' S A 
TREATISE 
ON THE 
CAUSES AND CONSEQUENCES 
OF 
HABITUAL CONSTIPATION. 
BY JOHN BURNE, M.D. 
Hk 
FELLOW OF THE BOYAL COLLEGE OF PHYSICIANS, PHYSICIAN TO THE 
WESTMTNSTEB HOSPITAL, ETC., ETC., ETC. 
PulaMplifa: 
HASWELL, BARRINGTON, AND HASWELL, 
293 MARKET STREET. 
NEW ORLEANS: JOHN J. HASWELL & CO. 
1 840. PREFACE. 
The object of this Treatise is to direct attention to ha- 
bitual constipation as a very frequent cause of general 
and of local disorder and disease; a subject but partially 
considered and investigated hitherto. 
For some interesting cases illustrative of parts of this 
work I am indebted to Dr. Williams, Dr. Stroud, Mr. Cal- 
laway, Mr. Morgan, Mr. Taunton, Dr. Roots, Sir Astley 
Cooper, Sir Benjamin Mr. Tupper, Mr. Bailer, 
Dr. Paris, Mr. Dendy, Dr. Hen. U. Thomson; to all of 
whom I return my grateful thanks. 
To the late Mr. Jukes of Stourport, Worcestershire, I 
am under great obligation not only for the valuable cases 
supplied by him, but for personal kindness shown to me on 
many occasions. I gladly avail myself of this opportunity 
to express my respect and regard for the virtues and abili- 
ties of that estimable man. 
J. B. 
24, Lower Brook Street, 
February 1, 1840. CONTENTS. 
INTRODUCTION -------- P. 13 
CHAPTER I. 
OF THE DISPOSITION, RELATIONS, ORGANIZATION, AND FUNCTIONS OF 
THE LARGE INTESTINE ------ - 16 
CHAPTER II. 
GENERAL REMARKS UPON, AND VARIOUS CONSEQUENCES OF HABITUAL 
CONSTIPATION. 
Inconvenience of Constipation.—Habitual Constipation a Source of general Dis- 
order and of local disease.—Tumours of the Breast dissipated.—Loaded Colon 
mistaken for Disease of the Liver.—Congestion of the Portal System and Disease 
of the Liver.—Hypochondriasis.—Neuralgia.—Epilepsy.—Spasmodic Contrac- 
tions of Muscles.—Duration of Constipation 21 
CHAPTER III. 
OF THE CONSEQUENCES OF HABITUAL CONSTIPATION ON THE GENE- 
RAL HEALTH 31 
CHAPTER IY. 
OF SICK-HEADACH, OR CEPHALALGIA WITH GASTRO-HEPATIC IRRI- 
TATION, SYMPATHETIC OF HABITUAL CONSTIPATION - - 42 
CHAPTER V. 
OF DISEASES OF THE STOMACH AS CONSEQUENCES OF HABITUAL CON- 
STIPATION. 
Indigestion. Gastrodynia. Pyrosis. Subacuto-chronic inflammation and or- 
ganic disease of the stomach - 46 10 
C ONTENTS. 
CHAPTER VI. 
OF THE CONSEQUENCES OF HABITUAL CONSTIPATION ON THE SEXUAL OR- 
GANS IN THE FEMALE, THROUGH THE SYMPATHY OF CONTIGUITY. 
Hyperaesthesia and Hypertrophy of the Womb. Dysmenorrhcea. Menorrhagia. 
Amenorrhoea. Leucorrhcea. Abortion. Miscarriage. Supposed preg- 
nancy -------66 
CHAPTER VII. 
OF DISEASES OF THE AND COLON AS CONSEQUENCES OF HABITUAL 
CONSTIPATION. 
Colic. Diarrhoea. Dysentery. Ileus. Accumulation of Feces. Obstruction. 
Displacement. Inflammation, acute, subacute, and chronic. Ulceration. 
Hypertrophy or thickening with induration and contraction. Stricture 77 
CHAPTER VIII. 
OF DISEASES OF THE RECTUM AS CONSEQUENCES OF HABITUAL 
CONSTIPATION. 
Impaction of feces in the rectum. Dilatation of the rectum. Prolapsus ani. 
Piles. Fissures. Fistula. Rigidity of the sphincter ani. Stricture. Supposed 
stricture. - - 92 
CHAPTER IX. 
C UTANEOUS DISEASES, AS CONSEQUENCES OF HABITUAL CONSTIPATION. 
Erysipelas—Erythema nodosum. Psoriasis. Impetigo. Acne - 106 
CHAPTER X. 
OF THE CAUSES OF HABITUAL CONSTIPATION. 
Inattention to the calls ofNature. The want of proper conveniences. Civilized 
life. Sedentary habits and occupations. Literary pursuits. Travelling. 
Pathological and mechanical causes. - - - - - " 110 
CHAPTER XI. 
OF THE TREATMENT OF HABITUAL CONSTIPATION. 
SECTION I. 
Peculiarities as regard the action of the bowels in some persons. Early rising. 
Habit of frequenting the closet regularly and of obeying the calls of nature. 
Exercise. Change of scene. Diet - - - - - - 128 CONTENTS. 
11 
SECTION II. 
ON THE USE OF APERIENT MEDICINES. 
As relates to age, sex, temperament, idiosyncrasy. Choice of aperient medicines. 
Frequency of their administration. Period of the day - 132 
SECTION III. 
OF THE ACTION AND VALUE OF APERIENT MEDICINES ADMINISTERED SINGLY OR 
IN COMBINATION. 
Sulphur. Magnesia. Rhubarb. Jalap. Aloes. Colocynth. Scammony. 
Camboge. Castor oil. Saline aperients. Senna - - - - 136 
SECTION IV. 
OF MEANS APPLIED TO THE LARGE INTESTINE. 
The Bougie. Lavements. Suppositories - - - - . 147 
SECTION V. 
OF THE TREATMENT OF OBSTRUCTION OF THE BOWELS - 150 
CHAPTER XII. 
ON THE INFLUENCE OF CONSTIPATION, AND OF THE ACCUMULATION 
OF MORBID SECRETIONS AND FECAL MATTERS IN THE LARGE 
BOWELS IN PREDISPOSING TO AND EXCITING THE MORE PREVALENT 
diseases of india : namely, congestion, inflammation, and 
ABSCESS OF THE LIVER, DIARRHOEA, DYSENTERY, AND ORGANIC 
DISEASES OF THE LARGE INTESTINE .... 154 OF 
THE CAUSES AND CONSEftUENCES 
OF 
HABITUAL CONSTIPATION. 
INTRODUCTION. 
Upwards of twenty years have now elapsed since my attention 
was directed to the influence of disorders of the digestive organs 
upon the general health by the admirable lectures of Mr. Abernethy. 
From the hour I first listened to the doctrines of that distinguished 
teacher, my mind has been so impressed with their importance, 
that I have taken advantage of every opportunity to test their 
general accuracy, and to investigate, in a more special manner, the 
sources of the numerous derangements comprised in disorders of 
the digestive organs. 
I had pursued this inquiry but a short time, when I was struck 
with the frequency of one particular cause, which could be traced 
as the only one in operation from the period of health to the esta- 
blishment of the disorders the subjects of investigation. I found, 
moreover, that these disorders ceased on the removal of this the 
presumptive cause; and thence concluded that they stood in the 
relation of effect to such cause. 
Next I discovered that this same cause had existed through a 
long period in diseases apparently only remotely connected with it; 
and then proceeded to ascertain its relation to these diseases, by 
tracing back, step by step, the manner of their formation: and the 
evidence which has resulted authorises me to attribute the origin 
and establishment of these diseases to the continued operation of 
the cause in question; namely, Habitual Constipation. 
Arrived at the belief that habitual constipation is capable of pro- 14 
BURNE ON HABITUAL CONSTIPATION. 
ducing very many disorders, I have devoted much time and atten- 
tion to discover the range of its influence and to inquire into its more 
immediate and remote effects : and the information obtained enables 
me to particularise a list of complaints which may reasonably, I 
think, be regarded as the consequences of habitual constipation. 
Nor have I presumed to reach this conclusion without having seen 
disease on an extensive scale at a dispensary and at a general hos- 
pital, independent of private practice, on a scale which has afforded 
an ample field for the observation and experience requisite to justify 
new views, and to form sound opinions. 
Of the disorders alluded to, some are the result of universal sym- 
pathy ; some of contiguous, others of remote, sympathy ; and some 
of physical irritation, and of direct mechanical operation. 
As the result of universal sympathy, may be enumerated those 
disordered conditions of the general health which predispose to any 
inveterate, or even malignant, disease, the local development of 
which, accident or other cause, may determine. 
Of contiguous sympathy are irritation of the sexual organs in 
men ; and many very serious affections of the sexual organs in 
women, as irritation, tenderness, and hypertrophy of the uterus; 
irregular menstruation ; abortion; leucorrhoea. Of remote sym- 
pathy are indigestion ; sick-headach; pyrosis; erysipelas; neuralgia; 
and spasmodic contraction of muscles, as of the jaw producing 
trismus, and of the extremities producing deformity. Of physical 
irritation are spasmodic colic ; rigidity of the sphincter ani; fistula 
ani; stricture of the rectum or other part of the large intestine; 
tenesmus ; dysentery ; and symptoms simulating strangulated her- 
nia. Of direct mechanical operation are dilatation of the rectum; 
haemorrhoids; and prolapsus ani. 
It gratifies me to find in the elaborate work of Dr. Good, that 
constipation is regarded as a cause of various complaints. “ The 
effects of constipation when long continued, are,” he says, “ pains 
in the head, nausea and sickness at the stomach, febrile irritation, 
general uneasiness in the abdominal region, congestion in the ab- 
dominal organs; and hence an impeded circulation of the blood, 
piles, varices in the lower limbs, and, as we have already seen, 
colic. Many hysterical affections, chlorosis, and chorea or St. 
Vitus’s dance, formerly supposed to be unconnected with the state 
of the bowels, are now proved to be very prejudicially influenced, 
if not excited, by constipation. Even symptoms, bad enough to 
cause the case to be set down as phthisis, and the patient to be sent 
to Madeira, were ascertained by Dr. Borthwick to arise from 
habitual costiveness, and to yield to purgatives.”* 
The practical and much valued “ Observations” of Dr. Hamilton 
on Purgative Medicines have not occupied the ground, or antici- 
pated the subject, of the present work. He remarks, “ This con- 
* Study of Medicine: by John Mason Good, M.D. Fourth edition. By 
Samuel Cooper, vol. i. p. 192, 193. INTRODUCTION. 
15 
stitutional costiveness is of dangerous tendency, and however desir- 
able it may be to rectify it, the consideration of it is not compre- 
hended in my present plan, which embraces only a few diseases, of 
which I consider costiveness to be the cause, or in which I appre- 
hend it to be a leading or permanent symptom.”* 
The extensive experience and acute observation of this excellent 
physician impressed him with the conviction, that “ the constipated 
and loaded state of the intestinal canal is a common cause of 
general bad health.”f Further, he says, that “ in mature age, and 
in the decline of life, symptoms, which are attributed to previous 
irregularities, to idiosyncrasy, to hereditary disposition, to disease, 
and to approaching old age, frequently arise from constipation of 
the bowels, or are intimately connected with it. The consideration, 
however, of these is but partly comprehended in my present under- 
taking.” 
“ Thus I have learned, that a knowledge how to regulate the 
alvine evacuation, constitutes much of the prophylactic part of 
medicine ; and hence how necessary it is to advise those, who either 
wish to preserve good health, or who are in quest of the lost treasure, 
to attend to this circumstance.”;}; 
The acknowledged valuable principles established by Mr. Aber- 
nethy, of the influence of disorders of the digestive organs upon 
local disease, and of the reciprocal influence of local disease upon 
the digestive organs, w'ere deduced from an extensive general 
observation of external disease. Assured of the principles, he did 
not engage himself in the analysis requisite to distinguish the special 
characters and sources of these disorders: but, with the candour 
of a great mind and with a view to encourage further inquiry, he 
remarked that “ accurate attention to the subject, especially in 
medical cases, may lead to important sub-divisions, which I have 
not yet been able to makethat “ The subject is so important, that 
the public would be highly indebted to any practitioner who would 
point out the varieties of these diseases, and the appropriate modes 
of cure.Ӥ It is this task which I propose to myself; in so far at 
least as relates to all those affections which, in my belief, arise from 
habitual constipation. 
Among these affections it will be seen that I have not included 
chorea or chlorosis, for the reason that experience has not satisfied 
me of the propriety of ranking these disorders among the conse- 
quences of habitual constipation, though unquestionably they are 
aggravated and protracted by it; and for the reason also, that their 
connexion with a deranged state of the alimentary canal, and the 
beneficial influence which purgatives exercise upon them, have been 
so ably pointed out and illustrated by Dr. Hamilton. 
* Observations on the Utility and Administration of Purgative Medicines in 
several Diseases. By James Hamilton, M.D. Second edition. Edinburgh, 
1806, p. 9. 
f Op. cit. p. 6. £ Op. cit. p. 7. 
§ Abernethy on Diseases of the Digestive OTgans, p. 42. 61. 16 
BURNE ON HABITUAL CONSTIPATION. 
CHAPTER I. 
OF THE DISPOSITION, RELATIONS, ORGANIZATION, AND FUNCTIONS OF 
THE LARGE INTESTINE. 
Disposition.—The large intestine, consisting of the caecum, colon, 
and rectum, is more spacious, though less long, than the small in- 
testine. The caecum is situated in the right iliac fossa, and the 
colon, directing itself upwards, takes a circuitous course around the 
abdominal cavity ; and, after forming the sigmoid flexure on the 
left side, gains the pelvis, into which it dips to terminate continu- 
ously in the rectum. 
In this course the ascending colon passes in front of the right 
kidney, and continuing along the anterior edge and under surface 
of the liver, in contact with it and with the gall bladder, traverses 
the upper part of the abdomen in a line with, and rather below, the 
large curvature of the stomach; and now, having, gained the left 
side, descends in front of the corresponding kidney as far as the 
spine of the ilium, where its tortuous course forms the sigmoid flex- 
ure, which, proceeding across the ilio-sacral articulation, dips into 
the pelvis to form the rectum, as has been stated. 
Relations.—In thus performing the extensive circle of the abdo- 
men, the colon places itself in contiguous relation with all the viscera 
of that cavity ; with the liver, stomach and spleen on its outer line 
of circumference; with the duodenum and convolutions of the small 
intestine on its inner line ; and with the kidneys and hepatic and 
pancreatic ducts on its posterior. The rectum also, in its course 
through the pelvis, lies in a similar relation with the prostate gland, 
vesiculae seminales, bladder, and urethra in the male; and with the 
uterus and vagina in the female. 
How varied and great, then, are the sympathies that may Result 
from this extensive and multiplied relation of contiguity between the 
large intestine and so many important organs of the abdomen and 
pelvis; and how worthy of research and elucidation are the disor- 
ders not only of this intestine itself, but of all those other organs 
which are connected with it by the relation of sympathy. 
Organization.—The peculiar organization of the large intestine 
consists in its longitudinal muscular fibres being collected into three 
ribbon-like bands, which, being of less length than the intestine it- 
self, cause it to be wrinkled across, and thus to form bulgings or 
cellules separated by corresponding depressions or furrows. These 
ribbon-like bands, commencing at the caecum, extend along the 
whole tract of the colon; and, converging as they gain the rectum, 
surround this bowel with an exceedingly thick and strong muscular 
tunic. 
The interior of the large intestine is lined by a mucous mem- 
brane, the villosities of which are much less apparent than in the OF THE LARGE INTESTINE. 
17 
small intestine. It has scarcely any valvuke conniventes, but is fur- 
nished with a great number of muciparous glands, large and soli- 
tary. Its supply of blood from the mesenteric arteries is less abun- 
dant than the supply to the small intestine. Its veins concur to form 
the vena portae. 
The organization of the rectum presents several marked peculia- 
rities. Its lower portion is destitute of a peritoneal tunic, while its 
upper is furnished with one which even forms a meso-rectum. Its 
muscular coat is composed of two planes of fibres; the internal cir- 
cular, the external longitudinal: and O’Beirne states that the longi- 
tudinal fleshy fibres are set closely together, so as to completely sur- 
round and cover the internal plane ; and that, in addition, each of 
the three longitudinal bands of the sigmoid flexure sends down strong 
fleshy fibres to be expanded upon and intermixed with those of the 
proper external plane. The longitudinal fibres predominate in the 
upper two-thirds of the rectum; the circular exist chiefly in the up- 
per third, and near the anus. “ It is therefore both an anatomical 
and a physiological fact, that this intestine exceeds every other part 
of the intestinal canal in the number and strength of its muscular 
coats, and consequently in muscular power.”* Its mucous mem- 
brane is described as thicker, redder, and more spongy than in the 
other parts of the intestinal canal; and by Houston as exhibiting se- 
veral valvular projections. Its vascularity is very great, no intes- 
tine receiving so many blood-vessels as the rectum in proportion to 
its volume. Its nerves are derived not only from the ganglionic 
system, but also from the cerebro-spinal; and it is therefore endowed 
not only with organic sensibility in common with the rest of the in- 
testinal canal, but with animal sensibility also. 
Functions.—The large intestine may be considered a reservoir in- 
tended to contain, for a certain time, the excrementitial residue of 
the alimentary matter, which, as soon as it is introduced into the 
caecum, takes the name of feculent matter, feces, excrement, &c. 
Until the excrementitial residue has arrived in the large intestine, it 
is said to be free from the fetid odour peculiar to human excrement 
—an assumed fact, which has given rise to the opinion that there is 
a power of fecification inherent in this intestine. This change, how- 
ever, is to be attributed more properly to the decomposition of the 
excrementitial matter from its abode in the intestine, than to any 
power of fecification inherent in it, as may be shown by a reference 
to pathanatomy. In cases of stricture of the upper part of the rec- 
tum, for example, there takes place in the colon a gradual though 
immense accumulation of feculent matter, soft, homogeneous, fetid, 
and deeply tinged with bile; and precisely the same thing happens 
where the obstruction is seated in the caecum, when a similar accu- 
mulation forms in the small intestine, distending it for a considerable 
distance upwards, and presenting the same appearance and charac- 
* New views of the Process of Defecation. By James O’Beirne. Dublin 
1833, p. 9. 18 
BURNE ON HABITUAL CONSTIPATION. 
ter in every respect as the accumulation in the colon, being like it 
soft, homogeneous, naturally tinged with bile, and emitting the cha- 
racteristic fetid odour.* 
These facts prove that fecification is not limited to the large 
intestine, but will be accomplished in any part of the intestinal 
canal, where the excrementitial residue is retained sufficiently long 
to go through the usual process of decomposition. 
The decomposition of the contents of the large intestine gives 
rise to the evolution of gas, which, by the stimulus of distension, 
excites the peristaltic action of the intestine, and is expelled by the 
additional conjoint aid of the diaphragm and abdominal muscles. 
When, however, the expulsion of the gas is opposed by the sphinc- 
ter, called into action by the will, it returns immediately into the 
colon, but is prevented passing into the smaller intestines by the 
ilio-caecal valve. The gas, thus confined in the large intestine, 
distends it, excites its contractions, and is driven, first in one direc- 
tion than in another, with a force sufficient to produce the disa- 
greeable rumbling noise, borborygmus. 
The use of the ilio-caecal valve is here conspicuous; for without 
it, the gas opposed in its natural passage downwards, would ascend 
into the small intestine and be discharged by the mouth—a horrible 
alternative. The chief use of this valve would seem to be to 
oppose the passage upwards of the fetid gas of the large intestine, 
because its construction is little adapted to oppose solid matter or 
even fluids, and because some reports authorise the belief that 
clysters, injected with great force, have overcome the resistance of 
this valve, and have been thrown up by vomiting. Besides, an 
anti-peristaltic action of the large intestine, powerful enough to 
propel its solid contents in this unnatural direction, is so rare as 
scarcely to admit of belief, and consequently not to need the 
obstacle of a valve. 
The quantity of gas in the colon is often considerable, and its 
change of place indispensable; for, was it confined to one part, 
the prolonged distension of this part would strain and paralyse its 
muscular fibres, and so impair the function of the gut. The ca- 
pacity of the colon, then, may be regarded not merely as a reser- 
voir for the fecal matter—for, except in states of disease, its great 
capacity would be altogether superfluous—but more especially for 
the gases evolved from that matter, which, when not allowed to 
escape, require space for motion to and fro; an essential provision, 
adequately supplied by the capacious colon. 
The functions of the colon are supposed by some not to be limited 
to the offices of a reservoir and of simple transference, but to be in 
part digestive and emunctory. 
Schultz entertains some very extraordinary notions of the func- 
tions of the caecum and colon, suggested to him in the first instance 
* See Case 4, in the author’s paper on the Caecum and Appendix, published 
in the Trans, of the Royal Med. and Chir. Society, vol. xx. p.2I3. OF THE LARGE INTESTINE. 
19 
oy his own sensations of what goes on within the intestinal canal. 
He speaks of having felt a palpitating agitation in the motion of 
the colon fro*m right to left: of having felt, after aperient medicine, 
bile flow abundantly into the duodenum, and traverse swiftly the 
whole small intestine to the caecum, there to collect, and then to 
move with the food slowly along the large intestine. He is of 
opinion that an acid digestion goes on in the caecum; that the bile 
passes along the intestine to join the food in the caecum after it 
has been digested there; that the ilio-caecal valve is closed like the 
pylorus, to prevent bile passing while caecal digestion is going on ; 
that digestion in the caecum and stomach have their periods—the 
stomach by day, the caecum by night.* For these opinions I do 
not discover any sufficient foundation. 
Sir Everard Home has adduced some facts on which he grounds 
an opinion that fat is formed in the large intestine: but, on perusal 
of his observations, I do not find they establish any other point 
than that lumps or masses of fat have been found in the alimentary 
canal of living animals. The remarkable difference in the short 
length and small dimensions of the colon and caeca of the casuary 
of Java—the colon one foot long, and each of the caeca only six 
inches long and a quarter of an inch in diameter—and in the great 
length and large dimensions of the colon and caeca of the African 
ostrich,—the colon forty-five feet long, and each of the caeca two 
feet nine inches long and three inches in diameter,—as associated 
with and adapted to the luxuriancy of Java and the dearth of Africa, 
struck Sir Everard forcibly, and suggested to him the opinion, that 
the colon and caeca were not unimportant in the office of assimila- 
tion.t 
The opinion that the large intestine is concerned in the digestion 
of the vegetable part of food, derives no support from the pheno- 
mena of its functions observed during health. The residual matter 
voided presents characters in no way different from that found in 
the caecum, except its greater consistency, its fluids having been in 
part absorbed. 
In the healthy condition of the digestive organs, the residuum of 
food having reached the large intestine, is already homogeneous 
and feculent, and offers no appreciable evidence of incomplete 
digestion, which it certainly would do if the vegetable part had 
not yet been assimilated. Nor is there any better reason to believe 
that this intestine acts as an emunctory for the purpose of remov- 
ing other excrementitious or hurtful parts from the system. 
It is important, for the clear understanding of this subject, that 
we contemplate the functions of the large intestine in its healthy 
state, otherwise our judgment may be misled; for because we find 
secretions from the colon, when diseased, form part of the egesta, 
we may erroneously conclude that therefore they do in the normal 
* De AlimentGrum Concoctione. Carolus Henricus Schultz. Berolina, 1834. 
+ On the Formation of Fat in the Intestines of living Animals. By Sir Ever- 
ard Home, bart. Philosophical Transactions, vol. ciii. 1813. 20 
BUENE ON HABITUAL CONSTIPATION. 
state. In the healthy action of the large intestine we are not able 
to recognise any difference of character in, or addition of substance 
to, the fecal matter during its transference. All those anormal 
excretions,—whether melanotic, sanguineous, mucous, or purulent, 
derived from the large intestine, are products of a pathological 
state of the mucous membrane. They are heterogeneously mixed 
or smeared over, or intimately and uniformly combined with, the 
proper feculent matter. Did any excrementitious secretions take 
place as the normal function of the large intestine, they certainly 
would be apparent, from the want of intimate combination with the 
residuum of food ; whereas the feculent matter voided is perfectly 
homogeneous. 
Besides, if the large intestine were an organ of excretory disas- 
similation, it would, in common with other organs of secretion, be 
richly supplied with blood; but the contrary is the case. 
There is comparatively less blood furnished to the colon than to 
the small intestine; while to the rectum the supply is most abun- 
dant: yet the rectum is not supposed by any to perform the office 
of excrementitious secretion. I do not hold with the opinion, that 
the large intestine, in health, supplies any considerable part of the 
excrementitious matter voided; or that, from its lining membrane, 
there takes place any other secretion than mucus to lubricate its 
surface and facilitate the transference of the feces. In Adynamic 
fevers, and many other disorders, one cannot hesitate to believe that 
a large portion of the foul alvine evacuations proceeds from the 
mucous membrane of the bowrnls itself; but this is the result of 
disease. 
The alimentary matter, deprived almost wholly of its nutritive 
properties, passes from the ileon into the caecum, whence it is 
transmitted along the colon, and, when arrived at the commence- 
ment of the rectum, excites a sensation which calls for its expulsion. 
The exoneration of this intestine once in tw7enty-four hours, although 
consistent with health, would appear to be less frequent than the 
uninfluenced order of nature requires. 
There can be little doubt that the large intestine, like the bladder, 
admits of a certain accumulation of its contents before it is stimu- 
lated to expel them; but I should be disposed to limit this accumu- 
lation to the residuary matter of an ordinary meal, and attribute 
any addition to the influence of habit. By reverting to the healthy 
action of the bowels in infancy—the only condition in life uninflu- 
enced by the will—we find evacuations take place pretty nearly in 
the same ratio as the number of meals; and that the residuary matter 
of one or tw7o meals is sufficient to provoke an expulsory movement: 
but as soon as the development of the mind admits impressions 
which influence the will, then do the dejections become less frequent, 
and eventually occur only at convenient periods, once or twice in 
the day, with an extraordinary regularity. Even thus early does 
the will influence the action of the bowels. 
In accordance with the law's of the animal economy, the protracted CONSEQUENCES OF HABITUAL CONSTIPATION. 
21 
presence of the feculent matter so obtunds the organic sensibility of 
the intestine, that a considerable accumulation is required to provoke 
its action, which therefore generally happens only once in twenty- 
four hours. In this time the feculent matter does not undergo any 
unfavourable change; but, when delayed for a longer period, it 
becomes, first, solid, then hard, friable, and knotty; a preternatural 
state, which renders its evacuation difficult, and which soon excites 
a morbid irritation of the bowel itself. In persons who have one 
evacuation daily, it occurs usually when the organic sensibility of 
the alimentary canal is heightened, as on getting up in the morning, 
or on rising from the breakfast table. Here the excrementitial residue 
of one day’s food has accumulated in the large intestine during the 
night without exciting an expulsory movement of the bowel, the 
perceptive power of the nervous system being less quick during 
sleep; but the state of sleep having passed away, the nervous sen- 
sibility is revived, or, from the excitement of breakfast, heightened, 
and the bowel stimulated to the act of exoneration, 
CHAPTER II. 
GENERAL REMARKS UPON, AND VARIOUS CONSEQUENCES OP HABITUAL 
CONSTIPATION. 
Inconvenience of Constipation.—Habitual Constipation a Source of general Dis- 
order and of local disease.—Tumours of the Breast dissipated.—Loaded Colon 
mistaken for Diseaseofthe Liver.—Congestion of the Portal System and Disease 
of the Liver.—Hypochondriasis.—Neuralgia.—Epilepsy.—Spasmodic Contrac- 
tions of Muscles.—Duration of Constipation. 
There are few persons who have not themselves experienced, at 
some period, the inconvenience of constipated bowels. Those in 
whom this inconvenience has been only occasional, will not be 
prepared to attach so much importance to the subject as it is the 
object of this work to point out; while all who have suffered from 
constipation habitually, will agree in regarding it one of the greatest 
troubles of life. Not only does it indispose the mind to exertion 
and the body to exercise, but it casts a gloom over the spirits, and 
is productive of that general discomfort which ruffles the temper 
and embitters the ordinary enjoyments of life. 
It is true that Nature has designedly provided for the retardation 
of the excrementitious matter in the large intestine by furnishing 
the extremity of the bowel with a muscular mechanism subject to 
the will; a controlling power, which, duly exercised, is essential to 
our comfort and convenience; but which, abused to set aside the 
calls of nature and so to retain the fecal matter within the bowel, 
is sure to be productive, sooner or later, of very formidable and 
disastrous consequences. 22 
BURNE ON HABITUAL CONSTIPATION. 
If we contemplate, for a moment, the processes and changes which 
take place in our food during its passage through the alimentary 
canal, and compare the characters of the excrementitious matter 
voided in the ordinary course of nature with the characters of that 
which has been unduly retained, we shall experience no difficulty in 
coming to the conclusion, that much injury, not only to the bowel 
but to the constitution, must, of necessity, result. The excrementi- 
tial residue in its natural state is consistent, soft, homogeneous, cohe- 
sive; but retained in the bowel, it becomes hard, knotty, dry, and 
friable: changes produced by the absorption of its fluids, which 
being necessarily conveyed into the blood, adulterate and corrupt 
it. Hence then an abundant source of impurity to the blood. 
Feculent matter, even in its natural state, irritates the intestine if 
retained beyond the usual period ; and how much more irritating 
must it prove, when its characters have become altered as above. 
Irritation of the large intestine, so induced, extends by sympathy 
to the liver and stomach, and by disturbing their functions, impairs 
digestion. From impaired digestion, there must proceed impure 
chyle, from impure chyle impure blood; and if impaired digestion, 
produced and prolonged by habitual constipation, should endure, 
not for months only but for years, how can we wonder that the 
whole mass of the blood should become corrupt, or that the solids 
derived from that blood should be corrupt also ? How can we won- 
der that eruptions should disfigure the body, or that untractable or 
malignant disease should break forth and shorten life? Can we 
hesitate then to believe that habitual constipation may be and is one 
frequent source of genera] disorder and of local disease? 
Although, in all treatises on disorders of the digestive organs, at- 
tention is recommended to the due evacuation of the intestinal ca- 
nal, and, since the promulgation of the doctrines of Mr. Abernethy, 
the same attention has been extended to other complaints, yet the 
influence of habitual constipation in the production of disease by di- 
rect and indirect agency has been in nowise appreciated ; the con- 
stipation having been regarded rather as an incidental circumstance 
than as a definite and original cause. Nor are we, on this account, 
aware of the vast power which an unremitting attention to the ac- 
tion of the bowels has in curing many disorders, and may have in 
ameliorating the character of many intractable diseases. “ Many 
morbid states,” says Dr. Holland, “ attributed, with the too frequent 
vagueness of medical language, to the stomach and liver, are chiefly, 
as I believe, connected with the colon as their seat and source.”* 
Believing, indeed, that the cachectic diathesis which gives rise to 
some malignant diseases may be generated by habitual constipation, 
I look forward with some degree of hope that, by keeping this prin- 
ciple steadily in view, the progress of the more chronic forms of 
these diseases may eventually be checked, and the morbid diathesis 
so amended, as to diminish their hitherto invariably fatal tendency, 
* Notes and Reflections. By Henry Holland, M._D. London, 1839, Select 
Medical Library—October, 1839. CONSEQUENCES OF HABITUAL CONSTIPATION. 
23 
—an opinion which derives some countenance from the following 
cases. 
Case I.—Tumour in the breast dissipated by attention to the bowels and general 
health. 
Charlotte Bowles, aged 43, was a patient at the Public Dispen- 
sary, in 1830. 
The complaints, on account of which she applied, were head- 
ache, flushings in the face, acidity of the stomach, great flatulence, 
and a confined state of the bowels, which had been most irregular 
for many years. After she had stated these symptoms, she showed 
me a tumour in the breast, which I remember to have examined; 
but having made no note of it at the time, I cannot speak confi- 
dently of its character, further than my impression that it was an 
indolent scirrhus, and that it did not call for local treatment. She 
was put on a course of alterative stomachic aperient medicine, 
with a view to regulate the bowels, and improve the general health ; 
but without any special reference to the tumour. She continued 
under treatment four months, got quite well, and was stronger and 
better than she had been for some years. When nearly recovered, 
she surprised me very much by saying, that the tumour in the breast 
had been diminishing for some time, and was now gone; which on 
examination I found to be the case, for the breast was soft and 
natural. I immediately wrote down the following history of the 
tumour, and regretted much that 1 had not made a note of her case 
when she first came under treatment. 
At 35 years of age, a hard tumour appeared in the left breast, 
above and to the outside of the nipple: and, in the course of eight 
months, attained the size of a walnut. It was attended with gnaw- 
ing lancinating pains, very severe at times. Leeches, lotions, and 
plasters had been of no avail; no medicine had been taken inter- 
nally. The tumour was excised by the late Mr. Compson; the 
wound healed, and no return of the tumour took place till five 
years afterwards. This second tumour was situated in the cica- 
trix left by the removal of the former one, was very hard, and 
attended also with darting pains: the nipple was not involved. 
It would be improper in me to give any decided opinion of the 
nature of this tumour; but its history and character, as given by 
the patient, namely, its hardness, the darting pains, its excision, its 
return in the cicatrix in five years with the same features of hard- 
ness and lancinating pain, afford presumptive evidence of a scirrhus 
of the most indolent and chronic form. 
Case II.—Tumour in the breast dissipated by regulating the bowels, and 
improving the general health. 
Mrs. Couchman, age 40, matron in the laundry at the Magdalen 
Hospital, had been troubled for eleven or twelve years with ob- 
stinate constipation of the bowels, always requiring the use of 
aperients, which if she neglected to take, she would pass an in- 24 
BURNE ON HABITUAL CONSTIPATION 
definite time without a dejection. Menstruation was regular, but 
not copious. 
She was affected with a tumour in the left breast occupying the 
outer part of the mammary gland, as large as a small egg, very 
hard, very tender, always painful; and pain of a darting character 
would at times seize her, go through the shoulder and down the 
left arm: the arm-pit was tender, but the glands not enlarged; yet 
the arm was swollen to the elbow, and she suffered so much in the 
breast when she used the arm, that she was obliged to desist. Her 
stomach -was greatly disordered; she was always uneasy after 
food, rather sick, sometimes even to vomiting, at others discharging 
clear, ropy wTater from her mouth. On several occasions she 
threw up blood, and passed blood with her dejections. Her appe- 
tite was so indifferent that she could take but little food : solid suited 
her better than slops or broth. She was so reduced in flesh and 
strength, that she could scarcely walk alone, and her face was 
linear, giving her altogether the aspect of a person declining 
under the influence of visceral or malignant disease. 
The tumour had been relieved more or less by leeches, applied 
under the direction of Mr. Bransby Cooper; the darting pains, 
nevertheless, continuing, and the tumour was disposed to increase. 
Her health being so much impaired, Mr, Cooper referred her to my 
charge at the beginning of the year 1838. The affection of the 
stomach appeared to me to be not merely functional: the imperfect 
digestion, the impatience of food from increased organic sensibility, 
and the emaciation, indicated certainly a greater or less degree of 
pathological congestion of the organ, which, coupled writh the state 
of the breast, led me to apprehend a scirrhus of the pylorus. The 
treatment adopted was on the principle of subduing subacuto- 
chronic inflammation of the stomach, and of regulating the bowels. 
The latter was effected with difficulty, partly on account of the 
obstinacy of the constipation, and partly on account of the irrita- 
bility of the stomach, which would not retain many of the more 
active purgatives. 
A variety of aperients was tried from time to time; those which 
agreed best and proved efficacious, were the infusion and tincture of 
senna with ertasote, and pills composed of the compound extract of 
colocynth, opium, and a little calomel. The creasote at all times 
tended to appease the stomach, and caused aperients to agree where 
otherwise they would have been rejected. Opium was essential in 
the treatment; and much good resulted from a mild though pro- 
longed course of mercury, the doses being of calomel half a grain, 
opium a quarter of a grain, taken twice a day after meals. When 
the gums became sore the mercury was suspended for a few days. 
In this manner both the calomel and the opium, as also the aperi- 
ents, were persevered in for many months with great improvement 
in the health, and the very unexpected subsidence, and ultimately 
the almost entire dissipation of the tumour in the breast. Bella- 
donna in the form of plaster was applied with decided benefit. CONSEQUENCES OF HABITUAL CONSTIPATION. 
25 
I have seen Mrs. Couchman this morning, April the 26th, 1839, 
and have examined the left breast, in which scarcely any vestige 
of the tumour remains. Her health is comparatively good, and, 
although she is still thin, she has gained flesh very much. The 
bowels require attention, and the stomach great discretion as regards 
food. In a note from Mr. Cooper, I find that he “ never considered 
the tumour of a malignant character.” 
The daily and unrestrained action of the bowels is so essential to 
the comfort of every individual, that any person, disappointed of an 
habitual evacuation, is rendered irritable and uncomfortable through 
the day; and his mind is not, as usual, alive to pleasure or ready at 
business. 
In the female sex, constipation is so universal that experience has 
taught me to hesitate in forming an opinion of the nature of an 
abdominal ailment, until I have assured myself, beyond doubt, of 
the entire evacuation of the large intestine: the want of which cir- 
cumspection has led to much error. 
A young lady was supposed to be labouring under disease of the 
liver, and had been subjected to a course of mercury and of other 
medicines without relief. She had fulness and tenderness in the 
neighbourhood of the liver, with pain in the shoulders, sallowness of 
the skin, and other signs of hepatic disease. Further advice was 
sought; and the bowels being found in an unsatisfactory state, it 
was suspected that the symptoms might arise from a loaded colon; 
and accordingly active purgative medicines were prescribed, which 
brought away a vast accumulation of hardened feces, and quickly 
and entirely dissipated the patient’s complaints. 
When we reflect that the right curve of the colon is in contact 
with the inferior surface of the liver, we shall have no difficulty in 
understanding how affections of the colon may, by contiguous sym- 
pathy, simulate affections of the liver;—how an irritation of the 
colon from hardened feces may, by communicating irritation to the 
liver, disturb its functions;—and how it is in vain to attempt to 
remove the hepatic symptoms while the affection of the colon, the 
cause, remains. In cases of this description, where there is doubt 
as to the state of the alimentary canal, I have frequently been aided 
in coming to a decision by referring to the urinary secretion, which, 
when the colon is loaded, is apt to be abundant and limpid as water. 
A copious discharge of colourless urine then is often diagnostic, as 
I have long observed. 
An habitual accumulation of feces, acting as a source of irritation 
to the abdominal viscera, generally induces a preternatural deter- 
mination of blood to these viscera, and brings about, eventually, a 
congestion of the portal system, which disposes the liver to disease. 
A lady, Mrs. W , of middle age and of full habit, who had 
an excessive difficulty in regulating her bowels, was subject to ful- 
ness and other uneasy sensations about the liver, which were not 
removed without the local abstraction of blood, in addition to proper 26 
BURNE ON HABITUAL CONSTIPATION. 
aperient and other medicines. On one occasion, when these sensa- 
tions existed, she was exposed to cold in travelling, and the conse- 
quence was a severe inflammation of the liver. And again in the 
course of a year, the state of the bowels being neglected, she ex- 
perienced another hepatic inflammation with most obstinate jaun- 
dice. 
In addition to an affection of the liver, but associated with it as 
I believe, the functions of the brain may gradually be so disturbed 
as, in the end, to disorder the manifestations of the mind, and give 
rise to hypochondriasis and melancholia. In many examples of 
abdominal dropsy from induration of the liver, the origin of the 
disease may be traced, with ever}' reasonable probability, to a conges- 
tion of the portal system resulting from the continued irritation of 
hardened feces in the colon. 
A maiden lady between 40 and 50 years of age, had for many 
years the bowels costive to a degree that she would pass seven or 
eight days without an evacuation. In her youth she had been 
cheerful, but as life advanced she became apprehensive and gloomy, 
and gave herself up entirely to religious devotions; a state of mind 
which, on the cessation of the menstrual flux, passed into confirmed 
insanity: she had at the same time induration of the liver, and 
soon afterwards dropsy of the belly. 
Should any not coincide with me in the view which I take of 
these cases, I beg to remind them of the sympathy which is known 
to exist between the liver and the mind. The depression of spirits 
attending disorders of the liver is familiar to everyone; and the 
examples are not few of jaundice induced by mental emotion. In 
hypochondriasis and melancholy there is an obvious reciprocal 
sympathy between the liver and the mind. The disturbed function 
of the liver may be produced in the first instance by constipation 
of the bowels: and the hypochondriasis be the result of sympathy. 
A young clergyman of melancholic temperament suffered from 
constipated bowels: his dejections were unfrequent, scanty, knotty; 
yet his digestion was good. The irregularity of his bowels was a 
constant trouble to him; he grew dejected in spirits, and his imagi- 
nation was ever at work on gloomy subjects. Though naturally of 
a strong mind he was now assailed with superstitious fears, which 
he could not ward off, and because three vicars had died soon after 
having been in possession of a certain benefice, he thought the same 
fate must await him. Here was a state of hypochondriasis excited 
by constipated bowels acting on the melancholic temperament. 
That the nervous system is much affected by the condition of 
the alimentary canal lias been remarked by Mr. Abernethy. He 
has “ known nervous pains cured by correcting the disorders which 
in these cases existed in the digestive organs.” For myself, I have 
more generally found that both these disorders and the nervous 
pains have been sympathetic of the irritation of constipated bowels; 
as the following example will show:— CONSEQUENCES OF HABITUAL CONSTIPATION. 
27 
Case III.—Neuralgia from habitual constipation cured by aperients. 
Mrs. Green, aged 31, of a spare habit of body, had been afflicted 
for some weeks with neuralgic twitches in the neck, on the left side, 
between the angle of the jaw and the mastoid process, which ex- 
tended occasionally along the jaw and over the side of the face and 
forehead. These twitches became violently painful, persisted for 
some hours, and returned at uncertain periods, night as well as day. 
During the paroxysms, the sensibility of the spot, before described, 
was so heightened that she could not suffer the air to blow upon it, 
and the slightest touch gave excruciating pain. She had risings in 
the throat, was subject to heats and flushings, to heaviness of the 
head and other ailments, which it is unnecessary here to detail. 
Habitually, she was very costive, seldom having dejections without 
the aid of medicine. 
She was instructed to take five grains of blue pill every night, 
and the carbonate and sulphate of magnesia with the compound de- 
coction of aloes twice a day. These medicines kept the bowels freely 
open; and in the course of five days the neuralgic pains had abated 
very much, only one paroxysm having occurred during this period. 
The same treatment being continued, with the addition of one grain 
of the sulphate of zinc twice a day, the pains, as well as her other 
complaints, were soon removed entirely. Prior to the adoption of 
the aperient plan, she had taken quinine, sulphate of zinc, and car- 
bonate of iron without benefit. 
Other examples of very serious disorders of the brain and nervous 
system, the effect of remote sympathy from a confined state of the 
body, might be adduced. Epilepsy, it would seem, is induced by 
this cause on some occasions, and may sometimes be cured in its 
early stage by restoring the functions of the large intestine. 
Case IV.—Epilepsy alternating with paralysis of the extremities. Constipation. 
Martha Stevens, age 15, a strong built girl, of a very confined 
habit of body, and in whom menstruation had not yet appeared, had 
been subject to fits daily for two years, which, with the exception 
of pain in the head for one or two minutes, supervened unexpect- 
edly, leaving her only time to call out, “ Catch me, catch me;” she 
would then fall immediately and remain stiff for hours, or struggle 
and be convulsed. At other times, instead of a fit, she would sud- 
denly lose the use of one limb, which would hang paralysed for 
hours and then recover; it might be the leg, or the arm ; or both 
legs, or both arms. Sometimes the jaw was locked for three or four 
hours; sometimes the neck was stiff, which generally ended in a fit; 
though the paralysis did not. Sometimes she was unable to speak; 
on one occasion for nearly two days. Withal the appetite was good; 
and she made no complaint. An emetic was directed to be taken in 
the evening, and jive or ten grains of the aloes and myrrh pill every 
night. 
The emetic brought a quantity of sour offensive ingesta off the 28 
BURNE ON HABITUAL CONSTIPATION. 
stomach; the pills operated freely; and, during the time she con- 
tinued under my observation, there was no recurrence of the fits or 
of the paralysis; and her eyes and countenance, which before were 
dull and inexpressive, now resumed the brightness and cheerfulness 
natural to her age. 
The success which attended the treatment of the above case, is 
not advanced as any sufficient ground on which to warrant the con- 
clusion, that epilepsy either depends on habitual constipation or can 
be cured by obviating it where it is found to coexist. The intract- 
able nature of epilepsy is too familiar to me to allow of my indulging 
any sanguine expectation from the fortunate result of a single case. 
The only other consequences of habital constipation to which I 
shall here advert are Spasmodic contractions of muscles; remark- 
able effects, producing in one person deformity of an extremity ; 
in another, lock-jaw; cases of much interest, and may be of great 
anxiety. Mr. Abernethy was disposed to regard traumatic tetanus 
as connected with the disorder of the digestive organs, which he 
had observed to arise between the infliction of the injury and the 
invasion of the disease: a notion strengthened by the following 
cases:— 
Case V.—Spasmodic contraction of the left fore-arm and hand. Obstinate 
constipation. 
Ann H , a young woman of robust frame and rigid fibre, 
had long suffered from most obstinate constipation, seldom experi- 
encing the calls of nature or any spontaneous effort on the part 
of the bowels, evacuations being procured only by the most active 
purgatives. Besides this she had no complaint except headach. 
On a sudden, there took place an involuntary contraction of the 
flexor muscles of the left fore-arm and hand, closing the hand firmly 
and bending the wrist upon the fore-arm. The spasm was so 
rigid, that no force which I could apply had any effect, in over- 
coming it, nor did the slightest muscular relaxation ensue during 
the many months she was under my care. The bowels remained 
unmanageable, resisting the most powerful cathartics and mani- 
festing no disposition to act of themselves. 
Case VI.—Trismus or lock-jaw which persisted five or six weeks : cured. 
Mrs. William D , a fine florid and rather corpulent person, 
had, for many years, been harassed by obstinate constipation of 
the bowels, flushings of the face, and sudden heats all over the 
body, together with pain and heaviness of the head. One day, on 
attempting to open her mouth she found the jaw stiff; and soon 
afterwards the mouth itself entirely closed. The idea of a lock- 
jaw alarmed her exceedingly; and she was indisposed for some 
days, more from agitation and anxiety than from any sympathetic 
disturbance of the system arising out of the condition of the jaw, 
which did not relax, but assumed the character of a chronic trismus. CONSEQUENCES OF HABITUAL CONSTIPATION. 
29 
Aware of the very costive habit of this patient, and unable to 
discover any other cause, I did not hesitate to attribute the lock- 
jaw to intestinal irritation excited by retained hard feculent matter; 
in conformity with which opinion the treatment was pursued. The 
colon was, in the first place, emptied by copious lavements, which 
brought away large quantities of scybalous matter ; and the bowels 
were afterwards regulated with great care by proper aperient me- 
dicines. Food was administered through the space left by the 
extraction of a tooth formerly; and, after a perseverance in this 
plan for five or six weeks, the muscular spasm began to relax, and 
in a short time subsided altogether; when the free action of the 
jaw was restored. 
The following extraordinary case has been very obligingly sent 
to me by Dr. Williams. 
Case VII.—Most obstinate constipation yielding only to mercury. Gastric 
irritation. Severe paroxysmal gastrodynia. Rigid contraction of the lower 
jaw, and of the upper and lower extremities, 
“ Dear Sir, 
“ The most remarkable case of constipation that I have met 
with, occurred in a lady, and is as follows:— 
“ The patient had enjoyed good health till the age of 35, when 
she was attacked with severe gastrodynia, accompanied with most 
obstinate constipation. The paroxysms lasted several hours and 
returned at short intervals for nearly a week, when they subsided, 
leaving her extremely weak. These attacks at first returned only 
at intervals of many months, but they gradually became more and 
more frequent, and at length quotidian; and from this period she 
lingered in a state of suffering seldom witnessed. Her appetite was 
good, but each meal was followed by a paroxysm of pain so severe 
and so continued that after trying every variety of diet, she limited 
herself to a dry biscuit with a little water or brandy and water in 
the course of the day, and even this was very commonly rejected. 
“Nothing gave her relief but opium; and of this medicine, she, 
for many months, took not less than 60 grains daily. Her bowels, 
independent of the astringent effects of the opium, were at all times 
greatly constipated ; and no quantity of neutral salts, castor oil, 
senna, rhubarb, or other mild remedies in the least moved her 
bowels; while elaterium, croton oil, or other powerful purgatives 
immediately inverted the action of the stomach and were rejected;— 
in short calomel was the only medicine that would act upon them, 
and this not until her mouth was severely affected. 
“ From this cause she frequently had no evacuation for six weeks 
together; and in one year, when she was much weakened from 
repeated salivation, so that it was necessary to defer the adminis- 
tration of the calomel as long as possible, she had only one evacu- 
ation every three months, or four in the whole year. At the times 
her bowels acted she suffered immensely, her pains being more se- 
vere, if possible, than those of labour. The fecal matter when BURNE ON HABITUAL CONSTIPATION. 
30 
passed was enormous in quantity, healthy in colour, and was formed 
into large round lumps or scybala, each certainly not less than a 
large foetal head, and so numerous as often to fill a common-sized 
pail. 
“ The disease proceeding, this lady oftentimes passed no urine 
for forty-eight hours, and then only hy the aid of the catheter. Her 
hands also became rigidly contracted, her legs ceased to be flexible, 
and for many months she was unable to depress her lower jaw, so 
that her mouth was permanently closed. Her pulse, which was at 
first good, became at length rapid, she sank into a state of complete 
marasmus, and eventually the death she fervently prayed for closed 
a life embittered by a world of painful and unmitigated suffering. 
It was the strict injunction of this lady that her body should not 
T>e subjected to posthumous examination. None of the many me- 
dical men whom she had consulted were able to determine the 
existence of any organic alteration. The only disease to which it 
could be compared was cancer; but the enormous quantity and 
natural character of the feces when they were passed, showed the 
whole tract of the intestinal canal to be healthy: while mercury, 
which aggravates cancer, mitigated for a short time every symptom 
in this case. On the contrary, the many nervous symptoms, the 
contracted hand, the semiflexure of the legs, and the closed jaw, 
seem to connect this disease rather with a neurosis of the great 
sympathetic and subsequently of the brain and spinal cord: and 
this view of the case is much strengthened by the fact of her elder 
sister having been for many years a martyr to the tic douloureux ; 
an affection from w'hich her brother has also severely suffered. 
“ I remain, (fee., 
(Signed) “ R. Williams. 
“ 39, Bedford Place, Russel Square, 
May 1st, 1839.” 
In my own experience instances of the duration of constipation 
varying from five \.o fifteen days are common. A gentleman under 
the care of Mr. Benjamin Phillips passed thirty-seven days without 
any evacuation ; and in the elaborate dictionary of Dr. Copland 
numerous references will be found to the most extraordinary cases 
on record. One of great interest is related by O’Beirne* of a young 
lady, aged 19, who passed neither flatus nor feces for near six 
months, and who nevertheless was restored to perfect health. An- 
other is published in the “ Dictionnaire des Sciences Medicates,” 
vol. vi. p. 257, in which the constipation had existed from birth: 
it was communicated to the Societe d’ Emulation de Paris, by M. 
Robe-Moreau. Although the individual ate a considerable quantity 
of food, he was in the habit of passing ten, twenty, thirty, forty 
days without any dejection: when he had dejections they were 
* New Views of the Process of Defecation. By James O’Beirne, M.D. 
Dublin, 1833. p. 74. et seq. CONSEQUENCES OF HABITUAL CONSTIPATION. 
31 
always preceded by colic pains. Notwithstanding this he became 
an officer of the marine, and for twenty years voyaged in all cli- 
mates. At the age of 42 he married. In 1806 the constipation 
was obstinate for four months, and threatened his life; yet, by 
the means employed, evacuations were procured, and continued 
for eight days successively, greatly to his relief: with these the 
stones of grapes eaten the year preceding passed. The improve- 
ment was of short duration : he was again overtaken, in 1809, 
with pains, vomiting, and most severe abdominal symptoms, which 
terminated his life, in the 54lh year of his age. On dissection, an 
obstruction “ cloison fibreuse” was discovered in the rectum, above 
which the gut was enormously distended, and contained thirty kilo- 
grammes (about sixty pounds) de matieres pultacees. 
In the general treatment of disease, it is in vain to look for the 
due and peculiar influence of medicines, so long as the bowels are 
confined ; for then some will not agree, as the preparations of iron ; 
and others will not act, as those of opium. In two instances of 
delirium tremens, which occur to me, opium was given in very 
large doses; but, instead of tranquilizing the nervous system, it 
aggravated the delirium to madness, until the bowels, which were 
loaded, had acted freely; then the opium took effect, and induced 
that welcome sleep which led to recovery. 
Further experience would justify me in extending this remark to 
all cases of delirium tremens, and in establishing, as a principle of 
treatment, the administration of cathartics prior to, or simultaneous 
with, the administration of opium. Sleep and amendment are not 
to be expected until the bowels have been thoroughly evacuated. 
CHAPTER III. 
OF THE CONSEQUENCES OF HABITUAL CONSTIPATION ON THE GENERAL 
HEALTH. 
Habitual constipation varies in degree, as also do its effects; and 
the effects are rapid or slow, according to the temperament, the 
age and the constitution. The effects depend also materially on the 
length of time the body has been subject to habitual constipation, 
as well as on its greater or less degree. Habitual confinement of 
the bowels, through a period of twenty years,—a common circum- 
stance,—will generate a train of consequences much more serious 
in character than when the habit has existed only for one year; and 
it will, therefore, be necessary to treat of the general effects under 
two heads, which may be called stages;—the first, embracing the 
earlier consequences; the second, the later or more remote. 32 
BURNE ON HABITUAL CONSTIPATION. 
The early consequences of habitual constipation accumulate less 
quickly in the young and phlegmatic than in the young and sanguine: 
they accumulate rapidly in the middle and later periods of life. 
It is in young females that the early consequences are more 
frequently seen : they, unhappily for themselves, being, from causes 
to be discussed hereafter, generally subject to a confined state of 
the body. To this fact I would solicit the attention of my profes- 
sional brethren, so early in life does a cause come into operation, 
which, continued through succeeding years, lays the foundation of 
most of those chronic diseases which embitter after-life. 
The period at which young females begin to experience irregu- 
larity of the bowels is about the age of puberty. At first, the incon- 
veniences are not such as to attract attention. Slight indisposition 
happens occasionally, and is attributed to any but the just cause, 
an unfrequent action of the bowels being sometimes thought by 
ladies of this age rather a desirable habit; but should these pages 
meet the eye of mothers, I beseech them, as they respect their chil- 
dren’s health, to give attention to this subject; and I cannot omit, 
in this place, to urge upon all those who charge themselves with 
the education of the female sex, the same attention as a matter of 
duty, I would say of humanity ; for no one thing is so likely to rouse 
into action, at this age, pulmonary, hepatic, or any other disease to 
which the individual may happen to be predisposed, as constipation 
of the bowels. 
Constipation persisting, there soon manifest themselves the primary 
signs of alvine difficulty ; namely, drowsiness and heaviness of the 
head. Then will be seen in many a darkness under the eyes, while 
the face is leuco-phiegmatic ; or, if the temperament is sanguine, 
there will be an extraordinary flush of apparent health. To the 
heaviness of the head is, by and by, superadded pain of various 
character and situation ; it may be an aching, a beating, or a throb- 
bing pain in the forehead or temples, or over one eye, with a sense 
of great weight or giddiness. Flushings of the face occur, and 
transient heats over the whole body, though the feet are, at the same 
time, cold. The drowsiness increases ; they find it difficult to 
rouse themselves to any kind of exertion. On going to bed they 
fall instantly into a sound sleep, which proves heavy but not refresh- 
ing ; for, on awaking in the morning, they feel tired, unwilling to 
leave the bed, and if they do not get up at once, sleep quickly over- 
comes them only to increase the sense of fatigue when they awake 
again. Menstruation will, in some, continue regular in the midst 
of this disorder, particularly in constitutions of a rigid fibre ; while, 
in those of a lax fibre it is often deficient or suppressed ; and, in 
those of a sanguine temperament, abundant even to menorrhagia. 
Leucorrhoea seldom fails to supervene. The urinary secretion is 
apt to be copious and colourless ; and flatulence in various degrees 
attends, although the digestion is not much, if at all, impaired. 
OF THE FIRST STAGE. CONSEQUENCES OF HABITUAL CONSTIPATION. 
33 
Case VIII.—The early consequences of habitual constipation in a young person 
of lax fibre. Menstruation scanty. 
Mary Lewis, age 18, complains of a constant beating pain in the 
forehead, with giddiness, heaviness, dulness, and languor: her face 
is pale generally, but dark under the eyes, and rather bloated : she 
falls asleep immediately on going to bed, sleeps heavily all night, 
and in the morning gets up unwillingly and not much refreshed: 
her feet are apt to be cold ; the appetite indifferent in the morning, 
good at dinner-time; the tongue and pulse not affected; the urine 
copious and pale; and menstruation has been scanty and irregular 
for the last seven months. 
She has been subject to confined bowels for eighteen months past, 
since which all these complaints have supervened. She is in the 
habit of passing two or three days without a dejection, and, when 
at the closet, has much striving with little effect, the excretion being 
scanty, hard, and knotty, and passed with pain. 
Case IX.—The early consequences of habitual constipation. Menstruation 
regular. 
1839, April. Collins, aged 24, a housemaid, has of late been 
troubled with a confined state of the bowels, no action taking place 
for two, three, or four days, unless quickened by medicine. 
Since her bowels have become irregular and constipated, she has 
experienced a heaviness in the head, is more than usually sleepy, 
so that in the day if she sits down she finds it difficult to keep her- 
self awake. Ongoing to bed she falls asleep at once, and rises in 
the morning with reluctance and a sense of weariness. If she gets 
up the moment she awakes, she then feels less tired; but if she 
neglects to do this, she afterwards leaves the bed with extreme un- 
willingness and a feeling of fatigue greater even than at the close 
of the day. She complains of some pain round the lower part of 
the back and above the pubes, and of some heat and fulness in the 
pelvis; but she menstruates regularly. Her appetite is tolerably 
good ; though she has some uneasiness after food, and her tongue is 
clammy. 
All the symptoms were soon removed by an alterative aperient 
course of medicine. 
Case X.—The early consequences of habitual constipation in a highly sanguine 
temperament. Menstruation too abundant. 
1830, March.—Maria Turner, aged 21, complains of a throbbing 
pain across the forehead and through the temples; of heaviness, 
sleepiness, stupor, and reluctance to exertion: she could fall asleep 
at any time in the day : if she stoops she experiences a great weight 
in the forepart of the head and giddiness; and, when sitting at 
needlework, feels as if she must fall forward. Whatever is on the 
table seems to be falling in a slanting direction; if she looks at 
any object for a moment, it appears double and dim, and her eyes 34 
BURNE ON HABITUAL CONSTIPATION. 
strike fire; she has a noise in the head and a beating in the temples 
which makes her lower teeth strike the upper; she feels her head 
jarred by shaking a bed ; and the sight even of anything in motion 
increases the headach, as also does unexpected noise. She is always 
hot about the head and flushed in the face, which gives her the as- 
pect of rude health: if she takes porter or wine she flushes exceed- 
ingly and becomes stupidly heavy : she is apt to faint from heat, or 
exertion, or in a crowded church : her feet are intensely cold, while 
the hands burn. 
She is no sooner in bed than she falls into a sound sleep, sleeps 
heavily all night, is very hot and yet requires much covering, and 
gets up with such reluctance and sense of fatigue, that she has 
scarcely resolution to put on her clothes. If she does not get out 
of bed the moment she awakes, she falls asleep again irresistibly, 
and is afterwards more tired than ever; her legs feel heavy as logs, 
and crampy pains run from the toe to the hip. Her spirits are de- 
jected even to the frequent shedding of tears, although naturally she 
is very cheerful; and her temper, formerly good, is grown irritable. 
She is apprehensive and alarmed without particular cause; and 
starts at the sudden opening of a door. The appetite is pretty 
good, though capricious: she is troubled with flatulence and rumb- 
ling noise in the abdomen to such an extent as to be heard by those 
near her, and to oblige her sometimes to go out of church: she has 
eructations, but no acidity: is always thirsty, and the lips are 
parched: the tongue is very foul and thickly covered with a dirty 
yellowish white fur, and, in the morning, with froth, when she ex- 
periences the vitiated taste of decomposed eggs: the pulse is acce- 
lerated; she perspires easily and much about the head at night. 
She has frequent and urgent micturition with ardor urinas : the 
urine is at one time pale and limpid, and passed in large quantities; 
at another it is scanty and thick, and emits an offensive odour. 
She menstruates abundantly every three weeks; and, in the inter- 
vals, is troubled with a copious leucorrhoea ; both of which debilitate 
her exceedingly. 
She has been subject to constipation of the bowels since the age 
of 19, now two years: during the last three months of which it has 
been more obstinate, no evacuation occurring oftener than once in 
five days, and then not without the aid of very powerful medicine. 
The dejections are always hard and knotty, with much slime. She 
feels constantly a bearing down and a kind of dragging sensation 
at the lower part of the rectum, causing a frequent indistinct desire, 
attended with great striving and the painful expulsion of only one 
or two scybals. The striving affects her head exceedingly. She 
has a burning heat and great itching about the anus; and frequent 
aching and griping pains in the belly, which draw her almost 
double. 
All these complaints have gradually sprung up since the bowels 
first became constipated, and they were removed and the health 
re-established by restoring the regular and natural evacuation of CONSEQUENCES OF HABITUAL CONSTIPATION. 
35 
the intestinal canal, after the manner which will be pointed out in 
the chapter on treatment. The particular medicines which bene- 
fitted her were an electuary composed of confection of senna and 
jalap, which operated more effectually and with less distress than 
every other medicine she had tried; and immediately the bowels 
were thoroughly acted upon, all the unpleasant symptoms began to 
subside. Lavements, castor oil, and other aperients had little effect 
upon her. She afterwards derived much benefit from a stomachic 
aperient mixture; and the leucorrhoea was cured by the liquor 
aluminis c., diluted. 
Remark.—Of the vast number of cases which have passed under 
my notice, I do not remember one in which so many distressing 
consequences have arisen in so short a space of time; a peculiarity 
to be attributed, in a great degree, to the highly sanguine and 
nervous temperament of the individual, and, in a less degree, per- 
haps, to predisposition; her mother, whose case will presently be 
related, having suffered from excessive constipation for many years. 
The habitual excretory function of the bowel may be merely 
sluggish, rendering the evacuations uncertain as to time and un- 
equal as to quantity ; a stale of things rather peculiar to persons of 
a melancholic temperament, in whom, whatever affects the mind, 
be it sadness or hilarity, affects in some degree the body. The 
mind, gloomy by constitution in these persons, retards, when 
depressed, the natural action of the large intestine, partly by ob- 
tunding the perceptive sensibility of the nervous system, partly by 
interrupting sympathetically the biliary secretion, and so depriving 
the excrementitious matter of its proper and efficient stimulus. 
While, on the other hand, emotions which exhilarate, which elate 
the mind, promote the action of the bowels by quickening the ner- 
vous sensibility generally, as well as by encouraging the secretory 
functions of the liver. 
OP THE SECOND STAGE. 
In tracing the early consequences of the habitual confinement of 
the body, it has been seen that they consist of a sympathetic deter- 
mination of blood to the head which oppresses the brain and 
nervous system; and in a sympathetic irritation of the abdominal 
and pelvic viscera, which disturbs the functions of some organs and 
heightens the sensibility of others. Hitherto these effects are so 
directly dependent on their cause, as to subside when the cause is 
removed, and it is only necessary to restore the action of the 
bowels in order to re-establish the health. But, when the habitual 
constipation of the bowels has been longer in operation, the conse- 
quences assume a less tractable character; they become in a 
degree independent of the original cause, and require an indi- 
vidual consideration and independent treatment. The indvid- 
ual remote effects do not come within the scope of the present 
chapter; of which the remainder will be limited to an account of 
the aggravated consequences on the general health. 36 
BURNE ON HABITUAL CONSTIPATION. 
The determination of blood to the head which, in the first stage, 
produces drowsiness by day and heavy sleep by night, now gradu- 
ally increasing with the prolonged existence of the cause, interferes 
at length with the functions of the brain. The mind becomes irrita- 
ble, apprehensive; noises jar, distract the brain,and strong light over- 
powers the eye, while at the same time the delicate sensibility of 
these organs is dulled by the cerebral congestion, and the senses, 
though morbidly alive to great impressions, are no longer adapted 
to acute and nice perception. There is, in addition, pain in the 
head generally, greater in a particular part, as on one side; often 
of a distracting character, giving sometimes the sensation of the 
brain opening and shutting; and sooner or later the person falls 
down in an apoplectic fit. I have known many of these cases, some 
occurring in persons of a florid complexion and gross habit of 
body; some in individuals pale and thin ; but, in all, there has ex- 
isted for years the common cause, an obstinate and difficult state 
of the bowels. 
So recently as September, 1838, a girl not more than 18 years of 
age was brought into the Westminster Hospital in a state of pro- 
found coma, of which she died ; and on dissection, there was found 
a large effusion of blood in the left hemisphere and in the ventri- 
cles. She had been long affected with pain in the head over the 
eye, and had long suffered from habitual constipation of the bowels, 
the only cause to which the headach and consequent apoplexy 
could be attributed. 
Case XI.—Determination of blood to the head. Constipation. 
Ellen Allen, age 26,—occupation sedentary; complained of 
continual weight and pain in the head, aggravated at times so as to 
stupify her,—of now and then feeling distracted as if she should 
lose her senses, when she was obliged to hold her head with both 
hands,—of great weight and beating over the eyes, and of a sense 
of their being bound down as if she could not open them,—of pain 
shooting down the spine. Her memory was become impaired, her 
eyesight weak; on looking steadily at her work, she would see 
double; various colours would float before her eyes, so confusing 
the sight that she would be obliged to desist from work. 
She had been subject to constipated bowels for 12 or 15 years, 
having only two or three evacuations in the week, and these con- 
sisting merely of scybals like marbles, which were voided with great 
striving, difficulty, and pain. She does not remember when she had 
a natural dejection. She had lost much of her hair in consequence 
of her ill health. 
Case XII.—Apoplectic cerebral congestion. Constipation. 
An unmarried lady, 28 years of age, of rigid fibre and fine frame 
of body, had been for many years subject to obstinate constipation, CONSEQUENCES OF HABITUAL CONSTIPATION. 
37 
the action of the bowels being procured with difficulty even by the 
strongest medicines. Her chief complaints had been a constant se- 
vere aching pain in the head and confusion of ideas; scanty men- 
struation ; violent flushing of the face and neck, and a sensation of 
overpowering heat, when, on a sudden, one morning after breakfast, 
she fell down in an apoplectic fit, in which the breathing was ster- 
torous, and sensibility and voluntary motion were suspended. 
By the abstraction of blood the pressure on the brain was re- 
lieved, and by securing the action of the bowels recovery was gra- 
dually brought about, no paralysis having taken place. 
Case XIII.—Apoplexy from constipation—fatal. 
Mrs. B., about 55 years of age, had suffered from obstinate con- 
stipation for the greater part of her life. She was of a gross habit 
of body, corpulent, and florid. Her ailments consisted in constant 
distracting pain in the head with a sense of fulness, and frequent 
overpowering flushing of the face. The difficulty experienced in 
obtaining alvine evacuations was excessive; she described her ef- 
forts at the closet as violent, ineffectual strivings, which only in- 
creased the desire without the power; the most she could force 
away being one or two hard knots of feculent matter. These striv- 
ings determined blood to the head to a degree as to give her the 
sensation that the head would burst; and eventually she fell down in 
a fit of apoplexy, w’hich annihilated the functions of the brain, and 
destroyed life. 
In common with the cerebral congestion there will be an impair- 
ment of the memory, a train of nervous symptoms, a general disor- 
der of the digestive organs, and a co-existing irritation of the pelvic 
viscera, the sympathetic result of the retained excrementitial mat- 
ter: all which states and affections will be best illustrated by appro- 
priate examples. 
Case XIV.—Headache. Trouble in the functions of the brain and nervous sys- 
tem, and of the digestive organs. Irritation of the pelvic viscera. Humours 
in different parts of the body. Constipation. 
Mrs. Ann Hemming, age 50, a widow, the mother of seven chil- 
dren,of a plethoric habit and melancholic temperament, had suffered 
from constipation of the bowels as long as she could remember. 
She thought she should never have an action of the bowels without 
the aid of medicine. She was affected with great heat about the 
rectum and vagina and during micturition, particularly if she omit- 
ted to take opening medicine. The urine was at one time copious 
and pale, at another high-coloured and scanty; little festerings 
showed themselves about the pudenda, and blind boils about the 
anus. She had been troubled with leucorrhoea for some years; and 
menstruation had latterly been irregular—a circumstance to be ex- 
pected at her period of life. She had long been liable to great heats 
in various parts of the body; and in the autumn she was subject to 38 
BURNE ON HABITUAL CONSTIPATION. 
an eruption behind the ears, attended with heat, irritation, and dis- 
charge. 
She had frequent headach, with a sense of weight at the occiput, 
and a confusion of mind which embarrassed her greatly. Flashes 
of light darted through the eyes, and dazzling things appeared before 
her. She went to sleep readily, but on awaking had a pain in the 
head with a sensation as if it opened and shut at the top. She was 
nervous and alarmed ; languid, uncertain, and unsteady for an hour 
after rising. The feet and hands, the feet particularly, were cold 
as if immersed in water, while the face and head burned. Formerly 
the appetite was good, lately precarious; she felt full for an hour 
or two after meals, was very flatulent, the flatus rolling about the 
belly and making a great and unpleasant noise. She had heart- 
burn and occasional pain under the shoulder-blades; the skin was 
sallow, the tongue clean notwithstanding, and the pulse natural, 
the urine pale and copious. 
Seven years ago she suffered much in her head, had great weight 
over the eyes, and for twelve months could not look up to the light, 
was confused and giddy, and her memory so bad, that if she went 
upstairs to fetch anything, she would forget what it was: she could 
no longer count or reckon correctly. For these symptoms she had 
been bled profusely; 150 leeches also had been applied to the head, 
which had been shaved and blistered ; she had been cupped besides, 
and all in the space of six months. Since this injudicious treat- 
ment, she has been exceedingly nervous, which she attributes to the 
great loss of blood. 
The great objects in the treatment of this case were, first, to regu- 
late the action of the bowels, and then to give tone and vigour to 
the nervous system. To accomplish the first object, aperients 
composed of magnesia and compound decoction of aloes or rhubarb 
were given so as to produce one or two dejections daily and not 
more ; for if the bowels acted several times her knees became tre- 
mulous. The infusion of senna was eventually resorted to, and found 
to be the most certain and efficacious as an aperient. These means 
being persevered in for several weeks, great benefit accrued. The 
heats and flushings passed away, the flatulence and fulness of the 
abdomen were diminished, and she was relieved from the appre- 
hension and alarm she used to feel on awaking in the night. To 
tranquilize and invigorate the nervous system, the following were 
prescribed :—R. Ferri Sulphatis, Quince Disulph. aa gr. xij. Extr. 
Colocynth. comp. 9ij. Opii, gr. ij. M. et in Pilulas xxiv. divide. 
Capiat ii. bis quotidie. 
From these remedies she derived great benefit: they regulated 
the bowels, strengthened her memory, and cured her nervous 
symptoms. 
Case XV.—Cephalalgia. Dyspepsia. Hypochondriasis. Leucorrhcea. Pro- 
lapsus anir Constipation. 
Mary Cousins, age 32, of fair complexion but most hypochon- 
driac aspect, having a fixed expression of the countenance, with the CONSEQUENCES OF HABITUAL CONSTIPATION. 
39 
eyes cast down and overhung by wrinkled eyebrows, applied for 
advice on the 21st of April, 1831. She complained of distressing 
pain in the head with weight across the forehead immediately above 
the eyebrows: she trembled much, her heart palpitated on the 
slightest hurry or alarm ; she was restless, anxious, apprehensive, 
and alarmed lest she should go out of her mind. She kept alone, 
being disinclined to associate with any one. She was always dis- 
posed to sleep, but when she lay down experienced most distressing 
sensations. At night when she fell asleep, she started up, sat up in 
bed, and sometimes was obliged to pace the room : she awoke with 
a distracting pain in the head, and could not then bear to be spoken 
to. Her eyesight, though naturally good, was impaired, much 
more at one time than at another; she was frequently unable to 
thread a needle, and could not work by candlelight, things then 
appearing double and dim. 
Her general health was very indifferent; she was thirsty, the 
tongue was foul, the taste unpleasant, the appetite capricious, and 
she was unable to take food in the morning till she had had some 
tea. She had a burning sensation all down the oesophagus, in the 
stomach and the bowels, with acid eructations and flatulence. She 
was frequently overcome with faintness and sudden sweats; the hands 
burned, while the feet were cold. For the last several months she 
had been troubled with leueorrhoea to a great degree, accompanied 
with ardor urinse, and frequent micturition, the urine being some- 
times pale and copious, at others high-coloured and scanty. She 
had a forcing sensation about the bladder and womb, and the rec- 
tum descended after striving at the closet, and would at times re- 
main prolapsed for a day and a night, when it was very painful. 
She had not menstruated for twelve months past, prior to which 
time she had been regular. She was the mother of one child. 
She had been subject to a confined state of the bowels for a very 
long period, passing a week and upwards'without a dejection; con- 
stantly wanting to go the closet, but when there passing only a single 
scybal with violent efforts. She required strong medicine, without 
which she never had a free dejection. 
1830. Mary Turner, age 44, a widow, (the mother of Maria 
Turner, Case X.), complained of an obstinate state of the bowels, 
many days passing without a dejection, which was then procured 
only by powerful medicine. The dejections were hard, like mar- 
bles, and covered with inspissated mucus which she described as a 
skin. She had a sense of weight at the anus, like an indistinct con- 
stant desire. If she did not obey an inclination at the moment, all 
efforts afterwards were ineffectual. She suffered from leueorrhoea 
and great heat about the pelvic viscera: the urine was often abun- 
dant and pale, often scanty and high-coloured. She suffered also 
from a most distressing sense of sinking at the stomach, attended 
sometimes with pain; and from flatulence and rumbling noise in the 
Case XYI.—Hemicrania. Leucorrhcea. Obstinate constipation. 40 
BURNE ON HABITUAL CONSTIPATION. 
bowels. The appetite w?as pretty good towards midday, but alto- 
gether deficient in the morning. 
She was subject to violent headache, first on one side and then on 
the other; her eyesight, formerly very good, had failed much of 
late. Latterly she had become apprehensive without obvious cause; 
and in the night when she awoke, she had a great dread of losing 
her senses. She felt languid and weak, quickly tired, and disin- 
clined to exertion. Menstruation, irregular for the last two years, 
had now ceased altogether. 
The ordinary aperients were first tried, but they did not act effi- 
ciently upon the bowels. Then she took the confection of senna 
with jalap, which exonerated the bowels thoroughly, at the same 
time mildly, and produced remarkable relief: all her complaints be- 
gan to diminish immediately ; and, by perseverance in this medicine, 
with the further aid of quinine and alteratives, the functions of the 
digestive organs, as well as of the brain and nervous systems, were 
gradually improved, and the health restored. 
Case XVII.—Dyspepsia. Borborygmus. Palpitation. Irregular menstrua- 
tion. Leucorrhrea. Constipation. 
1830. Mary Ann Finley, aged 33, unmarried, of delicate frame 
and sanguine temperament, had suffered from constipated bowels for 
upwards of ten years, the dejections being knotty, covered with 
mucus, and passed with pain. 
At first she experienced the usual consequences, heaviness of the 
head, sleepiness, and flushings and heats on trifling occasions. Then 
she was troubled with crampy pains in the abdomen and flatulent 
distention, the flatus rolling about the bowels and causing so much 
and so loud a rumbling noise as to oblige her to leave the room, and 
even, on some occasions, to go out of church. She felt full and op- 
pressed after meals, had an unpleasant bitter taste in the mouth, no 
appetite at breakfast, yet at midday was sinking for food; but, if 
she passed this time without eating, she was afterwards careless 
about it. She had frequent desire to make water, had heat and irri- 
tation about all the pelvic viscera, as also a copious leucorrhoea, 
which drained and exhausted her. At night she w7as apt to be fe- 
verish and restless, and in the morning languid and tired, as if she 
had not been to bed. The feet w7ere always cold, the hands hot. 
The dejections had latterly been soft, pale, scanty, and tenacious, 
not passing away freely; she had constant desire to exonerate the 
bowrels, but her efforts at the closet were unavailing. 
Menstruation had been painful and irregular for the last two 
years, both as to quantity and time; the periods recurring at 
intervals of six, five, and three weeks. Of late she has be- 
come nervous, and troubled with palpitation, and her spirits, 
which were naturally good, are depressed without any assignable 
cause. 
On the 10th of January, 1830, I was called to her in the night 
on account of a violent palpitation of the heart and short hurried CONSEQUENCES OF HABITUAL CONSTIPATION. 
41 
respiration, which seemed to threaten her existence. She was 
unable to lie down for fear of suffocation, and had scarcely slept 
the two preceding nights. The pulse was rapid, small, and weak; 
but there was no preternatural heat of the skin, the lower part of 
the body being very cool. The abdomen was full of flatulence, the 
flatus rolling about with noise. The dejections were soft, insuffi- 
cient, and offensive. 
The history of the case led me to conclude that all her symptoms 
had originally been produced by the irregularity of the alvine 
excretions, and that the present signs depended on dyspepsia, rather 
than on any inflammatory condition of the viscera of the chest. 
Accordingly, I prescribed camphor and hyoscyamus, to appease the 
nervous system, and warm rhubarb draughts to act upon the bowels. 
After two draughts had been taken, the body was freely purged, 
much to the relief of the palpitation and other signs : the respiration 
also became freer and deeper, and she was able to lie down. 
From this period her health improved slowly but decidedly, by 
constant attention to the bowels; the regular action of which was 
better secured by senna, than by any other aperient. She after- 
wards derived great benefit from the sulphate of iron, and enjoyed 
a better state of health than for many years. 
March, 1830. Frances B , age 42, had been always troubled 
with constipation of the bowels, and long subject to headach, gid- 
diness, sleepiness, flushings, and so on. She was very nervous, 
and lowr-spirited; easily alarmed, and disturbed by frightful dreams. 
She had a bad taste in the mouth; the tongue was clean but frothy, 
and the appetite indifferent. 
She complained particularly of violent sickness without vomit- 
ing; of great uneasiness from flatulent distention of the stomach, 
and of flatulent eructations: the distention was often so great that she 
was obliged to unlace her stays in the evening. The bowels were 
always confined, except that about every four days she was seized 
with pinching pains across the upper part of the colon, which lasted 
for one or two hours, when a purging would supervene, the de- 
jections being at first lumpy and dark, and passed with cutting 
pain, then thin, frothy, copious, offensive, and hot, to the number of 
four or five, all of which would take place in the course of one or 
two hours. The pain then subsided, and the bowels became again 
confined for several days, when the pain and purging would 
recur. She was directed to regulate the bowels with the carbonate 
and sulphate of magnesia: which, being effected, the symptoms 
were all gradually relieved. 
Case XVIII.—Constipation alternating with purging. Indigestion. 42 
BURNE ON HABITUAL CONSTIPATION. 
CHAPTER 1Y. 
OF SICK-HEADACH, OR CEPHALALGIA WITH GASTRO-HEPATIC IRRITATION, 
SYMPATHETIC OF HABITUAL CONSTIPATION. 
The popular term “sick-headach,” is associated with a train of 
symptoms of every-day occurrence; and, though not altogether 
confined to females, it is they particularly who suffer from this 
affection. 
An attack of sick-headach comes on for the most part suddenly. 
A lady, having gone to bed as well as usual, will awake in the 
morning with a sense of great weight in the head and pain in one 
temple, or over one eye ; or, she may be seized with these symp- 
toms at any period of the day; in which case she is obliged to re- 
tire to bed. After the pain has continued a few hours she grows 
sick, then vomits, throwing up quantities of greenish-yellow bile 
and mucus. The vomiting recurs at intervals and the stomach 
remains irritable, ejecting everything and resisting the influence of 
medicines of known efficacy in other cases of gastric irritation, till, 
at the expiration of twenty-four hours, the sickness and vomiting 
diminish and aperient medicines are retained, which in due time 
act upon the bowels, when the headach, sickness, and vomiting 
pass away. The individual soon regains her usual state of health, 
which continues without any material interruption till she is over- 
taken by another attack. 
The same symptoms and sufferings now recur, take the same 
course, are relieved by the same means, and she again recovers to 
be again attacked after a certain interval. The I'ecurrence of 
these paroxysms is more or less regular, so regular indeed as in 
many cases to be almost periodical: the periods varying in differ- 
ent individuals from one to five or six weeks; the length of interval 
depending much on the natural susceptibility of the individual, and 
on the urgency of the cause. The longer, also, persons have been 
afflicted with the sick-headach, the more frequently and the more 
severely do they suffer; as a general rule. 
Now the effects of these repeated attacks upon the constitution 
accumulate; and, about the critical period of female life, lead to or 
end in apoplexy: or in visceral disease, either of the liver, uterus, 
stomach, or alimentary canal. And in the absence of lesion of any 
of these organs, the general health suffers, so that, in the intervals 
of freedom from the attacks, the appetite is bad, and the digestion 
so weak that the greatest strictness in regimen and constant self- 
denial are required to guard against and prevent the troubles of 
indigestion: and, even with all the care possible, the general health 
declines. 
April 17, 1833. Mary Eaton, age nine years, has been subject 
to confined bowels from infancy, passing from three to seven days 
Case XIX—Sick-headach at the age of nine years. Constipation. CONSEQUENCES OF HABITUAL CONSTIPATION. 
43 
without a dejection. Latterly she has been affected with sick- 
headach once a week or oftener; the attack coming on suddenly 
with a violent pain over the left eye, succeeded in a few hours by 
sickness and vomiting of green-yellow bile. She goes to bed, and 
after 24 hours recovers. Her appetite was generally good, but she 
was dull and slept heavily. Her mother was also of a very con- 
stipated habit of body and subject to sick-headach. By the use of 
aperient medicines the girl got better immediately; but if the bow- 
els were neglected, a recurrence of the same symptoms was threat- 
ened. 
Case XX.—Sick-headach at the age of 14. Constipation.' 
1830. Ann Civial, aged 14. Her bowels have been confined 
habitually for several years, more obstinately within the last 12 
months, five or six days elapsing without an evacuation : the dejec- 
tions lumpy and black. Her face was sallow and dark, and puffy 
under the eyes, with a dull dejected expression ; the tongue was 
white, the feet always cold. 
She complained of pain in the forehead almost constant, with 
sense of weight so great as to make her drowsy and forgetful in 
the day : she fell asleep as soon as in bed, and w'ould wake up in 
the night agitated as from the night-mare. She w'as subject to pain 
in the stomach and to attacks of sickness every three or four weeks, 
alwrays preceded by a more violent pain in the forehead. The sick- 
ness would persist for two or three days, throwing up much yellow 
bile and mucus; but having subsided she would feel better, though 
for a few days only. 
Oct. 16. She began to take the aloes and myrrh pill every night, 
and afterwards the compound rhubarb pill combined with the blue 
pill; but these did not operate sufficiently, and she made but little 
progress. On the 11th Nov. she commenced with the carbonate and 
sulphate of magnesia and compound decoction of aloes, which, taken 
twTice a-day, acted freely on the bowels. When this was effected, 
all the symptoms gradually subsided, and in a few weeks it wag 
reported that the pain and heaviness of the head were removed, the 
sickness had not returned, the pain in the stomach was gone; that 
her spirits were good, and her health restored. 
Case XXI.—Sick-headach. Cerebral congestion. Dyspepsia. Constipation. 
1837, Nov. Roda Palmer, age 30, has for many years been 
troubled with a most obstinate state of bowels, requiring very strong 
medicine to act upon them, and this to be constantly repeated. 
Without the aid of powerful medicine the bowels would never be 
relieved. She has passed a fortnight without an action, which 
then was procured only by purgatives. The menstrua were regular : 
she was troubled with leucorrhcea. 
For several years she has been afflicted with paroxysms of violent 
sick-headach, recurring frequently; in which the pain in the fore- 44 
BURNE ON HABITUAL CONSTIPATION. 
head would be distracting for two days, and, during this period, she 
would be deadly sick, though unable to vomit. Preceding these 
attacks, the eyes would be dizzy and vision indistinct, everything 
appearing to move in a zigzag direction. She has also been sub- 
ject to pain in the stomach after food, with nausea and discharge of 
some watery fluid ; great distention of the bowels ; sense of coldness 
and weight at the stomach—“ like cold water and like a lump of 
lead against which she could not breathe”—causing her respiration 
to be oppressed and her heart to palpitate. 
In January her head became much worse, the pain very violent, 
and sense of weight and giddiness so great, that she could not hold 
her head up : the eyes were suffused and prominent, as if forced 
from their sockets: her ideas were confused; her memory so indis- 
tinct that when at work she would forget what she was doing. The 
appetite was indifferent, she was afraid to eat on account of the 
distress in the stomach which followed : her feet were always cold, 
while the face flushed frequently, and the head was hot. 
At this time the cerebral congestion threatened a fit of apoplexy, 
which was averted by a loss of blood both from the arm and by 
cupping. The loss of blood gave her temporary relief, but weak- 
ened her. She took a variety of medicines for several months on 
the principle of regulating the bowels and improving the state of the 
stomach; as calomel, opium, magnesia, aloes, senna, camboge, bis- 
muth ; it being always difficult to act upon the bowels even by most 
powerful medicine. 
Being at Leamington in the autumn of 1837, she applied to Mr. 
Middleton in order to be cupped for a return of the severe headach 
with determination of blood. This gentleman, like myself, was of 
opinion that all her symptoms, cerebral and gastric, depended on 
the constipated bowels, and therefore recommended her to try an 
aperient plan before she was cupped, her general aspect being op- 
posed to the loss of blood. Mr. Middleton happily hit upon a com- 
bination of aperients that answered perfectly: they consisted of Pil. 
Hydrarg.; Cambogice ; aa. gr. v., to be taken every night; andMag- 
nes. Sulph. ; ex Decoct. Aloes c. f 3jss. every morning. These 
operated better than any she had before taken, produced two or 
three dejections every morning; and from this period the affection 
of the head and the derangement of the stomach began and con- 
tinued gradually to subside and improve, and in the course of three 
or four weeks she could take food with comfort and pleasure, and 
go about her occupations with alacrity. 
Remarks.—No example has come within my knowledge more 
confirmatory of the fact of severe cerebral and gastro-hepatic dis- 
order being consequent on habitual constipation ; as proved, in the 
present instance, by the recovery of health through means adapted 
only to the regulation of the bowels. 
Of the causes of Sick-headach.—The general and most prominent 
causes of the sick-headach is habitual constipation, as shown by 
the preceding cases, in which the patients, only 9 and 14 years of CONSEQUENCES OF HABITUAL CONSTIPATION. 
45 
age, had not suffered from any other disordered function than the 
constipation prior to the supervention of the sick-headach ; and the 
sick-beadach was, moreover, suspended and cured by means 
adapted to the removal of the constipation. The dependence of 
these attacks on the irregular state of the bowels, is particularly 
well marked in Case XXI., in which the cephalalgia and gastro- 
hepatic irritation, though severe and of long standing, were entirely 
relieved by the restoration of the natural functions of the bowels. 
Where patients have long suffered from these combined ailments, 
the propriety of attributing them to habitual constipation, as the 
primary cause, is not at once obvious ; but if the history of any 
individual case is traced, it will be found that the constipation was 
the first departure from health, and that it preceded for a consider- 
able period the development of the sick-headach. 
As a secondary cause must be adduced indiscretion in diet, 
whether it consists in full meals and rich dishes, or in wine or other 
fermented liquors, malt liquor especially. These never fail to ag- 
gravate the sufferings ; for even an ordinary liberal diet can scarcely 
be borne where constipation exists: whereas, if that is removed*, 
the appetite and digestion improve, and individuals are no longer 
obliged to undergo the privations at table, which, otherwise, they 
are compelled to observe. Here and there I have met with an 
instance of sick-headach caused and kept up solely by high living, 
the bowels in these persons being regular: but the cases are so 
rare that they may be regarded as exceptions to the general rule. 
Of the treatment.—The object in the treatment of sick-headach 
is twofold: first, to relieve the paroxysm; secondly, to prevent a 
recurrence. 
When a paroxysm is farly set in, medicine will be of little avail; 
the headach and vomiting will persist in spite of creasote, opium, 
hydrocyanic acid, effervescing saline aperients, and the like; either 
and all of which will generally be ejected from the stomach, and 
the symptoms continue their usual period of from 24 to 72 hours. 
It is of importance, however, to bring about a free action of the 
bowels as soon as possible, to which end colocynth, calomel, and 
opium may be given. The cathartic pills should soon be followed 
by a senna and salts draught, which, if rejected, may nevertheless, 
as also the pills, be repeated once in eight hours till they have 
operated freely. Where the constipation is very great, the action 
of the above medicines should be facilitated by lavements. 
By the time the bowels have yielded to the means employed, the 
paroxysm will be passing away, when measures adapted to prevent 
its recurrence should be resorted to. After the subsidence of a 
paroxysm, the bowels require to be kept freely open in order that 
the great quantity of dark-green bile secreted* at this time by the 
liver—which has been congested and is now disgorging itself,— 
should be carried off. This having been accomplished, the state of 
the brain and liver should be inquired into, and if determination of 
blood to either of these organs,—as indicated by heaviness of th§ 46 
BUKNE ON HABITUAL CONSTIPATION. 
head and a sense of fulness and uneasiness in the right hypochon- 
drium—should exist, blood to a moderate extent ought to be ab- 
stracted by cupping or by leeches; and, if the habit should be ple- 
thoric, the loss of blood from the arm, to the amount of eight or 
twelve ounces, will be of essential service, and aid in maintaining 
the integrity of these organs. 
These organs being secured from the effects of congestion, a 
course of medicine especially directed to regulate and keep freely 
open the bowels should be commenced and persevered in, not merely 
for a week or a fortnight, but for several months, in order that the 
natural and spontaneous action of the intestinal canal may be 
brought about. Of the kind and quantity of aperient medicine, and 
of the frequency with which it should be administered, I shall speak 
in the chapter “ On the Use of Aperients.” Suffice it now to say 
that some constitutions will require and be benefited by powerful 
purgatives daily repeated for perhaps a week, while others will 
only bear mild aperients, at any time; all being, nevertheless, 
benefited by a regular action of the bowels by whatever means 
brought about. The same remark applies to blood-letting; the 
propriety and extent of which must be determined by the age, habit, 
and strength of the patient. 
In addition to aperients and combined with them, alkalis are, for 
the most part, serviceable, especially where there is heat of stomach 
and flushing of the face. Magnesia, in substance or in solution, is, 
on the whole, perhaps, the best; though circumstances may give a 
preference to soda, potass, or ammonia. Soda-water is often an 
agreeable and proper beverage; to which a small quantity of brandy 
may be added. Malt liquor must be entirely relinquished; and 
wine taken sparingly, not exceeding one glass; sherry the best. 
Where there is strength of frame and constitution, an abstinence 
from all fermented liquors will not only be borne, but be followed 
by decided benefit. 
Of Diet, — which, like aperients, forms an important point in the 
treatment of all the “ consequences”enumerated in this work,— I 
propose to speak hereafter, and will therefore not touch upon the 
subject at this time. 
CHAPTER V. 
OF DISEASES OF THE STOMACH AS CONSEQUENCES OF HABITUAL CON- 
STIPATION. 
Indigestion. Gastrodynia. Pyrosis. Subacuto-chronic inflammation and or- 
ganic disease of the stomach. 
The several affections—the first excepted—named at the head 
of this chapter, result, according to my experience, from the same CONSEQUENCES OF HABITUAL CONSTIPATION. 
47 
pathological condition of the stomach, varying in degree and stage, 
and are to be attributed to habitual constipation as the primary or 
remote, and even as the exciting cause, more frequently than any 
other. My object, at the present, is to put habitual constipation 
prominently forward as a cause of disorders of the stomach, in- 
stead of regarding it merely as an incidental or attendant symptom. 
I do not advance the opinion that habitual constipation is the 
exclusive cause of the above affections, but that it is the most fre- 
quent; a point I urge the more, that, in the treatment of these 
affections, remedies may be directed to the relief and removal of 
the constipation, as an essential and chief means of relieving and 
removing the disorders of the stomach. Not that, in the majority 
of instances, attention directed only to the relief of the constipation 
will suffice and supersede all other treatment; for effects, when of 
long standing, will often persist independent of the original cause, 
and require means specially adapted to them. Where, however, 
the cases are recent, the gastric symptoms will yield to, and be 
entirely removed by, attention to the bowels: as will be shown by 
instances to be adduced. 
Simple Indigestion,—as indicated by a sense of fulness and dis- 
tention of the stomach after meals, a bitter taste in the mouth, 
flatulent eructations, flushings of the face, and heaviness of the 
head,—is frequently sympathetic of habitual constipation; and, 
when so, is speedily relieved by a proper course of aperient medi- 
cines: the stomach recovering its powers of digestion as soon as 
the excretory office of the large intestine has been restored. 
As it forms no part of the plan of this work to treat specially 
and at length of Indigestion,—a subject already ably and fully 
written upon by Drs. Phillip, James Johnson, Paris, Abercrombie, 
and others,—I take cognisance of it no further than is necessary in 
considering it a very frequent consequence of habitual constipation. 
By Gastrodynia—literally, pain in the stomach—is understood 
uneasy or painful sensations in the stomach after food ; which may 
occur on single occasions only, or daily, more or less, for a length 
of time. It is variously described as a feeling of heaviness, 
weight, or absolute pain of an obtuse aching character, coming on 
usually after a meal, particularly dinner, sometimes immediately 
the food is swallowed, at other times not for one, two, or three 
hours, when the digested portions are passing on towards the pylorus. 
This gastrodynia,—called not inappropriately by Dr. James 
Johnson, “ morbid sensibility,”—exists at times as the only symp- 
tom, the appetite and the digestion remaining good: but more 
generally it is one of the many signs of impaired and difficult 
digestion. 
I have known gastrodynia caused accidentally by a hard pill taken 
on an empty stomach; the pain commencing when the pill, undis- 
solved, may be supposed to have reached or to be passing the pylo- 
rus. This pain may continue for twenty minutes, and then cease 
suddenly and entirely. It is of an obtuse aching character, and at- 48 
BURNE ON HABITUAL CONSTIPATION. 
tended with nausea and the discharge of a watery fluid from the 
mouth. Accompanying the gastrodynia there is often pain referred 
to the inferior and middle regions of the sternum, which the patient 
supposes to arise from an affection of the chest, but which is, in 
fact, sympathetic of the gastric disorder. On this symptom I would 
lay some stress. I have observed this pain in the region of the ster- 
num on a great many occasions, and I do not remember an instance 
in which it proceeded from any cause, pulmonary or cardiac, within 
the chest, but was always associated with disorder of the stomach, 
and abated and passed away according and as soon as this disorder 
was relieved and cured. 
Seeing that this impatience of the presence of food, this gastrody- 
nia or morbid sensibility, always precedes, and is often followed by, 
organic disease of the stomach, I am disposed to regard it as depen- 
dent on a pathological congestion of greater or less degree. Of 
this, as also of the treatment, I propose to speak further under the 
head “ Pyrosis:” and shall now, therefore, only adduce three cases 
in illustration. 
Case XXII.—Gastrodynia, or increased organic sensibility of the stomach. Ha- 
bitual constipation. 
August, 1839.—A young woman, 22 years of age, her occupation 
sedentary, complained of having been affected for six or eight 
months with a sense of fulness and uneasiness, almost amounting to 
pain, in the region of the stomach after dinner, lasting for two or 
three hours, with nausea and headach. She menstruated regular- 
ly; but her bowels were much constipated habitually. 
To take Hydrarg. Chloridi gr. ss., Opii gr. in the form of pill daily after din- 
ner; and the Mistura Magnesi® cum Magnesise Sulphate et Decocto Aloes 
Comp, at bedtime, in sufficient quantity to regulate the bowels. 
The calomel and opium relieved the gastrodynia immediately and 
perfectly; the mixture acted upon the bowels, and by perseverance 
she recovered without any change of plan. 
In another case very similar to the above, the uneasiness amount- 
ed to pain, came on immediately after having taken food, and ex- 
tended up the sternum ; so that the patient pointed to the sternum as 
the seat of suffering, rather than to the stomach. This sternal pain 
proved to be sympathetic of the gastric disorder, and subsided as 
the functions of the stomach were restored. 
Case XXIII.—Gastrodynia, or increased organic sensibility of the stomach, with 
attacks of violent sick-headach. Habitual constipation. 
1839, July 3d. Mrs. D , age 38, married, no child, menstrua- 
tion regular, but excessively painful. Complained of a sense of 
weakness with pain almost constant in the stomach, increased after 
dinner, when she experienced also a sense of fulness. She suffered 
moreover from a sense of sinking at the stomach and of want of 
food; yet if she took any it made her uneasy. She was much af- 
fected with headach, the pain—fixed sometimes in one, sometimes 
in the other temple—was aggravated distractingly almost every 
week; when there would supervene vomiting of salt water and bile. CONSEQUENCES OF HABITUAL CONSTIPATION. 
49 
She was habitually costive; which state had preceded all her 
other ailments for many years. She has been under the necessity 
of taking a great deal of opening medicine, or the pain in the head 
would have been insufferable. She was subject to flushings in the 
face and cold feet: and had been long troubled with leucorrhoea. 
She was able to take very little food, and was low in flesh and 
strength. 
To apply a blister to the region of the stomach ; to take Hydrarg. Chlorid. 
gr. ss., Opii gr. | after breakfast and dinner ; and Magnes. Carbon, gr. xv., 
Decoct. Aloes c. f. %ss. daily in the morning. 
From these remedies she derived great benefit. The calomel 
and opium agreed well, diminished the pain in the stomach and 
the uneasiness after food : the aloes and magnesia regulated the 
bowels; but if she did not attend to the calls of nature instantly, 
then she could not have an evacuation perhaps for two days. Her 
appetite improved, her spirits grew better, the headach greatly 
diminished, and she did not suffer from an attack of vomiting after 
the plan of treatment was commenced. The leucorrhoea wras 
benefited by an alum wash. The medicines having been taken for 
six weeks, she was directed to omit the pills lest the gums should 
become affected, but to continue the aperient mixture. For the 
dysmenorrhoea, to take Extracti Belladonna; gr. 4 twice a day 
while the pain was urgent. 
At the expiration of three months this patient’s complaints were 
removed, and she had begun to gain flesh. The belladonna had 
rendered the menstrual period less painful, and she now required 
no other treatment than to be put in possession of means to regulate 
the bowels. For this purpose the infusion of senna was recom- 
mended and answered perfectly. 
Case XXIV.—Subacuto-chronic gastritis. Habitual constipation. 
Mrs. W , aged 55, in whom menstruation ceased three years 
ago, presented herself for advice on the 10th of October, 1839. She 
had been troubled with a very confined state of the bowels for 
twenty years, the dejections being scanty and hard : yet strong 
medicine was not required to procure evacuations. Her stomach 
had been in an indifferent state for a considerable time; worse 
within the last six months. 
She was afflicted with pain in the pit of the stomach running through 
to the back and shoulders, aggravated after meals, particularly 
after dinner, when she felt full and distended and suffered very 
much until the stomach was emptied by vomiting, which usually 
happened in about one hour after the meal. So unwell did she feel 
while the food remained in the stomach that she would often take 
warm salt and water to accelerate the vomiting; which having 
taken place, relief followed, though the pain continued in a less 
degree. The matter cast up was acid, and produced great heat in 
the throat as it passed. She could retain breakfast on the stomach 50 
BURNE ON HABITUAL CONSTIPATION. 
with some trouble, but not dinner. Her feet and legs were always 
cold ; and cold weather affected her very much, animal heat being 
insufficiently generated. She was pale, sallow, and emaciated. 
To apply a blister to the region of the pylorus. To take two table-spoonfuls of 
the following mixture twice a day:—Of Soda?. Sesquicarb. Jj.; Magnes. 
Garb. Jij- ; Khei Pulv. gr. xv.; Sp. Ammon. Arom. f. Jiff ; Tinct. Hyoscy- 
amif. Jss.; Aqua? Cinnam., Aquae, aa. f. §iijss. M. To rub in about two 
scruples of the following liniment upon the inside of the thigh night and morn- 
ing :—U. Hydrarg. Chloridi 3J- j Adipis gj. M. 
By the 13th of November, five weeks from the commencement of 
the treatment, her mouth had become rather sore and her com- 
plaints removed. The blister relieved the stomach: the mixture 
neutralised the acidity, and acted upon the bowels once every day : 
the pain after meals and the vomiting ceased ; her digestion be- 
came good ; her legs and feet warm ; and she had begun to regain 
flesh. 
In the above three cases the gastrodynia, or increase of the 
organic sensibility of the stomach, existed without any watery dis- 
charge from the mouth: but I believe that they nevertheless de- 
pended upon a subacute pathological congestion of the pyloric 
extremity of the stomach, evidenced more particularly in the two 
last cases by the loss of flesh in addition to the gastric symptoms. 
The tendency of these cases was to terminate in thickening and 
induration of the tissues of the stomach, and occlusion more or less 
of the pylorus. 
Pyrosis or Water-brash, Subacuto-chronic Inflammation and Or- 
ganic Disease of the Stomach.—The Water-brash, Pyrosis, Car- 
dialgia, Sputatoria, or Gastrodynia Sputatoria, as variously called 
by Linnaeus, Cullen, and James Curry—on account of the most pro- 
minent symptoms being heat and pain in the stomach, with dis- 
charge of a clear watery and rather ropy fluid by the mouth—is 
too frequently regarded only as a functional disorder of the stomach. 
Of which opinion appear to be Linnaeus, Sauvages, Cullen, Pem- 
berton, Baillie, &c. 
The history of cases of pyrosis, traced through their several 
stages from the first symptoms of disordered stomach, will, I think, 
show that, when pain in the stomach occurs and continues to occur 
from the presence of food even in moderate or small quantities, 
there is not merely a heightened organic sensibility of the stomach 
depending on irritation, but on a subacute inflammation. 
This opinion is not invalidated by the fact that many suffer from 
pyrosis year after year, yet live to a good age: for although they 
live, they emaciate to a degree that plainly indicates the presence 
of visceral disease. Nor is it invalidated by the fact that many 
retain the appetite not only unimpaired, but very great: for this 
desire for food arises, not from the healthy condition of the sto- 
mach, or a corresponding power of digestion, but from the want of 
nutrition, from the want of blood, by the wrasted and emaciated 
body. The appetite is often good, but not so the digestion : for the 
instant the appetite is appeased by food, that instant the stomach CONSEQUENCES OF HABITUAL CONSTIPATION. 
51 
labours, suffers, and continues to suffer, until either the contents of 
the stomach have passed the pylorus, or have been thrown up by 
vomiting. And no sooner is the food ejected from the stomach 
than the appetite returns, and, being again gratified, again the 
uneasiness and pain recur. 
It is contrary to my experience that pyrosis exists “ often with- 
out any symptoms of dyspepsia.”* I cannot recal to mind one in- 
stance in which the digestion was not only not good but slow, diffi- 
cult, painful, imperfect, and frequently altogether impossible. The 
appetite often remains good, but not the digestion. I cannot, there- 
fore, but regard Cullen and his followers as in error when they 
state that persons affected with pyrosis are often free from dys- 
pepsia. 
It appears to me that two very different affections have been 
confounded together by writers on the water-brash: I mean the 
dyspepsia ebriosorum and the pyrosis. 
In the drunkard’s dyspepsy there is the morning retching with 
eructations of a thin glairy mucus or watery phlegm, often sour or 
acrid, from an empty stomach. 
In the pyrosis, there is a discharge of a clear, thin, insipid, watery 
and rather ropy fluid from the mouth, preceded by heat, uneasiness, 
or pain in the stomach, and nausea; and supervening not when the 
stomach is empty, but after a meal; and not so frequently in the 
morning as after dinner. 
In their description of pyrosis, Cullen, Mason Good, and some 
others, speak of its consisting of an “eructation in considerable 
abundance of a thin, watery liquor, chiefly in the morning, after food 
has been abstained from for many hours, and the stomach has no- 
thing in its cavity but its own fluids ;”f which applies to the drunk- 
ard’s dyspepsia rather than to pyrosis. The following cases will 
furnish full particulars of the history and course of pyrosis in its 
mildest and most severe forms; and afford evidence on which to 
ground and substantiate the opinion that the assemblage of symptoms 
constituting the pyrosis depends immediately on a subacuto-chronic 
inflammation of the stomach—not of its mucous membrane only, as 
is generally believed, but rather of the tissues intervening between it 
and the serous tunic—excited in the first instance, and afterwards 
kept up and aggravated by habitual constipation, in the greater 
number of instances that occur in this country. 
Case XXV.—Pyrosis from habitual constipation, cured by alteratives and ape- 
rients. 
1830, November 4. Mary Roxbury, age 58, a patient of the Pub- 
lic Dispensary, was affected with a discharge of dear ropy fluid 
“ from the stomach” three or four times a day, taking place about 
an hour after a meal, and preceded and accompanied by sickness ; 
* First Lines of the Practice of Physic. By William Cullen, M.D. Edin 
1781, vol. iv. p. 15 
| Study of Medicine by Mason Good, M.D. vol.i. p. 119. 52 
BURNE ON HABITUAL CONSTIPATION. 
but no food was thrown up with the water. She did not suffer from 
severe pain, but from a very uneasy fulness in the stomach after 
food, which was relieved by the discharge of the water. Her bowels 
were always confined, and had been so from a girl, frequently pass- 
ing a week without a dejection. She was much troubled with flatu- 
lence, borborygmus, haemorrhoids, and prolapsus. The water-brash 
had existed from the period when menstruation ceased, now 16 
years. She took Pilul. Hydrarg. gr. v. every other night, and Mag- 
nes. Carh. gr. xv., Rhei, gr. v. twice a-day, which agreed well, and 
were continued four weeks. 
By this time the water-brash had nearly ceased; and the uneasi- 
ness after food, the flatulence and the prolapsus had been relieved. 
These medicines not acting quite freely upon the bowels were dis- 
continued, and the confection of senna, in the dose of two drachms 
every night, substituted ; which had the desired effect. The function 
of the bowels being restored, the appetite and digestion improved, 
and she was discharged at the end of seven weeks free from com- 
plaint. 
Remarks.—In describing the clear ropy fluid as discharged from 
the stomach in this and in subsequent cases, I have followed the 
statement of the patient as the most faithful history. But it will by 
and by be shown that the patient’s notion—which is invariable—of 
the fluid proceeding from the stomach, is fallacious: the source of it 
being the salivary glands and muciparous follicles of the mouth and 
throat. 
March 11, 1835. Margaret Williams, a maid-servant, complains 
of pain in the epigastrium, with tenderness on pressure, extending 
to the left bypochondrium and mamma, through to the back and left 
shoulder. She feels comfortable for several hours in the morning, 
but, as soon as she has breakfasted, she becomes dreadfully uneasy, 
the pain being sharp and severe. Sickness succeeds, and, in ten 
minutes, a clear, ropy water runs from the mouth. She now again 
feels comfortable, and so continues till after dinner, when the same 
kind of pain and sickness recur with a sense of fulness. The pain 
persists for half or three-quarters of an hour, with thirst; then she 
grows sick and discharges the watery fluid in much greater quan- 
tity, to the extent even of three-quarters of a pint, quite clear and 
unmixed with food. She is again easy, until she has taken tea or 
supper, when the symptoms return. While the stomach is empty 
she feels better. She never takes food without pain. Her appetite 
varies; at one time it is pretty good, at another impaired. She has 
been affected with this complaint for the last four months, during 
which she has become very thin. Menstruation is regular as to 
time, but small in quantity. Her feet are cold; her face flushes; 
the surface of the tongue is white, its body red ; and she is liable to 
acid eructations. Her bow7els are always confined ; the dejections 
are scybalous and occur not oftener than once in three days. Her 
mother also had water-brash, 
Case XXVI.—Pyrosis, hereditary. Constipation. CONSEQUENCES OF HABITUAL CONSTIPATION. 
53 
To take Hydrarg. Cholrid. gr. i., Opii. gr. \ night and morning ; 
and Rhei. Potasses Sulphatis, aa. gr. x. every morning. In three 
weeks she reported much better, all the symptoms be alleviated, 
and sickness seldom recurring; the bowels rather confined, and 
the mouth slightly sore from the calomel. To take Pilul. Rhei 
Comp. gr. v after dinner daily ; and to repeat the calomel and 
opium once a day. From this time I saw the patient no more. 
Case XXVII.—Pyrosis, with vomiting after food, severe and of long standing, 
relieved by the nux vomica. Obstinate constipation. 
Hannah Connel, a full-grown, and formerly a stout and healthy 
Irish woman, was admitted into Guy’s Hospital the 12th of March, 
1828, under the care of Dr. Bright. She had had twelve children, 
worked hard, and reported herself of regular habits, taking, how- 
ever, a glass of gin in the morning. Menstruation had ceased two 
years; up to which period it had been always regular and copious. 
Leucorrhoea succeeded. 
About four years ago she began to be affected with a running of 
water from the mouth, and pain, heat, and heartburn in the stomach 
and up the oesophagus; and after the water-brash had existed one 
year, there supervened vomiting of the food. In this state she 
came into the hospital under Dr. Back, and after a month was dis- 
charged relieved: but the complaints soon returned, and have 
persisted and increased ever since. 
She is now affected with pain and a sense of fulness in the pit of the 
stomach; with a discharge of a clear, watery, and ropy fluid from 
the mouth, and vomiting as frequently as from six to twelve times 
in the day, particularly in the morning and evening. The quantity 
of fluid discharged will occasionally exceed a pint at one time, and 
frequently four pints in the course of the day. The watery dis- 
charge, together with vomiting, will occur sometimes in the night; 
and vomiting on every occasion of taking food, of whatever kind, 
which continues till everything is cast from the stomach; when she 
becomes easy'. So long as she refrains from food she is compara- 
tively free from suffering; but her appetite is good, and she feels 
hungry immediately after the stomach has rejected the food previ- 
ously taken. She complains of violent heat and scalding heartburn 
rising from the stomach to the throat, most urgent in the fore and 
afternoon; also of burning heat in the palms of the hands, and 
flushings in the face. 
Her bowels are always very much confined, dejections occurring 
not oftener than once in seven, ten, or fourteen days, and then not 
without the aid of medicine. She does not remember the time 
when she had a natural evacuation. The abdomen is distended 
with flatus, giving the appearance of pregnancy. The urine is 
hot, scanty, red and turbid: she suffers from piles, heat about the 
rectum, and painful dejections; and is troubled with a copious 
leucorrhoea. She is very much emaciated. 
The treatment was as follow's :—March 13. PiL Alois cum 54 
BURNE ON HABITUAL CONSTIPATION. 
Myrrha, gr. xv. bis die : JVucis Vomica: gr. ii. ter die. The nux 
vomica was gradually increased to gr. v. On the 26th the report 
states, she is altogether much better: the discharge of fluid, and 
the vomiting of food take place every evening regularly, but not at 
any other part of the day : and once she passed the whole day free. 
The vomiting in the evening is preceded for a quarter of an hour 
by hiccup, and a burning heat centring in the stomach and extend- 
ing up to the throat. On the 31st, the nux vomica w'as increased 
to gr. vii., and castor oil, daily, in the morning, was substituted for 
the aloes and myrrh pill; and on the 7th of April it was reported 
that she had two or three evacuations daily, that the pain was gone, 
the vomiting subsided, and that she felt well. 
Case XXVIII.—Pyrosis with vomiting of food. Constipation. Cured by 
counter-irritation, hydrocyanic acid, and aperients. 
January, 1832. Mrs. E , aged 34, applied to me early in 
this month, complaining of pain in the inferior region of the sternum 
and pit of the stomach, going through to the back and up to the 
right shoulder; and of throwing up first water and then food from 
the stomach after every meal, sometimes immediately, sometimes 
in one or two hours, according as she kept still or moved about: 
if she moved about quickly after a meal, she could not retain the 
food on the stomach, it was rejected at once. After the stomach 
had emptied itself, she, on all occasions, became easier. The 
matter thrown up by vomiting was sour and bitter. The pain was 
increased immediately after food, and accompanied with a sense of 
weight and distention which often induced her to refrain from 
food, that she might avoid the pain : but then she grew so faint and 
low, that she was obliged to cat. Temporary relief to the pain 
after meals was found from neat spirits. 
The bowels wrere very much confined, four or five days elapsing 
without a dejection, unless she took medicine: the dejections always 
lumpy, and passed with painful striving. She suffered from heat 
about the rectum, womb, and bladder; from ardor urinae and leu- 
corrhoea. Her hands and feet were cold, but she wras frequently 
overcome almost to fainting with heat and flushings about the head 
and face. She could not bear a close room. She slept heavily, and 
got up fatigued. The tongue w as white and furred, and she had a 
disagreeable bitter taste in the mouth. The pulse was small and 
weak. 
She had been affected with the w-ater-brash at irregular times 
for two or three years, and regularly two or three times a day for 
the last twrelve months, and with the pain in the stomach for six 
months, during the last three of which has been severe, and at- 
tended with a burning heat. For the last eight years she has suf- 
fered much from constipation, flushings in the face, and heaviness 
across the forehead, followed by indigestion, and all the other 
symptoms. She has been losing flesh for the last two or three 
months, and is now seriously emaciated. CONSEQUENCES OF HABITUAL CONSTIPATION. 
55 
To apply a blister to the region of the stomach. To take Magnes. Carb. gr. 
xv., Magne3. Sulphat. Ji., Tinct. Sennae, f. Ji. Aquae Menthae Yirid. f. Jj. 
twice a day in water. 
Much relief was derived from the blister, and although continu- 
ing to feel sick and in pain after meals, she has not thrown up 
either water or food since she came under treatment. The bow7els 
act regularly, but, as she suffers from acidity and the heat at 
stomach, the above medicines were discontinued after a fortnight, 
and the following substituted :— 
Magnes. Carb. Jss.; Sodae Sesquicarb. gr. xv. twice a day; R Acidi Hydro- 
cyanic! (Scheelii) f. 5SS« > Aquae destillat. f. ifij. A tea-spoonful to be 
taken when the pain in the stomach is urgent. 
February 7. The pain, which still supervenes after food, is re- 
lieved in ten minutes by the hydrocyanic acid. When first under 
treatment, she lived on thick gruel, latterly on boiled mutton, which 
has agreed w-ell. She remains quiet, and in the horizontal position 
after meals. She is considerably better, eats wfith appetite, begins 
to gain flesh and strength. The bowels act two or three times a 
day, and the dejections, which were at first dark, are of good 
colour. By pursuing the same treatment, observing the same 
strictness in diet and rest after food, she, in the course of some 
weeks, was relieved of all her symptoms and restored to pretty 
good health. 
Remarks.—In this case there can be little doubt of there having 
existed a subacuto-chronic pathological congestion of the pyloric 
extremity of the stomach, so interfering with digestion and the 
passage of the chyme into the duodenum as to prevent the body 
being properly nourished, and induce an alarming universal atrophy. 
The prospect was confirmed pyloric disease. It affords a good 
example of what may be accomplished, where the diseased action 
is not malignant, by treatment based on the principle of restoring 
the function of the bowels,—of appeasing the heightened organic 
sensibility of the stomach,—and of determining to the neighbouring 
surface by counter-irritation. 
Case XXIX.—Pyrosis. Subacuto-chronic inflammation and disease of the 
* stomach—hereditary. Constipation. 
Mrs. came under care in September, 1839. She had been 
affected with water-brash for many years, and, in consequence of 
suffering great uneasiness after food, has lived in the most abstemi- 
ous manner, avoiding everything of a questionable or indigestible 
nature, abstaining altogether from wine, and taking scarcely food 
enough to nourish the body. Even with these precautions, she 
generally vomited once after dinner, as w'ell as on every occasion 
when she departed in a slight degree from the more rigid system 
of diet. 
Her bowels have been habitually confined for many years, yet 
less so within the last twelve months. Her father wras also afflicted 
with the water-brash for a long period, and troubled with habitual 
constipation. 56 
BURNE ON HABITUAL CONSTIPATION. 
She was of middle age, sallow, very pale, in an alarming state 
of ana3mia and atrophy, and so weak as not to be able to walk, or 
even to sit up without fainting. Her appetite was trifling, and after 
food, however small the quantity, she suffered uneasiness in the 
stomach, and, in two or three hours, had a discharge of a ropy 
watery fluid by the mouth, succeeded by vomiting. Her pulse was 
small and feeble, but not frequent: the tongue clean, moist, and 
pale. Her stomach was so squeamish and capricious, that her 
meals and choice of food were most spare and limited. 
The same difficulty was felt in regard to medicine as to diet. 
She was so much and so quickly depressed by mercury, in any 
form, as have an almost insuperable aversion from it. 
Pills she could not swallow; and liquid medicine was so dis- 
agreeable to her palate and stomach that they were rejected. 
Neither could she bear counter-irritation of any kind, partly because 
her skin was irritable, and partly because of the annoyance. 
Fettered by these difficulties, the treatment was necessarily of the 
mildest description. By much persuasion she was induced to take 
of a grain of calomel with the same quantity of opium twice 
a-day in the form of powder : and the infusion of senna in doses of 
3ij, at bedtime, to secure the action of the bowels. 
The calomel and opium were persevered in for five days with 
advantage, when, the patient believing she felt low from the mer- 
cury, it, as also the opium, was omitted; and the trisnitrate of 
bismuth in the quantity of gr. ij. substituted. The senna, flavoured 
with liquorice, answered most effectually the purpose of regulating 
the bowels; a point of the first importance. As she felt thirsty 
and rather hot one evening, I persuaded her to try a weak effer- 
vescing draught, but it was quickly thrown up, and with it all the 
food she had taken during the day. 
Towards the end of October she spat up a little blood, which 
alarmed her very much, but happily proved of no moment. It was 
evidently from the throat. For this the diluted nitric acid teas 
prescribed, in the proportion of to f. Siv. of icater, the whole 
to be taken in the course of the day. It proved agreeable to her 
palate and stomach, refreshed her, and rather improved the appetite. 
In the course of a fortnight, the acid was combined with the com- 
pound decoction of guaiacum and a little syrup of lemon, which, 
being a pleasant mixture, was taken twice a-day in very small 
doses. 
At the present time, November the 16th, 1839, she is consider- 
ably improved in health, more, however, as respects comfort than 
increase of flesh and strength, though in these respects she is ad- 
vancing. Her bowels act most regularly by the aid of the senna. 
She takes the smallest possible quantities of food, but they are 
retained on the stomach and digested without uneasiness, a comfort 
she has not experienced for many years past. Her spirits are 
good ; and her sleep sound and tranquil as that of an infant. Find- 
ing that a weak acid suited the stomach, I advised her to try a 
little perry as a beverage; which has suited her excellently. CONSEQUENCES OF HABITUAL CONSTIPATION. 
57 
Remarks. — The improvement in this case, which now bids fair 
for recovery, I attribute very much to the regularity of the bowels, 
and to the perfectly tranquil mode of life this lady has led of late. 
Her daughter having married, and her sons being from home, she 
is left entirely to herself, is not fatigued by conversation, and is able 
to remain undisturbed after food, and in the horizontal position. 
This case has been introduced partly as an example of the pyrosis 
being hereditary, and partly to show the difficulties we have at 
times to encounter from constitutional and other peculiarities. The 
increased organic sensibility of the stomach and the daily vomiting, 
coupled with the emaciation and inability to take food, are con- 
clusive of there being disease of the stomach; thickening probably 
of its tissues, contraction of its cavity generally", and rigidity of the 
pylorus; the result of a very subacuto-chronic pathological con- 
gestion. The probability that the stomach is very much contracted 
rests on the circumstance of this patient not being able to swallow 
any thing suddenly, even in moderate quantity, without at once 
being sick. Even now that she is better, if she drinks a wine-glass- 
full of fluid at once, it is returned immediately. 
Much might, I think, be effected in similar cases by nourishing 
the body through the means of injections per alvum, which would 
allow the stomach to remain at rest and unannoyed by food or the 
process of digestion. In the present instance such a resource would 
not have been sanctioned by the patient. 
Case XXX. — Pyrosis — hereditary. Constipation. 
1830, March 6. Henry Sutton, aged 30, a sailor, applied at the 
Public Dispensary on account of a watery discharge “ from the 
stomach,” with which he had been troubled for many years. It 
came on generally about noon, sometimes very suddenly, was al- 
ways preceded by sickness, and followed by vomiting if there was 
any food in the stomach, but not otherwise. He has been subject 
to constipation of the bowels from boyhood. He stated that his 
mother had the water-brash for more than thirty years; that she 
also suffered from obstinate constipation ; and that she had no eva- 
cuation for six weeks previous to her death, which occurred at the 
age of 61. 
Remark.—This case is recorded with a view simply to state the 
facts of the mother and son having been the subjects both of water- 
brash and of habitual constipation: which, with other cases of a 
similar kind, afford grounds for regarding the water-brash as here- 
ditary on some occasions. 
Case XXXI.—Pyrosis — hereditary in three generations. Habitual constipation. 
1830. Joseph Wray, age 47, a shoemaker of regular habits, a 
patient of the Public Dispensary, has been affected with the water- 
brash for 20 years, but not constantly ; it being irregular in its 
attack, though coming on more frequently after broths, and when 
his bowels are most confined and flatulent. The discharge of water 58 
BURNE ON HABITUAL CONSTIPATION. 
amounts to a tea-cupful, is preceded by pain in the stomach for a 
quarter of an hour, and accompanied with heartburn. 
He has been troubled with constipation of the bowels for upwards 
of 20 years, indeed they were never regular; a week sometimes 
elapsing without a dejection, though usually three or four days. 
He always required medicine, which having acted he became cos- 
tive again. If he refrained from medicine, “ it would break forth” 
by a spontaneous purging; constipation succeeding. For 14 or 15 
years he has suffered from headach at the forepa'rt, and from heavi- 
ness and stupor, so that he had no spirit to move or follow his busi- 
ness. His appetite has nevertheless been good; yet after food he 
would be much annoyed by acidity and flatulent eructation. 
Joseph Wray’s father had the water-brash; and his eldest son, 
now 21 years of age, has it also; and is, moreover, affected with 
confined bowels. 
Remark.—This incomplete case is adduced on account of its his- 
tory, and of the remarkable occurrence of the water-brash in three 
successive generations; namely, the father, son, and grandson: 
strongly marking hereditary influence. 
Case XXXII.—Disease of the cardiac extremity of the stomach, and subacuto- 
chronic inflammation of the caecum and colon. Constipation. 
October 9, 1839. Mrs. , age 21, married two years, has no 
child, menstruates regularly, though scantily and with pain. She 
complains of sickness and pain in the stomach after food, of what- 
ever kind and whenever taken, which continue till the whole has 
been thrown up. Sometimes she vomits immediately the food that 
has been swallowed, at other times not till the expiration of an hour. 
First the food is vomited, then a hot, sour, ropy fluid which burns 
the throat, excoriates the mouth, and sets her teeth on edge. She 
does not become easy till the whole of this fluid has come up. Her 
appetite is good, and she never feels satisfied; yet the moment she 
swallows anything the above symptoms are induced. She is weak 
and much emaciated; the tongue is reddish, clean, moist: the pulse 
small: the hands and feet cold. 
She has always suffered from constipated bowels; strong medi- 
cines being requited to produce an action ; and has now been a 
week without a dejection, notwithstanding she has taken aperients 
every other night. The stomach symptoms have existed three 
years. 
On exploring the abdomen I find a tumour in the left hypochon- 
drium, hard and rounded, more perceptible in the erect than in the 
horizontal posture. It is situated deep, exactly in the region of the 
cardiac extremity of the stomach, being more forward and higher, 
and nearer the epigastric region, than the spleen. Connected with 
the gastric symptoms, I conclude it to arise from disease of the 
cardiac extremity of the stomach. 
J find, also, tenderness and pain in the regions of the cascum 
and sigmoid flexure, and along the whole tract of the colon, so dis- CONSEQUENCES OF HABITUAL CONSTIPATION. 
59 
tinct and well marked as to indicate a pathological condition of the 
whole of the lai'ge intestine: probably a subacuto-chronic inflam- 
mation and thickening of the mucous and submucous tissues with 
contraction of the gut: states which are common consequences of 
the irritation of knotty, hard, scybalous feces unduly retained in 
the large intestine. The aspect of the case is that of extensive 
disease both in the stomach and colon, advanced to a point proba- 
bly beyond the power of medicine. 
To take Hydrarg. Chloridi. gr. J, Opii. gr. $ after breakfast and dinner; Extract. 
Colocynth. Comp. gr. v., Opii. gr. 1-6 every night; and the Mist. Magnes. 
cum Magnes. Sulphat. et Decoct. Aloes Comp, every morning. To apply an 
Emplast. Hydrarg. cum Ammoniaco to the region of the stomach. 
October 16. The medicines operate well upon the bowels. The 
mixture has been taken in the evening, it having been rejected by 
the stomach when taken in the morning. She has experienced 
no relief. At the end of October when this report was concluded, 
no amendment had taken place. She suffered less in the horizontal 
than in the upright position. 
Remarks.—This case illustrates the connection between organic 
disease of the stomach and habitual constipation, which latter pre- 
ceded the stomach affection for years. The cardiac disease has 
occurred at an unusually early period of life. The pain and ten- 
derness in the seat and course of the large intestine accord exactly 
W'ith the symptoms and cases detailed by Mr. Annesley in his work 
on the Diseases of India : in which he has so amply shown that these 
symptoms indicate a morbid condition of the large intestine. The 
profession is much indebted to him for having pointed out and urged 
the necessity of exploring the abdomen, and the certainty with 
which disease of the large intestine may be traced, even where there 
is no tumour to fix the attention. 
Source of the fluid discharged during the paroxysms of Pyrosis.— 
In reflecting upon the phenomena of the water-brash, it strikes one 
as remarkable that the fluid discharged should not be mixed with 
the food recently taken into the stomach. 
It has been shown that the paroxysms of pyrosis come on after 
meals, that there is first pain, then nausea, and lastly the discharge, 
often very copious, of the tasteless, thin, clear, and rather ropy fluid, 
characteristic of the water-brash ; after which the paroxysm is at 
an end, and the patient feels comfortable. 
This history impresses one strongly with the notion that the fluid 
comes from the stomach, and that the ejection of it from the stomach 
affords the relief experienced at this moment. The patients, too, and 
many authors, participate in this opinion. Dr. Pemberton remarks, 
“ it seems, at first sight, rather extraordinary that a tasteless and 
limpid fluid should be capable of producing so much pain, and such 
disturbance in the stomach,” and then endeavours to account for 
this seeming anomaly by saying that “ the nerves of the tongue and 
of the stomach are not equally influenced by the same stimuli: a 
solution of antimonium tartarizatum, which is tasteless, can produce 60 
BURNE ON HABITUAL CONSTIPATION. 
the greatest effects upon the nerves of the stomach ; and many sub- 
stances highly acrimonious to the tongue and palate are not only 
agreeable, but even beneficial to the stomach.”* 
If this fluid came from the stomach, the stomach being full of the 
preceding meal, it is impossible to believe that none of the food 
would be thrown up with it; and as no food is mixed with the fluid, 
one must look elsewhere for its source. Whence else can it pro- 
ceed ? From the salivary glands and muciparous follicles of the 
mouth and throat! When an emetic is taken, and the person first 
feels sick, the mouth instantly fills with water, which runs from it 
in a clear stream, and then follows vomiting of the contents of the 
stomach. This clear stream is unquestionably furnished by the sali- 
vary glands and muciparous follicles of the mouth and throat, sud- 
denly excited to inordinate secretion by sympathy with the troubled 
stomach ; phenomena which form an exact parallel to the nausea 
of pyrosis and the sudden discharge of the limpid fluid. In both 
cases the fluid is tasteless, clear, thin, and rather ropy: and in both 
it proceeds from the same source; of which any one may satisfy 
himself by questioning patients closely, when he will be informed 
that the fluid runs from the mouth when nausea supervenes, but is 
not eructated or vomited, as Cullen, Mason Good, Abercrombie, 
Andral, and others describe. In severe cases of pyrosis, actual 
eructation and vomiting of the contents of the stomach succeeds the 
watery discharge from the mouth, but does not accompany it. 
The quantity of the fiuid is, on some occasions, very great indeed. 
In the case of Hannah Connel, (page 53), it amounted to three or 
four pints daily; and both Pembertonfand AndralJ mention instances 
in which the quantity was equally great. On account of this vast 
discharge, Drs. Rollo§ and Pemberton|| have endeavoured to trace 
an affinity and resemblance between diabetes mellitus and water- 
brash ; the reasons adduced in support of which it is not necessary 
now to go into; seeing that they have been based on the assumed 
fact of the fluid in pyrosis coming from the stomach; which has 
been shown not to be the case. 
Pathology of the Pyrosis or Water-brash.—In all cases where the 
stomach labours after food ; where uneasiness, distress, or absolute 
pain is pretty regularly experienced, though the quantity of food 
be small, and the quality not unwholesome, there is a heightened 
condition of the organic sensibility dependent not on a state of 
irritation merely, but on actual inflammation ; sub-acute, how’ever, 
in degree, chronic in duration; and therefere subacuto-chronic. 
And if, in addition, nausea supervenes, and finally vomiting, there 
* A Practical Treatise on Various Diseases of the Abdominal Viscera, by C. 
R. Pemberton, M.D. p. 105. Second Edition. London. 
fOp. cit. p.104. 
tClinique Medicate, quatrieme partie, Maladies de l’Abdomen, p. 398. 1827. 
§ Cases of Diabetes Mellitus, &c.: by John Rollo, M.D. p. 393,394. Second 
Edition. 
A Op. cit. p. 106. CONSEQUENCES OF HABITUAL CONSTIPATION. 
61 
is reason to suspect not merely the presence of an inflammatory con- 
gestion, but of an absolute organic change ; a suspicion strengthened 
at this time by the gradual diminution of the blood, and the decided 
loss of flesh, constituting a condition of universal anaemia and 
atrophy. In this opinion Abercrombie* concurs. 
It follows, then, that, not only where there exists the assemblage 
of symptoms, constituting pyrosis, but where there is gastrodynia, 
frequently and pretty regularly recurring after meals, there one 
must consider an inflammatory congestion to be present, and direct 
the treatment accordingly. These states differ obviously from the 
sense of sinking felt when the stomach is empty, and from the 
sense of distention with acid and flatulent eructations, when the 
stomach is full: symptoms so common where there is anxiety of 
mind, or food taken to satiety. In the latter cases the feelings 
may be termed uncomfortable; in the former, distressing. 
These states differ also from the accidental and single paroxysms 
of pyrosis, which may occur to any one who has swallowed articles 
of food of an indigestible kind, imperfectly masticated ; the passage 
of which through the pylorus will excite irritation, pain, nausea, 
and water-brash. A lady, now under care, states this to be the case 
with herself whenever she happens to eat pickles. 
The exact pathanatomicalf condition of the stomach in gastro- 
dynia and pyrosis admits of question. All will perhaps now agree 
—though I find in one of the most recent articles, published on 
pyrosis,J the pathology of it is not discussed—that a pathological 
congestion is present, but will not agree as to the tissue in which 
it is seated, or as to the structural changes which result. Aber- 
and Andral,|| fix it in the mucous membrane, and regard 
the thickening and induration of the other tissues as ulterior pro- 
cesses. It is difficult to imagine that the mucous membrane is not 
affected or concerned originally; but from my observation of these 
affections during life, and from the examination of the stomach after 
death, I am of opinion rather that the disease is situated mainly in 
the submucous tissue. 
Believing that all cases of organic disease of the stomach— 
whether cardiac or pyloric, malignant or otherwise—are preceded 
by gastrodynia or pyrosis, as forerunners or precursors of the or- 
ganic change; and finding, by dissection, that although these 
organic changes are seated in and occupy all the tissues except the 
serous, yet the mucous membrane is less affected and contributes 
less to the general thickening than do the submucous, muscular, 
and subserous tissues. Where there is no ulceration—as in cases 
. * Op. cit. p. 83. 
f The word “ Pathanatomy ” is proposed as synonymous with “Morbid 
Anatomy,” and relates only to morbid or diseased structure: a subject very 
different from “ Pathology,” which is the science or doctrine of diseasef 
\ Cyclopaedia of Practical Medicine. 
§ Op. cit. p. 19. 
|| Clinique Medicale, quatrieme partie, p. 362. 62 
BURNE ON HABITUAL CONSTIPATION. 
of simple thickening and induration, not milignant—the mucous 
membrane will often be found pale, sometimes vascular, perhaps 
swollen; but the thickening and induration occupy the tissues be- 
tween the mucous and serous tunics, and often pervade the whole 
stomach; the thickness of the indurated submucous tissue alone 
being frequently to the degree of one line, and sometimes even of 
seven lines; when the stomach is contracted to a small cavity, and 
altogether incapable of dilatation. I incline, therefore, to the opi- 
nion that the submucous, muscular, and subserous tissues—which 
constitute the substance of the parietes of the stomach—are the 
chief seat of diseased action, and not the mucous. 
In this opinion, I am supported by the fact that a muco-gastritis 
will exist for a very long period without involving the other tissues; 
although the cause of the inflammation shall be intense and con- 
tinued, as in spirit drinkers. I have, in many instances, examined 
the stomachs of these persons after death, and found the mucous 
membrane rather swollen, vascular, and softened; and, moreover, 
the muciparous follicles diseased, so as to be very apparent, being 
hypertrophied, white, round, flattish, and imbedded in the mem- 
brane, giving it very much the appearance of rough fish skin. 
The stomach is usually dilated, and its blood-vessels very large and 
numerous. 
Now in these instances, where there has unquestionably been a 
subacuto-chronic inflammation of the mucous membrane, the other 
tissues have not become involved: nor have these patients become 
affected with the discharge of a tasteless clear watery fluid after 
meals, as in pyrosis, but with the morning retching and eructation 
of a watery phlegm, salt, acrid, bitter; composed of an inordinate 
secretion from the gastric muciparous glands, and of bile which 
has found its way from the gall-bladder along the duodenum, and 
through the pylorus into the stomach. Not only has this dyspep- 
sia ebriosorum been confounded with pyrosis, but the pathana- 
tomical characters of both have been confounded also. 
Gastrodynia and pyrosis may be set forth as depending upon a 
subacuto-chronic inflammation, which, sooner or later, causes 
thickening and induration, more or less, of the submucous and sub- 
serous tissues, and hypertrophy of the muscular; the mucous mem- 
brane being affected, but in a very much less degree. The whole 
stomach may be equally diseased; but the portion more usually 
concerned is the pyloric rather than the cardiac; the tissues being 
then more diseased in the direct ratio of their vicinity to the pylo- 
rus; and the pylorus itself often involved. 
The seat of the diseased action, as here pointed out, is the rea- 
son why the pain supervenes some time after food has been taken; 
when, chymification having been in part effected, the contents of 
the stomach are passed on towards and through the pylorus. In 
this process the muscular tunic is particularly engaged, and being 
itself, as also its contiguous tissues, in the midst of inflammation 
and disease, its contractions are attended with pain, aggravated CONSEQUENCES OF HABITUAL CONSTIPATION. 
63 
and augmented by the heightened organic sensibility of the mucous 
membrane, and of the pylorus itself. The irritation produced by 
the contents of the stomach, as they are passed onwards to the 
pylorus excites nausea; the nausea excites, hy sympathy, the sud- 
den and copious secretion from the salivary and muciparous glands 
about the mouth and throat, which, consisting of saliva and mucus, 
runs from the mouth clear and ropy, and constitutes the water- 
brash; and, in the more severe cases, the nausea and watery dis- 
charge are followed by actual vomiting, the pyloric portion of the 
stomach, and the pylorus itself, not permitting the continued pre- 
sence of the gastric contents or their passage onwards. The food 
having been thrown up, or passed through the pylorus, ease fol- 
lows, and the patient remains comfortable until the next meal has 
re-supplied the cause of irritation. 
In proportion to the quantity of food which the stomach is able 
to retain, digest, and pass onwards to the duodenum for the support 
of the body, so in proportion does the patient either preserve or lose 
his flesh. 
This, then, I would venture to regard as the true pathology of 
gastrodynia and pyrosis. 
The explanation offered by Cullen, that “ it seems to begin by a 
spasm of the muscular fibres of the stomach, which is afterwards, 
in a certain manner, communicated to the blood-vessels and exha- 
lents, so as to increase the impetus of the fluids in these vessels, 
while a constriction takes place on their extremities. While, there- 
fore, the increased impetus determines a greater quantity than usual 
of fluid into these vessels, the constriction upon the extremities 
allows only the pure watery parts to be poured out, analogous in 
every respect to what happens in diabetes hystericus;”* or the 
explanation by Mason Good, that there is paresis, or inactivity of 
the proper absorbents of the stomach; or the surmise that the fluid 
may be furnished by the pancreas, need not be observed upon. 
Causes of Gastrodynia and Pyrosis.—The causes of these affec- 
tions are no doubt manifold. Indiscretion in diet, anxiety of mind, 
food not congenial to the stomach, or imperfect mastication, may 
excite all the phenomena described : as is seen in Lapland, where 
the nature of the food, principally dried fish, seems to cause half 
the population to be affected, which induced Linnaeus to consider 
pyrosis as epidemic in that country. As far as my observation has 
extended, the kind of food is not a frequent cause in this country. 
The cause, to which I would attribute the origin of these gastric 
diseases more frequently than to any other, is habitual constipation; 
for the reason that—as seen in the cases detailed—it had long pre- 
ceded the invasion of these complaints, and had been the first, and 
for a time the only, departure from the healthy functions of the 
body; and for the reason, also, that the complaints, if recent, will 
* First Lines of the Practice of Physic. By William Cullen, M.D. vol. iv. 
p. 15. 64 
BURNE ON HABITUAL CONSTIPATION. 
subside when the cause, constipation, has been removed. I wish 
however, to be understood as not regarding constipation to be the 
only but the most frequent cause in this country. 
The treatment which I have pursued and found successful,— 
not only in relieving but in curing gastrodynia and pyrosis,—has 
been based on the pathological views just set forth; and conducted 
on the principle of restoring the natural function of the bowels,—of 
appeasing the irritability of the stomach,—of subduing the subacute 
inflammatory action,—and of removing, as far as possible, its conse- 
quences on the tissues of the stomach. The means adopted have 
been calomel, opium, the local abstraction of blood, counter-irritation, 
and appropriate aperients. 
Inasmuch as the diseased actions are chronic and subacute, so 
the means have been mild and continued. The calomel has been 
given in the dose of half a grain and the opium of a quarter of a 
grain, twice a day; namely, after breakfast, and after dinner. At 
these periods the opium reconciles the stomach to the presence of 
food, and the calomel acts gradually as a mercurial. The dose of 
mercury is small in order that it might not salivate too soon; time 
being required to remove diseases of long standing. The effect of 
this combination is most happy: and success attends the treatment 
of almost every case which admits of recovery. The medicines 
are persevered in for many weeks; unless thegums become affected, 
when the calomel is omitted, but the opium continued. Opium was 
a favourite remedy of Cullen, has been adopted by others, and is 
an essential part of the treatment: though, when given alone, it is 
only palliative, as candidly stated by Cullen. 
Where the patients have not yet suffered much emaciation, the 
abstraction of blood hy cupping to a moderate amount, as four or 
six ounces from the region of the stomach, very much aids the cure : 
as also does the repeated application of blisters. In lieu of blisters, 
I have often used the croton oil,* a very efficacious counter-irritant, 
the pustules from which are smaller and less liable to run into ulcers 
than those produced by tartarised antimony. The croton oil may 
be used for this purpose in the proportion off fp of either 
rectified spirit or soap liniment. 
The nux vomica employed by Linnaeus, the bismuth by Odier and 
Marcet, the tinct. benzoes comp, by Baillie, and the hydrocyanic 
acid by others, are palliative only; but, as palliatives, they are effi- 
cacious. For several years past, I have seldom had recourse to 
any of these remedies, having found the calomel and opium so en- 
tirely successful. Creosote, in the dose of one minim to the ounce 
of weak gum-water; will often prove an excellent palliative. It was 
particularly acceptable to a patient sinking under a cancer of the 
pyloric extremity of the stomach: he kept it by him in bed, that he 
might frequently take a dose, which he said “ nourished and com- 
* It is remarkable, that out of a great variety of cases in which I have employed 
the croton oil externally, in one only was any effect produced'upon the stomach 
and bowels. CONSEQUENCES OF HABITUAL CONSTIPATION. 
65 
forted him.” The diluted nitric acid in small doses, as r\, x. is 
sometimes agreeable and serviceable. It refreshes the stomach, 
and relieves the heat that occasionally supervenes. 
Aperients, which form at all times a most important and essential 
part of the treatment, must be selected according as individuals 
require them to be mild or powerful, and according as any consti- 
tutional peculiarity or idiosyncrasy exists. I prefer senna ; or mag- 
nesia with the compound decoction of aloes, sometimes with the 
sulphate of magnesia, or sulphate of potass ; but occasionally the 
bowels will not respond to these milder aperients, when they require 
for a time the use of the drastic purgatives, as camboge, aloes, 
colocynth, jalap, &c.: castor oil, where not disagreeable to the 
stomach, is efficacious and appropriate. Whatever may be the 
aperient or purgative required, the bowels must be kept open; or 
all other treatment will avail no further than to afford temporary 
relief. 
Where the stomach is greatly distressed by food, and rejects it, 
or where enough cannot be taken or assimilated for the purpose of 
nutrition, a nutrient injection per alvum, twice a day, will aid in 
supporting the body, and prove a great relief to the stomach. 
The Diet should consist strictly of food of the plainest descrip- 
tion, and known to be of easy digestion. Broths seldom agree so 
well as solid food. Vegetables should be well done; and, if per- 
fectly tender, may be eaten in moderation. Everything that is rich 
should be avoided. Cream, butter, and sugar should be used 
sparingly. Strong wines and spirits will frequently afford a mo- 
mentary relief, but they are nevertheless injurious, and should be 
abstained from altogether. Perry, in the quantity of a wine-glassful 
twice a day, where the weakness is great, has proved agreeable 
and beneficial. 
Perfect rest after meals and the horizontal position favour very 
much the process of digestion in gastrodynia and pyrosis; the food 
often remaining on the stomach without pain, and digestion pro- 
ceeding ; whereas, if patients sit up or move about, pain is more 
apt to supervene, and the stomach to eject its contents. Two 
patients, labouring under pyrosis, informed me that the pain and 
uneasiness in the stomach ceased on their going to bed. 
Although I have entered more at length into the pathology of 
diseases of the stomach than the nature of this work called for, I 
have by no means done justice to so extensive a subject. The ob- 
ject of the present work is to show that many disorders are the 
consequences of habitual constipation, not to treat fully of the dis- 
orders themselves. I have, therefore, in the present chapter, ex- 
ceeded this object in some degree; which I was tempted to do in 
order to give my humble aid towards establishing a true pathology 
of some gastric diseases, regarded hitherto rather as of a functional 
than of an organic character. 66 
BURNE ON HABITUAL CONSTIPATION. 
CHAPTER VI. 
OF THE CONSEQUENCES OF HABITUAL CONSTIPATION ON THE SEXUAL OR- 
GANS IN THE FEMALE, THROUGH THE SYMPATHY OF CONTIGUITY. 
Hyperaesthesia and Hypertrophy of the Womb. Dysmenorrhcea. Menorrhagia. 
Amenorrhoea. Leucorrhcea. Abortion. Miscarriage. Supposed preg- 
nancy. 
The intimate connection between all the viscera of the pelvis, 
both in the male and female, subjects them to the influence of con- 
tiguous sympathy. Through this medium, irritation of any one or- 
gan is propagated to the rest; all become involved, and a multipli- 
city of symptoms arises, so complex and mixed, as to require great 
discrimination and experience to determine the organ on which they 
primarily depend. 
The symptoms emanating from an organ sympathetically affected 
will, not unfrequently, be so marked and prominent as to arrest the 
attention of the practitioner, and divert it from the real disorder: 
so truly has it been said by Sir Charles Clarke, that “ in proportion 
as the practitioner is engaged in treating the complaints of one or 
the other of these parts, he will be led to attribute the symptoms to 
that organ to which his attention has been chiefly directed.”* How 
constantly do we see tenesmus with mucous discharge from the 
rectum, in the male, sympathetic of disease of the bladder: and, 
vice versa, ardor urinae, difficult micturition, and even retention of 
urine, sympathetic of disease of the rectum. In the female, disease 
of the uterus will affect both the bladder and rectum; and irritation 
of the rectum will be propagated to the uterus and the bladder. 
It is my object to show that habitual constipation ought to be re- 
cognised as one very frequent, perhaps the most frequent, cause of 
affections of the sexual organs in females: and even where it is not 
absolutely the cause, that it is always a source of aggravation. Con- 
stipation of the bowels has been referred to by writers on the dis- 
eases of females, particularly by Sir Charles Clarke, as a co-existing 
symptom requiring attention in the treatment; but it has been alto- 
gether overlooked as a cause. 
O’Beirne, in discussing the physiology of the large intestine, has 
satisfactorily shown that the colon is the proper reservoir for the 
residual excrementitious matter; and that the rectum, so far from 
forming a part of this reservoir, is firmly contracted and closed; 
its normal functions being limited to the act of excretion. Accord- 
ing with this view, the colon alone would be subjected to the irrita- 
tion arising from the retained excrementitious matter in habitual 
constipation ; and irritation of the colon would, by contiguous sym- 
* Observations on those Diseases of Females which are attended by Dis- 
charges, part ii. 1814, p. 201. CONSEQUENCES OF HABITUAL CONSTIPATION. 
67 
pathy, affect the abdominal, not the pelvic, viscera. The sexual or- 
gans situated in the pelvis would, in fact, not then be exposed to ir- 
ritation: and the position with which I have set out could not be 
maintained, much less substantiated. 
That the colon and, sympathetically, the abdominal viscera suffer 
irritation from constipation, I have, in a former part of this work, 
pointedly remarked. The contiguity of a loaded colon to the liver 
will originate hepatic symptoms, and to the kidneys will excite a 
copious secretion of pale urine. It remains for me to show that 
feculent matter, in cases of habitual constipation, does actually get 
into and remain in the rectum, and prove a source of great irrita- 
tion to the neighbouring pelvic viscera. 
I have no difficulty in assenting to the conclusion arrived at by 
O’Beirne, that the rectum is not a reservoir for feculent matter, 
provided this opinion was limited to the normal and healthy func- 
tion and action of the large intestine. But where, as in habitual 
constipation, a preternatural accumulation takes place in the colon, 
especially in the sigmoid flexure, portions will find their way into 
the rectum ;—as instanced by the obscure continued indistinct 
desire to relieve the bowels, and by the evacuation merely of a 
hard scybal from time to time, rather by the striving efforts of the 
abdominal muscles, than by the action of the bowel itself, which 
indeed on these occasions seems passive ;—as instanced also by the 
examples, far from uncommon, of feces impacted in the rectum. 
Hard scybals lodging in the rectum excite a high degree of irri- 
tation on acount of the particular nervous endowments of this 
portion of the gut: for, in addition to the organic sensibility with 
which it is endowed—in common with the whole intestinal canal— 
by nerves from the ganglionic system, it is endowed, moreover, 
with animal sensibility by nerves from the cerebro-spinal system. 
The organic sensibility of the intestinal canal enables it to per- 
ceive the presence of the alimentary matter, and, stimulated by it, 
that peristaltic action results by which this matter is carried for- 
ward : but of this sensibility and of this action we are not con- 
scious. We do not feel, nor are we conscious of the passage of 
the alimentary matter along the intestinal canal; neither do we 
know in what part of the canal this matter is, at any given time, 
until it reaches the rectum, when we are admonished of its arrival 
by what is termed “ a call of nature.” This admonition is derived 
from the cerebro-spinal nervous system, and depends, in the present 
instance, on the rectum being supplied w7ith nerves from this sys- 
tem, the peculiar property of which is animal sensibility, or that 
sensibility which we can perceive and of which we are distinctly 
conscious. 
On this account the rectum, unaccustomed and not adapted to 
the protracted presence of feculent matter, is highly irritated by it; 
and determination of blood to the gut is the consequence. This 
irritation is propagated by the sympathy of contiguity to the other 
viscera of the pelvis, and an anormal quantity of blood is deter- 68 
BURNE ON HABITUAL CONSTIPATION. 
mined to them also. The effect of this determination or hyperemia 
is to heighten the sensibility of parts, and so to cause their func- 
tions to be performed with uneasiness and pain. Hence hyperces- 
thesia, or tenderness of the womb: hence the sense of heat about 
the rectum, pudenda, and bladder: hence dysuria and dysmenor- 
rhcea; and, I may add, painful sexual intercourse and difficult 
parturition. 
The further effect of hyperemia is an excess of nutrition, 
and often an inordinate increase of the natural functions; hence 
hypertrophy of the xoomb, menorrhagia, and leucorrhcea. This state 
of hyperaesthesia and hypertrophy of the womb has been accu- 
rately described by Dr. Gooch as the characteristic of the irrita- 
ble uterus. “ If the uterus is examined, it is found to be exquisitely 
tender; the finger can be introduced into the vigina, and pressed 
against its sides without causing uneasiness; but as soon as it 
reaches, and is pressed against the uterus, it gives exquisite pain. 
This tenderness, however, varies at different times, according to 
the degree of pain which has been latterly experienced. The neck 
and body of the uterus feel slightly swollen, but this condition also 
exists in different degrees, sometimes sufficiently manifest, some- 
times scarcely or not at all perceptible. Excepting, however, this 
tenderness, and occasionally this swelling, or rather tension, the 
uterus feels perfectly natural in structure. There is no evidence 
of schirrus in the neck, the orifice is not mis-shapen, its edges are 
not indurated.”* 
As another result of this general pelvic hyperemia, is an enlarged 
and congested state of the hemorrhoidal veins leading to frequent 
hemorrhage, and to the development of one kinds of piles. 
This state of irritation and general hyperemia of the viscera of 
the pelvis, predisposes them to structural disease ; and the irritation 
and hyperemia having been not only excited, but kept up and 
prolonged through many years by habitual constipation, disease, 
malignant or otherwise, is eventnally developed. It may be stricture 
of the rectum, or any of the formidable diseases of the womb. 
As a consequence, too, of this same state of irritation and hy- 
peremia, I would adduce the prurigo pudendi muliebris et podicis, 
of which almost all the distressing cases that have come within 
my own observation, have been preceded by long-existing habitual 
constipation. 
The disorders of the sexual organs enumerated in the preceding 
pages, have been shown to result sympathetically from the rectum, 
the portion of the large intestine upon which the injurious influence 
of habitual constipation is specially exerted. 
Now it happens, in other instances, that the rectum will escape 
and the colon suffer: then, instead of the pelvic, the abdominal 
viscera will sympathise, the liver and stomach particularly, on ac- 
count of their contiguity to the large intestine. 
*An Account of some of the most important Diseases peculiar to Women : by 
Robert Gooch, M.D. London, 1829, p. 312. CONSEQUENCES OF HABITUAL CONSTIPATION. 
69 
Irritation of the colon, excited and prolonged by habitual con- 
stipation, will assuredly produce determination of blood to the 
abdominal viscera, and consequent congestion of the portal system, 
the fruitful source of hepatic and gastric disorders. It is with this 
state of things that Amenorrhcea is apt to be associated, the function 
of the womb appearing to be diminished or suspended by the too 
great determination of blood to the other organs. In the most 
obstinate cases of amenorrhoea, how frequently do we find some 
co-existing organic disease, especially of the liver. Amenorrhoea, 
thus brought about, may be regarded as a remote, though not less 
decided, consequence of habitual constipation. 
The influence of habitual constipation upon the uterus is not 
confined to its unimpregnated state. Cases have from time to time 
come under my notice in which it has appeared to be cause, im- 
mediate or auxiliary, of abortion and miscarriage. Certainly, it 
is a frequent cause of aggravating the nausea and sickness at- 
tendant upon pregnancy, of which every one must have had 
abundant proof. 
Other cases have presented themselves to me in which ladies, 
near fifty years of age, have supposed themselves pregnant, the 
size of the abdomen from flatus, the absence of menstruation, and, 
as Dr. Gooch remarks, “ an anxiety to believe in pregnancy as a 
test of youthfulness,”* having impressed them with this notion. 
One lady was extremely anxious to engage a nurse and to provide 
childbed linen, till, by vaginal examination, I was able to give her 
the unwelcome intelligence that she was not pregnant. 
Case XXXIII.—Menorrhagia cured by obviating constipation. 
(Communicated by the late Mr. Jukes.) 
“ Mrs. S , aged 28, a delicate person, the mother of two 
children, had been troubled with irregular and profuse menstrua- 
tion for more than two years. She had been under medical treat- 
ment for the whole of that period, and had taken and used a great 
variety of medicines and applications without benefit: on the con- 
trary, she wras losing flesh, growing weaker, and suffering from 
palpitation and other nervous symptoms. 
“ I found all the indications of loaded bowels; and, on inquiry, 
was informed she had been exceedingly costive for many years. 
She was put upon a plan of stomachic aperients, with directions to 
let the bowels be moved freely aud satisfactorily daily. At the 
end of a fortnight she was so greatly relieved as to think herself 
well. She pursued the plan with great steadiness for three months, 
at the end of which time she had regained her flesh and strength 
and was quite well. 
“ I have seen this lady to-day, November 5th, 1830, in perfect 
health ; and learn that she has been once threatened by a return of 
* An Account of some of the most important Diseases peculiar to Women: by 
Robert Gooch, M.D. London, 1829, p. 225. 70 
BURNE ON HABITUAL CONSTIPATION. 
disease within the last two years, but that it was owing to her own 
negligence and disregard of the state of her bowels.7’ 
Case XXXIV.—Menstrua interrupted by constipation, and restored by attention 
to the bowels. 
Miss J. W had suffered from obstinate constipation for the 
last several months, during which the menstrua had been suspended. 
Her bowels, which were habitually regular, had become constipated 
on her leaving home ; and, soon afterwards, she ceased to be regular. 
On two or three other occasions, when she left home, her bowels 
became confined, and menstruation was suspended. Beside the 
interruption to the menstrual periods, she was troubled with other 
consequences of constipation, as flatulence, flushings in the face, 
and nervous symptoms, 
I directed her to take the compound decoction of aloes with the 
carbonate and sulphate of magnesia twice a-day ; which acted upon 
the bowels moderately and not unpleasantly. In the course of a 
fortnight menstruation returned, and her health was soon establishd 
by perseverance in the same means. 
Mary M. C , age 20, well grown, of rather spare habit and 
pale sallow complexion, came under my care in July, 1831. She 
had been subject to confined bowels as long as she could remember, 
two or three days passing without an evacuation; and on one oc- 
casion three weeks; the dejections being always hard and knotty. 
Atthe present time she experiences a constant bearingdown pain with 
ineffectual efforts; she has ardor urinse, pain in the back, and leu- 
corrhoea ; and is subject to cold feet in the winter. She began to 
menstruate at 18 years of age, and continued regular for four 
months ; after which the menstrua did not recur at the usual period. 
Then her respiration became short on moving about; she felt 
languid, perspired easily, and had headach. The menstrua, having 
been suspended for six months, returned scantily every three weeks, 
of a pale colour, and attended with much pain. 
The bowels were, in the first place, cleared by colocynth and 
calomel; after which she took the Pil. Aloes cum Myrrhd as an 
aperient, and the Pil. Ferri C. twice a-day. In the course of three 
weeks the menstrua recurred of a natural character and in sufficient 
quantity; the bowels acted regularly, and her complaints were all 
relieved, except the leucorrhoea, for which she was instructed to 
use the Liquor Aluminis Comp, diluted, as a wash. 
Case XXXV.—Chlorotic amenorrhoea. Constipation. 
Case XXXVI. — Utero-spinal irritation. Hypertrophy of the breast. Con- 
stipation. 
Caroline Heywood, age 19, applied to me for advice on the 10th 
of November, 1834. 
Her complaints were pain across the loins and extending round 
the hips ; pain deep-seated in the region of the uterus; heat in the CONSEQUENCES OF HABITUAL CONSTIPATION. 
71 
vagina with tenderness extending towards the womb; ardor urinae 
and leucorrhcea. She had pain in the left hypochondrium, great 
tenderness of the spine, so that she could not lean against a chair 
or bear her stays laced, and crampy pains in the lower extremities. 
She menstruated every twenty days abundantly. Her left breast 
was enlarged, rather hard, and very tender; she was very nervous 
and agitated : her pulse was frequent; and she suffered from pal- 
pitation of the heart. Her appetite was impaired, and her bowels 
habitually confined. 
For several weeks she was treated with blue pill and rhubarb, 
the ammoniated tincture of valerian and bitters; then, with prepa- 
rations of iron ; and, lastly, with ammonia, hyoscyamus, and con- 
fection of senna. 
From the first part of the treatment she received but little benefit. 
The iron disagreed; and it was not till she had recourse to the 
confection of senna, ammonia, and hyoscyamus that amendment 
was decided. The senna regulated the bowels exactly; and when 
this natural function was secured, then it was that she began to ex- 
perience relief. The heat and pain about the womb diminished, the 
menstrua became less profuse, the tenderness of the spine ceased, 
and the enlargement of the breast subsided. The appetite returned ; 
and on the 29th of December, she took leave of me, with injunction 
to persevere in regulating the action of the bowels. 
Case XXXVII.—Utero-spinal irritation. Constipation. 
Sarah Goodson, aged 29, unmarried, fair, sanguine temperament, 
menstruated regularly, but had been ill five months with the fol- 
lowing symptoms:—pain under the left breast with palpitation;— 
pain also in the left hypochondrium shooting through to the back;— 
tenderness over the left and inferior regions of the abdomen ex- 
tending round to the vertebral column, the vertebral column itself 
from the middle dorsal vertebra to the sacrum excessively tender, 
the slightest touch upon the spinous processes causing her to shrink 
and cry out. The corresponding parts of the right side were not 
affected. She had ardor urinae and sense of heat in the course of 
the vagina to the uterus. The tongue was rather red, and the 
pulse frequent and contracted. 
She stated that she had suffered more or less from similar com- 
plaints since the age of 20; that her bowels were habitually and 
most obstinately confined, a week passing without any dejection; 
the dejections always very hard, like marbles, and passed with 
pain. She had haemorrhoids, but no leucorrhoea. Her urine was 
at one time scanty and high-coloured, at another, copious and 
pale 
The uterus, on examination, proved to be very tender, and, when 
touched, the pain in the left hypochondrium w'as sensibly in- 
creased. The hymen w7as present, which rendered the examina- 
tion difficult. 
A warm bath was prescribed, also an enema every morning, and 72 
BURNE ON HABITUAL CONSTIPATION. 
a senna draught every evening at bed-time. Leeches were also 
directed to be applied to the uterus by means of the vigina leech 
tube. 
These means were ineffectual in procuring proper evacuations. 
The leeches could not be applied to the uterus, the nurse finding it 
impracticable to introduce the tube. On these accounts colocynth, 
calomel, and opium were added as aperients ; leeches were applied 
to the groins and sacrum ; blood was also drawn from the region 
of the sacrum by cupping; and, as soon as the tender spine would 
admit of friction, the croton oil embrocation was applied to it. The 
bowels having become manageable, the confection of senna was 
substituted for the other purgatives, and at the end of two months 
she left the hospital very much relieved. 
Case XXXVIII.—Leucorrhcea. Dysuria. Prolapsus uteri. Constipation. 
Mary Ann B , age 45, the mother of eight children, came 
under my care in October, 1830, affected with a profuse white dis- 
charge from the vagina, attended with heat and itching about the 
pudenda and neighbouring parts; with a bearing down of the womb, 
ardor urinse, and very frequent desire to micturate, passing little at 
a time; and with pain of a dragging character, in the back and in 
the left hypochondrium, less urgent when in bed. 
For very many years she had laboured under a constipated state 
of the bowels, the dejections being always hard and knotty, and 
evacuated with difficulty and striving; which, forcing down the 
womb, aggravated the prolapsus. The bowels were readily acted 
upon by medicine, though seldom without. Besides the above 
symptoms, she had the usual headach, flushings of the face, cold 
feet, &c., which seldom fail to be the attendants of habitual consti- 
pation, but her appetite and digestion—as is not unfrequently the 
case—remained good. Take Pulv. Rhei gr. v.; Sodce Sesquicarb. 
gr. x.; Pulv. Ipecacuanhce Comp. gr. iii. twice a-daxj: and use the 
Liq. Aluminis Comp, diluted, as a wash. 
From this powder, which, taken twice a-day, acted mildly and 
effectually, she quickly derived much benefit. The leucorrhcea di- 
minished, as also did the heat and itching about the pudenda. Mic- 
turition became less frequent; her general health improved; and the 
prolapsus had become as little troublesome as was possible with her 
obligation to work. 
Case XXXIX.—Sickness daring pregnancy aggravated seriously by constipa- 
tion. < 
I was requested to visit Mrs. M , in consultation with Mr. 
Terry, in July, 1831. 
She was six weeks gone with child. She was in bed, lying on 
the back with the head and shoulders raised, exhausted by constant 
sickness and vomiting. She was unable to retain anything on the 
stomach except toast and water, which had been the case for nearly 
a fortnight. Prior to this she had suffered also from nausea. She CONSEQUENCES OF HABITUAL CONSTIPATION. 
73 
complained much of pain and tenderness in the region of the sto- 
mach and liver, and more or less over the whole abdomen, with in- 
termitting twisting pains. The abdomen was rather hard; the res- 
piration was frequent; the tongue white; the pulse frequent, soft, and 
weak; the skin cool. She reported that her bowels had been regu- 
lar, having had one or two dejections daily, and that she was purged 
by medicine three days ago. She had been bled about a fortnight 
previously; and leeches had been applied to the region of the liver 
in the morning of the day I visited her. 
I suspected the patient was deceived as to the state of her bowels, 
and that the vomiting was excited and kept up by a loaded colon. 
She was therefore directed to have an enema immediately and to 
take 
01. Ricini 3iii.; Tinct. Opii Aquse Cinn'am. Jv. every four hours till the 
bowels should act; and then Magnesiae gr. viii.; Conf. Opii gr. v.; Aquae 
Menthse virid. $i. every four hours. 
On visiting her next day, I had the gratification to see her lying 
comfortably on her side free from sickness, vomiting and pain. The 
pulse had recovered its strength, and the tongue was less white. 
The enema and oil had operated four times ; the two first dejections 
were black and lumpy, the others of a more natural character. The 
relief was complete, and so much had the stomach recovered, that 
she longed violently for roast pig. 
Although the disorders of the female sexual organs, which I have 
described, have been produced wholly, or in great measure, by ha- 
bitual constipation, it does not follow that the treatment should be 
directed solely to the removal of the constipation ; or that, by its re- 
moval, the disorders will be invariably cured. Many will never- 
theless yield to this treatment only. Dr. Gooch, in discussing the 
remedies for the “ irritable uterus,” observes, “ another remedy is a 
mild course of mercury; from three to five grains of blue pill, or 
compound calomel pill mixed with five grains of extract of henbane, 
taken every night for several weeks, or every other night for many 
weeks, have sometimes, without affecting the gums, occasioned a 
very regular action of the bowels; and during its influence, the pe- 
riodical aggravations of pain have not recurred, and the permanent 
pain has diminished, and at length ceased altogether.”* 
Where causes have been long in operation the effects will con- 
tinue even after the original cause shall have been removed. In 
addition, then, to the relief of the constipation by appropriate ape- 
rients as an indispensable part of the treatment, other remedies 
adapted to the particular disorder must be conjoined. In cases of 
menorrhagia, for example, it is essential to exhibit remedies known 
to have a powerful effect upon anormal menstrual or sanguineous 
discharges from the womb. Of these the ergot claims the prefer- 
ence unquestionably. I have heard persons express doubts of its 
efficacy :*but so many cases under my own care have been bene- 
fited or cured by it, that I cannot but regard it as a most valuable 
* Op. cit. p. 323, 324. 74 
BURNE ON HABITUAL CONSTIPATION. 
addition to the materia medica. Not only has menorrhagia been 
controlled, but the hasmorrhage after abortion has been at once 
checked. Cases, in which an exhausting draining hasmorrhage 
has persisted for five or six weeks after abortion, have yielded at 
once to the influence of ergot. 
It is of consequence that the ergot be in good preservation, and 
free from decay, or its virtues may be negatived. It may be ad- 
ministered in substance, in infusion, in decoction, or in tincture: 
either of which preparations is efficacious. When given in sub- 
stance,—the dose ten or twelve grains,—it is usually mixed with a 
few grains of sulphate of potass, to facilitate its reduction to a fine 
powder; it being essential that all medicines administered in the 
form of powder should be in as fine a state of subdivision as pos- 
sible. 
Besides the ergot, mineral acids and tonics are often advanta- 
geous. The arsenious acid has lately been recommended by Mr. 
Hunt,* both in the form of the liquor potassae arsenitis and in sub- 
stance. Should any, for the sake of convenience, prefer to give it 
in substance, I urge them to take especial care that it is reduced to 
an impalpable powder before it is made up into pills; and, even 
with this precaution, I question whether it is admissible, on account 
of its virulent poisonous properties. An alkali should be conjoined. 
In the treatment of painful menstruation, dysmenorrhcea—the suf- 
ferings from which are indescribable, varying from pain in the 
lower part of the abdomen and back almost to torture, accompa- 
nied with sickness, vomiting, and death-like syncope—I have found 
the belladonna most valuable. 1 have usually prescribed it in the 
dose of a quarter of a grain of the extract, made into a small pill, 
which may be taken twice a day where patients suffer, but not 
very severely, for two or three days about the menstrual period. 
In the more urgent cases, I advise it to be repeated in one hour; 
then again after an interval of two; then of three hours; till two, 
three, or four doses have been taken, according to circumstances : 
and I have seldom been disappointed in the result. It may pro- 
duce giddiness and dimness of sight, but they soon pass away. 
Its unpleasant effects are less than of opium; and its efficacy de- 
cided. 
The conditions of hypertrophy and of hyperasthesia of the uterus 
are benefited essentially by leeches applied direct to the os uteri by 
a vagina tube ; or, more certainly, though with less delicacy, by 
means of the speculum, which gives the further advantage of dis- 
closing the actual state of the uterus. It is only just now that the 
use of the speculum is being introduced in this country ; and although 
the first impression of its indelicacy is great, yet, when one expe- 
riences its utility as a means of securing more accurate information 
of the condition of the organ than can be arrived at by the ordinary 
method of examination, one inclines to its adoption in urgent cases ; 
* Trans, of the Royal Med. and Chir. Soc., vol. xxi. p. 277. CONSEQUENCES OF HABITUAL CONSTIPATION. 
75 
and, proper delicacy being observed, females do not in general 
withhold their consent. 
That the healthy functions of the womb are interfered with by an 
habitually constipated state of the bowels, the preceding remarks 
and cases, will, I hope, make manifest. I have known several 
instances in which ladies—who either had not yet borne children, 
or in whom utero-gestation had been suspended—have become preg- 
nant quickly after their general health, and the uterine functions 
had been improved by securing the regular action of the bowels ; a 
circumstance which has happened in two persons within the last 
eighteen months. 
Leucorrhoea.—Among the many consequences of habitual consti- 
pation, leucorrhoea is not the least frequent or unpleasant. It is the 
result of irritation, from the sympathy of contiguity between the 
uteris, vagina, and rectum, and is generally attended by ardor urinse; 
by a sense of heat greater or less, often excessive, and tenderness 
of the parts about the orifice of the vagina. Singularly enough, a 
pain in the left side, about the hypocliondrium, is an ordinary con- 
comitant of leucorrhoea. I say singularly enough, because neither 
anatomy nor physiology, sound or morbid, explain why, in affec- 
tions of the uterine system, pain should be referred to this precise 
situation. But that this pain is connected with the female sexual 
organs appears evident from the circumstance of its being a symp- 
tom attendant both upon utero-gestation and prolapsus uteri, and is 
moreover proved by the fact, ascertained by Dr. Gooch and verified 
by myself, that the pain in the side is increased when the irritable 
uterus is touched during examination. So constant is this associa- 
tion, that when a patient suffers from pain in the left side, about the 
margin of the false ribs, it is almost certain that she is affected either 
with leucorrhoea or irritable uterus, or prolapsus, or is pregnant. 
It is from the muciparous glands about the os externum, as I 
have reason to believe, that the true leucorrhoea, the transparent 
mucous discharge proceeds; while the white mucous and purulent 
discharges may often be seen, by the aid of the speculum, to pro- 
ceed from the glands about the cervix uteri, and from the mucous 
lining of the uterus itself; the pathological condition of which uterus 
appears to be a subacuto-chronic inflammation, or muco-metritis, 
rather than a mere hyperemia, or congestion of blood. Pus is the 
proper product of an inflammation of a mucous membrane, and 
does not proceed from this tissue as a result merely of irritation. 
So violent, sometimes, are the symptoms, burning heat and fre- 
quent micturition, attending leucorrhoea, and so decidedly muco- 
purulent is the discharge, that the distinction between it and gonor- 
rhoea is not at once evident. A circumstance upon which I place 
much confidence, is the presence or absence of irritation and tume- 
faction of the inguinal glands. If these sympathise, I suspect go- 
norrhoea, for with gonorrhoea they are almost invariably involved 
more or less; whereas in the most severe cases of leucorrhoea,— 
when undoubtedly there has been inflammation of the vagina, probably 
also of the os uteri itself—the inguinal glands have not become 76 
BURNE ON HABITUAL CONSTIPATION. 
affected. I can only speak from my own experience, the result of 
which has impressed me strongly with the validity of this distinction. 
In the treatment of ordinary cases ofleucorrhoea, it is my custom 
to prescribe the liquor aluminis compositus diluted as a wash not as 
an injection ; for I find that, by applying it to the pudenda only, the 
labia being separated, it restrains and cures leucorrhoea. The use 
of a remedy as a lotion instead of as an injection, is a very great 
desideratum in all females, more particularly in those who are un- 
married. The readiness and almost certainly with which leucor- 
rhoea yields to this outward application, has, in part, led me to infer 
the source of leucorrhoea to be from the glands about the os exter- 
num, which secrete mucus so abundantly in the last stage of 
labour. 
In the muco-purulent form of vaginal discharge, attended with 
heat, irritation, and inflammatory congestion, the local abstraction 
of blood should precede the use of astringent lotions, and, above all, 
the bowels should be regulated by proper aperients. If astringent 
and irritating remedies are employed in the first place, the symptoms 
will be aggravated and very decided inflammation of the vagina and 
uterus excited. Within the last few weeks, a young married woman 
was brought to the hospital with severe injlammation of the uterus 
caused hy an injection. By means of the speculum, the os uteri 
was seen to be turgid, and of a vermilion red colour; it was very 
tender, and surrounded by tenacious muco-purulent matter. She 
was relieved by hot baths and depletory and antiphlogistic measures, 
The cases of purulent vaginal discharge with inflammatory con- 
gestion, are tedious to cure. Much perseverance is necessary on 
the part of the patient, to keep the bowels in a natural state; to 
submit to the local abstraction of blood from time to time; to use 
hip baths, so as to tranquilize irritation and remove inflammatory 
congestion before astringents are employed. Of these, I know of 
none better than the liquor aluminis compositus diluted, as already 
mentioned. Other practitioners prefer nitrate of silver, acetate of 
lead, bichloride of mercury, &c. 
The consequences of habitual constipation upon the sexual or- 
gans in the male, are less frequent and less severe than in the female; 
owing, first, to the less frequent existence of constipation; and, se- 
condly, to the less intimate relation between the sexual organs and 
the rectum. 
The portions of the male sexual organs most subject to the influ- 
ence of habitual constipation from the sympathy of contiguity, are 
the vesiculas seminales and the urethral extremities of the vasa defe- 
rentia, the influence upon which parts is to produce a state of in- 
creased determination of blood, of increased organic sensibility, and 
of irritation, the exhausting effects of which are inopportune excre- 
tions, and excessive sexual indulgence. CONSEQUENCES OF HABITUAL CONSTIPATION. 
77 
CHAPTER VII. 
OF DISEASES OF THE AND COLON AS CONSEQUENCES OF HABITUAL 
CONSTIPATION. 
Colic. Diarrhoea. Dysentery. Ileus. Accumulation of Feces. Obstruction. 
Displacement. Inflammation, acute, subacute, and chronic. Ulceration. 
Hypertrophy or thickening with induration and contraction. Stricture. 
Colic is a very frequent consequence of constipation, and varies 
in severity from an obscure aching pain to one of great intensity; 
remitting, intermitting, exacerbating; located generally about the 
navel, or in the region of the ascending or descending colon. 
In one instance it will supervene suddenly and with severity, the 
pain being of a violent twisting character, drawing the patient al- 
most double, and causing him to moan and call out. With the con- 
tinuance of the pain he grows excessively restless and changes his 
position, at one time lying on the belly, at another getting up on the 
knees, then walking about the chamber; all which symptoms con- 
tinue till the colon has been evacuated ; when they subside at once. 
In another instance, the pain will be aching and wearing, though 
not severe, and may affect the patient more or less daily for weeks, 
accompanied with frequent inclination to retire to the closet; which 
impresses him with the conviction that his bowels are much relaxed, 
though, in fact, little else than a scybal and mucus pass, the colon 
being and continuing to be loaded. In these cases exacerbations of 
great severity will sometimes occur and induce serious indisposition, 
which is the more obstinate, inasmuch as the patient, believing his 
bowels to be relaxed, is himself deceived and deceives sometimes the 
medical attendant, so as to prevent the appropriate remedies being 
had recourse to. Doubt on this point can only be cleared up by 
observing the dejections, the scanty, scybalous, and mucous cha- 
racter of which declares the loaded state of the colon. 
In a third instance, the colic pain shall consist only of one sudden 
violent twinge, which may attack a person in his usual health, and, 
by its intensity, cause him to fall down in a state of syncope, he 
breaking out, at the same instant, into a profuse sweat, greatly to 
the alarm of himself and friends. 
Where the case is a true colic and depends on a spasmodic con- 
traction of some part of the muscular tunic of the colon, the pain is 
referred to some region in the course of the colon. Where the pain 
is referred to the navel, I have reason to believe it depends on spasm 
of the small intestines, and is often the forerunner of ileus. 
Case XL.—Severe sterccraceous colic relieved immediately by an enema. 
A lady about 55 years of age and of very full habit, who had long 
suffered from constipation, was seized with violent griping twisting 
pains around the abdomen and great flatulent distention, causing 78 
BURNE ON HABITUAL CONSTIPATION. 
her to cry aloud and to be changing her position in bed perpetually. 
The pains remitted and exacerbated, but were not accompanied 
with any movement in the pulse, nor by any heat of skin, nor pre- 
ceded by any unusual indisposition. Her constipated habit was 
known to me ; and it was evident the colic proceeded from a loaded 
state of the large intestine. Without W'aiting, therefore, for the 
operation of medicine by the mouth, I directed a very copious 
domestic enema to be thrown up; the immediate effect of which 
was to evacuate the colon of nearly a utensil full of hard scybals, 
to the entire relief of the patient. 
A gentleman, about 35 years of age, of spare habit and nervous 
temperament was harassed by an irregular state of the bowels, 
they being generally much confined. At times he would be affected 
with colic pains and frequent inclination to retire to the closet, the 
dejections being scybalous, scanty, and mucous ; which nevertheless 
impressed him with the belief that his bowels were absolutely re- 
laxed ; the contrary in fact being the case. His health being weak 
and disordered, he set out on an excursion to Leamington, and, 
while on the road, the colic pains increased so considerably that it 
was with difficulty he reached the end of his journey. 
Arrived at the hotel, the pains were become most violent, and 
the gentleman excessively ill. Advice w7as obtained, and blood to 
a large amount abstracted under the notion of inflammation; medi- 
cines also were administered without relief. The pain persisted in 
all its intensity, and extinguished life in the course of sixteen hours. 
The body was opened and the colon discovered to be loaded with 
hardened feces; without any evidence or trace of inflammation. 
Case XLI.—Colic mistaken for inflammation ; fatal. 
Case XLII.—Colic pains and diarrhcea from feces accumulated in the colon. 
1830, February 24. Charlotte P , age 21, requested my 
advice on account of a griping twisting pain in the bowels with 
tenesmus and frequent scanty slimy dejections, attended with much 
striving; for which she had been under treatment, the bowels sup- 
posed to be relaxed. The abdomen was flatulent and distended; 
she had eructations, and a foul white tongue; and was subject to 
flushings and heats in the face with heaviness and headach. 
Suspecting the bow?els to be loaded, she was directed to take 
castor oil and laudanum, which seemed to purge her many times, 
yet without relief; afterwards she took magnesia, rhubarb, and 
Dover's powder, and next day there passed an immense dejection of 
more than half a utensil full of feculent matter. 
Case XLIII.—Colic pain producing syncope; mistaken for epilepsy. 
Calling one day on a friend, a solicitor, in the middle age of life, 
I found him in bed much out of spirits, and with a cut on his nose. 
He told me that, the day previous, he had fallen down in a fit of CONSEQUENCES OF HABITUAL CONSTIPATION. 
79 
epilepsy, and struck his head against the edge of a door, by which 
he received the cut on the nose. 
Knowing this gentleman not to be the subject of epilepsy, I 
questioned him as to the nature of the attack, and was informed 
that, on retiring to the closet, he was seized with a most acute 
griping pain in the bowels, which caused him to break out instantly 
into a profuse sweat, and to fall as if he had been struck down. 
His bowels were soon afterwards relieved, and he was now suffer- 
ing more from the apprehension of being liable to the return of 
what he supposed to be epilepsy, than from any bodily ailment, of 
which indeed he had none. He said his bowels were apt to be 
irregular and confined. 
From his account, and from the absence of any signs of epilepsy, 
1 was satisfied the attack was simply a fainting fit from sudden 
intense colic pain ; and having assured him that he might make his 
mind easy on the subject of epilepsy, and that, if he would attend 
to his bowels, he would be free from any recurrence, his spirits 
revived, and he felt himself no longer an invalid. From this period 
the gentleman remained perfectly free from any return. 
Another instance, exactly similar, occurred to me in the course 
of eighteen months afterwards. 
I was summoned in great haste one evening, the 23d of Novem- 
ber, 1830, to a gentleman said to be just seized with a fit. I 
hastened to his house and found the family in great alarm, and the 
gentleman, who had now recovered, pale and alarmed also, under 
the belief that the fit was apoplectic or something equally serious. 
On inquiry, it appeared that, while walking from the dinner table 
into the drawing room, he was suddenly seized with a violent 
twinge in the bowels, which made him perspire and fall senseless 
upon the sofa. 
It was evident that he had merely fainted from an intense colic 
pain, which I assured him was the case, and that he need not be 
under any apprehension for the future, the affair being only transi- 
tory and accidental. I prescribed a rhubarb draught, and next 
morning found the gentleman at breakfast in his usual health. 
It is unnecessary to multiply cases of colic, of which I have more 
at hand, arising from constipation. The cases adduced show how 
patients may deceive themselves into the conviction that the bowels 
are loose, when, in reality, the dejections are insufficient, though 
too frequent. Pain, moreover, however severe, does not of itself 
indicate inflammation or blood-letting, nor will the pain of colic be 
effectually relieved by it; while the loss of blood in a person of a 
nervous temperament, with a continuance of the acute suffering, 
may soon destroy life; whereas, attention directed to the removal 
of the cause would be at once successful. 
No greater error in medicine can be committed than the relying 
upon a single sign as indicative of a disease, which, when present, 
is evidenced by several. Inflammation is manifested not by pain 
alone, but by other signs co-existing; and therefore, when these 80 
BURNE ON HABITUAL CONSTIPATION. 
other signs are not present, it may safely be concluded that the 
pain does not result from inflammation, but from spasm, or 
neuralgia, &c. 
Remarks of a similar tendency apply to the cases of syncope, 
and to the possibility of mistaking them for epilepsy. Syncope 
is a sudden seizure from an accidental cause. Epilepsy has al- 
ways premonitory and precursory signs; and, besides, the fit itself 
is so different from syncope, that it is only to recollect that epilepsy 
is attended with convulsions, foaming at the mouth, and congestion 
of the face and head, in order to distinguish it most readily from 
syncope, where there is a death-like stillness and pallor. 
Case XLIV.—Dysentery consequent on habitual constipation, cured by saline 
aperients. 
Elizabeth Oliver, aged 40, married, but has not had children, 
came under my care in January, 1829. She had suffered from 
most obstinately confined bowels for fourteen or fifteen years, ac- 
companied with pain in the region of the tra verse colon, which had 
impaired her digestion and general health. For some time past, 
instead of constipation, she has had frequent dejections consisting 
more of mucus than of feces ; and latterly, they have been preceded 
by violent griping pains. It was evident from the small quantity 
of feculent matter voided, that the bowels—although apparently 
relaxed, dejections occurring several times in the day—wrere in 
reality confined, and an aperient treatment was accordingly 
pursued. 
Castor oil was first recommended; but, being retained on the 
stomach with difficulty, the sulphate of magnesia wTas substituted. 
Of this salt she took half an ounce every morning in a glass of 
wrarm water, which operated freely without much pain, and pro- 
duced liquid feculent stools. By a continuance of this plan, the 
mucous discharge from the rectum ceased, the dejections became 
natural, w7ere passed without pain, and the patient recovered her 
health. 
Case XLV.—Diarrhoea consequent on constipation, cured by saline aperients. 
Mrs. M,, age 28, came under my care in October, 1829. She 
complained of having been harassed for the last three months by 
five or six dejections occurring m the course of the day, with much 
straining and tenesmus. The dejections consisted generally of 
mucus streaked with blood ; and sometimes of red blood to the 
amount of several ounces. Feculent matter passed rarely; once 
or twice in the day, perhaps, a hard scybal covered with inspis- 
sated mucus, like a skin. She did not suffer pain in the bowels 
either before or after an evacuation. Her appetite and digestion 
were bad ; and she was troubled with headach and flushings in the 
face. She was directed to take, Magnes. Carb. gr. x., Magnes. 
9ij., Sulph. Tinct. Sennoe, Tinct. Lavandulae C. aa f 3ss., Aquae 
Cinnam./ gj., twice a day. CONSEQUENCES OF HABITUAL CONSTIPATION. 
81 
After three days, she called and informed me that the draughts 
had produced three or four feculent dejections daily, almost unac- 
companied with blood ; and that she began to feel much better. I 
saw nothing more of her for three weeks, when she paid me an- 
other visit, complaining of a return of the symptoms, she having 
discontinued the medicine as soon as she felt herself getting better. 
I now instructed her to take three grains of blue pill every night, 
and a Seicllitzpowder every morning, which produced one copious 
easy evacuation regularly. The discharge of blood ceased, and 
by perseverance in the plan, she got quite well. 
The accumulation of feces in the colon, to a greater or less ex- 
tent in constipated habits, a common occurrence, is often attended 
with no other inconvenience than the ordinary signs of irregular 
bowels, and is readily removed by purgative medicines which 
the patient has recourse to, from time to time, of his own accord. 
It happens, however, that feces so retained will collect into one 
mass, obstruct altogether the channel of the bowel, and excite a 
high degree of irritation, even inflammation, in that portion of the 
colon where the mass lodges, with all the attendant symptoms of 
pain, tenderness, sickness, vomiting, febrile movement, and even 
delirium. Often a tumour may be perceived in the region to 
which the pain is referred, which will more generally prove to be 
that of the caecum, or of the sigmoid flexure of the colon. 
The Obstruction induced by this cause is obstinate, and the in- 
flammation often very acute; always putting life at stake, and 
sometimes destroying it. A correct diagnosis at the outset is of 
the first consequence ; for, inasmuch as the obstruction cannot gene- 
rally be overcome in a less period than from five to ten days, if it 
happens to be regarded and treated as an idiopathic inflammation, 
the depletory and antiphlogistic measures adopted on this view, 
together with the great sufferings, will exhaust and destroy the 
patient before sufficient time has elapsed to admit of the obstruc- 
tion being removed. 
The Diagnosis of obstruction and consequent inflammation from 
feces accumulated and impacted in the caecum or colon, will be 
aided, and generally may be established, by the following charac- 
ter of the symptoms. 
The local signs, as pain, tenderness, and tension, precede the 
general signs of fever, and are not ushered in, though they are 
often followed, by chills or rigors; nor can they be traced to any 
of the ordinary accidental causes of idiopathic inflammation, as 
cold from exposure to wind, rain, &c. Moreover the countenance 
is not so anxious; nor is the febrile movement, when developed, so 
urgent. The pain, too, exacerbates like the pain of colic, and the 
vomiting is not so deadly. The usual points of obstruction are the 
crncum and sigmoid flexure of the colon, in one of which regions 
may be felt a deep-seated circumscribed tumour, produced by the 
impacted mass. Added to the above, females are more liable to 
this kind of obstruction than males, and the history of individual 82 
BURNE ON HABITUAL CONSTIPATION. 
patients as to whether they were of a costive habit, or otherwise, 
will assist the judgment of the practitioner. Yet implicit reliance 
cannot always be placed on their reports, so apt are they to be 
themselves deceived as to the state of their bowels. At this time I 
have a patient under care in the hospital; suffering from obstruction 
and acute inflammation, caused by feces impacted in the sigmoid 
flexure of the colon, who, nevertheless, supposed that up to the 
moment of attack her bowels had been freely open. Her case 
will be detailed. 
Should the obstruction and inflammation be seated in the sigmoid 
flexure, a long tube introduced into the rectum will reach the mass, 
and, when withdrawn, exhibit signs of fecal matter, which will be 
conclusive, especially if the lower part of the gut has been pre- 
viously cleared by an enema. 
The treatment will be considered in the chapter devoted to that 
subject. 
The three following cases have been kindly supplied by my 
friend Dr. Stroud, who has allowed me to abridge them for inser- 
tion in the present work. 
Case XLYI.—Hypertrophy of the heart and disease of the aorta. Mass of feces 
impacted in the ccum. Consequent inflammation of the small intestines, &c. 
“ William Franklin, a strongly-built man, aged 48 years, formerly 
a carpenter, placed himself under my care, August 17th, 1836. He 
had been ill for six months, but more so since the last month, with 
symptoms denoting disease of the heart. His breath is offensive. 
He was formerly troubled with flatulence, and sometimes vomits 
a sour matter. His bowels are rather confined. His urine is 
scanty, thick, and red, and was at first passed with pain and 
difficulty. In the beginning of October, he had three fits of palpita- 
tion, shortness of breath, and pain, either in the prsecordia, or in 
distant parts, the head, hips, lower end of the abdomen, &c., owing 
to which he was afraid to lie down. 
“On the last day of January, 1837, the heart’s action, which 
for some days had been increased, was first observed to be ac- 
companied with a musical tone, afterwards ascertained by my 
friend, John Bishop, Esq., of Bernard Street, to be the note C, 
which could be heard without any acoustic medium at some distance 
from the patient. From this time till his death, which took place 
on the 2d of March, his complaint was aggravated, with increasing 
weakness of body, and irritability of mind, swelling and numbness 
of the left arm and leg, pain and heat of the prascordia, palpitation 
extending to the throat, and at times a sense of tumour in the left 
axilla. 
“ On the 17th of February he began to be affected with bilious 
vomiting, and with pain and heat at the top of the head. On the 
19th, the vomiting became more constant, the morbid sounds of 
the prmcordia were increased, the bowels were not open without 
the aid of a glyster, and the abdomen was so painful as to cause CONSEQUENCES OF HABITUAL CONSTIPATION. 
83 
the body to be bent forwards. It was afterwards discovered that, 
owing to a concealed aversion, this man had often refused to use 
the opening medicines prescribed for him, and that constipation 
had consequently taken place, which at length terminated in ileus 
and enteritis. Venesection, leeches, and afterwards a blister to the 
abdomen, effervescing saline draughts, calomel with opium, and 
glysters, were now actively employed ; but, as the constipation was 
never properly subdued, the relief afforded was merely partial. 
Hiccup supervened. On the 26th, the vomiting became stercorace- 
ous. During the efforts to vomit, the sound of the heart was aug- 
mented. The belly was hard and tumid, the tongue swollen, with 
a yellow crust in the middle, and red edges. He had much thirst, 
some delirium, and little sleep, except what was procured by nar- 
cotics. On the 1st of March the musical tone of the heart was still 
audible, and follow’ed by a second and feebler sound in the direction 
of the left auricle. The radial pulse was full and strong, and there 
was a sense of constriction and debility in the upper part of the 
chest. On the 2d of March, about eleven in the forenoon, being 
the twelfth day of the abdominal inflammation, and about six months 
and a half from the commencement of my attendance, he quietly 
expired. 
“ On inspecting the body twenty-four hours after death, the fol- 
lowing appearances were observed :— 
“ Thorax.—The heart exceeded in bulk two fists of the subject; 
and, w’hen removed from the body, a large well-defined cavity was 
left between the opposite lungs. The pericardium was healthy, 
and contained a little colourless serum. The heart enclosed much 
blood on both sides, partly in the state of soft deep-red coagulum, 
partly in that of pale or yellowish semitransparent polypoid masses, 
but chiefly liquid. The right auricle was much dilated and dis- 
tended. Its musculi pectinati were extensive but slender. The 
right ventricle was narrow and moderately thick; the pulmonary 
artery large and thin. The left auricle was less dilated than the 
right. In both, the auriculae proprice were deep, but not strong. 
The left ventricle was dilated and hypertrophied. Its walls were 
of a bright and healthy aspect, and at least an inch thick. The 
cardiac valves were sound. The mitral was large and deep, and 
its carniae colutnnas were very strong. The aorta was to twice 
the usual size, if not more, moderately thick, of a yellowish colour, 
and deficient in elasticity, but neither scabrous nor ossified. Ex- 
ternally, at its root, was a dense network of injected vasa vasorum ; 
internally, a few opaque patches, which wrere scarcely prominent, 
but one of them encroached a little on the orifice of the right coronary 
artery. A similar morbid state, but gradually decreasing in degree, 
pervaded the whole thoracic aorta, which also contained a long 
rope of firm red coagulum. All the other vascular trunks were, 
likewise, distended with blood, and the coronary vessels were much 
injected, particularly the minute arteries. The arterial valves were 
thin but perfect. Those of the aorta had grow’n with the artery 
itself to a proportional size. 84 
BURNE ON HABITUAL CONSTIPATION. 
“ Abdomen.—The peritoneal sac was free from liquid. The 
omentum was destitute of fat, smoothly spread over the intestines, 
and attached at its lowest end to the mesentery by a bridle of ad- 
hesion. The parietal peritoneum showed no signs of inflammation, 
but the small intestines were inflamed, from the pylorus to the be- 
ginning of the ileum, being plump, inflated, and of a dull brick-red 
colour, with long ribbon-like streaks, probably produced by their 
partial contact. The omentum was voluminous and thin; but on 
section, discharged a large quantity of opaque yellow liquid. A 
similar liquid, but less abundant, was found in the inflamed intes- 
tines. The stomach was large and rather thin, without rugae or 
vascularity. The cardiac orifice was natural, the pyloric rather 
hard and contracted. The ileum was pale, empty, and small; the 
inflammation having been strictly confined to the duodenum and 
jejunum. The more immediate seat of this inflammation seemed to 
have been the middle coat, neither the peritoneal nor the mucous 
showing much redness. With the exception of a single ossified 
gland, attached to the ileum, the mesentery and its glands were 
sound. 
“ The caecum was distended by a large oblong ball of very hard, 
but otherwise natural feces, on which the intestine had contracted, 
so as to produce various bulgings and indentations. Hence, in bulk 
and general form, the ball resembled an overgrown potato, in sur- 
face a mulberry calculus on a large scale. The appendix vermi- 
formis was long, narrow, and pervious. The colon, which was 
pale and contracted, contained slender pieces of hardened feces. 
Its lower end and the rectum were wider. 
“ Remarks.—In this, as in some other cases, constipation was 
insidious and unsuspected, having been occasioned by the secret 
repugnance of the patient to take the aperient medicines prescribed 
for him, a repugnance probably suggested by the ill effects which 
he had endured from over-purging many years before. Among the 
remarkable circumstances of the case may be mentioned,—the 
limited extent of the obstruction, confined to a single large ball of 
indurated feces;—its peculiar situation in the ca3cum, where it did 
not absolutely close the passage; and its partial influence on the 
jejunum, duodenum, and omentum, which were actively inflamed, 
while the ileum and colon, although much nearer to the source of 
irritation, as well as the parietal peritoneum, were unaffected. The 
unusual length and permeability of the appendix vermiformis, con- 
sidered in conjunction with the fecal accumulation in its vicinity, 
may serve to show that the function ascribed to it by some authors, 
of preventing constipation by furnishing a large supply of lubricating 
mucus, is somewhat problematical. Had the nature of the case 
been ascertained during life at a period sufficiently early, the re- 
peated exhibition of emollient glysters, in the manner recommended 
by Dr. O’Beirne, would apparently have been the best, if not the 
only remedy.” CONSEQUENCES OF HABITUAL CONSTIPATION. 
85 
Case XLVII. —Diabetes. Death accelerated by an accumulation of feces in 
the colon. 
“ On the 17th of February, 1835, Isabella Heffer, about 33 years 
of age, was placed under my care. For a year or longer she has 
been labouring under diabetes, but moro decidedly since the last six 
or seven months. Her principal present symptoms are, an excessive 
secretion of saccharine urine, costiveness, sometimes for several 
days, with hard, dark-coloured motions, deficient perspiration, a 
harsh dry skin, great thirst, and a gradual reduction of flesh and 
strength. She has some redness of face and eyes, and occasionally 
pain in the forehead, but not much in the loins. Her pulse is weak 
and frequent, her tongue red at the edges, dry, rough, and brown 
in the middle. Her breath has a sour smell. She has a strong 
appetite, and takes much food. Her sleep is disturbed by dreams, 
and frequent calls to make water, and her legs are often affected 
with cramps during the night. 
“Mild opening medicine, consisting chiefly of the sulphate and 
carbonate of soda, having been administered, her bowels were much 
relaxed, but without pain. The first motions were scybalous, the 
subsequent ones liquid, dark-coloured, and offensive. Stronger 
medicine produced similar effects ; but, without aperients of some 
kind, the bowels became confined, and the motions hard. The 
urine was usually pale and sweet, and its daily amount from six to 
twelve pints. Having on one occasion been examined by Dr. 
Burne, its specific gravity was found to be 1032, and, on evapora- 
tion, a pint yielded eight or nine drachms of saccharine extract. 
“ Eighteen days after the first report, she had the misfortune to 
be knocked down and run over by a butcher’s cart, by which her 
left arm and knee were much bruised, and her whole system received 
a severe shock, producing nervousness, debility, and soreness in the 
upper part of the abdomen, and apparently accelerating her death ; 
which took place rather unexpectedly eleven days afterwards. 
“ Her death was more immediately induced by a sort of choler- 
oidal attack, founded on a very constipated state of bowels, which 
had seemingly been induced by a long course of over-eating, and 
neglect of aperient medicine, and had not been sufficiently noticed, 
or suspected. This attack occupied four days. During the two 
first of them she repeatedly vomited a sour, fetid, dark-colourea 
liquid, and had pains in the loins, limbs, and lower part of the belly 
During the two last she had no vomiting, but sank into somnolency, 
and finally into stupor and insensibility. 
“ An inspection took place forty-eight hours after death, with the 
following results:— 
“ Abdomen.—The belly was much distended by inflated bowels, 
which on the division of the peritoneum were ready to burst forth. 
There was no liquid in the peritoneal sac. The colon seemed to be 
elongated and displaced, as is usual when it is the seat of mecha- 
nical obstruction. The transverse arch was drawn upwards, carry- 
ing the omentum with it. The sigmoid flexure was long, and the 86 
BURNE ON HABITUAL CONSTIPATION. 
longitudinal bands were somewhat dilated. The whole colon was 
much distended, containing a large quantity of hardened, but other- 
wise healthy feces, partly in detached balls, with intervening por- 
tions of gas, partly in more continuous masses, especially at the 
lower end, and in the rectum, which was so much loaded, that the 
superincumbent uterus had in consequence become compressed and 
indented. The small intestines were plump and full, containing 
some liquid and more gas, and the lower end of the ileum, solid 
feces. The upper end of the alimentary canal, from the jejunum 
to the oesophagus, was lined internally with a dark green, and semi- 
feculent pulp. The mucous membrane seemed to be somewhat 
congested, but all the intestinal coats were thin and soft, without 
inflammation or ulceration; and the mesentery, with its glands, was 
nearly sound. 
“ The kidneys were of full size, rather firm, and exhaled a pecu- 
liar odour, having somewhat the character of caromel or burnt 
sugar. The cortical substance was of a pink red, and the mammil- 
lary processes, which were remarkably prominent, were of a deep 
purplish colour. 
“ Remark.—In this case, whatever may have been the influence 
of the original diabetes, the fatal termination was evidently accele- 
rated by the effects of great and unsuspected constipation, aided by 
the shock arising from a serious accident.” 
Case XLVIII.—Visceral Disease. Dropsy. Ileus from feculent masses accu- 
mulated insidiously in the large intestine. 
“ Christopher Willoughby, a tall well-made man, aged 63 years, 
came under my care, February 7, 1833. During the last three 
years he has had a chronic pectoral complaint, especially in winter. 
For some months past a degree of dropsy has supervened. 
“The sequel of this case did not materially differ from that of 
similar cases of chronic visceral inflammation attended with dropsy. 
Incurable, but admitting of palliation, it ran on with slight varia- 
tion of symptoms for somewhat more than five months, when it 
was terminated rather abruptly by a fatal attack of ileus, the result 
of unexpected constipation, originating probably in organic changes. 
The state of the bowels was at different times relaxed, or confined, 
and the motions either dark-colored, or pale, with occasional pain, 
or flatulence. 
“ At length, on the evening of July 6th, after constipation for 
two days, he was attacked with sickness, and in the course of that 
and the following day vomited between five and six pints of a 
blackish curdled liquid, accompanied with a burning pain in the pit 
of the stomach, and right hypochondrium, and occasional hiccup, 
but the belly bore pressure well. He was at the same time faint 
and languid, and seemed to expect death. His pulse wTas weak 
and frequent, his tongue white, and afterwards yellow in the mid- 
dle, with red edges, slightly inflamed gums, and thirst. The swell- 
ing of the abdomen was diminished, and the legs were even slender. CONSEQUENCES OF HABITUAL CONSTIPATION. 
87 
“ A blister was applied to the pit of the stomach, and aperient 
medicine of different kinds, with composing pills, and effervescing 
saline draughts, were administered without benefit. The bowels 
were scarcely opened by ordinary glysters, and one or two of 
tobacco infusion immediately returned without effect. A small 
quantity of scybalous matter was discharged. Several pints of 
thin dark-coloured bitter liquid, ultimately of a stercoraceous cha- 
racter, were vomited, and between whiles flowed without effort 
from the corners of the mouth. He died slowly on the evening of 
the 12th of July, after a gradual and progressive extinction of 
sensibilitv, with slight delirium. 
“ On inspection forty-eight hours after death, the following ap- 
pearances were observed:— 
11 Abdomen.—On dividing the linea alba, the omentum and trans- 
verse arch of the colon were found rather extensively adhering to 
the parietes, at and near the epigastrium. The peritoneum lining 
the abdominal muscles, was of a dark venous colour, and almost 
everywhere coated with a transparent film or false membrane, like 
gold-beater’s skin, which could be peeled off in a broad sheet. The 
peritoneal sac contained a gallon or more of serous liquid, which 
at the lower part was transparent and of a deep colour, like brandy, 
with a few albuminous flakes: but at the upper part was more 
opaque and yellow, as if mixed with bile. Yet, as the gall-bladder, 
which was small and thickened, contained little bile, and the ad- 
jacent surfaces were not tinged, the source of this colour, unless 
derived from the blood, was not obvious. 
“The omentum, which had a granular aspect, was retracted 
under the left extremity of the stomach, and was attached to the 
opposite parietes by a sheet of false membrane extending from its 
lower edge. The intestines presented a confused and irregular 
appearance, owing to adhesions and the loaded state of the colon 
noticed below. The oesophagus was large and full of feculent liquid ; 
the stomach of good size, its lining membrane of a dark colour, but 
sound, and the pylorus narrow and rigid, so as scarcely to admit 
the point of the fore-finger. The small intestines generally were 
plump and livid from venous congestion, one particular part being 
nearly of the colour of Prussian blue. The duodenum was small, 
thin, and soft, readily tearing on any attempt to disentangle it. 
“ The large intestine was universally bound down by adhesions 
to the stomach, duodenum, liver, and adjacent parietes, and, from 
the caecum downwards, was obstructed by large balls of hardened 
feces, with intervening contractions. The liver was of full size, and 
attached by numerous adhesions to the diaphragm, duodenum, colon, 
and abdominal parietes. Its external surface was natural, its sub- 
stance uniformly firm and fleshy, and of a deep pink colour, without 
mottling or deposit of any kind. Owing to its density, it presented 
considerable resistance to the scalpel, and when cut yielded a crisp 
sound, which could be heard at the distance of several feet. 
“ Remark.—In this case, the constipation, which came on insi- 88 
BURNE ON HABITUAL CONSTIPATION. 
diously and without suspicion, was doubtless promoted and increased 
by the numerous and firm adhesions, the result of long-continued 
chronic inflammation, by which the colon was closely attached to 
all the neighbouring parts, and its peristaltic motion proportionally 
impeded.” 
Case XLIX.—Obstruction and acute inflammation from feces, accumulated and 
impacted in the sigmoid flexure. Maniacal delirium. Recovery. 
On ihe 3d of November, 1838, I was called to Chelsea, in consul- 
tation with Mr. Barnes, on the case of a young female, about 17 
years of age, labouring under obstruction of the bowels, which had 
persisted many days. 
She was suffering from pain and great tenderness in the left ilio- 
inguinal region, where could be distinguished a circumscribed un- 
yielding tumour of considerable size. The rest of the abdomen was 
full and flatulent, but not painful nor very tender. She had vomited, 
had high fever, flushed face, frequent pulse, and foul tongue. She 
was maniacally delirious; viz: wide awake, talking incoherently, 
first on one subject, then on another, good-tempered, however, and 
smiling; at times excited ; and she did not sleep. 
I was informed that she was of a most costive habit, never having 
a dejection without strong medicine. It was therefore concluded 
that the tumour consisted of feculent matter impacted in the sigmoid 
flexure of the colon, and that the gastric and cerebral symptoms 
were sympathetic of the obstruction. She had been bled, and had 
taken the strongest purgatives without avail. It was therefore now 
decided to desist from violent measures, and to adopt a mild treat- 
ment of calomel, saline effervescing aperients, and injections. 
The injections would not pass beyond a certain point, but being 
persevered in, together with the other remedies, feculent matter be- 
gan to come away, and in the course of three days the whole of the 
tumour was removed. The action of the bowels being restored, not 
only did the abdominal but all the cerebral symptoms subside, and 
convalescence was soon established. 
The peculiar character of the delirium in the preceding case is 
worthy of remark, as it forms by no means a solitary instance of 
cerebral excitement and disorder of the manifestations of the mind 
as a consequence sympathetic of habitual constipation, and of accu- 
mulation of feces in the large intestine. I have under care, at the 
present time, a very severe case of a similar description in an inte- 
resting young lady, age 19, whose bowels have been habitually and 
obstinately confined, and in whom no other remote cause than ha- 
bitual obstinate constipation can be traced. 
The history of many of the cases in the present work details cere- 
bral and nervous symptoms of great severity as ordinary conse- 
quences of habitual constipation, viz., violent, and often distracting 
pains in the head with determination of blood, causing heaviness, 
giddiness, apoplexy: or low spirits, hypochondriasis, maniacal deli- 
rium, and mental alienation. CONSEQUENCES OF HABITUAL CONSTIPATION. 
89 
Mr. Annesley, in his great, work on the Diseases of India,* relates 
several cases of “ Hypochondriasis,” “ Melancholia,” “ Mental Ex- 
citement,” “Alienation,” and “Mania,” as connected with accu- 
mulations of morbid matters in the bowels, all of which recovered 
under “a most active and uninterrupted course of purgative medi- 
cines, in conjunction with other means.” 
M. Esquirol, in an able article on Melancholia,f states that of 
168 cases the colon was variously displaced in 33, and that con- 
stipation existed, which he viewed as the effect of the displacement. 
But I should coincide with Mr. Annesley in regarding these dis- 
placements as probable consequences of the accumulation of fecu- 
lent matter in the colon: the weight causing the meso-colon to 
elongate, and to favour displacement. 
Whatever may be the relation between habitual constipation and 
diseases of the brain and 7nind, the subject is of the first import- 
ance, and hitherto but little inquired into. It offers an extensive 
field, rich but uncultivated, ready to yield an abundant return to 
the industrious labourer. Opportunities for observation and in- 
quiry cannot be wanting where such splendid institutions as Beth- 
lem, St. Luke’s and other public hospitals and asylums, exist for 
the treatment and safe abode of the disordered in mind. It only 
requires that the opportunities should be appreciated by those who 
enjoy them, and then the so-called “ diseases of the mind” would 
soon be as well understood as the other departments of medical 
science: whereas, at present they are overspread with an utter 
darkness. J 
In another case of obstruction which I attended with Mr. Heath, 
ten days elapsed before the bowels could be brought to act, during 
which period the vomiting was very urgent, and the matter ejected 
stercoraceous, constituting a most severe case of ileus. The vital 
powers were so depressed that life was despaired of; scarcely a 
pulse could be felt for two or three days, and the skin, though not 
* Yol. ii. p. 117, et seq. 
f Diet, des Sciences Medicates, tome xxxii. p. 171, 172. 
£ It is a natural feeling on the part of the governors of lunatic hospitals, that 
the objects of their benevolence should be secured from the gaze of the curious, 
and that the admittance of the public should be most restricted and difficult: but 
as this is observed towards the medical profession, as well as towards the pub- 
lic, it closes the door against the advancement of science. From the lunatic 
hospitals no reports of cases, no details of dissections proceed; and the medical 
profession, though daily called upon for their aid and advice in the treatment of 
insanity, have not the means of gaining the information necessary to qualify 
them for the task. How much then must the public suffer! This consideration 
will, it may be hoped, suggest to the governors of these institutions the benefit 
they might confer on the public, and on the unfortunate objects of their care, by 
permitting medical men and medical students to frequent the wards of their 
lunatic hospitals, under proper regulations, as they do the wards of the general 
hospitals of the kingdom, and by establishing within the walls of their institu- 
tions courses of lectures on the Anatomy, Physiology, and Pathology of the 
Brain ; on Psychology ; and on the Treatment of the Insane. The day, I trust, 
and have reason to believe, is not far distant when these great objects of science 
and of public welfare will be attained. 90 
BURNE ON HABITUAL CONSTIPATION. 
absolutely clammy, was much below the natural temperature. In 
this, as in the case preceding, very strong purgatives had failed, 
and the bowels eventually acted by persevering in a calomel and 
saline aperient treatment. 
Case L.—Oolonitis or acute Inflammation of the colon with ulceration. Dis- 
placement of the colon. Habitual constipation. 
Rebecca Buchanan, age 23, was received into Westminster Hos- 
pital on the 25th of October, 183!). 
She had been delivered on the 7th of October, and went on well 
till the 11th, when she was seized wilh cold chills, pain in the 
abdomen, a sense of bearing down, and urgent tenesmus. The 
bowels were confined. Next day, the second of her illness, she 
began to vomit, the abdomen swelled, fever supervened, and deli- 
rium. On the third day she was bled ; on the 4th, the bowels began 
to be acted upon by medicine, and afterwards they continued re- 
laxed till her death. Every evacuation was preceded by violent 
dysenteric pain, which made her scream out. The tenesmus re- 
mained constant. The dejections were very black, like blood and 
matter mixed, and of a bad odour. The swelling of the abdomen 
arose from flatus, and was removed by the use of injections. She 
had taken a variety of medicines. 
On her admission into the hospital on the 15th day of her illness, 
she was in a very exhausted state, suffering much in the abdomen 
from tenderness, frequent dejections, dysenteric pains, and an ady- 
namic character of fever. The vomiting had abated. In the 
course of 5 days she sunk and died, having lived 20 days from the 
attack. 
From her mother-in-law I have learned that she was always of 
a most constipated habit, and had long suffered from and com- 
plained to her of pain and tenderness on the right side of the ab- 
domen, in the course of the ascending colon. 
Necrotomy 17 hours after death.—The abdomen having been 
laid open, the colon was seen to be displaced, as if doubled upon 
itself, the arch being reversed and hanging towards the pelvis like 
a festoon, so that its convexity looked downward and reached near 
to the pubis. In this position, the right and left posterior surfaces 
of the reversed arch or festoon lay upon and were adherent to 
the anterior surfaces of the ascending and descending colon. The 
left border and inferior portion of the omentum was adherent also 
to the descending colon, sigmoid flexure, and corresponding pa- 
rietes of the abdomen. In detaching the omentum from its adhe- 
sions, it was found that the colon lacerated most readily in several 
places. 
The internal surface of the arch and of part of the descending 
colon were lined by a thick tenacious elastic matter of a deep soot- 
black colour one and two lines in thickness, which adhered so 
firmly to the mucous membrane that, in attempting to detach it, 
the mucous membrane peeled off with it. The mucous membrane CONSEQUENCES OF HABITUAL CONSTIPATION. 
91 
itself was excessively softened, and although it adhered inti- 
mately to the black adventitious matter, yet it separated and peeled 
off from the other tissues of the colon most readily and distinctly. 
The interior surface of the caecum, ascending colon, and sigmoid 
flexure, were nearly free from this black matter, but the mucous 
membrane of these parts was also soft and lacerable, was studded 
with superficial ulcerations, or covered with a shreddy, whitish, 
tenacious fibrin. 
As well as the mucous, the other tissues of the colon were soft 
and lacerable. The colon contained a fluid of the same melanotic 
description as that voided during life. The other viscera normal. 
Remarks.—Allowing for the difference of intensity in disease in 
this and in hot climates, the above case presents an example of 
acute dysentery, viz. inflammation of the colon, corresponding 
in every particular with many of the eases related by Mr. An- 
nesley. 
The organic changes of softening and ulceration of the tissues 
of the colon were more general and in a greater degree than I re- 
member to have seen on any previous occasion, and may be con- 
sidered of rare occurrence in this climate. The pain in the region 
of the ascending colon, of which the patient had long complained, 
gives reason to believe that this gut was in an unsound condition 
prior to the fatal attack, which prior aflection of the colon, as 
also the acute dysentery, may be ascribed, the one immediately, 
the other remotely, to the irritation of the feculent matter retained 
by the constipation habitual to this patient. 
On two other occasions, I have met with acute inflammation of 
the colon, the signs of which were more or less obscure: the ob- 
scurity attributable to the fact, that our knowledge of the pathology 
of the colon is less advanced than that of the other portions of the 
alimentary canal. 
The displacement of the colon is a point of interest as connected 
with the habitual constipation, it being far from improbable that 
the weight of feces accumulated may gradually have produced 
elongation of the meso-colon, and brought about this change of 
position. In India, irregular flexures, displacements, and elonga- 
tions of the colon, were met with very frequently by Mr. Annesley, 
and attributed by him to the influence of accumulations of feculent 
matter, and to the greater laxity of tissues in hot climates.* 
Examples of the anormal position of the colon have been lately 
published by Dr. Buchanan: f and they no doubt are of frequent 
occurrence. Various instances are recorded by Morgagni: and I 
have myself seen several. 
Case LI.—Stricture of the colon. Communication between the ileon and the 
colon below the stricture. 
(Communicated by the late Mr. Jukes.) 
“ Mrs. H , age 63, the mother of six children, had been trou- 
* Diseases of India, vol. ii. p. 89. 
f London Medical Gazette for July 27, 1839. 92 
BURNE ON HABITUAL CONSTIPATION. 
bled with obstinate bowels the greater part of her life ; but for some 
time before I saw her in April 1796, the difficulty of getting stools 
had increased and occasioned fits of pain, which were seldom re- 
lieved till evacuation had been procured. 
“ Latterly, the usual measures had failed altogether; the belly wras 
become tumid and the colon was evidently loaded. Aperients and 
enemas brought but an inconsiderable quantity of matter from the 
bowels, for which reason they were persevered in ; and, as the bowels 
became unloaded, considerable relief was obtained, and I discon- 
tinued my attendance on the oth of June. From this time to the 
beginning of October I conclude she wrent on pretty well, as there 
is no note of my having seen her in July, August, or September. In 
October she was bled once generally, and several times locally, the 
belly being tympanitic, her sufferings very great, and no relief ob- 
tained by the warm bath or enemas. 
“ About the middle of November clammy sweats came on, the 
pulse was scarcely distinguishable, and dissolution was hourly ex- 
pected, when a purging unexpectedly took place, and every symp- 
tom of immediate danger subsided. She lived on in comparative 
ease till the end of January 1797, when she expired. 
“ On opening the cavity of the abdomen, the marks of inflamma- 
tion were so general, and the contents so firmly united, as to pro- 
duce considerable difficultv in tracing out the exact nature of the 
change. Several inches of the colon about its sigmoid flexure were 
contracted, thickened, and all but impervious to the passage of a 
probe: the contracted part was almost of a cartilaginous hardness, 
and ulceration had commenced. The lower portion of the ileon was 
united to the colon immediately below the stricture, and life preserved 
for the last few months, by the communication which had thus taken 
place between them.” 
Allied to the foregoing case of communication between the ileon 
and colon, 1 have, on dissection, met with several instances of ob- 
struction from organic disease, in which the process of communi- 
cation between the bowel above the point of obstruction and the gut 
below has been commenced, but death had ensued before it was 
completed. 
In a case of obstruction from disease of the emoum, the sigmoid 
flexure of the colon stretched over to the right side and had con- 
tracted an adhesion with the ileon near the caecum, the ileon being 
enormously distended with feculent matter. Had life been prolonged 
but a short time, a communication would have been effected, and 
the channel of the bowel restored. This and many other examples 
in which the sigmoid flexure of the colon has been found stretching 
across the lower regions of the abdomen, have led me to conjecture 
that one use of the loose and tortuous sigmoid flexure may be to 
provide the means of communication, and so to restore the channel 
of the bowel when an obstruction has taken place, which, without 
this resource, would inevitably and quickly prove fatal. CONSEQUENCES OF HABITUAL CONSTIPATION. 
93 
Hypertrophy and induration of the submucous tissue of the colon 
are consequences of habitual constipation, more frequent than stric- 
ture,—extend through a part or the whole of this bowel, and render 
it less dilatable and less capacious than natural. 
The submucous tissue in these instances is white, very coarse in 
its reticular texture, often a line or more in thickness, very inelastic, 
and unyielding. The gut is contracted wherever its parieties are 
thus thickened, and the canal consequently materially and perma- 
mently diminished, for it is altogether undilatable by either gas or 
feces. The mucous membrane is swollen, vascular, its free surface 
less smooth than natural, as it were coarsely villous, and having a 
resemblance to flock paper. 
These changes are the result of irritation and sub-acute patholo- 
gical congestion, excited by retained excrementitious matter in 
persons habitually constipated. 
CHAPTER VIII. 
OF DISEASES OF THE RECTUM AS CONSEQUENCES OF HABITUAL 
CONSTIPATION. 
Impaction of feces in the rectum. Dilatation of the rectum. Prolapsus ani. 
Piles. Fissures. Fistula. Rigidity of the sphincter ani. Stricture. Supposed 
stricture. 
The accumulation and impaction of feces may take place in the 
rectum, dilating it excessively and straining the muscular fibres of 
the bowel so that they lose their power of expulsion. In this man- 
ner the whole pelvis may be filled by a dilated loaded rectum. This 
residual matter, accumulated in such quantity, acts soon as a 
foreign body, the organic sensibility of the rectum not being adapted 
to its continued presence. Irritation is the result, then diarrhoea, 
tenesmus, a sense of bearing down, difficult micturition, and at times 
absolute retention of urine. 
Hardened feces, thus collected, cannot be expelled without artifi- 
cial aid : yet, as is justly remarked by Mr. Chevalier,* that which 
is softer may pass over this impacted mass in daily evacuations, 
and thus conceal the real mischief. In other instances these accu- 
mulations in the rectum will so entirely obstruct the action of the 
bowels as to induce symptoms resembling hernia. 
The diarrhoea which frequently attends and obscures an accumu- 
lation of feces in the rectum has been commented upon, in a very 
lucid manner, by Dr. John Warren of Taunton, the first person 
* See Observations on the Relaxed Rectum : by Thomas Chevalier, Esq., 
F.R.S. Medical and Chirurgical Transactions, vol. x. p. 400. 94 
BURNE ON HABITUAL CONSTIPATION. 
who appears to have discovered and thoroughly understood this 
cause of enteritic obstruction. His diagnosis of impaction, and of 
the diarrhoea resulting from it, is so clear and practical, that I must 
follow the example of Dr. O’Beirne, and quote in his own words. 
“ That this disease (says Dr. J. Warren) may, in future, be more 
easily distinguished from diarrhoea, which is so opposite to it in its 
nature, and with which it is so apt to be confounded, it may not be 
improper to remark, that in each of these cases above narrated, as 
well as in every other which I have seen of this disorder, the pain 
is principally seated in the lower part of the abdomen, and is always 
accompanied with a tenesmus, or a sense of bearing down, which 
is never attendant on a simple diarrhoea ; that the motions are at all 
times inconsiderable, and in general mixed with small scybala ; and 
that it is a disease which does not yield to any remedy administered 
under the supposition of its being only a purging. It is likewise 
worthy of notice, as a further diagnostic, that the pains attending it 
are infinitely more acute than any ever experienced in a diarrhoea. 
I must also add that it is a disorder peculiar to persons in advanced 
life (pregnant women excepted), as I have never met with an in- 
stance of it in patients of any age under sixty. I have, moreover, 
observed, that the female sex are more obnoxious to it than the 
male.”* 
Prolapsus ani is a very common and distressing consequence of 
habitual constipation, and arises, in great measure, from ineffectual 
efforts at the closet. So also does one kind of piles.f 
The rectum, from habitual neglect of the calls of nature, loses its 
tone and sensibility, and the presence of feculent matter no longer 
stimulates to exoneration: while the sense of uneasiness, the absence 
of evacuations, and an indistinct desire, causes the individual to 
strive to accomplish that, by means of the abdominal muscles, which 
is the proper office of the bowel. The pressure by the muscles of 
the abdomon, unassisted by the rectum, forces down the bowel 
without expelling its contents, a small sc.ybal only being the result 
of all the endeavours. The consequence is, that a portion of the 
mucous membrane is forced below the sphincter, is pinched and 
retained by it: and the same thing occurring, time after time, piles 
are in this way formed. 
Similar efforts will sometimes cause an entire portion of the bowel 
to protrude beyond the sphincter ; and, constipation continuing, and 
the same efforts being repeated, a confirmed prolapsus is the final 
result. The cause which produced, prolongs it; and it is in vain 
to attempt the cure of a prolapsus, produced in this manner, without 
at the same time regulating the action of the large intestine, and 
thus obviating the cause. 
Fissures, likewise, are apt to arise under the same circumstances, 
the hard scybalous feces, being forced through the sphincter by the 
* Duncan’s Medical Commentaries, vol. x. p. 260. 
f See the Cyclopaedia of Practical Medicine, vol. iv. p. 591, article Hae- 
morrhoids : by the Author. CONSEQUENCES OF HABITUAL CONSTIPATION. 
95 
efforts of the abdominal muscles, irritate and lacerate the mucous 
membrane : and the heat and irritation about the rectum consequent 
on habitual constipation contribute not only to produce, but to pro- 
long, these annoying complaints. 
The same' irritation, from the same cause, will often induce 
abcess and fistula: but it is not my purpose to enter at length into 
the subjects of this chapter, seeing that they belong particularly to 
the department of surgery. My principal aim is to show that 
habitual constipation is one of the most frequent causes of these 
distressing complaints; and, therefore, that strict attention to the 
daily evacuation of the bowels, by appropriate laxatives, is requsite, 
not as a preventive only, but as a part of the treatment necessary 
to the cure. 
One remark further I may venture upon. It is, that the severe, 
even alarming, hcemorrhage, which not uncommonly follows opera- 
tions for fistula, arises from the anormal vascularity of the rectum 
and pelvic viscera, the consequence of the irritation which always 
ensues from habitual constipation. For this reason I would urge 
the propriety of delaying the operation of fistula till the bowels have 
been regulated for some weeks, and the irritability and vascularity 
of the parts, by this means, diminished. 
Case LII.—Feces impacted in the rectum, with purging and violent tenesmus. 
(Communicated by the late Mi*. Jukes.) 
“ Mrs. W. had for years suffered from constipated bowels 
brought on, as she believes, by neglecting the calls of nature. Days 
would pass away without any proper evacuation. When I saw 
her, a contrary state of bowels had taken place, she being now 
much harassed by purging, which had existed more or less for 
many months. She had been in London on account, of the bad 
state of health of a son who resided there, and took the advice of 
an eminent and experienced physician : and the purging was not 
only diminished but restrained for a time by the measures he 
recommended. 
“ She returned home, and soon afterwards had a recurrence of 
the complaint; which did not again yield to the measures which 
had given her much relief in town. In this state I saw her, and 
heard the history of her disorder, which induced me to think this 
relaxed state of bowels might be kept up by the retention of im- 
proper matter; which, however, she conceived impossible, and 
submitted unwillingly to the use of aperients and injections; and 
as no speedy relief was obtained by them, she was the more con- 
firmed in her own opinion. Violent tenesmus, however, came on, 
with a bearing down most intolerable; much worse, she said, than 
she had ever experienced in any of her confinements. I examined 
the rectum and found a mass of hard matter which I could not 
break to pieces without the aid of an instrument. The mass con- 
sisted of a variety of undigested substances, which, when broken 96 
BURNE ON HABITUAL CONSTIPATION. 
down, were washed away by injections, to the perfect relief of the 
patient. 
“ The general health had been greatly impaired by the long con- 
tinued irritation produced in the stomach and bowels by the 
retention of this matter; but mild aperients, conjoined with bitters, 
very soon restored her to a good state of health. 
Case LIII.—Feces impacted in the rectum, with purging and vomiting. 
(Communicated by the late Mr. Jukes.) 
“ Mrs. Jones, about 52 years of age, a nervous, irritable woman, 
with torpid bowels requiring attention, was seized with sickness, 
vomiting, and purging, which continued for some days. She then 
had vain efforts to relieve the bowels, with a violent bearing down; 
and believing there was something to pass away, she had recourse 
to clysters; but without any relief. In this state I saw her; and, 
on examination, found a hard lump of matter in the rectum ; which, 
having been broken to pieces and washed away, all the symptoms 
disappeared. 
Case LIV.—Dilatation of the rectum from accumulation of soft feculent mat- 
ter. Supposed stricture. Wax candle used as a bougie slipped into the rec- 
tum. Nervous symptoms. 
(Communicated by the late Mr. Jukes.) 
“ Mrs. B., aged 67, has for years laboured under a highly dis- 
ordered state of the digestive organs, and, from the small and un- 
satisfactory nature of the evacuations, her medical attendant was 
induced to believe there was a stricture in the rectum, and a bougie 
was introduced with a confirmation on his mind of the correctness 
of that opinion. She had directions to use the bougie when neces- 
sary at her own discretion. Being from home, and without the 
bougie, she substituted, at bedtime, about six inches of wax candle, 
which, in the course of the night, slipped into the rectum. Some 
relief was obtained the next day, and nothing more was thought of 
the candle. 
“ Within a week I was requested to visit her, she was sick and 
vomiting, and had a great sense of bearing down, which her usual 
measures had failed to relieve. The above history was then given, 
and on examining the rectum, the sphincter was rigidly contracted, 
and the gut itself greatly distended with fecal matter by no means 
hard or resisting. In this mass was the candle, broken into two 
pieces, held together by the wick; this, with a large quantity of 
feculent matter, was removed from the rectum, which I found 
greatly distended. Of course she had no stricture. 
“ This lady, who had been troubled for years with almost every 
nervous symptom which a morbid state of the digestive organs is 
capable of producing, has enjoyed a good state of health since daily 
attention has been paid to the unloading of the colon and rectum.’, CONSEQUENCES OF HABITUAL CONSTIPATION. 
97 
Case LY.—Feces impacted in the rectum producing symptoms of strangulated 
hernia. 
“ Mr. Callaway (to whom I am indebted for this case) was 
called to a lady, 64 years of age, affected with symptoms of stran- 
gulated hernia; namely, vomiting, constipation, tumid and tender 
abdomen, and anxious countenance. He could not detect any 
tumour in the usual situations for hernial protrusion; and being in- 
formed that the constipation had existed eleven days, and that the 
nurse could not throw up the enemas prescribed, he was induced 
to examine the rectum, where he at once discovered a firm un- 
yielding mass, blocking up and obstructing the bowel. This mass 
was removed with great difficulty; and, on examination by a 
chemical friend, was found to be composed of soap, rhubarb, and 
cholesterine, which was explained by the fact of the old lady hav- 
ing been for a considerable time in the habit of taking, as an ape- 
rient, pills composed of soap and rhubarb. 
“ Soon after the impacted mass had been removed, the aperient 
medicines, given previously by the medical attendant, operated, to 
the entire relief of the vomiting and other symptoms.” 
Case LYI.—Feces impacted in the rectum. Dysuria. Gout. 
“ A lady, 04 years .of.age, consulted me in September, 1829, for 
an obstinate constipation of the bowels. She had been confined to 
her chamber, and partly to her bed, by a fit of the gout, with which 
she had been occasionally afflicted for some years past. For some 
days she had endured great uneasiness, and a bearing down like 
labour pains. 
“ I attempted by medicines to relieve her, without success. The 
nurse was then directed to administer an enema, which she found 
herself unable to accomplish, and I now proposed to examine the 
bowel. To this the lady strongly objected, on the grounds that 
her bowels were open; for the cathartics had caused some dark- 
coloured fluid feculent matter to pass, which had deceived the old 
lady regarding her state. 
“ An examination having, at length, been acceded to, I found the 
rectum so distended with feces as to fill the pelvis, and, by pressing 
upon the neck of the bladder, materially to impede the discharge of 
the urine. I unloaded the bowel without delay, and removed an 
amazing quantity of arid feces, to the astonishment of the attendants 
and relatives. This having been accomplished, all the disagreeable 
symptoms, together with the gout, vanished, and, by the use of 
mild aperients, she soon became convalescent.” 
(Communicated by Mr. Morgan.) 
Case LYII.—Feces impacted in the rectum. Aphthae. Erysipelas. Fatal. 
[Communicated by Mr. Morgan.] 
“ A lady of the age of 80 was brought to London from Waltham- 
stow, for the purpose of being under my care. The circumstances 98 
BURNE ON HABITUAL CONSTIPATION. 
of this case differed but little from the preceding, except that the 
constipation had been of longer standing, and her actual condition 
undiscovered. She had taken aperients for three months with no 
other effect than the removal of hard scybals. The nurse w7as di- 
rected to administer an enema, but, finding it impossible, I suspected 
a loaded state of the rectum, and proceeded accordingly. 
“ The accumulation, in this case, was greater than in the former, 
and more difficult to remove; the fecal matter being very arid ; it 
was, moreover, inodorous, and of light specific gravity. The old 
lady was very weak, and much depressed : the constitution had 
sympathised greatly with this local affection ; the tongue and fauces 
were aphthous: an erythematous blush showed itself about the mouth 
and nose, precursory to an extended erysipelas, which spread over 
the face and head, and extended also to the nates and neighbouring 
parts. Under these severe complaints she sunk and died in about 
ten days.” 
Case LYIII.—Feces impacted in the rectum. Retention of urine. Piles. 
[Communicated by Mr. Morgan.] 
“ A lady, 50 years of age, came to town from Sussex to consult 
the late Mr. Abernethy on account of some excrescences round the 
anus, supposed to be piles, which, in truth, they were. 
“ Disliking Mr. Abernethy, she placed herself under the care of 
another surgeon of great eminence, who proceeded to strangulate the 
piles ; ordering, at the same time, aperient medicines, which, although 
continued two or three days, produced no adequate effect. The 
surgeon was now summoned to her suddenly, on account of great 
pain and bearing down, as well as a total obstruction to her making 
water. I was sent for to draw off the urine, and, proceeding ac- 
cordingly, found the neck of the bladder so pressed upon as not to 
admit the passage of the catheter. I directly suspected the bowel 
to be the seat of mischief, but the patient being irritable and delicate, 
it was long before 1 could persuade her to allow an examination to 
be made. At length she submitted, and I removed a load of feces 
equal, nay, larger, in quantity, than in either of the two preceding 
cases. 
“ The rectum being emptied, she made water immediately, and, 
with proper attention to the alimentary canal, soon recovered.” 
Rigidity of the Sphincter Ani.—The sphincter, placed at the ex- 
tremity of the rectum, is a very powerful muscle serving to keep 
constantly closed the aperture of the gut. It yields with sympathetic 
consent to the passage of the excrementitious matter, when urged 
on by the combined action of the bowel and abdominal muscles, 
provided this action takes place once or twice daily, in accordance 
with the law of nature. But if the action of the bowel is less fre- 
quent, as from habitual constipation, then the sphincter, seldom di- 
lated by the passage of evacuations, contracts more and more, and 
.eventually becomes unyielding and rigid ; a state which offers more 
or less impediment to the action of the rectum, and encourages and 
increases the constipation. CONSEQUENCES OF HABITUAL CONSTIPATION. 
99 
This rigidity has been mistaken for stricture of the bowel, and is 
so decided in many cases, as to require special treatment by the 
bougie to overcome it; a point to which sufficient attention has not, 
I think, been generally accorded. Mr. Copeland* evidently de- 
scribes this state of rigidity, when he speaks of having frequently 
met with cases of very obstinate habitual constipation, in which 
“ the sphincture muscle was either unusually strong in its action, 
or unusually extensive and broad,” and which he treated success- 
fully by the bougie. By him it is regarded rather as a cause than 
a consequence of habitual constipation; a point on which, with 
deference to his experience, I differ from him. O’Beirnef refers 
the difficulty in these cases to the upper extremity of the rectum, 
which he considers to be in a state of stricture. 
Case LIX.—Rigidity of the sphincter ani, mistaken for stricture of the bowels. 
An unmarried lady, near 50 years of age, had long suffered 
from most obstinate habitual constipation, and its consequences, 
headach, impaired vision, flatulence, dyspepsia, and so on, for which 
she had consulted several physicians and surgeons without receiving 
much relief. Of these, a surgeon pronounced her complaint to be 
a stricture of the rectum, and treated it by the introduction of the 
bougie; during the use of which the bowels acted more regularly, 
and her complaints were mitigated; but, having discontinued this 
treatment, all the symptoms returned. 
The description of her sufferings led me to question the existence 
of a stricture; on which the lady replied, there could be no doubt 
of it, for it had produced a circular indentation on the bougie, 
which she herself saw. I proposed a consultation with an eminent 
accoucheur, which was acceded to. No stricture was found: 
“ What might have been,” said he, “ I know not, but there is no 
stricture now.” The sphincter, however, was firmly contracted 
and rigid ; which may have indented the bougie and confirmed the 
error. 
Case LX.—Excessive rigidity of the sphincter, particularly of its internal 
portion. Dilated rectum. Dyspepsia, &c. 
Mary Marshall, age 28, married nine years, but had not borne 
a child, complained of great difficulty in relieving the bowels; of 
an almost constant indistinct desire to retire to the closet; and of 
a forcing bearing down with a sensation of tightness and fulness 
at the anus, a burning heat, and an occasional acute lancinating 
pain. When she did not take aperient medicine, the dejections, 
always soft, were not only passed with great and excessive striv- 
ing, but were scanty : and although many occurred in the course 
of the day, the whole quantity was trifling and insufficient; a part 
# Observations on the Principal Diseases of the Rectum and Anus : by 
Thomas Copeland. London, 1814, p. 48, 49. 
I New Views of the Process of Defecation : by James O’Beirne, M. D., Dub- 
lin, p. 52. 100 
BURNE ON HABITUAL CONSTIPATION. 
being blood and mucus from the straining efforts. She had laboured 
under this difficulty for the last eighteen months; during the last 
twelve of which it has much increased. She had been subject to 
constipated bowels as long as she could remember; even before 
puberty days would pass without an evacuation. The dejections 
were hard, until the obstruction commenced, since which they have 
changed to the soft character described. In addition to the above 
ailments, she was troubled with sympathetic affections of the 
stomach and head, and was nervous and apprehensive. 
Prior to her entrance into Guy’s Hospital, the rectum had been 
examined and the disease pronounced to be stricture. Soon after 
her admission, she was again examined by Mr. Key. The sphincter 
was so contracted and unyielding that the investigation could be 
pursued only with gentleness and care. The mucous lining was 
corrugated into longitudinal folds, and at the circumference of the 
internal sphincter there was a resisting ring of a gristly hardness, 
exceedingly hot. The rectum above was sound but dilated. A 
bougie was introduced, and having remained in the bowel for a short 
time, the sphincter and gristly ring yielded, the mucous corruga- 
tions could be pressed smooth, and the bougie moved with freedom, 
whilst, at first, it was tightly embraced. 
Mr. Key directed that an injection of linseed oil one ounce, tinc- 
ture of opium five minims, should be administered daily, and one 
drachm of the sesquioxide of iron taken every night. 
From this plan great benefit was derived. The patient attributed 
her improvement to the injections, which tranquilized the gut, 
diminished the number of the evacuations and increased their quan- 
tity. Castor oil, taken as an aperient operated much more freely 
and copiously than formerly; to the great relief of the local symp- 
toms ; and, as these were removed, the affections of the stomach and 
head were removed also. 
Rigidity of the sphincter, as illustrated by the foregoing cases, is 
a frequent consequence of constipated bowels: and the determina- 
tion of blood to the muscle, produced by the irritation of the retained 
excrementitious matter, in the patient Mary Marshall, Case LX., 
had excited a vascular action, which threatened organic change, 
and may have led to schirrus and cancer. The effect of the bougie 
in relaxing the rigidity was very marked, and bears out the opinion 
I have advanced of the efficacy of mechanical treatment, in these 
cases, in addition to medicine. In Case LIX. where the bougie was 
employed under the impression of stricture of the bowel, relief was 
complete, the bowels becoming regular under its use ; and, had care 
been afterwards taken by the patient to promote the daily action of 
the bowels by appropriate medicine, a cure would have been 
effected. 
Case LXI.—Stricture of the rectum. Dyspepsia, and most distressing nervous 
symptoms. 
Mr. G. VV. L , a medical student in 1829, age 23, of a melan- 
cholic temperament, had been troubled with constipated bowels for CONSEQUENCES OF HABITUAL CONSTIPATION. 
101 
many years ; so obstinate, at times, that no dejection would take 
place for four or five days ; seldom without medicine, and, latterly, 
of a very powerful description, ordinary aperients seeming to act 
well till they reached the rectum, and then to lose their power. He 
was in the habit of making a great quantity of pale urine. He felt 
a constant desire to go to the closet, would go many times in the 
day ineffectually, a small lump enveloped in mucus like a skin being 
all that passed : he had pain across the loins with burning pain in 
the rectum and griping pains in the belly : felt flatus moving about, 
forming as it were lumps or swellings that would rise up in the 
abdomen and roll about distressingly. Besides these he had every 
symptom that attends dyspepsia and hypochondriasis, as acidity, 
tightness, distention, eructation after meals, palpitation, indescribable 
pains, and low spirits. 
He consulted Mr. Key and Mr. Copeland, both of whom found a 
stricture with a small ulcer an inch and a half or two inches within 
the sphincter. In addition to local treatment he was advised to try 
the following:—&. Liq. Hydrarg. Bic/tloridi. f. §i.; Tinct. Sennce 
f. oij. M.; Coch. unurn mediocre bis quotidie sumat. 
Case LXII.—Stricture of the rectum. Constipation. 
Lydia Davison, age 24, married seven years, and has had one 
child, habitually very costive, a week or more often elapsing with- 
out any evacuation, feeling nevertheless an indistinct desire, and 
making ineffectual efforts, or passing nothing more than a small 
hard scybal; after which blood would flow freely. About four 
years ago she began to experience a hot shooting pain about the 
anus, with itching and a tightness of the sphincter, accompanied 
with leucorrhoea and ardor urinae. Within the last two years, the 
alvine difficulty continuing equally great, the evacuations had 
changed from a hard scybalous to a soft character, and were more- 
over flat. She was sick and ill for a day or two from time to time, 
and suffered also from severe headach, flushings and heats in the 
face, and crampy, spasmodic, ventral pains. 
Eighteen months ago she had aphthous ulcers in the mouth, 
great heat at stomach, vast distention of the abdomen; and, during 
three weeks, had no evacuation whatever. At this time, a stricture 
of the rectum was discovered, and she was admitted into Guy’s 
Hospital. By examination, the sphincter was found to be rigid, 
the lower part of the bowel healthy ; but higher up, yet within reach 
of the finger, was a decided contraction one inch in extent, hard, 
rugous, and unyielding. She was directed to be cupped in the 
sacrum to four ounces, to have an injection every night, and to take 
the carbonate and sulphate of magnesia and tincture of senna as an 
aperient. A bougie to be introduced every day. 
From this treatment much benefit was derived, the aperient acted 
efficaciously, the sphincter lost its rigidity, and the stricture yielded 
to the bougie. 102 
BURNE ON HABITUAL CONSTIPATION. 
Case LXIII.—Annular stricture of the rectum. Enormous distention of, and 
feculent accumulation in the colon, mistaken in the early stage for pregnancy. 
(Communicated by Mr. Taunton.) 
December, 1814. A young woman, Dresdale, age 28, re- 
siding in Fetter Lane, had ascites about six years ago, from which 
she recovered perfectly. She married subsequently, and had one 
child. 
About three years ago she grew full in the abdomen, had the 
usual signs of pregnancy,—suppression of the menstrua, sickness, 
fulness of the mammas, with dark areolas,—and, supposing herself 
to ‘ be with child, engaged Mr. Bartlett to attend her. The abdo- 
men enlarged more and more until it appeared ready to burst, and 
within was often a noise from flatus which she compared to that 
caused by immersing empty bottles in water. The bowels were 
remarkably costive, an evacuation not occurring more than once 
in a month. Neither mild or powerful aperients had any effect. 
Fifteen months before her death, and after having eaten straw- 
berries, her bowels were much purged, greatly to her relief. From 
this period they could not be kept open either by medicine or other 
means. 
Necrotomy.—Upon an incision being made in the linea alba and 
a puncture in a convolution of the small intestine, both air and 
feculent matter were ejected with great force. The incision having 
been enlarged, the colon protruded, distended enormously with 
feces ; its circumference measuring twenty inches, and its capacity 
being to the extent of three gallons. The other viscera were 
normal, with the exception that they had suffered from pressure. 
The whole of the large intestine was removed and preserved by 
the late Mr. Taunton, and still forms part of the extensive and 
valuable museum prepared by the hand of that indefatigable man, 
and now in possession of his son, the present Mr. Taunton. 
The colon resembles that of a bullock rather than of a human 
subject, so vast are its dimensions. The stricture is situated at the 
termination of the sigmoid flexure in the rectum,—is annular and 
closed, exactly as if a ligature had been passed round this part of 
the gut and drawn tight; the parts both above and below being 
neither thickened nor otherwise diseased. -So completely was the 
channel of the bowel obstructed by this annular contraction that 
water would not pass either wray. 
Considering how much the rectum is exposed to the irritation 
of retained excrementitious matter, one is rather surprised that 
stricture of this gut is not a more frequent occurrence. It cer- 
tainly is far from a rare disease; but, at the same time, it is not so 
common as some are of opinion; an opinion which I have known 
carried to a most absurd extent. But the subject is not inviting, 
and I will therefore only state one instance that fell within my own 
knowledge, and allude to another that occurred in the practice of 
Dr. Roots. 
A medical practitioner, under my care for general indisposition, CONSEQUENCES OF HABITUAL CONSTIPATION. 
103 
which may not improperly be called “ a breaking up of the consti- 
tution,” from long continued sensuality, happened to dine at the 
house of a friend who had been under treatment for a stricture. 
This friend had derived so much benefit that he strongly advised 
the practitioner to consult his surgeon. He did so; and his com- 
plaints were at once pronounced to arise from a stricture. All 
this he told me when I next saw him, expressing at the same time 
his satisfaction and belief that his disease had been discovered. 
“ Well,” said I, “this I cannot understand! You have never had 
symptoms of stricture, for your bowels have acted regularly every 
day. Let the surgeon meet me at your house, and if there is stric- 
ture, it will be obvious to me as well as to him.” We did meet. 
The surgeon produced a long rectum bougie, twisted it like a cork- 
screw, and examined the rectum; but no evidence of stricture 
could he afford me. The surgeon, however, persisted in his opi- 
nion that a stricture was there; and affirmed, moreover, that he 
could distinguish the presence of a stricture ten or twelve inches 
up the gut by means of the bougie. Of this I was sceptical: and 
left the case in his hands. The bougie treatment was persevered 
in, and the patient in high spirits at the prospect of cure. 
In a few weeks I was requested to see the patient again. The 
imagined relief from the bougie had ceased with the novelty; and 
finding, in sad reality, that he grew worse instead of better, and 
remembering that he had never experienced any difficulty in the 
action of the bowels, he had now persuaded himself that he had 
not a stricture, and had, accordingly, declined any further mechani- 
cal treatment. He died, soon afterwards, of a sudden and severe 
cerebral attack; and permission having been granted to examine 
the body, I apprised the surgeon of it, and requested his assistance. 
No stricture nor trace of disease could be discovered, either in the 
rectum, colon, or intestinal canal. 
The above is not a solitary instance of persons having been 
treated for a stricture where no such affection existed. Another, 
in which the error led to fatal consequences, was witnessed by 
Dr. Roots, who has favoured me with the following particulars. 
The doctor was called, in great haste, one morning, to a gentle- 
man whom he found in a most alarming state from depression of 
the vital powers, and indescribable pain in the abdomen. The ab- 
domen was tense and tender; the pulse was scarcely perceptible: 
the skin was clammy: and the countenance anxious and haggard; 
all indicating the utmost danger. The surgeon in attendance—the 
same person as alluded to in the preceding case—reported that the 
symptoms arose from spasm, and informed the doctor that the 
patient had two strictures of the rectum, which, for some time past, 
he had been treating with the bougie;—that one had yielded;— 
that the patient having been out of town, returned last evening , 
and that he, the surgeon, endeavoured as usual, to pass the bougie, 
but could not succeed on account of a spasm of the gut;—that he 
persevered, when suddenly the patient complained of violent pain, 104 
BURNE ON HABITUAL CONSTIPATION. 
and soon afterwards became alarmingly ill;—that he had been 
with him all night and administered injections without avail; no- 
thing, except a little blood and mucus having been voided. Dr. 
Roots gave an unequivocal opinion that the symptoms arose from 
rupture of the bowel ; and that a fatal issue was at hand. 
The gentleman died in the course of the day. The body was 
examined and a lacerated perforation of the rectum discovered. 
Peritonitis has ensued, and castor oil, administered in the enemas, 
was seen in the cavity of the abdomen. There was no stricture. 
The resistance to the passage of any instrument, so generally 
met with about or ten inches up the rectum, is assigned to different 
causes. Dr. O’Beirne, in accordance with his opinion, that “the 
rectum, so far from being open, is firmly contracted and closed 
that, at its upper part, instruments pass as “if through a ring ;”f 
and that this particular part of the intestine is in a very constant 
state of excitement and spasm ;”J concludes, “ there scarcely can 
be a rational doubt, therefore, that it (the resistance) arises from a 
spasmodic state of the muscular coat of the intestine at this part;Ӥ 
while “White, Copeland, Shaw, Salmon, Calvert, Colles, agree in 
considering it to arise from the promontory or projecting ridge of 
the sacrum.”|| Dr. John Houston gives a very different explana- 
tion. He ascribes the resistance to several valvular projections of 
the lining membrane of the rectum, which form a sort of spiral 
tract down its cavity, and indicate the necessity of employing a 
spiral shaped, instead of a straight bougie.1T 
To which of these causes the resistance should be properly 
attributed, it would be out of my province to attempt to decide: but 
that there is resistance at the upper part of the rectum to the pas- 
sage of an instrument seems agreed on all sides; and O’Beirne, in 
giving instructions for the introduction of a long elastic tube as far 
as the sigmoid flexure, recommends that, “instead of yielding to it, 
the pressure upwards must be gradually increased until such time 
as the resistance is completely overcome.”** “ Ideas of pain and 
danger (he says) naturally associate themselves with any proposal 
for forcing open an imperviously contracted intestine. But long 
and extensive experience of the practice enables me to assert, that 
what the patient suffers scarcely deserves the name of pain, and 
that the danger is altogether unfounded and imaginary. Indeed, 
as to the danger of the proceeding, the only fear we can well en- 
tertain is that of bursting through the walls of the intestines; but 
if we only reflect, for a moment, on the extreme violence required 
to rupture living and healthy muscular fibre—on the great muscu- 
larity of the rectum—on the fact that the rectum closely embraces 
*New Views of the Process of Defecation, &c. By James O’Beirne, 
Dublin, 1833, p. 4. 
f Ibid., p. 7, t Ibid., p. 30. § Ibid., p. 63, note. 
|| Ibid., 58, note. If Ibid., p. 59, note. 
** New Views of the Process of Defecation, &c. By James O’Beirne. 
Dublin, 1833, p. 58. CONSEQUENCES OF HABITUAL CONSTIPATION. 
105 
the instrument, and confines its course to the cavity of the bowel; 
and then consider how ill adapted the gum elastic tube is, in every 
respect, for being directed against or for piercing the sides of the 
intestine, we shall at once see the groundless nature of all such 
fears. Besides, the proposal neither implies nor sanctions the use 
of such extreme and brute force; and it will never be found neces- 
sary in any case.”* 
To this sanguine rejection and too confident disregard of fear 
and danger in using force to overcome the resistance usually met 
with at eight or nine inches up the rectum, the case before narrated 
and witnessed by Dr. Roots affords a salutary caution. It is for 
this purpose, indeed, that I have been induced to touch upon a sub- 
ject pertaining to surgery exclusively; and, therefore, not within 
my province. 
In the treatment of stricture of any part* of the alimentary canal, 
saline aperients, particularly the natural saline springs of Chelten- 
ham, Leamington,and Norwood, will be found most valuable. They 
have the well-known property of rendering the excrementitious 
matter thin and watery, and thus fitting it, in an especial manner, 
to pass through any narrowing or contraction of the bowel. On 
this account they should be preferred before all others. 
The efficacy of the natural saline springs was manifest in the 
case of a gentleman labouring under a schirrous stricture of the 
rectum, whom I attended, in conjunction with the late Dr. Arm- 
strong and Mr. Wadd. While this patient remained in town we 
had the greatest difficulty in procuring evacuations by whatever 
means, and we consequently advised him to go to Cheltenham. No 
sooner had he commenced the use of the waters than the bowels 
acted most freely, the dejections being thin and watery: and so 
complete was the relief experienced, while he continued at Chel- 
tenham, that the patient thought himself cured. In this hope he 
returned to town; but, the very next day, alvine difficulty was ex- 
perienced. It was in vain that we again had recourse to every 
measure that suggested itself. Finally the bowels became ob- 
structed ; nothing whatever passed; and injections could not be 
thrown up. Sir Astley Cooper and Sir Benjamin Brodie were 
called in to consult on the expediency of attempting to penetrate 
the stricture, which was situated high up the rectum. These emi- 
nent surgeons, on account of the schirrous nature of the stricture, 
advised that no force should be used with the bougie, lest it should 
perforate the gut; parts in a state of schirrous disease being 
easily lacerated, but not susceptible of dilatation ; an opinion based 
on experience, and fully borne out by the state of the diseased gut, 
as found after dissolution. 
So great was the accumulation of feculent matter above the 
stricture, that the colon eventually ruptured, and death ensued in 
the course of twelve hours. On dissection, the tissues of the gut in 
* Ibid., p. 65. 106 
BURNE ON HABITUAL CONSTIPATION. 
the immediate vicinity of the schirrus were found to be so lacera- 
ble, that, had any force been used writh a bougie, the bowel must 
have been perforated inevitably. 
In every case of stricture, or obstruction of the bowels, from 
organic disease, in which I have had the opportunity of examina- 
tion after death, I have found the fecal matter accumulated above 
the stricture or obstruction soft invariably; w'hile the small por- 
tions of fecal matter absolutely entangled in the stricture or diseased 
part wrere hard and friable. If in cases of stricture, as in ordinary 
constipation, the feculent matter became quickly hard and scyba- 
lous, a fatal obstruction must at once and always be the consequence. 
CHAPTER IX. 
CUTANEOUS DISEASES, AS CONSEQUENCES OF HABITUAL CONSTIPATION. 
Erysipelas—Erythema nodosum. Psoriasis. Impetigo. Acne. 
It is not here offered as an opinion that the several kinds of ery- 
sipelas are consequences of habitual constipation : for erysipelas, 
both dynamic and adynamic—phlegtnonoid and typhoid—are daily 
seen to depend on a state of constitution vitiated and corrupted by 
intemperance, or by the impure air of ill-ventilated wards or apart- 
ments, not to say by contagion. 
The erysipelas to which I particularly allude, as a consequence 
of habitual constipation, is not of a very severe or dangerous de- 
scription. It may be situated on any part of the body, though it is 
generally on one side of the face. It is rather gradual in its forma- 
tion and progress, may often recur in the same patient, is seldom 
dangerous, and when erratic only so in a slight degree. It is less 
intensely red, less burning hot, less hard and resisting, less tender 
and painful than the phlegmonoid, is apt to be puffy or oedematous, 
and corresponds, in some degree, with the erysipelas oedemalodes 
of Willan and Bateman, though more, perhaps, with the bilious 
erysipelas of Desault, and the erythema of Cullen. Little or no fe- 
brile movement attends it, and the patients so affected are not con- 
fined to bed, or even to the room ; the lower class of persons being 
able to attend at dispensaries, and as out patients at hospitals. Yet, 
on some occasions, the development of this erysipelas will be at- 
tended with more or less fever, bilious vomiting, and headach; 
being a decided attack of cephalalgia with gastro-hepatic irritation. 
I regard this erysipelas as a consequence of habitual constipation, 
for the reason that such a state of the alimentary canal had long 
existed, and induced the usual disorders of the digestive and other 
organs prior to the manifestation of the erysipelas; and for the CONSEQUENCES OF HABITUAL CONSTIPATION. 
107 
reason, also, that it declines, and is removed by an aperient course 
of medicine ; and persists and recurs if this does not form a promi- 
nent part in the plan of treatment. Of this eyreipelas, “erysipele 
bilieuse,” Desault has given a very good though a very concise de- 
scription, and speaks of its connection with “ la mauvaise disposition 
des premieres voies,”* as one of the principal symptoms which dis- 
tinguishes it from the other kinds 
Case LXIV.—Erysipelas of the face cured by attention to the bowels. 
While I was passing part of the winter of 1824-5 at Nice with 
an invalid, I was desired to see a lady who was subject to constant 
attacks of erysipelas, and whose health had been so much and so 
long impaired, that my advice was sought rather as a matter of sa- 
tisfaction than with the expectation that benefit would accrue. 
I found her suffering from one of these attacks of erysipelas. The 
inflammation occupied the left lip, cheek, ear, and temple, which 
parts were pale red, and puffy, doughy, or oedematous, particularly 
the lower part of the cheek. The disease was not very painful nor 
tender, nor did it on this, or on any other former occasion, evince 
any tendency to metastasis to the brain. The appetite was entirely 
suspended; the tongue white and very much loaded; the face was 
sallow; the abdomen flatulent, and the dejections irregular, scanty, 
and very fetid, but not scybalous; her urine was red and loaded. 
She was rather corpulent; her flesh was now flabby, and she sel- 
dom left the house except to take a short drive. She informed me 
that her digestive organs had been disordered for many years, and 
her bowels difficult to manage, requiring laxative measures; but 
that aperients acted sometimes so violently as to distress and 
weaken her, which prevented her having recourse to them so often 
as she felt they were necessary. As a substitute, she was in the 
habit of using lavements of veal broth in quantities not exceeding 
four ounces as directed by a native practitioner. 
The history of her case satisfied me that the colon was the part 
of the alimentary canal most in fault; and the nature of the dejec- 
tions showed that its mucous membrane was not sound, there 
appearing to be a morbid and rather copious secretion from it, as 
forming part of the dejections.f My attention was therefore directed 
to procure the free evacuation of the large intestine, which, being 
difficult to accomplish by medicines taken into the stomach, was 
attempted by the use of lavements alone ; not in the small and ineffi- 
cient quantity in which they had heretofore been administered, but 
in quantity without limit; the attendant being instructed to throw up 
every morning as much as the colon would bear. 
The quantity injected on each occasion was very large, often 
from three to four pints, which, having remained a few minutes, 
* (Euvres Chirurgicales de P. J. Desault. Par Xav. Bichat. Paris, 1813, 
tome ii. p. 581. 
f See some judicious and interesting observations on this subject by Dr. Holland 
in his Notes and Reflections, p. 171. London, 1839; and Select Medical 
Library for October, 1839. 108 
BURNE ON HABITUAL CONSTIPATION. 
was discharged, and with it a vast deal of flatus and of ochre- 
coloured frothy—as if fermenting—half liquid excrementitious 
matter, of a most offensive character : which however became less 
fetid and less abundant on every repetition of the copious lavement. 
The relief was immediate: the erysipelas subsided, the disorders of 
the digestive organs vanished, and she became a new person, to the 
surprise of the medical attendant; the improvement resulting entirely 
from the complete and regular evacuation of the large intestines. 
Ill health had rendered this lady very nervous. The time 
appointed for my first visit was two o’clock, but I did not arrive till 
a few minutes after the hour, when I found that she was a good 
deal agitated, and that a handkerchief had been thrown over the 
timepiece to conceal the dial-plate: so much did the suspense of a 
few minutes affect her. It was a lesson never forgotten. 
Cass LXV Erysipelas, gastro-hepatic irritation, and cerebral congestion. 
Constipation. 
1830, February. Mrs. M. G , age 30, the mother of seven 
children, was affected with an erysipelatous inflammation about the 
ear and extending up under the hair, attended with a troublesome 
burning heat. She was also affected with violent giddiness, with 
pain and weight across the forehead, and occasional dimness of 
sight, worse on attempting to read, when she would see double. 
She slept too soundly, and got up with great reluctance and unre- 
freshed. She was sick, had a bitter taste in the mouth with a foul 
tongue, especially in the morning ; she flushed much in the face, and 
experienced heat of a burning dry character all over the body, 
amounting at night to feverishness. Her digestive organs had been 
long disordered, and her bowels much constipated, always requiring 
powerful medicine. Micturition was frequent. Menstruation re- 
gular. 
By means of alteratives and saline aperients combined with alkalis 
the erysipelas subsided, and the general health was improved. 
Remarks.—The subacute erysipelas, in this instance was merely 
an addition to the ordinary signs of disorders of the abdominal 
viscera and of congestion of the brain, the general attendants upon 
habitual constipation. Cases nearly of this description come under 
the observation of every person. They are adduced here not as 
illustrative of erysipelas itself, but to show that it is often one of 
the consequences of habitual constipation, and may be cured and 
its recurrence prevented by attention to the regular action of the 
bowels. 
Case LXVI.—Erysipelas. Aphthae. Feces impacted in the rectum. 
“ A lady, 80 years of age, was brought to London from Wal- 
thamstow to be under my care. She was affected with constipation 
of long standing, and had taken aperients for three months with 
(Communicated by Mr. Morgan.) CONSEQUENCES OF HABITUAL CONSTIPATION. 
109 
no other effect than the removal of some hard scybals. The nurse 
was directed to administer an enema, but found it impossible. I 
immediately discovered the mischief to be impaction of feces in 
the rectum, and, without further delay, proceeded to unload it. In 
this case the accumulation was very great, and difficult to remove, 
the fecal matter being arid, almost inodorous, and of light specific 
gravity. 
“ The old lady was very weak and depressed, and the constitu- 
tion had sympathised greatly with the local affection; the mucous 
membrane of the mouth and fauces was aphthous all over, and an 
erythematous blush showed itself on the lips and nose. At length 
an extensive erysipelas spread over the head and face and attacked 
also the anus and nates; under which she sunk in about ten days.” 
Several elderly ladies known to me are liable to accumulations 
in the colon and rectum, and to attacks of erysipelas, less severe 
than in the case just narrated, but depending evidently and wholly 
on a constipated state of the bowels. 
In agreeing with Desault and Abernethy that mild cases of ery- 
sipelas depend frequently and exclusively on the “ mauvaise dispo- 
tion des premieres voies,” viz. disorders of the digestive organs, 
I yet go further, and attribute not only the erysipelas, but also the 
disorders of the digestive organs themselves to habitual constipa- 
tion, for the reason that the constipation was the earliest deviation 
from the natural functions of the alimentary canal, and therefore 
the first cause. 
The cutaneous eruptions which I have observed to be more par- 
ticularly connected with habitual constipation, are the erythema 
nodosum, psoriasis, impetigo, and acne. 
In every case of the erythema nodosum that has occurred to me, 
constipation was a marked feature in the preceding state of the 
system, and the obviating this by proper aperients, the chief treat- 
ment. In young females this eruption will yield under the use of 
laxatives in ten or twelve days, as stated by Bateman, but in older 
persons it will prove more obstinate and persist for several weeks, 
which was the case in a female near fifty years of age, robust and 
corpulent, who had long been subject to great constipation, and 
in whom the erythema affected not only the leg but the thigh; an 
unusual circumstance. 
In Psoriasis and Impetigo a cooling saline laxative, and alkaline 
treatment, calculated to regulate the bowels, is, at all times, a 
necessary part of the treatment; medicines, directed merely to the 
state of the stomach or of the blood, will not effect a cure, as a 
general rule. One case of Psoriasis of the lips resisted all reme- 
dial means, till a very active cathartic of jalap and calomel was 
administered, when it yielded immediately. 
Although Acne is known to occur particularly in certain tem- 
peraments and constitutions, it is nevertheless influenced very 
materially by the state of the bowels, habitual constipation aggra- 
vating the inflammation around the base of the little tumours, and 110 
BURNE ON HABITUAL CONSTIPATION. 
increasing their size, so that they disfigure greatly the face and 
uncovered parts of the shoulders ; and not only is this result pro- 
duced, but a blotchy redness and heat will occupy the spaces 
intervening between the acne tumours, and give the face a most 
unpleasant and unfortunate aspect; at times subjecting the indi- 
viduals affected to the suspicion of syphilitic taint, or of intemper- 
ance ; when, instead of either, habitual constipation may be the 
true source. To this same source also I have in a former chapter 
already ascribed the Prurigo Poclicis et Pudendi Muliebris. 
CHAPTER X. 
OF THE CAUSES OF HABITUAL CONSTIPATION. 
Inattention to the calls ofNature. The want of proper conveniences. Civilized 
life. Sedentary habits and occupations. Literary pursuits. Travelling. 
Pathological and mechanical causes. 
Inattention to the calls of Nature.—Of all the causes which originate 
and establish habitual constipation, there is none certainly so general 
as inattention to the calls of nature. 
We have seen, in a former chapter, that the rectum, in common 
with the other parts of the intestinal canal, is endowed not merely 
with organic sensibility from the ganglionic system of nerves, of 
which sensibility we are not conscious, but also with animal sen- 
sibility from the cerebro-spinal system of nerves, of which sensibility 
wre are conscious. This sensibility with consciousness is excited 
when the excrementitial residue arrives at the rectum, and thus we 
are admonished of the period when it should be expelled: an ad- 
monition attended to at all times by the brute creation, and by 
children in whom the natural functions are allowed to go on un- 
restrained : but when puberty approaches, the calls of nature are 
not only ill obeyed, but even set aside by every trivial circumstance. 
A misplaced sense of delicacy, an absolute disregard of the calls of 
nature, some engagement from which persons do not at the moment 
liberate themselves, the inconsiderate or ill-planned situation ot the 
closet, or of the out-of-door cabinet d’aisance, all conspire to counter- 
act the operations of nature and to originate constipation. 
How often does it happen that ladies, feeling it not quite con- 
venient to retire to the closet at the moment they experience an 
admonition, defer it till a more favourable opportunity; but this 
opportunity having arrived their efforts are powerless ; the bowel 
will not then act; and disappointment and discomfort ensue. Deli- 
cacy on their part is carried to a most pernicious extent in England, 
while on the other side of the channel the reverse obtains; happily, 
perhaps, as regards health and ease. An English gentleman, 
while in France, having one day occasion to go to the cabinet CAUSES OF HABITUAL CONSTIPATION. 
111 
d’aisance, found it occupied by a lady ; the door not being bolted. 
Embarrassed, he retreated to his apartment; where in a few 
minutes, another lady of the family came to him, saying, “ Monsieur! 
la place est libre !” The Englishman blushed for an instant, but, 
quickly recovering, said to himself, en allant, “ Eh bien ! If Madame 
feels no delicacy in this matter, why should I?” 
It should be remembered that the exoneration of the bowels is a 
natural and necessary function, without which health cannot be 
enjoyed or preserved, and some resolution therefore should be ex‘- 
ercised in order to promote this object. Besides, if we regard it in 
another point of view, and reflect for an instant that by neglecting 
the evacuation of the lower bowel we permit foul and filthy matter 
to be retained within the body—which nature has ordained should 
pass away—we feel another and strong incentive to encourage and 
secure the habit of daily evacuation. Delicacy in this particular 
should be discountenanced, and trivial or even pressing engage- 
ments should be suspended in order to obey this injunction of 
nature, 
I am afraid that indolence and an absolute disregard of or even 
resistance to the calls of nature are not the least frequent causes 
of habitual constipation; feelings which have been yielded to per- 
haps without considering the penalty they must in the end inflict. 
How many persons are there who do not obey the calls of nature 
unless urged by an imperative necessity which they cannot resist. 
Little do such persons know the misery and ill health they entail 
upon themselves when they allow such habits to grow upon them : 
and surely when they are apprised of the evil consequences that 
must accrue they will make an effort to avert them by scrupulous 
attention to the regular exoneration of the bowels. 
Constipation having once commenced, soon becomes habitual; 
and does not attract attention till some pressing consequence arises, 
which having been removed or relieved the same stale of consti- 
pation is allowed to recur and to persist. 
The want of proper conveniences is most severely felt by society 
at large, though now less unquestionably than formerly. 
The situation of closets is often ill-judged. If of ready access, 
too exposed: if remote, inconvenient. In number too they are apt 
to be sadly deficient: one, perhaps, for a whole family, and this 
most unfortunately placed. Then, again, the out-of-door cabinet 
d’aisance is sometimes situated at a distance from the house, and 
the access to it often runs in front of the sitting-room windows ; 
the locality itself being often cold, damp, and repulsive. 
One cannot help wondering to see so much pains bestowed on 
the arrangement and decoration of a house wdiile a disregard is 
manifested with respect to the closets and cabinets d’aisance, upon 
which conveniences, nevertheless, the health and comfort of a 
family and their visiters depend. 
Is there any one who has not at times found the pleasures of a 
visit neutralized by difficulty in attending to the bowels? How 112 
BURNE ON HABITUAL CONSTIPATION. 
often do both sexes suffer from unusual constipation when from 
home, especially while travelling abroad, for want of proper con- 
veniences and opportunities ; sufferings which mar all their antici- 
pated enjoyments. Travellers on the Continent know well the 
miseries they have encountered in this respect. But we need not 
leave our own shores to experience annoyances like these; for in 
Britain itself there are towns in which a great part of the houses 
have not only insufficient conveniences, but absolutely none at all. 
• In the construction of houses, too much attention cannot be 
given in determining the situations in which the w'ater-closels are 
to be placed, in order that the access may be easy and the egress 
private: but above all let the number be sufficient. In every house, 
one at least should be appropriated to each sex: and one should be 
attached to the visiters’ apartment exclusively. Persons go to a 
vast expense in fitting up apartments and providing entertainment 
for their friends, but they neglect the one thing necessary to their 
comfort and enjoyment. 
How easy a matter is it in the country,—where the construction 
of w’ater-closets in-doors is more difficult and less necessary than 
in towns,—to erect two, instead of one, out-of-door cabinets 
d’aisance in spots convenient and approachable; an object attain- 
able by families in very moderate circumstances. 
Civilized Life.—Much as we have to rejoice at the advance of 
civilization, the blessings which spring from it are not without 
alloy. The congregation of human beings and of their habitations 
in towns involves numberless evils, of which mental excitement 
and bodily inactivity are not the least pressing. The mind is not 
merely employed but excited, while the limbs are scarcely used. 
Ladies may take a formal walk once in the day ; twice is a rare 
occurrence: but even this does not afford salutary exercise, the legs 
only being engaged, the arms “ hanging idly down.” The higher 
classes use scarcely any muscular exertion, the use of the limbs 
being superseded by the carriage. Then in young ladies the ac- 
complishments, which all endeavour to attain, require constant 
mental, to the neglect of bodily, exertion ; and, education concluded, 
the greater part of the day is passed in sedentary occupation or 
amusement. Custom so enslaves mankind that ladies are, as it 
wTere, prisoners in the house; they cannot walk in the streets; and 
few, comparatively, are able to enjoy the advantages of air and 
exercise in our parks and squares. Even in provincial towns the 
gardens attached to dwelling-houses are so confined that they offer 
little temptation or means of exercise; and this general want of 
muscular action encourages habitual constipation. 
The anxiety of mind too arising out of an advanced state of civi- 
lization has a great influence on the functions of the alimentary 
canal; not merely in causing indigestion, but in rendering torpid 
the peristaltic action of the intestines. Look at the multitude of 
anxious faces one meets daily in the streets. Think for a moment 
on the contentions, competitions, and responsibilities that men have CAUSES OF HABITUAL CONSTIPATION. 
113 
to encounter, and we shall not be surprised at the load of anxiety 
that oppresses the greater part. This anxiety depresses the energy 
of the nervous system and of all the organic functions. The powers 
of the stomach become languid and digestion is imperfect; the liver 
becomes sluggish and the supply of bile is defective; and the peris- 
taltic action of the intestinal canal grows slow and retards the ex- 
cretions : and thus do affections of the mind produce languor, in- 
digestion, constipated bowels, and all their consequences. 
In proof, we find that persons, while anxiously engaged in their 
business or profession, find it difficult or impossible to regulate their 
bowels; yet, immediately they emancipate themselves by an excur- 
sion into the country, the mind recovers its cheerfulness, the spirits 
their elasticity, and the bowels their normal function. 
Sedentary Habits and Occupations.—The sedentary habits of 
females in general are undoubtedly one cause of the habitual con- 
stipation under which they labour. Looking at the inactive life 
led by the majority of those who are above the station of domestics, 
one feels not only no surprise that the bodily functions should be ill 
performed, but one wonders that the consequences are not more 
serious. 
The abeyance in which muscular action and energy are kept by 
sedentary habits and occupations in either sex, is inconsistent with 
the vigorous circulation of the blood in the extremities; muscular 
action being one of the chief agents in the venous circulation. The 
effect is a languid circulation in parts remote from, and a conges- 
tion of blood in parts near to, the centre of the circulation; and 
hence cerebral and abdominal congestion; augmented, moreover, 
by the irritation arising from the condition of constipation itself, as 
has been already explained. The want of bodily exercise lessens 
the demand for food, weakens the digestion, and dyspepsia is added 
to the train of evils. 
There is no class of persons more deserving our commiseration 
than young women employed as semstresses, milliners, and the like. 
The poor girls sit and ply the needle during fourteen or fifteen 
hours of every day in the whole week, with scarcely intermission 
enough to take their meals. I am credibly informed that, in some 
establishments in this metropolis, these young persons breakfast at 
seven o’clock, work unremittingly till one, when they dine; and 
again work till ten and eleven o’clock at night: the time set apart 
for all their meals not amounting to one hour. Many do not leave 
the house from Monday morning to Saturday night. So exhausted 
are they at the close of their daily labours, that I hear they can 
scarcely “ drag themselves up stairs to bed the truth of all which 
is too plainly told by the pale sallow faces, palpitating hearts, and 
swollen ankles which they exhibit. 
With employment so unremitting exercise during the six work- 
ing days of the week is impracticable ; and not less impracticable 
is attention to the natural functions of the body. Can we picture 
to ourselves the misery of young persons doomed to pass that pe- 114 
BURNE ON HABITUAL CONSTIPATION. 
riod of their lives in one wearying, unvarying sedentary position,* 
which, under happier circumstances, should be full of cheerful va- 
riety, and exuberant in joyous activity: and all this to earn a pit- 
tance barely sufficient to furnish them with apparel and the common 
necessaries of life. 
Did the philanthropists, of whom this country can above all others 
boast, know the hardships these young girls are destined to suffer, 
some efforts would, I am sure, be made to improve their condition 
by lessening the number of hours they are now obliged to work, 
and by affording them the respite at meal times wffiich all our arti- 
zans enjoy. 
The want of muscular exercise in the inmates of boarding-schools, 
and the weakness of frame and of health which is thereby induced, 
is powerfully set forth by Dr. Forbes. On visiting a young patient 
* Any fixed sitting, or upright posture, is incompatible with the symmetrical 
growth of the body in young persons. It is lamentable to see the majority of 
young ladies deformed by a lateral curvature of the spine, not depending on weak- 
ness of constitution, or on original delicacy of frame, but arising purely from 
their having been compelled to sit upright, under the erroneous notion of pre- 
venting the deformity which this very system produces. 
The spine in young persons requires a perpetual change of position, in order 
that its development may be straight and perfect. If this change of position, 
which all young persons naturally seek, is not allowed ; and if they are desired 
“to sit upright,” “to hold themselves up,” the result will be, that the weight 
of the head and upper extremities either compresses the intervertebral substance, 
and causes a short, stiff, straight back, devoid of all elastic and graceful motion; 
or causes the spine to give way and bend to one side or to the other; thus pro- 
ducing the lateral curvature so general in young ladies. 
To remedy this deformity, as parents and governesses suppose, those abomi- 
nable high chairs, with tall straight backs, are called into requisition, and the 
young ladies are urged more and more strenuously to hold themselves erect, a 
system which aggravates and renders permanent the very deformity they have 
been striving and hoping to remove. No greater error ever prevailed than the 
notion that the curved spine is to be prevented or cured by the upright position. 
It is this very position, rigidly maintained, which causes the curvature, and de- 
forms so many frames of body cast by nature in a beautiful and perfect mould. 
Why is it that girls in the lowest class of life are well grown, when ladies 
are the reverse I Why is it that the housemaids have straight spines, while 
their young mistresses are deformed I Wrhy is it that boys are seldom seen with, 
while girls are seldom seen without, lateral curvature of the spinel Precisely 
because the motions and positions of boys are unrestrained, and the girls are 
controlled and fixed! 
Young ladies should be allowed to relieve the pliant spine from the weight of 
the head and upper extremities, as nature prompts, by frequent change of posi- 
tion, by seeking support against the back of a chair, by reclining on a sofa, some- 
times even by reposing in the entire horizontal position. Not only do these 
means prevent deformity, but, if employed before the growth of the body is 
completed, thpy will remove any deformity which may have taken place. Mus- 
cular exercise of the upper extremities in an upward direction, as by contri- 
vances suspended from the ceiling, is an excellent and essential auxiliary means, 
I have known many instances of lateral curvature of the spine quickly removed 
by the simple measures recommended; namely, by muscular exercise, followed 
by the horizontal position for a short period every day. 
The tall, straight-backed chairs usually placed at the piano should all be 
burnt, and stiff, long stays discarded, as inimicable to and incompatible with an 
elegant frame and graceful carriage. CONSEQUENCES OF HABITUAL CONSTIPATION. 
115 
at a boarding-school in a large town, he learnt on close and accu- 
rate inquiry, that there was not one of the girls who had been at 
the school two years that was not more or less crooked :* an 
astounding fact! 
For some very judicious observations on injuries of the spine from 
continuing the same attitude, from sedentary occupations, &c., I 
would refer the reader to the fourth chapter of the work of Andrew 
Combe, M.D., “ On Physiology applied to the Preservation of 
Health.” 
Literary Pursuits—In addition to the determination of blood to 
the brain which is produced by continued mental occupation, the 
sedentary habits of literary persons induce the congestion of the 
abdominal viscera, the disorders of the digestive organs, and the 
constipation of the bowels incident to a life of inactivity. 
While blood is determined in an anormal quantity to the viscera, 
the quantity and circulation in the extremities is so languid and defi- 
cient, that the temperature falls much below the natural standard, 
sufficient animal heat not being developed in parts so distant from 
the centre of the circulation. The consequence is much suffering 
from cold feet, with difficulty in keeping them warm even by arti- 
ficial means. 
The effects of the congestion and constipation fall not unfrequently 
on the liver more than on the other viscera, disordering the secre- 
tion of bile, causing it to enter into the blood and to produce the 
sallow face and gloomy hypochondriac countenance so conspicuous 
in those who “ cupidi literatim sunt.” In some of these persons, 
lawyers and schoolmasters particularly, the effects of mental labour 
and constipation fall chiefly on the brain, and lead to cerebral con- 
gestion and apoplectic seizures. 
Case LXVII.—Apoplectic congestion. Constipation. 
Mr. R , age 21, an usher in a school, tall, thin, sallow, very 
studious and sedentary, subject to cold feet, and of a constipated habit 
of body for several years, was affected on the 10th of December, 1832, 
with very great heaviness of the head attended with pain from the 
occiput to the forehead, and dimness of sight which lasted five days. 
Three weeks later he was seized, while walking in the evening, 
with giddiness and loss of memory and numbness of the left side. 
He staggered as he went home, and, when he had reached his room, 
fell down, but he rallied the same evening, walked out again and 
recovered. 
In the course of a fortnight he was attacked while in bed with a 
pain in the back of the head in the same spot as on the first occa- 
sion. He nevertheless got up as usual, but after breakfast felt con- 
fused and giddy. In the evening he called upon me for advice. 
He looked stupid and heavy, was dull, slow of speech, and forgetful, 
so that it was with difficulty he explained the object of his visit. 
His eyes were suffused, one side of the face was slightly paralyzed, 
* See Cyclopaedia of Practical Medicine, vol. i. p. 657, note by the editor, Dr. 
Forbes. 116 
BURNE ON HABITUAL CONSTIPATION. 
the corresponding side of the body weak, and his walk unsteady. By 
means of the loss of blood, a blister, and some purgatives, he was 
relieved immediately from the urgent symptoms. Afterwards the 
bowels were regulated by proper aperients combined with altera- 
tives, but it was many weeks before the brain entirely recovered 
from the shock. 
Case LXVIII.—Cerebral congestion. Constipation. 
A young lawyer sought my advice in July, 1838, for the following 
complaints—great heaviness of the head, sleepiness, and impairment 
of memory. I observed that his face was slightly paralyzed on the 
right side, and the corresponding eyeball rather more exposed and 
prominent. His pulse was only 64, the stroke slow. His bowels 
had long been habitually and obstinately confined : but his appetite 
was good. He had been very sedentary, reading much, and a close 
inmate of his chambers. He had been affected with these symptoms 
for several months, and for some time past had been under the care 
of a homoepathist, who had relied on infinitesimal doses of various 
drugs. 
It was self-evident that a very serious congestion of the brain 
existed and had existed many weeks, and that the patient was in 
danger of cerebral haemorrhage and its consequences. I therefore 
at once directed blood to be abstracted by cupping, and his bowels 
to be kept freely open by senna, aided by alterative doses of calomel 
and rhubarb. 
By these means the heaviness of the head and the sleepiness were 
materially diminished ; and after two or three w'eeks the expression 
of the face was nearly free from paralysis; yet recovery was 
imperfect; the pulse remained slow and unfrequent, the bowels con- 
tinued very obstinate, and cerebral symptoms recurred from time to 
time while he was under my care; proving that the congestion, 
which had been so long allowed to exist, had in all probability 
affected the organization of the brain ; if not irreparably, at all events 
to a degree that required long abstinence from mental occupation, 
strict diet, early habits, and well-regulated bowels to give a fair 
chance of recovery. 
Travelling has generally the effect of discouraging the action of 
the bowels; and on some occasions to the extent of producing great 
inconvenience by constipation. I have known ladies become very 
ill from this cause. A confined state of the bowels always increases 
the feverish heat which arises from travelling in a close carriage. 
Persons proposing to make long journeys would consult their com- 
fort by providing themselves with means to obviate constipation, or 
the pleasures even of their excursion may be very much broken in 
upon. The same remarks apply to voyages by sea. 
Constipation of greater or less duration, and even obstruction of 
the bowels, may be produced by a variety of causes, the considera- 
tion of which—although they induce, in the majority of instances 
an incidental rather than an habitual constipation—cannot with 
propriety be overlooked or omitted in this chapter. CONSEQUENCES OF HABITUAL CONSTIPATION. 
117 
These causes may be of a pathological or of a mechanical cha- 
racter. 
The 'pathological may depend on inflammation, spasm, or organic 
disease of the alimentary canal or neighbouring viscera ; as en- 
teritis, tuphlo-enteritis, or inflammation of the cascum ; disease of 
the pylorus, csecum, or appendix vermiformis; enteritic spasm; 
biliary calculus; renal calculus; and colica a plumbo; which 
causes require no other notice than a simple enumeration, inasmuch 
as they are incidental; and the constipation standing in the relation 
of a symptom to the diseases themselves is, therefore, always taken 
into consideration. 
Laxity or debility of the muscular fibre of the intestinal canal is 
by many regarded as a cause of habitual constipation ; in which 
opinion my own experience does not allow me to concur. The 
grounds on which this opinion has been formed, are the general 
laxity or debility of the individuals affected, and the thin pale state 
of the enteritic muscular tunic as seen on dissection. 
In tracing, however, the history of these cases, it will appear that 
the subjects of them had for a very long period been affected with 
habitual constipation,—that they had eventually died exhausted and 
emaciated,—and that the lax and pale muscular fibre of the intes- 
tines depended, in part, on the general impaired state of the health, 
and in part on distention from the evolution and presence of gas, as 
well as from the inaction which attends constipation—that, indeed, 
it was a result and effect rather than a cause. 
Deficiency of bile, from obstruction in the biliary ducts, from 
whatever cause, deprives the alimentary canal of its natural stimu- 
lus and renders the peristaltic action sluggish. 
So diseases of the brain, by impairing the powers of innervation, 
are causes of enteritic torpidity; often very unmanageable. 
Any anormal or pathological increase of the secretion of an organ 
may so diminish the fluid parts of the residual alimentary matter, 
and of the fluids naturally poured into the intestinal canal, as to be 
a continued source of constipation. This is exemplified in the 
diabetes mellitus ; in which, while there is an inordinate and aston- 
ishing increase in the secretion of urine, there is at the same time 
an almost entire suspension of the secretions proper to the alimen- 
tary canal ; the consequences of which are, that a dry, hard, and 
friable condition of the feces and a very costive state of the bowels 
are attendant symptoms of the disease. 
The mechanical causes may depend—on diminution of the natural calibre of 
some part of the intestinal canal from disease of the bowel itself, as stricture; 
or organized bands stretching across the channel of the gut:—on accidental 
adhesion, displacement, or twist of the bowel:—on diverticula:—or on the 
pressure of a tumour. 
Stricture has in a former chapter been regarded as an occasional 
consequence of habitual constipation, and as resulting from a dis- 
eased action excited by the unduly retained feculent matter. In 
now regarding it as a cause, I allude to those cases in which the BURNE ON HABITUAL CONSTIPATION. 
118 
bowels, habitually regular, have become irregular and obstinate in 
consequence of the formation of a stricture, the stricture having 
proceeded from a depraved condition of the constitution, rather 
than from any local exciting cause, as constipation. 
Organized bands stretching across the channel of the bowel are 
more generally met with in the rectum, and are spoken of by authors 
on diseases of that gut. I have myself met with them also in the 
cascum in one instance.* They constitute a very curious product 
of disease; and, forming an irregular coarse network across the 
channel of the bowel, prove a formidable source of constipation. 
At first sight, the origin and formation of these organized bands 
would appear difficult of explanation; but I agree with O’Beirnef 
in attributing them to an intense inflammation of the mucous mem- 
brane of the part, with effusion of fibrin, which, in the first place, 
agglutinates the opposite mucous surfaces to each other, then be- 
comes quickly organized, and obliterates the channel of the bowel. 
This obliteration would be complete and permanent, but that before 
the organization of the effused fibrin can be so far advanced as to 
give strength to the adhesion, the contents of the intestine above are 
urged onwards, and break up the adhesion in a number of points 
and directions, thus forming and leaving the various filaments, 
which, when afterwards completely organized, constitute the per- 
manent bands of which w’e are speaking. 
The network so formed across the channel of the bowel proves 
a serious source of constipation; and, if situated in a part beyond 
the reach of an operation, as in the caecum, it will eventually 
cause an entire obstruction, and destroy life. This was the 
order of events in the caecum case alluded to; the subject of 
which had suffered from a most untractable and obstinate constipa- 
tion for several years previous to the occurrence of the complete 
obstruction which proved fatal. 
When this network of organized bands is situated in the rectum 
it may be broken up, and the bands divided by an operation which 
then removes the source of the constipation; and the patient is re- 
lieved from his distress and danger. 
Adhesions, accidentally formed between two portions of intestine, 
or between the intestine and some part of the abdominal viscera, 
are occasionally' met with, which may have existed for an indefinite 
time without interfering with the action of the alimentary canal; 
and yet from some slight cause affecting this adhesion difficulty 
shall arise; and obstruction and inflammation ensue, as in stran- 
gulated hernia. Cases of this kind are related by Dr. Aber- 
crombie.J 
One is surprised to find on dissection how slight an adhesion will 
at times obstruct the action of the bowels to a fatal extent. In a 
* This case is detailed in my first Memoir on the Caecum and Appendix in 
the Transactions of the Medical and Chirurgical Society, vol. xx. p. 213. 
f Opcit. p. 43. 
i Diseases of the Stomach, Intestinal Canal, &c. Edinburgh, 1829, p. Ill, 
et seq. CAUSES OF HABITUAL CONSTIPATION. 
119 
gentleman, who died with all tne symptoms of obstruction after he 
had undergone the operation for strangulated hernia, it was found 
that the difficulty arose from an agglutination of the contiguous 
peritoneal surfaces of the convolution of the ileon which had formed 
the hernia, but had been entirely liberated from the strangulation, 
and returned into the abdomen. This agglutination, though suffi- 
cient to counteract the peristaltic function of the gut, was neverthe- 
less separated by the slightest force. The judicious precautions 
which surgeons take, after having divided the stricture, to draw out 
the gut which has been strangulated, in order to ascertain that no 
adhesions exist between it and the neck of the sac, may be advan- 
tageously extended—as this case shows—to the inner contiguous 
surfaces as well as to the circumference of the strangulated convo- 
lution. 
The Diverticulum.—A diverticulum is an anormal process from 
some portion of the intestinal canal, generally the jejunum or ileon, 
of from three to five inches in length, about the size of the middle 
finger, communicating openly with the bowel, but having its distal 
extremity closed, forming indeed a cul-de-sac, very similar to the 
appendix vermiformis, except that it is larger and has no mesentery. 
In the examination of bodies, I have met with these diverticula 
several times. In one case the diverticulum was the cause of death, 
as follows:— 
It happened in a labouring man at least 50 years of age, whose 
health up to the attack of which I am now speaking, had been al- 
ways good and his bowels free from pain or difficulty. When I 
visited him he was seriously ill in bed, having an aching obtuse pain 
fixed about the navel, with tenderness and some tumefaction of the 
abdomen, vomiting, though not frequent and obstinate constipation, 
with however no high degree of fever, and not so great an anxiety 
in the countenance as is seen in idiopatic enteritis. These symp- 
toms had formed rather gradually, he having been ill already five 
days, and I was of opinion that some accidental cause, as an inter- 
nal strangulation, existed. On questioning him as to any cause of 
obstruction, he recollected only one circumstance that bore on the 
subject; which was, that he had eaten hastily, a few days before 
the attack, some hard boiled beef. 
The symptoms resisted all the means which the character of the 
case suggested, and the patient died at the end often days. 
The body was examined, and a diverticulum, of the size already 
described, proceeding from the upper portion of the ileon situated 
in the middle of the abdomen, was discovered. But extending from 
its distal, or blind extremity, was a ligament formed by the exten- 
sion of its peritoneal tunic, which ligament proceeded and was fixed 
to the neighbouring mesentery, and underneath it a portion of the 
small intestine, having become accidentally strangulated, obstructed 
the channel of the bowel and produced the fatal symptoms above 
stated. 
Displacement of the Bowel in the form of an intussusception, or 120 
BURNE ON HABITUAL CONSTIPATION. 
of an internal or external strangulated hernia, becomes at once a 
cause of constipation and obstruction. 
Twist of the Bowel—A sudden twist of the bowel has been known 
to occur many times, and to produce a fatal obstruction. The por- 
tion of intestine most liable to this accident is the sigmoid flexure of 
the colon, on account of the loose arrangement of its meso-colon. 
Sir Astley Cooper has favoured me with the following example:— 
Case LXIX.—Twist of the sigmoid flexure of the colon. Obstruction : fatal. 
“ A person, near 30 years of age, who had made several voyages 
to the East Indies, was drinking in a.public-house in Lower Thames 
Street, and quarrelled with one of his companions, who threw him 
down and kicked him upon the abdomen. He rose, and complained 
of being excessively hurt, applying, at the same time, his hand to 
the region of the sigmoid flexure as the seat of his suffering. 
“On the following day the abdomen was swollen, and although 
he had‘an inclination to go to stool, it was ineffectual, and he sent 
for Dr. Lettsom. Day after day the abdomen increased; and, 
notwithstanding the most active purgatives and injections were 
administered, no relief could be obtained from the bowels. Sir 
Astley Cooper was now sent for to meet Dr. Lettsom; and found 
the abdomen tympanitic and distended to an enormous size, with 
constant eructations and vomiting of whatever he took. The 
tobacco enema was recommended, which had its full effect in pro- 
ducing relaxation and depression, yet failed to give relief to the 
bowels. Sir Astley, therefore, at the next consultation, advised 
that the abdomen should be punctured. The operation was per- 
formed immediately by means of a small trocar—for the patient 
was almost suffocated by the opposition which the distended abdo- 
men offered to the descent of the diaphragm—and an immense 
quantity of gas escaped through the canula. The relief experienced 
was for the moment complete: the patient expressing himself per- 
fectly relieved in his breathing. The abdomen, how'ever, soon 
began to swell again, and in forty-eight hours was as much dis- 
tended and produced as great dyspnoea as before the operation; 
and seeing that no permanent relief had been derived, Sir Astley 
did not consider himself justified in repeating the operation. In 
twenty-four hours he died, having lived altogether eight days from 
the injury. 
Necrotomy.—“ On opening the abdomen, the intestines protruded 
instantly and with force. It was the sigmoid flexure of the colon 
in which the distension was greatest, and this was the intestine 
which had been penetrated by the trocar. On further examination, 
the meso-colon was found to be exceedingly relaxed, and the sig- 
moid flexure itself twisted one turn and a half upon its own axis; 
and so complete was the obstruction, that not a particle of air would 
pass until it was replaced. 
“ If the exact situation of this had been known, Sir Astley is of CAUSES OF HABITUAL CONSTIPATION. 
121 
opinion that an incision into the abdomen would have enabled the 
surgeon to untwist and replace the gut easily.” 
An explanation of the manner in which a twist of the sigmoid 
flexure of the colon may take place has been attempted by O’Beirne, 
and is far from improbable. He says, that if the descending colon 
should happen, from any cause, to discharge into the sigmoid flexure 
a greater quantity of matter in a more rapid and sudden manner 
than usual, the latter, by making a sharp and nearly complete turn 
upon its own axis, may become so twisted as to cause a very per- 
fect and formidable species of obstruction.* This explanation 
cannot, of course, apply to those cases which arise from accident. 
Several examples of this twist of the sigmoid flexure have been 
recorded. Dr. Abercombie relates one in w7hich a very slight twist 
so interfered with the function of the intestine as to produce a fatal 
ileus. The point of the canal affected by this twist was at the 
termination of the sigmoid flexure, in the rectum.f 
Tumours in the Abdomen and Pelvis sometimes interfere with the 
action of the bowels, and cause constipation chiefly by pressure, 
arising from their great bulk or from their peculiar situation. This 
inconvenience is most frequent from tumours situated in the pelvis, 
partly because they occur here oftener than in the abdomen, and 
partly because of the resistance and counter-pressure of the bony 
structure. Yet seeing how common tumours of the uterus and 
appendages are (independent of utero-gestation), one is rather 
surprised that obstinate constipation is not a more general 
consequence of them. The fibrous tumours of the uterus are much 
more apt, than tumours of the ovaries, to interfere with the action 
of the neighbouring bowel. I have under my care at this time a 
person affected with the hard fibrous tumour of the uterus, in whom 
it is a matter of great difficulty to obviate the constipation produced 
by pressure on the gut. 
Tumours of the abdomen, glandular especially, sometimes so ob- 
struct the channel of the bowel as to excite, from time to time, not 
only constipation but inflammation. Two cases of this description, 
in males, have occurred in my practice within the last four years. 
In one, the bowels were rendered so habitually and obstinately con- 
stipated that strong and stimulating purgatives were always re- 
quired to obtain evacuations; and this gentleman was attacked at 
intervals with severe local pain, vomiting, obstruction, and febrile 
movement; viz. with inflammation of the part. By treatment, per- 
sisted in for many months, this tumour was happily dissipated; 
since which all alvine difficulty has ceased. 
In the other case, the tumour went on enlarging, and produced, 
from time to time, obstruction and inflammation, which placed the 
patient’s life in jeopardy on each- occasion. Eventually it attained 
an amazing bulk, rendering the abdomen very protuberant, while 
* Op. cit. p. 42. 
t Diseases of the Stomach, Intestinal Canal, &c. Edinburgh, 1828, p. 115. 122 
BURNE ON HABITUAL CONSTIPATION. 
the rest of the body wasted away. Death ensued ; and by exami- 
nation the tumour was found to consist of a schirro-fungoid growth 
of the lumbar glands; and must have •weighed from forty to fifty 
pounds. 
Pregnancy must also be regarded as an occasional cause of con- 
stipation. 
The mechanical causes of constipation may depend on foreign substances taken by 
the mouth, as magnesia; chalk; sulphur; cubebs; white mustard seed ; pills; 
sesquioxide of iron ; adulterated bread ; fruit-stones, and other substances. 
Magnesia.—Several instances have occurred in which magnesia 
taken daily in large doses, has accumulated in the alimentary canal 
to a great amount, in the form of balls, or in a single mass, pro- 
ducing irritation, obstruction, tumour, &c. The parts of the ali- 
mentary canal where the accumulation takes place, are the caecum, 
the sigmoid flexure of the colon, or the rectum. Sir Benjamin 
Brodie mentioned a case to me in which magnesia had collected in 
balls in the rectum and produced a high degree of irritation, which 
ceased when the balls of magnesia came away. A very interesting 
case is recorded by Mr. Everard Brande.* 
“ A lady was recommended to take magnesia, in consequence of 
some very severe nephritic attacks, accompanied with the passage 
of gravel. She was desired to take a tea-spoonful every night: and 
Henry’s calcined magnesia was preferred, as that always operated 
upon the bowels and 4 carried itself off,’ which other magnesia did 
not, but, on the contrary, felt heavy and uneasy in the stomach. 
The dose was gradually increased to two tea-spoonfuls, in order to 
produce effect upon the bowels, which this quantity never failed to 
do; the symptoms for which it was ordered were soon removed, 
but the plan was persevered in for two years and a half, with little 
intermission or irregularity, so that, as the average weight of a tea- 
spoonful is at least 40 grains and the average dose was a tea-spoonful 
and a half, it may be presumed that she took during the above period 
between nine and ten pounds troy. 
“ In the course of last autumn she suffered severely by a miscar- 
riage, and shortly afterwards by an attack of biliary calculus ; sub- 
sequent to which she became sensible of a tenderness in the left side 
just above the groin, connected with a deep-seated tumour, obscurely 
to be felt upon pressure, and subject to attacks of constipation, with 
painful spasmodic action of the bowels, tenesmus, and a highly irri- 
ble state of the stomach ; these attacks recurred every two or three 
weeks, varying in violence, but requiring the use of active remedies ; 
during one of them, about the middle of last March (1816), a large 
quantity of sand was voided by the rectum, attended with a peculiar 
acute and distressing pain in the seat of the tumour above-mentioned. 
This was lost. The following day, however, the same kind of eva- 
cuation happened again, and to the same extent, which being saved 
* The Journal of Science and the Arts. Edited at the Royal Institution of 
Great Britain, vol. i., p. 297. CAUSES OF HABITUAL CONSTIPATION. 
123 
and measured, was found to amount to two pints. Another attack 
took place upon the 5th of April, when several irregular lumps of a 
soft light brown substance were voided, having the appearance of 
a large mass broken down, and when dry extremely friable: a part 
of each of these two last were subjected to a careful analysis, and 
found to consist entirely of sub-carbonate of magnesia concreted 
by the mucus of the bowels, in the proportion of about 40 per cent. 
“ The use of magnesia was now given up, and that of an active 
purgative medicine enjoined, with some other necessary directions, 
and there is every appearance of returning health, although some 
slight attacks have recurred, and small portions of the same concre- 
tion still occasionally come aw'ay. 
“ An instance in many respects resembling this occurred in the 
practice of some gentleman of eminence in this town, in which not 
only large quantities of a concretion of a similar description were 
avoided, but upon examination after death, which took place six 
months after any magnesia had been taken, a collection, supposed 
to be from four to six pounds, was found imbedded in the head of 
the colon, which was of course much distended. Some notes which 
were made of this case are I fear not to be found.” 
A third case occurred in the practice of Mr. Tupper, who has 
kindly supplied me with what particulars his memory and notes 
afford. 
“ The subject of this case was a nobleman, corpulent, very dys- 
peptic, of constipated habit, and affected with disease of the prostate 
gland, on account of which the catheter had been used for a long 
period. His lordship had been in the habit of taking daily for 
many years a dessert or table spoonful of Magnesia. For some 
time before he died his bowels became more than usually constipated, 
and he suffered severely from spasmodic pains. The evacuations 
which passed were soft and offensive. Strong purgatives were in- 
effectual ; and, enemas having been administered in the ordinary 
manner with no better success, a long tube was passed up the rec- 
tum and injections thrown into the colon. By this means, aided 
also by aperients given by the mouth, evacuations were procured 
in which were quantities of magnesia. The same plan was per- 
severed in, and magnesia to the amount of at least one or two 
pounds was brought away. The patient was at no time affected 
with vomiting, nor was any tumour perceptible in the abdomen. 
After a few weeks the patient died, having become greatly emaci- 
ated from protracted disease and suffering!, 
Necrotomy.—“The bladder was sound, except that its muscular 
coat was thickened. The prostate gland,1 was enlarged and schir- 
rous. One portion of the gland, of a softer texture than the rest, 
projected into the cavity of the bladder from behind and above the 
beginning of the urethra ; which projection, upon every attempt to 
evacuate the urine, must have been forced over the mouth of the ure- 
thra so as completely to block up the passage, and thus to act as a 
perfect valve. The urethra was free from stricture. The rectum, to 
the extent of five inches, was in a schirrous state ; its coats being at 124 
BURNE ON HABITUAL CONSTIPATION. 
least three-quarters of an inch thick for the greatest part of this 
space. The diseased prostate gland was so connected with part 
of the diseased rectum that no line of separation, or even distinction 
between them, appeared upon an incision being made through both. 
On the exterior of the schirrous portion of the rectum, extending 
completely round it from its union with the prostate gland, w7as a 
firm schirrous mass, inseparably connected both with the gland and 
the gut; the thickness of which between the rectum and the sacrum 
exceeded an inch and three-quarters. 
“ From the diseased state of the rectum, and from the schirrous 
mass which surrounded it, the cavity of the gut had become so 
contracted as barely to admit a tube of less than one-third of an 
inch in diameter, and as all muscular action and even muscular 
structure was lost in the disease, it became necessary to introduce 
daily—for some weeks before his lordship’s death—a tube of this 
size beyond the stricture, in order to procure evacuations.” 
Chalk, like magnesia, is apt to accumulate and concrete. Dr. 
Good speaks of its aptitude to form balls or calculi in some part of 
the intestinal canal when used in large quantities and long perse- 
vered in. These balls may produce a very troublesome obstruc- 
tion or colic, of which Dr. Good knew various instances: some 
were attended with alarming symptoms before the balls were de- 
jected. Many of the balls were evacuated in masses of more than 
an ounce weight each.* 
Sulphur also has been found to accumulate in the alimentary 
canal. Dr. Donald Monrof relates a case which happened in his 
own practice. 
A lady took daily for two or three weeks a spoonful ot flowers 
of sulphur. Some months afterwards, she was affected with 
uneasiness of the bowels for w’hich she took five or six warm baths 
and then a dose of physic, after which she passed by stool a large 
quantity of whitish heavy stuff, which, on being thrown into hot 
water, washed, and examined, was found to be sulphur. She told 
the doctor, that she had not taken a grain of sulphur for five 
months before. She continued to pass sulphur for five or six days. 
Cubebs, when given in large repeated doses in gonorrhoea, has 
been found, on dissection, accumulated in great quantity in the 
colon by Dr. Paris, and has been found also, by the same physician, 
lodging and producing great irritation in the rectum. 
White Mustard. Seed has been known to accumulate in the intes- 
tinal canal. Mr. Ballar informs me that an old gentleman who 
had been in the habit of taking mustard seed daily for several 
weeks, was suddenly seized w7ith pains in the bowels. An active 
purgative w7as prescribed, and brought away a large quantity of 
the seed in the form of hard and compact balls to the entire relief 
of the patient. 
* The Study of Medicine : by John Mason Good, M. D. Fourth Edition : 
by Samuel Cooper, vol. i. p. 122. 
f A Treatise on Medical and Pharmaceutical Chemistry, and the Materia Me- 
dica: by Donald Monro, M. D. London, 1788, vol. ii. p. 259. CAUSES OF HABITUAL CONSTIPATION. 
125 
Pills.—The number of aperient pills which many persons are in 
the habit of taking is very great. Some quack pills are taken to 
the extent of from ten to thirty in the course of the day. Instead 
of passing away with the action of the bowels, which they have 
been taken to accelerate, they sometimes stick together and lodge 
in the colon or rectum, producing great irritation or obstruction. 
Dr. Paris was attending a patient affected with tormina of the 
bowels which he could not account for, till, after the action of a 
brisk purgative, a quantity of pills were voided, many sticking 
together and forming masses of greater or less size. 
In Case LY., already related at p. 97, pills of soap and rhubarb 
had amassed to such a degree as to form a large compact sub- 
stance in the rectum, which produced obstruction and all the 
symptoms of strangulated hernia. 
The Sesquioxide of Iron, given in very large doses, is liable to 
accumulate in the form of balls or concretions. Like magnesia, 
sulphur, cubebs, and chalk, the sesquioxide of iron, when concreted, 
lodges generally in the rectum, producing irritation, obstruction, 
and other serious symptoms. It is consequently and very properly 
recommended that, while patients are taking any of the above 
remedies which are liable to accumulate and concrete, the bowels 
should be cleared from time to time by a brisk cathartic. 
Adulterated Bread.—The bread of the London bakers is univers- 
ally adulterated with alum for the purpose of bleaching it. In this 
way bread made of inferior flour is specious to the eye, looking 
nearly as white as that made of the finest. On asking a baker 
why he did not make his bread simple and pure as bread made at 
home, he replied, “ Why, sir, we are obliged to put a good face 
upon it.” 
Although alum may be employed only in small quantities, gener- 
ally of ten or fifteen grains to the quartern loaf, as Dr. Paris* sup- 
poses, yet on account of its astringent property, and of the harsh 
dry character it gives to bread only two days old, I cannot but 
believe that it has an influence in checking the action of the bowels ; 
and that it must therefore be regarded as one of the causes which 
contribute to establish habitual constipation. 
The late Dr. Babington having often heard that the London 
bakers mixed alum in their bread—to which it was supposed to 
owe its whiteness—made several attempts to detect it, but without 
success. Being a man of humour, he determined to try another 
expedient. Having broken a loaf in two, he rubbed the surfaces 
with finely powdered alum, and directed that, when the baker next 
called, he should be informed. Accordingly the man was shown 
into the library, when the doctor, putting on a serious countenance, 
observed, “ I thought, Mr. Baker, you told me that you never put 
alum in your bread. Now,” producing the prepared loaf, “what 
is the meaning of this sparkling appearance, which any one may 
* Medical Jurisprudence, vol. i. p. 37a. 126 
BUENE ON HABITUAL CONSTIPATION. 
tell is alum by the taste V* Taken by surprise, and overwhelmed 
by a palpable proof of the fact, the haker inadvertently replied. 
“ I don’t well know how it can be, Sir, but suppose some accident 
has happened, for we don’t in general put as much into the whole 
batch.” And thus the doctor gained his point. 
Other astringents of a more deleterious nature have been added 
to bread by bakers, as gypsum, pipe-clay, and chalk; and an ex- 
tensive fraud was carried on in Cornwall, where a very consider- 
able portion of porcelain clay—decomposed felspar—from St. Anne’s 
was introduced into the bread. Dr. Paris was informed by Mr. 
Hume, the chemist, that on examining some biscuits prepared for 
the use of the Navy, he found as much as eight per cent, of gyp- 
sum.* 
Concretions, of the various kinds found in the intestinal canal, 
prove not only sources of spasmodic colic but sometimes of con- 
stipation and obstruction. Dr. Good divides them into three kinds; 
of which he has given a description in his “ Study of Medicine” 
(vol. i. page 376) under the head “ Enterolithus.” 
Fruit Stones, of cherries particularly, are swallowed in great 
quantities by the lower class of people, without inconvenience for 
the most part, but at times they lodge and accumulate in some 
part of the large intestine and originate obstruction'with all its 
attendant symptoms and consequences. 
It is related in the “ Philosophical Transactions,” that Mr. 
Knowlys being called upon to open a youth, who died, as was 
supposed, of the colic and convolvulus, found the caecum “ vastly 
extended and stuffed with abundance of cherry-stoneswhich 
then were proved to be the occasion of his death.f 
Cherry-stones accumulated in the caecum have discharged them- 
selves by abscess in the right groin : the patient recovered.J In a 
person who was affected with a tumour of the abdomen, attended 
with spasmodic pains and movements, and who died after three 
years of suffering, the colon was found distended with three pounds 
of cherry-stones, and amongst them forty lead balls which he had 
swallowed in the hope of obtaining ease.§ Another person who 
swallowed a great number of cherry-stones did not render them 
for six months: nevertheless he did not suffer inconvenience.|| 
Mr. Stephens relates a case in which a boy ten or eleven years 
old was seized with pain in the bowels, followed by obstruction. 
He had a continued tenesmus which induced Mr. Stephens to ex- 
amine the rectum. Here he found a large accumulation of cherry- 
stones which he extracted to the number of 312.TI Two cases of 
* Medical Jurisprudence, vol. i. p. 376. 
t Philosophical Transactions, vol. xxii. p. 617. 
% Memoires de l’Academie de Chirurgie, vol. 1, p. 569. 
§ Memoires de l’Academie de Chirurgie, vol. 1, p. 459. 
H Ibid., p. 460. 
If A Treatise on Obstructed and Inflamed Hernia, and on Mechanical Ob- 
structions of the Bowels internally: by Henry Stephens. Second Edition. 
London, 1831, p. 145. CAUSES OF HABITUAL CONSTIPATION. 
127 
fatal obstruction, the one from almonds eaten in considerable num- 
ber, the other from nuts, occurred within the knowledge of Drs. 
Hastings and Streeten.* 
Jin Egg-cup found in the Jleon.—Of all the causes of intestinal 
obstruction, one of the most extraordinary is that of the egg-cup 
found by Mr. Dendy in the ileon of a man. 
The man was 60 years of age. For several months he suffered 
from abdominal ailments : but three weeks previous to his death he 
had intense abdominal pain with retching, &c., and eventually other 
signs indicating strangulation or obstruction ;—such as stercorace- 
ous vomiting and singultus, tumefaction of the abdomen, &c.; the 
bowels, however, repeatedly ejecting very scanty fluid evacua- 
tions. 
On the examination of the body after death, an earthen-ware 
egg-cup was discovered closely impacted in the ileum about ten 
inches from the cascum, in which part its lodgment appears to have 
been determined by the adhesion of the ileon to a hernial sac. But 
for this obstacle, the egg-cup would probably have traversed the 
whole of the small intestines and reached the crecum, perhaps even 
the rectum, when it might have been discovered and extracted; for 
as it had passed the pylorus, which was found dilated, one can 
readily admit the probability of its passing through the more yield- 
ing ileo-coecal valve.f The egg-cup was supposed to have been 
swallowed. 
Allied to this case is the swallowing of knives and of pieces of 
metal and of money. 
In the first volume of the “ Memoirs of the Academy of Surgery” 
there is an extensive collection of examples of foreign substances 
swallowed : some of which acted as causes of constipation more or 
less dangerous and fatal, 
A piece of leather was swallowed by a shoemaker at Cologne 
while laughing; it stuck in the oesophagus and threatened suffoca- 
tion. Fabricus Hildanus pushed it into the stomach, but it did not 
pass away for six months.J A person swallowed a piece of a 
flute four inches long, which was passed by the anus after three 
days.§ Another swallowed a silver fork, which passed after many 
months of great suffering.fi 
Substances, even of large dimensions, swallowed, pass the pylo- 
rus, the valve of the caecum, and the whole tract of the alimentary 
canal in a most surprising manner. Even the egg-cup would pro- 
bably have passed also, had it not been arrested by the adhesion of 
one of the convolutions of the ileon to a hernial sac. 
The part of the alimentary canal where foreign substances are 
most frequently arrested is the rectum, just within the anus. In the 
* Cyclopaedia of Practical Medicine, vol. iv. p. 570. 
f This case, with the drawing of the cup, was published by Mr. Dendy in the 
“ Lancet,” 1833-4. vol. i. p. 675. 
X Memoires de P Academic de Chirurgie. A Paris, tome i. p. 447. 
§ Ibid. p. 514. § Ibid. 518'. 128 
BURNE ON HABITUAL CONSTIPATION. 
article above quoted, examples are given which show how neces- 
sary and important it is to examine the rectum where, in cases of 
constipation and obstruction, tenesmus and other signs of irritation 
of this gut are present. Tenesmus, more particularly, is a diag- 
nostic sign that should be fully appreciated as indicating the pre- 
sence of some substance in the rectum, in cases of obstruction. 
Not only does constipation and obstruction depend frequently on 
foreign substances swallowed, but sometimes also on substances 
introduced into the rectum. Some very extraordinary cases of this 
description are related by M. Morand,* of which the one quoted 
from Marchetti was no less extraordinary than cruel and malicious. 
CHAPTER XI. 
OP THE TREATMENT OF HABITUAL CONSTIPATION. 
SECTION I. 
Peculiarities as regard the action of the bowels in some persons. Early rising. 
Habit of frequenting the closet regularly and of obeying the calls of nature. 
Exercise. Change of scene. Diet. 
The treatment of habitual constipation embraces the considera- 
tion not only of the use of aperient medicines, but also of all other 
means, however simple, which promote the action of the bowels. 
Simple means will sometimes restore the function of the bowels, 
when active measures have failed: as will be seen by the follow- 
ing interesting case, just now related to me by one of the party. 
A gentleman with his wife and sister-in-law arrived at Interlachen 
in the spring. The sister-in-law had long suffered from constipa- 
tion, which she had failed to correct by the use of medicine: the 
menstrua had become irregular and scanty, and her health impaired. 
By the advice of a Swiss practitioner she took exercise and drank 
two or three glasses of goat’s whey early every morning: and hav- 
ing persevered in this plan for some time her bowels began to act 
of themselves, and continued to do so to the entire relief of the 
constipation. Soon afterwards she menstruated plentifully and re- 
gularly, and recovered a state of perfect health. 
Before we proceed to consider the relative value of the various 
means alluded to, it will be expedient to glance at certain peculiar- 
ities which attach to individuals. 
As a general result, it obtains that the bowels ought to relieve 
themselves freely once in twenty-four hours. Yet the exceptions 
* Ibid, tome iii. p. 620, et seg. TREATMENT OF HABITUAL CONSTIPATION. 
129 
are many in which persons have habitually two, even three, evacu- 
ations daily ; and, on the other hand, in which persons have habitu- 
ally an evacuation only every second or every third day ; both the 
one and the other habit being not only consistent with but conducive 
to the health and comfort of each class of persons. Two extra- 
ordinary instances of peculiarity in this respect are mentioned by 
Heberden.* In one the body was open only once a month ; in the 
other it was open twelve times a day for thirty years, and then 
seven times a day for seven years. To these exceptions the physi- 
cian should strictly attend; refraining in the one case from check- 
ing the naturally frequent, and in the other from accelerating the 
naturally unfrequent action of the bowels. It is the latter idio- 
syncrasy that will engage our attention. 
It has occurred to me, on several occasions, to meet with indi- 
viduals having the above peculiarities ; which experience has taught 
me to respect. Indeed the physician will act wdsely not to disre- 
gard idiosyncrasy of any description, whether it refer to the habit 
of body just spoken of, whether to the influence of particular 
drugs, or to the irritability of the skin. Some individuals cannot 
take the smallest dose of opium without unpleasant effects: some it 
distracts and maddens. Some are salivated by the smallest qaun- 
tity of mercury. Some have the skin so susceptible that leeches 
and blisters never fail to excite an erysipelas. 
To these peculiarities, when stated, we are too little disposed to 
listen; wTe are apt to regard them as caprices and fancies rather 
than as true idiosyncrasies, until some untoward occurrences ad- 
monish us that they cannot be slighted or disregarded without 
hazard to the well-being of our patients and to the reputation of 
ourselves. A gentleman is known to me whose bowels act habi- 
tually every alternate day, and who is never so well if they act 
more frequently, he becoming then W'eak and languid. I knew a 
lady, too, who enjoyed good health and lived to a great age, in 
whom an action took place habitually only once in three or four days, 
and whose health suffered if this habit was interfered with by medi- 
cine. Renauldinf mentions the instance of a lady who passed ordi- 
narily a whole week, and sometimes ten and fifteen days, without 
going to the closet; and she was scarcely ever indisposed. 
This less frequent action of the bowels, in particular individuals, 
is not properly a state of constipation, the dejections being of a 
healthy character, and not having undergone those changes of 
dryness and hardness which they usually do when so long retained. 
Here it would be unwise and officious to interfere, seeing that not 
only no inconvenience but absolute good results from this habit. 
In determining then the use of aperient medicines the physician 
should not be unmindful of these facts. 
It should be remembered, nevertheless, that this unfrequent action 
*Commentarii de Morborum Historia et Curatione. Editio Altera, p. 14* 
Londini. 
f Diet, des Sciences Medicales, vol. vi. p. 254. 130 
BURNE ON HABITUAL CONSTIPATION. 
of the bowels, though consistent with and conducive to the health 
of the individual, is pernicious to persons generally; and that it is 
to be regarded as salutary only where the dejections are copious, 
free, and of natural colour and consistence. For we meet with 
patients who contend that they are more comfortable and feel bet- 
ter on those days when there is no action of the bowels, although 
in them the excrementitial residue shall, by this retention, undergo 
the pernicious changes incidental to constipation, and be voided 
with pain and difficulty. In such persons I have never known the 
health good, however comfortable they may feel in the absence of 
dejections; and I have generally found that they are affected with 
piles or irritation of the rectum, which cause them to suffer when 
evacuations occur; and which local sufferings have been produced, in 
the first instance, and the health probably impaired, by the habit 
and state of constipation; and can only be relieved and improved 
by obviating it by appropriate means. 
Regimes.—The influence of regimen in obviating constipation 
by promoting the healthy and daily exoneration of the bowels is 
unquestionable. 
Early Rising favours the natural action of the bowels. By 
early rising, I would understand rather the avoiding a second sleep 
in the morning than the getting up at any specified hour. On ac- 
count of the difference of habits in different classes, and of those 
who reside in town and in the country, that hour which is early to 
one maybe late to another; and vice versa. Early rising, then, 
must be construed relatively. A certain duration of sleep is essen- 
tial. If the husbandman retires to rest at eight o’clock, and the 
citizen at eleven, both cannot be expected to rise at the same hour. 
Allowing eight hours sleep to each, early rising to the husbandman 
would be four, to the citizen seven o’clock. It is the lingering in 
bed, the going to sleep a second time after having enjoyed a good 
night’s rest, that does the mischief. A person awakes refreshed, 
light, cheerful: but if, instead of at once getting up, he dozes off to 
sleep again, he afterwards rises with unwillingness ; and finds his 
head heavy, his spirits dull, and his bowels indisposed to act. The 
reverse is the case with him who avoids this second sleep and thus 
in fact rises early: he is brisk and cheerful; a state highly favour- 
able to the alvine function. 
Next to early rising, and not less important is the habit of 
frequenting the closet regularly at a certain period of the day, 
and of strictly obeying the calls of nature. The mischief ac- 
cruing from neglect of this latter circumstance has been already 
commented upon ; it is only requisite for me now to urge the neces- 
sity of attending to these admonitions. However slight they may 
be, let them be obeyed; and, what is more, if the effect does not 
take place as anticipated, wait patiently and solicit nature ; by which 
means that end will often be accomplished which otherwise would 
seem impossible. 
The customs and callings of civilized life are too often opposed TREATMENT OF HABITUAL CONSTIPATION. 
131 
to the maintenance of health. We eat in such haste that one would 
suppose mastication was superfluous : hence one common source of 
indigestion and its consequences. So when we retire to the closet, 
if nature does not relieve herself at the instant, we make no further 
effort; and constipation is allowed to take place and to continue. 
Exercise, as opposed to sedentary habits, is often a successful 
means of obviating constipation. Many there are who, when in 
exercise, have their bowels regular; but who, when obliged to fol- 
low some sedentary occupation, suffer from constipation imme- 
diately. Gentle exercise immediately after breakfast is favourable 
to the end in view. Exercise of the muscular system, as a general 
means of preserving health, has been so admirably portrayed and 
insisted on by Drs. Combe,* Barlow,f and Forbes,J that I shall best 
consult the welfare of my readers, and of young persons especially, 
by referring them to the valuable observations of these authors. 
Change of scene to those who suffer from habitual constipation 
has often a marked salutary effect. I know a gentleman who, when 
confined to the city, was always troubled with costive bowels : but, 
when he was able to liberate himself from the anxieties of business 
and take an excursion into the country, the bowels acted of them- 
selves most freely and regularly. I know another who, when con- 
fined to his professional duties in town, suffers equally, but when he 
can escape from them, even for a day, the bowels are not only no 
longer confined, but act as it were with impatience. It does not 
follow, however, that change of scene produces this desirable effect 
upon all. Far from this, it does not relieve habitual constipation in 
the greater number, and it is this point particularly on which I desire 
to say a few words. 
The beneficial influence of change of scene on the general health 
is so fully appreciated, that it would be superfluous to expatiate on 
it at this time. Yet all the advantages which it would afford are 
often marred by a costive state of the bowels; the pernicious effect 
of which altogether counteracts the good which would otherwise 
result. Persons who make excursions to the country or to the con- 
tinent on the score of health should be provided with instructions 
and means to obviate constipation : else they may as well remain 
at home. I believe I may say without exaggeration, that inattention 
to this point is the main cause of the disappointment which those 
dyspeptics feel who go into the country for health, and find they 
return with little amendment. 
Diet.—By the aid of diet, much may often be accomplished. A 
glass of cold water taken on rising in the morning, will in some 
promote an action of the bowels. A light breakfast to those who 
* Physiology applied to the Preservation of Health. By Andrew Combe, 
M.D. Chap. IV. On the Nature of the Muscular System. 
f Cyclopaedia of Practical Medicine, article Physical Education. By Dr. Bar- 
low, of Bath, vol. i., p. 698. 
\ See note appended by the editor, Dr. Forbes, to the above article of Dr. 
Barlow, vol. i., p. 698- 132 
BURNE ON HABITUAL CONSTIPATION. 
are sedentary will favour this action, especially if eaten soon after 
getting up, when a heavy or full breakfast is of a very questionable 
propriety. 
Coarse brown or bran bread is very efficacious, the bran acting 
as a salutary stimulus to the peristaltic action of the intestines. It 
is open sometimes to the objection of the bran exciting irritation in 
the rectum; on wdiich account some persons are unable to continue 
its use. 
Figs, prunes, mustard seed, and ripe fruits are taken with the 
same view and often with good effect. It is probable that the seeds 
of figs and of mustard act, like bran, by their mechanical irritation, 
which promotes the action of the bow'els without any injurious influ- 
ence on the mucous membrane. The white mustard seed was some 
years ago taken almost generally in a vast variety of complaints, 
the greater number of which it wras found to alleviate, and some to 
cure. The stimulant property of mustard seed may have been, in 
part, the means of relief to dyspeptics, but I incline strongly to the 
opinion that the good resulting from the use of this seed depended 
on its securing the action of the bowels in those habitually costive, 
a proof of the vast influence which the regular evacuation of the 
alimentary canal has on all diseases. 
Bacon, either broiled and eaten hot, or boiled and eaten cold for 
breakfast, is a useful auxiliary in regulating the bowels. What is 
remarkable in relation to the fat of bacon is that dyspeptics digest 
it well and easily. Even persons who are bilious and altogether 
unable to partake of rich dishes eat bacon not only without unpleasant 
consequences but with decided advantage; the more so in propor- 
tion as it encourages the action of the bowels. 
Like the other articles which have been enumerated, bacon, par- 
ticularly broiled, should not be taken daily for too long a period, or 
it may recoil upon and satiate the stomach. It is better to vary 
diet from time to time, and to endeavour, by the judicious and alter- 
nateuuse of the several means described, to bring about and retain 
the natural function of the intestinal canal. Trivial and unimportant 
as these means may appear, they nevertheless exercise a decided 
and beneficial influence, and will often go far to re-establish the 
health, which has been much disordered by habitual constipation. 
SECTION II. 
ON THE USE OF APERIENT MEDICINES. 
A3 relates to age, sex, temperament, idiosyncrasy. Choice of aperient medicines. 
Frequency of their administration. Period of the day. 
The use of aperient medicines, in the treatment of habitual con- 
stipation, offers a very wide field for observation and remark; 
and is a subject to which an attention proportionate to its import- 
ance has not, I think, been accorded. TREATMENT OF HABITUAL CONSTIPATION. 
133 
The chief indication in the treatment of habitual constipation is 
to restore the excretory function of the alimentary canal to its nor- 
mal and natural state ; an object best accomplished, not by purging 
the bowels but by securing their full and free action at regular pe- 
riods by medicines which not only act but which dispose the bowels 
to act of themselves. Many aperients, as is well known, operate 
mildly and effectually, but leave the bowels constipated: while 
others operate equally well and leave the bowels disposed to their 
natural functions, a desideratum of the first importance. 
It has been too much the custom to remove constipation by doses 
of purgative medicine rather than to obviate it by the periodical 
administration of some appropriate aperient: the result of which 
practice is that the bowels are always either confined or purged; 
states deviating too much from their natural function to be com- 
patible with health. The medicines prescribed are pretty uniformly 
the same; colocynth and calomel, or a “ black dose” of senna and 
salts, being the ordinary resource. They purge the bowels but 
distress the patient; and leave him equally or more liable to consti- 
pation. 
In speaking thus, let me not be understood as speaking too gene- 
rally : the exceptions to the remark are many, but it will, I appre- 
hend, be admitted that the system of giving single aperient or 
cathartic doses, rather than of pursuing a systematic course of 
laxative treatment, prevails. 
The circumstances under which constipation exists vary indefi- 
nitely. They relate to age, sex, temperament, idiosyncrasy; they 
relate also to the affections which have arisen as consequences of 
the constipation, and to other affections which may happen inci- 
dentally to be combined with it, or of which the constipation may 
be only a symptom. All these points require to be considered be- 
fore it can be determined what aperient is most proper to be em- 
ployed. 
Age refers more particularly to the early and late periods of life. 
In childhood mild aperients, as castor oil and senna, are to be pre- 
ferred. I allude to children of a costive habit, which, although not 
frequent, is far from uncommon, and I have thought has been de- 
rived in some instances from the mother. These mild aperients are 
not introduced as substitutes of the active purgatives which are 
found to be so beneficial in many of the disorders of children: they 
are recommended only as the more desirable means of regulating 
the bowels where they are habitually confined. In advanced life 
the more active and stimulating resinous cathartics are generally 
requisite, the less powerful proving altogether ineffectual. Aloes, 
colocynth, camboge, and scammony administered singly or va- 
riously combined, act efficiently and pleasantly at this age; while 
rhubarb may fail altogether; which is especially the case in those 
affected with paralysis. 
Sex may perhaps demand less consideration than either of the 
other circumstances. On the whole I have found that females 134 
BURNE ON HABITUAL CONSTIPATION. 
require more active aperients than males: which may be ascribed 
to the greater frequency of constipation in them rather than to 
their sex. 
Temperament certainly merits consideration. Persons of a 
sanguine temperament will not, for the most part, bear or require 
an equal dose with those of the phlegmatic or melancholic. Yet 
the exceptions are numerous: and the physician therefore must 
often rely on his own discrimination to guide him in the choice of 
means. 
Idiosyncrasy should never be overlooked or slighted. Jn some 
persons, a dose of calomel will produce tremors and depression of 
spirits ; in others, it will gripe and rake the bowels most sadly. In 
some, rhubarb will not act, but, on the contrary, rather confine the 
bowels : in others, it is rejected from the stomach altogether. In 
some, magnesia lies so heavy and cold at the stomach that they 
refuse to take it. In many, salts produce flatulence and coldness 
in the bowels, with great rumbling and disturbance, and, at the 
same lime, insufficient and unsatisfactory evacuations. In many, 
aloes excite so much irritation in the rectum as to be altogether 
inadmissible. And, lastly, some persons are so griped by senna 
as to take it with great reluctance : although it is perhaps the most 
valuable, because the least injurious, aperient that we possess. 
It is surprising how great is the difference in individuals as to 
the degree of purging they will bear and require. I have known 
ladies made faint and really ill for two or three days by the action 
of an ordinary cathartic pill and draught; while others will bear and 
require purging to a very great degree; dose after dose, dejection after 
dejection, affording great relief. As no general rule can be laid 
down on this head, the practitioner must rely on his own judgment, 
formed on information derived from the patients themselves ; 
which will place him in possession of their constitutional peculiar- 
ities. 
The consequences already existing of habitual constipation should 
very materially influence our decision in the choice of aperient 
medicines. Where there is irritation of the pelvic viscera gener- 
ally, or any special affection of either of these viscera, or of the 
large intestine, the aperient must be selected accordingly. In irri- 
tation of the pelvic viscera all aperients which stimulate the rectum 
should be avoided ; or so combined with others as to neutralise or 
obviate this property. Thus, aloes given alone would be inadmis- 
sible, but conjoined with the sulphate and carbonate of magnesia 
forms a most valuable compound, efficient and not heating or irri- 
tating. So, in any affection of the bladder or womb, the same rule 
must be observed. Conceive the distress that would result from 
the use of a resinous cathartic w'here there is vesical or uterine 
irritation; and the comfort that will be derived from relieving the 
bowels by laxatives free from any irritating property, as senna, or 
salts and magnesia. Salts too, though desirable because they do 
not distress the rectum, are yet rather to be avoided where the TREATMENT OF HABITUAL CONSTIPATION. 
135 
bladder is very irritable, for the reason that they impregnate the 
urine and render it more stimulating. Whereas one object in the 
treatment of constipation combined with vesical irritation should 
be to diminish the saline and stimulating properties of the urine by 
diluents and by the avoidance of saline medicines. 
In fecal accumulations in the colon, and in accidental obstruc- 
tions independent of any organic cause, active and stimulating pur- 
gatives followed by salines may be most advantageously given at 
once in full dose: but if they fail of success, then I agree with 
Dr. Holland that the persisting in the use of these powerful cathartics 
is a question of very doubtful propriety. The practice pursued in 
Case XLIX. of discontinuing active means and substituting salines 
gives weight to the above remarks; it having been entirely suc- 
cessful. 
Where piles or anal fissures exist, sulphur has long been the popu- 
lar as well as the professional resource, on account of the mildness 
with which it operates: all acrid purgatives being universally 
avoided in these cases. 
Where any special disease, as stricture of the large intestine, if 
present, cathartics, however powerful, which act merely by increas- 
ing the peristaltic action of the intestine, are inefficient, the stricture 
offering an insuperable obstacle to the passage of feculent matter of 
ordinary consistence. Such cathartics urge on the intestine to in- 
effectual efforts, produce violent spasms and sometimes, indeed, 
rupture of the gut. Salines, on the contrary, not only excite the 
peristaltic action moderately but at the same time render the feces 
liquid, and thus favour and secure their passage through the nar- 
rowed channel of the bowel; greatly to the comfort and relief of 
the patient. 
It is not necessary to pursue this subject further at the present 
time; inasmuch as it yet remains for me to speak, in detail, of the 
properties and eligibilities of individual medicines: whatever may 
have been now omitted will naturally present itself for considera- 
tion ; and repetition be thus avoided. 
Not only is it important to select the aperient best suited to every 
individual case, but to determine the frequency with which it should 
be repeated, and the time of day at which it should be administered. 
Although the ultimate object in the treatment of habitual consti- 
pation is to bring about an action of the bowels once in twenty-four 
hours, it may not in all cases be proper to attempt this in the first 
instance by administering opening medicine daily. In persons 
habitually costive it is at first no easy matter to regulate the dose 
so that it may simply relieve the bowels. A small dose will often 
prove ineffectual, a large one too powerful; and w'ere this repeated 
every day the patient would be distressed. I have generally found 
it better, at the commencement, to administer aperients in sufficient 
dose every other day,—taking the chance of the bowels relieving 
themselves on the alternate day,—until they have been brought into 
a more tractable state, and the influence of medicines upon the in- 136 
BURNE ON HABITUAL CONSTIPATION. 
dividual ascertained: after which the aperient can be so regulated 
in dose as to be administered daily with advantage. 
Perseverance on the part of the patient is absolutely necessary, 
in order that the bowels maybe regularly exonerated, and continue 
to be so for a period sufficiently long to restore their natural habit and 
function. In proportion as the state of the bowels improves and 
becomes more tractable, so let the dose of the aperient be diminished, 
till at length little, and eventually none, shall be required. I have 
known persons obliged to commence with an ounce of infusion of 
senna, who have been gradually able to reduce it to a tea-spoonful. 
So with castor oil, dinner pills, and the like. 
The time of day at which opening medicine should be taken is 
of some moment. It being always conducive to the patient’s com- 
fort that the bowels should act in the morning, medicines should, 
with this view, be given either before dinner; at bed-time; or on 
getting up; according to the length of time they require for opera- 
tion. Pills are often taken advantageously a few minutes before 
dinner, for they act certainly better and in less dose than when 
taken after dinner. They may also be taken in the evening. Senna 
should be taken at bed-time, and, on the whole, it will he found 
that aperients sit better upon the stomach at this period than at 
any other; and, by carrying down the contents of the stomach 
and upper part of the alimentary canal during the first part of the 
night, promote and often insure tranquil rest, which otherwise 
would be disturbed. Salts should be taken on an empty stomach, 
and therefore in the morning; because they act quickly, usually in 
one or two hours, if the dose is well regulated. 
In those who are troubled with piles it is greatly to their com- 
fort to have the bowels relieved in the evening, because they soon 
afterwards go to bed, and their sufferings, which have been aggra- 
vated by the action of the bowels, are relieved by the horizontal 
position. Whereas, if the bowels act in the morning, the irritation 
arising therefrom is kept up during the day by exercise and the 
erect position. 
SECTION III. 
OF THE ACTION AND VALUE OF APERIENT MEDICINES ADMINISTERED SINGLY OR 
IN COMBINATION. 
Sulphur. Magnesia. Rhubarb. Jalap. Aloes. Colocynth. Scammony. 
Camboge. Castor oil. Saline aperients. Senna. 
It remains for me to endeavour to determine the action and value 
of aperient medicines administered singly or in combination, as 
well as the grounds on which they are to be preferred in the treat- TREATMENT OF HABITUAL CONSTIPATION. 
137 
ment of those disorders which have been regarded, in the former 
part of this work, as consequences of habitual constipation. 
Inasmuch as the circumstances under which aperient medicines 
are employed are numerous and complicated, so is it requisite to 
call to our aid the whole list of drugs classed as cathartics, with 
the single exception, perhaps, of elaterium. For although many 
of them are powerful and drastic when prescribed in full dose, they 
yet act mildly and efficaciously when the dose is moderated, or when 
they are combined with others less active. Besides, so great is the 
difference in the strength of drug required in different individuals, 
that colocynth, camboge, aloes, or scammony may be proper in 
one person, while a few grains of rhubarb may suffice in another. 
Even croton oil, in minute doses, proves often an eligible and 
valuable adjunct. 
It is not my purpose to describe at length or systematically the 
virtues and properties of cathartic drugs—a task already ably 
performed in treatises on Materia Medica and Pharmacology—but 
to endeavour to point out the manner in which they maybe adapted 
to the particular cases, so as most effectually to fulfil the great 
object in view, the obviating habitual constipation. 
Sulphur may be resorted to as an aperient in habitual constipa- 
tion when attended with piles, from its well-known mild operation, 
and the little distress it occasions to the rectum. It is usually com- 
bined with confection of senna, and given at bed-time; but in order 
that the action of the bowels may take place in the evening—which 
we have seen is desirable where there are piles—it would be better 
administered about noon. It is also given in any thick simple vehicle, 
as barley-water, gruel, or milk, once or twice a day, in the dose of 
half a drachm, or a drachm, and may be combined with magnesia, 
in the quantity of fifteen grains. When its odour is manifested on 
the skin, it should be discontinued. 
Magnesia, by its union with the acids which it meets with in the 
stomach and alimentary canal, often acts as an aperient. Its opera- 
tion however is so mild that it cannot always be depended upon ; 
yet in many persons it answers the purpose perfectly. It there- 
fore has the double power of correcting acidity in the stomach, 
and of promoting the action of the bowels; on which account it is 
taken by some persons daily in large quantities, as a tea or table 
spoonful. It should be recollected, that when taken in such quantity 
for a considerable time, it is liable to accumulate in the large in- 
testine in consequence of its insolubility; and therefore is a very, 
objectionable medicine in cases where there is any mechanical 
alvine obstruction, as stricture. 
The properties of magnesia render it a most valuable medicine 
when given in combination with other aperients; particularly with 
the sulphate of magnesia, or with the compound decoction of aloes 
or with both. Its combination with rhubarb, in the proportion of 
two grains to one, is an excellent and popular form. I generally 
prescribe the carbonate, which Dr. A. T. Thomson rather objects 138 
BURNE ON HABITUAL CONSTIPATION. 
toon account of the disengagement of the carbonic acid ; an in- 
convenience which I have myself not found complained of. Mag- 
nesia alone or in combination is particularly indicated where there 
is acidity, heat of stomach, and irritation of the pelvic viscera. 
Where magnesia lies heavy and cold in the stomach it should be 
avoided. In a lady whom I attend, the stomach rejects it al- 
together. 
The solution of magnesia recently introduced is likely to prove 
the most agreeable form for administration. 
Rhubarb, though an excellent stomachic aperient, is not a desir- 
able medicine in habitual constipation, because it is apt to leave the 
bowels confined. Where, however, there is dyspepsia with consti- 
pation, and where other aperients do not so well agree, rhubarb is 
a good resource. It associates well with ammonia, soda, magnesia, 
sulphate of potass, aloes, and bitters. 
For the purpose simply of an aperient, it may be made into a 
mass with the tincture of rhubarb, and divided into two or three 
grain pills, of which as many may be taken at bed-time, or before 
dinner, as are found requisite. Rhubarb forms into pills equally 
well with water, but when kept long in this state is liable to decay. 
Soap is often added to keep the pills moist, but as, when many are 
taken for a considerable time, the soap seems to favour their ac- 
cumulation into one tough mass in the large intestine, as in Case 
LV., p. 97, it is perhaps better omitted. I have known persons 
regulate their bowels and improve the appetite by chewing a few 
grains of rhubarb immediately before dinner every day. The com- 
pound tincture of rhubarb is an excellent cordial and tonic, but too 
heating to be used as an ordinary aperient. The idiosyncrasies in 
relation to rhubarb are, that it will not act as an aperient with some 
persons, or be retained on the stomach by others. 
Jalap is a most efficacious and excellent aperient, except that it 
is apt to nauseate the stomach; for which reason it is not so fre- 
quently prescribed as its virtues would justify. In moderate doses, 
it increases the peristaltic action of the bowels, and secures copious 
and consistent evacuations, without irritating the rectum or neigh- 
bouring viscera. Its dose too may be regulated with great nicety. 
I have found it agree well when combined with an equal quantity 
of rhubarb and made into pills with mucilage ; of which as many 
may be taken at bedtime as may be found necessary. It forms a 
good addition to aloes and the other resinous purgatives, where 
such aperients are proper. In many instances of very obstinate 
habitual constipation where other active aperients have failed, or 
have not been admissible, jalap has proved most effectual. In such 
cases I have administered it at bed-time mixed with the confection 
of senna : and at the present moment I have under care a person 
afflicted with the fibrous tumour of the uterus, in whom jalap is the 
only medicine that acts freely and without distress. The tincture 
added to aperient mixtures increases very much their efficacy. 
In a patient of the Public Dispensary, rather advanced in life, TREATMENT OF HABITUAL CONSTIPATION. 
139 
whose abdomen was tympanitic from constipation, so that she ap- 
peared like a person in an advanced state of pregnancy, the jalap,* 
in the dose of half a drachm, removed the flatulence most thoroughly. 
She had long suffered from this distension, and had received but 
little relief from other medicines. 
The extract of jalap, properly prepared, is an active and con- 
venient form for administration : but the extract kept in the shops 
is uncertain. A patient of mine, for whom the extract had been 
prescribed, found the pills inert: but having obtained some from 
another house, the due effect was produced. The efficient pills she 
had procured from Godfrey and Cooke, which induced me to in- 
quire of them how their extract was prepared, when I was informed 
that they macerated the jalap in rectified spirit, instead of spirit 
and water. 
Aloes, on account of its well-known purgative property and the 
readiness with which it is formed into pills—the most convenient 
form of medicine—is a popular resource as an aperient. It is very 
certain in its operation, but objectionable as a general remedy in 
habitual constipation, because it leaves the bowels disposed to be 
confined, so that no ground is gained beyond the immediate relief; 
and because when taken continuedly it rather loses its effect, and 
requires the dose to be augmented. It is objectionable also on 
account of its heating property and its irritating effect upon the 
rectum, and, through the sympathy of contiguity, on the other pelvic 
viscera. Where habitual constipation has already induced irrita- 
tion and congestion of the bladder, uterus, or rectum separately or 
combined, or where there are piles, anal fissures, or prolapsus, aloes 
is altogether inappropriate and inadmissible. 
In young persons particularly, in whom the organic sensibility is 
always more easily excited, it is still less proper as an habitual 
aperient, though excellent often as a remedy in chorea, chlorosis, 
and arnenorrhoea. In the middle or later periods of life, if there is 
little or no pelvic irritation present, it is found to regulate the bowels 
beneficially; and usually forms the active ingredient in dinner pills.f 
Many take pills of this description for years without inconvenience; 
and if attention is paid to the calls of nature, and a habit of frequent- 
ing the closet at a particular time, as at getting up in the morning 
or after breakfast, is cultivated, the dose may sometimes be lessened 
to a very harmless degree. The pills should be taken a few 
minutes before dinner. It is better that they should contain each 
* As an occasional purge, where the bowels are foul, as in persons on the eve 
of having an attack of gout, the following jalap draught, taken fasting in the 
morning, clears the alimentary canal most beneficially, and without distress:— 
R. Pulv, Jalap® ; Vini Colchici, Tinct. Hyoscyami, Tinct. Lavand. Comp., 
—singulorum f. 5ss-> Aquae Distillatse f. §i. Misce. 
-J- The following is a good form :— 
R Aloes 9j; Pulv. Rhei ; Pulv. Ipecacuanha gr. v.; Mellis gr. xii.; Spi- 
rit. Tenuioris quantum satis est. Misce, et in Pilulas xx. vel. xxx. vel xl. divide. 
Ex quibus unam, quas, vel tres paulo ante prandium quotidie sumat. 140 
BURNE ON HABITUAL CONSTIPATION. 
but a small dose of aloes, as the third or half of a grain or a single 
grain, in order that no more may be taken than is absolutely re- 
quired; so that, according as the habit is costive, and as the bowels 
may, from day to day, require—one, two, or three of the pills of 
either strength may be taken. When given in substance it should 
be reduced to a very fine powder. The mechanical division of 
this and of other resinous purgatives influences their operation. It 
is stated by Dr. A. T. Thomson,* that “ Resinous cathartics coarsely 
powdered cause griping and tenesmus, while in a state of more 
subtle division they operate with little sensible effect, a circumstance 
at variance with the law which regulates the degree of action of 
most other substances.” 
The compound decoction of aloes is comparatively free from 
the irritating property of aloes given in substance: and when pre- 
scribed in combination with the carbonate and sulphate of magne- 
siaj* constitutes one of the most useful medicines in the treatment 
of the consequences of habitual constipation. The mixture may be 
taken at bed-time, and repeated either on getting up, or at noon, 
on the following day. Given alone, the compound decoction is a 
good aperient in hypochondriac and many nervous dyspeptics; ex- 
cepting however where there is a feverish or inflammatory dispo- 
sition, as evinced by hot hand, flushed face, and high coloured 
urine. It may be taken in the quantity of half an ounce twice a 
day; or of six drachms, or of an ounce, the first thing in the morn- 
ing. For this purpose the simple tincture, the tinctura aloes, 
answers also in the same doses; but the excessive quantity of liquo- 
rice which it contains disgusts the palate and stomach when taken 
alone. 
Colocynth, which is always used in the form of extract, simple 
or compound, should be prescribed very nearly under the same 
circumstances, and with the same reservations as aloes. 
The simple extract is on the whole preferable as an habitual ape- 
rient; and either it or the compound may be advantageously com- 
bined with the extract of henbane, which diminishes its griping and 
irritating quality, and renders its action more agreeable. It is con- 
stantly employed in combination with calomel as an efficient purge : 
and occasionally I have had recourse to this combination, in small 
doses, in conjunction with mild and cooling aperients, during the 
early treatment, where the constipation has been obstinate and the 
patient bilious. In this case the stronger medicines—though at 
times desirable to shun—are frequently required until the bowels 
have been rendered tractable and responsive to milder means: 
which, with care, they soon become. 
In colic, from obstinate constipation, the colocynth and calomel 
* Cyclopaedia of Practical Medicine, article Cathartics, 
f The following is the general form used by the author:— 
R. Magnesia Carbonatis Jiss.; Magnesia Sulphatis 3yj.; Decocti Aloes 
Comp. f. 5ij.; Aqua Distillat. f. gvj. Misce. Cochlearia quo vel tria majora 
semel bisve quotidie capiat. TREATMENT OF HABITUAL CONSTIPATION. 
141 
conjoined with opium, all in full dose, may be given at the outset, 
and be followed by saline aperients: the effect of the whole being 
to allay pain, to excite the peristaltic action decidedly, and to render 
the retained excrement more or less liquid and easy of expulsion. 
Scammony, which in full dose is a very drastic purgative, and 
on that account not an eligible medicine to be employed alone in 
habitual constipation, is, nevertheless, useful and proper in combi- 
nation where the stronger medicines are required. With aloes and 
jalap* it is found at the Westminster Hospital to be effectual where 
the bowels are obstinate. With the powder of senna, in the form 
of confection, it adds to its efficacy. With the extract of jalap; as 
in the pulvis scammonii comp, of the London Pharmacopoeia, it is 
a most powerful cathartic, and in a modified dose is an effectual 
aperient; more agreeable however and suitable to the stomach when 
formed into pills with confection of roses than when administered 
in powder. 
Camboge, like scammony, is drastic in full dose, and open to the 
same general objection and commendation. It proved most useful 
and effectual in Case XXI., where it was almost impossible to regu- 
late the bowels by other means. In the compound camboge pill 
it is combined with aloes, ginger, and soap, a combination of most 
promising efficacy; but which, in my practice, has not answered 
my expectation; it having failed to act in proportion to the dose. 
I have observed the failure in other compounds of the pharmaco- 
poeia, as the compound rhubarb pill: and so little reliance am I 
able to place upon them, in a general way, that I almost invariably 
prescribe extempore and at length. This failure must, I think, be 
attributed to the inferior materials employed, the retail houses fre- 
quently purchasing these compounds ready prepared in the mass; 
and stipulating for a lower price than the genuine articles can be 
supplied at. It cannot in any way depend on the combinations 
themselves, as prescribed by the College, for they are appropriate 
and excellent. It must, I am sure, be a matter of common expe- 
rience and observation with practitioners that the opium in the pulvis 
ipecacuanhae comp, and in the pilulse saponis comp, produces less 
effect in proportion to the dose than when the opium is given alone. 
The latter, indeed, can scarcely be relied upon when the full effect 
of opium is desired. 
Calomel, on account of its specific virtues as a mercurial, is al- 
together unfit for use as an aperient. In the treatment of habitual 
constipation it can only be had recourse to where there is a con- 
gestion of the liver or disordered or deficient secretion of bile ; 
then it may be safely and advantageously employed in combination 
with rhubarb; aided, if necessary, by other aperients. Where the 
* R Scammonii, aloes, singulorum £)j.; Jalapsejss; Misturse Acacise quan- 
tum satis est. Misce et in Pilulas xx. divide. Capiat unam velquas bora de- 
cubitus. 
R. Scammonii, Aloes, singulorurn ; Terebinthinae Chiae Misce et 
in Pilulas xvj. divide. Sumat unam vel quas vespere. 142 
BURNE ON HABITUAL CONSTIPATION. 
bowels are obstinate and there is no objection, on the score of piles 
or pelvic irritation, it may be given at bed-time with colocynth, 
and be followed in the morning or in the day by a saline aperient 
with magnesia. As it is requisite in these cases to continue the 
calomel for some time, the dose should not exceed a quarter, half, 
or a whole grain. 
Calomel, after a few doses, will excite in some persons a most 
distressing irritation of the rectum with tenesmus; which is usually 
relieved by an injection of barley water, the calomel being discon- 
tinued of course. 
Calomel is too indiscriminately added to colocynth for the pur- 
pose of increasing its efficacy as an aperient, a practice certainly 
to be condemned, because of the specific influence of the mercurial 
which may suddenly and unexpectedly affect the individual so 
taking it; besides exposing him to the risk of cold. It is indeed, as 
has been already stated, entirely unfit to be used as an ordinary 
aperient. 
Castor Oil is, on the whole, one of the most innocuous and cer- 
tain aperients in the Materia Medica, and would no doubt be used 
habitually were it not that its taste is so disgusting to many, that 
they cannot take it or retain it upon the stomach. The castor oil 
of the present day, is tasteless, compared with that formerly in use, 
and can be taken by many without repugnance. It acts quickly, 
does not produce a subsequent costiveness; and the longer it is 
given the less the dose required; a great desideratum. If taken 
daily the quantity may gradually be diminished to half a tea-spoon- 
ful; Dr. Thomson says to a few drops ; and yet the full effect be 
maintained. 
The proper time for taking it is fasting in the morning; the best 
form is the pure oil floating on a little coffee, sherry wine, or brandy 
and water. A young woman, who had recently been in the West- 
minster Hospital—affected with uterine irritation, hypertrophy of 
the left mamma, and hysterical fits, the consequences of habitual 
constipation—and whose bowels it was difficult to regulate, went 
into the country, and, while there, took every morning, fasting, a 
single tea-spoonful of castor oil on coffee, which acted most regu- 
larly and pleasantly upon the bowels, and in a few weeks relieved 
and removed all her other symptoms, so that she returned to town 
and presented herself to me in perfect health; her case being a 
good illustration of the efficacy of castor oil, and of the dependence 
of the uterine and other ailments on the state of constipation. 
Croton Oil.—Though I cannot, from my own experience, say 
much in favour of minute doses of croton oil as an habitual aperi- 
ent—it being my practice to avoid having recourse to acrid and 
drastic cathartics as much as possible—yet, when other means have 
not answered, I have occasionally prescribed it in combination in 
the form of pill, and certainly with effect; though it has excited an 
unpleasant heat in the stomach, which did not allow it to be re- 
peated for any length of time. Others, however, speak favourably 
of its operation in doses of one-eighth or one-twelfth of a drop. TREATMENT OF HABITUAL CONSTIPATION. 
143 
Some very valuable and practical remarks on the mode of pre- 
paring and administering the croton oil were made by the late Mr. 
John Pope.* He showed that the acrid irritating property of the 
oil is contained in the husk and epidermic coat of the seed; and 
that, from the medulla alone of the seed, a perfectly safe and effica- 
cious purgative may be obtained. It is stated also that in India the 
medulla is employed in substance universally as the ordinary pur- 
gative of the natives ; a proof of its superiority, I think, over the oil 
in common use. Mr. Pope’s opinions and statements are borne out 
by our own knowledge of the kernel of the walnut, which, if we 
eat without peeling off the epidermis, is pungent, acrid, and disa- 
greeable ; but, deprived of it, the kernel is mild and of most pleasing 
flavour. I am afraid the information offered by Mr. Pope has not 
been taken advantage of in the preparation of the oil in general use, 
or we should have less occasion to complain of its irritating 
properties. 
The mode of administration recommended by Mr. Pope is an 
alcoholic tincture ;f for, although the oil of tiglium is only partially 
soluble in alcohol, he affirms that it takes up the whole of the purga- 
tive principle. This tincture is extremely convenient, admitting as 
it does of correct subdivision, so that any minute dose of the oil 
may thus be insured. A proper vehicle in which to administer the 
oil is the almond emulsion, the oil being first rubbed up with sugar.J 
The alcoholic tincture should be mixed with compound tragacanth 
powder and distilled water. For a child, the twelfth part of a 
drop is a sufficient dose. As a precaution any mixture containing 
the oil should be thoroughly shaken up before it is administered. 
In a case of cerebral irritation, with a drowsy insensibility approach- 
ing to coma, the obstinacy of the bowels was overcome by one 
drop of the tiglium oil mixed up with mucilage and water, and 
taken at two doses. It acted most powerfully, and the child forth- 
with began to recover. 
Croton oil is particularly adapted to cases of coma, where the 
power of deglutition is suspended on account of the smallness of its 
bulk and of its purgative property when merely placed upon the 
tongue. Two drops applied in this manner are a valuable resource 
under such circumstances. Dr. Hen. U. Thomson informs me that, 
in cases of apoplexy where the patient has been unable to swallow, 
he has succeeded in procuring a free action of the bowels by means 
of croton oil—five drops formed into a suppository with crumb of 
bread—introduced high into the rectum. 
* On a New Preparation of Croton Tiglium. By the late John Pope, Esq. 
Medical and Chirurgical Transactions, vol. xiii. p. 97. 
f Take of the seeds of Croton Tiglium, carefully deprived of the husk and 
epidermis, and bruised, two ounces, alcohol, sp. gr. 836° twelve ounces; digest 
for six days and strain. The dose of the filtered tincture for an adult is abou t 
20 minims, which may be made into a draught with compound powder of traga- 
canth and water. 
Mr. Pope preferred dissolving the oil in a little alcohol, in the proportion of 
one drop to half a drachm, in which state it is easily diffused in some thin fluid. 144 
BURNE ON HABITUAL CONSTIPATION. 
Saline aperients having the property of inducing a copious 
watery exhalation from the mucous surface of the intestine, as well 
as of increasing its peristaltic action, are especially adapted to 
evacuate the bowels where any pathological condition offers an im- 
pediment to the free passage of consistent feces. In cases of stric- 
ture, for example, of any part of the alimentary canal, saline ape- 
rients are our best resource ; for, by rendering the excrementitial 
matter thin and watery, they favour and effect its passage through 
the narrowed channel, which would altogether resist and not admit 
of the passage of feces in their ordinary state, however much the 
peristaltic action might be increased by more powerful cathartics. 
These latter, indeed, by the violence of their action against an ob- 
stacle which the gut cannot overcome, cause dreadful spasms, and 
occasionally rupture the bowel. 
Saline aperients administered alone, in cases of habitual consti- 
pation, often disagree, and are oftener ineffectual; “they do not 
work off,” especially in small repeated doses. In many they cause 
a headach, a coldness at the stomach, a rumbling of the bowels, 
and insufficient liquid evacuations; which, indeed, often pass and 
leave scybalous or hardened feces in the cells of the colon. 
Combined with an aperient of a different character, as aloes, 
rhubarb, senna, and the like, they agree well, are very efficacious 
and beneficial. I have already remarked on the combination of 
the sulphate and carbonate of magnesia and the compound decoc- 
tion of aloes, as exceedingly beneficial in constipation attended 
with heartburn, heat at the stomach, and iritation of the pelvic vis- 
cera. 
The sulphate of potass with rhubarb has long been a favourite 
opening draught for persons whose bowels are easily acted on, 
and distressed by stronger cathartics. Salts and senna are a com- 
mon domestic and efficient aperient, but so disagreeable as to be 
ill-adapted for continued use. As a dose, this mixture is tolerated, 
but the stomach abhors its frequent repetition. 
The cooling effect of saline aperients adapts them well to full 
habits with an excess of animal heat; or where there is a sensation 
of heat in the abdomen. Here they should be given so as to imi- 
tate, as much as possible, the natural saline springs of Cheltenham, 
Leamington, or Beulah Spa; viz. in a largely diluted solution, as 
from one drachm to half an ounce of the sulphate of magnesia dis- 
solved in half a pint of tepid water and taken fasting, or the imita- 
tion may be more close by a composition of several salts as directed 
in the Edinburgh Pharmacopoeia in the pulvis salinus compositus; 
the ingredients of which are chloride of sodium and sulphate of 
magnesia, of each four parts, sulphate of potass three parts. A 
most agreeable form is the Seidlitz powders, which are composed 
of the potassio-tartrate of soda, the sesquicarbonate of soda, and 
tartaric acid. Their operation is quick, usually within one or two 
hours, very copious and frequent, but in no way distressing either 
to the rectum or general system. Often it happens that the salines TREATMENT OF HABITUAL CONSTIPATION. 
145 
alone, though given as above, do not act satisfactorily; in which 
case they may be preceded and aided by a compound rhubarb pill, 
or a few grains of the extract of colocynth taken at bed-time: the 
heating effect of either of wrhich is counteracted by the saline on 
the following morning. 
Saline aperients associated with tonics are with many very 
favourite means of regulating the bowels in particular habits; as the 
sulphate of magnesia, or soda in solution with the sulphate of iron; 
or the sulphate of potass in infusion of quassia. 
Salines are desirable aperients in the dysentery of this country; 
and also in those states of thickening of the sub-mucous tissue of 
the colon, congestion of its mucous membrane, and diminution of 
its calibre, which result from habitual constipation in plethoric 
habits; and are indicated by tenderness on pressure in the region 
and course of the colon, and by griping pains always occurring 
during the action of other aperients, as well as by slight indisposi- 
tion, evidently depending on the digestive organs, and yet not dis- 
tinctly referable to the stomach or liver. 
Senna.—Of all the medicines which have the property of quick- 
ening the action of the alimentary canal, none certainly is so 
valuable and so generally applicable as senna. 
The obstacles to its continued use, in the treatment of habitual 
constipation, are its griping effects, its disagreeable taste, and the 
tendency of its preparations—the tincture excepted—to decom- 
position. In summer, for example, the infusion will not keep more 
than 24 hours, and the syrup and the confection ferment, incon- 
veniences not easily overcome: for, where aperient medicine 
requires to be taken every or every other day, it is quite necessary 
the patient should have it in some form that will preserve without 
decomposition for two or three weeks, in order that it may be 
always at hand, otherwise the regularity of the plan will be broken 
in upon, or the plan itself altogether abandoned as too troublesome. 
The tincture is too spirituous for ordinary use alone. 
It is said that the purgative property of senna is owing to 
a peculiar principle, cathartina, and that this principle is dis- 
solved by water at a temperature of 96°, which takes up little of 
the extractive or other matters on which the griping quality is 
supposed to depend.* If the extensive use of senna, so prepared, 
should prove this, it would be very important, and would establish 
the superiority of the liquor sennas of Battley prepared by cold 
infusion. It is known that the decoction destroys the virtues of 
senna, and renders its extract nearly inert. 
Various medicines are added to senna with a view to prevent its 
griping, but none can be altogether depended upon ; and some are 
not proper where senna requires to be used for a considerable 
period. I presume that the various proposed new methods of pre- 
* Cyclopaedia of Practical Medicine, article Cathartics : by A. T. Thomson, 
M. D. 146 
BURNE ON HABITUAL CONSTIPATION. 
paring senna are not free from objection, seeing that the London 
College have not adopted any of them, but have retained the old 
method of preparing the infusion with boiling water. Experiment 
however is wanted on this subject, and we must hope that the 
science of chemistry, which has supplied us with the active prin- 
ciples of bark, nux vomica, burnt sponge, &c., in the form of qui- 
nine, strychnine, and iodine, will be able to separate the cathartina 
of senna for ordinary use, free from the griping qualities of the 
gross material. 
Dr. A. T. Thomson states that the purgative property of senna 
is greatly augmented by the addition of camphor mixture and 
decoction of guaiacum ; and that other adjuncts, as magnesia, 
rhubarb, and the carbonates of alkalis, destroy its active properties. 
For ordinary use the confection of senna is a convenient and 
agreeable medicine, provided it is prepared strictly according to 
the formula in the Pharmacopoeia, the various ingredients in which 
cover the nauseous taste of the senna powder. As sold in the 
shops, it is a coarse, rough, and most disagreeable compound, con- 
taining often neither senna nor cassia, and may be purchased for 
one-third the price which the genuine preparation costs.* On 
this account, I recommended my patients to procure it at the 
Apothecaries’ Hall, where they can depend on having a genuine 
and superior medicine. The confection should be taken at bed- 
time : the dose, varying from one to two drachms, may be regulated 
to suit the individual. In summer it is liable to ferment, unless 
kept in a cool cellar, which is some impediment to its use at this 
season. 
The infusion of senna, though disagreeable to take, is very 
efficacious, but requires to be prepared every or every second day: 
the dose from two drachms to half an ounce at bed-time. The 
nauseous taste is effectually covered by liquorice. The tincture is 
too spirituous to be taken separately, except where persons ac- 
customed to stimulants are not heated by it: it is aperient in the 
dose of half an ounce or six drachms: but it is more suitably em- 
ployed as an addition to the infusion, or to other cathartics. The 
form of tincture is so convenient—because on account of not being 
liable to decomposition it is always ready and may be at hand— 
that I have lately used one prepared with five parts water and one 
part spirit, the other ingredients being the same as directed in the 
Pnarmacoposia, except that liquorice is added to disguise the taste. 
The tincture so prepared keeps well, is rather pleasant than other- 
wise, and may be taken in the dose of an ounce, more or less. 
An active and palateable compound may be formed of the powder 
of senna, scammony, and orange confection. 
Senna in combination with tonics is most valuable, where the 
double objects of giving strength and regulating the bowels is to 
* See Pharmacoposia of the Royal College of Physicians of London, translated 
hyMr. Phillips, 1837, p. 134. TREATMENT OF HABITUAL CONSTIPATION- 
147 
be gained. The tonic usually preferred is gentian, and so much 
has it found favour with the profession, that a formula, the mistura 
gentianae c., has been introduced into the last Pharmacopoeia. In 
it however the proportion of senna is greater than necessary, for 
the most part. With bark also, senna associates exceedingly well: 
“ I have known,” says Dr. Holland, “ many instances (of habitual 
constipation) where calomel, colocynth, and camboge, in large 
doses, have had little other effect than that of injurious irritation; 
but where a few drachms of infusion of senna with decoction of 
bark, have been amply sufficient in producing the desired action:” 
an observation in which I fully concur. Tonics given alone will 
very frequently not agree because the bowels are confined; yet 
agree perfectly and have the best effect when associated with an 
aperient; than which none is better than senna. In chlorosis with 
constipation, forexample, the pilulae ferri c. given in conjunction with 
the mistura gentianas c. are often surprisingly beneficial. 
Above all other aperients senna is valuable, not only on account 
of the mildness and certainty with which it acts, but because it 
disposes the bowels to act of themselves, and because in proportion 
as it is continued, the dose—instead of requiring to be augmented— 
may be diminished, and its full effect nevertheless be maintained. 
Moreover, it has certainly the property of disgorging the liver, and 
carrying off bile in a greater degree than any other medicine, ex- 
cept mercury. All these are points of the utmost importance in the 
treatment of habitual constipation. 
Of MEANS APPLIED TO THE LARGE INTESTINE. 
SECTION IV. 
Of the Bougie.—This instrument may, I think, be had recourse 
to with advantage more frequently than is customary in the treat- 
ment of habitual constipation, and some of its consequences. A 
bougie of moderate size introduced into the rectum and allowed to 
remain some minutes has been found on withdrawal to be followed 
by an action of the bowels. Employed for this purpose, it should 
be introduced eight or nine inches, so as to arrive at and dilate the 
upper part of the rectum, which according to O’Beirne is always 
contracted and in a state of spasm. The most convenient time for 
its employment is before rising in the morning, and its use should 
be persevered in daily by the patient himself. 
The same effect takes place in infants, if, when the bowels are 
confined, an urethra bougie is introduced a few inches up the rectum 
I have myself procured an action in this way; and it is familia. 
The Bougie. Lavements. Suppositories. BURNE ON HABITUAL CONSTIPATION. 
148 
that nurses introduce a twisted piece of paper for the same purpose 
and with the same success. A full-sized urethra bougie is however 
very preferable. 
In rigidity of the sphincter ani—a condition very common and 
often mistaken for stricture—the bougie is extremely useful. It acts 
upon the sphincter exactly as solid natural dejections would do ; 
and restores its normal facility of dilatation when a moderate force 
like the action of the gut is brought to bear upon it. Without the 
aid of the bougie, in these cases, dejections cannot be obtained ex- 
cept by strong cathartics; and as they mostly cause the feces to 
be soft and thin, these passthrough the sphincter without dilating it, 
and so allow the rigidity to continue as great an obstacle as before. 
In stricture of the rectum, not malignant, the bougie is of course 
the proper remedy: but in diminution of the calibre of the gut from 
scirrhous disease, it is inadmissible, because when force is employed 
scirrhous parts lacerate but do not dilate; a practical point agreed 
upon by all surgeons. 
In piles from extrusion of the mucous membrane, in prolapsus ani, 
in anal fissures, and in irritable anal ulcers, the bougie introduced 
daily with care and perseverance is of vast service, these affections 
being constantly associated with and in a great measure dependant 
upon rigid contraction of the sphincter, the effect of constipation. 
In scirrhus or cancer of the rectum, a tube of a size adapted to 
the contracted channel of the gut may be passed through the dis- 
eased part—provided it can be done without employing force— 
with a view to evacuate the bowel above, which otherwise might 
not be able to relieve itself. In this way accumulations above the 
disease are sometimes removed or prevented, and the patient saved 
from the additional sufferings which they would occasion. This 
object was accomplished by Mr. Tupper in the case of scirrhous 
rectum "with an accumulation of magnesia as related at page 123. 
Common plaster bougies are preferable to those made of caout- 
chouc, because they adapt themselves more easily to the course of 
the rectum. 
Of Lavements or Clysters.—Previous to the great intercourse 
which has taken place between France and England since the 
peace, lavements were looked upon with disgust and horror, and 
had recourse to only on extraordinary occasions. Now they are 
in common use.* 
As a means of obviating habitual constipation they are employed 
by some persons daily, with the effect of exonerating the large 
intestine more or less. However efficient they may, in this respect, 
appear to be, I have found, from long observation, that they are 
not free from very great objection. In the first place they do not 
continue to relieve the bowels fully and freely for any length of 
time:—in the next place, they do not dispose the bowels to resume 
* The best constructed instrument that I have seen, is the Patent Reservoir 
Syringe, by Weiss, 62, Strand. TREATMENT OF HABITUAL CONSTIPATION. 
149 
their natural action, but, on the contrary, render them more confined: 
—in the third place, they wash off the mucus from the intestine, 
which is followed by a degree of irritation and an unpleasant sense 
of heat, very similar to that which occurs after washing the hands 
in water simply:—in the fourth place, the feces become more 
scybalous and hard under their use :—and lastly, the individual does 
not feel the comfort or conviction of having had his bowels fully 
relieved ; on which account he is often induced to resort to a second 
lavement on the same day. Lavements fail in completely obvia- 
ting or curing habitual constipation. 
Lavements are nevertheless an excellent occasional resource; 
where, for example, a person has been disappointed of his usual 
evacuation, or where he is unable, in consequence of his engage- 
ments or of other circumstances, to take an habitual aperient, lest 
it may act at an inconvenient moment. In this case a lavement 
used in the morning relieves the bowels for the day, and is a great 
comfort. Or if, while travelling, the bowels become unusually con- 
stipated, and yet it is not convenient or scarcely possible to venture 
on medicine sufficiently strong to act, then a lavement is of essen- 
tial service, and often prevents absolute indisposition, as I have 
myself witnessed. 
The fluid to be injected should be of a bland nature, as barley 
water, thin gruel, linseed tea, or milk and icater ; but inasmuch as 
these are not always at hand, persons, I find, invariably end by 
using merely warm water, which has an injurious and irritating 
effect upon the mucous membrane of the rectum. Those in the 
habit of taking lavements should give attention to this subject, and 
make a point of using one of the bland fluids above-mentioned. 
Cold water is less hurtful to the intestine than warm : half a pint 
injected every morning has proved of essential service. Cold is an 
indefinite term : the temperature of what we understand by cold 
water varying many degrees according to the season. In the sum- 
mer cold water in the dressing-room would be 60° of temperature, 
in the winter it may be as low as 40°; the summer temperature is 
proper. The quantity injected should vary from half a pint to a 
pint or upwards ; which the sensations of the individual must deter- 
mine. 
Suppositories are of course not adapted for ordinary use. They, 
however, may prove of great value under extraordinary circum- 
stances, as where medicine cannot be given by the mouth, the patient 
being unable to swallow, as in apoplexy, coma, severe inflammation of 
the throat, or epiglottis. The cathartic best suited and most effec- 
tual as a suppository is the croton oil, which Dr. Hen. U. Thomson 
has employed, as already stated, in the quantity of five drops mixed 
with crumb of bread, and introduced high up the rectum, with great 
success in one or two cases of paralysis. 150 
BURNE ON HABITUAL CONSTIPATION. 
SECTION y. 
OF THE TREATMENT OF OBSTRUCTION OF THE BOWELS. 
In considering the treatment of obstruction of the bowels, the first 
step is to ascertain the cause; the next is to determine whether in- 
flammation co-exists. 
If the obstruction is discovered to arise from hernia, colica a 
plurnbo, enteritis, or the like, then treatment, appropriate to these 
cases, must be pursued. If it is supposed to depend on intus-sus- 
ception, the less that is done the better, beyond emptying the lower 
bowel by a clyster, assuaging the pain by opium, and appeasing and 
controlling irritation and inflammation by fomentations, baths, and 
moderate .antiphlogistic measures. Purgatives should be altogether 
avoided, inasmuch as, by exciting the peristaltic action of the intes- 
tine, they may increase the invagination, while it is impossible they 
can overcome the obstruction. The only chance of life is the slough- 
ing and separation of the portion of gut invaginated ; a process 
requiring time and the resources of a good constitution, husbanded 
by a good physician. 
If the obstruction is supposed to depend on any accidental dis- 
placement or twist of the bowel, internal remedies will be of little 
avail, they having no power to liberate the intestine. An active 
cathartic may, in the first instance, be tried, it being possible, though 
scarcely probable, that an energetic peristaltic action might disen- 
tangle the gut. Should any tumour be distinguished by most care- 
ful exploration of the abdomen, and the character of the seizure, as 
also the symptoms present, indicate that invagination, displacement, 
or twist exists, it would become a question how far an operation should 
be performed, with a view to liberate and disentangle the bowel, a 
question at all times of great difficulty, and most proper to be decided 
by consultation. Where either of these causes exists, death is for 
t<he most part certain, which may justify the risk of an operation. 
It is obstruction from feces or foreign substances arrested or ac- 
cumulated in the caecum or colon, or impacted in the rectum that 
will particularly engage our attention here. 
If the caecum or colon is the seat of the obstruction, a tumour 
may generally be distinguished in the right ilio-inguinal region, or 
in the region of that part of the colon where the obstruction is 
seated, which is most generally the sigmoid flexure. The general 
plan of treatment should be to abstract blood, more or less, from a 
vein, if the symptoms call for it; and also locally : secondly, to give 
one or two strong doses of purgative medicine, as colocynth and 
calomel, followed by senna and sulphate of soda: but if these fail, 
they should be discontinued, and the effervescing saline aperients 
be resorted to and persevered in; opium, or the salts of morphia, 
being at the same time administered to remove spasm and assuage TREATMENT OF OBSTRUCTION OF THE BOWELS. 
151 
pain. The first efforts not having been successful, time should be 
allowed; and fomentations and baths and clysters be employed as 
far as the patient’s strength will permit. Treated on this plan 
patients will survive and do well after many days (ten I have 
known) of actual obstruction, with vomiting and hiccup: but if 
violent measures are persisted in, they will too often sink under the 
treatment rather than the disease. 
The remarks of Dr. Holland on this subject are so judicious and 
practical, that I must take the liberty of quoting them at length. 
He says, “ In cases of actual obstruction of the bowels, where the 
name seems to lend a full sanction to the treatment, it may be 
affirmed that it is often carried on too grossly and indiscriminately. 
If vomiting does not prevent it, and frequently, indeed, at the risk 
of bringing this on, purgative is hurried after purgative with increase 
of dose, or adoption of more drastic medicines at each successive 
step ;—often with little thought as to the causes of obstruction— 
with much danger of producing inflammation in the obstructed part 
or elsewhere,—and with no due allowance for the tendency which 
all parts have to resume a healthy action, if left in quiet. 
“ I do not mean that purgatives should not be given in cases of 
obstructed bowels. But I wish to convey the caution, required, as 
I think, by the too uniform direction of practice in these instances; 
viz. that if there be distinct local pain, threatening inflammation in 
any part of the canal,—or much aclive irritation, with nausea and 
vomiting,—and if the first cathartic medicines, freely given, fail of 
success,—it behoves the physician well to consider whether he shall 
urge this treatment farther. There are, doubtless, cases where it 
is expedient to do so ; but many others where the irritation of dras- 
tic purgatives hurries on the patient to danger or fatal result:—and 
this not unfrequently, where quiet, abstinence equally from food 
and medicine, leeches and fomentations over tender parts of the 
abdomen, or still better, in some cases, leeches to the hsemorrhoidal 
vessels, would have removed obstruction, and relieved the com- 
plaint. 
In these important cases of apprehended obstruction of the 
bowels, it is obvious on the grounds just stated, that the first use of 
cathartic means should be the most vigorous, instead of the reverse. 
If the effect be obtained, it signifies little that the dose has some- 
what exceeded the necessity. If otherwise, the chances of mischief 
by repeated and augmented irritation are spared, and we obtain 
the indications most to be desired for further treatment.”* 
Should the obstruction, as indicated by tumour, be seated in the 
sigmoid flexure of the colon, clysters injected by means of a tube 
sufficiently long to pass to this point will often be successful, while 
clysters thrown up by the ordinary short pipe will altogether fail. 
The use of this long tube is strongly recommended by O’Beirne, 
who, through its means, has been able to remove obstructions of long 
* Notes and reflections : by Henry Holland, M.D., Select Med. Lib., Oct. 1839. 152 
BURNE ON HABITUAL CONSTIPATION. 
standing which have resisted all other measures. Even in ac- 
cumulations of feces in the colon without tumour, as in cases of 
stercoraceous colic, the long tube would insure the passage of the 
enema into the colon more certainly than the ordinary method. 
The enemas may be composed of infusion of senna and salts ; 
of castor oil and gruel; of compound extract of colocynth or of aloes 
one drachm, or of assafoetida tivo drachms, dissolved in millt: the 
great point being to throw up as much as the colon will bear, 
whelher it be one pint or one gallon. 
The colon thus distended acts with more vigour and effect—as 
the womb does before the liquor amnii has escaped—and the fluid 
having more or less broken up the accumulated mass, renders it 
comparatively easy of expulsion. 
The most successful and remarkable case of obstruction detailed 
by O’Beirne is that of a lady 19 years of age, who was affected 
with most obstinate constipation, vomiting of everything she ate or 
drank, excruciating spasms of the intestines and intense burning 
sensation in her stomach. Month after month she was under 
treatment, first by one physician then by another, who prescribed 
a variety of medicines, including fluid mercury and enemas, with 
little or no effect. 
In May, 1831, this patient placed herself under O’Beirne’s care. 
*• She was particular in insisting on the facts that she had taken 
various purgative draughts which had not been vomited up; that 
she had had at least one hundred injections of various kinds ad- 
ministered to her; and that, notwithstanding, she had not had a stool 
of any kind, or passed even flatus per anum, since early in the pre- 
ceding December, a period of nearly six months.” The enemas 
had been thrown up with a common bag and pipe. At the time 
O’Beirne took charge of this patient, “ the irritability of the stomach 
was such, that the only sustenance she could take, or had taken 
for two months previously, consisted of a table-spoonful of milk 
and lime-water taken frequently in the day, but vomited up as soon 
as it was swallowed.” 
O’Beirne proceeded in the treatment as follows:—“ As soon as 
an enema, consisting of a pint of warm water, two drachms of 
tincture of assafoetida, two ounces of olive oil, the same quantity 
of sulphate of magnesia, and an ounce of oil of turpentine, could 
be prepared, she was placed in bed, and turned on her left side. A 
gum elastic tube was introduced, but with greater difficulty than 
usual, to the height of nine or ten inches. No flatus escaping, and 
wishing to ascertain that cause, the tube was withdrawn, when its 
cavity and about two inches of its upper extremity was found covered 
with solid feces. 
“ It being now clear that the sigmoid flexure contained a mass 
of solid excrement, the tube was again introduced, and in doing so 
the same difficulty was experienced, and it became necessary to 
use the same degree of force. Still no flatus passed off. The 
syringe was now adapted to the tube, and the whole of the injec- TREATMENT OF OBSTRUCTION OF THE BOWELS. 
153 
tion thrown up. While this was doing she became very urgent to 
be allowed to go to the night-chair, but her entreaties were not 
complied with, until the whole of the fluid had been injected. The 
tube was then removed, and in less than two minutes she passed 
one of the most enormous stools I have ever seen; it nearly filled a 
large sized chamber-pot, was altogether solid, perfectly natural- 
looking, and arranged in remarkably thick coils.” 
The first difficulty having been overcome, the bowels were 
eventually cleared by repeated clysters and aperients. Other 
symptoms, of which spinal irritation was a prominent one, required 
attention and were removed : and she was restored to robust health 
nd perfect freedom from any tendency to costiveness.* 
A case of obstruction which well nigh proved fatal, occurred in 
the clinical wards of the Edinburgh Infirmary when I was a stu- 
dent at that university, confirmatory of the opinion of O’Beirne. 
All the usual means by purgatives and clysters had been tried 
in vain; when as a last resource the clinical clerk, Mr. Lane (a 
very intelligent student since deceased), aided by myself, undertook 
to administer the injections. A tube was introduced as high as 
possible, and an enema attempted to be thrown up by means of a 
syringe: as fast however as it passed into the rectum it returned, 
the sphincter being loose and relaxed. Thin cloth was then rolled 
round the tube and pressed most firmly against the anus, with a 
view to act as a plug: the syringe was used with force, and we 
succeeded in injecting a considerable quantity of the enema into 
the large intestine. Quickly afterwards the bowel acted vigorously, 
the obstruction was overcome, the accumulated feces were ex- 
pelled, and the patient did well from this time. 
Intestinal obstructions, which have resisted other means, have 
yielded sometimes to cold water dashed and sprinkled on the legs 
and feet: of which practice successful cases are recorded by Dr. 
Pringle and Dr. Middleton. The latter remarks that “ cold water 
flung on the legs and feet give strength and spirits, and abated the 
vomiting and pain.” 
Fluid mercury has been resorted to under similar circumstances. 
I have myself seen it administered in one instance, without how- 
ever any decided effect. It may traverse the intestinal canal and 
find its way through an accumulation or impaction of feces in the 
large intestine without effecting its removal or expulsion. Mr. 
William Perryf however relates that in a case of constipation with 
symptoms of inflammation in which blood-letting, cathartics, and 
injections had been employed, mercury (quicksilver), in the quantity 
of two ounces was given on the fourth day, in mulled wine, every 
third hour, and that after the third dose an evacuation took place 
and the patient recovered. 
Where the obstruction is attended with vomiting, which generally 
* New Views of the Process of Defecation : by James O’Beirne, M. D., p. 74, 
et seq. Dublin, 1833. 
f Duncan’s Medical Commentaries, vol. vi. p. 337. 154 
BURNE ON HABITUAL CONSTIPATION. 
happens, purgatives if combined with creasote in the quantity of 
one drop will often be retained on the stomach when otherwise 
they would be rejected. The property of relieving sickness and 
irritation of the intestinal mucous membrane is possessed by crea- 
sote in an eminent degree; but beyond this it is proved of little 
value in my experience. 
Where the obstruction is produced by feces impacted in the rec- 
tum, mechanical means require to be used in order to break up the 
mass and effect its removal. Previous to this operation purgatives 
and clysters are of no avail, but afterwards they assist in washing 
away and clearing completely the whole bowel. The sign, which 
in cases of obstruction should excite suspicion that the cause is 
seated in the rectum and lead to the examination of that gut, is te- 
nesmus : a practical observation borne out by examples related in 
a former part of this work. 
CHAPTER XII. 
ON THE INFLUENCE OF CONSTIPATION, AND OF THE ACCUMULATION 
OF MORBID SECIiETIONS AND FECAL MATTERS IN THE LARGE 
BOWELS IN PREDISPOSING TO AND EXCITING THE MORE PREVALENT 
diseases of india : namely, congestion, inflammation, and 
ABSCESS OF THE LIVER, DIARRHIEA, DYSENTERY, AND ORGANIC 
DISEASES OF THE LARGE INTESTINE.* 
In consulting Mr. Annesley’s splendid work on the diseases of 
India, with a view to profit from his observations on the physiology 
and pathology of the large intestines, it appeared that constipation 
and accumulation of morbid secretions and fecal matters in the 
large bowels were regarded by him as very frequent predisposing 
and exciting causes of intertropical diseases. Indeed on a careful 
perusal of the whole work, I was struck by the constant recurrence 
of the author to this subject; and more so by the important fact, as 
established in every chapter and in almost every page of the second 
volume, that constipation exists as generally and is as productive 
of disease in India as I have found it to be in this country. 
At first it was my intention to embody Mr. Annesley’s remarks 
and opinions in various parts of this work; but so extensive and va- 
luable do I find them to be, and so much do they coincide with and 
corroborate my own, that in justice to that gentleman, I propose to 
♦Abstracted from “ Researches into the Causes, Nature, and Treatment of the 
more prevalent Diseases of India, and of warm Climates generally. By James 
Annesley, Esq., of the Madras Medical Establishment, late Surgeon to the 
Madras General Hospital, M.R.C.S. and M.R.A.S.” INFLUENCE OF CONSTIPATION, ETC. 
155 
devote a separate chapter to an epitome of those parts of his great 
work which treat of constipation and the accumulations of morbid 
secretions and fecal matters in the large bowels, as predisposing and 
exciting causes of the more prevalent diseases of India. This plan 
I feel the more called upon to adopt, because of the good sense, sound 
judgment, practical information, and vast experience of the distin- 
guished author. 
It would appear that the more prevalent diseases of India are 
referable to three causes:— 
1. Terrestrial exhalations or malaria in different forms. 
2. The mode of living adopted by Europeans generally. 
3. Constipation and the accumulation of morbid secretions and 
fecal matters in the large bowels. 
The last only of which will engage our attention. 
In speaking of the functions of the large intestines Mr. Annesley 
introduces, as an important consideration, the derangements of the 
digestive process resulting from accumulation of gases in the caecum 
and colon, and from the infarction of feces in the same situation: 
and there is nothing, he believes, which tends more to diminish 
the tone and vital energy of the large intestines, and consequently 
to facilitate accumulations of feces and flatus in the cascum and 
colon, than want of attention to the earliest calls to stool. When 
these intimations are not attended to, a stop is put to the progress 
of the fecal contents along the whole line of the canal. 
In Chapter III. on the premonitory symptoms of intertropical 
diseases, it is remarked, that full living on animal food is frequently 
attended, in many temperaments, with a constipated or otherwise 
irregular state of the bowels, and a costive and offensive state of 
the stools; and this is more remarkable in those who take little or 
no exercise, and even in those who enjoy sea air, or change of air, 
without much personal exertion. The consequences of full diet, 
combined with insufficient exercise and a constipated state of the 
bowels, must be apparent to every one who reflects upon the laws 
of the animal economy. Although in many instances this state of 
existence can scarcely be viewed as constituting disorder, yet in 
others it is evidently so, and in every case it must at least be viewed 
as leading to it. Constipated states of the bowels, in persons living 
much upon animal food and rich dishes, tend very rapidly to pro- 
duce not only plethora of the vascular system, but also to vitiate 
the constitution of the blood itself. 
Torpor of the Functions of the Biliary Organs.—Mr. Annesley 
reckons habitual inattention to the due and daily discharge of the 
bowels one of the chief causes of disorder operating on the biliary 
secretions, through the medium of the digestive organs. A neglected 
state of the bowels is very frequently observed in soldiers; and, 
indeed, in all ranks of life. An open state of bowels and an oc- 
casional appropriate aperient seem to act beneficially upon the 
functions of the liver in a threefold capacity; viz. they preserve a 
free discharge of bile from the gall-bladder into the duodenum,— 156 
BURNE ON HABITUAL CONSTIPATION. 
they promote a due circulation of this fluid along the biliary ducts, 
—and they keep up a free circulation of blood in the portal vessels. 
Of the six cases detailed as examples of torpor and congestion of 
the liver, constipation was a prominent symptom in three, in one of 
which it had existed for nine days. In the other three the fre- 
quency of the action of the bowels is not mentioned in the history, 
but they all required and were benefited by the free use of 
aperients. 
In commenting upon these cases, Mr. Annesley observes, that 
were it necessary, he could detail a variety of cases wherein 
diminished action of the liver was connected with dyspepsia and a 
costive state of the bowels. In these cases there are usually present 
considerable flatulency, a loaded state of the caecum and colon, 
uneasy sensations generally, and a feeling of ill health without being 
so ill as to resort to medical advice. This state often continues for 
a considerable time without much increase of disorder until some 
energetic cause supervenes,—such as exposure to cold and wet, 
sleeping on the ground or in a current of air, intoxication, or the 
indulging in intoxicating liquors, &c.—and occasions an attack of 
hepatitis or dysentery. 
The functional disorders of the large bowels are characterized 
by a deficient tone or action, or by a torpid state of the functions 
of the different tissues composing these viscera; and although these 
disorders are often but little calculated to excite either the attention 
of the patient or the fears of the practitioner, in their early stages, 
yet they not unfrequently lead to serious consequences and excite 
dangerous diseases either in the structures in which they are seated, 
or in those of more remote organs. 
Mr. Annesley first turns the attention of the reader to morbid 
accumulations in the large bowels, and afterwards offers a few 
observations on some of the most important consequences which 
are induced, either in an immediate or in a remote manner, by this 
state of functional disorder. 
Remarks on Accumulations of Morbid Secretions and Fecal Mat- 
ters in the large Bowels. Amongst the more immediate conse- 
quences of a torpid state of the caecum and colon, Mr. Annesley 
regards retention of the mucous secretions; which he thinks ob- 
struct the ducts themselves of the follicles, and cause them to 
become distended and subsequently inflamed and ulcerated. 
When the fecal matters also are retained, an energetic cause of 
mischief is superadded, and disorder becomes more general. The 
more fluid portions are absorbed into the general circulation or 
portal vein, and produce injurious effects upon the liver and the 
system generally. Bile retained in the primae vise for an unusual 
time becomes also absorbed, and gives a sallow jaundiced aspect 
to the countenance. 
Besides the mischievous effects arising from the absorption of 
excrementitious matters, Mr. Annesley proceeds to consider the 
consequences of accumulations in the caecum and colon in a more INFLUENCE OF CONSTIPATION, ETC. 
157 
direct, and frequently mechanical manner. As consequences of 
these accumulations Mr. Annesley enumerates flaccidity of the 
muscular tunic of the bowels, enormous distention of the caecum 
and cells of the colon, partly by the flatus evolved from the new 
combinations into which the accumulated materials enter, and 
partly from the matters themselves which have been collecting 
from a remote period. 
The cascum and colon, when greatly distended, press upon the 
femoral nerves and blood-vessels, the vena cava, and iliac veins, 
producing numbness, cramps, pains in the lower extremities, and 
even oedema. The loaded and distended colon presses injuriously 
upon the kidneys, occasioning a dull aching and sense of weight in 
the loins. It interferes with the functions of the liver, duodenum, 
and stomach; and, when excessive, not only deranges their func- 
tions, but, by impeding the descent of the diaphragm, affects the 
heart and lungs, retards the return of blood from the head, and in- 
duces congestion of the brain and effusion of serum from its mem- 
branes. 
These accumulations in the large bowels derange the small intes- 
tines and stomach, impair digestion, chymification, and nutrition ; 
and an unhealthy and imperfectly prepared fluid passing through the 
mesenteric glands originates disease in them. The sordes and se- 
cretions which collect upon the mucous surface of the colon, occa- 
sion, in some instances, irritation and exhalation from the follicular 
glands, when a spontaneous diarrhoea supervenes and relieves the 
patient. In other cases, the irritation runs into inflammation of the 
mucous surface, frequently terminating in ulceration. Most of the 
worst cases of dysentery and chronic diarrhoea which are met with 
in India originate in this manner. The accumulations become also 
the nidus for worms, the irritation of which is a most frequent cause 
of disease. 
Other consequences, remote or immediate, are hypochondriacal 
and melancholic affections, and elongations and displacements of 
the colon itself, to all of which much consideration is given. 
The symptoms indicating a loaded state of the caecum and colon 
are various. Mr. Annesley recommends an accurate examination 
of the abdomen in all cases, commencing in the region of the caecum 
and following the direction of the colon around the abdomen to the 
region of the sigmoid flexure. Pain, fulness with a doughy sensa- 
tion, hardness, together with other symptoms, indicate chronic in- 
flammation, and accumulation of sordes or hardened feces; besides 
this examination other symptoms must be inquired into, and also 
the habits, constitutions, and temperaments of the patients. 
A loaded state of the bowels in warm climates is indicated by a 
disagreeable bitter taste in the mouth, sallow pale face covered with 
an oily moisture, dusky skin exhaling a disagreeable fetid perspira- 
tion. The appetite is at first but little impaired; digestion weak 
and difficult, stools scanty, infrequent, hard, or at least formed, and 
of a dark colour. Afterwards in some cases the stools are more 158 
BURNE ON HABITUAL CONSTIPATION. 
frequent, but still scanty; occasionally scybalous and attended with 
slight tenesmus. The urine is high-coloured, and deposites a co- 
pious sediment. Headach and various other nervous symptoms 
are also frequently complained of at an early stage. 
In a later stage are added to the foregoing symptoms, uneasiness, 
pain, sense of weight and distension of the abdomen: also loss of 
appetite, inactivity, dull pain of the loins resembling lumbago, weak- 
ness of the lower extremities with shooting pains, a furred tongue 
particularly in the morning, drowsiness, pain or weight in the head, 
and disturbed rest. If this state of things is allowed to remain, the 
consequent irritation of the mucous surface will induce diarrhoea, 
ulceration, and the worst forms of dysentery. 
Although daily evacuations from the bowels may take place, 
accumulations in the large bowels may exist to a considerable 
extent and mislead the practitioner. The cells and flexure of the 
colon and the caecum may contain morbid matters even of consid- 
erable bulk, without impeding the passage of other substances. In 
the colon represented in Plate XXXI. fig. 1. of Mr. Annesley’s 
work, all the cells were filled with feces, the middle passage only 
admitting of the transit of the liquid fecal matters. 
In numerous cases of accumulations in the large bowels the 
patients complained of a more than usual frequency of the calls to 
stool, which was generally misunderstood by the patient and the 
practitioner for copious discharges. Upon inspecting the stools in 
these cases, they are more or less fluid or of a soft consistence, 
offensive, and apparently composed of hardened feces broken down 
amid a dark-coloured fluid. Accumulations are, on frequent occa- 
sions, fixed in the caecum and above the sigmoid flexure of the colon. 
The causes of accumulations in the large bowels are stated to be 
whatever tends, directly or indirectly, to lower the energy of the 
digestive functions or of the whole frame : as sedentary occupations, 
wrant of pure air and of sufficient exercise, indolence, full living, 
late hours, too great indulgence in sleep or in bed, and the use of 
too warm and too soft beds. No cause is more common than ne- 
glecting to attend to every call to stool. 
A constipated state of the bowels is generally the first stage of 
morbid accumulations. An inactive state of the alimentary canal 
is extremely common among females, and is frequently observed in 
persons of a robust constitution during voyages by sea, or when 
travelling on horseback, or in a carriage. 
Of the treatment of Accumulations of Morbid Matters in the large 
Bou els.—The indications of cure when the bow'els are loaded with 
morbid secretions, or other fecal matters, are in the first place to 
remove them by suitable purgatives, and in the second to prevent a 
return of this species of disorder. 
Seven cases are detailed in illustration, four in gentlemen, three 
in ladies, in which were symptoms of indigestion, nervousness, con- 
stitutional disturbance, hysterical sensations, and so on, wfith irre- 
gular bowels; the dejections in some frequent but insufficient, in INFLUENCE OF CONSTIPATION, ETC. 
159 
others unfrequent; of various disordered character, bloody, viscid, 
tenacious, gelatinous, scybalous, dark, fetid, but never free and 
copious. In three of the cases there was fulness and tumefaction 
in the region of the caecum, and a doughy state of the abdomen. 
They were all treated on a purgative plan, consisting of calomel in 
doses of gr. x. or gr. xx. with gr. i. or gr. ij. of opium; together 
with colocynth, the aloes and myrrh pill, senna with bitters and 
compound decoction of aloes. 
Cursory remarks respecting several Disorders frequently depend- 
ing upon the accumulation of Morbid Matters in the Alimentary 
Canal, particularly in the Ccecum and Colon.—Mr. Annesley has 
not a doubt but most of the diseases that are called bilious, indiges- 
tions, nervous, and many of the obscure internal disorders arise 
from matters remaining in the colon which should be carried out 
of the body. Attention is first directed to the effect of such accu- 
mulations upon the position of the colon, and subsequently to those 
affections which are sympathetic. 
Mr. Annesley has met with many cases of elongation and un- 
natural position of the colon, some of which he thinks may have 
been congenital, others evidently pathological. He conceives it 
by no means improbable that accumulations indueeirregularflexures 
and displacements of the colon, and even an elongated state of this 
viscus; and he believes that the supervention of these consequences 
is favoured by a relaxed state of the meso-colon, of the peritoneal 
covering of the bowel, and particularly of the longitudinal bands. 
Impaction of hard fecal matters about the sigmoid flexure of the 
colon may cause this part of the bowel to be carried lower into 
the iliac region or pelvis, and lead to partial displacements, elonga- 
tions, and unnatural flexures of the colon. 
As consequences of this state of things are inflammation of the 
bowel with the usual symptoms of dysentery; or inflammation of 
the small intestines, or of the liver. Where active inflammation is 
not produced, there will be severe dyspeptic symptoms, and con- 
gestion and consecutive disease of the liver, attended, in some in- 
stances, with hypochondriacal symptoms which may terminate in 
melancholia and insanity, in persons having a predisposition to these 
affections. That these latter consequences may result from ac- 
cumulations in the large bowels has been satisfactorily demonstrated 
by the histories of numerous cases which came before Mr. Annesley, 
and by the successful result of the treatment adopted for their cure. 
Six most interesting cases of displacement, elongation, adhesions, 
and morbid duplicature of the caecum and various parts of the 
colon are described, and exceedingly well represented in the plates, 
and show the intimate connection between these morbid states and 
accumulations in the large bowels. 
Cursory Remarks on Hypochondriasis and Mental Alienation, in 
connection with Accumulation of Morbid Matters in the Bowels.— 
The generation and retention of morbid secretions and fecal matters 
in the large bowels cause the mental faculties not unfrequently to 160 
BURNE ON HABITUAL CONSTIPATION. 
become disordered in various grades, from the slighter shades of 
hypochondriasis, through the advanced stage of melancholia, until 
complete insanity is established. 
M. Esquirol, in his important observations on melancholia in the 
“ Dictionnaire des Sciences Medicales,” has stated that in one 
hundred and sixty-eight cases examined by him after death, he 
found displacement of the colon in thirty-three, the transverse arch 
of this bowel generally hanging down into the hypogastric region. 
Now whether this derangement proceeded from accumulations of 
fecal matters in this viscus, or from great relaxation and want of 
tone, the necessary consequence must have been to favour an 
unnatural retention and collection of fecal and excrementitious 
matters in the bowel, inducing sympathetic disorder in various parts 
of the system, more particularly in the brain itself. This effect— 
although not necessarily or generally proceeding from morbid 
accumulations in the primas vice, yet in those who are suffering 
from mental anxieties or disappointments, wffio expose themselves 
to the direct rays of the sun, and who have an hereditary predis- 
position to mental disorder—will very frequently supervene. And 
although the practitioner is not to consider morbid accumulations 
in the large bowel as the only, or even on many occasions as the chief, 
physical derangement to which he ought to direct his remedial 
means, he should, nevertheless, pay sufficient attention to the patho- 
logical state pointed out, more particularly as the indications of 
cure to which it leads are amongst the most important by which 
be can guide his practice, and when decidedly acted upon, perhaps 
the most successful in its ultimate issue. 
In a very great proportion of cases of melancholic alienation of 
mind, and indeed in other forms of mental disorder, the stools pro- 
cured by means of active purging are very dark, tenacious, and 
even of a pitchy blackness, resulting, in the opinion of Mr. Annes- 
ley, from the accumulation and admixture of the various secretions, 
excrementitious matters, and imperfectly digested food, poured into 
the alimentary canal, and from the changes they have undergone 
during their retention in that situation. Entertaining these views, 
Mr. Annesley has always made it a point, in cases of alienation, to 
institute a most active and uninterrupted course of purgative reme- 
dies in conjunction with other means, as local or general blood-let- 
ting, or tonic or cordial remedies: and in every case, treated by 
Mr. Annesley, the disorder began to yield as soon as the morbid 
accumulations were carried off, and the motions to assume a 
healthy character; the period varying from many days to several 
weeks. Six cases are adduced of hypochondriasis, melancholia, 
mania, and great mental excitement from morbid accumulations in 
the bowels and sympathetic irritation: all of which were cured by 
an alterative and purgative treatment in periods varying from three 
to seventeen weeks. 
He?neralopia or Night Blindness, frequent between the tropics, INFLUENCE OF CONSTIPATION, ETC. 
161 
more especially among the natives of India, is considered by Mr. 
Annesley as dependent upon debility, accompanied -with accu- 
mulations of morbid secretions in the primse viae, more particularly 
in the caecum and colon, together with torpid function of the liver 
and stomach. Among the natives this disease is generally induced 
by insufficient nourishment and want of attention to the functions of 
the bowels. A wrell regulated diet and purgative medicines have 
been found sufficient for the removal of hemeralopia, frequently 
without the assistance of any other remedy. Amongst Europeans 
these medicines are the most unequivocally necessary, for the 
bowels of those labouring under this affection are often particularly 
torpid, and require the most active purgatives to produce any effect 
upon them. 
Accumulations of Morbid Matters in the Bowels, as a Cause of 
JVervous and other Ailments.—It is Mr. Annesley’s opinion, that, 
owing to collections of morbid matters, and the consequently loaded 
and distended state of the large bowels, attacks of rheumatism and 
gout are often induced, particularly in those who are liable to these 
diseases, either from hereditary predisposition, previous attacks, or 
exposure to one or more of the concomitant and exciting causes 
whence they often spring. He has uniformly found that these 
complaints, yield soon after the morbid accumulations in the prim® 
vise, by which they are generally characterised, have been carried 
off by a proper employment of purgative remedies. 
It is his opinion also that a loaded and distended state of the 
caecum, colon, or sigmoid flexure produces, by pressure, partial 
paralysis and oedema of the lower extremities ; pains in the loins ; 
disturbed and impeded functions of the liver, stomach, and duo- 
denum ; and, when present to a very great extent, interference, by 
resisting the action of the diaphragm, with the functions of respira- 
tion and circulation; giving rise to dyspeptic disorders ; and sym- 
pathetically, to disorders of the brain and nervous system. The 
more usual forms of hysteria, epilepsy, chorea, paralysis, and even 
apoplexy, seem to be connected, if not altogether dependent upon, 
the conditions of the large bowels. Three cases are related, the 
subjects of them being ladies, in which were accumulations in the 
caecum and colon, occasioning anomalous nervous and hysterical 
symptoms, and in one a spasmodic affection. Recovery in all was 
effected by restoring the healthy functions of the bowels. 
Of acute uncomplicated Dysentery.—Collections of excrementitious 
matters in the large bowels tend very directly and very evidently to 
irritate the mucous surface on which they lodge, and to induce inflam- 
mation followed by ulceration, and even sphacelation, in a very short 
period, if the disease be neglected or injudiciously treated. In a great 
many cases this form of dysentery is preceded by a constipated state 
of the bowels, often of long duration, especially among persons who 
have recently arrived in India. To this condition frequently super- 
venes mucous diarrhoea, attended with pains of the abdomen, corn- 162 
BURNE ON HABITUAL CONSTIPATION. 
ing on at intervals, and generally preceding the alvine evacuations. 
This form of diarrhoea may continue for two or three days, passing 
gradually into dysentery, with all the characteristic signs of the 
disease. 
Accumulation of morbid matters in the bowels is supposed by Mr. 
Annesley to be one of the most frequent sources whence the acute 
uncomplicated form of intertropical dysentery seems to arise. 
Case CLXXIII. of acute, uncomplicated dysentery occurred in a 
young recruit, age 24, just arrived from England, who died after 
having been in the hospital about four days. On dissection it was 
found that the ca3cum and cells of the colon were filled with a dark 
green mucous and hard scybals of a still darker colour : the middle 
channel only admitting of the passage of the fecal matters. The 
whole mucous membrane was inflamed and ulcerated. 
Of the causes of Dysentery.—In respect of dysentery, as well as 
of fevers, Mr. Annesley says, it may be stated confidently that all 
situations productive of malaria, or which furnish exhalations from 
the decay of animal and vegetable matter under the operation of a 
hot and moist state of the atmosphere, will occasion dysentery in 
the predisposed subject: and that the seasons of an intertropical 
country, in which a moist state of the air is conjoined with the 
greatest daily range of temperature, are those that generally most 
conduce to the generation of this disease. 
The greater prevalence of dysentery in the male than in the 
female sex, arises chiefly from the greater and more frequent ex- 
posure of males to its exciting causes. When dysentery attacks 
females, it usually proceeds from morbid accumulations in the 
bowels. 
A powerful predisposing influence in the production of dysentery 
in soldiers, arises out of the circumstances connected with the 
voyage to India; as the quantity and quality of their food, their too 
liberal allowance of spirituous liquors, and the want of exercise 
during a period of four or five months. 
But there is another circumstance superadded to the above, tend- 
ing to heighten their influence and to occasion dysentery, more 
especially its acute and uncomplicated form ; namely, the costive 
state of the bowels to which passengers by sea are particularly 
liable, and the accumulations of fecal matters which consequently 
form in the caecum and colon, irritating these viscera, or disposing 
them to irritation, as soon as the frame is subjected to the influence 
of the common exciting causes of the disease. That numerous 
cases of dysentery originate in this way, and indeed commence 
very frequently with the characteristic signs of morbid accumula- 
tions in the large bowels, has been a matter of daily observation to 
Mr. Annesley in his practice among recruits, and other persons 
recently arrived in India. 
Amongst the predisposing causes of dysentery, the most power- 
ful, undoubtedly, are those states or functional disorders of the large INFLUENCE OF CONSTIPATION, ETC. 
163 
bowels already considered; particularly accumulations of fecal 
matters in the colon, and morbid elongations and displacements of 
parts of this viscus. 
In the concluding chapter on the Management of Troops on their 
Arrival in India, Mr. Annesley states, that during the period he 
had charge of the general hospital at Madras (five years), he had 
great opportunities of observing the state of the men after a voyage, 
and the state of predisposition in which they usually arrive in this 
country. In all cases, whether soldiers or sailors, in addition to 
a state of great vascular plethora and irritability of fibre, the mor- 
bid accumulations which had formed in the large bowels were so 
considerable, as actually to require medical discipline for weeks to 
restore them to healthy action. This is a circumstance of much 
practical importance, and points out what should be done upon the 
voyage to and on arrival in India, both as regards the health of the 
soldier and the treatment of his disease. 
MR. ANNESLEY TO DR. BURNE. 
Dear Sir, 
I have read with attention the notes you were so kind to send 
me for perusal, and they appear to me to give a full and very fair 
representation of my views as to that most fruitful source of disease, 
accumulation of fecal matters in the large bowels. I am indebted 
to you for the handsome manner in which you have thought proper 
to notice my humble labours, and I hope that your present 
endeavours will draw that attention to the subject which I conceive 
it merits, and which its great importance requires. 
I have long been of opinion that the want of due attention in the 
regulation of the alvine discharges generally, in all classes of the 
community, public and private, is one of the chief sources of the 
most formidable diseases we are acquainted with. The undue 
retention of fecal matters in the bowels, by keeping up irritation, 
and giving rise to constitutional disturbance, contributes materially 
to the production of that class of diseases, usually denominated 
nervous affections, common to both sexes in all parts of the world. 
I am enabled to speak very confidently upon this subject, from a 
most extensive and varied field of observation during a period of 
more than thirty years, and I am every day more and more con- 
vinced of the fact, that the want of proper attention to the alvine 
discharges from the bowels, and the permitting an accumulation of 
fecal matter in them, is a great cause of disease, not sufficiently 
attended to by medical practitioners in general. I do think it of 
the first importance that, in the treatment of all diseases, the distinc- 164 
BURNE ON HABITUAL CONSTIPATION. 
tion should be strongly marked in that most valuable class of medi- 
cines, between the purgatives that stimulate, and such as evacuate 
the bowels freely and fully, without causing any disturbance. I 
am aware that both tact and judgment are required in the exhibi- 
tion of these medicines; but the subject is well deserving of atten- 
tion. 
Believe me, dear Sir, 
Very faithfully yours, 
J. Annesley. 
H. No. 1, Albany, Piccadilly, 
Nov. 8, 1839. 
THE END.