If any part of the digestive function is deficient, impaired health, or mental and physical inefficiency expressed in the form of indigestion, is the result. If the bowel is at fault, constipation is the usual consequence. A perfectly healthy living machine must maintain a perfect digestion and regular bowel movements.

THE FUNCTION OF THE STOMACH is to mix and churn the food, and to add certain ingredients to the mixture so that before it is carried into the intestines it is (as far as it is the stomach's duty to render it) ready to be absorbed into the system. Before it reaches that part of the intestine which absorbs, it is acted upon again and certain other ingredients are added to it by certain other digestive organs. In time it is in shape to be used and it is sent along on its way. As it pa.s.ses onward the little sucking glands in the wall of the bowel suck up all the liquid element in the ma.s.s of food. The liquid element in the ma.s.s is the food itself, rendered liquid by the stomach and other digestive organs and juices. The remaining solid ma.s.s is that part of the food which the body cannot use and does not want. By the time the liquid element is absorbed, the solid ma.s.s (always kept moving by the bowel wall) has reached the r.e.c.t.u.m, ready to be pa.s.sed out at once, or very soon, provided--and upon this provision depends the success of the entire process,--it has all been done within a certain time. If the stomach takes too long to do its work we have indigestion. If the bowel takes too long to do its work we have constipation.

FERMENTATION.--Now let us consider the matter from another standpoint.

If food stays too long in the stomach it begins to ferment. When anything ferments it makes and evolves gas. You, no doubt, have noticed many times how the cork pops out of a bottle if its contents are "working," or fermenting. If you watch that bottle you will notice that it is quietly or actively evolving air bubbles. That is gas,--gas manufactured by the process of fermentation. This is exactly the process that goes on in the stomach or bowel of a dyspeptic, and it is this collection of foul, poisonous gas that causes the distress and bloated feeling which every dyspeptic suffers from after eating,--if it is this "flatulent" type of indigestion which is present.

THE SIGNIFICANCE OF CONSTIPATION.--If the food takes too long to pa.s.s through the bowel it causes, as we have stated, constipation. What is the real significance of constipation? It means that in pa.s.sing through the bowel the food has given up all its liquid element (which is all its nourishing element), but the bowel has been too slow in pa.s.sing it along. Consequently it is not ready to be expelled while it is yet a harmless semi-solid ma.s.s. It stays in the bowel too long--it begins to putrefy, bacteria attack it, and it is soon a semi-liquid, foul, rotting ma.s.s. The sucking glands in the intestinal wall continue to suck--that is their duty. They cannot discriminate between what is good and what is bad--they simply go on absorbing whatever is there to absorb. So there are absorbed into the system liquid and gaseous products which are poison.

This process has been called by a number of names; "self-poisoning"

explains the condition thoroughly. The other names are, auto-infection, auto-intoxication, enteric-infection, enteric-toxemia, intestinal indigestion.

The condition is a serious one, because it is absolutely impossible to feel well, or to enjoy good health, while it lasts. The feeling of being constantly sick, yet not sick enough to stop working or to demand a radical cure, affects a woman's efficiency, interferes with her capacity to work, her ability to render the home an abode of contentment, to be an agreeable companion, or to adequately take care of her children.

The constant absorption of intestinal poisons affects the system itself,--the symptoms are headache, neuralgia, loss of appet.i.te, nervousness, insomnia, vertigo, inability to concentrate, la.s.situde, indigestion. The condition which we name constipation is therefore one of supreme importance. From a medical standpoint, it is the biggest problem in the whole realm of disease. It is the most significant hygienic function of life, and it is becoming more and more important, and more and more a problem. Every modern factor upon which physical efficiency seems to depend is an enemy to the systematic regulation of this function. Our method of hurried and indiscriminate eating, our system of strenuous living, our unsanitary environment, our business activity, our method of pursuing pleasure, take no account of, and resent the time devoted to cultivating, as a hygienic necessity, this toilet requirement. This imperative call of nature is pushed aside by the child at play, by the housewife for a duty which could wait, by the merchant for an engagement. It is particularly an American disease, and it is uniquely an American woman's affliction. It is a curious commentary on the intelligence of the American people, who are ordinarily alert and a.n.a.lytical, to realize how few of them really know how serious a matter constipation is. They don't know because they have given the matter absolutely no thought. They have accepted it as a mere matter of fact, almost of fate.

INCOMPLETE CONSTIPATION.--There is a type of constipation that is not known to the average person and not well understood by those few who know of its existence. In this form of constipation there is a daily bowel movement but the movement is not complete. The bowel does not thoroughly empty itself; it has established this habit because of conditions under which it has had to do its work. If a woman neglects herself, becomes muscularly inactive, does not take proper out-door exercise, grows fat and lazy, eats irregularly and indiscriminately,--the bowel suffers with the rest of the system. The woman may have a healthy appet.i.te, may eat the wrong things at the wrong time, yet the bowel is supposed to go on acting rightly, but it does not. It, too, becomes lazy and acquires bad habits, and this form of incomplete constipation is the result. These patients look healthy and get little sympathy for any pains they may have. They may even gain in weight; they get headaches once in a while, and if they go shopping or visiting they don't feel quite well afterward. They are suffering from the effects of chronic constipation, though their bowels are apparently regular. They are marching onward toward apoplexy or Bright's disease of the kidney.

IMPORTANCE OF A CLEAN BOWEL.--Every mother, sooner or later, observes that a physician always thoroughly cleans out the bowel of a sick child at once, no matter what the character of the sickness is. He does this for two reasons,--first, because he knows that the great majority of children's ailments are of gastro-intestinal origin; second, if the origin of the disease is not in the stomach or bowels, experience has taught him that if the bowels are clean at the beginning of a disease, that disease will run a milder and shorter course than if complicated with a condition of self-poisoning. If a child develops fever the digestive function stops; whatever food is in the stomach or bowel will promptly ferment and putrefy because of the abnormal heat caused by the fever and the arrested digestion. If this is not cleaned out at once the self-poisoning process begins.

The above is a suggestive admission for a physician to make. It simply means that the vast majority of the calls made by a physician on ailing children are caused by errors in diet and can be completely cured by a dose of castor oil or calomel, or, better still, need never occur.

A mother who neglects, who is guilty of inattention to the conditions of her child's bowel, fails in one of the most important duties of motherhood. I know as a father and a physician that if a child's bowel acts regularly and thoroughly, that child is fortified to the highest efficient degree against the mult.i.tude of little ailments common to all children. A clean bowel means good blood, good digestion, ability to exercise properly, to sleep soundly and to think clearly. Such a child will resist infection and throw off the minor troubles that pave the way for serious sickness. It is a secret worth knowing.

A DAILY MOVEMENT OF THE BOWEL NECESSARY.--In order to preserve good health one thorough movement of the bowel is necessary daily. A baby may have two or three and enjoy robust health. A larger daily number suggests an abnormal condition of the bowel and an investigation should be made. If a nursing baby's bowels do not move before bedtime it should be given an injection of equal parts of glycerine and hot water, one-half cupful; or an enema of soap and water, or a glycerine suppository. When a child is six months old, in some sooner, it should be put on the stool at a certain time every morning. This will aid in the establishment of the habit, as a child soon understands why it is made to a.s.sume this position and acts accordingly.

The condition referred to above and which we termed incomplete constipation may affect the nursing infant. A child's bowels may move daily and yet the child will suffer from constipation. If the movements are watched it will be observed that certain children strain when at stool, and after a time succeed in pa.s.sing hard, dry lumps or b.a.l.l.s of fecal matter. Such a movement is a certain indication that the bowel is not emptying itself satisfactorily and that a constant toxemia or poisoning is going on. Very faithful efforts should be made to remedy this condition by the use of articles of diet that are known to be laxative, otherwise the condition is one that will "grow" with the child and establish an obstinate chronic constipation with all its miseries and dangers.

CONSTIPATION IN BREAST-FED INFANTS.--Many nursing infants thrive and gain in weight, yet they are constipated. Before you drug your baby be sure the fault is not your own. Many mothers are responsible for the constipation with which baby suffers. If the mother is constipated, so will the child be. Cure the constipation of the mother and the baby's bowels will regulate themselves. Nursing mothers who are large tea-drinkers have irregular bowels as a rule. A baby whose mother is lazy or indolent, who does not take a reasonable amount of exercise, whose diet is faulty and whose hours are bad, is a sufferer from constipation. The mother's life must be regulated, her diet and habits corrected, and the instructions carried out as already recommended. The breast milk should be examined and if any cause for constipation exists in it, it should be rectified as suggested elsewhere.

If it is thought advisable to resort to drugs for the immediate relief of the constipation of infants, the best ones are the aromatic fluid extract of cascara sagrada; milk of magnesia with equal parts of the aromatic syrup of rhubarb given in doses of one to three teaspoonfuls daily.

Irrigations, enemas, and suppositories should not be used continuously.

The habit is a bad one. The parts become accustomed to their use and fail to act. If the child is pa.s.sing dry and hard stools it is of advantage to inject two ounces of warm sweet oil at night, allowing it to remain in the bowel until the following morning. See page 312.

CONSTIPATION IN BOTTLE-FED INFANTS.--It is much easier to treat the constipation of bottle-fed babies than of those breast-fed, because the food can be changed to ensure regular bowel movements. The first change to be made in a bottle-fed baby who is habitually constipated is to add more cream to the food. The way to do this is to take out of the bottle of each feeding one tablespoonful of the food and put in its place one tablespoonful pure cream. If this change partly rectifies the bowel ailment, add more cream until the bowels are of the proper consistency.

Milk given constipated babies should be raw, never boiled, as boiled milk will always aggravate the trouble.

The use of oatmeal water instead of plain water in making the baby's food may cure the bowel trouble. Taking the sugar of milk out of the baby's food and putting in its place the same quant.i.ty of Mellin's food will sometimes cure the constipation.

One or two teaspoonfuls of milk of magnesia put into one feeding daily, or fifteen drops to one tablespoonful of the aromatic fluid extract of cascara sagrada will move the bowels. Orange juice, strained, two teaspoonfuls twice daily, is an excellent remedy and should be tried in every case. Sweet oil and pure cod liver oil, in doses of thirty drops to two teaspoonfuls three times daily after feedings, if the little patient is poorly nourished. If the stools remain hard and dry, an injection of two ounces of warm sweet oil at bedtime is an excellent method of aiding the bowel. The oil should remain in the bowel all night. This lubricates the parts, softens the fecal ma.s.s and stimulates the gut to perform its own work. See page 312.

CONSTIPATION IN CHILDREN OVER TWO YEARS OF AGE.--Most children when put upon a varied diet after the nursing days are over are relieved of any constipation which may have existed up to that time. There are a few, however, whose condition does not seem to improve. These children need attention. We should first insist on regular habits. A child should be told that its bowels must move every morning after breakfast. If this is absolutely insisted upon the child will soon recognize the uselessness of fighting the proposition and submit. If at any time a conscientious effort is made to move the bowel without result after fifteen minutes it is wise to use a glycerine suppository so that the bowel will empty itself.

It has been stated in another part of this book that there are children with whom milk does not agree. Experience has taught us that milk, especially milk that has been boiled, causes more cases of constipation in growing children than all other causes combined. Find out if it is milk that is the cause in any individual case. While these children cannot take whole milk just as it comes from the dairy without suffering in a great many ways, they can take milk and water, or milk and oatmeal water, prepared in the following way, without becoming constipated. A bottle of fresh milk is allowed to stand in a cool place for five hours, when the top ten ounces are skimmed off with a Chapin dipper and mixed with twelve ounces of oatmeal gruel or plain water. This can be used as a drink.

Parents can select from the following list of articles such combinations as may be suitable to const.i.tute the regular meals of a constipated child:

Lamb chops.

Rare steak.

Rare roast beef.

Hashed chicken.

Soft boiled eggs.

Cracked wheat.

Hominy.

Cornmeal.

Oatmeal, Scotch.

Bran biscuits.

Oatmeal crackers.

Graham wafers.

Stewed or baked apple.

Apple sauce.

Plain vanilla ice cream.

Animal broths, purees of peas.

Beans, and lentils.

Peas.

String beans.

Spinach.

Cauliflower.

Asparagus.

Stewed tomatoes, strained.

Whole wheat bread.

Zwieback.

Custard.

Stewed prunes.

Junket.

Cornstarch.

Malted milk is agreeable and advisable as a drink.

Orange juice or a sc.r.a.ped raw apple is allowable at this time.

Constipated children should eat plenty of good b.u.t.ter. Olive oil, two or three teaspoonfuls after each meal, is excellent. It can be kept up for months to advantage. Older children may eat raw and cooked fruits, figs, dates, baked potatoes, poultry, and fish. One or two raw apples or a peach or orange may be given daily. A strict observance of the above rules and diet will result in normal movements of the bowel if persisted in for a reasonable time. It may be necessary occasionally to use a suppository or an enema now and again until the habit is established.

In children from five to fifteen years of age the use of bran m.u.f.fins, with fruit, etc., as described above, will effect a cure of constipation without having to resort to drugs. I have cured many cases of constipation in growing children with these m.u.f.fins without making any other change in their diet or habits.

RECIPE FOR BRAN m.u.f.fINS

Take one pint of best flour, one quart unsifted bran, one teaspoonful bicarbonate of soda (baking soda), a pinch of salt.

Mix these thoroughly together, then add: six to eight tablespoonfuls good, New Orleans mola.s.ses, one pint of milk.

Mix together very thoroughly. Put in m.u.f.fin rings and bake in oven. About one ounce should be put in each ring as they raise easily. Eat with plenty of good b.u.t.ter. They should be given to children before each meal, when they are hungry, not after their stomachs are full. Put bran in dish first. Sift in flour, soda and salt. Mix these thoroughly together, then add one pint of milk (two cupfuls) and six to eight tablespoonfuls of New Orleans mola.s.ses. The quant.i.ty of mola.s.ses depends upon the individual taste. They are good for any child or adult whether constipation exists or not.

Drugs may be of temporary service in some cases. A pill of cascara sagrada is the best for this purpose. It should not be continued for more than two weeks. Castor oil, calomel, and other frequently-used cathartics should never be used in simple constipation.

TREATMENT OF OBSTINATE CONSTIPATION

There are cases that resist treatment of the kind described above. Diet and drugs do not succeed in establishing the habit of daily bowel movements. In these cases radical treatment is imperative. The diet should be the same as that described above, but it will be found advisable to cut out milk altogether. Cereals can be taken with sugar and b.u.t.ter instead of milk. The oil injection plan of Professor Kerley has given me excellent results. I quote his comments upon and method of giving it:--