GpightK?. 
 
 CGE2PJGKT DEPOSIT. 
 
 
 
Colon Hygiene 
 
Colon Hygiene 
 
 Comprising New and Important Facts Con' 
 cerning the Physiology of the Colon and an 
 Account of Practical and Successful Methods of 
 Combating Intestinal Inactivity and Toxemia 
 
 J. H. KELLOGG, M. D., LL.D. 
 
 Superintendent of the Battle Creek Sanitarium; Author of "Neurasthenia, 
 
 Its Causes and Cure," "Rational Hydrotherapy," "The Art of 
 
 Massage," "Light Therapeutics," etc. 
 
 Eighteenth Thousand 
 
 BATTLE CREEK, MICHIGAN 
 
 GOOD HEALTH PUBLISHING CO. 
 
 1916 
 
Copyright 1916 
 
 BY 
 
 J. H. KELLOGG 
 
 i 
 
 SEP II i9!6 
 
 ^CI.A438308 
 
 • fa 
 
Preface 
 
 That most despised and neglected portion of 
 the body, the colon, has in recent years been made 
 the. subject of much scientific study and research, 
 with the result that a lively controversy has been 
 stirred up over the question as to whether this or- 
 gan should be permitted to remain a part of the 
 "human form divine," or whether it should be 
 cast out as worse than useless and unworthy of a 
 place in the anatomy of the modern genus homo. 
 
 Anatomists have declared the colon to be a 
 useless appendage, a vestigial remnant left over 
 from a prehistoric state. Bacteriologists have 
 charged it with being an incubating chamber of 
 poison-forming germs, a hold of unclean and hate- 
 ful parasites, a veritable Pandora's box of disease 
 and degeneracy. Surgeons have removed the offend- 
 ing organ, and thus proved that it may be dispensed 
 with, and have claimed wonderful advantages from 
 this abbreviation of the prima vice. 
 
 Barclay Smith, the great English anatomist, first 
 suggested the uselessness of the colon. Metchnikoff 
 proved that animals that possess the longest 
 colons have the shortest lives, and announced that 
 the colon bacillus is the germ of old age. Sir 
 William Arbuthnot Lane, the eminent London 
 surgeon, cites a long list of grave maladies, ranging 
 
10 PREFACE 
 
 from tuberculosis to rheumatism, cured by removal 
 of this offending organ. 
 
 The war still wages. There are pro-colon par- 
 tisans as well as anti-colon enthusiasts. One thing 
 is certain, however, the colon can no longer be 
 ignored. That this organ, or rather the morbid 
 conditions that develop in it, plays a dominant role 
 in the causation of a long list of the gravest and 
 most common disorders, can no longer be denied. 
 
 In the treatment of every chronic disease, and 
 most acute maladies, the colon must be reckoned 
 with. That the average colon, in civilized com- 
 munities, is in a desperately depraved and danger- 
 ous condition, can no longer be doubted. The 
 colon must either be removed or reformed. From 
 the beginning of the colon controversy and for 
 many years before, the writer has been a very 
 earnest student of the questions involved, and has 
 formed very definite opinions, the validity of 
 which he, together with his colleagues of the fac- 
 ulty of the Battle Creek Sanitarium, has had oppor- 
 tunity to test in the treatment of many thousands 
 of sufferers from colon and colon-caused maladies. 
 The writer believes that methods have been worked 
 out by means of which the colon may be reformed 
 and made to do its work efficiently, not only in 
 ordinary cases, but in by far the great majority of 
 those cases which are thought by enthusiastic colon 
 surgeons to be suitable subjects for surgical treat- 
 ment. 
 
PREFACE 11 
 
 Until very recent years almost nothing has been 
 known of the physiology of the colon. This part 
 of the body has been almost a terra incognita. The 
 physiology of digestion stopped at the ileocecal 
 valve. How the colon dealt with its contents, how 
 the very necessary act of defecation was performed, 
 nobody knew. The discovery of the X-ray en- 
 abled Cannon and, later, Hertz to study the colon 
 while in action in animals and man. Elliot, Keith, 
 and other anatomists studied the intestine in dogs, 
 and finally Case, by perfecting the X-ray technic 
 of colon examinations, completed the physiologic 
 study of this previously neglected organ. The 
 combined result of the extensive labors of these 
 investigators has been a great flood of light upon 
 some of the most obscure questions in physiology. 
 These new facts, not yet known to the general 
 public, have rendered the greatest service in the 
 development of rational methods of dealing with 
 that most common and most destructive disease of 
 civilized peoples — constipation. The chief purpose 
 of this work is to present in a popular way these new 
 facts and the practical results to which they have 
 led. 
 
 Forty years' experience and observation in deal- 
 ing with chronic invalids, and careful study of 
 the results of the modern X-ray investigations of 
 the colon, together with observations made at the 
 operating table in many hundreds of cases, has 
 convinced the writer — 
 
12 PREFACE 
 
 1. That constipation with its consequences is 
 the result of the unnatural habits in relation to diet 
 and colon hygiene which prevail among civilized 
 people. 
 
 2. That patients are not constipated on gen- 
 eral principles, but that there exists in every case 
 of constipation some particular condition which is 
 the immediate cause of the delayed intestinal move- 
 ment, and which must be removed before definite 
 relief can be obtained, and that in the great ma- 
 jority of cases this cause is mechanical in character, 
 a fold, a kink, a redundancy, a contraction — in 
 short, some real and tangible obstruction. 
 
 3. That practically every case of constipation 
 is curable, and in all but exceptional cases without 
 the aid of surgery. It must be added, however, 
 that by cure is not meant the working of such a 
 miracle that the colon will perform its function 
 normally without attention to diet or other means 
 which encourage colon activity, but rather that by 
 observing certain rules and the faithful and con- 
 tinuous use of safe and simple means, the colon 
 may be made to perform its functions in a regu- 
 lar and efficient manner, without the use of 
 irritating laxative drugs. 
 
 If some of our recommendations at first impress 
 the reader unfavorably, we ask only that judg- 
 ment be suspended until the suggestion has been 
 given a fair test in actual experiment. Every 
 measure presented has been tested in the crucible 
 
PREFACE 13 
 
 of actual experience in hundreds of cases, and is 
 the result of a long series of practical tests made 
 for the purpose of determining the actual value of 
 individual remedies and perfecting practical methods 
 of relief. 
 
 If the reader misses the usual list of laxative 
 drugs, old and new, the reason is simply that 
 the writer regards all medicinal agents that force 
 bowel action by irritation (wrongly termed "stimu- 
 lation") as pernicious and, without exception, harm- 
 ful, and to be used only as temporary or emerg- 
 ency measures. In the words of the eminent Pro- 
 fessor Von Noorden, "Nothing is so bad as the 
 chronic use of laxative drugs." 
 
 The reader is asked especially to note that no 
 panacea is offered for colon miseries; there is no 
 "cure all" for constipation. The way out of the 
 slough of intestinal toxemia with its "biliousness," 
 headaches, neurasthenias, and multitudinous mal- 
 adies, is to be found only through living biolog- 
 ically, and making use of the "safe and sane" helps 
 which recent scientific progress has provided. 
 
 In attempting to put into semi-popular form the 
 scientific facts pertaining to the hygiene of the colon, 
 the writer does not desire to convey the impression 
 that the sufferer from severe constipation can 
 safely undertake to act as his own physician. The 
 purpose is rather to enable the patient who may 
 read this work to cooperate intelligently with the 
 wise up-to-date physician. 
 
14 PREFACE 
 
 The reader's attention is especially called to the 
 chapter on "The Bowel Habits of Uncivilized 
 Man," which contains a fund of original informa- 
 tion obtained at the cost of much effort, which is 
 both highly interesting and instructive. The author 
 desires here to acknowledge his obligations to some 
 hundreds of medical colleagues who have devoted 
 their lives to the noble work of carrying to heathen 
 lands the blessings of modern scientific medicine and 
 Christian civilization, and who have found time in 
 the midst of their arduous labors to answer the 
 questionaire and thus furnished the unique informa- 
 tion presented in this chapter. 
 
 PREFACE TO SECOND EDITION 
 
 REVISED AND ENLARGED 
 
 Although less than a year has elapsed since the 
 publication of the first edition of this volume, a new 
 edition is called for and the writer has improved 
 the opportunity to make a few important additions 
 to the book and to correct a few typographical 
 errors. The author also desires to express his grati- 
 tude for the very kindly reception which the book 
 has received and the hope that the revisions made in 
 this second edition will render the volume still more 
 useful and acceptable to those of the great army of 
 sufferers from chronic ailments into whose hands 
 the work may fall. 
 
Contents 
 
 The Colon . . . . . 17. 
 
 The Physiology of the Colon ...... 23 
 
 The Ileocecal Valve and Its Function . . 37 
 
 Normal Bowel Action 40 
 
 The Feces 51 
 
 Influences Which Excite Movements of the 
 
 Colon ., 58 
 
 Influences Which Lessen Intestinal Move- 
 ments 73 
 
 The Causes of Constipation 78 
 
 Habits Which give Rise to Constipation . 87 
 Disorders of the Digestive Tube . . . . 135 
 Alimentary Toxemia, or Intestinal Autoin- 
 toxication 159 
 
 Important Discussion of Alimentary Toxemia 
 
 before the Royal Society 177 
 
 Forms of Constipation 195 
 
 The Treatment of Constipation .... 201 
 
 Diet in Constipation 218 
 
 Baths and Other Home Treatments for Con- 
 stipation 241 
 
 Exercises Which combat Constipation ,. . 272 
 
16 CONTENTS 
 
 Efficient Electrical Methods 300 
 
 Special Treatment of Different Types of Con- 
 stipation 303 
 
 Treatment of Disorders Which Result from 
 
 Constipation 322 
 
 Bowel Habits of Uncivilized Man . . . 370 
 
The Colon 
 
 Ignoring technical anatomical details the food 
 canal may be described as a muscular tube about 
 ten times the length of the body, measuring the 
 trunk from the top of the head to the end of the 
 spinal column. The chief part is coiled up in the 
 lower cavity of the trunk, below the diaphragm. 
 The upper end of the canal is controlled by the 
 circular muscle of the lips, which is brought strongly 
 into play in whistling. The lower end is controlled 
 by the anus, also a voluntary circular muscle. At 
 other points along the canal, circular muscles are 
 placed to regulate the movements of the foodstuffs 
 during the process of digestion. Both in health and 
 disease these "food gates," as they may be called, 
 have a most important relation to digestion that has 
 not been fully appreciated until very recent times. 
 
 The upper end of the food tube is provided with 
 a special apparatus, the mouth and teeth, for taking 
 in food and preparing it to undergo the various 
 processes which are carried on in the deeper parts. 
 At the lower end of the canal is found a mechanism 
 that is wonderfully designed to receive and discharge 
 from the body the unused remnants of the food and 
 other waste materials — the pelvic colon. Of this 
 we shall learn more later. 
 
 17 
 
18 COLON HYGIENE 
 
 The Structure of the Food Tube 
 
 In structure, the food tube consists chiefly of 
 muscle and gland tissue. There are two sets of 
 muscle fibres. One set, the outer, runs lengthwise 
 of the canal; an inner, circular muscle structure, 
 surrounds the canal throughout its entire length. 
 
 Between the muscle layers is a layer of nerve 
 cells and fibres. These are connected with the 
 central nervous system, the brain and spinal cord, 
 but are capable of acting independently. 
 
 The food canal is lined with mucous membrane, 
 which presents at various points special groups of 
 glands that produce some of the various digestive 
 juices which act upon the food. The canal is cov- 
 ered through most of its course with a delicate 
 membrane, the peritoneum. 
 
 The food tube is roughly divided into six parts — 
 the mouth, oesophagus, stomach, small intestine, 
 colon and rectum. The intestine is attached to 
 the spine by a membrane, the mesentery, in which 
 pass the nerves and blood vessels which supply the 
 canal. 
 
 The colon may roughly be described as a mus- 
 cular reservoir about five feet in length and an inch 
 and a half to three inches in diameter. This reser- 
 voir is divided into four secondary reservoirs, the 
 cecum, the transverse colon, the pelvic colon, and 
 the rectum. The feces, in their preparation for 
 discharge from the body, are passed successively 
 from one to the other of these reservoirs, pausing 
 
*<3 
 

 
 a 
 
 O 
 
 u 
 
 
 
 
 
 u 
 
THE COLON 19 
 
 for a definite interval in each, with the exception of 
 the last. 
 
 Normal Position of the Colon 
 
 When in its normal position, the colon begins 
 at the lower right hand section of the abdominal 
 cavity; its head, a pouch much broader than the 
 rest of the colon, lies in the hollow of the right 
 iliac bone. This is the cecum. The small intes- 
 tine joins the cecum about an inch and a half 
 above its lower part, leaving a pocket, at the bottom 
 of which is attached the appendix. 
 
 From the cecum the intestine ascends along the 
 right side of the abdomen to the liver. This por- 
 tion is the ascending colon. At the liver a rather 
 sharp turn is made toward the left, the hepatic 
 flexure. 
 
 From this point the colon passes across the body 
 above the umbilicus, sloping upward toward the 
 left side, where it lies in close contact with the 
 spleen. This section is the transverse colon. 
 
 At the spleen the intestine makes a short turn, 
 the splenic flexure, then passes downward along 
 the left border of the abdominal cavity to the hip 
 bone (crest of the ileum). This is the descend- 
 ing colon. 
 
 Passing obliquely across the hollow surface of 
 the left iliac bone, the large intestine, here called 
 the iliac colon, reaches the upper border of the 
 pelvic cavity. Here it forms a loop, the pelvic 
 
20 COLON HYGIENE 
 
 colon, which has an average length of a foot and 
 a half, but which varies in length from six inches 
 to nearly three feet (in conditions of disease). The 
 pelvic colon and iliac colon together form the sig- 
 moid. The lower end of the pelvic colon joins 
 the terminal portion of the intestine, the rectum, 
 opposite the middle of the sacrum. The pelvic 
 colon varies in position according as it is empty or 
 filled. When empty, it falls over backward into 
 the pelvis, and lies upon the upper part of the 
 rectum. When it is in this position, a very pro- 
 nounced fold is formed at the junction with the 
 rectum, the pelvi-rectal fold, a factor in con- 
 trolling bowel movements. When the pelvic loop 
 is full, it rises and thus gradually obliterates the 
 fold and so opens the passage to the rectum. 
 
 The rectum extends from the pelvi-rectal fold 
 to the internal anal sphincter, being about six inches 
 in length. In its upper part are two or three 
 projecting folds of membrane known as Houston's 
 valves. 
 
 The thicker muscular walls of the rectum are 
 ordinarily contracted so that no cavity exists in 
 the upper part, although some gas and often (in 
 cases of disease) a considerable amount of fecal 
 matter may be found in the lower part. 
 
 The distance between the internal and external 
 sphincter is about one inch. This is the anal 
 canal, which is always tightly closed except dur- 
 ing defecation. 
 
ileocecal valve or a monger Lei. 
 A, Ileum; B, Ileocecal Valve; C, Colon. 
 
THE COLON 21 
 
 Just above the internal anal sphincter is found 
 a series of raised points or papillae, first described 
 by Horner of Philadelphia many years ago. These 
 papillae are the terminal points of special nerves 
 which when excited cause powerful contraction of 
 the colon and the abdominal muscles and dia- 
 phragm, and at the same time a complete relaxation 
 of the anal sphincter. 
 
 Here are also a number of shallow pockets in 
 the mucous membrane, the follicles of Horner, 
 whose function is to secrete a lubricating mucus. 
 Both follicles and papillae sometimes become in- 
 flamed and a source of pain. 
 
 Behind the rectum are located two muscles 
 which act an important part in defecation, the 
 levator ani muscles. In contracting, these muscles 
 pull the anus upward and compress the rectum, 
 and so squeeze out the last particles of fecal matter, 
 leaving the rectum completely empty. 
 
 The small intestine is a smooth tube of uniform 
 size, but the large intestine is sacculated. By a 
 thickening of its muscular structures at intervals 
 shallow pouches are formed in its sides. Along the 
 outer surface of the colon run thick bands of 
 muscle tissue which act in defecation like gathering 
 strings. In contracting, these bands draw the lat- 
 eral pouches together, so as to empty them of their 
 contents. These sacs or pouches are well shown 
 in the accompanying stereoradiogram, a rare view 
 of the colon. 
 
22 COLON HYGIENE 
 
 All parts of the large intestine, including the 
 rectum, are supplied with two sets of nerves, one 
 of which stimulates its muscles to contract, while 
 the other exercises an opposite influence. 
 
 In the accompanying plates will be seen represen- 
 tations of the colons of different animals. It is 
 especially interesting to note the close relation be- 
 tween the form of the colon and the character of 
 the food in various classes of animals. In flesh- 
 eating animals the colon is always short; in vege- 
 table eaters it is long as compared with the body 
 length. 
 
The Physiology of the Colon 
 
 The function of the colon is largely that of 
 a receptacle for unusable and waste matters, a sort 
 of human garbage box. On this account, perhaps, 
 this part of the food tube has been habitually neg- 
 lected. It has been regarded as of little conse- 
 quence. But modern studies of this part of the 
 intestine have shown that by neglect this temporary 
 reservoir of wastes may become a veritable breed- 
 ing place of miseries and maladies almost too num- 
 erous to mention. So many and so serious are the 
 disorders of mind and body which are now trace- 
 able to this part of the food tube, that not a few 
 eminent surgeons have advocated and practiced the 
 actual removal of the colon in cases of chronic 
 disease of various sorts, and in many instances with 
 surprisingly good results. 
 
 Professor Metchnikoff, of the Pasteur Institute, 
 Paris, Dr. Arbuthnot Lane, head surgeon of Guy's 
 Hospital, London, Dr. Barclay Smith, and numerous 
 other scientific men, eminent bacteriologists, physi- 
 ologists, anatomists and surgeons, have even an- 
 nounced the belief that the colon is a useless and 
 often dangerous structure and that it may be advan- 
 tageously dispensed with. 
 
 The writer does not accept this view, but holds 
 with Professor Keith, the eminent English anatom- 
 ist, that the evils attributed to the colon are really 
 
 23 
 
24 COLON HYGIENE 
 
 due to the adoption by man of a dietary unsuited to 
 his anatomy. All vegetable-eating animals have 
 long colons, as has man. The presumption is that a 
 vegetable diet requires a long colon. Meat-eating 
 animals, as the dog, have short colons. The frog 
 while in the tadpole state is a vegetable feeder and 
 has a very long colon. The adult frog feeds upon 
 flesh and has a very short colon. 
 
 The Wrong Use to Which We Put the Colon 
 
 The trouble with the civilized colon is not that 
 it is too long, but that it is put to a wrong use. 
 Civilized man has adopted the dog's diet while 
 having the colon of the chimpanzee. It may be ad- 
 mitted that if a man is to feed on the diet of the dog 
 he ought to have his colon abbreviated. This is, in 
 fact, the only way in which he could avoid a dan- 
 gerous biologic misfit. 
 
 It is hardly to be supposed, however, that Nature 
 has made so grave an error as to give to man an 
 organ which is not only a useless appendage, but 
 at the same time a prolific source of mischief. It 
 seems more rational to believe that if the colon, 
 an organ useful under normal conditions of life, is 
 found to be so great a source of mischief in our 
 civilized life, it is because of abnormal and pernic- 
 ious habits or other influences connected with the 
 life of the average civilized man. 
 
 The remedy is to be sought then, not in the 
 
Diagram Showing Normal Colon and 
 Ileocecal Valve 
 
THE PHYSIOLOGY OF THE COLON 25 
 
 extirpation of a portion of the body, but in a cor- 
 rection of those habits of life in which there has 
 been a departure from the condition normal to 
 the human species, and a return to practices and 
 conditions which are physiologically and biolog- 
 ically correct for the genus homo. 
 
 The First Function of the Colon 
 
 One important function of the colon is to re- 
 ceive and to discharge from the body the unusable 
 residue of foodstuffs. If these foodstuffs are of 
 such . a nature that they readily undergo putrefac- 
 tion, as do meats of all sorts, the colon contents 
 will become highly putrescent, offensive and poison- 
 ous, while still in the body. A non-putrefying 
 vegetable diet on the other hand furnishes a residue 
 which cannot putrefy, but ferments, forming harm- 
 less acids which aid bowel action. Hence the colon 
 is not out-of-date, as its critics have suggested, but 
 is only made to appear as a misfit by the adoption of 
 a diet which belongs to short-colon animals. This 
 view maintained for many years by all advocates of 
 the biologic diet is so eminently reasonable that it 
 cznnot fail to be accorded due recognition since it is 
 now supported by so eminent an authority as the 
 world-famous anatomist, Professor Keith, of Eng- 
 land. 
 
 Another important function of the alimentary 
 canal, one which is quite distinct from its function 
 
26 COLON HYGIENE 
 
 as a digestive apparatus, is its excretory function. 
 The intestine is the outlet of the bile, from fifteen 
 to twenty ounces being poured into the upper end 
 of the small intestine every twenty-four hours. The 
 bile is the most poisonous of all the bodily secretions, 
 being, according to Bouchard, six times as poisonous 
 as urine. It is through the bile that the body rids 
 itself of alkaline wastes, some of which are highly 
 poisonous in character. 
 
 Another fact of very great importance is that the 
 intestine is itself an excretory organ. Certain poi- 
 sons are excreted by the stomach, others find their 
 way out of the blood through the walls of the gall- 
 bladder and the small intestines. 
 
 The colon forms a receptacle for all these waste 
 and excretory substances, together with the un- 
 usable or undigested residues of the food. But 
 the collection of these waste matters is only an 
 incidental function of the colon, its really important 
 function being to conduct these waste and unusable 
 matters out of the body. 
 
 The food normally enters the first part of the 
 colon, or the cecum, in a nearly fluid state, its 
 composition being ninety per cent water, and only 
 one-tenth solid matter. During the passage of 
 the foodstuffs through the twenty-two feet of small 
 intestine, the digestible starches, fats, and proteins 
 are rendered soluble by the digestive fluids, and are 
 practically completely absorbed. The solid parts 
 left consist almost entirely of indigestible remnants 
 
THE PHYSIOLOGY OF THE COLON 27 
 
 of foods, waste products excreted by the liver and 
 the intestinal mucous membrane and microbes which 
 are produced in great numbers in the lower part 
 of the small intestine as well as in the colon. 
 The small intestine is not only the seat of the 
 principal digestive processes, but is also the prin- 
 cipal organ of absorption of the digested foodstuffs. 
 The colon normally absorbs only about one-sixth of 
 the water which remains in the material received 
 from the small intestine, the amount of which is 
 estimated at about half a pint, and practically none 
 of the foodstuffs. The small intestine absorbs daily 
 five or six quarts of liquids and all the products of 
 digestion. It is, in fact, the one great avenue for 
 the intake of nutrients, both solid and liquid. 
 
 About four hours after a meal, bubbling and 
 squirting sounds may be distinctly heard when the 
 ear is placed over the right lower abdomen, and an 
 hour or two later it is easy to produce splashing 
 and gurgling sounds by intermittent pressure over 
 the colon low down in the right side of the abdo- 
 men, showing that a considerable amount of fluid 
 has passed from the small intestine into the cecum. 
 It should be remembered that this is not a mere 
 mechanical process. The fluid food does not pass by 
 gravity from the small bowel into the large intestine 
 as water might trickle from a pipe into a reservoir. 
 The opening of the small intestine into the colon is 
 controlled by a sphincter, the ileocecal valve. This 
 circular muscle holds the food in check in the lower 
 
28 COLON HYGIENE 
 
 part of the small intestine long enough to make 
 sure that digestion is complete and the absorption 
 of digested foodstuffs practically finished. In other 
 words, the ileocecal valve is a sort of second pylorus, 
 and serves much the same purpose. 
 
 The pylorus and ileocecal gates hold back solid 
 and imperfectly digested foodstuffs, permitting the 
 fluid portion to pass on. In the cecum and ascend- 
 ing colon the food is detained by a special process, so 
 that its fluid portion may be absorbed, thus increas- 
 ing the consistency of the bowel contents. Gradu- 
 ally a portion of the water is taken up by the absorb- 
 ents, which are very numerous in this part of the 
 colon, and at the same time the more solid portions 
 are pushed along toward the upper end of the as- 
 cending colon, the fluid part dropping back into the 
 cecal pouch for absorption. 
 
 Keith, the eminent English anatomist, has re- 
 cently pointed out new facts of great interest in re- 
 lation to the control of the movements of the ali- 
 mentary canal. Keith has shown that the muscular 
 structures of the intestine have the same property 
 of rhythmic action as is possessed by the muscle 
 fibres of the heart. This tendency to rhythmic 
 movement of the individual fibres is an organized, 
 orderly action of certain centers or nodes which are 
 designated as pace makers. These nodes have been 
 shown to exist at the following points along the 
 alimentary canal — the upper or cardiac orifice of 
 the stomach, the pylorus, the duodenum, the ileo- 
 
THE PHYSIOLOGY OF THE COLON 29 
 
 cecal valve, the transverse colon, the junction of the 
 pelvic colon, the rectum and the internal anal 
 sphincter. 
 
 Movements of the Colon 
 
 Like the stomach, the colon has movements pe- 
 culiar to itself, — four very distinct modes of con- 
 traction. These are: 
 
 1. Molding movements, by which the contents 
 are slowly compressed and molded. These move- 
 ments are almost too slow to be noticed by the 
 eye in X-Ray examinations except by observations 
 made at intervals of a half hour or more. 
 
 2. Propulsive movements, by which the colon 
 contents are passed along so rapidly that the eye 
 cannot follow the movement. Movements of this 
 sort occur regularly when the bowels are evacuated 
 and also at other times. 
 
 3. Snake-like movements. Roeder, of Germany, 
 has recently described movements in which the 
 transverse or free part of the colon moves about 
 in a manner closely resembling the contortions of a 
 serpent. From this he concludes that the position 
 of the transverse colon, unless it is held fast by 
 adhesions, is not a definite one and is not a matter 
 of much importance. 
 
 4. Reverse Peristalsis. Anti-peristalsis, that is, 
 a reverse movement of the intestine, was first 
 observed by Jacobi, more than twenty years ago, 
 and has more recently been studied in cats by Can- 
 
30 COLON HYGIENE 
 
 non. These movements occur systematically while 
 the contents of the cecum are fluid in character, and 
 serve both to prevent the sudden and frequent dis- 
 charge of the bowel contents, as in diarrhoea, and 
 also to churn the contents of the cecum, thus bring- 
 ing every portion in contact with the walls of the 
 gut, so that absorption may be assisted. 
 
 As studied in animals, by Cannon, and in human 
 beings by Case, the rhythmical reverse movements 
 which occur in the colon, never in the small intes- 
 tine, are interrupted at regular intervals by a down- 
 ward peristalsis. These downward movements 
 occur at intervals of about fifteen seconds. 
 
 The tight closure of the ileocecal valve alone 
 prevents the contents of the cecum from being 
 forced by these powerful anti-peristaltic waves 
 backward into the small intestine. At intervals the 
 anti-peristaltic waves cease momentarily, while the 
 ileocecal valve relaxes, and small portions of material 
 are passed into the cecum from the small intestine; 
 then the anti-peristaltic waves again begin, churn- 
 ing the liquid material, spreading it over the sur- 
 face of the cecum and ascending colon, thus encour- 
 aging absorption, while at the same time exerting 
 a pumping action upon the venous and lymphatic 
 vessels, so that the contents of the cecum are rapidly 
 dried down to the proper consistency. 
 
 It is very probable that the common practice of 
 resisting the "call" of Nature for evacuation, may 
 have produced abnormal conditions of the colon, 
 
THE PHYSIOLOGY OF THE COLON 31 
 
 by which its normal functions are obscured to a very 
 considerable degree. The theory of anti-peristalsis, 
 first suggested by O'Bierne, accords well with the 
 facts of clinical experience, and may now be recog- 
 nized as a fully established fact, especially since 
 anti-peristalsis has been actually observed in man 
 by Case on numerous occasions, in the X-ray de- 
 partment of the Battle Creek Sanitarium. 
 
 The Pelvic Colon 
 
 The pelvic loop of the colon, which, with the 
 iliac colon forms what was formerly known as the 
 sigmoid flexure, constitutes the motive part of the 
 mechanism by means of which the feces are dis- 
 charged from the body. This loop of intestine, 
 when empty, lies low down in the pelvis, the lower 
 end of the loop where it joins the rectum being 
 closed by a sharp fold. There may be a sphincter 
 at this point, although not in a state of constant 
 contraction. The loop fills from below as fecal 
 matters gradually and slowly enter it from above. 
 As it fills, the loop gradually rises, finally reaching a 
 point at which the valve opens, so that the feces 
 can enter the rectum. As the rectum walls become 
 distended by the accumulation of feces, the defecat- 
 ing center is stimulated; and powerful nerve im- 
 pulses are sent out, which cause the pelvic loop to 
 contract, thus compressing its contents just as one 
 compresses the contents of a rubber bulb by squeez- 
 ing it with the hand. The contraction of the pelvic 
 
32 COLON HYGIENE 
 
 loop is normally so vigorous and complete that it is 
 fully emptied of its contents. The contraction of 
 the descending colon at the same time is normally 
 sufficiently strong to carry the contents of the des- 
 cending and iliac colon into and through the pelvic 
 loop, so that the left half of the colon, from the 
 splenic flexure to the anus is emptied in normal 
 defecation. At the end of the contraction, the pelvic 
 loop, or at least the mucous lining of the loop at its 
 lower end, may be pushed down into the rectum 
 like a piston, thus ensuring complete emptying of 
 the rectum. The action of the pelvic colon thus 
 resembles that of a bulb and piston combined, the 
 upper part acting like a compressing bulb, while the 
 lower part serves as a piston, thus forming a sur- 
 prisingly effective mechanism for discharging the 
 body wastes. 
 
 Careful and long-continued observations of the 
 time required for the passage of food through the 
 different sections of the .alimentary canal, have se- 
 cured very definite and exact information upon this 
 very important subject, on which are based the fig- 
 ures given below. 
 
 The following table shows, according to Rosen- 
 heim, the time required for the food to reach the 
 more important of the stations along the alimen- 
 tary tube, reckoning from the time the food is 
 eaten, since it is known that food begins to pass 
 out of the pylorus very soon after the beginning 
 of a meal: 
 
THE PHYSIOLOGY OF THE COLON 33 
 
 The Digestive Time Table 
 
 Cecum 4 hrs. 
 
 Hepatic flexure 6 hrs. 
 
 Splenic flexure 8 hrs. 
 
 Iliac colon 9 hrs. 
 
 Pelvic colon 10 hrs. 
 
 Rectum 16 hrs. 
 
 Discharge of residues 18 hrs. 
 
 The X-ray shows that food often reaches the 
 ileocecal valve within half an hour after it is taken 
 into the mouth. It does not pass into the colon at 
 once, However, but accumulates in the lowest coils 
 of the ileum, which fmaily becomes distended to 
 such a degree that segmentation is set up, and by 
 this means the food is pushed forward into the 
 cecum. 
 
 The last of the food taken into the stomach 
 does not reach the colon until the end of about nine 
 hours from the time it is eaten. Thus, the entire 
 meal should reach the pelvic colon, according to 
 Rosenheim, at the end of about fourteen hours. 
 
 The delay of six hours in the pelvic colon seems 
 wholly unreasonable and unnecessary. If the food 
 can pass from the splenic flexure to the pelvic colon 
 in two hours (Rosenheim) it would seem that it 
 ought to be able to traverse the short pelvic loop 
 in the same length of time, or less. The processes of 
 digestion and absorption of digested products is 
 completed before the splenic flexure is reached. The 
 
34 COLON HYGIENE 
 
 descending colon, iliac and pelvic colon, and the 
 rectum, contain few absorbent vessels. The feces 
 are ready for discharge from the body; what pos- 
 sible benefit can result from their Longer retention? 
 Putrefaction processes are actively at work produc- 
 ing ptomaines and other toxins in quantity. By 
 absorption, these may become a source of enormous 
 and irreparable mischief. Why should not the un- 
 usable food remnants, the wastes and microbes 
 which constitute the fecal mass, be gotten rid of 
 as soon as possible when prepared for exit? Is it 
 not more than probable that the lower part of the 
 human intestine, which is most subject to the in- 
 fluence of voluntary interference, has been so long 
 abused, discouraged and hindered that it has become 
 abnormally slow and dilatory? 
 
 Evacuation of the Colon 
 
 The evacuation of the bowels is accomplished 
 by means of seven distinct actions, three of which 
 are voluntary and four automatic. Arranged in 
 the order of natural sequence, the following are 
 the several acts which together constitute normal 
 bowel movement. 
 
 1. Descent of the diaphragm and compression 
 of the bowels, accomplished by taking a deep 
 breath. 
 
 2. Voluntary contraction of the abdominal 
 muscles, increasing the compression. 
 
THE PHYSIOLOGY OF THE COLON 35 
 
 3. Pressure of the thighs against the abdominal 
 wall (natural position in moving the bowels is 
 not the upright sitting position, but a crouching 
 or squatting position universally employed by 
 savages and in some pioneer rural communities). 
 
 The result of these three voluntary efforts is to 
 force a portion of the contents of the pelvic colon 
 into the rectum, the distention of which gives rise 
 to stimulation of the defecation center of the sym- 
 pathetic nervous system by means of which the four 
 automatic movements in defecation are brought into 
 action, consisting of the following: 
 
 4. Reflex contraction of the abdominal muscles, 
 reinforcing the voluntary contraction. 
 
 5. Contraction of the colon ; the descending and 
 pelvic colons are chiefly active, though sometimes 
 the whole colon contracts. 
 
 6. Reflex relaxation of the anal sphincter, in 
 obedience to the general law which holds through- 
 out the entire digestive tube, by virtue of which 
 a wave of contraction passing along any portion of 
 the canal is immediately preceded by a wave of 
 relaxation. 
 
 7. Contraction of the levator ani, a structure 
 which surrounds the rectum and contracts at the 
 end of defecation for the purpose of forcing out 
 the last remnants of fecal matter, so that the rec- 
 tum may remain empty until another movement 
 occurs. 
 
36 COLON HYGIENE 
 
 There are really eight steps in the defecation 
 process, if we include the preliminary filling of 
 the pelvic colon with fecal matter. A disturbance 
 of any one of these eight factors in the process 
 of defecation may result in constipation. If the 
 diaphragm contracts insufficiently because of weak- 
 ness, tight lacing, adhesions or any other cause, or 
 if the abdominal muscles are weak, as is generally 
 the case among civilized people, and if the position 
 assumed in evacuating the bowels is such that the 
 abdominal walls are not compressed by the thighs, 
 the result may be that the rectum is not filled suffi- 
 ciently to stimulate the defecation center, and so 
 the reflex necessary to set in operation the automatic 
 movements which empty the bowel, will not be pro- 
 duced. 
 
 To be effective, the distention of the rectum 
 must be complete, and must be accomplished 
 quickly. If the rectum is allowed to fill grad- 
 ually, stimulation may not occur. If, on the other 
 hand, distention of the rectum, as evidenced by a 
 desire to move the bowels, is not relieved by going 
 to stool, the desire for movement gradually dis- 
 appears through the loss of sensibility of the rec- 
 tal nerves, and the reflex k lost. The nerves which 
 preside over reflex activities are easily exhausted 
 by continued stimulation. Human physiology af- 
 fords many examples of this principle. 
 
The Ileocecal Valve and Its 
 Function 
 
 This is an extremely interesting and important 
 anatomical structure, which, though known to 
 science for three hundred and fifty years, has re- 
 ceived almost no attention until very recently. The 
 ileocecal valve was discovered by Servius in 1563, 
 A. D. It has been described by numerous anatomists, 
 but was until recently regarded rather as an ana- 
 tomical curiosity with no very important function. 
 
 The ileocecal valve consists of two parts — a 
 sphincter muscle and a two-lipped check valve. 
 The sphincter is formed by a thickening of 
 the circular muscular fibres of the small intestine 
 at its junction with the colon. The check valve is 
 formed by an invagination of the small intestine 
 into the colon. Something of an idea of the struc- 
 ture of the valve may be formed from the illustra- 
 tion opposite page 142. 
 
 Action of the Ileocecal Sphincter 
 
 *" Recent observations of Cannon have clearly 
 demonstrated that the ileocecal sphincter acts in 
 a manner very similar to the pylorus, retaining the 
 foodstuffs in the small intestine until the digestive 
 
 *The paragraphs in quotation marks are extracts from a paper 
 by the author entitled, "Incompetency of the Ileocecal valve." 
 
 37 
 
38 COLON HYGIENE 
 
 work of the mid-gut is complete and the digested 
 foodstuffs have been absorbed. 
 
 "Within the last few years Holzknecht, 
 Schwartz, Groedel, Case, and numerous other 
 roentgenologists have clearly demonstrated the 
 functional activity of the ileocecal valve in control- 
 ling the movements of foodstuffs from the small 
 intestine into the colon. These observations estab- 
 lish the necessity of the ileocecal valve for the fol- 
 lowing purposes: 
 
 "1. To hold back the digesting material in the 
 small intestine until the digested portion has been 
 transformed by the several digestive juices, and ab- 
 sorbed. 
 
 "2. To pass the mixture of unusable food resi- 
 due's, mucous, bile, and other excretions from the 
 small intestine into the colon in small successive 
 doses, so as to give the colon, the chief function of 
 which is the absorption of water and the discharge 
 of unusable food residues and excreta, an opportun- 
 ity to deal with the successive portions of material 
 brought to it without being over-loaded. 
 
 "3. To prevent a reflux of material from the 
 colon into the small intestine, which is accomplished 
 by co-operation of the muscular sphincter of the 
 proximal side, and the mechanical action of the 
 membranous folds on the distal side of the ileocolic 
 junction. The importance of this function of the 
 ileocecal valve is greatly emphasized by the demon- 
 stration, by Cannon, Schwartz, Case, and others, of 
 
THE ILEOCECAL VALVE AND ITS FUNCTION 39 
 
 the existence of an anti-peristaltic action in the 
 proximal half of the colon. Cannon gives a most 
 graphic description of very powerful anti-peristaltic 
 waves (as seen in the cat) beginning at about the 
 middle of the transverse colon and passing rapidly 
 backward along the colon to the cecum, compress- 
 ing the liquid contents of the cecum so strongly as 
 to cause a backward rush through the advancing 
 ring of constriction. Case has confirmed these* ob- 
 servations in the human subject in many cases." 
 
Normal Bowel Action 
 
 There is perhaps no important bodily function 
 so much neglected, and with such damaging results, 
 as defecation or bowel movement. This function is 
 too often looked upon as a humiliating act that 
 must be secreted and avoided whenever possible, 
 and that may properly be postponed to suit the 
 exigencies of business or pleasure. The "call" of 
 Nature for evacuation of the bowels is habitually 
 ignored or resisted by children and adults alike, 
 until it can no longer be suppressed, or until it 
 disappears. 
 
 This wrong attitude toward one of the most 
 important functions of the body is in large part 
 responsible for the almost universal existence of 
 constipation among civilized people, and of wide- 
 spread and most appalling evil consequences, as we 
 shall make clear in a subsequent chapter. 
 
 Ignorance of physiology, i and especially of the 
 physiology of digestion and nutrition, is doubtless 
 the cause of this widespread evil. It is the duty of 
 every physician and every trained nurse to do all 
 possible toward the enlightenment of the chronically 
 sick with whom they come in contact in relation to 
 the absolute necessity for frequent and complete 
 bowel action. 
 
 This is a subject which is too commonly tabooed 
 by a false modesty that is entirely out of place. 
 
 40 
 
NORMAL BOWEL ACTION 41 
 
 'Mothers and school teachers especially should give 
 the matter special consideration. They should make 
 sure that each child under their supervision has 
 formed and maintains correct and regular habits 
 in relation to evacuation of the bowels. 
 
 The Mechanism of Defecation 
 
 Until very recent times the process by which 
 the colon discharges its contents was one of the 
 most obscure in physiology. The discovery of the 
 X-ray and of a method of examination by which 
 the contents of the stomach and intestines could be 
 made to cast a shadow on the fluorescent screen 
 or upon a photographic plate, has thrown a flood 
 of light upon this extremely interesting and prac- 
 tical question. 
 
 As already remarked, the process of defecation 
 involves seven distinct acts. , Three of these are 
 under voluntary control, the other four being con- 
 trolled by a special center known as the "center 
 of defecation," located at the extreme lower end of 
 the spinal cord. 
 
 The act of defecation is called forth by a sensa- 
 tion of fulness in the lower part of the colon. In 
 a state of health we ordinarily perceive sensation 
 only near the extremities of the alimentary canal. 
 At the upper end of the food tube, guarding 
 the entrance to the esophagus, there is located a 
 reflex that controls the intake of food and liquids. 
 
42 COLON HYGIENE 
 
 There are nerves in the mucous membrane at the 
 back of the throat that, when stimulated by the con- 
 tact of foods or liquids, give rise to the swallowing 
 movement in which the esophagus opens and food 
 or liquid present in the throat is drawn in by a 
 strong suction movement. The act of swallowing is 
 impossible without the contact of something that 
 may be swallowed. 
 
 At the other end of the food tube, within a few 
 inches of the anus — that is, at the upper part of 
 the rectum — are found nerves that, when stimulated 
 by the contact of fecal matters, give rise to a pe- 
 culiar sensation recognized as a warning that the 
 bowel contents should be discharged from the body. 
 
 The "Call" 
 
 Natural bowel movement is preceded by sensa- 
 tions which clearly indicate the necessity for evacu- 
 ation of the bowels. The mechanism of this instinct- 
 ive notification of the necessity for giving atten- 
 tion to the needs of the body is very interesting. 
 We have already learned that the colon is sub- 
 divided into four separate compartments and that 
 the feces are dealt with by each of these in succes- 
 sion. In the cecum the consistency of the feces is 
 increased to such a degree that the mass can be 
 handled by the muscular wall of the bowel. The 
 ascending colon pushes the feces through the hepatic 
 flexure into the transverse colon. In this horizon- 
 
NORMAL BOWEL ACTION 43 
 
 tal portion of the canal the feces rest for a time 
 for further extraction of water. From the trans- 
 verse colon the feces are pushed up the incline 
 to the splenic flexure, and through this narrow 
 gateway into the descending colon, along which, in 
 the course of an hour or two, it finds its way to 
 the capacious loop of the pelvic colon, through 
 which it passes quickly to the lower end. Here its 
 further progress is arrested by the tightly folded 
 canal, just as a current of water through a rubber 
 tube may be controlled by a sharp bend in the tube. 
 
 The pelvic loop gradually fills, and in filling 
 is raised until the bowel is unfolded and thus 
 opened. Now, unless the feces have been so long 
 retained that they have become hard and dry, the 
 bowel contents are pushed on into the rectum. 
 
 Up to this point the progress of the food material 
 after leaving the mouth, during its passage through 
 the long food canal, has been unattended by any 
 sensation whatever. The process has been wholly 
 automatic, and, though controlled in a way show- 
 ing marvelous intelligence, wholly independent of 
 the consciousness. But now there is felt an un- 
 pleasant sense of weight in the region of the rectum. 
 This sensation increases as the rectum becomes 
 fuller, and there is a more or less urgent desire to 
 evacuate the bowels. 
 
 This is the "call" of Nature for bowel move- 
 ment, evoked by the contact of the feces with the 
 nerves of the rectum and distention of its walls. 
 
44 COLON HYGIENE 
 
 The fuller the rectum becomes, the more pressing 
 is the desire for evacuation. The "call" appears 
 only when the feces have reached the rectum. 
 
 It will now be easily seen how the "call" and 
 the bowel movement may be directly influenced by 
 numerous factors. Let us briefly notice some of the 
 most important of these, which will be discussed 
 more fully in a later chapter. 
 
 If the food taken is insufficient in bulk, the 
 pelvic loop will be only partly filled, and hence 
 will not rise high enough to permit the feces to pass 
 into the rectum, and hence there will be no "call" 
 and no movement. It is evident, also, that if the 
 amount of food taken is small, the pelvic loop may 
 be so long a time in filling that the feces which first 
 entered, will become so dry and compact that they 
 may form a mechanical obstruction, and thus the 
 onward movement necessary to reach the rectum 
 will be prevented, even though the bowel may rise, 
 and the gate which guards the entrance to the 
 rectum may be open. In starvation, no "call" 
 appears because there is nothing with which to fill 
 the loop and open the rectal gate. 
 
 Bodily movement has a certain amount of influ- 
 ence upon the position of the loop and the entrance 
 of feces into the rectum, especially deep breathing 
 exercises, and bodily exercises which produce deep 
 breathing. In deep breathing, the diaphragm is 
 pushed down upon the abdominal viscera, compress- 
 ing the colon as well as other parts against the ab- 
 
NORMAL BOWEL ACTION 45 
 
 dominal wall. By this means the feces in the loop 
 may be pushed through the fold into the rectum, 
 thus evoking a "call." 
 
 The increased depth of breathing and the com- 
 pression of the abdomen resulting from movement 
 when one first awakens in the morning are no doubt 
 the reasons why many persons experience a "call" 
 almost immediately upon awakening after a full 
 night's rest. During sleep the pelvic loop has been 
 quietly filling and rising, but the pressure has not 
 been quite sufficient to cause the feces to pass into 
 the rectum. A push from the diaphragm and the 
 abdominal muscles gives the little extra help needed 
 and the "call" comes. 
 
 By straining movements, such as accompany 
 bowel evacuation, sufficient fecal matter may be 
 pushed over into the rectum to create an effective 
 "call," when not previously felt. Hence the import- 
 ance of going regularly to stool even though no 
 "call" is experienced. 
 
 A cold morning bath helps in the same direction, 
 both by causing deep respiratory movements, which 
 increase the intra-abdominal pressure, and by caus- 
 ing a reflex contraction of the colon. 
 
 These facts are mentioned here in order to bring 
 the explanation of the "call" within the range of 
 common every-day experience, and to show its very 
 important bearing upon the practical management 
 of cases of constipation. 
 
 The act of swallowing a glass of water, espec- 
 
46 COLON HYGIENE 
 
 ially the drinking of cold water, and above all other 
 things the taking of food, by setting up peristaltic 
 movements may produce a "call," provided there 
 is at the time a quantity of feces in the pelvic loop. 
 If the loop is empty, food taking or anything else 
 which sets up intestinal peristalsis will serve to 
 help the feces along toward the pelvic colon, thus 
 leading to a "call" a little later. The immediate 
 effect of any such stimuli will of course depend 
 upon the position of the fecal mass in the colon. 
 If, for example, there is slight delay at the hepatic 
 flexure, perhaps as the result of neglect of usual 
 exercise or spending a day in bed, the use of meas- 
 ures to promote intestinal action may seem to pro- 
 duce no effect, whereas a bowel movement the next 
 morning may be the result of the impulse given 
 to the fecal mass by means of which the stagnation 
 in the ascending colon was overcome. 
 
 The Lost "Call" 
 
 The "call" to bowel movement is like the call 
 of the alarm clock set to awaken one in the morn- 
 ing. If not responded to, it soon ceases to be 
 heard. It is like the voice of conscience, which may 
 be wholly stifled by continued disregard. This is 
 only the operation of a general biologic law. A con- 
 tinuous sensation which is ignored, by and by fades 
 out of the consciousness. For example, the cloth- 
 ing gives rise to no sensation unless adjusted in 
 
NORMAL BOWEL ACTION 47 
 
 some unusual fashion, although in contact with 
 almost the entire cutaneous surface. We are un- 
 conscious of gloves or shoes, although our hands 
 or feet may be tightly compressed. So, if the "call" 
 evoked by the pressure of feces upon the nerves of 
 the rectum is not responded to, after the lapse of a 
 certain time the "call" is no longer heard. A mass 
 of feces may lie in the rectum, but it produces 
 no sensation. The writer has many times found 
 large fecal masses in the rectum of which the pa- 
 tient was wholly unconscious, although in some 
 instances there was evidence that they had been 
 present in the lower bowel for days or even weeks. 
 The first time a "call" is disregarded it will 
 return again when additional fecal matter is pushed 
 down from the pelvic colon by the stimulus of the 
 next meal, or as the result of some other influence 
 which excites intestinal action or increases intra- 
 abdominal tension. After having been disregarded 
 or resisted many times, however, the "call" becomes 
 less and less distinct, and by and by ceases entirely. 
 The rectal nerves have lost their normal sensibility. 
 They do not respond to the irritation produced by 
 the contact of fecal matters, but have acquired a 
 tolerance for such contact, just as the nerves of 
 taste may become accustomed to contact with hot 
 spices, so that they no longer cause any disagreeable 
 sensation, or the skin may cease to react to a mustard 
 plaster, so that a stronger irritant, as croton oil or 
 a hot irois. must be required to produce a blister. 
 
43 COLON HYGIENE 
 
 This condition of lost sensibility is one of the 
 most common causes of constipation, and a condition 
 which is sometimes very difficult to remove, although 
 always conquerable by persevering effort, thanks 
 to the great light thrown upon these cases by mod- 
 ern medical research. 
 
 To lose one's "call" is almost as bad as to lose a 
 fortune; indeed such a loss has more than once led 
 to loss of fortune, and to worse results. A "call" 
 that has been lost must be most assiduously sought 
 for until recovered, and put into efficient operation. 
 The methods for accomplishing this will be de- 
 scribed at length in a later chapter. 
 
 Why Do the Bowels Move Periodically? 
 
 There are two factors which are chiefly active 
 in producing bowel movements in normal individ- 
 uals. The first is the practice of taking food only 
 at stated intervals, regular meal hours. The sec- 
 ond is regularity in the hours of sleep and morning 
 rising. The omission of a meal, or a change in 
 the hours of meals or of sleep will at once change 
 or destroy the rhythm of bowel movements. Ani- 
 mals that eat continuously, as monkeys and barn- 
 yard fowls, have bowel movement many times a day. 
 
 The taking of food is the most active of all 
 natural excitants of bowel action. When food is 
 taken into the stomach, it produces powerful peris- 
 taltic waves which traverse the whole length of the 
 
NORMAL BOWEL ACTION 49 
 
 intestine and carry the intestinal contents forward 
 at a rate several times faster than the ordinary rate 
 of progression; the larger the meal, and the more it 
 is relished, the more pronounced is this effect. This 
 explains the almost universal experience that the 
 bowels move most freely and regularly soon after 
 the morning meal. 
 
 On rising in the morning after a full night's 
 sleep, so long a time has elapsed since the last bowel 
 movement that the feces have accumulated in the 
 pelvic loop and the descending colon, and it is only 
 necessary that sufficient stimulus should be applied 
 to cause feces to enter the rectum, and a "call" 
 and bowel movement will follow. The act of ris- 
 ing, sometimes the mere awakening and the accom- 
 panying turning and stretching movements, are 
 often sufficient to accomplish this. During sleep, 
 the intestinal movements are slowed. The progress 
 of the intestinal contents along the canal is at a 
 much slower rate than during the waking hours. 
 This is easily shown by X-ray observations after 
 a bismuth meal. At the moment of awakening, 
 all the bodily movements are quickened. The heart 
 beats faster, the force of the breathing is increased, 
 and the whole vital machine feels the impulse of 
 quickened energies. If the pelvic colon has been 
 slowly filling during the night, the various influences 
 which are brought into play at the moment of 
 awakening will be likely to cause the passage of a 
 sufficient quantity of feces from the pelvic loop 
 
50 COLON HYGIENE 
 
 into the colon to produce a "call" and an evacu- 
 ation. 
 
 Regularity of bowel movement is of the utmost 
 importance. It is a function which should be assidu- 
 ously cultivated. As we have seen, the periodicity 
 of alvine evacuation is not the result of any 
 mysterious influence, but is a product of forces 
 which are largely in our own control and are easily 
 understood. 
 
The Feces 
 
 The composition of the colon contents, the feces, 
 is very complicated and highly variable, depend- 
 ing very largely upon the character of the food. 
 The bowel discharges of the nursing infant consist 
 of fragments of undigested curds, fat, bile and a 
 small amount of mucus. The odor of a healthy 
 infant's stool is slightly acid, and yellowish in color. 
 The stool of an adult who subsists upon an ordi- 
 nary mixed diet contains a considerable amount of 
 food residues, seeds and skins of fruit, cellulose 
 from vegetables, and such whole-grain cereals as 
 oat-meal and cracked wheat, and also contains one 
 or two per cent of starch, about the same amount 
 of fat, and three or four per cent of protein. Sugar 
 is not present. The color is usually dark brown, 
 often black, and the odor putrid. The form varies 
 to a marked degree. 
 
 The stools of a person who subsists on a nat- 
 ural non-flesh diet closely resemble those of a healthy 
 infant. The odor is not putrid, but may be slightly 
 sour. 
 
 Strassburger has shown that about half the 
 solids of fecal matter is made up of bacteria. 
 When the stools are putrid it is because of the domi- 
 nance of the special bacteria which give rise to putre- 
 faction. In sour smelling stools, however, the bac- 
 teria present are chiefly those of the sort which cause 
 
 51 
 
52 COLON HYGIENE 
 
 fermentation and give rise to acid. The sour odor Is 
 due to the presence of acetic acid, which is more or 
 less volatile at low temperatures, Lactic acid is also 
 present. As it is non-volatile, its presence is shown 
 only by chemical tests, not by the odor. 
 
 The general belief that the feces or stools con- 
 sist chiefly of the unusable remains of foodstuffs is 
 entirely erroneous. As a matter of fact, even under 
 the most unfavorable conditions, the feces contain 
 really very little food material. 
 
 Composition of the Feces 
 
 The chief constituents of the feces are as follows : 
 Bile, remains of digestive juices, especially of the 
 pancreatic juice, mucus, excretory substances thrown 
 off by the intestinal mucous membrane, microbes 
 and various poisons produced by microbes, such as 
 indol, skatol, pyrrol, and numerous other poisons, 
 together with some small amounts of the various 
 food principles, and water. 
 
 The composition of the stool varies greatly 
 according as the diet contains much or little of 
 vegetables. On a vegetable diet the feces contain 
 much cellulose, and with the cellulose are increased 
 quantities of undigested protein and starch. The 
 amount of fat does not vary much, and sugar is 
 never present. 
 
THE FECES 53 
 
 Quantity 
 
 The weight of feces varies very much with the 
 diet, increasing with a vegetable diet, and diminish- 
 ing with a diet composed chiefly of animal substances. 
 Food which contains much cellulose passes through 
 the intestine much more quickly than does animal 
 food, and hence contains more water and undigested 
 food principles. The total weight of the feces for 
 twenty-four hours with a mixed diet is about five 
 ounces, of which three-fourths is water. With a 
 vegetable diet the weight is double, the proportion 
 of solid matter being slightly greater. 
 
 The Microbes of the Intestine 
 
 The reaction of the feces is neutral or slightly 
 acid on a vegetable diet, and strongly alkaline on a 
 flesh or mixed diet. This difference in reaction is 
 due to the diiference in the flora or species of bac- 
 teria which are present. Feces that are rich in 
 protein, the result of a mixed or flesh diet, contain 
 enormous quantities of putrefactive bacteria, which 
 produce alkaline substances in decomposing the 
 proteins — ammonia, ptomaines, and various toxins. 
 When considerable quantities of starch are present, 
 as with a vegetable diet, with very little protein, 
 acid-forming bacteria are dominant, and hence the 
 feces have an acid or neutral reaction. 
 
 This difference in reaction is one of the most 
 important of all the various characteristics of the 
 
54 COLON HYGIENE 
 
 feces, since it suggests at once the general character 
 of the flora, and thus points to the toxic or non- 
 toxic character of the stool. 
 
 Roger calls attention to more than one hundred 
 and sixty different species of bacteria which have 
 been found in the feces. Of these, more than one- 
 third were found to possess pathogenic or disease- 
 producing properties. Distaso points out more than 
 twenty species of putrefactive bacteria which are 
 found in the stools of flesh eaters, all of which pro- 
 duce very highly toxic products. One of the most 
 common and abundant of these is the Bacillus of 
 Welch, which produces enormous quantities of 
 offensive gas and highly active poisons. This 
 microbe, as well as the other putrefactive organisms 
 which are found in the feces, is found in an active 
 growing condition in butcher's meat and fresh flesh 
 foods of all sorts, as well as salted and dried fish. 
 This is doubtless the chief source of the dangerous 
 bacteria which carry on in the body the same putre- 
 factive processes to which they give rise outside 
 of the body. 
 
 The number of these microbes in the feces is 
 something prodigious. They often constitute from 
 one-third to one-half the total weight of dried feces. 
 Strassburger estimates the weight of the microbes 
 produced in the intestines in a single day at not less 
 than one-quarter of an ounce, and the number more 
 than one hundred trillions, of which a large propor- 
 tion may be poison-forming organisms. Only a small 
 
THE FECES 55 
 
 share of the bacteria are found alive in the feces (one 
 per cent, according to Strassburger), but all have 
 been alive and have each produced its portion of 
 poisonous substances in breaking up the protein upon 
 which it feeds. 
 
 The study of these bacteria is one of the most 
 important fields of research at present before the 
 bacteriologist, for it has been clearly shown that 
 the condition of the flora of the intestine is one of 
 the most important of all factors in determining 
 health or disease, long or short life. Of this subject 
 we shall learn more in a subsequent chapter. 
 
 Excretory Products 
 
 Not the least important constituents of the feces 
 are the waste products which they contain, a fact 
 quite too often overlooked. The mucous membrane 
 of the intestine, like the skin, is an excretory organ. 
 Although the extent of the intestinal mucus cov- 
 ering is only seven square feet, about one-third of 
 that of the skin, there is reason for believing 
 that its importance as an outlet is fully as great 
 as that of the skin, and probably much greater. This 
 fact has only recently been made known. By the 
 researches of Roger and others, it has been shown 
 that the mucous membrane removes from the body 
 some of the most deadly poisons which are produced 
 in our tissues, or which may be introduced from 
 without. If, for example, a quarter of a grain of 
 
56 COLON HYGIENE 
 
 morphia is injected underneath the skin of a person, 
 a large part of the poison will be found in the 
 stomach and intestine within a half hour. This ex- 
 cretion of poisons appears in the light of these new 
 researches to be one of the important offices of the 
 stomach. 
 
 Lime salts which are no longer needed in the body 
 are excreted through the intestine. 
 
 The bile poured into the intestine contains some 
 of the most deadly poisons produced in the body, 
 Bouchard found the bile to be six times as toxic as 
 the urine. 
 
 Examination of the Stools 
 
 When a doctor is called to see a sick infant, he 
 first of all inquires as to the bowel passages, and 
 the experienced nurse or mother always preserves 
 the infant's napkins to show to the doctor when he 
 comes. If the bowel passages have the usual con- 
 sistency and yellowish color and a slightly acid odor, 
 the doctor knows that there is no serious disturb- 
 ance of digestion; but if the stools are dark or 
 brownish in color and have a foul or putrid odor, 
 this fact alone is sufficient to show to the physician 
 or experienced nurse that the infant is sick. Any 
 physician who would omit to examine the stools of 
 an infant when called in consultation, would be 
 regarded either as ignorant or as quite remiss in his 
 duty. 
 
THE FECES 57 
 
 It is very strange indeed that until quite recently 
 almost no attention has been given to the stools of 
 adults, and even at the present time physicians quite 
 rarely take the trouble to make anything like a 
 thorough investigation of bowel passages. The doc- 
 tor usually contents himself by inquiring if the 
 bowels move regularly. When questioned concern- 
 ing the character of their stools, most patients are 
 unable to give any information. Something can be 
 learned from the general appearance of the stools, 
 but for really useful information it is necessary to 
 submit a specimen to a thorough laboratory investi- 
 gation at the hands of an expert in this particular 
 line of research. 
 
 It is not going too far to say that a thorough 
 examination of the stools should be made in every 
 case of chronic disease. This practice has already 
 been instituted in a few medical institutions where 
 a high degree of medical work is done, and the time 
 cannot be far distant when such an examination will 
 be a routine practice with all physicians who attempt 
 to keep abreast with the advance of medical science. 
 
Influences Which Excite Move- 
 ments of the Colon 
 
 The food tube is controlled by two sets of nerves. 
 One, the motor, excites contractions of the intes- 
 tine, while the other opposes this action, causing 
 cessation of movement and relaxation of the intes- 
 tine. The motor nerves are derived from the brain 
 and spinal cord ; those of the second class, known as 
 splanchnic nerves, from the sympathetic. 
 
 A very remarkable and interesting fact relating 
 to the action of these nerves should be mentioned 
 here as an aid to a full understanding of their action. 
 When the motor nerves of the intestine are stimu- 
 lated, they cause powerful contraction of both the 
 intestine and the abdominal walls, but relaxation of 
 both the internal and external anal sphincters. 
 When the sympathetic or splanchnic nerves of the 
 intestine are stimulated, they cause relaxation of 
 the intestines, with cessation of movement, and at 
 the same time strong contraction of the ileocecal 
 sphincter. These two facts explain many important 
 phenomena in relation to bowel movement and con- 
 stipation. 
 
 The relaxation of the anal sphincters when the 
 colon and abdominal muscles contract, is necessary 
 to facilitate the discharge of feces from the bowels. 
 This fact wholly agrees with the interesting obser- 
 
 58 
 
INFLUENCES WHICH EXCITE MOVEMENTS 59 
 
 vations of Bayliss and Starling, that mechanical 
 excitation of the intestine causes contraction at and 
 above the point of irritation, and relaxation below, 
 a most beneficent and wonderful adaptation of 
 means to ends. 
 
 One more important fact is especially worthy of 
 note in this connection, viz., that the intestine is sup- 
 plied with nerve ganglia of its own, located within 
 its walls, between its two layers of muscles, so that 
 it may act even when all cerebro-spinal and sympa- 
 thetic nerves are cut in experiment or paralyzed in 
 disease. A small bit of stomach or intestine removed 
 from a living animal, when stimulated by electricity 
 does not contract in continuous spasm as do ordinary 
 muscles, but contracts rhythmically, as does the 
 heart and other involuntary muscles. This is true, 
 however, only when the nerve ganglia are removed 
 with the muscle tissue. 
 
 The Bile 
 
 The bile is a normal stimulant to the colon, but 
 for some curious reason does not act upon the small 
 intestine. This seems unfortunate, for there is an 
 increasing volume of evidence that in some of the 
 most obstinate forms of constipation the chief cause 
 of trouble is located in the small intestine. Possibly 
 the biliary secretion of the degenerate modern civil- 
 ized man has lost something of its original value as 
 a laxative. The best proof of the laxative property 
 
60 COLON HYGIENE 
 
 of the bile is found in the remarkable colon-stimu- 
 lating properties of "bilen," an extract prepared 
 from the bile, which when introduced into the rec- 
 tum often produces active peristalsis within a few 
 minutes, with vigorous bowel movement. 
 
 A recent discovery has shown that the spleen also 
 produces a substance which powerfully stimulates 
 the intestinal peristalsis. This substance, however, 
 acts upon both the small and the large intestine. 
 
 Another remarkable substance, pituita, produced 
 by a small gland in the brain, the pituitary body, is 
 a most powerful stimulant to the entire intestinal 
 tract. 
 
 It seems hardly necessary to devote space to em- 
 phasizing the importance of so guarding the interests 
 of the liver and spleen as to receive constantly the 
 full benefit of the powerful aid these organs are 
 capable of giving to the muscular movements of the 
 alimentary canal. 
 
 The intestine has two special senses, the muscular 
 sense, which it possesses in a very high degree, and 
 a fine tactile sense located in its mucous lining. 
 The muscular sense is excited by distension of the 
 intestine, which causes tension of its muscular walls. 
 
 The Influence of Bulk 
 
 In operations upon the stomach and intestines, 
 the influence of mechanical stimulation is often seen. 
 Slight pressure upon the wall of the stomach or of 
 
INFLUENCES WHICH EXCITE MOVEMENTS 61 
 
 the intestine is sufficient to set up a contraction 
 which follows in a few seconds. Contraction of 
 the intestine, as shown by Bayliss and Starling, is 
 accompanied by dilatation of the intestine lower 
 down, so that room may be made for the material 
 that is being pushed along. Contact of the food 
 with the interior of the intestine produces like ef- 
 fects. The greater the bulk of the food, the greater 
 the effect. As shown by Cannon, segmentation, a 
 most effective means of food propulsion, becomes 
 really active only when the bowel is distended. 
 
 All foods which are completely digested and ab- 
 sorbed by the intestine, leaving little or no residue, 
 discourage peristalsis. This is the reason why rice, 
 boiled milk, and fine flour bread have become gener- 
 ally known as constipating foods. These foods are 
 not actively constipating; they simply do not leave 
 sufficient indigestible residue to afford the necessary 
 mechanical stimulation of the intestine. 
 
 In general, all animal foods encourage consti- 
 pation, for the reason that they are completely 
 soluble in the digestive fluids. Hair, feathers and 
 bones are almost the only animal tissues not capable 
 of complete solution in the digestive juices. It is 
 in part for this reason that carnivorous animals usu- 
 ally eat bones with the flesh on which they feed ; 
 the bones are of course necessary also for the lime 
 which they contain, and which is almost wholly 
 lacking in the soft tissues of animals. Most carniv- 
 orous animals also eat more or less vegetable food. 
 
62 COLON HYGIENE 
 
 Cats and dogs often nibble grass, and special weeds, 
 of which they appear to be extremely fond. Fowls 
 swallow feathers and sand. Horses sicken when 
 fed on corn alone. They must have a liberal supply 
 of coarser material. A Maine ship captain saved a 
 cargo of mules, when the supply of hay was swept 
 overboard, by feeding them shavings made by the 
 ship carpenters. A number of horses in the cargo 
 refused to eat the shavings and died. In England, 
 when the price of grain is high, the farmers feed 
 their stock on treacle, which is exceedingly cheap, 
 combined with wood sawdust, and with good results. 
 The animals readily fatten on this diet, and remain 
 in good health. 
 
 Most primitive people recognize the need of bulk 
 co maintain healthy action of the alimentary canal. 
 The Japanese and Chinese make large use of 
 various seaweeds. One of these under the name of 
 agar-agar has come to be well known in this country. 
 
 Agar-agar is prepared from a sea-weed that grows 
 on the coast of Japan and Ceylon. It is sometimes 
 known in commerce as Ceylon moss. It is also 
 known as Japanese isinglass or vegetable gelatine, 
 It does not, however, have the composition of gela- 
 tine. Its composition is practically identical with 
 cellulose. It is almost wholly indigestible in the 
 human alimentary canal. The commercial product 
 is prepared by cooking the seaweed with much 
 water in large kettles, then cooling the solution, and 
 passing it through colanders by which it is formed 
 
INFLUENCES WHICH EXCITE MOVEMENTS 63 
 
 into long strings. These are dried in the sun, and 
 then bleached in the sun and dew for several weeks. 
 This material is brought to the United States in 
 large bales. In its commercial form, as it is obtain- 
 able at many drug stores, agar-agar is hardly fit to 
 be placed in the stomach. It needs to be thoroughly 
 washed and disinfected by peroxide of hydrogen or 
 some other efficient means. It is also very tough and 
 inedible. 
 
 Mr. George Kennan, the celebrated Siberian 
 traveler, stated to the writer that the Eskimos eat 
 half digested reindeer moss as a remedy for and pre- 
 ventive of constipation. The moss is obtained by 
 killing the reindeer at a certain time after feeding, 
 removing the moss from the stomach, and submit- 
 ting it to a very slight and simple preparation. 
 
 The natives of Japan and China eat quantities 
 of dried raw turnip, bamboo sprouts, lily flowers 
 and roots and other vegetables with the rice which 
 forms the staple food of these people. 
 
 The Alaska Indians gather and dry a seaweed, 
 which they eat at all seasons as a laxative. 
 
 A missionary nurse working among the Alaska 
 Indians, sent us a few years ago a sample of the 
 seaweed which is used in its native state by these 
 people to prevent the constipation which would nat- 
 urally result from the nearly exclusive fish diet on 
 which these Indians are compelled to subsist at 
 certain seasons of the year. The sea-weed is simply 
 gathered and dried in the sun and pressed into large 
 
64 COLON HYGIENE 
 
 flat cakes between flat stones. The material thus 
 prepared is very black in color but is crisp and not 
 unpleasant in flavor. 
 
 The Hopi Indian makes a good laxative food by 
 grinding up in a stone mortar the whole nut of the 
 pinon, including the shell. 
 
 The Highland Scotchman escapes the constipa- 
 tion which would otherwise result from his diet of 
 buttermilk, oatmeal and potatoes, by eating his brose 
 (oatmeal) in a half raw state. 
 
 The wild Arab supplements his diet of camel's 
 milk and dates with wheat ground in a stone mill, 
 which supplies all the cellulose of the bran, with the 
 addition of a certain amount of pulverized stone. 
 
 The Orinoco Indians and the poor whites of the 
 Tennessee Mountains combat constipation by eating 
 considerable quantities of clay, as do horses and 
 other animals when fed on a too concentrated diet. 
 
 The desire for bulk} 7- green things, which afford 
 much bulk with little nourishment, that almost 
 every one experiences in the early spring time, when 
 the oncoming heat reduces the bulk of the food by 
 lessening the appetite, is an instinctive prompting 
 which cannot be disregarded without injury. 
 
 A western pioneer, who was shut up in the moun- 
 tains of the Coast Range by an early fall of snow, 
 and confined for three months with several com- 
 panions and a number of mules with no food but 
 corn meal, escaped without injury, although his 
 associates all suffered extremely from scurvy, by fol- 
 
INFLUENCES WHICH EXCITE MOVEMENTS 65 
 
 lowing the example of the mules, who dug tunnels 
 in the fifteen-foot snow drifts and ate the grass hid- 
 den underneath. 
 
 A diet consisting largely of meat, eggs, milk, cane 
 sugar and fine flour bread, leaves little or no residue 
 to act as a stimulus to the intestinal muscles. The 
 free use of greens and salads of lettuce, cabbage and 
 other uncooked foods fresh from the garden is essen- 
 tial to healthy intestinal activity. 
 
 The Sugars 
 
 Other elements of the food besides bulk, exert a 
 marked influence upon the activity of the digestive 
 organs. All the sugars stimulate intestinal activity. 
 Roger thinks this action is confined to the small 
 intestine, but in this he is in error, for every abdom- 
 inal surgeon knows the remarkable laxative effects 
 of an enema consisting of a half pint of molasses with 
 an equal amount of hot water. 
 
 Cane sugar is undesirable, however, because of 
 its irritating effects. The sugars of fruits — levu- 
 lose and dextrose — are wholesome and efficient. The 
 malt sugar produced by the action of the saliva upon 
 starch is of great service as a stimulant of gastric and 
 intestinal activity. Many mothers know of the 
 laxative effect of milk sugar added to the infant's 
 food. Malt sugar is better, because free from germs, 
 and more native to the body than the sugar of cow's 
 milk. 
 
66 COLON HYGIENE 
 
 Malt sugar, as shown by recent experiments, is 
 absorbed in one-fourth the time required for milk 
 sugar. 
 
 Fruit and Vegetable Acids 
 
 The acids of fruits and vegetables — citric, malic, 
 and tartaric, — are excellent laxatives. This is, in 
 part at least, the explanation of the good effects of 
 an orange taken at night or before breakfast. All 
 acid fruits are laxative. The tomato, a vegetable 
 fruit, is a most excellent stimulant of intestinal 
 action, chiefly through its citric acid. When possible, 
 the tomato as well as other acid fruits should be 
 eaten raw, to obtain the best effects. 
 
 Lactic and acetic acids developed in the intes- 
 tines by the growth of harmless acid-forming bac- 
 teria, are a powerful stimulant of intestinal action. 
 A. Schmidt of Halle, Germany, has demonstrated 
 that these acids are the normal stimulants of the 
 colon. When they are present in sufficient amount, 
 bowel activity is normal. Putrefaction produces an 
 alkaline condition in the colon which has a paralyz- 
 ing effect upon the intestinal movements. Sour milk 
 and buttermilk produce a decided laxative effect in 
 many persons, especially in children. 
 
 Fats 
 
 Oils and fats stimulate intestinal action. Not 
 only fats themselves, but the glycerine and soaps 
 
INFLUENCES WHICH EXCITE MOVEMENTS 67 
 
 which are formed by the digestion or decomposition 
 of fats in the intestine, are very active stimulants 
 of intestinal movements. 
 
 Mineral oil — white Russian paraffin oil — being 
 indigestible and unabsorbable, is a very powerful 
 stimulant of intestinal activity. It adds to the bulk 
 of the food, lubricates the food canal, hinders the 
 excessive absorption of water, and keeps the bowel 
 contents moist. 
 
 Gases 
 
 The carbonic acid gas and other gases formed in 
 the intestine by the fermentation of starch, cellulose, 
 and other foodstuffs are powerful stimulants to the 
 muscular activity of the bowel. When present in 
 excess, gases cause spasm of the circular muscles of 
 the intestine, with sharp colic pains. 
 
 Eating 
 
 The taking of food into the stomach is by far 
 the most powerful of all the natural stimulants of 
 the intestine. Very soon after food enters the mouth, 
 peristaltic movements begin in the stomach, and 
 quickly extend the whole length of the food canal. 
 This is the reason for the desire to evacuate the 
 bowels which most people experience soon after eat- 
 ing breakfast. The peristaltic waves set up carry 
 the feces down into the rectum, and this produces 
 the sensation which indicates the necessity for evacu- 
 ation. 
 
68 COLON HYGIENE 
 
 It has been shown that even the smell of agree- 
 able food is sufficient to cause increased intestinal 
 activity. The act of swallowing also excites intes- 
 tinal activity. 
 
 X-ray examinations show that the intestinal con- 
 tents move four times as fast during a meal as during 
 the interval between meals. 
 
 It is the opinion of the writer that bowel move- 
 ments should occur after each of the principal meals 
 of the day. This question is discussed further in a 
 later chapter. 
 
 Psychic Influences 
 
 Pleasurable emotions and excitement have been 
 known to produce intense activity of the intestines, 
 and even diarrhoea, while depressing emotions have 
 the opposite effect. This has been clearly demon- 
 strated experimentally, in animals as well as clin- 
 ically in human beings. 
 
 Electricity 
 
 This powerful agent may be applied in such a 
 way as greatly to stimulate intestinal activity. The 
 most effective method is the application of the sinu- 
 soidal current to the rectum and abdominal muscles, 
 or to the rectum and the central portion of the 
 back. Another very effective method, perhaps the 
 most efficient of all methods, is the application of a 
 
INFLUENCES WHICH EXCITE MOVEMENTS 69 
 
 bi-polar electrode to the inner surface of the pelvic 
 colon, which is the point of greatest delay in the 
 majority of constipated persons. 
 
 Mechanical Vibration 
 
 Powerful mechanical impulses may be communi- 
 cated to the intestines and the nerve ganglia which 
 control them, by suitable apparatus. The writer 
 has in numerous instances seen strong intestinal 
 movements set up by this form of stimulation. 
 
 Massage 
 
 This is another valuable means of stimulating the 
 bowel to increased activity. Kneading with the 
 hands or with a suitable mechanical appliance has 
 been shown to be capable of quickening the move- 
 ments of the intestine, if applied with sufficient 
 thoroughness. 
 
 Stroking, or reflex titillation of the skin, stimu- 
 lates the bowel in much the same way that tickling 
 the soles of the feet may give rise to powerful con- 
 tractions of the muscles of the legs. To be effective, 
 massage intended to influence the intestinal move- 
 ments must be given by an expert. 
 
 Abdominal Compression 
 
 This method acts upon the intestine by increasing 
 the intra-abdominal pressure. It is most effective 
 
70 COLON HYGIENE 
 
 when applied in cases in which the abdominal mus- 
 cles are weak and relaxed. 
 
 The compression may be made continuous by 
 the application of a tight abdominal bandage; or 
 intermittent pressure may be applied, if desired, by 
 means of an inflated rubber bag. These measures 
 will be explained more fully elsewhere. 
 
 Exercise 
 
 Bodily activity is another way of mechanically 
 stimulating the intestine. Vigorous exercise sets the 
 diaphragm and abdominal muscles at work in such 
 a way that the intestines are, between the two, vig- 
 orously kneaded and squeezed and thus stimulated 
 to action. 
 
 Every farmer knows the constipating effect of 
 idleness upon his horses and cattle. Most observing 
 persons have noted in their own experience the ad- 
 vantage of taking a brisk walk before or after 
 breakfast. 
 
 The sedentary man or woman not only loses the 
 immediate benefit which results from the increased 
 activity of the diaphragm and abdominal muscles, 
 but his abdominal muscles become permanently 
 weakened, relaxed, lacking in tone, and incapable 
 of supporting the intestines in their proper place, 
 thus adding a number of other factors which con- 
 tribute very materially to the lessening of intestinal 
 activity. 
 
INFLUENCES WHICH EXCITE MOVEMENTS 71 
 
 Posture 
 
 A stooped or relaxed posture in sitting or standing 
 tends strongly to induce constipation by weakening 
 the abdomial muscles and causing congestion of the 
 liver and all other abdominal organs. The viscera, 
 over-filled with blood, and lacking the support of the 
 abdominal muscles, become prolapsed. The colon 
 falls with the rest; kinks are formed; the intestinal 
 contents stagnate; the bowel becomes distended; the 
 ileocecal valve becomes incompetent, infection trav- 
 els up the small intestine, and a long list of ills 
 result. The check valve action of the ileocecal valve 
 is essential to the onward movement of the food 
 residues, and therefore the crippling of this valve 
 naturally leads to constipation. 
 
 An erect posture secures proper exercise of the 
 muscles of the trunk, correct breathing, normal cir- 
 culation of blood in the viscera, and promotes in a 
 high degree normal bowel movement. 
 
 Hot and Cold Applications 
 
 Cold applications, and even extremely hot appli- 
 cations, act as powerful stimulants to the intestinal 
 muscles. To be effective, the applications must be 
 short and intense. The cold spinal and abdominal 
 douche, and the cold douche to the feet and legs, 
 are the most effective external procedures. 
 
 The application of cold water to the bowel by 
 means of the enema at a temperature of 75° to 40° 
 
72 
 
 COLON HYGIENE 
 
 F. produces almost instant contraction of the bowel. 
 The action is so intense that great pain may be 
 produced, especially if a very low temperature is 
 employed. 
 
Influences Which Lessen Intestinal 
 Movements 
 
 There are certain foods and other agents and 
 influences that exercise a decided deterring influence 
 upon intestinal movements, either directly, or in- 
 directly through the suppression of the normal 
 stimuli. 
 
 Liquid Foods 
 
 Such foods as soups, gruels, porridges, and purees 
 contain so little solid matter that the bulk, consider- 
 able though it may be when the food is eaten, is 
 soon reduced to a very small volume. On this ac- 
 count liquid foods are almost always constipating. 
 The only exceptions are those liquid foods which 
 contain much sugar, acids, or fats. 
 
 Pasty cereals such as oatmeal mush, are 
 decidedly constipating in their influence, because of 
 their pasty consistency and the little mastication 
 which they receive. New bread, hot biscuits, 
 "noodles," and doughy foods of all sorts are like- 
 wise objectionable. 
 
 Concentrated Foods 
 
 Foods which contain little or no waste or in- 
 digestible material are so completely digested and 
 absorbed that the bulk left in the intestine is in- 
 
 71 
 
74 COLON HYGIENE 
 
 sufficient to stimulate segmentation or peristalsis. In 
 feeding the sick, the mistake is not infrequently made 
 of feeding exclusively fluid or concentrated foods, 
 with the idea that such foods tax the digestive 
 organs least. In a sense this is true, but the impor- 
 tance of maintaining proper bowel action is so great 
 that this must be considered in the dietary, and with 
 rare exceptions the patient will perfectly well toler- 
 ate simple salads, stewed fruit of some sort, whole 
 wheat preparations, especially wheat flakes, in which 
 the whole grain is represented. 
 
 The conventional "tea and toast" is about the 
 worst diet that could be offered a sick person. The 
 panadas, puddings, and "slops" of various sort are 
 little better. 
 
 The Properties of Fruit Juices 
 
 Fruit juices of all sorts are, on the other hand, 
 most suitable for almost all forms of sickness. They 
 contain choice nutriment in a form needing no di- 
 gestion, ready for immediate absorption and assimi- 
 lation. 
 
 Orange juice or freshly expressed juice of ap- 
 ples, grapes, or other sweet or sub-acid fruit, is 
 ideal nourishment for the sick. In the absence of 
 these fruits, dried fruit, soaked long in water may 
 furnish a very fair substitute. Canned fruit juices 
 come next in value. To these rice, or some other 
 cereal food, may be added in proper amount, with 
 malt sugar in some form. 
 
INFLUENCES WHICH LESSEN MOVEMENTS 75 
 
 Fasting 
 
 In a state of absolute fasting the intestine is in 
 a state of complete inactivity. The normal stimulus 
 of food is lacking, and there is nothing to call forth 
 the rhythmical activities which accompany normal 
 digestion. In another chapter we shall discuss at 
 some length the question of fasting as a curative 
 means, a method which has almost assumed the 
 character of a fad in certain sections. 
 
 Pain 
 
 Pain in almost any part of the body may arrest 
 intestinal action by causing a reflex interference. 
 Pain or inflammation in any part of the abdomen, 
 especially such painful affections as rectal ulcer or 
 fistula, inflamed hemorrhoids, chronic appendicitis, 
 inflammation of the bladder, prostate, uterus, ovaries, 
 and other pelvic organs, all give rise to inaction 
 of the intestine, not only by inhibiting or preventing 
 peristalsis, but also by causing obstruction through 
 contraction of the ileocecal sphincter. The pain and 
 irritation of an ulcer or fistula, or inflammed hemor- 
 rhoids, may induce constipation by causing spasms of 
 the anal muscle, and so preventing the normal re- 
 laxation in the act of defecation. 
 
 Miscellaneous Causes 
 
 Depressing emotions, such as anger, fear, or des- 
 pondency, all suppress the normal movements of the 
 
76 COLON HYGIENE 
 
 intestine, and thus form a vicious circle which con- 
 tinually aggravates both the malady and its cause. 
 
 Heat lowers muscular tone, and hence checks the 
 intestinal movements. This is well seen in the relief 
 obtained by the application of a fomentation to the 
 abdomen, or the administration of a hot bath or a 
 hot enema in a case of intestinal colic or diarrhoea. 
 
 Hot drinks, as well as hot baths, tend to slow 
 intestinal movements, and the habitual use of warm 
 enemas certainly aggravates the condition for which 
 the treatment is given. 
 
 Sweating, if very profuse, encourages intestinal 
 inactivity by removing large quantities of water 
 through the skin, and thus producing excessive dry- 
 ness of the intestinal contents. 
 
 Elevated body temperature, whether caused by 
 fever or by a hot bath of some sort, slows the intes- 
 tinal movements. 
 
 Sleep and inactivity slow the intestinal movements 
 by lessening the activity of the diaphragm and the 
 abdominal muscles. The first voluntary movements 
 made on awakening in the morning often start up 
 peristalsis, and often provoke a desire for evacuation 
 of the bowels. Persons who lead inactive lives almost 
 always suffer from constipation, though often un- 
 aware that this is the case, for reasons which we 
 shall present later. 
 
 Prolonged cold sitz baths cause intestinal in- 
 activity by inducing a spasm of certain of the food 
 gates, probably the ileocecal sphincter. This result 
 
INFLUENCES WHICH LESSEN MOVEMENTS 77 
 
 occurs if the bath is continued for more than seven or 
 eight minutes. When for any reason the use of the 
 prolonged sitz bath becomes necessary, special pre- 
 cautions in diet and otherwise must be taken to 
 prevent producing this undesirable effect. 
 
 A diet largely made up of meat necessarily favors 
 intestinal inactivity, first because the complete diges- 
 tion of the meat leaves too little residue to stimulate 
 peristalsis, and second because an excess of protein 
 encourages putrefactive processes in the intestine, 
 which establish an alkaline condition of the intestinal 
 contents, and thus prevent normal intestinal activity. 
 The stools of flesh eaters usually have a very strong 
 ammoniacal odor, and when tested by the chemist 
 are found to be strongly alkaline. Alkalies paralyze 
 the colon, while acids stimulate it. 
 
The Causes of Constipation 
 
 The causes of a disease so universal in civilized 
 communities must be very numerous to produce this 
 condition in so great a number of people living 
 under many different conditions, and with different 
 habits of life. In general it may be said that the 
 causes of constipation are abnormal habits or con- 
 ditions of life, the result of what we call civilization. 
 Savages rarely suffer from constipation, which is 
 also true of the more primitive of so-called civilized 
 nations. Chronic intestinal inactivity is much less 
 frequent among country people than among those 
 living in the city. It is manifestly a morbid condi- 
 tion peculiar to a state of high civilization; and 
 modern medical researches tend to show that this 
 condition and its results may justly be looked upon 
 as among the fundamental causes of the race de- 
 generacy which is becoming every 5^ear more apparent 
 in all highly civilized communities. 
 
 We may therefore expect to find adults suffering 
 from constipation much more than children, al- 
 though this malady often begins early in life. 
 Women are more subject than men to intestinal 
 inactivity and all the terrible consequences which 
 result from this condition. Westphalen asserts that 
 four-fifths of all women suffer from constipation 
 from their youth onward, a statement that is cor- 
 roborated by Foges, the eminent specialist of Vienna, 
 
 78 
 
THE CAUSES OF CONSTIPATION 79 
 
 and that few experienced practitioners will deny. 
 Adults have been longer exposed to the degenerative 
 influences of civilized life than have children, and 
 the life of civilized women is to a considerable 
 degree more highly artificial and unnatural than 
 that of men. 
 
 Professor Virchow more than half a century ago 
 called attention to the fact that post-mortem exam- 
 inations show evidences of disease of the intestines 
 in almost every case of many hundreds examined, 
 irrespective of the cause of death. Indeed, he 
 declared it to be almost impossible to find an adult 
 person whose intestines did not show adhesions and 
 other evidences of chronic disease. At that time 
 the origin and significance of these inflammatory 
 conditions was not understood. We now know that 
 infections of the interior of the intestine, by causing 
 inflammation of the intestinal walls, readily extend 
 to the outside, giving rise to inflammatory changes 
 and adhesions. In these adhesions, located in various 
 parts of the intestine, but particularly at special 
 points noted by Professor Virchow, and more re- 
 cently by Dr. Arbuthnot Lane, we have both a 
 consequence and a cause of constipation. 
 
 The Rationale of Constipation 
 
 To fully comprehend the influence of various 
 habits and conditions in developing constipation, 
 it is necessary to have in mind the mechanism of 
 
80 COLON HYGIENE 
 
 defecation and the conditions essential to the normal 
 colon action. The several acts by which the colon 
 is emptied of its contents may be briefly summarized 
 as follows: 
 
 1. Contraction of the diaphragm — a deep 
 breath. 
 
 2. Contraction of the abdominal muscles. 
 
 3. Pressure of the thighs against the abdomen 
 as in the squatting position assumed by the savage. 
 
 4. Reflex contraction of the abdominal muscles. 
 
 5. Contraction of the colon. 
 
 6. Relaxation of the anus. 
 
 7. Contraction of the levator-ani muscles. 
 Any influence which interferes with a single one 
 
 of these seven steps in the normal process of defeca- 
 tion may give rise to constipation, and when the 
 disturbing influence is of such character as to inter- 
 fere with several factors, the result is certain to be 
 an extremely obstinate form of colon inactivity. 
 
 The causes of constipation may become operative 
 either before or during the action of defecation. 
 In order that normal defecation should occur, it 
 is necessary that fecal matters should reach the 
 pelvic colon in condition to be expelled from the 
 body, and that the pelvic colon should be free to 
 rise out of the pelvis, so that it may discharge a 
 part of its contents into the rectum; and it is then 
 essential that there should be no interference with 
 any of the several factors which enter into the 
 normal act of defecation. 
 
THE CAUSES OF CONSTIPATION 81 
 
 Among the causes that may operate to prevent 
 the proper preparation of the bowel for the act 
 of defecation through the accumulation of the bowel 
 contents in the pelvic colon, are the following: 
 
 1. Deficient bulk of intestinal contents. If 
 the amount of the intestinal contents is too small 
 to distend the pelvic colon, the bowel will not be 
 stimulated to action. This condition naturally 
 results during fasting, and may also result from 
 the use of a concentrated diet. A diet largely made 
 up of animal foods; that is, fish, flesh, fowl, eggs 
 and milk, is always a concentrated diet, since these 
 materials are almost entirely digested and absorbed, 
 leaving no residue. On the other hand, vegetable 
 foods, with a few exceptions, — such as the banana, 
 potato, fine flour bread, and polished rice, — contain 
 a considerable amount of cellulose, which in human 
 beings is indigestible. 
 
 2. A spastic or contracted condition of the bowel 
 in the transverse, descending, or iliac colon may hold 
 back the intestinal contents, preventing them from 
 reaching the pelvic colon, and so may interfere with 
 normal bowel action. This condition exists in 
 nearly all persons suffering from colitis, the most 
 common seat of which is the descending colon. 
 The effect may be almost the same as that due to 
 organic change, as from ulcer or adhesions. 
 
 3. Adhesions, by interfering with the normal 
 contraction movements of the colon, may seriously 
 cripple its function. These adhesions may be the 
 
82 COLON HYGIENE 
 
 result of peritonitis due to chronic infection of the 
 mucous membrane extending through the wall of 
 the bowel to its peritoneal surface. Such adhesions 
 may occur between any part of the colon and the 
 abdominal wall, but are most likely to occur in 
 the lower part of the colon. Adhesions of this part 
 of the colon are in the writer's experience very 
 likely to be found present in cases of extremely 
 obstinate constipation. 
 
 4. Redundancy of the colon is another frequent 
 cause of constipation. The overloaded colon is grad- 
 ually stretched, until it may acquire nearly double 
 its normal length. The redundant colon often be- 
 comes folded upon itself, and adhesions form, giving 
 rise to kinks which produce mechanical obstacles 
 to the forward movement of the intestinal contents. 
 
 5. Incompetency of the ileocecal valve, by pre- 
 venting the forward movement of the intestinal 
 contents, hinders the normal filling of the pelvic 
 colon, and so leads to constipation. 
 
 6. Ordinarily, the whole bowel is not emptied 
 in the act of defecation. The length of the colon 
 is such that the residue from two or more meals 
 may be present in different parts of the intestine 
 at the same time. For example, the supper residue 
 may be passing into the cecum while the dinner 
 residue occupies the transverse colon and the break- 
 fast residue is in the pelvic colon ready to be dis- 
 missed. 
 
 The descending colon is normally found in an 
 
THE CAUSES OF CONSTIPATION 83, 
 
 empty state. When the intestinal contents are 
 pushed from the transverse colon over into the de- 
 scending colon, they are not long retained, as in other 
 parts of the colon, but pass rapidly down to the 
 pelvic colon, which seems to be intended by nature 
 for a sort of discharging reservoir, in which the 
 fecal matter accumulates until a sufficient degree 
 of distention of the bowel has been induced to 
 stimulate peristaltic action. 
 
 A lack of this distending stimulus, which is es- 
 sential to bowel activity, is a cause of constipation 
 in a large number of persons whose pelvic colons 
 have been over-distended. In such persons an 
 extremely bulky diet is necessary to fill the pelvic 
 colon to such a degree as to bring about the reflex 
 movements which induce normal bowel action. 
 
 In persons who are chronically constipated the 
 descending colon is often constantly filled. The 
 long contact of the poisonous fecal matters with 
 the mucous membrane gives rise to infection. . This 
 is colitis. Colitis causes contraction of the bowel, 
 thus becoming a new and most potent cause of 
 constipation. The contraction produced by colitis 
 not only obstructs the bowel, but also sets up anti- 
 peristaltic movements, thus reversing the action of 
 the bowel and carrying material back to the ascend- 
 ing colon and. cecum. Normally, the anti-peristaltic 
 contractions start at the middle of the transverse 
 colon and do not involve the lower half of the 
 colon. But when colitis and spasm are present, 
 
84 COLON HYGIENE 
 
 the reverse movement extends even to the pelvic 
 colon. This fact, discovered by Case, explains the 
 peculiarly irregular and erratic bowel movements 
 characteristic of colitis. 
 
 7. By compression of the waist, such as results 
 from the wearing of corsets and tight dresses, the 
 action of the diaphragm is greatly crippled. This 
 may be one reason why women in general suffer 
 from constipation more than do men. The feeble con- 
 dition of the diaphragm and other breathing muscles, 
 which is the natural result of neglect of exercise, 
 produces a similar effect in both men and women. 
 
 8. A feeble and relaxed condition of the ab- 
 dominal muscles, the result of a sedentary life, 
 and especially of a stooped and relaxed posture of 
 the body in sitting or standing, will necessarily 
 interfere with both voluntary and reflex contraction 
 of these important muscles, which is an essential 
 factor in normal defecation. When the colon has 
 been long over-distended by neglect, and relaxed 
 by the long-continued use of the warm enema, its 
 power to contract is necessarily greatly diminished. 
 This condition of the bowel not only prevents in- 
 efficient normal defecation, but the efficiency of the 
 bowel may be still further interfered with by 
 adhesions and kinks. 
 
 9. Hemorrhoids, fissures, ulcers, fistulae, and 
 simple irritation of the mucous membrane in the 
 anal region, may cause spasm or abnormal tightness 
 of the anal muscle, so that the ordinary reflex is 
 
THE CAUSES OF CONSTIPATION 85 
 
 insufficient to cause relaxation of the muscle, and 
 it thus becomes a mechanical obstacle to bowel 
 movement. 
 
 10. The levator- ani muscle frequently becomes 
 so weakened by continuous over-stretching, as the 
 result of accumulation of hard fecal matters in the 
 rectum, that it loses its power to contract. This 
 condition may also be induced by proctitis, a common 
 result of constipation. 
 
 When the rectum walls are thus weakened and 
 paralyzed, the rectum, instead of being always empty 
 except during defecation, always contains more or 
 less fecal matter, the constant contact of which with 
 the mucous membrane produces loss of sensibility and 
 chronic catarrh or proctitis, and often gives rise 
 to hemorrhoids, anal ulcer, abscesses, fistula and 
 local affections. 
 
 It is thus apparent that in all cases of constipation 
 there is a definite reason for intestinal inactivity. 
 In every case of really serious constipation — that is, 
 cases which are not relieved by regulation of diet — 
 careful inquiry must be made for the purpose of 
 ascertaining the exact conditions which are inter- 
 fering with normal intestinal movement, including 
 both the exciting and the predisposing causes of these 
 conditions, which will be considered at length in 
 succeeding pages. 
 
 In discussing the causes of constipation, we will 
 consider first of all the influence of habits of life 
 upon the function of defecation, and will then notice 
 
86 COLON HYGIENE 
 
 various morbid conditions in different parts of the 
 alimentary canal, which may give rise to constipa- 
 tion. 
 
 
Habits Which Give Rise to 
 Constipation 
 
 In considering the habits of life common among 
 civilized people which give rise to constipation, we 
 shall not undertake to arrange the subject matter 
 in the order of relative importance, but rather speak 
 first of those which are most common. 
 
 Hasty Eating 
 
 Insufficient mastication is a fault peculiar to civ- 
 ilized men. The savage, as well as the monkey 
 and all lower animals that are provided with teeth 
 for grinding food, masticates his food with the 
 greatest thoroughness. The accompanying cut made 
 from the lower jaw of a skull in the writer's pos- 
 session, shows the teeth of an ancient mound builder, 
 a Malkelkos Indian. The well-worn appearance of 
 the teeth affords sufficient evidence of the thorough- 
 ness with which they were used in grinding the nuts 
 and cereal food which formed the dietary of these 
 aborigines. 
 
 Hasty eating leads to constipation in a variety 
 of ways, but most directly, perhaps, by the rapid 
 introduction into the intestine of a large amount of 
 imperfectly masticated food material, which being 
 slowly digested, undergoes putrefaction and other 
 changes, by which the functions of every part of the 
 
 87 
 
88 COLON HYGIENE 
 
 digestive canal to the colon are more or less dis- 
 turbed. As has been mentioned, the food is normally 
 held back for three or four hours at the ileocecal 
 valve, to permit the completion of intestinal digestion 
 and absorption. When the food has been imperfect- 
 ly chewed, it may be too long delayed at this point. 
 
 As the result of the long delay in the small 
 intestine, the food mass contains too little water 
 when finally passed through into the colon, and 
 is moved along with great difficulty, and by delay 
 tends to dilatation of the colon. Under normal con- 
 ditions the food does not remain in the body more 
 than twenty-four hours, but under the conditions 
 just described it may be retained for forty-eight 
 hours or more, in the meantime undergoing putre- 
 factive changes, which not only render the normal 
 contents of the bowel alkaline, and thus deprive 
 the bowel of a normal stimulus, but in time produce 
 infection of the mucous membrane, which manifests 
 itself ultimately as chronic colitis, or chronic ap- 
 pendicitis. 
 
 Hasty eating is a fault almost universal with 
 the American people. The fifteen minutes' stop 
 for refreshments at the lunch counter or eating 
 house, and the general spirit of hurry which is 
 everywhere manifest in our bustling communities, 
 constantly encourage, almost enforce, wrong habits 
 in eating. If time is limited, it would be far better 
 to eat a smaller quantity and chew it well, than 
 to swallow the whole amount half masticated. 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 89 
 
 Excessive Mastication 
 
 Excessive chewing of the food, to which the term 
 "bradyphagia" has been applied, has been charged 
 with being a cause of constipation, and the charge 
 may be true. A person who follows the recom- 
 mendation made by some writers, to swallow nothing 
 which cannot be reduced to liquid in the mouth, 
 is sure to suffer from constipation as a consequence 
 of insufficient bulk. Some have not only carried 
 the practice of chewing to a great extreme, but have 
 reduced the quantity and bulk of food to so low a 
 limit that chronic constipation has been the natural 
 result. Constipation is indeed so common a result 
 that it has been by some commended as one of the ad- 
 vantages of thorough mastication, a "food economy" 
 that should be cultivated. This is certainly an error, 
 and a most dangerous one. We have been consulted 
 by a number of persons who have found themselves 
 suffering from severe constipation and resulting 
 autointoxication, in consequence of so greatly re- 
 ducing the amount of food eaten, and especially of 
 the amount of insoluble residue, that there was too 
 little left to evoke the necessary intestinal move- 
 ments. The human alimentary canal is adapted 
 to somewhat bulky and moderately coarse food- 
 stuffs, and does not work well when such food 
 materials are excluded from the bill of fare. Bulk 
 is almost as necessary as nutriment. 
 
 Food should be chewed sufficiently, that is, until 
 the tongue no longer discovers coarse particles. 
 
90 COLON HYGIENE 
 
 Insufficient Bulk 
 
 The alimentary canal of man, while not so long 
 in proportion to his size as that of the herbivorous 
 animals, is much larger and longer than in animals 
 which are intended to feed upon a flesh diet. The 
 human intestine is approximately ten times the 
 length of the body, that is, of the trunk, which is 
 approximately half the height. The colon is sac- 
 culated like the colon of herbivorous animals, and 
 like that of the higher ape, indicating the adaptation 
 of the intestines to bulky food. Fresh vegetables 
 of all wholesome sorts are highly essential to give 
 the food the necessary bulk required to stimulate 
 the intestines to activity. A diet of bread and meat 
 leaves almost no residue at all in the intestine. 
 
 Fruits and fresh uncooked vegetables are used far 
 less than they should be by the majority of people, 
 especially by the poor. The Russian peasant keeps 
 his bowels regular by the use of sauer-kraut, which 
 serves him the same purpose as the products of the 
 "silo" do the farmer's cattle. 
 
 Vegetables, especially such vegetables as carrots, 
 turnips, beets, parsnips, lettuce, cabbage and spinach, 
 contain a large amount of cellulose, which is not 
 readily digestible by the human digestive organs. 
 This cellulose is highly important to make the 
 nutritive elements of the food less concentrated 
 and to furnish to the intestines the necessary stimulus 
 to cause them to move the food and food residues 
 along at a proper rate. 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 91 
 
 Nearly all fruits and most vegetables, especially 
 that curious vegetable-fruit, the tomato, contain 
 organic acids, — citric, malic and tartaric. The free 
 use of foods containing these acids is as wholesome 
 for man as for other frugivorous animals. Their 
 laxative effect is essential to maintain a healthy 
 colon. 
 
 Meat Eating 
 
 Carnivorous animals have a short alimentary 
 canal and a smooth colon. The movement of food 
 stuffs along this short, smooth passage is rapid. 
 This is necessary for the preservation of the life of 
 the animal, as undigested remnants of meat long 
 retained in the body necessarily undergo putrefactive 
 changes with the production of ptomaines and 
 poisons of a dangerous character. The digestion 
 of meat leaves little residue, hence an animal that 
 lives chiefly on meat has but little bulk to stimu- 
 late the bowels to activity, a condition which favors 
 the putrefaction of undigested remnants, and this 
 by creating an alkaline condition of the intestines 
 soon develops constipation. 
 
 A diet of fine-flour bread and meat, with the 
 usual concomitants of the ordinary bill of fare, 
 would be an excellent prescription for the produc- 
 tion of constipation. Within the last century there 
 has been an enormous increase in the use of flesh 
 foods in all civilized countries; and the use of 
 modern milling proccesses has become almost uni- 
 
92 COLON HYGIENE 
 
 versaL Fine flour bread and meat form a combi- 
 nation that is productive of prodigious harm, not 
 only in causing constipation, but also in depriving 
 the bones of the lime salts which are essential for 
 their development and maintenance. From the 
 lack of lime salts comes decay of the teeth, and loss 
 of the teeth leads to imperfect mastication of food. 
 The increased consumption of flesh, and the sub- 
 stitution of fine-flour bread for the wheatmeal of 
 our ancestors, are two calamities, the evil results of 
 which upon the health of the men and women of 
 the present generation are incalculably great. 
 
 Milk 
 
 Within the last few years much evidence has 
 accumulated to the effect that cow's milk is by 
 no means the specially wholesome human nutriment 
 that it was once supposed to be. Bunge, a great 
 physiologist, and perhaps one of the world's great- 
 est authorities on foods, goes so far, indeed, as to 
 assert that many thousands of children are annually 
 killed by feeding on cow's milk; and many persons 
 have learned from their own observation that milk 
 does not agree with them. Cow's milk is excel- 
 lent food for calves, to which it is naturally adapted, 
 but for many human adults it appears to behave 
 almost as a poison. The probable cause is the very 
 common inability to digest the casein of cow's milk. 
 Personal observations in a very large number of 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 93 
 
 cases have convinced the writer that at least one- 
 third, and probably more than one-half, of the 
 persons suffering from chronic disease cannot use 
 cow's milk freely without more or less serious 
 injury. One of the prominent symptoms arising 
 from the use of cow's milk is the production of a 
 condition commonly known as "biliousness". The 
 tongue becomes coated, there is a bad taste in the 
 mouth, the breath is foul, the bowels are inactive, 
 and an examination of the stools shows the pres- 
 ence of considerable quantities of undigested casein 
 undergoing putrefaction. 
 
 The free use of milk is unknown among savages. 
 The writer has no doubt that the extensive use of 
 milk, under the mistaken notion that it is a spe- 
 cially valuable food for adults as well as for infants, 
 is one of the active causes of the steady increase of 
 constipation amongst civilized people. Putrefaction 
 of undigested casein in the colon produces an alka- 
 line condition which paralyzes the bowel and 
 encourages conditions by which the defecating mech- 
 anism is in various ways more or less irreparably 
 damaged. 
 
 A Bland or Monotonous Diet 
 
 Pawlow has shown the importance of taste as an 
 element in digestion. According to his experiments, 
 the activity of the stomach begins almost immedi- 
 ately after food is taken into the mouth. The 
 intensity of the gastric activity depends upon the 
 
94 COLON HYGIENE 
 
 degree of stimulation of the gustatory nerves. Cash 
 has shown by experiments on dogs that even the 
 smell of food produces peristaltic activity. If the 
 food is not relished, the stomach does not produce 
 "appetite juice", and the vigorous peristaltic move- 
 ments that are essential for sound digestion, and that 
 are equally necessary to stimulate movement of the 
 intestinal contents all along the line, are not ini- 
 tiated. It must be remembered, as has been shown 
 in a previous chapter, that the taking of food, 
 although it has for its primary object the introduc- 
 tion of nutritive material into the body, is incident- 
 ally necessary as a means of setting up the strong 
 peristaltic waves that push forward the fecal matters 
 that have accumulated in the colon, causing them 
 to pass through the sphincter which guards the 
 upper entrance of the rectum, and to set up the 
 series of automatic movements by which this waste 
 and unusable material may be removed from the 
 body. 
 
 In order, then, that these two prime purposes 
 of eating — namely, the nourishment of the body, 
 and the evacuation of poisonous material — should be 
 efficiently accomplished, it is necessary that the food 
 should be so inviting and stimulating to the senses 
 which participate in the enjoyment of food that 
 the digestive activity will be prompt and vigorous. 
 A meal taken without relish and eaten as a mere 
 matter of routine and duty does not accomplish 
 this. A person who eats without appetite is always 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 95 
 
 constipated. Even if the bowels move regularly, the 
 discharged materials should have been got rid of 
 twenty-four or forty-eight hours before; there is 
 a latent constipation, the evil results of which do 
 not materially differ in the main from those of 
 other forms of constipation, although likely to escape 
 attention. The bill of fare should be so varied 
 from day to day and from meal to meal, and the 
 food should be of such a character, that each meal 
 will be taken with keen relish. This is especially 
 important for persons whose lives are sedentary, 
 and who on this account are more likely to suffer 
 from loss of appetite, and the constipation which 
 is both a cause and a consequence of this difficulty. 
 
 The Exclusive Use of Cooked Food 
 
 While it is true that the cooking of food in 
 general increases digestibility, experience in the 
 feeding of both infants and adults has clearly shown 
 that a diet consisting exclusively of cooked food is 
 detrimental both to digestion and to general health, 
 and may lead to the most serious results. It has, 
 indeed, been shown that in children a cooked diet, 
 such as sterilized milk, for example, may lead to the 
 development of rickets and general mal-nutrition. 
 Combe, one of the world's greatest authorities on 
 infant feeding, asserts that the symptoms and injury 
 from such a dietary make their appearance within 
 two or three weeks. The writer's observations 
 
% COLON HYGIENE 
 
 have fully convinced him that adults as well as 
 infants suffer from this cause. It has long been 
 known that salt is not the exclusive cause of scurvy 
 in sailors, as was once supposed ; it is rather the lack 
 of certain elements — enzymes and vitamines found 
 in raw foods, many of which are destroyed by the 
 heat of cooking, and which are essential to good 
 nutrition. 
 
 Another objection to the exclusive use of a cooked 
 diet has a special relation to the subject in hand — 
 the fact that it renders the cellulose of the food too 
 readily digestible by the intestinal bacteria, so that 
 the amount remaining is insufficient to give to the 
 intestine the needed stimulus to movement. 
 
 The same objection also applies in relation to 
 starch. Raw starch is to a degree digestible in the 
 intestine, but cooked starch is much more readily 
 digestible. For good bowel action, it is necessary 
 that a certain amount of undigestible starch should 
 find its way into the colon. Cooked starch is 
 quickly converted into sugar, and is completely 
 absorbed in the small intestine. When no starch 
 reaches the colon, the acid-forming bacteria which 
 feed upon starch and convert it into lactic and other 
 acids, are not able to grow; acids are not formed, 
 the intestinal contents become alkaline, with the 
 formation of ammonia and the putrefaction of pro- 
 tein. This condition results in a semi-paralysis of 
 the colon, so that the feces are too long retained, 
 and putrefaction proceeds still farther. 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 97 
 
 Foods containing starch or cellulose should be 
 taken every day, or preferably at every meal. Among 
 foods of this kind to be specially recommended are 
 green corn fresh from the garden (uncooked), 
 lettuce, cabbage, and fresh fruits of all sorts, turnips 
 of the best varieties, and even radishes, if care be 
 taken to remove the acrid rind. Young carrots are 
 also relished by some prepared raw. As a salad 
 Cucumbers and raw tomatoes are excellent. 
 
 These raw foods must be thoroughly chewed, 
 as otherwise they may cause too long delay in the 
 stomach or in the small intestine. The universal 
 relish for fresh vegetables, and the intense craving 
 for them, is an evidence of their value. These food 
 stuffs, while supplying very little active nutriment, 
 nevertheless furnish the body with quantities of cer- 
 tain elements which modern research shows to be 
 essential, while at the same time they supply neces- 
 sary bulk and a sufficient amount of undigested 
 carbohydrates to establish in the colon conditions 
 essential for a normal activity. 
 
 Hot Foods and Drinks 
 
 Heat relaxes and paralyzes, while cold stimulates. 
 For a muscle in a state of cramp or violent contrac- 
 tion, the application of heat is the most efficient 
 remedy. When food is taken into the stomach 
 active muscular movements at once begin. As we 
 have seen, these movements are essential, not only 
 
98 COLON HYGIENE 
 
 for churning the food and passing it onward along 
 the digestive tube, but also to move forward the 
 contents of the colon to the sensitive point in the 
 rectum, at which are set up the automatic acrions 
 by which the bowels are moved. Heat, whether 
 taken into the stomach by food or drink, or applied 
 externally, has the effect of weakening these move- 
 ments. It does this by exciting the sympathetic 
 nerves which hinder or inhibit the movements ot 
 the stomach or intestine, and so check peristalsis. 
 The practice of eating food as hot as it can be 
 swallowed, and especially of taking hot drinks at 
 meals, is unquestionably a very active cause of 
 constipation. If the food is held in the mouth for 
 a sufficient length of time to permit thorough 
 mastication and the proper admixture of saliva, no 
 harm will result from serving it hot when necessary, 
 as it will be cooled in the mouth to body temperature 
 before swallowing. 
 
 Priessnitz, the sagacious peasant doctor of water 
 cure fame, noted the unwholesome effects of hot 
 foods more than a century ago. By experiments 
 upon pigs he demonstrated that hot food produced 
 an unhealthy state of the intestine. He accordingly 
 recommended his patients to take their food at the 
 natural temperature of the air, and the thousands 
 coming from every part of the civilized world who 
 annually ate at his table in the little village of 
 Graefenberg, hidden among the forests of Austrian 
 Silesia, testified to his success in the treatment of 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 99 
 
 chronic constipation and numerous other ills which 
 were at that time acknowledged incurable even by 
 the best physicians. 
 
 Hot foods and drinks produce a sensation of 
 comfort in the stomach directly after they are swal- 
 lowed. In certain forms of indigestion this effect of 
 heat is particularly noticeable. In these cases, how- 
 ever, temporary comfort is obtained only at the 
 expense of the later serious disadvantages of the 
 constipating effect of such a diet. 
 
 A Meager or Low Diet 
 
 Many persons suffer from constipation because 
 they do not eat enough. They are in constant fear 
 of overloading the stomach and bowels, and the 
 consequence is that these organs lack sufficient work 
 to stimulate them to proper activity. The writer 
 has many times surprised such patients by the pre- 
 scription of a meal two or three times as large as 
 was being taken. The patient has usually found 
 that he suffers no harm from his large meal, and is 
 able to digest it without difficulty, and has also 
 experienced a notable improvement in bowel action. 
 The peristaltic waves which move the food along 
 in the stomach and small intestine and the feces in 
 the colon, are set up by reflex action excited by the 
 food itself; that is, contact of the food with the 
 mucous membrane of the stomach and intestine ex- 
 cites certain nerves by which the muscles are stimu- 
 
100 COLON HYGIENE 
 
 lated to activity. This action may be likened to 
 the ringing of a bell in response to the touch of an 
 electric button, or the starting of an electric fan 
 by the moving of a switch. When taken into the 
 stomach, food by its contact with the mucous mem- 
 brane sets in operation the food motor that operates 
 in the upper part of the digestive canal to carry 
 the food stuffs along from one part of the digestive 
 tube to another and in the lower part to transport 
 rubbish and refuse to the place of exit. 
 
 The degree of this movement depends upon the 
 amount of stimulation, while the amount of stimu- 
 lation depends largely upon the bulk of food taken. 
 This stimulating effect is produced not only in the 
 stomach, but in the small intestine. 
 
 It is evident, then, that for vigorous stimula- 
 tion of the intestine, such as is needed to bring about 
 the evacuation of the colon, a full meal must be 
 more effective than a meagre one. This is one 
 important reason why the taking of food at regular 
 and not too frequent intervals is favorable to regular 
 bowel action. A small amount of food taken at 
 frequent intervals may not at any time set up a 
 sufficient degree of stimulus to give the bowel the 
 impulse required. 
 
 People who "diet" do themselves great injury 
 often by too great restriction of the bill of fare, 
 both in quantity and variety of food. A food that 
 the patient imagines to be constipating or otherwise 
 harmful is generally found to have the expected 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 101 
 
 result. Thus, item after item the food is discarded, 
 until the bill of fare is reduced to a few articles 
 which are usually taken without relish and with 
 more or less apprehension of injury. Such patients 
 might far better pay no attention to diet whatever; 
 they would run far less risk of injury by taking 
 whatever the appetite craved. 
 
 In this connection it should be noted, however, 
 that in increasing the amount of the food intake, 
 the increase should usually be in bulk rather than 
 in food value. The added bulk should consist of 
 such foodstuffs as lettuce, celery, turnips, tomatoes, 
 greens, fresh fruits and other articles which give 
 large bulk with little nourishment. 
 
 Constipating Diets 
 
 Nurses, and perhaps physicians also, sometimes 
 unwittingly do their patients great harm by re- 
 stricting the diet to bland or liquid foods, which 
 are often taken without relish, and which on this 
 account, as well as by lack of bulk, tend in the 
 highest degree to promote intestinal inactivity and 
 obstinate constipation. A diet like this naturally 
 necessitates the use of artificial means for moving 
 the bowels. Many a patient owes the beginning of 
 his constipation to such a course of dieting during 
 temporary illness. Milk, which has been so much 
 relied upon as a sick-room diet, is particularly objec- 
 tionable in a very large number of cases, for reasons 
 which have already been given. Buttermilk is pre- 
 
102 COLON HYGIENE 
 
 ferable, because of the lactic acid it contains, while 
 its value is greatly increased by the addition of malt 
 sugar or milk sugar, and wheatmeal porridge, or a 
 porridge of corn meal or oatmeal made with an 
 addition of wheat bran. Fruit juices are extremely 
 useful. There are very few cases in which such 
 fresh things as lettuce and scraped apple and other 
 raw fruits may not be taken with great advantage 
 as well as vegetable purees. The danger of the 
 use of solid food in these cases is purely imaginary, 
 if care is taken to exclude meat, fried foods, and 
 indigestible combinations. Thorough chewing of 
 the food is of course essential. 
 
 The dietaries generally prescribed in certain forms 
 of chronic disease, and considered to be essential, 
 are often highly constipating. This is particularly 
 true in the meat treatment for diabetes. Constipa- 
 tion is nearly always found present in persons suf- 
 fering from this malady. It will always be found, 
 indeed, that constipation existed before the appear- 
 ance of sugar in the urine. The writer has no doubt 
 that chronic constipation is one of the most prolific 
 causes of the rapid increase of diabetes in all civilized 
 communities. The statistics gathered in the United 
 States Census Bureau, show a death rate from this 
 source nearly ten times as great as twenty years ago. 
 As has been pointed out already, meat, which is 
 usually the staple article prescribed for diabetic 
 patients, leaves little residue, while at the same time 
 promoting putrefaction in the colon, thus establish- 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 103 
 
 ing conditions which of necessity favor constipation. 
 This difficulty may be entirely overcome by the 
 free use of green vegetables, bran, and vegetable 
 protein or pure gluten. 
 
 In the dietetic treatment of hyper-acidity, and 
 especially of ulcer of the stomach and the duodenum, 
 the usual prescription is of such a character as to 
 cause constipation, which in turn leads to intestinal 
 toxemia and to a relapse later on. The withholding 
 of bulk-forming food is by no means so essential in 
 these cases as has been supposed; the essential thing 
 is to avoid the stimulation of the gastric secretion by 
 flesh foods and the extractives of meat that are found 
 in bouillon, broths and meat extracts. These sub* 
 stances powerfully stimulate the gastric secretion, 
 and thus aggravate and perpetuate the ulceration. 
 They also produce autointoxication, which encour- 
 ages hyper-acidity and tends to the formation of 
 ulcer. Carefully prepared vegetable purees may 
 usually be given in these cases at least after the first 
 few days, not only without injury, but even with 
 much benefit, thus preventing the constipation which 
 is certain to result from the bland, liquid diet. 
 
 Fasting 
 
 Fasting, which is sometimes prescribed as a rerne* 
 dial measure, necessarily leads to constipation, unless 
 some preventive method is adopted. The use of the 
 enema is not sufficient. Washing out of the colon 
 can do nothing more than remove materials which 
 
104 COLON HYGIENE 
 
 have been deposited in it from the small intestine; 
 and in fasting, the small intestine as well as the 
 stomach is in a state of complete inactivity. Bile, 
 mucus and other secretions, as well as poisonous 
 excretions from the blood, are accumulating from 
 day to day, but there is no peristaltic movement to 
 carry them onward, because no food is taken into 
 the stomach. From these facts it is evident that 
 absolute fasting, except when made necessary by 
 some intestinal trouble or other equally imperative 
 exigency, is rarely likely to prove beneficial. As a 
 general measure for purifying the blood, removing 
 uric acid, or producing tissue renovation, it is never 
 required. The prodigious claims that have been 
 made for fasting as a means of physical regeneration, 
 are in the highest degree misleading. Not a few 
 people have done themselves irreparable damage by 
 a prolonged fast. The benefit derived from fasting, 
 except when made necessary by a surgical operation, 
 hemorrhage from the stomach or bowels or some 
 other emergency, is due to the withholding of pro- 
 tein and fats, so that the body has an opportunity 
 to clear itself of "cinders" and other waste and 
 toxic matters derived from foods rich in protein, 
 especially meat and eggs. All these benefits may 
 be obtained by the exclusive use of juicy fruits for 
 a limited period, or better still, by the use of fruit 
 of some kind with bran and some green vegeta- 
 ble, such as lettuce. By this means the food tube 
 is supplied with the bulk necessary to maintain its 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 105 
 
 rhythmical action. The acids and sugars of fruits 
 are active in the same direction, while at the same 
 time furnishing the body with the necessary fuel 
 to maintain animal heat, and support its activities, 
 so that it is not compelled to feed upon itself, as 
 certain animals when starving bite and tear their 
 own flesh, and suck their own blood. 
 
 The injury to which persons subject themselves 
 by a long fast is similar to that resulting from a 
 long fever; the conditions are really very similar. 
 The appetite of the fasting person disappears on 
 the third or fourth day, just as does that of the 
 fever patient, and from the same cause, namely, the 
 saturation of the tissues with toxins. In the case 
 of a fasting person, the result of the absorption of 
 poisons from the putrefying materials stored up in 
 the inactive colon — foul breath and coated tongue 
 —is evidence of this autointoxication, and not of 
 a process of body purification. The foul breath and 
 coated tongue are the result of a growth of bac- 
 teria in the mouth and the intestines, which is en- 
 couraged by the lowered vital resistance resulting 
 from abstinence. The clearing of the tongue that 
 occurs in many cases in from two to four weeks, is 
 likewise comparable to the clearing of the tongue 
 in typhoid fever, in about the same time, which re- 
 sults from the development of immunity against the 
 bacteria and bacterial poisons to which the body is 
 exposed. In the case of the fasting person, clearing 
 of the tongue may be induced by the taking of food. 
 
106 COLON HYGIENE 
 
 The coated tongue does not occur in a "protein" 
 fast, such as has been above described. 
 
 Obesity 
 
 In the treatment of obesity not due to disease 
 of the glands of internal secretion, restriction of 
 the quantity of food is essential; unless care is 
 taken, this naturally leads to constipation — a very 
 common result of dieting to reduce flesh. This 
 effect of reduced diet is aggravated by the sweating 
 which results from the hot baths administered, as 
 well as from the vigorous exercise required. Con- 
 stipation may be avoided in these cases by not di- 
 minishing the bulk of the food intake while re- 
 ducing its food value. Indeed, it is an advantage 
 to increase the bulk. The free use of green vege- 
 tables is especially indicated in obesity, as a means 
 of preventing constipation. 
 
 Condiments 
 
 Mustard, pepper, pepper sauce, cayenne, capsi- 
 cum, horseradish, and the whole list of hot, irritat- 
 ing substances which are frequently added to food 
 as seasoning, having no food value in themselves, 
 are active causes of constipation. These substances 
 produce, at first irritation, and later oh catarrh of 
 the stomach and intestines, leading to gastritis en- 
 teritis, and colitis, and ultimately to degeneration 
 of the gastric glands. The consequence is loss of 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 107 
 
 the normal reflex activity, to which the peristaltic 
 movements are due. But the worst effects of con- 
 diments are to be seen in the lower part of the small 
 intestine and in the colon. Condiments being in- 
 digestible, become more and more concentrated as 
 the food substances with which they are eaten are 
 absorbed, and hence their effects are seen in a very 
 pronounced degree at the extreme lower end of the 
 small intestine, and in the colon where the food 
 residues accumulate before passing on to the cecum 
 through the ileocecal valve. When the irritating 
 mass is pushed through the ileocecal valve, each 
 successive portion falls at once upon the floor of 
 the cecum, so that this small area, to which is at- 
 tached the appendix, receives, so to speak, the con- 
 centrated fire of these enemies of good digestion. 
 The resulting irritation in the meantime results in 
 infection, upon which follows colitis, and not in- 
 frequently acute and chronic appendicitis, affec-> 
 tions which are both a consequence of chronic con- 
 stipation. 
 
 The concentrated residues of the food stuffs ? 
 including the indigestible particles of mustard^ 
 pepper, or other condiment taken with the food, 
 brought in contact with the rectum cause chronic 
 catarrh; hemorrhoids develop together with ulcers, 
 fissures, and abscesses, followed by fistulae, and the 
 way is prepared for tuberculosis and cancer. 
 
 In India, especially in Ceylon, and also in Mex- 
 ico, countries in which curries and hot, peppery 
 
108 COLON HYGIENE 
 
 sauces are used, gastric catarrh, constipation and 
 hemorrhoids are almost universal among those ad- 
 dicted to the use of these pernicious food-poisons.. 
 
 Irregular Meals 
 
 When the meals are not taken regularly, the 
 rhythmic peristaltic impulse by which the feces are 
 pushed forward from the colon into the rectum is 
 lacking. If for example, a person's habit is to 
 move the bowels immediately after breakfast, and 
 the breakfast is not taken, the bowels will not 
 move, or if a movement occurs, it will be incom- 
 plete; instead of complete emtying of the colon be- 
 low the splenic flexure, which occurs in a normal 
 movement of the bowels, only the pelvic loop 
 will be emptied; and fecal matters remain in other 
 sections of the colon. After the next meal, the 
 stimulus may be sufficient to empty the colon com- 
 pletely; but if the irregularity is frequently re- 
 peated the normal rhythm of the bowels will be in- 
 terrupted. The forward movement of food stuffs 
 in the small intestine is continuous while digestion 
 is going on; but the movement in the large intes- 
 tine is more or less intermittent. If a meal is taken 
 when the pelvic colon is loaded, the stimulus of 
 the meal will cause the pelvic colon to contract 
 and push forward a portion of its contents into the 
 rectum. The feces in the rectum will excite the 
 defecating center, and thus set up the automatic 
 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 109 
 
 action by which a movement of the bowel is 
 effected. 
 
 If a meal is taken at a time when the feces 
 have not reached the pelvic colon, manifestly no 
 movement of the bowels can occur, and a general 
 contraction of the colon by which its contents are 
 discharged does not take place. If, on the other 
 hand, no meal is taken at a time when the pelvic 
 colon is filled, the movement must be delayed until 
 the next meal is taken, or perhaps until some un- 
 usual straining movement or exercise serves to 
 crowd out some of the fecal matter from the colon 
 into the rectum. If the fecal matters retained in 
 the pelvic colon become too dry to be readily 
 moved by normal stimuli, a laxative or an enema 
 becomes necessary. In many cases, this is the be- 
 ginning of chronic constipation; a few repetitions 
 may be sufficient to create a latent constipation in 
 which the bowel movements are always twenty- 
 four or forty-eight hours behind time. 
 
 Since bowel movement depends so largely upon 
 the stimulus derived from eating, it is evident that 
 regularity of bowel movement depends upon regu- 
 larity of eating. 
 
 If a full meal cannot be taken, some fresh fruit, 
 as an apple or two, or a couple of oranges, may 
 serve the purpose to maintain the normal rhythm. 
 When strong stimulation of the colon is needed 
 a bran biscuit may be added with advantage, to- 
 gether with a dose of paraffin. 
 
110 COLON HYGIENE 
 
 Tea and Coffee 
 
 Tea and coffee contain two substances the 
 poisonous effects of which are well known, viz: 
 caffein, a nerve poison practically identical with 
 uric acid, and tannin, an astringent well known 
 as one of the constituents of oak bark and many 
 other vegetable substances. A cup of "good" 
 coffee contains four grains of caffein and two of 
 tannin. There is, in fact, nearly three times as 
 much uric acid in a cup of coffee, in the form of 
 caffein, as in an equal quantity of urine. The ef- 
 fect of tannin upon animal tissues is well shown 
 in the process of tanning, by which animal skins 
 are converted into leather. Tannin is an active 
 poison to the mucous membrane of the stomach 
 and intestines; it not only interferes with the di- 
 gestive processes, but it produces changes in the 
 mucous membrane by which its power to respond 
 to the delicate impressions made by the food is 
 lessened. The result is diminished intestinal move- 
 ment and constipation. 
 
 Everyone is familar with the use of astringent 
 or tannin-containing remedies in diarrhea. How- 
 ever beneficial tannin may be in cases in which the 
 bowels are abnormally active, certainly its effects 
 are nothing but pernicious when habitually used. 
 The average civilized man requires stimulation of 
 his food tube rather than the use of substances 
 which produce a paralyzing effect. 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 1 1 ! 
 
 Insufficient Fluid 
 
 Most persons who suffer from constipation ha- 
 bitually drink too little water. Women drink less 
 than men. It is difficult to account for this scanty 
 use of a necessary of life, which costs little and is of 
 such inestimable value to the body. Water is far 
 more immediately necessary for the support of life 
 than is food. A man may live six weeks or two 
 months without tasting food in any form, but a 
 few days at the most is the limit of human life 
 without water. The consequence of a scanty use 
 of water is abnormal dryness of the feces, which 
 delays their passage through the lower colon, and 
 often causes an actual stoppage in the pelvic colon 
 or the rectum. 
 
 Persons who sweat much, either as the result of 
 hot weather, vigorous exercise, or hot baths, are 
 likely to suffer from constipation, unless special 
 care is taken to supply the body with water suffi- 
 cient to make good the loss. The skin ordinarily 
 throws off as perspiration an ounce and a half of 
 water each hour, or more than a quart in twenty- 
 four hours. By active exercise or sweating baths- 
 this amount may be increased to thirty or forty 
 ounces in an hour. The kidneys excrete two to 
 three pints daily. It is evident, then, that care 
 must be exercised to replace the water that is lost 
 through the skin and kidneys. 
 
 In diabetes there is a great loss of water through 
 
112 COLON HYGIENE 
 
 the kidneys. This also must be made up by drink- 
 ing. If these losses are not made good, the thirsty 
 tissues will absorb as much water as possible from 
 the feces, thus causing hardening and retention in 
 the lower bowel. 
 
 Scanty and highly colored urine is an evidence 
 that the tissues are in need of water. Dryness of 
 the skin often testifies to the same need. 
 
 Water should be taken in proper quantity ir- 
 respective of thirst. It may be made palatable by 
 the addition of fresh fruit juices. 
 
 For the average person a good plan is to take 
 a couple of glasses of water on rising, and the same 
 amount before retiring at night. A glassful should 
 be taken half an hour before dinner and supper, 
 and an equal amount two hours after eating. The 
 free use of oranges or orange juice, and of other 
 juicy fruits, serves the same purpose as water drink- 
 ing, to the extent of the liquid which they supply. 
 
 Persons suffering from obesity or diabetes are 
 sometimes restricted in the drinking of water, with 
 the result that constipation is produced, if this con- 
 dition does not already exist. This should never 
 be done. 
 
 In all cases in which there is a tendency to dry- 
 ness of the stools, water should be taken in increased 
 quantity. It is important in such cases also to di- 
 minish the amount of salt eaten. The addition of 
 salt to the food creates thirst for water to dissolve 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 1 13 
 
 it and to aid in its elimination through the skin 
 and the kidneys. 
 
 Children as well as adults need much more 
 water than they are usually given. Meat eaters 
 and those who use salt freely require a much larger 
 amount of water than do those who adhere to a low 
 protein dietary and who use little salt. 
 
 Irregular Sleep 
 
 The resumption of bodily activity on rising in 
 the morning is one of the important means by 
 which the bowels are made to act with regularity, 
 by stimulating the colon to empty a portion of its 
 contents into the rectum. When the hours of 
 sleep are irregular, and especially when insufficient 
 time is devoted to sleep, this physiological stimulus 
 is lacking, and constipation may be one of the evil 
 consequences resulting. Loss of sleep causes loss 
 of tone in the intestinal muscles, as well as ot 
 general muscular tone, and also lack of appetite, 
 thus diminishing the normal stimuli to bowel move- 
 ment, and so easily leading to constipation. Even 
 when the bowels do not move soon after rising, 
 the stimulus of rising after a good night's rest at 
 least aids in the filling of the pelvic loop, which 
 then only requires the stimulus of breakfast to 
 cause a normal bowel action. Regularity of sleep 
 is almost or quite as necessary for regular bowel 
 movement as is regularity of meals. 
 
114 COLON HYGIENE 
 
 Incorrect Breathing 
 
 A child does not have to be taught to breathe. 
 It breathes instinctively and hence correctly, for 
 all instinctive movements are physiologically and 
 hence correctly performed. But the breathing 
 muscles are voluntary muscles, and hence may be 
 controlled by the will. This fact permits modifi- 
 cations of the act of breathing, which may or may 
 not be physiological. Unfortunately, the condi- 
 tions of civilized life are such as lead to serious 
 perversions of the breathing process. Normally, 
 when air is inhaled the whole chest is enlarged, but 
 the chief movement is at the lower sides of the 
 chest. This broadening of the chest at its lowest 
 part stretches the diaphragm and thus gives it an 
 opportunity to exert its greatest force. Its form be- 
 ing arched, this is highly important. If its ends 
 are held in place, the top of the arch can descend 
 only a little, and while breathing is ineffective, the 
 lungs being imperfectly expanded, the compression 
 of the abdominal organs is equally inefficient. The 
 diaphragm, it must be remembered, is a double act- 
 ing pump. It creates a suction in the chest, while 
 at the same time it produces pressure in the abdo- 
 men. If its work is imperfectly done in one direc- 
 tion, it fails equally in the other. 
 
 The compressing movements produced by the 
 diaphragm at each inspiration are, when efficient, 
 of great service in assisting the movements of the 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 1 1 5 
 
 food along the alimentary tube. Acting upon the 
 stomach, which lies just beneath it, the diaphragm 
 churns the food and aids in pushing it along into 
 the intestine. Acting upon the colon, which on the 
 left side lies in contact with it, the diaphragm ren- 
 ders great assistance in helping to push the food 
 along toward the rectum. 
 
 But it is especially in the act of defecation that 
 the action of the diaphragm is important. The 
 very first step in the process of unloading the bowel 
 is in the sinking of the colon by a very deep 
 breath. If the sides of the chest are compressed 
 by belts or a corset, so that they cannot expand, 
 the diaphragm cannot descend more than a short 
 distance, and its action is inefficient. As a result, 
 the fecal matters stored up in the descending and 
 pelvic colon are not pushed onward to the rectum, 
 and the bowel is only partially emptied. Thorough 
 natural bowel movement is not possible without 
 free and vigorous movement of the diaphragm. 
 
 So, too, if the diaphragm is weak because of ha- 
 bitual shallow breathing, the result of a bad posi- 
 tion in sitting at work or study, the same result 
 follows. A position which hampers the move- 
 ments of the chest thus leads to constipation. 
 
 The ordinary house chair, especially the rock- 
 ing chair and easy chairs in general, train the body 
 in unhealthy attitudes and compel shallow breath- 
 ing. When the chest is depressed, as when sitting 
 in a hollow-backed chair, the abdominal muscles 
 
116 COLON HYGIENE 
 
 are relaxed, and the diaphragm cannot act well. 
 There can be no compression of the abdominal 
 viscera without a tense condition of the abdominal 
 muscles. In most constipated persons these mus- 
 cles are so relaxed and flabby that they render lit- 
 tle service. The colon in such cases is compressed 
 so feebly in defecation that it is never properly 
 emptied except when the stools are made fluid by 
 a laxative or by an enema. 
 
 When, on the other hand, the chest is raised, as 
 shown in the accompanying cut, the abdominal mus- 
 cles are stretched, they are thus made tense, and the 
 colon is kept under constant pressure, by which its 
 contents are moved along at the proper rate; and 
 when defecation occurs, these tense, well-developed 
 muscles are ready to do their necessary part of the 
 work 
 
 Probably the majority of sedentary men and 
 most civilizd women spend the greater part of 
 their lives under conditions which induce imperfect 
 breathing and lead to weakness of the abdominal 
 muscles, and so to constipation. 
 
 When we consider how universal among civilized 
 women is the practice of compressing the waist 
 by corsets or bands, we find a ready explanation of 
 the fact that four-fifths of them suffer all their lives 
 from constipation, while a large proportion suffer 
 more or less from disorders peculiar to their sex 
 which are by many supposed to be a necessary bur- 
 den laid upon them, and an inevitable consequence 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 1 17 
 
 of femininity but are really due to causes which 
 might be easily avoided. 
 
 Deficient Exercise 
 
 The relation between exercise and breathing and 
 the necessity for vigorous and untrammeled action 
 of the diaphragm have been already referred to in 
 the preceding paragraphs. Exercise promotes 
 bowel action, not only by aiding respiration and in- 
 ducing vigorous movements of the diaphragm, but 
 by calling into strong action the muscles of the 
 abdomen, and by raising the general muscular tone 
 of the body. 
 
 The excellent effects that walking has upon 
 bowel activity are well known. Riding is also of 
 great advantage in the same way. These exer- 
 cises, as well as many others, mechanically stimu- 
 late the colon as well as all parts of the intes- 
 tinal tract, by communicating to it a continued 
 series of slight shocks, by which reflex movements 
 are excited. The active play of children is as 
 necessary to maintain proper bowel action as for 
 muscular development. The movements of skip- 
 ping, hopping, jumping, are especially useful, be- 
 cause they induce sudden vigorous contractions of 
 the abdominal muscles, and vigorous diaphragm 
 movements by which the colon is compressed and 
 stimulated. The folk dancing of the middle ages, 
 which has been revived in recent years, is for the 
 
118 COLON HYGIENE 
 
 above reasons to be highly commended as a health 
 measure. It is important, however, to make a clear 
 distinction between the varied and vigorous move- 
 ments of the folk dance, in simple dress and under 
 wholesome conditions, and the monotonous and re- 
 strained movements of the social dance, in full 
 dress and under conditions ahvays physically, and 
 not infrequently morally, unwholesome. 
 
 Those whose occupations are such as to give 
 them plenty of exercise are fortunate in being able 
 to lead lives which in large measure conform to 
 natural requirements. Such persons never need 
 suffer from constipation if they eat proper food, 
 drink an abundance of water — at least three to 
 five pints daily — and take care to give the bowels 
 an opportunity for movement after each meal, and 
 promptly whenever there is a "call" for evacua- 
 tion. 
 
 Those who are compelled to lead sedentary lives, 
 and especially women, whose lives are nearly always 
 more or less sedentary in character, must take daily 
 and regular exercise of a sort calculated to benefit 
 the bowels if they would escape the evils of consti- 
 pation and its secondary results. Some of the special 
 exercises which have been shown by experience to 
 be of greatest service in combating constipation 
 will be described in a subsequent chapter. The ex- 
 ercises of greatest value are those which strengthen 
 the abdominal muscles. A spring abdominal sup- 
 porter will usually render great service (page 298). 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 1 19 
 
 Resisting the "Call" 
 
 The practice of resisting the "call" of Nature 
 to discharge from the body accumulated wastes and 
 rubbish is almost universal among civilized people, 
 as the result of refinement of manners and modesty 
 which lead to the concealment of certain animal 
 functions as much as possible. That this is the 
 result of what is commonly called false modesty 
 cannot be denied, and yet there are few who would 
 desire that this so-called false modesty should be 
 altogether laid aside. It is important, however, 
 that every person, children as well as adults, and 
 at a very early age, should be fully instructed re- 
 specting the evil results of resisting and thus thwart- 
 ing one of the most important of the bodily func- 
 tions. 
 
 The "call" signifies that the pelvic colon is full 
 of feces, and that a sufficient amount of fecal matter 
 has been pushed down into the rectum to arouse the 
 center of defecation and cause it to set in operation 
 the automatic processes concerned in bowel move- 
 ment. The colon is contracting, and there is a 
 tendency for the anus to relax, which must be 
 forcibly resisted to prevent immediate discharge of 
 feces. The feces are normally stored in the pelvic 
 colon, the portion which lies just above the rectum. 
 So long as they remain here, there is no desire for 
 movement, but when a portion of fecal matter 
 has been pushed down into the rectum, the time 
 
120 COLON HYGIENE 
 
 for evacuation has come, and the fact is indicated 
 by a more or less urgent "call." When the feces 
 are fluid, they reach the lowest part of the rectum 
 at once, and the "call" is a very urgent one; but 
 if they are of normal consistency, they are at first 
 retained in the upper part of the rectum, and the 
 "call" is less imperative, and may be suppressed by 
 strong resistance. 
 
 If, for any reason, the bowels are not permitted 
 to move at once, the "call" usually disappears after 
 a few minutes, and may not reappear until after 
 the next meal or even the next day. In the mean- 
 time, the feces which have entered the rectum lie 
 there, and through the absorption of water by the 
 intestines become each hour drier and harder, so that 
 when the "call" comes again as the result of more 
 feces being forced into the rectum and further dis- 
 tention produced, evacuation may be difficult or im- 
 possible without mechanical aid. 
 
 It is possible, also, that the fecal matters which 
 have been carried down to the lower part of the 
 colon may be returned. It is not probable that this 
 occurs to any great extent, however, for new install- 
 ments of feces are continually coming down from the 
 upper part of the intestine, and hence the feces 
 simply accumulate, first in the pelvic colon, then 
 in the iliac and ascending colon, and finally in the 
 transverse colon, and even in the cecum and ascend- 
 ing colon. 
 
 Although the bowels may be permitted to movej 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 121 
 
 when the next "call" occurs, the colon may not 6e 
 fully emptied. The colon contents may by this time 
 have become so dry and hard that the colon can- 
 not be emptied by an ordinary effort. Thus there 
 is left a residue* in the pelvic and descending colon, 
 which is likely to increase from day to day, or at 
 least as often as there is failure promptly to answer 
 the "call" to evacuation. 
 
 As the necessary result of this gradual accumula- 
 tion, the pelvic loop of colon becomes distended 
 more and more. This fact accounts for the varia- 
 tion in the size of this part of the colon which is 
 far greater than in any other part. The late Dr. 
 Byron Robinson of Chicago found in two hundred 
 carefully measured pelvic colons a variation in 
 length from five inches to thirty-three inches. The 
 writer has several times encountered at the operat- 
 ing table cases in which the pelvic colon was be- 
 tween two and three feet in length. 
 
 This stretching may extend to other parts, af- 
 fecting chiefly, of course, the movable parts of the 
 colon. The transverse colon often becomes loaded 
 with delayed and dried feces, which in thin persons 
 may be felt as hard irregular masses lying in the 
 region of the umbilicus. 
 
 The cecum is also often found greatly distended 
 as the result of this hoarding of feces by resisting 
 the "call". It is very probable that the fecal mat- 
 ters are sometimes forced back into the transverse 
 colon and the cecum by the strong contractions of 
 
122 COLON HYGIENE 
 
 the colon in attempts at defecation. When a "call" 
 is experienced, there are at once set up colon con- 
 tractions which would expel the feces if permitted 
 to do so ; but as the anus is held closed by voluntary- 
 contractions, the feces cannot be forced downward 
 after the pelvic colon is filled, and the natural re- 
 sult is a slipping back of fecal matters into the first 
 half of the colon, some portion even reaching the 
 cecum. 
 
 By resisting and ignoring the kindly hint of Na- 
 ture, that the body requires an opportunity to dis- 
 pose of its poisonous wastes and refuse, thousands, 
 perhaps we should say millions, of men and women 
 have brought upon themselves untold miseries, and 
 have shortened their lives and have greatly impaired 
 their efficiency and usefulness. Not a few persons 
 are almost at once conscious of injury. A dull 
 headache appears. There is less appetite than 
 usual for the next meal. Sleep is less sound and re- 
 freshing. The urine has a stronger odor, and the 
 breath is offensive. These are simply the evidences 
 of poisoning by absorption of toxins. The absorb- 
 ent process which dries out and hardens the feces, 
 carries with the water that is taken up and poured 
 into the blood, quantities of poisons which it holds in 
 solution. These poisons overwhelm the liver with 
 unnecessary labor, tax the kidneys, irritate or stupe- 
 fy the brain and nerves, and disturb every bodily 
 function. 
 
 The prompt evacuation of the bowels in response 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 123 
 
 to Nature's "call" is a sacred obligation which no 
 person can neglect without serious injury. Ig- 
 norance of this fact is one of the chief causes of 
 the prevalence of constipation, a condition in which 
 the body becomes a storehouse of the most disgust- 
 ing and offensive material, which saturates the tis- 
 sues with its horrible effluvium and its virulent 
 poisons and taints the very springs of life. 
 
 This fault is perhaps more common in America 
 than in any other part of the world, especially in 
 the cities. In English, German, French and Aus- 
 trian cities places are abundantly provided, where 
 well kept toilet conveniences are offered at a very 
 small cost. One sees often in Vienna such notices 
 as the following: "Urinal free. Seats, one 'heller' 
 (a farthing or half cent)." The toilet arrange- 
 ments at railway stations are sanitary and well 
 cared for. There is room for great improvement 
 in this particular in this country. Mothers should 
 give more attention to the habits of their children 
 in this respect. School teachers, at least in the pri- 
 mary grades, should instruct their pupils concern- 
 ing the importance of giving prompt heed to the 
 "call" of the bowels for attention. Among savages 
 this function receives much attention. A missionary 
 physician tells of an Arab who declined to live in 
 Aden because the city regulations required that the 
 bowels should be evacuated only in certain places, 
 as in all civilized communities, rather than any- 
 where at any time the "call" demanded. 
 
124 COLON HYGIENE 
 
 The worst results of these habits of postponing 
 attention to the bowels to a convenient time, is the 
 fact that the "call" after a time ceases. It is no 
 longer made; or, if made, is so faint that it is not 
 recognized. The continued pressure of the mass 
 of hardened feces upon the nerves of the rectum 
 destroys their sensibility, so that the "reflex" is no 
 longer in operation. The defecatory center is not 
 notified that evacuation is necessary, and the ac- 
 cumulation of feces continues with no remonstrance. 
 Quite a large proportion of chronic sufferers from 
 constipation reach this condition before they really 
 begin to give serious attention and study to the 
 matter. 
 
 There are thousands of persons who never ex- 
 perience a desire for evacuation of the bowels ex- 
 cept after taking a laxative. The cure of cases of 
 this sort is one of the most difficult problems con- 
 nected with this class of disorders, but with the 
 thorough co-operation of the patient the normal 
 "call" may be restored by patient application of the 
 proper measures. No victim of this condition 
 should rest contented until this has been accom- 
 plished. For the body to be deaf to the needs of its 
 sewage system, by which its most poisonous waste 
 matters are removed, is a far more dangerous and 
 serious condition than for it to be deprived of the 
 sense of hearing. Fortunately this condition, se- 
 rious as it is, may usually be relieved by the use of 
 simple means. 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 125 
 Hurried Defecation 
 
 The act of defecation normally occupies but a 
 few seconds. The colon acts with so much cel- 
 erity that when watched under the penetrating X- 
 rays its movements can scarcely be followed by the 
 eye. There is a vigorous surging which passes in 
 waves from one end of the colon within a few 
 seconds, and then the colon is at rest ; but it is easily 
 seen that the contents have either disappeared or 
 have been moved forward. After a normal move- 
 ment, the colon is empty from the splenic flexure 
 down, and there is seen to have been a forward 
 movement of feces in other parts of the colon. 
 
 There are, however, so many persons who are 
 not quite normal, even though apparently healthy, 
 that perfectly natural bowel movements are prob- 
 ably the exception rather than the rule among civil- 
 ized adults. It often happens, at least after the 
 first portion of feces has been expelled, that a 
 second or even a third installment is brought down, 
 and a second or third action of the colon occurs. 
 The pelvic loop of the colon has in most people 
 been so much abused by resisting the "call" and so 
 compelling an accumulation here, that it is often 
 so much dilated or so much folded upon itself that 
 two or even three efforts are necessary for its com- 
 plete evacuation. To accomplish this requires a 
 little patience, and sometimes a great deal of per- 
 severing effort. The first partial movement empties 
 
126 COLON HYGIENE 
 
 the rectum and the lower part of the distended pel- 
 vic colon. By straining, that is, by strong contrac- 
 tions of the diaphragm, aided perhaps by pressure 
 with the hands upon the lower abdomen on the left 
 side, an additional portion of feces may be forced 
 down into the rectum. This excites the center of 
 defecation just as touching the back of the throat 
 excites the vomiting center, causes the colon to con- 
 tract, the anus to open, and reinforcement of the 
 contraction of the abdominal muscles with a second 
 bowel movement results. In like manner, a third 
 or even a fourth movement may be secured. 
 
 But this requires time, perhaps five, ten or even 
 fifteen or twenty minutes. The bustling or wor- 
 ried business man, the hurried clerk, the student 
 who has barely time to reach his school before roll 
 call, the housekeeper who is perhaps superintend- 
 ing some important culinary operation, these and 
 a thousand other busy individuals believe that they 
 have not time to devote to a function looked upon 
 as grossly animal and repulsive, and so it is cut 
 short at the earliest moment possible. 
 
 Ignorance of the consequences does not, how- 
 ever, prevent the evil effects which certainly follow 
 such neglect. The feces left behind in the half- 
 emptied pelvic colon become so dry and hard be- 
 fore another opportunity for evacuation occurs 
 that the difficulty is greater than before, and so a 
 considerable quantity, often an increasing amount, 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 127 
 
 of feces is held back, and cumulative constipation 
 is established. 
 
 Undue haste in bowel movement is also en- 
 couraged by unsuitable toilet arrangements. In 
 many places, especially in country districts, the in- 
 sufferable "privy" still exists, and is a most prolific 
 source of misery. The use of such a place for 
 evacuation of the bowels is at all times more or 
 less inconvenient and offensive, and on this account 
 is avoided as much as possible, leading to neglect 
 of the "call", and when necessity compels the use 
 of the offensive place, the visit is made as brief as 
 possible. 
 
 In cold weather, the danger of injury from ex- 
 posure of the unprotected body to a low tempera- 
 ture, sometimes even zero weather, is very great, 
 especially in the case of feeble or delicate persons. 
 Extreme cold also tends to prevent effective defeca- 
 tion, by contracting the anal muscles so strongly 
 as to negative the efrect of the automatic reflex by 
 which the outlet is normally opened. 
 
 The toilet should be conveniently placed, and 
 should be made as warm and comfortable as a 
 bathroom. It should be kept in so neat and sani- 
 tary a condition as to be in no way offensive. 
 
 The time devoted to defecation should be suffi- 
 cient for complete emptying of the descending and 
 pelvic colon. All fullness and weight in this region, 
 as well as the sense of fullness in the rectum, which 
 commonly prompts to bowel movement, should 
 
128 COLON HYGIENE 
 
 disappear after defecation. If necessary to occupy 
 the mind by glancing over a morning paper, this 
 will do no harm provided that it is not allowed to 
 interfere with the muscular efforts which may be 
 necessary to force down into the rectum from the 
 pelvic colon a sufficient amount of feces to induce 
 an expulsive action of the bowels. 
 
 Unnatural Posture in Defecation 
 
 The natural position in defecation is squatting 
 or crouching. All savages assume this attitude in 
 moving the bowels. The reason for this, as has 
 been fully explained in a preceding chapter, is that 
 in the natural position the abdomen is compressed 
 by the thighs, and thus the feces are forced into the 
 rectum, and so the automatic process of bowel 
 movement is set going. 
 
 The ordinary water closet is so constructed that 
 natural bowel movement is impossible in its use* 
 By bending strongly forward, some compression of 
 the thighs may be effected, but it is only in the 
 squatting position that the pressure can be as great 
 as is possible and often necessary. By placing a 
 low platform in front of the closet so as to raise 
 the feet eight or ten inches, this objection may be 
 very largely overcome. Some closets are now made 
 with this idea in view, and are a great improvement 
 over the old style. The same thing may be ac- 
 complished by the use of a chamber. 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 129 
 
 Many surgeons have learned the importance of 
 the squatting position to secure complete evacua- 
 tion of the bowels and bladder, and forbid the use 
 of the bed pan in any except the feeblest cases, re- 
 quiring the patient to be supported as may be neces- 
 sary while using the chamber. 
 
 Although this matter is one of very great im- 
 portance, it is more than likely that half a century 
 will pass before manufacturers and plumbers, upon 
 whom we are dependent for these necessary con- 
 veniences, recognize to any appreciable extent the 
 need of a change in closet construction. 
 
 The Use of Tobacco 
 
 Numerous laboratory experiments have shown that 
 the use of tobacco in any form has a paralyzing 
 effect upon the splanchnic nerves. Without the aid 
 of the sympathetic nerves, normal, rhythmical 
 bowel movements are impossible. The fact that 
 some persons observe an apparently favorable in- 
 fluence from smoking, is accepted as evidence that 
 the effects of the weed are favorable to the bowels. 
 These cases are exceptional. They happen to be 
 cases in which there is an excessive action of the 
 sympathetic nerves, so that the paralyzing influence 
 of tobacco seems to be helpful. In general, and in 
 the long run, however, the use of tobacco is highly 
 injurious. Kreuznach, of Vienna, has recently 
 shown that nicotine produces arteriosclerosis of the 
 
130 COLON HYGIENE 
 
 splanchnic vessels. That is, it produces hardening 
 and degeneracy of the vessels which supply the 
 colon and other abdominal organs. This change 
 in the blood vessels gives rise to general degeneracy 
 and atony, and hence to constipation, by which it 
 is always accompanied. 
 
 Alcohol and Other Narcotic Drugs 
 
 Alcoholic beverages of all sorts tend to produce 
 constipation, by causing chronic and intestinal ca- 
 tarrh, ulcer of stomach, and paralysis of the sym- 
 pathetic nerves. 
 
 Opium in all forms produces a specific effect in 
 paralyzing the bowels. In former times in was 
 customary to administer opium in sufficient doses 
 in certain cases to cause complete inactivity of the 
 bowels for a week or more. In such cases the con- 
 stipation induced was often the beginning of 
 chronic constipation of a most obstinate character. 
 
 The very common use of opium for the relief of 
 pain is a prolific cause of constipation, especially 
 among women. The fact that a laxative drug is 
 given to overcome the constipating tendency, does 
 not prevent the evil that results, but only adds 
 another. 
 
 Bromides and sleep-producing or hypnotic drugs 
 of all sort tend to produce constipation, although 
 some of them are less harmful than opium. For- 
 tunately, the use of these drugs may easily be dis- 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 131 
 
 pensed with when the resources of hydrotherapy 
 and other physiologic means are made use of. 
 
 The Use of Purgatives 
 
 One of the best evidences of the universal prev- 
 alence of constipation is afforded by the enormous 
 use of laxative or purgative drugs. The quantity 
 of this class of drugs used annually far exceeds 
 that of any other class. Besides drugs proper, 
 there is sold a prodigious quantity of laxative 
 mineral waters. It would be difficult in the average 
 community to find a household in which there is 
 not kept on hand a supply of some favorite laxa- 
 tive. The columns of the newspapers are filled 
 with advertisements of drugs which act upon the 
 bowels. Many housekeepers lay in supplies of 
 bowel medicines as regularly as the stock of gro- 
 ceries and other necessaries, and medical advice is 
 sought no more in relation to one than the other. 
 Laxative drugs have come to be regarded as staple 
 commodities which stand, next to food and drink, 
 as necessities. 
 
 Unquestionably, an inestimable amount of in- 
 jury is done by the use of these intestinal irritants, 
 most of which are nostrums of the worst sort, pro- 
 viding temporary relief only at the expense of 
 permanent injury. 
 
 It is not too much to say that all laxative drugs 
 
132 COLON HYGIENE 
 
 are harmful. There is no such thing as a harm- 
 less laxative medicine. 
 
 Laxative drugs act in different ways, and some 
 are more harmful than others. "Salines" impose 
 heavy burdens upon the kidneys, besides irritating 
 the bowels. When long used, they produce an 
 obstinate intestinal catarrh, which aggravates the 
 constipation. Almost without exception, laxative 
 drugs increase the condition which they are sup- 
 posed to cure. The most difficult cases to cure are 
 those which have long made use of laxative drugs. 
 
 Not the least of the damage done by laxatives 
 is the injury to the stomach. The drug is ad- 
 ministered by the mouth for the purpose of reliev- 
 ing a difficulty at the other end of the digestive 
 tract, than which it would seem nothing could be 
 more irrational. In a large number of cases of 
 constipation, the whole trouble is a loss of the rec- 
 tal reflex. The feces accumulate in the rectum or 
 the pelvic colon because of failure of the discharg- 
 ing mechanism. What could be more really ab- 
 surd and irrational than to irritate and worry the 
 stomach and the whole twenty-five feet of small 
 intestine, besides the cecum and the greater part 
 of the colon, just for the purpose of exciting to 
 action the last six inches of the intestinal tube, the 
 rectum. 
 
 As we shall see in the further study of this 
 subject, constipation is not a disease, but only a 
 symptom The morbid condition upon which the 
 
HABITS WHICH GIVE RISE TO CONSTIPATION 133 
 
 symptom depends may be any one of a score or 
 more of things, or several in combination. For the 
 most part, these conditions, as we shall presently 
 see, are such as are certain to be greatly aggravated 
 by the use of laxatives or irritants of any sort. 
 
 The use of laxatives as a routine measure, a 
 practice which is almost universally in vogue with 
 the profession as well as with the laity, is most illog- 
 ical, and is productive of a prodigious amount of 
 injury. 
 
 The use of laxative drugs to cure constipation 
 must be regarded as one of the most certain and 
 prolific causes of this condition, and a person who 
 has once formed the habit of using laxatives must 
 as a rule continue the practice as long as he lives, 
 unless he is so fortunate as to find some one wise 
 enough to show him the way out of his troubles. 
 
 The systematic use of purgatives for "cleansing 
 the system," irrespective of the state of the bowels, 
 is a very old custom still in vogue in various places. 
 Nothing could more effectively operate to produce 
 the most obstinate sort of constipation. An ex- 
 cellent illustration of this baneful practice and its 
 results came under the writer's observation a num- 
 ber of years ago. A man past middle life sought 
 relief from a constipation which he declared re- 
 sponded to no drug in any dose. He had taken 
 half a pound of "salts" without effect. The history 
 which he gave revealed the cause of his unfortunate 
 condition. The patient stated that when a child 
 
134 COLON HYGIENE 
 
 at home it was the practice of his mother to give 
 to each child every Friday night a dose of "salts" 
 as a sort of house-cleaning process to prepare the 
 family for the proper observation of Sunday — 
 whatever that may have meant. The result was 
 that after a few years the weekly dose was quite 
 insufficient, and daily doses of increased size be- 
 came necessary. The dose increased from year to 
 year, and new remedies were adopted as one after 
 another ceased to be effective; until the whole list 
 of laxatives had been exhausted. 
 
 In another case, a patient who had taken at first 
 small doses of licorice root and other simples, had 
 become so constipated that even croton oil no longer 
 produced laxative effects. The only remedy that 
 remained at all efficient was a tablespoonful of un- 
 ground mustard seed taken before breakfast. Many 
 more lamentable examples of addiction to harm- 
 ful and disease-producing laxatives might be cited, 
 but such cases are familiar to every trained nurse as 
 well as all physicians. 
 
Disorders of the Digestive Tube 
 Associated with and Caus- 
 ing Constipation 
 
 The disorders of the alimentary canal, which 
 give rise to constipation, are very numerous. Some 
 are purely functional in character, others are or- 
 ganic or structural affections. All are of a nature 
 which cannot possibly be relieved by laxative drugs, 
 at least, more than temporarily, and most are likely 
 to be made worse by their use, a fact which shows 
 the folly of depending upon them for the relief 
 of this condition, which unfortunately is rarely 
 treated in any other way. 
 
 First let us study some of the functional dis- 
 turbances of the digestive tract, which may give 
 rise to inaction of the bowels. 
 
 Lack of Appetite. — Lack of desire for food is a 
 common result of constipation, and may also be a 
 cause of this condition, when it is the result of 
 some other cause, as lack of exercise, excessive 
 heat, etc. With loss of appetite there is absence 
 of relish for food, and hence a failure of the meal 
 to awaken those lively peristaltic movements which 
 are essential to propel forward in the colon the 
 hardening masses of fecal matter which are stored 
 up in its lower segments waiting to be discharged. 
 These who eat without appetite are always consti- 
 
 135 
 
136 COLON HYGIENE 
 
 pated, and while the lack of relish for the food 
 encourages the constipation, the latter still further 
 lessens the appetite, and so the difficulty continual- 
 ly becomes more and more aggravated. 
 
 In this condition there is usually found a coated 
 tongue and foul breath, which point unmistakably 
 to a state of low vital resistance and malnutrition. 
 With the removal of these conditions by the appli- 
 cation of the proper measures, the appetite will 
 improve and the bowels, if not organically crip- 
 pled, will assume their normal rhythm. 
 
 Atony or weakness of the muscular walls of the 
 colon itself, is no doubt sometimes a cause of very 
 obstinate constipation. This condition sometimes 
 appears to be hereditary. It occurs in families as 
 a family characteristic. It is possible that in these 
 cases the condition is only the result of improper 
 care in infancy. No doubt a great number of 
 cases of chronic dyspepsia and chronic constipation 
 have their origin in the very earliest period of in- 
 fancy. Prolonged indigestion in an infant may so 
 damage its stomach and colon as to cripple these 
 organs for life. The delicate structures of an in- 
 fant's colon are easily stretched to such a degree 
 as to be damaged permanently and to become a 
 source of trouble during the whole after life. 
 Cases of constipation which have existed for a life 
 time are not infrequently encountered. Fortunately 
 even these cases are often curable by the use of 
 rational means. 
 
DISORDERS OF THE DIGESTIVE TUBE 137 
 
 Atony of the colon is especially likely to be 
 encountered in persons long past middle age; but 
 it is not at all rare to meet cases, especially wo- 
 men, in which the colon shows all the signs of 
 senility at forty years, or even earlier. The age 
 of the colon, like that of the arteries, is not to be 
 reckoned in years, but is to be judged by the ex- 
 isting degree of tissue change. A colon which 
 has been continually distended with putrefying 
 feces or poisonous gases during twenty years or so 
 is a senile colon, no matter what the reputed age 
 of the possessor. An eminent French physiologist 
 has said, "A man is as old as his arteries;" and 
 it might be said with almost equal truth, "A man 
 is as old as his colon." 
 
 In fever the colon as well as other parts of the 
 intestine is in a state of semi-paralysis. The ele- 
 vated temperature of the blood paralyzes the sym- 
 pathetic nerves, and so interferes with rhythmical 
 movements and causes constipation. Very hot 
 weather and exposure to high artificial tempera- 
 tures produce a like effect. 
 
 In cases of extreme obesity, in which there are 
 abnormal fat accumulations and fatty changes in 
 various parts of the body, the intestine suffers with 
 other tissues, even undergoing fatty changes which 
 render it less effective in transporting its contents 
 and resulting in stasis and constipation. 
 
 Painful Affections of the Abdomen. — Pain in 
 almost any part of the abdomen may cause consti- 
 
138 COLON HYGIENE 
 
 pation, through reflex arrest of peristaltic move- 
 ment, and spasm of the ileocecal or pelvi-rectal 
 valve. Chronic appendicitis is a common cause of 
 this form of colon inactivity, sometimes called 
 reflex constipation. The discovery of the fact that 
 there is a sphincter at the ileocecal valve explains 
 the relief from constipation, which often follows 
 an operation for appendicitis. Painful affections 
 of the uterus, ovaries and uterine appendages, in- 
 flammation of the prostate gland, painful hemor- 
 rhoids, rectal ulcer, and possibly ulcer of the 
 stomach and duodenum may, through reflex dis- 
 turbance of the sympathetic centers cause spasm of 
 the ileocecal sphincter, and obstinate constipation. 
 The most common cause of spasm of the ileocecal 
 valve, however, is inflammation of the appendix, an 
 affection which is even more common than is gener- 
 ally supposed. The infection of the colon commonrv 
 known as colitis readily extends into the appendix, 
 which often becomes adherent to the lower end of the 
 small intestine and interferes with the action of the 
 ileocecal valve, both by causing spasm of the ileo- 
 cecal sphincter and by preventing proper closure of 
 the lips of the valve, so as to prevent the reflux of 
 fecal matters from the colon. Interference with 
 the closure of the valve is also prevented by ad- 
 hesions of the appendix to the cecum, a very common 
 condition. Delay of the intestinal contents in the 
 lower part of the small intestine, either by spasm of 
 the valve or incompetency (failure to close), is one 
 
A Spaslic Colon. Darkest Portion Shows Dila- 
 tation — Arrows Indicate Spastic Condition 
 
DISORDERS OF THE DIGESTIVE TUBE 139 
 
 of the most pernicious forms of constipation. The 
 delay occurs at a point where putrefaction is most 
 active and absorption is also greatest. Cases of this 
 sort usually present very active symptoms of in- 
 testinal toxemia. Such persons are often victims 
 of attacks of violent headache. They show much 
 indican in the urine, are likely to have high blood- 
 pressure, and sooner or later develop chronic Bright's 
 disease of the kidneys. 
 
 Painful affections of the abdominal organs, such 
 as chronic appendicitis, colitis, adhesions following 
 an abdominal operation, pelvic or bladder disease, 
 may cause constipation, not only by producing reflex 
 spasm of the ileocecal valve, but by restraining the 
 patient from making the necessary effort to expel 
 the colon contents. Such efforts naturally increase 
 the pain, and so are dreaded and avoided. In such 
 cases the application of a hot fomentation over the 
 seat of pain before ordering the effort to move the 
 bowels will often render very great service. A 
 hot sitz bath may be taken instead. A hot water bag 
 placed against the abdomen may be found useful 
 both by lessening pain and as a mechanical aid to 
 defecation. 
 
 Depressing Emotions. — Fear, disappointment, 
 anger, or any depressing emotion, may, through 
 the sympathetic nerves, cause reflex constipation. 
 Prof. Anderson, an eminent Danish physiologist 
 who has made an exhaustive study of the influence 
 of the emotions, found that depressing emo- 
 
140 COLON HYGIENE 
 
 tions powerfully excite the sympathetic. Some 
 persons are unable to move their bowels be- 
 cause they are in a state of fear that they cannot. 
 All persons are more or less at the mercy of the 
 sympathetic nervous system, but some much more 
 than others. A curious example of the effect of 
 mental influence is the case of a woman mentioned 
 by Hertz whose bowels were obstinately constipated 
 but who had a good movement of the bowels 
 whenever she gave one of her children a dose of 
 castor oil, although the oil produced no effect when 
 she took it herself. 
 
 Obstructions. — Probably half the cases * of 
 chronic constipation are really due to some form 
 of obstruction at some point along the food canal. 
 It matters little, apparently, where the obstruction 
 is; the effect is delay, and this results in constipa- 
 tion from absorption of water and the resulting ex- 
 cessive dryness of the feces. 
 
 Contracted Colon. — In cases of reflex spasm of 
 the colon, or spasm due to colitis, the intestine can 
 often be felt under the fingers, to which it gives 
 the sensation of a rubber tube. When the contrac- 
 tion is due to colitis, the intestine is not only hard 
 and contracted but is also tender to pressure, some- 
 times extremely so. In such cases there are likely 
 to be present various reflex pains such as headache, 
 or pains in the legs, which in women suggest 
 ovarian inflammation or some other pelvic disease. 
 
 This condition of the colon is most often found 
 
DISORDERS OF THE DIGESTIVE TUBE 141 
 
 on the left side, at the site of the iliac colon, some- 
 times extending upward, and may occasionally be 
 felt in the pelvic colon also. The cecum and the 
 ascending colon are not infrequently affected, and 
 more rarely the transverse colon, which may be 
 felt as a hard round cord passing across the abdo- 
 men just above or below the umbilicus. 
 
 These spastic contractions are not permanent; 
 they come and go, sometimes disappearing while 
 under the examining finger; but they cause great 
 delay in the progress of the feces along the bowel, 
 and thus lead to excessive dryness and constipation. 
 
 Organic or permanent contraction of the colon 
 is a much more serious condition than simple spas- 
 tic contraction, because usually incurable, except by 
 surgery. It may be the result of peritonitis or of 
 colitis followed by pericolitis and adhesions. 
 
 Incompetency of the Ileocecal Valve 
 
 One of the consequences of chronic constipation 
 is incompetency of the ileocecal valve. By over- 
 distention the intestine becomes so widely dilated 
 that the lips of the valve no longer come in contact 
 and so its check valve action is prevented, and the 
 putrefying contents of the colon readily pass back- 
 ward into the small intestine. The infection thus 
 induced may travel backward the entire length of 
 the small intestine, to the stomach, liver, gall-blad- 
 der, pancreas and duodenum, giving rise to ulcer 
 
142 COLON HYGIENE 
 
 of the stomach, duodenal ulcer, gall-stones, inflam- 
 mation of the gall-bladder, infections of the liver 
 and jaundice resulting from these conditions, and 
 pancreatitis, a still more serious condition. It is 
 probable also that the worst effects attributed to 
 alimentary toxemia or intestinal intoxication are 
 seen in cases in which through incompetency of the 
 ileocecal valve, the putrefying materials of the 
 colon find ready entrance to the small intestine, 
 and are thus rapidly absorbed. 
 
 When the ileocecal valve is incompetent, it is 
 of course incompetent to gases as well as liquids. 
 There is evidence that the valve sometimes becomes 
 incompetent to gases while it still may be com- 
 petent to liquids. Patients whose ileocecal valves 
 are incompetent suffer from great discomfort be- 
 cause of inability to expel gas from the intestine. 
 When an expulsive effort is made gas passes in both 
 directions, that is, out of the body and back up into 
 the small intestine. 
 
 There is reason to believe that the failure of 
 short-circuiting operations either with or without 
 removal of the colon or a part of it, is often due to 
 loss of the function of the ileocecal valve, which is 
 of course removed with the colon. Recent ad- 
 vances in the department of surgery make it pos- 
 sible to remedy this defect by constructing an ar- 
 tificial ileocecal valve. 
 
 In like manner incompetency of the ileocecal 
 check valve interferes with the complete and proper 
 
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DISORDERS OF THE DIGESTIVE TUBE 143 
 
 emptying of the colon and thus becomes a cause as 
 well as a consequence of constipation. 
 
 The worst evils resulting from incompetency 
 of the ileocecal valve may be corrected in the ma- 
 jority of cases by removing the cause, namely, re- 
 lieving the constipation to which it is due. While 
 in a majority of cases, this may be accomplished by 
 the employment of the thoroughgoing measures 
 suggested in this volume, a few cases remain in 
 which an operation is required for breaking up 
 adhesions of the pelvic colon and removing the 
 other obstructions which have been the cause of 
 the overloading and the distention of the cecum, 
 which produced the incompetency of the valve. 
 Fortunately such cases may be relieved by surgical 
 operation, and it is even possible to repair the valve 
 so as to enable it to resume its function. 
 
 "Greedy Colon" 
 
 Goodhard, Schmidt, and others hold that abnor- 
 mal dryness of the feces may be produced by excess- 
 ive digestion and absorption, leaving so little residue 
 that the bulk of the intestinal contents is too small 
 to stimulate peristaltic action. It is possible that 
 cases of this sort may exist, but it seems more prob- 
 able that the fault is a too concentrated diet or 
 deficient gastric or intestinal secretion, at least in 
 most of the cases in which this diagnosis has been 
 made. It is much easier to see how the intestine can 
 
144 COLON HYGIENE 
 
 fail to do its work completely than to understand 
 a condition of excessive activity of digestion. 
 
 Excessive Dryness of the Feces 
 
 Persons who sweat profusely, even if their 
 habits are active, often surfer from constipation, 
 because of dryness of the stool. This condition may 
 also result from sweating baths and from the 
 drinking of an insufficient amount of fluid, as we 
 have already seen. 
 
 Excessive activity of the kidneys, as in diabetes 
 mellitus or diabetes insipidus, may prockice the same 
 result, by depriving the feces of water. 
 
 A deficiency of fat in the food leads to constipa- 
 tion in like manner. The presence in the feces of 
 a certain amount of unabsorbed fat is useful not 
 only to prevent excessive dryness, but to prevent 
 too great adhesiveness of the feces and thus to fa- 
 cilitate movement along the colon. 
 
 Contraction of the Ileocecal Valve 
 
 Various causes, as we have already seen, may 
 cause delay at the ileocecal valve, such as reflex 
 spasm set up by pain in neighboring organs, and the 
 irritation of condiments or imperfectly digested 
 foodstuffs. Colitis may cause thickening of the 
 valve and partial obstruction. Recent observations 
 have shown that the valve is sometimes too small 
 at birth, causing congenital constipation. This 
 
DISORDERS OF THE DIGESTIVE TUBE 145 
 
 form of incompetency of the valve is fortunately 
 very rare, and like others may be remedied. 
 
 Incompetency is both a consequence and a cause 
 of constipation. The valve is often rendered in- 
 competent by over-stretching of the bowel, usually 
 the result of obstruction in the descending or 
 pelvic colon. When once the valve is crippled, the 
 constipation is made worse by the loss of the check- 
 valve action which aids the forward movement of 
 the bowel contents, so that the food residues oscil- 
 late back and forth between the large and the 
 small bowel, until the water content is so much re- 
 duced that a pasty mass is formed, which is pushed 
 forward only with great difficulty by the bowel, 
 which at this point is adapted to dealing with thin 
 liquids rather than semi-solid adhesive materials. 
 
 The stagnation resulting from this condition 
 readily leads to infection of the cecum and appendi- 
 citis, and to more remote affections, through ex- 
 tension of the infection backward along the small 
 intestine to the duodenum, stomach, gall-bladder, 
 liver and pancreas, causing inflammation of the gall 
 ducts and gall-bladder, gall-stones, pancreatitis and 
 possibly diabetes, duodenal and gastric ulcers, and 
 various other allied affections. 
 
 Delay at the Hepatic Flexure 
 
 • The cecum is a rather thin walled pouch, in- 
 tended only for holding a small amount of liquid 
 for a comparatively short time. When the bowels 
 
146 COLON HYGIENE 
 
 are restrained from normal action, by resisting the 
 "call" for evacuation, the cecum becomes filled by 
 the backing up of semi-solid feces, which cause it 
 to sag down, and in time dilate and displace it. 
 The over-filled and heavy cecum drags heavily 
 upon the hepatic flexure, and so narrows the pas- 
 sage along the colon at this point as to produce 
 partial obstruction and delay in the movement of 
 feces from the cecum over into the transverse 
 colon. The observations of Virchow, Lane and 
 others have shown that adhesions are often found 
 at this point, which narrow the bowel and pro- 
 duce more or less obstruction and delay. 
 
 Delay at the Splenic Flexure 
 
 At the splenic flexure the bowel forms a very 
 acute angle, so that the colon is narrower at this 
 point than at any other. The overloading of the 
 transverse colon, which results from gross neglect 
 to attend promptly to the "call" of Nature, drags 
 heavily upon the splenic flexure, and causes such 
 narrowing of the bowel as to result in very con- 
 siderable obstruction and delay. 
 
 As the feces are banked up in the transverse 
 colon, this segment of the intestines sags more and 
 more until it may be stretched to the very bottom 
 of the pelvis. This process of prolapse is, of course, 
 greatly favored by weakness of the abdominal 
 muscles. 
 
DISORDERS OF THE DIGESTIVE TUBE 147 
 Delay at the Pelvi-rectal Junction 
 
 The passage from the colon to the rec- 
 tum, which is closed and opened by the falling 
 and rising of the pelvic loop of the colon, 
 is sometimes obstructed by thickening due to in- 
 flammation or ulceration. Sometimes the pelvic 
 colon becomes adherent to the pelvic floor so that 
 it cannot rise, and there is more or less obstruction 
 to the passage of feces into the rectum. In such a 
 case, there must of necessity be an accumulation of 
 feces in the lower bowel above the rectum, and 
 as a consequence cumulative constipation will be 
 found present. 
 
 The inflammatory process by which adhesions 
 and thickenings are produced is easily set up by the 
 colitis and other infections which are the natural 
 consequence of retention of feces in the bowel for 
 an undue length of time, such as results from 
 postponing the evacuation of the bowels, or from 
 excessive dryness of the stool from any cause. 
 Stasis, that is, delay of fecal matters at any point 
 in their journey through the colon, is likely to be 
 followed by inflammation not only within the 
 bowel but in the whole thickness of the bowel wall 
 and on its outer surface, thus leading to adhesions 
 and loss of contractile power. An inflamed and 
 thickened bowel is always crippled and incapable 
 ot contracting upon the bowel contents in a normal 
 way. 
 
148 COLON HYGIENE 
 
 Thickening of Houston's Valves 
 
 It is believed by some surgeons that these mem- 
 branous valves sometimes become so thickened as 
 to form an obstruction to the passage of feces. The 
 writer has seen no cases of this sort, although he 
 has carefully looked for them in hundreds of 
 cases. 
 
 Delay at the Outlet 
 
 Failure of the anus to relax when the colon con- 
 tracts interferes seriously with defecation, and may 
 prevent movement of the bowels. This may re- 
 sult from various causes, as a weak stimulus from 
 the defecation center, or unduly contracted anal 
 muscles. This point will be considered further in 
 another connection. 
 
 Kinks 
 
 Virchow was the first to observe the conditions 
 to which Mr. Lane, an eminent London surgeon, 
 first applied the term "kinks," but his observations 
 received little attention until within recent years. 
 Mr. Lane has shown the important relation which 
 they bear to the functions of the colon and to 
 general conditions of the body arising from auto- 
 intoxication. 
 
 The narrowing which occurs from folding of 
 the bowel or compression by bands, is usually the 
 result of adhesions. The obstruction thus pro- 
 
DISORDERS OF THE DIGESTIVE TUBE 149 
 
 duced causes stasis, or stagnation, and increase of 
 putrefactive changes in the foodstuffs, with infec- 
 tions of the intestine, from which come still further 
 thickening and narrowing of the bowel, and so 
 continual increase of delay and of constipation. 
 
 The pelvic loop sometimes becomes so much 
 elongated that when it is emptied and falls over 
 backward into the pelvis it makes several folds 
 upon itself. If adhesions form an extension of infec- 
 tion through the wall to the outer surface, as they 
 sometimes do from pericolitis, "kinks" are developed 
 which may require surgical means of relief. 
 
 "Lane's Kink" 
 
 Within the last dozen years there has been much 
 discussion in medical circles about a "kink" located 
 at the lower end of the small intestine within a 
 few inches of the ileocecal valve. Lane, of Lon- 
 don, has attributed to these adhesions of the terminal 
 ileum stasis or stagnation of materials in the ileum, 
 and most of the disease conditions which develop in 
 the stomach, liver, duodenum, gall-bladder and pan- 
 creas. 
 
 Recent observations made at the operating table 
 by the writer and others, clearly show, however, that 
 "Lane's Kink" is practically always associated with 
 incompetency of the ileocecal valve. It seems most 
 probable that adhesions of the lower end of the 
 ileum are the result of inflammation caused by the 
 
150 COLON HYGIENE 
 
 backing up of fecal matters into the small intestine 
 through the open valve. It has also been observed 
 that these "ileal kinks," first mentioned by Lane, 
 are seldom obstructive, the real cause of the delay in 
 the small intestine associated with "kinks" being 
 incompetency of the ileocecal valve, which also is 
 the cause of the "kink." 
 
 Mechanical Effects of Constipation 
 
 Fecal accumulations in the rectum, and in some 
 cases possibly also accumulations in the pelvic colon 
 and in the caecum, may give rise to various reflex 
 pains on account of pressure. Pain in the buttocks 
 and the back of the thigh, and a dull pain in the 
 region of the sacrum is often due to the pressure of 
 fecal matters in the rectum. Neuralgia of the 
 testicles and of the ovaries, and dysmenorrhea in 
 young women, is often traceable to this cause. Ab- 
 normal sexual excitability, especially during sleep, 
 is also sometimes traceable to accumulations in the 
 rectum. Itching about the anus, is often caused 
 by the pressure of a small amount of fecal matter 
 in the anal canal, disappearing at once when the 
 feces are removed. Hemorrhoids may be caused by 
 the pressure of fecal matters upon the hemorrhoidal 
 veins; and varicocele, if not produced, is certainly 
 aggravated by accumulations of fecal matters in the 
 iliac colon. 
 
 Headache and sometimes vertigo and a sensation 
 
DISORDERS OF THE DIGESTIVE TUBE 151 
 
 of exhaustion and depression are symptoms com- 
 monly experienced by persons suffering from cumu- 
 lative constipation. These symptoms may be the 
 result of reflex action, which seems most probable, 
 or they may be in whole or in part the result of 
 chronic poisoning due to the absorption of long 
 retained fecal matters. The fact that the symptoms 
 disappear almost immediately when the bowel is 
 emptied by an enema, does not necessarily indicate 
 that the act is reflex. Effects due to autointoxication 
 are the result of over-saturation of the blood with 
 poisons derived from the bowel contents. When, 
 by removal of the source of the poisons, the intake 
 ceases, the liver and kidneys quickly clear the blood 
 of the subtle intoxicants, and the nerve disturbance 
 ceases. 
 
 The Bad Effects of Straining 
 
 The violent straining occasioned by the presence 
 of dry and hard feces in the rectum and lower colon 
 is not merely an inconvenience, but often results in 
 serious and sometimes fatal injury. 
 
 One of the most common results of straining at 
 stool, especially when prolonged or repeated several 
 times daily, is hemorrhoids, or piles. These are 
 excrescences which form just in the anus, or at its 
 lower edge. The accumulation of fecal matters in 
 the rectum obstructs the flow of blood in the veins 
 which have their origin at this point, and in straining 
 these veins become greatly distended with blood; 
 
152 COLON HYGIENE 
 
 their walls become thickened, forming irregular 
 masses which are usually forced out when the bowels 
 move. As the result of the straining, and often 
 as the result of the use of rough toilet paper, the deli- 
 cate mucous membrane becomes abraded or cracked, 
 infection occurs, and the hemorrhoids become in- 
 flamed and swollen causing still further thickening. 
 Thus the hemorrhoids gradually increase in size, un- 
 til they may become so large that the anal sphincters 
 are over-stretched and become relaxed, and in time 
 the rectum may be pushed outside whenever the 
 bowels move. Prolapse of the rectum is most likely 
 to occur in children and emaciated adults. 
 
 In persons suffering from arteriosclerosis or de- 
 generation of the blood-vessels, especially aged per- 
 sons, straining at stool may cause rupture of a blood 
 vessel and sudden death. In angina pectoris a 
 spasm msiy result from straining at stool, sudden 
 death having been known to occur in cases in which 
 the heart was very feeble. 
 
 Stricture 
 
 The bowel may be narrowed by the contraction 
 of the scar left behind by a healed ulcer due to tuber- 
 culosis, typhoid fever or other cause. When such 
 strictures are present, the peristaltic movements of 
 the intestine are often so strong as to 'be visible in 
 a thin patient through the abdominal walls. Such 
 cases require operation. 
 
DISORDERS OF THE DIGESTIVE TUBE 153 
 
 Cancers and Tumors 
 
 Cancer of the colon is not infrequent, constitut- 
 ing about nine per cent of all cancers. Cancer 
 occurs most frequently in the cecum or ascending 
 colon, and next most frequently in the rectum or 
 pelvic colon, points at which the greatest de- 
 lay of the feces occurs. 
 
 Cancer of the colon is not infrequently secondary 
 to cancer in some other location. When cancer 
 exists or has existed in the breast, stomach, or else- 
 where, obstinate constipation should lead to a care- 
 ful physical examination including an X-ray ex- 
 amination of the colon with special reference to 
 the presence of organic obstruction. 
 
 Intussusception 
 
 Acute obstruction due to "telescoping" of the 
 intestine requires immediate surgical attention. 
 
 Chronic constipation is held to be sometimes 
 due to such a telescoping of the pelvic colon into 
 the rectum. This condition is probably quite 
 rare, but it possibly may be more frequent than 
 has been hitherto supposed. Such cases require 
 surgical attention. 
 
 Disturbance of the Discharging Mechanism 
 
 The feces are formed by the gradual absorption 
 of the digested foodstuffs, and the drying out of 
 
154 COLON HYGIENE 
 
 the mass of debris left through the absorption of 
 water. When thus formed, the feces are slowly 
 moved along the colon toward the lowermost part 
 of the colon proper, the pelvic colon, where they 
 are deposited, the pelvic loop filling from below 
 upward. The filling begins at the bottom of the 
 loop, the junction of the colon with the rectum. 
 
 At this point a new mechanism is provided to 
 deal with the feces. They have become so dried 
 and hardened by the absorption of their liquid 
 part that they are no longer suited for transpor- 
 tation by the feeble peristaltic waves which con- 
 tinually course from one end of the intestinal tract 
 to the other. They must be dealt with by a more 
 powerful mechanism. This may be termed the 
 discharging mechanism or device, and it is certainly 
 a most remarkable apparatus. We need not repeat 
 here the description of the process of defecation, 
 which has been given in detail elsewhere. Briefly 
 summarized, it consists of three voluntary and four 
 involuntary acts. 
 
 1. Voluntary acts in defecation: (a) Con- 
 traction of the diaphragm, (b) Contraction of the 
 abdominal muscles, (c) Compression of the abdo- 
 men by the thighs. 
 
 2. I voluntary acts in defecation: (a) Con- 
 traction of the colon, (b) Relaxation of opening of 
 the anus, (c) Reinforced contraction of the ab- 
 dominal muscles, (d) Strong contraction of the 
 levator ani muscles lying behind the rectum. 
 
DISORDERS OF THE DIGESTIVE TUBE 155 
 
 When each of these several distinct voluntary 
 and involuntary acts is promptly and efficiently 
 performed, defecation is complete, and at least the 
 lower half of the colon is completely emptied. 
 Failure at any point results in incomplete defeca- 
 tion, and fecal matters are left behind, producing 
 cumulative constipation. Let us note the different 
 ways in which these several acts may be interfered 
 with. 
 
 Weak Contraction of the Diaphragm 
 
 If the diaphragm is weak from disuse or general 
 feebleness, if its movements are obstructed by cor- 
 sets or waist bands, if it is tied fast by adhesions 
 from pleurisy or crippled by hernia, it cannot act 
 efficiently, and the amount of feces pushed down 
 into the rectum may not be sufficient to call forth 
 a vigorous act of defecation. The result will be 
 that the colon will be only partially emptied, and 
 cumulative constipation will result, though the 
 rectum may be fully emptied and no sense of dis- 
 comfort be felt. The pelvic colon will be grad- 
 ually stretched by the accumulating contents until 
 it becomes enormously enlarged and forms a reser- 
 voir of putrefying feces, by which the body is con- 
 tinually poisoned, and a great variety of diseased 
 conditions produced. This condition is very com- 
 mon as the natural result of sedentary habits and 
 corset-wearing. 
 
156 COLON HYGIENE 
 
 Feeble Contraction of the Abdominal 
 Muscles 
 
 When the abdominal muscles are weak, relaxed, 
 separated, or otherwise inefficient, the results are 
 the same as when the diaphragm fails to do its 
 duty, for the two sets of muscles must work in co- 
 operation. 
 
 The ordinary water-closet seat renders complete 
 efficiency of the abdominal muscles and diaphragm 
 practically impossible, since it does not permit of 
 pressure by the thighs, an essential voluntary act 
 in defecation. 
 
 Deficient Contraction of the Colon 
 
 A feeble, dilated, inflamed, thickened, elongated, 
 adherent, overloaded, obstructed colon, cannot 
 possibly contract with sufficient vigor to empty it- 
 self of its unclean contents. Yet such is the chronic 
 condition of the colon in a very large proportion 
 of cases as the result of the operation of some one 
 or more of the causes which have been enumerated 
 in the foregoing paragraphs. 
 
 Nervousness, apprehension or fear may prevent 
 the normal reflex from acting. Hysteria or melan- 
 cholia may paralyze a patient's colon as well as an 
 arm or a leg. 
 
 Injured Levator Ani Muscles 
 
 When these muscles are crippled so that they 
 cannot contract properly, the rectum is not emptied 
 
DISORDERS OF THE DIGESTIVE TUBE 157 
 
 but remains relaxed and filled with feces, which 
 give rise to much annoyance, and may become a 
 cause of rectal ulceration and hemorrhoids. The 
 levator ani muscles are often damaged by lacera- 
 tions at childbirth, or by the prolonged contact 
 with hardened feces, which gives rise to atrophic 
 changes. Laceration of the perineum permits the 
 pelvic floor and anus to bulge forward, stretching 
 the rectum and thus creating a wide reservoir for 
 feces. 
 
 Anal Disease 
 
 Pain arising from ulcer, fissure, fistula or in- 
 flamed hemorrhoids may cause so strong a con- 
 traction of the anal sphincters that they fail to re- 
 lax at the command of the defecation center, so 
 that the bowel must force the feces down through 
 the rectum in opposition to these muscles. This 
 condition exists more frequently than was formerly 
 supposed. Many cases of obstinate constipation 
 have been cured by an operation for removal of 
 painful hemorrhoids or relief of a painful ulcer or 
 fistula. 
 
 Pregnancy, extreme retroversion of the uterus, 
 an enlarged and painful prostate, malignant or 
 other growths in or about the rectum, and in wo- 
 men, rectocele, from laceration of the perineum, 
 are causes of interference with the proper action 
 of the defecating mechanism. 
 
 The usual result of this defective action is to 
 
158 COLON HYGIENE 
 
 leave a quantity of feces in the rectum or the pelvic 
 colon or in both cavities. The retained feces be- 
 come dry and hard, sometimes to a surprising de- 
 gree, and form a mechanical obstruction which re- 
 sults in a damming back of the feces which are 
 left to accumulate in sections of the colon higher 
 up. 
 
 Loss of Rectal Reflex 
 
 The key to the automatic or involuntary act of 
 defecation is the rectal reflex, which is discharged 
 by contact of the feces with the walls of the rectum. 
 The long retention of feces in contact with the 
 rectal nerves destroys their sensibility and so the 
 reflex is lost. This is one of the worst results of 
 the disturbances in the defecating mechanism, 
 which have been above enumerated. Patients suffer- 
 ing with this form of constipation often report that 
 they have felt no desire for evacuation of the 
 bowels for years. The loss of hearing, or even of 
 the sense of sight, would really be less of a 
 calamity in many cases than the permanent loss 
 of this useful reflex, which is one of the most im- 
 portant protective mechanisms with which the body 
 is provided. Fortunately, however, the reflex 
 generally may be restored. 
 
 Disease of the spinal cord may permanently de- 
 stroy the defecatory center. Constipation is some- 
 times a most troublesome symptom in locomotor 
 ataxia. 
 
Alimentary Toxemia or Intestinal 
 Autointoxication 
 
 Bouchard, an eminent French physician, was 
 first to coin the word autointoxication, and to point 
 out the various ways in which the disease may be 
 produced by poisons generated in the body. He 
 called special attention to the fact that the intes- 
 tine, and especially the colon, is a prolific source 
 of poisons. Some of these poisons are excreted by 
 the liver. The bile, as shown by Bouchard, is six 
 times as poisonous as the urine, producing poison 
 enough within ten hours to cause death. The 
 mucous membrane of the intestine has been shown 
 to be another source of highly active poisons, 
 which are separated from the blood by the mucous 
 membrane and thrown into the cavity of the in- 
 testine to be removed from the body. 
 
 Still another source of intestinal poisons is the 
 putrefaction of that portion of the protein of the 
 food which fails to undergo absorption. 
 
 The bile, mucous, and other secretions of the 
 intestine and the adjacent glands also undergo put- 
 refaction when conditions are favorable. 
 
 This putrefactive process is, as shown by 
 Pasteur, the result of the growth of certain forms 
 of bacteria. These putrefactive bacteria are found 
 everywhere. They are present in great nura- 
 
 159 
 
160 COLON HYGIENE 
 
 bers wherever putrefaction is taking place. The 
 flesh of every dead animal is filled with teeming 
 millions of these poison-forming microbes within a 
 few hours after death. A piece of flesh taken from 
 an animal just killed, and placed in a tightly sealed 
 glass jar, will be found in a few days in an 
 advanced state of putrefaction. Experiments of 
 this kind were made by Professor Tissier of the 
 famous Pasteur Institute of Paris. He found it 
 impossible to obtain meat so fresh that it did not 
 contain bacteria of different species sufficient to 
 produce complete putrefaction. As ordinarily 
 eaten, the flesh of animals is always in a state of 
 more or less advanced putrefaction, and hundreds 
 of millions of living bacteria are found in every 
 morsel. This is true even when the flesh has 
 been cooked; ordinary cooking does not destroy 
 the putrefactive bacteria. 
 
 Commercial cow's milk also abounds with bac- 
 teria, some of which are of putrefactive sort. Street 
 dust consists very largely of putrefactive bacteria 
 derived from animal feces which have been drop- 
 ped in the street and ground into dust by passing 
 vehicles. It is evident then, that the human intes- 
 tine is very greatly exposed to infection by putre- 
 factive bacteria; and it needs no argument to show 
 that any delay of food residues capable of putre- 
 faction, together with the bile, mucus, and other 
 constituents of the feces, must result in the pro- 
 duction of a large amount of intestinal poison. 
 
ALIMENTARY TOXEMIA 161 
 
 In view of these facts, it is safe to say that the 
 worst effects of constipation are those which 
 arise from intestinal autointoxication. Not only 
 Bouchard, but Tissier, Combe, Bourget, Lane of 
 London, and a great number of able medical ex- 
 perts in all parts of the world have within the last 
 few years recognized the great and far-reaching 
 destructive effects of the absorption of bacterial 
 poisons from the intestinal tract. 
 
 It is entirely possible for a person to suffer from 
 intestinal toxemia without constipation, as in 
 cholera morbus, cholera infantum and summer 
 diarrhoeas of infancy; but it is impossible to have 
 constipation without intestinal autointoxication. 
 The fact that the symptoms of toxemia do not oc- 
 cur in every case is no evidence that they are not 
 present. The body must be unduly exposed to 
 toxic influences, even though it may possess to such 
 an extraordinary degree the power to defend itself 
 against these intestinal poisons that immediate visible 
 effects do not appear. 
 
 When the intestinal mucous membrane is intact, 
 it is able to exclude most of the intestinal poisons, 
 acting like a filter, which permits only the useful 
 substances to enter the blood. The liver, the 
 largest gland in the body, possesses the power to 
 destroy poison to a considerable degree. There 
 are various other organs of the body, such as the 
 glands of internal secretion, of which the thyroid 
 
162 COLON HYGIENE 
 
 gland is a conspicuous example, which aid in the 
 destruction of poisons. The kidneys both destroy 
 and eliminate poisons, and the skin and the lungs 
 also share in this protective work. 
 
 So long as the defensive powers of the body re- 
 main intact, enormous quantities of poisons may be 
 produced in the intestine without apparently evil 
 results. This is the reason why many constipated 
 persons seem to suffer no ill effects from intestinal 
 inactivity. 
 
 In every case, however, the time comes sooner 
 or later when the intestinal filter no longer acts 
 sufficiently in excluding poisonous matters — when 
 the liver is no longer able to destroy all the poisons 
 brought to the blood; w^hen the thyroid and other 
 glands have become worn out with over-activity ; 
 when the kidneys have ceased to be able to main- 
 tain the normal degree of blood purity by the ex- 
 cretion of poisons. 
 
 When the symptoms of toxemia appear, the fact 
 shows that the poison-destroying mechanism of 
 the body is broken down ; the great margin of safety 
 which Nature provides against emergencies, has 
 been used up; the defenses against autotoxins have 
 been swept away, and the tissues are flooded with 
 these subtle and mysterious disease-producing ele- 
 ments. 
 
 The simple and latent forms of constipation are 
 those in which the symptoms of toxemia are specially 
 prominent, for the reason that in these forms of 
 
ALIMENTARY TOXEMIA 163 
 
 constipation the delay occurs in those portions of 
 the digestive canal in which the intestinal contents 
 are still fluid, a condition in the highest degree 
 favorable to the growth of putrefactive bacteria. 
 Besides being fluid, the contents of the small in- 
 testine and first part of the colon contain a 
 varying amount of protein, the food element on 
 which putrefactive bacteria thrive, and from which 
 alone they are able to produce their deadly toxins. 
 
 In cumulative constipation, the protein is almost 
 wholly absorbed before the lower colon is reached, 
 and the amount of water is reduced to such an 
 extent that putrefaction is necessarily limited, and 
 the resulting autointoxication is proportionately 
 less. 
 
 In latent constipation, especially, the conditions 
 are in a high degree favorable for the development 
 of intestinal autointoxication. The stasis or stag- 
 nation above the ileocecal valve affords conditions 
 the most favorable for putrefaction and absorption 
 of putrefactive products. It is evident, then, that 
 the study of constipation cannot be complete with- 
 out a thorough study of intestinal toxemia. This 
 is especially true as regards the treatment of this 
 condition both with reference to the causes of the 
 constipation and its consequences. 
 
 Bacteria of the Intestine 
 
 Roger, the eminent successor of Bouchard, de- 
 scribed no less than one hundred sixty different spec- 
 
164 COLON HYGIENE 
 
 ies of bacteria which have been found in the alimen- 
 tary canal. Many of these produce no poisons. Others 
 produce simple organic acids which are under or- 
 dinary circumstances harmless; still others produce 
 alcohol, formic acid, butyric acid, and other sub- 
 stances which are unquestionably toxic, although 
 not appreciably so in the extremely minute quanti- 
 ties in which they are produced in the intestine 
 under strictly normal conditions. Still other mi- 
 crobes, of which some scores of species are found 
 in the intestine, produce subtle poisons which are 
 capable of causing deadly effects, even in very 
 minute quantities. Everyone is familiar with the 
 unpleasant effects of the volatile substances which 
 emanate from a mass of putrefying flesh. Head- 
 ache, nausea, and other symptoms may result from 
 the odors alone which arise from putrescent sub- 
 stances. These volatile substances are poisonous, 
 but other non-volatile poisons present are much more 
 active. Some are almost as powerful as the venoms 
 of snakes, which they resemble in chemical composi- 
 tion. The South American Indian poisons the 
 points of his deadly arrows by dipping them into 
 putrid flesh. Butchers as well as undertakers some- 
 times die as the result of a small cut made with a 
 knife soiled by contact with a dead body. The 
 same poisons are produced when putrefaction takes 
 place in the intestine. 
 
 None of the intestinal microbes are essential for 
 life or health. Pasteur supposed that all life was 
 
ALIMENTARY TOXEMIA 165 
 
 dependent upon microbes. One of his pupils, 
 Roux, showed this idea to be erroneous, at least as 
 regards vegetables, by causing beans to grow in 
 sterile soil and sterile water. Pasteur admitted his 
 error in regard to vegetable organism, but still 
 maintained that animals could not live without the 
 aid of intestinal bacteria. Nuttall and Thierfelder, 
 by experiments with guinea pigs, showed that these 
 animals could be brought into the world free from 
 germs, and made to grow on food which contained 
 no trace of bacteria. When th« animals were killed, 
 no bacteria were found in their intestines. Recent 
 experiments made by Roux showed that chickens 
 hatched and grown under sterile conditions thrived 
 better than chickens hatched under ordinary condi- 
 tions. 
 
 Numerous other experiments have confirmed 
 this fact, but most important of all were the obser- 
 vations of Levin at Spitzbergen, in the Arctic reg- 
 ion. This observer made careful examination of 
 scores of Arctic animals, and found that in the 
 majority of cases no bacteria were present in the 
 intestine. This fact will be easily understood 
 when the additional fact is known that the air, and 
 even sea-water, are in these cold regions practically 
 free from bacteria. 
 
 The fact that bacteria are present in the human 
 intestine is therefore no evidence that they supply 
 any human need. The presence of these minute 
 parasites is, instead, an unfortunate incident of our 
 
166 COLON HYGIENE 
 
 existence. Metchnikoff has shown that colon germs 
 in no way contribute to our well-being, but on the 
 contrary, are an undoubted cause of premature 
 senility, and the unnatural abbreviation of human 
 life, the sad lot of the average man. 
 
 Acid-Forming Bacteria 
 
 Professor Tissier, of Paris, well known as one 
 of the leading savants of the renowned Pasteur 
 Institute, many years ago made a profound study of 
 the bacteria of the intestine and established the 
 fact, which had been previously observed by Es- 
 cherich and others, that the intestine of a new born 
 babe is absolutely free from bacteria. Tissier made 
 an extended research of the manner of the invasion 
 of the intestine of the young child by bacteria. He 
 found that within about seven hours in summer 
 time, and twenty hours in winter time, when bac- 
 teria are less abundant in the air, the intestine of 
 the recently born child is found to be swarming 
 with bacteria, many of which are of the putrefactive 
 sort. Within a few days, however, the putrefactive 
 bacteria disappear, and a peculiarly shaped acid- 
 forming microbe, to which Professor Tissier gave 
 the name Bacillus bifidus, takes their place. 
 
 This observation was of the greatest importance. 
 It reveals the beneficent plan of Nature, by which 
 the young infant is protected from the deadly effects 
 of putrefactive organisms. So long as the Bacillus 
 
ALIMENTARY TOXEMIA 167 
 
 bifidus continues to hold its place as the dominant 
 microbe of the child's intestine, the stools are slightly 
 acid and the little one enjoys perfect health. The 
 child's intestine may be compared to a flower 
 garden which is so completely occupied by flowers 
 that there is no room for the growth of noxious 
 weeds. 
 
 As the child becomes older, and is fed upon 
 cow's milk, meat, and other foodstuffs which con- 
 tain putrefactive organisms, and is no longer nursed 
 at the breast, the Bacillus bifidus becomes less promi- 
 nent in the stools, putrefactive bacteria make their 
 appearance, the child becomes subject to constipa- 
 tion and diarrhoeas, and the troubles of life begin. 
 The stools, instead of being acid, acquire a foul 
 odor. In many instances, such symptoms of chronic 
 autointoxication, as rickets, scurvy, arrested growth, 
 emaciation, decay of the teeth, nasal catarrh, and 
 other evidences of physical weakness make their 
 appearance. 
 
 Infantile convulsions, night terrors, grinding the 
 teeth during sleep, fitfulness, feverishness, and num- 
 erous other symptoms of nervous disturbance in 
 infants, are directly due to poisoning as the result of 
 constipation, with intestinal putrefaction. So long 
 as the stool remains normally acid, constipation 
 does not occur, but when putrefaction and foul- 
 smelling feces occur then constipation appears with 
 a great variety of nervous and other symptoms which 
 are a natural consequence. 
 
168 COLON HYGIENE 
 
 A few years ago Massol, of Geneva, in study- 
 ing certain Bulgarian milk preparations discovered 
 a new lactic-acid-forming ferment. In testing its 
 properties he discovered that it possessed the faculty 
 of producing lactic acid in far greater quantities than 
 any other known ferment. The eminent Professor 
 Metchnikoff, of the Pasteur Institute, at once recog- 
 nized the value of this new discovery, and after a 
 careful study of the ferment, did not hesitate to 
 recommend it as a most important means of com- 
 bating many of the gravest forms of chronic disease, 
 and especially that most inveterate of all human 
 maladies, old age. 
 
 Professor Metchnikoff has long held the theory 
 that old age, as well as many common chronic dis- 
 orders, is due to poisons absorbed from the intes- 
 tines. These poisons are formed by certain germs 
 known as anaerobes. Some of these germs are found 
 in such great quantities in butcher's meat that Herte* 
 has given to them the name "meat bacteria." By 
 the use of meat these germs are introduced into 
 the intestine in great numbers. The poisons formed 
 by these germs are extremely virulent, and when 
 taken into the body, gradually break down the 
 liver, kidneys, and other defensive organs, and so 
 give rise to a large number of very common and 
 very serious diseases. This chronic poisoning first 
 makes its appearance in acute attacks, such as sick 
 headache, nervous headache, loss of appetite, coated 
 tongue, bilious attacks, irregular action of the 
 
ALIMENTARY TOXEMIA 169 
 
 bowels, diarrhea, appendicitis, febrile attacks resem- 
 bling malaria, and insomnia. 
 
 As the system becomes more and more saturated 
 with these poisons through the gradual failure of 
 the liver and kidneys and the constant multiplication 
 of the bacteria, other more chronic symptoms appear, 
 such as constant headache, mental confusion, neuras- 
 thenia, nervous exhaustion, gall-stones, hemorrhoids, 
 emaciation, browning of the skin, particularly about 
 the eyes, various skin diseases, especially acne, ec- 
 zema, psoriasis and urticaria, neuralgia, pain and 
 stiffness of the joints. After a time still worse con- 
 ditions make their appearance, such as Bright's dis- 
 ease, sclerosis or hardening of the liver, dropsy, 
 chronic rheumatism, and rheumatic gout. 
 
 Chronic autointoxication is unquestionably a 
 factor in nearly all chronic disorders, and lays the 
 foundation for tuberculosis, cancer of the stomach, 
 ulcer of the stomach, and other gastric disorders. 
 Many women supposed to be suffering from dis- 
 orders peculiar to their sex, are really suffering only 
 from autointoxication, which is the natural result 
 of prolapse of the viscera, colitis, and inattention to 
 the hygiene of the bowels. 
 
 It has long been known that the conditions above 
 mentioned may be greatly relieved by the use of 
 buttermilk and kumyss, but these remedies have 
 never gained very great confidence for the rea- 
 son that, while they have seemed to succeed remark- 
 ably in certain cases, in the majority of cases the 
 
170 COLON HYGIENE 
 
 relief obtained has been very temporary, and often 
 their use has been attended by complete failure. 
 The reason for this was the fact that the lactic fer- 
 ment of kumyss and buttermilk is not able to live 
 in the large intestine. This is the particular part 
 of the alimentary canal in which the poison-forming 
 anaerobes are found in largest numbers, especially in 
 the cecum. 
 
 Tissier's experiments showed that the Bulgarian 
 lactic ferment has such great vitality that it is able to 
 live in the colon. Its great activity in the formation 
 of acids enables it to kill off the anaerobes which can 
 live only in an alkaline medium. Fortunately the 
 new ferment is harmless, so that a person who is 
 suffering from autointoxication may, by introducing 
 into his alimentary canal a sufficient amount of the 
 lactic ferment, drive out the poison-forming germs, 
 or at least reduce their numbers to a very great ex- 
 tent. The importance of doing this will be realized 
 when it is known that the poisons which they form 
 are among the most highly toxic known. This is the 
 reason that constipation produces headache, and that 
 diarrhea is accompanied by such great exhaustion. 
 The headache and the prostration are simply results 
 of the poisons which are absorbed from the infected 
 intestines. 
 
 This ferment has been known for ages in Bul- 
 garia and the Orient generally. In Egypt it is 
 known as leben. In these countries a milk prepara- 
 tion containing the ferment is prepared by steriliz- 
 
ALIMENTARY TOXEMIA 17!. 
 
 ing the milk and adding the ferment to it. It 
 possesses the particular advantage that it does not 
 produce alcohol as does the kumyss ferment, and 
 when properly cultivated, it does not produce dis- 
 agreeable flavors by decomposing the caseins and 
 fats of the milk. 
 
 The use of the ferment has extended rapidly in 
 France and Switzerland, and has lately been intro- 
 duced into this country. For those who like milk 
 and are able to digest it readily, the milk prepara- 
 tion is very satisfactory, although the preparation 
 of the milk requires considerable care and pains to 
 prevent contamination. There are many, however, 
 with whom milk does not agree. Such persons 
 have been termed by Combe "casein dyspeptics." 
 For the benefit of such cases concentrated prepa- 
 rations of the ferment have been devised. Pure 
 cultures of the ferment are made in a bacteriological 
 laboratory and in concentrated form are made into 
 tablets. Three or four of these tablets taken after 
 or at meals in connection with a proper dietary, — 
 especially with the free use of farinaceous foods, and 
 maltose in the form of malt extracts or meltose — 
 develop rapidly, and by driving out the invading 
 anaerobes, stop the formation of poisons and give the 
 body an opportunity to clear itself from the accumu- 
 lated toxins, and thus establish conditions which 
 render recovery possible. Those who like milk, but 
 do not like it sour, may take it in its ordinary form, 
 adding the tablets. 
 
172 COLON HYGIENE 
 
 It is, of course, evident that a person adopting 
 this method should discontinue the use of meat en- 
 tirely, and should not use eggs freely. 
 
 Ancient Latin authors mention the use of sour 
 milk preparations by the primitive tribes which occu- 
 pied the country now inhabited by the Bulgarians 
 and other Balkan people by whom the Bulgarian 
 ferment is widely used. 
 
 The natives of Mesopotamia, living about Mount 
 Ararat make large use of the same ferment, which 
 they declare was preserved for them by the antedilu- 
 vian Noah; and it is certain that this ferment and 
 buttermilk prepared from it was well known to 
 Abraham and the other Hebrew patriarchs whose 
 use of it is mentioned in the Scriptures. 
 
 Natives of northern India make large use of a 
 sour milk preparation called dahi. An examina- 
 tion of a sample of this preparation, sent to us from 
 a friend living in Darjeeling, India, showed that it 
 contained an acid-forming organism identical with 
 the Bacillus Bulgaricus. A few years ago a medical 
 friend whom the author met in Edinburgh, Dr. 
 Matthieason, of Iceland, described to him a sour milk 
 preparation used in that country, known as "skyr," 
 which is made by first adding to the milk a "starter," 
 to which rennin is then added to curdle it. The 
 curd is separated from the whey and packed in casks 
 or barrels. Melted paraffin is poured over the sur- 
 face to preserve it. In this way it is kept for many 
 months, and is a valuable source of food in the win- 
 
ALIMENTARY TOXEMIA 173 
 
 ter season when milk is scarce. Doctor Matthieason 
 states that this product is found a highly efficient 
 remedy in relieving acute gastric and intestinal dis- 
 orders due to excessive meat-eating which is very 
 common in Iceland. A bacteriological study of skyr 
 made in the laboratory of the Battle Creek Sani- 
 tarium showed that it contains an acid-forming 
 organism resembling the Bacillus Bulgaricus which 
 grows very vigorously and produces large quantities 
 of lactic acid. 
 
 It thus appears that the use of lactic acid ferments 
 is a practice known to widely scattered nations and 
 from the most ancient times. The great care which 
 is taken by the most primitive people to preserve the 
 purity of the particular ferment which they employ, 
 and the high value which they place upon it in the 
 treatment of many diseases, leads one to wonder 
 that civilized people should have been so slow to 
 avail themselves of this valuable means of com- 
 batting some of the most dangerous and insidious 
 of the foes of human life. 
 
 Alimentary Toxemia 
 
 The condition known as intestinal autointoxica- 
 tion, intestinal toxemia, and more recently termed 
 alimentary toxemia, is one of the natural and most 
 far-reaching consequences of constipation and intes- 
 tinal stasis. All foodstuffs are capable of under- 
 going destructive change as the result of the action 
 
174 COLON HYGIENE 
 
 of germs upon them. Starches, dextrines, and sugars 
 (carbohydrates) ferment, while proteins putrify. 
 The products of the fermentation of carbohydrates 
 are acids which are harmless in the quantities in 
 which they are produced in the body. The products 
 of putrefaction are ptomaines, ammonia, and toxins, 
 all poisonous substances. Some of the ptomaines, 
 and toxins are closely akin to the venoms of poison- 
 ous serpents, and like them, are very active even in 
 very small quantities. 
 
 When there is delay in the movement of food- 
 stuffs along the digestive tract, fermentations or 
 putrefactions quickly begin. The immediate re- 
 sult will be the formation of odorless gases in the 
 intestines, with sour-smelling stools, if starch or 
 sugar is present in sufficient amount to give rise 
 to fermentation. If protein and fats are present 
 in large amount, then the result of delay will be 
 putrefaction and the formation of foul-smelling 
 gases and putrid stools. The sour stools of a 
 healthy infant may be put aside in a bottle, and will 
 undergo no change for an indefinite time. An 
 infusion of such stools may be injected into a small 
 animal without injury. An infusion from a putrid 
 stool, seething with the putrefaction of undigested 
 remnants of protein foodstuffs such as beefsteak, 
 mutton chops, pork, etc., will kill an animal very 
 quickly. Such a stool is swarming with deadly 
 bacteria, and is saturated with their poisons. Very 
 often these putrid masses have remained in the body 
 
ALIMENTARY TOXEMIA 175 
 
 for many hours or even days, during which time the 
 absorbents of the intestine are constantly sucking 
 up the poisons and distributing them throughout 
 the body, so that every cell and tissue is bathed 
 with them. 
 
 At first the evil effects of this systematic poison- 
 ing do not appear. Indeed, many years may elapse 
 before serious consequences make their appearance. 
 The reason for this is that the body is provided 
 with means of defence. The mucous membrane 
 acts as a filter to exclude poisons. The liver de- 
 stroys poisons. The thyroid gland, the suprarenal 
 capsules, and probably the spleen and several organs, 
 aid in the destruction of poisons. The suprarenal 
 glands are believed to be especially active in de- 
 stroying the poisonous pigments which are produced 
 by putrefaction in the intestine. After a longer 
 or shorter time these defences break down. The 
 mucous membrane becomes the seat of infection, — 
 colitis, — and allows a much larger quantity of 
 poisons to pass into the blood stream. The liver, 
 thyroid, and other poison-destroying organs become 
 damaged by overwork, and fail to keep the blood 
 clear of poisons. The kidneys are enormously over- 
 worked in their efforts to remove these deadly 
 poisons from the blood, and so lose their efficiency. 
 Now the effects of chronic poisoning begin to make 
 their appearance. Every organ and every function 
 of the body shows evidence of damage. The poisons 
 circulating in the blood irritate the walls of the 
 
176 COLON HYGIENE 
 
 blood vessels and cause first contraction, then hare - 
 ening and degeneration, or arteriosclerosis. The 
 brain and nerves show evidences of depression or 
 irritation, according to the nature of the dominat- 
 ing poisons. Headaches, neuralgia, neuritis, paraly- 
 sis, mental dullness, neurasthenia, even insanity, 
 are the results. Diseases of the liver, thyroid gland 
 and spleen develop. Skin diseases of various kinds, 
 and every sort of bodily derangement, are seen. 
 
Important Discussion of Alimen- 
 tary Toxemia Before the 
 Royal Society of Medi- 
 cine of Great Britain 
 
 About two years ago the subject of alimentary 
 toxemia was discussed in London before the Royal 
 Society of Medicine, by fifty-seven of the leading 
 physicians of Great Britain. Among the speakers 
 were eminent surgeons, physicians, and specialists in 
 the various branches of medicine. 
 
 Poisons of Alimentary Intestinal Toxemia 
 
 The following is a list of the various poisons 
 noted by the several speakers: Indol, skatol, phenol, 
 cresol, indican, sulphuretted hydrogen, ammonia, 
 histidine, urobilin, methylmercaptan, tetramethy- 
 lendiamin, pentamethylendiamine, putrescin, cadav- 
 erin, lecithin, neurin, cholin, muscarine, butyric 
 acid, beta-imidazolethylamine, methylgadinine, 
 ptomatropine, botulin, mytilotoxin, mytilo-conges- 
 tine, oxybetaine, tyramine, agmatine, tryptophane, 
 sepsin, indolethylamine, sulphemoglobine. 
 
 Of the thirty-six poisons mentioned above, several 
 are highly active, producing most profound effects, 
 and in very small quantities. In cases of alimentary 
 toxemia some one or several of these poisons is 
 
 177 
 
178 COLON HYGIENE 
 
 constantly bathing the delicate body cells, and 
 setting up changes which finally result in grave 
 disease. 
 
 Symptoms and Diseases Due to Alimentary 
 Toxemia 
 
 It should be understood that these findings are 
 not mere theories, but are the results of demonstra- 
 tion in actual practice by eminent physicians. Of 
 course it is not claimed that alimentary toxemia 
 is the only cause of all the symptoms and diseases 
 named: Although of many it may be the sole or 
 principal cause, some of them are due to other causes 
 as well. 
 
 In the following summary the various symptoms 
 and disorders mentioned in the discussion in Lon- 
 don, to which reference has been made above, are 
 grouped and classified. 
 
 The Digestive Organs 
 
 Duodenal ulcer causing partial or complete ob- 
 struction of the duodenum; pyloric spasm; pyloric 
 obstruction; distension and dilatation of the 
 stomach ; gastric ulcer ; cancer of the stomach ; ad- 
 hesions of the omentum to the stomach and liver; 
 inflammation of the liver; cancer of the liver. 
 
 The muscular wall of the intestine as well as 
 other muscles, atrophies, so that the passage of their 
 contents is hindered. The abdominal viscera lose 
 
Healthy and Hardened Arteries 
 
 tfo^TARA- KHTE^Y 
 
 CHHOtfVt FWWT\S 
 
 Sectional View of a Healthy Artery and Arteriosclerosis 
 
DISCUSSION OF ALIMENTARY TOXEMIA 179 
 
 their normal relationship to the spine and to each 
 other, on account of weakening of the abdominal 
 muscles; these displacements are much more marked 
 and serious in women. Other conditions are: 
 Catarrh of the intestines; foul gases and foul- 
 smelling stools; colitis; acute enteritis; appendicitis, 
 acute and chronic; adhesions and "kinks" of the 
 intestine; visceroptosis; enlargement of spleen; 
 distended abdomen; tenderness of the abdomen; 
 summer diarrhoea of children; inflammation of 
 pancreas; chronic dragging abdominal pains; gas- 
 tritis; cancer of pancreas; inflammatory changes of 
 gall-bladder; cancer of gall-bladder; gallstones; 
 degeneration of liver ; cirrhosis of liver ; infection of 
 the gums, and decay of the teeth; ulcers in the 
 mouth and pharynx. 
 
 Heart and Blood- Vessels 
 
 Wasting and weakening of the heart muscle; 
 microbic cyanosis from breaking up of blood cells; 
 fatty degeneration of the heart; endocarditis; myo- 
 carditis; subnormal blood pressure; enlargement of 
 the heart; the dilitation of the aorta; high blood 
 pressure; arteriosclerosis; permanent dilatation of 
 arteries. 
 
 Dr. W. Bezley says: "There are a few phases 
 of cardiovascular trouble (disease of heart and 
 blood vessels) with which disorder of some part 
 of the alimentary tract is not causatively associated." 
 
180 COLON HYGIENE 
 
 The Nervous System 
 
 Headaches of various kinds — frontal, occipital, 
 temporal, dull or intense, hemicrania; headache of 
 a character to lead to a mistaken diagnosis of brain 
 tumor. Dr. Lane tells of a case where a surgeon 
 had proposed an operation for the removal of a 
 tumor from the frontal lobe of the brain; the diffi- 
 culty was wholly removed by the exclusion of the 
 colon. Acute neuralgia pains in the legs; neuri- 
 tis; twitching of the eyes and of muscles of face, 
 arms, legs, etc. Lassitude; irritability; disturbances 
 of nervous system, varying from simple headaches 
 to absolute collapse; mental and physical depression. 
 "A medical man with neurasthenic symptoms and 
 a belief that he was ruined, recovered after he left 
 off taking an egg for breakfast." Insomnia; 
 troubled sleep, unpleasant dreams; unrefreshing 
 sleep, the patient awakening tired; excessive sleep- 
 iness, patient falling asleep in the daytime; shivery 
 sensations across lower spinal region; burning sen- 
 sations in face, hands, etc; epileptiform tic; typhoid 
 state; paralysis; chronic fatigue; horror of noises; 
 morbid introspection; perverted moral feelings; 
 melancholia, mania, loss of memory; difficulty of 
 mental concentration; imbecility; insanity; delir- 
 ium, coma. 
 
 The Eyes 
 
 Degenerative changes in the eye; inflammation 
 of the lens; inflammation of the optic nerve; hard- 
 
Ulcer of the Stomach 
 
 Cirrhosis of the Liver 
 
DISCUSSION OF ALIMENTARY TOXEMIA 181 
 
 ening of the lens; sclerotitis, sclerokeratitis ; iritis; 
 iridocyclitis; cataract; recurrent hemorrhage in the 
 retina; eyes dull and heavy. W. Long says: "As 
 an ophthalmic surgeon, I can look forward full 
 of hope to a future when those serious eye affec- 
 tions will cease to occur, because the physician has 
 taught mothers how to feed children properly, and 
 the dental surgeon has impressed upon the popula- 
 tion at large the importance of proper mastication 
 and the hygiene of the mouth." 
 
 The Skin 
 
 Formation of wrinkles; thin, inelastic, starchy 
 skin; pigmentation of the skin — yellow, brown, 
 slate-black, blue; muddy complexion; offensive se- 
 cretion from skin of flexures; thickening of the 
 skin of the back of the upper arm; irritability of 
 the skin; sweating of the palms of the hands and 
 the soles of the feet; eruptions of the skin — sores 
 and boils; pemphigus; pruritus; herpes; eczema; 
 dermatitis ; lupus erythematosus ; acne rosacea ; cold, 
 clammy extremities; dark circles under the eyes; 
 seborrhcea; psoriasis; pityriasis; alopecia; lichen: 
 planus; jaundice; "An infinitesimal amount of 
 poison may suffice to cause skin eruption." 
 
 Muscles and Joints 
 
 Degeneration of the muscles; "Muscles waste, 
 and become soft and in advanced cases tear easily." 
 
182 COLON HYGIENE 
 
 "In young life the muscular debility produces the 
 deformities which are called dorsal excurvation, or 
 round shoulders, lateral curvature, flat-foot, and 
 knock-knee." "Weakness of abdominal muscles 
 causes accumulation of feces in the pelvic colon, 
 which renders evacuation of contents more and 
 more difficult." Prominence of bones; rheumatic 
 pains simulating sciatica and lumbago ; various mus- 
 cular pains; muscular rheumatism; arthritis de- 
 formans; synovitis; rickets; arthritis, acute and 
 chronic. Tubercle, and rheumatoid arthritis are 
 the direct result of intestinal intoxication. Dr. Lane 
 says: "I do not believe it is possible for either of 
 these diseases to obtain a foothold except in the 
 presence of stasis." 
 
 Gemto-Urinary and Reproductive Organs 
 
 Various displacements, distortions and diseases of 
 the uterus ; change in the whole form and contour of 
 woman; fibrosis of breast; wasting of breasts; in- 
 duration of breasts; sub-acute and chronic masti- 
 tis; cancer of breast; metritis and endometritis; in- 
 fection of bladder especially in women; frequent 
 urination; albumosuria; acute nephritis, movable 
 kidney; floating kidney. Dr. Lane goes so far as 
 to say: "Autointoxication plays so large a part in 
 the development of diseases of the female genito- 
 urinary apparatus, that they may be regarded by the 
 gynecologist as a product of intestinal stasis." 
 
DISCUSSION OF ALIMENTARY TOXEMIA 183 
 
 General Disorders and Disturbances of 
 Nutrition 
 
 Degeneration of the organs of elimination, es- 
 pecially the liver, kidneys (Bright's disease) and 
 spleen; pernicious anemia; lowered resistance to in- 
 fection of all kinds; premature senile decay; retar- 
 dation of growth in children, accompanied by men- 
 tal irritability and muscular fatigue; adenoids; en- 
 larged tonsils; scurvy; enlarged thyroid (goitre) ; 
 various tumors of thyroid; Raynaud's disease. 
 
 In those who apparently suffer no harm from 
 constipation during a long series of years there is 
 perhaps, as suggested by Hertz, a partial immuni- 
 ty established. The writer has long believed that 
 such an immunity is sometimes established in the 
 very obstinate constipation which accompanies abso- 
 lute fasting, because of the cleansing of the tongue 
 and reappearance of appetite which often occurs 
 at the end of the second or third week of the fast, 
 a phenomenon very like that which appears in ty- 
 phoid fever and other continued fevers. It must 
 not be supposed, however, that even the establish- 
 ment of so-called immunity insures the body against 
 all injury. The labor of eliminating an enormous 
 amount of virulent toxins, which falls upon the 
 kidne}'s, damages the renal tissues and produces 
 premature failure of these essential organs. Any 
 process which develops toxins within the body is 
 a menace to the life of the tissues and should be 
 
184 COLON HYGIENE 
 
 suppressed as far as possible, and as quickly as pos- 
 sible. 
 
 The fact that symptoms of poisoning resulting 
 from constipation do not apear at once is no evidence 
 that injury is not done. Dr. Wm. Hunter in the 
 course of the London discussion remarked that 
 the fact that chronic constipation "might exist 
 in certain individuals as an almost permanent con- 
 dition without apparently causing ill-health is due 
 solely to the power and protective action of the 
 liver. It is not any evidence of the comparative 
 harmlessness of constipation per se, but only an 
 evidence that some individuals possess the cecum 
 and the colon of an ox, with the liver of a pig, 
 capable of doing any amount of distoxication." 
 
 In the face of such an array of evidence backed 
 up by authority of nearly sixty eminent English 
 physicians — and many hundreds of other English, 
 German, and French physicians whose names might 
 be added — it is no longer possible to ignore the 
 importance of alimentary toxemia or autointoxica- 
 tion as a factor in the production of disease. To 
 no other single cause is it possible to attribute one- 
 tenth as many various and widely diverse disorders. 
 It may be said that almost every chronic disease 
 known is directly or indirectly due to the influence 
 of bacterial poisons absorbed from the intestine. 
 The colon may be justly looked upon as a veritable 
 Pandora's box, out of which come more human 
 misery and suffering mental and moral as well as 
 physical than from any other known source. 
 
DISCUSSION OF ALIMENTARY TOXEMIA 185 
 
 The successful treatment of alimentary toxemia 
 often taxes to the utmost the resources of the best 
 equipped physician. Sometimes it is necessary to 
 call in the services of the surgeon. 
 
 It may be fairly said, however, that at least 
 nine-tenths of the possible benefits to be derived 
 from treatment is to be secured by combating in- 
 testinal stagnation. By such regulation of diet 
 and habits as to secure a thorough evacuation of 
 the bowels at least three times a day, or after each 
 meal, and by excluding from the diet flesh meats and 
 other putresicible substances, more can be accom- 
 plished toward eliminating from the intestine per- 
 nicious parasitic organisms and the multitudinous 
 poisons which they produce than all other means. 
 
 The sources of the poison-forming bacteria 
 which grow in the human intestine are numerous. 
 It is probable, however, that butcher's meat, fish, 
 oysters and other shellfish are the chief sources, for 
 Tissier found that when he obtained flesh from 
 the slaughterhouse in as fresh a condition as pos- 
 sible, it contained all the bacteria necessary to pro- 
 duce active putrefaction, which was made evident 
 to the sense of smell within twenty-four hours, and 
 became more and more pronounced from day to 
 day. 
 
 Bacteriologists have shown that the mouth al- 
 ways contains putrefactive bacteria. The normal 
 stomach is sterile during digestion, because the gas- 
 tric juice is a powerful germicide and destroys 
 
186 COLON HYGIENE 
 
 them ; but in stomachs which do not produce a suffi- 
 cient amount of gastric juiee, and in normal 
 stomachs when empty of food, great numbers of 
 these dangerous microbes may be found. 
 
 Below the stomach the number of bacteria in- 
 crease. At the lower end of the small intestine, 
 and in the caecum, the number of living bacteria 
 is the greatest. 
 
 The reason for this is the presence of food resi- 
 dues and body wastes of character suitable to en- 
 courage the growth of putrefactive bacteria, while 
 starch and sugar which are needed for the growth 
 of acid-forming organisms are absent, having been 
 digested and absorbed in the small intestine. 
 
 Changing the Intestinal Flora 
 
 Many people seek by change of climate, often 
 at great expense and inconvenience, to secure re- 
 lief from ailments which only require a change of 
 the character of the bacteria growing in their in- 
 testines and are to no appreciable extent affected 
 by the climatic influences. If sometimes relief is 
 found by such persons in a change of climate it is 
 because an incidental change of. their intestinal 
 bacterial growth happens to occur at the same 
 time. "Bilious" climates do not exist. "Bilious- 
 ness," an unscientific but significant and useful 
 word, signifies conditions that can be remedied 
 only by in some way getting rid of putrefactive 
 
DISCUSSION OF ALIMENTARY TOXEMIA 187 
 
 bacteria and putrefaction processes that are active 
 in the intestines. 
 
 Dr. Tissier, of the Pasteur Institute, was the 
 first to point the way to methods of changing the 
 flora of the intestine. His plan was to displace 
 "wild," noxious, poison-forming bacteria which have 
 taken possession of most adult intestines through 
 wrong habits of life, especially in diet, by harm- 
 less, acid-forming species, such as Nature plants 
 in the intestines of the young infant within a few 
 days after birth. 
 
 There are various ways in which the intestinal 
 flora may be changed. Three things are essential: 
 
 1. The diet must be such as to encourage the 
 growth of friendly germs, the acid-formers, and 
 discourage the growth of unfriendly and unde- 
 sirable ones, the poison-formers. This requires a 
 fleshless diet and in some cases a diet free from 
 animal protein, that is, a diet which excludes eggs 
 and milk as well as meats of all kinds. 
 
 2. The bowels must be made to move three 
 times a day or more frequently so as to hasten the 
 displacement of the undesirable bacteria and to 
 dislodge them from their hiding places. 
 
 3. The introduction of friendly, acid-forming 
 bacteria in such large numbers as to enable them 
 to take possession of the intestine and establish 
 themselves in the colon where their services in 
 combating putrefactive processes is needed. 
 
 The change of diet may be effected by adopting 
 
188 COLON HYGIENE 
 
 the "milk regimen" for a limited period. The "fruit 
 regimen" — fresh fruit and such green vegetables as 
 lettuce, celery, and cucumbers answers the same 
 purpose. The " whey cure," " kumyss cure," and 
 "milk cure" are other dietetic methods of changing 
 the flora. 
 
 Fasting will not change the flora for reasons 
 given elsewhere, (see pages 103-106). 
 
 In general, the antitoxic diet elsewhere described 
 (see pages 221-240) is the most practical solution of 
 the diet problem in relation to bacterial change in 
 the intestine. In cases in which it is desirable to 
 secure a gain in flesh in connection with a change 
 of the intestinal flora, a milk diet may be success- 
 fully employed. 
 
 The "Milk Regimen" 
 
 Cow's milk is not a natural food for grown-ups, 
 either human or bovine. Milk is deficient in iron, 
 and contains an excess of protein, and lime. Cow's 
 milk disagrees with many persons, children as well 
 as adults. It is certainly by no means an ideal 
 food. Yet many persons are benefited by its tem- 
 porary use when proper precautions are taken. 
 The first essential is that the milk shall be taken 
 in large amount, so large as greatly to exceed the 
 needs of the body, and thus fill the alimentary 
 canal with material which will promote the growth 
 of friendly bacteria, or sour milk germs, for which 
 milk supplies the very best medium. 
 
DISCUSSION OF ALIMENTARY TOXEMIA 189 
 
 A second essential is that the milk shall be 
 taken often. A half pint every half hour or every 
 forty minutes is the usual plan. This is necessary 
 to make it possible to take into the stomach the 
 five or six quarts of fluid required for one day's 
 milk ration. It is also important to maintain a 
 constant stream of fresh material passing along the 
 alimentary canal, so that a considerable portion 
 may reach the colon undigested and unabsorbed. It 
 is especially important that a sufficient amount 
 of milk sugar should reach the colon unabsorbed 
 to maintain in the colon a state of acid fermenta- 
 tion thereby preventing putrefaction and changing 
 the intestinal flora. This is, indeed, in many cases, 
 the chief benefit derived from the milk diet. To 
 encourage this change it is well to give at each al- 
 ternate feeding yogurt buttermilk in place of 
 sweet milk; or equal parts of sweet milk and milk 
 soured by the Bulgarian ferment may be taken at 
 each feeding. 
 
 Feeding begins at 7:00 a. m. and ends at 7:00 
 p. m. — twenty-five feedings in all. At 10:00 a. 
 m. and 4:00 p. m. the milk is omitted and a meal 
 of fruit is taken instead. The purpose of this is 
 to encourage bowel activity, since very free and 
 frequent bowel movement is essential to success. 
 The disappointing results often encountered in the 
 use of the milk diet are chiefly due to the constipa- 
 tion which is likely to be produced in many persons, 
 the natural result of which is intestinal toxemia 
 
190 COLON HYGIENE 
 
 and an aggravation of the very symptoms relief 
 from which is sought. 
 
 An ounce of wheat bran or agar-agar should be 
 taken daily in half ounce doses, preferably at 8:00, 
 10:00, 12:00, and 4:00 o'clock feedings. In cases 
 in which the colon is badly crippled, the use of 
 the Russian paraffin oil in doses of one tablespoon- 
 ful three or four times a day is necessary to secure 
 the active bowels required for a rapid and efficient 
 change of the flora. 
 
 When the period of exclusive milk feeding is 
 ended, the milk should be at once discarded and a 
 strict antitoxic diet adopted ; milk, meat, fish, fowl, 
 eggs and all kinds of animal protein must be dis- 
 carded. Milk is unwholesome for most invalids and 
 often even in very small amounts. This is especially 
 true of persons suffering from colitis. It is most 
 likely to produce unpleasant effects when taken 
 in small amounts with other foods. It is generally 
 tolerated when taken as an exclusive diet and in 
 large amount because of the special conditions estab- 
 lished whereby a change of the intestinal flora is 
 accomplished. 
 
 It should be remembered that the chief advantage 
 of the milk diet as a means of changing the intesti- 
 nal flora lie — ( 1 ) in the large amount of milk sugar 
 which by this means is carried into the colon and 
 there, fermenting, produces lactic acid and so pre- 
 vents the growth of the putrefactive bacteria; (2) 
 in the frequent bowel actions induced by the large 
 
DISCUSSION OF ALIMENTARY TOXEMIA 191 
 
 surplus of food ingested. The soft curds, undigested 
 and unabsorbed by their bulk as well as by their 
 acidity stimulate peristalsis to such a degree as to 
 cause several bowel movements daily. In certain 
 cases, however, in which mechanical obstacles to 
 bowel action exist, such as either spasm or incom- 
 petency of the ileocecal valve, or adhesions of the 
 pelvic colon, constipation may continue in spite of the 
 largest quantities of milk that can be taken. In such 
 cases the sugar of milk is wholly absorbed, leaving 
 the curds to putrefy in the lower colon, and the most 
 intense toxemia may result. The writer has met a 
 number of cases of this sort. This is the cause of 
 the disastrous failure of the "milk cure" in certain 
 cases. 
 
 The "Fruit Regimen" 
 
 To meet the needs of certain patients who have 
 an idiosyncrasy against milk, especially cases of 
 colitis, the writer has conducted a large number of 
 experiments for the purpose of discovering a diet 
 for changing the intestinal flora suitable for general 
 use and especially in cases in which milk is not 
 tolerated. The result of many experiments was the 
 selection of a diet consisting chiefly of wheat bran 
 and fruit; lettuce, cucumbers, tomatoes and any 
 other uncooked product of the garden may be added, 
 but the chief part of the diet must be bran and 
 fruit. Such a dietary practically eliminates protein 
 and fats. Food may be taken either three or four 
 
192 COLON HYGIENE 
 
 times a day. Two or three tablespoonfuls of ster- 
 ilized wheat bran should be taken at each meal. 
 A convenient way to take the bran is in the form 
 of a soup or porridge made with stewed toma- 
 toes or some fruit. A spoonful of oatmeal or corn- 
 meal may be added if desired. 
 
 All sorts of fruit may be eaten freely. Dates are 
 especially valuable because of the sugar which they 
 contain. 
 
 In addition, a paraffin tablet or a tablespoonful of 
 white Russian paraffin oil should be taken at each 
 meal. 
 
 The result will be three or four free bowel move- 
 ments daily, and at the end of three or four days 
 the stools will become odorless or nearly so. A slight 
 acidity is a good indication, showing that the flora is 
 completely changed, the putrefactive and poison- 
 forming germs having been displaced by the benefi- 
 cent acid-formers. 
 
 After the flora has been thus changed by a bran 
 and fruit diet closely adhered to for a few days % 
 a careful antitoxic diet should be closely followed as 
 a permanent regimen. It is a great error to suppose 
 that the intestinal flora can be definitely and perma- 
 nently changed by a brief course of treatment or 
 by any plan which does not include the complete and 
 permanent exclusion of "toxic" foods. Meats of all 
 sorts must be wholly discarded. Eggs must be used 
 sparingly if at all. In not a few cases milk must 
 be carefully avoided even as an ingredient of 
 
DISCUSSION OF ALIMENTARY TOXEMIA 193 
 
 soups and other dishes. Some persons may recoil at 
 the idea of so great a limitation of the dietary; but 
 a person who has suffered from such distressing 
 effects of chronic intestinal toxemia as a severe ec- 
 zema, frequent "sick headaches," Bright's disease or 
 arteriosclerosis will be quite willing to undergo al- 
 most any sort or degree of gustatory discipline if 
 assured that the sacrifice will secure the desired 
 result. Fortunately, this assurance may usually be 
 given with the greatest confidence that the results 
 will not be disappointing. 
 
 The free use of bran and paraffin must be con- 
 tinued indefinitely, and care must be taken not to 
 omit their use at a single meal. If thorough evac- 
 uation of the bowels does not occur three or four 
 times daily the amount of paraffin or quantity of 
 bran, or both, should be increased. Agar-agar in 
 some form may be used in place of bran, or in con- 
 nection with it. There need be no fear of injuring 
 the intestine by producing irritation. The writer 
 does not hesitate to make this statement after hav- 
 ing carefully watched the effects of the measures 
 above recommended in hundreds of cases. If the 
 measures suggested are employed with sufficient 
 thoroughness, and continued for a sufficient length 
 of time, the effort will not fail of success. It is nec- 
 essary in many cases, to supplement the regimen 
 recommended by means of treatment which will 
 thoroughly cleanse the colon, introduce a normal 
 flora, and reform the wild bacteria with which the 
 
194 COLON HYGIENE 
 
 colon is infected. For a detailed description of 
 these measures the reader is referred to the direc- 
 tions given elsewhere in this work for the treatment 
 of colitis. (See page 330). If an ammoniacal or 
 putrescent odor appears in the feces at any time the 
 fruit regimen must be resumed for a few days un- 
 til the odor disappears. The diet should be care- 
 fully studied and modified as necessary until the 
 stools become regular, frequent, and practically free 
 from odor, or at least free from putrescence. 
 
Forms of Constipation 
 Classification 
 
 Constipation, although a symptom rather than 
 a disease, itself becomes a cause of various and often 
 most serious vital disturbances. Every bodily func- 
 tion and every structure may suffer damage through 
 the failure of the body to be relieved of the highly 
 poisonous refuse which it is the duty of the colon to 
 discharge. 
 
 The symptoms by which the presence of consti- 
 pation may be known differ according to the form 
 of constipation which is present. Although many 
 different forms of constipation have been described, 
 practically all phases of this disorder may be in- 
 cluded under three heads, namely: 
 
 1. Simple constipation. 
 
 2. Cumulative constipation. 
 
 3. Latent constipation. 
 
 The Symptoms of Simple Constipation 
 
 When fecal matters remain in the intestines 
 more than twenty-four hours, constipation exists. 
 Some authorities place the limit at forty-eight hours, 
 while others assert that every individual is a law 
 unto himself, and that a bowel movement once in 
 two or three days is as normal for some persons as a 
 daily or twice-daily movement is for others. The 
 
 195 
 
196 COLON HYGIENE 
 
 writer feels certain that these authorities are in error. 
 Their conclusions have been drawn from observa- 
 tions made upon unhealthy rather than normal 
 individuals. For reasons stated elsewhere in this 
 work, the writer is fully persuaded that the normal 
 rhythm of the intestine is a movement after each 
 meal, or at least after each full meal. Certainly, 
 when the bowels do not move regularly at least 
 once a day, constipation may be said to exist. 
 
 In simple constipation the evacuation of the 
 bowel content is not complete. A normal desire 
 for evacuation occurs when the feces enter the 
 rectum, but normal bowel movements occur only 
 every other day, or perhaps at somewhat longer in- 
 tervals, or at irregular periods. There is simply a 
 slowing of the rate at which the food moves along 
 the alimentary canal, due to some one or more of the 
 many causes which have been mentioned in the pre- 
 ceding pages; but there is no disturbance of the 
 defecating mechanism. 
 
 Most cases of chronic constipation begin with 
 the simple form. The cause is most commonly a 
 concentrated diet, irregular meals, sedentary habits, 
 or neglect to attend promptly to the "call" for 
 evacuation of the bowels. 
 
 Symptoms of Cumulative Constipation 
 
 In cumulative constipation, which is perhaps the 
 most common form, the difficulty is almost wholly 
 
FORMS OF CONSTIPATION 197 
 
 confined to the lower part of the colon. Cumu- 
 lative constipation is for the most part a disorder 
 of the defecating mechanism. The food and the 
 feces move along the small intestine and the upper 
 part of the large intestine at the proper rate; but 
 after the feces have reached the pelvic colon, they 
 are retained either in the colon itself or in the rec- 
 tum, instead of being promptly discharged. The 
 special characteristics of cumulative constipation are 
 dry hard stools, loss of the rectal reflex, caused by 
 the retention of fecal matters in the rectum and 
 distension of the rectal walls, and in pronounced 
 cases, complete loss of the "call" for evacuation of 
 the bowels. In cumulative constipation, the diffi- 
 culty exists in the lower half of the colon, or be- 
 low the splenic flexure. 
 
 In well pronounced cases of cumulative consti- 
 pation, a considerable quantity of feces will always 
 be found present in the rectum, although in a cer- 
 tain number of cases the accumulation occurs only 
 in the pelvic colon. The latter cases are sometimes 
 the most difficult of relief, because of the existence 
 of obstruction at the pelvi-rectal valve, or of ad- 
 hesions of the pelvic loop to the floor of the pelvis. 
 Sometimes the pelvic colon has become so large by 
 overstretching that, when filled, it is so heavy that 
 it cannot rise, but becomes impacted in the hollow 
 of the sacrum, folded upon itself and incapable of 
 emptying itself. In such cases, as in most cases of 
 cumulative constipation, bowel movements occur 
 
198 COLON HYGIENE 
 
 only as the result of pressure from accumulation 
 of feces in the colon, a process which necessarily 
 involves great distension of the colon and resulting 
 injury to its walls, and to the ileocecal valve, which 
 is often rendered by this means wholly incompetent. 
 When in cases of cumulative constipation the 
 bowels are made to move by violent straining ef- 
 forts, the rectum is not emptied. A few masses of 
 hard, dry feces, sometimes a single mass covered 
 with mucous, may be extruded, but a thorough 
 emptying of the bowel never occurs. In cases in 
 which the rectum only has lost its sensibility, the 
 sense of weight and pressure often lead the patient 
 to make repeated efforts during the day to relieve 
 the bowels, with the result of securing perhaps each 
 time a small movement. This has been termed 
 "fragmentary constipation" by Boas, the eminent 
 Berlin specialist, but it is only a form of cumulative 
 constipation. 
 
 Symptoms of Latent Constipation 
 
 In latent constipation the bowels move regularly, 
 or at least daily. In most cases the patient has no 
 idea that he is suffering from constipation. An ex- 
 amination, however, by means of suitable tests 
 shows that there is delay at one or more points along 
 the food tube. There is no disturbance of the 
 mechanism of defecation. The "call" for bowel 
 movement occurs, and often with inconvenient fre- 
 
FORMS OF CONSTIPATION 199 
 
 quency, and the lower colon is emptied of its con- 
 tents. There is no accumulation of feces in the 
 rectum, but if a portion of charcoal or carmine is 
 given with a meal, forty-eight hours or even a longer 
 time may elapse before the colored matter makes its 
 appearance, and a longer time before it is all dis- 
 charged. 
 
 The exact point at which the delay occurs 
 may be ascertained by administering a bismuth 
 test meal and watching its progress along the food 
 tube by the aid of a powerful X-ray apparatus. An 
 examination of this sort is highly important in 
 cases of latent constipation, affording the only means 
 by which the real nature and location of the dis- 
 turbance can be ascertained. 
 
 The feces in latent constipation are generally 
 very dark in color, ragged and foul smelling, the 
 result of the advanced putrefaction induced by their 
 long retention. 
 
 The reflex contraction of the ileocecal valve pro- 
 duced by the pain of chronic appendicitis and other 
 painful affections of the pelvis and lower abdomen, 
 may be the cause of latent constipation, which, 
 when due to this cause, is sometimes called "reflex" 
 constipation, for the reason that it is generally re- 
 lieved by measures which lessen the activities of the 
 sympathetic nerve and so relax the ileocecal sphinc- 
 ter. Latent constipation is also very commonly 
 associated with colitis^ on account of the spastic con- 
 dition of the intestine often present in this disease, 
 
200 COLON HYGIENE 
 
 which may be a consequence as well as a cause 
 of latent constipation. 
 
 Incompetency of the ileocecal valve is probably a 
 very frequent cause of latent constipation. 
 
 A marked symptom of latent constipation when 
 associated with incompetency of the ileocecal valve is 
 the great amount of intestinal gas from which it is 
 impossible to get entire relief. This is due to the 
 fact that the gas generated in the colon escapes into 
 the small intestine and cannot be wholly expelled 
 because the colon discharged its contents internally, 
 into the small intestine, as well as externally. 
 
 Mixed Forms of Constipation 
 
 The majority of cases of constipation may be 
 clearly assigned to one of the above-defined classes. 
 Not infrequently, however, cases are encountered 
 which present most of the symptoms of the several 
 classes of constipation. Colitis with spastic con- 
 stipation is often observed in cases in which there is 
 also a failure of the defecating mechanism to per- 
 form its work properly, and cumulative constipation. 
 
The Treatment of Constipation 
 
 Hygiene 
 
 The first point of importance in the treatment 
 of constipation is hygiene. A person must by every 
 means in his power endeavor to improve his general 
 health. Chronic ill health always involves, either 
 primarily or secondarily, a lowering of the vital 
 status, and is in most cases not a result of a single 
 error in habits of life, but of numerous infractions 
 of the rules of healthy or biologic living. So many 
 different factors are involved in the function of 
 bowel movements, that it is highly essential that a 
 person who is suffering from chronic constipation 
 should seek by every available means to improve 
 his general health, and thus increase the vigor of all 
 his bodily functions. 
 
 If one's habits have been sedentary, he must make 
 a radical change in his mode of life. When possible, 
 a change from an indoor employment to an active 
 occupation out-of-doors is most desirable. This in 
 itself will in many cases be found quite sufficient 
 to secure regular bowel movements. 
 
 If the circumstances of life have been such as to 
 give rise to worry or nervous depression, some 
 change should be effected by which the causes of 
 irritation and depression may be gotten rid of, or 
 the individual should, by the cultivation of optim- 
 
 201 
 
202 COLON HYGIENE 
 
 ism, endeavor to rise above the influence of his 
 surroundings. 
 
 Constipation is in most cases simply one of the 
 unhappy results of the artificial conditions imposed 
 upon us by modern civilized life. The only escape 
 from this terrible handicap of all useful human 
 activities is to be found in a rational return to 
 Nature, in the adoption, so far as is necessary to 
 secure the physiological conditions, of natural and 
 primitive habits, particularly in reference to diet, 
 sleep, exercise, and out-of-door life. 
 
 Before proceeding further the reader who is 
 making a serious study of this subject is asked to 
 re-read carefully two of the preceding chapters, 
 entitled, "Influences Which Normally Excite the 
 Movements of the Colon" and "Influences Which 
 Discourage or Lessen Intestinal Movements," bear- 
 ing always in mind the fact that for the successful 
 treatment of constipation every possible factor which 
 aids bowel activity must be utilized, and that every 
 factor which has a discouraging influence must 
 be most carefully avoided. 
 
 General Habits 
 
 Many of the causes of constipation, and many 
 of the influences connected with every-day life which 
 tend to produce this condition, have been already 
 discussed with some detail, and need not be recon- 
 sidered here. The bearing of each one of these 
 
TREATMENT OF CONSTIPATION 203 
 
 causes should be considered in each individual case, 
 and not one unfavorable influence should be per- 
 mitted to remain. 
 
 Clothing 
 
 This has a very much more direct bearing upon 
 the functions of the colon than might at first be 
 supposed. Corsets and belts, as has already betn 
 shown, tend directly to produce constipation by 
 hampering the movements of the diaphragm, pre- 
 venting proper development and activity of the 
 abdominal muscles, and causing displacement of 
 the colon and other viscera into the lower portion 
 of the abdomen. Excess of clothing tends in the 
 same direction by overheating the body and pro- 
 ducing excessive perspiration and relaxation of the 
 muscular structures of the abdomen, and perhaps 
 also of the intestines. 
 
 Finally, as regards hygiene, every person who 
 is suffering from constipation and really desires to 
 be delivered from the miseries attendant upon this 
 condition should be careful to avoid all habits and 
 influences which tend to retard or discourage bowel 
 action and will most assiduously cultivate every 
 influence and habit which tends to encourage in- 
 testinal activity. 
 
 Constipation Always Curable 
 
 Every person who undertakes to combat con- 
 stipation should know at the start that his efforts if 
 
204 COLON HYGIENE 
 
 thoroughgoing and persistent may be expected to 
 win. There are many thousands of sufferers who 
 have become utterly discouraged through unsuccess- 
 ful efforts and have become convinced that the 
 malady is incurable, and that nothing more can 
 be done than to mitigate the evils of the malady as 
 much as possible by laxative drugs and the use of the 
 enema, withstanding their well-known evil effects. 
 There are many thousands of others who depend 
 wholly upon the use of laxative drugs or mineral 
 waters for bowel movements and who are unaware 
 of the harmful effects which inevitably result from 
 the long continued use of drugs which force bowel 
 movement by creating an artificial irritation. The 
 majority of such persons are always looking for 
 some new laxative drug to take the place of one 
 which has lost its effects, fully believing that there 
 is no other way of doing. There is apparently a 
 widespread belief that constipation is incurable. 
 This hopeless view, quite generally held by physi- 
 cians as well as the laity, is the very natural result 
 of the wrong methods which are generally employed, 
 and the great ignorance concerning the intimate 
 nature and causes of constipation. This ignorance 
 has been quite excusable, however, because of the 
 lack of scientific knowledge respecting the physi- 
 ology of bowel action. But now that the light of 
 new discovery has illuminated this dark corner of 
 human physiology, the treatment of constipation is 
 no longer necessarily a hopeless groping in the 
 
TREATMENT OF CONSTIPATION 205 
 
 dark but may be made a regular organized cam- 
 paign against an enemy whose nature and favorite 
 haunts are known and against which recent medical 
 science has provided efficient weapons. 
 
 And a veritable campaign the effort must be if 
 success is to be attained in really grave cases. But 
 victory may be attained in every case. It must be 
 understood, however, that there is no panacea for 
 constipation. There is no one simple means by 
 which all cases may be cured, and some cases require 
 the simultaneous employment of almost every known 
 rational remedy. A very few cases require the 
 aid of surgery; and even surgery seldom succeeds 
 when made the sole reliance. Fortunately surgery 
 is very rarely needed when all other means are ef- 
 ficiently used. 
 
 What Is a Cure of Constipation? 
 
 When a child has measles or scarlatina or when 
 a person suffers an attack of typhoid fever, the 
 usual result under modern management is such a 
 recovery that no traces of the disease or its effects 
 are discoverable. The individual is apparently as 
 well in every respect as before the illness. Mod- 
 ern medical research has taught us, however, that 
 this completeness in recovery is more apparent than 
 real. Besides the permanent injuries to eyes and 
 ears, which are often left after measles and scarlet 
 fever, there are not infrequently far more serious 
 
206 COLON HYGIENE 
 
 injuries to heart, lungs, or kidneys. And statistics 
 show that whenever typhoid fever and small-pox 
 are prevalent, pulmonary tuberculosis increases. 
 Thus we know that recovery does not really mean, 
 even in acute disease, absolutely complete restora- 
 tion to former soundness. 
 
 In chronic disease this is still more evident. An 
 attack of acute disease is like a sudden outburst of 
 flame in a dwelling from the upsetting of a lamp or 
 from some similar accident. The fire is usually 
 quickly extinguished and the house itself is little 
 injured. A chronic malady is often like a fire 
 which has begun in the basement of the house and 
 has gradually worked its way up in the inner 
 walls until it has reached the top and burst out in 
 flame through the roof. Acute disease we may 
 say is analagous to a fire in a house while chronic 
 disease is a fire of a house. In lung tuberculosis 
 a cure means an arrest of the disease process and a 
 healing of ulcerated surfaces in the lung; but lung 
 tissue which has been destroyed is not restored ; and 
 the consumptive who has been cured by the out- 
 of-door life and other means must continue to em- 
 ploy the essentials of the curative treatment in 
 order to keep well. No consumptive can expect to 
 remain well if he returns to the old conditions of 
 life under which he became ill. He must make a 
 radical change in his habits of life and the change 
 must be permanent. In case of an injury to a leg, 
 the patient may recover, but with the loss of a leg. 
 
TREATMENT OF CONSTIPATION 207 
 
 By the aid of an artificial leg he will be able to walk 
 very well, but not so well as with a natural limb. 
 
 The situation is exactly the same in constipa- 
 tion. In very chronic cases, much irreparable dam- 
 age has been done. The colon has been perma^ 
 nently crippled. The art of treatment is to find 
 out the exact nature of the injury and to find means 
 for supplying the needed aid, much as an artificial 
 leg in a large measure supplies the place of a missing 
 limb. These measures must be such as render 
 aid in a physiologic way, and must be harmless in 
 character. When once the necessary means have 
 been found and adapted to the individual case they 
 must be perseveringly employed not for a few 
 days or weeks or months; their use must become a 
 life habit. In general it is possible to secure a 
 considerable degree of improvement so that a few 
 and simple means will afford all the aid required 
 though at first the concerted use of many measures 
 was required. 
 
 If, for example, it is found that the addition to 
 the food of a liberal quantity of sterilized wheat 
 bran will secure three normal bowel movements 
 daily, this simple means must be faithfully used, 
 not only daily, but at every meal. If it is found 
 that the bowels are ready for evacuation at a certain 
 hour, a natural "call" being experienced at that- 
 time, this hour must be religiously set aside for this 
 duty. Nothing may be allowed to interfere with 
 this duty. Whatever plan or program is found to 
 
208 COLON HYGIENE 
 
 secure efficient bowel action, this program must be 
 carried out every day with greatest circumspection. 
 Nature must not be discouraged or thwarted in her 
 efforts. Every pains must be taken to foster every 
 symptom of returning normality in bowel functions. 
 When a "call" occurs, it must be answered at once. 
 The delay of a few minutes only may extinguish the 
 effort Nature is making to reestablish the normal 
 rhythm. It takes considerable will and character to 
 conquer constipation as well as knowledge and per- 
 severance. But the gain in clearness of mind, zest 
 for work, endurance of mind and body, and 
 general efficiency, to say nothing of such 
 gains as keenness of appetite, sweetness of breath, 
 clearness of skin, sound sleep and sense of joy in 
 being alive, are ample compensation for the effort 
 required. If it is a life-long battle to conquer 
 constipation, it may be a winning battle and one 
 which lengthens one's days and wonderfully in- 
 creases capacity for useful activity and enjoyment 
 of life. 
 
 When Is Surgery Needed? 
 
 It will not be possible to review in a brief para- 
 graph the various opinions which have been ex- 
 pressed by eminent medical authorities respecting the 
 "Mications for surgical relief in cases of obstinate 
 * ?tion, nor to offer the reasons for or against 
 surgical procedures which have been 
 
 
 '% 3fe 
 
TREATMENT OF CONSTIPATION 209 
 
 proposed. It must suffice simply to enumerate the 
 principal conditions concerning which the concensus 
 of authoritative surgical opinion is settled and 
 clearly defined. 
 
 Constipation due to organic obstruction resulting 
 from tuberculosis, cancer, or other morbid growths, 
 necessarily requires surgical interference, and an 
 abdominal surgeon should be consulted at once, 
 one experienced in intestinal surgery. This is 
 important, for in surgery of this character results 
 depend almost wholly upon exactness and perfection 
 of technic, such as can be gained only by long and 
 extensive practice. 
 
 Chronic as well as acute appendicitis is an indi- 
 cation which may open the way for relief of con- 
 stipation by removal of an active cause. This is 
 especially true in cases in which an X-ray examina- 
 tion shows many adhesions about the inflamed ap- 
 pendix, which fix the cecum so that it cannot empty 
 itself or perhaps cause obstruction of the lower end 
 of the small intestine. The necessity for opera- 
 tion may exist in cases of this sort, even when 
 little pain is felt in the region of the appendix. Not 
 every case in which such adhesions exist, however, 
 requires operation. By far the great majority may 
 be substantially relieved by non-surgical measures. 
 
 Adhesions of the ascending or descending colon, 
 and especially adhesions which compress the pelvic 
 colon and limit its movements, may be relieved by 
 appropriate surgical procedures when other means 
 
210 COLON HYGIENE 
 
 fail. These cases seldom require removal of the 
 colon or any portion of it, or even the so-called 
 short-circuiting operation which often affords only 
 temporary relief unless care is taken to restore the 
 ileocecal check valve. When adhesions of the pelvic 
 colon are broken up the pelvic loop must be sus- 
 pended in such a way as to prevent the reproduc- 
 tion of the restricting adhesions which will almost 
 certainly occur unless some efficient means of pre- 
 vention is adopted. 
 
 A very definite indication for operation in cer- 
 tain cases in which other n ~ans fail is incompetency 
 of the ileocecal valve accompanied by very pro- 
 nounced stasis or stagnation in the small intestine. 
 This condition is sometimes accompanied by the 
 most incorrigible constipation and by most pro- 
 nounced intestinal toxemia as shown by enormous 
 quantities of indican and other putrefactive products 
 in the urine and by intractable headaches. An 
 operation has within a few years been devised by 
 which the incompetent valve may be repaired so 
 as to effect a radical cure of the incompetency of 
 the valve and, fortunately without any considerable 
 degree of risk. This operation has been now per- 
 formed in a sufficient number of cases to demon- 
 strate its value in cases which do not yield to other 
 measures. 
 
 Diverticulitis (see page 348) sometimes requires 
 operation but probably much less often than has 
 been thought if thorough-going non-surgical meas- 
 
TREATMENT OF CONSTIPATION 211 
 
 ures of treatment are instituted. Anal hemorrhoids, 
 fissures, fistula, spasm due to local irritation, recto- 
 ceie in women and prolapse of the rectum are other 
 measures which may be readily cured by surgical 
 procedures which are not attended by risk nor 
 even, when skillfully done, by much pain or incon- 
 venience. 
 
 Regularity of Meals Necessary 
 
 The bowels do not move without a reason for 
 moving. The pelvic colon is an ejecting apparatus 
 for expelling fecal residues, which works only when 
 brought into action by the reflex nervous mechanism 
 which comprises the nerves of the rectum, the de- 
 fecating center, and the connecting nerve trunks. 
 The entrance of food into the rectum is like the 
 closing of a switch which controls the starting and 
 stopping of a motor. When the rectum is distend- 
 ed, the nerves are stimulated, and in turn excite the 
 defecating center where they originate. From this 
 center are sent out impulses which cause the pelvic 
 colon to contract strongly and empty itself. In 
 doing this it is assisted by strong contractions of the 
 abdominal muscles and of the rest of the colon. 
 
 This process, it must be remembered, is set in 
 operation only when there is a sufficient movement 
 of feces from the pelvic colon, where the feces are 
 stored, into the rectum, to produce the necessary 
 amount of stimulation. As we have already seen, 
 this is accomplished, normally, by peristaltic move- 
 
212 COLON HYGIENE 
 
 ments set up by taking into the stomach relishable 
 food. In constipation, these stimulating reflexes 
 are often weak, and must be reinforced by every 
 means possible. Hence the diet must be so managed 
 as to secure the maximum amount of stimulating 
 influence upon the lower bowel. Eternal vigilance 
 is necessary; every meal must be taken with refer- 
 ence to the bowel action. A single omission of a 
 meal, or a meal of unsuitable food, may be sufficient 
 to produce an undue accumulation of feces in the 
 colon and rectum, and unless this is immediately 
 corrected, the most serious results may follow. The 
 taking of food, then, serves a double purpose, it 
 supplies the body with needed nourishment and at 
 the same time furnishes the impulse needed to enable 
 the body to get rid of the unusable residues of a 
 previous meal and of a portion of its constantly 
 accumulating intestinal excretions. So if regularity 
 of bowel movement is to be expected, care to take 
 the food at regular intervals becomes a matter of 
 absolute importance. With the savage, regularity 
 of bowel movement is not a matter of so great 
 importance, for the reason that he is rarely so situ- 
 ated that he cannot respond quickly to the "call" for 
 evacuation. But civilized human beings by their 
 sj'Stematic and, in general, their closely occupied 
 life, must often find themselves in circumstances 
 which compel a considerable delay in answering 
 the "call" without being seriously incommoded. 
 Rather than interrupt the normal rhythm, even on 
 
TREATMENT OF CONSTIPATION 213 
 
 a single occasion, it would be better to incur a very 
 considerable degree of inconvenience, a fact which 
 the constipated must take to heart and carry in 
 mind; but it is better to observe such an order of 
 life and such regularity of habits as will cause the 
 bowels to move at a time at which they may without 
 haste or inconvenience receive the leisurely and 
 thorough attention which the importance of this 
 function demands. 
 
 Every meal must contain foods which will leave 
 a sufficient amount of residue to prevent stagnation. 
 To neglect this fact on a single occasion may in the 
 case of a constipated person, who by careful atten- 
 tion to regimen has established regular bowel habits, 
 cause the beginning of a return of all the old con- 
 ditions. 
 
 Too much emphasis cannot be laid upon the 
 absolute and unfailing faithfulness required to main- 
 tain the improved condition which may have been 
 attained. The majority of cases of constipation 
 relapse sooner or later, but chiefly because patients 
 return to their old irregular and careless habits. 
 Drugs are resorted to because by their use the 
 difficulty is temporarily overcome with so much less 
 trouble and self-control than is needed for the com- 
 plete regulation of one's habits of life, especially 
 in relation to eating. Sufficient care in the matter 
 of diet will be followed by success in nearly all 
 cases of simple constipation. It is necessary, how- 
 ever, that the proper regimen should be strictly and 
 uninterruptedly followed. 
 
214 COLON HYGIENE 
 
 Supplementary Bowel Movements 
 
 The act of defecation must be made as complete 
 as possible. The rectum and lower bowel are often 
 filled with dry feces which are an obstacle, the 
 removal of which by patient and continued effort 
 may be followed by a full and natural movement. 
 
 Sometimes a partial movement will be followed 
 by another, within a half hour or less. Many 
 persons evacuate their bowels in the morning by 
 two movements, one on rising and the other soon 
 after breakfast. Whatever may be the vagaries of 
 the individual colon, if it can be persuaded to act 
 at all, other things must be accommodated to its 
 needs. In many cases, always when the movement 
 seems less complete than usual, it is wise to give 
 the bowels a second opportunity for movement a few 
 minutes or half hour later. If a second "call" is 
 experienced, the matter should not be ignored, but 
 should receive instant attention. The moving of the 
 bowels is a matter of equal importance with the 
 taking of meals, and should be given the same con- 
 sideration. A crippled colon must be humored and 
 coddled, so to speak, and in many cases apparently 
 hopeless the result may be in time that the colon 
 may be trained back to habits of normal activity 
 and regularity. 
 
 Sleep 
 
 The important relation of sleep to constipation is 
 shown by the fact that loss of sleep, or a change of 
 
TREATMENT OF CONSTIPATION 215 
 
 sleeping hours from night to day, very quickly upsets 
 the bowel rhythm when it is nicely balanced in a 
 person of sedentary habits. Cannon showed that 
 the bowel contents advance very slowly during 
 sleep, but very rapidly during and directly after 
 eating. Evidently sleeping after eating must tend 
 to constipation by interfering with the normal ad- 
 vance of the colon contents toward the exit. 
 
 Loss of sleep does not, however, increase bowel 
 activity, but rather has an opposite effect, doubtless 
 because of its general depressing effects. This is 
 shown in the lack of appetite and in the coating of 
 the tongue which result from loss of sleep. Relish 
 for food is one of the normal stimuli of the intes- 
 tines. 
 
 Posture During Sleep 
 
 This is by no means a matter of no importance. 
 Gravity exerts a decided influence upon the con- 
 tents of the stomach and intestines in states of 
 disease, although the influence of this force is of little 
 moment in conditions of health. In health the food 
 is grasped by the digestive tube as soon as it reaches 
 the back of the throat, and this vital grip is main- 
 tained until the residue of the food is cast out at 
 the anus. 
 
 In disease, the situation may be greatly changed. 
 The walls of the stomach, instead of contracting 
 upon the food and kneading it, are relaxed and hang 
 
216 COLON HYGIENE 
 
 loosely separated like the sides of a bag. The 
 stomach no longer grips the food, and so gravitation 
 controls it to a large degree. Under these circum- 
 stances it is best for the patient to lie upon the 
 right side in case a meal has been eaten within two 
 or three hours before going to bed, or if there is 
 evidence of the presence of food or liquid in the 
 stomach on retiring. 
 
 When the cecum is known to be dilated and the 
 seat of stagnation, it is well to sleep upon the left 
 side, so as to facilitate the movement of food along 
 the relaxed colon. 
 
 In cases in which the abdominal muscles are 
 much relaxed and the whole colon dilated, so that 
 intra-abdominal pressure is much reduced, it is well 
 to lie upon the face, so that the weight of the body 
 may by constant pressure upon the abdominal con- 
 tents aid the progress of the feces along the crippled 
 colon. Thin persons may often adopt with advan- 
 tage the practice of sleeping on the face with a 
 pillow beneath the abdomen. Backache, and various 
 discomforts in the abdomen, especially in cases of 
 colitis, may be relieved by this simple -procedure. 
 Persons whose stomach and intestines are much re- 
 laxed and sluggish in consequence are much bene- 
 fited by lying upon the face for half an hour or an 
 hour after each meal. This not only aids the pas- 
 sage of liquids from the stomach, but helps the 
 colon, and prevents the excessive congestion of the 
 viscera, which naturally results from the excitement 
 
TREATMENT OF CONSTIPATION 217 
 
 of digestion when the intra-abdominal pressure is 
 very low. The nervousness from which many dys- 
 peptic and constipated persons suffer after eating 
 may be relieved and prevented by half an hour's 
 rest lying upon the face after meals. It should be 
 observed that it is not well to sleep at this time. 
 
Diet in Constipation 
 
 The writer once asked a celebrated Vienna pro- 
 fessor, "What do you do for constipation?" The 
 reply was, simply, "Diet." "But, professor, what 
 do you do for cases in which diet and all other 
 means have failed?" The reply was still, "Diet, 
 only diet." 
 
 Proper regulation of diet is certainly the most 
 important of all measures to be adopted in the 
 treatment of constipation although there are other 
 measures which are too valuable to be neglected. 
 A practical cure may in many cases be effected by 
 this means alone, provided, of course, that proper 
 attention is given to ordinary bowel hygiene. No 
 attempt should ever be made to treat a case of con- 
 stipation without proper regulation of diet. Such 
 a course, no matter how gratifying may be the re- 
 sults for the time being, must end in disaster; for a 
 physiologic diet is of all things most essential as 
 the means of securing normal activity of the intes- 
 tines. 
 
 First of all, the fact should be recognized that 
 food is Nature's laxative. Natural food taken in 
 the proper manner and at proper intervals gives to 
 the alimentary canal just the kind and amount of 
 stimulation that is required to maintain the normal 
 procession of nutrient material along the digestive 
 tract, and to effect the prompt discharge of un- 
 
 218 
 
DIET IN CONSTIPATION 219 
 
 usable residues and poisonous wastes from the body. 
 As has been pointed out in preceding chapters, one 
 of the effects of eating is to set up in the stomach 
 a series of vigorous peristaltic movements, which 
 pass from the stomach along the whole length of 
 the digestive tube. Under normal conditions 
 these movements are sufficient to cause the fecal 
 remains of a preceding meal to move down into 
 the lower and discharging part of the colon, thus 
 setting up the reflex actions which result in their 
 discharge from the body. This statement is not 
 based upon theory alone, but is founded upon care- 
 ful observations by expert roentgenologists, made 
 upon the stomach and intestines with the X-ray 
 after the administration of the bismuth meal. It 
 also agrees with the every-day experience of normal 
 persons. The natural time for the bowels to move 
 is soon after eating, and under fully natural con- 
 ditions a bowel movement occurs after each meal, 
 at least, after each principal meal. The writer 
 has met a number of persons whose intestines were 
 so sensitive to the stimulation of food that the tak- 
 ing of food at any time, even in a small quantity, 
 had the effect to produce within a few moments a 
 desire for evacuation of the bowels. Cases are 
 occasionally met in which the taking of food pro- 
 duced such strong stimulation that the patient 
 found it difficult to finish a meal without interrup- 
 tion by the demand of the bowels for evacuation. 
 In the dietetic treatment of constipation, it 
 
220 COLON HYGIENE 
 
 is necessary to understand the particular properties 
 of food stuffs to which stimulation of the intestinal 
 movements is due, and to make use of these several 
 qualities as they may be required in individual 
 cases. 
 
 The Laxative Properties of Foods 
 
 The properties of food stuffs to which a laxative 
 influence is due may be briefly enumerated as fol- 
 lows: 
 
 1. Sapid qualities to which flavor or tastes are 
 due. 
 
 2. Bulk, or rather the presence of cellulose, 
 which is capable of forming an indigestible residue. 
 
 3. Moisture, that is, a necessary amount of 
 liquid taken at meals or between meals, especially 
 in connection with cellulose which by absorbing 
 water holds it in the intestine. 
 
 4. Chemical properties which result from the 
 presence of sugars and organic acids in the food, 
 including the sugars formed by the digestion of 
 starch, and the lactic acids formed by the fermen- 
 tation of sugar in the intestine. Fats are also 
 somewhat laxative. 
 
 In the regulation of the diet for the relief of 
 constipation, the aim must be to make such selec- 
 tion of food stuffs as will furnish these various 
 laxative properties in the measure required by the 
 individual case. This is by no means a simple 
 matter, and requires, first a very thorough know- 
 
DIET IN CONSTIPATION 221 
 
 ledge of food values and second, a most thorough- 
 going investigation of each individual case, so that 
 not only the particular form of constipation from 
 which he is suffering may be known, whether it 
 is simple, cumulative, or latent constipation, but 
 also at what point or points in the intestinal track 
 the delay occurs, and the cause of the delay. The 
 force of this statement will be fully appreciated if 
 the chapter on "Causes of Constipation" has been 
 read with care. 
 
 Atoxic and Antitoxic Properties of Foods 
 
 In addition to the laxative properties of food 
 stuffs, there is another quality of equal importance, 
 which must be duly considered in the treatment 
 of constipation, because of the prolonged stay of 
 undigested food remnants in the alimentray canal 
 in constipation, and of the tendency to delay which 
 will always remain, even under the best conditions 
 which can be supplied. It is of the highest impor- 
 tance that the food should be of such a character 
 as to prevent as far as possible the putrefactive 
 changes which are always increased, and often to 
 an extraordinary degree, whenever there is delay. 
 
 Of the three essential food elements, carbo- 
 hydrates (starch, sugars and organic acids), fats, 
 and proteins, the last named only is capable of under- 
 going putrefaction. Foods rich in starch and su- 
 gar do not undergo putrefaction, either outside the 
 
222 COLON HYGIENE 
 
 body or within the intestine, and hence, are proper- 
 ly termed atoxic foods. 
 
 Fats in excess encourage putrefaction, while 
 starch and sugar in excess produce the opposite ef- 
 fect. By the fermentation of starch and sugar in 
 the intestine, acids are formed, which, as has al- 
 ready been pointed out, by interfering with the 
 growth of putrefactive bacteria, prevent putrefac- 
 tion. Fats ferment, when taken to excess, form- 
 ing butyric acid, an irritant poison. 
 
 Fruits, starch in vegetables like the potato, and 
 green vegetables of all sorts, which contain little 
 or almost no protein, together with certain sugars, 
 especially milk sugar, maltose or malt sugar, and 
 the sugar of fruits, and to a less degree, cereals, 
 particularly rice, which are very rich in starch, are 
 not only atoxic, being incapable of putrefactive 
 changes, but are also highly antitoxic, since they 
 in a high degree promote the formation of acids 
 in the intestine. 
 
 Antitoxic Value of Uncooked Foods 
 
 A most important point in connection with this 
 subject, which appears to have been overlooked by 
 writers on dietetics, is the antitoxic value of un- 
 cooked foods. Man is the only "cooking animal." 
 To the primitive man cookery was not only un- 
 known, but was as unnecessary as for any other 
 member of the animal kingdom. The only really 
 
DIET IN CONSTIPATION 223 
 
 valuable purpose served by cookery is to enable man 
 to make use of dried grains and certain coarse 
 vegetables, which would otherwise be unavailable 
 as food. Experience has proved that food is often 
 by cookery deprived of certain elements which are 
 essential to human nutrition. The argument made 
 by certain faddists who advocate the exclusive use 
 of a raw diet, that by cookery the life principle is 
 driven out of the food so that its nutritional value 
 is lost, has no scientific basis; nevertheless, it is 
 true that cookery destroys the life of the cells of 
 vegetable foods, and in so doing, deprives the food 
 of certain properties which are useful in the in- 
 testine. Living cells resist the attacks of the mic- 
 robes which produce fermentation and putrefaction. 
 A raw apple or potato remains intact for months, 
 while a cooked apple or potato is in a few days 
 covered with mould, and is in an active state of 
 fermentation and destructive change. Under 
 favorable circumstances such changes may take 
 place within a few hours, as is seen in the mould- 
 ing of bread over night if kept in a warm place. 
 In other words, raw food resists the destructive 
 changes which are produced by bacteria, w T hile 
 cooked food makes no such resistance. 
 
 An experiment made by the writer some years 
 ago gave very positive evidence of this fact. Two 
 equal portions of cabbage were taken. One por- 
 tion was cooked. Both portions were then inocu- 
 lated with equal quantities of putrefactive bacteria, 
 
224 COLON HYGIENE 
 
 by mixing with each a portion of fecal matter. The 
 two portions of cabbage were then placed for 
 twenty-four hours in an incubator in which the 
 temperature of the body was maintained. Exam- 
 ination showed that the bacteria in the cooked cab- 
 bage had increased enormously in numbers, where- 
 as in the uncooked cabbage the number of bacteria 
 had not increased, but had actually diminished. 
 
 Many persons have thought themselves benefit- 
 ed by the use of raw grains, such as wheat and oat- 
 meal. While it would be impossible for a person 
 to live on a diet consisting exclusively of raw 
 grains, it is possible that some benefit may be de- 
 rived from *the use of such food to a moderate ex- 
 tent, through the fact that uncooked starch digests 
 slowly. Cooked starch, as well as sugar and other 
 carbohydrates, is normally wholly absorbed in the 
 small intestine, or practically so, and therefore 
 furnishes no resistance to the growth of bacteria; 
 but raw starch, if taken in more than minute quan- 
 tities, as has been shown by experiment by the 
 writer, finds its way in considerable quantities into 
 the colon. Here, digestion slowly proceeds, pro- 
 ducing dextrin and sugar, which furnish to the 
 acid-forming bacteria just what they require for 
 their growth in a section of the intestine where 
 the help of these friendly organisms is most needed. 
 Man's natural dietary comprises food containing 
 a sufficient amount of raw starch to prevent ex- 
 tensive putrefaction in the colon; and therefore 
 
DIET IN CONSTIPATION 225 
 
 the art of cookery, while essential under the con- 
 ditions of modern civilization, is not altogether free 
 from disadvantages, which, however, may easily 
 be obviated by a proper selection of foods or, in 
 special cases, by including in the ordinary bill of 
 fare partially cooked foods containing a certain 
 portion of uncooked starch, such as oatmeal or 
 other grains cooked six to ten minutes. 
 
 Fruits are the most highly antitoxic of all food 
 stuffs. They possess in a high degree all the anti- 
 toxic properties of food. 
 
 1. They are most acceptable in an uncooked 
 state, both to the palate and to the digestive organs. 
 They are completely prepared for human sus- 
 tenance in the great laboratory of Nature, "cooked 
 in the sun," as they say in Mexico. "Cocido en el 
 sol?" asked a native fruit seller of the writer, who 
 Was seeking to purchase some tropical fruit in the 
 market place of a town in Old Mexico. 
 
 2. With very rare exceptions, fruits contain a 
 considerable amount of organic acids — citric, malic 
 or tartaric, — all of which possess antitoxic proper- 
 ties. Even many sweet fruits contain a considerable 
 amount of these acids, which are disguised by the 
 sugar, but which are not neutralized or destroyed 
 by it. 
 
 3. The sugars of fruits promote to a high de- 
 gree the growth of acid-forming bacteria in the 
 intestine, and thus lead to the formation of lactic 
 acid, which, like the acids of fruits, is antitoxic. 
 
226 COLON HYGIENE 
 
 The antitoxic properties of fruits, though not 
 understood until revealed by bacteriological re- 
 searches of recent years, have long been utilized 
 in a practical way in what is known as the "fruit 
 cure," the value of which in the treatment of 
 chronic bowel disorders has been well understood 
 for centuries. The grape cure of Switzerland and 
 certain parts of Germany, the cherry cure advo- 
 cated by Linnaeus, the great botanist, and similar 
 "cures" through the use of apples, peaches, and 
 other fruits, practised in several countries, owe 
 their value to the antitoxic properties of these 
 choicest of Nature's products. 
 
 The Antitoxic Laxative Diet 
 
 Every constipated person, then, requires a bill 
 of fare consisting of antitoxic and laxative foods. 
 It is most essential that his diet should eliminate 
 flesh foods of all sorts, including fish, oysters, fowl, 
 as well as beefsteaks, chops, and other red meats. 
 In many cases it is also wise to avoid eggs, or at 
 least to use them very sparingly. Many persons 
 find themselves able to digest the yolks of eggs, who 
 cannot take the whites either cooked or raw with- 
 out suffering inconvenience, because of the readiness 
 with which this form of albumin undergoes putre- 
 faction in the intestine. When eggs are freely 
 eaten, especially if hard boiled or poached, or in 
 the form of an omelette, portions of undigested 
 
DIET IN CONSTIPATION 227 
 
 albumin may always be found in the stools, and in 
 a state of very advanced putrefaction. The gas 
 formed in the colon when eggs are freely used 
 consists largely of sulphuretted hydrogen, which 
 is toxic as well as offensive, and affords most sub- 
 stantial evidence of the luxuriant growth of putre- 
 factive bacteria in the colon. 
 
 Those who have been accustomed to the free 
 use of meat and eggs are sometimes afraid to dis- 
 pense with them lest they should suffer from an 
 insufficient supply of protein; but the experiments 
 of Chittenden and the extensive practical experience 
 of the Battle Creek Sanitarium have shown most 
 conclusively that the amount of protein required 
 by the body is so small that it may readily be 
 furnished by food derived exclusively from the 
 vegetable kingdom. In other words, eggs, and 
 meat, and even cow's milk, are quite superfluous 
 as food, when a good variety of fruit, cereals and 
 fresh vegetables are available. If, however, an 
 additional supply of protein is required, it may 
 readily be obtained from nuts. Peanuts, pine nuts, 
 English walnuts and almonds are all rich in pro- 
 tein; a pound of pine nuts, in fact, contains fifty 
 per cent, more protein than a pound of lean beef, 
 and besides, contains twice as much more nutrient 
 in the form of a most easily digestible fat. Prac- 
 tically the same thing may. be said of almonds and 
 peanuts. Any possible deficiency in protein may 
 readily be made up by taking at meals a handful 
 
228 COLON HYGIENE 
 
 of any kind of nut meats. It is only necessary to 
 take care to masticate them thoroughly, so that 
 the protein present may easily be accessible to the 
 digestive juices. A somewhat extensive study of 
 the laxative and antitoxic properties of various 
 foods will be found of practical value. 
 
 Cellulose-Containing Foods 
 
 All vegetable foods contain more or less cellu- 
 lose, but the amount differs very greatly. This 
 element, as has already been mentioned, is highly 
 necessary as a means of securing normal bowel ac- 
 tion. Indeed, bulk, not simply in the food itself, 
 but in the residues left behind after the absorption 
 of the nutritive portions of the food, is of first 
 importance. This quality in food is even more 
 important than the antiseptic properties, for the 
 reason that putrefactive bacteria may always find 
 in the bile and other intestinal secretions abundant 
 material to support their growth, provided sufficient 
 delay occurs to encourage putrefactive changes. 
 The thing most necessary in the prevention of 
 putrefaction is rapidity of movement of food resi- 
 dues and body wastes along the intestine to the 
 exit. 
 
 The following tables show the amount and 
 percentage of cellulose found in the dried sub- 
 stance of various food stuffs: 
 
VEGETABLES 
 
 Grains 
 per ounce 
 
 FRUI1 
 
 Grains 
 
 per ounce 
 
 Huckleberries 61.5 
 Red Raspberries 37. 
 Blackberries 25. 
 
 '5 
 
 Dried Beans 
 
 40. | | 
 
 n zi 
 
 
 
 Dried Peas 
 
 28.5 | | 
 
 i i 
 
 Len4ils 
 
 20. □ 
 
 □ 
 
 Green Peas 
 
 935 □ 
 
 Cranberries 25. 
 
 □ 
 
 Cabbage 
 
 9-2 □ 
 
 Curran4s 23. 
 
 □ 
 
 Parsnip 
 
 8.65 □ 
 
 Figs 22.5 
 
 □ 
 
 Brussels jprouta 
 
 785 
 
 Goosberries 17-5 
 
 □ 
 
 Kohlrabi 
 
 7.75 U 
 
 Pears 15. 
 
 □ 
 
 Celeru 
 
 7. □ 
 
 Aprico4s 12.5 
 
 □ 
 
 Turnip 
 
 6.6 D 
 
 Prunes 10. 
 
 D 
 
 Pumpkin 
 
 6.1 D 
 
 C berries 10. 
 
 D 
 
 B. PoUo 
 
 5.45 
 
 Strawberries 10. 
 
 □ 
 
 B<?e±S 
 
 5.25 
 
 Oranges 10. 
 
 D 
 
 Asparagus 
 
 5.2 D 
 
 Plums 15 
 
 D 
 
 Carrot 
 
 4.9 | 
 
 Grapes 7.5 
 
 D 
 
 vSpinach 
 
 4.65 D 
 
 l<aiVins 7-5 
 
 D 
 
 Cauliflower 
 
 4.55 D 
 
 Shewed Raisins 7.4 
 
 D 
 
 Tom aloes 
 
 4.26 [ 
 
 Peaches 5. 
 
 D 
 
 Green Peas 
 
 4. 1 
 
 Apples <5- 
 
 D 
 
 Cucumber 
 
 3.9 [ 
 
 Bananas .3 
 
 1 
 
 LeHuce 
 
 3.65 1 
 
 
 
 Onion 
 
 3.55 1 
 
 
 
 Chart Showing Proportion of Cellulose in Some of the Common 
 Vegetables and Fruits — Also Grains of Cellulose per Ounce 
 
CEREALS 
 
 Cr*,ns 
 
 per ounce 
 
 Bran 200 I 
 
 Oatmeal 44. I I 
 
 Barley 20. □ 
 
 %e 15. □ 
 
 Wheat 10. D 
 
 Corn Meal <S\ fl 
 
 r-i. Flakes 1U. U 
 
 10. D 
 
 9. D 
 
 Co 
 
 GrahamFlour 
 Cranola 
 
 Rolled 
 Wheat 
 
 G rah aid 
 Bread 
 
 Wheat Criis i 
 
 Whole W. Bread 1. 
 
 6 D 
 
 75! 
 
 Unpolished 
 Rice 
 
 Polished 4 
 
 Rice .4 
 
 Fine ~ 
 
 Flour .3 
 
 DIETvS 
 
 Normal Diet- TtuA. \ 
 Green Vegetables, d- L 
 Graham Bread 
 
 Oatmeal 
 
 Cracked Whe*t L 
 
 rdinary Mixed | | 
 
 White Bread 
 and Milk. 
 
 D 
 
 Meat 
 
 Chart Showing Proportion of Cellulose in Some of the Common 
 Cereal Foods— Also Grains of Cellulose per Ounce 
 
DIET IN CONSTIPATION 229 
 
 CEBEALS 
 
 c S SI ° 
 
 §° .2,2 ">§ ™ a »o« $0^3 
 
 AhO &O&0 Ud OU.H OKu 
 
 Wheat (cooked) 2 10 26.3 38 30 
 
 Wheat Grits (cooked) . 1 5 18.4 27 60 
 
 Eolled Wheat (cracked) 2 9 26.3 36 30 
 
 Graham Flour 2 10 104 9.6 30 
 
 Fine Flour 3 1.5 101 1.4 200 
 
 Oatmeal (cooked) 10 44 18 37 6 
 
 Barley (cooked) 4 20 31.08 64 15 
 
 Polished Eice 4 2 101.8 1.96 150 
 
 Unpolished Eice 75 3.75101.8 3.68 82 
 
 Eye (small) 3 15 104 14.4 20 
 
 Corn Meal 2 10 103 9.7 30 
 
 Corn Flakes 2 10 103 9.7 30 
 
 Beans (dried) 8 40 100 40 75 
 
 Peas (dried) 5.7 28.5 100 28.5 10 
 
 Lentils 4 20 101.8 19.6 15 
 
 Granola (cooked) 2 10 101.7 9.8 30 
 
 Sterilized Bran 40 200 1.5 
 
 Graham Bread ....... 1.2 6 76 8 50 
 
 Whole Wheat Bread ..1 5 71.7 7 60 
 
 VEGETABLES 
 
 ~ v a 5 
 
 •flag 
 •N-as 
 
 £0 too 
 
 Asparagus 5.2 
 
 Beans . 4 
 
 Beets 5.25 
 
 Brussels Sprouts 7.85 
 
 Cabbage 9.2 
 
 Carrot (raw) 4.9 
 
 (3 
 
 .2 c 
 
 .2 ° 
 
 « a 
 
 5 <» 
 
 .S3Q 
 
 Ounces nec< 
 sary to give 
 300 grains 
 Cellulose. 
 
 13.9 
 
 37.4 
 
 57.7 
 
 30.96 
 
 12.9 
 
 75 
 
 11.6 
 
 45 
 
 57 
 
 6 
 
 131 
 
 40 
 
 8.8 
 
 145 
 
 32.4 
 
 14 
 
 36 
 
 60 
 
230 COLON HYGIENE 
 
 Cauliflower (steamed) 4.55 10.2 44.6 66 
 
 Celery (raw) 7 5.5 127 45 
 
 Cucumber (raw) 3.9 5 78 75 
 
 Green Peas 9.35 34.4 27 32.2 
 
 Kohlrabi (raw) 7.75 9 86 39 
 
 Lettuce 3.65 5.6 65 82 
 
 Onion 3.55 10.52 33.7 85 
 
 Parsnips 8.65 17.1 50 36 
 
 Peas (dried) 28.5 103 27 10.8 
 
 Potato (baked) 5.45 32.7 16.6 55 
 
 Pumpkin 6.1 9.3 65.6 50 
 
 Spinach 4.65 9.3 50 65 
 
 Tomatoes 4.20 6.6 63.6 71 
 
 Turnip 6.6 6.1 108 46 
 
 TEUITS 
 
 « S3 
 
 ° v a a 
 
 G S3 C O 
 
 1311 
 
 Prunes (cooked) 2 10 27.5 
 
 Apples 1 5 101 
 
 Pears 3 15 18.5 
 
 Peaches 1 5 12.8 
 
 Plums 1.5 7.5 24.7 
 
 Cherries 2 10 22.8 
 
 Baspberries, red 7.4 37 18.3 
 
 Blackberries 5 25 16.8 
 
 Huckleberries 12.2 61 21.5 
 
 Strawberries 2 10 11.4 
 
 Currants 4.6 23 16.7 
 
 Grapes 1.5 7.5 20.3 
 
 Eaisins 1.7 7.5 100.3 
 
 Eaisins (stewed) 1.7 7.4 100.6 
 
 Oranges 2 10 14.9 
 
 Bananas . 3 1.5 28.9 
 
 Figs 4.5 22.5 92.4 
 
 Apricots 2.5 12.5 16.3 
 
 Gooseberries (stewed) 3.5 17.5 19.4 
 
 Cranberries 5.0 25 48 
 
 in O w 
 
 co.S 
 
 36 
 5 
 
 81 
 
 40 
 
 30 
 
 44 
 200 
 150 
 300 
 
 87 
 138 
 
 36 
 
 38.4 
 
 67 
 
 5.2 
 24.3 
 74 
 90 
 51 
 
 «>.£ °3 
 c bc.S v 
 SogS 
 
 O caeo o 
 
 30 
 60 
 20 
 60 
 40 
 30 
 81 
 12 
 5 
 30 
 17 
 40 
 30 
 40 
 30 
 200 
 13.3 
 24 
 17 
 12 
 
DIET IN CONSTIPATION 231 
 
 Sterilized Wheat Bran 
 
 One of the oldest and certainly the most valu- 
 able remedy in the treatment of constipation is ordi- 
 nary wheat-bran. Bran consists almost entirely or 
 very largely of cellulose in an indigestible form. 
 While wheatmeal contains 2.5% of cellulose, bran 
 contains 18%, and in some cases even more. In 
 the form of bran, cellulose is well broken up, and 
 hence can be passed through the intestine without 
 difficulty. The apprehension which some authors 
 have expressed concerning the irritating effects of 
 bran are wholly without basis, except, of course, that 
 one would not think of using bran in a case of 
 gastric ulcer or acute inflammation of the stomach 
 or intestines: As a matter of fact, when well soft- 
 ened with water, bran is no longer irritating, but 
 is an emollient. The thin films of cellulose become 
 as soft and pliable as wet paper, and excite the 
 bowel, not by scratching or irritating it, but by a 
 gentle titillation, so to speak, and by giving to the 
 food sufficient mass to distend the intestine and 
 stimulate it to vigorous activity. 
 
 In its ordinary commercial form, bran is scarce- 
 ly fit for use, on account of the large amount of 
 dirt which it contains, including multitudes of 
 bacteria. For intestinal use as a laxative, it should 
 be carefully prepared by thorough cleaning and 
 washing of the wheat before grinding and steriliza- 
 tion of the bran. Sterilized bran, first introduced 
 
232 COLON HYGIENE 
 
 by the writer several years ago, is now prepared by 
 various manufacturers, and is put up in convenient 
 packages. One or two rounded tablespoonfuls 
 should be taken at each meal, the amount depend- 
 ing upon the character of other foods taken. The 
 writer has never seen any ill effects from the use of 
 sterilized bran which he has prescribed for many 
 years, although there are cases in which it fails to 
 produce the desired effect and has to be supple- 
 mented by the use of paraffin oil as a lubricant. 
 
 This is particularly true in cases in which the 
 cecum is greatly dilated or crippled by adhesions and 
 in cases in which there is obstruction of other parts 
 of the colon, especially the pelvic colon as the result 
 of adhesions. 
 
 The combination of paraffin oil with bran or 
 agar-agar in some form is also useful in cases of 
 spastic contraction due to colitis. 
 
 Experience shows that from an ounce to two 
 ounces of cellulose must be taken with the food 
 daily, to insure sufficient bulk to stimulate the 
 intestine to action. In cases in which the colon 
 is very redundant or is crippled by adhesions, even 
 double this amount may sometimes be needed, at 
 least until the bowel has been trained to normal 
 action. This amount of cellulose is provided by 
 two rounded tablespoonfuls of sterilized bran in 
 addition to other laxative foods. 
 
 The amount of food required to furnish an ounce 
 of cellulose may be ascertained by reference to the 
 foregoing tables. 
 
Agar-Agar in Edible Form 
 
 •' _. 
 
 Agar-Agar 
 
DIET IN CONSTIPATION 233 
 
 It should further be mentioned that in the use 
 of cellulose in concentrated form as in sterilized 
 bran, the whole amount used at a meal should not 
 be taken at once, as at the beginning or end of the 
 meal, but should be well mixed with the food by- 
 taking small portions at frequent intervals during 
 the meal. 
 
 Agar-Agar 
 
 The use of agar-agar, a Japanese sea-weed of 
 a nature similar to Iceland moss, is to be most 
 highly recommended as a means of giving the neces- 
 sary bulk to stimulate the intestine to prompt ac- 
 tion. 
 
 It may be used without any possible injury in 
 all cases of sluggish bowel action. When properly 
 prepared it is wholly free from unpleasant flavor, 
 and it manifests such astonishing avidity for water 
 that when it is present in the feces they cannot pos- 
 sibly become dry and hard. 
 
 In cases in which constipation is due to "greedy 
 colon," agar-agar or bran is indispensable. In such 
 cases the colon has acquired the power to eat up 
 enormous quantities of the cellulose of the food, so 
 that it is very difficult to increase the bulk of the 
 feces by the use of green vegetables. This is the 
 reason for the disappointment experienced by many 
 who hope to find in the free use of lettuce and like 
 green foods a panacea for their intestinal ills. 
 Agar-agar is hemi-cellulose, and has been shown by 
 
234 COLON HYGIENE 
 
 the experiments of Mendel and others to be indi- 
 gestible by any of the digestive fluids with which 
 it comes in contact in the human body. Agar-agar 
 must be taken in sufficient quantity to accomplish 
 the object sought. Two-thirds of an ounce to an 
 ounce is the quantity usually required for adults. 
 For young children a quarter to a half of this 
 quantity is sufficient. 
 
 Agar-agar is easily taken in soup, cereal coffee, 
 fruit juice or stewed fruit. It should be allowed 
 to soften and should then be swallowed without 
 chewing. 
 
 This remedy should be taken at meals in order 
 that it may be well intermingled with the food, and 
 so prevent the formation of hardened residues in 
 the intestine. 
 
 Agar-agar may be used with advantage as a 
 substitute for a meal, when food cannot be taken, 
 and when there is no appetite for food, and when 
 so used it maintains the intestinal rhythm which 
 would otherwise be lost, resulting in constipation. 
 It should in such cases be taken with fruit juice or 
 fresh or stewed fruit. When one finds at night 
 that the usual amount of food has not been taken, 
 an extra dose of agar-agar with a little fruit may 
 be taken before going to bed. No digestive work 
 is required by either the fruit or the agar-agar ex- 
 cept to move it along the digestive canal. It is 
 important to take fruit or fruit juice with ' the 
 agar-agar to excite the necessary peristalsis. 
 
DIET IN CONSTIPATION 235 
 
 Number and Size of Meals 
 
 In very many cases of chronic constipation the 
 colon, especially the cecum, has become so dilated 
 that it is seriously crippled. Its thin, atrophied 
 walls are unable to handle large masses of material* 
 In such cases, large bulky meals are likely to over- 
 weight the cecum and to form an impaction which 
 may remain for days, giving rise to fermentation, 
 distention of the colon with gas, colic pains, and 
 great inconvenience. Complaint is often made 
 that bulky foods cause much flatulence and distress 
 and seem to increase the constipation. The remedy 
 is not to be found in discarding "coarse vegetables" 
 or other bulky foods but in taking smaller and more 
 frequent meals. By this means the amount of 
 material present in any portion of the bowel at any 
 particular time will be reduced, the bowel will 
 never be over distended, and will have an oppor* 
 tunity gradually to recover its normal tone. 
 
 The proper plan for the meals in such a case is 
 to take two principal meals and two minor meals. 
 The principal meals should contain the chief part 
 of the nutriment; the minor meals should make 
 small demands upon the digestive organs; the bulk 
 should be about the same for each of the four meals. 
 No fats should be taken at the minor meals and 
 nothing requiring more than two hours for gastric 
 digestion. It is best to confine the minor meals to 
 fruit and cellulose. 
 
236 COLON HYGIENE 
 
 The cellulose may be taken in the form of bran 
 mush, bran cakes, colax, (Japanese sea weed or 
 Ceylon moss), or laxa, (sterilized bran and agar- 
 agar). Any sort of fresh juicy fruit may be eaten, 
 but bananas, dates, dried figs and raisins should 
 be avoided. Fresh figs or raw soaked purple figs 
 are excellent. Soaked raw prunes are also very 
 good indeed. 
 
 The arrangement of the four meals as regards 
 time may be the following: first, breakfast on ris- 
 ing, say 6:30 a. m., fruit and bran; second break- 
 fast, 9 :00 a. m. ; dinner 3 :00 p. m. ; fruit lunch at 
 bedtime. If these hours are not convenient, some 
 other arrangement may be made, care being taken 
 to avoid taking meals too near together. 
 
 The Use of Bran 
 
 Wheat bran is perhaps the most useful of all 
 food remedies for constipation. Bran may be 
 taken by itself or it may be used in many combina- 
 tions. Care must be taken to obtain clean bran, 
 which is not always easy, for the reason that the 
 bran is usually mixed with much dirt and offal 
 removed from the grain. To be fit for use, the 
 bran should be taken from wheat which has been 
 specially cleansed and washed. The bran should 
 be cooked and sterilized to destroy any adhering 
 germs. 
 
 Such bran only needs softening and is ready for 
 
DIET IN CONSTIPATION 237 
 
 immediate use. It may be eaten as a breakfast 
 cereal or it may be mixed with any other suitable 
 food such as oatmeal, toasted flakes, or even mashed 
 potatoes or boiled rice. 
 
 Sterilized bran may be added to bread, biscuit, 
 cake and breakfast cakes in proportion of one- 
 fourth or even more. It should be used freely at 
 every meal. Numerous excellent recipes are now 
 available for using bran in various palatable and 
 efficient ways. 
 
 Recipes for the Use of Bran 
 
 BRAN AND OATS 
 
 1 cup rolled oats 
 
 1 cup sterilized bran 
 
 2J/2 cups water 
 
 1 teaspoon salt 
 
 Heat the water to boiling. Add the salt, bran 
 and the rolled oats. Let boil five minutes. This 
 dish is a good corrective measure and at the same 
 time an excellent breakfast food. 
 
 STERILIZED BRAN 
 
 Look over and remove foreign substances from 
 bran and place in a rather shallow pan in a mod- 
 erate oven. Place a pan of hot water in the oven 
 to prevent burning. Bake a half hour, stirring the 
 bran often to prevent scorching. Grind in a coffee 
 mill. 
 
238 COLON HYGIENE 
 
 BRAN AND GRANOLA MUSH 
 
 1 cup sterilized bran 
 
 1 cup granola 
 3 cups water 
 
 \y 2 teaspoons salt 
 
 Mix the bran, granola and salt. Stir into the 
 boiling water and cook for a few minutes directly- 
 over the flame. 
 
 GRAHAM BREAD 
 
 3 cups milk and water (equal parts) 
 
 2 tablespoons malt honey or molasses 
 1^2 cups sterilized bran 
 
 About 2 quarts whole wheat flour 
 
 2 teaspoons salt 
 
 J/2 yeast cake 
 
 %. cup warm water 
 
 Soak the yeast in the warm water. Scald the 
 milk and cool to lukewarm. Potato water may 
 be used instead of the milk and water. Add water, 
 the molasses and salt, then the softened yeast. Mix 
 the flour and bran together and stir into the liquids. 
 Knead thoroughly, and put to rise in a warm place. 
 When light, mold into a loaf. Let rise again, and 
 when light bake in a hot oven about one hour. De- 
 crease the heat somewhat during the latter part of 
 the baking. This makes 3 small or 2 large loafs. 
 Graham flour may be used instead of the whole 
 wheat, in which case less bran will be needed. 
 
DIET IN CONSTIPATION 239 
 
 BRAN GRAHAM BISCUIT 
 
 1 cup sterilized bran 
 
 2 cups graham flour 
 1 cup milk 
 
 1 egg 
 
 2 teaspoons sugar 
 
 1 teaspoon salt 
 
 2 tablespoons butter 
 1 teaspoon soda 
 
 80 minims hydrochloric acid (C. P.) (This 
 amount of soda and hydrochloric acid is equivalent 
 to 4 teaspoons baking powder.) 
 
 Mix the flour, bran, sugar, and salt together. 
 Beat the egg slightly and add to the milk. Dis- 
 solve the soda in the milk, and add the melted but- 
 ter. Lastly, add the hydrochloric acid. Turn 
 very quickly into the dry ingredients. Mix lightly 
 but quickly. Turn upon a molding board and 
 shape with a biscuit cutter and bake fifteen to 
 twenty minutes in a hot oven. 
 
 If baking powder is used, omit the hydrochloric 
 acid and the soda, and proceed as follows: Mix 
 the dry ingredients together, beat the egg slightly, 
 and add to the milk. Stir the liquids into the dry 
 ingredients the same as for cream biscuits. Turn 
 out upon a slightly floured molding board and roll 
 to one-half inch in thickness. Cut into shape with 
 the biscuit cutter and bake in a hot oven. 
 
240 COLON HYGIENE 
 
 BRAN GEMS 
 
 1 cup sterilized bran 
 
 1 cup graham flour 
 
 ]/% cup milk 
 
 3 tablespoons melted butter 
 
 1 teaspoon salt 
 
 1 egg 
 
 1 tablespoon sugar 
 
 24 teaspoons soda 
 
 60 minims hydrochloric acid (C. P.) (This 
 amount of soda and hydrochloric acid is equivalent 
 to 3 teaspoons of baking powder.) 
 
 Mix the bran, flour, salt and sugar together. 
 Beat the egg, add the milk and one-half of the dry 
 ingredients. Stir in the hydrochloric acid. Mix 
 well and add the melted butter. Sift the soda with 
 the remaining half of the dry ingredients and stir 
 into ^the batter. Turn into buttered muffin pans 
 and bake in a hot oven twenty to thirty minutes. 
 
 BROSE 
 
 Mix equal parts of cornmeal, steel-cut oats, and 
 sterilized bran. Stir into three times its bulk of 
 boiling water. As soon as the mixture thickens, it 
 is ready to eat. Should not cook over four or five 
 minutes. This simple mixture will be found a most 
 efficient and satisfactory laxative breakfast food. 
 Eat with cream, butter, fresh or stewed fruit. 
 
Baths and Other Home Treatments 
 for Constipation 
 
 Water may render great service in constipation, 
 through the general improvement in health which 
 may be secured by its sytematic use. Cold water 
 is of the greatest service. The short spinal douche 
 is one of the most effective means which can be 
 employed for improving the tone of the nervous 
 system. 
 
 The inactive skin, due to the general saturation 
 of the body with toxins, is an indication for sweat- 
 ing baths. In constipation these should be made 
 short, however, barely long enough to stimulate the 
 skin to vigorous perspiration, and should be im- 
 mediately followed by a short general cold applica- 
 tion, including a cold douche to the spine, abdomen 
 and legs. Short, cold applications applied to the 
 surface cause reflex contraction of the internal in- 
 voluntary muscles. It is for this reason that plac- 
 ing the feet, sometimes even the hands, in cold 
 water will often produce a desire to empty the 
 bladder, through stimulation of the urinary centre. 
 
 The defecating centre and intestinal muscles may 
 be stimulated in the same way. Various local ap- 
 plications are of great service in improving the tone 
 of the bowels, though local cold applications must 
 be used with great discretion and with careful 
 
 241 
 
242 COLON HYGIENE 
 
 knowledge of the exact nature of the case; for the 
 tendency of cold to produce contraction of the in- 
 voluntary muscles leads to an aggravation of the 
 condition in colitis with spastic constipation. 
 
 Of the many different modes of applying cold 
 water, which may be of service, the following are 
 especially recommended : 
 
 The Exercise Bath 
 
 Swimming is undoubtedly the best form of bath, 
 as well as the best form of exercise for general 
 hygiene effects. Unfortunately, facilities for this 
 natural exercise bath are not available for the ma- 
 jority of persons, especially during the winter sea- 
 son. Some time ago, it occurred to the writer that 
 most of the advantages of the swimming bath might 
 be secured by combining exercise with the cold bath 
 in an ordinary bath tub. The following is a de- 
 scription of the rowing or surf bath as it is in use 
 at the Battle Creek Sanitarium: 
 
 The patient sits in a bath tub partly filled with 
 water, and dips water over himself while at the 
 same time executing the movements of rowing. The 
 temperature of the water may be 100° F. at the 
 start, but should be rapidly lowered by opening the 
 cold water faucet and, if necessary, letting out part 
 of the water while the cold water is running in. 
 The rowing and dipping apparatus consists of a 
 parr of handles to which is attached a dipper and 
 
The Balh Exerciser and Surf Bath 
 

 
1 he Pouring Douche 
 
BATHS AND OTHER HOME TREATMENTS 243 
 
 a rubber cord. The bather fills the bowl as he 
 reaches forward, then dashes' the water over his 
 body as he pulls the bowl towards his chest and 
 bends his body back. Strokes are made at the rate 
 of about thirty per minute. From one hundred to 
 one hundred and fifty strokes are made. The tem- 
 perature of the water grows continually colder to 
 the close of the bath or until pipe temperature is 
 reached. A temperature of 70° F. to 65° F. is 
 easily borne, and one finishes the bath with the 
 same delightful sensation of warmth and glow 
 which one feels after a swim in the surf. The tem- 
 perature of the water is, of course, under perfect 
 control, an advantage over sea bathing; and the 
 work done may be made as vigorous as one desires. 
 
 This exercise bath is most excellent for persons 
 suffering from constipation. The impact of the 
 cold water upon the surface of the abdomen re- 
 flexly stimulates intestinal activity. 
 
 The exercise bath is especially valuable in cases 
 of obesity. Both the exercise and the cold water 
 help to burn up the excessive accumulation of fat 
 in the abdominal wall and within the abdomen. 
 
 The Cold Douche 
 
 A short cold douche to the lower part of the 
 back, buttocks, abdomen and feet. The tempera- 
 ture should be 70° to 50° F., and the duration ten 
 to thirty seconds. With patients who are not ac- 
 
244 COLON HYGIENE 
 
 customed to applications of cold water, the tem- 
 perature of the douches should at first not be lower 
 than 70°. This should be gradually lowered at 
 each application until the temperature of 60° to 
 50° is reached. In general, the douche should be 
 preceded by a short hot bath to prepare the patient 
 for the cold application, and to secure prompt re- 
 action, which is still further encouraged by exer- 
 cise after the bath. 
 
 The Simultaneous Hot and Cold Douche 
 
 A very excellent form of bath especially adapted 
 to cases of constipation, is the simultaneous warm 
 shower bath (100° F.), with short cold douche 
 to the abdomen. The warm shower bath should 
 be applied for half-a-minute so that the skin will 
 be thoroughly warm first, and the cold spray or 
 broken jet should be applied to the abdomen with- 
 out interrupting the warm shower. The tempera- 
 ture of the spray should be 70° to 50°. The dura- 
 tion of the cold application should be not more 
 than a minute. At the end of the bath a short 
 general cold application lasting no more than ten 
 to fifteen seconds should be made to secure reaction, 
 and thus fix the blood in the skin. 
 
 Abdominal Pouring Douche 
 
 When a douche apparatus is not available, a 
 very efficient abdominal douche may be applied in 
 
Applying a Wet Girdle 
 
I 
 
BATHS AND OTHER HOME TREATMENTS 245 
 
 an ordinary bath tub. A hot bath at the tempera- 
 ture of 102° to 103° should be applied for one to 
 three minutes. Then the outlet should be opened 
 and cold water should be poured on the abdomen 
 while the water is running out. By lifting the dip- 
 per to the height of five or six feet a sufficient de- 
 gree of force may be obtained to produce a decided 
 reflex effect. The temperature of the water may 
 vary from 60° to ice cold, the temperature being 
 gradually lowered as the patient becomes accus- 
 tomed to the cold application. 
 
 Hot Sitz and Cold Pour 
 
 The patient sits in water at a temperature of 
 102° or 103° for two or three minutes, then leans 
 back in the tub while the attendant pours cold water 
 70° to 50° over the abdomen for half a minute. 
 
 Rubbing Cold Sitz Bath 
 
 In this bath the patient sits in water at a tem- 
 perature of 75° to 55° for two minutes, rubbing 
 himself vigorously meanwhile. This bath produces 
 a powerful reflex influence upon the intestines, es- 
 pecially in the colon, and is frequently followed 
 soon after by a desire to defecate. The patient 
 should rub himself continually during the bath, 
 and the feet may be kept in hot water if there is 
 a tendency to chilliness. The shoulders should be 
 covered by a woolen blanket. 
 
246 COLON HYGIENE 
 
 The Sedative Sitz Bath 
 
 A bath at the temperature of from 60° to 70° 
 for fifteen to twenty minutes produces powerful and 
 prolonged contraction of internal muscular struc- 
 tures. This bath is useful in diarrhoea, and is one 
 of the most efficient means of improving the tone 
 of the abdominal muscles and of an atonic colon. 
 This bath should not be given in cases of spastic 
 constipation. In general, prolonged cold baths of 
 any sort, (that is, baths longer than two or three 
 minutes), are aggravating in this condition. 
 
 Alternate Applications to the Abdomen 
 
 A hot fomentation to the abdomen for five to 
 ten minutes, followed by a cold application for one 
 minute, is an excellent means of stimulating peristal- 
 sis and improving the muscular tone. The cold 
 application may consist of a compress of ice water, 
 but the most effective method is to rub the abdomen 
 with a smooth piece of ice. The effect of this ap- 
 plication is increased by repeating the alternation 
 two or three times in succession. 
 
 The Wet Girdle 
 
 This is a simple method which has been used 
 for centuries by the peasantry of Europe. The ab- 
 dominal girdle consists of a coarse towel of three 
 yards in length, half of which is wet, the other half 
 remaining dry. Beginning with the wet end, the 
 
. \. 
 
 § 
 
 c 
 
 ^4 
 

BATHS AND OTHER HOME TREATMENTS 247 
 
 towel is wound round the trunk of the body, great 
 care being taken to see that it fits the skin snugly. 
 Outside the towel a flannel bandage is applied. The 
 towel should be changed before it becomes dry. It 
 should be worn night and day to secure the most 
 pronounced effect. The mackintosh or oiled mus- 
 lin, often applied with the moist bandage, should 
 be omitted when it is the purpose to relieve con- 
 stipation. 
 
 Fomentation to the Abdomen 
 
 The abdominal fomentation is a capital means 
 for use in spastic constipation, the result of colitis, 
 and when the ileocecal valve is in a state of spas- 
 modic contraction due to chronic appendicitis or 
 ovarian disease. In general the fomentation is 
 highly useful in all cases of constipation accom- 
 panied by pain in the abdomen, no matter what the 
 cause. 
 
 The electric fomentation heater is a convenient 
 means of heating a fomentation compress. 
 
 The best time for applying the fomentation is 
 soon after breakfast, or shortly before the regular 
 time for moving the bowels. Applications may be 
 made with great advantage two or three times 
 daily, or at least morning and night, so as to relax 
 the colon several times during the day. 
 
 In very pronounced cases of colitis, with spastic 
 constipation, a short very hot bath is of great ser- 
 vice. The duration of the bath should not be more 
 
248 COLON HYGIENE 
 
 than two to four minutes. It produces debility 
 and anemia if long continued and often repeated. 
 The effect of hot applications is to lessen the ir- 
 ritability of the nerve centers, and thus to relieve 
 the intestinal spasm which may be due to conges- 
 tion or inflammation of the appendix, ovaries, 
 bladder, rectum or gall-bladder, or still more often, 
 to colitis. 
 
 Combined Hot Bath and Hot Douche 
 
 Perhaps the most effective measure for the relief 
 of intestinal spasms, such as sometimes occurs in 
 muco-membranous colitis, is a warm bath (100° F.) 
 combined with a very hot spray to the abdomen. 
 The water should be allowed to fall on the abdo- 
 men in very fine streams with very little force, at 
 a temperature of 115° to 120°. The duration of 
 the application should be two to five minutes. It 
 should be followed by a cold application at a tem- 
 perature about 80° for one or two minutes. 
 
 The Hot Sitz 
 
 The hot sitz bath at a temperature of 112° to 
 118°, duration two to three minutes, cannot be 
 too highly praised as a measure of the highest value 
 for use in the treatment of reflex and spastic con- 
 stipation, with or without colitis. After the sitz 
 no cold application is made. The best time for the 
 bath is on rising in the morning. 
 
Photophore (above) and Thermophore (below) 
 
BATHS AND OTHER HOME TREATMENTS 249 
 
 The Photophore, and the Electric 
 Thermophore 
 
 These are measures of great value in the treat- 
 ment of spastic and reflex constipation, and are 
 especially useful in cases in which pain is a pro- 
 nounced symptom and a cause of reflex spasm. The 
 applications should be made morning and night in 
 place of the fomentation, and are much more ef- 
 fective. 
 
 The Enema 
 
 There are unquestionably certain cases in which 
 the colon has become so crippled by inflammations, 
 stretchings, distortions, adhesions and the degenera- 
 tion of its muscular structures, and consequent 
 weakening of its contractile powers, that it can no 
 longer be made to perform its functions, even by 
 the use of such accessories as act as mechanical or 
 physiological aids. In such cases and in certain 
 emergency cases, the judicious use of the enema is 
 not only helpful, but sometimes necessary. For 
 example, in cases of senile constipation, where as 
 the result of long continued colitis, the muscular 
 walls are thin and greatly stretched, while the 
 colon itself has become abnormally redundant and 
 folded upon itself, the daily or frequent use of the 
 enema may be required. 
 
 The best means of administering the enema is 
 the fountain syringe. The tube should be long 
 
250 COLON HYGIENE 
 
 enough so that the reservoir, if necessary, may be 
 raised to a height of five or six feet above the pa- 
 tient. When it is desired to stimulate the bowel 
 to immediate contraction, the reservoir should be 
 placed high, but when the purpose is to introduce 
 as large quantity of water as possible into the colon> 
 and to have it retained for a time, the reservoir 
 should be placed at a height not exceeding two or 
 three feet. 
 
 The position of the patient during the adminis- 
 tration of an enema is not a matter of very great 
 importance. In cases in which the pelvic colon is 
 low down in the pelvis, as is shown by examination, 
 it is well to put the patient in a knee-chest position. 
 The water should be introduced very slowly. Or- 
 dinarily, however, the patient may lie upon the 
 back or either side, or. the enema may even be ad- 
 ministered standing. The water quickly finds its 
 way along the colon, no matter what the position 
 of the patient may be. 
 
 The use of the colon tube is quite unnecessary. 
 Indeed, as the writer learned long ago by experience, 
 and as has been abundantly proved by examination 
 with the X-ray, the colon tube can rarely ever be 
 introduced bej^ond the rectum. It is arrested at 
 the pelvi-rectal fold, and simply returns and coils it- 
 self up in the rectum. A tube long enough to pass 
 the water through the anus is as useful as the longest 
 colon tube, unless the long tube is passed into the 
 pelvic colon past the ileosplenic flexure, a procedure 
 
BATHS AND OTHER HOME TREATMENTS 251 
 
 which is rarely required, and, of course, should only 
 be undertaken by a physician. 
 
 The enema may be employed in a variety of 
 ways adapted to different occasions and purposes, 
 and it may be repeated as many times as may be 
 necessary. Warm water dissolves hardened fecal 
 matters much more readily than cold water, yet in 
 some cases it may be necessary to repeat the enema, 
 at intervals of fifteen to twenty minutes, five or 
 six times before the effect desired is obtained. When 
 used for the purpose of softening hardened fecal 
 matters, the water should be introduced slowly, 
 and the patient should be instructed to retain as 
 much as possible. The enema should be repeated 
 as long as the water contains fecal matters when 
 returned. 
 
 The Hot Water Enema 
 
 The temperature of the water should be 105° 
 to 115° F. The quantity may be from one to three 
 pints. This is preferable in cases of colitis and when 
 abdominal pain or tenderness is present. 
 
 The Hot Soap Enema 
 
 The addition of soap to the water somewhat in- 
 creases its power to dissolve hardened feces, al- 
 though the advantage of its use is not so great as 
 might be supposed. The amount of soap should 
 be sufficient only to make very weak suds, as other~ 
 
252 COLON HYGIENE 
 
 wise, it may be irritating, especially if the soap con- 
 tains a considerable amount of free alkali. Ordinary 
 soap is best for the purpose. 
 
 The Hot Saline Enema 
 
 Half an ounce of salt is added to two quarts of 
 water at a temperature of 105° to 1 15 c F. 
 
 The purpose of the addition of salt is to lessen 
 the irritation of the mucous membrane. It is of 
 special use in cases of colitis, in which the enema 
 is administered for the purpose of removing mucous 
 and relieving spasms of the intestine. The applica- 
 tion should be repeated until no mucous returns 
 with the water. Care must be taken to secure 
 evacuation of the water so as to avoid retention of 
 a large amount of salt, which may do serious in- 
 jury. 
 
 The Cold Water Enema 
 
 A cold application to the interior of the bowel 
 is one of the most powerful means of stimulation 
 which can be safely employed. Half a pint of water 
 at a temperature of 50° will usually set up a very 
 strong and painful contraction of the lower bowel. 
 It is on this account necessary to begin -with a mod- 
 erate temperature. The first enema should have 
 a temperature of 80° to 85 c F. The temperature 
 may be lowered on each application five to ten de- 
 grees, or until sufficient powerful contractions are 
 
BATHS AND OTHER HOME TREATMENTS 253 
 
 produced to expel quickly the water introduced. By 
 gradually reducing the temperature in this way, 
 one as low as 40° may finally be used without 
 causing excessive pain. Such low temperatures 
 are very seldom required except in dysentery, in 
 which they often render great service. 
 
 The cold enema is of special use in cases in which 
 the colon has become gradually dilated and has be- 
 come atonic, and contracts with insufficient force 
 to expel its contents. In such cases a warm or hot 
 enema is usually retained. By following the warm 
 enema with half a pint or a pint of water at 60° 
 to 70° F., prompt contraction of the bowel almost 
 invariably follows, with expulsion of the bowel con- 
 tents. This is a very important practical use of the 
 cold enema, as the retention of the water in cases 
 in which the bowel is filled with putrefying fecal 
 matters is very often followed by very unpleasant 
 and even serious effects, through the absorption of 
 enormous quantities of toxic substances, which are 
 dissolved by the water and brought into contact 
 with the absorbing surface of the bowel. In such 
 cases the hot enema should be immediately followed 
 by a small cold enema, and the cold enema should 
 be repeated several times, if necessary. 
 
 The Oil Enema 
 
 The amount of oil required is four to sixteen 
 ounces. Either pure olive oil or any sweet oil may 
 
254 COLON HYGIENE 
 
 be employed. The latter is just as good as the 
 former, and is less likely to produce nausea and 
 vomiting, which sometimes follows the use of olive 
 oil of an inferior grade. The temperature of the oil 
 should be 104°. As a means of softening hardened 
 feces, oil is no better than water; in fact, accord- 
 ing to the writer's experience, it is less efficient. It 
 is useful, however, as a means of lubricating the 
 lower bowel, and when introduced at night pre- 
 vents hardening and drying of the feces. For this 
 purpose 4 to 6 ounces should be introduced at night. 
 When used for the purpose of lubrication only, a 
 good plan is to administer the oil before breakfast. 
 This is an excellent means of securing a thorough 
 evacuation of the colon. 
 
 Sugar and Water Enema 
 
 Sugar is a powerful stimulant of the colon. A 
 very old-fashioned remedy is the introduction of 
 molasses into the colon. To half a pint or pint of 
 molasses an equal quantity of hot water is added. 
 A prompt action of the colon usually follows the 
 introduction of this mixture. The writer has for 
 years used malt sugar for this purpose, and with 
 most satisfactory results. The malt sugar not only 
 acts as a stimulant to the bowel, but at the same 
 time furnishes valuable nourishment. Four ounces 
 of malt sugar should be added to a pint of water. 
 
BATHS AND OTHER HOME TREATMENTS 255 
 
 Paraffin Oil Enema 
 
 Liquid paraffin, or paraffin oil, may be used as 
 an enema in place of olive oil and other oils, and 
 has the advantage that it does not produce nausea 
 or other unpleasant symptoms. Paraffin oil is bet- 
 ter than any animal or vegetable oil, for the reason 
 that it is not a fat, and is not absorbed, neither will 
 it undergo fermentation. The oil enema often 
 causes nausea, loss of appetite, and coating of the 
 tongue. This may be avoided by the use of paraffin 
 oil. Only the specially purified refined white Rus- 
 sian oil should be used. 
 
 The Alum Enema 
 
 In cases in which the bowels cannot be made to 
 move promptly by other means, alum has been found 
 to be effective. A teaspoonful of powdered alum 
 is used in a quart of water. By using cool water 
 70° to 80° the effect may be increased. 
 
 The Gh^cerine Enema 
 
 Pure glycerine introduced into the rectum in a 
 quantity of one to four ounces is a useful means 
 of stimulating bowel movements, by bringing about 
 the defecating reflex. When pure glycerine is 
 found to lead to too much irritation, as is some- 
 times the case, it should be used with an equal 
 quantity of water. 
 
256 COLON HYGIENE 
 
 The Cold Rectal Douche 
 
 By introducing cold water into the rectum with 
 considerable force, a most powerful stimulation may- 
 be produced. The temperature of the water should 
 be 70° to 80° F. If the stream furnished by the 
 ordinary fountain douche has not sufficient force 
 for this, a bulb syringe is necessary. 
 
 In administering the rectal douche a return tube 
 should always be used, so that the rectum will not 
 be over-distended. A small tube should be connected 
 with the syringe, and a large one should be intro- 
 duced alongside it, to counteract over-distension of 
 the rectum. When the powerful stimulation of the 
 rectal douche is required, it is not desired to secure 
 the stimulation which results from distention of the 
 rectum, for in these cases the rectum is always re- 
 laxed, and has to a certain degree lost its contractile 
 power. It is desired only to obtain the stimulating 
 effects produced by a low temperature and the im- 
 pact of a stream of water introduced with consider- 
 able force, the effect of such an application is to 
 produce almost immediately a very strong defecat- 
 ing reflex, with contraction of the pelvic colon and 
 forcible expulsive efforts. 
 
 It is well that the enema tube should be intro- 
 duced its full length and should be directed some- 
 what backward, so that the stream of water may 
 be received upon the upper part of the rectum and, 
 if possible, reach the pelvi-rectal fold. 
 
BATHS AND OTHER HOME TREATMENTS 257 
 
 In cases in which the sensibility of the rectum is 
 largely lost, this measure affords a very excellent 
 means of restoring normal sensibility. In extreme 
 cases the alternating rectal douche may be employed, 
 using first water at a temperature of 115°, then 
 water at a temperature of 60° to 70°. In some 
 extreme cases the temperature of the water is as 
 low as 40° or 50°. The application should be 
 made every ten seconds. 
 
 Injury from Drug Laxatives 
 
 While the temporary use of medicinal laxatives is 
 sometimes necessary, and always justifiable when 
 required as an emergency means, there can be no 
 doubt that the continued use of drugs of any sort 
 is highly injurious to the intestines, and in many 
 cases to other organs with which the drug comes 
 in contact, particularly the liver and kidneys, which 
 are burdened with the elimination of a certain part 
 of the drugs employed. 
 
 All laxative drugs are irritant poisons. They 
 affect the stomach as well as the colon and small 
 intestine. Their long continued use in time gives 
 rise to gastric and intestinal catarrh, colitis and the 
 varied evils which accompany these disorders, es- 
 pecially hemorrhoids, appendicitis, intestinal tox- 
 emia and certain aggravation of the constipation 
 which they are given to relieve. 
 
 Most drugs which act upon the bowels produce 
 
258 COLON HYGIENE 
 
 their effect only rafter having been absorbed and 
 circulated through the blood. This has been proved 
 to be true even in the case of saline laxatives, which 
 are absorbed in the upper part of the intestine, and 
 acting through the nerve centers controlling the 
 colon, produce a laxative effect long before the drug 
 has reached the colon through the intestine. 
 
 The effects of many other laxative drugs may be 
 produced by injection under the skin. 
 
 It is thus evident that the action of laxative 
 drugs is not confined to the intestine, but through 
 absorption into the blood stream these irritating 
 substances are brought into contact with all the 
 tissues. 
 
 Among the most largely used laxative drugs are 
 aloes, senna, rhubarb and cascara. All of these 
 drugs contain substances which are irritant poisons 
 derived from anthracene. 
 
 According to Levin, when a preparation of aloes 
 is "employed for a length of time, there occurs, in 
 consequence of the persistent congestion of the 
 descending colon and rectum, dilation of the hemor- 
 rhoidal veins." Fallopius said that "out of a hun- 
 dred persons who make habitual use of aloes, ninety 
 are attacked by hemorrhoids." 
 
 Sollman says that: "When injected hypoder- 
 mically, aloin causes a tubular nephritis, acute 
 B right's disease." The extensive use of this ir- 
 ritating drug in various popular laxative drugs and 
 much advertised nostrums may well be one of the 
 
BATHS AND OTHER HOME TREATMENTS 259 
 
 active causes of the alarming increase in disease 
 of the kidneys, which has occurred within the last 
 thirty years. 
 
 Rhubarb, according to Sollman, contains a poison 
 that produces a secondary constipation. 
 
 Saline laxatives throw an enormous burden upon 
 the kidneys, and when often repeated give rise to 
 a very obstinate colitis. 
 
 They also impair digestion, in time, setting up 
 gastric and duodenal catarrh and producing achylia, 
 a condition in which the stomach glands produce 
 no hydrochloric acid, thus leaving both the stomach 
 and the intestine a prey to the various sorts of per- 
 nicious bacteria which are constantly finding their 
 way into the stomach through the mouth, especially 
 through the medium of flesh foods, milk, and 
 cheese. 
 
 The effects of laxative mineral waters are es- 
 sentially the same as those of saline laxatives, which 
 they are. 
 
 Saline laxatives are particularly injurious to bed- 
 ridden patients, because of the slow emptying of 
 the stomach usual in such cases, in consequence of 
 which the stomach is more than ordinarily damaged. 
 
 Calomel, a drug which since the time of Paracel- 
 sus has been extensively used as a laxative, and in 
 conditions resulting from constipation, one of the 
 most common of which is popularly known as 
 "biliousness," is often a potent remedy, affording 
 prompt relief, but when its use is often repeated, it 
 
260 COLON HYGIENE 
 
 becomes a highly dangerous and injurious agent. 
 All metallic drugs are combated by the liver, 
 which absorbs as much as possible of the poison 
 into its own tissues as a means of protecting the 
 rest of the body. Thus the liver is particularly 
 subject to injury. Bennett, of Edinburgh, showed 
 more than a hundred years ago that calomel does 
 not increase the action of the liver, and his observa- 
 tions have been in recent years confirmed by Ruther- 
 ford and others. 
 
 Every chronic sufferer from constipation should 
 know that there is no laxative drug known, the 
 constant use of which is harmless. All laxative drugs 
 are irritants. The more certain their action as laxa- 
 tives, the more certainly will their continuous use 
 for any length of time be followed by serious in- 
 jury. Said an eminent German physician, "Nothing 
 is so bad as the chronic use of laxative drugs." 
 
 White Russian ParafEn Oil 
 
 Dr. Neville Wood some years ago, suggested the 
 use of pure liquid paraffin, a product of petroleum. 
 Schmidt, Lane and others have made much use of 
 this preparation and have noted excellent results. 
 The writer has made use of this remedy in hundreds 
 of cases with great success. 
 
 Petroleum oil, as found in its native state, has 
 been long used by primitive people and pioneers 
 as a remedy for constipation. Arbuthnot Lane 
 
BATHS AND OTHER HOME TREATMENTS 261 
 
 informed the writer that he had learned from 
 authentic sources that petroleum has been used for 
 centuries by the Kaffirs, and it is well known that 
 it was employed as a domestic remedy in America 
 long before it was used for illuminating purposes. 
 The oil was found floating upon the waters of cer- 
 tain streams, and was collected and sold by itinerant 
 peddlers, and occasionally in drug stores. 
 
 Paraffin is not acted upon by any of the digestive 
 juices, and is not absorbed. It prevents the drying 
 of the feces, lubricates the colon and rectum, and 
 also to some extent prevents the absorption of toxins 
 from the intestine. It may possibly to some degree 
 encourage fermentation by preventing the absorp- 
 tion of digesting food stuffs, and in the same way 
 may tend to encourage putrefaction. The writer, 
 on this account, has found it of use to combine it 
 with agar-agar, so as to facilitate intestinal action 
 by increasing the bulk of the feces. By the addition 
 of some syrup, carbohydrates and concentrated fruit 
 juice, honey, or malt syrup, the tendency to putre- 
 faction in the colon may be antagonized, and there- 
 by any possible evil results avoided. 
 
 Paraffin oil will not remedy every defect in the 
 defecating process and hence will not cure every 
 case of constipation, but it comes nearer being a 
 panacea than any remedy which has heretofore 
 been found, and does meet a surprisingly large 
 number of indications. After a careful study of 
 its effects in several thousand cases, the writer feels 
 
262 COLON HYGIENE 
 
 justified in saying with much confidence that paraf- 
 fin oil may be relied upon to accomplish the follow- 
 ing results in the treatment of chronic constipation: 
 
 1. It lubricates the alimentary canal through- 
 out its whole length. In a large number of cases 
 of constipation there is an excessive absorption of 
 water from the colon, leaving the feces dry or pasty 
 and adhesive. An examination of the rectum and 
 pelvic colon in such cases shows the mucous mem- 
 brane to be deficiently lubricated by mucus, and 
 covered with flakes of adhering feces. The use 
 of half an ounce or an ounce of paraffin oil at bed- 
 time, and half as much an hour before each meal, 
 will in two or three days change the condition 
 completely, as shown by proctoscopic examination. 
 
 2. This mechanical lubricating action of paraffin 
 is highly important in overcoming kinks due to re- 
 dundance or to adhesions resulting from colitis or 
 other causes. When the mucous surface is kept 
 well lubricated, the fecal matter slips along and 
 easily overcomes mechanical obstacles, which other- 
 wise become formidable sources of obstruction. 
 
 3. The human alimentary canal, like that of 
 other primates, as illustrated in the diet of the 
 higher apes, is adapted to a moderately coarse bill 
 of fare. The concentrated diet of our modern 
 civilized life contains so little indigestible material 
 that the residue forms a pasty mass which tends to 
 adhere to the intestinal wall, especially when any 
 obstruction is presented by kinks, folds, adhesive 
 
BATHS AND OTHER HOME TREATMENTS 263 
 
 bands, or a spastic state of the bowel due to colitis. 
 When delay occurs, the further absorption of water 
 converts these pasty residues into hard masses, scy- 
 bala, which sometimes have almost the density of 
 wood. Fats of all sorts are more or less laxative 
 if taken in sufficient amount, through their effect 
 in modifying the character of the food residues. 
 They render the mass less adhesive and to some 
 extent prevent dryness; but both animal and vege- 
 table fats are digestible and absorbable, and hence 
 are not to any considerable degree effective in chang- 
 ing the character of the stools unless eaten in 
 amounts larger than can be used, so that a consider- 
 able portion remains behind in the colon. Such 
 large quantities of fat encourage putrefaction, lessen 
 appetite, diminish the secretion of hydrochloric acid, 
 interfere with the motility of the stomach and the 
 small intestine, and may produce great disturbance 
 of the body metabolism. Paraffin oil is free from 
 these objections, since it is wholly non-absorbable, 
 and a comparatively small amount serves the pur- 
 pose required, because it all remains in the intes- 
 tine. 
 
 4. Paraffin is useful in all forms of intestinal 
 stasis or stagnation, no matter what the cause, by 
 preventing the abnormal drying out of the food 
 residue which is the necessary result of too long 
 retention in contact with absorbing surfaces. 
 
 5. Another remarkably interesting and useful 
 property of paraffin oil is found in the fact that it 
 
264 COLON HYGIENE 
 
 stimulates activity of the small intestine. Observa- 
 tions, in a large number of cases, made by Dr. J. 
 T. Case, Roentgenologist at the Battle Creek Sani- 
 tarium, have shown that paraffin oil greatly ac- 
 celerates the passage of material through the small 
 as well as the large intestine. This action is ex- 
 ceedingly important in those forms of intestinal 
 toxemia which depend upon iliac stasis, by far the 
 most serious of all forms of stasis. Stagnation in 
 the small intestine is of far greater importance than 
 stasis in the colon, for the reason that both putre- 
 faction and absorption are much more active in 
 this part of the digestive tube than in the large in- 
 testine. Even in cases in which iliac stasis is due to 
 the so-called Lane's kink, as shown by X-ray ex- 
 amination, great relief may usually be obtained by 
 the regular use of paraffin. This has been demon- 
 strated in many cases. It is only in the most ex- 
 treme cases, when adhesions are so extensive that 
 the lumen of the intestine is very greatly reduced, 
 that surgical measures become necessary. 
 
 6. One of the most interesting features of the 
 many-sided useful activities of paraffin, is its be- 
 havior toward intestinal toxins. These toxins con- 
 sist, not only of bile acids and alkaline wastes of 
 various sorts excreted by the intestinal mucous 
 membrane, but in addition, of a great variety of 
 ptomaines and toxins produced through bacterial 
 action, especially in the colon, and also in the small 
 intestine in cases of incompetency of the ileocecal 
 
BATHS AND OTHER HOME TREATMENTS 265 
 
 valve. Paraffin is a highly active solvent, and 
 readily dissolves these waste and poisonous sub- 
 stances, many of which are more soluble in paraffin 
 oil than in water. The result is that the paraffin 
 oil, itself not absorbable, takes up a very consider- 
 able portion of toxins found present in the intestinal 
 tract, and thus prevents their absorption. When 
 paraffin is used, it may always be seen in the stools, 
 showing a brownish or blackish color, due to the 
 substances which it holds in solution. In a labor- 
 atory test made by a competent chemist by request 
 of the writer, it was found that when paraffin oil 
 was shaken with a watery solution of indol, more 
 than half the indol was quickly taken up by the 
 paraffin. The use of paraffin thus affords an ef- 
 fective means of hindering the absorption of in- 
 testinal toxins, and conveying them out of the body. 
 
 7. Paraffin oil serves a useful purpose in pro- 
 tecting the mucous membrane when it is in an ir- 
 ritated state, as in cases of chronic colitis. The 
 value of petrolatum and other neutral petroleum 
 products as a dressing for wounds is well known. 
 Paraffin acts in an equally favorable way upon 
 irritated mucous surfaces. It has long been used 
 for this purpose in the treatment of diseases of the 
 nose and throat. 
 
 8. Paraffin serves another useful protective pur- 
 pose in hindering the absorption of poisons by 
 mucous surfaces which have been deprived of their 
 epithelium. The normal epithelial covering of the 
 
266 COLON HYGIENE 
 
 intestines has remarkable filtering powers, by which 
 toxins, especially colloid poisons, are excluded. 
 
 This filtering power is lost when the surface is 
 denuded. A protective layer of oil renders great 
 service in such cases, by hindering the absorption 
 of these poisonous matters, which occurs with great 
 readiness through abraded surfaces. 
 
 9. In cases of colitis, paraffin oil protects the 
 irritated surfaces, but also through its lubricating 
 effect and through softening the intestinal contents, 
 aids greatly in overcoming the spastic condition of 
 the intestine, which in many cases of chronic con- 
 stipation is so formidable an obstacle to recovery. 
 Laxatives of all sorts increase the spasticity of the 
 intestine, and so aggravate the constipation which 
 they are given to relieve. This is one reason why 
 many are more constipated after taking a laxative 
 than before. Temporary relief is obtained by the 
 production of watery stools which are able to pass 
 through the contracted bowel, but as soon as the 
 first effects of the laxative pass off, constipation be- 
 comes worse than before, since the spasm is greater. 
 Paraffin lubricates and protects the sensitive sur- 
 face of the spastic bowel, and at the same time 
 softens the intestinal contents so as to permit pas- 
 sage through the bowel without mechanical irrita- 
 tion. Cases of colitis are greatly benefited by the 
 regular use of paraffin. 
 
 10. X-ray observations of Case, confirmed in 
 many cases at the operating table by the writer, 
 
BATHS AND OTHER HOME TREATMENTS 267 
 
 have shown that incompetency of the ileocecal 
 valve is a most common and effective cause of iliac 
 stasis. Experience in treating several hundreds of 
 cases have shown that, aside from the regulation 
 of diet, and the use of bran and agar-agar, the 
 regular use of paraffin oil is the most effective 
 means of combating this condition. Medicinal 
 laxatives increase the antiperistalsis by which the 
 reflux from the colon into the small intestine is 
 increased. Case has shown by X-ray examination 
 that paraffin increases the motility of the small in- 
 testine, while it does not increase antiperistalsis. It 
 is thus a rational and efficient remedy of great value 
 in dealing with this very large and important class 
 of cases. 
 
 11. In all cases in which the stagnation of the 
 small intestine is due to spasm of the ileocecal valve, 
 induced by chronic appendicitis, ovarian irritation 
 or inflammation, colitis, or possibly painful rectal 
 disease through reflex irritation, paraffin proves it- 
 self to be an invaluable remedy, since it has the 
 property of increasing the peristaltic activity of the 
 small intestine to such a degree as to enable it to 
 overcome the spasm of the ileocecal valve without 
 producing irritation, which would inevitably in- 
 crease the spasm of the sphincter, as do drug laxa- 
 tives. The neutral character of paraffin, which 
 enables it to stimulate and facilitate intestinal mo- 
 tility without producing irritation, is invaluable. 
 
 12. The regular use of paraffin oil very generally 
 
268 COLON HYGIENE 
 
 relieves hemorrhoids and fissure, even when of 
 some years' standing. These morbid conditions 
 are usually the result of constipation, and are main- 
 tained and aggravated by straining at stool. By the 
 habitual use of paraffin, the stools are made soft, 
 straining is avoided, the intestinal contents are ren- 
 dered less irritating and infectious, and thus the 
 diseased tissues are readily healed. 
 
 Since adopting the use of paraffin, the author has 
 found that the number of cases in which operation 
 for hemorrhoids is needed is greatly reduced. Pa= 
 tients who have contemplated submitting to opera- 
 tion for removal of hemorrhoids of many years* 
 standing, in a short time after beginning the use 
 of paraffin, often find themselves so completely re- 
 lieved that an operation is no longer necessary 
 
 13. Paraffin is capable of rendering invaluable 
 service in cases of intestinal intoxication, by increas- 
 ing the number of daily stools. The length of 
 time which foodstuffs remain in the intestine is 
 reduced from several days to a few hours. This 
 greatly lessens the opportunity for development 
 of putrefactive processes and the absorption of 
 putrefaction products. It may be justly said that 
 no other remedy is capable of rendering such im- 
 portant and efficient service in combating constipa- 
 tion as this simple and harmless agent; but it must 
 be continuously, a proper dose (one or two table- 
 spoonfuls) at each meal. 
 
BATHS AND OTHER HOME TREATMENTS 269 
 
 Objectionable Features of Paraffin 
 
 The few unpleasant effects attending the use of 
 paraffin are really so slight in character that they 
 are generally easily overcome. Sometimes, how- 
 ever, they constitute a real obstacle to the use of this 
 most valuable remedy. The chief objections which 
 are met are the following: 
 
 1. An unpleasant oily taste which to some peo- 
 ple is so disagreeable as to produce nausea and loss 
 of appetite* 
 
 2. A disposition to separate from the other intes- 
 tinal contents. It usually appears as a brown oily 
 liquid separated from the rest of the stool and 
 sometimes the separation is so marked that the stools 
 are very ragged, or consist of hard lumps smeared 
 with brown oil. 
 
 3. Paraffin oil is so limpid that it readily finds 
 its way to the rectum ahead of the other bowel 
 contents, and very easily escapes, either with or 
 without the expulsion of flatus. The patient is often 
 unconscious of the escape until it is noted that the 
 clothing is badly soiled. 
 
 The difficulty of taking paraffin the writer suc- 
 ceeded in overcoming almost entirely by preparing 
 a very heavy emulsion through the assistance of gum 
 acacia. This emulsion is easily taken in hot or cold 
 weather, but is open to the objections raised under 
 two and three. 
 
270 COLON HYGIENE 
 
 Paraffin Tablets 
 
 All objections are removed by the use of paraffin 
 in solid form. Paraffin tablets which are solid at or- 
 nary temperatures, but melt at the temperature of 
 the inside of the body, are easily taken with the 
 food. Paraffin in this form mixes with the feces 
 thoroughly and does not separate. A single tablet 
 (one-half ounce) is sufficient for a dose. One tab- 
 let is taken with each meal. Two or more tablets 
 may be taken without injury. 
 
 Lubrication of the Rectum 
 
 In many cases of chronic constipation the lower 
 colon and the rectum become dry, the result of 
 atrophy of the lubricating mucous glands which 
 have been destroyed by colitis or chronic proctitis. 
 This condition may extend up into the pelvic colon. 
 As a result, the feces adhere to the walls of the 
 bowel and so accumulate, forming impactions and 
 cumulative constipation, one of the most frequent 
 forms of constipation. In many such cases only 
 partial relief is obtained by a laxative diet. By the 
 use of paraffin oil, one or two tablespoonfuls before 
 each meal, the colon and rectum may be lubricated 
 artificially. In some cases, further lubrication is 
 needed. For this purpose there is nothing so useful 
 as a specially prepared paraffin which melts at a 
 temperature of 102° F., or just above the body 
 temperature. This is heated until it is nearly all 
 
BATHS AND OTHER HOME TREATMENTS 271 
 
 melted, by placing the container in hot water. Then 
 with a piston syringe three or four ounces of the 
 warm melted paraffin is introduced into the rectum. 
 
 To enable the paraffin to reach the pelvic colon 
 the patient should assume the knee chest position 
 for two or three minutes after the paraffin is intro- 
 duced and should take deep breaths to encourage 
 the distribution of the melted oil. 
 
 The temperature of the body being about 100° 
 F., or less than that of the paraffin, the latter will 
 be cooled below its melting point, and so will ac- 
 quire the consistency of a soft ointment which ad- 
 heres to the surface of the bowel, and serves as a 
 most efficient lubricant. 
 
Exercises Which Combat 
 Constipation 
 
 The exercises that are of the greatest value in 
 cases of constipation are those which bring into 
 strong action the muscles of the abdomen. The 
 abdominal muscles are generally weak and relaxed, 
 and the intra-abdominal pressure is consequently 
 low. 
 
 By appropriate exercises the weak muscles may 
 be strengthened; the intra-abdominal pressure may 
 be raised, and the colon may be thus enabled to 
 contract with sufficient impetus to expel, its con- 
 tents. 
 
 Hill Climbing 
 
 Hill climbing is a more valuable exercise than 
 walking on the level, because the abdominal muscles 
 are brought into more active play. When moun- 
 tain climbing is not an available form of exercise, 
 nearly the same results may be obtained by climb- 
 ing a ladder or by walking up and down stairs. 
 The writer has also made use of the treadmill as 
 the means of securing muscular exercise similar to 
 that required in hill climbing. 
 
 272 
 
EXERCISES FOR CONSTIPATION 273 
 Horseback Riding 
 
 Horseback exercise is especially indicated as an 
 exercise for constipation. Riding a considerable 
 distance, however, is necessary to produce any de- 
 cided effect, as, on the whole, horseback riding to 
 a person accustomed to it, is not very active exer- 
 cise, except when riding a hard trotting horse. 
 
 Rowing 
 
 Rowing is one of the very best exercises to com- 
 bat constipation, provided the chest is held high 
 during the exercise, and especially if care is taken 
 to give the trunk as strong a backward movement 
 as possible; but care must be taken to avoid holding 
 the trunk forward with the shoulders rounded and 
 the chest depressed. 
 
 Tennis 
 
 Tennis may be highly commended for young 
 persons and those who are sufficiently strong to 
 engage in this form of exercise without injury. 
 This very popular game is, however, too vigorous 
 for persons with weak hearts. 
 
 The Medicine Ball 
 
 This is a capital exercise for persons who are 
 fairly strong. It brings the muscles of the trunk 
 into vigorous action. 
 
274 COLON HYGIENE 
 
 Work Exercise 
 
 The movements of chopping and digging, swing- 
 ing the hammer and mowing are highly valuable 
 exercises if taken with due care to maintain the 
 body in an erect position. Many household occu- 
 pations, such as scrubbing, washing, and general 
 housework, are execellent forms of exercise when 
 correct posture is maintained. 
 
 Posture 
 
 Of first importance to persons suffering from 
 constipation is the maintenance of an erect position 
 of the trunk. When the chest is lowered, as in 
 sitting in a relaxed attitude, the distance between 
 the breast bone and pelvis is diminished so that the 
 large muscles, which form the front of abdominal 
 wall are shortened and relaxed. In this attitude 
 the muscles cannot be contracted sufficiently to pro- 
 duce the proper degree of intra-abdominal pressure. 
 When the chest is held high, the rectus muscles are 
 stretched and are thus able by contraction to pro- 
 duce the maximum effect in compressing the colon. 
 Flat-chested persons are predisposed to constipation 
 because of inefficient action of the abdominal 
 muscles. 
 
 The ordinary chair must be regarded to a very 
 considerable degree as responsible for the prevalence 
 of flat chest and round shoulders, and the evils 
 which result from this deformity. It is possible to 
 
Incorrect Standing Position 
 
Getting Correct Standing 
 Posture (First Position). 
 
 Method of Getting Correct 
 Standing Posture (Second Po- 
 sition). 
 
Getting Correct Standing 
 Posture (Third Position). 
 
 Correct Standing Posture. 
 
EXERCISES FOR CONSTIPATION 275 
 
 sit in an erect attitude in a chair of any shape; but 
 with a chair with a straight back, constant effort is 
 required, by forcible contraction of the muscles, to 
 maintain the body in an erect position. The moment 
 the muscles are permitted to relax, the trunk falls 
 into an abnormal and unhealthy attitude, the spinal 
 column being curved backward instead of forward, 
 as is natural and necessary for health. This will 
 readily be understood by reference to the accompany- 
 ing cuts. 
 
 As the result of an habitually wrong attitude in 
 sitting, the same improper attitude is maintained 
 when standing and walking, and the figure becomes 
 deformed. A flat chest, round shoulders, and a 
 forward carnage of the hips are characteristics to 
 be found in the great majority of persons who lead 
 sedentary lives, especially those who sit much at 
 their work, such as accountants, writers, teachers, 
 and professional people generally. One of the first 
 things, then, for a constipated person to do is to 
 correct his sitting and standing attitudes. This 
 may be done by careful execution of the following 
 exercises, which the writer has employed for more 
 than 25 years with much satisfaction in the treat- 
 ment of cases of this sort. 
 
 To Correct the Standing Posture 
 
 Stand against a straight wall. Place heels, hips, 
 shoulders, head and hands firmly against the wall. 
 
276 COLON HYGIENE 
 
 Now bend the head backward as far as possible, 
 or until the eyes look straight up to the ceiling, at 
 the same time permitting the chest and shoulders 
 to move forward. While holding the head in this 
 position, press the hands firmly against the wall; 
 draw the chin down to position without allowing 
 the shoulders to move backward ; still holding the 
 body rigid, allowing the arms to fall at the sides. 
 In this position the chest will be held high and the 
 abdominal muscles well drawn in. While holding 
 this position execute movements with the arms; 
 arm raising above the head, swimming movements, 
 etc. 
 
 This is the correct standing position and should 
 as far as possible, be constantly maintained in stand- 
 ing and walking. It is impossible, of course, to 
 hold the muscles constantly rigid. In relaxing, 
 however, care should be taken to keep the chest 
 forward, so that the body does not fall back into 
 the former incorrect attitude. 
 
 Exercises to Correct the Sitting Posture 
 
 Sitting upon a chair or stool, preferably the latter, 
 proceed as follows: 
 
 Place the hands on the hips, with the thumbs 
 behind. Bend the head backward so as to look 
 straight up to the ceiling; now bend forward as far 
 as possible while still keeping the eyes on the ceiling ; 
 now make firm pressure with the thumbs, and while 
 
u 
 
EXERCISES FOR CONSTIPATION 277 
 
 pressing hard bring the body up to the erect position. 
 Still keeping the eyes upon the ceiling, holding the 
 elbows as far back as possible, and without for an 
 instant lessening the pressure on the thumbs, bring 
 the chin down to position. 
 
 If this movement is executed according to direc- 
 tion, it will bring the body into perfect position, 
 with the chest raised high and the abdominal mus- 
 cles well drawn in, as shown in the accompanying 
 cut. To secure definite and beneficial results it is 
 necessary to use a chair having a back of the right 
 shape as shown in the accompanying illustration. 
 
 Breathing Exercise 
 
 Sit with the hands at the back of the neck, and 
 the elbows in line with the shoulders, the chest 
 held high, and the abdominal muscles well drawn 
 in. Raise the heels and make rapid movements 
 upon the floor with the toes for one minute. Then 
 take ten deep breaths, still holding the arms in posi- 
 tion. 
 
 Rocking Chair Exercise 
 
 Sitting upon the front edge of a chair, with the 
 hands upon the hips, the thumbs behind, the elbows 
 well drawn back, bend forward to an angle of 45° 
 and then, holding the body rigid, throw the trunk 
 backward, lifting the feet clear of the floor. Repeat. 
 The effect wiil be a rocking movement. Breathe 
 
278 COLON HYGIENE 
 
 deeply. Repeat forty times. A rocking chair may 
 be conveniently used in taking this exercise. 
 
 Exercise to Raise the Chest 
 
 Lie upon the back on a hard surface; place be- 
 neath the hollow of the back a roll of blankets or 
 a folded pillow or cushion about six inches in 
 diameter. The purpose of this is to give the spinal 
 column the forward curve which is natural to it, 
 and thus to raise the chest. The roll should be 
 placed at such a point as to raise the chest to the 
 fullest extent, while the head and shoulders still 
 rest upon the couch. In this position, deep breath- 
 ing movements should be practiced at the rate of 
 about ten a minute. 
 
 To Strengthen the Abdominal Muscles 
 
 With the back supported as in the previous 
 paragraph, raise both legs to the perpendicular. 
 Repeat ten to forty times. A deep breath should 
 be taken just before the legs are raised, and after 
 each movement there should be a pause during 
 which a deep breath is taken. 
 
 Feeble and very fleshy persons are often at first 
 not able to raise the legs. In such cases the exer- 
 cise will begin with the legs drawn up to a fixed 
 position. By extending the legs and allowing them 
 at the same time to drop slowly to the starting 
 position, the abdominal muscles may be brought 
 
EXERCISES FOR CONSTIPATION 279 
 
 into strong contraction, and as they gradually in- 
 crease in strength, the legs may be flexed less until 
 they can be raised to a vertical position without 
 flexion. 
 
 Trunk Raising Exercise 
 
 Lying on the back and holding the legs firmly 
 extended, raise the arms forward and raise the body 
 to the perpendicular, then bend forward, and, if 
 possible, touch the toes. Repeat ten to twenty 
 times. 
 
 Rolling Exercise 
 
 Rolling over on the floor or on a wide bed is a 
 capital exercise for strengthening the lateral muscles 
 of the trunk. Practice for five minutes. 
 
 Rocking Exercise, Lying 
 
 Flex the left leg upon the abdomen; clasp the 
 hands beneath the knee and pull as hard as pos- 
 sible, so as to force the thigh down upon the ab- 
 domen; then, with the other leg fully extended, 
 cause the body to execute rocking movements by 
 quickly moving the leg up and down, assisting by 
 forward and backward movements of the head. 
 Repeat same with the right leg. This is a very ef- 
 fective exercise if taken vigorously and repeated 
 three times a day for five or ten minutes. 
 
280 COLON HYGIENE 
 
 Arm and Trunk Exercise with Deep 
 Breathing 
 
 Standing with the chest held high, place left hand 
 upon the left hip. With a swinging movement 
 outward bring the right arm to the perpendicular, 
 and then holding the arm in position, bend the 
 body to the left side as far as possible, breathing 
 in. Rise to position, breathing out. Repeat four 
 times and then execute the same movement with 
 the right hand upon the hip, breathing in. 
 
 Squatting Exercise 
 
 Standing, with the heels separated ten or twelve 
 inches, the hands upon the hips, execute squatting 
 movements, bringing the trunk as near to the floor 
 as possible, and bending slightly forward. An 
 excellent exercise to stimulate bowel movement. 
 
 Running on All Fours 
 
 With arms and legs extended run about the 
 room for five or ten minutes. Running on all fours. 
 This movement was prescribed by a Berlin physician 
 for an eminent German Statesman, with excellent 
 results. 
 
 Knee-Chest Breathing 
 
 Placing the body in the knee-chest position, ex- 
 ecute deep breathing movements, filling the chest 
 
EXERCISES FOR CONSTIPATION 281 
 
 as completely as possible, then, holding the chest 
 in position, draw in the abdomen as much as pos- 
 sible while breathing out. 
 
 Colon Compressing Exercise 
 
 Sitting on a low seat or with the feet raised upon 
 a stool, place the closed fists in the left groin and 
 bend the trunk strongly forward so as to com- 
 press the hands between the thighs and the abdo- 
 men. Take several deep breaths while holding the 
 body in this position. 
 
 Inclined Plane Exercises 
 
 Among the most important of all forms of ex- 
 ercises for combating constipation, series of certain 
 simple exercises are taken upon an inclined plane, 
 with the head low. The special advantages of the 
 inclined plane are: 
 
 1. The head-low, hips-high position greatly 
 aids in the replacement of the prolapsed stomach 
 and colon, conditions almost universally present 
 in chronic constipation. 
 
 2. The head-low position drains the abdomen 
 of blood, thus relieving congestion of the viscera. 
 
 3. Exercises of the trunk muscles should always 
 be taken after the prolapsed viscera have been re- 
 stored to position. When this is not done, the ef- 
 fect may be to increase the displacement whenever 
 the abdominal muscles are strongly contracted. 
 
282 COLON HYGIENE 
 
 There are three classes of exercises to be taken 
 with the inclined plane, viz: (1) Stretching ex- 
 ercises, (2) Colon replacing exercises, and (3) 
 Trunk exercises. 
 
 The folding exercise table is a convenient ap- 
 pliance for use in these exercises. It may be in 
 part replaced by an ordinary ironing board placed 
 with one end resting upon the side of a bed, couch 
 or window sill, the other on the floor. The ex- 
 ercise table is provided with a strap at one end 
 to hold the feet and prevent slipping down and a 
 rope with handle attached for pulling the body 
 up. At the sides are placed handles to be grasped 
 by the patient. 
 
 Getting in Position 
 
 The following is a convenient method of plac- 
 ing one's self in position upon the table: Standing 
 upon the left side of the table grasp the strap with 
 the right hand. Sit down upon the table and 
 swing up one foot and place it under the strap 
 and then bring up the other foot in the same way 
 and then grasp the sides of the table or the handles 
 and let the trunk fall down into position. While 
 an ordinary ironing table may be used, the strap for 
 the feet and the handles for the hands are really 
 essential for convenient use. 
 
 After getting into position upon the table, the 
 patient takes a few very deep breaths, holding the 
 chest high while breathing out. 
 
The Exercise Table 
 
EXERCISES FOR CONSTIPATION 283 
 Exercises 
 
 Grasping the handles, bend the head backward 
 as far as possible, at the same time widely opening 
 the mouth as in yawning. 
 
 Position 
 
 Patient lies upon an inclined table grasping the 
 handles, (a) Right arm, left leg stretch. (b) 
 Grasping handle with left hand raise the right arm 
 above the head and at the same time point the toe 
 of the left foot and reach as far as possible in oppo- 
 site directions, (c) Do the same with the left arm 
 and right leg. 
 
 Colon Replacing Exercises 
 
 Lying on the inclined table with feet under the 
 strap, place the hands upon the lower abdomen and 
 breathe deeply; with each expiration press hard 
 upon the little-finger side of the hands and draw 
 the hand upward so as to push the contents of 
 the abdomen toward the diaphragm. Hold the 
 hands firmly in position during the inspiration. 
 Repeat ten or twelve times. 
 
 Abdominal Compression-Breathing 
 
 Compress the abdomen firmly with the hands 
 and take a slow deep breath. Repeat fifteen or 
 twenty times. 
 
284 COLON HYGIENE 
 
 Diaphragm Exercise 
 
 Lie upon the face over a folded pillow or 
 cushion with the feet under the strap and the head 
 resting upon the folded arms. Take deep breaths. 
 This is an exercise for relieving congestion of the 
 abdominal viscera, strengthening the breathing 
 muscles. At each breath the diaphragm is com- 
 pelled to lift the weight of the trunk. 
 
 Exaggerated Knee-Chest Breathing 
 
 Grasping the handles, rise from the position of 
 the preceding exercise to a kneeling position, push- 
 ing the pillow forward a little and then take the 
 knee-chest position; take ten to fifty deep breaths. 
 This is a most effective means of draining the over- 
 filled blood-vessels of the abdomen and pelvis, and 
 sets gravitation to work pulling the prolapsed or- 
 gans into position. The exercise is still more effec- 
 tive if taken after filling the colon with water, as 
 the added weight of the prolapsed organ assists in 
 restoring it to position.' 
 
 Leg Raising 
 
 Lying on the back, hands grasping the handles, 
 while holding both legs straight and toes pointed, 
 raise them to vertical position while counting four. 
 Lower at the same rate. Repeat eight to twelve 
 
EXERCISES FOR CONSTIPATION 285 
 
 times, taking one or two deep breaths after each 
 movement. 
 
 Trunk Twisting 
 
 Back lying, feet under strap, throw the extended 
 right arm over to the left, at the same time turning 
 the face and shoulders in the same direction. Re- 
 turn to position, and repeat eight or ten times. Do 
 the same with the left arm. 
 
 Hips Rolling 
 
 Back lying, draw the knees up as far as possible, 
 then extend the limbs vigorously as far as pos- 
 sible toward the left, rolling the body in the same 
 direction. When the legs are completely extended, 
 carry them straight across to the opposite side, roll- 
 ing back toward the right side. Complete the 
 movement by drawing the legs back to the flexed 
 position and returning to the starting position. 
 Repeat ten or twelve times, pausing long enough 
 after each movement to take one or two deep 
 breaths. This is a most excellent exercise for all 
 the muscles of the trunk. 
 
 Static Exercises 
 
 These are exercises which may be taken while 
 one is engaged in study, writing, book-keeping, or 
 some sedentary occupation, without interfering 
 with the work in hand. The purpose being to 
 
286 COLON HYGIENE 
 
 combat the pernicious effects of any form of con- 
 fining work. 
 
 With the chest held high, the abdominal mus- 
 cles well drawn in, and the body supported in a 
 correct posture, deep breathing may be practiced 
 with most excellent results. The breathing may 
 often be made rhythmical with the work, especially 
 in typewriting, adding and similar work which is 
 more or less mechanical in character. In this way 
 exercise may become a means of increasing efficiency 
 directly, as well as through better aeration of the 
 blood and the resulting improvement in mental and 
 physical activity. 
 
 This deep breathing may be practiced under al- 
 most any conditions without interfering with the 
 work in hand. When riding on the street cars or 
 in an automobile, even when sitting in church or 
 at a lecture, deep breathing may be practiced al- 
 most continually. The practice will be found to 
 promote bowel activity, and to enormously increase 
 efficiency and endurance. When the habit is once 
 formed the deep breathing becomes automatic. 
 Typists, printers, and persons engaged in similarly 
 unhealthful occupations may, by this means so 
 strengthen their resistance, and maintain such a 
 high state of vital efficiency, that they may possibly 
 escape the dreaded pulmonary tuberculosis, the 
 malady above all others that is the most fatal to 
 this class of workers. 
 
EXERCISES FOR CONSTIPATION 287 
 
 Tension Exercises 
 
 During life the muscles are always in a state of 
 tension; that is, every muscle is more or less active 
 even when it seems to be at rest. This tension is 
 increased by cold to the point of producing visible 
 movements of shivering. It is also increased by 
 pain or inflammation, as is seen in the rigid con- 
 traction of the abdominal muscles in appendicitis. 
 Tension may also be increased by a simple effort 
 of the will. The mere thinking of a bodily move- 
 ment, in fact, increases the tension of the muscles 
 which are concerned in the movement, and to such 
 a degree that long-continued fatigue may result, 
 showing that work has been done, as when one 
 watches the performance of acrobats, or a closely 
 contested athletic game. This fact may be made 
 of practical value. Thus if one's feet are cold, they 
 may be quickly warmed by alternately tensing and 
 lelaxing the muscles of the legs, or by making slow, 
 tense, flexion and extension movements of the feet. 
 
 In like manner all the muscles of the legs may 
 be brought into active play by simply setting or 
 tensing the muscles of the legs that is, holding the 
 limbs rigid with as much force as possible. The 
 muscles of the trunk and arms may be tensed in 
 like manner. All the muscles may be tensed at 
 once, or different sections as arm muscles, trunk 
 muscles, or the muscles of a single limb may be 
 exercised in succession. Tension exercises may be 
 
288 COLON HYGIENE 
 
 taken in may cases without the slightest interfer- 
 ence with one's work; and when the work is very 
 sedentary one may by this means, without loss of 
 time, secure a large part of the benefit of such ac- 
 tive exercises as walking, tennis, playing, etc. Such 
 exercises should not be considered as a substitute, 
 however, for out-of-door exercise, but rather as a 
 supplement to such exercise. 
 
 One very excellent form of exercise which may 
 be taken while sitting at desk at work or when 
 reading or studying is rapid raising or lowering 
 of heels, either together or in alternation. The heels 
 are raised so that the weight of the limbs rests on 
 the toes, and the limbs are then set in rapid mo- 
 tion. Bracing the feet together, a similar move- 
 ment may be executed with the knees rapidly sepa- 
 rating and closing. The movement is so rapid that 
 the exercise closely resembles shivering. 
 
 One excellent use for movements of this kind 
 is to prevent taking cold when one is exposed to 
 a draft. If, for example, one feels a draft of cold 
 air on the back of the neck, he may prevent ill 
 effects by simply tensing muscles of the neck, or 
 indeed, by holding the muscles rigid while making 
 slow movements of the head, either forward and 
 backward or side-wise. In out-of-door sleeping, 
 exercises of this sort may be resorted to as a means 
 of warming the feet and limbs. These warming 
 exercises are important for persons suffering from 
 constipation, because of the tendency that such 
 
EXERCISES FOR CONSTIPATION 289 
 
 persons have to coldness of the extremities, the 
 result of spasm of the blood vessels, due to the 
 influence of intestinal poisons upon the vasomotor 
 centers. 
 
 Special Means to Aid Defecation 
 
 The general aim of all the exercises given in 
 this book is to aid defecation by strengthening the 
 muscles of the trunk and abdomen, and forming the 
 breathing movements. There are special exercises 
 which may be employed during defecation which 
 render effective aid in evacuation of the bowels. 
 
 The natives of India, as mentioned elsewhere, 
 aid evacuation when the bowels are constipated by 
 pressing a ball formed by a folded cloth upon the 
 lower left side of the abdomen. Many consti- 
 pated persons have found by experience the advan- 
 tage of pressing upon this part of the abdomen with 
 one or both closed fists, during defecation. 
 
 Persons who have very relaxed abdominal walls 
 often find it very advantageous to compress and 
 knead the abdomen during defecation, especially 
 upon the left side. A medicine ball may be used 
 for the purpose. The ball is held firmly against 
 the abdomen, the under side resting on the separated 
 thighs. By bringing the thighs together at the 
 same time pressing with the hands, the ball is forced 
 against the abdomen. The abdomen may in this 
 way be compressed with considerable force. The 
 closed fist may be used in place of the ball. 
 
290 COLON HYGIENE 
 
 An Exercise Program 
 
 When possible exercise should always be taken 
 in a rhythmical way. This effect may be secured 
 by means of counting, or better still by the aid ef 
 music, for which a phonograph, victrola or a graph- 
 aphone serves an excellent purpose. 
 
 The following is an excellent program of ex- 
 ercises for a person of average strength: 
 
 1. On rising, take an exercise bath (see page 
 242), beginning with the water at a temperature 
 of 90 degrees and ending at 70 degrees to 60 degrees 
 or pipe temperature. Row 100 to 200 strokes 
 counting. 
 
 2. Inclined plane breathing and replacement 
 exercises. (See page 281.) 
 
 3. Inclined plane exercise to strengthen ab- 
 dominal muscles. (See page 282.) 
 
 4. Special exercise to aid defecation. (See 
 page 289.) 
 
 After exercise make an attempt to move the 
 bowels if a movement has not already been se- 
 cured. 
 
 Abdominal Massage 
 
 Before beginning the treatment of any case of 
 constipation by massage, a careful study of the 
 case should be made, so that the causes of the con- 
 dition present may be well understood. Such an 
 examinati6n requires, in serious cases, at least an 
 
Kneading ihe Colon 
 
EXERCISES FOR CONSTIPATION 291 
 
 X-ray examination with a bismuth meal. The bis- 
 muth enema must also be administered to show the 
 condition of the colon and of the ileocecal valve. 
 A radiogram of the colon or at least a tracing made 
 by the aid of the X-ray, showing the position, size 
 and form of the different portions of the colon is 
 of greatest service. With the radiogram and such 
 a sketch of the colon at hand, the masseur can make 
 his applications with such a degree of accuracy 
 as to effect a maximum amount of good with a 
 minimum degree of effort, and without wearying 
 his patient needlessly. The following methods of 
 colon massage are described at greater length in 
 the author's work on massage.* 
 
 Massage of the Cecum 
 
 In cases in which there is stagnation of the fecal 
 matters in the cecum and ascending colon, massage 
 should be applied, with the patient's hips elevated 
 to an angle of about 45°. Deep kneading move- 
 ments should be made from below upwards, work- 
 ing along the colon in the direction of the lower 
 ribs of the right side. When the liver is reached, 
 the kneading movements should be carried across 
 the body in the direction of the transverse colon. 
 The hips of the patient should then be lowered, and 
 the kneading movement should be directed down- 
 
 *"The Art of Massage" Published by Good Health Pub. Co 
 Battle Creek, Michigan. 
 
292 COLON HYGIENE 
 
 ward along the descending colon, starting from 
 high up on the ribs of the left side. When the upper 
 border of the hip bone is reached, the movement 
 should follow the inner surface of the bone to the 
 pelvis. Not infrequently the colon is found in a 
 contracted or spastic state when it feels like a rub- 
 ber tube and may be rolled under the fingers. It 
 is usually sensitive to pressure. When the pelvic 
 colon is enlarged, it may also sometimes be felt, 
 though not infrequently when it is distended with 
 feces it lies so low in the pelvis that it cannot be 
 reached. By putting the patient in a knee-chest 
 position, and executing deep-breathing movements 
 while making deep pressure with one hand on each 
 side just above the groins, the pelvic colon can 
 sometimes be lifted out of the pelvis, so that it can 
 be brought within reach, and the hard masses with 
 which it is filled may be broken up. In this region 
 the colon will often be found filled with masses of 
 hardened feces. 
 
 After careful manipulation of the contracted 
 colon for a few minutes it will dilate, the spastic 
 condition disappearing for the time being. The 
 writer has often noticed this in making examina- 
 tions of the colon. Harsh manipulations are likely 
 to produce the opposite effect increasing the spasm 
 This fact has led some authors to forbid massage 
 altogether in cases of colitis, but this is quite 
 wrong. Massage is highly beneficial in these 
 cases but the manipulations must not be too severe. 
 
Vibrating Chair 
 
EXERCISES FOR CONSTIPATION 293 
 
 Mechanical Kneading and Vibration 
 
 Mechanotherapy is capable of rendering more 
 service in constipation than in any other single con- 
 dition. 
 
 The mechanical applications which are of 
 greatest service are kneading and vibration. Sev- 
 eral mechanical kneaders have been devised. The 
 one shown in the accompanying cut the writer has 
 had in use for more than twenty years, and with 
 satisfactory results. Patients generally realize im- 
 mediate benefit from the use of the kneader, which 
 may be employed for fifteen or twenty minutes 
 twice a day, an hour after breakfast, and an hour 
 or two after dinner. 
 
 The apparatus consists of six kneading arms at- 
 tached to eccentrics, arranged in such a way as to 
 be brought to bear upon the abdomen in consecutive 
 order. The surface upon which the patient rests 
 is at the same time moved to and fro in such a way 
 that the kneading movement travels in a series of 
 circles round the abdomen. The vigor of the appli- 
 cation can be regulated at will. 
 
 There are vibrators of various kinds in use. The 
 majority, however, are possessed of too little power 
 to be of service in the treatment of the abdomen. 
 The best for this purpose are the dumb-bell vibrator 
 and the vibrating chair. Hill's dumb-bell vibrator 
 has the advantage that it is heavy enough to com- 
 press the abdomen to a sufficient degree; and the 
 
294 COLON HYGIENE 
 
 power of the apparatus is sufficient to give the 
 whole abdomen an active vibratory movement. It 
 has been proved that these vibratory movements 
 induce peristaltic action, while at the same time the 
 weight of the instrument increases the abdominal 
 pressure, and tends to fix the parts to which the 
 application is made, so as to secure a maximum de- 
 gree of effect. 
 
 The vibrating chair aids bowel action both by 
 directly exciting the centers of the spinal cord and 
 by stimulating the lower bowel. The use of the 
 chair for ten or fifteen minutes will in many persons 
 develop a lively "call" for bowel movement. 
 
 Self-Kneading of the Bowels at Stool 
 
 In many cases of cumulative constipation the 
 chief trouble is in the pelvic colon. This loop of 
 intestine, usually about a foot in length, and possess- 
 ing thick muscular walls, becomes sometimes so 
 enormously stretched and attenuated by accumula- 
 tions of fecal matters and gas that its walls are 
 weak and contract very feebly, and it is no longer 
 an efficient instrument for forcing the feces into 
 the rectum, and thus inducing the defecating reflex 
 by which the bowel is normally emptied. In such 
 a case the patient may sometimes assist himself by 
 placing the hand at the lower part of the abdomen 
 on the left side and making deep pressure with the 
 tips of the fingers, or placing the fist between the 
 
EXERCISES FOR CONSTIPATION 295 
 
 thigh and the abdomen so as to compress the pelvic 
 colon. Kneading of the iliac colon, which lies in 
 the hollow of the left iliac bone, is also useful. 
 
 The Cannon Ball 
 
 The cannon ball is a rather old-fashioned but 
 useful means of self treatment, by which the pa- 
 tient may apply massage to the colon in a very 
 efficient way. A small cannon ball weighing about 
 twenty or twenty-five pounds is rolled along the 
 course of the colon from the cecum toward the 
 rectum. The patient should lie with the shoulders 
 slightly elevated so as to relax the abdominal mus- 
 cles as much as possible. 
 
 The cannon ball should be applied daily soon 
 after breakfast, or a little before the time at which 
 the bowels are most likely to move. The chief ben- 
 efit to be derived from the cannon ball is to aid 
 in propelling into the rectum from the pelvic colon 
 a sufficient amount of fecal matter to awaken a 
 lively stimulation of the defecating center, and so 
 to secure a strong impulse and a full evacuation of 
 the colon below the splenic flexure. 
 
 The Weighted Compress 
 
 This consists of a thick flannel compress between 
 the folds of which is quilted in a considerable quan- 
 tity, say fifteen to twenty-five pounds, of lead shot 
 The compress should be large enough to cover the 
 
296 COLON HYGIENE 
 
 entire abdomen. It should be applied for an hour 
 before time for evacuation of the bowels, deep 
 breathing movements being executed in the mean- 
 time at the rate of twelve to sixteen per minute. 
 
 The Shot Bag 
 
 This device has essentially the same purpose as 
 the preceding, but may be applied in such a way 
 as to secure a more pronounced local effect; as, for 
 example, to force stagnating material out of the 
 cecum or the iliac colon. It may, in some cases, 
 also be of service in forcing feces from the pelvic 
 colon into the rectum, when the pelvic loop has 
 been weakened by excessive overloading and dis- 
 tention with gas. The usual weight of the shot 
 bag is twenty to twenty-five pounds. It should 
 be placed over the spot where the accumulation 
 can be felt with the fingers or seen with the X-ray 
 and should be left in place for an hour, while deep 
 breathing movements are practiced at the rate of 
 twelve to sixteen per minute. 
 
 This simple measure has the advantage that it 
 may be used by the intelligent patient at his home, 
 and its use may be continued for an indefinite time 
 without injury, which cannot be said of any drug 
 remedy. All drugs which act by irritating the in- 
 testine, sooner or later, usually sooner, produce 
 colitis and other disorders. There are no harmless 
 drugs. Of course this does not apply to such purely 
 mechanical and harmless means, as bran and paraffin. 
 
Relaxed protuberant abdo- 
 men, a result of bad sitting 
 position and relaxed muscles. 
 
 The same person standing, 
 poise corrected and abdomen 
 held up by a spring supporter. 
 
EXERCISES FOR CONSTIPATION 297 
 
 Pneumatic Compression of the Abdomen 
 
 Compression of the abdomen by an inflated rub- 
 ber bag is a measure of value, of which the writer 
 has made use for some years. On one occasion, 
 a patient who seemed dead from surgical shock was 
 restored almost instantly by placing a rubber bag 
 under an abdominal bandage and inflating it as 
 fully as possible. The face, which had become 
 ashen gray, while the heart had ceased to beat, at 
 once became flushed with the color of health, the 
 heart began to beat, the patient began breathing, 
 and death was averted. This observation showed 
 the effect of abdominal compression applied in this 
 way, and suggested the use of the same means to 
 increase the intra-abdominal tension as an aid to 
 bowel movement. In using the bag for this pur- 
 pose, it must be tightly compressed by means of a 
 stout bandage, and must be large enough to cover 
 the whole abdomen, so that when inflated it will 
 well fill the abdominal cavity, pressing before it 
 the relaxed abdominal wall. 
 
 The compression bag is of special service in cases 
 in which the abdominal muscles are very greatly 
 relaxed, as in women who have borne a number 
 of children, and whose muscles have not been well 
 developed. It is most applicable to those who have 
 not a superabundance of fat, especially those who 
 have lost much in weight after having been over- 
 fat. 
 
298 COLON HYGIENE 
 
 The Abdominal Supporter 
 
 While compression of the trunk at the waist is 
 always harmful, compression and support of the 
 lower abdomen is of great service in many cases, 
 because of the unnatural feebleness of the abdom- 
 inal muscles. In fleshy patients almost any sort 
 of bandage will accomplish good, but in thin pa- 
 tients an ordinary bandage is of little use, for 
 the reason that it is held out in front by edges of 
 the iliac bones, and so does not press with sufficient 
 firmness upon the lower abdomen where support is 
 needed. 
 
 The most effective support in such cases can be 
 secured only by a bandage which is compressed by 
 springs. Such a bandage, which the writer has 
 had in use for more than a dozen years, is shown 
 in the accompanying cut. In fleshy patients a 
 stout bandage made of ducking and cut to fit 
 snugly is of greatest service. 
 
 The bandage must be worn constantly when 
 the patient is on his feet. Its purpose is not simply 
 to support the viscera, which the best of bandages 
 can do only in a very small degree, but to increase 
 the intra-abdominal pressure to such a degree as to 
 assist the colon in disposing of its contents. Some 
 oatients are completely relieved of constipation by 
 the use of a proper bandage. 
 
 In most cases it is necessary to employ perineal 
 bands to keep the bandage in position at the lower 
 abdomen, where alone it can be of service. 
 
EXERCISES FOR CONSTIPATION 299 
 
 Pain in the back is one of the disagreeable symp- 
 toms which an efficient bandage often relieves, es- 
 pecially when the pain is due to enteroptosis, or 
 prolapse of the intestines, rather than colitis. 
 
 A sense of exhaustion, often resulting from low 
 intra-abdominal tension, which permits an undue 
 amount of blood to accumulate in the abdominal 
 vessels, robbing the brain and spinal cord, is almost 
 immediately relieved by a proper bandage. 
 
 The bandage is only a palliative, however, and 
 its use must be accompanied by the development 
 of the abdominal muscles by means of massage, 
 electricity, and suitable exercises. 
 
 In cases requiring the use of the abdominal 
 supporter during the day, the moist abdominal girdle 
 should be worn at night to aid in relieving con- 
 gestion. The bandage should be used with the 
 mackintosh protection, and the bandage should be 
 removed or renewed before it becomes dry. 
 
Efficient Electrical Methods 
 
 While electricity is certainly not a panacea for 
 constipation, nor for any other disease, and is cer- 
 tainly not able to accomplish a tithe of the miracles 
 which have been attributed to it, it is neverthe- 
 less, when skillfully applied, a most valuable remedy 
 in constipation. As ordinarily used by means of 
 sponges held in the hands, and employing a current 
 from a small buzzing faradic machine, nothing 
 more is accomplished than a slight titillation of the 
 skin and giving the patient a slight amount of 
 pain, which may, however, in some cases, exercise 
 a beneficial psychological effect. 
 
 Electricity may render valuable service in con- 
 stipation in two ways: (1) By inducing automatic 
 exercise of the abdominal muscles and so restoring 
 their tone and strength; and (2) by stimulating 
 the colon itself and thus inciting bowel action, and 
 (3) by restoring lost nerve sensibility to the rectum. 
 This it does both by directly exciting bowel action 
 and by raising to activity sensibility of the rectum 
 when lost by neglect. 
 
 Automatic Exercise 
 
 Automatic exercise of the abdominal muscles 
 may best be administered by the aid of the nim- 
 soidal electrical current. . The static farradic cur- 
 
 300 
 
EFFICIENT ELECTRICAL METHODS 301 
 
 rent may be used, but they are more or less painful 
 and less easily controlled. The sinusoidal current is 
 practically painless. The most convenient method 
 of using the current is by means of the automatic 
 exercise apparatus, which may be adjusted so as 
 to cause any desired number of vigorous contrac- 
 tions of the abdominal muscles per minute. 
 
 By this means the abdominal muscles and the 
 nerves and nerve centers which control them may 
 be powerfully stimulated and their functions grad- 
 ually restored. 
 
 Electrical Stimulation of the Colon 
 
 Applications of electricity to the surface of the 
 body do not excite action in the colon; but the 
 colon may be excited by the application of the 
 current directly to the interior of the colon. This 
 cannot be done by the patient himself, as the ser- 
 vices of an expert proctologist are needed for the 
 proper placing of the electrode. 
 
 Electrical Stimulation of the Rectum 
 
 The application of the sinusoidal current to the 
 rectum by means of a proper electrode is a most 
 effective means of stimulation of the rectum when 
 its normal sensibility has been greatly diminished 
 or greatly lost by neglecting to attend properly to 
 Nature's "call" for evacuation of the bowels. For 
 this purpose the very rapidly alternated current is 
 
302 COLON HYGIENE 
 
 best. The applications should be made daily. The 
 duration of the application should be about ten or 
 fifteen minutes, and the strength of the current as 
 much as the patient can bear without discomfort. 
 Not infrequently the effect of the application is to 
 provoke an immediate evacuation of the bowels. 
 
 Diathermy or Thermopenetration 
 
 This new application of electricity which we 
 owe to Dr. Nagelschmidt, of Berlin, is a most in- 
 teresting medical use of the so-called wireless 
 electrical current. In the body the high frequency 
 waves of electrical energy are wholly converted 
 into heat so that no electrical sensation or other 
 sensation except heat is felt. The special advan- 
 tage of diathermy over other forms of heat applica- 
 tions is that the heat may be applied to the deepest 
 parts as easily as to superficial parts. This is due 
 to the wonderful penetrating power of this current. 
 
 Diathermy is a valuable means for employment 
 in the treatment of colitis. The application of 
 the current to the spastic colon causes it to relax, 
 and likewise relieves the pain in the colon as well 
 as the back and other reflexly related parts. 
 
Special Treatment of Different 
 Types of Constipation 
 
 The practical management of cases of constipa- 
 tion is in its main features the same irrespective 
 of the type or form which the disease may assume. 
 However, there are certain special features of each 
 of the several characteristic phases of this diseased 
 condition, which require special consideration. 
 
 Without recapitulating the details of what has 
 been said in the preceding chapters respecting the 
 hygiene and preventive methods, the next few pages 
 will be devoted to a summary of the methods which 
 have proved most effective in dealing with several 
 forms of constipation. 
 
 Treatment of Simple Constipation 
 
 The patient must set himself resolutely to im- 
 prove his general health in every possible way. He 
 must avoid all habits known to be injurious, such 
 as the use of tobacco, alcohol, tea or coffee. Indulging 
 in late hours ; irregular meals ; use of rich and highly 
 seasoned foods; unwholesome dress; worry; and 
 every unnecessary expenditure of vital energy which 
 does not bring with it a compensating addition to 
 vital resources, must be resolutely abandoned. The 
 general rules and principles which have been set 
 forth in the preceding chapters respecting the reg- 
 
 303 
 
304 COLON HYGIENE 
 
 ularity of bowel movement and the use of laxative 
 foods in sufficient quantity must be scrupulously 
 followed. 
 
 The special exercises recommended for strength- 
 ening the abdominal muscles, correcting wrong 
 attitudes in sitting and standing, must be taken 
 systematically twice a day. Feeble persons will, 
 of course, begin with lighter exercises, increasing 
 their vigor as they improve. No less than thirty 
 minutes should be devoted to exercise daily. 
 
 The exercise bath is especially recommended be- 
 cause it economizes time by combining the tonic 
 cold bath with vigorous exercise of the most help- 
 ful sort. 
 
 In all cases in which the colon is prolapsed, and 
 when there is a flabby state of the abdominal mus- 
 cles, a carefully fitted abdominal supporter must 
 be worn. 
 
 Diet 
 
 The most important of all measures is the care- 
 ful regulation of the diet, not only with a general 
 view to a laxative effect, but to suit the needs of 
 the individual patient. It must be remembered 
 that, above all things, the food must be attractive 
 and it should be eaten at such times and in such 
 quantity that it will always be taken with keen 
 relish. When the mouth waters at the sight and 
 smell of food, it is a good sign that the whole di- 
 gestive apparatus is ready to undertake the work of 
 digestion with promptness and vigor. 
 
SPECIAL TREATMENT 305 
 
 The bill of fare must as far as possible be made 
 up of food stuffs which leave a residue of cellulose. 
 Fine flour bread should be wholly discarded from 
 the dietary. Bread or biscuit made from coarse 
 graham meal or rye meal should replace other bread 
 stuffs. It is in many cases advantageous to increase 
 the amount of cellulose in the bread, by the addi- 
 tion to graham flour of bran to the amount of about 
 one-tenth the weight of the flour. The bran and 
 graham flour should be prepared from well washed 
 wheat. If such flour cannot be readily procured, 
 wheat may be purchased, washed, dried and ground 
 in a hand mill. A few bacteria introduced into a 
 slice of bread prepared from unwashed wheat 
 might not in itself be capable of doing any great 
 amount of injury, but it must be remembered that 
 under the favorable conditions presented by stag- 
 nating fecal matters in the colon, poison-forming 
 bacteria develop with extraordinary rapidity. 
 
 All green vegetables should be freely used at 
 the principal meals. Potatoes may be eaten in 
 moderation, but should not constitute the chief 
 vegetable food, for the reason that they are almost 
 completely digested, containing a minimum amount 
 of cellulose, as will be seen by reference to the 
 table of vegetable foods. It is well to select those 
 vegetables which are richest in cellulose. When the 
 digestion is fairly good, such vegetables as beet- 
 root, spinach, squash, asparagus, cabbage, carrots, 
 turnips, and cauliflower should be very freely used. 
 
306 COLON HYGIENE 
 
 Two or three of these vegetables may be taken at 
 each meal. Uncooked vegetables of some sort 
 should be taken at least twice a day at the principal 
 meals. Lettuce, celery, cucumber and cabbage 
 may always be taken with the greatest advantage, 
 when the digestion is fairly good. There are very 
 few who cannot take one or more of these green 
 vegetables if care is taken to observe that they are 
 fresh and crisp, and pains are taken to masticate 
 thoroughly. Even radishes may be eaten in modera- 
 tion, if the irritating skin is removed. 
 
 Fruit, both stewed and fresh, should constitute 
 a part of each meal. Fruit is especially valuable 
 for the last meal of the day, and fresh fruit may be 
 taken with advantage just before retiring at night, 
 and as an early meal by those who rise early and 
 breakfast late. The acids and sugars in fruits 
 stimulate bowel action, but to secure this effect 
 they must be taken in considerable quantity. Those 
 who take two meals a day may often take with 
 advantage two or three oranges or as many apples 
 just before going to bed at night. Juicy fruit re- 
 quires no work of the digestive organs, except to 
 move it along and absorb the predigested nutrient 
 which it contains. This remark, of course, does 
 not apply to such fruits as dates, which contain a 
 considerable amount of cane sugar, nor to the 
 banana, which is really quite a hearty food, but 
 relates only to such juicy fruits as oranges, apples, 
 peaches, apricots, berries, pears and grapes. 
 
SPECIAL TREATMENT 307 
 
 When the bill of fare consists largely of such 
 food stuffs as fruits and vegetables, it is necessary 
 to give careful attention to the actual food content 
 of the meal. There is a wide variation in the 
 amount of nutriment contained in different fruits 
 and vegetables. For example, an ordinary serving 
 of potatoes represents 100 calories of food, while 
 a serving of cauliflower represents 25, and is mostly 
 wood and water. A serving of beetroot represents 
 25 calories, while a serving of cabbage or lettuce 
 contains only 7 calories. 
 
 Many persons suffering from constipation find 
 it better to take two meals a day rather than a 
 larger number. A full meal is a much stronger 
 stimulus to the stomach and to the intestine than 
 a mere "bite" of food or a half meal. By taking 
 two good sized meals a day, a good bowel move- 
 ment may usually be secured after each meal, while 
 the same quantity of food taken at three or four 
 meals might produce but one thorough movement, 
 the stimulus of the smaller meals being only suffi- 
 cient to produce a partial emptying of the intestine. 
 The question as to the number of meals is one 
 that should receive careful consideration, and often 
 requires the exercise of the best skill and judg- 
 ment. Stomachs which empty slowly require a 
 longer interval between meals. 
 
 It is especially important that care should be 
 taken to include in the bill of fare a sufficient 
 amount of fat. Fat is not only a nutrient of the 
 
308 COLON HYGIENE 
 
 very highest value, but it is a laxative food ele- 
 ment, partly because by its use the secretion of the 
 bile and other intestinal juices is promoted, so that 
 the intestine is benefited by their laxative influence, 
 and also because a portion of the fat remains be- 
 hind unabsorbed, acting as a lubricant and also 
 as a stimulant to the colon. 
 
 Most cases of simple constipation are promptly 
 relieved by the adoption of the measures above 
 recommended. The amount of bran may be in- 
 creased almost ad libitum when necessary. In 
 addition to the bran taken in the food, one or even 
 two heaping tablespoonfuls of cooked and sterilized 
 bran may be taken at each meal. Palatable prep- 
 arations of bran are now available which makes 
 possible the free use of this most important aid to 
 bowel action without inconvenience. 
 
 If any further assistance is needed it is to be 
 found in the use of white Russian paraffin oil, the 
 details concerning which having been given in a 
 preceding chapter. (See pages 260-270.) 
 
 Treatment of Cumulative Constipation 
 
 In the treatment of cumulative constipation it 
 is to be borne in mind that the principal obstacle 
 to bowel movement is the undue accumulation of 
 fecal matters either in the pelvic colon or the 
 rectum, or as is most often the case, in both the 
 pelvic colon and the rectum. In many cases the 
 
SPECIAL TREATMENT 309 
 
 food is carried from the stomach to the colon with 
 a proper degree of rapidity, and the feces move at 
 the normal rate through the colon, until they have 
 passed the splenic flexure. At this point the delay 
 begins. In time, through extraordinary neglect, 
 when the feces are allowed to accumulate for days 
 and even weeks in succession, the colon and even the 
 small intestine may become enlarged through the 
 obstruction at the outlet. 
 
 The chief cause of cumulative constipation, in 
 ordinary cases, as has already been pointed out, is 
 neglect to attend to the "call" of Nature for the 
 evacuation of the bowels. When the "call" occurs, 
 it is because the rectum is distended with feces. 
 
 If the defecating mechanism then is interrputed 
 in its action, and its purpose thwarted many times, 
 the "call" becomes residuary, and the effort to 
 defecate is so slight that it is easily suppressed. 
 Later, in the worst cases, the desire to evacuate 
 the bowels entirely disappears. In these cases the 
 sensibility of the rectum has become blunted to 
 such a degree that the normal reflex is lost. The 
 rectum tolerates the presence of feces without pro- 
 test and without giving any signal to the defecating 
 center that bowel movement is required. 
 
 It is evident, then, that in the treatment of cases 
 of cumulative constipation the first and most essen- 
 tial thing is restoration of the normal sensibility 
 of the rectum. It must be remembered, however, 
 
310 COLON HYGIENE 
 
 that in most cases of cumulative constipation, as well 
 as in other forms of constipation, the condition has 
 existed for a long time. The disease has conse- 
 quently extended to the entire colon, and perhaps 
 to the entire intestine, and success will not be ob- 
 tained by attention to the colon and rectum alone; 
 consequently, the treatment of cumulative constipa- 
 tion requires the use of all the measures which have 
 been recommended for simple constipation, the de- 
 scription of which need not be repeated here. 
 
 The first thing to be done, in beginning the treat- 
 ment of cumulative constipation is to thoroughly 
 evacuate the lower bowel and rectum. This is 
 best accomplished by the use of the enema. It is 
 certainly irrational to administer a laxative or 
 cathartic, which disturbs the alimentary canal 
 through its whole length, for the purpose of remov- 
 ing an obstructive accumulation which perhaps lies 
 within six inches of the lower outlet. 
 
 A simple water enema at a temperature of 104° 
 to 110° should be given to soften the hardened feces, 
 and should be repeated at intervals of half an hour, 
 until the colon is completely emptied, as shown by 
 the return of clear water. The addition of soap 
 to the water sometimes hastens the softening of very 
 hard fecal matter. Warm oil has been much recom- 
 mended, but it dissolves hard feces less rapidly than 
 water. At first it may be impossible to introduce 
 more than a small quantity of water, on account 
 of the extreme distention of the rectum and pelvic 
 
SPECIAL TREATMENT 31 1 
 
 colon with feces. By a persevering effort, however, 
 success will be attained ; as the hard feces are gradu- 
 ally softened and dissolved, larger quantities of 
 water may be introduced until the whole colon may 
 be filled with water and emptied of its putrefying 
 contents. In cases in which the fecal accumulation 
 has been going on for several weeks, the patient 
 must be put in charge of an experienced nurse, 
 whose efforts under careful instruction, must be 
 unremitting until the task is completely accom- 
 plished. When the feces are very hard, and the 
 masses of considerable size, oil should be used at 
 intervals to lubricate the walls of the bowels, which, 
 in such cases, are often dry and sometimes rough- 
 ened. 
 
 After the bowels have been first thoroughly 
 emptied, infinite care must be taken to see that an- 
 other accumulation never occurs. Every time the 
 bowel is distended by fecal accumulation, its muscles 
 are weakened, the sensibility of its nerves dimin- 
 ished, and any improvement which may have been 
 secured by previous treatment is lost. By the sys- 
 tematic use of the enema, the bowel being kept 
 empty, gradually contracts and returns to something 
 like its normal proportions. 
 
 The cold enema should always be used for con- 
 tracting the bowel after the fecal matters have been 
 removed by a warm enema. When once the bowel 
 has been thoroughly emptied, warm water may no 
 longer be required, and it will not be necessary to 
 
312 COLON HYGIENE 
 
 resort to the use of the hot enema. The tempera- 
 ture of the water ordinarily used for the evacuation 
 of the bowels may then be about 80°. After a little 
 training, a lower temperature may readily be toler- 
 ated and is greatly preferable. When very cold 
 water is used, the effect is sometimes to produce a 
 spasm of the anus, so that the contraction of the 
 muscles prevents proper movement. When this 
 occurs, the anus may be relaxed by the application 
 of a sponge or napkin saturated with very hot water, 
 or water of a higher temperature may be used for 
 the enema. 
 
 The best time for administering the enema is in 
 the morning, after breakfast; but if circumstances 
 will not permit this, the bowels may be moved at 
 night after supper, or just before retiring. With 
 patients who suffer from hemorrhoids or painful 
 ulcers of the rectum, the hour of retiring is the best 
 time for moving the bowels by an enema, as after- 
 ward there may be prolonged rest on the back. This 
 prevents the extrusion of swollen hemorrhoids or 
 prolapsing rectum, and gives rest to the anal muscles, 
 and so prevents the nagging, painful contractions 
 which often follow bowel movement when fistula* 
 or ulcers are present. 
 
 By the systematic use of the cold enema the di- 
 lated colon may gradually be restored to its normal 
 size; its relaxed walls will recover their tone, and 
 its function will be more properly performed. When 
 sensibility of the rectum has been lost it may also 
 
SPECIAL TREATMENT 313 
 
 gradually be recovered. It is necessary, however, 
 that the greatest care should be taken to see that the 
 colon and rectum are never once distended by fecal 
 accumulation. Many persons suffering from cumu- 
 lative constipation take an enema every other day, 
 or once or twice a week, waiting for symptoms of 
 accumulation before the enema is taken. This prac- 
 tice is altogether wrong, and results only in a per- 
 petuation of the disease. Of course, when an ac- 
 cumulation occurs, it must be removed, but if a 
 cure is expected, accumulations must not be per- 
 mitted to occur. 
 
 In obstinate cases the application of a sinusoidal 
 electric surrent to the colon and the rectum aids 
 greatly in the restoration of these parts to a normal 
 condition. By the use of special electrodes electricity 
 may be applied to the interior of the colon, as well 
 as to the rectum, thus securing vigorous contractions 
 of the bowel, which are not always produced by ex- 
 ternal applications, especially in chronic cases in 
 which the intestine has to a large degree lost its 
 normal sensibility. While strong electrical appli- 
 cations made to the spine and abdomen sometimes 
 stimulate the muscles of the intestine as well as those 
 of the abdominal wall, when the intestinal muscles 
 have long been over-stretched and are perhaps to 
 some degree degenerated, direct applications are 
 necessary. These must be made by a physician by 
 the aid of the proctoscope, which can be readily 
 passed into the pelvic colon. 
 
314 COLON HYGIENE 
 
 Vibration and massage of the interior of the 
 rectum are measures of doubtful value. They are 
 likely to give rise to abrasion and irritation of the 
 mucous membrane, and are not to be recommended. 
 
 In cases of cumulative constipation, in which 
 painful ulcer or irritable hemorrhoids exist, effort 
 to restore normal action of the bowels may be made 
 ineffective by spasm of the sphincter muscles. This 
 may be relieved temporarily by external applications 
 of heat by means of a fomentation. A very effective 
 plan is to move the bowels while sitting over hot 
 water. Boiling hot water may be poured into 
 a chamber or other suitable vessel. The steam re- 
 laxes the anal sphincters, and not only facilitates the 
 bowel movement, but relieves or prevents the pain. 
 
 Dryness of the lower bowel due to deficient 
 secretion, the result of chronic proctitis and asso- 
 ciated with loss of rectal sensibility, is not infre- 
 quently a cause of obstinate cumulative constipation. 
 The stools are exceedingly hard and dry, and are 
 discharged with great difficulty. When the rectum 
 of such a patient is examined, the mucous membrane 
 is found to be exceedingly dry, and often irritated. 
 The normal lubricating mucus is not present. The 
 result is the delay of the feces in the rectum until a 
 dry hard mass is formed, which is not easily gotten 
 rid of. In such cases, lubrication of the rectum 
 is needed. The remedy for this is paraffin, of a 
 special sort which melts at 102° F. For details 
 respecting the use of this highly valuable remedy 
 see pages 260-270. 
 
SPECIAL TREATMENT 3 1 5 
 
 Treatment of Latent Constipation 
 
 In this form of constipation the stools are regular, 
 the bowels move every day, and there is no accumu- 
 lation of feces in the rectum. The patient is gen- 
 erally unaware of the fact that he is suffering from 
 constipation, although not infrequently an observing 
 patient becomes satisfied that there is something 
 wrong, often because of too frequent bowel move- 
 ments, which are not uncommon, together with pain, 
 the passage of mucus, perhaps, and other symptoms. 
 
 In a London clinic the writer once heard a 
 Scotch laborer complain of very frequent bowel 
 movement. The examining doctor said to him, 
 "Then you are suffering from diarrhoea". "No, 
 Doctor," replied the patient, "I think I am suffer- 
 ing from constipation in diarrhoea form," — a good 
 practical description of certain forms of latent con- 
 stipation. This patient was found to have a very 
 extensive accumulation of feces due to cancer of the 
 rectum. 
 
 In addition to the most thoroughgoing application 
 of all the measures recommended for simple con- 
 stipation, a thorough examination including an 
 X-ray inspection of the whole intestinal tract, after 
 a bismuth meal must be made. The rectum and 
 lower bowel must be carefully examined to exclude 
 cancer or other organic disease. Careful examina- 
 tion must be made in the region of the appendix, 
 and in women a thorough "pelvic examination is 
 
316 COLON HYGIENE 
 
 necessary, since in many cases the delay may occur 
 above the ileocecal valve, in consequence of spasm of 
 the sphincter at this point. Or the delay may be 
 due to incompetency of the ileocecal valve. 
 
 "Lane's kink" may be an occasional cause of 
 latent constipation. It is more likely to be a result 
 of this condition. 
 
 When the difficulty is due to spasm of the ileo- 
 cecal valve, the result of reflex irritation from the 
 inflamed appendix or from inflammation of the 
 ovaries, uterus, bladder, or prostate, or painful 
 disease of the rectum, it is of course necessary that 
 these conditions should be removed by proper treat- 
 ment. Temporary relief is generally most readily 
 obtained by hot fomentations over the abdomen, 
 with special attention to the seat of pain. The hot 
 sitz bath, the hot enema and the wet girdle covered 
 with mackintosh, worn day and night, are measures 
 of great importance, and often secure very complete 
 and speedy relief. 
 
 When the intestinal inactivity is the result of 
 general feebleness, short cold baths should be em- 
 ployed daily. A cold bath may consist of a general 
 cold shower of from fifteen to twenty seconds' dura- 
 tion, a cold douche to the spine, a cold towel rub. 
 or cold sheet rub, according to the strength of the 
 patient. The cold bath should be preceded by a 
 short electric light bath. It aids in the elimination 
 of accumulated toxins, and prepares the skin to react 
 to cold application. 
 
SPECIAL TREATMENT 3 1 7 
 
 In latent constipation, the enema is sometimes 
 useful chiefly as a means of introducing water by 
 which the accumulated toxins may be washed out 
 through the kidneys. In such cases the difficulty 
 lies too high to be reached by the enema. The large 
 cool or cold enema may, however, render service in 
 cases in which the delay is due to atony, by improv- 
 ing the tone of the bowel muscles and so aiding peris- 
 taltic movement, by which the accumulated putrefy- 
 ing material in the lower part of the intestine may 
 be moved on to the colon, and so be gotten rid of r 
 The cold enema should not be used, however, in 
 cases where there is reason to suspect spasm of the 
 ileocecal valve, which is likely to be the case when 
 latent constipation is associated with painful disease 
 in any part of the pelvic region. In these cases a hot 
 enema should be employed. 
 
 The rapid absorption of water from the colon 
 is shown by the copious discharge of urine which 
 usually appears within a few minutes after an enema 
 is taken. The increase in the quantity of urine- 
 occurs so quickly after a large enema, that some 
 medical writers in the early part of the last century 
 were led to advance the theory that a direct con- 
 nection existed between the colon and the kidneys- 
 This fanciful theory has, of course, no anatomical 
 foundation. 
 
 Mechanical kneading, the application of the sinu- 
 soidal current, and intelligently administered mas- 
 sage and other means by which success may be 
 attained in combatting latent constipation. 
 
318 COLON HYGIENE 
 
 The Treatment of Spastic and Reflex 
 Constipation 
 
 These conditions, most commonly associated with 
 colitis or appendicitis, require the use of special 
 measures. In spastic constipation the cause of stag- 
 nation of the intestinal contents may rest anywhere 
 between the ileocecal valve and the anus. 
 
 In many cases of so-called spastic constipation, 
 this condition is only a complication of colitis or 
 chronic infection of the colon, due to delay of fecal 
 matters in the colon. 
 
 The best means of securing immediate relief in 
 cases of this sort are the hot sitz bath, the hot 
 enema, and hot fomentations or diathermy applied 
 over the abdomen. 
 
 In cases of painful disease of the ovaries or uterus, 
 the hot vaginal irrigation must be used in addition 
 to the hot enema. 
 
 The constipation which occurs at the monthly 
 period in women suffering from menorrhagia, may 
 often be removed by a hot hip and leg pack applied 
 by means of a woolen blanket wrung out of water 
 as hot as possible. The application of cold water 
 after the pack should be avoided. The patient 
 should be wrapped in dry blankets, and gradually 
 cooled by tepid spraying. 
 
 Sometimes the warm oil enema proves more ser- 
 viceable than the hot water enema, because less 
 irritating. The addition of salt to the water is 
 
SPECIAL TREATMENT 319 
 
 sometimes useful in cases in which the mucous mem- 
 brane of the intestine is eroded, as a weak solution 
 of salt is less irritating to raw surfaces than pure 
 water. 
 
 The application of the arc light and the photo- 
 phore are extremely useful means of relieving the 
 internal spasm. These applications should be made 
 daily for ten to fifteen minutes* duration. In 
 severe cases the light applications may be intensified 
 by a special device through which the excessive rise 
 of temperature is prevented by a stream of cool ail 
 or water playing upon the abdomen. 
 
 When making general cold applications, the abdo- 
 men should be protected by a warm flannel or a hot 
 fomentation. A patient suffering from constipation 
 must take special care to avoid chilling, and must 
 keep the feet and hands warm. The chilling of the 
 hands and feet always aggravates the- spasm. The 
 drinking of ice-cold water must also be prohib- 
 ited. 
 
 The cold towel rub is especially suited to these 
 cases, as a general tonic measure. 
 
 A person skilled in massage may make good use 
 of this measure in the general application of heat, in 
 cases in which massage is indicated, as when the 
 cecum is loaded as the result of contraction of the 
 transverse colon, or at the splenic flexure. The ten- 
 dency of massage to aggravate the contraction is 
 counteracted by a general application of heat. 
 
 The moist abdominal bandage without the mack- 
 
320 COLON HYGIENE 
 
 intosh cover should be done at night and if possible 
 also during the day time. 
 
 The abdominal supporter is also highly important 
 in these cases, to prevent drag upon the mesentary 
 by prolapse of the bowels. The writer has ob- 
 served several cases in which the wearing of an 
 efficient abdominal supporter has given prompt re- 
 lief from very obstinate constipation. 
 
 The Treatment of Mixed Cases of 
 Constipation 
 
 In many, perhaps the majority of cases of con- 
 stipation, the type of the disease is mixed. The 
 association of spastic constipation with latent . or 
 cumulative con tipation is specially common. Cases 
 which begin as simple constipation, later become 
 cumulative constipation, and finally develop spastic 
 or latent constipation through infection of the colon, 
 or colitis, the natural result of stagnation of the 
 bowel contents. 
 
 The measures recommended for the treatment 
 of spastic constipation should be applied with such 
 other measures as may be indicated. If the rectum 
 and the pelvic colon are filled with feces, these 
 must be removed by the means recommended in the 
 treatment of cumulative constipation, and the gen- 
 eral measures suggested for the relief of that form 
 of the disease must be perseveringly employed. 
 
 In the use of electricity in cases of this sort, the 
 
SPECIAL TREATMENT 32! 
 
 applications must be combined with hot applications, 
 in order to avoid increase of the spastic contraction. 
 
 When electricity is applied to the rectum, a 
 fomentation should be applied to the abdomen dur« 
 ing the application, or immediately afterward. 
 
 The thermophore affords the most effective means 
 of applying heat to the abdomen during electrical 
 applications. During a general cold application 
 heat should be applied over the abdomen, to pro- 
 tect the intestine. 
 
 A flannel bandage should be worn over the 
 abdomen constantly when the moist abdominal 
 bandage is not employed, and an abdominal sup« 
 porter should be worn. 
 
 Coarse vegetables and other bulky food stuffs 
 should not be avoided because colitis is present 
 Colitis is the result of constipation, and this will be 
 aggravated by the bland concentrated diet, which 
 is commonly recommended for colitis. Experience 
 has very clearly demonstrated the value of a bulky 
 vegetable diet in colitis as well as in constipation, 
 
 Agar-agar is specially valuable in these cases, for 
 the reason that it affords bulk, and aids in clearing 
 away the accumulated mucus, while at the same 
 time producing no irritation. The irritation sup- 
 posed to rise from the cellulose of fruits is far less 
 than is generally thought. Bran and ground wood 
 have been used with excellent results as poultices 
 for raw surfaces and dressings for wounds. Wet 
 bran, like wet paper, is not irritating. 
 
Treatment of Disorders Which 
 Result from Constipation 
 
 While constipation, through the autointoxication 
 to which it leads, is both an exciting and predis- 
 posing cause of many very serious chronic diseases 
 from which human beings suffer, there are many 
 other maladies which are so immediately aggravated 
 by an inactive state of the bowels, that this condi- 
 tion becomes a dominant factor in dealing with 
 them. In this chapter a brief mention will be made 
 of the more important of these diseases. 
 
 Catarrhal Colitis 
 
 The chief seat of this disease is the lower colon, 
 especially the pelvic colon and the iliac colon. 
 Sometimes, however, the effect extends to the 
 entire colon. 
 
 The disease is essentially a chronic infection of 
 the mucous membrane, and is the result of the 
 injury done to the tissues by the prolonged contact 
 with putrefying fecal matters which in constipation 
 accumulate and are often retained for days in the 
 lower colon. To understand the effect of these 
 poisonous matters upon the mucous membrane, 
 when acting continuously for days with constantly 
 increasing virulence, it is only necessary to consider 
 for a moment what result would follow an applica- 
 
 222 
 
TREATMENT OF DISORDERS 323 
 
 tion of the same sort of material to the skin 
 for several days in succession. The remarkable 
 vitality with which the mucous membrane is en- 
 dowed, enables it to retain its integrity for a con- 
 siderable length of time, but sooner or later, its 
 resistance breaks down, and it becomes the seat of 
 a chronic inflammation similar to that which affects 
 the mucous membrane of the nose in nasal catarrh. 
 An examination of the stools shows constantly 
 present mucous and white blood cells, which are 
 thrown off by the mucous membrane in its efforts 
 to defend itself against the attack of the myriads 
 of microbes which are constantly assailing it, and 
 the various highly virulent poisons which they 
 produce. The character of these poisons may be 
 judged from the nauseous odors emanating from 
 the putrefying feces which are discharged when 
 a laxative is administered, and sometimes as the 
 result of an enema. The real character of the feces 
 produced, by a constipated person cannot always be 
 judged by an examination of the hard, dry masses 
 which are discharged from the lower bowel, for the 
 reason that the noxious substances which they con- 
 tained have been absorbed higher up in the bowel. 
 Some persons, indeed, have made the mistake of 
 supposing that the comparatively inodorous feces 
 which they discharged, and which have been 
 retained so long that they have become as hard and 
 dry as wood, afford evidence of an exceptionally 
 aseptic and wholesome state of their intestine. In 
 
324 COLON HYGIENE 
 
 one such case the writer succeeded in disabusing 
 the mind of a very optimistic individual, by ad- 
 ministering a dose of charcoal, which, acting as a 
 laxative, brought down from the cecum and trans- 
 verse colon a semi-fluid stool which was loathsome 
 almost beyond description, and which when sub- 
 mitted to chemical and bacteriological examination, 
 was shown to contain prodigious numbers of 
 bacteria, and putrefaction products in extraordinary 
 amount. This person, a man of unusual intel- 
 ligence, but unacquainted with the physiology and 
 bacteriology of the intestine, lived under the er- 
 roneous impression that by the thorough mastication 
 of his food he rendered digestion so complete, and 
 his intestine so sterile, that the putrefactive processes 
 commonly present were suppressed, whereas, the 
 truth was that putrefaction was very active in his 
 colon, and his feces were inodorous only because 
 they had been retained so long that the putrefactive 
 process had consumed everything putresicible, and 
 the maladorous and other substances had been taken 
 up into the blood by the absorption, and had been 
 discharged through the lungs, skin and kidneys, 
 instead of being eliminated through the bowels, the 
 natural and only safe and decent outlet for such 
 loathsome products. In this case, as might be ex- 
 pected, evidence of the presence of catarrhal colitis 
 was present, the little knob of wooden-like feces 
 discharged at intervals of several days, being always 
 covered with a thick layer of opaque mucus. 
 
TREATMENT OF DISORDERS 325 
 
 The frequent bowel movement in colitis is due 
 not only to the irritation produced by the stagnation 
 of fecal contents but to the fact that the contracted 
 bowel relaxes at intervals and permits the passage 
 of material which has been accumulated above it. 
 When the bowel is completely contracted the ob- 
 struction is complete. In examining the patients 
 suffering from colitis the writer has often noticed 
 the complete relaxation of the bowel which but a 
 few moments before was so contracted that it could 
 be rolled under the finger like a piece of thick 
 rubber tubing. 
 
 In catarrhal colitis, the stools may be either 
 liquid, or composed of hard lumps somewhat re- 
 sembling the feces of goats, or they may be mixed 
 in character. The stools are sometimes quite watery 
 in character, and may contain traces of blood. 
 Patients often think that they are suffering from 
 diarrhoea, on account of the frequent semi-liquid 
 discharges. The cause of liquid stools is the irrita- 
 tion produced by the hardened and irritating feces. 
 The irritation is not mechanical, however, but is 
 due to the poisonous and irritating substances which 
 are produced by the bacteria growing in the feces, 
 in other words, by the putrefaction which is taking 
 place. 
 
 In many cases there is a quite regular alternation 
 of constipation and diarrhoea; the feces accumulate 
 for several days, when the irritation becomes so 
 great that by a profuse flow of serum and an 
 
326 COLON HYGIENE 
 
 abundant secretion of mucus occurs, the mass is 
 softened, and temporary relief is obtained through 
 the complete or partial unloading of the bowels by 
 several soft stools. 
 
 This condition, which is usually associated with 
 cumulative constipation, is often complicated by a 
 latent constipation, which results from spastic con- 
 traction of the bowel. The most common seat of 
 this contraction is the descending or pelvic colon; 
 but it may often be noted in the transverse and 
 ascending colon. In these cases, the autointoxication 
 which is always present is more pronounced in 
 degree, because of the more fluid character of the 
 intestinal contents in the upper bowel. That the 
 disease not infrequently extends to the whole colon 
 is shown not only by the contracted condition of 
 the ascending colon and even of the cecum, but 
 also by the presence of masses of hardened feces 
 which may be frequently felt in both these portions 
 of the colon. 
 
 The ultimate effect of long-continued inflamma- 
 tion of the mucous membrane is the same in the 
 colon as in the nose and other parts provided with 
 a mucous lining. After a time, which varies accord- 
 ing to the resistance of the individual and the in- 
 tensity of the disease, degenerative changes occur 
 in the mucous membrane; its glands disappear, and 
 it becomes thin and parchment-like. The degenera- 
 tion extends to the muscles which lie beneath the 
 mucous membrane. The intestinal wall is thus 
 
TREATMENT OF DISORDERS 327 
 
 thinned and weakened and loses its power of con- 
 tractility to a large degree; it becomes distended 
 and enlarged by gases and fecal accumulation, and 
 thus the difficulty becomes greatly aggravated. In 
 these cases, the colon, or at least the portion of it 
 which is affected, becomes much like a distended 
 bladder, losing a large part of its functions as a 
 living muscular tube; it fails to respond to the 
 nervous impulses by which the act of defecation 
 is normally affected, and serves merely as a reservoir 
 in which accumulate waste and remnants of un- 
 digested and undigestible foodstuffs, there to remain 
 undergoing fermentation and putrefaction, develop- 
 ing offensive gases and irritating poisons, until re- 
 moved from the body by some mechanical means. 
 In these cases an essential part of the defecating 
 mechanism is practically destroyed or rendered in- 
 operative, and it becomes necessary to resort to me- 
 chanical means, as an enema of water or oil, for 
 emptying the bowels. Lane and other surgeons 
 have removed the colon in these cases, an operation 
 which is doubtless sometimes necessary, although 
 less often required than has been advocated by some, 
 provided the patient can have the benefit of a com- 
 plete regulation of the dietary, and will follow a 
 suitable regimen. 
 
 The disastrous consequences which result from 
 chronic catarrhal colitis are not confined to the colon. 
 The disease often extends to the small intestine. In 
 aggravated cases the accumulation in the cecum 
 
328 COLON HYGIENE 
 
 becomes so great that the ileocecal valve is dilated 
 to such an extent that the contents of the cecum 
 and small intestine intermingle. The very perfect 
 valve arrangement provided by Nature at the 
 junction of the small intestine with the colon, which 
 is rendered still more effective by a sphincter 
 muscle placed just above it, is evidently intended 
 to prevent any possible return of matters from the 
 colon to the small intestine. In the small intestine 
 the presence of carbohydrates prevents the growth 
 of putrefactive organisms, by encouraging the forma- 
 tion of acids. In the colon, however, especially 
 when there is stasis or accumulation of fecal matters, 
 the delay permits the complete absorption of starch 
 and sugar, so that there is no material to encourage 
 the acid-forming bacteria, and the poison-forming 
 microbes, being unhindered, undergo rapid develop- 
 ment, and greatly increase in virulence, finding 
 always plenty of food material in the mucus, bile, and 
 other intestinal secretions, as well as the larger or 
 smaller quantities of food protein which remains 
 undigested or unabsorbed. When these dangerous 
 microbes are carried into the small intestine, they 
 may continue to develop and gradually work their 
 way up the intestine. 
 
 The cecum becomes dilated and distorted in 
 shape, because of the weakening of its walls in 
 consequence of the undue accumulation of its con- 
 tents. The cecum may be so dilated and stretched 
 that it is found far over toward the left side of 
 
TREATMENT OF DISORDERS 329 
 
 the body, or lying deep down in the pelvis. The 
 damaged ileocecal valve no longer controls the 
 opening between the small intestine and the colon. 
 The feces are no longer found exclusively in the 
 colon. The small intestine may for several feet be 
 filled with fecal matters of the consistency of putty, 
 such as are normally found only in the transverse 
 colon and beyond. 
 
 Putrefaction of the contents of the small intestine 
 is a very much more serious matter than putrefaction 
 in the colon, for the reason that the small intestine 
 is much more richly supplied with absorbents, and 
 is also less prepared to defend itself against the at- 
 tacks of the virulent miscrobes which are always 
 present in connection with putrefactive processes. 
 
 This infection of the small intestine with fecal 
 matters introduces a whole series of troubles which 
 unfold as the infection ascends along the intestine. 
 The ascending infection finally reaches the duo- 
 denum, which not infrequently becomes the seat of 
 a chronic catarrhal condition, the result of which 
 may be ulceration. Observations of Moynihan and 
 others have shown that duodenal ulcer is three or 
 four times as frequent as ulcer of the stomach. 
 Pain occurring three or four hours after meals is 
 very frequently due to duodenal ulcer. From the 
 duodenum, infection often travels through the bile 
 ducts to the liver and the gall bladder. Chronic in- 
 fection of the gall bladder and gall stones are thus 
 developed. The infection may also ascend the pan- 
 
330 COLON HYGIENE 
 
 creatic duct, which is closely associated with the 
 bile duct, and may cause chronic inflammation of 
 the pancreas, one of the results of which may be 
 diabetes. From observations recently made respect- 
 ing the causes of diabetes it is probable that inflam- 
 mation of the pancreas arising in this way is among 
 the most common causes of this disease. Observa- 
 tions made in the X-ray department of the Battle 
 Creek Sanitarium indicate that the ileocecal valve 
 Is usually incompetent in diabetes. This is a most 
 significant fact. The ileocecal valve protects the 
 small intestine from infection; when it becomes in- 
 competent, there is nothing to prevent the develop- 
 ment of an ascending infectious process, which may 
 bring about all of the conditions above mentioned. 
 
 Treatment 
 
 The successful treatment of colitis requires, first 
 of all, a change of the intestinal flora; that is, the 
 infectious bacteria to which the disease is due must 
 be gotten rid of. Since the first cause of colitis 
 is constipation, it is evident that frequent bowel 
 movement is also essential ; in other words, the colon 
 must be kept clean. The diarrhea which is some- 
 times present in colitis is the result of Nature's ef- 
 fort to clear the intestine from offending materials. 
 The mucus which is often discharged in large quan- 
 tities is a protective material which Nature pours 
 out upon the surface of the intestine to protect the 
 tissues against the attacks of bacteria and parasites 
 
TREATMENT OF DISORDERS 331 
 
 which flourish in the colons of persons suffering 
 from this disease. 
 
 Various species of bacteria are capable of giving 
 rise to colitis, according to Tissier. In general, it 
 may be said that colitis is the result of the presence 
 in the colon of excessive numbers of putrefactive 
 bacteria. 
 
 In recent years, attention has been called to 
 the fact that acute infections of the colon are 
 sometimes due to animal parasites. Certain amoebae, 
 flagellates, spirochetes and other forms of protozoa 
 are also found in great numbers in the colon in cases 
 of chronic constipation and colitis, as well as in cases 
 of amoebic dysentery. These organisms have been 
 regarded by most authorities as pseudo parasites, 
 with the exception of those of amoebic dysentery. 
 Dr. Ronald Ross has recently pointed out the fact 
 that all these organisms are parasitic and dangerous. 
 If they do not set up acute inflammation character- 
 istic of amoebic dysentery, they bore into the mucous 
 membrane and thus prepare hiding places for per- 
 nicious bacteria, which develop chronic infections 
 and intestinal toxemia. Observations made a few 
 years ago by Miss York show that these animal 
 parasites are rarely found in the stools of persons 
 who subsist upon a non-flesh dietary. They abound 
 in feces which are in part made up of undigested 
 residues of flesh foods. 
 
332 COLON HYGIENE 
 
 Measures Essential in the Treatment 
 of Colitis 
 
 As already stated, it is necessary in the treat- 
 ment of colitis first of all to adopt thoroughgoing 
 measures to secure a change of the intestinal flora. 
 The writer has found that this may be accomplished 
 in a short time by placing the patient on a special 
 diet, which for convenience is termed a fruit regi- 
 men. ;- For a description of this regimen see page 
 191. After a few days of this regimen (three days 
 to a week) the character of the stools will be found 
 to be wholly changed. The stools become soft, al- 
 most odorless and frequent, the tongue clears, the 
 appetite is keen and is satisfied with simple foods. 
 Cereals and a moderate amount of fats can now be 
 added to the bill of fare, but the fruits, bran or 
 agar-agar, and paraffin must be continued. 
 
 The diet must be made so bulky and laxative that 
 the bowels move three or four times a day. Four 
 movements a day are better than three. The stools 
 should be odorless or they may have a slight sour 
 odor. An ammoniacal or putrid odor is evidence 
 that the flora has not yet been changed, and the 
 fruit regimen must be continued or repeated after 
 a few days. Sometimes several repetitions of the 
 regimen at intervals of a week or two are required 
 for complete success. Animal products of all sorts 
 must be avoided. Even milk must be excluded, as 
 well as eggs and meat. As pointed out by Tissier 
 
TREATMENT OF DISORDERS 333 
 
 some years ago, the bacteria which produce colitis 
 thrive best upon animal protein. 
 
 Another point of importance is to supply the 
 colon with carbohydrates. Sugar administered by 
 the mouth never reaches the colon, for the reason 
 that it is so readily absorbed that it is all taken up 
 by the small intestine. Cooked starch is digested so 
 quickly that it is also absorbed from the small in- 
 testine, only a mere trace reaching the colon. The 
 way to get carbohydrate into the colon is either to 
 introduce it by enema, or to administer it in an un- 
 cooked, or partially cooked, state, so that it may 
 have an opportunity to reach the colon before diges- 
 tion is complete. It is well known that saliva does 
 not act upon cooked starch. 
 
 Raw starch may be digested by the pancreatic 
 juice, but the process is very slow, and so when 
 starch is taken raw a considerable proportion, ten 
 to twenty per cent according to the writer's observa- 
 tions, may reach the colon. In the colon there are 
 always present bacteria capable of digesting raw 
 starch and converting it into sugar. When sugar 
 is present, not only the ordinary lactic acid forming 
 bacillus but the various putrefactive bacteria seize 
 upon the sugar with great avidity and convert it 
 into lactic acid. It appears that even putrefactive 
 germs are putrefactive, or carnivorous, only when 
 compelled to be so through the absence of carbo- 
 hydrate in available form. When sugar is present, 
 putrefaction does not take place. This important 
 fact was pointed out by Kendall some years ago, 
 
334 COLON HYGIENE 
 
 and demonstrates that it is possible to reform the 
 bacteria of the colon, and this is much more easily 
 accomplished than to drive out the various species 
 of bacteria which, in most cases, have been thor- 
 oughly established in the intestine for years, and 
 occupy every nook and corner of the colon; they 
 cling so tenaciously to the territory which they have 
 invaded, that it is practically impossible to drive 
 them out so completely that a sufficient number 
 will not be left behind to quickly re-establish them- 
 selves when favorable conditions develop. 
 
 Raw starch may be introduced in various ways. 
 A convenient method is by the use of "brose" (see 
 page 237). Another excellent plan is the follow- 
 ing: Pour into a bowl six ounces of boiling water. 
 Rapidly stir in a heaping tablespoonful of fine oat- 
 meal, or rolled oats, which has been passed through 
 a vegetable grinder. Let it stand one side for five 
 minutes and add a little salt and eat as porridge. 
 The preparation is not unpalatable. If desired, it 
 may be taken as a beverage with the addition of a 
 little water or fruit juice. 
 
 In addition to the above, there are several other 
 highly effective measures which may be advantage- 
 ously employed in the treatment of colitis. Not- 
 withstanding the free use of bran or agar-agar and 
 paraffin, the colon may be so crippled that it does 
 not completely empty itself and a sufficient amount 
 of material is constantly left behind to encourage 
 putrefaction, and to prevent the healing of the dis- 
 eased surfaces. Examination with the X-ray shows 
 
TREATMENT OF DISORDERS 335 
 
 in these cases a spastic, or contracted, condition of 
 the descending or pelvic colon, and in many cases 
 a prolapsed condition of the pelvic colon, which 
 may be adherent. In these cases, the colon must be 
 daily washed out by means of an enema consisting 
 of two or three pints of salt water. The tempera- 
 ture of the water should be 105° to 108°. The 
 enema should be repeated several times, or until the 
 water returns clear. The effectiveness of the enema 
 is greatly increased by thorough massage of the 
 colon, especially of the pelvic colon, with the patient 
 in the knee-chest position. When the pelvic colon 
 is distended by the enema it may be manipulated 
 more effectively. 
 
 After the colon has been thoroughly emptied, an 
 injection is made consisting of a culture of Bacillus 
 Bulgaricus in whey, to which has been added a 
 small portion of well boiled starch and also a small 
 quantity of malt sugar. By this means the colon 
 is inoculated with germs; in other words, a new 
 flora is planted and supplied with the material to 
 promote its growth and development, and to help 
 reform the wild bacteria of the colon to which co- 
 litis is due. 
 
 It is well to use short tonic baths, the moist ab- 
 dominal bandage, fomentations and other applica- 
 tions of heat to this region. Light baths, and meas- 
 uses of all sorts which build up the general health, 
 must supplement the local measures above suggested. 
 This method of dealing with cases of colitis has 
 long ago passed the experimental stage. By thor- 
 
336 COLON HYGIENE 
 
 ough application of these simple means many hun- 
 dreds of chronic sufferers from colitis have been not 
 only relieved, but cured. It must be remembered, 
 however, that the measures found necessary to effect 
 a cure of this distressing ailment must be adhered 
 to more or less strictly after the cure, as the only 
 certain means of preventing recurrence. 
 
 Proctitis 
 
 In cases in which cumulative constipation in- 
 volves the rectum, infection, here known as 
 proctitis, develops in this part also. Infection may 
 extend from the pelvic colon into the rectum. When 
 the rectum is involved, the patient often suffers 
 from more or less constant pain and uneasiness in 
 this region; there may be frequent desire to move 
 the bowels, but however frequently the bowels may 
 be moved, there will always be some feces remain- 
 ing in the rectum, together with mucus and, oc- 
 casionally, blood. An examination of the rectum 
 sometimes shows ulceration. In advanced cases, 
 the mucous membrane is smooth and dry, with 
 patches of mucus adhering here and there, and 
 frequently raw surfaces which bleed when touched. 
 The conditions are identical with those which are 
 found in the bowel higher up. The point of junc- 
 tion of the colon and the rectum is a favorite 
 seat for ulcerations and thickenings of the mucous 
 imembrane. 
 
TREATMENT OF DISORDERS 337 
 
 When the disease extends deeper into the wall of 
 the bowel, as it does sooner or later, thickening and 
 rigidity result. By extension of the disease through 
 the membranous wall, the outer surface becomes 
 inflamed, and adhesions may occur between the 
 lower bowel and the bladder, which sometimes 
 result in fistulae between the two viscera. Adhesions 
 may also occur between the colon and small in- 
 testines and other parts; the ulcerations may heal 
 and form cicatrices, which contract and produce 
 obstruction. The lower part of the rectum and the 
 juncture of the colon and rectum, the pelvirectal 
 valve, usually show the worst effects of catarrhal 
 colitis, and these points are the favorite seat of 
 cancerous growths. The long continued irritation 
 to which these parts are subjected also leads to the 
 development of other growths, which, together with 
 ulcerations, as has been shown by Mummery, a 
 very eminent London specialist, are very prone to 
 develop into cancer, and on this account, every 
 person who suffers from catarrhal colitis, as shown 
 by the presence of mucus in the stools, should 
 submit himself to a physician for examination in 
 order that any existing tendency towards maligancy 
 may be recognized sufficiently early to permit of 
 its radical treatment. 
 
 The treatment of proctitis is essentially the same 
 as that already outlined for colitis. Change of the 
 intestinal flora, frequent bowel movements, daily 
 cleansing of the colon, an anti-toxic diet, and the 
 
338 COLON HYGIENE 
 
 introduction into the colon of cultures of lactic acid 
 forming organisms are the most important measures. 
 Faithful employment of these measures will usually 
 effect a cure. 
 
 Muco-membranous Colitis 
 
 This disease is probably only a variety of the 
 preceding. Of this the writer has been convinced 
 for many years, although most authorities still 
 describe this malady as a nervous disorder. The 
 only particulars in which it differs from catarrhal 
 colitis are: 
 
 1. The fact that mucus is not constantly present 
 in the stools as in catarrhal colitis. 
 
 2. The presence of membranes which are some- 
 times complete casts of the bowel, and may be a 
 foot or more in length. 
 
 3. Colic pains. 
 
 4. Intermittent occurrence of the symptoms. 
 These differences are not sufficient to characterize 
 
 this condition as a distinct disease. Constipation 
 is the predisposing condition which lies back of this 
 disease, as well as of catarrhal colitis. If the in- 
 fection is not sufficiently intense to produce con- 
 tinuous symptoms, it is only necessary that it should 
 be increased by some indiscretion in diet, exhaustion, 
 a severe cold, or some other factor, to precipitate 
 an attack. The casts consist of coagulated mucus, 
 and not mucous membrane as patients often imagine. 
 
TREATMENT OF DISORDERS 339 
 
 The colic pains are due to violent contraction of 
 the colon, which are excited by the accumulation 
 of gas and irritating fecal matter. This disease 
 is often associated with chronic affections of the 
 pelvic organs, and is much more frequent in women 
 than in men. 
 
 Colitis in any form is a serious condition which 
 cannot be safely neglected. Sooner or later it creates 
 conditions which are beyond remedy except by 
 surgical means. 
 
 Treatment 
 
 The treatment of this condition does not differ 
 from that already outlined for the treatment of 
 colitis. Medicinal laxatives of all sorts must be 
 avoided, because these only serve to aggravate and 
 perpetuate the disease. 
 
 Enlargement of the Liver and Spleen 
 
 Marked enlargement of the liver and spleen are 
 frequently the result of chronic constipation with 
 intestinal autointoxication. The constant flooding 
 of the liver with toxins must result in damage to 
 its tissues. Boix showed this in his experiments 
 upon rabbits. Some years ago the writer en- 
 countered a case of enormous enlargement of the 
 liver, in which there had never been any use of 
 alcohol, and there could be found no more tangible 
 cause for the disease than a chronic constipation 
 
340 COLON HYGIENE 
 
 which had existed for many years. The writer has 
 seen many cases of decided enlargement of the liver 
 and spleen, in which constipation and autointoxica- 
 tion existed to a marked degree. 
 
 Fecal Tumors 
 
 When the obstruction which causes a delay in 
 the movement of feces through the colon is 
 permanent, the mass of accumulated feces may at- 
 tain such a size as to be easily felt through the 
 abdominal wall. Fecal tumors may generally be 
 distinguished from other tumors by their doughy 
 consistency, that is, their shape may be moulded 
 by pressure with the fingers. Such forms sometimes 
 disappear suddenly and may be broken up by the 
 manipulation of the hands, or softened by means 
 of enemas of warm water or warm oil. Sometimes 
 a surgical operation is necessary for their removal. 
 
 The late Dr. Lawson Tait told the writer of 
 a case to which he was called to operate for the 
 removal of a large abdominal tumor, which proved 
 to be a tumor of this sort. On opening the abdo- 
 men, the small intestine was found to be enormously 
 distended just at the ileocecal valve. On inquiry, 
 it was found that the patient, who was recently con- 
 valescent from typhoid fever, had swallowed rather 
 rapidly a large quantity of milk. Suspicion at once 
 arose in the mind of the surgeon that the mass might 
 consist of undigested curds. With this idea in mind, 
 he carefully manipulated the tumor with his fingers, 
 
TREATMENT OF DISORDERS 341 
 
 and finally succeeded in breaking up the mass to 
 such a degree that it became possible to push the frag- 
 ments through the ileocecal valve, and thus a more 
 serious operation was avoided. 
 
 Volvulus 
 
 Sometimes the processes which begin in the in- 
 testine and work outward through the intestinal 
 wall give rise to inflammatory changes in the mem- 
 branous fold of mesentery to which the pelvic loop 
 of the colon is attached. As a result the mesentery 
 is gradually shortened until the ends of the loop 
 are brought close together and fixed. With the 
 colon in this position, there is a great risk of ob- 
 struction from the twisting of the loop, which 
 occasionally happens, giving rise to what is known 
 as volvulus. In a case of this kind prompt surgical 
 relief is very essential. A short delay may give 
 rise to gangrene of the intestine, and general 
 peritonitis. 
 
 Disorders of the Stomach 
 
 Although located at the other extremity of the 
 digestive canal from the colon, the stomach is, 
 nevertheless, in various ways and to a profound 
 degree influenced by chronic constipation. Loss of 
 appetite is a very common symptom in constipation, 
 and so constipation is increased through the lack 
 of the vigorous stimulation given to the movement 
 of the intestine by the taking of food with relish. 
 
342 COLON HYGIENE 
 
 Hyperhydrochloria, gastritis, and even ulceration 
 in the stomach and duodenum are by many eminent 
 medical men attributed to the stagnation of the 
 intestinal contents. 
 
 Diseases of the Heart and Blood Vessels 
 
 Palpitation of the heart is a common consequence 
 of an acute accumulation of feces in the colon, 
 probably the result of the excessive absorption of 
 toxins to which such accumulations give rise. 
 
 Pseudo-angina pectoris, in which the patient suf- 
 fers pain in the region of the heart entirely sim- 
 ilar to those which occur in angina pectoris, are 
 frequently associated with chronic constipation. 
 Chronic constipation or the autointoxication result- 
 ing from it may be regarded as a cause of true angina 
 pectoris as well as of pseudo-angina. Arteriosclero- 
 sis affecting the vessels of the heart has been clearly 
 shown by Bouchard and other authorities to be 
 one of the common results of chronic constipation, 
 and attacks of angina pectoris often appear among 
 other symptoms of the degenerative changes which 
 have taken place. Years ago Boix of Paris showed 
 that the poisons produced by the colon bacillus are 
 capable of producing these degenerative changes 
 which result in sclerosis of the arteries of the liver, 
 spleen, and other glands. 
 
 Premature Senility 
 
 The senile appearance of many persons who have 
 long suffered from chronic constipation, as well as 
 
TREATMENT OF DISORDERS 343 
 
 the steady decline of longevity in countries in which 
 constipation is prevalent, is evidence of the mis- 
 chievous results of the constant absorption of the 
 poisons produced by colon germs which Metch- 
 nikoff regards as the cause of old age. The pig- 
 mentation of the skin appearing first about the eyes 
 and as brown spots upon the hands, the thinning of 
 the skin of the hands and parchment-like appearance 
 of the skin are familiar symptoms of senility induced 
 by alimentary toxemia. It is highly important to 
 note that these senile changes are not confined to 
 the skin. The changes in the skin are only the 
 external signs of similar degenerative changes tak- 
 ing place in the bloodvessels, liver, kidneys, and 
 other vital internal parts. 
 
 Disease of the Kidneys 
 
 The poisoning resulting in chronic constipation 
 is frequently indicated by the appearance of albumen 
 and casts in the urine. A long continuance of this 
 poisoning gives rise to changes in the kidney, which 
 are commonly known as Bright's disease. It is in- 
 deed quite possible that chronic constipation may be 
 one of the most important of all causes of this 
 terrible malady. Statistics of all civilized countries 
 show that Bright's disease is increasing very rapidly. 
 In the United States the number of persons dying 
 of it is at the present time 2.31 times as great as 
 thirty years ago. In certain cities the proportion is 
 still higher, the increased mortality rate from this 
 
344 COLON HYGIENE 
 
 cause amounting to 164 per cent. The large use 
 of meat in connection with this condition of consti- 
 pation greatly aggravates the evils arising from this 
 condition, because meat not only affords the poison- 
 forming bacteria just the sort of material they re- 
 quire to promote their growth, but also introduces 
 into the intestine in large numbers the most viru- 
 lent forms of putrefactive bacteria. 
 
 Suppuration of the kidney, shown by pus in the 
 urine as well as by local pains and other symptoms, 
 is usually associated with chronic constipation. 
 Infection of the kidney with colon germs may occur 
 through the urinary tract, the germs travelling by 
 the ureters to the kidney, or direct infection may 
 occur. The bacteria which grow in the intestines, 
 specially when their virulence is increased by stasis 
 or stagnation, readily penetrate the walls of the 
 intestine and adjacent organs. The right kidney 
 lies in immediate proximity to the colon. 
 
 Bacteriological examination of the urine in cases 
 of suppuration of the kidney often shows the pres- 
 ence of colon germs. 
 
 Movable Kidney 
 
 The right kidney is so closely connected with the 
 hepatic flexure of the colon that any change of 
 position of this portion of the colon must have more 
 or less effect upon the kidney. When the cecum 
 and the ascending colon become overloaded, the 
 
TREATMENT OF DISORDERS 345 
 
 drag upon the kidney may become so great as to 
 loosen it from its moorings, and lead to floating 
 kidney. 
 
 Disease of the Liver and Gail-Bladder 
 
 Recent observations have shown that when putre- 
 fying feces accumulate in the colon great numbers 
 of bacteria pass through the walls of the intestine 
 into the branches of the portal vein, and are car- 
 ried to the liver. The liver destroys many of these 
 bacteria, but not a few of them pass out in the bile, 
 and thus infect the bile passages of the liver and gall- 
 bladder. It is possible, also, that infection may 
 occur directly from the intestine. The bacteria may 
 ascend the gall ducts to the gall-bladder and the 
 liver. Modern research has shown that gall-stones 
 are always due to bacteria, which are found in the 
 interior of the gall-stones. Persons suffering from 
 disorders of the gall-bladder, and from gall-stones, 
 are always chronic sufferers from constipation and 
 alimentary toxemia, to which unquestionably their 
 liver troubles are chiefly due. 
 
 Insomnia 
 
 One very rarely finds a person suffering from 
 insomnia who is not constipated. Not infrequently, 
 the constipation is present in the latent form, and 
 its existence may not be expected. Examination of 
 the stools and inspection of the tongue give clear 
 evidence of the existence of stasis in the colon. The 
 
346 COLON HYGIENE 
 
 insomnia is due to the irritation of the brain cells 
 produced by the poisons with which the blood 
 is saturated through absorption from the colon. 
 The use of soporifics only secures temporary relief 
 with a certainty of making the patient worse 
 through disturbing his digestion, destroying his appe- 
 tite, and thus making his constipation worse. By 
 relief of constipation through proper diet, and the 
 adoption of other rational measures the insomnia 
 may be made to disappear, and usually with very 
 great promptness. 
 
 Headache 
 
 This very common and most distressing effect of 
 chronic constipation is due to putrefaction poisons 
 absorbed from the colon, and constipation quickly 
 disappears when the intestinal flora is changed and 
 the bowels made to move well three times a day. 
 Copious water drinking, especially drinking two or 
 three glasses of hot water two or three times a day 
 ameliorates the symptom by aiding the elimination of 
 poisons. Attacks of migraine are always preceded 
 by an increase of stasis, that is, by an accumu- 
 lation of fecal matters which throws into the blood 
 a new flood of indican and other toxins. By a 
 thorough emptying of the colon through the use of 
 the enema the attack may always be mitigated and 
 sometimes averted. If the attack has actually be- 
 gun, however, the result is less satisfactory although 
 
TREATMENT OF DISORDERS 347 
 
 even then the duration of the attack if not its intens- 
 ity may be lessened by emptying the colon by 
 repeated enemas. When vomiting or nausea is 
 present, the enema should be repeated several times 
 a day as a means of introducing much needed fluid. 
 An excellent plan is to introduce into the colon to 
 be retained and absorbed half a pint to a pint of 
 water every hour or two. 
 
 The excruciating pain of migraine may be made 
 more endurable by fomentations or alternate hot 
 and cold applications to the painful parts. The 
 use of morphia and other narcotic or pain retrieving 
 drugs is most pernicious. The use of drugs pur- 
 chases but present relief at the expense of increased 
 future suffering. Such drugs increase the consti- 
 pation and so aggravate the toxemia and not infre- 
 quently a drug habit is formed. 
 
 Rachitis, Arrest of Growth and Other Dis- 
 turbances of Nutrition in Infants 
 
 The researches of Combe and Rouget have clearly 
 shown the relation of intestinal intoxication to the 
 arrested growth and other disturbances of nutrition 
 which are frequently observed in infants and young 
 children and that constipation lies at the foundation 
 in most of these cases. One of the most important 
 of all the duties of the nurse is to attend carefully 
 to the condition of the infant's bowels, as neglect 
 in the first weeks of infancy may lay the foundation 
 
348 COLON HYGIENE 
 
 of troubles which years of painstaking efforts will 
 be required to relieve, and which may be irrepar- 
 able. 
 
 Diverticulitis 
 
 This newly-described disease affects especially 
 the colon, and particularly the pelvic colon. It 
 consists in the formation of small pouches along the 
 border of the colon, which sometimes increase to a 
 considerable size. These pouches become filled with 
 feces, which often set up irritation and give rise to 
 abscesses. 
 
 Many of these pouches have very narrow mouths 
 so that fecal matter readily accumulates in them. 
 This condition involves many serious dangers. If 
 the mouth of a diverticulum becomes closed, the 
 infectious contents quickly give rise to inflamma- 
 tion which may result in ulcer of the bowel, abscess, 
 or adhesions with the formation of a tumor mass 
 and obstruction. When diverticuli are known to 
 exist, the patient should take care to keep the bowels 
 freely open by a very laxative diet and the use of 
 Russian paraffin oil. 
 
 Diverticulitis is caused by injury to the intestinal 
 wall produced by colitis followed by overdistention 
 of the bowel by accumulation of fecal matters. 
 
 Each diverticulum involves exactly the same dan- 
 gers which are connected with a chronically inflamed 
 appendix. 
 
 Diverticulitis may cause obstruction of the bowels, 
 both by giving rise to adhesions and by causing thick- 
 
TREATMENT OF DISORDERS 349 
 
 ening of the walls of the intestine, and so gradually 
 narrowing its lumen until complete obstruction 
 occurs. This condition is sometimes mistaken for 
 cancer. 
 
 Cancer 
 
 The discoveries of Ross respecting the cause of 
 cancer show very clearly the reason for the special 
 frequency of cancer in the pelvic colon and the 
 rectum. According to Ross, cancer is due to an 
 abnormal stimulation of the processes of normal 
 cell growth. He has shown by elaborate laboratory 
 researches that cholin and cadaverin, two of the 
 products of the putrefaction of flesh or protein, are 
 powerful augmenters of cell action, and in recent 
 experiments he has been able by these poisons to 
 produce in guinea pigs growths which have all the 
 characteristics of cancer. Certainly no part of the 
 body is more exposed to the influence of these putre- 
 factive products than is the lower bowel. It is 
 evident, then, that this portion of the body should 
 receive prompt attention on the occurrence of the 
 slightest symptoms of disease, and that as a protec- 
 tive measure putrefaction of the feces should be 
 prevented by proper regulation of diet and of the 
 bowel movement. 
 
 Tuberculosis of the Bowels 
 
 Intestinal tuberculosis appears to be increasing. 
 That this should be the case is not surprising, in 
 view of the fact that constipation is becoming more 
 
350 COLON HYGIENE 
 
 and more prevalent each year. The contact of 
 poisonous fecal matters with the mucous membrane 
 lowers its resistance and renders it susceptible to the 
 infectious influence of the tubercle germ. All forms 
 of tuberculosis, as the history of cases shows, are 
 almost invariably preceded by chronic constipation 
 for a prolonged period. 
 
 Backache 
 
 Aside from symptoms which relate to the rectum, 
 backache is perhaps the most common of all local 
 symptoms arising from constipation. In women 
 this symptom is usually attributed to disease of the 
 womb or ovaries. It is safe to say that in by far 
 the larger number of cases the pain is due not to 
 disease of the organs peculiar to women, but to a 
 diseased condition of the colon, set up by long con- 
 tinued contact with putrefying fecal matters. In 
 many cases tender points can be felt by deep pressure 
 along the iliac or the descending colon. Sometimes 
 the pelvic colon may be located. By the aid of the 
 X-ray and the fluoroscope it is possible to locate and 
 make pressure upon every part of the colon, as well 
 as to note its form and size, and thus the presence of 
 disease may now easily be located when present. 
 
 The pain is reflex in character, and may often be 
 produced by pressure upon a contracted and tender 
 part of the colon. Pains over the sacrum are quite 
 as often due to disease of the rectum as to disease 
 of the uterus or ovaries. As constipation is so con- 
 
TREATMENT OF DISORDERS 351 
 
 stantly associated with disease of the pelvic organs, 
 it is a question of interest whether the pain usually 
 attributed to pelvic disease, when this is present, 
 may not in many cases be really due to disease of the 
 colon or rectum. Tender spots in the lower part 
 of the back are usually due to the same cause, and 
 only rarely indicate disease of the spine. 
 
 The congestion of the abdominal organs which 
 results from chronic constipation is the cause of a 
 great variety of reflex pains in the back and sides. 
 Coldness, numbness, prickling and creeping sensa- 
 tions, and points of tenderness in the abdomen, a 
 sense of weight, dragging and pressure, are only a 
 few of the distressing symptoms which arise from 
 visceral congestion due to the absorption of toxins 
 from the intestinal tract, and the infection of the 
 intestinal mucous membrane resulting from chronic 
 constipation. 
 
 Exophthalmic Goitre 
 
 This serious disorder, which is becoming con- 
 stantly more common, is unquestionably due to 
 chronic intestinal poisoning, and hence may be the 
 result of constipation, which in some form is always 
 present in cases of chronic intestinal autointoxication. 
 To treat this malady simply by removal of a part of 
 the thyroid gland by a surgical operation, or by 
 partial destruction of the gland by the X-ray with- 
 out giving attention to its cause, is certainly irra- 
 
352 COLON HYGIENE 
 
 tional, since the enlargement and activity are the 
 effects, no doubt, the absorption of toxins from the 
 intestinal canal. The gland enlarges because of the 
 extraordinary amount of work demanded of it, its 
 special function in the body being to aid in the 
 destruction of poisons, especially those developed in 
 the intestine by the decomposition of protein. Ani- 
 mals whose thyroids have been removed soon develop 
 convulsions and die when fed on a meat diet, but 
 thrive indefinitely on a diet which excludes meat. 
 
 Myxedema 
 
 A disease which is the antithesis of exophthalmic 
 goitre, myxedema, is really due to the same cause. 
 The thyroid gland becomes worn out by excessive 
 work, and its function is lost. In consequence, the 
 whole body suffers from peculiar degenerative 
 changes. The skin and hair become dry, pale and 
 sodden in appearance, the speech is thick, the expres- 
 sion is peculiar and characteristic, and the intellect is 
 dulled. The cause of this peculiar disease was 
 wholly a mystery until the function of the thyroid 
 was discovered. It is now known to be due to the 
 failure of this important gland to do its work, as 
 the result of degeneration, which is in most cases 
 the result of the excessive work imposed upon it by 
 the autointoxication induced by a high protein diet: 
 that is, by the free use of meat and eggs, especially 
 when associated with constipation. 
 
TREATMENT OF DISORDERS 353 
 
 Hypothyroidism, incipient myxedema, is a very 
 common malady. The thyroid is less active than 
 it should be though its function is not wholly lost. 
 Dryness of the hair, falling of the hair, and dryness 
 of the skin are common symptoms of this condition, 
 seen associated with chronic constipation, and the 
 natural result of long overwork of the thyroid in 
 destroying colon poisons. 
 
 Chronic Rheumatism and Rheumatic Gout 
 ( Osteo- Arthritis ) 
 
 Both these diseases are closely associated with 
 constipation and alimentary toxemia. Herter showed 
 that certain putrefactive organisms are always pres- 
 ent in great numbers in the stools of persons suffer- 
 ing from rheumatic gout. The experience of many 
 physicians has shown that great improvement often 
 follows the adoption of a low protein diet in these 
 cases; and the benefit derived from securing 
 increased activity of the bowels has made many a 
 mineral spring famous as a cure-all for rheumatics. 
 
 The writer has seen hundreds of chronic sufferers 
 from these maladies greatly relieved and many 
 cured by a low protein diet and the restoration of 
 normal colon activity. 
 
 Pigmentation of the Skin and Skin Diseases 
 
 When meat and eggs are eaten freely, accord- 
 ing to Combe, there may be produced in the intestine 
 
354 COLON HYGIENE 
 
 a large amount of a brown poisonous coloring sub- 
 stance, "brenzcatchin," to destroy which is one of 
 the functions of the suprarenal capsules. When 
 these glands become defective, through overwork, 
 this substance accumulates and, being deposited in 
 the skin, gives rise to dinginess of the complexion, 
 brown circles around the eyes, so-called "liver 
 patches" on the face and other parts, brown spots 
 upon the hands, and a deepening of the color of 
 parts of the skin which are normally pigmented, 
 as the axillary regions, groins, and in many patients 
 a line down the center of the back. 
 
 This pigmentation is commonly seen in aged 
 persons, in whom as in others its cause is the consti- 
 pation which is usually associated with old age. The 
 same pigmentation is sometimes seen in young per- 
 sons, and even in infants, as the result of intense 
 poisoning from intestial putrefaction. When an 
 antitoxic diet is aaopted, and the bowels are made 
 to act normally, the pigmentation disappears with 
 remarkable quickness. Dr. Lane of London has 
 demonstrated the connection between this abnormal 
 pigmentation and putrefaction in the colon, by 
 removing the colon. He states that the worst cases 
 show a surprising change for the better in a few 
 days, and the pigmentation wholly disappears within 
 a few weeks. Cases seen by the writer in a London 
 hospital seemed to verify this claim, which is also 
 Supported by the results of securing frequent daily 
 movements in very chronic cases of constipation. 
 
TREATMENT OF DISORDERS 355 
 
 Eczema 
 
 Eczema, one of the most common and most dis- 
 tressing of skin maladies, has long been known by 
 skin specialists to be caused by constipation. Doctor 
 Bulkley, the eminent skin specialist of New York 
 City, has within the last thirty years many times 
 called attention to the fact that eczema is encour- 
 aged by the use of flesh food, and that most chronic 
 cases are curable by strict adherence to a non-flesh 
 dietary, even when all other measures have failed 
 to give relief. 
 
 A most distressing form of this disease is ec- 
 zema of the anal region, one of the frequent re- 
 sults of constipation. This annoying ailment usu- 
 ally disappears very soon when the bowels are made 
 to move three times a day, and meat is excluded 
 from the diet. 
 
 Temporary relief from the horrible itching of 
 eczema may be obtained in many cases by bathing the 
 parts with very hot water (120° F.), or by exposing 
 them to hot steam. Then apply an unguent, con- 
 sisting of the following: lanolin 2 drams, borogly- 
 ceride 1 dram, cold cream 6 drams. This method 
 usually succeeds especially well in old cases in which 
 the skin is dry or scaly. The eruption usually dis- 
 appears very quickly after a proper X-ray applica- 
 tion. The actinic ray is sometimes more effective. 
 The affected parts should be constantly and very 
 carefully protected. 
 
356 COLON HYGIENE 
 
 Psoriasis 
 
 This form of skin disease, usually more obstinate 
 though less distressing than eczema, is generally 
 incurable without the adoption of a fleshless diet and 
 restoration of the normal function of the colon. 
 In many cases nothing else is needed to effect a 
 permanent cure. A few applications of the actinic 
 rays by means of the arc light or the "mercury light" 
 will generally cause the eruptions to disappear. 
 Apply the skin cream given on previous page. 
 
 Itching Skin without Eruption 
 
 Many constipated persons, especially old persons, 
 suffer from intense itching and burning of the skin, 
 especially of the back and other parts of the arms 
 and legs. The affection is generally worse in cold 
 weather and when hard water is used for baths. A 
 soap and water bath is generally followed by an 
 increase of the itching. If the skin is scratched, an 
 eruption resembling eczema appears. 
 
 Besides combatting the constipation nearly always 
 present, bathe the parts with water as hot as can be 
 borne (120° F.) several times daily. Avoid rub- 
 bing. After bathing, apply skin cream freely. The 
 cream should be applied to the whole surface of the 
 body after bathing and daily or even twice a day. 
 If necessary to completely relieve the itching, men- 
 thol may be added to the cream in the proportion 
 of ten grains to the ounce. 
 
TREATMENT OF DISORDERS 357 
 
 Vertigo 
 
 This unpleasant symptom is a very common result 
 of constipation. Vertigo is a common symptom in 
 cases of arteriosclerosis caused by constipation, and 
 sometimes results from irritation produced by the 
 presence of feces in the rectum. In certain nervous 
 persons, vertigo, faintness or exhaustion are some- 
 times experienced when the bowels are evacuated by 
 a saline laxative or by an enema. The cause of this 
 is doubtless the absorption of poisons brought into 
 solution by the large amount of fluid present in the 
 intestine. So long as the feces are hard, little absorp- 
 tion can take place. But when they become semi- 
 fluid, the poisons present are brought into solution 
 and are also made to come in contact with the 
 mucous membrane, so that rapid absorption occurs. 
 In some instances, the prostration is such that recov- 
 ery does not take place for several hours. These are 
 probably cases in which the liver and kidneys are 
 crippled as the result of long-standing disease. 
 
 Dr. Case has observed that unpleasant symptoms 
 immediately following an enema are connected with 
 the entrance of the injected liquid into the small 
 intestine through an incompetent ileocecal valve. 
 This is an interesting observation. It suggests that 
 vertigo at other times may be due to refluxed ma- 
 terial from the colon, due to antiperistaltic action of 
 the colon. The wretched feeling which many 
 neurasthenics experience in the morning may be 
 
358 COLON HYGIENE 
 
 due to the same cause. Case has observed that 
 although the small intestine may be entirely empty 
 at night, in the morning several feet of the intestine 
 may be filled with fecal matters which have returned 
 from the colon through an incompetent ileocecal 
 valve. 
 
 Disorders of the Urinary and Generative 
 Organs 
 
 Urinary troubles in both men and women, as well 
 as in children, are often traceable to constipation. 
 Very foul-smelling urine often owes its unnatural 
 odor to the presence of putrefaction poisons absorbed 
 from the intestine. 
 
 Both inability to urinate and a frequent desire to 
 urinate may result from the accumulation of feces 
 in the rectum. In children the escape of urine dur- 
 ing sleep is often due to constipation. 
 
 Prolapse and retroversion of the uterus is a com- 
 mon result of the straining necessitated by constipa- 
 tion in women and girls. 
 
 Dysmenorrhoea, leucorrhoea, and a varicose con- 
 dition of the broad ligaments, which is accompanied 
 by much pain and discomfort, may result from the 
 pressure of feces in the rectum and lower colon. 
 Nocturnal seminal losses and an abnormal irritabil- 
 ity of the parts, causing erection and also neuralgic 
 pains in the testicles, and varicose veins, may result 
 from the congestion caused by the pressure of feces 
 in the rectum and lower colon. 
 
TREATMENT OF DISORDERS 359 
 
 Fecal Fever 
 
 Accumulation of feces in the colon is a frequent 
 cause of attacks of fever which so much resemble 
 malarial paroxysms that they are usually treated by 
 the administration of quinine. There is often a 
 distinct chill, followed by fever and sweating. The 
 tongue is coated, the breath bad, and there is much 
 headache, and sometimes vomiting. The fever may 
 last several days, but disappears quickly when the 
 bowels have been thoroughly evacuated. 
 
 These attacks are very common in persons who 
 are subject to colitis, and much mucus is often dis- 
 charged when the bowels are cleared out. 
 
 Abdominal surgeons have constant occasion to 
 note the effect of fecal accumulations in raising the 
 temperature. A rise of temperature after operation 
 is more often due to this cause than to any other. 
 This fact led to the practice of thoroughly evacuat- 
 ing the bowels before operation, and early moving 
 them afterwards, an innovation introduced by the 
 late Dr. Lawson Tait, and which has been the means 
 of saving more lives than any other modern improve- 
 ment in surgery, except aseptic technic in operation. 
 
 Neglect to secure complete and regular evacuation 
 of the bowels is a frequent cause of rise of tempera- 
 ture after confinement and in convalescence from 
 acute illness. Accumulation of feces not infre- 
 quently occurs when the bowels move daily, and 
 even when the bowels are quite loose, as shown by 
 
360 COLON HYGIENE 
 
 the immense quantities of loathsome material which 
 may be washed out by means of a thorough enema. 
 The writer recalls a case in which a woman who 
 had very loose movements for two or three weeks 
 was found to have an enormous mass of hardened 
 fecal matter in the rectum, and a very great accumu- 
 lation of feces in the lower colon. 
 
 Bed patients should always be made to sit up 
 when moving the bowels or urinating, when this is 
 at all possible, so as to secure complete evacuation of 
 the urine and feces. In most cases this may be done 
 without injury after the second day. The same 
 remark applies with special interest to cases of con- 
 finement. There is so often an accumulation of feces 
 in the colon in pregnancy, especially within the last 
 two or three weeks before confinement, that it is 
 highly important to give the matter prompt atten- 
 tion at once after the child is born, as well as before 
 confinement. Very often a great quantity of putre- 
 fying material will be removed, the retention of 
 which may give rise to autointoxication with fever 
 and even worse symptoms. 
 
 Flatulency 
 
 This symptom may result either from the exces- 
 sive formation of gas in the intestine, or from the 
 accumulation of gas. A certain amount of gas is 
 natural. The presence of gas in the intestine is 
 an aid to peristalsis. This is especially true of 
 the large intestine. 
 
TREATMENT OF DISORDERS 361 
 
 Excessive formation of gas occurs through 
 the action of bacteria upon the food stuffs. Gas 
 is most readily formed from cooked starch or sugar, 
 but may be formed from cellulose and from pro- 
 tein. Odorless gas is usually formed from starch 
 or sugar, inflammable gas from cellulose, and gas 
 having a foul odor from protein. These different 
 elements of the food are acted upon by different 
 species of bacteria, so that the character of the gas 
 formed in the intestine becomes something of an 
 index to the sort of bacteria present. Bacteria 
 which act upon starch, sugar and cellulose are com- 
 paratively harmless while the presence of foul 
 smelling gases indicates the presence of putrefaction 
 and the pernicious bacteria and the virulent poisons 
 which are always present in this condition. 
 
 The formation of gas in excess is due primarily 
 not so much to the excessive use of starchy food, as 
 many persons suppose, but to stasis or stagnation 
 of the food. Bouchard showed long ago that if the 
 foodstuffs remain in one part of the alimentary 
 canal, even in the stomach, fermentation and other 
 bacterial changes take place. 
 
 An important remedy for flatulence, then, is in- 
 creased intestinal activity. When the gas is confined 
 to the colon an enema, either warm or cool, will 
 usually secure relief; for permanent relief the 
 causes of the constipation must be removed by sys- 
 tematic treatment. 
 
 Flatulence which is not relieved by emptying the 
 
362 COLON HYGIENE 
 
 colon is due to incompetency of the ileocecal valve. 
 The absence of the check valve at the junction of 
 the small intestine with the colon permits the gas 
 to pass back into the small intestine. This condition 
 is generally greatly mitigated by increased activity 
 of the bowels; a radical cure may be accomplished 
 by repairs of the ileocecal valve. 
 
 Flatulence may become dangerous in cases of high 
 blood pressure with degeneration of the blood ves- 
 sels. The great accumulation of gas in the intestines 
 forces the blood out of the abdominal vessels into 
 the general circulation, and so raises the blood 
 pressure. If the blood pressure is already high, and 
 the blood vessels seriously weakened, the rise of 
 pressure may be sufficient to cause a rupture and 
 apoplexy with paralysis, if the rupture occurs in the 
 brain. 
 
 The wet girdle or moist abdominal bandage is 
 often found a most efficient means of combating 
 flatulence. The bandage must be kept moist, and 
 should not be too warmly covered. The mackintosh 
 cover must be omitted, the purpose being to promote 
 evaporation and thus maintain a mild stimulant 
 action upon the intestine. The bandage will dry 
 out in three or four hours, when it should be 
 renewed. It may be worn with advantage 
 both night and day. The bandage must be changed 
 or boiled daily to avoid producing skin infection, 
 
 Flatulence in the colon always means stasis, that 
 is, delayed feces which need removal. Persons who 
 
TREATMENT OF DISORDERS 363 
 
 have been accustomed to a hearty meat diet some- 
 times suffer considerably from flatulence when a 
 change is made from meat to vegetables, but this 
 should not be considered as a need to return to a 
 highly nitrogenous diet. After a short time the 
 activity of the bowels will be increased to such a 
 degree that the constipation will be overcome, and 
 the flatulence will disappear. In cases in which the 
 free use of cereals or starch food is accompanied by 
 acidity of the stomach or heartburn soon after eating, 
 the difficulty may be relieved by increasing the 
 amount of fat taken with the meals. Usually one 
 or two tablespoonsful of olive oil taken at the be- 
 ginning of the meal will cause the disappearance 
 of this unpleasant symptom. 
 
 Foul Tongue and Bad Breath 
 
 These common conditions are more often due to 
 constipation than to neglect of the mouth. A high 
 protein diet, that is the free use of eggs and meats, 
 together with constipation even in very mild degree, 
 will cause coating of the tongue and a fecal odor 
 of the breath. The general low resistance caused 
 by chronic toxemia destroys the ability of the saliva 
 to prevent the growth of germs in the mouth and 
 the result is coating of the tongue, ulceration of the 
 gums and decay of the teeth. 
 
 The cure is not to be found in dentifrices, lotions, 
 tooth brushes or dental procedures, "mouth treat- 
 
364 COLON HYGIENE 
 
 ment," etc., but in removal of the cause by 
 draining the bowels through diet and other 
 measure, to move thoroughly three times daily. Of 
 course the toilet of the mouth and "mouth treat- 
 ment" by a skillful dental surgeon must not be 
 neglected. 
 
 A diet consisting exclusively of wheat bran and 
 fruit, preferably apples and oranges, continued for 
 three or four days will rapidly clear the tongue and 
 sweaten the breath in ordinary cases. Half a pound 
 of sterilized bran should be eaten daily and apples 
 may be eaten in any quantity which does not cause 
 inconvenience. Twelve to sixteen apples taken at 
 four meals will usually be found sufficient. The 
 fruit must be eaten raw and should be well chewed. 
 One or two apples or other fruit may be eaten 
 whenever a craving for food is felt. Fruit imposes 
 little or no labor upon the digesive organs. Berries, 
 grapes, peaches, oranges, melons, tomatoes, lettuce 
 cucumbers and celery may be added to the bill of 
 fare if desired. The greater the bulk and the less 
 the actual food value represented in the food the 
 better. 
 
 The addition of bran is necessary for the reason 
 that the tender cellulose of fruit is often almost 
 completely digested and so furnishes little residue. 
 
 The "milk regimen" conducted according to the 
 author's method (see pages 188-190), for one to 
 two weeks rarely fails to clear the tongue and to 
 remove the foul odor of the breath. 
 
TREATMENT OF DISORDERS 365 
 
 Hemorrhoids 
 
 The pain and inconvenience from hemorrhoids 
 is usually the result of infection. The distended 
 veins do little harm unless inflamed. The infection 
 results from the retention of fecal matter in the 
 folds of the mucous membrane. Straining at stool 
 distends the veins and cracks the mucous membrane, 
 thus opening up channels for infection. Abrasions 
 are also often produced by rough toilet paper and 
 by lack of care in the insertion of the enema tube. 
 Thorough cleansing of the parts with water after 
 bowel movement is an excellent preventive measure. 
 This is the universal custom in India and is certainly 
 more sanitary if less convenient than the method 
 in universal use in western countries. The use of 
 an antiseptic suppository after each bowel move- 
 ment is a most useful precaution. Suppositories 
 made of cocoa butter and containing two grains 
 each of tannic acid are most excellent for this 
 purpose. 
 
 When the bowels move freely three or four times 
 a day hemorrhoids are rarely troublesome, at least 
 when the precautions above recommended are em- 
 ployed. In many cases they apparently disappear. 
 When persistent however, they should be removed. 
 This may be done with perfect safety and with 
 so little inconvenience that no one who suffers from 
 hemorrhoids should hesitate to have them removed. 
 Chronic irritation is an invitation to cancer. 
 
366 COLON HYGIENE 
 
 Anal Fissure or Ulcer 
 
 This painful affection most generally follows 
 hemorrhoids. If it does not speedily disappear 
 when the bowels become regular, resort to operation 
 is necessary. Operation is also indicated when the 
 ulcer renders defecation painful and thus interferes 
 with regular bowel action, which is most generally 
 the case. 
 
 The operation need not be dreaded. The 
 modern methods of dealing with surgical cases of 
 this sort are entirely safe and nearly painless. 
 
 Anal Itching 
 
 This is usually a form of eczema which is kept 
 up by an irritating discharge from the rectum. The 
 measures recommended for eczema will effect a 
 speedy cure after the bowels have been regulated 
 and the rectal irritation or proctitis has been cured, 
 
 Rectal Prolapse 
 
 In cases of prolapse of the rectum frequent 
 movements of the bowels are necessarily avoided on 
 account of the inconvenience involved. Such cases 
 may be cured by a simple and safe surgical pro- 
 cedure. Such an operation should be the first step 
 in the effort to cure the chronic constipation present 
 After the operation, the free use of bran and paraffin 
 at each meal will prove efficient. 
 
TREATMENT OF DISORDERS 367 
 
 Anal Incontinence 
 
 Persons whose anal sphincters have been para- 
 lyzed by disease or by careless surgery often keep 
 the bowels constipated to avoid annoyance from in- 
 continence. In such cases it is of course necessary 
 first of all to remedy the anal defect. This may 
 usually be done by a skillful surgeon and the opera- 
 tion is attended by no serious risk. 
 
 Anal Spasm 
 
 Undue contraction of the anal sphincter is 
 generally associated with fissure, hemorrhoids or 
 rectal irritation. If not speedily relieved by removal 
 of the source of irritation the operation of stretching 
 the sphincter is necessary. Excessive tension of the 
 sphincter appears to be sometimes present without 
 evidence of local irritation. 
 
 Abdominal Tenderness 
 
 Very hot fomentations applied two or three times 
 a day for ten or fifteen minutes are almost a 
 sovereign remedy for the abdominal tenderness 
 usually found in chronically constipated persons, 
 especially when colitis is present. The moist ab- 
 dominal bandage used at night with a mackintosh 
 cover is a very old-fashioned and still unrivalled 
 remedy for tenderness, soreness and ill-defined pain 
 in the abdomen. These remedies are more than 
 
368 COLON HYGIENE 
 
 merely paliative, but of course are not in themselves 
 curative unless the constipation which gives rise to 
 the congestion of the sympathetic nerve centers, to 
 which the pain is due, is also cured by use of the 
 proper means. 
 
 Colic Pains 
 
 Apply very hot fomentations to the abdomen and 
 administer a hot enema. Repeat the applications 
 both of the fomentations and of the hot enema until 
 the pain ceases as it soon will do. Heat is a most 
 excellent antidote for pain. It also relaxes muscular 
 spasm; it is thus a most appropriate remedy for 
 intestinal colic. 
 
 "Kinks" 
 
 So much is being said about "kinks" in current 
 medical literature it is not remarkable that the laity 
 should begin to take an interest in the subject. The 
 writer's chief purpose in mentioning this subject 
 here is to emphasize the fact that "kinks" are of 
 far less consequence than was at first supposed. 
 X-ray evidence has demonstrated that kinks and 
 folds in the colon are seriously obstructive only in 
 very rare cases. To advise a surgical operation 
 simply because the X-ray shows a "kink" or fold 
 in the transverse colon or a very pronounced pro- 
 lapse is most improper. It has been proved that 
 the so-called "Lane's kink" of the terminal ileum 
 
TREATMENT OF DISORDERS 369 
 
 is seldom a source of trouble and very rarely re- 
 quires surgical interference. By the adoption of 
 an atoxic diet from which all animal protein is 
 excluded and by the employment of the necessary 
 measures for securing three bowel movements daily 
 the troubles supposed to arise from "kinks" rarely 
 fail to disappear; and without the adoption of these 
 measures surgery affords only temporary relief, 
 sometimes not even that, pts a return for the very 
 great risk to life and 'lie severe suffering and shock 
 involved in such operations as "short circuiting" 
 and removal of the colon. 
 
Bowel Habits of Uncivilized Man 
 
 Civilized human beings have departed so far from 
 natural primitive modes of life, and have adopted 
 so many unphysiologic practices, that it is quite 
 impossible from the conventional usages of civilized 
 people, to form any just conclusion of what are nat- 
 ural or biologic modes of life for human beings. 
 This is particularly true of customs and habits in re- 
 lation to human alimentation. From a study of the 
 modern hotel bill of fare one could not possibly 
 obtain even a suggestion of man's primitive and 
 biologic diet. The natural conclusion would be 
 that man is a universal feeder, since the average 
 hotel menu presents practically everything that any 
 animal eats; but biology teaches us that man is 
 naturally frugivorous, and science offers no reason 
 why he should have departed from his original bill 
 of fare, to which his nearest relatives, the anthro- 
 poid apes, the chimpanzee, the orangoutang and the 
 gorilla, living in their native forests, still scrup- 
 ulously adhere. 
 
 Man has not only developed wrong habits in 
 relation to the kind of food he eats, but has become 
 unbiologic in almost every phase of his daily life. 
 Constipation is simply one of the natural conse- 
 quences of these perversions. It is scarcely too much 
 to say that the average civilized man is the victim 
 of chronic constipation. If his bowels move once 
 
 370 
 
BOWEL HABITS OF UNCIVILIZED MAN 371 
 
 a day, or even once in two days, he feels that his 
 condition is very satisfactory; whereas Cannon, in 
 his work entitled "The Mechanical Factors of Di- 
 gestion," has shown that practically all the digestible 
 food taken at an ordinary meal is digested and 
 absorbed within eight or nine hours from the time 
 it is eaten, and the unuseable residue is at the end 
 of this period found deposited in the colon, ready 
 for ejection. Since the chief business of the colon 
 is to eject wastes from the body, why should the 
 performance of its function be so long delayed? 
 The colon contents are largely made up of bacteria 
 and excretory products, the undigestible elements 
 of the food constituting only about one-half its 
 bulk, while starch, fats, and protein are found in 
 only very small and negligible quantities. It should 
 be remembered that bowel movement is not simply 
 for the purpose of discharging the unuseable residues 
 of food. An equally essential reason for bowel 
 movement is the discharge of the bile and other 
 highly poisonous excretions which are discharged 
 into the colon from the blood. No possible good, but 
 only much harm, can come then from the prolonged 
 retention of these body wastes and unuseable resi- 
 dues. There is in fact no physiologic reason why 
 food residues should be retained in the body more 
 than twelve to eighteen hours, or at longest twenty- 
 four. It is evident, then, that bowel movements 
 should occur at frequent intervals, for the purpose 
 of removing these waste and poisonous materials. 
 
372 COLON HYGIENE 
 
 The natural intestinal rhythm, as has been 
 previously explained, provides for an unloading of 
 wastes by a bowel movement after each meal and 
 sometimes an additional one on rising. This requires 
 three or four bowel movements daily. Although 
 convinced by careful and extended observations in 
 dealing with many thousands of invalids, that the 
 bowels should be made to move several times a day, 
 the writer several years ago set about collecting 
 from original sources facts concerning the habits 
 of uncivilized tribes of human beings. 
 
 The keeper of the London Zoological Gardens, 
 informed the writer that the chimpanzee, orang, and 
 the other large apes move their bowels four times 
 daily with perfect regularity. Professor Hornaday, 
 superintendent of the Bronx Park informs us that 
 the large apes in the great collection under his super- 
 vision move their bowels three times a day. 
 
 Extensive inquiries made by means of a question- 
 aire sent out to physicians practising among primi- 
 tive people in various parts of the world, show that 
 the custom among many of those who live in a 
 really primitive state, and have been little influenced 
 by contact with civilization, is the same as that of 
 the higher apes. Replies were received from one 
 hundred and forty physicians who have had abun- 
 dant opportunity to become acquainted with the 
 habits and usages of the wild or half civilized people 
 with whom they have been closely associated, and 
 among whom they have practiced for years. A sum- 
 
BOWEL HABITS OF UNCIVILIZED MAN 373 
 
 mary of these replies will be found highly interest- 
 ing, especially in the light of the physiological facts 
 which have been presented in the previous pages. 
 It is most instructive to find wild and primitive 
 people in widely separated portions of the globe 
 following identical usages to which they have been 
 trained by Nature, the universal teacher. A com- 
 mon instinct has led to a practical uniformity of 
 habits among wild tribes who have not yet been 
 sophisticated and perverted by contact with civiliza- 
 tion. It is interesting also to note the same identity 
 between wild tribes and those most remarkable 
 creatures of the tropical wilds, the anthropoids, in 
 practices connected with eating and bowel action. 
 For much valuable and interesting information, a 
 small portion of which is summarized in this 
 chapter, I am indebted to scores of missionary phy- 
 sicians who have devoted their labors to the noble 
 work of civilizing and Christianizing the people of 
 heathen lands. 
 
 From the original and authentic information the 
 fact appears that among tribes which have been un- 
 influenced by the customs of civilization, who still 
 adhere to primitive habits in diet, and who live a 
 free and active life in the wild, the bowels move 
 two or three times daily. A single daily movement 
 is regarded by such people as constipation, and gives 
 rise to alarm. The one-movement-a-day habit ap- 
 pears only among those classes or castes who live 
 a sedentary life and have adopted unnatural habits 
 
374 COLON HYGIENE 
 
 in diet, such as the use of hot condiments, concen- 
 trated food, etc. The aristocratic classes of India 
 and China afford striking examples of this, suffering 
 much from constipation in consequence of their idle 
 and luxurious habits, and from the use of curries 
 and other unwholesome condiments, while the 
 working classes whose diet and habits are more 
 nearly normal: are generally exempt. 
 
 As regard the frequency of bowel movements, 
 physicians located in the following countries, re- 
 ported the usual custom to be two or more daily, 
 usually two, for the very good reason that two meals 
 only are eaten, the first movement being on rising, 
 or after the first meal, and the second soon after 
 the second meal, or before retiring: 
 
 Rhodesia, Uganda Protectorate, Nyassaland, Ni- 
 geria, Harda (India), Delhi (India), Punjab (In- 
 dia), Kashmir, Nagpur (India), Bawda (India), 
 Persia, — three or four times in summer when fruits 
 are plentiful. Aintab (Turkey), Harpoot (Tur- 
 key), West Coast of Africa, — two or three. Portu- 
 guese Congo, — two or three. Egypt, — children 
 four or five. Japan, Arabia, — two or three. 
 
 It is interesting to note that the experience of 
 the millions of primitive and half-civilized people 
 who inhabit the above named countries demonstrates 
 perfectly that an intake of food should be soon fol- 
 lowed by an output of food residues and wastes. 
 
 In all these countries, as among practically all 
 
BOWEL HABITS OF UNCIVILIZED MAN 375 
 
 primitive people, great attention is given to the 
 bowels. The mothers carefully train their children 
 to move their bowels at regular times, and much 
 pains is taken to make the diet such as to promote 
 intestinal activity. The virtues of fruits and green 
 vegetables are fully appreciated, and where rice 
 is the principal food, as in most of the Orient, large 
 use is made of green vegetables. S 
 
 It is especially of interest to note the frequency 
 with which some custom in relation to bowel hygiene 
 is found in vogue among primitive people who have 
 practiced it from time immemorial, while among 
 civilized people the same practice has only recently 
 become known as one of the discoveries of modern 
 medical science. It is becoming more and more 
 evident that our modern civilization in emerging 
 from barbarism has left behind much that was not 
 only useful but essential to a healthy physical life, 
 and we may therefore profit by a careful study of 
 the habits of primitive people and even of those wild 
 animal species which belong with man in the class 
 of primates, and are closely allied to the human 
 species in structure and function. 
 
 Here are a few extracts from the replies- to our 
 questionaire, which will be found most instructive 
 as well as interesting: 
 
 "I am of the opinion that diet has a great in- 
 fluence. The Labances eat plenty of figs, either 
 alone or mixed with juice of grapes or juice of carob 
 beans, brown bread, fruits, vegetables, olive oil, 
 
376 COLON HYGIENE 
 
 olives, etc., and drink plenty of spring water at 
 meal times." — A. J. Manasseh, M. D., Bruana, 
 Beyrout, Syria. 
 
 "Laxative foods used are the following: Cooked 
 manioc leaves, bananas, pineapples, bingondia (a 
 sour-sweet seedy fruit), plantains, peanuts, palm 
 oil, pumpkin seeds mashed and cooked. Raw guava 
 leaves are used for diarrhoea, also the clay mounds 
 built by white ants." — Mattie and P. Frederickson, 
 Belgian Congo, West Central Africa. 
 
 It is interesting to note that the most primitive 
 tribes of savages have recognized the importance of 
 regular and frequent bowel action and provided for 
 the maintenance of this important function by in- 
 cluding in their dietary special laxative foods such 
 as named above. This usage is practically universal 
 among wild tribes in all parts of the world. 
 
 "In the Cape Colony the staple food is stamped 
 maize and sour milk; the absence of the sour milk 
 leads to constipation. In the Northern Transvaal 
 the staple food is thick maize porridge, sour milk, 
 and, in summer, green vegetables. People go more 
 often (i. e., say three times a day) when taking 
 both vegetables and milk. When these are scarce, 
 they may go only once." — Neil Macvicar, M. D., 
 Lorendall, South Africa. 
 
 It is especially interesting to note that the Cape 
 Colony natives have by experience learned to ap- 
 preciate the value of sour milk as a laxative food 
 and corrective of intestinal disorders. Several Af- 
 
BOWEL HABITS OF UNCIVILIZED MAN 377 
 
 rican travelers have called attention to the fact that 
 among the native tribes of Africa milk is generally 
 used in the soured state. The custom is to put the 
 milk into a gourd at night which is reserved for 
 this particular purpose. In the morning the milk 
 is soured and ready for use. At night a new sup- 
 ply of milk is put into the empty gourd which is 
 never washed and so preserves the lactic-acid-form- 
 ing ferment in an active state. 
 
 "The natives are, in Toro, almost entirely vege- 
 tarians, living on millet or plantains or beans. 
 They rarely get meat. In 9642 out-patients seen 
 during the last seven months of 1911, there were 
 174 cases of constipation, one and eight-tenths per 
 cent of the. whole." — J. Howard Cook, M. D., 
 Uganda Protectorate, East Africa. 
 
 In this country the percentage of patients in 
 whom constipation is present is just the reverse of 
 that in Uganda. Whereas in Uganda there are 
 less than two per cent who are constipated, in civ- 
 ilized countries among sick people there is scarcely 
 one in a hundred who is not constipated. 
 
 "The rather coarse diet, largely grains and vege- 
 tables, has a favorable influence on the bowel move- 
 ments. The stools are usually very large and fairly 
 soft."— A. H. Norton, M. D., Haiju, Korea. 
 
 "The people eat large quantities of rice, turnips, 
 peppers, roots, vegetables and little meat. The 
 large quantity of residue must act as a stimulus to 
 peristalsis." — W. C. Purviance, M. D., Chung Ju, 
 Korea. 
 
378 COLON HYGIENE 
 
 " Cereals, as wheat, barley, oats, millet seed, and 
 all kinds of vegetables, are the staple food here 
 (extreme north of Korea) ; very little fish and lass 
 meat is eaten." — F. H. Birdmann, M. D., Dotson, 
 Korea. 
 
 The natives of Korea like those of China and 
 Japan are generally known as rice eaters. It is in- 
 teresting to note that the natives of Korea make 
 large use of turnips and vegetables and little use of 
 meat. Flesh foods are unquestionably constipating 
 in their nature, not only because they are completely 
 digestible, leaving little residue behind, but because 
 the putrefaction to which they give rise results in 
 the formation of ammonia and other alkaline sub- 
 stances which paralyze the bowel. "Meat bacteria" 
 which swarm in all kinds of flesh foods are also a 
 prolific cause of colitis, which by causing spastic 
 contraction of the descending colon and the pelvic 
 colon, produces mechanical obstruction to bowel 
 movement, and also as shown by Dr. J. T. Case, 
 induces powerful retro-peristaltic contractions by 
 which the intestinal contents are forced back into 
 the right half of the colon. The cecum and as- 
 cending colon become greatly dilated as a result, 
 and in time the cecum becomes movable and pro- 
 lapsed. The stretching of the colon enlarges the 
 ileocolic junction until the ileocecal valve becomes 
 incompetent, thus establishing the condition known 
 as intestinal toxemia with its long train of evil con- 
 sequences. The vegetarian habits of the people of 
 Korea are without doubt of great service to them 
 
 \ 
 
BOWEL HABITS OF UNCIVILIZED MAN 379 
 
 in enabling them to successfully combat the highly- 
 unsanitary conditions under which they live. 
 
 "Bowel movement full and frequent among the 
 working people, who eat large quantities of vege- 
 tables ; more disturbed among the better classes, who 
 eat more meat." — J. K. Cox, M. D., West China. 
 
 "My experience with patients has been that they 
 are not so subject to constipation as persons in the 
 U. S. whom I have treated. Think probably the 
 free use of greens and other vegetables has some- 
 thing to do with the difference, as well as not post- 
 poning the call of Nature, as is done by civilized 
 persons."— Ida M. Scott, M. D., Tak Hink Chan, 
 South China. 
 
 "The vast majority of the people live on coarse 
 grains and coarse vegetables, which are favorable 
 to large bowel movements." — Geo. D. Lowry, 
 M. D., Peking, China. 
 
 "In my own case, going onto a purely local diet 
 of rice and coarse vegetables is usually accompanied 
 with looser motions." — George Hadden, M. D., 
 Yung-an Fookin Pwo., China. 
 
 "Rice is the principal diet, but is usually accom- 
 panied by considerable quantities of vegetables, 
 largely what we call greens. The Chinese have a 
 great variety of leaves and stocks that are used for 
 greens, such as cabbage, lettuce, and many other 
 kinds that we do not see in America. With this 
 diet and exercise, the healthy Chinaman usually has 
 free bowel action. I think the 'greens' is a very 
 
380 COLON HYGIENE 
 
 suitable diet for this climate." — Jean McBurney, 
 M. D., Cheung Chow, Hong Kong, China. 
 
 "Foods coarse, and largely vegetable, especially 
 among the country people, which means four-fifths 
 of the population. Chinese are not meat eaters to 
 a great extent." — F. F. Tucker, M. D., Pangkiach- 
 wang, Shantung, China. 
 
 "The natives eat much vegetables, which regu- 
 late the bowels." — Cecil I. Davenport, M. D., 
 Shanghai, China. 
 
 The people of China as well as those of Korea 
 are evidently protected from the natural constipat- 
 ing tendency of a rice diet by the free use of coarse 
 vegetables. The large use of vegetables of all sorts 
 which is practiced in the Orient is generally for- 
 gotten by those who call attention to the fact that 
 rice is the staple foodstuff in this part of the world. 
 It is true that rice is the chief source of nutriment 
 but at the same time nature has taught these people 
 to make ample provision for the bulk which is es- 
 sentially to stimulate normal peristalsis by the use 
 of greens and vegetables of all sorts. Vegetables 
 are used not only during the summer months but 
 at other seasons also. Turnips and several other 
 roots are preserved by pickling in salt brine as cu- 
 cumbers are preserved in this country. A very large 
 use is also made of bamboo sprouts, of the leaves 
 and roots of certain lilies which are preserved by 
 drying and of several varieties of seaweed, from 
 some of which a gelatinous substance known as Jap- 
 anese isinglass or agar-agar is made while others 
 
BOWEL HABITS OF UNCIVILIZED MAN 381 
 
 are used in their native state as Iceland moss and 
 Irish moss are used in this country. 
 
 "The natives note that in eating pumpkins and 
 prunes they have more bowel movements. An old 
 man told me that if a person, early in the morning 
 before taking any food, eats ten fresh prunes from 
 the tree, hell have bowel movements easily." — G. 
 Yeram, M. D., Gumaldjine, Turkey. 
 
 The most primitive people have learned by ob- 
 servation the importance of bulk, a lesson which has 
 yet to be learned by the great majority of people in 
 civilized lands. Knowledge of the laxative value 
 of fruits, especially of prunes is, however, quite 
 widely diffused. The Turkish peasant who told 
 our friend Dr. Yeram that ten fresh prunes taken 
 from a tree would produce a laxative effect was 
 perhaps not aware however, that dried prunes may 
 be so freshened by soaking in cold water for 24 
 hours that their laxative quality is to a large ex- 
 tent restored. The free use of raw soaked prunes 
 is a highly valuable food remedy for constipation 
 which has long been in use by many European and 
 American physicians. 
 
 "The principal food of both city and rural popu- 
 lation of the region is boolghoor (cracked wheat, 
 which has been cooked, dried, and the thin outer 
 skin removed before cracking. It is cooked in many 
 ways. The commonest is to boil it about ten min- 
 utes, and add a little melted butter before serving), 
 and coarse bread of wheat or barley, varied by len- 
 tils and other legumes, and the fermented milk of 
 
382 COLON HYGIENE 
 
 the country (yougurt in Turkish, leben in Arabic, 
 or matzoon in Armenian). The village people eat 
 considerable fruit, especially grapes in season, but 
 very little meat or vegetables. The city dwellers 
 eat a good deal of meat and vegetables, more fruit, 
 and less youghurt than the villagers. They also 
 eat finer bread and more spices and condiments. In 
 general, I may say that constipation is relatively 
 much less common than in America, and much less 
 common among the villagers than the city people; 
 in fact, very seldom seen in those who eat boolghoor. 
 The posture assumed in defecation may also have 
 something to do with it. They never sit on a stool, 
 but always use the natural, squatting posture. In 
 the city, where they have regular privies, the ar- 
 rangement is a slit or opening in the floor, over 
 which the person squats. The universal habit is to 
 move the bowels three times a day." — F. D. Shep- 
 ard, M. D., Aintab, Turkey. 
 
 The above interesting account of the dietetic hab- 
 its of the people of Turkey kindly sent us by the 
 late Dr. Shepard contains enough practical hints 
 about dietetic methods of combating constipation to 
 enable almost any practical person to formulate for 
 himself an efficient and laxative dietary. It is evi- 
 dent that however much we may be in advance of 
 the ignorant Turkish peasant in the various forms 
 of culture which together make up what we call 
 civilization, we may study his methods in diet with 
 great profit. 
 
 The matter of the position in sitting at stool to 
 
BOWEL HABITS OF UNCIVILIZED MAN 383 
 
 which Dr. Shepard also called attention is one of 
 no small importance. We are learning more and 
 more the importance of making a careful note of 
 the hints which nature gives us in the instinctive 
 leadings of animals and human beings living in a 
 wild or primitive state which have resulted in the 
 formation of customs and habits, the essential re- 
 lation of which to our physical welfare has been 
 heretofore too much disregarded. 
 
 In all parts of Turkey, it is the custom of the 
 people to move the bowels three times daily which 
 is the natural result of the use from early child- 
 hood of the several laxative foods above mentioned. 
 Of this we are assured by a personal statement made 
 to the writer by the late Dr. Shepard who was 
 most intimately acquainted with the habits of the 
 Turkish people through living and practicing among 
 them for more than thirty years. That the custom 
 of tri-daily bowel movement is common to all 
 classes is shown by an incident related to the writer 
 by the eminent Sir Arbuthnot Lane of London, 
 England. The famous surgeon was one day con- 
 sulted by an official from the Turkish Embassy in 
 London who desired relief from constipation. When 
 asked for a particular account of his symptoms he 
 admitted that his bowels moved once a day but 
 declared that he was greatly constipated and not 
 half a man, and that when his bowels moved three 
 times a day his vitality and stamina were more than 
 doubled. 
 
 "Yoghurt is the form in which milk is taken 
 
384 COLON HYGIENE 
 
 in Persia. We rarely see appendicitis in the natives. 
 I often wonder whether the yoghurt may be the 
 preventive. The common people live on yoghurt, 
 cheese, bread, and fruit. Meat only occasionally. 
 They all consider milk (not yoghurt) a laxative, 
 and so it seems to be for the natives." — W. S. 
 Vaunemann, M. D., Labriz, Persia. 
 
 It is certainly very interesting to note that the 
 custom of using sour milk should be nearly uni- 
 versal among the hundreds of different tribes and 
 nations filling the vast territory from the southern 
 tip of the dark continent to Persia. It is also in- 
 teresting to observe a verification of the observa- 
 tions made some years ago by Dr. Senn who studied 
 the people of the east coast of Africa and noted the 
 absence of appendicitis, an observation also con- 
 firmed by Dr. Lucus-Champonniere of France, who 
 found appendicitis very rare among the wheat- and 
 date-eating Arabs of Algiers, and among the inmates 
 of prisons and insane asylums in France where meat 
 is rarely made a part of the bill of fare. 
 
 "The diet seems to favor looseness, since it con- 
 sists largely of coarse bread from unbolted flour; 
 also in summer of large quantities of fruit in- 
 gested." — J. A. Funk, M. D., Hamadan, Persia. 
 
 The use of superfine white flour appears to be 
 almost wholly confined to civilized nations and 
 there can be no doubt that to this practice is largely 
 chargeable the almost universal prevalence of con- 
 stipation in countries which claim to be the most 
 advanced in civilization. 
 
BOWEL HABITS OF UNCIVILIZED MAN 385 
 
 "It is a common saying among them that milk 
 acts as a laxative, especially if freshly milked and 
 unboiled." — P. W. Brigstocke, M. D., Jerusalem, 
 Palestine. 
 
 The fact that boiled milk is constipating has long 
 been recognized in this and other civilized countries. 
 It appears that the same fact is known to the un- 
 educated natives of Syria. It is only recently that 
 science has offered the explanation which has been 
 supplied by the bacteriological laboratory that boiled 
 milk undergoes putrefaction in the intestine because 
 of the destruction of the acid-forming bacteria which 
 abound in raw milk which has been exposed to the 
 air, and stimulate bowel action and prevent putre- 
 faction. 
 
 "The diet is largely a vegetable and cereal one, 
 meat being eaten only occasionally." — A. F. Grant 
 M. D., Assiut, Egypt. 
 
 It is instructive to note that the Egyptians are 
 still as in ancient times practically non-flesh eaters. 
 The experience of two or three thousand years has 
 not convinced these simple tillers of the soil that 
 the natural products of the earth are not capable 
 of affording ample and sufficient nourishment. The 
 fertile valley of the Nile in centuries far remote 
 from the present supported a population perhaps 
 more dense than has been' maintained in any other 
 part of the world. It may be that some future time 
 will again see this highly favored region teeming 
 with human life and enterprise, supported as of old 
 by the products of its marvelously fertile soil. 
 
386 COLON HYGIENE 
 
 "The coarse simple diet — millet or corn porridge 
 or bread, cabbage, soup, etc. — of the country seems 
 to favor regularity of the bowels." — Mrs. Estella 
 A. Perkins, M. D., Pao Ting, China. 
 
 "The almost exclusive vegetable diet — rice, cab- 
 bage, etc., — seems on the whole to be favorable, and 
 constipation is not so common among the sedentary 
 classes as might be expected." — B. S. Browne, 
 M. D., Ningpo, China. 
 
 "Constipation is not common, but the inhabitants 
 of Manchuria are mostly vegetarians, i. e., eat little 
 butcher meat except on festive occasions." — Drs. 
 Christie and Muir, Mukden. 
 
 "People suffering from diarrhoea frequently take 
 rice and 'dahi' (curds, sour milk), to check it. 
 Ordinary milk they generally consider constipat- 
 ing." — N. C. Henderson, M. D., India. 
 
 A specimen of dahi sent us by a friend from 
 Darjeling was found to be practically identical with 
 the yoghourth of Bulgaria, the matzoon of Armenia 
 and the leben of Egypt. The so-called Bacillus 
 Bulgaricus is apparently the active acid producer 
 in all these fermented milks. The strain obtained 
 from dahi appeared to be particularly active, grow- 
 ing with much vigor and producing lactic acid very 
 freely. 
 
 "People eat wheat, Indian corn, and millet seed 
 breads. The first named is supposed to be consti- 
 pating, and the last two laxative." — W. L. Pennell, 
 M. D., Bannu, India. 
 
 "The coarse wheat and barlev flour used for 
 
BOWEL HABITS OF UNCIVILIZED MAN 387 
 
 their bread is, without doubt, favorable to regu- 
 larity." — Edna B. Kuslar, M. D., Phalera, India. 
 
 It is probably not known to most civilized peo- 
 ple that wheat as well as rice is very largely used 
 in India. England annually obtains enormous 
 quantities of wheat from her Indian provinces the 
 price of which is such that the Hindu peasant finds 
 it necessary to make rice his staple, although con- 
 siderable quantities of wheat bread are used by the 
 wealthier classes. It is interesting to note, however, 
 that the wheat thus used by the natives is chiefly 
 employed in the state of coarse meal, rather than 
 the fine bolted flour from which two most impor- 
 tant elements, cellulose and vitamines, have been 
 removed by the milling process. 
 
 "Usual diet of rice with green vegetables, lentils 
 or occasionally meat, favors regular motions. Boiled 
 radishes favor diarrhoea, and fish favors constipa- 
 tion." — Dr. Minnie Gomery, Idlamabad, Kashmir. 
 
 "Diet, rice and vegetables, rarely meat?. Rice is 
 eaten in great excess. People pass large stools, as 
 a lot of rice is ejected. Presumably nitrogen and 
 salts are used up and starch excreted." — H. E. 
 Rawlence, M. D., Srueagai, Kashmir, India. 
 
 Even remote Kashmir, which has been so little 
 in touch with modern civilization, appears to be 
 really up to date in matters dietetic. Meat is only 
 used occasionally, whereas green vegetables and 
 lentils combined with rice constitute the regular 
 dietary. 
 
 The passing of quantities of undigested rice is 
 
388 COLON HYGIENE 
 
 doubtless due to the fact that the rice is imperfectly 
 cooked, a custom very common in rice-eating coun- 
 tries, and perhaps a wholesome one. The Scotch 
 highlander eats his oatmeal less than half cooked 
 and is wonderfully sturdy. Some undigested starch 
 in the feces prevents putrefaction. 
 
 The diet being chiefly vegetarian (among the 
 Hindus it is so entirely), the large amount of vege- 
 tables taken seems to act as the necessary stimulus 
 to the bowel." — Robert Madison, M. D., Rajshalu, 
 India. 
 
 "Diet of the people mostly fruit and vegetable. 
 Have found that when fruit and salad oil could be 
 added, tongues are clean, moist and red. Where 
 the white bread is taken in imitation of the for- 
 eigner, troubles begin similar to those at home. The 
 national custom is to eat but two meals a day." — 
 Belle J. Allen, M. D., Baroda Camp, India. 
 
 The observation made by Dr. Allen, that the 
 natives of India begin to suffer from constipation 
 when they adopt the use of white bread, though 
 previously free from this curse of civilization, is 
 highly instructive. It is interesting to note that 
 the U. S. Agricultural Department is making a 
 strong effort to bring to the notice of the American 
 the importance of using the whole grain instead of 
 discarding the outer portion or bran which is now 
 known to contain by far the largest share of the 
 lime essential for perfect nutrition as well as the 
 highly essential vitamines. It is also interesting to 
 note that though the native of India as well as of 
 
BOWEL HABITS OF UNCIVILIZED MAN 389 
 
 most other countries of the globe eat but two meals 
 a day, the prevailing bowel habit among these peo- 
 ple is two or three movements daily. More fre- 
 quent meals should give rise to more frequent move- 
 ments and would doubtless produce this effect in 
 this and most civilized countries were it not for the 
 highly concentrated and highly constipating char- 
 acter of the diet. 
 
 "Motions are large, bulky and not formed, but 
 pultaceous. People of these parts eat largely of 
 ground wheat and vegetables, not much meat. Hin- 
 dus seldom eat flesh." — A. H. Browne, M. D., Am- 
 ristsar, India. 
 
 "Meat tends to constipate; vegetables and milk 
 tend to loosen."— M. M. Brown, M. D., Sargodha, 
 Punjab, India. 
 
 Dr. Brown as well as other close observers of the 
 relation of diet to health among people of simple 
 habits notes the effects of a meat diet in producing 
 constipation. The reason for this as indicated else- 
 where is that a meat diet produces colitis and in- 
 testinal putrefaction. 
 
 "People coming from the interior are much more 
 regular than those living in Smyrna, where more 
 meat is eaten than in the interior. After some time 
 in Smyrna, such people tend to become less regular." 
 — D. McKenzie Newton, M. D., Smyrna. 
 
 "The use of peanuts in all forms, and the eating 
 of cooked green leaves of several kinds, used daily 
 keeps their bowels in good shape." — A. Sims Roma, 
 M. D., Ferrovia, Italy. 
 
390 COLON HYGIENE 
 
 "On the ordinary native diet there is scarcely 
 ever any constipation. On other diet, occasionally." 
 — E. MacKenzie, M. D., Hog Harbor, Santo, New 
 Hebrides. 
 
 Rare Occurrence of Cancer and Appendi- 
 citis Among Primitive Tribes 
 
 It is the universal testimony that cancer and ap- 
 pendicitis are extremely rare. Doctor Shepard, of 
 Aintab, Turkey, who has had an enormous practice 
 among the Turks for more than a quarter century, 
 and is perhaps recognized as the leading abdominal 
 surgeon of the Orient, writes: 
 
 "There is relatively very little appendicitis here. 
 I do from 500 to 600 important surgical operations 
 a year, but only six to eight appendectomies. Can- 
 cer of the intestinal tract is quite rare (as are all 
 forms of cancer), although ulcer of the stomach is 
 common." 
 
 Dr . W. W. Peter, of Shanghai, says, "I never 
 heard of appendicitis in a Chinaman." 
 
 The fact that cancer is a disease peculiar to ad- 
 vanced civilization is clearly shown by the replies 
 received from one hundred and twelve physicians 
 located in the following countries: Mexico, Pales- 
 tine, Arabia, Turkey, Egypt, South Africa, East 
 Africa, Central Africa, Nigeria, Japan, Syria, Ko- 
 rea, Persia, Siam, India, Asia Minor, New Hebri- 
 des. Forty-three of the one hundred and twelve 
 reported that they had never seen cancer of the 
 bowels. Nine physicians from different parts of 
 
BOWEL HABITS OF UNCIVILIZED MAN 391 
 
 Africa, the west coast, Tunis, Nigeria, Rhodesia, 
 Uganda, East Africa, British Central Africa, the 
 Portuguese Congo and Belgian Congo all report 
 having never seen a case of cancer of the bowels 
 among the natives. 
 
 Primitive Remedies for Constipation 
 
 The following extracts from replies to our ques- 
 tionaire illustrate the habits of people in relation 
 to bowel movements and the simple but often highly 
 sensible methods employed by them for relief: 
 
 "The chief duty of the Indleburds, or priestly 
 caste, is the care of such matters (the movement 
 of the bowels). A fine is levied in case of neglect." 
 —P. N. Darling, M. D., India. 
 
 The observation of Dr. Darling that one of the 
 duties of the priest in India is to educate the people 
 in reference to the proper care of the bowels is 
 highly suggestive. In this country, the subject of 
 bowel hygiene has been so universally neglected that 
 even parents are quite ignorant concerning the bowel 
 habits of their children and often allow them to 
 drift into diseased conditions, the evil effects of 
 which are felt throughout their entire lifetime. 
 Physical, mental and moral evils resulting from 
 constipation are so great that it is not an exaggera- 
 tion to say that teachers as well as preachers could 
 not make a better use of a portion of their time 
 and talents than by the education and training of 
 the children in the proper care of the colon. 
 
 "The natives give prompt attention to the bowels. 
 
392 COLON HYGIENE 
 
 I have again and again had it given me as a reason 
 for not living in Aden, that people had there to go 
 to the closet in order to evacuate their bowels, 
 rather than relieve themselves any place, as this was 
 only permitted for children." — John C. Young, 
 M. D., Sheikh Othman, Aden. 
 
 The above observation by Dr. Young affords 
 powerful testimony to the importance attached by 
 the Arabs to the prompt response to the call of 
 nature for evacuation of the bowels. 
 
 Dr. Davidson of Travancore, India, says: "Ap- 
 pendicitis very rare here. Only about six cases out 
 of at least 1,000 major operations." 
 
 Dr. Davidson's experience in meeting only six 
 cases of appendicitis among a thousand major op- 
 erations is striking evidence of the rarity with which 
 appendicitis occurs among non-flesh eating people. 
 This observation agrees with that of Dr. Senn who 
 noted the absence of appendicitis among the vege- 
 table-eating natives of the east coast of Africa. An 
 examination of the annual report of the Mayo 
 Clinic shows 19 per cent of all cases examined to 
 be suffering from appendicitis, and at operation the 
 appendix was found diseased and requiring re- 
 moval in 21 per cent of all cases operated, whereas, 
 Dr. Davidson found in India only six tenths of 
 one per cent, a frequency thirty-five times less. 
 
 "No instruments used; people generally boil mo- 
 lasses (not maple, but grape juice) and common 
 salt together to the consistency of wax, and make 
 
BOWEL HABITS OF UNCIVILIZED MAN 393 
 
 suppositories to apply per rectum." — S. C. Kaval- 
 gian, M. D., Ada Pazar, Asia Minor, Turkey. 
 
 "In cases of constipation or obstruction, very 
 forcible measures are employed, such as massage, 
 kneading the abdominal wall and exerting pressure 
 upon the abdomen, and even kicking." — E. Mar- 
 garet Phillips, M. D., Ping Yin, China. 
 
 "Brown sugar is the laxative usually relied 
 upon."— Walter W. Williams, M. D., Yung-an 
 Fookin Pwo., China. 
 
 The above observations in China and Turkey 
 show the sagacity of primitive people in discovering 
 simple food remedies for constipation. When taken 
 in large quantities, sugar produces laxative effects, 
 not only because of its specific stimulating effect 
 upon the intestine but because of the stimulating 
 effect of the lactic acid produced by the fermenta- 
 tion of the sugar in the colon. 
 
 "For relief of constipation a sort of large rolling 
 pin is freely rolled up and down the abdomen while 
 the patient is lying supine." — H. G. Barrie, M. D., 
 Kuling, China. 
 
 The use of the rolling pin as a means of reliev- 
 ing constipation is an original Chinese invention, 
 although a cannon ball as well as various kinds of 
 apparatus have been long in use in this country as 
 a means of mechanically stimulating the bowels to 
 activity. 
 
 "They use a smooth stalk of millet to stimulate 
 the lower bowel." — Elizabeth Beatty, M. D., 
 Kwangning, Manchuria, China. 
 
394 COLON HYGIENE 
 
 Mechanical stimulation of the rectum has long 
 been known to be a powerful means of exciting 
 peristalsis, but the method is not to be recom- 
 mended because of the danger of producing in- 
 flammation and infection of the rectum, the result 
 of which might lead to hemorrhoids, fissure or ab- 
 scess, inducing fistula. 
 
 "A very crude method for giving an enema is 
 to take a small slender piece of bamboo for a nozzle 
 and a bag made of pig gut, and use it as a syringe." 
 —William M. Berss, M. D., Chenchow, South 
 Hunan, China. 
 
 "They have no instruments, but often use honey 
 suppositories." — W. H. Park, M. D., Soochow, 
 China. 
 
 "They have a funnel-shaped enema which is be- 
 ing displaced by European bulb syringes." — J. Da- 
 vidson Frazier, M. D., Resht, Persia. 
 
 "The people have few or no remedies, save the 
 drinking of a large quantity of hot water, which 
 they often do when conscious of the need, and with 
 quite good effect." — H. W. Schwartz, M. D., 
 Yokohama, Japan. 
 
 "Massage is employed ; drugs very rarely." — 
 Walter Virden, M. D., Rhodesia, South Africa. 
 
 "Enemata given in the knee-elbow position with 
 a funnel made of a leaf, and a pipe made of a 
 gourd or vegetable stump." — J. Howard Cook, 
 M. D., Fort Portal, Uganda Protectorate, East 
 Africa. 
 
 It is interesting to note that even the mem- 
 
BOWEL HABITS OF UNCIVILIZED MAN 393 
 
 bers of savage tribes are acquainted with the value 
 of the enema and have been able to improvise 
 means for the getting of water into the bowels. 
 Some of the means employed are like the above 
 very highly ingenious. It is also interesting to 
 learn from the observations of Dr. Cook of the 
 employment of the knee-elbow position by the na- 
 tives of Uganda. The credit for the invention of 
 the knee-elbow position has been given to an Amer- 
 ican physician. It seems, however, that in this 
 particular civilized people are as in many other 
 ways in matters pertaining to physical welfare, 
 easily outdone by the natives of many primitive 
 tribes. 
 
 "Roots are sometimes cooked in water and given 
 as an enema by means of an ox horn with perforated 
 end — large quantity poured in. In the Northern 
 Transvaal purgatives are not required. Enema ap- 
 pliances not known." — Neil Macvicar, M. D., 
 Lorendall, South Africa. 
 
 "The natives regularly use enemata, introduced 
 with gourds." — D. Robertson, M. D., Itu, South 
 Nigeria. 
 
 "They have medicines for use as purgatives, and 
 also use enemas, which are administered by means 
 of a sort of gourd with long neck. The gourd is 
 filled, and the water flows in by gravitation. The 
 patient lies prone." — E. C. Sirley, M. D., W. Coast 
 of Africa. 
 
 "The use of common soap passed up into the anus 
 or some similar substance is often used by the na- 
 
396 COLON HYGIENE 
 
 tives of this country to overcome constipation." — 
 W. O. Ballantine, M. D., Rahuri, Western India. 
 
 "Soap suppositories is a common native remedy; 
 enemas are never used; they consider it shameful. 
 Massage of the abdominal wall is practiced, too." — 
 R. T. H. Cox, M. D., Persawan, N. India. 
 
 The Hindu mother knows the value of the sup- 
 pository as a remedy for infants as well as does the 
 American mother. Experience is a wonderful 
 teacher and in this school the most ignorant savage 
 mother has just as good an opportunity to learn 
 and make advancement as the mother of the most 
 highly civilized land. 
 
 "A smack in the stomach with a colo spade is 
 often used, and is invariably productive of a profuse 
 and continued motion. Some of the hill tribes carry 
 under the left arm pit finely engraved brass tongs 
 for the purpose of extracting in their entirety the 
 masses of fecal matter. These are shaped by the 
 women of the tribe, and are used in their war 
 catapults in tribal warfare." — P. N. Darling, M. 
 D., India. 
 
 This drastic method of stimulating bowel action 
 may sometimes produce injury, but could not pos- 
 sibly be more productive of mischief than is the 
 common, almost universal, use in all' civilized coun- 
 tries of laxative mineral waters and drastic cathar- 
 tic remedies of all sorts. 
 
 "The population generally deal largely in drastic 
 purgatives. A man will take a month's leave from 
 work for nothing more than a course of purgation, 
 
BOWEL HABITS OF UNCIVILIZED MAN 397 
 
 often very severe." — F. V. Thomas, M. D., Palwal, 
 near Delphi, India. 
 
 This method of dealing with constipation could 
 scarcely be more injurious than the continued use 
 of stomach and colon irritating drugs. As Von 
 Noorden well says, "nothing is so bad as the 
 chronic use of laxative drugs." 
 
 "The native position, squatting at stool, with 
 front of thigh against the abdomen, encourages 
 evacuations." — W. J. Maule, M. D., Miraj, India. 
 
 The squatting position in moving the bowels ap- 
 pears to be universal among all people with the 
 exception of those who call themselves civilized. 
 It is singular indeed that in relation to this most 
 important function of the body the wildest and most 
 unsophisticated natives are really in advance of the 
 most highly civilized people. The value of the 
 squatting position as a means of relieving the bowels 
 has been recognized for years but the knowledge 
 has had little influence upon the habits of the peo- 
 ple in this particular. It is pointed out elsewhere 
 in this work how the objectionable features of the 
 ordinary closet seat may be overcome by elevating 
 the feet upon a stool eight or ten inches high placed 
 in front of the closet seat. 
 
 "The position in which the native helps his ex- 
 pulsion of feces from colon and rectum is this: he 
 sits on his haunches and presses the left side of the 
 lower abdomen with the hand or a bunch of cloth." 
 — T. Davidson, M, D., South Travancore, South 
 India. 
 
398 COLON HYGIENE 
 
 The practice above referred to by Dr. Davidson 
 is interesting evidence of the East Indian's capacity 
 for intelligent observation. The descending colon 
 and pelvic colon are located in the lower left side 
 of the abdomen and pressure just at this point may 
 be of the greatest value in aiding evacuation of the 
 bowels. The writer has for many years recom- 
 mended patients to assist themselves when neces- 
 sary by pressing firmly with the closed fist or with 
 both fists upon the left side of the lower abdomen. 
 Deep pressure made at this point will often arouse 
 the lower bowel to immediate action, causing in- 
 stantaneous expulsion of gas and in many cases 
 within a few seconds a large evacuation of retained 
 fecal matters. The use of a bunch of cloth for the 
 purpose of increasing the pressure is an original in- 
 vention of the East Indian and is highly suggestive. 
 A patient recently reported to the writer the dis- 
 covery that a newspaper folded into a round mass 
 serves an excellent purpose for making compression 
 over the pelvic colon. 
 
 "The use of a piece of oiled soap is common, 
 which may have been learned from the English; 
 an oiled rag is used, too." — A Missionary Physi- 
 cian of India. 
 
 For more than thirty years the writer has made 
 occasional use of an oiled ball of cotton or of a 
 cheese cloth pledget saturated with oil and placed 
 in the rectum at night as a means of combating cer- 
 tain forms of constipation. The results have been 
 very excellent. Saturation of the pledget with a 
 
BOWEL HABITS OF UNCIVILIZED MAN 399 
 
 culture of the Bacillus Bulgaricus is still more ef- 
 fective in some cases. 
 
 "The chief practice is the habit of squatting at 
 stool. Have had patients leave the Hospital be- 
 cause they could not have a normal movement with- 
 out their own kind of commode. Complaints ceased 
 with a native place provided." — Belle J. Allen, 
 M. D., Baroda Camp, P. O., India. 
 
 An opening in the floor over which the user 
 squats is the provision made for bowel evacuation 
 in many parts of France, as well as in Oriental 
 countries. Even in Paris, as recently as twenty 
 years ago, the, writer found this arrangement in use 
 in the small hotels of the suburbs of the city. It 
 is interesting to note that Dr. Allen's patients were 
 willing to forego the advantages of hospital care 
 rather than suffer the serious consequences of dis- 
 turbed bowel action from interference with the 
 normal mode of defecation. 
 
 A missionary physician writing us from South 
 Africa related the following incident as an illustra- 
 tion of the care which the natives take to secure free 
 movement of the bowels. Said the doctor, "A na- 
 tive called on me yesterday morning and asked for 
 medicine to relieve a dreadful constipation. I said 
 to him, "When did your bowels move last?" He 
 replied, "This morning, Doctor." "But I under- 
 stood you to say you were constipated." "Yes," 
 replied the native, "I am horribly constipated. My 
 bowels only move once a day." 
 
 Since the publication of the first edition of this 
 
400 COLON HYGIENE 
 
 work the writer has learned from Dr. Wilfred 
 Grenfell, of Labrador, that it is the custom in that 
 country to feed reindeer moss to the dogs that are 
 used almost exclusively for transportation. After 
 mixing with oil the moss is eaten by the dogs with 
 great avidity and they appear to thrive upon it. It 
 is strange, indeed, that civilized man should be 
 about the only creature among the members of the 
 animal kingdom who neglects to supply his alimen- 
 tary canal with the material necessary to supply the 
 intestine with the normal stimulus to action. In 
 civilization, domestic animals fare better than hu- 
 man beings in this regard. When the horse, ox, or 
 cow loses appetite and becomes constipated, bran 
 mash is the farmer's ready and efficient remedy. 
 But strange to say the farmer never thinks of giving 
 himself the benefit of this simple and natural rem- 
 edy, but instead dopes himself with purgative pills 
 or mineral waters which ruin his digestion, spoil 
 his kidneys, increase constipation, and ultimately in- 
 duce colitis, one of the most common and most for- 
 midable of all the evil effects produced by chronic 
 constipation. 
 
 THE COLON CODE 
 
 1. Move the bowels at least three times a day. 
 (See pages 211, 212, 219.) 
 
 2. Answer the "call," even the slightest, at once. 
 Delay of five or ten minutes mav be disastrous. 
 (See'pages 42-50, 122-124, 208.) 
 
 3. Give the bowels an opportunity 7 for evacua- 
 
THE COLON CODE 401 
 
 tion on rising, at bedtime, and after each meal, 
 even if there is no call. (See pages 40-50.) 
 
 4. Allow sufficient time for complete and thor- 
 ough evacuation of the colon. (See pages 125-128.) 
 
 5. If the "call" returns after a movement, make 
 a second or even a third visit to the toilet. (See 
 page 214.) 
 
 6. Place a stool in front of the .closet seat to 
 raise the feet. (See page 128.) 
 
 7. Eat laxative food at every meal. A single 
 omission may upset the bowel system for several 
 days. (See pages 220-234.) 
 
 8. If necessary to secure three full evacuations 
 daily, take a tablespoonful of bran, or one-third of 
 an ounce of agar-agar, and half an ounce to an 
 ounce of white Russian paraffin oil at each meal. 
 (See pages 231-239.) 
 
 9. Eat regularly and avoid concentrated foods. 
 
 10. Change the intestinal flora by the fruit reg- 
 gimen or the milk regimen (186-188). The consti- 
 pation will not be permanently cured so long as the 
 stools are putrescent or very foul smelling. 
 
 11. Drink two or three quarts of water daily, 
 one or two glasses of cold water at bedtime and the 
 same on rising. (See pages 111, 112, 118.) 
 
 12. Take deep breathing and abdominal exer- 
 cises daily. (See pages 69, 84, 114-116, 272-298.) 
 
 13. Wear loose clothing and if the abdomen sags 
 wear a spring supporter constantly when on the 
 feet. (See pages 84, 203, 298.) 
 
402 COLON HYGIENE 
 
 14. If necessary, use an enema after breakfast — 
 three pints of water at 80° to 70° F. A smaller 
 enema of cool water (one-half to one pint) may be 
 used after each meal or after dinner and at bed- 
 time to establish the three-a-day rhythm. (See page 
 312.) 
 
 15. A small enema (half pint of tepid or cool 
 water at bedtime often secures a good morning 
 movement. An enema of a few ounces of paraffin 
 oil (four to six) may be used to combat dryness of 
 the stool. (See page 312.) 
 
 16. In many cases of colitis, with spastic contrac- 
 tion of the descending or pelvic colon, a complete 
 movement rarely occurs. The feces are slowly 
 pushed through the constricted bowel. In such 
 cases what may be termed supplementary bowel 
 movements are necessary. A few minutes after the 
 movement, or it may be an hour after, a slight 
 "call" may be experienced. This should be re- 
 sponded to at once, and even if the call is repeated. 
 When the bowels do not move satisfactorily, it is 
 well to wait for several minutes, meantime occupy- 
 ing the mind with reading the morning paper, per- 
 haps. This affords time for a new instalment of 
 waste material to be pushed down from the upper 
 part of the colon. 
 
 17. A very hot sitz bath for two to five minutes, 
 or a hot fomentation, taken before breakfast, is an 
 excellent means of relaxing the contracted colon in 
 cases of colitis, and so preparing the bowel for a 
 good after-breakfast evacuation. 
 
COLON CODE 403 
 
 18. Fruit on rising, and on going to bed, may be 
 taken when necessary as an aid to other measures. 
 One or two oranges, an apple, a couple of plums, or 
 a dish of berries eaten without cream (malt sugar 
 may be added), or a bunch of flresh grapes are suit- 
 able for this purpose. The fruits named do not tax 
 the digestive organs because they contain no fat, 
 very little protein, and no raw starch, the starch 
 having been digested by the process of ripening. 
 They are all rich in vitamines and highly refresh- 
 ing. When taken into the stomach they induce a 
 lively peristalsis which is continued down the in- 
 testine and helps to advance the fecal mass toward 
 the point of exit. The fruit taken on rising helps 
 to secure a full bowel movement after breakfast. 
 The fruit at bedtime prepares the way for a bowel 
 evacuation on rising. 
 
Index 
 
 Abdomen, pain in 137-139 
 
 relaxed, and constipation 84 
 
 weak contraction of 156 
 
 compression-breathing 283 
 
 massage in treatment of constipation 290, 291 
 
 muscles, to strengthen 278 
 
 pouring douche bath 244, 245 
 
 support in spastic constipation 320 
 
 support in treatment of constipation 298 
 
 tenderness of, resulting from constipation 367 
 
 Acids, laxative effects 66, 91 
 
 Adhesions, interference with peristalsis 81 
 
 Agar-agar, how used 233, 234 
 
 in mixed constipation 321 
 
 laxative properties of. 62 
 
 Alcohol, constipatjve effects of 130 
 
 Alternate applications to abdomen, fomentations... 246 
 
 Anal fissure, resulting from constipation 366 
 
 incontinence, resulting from constipation 367 
 
 itching, resulting from constipation 366 
 
 spasm, resulting from constipation 366 
 
 Anger, and constipation 75, 139 
 
 Appetite juice, necessity of 94, 95 
 
 lack of m 135-137 
 
 Arc light, in spastic constipation 319 
 
 Arteriosclerosis, in constipation 152 
 
 Autointoxication, intestinal, cause of 159 
 
 Bacillus bifidus 166, 167 
 
 bulgaricus 168-173 
 
 Welch's ; 5* 
 
 Backache, resulting from constipation 350, 351 
 
 Bacteria, acid forming 166-173 
 
 changing intestinal 186 
 
 putrefactive action in colon 53, 55 
 
 putrefactive effects of 168, 169 
 
 of intestine 163-173 
 
 404 
 
INDEX 405 
 
 Baths, abdominal pouring douche 244, 245 
 
 alternate applications to abdomen 246 
 
 cold douche 243 244 
 
 cold sitz, constipative effects 76 
 
 exercise 242, 243 
 
 fomentation to abdomen 246, 247 
 
 hot bath and hot douche 248 
 
 hot sitz 248 
 
 hot sitz and cold pour 245 
 
 in latent constipation 317 
 
 in spastic constipation 318 
 
 in treatment of constipation 241-248 
 
 rubbing cold sitz bath 245 
 
 wet girdle 246, 247 
 
 sedative sitz bath 246 
 
 simultaneous hot and cold douche 244 
 
 Bile, composition of 60 
 
 relation to constipation 59, 60 
 
 Blood-vessels, diseases of 179, 180, 342 
 
 Bowel habits of primitive tribes 370-399 
 
 in Aden 391 
 
 in Africa 376, 394, 395 
 
 in China 379, 380, 386, 393, 394 
 
 in Egypt 385 
 
 in India 386, 391, 392, 396, 398 
 
 in Italy 389 
 
 in Japan 394 
 
 in Kashmir 387 
 
 in Korea 377, 378 
 
 in Mukden 386 
 
 in New Hebrides 390 
 
 in Palestine 385 
 
 in Persia 383, 384, 394 
 
 in Smyrna 389 
 
 in South Nigeria 395 
 
 in Syria : 375, 376 
 
 in Turkey < 381, 382, 393 
 
 Bowel kneading at stools, in treatment of 
 
 constipation 294 
 
 Bran-fruit diet 191, 193 
 
 Bran, how to sterilize 237 
 
 how to use 236, 240 
 
406 INDEX 
 
 Bran, recipes 237-240 
 
 gems, recipe 240 
 
 bran and Granola mush, recipe 238 
 
 bran and graham biscuits, recipe 239 
 
 Breathing exercise 277 
 
 incorrect 114-117 
 
 Brose 240 
 
 Bulk, afforded by vegetables 90 
 
 influence on peristalsis 60- 65 
 
 lack of 90, 91, 99-101 
 
 Buttermilk, laxative effects of 101, 102 
 
 "Call," importance of 119-124 
 
 Cancer, of colon 153 
 
 resulting from constipation 349 
 
 Cannon ball, in treatment of constipation 295 
 
 Catarrhal colitis, resulting from constipation ... 322-329 
 Cecum, massage in treatment of constipation. .291, 292 
 
 Cellulose, amount in various foods 228-230 
 
 Ceylon moss, laxative properties of 62 
 
 Chair, an unhealthful 115 
 
 Changing intestinal flora 186, 194 
 
 Chest raising exercise 278 
 
 Clothing, in treatment of constipation 203 
 
 Coffee, constipative effect of 110 
 
 Cold douche and intestinal activity 70 
 
 Cold douche bath 97-99, 243, 244 
 
 Colic, resulting from constipation 368 
 
 Colitis, muco-membranou,s, resulting from 
 
 constipation 338, 339 
 
 Colitis, resulting from constipation 322-325 
 
 when observed 200 
 
 treatment of 330-336 
 
 Colon, adhesions 81 
 
 atony 136, 137 
 
 code 400-403 
 
 compressing the 281 
 
 contraction of 80, 140, 141 
 
 evacuation of 34-36 
 
 excitant influences 58- 72 
 
 function of ._ 23- 28 
 
 length in animals 9 
 
 movements of 28- 30 
 
 obstruction of 12-140 
 
INDEX 407 
 
 Colon, pelvic loop 31 
 
 physiology of 17-36 
 
 position of 19 
 
 replacing of 283 
 
 splenic flexure 146 
 
 usefulness of 9 
 
 weak contraction of 156 
 
 Compression of waist 84 
 
 Concentrated foods, constipative effects of... 73, 74, 81 
 
 Condiments, injurious effects of 106-108 
 
 Constipation, abdominal supporter in treatment of. . 298 
 
 baths in treatment of 241-249 
 
 causes of 12, 78-87, 134 
 
 cumulative 308-314 
 
 curability of 203-211 
 
 curable without drugs 12 
 
 diet in 218, 240, 304-308 
 
 exercise in treatment of 272-290 
 
 influences which promote 73- 77 
 
 latent, treatment of 315-317 
 
 massage, in treatment of 290-297 
 
 mechanical effects of 150 
 
 treatment of 201-217 
 
 mixed cases 320, 321 
 
 reflex 138 
 
 reflex, treatment of 318-320 
 
 simple 303-308 
 
 symptoms in cumulative 195-197 
 
 symptoms in latent 197-199 
 
 symptoms in simple 195, 196 
 
 symptoms in spastic 200 
 
 spastic, treatment of 318-320 
 
 use of paraffin oil 260-271 
 
 Cooked foods, excessive use of 95-97 
 
 Corset and constipation 84 
 
 Cream, skin 355 
 
 Cumulative constipation, treatment of 308-314 
 
 Deep breathing exercises 280 
 
 Defecation, special exercises to aid 289 
 
 Descending colon, contraction of 8? 
 
 Diabetes, amount of water needed 112 
 
 one cause of 330 
 
408 INDEX 
 
 Diaphragm exercise 284 
 
 Diaphragm, weakened 155 
 
 Diathermy, in constipation 302 
 
 Diet, Bran-fruit 191-193 
 
 in mixed constipation 321 
 
 special milk 183-191 
 
 Digestion, time table 32 
 
 Digestive organs, disorders of 179 
 
 Diseases resulting from constipation 338-368 
 
 Diverticulitis, resulting from constipation.... 348 
 
 when operable .210-211 
 
 Drugs, constipative effects of 131-135 
 
 injury from 257-260 
 
 useless 12-13 
 
 Dryness of diet, effects of Ill 
 
 Duodenum, infection of 329 
 
 catarrh of 329 
 
 ulceration of 329 
 
 Eating and constipation 87 
 
 Eating, laxative effects of 67 
 
 Eczema, resulting from constipation 348 
 
 Electricity and intestinal activity 68, 69 
 
 in treatment of constipation 300-302 
 
 Emotions, depressing, constipative effects of.. 75, 76, 139 
 
 Enema, in cumulative constipation 310-313 
 
 in latent constipation 317 
 
 in spastic constipation 318, 319 
 
 alum 255 
 
 cold rectal douche 256 
 
 cold water 252, 253 
 
 glycerine 255 
 
 hot saline 252 
 
 hot soap 251 
 
 hot water 251 
 
 how given 249-251 
 
 oil 253, 254 
 
 paraffin oil 255 
 
 sugar and water 254 
 
 Evacuation, mechanism of 34-36, 40-50, 153-158 
 
 Exaggerated knee-chest breathing 284 
 
INDEX 409 
 
 Exercise and intestinal activity 70 
 
 bath 242, 243 
 
 effects of 117, 118 
 
 program 290 
 
 Exercises, abdominal muscles 278, 283 
 
 automatic 300, 301 
 
 Exercises, breathing 277, 280, 281, 283, 284 
 
 chest raising 278 
 
 colon .281, 283 
 
 diaphragm 284 
 
 hill climbing 272 
 
 hips rolling 285 
 
 horseback riding 273 
 
 inclined plane 281, 282 
 
 leg raising 284 
 
 medicine ball 273 
 
 posture 274-277 
 
 rocking 279 
 
 rocking chair 277, 278 
 
 rolling 279 
 
 rowing 273 
 
 running 280 
 
 squatting 280 
 
 static 285, 286 
 
 tennis 273 
 
 tension 287, 288 
 
 trunk raising 279 
 
 trunk twisting 285 
 
 work 274 
 
 Exophthalmic goitre, resulting from 
 
 constipation 351, 352 
 
 Eyes, disorders of 180, 181 
 
 Fallopius, quoted ., 258 
 
 Fasting, constipative effects of 75, 103-106 
 
 Fats, and intestinal activity 66 
 
 Fear, and constipation 75, 139 
 
 Fecal fever, resulting from constipation 359, 360 
 
 tumors, resulting from constipation 340 
 
 Fever, fecal, resulting from constipation 359, 360 
 
 Fissure, anal, resulting from constipation 364 
 
 Flatulency, resulting from constipation 360,363 
 
 Fomentation to abdomen 247 
 
410 INDEX 
 
 Food gates, location of 17 
 
 Food, insufficient amount of 99-101 
 
 tube, structure of 18 
 
 Foods, atoxic and antitoxic 221-240 
 
 laxative \ 220, 221 
 
 uncooked 222-226 
 
 Fruit acids, laxative effects of 66, 74, 91 
 
 regimen 191-194 
 
 Gall-bladder, diseases of, resulting from constipation 345 
 
 infection of 329 
 
 Gases, and intestinal activity 67 
 
 Gas, formation in intestine 175 
 
 Gastric disorders, resulting from constipation 341 
 
 Generative organs, disorders of, resulting from 
 
 constipation 358 
 
 Glycerine, enema 255 
 
 Goitre, exophthalmic, resulting from constipation 351, 352 
 
 Gout, rheumatic, resulting from constipation 353 
 
 Graham and bran biscuits, recipe for 239 
 
 Graham bread, recipe for 238 
 
 Granola and bran mush, recipe for 238 
 
 Habits, in treatment of constipation 202, 203 
 
 relation to constipation 87 
 
 Headache, caused by constipation 150, 151, 346, 347 
 
 Heart disorders, resulting from constipation 342 
 
 Heat, and intestinal activity 70 
 
 constipative effects of 76 
 
 effects of 97-99 
 
 Hemorrhoids, resulting from constipation 365 
 
 Hepatic flexure, delay at 145, 146 
 
 Hill climbing 272 
 
 Hips rolling 285 
 
 Horseback riding 273 
 
 Hot bath and hot douche 248 
 
 drinks, constipative effects of 76, 97, 98 
 
 foods, constipative effects of 97, 98 
 
 sitz and cold pour bath 245 
 
 sitz bath 248 
 
 Houston's valves, thickening of 148 
 
 Hygiene, in treatment of constipation 202, 203 
 
 Iliac colon, construction of 81 
 
INDEX 411 
 
 Ileocecal valve, contraction of 144, 145 
 
 incompetent 82, 141, 149 
 
 structure and function of 27, 28, 37- 39 
 
 Incontinence of anus 367 
 
 Indians, Alaska, diet of 63 
 
 Hopi, diet of 64 
 
 Indians, Malkelkos 87 
 
 Orinoco, diet of 64 
 
 South American 164 
 
 Insomnia, resulting from constipation 345 
 
 Intestinal canal, structure of 18 
 
 content, composition of 53- 56 
 
 content, consistency of 26 
 
 flora, changing the 186-194 
 
 Intussusception of colon 153 
 
 Irregular meals, injury of 108, 109 
 
 Itching anus, resulting from constipation 366 
 
 skin, resulting from constipation 356 
 
 Isinglass, Japanese 62 
 
 Japanese isinglass, laxative properties of 62 
 
 seaweed, how used 233, 234 
 
 seaweed, laxative properties of 62 
 
 Joints, diseases of 181, 182 
 
 Kidney, diseases of, resulting from constipation . 343, 344 
 
 movable, resulting from constipation 344 
 
 Kinks, cause of constipation 148, 149 
 
 resulting from constipation 368, 369 
 
 Knee-chest breathing exercise 280, 281 
 
 Latent constipation, treatment of 315, 317 
 
 Laxative foods 220, 221 
 
 Leg raising exercise 284 
 
 Liquids, constipative effects of 73 
 
 need of in diet 111-115 
 
 Liver, aid to peristalsis 59- 60 
 
 diseases of, resulting from constipation.... 345 
 enlargement, resulting from constipation . . . 339 
 
 how crippled 161-163 
 
 Locomotor ataxia, caused by constipation 158 
 
 Massage and intestinal activity 69, 70 
 
 in cumulative constipation 314 
 
 in latent constipation 317 
 
 in spastic constipation 319 
 
412 INDEX 
 
 Massage, abdominal. . 290, 291 
 
 bowel 294 
 
 cannon ball 295 
 
 cecum 291, 292 
 
 mechanical 293 
 
 pneumatic compression 297 
 
 Massage, shot bag 296 
 
 weighted compress 295, 296 
 
 Mastication, excessive 89, 90 
 
 Meals, number and size of 235, 236 
 
 irregularity of 108, 109 
 
 regularity of 211-213 
 
 Meat, constipative effects of 77, 91, 92, 103 
 
 Mechanical massage, in treatment of 
 
 constipation 293 
 
 Medicine Ball 273 
 
 Milk, cause of toxemia '. 160 
 
 constipative effects of 92, 93, 101 
 
 regimen 188-191 
 
 Muco-membranous colitis, resulting from 
 
 constipation .338, 339 
 
 Muscles, degeneration of 181, 182 
 
 Myxedema, resulting from constipation 352, 353 
 
 Mush, constipative effects of 74 
 
 Nerves, disorders of 180 
 
 Neuralgia, caused by constipation 150 
 
 Nutrition, disturbance of 183 
 
 disturbance in infants 347 
 
 Obesity, amount of water needed 112 
 
 tendency to constipation 106 
 
 Obstruction of colon 140 
 
 Osteo-arthritis, resulting from constipation 353 
 
 Pain, constipative 'effects of 75 
 
 Pancreas, infection of 330 
 
 chronic inflammation of 330 
 
 Paraffin oil, action of 260-271 
 
 enema 255 
 
 in cumulative constipation 314 
 
 Russian 67 
 
 when used 308 
 
 Pelvic colon, delay in 33 
 
 how filled 31, 43 
 
INDEX 413 
 
 rectal junction, delay at , 147 
 
 Peristalsis, of transverse colon 29 
 
 propulsive 29 
 
 molding '& 
 
 reverse 29 
 
 Perspiration, excitant of peristalsis 76 
 
 Photophore, in spastic constipation 319 
 
 use of, in constipation 249 
 
 Pigmentation of the skin, resulting from 
 
 constipation 353, 354 
 
 Pituitary body, intestinal stimulus 60 
 
 Pneumatic compress, use of in treatment of 
 
 constipation 297 
 
 Posture and intestinal activity. . * 70 
 
 importance of correct 114-116 
 
 to correct sitting 276, 277 
 
 to correct standing 274-276 
 
 Proctitis, resulting from constipation 336-338 
 
 treatment of 337 
 
 Psoriasis, resulting from constipation 356 
 
 Psychic influences and intestinal activity 68 
 
 Pylorus, function of 28 
 
 Rachitis, resulting from constipation 347 
 
 Raw foods 222-226 
 
 beneficial effects of 95, 97 
 
 Rectal prolapse, resulting from constipation 366 
 
 Rectum, structure and function 20, 21 
 
 Redundancy, of colon 82 
 
 Rheumatic gout, resulting from constipation . . . 353 
 Rheumatism, chronic, resulting from constipation 353 
 
 Rocking chair exercises 277, 278 
 
 Rolling exercise 279 
 
 Rowing 27 
 
 Royal Society, discussion of toxemia , 177-193 
 
 Rubbing, cold sitz bath 245 
 
 Running, on all fours 280 
 
 Russian paraffin oil 260-271, 308 
 
 Sauer-kraut, used by Russians 90 
 
 Sedative sitz bath 246 
 
 Senility, resulting from constipation 342, 343 
 
 Shot bag, use of in treatment of constipation. 296 
 
 Simultaneous hot and cold douche bath 244 
 
414 INDEX 
 
 Sinuisoidal current, in cumulative constipation.. 313 
 
 in latent constipation 317 
 
 Sitz baths, hot sitz 248 
 
 hot sitz with cold pour 244 
 
 rubbing cold sitz 245 
 
 sedative sitz 246 
 
 Skin cream, recipe 248 
 
 diseases, resulting from constipation. . .181, 353, 367 
 
 Sleep, constipative effects of 76 
 
 Sleep, irregularity of 113 
 
 posture during 215-217 
 
 results of loss of 214, 215 
 
 Small intestine, function of 27 
 
 infection of 329 
 
 structure of 21 
 
 Spasm, anal, resulting from constipation 367 
 
 Spastic constipation, treatment of 318-320 
 
 when observed 200 
 
 Special exercises, to aid defecation 289 
 
 Spleen, a stimulant of peristalsis 60 
 
 enlargement, resulting from constipation... 339 
 
 Splenic flexure, delay at 146 
 
 Squatting exercise 280 
 
 Static exercise 285, 286 
 
 Stomach disorders, resulting from constipation. 341 
 
 Stricture, need of operation. 152 
 
 Sugar, and intestinal activity 65 
 
 Surgery, when needed 208, 211 
 
 Tea, constipative effects of 74,110 
 
 Tennis 273 
 
 Tension exercise 287, 288 
 
 Thermaphore, in mixed constipation 321 
 
 use of in constipation 249 
 
 Time Table, of digestion 32 
 
 Tobacco, constipative effects of 129 
 
 Toxemia, intestinal, cause of 159-193 
 
 characteristic effects of 175, 176, 178-186 
 
 discussed in Royal Society 177-193 
 
 Transverse colon, contraction of 81 
 
 Trunk raising 279 
 
 twisting 285 
 
INDEX 415 
 
 Tuberculosis of bowels, resulting from 
 
 constipation 349, 350 
 
 Tumors, fecal, resulting from constipation 340 
 
 Tumor of colon 153 
 
 Ulcer, resulting from constipation 366 
 
 Urinary organs, disorders of, resulting from 
 
 constipation 358 
 
 Vegetable acids, laxative effects of 66- 91 
 
 gelatin, laxative properties of 62 
 
 laxative effects of 101 
 
 use by animals and primitives 61- 65 
 
 Vertigo, resulting from constipation 357 
 
 Vibration and intestinal activity 69 
 
 in cumulative constipation 314 
 
 in treatment of constipation 293, 294 
 
 Volvulus, resulting from constipation 341 
 
 Weighted compress, use of in treatment of 
 
 constipation 295, 296 
 
 Welch's bacillus 54 
 
 Wet girdle bath 246, 247 
 
 White bread, constipative effects of 91 
 
 Work 274 
 
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