Part 15 (1/2)
THE BUGABOO OF CONSTIPATION
Popular Superst.i.tions
In line with the taboos connected with the taking of food are the ceremonials attendant upon its elimination. Taking anxious thought about functions well established by nature is a feature of conversion-hysteria, the displacement of emotional desire from its psychic realm into symbolic physical expression. Whatever other symptoms nervous people may manifest, they are almost sure to be troubled with chronic constipation. It is true that there are many constipated people who do not seem to be nervous and who resent being cla.s.sed among the neurotics. Everybody knows that the occasional individual who has difficulty in swallowing his food is nervous and that the, trouble lies not in the muscles of his throat but in the ideas of his mind. But very few people seem to realize that the more common individual who makes hard work of that other simple process-elimination of his intestinal waste matter-is suffering from the same kind of disturbance and giving way to a nervous trick. When all the facts are in, the constipated person will have hard work to clear himself of at least one count on the charge of nerves.
An Oft-told Tale. Sooner or later, then, the neurotic, whether he calls himself a neurotic or not, is very likely to begin worrying over his diet or his sedentary occupation. He imagines himself the victim of autointoxication, afflicted with paralysis of the colon or dearth of intestinal secretions. He leaves off eating white bread, berries, cheese, chocolate, and many another innocent food, and insists on a diet of bran-biscuit, flaxseed breakfast-foods, prunes, spinach, cream, and olive-oil with doses of mineral oil between meals. In all probability, he begins a course of ma.s.sage or he starts to take extra long walks and to exercise night and morning, pulling his knees up to his chin and touching his fingers to his toes. When all these measures fail, he gives in to the morning enema or the nightly pill, in imminent danger of succ.u.mbing to a life-long habit.
The Truth About Constipation
What the Colon Is For. It is well, then to have a fair understanding of the structure and purpose of our intestinal machinery. Contrary to general opinion, the intestines are not a dumping-ground but a digestive organ. After the food is partly digested in the stomach, it pa.s.ses through a twenty-two foot tube (the small intestine) into a five-foot tube (the large intestine or colon) where digestion is completed, the nutriment is absorbed, and the waste matter is pa.s.sed on and out through the r.e.c.t.u.m. As the food pa.s.ses along the colon, pushed slowly ahead by the peristaltic wave, or rhythmic muscular contractions of the intestinal wall, it is seized upon by the four hundred varieties of friendly bacteria which inhabit the intestines of every healthy person, and is changed into a form which the body can a.s.similate. Digestion in the stomach and small intestine is carried on by means of certain digestive juices, but in the large intestine it is the bacteria which do the work. Without them we could not live.
Around the colon is a thick network of little blood vessels, all of which lead straight to the liver, the storehouse of the body. After the food is fully digested, it is pa.s.sed through the thin intestinal wall into these tiny vessels and carried away to liver and muscles for storage or for immediate use.
This process of absorption is carried on throughout the whole length of the colon. Not until the very end of the intestine is reached is all the nutrition abstracted. The bowel-content can properly be called waste matter only after it has reached the r.e.c.t.u.m or pouch at the lower end of the colon. Even then, this waste matter is not poison, but merely indigestible material which the body cannot handle.
Food, not Poison. The colon is not a cesspool but a digestive and a.s.similating organ. Its content is not poison but food. Active elimination is important not so much because delay causes autointoxication or poisoning as because too large a ma.s.s is hard to manage and irritates the intestinal wall. The problem is not so much one of toxicology as of simple mechanics. If Nature had put within the body five feet of tubing which could easily become a cesspool and a breeder of poison, it is not at all likely that she would have laid alongside an elaborate system of blood vessels leading not out to the kidneys but into the storehouse of the liver; and if civilized man's changed manner of living had so upset Nature's plans as easily to transform his internal machinery into a chronic source of danger, we may be sure that he would long ago have gone the way of the unfit and succ.u.mbed to his own poisons.
Possible Invasions. It is true that the intestinal tract, like the rest of the body, is open to attack by harmful bacteria. But in a great majority of cases, these enemy bacteria are either quickly destroyed by the beneficent microbes within or are immediately cast out as unfit. Any germs irritating to the intestinal wall cause the mucous membrane to produce an unusual flow of mucus which washes away the offending bacteria in what we call a diarrhea. [52]
[52] If the invading army proves obstinate and the diarrhea continues a day or so, it is wise to a.s.sist Nature by a dose of castor-oil, which gives an additional insult to the intestinal wall, spurs it on to a desperate effort, and hastens the cleansing process. In severe cases the more promptly the castor-oil is administered the better. Such emergency measures are very different from the habitual use of insulting drugs.
Sometimes the wrong kind of bacteria do persist, causing anemia, rheumatism, sciatica, or neuritis. When these disorders are not the result of infection from teeth, tonsils, or other sources of poison, but are really caused by intestinal bacteria, I have found that a diet of b.u.t.termilk (lactic acid bacteria), with turnip-tops or spinach to supply the necessary mineral salts, often succeeds in planting the right bacteria and driving out the disturbing ones. These disorders are invasions from without, like tuberculosis or malaria, and are as likely to attack the person with easy bowel movements as the one with the most chronic constipation.
Autointoxication. A good deal of the talk about autointoxication is just talk. It sounds well and affords an easy explanation for all sorts of ills, but in a large majority of cases the diagnosis can hardly be substantiated. Uninformed writers of newspaper articles on the care of the body, or purveyors of purgatives or apparatus for internal baths are fond of dilating on the ”foulness of the colon” as a leading cause of disease. As a rule, they advise either a strict diet, some kind of cathartic, or an elaborate process of was.h.i.+ng out the colon to clear the body of its terrible acc.u.mulation of poisons.
Cathartics and Enemas. He who makes a practice of flus.h.i.+ng out his intestinal tract with high enemas and internal baths is like a person who eats a good dinner and then proceeds to wash out his stomach. In the mistaken idea that he is making himself clean, he is was.h.i.+ng what was never intended to be washed and robbing the body of the nutrition which it needs. And the man who persists in the pill habit is making a worse mistake, adding insult to injury and forcing the mucous membrane to toughen itself against such malicious attacks.
Cathartics and Operations. Even in emergencies, the use of purgatives as a routine measure is happily decreasing year by year. For many years I have deplored the use of purgatives before and after operations. That other pract.i.tioners are coming to the same conclusion is witnessed by a number of papers recently read in medical societies condemning purgation at the time of operation.
Among the most favorably received papers of the California Medical Societies have been one by Emmet L. Rixford, surgeon of the Stanford University Medical College, read before the Southern California Medical Society at Los Angeles December 8, 1916, and one by W.D. Alvarez at the California Medical Society, Del Monte, 1918,-both condemning the use of purgatives as a routine measure before operations. An article ent.i.tled the ”Use and Abuse of Cathartics” in the ”Journal of the American Medical a.s.sociation” admirably summarizes the disadvantages of purgation at such a time. [53]
[53] ”1 Danger of dissemination of infection throughout the peritoneal cavity, in case localized infection exists.
”2 Increased absorption of toxins and greater bacterial activity by reason of the fact that undigested food has been carried down into the colon to serve as pabulum for bacteria, and that liquid feces form a better culture medium than solid feces.
”3 Increased distention of the intestine with gas and fluid, when it should be empty....
”4 Psychic and physical weakness produced by dehydration of the body, disturbance in the salt balance of the system, and the loss of sleep occasioned by the frequent purging during the night preceding the operation. As Oliver Wendell Holmes says: 'If it were known that a prize fighter were to have a drastic purgative administered two or three days before a contest, no one will question that it would affect the betting on his side unfavorably. If this be true for a powerful man in perfect health, how much more true must it be of the sick man battling for life.'
”5 Increase in postoperative distress and danger: thirst, gas pains, and even ileus....”-Journal of American Medical a.s.sociation, Vol. 73, No. 17, p. 1285, Oct. 25. 1919.
Four years ago I was called to a near-by city to see a former patient who two days before had had a minor operation,-removal of a cyst of the breast. She was dazed, almost in a state of surgical shock and very near collapse. I found that she had been put through the usual course of purgation before operation and starvation afterward, and I diagnosed her condition as a state bordering on acidosis, or lowering of the alkaline salts of the body. I ordered food at once. She rallied and recovered.
A few months later this same woman had to undergo a much more serious operation for multiple fibroids of the uterus and removal of the appendix. This time I advised the surgeon against the use of any purgative, and he took my remarks so seriously that he did not even allow an enema to be given. This time the patient showed no signs of exhaustion and had very few gas pains. I firmly believe that the day will soon come when a patient under operation, or a patient after childbirth, will no longer be depleted by a weakening and dehydrating cathartic and by a period of starvation, at a time when he needs all the energy he can summon.
Cathartics and Childbirth. The article referred to in the ”Journal of the American Medical a.s.sociation” cites the experiences of Dr. R. McPherson of the Lying-in Hospital of New York, ”who showed that the routine purgation after confinement is not only useless but harmful. Of 322 women who were not purged, only three had fever (and one of them a mammary abscess); most of them had normal bowel movements and those who did not were given an enema every third day. Of 322 women who were delivered by the same technique and the same operators but were purged in the usual routine manner, twenty-eight had some fever.” This experience of one physician is corroborated by that of others who find that the more we tamper with the natural functions in time of stress the harder do we make the recuperative process. There are certainly times when catharsis is necessary but ”one thing is certain, the day for routine purgation is past.” [54] Even in emergencies we need to know why we administer cathartics and in chronic cases we may be sure that they are always a mistake.
[54] Ibid, p. 1286.
”An Old Trick.” Before we make a practice of interfering with Nature's processes, it is well to remember how old and stable those processes are. As long as there has been the taking in of food, there has been also the casting out of waste matter. The sea-anemone closes in on the little mollusk that floats against its waving petals, a.s.similates what it can and rejects the rest. In the long line from sea-anemone to man, this automatic process of elimination has gone on without a hitch, adapting itself with perfect success to the changing habits of the varying types of life. So old a process is not easily upset. And, be it noted, in the human body this automatic, involuntary process still goes on with very little trouble until it reaches a point in the body where man, the thinking animal, tries to control it by conscious thought.