THERE is a widespread notion abroad, that if the bowels are not relieved once a day something dreadful will happen. This is one of the difficulties homoeopathic doctors have to contend with when treating new converts for an acute illness. Circumstances alter cases, and under altered conditions it is not to be expected that all functions will continue to go on as before. Nor is it necessary. Therefore, the old notion that if the bowels do not act every day they must be punished and made to do so like disobedient children, is a relic of barbarism that must be done away with. Nature must be led and not driven if we are to expect curative results.
There is, however, a germ of truth in the popular idea. Given normal conditions, it is desirable that the bowels should be evacuated sufficiently at regular intervals. This is so far a justification for the pill-makers: it is only their method of remedying the difficulty, when such exists, that is at fault. Let us consider the conditions.
The contents of a motion or excreta, as they are very properly called, consist of waste materials. They are not composed, as is popularly imagined, of portions of the food which are not digested. When food can be identified, it is an indication that the digestive process is imperfect, and constitutes a condition termed lienteria. Normally all the food is altered by the digestive juices, and taken up by the lymphatics and blood- vessels, which carry it to all the tissues of the body, and carry away from them the waste products which are incapable of any further useful combination in the body. These are passed off by the lungs, skin, kidneys, and bowels. But it is the mucous membrane of the intestines and its glands that separate the fecal-matter from the blood-vessels, and it is this excretion which, with any absolutely indigestible substances that may have been eaten, constitutes the stool.
All the excretions of the body are poisonous, and if unduly retained are apt to set up poisonous symptoms. It is the same with the fecal matter: if it is not got rid of at the proper time, reabsorption takes place to some extent, with the result that many disagreeable sensations may be experienced, prominent among them being headache and malaise. In rare instances, as Dr. Burford has pointed out, the use of an enema has brought on fecal poisoning in the shape of an attack of fever with eruption, lasting a day or two. The explanation of this is that the fluid of the enema has rendered the waste materials of the stool more soluble, and before the muscular coat of the intestine has reacted to the stimulus and expelled the motion, the mucous membrane has reabsorbed some of the poisonous material. Hence I say the popular idea that the daily action is a sine quanon of existence is not without some foundation of fact. But I hasten to add that it is not by any means universally true. There is no absolute rule in the matter. Constipation is an entirely relative term; every man is a law to himself. This may be laid down as a rule: However long a person may go between the actions, so long as the actions are without difficulty, and in the interval he experiences no unpleasant symptoms, there is no constipation. Many persons can go two, three, and even four days and longer, without any ill effect, and for them to worry their intestines with purgatives to obtain an action every day is the worst possible policy. Other people again, must have at least two motions a day to be comfortable; and so long as the motions are normal, they can no more be said to have diarrhoea than the others can to have constipation.
By the word “constipation” I understand the habitual retention of the feces beyond the time proper to the individual; or, difficulty or pain in the passage of motions, whether unduly retained or not.
Constipation may be due to a great variety of causes, and due regard must be had to these if it is to be successfully treated. Five leading factors in the physiology of the function are: (1), The muscles of defecation, chiefly the diaphragm and the abdominal muscles; (2), the muscular wall of the intestines, and chiefly of the lower portion; (3), the mucous membrane of the bowels; (4), the secretions of the liver and pancreas which are poured into the bowel; and (5), the condition of the anal orifice. Defects in any one of these particulars may lead to constipation. All these elements are under the control of the systemic nerves, and nervous affections are often accompanied by constipation.
Heredity has often a great deal to do with the tendency to the disease, but there is no use in accepting morbid inheritances as if they were inevitable. If medical men were never able to remedy affections that are hereditary they would be of little use in the world. Irregular habits of life are responsible for many cases of the kind; improper food and drink, exposure and hardships for others, and for yet others, poisonous trades and improper medicines.
The varieties of constipation are endless, and attempts to classify them are not of much practical value. I shall illustrate a number of them in later chapters. Before closing this one, it may be useful to say a word on the terminology. “Constipation” and “costiveness” are generally used as synonymous terms. They may be used sometimes with slightly different shades of meaning by some writers but practically they mean the same thing. The word “obstipation” is used for cases where the degree is extreme. “Stoppage” or “intestinal obstruction” means some local mechanical interference with the passage of feces through the bowel. This is a comparatively rare condition, and is accompanied with a good deal of danger depending on the nature of the obstruction.
