We all know from physiology that the expulsion of fœcal matter from the intestines takes place in such a manner that the contents therein act as a kind of extraneous body with stimulating action upon the walls of the intestines and the plexus myentericus contained in the same. Consequently there follows a contraction of the walls of the intestines, and their contents are expelled. All nerves, the plexus myentericus included, are under the control of the central nervous system, which creates motor impulses through the medium of the pneumogastric (vagus), or may cause a check to the peristaltic movements through the intervention of the splanchnic nerves.
Thus, as we see, different agencies influencing the central nervous system, like strong emotions, shock, etc., may cause an irritation of the pneumogastric, the motor nerve of the intestines, and thus occasion a movement of the bowels. Different toxic products may act also upon the pneumogastric; strong motor action of the intestine with diarrhœa may also be caused by the abundant secretion of the thyroid gland, as in Graves’s disease, where an excess of toxic matters of the thyroid gland are secreted.
In the same way we can also produce diarrhœa if we give thyroid extracts in too abundant quantity; but giving the same in more moderate doses will effect an improvement in the peristaltic movements.
That the thyroid gland has a controlling influence on the innervation of the intestine is evident from the fact that, when the thyroid is degenerated, the bowels are very sluggish. Under such conditions we often find very stubborn constipation; but when we administer to such persons thyroid extracts for a given time, we note a considerable improvement of the bowels, which can even go to the extent, if too excessive doses be given, of causing diarrhœa as already mentioned.
In addition to the thyroid gland, there are other ductless glands which seem to influence the peristaltic movements by acting on the splanchnic nerves, and these are the sexual glands. In women they are frequently altered. Dysmenorrhœa, amenorrhœa, and other troubles are frequent, and constipation is a typical symptom of such conditions. This may also serve to explain why women are more often constipated than men.
But the alteration of the sexual glands can also cause constipation in men, if we may draw the inference from the great frequency of constipation in diseases of the prostate gland, which to some extent may be in relation with the subject with which we are now dealing.
In order to avoid constipation we must therefore observe a careful hygiene of the thyroid, and also of the sexual glands, following the advice we offer in special Chapters XVIII and XLVIII.
Besides constipation, as above, from the central nervous system, the same may be caused through the lack of a stimulation which may come from the intestinal contents. As we have already seen, the peristaltic movements of the intestine and the expulsion of fæcal matter take place through the stimulation of the nerves in the intestinal walls by the intestinal contents, which act either mechanically or by the irritation which their fermentation causes.
To prevent constipation we must take such nourishment as will act in a stimulating way, either mechanically, owing to its bulk, or by the fermentation it causes. In order to have good bowel movements we must create them, and this is best done, not by a diet of meat and finely ground cereals, which are absorbed with scarcely any residue to effect the purpose, but by one of vegetables and fruit, which contain cellulose in the largest quantity, this substance forming the framework of the structure in which the cells are imbedded; it constitutes the wall of the cells. This cellulose provides us with the best residue from food, which, if present in large quantities, will exercise a mechanically stimulating action on the intestinal walls.
Vegetables are thus a valuable aid in the prevention of constipation, and of these the following are the best: spinach, carrots, green beans, and boiled lettuce, taking into consideration their action as laxative food. Cabbage also acts well as a bulky food.
Graham bread and brown bread in general, and in particular a special kind, called “cellulose” bread, are also very good agents with which to prevent and to treat habitual constipation. Some breads, as various kinds made from bran, are so coarse that, to a certain extent, they may be considered as setting up a kind of internal massage of the intestines.
Not only vegetables, but fruits, by reason of the fruit sugar and acids they contain, may also prove laxative if taken in given quantities. Fruits may be taken stewed, as a compote, or baked, as for instance, apples; they may also be taken au naturel if the condition of the stomach permits. Of compotes the most laxative are plums, prunelles (sour figs), and apples; also pineapples, cherries, and various berries, all of which may also be partaken of in the form of a mush or purée, to great advantage; also fruit juices and fruit wines, if free from alcohol.
Of fresh fruits, grapes and, according to our observation, pineapples also undoubtedly have the best laxative quality, as also have green figs, which can be taken regularly as a preventive against constipation. Figs when dried, especially the so-called Olympia figs from Smyrna, or the California variety, are also most beneficial, their laxative properties to a certain extent being probably due to the seeds which they contain, which serve as a means for intestinal massage.
Orange and grape-fruit, taken on an empty stomach in the morning, may also have a laxative effect, due probably to the quantity of fruit acids they contain.
We sometimes hear patients complain of constipation after partaking of milk. According to our experience, this is more often the case when boiled milk, heated above 60° C., is taken. On the other hand, we believe that when uncooked milk is taken it may act as a laxative in many persons, due to the action of milk-sugar and acid. Acidulated milk may have this property in a greater degree, as also may buttermilk, and especially whey; all of these are, on the whole, good laxatives.
The diet of those suffering from habitual constipation should be as follows: In the morning, on rising, take a glass of cold water and an orange. For breakfast, one or two oranges or several slices of fresh pineapple, or, in countries where one is so fortunate as to obtain such delicious and wholesome fruit, a grape-fruit; after that one or two soft boiled eggs, cereals, Graham or brown bread, or one of the kinds of coarse breads rich in cellulose, and fresh butter thickly spread on the bread (if the stomach is good). Then follow with orange marmalade or purée of prunes, ending with some grapes. Honey (another excellent laxative) may also be added. Two glasses of milk or more, for those who can stand it; in fact, as much as they desire. For dinner, the following is recommended: Roast or boiled meat, two sorts of green vegetables (by preference spinach), French beans, carrots, boiled lettuce, one course of stewed compote of fruit, and finish with dessert of grapes, figs (dried or green), or preserved plums (California or Bordeaux). For drink, mineral waters, such as the various light American kind, either mixed with wine or alone. Alkaline waters, such as Biliner, Vichy, etc., if taken very cold, may also contribute to the laxative action. For supper, something akin to breakfast. As we shall point out in the chapter on the hygiene of food, we recommend meat only once a day.
We are confident, from experience gained with our own patients, that people who follow such a regimen will have an easy bowel movement daily, and will thus avoid those dangers which are connected with the habitual use of laxative drugs.
For those who, in spite of such a course of diet, have sluggish bowels, we recommend massage and electricity, and also certain hydrotherapeutic procedures. The method of carrying out such must be obtained from the special hand-books written for that purpose; but we would merely mention here that massage should preferably be performed by one belonging to the medical profession, or, at any rate, by one trained in the Swedish system.
Electricity may be applied by either galvanic or faradic current, both of which give excellent results.
Hydrotherapeutics must not be overdone or harm may result. We find that a compress of lukewarm water (Pressnitz compress) worn round the abdomen and back through the night, produces good results in many cases, if the diet is, at the same time, appropriate.
For those who only suffer occasionally from constipation, as, for instance, after a railway journey, it is an easy and always efficacious method (if there is no inveterate constipation) to take a suppository of glycerine and introduce it into the rectum. After only ten to fifteen minutes interval there may be a copious evacuation.
In persons where the dietetic and above-mentioned mechanical remedies have not proved effective, irrigation of the rectum and intestines should be employed. We would not, however, advise the constant use of this method, as torpidity of the intestine might result if practiced daily (see chapter on the hygiene of the intestines).
In cases where there is a more serious degree of constipation a little soap, or olive or castor oil, should be added to the water, together with a little soda to assist the formation of an emulsion.
Enemata possess the advantage of having nothing to do with the stomach, and thus this important organ can be spared much irritation which, unfortunately, cannot be avoided when other purging remedies, such as drugs, are given, all of which must pass through the stomach when taken by the mouth. If we find it necessary to resort to laxative drugs by the mouth we must first try such drugs as are least irritating to the stomach and intestines, and foremost among these is rhubarb, which can be taken in the form of a compote as well as a drug. To this it is well to add magnesia and bicarbonate of soda. We should, if possible, administer only the mildest purgatives, and, therefore, if rhubarb is not effective, we may give cascara sagrada, or the pulp of tamarind, which is, moreover, pleasant to take; but the action is not so pronounced as in the case of cascara sagrada (rhamnus purshiana).
Before resorting to drugs, however, we think it would be better to try the natural mineral waters, and only when these fail should we fall back on drugs.
There are two kinds of mineral waters, each varying in its action: 1. The milder acting water, of a laxative nature. 2. Stronger water, with drastic action. Of the former we will mention those which are employed for several weeks continuously for a regular cure: Germany: Kissingen; Austria: Carlsbad; Marienbad. As the author of this book is himself a practicing physician at one of these springs, he thinks it more becoming to pass over in silence which of these waters is preferable. Each of them, as also many others not mentioned for want of space, have their undoubted merits. A teaspoonful of Sprudel salt, taken in a glass of lukewarm water in the morning on an empty stomach, will give excellent results; but it should not be taken every day for any length of time, as otherwise, as with all other drugs if taken continuously, it may deaden the excitability of the nerves of the intestines, and success depends upon keeping these nerves in such a condition that they may respond, upon a light stimulation, with a contraction of the intestinal walls and expulsion of the fæcal matter.
Of the strong mineral waters with drastic action, there are several excellent springs in America, some of them surpassing many of the European mineral waters. In Europe there are in Hungary: Hunyadi-Janos, Ferencz-Jozsefforrás, etc.; Spain: Rubinat, Villacabra-Loeches, etc.; and elsewhere a number of such springs. As all are natural remedies they should be used in preference to drugs when the intestine does not respond to mild laxatives and a strong whip is needed. In my opinion they are less fitted for every day treatment, though well adapted for a thorough cleaning out of the intestine to get rid of stagnant matter (see Chapter XIX).
These strong, drastic, natural waters act by causing a transudation into the intestine, creating a condition somewhat similar to a catarrh, but in a more benign way.
Briefly, the best and most rational treatment of sluggish bowels is by stimulating the intestine by means of an appropriate diet which, at the same time, tends to ward off old age.