ALIGNMENT OF TEETH- CORRECTING IRREGULAR TEETH

ALIGNMENT OF TEETH

 Teeth that are irregular, that overlap or stick out in odd directions, can present problems. Sometimes there is malocclusion-failure of upper and lower teeth to meet (occlude) properly. Heredity may account for this. Irregularity also may stem from early loss of baby teeth because of decay or accident or from failure of the baby teeth to fall out at the right time. 

When there are regular visits to the dentist, he can, in the case of a pre- maturely lost baby tooth, insert a "spacer" to help maintain the space so that permanent teeth will have the opportunity to grow in properly. And if a baby tooth is being retained too long, he can, with the help of x-ray examination, determine the presence and developmental state of the permanent tooth that is to replace it and can take appropriate measures. Some dentists believe that irregular teeth may be the result of excessive thumb and finger sucking at the time the second teeth are coming in.

Since a healthy, happy child usually has given up sucking his thumb by the time he is six, it is advisable to discuss this habit with your doctor if it persists. Another factor in irregular tooth alignment and faulty bite is insufficient chewing because the diet is overloaded with soft foods.

CORRECTING IRREGULAR TEETH 

Poorly aligned teeth are likely to do more than detract from appearance. Often, food tends to collect behind them and the gums may become irritated. When only a few teeth meet properly in chewing, the force of the bite falls entirely upon them and may loosen them. Your dentist can check to determine whether a child's bite is poor. He can detect the first signs of serious malocclusion and advise whether and when orthodontic treatment to correct it should be undertaken. 

The earlier a potentially serious case of malocclusion is detected and treated, the less time may be needed for its correction. o An irregular tooth or two does not necessarily mean malocclusion and may not really be disfiguring. Your dentist can tell you whether it is advisable to have treatment. Orthodontic treatment takes time, patience, skill. It can be expensive. If your child really needs orthodontic care and you cannot afford it, discuss the matter with your dentist and investigate dental clinics. 

Dental care tools and how to use?

Dental Care TOOLS

 A toothbrush, preferably soft-bristled, never hard, since it will be used at the gumline as well as on the teeth

 Dental floss

 An irrigator, or water spray, attachable to the bathroom faucet

 Many types are available. Your dentist may recommend one.

A small, inexpensive, plastic-handled mouth mirror, available from your dentist or drugstore

How TO PROCEED

BRUSHING

 Properly used, a toothbrush can clean three of the five surfaces of the teeth-chewing, cheek side and tongue side. Note: A critical, often missed zone is the last one-sixteenth inch of the tooth at the gum margin. Plaque and bacteria near the gum as well as on the rest of the tooth must be removed. Direct the brush bristles gently into the crevice between gum and teeth. 

Mildly vibrate brush handle so bristles do not travel and skip about but can dislodge material in this area. A soft-bristle brush gently used will do no damage to gum tissue; a stiff bristle brush may. Next, move brush, applying gentle but firm pressure, so bristles travel over surface of tooth. Brush upper teeth with a downward motion; lower, with upward motion. 

Brush surfaces next to tongue and surfaces next to cheek. Then clean the chewing surfaces, brushing across tops of teeth. Brush at least half a dozen strokes in each area.

FLOSSING

 Plaque must be cleaned away from the other two surfaces of the teeth-the sides, or interdental surfaces. Floss can accomplish this. Cut off a piece of floss 18 to 24 inches long. Wrap the ends around the forefinger and middle finger of each hand, leaving the thumbs free. To floss between upper teeth, use thumbs as guide; hold thumbs about 1 inch apart, keeping floss taut. For lower teeth, use forefingers as guide, keeping them 1 inch apart.

 Slip the floss between each pair of teeth. Do not try to snap floss through a tight area; work it gently back and forth until it passes through. Carry the floss to the base of one tooth, stopping when it is just under the edge of the gum. Scrape the floss up and down against the side of the tooth until you get a rough or "squeaky" feeling, which indicates you have broken through the plaque and are actually touching the tooth. After cleaning the side of one tooth, clean the side of the adjoining tooth.

 RINSING

 After brushing and flossing, vigorous rinsing will remove dislodged food particles, plaque, and bacteria. An irrigating spray also helps clean under any bridges or braces and in gum pockets where brush and floss cannot reach. Place the spray tip in the mouth pointing toward the tongue and adjust water flow until pressure and temperature feel good. Move tip so warm water washes spaces between teeth and between gums and teeth. The spray should not be painful at any time. 

HOW CAN YOU USE PREVENTIVE TECHNIQUES for Dental care?

HOW CAN YOU USE PREVENTIVE TECHNIQUES?

A cardinal rule is to see your dentist for regular checkups. Get your children to him early, even at age two. Encourage your dentist to use preventive measures in the office-fluoride topical applications once or twice a year, or oftener if needed, and not only for children but for adults in the family. 

If your dentist is too busy or not interested, you can find one who will be interested, happy to take the time for the applications and for instruction.

Make use of the following guide for mouth care which details, step by step, the home oral hygiene measures advocated by many dentists who are leaders in the preventive approach. You can check the guide with your dentist for any special suggestions he may have that could make it even more valuable for you.

A GUIDE FOR EFFECTIVE MOUTH CARE

This is a guide to thorough cleaning of the mouth, not just brushing of the teeth, as a means of helping to prevent both decay and gum disease. It is important to remember that decay occurs when bacteria attack food particles and produce acid which eats away at the tooth structure. The bacteria cluster on teeth in a film called plaque. 

Plaque also fosters tartar formation and, in turn, gum inflammation and infection. Whenever possible, brush after eating to remove food particles.

But remember: one complete cleaning of the mouth, preferably at night before retiring when you can take time to be thorough, is essential. Because it takes 24 hours for plaque to form anew, one such cleaning daily can help eliminate this prime factor in both gum disease and decay.

THE DECAY PROCESS-ADVANCES AGAINST GUM DISEASE

THE DECAY PROCESS 

Decay, essentially, is an acid-etching process. The acid is formed when bacteria, always present in the mouth, digest food particles left in the mouth. The acid attacks the enamel, the outer layer of the teeth which, even though it is the hardest substance in the body, will dissolve in acid. Decay is sneaky. Even a tiny hole, one you cannot see, through the enamel can be enough to allow acid to enter to start dissolving the dentin, the softer structure under the enamel. 

When the decay process finally reaches the pulp, the living part of the tooth containing nerves and blood vessels, you may feel pain, but not necessarily. A tooth may r. be almost completely rotted away and abscessed without causing pain. It would be bad enough if the effects of decay in a tooth were limited to the tooth, but a diseased tooth can allow bacteria to enter the blood- stream to be circulated to the rest of the body. Dr. J. C. Muhler, of Indiana University, one of the country's leading dental researchers, has written:

ADVANCES AGAINST GUM DISEASE 

Meanwhile, gum disease-technically known as periodontal disease-has come in for hard study. And not only have effective methods to help The Armed Forces always had been faced with a serious dental disease problem. Entering servicemen had an average of seven decaying teeth each, and developed more while on duty; service dentists couldn't begin to cope adequately. In 1961, the Army set up a small-scale experimental program. 

Servicemen had their teeth cleaned in the dental chair, but instead of finishing up with the usual abrasive polishing paste to make the teeth gleam, Army dentists used a paste with fluoride added.

Along with bright teeth, servicemen also got fluoride burnished into the enamel during the polishing. In the same sitting, a topical fluoride solution was dabbed on. 

They were then sent away to make regular daily use of a fluoridated toothpaste. . By 1963, Army dentists had expanded the program so it reached more than 300,000 men. It has been expanding since, and in the Navy and Air Force as well. Result: huge reductions in new cavity formation. A comparison study at the Navy's New London, Connecticut, base, for example, showed an 86 percent reduction in the decay rate among men on the program. 

After two years of experience with the program at the Naval Academy at Annapolis, Admiral Kyes could report that "midshipmen now have a caries expectancy of one new cavity in ten years," versus the average rate of university students of the same age of two new cavities each year. 

Harmones and glands - overactivity and underactivity

Many hormones

The Endocrine Glands I 263 is known to pour out a dozen or so; the adrenals more than 30. The following table shows a number of the hormones and some of the dis- eases resulting when a gland is too active or not active enough: Disease Caused by Exophthalmic goiter (also Myxedema, called Graves' disease or cretinism (in hyperthyroidism) infants)

ROLL CALL OF THE GLANDS 

The Islets of Langerhans Diabetes is the most familiar of the diseases caused by endocrine gland disorder. GLAND Thyroid Parathyroid Islets of Langerhans (pancreas) Adrenal Cortex Medulla Gonads Female (ovary) Male (testis) Pituitary anterior lobe posterior lobe HORMONE Thyroxin Parathormone Insulin Cortin, cortisone, etc. Adrenaline Estrogen (estrin) Androgen (testosterone) Corticotropin, thyrotropin, gonadotropins, lactogenic hormone, prolactin Vasopressin, oxytocin

OVERACTIVITY 

Hyperparathyroidism (osteitisfibrosacystica) Hyperinsulinism Cushing's syndrome, adrenal hypercorticism, adrenal virilismHyperadrenalism, pheochromocytoma Menstrual irregularities Excessive virilism Cushing's syndrome (hyper adrenalism) r gigantism (acromegaly) 

UNDERACTIVITY Parathyroid tetany Diabetes mellitus Addison's disease May contribute to symptoms of Addison's disease Menopause Eunuchism Dwarfism, Simmonds' disease Diabetes insipidus The islets of Langerhans of the pancreas secrete insulin.

This hormone enables the body to use, or burn, sugar and starch after they have been converted by digestive juices into glucose. The body must utilize glucose (sugar) to provide heat and energy and to help in utilization of other foods. Any sugar the body does not immediately need is stored in the tissues to be drawn on later, like money in the bank. 

When the islets fail to provide insulin to spark this process, the sugar passes unused into the blood and is eliminated in the urine. The quantity of urine increases, causing the diabetic to become thirsty and to drink more fluid, which in turn is quickly eliminated. Not all reasons why the islets may fail to produce enough insulin are known. 

Eye

Eye 

In one experiment, when subjects were asked to estimate the size of coins and cardboard disks that were exactly the same size, they guessed, on the average, that the coins were one-fourth larger than the disks-and the poorer off financially a subject was, the more he overestimated coin size. The eyes even serve a purpose beyond seeing. 

They have a marked effect on taste, as shown by studies at a U.S. Air Force medical laboratory where volunteers were fed in a completely darkened room. Unable to see the food, they could detect no difference in taste between white and whole-wheat bread or between various canned foods. Eye Problems and Their Prevention Defects and diseases to which the eyes are susceptible account, in part, for the fact that there are nearly half a million people in the United States who are totally blind and two million more who are partially blind. 

But in part, too, this unpleasant fact is the result of misunderstanding, neglect, and delay in seeking aid, for many potentially blinding disorders can be prevented, or arrested, or even cured with prompt attention. In addition, of course, about 40 percent of the population wears glasses, indicating that the vision of almost one of every two people leaves something to be desired.

Three common eye defects-farsightedness, nearsightedness, and astigmatism-are the result of simple optical aberrations in the eye. If the lens is to focus light rays directly on the retina, it must be at the proper distance. When the eyeball is too short, the lens will be too close;  Prevention: Body conversely, if the eyeball is elongated, the lens will be too far away. Moreover, to accommodate to both near and far objects, the lens must change its curvature to maintain proper focus. At birth, the average baby has foreshortened eyeballs and is far- sighted. 

From about age 6 to age 20, the eyeballs elongate. After about age 45, people tend to become farsighted again because the lens, going through a normal hardening process, loses some of its ability to change curvature to focus on near objects.

Nearsightedness is usually due to a lengthening of the eyeball, an increase in curvature of the cornea, or a change in refraction of the lens. Astigmatism is usually caused by an irregularity of the shape of the cornea. When the cornea does not have a perfect curve, images is distorted. The effect can be similar to that of looking through a dirt- streaked pane of glass. 

Fortunately, nearsightedness, farsightedness, and astigmatism are readily corrected with eyeglasses. And it is important that these conditions be corrected, for both comfort and good eye health. If, for example, one eye is more effective than the other, the good eye may do all the work, which could be bad for it and also for the one that is not being used.

This is why children's eyes should be checked at an early age, even before school, and why you should mind your own eyesight, remembering that changes do occur with time. Have your eyes examined as soon as you find yourself holding things off at a distance to see them, or when you notice that you no longer see as well as you once did in poor light. 

Always have an eye doctor examine your eyes and prescribe any necessary lenses. It is true, of course, that eyeglasses are an expense and possibly a bit of a nuisance. But what a joy it is to see properly and to know you are protecting your precioussight. 

The central nervous system

The central nervous system works in more than one way. There are simple reflex actions and there are reactions at higher levels. Consider, for example, what happens when you unexpectedly touch a hot object. Instantly, your hand is jerked away. The pain stimulated the receptor endings in a sensory nerve in the skin. Nerve impulses immediately flowed along a fiber, passed through a sensory branch of a spinal nerve and into the cord. 

There then followed a quick transfer across a synap of a central nerve in the cord, another transfer across another synapse t a motor nerve, which then passed impulses out of the cord and along a motor fiber of a spinal nerve through the body to the muscles. The muscles reacted; your hand was jerked away. It took just a fraction of a second for the entire reflex-an involuntary process, requiring n thought, assuring immediate helpful action.

 But there was another reaction, too-at higher levels. Although you were not consciously aware of the reflex as it happened, you very quickly learned about it through another transfer in the cord.

The areas sent messages to your muscles, and you moved to the tap. And, as you probably realize, while all this was going on, your emotional centers entered the picture and you had some feelings-perhaps of anger, or disgust, or both-about the event. 

The Autonomic Nervous System A second nervous system, the autonomic, provides for control, on an automatic basis, of vital internal organs. The autonomic system has two nicely balanced parts-the sympathetic and the parasympathetic-which oppose each other, much like accelerator and brake of a car. In so doing, they make possible a precise balance. The sympathetic system begins at the base of the brain and runs along both sides of the spinal column. 

THE NERVOUS SYSTEM

THE NERVOUS SYSTEM

The brain is likened to a control center, then the nervous system can be thought of as a two-way communications network through which informational messages flow to the control center and command messages are transmitted from the center. The informational, or sensory, messages come from the outside world through the sense organs (eyes, ears, etc.); they also come from within the body itself-there are billions of receptors all over the body concerned with various functions. 

The nervous system is organized to give you essential voluntary control over many actions. It is also set up to relieve you of concern with routine matters. Thus, for example, you eat dinner and decide whether you like or dislike a certain dish and wish to finish it.

On the other hand, you walk along, stumble on an object; without thought on your part, the muscles of the legs are automatically commanded to react, and one leg is extended and the other flexed so you maintain your balance. How Nerves Work Messages travel along nerves, at speeds of as much as 250 miles an hour, as the result of both electrical and chemical action. 

A nerve cell, or neuron, when viewed under a microscope, looks like a tiny blob, rounded or irregular in shape, with one or more threads extending from it. The blob is the actual nerve cell body; the threads are nerve fibers. Shorter fibers, called dendrites, bring messages to the cell body; they may range from a very small fraction of an inch to several feet in length.

One fiber, longer than the others and called the axon, transmits messages away from the cell body. A nerve impulse, going through the nerve network, travels over the fibers of many cells. As it reaches the end of one fiber, it jumps a gap, called a synapse, to the next fiber. Chemicals produced and stored around synapses can help the impulse to jump the gaps or can block the impulse. Some drugs that act in the nervous system-some of those for high blood pressure, for example-accomplish their tasks by affecting the chemicals at the synapses. 

THE FEMALE GENITAL SYSTEM

THE FEMALE GENITAL SYSTEM 

The reproductive anatomy in the female takes the form of the letter "Y." At the ends of the two top arms are the ovaries. The arms themselves are formed by the fallopian tubes, also called oviducts, thin passageways through which eggs released from the ovaries travel. At the Y's center is the uterus, or womb, the muscular pear-sized organ which will house and nourish a fertilized egg from earliest stages through all phases of fetal development, enlarging greatly in the process.

The cervix is the neck of the uterus, which seals off the uterine cavity until, in the last hours prior to birth of a baby, it changes its shape. The cervix leads into the vagina, the receiver of sperm during intercourse and the exit passage for the baby at birth. Elsewhere in this book, as the Index indicates, are discussions of menstruation, menopause, pregnancy, childbirth, and sterility. Hygiene Douches are not essential to feminine hygiene, although many women have been persuaded to take frequent douches with commercial preparations because of advertisements implying that no woman can be clean or dainty without them.

Actually, nature has provided for the cleansing of the internal passages. If you wish to take an occasional douche, it should be of the mildest type, imitating nature's own secretions. You can use a physiological salt solution: add two level teaspoonful of table salt to a quart of moderately warm water.

Administer the douche under gentle pressure. Whether a woman, during the menstrual period, should use an internal absorptive pad (tampon) or an external sanitary pad is entirely a matter of personal preference.

 Either is safe. Each woman can decide for herself, based upon which she finds more effective and comfortable. An unmarried woman can wear an internal pad if her hymen happens to be well perforated-and this may be the case, contrary to some opinion, whether or not she has ever had sexual relations. 

Certain kinds of exercise may cause rupture of the hymen in a virgin. If the hymen is completely lacking in perforation-a condition called imperforate hymen-there may be interference with menstruation, and a minor surgical procedure may be needed to create an opening. Any irregularity in menstruation, once menstruation has become well established, should be checked with your physician. Infections Syphilis, gonorrhea, and non-venereal infections can seriously damage the female reproductive system. 

Gonorrhea and preventive care and cure

Gonorrhea is a common venereal disease. Prior to the development of effective antibacterial agents, it was a serious problem. Now it can usually be cured with one injection of penicillin. Every person, female as well as male, should read the section on gonorrhea. Even children are susceptible. Gonorrhea can be transmitted in ways other than sexual contact. 

If you understand the facts thoroughly, you will know how to prevent gonorrhea. The other venereal diseasesless common and less importantare chancroid, lymphogranulomainguinale, and veneral warts. These are made evident in men by sores on the penis or enlarged lymph nodes in the groin. (Women, too, may contract these diseases.)

They respond to treatment while in early stages and no time should be lost in consulting your physician. Venereal diseases can be prevented. The simplest and most effective prophylactic is the condom, or rubber sheath. Some men think this diminishes the pleasure of intercourse. 

But anyone who has seen really severe cases of venereal disease comes away convinced that if a man must expose himself to the dangers of VD, he can well afford to reduce slightly the physical pleasure in return for protection and freedom from worry. 

The testicles are not often affected by disease. They are not, however, immune to involvement and may be affected by mumps, undulant fever, or gonorrhea. The cord that supports them may be invaded by an extension of a hernia, or there may be enlarged veins. The epididymis may become diseased. If you notice a swelling, lump, or congestion of the scrotum or testicles, be sure to see your physician as soon as possible.

Urinary Bladder

THE BLADDER

 A tube, or ureter, leads from each kidney to the urinary bladder. The bladder empties through the urethra, a tube leading to an external open- ing called the meatus. The bladder, which functions as a collecting and temporary storage point for urine, expands to accommodate increasing amounts. With the accumulation of about half a pint, reflex contractions lead to a desire to urinate, or micturate. 

The contractions stimulate pressure receptors in the muscles of the bladder wall, from which nervous impulses go to the brain. When it is convenient to urinate, the brain sends out signals which cause the bladder's external sphincter to relax.

The signals also set up a whole series of other events, including holding of the breath, forcing of the diaphragm down, and contraction of the abdominal wall, which in- crease pressure on the bladder and help it void its accumulated urine. Such is the complexity of the process that it is hardly any wonder that most children are walking before they become able to urinate with con- trolled competence. 

Normal daily production of urine may range from two to three pints. In some diseases, such as diabetes insipidus, the quantity is increased; in others, fever and diarrhea decrease it. Tea, coffee, alcohol, excitement, and nervousness increase urine output; hot water decreases it. Whatever the actual liquid output, a day's urine generally contains about two ounces of solids. 

THE GENITOURINARY SYSTEM

THE GENITOURINARY SYSTEM

EVERY BODY cell not only must build its substance and obtain its energy from nutrients supplied in the food you eat; it must get rid of wastes. And all cells deliver their waste products continuously to the blood. In turn, the blood carries them to various centers for excretion. 

Thus, carbon dioxide and some water in the form of vapor are removed from the blood in the lungs. Salts and additional water pour out through the skin's sweat glands. Other wastes, including water, salt, urea, and uric acid-leave the blood in the kidneys. Blood enters the kidneys through the renal arteries and leaves through the renal veins and, in circulating within the two kidneys, goes through a fabulous filtering system. 

The kidneys-each about 4-1/2" long, 2-1/2" wide, 1-1/2" thick, and weighing 5 ounces-are located deep in the abdomen at about the level of the lowest ("floating") ribs. Essentially, they are filters containing intricate plumbing-a system of tiny tubes called nephrons whose combined length in each kidney is about 140 miles. To the naked eye, a single nephron would resemble a grain of sand. Under a microscope, it has the look of a twisted worm with a huge head. The head, called the glomerulus, is covered with a network of capillaries that carry blood continuously into the glomerulus. 

The tail is the tubule. In a healthy kidney, as blood enters a glomerulus, a fluid is separated from it. The fluid contains neither red, nor white blood cells nor only a trace of large protein molecules. The fluid passes along the tubule, and about 99 percent of the water, amino acids, proteins, glucose, and minerals needed by the body are returned to the bloodstream. The remaining fluid, with its content of waste materials, is eliminated from the body as urine. Every 24 hours, the kidneys filter about 200 quarts of fluid and salts.

One or two quarts of the waste go to the bladder and are flushed out of the body. Actually, the kidneys have a tremendous reserve capacity; they could clean nine times more fluid than they are called upon to do, and for this reason one healthy kidney can readily serve the body's needs. The kidneys function to maintain the correct balance between the salts and water of the body, to get rid of any toxic substances, and to keep the body in correct mineral balance. For example, too much potassium in the blood could stop the heart quite as effectively as a bullet. 

Stomach and digestive problems and preventive care

 1. LUMINATION

 Choose a time, shortly to defecate whether or not you have "the urge." Allow ten minutes. Relax, be comfortable, read if you like-the important thing is not to feel tense or hurried. Prop your feet on a footstool so your knees are close to your chest. If you choose to go before breakfast, it will help to drink a glass or two of fluid upon getting out of bed; it can be warm or cool water, fruit juice, tea, or coffee. Teaching your bowels to move regularly is a little like training yourself to wake up at a given hour every morning; it can be done, with patience, and once acquired the habit persists.

 2. DIET. 

The residue of foods you eat is easier to eliminate if it contains some roughage in the form of fibers, lubricants in the form of fats or oils, and fluid. These should be included in the diet of healthy people. (In some disease states, there may be an inability to tolerate roughage; in such cases, a physician will so advise.) To cure or prevent constipation, make certain your diet includes: For breakfast: 1/2 to 1 glass of tomato, grapefruit, prune, or orange juice. 

Also include one item from each of the following, (a) through (e): (a) Mixed dried or stewed fruits-prunes, apricots, figs (b) Cooked, whole-grain cereals with milk-barley, brown rice, oats, wheat (c) Margarine (d) Whole-grain bread (e) Beverage For lunch, dinner or supper, some of the following: Green leafy vegetable--beet greens, spinach, escarole, lettuce, turnip greens, dandelion greens, mustard greens Baked potatoes (eat the skins) Margarine, salad oils Dried or stewed fruits-especially for dessert at evening meal Take two glasses of fluid between meals and at least eight all told during the day. 

Drink an extra amount of water in summer because part of it is lost in perspiration.

3. EXERCISE. 

Strong abdominal muscles help elimination. If you do not have a firm, well-toned abdominal wall, start the exercises described on page 89. If your job requires much sitting and very little physical activity, you should indulge in regular sports or other forms of exercise. You will feel better generally as well as have fewer tendencies toward constipation.

 4. LIVE SENSIBLY. 

Try as much as you can to avoid the stresses and strains of modern living. Get relaxation to help temper those stresses and strains. Don't worry about constipation. If your physician gives you a clean bill of health on your regular visits, and you follow our suggestions for home checkups (page 33), constipation is not going to harm your health. Usually, these suggestions are enough to prevent or cure constipation. If they are not, and failure to move the bowels causes real discomfort, you may:

5. TAKE AN ENEMA. 

Use a pint of warm water containing a level tea- spoonful of table salt. If you use an enema bag, hold it about two feet above the toilet seat; if you use a bulb, do not press it too hard-the water should flow under gentle pressure. This should help soften the stool so it can be passed easily. You may take an enema every day-but remember that this is a crutch and the sooner you discard it, the better. If an enema does not help, your physician can show you how to insert olive oil into the rectum at night through a catheter, which will soften the stool and make it easier to pass in the morning.

6. LAXATIVES. 

If you cannot take an enema, use a mild laxative such as petrolatum and agar, aromatic cascara sagrada, or milk of magnesia. Do not do this until you have given your bowels a chance to work by themselves. An important step in curing constipation may be to stop taking all laxatives and cathartics. Strange as it seems, laxatives are frequently the cause of constipation and seldom are necessary in its cure. As noted above, mineral oil may be of value. A final warning: Don't give a laxative to a child, and don't take one yourself, if there is any fever, nausea, pain, or general feeling of illness associated with the constipation. It can cause fatal consequences if the condition is caused by appendicitis.

Definition of constipation

Here is the medical definition of real constipation:

A person has constipation when bowel movements are too hard to pass easily or are so infrequent that uncomfortable symptoms result. Constipation does not mean failure to pass a stool daily; this may be imaginary constipation. Hard movements that require straining can bring about rectal troubles such as hemorrhoids and fissures or may aggravate a hernia or the tendency to hernia. Constipation may cause uncomfortable symptoms such as nausea, heartburn, headache, or distress in the rectum or intestines, continuing until the stool is passed. 

Notice that we say uncomfortable rather than harmful symptoms; that are because these symptoms stem from nerve impulses to various parts of the body when the rectum is distended by retained fecal matter. They are not due to "autointoxication," or absorption of poisons from the fecal matter. It has actually been established that similar symptoms can be brought on when cotton is placed in the rectum after all fecal matter has been removed. Some people suffer more than others from these symptoms, not because of their imagination but because they are actually more sensitive. 

In imaginary constipation, the bowel movements are not difficult to pass; they cause no unpleasant symptoms; they simply do not take place as often as the individual thinks they should. Often, it is a mother or other relative who insists the movements should be more frequent. The fact is that bowel movements can be normal without being "average." While the "average person" has a movement daily, usually immediately after breakfast, countless people are normal even though they have more than one movement a day, or a movement only every second day, or every third, fourth, fifth, or even eighth day. 

People vary markedly in body makeup, type of intestine, eating habits, physical activity, and custom. By self-induced constipation, we mean the kind caused by one or more of the following: improper diet (eating the wrong things or eating too little); the use (that is, abuse) of laxatives, cathartics, etc.; irregularity in habits of elimination.

Modern living, with its strains, stresses, and sedentary habits, helps promote constipation; indeed, in some primitive languages there is no word such as constipation because the need for it does not exist. Functional constipation can also be caused by "sluggishness." As we have seen, after food has been digested in the stomach and intestines, the residue, a watery material, enters the colon. Water is absorbed in the colon; that is why the feces may become hard and difficult to pass if they remain too long in the colon. The stools are propelled along by a series of wavelike, peristaltic movements. Usually the waves are strongest in the morning, which is why it may be easiest to have a bowel movement before or just after breakfast. In some people, peristalsis is weak. 

This may happen with increased age, and some elderly people may require an aid to elimination. Mineral oil is the best remedy. But we think it wise to accept as helpful virtually any method that an elderly person has long used and found satisfactory -whether it is hot lemon water early in the morning or the enema that some elderly people believe has magical virtues. In such cases, the important thing is to watch for any sudden change in established bowel habits. How to Cure-and Prevent-Functional Constipation If you now do have constipation, there are certain things you can do to Cure it, and these same methods will also prevent you from becoming constipated. 

Gallblader and constipation

Fortunately, the gallbladder can be surgically removed when necessary; the body can get along well with- out it. Except for keeping your weight normal, there is nothing you need do about the everyday care of the gallbladder. Obesity increases the tendency toward gallbladder disease. Women who have had more than one or two children are somewhat more likely to suffer from gallstones; and in general, after age 40, about twice as many women as men have this problem.

 Once stones form, they cannot be dissolved; sometimes, how- ever, they pass spontaneously into the intestines. Your physician has methods of stimulating bile flow and of decreasing infection in the gall- bladder, and these measures may reduce the formation of additional stones. The best thing you can do for your pancreas is to avoid overweight, which predisposes people to diabetes.

 CONSTIPATION

 Many people suffer from constipation that is nonexistent, except in their imagination, or self-induced, or could be corrected or prevented with relatively simple measures. It is a fact-and this deserves emphasis-that constipation can be organic, that is, the result of some physical change. It can be caused by a tumor that obstructs the intestines, a stricture that narrows them, or some disease such as a hypothyroid condition. 

That is why it is important to consult your physician if you have constipation, especially if it has developed fairly suddenly. This is essential for middle-aged anti older people to make certain that if a cancer does exist, it is discovered in the early, curable stage. 

APPENDIX

APPENDIX 

The appendix is a wormlike appendage at the junction of small and large intestines. Its reason for existence is not clear. The apparently useless structure, unfortunately, can be the source of serious illness. No age group is immune to appendicitis, an inflammation of the appendix (page 531). Its prompt diagnosis can lead to effective removal of the inflamed organ before serious complications can occur. 

The operation is comparatively simple and safe when performed early by a competent surgeon. The one thing you can do about your appendix is to realize that if it is inflamed, you may cause it to rupture if you take a laxative or apply a hot water bottle over it.

CARE OF THE DIGESTIVE SYSTEM 

Unlike the chest with its rib cage, the abdomen offers relatively little protection for its organs. Liver, spleen, and kidneys may be ruptured by accidental injuries. The abdominal muscles should be kept strong to help protect adjacent organs, a need recognized by all coaches of athletic teams. Disorders of the gastrointestinal system are among the most commonly encountered in medical practice. 

Almost everyone has some degree of difficulty at one time or other. The disorders can be functional. Because of the extensive nerve connections involved in the digestive system, fear, anger, and other nervous upsets can readily set off attacks of nausea, cramps, diarrhea, and other symptoms. 

GALLBLADDER, PANCREAS, AND SPLEEN

GALLBLADDER, PANCREAS, AND SPLEEN 

The gallbladder, already discussed, is a kind of "side pocket" in the channel through which bile flows from the liver into the intestine, serving as a storage place. The pancreas, which weighs about three ounces, lies high up in the abdomen, deep behind the stomach. The pancreatic duct carries the digestive secretion, pancreatic fluid, through a common opening with the bile duct, into the duodenum. 

The fluid contains three important enzymes: amylase acts on carbohydrate foods; lipase functions in fat digestion; and trypsin is a protein-digesting agent. Equally important are the islets of Langerhans which are contained in the pancreas and produce insulin, a lack of which causes diabetes. 

The spleen, although often bracketed in people's minds with the pancreas, is not an organ of digestion. Roughly fist-shaped and about six inches long, it lies high up behind the stomach. In the unborn baby, the spleen plays an important role in producing red and white blood cells. After birth, it no longer manufactures red cells but still makes white cells.

 In adult life, it makes neither but does serve by doing the opposite-destroying old blood cells. The spleen is not vital; it can be removed without harm. While it is a useful organ, its functions can be performed elsewhere in the body. Normally, the spleen cannot be felt from outside unless it enlarges considerably.

It usually does so when affected by disease, and in extreme cases may increase fifty fold in size. Enlargement may carry some hazard since the spleen, when engorged with blood, may produce severe internal bleeding after a bump or knock that ordinarily would be trivial. 

THE LARGE INTESTINE

THE LARGE INTESTINE By the time a meal has spent several hours in the stomach and another five hours or so in the small intestine, all that remains to enter the large intestine is a combination of water and indigestible waste, and it enters through a valve that prevents backflow. 

The large intestine, or colon, is about two to three inches in diameter. Upon entering, material travels upward through the ascending colon along the right side of the body, then through a sharp curve under the liver on the right and via the transverse colon across the top of the abdomen just below the diaphragm. Another sharp curve carries the material to the descending colon along the left side. The lower end of this part leads into an S-shaped section, the sigmoid colon. 

The colon ends in the rectum. Waste is held in the rectum by a sphincter muscle until it is discharged through the anal opening. Peristaltic movements in the colon are normally slower than elsewhere in the digestive tract. Waste often requires 12 to 24 hours to pass through. The colon has no digestive function but it does serve a vital purpose in absorbing water into the blood to maintain the water balance of the body. 

Indigestible material, which enters the colon in a watery mixture, becomes nearly solid, because of the water absorption, by the time it reaches the lower end of the colon.

Even with the absorption of large quantities of water, feces still consist of two-thirds water. The remainder is made up of small amounts of food residue, bacteria, intestinal secretions, and intestinal cellular re- mains-the reason why feces are produced even during starvation. Under normal conditions, the amount of feces may vary considerably. 

On the average, about 12 ounces of chyme may enter the colon daily (somewhat more on a rich vegetable diet), and from this will be derived about 4 ounces of feces. Intestinal gas, or flatus, is natural. It is a mixture of swallowed air and gases produced by intestinal bacteria. The bacteria quite normally occupy the digestive tract; some contribute materially to health by producing vitamins. While waste products are excreted in the form of semisolid feces, some, including salts and proteins, are filtered from the blood, along with excess water, by the kidneys and excreted as urine. 

THE SMALL INTESTINE

The intestines, small and large combined, form a continuous tube from stomach to anus. The small intestine, so called because of its lesser diameter, plays important roles in both digestion and absorption. It is about 20 feet long, roughly four times as long as the large intestine, and resembles a coiled tube about one inch in diameter. The first part of the small intestine, the duodenum, begins at the pylorus of the stomach and extends about 12 inches, making several bends in the upper region of the abdominal cavity.

The duodenum joins the jejunum, a second region extending about 8 feet and less coiled than the other regions. The final, much coiled, region of the small intestine is the 12-foot-Iong ileum. As enzyme enters the duodenum, more digestive juices are added, not only by the intestine itself but also by the pancreas and the liver. 

Several enzymes in pancreatic fluid act upon all types of food-breaking down proteins into their amino acid constituents, converting large and complex sugar molecules into simple sugars, and changing fats to fatty acids. (Insulin is also secreted by the pancreas, but it goes directly into the bloodstream rather than into the intestine, where it would be destroyed by digestive juices; this is the reason why insulin, when required by diabetics, cannot be taken by mouth but must be injected.)

A discussion of oral drugs (not insulin) for use in the treatment of diabetes can be found on page 569. Bile enters the duodenum either directly from the liver where it is produced or from the gallbladder where it is stored. It serves to emulsify fatty foods, so they become easier to absorb, and to reduce the acidity of the chyme. Bile also functions as a carrier for the pigments of red blood cells that have been destroyed. 

These pigments, which undergo chemical changes in the intestinal tract, give the characteristic yellow-brown color to feces. While a limited amount of actual absorption of digested materials occurs in the stomach, it is in the small intestine that the bulk of absorption takes place. For this purpose, the walls of the small intestine are lined with tiny, fingerlike projections, the villi. Millions of villi give the mucous membrane lining the small intestine a velvety appearance. In constant motion, the villi keep the chyme mixed with digestive juices while carrying on absorption through two types of vessels.

Tiny, branching capillaries, smallest of blood vessels, form a network in each villus to absorb sugars and amino acids

 Other vessels, lacteals, contain lymph, a fluid present in the spaces between body cells. Fat products generally are absorbed by the lacteals. Indigestible food remains in the intestine. 

THE STOMACH

The stomach, which resembles a bag, is about a foot long and six inches wide. Its capacity is about two and a half pints, and a heavy meal may take as long as six hours to pass through it. The stomach wall has three layers of muscles-circular, Longitudinal], and oblique. tach contracts in a different direction, permitting the stomach to squeeze, twist, and churn its contents, actions that are important.

In addition to mucous glands, it contains other glands which secrete hydrochloric acid and several enzymes. One enzyme, rennin, acts on casein, a protein in milk, forming a curd to be digested by other enzymes. Lipase, an enzyme which splits some fats, including those in cream and egg yolk, plays a small role in the stomach, a larger one in the intestine. Hydrochloric acid helps in the digestion of proteins and has other useful chemical effects. 

Another enzyme produced by the stomach, pepsin, helps digest the milk curd resulting from the action of rennin. What emerges from the stomach after the activity there is a semifluid material called enthymeme. It takes little time, a matter of minutes, for fluids -water, beverages of various kinds-to pass through the stomach. But the rest of a meal spends from three to as much as six hours in the stomach.

The time is affected somewhat by the nature of the food. Carbohydrates pass through most quickly; proteins take longer; fats require the most time. Some fats, in fact, slow the digestive process in the stomach for other foods by slowing secretion of gastric juices, thus somewhat prolonging stomach emptying time.

 At both ends, stomach muscles form sphincters, ringlike valves. At the junction of stomach and esophagus, there is the cardiac sphincter. A similar but stronger valve, the pyloric sphincter, lies at the lower end of the stomach where it joins the small intestine. The two valves close the stomach during digestive activities. When chyme is ready to move on to the intestine, the pyloric sphincter opens and closes several times to allow the stomach to gradually empty. 

One phenomenon associated with the stomach is worth noting here. Somehow, the stomach, which secretes hydrochloric acid to digest proteins in foods, is not itself digested by the acid. How it resists the action of an acid that is capable of dissolving even iron is not fully understood. Yet it does resist, and it is normal to have a usual quota of acid in the stomach-this, despite the concern of millions of Americans who, with the help of constant reminders from the manufacturers of various ant- acids, spend about $100 million a year to neutralize stomach acid.