Constipation: Chapter 4

1--Constipation of the Neurotic

    AN EXTREME type of nervous temperament, presenting mental or physical symptoms described in previous chapters--under a drouthy state of body--and especially given to worry, insomnia, and many hysterical symptoms. There may be heart disturbance--endocarditis--and arterial hardening; giddiness, black specks before the eyes, and often great mental discomfort; such symptoms as belong to pronounced enervation and toxemia. There is often much poverty of flesh, and little or no appetite, except for coffee and a roll, and almost no desire for water; in a small percentage of these cases, however, there may be a voracious appetite, with inability to digest more than a small share of the food eaten.

    Treatment: Patient must take the rest cure--must be put to bed and company proscribed. Such patients must be kept away from business, domestic and social life. They may be allowed to read a little--not enough, however, to fatigue. A short warm bath before retiring time every evening, or of a morning, if the evening bath causes nervousness; follow with enough towel rubbing to dry the skin; then the patient should be left alone for the night. Frequent gentle rubbing of the spine has a quieting effect.

    Every morning a glass or two of warm or cold water. Cold water may cause discomfort because of stomach neurosis. The water should be sipped slowly. A warm sponge bath may be given at bedtime; follow with dry rubbing with soft towel or open hand. Fruit often disagrees; when it does, then for breakfast a few sips of gruel or teakettle tea. At noon combination salad and spinach. For supper, one or two Triscuits* or slices of whole-wheat bread toasted, eaten dry with a little butter, followed with a pint or more of teakettle tea. When better, raw fruit for breakfast, meat and salad at noon, and buttermilk for supper. Food must be limited, and patient kept in bed until nerve energy is restored; then secretions and excretions will return. The constipation is due to enervation. (*See Appendix.)

    Give of any foods only in amounts that can be taken with relish. If there is no relish for any food, a fast must be taken of sufficient duration to permit a keen relish to come for any food, Positively no eating without enjoyment. When no food is eaten, three pints of water should be taken each day until fresh fruit can be taken with a relish and comfort; then stop water drinking.

    A small warm-water enema--one pint of water every night following every day passed without a bowel movement. If a high enema appears to be needed, it may be given once or twice a week until the bowels can be depended upon to move daily. If the tongue is coated, and there is much discomfort, no food; hot stupes to abdomen and perfect quiet to full relief.

    When patient is much better, he may get out of bed from ten to three o'clock daily, and the food may be increased. Breakfast may be the same. Dinner: Every other day meat, and the alternate days starch, and with both dinners vegetable puree or cooked vegetables and combination salad. A short sleep of a half hour's duration after the noon meal should be established as a daily habit. Rest and sleep are necessary to prevent a return of the nervous symptoms.

2--Constipation in the Neurasthenic

    Those coming under this head are naturally introspective--inclined to be self-centered, and to enlarge upon and exaggerate the importance of all their discomforts. These subjects are known by all who have met them as semi-invalids; they have the disagreeable habit of talking to everyone they meet about themselves--about their ills and the treatment. Doctors, with strong personalities, may uproot one set of beliefs (cure one set of symptoms) by substituting another set; but to rid such a patient of all belief in disease--remove the sick habit entirely--is almost impossible, and indeed it is an accomplishment vouchsafed only to high-class medical artists--psychologists. The "bull in the china shop" variety of doctors only vandalize such sick people. If such invalids can be swept off their mental legs by an overwhelming interest in a profession, business, art, or social life, while the mental absorption is in full force, the sick habit may be forgotten, and the erstwhile constipation will be forgotten--cured--also. It takes a wise doctor to determine just how much truth, or real excuse, there is for all the complaining of these psycho-pathogenetics,* and a still wiser one to lead them out of their delusions. (*Psycho-pathegenetics--mental builders of disease.)

    Treatment: The treatment for this class of patients may be summed up in a few words, namely, treat them daily according to their moods, which may be different each day. Eating suggested for the neurotic may be used in these cases.

    The class of doctors who treat patients in keeping with what they (the patients) say concerning themselves are a dangerous class for neurasthenics to employ, for heroic treatment applied to fanciful ills, or ills that are crises scintillating from an unrecognized perverted nutrition or acidosis, must in time wreck the best constitution. If the doctor employed has surgical mania, the patient may be induced to have several of his minor organs removed, etc.

    The neurasthenic is very sensitive and possesed of a mercurial nature, and should be taught early in life not to take himself too seriously--not to take his sensations to heart--not to build too largely on any symptom; for, being very sensitive, introspective and self-centered, unless trained to think in other lines, a sick habit will be built that will baffle the most skilled physician in his efforts to cure.

    When this class of patients concentrate their attention on their bowels, the central thought is that the bowels are hopelessly constipated. The neurasthenic is a pessimist; his ills are always to be, but never are, cured. It proves the truth of the saying: "As a man thinketh in his heart, so is he." This class of patients can be cured, but never by doctors who believe in disease as an entity.

    These patients are not so set that they can not have their minds changed. To illustrate: Suppose the whole force of the mind is set on constipation; then a thorough examination is made--the examination of course must always be impressive, scientific--and the physician must find a disease of greater importance than the sluggish state of the bowels; say a slow-forming tumor on the pleura, which in time must exert so much pressure on the lungs as to develop a very harassing cough. If the physician is forceful enough, he will cure his patient of constipation, but develop a distressing cough that in time will wear the patient out, unless another psychological pathology can be exchanged for the cough. In the field of medical diagnosis just such swapping of one disease for another is of daily occurrence. An imaginative doctor and a neurasthenic patient have a monkey-and-parrot time of it. The parrot always gets the worst of it, however.

    Self-delusion is more or less a complication to be met with in all sick people. Most sick people are easy marks, and are more or less victims of the fools or knaves of the profession--they are easily humbugged. The profession is divided into three classes. One class deliberately and premeditatedly mislead the patient; the second class are deluded by the sick and harm the patients by helping them to delude themselves; the third class are honest and endeavor to lead the people into the light of truth about themselves and their diseases. The "code of ethics" is a social gulf fixed between laymen and the profession. When a professional man crosses to the people he leaves hope behind.

    The neurasthenic must be treated as each case demands, and as the changing moods of each case demand. The symptoms are to be treated as similar symptoms are treated in other diseases. The mind must be controlled; the patient must be led, never agreed with. Great tact is required.

3--Constipation of the Plethoric*
(*Plethoric, polyemic, too much blood--full-blooded.)

    Too much blood comes from an omnivorous digestion--a digestion that utilizes one hundred per cent of the food intake in those who overeat habitually.

    Plethoric patients, pronouncedly catarrhal; gastro- intestinal catarrh; thickened mucous membranes of throat and nose; more or less deafness; adenoids and enlarged tonsils; giving a history of regular bowels; much over weight; subject to many crises, such as headache, sore throat, toothache, spongy gums, pyorrhea, neuralgia, rheumatism, lumbago, heavy sleeping, and tired and uncomfortable on awakening; drowsy after eating; broad, thick tongue, heavily coated; rotten breath and odor from body; full pulse and an overworked heart and other symptoms; may be a little sugar and albumen in the urine; dizzy, light-headed; and in advanced cases hyperemia of the brain, pain in the back of the head, and, if not relieved, apoplexy, paralysis and death.

    Constipation in this class of patients is more on the order of an impaction; the bowels move daily, yet there is a fecal retention causing the giving out of bad odors of breath, skin and the gas that passes from stomach and bowels. All secreting organs are eventually enervated from being worked overtime, elimination under the circumstances is always imperfect, and more or less decomposition is taking place in the bowels all the time, causing septic infection, setting up anemia, kidney and other derangements. To this class belong Bright's disease, diabetes, colitis, piles, apoplexy, asthma, tuberculosis, skin diseases, pyorrhea and other diseases. Many are carried off with pneumonia and other acute diseases. These are the patients who are infested with germs and parasites, for they eat so much that they overtax their digestive secretions and lose the protecting power of these secretions. Resistance being lost, these are the "carriers" so-called--a class of people who have no recourse when abused by medical superstition. They are also the class who are infested with hook-worm, tape-worm, etc.

    There may be collateral symptoms, such as fullness in head, inclination to giddiness, headache, backache, a tired feeling all the time, more marked on getting up of a morning; feet and hands inclined to swell; eyelids puff of morning; the face is inclined to puff, grow turgid and purplish on lying down; sleep is more or less disturbed from difficult breathing, the cause being a turgid or congested state of the mucous membrane and submucous tissues of mouth, throat, and pharynx. The full tissues drop down into the throat and obstruct breathing. The toxin poison absorbed from the intestines in these subjects develops hard arteries, high blood- pressure, and tends to cerebral hemorrhage or apoplexy, kidney and heart trouble, diseases of liver, gall-duct and gall-bladder, rheumatism and other derangements. These become, many of them, the victims of epidemics.

    The treatment should be a continuous fast, enemas of salt water and lavage daily until elimination has rid the patient of all his malodors, which means getting rid of toxemia.

    Enemas are highly necessary in these cases, and they should be used until the bowels are thoroughly cleaned out. Stomach lavage daily until the tongue is clean and bad odors all gone. At the end of the first week or ten days, if the tongue and breath are bad, give a small dose of the laxative which I name "Three-In-One."* (*See Appendix.) Use one heaping teaspoonful in a pint of quite warm water and pour into the stomach through the stomach tube after the lavage and before the tube is removed. The laxative is to be used daily unless more than one bowel movement is secured each day, then cut the "Three-In-One" to one-half teaspoonful, but continue the same amount of water. As the patient improves and the bowels are moving daily, the "Three-In-One" may be reduced to one-fourth heaping teaspoonful in the same amount of water. When the laxative is no longer necessary, the pint of water, either quite warm or cold, should be used as a daily habit. This laxative is all that is left of my original drug armamentum. Bran, agaragar, enemas, and oils have proved a vanity and a vexation of spirit. The use of them is always followed with constipation. Even "Three-In-One" will fail if patient returns to old habits of eating and stimulating. A hot bath daily, followed with cold sponge or spray, and then a coarse towel rubbing. Is it necessary to say that tobacco and alcoholics must not be used? Indeed, this treatment, to make life safe, makes the giving up of all stimulants very easy for those who wish to get rid of their habits.

    Food will not be given until the patient is comfortable, seldom before the end of the third week, and even a longer fast may be necessary. When symptoms indicate that food may be given, feeding will start with fresh uncooked fruit three times a day, and water-drinking is to be stopped; after three days on fruit continue fruit for breakfast; salad at noon; buttermilk at night. If all is going well at the beginning of the second week, salad and spinach for dinner; every other day add meat; on alternate days baked potato, corn bread, or any coarse bread may be eaten with succulent vegetables and a salad. Spinach or onions should be one of the cooked vegetables at each dinner because of their laxative properties. If the bowels fail to move daily, prunes may be added to the fresh fruit meals; and if the bowels persist in being sluggish, every evening the small salt enema is to be used.

    When all signs of plethory and toxemia are gone, and there is a lack of vim, and a tendency for too much loss of weight, a starch may be added to the buttermilk for supper-two ounces of toasted bread and butter; or any of the breakfast foods; occasionally, once or twice a month, thoroughly cooked beans or peas. Always observe rule No. 1,* if digestive trouble-constipation and toxemia-would be avoided. (*See Appendix.)

4--Constipation in the Sedentary or Inactive

    This is a condition brought about by sedentary habits. There is usually gas distention, causing discomfort--often pain under liver. Intra-abdominal pressure, due to gas distention and accumulated fat, brings on hernias, floating kidneys, painful urination and irritable bladder and piles. Habitual gas distention is accompanied by colitis and proctitis, causing tormina or great straining at stool, which forces prolapsus of the colon and rectum. Drugs--any of the laxative or aperient drugs or mineral waters--figs, confectioner's wares, sugar or sweetened foods, and too much starch, aggravate and complicate. Prostatic enlargement is intensified and in time brings on retention of urine. Where there is a ptosic state of the pelvic organs--falling or misplaced womb, ovaries, or tumors of womb and ovaries--all lend their influence in bringing on obstruction and constipation.

    At the beginning of chronic constipation, ptosis is quite general, and is more or less operative as one of the causes of constipation in all old or young adults who are inactive, and may be in children who are fed too much sweets and are forced into enough inactivity to induce atony (lack of tone) of the muscular system.

    The first cause of loss of tone or energy is inactivity, and anything practiced in daily life that uses up nerve energy adds to the lowered resistance. Lost resistance is another name for enervation. Enervation and inactivity lead to atony and lost functional power.

    When the body is enervated there is a checking of all secretions and excretions. This retention of excretory material poisons the system, producing toxemia, which in turn further weakens organic functioning. The diathetic organs--the organs hereditarily below the normal standard--give down first, and in our present state of civilization the bowels appear most vulnerable.

    There is, undoubtedly, in those who are greatly troubled with constipation a diathesis--a heredity--a tendency to take on constipation, because we see daily others subjected to the same influence and they do not develop it.

    Eating too freely of fresh fruits, in conjunction with a mixed rich diet, causes fermentation and diarrhea, followed by constipation. In the enervated this eating habit further weakens muscular action, and when the dietetic errors are corrected for a time, the bowels are left obstinately constipated. Diarrhea and constipation are often found alternating.

    Observant people have noticed that when their bowels have been overstimulated to move even to diarrhea, by imprudent eating or drugs, or by laxative foods, a period of atony (inactivity) follows. If the subject is melancholic, hysterical, neurasthenic, anemic, or building arteriosclerosis, an imprudent physician may convert a moderate atonic constipation into an obstinate chronic type by urging the use of drugs or enemas.

    After constipation is once established, then physical degeneration advances very rapidly, and will continue unless drugs or enemas are used to force daily evacuation; but such relief is unsatisfactory, for the more forcing the more obstinate the constipation will become.

    This class of patients are usually quite catarrhal; they frequently develop asthma, hay fever and colitis. Simple catarrhal inflammation, marked by periodic diarrhea, is a forerunner of membranous inflammation; indeed, the catarrhal stage is the earlier or first stage of the membranous form. In the latter stage, or chronic catarrh of the colon, the first symptom to draw the attention of the patient to the disease of the bowels is the coating of hard fecal lumps (sybala) with a jelly-like substance. When this symptom appears there is usually gas distention in lower bowels, flatulency of stomach and bowels, tired feeling or want of energy, fullness of head, dizziness, drowsiness, lack of attention, difficulty in concentration; when there is pain it is caused by gas distention or impaction. The hardened feces are usually found at the flexures of the colon; they irritate and cause pain or colic; there are long strings of mucus, bands of mucus, sometimes mucus the shape of the lining membrane of the bowels, thrown off; the latter often causes the patient to think the mucous membrane is sloughing off. When this stage is reached a spastic* state of the bowels is sometimes developed-there is a drawing or distorting of the shape of the bowels which obstructed the mechanism, which adds to constipation and causes a state demanding surgical interference. (*Spastic, drawn out of place.) Certainly such cases are out of the physician's class; but no operation should be performed unless demanded by a malposition made permanent by organic change. Adhesions following operations do rarely occur, but when they do, surgery is the treatment necessary.

    Treatment: It should be obvious to the discerning that the most important measure to adopt in the treatment of constipation caused by inactivity--sedentary habits--is physical culture, and there is not a more loathed prescription, unless it is the restriction of food to the gluttonous, for atony of the muscular system leads to apathy--laziness--a loathing of activity.

    The listless, apathetic patient dreads motion; when the muscular system is flabby, the mental corresponds, and the rule is that the will is paralyzed. These people will not exercise unless forced to do so; if left on honor to practice a given amount of exercise daily, their honor is weaker than their desire to rest. If they could be cured without an effort on their part, they would buy and pay well for health; they would not keep it, however, if to retain it required daily attention in the line of dieting and exercise. There appears to be but one way to keep the apathetic patient from falling down into complete intestinal muscular paralysis, and that is to furnish enough amusement to stimulate activity. Women of this class are strong for the butterfly life. When there is amusement on hand--an opportunity to see the wheels go round--they can show great activities and can be as lively in taking exercise as those with the more active temperament; but as soon as the stimulant--the opportunity to have pleasure--is passed, they settle down into a state of lethargy and cannot be induced to take exercise even if the neglect causes them to have most miserable health. People of this temperament, when they have once brought on toxemia and constipation, will be forever seeking health, and forever refusing to do what is necessary to gain health. They want to find some one who can cure them in spite of themselves. The constipation in colitis is made worse by carbohydrate foods; hence, besides exercise, these patients must be put on a very restricted diet. Bread, cereals of all kinds, sweets of all kinds, must be interdicted, except a very limited amount of thoroughly toasted bread and sweet, fresh fruit. The sweet dried fruits eaten quite regularly cause indigestion and fill the bowels with gas.

    Apples well ripened and sweet grapes are admirable in the winter; most of the summer fruits, including melons, may be eaten in the summer. Fruit and teakettle tea for breakfast; two ounces of toasted white bread, eaten dry with a little butter, followed with a glass of buttermilk sipped slowly, followed with two glasses of hot water, may be eaten at noon. For dinner in the evening, meat, non-starchy vegetables--those maturing above the ground--and a combination salad. If any change is made, the toast can be cut one-half and the milk and water doubled in quantity.

    Enemas, two quarts of blood-warm water, may be used twice a week; and a small enema, one pint of warm water, every night when the large enema is not used. The small enema should be held fifteen to twenty minutes before trying to have a movement. No drugs or food laxatives are to be used.

    If exercise is taken every three hours faithfully, and the above diet rigidly adhered to, a cure will follow.

    It should be remembered that chronic colitis with constipation is not cured by conventional treatment; much malpractice is resorted to. This disease creates so many symptoms that patients are subjected to many operations which leave them no better, if not worse. Social life must be given up and a business made of getting well.

    A poised state of mind and body must be cultivated, or the best treatment will fail.

5--Constipation in the Aged

    The old and feeble cannot take exercise, for they fall into the very bad habit of never bestirring themselves. There is an inexcusable, because silly and untrue, idea that old folks must be dignified and never move in any undignified manner; which, literally interpreted, means they must move with dignity and grace becoming people of their age. This sluggishness leads to such a state of lost muscular power that helplessness follows, and everyone who happens to be near such a subject, recognizing the physical weakness, lends a hand to help. Everybody takes a hand in saving the old man or the old woman from making an effort; the result is that old people get to looking for and expecting a lift from everybody, allowing their muscular system to die from inactivity--lack of use. The result is aging and premature death. No part of the body suffers more from physical neglect than the bowels, and constipation in the old is due to this cause, plus coffee and toast; hence there can not be any cure unless there is a retracing of steps--a going back and building power through exercise. Massage and mechano-therapy may give a little relief, but the eternal fiat was sent out at the beginning of time. Man must earn his digestion by work--to him that hath courage to work for muscle, muscle shall be given, but to him who hath not courage to work for power, even that which he hath will be taken from him. No, we never get so old but that we shall be punished by our sins of omission of work.

    Those who are senseless (illogical) may say father and mother have been so good that God will spare them for the good they have done. Yes, their god, the god of bad habits, will spare them; but the real God happens to have jurisdiction over the laws of daddy's and mamma's personal being, and He does not change His laws. When man became a living soul he became the builder of himself by a wise adjustment of himself to the laws which are fixed and eternal. We answer to the laws of our being, and God never interferes when one of His saints becomes constipated from inactivity. There is but one cure, and that is activity--get a hustle on ourselves.

    Treatment: As old people will not exercise to restore tone, there is no help for them except to eat laxative foods and take the lighter forms of laxative drugs so long as they will act; then the stronger drugs and high enemas must be used until death. Of course, fruit cooked and raw, vegetables cooked and raw, are very necessary foods for old as well as young. Old people with kidney, bladder and urethral irritations should not eat root vegetables--only vegetables that grow above ground. At all ages those who are constipated and have excessive or frequent urination, with discomfort in bladder or urethra, with dilated veins at the mouth of the urethra caruncle, should not eat the root vegetables.

    Old people who have fallen into a state of inactivity and have enough ambition to make a reasonable effort to renew life will find obedience to the law of their nature will be followed by a gradual amelioration of their discomforts and a renewal of life and vigor.

    Radical changes in the order of their living is not advisable.

    If toast and coffee has been the breakfast, they should eat half as much toast; changing white bread for whole-wheat, and, instead of softening the bread in the coffee, eat it dry. If chewing it is impossible, break a portion and gum and mouth it until liquefied, then swallow, then take another portion, treating it the same way, and continue until the whole allowance is eaten; then sip the coffee slowly; after the coffee, sip slowly a cup of equal parts of hot water and milk. Beginning the fourth day, eat the bread the same way, prepare the coffee the same way, but before pouring the coffee place in the cup one tablespoonful of hot milk and water, then fill the cup with coffee, sip slowly, and follow with a cup of hot milk and water. At the end of seven days use two tablespoonfuls of hot milk and water before filling the cup with coffee.

    In seven days more use three tablespoonfuls of hot milk and water before filling the cup with coffee, sip slowly, then follow with the cup of hot milk and water. Continue the reduction of coffee until the coffee is dropped and two cups of hot milk and water are being taken, after which take the half of a good eating apple, reducing the bread one-half. If the apple can not be chewed, chop it fine, or grind it in a vegetable mill, and eat it slowly, sucking and tasting and mixing with saliva. Unless much saliva is taken with the apple, starch and milk, the patient will be troubled with gas.

    One week after beginning the apple, stop the bread and eat a whole apple before sipping the two cups of teakettle tea; continue for seven days, then begin a gradual increase in the water and milk until one quart is taken, preceding it each morning with an apple or some other fresh fruit.

    The noon meal may be a dish of salad--a dinner plate full: lettuce, tomatoes and cucumbers in the summer; in winter, lettuce, tomatoes (canned or fresh) and celery. Three-fourths of the salad should be lettuce. Dress with salt, oil and lemon juice. Every other day with the salad, meat--lamb, chicken, egg or cottage cheese--and one or two cooked nonstarchy vegetables, those maturing above the ground. The alternate days use starch in place of meat. See list of starches.

    Evening meal, a glass of buttermilk, followed with a glass of hot water. When more buttermilk can be taken with a relish, it may be taken, always followed with a like quantity of hot water.

    No water is to be used between meals. if desired, a glass of hot or cold water may be taken on getting up of a morning.

    These patients are usually quite stiff in the spine; they should exercise every three hours, using the first three movements exclusive of the others, for one or two weeks, adding the others one by one, in the order named and as strength will permit.

    The exercise must be started moderately and increased as strength increases. Regularity and persistence will be rewarded with a gradual gain.

    All laxative drugs and food must be quit. A small enema--a half or a whole pint of warm water--may be placed in the bowel with a fountain syringe every night and held for fifteen or twenty minutes, then try to have a movement; if not successful, don't worry, but try it the next night and every night, except on days when the bowels move.

    Patience and persistence will surely be rewarded; remember it took years to bring on this enervated state, and it takes time and perseverance to overcome it. Fretting, worrying and impatience will certainly hold back recovery. To cure constipation means the restoring of lost energy, and it cannot be accomplished quickly. Correct eating, and eating lightly, with the faithful carrying out of the exercise program, is the only way to cure. Enervating the bowels by the persistent use of so-called remedies builds the very derangement which they are given to relieve.

6--Constipation of Infants

    Babies from birth are often constipated; the common cause is overfeeding. Reducing the intake of food one-half, and the use of suppositories or other innocent nursery palliatives are often all that is necessary to bring about full relief and cure, but where overfeeding is persisted in, all palliatives fail in the course of time to relieve. Overfeeding, or whatever the cause, must be discovered and removed.

    Galactorrhea (excessive secretion of milk) is a common cause of overfeeding soon after the birth of a child. To relieve the discomfort of the mother from the distention of the breasts, nurses and friends, and too often the doctor, urge the mother to feed the child frequently; consequently a child that would sleep twenty-three and a half hours out of twenty-four is shaken up from ten to twelve times every twenty-four hours and made to nurse. The result is that the child is educated into gluttony. "If God did not intend the child to be fed all it could hold, why did He provide so much?" Consequently, when the babe is so full that the milk jostles out of its mouth every time it is moved, stupidity continues to declare, as it always has: "All healthy children spit up their food; all healthy children have colic for three months after birth; and all healthy children flood themselves out of their beds at night from frequent urination (polyuria)."

    Here we have the primary cause of about all infantile diseases. Children started in this way are in line for constipation and the sequential toxemia (infectious diseases).

    The mother is advised to eat for two during pregnancy; and after child-birth she is urged to gluttonize--inundate her body with fluid foods, table beverages, including light alcoholics, to cause her to give plenty of milk--to develop galactorrhea (excessive secretion of milk); and if the fluid excess does not cause galactorrhea and constipation, it will develop polyuria (excessive urination) and constipation, which derangements are also, as stated above, developed in the child.

    The mother's excessive eating and drinking bring her to discomfort, and often to ill health, and, worst of all, may cause galactozemia (loss of milk).

    When a child must be given artificial feeding after having gluttonized on the mother's milk until constipated, and forced into polyuria, the prospects of evolving into health on artificial feeding are slim, and hopeless unless carefully taken care of and by wiser heads than have conducted the care of the child up to the forced change.

    Treatment: To control galactorrhea of mother and her constipation, she must stop drinking; positively no water at meal times nor between meals; no table beverages of any kind. By controlling excessive lactation or urination, fluid distribution will be normalized and the diverted fluid secretion to the breasts or kidneys will be restored to the bowels and constipation overcome. While this change is being brought about, which should not be expected to take place suddenly, simple remedies for securing a daily evacuation must be used, namely, rectal dilators; half pint water and teaspoonful of salt placed in rectum and held for half hour; quart of soapy water; if small enemas fail, use large ones of simply pure warm water. Coarse bread and butter, the bread well baked, may be eaten for breakfast with a few black figs or dry prunes, or baked apples without dressing. Tensing exercise of the entire body for half hour before getting out of bed every morning, giving special attention to the bowels; also brisk walks of a mile or more, twice daily. Cooked spinach and onions; raw spinach may be used in the combination salad.

    Laxative mineral waters are not good, for they will be carried out of the system through the lacteal glands, thereby making the baby sick; or if the kidneys are overactive the kidney route will be taken, leaving the bowels unaffected.

    If the mother is quite stout--overweight--her eating should be for breakfast: fresh uncooked fruit--whatever fruit is seasonable; if berry time, berries, a reasonable amount of sugar and milk half cream; baked apples with sugar and milk half cream. Dinner at noon may consist of meat, eggs or fish, a combination salad and two cooked, succulent, topground vegetables; fruit for dessert if desired. Evening meal, stale or toast bread and milkbutter very sparingly.

    Those who are starch and sugar poisoned--those young mothers who are chocolate-candy poisoned--may complain that fruit distresses them; causes them to bloat and feel uncomfortable. They should cut down the amount, but they should not stop fruit eating. When mother and child are quite normal the mother may have for supper: biscuit, butter and honey with fresh fruit every other day; the alternate days, cereals dressed with salt and butter or milk half cream, no sugar. Occasionally a baked potato or corn bread, using not to exceed a cubic inch of butter for the entire day, half of which may be used at supper. Toasted bread inclines to constipate, hence well-baked bread is better than twicebaked bread; stale bread is best. Mastication is of more importance than the kind of bread!

    If the milk secretion declines rapidly, the mother may be given a glass of whole milk after her breakfast and supper are eaten (before leaving the table, of course).

    Correcting excessive milk secretion (galactorrhea) will usually correct constipation in the mother.


    Children who are fed every two hours the first two months and every two or three hours, night and day, after that age must present symptoms of indigestion, such as more or less milk curds in stools, gas in stomach and bowels, constipation, restlessness, fretfulness, crying and sucking at hands or anything that touches the mouth; this latter symptom is mistaken for a sign of hunger, and, to add pain to misery, more nurse is given. Such signs, interpreted as hunger in children being fed every three hours, are reflex symptoms and should be interpreted as due to discomfort in stomach and bowels, and, instead of giving more food, no food except fruit juice (orange in winter, and berries, or juice from a Tilden salad, in summer) every three hours or three times a day until comfortable; then return the child to the breast and feed not oftener than four times a day, and positively no feeding at night. Watch the stools and if white specks appear reduce the length of time the child nurses one-fourth or one-half, if necessary to secure perfect digestion.

    How long should a child nurse? That must depend on the amount of labor required to get the milk. Some breasts require little drawing; the milk flows without eff ort on the baby's part. When the milk flows easily the child should be held above the breast, causing it to take the milk against gravity. Ten minutes will fill the babe to overflowing where the milk draws easily; six minutes at such a breast will be long enough to give the baby sufficient; while there are other mothers who will have to allow their babies to nurse twelve to twenty minutes. The guide must be curds in stools and constipation. Neither will be in evidence when the child is not overfed. But after constipation is brought on and the kidneys are forced to do vicarious work for the bowels, the feeding must stop for a day or two; then give three or four to eight or twelve minute nursings three times a day. The mothers with the easy flow should give three to four minutes for their babies to nurse; and the other mothers the time specified above. As the children improve, increase the time until they are taking all they want three times a day.

    If mothers or nurses would watch the babies and cut down the intake of food instanter on the appearance of curds in stools or on the increase in urination, constipation would not flourish as it now does among young children.

7--Constipation in Children

    Children should be educated into having a bowel movement every morning before starting to school. It is the parents' duty to see to the education of their children in a knowledge of laxative foods, and when to eat them, and the evils resulting from neglect of the bowels.

    School boards should provide footstools where the vault seats are too high. It is necessary for the thighs to press against the abdomen to give the abdominal muscles support while bearing down to force expulsion of feces. This is required by grown-ups as well.

    Treatment: When children become constipated their diet must be modified to meet requirements. The amount of starch must be reduced. They should not eat more than half their usual amount of bread, toast, cereals or breakfast foods. They are to be fed more fruit: prunes, black figs, fresh pears, baked apples, fresh uncooked fruits. The child should eat all desired of the fruits for breakfast, followed with a cup or two of teakettle tea.

    Cooked cereal, dressed with milk and salt, followed with teakettle tea for lunch. No cream or sugar.

    For dinner, whole-wheat biscuit, or muffins, butter and a little honey; follow with a glass of teakettle tea, sipping slowly. This dinner every other day; the alternate dinners may be whole-wheat bread, corn bread or baked potatoes and butter with a combination salad; also succulent vegetables if desired.

    When mucus is occasionally seen in the stools it indicates colitis. Abdominal paincolic-is caused by gas distention, with soreness to touch on slight pressure. Stop food, use copious enemas until bowels are relieved of accumulation, and then feed as above directed, watching for symptoms of constipation. When there is distention from gas with soreness or pain, give fruit juices only and relieve the gas distention by enemas. Don't allow a surgical maniac to remove the appendix.

    Positively no eating between meals. Sweets, especially syrups, eaten with bread or other starch, tend to develop acidity and colic. Sugar on breakfast foods leads to indigestion.

    Children with constipation, frequent attacks of colic, or discomfort in stomach and bowels must be kept away from candy and sweets. Sweet potatoes, navy or butter beans, ginger bread, sugar on breakfast foods, and eating between meals must be avoided. They should be allowed to stay from food long enough so that they can take with relish toasted whole-wheat bread and butter, and after eating it dry, then sip with a spoon a glass or two of teakettle tea; this is for breakfast; for noon meal, bread, butter and fresh fruit; evening meal, a combination salad and toasted bread, once a week baked potatoes and once or twice a week meat. Positively nothing between meals, not even water. If bowels remain constipated after one week of this style of feeding, then change breakfast to a bowl of well-cooked porridge, made from corn or oatmeal. Stir in the porridge one teaspoonful of flaxseed meal, dress with salt and butter, or milk half cream.

    Where children are troubled with polyuria (passing great quantities of urine) they must be fed dry foods and fresh fruit, and kept away from milk and water.

    Regular meal times, no eating between meals, eating the bread dry, no water drinking, will correct constipation in a short time. If meals are as directed above there will be no thirst. Thirst comes from conventional eating--wrong food combinations-and when the water-drinking habit is established, indigestion, catarrh and all children's diseases follow. Keep this in mind: all diseases of childhood start with gastro-intestinal catarrh, even diphtheria and smallpox.

8--Atonic and Spastic Constipation

    The difference between atonic and spastic constipation may be explained as follows:

    Atonic Constipation is common; in fact, most constipations are of this order. Sluggishness of the bowels may exist for some time without causing appearances of ill health; perhaps there may be a heavy head or headache, and a lack of energy, without the cause being known. Flatulency and gas distention may cause some discomfort; laxative foods and enemas are effective for relieving. In common constipation there is no excess of mucus; rectum is often full; the sigmoid flexure and the transverse colon are inclined to be full.

    Treatment: Large enemas twice a day until bowels are cleared out, then small enemas every night. Stay in bed for two weeks or longer. Practice the tensing exercise every three hours, as long each time as possible; increase the amount taken as fast as strength increases. When out of bed add walking and other forms of exercise. Get busy, stay busy, and take the M. D. P. Recovery will be slow; but a cure will be speeded up by lots of exercise. Keep the mind and body poised.

    Spastic Constipation: The spastic or distorted bowel is caused by drawing or spasm, and is not very common; when present, it may have a neurosis or lead-poisoning history; always gastro-intestinal catarrh, or pronounced colitis with ulceration. The leading symptoms are pain, and mucus in the stools. Pain may be slight or very severe. Some authorities declare that pain belongs to spastic constipation. My experience does not quite agree. Pain is always found in catarrh of any portion of the intestinal canal, and the reason for it is that starch is not well digested and requires so much time that fermentation takes place, causing distention. Distention or inflation with gas is the cause of great discomfort. Where the gas is confined to a given locality by spasm or contraction, the pain is often very great, driving the surgeon more anxious for fees than cures to remove the appendix, ovary, womb, gall-bladder, resect a part of the colon, or remove something, anything. No cure can follow, but that does not matter; the operation was skilfully and successfully performed. Such operations are on the order of daylight bank robberies, except that the intimidation is by a threat that the disease will kill, instead of a gun-play; the latter may be a little more honorable and without detrimental after-affects.

    Drugs or anything to force a movement must be much more powerful than is common for atonic constipation and much more painful. Many place diagnostic significance in the shapes of fecal matter as expelled, which is said to be pencil- or ribbon-like. Certainly such shapes must be made by the outlet--the anus; for a peculiar shape formed above must be changed at the outlet. In palpating, the colon feels hard, cord-like and about the size of the little finger, and sensitive. The most pronounced symptom is long, stringy, membraneous stools.

    Treatment: So far as curing this type of constipation is concerned, it depends on whether the patient will co-operate. It takes time and patience. A stay in bed for months is necessary, with poise of mind and body. Relief may be given these patients by teaching them to eat within their digestive limits of the stomach and upper bowels. Foods that require several hours to digest are passed on to the colon, where digestion has ceased because of disease, and decomposition is ever present. These are not diseases to be corrected by laxative foods and drugs. Enemas high or low when necessary are the only forcing measures that should ever be employed to secure an evacuation; all others increase the disease. Very rarely mineral-spring water enough to bring relief when the enemas fail; the water from the spring, not the concentrates.

    Meat, eggs, fish and dairy products may be used, but never in conjunction with starch. Starchy foods should not be eaten. Ripe fruit is always admissible. Unripe fruit causes gas distention and pain. Gruel made of any of the cereals and strained, removing bran, hull or rough particles, may be used, if pain does not follow; if pain follows, the starch is not digested and it should not be given. Meat should not be swallowed in chunks. Lamb, chicken, fish or eggs with vegetable salad, dressed with sugar and salt, no oil, for dinner. Milk and water, fifty-fifty, for the other two meals.

    Those with this form of constipation are made very miserable by eating foods rich in cellulose; indeed, this element in fruit and vegetables must be removed. In severe types of this disease cooked vegetables are not to be used.

    Rough foods usually given to overcome ordinary constipation make patients with colitis, especially the spastic type, most miserable.

    For breakfast, a cup or two of gruel (when it can be taken without pain following), seasoned with salt and very little butter. It is to be taken hot and thin enough to sip slowly; or

    one or two eggs beaten with strained orange or grapefruit juice, enough to make a cup of the mixture; or two glasses of hot milk and water, equal parts. These foods are to be taken very slowly. In severe cases hot milk and water up to one quart, twice a day; and for dinner, meat and salad. When much better the dinner may be lean meats broiled or cooked en casserole; a puree of tomato, spinach, celery, asparagus, or cabbage; -and a combination salad run through a vegetable mill or cut very fine; and then the patient must masticate and insalivate well.

    Suppers should be the same as breakfast. Milk and water is a safe meal.

    Tensing exercise should be practiced daily as much as possible.

    All very sick people should attend the Tilden Health School long enough to be educated into knowing how to take proper care of themselves.

(Falling of the Stomach)

(Falling of the Intestines)

    A gravitating of the stomach and bowels means the same as gravitation or falling down of the muscles of the arms, legs, abdomen, neck, jaw or cheeks, and gives as much excuse for surgery as do the latter muscles of the surface of the body. Suppose a surgeon should propose surgery for relaxation--ptosis--of the biceps? Beauty doctors shorten the muscles at the sides of the face of lazy women. Expert surgeons operate on gluttonous men and women because their sagging stomachs and bowels refuse to carry the load placed upon them. Why? The bowels and muscles named have lost their tone from neglect of exercise, and to endeavor to restore them to their rightful position by surgical operation is idiotic faddism. Certainly to advocate such a procedure shows ignorance of the fundamentals of physics.

    The lost power may be shown in many ways. One of the commonest is gas distention with borborygmus (rumbling in bowels). When the lost tone is great the bowels may become greatly distended because they have lost power to force the gas down and out. This lost peristaltic (expulsive function) power favors accumulation of fecal matter and gas. In severe ballooning of the intestine I have seen patients and doctors fooled into believing that pregnancy existed. Lost tone of stomach and bowels, due to neglect of exercise, is followed by slow digestion and a filling up of these organs with gas. The gas distention favors constipation; also, besides causing discomfort, pain, heart palpitation, nervousness, apprehension and discouragement, the gas distention, in those with much fat accumulation, causes intra-abdominal pressure and a dropping down of the pelvic organs--the reproductive organs--and bladder. This adds another cause of constipation by obstructing the rectum and furnishes operations for exploiting surgeons.

    Ptosis of the sigmoid flexure of the colon, and prolapsus of the rectum, present the most obstinate forms of constipation. Indeed, the name "constipation" is a misnomer, for the inability to have a movement is due to obstruction--a blocking of the passage by folding and dropping down of the mucous membrane of the colon and rectum into the axes of the rectal strait, most effectually blocking the fecal passage.

    The free circulation of the blood in the pelvic organs is interfered with, causing passive engorgement; following which enlargement of the womb and fibroid growth develop, which adds to the obstruction. Add to this formidable array of symptoms colitis, proctitis, prolapsus of the rectum and piles, and we have a complicated state that taxes the most skilled physicians to overcome. Surgery cures by removing the offending organs--simple, isn't it? Add poverty to a symptomcomplex of this character and, without excellent good sense on the part of the patient, a cure is hopeless. Of course charitable hospitals relieve these patients of their appending organs, for God's sake, and incidentally give practice to ambitious surgeons, enabling them to become expert in alluring the elusive lucre from one checking account to another, and in this way improve the circulation and keep the public's feet warm.

    Treatment: Such cases require several months in bed, with faithful exercising every three hours every day, and a limited supply of food.

    Exercise is positively necessary to help overcome this most stubborn type of constipation, and in no other way can it be cured.

    Exercise is a necessary auxiliary to the cure of all diseases, and certainly constipation is no exception to the rule. The best treatment must fail unless perfect poise of mind and body can be secured. Impatience, irritability, fear, apprehension put such cases in the invalid class for life.

    Self-control must be the first therapeutic measure instilled, without which the treatment starts with failure. Full self-control places nearly every incurable disease in the curable class. Self-control means the giving up of every bad habit, both mental and physical. This accomplished, nature has a clear field; all the doctor can do is to help in removing obstruction, not organs, but bad habits of body and mind, giving hope and overcoming ignorance; and in this he is liable to be more of a vandal than a help if he fails to keep his eye on service.

    Ptosis or falling down of the abdominal and pelvic organs is the cause of the diseases that furnish the surgeon with most of his operations. Constipation is first, last and all the time one symptom of ptosis; it is built by ptosis and ptosis is built by it. When constipation is established, increase in toxemia follows as surely as the night follows the day--as surely as effect follows cause--and when toxemic saturation is developed, the universal cause of all diseases is established. Just what disease will develop depends on diathesis, habits and environmental influences. Diathesis, like the tubercular or gouty, will cause those who have erred in living until their general health is broken down with toxemia to develop tuberculosis or rheumatism. Those with special organic diatheses will have their vulnerable organs break down and disease will be in keeping with the diathesis; for example, if the hereditary tendency is to cancer of the breast, womb, or stomach, this disease of these organs will develop. Habit and environment will hasten the development of diseases to which inheritance predisposes, and where there is no predisposition, the organs that receive the stress of bad habits will give down and in time develop organic disease.

    When so much disease and its accompanying discomfort and unhappiness are liable to follow neglect of exercise and right living, it certainly behooves the healthy and those who are just entering the life of invalidism to get busy and right all errors. It is no uncommon thing to see the food-poisoned dragging themselves about, old and decrepit, yet not sixty years of age, many from thirty to forty.

    Exercise or physical culture cannot take the place of correct diet, and vice versa; and the mental attitude is not to be neglected. It should not be forgotten that optimism is as necessary as right living and exercise, for it is optimism that makes reform possible; the pessimist paralyzes his will for acting and getting benefit by autosuggestion. To him it is: "Oh, what's the use?" There is but one answer, namely, everything is purposeful and necessary, and is for our good if we learn from experience to adjust ourselves to nature's requirements. It is only when we disregard law and order that we pay with discomfort, and if we disregard pain and refuse to be taught by it, then we pay with our lives.

    When there is constipation, gas in bowels, and the accompanying discomfort, and the X-ray doctor declares that there is ptosis, and the surgeon declares there is appendicitis or gall-bladder derangement, and consultants insist on taking out the appendix, and draining the gall-bladder or extirpating it, etc., etc., don't do it, but get busy as follows:

    In all cases of ptosis the patient must be kept in bed with warmth to feet, and taught the tensing exercises. The knee-shoulder position must be practiced often every day.

    After the morning exercise, a warm sponge bath, followed with dry towel rubbing; then back to bed, to be followed with exercise every three hours. Patients in full weight should fast for a week, and when the tongue is coated, a stomach lavage every morning for a week; a two-quart warm-water enema every night for a week and after the first week a pint salt-water enema may be used every night until the bowels are regular. It should not be forgotten that as soon as enervation is overcome, secretions and excretions will be established, after which the bowels will function. Every forcing measure used to move the bowels, even the larger enema, enervates and delays recovery. Sometimes, in nervous subjects who are more constipated in their minds than in their bodies, a little forcing may be necessary for the psychological effect. Those in full flesh should fast until well cleaned up.

    Correct all constipating habits. All stimulants--tobacco, coffee, tea and overeating, as well as improper eating--must stop. Exercise must be practiced daily--often enough and long enough at a time to restore tone to the entire body.

    Patients should be free from discomfort for two days, then give orange juice three times a day. If the patient is heavy, overweight, he should fast for a week or two before beginning on the fruit. A daily enema should be used until food other than fruit is being eaten.

    The first food besides fruit should be dry toast, followed with a pint of teakettle tea, and given morning, noon and night; after the first day a dish of prunes may be eaten with the breakfast; this eating is to be continued for two or three days, then for noon or night dinner give lamb or chicken stew, cooked spinach or onions, and one other succulent vegetable, and a Tilden salad. This meat dinner is to be used every other day, and after a week other meats, eggs, and fish may be used.

    The object in eating should be to keep as nearly normal as possible; overeating leads to faulty elimination--constipation.

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