS

Definition: an acute catarrhal inflammation of the membrane of the pharynx, soft palate, and uvula frequently associated with tonsilitis (tonsillitis) and laryngitis.

Symptoms: Chilliness, slight fever, stiffness and tenderness of the muscles of the neck, soreness of the throat, pain upon swallowing, dryness and tickling of the throat and a hacking cough are the chief symptoms. The throat is red and the membrane swollen.

Complications: Extension of the inflammation to the larynx may cause hoarseness; to the ear through the Eustachian tube may result in deafness.

Etiology: Gastro-intestinal indigestion superimposed, upon a primary of metabolic toxemia gives rise to this catarrhal crisis. It often follows exposure to cold or to wet, and to other influences that overtax the enervated and toxemic.

Prognosis: Speedy recovery follows in all cases cared for hygienically.

Care of the Patient: These cases need rest and toxin elimination. Nothing gives more prompt results than fasting. There is no need for the antiseptic gargles commonly employed. Gargling the throat is at all times a practice based on delusion.

PHARYNGITIS — Chronic

Definition: This is a chronic "sore throat" which follows upon repeated acute crises. Chronic "disease" is due to chronic provocation.

Symptoms: Two forms are described — namely; (1) hypertrophic and (2) atrophic.
In the hypertrophic form (glandular sore throat, clergyman's sore throat, chronic follicular pharyngitis) the throat membrane is thick, swollen, traversed by dilated veins, and studded with numerous elevations which correspond to distended follicles and overgrown lymphatic tissue.
In the atrophic form (pharyngitis sicca) the membrane of the throat is pale, smooth, glossy and dry.
In both forms the voice is husky, its use is followed by distress; secretion (mucus) is increased, so that there is a constant desire to clear the throat, and there are frequent disagreeable sensations, such as fullness and tickling.

Etiology: This is an extension of chronic gastro-intestinal catarrh and indigestion and, follows upon, the heels of repeated acute crises. Irritation of the throat from overuse or wrong use of the voice, tobacco smoke, alcohol, etc., predispose the membrane to affection.

Care of the Patient: As in all other affections, the removal of the cause — toxemia and indigestion — is of primary importance. All sources of local irritation — smoking, use of the voice, mouth-breathing, irritating eructations from the stomach — must be corrected or removed. The practice of hawking and scraping to clear the throat is very irritating and should be forbidden.
Fasting, a discontinuance of all enervating practices, and the adoption of healthful habits will result in early recovery.

RETROPHARYNGEAL ABSCESS

Definition: This is a suppurative inflammation of the paryngeal lymphatics, and is often called Retropharyngeal Lymphadenitis.
Symptoms: Pain in the throat, inability to swallow (dysphagia) difficulty in breathing (dyspnea), alteration in 'the voice and a swelling projecting from the back pharyngeal wall are the chief symptoms.

Etiology: This condition develops usually as a complication of follicular tonsilitis, suppurative rhinitis, otitis media, caries of the cervical vertebrae, or one of the "specific fevers." It occurs largely in children. It is of septic origin.

Prognosis: This is good.

Care of the Patient: The abscess will usually drain spontaneously but may be surgically drained. Otherwise the care should be the same as for all other acute, suppurative processes.
TONSILLAR AFFECTIONS
ADENOIDS

Definition: this is the popular name for enlargement (hypertrophy) of the pharyngeal tonsil. Adenoids are also frequently referred to as "adenoid growths" and "adenoid vegetations."

Symptoms: Adenoids usually accompany chronic follicular tonsilitis. The membranes of the nose and throat are passively congested and thickened. Besides the enlargement of the pharyngeal tonsil, there is a concomitant swelling of the thousands of lymph nodes and nodules adjacent to the tonsil.
In young children (under fifteen) "adenoids" are frequently so much enlarged that they obstruct the nasal passage, resulting in the habit of breathing through the mouth. Due partly to the interference with oxygenation, but largely to the systemic condition that gives rise to this condition, such children are flat-chested, thin, anemic and often mentally dull. The nostrils are pinched and coughing commonly accompanies the condition. Sleep is interfered with and these children become dull, listless, and chronically tired. Frequent "attacks" of bronchitis are not uncommon concomitants.

Prognosis: The "adenoids" normally shrink in size after puberty and are seldom the seat of trouble thereafter. They rapidly shrink under Hygienic care.

TONSILITIS

Definition: This is inflammation of the tonsils and may be either acute or chronic. Any or all of the tonsils — faucial, pharyngeal, tubal, lingual and larnygeal — may be involved.

Acute Fossulitis, erroneously called Acute Tonsilitis, is inflammation of the mucous membrane which covers the outer surface of the faucial tonsils and dips down into and lines the tonsillar crypts or fossulae. This is the most common form of tonsilitis or "sore throat."

Chronic Fossulitis, or chronic follicular tonsilitis, is a persistent, low grade catarrhal inflammation. The condition is characterized by the constant presence of dirty gray or yellow plugs of "cheesy" matter hanging from the fossulae. When these are thrown out they have a foul taste and a foul odor.

Hypertrophy of the Tonsils: This is the term applied to enlarged (as distinguished from) large tonsils. It accompanies chronic catarrh of the throat.

The Lingual Tonsil (the tongue tonsil) seems to be inflamed less commonly than the faucial, and pharyngeal tonsils, though this may occur more often than is generally supposed. When it becomes in-flamed the whole base of the tongue sometimes becomes inflamed also. The tongue becomes tender on pressure and both talking and swallowing become difficult. Breathing may even be affected.

The Tubal Tonsils often become enlarged and inflamed. This is usually accompanied with the swelling of the thousands of nodes and nodules in the immediate neighborhood, and also by a passive, non-inflammatory swelling of the mucous membrane lining the cavity back of the nose and this may, in turn, partly close the Eustachian tube resulting in catarrhal deafness. This catarrh may even extend up into the Eustachian tube and into the middle ear. Most such cases are remediable by the plan of care later to be described.

Symptoms: Acute fossulitis (follicular tonsilitis) usually sets in suddenly with a rapid rise of temperature which may range from 101 F. to as high as 104 F. The throat is sore, hot, dry, scratchy and swallowing is difficult. The tongue is coated and the breath foul. The tonsils enlarge, the surrounding tissues become congested and inflamed, the glands under the jaw and down on to the throat become swollen and sore. One or more gray or yellow spots or patches form on one or both tonsils. These spots are composed of a cheesy matter in the crypts or fossulae. They are not composed of pus. Headache, backache, etc. may be present.

Quincy presents these same symptoms, often aggravated, plus the formation of the abscess.
Inflammations and enlargements of the various tonsils are usually associated with other conditions of the mouth, nose and throat, such as catarrh, colds, sinus inflammation, inflammation in the antrum and posterior nares, abscessed teeth, etc.

Etiology: These troubles develop in children and adults who suffer with gastro-intestinal indigestion and who habitually overeat on milk, bread, cereals, and other starches, sugar, cakes, pies, preserves, syrups, pancakes, candies, ice-cream and the like. Add these factors to faulty elimination and such persons will develop trouble every time a drop in temperature, an unusual exposure, or an environmental stress places a heavier tax upon their nervous energies and, thus, puts an added check to elimination. "Adenoids" are less frequent in the breast-fed than in bottle-fed infants. Cereals with milk and sugar, fruits with starches and sugar; frequent between-meal eating — these will cause enough digestive derangement to produce tonsilitis.
A primary catarrhal condition, due to toxic saturation, is always in evidence preceding tonsillar troubles. Recurrent acute crises of catarrhal laryngitis, pharyngitis, or tonsilitis eventually lead to a depraved or weakened state of the mucous membranes and to chronicity. Scrofulous children, who are constantly in ill health, merging from one septic state to another, have frequent or continuous tonsillar trouble.

Care of the Patient: In acute tonsilitis, quincy, etc., no food should be taken until all acute symptoms are gone, after which a fruit diet should be fed for from three to five days. If the condition is chronic a fast or a diet of juice may be employed until the throat is clean and breathing is free and easy. Thereafter a fruit diet or fruit and vegetable diet should be fed until the tonsils are normal, after which moderate quantities of proteins and starches should be added to the diet. In enlarged (hypertrophied) tonsils the fast is sufficient to reduce the tonsils to normal. Care should be exercised not to attempt to reduce normally large tonsils.

QUINCY

Definition: Erroneously called abscessed tonsil, but really a peri-tonsillar abscess, quincy is an abscess which forms in the tissues surrounding (usually above) the faucials. This may form on one or both sides of the throat.

Symptoms: Quincy begins as common "tonsilitis" or acute or chronic fossulitis and, due to improper care, or to overwhelming of the lymph glands, extends to adjacent and underlying tissues and nodes and nodules, culminating in abscess formation. The abscess usually ruptures into the throat. Thus, these "two diseases" are really one.

Care of the Patient: Surgical removal of the tonsils is the present vogue. It removes affected organs, not the cause of the affection. Dr. Harry Clements, of England, an esteemed friend of the author, remarks in his Children's Ailments: "When parents and guardians become enlightened as to the proper function of the tonsils, they will not turn to surgeons for help, they will turn on themselves with reproach." Rare cases require to be lanced, most cases rupture spontaneously and drain. Care should be the same as for acute tonsilitis.
AFFECTIONS OF THE ESOPHAGUS
CANCER OF THE ESOPHAGUS

Cancer may develop in the esophagus, as elsewhere in the body. Its chief local symptom is obstruction so that swallowing is interfered with or prevented altogether. Dr. Weger says: "Cancer of the esophagus is invariably fatal and requires palliation before the end." Prevention is possible only by right living. See "Cancer" in this volume.

ESOPHAGITIS

Definition: This is a catarrhal inflammation of the esophagus which accompanies catarrh of the throat or of the stomach. It represents merely an extension of catarrh from these other parts and requires no care other than that given for pharyngitis or gastritis.

STENOSIS OF THE ESOPHAGUS

Definition: This is obstruction of the esophagus and is divided into two general forms, as follow:

Esophagismus (spasm of the esophagus) is seen in hysteria and chorea, or it may be due to the irritation of a fissure, or an ulcer. It is often seen alone in neuropathic subjects.

Symptoms: These are difficulty in swallowing which is often paroxysmal or periodic, regurgitation of food, and in a few cases discomfort or actual pain while eating. Dilatation of the esophagus may develop as a result.

Care of the Patient: These cases represent nervous troubles and should be cared for as described under the care of nervous troubles.

Organic Obstruction: Stenosis of the esophagus may result from (1) external pressure produced by a tumor, an enlarged gland, an aneurysm, etc., or (2) by cicatrization (scar formation) of an ulcer produced by corrosive acids or alkalis; or (3) by cancer of the esophageal wall.

Symptoms: Slowly increasing difficulty in swallowing with regurgitation of food, is the chief symptom. The esophagus is often much dilated above the point of obstruction so that food may collect in the pouch thus formed. .

Care of the Patient: Constitutional care to remedy the local catarrhal condition, reduce the enlarged gland and the aneurysm, consists of rest, fasting and a strict dietetic regimen. Locally, stretching (dilatation) of the esophagus may be essential. If the tumor cannot be autolyzed it should be removed surgically.
AFFECTIONS OF THE STOMACH
ATONY OF THE STOMACH

Definition: Also, known as motor insufficiency and myasthenia gastrica, this, condition consists in relaxation of the muscular coat, of the stomach and a lack of its propulsive powers.

Symptoms: As a rule there is neither vomiting nor pain and the sufferer considers himself to he otherwise in good health. He has a good appetite and may habitually overeat. In simple atony a sense of fullness and discomfort after eating, especially if the meal has been large, and frequent belching of gas are the chief symptoms. The severity of the symptoms is often proportioned to the quantity of food taken. Fluids are as likely to cause discomfort as solids. The symptoms cease when the stomach empties itself.
An exact diagnosis can be made only by an examination of the stomach contents.

Complications: Atony frequently leads to gastrectasis. Where there is also atony of the intestines, there is likely to be marked nervous symptoms — headaches, vertigo, and paresthesia — and considerable disturbance of nutrition.

Etiology: Motor insufficiency represents marked enervation of the stomach and may follow upon any profound enervating influence. It often appears in acute form after intense emotional excitement or traumatism. It may follow severe fevers, or accompany adynamic biogonies in which there is much malnutrition. It is often seen in neurasthenics. Intemperance in eating and drinking is a frequent cause. The use of tobacco causes a relaxation of the stomach. It may exist as a complication of gastroptosis, chronic gastritis, nervous dyspepsia, and hypersecretion. In a few cases it seems to be congenital.

Prognosis: This is good in all cases if the patient will follow instructions.

Care of the Patient: Nothing so quickly restores normal tonicity of the stomach as rest. A fast, therefore, is essential in all these cases. Equally important is the correction of all emotional and physical habits that produce enervation. Overeating, drinking, smoking, etc., must be discontinued. The diet must be radically changed. Natural foods should be substituted for the conventional diet of denatured foods. A general health-building regimen of exercise, plenty of rest and sleep, sun baths, etc., should tone up the whole system, for gastric atonicity is only part of a general lowering of tone.

GASTRECTASIS

Definition: This is dilatation of the stomach. It is not a common condition.

Symptoms: The condition is characterized by nausea and vomiting, which may come on suddenly, surprising the patient by the amount of vomitus ejected. The large amount is due to an accumulation, of material in the stomach. Perhaps the only conclusive evidence of dilatation, except that of X-ray picture, is that found by the doctor upon examination revealed by a splashing of the fluids or contents of the stomach.

Etiology: True dilatation is a chronic condition resulting from years of irritation from overeating, wrong eating, drugs, condiments, etc. The irritation causes a hardening of the tissues and ulceration, producing a strictured condition of the pyloris. In some cases the pyloric obstruction is due to cancer.

Prognosis: Dr. Weger says: "Gastric dilatation almost invariably recovers by proper treatment." This can refer only to those cases not resulting from pyloric cancer.

Care of the Patient: It is first necessary to stop all food until the thickening, irritation and inflammation of the pyloris is removed. This will restore the opening into the duodenum. All enervating habits must be discontinued and correct feeding adhered to after the fast. If the pyloric obstruction is due to cicatrical stenosis or to cancer, the above measures will not remedy the dilatation. Surgery may be of value in these later cases.

GASTRIC ULCER

Definition: A circumscribed loss of tissue in the stomach, usually involving both the mucous membrane and the deeper structures. An ulcer differs from a wound in the following ways: A wound arises from some external source; an ulcer has its cause within the body. A wound is always idiopathic; an ulcer is always symptomatic. The tendency of the wound is to heal because its cause is removed: the cause acted but momentarily. An ulcer persists and often enlarges, because its cause persists and often increases. The healing of an ulcer therefore depends primarily upon the removal and correction of the internal condition of which it is but a symptom. This done, the ulcer quickly heals.

Symptoms: Pain, usually paroxysmal, severe and localized, though it may radiate to the back or sides, is usually present. In many cases taking food induces or aggravates the pain and this lasts until the stomach is emptied, either by vomiting or by emptying into the intestine. Localized tenderness is often felt. Vomiting, usually of undigested food and acid fluid, which is quite frequent, usually comes on from one-half hour to two hours after eating. Hemorrhage into the stomach with vomiting of blood occurs in more than half the cases and, is said to cause death in about twenty per cent of all fatal cases of ulcer. There is an excessive secretion of hydrochloric acid (hyperacidity). Symptoms of indigestion (dyspepsia) precede most cases, though in some cases there are few symptoms until sudden perforation into the peritoneum, pleura, pericardium, or intestine, with hemorrhage, occurs.

Complications: Perforation occurs in from 8 to 10 per cent of cases. General or circumscribed peritonitis results from perforation. The peritonitis is a conservative process resulting in adhesions and walling up of the perforation. Sub-phrenic abscess sometimes follows the formation of adhesions. Stenosis, either of the cardiac or pyloric orifices, or hour-glass constriction of the stomach may result from contraction of the cicatrices — scars. About 20 per cent of ulcers become malignant — cancerous.

Etiology: As gastric catarrh evolves, the catarrh passes to inflammation, from inflammation to induration (hardening), and from induration to ulceration. Stomach ulcer is the end of a chain of stomach disorders beginning with irritation — indigestion from imprudent eating or drinking — which, when very severe, or oft repeated causes inflammation (catarrh); and when the abuse of the stomach is continued, ulceration follows, or induration (hardening), then cancer.
Decidedly nervous individuals who consume much starch — bread, cake and pastry — are more inclined to develop ulcer. Where there is a decided acidity of the secretion, inflammation and ulceration are almost sure to develop. Discomfort and often great pain accompany this condition.
It is not uncommon to see a patient whose stomach is so sour that, on drinking water and vomiting, the returned water and diluted — acid are strong enough to sear the throat and paralyze the epiglottis so it can not close, and an attempt to drink water will cause the water to run into the nose. Even gases eructated from such a stomach burn the membranes of the nose and throat.

Prognosis: This is very favorable in all early cases. Many persist for years, then recover. Relapses, so common under regular care, are due to failure to remove causes. Advanced cases, in the profoundly enervated may end fatally in spite of the best of care.

Care of the Patient: The palliative treatments in vogue are so unsatisfactory that a noted American surgeon recommends that ulcers be removed after they have been cured nine times. As in all other troubles, the first necessity is the removal of the causes — immediate and remote — of the trouble. All enervating habits must be discontinued and sufficient rest in bed secured to permit of restoration of full nerve energy. A fast, both to hasten elimination of toxemia and to give the stomach an opportunity to heal, is essential. Chronic provocation by food, indigestion and drugs prevent healing. Food also keeps up the excessive gastric secretion. Fasting soon stops gastric secretion so that, while it often increases the pain during the first two or three days, it speedily establishes a state of comfort so that satisfactory healing may proceed. The fast should last until the body is free of toxemia.
Feeding after the fast should be, in most particulars, exactly opposite to the feeding commonly employed in cases of ulcer. Instead of the highly acid-forming diet in vogue, an alkaline diet should be employed. Fruits and vegetables, and these raw, should make up the bulk of the diet. If, at first, there is sensitiveness to the roughage in these foods, raw juices of the fruits and vegetables, and purees and strained vegetable soups may be used. Cooked fruits are never to be used.
Every health building agent — sunshine, exercise, etc. — should he employed as early as possible.
Operations are notoriously unsatisfactory in ulcers. First, the operation does not remove the cause of the ulcer. Second, the ulcer is in a field of inflammation in the mucous membrane, which inflammatory field may be quite limited or may involve much of the gastric mucosa, and an operation will remove the ulcer, but there is always quite an area of inflamed mucous membrane left after the ulcer is removed and this inflamed membrane tends to ulcerate. Two, three, four, five and even more operations are performed for the removal of ulcers, as these persist in developing. There is nothing to restore an inflamed mucous membrane to health when the causes of the inflammation are left operative.

GASTRORRHAGIA

Definition: This is hemorrhage from the stomach (hematemesis).

Symptoms: Vomiting of blood and loss of blood through the bowels is the characteristic symptom. The amount of blood lost varies considerably. Rarely there is loss of a quart or more. The blood is usually dark, is often mixed with food, has an acid reaction, and may be fluid or clotted. Acute anemia may develop if the hemorrhage is severe, producing such symptoms as pallor, weakness, vertigo, ringing in the ears, dimness of sight, syncope, and convulsions.

Etiology: Hematemesis is a symptom rather than an affection and may result from (1) traumatism, (2) gastric ulcer or erosion, (3) gastric cancer, (4) acute gastritis, (5) obstruction of the gastric vessels by an embolism, (6) rupture of an aneurysm, (7) blood dyscrasia, as in scurvy, purpura, grave anemia, etc., (8) venous engorgement of the stomach consequent upon enlargement of the spleen, or hardening of the liver. Sometimes it is seen in hysteria and what is falsely called "vicarious menstruation." Swallowing of blood from the nose, mouth or throat is not a gastric hemorrhage, this is commonly listed as a cause of hematemesis.

Prognosis: Hemorrhage from the stomach is rarely great enough to cause death and recovery depends upon recovery from the causative pathology. The most dangerous hemorrhages result from cirrhosis of the liver, aneurysm and splenomegaly.

Care of the Patient: Immediately rest in bed and absolute quiet, without food until the hemorrhage has ceased, are essential. Food, thereafter should be liquid and non-irritating, until the stomach is again able to take regular food. Care for the causitive pathology as instructed under their various heads — cancer, ulcer, aneurysm, etc., etc.
AFFECTIONS OF THE INTESTINES
APPENDICITIS

Definition: This is an acute inflammation of the appendix vermiformis, a worm-shaped process of the cecum. It is part of typhilitis (inflammation of the cecum) or perityphilitis (inflammation of the investing membrane of the cecum) and never exists alone.

Symptoms: Sudden pain, often generalized at first, but later most marked in the right side, with circumscribed tenderness, most frequently felt over McBurney's point midway on a line between the navel and the anterior superior iliac spine, mark the beginning of the affection. The abdomen is tense and the right thigh drawn up. There is fever ranging from 100 to 103 F. Nausea, vomiting and constipation, rarely diarrhea, are seen.

Complications: Bowel obstruction and peritonitis, due to rupture of the appendicular abscess into the abdominal cavity, are the chief complications. There is likely to be much scar tissue and adhesions left. Rupture of the abscess into the peritoneal cavity has three sets of causes (1) the use of morphine, (2) the use of the ice-bag (3) deep digging into the abdomen by physician and surgeon in making the diagnosis. The first two of these prevent formation of the protective wall nature throws around the evolving abscess; the last breaks down the wall after it is formed.

Chronic Appendicitis: This either does not exist or is so rare surgeons never see a case. Cases operated on for chronic appendicitis prove to he colitis, or neuritis, or neuralgia, or gall stones, or kidney stones, or cystitis, or ovaritis, or metritis, or pregnancy, or a rotated innominate, or other such conditions.

Etiology: Colitis, putrefaction and constipation precede and lead up to the development of every case of appendicitis. It is impossible to imagine a perfectly healthy cecum with a diseased appendix. There is first enervation and toxemia with its consequent gastro-intestinal catarrh. Then much gastro-intestinal decomposition infects the cecum and appendix setting up severe inflammation with possible abscess formation. There is no appendicitis without habitual intestinal indigestion, and this habit is built and continued by overeating, and wrong food preparation.

Prognosis: This is good if hygienic measures are instituted at the outset.

Care of the Patient: Tilden says, "The treatment for appendicitis amounts to a wise letting alone." The patient should be put to bed and a hot water bottle placed at the feet. No food but water should be allowed. If food of any kind is given vomiting will occur and intense pain will follow almost immediately. If food is not taken the patient will soon become comfortable. Anyone who feeds, even a little, in appendicitis will not have the success we do. When we say "do not feed," we do not mean to give the patient a little fruit juice, or an occasional sip of milk, or a little taste of ice-cream, or little lumps of ice to cool the stomach. Little driblet meals are enough to work havoc.
Cathartics and laxatives induce forceful peristalsis and keep the inflamed part of the colon in agony. Their use is now condemned, even by the medical profession. The violent peristalsis induced by laxatives is likely to cause perforation of the abscessed bowel. In appendicitis, with abscess, the bowel movements are cut off from above by abscess pressure and the muscle fixation that nature provides to protect the parts and prevent rupture taking place in any direction except into the bowels; hence no attempt should be made to move the bowels. Page says: "Never do I badger the bowels, either by physic or enema, since this sort of thing tends to increase inflammation. The bowels will take care of themselves in due time I find."
If pain is intense a hot towel may be placed on the abdomen over the region of pain, but no drugs or ice bag should be resorted to. The ice bag hastens the development of gangrene.
Do not dig into the patient's belly with your fingers, nor allow other doctors to do the same to confirm the diagnosis. If we can get these cases before the examiners have done irreparable damage by their barbarous and unscientific digging into the belly on the pretext of diagnosing the "disease," we do not have any trouble in caring for them.
The tendency of the abscess is to rupture into the colon and the pus passes out in the stools. When nature opens the appendicular abscess she does so in a way to favor drainage into the gut; whereas operation provides for drainage against gravity. In rare cases it ruptures into the bladder. Tilden says: "Nearly every case of rupture of the appendiceal abscess (into the abdominal cavity) has been 'brought about by the surgeon in his zeal to diagnose the disease and determine if the usual tumor-like development — pus sac — can be found."
Dr. Richard C. Cabot, of Harvard, says: "People who cannot get operated on at once for acute appendicitis may get through by starving themselves in the attack." A doctor who is capable of piloting a case of appendicitis to a successful natural cure should be able to teach the recovered patient how to prevent a recurrence.

CONSTIPATION

Definition: Constipation is sluggish action of the bowels — intestinal stasis — infrequent or difficult evacuation of the feces.

Symptoms: Difficult and infrequent bowel movement, hard, usually foul, stools, gas and occasionally pain or discomfort in the abdomen are the characteristic symptoms of constipation. Sometimes nausea is present. Headaches and other symptoms attributed to constipation are due to other causes. Toxemia antedates constipation and is not caused by constipation. Two general types of constipation are described as follows:

Spastic Constipation, in which the stools are likely to be small, hard, round balls. In this form there is a spastic condition of the muscles of the colon.

Flaccid Constipation, in which there is a loss of tone (flaccidity) in the walls of the colon.

Etiology: Dr. Page says "In common life, it is rare indeed that constipation is the result of a deficient diet, although it often arises from lack of nourishment consequent upon excess, or an unwholesome variety of food, or both. Usually it may be regarded as the 'reaction' from over-action. The not uncommon experience, in regular order, is this: excess in diet, diarrhea, constipation, physic or enema, purgation, worse constipation, more physic and so on. The term reaction here means simply that the organs involved having been irritated by undigested food, and having by means of increased action cleared away the obstruction, now seek restoration by the most natural method, as the name itself implies — rest. What are commonly called diseases are in reality cures; and the common practice with drug doctors, of controlling the symptoms is like answering the cries of a drowning man with a knock on the head." — The Natural Cure, p. 112.
"Passing Enervation and Toxemia which are basic causes and omnipresent where there is any departure from the normal health standard, overfeeding is first, last and all the time the cause of constipation in children," says Dr. Tilden. Overfeeding is followed by imperfect digestion, flatulency, bowel discomfort, loose movements with curds in the stools. The amount of the curds increases as the digestive impairment becomes greater and, finally, the stools may become hard, dry anti even lumpy. Children that are properly, cared for and properly fed never have constipation.

Care of the Patient: Constipation will end when nerve energy is restored and the causes of enervation are removed. We should keep in mind that it is good health that insures daily movements and not daily movements that insure good health.
There should be no resort to laxative, cathartic or purgative drugs; to force bowel movement. As Tilden puts it: "Nature cleans out the bowels in her own way when she is ready — indeed she often cleans them out with such force and vigor that the human doctoring habit decides they must be checked. If checked it may mean death. Why, then, not be patient when the bowels are not inclined to move of their own volition?"
Physic may produce enough irritation of the bowels to produce a copious outpouring of fluid and vigorous action in expelling the feces and the drug, but this same irritating effect inhibits elimination proper. This is the opposite of what is intended. Irritant drugs further enervate, oppose excretion, and make the constipation worse. Forcing the bowels to move voids what is in the bowels, but it does not secure elimination.
Does the drug cure constipation? No. The supposed beneficial effects of purgatives and laxatives, whether mild or violent, do not extend beyond the period of excitation; after which the whole digestive tract lapses into its previous inertia. Nothing worth considering has been gained. The hysterical and impatient grab a pill or a bottle as soon as their bowels fail to act, and give them the lash. The drugs, being powerful irritants, occasion rapid, forceful contractions of the muscles of the stomach, intestines and colon, and the pouring out of large quantities of secretions to wash away the irritant drug. The dupes of such practices secure the bowel action they desire, but at a frightful cost. There is now greater need for rest than before the drug was taken. There is now less of the normal lubricants of the intestine and bowel than before. There must, of necessity, be a longer period of rest following such violent activity. But the rest is not allowed. Another dose of the drug is taken, resulting in another period of over-work, necessitating more rest. This process keeps up until chronic constipation results and, if it goes on, permanent weakness, and ultimately, atrophy of the muscles and glands of these organs, with a thickening and hardening of their lining membranes and derangement of secretion.
Dr. Page truly says: "Next to the mistake of resorting to drugs in these cases, is the quite common one of swallowing special kinds of food for the same purpose, and there is some question as to which of the two evils is the least. An excessive quantity of rye mush, wheaten grits, or oat groats, with a generous dressing of butter, syrup, milk or honey to wash it down in abnormal haste, will often purge the bowels like the most drastic poison." — The Natural Cure, p. 114.
To many doctors and dietitians, the main object of diet seems to be to prepare foods or food mixtures that will increase peristalsis.
This is a misuse of food. It is not the function of the digestive tract to be constantly filling up and emptying out again. The purpose of food is to nourish the body. Overworking the bowels with olive oil, wheat bran, agar agar, psyllium seed, and other bulky and roughage articles of diet robs the organism of part of its nerve energy.
Feeding bulk and roughage secures movement on the well-known principle of the hay bailer — that of pushing one bale of hay out with the one behind. Dietitians push one meal out with the next.
It is well known that the effects of all laxative and cathartic drugs "wear out." The size of the dose must frequently be increased and the drug must occasionally be exchanged for a different one. But it is not generally understood that the laxative foods also "wear out." One must eat more and more of them; even then they will finally cease to occasion action. Eating quantities of "roughage" or "bulk" will not cure constipation. Of more importance than the thing to be moved (the bulk) is the motive power — the power of movement.
Tired (constipated) bowels need rest, not work; more nerve energy, not more expenditure; better nutrition, not more bulk. Enemas, colonic irrigations, rectal dilators, etc., are every bit as evil in their effects as drugs and roughage and they have no more effect in removing cause than these other things. The same is true of mineral oils.
The chief cause of chronic constipation is the constipation cures. Nobody ever gets free of this functional failing so long as these are employed.
Digestive Organs
DUODENAL ULCER
Definition: This is an ulcer of the duodenum. The term peptic ulcer is given to ulcers of the esophagus, stomach and duodenum — surfaces that come in contact with the gastric juice.

Etiology: As intestinal catarrh evolves, the catarrh of the duodenum passes to inflammation, and from inflammation to ulceration. The cause of duodenal ulcer is the same as that of gastric ulcer.

Complications: See gastric ulcer.

Prognosis: See gastric ulcer.

Care of the Patient: Care for the patient as described for gastric ulcer.
FISTULA — Anal
Definition: A fistula near the anus which may or may not communicate with the rectum. A fistula is a deep sinus ulcer, often leading to an internal or hollow organ.

Symptoms: Pain, especially upon bowel movement, in the rectum, inflammation, pus and the presence of the fistula are the leading symptoms. One or more fistulas may be present.

Etiology: Fistulas develop from abscesses that form as a result of inflammation. They are seen chiefly in colitis (proctitis) and hemorrhoids.

Prognosis: This is usually good.

Care of the Patient: Fistulas heal when the underlying toxemia is removed. Fasting and rest and a corrected mode of living constitute the requirements.
INTESTINAL COLIC (Enteralgia)
Definition: This is intestinal pain of a spasmodic character. It is also called Tormina.

Symptoms: The outstanding symptom is paroxysmal pain of a cramp-like character which centers around the navel and is relieved by pressure. The abdomen is usually distended. Severe colic may lead to collapse, indicated by vomiting, feeble pulse, pinched features and cold sweats. The paroxysms last from a few minutes to several hours and usually end by a discharge of gas.

Etiology: Overeating, profuse water drinking, irritating food, and fecal accumulations are the chief causes. Any cause of indigestion and gas accumulation may bring on colic. Coffee drinking will do it in some. Colic is also seen in enteritis, dysentery, appendicitis, intestinal obstruction, lead poisoning, locomotor ataxia and as a reflex from pathology in the ovaries, uterus, liver, vertebrae, etc.

Care of the Patient: All that is needed is abstinence from food until the crisis is well passed and proper eating thereafter. If the colic is due to gas, it is possible to hasten the expulsion of the gas by massage of the abdomen.

Colic in Infants and Children: This is a very common complaint in overfed children and causes anxious parents to walk the floor night after night.

Symptoms: The symptoms of colic are pain, flatulence, expulsion of gas, diarrhea, or constipation, green or curdy stools, eructations and perhaps vomiting.
Drawing up the legs when crying is not an evidence of colic in babies. Most babies draw up their legs when they cry from whatever cause and one that is crying vigorously will always draw up the legs and arms.
Have you ever watched the tossing and listened to the agonizing cries of the baby with colic? Have you ever watched anxious parents walk the floor nearly all night with such a baby in their vain efforts to stop its crying? If you have, you know that colic is no laughing matter — at least, not with the child and its parents. Dr. Page says:
"When a vast audience is convulsed with laughter over Mark Twain's witty description of the experiences of parents with colicky babies, it may be well for them to forget, for the moment, the thousands of little audiences of two, or three, or four, gathered about the death-beds of emaciated little ones dying in convulsions, not of laughter, and that provoke no laughter, either on earth or in heaven. More than eight hundred such audiences in one city, in a single week, who can force even a smile to their wan countenances, except it be, perchance, a smile of resignation to what seems to be a token of the chastening, though loving hand of God."

Etiology: Besides over feeding (the most common cause), colic may be induced by getting cold or over-heated or by any other influence that deranges digestion. Babies that are fed properly, kept dry and warm and not handled too much and not over-heated do not have colic.
It was and is yet to some extent, the custom to cram babies full of milk every two hours and feed them every time they cried between feeding times, and keep them purging and puking, until they finally became constipated, after which they would writhe and shriek with colicky pains. Then mother or nurse or even father would wrap them in hot clothes turn them on their little bellies across the attendant's knees and try to jounce the wind out of them. Paregoric, castoria, cathartics and other forms of drugging are frequently resorted to.
Tilden says: "Feeding starchy foods before the completion of the second year is the cause of stomach derangements. The sugar that is put into cereal foods causes children to fatten; the fermentation from starch and sugar fills the bowels with gas, and is one of the causes of pain in the abdomen, restless nights, the bed-wetting habit, and, in the nervous temperament, chorea or St. Vitus dance; and, neither last nor least, constipation."

Care of the Patient: The remedy for colic is: stop all feeding until comfort has, returned. Thereafter feed and care for the child properly. Relief can usually be induced by resting the infant on its abdomen.
PTOMAINE POISONING (Botulism)
Definition: Poisoning by an alkaloid or basic product of putrefaction — ptomaine. It is now customary to deny the reality of ptomaine poisoning and to blame germs for the "disease."

Symptoms: These usually start with a feeling of languor, perhaps headache, aching all over, and vomiting. Griping pains in the bowels are sometimes present, at other times there is a real cholera morbus. In some cases there is trembling almost equal to that of ague. There may be difficult breathing, a feeling of faintness and oppression over the stomach area. There are a coated tongue, foul breath, lack of desire for food, prostration and fever.

Etiology: Poisoning may result from taking decomposing food into the body or from decomposition of good food after it is taken in. It results from decomposition of animal foods.
Though ptomaine poisoning is commonly thought to be due to eating spoiled foods, the very best foods, if eaten too rapidly, or badly combined, or in too great quantities, or by one who is fatigued, or when overwrought emotionally, or greatly enervated from eroticism or any form of sensualism, are liable to decompose and produce ptomaine poisoning. It not infrequently happens that when wholesale poisoning follows a banquet, analysis of the food served fails to show anything wrong with the food. In all cases, only part of the eaters are poisoned. In such cases, the wrong food is examined. The spoiling of the food occurs after it is eaten. Autogenerated botulism (intestinal sepsis) is common, but is named something else. A large percentage eat too much, eat wrong combinations and eat when they should not. The resulting food poisoning passes unidentified. Tilden says: "Right combinations, and quantity within digestive limitations, are always safe, even if the food should be tainted. Much tainted food is eaten daily without poisoning; or the poisoning is so slight that it is not thought of. A cold, a slight sore throat, or a diarrhea may be the only inconvenience, and these will not show up except in the toxemic."

Meat Poisoning results from eating spoiled meats, or from decomposition of meat after it is eaten. Sausages, blood-pudding, "ripened" poultry, canned meats, etc., and especially imported sausages, are likely to produce ptomaine poisoning. Imported sausage has been known to produce death after lying in the bowels for a week after it was eaten. As a rule the poisoning comes on rapidly.

Ice Cream Poisoning: This occurs frequently during the summer months when large quantities of ice-cream are consumed. It is milder than meat poisoning — nausea and vomiting, preceded by a chill, and sometimes diarrhea, are its chief symptoms.

Prognosis: Some cases of ptomaine poisoning are so virulent that the patient dies in a few hours. Most cases will recover if given proper care.

Care of the Patient: If the stomach does not empty itself by vomiting, the stomach pump should be used to empty it. The patient must be kept warm and no food allowed until the symptoms have entirely disappeared. Food given too soon sets up more poisoning, and a relapse, possibly with death, will follow. Or, some vulnerable organ will become chronically impaired. Tilden says, "if feeding is begun as soon as the patient is relieved, the symptoms may lead off into chronic gastro-intestinal disease, which may break down the constitution to such an extent that the patient will die in a year or two."
We have found no need for enemas and other means of "cleansing" the bowels. Discussing a case of ptomaine poisoning in a woman, Tilden says: "attempts at clearing the bowels had been very unsatisfactory until the seventh day; then the movement came because secretions were reestablished."
AFFECTIONS OF THE LIVER
ABSCESS OF THE LIVER
Symptoms: Locally there is usually severe pain in the liver region and right shoulder. A circumscribed bulge may sometimes be seen below the ribs, though the enlargement of the liver is more often upward than downward. The liver is tender. Slight jaundice sometimes develops but is often absent. Constitutionally, chills, remittent or irregular fever, profuse sweating, marked anemia, and leukocytosis result from sepsis. Rupture into the lung is characterized by severe coughing and the expectoration of large amounts of pus, often of chocolate color, often mixed with blood. In some cases the condition runs a latent course and perforation offers the first symptom.

Complications: Perforation into the lung, peritoneum, stomach, pleura, pericardium or vena-cava, intestine, or externally, may occur.

Etiology: This affection is rare in the United States, as it is seen chiefly in the tropics. It may result from traumatic injury, embolism, or pyemia, the pus being brought to the liver from abscesses elsewhere in the body. Parasites are supposed to pass from the intestine through the gall duct to the liver and cause some cases, while stones give rise to other cases. Probably many cases evolve out of the extension of gastro-intestinal catarrh to the liver. In all cases enervation and toxemia brought on by wrong life, are primary.

Prognosis: Death results from septic poisoning, or from perforation into the lung, peritoneum, stomach, pleura, pericardium, or vena cava. Recovery may follow spontaneous rupture into the stomach, bowels, lungs or externally. Recovery also sometimes follows surgical drainage. Dr. Tilden says he has seen cases discharge "pus through the lungs for fifteen years before they died of pyemia or some other disease induced by pus poisoning."

Care of the Patient: "While it is an up-hill affair," says Tilden, "and takes years, yet, if the patient is not too old when the disease takes hold of him, he may live to see the end of it." We have found that physical, mental and physiological rest bring great relief in these cases, while nothing but benefit comes from efforts to relieve the body of the ever-present encumberance of toxemia. Aside from this, "diet and surgery are the only treatment."

AMYLOID LIVER (Waxy Liver)

Definition: This condition, also, called lardaceous liver, is an enlargement of the liver due to the deposition therein of a peculiar albuminoid substance.

Symptoms: The chief symptoms obvious to the layman are pronounced anemia and emaciation. Jaundice and ascites are rare. The examiner finds the liver to be uniformly enlarged, smooth, firm and pointless, with a rounded edge. The spleen and kidneys almost always share in the degeneration, so that the spleen is enlarged and hard and the urine contains albumen and tube-casts.

Etiology: This condition develops as a complication of some prolonged suppurative process, especially that resulting from tuberculosis, and involving the bones. It is sometimes seen in malarial cachexia.

Prognosis: Recovery depends upon recovery from the suppurative process or the malaria. Recoveries are not frequent.

Care of the Patient: Primary attention must be given to remedying the primary pathology — see tuberculosis, and malaria.
CIRRHOSIS OF THE LIVER
Definition: This is hardening of the liver due to an increase and thickening of its connective tissue. Several forms are described as: atrophic cirrhosis, which is hardening with wasting of the liver; hyper-trophic cirrhosis, which is hardening with enlargement of the liver; alcoholic cirrhosis, which is hardening caused by alcohol; capsular cirrhosis (chronic perhepatitis), which is hardening of the investing membrane of the liver; "syphilitic" cirrhosis, which is hardening accompanied by the formation of gummata, or little tumor-like masses attributed to "syphilis."

Symptoms: Medical authorities tell us that this, like many other pathologies of the liver often reaches full development without presenting many symptoms; but it is the Hygienic position that the premonitory or primary symptoms have been present for years but have been ignored or unnoticed. For years there have been furred tongue, irregular bowels, occasional vomiting of mucus, gastritis with symptoms of indigestion, engorgement of the blood vessels in the region of the stomach and liver, even hemorrhage from the stomach and esophagus. How can one drink alcoholics for years, or use pepper (which hardens the liver quicker than alcohol) for years without showing symptoms of irritation of the stomach and tumefaction of the liver? Years of over eating of starch, sugar and fat also help to build cirrhosis of the liver and. this form of imprudence always presents symptoms for years before the hardening develops.

Complications: Ascites, general dropsy, hemorrhages into the skin and mucous membranes, hematamesis, enlargement of the superficial abdominal veins, with such symptoms of "hepatic intoxication" as delirium and coma, are common in advanced stages of cirrhosis.

Prognosis: Perhaps all cases end fatally, in one way or another, but the course of the affection may run from five to ten years.

Care of the Patient: Tilden says: "There is not much to be done. Patients may be tapped and water taken off, which will give relief for a short time; but the water certainly will return. The time for curing the case has passed, perhaps many years ago. When the liver is so organically disorganized and the auxiliary organs of the body are so deranged as in these cases, there is nothing to be done, except whatever palliation may be required to give the patient temporary relief." It is obvious he is talking of the late stages of the pathology. It is fortunate, to quote Weger that "if the entire organ is not involved in the degenerative process, fairly satisfactory function may be maintained in that part not broken down. Right living stays the process of degeneration and comparative comfort and longer life may be anticipated by those who recognize and respect their food and other limitations," who give up alcoholics, pepper, etc.
AFFECTIONS OF THE BILE PASSAGES AND GALL-DUCT
CHOLANGITIS

Definition: This is inflammation of the bile ducts. Two forms are described as follow:

Catarrhal Cholangitis (catarrh of the bile duct, catarrhal jaundice) may be either acute or chronic.

Symptoms: Acute. Symptoms of gastro-intestinal catarrh —coated tongue, foul breath, loss of appetite, pain in the stomach region, vomiting, perhaps diarrhea — usually precede symptoms of obstructive jaundice which is indicated by yellow skin and conjunctiva, light stools and dark urine. In some cases there is slight fever with swelling and tenderness of the liver.

Chronic. Often jaundice is chronic, usually developing gradually without pain and increasing steadily from week to week, while the gall bladder increases in size, are seen in compression of the common duct by a tumor or by scar tissue. Persistent jaundice of varying intensity, preceded by colicky pains, and accompanied by ague-like paroxysms of fever, chill and sweat is seen in obstruction of the common bile duct by stones.

Etiology: Acute cholangitis is met with largely in young adults as an extension of gastro-intestinal catarrh and after so-called "infectious" fevers. It is, in other words, the outgrowth of toxemia and indigestion. Chronic cholangitis sometimes results from repeated acute crises, but is thought to more often result from obstruction of the common bile duct by stones, scars, tumors, etc. As these are of toxic origin, we may regard toxemia as the basic cause.

Prognosis: Acute cholangitis usually recovers in two weeks or less. The chronic form may last for years. Recovery depends upon removal of its exciting cause.

Suppurative Cholangitis: This is suppurative inflammation of the biliary ducts.

Symptoms: Fever, chills, sweats, with jaundice, local discomfort or actual pain, enlargement of the liver, perhaps also of the spleen, and emaciation with, generally, distention of the gall-bladder from concomitant cholecystitis, accompany this condition.

Etiology: Suppuration of the gall-duct is generally a sequel to gall-stones or to obstruction of the gall-duct by tumor. It occasionally follows maltreated pneumonia or typhoid or a similar biogony.

Prognosis: This affection is considered grave and surgery is thought to offer the "only chance of cure." This is not Hygienic experience.

Care of the Patient: Cholangitis is, primarily, a catarrhal condition, an extension of gastro-intestinal catarrh, growing out of toxemia, and care should be directed to elimination of the toxemia and clearing up of the catarrhal condition. Fasting, rest and a corrected mode of living will accomplish this. Even suppurative cholangitis will, in most instances, terminate in recovery when the toxic load is taken off the organism and normal metabolism restored.

CYSTS OF THE PANCREAS

Cysts of the pancreas are divided into three groups as follow:
Retention Cysts resulting from impaction of a calculus, stricture or tumor.

Traumatic Cysts resulting from hemorrhagic extravastation.

Proliferation Cysts formed by carcinomatus are edenomatous tumors.

Symptoms: These vary. The most common are deep-seated pain in the stomach region, digestive disturbances, vomiting and emaciation. If the cyst presses upon the bile duct, jaundice occurs; if it presses upon the portal vein ascites develops. Sugar is sometimes found in the urine and free fat and undigested muscle fibre may be present in the stools. A smooth, round, fluctuating tumor may often be felt in the upper part of the abdomen.

Etiology: The immediate causes are given in the classification above. Toxemia and chronic pancreatitis are back of these immediate causes.

Care of the Patient: Fasting and a complete revolution in the mode of living will sometimes result in the absorption of the cyst. In other cases it will be reduced and the symptoms end. Where this fails, surgery is the only other recourse. It should be the last, not the first, recourse.

PANCREATIC CALCULI

Definition: This is stones in the pancreas.

Symptoms: Pancreatic colic, which resembles biliary colic, except that the pain is more likely to radiate to the left and is usually unattended with jaundice, develops when the stone is forced through the pancreatic duct. Sugar in the urine, fatty stools and the discovery of stones containing chiefly carbonate or phosphate of lime in the stools confirm the diagnosis.

Etiology: Catarrh of the pancreatic ducts, an extension of gastro-intestinal catarrh, with stagnation of the pancreatic secretions, results in stone formation.

Care of the Patient: Same as that for gall-stones, which see.
AFFECTIONS OF THE PERITONEUM
ADHESIONS

Definition: An abnormal joining of parts to each other.

Symptoms: Pain and discomfort are the usual symptoms complained of. Most adhesions produce no symptoms.

Etiology: Adhesions result from inflammation. They frequently follow abdominal and pelvic operations in the thoracic, abdominal and pelvic cavities

Care of the Patient: Every operation for adhesions leaves more adhesions than it finds. Most of the symptoms complained of are due to indigestion and gas. These should be cared for as directed elsewhere. The claim that adhesions may be broken up by massage is not well founded. Fasting has been known to cause adhesions to end it is well to know that adhesions rarely cause any trouble.

PERITONITIS — Acute

Definition: This is inflammation of the peritoneum or membrane lining the interior of the abdominal cavity and surrounding the viscera. The inflammation may be general or localized.

Symptoms: Intense abdominal pain and tenderness are the most prominent symptoms. Breathing is shallow and costal. The features are pinched and the expression is anxious; The abdomen is distended and its walls rigid. To relieve the tension on the abdominal muscles, the subject lies motionless on his back with the legs and thighs drawn up. Moderate fever (102 to 104 F.) with small, rapid and "wiry" pulse, are usually accompanied by constipation, while vomiting and hic-coughing are common. In severe cases rapid collapse, indicated by fall in temperature, rapid, feeble pulse, suppression of the urine and a cold, clammy surface, ensues.

Etiology: Primary peritonitis is very rare and may result from trauma, or a "rheumatic" state, superadded to toxemia.
Secondary peritonitis is an extension of inflammation elsewhere — of any of the viscera of the chest, abdominal cavity and pelvis. Simple inflammation, or abscess, of the liver may extend to the peritoneum. Cancer of any part of the three cavities of the trunk may result in peritonitis. Peptic ulcer, ulcer of the bowels, colitis, muco-colitis, appendicitis, typhilitis, ovarine and uterine inflammation, septic inflammation of the uterus following childbirth or abortion, may extend to the peritoneum. External abdominal wounds may perforate the peritoneum. The condition is also seen in some severe forms of typhoid.

Prognosis: This is usually good in localized peritonitis. In generalized peritonitis the outlook is always grave; perforative cases are particularly grave. Tilden says: "In septicemia, following childbirth or abortion, intense pain in the abdomen, quick pulse, flushed face, preceded by rigor, means a fatal case, unless it is quickly comprehended and the right treatment used immediately."

Care of the Patient: Peritonitis means septic infection of the peritoneum. The general care must, therefore, be the same as for sepsis — infection elsewhere — rest, fasting, warmth. Since peritonitis is almost always secondary to other inflammations, care must be as directed under these other affections.
In general it is felt that perforation by an ulcer of the stomach or intestine, or the rupture of an abscess of the liver or of the appendix into the peritoneal cavity will cause a fatal peritonitis unless the abdomen is opened immediately and thoroughly washed out. In 1927 Dr. Win. Howard Hay wrote me that he had "had nothing but complete recoveries in approximately 250 cases (of appendicitis), which list includes thirteen perforations with abscess," and this without resort to surgery. Weger says of peritonitis, "here again, we emphasize the rarity of such diseases in people who live normal lives, who keep their resistance high and their toxins low."

PERITONITIS — Chronic

Symptoms: There is slight, or no, fever; pain is not severe, but is frequently paroxysmal. More or less diffuse tenderness is present. Often there is marked anemia and emaciation. The abdomen is usually distended.

Etiology: Most cases are supposed to be tuberculous or cancerous. Some cases are sequels to acute peritonitis. A few cases result from extension of inflammation in the pelvis. Many cases follow abdominal operations.
Prognosis: Simple peritonitis usually ends in recovery, especially in children. Tuberculous peritonitis often recovers. Cancerous peritonitis is always fatal.

Care of the Patient: Care must depend on the primary trouble — cancer, tuberculosis, uterine and ovarine inflammations, etc. See these affections.