"It is a greater disgrace to be sick than to be in the penitentiary. When you are arrested it is because you have broken a man-made statute, but when you are ill, it is because you have disobeyed one of God's laws."
"It is a greater disgrace to be sick than to be in the penitentiary. When you are arrested it is because you have broken a man-made statute, but when you are ill, it is because you have disobeyed one of God's laws."
Constipation—Regularity of Bowel Function—The Function of the Stomach—Fermentation—Incomplete Constipation—Importance of a Clean Bowel—A Daily Movement of the Bowel Necessary—Constipation in Breast-Fed Infants—Treatment of Constipation in Breast-Fed Infants—Constipation in Bottle-Fed Infants—Treatment of Constipation in Bottle-Fed Infants—Constipation in Children Over Two Years of Age—Diet List for Constipation in Children—Bran Muffins in Constipation—Treatment of Obstinate Constipation—Oil Injections in Constipation.
Constipation—Regularity of Bowel Function—The Function of the Stomach—Fermentation—Incomplete Constipation—Importance of a Clean Bowel—A Daily Movement of the Bowel Necessary—Constipation in Breast-Fed Infants—Treatment of Constipation in Breast-Fed Infants—Constipation in Bottle-Fed Infants—Treatment of Constipation in Bottle-Fed Infants—Constipation in Children Over Two Years of Age—Diet List for Constipation in Children—Bran Muffins in Constipation—Treatment of Obstinate Constipation—Oil Injections in Constipation.
The most frequent cause of ill health and inefficiency in the human race is inattention to regulation of the bowel function. Good health depends upon many causes of which good blood is an absolutely necessary requisite. Good blood depends upon what feeds and sustains it. There are other contributing factors, such as the proper kind of exercise, the proper amount and quality of fresh air, the method of living, etc., but these are all food in a sense. The food we take in is acted upon by the various digestive juices until everything is extracted from it that contributes to the building up of the body. Whatever is left, whatever the body does not want, is immediately, or within a reasonable time, passed out in the form of a movement of the bowels.
If any part of the digestive function is deficient, impaired health, or mental and physical inefficiency expressed in the form of indigestion, is the result. Ifthe bowel is at fault, constipation is the usual consequence. A perfectly healthy living machine must maintain a perfect digestion and regular bowel movements.
The Function of the Stomachis to mix and churn the food, and to add certain ingredients to the mixture so that before it is carried into the intestines it is (as far as it is the stomach's duty to render it) ready to be absorbed into the system. Before it reaches that part of the intestine which absorbs, it is acted upon again and certain other ingredients are added to it by certain other digestive organs. In time it is in shape to be used and it is sent along on its way. As it passes onward the little sucking glands in the wall of the bowel suck up all the liquid element in the mass of food. The liquid element in the mass is the food itself, rendered liquid by the stomach and other digestive organs and juices. The remaining solid mass is that part of the food which the body cannot use and does not want. By the time the liquid element is absorbed, the solid mass (always kept moving by the bowel wall) has reached the rectum, ready to be passed out at once, or very soon, provided—and upon this provision depends the success of the entire process,—it has all been done within a certain time. If the stomach takes too long to do its work we have indigestion. If the bowel takes too long to do its work we have constipation.
Fermentation.—Now let us consider the matter from another standpoint. If food stays too long in the stomach it begins to ferment. When anything ferments it makes and evolves gas. You, no doubt, have noticed many times how the cork pops out of a bottle if its contents are "working," or fermenting. If you watch that bottle you will notice that it is quietly or actively evolving air bubbles. That is gas,—gas manufactured by the process of fermentation. This is exactly the process that goes on in the stomach or bowel of a dyspeptic, and it is this collection of foul, poisonous gas that causes the distress and bloated feeling which every dyspeptic suffers from after eating,—if it is this "flatulent" type of indigestion which is present.
The Significance of Constipation.—If the food takestoo long to pass through the bowel it causes, as we have stated, constipation. What is the real significance of constipation? It means that in passing through the bowel the food has given up all its liquid element (which is all its nourishing element), but the bowel has been too slow in passing it along. Consequently it is not ready to be expelled while it is yet a harmless semi-solid mass. It stays in the bowel too long—it begins to putrefy, bacteria attack it, and it is soon a semi-liquid, foul, rotting mass. The sucking glands in the intestinal wall continue to suck—that is their duty. They cannot discriminate between what is good and what is bad—they simply go on absorbing whatever is there to absorb. So there are absorbed into the system liquid and gaseous products which are poison.
This process has been called by a number of names; "self-poisoning" explains the condition thoroughly. The other names are, auto-infection, auto-intoxication, enteric-infection, enteric-toxemia, intestinal indigestion.
The condition is a serious one, because it is absolutely impossible to feel well, or to enjoy good health, while it lasts. The feeling of being constantly sick, yet not sick enough to stop working or to demand a radical cure, affects a woman's efficiency, interferes with her capacity to work, her ability to render the home an abode of contentment, to be an agreeable companion, or to adequately take care of her children.
The constant absorption of intestinal poisons affects the system itself,—the symptoms are headache, neuralgia, loss of appetite, nervousness, insomnia, vertigo, inability to concentrate, lassitude, indigestion. The condition which we name constipation is therefore one of supreme importance. From a medical standpoint, it is the biggest problem in the whole realm of disease. It is the most significant hygienic function of life, and it is becoming more and more important, and more and more a problem. Every modern factor upon which physical efficiency seems to depend is an enemy to the systematic regulation of this function. Our method of hurried and indiscriminate eating, our system of strenuous living, our unsanitary environment, our business activity, our method of pursuingpleasure, take no account of, and resent the time devoted to cultivating, as a hygienic necessity, this toilet requirement. This imperative call of nature is pushed aside by the child at play, by the housewife for a duty which could wait, by the merchant for an engagement. It is particularly an American disease, and it is uniquely an American woman's affliction. It is a curious commentary on the intelligence of the American people, who are ordinarily alert and analytical, to realize how few of them really know how serious a matter constipation is. They don't know because they have given the matter absolutely no thought. They have accepted it as a mere matter of fact, almost of fate.
Incomplete Constipation.—There is a type of constipation that is not known to the average person and not well understood by those few who know of its existence. In this form of constipation there is a daily bowel movement but the movement is not complete. The bowel does not thoroughly empty itself; it has established this habit because of conditions under which it has had to do its work. If a woman neglects herself, becomes muscularly inactive, does not take proper out-door exercise, grows fat and lazy, eats irregularly and indiscriminately,—the bowel suffers with the rest of the system. The woman may have a healthy appetite, may eat the wrong things at the wrong time, yet the bowel is supposed to go on acting rightly, but it does not. It, too, becomes lazy and acquires bad habits, and this form of incomplete constipation is the result. These patients look healthy and get little sympathy for any pains they may have. They may even gain in weight; they get headaches once in a while, and if they go shopping or visiting they don't feel quite well afterward. They are suffering from the effects of chronic constipation, though their bowels are apparently regular. They are marching onward toward apoplexy or Bright's disease of the kidney.
Importance of a Clean Bowel.—Every mother, sooner or later, observes that a physician always thoroughly cleans out the bowel of a sick child at once, no matter what the character of the sickness is. He does this for two reasons,—first, because he knows that the greatmajority of children's ailments are of gastro-intestinal origin; second, if the origin of the disease is not in the stomach or bowels, experience has taught him that if the bowels are clean at the beginning of a disease, that disease will run a milder and shorter course than if complicated with a condition of self-poisoning. If a child develops fever the digestive function stops; whatever food is in the stomach or bowel will promptly ferment and putrefy because of the abnormal heat caused by the fever and the arrested digestion. If this is not cleaned out at once the self-poisoning process begins.
The above is a suggestive admission for a physician to make. It simply means that the vast majority of the calls made by a physician on ailing children are caused by errors in diet and can be completely cured by a dose of castor oil or calomel, or, better still, need never occur.
A mother who neglects, who is guilty of inattention to the conditions of her child's bowel, fails in one of the most important duties of motherhood. I know as a father and a physician that if a child's bowel acts regularly and thoroughly, that child is fortified to the highest efficient degree against the multitude of little ailments common to all children. A clean bowel means good blood, good digestion, ability to exercise properly, to sleep soundly and to think clearly. Such a child will resist infection and throw off the minor troubles that pave the way for serious sickness. It is a secret worth knowing.
A Daily Movement of the Bowel Necessary.—In order to preserve good health one thorough movement of the bowel is necessary daily. A baby may have two or three and enjoy robust health. A larger daily number suggests an abnormal condition of the bowel and an investigation should be made. If a nursing baby's bowels do not move before bedtime it should be given an injection of equal parts of glycerine and hot water, one-half cupful; or an enema of soap and water, or a glycerine suppository. When a child is six months old, in some sooner, it should be put on the stool at a certain time every morning. This will aid in the establishment of the habit, as a child soon understands why it is made to assume this position and acts accordingly.
The condition referred to above and which we termed incomplete constipation may affect the nursing infant. A child's bowels may move daily and yet the child will suffer from constipation. If the movements are watched it will be observed that certain children strain when at stool, and after a time succeed in passing hard, dry lumps or balls of fecal matter. Such a movement is a certain indication that the bowel is not emptying itself satisfactorily and that a constant toxemia or poisoning is going on. Very faithful efforts should be made to remedy this condition by the use of articles of diet that are known to be laxative, otherwise the condition is one that will "grow" with the child and establish an obstinate chronic constipation with all its miseries and dangers.
Constipation in Breast-Fed Infants.—Many nursing infants thrive and gain in weight, yet they are constipated. Before you drug your baby be sure the fault is not your own. Many mothers are responsible for the constipation with which baby suffers. If the mother is constipated, so will the child be. Cure the constipation of the mother and the baby's bowels will regulate themselves. Nursing mothers who are large tea-drinkers have irregular bowels as a rule. A baby whose mother is lazy or indolent, who does not take a reasonable amount of exercise, whose diet is faulty and whose hours are bad, is a sufferer from constipation. The mother's life must be regulated, her diet and habits corrected, and the instructions carried out as already recommended. The breast milk should be examined and if any cause for constipation exists in it, it should be rectified as suggested elsewhere.
If it is thought advisable to resort to drugs for the immediate relief of the constipation of infants, the best ones are the aromatic fluid extract of cascara sagrada; milk of magnesia with equal parts of the aromatic syrup of rhubarb given in doses of one to three teaspoonfuls daily.
Irrigations, enemas, and suppositories should not be used continuously. The habit is a bad one. The parts become accustomed to their use and fail to act. If the child is passing dry and hard stools it is of advantage to inject two ounces of warm sweet oil at night, allowingit to remain in the bowel until the following morning. See page 312.
Constipation in Bottle-Fed Infants.—It is much easier to treat the constipation of bottle-fed babies than of those breast-fed, because the food can be changed to ensure regular bowel movements. The first change to be made in a bottle-fed baby who is habitually constipated is to add more cream to the food. The way to do this is to take out of the bottle of each feeding one tablespoonful of the food and put in its place one tablespoonful pure cream. If this change partly rectifies the bowel ailment, add more cream until the bowels are of the proper consistency. Milk given constipated babies should be raw, never boiled, as boiled milk will always aggravate the trouble.
The use of oatmeal water instead of plain water in making the baby's food may cure the bowel trouble. Taking the sugar of milk out of the baby's food and putting in its place the same quantity of Mellin's food will sometimes cure the constipation.
One or two teaspoonfuls of milk of magnesia put into one feeding daily, or fifteen drops to one tablespoonful of the aromatic fluid extract of cascara sagrada will move the bowels. Orange juice, strained, two teaspoonfuls twice daily, is an excellent remedy and should be tried in every case. Sweet oil and pure cod liver oil, in doses of thirty drops to two teaspoonfuls three times daily after feedings, if the little patient is poorly nourished. If the stools remain hard and dry, an injection of two ounces of warm sweet oil at bedtime is an excellent method of aiding the bowel. The oil should remain in the bowel all night. This lubricates the parts, softens the fecal mass and stimulates the gut to perform its own work. See page 312.
Constipation in Children Over Two Years of Age.—Most children when put upon a varied diet after the nursing days are over are relieved of any constipation which may have existed up to that time. There are a few, however, whose condition does not seem to improve. These children need attention. We should first insist on regular habits. A child should be told that itsbowels must move every morning after breakfast. If this is absolutely insisted upon the child will soon recognize the uselessness of fighting the proposition and submit. If at any time a conscientious effort is made to move the bowel without result after fifteen minutes it is wise to use a glycerine suppository so that the bowel will empty itself.
It has been stated in another part of this book that there are children with whom milk does not agree. Experience has taught us that milk, especially milk that has been boiled, causes more cases of constipation in growing children than all other causes combined. Find out if it is milk that is the cause in any individual case. While these children cannot take whole milk just as it comes from the dairy without suffering in a great many ways, they can take milk and water, or milk and oatmeal water, prepared in the following way, without becoming constipated. A bottle of fresh milk is allowed to stand in a cool place for five hours, when the top ten ounces are skimmed off with a Chapin dipper and mixed with twelve ounces of oatmeal gruel or plain water. This can be used as a drink.
Parents can select from the following list of articles such combinations as may be suitable to constitute the regular meals of a constipated child:
Lamb chops.Rare steak.Rare roast beef.Hashed chicken.Soft boiled eggs.Cracked wheat.Hominy.Cornmeal.Oatmeal, Scotch.Bran biscuits.Oatmeal crackers.Graham wafers.Stewed or baked apple.Apple sauce.Plain vanilla ice cream.Animal broths, purées of peas.Beans, and lentils.Peas.String beans.Spinach.Cauliflower.Asparagus.Stewed tomatoes, strained.Whole wheat bread.Zwieback.Custard.Stewed prunes.Junket.Cornstarch.
Lamb chops.Rare steak.Rare roast beef.Hashed chicken.Soft boiled eggs.Cracked wheat.Hominy.Cornmeal.Oatmeal, Scotch.Bran biscuits.Oatmeal crackers.Graham wafers.Stewed or baked apple.Apple sauce.Plain vanilla ice cream.Animal broths, purées of peas.Beans, and lentils.Peas.String beans.Spinach.Cauliflower.Asparagus.Stewed tomatoes, strained.Whole wheat bread.Zwieback.Custard.Stewed prunes.Junket.Cornstarch.
Malted milk is agreeable and advisable as a drink.
Orange juice or a scraped raw apple is allowable at this time. Constipated children should eat plentyof good butter. Olive oil, two or three teaspoonfuls after each meal, is excellent. It can be kept up for months to advantage. Older children may eat raw and cooked fruits, figs, dates, baked potatoes, poultry, and fish. One or two raw apples or a peach or orange may be given daily. A strict observance of the above rules and diet will result in normal movements of the bowel if persisted in for a reasonable time. It may be necessary occasionally to use a suppository or an enema now and again until the habit is established.
In children from five to fifteen years of age the use of bran muffins, with fruit, etc., as described above, will effect a cure of constipation without having to resort to drugs. I have cured many cases of constipation in growing children with these muffins without making any other change in their diet or habits.
Take one pint of best flour, one quart unsifted bran, one teaspoonful bicarbonate of soda (baking soda), a pinch of salt. Mix these thoroughly together, then add: six to eight tablespoonfuls good, New Orleans molasses, one pint of milk. Mix together very thoroughly. Put in muffin rings and bake in oven. About one ounce should be put in each ring as they raise easily. Eat with plenty of good butter. They should be given to children before each meal, when they are hungry, not after their stomachs are full. Put bran in dish first. Sift in flour, soda and salt. Mix these thoroughly together, then add one pint of milk (two cupfuls) and six to eight tablespoonfuls of New Orleans molasses. The quantity of molasses depends upon the individual taste. They are good for any child or adult whether constipation exists or not.
Take one pint of best flour, one quart unsifted bran, one teaspoonful bicarbonate of soda (baking soda), a pinch of salt. Mix these thoroughly together, then add: six to eight tablespoonfuls good, New Orleans molasses, one pint of milk. Mix together very thoroughly. Put in muffin rings and bake in oven. About one ounce should be put in each ring as they raise easily. Eat with plenty of good butter. They should be given to children before each meal, when they are hungry, not after their stomachs are full. Put bran in dish first. Sift in flour, soda and salt. Mix these thoroughly together, then add one pint of milk (two cupfuls) and six to eight tablespoonfuls of New Orleans molasses. The quantity of molasses depends upon the individual taste. They are good for any child or adult whether constipation exists or not.
Drugs may be of temporary service in some cases. A pill of cascara sagrada is the best for this purpose. It should not be continued for more than two weeks. Castor oil, calomel, and other frequently-used cathartics should never be used in simple constipation.
There are cases that resist treatment of the kind described above. Diet and drugs do not succeed in establishingthe habit of daily bowel movements. In these cases radical treatment is imperative. The diet should be the same as that described above, but it will be found advisable to cut out milk altogether. Cereals can be taken with sugar and butter instead of milk. The oil injection plan of Professor Kerley has given me excellent results. I quote his comments upon and method of giving it:—
"Oil Injections."—"For this purpose a soft-bulb syringe of four ounces' capacity is ordered. Over the hard rubber tip is place a small sized adult rectal tube or a No. 18 American catheter. The catheter or tube is cut so that but nine inches remain for use. The cut end is forced over the small, hard rubber tip of the syringe. A fountain syringe is impracticable for this purpose, as it is soon destroyed by the oil and rendered unfit for use. Besides, sufficient pressure is not produced to force the oil into the gut even with a high elevation of the bag. The child is placed on his back or on his left side. The syringe is filled with oil, the tube is lubricated, and passed through the rectum as far as it can go. When it has been passed to the full nine inches, as may readily be done with a little practice, the syringe is emptied and the tube withdrawn. The injection should be given after the child has been placed in bed for the night. It is our object to have the oil retained during the night. If a passage of the bowels is produced at the time, or if the oil leaks out during the night, a small quantity should be used. In some of my patients I have been able to use but one ounce. In very few, indeed, does it cause an evacuation at the time. If there is a tendency to leakage a napkin should be worn to avoid soiling the bed-linen. The following morning after breakfast, the child is placed on the vessel and kept there until a bowel movement results or until fifteen minutes have elapsed. In a great many cases if the constipation has been obstinate for months, the bowel will be at once evacuated. When this does not occur in fifteen minutes, a glycerine suppository is inserted, which invariably produces an evacuation. This use of the suppository, according to my observation,can usually be dispensed with in a very few days; the use of the oil, however, may have to be continued for several weeks. When the child has had the oil nightly and an evacuation the next morning without assistance for two weeks, I direct that the oil be omitted for a night and the effect noted. If the usual passage occurs after breakfast, the oil is given for five nights and then omitted. If the case progresses satisfactorily the use of the oil is gradually omitted, being given at first every second night, then every third, fourth, or fifth night, etc. A considerable number of cases have been completely relieved in two months. In the event of no passage following the omission of the oil, its use is continued for two weeks longer, when it is again omitted for a night." To illustrate this point the following case is cited.
"Illustrative Case.—A boy three years of age had never had a bowel evacuation without drugs, soap enemas, or suppositories since birth, and finally these were no longer effective. The mother, thoroughly frightened, brought the child to me. Eight months of diet and the use of the oil were required before he was entirely well. It is now three months since the local treatment was discontinued and the bowel function remains normal.
"The diet with the absence of milk must be continued for months after the patient is apparently well, and he must not be allowed to pass a single morning without an evacuation at the usual time. In assuming the management of one of these cases I explain to the mother or nurse that the treatment is not pleasant for the child or the attendant, and that it may have to be persisted in for weeks, and unless she is willing to carry it out to the end, it would better not be undertaken. I assure her, however, that with her coöperation, which is usually readily given, the child will make a complete recovery. Cases that are slow in responding to treatment, I usually give the additional advantage of abdominal massage from twenty minutes to one-half hour, before the child is placed at stool. The massage should practiced by one skilled in the work.
"The above local measures apply particularly to childrenafter the eighteenth month. They may be used earlier, however, following out the diet along the lines laid down for bottle-fed children who suffer from constipation. In very young children a smaller amount of oil should be used, never more than two ounces, usually one ounce is all that is required. When the oil treatment is under way, whatever the age of the patient, laxative drugs should not be given."
Chief Cause of Constipation in Women—Constipation a Cause of Domestic Unhappiness—The Requirements of Good Health—The Cost of Constipation—Constipation and Social Exigencies—One of the Important Duties of Mothers—Constipation and Diseases of Women—Constipation is Always Harmful—Constipation and Pregnancy—Explanation of Incomplete Constipation—Causes of Constipation—Negligence—Lack of Exercise—Lack of Water—Lack of Bulk in the Food Taken—Abuse of Cathartic Drugs and Aperient Waters—Overeating—Treatment of Constipation in Women.
Chief Cause of Constipation in Women—Constipation a Cause of Domestic Unhappiness—The Requirements of Good Health—The Cost of Constipation—Constipation and Social Exigencies—One of the Important Duties of Mothers—Constipation and Diseases of Women—Constipation is Always Harmful—Constipation and Pregnancy—Explanation of Incomplete Constipation—Causes of Constipation—Negligence—Lack of Exercise—Lack of Water—Lack of Bulk in the Food Taken—Abuse of Cathartic Drugs and Aperient Waters—Overeating—Treatment of Constipation in Women.
It has been stated that constipation is almost universal among the women of America. It is a fact that very few American women enjoy, to a reasonable degree, a permanently satisfactory bowel condition. Constipation is an acquired habit and unquestionably negligence is the primary and the chief cause of it. The negligence, no doubt, begins at a very early age; it is at least an established habit before any intelligent, consecutive effort is made to remedy it. Inasmuch as women are the mothers of the race, and as their part in the scheme of lifeisthe supreme one; and as constipation has been shown to be a serious, far-reaching, significant disease, a very sincere and persistent crusade should be made to educate women as to its importance. For a less altruistic purpose, tremendous popular movements have been carried to success. For a less service rendered to the race names have achieved renown. In addition to the symptoms stated in the preceding paper, the condition which we now desire to emphasize is the effect of the constant self-poisoning on the general health and its effect upon a woman's reproductive efficiency.
The poison being constantly absorbed, means general bad health, bad health to a degree depending upon the degree of constipation which is the cause of the poisoning. It may be simply that the woman does not wholly enjoy good health, or that she is completely incapacitatedbecause of chronic bad health, or any degree of indifferent health between these two extremes.
If the degree of poison is sufficient to cause habitual poor health, its effect upon the blood must be bad, and the effect of the bad blood upon the nervous system and the other vital organs cannot be good. Now if this process has been going on for many years, the condition of the woman, who is its victim, as an efficient machine, compared with the woman in whom this condition never did exist, must be very different indeed. This condition of affairs—inasmuch as constipation is so common in women—must have a tremendous significance when estimating the vitality and efficiency of the coming generation.
We might go much further and yet be sure of our position, and maintain that it is this national autotoxemia, this scourge of womanhood, that is to a great extent responsible for the characteristic American "vice of neurasthenia," and of the domestic infelicity and unhappiness which are so common in the large cities of this country. If we add to the intestinal autotoxemia of constipation, the tendency to, or vice of, indiscriminate eating and drinking—of which the American people are particularly guilty—we would be on firmer ground. In fact we would feel that we had pointed out the one underlying cause of most of the domestic irritability prevalent to-day, which is of serious importance, and which is, fortunately, capable of correction. It is a matter of everlasting and continuous education.
The Requirements of Good Health.—There are certain fundamental basic requirements which are essential to good health: fresh air, good water, a reasonable amount of physical and mental exercise, nutritious food, freedom from unnecessary and unreasonable worry, frequent bathing, and a daily movement of the bowels. The reason why constipation is of such serious importance is because it is the only basic requirement of good health that afflicts a large majority of the race at the same time. The health of so many is being undermined by this one affliction, that it dominates all other factors that have any bearing upon posterity. A woman may enjoy allthe essential conditions necessary to good health, yet she may be constipated, and the presence of this condition will undermine, in her constitution, all the benefits she derives from her advantageous environments. It will do more; it will be responsible for the disposition,—the temperament,—of that woman. The natural disposition of that woman may be an amicable one; if it were allowed to express itself naturally it would be kind, gentle, considerate, affectionate. No woman, however, the victim of chronic constipation, can preserve an equable temperament or an amicable disposition. It is impossible—with her nerves being constantly poisoned—that she can hold the symptoms of that condition in abeyance. She must be irritable and nervous and sick of herself and everything and everybody. The home as a direct result suffers; its atmosphere is not one of contentment and peace and affection. Constipation, therefore, blights the home and the influence of one blighted home may have a far-reaching effect on the story of the human race. It is responsible also for that woman's mental attitude outside the home. Instead of exerting an optimistic influence, her whole existence is a message of pessimism and discouragement. Multiply these influences and messages to correspond with the prevalence of the disease and we have a condition that is tremendously significant, a condition that is really a pressing economic issue. A constipated woman is an anti-eugenist—a eugenic atrocity.
We have no desire to create a false impression or to build up a foolish fear. Are we justified in regarding this as one of the most important, if not the most important, disease condition; the most menacing physical vice, which the human race has to combat? Let us offer the following brief facts in witness of our stand:
The Cost of Constipation.—It has been estimated that consumption (the great white plague) kills one-tenth of all the human race. Cancer kills half as many, or one in every twenty. Constipation, and the diseases which are caused directly by it, kills one in every three of all the people on the civilized globe.
Constipation has been responsible for the expenditureof millions of dollars in advertising in the newspapers alone,—more, probably, than has been spent in advertising remedies for all other diseases combined. Do you suppose this money was a donation? Do you suppose these keen, alert interpreters of the spirit of the times, the up-to-date business men, were not and are not aware that constipation is the "universal disease"?
Every drug store, in every civilized spot on earth, has its shelves loaded down with constipation remedies; dinner pills, liver pills, cathartic pills, tablets in all possible coatings and combinations, mineral waters from a multitude of springs, aperient drinks by the dozen, laxative teas and cordials, cathartic oils and emulsions. If the demand for these articles should cease most of the drug stores would close up.
Many millions of dollars have been made and are being made by various men and concerns, who have devised ingenious mechanical agencies which are supposed to cure, and in curing renew the lost health caused by constipation. We have in mind in this connection, a man who conceived the ingenious plan of putting the opening of an ordinary fountain syringe in the middle instead of at the end and made a fortune out of it. In this opening he places an upright nozzle, and instead of hanging the bag up and allowing the water to run into the bowel, he has the patient sit on the bag and thereby the water is forced into the bowel. He has written a two-hundred page book on the advantages of this idea, and his "literature" contains the names of famous men and women in all walks of life who use his device. The name of one of the famous judges of the Supreme Court of the United States was there; another was the name of a popular operatic beauty who writes for the daily press little essays on "How to be beautiful!" and "How to keep well!" He deserves his success. He is an emancipator and has doubtless done a great deal of good. His success demonstrates, beyond contradiction, the prevalence of the malady under discussion, and it must be remembered that he is only one of hundreds who garner from the same ample harvest.
If we could estimate in value the economic loss sustained by the race because of the inefficiency of the victims of intestinal intoxication, due to constipation, the sum would be colossal. Even then it would only represent the direct economic deficiency—it would not express, nor could any figure adequately represent, the indirect loss sustained by the race because of the temperamental characteristics, which are the products of intestinal poisoning, and which produce domestic tragedies and economic failures.
Has this array of evidence any meaning, or does it just happen to be so? We leave it to the reader; if it stimulates thought, or pricks a conscience it will have done its duty.
Constipation and Social Exigencies.—The cause of constipation in women, whose social station commands every sanitary, hygienic, and dietary luxury, is their method of living, the food they eat, and the negligence which is almost obligatory because of social exactions. If constipation did not so frequently accompany "good" living (which is the modern name for overeating and drinking) we would have thousands and thousands of healthy, robust, contented women, fit and willing to assume the onerous duties concomitant with motherhood. All their enthusiasm, however, is expended in the effort to keep "in the ring," to overcome the effects of the poison of constipation, to preserve their youth and freshness, to undo what neglect has accomplished. It is because of the failure of this simple function that my lady seeks the masseur, the facial artist, the society doctor, the beauty expert, and the thousand and one agencies, which an extravagant and profligate age has made necessary to foster the efficiency of its votaries.
I am optimistic, however, regarding the future. I believe the human race is improving, despite the disadvantageous surroundings and conditions which hamper honest effort and stultify truth. A higher efficiency is the goal, and the intention is to obtain this desideratum by fair and by just means. There is an awakening, an unrest, a groping for knowledge in almost every field of human endeavor, and there is none in which the yearningfor fact, for truth, for instruction, is stronger and keener, than in the world-wide movement in the interest of a better motherhood, and in a more serious study of child life. It is an encouraging sign, a hopeful promise, of what the future has in store.
One of the Important Duties of Mothers.—The immediate lesson to be learnt from the facts just recounted is to instruct mothers in their duty toward their daughters. If each mother would retain the confidence of her daughter sufficient to instruct her in the duties which are important, how much needless suffering would be saved. To know as a matter of fact whether the daughter's bowels are in good condition will appeal to all who read this as being of very great importance. It is not only necessary to know if they have a movement every day, it is necessary to know the character of the daily movement; whether it is hard and dry and necessitates straining,—the evil consequences of which, in young girls, is very serious indeed,—or if it is habitually loose and suggestive of what has been described as incomplete constipation.
If the mothers of America would consecrate themselves to this simple task, who could tell in mere words the effect it would have on the race yet unborn? There are problems of scientific intent, and of fancy names, that engage the attention of philanthropically inclined ladies, and which are emblazoned on the society columns of the daily press, of much less importance to the human family than the homely duty we ask mothers to devote themselves to.
Constipation and Diseases of Women.—Constipation is present in a very large majority of the cases of diseases of women. It may be caused by disease of the womb, or it may cause disease of the womb. There is no question about the bad effect constipation has upon all diseases of this type. In many cases it is absolutely impossible to effect a cure without first curing the accompanying constipation.
We seldom appreciate how severe a degree of constipation a growing girl will submit to without seeking relief. Some of the worst cases of constipation that have beenknown, have been in girls between the ages of sixteen and twenty. The mechanical effects of such a condition can well be imagined. The constant, severe straining, necessary to evacuate the bowel, has, in very many instances, produced congestion and displacement of the womb and ovaries. It is not observed at this time, or if observed it is not understood, and thus is laid the foundation for years of neurasthenia, helplessness, and disease.
The more we investigate the ramifications of constipation the more we learn of its seriousness and of its significance.
Constipation is Always Harmful.—There is no period in life when constipation can be borne with impunity. Youth, with its virility and vitality, will endure its consequences with an apparent negation, so far as positive or specific results are concerned, but it is only an apparent impunity. There is always a certain amount of strength built up, held in reserve as a heritage of youth, which will withstand a certain amount of physical license, but if this reserve is assailed by an unnecessary imposition, and is successfully undermined, there will be infinitely less reserve to call upon in the legitimate battle of life. Life is too real, too concentrated, too strenuous, and health is too precious to be wilfully wasted in any form of self-abuse.
Constipation and Pregnancy.—Mothers will appreciate from the foregoing explanation why constipation is eugenically a crime during pregnancy. The evils which result from constipation mechanically, frequently have serious consequences by interfering with the circulation of the blood to the womb, by forcing the womb to assume wrong positions, by straining at stool, and by preventing the kidneys from functionating properly; these may render the life of the pregnant woman miserable, and may be the direct cause of a painful, prolonged, difficult labor. The evils which result from constipation because of the absorption of poisons by the bowel are of the gravest importance during pregnancy. These poisons affect the general health; the victim is tired, listless, and apathetic, and is thereby disinclined to exercise adequately;the appetite is poor; there are headaches, neuralgias, insomnia, nervousness, melancholia, and general mental and physical inertness. What hope may a pregnant woman entertain of having "an easy confinement," or of bringing a healthy child into the world under these circumstances? Who is to blame? Sometimes it is necessary to tell the unadorned truth,—the woman is to blame. No woman has a right to assume the responsibilities of maternity who has not had enough respect for herself to discontinue habits which caused this failing, or who has not had strength of will enough to begin its successful cure. Get busy,—do something,—it is never "too late," but do it now.
Before we take up the treatment of constipation in women, it is necessary to explain more fully the type of constipation which we referred to as "incomplete" constipation. There is a condition of the bowel, in which we find its wall coated with hard fecal matter. The size of the bowel may be dilated as a consequence. This condition may occupy part, or most, of the entire length of the large intestine. In the middle of this hard mass there is a small channel through which semi-liquid matter passes. When the bowel moves, it is this semi-liquid matter that passes out, and this constitutes the daily movement. We have consequently a condition in which we have a daily movement but not a complete emptying of the bowel. The character of the stools from such a bowel must necessarily be more or less of a semi-liquid consistency, because the intestine, being coated with a hard dried out layer of old fecal substance, is prevented from absorbing the liquid part of the fresh fecal mass passing through it. This condition may exist for a considerable time, but it will slowly undermine the health and vitality of any person in whom it exists. The symptoms which a patient in this condition complains of are,—a feeling of being tired and languid, no energy or vim, headache, loss of appetite, loss of flesh, neuralgic pains, nausea, vertigo (dizziness), insomnia, frequent colds, cold hands and feet, biliousness, sallow skin and muddy complexion, liver spots, coated tongue and a "bad breath," nervousness, melancholia, various abnormal conditionsand diseases of the skin, pimples, blackheads, eruptions, eczema, piles, appendicitis, diseases of the intestinal wall as a result of the constipation, Bright's disease of the kidney, and many other morbid conditions. Any physician could name many symptoms, which were never properly understood but which are now known to be caused by the absorption of poisons resulting from inactivity of the bowels. Patients may not necessarily have all of the above symptoms; they may have a number of them, or they may have all of them, and they may have others not mentioned at all.
Treatment of Constipation in Women.—To effect a movement of the bowels in a patient who is a victim of constipation is not a cure. We can indefinitely cause bowel action by drugs, etc., but the condition will remain the same or worse. When habitual constipation exists there is an underlying condition affecting the entire system which indicates that something is radically wrong. It may be necessary to change the whole routine of the patient's life. It will certainly be necessary at the very beginning to inquire into the daily diet, exercise, and surroundings.
During the past ten years there has been born every few days a new medical "ism," a new religious cult. Why? Because human nature is an unstable equation. We are never satisfied with the old order of things and there will always be a following wherever there is a leader. These "isms" and cults do not survive. Some seem to thrive, others die a natural death. There is a law, as old as the hills, that you cannot get something for nothing in this world. We learn its bitter truth as the years pass, and when we get over the day dreams and the sentiment of youth we settle down to real work. If we desire to retain good health, or regain lost health, we must do something. No one can hand it to us on a silver plate, nor can anyone work a miracle in our behalf. We cannot buy health, we must deserve it.
This is the secret of the success of all schemes to cure disease. The human family will not knuckle down and swallow the truth. The man or woman in poor health is looking for Aladdin's lamp everywhere and always. Anew bait, dressed up in lubricated, oily words, promising impossible results, will be accepted as the simple unadorned truth, and will be bought and paid for, in the end forgotten. The royal road, the easy road, which they are looking for is impossible. There is no way by which any one of us may continue to break the laws of nature and retain or regain our lost health. Miracles are impossible. Prayers without deeds are empty mouthings and a waste of time. Let us see how this works out in the treatment of constipation. We must find the cause of the constipation. I will name the causes in their order of frequency.
Negligence.—This is unquestionably the primary cause of almost all cases of bowel inactivity. As has been already noted, the exigencies of modern life are of such a strenuous nature that we do not find the time to devote to this function the degree of systematic attention which it demands in order to preserve a healthy condition of intestinal regularity. The bowel is simply a complex muscle controlled by an elaborate system of nerves of an involuntary type. In order to preserve the highest degree of efficiency of this complicated mechanism, it must be permitted to obey the laws nature endowed it with and which it must obey. When the fecal mass reaches the rectum the nerve centers, acting through the spinal cord, send a message to the rectum something like this: "Empty yourself of your contents, we have made all preparations and everything is ready." The rectum obeys to the extent of notifying you that it wants to be relieved; you feel the desire to evacuate the bowels. If you obey, all is well, nature is appeased, you encourage the systematic regularity necessary to good health. If you do not obey, you upset the delicate mechanism, and frequent negligence of this character will result in the complete disarrangement of this complex machinery so that it will fail to warn you that a bowel movement is necessary and constipation is established. We must therefore retrace our steps and re-educate the bowel systematically to empty itself at a certain time every day. This can be done in nearly every case without artificial assistance. It may take time but it is wortha little methodical persistence. The point is, you must do it; no "ism" or esoteric agency can do it for you.
Mothers will recognize from this explanation the necessity of establishing the habit in children at the earliest possible moment.
Lack of Exercise.—What does the word exercise imply? It implies movement, better circulation of the blood, better health and tone to every part of the body, more oxygen, and a richer, better quality of blood, and because of a better quality of blood, which is the fuel of the body machine, we have a better, smoother working machine. Every human being requires a certain amount of exercise; otherwise the machine will not run smoothly. If this exercise is not obtained, things begin to go wrong. One of the very first signs to indicate that the machine is not running as it ought to run, is a sluggish condition of the whole digestive apparatus and a certain degree of bowel inactivity (constipation) follows. There is no substitute for this need. Drugs will not help you, mechanical devices will not do the work for you, though they may aid you. You must do the work yourself. If you fail or hesitate to recognize the truth, if you temporize or procrastinate, you are only deferring the issue. The argument that you have not the time, that your work will not permit you, is no argument at all. You must do it or reap the consequences; you certainly cannot escape them. The wise woman accepts the situation, the fool goes to an early grave.
Lack of Water.—Constipation may be due to a deficiency of water in the system. Women who suffer from this type do not drink enough water. The bowel may be willing and able to do its duty, but is handicapped because a certain amount of liquid is essential to proper digestion and natural bowel activity. At least six glasses of water should be taken by every healthy adult human being in each twenty-four hours. The best time to take this water is as follows: one glass on arising, two between breakfast and lunch, two between lunch and dinner, and one on retiring. Between meals means one hour after a meal and at least one-half hour before the following meal. No liquid should be taken during a meal, orimmediately after, or before a meal. All water taken may be hot or cold, according to the fancy of the taker. It is of advantage to squeeze the juice of half a lemon into the water taken on arising if there is any tendency to constipation or if the liver is lazy or torpid. It is also good for the complexion.
Lack of Bulk in the Food Taken.—Sometimes the character of the food taken is such that there is no body to it. The process of digestion so completely liquefies it that the bowel has no solid matter to manipulate. To excite the peculiar movements of the intestinal wall there must be substance in the contents. The variety of the daily food must be so arranged as to provide this. A list of these foods is provided elsewhere in this book. Certain other foods stimulate intestinal activity, not because of their bulk, but because of the chemical elements they contain. All forms of sugar, the sugars of fruits, the acids of fruits and vegetables, are excellent natural laxatives. Sour milk and buttermilk, oils and fats, are also of distinct value in this respect.
On the other hand, soups, gruels, porridges, and purées are constipating because the digestive process reduces them to liquids and leaves no bulk for the bowel to act upon. New bread, hot biscuits, "noodles," and doughy foods are also objectionable, especially to children. Hot baths, hot drinks, hot enemas, and sweating are also constipating because they extract so much liquid from the bowel leaving the contents excessively dry.
Abuse of Cathartic Drugs and Aperient Waters.—This is a widespread evil; it may justly be regarded as a national curse. The victims of this custom do not realize that they are addicted to a habit which must be rightly regarded as equally as bad as the drink habit, so far as its ultimate effect on the general health and the prospect of longevity is concerned. Its popularity is a product of our national vice of indiscriminate eating and drinking. It is more common among the class who live in restaurants, hotels, and boarding houses, who keep late hours, eat late suppers and who do not exercise enough. These individuals eat too much and live too high. After a time the liver becomes sluggish, the stomach fails todigest properly, the bowels lose their tone, and flatulent indigestion or some other more or less serious condition follows; to maintain the pace, to feel and keep fit, they discover that a glass of some advertised aperient or laxative water before breakfast works wonders, tides them over for the time being and keeps them "in the ring." They compliment themselves and push the specter of age aside.
The thought that they were not "as young as they once were," or that they must go slow, was not a very pleasing suggestion, so having found a "cure" by adding another bad habit on top of an existence which is composed of nothing but bad habits, they start all over again. The suggestion that their trouble is a warning that "things are going wrong" and that the whole plan of living must be radically and promptly changed does not meet with their approval, and so the Department of Health statistics heap up the records of deaths due to heart disease, hardening of the arteries, Bright's disease of the kidneys and apoplexy. It is not a happy tale, but the truth is often tragic.
When a woman finds that her physical efficiency depends upon the habitual use of cathartic drugs or laxative waters, she must regard the knowledge with respect, she must give it serious consideration, and she must adopt means to so change her method of living, that nature will be given a chance to work in her interest—not against her. Better to find out exactly where the troubleisnow, and go after it than to travel too far along the wrong road. Many die from the "disease" of procrastination.
Overeating.—Overeating may be included in this classification because it so overworks the digestive apparatus that it is impossible for it satisfactorily to complete its function. Any reader desirous of understanding the full significance of overeating in this connection should carefully read the article on this subject on pages 289 and 290.
There are, of course, a great many other causes for constipation but these are the important ones. When we find the cause of any particular case it will suggest the remedy and we must employ it faithfully if we hope toeffect a cure. If it is negligence, we must correct that fault and compel our daily routine to accommodate itself to a regular observance of this function. If it is lack of exercise, we must get more exercise, or if it is lack of bulk in our food, we must change our method of living and select with more care the foods we eat. If it is lack of water, we can correct the constipation by adding the proper amount of water at the proper time.
A patient who has been a victim of chronic constipation for some time must live a life somewhat after the following general plan:
She should increase the vegetables, fruits, and fats in her diet and she should drink enough water. It is a good plan to sip slowly one-half pint of hot or cold water morning and evening. Daily exercise in the open air is advisable; exercise of some kind, even if taken indoors, is imperative. Walking, riding, bicycling, tennis, golf, swimming, are the best forms of exercise for women. Indoor gymnastics can be made a satisfactory substitute. After the exercise a hot shower bath and a cold sponge bath or cold plunge or a swim should follow.
Women in very moderate circumstances may walk briskly a distance of three or four miles, and on returning can take a warm bath followed by a brisk rub-off with a coarse towel wrung out of cold water, or they can use a hose with a spray nozzle and allow the cold water to run over them for a few seconds after the warm dip in the bath tub. After the adoption of these measures the bowels may tend to regulate themselves. If so, this is the proper time to cultivate the habit of regularity, by selecting a certain time each morning or before retiring for this function. The patient should go to the toilet at the regular time even if the desire is not present. By straining slightly, and by encouraging the voluntary desire, the bowel may receive the necessary stimulation and an evacuation may result. If there should seem to be no disposition on the part of the bowel to become accustomed to this procedure, we must aid it for the time being. A glycerine or soap suppository, a glass of aperient water, Pluto, Hunyadi, Apenta, or the imported Carlsbad salt in warm water, or the effervescent Citrate of Magnesium,will result in a prompt emptying of the bowel. There are a great many other cathartic drugs and many well-known laxative pills, etc., but these are not necessary if a systematic effort is being made to cure the constipation, because success will come within a reasonable time if the patient will not become unduly discouraged. Many victims are deficient in fat; the bowel needs lubrication; we therefore recommend a good quality of olive oil, one tablespoonful after each meal. Frequently it is of advantage to inject, high up in the bowel, two or three ounces of sweet oil at night, as is done in children, and which is fully described in the previous chapter.
If the constipation is due to deranged nerves, in which the reflexes of the intestinal wall seem to share, we advise massage of the abdomen, and an occasional hot or cold rectal injection. The proper quantity to use for this purpose is from two to three quarts. The solution to use is the normal salt solution. See page 627.
In that form of incomplete constipation in which we stated that there was a layer of hard, impacted feces covering the bowel wall, a special method of treatment is necessary. In these cases nothing will succeed as satisfactorily as very hot, high rectal injections. The object of course is to rid the bowel of the old, hard, dry mass, which has collected there, before we can hope to get the bowel into condition to perform its own work. It is almost incredible that the human bowel can hold so much old dried-out, nasty stuff as is stored up in these constipated bowels. Hot salt water, as hot as can be tolerated, two or three quarts at a time, is the correct way to dislodge this mass. It will not be done at once; it frequently takes two or three weeks before the bowel is fairly clean. The irrigations should be given every second night until the bowel is clean. The method of giving these washings is fully described on page 312. While these irrigations are being given the patient should take olive oil by the mouth, one tablespoonful after each meal. The proper food, open-air exercise, sanitary living, plenty of water, and regular attention to the bowel movements will in the end cure the affliction.