The Abdominal and Pelvic Brain
Byron Robinson, M. D.
CONSTIPATION - ITS PATHOLOGIC PHYSIOLOGY AND
TREATMENT BY EXERCISE, HABITAT, DIET AND
"VISCERAL DRAINAGE. "
"Now is the winter of our discontent made glorious summer by this
sun of York"
- Shakespeare in Richard III
"Literature is the immortality of speech." - Schlegel.
Constipation is infrequent or incomplete evacuation
of the colon resulting in fecal retention.
ETIOLOGY OF CONSTIPATION.
The etiology of constipation is obscure. One
writer alone offers some score of causes. Sluggishness of the bowel,
whatever that means, is the most frequently mentioned. The tractus
intestinalis is practically under the domain of the sympathetic nerve,
nervus vasomotorius. Certain general etiologic conditions may be
I. Physiology of the tractus intestinalis.
In the etiology of constipation four physiologic factors are involved,
viz., (a) peristalsis, (b) absorption, (c) secretion, (d) sensation.
Any one or all of these functions may be impaired.
II. Local Causes. - The local causes of constipation
may be: (1) splanchnoptosia - inefficient muscular contraction; (2) constriction
of some segment of the colon; (3) collections of scybola or intestinal
concretions, as in cecum, sigmoid and rectum; (4) enfeebled contraction
of the intestinal muscularis; (5) local disease, as appendicitis, cholecystitis,
pelvic peritonitis mesosigmoiditis - producing paresis.
III. General Causes. - The general causes
of constipation are: (1) inefficient function (peristalsis, absorption,
secretion, sensation); (2) excessive mental or physical activity) (3) special
habits; (4) dietetic errors; (5) diseases of adjacent viscera; (6) factors
which induce dryness of feces from inefficient secretion or excessive absorption;
(7) impaired peristalsis of the colon.
IV. Anatomy. - The proper function of the tractus
intestinalis depends on a normal nerve, blood and lymph apparatus.
For perfect physiology, a maximum nerve, blood and lymph supply is required.
The muscularis intestinalis, as well as the mucosa intestinalis, must be
perfect. From frequent diseases (catarrh) of pueritas and consequent
defective digestion, with resulting deficient nourishment, a non-developed
and defective tractus intestinalis remains for life.
Atrophic or infantile segments of the digestive
tract (especially the enteron or smallintestine, which is the essential
segment - receiving the secretions from liver and pancreas) burden the
adult. For example, I found in the personal measurements of the enteron
in six hundred and five adults that the length of the enteron was, maximum,
thirty-two feet; minimum, ten and one-half feet, and average, twenty-one
feet. The enteron (a single segment and the most essential one),
the business portion of the digestive tract, varies more than three times
its minimum length. These facts demonstrate that the tractus intestinalis
is frequently defective in length, in development, nerve, blood and lymph-in
anatomy. Abnormally diminutive digestive apparatus may occur.
The following recorded data secured by the personal examination of six
hundred and five adults, may be suggestive in regard to the anatomy of
the tractus intestinalis:
1. The average length of the enteron in four
hundred and fifty-three males was twenty-three feet.
2. The average length of the enteron in one
hundred and fifty-two females was nineteen feet.
3. Man's enteron averages four feet longer
than that of woman.
4. The enteron increases in length most rapidly
a few months subsequent to birth, when it may grow one and one-half feet
5. The enteron assumes its chief length in
6. The chief variation in the length of the
enteron depends on enteritis, compromising the enteronic peristalsis, absorption,
secretion, and sensation, and consequently digestion, during early extrauterine
7. Extraordinary lengths of the enteron depend
on the favorable conditions of a maximum enteronic nerve and vascular supply,
with maximum assimilation continued beyond the usual period of enteronic
8. A subject with maximum length of enteron
possesses a stronger constitution than a subject with minimum length, as
he can digest and economize more food.
9. A maximum enteronic, nerve, vascular, glandular,
and muscular apparatus, with similar food, would practically produce a
similar length of enteron.
10. The foods which produce the most vigorous
enteronic functions (peristalsis, absorption, sensation, and secretion)
are those that leave the greatest indigestible fecal residue, which excites
the enteronic muscularis into peristalsis, thus attracting more blood and
inciting the enteronic mucosa to, greater secretion and absorption - increasing
digestion and, consequently, enteronic growth.
11. General and local disease influence the
length of the enteron, especially during childhood, the period in life
of rapid enteronic growth.
12. A child nourished with food which requires
vigorous digestion, leaves a fecal indigestible residue, as cereals, would
attract more blood to the enteron, enhancing its growth, than one nourished
on milk only, which passes through the enteron without inducing vigorous
peristalsis, and leaves little indigestible residue.
13. The human enteron presents colossal differences
as to length: Males 11 1/2 feet minimum, 32 feet maximum = 20 feet; female
10 1/2 feet minimum feet, 30 feet maximum = 19 1/2 feet. This variation
of twenty feet is almost equal to the length of an average enteron.
The enteron varies over double, or two and one-half times its length.
14. In adults the relation of the length of
the enteron to the body length is as 7.2 is to 1. There is a vast
difference between the absolute and relative length of the enteron of man.
15. The enteron measured in situ is three
to six feet less in length than when extirpated.
16. Different diseases of the enteron may
result in elongation or contraction. The above defects are not heredity,
but acquired by disease. They will offer a clew to conditions for
V. Mechanical. - Constipation may arise from
stricture, flexions, peritoneal adhesions, neoplasm, splanchnoptosia, obstruction
VI. Dietetic. - Quality of foods, quantity
of fluid, chemical composition, are important considerations. (a) Food
must possess sufficient variety (mixed) in quantity, quality, chemical
composition, and be ingested at regular intervals. The food should
be mixed, however, and possess sufficient indigestible matter to leave
ample residue to stimulate peristalsis (and hence absorption, sensation,
and secretion). An excessive amount of coarse, indigestible food
will result in an excessive fecal residue, which excessively stimulates
peristalsis, absorption, secretion and sensation-resulting in muscular
fatigue and defective sensibility of the mucosa-consequently reflex action
is impaired. (b) Ample fluids at regular intervals should be ingested.
For a person of one hundred and fifty pounds three pints daily is required
to supply the bodily waste (i. e., for tractus intestinalis respiratorius,
urinarius, perspiratorius); eight ounces should be drunk every two hours
for six times daily.
Fecal matter is about seventy-five per cent fluid
and twenty-five per cent solid. The value of fluids for the tractus
intestinalis is evident, because in hot weather, with consequent vigorous
activity of the tractus respiratorius, constipation results. The
chief value of mineral water is the quantity drunk. Excessive fluids
deteriorate digestion; (c) foods should possess chemical qualities.
Carbohydrates produce acidity, nitrogenous foods alkalinity, and mixed
foods neutrality of the digestive tract. Evacuation of the tractus
intestinalis depends on (a) sufficient volume of feces, (b) sufficient
volume of fluid contents, (c) the presence of substances which act as a
chemical irritant to peristalsis. Dr. Walter Baumgarten attempted
to devise a substance which would not only be difficult to absorb, but
would retain its watery contents. He adminstered eight grains of
the dry, shredded agar-agar three times daily, whence he found the stool
increased in volume and watery content.
VII. Pathologic. - The pathologic impairment of
peristalsis, secretion, absorption, and sensation of the tractus intestinalis,
must be studied to account for the constipation.
Chronic peritonitis, an important factor in constipation,
is frequently due to chronic peritoneal inflammation. In the major
regions of peritonitis the story of constipation is told. Chronic
peritonitis occurs in the oviducts (80 per cent), in the ileo-coeco-appendicular
region (70 per cent, over right psoas), in the mesosigmoid (80 per cent,
over left psoas), in the cholecyst and right colonic flexure region (45
per cent), between the right kidney and the liver (40 per cent), i. e.,
muscular trauma on viscera induces the migration of germs or their products
through the visceral mucosa, muscularis and finally into the adjacent peritoneum
inciting plastic peritonitis.
There may be defective innervation of the muscularis
of the digestive tract and abdominal wall (splanchnoptosia). Brain
and spinal cord disease (insane and neurotic) and exhausted disease.
Inhibition of reflex action may arise to check defecation, as from
fissure, ulcer, hemorrhoid, operation, painful vesical affections, hypertrophy
of anal sphincter. Also constipation is associated with lethargy
or sluggishness of the bowels from local peritoneal or visceral inflammation,
as appendicitis, ovaritis, salpingitis, cholecystitis, pelvic peritonitis.
It is in such cases that opium (a sedative to the local irritation) acts
as a cathartic.
The state of the contents of the bowels is significant
as chronic dyspepsia, irregular eating and evacuation and insufficient
fluid accompanying the food.
Anatomic peculiarities may lead to constipation,
as elongated cecum, sigmoid, and adherent U-shaped
transverse colon, all of which may lie in the pelvis. Much of constipation
is a perversion of the sympathetic nerves controlling the tractus intestinalis.
VIII. Sex. - Woman is more liable to constipation
than man, because in her the tractus genitalis is violently changed periodically
- robbing the tractus intestinalis of its usual quantity of blood (puberty,
menstruation, pregnancy, and pelvic disease); (2) woman is less active,
more sedentary than man; (3) woman is afflicted with more splanchnoptosia;
(4) woman experiences more changes in her visceral circulation (during
sexual life) than man (physiology and pathology of genitals).
IX. Age Relations. - In senescence constipation
may occur from limited food employed, limited exercise, and limited functions,
due to the degeneration of senescence. In senility, peristalsis,
absorption, secretion and sensation is limited from limited blood supply,
due to arterio-sclerosis. In peuritis anatomic peculiarities exist.
The tractus intestinalis develop irregularly, the nervous system is not
in final established control, the mucosa, muscularis, tractus nervosus
and tractus vascularis may be defective in development. Catarrh occurs
with facility and frequently. The tractus intestinalis is subject
to vast vicissitudes of fortune, both in regard to food and attacks of
catarrh. Hence its circulatory life - its basic life - is subject
to vast, frequent and rapid changes.
Constipation is a neurosis of the fecal reservoir.
It belongs essentially among the affections of the sympathetic nerves.
The system of nerves (including Auerbach's and the
Billroth-Meissner plexuses) which rule the gastrointestinal tract is strictly
in the domain of the sympathetic. However, the physiological manifestations
of the nerves ruling the enteron are quite different from those ruling
the colon. The nerves ruling the enteron act with intense vigor and
great rapidity. The nerves ruling the colon and rectum act with moderate
force and very slowly. The enteron rapidly forces the contents of
Bauhin's valve in a few hours. The nerves of the colon and rectum
act slowly, evacuating the fecal reservoir usually once every twenty-four
The changes in the physiological action from the
vigorous, rapid motion of the enteron, to the moderate, slow movement of
the colon and rectum, must be due to the intervention of the inferior mesenteric
ganglion, located at the root of the inferior mesenteric artery, which
emits its radiating branches along the inferior mesenteric artery, supplying
the left end of the transverse colon, the left colon, the sigmoid flexure
and rectum. The right colon and the right half of the transverse
colon are supplied by the abdominal brain, sending branches along the superior
mesenteric artery. Now, it is quite probable that the slow movement
of the nerves belongs entirely to the left colon, sigmoid and rectum, which
is entirely supplied by branches of the inferior mesenteric ganglia.
Hence, for the regular periodic evacuation of feces,
a habit established by ages, we must look to the immediate rhythmic control
of the inferior mesenteric ganglion. This is in accord with the idea
that the stool, before expulsion, lies in the sigmoid and rectal ampulla.
That the portion of the bowel concerned in evacuation is under control
of a nervous mechanism, may be inferred from the fact that a person can
establish almost any definite hour for regular defecation. A person
can sometimes restrain the stool without difficulty for several days.
For the cause of constipation we must look to a peculiar nervous disturbance
in the peristalsis, absorption, secretion, and sensation of the colon,
or of that part of the colon supplied by the branches of the inferior mesenteric
In constipation the feces are found in the colon
and not in the enteron. This abnormality of the colonic innervation
may be congenital, or acquired. Some individuals are constipated
from childhood. A boy of fifteen came to my office a short time ago
who had never had a stool from babyhood onward without a rectal injection,
or some strong physic. By careful examination it appeared that neither
the cerebro-spinal nor the sympathetic system was fully or completely developed.
However, in a month, from physical procedures, select food, ample fluid
at regular intervals, massage, rectal injections, vigorous riding and regular
stool hours, we secured a habit of daily evacuation. Here, doubtless,
the trouble was congenital-deficient and imperfect development.
Depressing mental affections derange the regular bowel action. However,
in constipation accompanying melancholia, or mental disturbances, it seems
to me that it is impossible, at present, to decide which is the cause and
which is the effect. To illustrate the influence of the nervous system
over bowel evacuation, observe how a railroad journey, a change of locality,
festival and change of labor, affect a constipated condition. Besides,
autopsies of persons dead from other diseases teach that in constipation
seldom can structural lesions be demonstrated. The chief features
of habitual constipation tend to show that the abnormal condition must
be sought in a neurosis of the colon (especially to the left colon, the
sigmoid and rectum). The exact nature of the colonic affection is
unknown. Another factor in constipation is that though the nervous
system of the colon be fairly developed, yet the muscularis of the colon
is not normally developed. There is atony of the colonic wall, well
expressed by old Latin authors as atonia intestine. But in this case
perhaps the colon muscular atrophy refers to the nerves, as they control
the lumen of the blood-vessel, which is the real nourisher and instigator
In regard to the relations of the skeletal muscles
to the intestinal muscles, in constipation, we maintain that they are entirely
independent of each other, except mechanically.
The subject with the most weakened and miserable
condition of the skeletal muscles may be absolutely regular in bowel evacuation,
or may suffer severe constipation. Of course, we must not omit the
mechanical influence of the abdominal muscles in defecation. The
abdominal muscles increase the intra-abdominal pressure, and thus aid evacuation,
but it is not likely that they increase peristalsis. Perhaps in general
the skeletal or intestinal muscles play but a small role in constipation.
The matter lies closer to the nervous system.
Bouveret and Dunin have claimed that habitual constipation
was a frequent accompaniment of general nervousness, especially of neurasthenia;
that the neurosis was the constipation, not the constipation the cause
of neurosis. This idea is apt to prevail with most force among those
physicians who, in curing the patient of the general neurosis, neurasthenia,
have seen the constipation disappear. Fleiner asserts that stool
retardation is due to spasmodic contraction of the colon segments, grasping
their contents. This would make the trouble depend on the nervous
The mechanical conditions that induce constipation will not be here
considered, except so far as their purely nervous mechanism and influence
is concerned. Hence, such factors as strangulation by peritonitic
bands and through apertures, and the mechanical difficulties of splanchnoptosia
and pressure of abdominal tumors, are not here discussed. However,
we must not overlook the obstacles placed in the way of the intestinal
nerves by inflammation of any one of the bowel coats, or tunics, as peritonitis,
or inflammation of the muscularis, or of the mucosa. As abdominal
surgeons, we well know that acute peritonitis produces immediate constipation,
checking peristalsis by edema, congestion and exudation, into one of the
bowel tunics, especially the peritoneum. The peripheral bowel nerve
apparatus is deranged by pressure, infection and malnutrition. It
may rapidly recover. But, doubtless, a crippled and defective condition
frequently remains - nonmechanical. As a result of peritonitis or
inflammation of any one of the bowel tunics, producing habitual constipation,
we must especially examine the flexura coli lienalis and the flexura sigmoidea.
Not infrequently the action of the distal end of the diaphragmatic muscles
produces inflammation of the left colon, by inducing migration of microbes
through muscular trauma.
Also the conditions disturbing the rectal nerves
must be considered as causing congestion and results. In constipation
we only include the colon segment supplied by the branches of the inferior
mesenteric ganglion. It must not be supposed for one moment that
peritonitis around the evacuating fecal depository is always recognized.
Far from it, for in some six hundred recorded adult autopsies I found evidences
of peritonitis in the peritoneum of the left colon in fully eighty per
cent of subjects. In fact, in the esosigmoid alone there was about
seventy-five per cent of peritonitis.
X-RAY OF DUCTUS BILIS ET DUCIUS PANCREATICUS .
This illustration suggests the quantity of nerves required to ensheath
the ducts and vessels of the liver and pancreas as fenestrated, nodular
Constipation may arise in some persons from deficient
or abnormally small abdominal brain, or from premature senility in the
abdominal sympathetic, which innervates the gastrointestinal tract; also
from cerebrospinal disease, which inhibits sources of energy. Exhaustion,
mental or physical, is a potent factor in constipation. A deficient
blood supply to the parenchymal ganglion does not invigorate it sufficiently
to induce peristalsis. Exhaustion from over-exertion, excessive sexual
action, or extra loss of blood, is a common cause of constipation in young
women. Depression from disappointment, from death, from unrequited
love, and many other causes, is quite apparent in the youthful, producing
constipation - a purely nervous phenomenon.
Constipation in lead colic is a nervous phenomenon,
apparent in the intestinal pain, and in the white ring-like contraction
of the circular bowel fibers. The etiological factor is the irritation
of the parenchymal ganglia of the bowel wall by the lead. Spasm,
irregularity of inertia, characterizes the bowel in lead colic, except
in the etiology.
Violent and persistent constipation depends on perverted
muscular action, peristalsis, absorption, sensation or secretion, due in
general to some deficiency of nerve force. Colonic inertia may rest
on deficient blood supply to the parenchymal ganglia, but this is directly
under the control of the sympathetic, which holds sway over the vessel's
It must always be borne in mind that the size of
the sympathetic differs very much in different individuals. When
a small-sized visceral nervous system becomes impaired, as it easily will,
its phenomena are not only marked, but difficult to correct. A large
dose of digitalis slows the heart, and whether the spinal accessory or
vagus, digitalis inhibits its action. Nothnagel suggests that opium
works similarly on the splanchnics, i. e., by slowing peristalsis.
The movements of the enteron are largely dependent
on the amount of blood in the intestinal wall i. e., the amount of fresh
blood which supplies the parenchymal ganglia.
In regard to antiperistalsis, in scores of experiments
on dogs, rabbits, guinea-pigs, etc., I saw no such a phenomenon.
The vomiting in ileus paralyticus or peritonitis maybe due to simple contraction
of the stomach on the enclosed contents, when the fluids pass through the
esophagus in the direction of the least resistance. The monstrously
large, wide cecum of herbivore, a vestigial stomach, as in the cow and
horse, is emptied by peristalsis and not by antiperistalsis, as noted by
Jreper. It may be that the peristalsis is increased in diarrhea,
yet it may be just as active in constipation, but in this the colonic movements
are vain and futile, from inability to force the contents into successive
new segments, for an empty bowel is a still one, and a full bowel is an
active one. Also active peristalsis will invite more blood into the
bowel wall, which, in turn, induces active motion in the segments. Doubtless,
herein lies the value of abdominal massage. Whatever checks the flow
of fresh blood to the bowel wall slows peristalsis, and this explains the
constipation of anemia.
The natural secretions, as the bile and the pancreatic
fluids, are, perhaps, sufficient alone to excite the parenchymal, ganglia
to action, with but little or no aid from the splanchnics. Hence,
from the inactive hepatic and pancreatic secretion, constipation may result.
Consequent swelling of the mucosa from catarrh, in the bile ducts, may
exclude the bile from other channels, which would deprive the parenchymal
ganglia of their accustomed stimulus.
The relations of adjacent viscera and their condition
may influence constipation. If the accustomed secretions, bile, pancreatic
and gastro-intestinal, diminish, the bowel will not receive the impulse
which the normal amount of secretions impart, and peristalsis partially
fails. Diarrhea may be instigated by congestion, then by edema and,
instead of infiltrating the bowel wall, the result may be rapid exudation
Increased peristalsis, however, is not necessarily
accompanied by increased secretion and exudation. The irritation
which produces the peristalsis may so irritate the parietal intestinal
ganglia as to lessen the caliber of the blood vessels and thus check secretion.
In administering certain purgatives it is found that they are followed
by watery evacuations. But this may be due to exalted peristalsis
of the bowel, allowing insufficient time for absorption, e. g., in times
of quiet peace in the bowel secretion and absorption balance each other;
but if segments of the bowel become irritated by cathartics, the secretions
may become very much increased. Yet, owing to the vigorous peristalsis,
the fluids are rushed distalward, not allowing sufficient time for, absorption.
Constipation is generally a form of neurosis, which
may partake of a sensory, motor of secretary nature. It may, however,
have a complex course and origin. Constipation is a condition in
which the colon is not evacuated daily, except by the aid of evacuants,
rectal injections or physical procedures. The great majority of the
human family having a daily bowel evacuation establishes the normal frequency
at once a day. Exceptions to this rule may be observed in certain
individuals who have two stools daily, others one stool in two or three
days, while again Pick reports patients who have one stool a week.
A doubtful report was made by Dr. Robert Williams, where a woman had four
bowel movements a year, three months apart.
This irregularity or deviation from normal defecation,
need not necessarily be based on demonstrable pathological conditions.
In constipation we have several elements to consider, the mucosa, the muscularis,
the blood-vessels, the serosa, and the nerve supply.
Perhaps the greatest etiological factor of constipation
is enteritis, catarrh of the colonic mucosa. This would involve the
secretary nerves. In fact, catarrhal diseases of the colonic mucosa
are the active factors in ever-changing forms of constipation and diarrhea,
which, doubtless, involve the secretary nerves more than the motor nerves.
Of course, the regularity of stool depends very much on the quality and
quantity of food ingested, for if the food leaves no residue it will conduce
constipation, for the greatest of all stimuli to colonic motion is food
in contact with the intestinal mucosa. The peripheral nerves of the
intestinal mucosa receive impetus and sensation from the analward moving
The chief influence in constipation is the blood
and food. The formation of the stool depends mainly on the relation
of the solids and fluids introduced into the stomach.
A close relation exists in constipation between
the quantity of food ingested, and the resulting fecal residue, which actively
counts in treatment. Water is one of the best adjunct evacuants.
An exclusively milk diet may create constipation, because the small residue
is insufficient to excite peristalsis through the peripheral nerves.
If milk creates diarrhea, it is likely from some sudden development of
germs, or fermentation. The utility of graham bread in curing constipation
lies in the fact that a large indigestible residue remains, inducing colonic
contraction; its contained salts either invite fluids or excite peristalsis,
both resulting in a kind of massage, or acting like a foreign body to the
The habits of life are closely associated with constipation.
Society women and traveling men, with irregular ingestion and habits, are
liable to constipation. Sedentary habits, deficient exercise and
excessive mental work, tend to produce constipation. The use of narcotics,
deficient drinking of water, active perspiration and uncomfortable closets
play a role in inducing constipation. Excessive eating or excessive
ingestions in the gastro-intestinal canal may lead to atony of the intestinal
wall, and consequent constipation. The causal relation of constipation
must be sought in the digestive tract itself, in the quality and quantity
of food ingested, in the habits, in the relations of other viscera.
In certain cerebro-spinal diseases, the sensory nerves of the intestinal
mucosa may be obtunded or blunted, so that the ordinary peristalsis is
not excited by the ordinary stimulus of food residue. The peripheral
sensory apparatus of the mucosa does not perceive the usual stimulus, and
the bowels become torpid. This is common in certains form of hysteria,
or better, visceral neurosis. In melancholics and hypochondriacs
the barometer of their spirits seems often to tally exactly with the bowel
activity. The greater the activity of their bowels the more lively
and natural their mentality. But it must not be forgotten that constipation
is often occasioned by the mental condition. We know personally that
vomiting may be induced by a physical cause, or by a mental one.
Some will vomit from seeing a fly in the soup. So it is with a genital
neurosis, it may create constipation, or may induce a local neurosis by
bathing the innumerable ganglia with waste-laden blood. If secretion
be deficient, absorption continues, the feces harden, form an increasing
plug, and becomes such an impediment that even vigorous peristalsis will
not produce the analward movement required.
Heredity and congenital ailments play a role through the defects in
the nerves of the intestines. We deal here chiefly with the purely
nervous influence, as the intestinals of the cachectic may be confined,
or may act very irregularly. Persons with defective nervous systems,
as idiots and the insane, suffer from constipation. The ill-defined
hysteric person, or the neurotic subject, is painfully afflicted with constipation,
with sluggish bowels, and some of these very subjects are continually complaining
of colicky pains, which are to be interpreted as vain attempts of peristalsis
to force the bowel contents analward.
In constipation splanchnoptosia plays its role by
flexing the intestine, producing conditions which require more vigorous
peristalsis to overcome; in short by compromising the bowel caliber.
In splanchnoptosia the hepatic and splenic flexures are both made more
acute by the consequent dragging of the ligamentum hepatico-colicum et
Relaxed, pendulous abdominal walls are incapable
of exerting normal or sufficient pressure on the tractus intestinalis to
control circulation (lymph or blood) or to expel the feces.
The fecal reservoir, as previously stated, is the
left half of the transverse colon, the left colon, the sigmoid and rectum,
the field ruled by the inferior mesenteric ganglion. It has been
asserted by my respected teacher, Nothnagel, that constipation is relatively
frequent in comparison with the rarity of peritoneal fixation. I
wish respectfully to differ from this excellent and instructive Viennese
teacher. In some six hundred personal autopsies I found peritonitis
in the fecal reservoir in at least eighty per cent of the subjects.
This peritonitis, due to two causes, viz., traumatic muscular. action of
the psoas magnus on the sigmoid, and of the distal left limb of the diaphragm
on the left colon, which induces migration of pathologic microbes to the
serosa; and the abrading of the mucosa of the fecal reservoir at the flexures
(splenic and sigmoid), allowing the wound to become infected, and the migration
of pathogenic germs to the serosa.
Nowhere in the body is infection from the mucal
abrasion more definite than at the ligamentum phrenico-colicum sinistrum.
In six hundred adult autopsies we found that the fecal reservoir was afflicted
with peritonitis in more than eighty per cent of the cases. Did eighty
per cent of these cases suffer from constipation? We think not.
Therefore, according to our six hundred autopsies, peritonitis of the fecal
reservoir is far more common than constipation, for eighty per cent of
adults do not suffer from constipation. Hence, we are forced to the
opinion that peritonitis of the fecal reservoir has undoubtedly an influence
in inducing constipation, by traumatizing the nerves presiding over defecation.
The nerves may suffer from pressure by exudates or edema, from congestion
or malnutrition. The final outcome is derangement of the nerves of
the fecal reservoir - exaltation or debasement of sensation and motion.
As probability is the rule of life, the results of peritonitis of the fecal
reservoir is here referred to, and not acute peritonitis. I have
shown (Peritoneal Adhesions After Laparotomy, Amer. Gyn. and Obstet.
Jour., December, 1895) that gross peritoneal adhesions (bands) attached
to organs of maximum peristaltic action, as the middle of the sigmoid flexure
and the oviducts (or their amputated ends), the mobile bladder, or the
active peristaltic loop of enteron, frequently create very much pain, though
not necessarily constipation. Yet the finer pathological infiltrations,
perhaps, not even microscopic, or at least insufficient to create condition
of the fecal reservoir which may be far more effective in causing constipation,
than the gross peritoneal bands which simply fix, dislocate viscera, or
parts of viscera, are an important factor in inducing constipation in splanchnoptosia.
Perhaps splanchnoptosia should be viewed as a constitutional disease, a
general neurosis. The viscera supports very gradually elongate in
splanchnoptosia, and the nerves as gradually lose their tone. That
the visceral nerves are involved in splanchnotosia is very evident from
the manifest derangement of the nerves of sensation, motion, absorption,
and secretion. Splanchnoptosia is a weakening of the nervous system,
a special slackening, or elongation of the visceral supports, which we
must acknowledge is not manifest in the digestive tract muscles, but attacks
the skeletal muscles (e.g., of the abdominal wall).
Every practitioner has observed that with the induction
of habitual constipation a peculiar nervous phenomenon also arises.
The popular opinion is that the constipation is the cause of the neurosis,
but such an opinion does not always stand the test of analysis. Is
the neurosis not the cause of the constipation? The finer beginnings
of the neurosis was not observed, while the grossness of constipation is
discernible form the beginning to end. After constipation has once
started, a train of symptoms may set in, as long retention of the
feces allows them to become dry and hard from absorption of fluids.
The feces becomes pressed into the saccules of the colon, a hard, irregular
masses, known as scybala. Such masses, by continued pressure, may
produce mucus ulceration. The subject experiences fullness in the
abdomen and disagreeable sensations; the appetite disappears, gases are
eructed, and a disagreeable taste arises. The skin may assume a muddy
color, and the fecal masses may be covered with mucus in various quantities.
Some practitioners falsely attribute the lime, or mucus, to colonic catarrh.
The excessive mucus is due to irritation of the mucosa by the fecal masses,
which irritation may also induce a hyperemia of the mucosa, producing disordered
secretion, with fermentation and gases. The fecal accumulation can
produce not only a transitory mucal hyperemia, excessive secretion and
diarrhea, but anatomic changes, such as colonic catarrh, trauma of the
colonic wall and local peritonitis. Considerable colic may arise
from the attempts of the colon to expel the large accumulated masses, which
palpation may reveal.
But, to speak of the difficulties arising from hardened masses of accumulated
feces is only to bring in mechanical difficulties, with all their train
of evils, on the three tunics of the colon and their functions, which is
not our chief theme. Our contention is that constipation is a neurosis
of the fecal reservoir.
To illustrate how intimately the nervous system rules the fecal reservoir
in its periodic evacuations, all that is necessary is to recall how many
patients relate that, on change of business, residence, or scenery, the
evacuations being neglected, cease their regularity. So far as I
am aware, constipation always has one of its results, the collection of
feces in the colon, from the rectal ampulla to Bauhin's valve, but the
chief locality is the middle of the transverse colon to the rectal ampulla.
The collection of fecal masses in the right colon is rare, and, perhaps,
in the right half of the colon it is also rare, except from mechanical
causes, i. e, if half of the colon be full of hardened feces, the right
half will be full, from the physical fact of its inability to force them
The train of evils resulting from constipation is
almost endless, e.g., the fecal masses produce pressure on the returning
veins of the fecal reservoir, causing congestion, especially in the rectal
veins, resulting in hemorrhoids. Perier has recently attempted to
show that the so-called "fecal fever" is due to absorption from the digestive
tract. The proof of this he demonstrates by a cathartic reducing
the fever. This view of Perier has some show of truth in it, for
in puerperal sepsis, in fever after operation, a cathartic reduces the
fever like a charm. The drain by the cathartic directs the poison
outward. However, it must be remembered that high temperature subsequent
to some pelvic operations, is rather due to absorption of septic matter
remaining in the pelvis than absorption from the bowel. For long
past and even today certain widespread opinions, in regard to certain definite
connections between the central nervous system and constipation exist.
Constipation and the central nervous system are brought into close relations.
All grades of symptoms, from the slightest disturbance to hypochondrical
and severe Psychical, are included as due to constipation. Certain
writers have tried to show that relations exist between dyspepsia and constipation
on the one hand, and hypochondria and melancholia on the other. Virchow
started such views nearly fifty years ago, and Virchow always wrote with
a pencil of light. The celebrated neurologist, Romberg, claimed in
1850, that constipation could induce hypochondria. It is not strange
that the opinion of such giants as Virchow and Romberg, both strengthened
by observations, should prevail so long. But our belief is that constipation
is a neurosis of the fecal reservoir. Hence, constipation, melancholia,
and hypochondria are the result of neurosis, and not the cause. We
must look to neurasthenia as the forerunner of constipation, as the neurotic
invader of the fecal reservoir bringing in its wake constipation.
When neurasthenia and melancholia enter, the process becomes retarded.
Recently, Dunin has favored the view that constipation is the result of
a neurosis and not the cause. True it is that nervous persons do
not always suffer from constipation nor are non-nervous persons invariably
free from it, but, first, be it remembered that the fecal reservoir is
chiefly under the influence of the inferior mesenteric ganglion, and its
radiating nerves (sympathetic), and not the cerebro-spinal, though the
last-named exercises certain influences over the fecal reservoir; also,
that the fecal neurosis is a local affair, i. e., the peripheral nerves
supplying the colon in area of the inferior mesenteric artery may be attacked
by disease, independently of the remaining sympathetic and cerebro-spinal
The general view here entertained in regard to constipation
and neurosis is: That the constipation is the cause of nervous symptoms,
e. g., a person suffers for several days from constipation and light cerebral
symptoms arise, as headache, dizziness, pressure in the head and inability
to think well. There may be feelings of heat in the head and considerable
general languor. The urine may be a little scanty and high-colored,
with hot and dry skin. There is often slight respiratory disturbance.
Physicians generally attempt to prove that all these cerebral symptoms
depend on the several days of constipation, from the fact that after a
brisk cathartic the cerebral symptoms disappear. This circle may
be, and often is, repeated in the same individual.
At first sight this explanation, with its practical
demonstration, seems very laudable. But is it satisfactory?
Can not the neurosis, the subjective light cerebral symptoms, be the cause
of constipation? It is not easy to give a categorical proof of this.
The disturbance, or hindrance, in respiration and circulation may find
an explanation in the elevation of the diaphragm.
The cerebral circulation may be disturbed by the
reflex irritation of the abdominal viscera, transmitting the irritation
by way of the lateral chain of the sympathetic and the splanchnics.
Leube has recently reported cases where the person became dizzy from pressure
in the rectum, either by fecal masses, or by the finger. Here the
dizziness arises from irritation of the hemorrhoidal plexus of nerves.
Again, Senator suggests that the absorption of certain
gases, as sulphureted hydrogen, might induce poisonous symptoms.
Nothnagel suggests that in constipation ptomaines might be absorbed, inducing
cerebral symptoms. But Bouchard demonstrated that toxic fecal ptomaines
may occur in fluid feces, as is seen in the large amount found in the urine
of patients afflicted with diarrhea. Again, the cerebral symptoms
depend on the constipation. Is the argument the same with melancholia
and hypochondria? Does it depend on constipation? In other
words, does constipation cause, in otherwise healthy persons, hypochondria,
or other psychoses? We think it does not. The proposition should
be made in two forms:
(a) Constipation may occur in otherwise healthy
persons. These, we claim, do not suffer the hypochondria and psychoses.
(b) Constipation occurs in patients with a
neurotic tendency. These last are the subjects which suffer from
melancholic psychoses during constipation. It is undeniable that
psychical depression may develop during constipation in certain persons,
but they are of the neurotic type, and in these the abdominal disturbance
of the bowels would similarly affect (as disturbances in any other functions)
the weakest point, i. e., the part of the animal economy which resists
the least. Single-handed and alone constipation does not create hypochondria
and melancholia, but in a system burdened with neurotic tendencies, with
unstable nerves, they may exist, but are, perhaps, the cause of the constipation.
Virchow says the following: "Das bei einer gewissen
erregungs fahigkeit widerstands losigkeit (predisposition), des nerven
apparatus storkungen mit dem character der exaltation an den sensitiven
und dem der depression und den motorichen nerven herrufen." Freely
translated it is, "That by certain tendencies (non-resistance, predisposition)
of the nervous apparatus, disturbances of the abdominal viscera may produce
the character of exaltation in the sensitive nerves, and depression in
the motor nerves."
It appears to me, however, that the popular professional
idea of the effect of constipation on the brain is exaggerated, and much
of the belief is untenable.
The celebrated English author and physician, Dr.
Barnes, held that constipation was the cause of chlorosis. Perhaps
this view arises from the supposed fact that some of the chlorotic girls
recovered after cathartic treatment. But, since chlorosis is a disease
of a certain age, i. e., from fifteen to twenty-five years, such a fact
remains to be proved, for the constipation accompanying chlorosis constitutes
but a small portion of the ailments atacked by it. Constipation and
neurosis are, nevertheless, close relatives in many subjects with peculiar
The relation of the gastro-intestinal canal to other
viscera is of prime importance as modifying peristalsis. The emphysematous
lungs force the diaphragm distalward, and this destroys the tendency to
free peristalsis. Heart. liver and kidney diseases, if they produce
congestion in the bowel coats - serosa, muscularis and mucosa - will lessen
peristalsis and consequent fecal motion. Diabetes induces constipation
by diverting fluids from the intestinal tract, and the consequent drying
of the feces. In the chlorotic and anemic it is difficult to distinguish
cause and effect. They are both constipated. But the retardation
of fecal movements may be followed by anemia and chlorosis, or auto-intoxication.
However, chlorosis belongs to females, in general, from puberty to the
age of twenty-five. It is a developmental disease. In fevers
deficient peristalsis induces constipation. Excessive sweating, also,
renders the feces dry, and the diminution in the amount of food taken leaves
less residue to stimulate peristalsis.
X-RAY OF DUCTUS PANCREATICUS ET DUCTUS BILIS
The pancreatic and liver ducts, ensheathed by a network of fenestrated,
nodular nerve plexuses. Also the portal vein.
Fleischer suggest that in fevers the high temperature
of the blood bathing the ganglia in the walls of the bowel tends to inhibit
peristalsis, and hence cause constipation.
Under sympathetic nerve influence we are not including
constipation from mechanical factors, as volvulus, flexions, obstruction
by peritoneal bands and through apertures, pressure from tumors, strictures,
or dislocated organs. Experience teaches emphatically that enteritis,
or catarrh of the enteron, induces constipation. If catarrh of the
colon and enteron exists, diarrhea and constipation will generally alternate.
The secretary, as well as the motor nerves, are highly involved in catarrh.
Ulcerative processes in the mucosa inducing diarrhea are not included in
nerve influence. We, of course, have constipation in atony of the
bowel wall, as well as in partial paresis.
Bowel weakness arises in potators, tabetic and tubercular
patients, and in those with progressive splanchnoptosia.
It is plain to any one that a neurosis acts in various
ways on the tractus intestinalis, influencing constipation or diarrhea.
The hysteric and neurasthenic both suffer from irregular constipation.
It is a common observation that patients who complain of abdominal neuralgias
suffer more or less from constipation. It appears as if the nerves
of the bowel do not work in harmony, the bowel is incapable of regularly
emptying itself. Besides, neuralgia is, doubtless, a malassimilation
of a sensory nerve, and since the sensory and motor nerves are complements
of each other, they must work in harmony to accomplish an object - evacuation.
The bowel contents irritate the periphery of a sensory nerve in the mucosa,
this is carried by the organizing ganglia of the muscular wall, which induces
muscular motion. The blood vessels of the bowel wall exert vast influence
over peristalsis, and the vessels are ruled by the sympathetic nerves.
With deranged nerves of the intestines there will necessarily be deranged
circulation, and either congestion or anemia induces a lowering of peristalsis
- constipation. The circulation on the surface of the body is only
an index of what is occurring inside. Now, it is common in neurotic
persons to observe a dozen marked changes in the superficial circulation
in a single day. The changes of circulation affect the bowel wall
in a similar way that they do the surface. The effectiveness of circulatory
changes is, perhaps, best observed in the serous covering the bowel, as
in peritonitis, where constipation exists. In peritonitis the bowel
wall becomes edematous, congested, and the peripheral nerve apparatus is
compromised by pressure and malnutrition, so that we always expect constipation
in peritonitis. The circulation is deranged.
In the territory of the secretary nerves, which belong to the sympathetic,
as well as the motor and sensory nerves of the intestines, a vast field
lies unopened. At ordinary times secretions progress in definite
proportions, but, pathologically, we have excessive, deficient, or disproportionate
secretions, e. g., there may be excessive bile, HCL, gastric or pancreatic
fluids, or all of these may be deficient. Again, the bile may be
secreted in proper amounts, so that we would have disproportionate secretion,
which induces fermentation, the development of gases, tympany, and the
undue development of certain microbes. If deficient HCI, or bile,
be secreted, both of which are antiseptic, microbes develop. Also,
it must not be forgotten that deficiency of secretion checks peristalsis,
whether it be deficiency of bile, pancreatic, or other gastrointestinal
fluids, and slowing of peristalsis invites constipation.
To illustrate the influence of nerves over peristalsis,
observe how the irritation of a small fissure will induce constipation,
first by abstention from stool and, second, by breaking the regular habit
of stool. By forcible dilatation of the rectum the regular stool
habit assumes its old course. In the case of anal fissure the irritation
is purely reflex on the remaining portion of the gastrointestinal canal.
It would appear that constipation, in certain forms, may be well remedied
by daily dilatation of the sphincter. This dilates and flushes its
peripheral capillaries. Dr. Bier reports successes in the Wiener
Med. Blaetter, l891, No. 25.
The complex symptoms of constipation may be indecisively
divided into general and local symptoms. The general and most disastrous
symptom is that of auto-intoxication. It represents a series of manifestations
in the territory of the nervous system, whether it be chronic or acute,
common symptoms or headache, dizziness and neuralgias about the abdomen,
as well as sleepiness, melancholia, languor, a feeling of debility and
nausea. Pick says the visible expression of the constipation is the
richness of excretory principals in the urine, and the increased toxicity
of the same.
One of the local symptoms of constipation is the
feeling of fullness and pressure in the abdomen, which is generally distended.
The passage of gas gives temporary relief. The diaphragm is forced
proximalward, compromising the heart, so that it not infrequently palpitates,
and the lung manifests difficulty in respiration. In certain cases
considerable colic is produced at stool, from irritation of the bowel wall
by hard fecal masses. The positions of local colic from expelling
hardened feces are the ampulla of the rectum, the cecum, the hepatic and
splenic flexures, the middle of the transverse colon, and S-romanum.
Large, hard, rough fecal masses not only cause much pain, but they abrade
the mucosa and finally produce ulcerations, which heal slowly.
Visceral Circulation in Constipation. - The proverbial
advice of the elderly doctor, when he wishes to be social, entertaining
and instructive, is to keep the head cool, the feet warm, and the bowels
This philosophic advice is frequently theoretical,
rather than practical, from an application to the actual living habits
of the subject. In the present modes of living among women constipation
plays an extensive and damaging .role. The evil effects of constipation
extend to adjacent visceral tracts, as circulation, respiration, and particularly
on the tractus glandularis - secretions. The most important visceral
tract of life itself is the tractus vascularis, over which the sympathetic
nerve, nervus vasomotorius, maintains direct control. An ample stream
of fresh blood can not properly irrigate constipated visceral organs.
In constipation one or more of the four great common visceral functions
- peristalsis, secretion, sensation or absorption-are disordered.
The disturbance of circulation in constipation may be. local or general.
We observe the profound anemia of girls, frequently following the phase
The circulatory changes are at first local, later
general. The anemic, chlorotic girl (from fifteen to twenty-five
years of age) is plump, fat, and beautiful - in fact, it is the anemia
of the good-looking girls. It appears concomitant with the disordered
local circulation (genital); the later, general, disordered circulation,
is accompanied by disordered, hypertrophied glandular system (tractus lymphaticus)
and constipation. The chlorotic girl might profitably pose as an
alabaster or marble statue. Hence, disordered circulation (pubertas),
accompanied by disordered general circulation, disordered tractus lymphaticus,
and constipation (disordered peristalsis, or secretion, or absorption).
In the establishment of menstruation numerous local
(genital congestion or anemia) or general (chlorosis) circulatory disturbances
arise. In pubertas the luxuriant vessels (veins) of the ovary and
its compensatory balanced arm, the endometriuin, become congested, engorged,
which robs the blood from the tractus intestinalis and disturbs not only
local, but general circulation, which condition is intensified in gestation.
Until the habit of menstruation is established the
local change of circulation may induce constipation. In fact, I have
relieved numerous gynecological patients by restoring normal evacuations
of the bowels, and vice versa, normal genitals may restore normal bowel
In short, detailed attention to the circulations - a matter directly
under command of the sympathetic - is one of the most important factors
in regulating constipation.
It is the detailed study of sanitorium patients,
as to life, habits, diet and fluids, that makes the sanitorium financially
profitable and suggestive, at least to the so-called surgeon who is so
busy with major operations that he walks over gold and silver daily.
The neglect of accurate diagnosis and consequent neglect of detailed treatment
and defects of common functions, constipation, by the physician, is the
reason of the multiplication of sanitoria, and the consequent loss of feces
and confidence in the home physician.
It is the duty of the physician in defects of the
common visceral functions - peristalsis, absorption, and secretion - to
introduce visceral drainage to relieve the patient of waste-laden blood,
and restore normal circulation. The physician should decide in detail
the quality and quantity of the food and fluids ingested, and determine
the methods of sewerage. He should recognize the secretary and motor
activity of the tractus intestinalis, and the fascio-elastic muscular apparatus
of the abdominal wall, which aids in evacuating the bowels.
Women, especially the young, must be taught the
absolute necessity of regular daily evacuations, regardless of environments,
time, place, views, or agreeability. The woman should know that exercise,
muscular activity, is necessary for the abdominal muscles to force continually
the bowel movements, contents, analward. Active bodily movements,
fresh air, bicycling, walking, aid very much to maintain visceral circulate
on. Artificial checks to respiration, as the corset or tight bands,
check circulation, especially visceral, and hence peristalsis, absorption
and secretions of the tractus intestinalis is checked. The corset
is an enemy to circulation, and a friend to constipation and is unhesitatingly
Only ocular demonstration will convince a woman
against corsets, so firm has become the senseless iron rule of fashion.
To illustrate the important influence of circulation
in constipation, the first week of marriage may be noted. The extra
irritation of the genitals induces a genital hyperemia, a congestion which
robs the blood from the tractus intestinalis, leaving in its ivake intestinal
paresis - constipation.
Menstrual disturbances, chronic genital inflammation,
entice blood from the tractus intestinalis, leaving defective intestinal
peristalsis from lack of blood. Removal of chronic congested genitals
may restore normal action of the genital tract by returning to them their
normal blood stream. Not only does pregnancy induce constipation
by enticing a continual blood stream toward the genitals from the intestinal
tract, but in the puerperium the abdominal muscular apparatus has lost
its original elastic tone, its power of compression. The enforced
corporeal rest and non-irritating food administered engenders a constipation
by disordered, unbalanced circulation.
In the puerperium, instead of an abdominal binder,
the abdominal muscles should be massaged. The patient should practice
on the abdominal muscles gymnastic exercises, in order to quickly restore
them to normal action, and thus avoid one of the prime factors of splanchnoptosia.
The abdominal binder, the enforced rest, and concentrated
food in the puerperium, all tend to lessen the visceral circulation, especially
in the intestinal tract, and hence to entice constipation.
The Diagnosis of Constipation. - First and foremost
an examination, extending from mouth to anus, is a prerequisite to diagnose
The mouth, and especially the teeth, unfold an important
The state of the abdominal and thoracic walls are
significant. Does splanchnoptosia exist with its general consequences?
What is the state of the rectum (fissure, hemorrhoid,
ulcer?) is of extreme importance.
The tractus vascularis tells its own story in arteriosclerosis,
which would indicate defective circulation in the splanchnic area.
Careful palpation of the plexuses and connection
cords of the abdominal sympathetic should be practiced, as they regulate
the caliber of the splanchnic vessels. Tenderness of the abdominal
sympathetic plexus indicates an irritable condition of the viscera.
If marked sclerosis exists, the abdominal aorta is palpable and tender.
It is enltrged, movable, and pulsates vigorously, The tendernesss is to
be localized especially along the plexus aorticus distal to the umbilicus,
and in the plexus celiacus (abdominal brain) proximal to the umbilicus.
This tenderness indicates a neuritis of the sympathetic, or vasomotor plexuses.
Colic, due to spasm of vessels (arteriosclerosis), must be differentiated
from colic due to enteritis. In neuritis of the sympathetic plexuses,
the pain and tenderness is localized in the celiac and aortic plexuses,
and along the route of the ensheathed, which is characterized by spasmodic
and periodic exacerbation. Peritonitis announces a more diffuse tenderness.
and it is less spasmodic and periodic. Enteritis presents tenderness,
localized in the course of the enteron, and is accompanied by other symptoms,
as mucus in stools. The diagnosis of constipation is a small factor
in practice, but the finest head, with the best skill, is required to diagnose
the etiology, for on the cause of this malady rests the successful treatment.
It is needless to say that a thorough and complete physical examination
is absolutely necessary. For constipation may depend on the kind
of food taken, on habits of life, on drugs employed, or on defects in the
system. Some affirm that heredity plays a role in constipation; however,
this is only a cloak to cover what we do not know. Many persons who
have only one stool in two days, and remain healthy, are not constipated,
and require no treatment.
Treatment of Constipation - General Remarks. - First
and foremost in the treatment of constipation, should be considered the
diet. Some physicians have a diet list. In certain cases it
is convenient, but generally of little value. Oatmeal and graham
bread, with milk as a beverage, leaves ample residue to induce peristalsis,
which soon overcomes constipation. In such cases, also, a few daily
colonic flushings aid wonderfully, with the establishment of a regular
hour for evacuation. Especial stress should
be laid on the matter of avoiding cathartics; they are among the chief
causes of constipation. The best methods of curing constipation are
those which imitate nature the closest, and most perfectly. They
are, in order:
1. The regulation of diet (ingesta).
2. Physical procedures.
3. The judicious use of laxatives.
In the regulation of the diet several factors are
requisite, viz., food which leaves a large residue, which will impart the
necessary constant stimulus to successive bowel segments. Peristalsis
requires a physical stimulus, a bolus that will feel its way from stomach
to anus. The diet should be a mixed one of cereals, meats and fruits,
as well as concentrated foods. It should be eaten at regular, fixed
hours. The bowel is an organ wonderfully inclined, in certain persons,
to assume sluggish, stubborn habits. Subjects who eat irregularly
are apt to become just as irregular in evacuation. To show the effect
of the habit, observe how much more women are constipated than men - a
result of insufficient physical exercise, or sedentary life. Also,
ample fluid should be taken with the foods.
The good effect of graham bread is chiefly due to the large residue,
and the contained salts - both acting physically on the bowel, causing
peristalsis. The habits of the use of narcotics, drinking, smoking,
chewing, and taking of morphine, sexual abuses, over-mental activity, etc.,
should be modified.
The second method of treatment in constipation is
the use of some physical procedure. Of these several are important.
Among the first is the establishment of regular habits of evacuation and
overcoming irregular ones. The bowels should be evacuated every morning
after breakfast, i. e., after drinking hot fluid and eating hot food.
Heat starts peristalsis. The mental state
has much influence over the bowels, so that if the mind is set on a distinct
hour for an evacuation, it is pretty sure to be secured. Another valuable
factor is regular and vigorous daily exercise. The most natural are
walking, horseback or bicycle riding. The habit of exercise is nearly
always sufficient to overcome constipation. Gymnastics serve a similar
When the above exercises are not performed, one
of the sovereign cures of constipation is voluntary cultivation of the
abdominal muscles, or massage; at first, weak or light rubbing should be
employed once or twice daily; subsequently, vigorous massage should be
carried on. Stroking, rubbing, tapping, kneading and gripping the
abdominal wall should be judiciously performed. The large intestine
should be massaged from cecum to rectum, following the line of the colon,
and the direction of the fecal current. Rolling a bag of shot or
dry sand over the abdomen is effective, if continued many days. Much
patience on the part of both physician and patient will be required to
continue the massage, for it may need a month to accomplish permanent results
by this process. Rolling on the abdomen for ten or fifteen minutes
every morning accomplishes goods results in constipation. Another
excellent remedy for both its mental and physical effects, is electricity.
Either the galvanic or the faradic current is effective. The muscle
walls of the abdomen can not only be treated by electricity, but one of
the electrodes may be inserted into the rectum. Another physical
procedure of great value for a limited employment in constipation is irrigation,
or colonic flushings, or rectal injections. However, rectal injections
blunt the sensibility of the rectal mucosa. For mild cases a rectal
injection of one-half pint of plain or salt water is sufficient to irritate
the bowel, and excite an evacuation. In more stubborn cases a quart
of water, containing irritants, may be injected, by a fountain syringe,
held two feet above the patient, and allowing the fluid to flow into the
bowel. Another method is turn a chair upside
down, place a quilt over it, and then place the patient over this inclined
plane, with the hips well elevated, and shoulders well down. Then
allow a quart of water (containing desired ingredients) to gradually pass
into the colon.
Besides the water injections, one may employ stimulants,
such as epsom salts, olive oil, glycerine and water, at different temperatures.
An excellent rectal injection is a half pint each of molasses and milk.
It is hygroscopic. The irrigation is accomplished with more safety
and efficiency with the fountain syringe at a low level, e. g., about two
feet above the patient's hips. Cold fluid injections excite the bowels;
however, warm fluids dissolve feces more rapidly.
Olive oil treatment. - Constipation is benefitted
by persistent course of administration of olive oil for a period of months.
I ordered a tablespoonful after each meal. The chemical action of
the olive oil is a result of the separation of the oil by bile and pancreatic
ferments. Through the bile and pancreatic fluids the fatty acids
and soaps are produced which exert a mild chemical action, inducing evacuation.
To soften and dissolve fecal masses olive oil is excellent. The value
of the olive oil employed per rectum is dependent not only on its physical
properties as softening and dissolving feces, coating and protecting the
mucosa, and diminishing the absorption of water, but also on its chemical
To produce an immediate stool, a cold-water rectal
injection of one-half a pint will be the most effective, as it at once
induces active peristalsis. This may be added by rolling a bag of
sand or shot over the abdomen. Daily dilatation of the rectum, especially
when it is inclined to spasm, or is subject to fissure, ulceration or hemorrhoids,
is a usual procedure. However, fissures, ulcers and hemorrhoids are
proper cases for operations.
Finally, in the treatment of constipation, we come
to use of drugs - at once the most disastrous and inefficient of all methods.
Cathartics are to be avoided as much as possible in constipation.
Constipation is generally the result of catarrh. Cathartics influence
catarrh injuriously by further complicating the circulation, and inducing
congestions and depletions. In the treatment of diseases peculiar
to women, which I have diligently followed for twenty years, and where
constipation is a common matter, I seldom advise a cathartic, pure and
simple. The method I have followed successfully for years is what
I term visceral drainage, presently to be described. Drastic cathartics
are the friends of constipation. The number of cathartics is very
great. The choice of one will depend on whether the drug is intended
for long or short use. If a cathartic be employed for a short use,
to secure an immediate evacuation, one of vigorous nature should be selected.
For this purpose none are superior to mild chloride, followed by magnesium
sulphate. The mild chloride stimulates the whole gastrointestinal
glandular apparatus, while the magnesium sulphate induces a large flow
of fluids into the bowel. I have used these cathartics thousands
of times, and have not yet observed superior ones. The violent, drastic
cathartics, such as croton oil, podophylin, colocynth and elaterium, are
Should a cathartic be required for prolonged use,
one of a mild nature should be selected, such as rhubarb, magnesium sulphate,
senna, aloes and cascara sagrada. Drugs administered for chronic
constipation should be employed at night, so that the quietude of the patient
will allow the drug to pass slowly over the whole mucosa. I am of
the opinion that the addition of belladonna to cathartic pills is superfluous,
and therapeutically only adds injury to insult. The cathartic insults
the mucosa, while the belladonna injures it, by attempting to deceive it
by anesthesia-both enemies to the normal, peaceful, mucosa life:
The beneficial effects of mineral waters, which
generally depend upon the contained glauber and epsom salts, are only secured
by long-continued use. Of the two forms of drugs, pills or liquids,
given for constipation, the pill form is the superior one, because it works
slowly, and thus imitates nature more closely. Nature always resents
violent insults, with evil consequences. Nature itself is a bundle
of habits, and if we are to be successful, we must imitate her methods.
Hence, we must employ for constipation, diet, fluid, exercise, physical
procedure, and, lastly, adjuvant cathartics - we must study the sympathetic
The treatment of constipation does not consist in
searching after and administering drugs, but rather in the avoidance of
their use. We may first say that constipation is not curable by any
planless method, nor by any planned method imperfectly executed, while
there may really be non-removable anatomical conditions causing the difficulty.
Planless prescribing of cathartics is worse than useless. The
head and front of all therapeutics in constipation is due to an original,
abnormal, nervous suspension of the peristalsis of the fecal reservoir.
This concerns us and our therapeutics; though we may find difficulty in
excluding congenital defects, such as atony of the bowel wall, or constipation
due to dislocated viscera. Is the constipation, as Dunin suggests,
a mere symptom of neurasthenia? If our original proposition be true,
viz., that constipation is a neurosis of the fecal reservoir, cathartics
are not only useless, but harmful.
X-RAY OF DUCTUS BILIS ET DUCTUS PANCREATICUS OF HORSE
Bile and pancreatic ducts of horse which possess no cholecyst or gall
In constipation we should attempt to cure the neurosis,
the neurasthenia, when the constipation will disappear. The moral
part of the patient should receive attention, for often there is far more
in the suggestions added to medicine, than the remedies themselves can
supply. If constipation depends on suspension of peristalsis, either
from muscular atony or deficient innervation, it is plain how malpractice
resides in the use of cathartics. Physical procedures must above
all be employed in muscular atony, or defective innervation, of the fecal
reservoir. In the treatment of constipation it may aid to determine
the etiologic cause, as atonic constipation, associated muscular atrophy;
neurotic constipation, associated with disorders of the cerebro-spinal
axis or the sympathetic (tabes, lead poisoning); metabolic constipation,
associated with disordered metabolism, as excessive obesity, sweating,
diabetes, anemia; trophic constipation, associated with subjects ingesting
excessive meats or other dietetic errors.
Suggestion. - I wish here to emphasize the subject
of suggestion in the control or cure of constipation. The control
of mind over matter has no uncertain sound in the aid to cure constipation.
The psychic effect of a well-directed suggestion is of ten effective in
stimulating peristalsis for regular stated times for evacuation.
For example, tell a patient, definitely, to go to stool after breakfast,
as the hot coffee stimulates the bowel to action. He will not only
concentrate his mind on the function, but will cultivate his mind for a
definite period for evacuation, which I consider of vast value. Occasionally,
particularly in neurotics, this will effect a cure. With the suggestion
for a daily evacuation at a stated period should be combined simple convenient
remedies, as gymnastic exercise, special diet, in order that the patient
may observe cause and effect.
Dietetic Summary - Quality of foods, quantity of
fluid, chemical composition, are important considerations. (a) Food must
possess sufficient variety (mixed)'in quantity, quality, chemical composition,
and be ingested at regular intervals. The food should be mixed, however,
possess sufficient indigestible matter to leave ample residue to stimulate
peristalsis (and hence absorption, sensation and secretion). An excessive
amount of coarse, indigestible food will result in an excessive fecal residue,
which excessively stimulates peristalsis, absorption, secretion and sensation
- resulting in muscular fatigue and defective sensibility of the mucosa
- consequently, reflex action is impaired.
(b) Ample fluids, at regular intervals, should be ingested. For
a person of one hundred and fifty pounds five pints is required to supply
the bodily waste (i. e., tractus intestinalis, respiratorius, urinarius,
perspiratorius), eight ounces should be drunk every two hours for six times
daily. Fecal matter is about seventy-five per cent fluid and twenty-five
per cent solid. The value of fluids for the tractus intestinalis
is evident, because in hot weather, with consequent vigorous action of
the tractus perspiratorius, constipation results. The chief value
of mineral water is the quantity drank. Excessive fluids deteriorate
(c). Foods should possess chemical qualities.
Carbohydrates produce acidity, nitrogenous foods alkalinity, and mixed
foods neutrality of the digestive tract. Evacuation of the tractus
intestinalis depends on: (a) Sufficient volume of feces, (b) sufficient
volume of fluid contents, (c) the presence of substances which act as a
chemical irritant to peristalsis. Dr. Walter Baumgarter attempted
to devise a substance which would not only be difficult to absorb, but
would retain its watery contents (be hygroscopic). He administered
eight grains of the dry, shredded agar-agar three times daily, whence he
found the stool increased in volume and watery contents.
Visceral Drainage. - I wish here to introduce a
method of treatment for constipation which I have employed successfully
for a score of years. I have termed it "Visceral Drainage."
One of the most important principles in surgery
is ample drainage of (septic) wounds. One of the most important principles
in internal medication is ample drainage of the viscera. Fifteen
years of the application of what I term "Visceral Drainage," in dispensary
and private practice, has afforded me ample time to observe its extensive
application and utility. Viscera are drained by several means; however,
the two most rational and practical methods of visceral drainage are: (A)
by fluids; (B) by appropriate foods. The viscera are the sewers of
the body, and their proper drainage and flushing is the key to health and
its maintenance. Draining the viscera drains and flushes the internal
tissue and tissue spaces.
The muscles are powerful regulators of circulation
(as exercise), hence there is stimulation, which increases the tone of
vessels, blood currents, and prevents consequent congestion (the arch enemy)
in chronic disease. The myometrium, like living ligatures, control
the blood supply of the uterus. Visceral
drainage initiates and maintains peristalsis, which controls visceral blood
supply. A stimulus - whether it be an icicle, red-hot iron, electricity,
massage, exercise - is what the flaccid muscles require to maintain peristalsis,
which controls secretion and absorption. The endometrium flooded
with excessive secretion (leucorrhea) rapidly assumes its normal secretion
by stimulating the myometrium (by douche, massage, etc.).
A - Visceral Drainage by Fluids. - The best diuretic
is water. It is the greatest eliminant. A man of one hundred
and fifty pounds should produce daily some forty-five ounces of urine.
If we calculate the loss of fluid by the tractus perspiratorius, tractus
intestinalis, and tractus respiratorius, it will require about five pints
of the ingested fluid to produce daily forty-five ounces of urine.
Many subjects do not drink over three pints of fluid daily, and that is
performed chiefly at meal time, not only burdening the tractus intestinalis
with the meal, but fluid also. Large numbers of people drink insufficiently
and suffer consequent oliguria. Such subjects are burdened with waste-laden
blood, inflicting irritation and trauma on the nerve periphery. They
are in conflict with their own secretions. Many women oppose free
drinking, from the idea that it creates fat. Ample quantities of
fluid, at regular intervals, is the safety valve of health and capacity
for mental or physical labor. Ample fluids not only flush the sewers
of the body, but wash the internal tissues and tissue spaces, relieving
waste-laden blood. The soluble matter and salts are not only dissolved
(preventing trauma and infection) and eliminated, but the insoluble matter
and salts are flooded from the system, relieving wasteladen blood by such
powerful streams of fluid that calculus is not liable to be formed.
For many years I have diluted the urine, increased
its volume (consequently, increased ureteral peristalsis), and clarified
it by administering eight ounces of one-half or one-quarter normal salt
solution, six times daily. I have made sodium chloride tablets (twelve-grain,
each with flavor). The patient places on the tongue a half tablet
(NaCl), and drinks a glass of water (better hot) before each meal.
This is repeated in the middle of the forenoon (ten A. M.), middle of the
afternoon (three P. M.), and at bedtime (nine P. M.). The patient thus
drinks three pints of (one-quarter to one-half) normal salt solution daily.
This practically renders the urine normal, and acts as ample prophylaxis
against the formation of urinary, hepatic, pancreatic, fecal calculus,
and sewers the body of waste material. The formation of a calculus can
not occur when ample fluid bathes the glandular exit canals. In deficient
fluid, crystals form calculus with facility. The maximum concentrated
solution of urine, bile, or pancreatic juice, tends to crystalize with
vastly more facility than dilute urine, bile, and pancreatic juice.
In "Visceral Drainage" single crystals, on first formation, are rapidly
floated with facility when ample fluids are present; while in small quantities
of fluid, with weak stream, the crystals tend to lodge, accumulate, and
form calculus. Oliguria is a splendid base for calculus formation.
If parenchymatous nephritis exists, the NaCl should not be administered,
as it excessively stimulates the renal parenchymatous cells. In such
cases administer the water only.
For over ten years I have been using sodium chloride
tablets, more or less, in my practice. During that time some practical
clinical views have been gained, and repeated so frequently that they have
become established, I think, beyond the shadow of a doubt. The following
propositions have been repeatedly demonstrated so many hundreds of times
during the last ten years in our clinics and surgical operations, that
I shall consider them established until otherwise disproven:
1. Sodium chloride (in one-half to one-quarter
normal physiological salt solution) is a powerful stimulant to the renal
epithelium (tractus urinarius).
2. Sodium chloride should not be administered
in parenchymatous nephritis (not even in food), as it exacerbates and irritates
the diseased, inflamed parenchymatous cells.
3. Sodium chloride (in one-half to one-quarter
normal physiologic salt solution) is a vigorous stimulant to the epithelium
of the tractus intestinalis, inducing fluid to flow into the lumen, stimulating
peristalsis and softening the feces.
4. Sodium chloride increases absorption, secretion
and peristalsis of the tractus intestinalis. It is an excellent remedy
to quench thirst after peritonotomy, by copious gradual rectal irrigations
(allowing a pint in forty-five minutes to flow over the sigmoid and rectal
5. The administration of eight ounces of one-half
to one-quarter normal physiologic salt solution (better hot), every two
hours, for six times daily, will increase the quantity and clarify the
urine, eliminate its color, making it appear almost like spring water in
three to five days. The feces will be softened, increase, in volume,
6. Sodium chloride is a vigorously active
stimulant to glandular epithelium (as that of the tractus urinarius, tractus
intestinalis, tractus cutis, salivary, hepatic and pancreatic glands).
7. The effect of the one-half to one-quarter
normal physiological salt solution (six times daily) on the tractus urinarius
is to increase the quantity and clarify the urine.
B - Visceral Drainage by Foods. - To drain the viscera
by proper foods may sound paradoxical, but the four grand functions of
the tractus intestinalis - peristalsis, absorption, sensation and secretion
- are maintained, practically, by food alone. The appropriate food
produces the appropriate degree of peristalsis, and the quantity of intestinal
secretions, which is absolutely essential for visceral drainage-and to
prevent constipation. The food that will induce proper peristalsis,
stimulate sensation, absorption and secretion, is that which leaves a large
residue to stimulate the distal bowel, enteron and colon, such as cereals,
oils, and vegetables. Peristalsis is necessary for secretion, for
peristalsis massages the secretary glands in the tractus intestinalis,
enhancing secretion, e. g., the rational treatment of excessive uric acid
in the urine consists of administering food that contains elements to produce
basic combinations with uric acid, forming urates (usually sodium), which
are freely soluble. This will diminish the free uric acid in. the
urine. Excessive uric acid in the urine is an error in metabolism.
The question of diet to determine is: (a) What kind of food causes the
calculus-producing material in the urine? (b) What kind of food influences
the solubility of the calculus-producing material in the urine?
1. The meat-eater is the individual with the
maximum quantity of free uric acid in the urine. Flesh is rich in
uric acid. Hence, in excess of uric acid in the urine, flesh (meat,
fish and fowl, are all about equal in power to produce uric acid) should
be practically excluded, because it increases free uric acid in the urine.
Flesh eaters have uric acid stone. vegetarians have phosphate, oxalate
Generally, the subject who suffers from uric acid is a generous liver,
liberally consuming meat and highly-seasoned foods, indolent and sedentary
persons, and alcoholic indulgers. Thirty-three per cent of uric acid
is nitrogen. Uric acid is derived from the nuclei that form a constituent
of all cell nuclei, and which are taken in the body as a food. Beef
bouillon may be cell administered, because the extract matters in it will
scarcely increase the uric acid. A general meat diet largely increases
the free uric acid in the urine.
2. The food should contain matters rich in
sodium, potassium and ammonium, which will combine as bases with uric acid,
producing alkaline urates, which are perfectly soluble in the urine.
These typic foods are the vegetables, which not only render the necessary
alkalies to reduce and transform the free uric acid into resulting soluble
urates, but leave an ample residue to cause active intestinal peristalsis,
aiding in the evacuation through the digestive tract. Hence, the
patient should consume large, ample quantities of cabbage, cauliflower,
beans, peas, radishes, turnips, and spinach in order that the sodium, potassium,
and ammonium existing in the vegetables may combine, as bases, with free
uric acid in the urine, producing soluble urates, thus diminishing free
uric-acid. A vegetable diet diminishes the free uric acid in the
urine thirty-five per cent less than a meat diet. Again, the administration
of eggs and milk (lactoalbumin) limits the production of uric acid.
The most rational advice is to order the subject to live on a mixed diet,
consuming the most of that kind of food which lessens the uric acid in
the urine - vegetables.
If the appropriate food is so valuable in "visceral
drainage treatment" of the typical uric acid subject, the appropriate food
selected for subjects of biliary and pancreatic calculus will be relatively
as useful. The foods that make soluble basic salts with secretions
should be selected. Besides, the selection of appropriate food is
frequently amply sufficient to drain the intestinal tract to prevent constipation.
It is true, foods alone are not a complete substitute for fluids, but vast
aid in visceral drainage may be accomplished by administering food containing
considerable indigestible matter, so that a large fecal residue, saturated
with fluid, will stimulate the intestines, especially the colon, to continuous
vigorous activity, maintaining the maximum action of the four grand functions-peristalsis,
absorption, sensation and secretion. For many years I have treated
subjects with excess of uric acid in the urine by administering an alkaline
laxative tablet in fluid. The tablet is composed of: Cascara sagrada,
one-fortieth of a grain; NaHCO2 one grain; socotrine aloes, one-third grain;
KHCO3, one-third grain; MgSO4, two grains. The tablet is used as
follows: One-sixth to one tablet (or more, as required, to move the bowels
once daily) is placed on the tongue before meals, and followed by eight
ounces of water (better hot). At ten A. M., three P. M., and bedtime,
one-sixth to one tablet is placed on the tongue, and followed by a glassful
of fluid. In the combined treatment the sodium chloride tablet and
alkaline tablet are both placed on the tongue together. This method
of treatment furnishes alkaline bases (sodium and potassium and ammonium)
to combine with the free uric acid in the urine, producing perfectly soluble
alkaline urates, and materially diminishing the free uric acid. Besides,
the alkaline laxative tablet increases the peristalsis, absorption, sensation
and secretion of the intestinal tract, aiding evacuation. I have
termed the sodium chloride and the alkaline laxative method the "visceral
drainage treatment." The alkaline and sodium chloride tablets take the
place of the so-called mineral waters. Our internes have discovered
that on entering the hospital the patient's urine presents numerous crystals
under the microscope. However, after following the "visceral drainage
treatment" for a few days crystals can not again be found. The hope
of removing a formed localized ureteral, or other, calculus, lies in securing
vigorous ureteral or other duct peristalsis with a powerful ureteral or
other duct stream, aided by systematic massage over the psoas muscle and
per vaginam. Subjects afflicted with excess of uric acid in the urine,
or other form of calculus, need not make extended sojourns to watering
places, nor waste their time at mineral springs, nor tarry to drink the
hissing Sprudel, for they can be treated successfully in a cottage, or
in a palace. The treatment of a uric acid or other calculus consists,
therefore, in the regulation of food and water. It is dietetic.
The control, relief and prophylaxis of uric acid diathesis or tendency
to other calculus formation, is a lifelong process. When the uric
acid or other calculus has passed spontaneously the patient does not end
his treatment, but should pursue a constant systematic method of drinking
ample fluids at regular intervals, and eat food which contains bases to
combine with the free uric acid or other compounds producing soluble urates
or other soluble compounds.
I continue this treatment for weeks, months, and
the results are remarkably successful. The urine becomes clarified,
like spring water, and increased in quantity. The tractus intestinalis
becomes freely evacuated regularly daily. The blood is relieved of
waste-laden and irritating material. The tractus cutis eliminates
freely, and the skin becomes normal. The appetite increases, the
sleep becomes improved, the feelings become hopeful. The sewers of
the body are well drained and flushed.
Chronic constipation is compensatory, for during
this condition a greater portion of the food ingested undergoes digestion
and absorption than in the normal individual, and consequently the fecal
residue is more limited. By reason of the fecal residue there is
less material, and a less favorable medium for the development of bacteria,
in consequence of which less irritating products occur, on which the stimulus
to the required peristalsis, more or less, depends. The varying pressure
of the abdominal walls on the viscera modifies the viscera circulation
in quantity and rapidity. The visceral vessels, especially the abdominal,
constitute a kind of hemogenous reservoir for surplus of blood, by which
general blood pressure may be regulated among viscera. The dilatation
of abdominal visceral vessels may be so great that cerebral anemia may
advance to a state of syncope, collapse, or shock. We may yet learn
to apply Bier's congestion, or blood controlling methods, to cure constipation
by practicing on the sphincters. Abdominal visceral circulation must
not only be controlled for maximum digestion (which is normal absorption,
secretion, sensation and peristalsis of the enteron), but also for maximum
colon peristalsis, which is required for normal evacuation. We know
that mental or physical excitement at meals modifies digestion (which means
modification of circulation). Dilatation of the blood vessels in
the splanchnic area lowers the blood pressure, increases rate, rhythm and
force of pulse. Maximum circulation in abdominal organs is conducive
to maximum absorption, secretion, sensation and peristalsis. Pathologic
increase of circulation in the abdominal viscera leads to corresponding
activity of unction. This lends a clue to treat constipation.
Increased secretion of the glands of the tractus intestinalis, in consequence
of nervous influence, is well known (which refers to circulation).
Visceral congestion (chronic) leads to relaxation
of visceral supports. Interruption of circulation (anemia) leads
to visceral spasm, colic. Spasm of the muscle of the digestive apparatus
produces colic. There can be slight doubt, clinically, that spasmodic
(anemic) constipation occurs - e. g., lead or (anemic) colic. In
the practice of medicine the vascular area governed by the splanchnics
will be more utilized in therapeutics. For example, the headaches,
dizziness, faintness, syncope, vertigo, which appear and disappear suddenly
without sufficient time for autointoxication, infections, are likely to
produce circulatory changes in the splanchnic and producing cerebral anemia.
So, also, cold bands and feet, aching pains in limbs, neuralgic pains in
various bodily regions, may be due to excessive tendency of blood to the
splanchnic area. Irritation of the nerves of the splanchnic vessels
are transmitted to distant regions, leading to spasms (anemia, ischemia)
of vessels, and pain, cramps in muscles. This may explain the frequent
colic, cramps, of neurotic subjects.
Circulatory disturbances in the tractus intestinalis
should not be mistaken for: (a) Mechanical irritation from coarse food,
(b) chemical irritation from ingested irritants (as acids, spices, meats),
(c) pathologic physiology, as excessive, deficient or disproportionate
secretion and consequent fermentation (microbic). The dilatation
of the splancbnic vessels are physiologically opposed to the dilatation
of the peripheral vessels, and since the splanchnic vessels are controlled
by a nervous mechanism, it may be hoped that a definite therapeutic remedy
will appear that will contract, or dilate, these visceral vessels.
Since physiologic antagonism exists between the splanchnics and peripheral
vessels, agents which dilate the splanchnics contract the peripheral vessels,
and vice versa. The dilatation of the anal sphincter dilates and
flushes the peripheral capillaries with it, contracts the splanchnic vessels.
The peripheral vessels may be dilated by mechanical means, as massage,
hypertrophy, a hot and cold water chemical irritation, as mustard, turpentine.
Normal evacuations of the tractus intestinalis require
an ample stream of fresh blood irrigating the intestinal tract, which is
accomplished by administering food with indigestible remnants.
The tendency of the blood stream to any other visceral
tract than the intestinal, lessens the peristalsis, absorption, sensation
and secretion, favoring constipation.
In pubertas, menstruation, gestation or chronic
genital inflammation, the circulation tends toward the genitals, robbing
the tractus intestinalis of blood, inducing constipation.
In the puerperium the patient should exercise, employ
gymnastics, massage the abdominal muscles, ingest foods which have a residue,
and limit the enforced rest to a week, in order to restore muscular action
and visceral circulation, especially the intestinal.
Chronic inflammation, tumor, irritation on any one
visceral tract, tends to unbalance the normal circulation in all other
visceral tracts - inducing constipation - hence to improve constipation,
remove the disease or disturbance in other visceral tracts.
Any defective segment of the tractus intestinalis
(gastrium, enteron, colon) should be repaired, and any defective function
(peristalsis, secretion, sensation and absorption) should be restored.
A subject of one hundred and fifty pounds requires
five pints of fluid daily to produce ample visceral circulation (to supply
the physiologic demands of the tractus urinarius, tractus cutis, tractus
respiratorius, tractus intestinalis).
Vegetables and graham bread (which should contain
the flour, shorts and bran) leave ample residue to stimulate the tractus
intestinalis, inviting a vigorous circulation.
Rectal injections and colonic irrigation should
not be employed frequently, as the rectum may lose its sensitiveness, becoming
so blunted in sensibility that it will forget to act when fecal matter
is present. Clysters of oil are excellent remedies to soften fecal
Persistent use of galvanic and faradic electricity
produces favorable effects on constipation, the electricity energizes the
abdominal walls and intestinal muscles. However, I can not report such
favorable results as those of C. V. Wild, in his excellent essay, "Die
Verheutung und Behandlung der Chronischen Verstopfung bei Frauen und Madchen."
Constipation, if pursued by both patient and physician, with
favorable will and energy, is practically a curable disease.