An Essay 
ON 
Habitual Constipation, 
BY 
S. J. DONALDSON, M. D. AN ESSAY 
ON 
HABITUAL CONSTIPATION. 
BY 
V 
S. J. DONALDSON, 
M. T)., Jefferson Medical College, Phila., Pa., Fellow New York, 
Medico-Chirurgical Society, Gynaecologist to the Ward’s 
Island Homoeopathic Hospital, New York City. Author 
of "A Treatise on Uterine Displacements.” “Con- 
tributions to Gynaecology,” “A Treatise on 
Uterine Catarrh,” “A Treatise on Dys- 
menorrhcea,” etc. 
PRESS OF 
E. P. COBY & CO., 
93 and 95 William Street, 
New York. Chapter I. 
ON. THE NATURE AND PRINCIPAL CAUSES 
OF COSTIVENESS. 
Habitual constipation is such an ordinary and 
apparently simple affection, that casually it may seem 
strange to make it the subject of an essay, but those 
who fully comprehend its significance, and realize to 
what extent it may embitter human existence, recog- 
nize in it a matter of vital importance. It would be 
an error to impute to the profession a spirit of indif- 
ference concerning this anomaly, for physicians have 
always been accustomed to bestow assiduous attention 
upon the state of the intestinal function, and were 
we to judge by their maxims and methods Ave might 
justly infer that activity of the bowel constituted, in 
their opinion, the prime factor in therapeutics. No 
one can be wrholly ignorant of the views entertained 
and stereotyped methods practised for the promotion 
of the visceral process. A review of medical literature 
shows that of all therapeutic measures advocated, 
those that stimulate or irritate the alimentary tract 
are the most popular, and one cannot fail to be 
impressed with the constantly recurring insistence 
upon the necessity of purgation for the relief of all 
manner of physical perversions. True, a broader 4 
knowledge of the action of drugs, a more correct 
comprehension of physiological laws, and a deeper 
penetration into the source and nature of disease, have 
latterly greatly modified medical doctrine and prac- 
tice in every department, and especially in the matter 
before us; nevertheless, although considerably 
moderated, it cannot be denied that the injurious 
methods born of previous erroneous customs are still 
largely in vogue. With a view to obtaining a more 
definite and comprehensive understanding of this 
important topic, I will endeavor in the following 
pages to consider, from a common-sense standpoint, 
the source, nature and rational management of con- 
stipation. In doing this I will be compelled to refer 
somewhat critically to prevailing doctrines and cus- 
toms, and in order that the argument may be pre- 
sented clearly and forcibly, will also be obliged to 
review certain physiological principles with which 
physicians are conversant. 
While chronic constipation obtains in both sexes 
and is highly detrimental to each, it is more especially 
so to the well being of women; we wfill therefore discuss 
the subject with particular reference to this fact, 
although the principles adduced and therapeutic 
measures commended will be applicable to the disorder 
wherever existing. 
Intestinal inertia is not only far more prevalent 
with women than with men, but owing to anatomical 
and physiological sexual peculiarities, it is fraught 
with more disastrous consequences. This inequality 
of occurrence in the sexes is due to several obvious 
influences. Accustomed neglect of physical exertion 
is highly conducive to intestinal torpidity. The rectal 5 
and pelvic tissues of the female are less resistant, and 
are not endowed with the same power of resilience 
possessed by the analogous male structures. Further- 
more, there seems to exist in the sex a peculiar inher- 
ent proclivity to procrastinate the act of defecation; 
also they are prone to indulge more largely in the use 
of unwholesome articles of diet. With them it is not 
merely the retention of irritating and noxious matter 
that engenders unfortunate complications, but the 
vascular and mobile character of the female gener- 
ative organs presents the most serious phase when 
associated with this abnormity and the consequent 
forcible efforts exercised in expelling accumulated 
hardened faeces. 
That we may intelligently discuss abnormal defe- 
cation it will he necessary first to refer briefly to some 
of the salient physiological features connected with 
the normally performed process. This will unavoid- 
ably necessitate the presentation of certain familiar 
and accepted principles, but we trust that later it will 
be recognized as appropriate to the objective point of 
our argument. 
It is not my intention to deal with that variety of 
constipation dependant upon mechanical obstruction, 
such as rectal stenosis, strangulated hernia, intussus- 
ceptions, etc., but simply with that form which is 
encountered under ordinary physical conditions. It 
is well known that the intestinal organs possess a two- 
fold physiological function, that of assimilation and 
elimination. The absorbent power of the large bowel 
is especially active, a fact corroborated by the experi- 
ence of any one having been compelled to resort to 
rectal alimentation. A careful consideration of the 6 
physiological action of the alimentary canal would 
be appropriate and profitable, but for the sake of 
conciseness we must limit our observations chiefly to 
that horseshoe-shaped lower portion designated the 
colon. A brief reviewal of its anatomical and phys- 
iological peculiarities may aid us in our deduc- 
tions. This organ we know is ordinarily one-fifth 
the length of the entire intestine, or more definitely, 
about the length of the body. Its caliber is from 1 )4 to 
2)4 inches, the widest portion being at its origin in the 
right iliac fossa, where the smaller intestine enters it at 
right angles, as if thrust through a slit made in its left 
side, which we recognize as the ileocaecal junction or 
valve. Concerning this opening it may not be irrele- 
vant to insert a few remarks. In several instances I 
have been strongly impressed by the erroneous ideas 
entertained concerning the nature of the ileocaecal 
valve. Repeatedly I have been cognizant of active 
but futile efforts made by medical men to project air 
or fluids per rectum into the ileum for the avowed 
purpose of dislodging an incarcerated portion of the 
small gut, or the disentanglement of a suppositious 
“knot” in the intestine. I have also heard physi- 
cians, as well as patients, positively declare that in 
certain cases of obstinate vomiting, liquids thrown 
into the rectum have found their way through the 
intestinal canal, and were ejected through the mouth. 
Now, it is absolutely impossible for this to occur, as 
the slit through which the small intestine opens is 
most effectually guarded by two semi-limar segments 
or lips. These labial folds, projecting their free mar- 
gins into the large intestine, offer no impediment to 
the full egress of matter from above, but are so Diagram representing the various abdominal organs and their relative 
positions : 
1. Inferior concave surface of the liver. 2. Round ligaments of the liver. 
3. Gall bladder. 4 Edge of the superior surface of the right lobe of the 
liver. 5. Diaphragm from which the anterior portion has been removed, 
along with the anterior truncal wall. 6. Lower segment of the aesophagus 
or gullet. 7. Stomach. 8. Omentum connecting the stomach with the 
liver. 9. Anterior border of the spleen. JO. Omentum connecting the 
spleen with the stomach. 11. First portion of the small intestine known as 
the duodenum. 12, 12. Convoluted mass of the small intestine. This di- 
vision of the intestine is usually about twenty-flve feet in length ; the large 
bowel is seen surrounding the mass of small intestine. 13. Beginning of 
the colon. This part is designated the caecum (blind pouch) x. Junction 
of the small and large intestine. The transverse slit into which the smaller 
bowel is inserted is situated at the inner and posterior portion of the caecum 
and forms wrhat is termed the ileocaecal valve. 14. Vermiform appendix— 
a small cylindrical tube from two to five inches in length, and about a third 
of an inch in diameter, communicating with the caecum; its use is un- 
known. It will be seen that the colon passes directly upwrard to the under 
surface of the right lobe of the liver; this division is called the ascending 
portion ; here it bends sharply and crosses to the opposite side, forming tte 
transverse portion, 15, 15. Just beneath the spleen it is again abruptly (re- 
flected, and descends to the left iliac, fossa, where it is doubled into the 
form of the italic letter S, forming what is known (16) as the sigmoid flexure. 
From thence it extends obliquely inward, backward, and downward, merg- 
ing into the rectum. 17. Fundus of the urinary bladder. 8 
constructed, and their coaptation is so perfect, that 
neither fluids or gases can, by any means, be made 
to pass from below upward. 
Owing to the remarkably sacculated conformation 
of the colon, its internal or absorbent surface is much 
greater than a casual observation would suggest. 
It will be remembered that while the large, like 
the small intestine, -has four coats, viz., serous, mus- 
cular, areolar and mucous, they differ decidedly in 
their distribution and histological aspects. The 
longitudinal muscular fibres, instead of being dis- 
posed evenly over the intestinal wall, are found 
chiefly in three bundles which extend from the blind 
pouch to the commencement of the rectum, and 
dividing the colon circumferentially into three longi- 
tudinal rows of sacculi. These bands being shorter 
by one-half than the actual length of the intermediate 
intestine, act like three puckering strings, hence the 
sacculated or pouched appearance of the colon. 
These pouches are again divided by crescentric 
ridges or folds, wherein the circular muscular fibres 
are ipost abundant, although the circular fibres are 
much more evenly distributed than the longitudinal. 
This sacculated condition is comparatively meagre in 
the infantile colon, and becomes more marked with 
age, especially where habitual constipation has existed. 
Where the sigmoid portion blends with the rectal, 
the sacculi suddenly disappear, and the muscular, 
longitudinal fasciculi speedily spread, forming a uni- 
form thick stratum. The circular fibres are distri- 
buted more evenly, thereby forming the smooth elastic 
muscular rectal wall. The mucous surface of the 
is peculiar; unlike that of the ileum, it is devoid 9 
of villi. The submucous coat through which ramify 
the blood vessels, nerves and lymphatics, rests loosely 
upon the muscular coat, while it is quite intimately 
attached to the mucous membrane. This loose 
attachment is especially marked along the rectal por- 
tion, hence the gliding, oscillating sensation experi- 
enced by the touch. 
If the external surface of the colon he examined 
with a lens, there will he discovered a remarkable, 
cribriform appearance. These crypts are the mouths 
of Lieberkulm’s follicles, and so abundant are they 
as to be estimated by millions. 
We have already referred to the absorbent ability 
of the large bowel; indeed, it appears that its grand 
function is that of inspissation. Below the stomach 
no portion of the intestinal tract manifests this 
imbibing power to such a degree as the lower third of 
the colon. Let us notice the manner in which this 
inspissating process is peformed. When the alimental 
material escapes from the ileum into the caecum, it is 
a thin chymous fluid. This grumous matter is now 
moved gently onward from one sacculus to the next 
by the rhythmic contractions of the muscular coats of 
the intestine, these vermicular movements passing 
slowly from behind forward, in successive wave-like 
motions. As the pulpified material moves onward, 
its liquid constituents are gradually taken up by the 
absorbents, so that by the time it reaches the sigmoid 
flexure it possesses a semi-solid consistency. When 
the mass enters the upper portion of the rectum, it 
has passed the boundary of the involuntary peristalsis, 
and its progress consequently is temporarily arrested— 
the drying process, however, still continuing. When 10 
there is a sufficient accumulation within the rectal 
ampulla the presence of the mass irritates the spinal 
nerves, and these solicit the attention of the cerebral 
ganglia. Should time and circumstances be favorable, 
the sympathetic ganglia also are notified, the distal cir- 
cular fibres relax and are pulled open by the power- 
ful contractions of the longitudinal fibres, the circular 
fibres behind vigorously contract, and the mass is 
expelled, the act being completed normally without 
any voluntary muscular effort. Most strenuously do 
we assert that the bowel possesses intrinsically all the 
requisite power for alvine expulsion, and maintain 
that the doctrines taught in our text-books claiming 
that diaphragmatic and other extrinsic voluntary 
influences are normal accessories, are not only 
erroneous but mischievous in their tendencies, since 
they engender and uphold evil habits. 
In studying the nature and history of habitual 
constipation, we will ordinarily be able to trace it to 
certain definite creative and perpetuating influences. 
There are a variety of these predisponents which may 
act singly or conjointly. As a comprehensive and 
sound diagnosis is indispensable to successful thera- 
peutics, we will study some of the more pronounced 
originating and establishing causes under their sepa- 
rate heads. 
1st. Negligence. 
2d. Lack of exercise. 
3d. Abuse of purgatives and laxatives. 
4th. The use of the rectal douche. 
5th. Voluntary muscular expulsive efforts. 
6th. Nervous derangements. 11 
NEGLIGENCE. 
In this age of emulation, where, in every depart- 
ment of life, the mental and physical faculties are kept 
continually at their highest tension, many, through 
ignorance of physiological laws or lack of due consider- 
ation, unconsciously form the extremely unfortunate 
habit of disregarding the regular daily require- 
ments of personal health. The ambitious literateur, 
the active merchant, the society devotee, have their 
minds so absorbed by their respective engrossing pur- 
suits, that from the moment of waking to that of 
sleeping, they will devote no time to commonplace, 
personal matters that can possibly be temporarily 
deferred. All are unduly hurrying to begin their 
arduous duties, which, once entered upon, demand 
such uninterrupted and assiduous attention through- 
out the entire day that it would be somewhat embar- 
rassing, and often impossible, to respond to the 
promptings of nature for the evacuation of the 
bowels. Nature has given to all a faithful monitor 
which attracts the attention of each individual for 
the expulsion of accumulated excrement at regularly 
recurring periods. This physiological phenomenon 
is subservient to will-power which enables man, to a 
certain extent, to direct and control times and cir- 
cumstances. Should these sensations be repeatedly 
ignored or long deferred, the regularity of their 
recurrence is destroyed. At first they will disappear, 
to return when circumstances admit of their receiv- 
ing due attention, but even then it will be found that 
the drying process and accumulation have been steadily 
progressing in the rectal receptacle, and accordingly 
the act will be accomplished with more difficulty. 12 
Should these natural promptings be systematically 
disregarded, they not only diminish in regularity and 
energy, but cease altogether, and respond only to the 
exercise of the will, or appear in the form of actual 
pain excited by the over distention of the bowel with 
the hardened mass. Every one knows how the 
healthy involuntary signals of the rectal nerves can 
be suppressed, as well as aroused by will-power, and 
it is equally well known that when the normal sensa- 
tions are wilfully and persistently disregarded, little 
by little this neglect destroys the healthy nervous 
action of the bowel, and in its place we have unwit- 
tingly established an inveterate enemy, and one not 
easily dislodged. And now, when too late, we realize 
that nature’s rules cannot be disregarded with im- 
punity, for, as heretofore, the will has arbitrarily 
exercised its domination in suppressing natural 
promptings, so now the perverted functions posi- 
tively refuse to respond to any effort of will-power. 
Not only does the prolonged presence of scybalae 
impair the normal sentient properties of the rectum, 
but the pressure of the retained mass induces atrophy 
of the muscular coats of the bowel, and through this 
atrophy and dilation the intestinal wall is rendered 
powerless, and, therefore, the peristalsis disappears. 
This condition is very common in women addicted to 
costiveness; here the rectal ampulla is greatly dilated 
and almost invariably filled with scybalae, while the 
rectal Avails will be found semi-paralyzed and thin, 
often bulging into the vagina, and in this way origi- 
nating rectocele. Even when the intestinal walls are 
normally conditioned, cases occasionally occur where 
the faeces accumulate and stretch the contractile 13 
fibres beyond their capacity, so that they lose their 
power to contract, to the great discomfort and 
embarassment of the individual; and when once sub- 
jected to this distending process, it requires pro- 
longed assiduous attention to restore them to their 
former state of tonicity. 
LACK OF EXERCISE. 
Physical inaction is another fruitful source of 
chronic constipation. It is a well known physiologi- 
cal fact that each part of the body reflects, to a 
greater or lesser degree, the condition of the whole. 
It is also equally true that negligence of physical 
exercise results in a corresponding degeneration of 
the unused tissues. 
If we would retain the normal integrity of the 
body, every portion of it should be subjected to a 
certain amount of regular healthful exercise, and a 
disregard of this principle entails a host of physical 
and mental ills. Without bodily activity the circula- 
tion of the blood is imperfectly carried on, digestion 
and assimilation are greatly impaired, the lymphatics 
and emunctories become clogged, and the system 
loaded with effete and noxious matter. The physical 
result of all this is depreciation of the vital fluids, 
and waste and enfeeblement of sustaining tissues, 
which may be substituted by unconsumed carbonace- 
ous matter in form of fat. The effect upon the 
mental faculties is a weakening and undermining of 
these faculties. As a natural associated sequence of 
this general torpor we have the intestinal canal loaded 
with residual debris and effete products. 14 
There are two classes subject to this form of costive- 
ness. The first includes those whose vocations 
presumably preclude to a great degree out-door pur- 
suits, or whose duties demand the exertion of only a 
restricted portion of the body. In this class are 
bookkeepers, tailors, seamstresses, etc. The other 
includes mainly those in the higher social ranks, who 
lead an indolent life, and who, from sheer laziness, 
decline to avail themselves of the benefits to be 
derived from activity. In this latter order are often 
found our most intractable cases, for through the 
enervating influences of a sedentary life, and a native 
stolidity or mental torpidity, it is almost impossible 
to arouse in them a just appreciation of the impor- 
tance of physical recreation, or to obtain from them a 
faithful compliance or even satisfactory comprehen- 
sion of the principles however faithfully presented. 
Few abnormities are more vexatious and unsatisfac- 
tory to treat than habitual costiveness dependant 
upon slothfulness of mind and body. Indeed, 
nowhere do physicians encounter more exasperating 
cases than in these patients who, through obnoxious 
customs and self-sufficiency, have become indifferent 
and often averse to the dictates of reason. Admonish 
them with all earnestness, and they will listen com- 
placently and tacitly adhere to their previous opin- 
ions and vicious habits. Insist that common-sense 
practicalities be respected, and in all probability you 
will, ere long, be superseded by some obsequious 
person, who, with a view to self-aggrandizement, is 
ever ready to pander to the perverse views of the 
shallow-minded. 15 
ABUSE OF PUKGATIVES AND LAXATIVES. 
Many of us who graduated ten years ago will 
remember that the professor in obstetrics recom- 
mended that a gentle purge be administered to the 
infant a few hours old. That this was formerly 
deemed a commendable expedient, older physicians 
and nurses can testify. To what extent this custom 
prevails to-day the writer is unable to state, but, 
doubtless, it is considerably modified. In this we have 
a very suggestive feature for our consideration, as with- 
out question the misery arising from habitual consti- 
pation ofttimes has its foundation in the mischievous 
drugging of childhood, from which time the animal 
economy has been systematically ruined through the 
evil practice inaugurated in the cradle. Were we to 
judge by the precepts and practice of the masses, we 
would certainly infer that “an open state of the 
bowels ” constituted the sine qua non of their phys- 
ical well-being. To this end there is a brisk demand 
for all kinds of patent drugs, aperient waters, and a 
host of cathartic compounds that flood the country 
and are dispensed in such enormous quantities. One 
manufacturer assured me that he alone sold annually 
over seven tons of his cathartic pills. So infatuated 
are the majority with this wretched doctrine that a 
feeling of malaise immediately suggests some anom- 
aly which they designate as “torpidity of the liver,” 
“biliousness,” or some other ill-defined malady which 
they conceive lurking among the visceral organs, and 
straightway bring to bear the artillery of their pur- 
gative armamentarium for the dislodgement of the 
ideal foe. 16 
If a sensation of unusual lassitude, headache, indi- 
gestion, sleeplessness, flatulency or other discomfort 
is experienced, a “blue pill,” an “anti-bilious” pill, 
an “ aperient ” or “ opening pill ” is at once resorted to, 
either self-prescribed or gratuitously recommended by 
some injudicious friend, who has always on hand 
a remarkably effective article. There is no neces- 
sity for applying to the physician, as every pharmacy 
is replete with all these nostrums, and often presided 
over by consequential officious persons ever ready to 
offer their personal advice. The public have but 
slight knowledge of how much of the misery of life 
originates in the individual patronage of this wide- 
spread evil, nor how the road to a lucrative professional 
practice is paved by this ill-advised custom. But how 
is it that this unfortunate habit has so obtained with 
the masses in every civilized country, that the com- 
mon ailments of the body are largely associated with 
the notorious idea of purgation? As an aid in 
answering this question let us refer to the medical 
literature of the past century. A review of the 
teachings therein advanced on constipation is highly 
interesting, not from any absolute merit it possesses 
(for in this respect it is wretchedly meagre), but it 
displays a monotonous insistance of the necessity of 
purgation in some form or degree. In the earliest of 
these writings we even find “blood-letting” and 
“active emesis” combined Avitli the administration of 
drastic catharsis recommended for chronic costive- 
ness. Later, or about the middle of the present cen- 
tury, we miss the phlebotomy and vomiting, and only 
active purgatives are recommended, such as large 
doses of jalap, sulphate of magnesia, calomel, 17 
mandrake, aloes, colocynth, and even croton oil, given 
usually in combination with several other ingredients. 
The minds of the authors are evidently imbued with 
the belief that their duty was not correctly performed 
unless the catharsis was pushed to the extreme, for 
we are assured that unless the purgation be “thor- 
ough,” or “brisk,” or “full and active,” masses of 
alvine matter may remain, and that the “habit” will 
not be “brokenup.” Furthermore, they recommend 
a “ course ” of purgation, that is, a repetition of the 
process with a certain number of days intervening. 
As we approach the present period we find laxatives, 
electuaries, massage and dietetics advised, and there 
has crept in a tone of disaproval of drastic cathar- 
tics. Some of these modern writings contain really 
excellent hygienic doctrine, but with hardly a single 
exception the teaching is rendered null and void by the 
final advice,—the employment of aperients or laxa- 
tives. One advises a pill of aloes and strychnia after 
each meal, or a larger single dose on retiring. 
Another commends some one of the numerous aperi- 
ent “saline” or “mineral” waters in sufficient 
quantity to secure solvency of the alvine matter. 
Humiliating then, as it may be, it cannot be denied 
that the fons et origo of this universal custom of 
resorting to cathartics, with all the wretchedness 
entailed, is found in the orthodox precepts of the 
medical profession. 
The multitude of laxative compounds advocated 
and employed to stimulate the intestinal func- 
tion need not be enumerated. That this method 
of therapy is diametrically opposed to sound 
reason is plain to all who are acquainted with the 18 
action of drugs. Not a single medicament can be 
instanced that does not exert its primary and second- 
ary physical effect, in every case the secondary being 
opposite to and more abiding than the primary. As 
an illustration take alcohol. Its first action is stimu- 
lation, its second depression. The action of narcot- 
ics is to produce sleep, but this is invariably followed 
by a period of obstinate wakefulness. The adminis- 
tration of digitalis or veratrum viride in doses suffi- 
cient to decrease the activity of the heart is followed 
by accelerated action. Were it necessary the demon- 
stration of the duality of drug action could be 
extended indefinitely. 
Another well-known feature in therapeutics is, that 
the system becomes so inured to the drug to which it 
is repeatedly subjected, that to overcome this inure- 
ment, together with the acquired opposite state which 
follows upon its previous action, a successive increase 
must be made in the dose administered: hence a man 
who can originally induce sleep on the eighth of a 
grain of morphine, will, through repeated indulgence, 
be compelled to take ten times the amount before a 
corresponding soporific effect is secured. Nowhere is 
the double action of drugs more clearly displayed 
than in the administration of cathartics. Every one 
who has observed or experienced the action of purga- 
tives will acknowledge that a dose of castor oil, sul- 
phate of magnesia, rhubarb, jalap, mandrake, or any 
other cathartic, is assuredly followed secondarily by 
costiveness. And yet, confronted with this evident 
fact, the profession, as well as the laity, act in direct 
opposition to a law as apparent as that of gravita- 
tion. 19 
USE OF THE RECTAL SYRINGE. 
Some years ago the recognition of the insufficiency 
and evil results of purging for the relief of intestinal 
torpidity, originated the practice of applying solvents 
directly to the retained matter. The use of the rec- 
tal syringe has been highly extolled by many, and, 
a priori, it does seem more philosophical in its work- 
ings, and fraught with less serious consequences, than 
that which necessitates the disturbance of the entire 
alimentive apparatus. The daily employment of the 
syringe has been advocated by the majority in the 
profession, including the highest authorities in both 
schools, and now let us look into the wisdom of this 
advocacy. Nothing is more readily demonstrated 
than the certainty that nature resents all officious 
interference with the normal performance of her 
duties. If we presume to take the responsibility of 
supplying an artificial process for the natural one, 
nature either directly repels our intrusion or with- 
draws her services, and relinquishes to us the task. 
A dry, harsh condition of the hair succeeds the appli- 
cation of grease. The auricular canal and tympanum 
are rendered parched and irritable by the repeated 
use of artificial lubricants. The natural pliancy and 
moisture of the skin can be destroyed by the con- 
tinued employment of oil, and so throughout every 
physiological feature of the body, nature is eminently 
conservative and will brook no encroachment. The 
use of the rectal syringe still further emphasizes this 
principle. Those having studied this matter will 
testify that the lifeless condition of the rectum conse- 
quent upon a prolonged use of the syringe or rectal 
suppositories is infinitely more difficult to overcome 20 
than the worst form of costiveness dependent upon or- 
dinary conditions. The lower bowel is endowed with 
a myriad of muciparous glands for the supply of a 
natural solvent. If an artificial one be substituted, 
and its use persisted in, the glandular structures 
whose function is the secretion of intestinal juices for 
the maintenance of normal solvency and easy expul- 
sion of the alvine excreta, soon become inactive and 
finally atrophied through disuse and the application 
of mischievous irritants. 
In the face of the foregoing incontrovertible facts, 
catharsis is persistently advocated by the profession, 
and the habitual use of the syringe extolled as a 
“blessing” for the relief of intestinal torpidity. It 
is difficult to excuse such a widespread fatuity among 
men enjoying to such an extent opportunities for 
practical observation, and to whom the faculty of 
intelligent discrimination is so universally accredited. 
A certain writer has recently denied to physicians, as 
a class, the right to be enrolled among thinkers, and 
surely we can hardly defend ourselves against the 
imputation, when we are confronted on every hand 
with practices wherein philosophical principles are 
habitually ignored, and short-sighted, reprehensible 
methods upheld; where established opinions are zeal- 
ously cherished and prosecuted, and where every new 
doctrine that opposes accepted beliefs is ridiculed or 
bitterly denounced. In the matter before us we 
have a good illustration of this blind adherence to 
ancient precepts, as well as a proof of this deficiency 
in the exercise of the reasoning powers, for wherever 
obstinate costiveness is complained of, we find medi- 
■cal men commending therapeutic agents the ultimate 21 
effect of which is the manifest creation and es- 
tablishment of the morbid condition which their 
use is supposed to relieve.. Any observer of the dual 
action of purgatives will readily perceive the absurdity 
of all this, nor is the folly lessened by the mere 
diminution of the dose; for the principle and final 
result are the same, being only a question of time and 
degree, mild doses leading up to and demanding 
larger quantities. Let it not be inferred that we 
unqualifiedly prohibit catharsis or the use of the 
syringe, for there are recognized cases where the 
well-being of patients demands an efficient cathartic 
or rectal enema, as when there exists an impac- 
tion of hardened faeces within the bowel, but 
these occasions are comparatively rare. It is the 
mischievous and systematic repetition of this form 
of treatment that merits condemnation. If we 
would avail ourselves of the legitimate curative prop- 
erties of laxatives let them be administered appro- 
priately, in repeated small doses, for the relief of 
diarrliceas, when they will yield brilliant results. 
VOLUNTARY MUSCULAR EXPULSIVE EFFORTS. 
We have previously referred to the habit of strain- 
ing at stool as one of the predisponents to costive- 
ness. When voluntary expulsive efforts are habitually 
made the intestinal peristalsis is proportionately 
destroyed through disuse, and consequently the 
intestinal wall becomes more passive and its tissues 
less resistent; therefore the caliber of the tube 
increases and the sacculi deepen. Not only is the 
peristaltic action of the bowel impaired, through the 
influence of extraneous efforts, but the rectal, perineal 22 
and pelvic tissues are injured by this straining. It 
is not necessary to describe the general turgescence 
that accompanies each effort. So markedly do these 
efforts affect the entire vascular system that remote 
parts, such as the tissues of the hands and face will 
for the moment be visibly injected. How much 
greater must be the determination of blood to the 
parts directly involved may readily be infered. These 
parts, it must be remembered, abound more fully in 
areolar tissue and valveless veins than any other por- 
tion of the body, and therefore are highly susceptible 
to congestion and subsequent deterioration. When 
habitual forcible defecation is practised the walls of 
the pelvic blood-vessels gradually lose their resilience 
and dilate. The capillary circulation becomes weak- 
ened and the insufficiently-nourished tissues lose their 
tonicity and degenerate, although their actual 
bulk may increase through blood stasis. Later, we 
have the enormously dilated capillaries coalescing and 
forming sinuous meshes, as witnessed in hemorrhoidal 
development, which is merely a tangible expression 
of that which is occurring in less visible structures. 
While violent expulsive efforts often seriously affect 
men, producing hemorrhoids, rectal prolapsions, 
prostatic enlargements, &c., the consequences are 
infinitely more disastrous to women. The pelvic 
structures in the female are pre-eminently unfortu- 
nate in their construction, situation, and attachment, 
when considered in connection with those influences 
which contribute to turgescence and, at the same 
time, to depression. They are highly endowed with 
blood-vessels which ramify largely through loose 
areolar tissue, while their attachments to firmer 23 
surrounding structures are notably yielding. Super- 
added to these conditions, the pelvic floor presents 
a very imperfect support to these mobile organs. The 
outcome of all this may be described as follows: 
When a woman assumes the position necessary to 
defecation, and vigorous expulsive efforts are made, 
all the pelvic parts become engorged and are forced 
toward the outlet. The continuation of this vicious 
habit is invariably followed sooner or later with 
serious consequences. From it we have first blood 
stasis, with consequent devitalization of the textures, 
followed by prolapsions of the uterus, rectum, 
vagina, bladder and ovaries. 
As illustrative cases are always instructive, a report 
of the following typical case may aid us in portraying 
the evil consequences of habitual catharsis, rectal 
enemas, and forcible defecation combined. Mrs. 
, aged 39, a strong, robust woman, possessing 
naturally an excellent constitution, relates the follow- 
ing history: Has always been in the habit of taking 
purgatives to correct “ biliousness,” she being natu- 
rally an immoderate eater of the richest food. Con- 
fesses to having taken massive doses of “rhubarb,” 
“salts,” “jalap,” etc., and to have faithfully tested 
the reputed virtues of all the popular cathartic pills, 
drastic compounds, and other nostrums familiar to 
this class of patients. When the power of one form 
of cathartic was exhausted, she would resort to another 
more active. Declares that she customarily takes 
four times the amount specified without obtaining 
satisfactory results. About the age of thirty-five, 
suffered greatly from piles, which she says were cured 
by a “ course ” of sulphur and tar. She was next 24 
troubled with indigestion, and her medical attendant 
advised her to substitute the use of the syringe for 
the usual purgation. For about a year this advice 
was followed, with apparently happy results, but in 
time this procedure also began to fail, although the 
syringe was most faithfully employed. At the time 
of our consultation she is suffering from dyspepsia 
and great pelvic discomfort. She endeavors to evacu- 
ate the bowels twice a week, which is accomplished 
bv the combined use of cathartics and enemas. 
Before retiring, she.swallows a large portion of some 
cathartic, and injects into the rectum about half a 
pint of warm water and olive oil, which is retained, 
if possible, until morning, when she again employs a 
full rectal enema, which she js often obliged to 
repeat, and, after all this, is obliged to strain vio- 
lently to rid the bowel of the partially dissolved scy- 
balae. After the operation, the parts are swollen and 
congested, and she is forced to lie down on account 
of the dragging, throbbing, and aching through the 
pelvis. The rectum is lax and capacious, with its 
mucosa swollen and prolapsed; uterus and vaginal 
walls are engorged and also somewhat prolapsed, 
secreting a profuse catarrhal discharge. All of these 
abnormities are directly dependant upon the difficulties 
connected with the inertia of the bowel, the origin of 
all her suffering being unquestionably the ill-advised 
use of cathartics. 
This may justly be regarded as a severe case, but is by 
no means an exceptional one, for it is unfortunately a 
familiar picture to the eye of the physician. The 
majority of women who are the victims of habitual con- 
stipation and addicted to expulsive efforts, experience 25 
to some degree dragging lumbar pains and pelvic 
discomfort following the act of defecation. Many of 
them confess that during the efforts the womb is 
pushed down and presents itself at the vaginal 
entrance. It is evident that the prolonged repetition 
of this pernicious custom must eventually result in 
prolapsions and other unfortunate complications of 
the female generative organs. From careful observa- 
tion I am convinced that the greater proportion of 
dislocations of these organs is directly traceable to 
evil habits connected with constipation, and conse- 
quently it is utterly impossible to achieve success in 
the management of thgse anomalies until we cor- 
rectly deal with the prime causative factor. 
XERVOUS DERAXGEMEXTS. 
To the reflecting physician frequent opportunities 
are offered for observing the sympathy existing 
between the cerebral and visceral organs, which rela- 
tionship is most clearly pronounced in nervous or 
delicate organizations. 
As an illustration of this sympathetic affinity we 
may cite the phenomena of palpitation, dysuria, or 
diarrhoea, consequent upon the relaxing influence of 
fright or mental trepidation; also that of indigestion 
and hepatic derangements from mental worry or 
excitement. Conversely, the mental faculties may 
be greatly modified by reflections from physical con- 
ditions, as for instance, after a full meal a sensation 
of drowsiness and mental lassitude will supervene. 
It is physologically well known that the nerve fluid 
or vital force can be diverted and concentrated upon 
one predominating process. If the digestive process 26 
be for the time in the ascendant, and there is no 
special demand for mental labor, the brain lends its 
nerve force and becomes temporarily dormant; if, 
on the contrary, mental activity be dominant, then 
the supreme nerve ganglia commands the entire nerve 
force. Since the well-being of the human economy 
depends so manifestly upon the working in harmony of 
the mental and physical faculties, it can readily be con- 
ceived in what manner certain influences, directly 
destroying this equilibrium, might result in the per- 
version of the intestinal function, and thus engender 
costiveness. It would be impossible to describe in 
detail the manifold phases involved in this prin- 
ciple. 
We frequently hear business and literary men 
assert that their bowels are always disordered when 
undergoing some severe mental ordeal, while, on the 
other hand, if surrounded by pleasant circumstances 
no difficulty of that nature is experienced. There is 
still another, a nervously introspective class, who seem 
possessed with an all-absorbing idea of the vital impor- 
tance of daily defecation, and are so deeply impressed 
with the thought of the direful consequences that 
must inevitably follow a failure in this respect, that 
through sheer over-anxiety the process is perverted. 
Naturally such individuals soon become the victims 
of drugging and rectal enemas, and furnish our most 
inveterate cases. 
Acute mental emotion, fright, worry, etc., very 
commonly induce temporary diarrhoea; when, how- 
ever, the morbid excitement has been of so long dura- 
tion that the nervous system has thereby become 
more or less unhinged, we have, as a rule, a very 27 
intractable form of intestinal inertia. This phenom- 
enon is especially marked when the affliction is fol- 
lowed by a state of protracted despondency, and 
constant apprehension of impending evil. 
The remarkable sympathy existing between the 
cerebral and intestinal organs is displayed in the 
semi-paralyzed state so prevalent among those pa- 
tients afflicted with melancholia or aberration of the 
mind. Lack of space forbids fuller consideration of 
this most important phase of our subject, but we 
cannot too strongly emphasize the significance of 
psychical phenomena, for therein will often be found 
the key for the solution of the perplexing problem. 
In the foregoing pages the nature and prominent 
sources of constipation have been briefly considered, 
and we recognize numerous minor phases not referred 
to, but these will be found to hinge largely upon the 
salient points heretofore advanced. 
Before entering upon the discussion of the manage- 
ment of constipation, we will make a passing com- 
ment upon the morbid physical perversion which may 
be provoked by the prolonged retention of alvine 
matter within the bowel. The physical expressions 
arising from habitual costiveness are both approxi- 
mate and remote. To the local disturbances already 
alluded to, we may add those arising from the accu- 
mulation of scybalae along the bowel, the presence of 
which may prove a source of considerable topical irri- 
tation in the form of colic, neuralgia of the ovaries, 
catarrh of the intestine or uterus, and irritability of 
the bladder. Beside these local complications there 
is a train of more remote expressions engendered, of 
which due cognizance must be taken. Throughout 28 
the entire gastrointestinal apparatus there exists a 
manifest solidarity of action, so that anything dis- 
turbing or interfering with the function of the lower 
portion is reflected throughout the whole alimental 
organs. If the peristalsis of the colon be torpid, the 
ileum will act sluggishly and the gastric function also 
becomes enervated. When those organs through 
which the portal veins ramify, perform their office 
imperfectly, the disturbance reacts upon the liver, 
causing serious derangement of that complex organ. 
Furthermore, physiology teaches the existence of a 
remarkable degree of fellowship between the excre- 
tories, so that when the function of one is suspended 
the others extend their aid to that which is disabled, 
and in this way vicarious depuration is established. 
Let us note how this is displayed in connection with 
our subject. We have already referred to the two- 
fold function of the colon, viz., excretion and absorp- 
tion; therefore, when the disintegrated alvine matter is 
willfully or unavoidably retained within the bowel 
far beyond the healthful period, nature attempts to 
rid the system of the excrementa through other 
channels, therefore, a part of the putrid matter is 
absorbed-, metamorphosed, enters into the circulation, 
and finds its exit by other emunctories, viz., the kid- 
neys, skin and lungs. The laws of nature cannot be 
thwarted with impunity, and in this case the penalty 
is just, severe, and appropriate. As might naturally 
be inferred, the entering into the circulation of excre- 
mentitious matter constitutes a form of blood poison- 
ing. As an expression of this blood deterioration, 
the extremities become cold and clammy, with oft- 
times a sensation of numbness and formication. The 29 
cerebral ganglia are also affected, as shown in forget- 
fulness, difficulty in concentration of the thoughts, 
drowsiness, melancholy, headache, etc. The sleep is 
disturbed by evil dreams, and a sensation of extreme 
weariness prevails on awakening. The eyes grow 
muddy and lustreless, with dark rings underneath. 
The skin becomes pallid and sallow, and is subject to 
eruptions, often emitting an offensive smell. The 
disgusting characteristic odor of the exhaled breath 
proclaims unmistakably the part which the lungs 
have to play in this vicarious elimination of trans- 
formed alvine excreta. 
Beside the general depreciation, the organs directly 
involved in the supplemental depuration soon become 
impaired and in time seriously diseased. 
Any one would naturally suppose that this obnox- 
ious physical state would be oftener found in the lower 
classes, but, remarkable as it may seem, experience 
warrants the assertion that it is by no means excep- 
tional among those who, judging from their surround- 
ings and exalted sentiments, would indignantly 
resent any imputation of willful neglect in the mat- 
ter of physical purity. Chapter II. 
THE TREATMENT OF CONSTIPATION. 
A priori nothing would seem more simple than the 
treatment of constipation. A mere tyro in the heal- 
ing art can, whenever the occasion demands, select 
and administer some one of the familiar cathartics in 
sufficient quantity for the stimulation of the sluggish 
bowel. The proceeding appears to so entirely meet 
the requirements of the moment, and is, withal, so 
readily accomplished, that the majority deem it un- 
necessary to seek professional advice for the relief of 
that which seems so trivial a matter ; hence self-pre- 
scribed catharsis is everywhere customary, the phy- 
sician being consulted only when the ordinary means 
have failed to produce the desired -effect, and when 
this occurs, the anomaly has, as a rule, assumed an 
exceedingly intractable form, and may test professional 
skill to the utmost. To deal intelligently with these 
cases, it is absolutely necessary for us to enter into a 
most thorough investigation of all the details of each 
individual case, as regards temperament, personal 
habits and constitutional peculiarities, since a full and 
intelligent analysis of these can alone guide us to a 
successful issue. Unfortunately, the investigation 
usually accorded these cases by the physician is super- 
ficial, and they are disposed of summarily with methods 
that inevitably add to the obstinacy of the malady. 
If any one doubts the justness of this representation, 32 
let him visit any of the principal dispensaries and ob- 
serve the inauguration of ordinary therapy employed. 
Let him also study that which is prescribed for 
patients in a higher social scale, and he will learn 
that almost invariably the one class is treated with 
crude laxatives, the other with aperients more deli- 
cately prepared in the form of granules or effervescing 
draughts, but the immediate object to be obtained in 
either case is the same, the final consequences alike 
injurious, and the predominating spirit equally repre- 
hensible. So far as the ultimate misfortune is con- 
cerned, it is of slight consequence whether the cathar- 
tic be a fulsome portion of jalap, or a savory elect- 
uary—a dose of salts or castor oil, or an effervesc- 
ing draught of aperient water, or deftly-coated 
granules. On every hand and in every department 
we encounter this error, and we soon learn that the 
contravention of a universal custom in vogue for ages, 
and that has been sanctioned by the highest authori- 
ties, is an almost hopeless task. Furthermore, 
nothing is more distasteful to the ordinary mind 
than doctrines drawing upon the reason, or en- 
croaching upon time-honored beliefs. Advance to 
the masses some vague theory calling the imagina- 
tion into full play, and let it be never so absurd, pro- 
viding it savors of the inscrutable, it will be eagerly 
accepted. 
In dealing with the matter under consideration, we 
will find a striking illustration of this subjective 
phenomenon. Explain the laws of physiology in the 
simplest and most comprehensive manner, illustrate 
your argument by practical as well as philosophical 
data, and the majority will listen complacently, and 33 
will, in all probability, in the near future, ask you 
for an “ opening pill,” a “ cooling purge,” or some 
“ anti-bilious ” compound. Should they be considerate 
of your sensibilities they may give way sufficiently to 
pursue their previous course surreptitiously, obtaining 
their fresh drugs from some other source. Many a 
physician who realizes the baleful effects of cathartics, 
yields his better judgment to the importunities of 
some irritable patient, who will be content with 
nothing but an immediate demonstration of the effi- 
cacy of drugs ; therefore, to obtain the confidence of 
his patient, the physician violates his conscience, and, 
for the time being, descends to the level of an illiterate 
pill vender. 
We will find that more than ordinary tact is required 
to cope with this prejudice in favor of established 
customs, which constitutes a prime obstacle in the way 
of our success. Unless we can obtain the full and 
intelligent cooperation of the patient in this respect 
the outlook is unfavorable. For the attainment of 
this object we must employ such explanatory argu- 
ments as are applicable, clothed in clear and unmis- 
takable language. In ascertaining the history of the 
complaint we will often be informed that it is inher- 
ited, but we will do well to discriminate between a 
transmitted constitutional anomaly and a vicious 
custom that originates the defect. We fully recog- 
nize the fact that intestinal tonicity varies greatly 
in different constitutions, some being predisposed 
to laxity on slight provocation, and per contra, 
but we believe that costiveness as a disease per 
se is rarely inherited ; while, on the other hand, 
the habits which give rise to the anomaly are very 34 
commonly bequeathed from one generation to another, 
until finally the disturbance artificially originated 
may merge into an organic transmittible dyscrasy. 
Again, we should not restrict our investigation to the 
tracing of the general outlines, such as the history of 
the case, methods resorted to for its relief, effects of 
different agents employed, nature of diet, digestion, 
personal habits, amount and kind of physical exercise, 
occupation, etc. All these are cardinal features, and 
must be carefully noted in our management, but they 
are hardly more essential contingencies than others, 
seemingly more remote ; therefore we pass further on 
and study the constitutional dyscrasia, when possibly 
we may find that the abnormity is engrafted upon a 
strumous diathesis ; as, for instance, a previous skin 
eruption may have been transferred to the internal 
surfaces, thereby perverting the function of the 
mucous follicles. The idea generally obtains that in- 
testinal catarrhs invariably tend to diarrhoea, but the 
opposite is often the fact. 
Furthermore, there may exist some neurotic affec- 
tion in the background, as a spinal lesion may 
first be manifested by intestinal inertia. The 
hysterical and emotional elements are worthy of 
especial consideration, since they not unfrequently 
promote the worst forms of the disease. Indeed, it 
is impossible to present all the various phases which 
must be included in our discrimination, for the 
more obscure psychical conditions peculiar to indi- 
vidual cases should receive equal attenion with the 
salient physical and mental phenomena. Manner, 
speech, tone of voice, facial expression, are all suggest- 
ive, and their subtle changes and delicate shading 35 
frequently reveal an indispensable indication often 
tending to modify the views obtained from the more 
manifest pathological expressions. 
DISCONTINUANCE OF HABITUAL DRUGGING. 
Having outlined tlie ordinary diagnostic features, 
let us revert to the discussion of the details of our 
therapy. In the first place, we will usually find in 
these patients various habits which it will be neces- 
sary to correct. Let us suppose that the patient has, 
from long usage, become dependent upon artificial 
agents for the stimulation of the intestinal peris- 
talsis. Shall their use be abolished abruptly and un- 
qualifiedly, or shall they be gradually discontinued ? 
Certainly the latter course seems the more natural 
and feasible, but actual experience proves that it is 
not the successful one, and when we reflect for a mo- 
ment we will perceive that a gradual weaning from 
the use of purgatives is not a rational method, since 
through the secondary effect of the irritant an occa- 
sional dose or enema cancels the advantage that may 
have been obtained from a period of abstinence. A 
decrease of the size of the dose will not only fail to 
accomplish the purpose for which it is given, but will 
invariably increase the pre-existing difficulty. 
Patients should be made to fully comprehend this 
matter if possible, that they may intelligently sub- 
mit to the absolute banishment of every form of laxa- 
tive drug and rectal enema. Of course, we concede 
that there are circumstances where a purge or rectal 
enema is indispensable, as for instance, when physical 
exercise is inadmissible through accident or surgical 
procedures, or where through neglect the bowel has 36 
become impacted and paralyzed with a large accumu- 
lation of hardened fasces. For reasons previously ex- 
plained, patients should be instructed to abstain as 
much as possible from expulsive efforts during defeca- 
tion. By persistently refraining from these, they will 
find that the normal extruding power (the peristalsis) 
will gradually develop, and become altogether suffi- 
cient. This suggestion (as heretofore illustrated) is 
especially important when dealing with costiveness in 
women. 
The above views are advanced advisedly, after care- 
ful deliberation, and based upon extensive observa- 
tion ; but at the same time we are conscious that 
they will encounter opposition from the generality of 
patients, and many physicians. Nevertheless we are 
confident that this oppugnancy will diminish after 
careful reflection, and disappear entirely upon faith- 
ful practical application. 
The situation now suggests the question—what ex- 
pedients shall be substituted for these discarded agents, 
in order that the normal evacuation of the bowels 
may be accomplished ? There are various means 
which we will have to call into requisition more or less 
simple, familiar and effectual, but very imperfectly 
appreciated by the masses. Should constitutional 
indications be manifest, it is presupposed that the ap- 
propriate internal remedy is administered ; these we 
will discuss later. 
PHYSICAL EXERTION AS A REMEDIAL AGENT. 
Those who have read the previous pages will, doubt- 
less, anticipate that which we have to say regarding 
the merits of e-xercise. All that has been advanced 37 
concerning inactivity as a prominent cause of cos- 
tiveness, might be reiterated and still farther elab- 
orated. The value of exercise as a remedial means 
for constipation cannot be overrated, yet the vital 
relation it sustains to the physical economy is recog- 
nized by comparatively few ; it is intimately associ- 
ated with respiration, and scarcely less indispensable. 
Let us notice more definitely the relation exercise 
hears to the accomplishment of our purpose. First 
it dislodges effete cell product, promotes the function 
of all the absorbents, quickens the circulation, and 
secures the elimination of tissue debris. It deepens 
and increases respiration proportionately, so that 
a man walking six miles an hour imbibes eight times 
as much oxygen as when inactive. Now, physiology 
proves that there is no more efficient chologogue and 
laxative than oxygen. The inhalation of oxygen 
artificially obtained will often secure an elimination 
of bile and induce catharsis, where “ blue pills” and 
other chologogues have failed. Beside the elimina- 
tion of noxious elements and greater appropriation of 
oxygen, secured through physical exertion, there 
ensue direct mechanical results. The increased rise 
and fall of the diaphragm produces a corresponding 
motion of all the abdominal organs, and the alternate 
contraction and relaxation of the abdominal muscles 
likewise promote the function of the subjacent or- 
gans. It would be indeed exceptional to find an 
oarsman, a wood-chopper, an active farmer, or a pe- 
destrian troubled with inertia of the intestine, unless 
induced by recent or habitual purgation. The writer 
cannot recall a single instance where actual constipa- 
tion has existed in men following these or similar 38 
active pursuits. Let it not be supposed that an air- 
ing in a cushioned carriage, or a loitering stroll, 
represents our conception of exercise. To be effectual 
it should be performed judiciously and energetically, 
begun discreetly, practised daily, and increased as 
strength develops. The action should be brisk to 
deepen the respiration and quicken circulation, bnt 
should not be continued to actual fatigue. Occasion- 
ally patients will overexert themselves, and experience 
unfavorable effects, thereby not only incapacitating 
themselves from further effort, but acquiring a decided 
distaste for future attempts. It is most surprising 
to witness the prevailing disinclination to out-door 
exercise everywhere evinced by those unaccustomed 
to it. Some are by nature indolent, but the chief 
source of this manifest unwillingness is the enfeeble- 
ment consequent upon the disuse of the muscles. 
Hence it occurs that no sooner is exercise advised 
than these patients advance a thousand pretexts to 
show the impossibility of its fulfillment. Lack of 
time, strength, means, circumstances, are but a few 
of those that will be presented. The seamstress, 
tailor, bookkeeper and school teacher live as near 
their places of business as possible. The merchant, 
lawyer and banker, ride to their offices, the busy 
housekeeper finds no leisure moments from her 
duties, while the wealthy and indolent limit their 
sphere of action to the drawing-room and easy car- 
riage. The natural result of all this is, atrophy of 
the muscular system, and a corresponding inability 
and aversion to physical efforts. 
It is a fortunate coincident, that with the develop- 
ment of physical power, there is a corresponding 39 
increase in the desire for activity. This is a beneficent 
law, and should be more fully respected. Could 
humanity be everywhere made to appreciate the 
advantages and actual pleasure accruing from well- 
regulated bodily activity, it would be eagerly prose- 
cuted. The fact will suggest itself, that there are 
many instances where, through disease or other 
misfortune, the individual is incapacitated, and 
so debarred from the benefits to be derived from 
exercise. When this occurs, artificial or passive mo- 
tion in the form of massage should be substituted. Not 
only should the abdomen be intelligently kneaded, 
but the tissues of the entire body should likewise be 
manipulated in a practical manner, always beginning 
at the distal extremities. The patient should also be 
instructed to practice deep or abdominal respiration 
for the double purpose of oxygenation and motory 
stimulation of the intestinal peristalsis. There are 
cases, of course, where these measures are not feasible, 
and much must be left to individual discretion. The 
Faradic current, applied along the course of the 
colon, will often prove a valuable auxiliary in arous- 
ing the sluggish peristalsis. 
COLD ABLUTIONS. 
The application of cold packs or baths to the 
abdomen is also a remarkably effective agent in 
the treatment of constipation. In lean persons the 
vermicular movements of the bowel, excited by 
the laying of the cold hand upon the abdomen, can 
often be perceptibly felt. The reflex stimula- 
tion of involuntary muscular tissues consequent 
upon the application of cold to the peripheral 40 
nerves is a familiar circumstance, of which the ac- 
coucheur frequently takes advantage, but it is not 
generally recognized that the intestinal coats are 
affected to a still greater degree of contractility by 
similar means. In accordance with this fact, we re- 
commend cold sponge and shower baths in all cases of 
intestinal torpidity. Where the vital forces are depre- 
ciated, it is necessary that these cold ablutions be 
performed in a warm room, and energetically, to insure 
a healthful reaction, otherwise unfavorable depres- 
sion is apt to ensue. An ordinary hat bath tub and 
large porous sponge are often preferable to the 
usual bath room appurtenances, and two or three 
minutes spent in the application is quite sufficient, 
and should be followed by a brisk shampooing until a 
general glow pervades the system. The warm or 
tepid bath cannot be too strongly condemned, as it is 
devitalizing, relaxes the cutaneous textures, renders 
the body liable to colds with consequent catarrhal af- 
fections, creates lassitude, depression of spirits and 
general atony, while the cold bath produces exactly 
the opposite effect. It is exhilarating, imparts tone 
to the skin and mucous membranes, relieves wakeful- 
ness, and elevates the physical standard. It is essen- 
tial that the lower extremities be included in the cold 
lavement, as this equalizes the circulation, effectually 
relieves habitually .cold feet, and is a sovereign rem- 
edy for cerebral hypersemia. Those who intelligently 
comprehend the function of the skin will recognize the 
direct effect which frequent cold bathing exerts upon 
the mental and corporeal well being. It will be re- 
membered that the excretory process of the skin is 
second in importance to none, and, to a certain 41 
degree, it is also a respiratory organ exhaling car- 
bonic acid and absorbing oxygen. Should the 
cutaneous glands be completely sealed up by any out- 
ward application, cutaneous asphyxia and death ensue. 
When we reflect that the skin ordinarily exhales 
daily from three to four pints of aqueous excreta 
containing fat, albumen, urea, and inorganic salts, 
and that this extraneous matter mixes with the effete 
epidermic cells and dries upon the surface, it is 
readily understood that were this oily albuminous ex- 
cretion permitted to accumulate it might form no 
trifling obstruction to the healthful action of the skin. 
Beside the tonic effect exerted upon the general 
secretory organs, especially those of digestion, cold 
ablutions of the surface act remarkably beneficially 
upon the mental and will powers. From the adop- 
tion of this practice the writer has frequently seen 
languor, lassitude and despondency disappear, to be su- 
perseded by a more sprightly, energetic and attentive 
spirit, wdiile previous seeming impossibilities resolved 
themselves into simple actualities. This strengthen- 
ing of the will-power by the daily cold bath leads us 
to the consideration of a very essential feature of our 
subject, viz., the value of concentration of mind, or 
will-poioer, as a remedial agent in the removal of intes- 
tinal inertia. We have previously referred to the com- 
mand which the will exerts over the function of the 
intestinal tract, especially the rectal portion. While 
the mind is authoritative in suppressing.the prompt- 
ings of nature, it also possesses remarkable capability 
of awakening the peristalsis to expulsion. Fifteen 
years ago the writer was greatly impressed by the 
views advanced in Carpenter’s Physiology regarding 42 
mental domination over the intestinal function. 
In the earlier editions of this work it is maintained 
that few cases of constipation will resist a half hour’s 
determined fixing of the mind upon the accomplish- 
ment of the act of defecation. Since then, observa- 
tion has many times demonstrated the truth of this 
principle; but often there are found cases of deficiency 
in the will power, with confusion and instability of 
the mental faculties. Intimately blended with the 
strong desire to accomplish the act will be an over- 
anxiety, or over-ruling disbelief in all methods save 
active material agents Coupled with this distrust 
there is usually an unfortunate trepidation or appre- 
hension of dire calamity if the bowels should remain 
unmoved beyond the accustomed period. This 
over-anxiety is manifested in nervous, timorous 
subjects, and is peculiarly trying to encounter, 
since it not only subverts the healthful /Tction of 
the will, but opposes physiological processes by the 
perversion of the vital forces, sometimes causing 
unnatural spasm of the sphincters. To secure mental 
composure and efficiency of will-power, the most val- 
uable agents are cold bathing, shampooing, and 
physical exercise. Let it be remembered that it is 
sometimes as necessary to divert the attention of ex- 
citable, apprehensive patients from an over-estimate 
of the importance of a daily evacuation, as it is to 
persuade others to give proper heed to it. It is a 
very difficult .and delicate matter to maintain a favor- 
able demeanor toward our sensitive and watchful 
patients, since incalculable mischief may be wrought 
by too strenuous admonition, or even a serious ex- 
pression of countenance. 43 
HABIT-FORMATION. 
An intelligent comprehension, and practical appli- 
cation, of the advantages obtainable through the 
formation of habit, should always he insisted upon, 
as comparatively few realize to what extent we are all 
its subjects. An infant can be accustomed to three 
nursings in the twenty-four hours, and will thrive, or 
it will as readily acquire the desire for food every two 
hours. Adults who eat but two regular meals a day 
experience no craving for food during the interven- 
ing hours ; while on the other hand three meals may 
be taken, and a fourth added at midnight, and 
after a few days none of these meals can be dispensed 
with, without unpleasant feelings being experienced 
for a time. We have frequent illustration of the 
power of habit, in persons who have accustomed 
themselves to a lunch upon retiring, and when it is 
prohibited the sensation of hunger will banish sleep. 
This power possessed by regularly recurring custom 
pervades every condition of our existence, whether it 
be of diet, sleep, thought or speech, action or inac- 
tion. It is also a matter of individual creation, and 
although when once established is arbitrary in its 
domination, still it can be either suppressed or 
strengthened through the higher power of the will, 
for there is not a gland or ultimate cell structure that 
cannot be modified and directed by the mental pow- 
ers. The writer has observed several remarkable 
illustrations of the controlling influence of the will 
in individuals who could not only suspend respiration 
but also the action of the heart. 
We perceive, therefore, that in the uprooting of 
wrong physical customs, and the establishing of those 44 
more desirable, the will is the ruling and indis- 
pensable factor. When once a habit is formed it is 
persistent unless wilfully suppressed. 
To make a practical application of these princi- 
ples to the cure of costiveness, let the patient desig- 
nate some hour most suitable in which the attention 
shall be devoted to the accomplishment of defecation. 
The effort should be made promptly at the ap- 
pointed time, even if no natural promptings for a 
discharge be felt. The trial should be made confi- 
dently and deliberately, and with the least possible 
expulsive effort. The first few attempts may not be 
successful, but eventually the determinate will-power 
will prevail over the tissues, and this once accom- 
plished, the habit is easily formed which will become 
arbitrary in proportion to its duration. It is hardly 
necessary to add that the most appropriate time to 
select is the morning, directly after the first meal. 
The mind is then most tranquil, and the nerve for- 
ces have not as yet been monopolized by the absorbing 
cares of the day. Moreover, it is the time best calcu- 
lated for the application of other accessories, such as 
cold sponging, shampooing, kneading of the bowels, 
and other physical exercise. 
SOLVENTS. 
For the easy expulsion of the faeces, a certain 
solubility is the first requisite. If a particle of dust or 
other irritant conies in contact with the conjunctiva, 
we have a flood of tears; snuff and other excitants 
drawn into the nostrils stimulate the functional activ- 
ity of the Schneiderian membrane : in both cases 
nature by defluxion endeavors to wash away the 45 
offending irritant, and either of these instances illus- 
trates that which actually occurs when a portion of 
an irritating drug is taken to secure liquefaction of 
the faeces. The medicinal substance coming in 
contact with the intestinal mucosa and nerve fila- 
ments, induces a more rapid secretion of the intestinal 
juices, that the offending matter may be speedily ex- 
pelled. These medicaments are popularly designated 
“mild” or “brisk” cathartics, “laxatives” and 
“anti-bilious potions,” “liver invigorators,” “in- 
testinal stimulants,” and a host of familiar appella- 
tions. As a rule the activity of the catharsis induced 
is in proportion to the irritative or obnoxious proper- 
ties of the cathartic administered. Purgation is 
invariably a protest of the system against the presence 
of some offending substance. The misfortunes ulti- 
mately accruing from the indiscriminate employment 
of purgatives have already been referred to. When 
an increase of the solubility of the fasces is demanded, 
we know of no more healthfully efficient solvent than 
absolutely pure water, taken freely at proper intervals. 
Alittle observation will show that the quantity of Avater 
drank by persons of costive habits is comparatively 
limited, these patients usually prefering tea, choco- 
late, coffee, etc. Every known law demonstrates 
conclusively that water is the natural drink of all 
living creatures. We are accustomed to its external 
use as a cleansing medium, but it is no less purifying 
Avhen taken internally ; indeed it is in every sense of 
the word a detergent Entering into the blood ves- 
sels, it traverses the most remote recesses of the 
structure, dissolves the morbid debris, and returns 
with these impurities to the excretory channels. An 46 
erroneous idea seems to prevail that water, to be 
medicinally desirable as well as palatable, should be 
impregnated with certain organic and inorganic 
matter. 
We are frequently compelled to listen to oft- 
rehearsed glowing accounts of remarkable effects 
secured by a visit to some popular sanitary spring, 
and it is a ludicrous feature that the benefits derived 
are always accredited to the peculiar impurities with 
which the water is impregnated. Since the earliest 
time patients have performed pilgrimages, often com- 
passing a distance of thousands of miles, to some spot 
noted for the virtue of its medicinal waters. When 
their destination is reached the former mode of life 
is discarded, new scenes and healthful habits are sub- 
stituted, more judicious dietary methods are adopted, 
and a liberal allowance of water is intelligently pre- 
scribed and faithfully taken. The results are often 
most satisfactory, but the physiologist knows perfectly 
well that it is not the amount of carbonic acid, alum, 
iron, or other foreign ingredient, that has produced 
the agreeable change, but the numerous other acces- 
sories which have abolished former faulty influences 
and established others more favorable. Statistics 
show that those sanitary springs supplying water 
freest from all foreign matter, yield a greater per- 
centage of “ cures ” than those impregnated with the 
various salts and minerals. It would, however, be a 
difficult task to convince the masses of this fact, since 
they are always most favorably impressed by the water 
that most strongly appeals to the five senses, for it is 
undeniable that to most minds a strong odor, a pun- 
gent taste, a high temperature, or an effervescence, 47 
endows the fountain with special virtue. It is a rea- 
sonable inference that spring waters abounding in 
minerals are beneficial when properly employed, but 
the intrinsic virtues of even these are always greatly 
overrated. For our present purpose the nearer the 
water approaches absolute purity the more desirable 
it is. When impregnated either naturally or arti- 
ficially with gases or salts, organic or inorganic 
matter, its value is proportionately lessened, if not 
rendered positively injurious. In the list of objec- 
tionable beverages we include all soda and aperient 
waters, without exception, since none of them pos- 
sess the merits attributed them, and the majority 
are harmful in their ulterior effects. Tea and coffee 
also should be prohibited, as their active principles 
vitiate the normal chemical constituents of the 
digestive juices, and also depreciate the nerve action 
of the alimental organs. While water affords the most 
bland and efficient solvent, its use is often unwittingly 
abused, much mischief ensuing therefrom. For its 
intelligent employment as a remedial agent, it may be 
well to note the relation it sustains to the digestive 
process. In the first place, liquids should not be in- 
gested simultaneously with solid food, and we main- 
tain that the prevalent custom of drinking at meal- 
time is the chief cause of indigestion, and will briefly 
adduce reasons for holding this belief. For the ful- 
filment of the digestive process, nature has provided 
and located along the alimental canal certain glands, 
whose functions are the secretion of various juices 
which exert a chemical action upon the different 
articles of food, thereby reducing the various alimental 
matters into a state fit for absorption and assimilation. 48 
Three pairs of glands pour a viscid alkaline fluid into 
the mouth, where, through the process of mastication, 
it is mixed with the food, and converts farinaceous and 
starchy food into dextrine, or grape sugar, but this 
salivary fluid does not act upon the albuminous com- 
pounds. These pass to the stomach, where there are 
a myriad of glands secreting an acid fluid, and by this 
gastric juice the albuminous food, meat, eggs, etc., are 
converted into an assimilative matter termed peptone. 
Fatty substances are not directly acted upon until 
they pass out of the stomach and come m contact 
with the bile and pancreatic juice, whereby the olea- 
ginous matter is emulsified, or minutely divided, to 
be readily taken up by the absorbents. These several 
juices must possess a certain degree of strength and 
consistency, in order that their chemical action upon 
the ingesta may be complete. Now, it is quite.ob- 
vious, if their normal standard be perverted or lowered 
by the admixture of diluents or inimical ingredients, 
their action is correspondingly impaired, and the 
ulterior change of food into normal chyme is pre- 
vented. It is readily comprehended that starchy 
matter, imperfectly masticated and washed into the 
stomach with some artificial liquid, is unprepared for 
assimilation, and therefore undergoes fermentation, 
often giving rise to acidity, flatulency, etc. Further- 
more, when large quantities of water or other fluids 
are introduced into the stomach at the time of eating, 
the gastric juice is so depreciated as to be incapable 
of converting albumen into peptone, hence digestion 
of these substances is postponed until the extraneous 
fluid is absorbed, by which time the ingesta have often 
undergone an unwholesome transformation. A 49 
decidedly erroneous belief obtains with the masses, that 
liquid foods, such as beef teas, broths, gruels, etc., 
are more readily assimilated than more solid prepara- 
tions, whereas the converse of this is true. A bit of 
raw or properly broiled beef, thoroughly masticated, 
is much more readily digested than a tea made of the 
same quantity. A bit of dry bread, eaten slowly, is 
far preferable as regards assimilation*to the same 
amount of gruel. Let it be distinctly understood 
that the digestive process is always suspended 
until the surplus fluid has been absorbed. In 
some persons the absorption is accomplished much 
more rapidly than in others, and therefore the 
interference arising from the extraneous fluid is 
relatively brief and unimportant. Where the 
digestive powers are impaired, however, it is a 
serious obstacle in the way of assimilation. Any 
one whose digestion is performed vigorously and 
perfectly, will find it difficult to realize the importance 
of these suggestions, but the victims of enfeebled 
digestion can, from actual experience, readily confirm 
the truth of these assertions. The principle is phys- 
iologically based, and applicable to all mammalia. 
At one time the writer witnessed in the lower animal 
life an apt exemplification of this. A stable had 
been built for the accommodation of a number of 
favorite horses, and in each manger was placed a 
small trough of constantly running water ; therefore 
as the horses ate their dry food they took with it 
frequent sips of water. Before many days their 
physical condition was noticeably depreciated, they 
became listless, evinced an aversion to food, were 
easily fatigued, and their coats lost their glossiness 50 
and were roughened. Veterinary skill was employed 
for some time with no success, until finally it was 
suggested that the mode of watering was the source 
of the difficulty. Acting upon this hint the appli- 
ances were removed, and the animals watered an 
hour after their grain had been eaten, and the re- 
sult was a speedy return to their former health. 
In conformity with the physiological views above 
mentioned, we recommend a total abstinence from 
all artificial diluents at the time of eating ; this 
rule is commendable for all, but must be rigidly en- 
forced with patients subject to feeble digestion, which 
condition is very commonly associated with chronic 
costiveness. Water should be taken freely but slowly 
a full hour before meals. This secures the cleansing 
of the stomach from all residual, grumous matter, a 
portion of it is absorbed, and the remainder passes 
along the canal acting as a solvent. Large draughts 
of cold water should be avoided, since it chills the 
delicate tissues and nerve filaments, and although no 
evil effects may immediately follow, they will be ex- 
perienced eventually, and when they do appear are 
usually very intractable. In the morning therefore, on 
arising, let a goblet of water be slowly drank, another 
on retiring, and if it is found necessary a third 
may be added at midday, but it is well to form the 
habit of drinking but twice in the twenty-four hours. 
We remark, incidentally, that the custom of drinking 
ad libitum and freely during the warm season is most 
injurious, and also entirely unsatisfactory, as every one 
will testify from his own experience, that the heat 
seems more oppressive and less endurable after 
copious cold draughts. Superabundant fluids within 51 
the tissues tend to elevate the bodily temperature, 
therefore by transudation nature hastens to rid the 
system of it. When water is not discharged in this 
Avay it has a propensity to promote corpulency. Ob- 
servation will show that persons tending to obesity are 
relatively large consumers of liquids. Should there 
be evidence of irritation or catarrh of the gastric 
mucosa, water as hot as can be comfortably swallowed 
should be substituted for cold, as it exerts a well- 
known constringent effect upon the dilated or indo- 
lent capillaries, whereas the secondary effect of tem- 
porary refrigeration is an increase of hyperaemia. To 
this is due the circumstance that hot water will often 
arrest obstinate vomiting, which will only be aggra- 
vated by cold. When there is an excess of acid in the 
stomach, the juice of a lemon added to the goblet 
of water will not only render the drink more palatable, 
but will also correct the disposition to an over- 
secretion of acid, upon the same principle that we 
administer laxatives for the cure of diarrhoea. The 
lemon juice is also a valuable “anti-bilious” agent. 
When we have to deal with a chronic case, where the 
patient has long depended upon cathartics and 
enemas, we will find a highly desirable laxative in 
ordinary West India molasses, which, unlike other 
laxatives, has no objectionable secondary effect. This 
may be mixed with the drink or eaten with the food. 
From one to four teaspoonfuls taken twice daily will 
usually secure alvine solvency. 
For obvious reasons the inordinate use of sweets 
should be discountenanced, therefore we dispense 
with the treacle as speedily as practicable. The 
pulp of an apple, swallowed before the water, each morning, will also prove an excellent adjunct, 
and is preferable to treacle should the individual be 
predisposed to “ heartburn ” or acidity of the 
stomach. It should be reduced to a pulp by scraping, 
or else be very thoroughly masticated. A sound, 
fresh orange eaten before meals is also a commend- 
able solvent. 
52 Chapter III. 
THERAPEUTICS CONTINUED. 
We now come to the discussion of dietetics, as ap- 
plied to the treatment of costiveness. It is generally 
understood that certain articles of food favor laxness 
of the bowels more than others, but this knowledge 
is far from being definitely formulated. As, for 
instance, oatmeal is often erroneously accredited with 
promoting intestinal peristalsis, and therefore its 
use is frequently followed by discouragement. Again, 
chicken is popularly regarded as a desirable delicacy 
and an appropriate article for a weakened stomach, 
whereas it is by no means easily digested. Further- 
more, gruels and puddings of farinaceous substances 
are constantly prescribed by physicians as well as the 
laity, as articles of diet peculiarly easy of assimila- 
tion ; but we have already remarked that all starchy 
foods should he subjected to thorough admixture 
with the salivary fluid before they can be reduced to 
the assimilative condition, therefore, when swallowed 
hastily, as they ordinarily are when injested in the 
semi-fluid form, they often act as positive irritants. 
The scope of this paper will not admit of a comprehen- 
sive notice of the manifold dietetic features directly 
related to our subject, therefore, without entering into 
detail, we will only attempt a few leading suggestions. 
In the first place, those afflicted with indigestion, 
or its frequent associate, constipation, must resolve 
PHILOSOPHY OP DIET. 54 
in good faith to abjure gratification of the palate ; 
for, without peradventure, intestinal disorders, like 
the majority of physical ills, are self-imposed. 
It is useless to attempt the cure of constipation de- 
pendent upon a diseased state of the rectum, conse- 
quent upon a liver deranged from brandy-drinking or 
other intemperance, unless we deal directly with the 
fons et origo of the difficulty. The same rule applies 
to errors in food. It is simply absurd to institute a 
one-sided medicinal regimen, and yet overlook faulty 
dietetic habits, such as indulgence in pastry, spices, 
and other harmful -articles. Rectification of these 
evils is much more the duty of the physician than 
the concocting of some wretched medicinal obstru- 
ent. 
Nor are the benefits accruing from sound digestion 
of a purely local nature, for, as previously stated, 
mental perversion underlies the most intractable 
form of intestinal inertia ; and since indigestion is a 
chief source of despondency, it will readily be per- 
ceived that the advantages secured can be reflex as 
well as direct. 
Let us notice the relative merits of the ordinary 
cereals as laxatives. First on the list we find rye the 
most effectual, albeit a mush made of this meal is not 
appetizing in appearance, but nevertheless is quite 
palatable when thoroughly and properly cooked, and 
when eaten with treacle yields very satisfactory re- 
sults. Hasty-pudding, made from coarsely-ground 
maize, stands next in importance. Wheaten grits 
ranks third, but it has the advantage of being more 
generally acceptable to the palate and sight, there- 
fore it will be more popular. Finally we have barley 55 
and oatmeal, which are easy of assimilation but very 
slightly laxative. 
Again we reiterate the necessity of impressing upon 
patients the importance of subjecting these soft prep- 
arations to thorough mastication, otherwise they are 
likely to undergo fermentation within an enfeebled 
stomach, causing acidity and flatulency. Bread made 
from any of these cereals, and eaten when stale, is 
preferable to any boiled admixture, since lack of 
moisture necessitates more thorough mastication. 
We may drop a word en passant concerning that fa- 
vorite abomination, toast, which, as any one at, all 
observant should know, has a strong tendency to fer- 
ment and cause acidity, from the fact that the ulti- 
mate starch granules are rendered hard and in- 
soluble by the searing process to which they have been 
subjected. The nutritive properties of all food, 
whether animal or vegetable, are greatly impaired by 
frying, and this method of cooking cannot be too 
forcibly denounced. In the list of commendable 
edibles will be found boiled beets, onions and squash, 
baked potatoes and apples, raw peaches, and the 
various native berries, especially the blue or whortle- 
berry. From this list we expunge turnips, cabbage, 
cauliflower, cucumbers, carrots, cherries, quinces, 
etc. 
We will mention the albuminous food constituents 
in the ratio of their nutritive and assimilative proper- 
ties, beginning with the most assimilable : Venison, 
beef, mutton, turkey, fish, chicken, pork, and veal. 
It is generally known that raw fresh meat is more 
readily converted into peptone than cooked, for the 
simple reason that cooking coagulates the albuminoid 56 
constituents, rendering them to a degree insoluble. 
Corned beef, and all other meats similarly pickled, are 
very indigestible, the chemical action of the brine 
rendering the ultimate fibrillae and cell structure hard 
and insoluble. The division of meat into minute 
particles before injestion greatly facilitates its rapid 
and complete transformation into peptone. In pass- 
ing from this part of our subject, it may he well to 
briefly recapitulate our therapeutic views. 
First. It is very essential that an accurate differen- 
tiation be made between emotional and actual physical 
influences, as an oversight in this particular will surely 
result unfavorably. To this end we closely analyze 
the temperament and mental condition of the patient, 
together with the history of the case. 
Second. Every form of cathartic, whether mild or 
drastic, must be absolutely discarded, since by their 
use all other aids are rendered nugatory. 
Third. The intestinal process should be clearly 
explained, and the prevalent custom of exerting 
forcible expressment discouraged. 
Fourth. The philosophy of out-door 'exercise, as 
related to the physical well-being in general, and the 
promotion of the intestinal function in particular, 
should be properly elucidated. 
Fifth. The advantages accruing from the employ- 
ment of the cold bath, and the proper method of its 
application, must be taught. 
Sixth. The patient, as far as possible, should be 
made to understand the supremacy of will-power, 
with especial reference to the formation of habit. 
Seventh. Particular stress is next laid upon the 
possibility and importance of establishing a daily 57 
habit, which may be accomplished by the concentra- 
tion of the thoughts, at a certain hour daily, for the 
securing of an evacuation. This deliberate and per- 
sistent exercise of the will seldom fails to arouse the 
desired inclination. 
Eighth. The efficiency of water as a solvent, the 
proper time for taking it, and the superiority of 
warm over cold as a remedial agent, should be clearly 
set forth, that patients may avail themseves of these 
advantages. Dietary rules that are in accordance 
with and sustained by physiological laws should be 
enforced, and all information that can be gained from 
personal experience respected. 
Our subject would be incomplete were we to omit 
all reference to the costiveness of childhood and old 
age. In the foregoing pages we have already shown 
that constipation of infancy is usually the result of 
neglect, or mischievous interference on the part of 
those having the supervision of the little ones. Our 
first duty, plainly, is to eradicate the source of the 
difficulty, a task not readily accomplished, for we 
have to encounter a stubborn persistence in erroneous 
customs, beside a disinclination to any added labor on 
the part of parents or nurses. The mother has not 
always the mental fortitude to deprive herself of cer- 
tain articles of food, even though secondarily they 
may irritate her nursling, and it is so natural to nurse 
the infant whenever it cries. Moreover, it is so easy 
to administer a dose of castor oil, rhubarb, or other 
laxative, and what is more reprehensible still, to the 
over-weary nurse it is a great temptation to give a 
few drops of “ soothing syrup,” especially Avhen war- 
ranted (as they all are) to be entirely free from 58 
opiates. It is not desirable to attempt in extenso, a 
detailed enumeration of the evils to which infants are 
subjected. They are commonly the victims of blind 
ignorance and of obdurate continuance in harmful 
practices, which are too often overlooked if not actu- 
ally advocated by the medical adviser. Constipation 
in childhood, as in maturity, is not unfrequently but 
an expression of hepatic or intestinal engorgement, 
dependent upon indigestion that is the consequence 
of over-feeding or other dietary irregularities. 
In the first place, we must impress upon parents 
and nurses the importance of an absolute discontin- 
uance of the use of every form of medicament that is 
not positively demanded ; and it must be forced home 
to the minds of those having the care of young chil- 
dren that castor oil, rhubarb, and other favorite lax- 
atives, are highly injurious, only admissible when an 
habitual disjiosition to morbid laxity of the bowels is 
to be corrected. Unless imperatively demanded by 
illness, a nursing child should be fed regularly, never 
oftener than once in three hours, and not at all between 
the hours of ten at night and six in the morning. 
The prevalent custom of nursing infants during the 
night is injurious to the well being of the child, and 
an unnecessary, self-imposed affliction to the mother. 
A period of absolute rest is as essential to the health 
of the infantile digestive organs as to those of the 
adult, and unless this law is respected a diseased con- 
dition ensues, the child becomes wakeful, petulant, 
unmanageable, and develops a train of unfortunate 
symptoms, sometimes Avitli constipation and again 
with diarrhoeas. With proper nursing, inertia of the 
boAvel will seldom develop ; but should it appear, 59 
consequent upon sonje oversight or mismanagement on 
the part of the mother, an occasional massage of the 
abdomen with the hand, and a careful regulation of 
the mother’s diet, will soon restore the normal func- 
tion. When, through some misfortune, an infant is 
deprived of its natural food, and an artificial one is 
necessarily substituted, it should first be fed with a 
spoon, and then taught to drink from a cup as soon 
as possible. That abominable device, the nursing 
bottle, should never he tolerated, no matter what its 
form, or how urgent the plea for its use. It is an 
unclean invention, which naturally finds favor in *the 
eyes of the indolent, and is answerable for the destruc- 
tion of many thousands of young lives annually. An 
infant can be taught to feed from a spoon as readily 
as to nurse a bottle, and when fed in this way will 
receive only that which is actually required, but when 
the bottle is employed, as long as the nipple is re- 
tained in the mouth the child will suck automat- 
ically, thereby repeatedly overloading the stomach. 
Furthermore, when the bottle is the medium for 
food, nurses generally form a most pernicious habit 
of resorting to it to soothe all childish griefs and dis- 
quietudes, so that a morbid affection for it is engen- 
dered, and, waking or sleeping, it is a constant com- 
panion. How often do we see infants involuntarily 
sucking sour, vitiated air from an empty bottle, the 
nurse wholly regardless of the baleful circumstance. 
No language can too strongly condemn this infanti- 
cidal custom. Viewed from a physiological stand- 
point, it is no wonder that sixty per cent, of all deaths 
occur in childhood. We repeat, that infants arti- 
ficially nourished should be fed regularly from a 60 
spoon or cup, never to never during the 
night. 
Should the bowels be ordinarily somewhat confined, 
it is no cause for alarm, quite the reverse, for it an- 
nounces an inherent vigor ; however, if the hardened 
fa?ces give rise to positive discomfort, a little treacle 
or barley gruel may be added to the milk, as these, 
assisted by cold sponging and shampooing of the ab- 
domen, will, as a rule, provide against simple every- 
day contingencies. It is also incumbent upon the 
nurse or mother to institute in children regular 
periods for the evacuation of the excreta. It is won- 
derful at how early an age the power of forming hab- 
its can be developed, therefore, by proper attention, 
and such judicious management as will readily suggest 
itself to an intelligent person, the infant of a few 
months can be accustomed to evacuate the bowels at 
certain stated times. 
The treatment of costiveness in the aged presents 
peculiar and often obstinate characteristics. Ad- 
vanced age is usually associated with a corresponding 
diminution of vital energies, which is expressed by 
enfeeblement of the muscular system, and the more 
sluggish performance of the general functions. 
It is but natural to infer that, with the senile waste 
of substance and strength of the limbs, there occurs 
a coincident degeneration of the intestinal tonicity, 
and accordingly we are disposed to concede that con- 
stipation may be an unavoidable affliction of the aged. 
Nevertheless, occasionally there are found individuals 
who have passed through their four score years, and 
who yet experience no inconvenience from intestinal 
inertia. In these cases we invariably learn that 61 
regularity in this respect has always been maintained 
without extraneous aid, while, on the other hand, we 
seldom find elderly people seriously afflicted with 
costiveness who have not previously resorted in a 
greater or less degree to artificial means, and to the 
habitual exercise of diaphragmatic expressment. 
Therefore it is difficult *to decide to what extent the 
anomaly is physiological, or how much is due to life- 
long indiscretions. Be that as it may, we will find 
that, as the buoyancy of the animal economy depre- 
ciates, there is encountered a corresponding difficulty 
in arousing and maintaining the intestinal function, 
and in many instances artificial aids may be impera- 
tively demanded. Still, even here, all active inter- 
ference should be a dernier ressort, for it must he re- 
membered that purgation is especially objectionable 
to the aged, as it still further depresses the declining 
powers, and the secondary ill effects are deeper seated 
and more persistent than in earlier life. 
For this reason it is imperative that all active 
catharsis or rectal enemata be deferred until all those 
practical hygienic regulations heretofore discussed, 
such as cold sponging and massage of the abdomen, 
fruit and coarse food dietetics, etc., have been thor- 
oughly tested. Exercise may not always be possible 
on account of wasted limbs and failing strength, but 
it should always be encouraged when practicable. 
Beside the employment of hygienic measure, there is 
one agent which I have always found a sovereign 
remedy for the relief of these cases, and is equally 
efficacious in all forms of constipation ; this is fresh 
buttermilk, taken at discretion. Beside the gentle 
solvent effect exerted, it is a valuable nutrient and easy 
of assimilation. 62 
Finally, we have to consider the internal medicai 
ments which will only be indicated by the symptoms 
evinced in each individual case. There is a host of 
these remedies commended in the various materia 
medicas, but I have found comparatively few worthy 
of the praise accorded them. When costiveness is 
directly engrafted upon a constitutional dyscrasy, ex- 
hibiting well-defined symptoms, we will usually obtain 
happy results from the administration of the appro- 
priate remedy ; we must, however, guard against the 
shortsighted policy of relying too implicitly upon the 
efficacy of drugs, but strive to combine with our 
therapeutics common sense practicalities. 
ALOES 
Is very extensively employed by the representatives of 
the heroic school for all forms of intestinal inertia. It 
is doubtful if the action of any other drug is so com- 
pletely misapprehended, or its use so greatly abused. 
When administered in large doses, it is certainly a 
very efficient cathartic, and in smaller doses its 
primary action is likewise that of a laxative, but its 
secondary or ultimate effect is directly opposite to the 
one sought, and this undesirable condition is deep- 
seated, persistent, and often very troublesome. Since 
the use of this drug is quite general, it may be well 
to study its action in order to illustrate the principle 
—the duality of drug action—upon which we base our 
method of drug selection and administration. 
A massive dose of aloes induces hepatic engorge- 
ment, abdominal plethora, consequent upon obstruc- 
tion of the portal circulation, with congestion and 
varices of the rectum. The inordinate excitation of 63 
the viscera stimulates their functional activity, hence 
we have a hyperexcretion of bile and intestinal juices, 
resulting in purgation. When the medication is lim- 
ited to one application, a corresponding reaction fol- 
lows, this secondary state being diametrically opposite 
to the primary in all its features. If, however, the 
prescription is persistently repeated and increased, 
the reactionary powers are perverted, and we may 
have an abiding textural change wrought in those 
organs upon which the action of the drug is expended. 
It is evident that, in strict accordance with the law of 
similars, aloes is not often available for the relief of 
constipation, but is more frequently called for in the 
treatment of diarrhoeas exhibiting its pathogenic 
symptoms. When, however, associated with consti- 
pation, we have morbid structural conditions re- 
sembling those that are consequent upon the inordi- 
nate use of aloes, we will witness brilliant curative 
effects follow its administration in small doses. The 
symptoms calling for this remedy are : Obstinate con- 
stipation following diarrhoeas, with urging to stool ; 
hemorrhoids resembling clusters of grapes ; a sensa- 
tion of burning soreness; itching, and dragging 
weight in the fundament ; a bearing-down pain 
which compQls straining, followed by discharge of 
blood or lumps of jelly-like mucous, leaving an 
aching, and a sensation as though the sphincter ani 
had not contracted ; a twisting, griping pain around 
the umbilicus, and deep soreness in the hypogastrium ; 
stomach distended with flatus and tender upon pres- 
sure ; stitching, burning pains in the region of the 
loins—often indicated in the treatment of the phleg- 
matic and indolent, those who are subject to abdom- 
inal plethora. 64 
ALUMINA. 
The chief indication for this remedy is a condition 
of semi-paralysis of the rectum and bladder. The 
inclination to evacuate may be experienced, but the 
power to expel the accumulation is deficient, hence a 
large conglomeration of indurated f*ces forms in the 
rectal ampulla. The abdominal walls also share in 
this feeling of weakness, and are often pendulous. 
Tensive or dull headache is a usual concomitant, and 
the patient evinces a nervousness and apprehen- 
sion that the effort will be unsuccessful. It is often 
indicated in the debilitated and aged ; suitable also to 
young children. 
In the treatment of costiveness we will frequently 
encounter great mental depression ; weariness of life, 
with suicidal thoughts ; loss of memory, with great 
fatigue attending any mental effort, also a dread of 
impending loss of reason. For the relief of these 
symptoms aurum is a sovereign remedy. It is also 
valuable as a remedy for those mental conditions fol- 
lowing disappointment, religious excitement, grief, 
etc., which tend to a state of helplessness, despair and 
melancholy. 
The head aches, feels sore, with nocturnal boring 
pains in the skull. It is an admirable remedy for ill 
effects following the abuse of mercury, and is espe- 
cially useful where there is a syphilitic taint. The 
stools are hard, dry and nodular, with rectal catarrh. 
AURUM MURIATICUM. 
■Some old school authorities extol this remedy in 
the treatment of costiveness, maintaining that its 
BELLADONNA. 65 
virtue lies in the relaxing effect it exercises upon the 
sphincters. The new school also recognizes its reme- 
dial qualities, but holds that its curative action is 
explained in a different and more scientific manner. 
We may not here enter into a discussion of this mat- 
ter, but simply state that belladonna may be pre- 
scribed with advantage when the following symptoms 
are present : A “broken back ’’ feeling, with a con- 
stricted, itching, pressing-out sensation in the anus ; 
the mucous 'membrane is injected, swollen and 
everted ; there is a feeling as though all the parts 
would extrude, were straining exerted. There is often 
associated throbbing painfulness and tenderness over 
the abdomen ; pressure or jars aggravate the soreness ; 
the colon is sometimes visibly distended and is sore 
to the touch ; the pulse is full, bounding and tense, 
and throbbing is felt throughout the body; the 
patient feels chilly internally and hot externally, yet 
is averse to uncovering; head and face congested, 
eyes injected ; pains appear and disappear suddenly. 
This remedy is suited to the young, full-blooded, or 
plethoric constitutions subject to congestions, with 
high temperature and delirium when sick. It is 
more frequently called for in recent cases of costive- 
ness when associated with acute complications. 
BRYONIA. 
This remedy is especially adapted to the constipation 
which is engrafted upon a rheumatic diathesis, and 
exacerbates in warm weather. It is further indicated 
when the patient is irritable, passionate and morose ; 
subject to headache early in the morning, when first 
opening the eyes j disordered stomach, tongue coated, 66 
and an insipid, sweet, musty taste, with a collection 
of frothy saliva ; stitching, cutting pains in the abdo- 
men and different parts of the body when first moving. 
The faeces are very hard and dry, as if burnt. 
FERRUM PHOS. 
Is indicated by the following symptoms : Obstinate 
constipation with prolapsus ani, and piles, associated 
with the following constitutional expressions: anaemia; 
face ashy pale or greenish tint, but flushes readily 
with sudden emotion or pain ; lips, ears and extrem- 
ities blanched ; feet and hands cold ; vertigo on sud- 
denly rising from a horizontal position or from stoop- 
ing ; palpitation frequent ; persistent chilliness ; 
flatulence and fulness of the epigastrium ; aversion 
to meat diet. 
Cases of costiveness are repeatedly presented where 
it is evident that the perversion of the intestinal func- 
tion is attributable to a morbid condition of the vital 
fluids, and it is always impossible to correct the un- 
natural secretion until we administer the appropriate 
constitutional remedy. The diathesis calling for the 
employment of graphites is peculiarly well marked 
and unmistakable. The chief indications are : Ulcer- 
ative or eczematous state of the skin ; blotches appear 
on various parts of the body, more frequently in the 
flexures or moist portions. The diseased surface 
cracks and exudes a sticky serous matter ; ulcers and 
wounds not disposed to heal ; tetter appears between 
the fingers, in the armpits, between the nates, flexure 
of the thighs and legs ; feet and legs are disposed to 
swell and ulcerate ; patients are often dull of com- 
GRAPHITES 67 
prehension and inclined to obesity ; stools hard, large, 
and knotted. The rectum is inclined to prolapse, 
with passive hemorrhoids, and there is often present 
very obstinate anal fissures and burning rliagades of 
the anus. It is further indicated by a profuse, 
white, vaginal discharge, which excoriates the parts. 
This remedy is highly extolled by both schools as an 
efficient agent in arousing intestinal peristalsis. My 
experience with it has not been such as to render me 
enthusiastic regarding it, and I am confident it is too 
generally prescribed for all forms of costiveness, but 
when properly selected is undoubtedly an excellent 
remedy. It is especially indicated in dark, thin, 
irritable, dyspeptic subjects, who are given to excesses 
and the use of coffee, spirituous liquors, etc. ; better 
adapted to the studious or nervous than to the seden- 
tary or lymphatic ; patients subject to liemicrania, 
vertigo, flatulency, tenderness over region of hypo- 
gastrium; hepatic complications, sallow, jaundiced 
skin ; obstructed portal circulation, with varices of 
the rectum ; alternate constipation with diarrhoea ; 
cramp-like pains through the pelvis and abdomen ; 
dizzy sensation, with anxiety and apprehension of 
paralysis. 
NlTX YOM. 
OPIUM. 
My experience leads me to regard this remedy 
as one worthy of more respect and general applica- 
tion for the relief of intestinal torpidity than is ac- 
corded it. It is especially adapted to the aged, and 
when the inactivity of "the bowel is due to cerebral 
complications. The more immediate indications are : 68 
Torpor of will, coma, stupid expression of face, which 
may be bloated and dark red, or pale and sunken with 
a relaxed appearance ; lower jaw hangs down, mouth 
and throat dry, with great thirst; nausea ; dull, heavy 
pain in epigastrium, and marked inactivity of digest- 
ive organs ; incarcerated flatus with crampy pain, 
and sensation of pressing asunder in the abdomen ; 
retention of stools, not so much due to condition or 
size, as to symptoms of intestinal paresis. 
This remedy will afford more brilliant results in the 
treatment of costiveness than any other in the materia 
medica. By its aid the writer has been enabled to 
effect some astonishing and most satisfactory cures of 
long-standing, inveterate costiveness. Among its 
pathognomonic indications are principally the follow- 
ing symptoms : Faeces long, slender and tough, 
voided with the utmost difficulty ; the mind is over- 
active, being lively and gloomy by turns ; apprehen- 
sive of approaching evil; marked prostration follows 
mental efforts ; excitable, naturally vivacious but 
easily moved to melancholy and tears ; fears softening 
of the brain; face pale, sallow, hippocratic, hollow 
cheeks with circumscribed red spots ; lips and tongue 
dry and cracked; tongue and gums bleed readily; 
nausea with eructations of food ; oppression, fulness, 
cramps, goneness, and burning sensation in stomach ; 
abdomen sensitive, with a rolling, rumbling, empty 
feeling ; chest feels full, respiration difficult, with a 
quick dry cough, worse upon changing from warm to 
cold air ; suitable for tall, slim, stoop-shouldered 
subjects. 
PHOSPHORUS. 69 
PLUMBUM. 
Stools hard and lumpy, expelled with great diffi- 
culty and severe pain ; violent colic and painful 
spasms of the anal sphincters. Concerning this 
remedy Dr. C. Wesselhoeft has remarked : “ This is 
unquestionably a great remedy in certain forms of 
constipation. When we consider the morbid state of 
histological elements, as produced by lead, we are 
enabled to form an adequate idea of the conditions 
which that metal will cure. Paralysis of the extensor 
muscles, which are powerless, with most probable 
paralysis of the longitudinal muscles of the intestines, 
while the circular fibres are in a state of chronic con- 
striction (painful), all serve to illustrate the class of 
symptoms to which lead is applicable as a remedy. 
“ The hypochondriacal mental symptoms of lead 
apply to many persons of costive habit. Melancholia 
which may be profound (in cases of insanity with 
,comatose state and complete obtuseness of the senses); 
anxiousness of an extraordinary degree. The stools 
resemble sheep’s dung, and are of blackish or green 
color ; in other cases they are ashy gray. The stools 
may be merely irregular, or they may occur every 
other day, or only once in ten days or a fortnight. 
No flatus is passed in cases of constipation in which 
lead is likely to give relief, and there may be fre- 
quent attacks of paroxysmal colic in such cases of 
costive habit. 
“ The form of mental disease which is caused by 
lead, and the peculiarly obstinate constipation or 
costiveness induced by that metal, renders it one of 
the most important remedies in cases of insanity, of 70 
which constipation is almost an invariable accom- 
paniment.” 
STANNUM. 
The following symptoms call for the administration 
of this remedy: Stools indurated, knotty, voided 
with difficulty, and the act is succeeded by a sensa- 
tion of insufficiency, or inclination to repeat the 
effort. The mind is forgetful and despondent, with 
marked restlessness, loss of will and energy ; an aver- 
sion to society, as thinking or talking aggravates all 
the symptoms ; is pensive, dull and inactive, dwells 
upon her wretchedness ; a sense of powerlessness in 
the rectum ; empty, gone feeling in the stomach, feels 
too weak to speak. In women, the chief pathogno- 
monic symptoms for this remedy are, melancholy and 
great prostration preceding and during the menses, 
bearing-down sensation in the uterine region, prolapsus 
of the uterus and vagina, with languor and debility 
which impels her to lie down ; leucorrlioea profuse 
with great prostration ; dry cough, and oppressed 
breathing when reclining ; hoarse, deep-toned voice, 
with transparent sputum, which has a sweetish, 
putrid taste ; weak, trembling, with insupportable 
restlessness in limbs. 
SULPHUR. 
This is indicated when the patients are subject to 
skin eruptions, blotches, or pimples, from which 
oozes a watery fluid ; voluptuous tingling or itching 
when undressing, or upon getting warm in bed ; 
burning soreness after scratching ; sour, bitter taste ; 
tongue furred, white in centre with red edges; sen- 
sation of lump in throat, sour eructations ; regurgi- 71 
tations of food, aversion to meat; enlargement and 
tenderness of liver ; stitches and colicky pains in left 
side of abdomen from restricted gas; costiveness, 
alternating with morning diarrhoea, which hastens 
the patient from bed in the morning ; stools scald 
and excoriate the anus ; lancinating, pulsating, itch- 
ing and burning pain after discharge ; sinking, faint- 
ing sensation accompanies the evacuation. Espe- 
cially suited to lean, round-shouldered patients 
affected with herpetismus. 
Throughout this paper the endeavor has been to 
present most prominently the philosophy of correct 
living as the chief remedial means, holding drugs as 
secondary accessories. We apprehend that our phar- 
macodynamics will be regarded as extremely meagre 
and disappointing by those who are accustomed to 
study disease by peering through the glass of symp- 
tomatology simply. 
Xothing is easier than the multiplication of pages 
by the reproduction of matter found in previous 
works on materia medica, and we may add that 
nothing is more undesirable. 
The trend of this tiresome reiteration of original 
material is toward mental enervation in our ranks, 
and a fostering of that spirit of indolence which is 
ever seeking some short cut in therapeutics. While 
we heartily endorse the doctrine of symptomatology, 
when properly construed, we recognize many vital 
features in the treatment of disease not included 
within its limits. He who ignores hygienic essentials, relying solely for success in the treatment of consti- 
pation upon the administration of some “ indicated 
remedy/’ pursues an absurdly narrow-minded course, 
and one which merits the unstinted disapproval of 
discerning practitioners. 
72