Colon Hygiene 
Comprising New and Important Facts Con- 
cerning the Physiology of the Colon and an 
Account of Practical and Successful Methods of 
Combating Intestinal Inactivity and Toxemia 
/'• 
JOHN HARVEY KELLOGG, 
M.D., LL.D., F.A.C.S. 
Fellozv of the Royal Society of Medicine, of the American 
Medical Association, the Societe drHygiene de Francaise, the 
American Geographical Society, Late Member of the Michigan 
State Board of Health, Editor of Good Health, author of “The 
New Dietetics,” and of numerous other works on health. 
Superintendent of the Battle Creek Sanitarium. 
Thirty-first Thousand 
Edition/ 
THE MODERN MEDICINE PUBLISHING CO. 
Battle Creek, Michigan Copyright, 1912, 1915, 1916, 1917, 1923 
BY 
JOHN HARVEY KELLOGG PREFACE 
That most despised and neglected portion of the 
body, the colon, has in recent years been made the 
subject of much scientific study and research, with 
the result that a lively controversy has been stirred 
up over the question as to whether this organ should 
be permitted to remain a part of the “human form 
divine,” or whether it should be cast out as worse 
than useless and unworthy of a place in the anatomy 
of the modern genus homo. 
Anatomists have declared the colon to be a useless 
appendage, a vestigial remnant left over from a pre- 
historic state. Bacteriologists have charged it with 
being an incubating chamber of poison-forming germs, 
a hold of unclean and hateful parasites, a veritable 
Pandora’s box of disease and degeneracy. Surgeons 
have removed the offending organ, and thus proved 
that it may be dispensed with, and have claimed won- 
derful advantages from this abbreviation of the prime2 
vice. 
Barclay Smith, the great English anatomist, first 
suggested the uselessness of the colon. Metchnikoff 
proved that animals that possess the longest colons 
have the shortest lives, and announced that the colon 
3 4 
PREFACE 
bacillus is the germ of old age. Sir William Arbuth- 
not Lane, an eminent London surgeon, cites a long 
list of grave maladies, ranging from hypochondria to 
rheumatism, cured by removal of this offending organ. 
The war still wages. There are pro-colon partisans 
as well as anti-colon enthusiasts. One thing is certain, 
however, the colon can no longer be ignored. That 
this organ, or rather the morbid conditions that de- 
velop in it, plays a dominant role in the causation of a 
long list of the gravest and most common disorders, 
can no longer be denied. 
In the treatment of every chronic disease, and most 
acute maladies, the colon must be reckoned with. 
That the average colon, in civilized communities, is in 
a desperately depraved and dangerous condition, can 
no longer be doubted. The colon must either be 
removed or reformed. From the beginning of the 
colon controversy and for many years before, the 
writer has been a very earnest student of the questions 
involved, and has formed very definite opinions, the 
validity of which he, together with his colleagues of 
the faculty of the Battle Creek Sanitarium, has had 
opportunity to test in the treatment of many thousands 
of sufferers from colon and colon-caused maladies. 
The writer believes that methods have been worked 
out by means of which the colon may be reformed 
and made to do its work efficiently, not only in or- 5 
PREFACE 
dinary cases, but in by far the great majority of those 
cases which are thought by enthusiastic colon sur- 
geons to be suitable subjects for surgical treatment. 
Until very recent years almost nothing has been 
known of the physiology of the colon. This part of 
the body has been almost a terra incognita. The phys- 
iology of digestion stopped at the ileocecal valve. How 
the colon dealt with its contents, how the very neces- 
sary act of defecation was performed, nobody knew. 
The discovery of the X-ray enabled Cannon and, later, 
Hertz to study the colon while in action in animals 
and man. Elliot, Keith and other anatomists studied 
the intestine in dogs, and finally Case, by perfecting 
the X-ray technic of colon examinations, completed 
the physiologic study of this previously neglected organ, 
The combined result of the extensive labors of these 
investigators has been a great flood of light upon 
some of the most obscure questions in physiology. 
These new facts, not yet known to the general public, 
have rendered the greatest service in the development 
of rational methods of dealing with that most common 
and most destructive disease of civilized peoples—con- 
stipation. The chief purpose of this work is to present 
in a popular way these new facts and the practical 
results to which they have led. 
Forty years’ experience and observation in dealing 
with chronic invalids, and careful study of the results 6 
PREFACE 
of the modern X-ray investigations of the colon, to- 
gether with observations made at the operating table 
in many hundreds of cases, has convinced the writer— 
1. That constipation with its consequences is the 
result of the unnatural habits in relation to diet and 
colon hygiene which prevail among civilized people 
2. That patients are not constipated on general 
principles, but that there exists in every case of con- 
stipation some particular condition which is the im- 
mediate cause of the delayed intestinal movement, and 
which must be removed before definite relief can be 
obtained, and that in the great majority of cases this 
cause is mechanical in character, a fold, a kink, a re- 
dundancy, a contraction—in short, some real and tan- 
gible obstruction. 
3. That practically every case of constipation is 
curable, and in all but exceptional cases without the 
aid of surgery. It must be added, however, that by 
cure is not meant the working of such a miracle that 
the colon will perform its function normally without 
attention to diet or other means which encourage colon 
activity, but rather that by observing certain rules and 
the faithful and continuous use of safe and simple 
means, the colon may be made to perform its functions 
in a regular and efficient manner, without the use of 
irritating laxative drugs. PREFACE 
7 
If some of our recommendations at first impress the 
reader unfavorably, we ask only that judgment be sus- 
pended until the suggestion has been given a fair test 
in actual experiment. Every measure presented has 
been tested in the crucible of actual experience in 
hundreds of cases, and is the result of a long series of 
practical tests made for the purpose of determining 
the actual value of individual remedies and perfecting 
practical methods of relief. 
If the reader misses the usual list of laxative drugs, 
old and new, the reason is simply that the writer re- 
gards all medicinal agents that force bowel action by 
irritation (wrongly termed “stimulation”) as perni- 
cious and, without exception, harmful, and to be used 
only as temporary or emergency measures. In the 
words of the eminent Professor Von Noorden, 
“Nothing is so bad as the chronic use of laxative 
drugs.” 
The reader is asked especially to note that no pan- 
acea is offered for colon miseries; there is no “cure 
all” for constipation. The way out of the slough of 
intestinal toxemia with its “biliousness,” headaches, 
neurasthenias, and multitudinous maladies, is to be 
found only through living biologically, and making use 
of the “safe and sane” helps which recent scientific 
progress has provided. 8 
PREFACE 
In attempting to put into semi-popular form the 
scientific facts pertaining to the hygiene of the colon, 
the writer does not desire to convey the impression 
that the sufferer from severe constipation can safely 
undertake to act as his own physician. The purpose is 
rather to enable the patient who may read this work 
tc co-operate intelligently with the wise up-to-date 
physician. 
The reader’s attention is especially called to the 
chapter on “The Bowel Habits of Uncivilized Man,” 
which contains a fund of original information obtained 
at the cost of much effort, which is both highly inter- 
esting and instructive. The author desires here to 
acknowledge his obligations to some hundreds of med- 
ical colleagues who have devoted their lives to the noble 
work of carrying to heathen lands the blessings of 
modern scientific medicine and Christian civilization, 
and who have found time in the midst of their arduous 
labors to answer the questionnaire and have thus fur- 
nished the unique information presented in this chapter. PREFACE 
9 
Preface to the Fifth Edition 
Since the publication of the first edition of this work 
the somewhat revolutionary notions presented in its 
pages have become widely disseminated, and the meth- 
ods suggested have been copied and even exploited by 
numerous specialists. 
While there are still those who entertain doubts of 
the importance of the colon and colon poisons as fac- 
tors in the causation of disease and who consider con- 
stipation a natural and innocuous condition, the number 
of these reactionary and benighted brethren is growing 
steadily less. The penetrating intelligence of Victor 
Hugo recognized the vicious character of the neglected 
colon even before Metchnikoff and Bouchard had ex- 
posed its malign and destructive influence upon every 
bodily function. Hugo thus picturesquely character- 
izes the colon: “The serpent is in man. It is the intes- 
tine. The belly is a heavy burden; it disturbs the 
equilibrium between the soul and the body. It fills 
history. ... It is the mother of vices. The colon is 
king.” 
This view of the colon justified Sir Arbuthnot 
Lane’s summary method of dealing with the problem 
by extirpating the organ. But we have in recent years 
learned that it is after all not the colon, but its contents 
that must be regarded as the disturbing factor. When 10 
PREFACE 
the colon contents are reformed by changing the flora 
so that putrefaction disappears, the disturbing poisons 
are no longer produced and the colon, even though con- 
siderably crippled by long abuse may cease to be a cause 
of offense. In a great proportion of cases change of 
the intestinal flora is accompanied by the disappearance 
of constipation, the colon acting efficiently under the 
stimulation of a normal aciduric flora. 
Many additions have been embodied in the present 
edition which will add to the value of the work as a 
guide to the proper hygienic care of the colon and, it 
is hoped, will aid both the physician and the patient in 
battling against the most universal and perhaps the 
most pernicious of all the maladies which afflict civil- 
ized man. TABLE OF CONTENTS 
PAGES 
The Colon 17-24 
The Structure of the Food Tube—Normal Position 
of the Colon. 
The Physiology of the Colon 25-44 
The Colon a Waste Receptacle—The Colon Absorbs 
Little—The Digestive Tract Compared to a Railroad 
System—Movements of the Colon—Discharging 
Function of the Pelvic Colon—The Digestive Time 
Table—Evacuation of the Colon. 
The Ileocecal Valve and Its Function 45-47 
Action of the Ileocecal Sphincter. 
Normal Bowel Action 48-62 
The Mechanism of Defecation—The “Call”—The 
Lost “Call”—Why Do the Bowels Move Periodically 
—The House-Broken Colon. 
The Feces 63-74 
The Microbes of the Intestine—Excretory Products 
—Examination of the Stools. 
Influences Which Excite Movements of the Colon 75-95 
The Influence of Bulk—Fruit and Vegetable Acids— 
Fats—Gases—Eating—Psychic Influences—Electric- 
ity — Mechanical Vibration — Massage — Abdominal 
Compression—Exercise—Posture—Hot and Cold Ap- 
plications—Hot Applications—The Hot Enema with 
Acid. 
Influences Which Lessen Intestinal Movements. 96-103 
Liquid Foods — Concentrated Foods — Vitamins 
Needed—Fasting—Pain—Miscellaneous Causes. 
Causes of Constipation 104-114 
The Rationale of Constipation. 
11 12 
PAGES 
Six Dangerous Errors About the Colon 115-124 
Laxative Drugs and Mineral Waters Highly In- 
jurious. 
Psychology of the Colon 125-129 
Habits Which Give Rise to Constipation 130-183 
Rejection of Roughage—Insufficient Bulk—Meat 
Eating—An Excessively Bland or Monotonous Diet 
—The Exclusive Use of Cooked Food—Hot Foods 
and Drinks—A Meager or Low Diet—Constipating 
Diets—'Fasting—Condiments—Irregular Meals—Tea 
and Coffee—Insufficient Fluid—Irregular Sleep—In- 
correct Breathing—Deficient Exercise—Resisting the 
“Call”—Hurried Defecation—Unnatural Posture in 
Defecation—The Use of Tobacco—Alcohol and 
Other Narcotic Drugs—The Use of Purgatives— 
Posture—Horace Fletcher’s Error. 
Disorders of the Digestive Tube Associated with 
Constipation 184-221 
Reverse Peristalsis the Explanation of Many Gas- 
tric Symptoms—Vomiting—Nausea and Aversion to 
Food—A Sense of Fulness—Belching—Globus— 
Coated Tongue and Foul Breath—Biliousness— 
Atony—Lack of Appetite—Painful Affections of the 
Abdomen — Depressing Emotions — Obstructions— 
Contracted Colon—Incompetency of the Ileocecal 
Valve—“Greedy Colon”—Excessive Dryness of the 
Feces—Delay in the Cecum—Delay at the Pelvi- 
rectal Junction—Thickening of Houston’s Valves— 
Delay at the Outlet—Lane’s Kink—Mechanical Ef- 
fects of Constipation—The Bad Effects of Strain- 
ing—'Stricture—'Cancers and Tumors—Intussuscep- 
tion—Anal Disease—Obstruction from Pressure— 
Loss of Rectal Reflex. 
Intestinal Toxemia or Autointoxication 222-248 
Autointoxication without Constipation—The Intes- 
tinal Filter—Bacteria of the Intestine—The Protec- 
tive Acid-Forming Bacteria—Old Age Due to Colon 
Poisons-—Many Diseases Caused by Colon Poisons— 
The Effects of Constipation or Stasis—Intestinal 
CONTENTS CONTENTS 
13 
PAGES 
Gas—The Absorption of Bacteria—Immunity to In- 
testinal Bacteria—Universal Tqxemia—Colon Pois- 
ons and Fatigue. 
Important Discussion of Alimentary Toxemia 249-274 
Poisons of Alimentary Intestinal Toxemia—The Di- 
gestive Organs—Heart and Blood-Vessels—The 
Nervous System—The Eyes—The Skin—Muscles 
and Joints—Genito-Urinary Organs—General Dis- 
orders and Disturbances of Nutrition—Observations 
of Herter and Others on the Intestinal Flora and 
Autointoxication—Different Types of Intestinal 
Autointoxication—Intestinal Toxemia a Cause of 
Senility—Welch’s Bacillus Sometimes Gives Rise to 
Diarrhea—Mental Disease from Intestinal Toxemia 
—Epilepsy and Colon Poisons—Disease of the Thy- 
roid Due to Colon Poisons—Congenital Effects of 
Autointoxication—Pernicious Anemia. 
Changing the Intestinal Flora 275-294 
Changing the Intestinal Flora without Cultures— 
The Quantity of Lacto-Dextrin Required—The Best 
Time for Taking Lacto-Dextrin—To Keep the Flora 
Changed. 
Different Forms of Stasis and Constipation 295-303 
Cecal Constipation. 
The Carmine Test for Intestinal Motility 304-306 
The Treatment of Constipation 307-333 
Hygiene—'Constipation Always Curable—What is a 
Cure of Constipation?—When Is Surgery Needed? 
—Regularity of Meals Necessary—Supplementary 
Bowel Movements—Give the Colon Time for Action 
—Do Not Worry—The Rational Treatment of Con- 
stipation—Clothing—Sleep—Posture During Sleep. 
Diet in Constipation 334-366 
The Laxative Properties of Foods—Atoxic and Anti- 
toxic Properties of Foods—Antitoxic Value of Un- 
cooked Foods—'The Antitoxic Laxative Diet—Cellu- 
lose-Containing Foods—Sterilized Wheat Bran— 
Agar-Agar—Number and Size of Meals—The Use 
of Bran—Recipes for the Use of Bran—Laxative 
Breakfast Foods, 14 
CONTENTS 
PAGES 
Baths and Other Home Treatments for Constipa- 
tion 367-410 
The Cold Douche—The Simultaneous Hot and Cold 
Douche—Abdominal Douche—Hot Sitz and Cold 
Pour—Rubbing Cold Sitz Bath—The Sedative Sitz 
Bath—Alternate Applications to the Abdomen—The 
Wet Girdle—Fomentation to the Abdomen—Com- 
bined Hot Bath and Hot Douche—The Hot Sitz— 
The Photophore, and the Electric Thermophore— 
The Enema—How to Administer the Enema—The 
Hot Water Enema—The Hot Soap Enema—The 
Hot Saline Enema—The Cold Water Enema—The 
Oil Enema—Sugar and Water Enema—The Acid 
Enema—Paraffin Oil Enema—The Glycerine Enema 
—The Cold Rectal Douche^—Injury from Drug Laxa- 
tives—Mineral Oil—Objectionable Features of Par- 
affin—Paraffin Tablets—The Food Residues, Not the 
Intestine, Require Lubrication—Lubrication of the 
Rectum. 
Exercises Which Combat Constipation 411-445 
Hill Climbing—'Horseback Riding—Rowing—Tennis 
—The Medicine Ball—Work Exercises—Posture Ex- 
ercises—To Correct the Standing Posture—Exercise 
to Correct the Sitting Posture—Breathing Exercise 
—Rocking Chair Exercise—Exercise to Raise the 
Chest—To Strengthen the Abdominal Muscles— 
Trunk Raising Exercise—Rolling Exercise—Rocking 
Exercise, Lying—Arm and Trunk Exercise with 
Deep Breathing—Squatting Exercise—Running on all 
Fours—Knee-Chest Breathing—Colon Compressing 
Exercise—Inclined Plane Exercises—Getting in Posi- 
tion—Colon Replacing Exercises—Abdominal Com- 
pression'—Diaphragm Exercise—Exaggerated Knee- 
Chest Breathing—Leg Raising—Trunk Twisting- 
Hips Rolling—Static Exercises—Tension Exercises 
—An Exercise Program—Special Means to Aid 
Defecation—Abdominal Massage—Massage of the 
Cecum—Mechanical Kneading and Vibration—Self- 
Kneading of the Bowels at Stool—The Cannon Ball 
—The Weighted Compress—The Shot Bag—Pneu- 
matic Compression of the Abdomen—The Abdominal 
Supporter. CONTENTS 
15 
PAGES 
Efficient Electrical Methods 446-449 
Automatic Exercise—Electrical Stimulation of the 
Colon—Electrical Stimulation of the Rectum—Dia- 
thermy or Thermo-penetration. 
Special Treatment of Different Types of Constipa- 
tion 450-474 
Treatment of Simple Constipation—Diet—Treatment 
of Rectal Constipation—Treatment of Spastic or 
Latent Constipation—The Treatment of Mixed Cases 
of Constipation. 
Treatment of Disorders Which Result from Con- 
stipation 475-541 
Catarrhal Colitis—Proctitis—Muco-membranous Co- 
litis—Enlargement of the Liver and Spleen—Fecal 
Tumors—Volvulus—Disorders of the Stomach—Dis- 
eases of the Heart and Blood Vessels—Premature 
Senility—Disease of the Kidneys—Disease of the 
Liver and Gall Bladder—Insomnia—Headache— 
Rachitis, Arrest of Growth and Other Disturbances 
of Nutrition in Infants—Cancer—Tuberculosis of 
the Bowels—Backache—Exopthalmic Goiter—Myxe- 
dema—‘Chronic Rheumatism and Rheumatic Gout— 
Pigmentation of the Skin and Skin Diseases—Eczema 
—Psoriasis—Itching Skin without Eruption—Vertigo 
—Disorders of the Urinary and Generative Organs— 
Fecal Fever—Flatulency—Foul Tongue and Bad 
Breath—Anal Infections—Hemorrhoids—Anal Fis- 
sure or Ulcer—Anal Fistula—‘Anal Itching—Rectal 
Prolapse—Anal Incontinence—Anal Spasm—Abdom- 
inal Tenderness—Colic Pains—“Kinks.” 
Bowel Habits of Uncivilized Man 542-582 
Rare Occurrence of Cancer and Appendicitis Among 
Primitive Tribes—Primitive Remedies for Constipa- 
tion. 
Ths Colon Code ,583-586 ILLUSTRATIONS 
PAGE 
Stereoradiogram of Normal Colon 23 
Some Animal Colons 24 
Diagram Showing Normal Colon and Ileocecal Valve.... 32 
Diagram Showing Right Half of Colon Removed. 33 
Diagram of “Short-Circuited” Colon 33 
Ileocecal Valve of a Conger Eel 44 
Ileocecal Valve 45 
Colon Bacteria (colored) 74 
A Congo Fetish 88 
Applying the Dumbbell-Vibrator 88 
The Vibrating Chair 89 
Mechanical Massage of the Colon 90 
Bowel Kneading Apparatus 91 
Lower Jaw of a Mound Builder 130 
A Slumped Sitting Posture 152 
A Correct Sitting Posture 152 
A Disease-Producing Chair 153 
A Health Chair 153 
Adherent Pelvic Colon 212 
Pelvic Colon Restored to Position by Operation 212 
Stereoradiogram Showing Incompetency of Ileocecal Valve 213 
Radiogram of Gall Stones 250 
Ulcer of the Stomach 250 
Cirrhosis of the Liver 250 
Diseased Arteries 251 
Arteries Showing Effects of Arteriosclerosis 251 
Crude Agar 352 
Agar in Sterilized and Edible Form 352 
Fomentation 372 
Wet Girdle 372 
The Photophore 373 
The Thermophore 373* 
A Folding Exercise Table 422 
The Abdominal Supporter 444 
Kneading the Colon 445 
A Spastic Colon 466 
16 THE COLON 
Ignoring technical anatomical details the 
food canal may be described as a muscular 
tube about ten times the length of the body, 
measuring the trunk from the top of the head 
to the end of the spinal column. The chief 
part is coiled up in the lower cavity of the 
trunk, below the diaphragm. The upper end 
of the canal is controlled by the circular 
muscle of the lips, which is brought strongly 
into play in whistling. The lower end is con- 
trolled by the anus, also a circular muscle but 
which acts both voluntarily and involuntarily. 
At other points along the canal, circular mus- 
cles are placed to regulate movements of the 
foodstuffs during the process of digestion. 
Both in health and disease these “food gates,” 
as they may be called, have a most important 
relation to digestion that has not been fully 
appreciated until very recent times. 
The upper end of the food tube is provided 
with a special apparatus, the mouth and teeth, 
for taking food and preparing it to undergo 
the various processes which are carried on in 
17 18 
COLON HYGIENE 
the deeper parts. At the lower end of the 
canal is found a mechanism that is wonder- 
fully designed to receive and discharge from 
the body the unused remnants of the food and 
other waste materials—the pelvic colon. Of 
this we shall learn more later. 
The Structure of the Food Tube 
In structure, the food tube consists chiefly 
of muscle and gland tissue. There are two 
sets of muscle fibres. One set, the outer, runs 
lengthwise of the canal; an inner, circular 
muscle structure surrounds the canal through- 
out its entire length. 
Between the muscle layers is a layer of 
nerve cells and fibres. These are connected 
with the central nervous system, the brain and 
spinal cord, but are capable of acting inde- 
pendently. 
The food canal is lined with mucous mem- 
brane, which presents at various points special 
groups of glands that produce some of the 
various digestive juices which act upon the 
food. The canal is covered through most of 
its course with a delicate membrane, the peri- 
toneum. THE COLON 
19 
The food tube is roughly divided into six 
parts—the mouth, esophagus, stomach, small 
intestine, colon and rectum. The intestine is 
attached to the spine by a membrane, the mes- 
entery, in which pass the nerves and blood 
vessels which supply the canal. 
The zoologist divides the alimentary canal 
into three parts. The first part extends from 
the mouth to the pylorus, or lower opening of 
the stomach. This part is known as the fore- 
gut. The second portion, extending from the 
stomach to the colon, is called the mid-gut. 
These three parts of the food tube have each 
a distinct function. The fore-gut receives the 
food and prepares it for digestion; the mid- 
gut digests and absorbs the digestible por- 
tion of the food and body wastes and disposes 
of them. 
The colon may roughly be described as a 
muscular reservoir about five feet in length 
and an inch and a half to three inches in di- 
ameter. This reservoir is divided into four 
secondary reservoirs, the cecum, the trans- 
verse colon, the pelvic colon, and the rectum. 
The feces, in their preparation for discharge 
from the body, are passed successively from 20 
COLON HYGIENE 
one to the other of these reservoirs, pausing 
for a definite interval in each, with the ex- 
ception of the last. 
Normal Position of the Colon 
When in its normal position, the colon be- 
gins at the lower right hand section of the 
abdominal cavity; its head, a pouch much 
broader than the rest of the colon, lies in the 
hollow of the right iliac bone. This is the 
cecum. The small intestine joins the cecum 
about an inch and a half above its lower part, 
leaving a shallow pocket, at the bottom of 
which is attached the appendix. 
From the cecum the intestine ascends along 
the right side of the abdomen to the liver. 
This portion is the ascending colon. At the 
liver a rather sharp turn is made toward the 
left, the hepatic flexure. 
From this point the colon passes across the 
body above the umbilicus, sloping upward 
toward the left side, where it lies in close con- 
tact with the spleen. This section is the trans- 
verse colon. 
At the spleen the intestine makes a short 
turn, the splenic flexure, then passes down- THE COLON 
21 
ward along the left border of the abdominal 
cavity to the hip bone (crest of the ileum). 
This is the descending colon. 
Passing obliquely across the hollow surface 
of the left iliac bone, the large intestine, here 
called the iliac colon, reaches the upper bor- 
der of the pelvic cavity. Here it forms a 
loop, the pelvic colon, which has an average 
length of a foot and a half, but which varies 
in length from six inches to nearly three feet 
(in conditions of disease). The pelvic colon 
and iliac colon together form the sigmoid. 
The end of the pelvic colon joins the 
terminal portion of the intestine, the rectum, 
opposite the middle of the sacrum. The pel- 
vic colon varies in position according as it is 
empty or filled. When empty, it falls over 
backward into the pelvis, and lies upon the 
upper part of the rectum. When it is in this 
position, a very pronounced fold is formed at 
the junction with the rectum, the pelvi-rectal 
fold, a factor in controlling bowel movements. 
When the pelvic loop is full, it rises and thus 
gradually obliterates the fold and so opens the 
passage to the rectum. 
The rectum extends from the pelvi-rectal 22 
COLON HYGIENE 
fold to the internal anal sphincter, being about 
six inches in length. In its upper part are two 
or three projecting folds of membrane known 
as Houston’s valves. 
The thicker muscular walls of the rectum 
are ordinarily contracted so that no cavity ex- 
ists in the upper part, although some gas and 
often (in cases of disease) a considerable 
amount of fecal matter may be found in the 
lower part. 
The distance between the internal and ex- 
ternal sphincter is about one inch. This is the 
anal canal, which is always tightly closed ex- 
cept during defecation. 
Just above the internal anal sphincter is 
found a series of raised points or papillae, first 
described by Horner of Philadelphia many 
years ago. These papillae are the terminal 
points of special nerves which when excited 
cause powerful contraction of the colon and 
the abdominal muscles and diaphragm, and 
at the same time a complete relaxation of the 
anal sphincter. 
Here are also a number of shallow pockets 
in the mucous membrane, the follicles of 
Horner, whose function is to secrete a lubri- Cecum of an Opossum 
Some Animal Colons 
Cecum of a Dog 
Cecum and Appendix 
of a Chimpanzee 
Colon of a Japanese 
Deer Stereoradiogram of Normal Colon, Showing Pouches THE COLON 
23 
eating mucus. Both follicles and papillae 
sometimes become inflamed and a source of 
pain. 
Surrounding the rectum are two muscles 
which act an important part in defecation, the 
levator ani muscles. In contracting, these 
muscles pull the anus upward and compress 
the rectum, and so squeeze out the last parti- 
cles of fecal matter, leaving the rectum com- 
pletely empty. 
The small intestine is a smooth tube of uni- 
form size, but the large intestine is sacculated. 
By a thickening of its muscular structures at 
intervals shallow pouches are formed in its 
sides. Along the outer surface of the colon 
run thick bands of muscle tissue which act in 
defecation like gathering strings. In con- 
tracting, these bands draw the lateral pouches 
together, so as to empty them of their contents. 
These sacs or pouches are well shown in the 
accompanying stereoradiogram, a rare view 
of the colon. 
All parts of the large intestine, including 
the rectum, are supplied with two sets of 
nerves, one of which stimulates its muscles to 
contract, while the other exercises an opposite 
influence. 24 
COLON HYGIENE 
In the accompanying plates will be seen 
representations of the colons of different ani- 
mals. It is especially interesting to note the 
close relation between the size of the colon 
and the character of the food in various classes 
of animals. In flesh-eating animals the colon 
is always short; in vegetable eaters it is long 
as compared with the body length. 
Several authorities have reported observa- 
tions on human beings which are quite in 
accord with the above facts. For example, an 
observer reports that a certain Asiatic people, 
whose diet has for centuries been strictly veg- 
etarian, have longer colons than those of the 
Eskimos, whose diet is almost exclusively 
meat. THE PHYSIOLOGY OF THE 
COLON 
The chief use of the colon is to receive 
and discharge unusable waste matters, a 
sort of human garbage box. On this account, 
perhaps, this part of the food tube has been 
habitually neglected. It has been regarded as 
of little consequence. But modern studies of 
this part of the intestine have shown that by 
neglect this temporary reservoir of wastes 
may become a veritable breeding place of 
miseries and maladies almost too numerous to 
mention. So many and so serious are the dis- 
orders of mind and body which are now trace- 
able to this part of the food tube, that not a 
few eminent surgeons have advocated and 
practiced the actual removal of the colon in 
cases of chronic disease of various sorts, and 
in many instances with surprisingly good 
results. 
Professor Metchnikoff, of the Pasteur Insti- 
tute, Paris, Dr. Arbuthnot Lane, head surgeon 
of Guy’s Hospital, London, Dr. Barclay 
Smith, and numerous other scientific men, em- 
25 26 
COLON HYGIENE 
inent bacteriologists, physiologists, anatomists 
and surgeons, have even announced the belief 
that the colon is a useless and often dangerous 
structure and that it may be advantageously 
dispensed with. 
The writer does not accept this view, but 
holds with Professor Keith, the eminent Eng- 
lish anatomist, that the evils attributed to the 
colon are really due to the adoption by man 
of a dietary unsuited to his anatomy. All 
vegetable-eating animals have long colons, as 
has man. The presumption is that a vegetable 
diet requires a long colon. Meat-eating ani- 
mals, as the dog, have short colons. The frog 
while in the tadpole state is a vegetable feeder 
and has a very long colon. The adult frog 
feeds upon flesh and has a very short colon. 
The Wrong Use to Which We Put the 
Colon 
The trouble with the civilized colon is not 
that it is too long, but that it is put to a wrong 
use. Civilized man has adopted the diet of 
the dog while having the colon of the chim- 
panzee. It may be admitted that if a man is PHYSIOLOGY OF THE COLON 
27 
to feed on the diet of the dog he ought to have 
his colon abbreviated. This is, in fact, the 
only way in which he could avoid a danger- 
ous biologic misfit. 
It is hardly to be supposed, however, that 
Nature has made so grave an error as to give 
to man an organ which is not only a useless 
appendage, but at the same time a prolific 
source of mischief. It seems more rational to 
believe that if the colon, an organ useful under 
normal conditions of life, is found to be so 
great a source of mischief in our civilized 
life, it is because of abnormal and pernicious 
habits or other influences connected with the 
life of the average civilized man. 
The remedy is to be sought then, not in 
the extirpation of a portion of the body, but 
in a correction of those habits of life in which 
there has been a departure from the condition 
normal to the human species, and a return to 
practices and conditions which are physiolog- 
ically and biologically correct for the genus 
homo. 28 
COLON HYGIENE 
The Colon a Waste Receptacle 
One important function of the colon is to 
receive and to discharge from the body the 
unusable residue of foodstuffs. If these food- 
stuffs are of such a nature that they readily 
undergo putrefaction, as do meats of all sorts, 
the colon contents will become highly putres- 
cent, offensive and poisonous, while still in the 
body. A milk-and-vegetable diet on the other 
hand furnishes a residue which does not read- 
ily putrefy, but ferments, forming harmless 
acids which aid bowel action. Hence the 
colon is not out-of-date, as its critics have sug- 
gested, but is only made to appear as a mis- 
fit by the adoption of a diet which belongs to 
meat-eating or short-colon animals. This 
view, maintained for many years by advocates 
of the biologic diet, is so eminently reasonable 
that it cannot fail to be accorded due recogni- 
tion since it is now supported by so eminent 
an authority as the world-famous anatomist, 
Professor Keith, of England, who insists “the 
fault is not with the engine, but with the fuel.” 
Another important function of the alimen- 
tary canal, one which is quite distinct from its PHYSIOLOGY OF THE COLON 
29 
function as a digestive apparatus, is its excre- 
tory function. The intestine is the outlet of 
the bile, from fifteen to twenty ounces being 
poured into the upper end of the small intes- 
tine every twenty-four hours. The bile is 
the most poisonous of all the bodily secretions, 
being, according to Bouchard, six times as 
poisonous as urine. It is through the bile that 
the body rids itself of alkaline wastes, some 
of which are highly poisonous in character. 
Another fact of very great importance is 
that the intestine is itself an excretory organ. 
Certain poisons are excreted by the stomach, 
others find their way out of the blood through 
the walls of the gall-bladder and the small in- 
testines. 
The colon forms a receptacle for all these 
waste and excretory substances, together with 
the unusable or undigested residues of the 
food. But the collection of these waste mat- 
ters is only an incidental function of the colon, 
its really important function being to conduct 
these waste and unusable matters out of the 
body. 30 
COLON HYGIENE 
The Colon Absorbs Little 
The food normally enters the first part of 
the colon, or the cecum, in a nearly fluid state, 
its composition being ninety per cent water, 
and only one-tenth solid matter. During the 
passage of the foodstuffs through the twenty- 
two feet of small intestine, the digestible 
starches, fats, and proteins are rendered solu- 
ble by the digestive fluids, and are practically 
completely absorbed. The solid parts left 
consist almost entirely of indigestible rem- 
nants of foods, waste products excreted by the 
liver and the intestinal mucous membrane and 
microbes which are produced in great num- 
bers in the lower part of the small intestine 
as well as in the colon. The small intestine is 
not only the seat of the principal digestive 
processes, but is also the principal organ of 
absorption of the digested foodstuffs. The 
colon normally absorbs only about one-sixth 
of the water which remains in the material 
received from the small intestine, the amount 
of which is estimated at about half a pint, and 
practically none of the foodstuffs. The small 
intestine absorbs daily five or six quarts of PHYSIOLOGY OF THE COLON 
31 
liquids and all the products of digestion. It 
is, in fact, the one great avenue for the intake 
of nutrients, both solid and liquid. 
About four hours after a meal, bubbling 
and squirting sounds may be distinctly heard 
when the ear is placed over the right lower 
abdomen, and an hour or two later it is easy 
to produce splashing and gurgling sounds by 
intermittent pressure over the colon low down 
in the right side of the abdomen, showing that 
a considerable amount of fluid has passed 
from the small intestine into the cecum. It 
should be remembered that this is not a mere 
mechanical process. The fluid food does not 
pass by gravity from the small bowel into the 
large intestine as water might trickle from a 
pipe into a reservoir. The opening of the 
small intestine into the colon is controlled by 
a sphincter, the ileocecal valve. This circular 
muscle holds the food in check in the lower 
part of the small intestine long enough to 
make sure that digestion is complete and the 
absorption of digested foodstuffs practically 
finished. In other words, the ileocecal valve 
is a sort of second pylorus, and serves much 
the same purpose. 32 
COLON HYGIENE 
The pylorus and ileocecal gates hold back 
solid and imperfectly digested foodstuffs, per- 
mitting the fluid portion to pass on. In the 
cecum and ascending colon the food is de- 
tained by reverse peristalsis, so that its fluid 
portion may be absorbed, thus increasing the 
consistency of the bowel contents. Gradually 
a portion of the water is taken up by the ab- 
sorbents, which are very numerous in this 
part of the colon, and at regular intervals the 
more solid portions are pushed along toward 
the upper end of the ascending colon, the fluid 
part dropping back into the cecal pouch for 
absorption. 
The Digestive Tract Compared to a 
Railroad System 
Keith, the eminent English anatomist, has 
recently pointed out new facts of great interest 
in relation to the control of the movements 
of the alimentary canal. Keith has shown that 
the muscular structures of the intestine have 
the same property of rhythmic action as is 
possessed by the muscle fibres of the heart. 
This tendency to rhythmic movement of the 
individual fibres is organized into an orderly Diagram Showing Normal Colon and 
Ileocecal Valve Diagram of “Short-Circuited” Colon 
Diagram Showing Right Half of Colon 
Removed PHYSIOLOGY OF THE COLON 
33 
action by certain centers or nodes which are 
designated as pace makers. These nerve cen- 
ters are placed at intervals along the alimen- 
tary tract, thus dividing it into sections. 
Each section is separated from the next one 
by a circular muscle or sphincter. By this 
arrangement the activity of each section in 
manipulating the food and passing it along is 
more or less independent, as the sphincter 
muscle prevents the contraction waves from 
passing from one section into another. Ac- 
cording to Dr. Keith, each section is, like the 
heart, supplied with a controlling nerve cen- 
ter or “pace maker.” From this center arises 
periodically an impulse which maintains a 
rhythmic action of that particular part of the 
muscular tube which it controls. Four such 
nerve centers have been definitely located and 
studied. This new conception of the intestinal 
tract set forth by Dr. Keith compares the in- 
testinal canal to a railroad which is divided 
into block sections, each section being con- 
trolled by its own signal man and telephone. 
The signal man of one section refuses to allow 
a second train to enter his section until it is 
cleared by the passage of the train then pres- 34 
COLON HYGIENE 
ent into the section beyond. If a section any- 
where becomes blocked notice is sent back to 
the section behind so that traffic is stopped all 
along the line. This explains the lack of ap- 
petite, nausea, regurgitation of food, vomiting 
of bile and other unpleasant symptoms which 
often accompany colitis and spastic constipa- 
tion. 
According to Dr. Keith, the mouth consti- 
tutes the first section, defined by a sphincter 
at the upper end of the esophagus. At the 
lower end of the esophagus where it joins the 
stomach is a second sphincter. The pylorus 
is the third sphincter. Still another sphincter 
is found at the junction of the duodenum and 
the small intestine. The fifth sphincter is 
found at the end of the small intestine just 
above the ileocecal valve. Near the middle 
of the transverse colon is a sixth sphincter. 
At the junction of the colon with the rectum 
is found a seventh sphincter. The sphincter 
ani, which closes the lower end of the intes- 
tine, is an eighth sphincter. Each of these 
sphincters is controlled by a special nerve 
supply. 
A disturbance of any one of these sphincters PHYSIOLOGY OF THE COLON 
35 
may produce disorder all along the line of the 
alimentary canal. For example, a spasm or 
undue contraction of a sphincter may stop 
the action of all the parts above it. 
Movements of the Colon 
Like the stomach, the colon has movements 
peculiar to itself,—four very distinct modes 
of contraction. These are: 
1. Molding movements, by which the con- 
tents are slowly compressed and molded. 
These movements are almost too slow to be 
noticed by the eye in X-Ray examinations ex- 
cept by observations made at intervals of a 
half hour or more. 
2. Propulsive movements, by which the 
colon contents are passed along so rapidly that 
the eye cannot follow the movement. Move- 
ments of this sort occur regularly when the 
bowels are evacuated and also at other times. 
3. Snake-like movements. Roeder, of 
Germany, has recently described movements 
in which the transverse or free part of the 
colon moves about in a manner closely resem- 
bling the contortions of a serpent. From this 
he concludes that the position of the trans- 36 
COLON HYGIENE 
verse colon, unless it is held fast by adhesions, 
is not a definite one and is not a matter of 
much importance. 
4. Reverse Peristalsis. Anti-peristalsis, that 
is, a reverse movement of the intestine, was 
first observed by Jacobi, more than twenty 
years ago, and has more recently been studied 
in cats by Cannon. These movements occur 
systematically while the contents of the cecum 
are fluid in character, and serve both to pre- 
vent sudden and frequent discharge of the 
bowel contents, as in diarrhoea, and also to 
churn the contents of the cecum, thus bring- 
ing every portion in contact with the walls of 
the gut, so that absorption may be assisted. 
As studied in animals, by Cannon, and in 
human beings by Case, the rhythmical reverse 
movements which occur in the colon, never in 
the small intestine, are interrupted at regular 
intervals by a downward peristalsis. 
The tight closure of the ileocecal valve 
alone prevents the liquid contents of the cecum 
from being forced by the anti-peristaltic 
waves backward into the small intestine. 
At intervals the anti-peristaltic waves cease 
momentarily, while the ileocecal valve relaxes, PHYSIOLOGY OF THE COLON 
37 
and small portions of material are passed into 
the cecum from the small intestine; then the 
anti-peristaltic waves again begin, churning 
the liquid material, spreading it over the sur- 
face of the cecum and ascending colon, thus 
encouraging absorption, while at the same 
time exerting a pumping action upon the ven- 
ous and lymphatic vessels, so that the contents 
of the cecum are rapidly dried down to the 
proper consistency. 
It is very probable that the common prac- 
tice of resisting the “call” of Nature for 
evacuation, may have produced abnormal con- 
ditions of the colon, by which its normal 
functions are obscured to a very considerable 
degree. The theory of anti-peristalsis, first 
suggested by O’Bierne, accords well with the 
facts of clinical experience, and may now be 
recognized as a fully established fact, espe- 
cially since anti-peristalsis has been actually 
observed in man by Case on numerous occa- 
sions, in the X-ray department of the Battle 
Creek Sanitarium, and by other observers else- 
where. Griitzner has shown that antiperistal- 
sis waves beginning in the colon may travel 
backward to the stomach. 38 
COLON HYGIENE 
Discharging Function of the Pelvic Colon 
The pelvic loop of the colon, which, with 
the iliac colon forms what was formerly 
known as the sigmoid flexure, constitutes the 
motive part of the mechanism by means of 
which the feces are discharged from the body. 
This loop of intestine, when empty, lies low 
down in the pelvis, the lower end of the loop 
where it joins the rectum being closed by a 
sharp fold. There may be a sphincter at this 
point, although not in a state of constant con- 
traction. The loop fills from below as fecal 
matters gradually and slowly enter it from 
above. As it fills, the loop gradually rises, 
finally reaching a point at which the valve 
opens, so that the feces can enter the rectum. 
As the rectal walls become distended by the 
accumulation of feces, the defecation center is 
stimulated, and powerful nerve impulses are 
sent out, which cause the pelvic loop to con- 
tract, thus compressing its contents just as one 
compresses the contents of a rubber bulb by 
squeezing it with the hand. The contraction 
of the pelvic loop is normally so vigorous 
and complete that it is fully emptied of its PHYSIOLOGY OF THE COLON 
39 
contents. The contraction of the descending 
colon at the same time is normally sufficiently 
strong to carry the contents of the descending 
and iliac colon into and through the pelvic 
loop, so that the left half of the colon, from 
the splenic flexure to the anus, is emptied in 
normal defecation. At the end of the contrac- 
tion, the pelvic loop, or at least the mucous 
lining of the loop at its lower end, may be 
pushed down into the rectum like a piston, 
thus ensuring complete emptying of the rec- 
tum. The action of the pelvic colon thus re- 
sembles that of a bulb and piston combined, 
the upper part acting like a compressing bulb, 
while the lower part serves as a piston, thus 
forming a surprisingly effective mechanism 
for discharging the body wastes. 
The Digestive Time Table 
Careful and long-continued observations of 
the time required for the passage of food 
through the different sections of the alimen- 
tary canal, have secured very definite and 
exact information upon this very important 
subject, on which are based the figures given 
below. 40 
COLON HYGIENE 
The following table shows, according to 
Rosenheim, the time required for the food to 
reach the more important of the stations along 
the alimentary tube, reckoning from the time 
the food is eaten, since it is known that food 
begins to pass out of the pylorus very soon 
after the beginning of a meal: 
Cecum 4 hrs. 
Hepatic flexure 6 hrs. 
Splenic flexure 8 hrs. 
Iliac colon 9 hrs. 
Pelvic colon 10 hrs. 
Rectum - 16 hrs. 
Discharge of residues 18 hrs. 
The X-ray shows that food often reaches 
the ileocecal valve within half an hour after 
it is taken into the mouth. It does not pass 
into the colon at once, however, but accumu- 
lates in the lowest coils of the ileum where it 
remains until digestion is completed and the 
digested foodstuffs absorbed. When this has 
been accomplished, the ileocecal sphincter re- 
laxes at intervals, allowing portions of the 
unusable resides to pass into the cecum until 
the ileum is completely emptied. PHYSIOLOGY OF THE COLON 
41 
The last of the food taken into the stomach 
does not reach the colon until the end of 
about nine hours from the time it is eaten. 
Thus, the entire meal should reach the pelvic 
colon, according to Rosenheim, at the end of 
about fourteen hours. 
The delay of six hours in the pelvic colon 
seems wholly unreasonable and unnecessary. 
If the food can pass from the splenic flexure 
to the pelvic colon in two hours (Rosenheim) 
it would seem that it ought to be able to trav- 
erse the short pelvic loop in the same length 
of time, or less. The processes of digestion 
and absorption of digested products is com- 
pleted before the splenic flexure is reached. 
The descending colon, iliac and pelvic colon, 
and the rectum, contain few absorbent vessels. 
The feces are ready for discharge from the 
body; what possible benefit can result from 
their longer retention? Putrefaction proc- 
esses are actively at work producing ptomaines 
and other toxins in quantity. By absorption, 
these may become a source of enormous and 
irreparable mischief. Why should not the un- 
usable food remnants, the wastes and microbes 
which constitute the fecal mass, be gotten rid 42 
COLON HYGIENE 
of as soon as possible when prepared for 
exit? Is it not more than probable that the 
lower part of the human intestine, which is 
most subject to the influence of voluntary 
interference, has been so long abused, discour- 
aged and hindered that it has become abnor- 
mally slow and dilatory? 
Evacuation of the Colon 
The evacuation of the bowels is accom- 
plished by means of seven distinct actions, 
three of which are voluntary and four auto- 
matic. Arranged in the order of natural se- 
quence, the following are the several acts 
which together constitute normal bowel move- 
ment. 
1. Descent of the diaphragm and compres- 
sion of the bowels, accomplished by taking a 
deep breath. 
2. Voluntary contraction of the abdominal 
muscles, increasing the compression. 
3. Pressure of the thighs against the ab- 
dominal wall (the natural position in moving 
the bowels is not the sitting position, but a 
crouching or squatting position universally 
employed by savages and in pioneer rural 
communities). 43 
PHYSIOLOGY OF THE COLON 
The result of these three voluntary efforts 
is to force a portion of the contents of the 
pelvic colon into the rectum, the distention of 
which gives rise to stimulation of the defeca- 
tion center of the sympathetic nervous system 
by means of which the four automatic move- 
ments in defecation are brought into action, 
consisting of the following: 
4. Reflex contraction of the abdominal 
muscles, reinforcing the voluntary contraction. 
5. Contraction of the colon; the descend- 
ing and pelvic colons being chiefly active, 
though sometimes the whole colon contracts. 
6. Reflex relaxation of the anal sphincter, 
in obedience to the general law which holds 
throughout the entire digestive tube, by virtue 
of which a wave of contraction passing along 
any portion of the canal is immediately pre- 
ceded by a wave of relaxation. 
7. Contraction of the levator ani, a mus- 
cle which surrounds the rectum and con- 
tracts at the end of defecation for the purpose 
of forcing out the last remnants of fecal 
matter, so that the rectum may remain empty 
until another movement occurs. 
There are really eight steps in the defe- 44 
COLON HYGIENE 
cation process, if we include the prelimi- 
nary filling and rising of the pelvic colon. 
A disturbance of any one of these eight factors 
in the process of defecation may result in con- 
stipation. If the diaphragm contracts insuf- 
ficiently because of weakness, tight lacing, 
adhesions or any other cause, or if the abdom- 
inal muscles are weak, as is generally the case 
among civilized people, and if the position 
assumed in evacuating the bowels is such that 
the abdominal walls are not compressed by 
the thighs, the result may be that the rectum 
is not filled sufficiently to stimulate the defeca- 
tion center, and so the reflex necessary to set 
in operation the automatic movements which 
empty the bowel, will not be produced. 
If the distention of the rectum, as evidenced 
by a desire to move the bowels, is not relieved 
by going to stool, the desire for movement 
gradually disappears through the loss of sensi- 
bility of the rectal nerves, and the reflex is 
lost. The nerves which preside over reflex 
activities are easily exhausted by continued 
stimulation. Human physiology affords many 
examples of this principle. Ileocecal Valve of a Conger Eel. 
A. Ileum; B. Ileocecal Valve; C. Colon A. Normal Ileocecal Valve. B. Partially Incompetent Ileocecal Valve. 
C. Wholly Incompetent Ileocecal Valve. THE ILEOCECAL VALVE AND 
ITS FUNCTION 
This is an extremely interesting and im- 
portant anatomical structure, which, though 
known to science for three hundred and fifty 
years, has received almost no attention until 
very recently. The ileocecal valve was dis- 
covered by Servius in 1563, A. D. It has 
been described by numerous anatomists, but 
was until recently regarded rather as an ana- 
tomical curiosity with no very important 
function. 
The ileocecal valve consists of two parts— 
a sphincter muscle and a two-lipped check 
valve. The sphincter is formed by a thicken- 
ing of the circular muscular fibres of the small 
intestine at its junction with the colon. The 
check valve is formed by an invagination of 
the small intestine into the colon. Something 
of an idea of the structure of the valve may be 
formed from the accompanying illustration. 
45 46 
COLON HYGIENE 
Action of the Ileocecal Sphincter 
Recent observations of Cannon have 
clearly demonstrated that the ileocecal sphinc- 
ter acts in a manner very similar to the py- 
lorus, retaining the foodstuffs in the small 
intestine until the digestive work of the mid- 
gut is complete and the digested foodstuffs 
have been absorbed. 
Within the last few years Holzknecht, 
Schwartz, Groedel, Case, and numerous other 
roentgenologists have clearly demonstrated the 
functional activity of the ileocecal valve in 
controlling the movements of foodstuffs from 
the small intestine into the colon. These ob- 
servations establish the necessity of the ileo- 
cecal valve for the following purposes: 
1. To hold back the digesting material in 
the small intestine until the digested portion 
has been transformed by the several digestive 
juices, and absorbed. 
2. To pass the mixture of unusable food 
residues, mucous, bile, and other excretions 
from the small intestine into the colon in small 
successive doses, so as to give the colon, the 
chief function of which is the absorption of 47 
ILEOCECAL VALVE AND FUNCTION 
water and the discharge of unusable food 
residues and excreta, an opportunity to deal 
with the successive portions of material 
brought to it without being over-loaded. 
3. To prevent a reflux of material from 
the colon into the small intestine, which is 
accomplished by co-operation of the muscular 
sphincter of the proximal side, and the me- 
chanical action of the membranous folds on 
the distal side of the ileocolic junction. The 
importance of this function of the ileocecal 
valve is greatly emphasized by the demonstra- 
tion, by Cannon, Schwartz, Case, and others, 
of the existence of an anti-peristaltic action in 
the first half of the colon. 
Recent observations made by Boas and 
others show that a slight anti-peristaltic move- 
ment extending from the colon to the stomach 
is very frequent, possibly constant. Charcoal 
and various pigments introduced into the rec- 
tum at night in fasting persons may be found 
in the stomach the next morning. This anti- 
peristalsis is greatly increased by constipation 
and, when pronounced, gives rise to water- 
brash, nausea, “bilious attacks,” vomiting, 
coated tongue and loss of appetite. NORMAL BOWEL ACTION 
There is perhaps no important bodily 
function so much neglected, and with such 
damaging results, as defecation or bowel 
movement. This function is too often looked 
upon as a humiliating act that must be secreted 
and avoided whenever possible, and that may 
properly be postponed to suit the exigencies 
of business or pleasure. The “call” of Nature 
for evacuation of the bowels is habitually ig- 
nored or resisted by children and adults alike, 
until it can no longer be suppressed, or until 
it disappears. 
This wrong attitude toward one of the 
most important functions of the body is in 
large part responsible for the almost universal 
existence of constipation among civilized peo- 
ple, and of widespread and most appalling 
evil consequences, as we shall make clear in 
a subsequent chapter. 
Ignorance of physiology, and especially of 
the physiology of digestion and nutrition, is 
doubtless the cause of this widespread evil. 
It is the duty of every physician and every 
48 49 
NORMAL BOWEL ACTION 
trained nurse to do all possible toward the en- 
lightenment of the chronically sick with whom 
they come in contact in relation to the absolute 
necessity for frequent and complete bowel 
action. 
This is a subject which is too commonly 
tabooed by a false modesty that is entirely out 
of place. Mothers and school teachers espe- 
cially should give the matter special consid- 
eration. They should make sure that each 
child under their supervision has formed and 
maintains correct and regular habits in rela- 
tion to evacuation of the bowels. 
The Mechanism of Defecation 
Until very recent times the process by 
which the colon discharges its contents was 
one of the most obscure in physiology. The 
discovery of the X-ray and of a method of 
examination by which the, contents of the 
stomach and intestines could be made to cast 
a shadow on the fluorescent screen or upon a 
photographic plate, has thrown a flood of 
light upon this extremely interesting and 
practical question. 50 
COLON HYGIENE 
As already remarked, the process of defeca- 
tion involves seven distinct acts. Three of 
these are under voluntary control, the other 
four being controlled by a special center 
known as the “ center of defecation,” located 
at the extreme lower end of the spinal cord. 
The act of defecation is called forth by a 
sensation of fulness in the lower part of the 
colon. In a state of health we ordinarily per- 
ceive sensation only near the extremities of 
the alimentary canal. At the upper end of 
the food tube, guarding the entrance to the 
esophagus, there is located a reflex that con- 
trols the intake of food and liquids. There 
are nerves in the mucous membrane at the 
back of the throat that, when stimulated by 
the contact of foods or liquids, give rise to the 
swallowing movement in which the esophagus 
opens and food or liquid present in the throat 
is drawn in by a strong suction movement. 
The act of swallowing is impossible without 
the contact of something that may be swal- 
lowed. 
At the other end of the food tube, within 
a few inches of the anus—that is, at the upper 
part of the rectum—are found nerves that, 51 
NORMAL BOWEL ACTION 
when stimulated by the contact of fecal mat- 
ters, give rise to a peculiar sensation recog- 
nized as a warning that the bowel contents 
should be discharged from the body. 
The “Call” 
Natural bowel movement is preceded by 
sensations which clearly indicate the necessity 
for evacuation of the bowels. The mechan- 
ism of this instinctive notification of the neces- 
sity for giving attention to the needs of the 
body is very interesting. We have already 
learned that the colon is subdivided into four 
separate compartments and that the feces are 
dealt with by each of these in succession. In 
the cecum the consistency of the feces is in- 
creased to such a degree that the mass can be 
bandied by the muscular wall of the bowel. 
The ascending colon pushes the feces through 
the hepatic flexure into the transverse colon. 
In this horizontal portion of the canal the 
feces rest for a time for further extraction of 
water. From the transverse colon the feces 
are pushed up the incline to the splenic flex- 
ure, and through this narrow gateway into the 
descending colon, along which, in the course 52 
COLON HYGIENE 
of an hour or two, it finds its way to the capa- 
cious loop of the pelvic colon. 
The pelvic loop gradually fills, and in fill- 
ing is raised until the bowel is unfolded and 
thus opened. Now, unless the feces have been 
so long retained that they have become hard 
and dry, the bowel contents are pushed on 
into the rectum. 
Up to this point the progress of the food 
material after leaving the mouth, during its 
passage through the long food canal, has been 
unattended by any sensation whatever. But 
now there is felt an unpleasant sense of weight 
in the region of the rectum. This sensation 
increases and there is a more or less urgent 
desire to evacuate the bowels. 
This is the “call7 of Nature for bowel 
movement, evoked by the contact of the feces 
with the nerves of the rectum and distention 
of its walls. The fuller the rectum becomes, 
the more pressing is the desire for evacuation. 
The “call” appears only when the feces have 
reached the rectum. 
It will now* be easily seen how the “call” 
and the bowel movement may be directly in- 
fluenced by numerous factors. Let us briefly NORMAL BOWEL ACTION 
53 
notice some of the most important of these, 
which will be discussed more fully in a later 
chapter. 
The taking of food is the most powerful 
of all natural stimuli of peristaltic activity. 
The taking of food, even in small amounts, 
starts up peristaltic waves which push for- 
ward the food residues in the lower part of 
the small intestine and carry them into the 
colon; and the fecal masses in the colon are 
pushed on to make room for other oncoming 
residues. 
If the food taken is insufficient in bulk, the 
pelvic loop will be only partly filled, and 
hence will not rise high enough to permit the 
feces to pass into the rectum, and hence there 
will be no “call” and no movement. It is 
evident, also, that if the amount of food taken 
is small, the pelvic loop may be so long a time 
in filling that the feces which first entered 
will become so dry and compact that they may 
form a mechanical obstruction, and thus the 
onward movement necessary to reach the rec- 
tum will be prevented, even though the bowel 
may rise, and the gate which guards the en- 
trance to the rectum may be open. In starva- 54 
COLON HYGIENE 
tion, no “call” appears because there is nothing 
with which to fill the loop and open the rectal 
gate. 
Bodily movement has a certain amount of 
influence upon the position of the loop and 
the entrance of feces into the rectum, espe- 
cially deep breathing exercises, and bodily 
exercises which produce deep breathing. In 
deep breathing, the diaphragm is pushed down 
upon the abdominal viscera, compressing the 
colon as well as other parts against the ab- 
dominal wall. By this means the feces in the 
pelvic loop may be pushed on into the rectum, 
thus evoking a “call.” 
The increased depth of breathing and the 
compression of the abdomen resulting from 
movement when one first awakens in the 
morning are no doubt the reasons why many 
persons experience a “call” almost immedi- 
ately upon awakening after a full night’s 
rest. During sleep the pelvic loop has been 
slowly filling and rising, but the pressure has 
not been quite sufficient to cause the feces to 
pass into the rectum. A push from the dia- 
phragm and the abdominal muscles gives the 
little extra help needed and the “call” comes. NORMAL BOWEL ACTION 
55 
By straining movements, such as accom- 
pany bowel evacuation, sufficient fecal matter 
may be pushed over into the rectum to create 
an effective “call,” when not previously felt. 
Hence the importance of going regularly to 
stool even though no “call” is experienced. 
A cold morning bath helps in the same 
direction, both by causing deep respiratory 
movements, which increase the intra-abdom- 
inal pressure, and by causing a reflex contrac- 
tion of the colon. 
These facts are mentioned here in order to 
bring the explanation of the “call” within the 
range of common every-day experience, and 
to show its very important bearing upon the 
practical management of cases of constipa- 
tion. 
The act of swallowing a glass of water, es- 
pecially the drinking of cold water, and above 
all other things the taking of food, by setting 
up peristaltic movements may produce a 
“call,” provided there is at the time a quan- 
tity of feces in the pelvic loop. If the loop is 
empty, food taking or anything else which 
sets up intestinal peristalsis will serve to help 
the feces along toward the pelvic colon, thus 56 
COLON HYGIENE 
leading to a “call” a little later. The imme- 
diate effect of any such stimuli will of course 
depend upon the position of the fecal mass in 
the colon. If, for example, there is slight 
delay in the transverse colon, perhaps as the 
result of neglect of usual exercise or spending 
a day in bed, the use of measures to promote 
intestinal action may produce no immediate 
effect, whereas a bowel movement the next 
morning may be the result of the impulse 
given to the fecal mass by means of which 
the stagnation in the ascending colon was over- 
come. 
The Lost “Gall” 
The “call” to bowel movement is like the 
call of the alarm clock set to awaken one in 
the morning. If not responded to, it soon 
ceases to be heard. It is like the voice of 
conscience, which may be wholly stifled by 
continued disregard. This is only the opera- 
tion of a general biologic law. A continuous 
sensation which is ignored, by and by fades 
out of the consciousness. For example, the 
clothing gives rise to no sensation unless ad- 
justed in some unusual fashion, although in 57 
NORMAL BOWEL ACTION 
contact with almost the entire cutaneous sur- 
face. We are unconscious of gloves or shoes, 
although our hands or feet may be tightly 
compressed. So, if the ‘call” evoked by the 
pressure of feces upon the nerves of the rec- 
tum is not responded to, after the lapse of a 
certain time the “call” is no longer heard. A 
mass of feces may lie in the rectum, but it 
produces no sensation. The writer has many 
times found large fecal masses in the rectum 
of which the patient was wholly unconscious, 
although in some instances there was evidence 
that they had been present in the lower bowel 
for days or even weeks. 
The first time a “call” is disregarded it will 
return again when additional fecal matter is 
pushed down from the pelvic colon by the 
stimulus of the next meal, or as the result of 
some other influence which excites intestinal 
action or increases intra-abdominal tension. 
After having been disregarded or resisted 
many times, however, the “call” becomes less 
and less distinct, and by and by ceases entirely. 
The rectal nerves have lost their normal sen- 
sibility. They do not respond to the irritation 
produced by the contact of fecal matters, but 58 
COLON HYGIENE 
have acquired a tolerance for such contact, 
just as the nerves of taste may become accus- 
tomed to contact with hot spices, so that they 
no longer cause any disagreeable secretion, 
or the skin may cease to react to a mustard 
plaster, so that a stronger irritant, as croton 
oil or a hot iron, must be required to produce 
a blister. 
This condition of lost sensibility is one of 
the most common causes of constipation, and 
a condition which is sometimes very difficult 
to remove, although always conquerable by 
persevering effort, thanks to the great light 
thrown upon these cases by modern medical 
research. 
To lose one’s “call” is almost as bad as to 
lose a fortune; indeed such a loss has more 
than once led to loss of fortune, and to worse 
results. A “call” that has been lost must be 
most assiduously sought for until recovered, 
and put into efficient operation. The meth- 
ods for accomplishing this will be described 
at length in a later chapter. NORMAL BOWEL ACTION 
59 
Why Do the Bowels Move Periodically? 
There are two factors which are chiefly 
active in producing bowel movements in nor- 
mal individuals. The first is the practice of 
taking food only at stated intervals, regular 
meal hours. The second is regularity in the 
hours of sleep and morning rising. The omis- 
sion of a meal, or a change in the hours of 
meals or of sleep will at once change or de- 
stroy the rhythm of bowel movements. Ani- 
mals that eat continuously, as monkeys and 
barnyard fowls, have bowel movement many 
times a day. 
The taking of food is the most active of all 
natural excitants of bowel action. When food 
is taken into the stomach, it produces power- 
ful peristaltic waves which traverse the whole 
length of the intestine and carry the intestinal 
contents forward at a rate several times 
faster than the ordinary rate of progression; 
the larger the meal, and the more it is relished, 
the more pronounced is this effect. This ex- 
plains the almost universal experience that 
the bowels move most freely and regularly 
soon after the morning meal. 60 
COLON HYGIENE 
On rising in the morning after a full night’s 
sleep, so long a time has elapsed since the last 
bowel movement that the feces have accumu- 
lated in the pelvic loop and the descending 
colon, and it is only necessary that sufficient 
stimulus should be applied to cause feces to 
enter the rectum, and a “call” and bowel 
movement will follow. The act of rising, 
sometimes the mere awakening and the ac- 
companying turning and stretching move- 
ments, are often sufficient to accomplish this. 
During sleep, the intestinal movements are 
slowed. The progress of the intestinal con- 
tents along the canal is at a much slower rate 
than during the waking hours. This is easily 
shown by X-ray observations after a bismuth 
meal. At the moment of awakening, all the 
bodily movements are quickened. The heart 
beats faster, the force of the breathing is in- 
creased, and the whole vital machine feels the 
impulse of quickened energies. If the pelvic 
colon has been slowly filling during the night, 
the various influences which are brought into 
play at the moment of awakening will be likely 
to cause the passage of a sufficient quantity of 
feces from the pelvic loop into the colon to 
produce a “call” and an evacuation. 61 
NORMAL BOWEL ACTION 
The House-broken Colon 
Regularity of bowel movement is of the ut- 
most importance. It is a function which 
should be assiduously cultivated. As we have 
seen, the periodicity of alvine evacuation is 
not the result of any mysterious influence, but 
is a product of forces which are largely in our 
own control and are easily understood. From 
early infancy, the habit of prompt attention 
to the “call” for evacuation of the colon 
should be assiduously cultivated. Instead of 
doing this, the mother usually subjects the 
little one to a process of house-breaking much 
like that to which house dogs are subjected. 
The result is the derangement of the natural 
order which empties the colon after each meal 
or three or four times a day, and the establish- 
ment of a crippled condition of the colon 
which permits but one evacuation a day, a 
form of constipation which is so universal 
among civilized people that it has come to be 
regarded as natural. Indeed, the majority of 
people and many physicians regard regularity 
as the essential element of colon health, and 
almost ignore the matter of frequency and 62 
COLON HYGIENE 
thoroughness of evacuation. The late Sir 
Lauder Brunton, the eminent English in- 
ternist, told of a lady who answered his inquiry 
about the colon function, “perfectly regular, 
sir, perfectly regular.” When further ques- 
tioned, she disclosed the fact that although 
bowel movements were perfectly regular, they 
occurred only once in three weeks. 
As soon as the little one begins to run about, 
the mother begins to train it to restrain the 
movements of the bladder and bowels to suit 
convenience of time and place. A false sense 
of modesty also becomes a restraining influ- 
ence which soon upsets the normal intestinal 
rhythm and lays the foundation for life-long 
stasis and constipation and all the miseries 
associated with these conditions and the auto- 
intoxication to which they give rise. THE FECES 
The composition of the colon contents, the 
feces, is very complicated and highly vari- 
able, depending very largely upon the char- 
acter of the food. The bowel discharges of 
the nursing infant consist of fragments of un- 
digested curds, fat, bile and a small amount of 
mucus. The odor of a healthy infant’s stool 
is slightly acid, and yellowish in color. The 
stool of an adult who subsists upon an or- 
dinary mixed diet contains a considerable 
amount of food residues, seeds and skins of 
fruit, cellulose from vegetables, and such 
whole-grain cereals as oat-meal and cracked 
wheat, and also contains one or two per cent 
of starch, about the same amount of fat, and 
three or four per cent of protein. Sugar is 
not present. The color is usually dark brown, 
often black, and the odor putrid. The form 
varies to a marked degree. 
The stools of a person who subsists on a 
natural non-flesh diet and whose bowels move 
three times a day are very different from 
those of a meat eater and closely resemble 
63 64 
COLON HYGIENE 
those of a healthy infant. The odor is not 
putrid, but may be slightly sour. 
Strassburger has shown that about half the 
solids of fecal matter is made up of bacteria. 
When the stools are putrid it is because of 
the dominance of the special bacteria which 
give rise to putrefaction. In sour smelling 
stools, however, the bacteria present are 
chiefly those of the sort which cause fermen- 
tation and give rise to acid. The sour odor 
is due to the presence of acetic acid, which is 
more or less volatile at low temperatures. 
Lactic acid is also present. As it is non-vol- 
atile, its presence is shown only by chemical 
tests, not by the odor. 
The general belief that the feces or stools 
consists chiefly of the unused remains of food- 
stuffs is entirely erroneous. As a matter of 
fact, even under the most unfavorable con- 
ditions, the feces contain really very little food 
material. 
The chief constituents of the feces are as 
follows : bile, remains of digestive juices, es- 
pecially of the pancreatic juice, mucus, ex- 
cretory substances thrown off by the intestinal 
mucous membrane, microbes and various poi- THE FECES 
65 
sons produced by microbes, such as indol, 
skatol, pyrrol, and numerous other poisons, 
together with some small amounts of the vari- 
ous food principles, and water. 
The composition of the stool varies greatly 
according as the diet contains much or little 
of vegetables. On a vegetable diet the feces 
contain much cellulose, and with the cellulose 
are increased quantities of undigested protein 
and starch. The amount of fat does not vary 
much, and sugar is never present. 
The weight of the feces varies with the 
diet, increasing with a vegetable diet, and 
diminishing with a diet composed chiefly of 
animal substances. Food which contains much 
cellulose passes through the intestine much 
more quickly than does animal food, and 
hence contains more water and undigested 
food principles. The total weight of the feces 
for twenty-four hours with a mixed diet is 
about five ounces, of which three-fourths is 
water. With a vegetable diet the weight is 
double, and the proportion of solid matter is 
slightly greater. 66 
COLON HYGIENE 
The Microbes of the Intestine 
The reaction of the feces is neutral or 
slightly acid on a vegetable diet, and strongly 
alkaline on a flesh or mixed diet. This dif- 
ference in reaction is due to the difference in 
the flora or species of bacteria which are pres- 
ent. Feces that are rich in protein, the result 
of a mixed or flesh diet, contain enormous 
quantities of putrefactive bacteria, which pro- 
duce alkaline substances in decomposing the 
proteins—ammonia, ptomaines, and various 
toxins. When considerable quantities of starch 
are present, as with a vegetable diet, with very 
little protein, acid-forming bacteria are more 
numerous and the feces may have an acid or 
neutral reaction. 
This difference in reaction is one of the 
most important of all the various character- 
istics of the feces, since it suggests at once the 
general character of the flora, and thus points 
to the toxic or non-toxic character of the stool. 
This remark does not apply, however, to bu- 
tyric acid, which is often present in highly 
putrefactive stools, to which it gives a rancid 
odor. 67 
THE FECES 
Roger calls attention to more than one 
hundred and sixty different species of bac- 
teria which have been found in the feces. Of 
these, more than one-third were found to 
possess pathogenic or disease-producing prop- 
erties. Distaso points out more than twenty 
species of putrefactive bacteria which are 
found in the stools of flesh eaters, all of which 
produce very highly toxic products. One of 
the most common and abundant of these is the 
Bacillus of Welch, which produces enormous 
quantities of offensive gas and highly active 
poisons. This microbe, as well as the other 
putrefactive organisms which are found in 
the feces, is found in an active growing con- 
dition in butcher’s meat and fresh flesh foods 
of all sorts, as well as salted and dried fish. 
These are doubtless the chief sources of the 
dangerous bacteria which carry on in the body 
the same putrefactive processes to which they 
give rise elsewhere. Welch’s bacillus is the 
cause of gas gangrene. 
The number of these microbes in the feces 
is something prodigious. They often consti- 
tute from one-third to one-half the total 
weight of dried feces, Strassburger estimates 68 
COLON HYGIENE 
the weight of the microbes produced in the 
intestines in a single day at not less than one- 
quarter of an ounce, and the number more 
than one hundred trillions, of which a large 
proportion may be poison-forming organisms. 
Only a small share of the bacteria are found 
alive in the feces (one per cent, according to 
Strassburger), but all have been alive and 
have each produced its portion of poisonous 
substances in breaking up the protein upon 
which it feeds. 
The study of these bacteria is one of the 
most important fields of research at present 
before the bacteriologist; for it has been 
clearly shown that the condition of the flora 
of the intestine is one of the most important 
of all factors in determining health or disease, 
long or short life. Of this subject we shall 
learn more in a subsequent chapter. 
Excretory Products 
Not the least important constituents of the 
feces are the waste products which they con- 
tain, a fact quite too often overlooked. The 
mucous membrane of the intestine, like the 
skin, is an excretory organ. Although the 69 
THE FECES 
extent of the intestinal mucus covering is only 
seven square feet, about one-third of that of 
the skin, there is reason for believing that its 
importance as an outlet is fully as great as 
that of the skin, and probably much greater. 
This fact has only recently been made known. 
By the researches of Roger and others, it has 
been shown that the mucous membrane re- 
moves from the body some of the most deadly 
poisons which are produced in our tissues, or 
which may be introduced from without. If, 
for example, a quarter of a grain of morphia 
is injected underneath the skin of a person, a 
large part of the poison will be found in the 
stomach and intestine within a half hour. 
This excretion of poisons appears in the light 
of these new researches to be one of the im- 
portant offices of the stomach. 
Lime salts which are no longer needed in 
the body are excreted through the intestine. 
The bile poured into the intestine contains 
some of the most deadly poisons produced in 
the body. These poisons are often concen- 
trated by re-absorption, the natural result of 
constipation. 70 
COLON HYGIENE 
Examination of the Stools 
When a doctor is called to see a sick infant, 
he first of all inquires as to the bowel passages, 
and the experienced nurse or mother always 
preserves the infant’s napkins to show to the 
doctor when he comes. If the bowel passages 
have the usual consistency and yellowish color 
and a slightly acid odor, the doctor knows 
that there is no serious disturbance of diges- 
tion; but if the stools are dark or brownish 
in color and have a foul or putrid odor, this 
fact alone is sufficient to show to the physi- 
cian or experienced nurse that the infant is 
sick. Any physician who would omit to ex- 
amine the stools of an infant when called in 
consultation, would be regarded either as ig- 
norant or as quite remiss in his duty. 
It is very strange, indeed, that until quite 
recently almost no attention has been given 
to the stools of adults, and even at the pres- 
ent time physicians quite rarely take the 
trouble to make anything like a thorough in- 
vestigation of bowel passages. The doctor 
usually contents himself by inquiring if 
the bowels move regularly. When ques- THE FECES 
71 
tioned concerning the character of their stools, 
most patients are unable to give any informa- 
tion. Something can be learned from the 
general appearance of the stools, but for really 
useful information it is necessary to submit 
a specimen to a thorough laboratory investi- 
gation at the hands of an expert in this par- 
ticular line of research. 
It is not going too far to'say that a thorough 
examination of the stools should be made in 
every case of chronic disease. This practice 
has already been instituted in a very few 
medical institutions where first-class medical 
work is done, and the time cannot be far dis- 
tant when such examination will be a routine 
practice with all physicians who attempt to 
keep abreast with the advance of medical 
science. 
Careful microscopic examination is of 
course necessary to determine the presence or 
absence of parasites. In the South, hookworm 
disease is not confined to the mountain dis- 
tricts. Evidence of the presence of these 
parasites has often been found in the stools 
of well-to-do people living in large Southern 
cities. The tapeworm parasite occurs in all 72 
COLON HYGIENE 
parts of the United States. Parasitic ameba 
are encountered with increasing frequency. 
Most important of all for the average pa- 
tient is the bacteriological examination. This 
should be made in every case of constipation, 
but not simply for the purpose of determin- 
ing whether or not putrefactive changes, with 
the pernicious organisms which give rise to 
putrefaction, are present; for putrefactive or- 
ganisms are dominant in all cases of stasis and 
constipation. The examination is to deter- 
mine the degree of infection as shown by the 
relative proportions of acid-forming and pu- 
trefactive organisms. The gram stain is very 
useful for this purpose. In general, the 
greater the number of gram positive organ- 
isms, the better the flora. 
A flora which gives with the gram stain 5 
positive and 95 negative, is an extremely bad 
one. Such a flora will be highly putrid, alka- 
line in reaction, and will show great numbers 
of B. Welchii, B. proteus and other putrefac- 
tive organisms, and aciduric organisms will 
be absent. This is the sort of flora often found 
in cases of chronic rheumatism (osteoarthri- 
tis), gall bladder disease, chronic colitis or 73 
THE FECES 
appendicitis, premature senility, migraine and 
neurasthenia. 
When a patient with such a flora, by proper 
diet and the use of lacto-dextrin changes his 
flora to such a degree that the gram stain is 
reversed, giving 95 positive and 5 negative, 
the picture changes completely. The stools 
are no longer putrid or ammoniacal, but be- 
come neutral or slightly acid in odor and re- 
action. B. acidophilus is dominant and B. 
Welchii and other spore-bearing organisms 
are absent. The bowels move better, are often 
loose instead of constipated and the patient 
usually feels an immediate and decided 
change for the better. 
The accompanying cut shows the contrast 
between a gram positive and a gram negative 
flora as seen under the microscope. The or- 
ganisms shown in red are putrefactive; the 
blue, acid-formers, chiefly B. acidophilus and 
B. bifidus. 
A flora which shows gram positive 20 to 
30 and gram negative 80 or 70, a very common 
finding, is the ordinary bad flora of mixed 
feeders. With constipation or stasis, such a 
flora becomes a grave cause of disease because 74 
COLON HYGIENE 
of the enormous burden thrown upon the liver 
and kidneys in the destruction and elimina- 
tion of putrefaction products, some of which 
are highly toxic. As the flora is gradually 
changed to gram positive 75 and negative 25, 
then positive 80 or 90 and negative 20 to 10, 
the patient experiences progressive improve- 
ment in feeling and well-being. The bowels 
move better and all the bodily functions are 
better performed. A great handicap has been 
removed and the vital machinery has an op- 
portunity for unhampered action. The cur- 
ative forces of the body that before were 
occupied in battling against poisons absorbed 
from the colon and repairing the damages 
done by them, are now left unhandicapped 
for the task of correcting diseased conditions 
and restoring the normal vital equilibrium of 
health. A . B 
Colon Bacteria 
The red color indicates species which produce putrefaction and give rise to toxins; the blue color, 
acid-forming organisms which are friendly. A. Stool from a child suffering from intestinal toxemia. 
B. Same case ten days later after flora was changed by a change of diet and other measures. INFLUENCES WHICH EXCITE 
MOVEMENTS OF THE 
COLON 
The food tube is controlled by two sets of 
nerves. One, the motor, excites contractions 
of the intestine, while the other opposes this 
action, causing cessation of movement and re- 
laxation of the intestine. The motor nerves 
are derived from the brain and spinal cord; 
those of the second class, known as splanchnic 
nerves, from the sympathetic. 
A very remarkable and interesting fact re- 
lating to the action of these nerves should be 
mentioned here as an aid to a full understand- 
ing of their action. When the motor nerves 
of the intestine are stimulated, they cause 
powerful contraction of both the intestine and 
the abdominal walls, but relaxation of both 
the internal and external anal sphincters. 
When the sympathetic or splanchnic nerves 
of the intestine are stimulated, they cause re- 
laxation of the intestines, with cessation of 
movement, and at the same time strong con- 
75 76 
COLON HYGIENE 
traction of the ileocecal sphincter. These two 
facts explain many important phenomena in 
relation to bowel movement and constipation. 
The relaxation of the anal sphincters when 
the colon and abdominal muscles contract, is 
necessary to facilitate the discharge of feces 
from the bowels. This fact wholly agrees 
with the interesting observations of Bayliss 
and Starling, that mechanical excitation of 
the intestine causes contraction at and above 
the point of irritation, and relaxation below. 
The intestine is supplied with nerve ganglia 
of its own, located within its walls, between 
its two layers of muscles. A small bit of 
stomach or intestine removed from a living 
animal, when stimulated by electricity does 
not contract in continuous spasm as do ordi- 
nary muscles, but contracts rhythmically. 
A remarkable substance, pituitrin, pro- 
duced by a small gland in the brain, the pitu- 
itary body, is a most powerful stimulant to 
the entire intestinal tract. Used hypoder- 
mically, this substance rarely fails to produce 
within a few minutes very vigorous bowel 
action. It is much used for this purpose 
after operations involving the abdomen. A 
B 
Veillon Tube Cultures Showing, A. Flora Changed, No Gas; 
B. Putrefactive Flora, Welch’s Bacillus, Much Ga* INFLUENCES WHICH EXCITE MOVEMENTS 
77 
The Influence of Bulk 
The intestine has two special senses, the 
muscular sense, which it possesses in a very 
high degree, and a fine tactile sense located in 
its mucous lining. The muscular sense is ex- 
cited by distension of the intestine, which 
causes tension of its muscular walls. 
In operations upon the stomach and intes- 
tines, the influence of mechanical stimulation 
is often seen. Slight pressure or traction upon 
the wall of the stomach or of the intestine is 
sufficient to set up a contraction which follows 
in a few seconds. Contact of the food with 
the interior of the intestine produces like 
effects. The greater the bulk of the food, the 
greater the effect. As shown by Cannon, seg- 
mentation, a most effective means of food pro- 
pulsion, becomes really active only when the 
bowel is distended. 
Foods which are completely digested and 
absorbed by the intestine, leaving little or no 
residue, do not encourage peristalsis. This is 
the reason why rice, boiled milk, and fine flour 
bread have become generally known as con- 
stipating foods, These foods are not actively 78 
COLON HYGIENE 
constipating; they simply do not leave suffi- 
cient indigestible residue to afford the neces- 
sary mechanical stimulation of the intestine. 
In general, all animal foods encourage con- 
stipation, for the reason that they are very 
completely soluble in the digestive fluids. 
Hair, feathers and bones are almost the only 
animal tissues not capable of complete solu- 
tion in the digestive juices. It is in part for 
this reason that carnivorous animals usually 
eat bones with the flesh on which they feed; 
the bones are of course necessary also for the 
lime which they contain, and which is almost 
wholly lacking in the soft tissues of animals. 
Most carnivorous animals also eat more or less 
vegetable food. Cats and dogs often nibble 
grass, and special weeds, of which they ap- 
pear to be extremely fond. Fowls swallow 
feathers and sand. Horses sicken when fed 
on corn alone. They must have a liberal sup- 
ply of coarser material. A Maine ship cap- 
tain saved a cargo of mules, when the supply 
of hay was swept overboard, by feeding them 
shavings made by the ship carpenters. A 
number of horses in the cargo refused to eat 
the shavings and died. In England, when the 79 
INFLUENCES WHICH EXCITE MOVEMENTS 
price of grain is high, the farmers feed their 
stock treacle, which is very cheap, combined 
with wood sawdust, and with good results. 
The animals readily fatten on this diet, and 
remain in good health. 
Most primitive people recognize the need 
of bulk to maintain healthy action of the ali- 
mentary canal. The Japanese and Chinese 
make large use of various seaweeds. One of 
these under the name of agar-agar has come 
to be well known in this country. 
Agar-agar is prepared from a sea-weed 
that grows on the coast of Japan and Ceylon. 
It is sometimes known in commerce as Ceylon 
moss. It is also known as Japanese isinglass 
or vegetable gelatine. It does not, however, 
have the composition of gelatine. Its compo- 
sition is practically identical with cellulose. 
It is almost wholly indigestible in the human 
alimentary canal. The commercial product 
is prepared by cooking the seaweed with 
much water in large kettles, then cooling the 
solution, and passing through colanders by 
which it is formed into long strings. These 
are dried in the sun, and then bleached in the 
sun and dew for several weeks. This mate- 80 
COLON HYGIENE 
rial is brought to the United States in large 
bales. In its commercial form, as it is obtain- 
able at many drug stores, agar-agar is hardly 
fit to be placed in the stomach. It needs to 
be thoroughly washed and disinfected. 
Mr. George Kennan, the celebrated Sibe- 
rian traveler, stated to the writer that the Es- 
kimos eat half digested reindeer moss as a 
remedy for and preventive of constipation. 
The moss is obtained by killing the reindeer 
at a certain time after feeding, removing the 
half-digested moss from the stomach, and sub- 
mitting it to a very slight and simple prepara- 
tion. 
The natives of Japan and China eat quan- 
tities of dried raw turnip, bamboo sprouts, lily 
flowers and roots and other vegetables and 
“greens” of many sorts with the rice which 
forms the staple food of these people. 
The Alaska Indians gather and dry a sea- 
weed which is used in its native state by these 
people to prevent the constipation which 
would naturally result from the nearly exclu- 
sive fish diet on which these Indians are com- 
pelled to subsist at certain seasons of the year. 
The sea-weed is simply gathered and dried INFLUENCES WHICH EXCITE MOVEMENTS 
81 
in the sun and pressed into large flat cakes 
between flat stones. The material thus pre- 
pared is very black in color but is crisp and 
not unpleasant in flavor. Natives of Peru 
make use of dried kelp, a common seaweed. 
The Hopi Indian makes a good laxative 
food by grinding up in a stone mortar the 
whole nut of the pinon, including the shell. 
The Highland Scotchman escapes the con- 
stipation which would otherwise result from 
his diet of buttermilk, oatmeal and potatoes, 
by eating his brose (oatmeal) in a half raw 
state—simply scalded instead of boiled. 
The wild Arab supplements his diet of 
camel’s milk and dates with wheat ground in 
a stone mill, which supplies all the cellulose 
of the bran, with the addition of a certain 
amount of pulverized stone. 
The Orinoco Indians and the poor whites 
of the Tennessee Mountains combat constipa- 
tion by eating considerable quantities of clay, 
as do horses and other animals when fed on 
a too concentrated diet. ... 
The desire for bulky green things, which 
afford much bulk with little nourishment, that 
almost every one experiences in the early 82 
COLON HYGIENE 
spring time, when the oncoming heat reduces 
the bulk of the food by lessening the appetite, 
is an instinctive prompting which cannot be 
disregarded without injury. 
A western pioneer, who was shut up in the 
mountains of the Coast Range by an early fall 
of snow, and confined for three months with 
several companions and a number of mules 
with no food but corn meal, escaped without 
injury, although his associates all suffered ex- 
tremely, by following the example of the 
mules, who dug tunnels in the fifteen-foot 
snow drifts and ate the grass hidden under- 
neath. 
A diet consisting largely of meat, eggs, 
milk, cane sugar and fine flour bread, leaves 
little or no residue to act as a stimulus to the 
intestinal muscles. The free use of greens and 
salads of lettuce, cabbage and other uncooked 
foods fresh from the garden is essential to 
healthy intestinal activity. 
Other elements of the food besides bulk, 
exert a marked influence upon the activity of 
the digestive organs. All the sugars stimulate 
intestinal activity. Roger thinks this action is 
confined to the small intestine, but in this he INFLUENCES WHICH EXCITE MOVEMENTS 
83 
is in error, for every abdominal surgeon 
knows the remarkable laxative effects of an 
enema consisting of a half pint of molasses 
with an equal amount of hot water. 
Cane sugar is undesirable, however, because 
of its irritating effects. The sugars of fruits 
—levulose and dextrose—are wholesome and 
efficient. The malt sugar produced by the 
action of the saliva upon starch is of great 
service as a stimulant of gastric and intestinal 
activity. Many mothers know of the laxative 
effect of malt sugar added to the infant’s food. 
Lactose, or milk sugar, is to some persons 
decidedly laxative, even in doses of two or 
three dessertspoonfuls taken daily before 
breakfast. Lacto-dextrin is a highly valuable 
laxative through its efficiency in changing the 
intestinal flora. It causes the B. acidophilus 
to become dominant and the acids formed 
stimulate peristalsis. 
Fruit and Vegetable Acids 
The acids of fruits and vegetables—citric, 
malic, and tartaric,—are excellent laxatives. 
This is, in part at least, the explanation of the 
good effects of an orange taken at night or 84 
COLON HYGIENE 
before breakfast. All acid fruits are laxative. 
The tomato, a vegetable fruit, is a most ex- 
cellent stimulant of intestinal action. When 
possible, the tomato as well as other acid fruits 
should be eaten raw, to obtain the best effects. 
Lactic and acetic acids developed in the 
intestines by the growth of harmless acid- 
forming bacteria, are powerful stimulants 
of intestinal action. A. Schmidt of Halle, 
Germany, has demonstrated that these acids 
are the normal stimulants of the colon. When 
they are present in sufficient amount, bowel 
activity is normal. Putrefaction produces an 
alkaline condition in the colon which has a 
paralyzing effect upon the intestinal move- 
ments. Sour milk and buttermilk produce a 
decided laxative effect in many persons, espe- 
cially in children. By changing the intestinal 
flora, the contents of the colon become acid, 
and thus bowel action is improved. This 
alone is often sufficient to cause regular bowel 
movements in very obstinate cases of constipa- 
tion. •• ’ . • ' 
The addition to a hot (105° F.) enema of 
citric or lactic acid (one or two drams) or 
the juice of one or two lemons (two or three 85 
INFLUENCES WHICH EXCITE MOVEMENTS 
ounces of lemon juice) is a most effective 
means of stimulating a sluggish colon to ac- 
tivity. Acids thus applied directly to the 
colon are much more efficient than when taken 
by mouth. 
Fats 
Oils and fats stimulate intestinal action. 
Not only fats themselves, but the glycerine 
and soaps which are formed by the digestion 
or decomposition of fats in the intestine, are 
very active stimulants of intestinal movements, 
Mineral oil, being unabsorbable, is a very 
powerful stimulant of intestinal activity. It 
adds to the bulk of the food, lubricates the 
food canal, hinders the excessive absorption 
of water, and keeps the bowel contents moist. 
Gases 
The carbonic acid gas and other gases 
formed in the intestine by the fermentation 
of starch, cellulose, and other foodstuffs are 
powerful stimulants to the muscular activity 
of the bowel. When present in excess, gases 
cause spasm of the circular muscles of the in- 
testine, with sharp colic pains. 86 
COLON HYGIENE 
Eating 
The taking of food into the stomach is by 
far the most powerful of all the natural stim- 
ulants of the intestine. Very soon after food 
enters the mouth, peristaltic movements begin 
in the stomach, and quickly extend the whole 
length of the food canal. This is the reason 
for the desire to evacuate the bowels which 
most people experience soon after eating 
breakfast. The peristaltic waves set up carry 
the feces down into the rectum, and this pro- 
duces the sensation which indicates the neces- 
sity for evacuation. 
It has been shown that even the smell of 
agreeable food is sufficient to cause increased 
intestinal activity. The act of swallowing also 
excites intestinal activity. 
Hurst, of London, holds that there is very 
little movement of the food residues along 
the intestinal tract except during the taking 
of food. According to Hurst, X-ray examina- 
tions show that the taking of food into the 
stomach sets up vigorous peristaltic waves 
which move the contents of the small intestine 
forward into the colon and propel the food INFLUENCES WHICH EXCITE MOVEMENTS 
87 
residues already in the colon further on 
toward the exit. The natural result of this 
physiological arrangement is to bring about 
a bowel movement after each meal. 
Psychic Influences 
Pleasurable emotions and excitement have 
been known to produce intense activity of the 
intestines, and even diarrhoea, while depress- 
ing emotions have the opposite effect. This 
has been clearly demonstrated experimentally, 
in animals as well as clinically in human 
beings. The effect of fear and worry is to 
cause a contracted or spastic condition of the 
descending colon, an effectual bar to bowel 
movement. A patient’s anxiety lest his bowels 
shall not move may throw his colon into a 
state of stage fright, so to speak, and render 
it incapable of normal action. 
The automatic functions of the body are 
interfered with when the mind is concentrated 
upon them. This is the cause of stuttering. 
The stammerer’s impediment of speech dis- 
appears as soon as he forgets about it. 
The Congo native touches a fetish prepared 
for him by a witch doctor, when he is consti- 88 
COLON HYGIENE 
pated, and his bowels forthwith move. The 
accompanying cut shows a fetish employed 
for this purpose, which was presented to us 
by a medical friend, Dr. Stauffacher, for 
many years a medical missionary in the Congo 
region. The fetish is hung on a tree close to 
the path that leads to the retiring place in the 
nearby jungle. As the native passes he touches 
the fetish and straightway his bowels move. 
When the writer remarked, “Of course, the 
constipated patient soon finds that the fetish 
is useless,” the doctor replied, “But it works, 
it really works remarkably well, and is in 
very general use.” It is possible that the 
“liver pads” of a generation ago may have 
“worked” on the same psychologic plan. 
Cannon, studying the intestinal movements 
in the cat, by the aid of the X-ray observed 
that all movement instantly stopped when the 
cat’s tail was pinched, causing her to “spit” 
in resentment. The intestinal activity was 
only resumed when the effect of the irritation 
had passed away, as shown by the contented 
purring of the animal. A Congo Fetish—Famous as a Cure for Constipation 
Applying the Dumbbell Vibrator The Vibrating Chair 89 
INFLUENCES WHICH EXCITE MOVEMENTS 
Electricity 
This powerful agent may be applied in 
such a way as to greatly stimulate intestinal 
activity. The most effective method is the 
application of the sinusoidal current to the 
rectum and abdominal muscles, or to the rec- 
tum and the central portion of the back. An- 
other very effective method, perhaps the most 
efficient of all methods, is the application of 
a bi-polar electrode to the inner surface of 
the pelvic colon, which is the point of greatest 
delay in the majority of constipated persons. 
Mechanical Vibration 
Powerful mechanical impulses may be 
communicated to the intestines and the nerve 
ganglia which control them, by suitable ap- 
paratus. The writer has in numerous in- 
stances seen strong intestinal movements set 
up by this form of stimulation. The writer 
was recently informed that it is the practice 
of the trainers of performing horses to cause 
the animals to empty their colons just before 
they are led out to perform by vibratory 
stroking over the lower colon. 
The accompanying cut shows a dumbbell 90 
COLON HYGIENE 
vibrator which is effective when applied 
along the course of the colon, especially over 
the pelvic colon which lies low in the left 
side. Still more powerful effects may be in- 
duced by application of the dumbbell vibra- 
tor to the sacrum and the anal region. 
The vibrating chair, the vibrating stool, 
and the vibratory table are all powerful means 
of stimulating the colon. The oscillo-manip- 
ulator is another efficient means by which 
mechanical stimulation may be applied to the 
colon. These several appliances, devised by 
the writer for use in the Battle Creek Sanita- 
rium, are shown in the accompanying cuts.* 
Massage 
This is another valuable mechanical means 
of stimulating the bowel to increased activity. 
Kneading with the hands or with a suitable 
mechanical appliance has been shown to be 
capable of quickening the movements of the 
intestine, if applied with sufficient thorough- 
ness. The writer has elsewhere described the 
* Manufactured by the Sanitarium Equipment Company, Battle 
Creek, Mich. Mechanical Massage of the Colon with the Oscillo-Manipulator Bowel Kneading Apparatus INFLUENCES WHICH EXCITE MOVEMENTS 
91 
technic of abdominal massage.* It may be 
noted here that manual massage to be most 
effective must be given in such a way as to 
definitely reach and sharply compress the 
colon so as to stimulate it to action. The 
colon can best be reached at the sides of the 
abdomen near the groins. 
Stroking, or reflex titillation of the skin, 
stimulates the bowel in much the same way 
that tickling the soles of the feet may give 
rise to powerful contractions of the muscles 
of the legs. To be effective, massage in- 
tended to influence the intestinal movement 
must be given by an expert. 
Mechanical kneading of the abdomen is 
in many cases remarkably effective in reliev- 
ing constipation. Not infrequently a bowel 
movement occurs immediately after a ten- 
minutes’ application. The accompanying cut 
shows an abdominal kneading machine de- 
vised by the writer and in use for many years 
in the Mechanotherapy Department of the 
Battle Creek Sanitarium. 
* “The Art of Massage.” Modern Medicine Publishing Company, 
Battle Creek, Mich. 92 
COLON HYGIENE 
Abdominal Compression 
This method acts upon the intestine by in- 
creasing the intra-abdominal pressure. It is 
most effective when applied in cases in which 
the abdominal muscles are weak and relaxed. 
The compression may be made continuous 
by the application of a tight abdominal band- 
age; or intermittent pressure may be applied, 
if desired, by means of an inflated rubber 
bag. These measures will be explained more 
fully elsewhere. 
Exercise 
Bodily activity is another way of mechan- 
ically stimulating the intestine. Vigorous ex- 
ercise sets the diaphragm and abdominal mus- 
cles at work in such a way that the intestines 
are, between the two, vigorously kneaded and 
squeezed and thus stimulated to action. 
Every farmer knows the constipating effect 
of idleness upon his horses and cattle. Most 
observing persons have noted in their own ex- 
perience the advantage of taking a brisk walk 
before or after breakfast. 
The sedentary man or woman not only 93 
INFLUENCES WHICH EXCITE MOVEMENTS 
loses the immediate benefit which results 
from the increased activity of the diaphragm 
and abdominal muscles, but his abdominal 
muscles become permanently weakened, re- 
laxed, lacking in tone, and incapable of sup- 
porting the intestines in their proper place, 
thus adding a number of other factors which 
contribute very materially to the lessening of 
intestinal activity. 
Posture 
A stooped or relaxed posture in sitting or 
standing tends strongly to induce constipation 
by weakening the abdominal muscles and 
causing congestion of the liver and all other 
abdominal organs. The viscera, over-filled 
with blood, and lacking the support of the 
abdominal muscles, become prolapsed. The 
colon falls with the rest; the intestinal con- 
tents stagnate; the bowel becomes distended; 
the ileocecal valve becomes incompetent, in- 
fection travels up the small intestine, and a 
long list of ills result. * 
An erect posture secures proper exercise 
of the muscles of the trunk, correct breathing, 
normal circulation of blood in the viscera, and 94 
COLON HYGIENE 
promotes in a high degree normal bowel 
movement. 
A further cause of injury is the lowering 
of the diaphragm and diminished action of 
this important muscle, which when normally 
active applies to the colon and other viscera 
a sort of rhythmic massage which is a valu- 
able aid to bowel action. 
Hot and Cold Applications 
Cold applications, and even extremely hot 
applications, act as powerful stimulants to the 
intestinal muscles. To be effective, the appli- 
cations must be short and intense. The cold 
spinal and abdominal douche, and the cold 
douche to the feet and legs, are the most ef- 
fective external procedures. The cold enema 
(75° F. to 40° F.) produces almost immediate 
bowel movement. The cool enema should 
not be used in cases of spastic colitis. 
Hot Applications 
Hot applications, externally and internally, 
often aid bowel action by relaxing a spastic 
cr contracted colon. The colon may be con- 
tracted as the result of irritation through re- INFLUENCES WHICH EXCITE MOVEMENTS 
95 
flex action from diseased ovaries or some 
other diseased vital organ, or even as the re- 
sult of some depressing emotion such as fear, 
worry or anger. In such conditions, bowel 
action is best encouraged by applications of 
heat, either external or internal, which relax 
the contracted bowel. External applications 
of heat may be made by means of the fomen- 
tation, the moist abdominal bandage, the hot 
sitz bath, or by means of the photophore or 
other means of applying heat. 
The hot enema (102° to 105° F.) is a most 
efficient means of relieving bowel spasm. It 
should be used in all cases of spastic constipa- 
tion and colitis to insure complete emptying. 
The Hot Enema with Acid 
The addition to the hot enema of the juice 
of a lemon or one or two drams of citric or 
lactic acid or two tablespoonfuls of lactose- 
dextrin, will greatly increase its efficiency. 
The heat of the enema relaxes the contracted 
bowel while the acid present stimulates the 
bowel to normal contraction without produc- 
ing a state of spasm. This method often suc- 
ceeds when other means fail. INFLUENCES WHICH LESSEN IN- 
TESTINAL MOVEMENTS 
There are certain foods and other agents 
and influences that exercise a decided slow- 
ing influence upon intestinal movements, 
either directly, or indirectly through the sup- 
pression of the normal stimuli. 
Liquid Foods 
Such foods as soups, gruels, porridges, and 
purees contain so little solid matter that the 
bulk, considerable though it may be when 
the food is eaten, is soon reduced to a very 
small volume. On this account liquid foods 
are almost always constipating. The only ex- 
ceptions are those liquid foods which contain 
much sugar, acids, or fats. 
Pasty cereals such as oatmeal mush, are 
decidedly constipating in their influence, be- 
cause of their pasty consistency and the little 
mastication which they receive. New bread, 
hot biscuits, “noodles,” and doughy foods of 
all sorts are likewise objectionable. 
96 97 
INFLUENCES WHICH LESSEN MOVEMENTS 
Concentrated Foods 
Foods which contain little or no waste or 
indigestible material are so completely di- 
gested and absorbed that the bulk left in the 
intestine is insufficient to stimulate segmenta- 
tion or peristalsis. In feeding the sick, the 
mistake is not infrequently made of feeding 
exclusively fluid or concentrated foods, with 
the idea that such foods tax the digestive or- 
gans least. In a sense this is true, but the im- 
portance of maintaining proper bowel action 
is so great that this must be considered in the 
dietary, and with rare exceptions the patient 
will perfectly well tolerate simple salads, 
stewed fruit of some sort, whole wheat prepa- 
rations, especially wheat flakes, in which the 
whole grain is represented, and even cooked 
bran. 
The conventional “tea and toast” is about 
the worst diet that could be offered a sick per- 
son. The panadas, puddings, and “slops” of 
various sort are little better. 
Fruit juices of all sorts are, on the other 
hand, most suitable for almost all forms of 
sickness. They contain choice nutriment in a 98 
COLON HYGIENE 
form needing no digestion, ready for imme- 
diate absorption and assimilation. 
Orange juice or freshly expressed juice of 
apples, grapes, or other sweet or sub-acid 
fruit, is ideal nourishment for the sick. In 
the absence of these fruits, dried fruit, soaked 
long in water may furnish a very fair substi- 
tute. Canned fruit juices come next in value. 
To these rice, or some other cereal food, may 
be added in proper amount, with malt sugar 
in some form. Roughage in the form of let- 
tuce, celery, purees of fresh vegetables such 
as turnips, carrots, tomatoes and especially 
spinach and other greens is especially useful 
and is seldom contraindicated. 
Vitamins Needed 
McCarrison has shown that vitamins, par- 
ticularly the vitamin B, encourage intestinal 
activity. The so-called “constipating foods” 
are lacking in this highly essential food prin- 
ciple. Care must be taken to make free use 
of foods rich in this element, such as bran, 
greens, Savita (yeast extract), Zo, and all vi- 
tamized foods. INFLUENCES WHICH LESSEN MOVEMENTS 
99 
Abstinence 
In a state of absolute fasting the intestine 
is in a state of complete inactivity. The nor- 
mal stimulus of food is lacking, and there is 
nothing to call forth the rhythmical activities 
which accompany normal digestion. This 
fact is too often overlooked in the care of sur- 
gical patients and in the treatment of obesity, 
gastric and duodenal ulcer, and other condi- 
tions in which the intake of food is suspended 
or reduced. In such cases it is highly impor- 
tant that the colon should be washed out 
thoroughly by an enema at least twice daily. 
It must not be forgotten that the colon is not 
merely a receptacle for unusable food rem- 
nants, but is also an excretory organ, and the 
avenue through which the highly poisonous 
bile is discharged. It has been shown that 
the bile is six times as poisonous as the urine. 
The secretion of bile is continuous and its 
prompt discharge from the body is as impor- 
tant as the discharge of the far less poisonous 
urine. 100 
COLON HYGIENE 
Pain 
Pain in almost any part of the body may 
arrest intestinal action by causing a reflex in- 
terference. Pain or inflammation in any part 
of the abdomen, especially such painful af- 
fections as rectal ulcer or fistula, inflamed 
hemorrhoids, chronic appendicitis, inflamma- 
tion of the bladder, prostate, uterus, ovaries, 
and other pelvic organs, all give rise to inac- 
tion of the intestine, not only by inhibiting 
or preventing peristalsis, but also by causing 
obstruction through contraction of the ileoce- 
cal sphincter. The pain and irritation of an 
ulcer or fistula, or inflamed hemorrhoids, 
may induce constipation by causing spasms of 
the anal muscle, and so preventing the normal 
relaxation in the act of defecation. 
Miscellaneous Causes 
Depressing emotions, such as anger, fear, or 
despondency, all suppress the normal move- 
ments of the intestine, and thus form a vicious 
circle which continually aggravates both the 
malady and its cause. 
The effect of these depressing emotions is INFLUENCES WHICH LESSEN MOVEMENTS 
101 
to raise nerve tension. The so-called “muscle 
tonus” is increased. The descending and pel- 
vic colon may become spastic, that is, strongly 
contracted. This condition of the colon ren- 
ders impossible normal bowel action and may 
even give rise to an exaggerated reverse peri- 
stalsis, by which the contents of the colon are 
carried backward through an incompetent 
ileocecal valve into the small intestine, a con- 
dition often encountered in persons suffering 
from so-called neurasthenia, or “nervous pros- 
tration.” 
Heat lowers muscular tone, and hence 
checks the intestinal movements. This is well 
seen in the relief obtained by the application 
of a fomentation to the abdomen, or the ad- 
ministration of a hot bath or a hot enema in 
a case of intestinal colic or diarrhoea. 
Hot drinks, as well as hot baths, tend to 
slow intestinal movements by relaxing the 
bowels or lowering “tonus,” and the habitual 
use of hot (105° F.) enemas often aggravates 
the condition for which the treatment is given. 
This tendency of the hot enema may be 
avoided by taking care never to use a larger 
quantity than two quarts of water and to fol- 102 
COLON HYGIENE 
low the hot enema by a small enema of water 
at a lower temperature (80°). With these 
precautions, the enema may be used for an 
indefinite time without injury. 
Sweating, if very profuse, encourages in- 
testinal inactivity by removing large quanti- 
ties of water through the skin, and thus pro- 
ducing excessive dryness of the intestinal 
contents. 
Elevated body temperature, whether caused 
by fever or by a hot bath of some sort, tends 
to slow the intestinal movements. 
Sleep and inactivity slow the intestinal 
movements by lessening the activity of the dia- 
phragm and the abdominal muscles. The 
first voluntary movements made on awaken- 
ing in the morning often start up peristalsis, 
and often provoke a desire for evacuation of 
the bowels. Persons who lead inactive lives 
almost always suffer from constipation, though 
often unaware that this is the case, for reasons 
which we shall present later. 
Loss of sleep. Loss of sleep often inter- 
rupts bowel movements by causing a spastic 
or contracted condition of the descending 
colon and pelvic colon. This is the result of 103 
INFLUENCES WHICH LESSEN MOVEMENTS 
the increased “tension” caused by loss of sleep. 
Prolonged cold sitz baths cause intestinal 
inactivity by inducing a spasm of certain of 
the food gates, probably the ileocecal sphinc- 
ter. This result occurs if the bath is continued 
for more than seven or eight minutes. When 
for any reason the use of the prolonged sitz 
bath becomes necessary, special precautions 
in diet and otherwise must be taken to prevent 
producing this undesirable effect. 
A diet largely made up of meat necessarily 
favors intestinal inactivity, first because the 
complete digestion of the meat leaves too 
little residue to stimulate peristalsis, and sec- 
ond, because an excess of protein encourages 
putrefactive processes in the intestine, which 
establish an alkaline condition of the intestinal 
contents. The stools of flesh eaters usually 
have a very strong ammoniacal odor, and 
when tested by the chemist are found to be 
strongly alkaline. Alkalies paralyze the colon, 
while acids stimulate it. CAUSES OF CONSTIPATION 
The causes of a disease so universal in 
civilized communities must be very numer- 
ous to produce this condition in so great a 
number of people living under many different 
conditions, and with different habits of life. 
In general it may be said that the causes of 
constipation are abnormal habits or condi- 
tions of life, the result of what we call civil- 
ization. Savages rarely suffer from constipa- 
tion,which is also true of the more primitive 
of so-called civilized nations. Chronic in- 
testinal inactivity is much less frequent among 
country people than among those living in the 
city. It is manifestly a morbid condition pe- 
culiar to a state of high civilization; and 
modern medical researches tend to show that 
this condition and its results may justly be 
looked upon as among the fundamental causes 
of the race degeneracy which is becoming 
every year more apparent in all highly civil- 
ized communities. 
We may therefore expect to find adults 
suffering from constipation much more than 
104 CAUSES OF CONSTIPATION 
105 
children, although this malady often begins 
early in life. Women are more subject than 
men to intestinal inactivity and all the terri- 
ble consequences which result from this con- 
dition. Westphalen asserts that four-fifths of 
all women suffer from constipation from their 
youth onward, a statement that is corroborated 
by Foges, the eminent specialist of Vienna, 
and that few experienced practitioners will 
deny. Adults have been longer exposed to the 
degenerative influences of civilized life than 
have children, and the life of civilized women 
is to a considerable degree more highly arti- 
ficial and unnatural than that of men. 
Professor Virchow more than half a cen- 
tury ago called attention to the fact that post- 
mortem examinations show evidences of dis- 
ease of the intestines in almost every case of 
many hundreds examined, irrespective of the 
cause of death. Indeed, he declared it to be 
almost impossible to find an adult person 
whose intestines did not show adhesions and 
other evidences of chronic disease. At that 
time the origin and significance of these in- 
flammatory conditions was not understood. 
We now know that infections of the interior 106 
COLON HYGIENE 
of the intestine, by causing inflammation of 
the intestinal walls, readily extend to the out- 
side, giving rise to inflammatory changes and 
adhesions. In these adhesions, located in va- 
rious parts of the intestine, but particularly at 
special points noted by Professor Virchow, 
and more recently by Dr. Arbuthnot Lane, 
we have both a consequence and a cause of 
constipation. 
The Rationale of Constipation 
To fully comprehend the influence of vari- 
ous habits and conditions in developing con- 
stipation, it is necessary to have in mind the 
mechanism of defecation and the conditions 
essential to the normal colon action. The 
several acts by which the colon is emptied of 
its contents may be briefly summarized as 
follows: 
1. Contraction of the diaphragm—a deep 
breath. 
2. Contraction of the abdominal muscles. 
3. Pressure of the thighs against the abdo- 
men as in the squatting position assumed by 
the savage. 107 
CAUSES OF CONSTIPATION 
4. Reflex contraction of the abdominal 
muscles. 
5. Contraction of the colon. 
6. Relaxation of the anus. 
7. Contraction of the levator-ani muscles. 
Any influence which interferes with a 
single one of these seven steps in the normal 
process of defecation may give rise to consti- 
pation, and when the disturbing influence is 
of such character as to interfere with several 
factors, the result is certain to be an extremely 
obstinate form of colon inactivity. 
The causes of constipation may become 
operative either before or during the action 
of defecation. In order that normal defeca- 
tion should occur, it is necessary that fecal 
matters should reach the pelvic colon in con- 
dition to be expelled from the body, and that 
the pelvic colon should be free to rise out of 
the pelvis, so that it may discharge a part of 
its contents into the rectum; and it is then 
essential that there should be no interference 
with any of the several factors which enter 
into the normal act of defecation. 
Among the causes that may operate to pre- 
vent the proper preparation of the bowel for 108 
COLON HYGIENE 
the act of defecation through the accumula- 
tion of the bowel contents in the pelvic colon, 
are the following: 
1. Deficient bulk of intestinal contents. If 
the amount of the intestinal contents is too 
small to distend the pelvic colon, the bowel 
will not be stimulated to action. This condi- 
tion naturally results during fasting, and may 
also result from the use of a concentrated 
diet. 
2. A spastic or contracted condition of the 
bowel in the transverse, descending, or iliac 
colon may hold back the intestinal contents, 
preventing them from reaching the pelvic 
colon, and so may interfere with normal bowel 
action. 
3. Adhesions, by interfering with the nor- 
mal contraction movements of the colon, may 
seriously cripple its function. 
The most common and crippling adhesions 
are those connected with the pelvic colon and 
the cecum. The pelvic colon when empty 
collapses and sinks to the lowest part of the 
abdominal cavity. The prolapsed bowel may 
become adherent wherever it happens to fall 
and then may fail to rise. A pelvic colon thus CAUSES OF CONSTIPATION 
109 
crippled no longer acts in an efficient manner 
to discharge the food residues and as a result 
the fecal matters accumulate in the descend- 
ing colon until the pressure becomes so great 
that they are forced through to the rectum. 
This is one of the most obstinate forms of 
constipation. A practical cure may usually 
be accomplished by changing the intestinal 
flora and regulating the diet and the daily 
enema; but in some instances surgery is nec- 
essary to release the adhesions of the pelvic 
colon and to fix it in its normal position. 
The colon may also be seriously crippled 
by adhesions of the cecum. Such adhesions 
may be the result of colitis or may be due to 
appendicitis. They are very likely to be pres- 
ent in cases in which operations have been 
performed for the relief of appendicitis. Ad- 
hesions of the cecum prevent its normal ac- 
tion which is to lift up and push into the 
transverse colon the food residues which enter 
the colon from the small intestine. When 
the cecum can no longer perform this func- 
tion, it becomes a sort of cesspool in which 
fecal matters accumulate and often reach an 
advanced stage of putrefaction. The adher- 110 
COLON HYGIENE 
ent cecum often becomes dilated to an enor- 
mous extent, filling the pelvis and compressing 
the rectum. 
4. Ordinarily, the whole bowel is not emp- 
tied in the act of defecation. The length of 
the colon is such that the residue from two or 
more meals may be present in different parts 
of the intestine at the same time. For ex- 
ample, the supper residue may be passing 
into the cecum while the dinner residue occu- 
pies the transverse colon and the breakfast 
residue is in the pelvic colon ready to be dis- 
missed. 
The descending colon is normally found in 
an empty state. When the intestinal contents 
are pushed from the transverse colon over into 
the descending colon, they are not long re- 
tained, as in other parts of the colon, but pass 
rapidly down to the pelvic colon, which seems 
to be intended by Nature for a sort of dis- 
charging reservoir, in which the fecal matter 
accumulates until a sufficient degree of dis- 
tention of the bowel has been induced to 
stimulate peristaltic action. 
A lack of this distending stimulus, which 
is essential to bowel activity, is a cause of con- CAUSES OF CONSTIPATION 
111 
stipation in a large number of persons whose 
pelvic colons have been over-distended. In 
such persons an extremely bulky diet is neces- 
sary to fill the pelvic colon to such a degree 
as to bring about the reflex movements which 
induce normal bowel action. 
5. In persons who are chronically consti- 
pated the descending colon is often constantly 
filled. The long contact of the poisonous fecal 
matters with the mucous membrane gives rise 
to infection. This is colitis. Colitis causes 
contraction of the bowel, thus becoming a 
new and most potent cause of constipation. 
The contraction caused by colitis not only ob- 
structs the bowel, but also sets up anti-peri- 
staltic movements, thus reversing the action of 
the bowel and carrying material back to the 
ascending colon and cecum. Normally, the 
anti-peristaltic contractions start at the middle 
of the transverse colon and do not involve 
the lower half of the colon. But when colitis 
and spasm are present, the reverse move- 
ment extends even to the pelvic colon. This 
fact, discovered by Case, explains the pecu- 
liarly irregular and erratic bowel movements 
characteristic of colitis. 112 
COLON HYGIENE 
6. By compression of the waist, such as re- 
sults from the wearing of corsets and tight 
dresses, the action of the diaphragm is greatly 
crippled. This may be one reason why women 
in general suffer from constipation more than 
do men. The feeble condition of the dia- 
phragm and other breathing muscles, which 
is the natural result of neglect of exercise, 
produces a similar effect in both men and 
women. 
7. A feeble and relaxed condition of the 
abdominal muscles, the result of a sedentary 
life, and especially of a stooped and relaxed 
posture of the body in sitting or standing, will 
necessarily interfere with both voluntary and 
reflex contraction of these important muscles, 
which is an essential factor of normal defeca- 
tion. When the colon has been long over- 
distended by neglect, and relaxed by the long- 
continued use of the warm enema, its power 
to contract is necessarily greatly diminished. 
This condition of the bowel not only prevents 
efficient normal defecation, but the efficiency 
of the bowel may be still further interfered 
with by adhesions and kinks. 
8. Hemorrhoids, fissures, ulcers, fistulas, CAUSES OF CONSTIPATION 
113 
and simple irritation of the mucous membrane 
in the anal region, may cause spasm or abnor- 
mal tightness of the anal muscle, so that the 
ordinary reflex is insufficient to cause relaxa- 
tion of the muscle, and it thus becomes a me- 
chanical obstacle to bowel movement. 
9. The levator-ani muscle frequently be- 
comes so weakened by continuous over-stretch- 
ing, as the result of accumulation of hard 
fecal matters in the rectum, that it loses its 
power to contract. This condition may also 
be induced by proctitis, a common result of 
constipation. 
When the rectum walls are thus weakened 
and paralyzed, the rectum, instead of being 
always empty except during defecation, al- 
ways contains more or less fecal matter, the 
constant contact of which with the mucous 
membrane produces loss of sensibility and 
chronic catarrh or proctitis, and often gives 
rise to hemorrhoids, anal ulcer, abscesses, fis- 
tula and local affections. 
It is thus apparent that in all cases of con- 
stipation there is a definite reason for intes- 
tinal inactivity. In every case of really serious 
constipation—that is, cases which are not re- 114 
COLON HYGIENE 
lieved by regulation of diet—careful inquiry 
must be made for the purpose of ascertaining 
the exact conditions which are interfering 
with normal intestinal movement, including 
both the exciting and the predisposing causes 
of these conditions, which will be considered 
at length in succeeding pages. 
Most cases of constipation, even of the most 
obstinate character, may be greatly if not 
wholly relieved by regulating the diet, espe- 
cially by changing the intestinal flora. Even 
when there may exist a considerable degree of 
mechanical disturbance because of adhesions, 
incompetency of the ileocecal valve, dilata- 
tion of the cecum, etc., great betterment of the 
patient’s condition may be secured, especially 
by changing the intestinal flora; for it is the 
contents of the colon, not the colon itself, 
which is the real cause of disturbance. Cer- 
tainly, no operation is called for until other 
measures have been faithfully tried.. SIX DANGEROUS ERRORS ABOUT 
THE COLON 
It is probable that more disease, premature 
old age and death, misery and even crime, 
originate from constipation than from any 
other bodily disorder. Constipation is not in 
itself a disease, but is a symptom the cause of 
which may be disease or simply neglect. 
There are several very prevalent errors 
respecting the colon and its functions which 
are probably responsible for most of the mis- 
chief which arises from disorders of this part 
of the body. 
One of the most universal and mischievous 
of errors about the humble colon is that its 
function is one which modesty imperatively 
demands shall be concealed even at the ex- 
pense of great suffering. It is indeed only in 
very recent times' that public transportation 
companies,'railroad and trolly lines, have be- 
gun to make anything like decent or adequate 
provision for the colon needs of their patrons. 
And even at the present time there are hun- 
115 116 
COLON HYGIENE 
dreds of small stations and waiting rooms 
wholly unsupplied with toilet conveniences. 
Very few of our cities and towns offer any 
sort of public toilet provisions for either men 
or women. 
Thousands of factories and other places 
where men or women are employed provide 
no adequate toilet arrangements. 
It is a most dangerous error to suppose that 
the colon function can be neglected or post- 
poned with impunity. Many people, perhaps 
the majority, regard the moving of the bowels 
as a disagreeable duty which may be post- 
poned to suit the demands of business or con- 
venience. 
The results are most disastrous. The ma- 
jority of chronic human ills are the result of 
this neglect. • 
Another common error which is held by 
most medical men as well as by the laity is 
that the stool should be “formed.” This is a 
false notion which has grown out of the 
universal constipation habit which prevails 
among civilized folk. 
The vegetarian Hindus, of Armistar, who 
live chiefly on ground wheat and vegetables, 117 
SIX DANGEROUS COLON ERRORS 
according to Dr. A. H. Browne, have “large, 
bulky, and not formed, but pultaceous” stools. 
A well-formed stool always means consti- 
pation. The significance is that the colon is 
packed full like a sausage and that the fecal 
matters have been so long retained that they 
have been compacted by the absorption of 
water. The whole colon is filled, and the 
bowel movement is the result of the pressure 
of the incoming food residues at the other 
end. When the body wastes are promptly dis- 
charged as they should be, the colon never 
contains the residues of more than two meals 
and at the after-breakfast movement should 
be completely emptied so that the disinfecting 
and lubricating mucus which its walls secrete 
may have the opportunity to cleanse and dis- 
infect the body’s garbage receptacle and thus 
keep it in a sanitary condition. 
The California doctor who advised his pa- 
tient to restrain his desire for bowel move- 
ment at night and “save it till the next morn- 
ing” so that “he might have a well-formed 
stool,” had not the first conception of the 
normal function of the colon. 
That one bowel movement a day is nor- 118 
COLON HYGIENE 
mal and efficient evacuation of the bowels 
is another error which is universally enter- 
tained. One bowel movement a day is a 
positive indication of constipation. X-ray 
examinations of the colon after a test meal 
show that in persons whose bowels move once 
a day the body wastes are usually retained for 
fifty hours or more. Hurst, of London, and 
not a few other authorities finding this con- 
dition almost universal have been led to 
regard it as normal. But in this they are 
certainly in error. X-ray examinations show 
that in eight hours from the beginning of a 
meal the process of digestion has been com- 
pleted, the digested food has been absorbed, 
and the unusable residue has been pushed 
half way through the colon, in other words, 
is within two and a half feet of the lower 
opening of the colon. In eight hours the food 
has travelled more than twenty-five feet or 
ten times the distance which remains to be 
travelled. The work of digestion is finished, 
the useful part of the food has been absorbed, 
there remains nothing to be done but to dis- 
pose of the indigestible and useless residue by 
pushing it along two or three feet further. 119 
SIX DANGEROUS COLON ERRORS 
Certainly no good reason can be assigned for 
the further retention of the waste matters. It 
is indeed highly absurd to suppose that forty 
hours are needed to transport the feces two 
and a half feet when they have already trav- 
elled twenty-five feet in eight hours. 
The bowels should move at least three 
times a day or after each meal. Four move- 
ments daily is a still better rhythm and is 
easily established by a biologic regimen. This 
the writer has proven not in a few exceptional 
cases but in thousands of patients who have 
been willing to take the trouble to train their 
bowels by means of a proper diet and other 
simple and natural means. 
A fourth error which leads to wrong con- 
clusions and paralyzes efforts toward change 
of conditions is the supposition that the stools 
or fecal matters are necessarily putrescent and 
loathsome. This is by no means true. The 
writer has had under his care at different 
times a number of patients who had temporary 
openings close to the lower end of the small 
intestine where it joins the colon. Examina- 
tion of the intestinal contents when they had 
an opportunity to escape at this point showed 120 
COLON HYGIENE 
that they are often wholly free from offensive 
odors and other evidences of decomposition. 
This fact as well as many others shows that 
the changes which take place in the colon are 
the cause of the offensive character of the 
stools. This is the natural and necessary re- 
sult of the long delay of putrescible material 
in the warm, moist colon, always swarming 
with germs and the most favorable place pos- 
sible to imagine for the promotion of putre- 
factive processes. Let the reader try to 
imagine what would happen to a beefsteak 
carried in an inside pocket next the warm 
skin for two or three days. It would certainly 
become far advanced in decay. And that is 
just what happens to every particle of undi- 
gested meat and other proteins. The change 
known as putrefaction is slow in beginning; 
it makes little advancement the first twenty- 
four hours, but after that the intensity of the 
process increases very rapidly. 
The carmine capsule test shows that in 
most cases in which the bowels move once 
daily, the waste disposal function is always 
several days in arrears. The colon contains 
the waste and residues of several meals,—any- SIX DANGEROUS COLON ERRORS 
121 
where from five to twenty or even more, so 
that there is ample opportunity for the putre- 
factive process to get well under way. 
This putrefaction is the source of the foul 
odor and gases which originate in the colon, 
and which are not only most offensive to the 
sense of smell, but as is well known, are also 
highly poisonous, and may give rise to nausea, 
“biliousness,” loss of appetite, foul tongue, bad 
breath, dingy skin, headache, Bright’s disease, 
and a host of other grave disorders. 
The stools of a person who lives biologi- 
cally, that is, whose diet is restricted to food- 
stuffs which do not readily undergo putrefac- 
tion, such as fruits, grains, nuts, roots, green 
vegetables and milk, are often almost odorless. 
The sickening, ammoniacal odor usually 
present is absent. The stools, if not odorless, 
may have an acid odor, like the bowel dis- 
charges of a young breast-fed infant. The 
difference is the same as that between the 
stools of a dog and those of a sheep, and for 
the same reason. In the case of the dog and 
the meat-eater there are always to be found 
in the colon fragments of decaying flesh; 
while in the colon of the sheep, the nursing 122 
COLON HYGIENE 
infant or the flesh-abstainer, the food residues 
present consist chiefly of substances which fer- 
ment, producing acids, but do not undergo 
putrefaction. 
Some years ago a leading English physician 
recommended constipation as a measure of 
food economy. It was the contention of this 
physician that if the bowels were moved only 
once in two or three days the absorption of 
food would be more complete and hence less 
food would be needed. Some years later, 
Horace Fletcher gave wide publicity to this 
idea in connection with his chewing cam- 
paign. Mr. Fletcher insisted that the food 
must be chewed until liquefied before swal- 
lowing, and that all fibrous or insoluble ma- 
terial should be rejected and returned to the 
plate. Very pronounced constipation was the 
natural result of this practice. Small and in- 
frequent stools were recognized as one of the 
expected results of Fletcherism. Mr. Fletcher 
himself considered his personal practice of 
moving the bowels once or twice a week, a 
very hard and scanty stool, one of the proofs 
of the advantage of his theory. Hundreds 
who were convinced of the advantages of 123 
SIX DANGEROUS COLON ERRORS 
thorough mastication of the food and made 
a trial of Fletcherism were compelled to give 
it up, as did Prof. William James, because of 
the bad effects of the constipation which re- 
sulted and was wrongly charged to mastica- 
tion, although really due to the rejection of 
cellulose which is necessary to furnish bulk 
for the stimulation of the intestine. 
While it is doubtless true that less food is 
usually consumed by persons who are consti- 
pated, this fact is not the result of increased 
food economy but of lack of appetite. The 
toxemia which lessens the appetite lessens also 
initiative, endurance and efficiency, and can- 
not be considered in any way an advantage. 
Laxative Drugs and Mineral Waters 
Highly Injurious 
Still another grave error which has come 
to be almost universal is the trust reposed in 
saline mineral waters and other laxatives as 
means of combating colonic stasis or constipa- 
tion. X-ray examinations, made by Dr. Case 
and others in hundreds of cases, have proven 
that laxatives of all sorts do great harm by 
causing spasm or spasticity of the lower part 124 
COLON HYGIENE 
of the colon and by increasing antiperistalsis, 
by which the fecal wastes are held back in 
the cecum and first half of the colon which 
thereby becomes distended, overstretched and 
permanently damaged. One of the conse- 
quences of this overstretching of the colon is 
the crippling of the ileocecal valve which is 
rendered incompetent so that the putrid fecal 
matters accumulated in the colon are forced 
back into the small intestine and are thus 
mingled with the digesting foodstuffs and ab- 
sorbed into the blood along with them. This 
is essentially the same thing as discharging a 
sewer pipe onto the dinner table and mingling 
sewage with the food. 
All laxative waters and medicinal laxatives 
of every sort are harmful. They afford tem- 
porary relief at the expense of increasing the 
difficulty by irritating the colon, causing co- 
litis and obstinate contraction of the descend- 
ing and pelvic colon, a condition practically 
equivalent to stricture of the bowel. The 
habitual use of laxatives is the most certain 
method of producing the most intractable 
forms of constipation. PSYCHOLOGY OF THE COLON 
The colon is richly supplied with sym- 
pathetic nerves and is highly sensitive to 
influence by all emotions pleasurable or the 
opposite. Cannon and various other observers 
have shown that unpleasant emotions of all 
sorts check peristalsis. Even very slight emo- 
tional excitement, as slight anxiety, annoyance, 
apprehension or ill-temper, may stop all 
movement of the intestine, as well as of the 
stomach, together with gastric secretion. 
The colon, like the face, responds to every 
passing emotion. The intestine is perhaps 
more sensitive than are the muscles of the face 
to emotional excitement because more richly 
supplied with blood-vessels and sympathetic 
nerves. X-ray studies of animals have dem- 
onstrated the intimate association of the colon 
with the sympathetic nervous system and the 
profound effects of all forms of emotional ex- 
citement. In a dog placed in strange sur- 
peristalsis ceased for several hours. 
When a cat’s tail was pinched, while under 
observation, peristalsis ceased. The move- 
125 126 
COLON HYGIENE 
ments did not begin again until the cat was 
pacified as shown by a contented “purring.” 
The depressing influence of fear is well 
established. The frightened colon cannot dis- 
charge its contents because the descending 
colon is in a spastic state. So long as the 
patient is fearful that his bowels will not 
move, they will not. The colon is in a state of 
stage fright. It is crippled; but all that is 
needed for a cure may be to get rid of appre- 
hension and fear. In such a case, the most 
effective remedies, any amount of bran and 
paraffin oil, will not move the bowels until 
the element of fear is removed. Confidence 
and faith will change the situation. Christian 
Science, Coueism, “faith healing,” a fetish, a 
“liver pad,” “magnetic” suppositories, any- 
thing that abolishes fear and establishes faith 
and optimistic expectation, will effect a cure. 
The angry colon shuts up like a clam and 
declares “no thoroughfare here.” Some per- 
sons are obstinately constipated because of a 
chronic state of ill will or anger. It is re- 
corded that Cromwell’s bowels had not moved 
for a wTeek before he caused King Charles to 
be beheaded. And the theologian Calvin was 127 
PSYCHOLOGY OF THE COLON 
in a similar state when he signed the death 
warrant which sent Servetus to the stake. 
Grief shuts up the outlet of the body’s 
sewage system as tightly as does fear or anger. 
The worried colon neither secretes nor con- 
tracts. Both secretion and contraction are 
needed for efficient action,—secretion for lu- 
brication and contraction for transportation 
of the food residues to the exit. In the “rice 
ordeal,” long in use in India for the detection 
of the guilty one among a number of suspected 
persons, a portion of the sacred rice is placed 
in the mouth of each one. After a few 
minutes, the rice is removed from each mouth 
and placed upon the sacred fig leaf. The 
rice from the guilty is dry! A physiological 
proof of his criminality. An X-ray examina- 
tion would show his colon as well as his 
salivary glands to be inactive. 
The colon is imitative. When one dog 
empties his bladder or his colon, other dogs 
in sight are seized by the same impulse. 
Pouring water is a common device for induc- 
ing action of the bladder. The colon is also 
influenced. A German mother moved her 
own bowels by giving castor oil to her little 128 
COLON HYGIENE 
girl (Oppenheim). A visit to the toilet by 
association of ideas tends strongly to provoke 
bowel action. The writer is acquainted with 
a gentleman whose bowels habitually move at 
night when he removes his clothing in prepa- 
ration for bed. If he happens to undress in 
the daytime, a desire to move the bowels ap- 
pears as soon as the clothing is removed. 
The hysterical colon may become a cause 
of distressing embarassment. The late Dr. 
Goodell told of the case of a lady whose colon 
began producing a series of remarkable ex- 
plosions whenever she became excited. On 
this account, she was barred from attending 
the theater or any public assembly. 
Loss of sleep, business worries, domestic 
trials, harassment from any cause, may render 
the colon inoperable. 
In view of these facts, which might be 
multiplied at great length, it is evident that 
a right mental attitude is essential for the 
successful treatment of a sluggish colon as 
well as roughage, lubrication, etc. With the 
laxative diet and various food accessories, 
must be mingled the firm faith that the natural 
and biologic means- employed will accom- PSYCHOLOGY OF THE COLON 
129 
plish the desired object. Such a faith will 
lead to regular visits to the toilet at the times 
when the bowels should move; that is, after 
each meal, on rising in the morning and on 
going to bed at night. Do not wait for a 
“call,” but invite a call by giving the colon a 
chance for evacuation and by all means avoid 
haste. A hurried visit to the toilet will not 
encourage normal colon activity. A slow 
colon must be given time, especially when by 
a change of diet and attention to colon hygiene 
it is just beginning to behave in something 
like a normal manner. By patient training, 
the sluggish bowel may after a time be trained 
to act with normal promptness and celerity. HABITS WHICH CAUSE CON- 
STIPATION 
In considering the habits of life common 
among civilized people which give rise to 
constipation, we shall not undertake to arrange 
the subject matter in the order of relative im- 
portance, but rather speak first of those which 
are most common. 
Hasty Eating 
Insufficient mastication is a fault peculiar 
to civilized men. The savage, as well as the 
monkey and all lower animals that are pro- 
vided with teeth for grinding food, masticates 
his food with the greatest thoroughness. The 
accompanying cut made from the lower jaw 
of a skull in the writer’s possession, shows the 
teeth of an ancient mound builder, a Malkel- 
kos Indian. The well-worn appearance of 
the teeth affords sufficient evidence of the 
thoroughness with which they were used in 
grinding the nuts and cereal foods eaten by 
aborigines. 
130 Lower Jaw of Mound Builder HABITS WHICH CAUSE CONSTIPATION 
131 
A most interesting fact which has been 
brought to light by the X-ray studies of the 
intestine made by Hurst, of London, and 
others, clearly shows the great importance of 
thorough mastication and great deliberation 
in eating. The roentgenologists have demon- 
strated that the stomach and small intestine 
are in almost constant action. Peristaltic 
waves pass over the stomach several times a 
minute. Even when the stomach is empty, its 
activity continues and, in fact, may increase, 
finally becoming so violent as to produce, as 
shown by Cannon, of Harvard University, the 
sensation of hunger. The small intestine con- 
tinues to act so long as any portion of food 
remains to be acted upon, only becoming 
quiet after all food residues and wastes have 
been pushed forward into the colon. 
But the colon behaves more like a receiving 
chamber. It is, in fact, the garbage receptacle 
of the body; serving chiefly to receive and to 
pass out of the body the unusable residues of 
food substances and certain body wastes which 
are excreted through the intestine. 
Careful X-ray examinations of the colon 
show it to be almost entirely inactive except 132 
COLON HYGIENE 
during and immediately after the taking of a 
meal. The chewing of food apparently stim- 
ulates the colon to action through what is 
known as the gastrocolic reflex and so after 
each meal there is a mass movement in the 
colon which Hurst describes as “a powerful 
peristaltic wave which moves rapidly along a 
considerable length of the bowel carrying all 
the contents before it.” By this mass move- 
ment, the colon contents are carried down to 
the pelvic colon where they may remain until 
the next meal, when another mass movement is 
set up which carries the fecal matters from 
the pelvic colon into the rectum, thereby giv- 
ing rise to the “call” which is Nature’s de- 
mand for an opportunity for defecation. 
Two important lessons may be drawn from 
these observations. First, it is evident that 
chewing of the food is an important means 
of setting up in the colon the movements nec- 
essary to push forward its contents toward the 
outlet. When food is swallowed in a hasty 
manner, the colon may not receive the amount 
of stimulation required for efficient action 
and as the result the intestinal contents are not 
near enough to the outlet of the colon to insure 
evacuation after the following meal. HABITS WHICH CAUSE CONSTIPATION 
133 
An additional suggestion derived from 
these interesting observations is that the tak- 
ing of some simple food between meals or at 
bedtime may serve a highly useful purpose 
in stimulating the colon to increased activ- 
ity, thus promoting those “mass movements” 
which are necessary to bring the intestinal 
contents to the outlet and secure efficient and 
frequent evacuation. Fruit is the food best 
adapted to this purpose. One or two oranges 
or apples or some other juicy fruit either at 
bedtime or midway between meals, has been 
found by many persons a most excellent 
means of promoting normal bowel movement. 
Some years ago, the writer inquired of the 
man in charge of the monkey-house at the 
London “Zoo” with reference to the frequency 
of bowel movements in these interesting ani- 
mals. The information received was to the 
effect that the big apes moved their bowels 
four times a day and the small monkeys ten or 
twelve times a day. The reason of the more 
frequent bowel movements of the small mon- 
keys was found to be that the large apes were 
fed regularly three times a day, while the 
small monkeys were fed continuously by visi- 134 
COLON HYGIENE 
tors, who were permitted to give them nuts, 
bread, fruit, etc., so that the monkeys were 
eating practically all of the time. 
Rejection of Roughage 
Excessive chewing of the food, to which 
the term “bradyphagia” has been applied, has 
been charged with being a cause of constipa- 
tion. The charge is unjust. A person who 
follows the recommendation made by Flet- 
cher, to swallow nothing which cannot be 
reduced to liquid in the mouth, is sure to suf- 
fer as a consequence of insufficient bulk but 
not from the thoroughness of mastication. 
Food should be chewed sufficiently; that is, 
until the tongue no longer discovers coarse 
particles, but the excessively prolonged chew- 
ing advocated by Fletcher is unnecessary and 
was not practiced by him except for experi- 
mental or exhibition purposes. 
Insufficient Bulk 
The alimentary canal of man, while not so 
long in proportion to his size as that of the 
herbivorous animals, is much larger and 
longer than in animals which are intended to 135 
HABITS WHICH CAUSE CONSTIPATION 
feed upon a flesh diet. The human intestine 
is approximately ten times the length of the 
body, that is, of the trunk, which is approxi- 
mately half the height. The colon is saccu- 
lated like the colon of herbivorous animals, 
and like that of the higher apes, indicating 
the adaptation of the intestines to bulky food. 
Meat Eating 
Carnivorous animals have a short alimen- 
tary canal and a smooth colon. The move- 
ment of foodstuffs along this short, smooth 
passage is rapid. This is necessary for the 
preservation of the life of the animal, as un- 
digested remnants of meat long retained in 
the body necessarily undergo putrefactive 
changes with the production of ptomaines 
and poisons of a dangerous character. The 
digestion of meat leaves little residue, hence 
a person who lives chiefly on meat suffers 
from constipation, a condition which favors 
the putrefaction of undigested food remnants, 
and this, by creating an alkaline condition of 
the intestines, paralyzes the bowel and further 
increases the constipation. 
Meat also causes constipation through the 136 
COLON HYGIENE 
fact that it encourages putrefaction of the 
colon both by introducing putrefactive organ- 
isms in great numbers and also by providing 
material which is best calculated to encourage 
the growth of putrefactive organisms in the 
colon. Through the putrefaction of undi- 
gested remnants of the meat eaten, ammonia 
and other alkaline substances are formed 
which paralyze the bowel. 
The infection of the bowel which results 
from meat-eating also gives rise to colitis and 
causes a spastic or contracted condition of the 
descending colon, a condition found present in 
the most obstinate forms of .constipation. 
An Excessively Bland or Monotonous Diet 
Pavlov has shown the importance of taste 
as an element in digestion. According to his 
experiments, the activity of the stomach be- 
gins almost immediately after food is taken 
into the mouth. The intensity of the gastric 
activity depends upon the degree of stimula- 
tion of the gustatory nerves. Cash has shown 
by experiments on dogs that even the smell of 
food produces peristaltic activity. HABITS WHICH CAUSE CONSTIPATION 
137 
In order, then, that these two prime pur- 
poses of eating—namely, the nourishment of 
the body, and the evacuation of poisonous 
material—should be efficiently accomplished, 
it is necessary that the food should be so in- 
viting and stimulating to the senses which 
participate in the enjoyment of food that the 
digestive activity will be prompt and vigor- 
ous. A meal taken without relish and eaten 
as a mere matter of routine and duty does not 
accomplish this. A person who eats without ap- 
petite is always constipated. Even if the bowels 
move regularly, the discharged materials 
should have been gotten rid of twenty-four 
or forty-eight hours before; there is a latent 
constipation, the evil results of which do not 
materially differ in the main from those of 
other forms of constipation, although likely 
to escape attention. The bill of fare should 
be so varied from day to day and from meal 
to meal, and the food should be of such a 
character, that each meal will be taken with 
keen relish. This is especially important for 
persons whose lives are sedentary, and who on 
this account are more likely to suffer from 
loss of appetite, and the constipation which is 138 
COLON HYGIENE 
both a cause and a consequence of this diffi- 
culty. 
The Exclusive Use of Cooked Food 
While it is true that the cooking of food in 
general increases digestibility, experience in 
the feeding of both infants and adults has 
clearly shown that a diet consisting exclusively 
of cooked food is detrimental both to digestion 
and to general health, and may lead to the 
most serious results. 
Some raw foods should be taken every day, 
or preferably at every meal. Among foods of 
this kind to be specially recommended are 
green corn fresh from the garden (uncooked), 
celery, lettuce, cabbage, fresh fruits of all 
sorts, turnips of the best varieties, cucumbers, 
tomatoes, and radishes, if care be taken to 
remove the acrid rind. Young carrots, pre- 
pared raw, are also relished by some. 
These raw foods must be thoroughly 
chewed, as otherwise they may cause too long 
delay in the stomach. The universal relish 
for fresh vegetables, and the intense craving 
for them, is an evidence of their value. These 
foodstuffs, while supplying very little actual HABITS WHICH CAUSE CONSTIPATION 
139 
nutriment, nevertheless furnish the body with 
certain elements which modern research 
shows to be essential, while at the same time 
they supply necessary bulk and a sufficient 
amount of undigested carbohydrates to estab- 
lish in the colon conditions essential for a 
normal activity. 
The vitamins which are most abundant in 
raw vegetables, are wonderful vital stimulants 
and apparently aid digestion. When the vita- 
mins are deficient, toxic conditions shown by 
putrid stools soon develop. McCarrison has 
shown that vitamins are needed to energize 
the intestinal muscles. This is especially true 
of vitamin B, which is found in wheat bran 
and the germ of wheat, but is deficient in fine 
flour and many breakfast foods. 
Hot Foods and Drinks 
Heat relaxes and paralyzes, while cold 
stimulates. The practice of eating food as 
hot as it can be swallowed, and especially of 
taking hot drinks at meals, is unquestionably 
a very active cause of constipation. 140 
COLON HYGIENE 
A Meager or Low Diet 
Many persons suffer from constipation be- 
cause they do not eat enough. They are in 
constant fear of overloading the stomach and 
bowels, and the consequence is that these or- 
gans lack sufficient work to stimulate them to 
proper activity. 
People who “diet” often do themselves 
great injury by too great restriction of the 
bill of fare, both in quantity and variety 
of food. A food that the patient imagines to 
be constipating or otherwise harmful is gen- 
erally found to have the expected result. 
Thus, item after item of the food is discarded, 
until the bill of fare is reduced to a few ar- 
ticles which are usually taken without relish 
and with more or less apprehension of injury. 
Such patients might far better pay no atten- 
tion to diet whatever; they would run far less 
risk of injury by taking whatever the appetite 
craved. 
In increasing the amount of the food in- 
take, the increase should usually be in bu’k 
rather than in food value. The added bulk 
should consist of such foodstuffs as lettuce, HABITS WHICH CAUSE CONSTIPATION 
141 
celery, turnips, tomatoes, greens, fresh fruits, 
bran and other articles which give large bulk 
with little nourishment. 
Gonstipating Diets 
Nurses, and perhaps physicians also, some- 
times unwittingly do their patients great harm 
by restricting the diet to bland or liquid foods, 
which are often taken without relish, and 
which, on this account, as well as by lack of 
bulk, tend in the highest degree to promote 
intestinal inactivity and obstinate constipation. 
A diet like this naturally necessitates the use 
of artificial means for moving the bowels. 
Many a patient owes the beginning of his con- 
stipation to such a course of dieting during 
temporary illness. Milk, which has been so 
much relied upon as a sick-room diet, is par- 
ticularly objectionable in a considerable num- 
ber of cases, and should be much less freely 
used. Buttermilk is preferable, because of the 
lactic acid it contains. Its value is greatly in- 
creased by the addition of malt sugar or milk 
sugar, and wheatmeal porridge, or a porridge 
of corn meal or oatmeal made with the ad- 
dition of wheat bran. Fruit juices are ex- 142 
COLON HYGIENE 
tremely useful. There are very few cases in 
which such fresh things as lettuce and scraped 
apple and other raw fruits may not be taken 
with great advantage as well as vegetable 
purees. The danger of the use of solid food 
in these cases is largely imaginary, if care is 
taken to exclude meat, fried foods, and indi- 
gestible combinations. Thorough chewing of 
the food is of course essential. 
The dietaries generally prescribed in cer- 
tain forms of chronic disease, and considered 
to be essential, are often highly constipating. 
This is particularly true in the treatment for 
diabetes. 
In the dietetic treatment of hyperacidity, 
and especially of ulcer of the stomach and the 
duodenum, the usual prescription is of such 
a character as to cause constipation, which in 
turn leads to intestinal toxemia and to a re- 
lapse later on. 
Fasting 
Fasting, which is sometimes prescribed as 
a remedial measure, necessarily leads to con- 
stipation, unless some preventive method is 
adopted. The use of the enema is not suffi- 143 
HABITS WHICH CAUSE CONSTIPATION 
cient. Washing out of the colon can do noth- 
ing more than remove materials which have 
been deposited in it from the small intestine; 
and, in fasting, the small intestine as well as 
the stomach is in a state of complete inactivity. 
Bile, mucus and other secretions, as well as 
poisonous excretions from the blood, are ac- 
cumulating from day to day, but there is no 
peristaltic movement to carry them onward, 
because no food is taken into the stomach. 
From these facts it is evident that absolute 
fasting, except when made necessary by some 
intestinal trouble or other equally imperative 
exigency, is rarely likely to prove beneficial. 
Condiments 
Mustard, pepper, pepper sauce, cayenne, 
capsicum, horseradish, and the whole list of 
hot, irritating substances which are frequently 
added to food as seasoning, having no food 
value in themselves, are active causes of con- 
stipation. 
The concentrated residues of the foodstuffs, 
including the indigestible particles of mus- 
tard, pepper, or other condiment taken with 
the food, brought in contact with the rectum 144 
COLON HYGIENE 
cause chronic catarrh; hemorrhoids develop 
together with ulcers, fissures, and abscesses, 
followed by fistulae, and the way is prepared 
for tuberculosis and cancer. 
In India, especially in Ceylon, and also in 
Mexico, countries in which curries and hot, 
peppery sauces are used, gastric catarrh, con- 
stipation and hemorrhoids are almost uni- 
versal among those addicted to the use of these 
pernicious food-poisons. 
Irregular Meals 
When the meals are not taken regularly, 
the rhythmic peristaltic impulse by which the 
feces are pushed forward from the colon into 
the rectum is lacking. If, for example, a per- 
son’s habit is to move the bowels immediately 
after breakfast, and the breakfast is not taken, 
the bowels may not move, or if a movement 
occurs, it will be incomplete; instead of com- 
plete emptying of the colon below the splenic 
flexure, which occurs in a normal movement 
of the bowels, only the pelvic loop will be 
emptied; and fecal matters remain in other 
sections of the colon. HABITS WHICH CAUSE CONSTIPATION 
145 
Since bowel movement depends so largely 
upon the stimulus derived from eating, it is 
evident that regularity of bowel movement 
depends upon regularity of eating. 
If a full meal cannot be taken, some fresh 
fruit, as an apple or two, or a couple of 
oranges, may serve the purpose to maintain 
the normal rhythm. When strong stimula- 
tion of the colon is needed a bran biscuit may 
be added with advantage, together with a dose 
of paraffin. 
Tea and Coffee 
Tea and coffee contain two substances the 
poisonous effects of which are well known, 
viz: caffein, a nerve poison practically iden- 
tical with uric acid, and tannin, an astringent 
well known as one of the constituents of oak 
bark and many other vegetable substances. 
Everyone is familiar with the use of astrin- 
gent or tannin-containing remedies in diar- 
rhea. However beneficial tannin may be in 
cases in which the bowels are abnormally 
active, certainly its effects are nothing but per- 
nicious when habitually used. The average 
civilized man requires stimulation of his food 146 
COLON HYGIENE 
tube rather than the use of substances which 
produce a paralyzing effect. 
Insufficient Fluid 
Most persons who suffer from constipation 
habitually drink too little water. Women 
drink less than men. It is difficult to account 
for this scanty use of a necessary of life, which 
costs little and is of such inestimable value to 
the body. Water is far more immediately 
necessary for the support of life than is food. 
A man may live six weeks or two months 
without tasting food in any form, but a few 
days at the most is the limit of human life 
without water. The consequence of a scanty 
use of water is abnormal dryness of the feces, 
which delays their passage through the lower 
colon, and often causes an actual stoppage in 
the pelvic colon or the rectum. 
Person who sweat much, either as the re- 
sult of hot weather, vigorous exercise, or hot 
baths, are likely to suffer from constipation, 
unless special care is taken to supply the body 
with water sufficient to make good the loss. 
The skin ordinarily throws off as perspiration 
an ounce and a half of water each hour, or HABITS WHICH CAUSE CONSTIPATION 
147 
more than a quart in twenty-four hours. By 
active exercise or sweating baths this amount 
may be increased to thirty or forty ounces in 
an hour. The kidneys excrete two to three 
pints daily. It is evident, then, that care must 
be exercised to replace the water that is lost 
through the skin and kidneys. 
In diabetes there is a great loss of water 
through the kidneys. This, also, must be made 
up by drinking. If these losses are not made 
good, the thirsty tissues will absorb as much 
water as possible from the feces, thus causing 
hardening and retention in the lower bowel. 
Scanty and highly colored urine is an evi- 
dence that the tissues are in need of water. 
Dryness of the skin often testifies to the same 
need. 
Water should be taken in proper quantity 
irrespective of thirst. It may be made palat- 
able by the addition of fresh fruit juices. 
For the average person a good plan is to 
take a couple of glasses of water on rising, 
and the same amount before retiring at night. 
A glassful should be taken half an hour be- 
fore dinner and supper, and an equal amount 
two hours after eating. The free use of or- 148 
COLON HYGIENE 
anges or orange juice, and of other juicy 
fruits, serves the same purpose as water drink- 
ing, to the extent of the liquid which they 
supply. 
Persons suffering from obesity or diabetes 
are sometimes restricted in the drinking of 
water, with the result that constipation is pro- 
duced, if this condition does not already exist. 
This should never be done. 
In all cases in which there is a tendency 
to dryness of the stools, water should be taken 
in increased quantity. It is important in such 
cases, also, to diminish the amount of salt 
eaten. The addition of salt to the food creates 
thirst for water to dissolve it and to aid in its 
elimination through the skin and the kidneys. 
Children, as well as adults, need much more 
water than they are usually given. Meat eat- 
ers and those who use salt freely require a 
much larger amount of water than do those 
who adhere to a low protein dietary and who 
use little salt. 
Irregular Sleep 
The resumption of bodily activity on rising 
in the morning is one of the important means 
by which the bowels are made to act with HABITS WHICH CAUSE CONSTIPATION 
149 
regularity, by stimulating the colon to empty 
a portion of its contents into the rectum. 
When the hours of sleep are irregular, and 
especially when insufficient time is devoted to 
sleep, this physiological stimulus is lacking, 
and constipation may be one of the evil con- 
sequences resulting. Loss of sleep causes loss 
of appetite, thus diminishing the normal stim- 
uli to bowel movement, and so easily leading 
to constipation. Even when the bowels do 
not move soon after rising, the stimulus of ris- 
ing after a good night’s rest at least aids in the 
filling of the pelvic loop, which then only re- 
quires the stimulus of breakfast to cause a 
normal bowel action. Regularity of sleep is 
almost or quite as necessary for regular bowel 
movement as is regularity of meals. 
Loss of sleep causes constipation by pro- 
ducing a spastic state of the colon, as already 
noted. 
Incorrect Breathing 
A child does not have to be taught to 
breathe. It breathes instinctively and hence 
correctly, for all natural instinctive move- 
ments are physiologically and efficiently per- 
formed. But the breathing muscles are vol- 150 
COLON HYGIENE 
untary muscles, and hence may be controlled 
by the will. This fact permits modifications 
of the act of breathing, which may or may 
not be physiological. Unfortunately, the con- 
ditions of civilized life are such as lead to se- 
rious perversions of the breathing process. 
Normally, when air is inhaled the whole chest 
is enlarged, but the chief movement is at the 
lower sides of the chest. This broadening of 
the chest at its lowest part stretches the dia- 
phragm and thus gives it an opportunity to 
exert its greatest force. Its form being 
arched, this is highly important. If its ends 
are held in place, the top of the arch can de- 
scend only a little, and while breathing is 
ineffective, the lungs being imperfectly ex- 
panded, the compression of the abdominal or- 
gans is equally inefficient. The diaphragm, 
it must be remembered, is a double acting 
pump. It creates a suction in the chest, while 
at the same time it produces pressure in the 
abdomen. If its work is imperfectly done in 
one direction, it fails equally in the other. 
The compressing movements produced by 
the diaphragm at each inspiration are, when 
efficient, of great service in assisting the move- HABITS WHICH CAUSE CONSTIPATION 
151 
ments of the food along the alimentary tube. 
Acting upon the stomach, which lies just be- 
neath it, the diaphragm churns the food and 
aids in pushing it along into the intestine. 
Acting upon the colon, which on the left side 
lies in contact with it, the diaphragm renders 
great assistance in helping push the food along 
toward the rectum. 
But it is especially in the act of defecation 
that the action of the diaphragm is important. 
The very first step in the process of unloading 
the bowel is in the sinking of the colon by a 
very deep breath. If the sides of the chest 
are compressed by belts or a corset, so that 
they cannot expand, the diaphragm cannot de- 
scend more than a short distance, and its ac- 
tion is inefficient. As a result, the fecal mat- 
ters stored up in the descending and pelvic 
colon are not pushed onward to the rectum, 
and the bowel is only partially emptied. 
Thorough natural bowel movement is not 
possible without free and vigorous movement 
of the diaphragm. 
So, too, if the diaphragm is weak because 
of habitual shallow breathing, the result of a 
bad position in sitting at work or study, the 152 
COLON HYGIENE 
same result follows. A position which ham- 
pers the movements of the chest thus leads to 
constipation. 
The ordinary house chair, especially the 
rocking chair and easy chairs in general, train 
the body in unhealthy attitudes and compel 
shallow breathing. When the chest is de- 
pressed, as when sitting in a hollow-backed 
chair, the abdominal muscles are relaxed, and 
the diaphragm cannot act well. 
When, on the other hand, the chest is raised, 
as shown in the accompanying cut, the abdom- 
inal muscles are stretched, they are thus made 
tense, and the colon is kept under constant 
pressure, by which its contents are moved 
along at the proper rate; and when defecation 
occurs, these tense, well-developed muscles, 
together with the diaphragm, are ready to do 
their necessary part of the work. 
Deficient Exercise 
The relation between exercise and breath- 
ing and the necessity for vigorous and un- 
trammeled action of the diaphragm have been 
already referred to in the preceding para- 
graphs. Exercise promotes bowel action, not A Correct Sitting Posture in a Badly 
Constructed Chair 
(Shadowgraph) 
A “Slumped” Sitting Posture 
(Shadowgraph) A Health Chair 
A Disease-Producing Chair HABITS WHICH CAUSE CONSTIPATION 
153 
only by aiding respiration and inducing vig- 
orous movements of the diaphragm, but by 
calling into strong action the muscles of the 
abdomen, and by raising the general muscular 
tone of the body. 
The excellent effects that walking has upon 
bowel activity are well known. Riding is also 
of great advantage in the same way. These 
exercises, as well as many others, mechanically 
stimulate the colon as well as all parts of the 
intestinal tract, by communicating to it a con- 
tinued series of slight shocks, by which reflex 
movements are excited. The active play of 
children is as necessary to maintain proper 
bowel action as for muscular development. 
The movements of skipping, hopping, jump- 
ing are especially useful because they induce 
sudden vigorous contractions of the abdominal 
muscles and vigorous diaphragm movements 
by which the colon is compressed and stimu- 
lated. The folk dancing of the Middle Ages, 
which has been revived in recent years, is for 
the above reasons to be highly commended as 
a health measure. It is important, however, 
to make a clear distinction between the varied 
and vigorous movements of the folk dance, in 154 
COLON HYGIENE 
simple dress and under wholesome conditions, 
and the monotonous and restrained move- 
ments of the social dance, in full dress and 
under conditions always physically, and not 
infrequently morally, unwholesome. 
Those whose occupations are such as to give 
them plenty of exercise are fortunate in being 
able to lead lives which in large measure con- 
form to natural requirements. Such persons 
never need suffer from constipation if they eat 
proper food, drink an abundance of water— 
at least three to five pints daily—and take 
care to give the bowels an opportunity for 
movement after each meal, and promptly 
whenever there is a “call” for evacuation. 
Those who are compelled to lead sedentary 
lives, and especially women, whose lives are 
nearly always more or less sedentary in char- 
acter, must take daily and regular exercise of 
a sort calculated to benefit the bowels if they 
would escape the evils of constipation and its 
secondary results. Some of the special exer- 
cises which have been shown by experience to 
be of greatest service in combating constipa- 
tion will be described in a subsequent chapter. 
The exercises of greatest value are those HABITS WHICH CAUSE CONSTIPATION 
155 
which strengthen the abdominal muscles. A 
spring abdominal supporter will usually ren- 
der great service (page 298). 
Resisting the “Gall” 
The practice of resisting the “call” of Na- 
ture to discharge from the body accumulated 
wastes and rubbish is almost universal among 
civilized people, as the result of refinement of 
manners and modesty which lead to the con- 
cealment of certain animal functions as much 
as possible. That this is the result of what is 
commonly called false modesty cannot be de- 
nied, and yet there are few who would desire 
that this so-called false modesty should be al- 
together laid aside. It is important, however, 
that every person, children as well as adults, 
and at a very early age, should be fully in- 
structed respecting the evil results of resisting 
and thus thwarting one of the most important 
of the bodily functions. 
The “call” signifies that the pelvic colon is 
full of feces, and that a sufficient amount of 
fecal matter has been pushed down into the 
rectum to arouse the center of defecation and 
cause it to set in operation the automatic proc- 156 
COLON HYGIENE 
esses concerned in bowel movement. The 
colon is contracting, and there is a tendency 
for the anus to relax, which must be forcibly 
resisted to prevent immediate discharge of 
feces. The feces are normally stored in the 
pelvic colon, the portion which lies just above 
the rectum. So long as they remain here, 
there is no desire for movement, but when a 
portion of fecal matter has been pushed down 
into the rectum, the time for evacuation has 
come, and the fact is indicated by a more or 
lesss urgent “call.” When the feces are fluid, 
they reach the lowest part of the rectum at 
once, and the “call” is a very urgent one; but 
if they are of greater consistency, they are at 
first retained in the upper part of the rectum, 
and the “call” is less imperative, and may be 
suppressed by resistance. 
If, for any reason, the bowels are not per- 
mitted to move at once, the “call” usually dis- 
appears after a few minutes, and may not re- 
appear until after the next meal or even the 
next day. In the meantime, the feces which 
have entered the rectum lie there, and through 
the absorption of water by the intestines be- 
come each hour drier and harder, so that 157 
HABITS WHICH CAUSE CONSTIPATION 
when the “call” comes again as the result of 
more feces being forced into the rectum and 
further distention produced, evacuation may 
be difficult or impossible without mechanical 
aid. 
It is possible, also, that the fecal matters 
which have been carried down to the lower 
part of the colon may be returned. It is not 
probable that this occurs to any great extent, 
however, for new installments of feces are 
continually coming down from the upper part 
of the intestine, and hence the feces simply ac- 
cumulate, first in the pelvic colon, then in the 
iliac and ascending colon, and finally in the 
transverse colon, and even in the cecum and 
ascending colon. 
Although the bowels may be permitted to 
move when the next “call” occurs, the colon 
may not be fully emptied. The colon contents 
may by this time have become so dry and 
hard that the colon cannot be emptied by an 
ordinary effort. Thus there is left a residue 
in the pelvic and descending colon, which is 
likely to increase from day to day, or at least 
as often as there is failure promptly to answer 
the “call” to evacuation. 158 
COLON HYGIENE 
As the necessary result of this gradual ac- 
cumulation, the pelvic loop of colon becomes 
distended more and more. This fact accounts 
for the variation in the size of this part of the 
colon which is far greater than in any other 
part. The late Dr. Byron Robinson, of Chi- 
cago, found in two hundred carefully meas- 
ured pelvic colons a variation in length from 
five inches to thirty-three inches. The writer 
has several times encountered at the operating 
table cases in which the pelvic colon was fully 
two feet in length. 
This stretching may extend to other parts, 
affecting chiefly, of course, the movable parts 
of the colon. The transverse colon often be- 
comes loaded with delayed and dried feces, 
which in thin persons may be felt as hard ir- 
regular masses lying in the region of the um- 
bilicus. 
The cecum is also often found greatly dis- 
tended as the result of this hoarding of feces 
by resisting the “call.” It is very probable 
that the fecal matters are sometimes forced 
back into the transverse colon and the cecum 
by the strong contractions of the colon in at- 
tempts at defecation. When a “call” is expe- 159 
HABITS WHICH CAUSE CONSTIPATION 
rienced, there are at once set up colon con- 
tractions which would expel the feces if per- 
mitted to do so; but as the anus is held 
closed by voluntary contractions, the feces 
cannot be forced downward after the pelvic 
colon is filled, and the natural result is a slip- 
ping back of fecal matters into the first half 
of the colon, some portion even reaching the 
cecum. 
By resisting and ignoring the kindly hint 
of Nature, that the body requires an oppor- 
tunity to dispose of its poisonous wastes and 
refuse, thousands, perhaps we should say mil- 
lions, of men and women have brought upon 
themselves untold miseries, and have shortened 
their lives and have greatly impaired their ef- 
ficiency and usefulness. Not a few persons 
are almost at once conscious of injury. A dull 
headache appears. There is less appetite than 
usual for the next meal. Sleep is less sound 
and refreshing. The urine has a stronger 
odor, and the breath is offensive. These are 
simply the evidences of poisoning by absorp- 
tion of toxins. The absorbent process which 
dries out and hardens the feces, carries with 
the water that is taken up and poured into the 160 
COLON HYGIENE 
blood, quantities of poisons which it holds 
in solution. These poisons overwhelm the 
liver with unnecessary labor, tax the kidneys, 
and disturb every bodily function. 
The prompt evacuation of the bowels in 
response to Nature’s “call” is a sacred obli- 
gation which no person can neglect without 
serious injury. Ignorance of this fact is one 
of the chief causes of the prevalence of con- 
stipation, a condition in which the body be- 
comes a storehouse of the most disgusting and 
offensive material, which saturates the tissues 
with its horrible effluvium and its virulent 
poisons and taints the very springs of life. 
This fault is perhaps more common in 
America than in any other part of the world, 
especially in the cities. In English, German, 
French and Austrian cities, places are abun- 
dantly provided where well kept toilet con- 
veniences are offered at a very small cost. One 
sees often in Vienna such notices as the fol- 
lowing: “Urinal free. Seats, one ‘heller’ (a 
farthing or half cent).” The toilet arrange- 
ments at railway stations are sanitary and 
well cared for. There is room for great im- 
provement in this particular in this country. HABITS WHICH CAUSE CONSTIPATION 
161 
Mothers should give more attention to the 
bowel habits of their children. School teach- 
ers, at least in the primary grades, should in- 
struct their pupils concerning the importance 
of giving prompt heed to the “call” of the 
bowels for attention. Among savages this 
function receives much attention. A mission- 
ary physician tells of an Arab who declined 
to live in Aden because the city regulations 
required that the bowels should be evacuated 
only in certain places, as in all civilized com- 
munities, rather than anywhere at any time 
the “call” demanded. 
The worst result of these habits of post- 
poning attention to the bowels to a convenient 
time, is that the “call” after some time 
ceases. It is no longer made; or, if made, is 
so faint that it is not recognized. The con- 
tinued pressure of the mass of hardened feces 
upon the nerves of the rectum detroys their 
sensibility, so that the reflex is no longer in 
operation. The defecatory center is not noti- 
fied that evacuation is necessary, and the ac- 
cumulation of feces continues with no remon- 
strance. Quite a large proportion of chronic 
sufferers from constipation reach this condi- 162 
COLON HYGIENE 
tion before they really begin to give serious 
attention and study to the matter. 
There are thousands of persons who never 
experience a desire for evacuation of the 
bowels except after taking a laxative. The 
cure of cases of this sort is one of the most 
difficult problems connected with this class 
of disorders, but with the thorough co-opera- 
tion of the patient the normal “call” may be 
restored by patient application of the proper 
measures. No victim of this condition should 
rest contented until this has been accom- 
plished. For the body to be deaf to the needs 
of its sewage system, by which its most poi- 
sonous waste matters are removed, is a far 
more dangerous and serious condition than 
for it to be deprived of the sense of hearing. 
Fortunately this condition, serious as it is, may 
usually be relieved by the use of simple means. 
Hurried Defecation 
The act of defecation normally occupies 
but a few seconds. The colon acts with so 
much celerity that when watched under the 
penetrating X-rays its movements can scarcely 
be followed by the eye. There is a vigorous HABITS WHICH CAUSE CONSTIPATION 
163 
surging which passes in waves from one end 
of the colon within a few seconds, and then 
the colon is at rest; but it is easily seen that 
rhe contents have either disappeared or have 
been moved forward. After a normal move- 
ment, the colon is empty from the splenic 
flexure down, and there is seen to have been a 
forward movement of feces in other parts of 
the colon. 
There are, however, so many persons who 
are not quite normal, even though apparently 
healthy, that perfectly natural bowel move- 
ments are probably the exception rather than 
rhe rule among civilized adults. It often 
happens, at least after the first portion of 
feces has been expelled, that a second or even 
a third installment is brought down, and a 
second or third action of the colon occurs. 
The pelvic loop of the colon has in most peo- 
ple been so much abused by resisting the 
“call”, and so compelling an accumulation 
there, that it is often so greatly dilated or so 
much folded upon itself that two or even 
three efforts are necessary for its complete 
evacuation. To accomplish this requires a 
little patience, and sometimes a great deal of 164 
COLON HYGIENE 
persevering effort The first partial move- 
ment empties the rectum and the lower part 
of the distended pelvic colon. By waiting 
and repeated effort, aided perhaps by pres- 
sure with the hands upon the lower abdomen 
on the left side, an additional portion of feces 
may be forced down into the rectum. This 
excites the center of defecation, just as touch- 
ing the back of the throat excites the vomiting 
center, causes the colon to contract, the anus 
to open, and a second bowel movement results. 
In like manner, a third or even a fourth in- 
stallment may sometimes be secured. 
But this requires time, perhaps five, ten 
or even fifteen minutes. The bustling or wor- 
ried business man, the hurried clerk, the stu- 
dent who has barely time to reach his school 
before roll call, the housekeeper who is per- 
haps superintending some important culinary 
operation, these and a thousand other busy 
individuals believe that they have not time to 
devote to a function looked upon as grossly 
animal and repulsive, and so it is cut short at 
the earliest moment possible. 
Ignorance of the consequences does not, 
however, prevent the evil effects which cer- HABITS WHICH CAUSE CONSTIPATION 
165 
tainly follow such neglect. The feces left be- 
hind in the half-emptied pelvic colon become 
so dry and hard before another opportunity 
for evacuation occurs that the difficulty is 
greater than before, and so a considerable 
quantity, often an increasing amount, of feces 
is held back, and cumulative constipation is 
established. 
Undue haste in bowel movement is also en- 
couraged by unsuitable toilet arrangements. 
In many places, especially in country districts, 
the insufferable “privy” still exists, and is a 
most prolific source of misery. The use of 
such a place for evacuation of the bowels is 
at all times more or less inconvenient and of- 
fensive, and on this account is avoided as 
much as possible, leading to neglect of the 
“call,” and when necessity compels the use of 
the offensive place, the visit is made as brief 
as possible. 
In cold weather, the danger of injury from 
exposure of the unprotected body to a low 
temperature, sometimes even zero weather, is 
very great, especially in the case of feeble or 
delicate persons. Extreme cold also tends to 
prevent effective defecation, by contracting 166 
COLON HYGIENE 
the anal muscles so strongly as to negative the 
effect of the automatic reflex by which the 
outlet is normally opened. 
The toilet should be conveniently placed, 
and should be made as warm and comfortable 
as a bathroom. It should be kept in so neat 
and sanitary condition as to be in no way 
offensive. 
The time should be sufficient for complete 
emptying of the descending and pelvic colon. 
All fullness and weight in this region, as well 
as the sense of fullness in the rectum, which 
commonly prompts to bowel movement, 
should disappear after defecation. If neces- 
sary to occupy the mind by glancing over a 
morning paper, this will do no harm provided 
that it is not allowed to interfere with the mus- 
cular efforts which may be necessary to force 
down into the rectum from the pelvic colon 
a sufficient amount of feces to induce an ex- 
pulsive action of the bowels. 
Unnatural Posture in Defecation 
The natural position in defecation is squat- 
ting or crouching. All savages assume this 
attitude in moving the bowels. The reason HABITS WHICH CAUSE CONSTIPATION 
167 
for this, as has been fully explained in a pre- 
ceding chapter, is that in the natural position 
the abdomen is compressed by the thighs, and 
thus the feces are forced into the rectum, and 
so the automatic process of bowel movement 
is set going. 
The ordinary water closet is so constructed 
that natural bowel movement is impossible in 
its use. By bending strongly forward, some 
compression of the thighs may be effected, but 
it is only in the squatting position that the 
pressure can be as great as is possible and 
often necessary. By placing a low platform 
in front of the closet so as to raise the feet 
eight or ten inches, this objection may be very 
largely overcome. Some closets are now 
made low and sloping with this idea in view, 
and are a great improvement over the old style. 
Many surgeons have learned the impor- 
tance of the squatting position to secure com- 
plete evacuation of the bowels and bladder, 
and forbid the use of the bed pan in any ex- 
cept the feeblest cases, requiring the patient 
to be supported as may be necessary while 
using the chamber. 168 
COLON HYGIENE 
Although this matter is one of very great 
importance,'it is more than likely that half a 
century will pass before manufacturers and 
plumbers, upon whom we are dependent for 
these necessary conveniences, recognize to any 
appreciable extent the need of a change in 
closet construction. 
The Use of Tobacco 
Numerous laboratory experiments have 
shown that the use of tobacco in any form has 
a paralyzing effect upon the splanchnic 
nerves. Without the aid of these sympathetic 
nerves, normal, rhythmical bowel movements 
are impossible. The fact that some persons ob- 
serve an apparently favorable influence from 
smoking, is accepted as evidence that the ef- 
fects of the weed are favorable to the bowels. 
These cases are exceptional. In general, the 
use of tobacco is highly injurious to the intes- 
tine. Kreuznach, of Vienna, has recently 
shown that nicotine produces arteriosclerosis 
of the splanchnic vessels. That is, it produces 
hardening and degeneracy of the vessels 
which supply the colon and other abdominal 
organs. This change in the blood vessels gives HABITS WHICH CAUSE CONSTIPATION 
169 
rise to general degeneracy and atony, and 
hence to constipation, by which it is always 
accompanied. 
Alcohol and Other Narcotic Drugs 
Alcoholic beverages of all sorts tend to pro- 
duce constipation, by causing chronic intes- 
tinal catarrh, ulcer of the stomach, and paral- 
ysis of the sympathetic nerves. 
Opium in all forms produces a specific ef- 
fect in paralyzing the bowels. In former 
times it was customary to administer opium 
in sufficient doses in certain cases to cause 
complete inactivity of the bowels for a week 
or more. In such cases the constipation in- 
duced was often the beginning of chronic con- 
stipation of a most obstinate character. 
The very common use of opium for the re- 
lief of pain is a prolific cause of constipation, 
especially among women. The fact that a 
laxative drug is given to overcome the con- 
stipating tendency, does not prevent the evil 
that results, but only adds another. 
Bromides and sleep-producing or hypnotic 
drugs of all sorts tend to produce constipation, 
although some of them are less harmful than 170 
COLON HYGIENE 
opium. Fortunately, the use of these drugs 
usually may be dispensed with when the re- 
sources of hydrotherapy and other physiologic 
means are made use of. 
The Use of Purgatives Aggravates 
One of the best evidences of the universal 
prevalence of constipation is afforded by the 
enormous use of laxative or purgative drugs. 
The quantity of this class of drugs used an- 
nually far exceeds that of any other class. 
Besides drugs proper, there is sold a prodigi- 
ous quantity of laxative mineral waters. It 
would be difficult in the average community 
to find a household in which there is not kept 
on hand a supply of some favorite laxative. 
The columns of the newspapers are filled 
with advertisements of drugs which act upon 
the bowels. Many housekeepers lay in sup- 
plies of bowel medicines as regularly as the 
stock of groceries and other necessaries, and 
medical advice is sought no more in relation 
to one than the other. Laxative drugs have 
come to be regarded as staple commodities 
which stand, next to food and drink, as neces- 
sities. HABITS WHICH CAUSE CONSTIPATION 
171 
Unquestionably, an inestimable amount of 
injury is done by the use of these intestinal 
irritants, most of which are nostrums of the 
worst sort, providing temporary relief only 
at the expense of permanent injury. 
It is not too much to say that all laxative 
drugs are harmful. There is no such thing as 
a harmless laxative medicine. 
Laxative drugs act in different ways, and 
some are more harmful than others. “Salines” 
impose heavy burdens upon the kidneys, be- 
sides irritating the bowels. When long used, 
they produce an obstinate intestinal catarrh, 
which aggravates the constipation. Almost 
without exception, laxative drugs increase the 
condition which they are supposed to cure. 
The most difficult cases to cure are those 
which have long made use of laxative drugs. 
Not the least of the damage done by laxa- 
tives is the injury to the stomach. The drug 
is administered by the mouth for the purpose 
of relieving a difficulty at the other end of the 
digestive tract, than which it would seem 
nothing could be more irrational. In a large 
number of cases of constipation, the whole 
trouble is a loss of the rectal reflex. The feces 172 
COLON HYGIENE 
accumulate in the rectum or the pelvic colon 
because of failure of the discharging mech- 
anism. What could be more really absurd 
and irrational than to irritate and worry the 
stomach and the whole twenty-five feet of 
small intestine, besides the cecum and the 
greater part of the colon, just for the purpose 
of exciting to action the last six inches of the 
intestinal tube, the rectum? 
As we shall see in the further study of this 
subject, constipation is not a disease, but only 
a symptom. The morbid condition upon 
which the symptom depends may be any one 
of a score or more of things, or several in 
combination. For the most part, these condi- 
tions, as we shall presently see, are such as are 
certain to be greatly aggravated by the use of 
laxatives or irritants of any sort. 
The use of laxatives as a routine measure, 
a practice which is almost universally in 
vogue with the profession as well as with the 
laity, is most illogical, and is productive of a 
prodigious amount of injury. 
The use of laxative drugs must be regarded 
as one of the most certain and prolific causes 
of constipation, and a person who has once HABITS WHICH CAUSE CONSTIPATION 
173 
formed the habit of using laxatives must as a 
rule continue the practice as long as he lives, 
unless he is so fortunate as to find some one 
wise enough to show him the way out of his 
troubles. 
The systematic use of purgatives for “cleans- 
ing the system,” irrespective of the state of 
the bowels, is a very old custom still in vogue 
in various places. Nothing could more ef- 
fectively operate to produce the most obsti- 
nate sort of constipation. An excellent illustra- 
tion of this baneful practice and its results 
came under the writer’s observation a number 
of years ago. A man past middle life sought 
relief from a constipation which he declared 
responded to no drug in any dose. He had 
taken half a pound of “salts” without effect. 
The history which he gave revealed the cause 
of his unfortunate condition. The patient 
stated that when a child at home it was the 
practice of his mother to give to each child 
every Friday night a dose of “salts” as a sort 
of house-cleaning process to prepare the fam- 
ily for the proper observation of Sunday— 
whatever that may have meant. The result 
was that after a few years the weekly dose 174 
COLON HYGIENE 
was quite insufficient, and daily doses of in- 
creased size became necessary. The dose in- 
creased from year to year, and new remedies 
were adopted as one after another ceased to 
be effective, until the whole list of laxatives 
had been exhausted. 
Posture 
A habitual posture which relaxes the ab- 
dominal muscles and so weakens them by 
disuse that they lose their normal tone may 
become a potent cause of constipation. It 
has been shown that a slowing of the blood 
movement through the intestine results in 
a slowing or interruption of peristalsis. The 
mass movement of the colon which takes 
place normally during or immediately after 
a meal is without doubt due to the quickening 
of the circulation which occurs as the result 
of the entrance of food into the stomach by 
which the whole digestive system is excited 
to activity. The increased movement of 
blood through the intestines during digestion 
is so great that other forms of bodily activity 
are often more or less interfered with, par- 
ticularly the activity of the brain, which, HABITS WHICH CAUSE CONSTIPATION 
175 
when in vigorous action, requires one-fifth 
of the total blood supply of the body. 
Students, writers, bookkeepers, seamstresses, 
most professional men and most persons whose 
habits are sedentary or who sit much at their 
work are likely to assume a relaxed position 
as shown in the accompanying cuts. This pos- 
ture robs the abdominal vessels of the mechan- 
ical support which they require from the ab- 
dominal walls. Persons who habitually sit in 
this relaxed attitude retain the same attitude 
when on their feet so that the abdominal blood 
vessels are constantly filled with stagnating 
blood, the natural result of which is a deficient 
activity of the intestines and an abnormal 
accumulation of food residues in the colon. 
Many persons who are habitually constipated 
observe that the bowels move regularly and 
several times daily when much exercise is 
taken, as during a vacation outing. This fact 
emphasizes the importance of exercise not 
only as a means of preventing constipation 
but as a means of cure. 176 
COLON HYGIENE 
Horace Fletcher’s Error 
About twenty years ago (1902) Mr. Hor- 
ace Fletcher began his chewing campaign 
and by his enthusiastic advocacy of the value 
of thorough mastication of the food induced 
many thousands of people to give more atten- 
tion to the manner of taking their food. 
Mr. Fletcher was right in his estimate of 
the value of thorough mastication of the food, 
though he was wrong in supposing much 
chewing to be a rule of universal application. 
In cases of hyperacidity, in which the stom- 
ach makes an excess of gastric acid, the food 
should be chewed as little as possible, since 
more chewing makes more acid. But, of 
course, the food must be prepared in the 
form of puree, so that chewing is not needed 
for mechanical preparation. 
Mr. Fletcher somehow hit upon the idea 
that it was essential that all the food should 
be made liquid in the mouth, and that any 
part of the food which could not be reduced 
to liquid form in the mouth should be dis- 
carded. This idea was not included in his 
discoveries about the discriminating power of HABITS WHICH CAUSE CONSTIPATION 
177 
the gustatory nerves, and was not a legitimate 
inference from the demonstrated value of 
thorough chewing; it was a pure supposition 
or hypothesis, or perhaps we should say mere 
conjecture. But Mr. Fletcher attached to this 
assumption all the importance of a demon- 
strated truth, and dwelt much upon it. This 
most unfortunate error was his undoing. It 
led him to avoid foodstuffs which contained 
insoluble substances, such as the seeds and 
skins of fruits, and to restrict his dietary to 
soft foods, soups, purees, and liquid foods. 
One result of the use of soft foods which 
required little chewing was rapid decay of his 
teeth. On his various visits to Battle Creek, 
he was constantly in the hands of a dentist, 
who told the writer more than once that he 
was astonished at the bad condition in which 
he found Mr. Fletcher’s teeth, and at the 
rapidity with which they were undergoing 
decay. 
But another and a still more serious result 
of the soft diet, wholly free from indigestible 
elements, was a most obstinate constipation. 
Mr. Fletcher told me on several occasions 
that his bowels moved only once or twice a 
week. 178 
COLON HYGIENE 
After a time Mr. Fletcher came to look 
upon this chronic constipation as a great ad- 
vantage, and as a proof of the virtue of extra 
mastication. He argued that thorough chew- 
ing secured such perfect digestion and such 
complete absorption and utilization of the 
food that there was left no residue for germs 
to act upon, and so was a sort of sterilizing 
process. As proof of this, he offered the fact 
that the small hard stools which he dismissed 
from his colon at intervals of several days 
were almost odorless. As a convincing argu- 
ment, he one morning came into my office and, 
pulling a handkerchief from his coat pocket, 
opened it and presented a small brown mass 
less in size than his thumb, and remarked, 
“This is my morning stool, and you will see 
that it is free from odor.” Then, thrusting a 
hand into another pocket, he drew out two 
other brown rolls of similar appearance say- 
ing: “Here are two stools which I have been 
carrying around as pocket pieces for several 
months. As you will see, they are wholly 
free from odor.” His face was beaming, and 
he evidently felt that he had achieved a tri- 
umph in food economy. HABITS WHICH CAUSE CONSTIPATION 
179 
Mr. Fletcher was so carried away with this 
idea that for some time, at least, he made 
quite a hobby of it, and it came to be gen- 
erally understood that infrequency of bowel 
movements was a regular part of the Fletcher 
regime, or “Fletcherism,” as he preferred to 
call it. 
Mr. Fletcher’s enthusiasm for this feature 
of his system was somewhat cooled, however, 
by a circumstance reported to us by a New 
York lady magazine writer, who stated that 
on one occasion when he was explaining 
“Fletcherism” to a group of New York club 
women, he exhibited and passed around his 
specimens, or attempted to do so, but failed 
because the ladies fled in dismay. 
The writer labored long and often with 
Mr- Fletcher to convince him of his error, 
the evil effects of which were made evident 
by his badly coated tongue and bad breath, as 
well as by the rapid decay of his teeth and 
other indications of pronounced autointoxica- 
tion. All of my efforts were unavailing, how- 
ever, for several years. 
In the meantime, Dr. Van Someren, Mr. 
Fletcher’s son-in-law, made a visit to Battle 180 
COLON HYGIENE 
Creek. His condition was found to be still 
worse. He remarked one day, that the man- 
agement of his bowels was a great trouble. 
His bowels moved only once a week and 
sometimes less frequently- He was very neu- 
rasthenic, and was evidently suffering greatly 
from toxemia, which led to his death a year 
or two later. 
Finally, I succeeded in inducing Mr. 
Fletcher to submit to a “motility test.” The 
test consisted in giving a quantity of finely 
pulverized charcoal, so as to impart to the 
food residues a black color, and by this means 
determine the length of time required for it 
to pass through the alimentary canal. The 
charcoal was given at breakfast. The next 
morning Mr. Fletcher called for me early 
and asked me to come to his room- He was 
greatly disturbed. “Doctor,” said he, “what 
was that medicine you gave to me? It must 
have been something dreadful. I fear it poi- 
soned me. It got me up at four o’clock this 
morning, and a bowel movement occurred, 
and the material passed had a most loathsome 
and disgusting odor.” 
It was by no means easy to convince him HABITS WHICH CAUSE CONSTIPATION 
181 
that the bad odor was due to the putrefaction 
of bile and other excretions which had been 
retained for days in the cecum after they 
should have been dismissed from the body. 
Of course, the only possible effect of the char- 
coal had been to lessen the odor, although it 
had apparently stimulated activity of the 
bowels, producing a laxative eifect because 
the colon had been so long unused to the con- 
tact of insoluble or indigestible residues. 
I explained to Mr. Fletcher the fact 
pointed out by Bouchard, that the bile is a 
highly poisonous excretion, being six times as 
toxic as urine. I also called his attention to 
the fact that both bile and intestinal mucus 
are putrescible substances, and that putrefac- 
tion always occurs when there is long delay in 
the colon. He still held to his thesis, how- 
ever. 
Having now the positive proof that he was 
absolutely wrong in his contention, and that 
his hard stools were odorless only because 
they had been retained so long that the mal- 
odorous indol and skadol had been almost 
wholly absorbed, I did not hesitate to take a 
strong and open stand against this feature of 182 
COLON HYGIENE 
his theory. I had frequent occasion to do so 
because of inquiries from patients who had 
suffered from the constipating effects of 
“fletcherizing,” that is, thorough chewing of 
the food and rejection of all insoluble resi- 
dues. Many persons who were forced to 
abandon “fletcherizing,” because of the re- 
sulting constipation and autointoxication, sup- 
posed that the evil effects they suffered were 
due to chewing; whereas it was, instead, due 
to rejection of the insoluble residue which is 
a necessary element of our food to furnish the 
needed bulk for stimulation of the intestine. 
Said the late Professor William James, who 
was for a time one of Mr. Fletcher’s most en- 
thusiastic converts, “I had to give it up after 
a three months’ trial. It nearly killed me.” 
I deem it just both to Mr. Fletcher and 
myself, to write thus frankly, for he gave 
wide publicity to the fact that I endorsed his 
ideas of chewing, but did not mention my pro- 
tests against his idea of the value of colon in- 
activity. 
The last time I met Mr. Fletcher was at 
the Lotus Club in New York on the occasion 
of his last visit to this country. I was struck HABITS WHICH CAUSE CONSTIPATION 
183 
with the rapidity with which he had aged 
since I last met him. He looked highly toxic. 
I undertook once more to expostulate with 
him about his insistence upon the rejection of 
insoluble residues in his food, and cited vari- 
ous instances of injury from the following of 
his teaching. He seemed to be more open- 
minded on the subject, and after returning 
home I received a letter from him in which 
he referred to bran in a way which led me to 
infer that he was making use of it as a laxa- 
tive, and he added that his bowels were mov- 
ing daily. 
I have reason to believe that at last Mr. 
Fletcher saw his error and endeavored to 
correct it, at least as far as his own habits 
were concerned. But, unfortunately, it was 
too late. The mischief had been done. His 
vital stamina to resist disease had been ex- 
hausted by many years’ struggle against colon 
poisons. 
Mr. Fletcher’s experience inculcates the 
lesson that there is no panacea for the ravages 
of time. Long life cannot be made sure by 
any simple formula. Thoroughgoing obedi- 
ence to all the laws of “biologic living” is the 
price which must be paid. DISORDERS OF THE DIGESTIVE 
TUBE ASSOCIATED WITH AND 
CAUSING CONSTIPATION 
The disorders of the alimentary canal, 
which give rise to constipation, are very nu- 
merous. Some are purely functional in char- 
acter, others are organic or structural affec- 
tions. All are of a nature which cannot pos- 
sibly be more than temporarily relieved by 
laxative drugs, and most are likely to be 
made worse by their use, a fact which shows 
the folly of depending upon them for the 
relief of this condition, which, unfortunately, 
is rarely treated in any other way. 
Reverse Peristalsis the Explanation of 
Many Gastric Symptoms 
Recent observations by Griitzner, Bern- 
heim, Alvarez, Case, Boldyreff and others 
show that the normal peristaltic movements 
of the alimentary tract, by means of which 
foods and food residues are moved progress- 
184 DISORDERS OF THE DIGESTIVE TUBE 
185 
ively from the mouth to the outlet of the 
anus, may be reversed. Strong antiperistaltic 
movements have frequently been observed in 
the colon. These movements usually start 
from the center of the colon. Case and 
others have observed movements beginning 
near the lower end of the colon when this 
part of the bowel was distended. Case has 
reported cases in which the reflux has ex- 
tended even to the duodenum. Treves, the 
London surgeon, reported a case in which 
castor oil and water colored with an aniline 
dye were vomited within ten minutes after 
they were introduced by enema into the colon. 
The surgeon thought such rapid movement of 
liquids from the rectum to the stomach must 
be impossible without the existence of an 
opening connecting the stomach with the 
colon. He accordingly operated, but to his 
surprise found the stomach and intestines to 
all appearance perfectly normal. A number 
of other similar cases have been reported. In 
these cases the reverse movement of the in- 
testine is apparently even more vigorous than 
the ordinary peristalsis in the normal direc- 
tion. Such rapid antiperistaltic movements 186 
COLON HYGIENE 
are doubtless very rare. There is accumulat- 
ing evidence, however, that a very slow, al- 
most imperceptible, reverse peristalsis is an 
exceedingly common phenomena and is the 
real cause of many of the symptoms associated 
with disorders of the stomach. 
These reverse movements may be caused by 
various morbid conditions, especially by 
chronic appendicitis, disease of the gall blad- 
der, duodenal ulcer, pregnancy, diseased con- 
ditions of the womb and ovaries in women 
and of the bladder and prostate in men; but 
the most common of all causes appears to be 
the accumulation of food residues in the 
colon. Chronic constipation, or intestinal sta- 
sis, is thus shown to be the cause of most of 
the disorders of the alimentary canal as well 
as the origin, through intestinal toxemia, of a 
vast number of general disorders. Alvarez 
inclines to the opinion that the disturbances 
caused by fecal accumulations in the colon are 
chiefly of a mechanical nature, while others 
hold to the view that the principal factor is 
the absorption of poisons resulting from the 
putrefactive changes which are always asso- 
ciated with delay of food residues in the colon. 187 
DISORDERS OF THE DIGESTIVE TUBE 
The probable truth is that both of these fac- 
tors are active. It is certain that relief of 
constipation and changing the intestinal flora 
are the most effective means of combating 
many of the most annoying symptoms con- 
nected with the stomach and intestines as well 
as the various conditions commonly attributed 
to intestinal toxemia or autointoxication. 
A great mass of facts demonstrated by lab- 
oratory research and culled from clinical ob- 
servation has been cited by Alvarez in sup- 
port of the views above advanced. The con- 
clusions reached with reference to the causes 
of the various symptoms commonly associated 
with disorders of the stomach may be briefly 
summarized as follows:— 
Vomiting 
Vomiting is undoubtedly the result of a 
reverse movement of the intestine. During 
X-ray observations, peristaltic waves have 
been seen to pass from the duodenum to the 
stomach, and it is impossible to account for 
the vomiting of fecal matters and substances 
introduced experimentally into the rectum 
except by the occurrence of reverse peristalsis. 188 
COLON HYGIENE 
It was noted by Hippocrates that purging 
usually ceases when vomiting begins. Purg- 
ing has even been treated by the administra- 
tion of emetics, and it has been found possible 
to nourish pregnant women suffering from 
prolonged vomiting by introducing nutritive 
enemas, which were doubtless carried from 
the colon into the small intestine. Feeding in 
this manner will, of course, be facilitated by 
incompetency of the ileocecal valve which 
exists in a large proportion of patients who 
have long suffered from constipation. Regur- 
gitation, as Alvarez suggests, is simply mild 
vomiting. The reverse peristaltic waves are 
too slight to produce the violent movements 
of vomiting, so that only small quantities of 
liquid are lifted. Distention of the colon 
causes it to give rise to reverse waves of suffi- 
cient intensity to reach the stomach, although 
with a force barely sufficient to lift from the 
stomach to the mouth small quantities of the 
stomach contents. The material lifted to the 
mouth may be either fresh food in which the 
process of digestion has not yet been begun or 
highly acid gastric juice from the lower part 
of the stomach, or even duodenal fluids, bile DISORDERS OF THE DIGESTIVE TUBE 
189 
and pancreatic juice which, when the pylorus 
is open, may be carried upward along the 
lesser curvature of the stomach to the esoph- 
agus. 
Nausea and Aversion to Food 
Nausea without either vomiting or regur- 
gitation is another symptom of mild reverse 
peristalsis. The accumulation of fecal resi- 
dues in the colon is undoubtedly the most 
common cause of nausea, although it is en- 
tirely possible that the toxins absorbed from 
putrefying residues in the colon may also give 
rise to nausea. 
Aversion to food may also be the result of 
many different causes, both mental and phys- 
ical. There is, however, good reason for be- 
lieving that in many cases, perhaps the ma- 
jority of cases, the lack of appetite is but a 
mild manifestation of the interruption of the 
normal progress of food or food residues 
along the intestinal tract. Cannon demon- 
strated long ago that when obstruction occurs 
in any portion of the bowel there is at once 
stoppage of movement in the higher lying 
parts. It has often been noted that the stom- 190 
COLON HYGIENE 
ach ceases to pass its contents into the intes- 
tine when the intestine lower down is over- 
filled. A colon overfilled with residues thus 
becomes a cause of gastric disturbance, the 
emptying of the stomach is slowed and the 
hindrance may be so great as to produce not 
simply a lack of inclination to the taking of 
food but a complete aversion to food of any 
sort. This aversion may extend even to liq- 
uids. The writer has frequently observed 
that persons suffering from extreme intestinal 
toxemia usually drink very little and find it 
difficult to swallow more than small quantities 
of water. This aversion to food and drink 
may be in part due to the influence of putre- 
factive toxins upon the hunger center and the 
appetite center, but since Cannon has shown 
that hunger is due to contraction of the stom- 
ach it is entirely reasonable to believe that 
the slowing of the gastric movements or re- 
versal of these movements may be the prin- 
cipal cause of loss of appetite and of the feel- 
ing of nausea which is often associated with 
the lack of appetite. 191 
DISORDERS OF THE DIGESTIVE TUBE 
A Sense of Fulness 
Chronic dyspeptics often complain of diffi- 
culty in eating because of a “sense of fulness” 
which appears shortly after a few mouth- 
fuls of food have been eaten. Cannon, Carl- 
son and other observers have shown that the 
normal stomach gradually enlarges to accom- 
modate the increasing volume of contents dur- 
ing the intake of food. This appears to be 
brought about by a reflex action which causes 
gradual relaxation of both the gastric walls 
and the muscular walls of the abdomen. This 
reflex appears to be interfered with by a mild 
reversal of the normal peristaltic movements. 
Distention of the colon may well give rise to 
this condition. In duodenal feeding the too 
rapid introduction of foods will quickly de- 
velop the sense of fulness in the stomach al- 
though no food whatever has entered the 
stomach. It is quite possible that disease of 
the gall bladder, ulcer of the duodenum or a 
chronically inflamed appendix may be a 
cause of these reverse movements; but in the 
great majority of cases chronic constipation 
may be held responsible for this condition. 
By waiting a few moments, especially by di- 192 
COLON HYGIENE 
version of the mind from the condition pres- 
ent, as by pleasant conversation or the reading 
of the morning paper, the symptom will pass 
off and eating may be resumed. Worried 
mothers and mentally depressed business men 
often complain of this symptom. In these 
cases the explanation may be easily found 
through the depressing effect of the mind 
upon the activity of the colon and the result- 
ing stasis. 
Belching 
Alvarez points out there are three kinds of 
belching: (1) A slight gurgling sensation 
felt in the esophagus; (2) the eructation of 
gas from the stomach; and (3) a movement 
of air downward into the stomach or a volun- 
tary or semi-voluntary swallowing of air. 
Observations made by the writer, Dr. Case 
and others have clearly demonstrated that 
so-called belching is in the majority of cases 
simply the swallowing of air or the eructation 
of air which has been swallowed. It should 
be remembered, however, that this is not 
simply a vicious habit which has been volun- 
tarily acquired, but is an effort on the part of DISORDERS OF THE DIGESTIVE TUBE 
193 
the patient to relieve a feeling of discomfort 
experienced in the stomach. The condition 
seems to be similar to that which sometimes 
gives rise to hiccough. Not infrequently hic- 
cough and belching are associated. It is 
probable that in many cases the gastric dis- 
comfort is the result of a reverse peristalsis 
which brings gas or liquid into the stomach. 
Swallowing of air opens the upper orifice of 
the stomach and so permits some of the gastric 
contents to escape and thus affords momen- 
tary relief. It is well known that gas is rarely 
generated in the stomach by fermentation. 
Gas in the stomach is either swallowed or 
brought up from the intestine by reverse peri- 
stalsis. 
Instead of seeking relief by the swallowing 
of air, persons suffering from this inconven- 
ience may obtain relief by sipping a glassful 
of very hot water, perhaps with the addition 
of a little soda. This will open the upper ori- 
fice of the stomach and allow the escape of 
disturbing liquid or gas and permit the re- 
verse waves to run out as Alvarez suggests, 
and thus bring relief; but at the same time 
the real cause of the trouble, which probably 194 
COLON HYGIENE 
exists lower down in the bowel, must be 
sought out and removed. 
Globus 
This very unpleasant sensation felt in the 
esophagus is known to be the result of violent 
contraction of the muscular tube. It seems 
to be the result of the meeting of two peristal- 
tic waves, one coming from above, the other 
from below. Hysterical patients suffer from 
globus more than others because they are uni- 
versally constipated and hence the subjects of 
pronounced reverse peristalsis. Globus is 
sometimes a result of an attempt to swallow 
when a wave of regurgitation is passing up- 
ward. 
Coated Tongue and Foul Breath 
These conditions which accompany bilious- 
ness are doubtless in part due to a general 
lowering of vital resistance with depreciation 
of the germicidal properties of the blood 
serum, as a result of which the saliva loses 
to a certain extent its power to prevent the 
growth of bacteria in the mouth, which ap- 
pears to be one of the important functions of 
this secretion. It appears, however, from the DISORDERS OF THE DIGESTIVE TUBE 
195 
experiments of Griitzner and others that the 
coating of the tongue, which is known to be 
due to the growth of bacteria, may be in some 
cases the result of reverse peristalsis. Griitz- 
ner showed that bacteria and lycopodium in- 
troduced into the rectum in dogs were within 
a few hours carried to the mouth. Hundreds 
of bacteriological examinations of the saliva 
made in the laboratory of the Battle Creek 
Sanitarium have shown that in a very large 
proportion of the cases examined, colon bacilli 
are found present in large numbers. 
Since it is well known that the bile fre- 
quently enters the stomach during sleep, since 
it is also known that colon bacilli are fre- 
quently found in the bile, it will readily be 
seen that these pernicious organisms may 
easily find their way by regurgitation to the 
mouth; and if the saliva has lost its normal 
power to inhibit the growth of these organ- 
isms the natural result will be an unusual de- 
velopment and the densely coated tongue and 
foul smelling breath which are found in per- 
sons suffering from the condition commonly 
known as biliousness. 196 
COLON HYGIENE 
Biliousness 
The term “biliousness,” while not in a 
strict sense scientific, nevertheless describes a 
pretty clearly defined condition with which 
many people are, unhappily, only quite too 
familiar. The lack of appetite, sense of mal- 
aise, indisposition to effort, mental or physical, 
drowsiness, often giddiness, coated tongue, 
unpleasant taste in the mouth, malodorous 
breath, inactivity of the bowels, dinginess of 
the skin, dark circles around the eyes, head- 
ache, inability to concentrate the mind, are 
all symptoms of a state of profound toxemia, 
the source of which is by the laity universally 
associated with the liver. It is a common re- 
mark of such patients, “If I could only get 
the bile off my stomach, I am sure that I 
would be relieved.” Not infrequently, at- 
tacks of biliousness are periodical and are as- 
sociated with migraine, or sick headache. 
Many persons have observed a sense of un- 
usual well-being immediately after an attack 
in which there has been free vomiting of bile. 
Many patients have discovered for them- 
selves that an attack of biliousness may some- 
times be averted by means of a dose of salts DISORDERS OF THE DIGESTIVE TUBE 
197 
or free purgation produced by mineral waters 
or cathartic pills of some sort. It is a com- 
mon practice with physicians, especially in 
the Southern States, to relieve or avert an at- 
tack of biliousness by liberal doses of calomel. 
By vomiting or free purgation, a considerable 
quantity of bile is gotten rid of. 
Observations made by Lauder Brunton, 
Schiff, and others, show that the cause of so- 
called “biliousness,” in many cases at least, is 
a concentration of the bile which, when not 
properly discharged, is absorbed and again 
excreted, thus becoming more and more con- 
centrated. Persons whose bowels move freely 
and efficiently three times a day will not suf- 
fer from excessive absorption and concentra- 
tion of bile; but constipated persons, includ- 
ing those whose bowels move but once a day, 
must always suffer from bile absorption, for 
the reason that the food residues and excre- 
tions which are normally discharged in less 
than twenty hours from the time food is 
taken, are retained two or three days or even 
more, giving abundant opportunity for the 
reabsorption not only of bile, but of other ex- 
cretions. 198 
COLON HYGIENE 
Another feature which contributes to the 
excessive absorption of bile is a deficiency of 
gastric acid. One of the functions of the gas- 
tric acid is to precipitate, or render insoluble, 
the poisonous pigments and other toxic sub- 
stances which are found in the bile. These 
are among the most highly poisonous sub- 
stances found in the excretions. When the 
gastric acid is present in sufficient amount, 
these poisons are thrown down in an insoluble 
form and are carried off with other waste 
matters; but when the gastric acid is defi- 
cient, these poisons remain soluble and are 
thus rapidly absorbed. If, in addition to this 
condition, constipation exists, which is very 
likely to be the case, the bile poisons will nat- 
urally accumulate not only in the bile but in 
the blood stream and in the tissue fluids, pro- 
ducing a condition which may be called 
‘‘chronic biliousness.” 
Even persons who suffer from an excess of 
gastric acid may have excessive absorption of 
bile if large quantities of soda are used to 
neutralize the gastric acid,—a very common 
practice. 
In recent years, a method has been devel- DISORDERS OF THE DIGESTIVE TUBE 
199 
oped by which the gall-bladder may be emp- 
tied and the bile may be withdrawn without 
purgation. This is known as non-surgical 
drainage of the gall-bladder. The method 
consists in the passage of a small tube first 
into the stomach and then on into the duode- 
num. The operation is simple and generally 
gives the patient very little inconvenience. 
Not infrequently wonderful relief is obtained 
from headaches and other discomforts almost 
immediately after the withdrawal of a quan- 
tity of bile. 
In persons suffering from autointoxication, 
that is, a condition in which the food residues 
are permitted to undergo putrefaction in the 
colon, thus introducing into the blood stream 
through absorption an excess of poisonous 
substances with which the liver must deal, 
there is an unusual tendency known as “bil- 
iousness.” Indeed, in such cases the condition 
known as “biliousness” may be continuously 
present. To the normal bile poisons in these 
cases are added the poisons resulting from 
putrefaction. Thus the bile becomes very 
highly toxic. 
The intestinal stasis or constipation asso- 200 
COLON HYGIENE 
ciated with intestinal toxemia leads to the ab- 
sorption of a large part of these poisons 
while awaiting evacuation, and thus a highly 
active vicious circle is formed. 
The permanent remedy for these condi- 
tions is to be found, not in the use of laxative 
or other drugs, but in changing the intestinal 
flora and such regulation of the diet as will 
prevent putrefaction of the food residues and 
will secure such frequent evacuation of the 
colon as will leave no opportunity either for 
putrefactive changes to occur or for the 
undue absorption of bile. When this is ac- 
complished, all the symptoms of biliousness 
rapidly disappear and do not re-appear so 
long as normal conditions are maintained in 
the intestine. 
The change of intestinal flora may be 
readily accomplished by the use of large 
doses of lactose or dextrine or, better, a com- 
bination of these special carbohydrates, lacto- 
dextrin, which should be used in quantities 
sufficiently large to flood the entire intestine. 
The results obtained by this method in hun- 
dreds of cases of chronic biliousness have 
proved in the highest degree satisfactory. DISORDERS OF THE DIGESTIVE TUBE 
201 
Atony 
In operating upon the colon and other 
parts of the intestine, the writer has often 
found a very great thinning of the intestinal 
wall and marked evidence of degeneration of 
the mucous membrane. The over-action of 
the mucous glands which is characteristic of 
colitis naturally, in time, results in degener- 
ation of the mucous follicles and a consequent 
deficiency of the normal lubricating mucus 
which is essential for normal bowel action. 
It is probable, however, that in the major- 
ity of cases of so-called atony of the colon, 
with atonic constipation, the real cause of the 
inactive state of the colon is to be found in the 
putrid character of the feces. Putrid feces 
are always alkaline, usually containing con- 
siderable quantities of ammonia. Alkaline 
substances of all sorts paralyze the colon. 
Lack of Appetite 
Lack of desire for food is a common result 
of constipation, and may also be a cause of 
this condition, when it is the result of some 
other cause, as lack of exercise, excessive heat, 
etc. With loss of appetite there is absence of 202 
COLON HYGIENE 
relish for food, and hence a failure of the 
meal to awaken those lively peristaltic move- 
ments which are essential to propel forward 
in the colon the hardening masses of fecal 
matter which are stored up in its lower seg- 
ments waiting to be discharged. Those who 
eat without appetite are always constipated, 
and while the lack of relish for the food en- 
courages the constipation, the latter still fur- 
ther lessens the appetite, and so the difficulty 
continually becomes more and more aggra- 
vated. 
Painful Affections of the Abdomen 
Pain in almost any part of the abdomen may 
cause constipation through reflex arrest of 
peristaltic movement and spasm of the de- 
scending or pelvic colon. Cases of this sort 
usually present very active symptoms of in- 
testinal toxemia. Such persons are often vic- 
tims of attacks of violent headache. They 
show much indican in the urine, are likely to 
have high blood-pressure, and sooner or later 
develop chronic Bright’s disease of the kid- 
neys. 
Painful affections of the abdominal organs, 203 
DISORDERS OF THE DIGESTIVE TUBE 
such as chronic appendicitis, colitis, adhesions 
following an abdominal operation, pelvic or 
bladder disease, may cause constipation, not 
only by producing reflex spasm of the colon 
but by restraining the patient from making 
the necessary effort to expel the colon con- 
tents. Such efforts naturally increase the 
pain, and so are dreaded and avoided. In 
such cases the application of a hot fomenta- 
tion over the seat of pain before ordering the 
effort to move the bowels will often render 
very great service. A hot sitz bath may be 
taken instead. A hot water bag placed against 
the abdomen may be found useful both by 
lessening pain and as a mechanical aid to 
defecation. 
Depressing Emotions 
Fear, or any depressing emotion may, 
through the sympathetic nerves, cause reflex 
constipation. Prof. Anderson, an eminent 
Danish physiologist who has made an exhaus- 
tive study of the influence of the emotions, 
found that depressing emotions powerfully 
excite the sympathetic. Some persons are 
unable to move their bowels because they are 204 
COLON HYGIENE 
in a state of fear that they cannot. All per- 
sons are more or less at the mercy of the sym- 
pathetic nervous system, but some much 
more than others. 
Obstructions 
In a small number of very obstinate cases, 
chronic constipation is really due to some 
form of obstruction at some point along the 
food canal. It matters little, apparently, 
where the obstruction is; the effect is delay, 
and this results in constipation from absorp- 
tion of water and the resulting excessive dry- 
ness of the feces. 
Contracted Colon 
In cases of reflex spasm and in colitis, 
the intestine may often be felt under the 
fingers, to which it gives the sensation of a 
rubber tube. When the contraction is due to 
colitis, the intestine is not only hard and con 
tracted but is also tender to pressure, some- 
times extremely so. In such cases there are 
likely to be present various reflex pains such 
as headache, or pains in the legs, which in 205 
DISORDERS OF THE DIGESTIVE TUBE 
women suggest ovarian inflammation or some 
other pelvic disease. 
This condition of the colon is most often 
found on the left side, at the site of the iliac 
colon, sometimes extending upward, and may 
occasionally be felt in the pelvic colon also. 
The cecum and the ascending colon are not 
infrequently affected, and more rarely the 
transverse colon, which may be felt as a hard 
round cord passing across the abdomen just 
above or below the umbilicus. 
These spastic contractions are not perma- 
nent; they come and go, sometimes disap- 
pearing while under the examining finger; 
but they cause great delay in the progress of 
the feces along the bowel, and thus lead to 
excessive dryness and constipation. 
Organic or permanent contraction of the 
colon is a much more serious condition than 
simple spastic contraction, because usually in- 
curable, except by surgery. It may be the 
result of peritonitis or of colitis followed by 
pericolitis and adhesions. 206 
COLON HYGIENE 
Incompetency of the Ileocecal Valve 
One of the effects of chronic constipa- 
tion is incompetency of the ileocecal valve. 
By overdistention the intestine becomes so 
widely dilated that the lips of the valve no 
longer come in contact and so its check valve 
action is prevented, and the putrefying con- 
tents of the colon readily pass backward into 
the small intestine. The infection thus in- 
duced may travel backward the entire length 
of the small intestine, to the stomach, liver, 
gall-bladder, pancreas and duodenum, giving 
rise to ulcer of the stomach, duodenal ulcer, 
gall-stones, inflammation of the gall-bladder, 
infections of the liver and jaundice resulting 
from these conditions, and pancreatitis, a still 
more serious condition. It is probable, also, 
that the worst effects attributed to alimentary 
toxemia or intestinal intoxication are seen in 
cases in which, through incompetency of the 
ileocecal valve, the putrefying materials of 
the colon find ready entrance to the small in- 
testine, and are rapidly absorbed. 
When the ileocecal valve is incompetent, 
it is of course incompetent to gases as well as 
liquids. There is evidence that the valve DISORDERS OF THE DIGESTIVE TUBE 
207 
sometimes becomes incompetent to gases 
while it still may be competent to liquids. 
Patients whose ileocecal valves are incompe- 
tent suffer from great discomfort because of 
inability to expel gas from the intestine. 
When an expulsive effort is made gas passes 
in both directions, that is, out of the body 
and back up into the small intestine. 
There is reason to believe that the failure 
of short-circuiting operations either with or 
without removal of the colon or a part of it, 
is often due to loss of the function of the ileo- 
cecal valve, which is of course removed with 
the colon. Recent advances in the depart- 
ment of surgery make it possible to remedy 
this defect by constructing an artificial ileo- 
cecal valve. This operation is rarely neces- 
sary, however, since methods for changing 
the intestinal flora have been perfected and 
made practical. 
In like manner incompetency of the ileo- 
cecal check-valve interferes with the com- 
plete and proper emptying of the colon and 
thus becomes a cause as well as a consequence 
of constipation. 
The worst evils resulting from incompe- 208 
COLON HYGIENE 
tency of the ileocecal valve may be corrected 
in the majority of cases by removing the 
cause, namely, relieving the constipation to 
which it is due. While, in a majority of cases, 
this may be accomplished by the employment 
of the thoroughgoing measures suggested in 
this volume, a few cases remain in which an 
operation is required for breaking up adhe- 
sions of the pelvic colon and removing the 
other obstructions which have been the cause 
of the overloading and the distention of the 
cecum, which produced the incompetency of 
the valve. Fortunately such cases may be re- 
lieved by surgical operation, and it is even 
possible to repair the valve so as to enable it 
to resume its function. 
“Greedy Colon” 
Goodhard, Schmidt, and others hold that 
abnormal dryness of the feces may be pro- 
duced by excessive digestion and absorption, 
leaving so little residue that the bulk of the 
intestinal contents is too small to stimulate 
peristaltic action. It is possible that cases of 
this sort may exist, but it seems more probable 
that the fault is a too concentrated diet or de- DISORDERS OF THE DIGESTIVE TUBE 
209 
ficient gastric or intestinal secretion, at least 
in most of the cases in which this diagnosis 
has been made. It is much easier to see how 
the intestine can fail to do its work com- 
pletely than to understand a condition of ex- 
cessive activity of digestion. 
Excessive Dryness of the Feces 
Persons often suffer because of dryness of 
the stool. This condition may also result 
from sweating baths and from the drinking of 
an insufficient amount of fluid, as we have al- 
ready seen. 
Excessive activity of the kidneys, as in dia- 
betes mellitus or diabetes insipidus, may pro- 
duce the same result, by depriving the feces 
of water. 
A deficiency of fat in the food leads to con- 
stipation in like manner. The presence in 
the feces of a certain amount of unabsorbed 
fat is useful not only to prevent excessive dry- 
ness, but to prevent too great adhesiveness of 
the feces and thus to facilitate movement 
along the colon. • . 210 
COLON HYGIENE 
Delay in the Cecum 
The cecum is a shallow pocket intended to 
hold a small amount of liquid for a short time. 
If the bowels are restrained from normal ac- 
tion by resisting the “call” for evacuation, the 
cecum becomes filled by the backing up of 
semi-solid feces, which cause it to sag down, 
and in time dilate and displace it. The over- 
filled and heavy cecum drags heavily upon 
the hepatic flexure, and so narrows the pass- 
age along the colon at this point as to produce 
partial obstruction and delay in the move- 
ment of feces from the cecum over into the 
transverse colon. 
Normally, at frequent intervals, the cecum 
contracts upon its contents, lifting the residues 
up through the ascending colon and over into 
the transverse colon. When the cecum is di- 
lated, its ability to push its contents along is 
greatly lessened, and when it is adherent, this 
highly important function is lost altogether. 
The dilated and adherent colon is thus a 
stagnant cesspool in which food residues and 
body wastes accumulate and putrefy, being 
retained in many cases for days and even DISORDERS OF THE DIGESTIVE TUBE 
211 
weeks, generating indol, skatol and other poi- 
sons, as well as various poisonous gases 
which distend the bowel and through absorp- 
tion poison the blood and the tissues. This 
condition gives rise to the so-called right- 
sided constipation in which the stools are 
soft, often liquid and highly putrid, and the 
bowels move several times daily, as contrasted 
with the dry and infrequent stools of the more 
common left-sided constipation. 
Delay at the Pelvi-rectal Junction 
The passage from the colon to the rectum, 
which is closed and opened by the falling and 
rising of the pelvic loop of the colon, is some- 
times obstructed by thickening due to inflam- 
mation or ulceration. Sometimes the pelvic 
colon becomes adherent to the pelvic floor so 
that it cannot rise, and there is more or less 
obstruction to the passage of feces into the 
rectum. In such a case, there must of neces- 
sity be an accumulation of feces in the lower 
bowel above the rectum, and as a consequence 
cumulative constipation will be found pres- 
ent. 
Fortunately this crippled condition of the 212 
COLON HYGIENE 
pelvic colon, often the chief obstacle to nor- 
mal bowel action, may be completely re- 
moved by a comparatively simple surgical 
operation which consists in breaking up the 
adhesions and suspending the pelvic loop by 
means of the omentum. This operation has 
proved completely successful in scores of 
cases. The accompanying cuts show the ap- 
pearance of the colon before and after 
the operation. It should be noted that the 
bowel is suspended by the omentum and is not 
attached directly to the abdominal wall. The 
latter operation rarely succeeds and causes so 
much pain that a second operation to release 
the bowel is often necessary. In the majority 
of cases, no operation is required if the pa- 
tient will change the intestinal flora and keep 
it changed, although the daily use of the 
enema may be necessary for some weeks or 
even months. It is. quite possible that absorp- 
tion of the adhesions may take place in cer- 
tain cases after the flora has been changed and 
the colitis cured. Absorption of adhesions, as 
well as the cure of the colitis always present, 
is promoted by the persistent use of the hot 
enema (105° to 112° F.). Pelvic Colon Restored to Position 
by Operation 
Adherent Pelvic Colon Stereoradiograph Showing Incompetency of the Ileocecal Valve, Indicated by the Presence of Bismuth in the 
Small Intestine after a Bismuth Enema. 
(View with Stereoscope) DISORDERS OF THE DIGESTIVE TUBE 
213 
Thickening of Houston’s Valves 
It is believed by some surgeons that these 
membranous valves sometimes become so 
thickened as to form an obstruction to the 
passage of feces. The writer has seen no case 
of this sort, although he has carefully looked 
for them in hundreds of cases. 
Delay at the Outlet 
Failure of the anus to relax when the colon 
contracts interferes seriously with defecation, 
and may prevent movement of the bowels. 
This may result from various causes, as a 
weak stimulus from the defecation center, or 
unduly contracted anal muscles. This point 
will be considered further in another connec- 
tion. 
“Lane’s Kink” 
Within the last dozen years there has been 
much discussion in medical circles about a 
“kink” located at the lower end of the small 
intestine within a few inches of the ileocecal 
valve. Lane, of London, has attributed to 
these adhesions of the terminal ileum stasis 
or stagnation of materials in the ileum, and 214 
COLON HYGIENE 
most of the disease conditions which develop 
in the stomach, liver, duodenum, gall-bladder 
and pancreas. 
Recent observations made at the operating 
table by the writer and others, clearly show, 
however, that “Lane’s Kink” is practically 
always associated with incompetency of the 
ileocecal valve. It seems most probable that 
adhesions of the lower end of the ileum are 
the result of inflammation caused by the back- 
ing up of fecal matters into the small intes- 
tine through the open valve. It has also been 
observed that these “ileal kinks,” first men- 
tioned by Lane, are seldom obstructive, the 
real cause of the delay in the small intestine 
associated with “kinks” being incompetency 
of the ileocecal valve, which also is the cause 
of the “kink.” 
Mechanical Effects of Constipation 
Fecal accumulations in the rectum, and in 
some cases possibly also accumulations in the 
pelvic colon and in the cecum, may give rise 
to various reflex pains on account of pressure. 
Pain in the buttocks and the back of the 
thigh, and a dull pain in the region of the DISORDERS OF THE DIGESTIVE TUBE 
215 
sacrum is often due to the pressure of fecal 
matters in the rectum. Neuralgia of the tes- 
ticles and of the ovaries, and dysmenorrhea 
in young women, is often traceable to this 
cause. Abnormal sexual excitability, espe- 
cially during sleep, is also sometimes trace- 
able to accumulations in the rectum. Itching 
about the anus is often caused by the pressure 
of a small amount of fecal matter in the anal 
canal, disappearing at once when the feces are 
removed. Hemorrhoids may be caused by 
the pressure of fecal matters upon the hemor- 
rhoidal veins; and varicocele, if not pro- 
duced, is certainly aggravated by accumula- 
tions of fecal matters in the iliac colon. 
i 
Headache and sometimes vertigo and a 
sensation of exhaustion and depression are 
symptoms commonly experienced by persons 
suffering from constipation. These symptoms 
may be the result of reflex action, which 
seems most probable, or they may be in whole 
or in part the result of chronic poisoning due 
to the absorption of long retained fecal mat- 
ters. The fact that the symptoms disappear 
almost immediately when the bowel is emp- 
tied by an enema, does not necessarily indi- 216 
COLON HYGIENE 
cate that the act is reflex. Effects due to auto- 
intoxication are the result of over-saturation 
of the blood with poisons derived from the 
bowel contents. When, by removal of the 
source of the poisons, the intake ceases, the 
liver and kidneys quickly clear the blood of 
the subtle intoxicants, and the nerve disturb- 
ance ceases. 
The Bad Effects of Straining 
The violent straining occasioned by the 
presence of dry and hard feces in the rectum 
and lower colon is not merely an inconveni- 
ence, but often results in serious and some- 
times fatal injury. 
One of the most common results of strain- 
ing at stool, especially when prolonged or re- 
peated several times daily, is hemorrhoids, or 
piles. These. are excrescences which form 
just in the anus, or at its lower edge. The ac- 
cumulation of fecal matters in the rectum ob- 
structs the flow of blood in the veins which 
have their origin at this point, and in strain- 
ing these veins become greatly distended with 
blood; their walls become thickened, form- 
ing irregular masses which are usually forced 217 
DISORDERS OF THE DIGESTIVE TUBE 
out when the bowels move. As the result of 
the straining, and often as the result of the 
use of rough toilet paper, the delicate mucous 
membrane becomes abraded or cracked, in- 
fection occurs, and the hemorrhoids become 
inflamed and swollen. Ulcer or fissure may 
develop. Thus the hemorrhoids gradually 
increase in size, until they may become so 
large that the anal sphincters are over- 
stretched and become relaxed, and in time 
the rectum may be pushed outside whenever 
the bowels move. Prolapse of the rectum is 
most likely to occur in children and emaci- 
ated adults. 
In persons suffering from arteriosclerosis 
or degeneration of the blood-vessels, espe- 
cially aged persons, straining at stool may 
cause rupture of a blood vessel and sudden 
death. In angina pectoris a spasm may result 
from straining at stool, sudden death having 
been known to occur in cases in which the 
heart was very feeble. The same should be 
said with reference to cases of myocarditis. 
Most smokers over forty have reason for ob- 
serving this caution. 218 
COLON HYGIENE 
Stricture 
The bowel may be narrowed by the con- 
traction of the scar left behind by a healed 
ulcer due to tuberculosis, typhoid fever or 
other cause. When such strictures are pres- 
ent, the peristaltic movements of the intestine 
are often so strong as to be visible in a thin 
patient through the abdominal walls. Such 
cases require operation. 
Cancers and Tumors 
Cancer of the colon is not infrequent, con- 
stituting about 9 per cent of all cancers. 
Cancer occurs most frequently in the cecum 
or ascending colon, and next most frequently 
in the rectum or pelvic colon, points at which 
the greatest delay of the feces occurs. 
Cancer of the colon is not infrequently sec- 
ondary to cancer in some other location. 
When cancer exists or has existed in the 
breast, stomach, or elsewhere, obstinate con- 
stipation should lead to a careful physical ex- 
amination including an X-ray examination of 
the colon with special reference to the pres- 
ence of organic obstruction. 219 
DISORDERS OF THE DIGESTIVE TUBE 
Intussusception 
Acute obstruction due to “telescoping" of 
the intestine requires immediate surgical at- 
tention. 
Chronic constipation is held to be some- 
times due to such a telescoping of the pelvic 
colon into the rectum. This condition is prob- 
ably quite rare, but it possibly may be more 
frequent than has been hitherto supposed. 
Such cases require surgical attention. 
Anal Disease 
Pain arising from ulcer, fissure, fistula or 
inflamed hemorrhoids may cause so strong a 
contraction of the anal sphincters that they 
fail to relax at the command of the defecation 
center, so that the bowel must force the feces 
down through the rectum in opposition to 
these muscles. This condition exists more fre- 
quently than was formerly supposed. Many 
cases of obstinate constipation have been 
cured by an operation for removal of painful 
hemorrhoids or relief of a painful ulcer or 
flstula. 220 
COLON HYGIENE 
Obstruction from Pressure 
Pregnancy, extreme retroversion of the 
uterus, an enlarged and painful prostate, ma- 
lignant or other growths in or about the rec- 
tum, and in women, rectocele, from laceration 
of the perineum, are causes of interference 
with the proper action of the defecating 
mechanism. 
The usual result of this defective action is 
to leave a quantity of feces in the rectum or 
the pelvic colon or in both cavities. The re- 
tained feces become dry and hard, some- 
times to a surprising degree, and form a me- 
chanical obstruction which results in a dam- 
ming back of the feces which are left to ac- 
cumulate in sections of the colon higher up. 
Loss of Rectal Reflex 
The key to the involuntary part of the 
act of defecation is the rectal reflex, which is 
discharged by contact of the feces with the 
walls of the rectum. Long retention of 
feces in contact with the rectal nerves destroys 
their sensibility and so the reflex is lost. This 
is one of the worst results of the disturbances 221 
DISORDERS OF THE DIGESTIVE TUBE 
in the defecating mechanism, which have 
been above enumerated. Patients suffering 
with this form of constipation often report 
that they have felt no desire for evacuation 
of the bowels for years. The loss of hearing, 
pr even of the sense of sight, would really be 
less of a calamity in many cases than the per- 
manent loss of this useful reflex, which is one 
of the most important protective mechanisms 
with which the body is provided. Fortu- 
nately, however, the reflex generally may be 
restored. 
Disease of the spinal cord may perma- 
nently destroy the defecatory center. Consti- 
pation is sometimes a most troublesome symp- 
tom in locomotor ataxia. INTESTINAL TOXEMIA OR 
AUTOINTOXICATION 
Bouchard, an eminent French physician, 
was first to coin the word autointoxication, 
and to point out the various ways in which the 
disease may be produced by poisons generated 
in the body. He called special attention to 
the fact that the intestine, and especially the 
colon, is a prolific source of poisons. Some 
of these poisons are excreted by the liver. 
The bile, as shown by Bouchard, is six times 
as poisonous as the urine, producing poison 
enough within ten hours to cause death. The 
mucous membrane of the intestine has been 
shown to be a source of poisons which are 
separated from the blood by the mucous 
membrane and thrown into the cavity of the 
intestine to be removed from the body. 
Still another source of intestinal poisons is 
the putrefaction of that portion of the protein 
of the food which fails to undergo absorption. 
The bile, mucus, and other secretions of 
the intestine and the adjacent glands also un- 
222 223 
INTESTINAL TOXEMIA 
dergo putrefaction when conditions are fa- 
vorable. 
This putrefactive process is, as shown by 
Pasteur, the result of the growth of certain 
species of bacteria. These putrefactive bac- 
teria are found everywhere. They are pres- 
ent in great numbers wherever putrefaction 
is taking place. The flesh of every dead ani- 
mal is filled with teeming millions of these 
poison-forming microbes within a few hours 
after death. A piece of flesh taken from an 
animal just killed, and placed in a tightly 
sealed glass jar, will be found in a few days 
in an advanced state of putrefaction. Experi- 
ments of this kind were made by Professor 
Tissier of the famous Pasteur Institute of 
Paris. He found it impossible to obtain meat 
so fresh that it did not contain bacteria of 
different species sufficient to produce com- 
plete putrefaction. As ordinarily eaten, the 
flesh of animals is always in a state of more 
or less advanced putrefaction, and many 
millions of living bacteria are found in every 
morsel. This is true even when the flesh has 
been cooked; ordinary cooking does not de- 
stroy the putrefactive bacteria. 224 
COLON HYGIENE 
Street dust consists very largely of putre- 
factive bacteria derived from animal feces 
which have been dropped in the street and 
ground into dust by passing vehicles. It is 
evident then, that the human intestine is very 
greatly exposed to infection by putrefactive 
bacteria; and it needs no argument to show 
that any delay of food residues capable of 
putrefaction, together with the bile, mucus, 
and other constituents of the feces, must re- 
sult in the production of a large amount of 
intestinal poisons. 
In view of these facts, it is safe to say that 
the worst effects of constipation are those 
which arise from intestinal autointoxication. 
Not only Bouchard, but Tissier, Combe, 
Bourget, Lane of London, and a great num- 
ber of able medical experts in all parts of the 
world have within the last few years recog- 
nized the great and far-reaching destructive 
effects of the absorption of bacterial poisons 
from the intestinal tract. Within the last few 
years a very great interest has arisen in meth- 
ods of changing the intestinal flora by dietetic 
regulation. INTESTINAL TOXEMIA 
225 
Autointoxication without Constipation 
It is entirely possible for a person to suffer 
from intestinal toxemia without constipation, 
as in cholera morbus, the diarrheas of in- 
fancy, chronic diarrhea and colitis; but it is 
impossible to have constipation without intes- 
tinal autointoxication. The fact that the 
symptoms of toxemia do not occur in every 
case is no evidence that they are not present. 
The body must be unduly exposed to toxic 
influences, even though it may possess to such 
an extraordinary degree the power to defend 
itself against these intestinal poisons that im- 
mediate visible effects do not appear. 
The Intestinal Filter 
Says Herter, “In experiments made many 
years ago with indol, it was found that the 
epithelium of the digestive tract possesses in 
a high degree the capacity to bind indol in 
such a way that this substance cannot be re- 
covered by distillation. I think it likely that 
in cases where there is excessive production 
and absorption of indol in the intestinal tract 
the epithelium acts as a protective agency to 
the organism as a whole. This action of the 226 
COLON HYGIENE 
epithelial cells is certainly not confined to 
indol.” 
The mucous membrane also affords pro- 
tection against the penetration of bacteria 
into the circulation. This is especially true 
of the mucous membrane of the colon. Bac- 
teria are able to penetrate the walls of the 
small intestine and of the vermiform appendix 
much more easily than the walls of the colon. 
The bacteria also penetrate the mucous mem- 
brane of young infants much more readily 
than that of adults. Ficker found that hun- 
ger and exhaustion favor greatly the entrance 
of bacteria and the development of infection, 
especially the infection of typhoid fever. 
Ficker suggested that penetration of the muc- 
ous membrane of exhausted animals by bac- 
teria was the cause of the rapid decomposi- 
tion of the flesh of animals killed when in a 
state of exhaustion, as in the case of hunted 
animals which have been driven long dis- 
tances. 
Overeating leads to autointoxication by 
supplying to the colon an unusual amount of 
unabsorbed material. The more completely 
absorption takes place in the small intestine INTESTINAL TOXEMIA 
227 
the less bacterial development in the colon. 
A cathartic has an effect similar to that of 
overeating by causing undigested food to 
enter the colon in considerable quantities. A 
cathartic which does not move the bowels 
but only hastens the contents of the small in- 
estine into the colon increases toxemia, caus- 
ing headache, flatulence and exhaustion. This 
is particularly true in persons suffering from 
chronic intestinal autointoxication or so-called 
biliousness. 
Wholesome food, if rich in protein, taken 
in an unusually large amount, may give rise 
to a severe attack of intestinal intoxication, 
indicated by vomiting, diarrhea, headache, 
coated tongue and depression. The explana- 
tion of these cases is to be found in the con- 
stant presence in the colon of putrefactive or- 
ganisms such as Welch’s bacillus and B. pu- 
trificus. So long as the amount of protein in 
the food is small it is so completely digested 
and absorbed that the amount which reaches 
the colon to be acted upon by putrefactive 
bacteria and converted into toxins is too small 
to produce any considerable degree of injury; 
but when the intake of protein is considerably 228 
COLON HYGIENE 
increased, the quantity of toxins produced is 
more than the body is able to deal with and 
toxic effects appear. 
According to Herter, Welch’s bacillus 
may be found in the stools of most adult per- 
sons (mixed feeders), including many per- 
sons who appear to be in perfect health. 
When the intestinal mucous membrane is 
intact, it is able to exclude most of the intes- 
tinal poisons, acting like a filter, which per- 
mits only the useful substances to enter the 
blood. The liver, the largest gland in the 
body, possesses the power to destroy poison to 
a considerable degree. There are various 
other organs of the body, such as the glands 
of internal secretion, of which the thyroid 
gland is a conspicuous example, which aid in 
the destruction of poisons. The kidneys both 
destroy and eliminate poisons, and the skin 
and the lungs also share in this protective 
work. 
So long as the defensive powers of the body 
remain intact, enormous quantities of poisons 
may be produced in the intestine without ap- 
parently evil results. This is the reason why 
many constipated persons seem to suffer no ill 
effects from intestinal inactivity. INTESTINAL TOXEMIA 
229 
In every case, however, the time comes 
sooner or later when the intestinal filter no 
longer acts sufficiently in excluding poisonous 
matters—when the liver is no longer able to 
destroy all the poisons brought to the blood; 
when the thyroid and other glands have be- 
come worn out with over-activity; when the 
kidneys have ceased to be able to maintain 
the normal degree of blood purity by the ex- 
cretion of poisons. 
When the symptoms of toxemia appear, the 
fact shows that the poison-destroying mech- 
anism of the body is broken down; the great 
margin of safety which Nature provides 
against emergencies, has been used up; the 
defenses against autotoxins have been swept 
away, and the tissues are flooded with these 
subtle and mysterious disease-producing ele- 
ments. 
Bacteria of the Intestine 
Roger, the eminent successor of Bouchard, 
described no less than one hundred sixty dif- 
ferent species of bacteria which have been 
found in the alimentary canal. Many of these 
produce no poisons. Others produce simple 
organic acids which are under ordinary cir- 230 
COLON HYGIENE 
cumstances harmless; still others produce al- 
cohol, formic acid, butyric acid, and other 
substances which are unquestionably toxic, 
although not appreciably so in the extremely 
minute quantities in which they are produced 
in the intestine under strictly normal condi- 
tions. Still other microbes, of which some 
scores of species are found in the intestine, 
produce subtle poisons which are capable of 
causing deadly effects, even in very minute 
quantities. Everyone is familiar with the un- 
pleasant effects of the volatile substances 
which emanate from a mass of putrefying 
flesh. Headache, nausea, and other symptoms 
may result from the odors alone which arise 
from putrescent substances. These volatile 
substances are poisonous, but other non-vola- 
tile poisons present are much more active. 
Some are almost as powerful as the venoms of 
snakes, which they resemble in chemical com- 
position. The South American Indian poi- 
sons the points of his deadly arrows by dip- 
ping them into putrid flesh. Butchers as well 
as undertakers sometimes die as the result of 
a small cut made with a knife soiled by con- 
tact with a dead body. The same poisons are INTESTINAL TOXEMIA 
231 
produced when putrefaction takes place in 
the intestine. 
None of the intestinal microbes are essen- 
tial for life or health. Pasteur supposed that 
all life was dependent upon microbes. One 
of his pupils, Roux, showed this idea to be 
erroneous, at least as regards vegetables, by 
causing beans to grow in sterile soil and ster- 
ile water. Pasteur admitted his error in re- 
gard to vegetable organisms, but still main- 
tained that animals could not live without 
the aid of intestinal bacteria. Nuttall and 
Thierfelder, by experiments with guinea pigs, 
showed that these animals could be brought 
into the world free from germs, and made to 
grow on food which contained no trace of 
bacteria. When the animals were killed, no 
bacteria were found in their intestines. Re- 
cent experiments made by Roux showed that 
chickens hatched and grown under sterile con- 
ditions thrived better than chickens hatched 
under ordinary conditions. 
Numerous other experiments have con- 
firmed this fact, but most important of all 
were the observations of Levin at Spitz- 
bergen, in the Arctic region. This observer 232 
COLON HYGIENE 
made careful examination of scores of Arctic 
animals and found that in the majority of 
cases no bacteria were present in the intestine. 
This fact will be easily understood when the 
additional fact is known that the air, and even 
sea-water, are in these cold regions practi- 
cally free from bacteria. 
The fact that bacteria are present in the 
human intestine is therefore no evidence that 
they supply any human need. The presence 
of these minute parasites is, instead, an un- 
fortunate incident of our existence. Metch- 
nikoff has shown that colon germs in no way 
contribute to our well-being, but on the con- 
trary, are an undoubted cause of premature 
senility, and the unnatural abbreviation of 
human life, the sad lot of the average man. 
The Protective Acid-Forming Bacteria 
Professor Tissier, of Paris, well known as 
one of the leading savants of the renowned 
Pasteur Institute, many years ago made a pro- 
found study of the bacteria of the intestine 
and established the fact, which had been pre- 
viously observed by Escherich and others, 
that the intestine of a new born babe is abso- INTESTINAL TOXEMIA 
233 
lutely free from bacteria. Tissier made an 
extended research of the manner of the inva- 
sion of the intestine of the young child by 
bacteria. He found that within about seven 
hours in summer time, and twenty hours in 
winter time, when bacteria are less abundant 
in the air, the intestine of the recently born 
child is found to be swarming with bacteria, 
many of which are of the putrefactive sort. 
Within a few days, however, the putrefactive 
bacteria disappear, and a peculiarly shaped 
acid-forming microbe, to which Professor 
Tissier gave the name bacillus bifidus, takes 
their place. 
This observation was of the greatest im- 
portance. It reveals the beneficent plan of 
Nature, by which the young infant is pro- 
tected from the deadly effects of putrefactive 
organisms. So long as the bacillus bifidus 
continues to hold its place as the dominant 
microbe of the child’s intestine, the stools are 
slightly acid and the little one enjoys perfect 
health. The child’s intestine may be com- 
pared to a flower garden which is so com- 
pletely occupied by flowers that there is no 
room for the growth of noxious weeds. 234 
COLON HYGIENE 
As the child becomes older, and is fed 
upon cow’s milk, meat, and other foodstuffs 
which contain putrefactive organisms, and is 
no longer nursed at the breast, the bacillus 
bifidus becomes less prominent in the stools, 
putrefactive bacteria make their appearance, 
the child becomes subject to constipation and 
diarrheas, and the troubles of life begin. 
The stools, instead of being acid, acquire a 
foul odor. In many instances, such symptoms 
of chronic autointoxication as rickets, scurvy, 
arrested growth, emaciation, decay of the 
teeth, nasal catarrh, and other evidences of 
physical weakness make their appearance. 
Infantile convulsions, night terrors, grind- 
ing the teeth during sleep, fitfulness, feverish- 
ness, and numerous other symptoms of nerv- 
ous disturbance in infants, are directly due to 
poisoning as the result of constipation, with 
intestinal putrefaction. So long as the stool 
remains normally acid, constipation does not 
occur, but when putrefaction and foul-smell- 
ing feces occur then constipation appears 
with a great variety of nervous and other 
symptoms which are a natural consequence. INTESTINAL TOXEMIA 
235 
Changing the Flora with B. Acidophilus 
In 1900, Moro discovered in infants’ stools 
the B. acidophilus, an acid-forming organism. 
Dr. Tissier found in Bulgarian buttermilk a 
germ which seemed to be identical with the 
acid-forming organism found in the human 
intestine. Metchnikofif proclaimed the Bul- 
garian germ as a panacea for colon troubles 
and the various maladies which result from 
autointoxication. It is now known that the 
Bulgarian germ has little or no value as a 
means of combating intestinal toxemia for the 
reason that it is not a native of the colon and 
will not live and grow in the human colon as 
the B. acidophilus will do. It is not really 
necessary, however, to implant the B. acido- 
philus, as small numbers are always present 
in the colon and by the free administration 
of special carbohydrates may be made to de- 
velop such a luxuriant growth that the per- 
nicious organisms will be crowded out. This 
is called “changing the flora.” For many 
years, Metchnikofif sought to accomplish this, 
but failed. Fortunately, we are now able to 
change the flora with prompt certitude by 
proper feeding. 236 
COLON HYGIENE 
Old Age Due to Colon Poisons 
Professor Metchnikoff announced the the- 
ory that old age, as well as many common 
chronic disorders, is due to poisons absorbed 
from the intestines. These poisons are formed 
by certain germs known as anaerobes. Some 
of these germs are found in such great quan- 
tities in butcher’s meat that Herter has given 
to them the name “meat bacteria.” By the 
use of meat these germs are introduced into 
the intestine in great numbers. The poisons 
formed by these germs are extremely virulent, 
and when taken into the body, gradually 
break down the liver, kidneys, and other de- 
fensive organs, and so give rise to a large 
number of very common and very serious dis- 
eases. The chronic poisoning first makes its 
appearance in acute attacks, such as sick head- 
ache, nervous headache, loss of appetite, 
coated tongue, bilious attacks, irregular ac- 
tion of the bowels, diarrhea, appendicitis, 
febrile attacks resembling malaria, and in- 
somnia. INTESTINAL TOXEMIA 
237 
Many Diseases Caused by Colon Poisons 
As the system becomes more and more sat- 
urated with these poisons through the grad- 
ual failure of the liver and kidneys and the 
constant multiplication of the bacteria, other 
more chronic symptoms appear, such as con- 
stant headache, mental confusion, neurasthe- 
nia, nervous exhaustion, gall-stones, hemor- 
rhoids, emaciation, browning of the skin, 
particularly about the eyes, various skin dis- 
eases, especially acne, eczema, psoriasis and 
urticaria, neuralgia, pain and stiffness of the 
joints. After a time still worse conditions 
make their appearance, such as Bright’s dis- 
ease, sclerosis or hardening of the liver, 
dropsy, chronic rheumatism, and rheumatic 
gout. 
Chronic autointoxication is unquestion- 
ably a factor in nearly all chronic disorders, 
and lays the foundation for tuberculosis, 
cancer of the stomach, ulcer of the stomach, 
and other gastric disorders. Many women 
supposed to be suffering from disorders pe- 
culiar to their sex, are really suffering only 
from autointoxication, which is the natural 238 
COLON HYGIENE 
result of prolapse of the viscera, colitis, and 
inattention to the hygiene of the bowels. 
It has long been known that the conditions 
above mentioned may be greatly relieved by 
the use of buttermilk and kumyss, but these 
remedies have never gained very great con- 
fidence for the reason that, while they have 
seemed to succeed remarkably in certain 
cases, in the majority of cases the relief ob- 
tained has been very temporary, and often 
their use has been attended by complete fail- 
ure. The reason for this was the fact that 
the lactic ferment of kumyss and buttermilk 
is not able to live in the large intestine. This 
is the particular part of the alimentary canal 
in which the poison-forming anaerobes are 
found in largest numbers, especially in the 
cecum. All foodstuffs are capable of under- 
going destructive change as the result of the 
action of germs upon them. Starches, dex- 
trines, and sugars (carbohydrates) ferment, 
while proteins putrefy. The products of the 
fermentation of carbohydrates are acids 
that are harmless in the quantities in which 
they are produced in the body. The prod- 
ucts of putrefaction are ptomaines, ammo- INTESTINAL TOXEMIA 
239 
nia, and toxins, all poisonous substances. 
Some of the ptomaines and toxins are closely 
akin to the venoms of poisonous serpents, and, 
like them, are very active even in very small 
quantities. 
The Effects of Constipation or Stasis 
When there is delay in the movement of 
foodstuffs along the digestive tract, fermen- 
tations or putrefactions quickly begin. The 
immediate result will be the formation of 
odorless gases in the intestines, with sour- 
smelling stools, if starch or sugar is present 
in sufficient amount to give rise to fermenta- 
tion. If protein and fats are present in large 
amount, then the result of delay will be pu- 
trefaction and the formation of foul-smelling 
gases and putrid stools. An infusion from a 
putrid stool, seething with the putrefaction 
of undigested remnants of protein foodstuffs 
such as beefsteak, mutton chops, pork, etc., 
will kill an animal very quickly. Such a 
stool is swarming with deadly bacteria, and 
is saturated with their poisons. Very often 
these putrid masses have remained in the 
body for many hours or even days, during 240 
COLON HYGIENE 
which time the absorbents of the intestine are 
constantly sucking up the poisons and distrib- 
uting them throughout the body, so that every 
cell and tissue is bathed with them. 
At first the evil effects of this systematic 
poisoning do not appear. Indeed, many years 
may elapse before serious consequences make 
their appearance. The reason for this is that 
the body is provided with means of defence. 
The mucous membrane acts as a filter to ex- 
clude poisons. The liver destroys poisons. 
The thyroid gland, the suprarenal capsules, 
and probably the spleen and several organs, 
aid in the destruction of poisons. The supra- 
renal glands are believed to be especially ac- 
tive in destroying the poisonous pigments 
which are produced by putrefaction in the 
intestine. After a longer or shorter time these 
defenses break down. The mucous mem- 
brane becomes the seat of infection,—colitis, 
—and allows a much larger quantity of poi- 
sons to pass into the blood stream. The liver, 
thyroid, and other poison-destroying organs 
become damaged by overwork, and fail to 
keep the blood clear of poisons. The kidneys 
are enormously overworked in their efforts INTESTINAL TOXEMIA 
241 
to remove these deadly poisons from the 
blood, and so lose their efficiency. Now the 
effects of chronic poisoning begin to make 
their appearance. Every organ and every 
function of the body shows evidence of dam- 
age. The poisons circulating in the blood 
irritate the walls of the blood vessels and 
cause first contraction, then hardening and 
degeneration, or arteriosclerosis. The brain 
and nerves show evidences of depression or 
irritation, according to the nature of the dom- 
inating poisons. Headaches, neuralgia, neu- 
ritis, paralysis, mental dullness, neurasthenia, 
even insanity, are the results. Diseases of the 
liver, thyroid gland and spleen develop. 
Skin diseases of various kinds and every sort 
of bodily derangement, are seen. 
Intestinal Gas 
Numerous observations by Herter and his 
assistants clearly showed that intestinal gas is 
chiefly due to the activity of the colon bacil- 
lus and Welch’s bacillus. Excessive produc- 
tion of foul smelling gas may generally be 
taken as an indication of the presence of 
Welch’s bacillus in great numbers. The 242 
COLON HYGIENE 
colon bacillus also produces gas but in less 
quantities. 
The Absorption of Bacteria 
It is now known that millions of bacteria 
are absorbed daily from the colon. When co- 
litis is present the bacteria more readily find 
entrance to the circulation. Experiments on 
rabbits have shown that when colon bacilli 
are injected into the blood vessels at frequent 
intervals during a period of several weeks 
very pronounced changes take place in the 
liver, kidneys and other vital organs. These 
changes consist in the increase of connective 
tissue, which results in fibroid degeneration. 
It was pointed out some years ago by Pro- 
fessor Adami that bacteria are constantly 
to be found in the liver and kidneys and 
other vital organs to which they are carried 
by the blood stream. They are also carried 
by leucocytes or white blood cells which 
swallow them and transport them to distant 
parts of the body. Some of the bacteria swal- 
lowed by the white cells are destroyed but 
many remain alive and even continue to grow. 
It has been demonstrated that gallstones INTESTINAL TOXEMIA 
243 
are one of the consequences of bacterial infec- 
tion. One of the functions of the liver is to 
remove bacteria from the blood, sending it 
out with the bile. In this way the gallblad- 
der often becomes infected, cholesterin is 
separated from the blood and gallstones are 
formed. It is known that cholesterin is pres- 
ent in excessive quantity in meat eaters. Meat 
eating also infects the intestine and encour- 
ages the growth of putrefactive bacteria. 
Immunity to Intestinal Bacteria 
Kidd, an English surgeon, maintains that 
absorption of bacteria is constantly taking 
place and on such an extensive scale that the 
body may be properly called a bacterial 
sponge. The absorption takes place not only 
from diseased teeth and other infected foci 
but especially from the intestine. The only 
reason these bacteria with which we live con- 
tinually in close contact do not destroy us is 
that an immunity is developed by the con- 
stant absorption of small numbers of germs. 
When the number of germs absorbed is con- 
siderably larger than usual, which frequently 
occurs, the result is a noticeable disturbance 244 
COLON HYGIENE 
which may be manifested by depression and a 
feeling of being out of sorts; or in case the 
absorption is large, a chill with a slight rise 
of temperature. The influx of unusual quan- 
tities of bacteria may give rise to neuralgic 
pains, commonly termed neuritis, or to pains 
in the muscles or joints usually designated as 
rheumatism. When the invading germs col- 
onize in some particular organ, the result 
may be a cystitis or infection of the bladder, 
pyelitis, an inflammation of the gallbladder, 
a duodenal ulcer, an inflammation of the 
prostate or of the kidney and various other 
local infections. Orth and others have shown 
that pernicious organisms may penetrate the 
mucous membrane of the intestine and enter 
the lymphatic channels and thus find their 
way into the circulation. The spread of bac- 
teria in the body, in fact, seems to be chiefly 
through the lymphatics rather than through 
the blood vessels. 
Danysz has presented a great amount of 
evidence in support of the view that many 
common cutaneous maladies are due to ana- 
phylaxis caused by bacterial poisons devel- 
oped in the intestine to which the body has INTESTINAL TOXEMIA 
245 
been sensitized. He claims to have cured 
many cases of rheumatism, eczema, asthma, 
urticaria and other disorders by the use of 
vaccines prepared from intestinal toxins. 
The writer has encountered many cases in 
which the views of Danysz were fully con- 
firmed both by the clinical findings and the 
results of treatment. It should be said, how- 
ever, that the real cure is to be found, not in 
vaccination, but in a thoroughgoing change 
of the intestinal flora. 
Universal Toxemia 
In civilized countries so many errors in 
diet are cultivated through ignorance or false 
conceptions of food values and the colon is so 
universally abused or neglected that chronic 
autointoxication, or intestinal toxemia, has 
come to be a practically universal condition. 
Dr. Bryce, of Birmingham, a well-known 
physician and medical author, recognizing 
this fact says, 
“We lavish money on our houses to secure 
perfect drainage for them, but we fail to se- 
cure it for ourselves. If the main drainage 
system of any house leaks, saturating the sub- 246 
COLON HYGIENE 
soil with sewage matter, we soon put our- 
selves in communication with the sanitary au- 
thorities. Yet we permit the main excretory 
system of our bodies to harbour foul, stinking, 
and putrefying substances, which overflow 
into all our tissues, flooding them with living, 
disease-producing germs, and are surprised 
and often aggrieved because we are stricken 
down with illness. 
“For that is the effect of chronic intestinal 
stasis, and it is perfectly clear, by Dr. Kel- 
logg’s standard of intestinal activity (three 
evacuations daily), that we are all victims of 
colonic stagnation. This means that there is 
an excess of toxic material in the small intes- 
tine, with absorption into the circulation of a 
greater quantity of poisonous products than 
can be converted into harmless substances and 
excreted by the organs of defence.” 
Colon Poisons and Fatigue 
Sir Lauder Brunton long ago called atten- 
tion to the colon as a source of fatigue poi- 
sons, an observation which has since been 
abundantly confirmed by many investigators. 
This fact readily accounts for the atrophy, INTESTINAL TOXEMIA 
247 
depression, mental confusion, mental dulness 
and moral perversion which is observed in 
these cases. It must be remembered, also, 
that the colon is the source of a great variety 
of poisons, each producing its own specific ef- 
fects, so that a great number of the symptoms 
observed in the various forms of acute and 
chronic mental disease may be easily ac- 
counted for. 
Herter observed that the administration of 
indol by the stomach was followed by a pro- 
nounced sense of muscular fatigue. He also 
observed that persons showing much indican 
in the urine often suffered greatly from a 
sense of exhaustion. At the request of Her- 
ter, Professor Lee, of Columbia University, 
.made experiments upon various animals to 
test the effects of indol upon muscle fatigue. 
He found the effect to be very pronounced, 
especially in the case of a warm blooded ani- 
mal, the cat, in which a solution of indol 1 
part to 25,000 reduced the amount of work 
done in the ratio of 100 to 37. 
Anything which tends to develop a state 
of acidosis by diminishing the alkalinity of 
the blood and body fluids at once becomes a 248 
COLON HYGIENE 
cause of exhaustion or fatigue. Constipated 
persons are always lacking in endurance. The 
chronic sufferers from constipation, colitis 
and autointoxication are notably lacking in 
stamina. 
All carnivorous animals suffer from auto- 
intoxication, and for this reason usually lack 
the endurance possessed in so remarkable a 
degree by vegetable feeding animals. Roose- 
velt noted that a horse with a heavy man on 
his back was able to run down a lion in a mile 
and a half. Flesh abstaining athletes are in- 
variably the winners in endurance contests. VEGETABLES 
Grami 
per ounce 
Dried Beans 40. I I 
Dried Peas 28.5 1 1 
Lenlils 20. I I 
Creen Peas 9.35 □ 
Cabbage 9.2 Q 
Parsnip 865 Q 
Brussels’ 5prouls 7-85 [J 
Kohlrabi 7.75 □ 
Celery 7. Q 
Turnip 6.6 0 
Pumpkin 6.1 D 
B.Polalo 5.45 0 
Beefs 5.25 0 
Asparagus 5.2 0 
Carrols 4.9 [] 
iSpinach 4.65 0 
Cauliflower 4.55 D 
Tomafoes 4.26 J 
Creen Peas 4. J 
Cucumber 3.9 | 
Lei luce 3.65 [j 
Onion 3.55 | 
FRUITS 
Grains 
per ounce 
Huckleberries 61.5 1 1 
Red Raspberries 37. I 1 
Blackberries 25. I 1 
Crdn berries 25. I I 
Curranls 23. | 1 
Figs 22.5 I I 
Goosberries 17.5 □ 
Pears 15. 
Apricols 12.5 Q 
Prunes 10. Q] 
Cherries 10. □ 
Slrawberries 10. Q 
Oranges 10. [U 
Plums 7-5 0 
Grapes 7.5 Q 
Raisins 7.5 Q 
Slewed Raisins 7.4 0 
Peaches 5. [] 
Apples 5. [] 
Bananas .3 J 
Chart Showing Proportion of Cellulose in Some of the Common 
Vegetables and Fruits—Also Grains of Cellulose per Ounce Crams 
per ounce 
200 1 ~~1 
Oafmeal 44. 1 I 
Barley 20. 1 1 
% 15. □ 
Wheal 10. □ 
Corn Meat I I 
Corn Flakes 1U. I I 
GrahamFlour 4A I I 
Cranola Ivt. | | 
Rolled A I I 
Wheat V. U 
Graham ["1 
Bread O LI 
Wheat Grits j II 
Whole W. Bread 1. U 
Unpolished j 
Rice .751 
Polished i I 
Rice .4 I 
Fine _ I 
Flour .3 I 
CEREALS 
DIETS 
Normal Dief- Trui4, I I 
Green Vegetables. 6' 1 I 
Graham Dread 
Oaf meal 
Cracked Wheat I I 
Ordinary Mixed 1 [ 
While Bread PI 
and Milk U 
Meal [] 
Chart Showing Proportion of Cellulose in Some of the Common 
Cereal Foods—Also Grains of Cellulose per Ounce. IMPORTANT DISCUSSION OF ALI- 
MENTARY TOXEMIA BY THE 
ROYAL SOCIETY OF MEDI- 
CINE OF GREAT BRITAIN 
About two years ago the subject of alimen- 
tary toxemia was discussed in London by the 
Royal Society of Medicine, fifty-seven of the 
leading physicians of Great Britain partici- 
pating. Among the speakers were eminent 
surgeons, physicians, and specialists in the 
various branches of medicine. 
Poisons of Alimentary Intestinal Toxemia 
The following is a list of the various poi- 
sons noted by the several speakers: Indol, 
skatol, phenol, cresol, indican, sulphuretted 
hydrogen, ammonia, histidin, urobilin, meth- 
ylmercaptan, tetramethylendiamin, penta- 
methylendiamin, putrescin, cadaverin, leci- 
thin, neurin, cholin, muscarin, butyric acid, 
beta-imidazolethylamin, methylguadinin, 
ptomatropin, botulin, mytilotoxin, mytilo- 
congestin, oxybetain, tyramin, agmatin, 
249 250 
COLON HYGIENE 
tryptophan, sepsin, indolethylamin, sulphe- 
moglobin. 
Of the thirty-six poisons mentioned above, 
several are highly active, producing most pro- 
found effects, and in very small quantities. 
In cases of alimentary toxemia some one or 
several of these poisons are constantly bathing 
the delicate body cells, and setting up changes 
which finally result in grave disease. 
It should be understood that these findings 
are not mere theories, but are the results of 
demonstration in actual practice by eminent 
physicians. Of course it is not claimed that 
alimentary toxemia is the only cause of all 
the symptoms and diseases named: although 
of many it may be the sole or principal cause, 
some are due to other causes as well. 
In the following summary the various 
symptoms and disorders mentioned in the dis- 
cussion by the different speakers, are grouped 
under appropriate headings:— 
The Digestive Organs 
Duodenal ulcer causing partial or com- 
plete obstruction of the duodenum; pyloric 
spasm; pyloric obstruction; distension and Radiogram of Gall Stones 
Cirrhosis of the Liver 
Ulcer of the Stomach Diseased Arteries 
clothe K'fV’ftnnxs 
Sectional View of Arteries Showing Effects of 
Arteriosclerosis IMPORTANT DISCUSSION 
251 
dilation of the stomach; gastric ulcer; cancer 
of the stomach; adhesions of the omentum to 
the stomach and liver; inflammation of the 
liver; cancer of the liver. 
The muscular wall of the intestine as well 
as other muscles atrophies, so that the passage 
of their contents is hindered. The abdominal 
viscera lose their normal relationship to the 
spine and to each other, on account of weak- 
ening of the abdominal muscles; these dis- 
placements are much more marked and seri- 
ous in women. Other conditions are: ca- 
tarrh of the intestines; foul gases and foul- 
smelling stools; colitis; acute enteritis; ap- 
pendicitis, acute and chronic; adhesions and 
“kinks” of the intestine; visceroptosis; en- 
largement of spleen; distended abdomen; 
tenderness of the abdomen; summer diar- 
rhea of children; inflammation of pancreas; 
chronic dragging abdominal pains; gas- 
tritis; cancer of pancreas; inflammatory 
changes of gall-bladder; gallstones; cancer 
of gall-bladder; degeneration of liver; cir- 
rhosis of liver; infection of the gums, and 
decay of the teeth; ulcers in the mouth and 
pharynx. 252 
COLON HYGIENE 
Heart and Blood-Vessels 
The following conditions were named by 
various speakers as due to intestinal toxemia: 
Wasting and weakening of the heart mus- 
cle; microbic cyanosis from breaking up of 
blood cells; fatty degeneration of the heart; 
endocarditis; myocarditis; subnormal blood 
pressure; enlargement of the heart; dilatation 
of the aorta; high blood pressure; arterio- 
sclerosis; permanent dilatation of arteries. 
Dr. W. Bezley says: “There are few 
phases of cardiovascular trouble (disease of 
heart and blood vessels) with which disorder 
of some part of the alimentary tract is not 
causatively associated.” 
The Nervous System 
Profound disturbances of the nervous sys- 
tem are shown by various headaches—frontal, 
occipital, temporal, dull or intense, hemicra- 
nia; headache of a character to lead to a mis- 
taken diagnosis of brain tumor. Dr. Lane tells 
of a case where a surgeon had proposed an op- 
eration for the removal of a tumor from the 
frontal lobe of the brain; the difficulty was 253 
IMPORTANT DISCUSSION 
wholly removed by the exclusion of the colon. 
Acute neuralgic pains in the legs; neuritis; 
twitching of the eyes and of muscles of face, 
arms, legs, etc. Lassitude; irritability; dis- 
turbances of nervous system, varying from 
simple headaches to absolute collapse; mental 
and physical depression. “A medical man 
with neurasthenic symptoms and a belief that 
he was ruined, recovered after he left off tak- 
ing an egg for breakfast.” Insomnia; trou- 
bled sleep, unpleasant dreams; unrefreshing 
sleep, the patient awakening tired; excessive 
drowsiness; shivery sensations across lower 
back; burning sensations in face, hands, 
etc.; epileptiform tic; typhoid state; paraly- 
sis; chronic fatigue; horror of noises; morbid 
introspection; perverted moral feelings; mel- 
ancholia, mania, loss of memory; difficulty 
of mental concentration; imbecility; insan- 
ity; delirium, coma. 
The Eyes 
Show degenerative changes; inflamma- 
tion of the lens; inflammation of the optic 
nerve; hardening of the lens; sclerotitis, 
sclerokeratitis; iritis; iridocyclitis; cataract; 254 
COLON HYGIENE 
recurrent hemorrhage in the retina; eyes dull 
and heavy. W. Long says: “As an ophthal- 
mic surgeon, I can look forward full of hope 
to a future when those serious eye affections 
will cease to occur, because the physician has 
taught mothers how to feed children pro- 
perly, and the dental surgeon has impressed 
upon the population at large the importance 
of proper mastication and the hygiene of the 
mouth.” 
The Skin 
Among the skin symptoms noted by various 
experts may be mentioned the following:— 
Formation of wrinkles; thin, inelastic, 
starchy skin; pigmentation of the skin—yel- 
low, brown, slate-black, blue; muddy com- 
plexion; offensive secretion from skin flex- 
ures; thickening of the skin of the back of 
the upper arm; irritability of the skin; 
sweating of the palms of the hands and the 
soles of the feet; eruptions of the skin—sores 
and boils; pemphigus; pruritis; herpes; 
eczema; dermatitis; lupus erythematosus; 
acne rosacea; cold, clammy extremities; dark 
circles under the eyes; seborrhea; psoriasis; 
pityriasis; alopecia; lichen; planus; jaun- 255 
IMPORTANT DISCUSSION 
dice. “An infinitesimal amount of poison 
may suffice to cause skin eruption.” 
Muscles and Joints 
Degeneration of the muscles; “Muscles 
waste and become soft and in advanced cases 
tear easily.” “In young life the muscular de- 
bility produces the deformities which are 
called dorsal excurvation, or round shoulders, 
lateral curvature, flat-foot, and knock-knee.” 
“Weakness of abdominal muscles causes ac- 
cumulation of feces in the pelvic colon, 
which renders evacuation of contents more 
and more difficult.” Prominence of bones; 
rheumatic pains simulating sciatica and lum- 
bago; various muscular pains; muscular rheu- 
matism; arthritis deformans; synovitis; rick- 
ets; arthritis, acute and chronic. Tubercle, 
and rheumatoid arthritis are the direct re- 
sult of intestinal intoxication. Dr. Lane says: 
“I do not believe it is possible for either of 
these diseases to obtain a foothold except in 
the presence of stasis.” 256 
COLON HYGIENE 
Genito-Urinary and Reproductive Organs 
Intestinal toxemia appears as a very active 
cause of disorders of the genito-urinary or- 
gans, among which are mentioned the fol- 
lowing :— 
Various displacements, distortions and dis- 
eases of the uterus; change in the whole form 
and contour of woman; fibrosis of breast; 
wasting of breasts; induration of breasts; 
sub-acute and chronic mastitis; cancer of 
breast; metritis and endometritis; infection 
of bladder especially in women; frequent 
urination; albumosuria; acute nephritis, 
movable kidney; floating kidney. Dr. Lane 
goes so far as to say: “Autointoxication plays 
so large a part in the development of diseases 
of the female genito-urinary apparatus, that 
they may be regarded by the gynecologist as 
a product of intestinal stasis.” 
General Disorders and Disturbances of 
Nutrition 
In this class of disorders are named:— 
Degeneration of the organs of elimination, 
especially the liver, kidneys (Bright’s dis- IMPORTANT DISCUSSION 
257 
ease) and spleen; pernicious anemia; low- 
ered resistance to infection of all kinds; pre- 
mature senile decay; retardation of growth 
in children, accompanied by mental irritabil- 
ity and muscular fatigue; adenoids; en- 
larged tonsils; scurvy; enlarged thyroid 
(goiter); various tumors of thyroid; Ray- 
naud’s disease. 
In those who apparently suffer no harm 
from constipation during a long series of 
years there is perhaps, as suggested by Hurst, 
a partial immunity established. The writer 
has long believed that such an immunity is 
sometimes established in the very obstinate 
constipation which accompanies absolute fast- 
ing, because of the cleansing of the tongue 
and reappearance of appetite which often 
occurs at the end of the second or third week 
of the fast, a phenomenon very like that 
which appears in typhoid fever and other 
continued fevers. It must not be supposed, 
however, that even the establishment of so- 
called immunity insures the body against all 
injury. The labor of eliminating an enor- 
mous amount of virulent toxins, which falls 
upon the kidneys, damages the renal tissues 258 
COLON HYGIENE 
and produces premature failure of these es- 
sential organs. Any process which develops 
toxins within the body is a menace to the life 
of the tissues and should be suppressed as far 
as possible, and as quickly as possible. 
The fact that symptoms of poisoning re- 
sulting from constipation do not appear at 
once is no evidence that injury is not done. 
Dr. William Hunter in the course of the Lon- 
don discussion remarked that the fact that 
chronic constipation “might exist in certain in- 
dividuals as an almost permanent condition 
without apparently causing ill-health is due 
solely to the protective power and action of the 
liver. It is not any evidence of the compara- 
tive harmlessness of constipation per se, but 
only an evidence that some individuals 
possess the cecum and the colon of an ox, 
with the liver of a pig, capable of doing any 
amount of distoxication.” 
In the face of such an array of evidence 
hacked up by the authority of nearly sixty emi- 
nent English physicians—and many hundreds 
of other English, German, and French phys- 
icians whose names might be added—it is no 
longer possible to ignore the importance of IMPORTANT DISCUSSION 
259 
alimentary toxemia or autointoxication as a 
factor in the production of disease. To no 
other single cause is it possible to attribute 
one-tenth as many various and widely diverse 
disorders. It may be said that almost every 
chronic disease known is directly or indi- 
rectly due to the influence of bacterial poisons 
absorbed from the intestine. The colon may 
be justly looked upon as a veritable Pandora’s 
box, out of which come more human misery 
and suffering, mental and moral as well as 
physical, than from any other known source. 
The successful treatment of alimentary 
toxemia often taxes to the utmost the re- 
sources of the best equipped physician. 
Sometimes it is necessary to call in the serv- 
ices of the surgeon. 
It may be fairly said, however, that at 
least nine-tenths of the possible benefits to be 
derived from treatment is to be secured by 
combating intestinal stagnation. By such 
regulation of diet and habits as to secure a 
thorough evacuation of the bowels at least 
three times a day, or after each meal, and by 
excluding from the diet flesh meats and other 
putrescible substances, more can be accom- 260 
COLON HYGIENE 
plished toward eliminating from the intestine 
pernicious parasitic organisms and the multi- 
tudinous poisons which they produce than by 
all other means. 
The sources of the poison-forming bacteria 
which grow in the human intestine are nu- 
merous. It is probable, however, that but- 
cher’s meat, fish, oysters and other shellfish 
are the chief sources, for Tissier found that 
when he obtained flesh from the slaughter- 
house in as fresh a condition as possible, it 
contained all the bacteria necessary to pro- 
duce active putrefaction, which was made 
evident to the sense of smell within twenty- 
four hours, and became more and more pro- 
nounced from day to day. 
Bacteriologists have shown that the mouth 
always contains putrefactive bacteria. The 
normal stomach is sterile during digestion, 
because the gastric juice is a powerful germi- 
cide and destroys them; but in stomachs 
which do not produce a sufficient amount of 
gastric juice, and in normal stomachs when 
empty of food, great numbers of these dan- 
gerous microbes may be found. 
Below the stomach the number of bacteria IMPORTANT DISCUSSION 
261 
increase. At the lower end of the small in- 
testine, and in the cecum, the number of liv- 
ing bacteria is the greatest. 
The reason for this is the presence of food 
residues and body wastes of character suitable 
to encourage growth of putrefactive bacteria, 
while starch and sugar which are needed for 
the growth of acid-forming organisms are 
absent, having been digested and absorbed in 
the small intestine. 
Observations of Herter and Others on the 
Intestinal Flora and Autointoxication 
In examination of the stools of very young 
infants, Herter found that B. bifidus, an acid- 
ophile organism, was always present in the 
meconium, which thus serves as a protection 
against the entrance of putrefactive bacteria. 
The same acute observer noted that the 
stools of a healthy nursing infant may be 
placed in a closed test tube in an incubator 
for several weeks without the development of 
putrefaction, and this is true even when the 
material has been inoculated with highly 
putrefactive organisms such as B. putrificus. 
He also observed that in cases of children 262 
COLON HYGIENE 
subject to pronounced intestinal putrefaction 
there is a retardation of growth with ab- 
dominal distention and poisoning of the mus- 
cular system, shown by signs of weariness and 
slowness in learning to walk. 
Different Types of Intestinal Autointoxica- 
tion (Herter) 
1. The indolic type associated with a large 
amount of indican in the urine. In these 
cases there is stasis in the small intestine and 
incompetency of the ileocecal valve. The 
indican is produced by colon bacilli and B. 
putrificus, the colon bacillus acting upon par- 
tially digested proteins and the putrificus 
upon the proteins which have escaped diges- 
tion and absorption. These patients suffer 
from headaches. There is usually marked 
dilatation of the cecum, often with adhesions 
of the cecum or the appendix. In many cases 
operations for removal of the appendix have 
been performed without benefit. The bowel 
movements are often loose and frequent. Pa- 
tients not infrequently have regular daily 
stools quite putrid in odor. 
2. The butyric type. The stools have a IMPORTANT DISCUSSION 
263 
very strong rancid odor of butyric acid. 
Bacteriological examination shows the dom- 
inance of Welch’s bacillus. B. putrificus is 
also often present. The reaction of the stool 
may be acid, due to the large amount of bu- 
tyric acid, and indol may be wholly absent; 
hence indican will not appear in the urine in 
any quantity. 
The feces in cases of butyric acid intoxica- 
tion often contain a hemolytic substance, that 
is, a substance which is capable of causing 
disintegration of the blood cells. It was held 
by Herter that this might be an efficient cause 
of anemia. The anemia produced in these 
cases is of the secondary type, the coloring 
matter being reduced more than the red cell 
count. 
Experiments (Herter) have shown that the 
Welch’s bacillus produces substances capable 
of destroying the red blood cells. In these 
cases the total number of blood cells is re- 
duced. Later the hemoglobin is reduced in 
greater proportion than the number of red 
cells. Patients show evidences of premature 
senility such as brown spots upon the hands 
and face, general pigmentation of the skin, 264 
COLON HYGIENE 
loss of suppleness of the skin, wrinkling of the 
skin of the face and hands. 
The butyric acid type of intoxication is 
very commonly associated with colitis. The 
stools show an abundance of thick, opaque 
mucus, frequently in the form of flakes or 
casts and not infrequently mixed with pus. 
3. A combination of the two classes de- 
scribed, that is, of the indolic and butyric 
acid types of intestinal intoxication consti- 
tutes the third class, which is the most severe 
of all forms of intestinal toxemia. These pa- 
tients have usually suffered for many years 
and have frequently depended for years upon 
mineral waters and other laxatives of various 
sorts for bowel movements. They are 
considerably depreciated physically; often 
greatly depressed mentally; not infrequently 
develop manic depressive insanity with sui- 
cidal tendencies. Many of these patients are 
classed as neurasthenics. Not a few find 
refuge in asylums for the insane. Not a small 
percentage of these cases drift into drug 
habits as the result of extreme nervous de- 
pression, toxic neuralgia, insomnia and other 
miseries which their depreciated morale ren- IMPORTANT DISCUSSION 
265 
ders them unable to endure. It is quite prob- 
able that not a few cases of pernicious anemia 
have their beginning in this type of intestinal 
autointoxication. This was the view of Her- 
ter, and his observations are clearly supported 
by those of the writer as well as many others. 
Herter pointed out so long ago as 1907 
(The Common Bacterial Infections of the 
Digestive Tract) that the B. acidophilus 
combats putrefaction through its “ability to 
grow in a more strongly acid medium than 
can be withstood by meat bacteria.” Herter 
also mentioned that “if large numbers of 
these bacteria be administered to a dog by 
mouth, other flora may be temporarily sup- 
pressed to a large extent. But as in the case 
of feeding other kinds of microorganisms 
leading part can only be maintained by con- 
tinuously feeding large numbers of the acid- 
ophiles.” Herter thus anticipated the later 
work of Rettger and others, although the 
latter greatly extended the original observa- 
tions of Herter and showed their practical 
bearing on therapeutics. 266 
COLON HYGIENE 
Intestinal Toxemia a Cause of Senility 
Herter observed that “the onset of senility 
may be distinctly accelerated through the de- 
velopment of intestinal infections in which 
the putrefactive anaerobes are prominently 
represented.” He says, “I have observed this 
in cases where it has appeared to me a cer- 
tainty that other toxic causes of premature 
senility could be excluded. It is probable 
that the ‘wild races’ of bacteria of which he 
(Metchnikoff) speaks as responsible for 
senile changes consist largely of putrefactive 
microorganisms. I am inclined to give prom- 
inence to B. aerogenes capsulatus (Welch’s 
bacillus) as the most important factor in the 
production of the putrefactive decomposi- 
tions of advanced age.” 
Herter fed a cat on raw meat and found 
the entire intestinal tract infected by the 
Welch’s bacillus in great numbers. Examin- 
ation of the stools of lions, tigers, wolves and 
dogs and other carnivorous animals showed 
pronounced infection with the Welch’s bacil- 
lus. A guinea-pig inoculated with the feces 
of these animals died in 15 to 18 hours. Ex- IMPORTANT DISCUSSION 
267 
amination of the stools of the buffalo, goat, 
camel, elephant, and horse showed Welch’s 
bacillus only in the case of the buffalo, in the 
stools of which a few Welch’s bacilli were 
found. 
Welch’s Bacillus Sometimes Gives Rise to 
Diarrhea 
Herter has shown that the living cells of 
the body, especially the liver, kidneys, mus- 
cles and the mucous membrane of the intes- 
tinal tract, have the power to absorb consider- 
able quantities of indol and phenol, holding 
them so firmly that they cannot be recovered 
by distillation. This function is of great im- 
portance for the reason that even minute 
quantities of indol or phenol in the blood 
produce great nervous disturbances. In some 
animals the liver is less active than usual in 
removing indol from the blood and holding 
it. In such cases indol produces highly dis- 
turbing effects upon the nervous system. 
Drs. Richard and Howland demonstrated 
the highly toxic effects of indol by first sen- 
sitizing animals or lowering their resistance 
by the injection of minute quantities of po- 268 
COLON HYGIENE 
tassium cyanide, the amount of cyanide in- 
jected being so small as to produce no notice- 
able effect. In animals so prepared indol was 
found to produce highly toxic effects in 
minute doses. 0.0003 grams of indol per gram 
of body weight injected into a guinea-pig 
produced characteristic twitchings in 8 min- 
utes, the attack lasting 97 minutes. The same 
quantity of indol was then injected into an- 
other guinea-pig which had previously re- 
ceived 0.005 milligrams of potassium cya- 
nide per gram of body weight. The twitch- 
ing began in 2 minutes, was much more vio- 
lent, and lasted 5 hours. 
Mental Disease from Intestinal Toxemia 
For many years experts in mental disease, 
both in this country and in Europe, have 
maintained that certain forms of insanity, 
particularly dementia praecox and manic de- 
pressive insanity, are due to functional dis- 
turbances or structural degenerations set up 
by toxins derived from focal infections, the 
seat of which may be the tonsils, the teeth, 
the genital organs or even the gallbladder or 
the appendix, but which is most frequently IMPORTANT DISCUSSION 
269 
found to be the colon. In many cases at least, 
and probably in a very large proportion of 
all cases, infections of the tonsils, teeth and 
other so-called focal infections, are really the 
result of the lowered vital resistance pro- 
duced by long-continued absorption of poi- 
sons from the colon. 
Cotton and others have in recent years in- 
sisted upon the great importance of the colon 
as a factor in mental disease. These authori- 
ties cite many cases in which removal of the 
£olon or a large part of it has resulted in 
restoration of the patient to mental sound- 
ness when other means had failed. The 
writer is of- the opinion that in these cases a 
change of the intestinal flora by the methods 
pointed out and careful attention to colon 
hygiene would have accomplished the same 
results. The colon itself is not the offender. 
The source of the trouble is the contents of 
the colon. Stasis is of course a factor; but 
when putrefaction is suppressed, the colon 
contents are no longer toxic, and stasis, even 
reflux, is a matter of less moment. In fact, 
cases are exceedingly rare in which a thor- 
ough-going change of the intestinal flora 270 
COLON HYGIENE 
does not result in restoring normal colon ac- 
tivity. The only exceptions should be found 
in cases of mechanical obstruction. 
Epilepsy and Colon Poisons 
Epilepsy is another disease which in many 
cases may be traced to intestinal poisons. The 
presence in the urine of epileptics, in large 
quantities, of poisons capable of producing 
convulsions was pointed out many years ago 
by Bouchard and his students. Later Herter 
observed unmistakable evidence of excessive 
intestinal putrefaction in more than 70 per 
cent of over 200 cases of epileptics investi- 
gated. Clinical experience at the Battle 
Creek Sanitarium during the last 45 years has 
shown in a great number of cases a definite 
connection between the intestinal toxemia 
which results from chronic constipation and a 
high protein diet and the various forms of 
epilepsy. It has been definitely proven not 
only by the experience of the writer and his 
colleagues but by that of hundreds of other 
physicians, that the suppression of intes- 
tinal putrefactions by increasing the activity 
of the intestines and placing the patient upon IMPORTANT DISCUSSION 
271 
an antitoxic diet, excluding meats of all 
kinds, may wholly control epileptic con- 
vulsions in many cases and in nearly all 
cases greatly lessen their frequency and se- 
verity. In not a few instances complete and 
permanent cures have been effected, if not 
with diet alone, by regulation of the diet in 
connection with other measures which with- 
out diet regulation have proved entirely in- 
efficient. 
Disease of the Thyroid Due to Colon 
Poisons 
First Combe and Ewald, and later others, 
called attention to the beneficial effects se- 
cured by withdrawing meats of all kinds 
from the diet of persons suffering from dis- 
ease of the thyroid gland. Cases of myxe- 
dema and simple goiter are benefited as well 
as cases of exophthalmic goiter and hyper- 
thyroidism. 
The practice of eliminating meat from the 
diet in cases of this sort is well supported by 
Breisacher’s experiment by which it was 
proven that dogs whose thyroid glands had 
been removed do very well on a diet of bread 272 
COLON HYGIENE 
and milk although they develop convulsions 
and die within a few weeks when given meat. 
It has long been known that rabbits toler- 
ate removal of the thyroid gland so well that 
in many cases they appear to be almost unin- 
jured by the operation, doubtless because of 
the small amount of putrefaction products in 
their intestines. 
Congenital Effects of Autointoxication 
McCarrison has demonstrated by experi- 
ments on goats that congenital goiter may be 
caused by the absorption of fecal matters 
from the intestine of the mother. Fecal con- 
tamination through soil or water may possi- 
bly be the source of congenital goiter in 
human beings as well as in goats. Absorption 
of putrefaction products from the intestine 
overtaxes the capacity of the thyroid of the 
fetus, leading to compensatory overgrowth. 
The inference is a fair one that thyroid dis- 
ease in adults may arise from the same cause. 
Pernicious Anemia 
A disease which is becoming constantly 
more prevalent in civilized countries, and 
which in its advanced stages offers no hope IMPORTANT DISCUSSION 
273 
for recovery, is believed by many clinicians 
to find its origin in intestinal infection due 
primarily to constipation. The putrefaction 
of food residues in the colon affords a favor- 
able opportunity for the development of per- 
nicious organisms which give rise to colitis. 
As the resistance of the intestinal mucous 
membrane is broken down by the destruction 
of its protective epithelial covering, the bac- 
terial poisons swarm into the blood and in 
time break down the resistance of the blood 
and the tissue fluids. This lowered resistance 
is manifested in pyorrhea, decay of the teeth, 
degeneration of the liver, kidneys and of the 
glands of the stomach, leading to achylia. 
The blood making organs finally degenerate, 
producing changes in the blood characteristic 
of pernicious anemia. Lastly, degeneration 
of the spinal cord develops and paralysis 
makes its appearance, sometimes accom- 
panied by mental indications of degeneration 
of the brain. Cases which have reached this 
stage are hopeless, but in the early stages of 
the disease recovery not infrequently occurs 
as the result of changing the intestinal flora 
and strictly following an antitoxic regimen. 274 
COLON HYGIENE 
Herter observed that carnivorous animals 
are much more likely to develop pernicious 
anemia, especially in the later years of their 
lives, saying “that it is usual in the later years 
of life for meat eating animals to show a 
much diminished volume of blood and at 
least a moderate fall in the hemoglobin. 
Instances are stated to be not uncommon in 
which a pernicious type of anemia has de- 
veloped in the carnivora. On the contrary, 
among the herbivora it is said that pro- 
nounced anemias are very rare.” CHANGING THE INTESTINAL 
FLORA 
The plants which grow in a region consti- 
tute its “flora.” Germs are the lowest order 
of plant life. The different germs which 
grow in the colon together constitute its flora. 
Germs which cause fermentation of starch or 
sugar and which form acids are harmless. 
Germs which decompose albumen or pro- 
tein and cause putrefaction produce ammonia 
and many other highly poisonous substances. 
These are pernicious organisms which are 
the cause of many maladies and induce pre- 
mature old age. These are the germs called 
“wild” by Metchnikoff and believed by him 
to be the cause of old age. 
Dr. Tissier, of the Pasteur institute, was 
the first to point the way to methods of chang- 
ing the flora of the intestine. His plan was to 
displace the “wild,” noxious, poison-forming 
bacteria which have taken possession of most 
adult intestines through wrong habits of life, 
especially in diet, by harmless, acid-forming 
species, such as Nature plants in the intestines 
275 276 
COLON HYGIENE 
of the young infant within a few days after 
birth. 
There are various ways in which the intes- 
tinal flora may be changed. Two things are 
essential: 
1. The diet must be such as to encourage 
the growth of friendly germs, the acid-form- 
ers, and discourage the growth of unfriendly 
and undesirable ones, the poison-formers. 
This requires a fleshless diet and in some cases 
a diet free from animal protein, that is, a 
diet which excludes eggs and milk as well as 
meats of all kinds. 
2. The bowels must be made to move three 
times a day or more frequently so as to hasten 
the displacement of the undesirable bacteria 
and to dislodge them from their hiding 
places. The colon must be thoroughly emp- 
tied daily. 
The necessary change of diet may be some- 
times effected by adopting the “milk regi- 
men” for a limited period. The “fruit regi- 
men”—fresh fruit and such green vegetables 
as lettuce, celery, and cucumbers answers the 
same purpose. The “whey cure,” “kumyss 
cure,” and “milk cure”- and other dietetic CHANGING THE INTESTINAL FLORA 
277 
methods of changing the flora are highly use- 
ful. Fasting will not change the flora. 
For a thorough change of the flora a spe- 
cial regimen with careful technic is needed 
for the uniform success which is possible by 
recently perfected methods. To keep the 
flora changed an antitoxic diet must be 
adopted and carefully followed and the thor- 
oughgoing technic for completely changing 
the flora must be repeated at rather frequent 
intervals. 
B. acidophilus, discovered by Moro, has 
been proven to be the chief acid-forming 
or protective organism of the colon. This 
germ is present and dominant in the stools of 
healthy infants, also in the stools of milk-fed 
calves and other milk-eating animals and 
even in the droppings of milk-fed chickens. 
So long as the B. acidophilus is dominant, 
putrefactive changes in the colon are absent 
or very slight. The B. acidophilus can grow 
in the colon only when it has an adequate 
supply of lactose or dextrine. Cow’s milk en- 
courages the growth of the B. acidophilus be- 
cause it contains 4 per cent of lactose. In 
the use of B. acidophilus to change the intes- 278 
COLON HYGIENE 
tinal flora it must be used in liberal quanti- 
ties. A few tablets or a few drops of the cul- 
ture accomplish little, at least are insufficient 
to effect a material change in very pro- 
nounced cases of autointoxication. To 
change the flora and to keep it changed it is 
necessary to employ large quantities of cul- 
ture. Either whey or milk cultures are best 
suited for this purpose. 
Milk culture, or so-called acidophilus but- 
termilk, may be prepared at home and should 
be used in quantities of two to three pints 
daily in connection with an antitoxic diet, 
that is, a diet from which meats of all kinds 
are rigorously excluded. In preparing aci- 
dophilus buttermilk it is necessary that the 
milk should be thoroughly sterilized and that 
a freshly prepared and efficient culture 
should be employed. The culture should be 
obtained from a reliable laboratory to insure 
efficiency. 
The following method of preparing acido- 
philus buttermilk has been found satisfac- 
tory: To one pint of evaporated condensed 
milk (unsweetened) add an equal quantity of 
boiling water. Cover and allow to stand until CHANGING THE INTESTINAL FLORA 
279 
cooled to a temperature of 105 degrees. Put 
in a thermos bottle together with one ounce 
of a pure fresh liquid culture of acidophilus. 
Stopper the bottle, shake two or three times to 
insure complete mixture of the culture with 
the milk, wrap in a heavy woolen blanket and 
put in a warm place for 24 to 36 hours. In 
cold weather a two quart fruit jar half full of 
boiling water should be wrapped up with the 
thermos bottle to make sure that a tempera- 
ture of about 100 degrees is maintained for 
24 to 36 hours. Shake the bottle before open- 
ing. If desired, the buttermilk may be beaten 
with an egg beater after removal from the 
thermos bottle to make “smooth.” 
Acidophilus buttermilk is less acid than 
ordinary buttermilk often is. It should be 
freshly prepared every day. The buttermilk 
itself cannot be used as a starter for a new 
lot as it becomes contaminated with air germs 
which grow more rapidly than the B. acido- 
philus, and so prevent development. Care 
must be exercised that the containers used 
are thoroughly cleansed in boiling water to 
prevent contamination. The more closely the 
bacteriological laboratory technic is followed 280 
COLON HYGIENE 
the better will be the quality of the butter- 
milk. 
Changing the Intestinal Flora without 
Cultures 
Even in cases requiring change of the intes- 
tinal flora, including pretty nearly all civil- 
ized human beings, the B. acidophilus is still 
present in the colon although in very small 
numbers, the putrefactive flora having taken 
possession of the field. A good flora may 
be restored without the use of cultures by ad- 
ministering large quantities of the special car- 
bohydrates which are needed by the B. acid- 
ophilus to enable it to grow with such luxuri- 
ance as to overwhelm and drive out of the in- 
testine the putrefactive bacteria. The latter 
method is in some respects preferable to the 
first. If we encourage the growth of the pro- 
tective organisms present by proper feeding 
we shall be certain that the results secured 
may be easily made permanent by continuing 
the proper feeding. If, on the other hand, we 
administer quantities of the organism which 
have been grown outside of the body, the 
good results secured will only last so long CHANGING THE INTESTINAL FLORA 
281 
as the cultures are being given in large quan- 
tities, for they will not grow and develop in 
the body unless encouraged by special feed- 
ing with lactose or dextrine. 
Lactose and dextrine are the only carbo- 
hydrates that can be relied upon to encour- 
age a luxuriant growth of B. acidophilus in 
the colon. These carbohydrates are absorbed 
much more slowly than others and are thus 
able to reach the colon before complete ab- 
sorption. To make certain that a sufficient 
amount of lacto-dextrin reaches the colon 
to change the flora, that is, to encourage the 
growth of the B. acidophilus sufficiently to 
make it dominant and discourage the growth 
of the putrefactive organisms, it is necessary 
that large doses should be taken. 
Lactose has been found inconvenient for 
several reasons. First, it sometimes gives rise 
to nausea; second, it becomes after a few 
days repugnant to most persons; third, it is 
difficult to dissolve; fourth, and perhaps the 
most important of all, the use of such large 
quantities of sugar for a considerable period 
sometimes causes the appearance of sugar in 
the urine. This might prove to be highly in- 282 
COLON HYGIENE 
jurious to a person already having a tendency 
to diabetes. Dextrine is equally as valuable 
as lactose for changing the flora, but its use 
for human beings is impracticable because 
its taste is so disagreeable it is practically im- 
possible to swallow the quantity required. 
The objectionable features of both lactose 
and dextrine have been overcome by combin- 
ing the two, not by simple mechanical mix- 
ture but by adding lactose to a specially pre- 
pared dextrine in such proportions as to pro- 
duce a readily soluble, highly agreeable 
product which may be used without difficulty 
for an indefinite period of time. 
This product, known as lacto-dextrin, not 
only changes the intestinal flora but is a 
highly concentrated food, each ounce having 
a food value of about 120 calories. 
Another important advantage of lacto-dex- 
trin is the fact that it contains the important 
antiscorbutic vitamin C, which is wholly 
lacking in lactose, and is necessary for the 
utilization of carbohydrates. CHANGING THE INTESTINAL FLORA 
283 
The Quantity of Lacto-Dextrin Required 
For rapidly changing the intestinal flora it 
is necessary to administer large doses, suffi- 
cient to fill the alimentary tract, or otherwise 
the total amount taken may be absorbed before 
reaching the colon, where its presence is 
necessary to encourage the growth of the B. 
acidophilus. This amount varies in different 
persons. On the average the required dose 
is two to three ounces. This quantity must be 
taken three times a day. In exceptional 
cases four or five ounces may be required. 
These are cases in which the intestine is so 
badly crippled that so long a time is required 
for the lacto-dextrin to reach the colon that 
an unusual proportion of it is absorbed. 
These large doses must be taken until the 
flora is changed, and afterwards doses half as 
large will generally suffice to maintain the 
change, that is, to prevent the return of the 
intestinal putrefaction and consequent auto- 
intoxication. 284 
COLON HYGIENE 
The Best Time for Taking Lacto-Dextrin 
Lacto-dextrin may be used advantage- 
ously at any time, with meals as an addition 
to fruits, or between meals as a drink—it 
makes a very agreeable beverage. An ex- 
cellent time for taking lacto-dextrin in ordi- 
nary cases is about one hour before each meal. 
It should be taken with a liberal quantity of 
water. A full dose requires about 12 to 16 
ounces or two large tumblerfuls of water. 
The product is more readily soluble in hot 
water than in cold, hence hot water is de- 
cidedly preferable. A convenient way for 
taking is to put about one-half the dose, two 
heaping dessert spoonfuls, in a tumbler, add 
an equal quantity of hot water, stir quickly 
with a fork till smooth, then add hot water to 
fill the tumbler. After swallowing this, pre- 
pare another similar dose. Repeat this be- 
fore each meal. 
Not infrequently the taking of a large dose 
of this concentrated food a short time before 
a meal lessens the appetite. This need not give 
alarm, for it is to be remembered that lacto- 
dextrin is itself a highly concentrated food. 285 
CHANGING THE INTESTINAL FLORA 
A heaping dessert spoonful represents about 
100 calories, and the full day’s dose repre- 
sents fully half the amount of food required 
by the average individual engaged in light 
employment. Persons who are overfat or of 
average weight and hence do not desire to 
add to their weight must necessarily reduce 
the amount of food eaten while taking lacto- 
dextrin. Such persons should make the diet 
consist chiefly of coarse vegetables such as 
cabbage, cauliflower, green peas, string beans, 
lettuce, celery, Brussels sprouts, asparagus 
and fresh fruits of all sorts with a moderate 
allowance of bread, potatoes, cereals, milk, 
buttermilk, etc. Persons who are thin in flesh 
and desire to add to their weight should take 
the lacto-dextrin about three hours after 
meals. When taken at this time lacto-dextrin 
does not lessen the appetite for other food 
and so may be taken in addition to the regu- 
lar full diet and will thus insure a decided 
and usually very rapid gain in flesh. 286 
COLON HYGIENE 
To Keep the Flora Changed 
This is not a case in which the theological 
doctrine of “Once in grace, always in grace” 
is applicable. Even when the flora has been 
completely changed, if the measures em- 
ployed to effect a change are completely 
withdrawn, the old putrefactive flora will be 
found back in full force within a week or ten 
days. To keep the flora changed requires a 
constant battle. 
The things which must be done without 
fail and systematically are the following: 
1. The bowels must be thoroughly emptied 
every day. To insure this, the bowels should 
be trained to move three times a day or after 
each meal. In many cases an additional be- 
fore breakfast movement occurs and this is 
advantageous. . To secure this efficient action 
of the bowels the use of large quantities of 
bulky foods is necessary together with proper 
lubrication. An ounce to an ounce and a 
half of bran is required in obstinate cases and 
paraffin oil in liberal quantities is also needed. 
Fresh fruit, greens and such vegetables as 
lettuce, celery, cabbage, beets, parsnips, etc., CHANGING THE INTESTINAL FLORA 
287 
should be freely used. Bulky or laxative 
foods must be used in liberal quantities, not 
once a day only, but at every meal. If one of 
the daily meals is taken away from home at a 
lunch counter, hotel or restaurant, a quantity 
of “ballast” may be taken along in the pocket. 
Laxa is especially excellent for this purpose. 
This is a combination of bran and agar, 
which is the most efficient form of roughage 
with which the writer is acquainted. It is 
prepared in the form of a biscuit which may 
be carried in the pocket and is quite palatable 
and easily eaten either with or without other 
food. If the ordinary meal is omitted, one or 
two laxa biscuit may be taken with a little 
fruit so as to avoid interrupting the normal 
intestinal rhythm. 
2. An antitoxic diet must be closely fol- 
lowed, that is, meats of all sorts, including 
fowl, fish, etc., must be rigorously excluded 
from the diet. This is necessary not only for 
rapidly changing the intestinal flora but after 
the flora has been changed to prevent reinfec- 
tion of the intestine. A single chop or serving 
of fish or chicken may suffice to re-inoculate 
the intestine with the putrefactive flora and 288 
COLON HYGIENE 
render necessary a new campaign to change 
the flora by means of large doses of lacto- 
dextrin. In some cases even eggs must be 
used very sparingly. The yolk of the egg is 
preferable to the white, being less putrescible 
and less likely to encourage putrefaction in 
the colon. When eggs are eaten, the greatest 
care should be taken to insure perfect fresh- 
ness. In hot weather an egg will not remain 
fresh for more than two or three days, and 
ordinary commercial eggs are quite liable to 
contain bacteria even when perfectly fresh. 
Bacteriological examinations of eggs have 
shown that about one egg in seven is infected 
when laid. It is necessary that the food and 
surroundings of chickens should be thor- 
oughly clean in order to insure that the eggs 
are wholly free from bacteria even when 
fresh. Eggs from milk-fed chickens are of 
the best sort. 
3. Three or four ounces of lacto-dextrin 
should be used daily. In many cases a single 
morning dose of two to four heaping dessert 
spoonfuls is found to be efficient. This dose 
in many acts as a decided laxative. Changing 
the flora always increases the efficiency of the CHANGING THE INTESTINAL FLORA 
289 
colon. If acidophilus buttermilk is used, 
about two pints should be taken daily to 
maintain a good intestinal flora. Perhaps the 
best plan of all is to combine the buttermilk 
with lacto-dextrin. When this is done only a 
half dose of each will be required, say two or 
three tablespoonfuls of lacto-dextrin daily 
and one or two glasses of buttermilk. 
When lactose or dextrin is administered 
to change the intestinal flora gas production 
is often at first greatly increased, causing fre- 
quently a considerable degree of discomfort. 
This may be taken as an indication (1) that 
the Welch’s bacillus is present in large num- 
bers and (2) that the lactose or dextrin is 
reaching the colon in efficient quantities. The 
increased gas production due to the action 
of the Welch’s bacillus upon the carbohy- 
drate is fortunately accompanied by a pro- 
duction of lactic acid which will soon stop 
the growth of the Welch’s bacillus, which is 
highly sensitive to acid, ceasing to grow in 
the presence of one-tenth of one per cent of 
acid, whereas the protective B. acidophilus 
and other acid-loving organisms are capable 
of growing in the presence of one-half of one 290 
COLON HYGIENE 
per cent of acid. The colon bacillus also 
produces gas in considerable quantities and 
in many cases is the chief cause of gas pro- 
duction. 
In efforts to change the intestinal flora it 
is important to reduce the intake of food. It 
is especially important that the amount of 
protein should be reduced. An excess of food 
always encourages the growth of the perni- 
cious organisms in the colon. On this ac- 
count, a fruit regimen for a few days (three 
or four days) is particularly advantageous. 
In cases accompanied by emaciation in which 
the milk regimen is indicated care should be 
taken to change the flora by a few days of 
fruit regimen with lacto-dextrin before be- 
ginning the milk feeding in order to avoid 
increased growth of the putrefactive organ- 
isms which will result from the introduction 
of the great excess of protein into the colon 
which necessarily accompanies systematic 
milk feeding. 
Herter lays special stress upon the sup- 
pression of foods containing putrefactive bac- 
teria, remarking, “It is clear that in such 
cases the greater the freedom of the food CHANGING THE INTESTINAL FLORA 
291 
from putrefactive bacteria, the less will be 
the liability to putrefaction at lower levels” 
(that is, below the stomach). 
Herter insists that milk which contains 
Welch’s bacillus, B. putrificus and other pu- 
trefactive organisms should be sterilized. He 
also calls attention to the fact that cheese 
commonly contains large numbers of putre- 
factive bacteria, and remarks, “Cheese is 
therefore an article generally to be excluded 
from the dietary of nearly all cases of excess- 
ive chronic intestinal putrefaction.” Cheese 
freshly prepared from clean milk, cottage 
cheese, is permitted. Attention is specially 
called to the fact that in the use of uncooked 
fruit great care must be taken to avoid the 
bacteria found on the surface of fruits. 
Among the pernicious organisms with which 
fruits are frequently infected are the B. pu- 
trificus and the bacillus of malignant edema, 
two exceedingly pernicious organisms. These 
Rettger has found to be very abundant on the 
skins of bananas. 
Herter lays emphasis upon the thorough 
cleansing of the teeth so as to avoid infection 
of the food with the putrefactive bacteria 292 
COLON HYGIENE 
which develop in the mouth when the teeth 
are not well cleansed. 
Herter also prohibits the use of condi- 
ments, insists upon the thorough mastication 
of the food and calls special attention to the 
fact “that the intestinal contents of carnivora 
(meat-eating animals) contain many more 
putrefactive, spore-bearing bacteria than is 
the case with the herbivora.” 
Change of the intestinal flora is one of 
the most efficient of all means to be employed 
for combating constipation. This is true for 
the reason that putrefaction gives rise to am- 
monia and other alkaline products which 
paralyze the colon. That all alkalies have 
this effect is a well established physiologic 
fact, while it is equally well established that 
acids excite the colon to normal activity. The 
addition of the juice of one or two lemons to 
the water employed as an enema is an efficient 
means of stimulating the bowel when this is 
necessary. 
When the flora has been thoroughly 
changed, the normal acid-forming organism 
B. acidophilus being dominant, acids are con- 
stantly formed in the colon which excite it to 293 
CHANGING THE INTESTINAL FLORA 
normal activity and tend to restore it to a 
normal condition. 
The “Milk Regimen” 
Cow’s milk is not a complete food for 
grown-ups, either human or bovine. Milk is 
deficient in iron, and contains an excess of 
protein and lime. Cow’s milk disagrees with 
some persons, children as well as adults. It 
is, nevertheless, highly valuable as a supple- 
mentary food, and when properly employed, 
renders invaluable service in supplying lime 
and a superior quality of protein and other 
easily assimilable elements. 
The “milk regimen” differs from a milk 
diet in the fact that it requires the giving of 
milk in a particular way and in combination 
with bran and paraffin oil. The full details of 
the “milk regimen” are described in the au- 
thor’s work, “Autointoxication.” DIFFERENT FORMS OF STASIS 
AND CONSTIPATION 
Constipation is not a disease, but a symp- 
tom. It may have as many different causes as 
headache or inability to sleep. It is impor- 
tant to bear this fact in mind for the evident 
reason that a condition due to varied causes 
must require different measures of treatment. 
It is also important to recognize the fact that 
the real evil to be combated is stagnation, 
which may or may not be accompanied by 
constipation. 
Constipation is defined by the dictionaries 
as a condition in which “the evacuations are 
obstructed or stopped and the feces are hard 
and expelled with difficulty.” A medical 
dictionary defines constipation as “infrequent 
or difficult evacuation of the feces.” These 
definitions express the idea respecting the 
condition commonly known as constipation 
generally held by both the profession and the 
laity. Unfortunately, the word constipation, 
as thus defined, does not properly represent 
the fundamental condition of which the so- 
294 DIFFERENT FORMS OF STASIS 
295 
called constipation is a symptom only and 
which is the source of the toxemia, colitis 
and numerous other morbid conditions asso- 
ciated with constipation. This fundamental 
condition is stagnation or prolonged retention 
of the food residues and body wastes in the 
colon. This condition is technically known 
as stasis, a word derived from the Greek 
meaning stoppage. 
But stasis in the colon is not necessarily 
associated with either infrequent or difficult 
bowel movements. Not infrequently bowel 
movements are abnormally frequent and 
“loose” when very marked stasis is present. 
Frequent, loose stools are, in fact, present in 
a great many cases of autointoxication or in- 
testinal toxemia through long retention and 
consequent putrefaction of the colon contents. 
It is apparent, then, that the word constipa- 
tion does not really describe the condition 
with which we are dealing since we may have 
stasis with frequent movement as well as with 
infrequent evacuations. As a matter of fact, 
in the very worst cases of stasis, those in which 
the symptoms of autointoxication are most 
pronounced, six or even more bowel move- 296 
COLON HYGIENE 
merits may occur daily. What matters, is not 
that the bowels should move so frequently, 
but that the colon, at least the greater part 
of it, should be completely emptied at each 
movement. This is normally accomplished 
by three or four daily evacuations. When 
three complete evacuations occur daily there 
is little opportunity for the putrefaction of 
food residues and wastes in the colon and 
consequently the amount of toxins produced 
and absorbed will be small. On the other 
hand, when one evacuation occurs daily, the 
retention of fecal matters, as shown by Hurst 
and others, will be 48 hours or more, a period 
which allows abundant opportunity for pu- 
trefactive changes. But it is not to be for- 
gotten that there may be three or four or 
twice as many evacuations daily without the 
colon being at any time thoroughly emptied. 
This is, in fact, the condition usually present 
in chronic diarrhea. X-ray examinations 
made in these cases frequently demonstrate 
the retention of fecal matters for three to five 
days and in some cases even longer. It thus 
happens that many persons who think they 
are not constipated because their bowels move 297 
DIFFERENT FORMS OF STASIS 
daily, and who are not constipated in the 
sense in which the term constipation is ordi- 
narily used, may nevertheless be suffering 
from stasis and perhaps to a very high degree. 
These facts, which have been made clear 
by X-ray studies of the colon by physiologists 
and roentgenologists within the last twelve or 
fifteen years, require not only a new definition 
of constipation but a new classification of 
cases. Most cases of constipation may be di- 
vided into two classes: 
1. Simple or rectal constipation in which 
only the left half of the colon, or simply the 
rectum, is involved. 
2. Cecal constipation in which, although 
the entire colon is involved in the disease, the 
stasis or retention of fecal matters is chiefly 
confined to the cecum. 
In simple constipation the fecal matters ac- 
cumulate chiefly in the rectum and the pelvic 
colon where the fecal masses sometimes be- 
come so dry and hard that it is necessary to 
remove them by mechanical means. These 
hard, dry feces when examined are found to 
have comparatively little odor. The bacteria 
are nearly all dead, scarcely one per cent 298 
COLON HYGIENE 
being found alive, although Strassburger 
found in some cases that nearly one-half the 
whole fecal mass consists of dead and living 
bacteria. 
Cecal Constipation 
In cecal constipation the fecal matters re- 
main fluid. Because of this fact, together with 
their long retention, a very advanced stage of 
putrefaction is reached; hence the character- 
istic differences between the two forms of 
constipation, simple, or left sided, and cecal, 
or right sided. In left sided constipation the 
stools are hard, dry, infrequent and have little 
odor, and in many cases these patients show 
few of the symptoms of autointoxication, the 
chief symptoms being backache, sometimes 
headache and a coated tongue and slightly 
malodorous breath. 
In the right sided or cecal form of consti- 
pation the stools are loose and freqilent and 
are very foul smelling. Considerable quan- 
tities of mucus are often present and the gen- 
eral symptoms of autointoxication are usually 
pronounced. Achylia is frequently present, 
the tongue coated, the breath bad, the teeth DIFFERENT FORMS OF STASIS 
299 
usually badly decayed, the skin sallow, the 
urine concentrated and loaded with toxins, 
often showing casts, and in many cases the 
liver is found enlarged, and tests for renal 
efficiency show that the kidneys are becoming 
diseased. 
The so-called right sided, or cecal consti- 
pation, is the advanced stage of intestinal 
stasis. The history of these cases begins with 
ordinary simple constipation. The long re- 
tention of fecal matters in the lower part of the 
colon leads to infection and colitis with con- 
traction of the descending and pelvic colon as 
a result of which fecal matters are held back 
in the right side of the colon so that the stasis 
is transferred from the left side to the right 
side. The larger amount of water present 
with the food residues in this part of the 
colon encourages the development of putre- 
factive organisms in increased numbers and 
virulence, and the mucous membrane of the 
cecum becomes diseased. The infection may 
even extend to the small intestine. The 
cecum becomes dilated, adhesions of the ap- 
pendix or cecum are developed so that the 
cecum is not only weakened by the over- 300 
COLON HYGIENE 
stretching of its muscular walls but is held 
fast by adhesions so that it cannot perform its 
function of contracting upon its contents and 
lifting and pushing the food residues over 
into the transverse colon. The ileocecal valve 
is destroyed by the dilatation of the cecum 
and as a result the putrefying contents of the 
cecal cesspool are allowed to pass back into 
the small intestine. The active reverse move- 
ments which take place in the colon begin- 
ning soon after a meal tend to force the con- 
tents of the cecum back into the small intes- 
tine, thus increasing the absorption of putre- 
faction products. So long as these putresci- 
ble materials are retained in the colon the 
amount of absorption is comparatively slight; 
but when they are forced back into the small 
intestine, where absorption is exceedingly 
rapid, these putrefactive poisons rapidly find 
their way into the blood stream and give rise 
to the numerous disturbances which are 
rightly attributed to intestinal toxemia. Cecal 
constipation is thus only the advanced stage 
of simple or rectal constipation which begins 
with the lower bowel as the result of neglect 
to answer the call of nature for bowel move- 
ment. 301 
DIFFERENT FORMS OF STASIS 
Mixed Cases. In most cases of chronic 
constipation, both the right and left sides of 
the colon are affected. The disease, begin- 
ning in the rectum, has gradually extended to 
the whole colon. Colitis in some degree is 
practically always present. The rectum is 
insensitive, the pelvic or descending colon 
spastic and the cecum dilated; and in many 
cases there are adhesions of the cecum as well 
as a prolapsed and often adherent condition 
of the pelvic colon. These mixed cases are 
often named in accordance with the domi- 
nant symptoms present. If the stools are dry 
and the rectum much dilated and insensitive, 
the case is called rectal constipation. If the 
colon is highly spastic and the intestine sensi- 
tive and painful, spastic constipation will be 
the diagnosis. If stools are frequent and per- 
haps a little loose and very putrid, latent con- 
stipation will be the designating term. But in 
all cases, the fault is the same, stasis or delay 
in the disposal of the food residues and 
wastes, and all the various morbid conditions 
present are the results of the infection grow- 
ing out of putrefactive changes and the 
growth of pernicious bacteria in the colon. 302 
COLON HYGIENE 
In well pronounced cases of simple consti- 
pation, a considerable quantity of feces will 
always be found present in the rectum, al- 
though in a certain number of cases the ac- 
cumulation occurs only in the pelvic colon. 
The latter cases are sometimes the most diffi- 
cult of relief, because of the existence of ob- 
struction at the pelvi-rectal valve, or of adhe- 
sions of the pelvic loop to the floor of the 
pelvis. Sometimes the pelvic colon has be- 
come so large by overstretching that, when 
filled, it is so heavy that it cannot rise, but 
becomes impacted in the hollow of the sac- 
rum, folded upon itself and incapable of 
emptying itself. In such cases, bowel move- 
ments occur only as the result of pressure 
from accumulation of feces in the colon, a 
process which necessarily involves great dis- 
tension of the colon and resulting injury to 
its walls, and to the ileocecal valve, which is 
often rendered by this means wholly incom- 
petent. 
When in these cases of rectal constipation 
the bowels are made to move by straining 
efforts, the rectum is often not emptied. A 
few masses of hard, dry feces, sometimes a 303 
DIFFERENT FORMS OF STASIS 
single mass covered with mucus, may be ex- 
truded, but a thorough emptying of the bowel 
never occurs. In cases in which the rectum 
has not wholly lost its sensibility, the sense of 
weight and pressure often lead to many re- 
peated efforts during the day to relieve the 
bowels, with the result of securing perhaps 
each time a small movement. This has been 
termed “fragmentary constipation” by Boas, 
the eminent Berlin specialist, but it is only a 
form of simple constipation. 
A marked symptom of latent constipation 
when associated with incompetency of the 
ileocecal valve is the great amount of intes- 
tinal gas from which it is impossible to get 
entire relief. This is due to the fact that the 
gas generated in the colon escapes into the 
small intestine and cannot be wholly expelled 
because the colon discharges its contents in- 
ternally, into the small intestine, as well as 
externally. A copious hot enema usually af- 
fords relief in such cases. THE CARMINE TEST FOR INTES- 
TINAL MOTILITY 
The length of time required for the pass- 
age of material through the alimentary canal 
may be readily ascertained by the adminis- 
tration of some substance which will give to 
the intestinal contents a decided color which 
can be easily recognized. Animal charcoal, 
carmine and even highly colored fruit, such 
as the huckleberry, may be used for this pur- 
pose. It is necessary, of course, that while 
taking the test care should be taken to avoid 
taking foods of such a color as might lead to 
confusion with the color of the test substance. 
In applying the test, two capsules containing 
five grains each of carmine are usually given 
at breakfast, say at 8 A. M. Each stool is af- 
terwards examined and the time noted when 
the red color of the carmine appears. The 
examination of the stools continues until the 
color disappears. This time is also noted. 
From a large number of observations, sev- 
eral hundred, it has been determined that in 
a normal person the color should make its 
304 THE CARMINE TEST 
305 
appearance within twelve hours from the 
time it has been taken and should disappear 
within twenty-five hours. In a considerable 
number of persons, the color appears in less 
than twelve hours and disappears in eighteen 
hours or even less. It is probable that the 
shorter periods mentioned are more nearly 
the normal and that the periods of twelve 
hours for appearance and twenty-five hours 
for disappearance should be regarded as the 
extreme limits of normal motility. The nor- 
mal time for the stomach to empty itself is 
four to five hours. At the end of seven or 
eight hours, the small intestine should be 
emptied and the unutilized food residues 
should be found wholly in the colon. These 
residues normally find their way to the rec- 
tum in three or four hours more, and there 
seems to be no good reason why unusable and 
putrescible materials should be retained for 
a longer time, to undergo decomposition and 
contaminate the blood through the absorption 
of the poisonous products. 
In barnyard fowls, the length of time re- 
quired for food to traverse the entire alimen- 
tary canal is three hours and a half. In some 306 
COLON HYGIENE 
animals, the period is not more than one hour. 
In cases of chronic constipation, the time 
for the appearance and the disappearance of 
the test color is very greatly lengthened. The 
time of appearance is not infrequently pro- 
longed to twenty-four or thirty-six hours and 
the time of disappearance is, in a large pro- 
portion of cases, forty-eight hours or more. 
Seventy-two hours or three days is not an un- 
common observation, and the writer has ob- 
served cases in which the color did not dis- 
appear until the end of four days and, in one 
case, six days. Cases are occasionally ob- 
served in which the color disappears and then 
reappears. The explanation of this circum- 
stance is the existence of a greatly dilated 
cecum in which a portion of a meal may be 
retained while the residues of a subsequent 
meal pass over and on to exit. 
By means of the carmine test, the degree of 
stasis or stagnation of intestinal contents may 
be ascertained and the improvement resulting 
from diet or treatment may be observed. 
This test is one that ought not to be omitted in 
any case of obstinate constipation which does 
not readily yield to the measures applied and 
it is advantageous in all cases. THE TREATMENT OF 
CONSTIPATION 
Hygiene 
The first point of importance in the treat- 
ment of constipation is hygiene. Chronic ill 
health always involves, either primarily or 
secondarily, a lowering of the vital status, and 
is in most cases not a result of a single error 
in habits of life, but of numerous infractions 
of the rules of healthy or biologic living. So 
many different factors are involved in the 
function of bowel movement, that it is highly 
essential that a person who is suffering from 
chronic constipation should seek by every 
available means to improve his general 
health, and thus increase the vigor of all his 
bodily functions. Disease is cured by the 
body itself, not by doctors or remedies. 
If one’s habits have been sedentary, he 
must make a radical change in his mode of 
life. When possible, a change from an in- 
307 308 
COLON HYGIENE 
door employment to an active occupation out- 
of-doors is most desirable. 
If the circumstances of life have been such 
as to give rise to worry or nervous depression, 
some change should be effected by which the 
causes of irritation and depression may be 
gotten rid of; or the individual should, by 
the cultivation of optimism, endeavor to rise 
above the influence of his surroundings. 
Constipation is in most cases simply one of 
the unhappy results of the artificial condi- 
tions imposed upon us by modern civilized 
life. The only escape from this terrible 
handicap of all useful human activities is to 
be found in a rational return to Nature, in 
the adoption, so far as is necessary to secure 
the physiological conditions, of natural and 
primitive habits, particularly in reference to 
diet, sleep, exercise, and out-of-door life. 
Before proceeding further the reader who 
is making a serious study of this subject is 
asked to re-read carefully two of the preced- 
ing chapters, entitled, “Influences Which 
Normally Excite the Movements of the 
Colon” and “Influences Which Discourage 
or Lessen Intestinal Movements,” bearing TREATMENT OF CONSTIPATION 
309 
always in mind the fact that for the success- 
ful treatment of constipation every possible 
factor which aids bowel activity must be 
utilized, and that every factor which has a 
discouraging influence must be most carefully 
avoided. 
Constipation Always Curable 
Every person who undertakes to combat 
constipation should know at the start that his 
efforts if thorough-going and persistent may 
be expected to win. There are many thou- 
sands of sufferers who have become utterly 
discouraged through unsuccessful efforts and 
have become convinced that the malady is 
incurable, and that nothing more can be done 
than to mitigate the evils of the malady as 
much as possible by laxative drugs notwith- 
standing their well-known evil effects. There 
are many thousands of others who depend 
wholly upon the use of laxative drugs or min- 
eral waters for bowel movements, who are 
unaware of the harmful effects which inevi- 
tably result from the long continued use of 
drugs which force bowel movement by creat- 
ing an artificial irritation. The majority of 310 
COLON HYGIENE 
such persons are always looking for some new 
laxative drug to take the place of one which 
has lost its effects, fully believing that there 
is no other way. 
There is apparently a widespread belief 
that constipation is incurable. This hopeless 
view, quite generally held by the laity, is the 
very natural result of the wrong methods 
which are generally employed, and the great 
ignorance concerning the intimate nature and 
causes of constipation. This ignorance has 
been quite excusable, however, because of the 
lack of scientific knowledge respecting the 
physiology of bowel action. But now that the 
light of new discovery has illuminated this 
dark corner of human physiology, the treat- 
ment of constipation is no longer necessarily 
a hopeless groping in the dark but may be 
made a regular organized campaign against 
an enemy whose nature and favorite haunts 
are known and against which recent medical 
science has provided efficient weapons. 
And a veritable campaign the effort must 
be if. success is to be attained in really grave 
cases. But victory may be attained in every 
case. It must be understood, however, that 311 
TREATMENT OF CONSTIPATION 
there is no panacea for constipation. There 
is no simple means by which all cases may be 
cured, and some cases require the simulta- 
neous employment of almost every known ra- 
tional remedy. A very few cases require the 
aid of surgery; and even surgery seldom suc- 
ceeds when made the sole reliance. Fortu- 
nately surgery is very rarely needed when all 
other means are efficiently used. 
What Is a Cure of Constipation? 
When a child has measles or scarlatina or 
when a person suffers an attack of typhoid 
fever, the usual result under modern manage- 
ment is such a recovery that no traces of the 
disease or its effects are discoverable. The 
individual is apparently as well in every re- 
spect as before the illness. Modern medical 
research has taught us, however, that this 
completeness in recovery is more apparent 
than real. Besides the permanent injuries to 
eyes and ears, which are often left after mea- 
sles and scarlet fever, there are not infre- 
quently far more serious injuries to heart, 
lungs, or kidneys. And statistics show that 
whenever typhoid fever and small-pox are 312 
COLON HYGIENE 
prevalent, pulmonary tuberculosis increases. 
Thus we know that recovery does not really 
mean, even in acute disease, absolutely com- 
plete restoration to former soundness. 
In chronic disease this is still more evident. 
An attack of acute disease is like a sudden 
outburst of flame in a dwelling from the up- 
setting of a lamp or from some similar acci- 
dent. The fire is usually quickly extin- 
guished and the house itself is little injured. 
A chronic malady is often like a fire which 
has begun in the basement of the house and 
has gradually worked its way up in the inner 
walls until it has reached the top and burst 
out in flame through the roof. Acute disease 
we may say is analagous to a fire in a house 
while chronic disease is a fire of a house. In 
lung tuberculosis a cure means an arrest of 
the disease process and a healing of ulcerated 
surfaces in the lung; but lung tissue which 
has been destroyed is not restored; and the 
consumptive who has been cured by the out- 
of-door life and other means must continue 
to employ the essentials of the curative treat- 
ment in order to keep well. No consumptive 
can expect to remain well if he returns to the TREATMENT OF CONSTIPATION 
313 
old conditions of life under which he became 
ill. He must make a radical change in his 
habits of life and the change must be perma- 
nent. In case of an injury to a leg, the pa- 
tient may recover, but with the loss of a leg. 
By the aid of an artificial leg he will be able 
to walk very well, but not so well as with a 
natural limb. 
The situation is exactly the same in consti- 
pation. In very chronic cases, much irrepar- 
able damage has been done. The colon has 
been permanently crippled. The art of treat- 
ment is to find out the exact nature of the 
injury and to find means for supplying the 
needed aid, much as an artificial leg in a 
large measure supplies the place of a missing 
limb. These measures must be such as render 
aid in a physiologic way, and must be harm- 
less in character. When once the necessary 
means have been found and adapted to the 
individual case they must be perseveringly 
employed not for a few days or weeks or 
months; their use must become a life habit. 
In general it is usually possible to secure such 
a degree of improvement that a few and sim- 
ple means will afford all the aid required, al- 314 
COLON HYGIENE 
though at first the concerted use of many 
measures may be required. 
If, for example, it is found that the addi- 
tion to the food of a liberal quantity of ster- 
ilized wheat bran will secure three normal 
bowel movements daily, this simple means 
must be faithfully used, not only daily, but 
at every meal. If it is found that the bowels 
are ready for evacuation at a certain hour, 
a natural “call” being experienced at that 
time, this hour must be religiously set aside 
for this duty. Nothing should be allowed to 
interfere with this duty. Whatever plan or 
program is found to secure efficient bowel 
action, this program must be carried out 
every day with greatest circumspection. Na- 
ture must not be discouraged or thwarted in 
her efforts. Every pains must be taken to 
foster every symptom of returning normality 
in bowel functions. When a “call” occurs, 
it must be answered at once. The delay of a 
few minutes only may extinguish the effort 
Nature is making to re-establish the normal 
rhythm. It takes considerable will and char- 
acter to conquer constipation as well as 
knowledge and perseverance. But the gain TREATMENT OF CONSTIPATION 
315 
in clearness of mind, zest for work, endur- 
ance of mind and body, and general effi- 
ciency, to say nothing of such gains as keen- 
ness of appetite, sweetness of breath, clear- 
ness of skin, sound sleep and sense of joy in 
being alive, are ample compensation for the 
effort required. If it is a life-long battle to 
conquer constipation, it may be a winning 
battle and one which lengthens one’s days and 
wonderfully increases capacity for useful ac- 
tivity and enjoyment of life. 
When Is Surgery Needed? 
It will not be possible to review in a brief 
paragraph the various opinions which have 
been expressed by eminent medical authori- 
ties respecting the indication for surgical re- 
lief in cases of obstinate constipation, nor to 
offer the reasons for or against the various 
surgical procedures which have been pro- 
posed. .It must suffice simply to enumerate 
the principal conditions concerning which 
the consensus of authoritative surgical opin- 
ion is settled and clearly defined. 
Constipation due to organic obstruction re- 
sulting from tuberculosis, cancer, or other 316 
COLON HYGIENE 
morbid growths, necessarily requires surgical 
interference, and an abdominal surgeon should 
be consulted at once, one experienced in in- 
testinal surgery. This is important, for in sur- 
gery of this character results depend almost 
wholly upon exactness and perfection of 
technic, such as can be gained only by long 
and extensive practice. 
Chronic as well as acute appendicitis is a 
condition which may open the way for relief 
of constipation by removal of an active cause. 
This is especially true in cases in which an 
X-ray examination shows many adhesions 
about the inflamed appendix, which fix the 
cecum so that it cannot empty itself or per- 
haps cause obstruction of the lower end of 
the small intestine. The necessity for opera- 
tion may exist in cases of this sort, even when 
little pain is felt in the region of the appen- 
dix. Not every case in which such adhesions 
exist, however, requires operation. By far 
the great majority may be substantially re- 
lieved by non-surgical measures. 
Adhesions of the ascending or descending 
colon, and especially adhesions which com- 
press the pelvic colon and limit its move- TREATMENT OF CONSTIPATION 
317 
ments, may be relieved by appropriate sur- 
gical procedures when other means fail. 
These cases seldom require removal of the 
colon or any portion of it, or even the so- 
called short-circuiting operation which af- 
fords only very temporary relief unless care 
is taken to restore the ileocecal check valve. 
When adhesions of the pelvic colon are 
broken up the pelvic loop must be suspended 
in such a way as to prevent the reproduction 
of the restricting adhesions which will almost 
certainly occur unless some efficient means 
of prevention is adopted. 
A very definite indication for operation in 
certain cases in which other means fail is in- 
competency of the ileocecal valve accompa- 
nied by very pronounced stasis or stagnation 
in the small intestine. This condition is 
sometimes accompanied by the most incor- 
rigible constipation and by most pronounced 
intestinal toxemia as shown by enormous 
quantities of indican and other putrefactive 
products in the urine and by intractable head- 
aches. An operation has within a few years 
been devised by which the incompetent valve 
may be repaired so as to effect a radical cure 318 
COLON HYGIENE 
of the incompetency of the valve and, for- 
tunately, without any considerable degree of 
risk. This operation has been now per- 
formed in a sufficient number of cases to 
demonstrate its value in cases which do not 
yield to other measures. 
The perfection of practical methods for 
changing the intestinal flora by means of which 
the change may be accomplished with reason- 
able promptness in practically all cases have 
rendered unnecessary most of the operations 
devised by Lane and others for the cure of 
intestinal stasis. Even at Guy’s Hospital, 
London, where Mr. Lane developed his op- 
erations for short circuiting and removal of 
the colon, according to recent reports, these 
operations are no longer performed, or at 
least are resorted to only very rarely. When 
the flora has been thoroughly changed, stasis 
usually disappears. If there still remains 
some degree of stasis no harm is done because 
putrefaction with the resultant development 
of poisonous products is .prevented. 319 
TREATMENT OF CONSTIPATION 
Regularity of Meals Necessary 
The bowels do not move without a reason 
for moving. The pelvic colon is an ejecting 
apparatus for expelling fecal residues, which 
works only when brought into action by the 
reflex nervous mechanism which comprises 
the nerves of the rectum, the defecating cen- 
ter, and the connecting nerve trunks. The 
entrance of food into the rectum is like the 
closing of a switch which controls the start- 
ing and stopping of a motor. When the rec- 
tum is distended, the nerves are stimulated, 
and in turn excite the defecating center 
where they originate. From this center are 
sent out impulses which cause the pelvic 
colon to contract strongly and empty itself. 
In doing this it is assisted by strong contrac- 
tions of the abdominal muscles and of the 
rest of the colon. 
This process, it must be remembered, is 
set in operation only when there is a sufficient 
movement of feces from the pelvic colon, 
where the feces are stored, into the rectum, 
to produce the necessary amount of stimula- 
tion. As we have already seen, this is accom- 320 
COLON HYGIENE 
plished, normally, by peristaltic movements 
set up by taking into the stomach relishable 
food. In constipation, these stimulating re- 
flexes are often weak, and must be reinforced 
by every means possible. Hence the diet 
must be so managed as to secure the maxi- 
mum amount of stimulating influence upon 
the lower bowel. Eternal vigilance is neces- 
sary; every meal must be taken with refer- 
ence to the bowel action. A single omission 
of a meal, or a meal of unsuitable food, may 
be sufficient to produce stagnation, and unless 
this is at once corrected, the most serious re- 
sults may follow. The taking of food, then, 
serves a double purpose; it supplies the body 
with needed nourishment and at the same 
time furnishes the impulse needed to enable 
the body to get rid of the unusable residues of 
a previous meal and of a portion of its con- 
stantly accumulating intestinal excretions. So 
if regularity of bowel movement is to be ex- 
pected, care to take the food at regular inter- 
vals becomes a matter of absolute importance. 
With the savage, regularity of bowel move- 
ment is not a matter of so great importance, 
for the reason that he is rarely so situated TREATMENT OF CONSTIPATION 
321 
that he cannot respond quickly to the “call” 
for evacuation. But civilized human beings 
by their systematic and, in general, their 
closely occupied life, must often find them- 
selves in circumstances which compel a con- 
siderable delay in answering the “call” with- 
out being seriously incommoded. Rather 
than interrupt the normal rhythm, even on 
2. single occasion, it would be better to incur 
a very considerable degree of inconvenience, 
a fact which the constipated must take to 
heart and carry in mind; but it is better to 
observe such an order of life and such regu- 
larity of habits as will cause the bowels to 
move at a time at which they may without 
haste or inconvenience receive the leisurely 
and thorough attention which the importance 
of this function demands. 
Every meal must contain foods which will 
leave a sufficient amount of residue to prevent 
stagnation. To neglect this fact on a single 
occasion may, in the case of a constipated per- 
son, who by careful attention to regimen has 
established regular bowel habits, cause the 
beginning of a return of all the old condi- 
tions. 322 
COLON HYGIENE 
Too much emphasis cannot be laid upon 
the absolute and unfailing faithfulness re- 
quired to maintain the improved condition 
which may have been attained. The major- 
ity of cases of constipation relapse sooner or 
later, but chiefly because patients return to 
their old irregular and careless habits. 
Drugs are resorted to because by their use 
the difficulty is temporarily overcome with so 
much less trouble and self-control than is 
needed for the complete regulation of one’s 
habits of life, especially in relation to eating. 
Sufficient care in the matter of diet will be 
followed by success in nearly all cases of 
simple constipation. It is necessary, however, 
that the proper regimen should be strictly 
and uninterruptedly followed. 
Supplementary Bowel Movements 
The act of defecation must be made as 
complete as possible. The rectum and lower 
bowel are often filled with dry feces which 
are an obstacle, the removal of which by pa- 
tient and continued effort may be followed by 
a full and natural movement, 323 
TREATMENT OF CONSTIPATION 
Sometimes a partial movement will be fol- 
lowed by another, within a half hour or less. 
Many persons evacuate their bowels in the 
morning by two movements, one on rising 
and the other soon after breakfast. What- 
ever may be the vagaries of the individual 
colon, if it can be persuaded to act at all, 
other things must be accommodated to its 
need. In many cases, always when the move- 
ment seems less complete than usual, it is 
wise to give the bowels a second opportunity 
for movement a few minutes or half an hour 
later. If a second “call” is experienced, the 
matter should not be ignored, but should re- 
ceive instant attention. The moving of the 
bowels is a matter of equal importance with 
the taking of meals, and should be given the 
same consideration. A crippled colon must 
be humored and coddled, so to speak, and in 
many cases apparently hopeless the colon may 
be trained back to habits of normal activity 
and regularity. It must not be expected, how- 
ever, that this will be accomplished in a day 
or a few days. Many months of patient effort 
may be required. 324 
COLON HYGIENE 
Give the Colon Time for Action 
A hurried visit to the toilet does not give 
the colon time for efficient action. Great 
haste may cause spastic contraction and pre- 
vent evacuation. 
The colon is not completely filled with 
fecal matter except in cases in which the 
bowels move but once a day or less frequently 
so that there is an accumulation of food resi- 
dues which completely fill and distend the 
gut. Under normal conditions the lower 
bowel or pelvic colon acts as a reservoir for 
the food residues which are ready for dis- 
missal, and when this part of the intestine is 
filled and begins to overflow into the rectum, 
a reflex is set up which empties the pelvic 
colon. It sometimes happens that the whole 
left half of the colon is emptied by the same 
contraction that discharges the contents of the 
pelvic colon, but not infrequently the first 
evacuation only empties the pelvic colon, 
while at the same time starting a movement 
of material along the descending colon which 
a few minutes later reaches and again fills 
the pelvic colon and so leads to a second TREATMENT OF CONSTIPATION 
325 
evacuation. On this account sufficient time 
should be allowed at the toilet to permit the 
bowel to bring down a second or a third in- 
stallment of fecal residues. The five or even 
ten minutes devoted to this purpose will be a 
good investment. When sufficient time is not 
given for complete evacuation, the retained 
fecal matters often become dry and impacted 
and the next evacuation will not occur at the 
proper time, and when it does occur may re- 
quire straining and cause hemorrhoids or fis- 
sures which usually disappear when bowel 
movements are frequent, regular and of nor- 
mal character. 
Do Not Worry 
Worry, or apprehension about the condi- 
tion of the colon, or possible failure of evacu- 
ation, may become a serious cause of consti- 
pation. There is little room for doubt that 
depressing emotions have the effect to cause 
i strong spastic contraction of the descending 
colon which presents an almost impassable 
bar to evacuation. The movements of the 
colon, like those of the heart, stomach, liver 
and other vital organs, are normally auto- 326 
COLON HYGIENE 
matic. They cannot be controlled by the 
human will, of which they are altogether in- 
dependent; but all these organs may be 
powerfully influenced by the imagination. 
Powerful emotions, fear, disappointment or 
even joy, may double the rate of the heart 
beat or even cause the heart to cease to beat. 
Anger, bad news, or even the memory of a 
disgusting sight or smell, may reverse the ac- 
tion of the stomach and cause vomiting. 
One must keep on good terms with his 
waste disposal system if he expects it to op- 
erate efficiently, or at least he must avoid in- 
terference through obstructive mental activ- 
ity. If one feels sure his bowels are not going 
to move they probably will not move; on the 
other hand, confidence and expectation added 
to a proper preparation by rational diet and 
other measures are the best assurance of nor- 
mal functioning. 
The psychologist eliminates the element of 
fear and establishes a healthful mental state 
by requiring his patient to rapidly repeat 
over and over some phrase such as “I am get- 
ting better and better every day in every 
way.” There is no healing magic in these TREATMENT OF CONSTIPATION 
327 
phrases; they simply serve to establish a 
hopeful, expectant mental state which pre- 
vents the obstructive action of depressing 
emotions and thus permits the automatic 
mechanism to operate in a normal manner. 
So the constipated person should not find 
fault with his colon and should refuse to 
entertain the idea that he is incurably consti- 
pated; but after making use of the rational 
measures recommended in this book should 
confidently expect the good results which he 
is practically certain to realize. To divert 
the mind from unpleasant memories and to 
insure giving the colon time for action it is a 
good plan to occupy the mind pleasantly 
while waiting at the toilet by reading a morn- 
ing paper or some other entertaining litera- 
ture. 
When the colon has by careful manage- 
ment once become established in normal hab- 
its, the greatest care must be exercised to 
avoid interrupting the daily rhythm. A cer- 
tain time must be set apart for evacuation 
and the hour must be religiously observed. 
Nothing should be permitted to delay imme- 
diate attention to the slightest “call.” In 328 
COLON HYGIENE 
this way, very badly crippled colons have 
been restored to a very nearly normal condi- 
tion. The colon must be treated with due 
respect and consideration. A little neglect 
will quickly bring back all the old miseries. 
Just one failure to evacuate at the usual hour, 
one meal without the proper amount of 
roughage, even the missing of a meal, or the 
omission of the very necessary lubricating oil, 
or neglect to keep the flora changed, may 
necessitate some days or weeks of most pains- 
taking effort to reestablish normal regularity. 
The Rational Treatment of Constipation 
Many of the causes of constipation, and 
many of the influences connected with every- 
day life which tend to produce this condition, 
have been already discussed with some detail, 
and need not be reconsidered here. The 
bearing of each one of these causes should be 
considered in each individual case, and not 
one unfavorable influence should be permit- 
ted to remain. 329 
TREATMENT OF CONSTIPATION 
Clothing 
This has a very much more direct bearing 
upon the functions of the colon than might at 
first be supposed. Corsets and belts, as has 
already been shown, tend directly to pro- 
duce constipation by hampering the move- 
ments of the diaphragm, preventing proper 
development and activity of the abdominal 
muscles, and causing displacement of the 
colon and other viscera into the lower portion 
of the abdomen. Excess of clothing tends in 
the same direction by overheating the body 
and producing excessive perspiration and re- 
laxation of the muscular structures of the ab- 
domen, and perhaps also of the intestines. 
Proper clothing of the feet is a matter of 
no small importance. Chilling of the feet 
may cause spastic contraction of the descend- 
ing colon and thus render the bowel incap- 
able of promptly discharging its contents. 
The feet must be kept dry and warm. Shoes 
must be comfortable. Shoes which pinch the 
feet or cause flat foot, may make the colon 
spastic. 330 
COLON HYGIENE 
Sleep 
The important relation of sleep to consti- 
pation is shown by the fact that loss of sleep, 
or a change of sleeping hours from night to 
day, very quickly upsets the bowel rhythm 
when it is nicely balanced in a person of sed- 
entary habits. Cannon showed that the bowel 
contents advance very slowly during sleep, 
but very rapidly during and directly after 
eating. It is known, also, that sleep slows the 
movements of the stomach and intestine. Evi- 
dently sleeping after eating must tend to 
constipation by interfering with the normal 
advance of the colon contents toward the exit. 
Loss of needed sleep does not, however, 
increase bowel activity, but rather has an op- 
posite effect, doubtless because of its general 
depressing effects. This is shown in the lack 
of appetite and in the coating of the tongue 
which result from loss of sleep. Relish for 
food is one of the normal stimuli of the in- 
testines. The increased nerve “tension” noted 
in persons who have been deprived of sleep, 
and especially in persons who suffer from in- 
ability to sleep, is manifested in many very TREATMENT OF CONSTIPATION 
331 
definite ways, one of which is a very pro- 
nounced contraction of the descending colon. 
The colon is often so firmly contracted as to 
be completely closed up, and it may be felt 
low down in the right side of the abdomen 
and rolled under the finger and gives an im- 
pression resembling that of a piece of firm 
rubber tubing. 
Posture During Sleep 
This is by no means a matter of no impor- 
tance. Gravity exerts a decided influence 
upon the contents of the stomach and intes- 
tines in states of disease, although the influ- 
ence of this force is of little moment in condi- 
tions of health. In health the food is grasped 
by the digestive tube as soon as it reaches the 
back of the throat, and this vital grip is main- 
tained until the residue of the food is cast out 
at the anus. 
In disease, the situation may be greatly 
changed. The walls of the stomach, instead 
of contracting upon the food and kneading it, 
may be relaxed and hanging loosely sepa- 
rated like the sides of a bag. The stomach 
no longer grips the food, and so gravitation 332 
COLON HYGIENE 
controls it to a large degree. Under these 
circumstances it is best for the patient to lie 
upon the right side in case a meal has been 
eaten within two or three hours before going 
to bed, or if there is evidence of the presence 
of food or liquid in the stomach on retiring. 
When the cecum is known to be dilated 
and the seat of stagnation, it is well to sleep 
upon the left side, so as to facilitate the move- 
ment of food along the relaxed colon. 
In cases in which the abdominal muscles 
are much relaxed and the whole colon di- 
lated, so that intra-abdominal pressure is 
much reduced, it is well to lie upon the face, 
so that the weight of the body may by con- 
stant pressure upon the abdominal contents 
aid the progress of the feces along the crip- 
pled colon. Thin persons may often adopt 
with advantage the practice of sleeping on 
the face with a pillow beneath the abdomen. 
Backache, and various discomforts in the ab- 
domen, especially in cases of colitis, may 
often be relieved by this simple procedure. 
Persons whose stomach and intestines are 
much relaxed and sluggish in consequence 
are much benefited by lying upon the TREATMENT OF CONSTIPATION 
333 
face for half an hour or an hour after each 
meal. This not only aids the passage of 
liquids from the stomach, but helps the colon, 
and prevents the excessive congestion of the 
viscera, which naturally results from the ex- 
citement of digestion when the intra-abdom- 
inal pressure is very low. The nervousness 
from which many dyspeptic and constipated 
persons suffer after eating may often be re- 
lieved and prevented by half an hour’s rest 
lying upon the face after meals. It should 
be observed that it is not well to sleep long 
after eating, though a short nap, lying on the 
face, will do no harm and may encourage 
bowel action. DIET IN CONSTIPATION 
The writer once asked a celebrated Vienna 
professor, “What do you do for constipa- 
tion?” The reply was, simply, “Diet.” “But, 
professor, what do you do for cases in which 
diet and all other means have failed?” The 
reply was, “Diet, only diet.” In explanation 
the professor added that more bulk was 
the thing most needful, adding more and 
more daily until the bowels were made to 
move. 
Proper regulation of diet is certainly the 
most important of all measures to be adopted 
in the treatment of constipation, although 
there are other measures which are too valu- 
able to be neglected. A practical cure may 
in many cases be effected by this means alone, 
provided, of course, that proper attention is 
given to ordinary bowel hygiene. No at- 
tempt should ever be made to treat a case of 
constipation without proper regulation of 
diet. Such a course, no matter how gratify- 
ing may be the results for the time being, 
must end in disaster; for a physiologic diet 
334 DIET IN CONSTIPATION 
335 
is of all things most essential for securing 
normal action of the intestines. 
First of all, the fact should be recognized 
that food is Nature’s laxative. Natural food 
taken in the proper manner and at proper in- 
tervals gives to the alimentary canal just the 
kind and amount of stimulation that is re- 
quired to maintain the normal procession of 
material along the digestive tract, and to ef- 
fect the prompt discharge of unusable resi- 
dues and poisonous wastes from the body. 
As has been pointed out in preceding chap- 
ters, one of the effects of eating is to set up in 
the stomach a series of vigorous peristaltic 
movements, which pass from the stomach 
along the whole length of the digestive tube. 
Under normal conditions these movements 
are sufficient to cause the fecal remains of a 
preceding meal to move down into the lower 
and discharging part of the colon, thus setting 
up the reflex actions which result in their 
evacuation. This statement is not based upon 
theory alone, but is founded upon careful ob- 
servations by expert roentgenologists, made 
upon the stomach and intestines with the X- 
ray after the administration of the bismuth 336 
COLON HYGIENE 
meal. It also agrees with the every-day ex- 
perience of normal persons. The natural 
time for the bowels to move is soon after eat- 
ing, and under fully natural conditions a 
bowel movement occurs after each meal. The 
writer has met a number of persons whose 
intestines were so sensitive to the stimulation 
of food that the taking of food at any time, 
even in a small quantity, had the effect to 
produce within a few moments a call for 
evacuation. Cases are occasionally met in 
which the taking of food produces such strong 
stimulation that the patient finds it difficult 
to finish a meal without interruption by the 
demand of the bowels for evacuation. 
In the dietetic treatment of constipation, 
it is necessary to understand the particular 
properties of food stuffs to which stimulation 
of the intestinal movements is due, and to 
make use of these several qualities as they 
may be required in individual cases. 
The Laxative Properties of Foods 
The properties, of food stuffs to which a 
laxative influence is due may be briefly enu- 
merated as follows: DIET IN CONSTIPATION 
337 
1. Sapid qualities to which flavor or tastes 
are due. 
2. Bulk, or rather the presence of cellu- 
lose, which is capable of forming an indi- 
gestible residue. 
3. Moisture, that is, a necessary amount of 
liquid taken at meals or between meals, es- 
pecially in connection with cellulose which 
by absorbing water holds it in the intestine. 
4. Chemical properties which result from 
the presence of sugars and organic acids in 
the food, including the sugars formed by the 
digestion of starch, and the lactic acid formed 
by the fermentation of sugar in the intestine. 
Fats are also somewhat laxative. 
In the regulation of the diet for the relief 
of constipation, the aim must be to make such 
selection of food stuffs as will furnish these 
various laxative properties in the measure re- 
quired by the individual case. This is by no 
means a simple matter, and requires, first, a 
very thorough knowledge of food values and 
second, a most thoroughgoing investigation of 
each individual case, so that not only the par- 
ticular form of constipation from which he is 
suffering may be fully known, but also at 338 
COLON HYGIENE 
what point or points in the intestinal track 
the delay occurs, and the cause of the delay. 
The force of this statement will be fully ap- 
preciated if the chapter on “Causes of Con- 
stipation” has been read with care. 
Atoxic and Antitoxic Properties of Foods 
In addition to the laxative properties of 
food stuffs, there is another quality of equal 
importance, which must be duly considered 
in the treatment of constipation, because of 
the prolonged stay of undigested food rem- 
nants and body wastes in the food canal 
and of the tendency to delay which will al- 
ways remain, even under the best conditions 
which can be supplied. It is of the highest 
importance that the food should be of such a 
character as to prevent as far as possible the 
putrefactive changes which are always in- 
creased, and often to an extraordinary degree, 
whenever there is delay. 
Of the three essential food elements, car- 
bohydrates (starch, sugars and organic acids), 
fats, and proteins, the last named only is cap- 
able of undergoing putrefaction. Foods rich 
in starch and sugar do not undergo putrefac- DIET IN CONSTIPATION 
339 
tion, either outside the body or within the in- 
testine, and hence, are properly termed 
atoxic foods. 
Fats in excess encourage putrefaction, 
while starch and sugar in excess produce the 
opposite effect. By the fermentation of 
starch and sugar in the intestine, acids are 
formed, which, as has already been pointed 
out, by interfering with the growth of putre- 
factive bacteria, prevent putrefaction. Fats 
ferment, when taken to excess, forming bu- 
tyric acid, an irritant poison. 
Fruits, starch in vegetables like the potato, 
and green vegetables of all sorts, which con- 
tain little or almost no protein, together with 
certain sugars, especially milk sugar, maltose 
or malt sugar, and the sugar of fruits, and to 
a less degree cereals, particularly rice, which 
are very rich in starch, are not only atoxic, 
being incapable of putrefactive changes, but 
are also highly antitoxic, since they in a high 
degree promote the formation of acids in the 
intestine. 340 
COLON HYGIENE 
Antitoxic Value of Uncooked Foods 
A most important point in connection with 
this subject, which appears to have been over- 
looked by writers on dietetics, is the antitoxic 
value of uncooked foods. Man is the only 
“cooking animal.” To primitive man cook- 
ery was not only unknown, but was as un- 
necessary as for any other member of the 
animal kingdom. The only really valuable 
purpose served by cookery is to enable man to 
make use of dried grains and certain coarse 
vegetables, which would otherwise be una- 
vailable as food. Experience has proved that 
food is often by cookery deprived of certain 
elements which are essential to human nutri- 
tion. The argument made by certain faddists 
who advocate the exclusive use of a raw diet, 
that by cookery the life principle is driven 
out of the food so that its nutritional value is 
lost, has no scientific basis; nevertheless, it is 
true that cookery destroys the life of the cells 
of vegetable foods, and in so doing, deprives 
the food of certain properties which are use- 
ful in the intestine. Living cells resist the at- 
tacks of the microbes which produce fermen- DIET IN CONSTIPATION 
341 
tation and putrefaction. A raw apple or po- 
tato remains intact for months, while a cooked 
apple or potato is in a few days covered with 
mold, and is in an active state of fermentation 
and destructive change. 
In the light of modern researches it appears 
that the chief advantage gained in the use of 
raw food is due to the fact that cooking 
greatly injures or destroys the anti-scorbutic 
vitamin which is essential to good nutrition. 
Much chronic illness is due to this cause. 
There is reason for believing that this vita- 
min aids bowel action (McCarrison). In 
its absence constipation and autointoxication 
are very pronounced. 
An experiment made by the writer some 
years ago gave very positive evidence of this 
fact. Two equal portions of cabbage were 
taken. One portion was cooked. Both por- 
tions were then inoculated with equal quan- 
tities of putrefactive bacteria, by mixing with 
each a portion of fecal matter. The two por- 
tions of cabbage were then placed for twenty- 
four hours in an incubator in which the tem- 
perature of the body was maintained. Exam- 
ination showed that the bacteria in the cooked 342 
COLON HYGIENE 
cabbage had increased enormously in num- 
bers, whereas in the uncooked cabbage the 
number of bacteria had not increased, but 
had actually diminished. 
Many persons have thought themselves 
benefited by the use of raw grains, such as 
wheat and oatmeal. While it would be im- 
possible for a person to live on a diet con- 
sisting exclusively of raw grains, it is possible 
that some benefit may be derived from the 
use of such food to a moderate extent, through 
the fact that uncooked starch digests slowly. 
Cooked starch, as well as sugar and other 
carbohydrates, is normally wholly absorbed 
in the small intestine, or practically so, and 
therefore furnishes no resistance to the growth 
of bacteria; but raw starch, if taken in more 
than minute quantities, as the writer has 
shown by experiment, finds its way in con- 
siderable quantities into the colon. Here, di- 
gestion slowly proceeds, producing dextrin 
and sugar, which furnish to the acid-forming 
bacteria just what they require for their 
growth in a section of the intestine where the 
help of these friendly organisms is most 
needed. Man’s natural dietary comprises food DIET IN CONSTIPATION 
343 
containing a sufficient amount of raw starch 
to prevent extensive putrefaction in the colon; 
and therefore the art of cookery, while essen- 
tial under the conditions of modern civiliza- 
tion, is not altogether free from disadvan- 
tages, which, however, may easily be obvi- 
ated by a proper selection of foods or, in 
special cases, by including in the ordinary 
bill of fare partially cooked foods containing 
a certain portion of uncooked starch such as 
oatmeal or other grains cooked six to ten 
minutes. 
Fruits are the most highly antitoxic of all 
food stuffs. They possess in a high degree all 
the antitoxic properties of food. 
They are most acceptable in an uncooked 
state, both to the palate and to the digestive 
organs. They are completely prepared for 
human sustenance in the great laboratory of 
Nature “cooked in the sun,” as they say in 
Mexico. “Cocido en el sol?” asked a native 
fruit seller of the writer, who was seeking to 
purchase some tropical fruit in the market 
place of a town in Old Mexico. 
With very rare exceptions, fruits contain a 
considerable amount of organic acids—citric, 344 
COLON HYGIENE 
malic or tartaric,—all of which possess anti- 
toxic properties. Even many sweet fruits 
contain a considerable amount of these acids, 
which are disguised by the sugar, but which 
are not neutralized or destroyed by it. 
The sugars of fruits promote to a high de- 
gree the growth of acid-forming bacteria in 
the intestine, and thus lead to the formation 
of lactic acid, which, like the acids of fruits, 
is antitoxic. 
The antitoxic properties of fruits, though 
not understood until revealed by bacterio- 
logical researches of recent years, have long 
been utilized in a practical way in what is 
known as the fruit cure, the value of which 
in the treatment of chronic bowel disorders 
has been well understood for centuries. The 
grape cure of Switzerland and certain parts 
of Germany, the cherry cure advocated by 
Linnaeus, the great botanist, and similar 
“cures” through the use of apples, peaches, 
and other fruits, practised in several coun- 
tries, owe their value to the antitoxic proper- 
ties of these choicest of Nature’s products. DIET IN CONSTIPATION 
345 
The Antitoxic Laxative Diet 
Every constipated person, then, requires a 
bill of fare consisting of antitoxic and laxa- 
tive foods. It is most essential that his diet 
should eliminate flesh foods of all sorts, in- 
cluding fish, oysters, fowl, as well as beef- 
steaks, chops, and other red meats. In many 
cases it is also wise to avoid eggs or at least 
to use them very sparingly. Many persons 
find themselves able to use the yolks of eggs, 
who cannot take the whites either cooked or 
raw without suffering inconvenience, because 
of the readiness with which this form of al- 
bumin undergoes putrefaction in the intestine. 
When whole eggs are freely eaten, especially 
if hard boiled or poached, or in the form of 
an omelette, portions of undigested albumin 
may always be found in the stools, and in a 
state of very advanced putrefaction. 
Those who have been accustomed to the 
free use of meat and eggs are sometimes 
afraid to dispense with them lest they should 
suffer from an insufficient supply of protein; 
but the experiments of Chittenden and the 
extensive practical experience of the Battle 346 
COLON HYGIENE 
Creek Sanitarium have shown most conclu- 
sively that the protein requirements of the 
body may be fully supplied by a diet from 
which meat is wholly excluded, and even eggs 
may be dispensed with if half a pint or a 
pint of milk is used daily in connection with 
other foods consisting exclusively of fruits, 
grains, and vegetables. The sufficiency of a 
diet of this sort has; been definitely proven by 
the experiments of Sherman, of Columbia 
University, on both animals and human beings. 
It is even possible to arrange an adequate bill 
of fare with the exclusion of milk provided 
nuts are freely used. 
Peanuts, walnuts and almonds are rich in 
protein; a pound of pine nuts, in fact, con- 
tains 50 per cent more protein than a pound 
of lean beef, and besides, contains twice as 
much more nutrient in the form of a most 
easily digestible fat. Practically the same 
thing may be said of almonds and peanuts. 
Any possible deficiency in protein may read- 
ily be made up by taking at meals a handful 
of any kind of nut meats. It is highly impor- 
tant to remember that nuts must be very 
thoroughly masticated, so that the protein DIET IN CONSTIPATION 
347 
present may be easily accessible to the diges- 
tive juices. 
Meats are constipating, first, because when 
digested they leave but a small amount of 
residue. The bulk of the food residues is 
several times as great with a vegetable diet as 
when the diet consists largely of meats, eggs, 
and milk. A second reason for the constipat- 
ing effect of meat is the infection of the colon 
with putrefactive bacteria always found in 
butcher’s meat, as well as in dried and salted 
meats, and the toxic effect of the ammonia 
and other putrefaction products which par- 
alyze the colon. 
Cellulose-Containing Foods 
All vegetable foods contain more or less 
cellulose, but the amount differs very greatly. 
This element, as has already been mentioned, 
is highly necessary as a means of securing 
normal bowel action. Indeed, bulk, not 
simply in the food itself, but in the residues 
left behind after the absorption of the nutri- 
tive portions of the food, is of first impor- 
tance. This quality in food is even more im- 
portant than the antiseptic properties, for the 348 
COLON HYGIENE 
reason that putrefactive bacteria may always 
find in the bile and other intestinal secretions 
abundant material to support their growth, 
provided sufficient delay occurs to encourage 
putrefactive changes. 
Sterilized Wheat Bran 
One of the oldest and certainly the most 
valuable remedy in the treatment of constipa- 
tion is ordinary wheat bran. Bran consists 
largely of cellulose in an indigestible form, 
and is passed through the intestine without 
difficulty. The apprehension which some au- 
thors have expressed concerning the irritat- 
ing effects of bran are wholly without basis, 
except, of course, that one would not think of 
using bran in a case of acute inflammation of 
the stomach or intestines. As a matter of fact, 
when well softened with water, bran is no 
longer irritating, but is an emollient. The 
thin films of cellulose become as soft and pli- 
able as wet paper, and excite the bowel, not 
by scratching or irritating it, but by a gentle 
titillation and by giving to the food sufficient 
mass to distend the intestine and stimulate it 
to vigorous activity. The cellulose and cork DIET IN CONSTIPATION 
349 
layers of bran absorb water with avidity and 
hold it, thus keeping the feces soft. 
To be efficient, the particles of bran must 
be coarse. A large part of ordinary bran is 
made up of dirt, dust, germs, starch, and 
fine bran, all of which have little or no laxa- 
tive properties. A large flake of bran in the 
mouth will keep the tongue busy until it is 
removed. If the same bit of bran were 
ground into small particles its presence in the 
mouth would not be noticed, and the tongue 
would not be excited to action. The same is 
true of the stomach and intestine. Only the 
very coarsest bran is efficient. The same is 
true of agar and other forms of roughage. 
This was first pointed out for agar by Pro- 
fessor Ad. Schmidt, and was proven with 
reference to bran by the writer some years 
ago. So-called bran flakes contain only about 
half as much cellulose as do ordinary bran 
and this is broken up into such fine particles 
by the process of flaking that it has little or 
no laxative value. 
In its ordinary commercial form, bran is 
scarcely fit for use, on account of the large 
amount of dirt which it contains, including 350 
COLON HYGIENE 
multitudes of bacteria. For intestinal use as 
a laxative, it should be carefully prepared by 
thorough cleaning and washing of the wheat 
before grinding and sterilization after mill- 
ing. Sterilized bran, first introduced by the 
writer nearly twenty years ago, is now pre- 
pared by various manufacturers, and is put 
up in convenient packages. One or two 
rounded tablespoonfuls should be taken at 
each meal, the amount depending upon the 
character of other foods taken. The writer 
has never seen any ill effects from the use of 
sterilized bran, which he has prescribed for 
many years, although there are cases in which 
it fails to produce the desired effect and has 
to be supplemented by the use of paraffin oil 
as a lubricant. 
This is particularly true in cases in which 
the cecum is greatly dilated or crippled by 
adhesions and in cases in which there is ob- 
struction of other parts of the colon, espe- 
cially the pelvic colon as the result of adhe- 
sions. 
The combination of paraffin oil with bran 
or agar-agar in some form is also useful in 
cases of spastic contraction due to colitis. DIET IN CONSTIPATION 
351 
Experience shows that from an ounce to 
two ounces of bran must be taken with the 
food daily, to insure sufficient bulk to stimu- 
late the intestine to action. In cases in which 
the colon is very redundant or is crippled by 
adhesions, even a larger amount may some- 
times be needed, at least until the bowel has 
been trained to normal action. This amount 
of cellulose is provided by two rounded 
tablespoonfuls of sterilized bran in addition 
to other laxative foods at each meal. 
The amount of food required to furnish 
an ounce of cellulose may be ascertained by 
reference to the foregoing tables. 
It should further be mentioned that in the 
use of cellulose in concentrated form as in 
sterilized bran, the whole amount used at a 
meal should not be taken at once, as at the be- 
ginning or end of the meal, but should be 
well mixed with the food by taking small 
portions at frequent intervals during the 
meal. 
Agar-Agar 
The use of agar-agar, a Japanese sea-weed 
of a nature similar to Iceland moss, is to be 
most highly recommended as a means of giv- 352 
COLON HYGIENE 
ing the necessary bulk to stimulate the intes- 
tine to prompt action. 
It may be used without any possible injury 
in all cases of sluggish bowel action. When 
properly prepared it is wholly free from un- 
pleasant flavor, and it manifests such aston- 
ishing avidity for water that when it is pres- 
ent in the feces they cannot possibly become 
dry and hard. 
In cases in which constipation is due to 
“greedy colon,” agar-agar or bran is indis- 
pensable. In such cases the colon has ac- 
quired the power to eat up enormous quanti- 
ties of the cellulose of the food, so that it is 
very difficult to increase the bulk of the feces 
by the use of green vegetables. This is the 
reason for the disappointment experienced by 
many who hope to find in the free use of let- 
tuce and the like green foods a panacea for 
their intestinal ills. Agar-agar is hemi-cellu- 
lose, and has been shown by the experiments 
of Mendel and others to be indigestible by 
any of the digestive fluids with which it 
comes in contact in the human body. Agar- 
agar must be taken in sufficient quantity to 
accomplish the object sought. Two-thirds of Crude Agar 
Agar in Sterilized and Edible Form DIET IN CONSTIPATION 
353 
an ounce to an ounce is the quantity usually 
required for adults. For young children a 
quarter to a half of this quantity is sufficient. 
Agar-agar is easily taken in soup, cereal 
coffee, fruit juice or stewed fruit. It should 
be allowed to soften and should then be swal- 
lowed without chewing. 
This remedy should be taken at meals in 
order that it may be well intermingled with 
the food, and so prevent the formation of 
hardened residues in the intestine. 
Agar-agar may be used with advantage as 
a substitute for a meal, when food cannot be 
taken, and when there is no appetite for food, 
and when so used it maintains the intestinal 
rhythm which would otherwise be lost, re- 
sulting in constipation. It should in such 
cases be taken with fruit juice or fresh or 
stewed fruit. When one finds at night that 
the usual amount of food has not been taken, 
an extra dose of agar-agar with a little fruit 
may be taken before going to bed. No di- 
gestive work is required by either the fruit or 
the agar-agar except to move it along the di- 
gestive canal. 354 
COLON HYGIENE 
Number and Size of Meals 
In very many cases of chronic constipation 
the colon, especially the cecum, has become 
so dilated that it is seriously crippled. Its 
thin, atrophied walls are unable to handle 
large masses of material. In such cases, large 
bulky meals are likely to overweight the 
cecum and to form an impaction which may 
remain for days, giving rise to fermentation, 
distention of the colon with gas, colic pains, 
and great inconvenience. Complaint is often 
made that bulky foods cause much flatulence 
and distress and seem to increase the constipa- 
tion. The remedy is not to be found in dis- 
carding “coarse vegetables” or other bulky 
foods but in taking smaller and more fre- 
quent meals. By this means the amount of 
material present in any portion of the bowel 
at any particular time will be reduced, the 
bowel will never be over distended, and will 
have an opportunity gradually to recover its 
normal tone. 
The proper plan for the meals in such a 
case is to take two principal meals and two 
minor meals. The principal meals should 355 
DIET IN CONSTIPATION 
contain the chief part of the nutriment; the 
minor meals should make small demands 
upon the digestive organs; the bulk should 
be about the same for each of the four meals. 
No fats should be taken at the minor meals 
and nothing requiring more than two hours 
for gastric digestion. It isi best to confine the 
minor meals to fruit and roughage (bran or 
agar in some form). 
The cellulose may be taken in the form of 
bran mush, bran cakes, colax, (Japanese sea 
weed or Ceylon moss), or laxa, (sterilized 
bran and agar-agar). Any sort of fresh juicy 
fruit may be eaten, but bananas, dates, dried 
figs and raisins should be avoided. Fresh figs 
or raw soaked purple figs are excellent. 
Soaked raw prunes are also very good indeed. 
The arrangement of the four meals as re- 
gards time may be the following: first, break- 
fast on rising, say 6:30 a. m., fruit and bran; 
second breakfast, 9:00 a. m.; dinner 3:00 p. 
m.; fruit lunch at bedtime. If these hours 
are not convenient, some other arrangement 
may be made, care being taken to avoid tak- 
ing meals too near together. 356 
COLON HYGIENE 
The Use of Bran 
Wheat bran is perhaps the most useful of 
all food remedies for constipation. Bran may 
be taken by itself or it may be used in many 
combinations. Care must be taken to obtain 
clean bran, which is not always easy, for the 
reason that the bran is usually mixed with 
much dirt and offal removed from the grain. 
To be fit for use, the bran should be taken 
from wheat which has been specially cleansed 
and washed. The bran should be cooked and 
sterilized to destroy any adhering germs. 
Such bran only needs softening and is ready 
for immediate use. It may be eaten as a 
breakfast cereal or it may be mixed with any 
other suitable food such as oatmeal, toasted 
flakes, or even mashed potatoes or boiled rice. 
Sterilized bran may be added to bread, 
biscuit, cake and breakfast cakes in propor- 
tion of one-fourth or even more. It should 
be used freely at every meal. Numerous ex- 
cellent recipes are now available for using 
bran in various palatable and efficient ways. 357 
DIET IN CONSTIPATION 
Recipes for the Use of Bran 
BRAN AND OATS 
1 cup rolled oats 
1 cup sterilized bran 
2K cups water 
1 teaspoon salt 
Heat the water to boiling. Add the salt, 
bran and the rolled oats. Let boil five min- 
utes. This dish is a good corrective measure 
and at the same time an excellent breakfast 
food. 
STERILIZED BRAN 
Look over and remove foreign substances 
from bran and place in a rather shallow pan 
in a moderate oven. Place a pan of hot water 
in the oven to prevent burning. Bake a half 
hour, stirring the bran often to prevent scorch- 
ing. Grind in a coffee mill. 
BRAN AND GRANOLA MUSH 
1 cup sterilized bran 
1 cup granola 
3 cups water 
\A teaspoons salt. 358 
COLON HYGIENE 
Mix the bran, granola and salt. Stir into 
the boiling water and cook for a few minutes 
directly over the flame. 
GRAHAM BREAD 
3 cups milk and water (equal parts) 
2 tablespoons malt honey or molasses 
VA cups sterilized bran 
About 2 quarts whole wheat flour 
2 teaspoons salt 
V* yeast cake 
A cup warm water 
Soak the yeast in the warm water. Scald 
the milk and cool to lukewarm. Potato water 
may be used instead of the milk and water. 
Add water, the molasses and salt, then the 
softened yeast. Mix the flour and bran to- 
gether and stir into the liquids. Knead thor- 
oughly, and put to rise in a warm place. 
When light, mold into a loaf. Let rise again, 
and when light bake in a hot oven about one 
hour. Decrease the heat somewhat during 
the latter part of the baking. This makes 3 
small or 2 large loaves. Graham flour may 
be used instead of the whole wheat, in which 
case less bran will be needed. DIET IN CONSTIPATION 
359 
BRAN BISCUIT 
1 cup sterilized bran 
2 cups graham flour 
1 cup milk 
1 egg 
2 teaspoons sugar 
1 teaspoon salt 
2 tablespoons butter 
1 teaspoon soda 
80 minims hydrochloric acid (C. P.) 
(This amount of soda and hydrochloric acid 
is equivalent to 4 teaspoons baking powder.) 
Mix the flour, bran, sugar, and salt to- 
gether. Beat the egg slightly and add to the 
milk. Dissolve the soda in the milk, and add 
the melted butter. Lastly, add the hydro- 
chloric acid. Turn very quickly into the dry 
ingredients. Mix lightly but quickly. Turn 
upon a molding board, shape with a bis- 
cuit cutter and bake fifteen to twenty minutes 
in a hot oven. 
If baking powder is used, omit the hydro- 
chloric acid and the soda, and proceed as fol- 
lows: Mix the dry ingredients together, beat 
the egg slightly and add to the milk. Stir 360 
COLON HYGIENE 
the liquids into the dry ingredients the same 
as for cream biscuits. Turn out upon a 
slightly floured molding board and roll to 
one-half inch in thickness. Cut into shape 
with the biscuit cutter and bake in a hot 
oven. 
BRAN GEMS 
1 cup sterilized bran 
1 cup graham flour 
7A cup milk 
3 tablespoons melted butter 
1 teaspoon salt 
1 egg 
1 tablespoon sugar 
H teaspoons soda 
60 minims hydrochloric acid (C. P.) 
(This amount of soda and hydrochloric acid 
is equivalent to 3 teaspoons of baking pow- 
der.) 
Mix the bran, flour, salt and sugar to- 
gether. Beat the egg, add the milk and one- 
half of the dry ingredients. Stir in the hy- 
drochloric acid. Mix well and add the 
melted butter. Sift the soda with the remain- 
ing half of the dry ingredients and stir into 361 
DIET IN CONSTIPATION 
the batter. Turn into buttered muffin pans 
and bake in a hot'oven twenty to thirty min- 
utes. 
Laxative Breakfast Foods 
The average individual finds the use of 
bran at every meal something of a task, and, 
indeed, may find it very difficult to persevere 
in the practice. On this account it is desir- 
able that roughage should be presented in 
different forms. Probably bran is on the 
whole the most efficient form of roughage. 
It acts not by irritation but by titillation or 
contact stimulation. To be effective, how- 
ever, the particles of bran must be in their 
natural state, and the larger the better. Bran 
that has been milled or processed in such a 
way as to lessen the size of the particles has 
little or no efficiency. A large particle of bran 
placed in the mouth will keep the tongue 
busy until it is located and removed. There 
is no irritation produced, only a gentle excita- 
tion to activity until the foreign body has 
been disposed of. The stomach, intestine and 
colon behave in a like manner. If the same 
particle of bran were divided into twenty 
pieces, these fine particles might remain in 362 
COLON HYGIENE 
the mouth, stomach or any other part of the 
intestine for a long time without being no- 
ticed. They would produce no reflex activity. 
Bran in this form is merely dust and the num- 
ber of nerves with which each particle comes 
in contact is too small to provoke a reflex 
action. 
Scarcely more than a third of the particles 
of ordinary bran are large enough to produce 
a marked laxative effect. For this reason 
much of the bran and many of the numerous 
bran products now offered on the market are 
of very little service. Many persons become 
discouraged in the use of bran because of this. 
Only specially prepared bran in which the 
finer portion has been removed and products 
of which this carefully selected bran is the 
basis can be relied upon to produce laxative 
effects. Fortunately, a number of such prod- 
ucts are now available. In addition to the orig- 
inal sterilized bran first prepared and used at 
the Battle Creek Sanitarium and known as 
Sanitarium Bran, two other efficient prod- 
ucts which conform to the above specifica- 
tions are now available,—Vita-Bits, a granular 
ready-to-eat food which contains two parts of 363 
DIET IN CONSTIPATION 
bran by measure to one of other ingredients, 
and Branola, a partially cooked breakfast ce- 
real which consists of the outer covering of 
the wheat berry together with the adjacent 
gluten layer, an exceedingly palatable break- 
fast cereal. Brose, Vita-Bits, Branola, Laxa 
and Sanitarium Bran, with figs, dates, prunes, 
and other fruits, greens and fresh vegetables, 
furnish a sufficient variety of efficient laxa- 
tive preparations to serve all practical pur- 
poses. Of course all whole grain prepara- 
tions such as shredded wheat, oatmeal, gra- 
ham bread, cracked and whole wheat and 
bran in every form, are wholesome and more 
or less useful sources of roughage; but in 
flaked cereals the bran is so broken up as to 
render little service. 
There are now many laxative foods offered 
for sale by grocers and advertised in news- 
papers, most of which have more or less 
value, although differing considerably in ef- 
ficiency. In general, all pure bran prepara- 
tions are efficient. Bran biscuit, crackers and 
cookies and so-called whole wheat bread and 
crackers are inefficient because the amount of 
bran they contain is too small to furnish the 364 
COLON HYGIENE 
required bulk. Bran must be used in a large 
way to produce results. A teaspoonful or two 
of bran renders little or no service. Large 
amounts, one to three heaping dessert spoon- 
fuls are required, and must be taken at every 
meal. 
The following laxative foods were first 
prepared for use at the Battle Creek Sanita- 
rium and their efficiency is there daily dem- 
onstrated in practical use: 
Sanitarium Sterilized Bran. Prepared 
from carefully cleaned wheat. Large flakes. 
Excellent flavor. Ready to serve. Much 
more efficient than ordinary bran of which 
fully two-thirds is excluded in the prepara- 
tion of this product which is the original 
sterilized bran. 
Brose. A combination of bran with oats 
and corn. Slightly parched. Cooks in ten 
minutes. An excellent laxative, especially 
for children. Rich in vitamin B and food 
iron. 
Sanitarium Bran Flakes. (Vitamized) 
The most agreeable of all bran preparations, 
* All the foods described were developed for the Battle Creek 
Sanitarium in the laboratories of the Battle Creek Food Company of 
Battle Creek, Mich., U.S.A DIET IN CONSTIPATION 
365 
but less efficient than the coarser particles of 
Sanitarium Sterilized Bran. Rich in food 
iron and vitamin B. 
Laxa. An agreeable combination of bran 
and agar in biscuit form. Crisp and tasty. 
The most highly efficient of all forms of 
roughage. Very convenient for travelers. 
Fig Marmalade. A toothsome sweet pre- 
pared from purple figs and malt sugar. Con- 
tains no cane sugar, and hence may be eaten 
freely. Highly laxative. A similar marma- 
lade is prepared from prunes. 
Malt Sugar (Maltose-dextrin). A sugar 
(maltose-dextrine) prepared by the diastatic 
digestion of starch. In syrup or powder 
form. Rich in food lime and iron which are 
wholly lacking in cane sugar. Decidedly 
laxative for infants. Slightly laxative for 
adults. A very agreeable flavor. Should be 
used instead of cane sugar. 
Paramels. A mineral oil in solid form 
which melts at body temperature. An ac- 
cessory preparation which supplies lubrica- 
tion and so facilitates the disposal of residues 
and wastes. Is very often needed in addition 
to roughage foods. In tablet form. One is 
taken at each meal. 366 
COLON HYGIENE 
Diabetic Bran. Sanitarium Sterilized Bran 
from which the starch has been wholly re- 
moved by a digesting process. The bran is 
first cooked, then digested with diastase until 
all the starch is changed to dextrin and so 
made soluble. Washing several times then 
removes the starch almost to the very last 
trace. The amount left is so small as to be 
negligible. Only a small part of the starch 
can be removed even by the most thorough 
washing unless the starch is first rendered 
soluble by conversion into sugar and dextrin. 
Branola. The most laxative of breakfast 
cereals. It consists of the outer covering of 
the grain with the adhering layer of gluten 
cells and comprises the choicest parts of the 
grain, including the iron, lime and vitamin 
(B). Branola has all the virtues of the whole 
wheat and in increased proportions. Slightly 
parched. Cooks in ten or fifteen minutes. BATHS AND OTHER HOME TREAT- 
MENTS FOR CONSTIPATION 
Water may render great service in consti- 
pation through the general improvement in 
health which may be secured by its systematic 
use. Cold water is of the greatest service. 
The short spinal douche is one of the most 
effective means which can be employed for 
improving the tone of the nervous system. 
The inactive skin, due to the general sat- 
uration of the bodv with toxins, is an indica- 
tion for sweating baths. In constipation these 
should be made short, however, barely long 
enough to stimulate the skin to vigorous per- 
spiration, and should be immediately fol- 
lowed by a short general cold application, in- 
cluding a cold douche to the spine, abdomen 
and legs. Short, cold applications applied to 
the surface cause reflex contraction of the in- 
ternal involuntary muscles. It is for this rea- 
son that placing the feet, sometimes even the 
hands, in cold water will often produce a de- 
sire to empty the bladder, through stimula- 
tion of the urinary center. 
367 368 
COLON HYGIENE 
The defecating center and intestinal mus- 
cles may be stimulated in the same way. Va- 
rious local applications are of great service in 
improving the tone of the bowels, though 
local cold applications must be used with 
great discretion and with careful knowledge 
of the exact nature of the case; for the tend- 
ency of cold to produce contraction of the in- 
voluntary muscles leads to an aggravation of 
the condition in colitis with spastic constipa- 
tion. 
Of the many different modes of applying 
cold water, which may be of service, the fol- 
lowing are especially recommended: 
The Cold Douche 
A short cold douche to the lower part of the 
back, buttocks, abdomen and feet. The tem- 
perature should be 70° to 50° F., and the dur- 
ation ten to thirty seconds. With patients 
who are not accustomed to applications of 
cold water, the temperature of the douches 
should at first not be lower than 70°. This 
should be gradually lowered at each applica- 
tion until the temperature of 60° to 50° is 
reached. In general, the douche should be BATHS AND HOME TREATMENTS 
369 
preceded by a short hot bath to prepare the 
patient for the cold application, and to secure 
prompt reaction, which is still further en- 
couraged by exercise after the bath. 
The Simultaneous Hot and Gold Douche 
A very excellent form of bath especially 
adapted to cases of constipation, is the simul- 
taneous warm shower bath (100° F.), with 
short cold douche to the abdomen. The 
warm shower bath should be applied for half 
a minute so that the skin will be thoroughly 
warm first, and the cold spray or broken jet 
should be applied to the abdomen without in- 
terrupting the warm shower. The tempera- 
ture of the spray should be 70° to 50°. The 
duration of the cold application should be not 
more than a minute. At the end of the bath 
a short, general, cold application lasting no 
more than ten to fifteen seconds; should be 
made to secure reaction, and thus fix- the 
blood in the skin. ** 370 
COLON HYGIENE 
Abdominal Douche 
When a douche apparatus is not available, 
a very efficient abdominal douche may be ap- 
plied in an ordinary bath tub. A hot bath 
at the temperature of 102° to 103° should be 
applied for one to three minutes. Then the 
outlet should be opened and cold water 
should be poured on the abdomen while the 
water is running out. By lifting the dipper 
to the height of five or six feet a sufficient de- 
gree of force may be obtained to produce a 
decided reflex effect. The temperature of the 
water may vary from 60° to ice cold, the tem- 
perature being gradually lowered as the pa- 
tient becomes accustomed to the cold appli- 
cation. 
Hot Sitz and Cold Pour 
The patient sits in water at a temperature 
of 102° or 103° for two or three minutes, then 
leans back in the tub while the attendant 
pours cold water 70° to 50° over the abdomen 
for half a minute. BATHS AND HOME TREATMENTS 
371 
Rubbing Gold Sitz Bath 
In this bath the patient sits in water at a 
temperature of 75° to 55° for two minutes, 
rubbing himself vigorously meanwhile. This 
bath produces a powerful reflex influence 
upon the intestines, especially in the colon, 
and is frequently followed soon after by a de- 
sire to defecate. The patient should rub 
himself continually during the bath, and the 
feet may be kept in hot water if there is a 
tendency to chilliness. The shoulders should 
be covered by a woolen blanket. 
The Sedative Sitz Bath 
A bath at a temperature of from 60° to 
70° for fifteen to twenty minutes produces 
powerful and prolonged contraction of in- 
ternal muscular structures. This bath is 
useful in diarrhea, and is one of the most 
efficient means of improving the tone of the 
abdominal muscles and of an atonic colon. 
This bath should not be given in cases of 
spastic constipation. In general, prolonged 
cold baths of any sort, (that is, baths longer 372 
COLON HYGIENE 
than two or three minutes), are aggravating 
in this condition. 
Alternate Applications to the Abdomen 
A hot fomentation to the abdomen for five 
to ten minutes, followed by a cold application 
for one minute, is an excellent means of stim- 
ulating peristalsis and improving the mus- 
cular tone. The cold application may consist 
of a compress of ice water, but the most ef- 
fective method is to rub the abdomen with a 
smooth piece of ice. The effect of this appli- 
cation is increased by repeating the alterna- 
tion two or three times in succession. 
The Wet Girdle 
This is a simple method which has been 
used for centuries by the peasantry of Eu- 
rope. The abdominal girdle consists of a 
coarse towel of three yards in length, half of 
which is wet, the other half remaining dry. 
Beginning- with the wet end, the towel is 
wound round the trunk of the body, great 
care being taken to see that it fits the skin 
snugly. Outside the towel a flannel bandage Wet Girdle 
F omentation The Photophore 
The Thermophore BATHS AND HOME TREATMENTS 
373 
is applied. The towel should be changed be- 
fore it becomes dry. It should be worn 
night and day to secure the most pronounced 
effect. The mackintosh or oiled muslin, 
often applied with the moist bandage, should 
be omitted when it is the purpose to relieve 
constipation. 
Fomentation to the Abdomen 
The abdominal fomentation is a capital 
means for use in spastic constipation, the re- 
sult of colitis, and when the ileocecal valve is 
in a state of spasmodic contraction due to 
chronic appendicitis or ovarian disease. In 
general the fomentation is highly useful in all 
cases of constipation accompanied by pain in 
the abdomen, no matter what the cause. 
The electric fomentation heater is a con- 
venient means of heating a fomentation com- 
press. 
The best time for applying the fomentation 
is soon after breakfast, or shortly before the 
regular time for moving the bowels. Appli- 
cations may be made with great advantage 
two or three times daily, or at least morning 374 
COLON HYGIENE 
and night, so as to relax the colon several 
times during the day. 
In very pronounced cases of colitis, with 
spastic constipation, a short very hot bath is 
of great service. The duration of the bath 
should not be more than two to four minutes. 
It produces debility and anemia if long con- 
tinued and often repeated. The effect of hot 
applications is to lessen the irritability of the 
nerve centers, and thus to relieve the intes- 
tinal spasm which may be due to congestion 
or inflammation of the appendix, ovaries, 
bladder, rectum or gall-bladder, or still more 
often, to colitis. 
Combined Hot Bath and Hot Douche 
Perhaps the most effective measure for the 
relief of intestinal spasms, such as sometimes 
occur in muco-membranous colitis, is a 
warm bath (100° F.) combined with a very 
hot spray to the abdomen. The water should 
be allowed to fall on the abdomen in very fine 
streams with very little force, at a temperature 
of 115° to 120° F. The duration of the appli- 
cation should be two to five minutes. It should BATHS AND HOME TREATMENTS 
375 
be followed by a cold application at a tem- 
perature about 80° for one or two minutes. 
The Hot Sitz 
The hot sitz bath at a temperature of 112° 
to 118° F., duration two to three minutes, can- 
not be too highly praised as a measure of the 
highest value for use in the treatment of re- 
flex and spastic constipation, with or without 
colitis. After the sitz no cold application is 
made. The best time for the bath is on rising 
in the morning. 
The Photophore, and the Electric 
Thermophore 
These are measures of great value in the 
treatment of spastic and reflex constipation, 
and are especially useful in cases in which 
pain is a pronounced symptom and a cause of 
reflex spasm. The applications should be 
made morning and night in place of the fo- 
mentation, and are much more effective. 376 
COLON HYGIENE 
The Enema 
This most useful means of treatment, the 
enema, is one of the most abused of all mea- 
sures employed to combat constipation. It 
cannot be said to have done as much harm as 
has been done by laxative drugs and mineral 
waters, but not a little harm has resulted from 
its abuse, although when properly used it is 
one of the most harmless of measures. 
According to Pliny, the first writer on nat- 
ural history, the use of the enema was learned 
by the ancients from the stork which was 
“observed to inject water into its bowels by 
means of its long beak.” It is now known, 
however, that this was an error of observation. 
The stork does not inject water into its colon, 
and probably has no occasion to seek relief 
in this way. The great bird, like many other 
feathered creatures, has near the anal region 
an oil secreting structure known as the preen 
gland. What Pliny saw was the stork oiling 
its beak in preparation for preening its fea- 
thers. 
But the use of the enema has been known 
from the most ancient times and is employed BATHS AND HOME TREATMENTS 
377 
by the most primitive tribes. The native of 
the Congo administers an enema to himself 
by lying down upon the ground and inserting 
into the rectum the perforated lip of a bison’s 
horn filled with water from a nearby stream. 
The modern enema syringe was devised 
about the time of the discovery of America 
by Columbus. 
Within a century the enema came into 
such honor that the physician who attended 
Louis XIII thought it worth while to record 
the exact number of enemas administered to 
the king (220) during the last six months of 
his life. 
During the succeeding reign, that of Louis 
XIV, the enema became almost a rage in 
Paris. The court ladies and dudes discovered 
that by keeping the colon clean the complex- 
ion was improved and so it became the 
fashion to take several enemas daily to keep 
the skin white and the complexion fresh. 
This was a shrewd observation, for the reason 
that the same thing that keeps the complexion 
fresh also keeps the liver, kidneys, heart and 
other vital organs free from the destructive 
influence of poisons and keeps the mind 378 
COLON HYGIENE 
young. Here is a hint to modern beauties 
who desire to preserve their good looks. A 
clean colon is worth for this purpose a ton of 
cosmetics. 
The damaging influence of colon poisons 
upon the mind is not a modern discovery. It 
is recorded that Voltaire was at one time so 
despondent that he remarked to a friend that 
he had resolved to hang himself. The friend 
called next day, anxious to know what had 
happened, and was delighted to find that a 
complete revolution had taken place over 
night. Voltaire met him with a smile and 
the simple explanation, “I have been well 
washed out.” 
Twenty-five or thirty years ago a New 
York charlatan made a fortune by selling 
what he termed “Hall’s Secret,” which con- 
sisted of nothing more than a small pamphlet 
in which instruction was given about the use 
of the enema for which a charge of $4.00 was 
made. Large numbers of persons testified to 
the rejuvenating effects of this simple treat- 
ment which doubtless did some good, al- 
though many were injured by the large 
amount of water advised. “Hall” asserted BATHS AND HOME TREATMENTS 
379 
that he regularly made use of one gallon of 
water to fill and wash out his colon. 
The enema is still being exploited by char- 
latans in various ways, but is prescribed less 
often than it should be by medical practi- 
tioners. Soon after the enema became so ex- 
traordinarily popular in the time of Louis 
XIV, the doctors turned this remedy over to 
the pharmacists, who later turned it over to 
the barbers, who at that time combined with 
their tonsorial duties cupping, bleeding, 
leeching and minor surgery in addition to the 
giving of enemas and sundry other medical 
“chores.” 
The only harm which results from the use 
of the enema is due to over-distention of the 
colon by the use of too large an amount of 
water. The amount should not exceed two 
quarts. For greatest efficiency, the water 
should be introduced slowly, and little force 
should be used. The temperature of the 
water should be generally about 8S°F. When 
colitis or a spastic condition is present, the 
hot enema (102° to 105° F.) should be used. 
When the rectum is dilated or inactive, that 
is, in cases of rectal constipation, when the 380 
COLON HYGIENE 
“call” is lost, the temperature employed 
should be about 80° F. or even less. A small 
cool enema (pint or half-pint) should be used 
after the last enema and is highly useful as 
a means of stimulating a sluggish colon. It 
is well to introduce into the rectum a pint or 
half-pint of lukewarm water at bedtime to be 
retained over night in cases in which the 
stools are dry and hard. 
When the enema is not promptly dis- 
charged, the juice of one or two lemons 
should be added to the water to stimulate 
peristalsis. 
Irritation of the anus and sometimes hem- 
orrhoids results from the frequent use of the 
enema. This may be prevented by lubricat- 
ing the enema tube with carbolated vaseline 
and by the application of carbolated vaseline 
to the anal canal after each bowel movement. 
When used in the manner above indicated, 
the enema may be employed for months or 
even years without injury. The daily use of 
the enema is greatly preferable to the reten- 
tion in the colon of putrid fecal matters even 
for a few hours. 
The use of an enema at night to empty the BATHS AND HOME TREATMENTS 
381 
colon does not interfere with the natural 
morning bowel movement, but encourages it. 
An enema at night often relieves insomnia by 
getting rid of troublesome gas and preventing 
the absorption of nerve-disturbing poisons. 
How to Administer the Enema 
There are unquestionably certain cases in 
which the colon has become so crippled by 
inflammations, stretchings, distortions, adhe- 
sions, and the degeneration of its muscular 
structures, and consequent weakening of its 
contractile powers, that it can no longer be 
made to perform its functions, even by the 
use of accessories which act as mechanical or 
physiological aids. In such cases and in cer- 
tain emergency cases, the judicious use of the 
enema is not only helpful, but sometimes nec- 
essary. For example, in cases of senile con- 
stipation, where, as the result of long con- 
tinued colitis, the muscular walls are thin and 
greatly stretched, while the colon itself has 
become abnormally redundant and folded 
upon itself, the daily or frequent use of the 
enema may be required. 
The best means of administering the enema 382 
COLON HYGIENE 
is the fountain syringe. The tube should be 
long enough so that the reservoir, if necessary, 
may be raised to a height of five or six feet 
above the patient. When it is desired to 
stimulate the bowel to immediate contraction, 
the reservoir should be placed high, but when 
the purpose is to introduce as large a quantity 
of water as possible into the colon and to have 
it retained for a time, the reservoir should be 
placed at a height not exceeding two or three 
feet. 
The position of the patient during the ad- 
ministration of an enema is not a matter of 
very great importance. In cases in which the 
pelvic colon is low down in the pelvis, as is 
shown by examination, it is well to put the 
patient in a knee-chest position. The water 
should be introduced very slowly. Ordina- 
rily, however, the patient may lie upon the 
back or either side, or the enema may even be 
administered standing. The water quickly 
finds its way along the colon, no matter what 
the position of the patient may be. 
The use of the colon tube is quite unneces- 
sary. Indeed, as the writer learned long ago 
by experience, and as has been abundantly BATHS AND HOME TREATMENTS 
383 
proved by examination with the X-ray, the 
colon tube can rarely ever be introduced 
beyond the rectum. It is arrested at the pelvi- 
rectal fold, and simply returns and coils itself 
up in the rectum. A tube long enough to 
pass the water through the anus is as useful 
as the longest colon tube, unless the long tube 
is passed into the pelvic colon past the ileo- 
splenic flexure, a procedure which is rarely 
required, and, of course, should only be un- 
dertaken by a physician. 
The enema may be employed in a variety 
of ways adapted to different occasions and 
purposes, and it may be repeated as many 
times as may be necessary. Warm water dis- 
solves hardened fecal matters much more 
readily than cold water, yet in some cases it 
may be necessary to repeat the enema, at in- 
tervals of fifteen to twenty minutes, five or 
six times before the effect desired is obtained. 
When used for the purpose of softening hard- 
ened fecal matters, the water should be intro- 
duced slowly, and the patient should be 
instructed to retain as much as possible. The 
enema should be repeated as long as the water 
contains fecal matters when returned. 384 
COLON HYGIENE 
The Hot Water Enema 
The temperature of the water should be 
105° to 115° F. The quantity may be from 
one to three pints. This is preferable in cases 
of colitis and when abdominal pain or ten- 
derness is present. 
The Hot Soap Enema 
The addition of soap to the water some- 
what increases its power to dissolve hardened 
feces, although the advantage of its use is not 
so great as might be supposed. The amount 
of soap should be sufficient only to make very 
weak suds, as otherwise it may be irritating, 
especially if the soap contains a considerable 
amount of free alkali. Ordinary soap is best 
for the purpose. 
The Hot Saline Enema 
Half an ounce of salt is added to two 
quarts of water at a temperature of 105° to 
115° F. : 
The purpose of the addition of salt is to 
lessen the irritation of the mucous membrane. 
It is of special use in cases of colitis, in which BATHS AND HOME TREATMENTS 
385 
the enema is administered for the purpose of 
removing mucus and relieving spasms of the 
intestine. The application should be re- 
peated until no mucus returns with the 
water. Care must be taken to secure evacua- 
tion of the water so as to avoid retention of a 
large amount of salt, which may do serious 
injury. 
The Gold Water Enema 
A cold application to the interior of the 
bowel is one of the most powerful means of 
stimulation which can be safely employed. 
Half a pint of water at a temperature of 50° F. 
will usually set up a very strong and painful 
contraction of the lower bowel. It is on this 
account necessary to begin with a moderate 
temperature. The first enema should have a 
temperature of 80° to 85° F. The tempera- 
ture may be lowered on each application five 
to ten degrees, or until sufficiently powerful 
contractions are produced to expel quickly 
the water introduced. By gradually reducing 
the temperature in this way, one as low as 40° 
F. may finally be used without causing exces- 
sive pain. Such low temperatures are very 386 
COLON HYGIENE 
seldom required except in dysentery, in which 
they often render great service. 
The cold enema is of special use in cases 
in which the colon has become gradually di- 
lated and has become atonic, and contracts 
with insufficient force to expel its contents. In 
such cases a warm or hot enema is usually re- 
tained. By following the warm enema with 
half a pint or a pint of water at 60° to 70°F., 
prompt contraction of the bowel almost in- 
variably follows, with expulsion of the bowel 
contents. This is a very important practical 
use of the cold enema, as the retention of the 
water in cases in which the bowel is filled 
with putrefying fecal matters is very often 
followed by very unpleasant and even serious 
effects, through the absorption of enormous 
quantities of toxic substances, which are dis- 
solved by the water and brought into contact 
with the absorbing surface of the bowel. In 
such cases the hot enema should be immedi- 
ately followed by a small cold enema, and the 
cold enema should be repeated several times, 
if necessary. BATHS AND HOME TREATMENTS 
387 
The Oil Enema 
The amount of oil required is four to 
six ounces. Either pure olive oil or any 
sweet oil may be employed. The latter is 
just as good as the former, and is less likely 
to produce nausea and vomiting, which some- 
times follows the use of olive oil of an infe- 
rior grade. The temperature of the oil 
should be 104° F. As a means of softening 
hardened feces, oil is no better than water; in 
fact, according to the writer’s experience, it 
is less efficient. It is useful, however, as a 
means of lubricating the lower bowel, and 
when introduced at night prevents hardening 
and drying of the feces. For this purpose four 
to six ounces should be introduced at night. 
When used for the purpose of lubrication 
only, a good plan is to administer the oil be- 
fore breakfast. This is an excellent means of 
securing a thorough evacuation of the colon. 
Sugar and Water Enema 
Sugar is a powerful stimulant of the colon. 
A very old-fashioned remedy is the introduc- 
tion of molasses into the colon. To half a 388 
COLON HYGIENE 
pint or pint of molasses an equal quantity of 
hot water is added. A prompt action of the 
colon usually follows the introduction of this 
mixture. The writer has for years used malt 
sugar for this purpose, and with most satisfac- 
tory results. The malt sugar not only acts as 
a stimulant to the bowel, but at the same 
time furnishes valuable nourishment. Four 
ounces of malt sugar should be added to a 
pint of water. 
The Acid Enema 
The colon responds more naturally and 
vigorously to mild acid stimulation than to 
almost any other form of stimulation. It is 
due to the fact that under normal conditions 
the contents of the colon are acid. Putrefac- 
tion produces ammonia and other alkaline 
substances which paralyze the colon. For an 
acid enema, add to three or four pints of 
water the juice of one or two lemons, or in 
the absence of lemons a dram or more of lac- 
tic or citric acid may be added to the water. 
It is necessary to make sure that the acid is 
completely dissolved and thoroughly mixed. BATHS AND HOME TREATMENTS 
389 
Paraffin Oil Enema 
Liquid paraffin, or paraffin oil, may be 
used as an enema in place of olive oil and 
other oils, and has the advantage that it does 
not produce nausea or other unpleasant symp- 
toms. Paraffin oil is better than any animal 
or vegetable oil, for the reason that the oil 
enema often causes nausea, loss of appetite, 
and coating of the tongue. 
The Glycerine Enema 
One to four ounces of pure glycerine in- 
troduced into the rectum is a highly efficient 
laxative when the “call” is lost. If pure gly- 
cerine is found too irritating add an equal 
amount of water. 
The Cold Rectal Douche 
By introducing cold water into the rectum 
with considerable force, a most powerful 
stimulation may be produced. The tempera- 
ture of the water should be 70° to 80° F. If 
the stream furnished by the ordinary fountain 
douche has not sufficient force for this, a bulb 
syringe is necessary. 390 
COLON HYGIENE 
In administering the rectal douche a re- 
turn tube should always be used, so that the 
rectum will not be over-distended. A small 
tube should be connected with the syringe, 
and a large one should be introduced along- 
side it to counteract the over-distention of the 
rectum. When the powerful stimulation of 
the rectal douche is required, it is not de- 
sired to secure the stimulation which results 
from distention of the rectum, for in these 
cases the rectum is always relaxed, and has 
to a certain degree lost its contractile power. 
It is desired only to obtain the stimulating 
effects produced by a low temperature and 
the impact of a stream of water introduced 
with considerable force; the effect of such 
an application is to produce almost immedi- 
ately a very strong defecating reflex, with 
contraction of the pelvic colon and forcible 
expulsive efforts. 
It is well that the enema tube should be in- 
troduced its full length and should be di- 
rected somewhat backward, so that the stream 
of water may be received upon the upper part 
of the rectum and, if possible, reach the pelvi- 
rectal fold. BATHS AND HOME TREATMENTS 
391 
In cases in which the sensibility of the rec- 
tum is largely lost, this measure affords a 
very excellent means of restoring normal 
sensibility. In extreme cases the alternating 
rectal douche may be employed. 
Injury from Drug Laxatives 
While the temporary use of medicinal 
laxatives is sometimes necessary, and always 
justifiable when required as an emergency 
means, there can be no doubt that the con- 
tinued use of drugs of any sort is highly in- 
jurious to the intestines, and in many cases to 
other organs with which the drug comes in 
contact, particularly the liver and kidneys, 
which are burdened with the elimination of 
a certain part of the drugs employed. 
All laxative drugs are irritant poisons. 
They affect the stomach as well as the colon 
and small intestine. Their long continued 
use in time gives rise to gastric and intestinal 
catarrh, colitis and the varied evils which ac- 
company these disorders. 
All laxative drugs, excepting, of course, 
agar and paraffin, which should be regarded 
as accessory foods rather than as drugs, cause 392 
COLON HYGIENE 
a spastic contraction of the descending colon. 
It is for this reason that the use of drug laxa- 
tives is usually followed by increased ineffi- 
ciency of the colon. In such cases the water 
given by enema is retained or returned slowly. 
Most drugs which act upon the bowels 
produce their effect only after having been 
absorbed and circulated through the blood. 
This has been proved to be true even in the 
case of saline laxatives, which are absorbed 
in the upper part of the intestine, and acting 
through the nerve centers controlling the 
colon, produce a laxative effect long before 
the drug has reached the colon through the 
intestine. 
The effects of any other laxative drugs 
may be produced by injection under the skin. 
It is thus evident that the action of laxative 
drugs is not confined to the intestine, but 
through absorption into the blood stream 
these irritating substances are brought into 
contact with all the tissues. 
Among the most largely used laxative 
drugs are aloes, senna, rhubarb and cascara. 
All of these drugs contain substances which 
are irritant poisons derived from anthracene. BATHS AND HOME TREATMENTS 
393 
According to Levin, when a preparation of 
aloes is “employed for a length of time, there 
occurs, in consequence of the persistent con- 
gestion of the descending colon and rectum, 
dilation of the hemorrhoidal veins.” Fallo- 
pius said that “out of a hundred persons who 
make habitual use of aloes, ninety are attacked 
by hemorrhoids.” 
Sollman says that: “When injected hypo- 
dermically, aloin causes a tubular nephritis, 
acute Bright’s disease.” The extensive use of 
this irritating drug in various popular laxa- 
tive drugs and much advertised nostrums 
may well be one of the active causes of the 
alarming increase in disease of the kidneys, 
which has occurred within the last thirty 
years. 
Rhubarb, according to Sollman, contains a 
poison that produces a secondary constipation. 
Saline laxatives throw an enormous bur- 
den upon the kidneys, and when often re- 
peated give rise to a very obstinate colitis. 
They also impair digestion, in time, setting 
up gastric and duodenal catarrh and produc- 
ing achylia, a condition in which the stomach 
glands produce no hydrochloric acid, thus 394 
COLON HYGIENE 
leaving both the stomach and the intestine a 
prey to the various sorts of pernicious bac- 
teria which are constantly finding their way 
into the stomach through the mouth, espe- 
cially through the medium of flesh foods, 
milk, and cheese. 
The effects of laxative mineral waters are 
essentially the same as those of saline laxat 
tives, which they are. 
Saline laxatives are particularly injurious 
to bedridden patients, because of the slow 
emptying of the stomach usual in such cases, 
in consequence of which the stomach is more 
than ordinarily damaged. 
Calomel, a drug which since the time of 
Paracelsus has been extensively used as a lax- 
ative, and in conditions resulting from consti- 
pation, one of the most common of which is 
popularly known as “biliousness,” is often a 
potent remedy, affording prompt relief; but 
when its use is often repeated, it becomes a 
highly dangerous and injurious agent. All 
metallic drugs are combated by the liver, 
which absorbs as much as possible of the poi- 
son into its own tissues as a means of protecting 
the rest of the body. Thus the liver is par- BATHS AND HOME TREATMENTS 
395 
licularly subject to injury. Bennett, of Edin- 
burgh, showed more than a hundred years 
ago that calomel does not increase the action 
of the liver, and his observations have been in 
recent years confirmed by Rutherford and 
others. 
Every chronic sufferer from constipation 
should know that there is no laxative drug 
known, the constant use of which is harmless. 
All laxative drugs are irritants. The more 
certain their action as laxatives, the more 
certainly will their continuous use for any 
length of time be followed by serious injury. 
Said an eminent German physician, “Noth- 
ing is so bad as the chronic use of laxative 
drugs.” 
Mineral Oil 
Petroleum oil, as found in its native state, 
has been long used by primitive people and 
pioneers as a remedy for constipation. Ar- 
buthnot Lane informed the writer (1911) 
that he had learned from authentic sources 
that petroleum had been used for centuries by 
the Kaffirs, and it is well known that it was 
employed as a domestic remedy in America 
long before it was used for illuminating pur- 396 
COLON HYGIENE 
poses. The oil was found floating upon the 
waters of certain streams and was collected 
and sold by itinerant peddlers, and occasion- 
ally in drug stores. 
Paraffin is not acted upon by any of the 
digestive juices, and is not absorbed. It pre- 
vents the drying of the feces, lubricates the 
colon and rectum, and also to some extent 
prevents the absorption of toxins from the in- 
testine. It may possibly to some degree en- 
courage fermentation by preventing the ab- 
sorption of digesting food stuffs and in the 
same way may tend to encourage putrefac- 
tion. The writer, on this account, has found 
it of use to combine it with agar-agar, so as 
to facilitate intestinal action by increasing the 
bulk of the feces. By the addition of some 
syrup, carbohydrates and concentrated fruit 
juice, honey, or malt syrup, the tendency to 
putrefaction in the colon may be antagonized, 
and thereby any possible evil results avoided. 
Paraffin oil will not remedy every defect 
in the defecating process and hence will not 
cure every case of constipation, but it comes 
nearer being a panacea than any remedy 
which has heretofore been found, and does BATHS AND HOME TREATMENTS 
397 
meet a surprisingly large number of indica- 
tions. After a careful study of its effects in 
several thousand cases, the writer feels justi- 
fied in saying with much confidence that par- 
affin oil may be relied upon to accomplish 
the following results in the treatment of 
chronic constipation: 
1. It lubricates the alimentary canal 
throughout its whole length. In a large 
number of cases of constipation there is an 
excessive absorption of water from the colon, 
leaving the feces dry or pasty and adhesive. 
An examination of the rectum and pelvic 
colon in such cases shows the mucous mem- 
brane to be deficiently lubricated by mucus, 
and covered with flakes of adhering feces. 
The use of half an ounce or an ounce of par- 
affin oil at bedtime, and half as much an hour 
before each meal, will in two or three days 
change the condition completely, as shown 
by proctoscopic examination. 
2. This mechanical lubricating action of 
paraffin is highly important in overcoming 
kinks due to redundance or to adhesions re- 
sulting from colitis or other causes. When the 
mucous surface is kept well lubricated, the 398 
COLON HYGIENE 
fecal matter slips along and easily overcomes 
mechanical obstacles, which otherwise be- 
come formidable sources of obstruction. 
3. The human alimentary canal, like that 
of other primates, as illustrated in the diet 
of the higher apes, is adapted to a moderately 
coarse bill of fare. The concentrated diet of 
our modern civilized life contains so little 
indigestible material that the residue forms 
a pasty mass which tends to adhere to the in- 
testinal wall, especially when any obstruction 
is presented by kinks, folds, adhesive bands, 
or a spastic state of the bowel due to colitis. 
When delay occurs, the further absorption 
of water converts these pasty residues into 
hard masses, scybala, which sometimes have 
almost the density of wood. Fats of all sorts 
are more or less laxative if taken in sufficient 
amount, through their effect in modifying the 
character of the food residues. They render 
the mass less adhesive and to some extent pre- 
vent dryness; but both animal and vegetable 
fats are digestible and absorbable, and hence 
are not to any considerable degree effective 
in changing the character of the stools unless 
eaten in amounts larger than can be used, so BATHS AND HOME TREATMENTS 
399 
that a considerable portion remains behind in 
the colon. Such large quantities of fat en- 
courage putrefaction, lessen appetite, dimin- 
ish the secretion of hydrochloric acid, inter- 
fere with the motility of the stomach and the 
small intestine, and may produce great dis- 
turbance of the body metabolism. Paraffin 
oil is free from these objections, since it is 
wholly non-absorbable, and a comparatively 
small amount serves the purpose required, 
because it all remains in the intestine. 
4. Paraffin is useful in all forms of intes- 
tinal stasis or stagnation, no matter what the 
cause, by preventing the abnormal drying out 
of the food residue which is the necessary re- 
sult of too long retention in contact with ab- 
sorbing surfaces. 
5. Another remarkably interesting and use- 
ful property of paraffin oil is found in the 
fact that it stimulates activity of the small 
intestine. Observations, in a large number 
of cases, made by Dr. J. T. Case, Roentgen- 
ologist at the Battle Creek Sanitarium, have 
.shown that paraffin oil greatly accelerates the 
passage of material through the small as well 
as the large intestine. This action is exceed- 400 
COLON HYGIENE 
ingly important in those forms of intestinal 
toxemia which depend upon iliac stasis, by 
far the most serious of all forms of stasis. 
Stagnation in the small intestine is of far 
greater importance than stasis in the colon, 
for the reason that both putrefaction and ab- 
sorption are much more active in this part of 
the digestive tube than in the large intestine. 
Even in cases in which iliac stasis is due to 
the so-called Lane’s kink, as shown by X-ray 
examination, great relief may usually be ob- 
tained by the regular use of paraffin. This 
has been demonstrated in many cases. It is 
only in the most extreme cases, when adhe- 
sions are so extensive that the lumen of the 
intestine is very greatly reduced, that surgical 
measures become necessary. 
6. One of the most interesting features of 
the many-sided useful activities of paraffin, is 
its behavior toward intestinal toxins. These 
toxins consist, not only of bile acids and alka- 
line wastes of various sorts excreted by the 
intestinal mucous membrane, but in addition, 
of a great variety of ptomaines and toxins 
produced through bacterial action, especially 
in the colon, and also in the small intestine in BATHS AND HOME TREATMENTS 
401 
cases of incompetency of the ileocecal valve. 
Paraffin is a highly active solvent, and read- 
ily dissolves these waste and poisonous sub- 
stances, many of which are more soluble 
in paraffin oil than in water. The result is 
that the paraffin oil, itself not absorbable, 
takes up a very considerable portion of tox- 
ins found present in the intestinal tract, and 
thus prevents their absorption. When paraf- 
fin is used, it may always be seen in the stools, 
showing a brownish or blackish color, due to 
the substances which it holds in solution. In 
a laboratory test made by a competent chem- 
ist by request of the writer, it was found that 
when paraffin oil was shaken with a watery 
solution of indol, more than half the indol 
was quickly taken up by the paraffin. The 
use of paraffin thus affords an effective means 
of hindering the absorption of infective tox- 
ins, and conveying them out of the body. 
7. Paraffin oil serves a useful purpose in 
protecting the mucous membrane when it is 
in an irritated state, as in cases of chronic co- 
litis. The value of petrolatum and other neu- 
tral petroleum products as a dressing for 
wounds is well known. Paraffin acts in an 402 
COLON HYGIENE 
equally favorable way upon irritated mucous 
surfaces. It has long been used for this pur- 
pose in the treatment of diseases of the nose 
and throat. 
8. Paraffin serves another useful protective 
purpose in hindering the absorption of poi- 
sons by mucous surfaces which have been de- 
prived of their epithelium. The normal epi- 
thelial covering of the intestines has remark- 
able filtering powers, by which toxins, espe- 
cially colloid poisons, are excluded. 
This filtering power is lost when the sur- 
face is denuded. A protective layer of oil 
renders great service in such cases, by hinder- 
ing the absorption of these poisonous matters, 
which occurs with great readiness through 
abraded surfaces. 
9. In cases of colitis, paraffin oil protects 
the irritated surfaces, but also through its lu- 
bricating effect and through softening the in- 
testinal contents, aids greatly in overcoming 
the spastic condition of the intestine, which in 
many cases of chronic constipation is so for- 
midable an obstacle to recovery. Laxatives 
of all sorts increase the spasticity of the in- 
testine, and so aggravate the constipation BATHS AND HOME TREATMENTS 
403 
which they are given to relieve. This is one 
reason why many are more constipated after 
taking a laxative than before. Temporary re- 
lief is obtained by the production of watery 
stools which are able to pass through the 
contracted bowel, but as soon as the first ef- 
fects of the laxative pass off, constipation be- 
comes worse than before, since the spasm is 
greater. Paraffin lubricates and protects the 
sensitive surface of the spastic bowel, and at 
the same time softens the intestinal contents 
so as to permit passage through the bowel 
without mechanical irritation. Cases of 
colitis are greatly benefited by the regular 
use of paraffin. 
10. X-ray observations of Case, confirmed 
in many cases at the operating table by the 
writer, have shown that incompetency of the 
ileocecal valve is a most common and effec- 
tive cause of iliac stasis. Experience in treat- 
ing several hundreds of cases has shown that, 
aside from the regulation of diet, and the use 
of bran and agar-agar, the regular use of par- 
affin oil is the most effective means of com- 
bating this condition. Medicinal laxatives 
increase the antiperistalsis by which the re- 404 
COLON HYGIENE 
flux from the colon into the small intestine is 
increased. Case has shown by X-ray exam- 
ination that paraffin increases the motility of 
the small intestine, while it does not increase 
antiperistalsis. It is thus a rational and effi- 
cient remedy of great value in dealing with 
this very large and important class of cases. 
11. In all cases in which the stagnation of 
the small intestine is due to spasm of the 
ileocecal valve, induced by chronic appendi- 
citis, ovarian irritation or inflammation, coli- 
tis, or possibly painful rectal disease through 
reflex irritation; paraffin proves itself to be 
an invaluable remedy, since it has the prop- 
erty of increasing the peristaltic activity of 
the small intestine to such a degree as to en- 
able it to overcome the spasm of the ileocecal 
valve without producing irritation, which 
would inevitably increase the spasm of the 
sphincter, as do drug laxatives. The neutral 
character of paraffin, which enables it to 
stimulate and facilitate intestinal motility 
without producing irritation, is invaluable. 
12. The regular use of paraffin oil very 
generally relieves hemorrhoids and fissure, 
even when of some years’ standing. These BATHS AND HOME TREATMENTS 
405 
morbid conditions are usually the result of 
constipation, and are maintained and aggra- 
vated by straining at stool. By the habitual 
use of paraffin, the stools are made soft, 
straining is avoided, the intestinal contents 
are rendered less irritating and infectious, 
and thus the diseased tissues are readily 
healed. 
Since adopting the use of paraffin, the 
author has found that the number of cases in 
which operation for hemorrhoids is needed is 
greatly reduced. Patients who have contem- 
plated submitting to operation for removal of 
hemorrhoids of many years’ standing, in a 
short time after beginning the use of paraffin, 
often find themselves so completely relieved 
that an operation is no longer necessary. 
13. Paraffin is capable of rendering invalu- 
able service in cases of intestinal intoxication, 
by increasing the number of daily stools. The 
length of time which foodstuffs remain in the 
intestine is reduced from several days to a few 
hours. This greatly lessens the opportunity 
for development of putrefactive processes 
and the absorption of putrefaction products. 
It may be justly said that no other remedy is 406 
COLON HYGIENE 
capable of rendering such important and ef- 
ficient service in combating constipation as 
this simple and harmless agent; but it must 
be continuously, a proper dose (one or two 
tablespoonfuls) at each meal. 
Objectionable Features of Paraffin 
The few unpleasant effects attending the 
use of paraffin are really so slight in charac- 
ter that they are generally easily overcome. 
Sometimes, however, they constitute a real 
obstacle to the use of this most valuable rem- 
edy. The chief objections which are met are 
the following: 
1. An unpleasant oily taste which to some 
people is so disagreeable as to produce nau- 
sea and loss of appetite. 
2. A disposition to separate from the other 
intestinal contents. It usually appears as a 
brown oily liquid separated from the rest of 
the stool and sometimes the separation is so 
marked that the stools are very ragged and 
consist of hard lumps smeared with brown oil. 
3. Paraffin oil is so limpid that it readily 
finds its way to the rectum ahead of the other 
bowel contents, and very easily escapes, either BATHS AND HOME TREATMENTS 
407 
with or without the expulsion of flatus. The 
patient is often unconscious of the escape 
until it is noted that the clothing is badly 
soiled. 
The difficulty of taking paraffin the writer 
succeeded in overcoming in part by prepar- 
ing a heavy emulsion by the use of gum aca- 
cia. The emulsion is easily taken in hot or 
cold water and is much better tolerated by 
invalids and children. 
Paraffin Tablets 
All objections are removed by the use of 
paraffin in solid form. Paraffin tablets which 
are solid at ordinary temperatures, but melt 
at the temperature of the inside of the body, 
are easily taken with the food. Paraffin in 
this form mixes with the feces thoroughly and 
does not separate. A single tablet (one-half 
ounce) is usually sufficient for a dose. One 
tablet is taken with each meal. Two or more 
tablets may be taken without injury. Paraffin 
taken in this form (Paramels) is much more 
efficient than in the ordinary form, requiring 
only about half the quantity. They have a 
special advantage in the fact that they may be 408 
COLON HYGIENE 
taken with the meals and thus, becoming thor- 
oughly mixed with the meal, the paraffin ad- 
heres to the food residues and renders most 
efficient lubrication. Paraffin in this form is 
never discharged unconsciously and so does 
not soil the clothing. In use the tablets should 
be cut into half a dozen pieces, which should 
be taken at intervals during each meal, and 
always with food in the mouth with which 
it should be thoroughly mixed. 
The Food Residues, Not the Intestine, Re- 
quire Lubrication. 
It is to be remembered that it is the food 
or food residues rather than the alimentary- 
canal that requires lubrication. It is this fact 
which renders paraffin oil inefficient in many 
cases. It does not mix well with the food. 
When taken before the meal, it passes along 
the intestine ahead of the food. When taken 
after the meal, it follows after the food. In- 
spection of the stools always shows a quantity 
of oil floating upon the surface. This float- 
ing oil has rendered no service as it has not 
been mixed with the food. The solid form of 
paraffin, which melts at the temperature of BATHS AND HOME TREATMENTS 
409 
the body, has the advantage that when taken 
with the food and thoroughly intermingled 
with it, it remains with the food residues and 
does not separate, and thus becomes an effi- 
cient lubricant. Experience shows that Para- 
mels often succeed in cases in which paraffin 
oil apparently has no effect. 
Lubrication of the Rectum 
In many cases of chronic constipation the 
lower colon and the rectum become dry, the 
result of atrophy of the lubricating mucous 
glands which have been destroyed by colitis 
or chronic proctitis. This condition may ex- 
tend up into the pelvic colon. As a result, the 
feces adhere to the walls of the bowel and so 
accumulate, forming impactions and cumu- 
lative constipation. In many such cases only 
partial relief is obtained by a laxative diet. 
By the use of Paramels the lower intestine 
may be lubricated so as to prevent adhesion of 
residues. Ordinary paraffin oil does not serve 
the purpose satisfactorily for the reason that 
it will neither mix with the food nor adhere 
to the intestinal wall. The special paraffin used 410 
COLON HYGIENE 
in Paramels, having a melting point slightly 
above the body, at the body temperature ac- 
quires the consistency of a soft ointment 
which adheres to the surface of the bowel, 
and serves as a most efficient lubricant. 
In specially obstinate cases this special par- 
affin (melting point 104° F.) may be injected 
into the rectum at night with great benefit. 
The temperature should be 104° F. and the 
quantity, two to eight ounces. EXERCISES WHICH COMBAT 
CONSTIPATION 
The exercises that are of the greatest value 
in cases of constipation are those which bring 
into strong action the muscles of the abdomen. 
The abdominal muscles are generally weak 
and relaxed, and the intra-abdominal pressure 
is consequently low. 
By appropriate exercises the weak mus- 
cles may be strengthened; the intra-abdom- 
inal pressure may be raised and the colon may 
be thus enabled to contract with sufficient 
impetus to expel its contents. 
Hill Climbing 
Hill climbing is a more valuable exercise 
than walking on the level, because the ab- 
dominal muscles are brought into more active 
play. When mountain climbing is not an 
available form of exercise, nearly the same 
results may be obtained by climbing a ladder 
or by walking up and down stairs. The 
writer has also made use of the treadmill as 
411 412 
COLON HYGIENE 
the means of securing muscular exercise sim- 
ilar to that required in hill climbing. 
Horseback Riding 
Horseback exercise is especially indicated 
as an exercise for constipation. Riding a con- 
siderable distance, however, is necessary to 
produce any decided effect, as, on the whole, 
horseback riding to a person accustomed to 
it, is not very active exercise, except when 
riding a hard-trotting horse. 
Rowing 
Rowing is one of the very best exercises to 
combat constipation, provided the chest is 
held high during the exercise, and especially 
if care is taken to give the trunk as strong a 
backward movement as possible; but care 
must be taken to avoid holding the trunk for- 
ward with the shoulders rounded and the 
chest depressed. 
Tennis 
Tennis may be highly commended for 
young persons and those who are sufficiently 
strong to engage in this form of exercise EXERCISES TO COMBAT CONSTIPATION 
413 
without injury. This very popular game is, 
however, too vigorous for persons with weak 
hearts. 
The Medicine Ball 
This is a capital exercise for persons who 
are fairly strong. It brings the muscles of 
the trunk into vigorous action. 
Work Exercises 
The movements of chopping and digging, 
swinging the hammer and mowing are highly 
valuable exercises if taken with due care to 
maintain the body in an erect position. Many 
household occupations, such as scrubbing, 
washing, and general housework, are excel- 
lent forms of exercise when correct posture 
is maintained. 
Posture Exercises 
Of first importance to persons suffering 
from constipation is the maintenance of an 
erect position of the trunk. When the chest 
is lowered, as in sitting in a relaxed attitude, 
the distance between the breast bone and pel- 
vis is diminished, so that the large muscles 
which form the front of the abdominal wall 414 
COLON HYGIENE 
are shortened and relaxed. In this attitude the 
muscles cannot be contracted sufficiently to 
produce the proper degree of intra-abdominal 
pressure. When the chest is held high, the 
rectus muscles are stretched and are thus able 
by contraction to produce the maximum ef- 
fect in compressing the colon. Flat-chested 
persons are predisposed to constipation be- 
cause of inefficient action of the abdominal 
muscles. 
The ordinary chair must be regarded to a 
very considerable degree as responsible for 
the prevalence of flat chest and round shoul- 
ders, and the evils which result from this 
deformity. It is possible to sit in an erect 
attitude in a chair of any shape; but with a 
chair with a straight back, constant effort is 
required, by forcible contraction of the mus- 
cles, to maintain the body in an erect position. 
The moment the muscles are permitted to 
relax, the trunk falls into an abnormal and 
unhealthy attitude, the spinal column being 
curved backward instead of forward, as is 
natural and necessary for health. EXERCISES TO COMBAT CONSTIPATION 
415 
As the result of an habitually wrong atti- 
tude in sitting, the same improper attitude is 
maintained when standing and walking, and 
the figure becomes deformed. A flat chest, 
round shoulders, and a forward carriage of 
the hips are characteristics to be found in the 
great majority of persons who lead sedentary 
lives, especially those who sit much at their 
work, such as accountants, writers, teachers, 
and professional people generally. One of 
the first things, then, for a constipated person 
to do is to correct his sitting and standing at- 
titudes. This may be done by careful execu- 
tion of the following exercises, which the 
writer has employed for more than 25 years 
with much satisfaction in the treatment of 
cases of this sort. 
To Correct the Standing Posture 
Stand against a straight wall. Place heels, 
hips, shoulders, head and hands firmly 
against the wall. Now bend the head back- 
ward as far as possible, or until the eyes look 
straight up to the ceiling, at the same time 
permitting the chest and shoulders to move 
forward. While holding the head in this 416 
COLON HYGIENE 
position, press the hands firmly against the 
wall; draw the chin down to position with- 
out allowing the shoulders to move backward, 
still holding the body rigid, allowing the 
arms to fall at the sides. In this position the 
chest will be held high and the abdominal 
muscles well drawn in. While holding this 
position execute movements with the arms; 
arm raising above the head, swimming move- 
ments, etc. 
This is the correct standing position and 
should, as far as possible, be constantly main- 
tained in standing and walking. It is impos- 
sible, of course, to hold the muscles constantly 
rigid. In relaxing, however, care should be 
taken to keep the chest forward, so that the 
body does not fall back into the former incor- 
rect attitude. 
Exercises to Correct the Sitting Posture 
Sitting upon a chair or stool, preferably 
the latter, proceed as follows: 
Place the hands on the hips, with the 
thumbs behind. Bend the head backward so 
as to look straight up to the ceiling; now 
bend forward as far as possible while still EXERCISES TO COMBAT CONSTIPATION 
417 
keeping the eyes on the ceiling; now make 
firm pressure with the thumbs, and while 
pressing hard bring the body up to the erect 
position. Still keeping the eyes upon the 
ceiling, holding the elbows as far back as 
possible, and without for an instant lessening 
the pressure on the thumbs, bring the chin 
down to position. 
If this movement is executed according to 
directions, it will bring the body into perfect 
position, with the chest raised high and the 
abdominal muscles well drawn in, as shown 
in the accompanying cut. To secure definite 
and beneficial results it is necessary to use a 
chair having a back of the right shape as 
shown in the accompanying illustration. 
Breathing Exercise 
Sit with the hands at the back of the neck, 
and the elbows in line with the shoulders, the 
chest held high, and the abdominal muscles 
well drawn in. Raise the heels and make 
rapid movements upon the floor with the toes 
for one minute. Then take ten deep breaths, 
still holding the arms in position. 418 
COLON HYGIENE 
Rocking Chair Exercise 
Sitting upon the front edge of a chair, with 
the hands upon the hips, the thumbs behind, 
the elbows well drawn back, bend forward to 
an angle of 45° and then, holding the body 
rigid, throw the trunk backward, lifting the 
feet clear of the floor. Repeat. The effect 
will be a rocking movement. Breathe 
deeply. Repeat forty times. A rocking chair 
may be conveniently used in taking this ex- 
ercise. 
Exercise to Raise the Chest 
Lie upon the back on a hard surface; 
place beneath the hollow of the back a roll of 
blankets or a folded pillow or cushion about 
six inches in diameter. The purpose of this 
is to give the spinal column the forward 
curve which is natural to it, and thus raise 
the chest. The roll should be placed at such 
a point as to raise the chest to the fullest ex- 
tent, while the head and shoulders still rest 
upon the couch. In this position, deep 
breathing movements should be practiced at 
the rate of about ten a minute. EXERCISES TO COMBAT CONSTIPATION 
419 
To Strengthen the Abdominal Muscles 
With the back supported as in the previous 
paragraph, raise both legs to the perpendicu- 
lar. Repeat ten to forty times. A deep 
breath should be taken just before the legs are 
raised, and after each movement there should 
be a pause during which a deep breath is 
taken. 
Feeble and very fleshy persons are often at 
first not able to raise the legs. In such cases 
the exercise will begin with the legs drawn 
up to a fixed position. By extending the legs 
and allowing them at the same time to drop 
slowly to the starting position, the abdominal 
muscles may be brought into strong contrac- 
tion, and as they gradually increase in 
strength, the legs may be flexed less until 
they can be raised to a vertical position with- 
out flexion. 
Trunk Raising Exercise 
Lying on the back and holding the legs 
firmly extended, raise the arms forward and 
raise the body to the perpendicular, then 
bend forward, and, if possible, touch the toes. 
Repeat ten to twenty times. 420 
COLON HYGIENE 
Rolling Exercise 
Rolling over on the floor or on a wide bed 
is a capital exercise for strengthening the 
lateral muscles of the trunk. Practice for 
five minutes. 
Rocking Exercise, Lying 
Flex the left leg upon the abdomen; 
clasp the hands beneath the knee and pull as 
hard as possible, so as to force the thigh down 
upon the abdomen; then, with the other leg 
fully extended, cause the body to execute 
rocking movements by quickly moving the 
leg up and down, assisting by forward and 
backward movements of the head. Repeat 
same with the right leg. This is a very ef- 
fective exercise if taken vigorously and re- 
peated three times a day for five or ten 
minutes. 
Arm and Trunk Exercise with Deep 
Breathing 
Standing with the chest held high, place 
left hand upon the left hip. With a swinging 
movement sidewise bring the right arm to EXERCISES TO COMBAT CONSTIPATION 
421 
the perpendicular, and then, holding the arm 
in position, bend the body to the left side as 
far as possible, breathing in. Rise to position, 
breathing out. Repeat four times and then 
execute the same movement with the right 
hand upon the hip, breathing in. 
Squatting Exercise 
Standing, with the heels separated ten or 
twelve inches, the hands upon the hips, exe- 
cute squatting movements, bringing the trunk 
as near to the floor as possible, and bending 
slightly forward. An excellent exercise to 
stimulate bowel movement. 
Running on All Fours 
With arms and legs extended run about 
the room for five or ten minutes—running 
on all fours. This movement was prescribed 
by a Berlin physician for an eminent German 
statesman, with excellent results. 
Knee-Chest Breathing 
Placing the body in the knee-chest position, 
execute deep breathing movements, filling the 
chest as completely as possible, then, holding 422 
COLON HYGIENE 
the chest in position, draw in the abdomen as 
much as possible while breathing out. 
Colon Compressing Exercise 
Sitting on a low seat with the feet raised 
upon a stool, place the closed fists in the left 
groin and bend the trunk strongly forward so 
as to compress the hands between the thighs 
and the abdomen. Take several deep breaths 
while holding the body in position. 
Inclined Plane Exercises 
Among the most important of all forms of 
exercises for combating constipation, a series 
of certain simple exercises are taken upon an 
inclined plane, with the head low. The spe- 
cial advantages of the inclined plane are: 
1. The head-low, hips-high position greatly 
aids in the replacement of the prolapsed 
stomach and colon, conditions almost uni- 
versally present in chronic constipation. 
2. The head-low position drains the abdo- 
men of blood, thus relieving congestion of the 
viscera. 
3. Exercises of the trunk muscles should 
always be taken after the prolapsed viscera A Folding Exercise Table EXERCISES TO COMBAT CONSTIPATION 
423 
have been restored to position. When this is 
not done, the effect may be to increase the dis- 
placement whenever the abdominal muscles 
are strongly contracted. 
There are three classes of exercises to be 
taken with the inclined plane, viz: (1) 
Stretching exercises, (2) Colon replacing 
exercises, and (3) Trunk exercises. 
The folding exercise table is a convenient 
appliance for use in these exercises. It may 
be in part replaced by an ordinary ironing 
board placed with one end resting upon the 
side of a bed, couch or window sill, the other 
on the floor. The exercise table is provided 
with a strap at one end to hold the feet and 
prevent slipping down and a rope with a 
handle attached for pulling the body up. At 
the sides are placed handles to be grasped by 
the patient. 
Getting in Position 
The following is a convenient method of 
placing one’s self in position upon the table; 
Standing upon the left side of the table 
grasp the strap with the right hand. Sit 
down upon the table and swing up one foot 424 
COLON HYGIENE 
and place it under the strap, and then bring 
up the other foot in the same way, and then 
grasp the sides of the table or the handles and 
let the trunk fall down into position. While an 
ordinary ironing board may be used, the strap 
for the feet and the handles for the hands are 
really essential for convenient use. 
After getting into position upon the table, 
the patient takes a few very deep breaths, 
holding the chest high while breathing out. 
Exercises 
Grasping the handles, bend the head back- 
ward as far as possible, at the same time 
widely opening the mouth as in yawning. 
Position 
Patient lies upon an inclined table grasp- 
ing the handles, (a) Right arm, left leg 
stretch, (b) Grasping handle with left hand 
raise the right arm above the head and at the 
same time point the toe of the left foot and 
reach as far as possible in opposite directions, 
(c) Do the same with the left arm and right 
leg. EXERCISES TO COMBAT CONSTIPATION 
425 
Colon Replacing Exercises 
Lying on the inclined table with feet under 
the strap, place the hands upon the lower ab- 
domen and breathe deeply; with each ex- 
piration press hard upon the little-finger side 
of the hands and draw the hand upward so as 
to push the contents of the abdomen toward 
the diaphragm. Hold the hands firmly in 
position during the inspiration. Repeat ten 
or twelve times. 
Abdominal Compression-Breathing 
Compress the abdomen firmly with the 
hands and take a slow deep breath. Repeat 
fifteen or twenty times. 
Diaphragm Exercise 
Lie upon the face over a folded pillow or 
cushion with the feet under the strap and the 
head resting upon the folded arms. Take 
deep breaths. This is an exercise for reliev- 
ing congestion of the abdominal viscera, 
strengthening the breathing muscles. At each 
breath the diaphragm is compelled to lift the 
weight of the trunk. 426 
COLON HYGIENE 
Exaggerated Knee-Chest Breathing 
Grasping the handles, rise from the posi- 
tion of the preceding exercise to a kneeling 
position, pushing the pillow forward a little 
and then take the knee-chest position; take 
ten to fifty deep breaths. This is a most ef- 
fective means of draining the overfilled blood 
vessels of the abdomen and pelvis, and sets 
gravitation to work pulling the prolapsed 
organs into position. The exercise is still 
more effective if taken after filling the colon 
with water, as the added weight of the pro- 
lapsed organ assists in restoring it to position. 
Leg Raising 
Lying on the back, hands grasping the 
handles, while holding both legs straight and 
toes pointed, raise them to vertical position 
while counting four. Lower at the same rate. 
Repeat eight to twelve times, taking one or 
two deep breaths after each movement. 
Trunk Twisting 
Back lying, feet under strap, throw the 
extended right arm over to the left, at the 
same time turning the face and shoulders in EXERCISES TO COMBAT CONSTIPATION 
427 
the same direction. Return to position, and 
repeat eight or ten times. Do the same with 
the left arm. 
Hips Rolling 
Back lying, draw the knees up as far as 
possible, then extend the limbs vigorously as 
far as possible toward the left, rolling the 
body in the same direction. When the legs 
are completely extended, carry them straight 
across to the opposite side, rolling back 
toward the right side. Complete the move- 
ment by drawing the legs back to the flexed 
position and returning to the starting position. 
Repeat ten or twelve times, pausing long 
enough after each movement to take one or 
two deep breaths. This is a most excellent 
exercise for all the muscles of the trunk. 
Static Exercises 
These are exercises which may be taken 
while one is engaged in study, writing, book- 
keeping, or some sedentary occupation, with- 
out interfering with the work in hand, the 
purpose being to combat the pernicious ef- 
fects of any form of confining work. 428 
COLON HYGIENE 
With the chest held high, the abdominal 
muscles well drawn in, and the body sup- 
ported in a correct posture, deep breathing 
may be practiced with most excellent results. 
The breathing may often be made rhythmical 
with the work, especially in typewriting, 
adding and similar work which is more or 
less mechanical in character. In this way 
exercise may become a means of increasing 
efficiency* directly, as well as through better 
aeration of the blood and the resulting im- 
provement in mental and physical activity. 
This deep breathing may be practiced 
under almost any conditions without interfer- 
ing with the work in hand. When riding on 
the street cars or in an automobile, even when 
sitting in church or at a lecture, deep breath- 
ing may be practiced almost continually. 
The practice will be found to promote bowel 
activity, and to enormously increase efficiency 
and endurance. When the habit is once 
formed the deep breathing becomes auto- 
matic. Typists, printers, and persons en- 
gaged in similarly unhealthful occupations 
may, by this means, so strengthen their resist- 
ance, and maintain such a high state of vital EXERCISES TO COMBAT CONSTIPATION 
429 
efficiency, that they may possibly escape the 
dreaded pulmonary tuberculosis, the malady 
above all others that is the most fatal to this 
class of workers. 
Tension Exercises 
During life the muscles are always in a 
state of tension; that is, every muscle is more 
or less active even when it seems to be at 
rest. This tension is increased by cold to the 
point of producing visible movements of 
shivering. It is also increased by pain or 
inflammation, as is seen in the rigid contrac- 
tion of the abdominal muscles in appendi- 
citis. Tension may also be increased by a 
simple effort of the will. The mere thinking 
of a bodily movement, in fact, increases the 
tension of the muscles which are concerned 
in the movement, and to such a degree that 
long-continued fatigue may result, showing 
that work has been done, as when one watches 
the performance of acrobats, or a closely con- 
tested athletic game. This fact may be made 
of practical value. Thus if one’s feet are cold, 
they may be quickly warmed by alternately 
tensing and relaxing the muscles of the legs, 430 
COLON HYGIENE 
or by making slow, tense, flexion and exten- 
sion movements of the feet. 
In like manner all the muscles of the legs 
may be brought into active play by simply 
setting or tensing the muscles of the legs, that 
is, holding the limbs rigid with as much force 
as possible. The muscles of the trunk and 
arms may be tensed in like manner. All the 
muscles may be tensed at once, or different 
parts, as the arm muscles, trunk muscles, or the 
muscles of a single limb may be exercised in 
succession. Tension exercises may be taken 
in many cases without the slightest interfer- 
ence with one’s work; and when the work is 
very sedentary one may by this means, with- 
out loss of time, secure a large part of 
the benefit of such active exercises as walking, 
tennis, golf, etc. Such exercises should not 
be considered as a substitute, however, for 
out-of-door exercise, but rather as a supple- 
ment to such exercise. 
One very excellent form of exercise which 
may be taken while sitting at desk at work or 
when reading or studying, is rapid raising or 
lowering of heels either together or in alter- 
nation. The heels are raised so that the weight EXERCISES TO COMBAT CONSTIPATION 
431 
of the limbs rests on the toes, and the limbs 
are then set in rapid motion. Bracing the 
feet together, a similar movement may be 
executed with the knees rapidly separating 
and closing. The movement is so rapid that 
the exercise closely resembles shivering. 
One excellent use for movements of this 
kind is to prevent taking cold when one is 
exposed to a draft. If, for example, one feels 
a draft of cold air on the back of the neck, he 
may prevent ill effects by simply tensing the 
muscles of the neck, or indeed, by holding the 
muscles rigid while making slow movements 
of the head, either forward and backward or 
side-wise. In out of door sleeping, exercises 
of this sort may be resorted to as a means of 
warming the feet and limbs. These warming 
exercises are important for persons suffering 
from constipation, because of the tendency 
that such persons have to coldness of the ex- 
tremities, the result of spasm of the blood 
vessels, due to the influence of intestinal poi- 
sons upon the vasomotor centers. 432 
COLON HYGIENE 
An Exercise Program 
When possible exercise should always be 
taken in a rhythmical way. This effect may 
he secured by means of counting, or better 
still by the aid of music, for which a phono- 
graph, victrola or a graphophone serves an 
excellent purpose. 
The following is an excellent program of 
exercises for a person of average strength: 
1. On rising, take an exercise bath (see 
page 242), beginning with the water at a 
temperature of 90 degrees and ending at 70 
degrees to 60 degrees or pipe temperature. 
Row 100 to 200 strokes counting. 
2. Inclined plane breathing and replace- 
ment exercises. 
3. Inclined plane exercise to strengthen 
abdominal muscles. 
4. Special exercise to aid defecation. 
After exercise make an attempt to move 
the bowels. 
The author has arranged a series of 20 
graduated exercises* which when used system- 
atically, will secure good, all-round muscu- 
* For description address The Health Extension Bureau, Battle 
Creek, Michigan. 433 
EXERCISES TO COMBAT CONSTIPATION 
lar development and are especially designed 
to aid bowel action. 
A description of these exercises with ap- 
propriate music has been placed upon “rec- 
ords” by the Columbia Graphophone Com- 
pany and may be reproduced on any of the 
various phonographic machines used for this 
purpose. 
Special Means to Aid Defecation 
The general aim of all the exercises given 
in this book isi to aid defecation by strength- 
ening the muscles of the trunk and abdomen, 
and forming the breathing movements. There 
are special exercises which may be employed 
during defecation which render effective aid 
in evacuation of the bowels. 
The natives of India, as mentioned else- 
where, aid evacuation when the bowels are 
constipated by pressing a ball formed by a 
folded cloth upon the lower left side of the 
abdomen. Many constipated persons have 
found by experience the advantage, of press- 
ing upon this part of the abdomen with one 
or both closed fists during defecation. 
Persons who have very relaxed abdominal 434 
COLON HYGIENE 
walls often find it very advantageous to com- 
press and knead the abdomen during defeca- 
tion, especially upon the left side. A medicine 
ball may be used for the purpose. The ball 
is held firmly against the abdomen, the under 
side resting on the separated thighs. By 
bringing the thighs together, at the same time 
pressing with the hands, the ball is forced 
against the abdomen. The abdomen may in 
this way be compressed with considerable 
force. The closed fist may be used in place 
of the ball. 
Abdominal Massage 
A radiogram of the colon or a tracing 
made by the aid of the X-ray, showing the 
position, size and form of the different por- 
tions of the colon is of greatest service. With 
the radiogram and such a sketch of the colon 
at hand, the masseur can make his applica- 
tions with such a degree of accuracy as to 
effect a maximum amount of good with a 
minimum degree of effort, and without 
wearying his patient needlessly. The follow- 
ing methods of colon massage are described EXERCISES TO COMBAT CONSTIPATION 
435 
at greater length in the author’s work on 
massage.* 
Massage of the Cecum 
In cases in which there is stagnation of the 
fecal matters in .the cecum and ascending 
colon, massage should be applied, with the 
patient’s hips elevated to an angle of about 
45°. Deep kneading movements should be 
made from below upwards, working along 
the colon in the direction of the lower ribs of 
the right side. When the liver is reached, the 
kneading movements should be carried across 
the body in the direction of the transverse 
colon. The hips of the patient should then be 
lowered, and the kneading movement should 
be directed downward along the descending 
colon, starting from the lower rib of the 
left side. When the upper border of the hip 
bone is reached, the movement should follow 
the inner surface of the bone to the pelvis. 
Not infrequently the colon is found in a 
contracted or spastic state when it feels like 
a rubber tube and may be rolled under the 
lingers. It is usually sensitive to pressure. 
*Tbe “Art of Massage.” Published by the Modern Medicine 
Publishing Company, Battle Creek, Michigan. 436 
COLON HYGIENE 
When the pelvic colon is enlarged, it may 
also sometimes be felt, though not infre- 
quently when it is distended with feces it lies 
so low in the pelvis that it cannot be reached. 
By putting the patient in a knee-chest posi- 
tion, and executing deep-breathing move- 
ments while making deep pressure with one 
hand on each side just above the groins, the 
pelvic colon can sometimes be lifted out of 
the pelvis, so that it can be brought within 
reach, and the hard masses with which it is 
filled may be broken up. In this region the 
colon will often be found filled with masses 
of hardened feces. 
After careful manipulation of the con- 
tracted colon for a few minutes it will dilate, 
the spastic condition disappearing for the 
time being. The writer has often noticed 
this in making examinations of the colon. 
Harsh manipulations are likely to produce 
the opposite effect, increasing the spasm. This 
fact has led some authors to forbid massage 
altogether in cases of colitis, but this is quite 
wrong. Massage is highly beneficial in these 
cases but the manipulations must not be too 
severe. EXERCISES TO COMBAT CONSTIPATION 
437 
Mechanical Kneading and Vibration 
Mechanotherapy is capable of rendering 
more service in constipation than in any other 
single condition. 
The mechanical applications which are of 
greatest service are kneading and vibration. 
Several mechanical kneaders have been de- 
vised. The one illustrated in this book, 
the writer has had in use for more than 
twenty years, and with satisfactory results. 
Patients generally realize immediate benefit 
from the use of the kneader, which may be 
employed for fifteen or twenty minutes twice 
a day, an hour after breakfast, and an hour 
or two after dinner. 
The apparatus consists of six kneading 
arms attached to eccentrics, arranged in such 
a way as to be brought to bear upon the ab- 
domen in consecutive order. The surface 
upon which the patient rests is at the same 
time moved to and fro in such a way that the 
kneading movement travels in a series of 
circles round the abdomen. The vigor of the 
application can be regulated at will. 
There are vibrators of various kinds in 438 
COLON HYGIENE 
use. The majority, however, are possessed of 
too little power to be of service in the treat- 
ment of the abdomen. The best for this pur- 
pose are the dumb-bell vibrator and the vi- 
brating chair. Hill’s dumb-bell vibrator has 
the advantage that it is heavy enough to com- 
press the abdomen to a sufficient degree; and 
the power of the apparatus is sufficient to 
give the whole abdomen an active vibratory 
movement. It has been proved that these vi- 
bratory movements induce peristaltic action, 
while at the same time the weight of the in- 
strument increases the abdominal pressure, 
and tends to fix the parts to which the appli- 
cation is made, so as to secure a maximum 
degree of effect. 
The vibrating chair aids bowel action both 
by directly exciting the centers of the spinal 
cord and by stimulating the lower bowel. 
The oscillo-manipulator is the latest and 
perhaps the best means yet devised for me- 
chanical manipulation of the abdomen as well 
as of other parts of the body. It is surpris- 
ingly efficient. 439 
EXERCISES TO COMBAT CONSTIPATION 
Self-Kneading of the Bowels at Stool 
In many cases of cumulative constipation 
the chief trouble is in the pelvic colon. This 
loop of the intestine, usually about a foot in 
length, and possessing thick muscular walls, 
becomes sometimes so enormously stretched 
and attenuated by accumulations of fecal 
matters and gas that its walls are weak and 
contract very feebly, and it is no longer an 
efficient instrument for forcing the feces into 
the rectum, and thus inducing the defecating 
reflex by which the bowel is normally emp- 
tied. In such a case the patient may some- 
times assist himself by placing the hand at the 
lower part of the abdomen on the left side 
and making deep pressure with the tips of 
the fingers, or placing the fist between the 
thigh and the abdomen so as to compress the 
pelvic colon. Kneading of the iliac colon, 
which lies in the hollow of the left iliac bone, 
is also useful. 
The Gannon Ball 
The cannon ball is a rather old-fashioned 
but useful means of self treatment, by which 
the patient may apply massage to the colon 440 
COLON HYGIENE 
in a very efficient way. A small cannon ball 
weighing about twenty or twenty-five pounds 
is rolled along the course of the colon from 
the cecum toward the rectum. The patient 
should lie with the shoulders slightly ele- 
vated so as to relax the abdominal muscles as 
much as possible. 
The cannon ball should be applied daily 
soon after breakfast, or a little before the 
time at which the bowels are most likely to 
move. The chief benefit to be derived from 
the cannon ball is to aid in propelling into 
the rectum from the pelvic colon a sufficient 
amount of fecal matter to awaken a lively 
stimulation of the defecating center, and so 
to secure a strong impulse and a full evacua- 
tion of the colon below the splenic flexure. 
The Weighted Compress 
This consists of a thick flannel compress 
between the folds of which is quilted in a 
considerable quantity, say fifteen to twenty- 
five poundiS of lead shot. The compress should 
be large enough to cover the entire abdomen. 
It should be applied for an hour before time 
for evacuation of the bowels, deep breathing EXERCISES TO COMBAT CONSTIPATION 
441 
movements being executed in the meantime 
at the rate of twelve to sixteen per minute. 
The Shot Bag 
This device has essentially the same pur- 
pose as the preceding, but may be applied in 
such a way as to secure a more pronounced 
local effect, as, for example, to force stag- 
nating material out of the cecum or the iliac 
colon. It may, in some cases, also be of 
service in forcing feces from the pelvic colon 
into the rectum, when the pelvic loop has 
been weakened by excessive overloading and 
distention with gas. The usual weight of the 
shot bag is twenty to twenty-five pounds. It 
should be placed over the spot where the 
accumulation can be felt with the fingers or 
seen with the X-ray and should be left in 
place for an hour, while deep breathing 
movements are practiced at the rate of twelve 
to sixteen per minute. 
This simple measure has the advantage 
that it may be used by the intelligent patient 
at his home, and its use may be continued for 
an indefinite time without injury, which can- 
not be said of any drug remedy. All drugs 442 
COLON HYGIENE 
which act by irritating the intestine, sooner 
or later, usually sooner, produce colitis and 
other disorders. There are no harmless 
drugs. Of course this does not apply to such 
purely mechanical and harmless means as 
bran and paraffin. 
Pneumatic Compression of the Abdomen 
Compression of the abdomen by an inflated 
rubber bag is a measure of value, of which 
the writer has made use for some years. On 
one occasion, a patient who seemed dead 
from surgical shock was restored almost in- 
stantly by placing a rubber bag under an ab- 
dominal bandage and inflating it as fully as 
possible. The face, which had become ashen 
gray, while the heart had ceased to beat, at 
once became flushed with the color of health, 
the heart began to beat, the patient began 
breathing and death was averted. This ob- 
servation showed the effect of abdominal 
compression applied in this way, and sug- 
gested the use of the same means to increase 
the intra-abdominal tension as an aid to 
bowel movement. In using the bag for this 
purpose, it must be tightly compressed by EXERCISES TO COMBAT CONSTIPATION 
443 
means of a stout bandage, and must be large 
enough to cover the whole abdomen, so that 
when inflated it will well fill the abdominal 
cavity, pressing before it the relaxed abdom- 
inal wall. 
The compression bag is of special service 
in cases in which the abdominal muscles are 
very greatly relaxed, as in women who have 
borne a number of children, and whose mus- 
cles have not been well developed. It is 
most applicable to those who have not a 
superabundance of fat, especially those who 
have lost much in weight after having been 
overfat. 
The Abdominal Supporter 
While compression of the trunk at the 
waist is always harmful, compression and 
support of the lower abdomen is of great 
service in many cases, because of the unnat- 
ural feebleness of the abdominal muscles. In 
fleshy patients almost any sort of bandage 
will accomplish good, but in thin patients an 
ordinary bandage is of little use, for the reason 
that it is held out in front by edges of the 
iliac bones, and so does not press with suffi- 444 
COLON HYGIENE 
dent firmness upon the lower abdomen where 
support is needed. 
The most effective support in such cases 
can be secured only by a bandage which is 
compressed by springs. Such a bandage, 
which the writer has had in use for more than 
a dozen years, is shown in the accompanying 
cut. In fleshy patients a stout bandage made 
of ducking and cut to fit snugly is of greatest 
service. 
The bandage must be worn constantly 
when the patient is on his feet. Its purpose 
is not simply to support the viscera, which 
the best of bandages can do only in a very 
small degree, but to increase the intra-abdom- 
inal pressure to such a degree as to assist the 
colon in disposing of its contents. Some pa- 
tients are completely relieved of constipation 
by the use of a proper bandage. 
In most cases it is necessary to employ 
perineal bands to keep the bandage in posi- 
tion at the lower abdomen, where alone it can 
be of service. 
Pain in the back is one of the disagreeable 
symptoms which an efficient bandage often 
relieves, especially when the pain is due to The Abdominal Supporter 
Relaxed protuberant ab- 
domen, a result of bad sit- 
ting position. 
The same person stand- 
ing, poise corrected and ab- 
domen held up by a spring 
supporter. Kneading the Colon EXERCISES TO COMBAT CONSTIPATION 
445 
enteroptosis, or prolapse of the intestines, 
rather than colitis. 
A sense of exhaustion, often resulting from 
low intra-abdominal tension, which permits 
an undue amount of blood to accumulate in 
the abdominal vessels, robbing the brain and 
spinal cord, is almost immediately relieved 
by a proper bandage. 
The bandage is only a palliative, however, 
and its use must be accompanied by the de- 
velopment of the abdominal muscles by means 
of massage, electricity, and suitable exercises. 
In cases requiring the use of the abdominal 
supporter during the day, the moist abdom- 
inal girdle should be worn at night to aid in 
relieving congestion. The bandage should 
be used with the mackintosh protection, and 
the bandage should be removed or renewed 
before it becomes dry. EFFICIENT ELECTRICAL 
METHODS 
While electricity is certainly not a panacea 
for constipation, nor for any other disease, 
and is certainly not able to accomplish a 
tithe of the miracles which have been attrib- 
uted to it, it is nevertheless, when skillfully 
applied, a most valuable remedy in constipa- 
tion. As ordinarily used by means of sponges 
held in the hands, and employing a current 
from a small buzzing faradic machine, noth- 
ing more is accomplished than a slight titilla- 
tion of the skin and giving the patient a 
slight amount of pain, which may, however, 
in some cases, exercise a beneficial psycho- 
logical effect. 
Electricity may render valuable service in 
constipation in two ways: (1) By inducing 
automatic exercise of the abdominal muscles 
and so restoring their tone and strength; and 
(2) by stimulating the colon itself and thus 
inciting bowel action; and (3) by restoring 
lost nerve sensibility to the rectum. This it 
does both by directly exciting bowel action 
446 ELECTRICAL METHODS 
447 
and by raising to activity sensibility of the 
rectum when lost by neglect. 
Automatic Exercise 
Automatic exercise of the abdominal mus- 
cles may best be administered by the aid of 
the sinusoidal electrical current. The static 
or faradic current may be used, but they are 
more or less painful and less easily controlled. 
The sinusoidal current is practically painless. 
The most convenient method of using the 
current is by means of the automatic exercise 
apparatus which may be adjusted so as to 
cause any desired number of vigorous con- 
tractions of the abdominal muscles per 
minute. 
By this means the abdominal muscles and 
the nerves and nerve centers which control 
them may be powerfully stimulated and their 
functions gradually restored. 
Electrical Stimulation of the Colon 
Applications of electricity to the surface 
of the body do not excite action in the colon; 
but the colon may be excited by the applica- 
tion of the current directly to the interior of 448 
COLON HYGIENE 
the colon. This cannot be done by the patient 
himself, as the services of an expert proctol- 
ogist are needed for the proper placing of 
the electrode. 
Electrical Stimulation of the Rectum 
The application of the sinusoidal current 
to the rectum by means of a proper electrode 
is a most effective means of stimulation of the 
rectum when its normal sensibility has been 
greatly diminished or lost by neglecting 
to attend properly to Nature’s “call” for 
evacuation of the bowels. For this purpose 
the very rapidly alternated current is best. 
The applications should be made daily. The 
duration of the application should be about 
ten or fifteen minutes, and the strength of 
the current as much as the patient can bear 
without discomfort. Not infrequently the 
effect of the application is to provoke an im- 
mediate evacuation of the bowels. 
Diathermy or Thermo-penetration 
This new application of electricity which 
we owe to Dr. Nagelschmidt, of Berlin, is a 
most interesting medical use of the so-called ELECTRICAL METHODS 
449 
wireless electrical current. In the body the 
high frequency wave,s of electrical energy 
are wholly converted into heat so that no 
electrical sensation or other sensation except 
heat is felt. The special advantage of dia- 
thermy over other forms of heat applications 
is that the heat may be applied to the deepest 
parts as easily as to superficial parts. This is 
due to the wonderfully penetrating power of 
this current. 
Diathermy is a valuable means for em- 
ployment in the treatment of colitis. The 
application of the current to the spastic colon 
causes it to relax, and likewise relieves the 
pain in the colon as well as the back and 
other reflexly related parts. SPECIAL TREATMENT OF DIF- 
FERENT TYPES OF 
CONSTIPATION 
The practical management of cases of con- 
stipation is in its main features the same, ir- 
respective of the type or form which the 
disease may assume. However, there are 
certain special features of each of the several 
characteristic phases of this diseased condi- 
tion which require special consideration. 
Without recapitulating the details of what 
has been said in the preceding chapters re- 
specting the hygiene and preventive methods, 
the next few pages will be devoted to a 
summary of the methods which have proved 
most effective in dealing with several forms 
of constipation. 
Treatment of Simple Constipation 
The patient must set himself resolutely to 
improve his general health in every possible 
way. He must avoid all habits known to be 
injurious, such as the use of tobacco, alcohol, 
450 TREATMENT OF CONSTIPATION 
451 
tea or coffee. Indulging in late hours, ir- 
regular meals, use of rich and highly sea- 
soned foods, unwholesome dress, worry and 
every unnecessary expenditure of vital en- 
ergy which does not bring with it a com- 
pensating addition to vital resources, must 
be resolutely abandoned. The general rules 
and principles which have been set forth in 
the preceding chapters respecting the regu- 
larity of bowel movement and the use of 
laxative foods in sufficient quantity must be 
scrupulously followed. 
The special exercises recommended for 
strengthening the abdominal muscles, cor- 
recting wrong attitudes in sitting and stand- 
ing, must be taken systematically twice a day. 
Feeble persons will, of course, begin with 
lighter exercises, increasing their vigor as 
they improve. No less than thirty minutes 
should be devoted to exercise daily. 
The exercise bath is especially recom- 
mended because it economizes time by com- 
bining the tonic cold bath with vigorous 
exercise of the most helpful sort. 
In all cases in which the colon is prolapsed, 
and when there is a flabby state of the abdom- 452 
COLON HYGIENE 
inal muscles, a carefully fitted abdominal 
supporter must be worn. 
Diet 
The most important of all measures is the 
careful regulation of the diet, not only with 
a general view to a laxative effect, but to 
suit the needs of the individual patient. It 
must be remembered that, above all things, 
the food must be attractive and it should be 
eaten at such times and in such quantity that 
it will always be taken with keen relish. 
When the mouth waters at the sight and 
smell of food, it is a good sign that the whole 
digestive apparatus is ready to undertake the 
work of digestion with promptness and vigor. 
The bill of fare must as far as possible be 
made up of foodstuffs which leave a residue 
of cellulose. Fine flour bread should be 
wholly discarded from the dietary. Bread or 
biscuit made from coarse graham meal or 
rye meal should replace other breadstuffs. 
It is in many cases advantageous to increase 
the amount of cellulose in the bread by mix- 
ing with the flour one-tenth its weight of bran. TREATMENT OF CONSTIPATION 
453 
All green vegetables should be freely used 
at the principal meals. Potatoes may be 
eaten in moderation, but should not constitute 
the chief vegetable food, for the reason that 
they are almost completely digested, contain- 
ing a minimum amount of cellulose, as will 
be seen by reference to the table of vegetable 
foods. It is well to select those vegetables 
which are richest in cellulose. When the 
digestion is fairly good, such vegetables as 
beetroot, spinach, squash, asparagus, cabbage, 
carrots, turnips, and cauliflower should be very 
freely used. Two or three of these vegetables 
may be taken at each meal. Uncooked vege- 
tables of some sort should be taken at least 
twice a day at the principal meals. Lettuce, 
celery, cucumber and cabbage may always be 
taken with very great advantage if the gastric 
digestion is fairly good. There are very few 
who cannot take one or more of these green 
vegetables if care is taken to observe that 
they are fresh and crisp, and pains are taken 
to masticate thoroughly. Even radishes may 
be eaten in moderation, if the irritating skin 
is removed. 
Fruit, both stewed and fresh, should con- 454 
COLON HYGIENE 
stitute a part of each meal. Fruit is espe- 
cially valuable for the last meal of the day, 
and fresh fruit may be taken with advantage 
just before retiring at night, and as an early 
meal by those who rise early and breakfast 
late. The acids and sugars in fruits stimulate 
bowel action, but to secure this effect they 
must be taken in considerable quantity. 
Those who take two meals a day may often 
take with advantage two or three oranges or 
as many apples just before going to bed at 
night. Juicy fruit requires no work of the 
digestive organs, except to move it along and 
absorb the predigested nutrient which it con- 
tains. This remark, of course, does not apply 
to such fruits as dates, which contain a con- 
siderable amount of cane sugar, nor to the 
banana, which is really quite a hearty food, 
but relates only to such juicy fruits as oranges, 
apples, peaches, apricots, berries, pears and 
grapes. 
When the bill of fare consists largely of 
such foodstuffs as fruits and vegetables, it 
is necessary to give careful attention to the 
actual food content of the meal. There is a 
wide variation in the amount of nutriment TREATMENT OF CONSTIPATION 
455 
contained in different fruits and vegetables. 
For example, an ordinary serving of potatoes 
represents 100 calories of food, while a serv- 
ing of cauliflower represents 25, and is mostly 
wood and water. A serving of beetroot rep- 
resents 25 calories, while a serving of cabbage 
or lettuce contains only 7 calories. 
It is important to remember that every 
meal must include a due proportion of ballast 
or roughage and there is very little danger 
that the amount will be too large. The stom- 
ach can easily deal with a very considerable 
amount of indigestible material. Even per- 
sons suffering from colitis and other intestinal 
disorders may take large quantities of rough- 
age not only without injury but with great 
benefit. It should be constantly remembered 
that bran is not irritating and the colitis is 
the result, not of mechanical irritation but 
of the chemical irritation of putrefaction 
products. 
The question as to the number of meals is 
one that should receive careful consideration, 
and often requires the exercise of the best 
skill and judgment. Stomachs which empty 
slowly require more time between meals. 456 
COLON HYGIENE 
It is especially important that care should 
be taken to include in the bill of fare a suffi- 
cient amount of fat. Fat is not only a nutrient 
of the very highest value, but it is a laxative 
food element, partly because by its use the 
secretion of the bile and other intestinal juices 
is promoted, so that the intestine is benefited 
by their laxative influence, and also because a 
portion of the fat remains behind unabsorbed, 
acting as a lubricant and also as a stimulant 
to the colon. 
Most cases of simple constipation are 
promptly relieved by the adoption of the 
measures above recommended. The amount 
of bran may be increased almost ad libitum 
when necessary. In addition to the bran 
taken in the food, one or even two heaping 
tablespoonfuls of cooked and sterilized bran 
may be taken at each meal. Palatable prep- 
arations of bran are now available which 
makes possible the free use of this most im- 
portant aid to bowel action without inconve- 
nience. If any further assistance is needed it 
is to be found in the use of mineral oil and 
changing the intestinal flora by the use of 
lacto-dextrin. TREATMENT OF CONSTIPATION 
457 
Treatment of Rectal Constipation 
In the treatment of rectal constipation it 
is to be borne in mind that the principal ob- 
stacle to bowel movement is the undue accu- 
mulation of fecal matter® either in the pelvic 
colon or the rectum, or as is most often the 
case, in both the pelvic colon and the rectum. 
In many cases the food is carried from the 
stomach to the colon with a proper degree of 
rapidity, and the feces move at the normal 
rate through the colon, until they have passed 
the splenic flexure. At this point the delay 
begins. In time, through extraordinary neg- 
lect, when the feces are allowed to accumu- 
late for days and even weeks in succession, 
the colon and even the small intestine may be- 
come enlarged through the obstruction at the 
outlet. 
The chief cause of rectal constipation, in 
ordinary cases, as has already been pointed 
out, is neglect to attend to the “call” of Na- 
ture for the evacuation of the bowels. When 
the “call” occurs, it is because the rectum is 
distended with feces. 
If the defecating mechanism is interrupted 458 
COLON HYGIENE 
in its action, and its purpose thus thwarted, 
the “call” becomes less intense and the effort 
to defecate is so slight that it is easily sup- 
pressed. Later, in the worst cases, the de- 
sire to evacuate the bowels entirely disap- 
pears. In these cases the sensibility of the 
rectum has become blunted to such a degree 
that the normal reflex is lost. The rectum 
tolerates the presence of feces without protest 
and without giving any signal to the defecat- 
ing center that bowel movement is required. 
It is evident, then, that in the treatment 
of cases of rectal constipation the first and 
most essential thing is restoration of the nor- 
mal sensibility of the rectum. It must be re- 
membered, however, that in most cases of 
rectal constipation, as well as in other forms 
of constipation, the condition has existed for 
a long time. The disease has consequently 
extended to the entire colon, and perhaps to 
the entire intestine, and success will not be 
obtained by attention to the colon and rectum 
alone; consequently, the treatment of rectal 
constipation requires the use of all the meas- 
ures which have been recommended for sim- 
ple constipation. TREATMENT OF CONSTIPATION 
459 
The first thing to be done in beginning the 
treatment of rectal constipation is to thor- 
oughly evacuate the lower bowel and rectum. 
This is best accomplished by the use of the 
enema. It is certainly irrational to admin- 
ister a laxative or cathartic, which disturbs 
the alimentary canal through its whole length, 
for the purpose of removing an obstructive 
accumulation which perhaps lies within six 
inches of the lower outlet. 
A simple water enema at a temperature of 
104° to 110° F. should be given to soften the 
hardened feces, and should be repeated at in- 
tervals of half an hour, until the colon is 
completely emptied, as shown by the return 
of clear water. The addition of soap to the 
water sometimes hastens the softening of very 
hard fecal matter. Warm oil has been much 
recommended, but it dissolves hard feces less 
rapidly than water. At first it may be im- 
possible to introduce more than a small quan- 
tity of water, on account of the extreme 
distention of the rectum and pelvic colon 
with feces. By persevering effort, however, 
success will be attained; as the hard feces are 
gradually softened and dissolved, larger 460 
COLON HYGIENE 
quantities of water may be introduced until 
the whole colon may be filled with water and 
emptied of its putrefying contents. In cases 
in which the fecal accumulation has been 
going on for several weeks, the patient must 
be put in charge of an experienced nurse, 
whose efforts, under careful instruction, must 
be unremitting until the task is completely 
accomplished. When the feces are very hard, 
and the masses of considerable size, oil should 
be used at intervals to lubricate the walls of 
the bowels, which, in such cases, are often 
dry and sometimes roughened. 
After the bowels have been first thoroughly 
emptied, infinite care must be taken to see 
that another accumulation never occurs. 
Every time the bowel is distended by fecal 
accumulation, its muscles are weakened, the 
sensibility of its nerves diminished, and any 
improvement which may have been secured 
by previous treatment is lost. By the syste- 
matic use of the enema, the bowel, being kept 
empty, gradually contracts and returns to 
something like its normal proportions. 
The cold enema should always be used for 
contracting the bowel after the fecal matters TREATMENT OF CONSTIPATION 
461 
have been removed by a warm enema. When 
once the bowel has been thoroughly emptied, 
warm water may no longer be required and 
it will not be necessary to resort to the use 
of the hot enema. The temperature of the 
water ordinarily used for the evacuation of 
the bowels may then be about 80°. After a 
little training, a lower temperature may read- 
ily be tolerated and is greatly preferable. 
When very cold water is used, the effect is 
sometimes to produce a spasm of the anus, so 
that the contraction of the muscles prevents 
proper movement. When this occurs, the 
anus may be relaxed by the application of a 
sponge or napkin saturated with very hot 
water, or water of a higher temperature may 
be used for the enema. 
The best time for administering the enema 
is in the morning, after breakfast; but if 
circumstances will not permit this, the bowels 
may be moved at night after supper, or just 
before retiring. With patients who suffer 
from hemorrhoids or painful ulcers of the 
rectum, the hour of retiring is the best time 
for moving the bowels by an enema, as after- 
ward there may be prolonged rest on the 462 
COLON HYGIENE 
back. This prevents the extrusion of swollen 
hemorrhoids or prolapsing rectum, and gives 
rest to the anal muscles, and so prevents the 
nagging, painful contractions which often 
follow bowel movement when fistulae or ul- 
cers are present. 
By the systematic use of the cold enema the 
dilated colon may gradually be restored to its 
normal size; its relaxed walls will recover 
their tone, and its function will be more 
properly performed. When sensibility of the 
rectum has been lost it may also gradually be 
recovered. It is necessary, however, that the 
greatest care should be taken to see that the 
colon and rectum are never once distended by 
fecal accumulation. Many persons suffering 
from rectal constipation take an enema every 
other day, or once or twice a week, waiting 
for symptoms of accumulation before the 
enema is taken. This practice is altogether 
wrong, and results only in a perpetuation of 
the disease. Of course, when an accumula- 
tion occurs, it must be removed, but if a cure 
is expected, accumulations must not be per- 
mitted to occur. 
In obstinate cases the application of a sin- TREATMENT OF CONSTIPATION 
463 
usoidal electric current to the colon and the 
rectum aids greatly in the restoration of these 
parts to a normal condition. By the use of 
special electrodes electricity may be applied 
to the interior of the colon, as well as to the 
rectum, thus securing vigorous contractions 
of the bowel, which are not always produced 
by external applications, especially in chronic 
cases in which the intestine has to a large 
degree lost its normal sensibility. Very 
strong electrical applications made to the 
spine and abdomen sometimes stimulate the 
muscles of the intestine as well as those of the 
abdominal wall; but if the intestinal muscles 
have long been over-stretched and are per- 
haps to some degree degenerated direct ap- 
plications are necessary. These must be 
made by a physician by the aid of the proc- 
toscope, which can be readily passed into the 
pelvic colon. 
Vibration and massage of the interior of 
the rectum are measures of doubtful value. 
They are likely to give rise to abrasion and 
irritation of the mucous membrane, and are 
not to be recommended. 
In cases of rectal constipation in which 464 
COLON HYGIENE 
painful ulcer or irritable hemorrhoids exist, 
effort to restore normal action of the bowels 
may be made ineffective by spasm of the 
sphincter muscles. This may be relieved 
temporarily by external applications of heat 
by means of a fomentation. A very effective 
plan is to move the bowels while sitting over 
hot water. Boiling hot water may be poured 
into a chamber or other suitable vessel. The 
steam relaxes the anal sphincters, and not 
only facilitates the bowel movement, but re- 
lieves or prevents the pain. 
Dryness of the lower bowel due to defi- 
cient secretion, the result of chronic proctitis 
and associated with loss of rectal sensibility, 
is not infrequently a cause of obstinate rectal 
constipation. The stools are exceedingly hard 
and dry, and are discharged with great dif- 
ficulty. When the rectum of such a patient 
is examined, the mucous membrane is found 
to be exceedingly dry, and often irritated. 
The normal lubricating mucus is not present. 
The result is the delay of the feces in the 
rectum until a dry, hard mass is formed, 
which is not easily gotten rid of. In such 
cases, lubrication of the rectum is needed. TREATMENT OF CONSTIPATION 
465 
For this purpose there is nothing so useful as 
a specially prepared paraffin which melts at 
a temperature of 102° F., or just above the 
body temperature. This is heated until it is 
nearly all melted, by placing the container.in 
hot water. Then with a piston syringe three 
or four ounces of the warm melted paraffin is 
introduced into the rectum. 
To enable the paraffin to reach the pelvic 
colon the patient should assume the knee 
chest position for two or three minutes after 
the paraffin is introduced and should take 
deep breaths to encourage the distribution of 
the melted oil. 
Treatment of Spastic or Latent 
Constipation 
In this form of constipation the stools are 
regular, the bowels move every day, and there 
is no accumulation of feces in the rectum. 
The patient is generally unaware of the fact 
that he is suffering from constipation, al- 
though not infrequently an observing patient 
becomes satisfied that there is something 
wrong, often because of too frequent bowel 
movements, which are not uncommon, to- 466 
COLON HYGIENE 
gether with pain, the passage of mucus, per- 
haps, and other symptoms. 
In a London clinic the writer once heard a 
Scotch laborer complain of very frequent 
bowel movement. The examining doctor 
said to him, “Then you are suffering from 
diarrhea.” “No, Doctor,” replied the pa- 
tient, “I think I am suffering from constipa- 
tion in diarrhea form,”—a good practical 
description of certain forms of latent consti- 
pation. This patient was found to have a 
very extensive accumulation of feces due to 
cancer of the rectum. 
In addition to the most thorough-going ap- 
plication of all the measures recommended 
lor simple constipation, a thorough examina- 
tion, including an X-ray inspection of the 
whole intestinal tract after a bismuth meal, 
must be made. The rectum and lower bowel 
must be carefully examined to exclude can- 
cer or other organic disease. Careful exam- 
ination must be made in the region of the 
appendix, and in women a thorough pelvic 
examination is necessary, since in many cases 
the delay may occur above the ileocecal 
valve, in consequence of spasm of the sphinc- A Spastic Colon. Darkest Portion Shows Dila- 
tation of Right Colon—Arrows Indicate 
Spastic Condition of Descending Colon TREATMENT OF CONSTIPATION 
467 
ter at this point. Or the delay may be due 
to incompetency of the ileocecal valve. 
The real cause of delay in this form of 
constipation is to be found in the spastic or 
contracted condition of the descending colon 
which results in dilation of the cecum. 
When the difficulty is due to spasm of the 
ileocecal valve, the result of reflex irritation 
from the inflamed appendix or from inflam- 
mation of the ovaries, uterus, bladder, or 
prostate, or painful disease of the rectum, it 
is of course necessary that these conditions 
should be removed by proper treatment. 
Temporary relief is generally most readily 
obtained by hot fomentations over the abdo- 
men, with special attention to the seat of pain. 
The hot sitz bath, the hot enema and the wet 
girdle covered with mackintosh, worn day and 
night, are measures of great importance, and 
often secure very complete and speedy relief. 
When the intestinal inactivity is the result 
of general feebleness, short cold baths should 
be employed daily. A cold bath may consist 
of a general cold shower of from fifteen to 
twenty seconds’ duration, a cold douche to 
the spine, a cold towel rub, or cold sheet rub, 468 
COLON HYGIENE 
according to the strength of the patient. The 
cold bath should be preceded by a short elec- 
tric light bath. It aids in the elimination of 
accumulated toxins, and prepares the *skin to 
react to the cold application. 
In spastic constipation, the enema is some- 
times useful chiefly as a means of introducing 
water by which the accumulated toxins may 
be washed out through the kidneys. In such 
cases the difficulty lies too high to be reached 
by the enema. The large cool or cold enema 
may, however, render service in cases in 
which the delay is due to atony, by improving 
the tone of the bowel muscles and so aiding 
peristaltic movement, by which the accumu- 
lated putrefying material in the lower part of 
the intestine may be moved on to the colon, 
and so be gotten rid of. The cold enema 
should not be used, however, in cases where 
there is reason to suspect spasm of the ileo- 
cecal valve, which is likely to be the case 
when latent constipation is associated with 
painful disease in any part of the pelvic re- 
gion. In these cases a hot enema should be 
employed. 
The rapid absorption of water from the TREATMENT OF CONSTIPATION 
469 
colon is shown by the copious discharge of 
urine which usually appears within a few 
minutes after an enema is taken. The in- 
crease in the quantity of urine occurs so 
quickly after a large enema, that some med- 
ical writers in the early part of the last cen- 
tury were led to advance the theory that a 
direct connection existed between the colon 
and the kidneys. This fanciful theory has, of 
course, no anatomical foundation. 
Mechanical kneading, the application of 
the sinusoidal current, and intelligently ad- 
ministered massage and other means by which 
success may be attained in combating latent 
constipation are useful measures. 
In the treatment of these cases it is to be 
remembered that while the principal seat of 
stasis is the right side of the colon, the cecum 
and the ascending colon, which by dilatation 
have become converted into a cesspool which 
is rarely ever completely emptied, the pri- 
mary seat of disease is to be found in the left 
side of the colon. The descending and often 
the pelvic colon are in an almost constant 
state of spasm, so-called spastic condition, and 
so long as this condition exists, little headway 470 
COLON HYGIENE 
can be made toward relieving the condition 
of the right side and the autointoxication 
arising from it. 
In many cases of so-called spastic consti- 
pation, this condition is only a complication 
of colitis or chronic infection of the colon, 
due to delay of fecal matters in the colon. 
The best means of securing immediate re- 
lief in cases of this sort are the hot sitz bath, 
the hot enema, and hot fomentation or dia- 
thermy applied over the abdomen. 
In cases of painful disease of the ovaries 
or uterus, the hot vaginal irrigation must be 
used in addition to the hot enema. 
Sometimes the warm oil enema proves 
more serviceable than the hot water enema, 
because less irritating. The addition of salt 
to the water is sometimes useful in cases in 
which the mucous membrane of the intestine 
is eroded, as a weak solution of salt is less 
irritating to raw surfaces than pure water. 
The application of the arc light and the 
photophore are extremely useful means of 
relieving the internal spasm. These applica- 
tions should be made daily for ten to fifteen 
minutes’ duration. In severe cases the light TREATMENT OF CONSTIPATION 
471 
applications may be intensified by a special 
device through which the excessive rise of 
temperature is prevented by a stream of cool 
air or water playing upon the abdomen. 
When making general cold applications, 
the abdomen should be protected by a warm 
flannel or a hot fomentation. A patient suf- 
fering from constipation must take special 
care to avoid chilling, and must keep the feet 
and hands warm. The chilling of the hands 
and feet always aggravates the spasm. The 
drinking of ice-cold water must also be pro- 
hibited. 
The cold towel rub is especially suited to 
these cases, as a general tonic measure. 
A person skilled in massage may make 
good use of this measure in the general ap- 
plication of heat, in cases in which massage is 
indicated, as when the cecum is loaded as the 
result of contraction of the transverse colon, 
or at the splenic flexure. The tendency of 
massage to aggravate the contraction is coun- 
teracted by a general application of heat. 
The moist abdominal bandage without the 
mackintosh cover should be worn at night 
and if possible also during the day time. 472 
COLON HYGIENE 
The abdominal supporter is also highly 
important in these cases, to prevent drag upon 
the mesentery by prolapse of the bowels. The 
writer has observed several cases in which the 
wearing of an efficient abdominal supporter 
has given prompt relief from very obstinate 
constipation. 
The Treatment of Mixed Cases of 
Constipation 
In many, perhaps the majority, of cases of 
constipation, the type of the disease is mixed. 
The association of spastic constipation with 
latent or cumulative constipation is specially 
common. Cases which begin as simple con- 
stipation, later become cumulative constipa- 
tion, and finally develop spastic or latent 
constipation through infection of the colon, 
or colitis, the natural result of stagnation of 
the bowel contents. 
The measures recommended for the treat- 
ment of spastic constipation should be ap- 
plied with such other measures as may be 
indicated. If the rectum and the pelvic colon 
are filled with feces, these must be removed 
by the means recommended in the treatment TREATMENT OF CONSTIPATION 
473 
of rectal constipation, and the general meas- 
ures suggested for the relief of that form of 
the disease must be perseveringly employed. 
In the use of electricity in cases of this sort, 
the applications must be combined with hot 
applications, in order to avoid increase of the 
spastic contraction. 
When electricity is applied to the rectum, 
a fomentation should be applied to the abdo- 
men during the application, or immediately 
afterward. 
The thermophore affords the most effec- 
tive means of applying heat to the abdomen 
during electrical applications. During a gen- 
eral cold application heat should be applied 
over the abdomen, to protect the intestine. 
A flannel bandage should be worn over the 
abdomen constantly when the moist abdom- 
inal bandage is not employed, and an abdom- 
inal supporter should be worn. 
Coarse vegetables and other bulky food- 
stuffs should not be avoided because colitis 
is present. Colitis is the result of constipa- 
tion, and this will be aggravated by the bland 
concentrated diet which is commonly recom- 
mended for colitis. Experience has very 474 
COLON HYGIENE 
clearly demonstrated the value of a bulky 
diet in colitis as well as in constipation. 
Agar-agar is specially valuable in these 
cases, for the reason that it affords bulk, and 
aids in clearing away the accumulated mucus, 
while at the same time producing no irrita- 
tion. The irritation supposed to rise from 
the cellulose of fruits is far less than is gen- 
erally thought. Bran and ground wood have 
been used with excellent results as poultices 
for raw surfaces and dressings for wounds. 
Wet bran, like wet paper, is not irritating. TREATMENT OF DISORDERS 
WHICH RESULT FROM 
CONSTIPATION 
While constipation, through the autoin- 
toxication to which it leads, is both an excit- 
ing and predisposing cause of many very 
serious chronic diseases from which human 
beings suffer, there are many other maladies 
which are so immediately aggravated by an 
inactive state of the bowels, that this condi- 
tion becomes a dominant factor in dealing 
with them. In this chapter a brief mention 
will be made of the more important of these 
diseases. 
Catarrhal Colitis 
The chief seat of this disease is the lower 
colon, especially the pelvic colon and the iliac 
colon. Sometimes, however, the effect ex- 
tends to the entire colon. 
The disease is essentially a chronic infec- 
tion of the mucous membrane, and is the 
result of the injury done to the tissues by the 
prolonged contact with putrefying fecal mat- 
475 476 
COLON HYGIENE 
ters which in constipation accumulate and are 
often retained for days in the lower colon. 
To understand the effect of these poisonous 
matters upon the mucous membrane, when 
acting continuously for days with constantly 
increasing virulence, it is only necessary to 
consider for a moment what result would 
follow an application of the same sort of ma- 
terial to the skin for several days in succession. 
The remarkable vitality with which the mu- 
cous membrane is endowed, enables it to re- 
tain its integrity for a considerable length of 
time; but sooner or later its resistance breaks 
down, and it becomes the seat of a chronic 
inflammation similar to that which affects the 
mucous membrane of the nose in nasal ca- 
tarrh. An examination of the stools shows 
constantly present mucus and white blood 
cells, which are thrown off by the mucous 
membrane in its efforts to defend itself against 
the attack of the myriads of microbes which 
are constantly assailing it, and the various 
highly virulent poisons which they produce. 
The character of these poisons may be judged 
from the nauseous odors emanating from the 
putrefying feces which are discharged when TREATMENT OF RESULTS OF CONSTIPATION 
477 
a laxative is administered, and sometimes as 
the result of an enema. The real character 
of the feces produced by a constipated person 
cannot always be judged by an examination 
of the hard, dry masses which are discharged 
from the lower bowel, for the reason that the 
noxious substances which they contained have 
been absorbed higher up in the bowel. 
The frequent bowel movement in colitis is 
due not only to the irritation produced by the 
stagnation of fecal contents but to the fact 
that the contracted bowel relaxes at intervals 
and permits the passage of material which 
has been accumulated above it. When the 
bowel is completely contracted the obstruc- 
tion is complete. In examining the patients 
suffering from colitis the writer has often 
noticed the complete relaxation of the bowel 
which but a few moments before was so con- 
tracted that it could be rolled under the finger 
like a piece of thick rubber tubing. 
In catarrhal colitis, the stools may be 
either liquid, or composed of hard lumps 
somewhat resembling the feces of goats, or 
they may be mixed in character. The stools 
are sometimes quite watery in character, and 478 
COLON HYGIENE 
may contain traces of blood. Patients often 
think that they are suffering from diarrhea, 
on account of the frequent semi-liquid dis- 
charges. The cause of liquid stools is the 
irritation produced by the hardened and ir- 
ritating feces. The irritation is not mechan- 
ical, however, but is due to the poisonous 
and irritating substances which are produced 
by the bacteria growing in the feces, in other 
words, by the putrefaction which is taking 
place. 
In many cases there is a quite regular al- 
ternation of constipation and diarrhea; the 
feces accumulate for several days, when the 
irritation becomes so great that a profuse 
flow of serum and an abundant secretion of 
mucus occurs, the mass is softened, and tem- 
porary relief is obtained through the com- 
plete or partial unloading of the bowels by 
several soft stools. 
This condition is always associated with 
cecal or right-side constipation, and with a 
spastic contraction of the bowel. The most 
common seat of this contraction is the de- 
scending or pelvic colon; but it may often 
be noted in the transverse and ascending TREATMENT OF RESULTS OF CONSTIPATION 
479 
colon. In these cases, the autointoxication 
which is always present is more pronounced in 
degree, because of the more fluid character 
of the intestinal contents in the upper bowel. 
The disease not infrequently extends to the 
whole colon as is shown not only by the con- 
tracted condition of the ascending colon and 
even of the cecum, but also by the presence 
of masses of hardened feces which may be 
frequently felt in both these portions of the 
colon. 
The ultimate effect of long-continued in- 
flammation of the mucous membrane is the 
same in the colon as in the nose and other 
parts provided with a mucous lining. After 
a time, which varies according to the resist- 
ance of the individual and the intensity of 
the disease, degenerative changes occur in the 
mucous membrane; its glands disappear, and 
it becomes thin and parchment-like. The de- 
generation extends to the muscles which lie 
beneath the mucous membrane. The intes- 
tinal wall is thus thinned and weakened and 
loses its power of contractility to a large 
degree; it becomes distended and enlarged 
by gases and fecal accumulation, and thus 480 
COLON HYGIENE 
the difficulty becomes greatly aggravated. 
The colon becomes much like a greatly dis- 
tended bladder, losing a large part of its 
functions as a living muscular tube; it fails to 
respond to the nervous impulses by which the 
act of defecation is normally affected and 
serves merely as a reservoir in which accu- 
mulate waste and remnants of undigested and 
undigestible foodstuffs, there to remain un- 
dergoing fermentation and putrefaction, de- 
veloping offensive gases and irritating poi- 
sons, until removed from the body by some 
mechanical means. In these cases an essential 
part of the defecating mechanism is practi- 
cally destroyed or rendered inoperative, and 
it becomes necessary to resort to mechanical 
means, as an enema of water or oil, for emp- 
tying the bowels. Lane and other surgeons 
have removed the colon in these cases, an op- 
eration which is doubtless sometimes neces- 
sary, although less often required than has 
been advocated by some, provided the patient 
can have the benefit of a complete regulation 
of the dietary, and will follow a suitable 
regimen. In all cases the flora must be 
changed. TREATMENT OF RESULTS OF CONSTIPATION 
481 
The disastrous consequences which result 
from chronic catarrhal colitis are not con- 
fined to the colon. The disease often extends 
to the small intestine. In aggravated cases 
the accumulation in the cecum becomes so 
great that the ileocecal valve is dilated to 
such an extent that the contents of the cecum 
and small intestine intermingle. The very 
perfect valve arrangement provided by Na- 
ture at the junction of the small intestine with 
the colon, which is rendered still more effec- 
tive by a sphincter muscle placed just above 
it, is evidently intended to prevent any pos- 
sible return of matters from the colon to the 
small intestine. In the small intestine the pres- 
ence of carbohydrates prevents the growth of 
putrefactive organisms, by encouraging the 
formation of acids. In the colon, however, 
especially when there is stasis or accumula- 
tion of fecal matters, the delay permits the 
complete absorption of starch and sugar, so 
that there is no material to encourage the 
acid-forming bacteria; and the poison-form- 
ing microbes, being unhindered, undergo 
rapid development, and greatly increase in 
virulence, finding always plenty of food ma- 482 
COLON HYGIENE 
terial in the mucus, bile, and other intestinal 
secretions, as well as the larger or smaller 
quantities of food protein which remain un- 
digested or unabsorbed. When these danger- 
ous microbes are carried into the small in- 
testine they may continue to develop and 
gradually work their way up the intestine. 
The cecum becomes dilated and distorted 
in shape, because of the weakening of its 
walls in consequence of the undue accumula- 
tion of its contents. The cecum may be so 
dilated and stretched that it is found far over 
toward the left side of the body, or lying deep 
down in the pelvis. The damaged ileocecal 
valve no longer controls the opening between 
the small intestine and the colon. The feces 
are no longer found exclusively in the colon. 
The small intestine may for several feet be 
filled with fecal matters of the consistency of 
putty, such as are normally found only in the 
transverse colon and beyond. 
Putrefaction of the contents of the small 
intestine is a very much more serious matter 
than putrefaction in the colon, for the reason 
that the small intestine is much more richly 
supplied with absorbents, and is also less pre- TREATMENT OF RESULTS OF CONSTIPATION 
483 
pared to defend itself against the attacks of 
the virulent microbes which are always pres- 
ent in connection with putrefactive processes. 
This infection of the small intestine with 
fecal matters introduces a whole series of 
troubles which unfold as the infection as- 
cends along the intestine. The ascending in- 
fection finally reaches the duodenum, which 
not infrequently becomes the seat of a chronic 
catarrhal condition, the result of which may 
be ulceration. Observations of Moynihan 
and others have shown that duodenal ulcer is 
three or four times as frequent as ulcer of 
the stomach. Pain occurring three or four 
hours after meals is very frequently due to 
duodenal ulcer. From the duodenum, infec- 
tion often travels through the bile ducts to 
the liver and the gall bladder. Chronic in- 
fection of the gall bladder and gall stones are 
thus developed. The infection may also as- 
cend the pancreatic duct, which is closely 
associated with the bile duct, and may cause 
chronic inflammation of the pancreas, one of 
the results of which may be diabetes. From 
observations recently made respecting the 
causes of diabetes it is probable that inflam- 484 
COLON HYGIENE 
mation of the pancreas arising in this way 
is one of the most common causes of this 
disease. Observations made in the X-ray de- 
partment of the Battle Creek Sanitarium 
indicate that the ileocecal valve is usually 
incompetent in diabetes. This is a most sig- 
nificant fact. The ileocecal valve protects 
the small intestine from infection; when it 
becomes incompetent, there is nothing to pre- 
vent the development of an ascending infec- 
tious process, which may bring about all of 
the conditions above mentioned. 
Treatment 
The successful treatment of colitis requires, 
first of all, a change of the intestinal flora; 
that is, the infectious bacteria to which the 
disease is due must be gotten rid of. Since 
the first cause of colitis is constipation, it is 
evident that frequent bowel movement is also 
essential; in other words, the colon must be 
kept clean. The diarrhea which is some- 
times present in colitis is the result of Na- 
ture’s effort to clear the intestine from of- 
fending materials. The mucus which is often 
discharged in large quantities is a protective 485 
TREATMENT OF RESULTS OF CONSTIPATION 
material which Nature pours out upon the 
surface of the intestine to protect the tissues 
against the attacks of bacteria and parasites 
which flourish in the colons of persons suffer- 
ing from this disease. 
Various species of bacteria are capable of 
giving rise to colitis, according to Tissier. In 
general, it may be said that colitis is the result 
of the presence in the colon of excessive num- 
bers of putrefactive bacteria. 
In recent years, attention has been called 
to the fact that acute infections of the colon 
are sometimes due to animal parasites. Cer- 
tain amoebae, flagellates, spirochetes and 
other forms of protozoa are also found in 
great numbers in the colon in cases of chronic 
constipation and colitis, as well as in cases 
of amoebic dysentery. These organisms have 
been regarded by most authorities as pseudo 
parasites, with the exception of those of 
amoebic dysentery. Dr. Ronald Ross has 
recently pointed out the fact that all these 
organisms are parasitic and dangerous. If 
they do not set up the acute inflammation 
characteristic of amoebic dysentery, they 
bore into the mucous membrane and thus pre- 486 
COLON HYGIENE 
pare hiding places for pernicious bacteria, 
which develop chronic infections and intes- 
tinal toxemia. Observations made a few 
years ago in the laboratory of the Battle 
Creek Sanitarium show that these animal par- 
asites are rarely found in the stools of per- 
sons who subsist upon a non-flesh dietary. 
They abound in feces which are in part made 
up of undigested residues of flesh foods. 
The measures necessary for the treatment 
of colitis are comparatively simple and by 
their thorough application practically all 
cases are curable. Only in its advanced, ul- 
cerated stage does the disease sometimes be- 
come incurable. 
As already stated, it is necessary in the 
treatment of colitis first of all to adopt thor- 
oughgoing measures to secure a change of the 
intestinal flora. The writer has found that 
this may be accomplished in a short time by 
placing the patient on a special diet, which 
for convenience is termed a fruit regimen. 
For a description of this regimen see Index. 
After a few days of this regimen (three days 
to a week) the character of the stools will be 
found to be wholly changed. The stools be- 487 
TREATMENT OF RESULTS OF CONSTIPATION 
come soft, almost odorless and frequent, the 
tongue clears, the appetite is keen and is 
satisfied with simple foods. Cereals and a 
moderate amount of fats can now be added 
to the bill of fare, but the fruits, bran, and 
paraffin must be continued. 
The diet must be made so bulky and lax- 
ative that the bowels move three or four times 
a day. Four movements a day are better 
than three. The stools should be odorless or 
they may have a slight sour odor. An am- 
moniacal or putrid odor is evidence that the 
flora has not yet been changed, and the fruit 
regimen must be continued or repeated after 
a few days. Sometimes several repetitions of 
the regimen at intervals of a few days are 
required for complete success. In bad cases 
animal products of all sorts must be avoided. 
Even milk must be excluded, as well as eggs 
and meat. As pointed out by Tissier some 
years ago, the bacteria which produce colitis 
thrive best upon animal protein. 
In addition to the above, there are several 
other highly effective measures which may be 
advantageously employed in the treatment of 
colitis. Notwithstanding the free use of bran 488 
COLON HYGIENE 
or agar-agar and paraffin, the colon may be 
so crippled that it does not completely empty 
itself and a sufficient amount of material is 
constantly left behind to encourage putrefac- 
tion, and to prevent the healing of the dis- 
eased surfaces. Examination with the X-ray 
shows in these cases a spastic, or contracted, 
condition of the descending or pelvic colon, 
and in many cases a prolapsed condition of 
the pelvic colon, which may be adherent. In 
these cases, the colon must be daily washed 
out by means of an enema consisting of two 
or three pints of salt water. The temperature 
of the water should be 105° to 108° F. The 
enema should be repeated several times, or 
until the water returns clear. The effective- 
ness of the enema is greatly increased by 
thorough massage of the colon, especially of 
the pelvic colon, with the patient in the knee- 
chest position. When the pelvic colon is dis- 
tended by the enema it may be manipulated 
more effectively. 
After the colon has been thoroughly emp- 
tied, an injection is made consisting of a cul- 
ture of Bacillus Acidophilus in whey, to 
which has been added a small portion of well 489 
TREATMENT OF RESULTS OF CONSTIPATION 
boiled starch and also a small quantity of 
malt sugar. By this means the colon is inoc- 
ulated with protective germs; in other words, 
a new flora is planted and supplied with the 
material to promote its growth and develop- 
ment, and to help reform the wild bacteria of 
the colon to which colitis is due. 
The diet should be not only strictly anti- 
toxic, excluding meats of every kind, but 
must include liberal tri-daily doses of lacto- 
dextrin. For prompt and definite results 
the patient should adopt all the measures 
elsewhere indicated for changing the intes- 
tinal flora. In bad cases the maximum dose, 
three or four ounces, must be continued for 
several weeks or until mucus disappears from 
the stools and the stools are no longer pu- 
trescible. When possible, a bacteriological 
examination should be made to make certain 
a thorough change of flora has been accom- 
plished. Lacto-dextrin must be used in 
smaller doses, one or two ounces three times 
a day, for several months after the flora has 
been changed, and in many cases the con- 
tinuous use of lacto-dextrin is not only 
desirable but necessary to prevent relapse. 490 
COLON HYGIENE 
Proctitis 
The infection known as colitis very often 
extends from the pelvic colon into the rectum. 
When the rectum is involved, the patient 
often suffers from more or less constant pain 
and uneasiness in this region; there may be 
frequent desire to move the bowels, but how- 
ever frequently the bowels may be moved, 
there will always be some feces remaining 
in the rectum, together with mucus and, oc- 
casionally, blood. An examination of the 
rectum sometimes shows ulceration. In ad- 
vanced cases, the mucous membrane is smooth 
and dry, with patches of mucus adhering 
here and there, and frequently raw surfaces 
which bleed when touched. The conditions 
are identical with those which are found in 
the bowel higher up. The point of junction 
of the colon and the rectum is a favorite seat 
for ulcerations and thickenings of the mucous 
membrane. 
When the disease extends deeper into the 
wall of the bowel, as it does sooner or later, 
thickening and rigidity result. By extension 
of the disease through the membranous wall, TREATMENT OF RESULTS OF CONSTIPATION 
491 
the outer surface becomes inflamed, and ad- 
hesions may occur between the lower bowel 
and the bladder, which sometimes result in 
fistulas between the two viscera. Adhesions 
may also occur between the colon and small 
intestines and other parts; the ulcerations 
may heal and form cicatrices, which contract 
and produce obstruction. The lower part of 
the rectum and the juncture of the colon and 
rectum, the pelvi-rectal valve, usually show 
the worst effects of catarrhal colitis, and these 
points are the favorite seat of cancerous 
growths. The long continued irritation to 
which these parts are subjected also leads to 
the development of other growths, which, 
together with ulcerations, as has been shown 
by Mummery, a very eminent London spe- 
cialist, are very prone to develop into cancer, 
and on this account, every person who suffers 
from catarrhal colitis, as shown by the pres- 
ence of mucus in the stools, should submit 
himself to a physician for examination in 
order that any existing tendency towards ma- 
lignancy may be recognized sufficiently early 
to permit of its radical treatment. 
The treatment of proctitis is essentially the 492 
COLON HYGIENE 
same as that already outlined for colitis. 
Change of the intestinal flora, frequent bowel 
movements, daily cleansing of the colon, an 
antitoxic diet, and the introduction into the 
colon of cultures of lactic-acid-forming or- 
ganisms are the most important measures. 
Faithful employment of these measures will 
usually effect a cure. 
Muco-membranous Colitis 
This disease is probably only a variety of 
the preceding. Of this the writer has been 
convinced for many years, although most au- 
thorities still describe this malady as a nerv- 
ous disorder. The only particulars in which 
it differs from catarrhal colitis are: 
1. The fact that mucus is not constantly 
present in the stools as in catarrhal colitis. 
2. The presence of membranes which are 
sometimes complete casts of the bowel, and 
may be a foot or more in length. 
3. Colic pains. 
4. Intermittent occurrence of the symp- 
toms. 
These differences are not sufficient to char- 
acterize this condition as a distinct disease. TREATMENT OF RESULTS OF CONSTIPATION 
493 
Constipation is the predisposing condition 
which lies back of this disease, as well as of 
catarrhal colitis. If the infection is not suffi- 
ciently intense to produce continuous symp- 
toms, it is only necessary that it should be 
increased by some indiscretion in diet, ex- 
haustion, a severe cold, or some other factor, 
to precipitate an attack. The casts consist of 
coagulated mucus, and not mucous mem- 
brane as patients often imagine. The colic 
pains are due to violent contractions of the 
colon, which are excited by the accumulation 
of gas and irritating fecal matter. This dis- 
ease is often associated with chronic affec- 
tions of the pelvic organs. 
The treatment of this condition does not 
differ from that already outlined for the 
treatment of colitis. Medicinal laxatives of 
all sorts must be avoided, because these only 
serve to aggravate and perpetuate the disease. 
Indeed, the use of laxatives, mineral waters, 
etc., is one of the most common causes of this 
condition. This is true of medicinal laxatives 
of every description. This fact alone is suffi- 
cient to condemn the use of these drugs ex- 
cept for temporary effect in emergency. 494 
COLON HYGIENE 
Muco-membranous colitis as well as or- 
dinary colitis can be thoroughly cured only 
by changing the intestinal flora. (See Index). 
Enlargement of the Liver and Spleen 
Marked enlargement of the liver and 
spleen are frequently the result of chronic 
constipation with intestinal autointoxication. 
The constant flooding of the liver with toxins 
must result in damage to its tissues. Boix 
showed this in his experiments upon rabbits. 
Some years ago the writer encountered a case 
of enormous enlargement of the liver, in 
which there had never been any use of alco- 
hol, but constipation which had existed for 
many years. Change of the intestinal flora is 
essential. will change the flora 
and aid the liver to repair itself. Meats must 
be scrupulously avoided and lacto-dextrin 
should be used continuously for some months. 
Fecal Tumors 
When the obstruction which causes a de- 
lay in the movement of feces through the 
colon is permanent, the mass of accumulated 
feces may attain such a size as to be easily 495 
TREATMENT OF RESULTS OF CONSTIPATION 
felt through the abdominal wall. Fecal tu- 
mors may generally be distinguished from 
other tumors by their doughy consistency, 
that is, their shape may be moulded by press- 
ure with the fingers. Such tumors sometimes 
disappear suddenly and may be broken up by 
the manipulation of the hands, or softened by 
means of enemas of warm water or warm oil. 
Sometimes a surgical operation is necessary 
for their removal. 
The late Dr. Lawson Tait told the writer 
of a case to which he was called to operate 
for the removal of a large abdominal tumor, 
which proved to be a tumor of this sort. On 
opening the abdomen, the small intestine was 
found to be enormously distended just at the 
ileocecal valve. On inquiry, it was found that 
the patient, who was recently convalescent 
from typhoid fever, had swallowed rather rap- 
idly a large quantity of milk. Suspicion at once 
arose in the mind of the surgeon that the mass 
might consist of undigested curds. With this 
idea in mind, he carefully manipulated the 
tumor with his fingers, and finally succeeded 
in breaking up the mass to such a degree that 
it became possible to push the fragments 496 
COLON HYGIENE 
through the ileocecal valve, and thus a more 
serious operation was avoided. 
Volvulus 
Sometimes the processes which begin in 
the intestine and work outward through the 
intestinal wall give rise to inflammatory 
changes in the membranous fold of mesentery 
to which the pelvic loop of the colon is at- 
tached. As a result the mesentery is gradually 
shortened until the ends of the loop are 
brought close together and fixed. With the 
colon in this position, there is a great risk of 
obstruction from the twisting of the loop, 
which occasionally happens, giving rise to 
what is known as volvulus. In a case of this 
kind prompt surgical relief is very essential. 
A short delay may give rise to gangrene of 
the intestine, and general peritonitis. 
Disorders of the Stomach 
Although located at the other extremity of 
the digestive canal from the colon, the stom- 
ach is, nevertheless, in various ways and to a 
profound degree influenced by chronic con- 
stipation. Loss of appetite is a very common TREATMENT OF RESULTS OF CONSTIPATION 
497 
symptom in constipation, and so constipation 
is increased through the lack of the vigorous 
stimulation given to the movement of the in- 
testine by the taking of food with relish. 
Most gastric disorders are the result of 
stagnation of food residues and putrefactive 
changes in the colon and disappear when the 
flora is changed and the bowels made to move 
efficiently three times a day. 
Diseases of the Heart and Blood Vessels 
Palpitation of the heart is a common con- 
sequence of an acute accumulation of feces 
in the colon, probably the result of the ex- 
cessive absorption of toxins to which such 
accumulations give rise. 
Pseudo-angina pectoris, in which the pa- 
tient suffers pains in the region of the heart 
entirely similar to those which occur in an- 
gina pectoris, is frequently associated with 
chronic constipation. Chronic constipation 
or the autointoxication resulting from it may 
be regarded as a cause of true angina pectoris 
as well as of pseudo-angina. Arteriosclerosis 
affecting the vessels of the heart has been 
clearly shown by Bouchard and other author- 498 
COLON HYGIENE 
ities to be one of the common results of 
chronic constipation, and attacks of angina 
pectoris often appear among other symptoms 
of the degenerative changes which have taken 
place. Years ago Boix, of Paris, showed that 
the poisons produced by the colon bacillus 
are capable of producing these degenerative 
changes which result in sclerosis of the ar- 
teries of the liver, spleen, and other glands. 
Premature Senility 
The senile appearance of many persons who 
have long suffered from chronic constipation, 
as well as the steady decline of longevity in 
countries in which constipation is prevalent, 
is evidence of the mischievous results of the 
constant absorption of the poisons produced 
by colon germs which Metchnikoff regards 
as the cause of old age. The pigmentation 
of the skin appearing first about the eyes and 
as brown spots upon the hands, the thinning 
of the skin of the hands and parchment-like 
appearance of the skin are familiar symp- 
toms of senility induced by alimentary toxe- 
mia. It is highly important to note that these 
senile changes are not confined to the skin. TREATMENT OF RESULTS OF CONSTIPATION 
499 
The changes in the skin are only the external 
signs of similar degenerative changes taking 
place in the blood vessels, liver, kidneys, and 
other vital internal parts. 
Disease of the Kidneys 
The poisoning resulting in chronic consti- 
pation is frequently indicated by the appear- 
ance of albumen and casts in the urine. A 
long continuance of this poisoning gives rise 
to changes in the kidney, which are com- 
monly known as Bright’s disease. It is indeed 
quite possible that chronic constipation may 
be one of the most important of all causes of 
this terrible malady. Statistics of all civil- 
ized countries show that Bright’s disease is 
increasing very rapidly. At the present time 
the number of persons dying of renal disease 
in the United States is 130 per cent greater 
than thirty years ago. In certain cities the pro- 
portion is still higher, the increased mortality 
rate from this cause amounting to 164 per cent. 
The large use of meat in connection with this 
condition of constipation greatly aggravates 
the evils arising from this condition, because 
meat not only affords the poison-forming bac- 500 
COLON HYGIENE 
teria just the sort of material they require to 
promote their growth, but also introduces 
into the intestine in large numbers the most 
virulent forms of putrefactive bacteria. 
Suppuration of the kidney, shown by pus 
in the urine as well as by local pains and 
other symptoms, is usually associated with 
chronic constipation. Infection of the kidney 
with colon germs may occur through the 
urinary tract, the germs travelling by the 
ureters to the kidney, or direct infection may 
occur. The bacteria which grow in the in- 
testines, especially when their virulence is 
increased by stasis or stagnation, readily 
penetrate the walls of the intestine and ad- 
jacent organs. The right kidney lies in im- 
mediate proximity to the colon. 
Bacteriological examination of the urine 
in cases of suppuration of the kidney often 
shows the presence of colon germs. 
Regulation of the diet is the first thing to 
be done in every case of disease of the kidneys. 
The dietetic measures adopted should be 
such as will lessen the amount of work re- 
quired of the kidneys to the greatest extent 
possible. Tea, coffee, meat extracts, bouillon, 501 
TREATMENT OF RESULTS OF CONSTIPATION 
as well as meats of all kinds, must be rigor- 
ously excluded from the diet and the most 
thorough-going measures must be adopted for 
changing the intestinal flora and securing 
complete and thorough evacuation of the 
bowels three or four times a day. In many 
cases the daily use of the enema for weeks or 
even months is advisable to make certain that 
the colon is completely emptied. Lacto- 
dextrin must be used in such quantities as 
to suppress completely putrefaction in the 
colon. Acidophilus buttermilk may be ad- 
vantageously used in many cases. 
Disease of the Liver and Gall-Bladder 
Recent observations have shown that when 
putrefying feces accumulate in the colon 
great numbers of bacteria pass through the 
walls of the intestine into the branches of the 
portal vein, and are carried to the liver. The 
liver destroys many of these bacteria, but not 
a few of them pass out in the bile, and thus 
infect the bile passages of the liver and gall- 
bladder. It is possible, also, that infection 
may occur directly from the intestine. The 
bacteria may ascend the gall ducts to the gall- 502 
COLON HYGIENE 
bladder and the liver. Modern research has 
shown that gall-stones are always due to bac- 
teria, which are found in the interior of the 
gall-stones. Persons suffering from disorders 
of the gall-bladder, and from gall-stones, are 
always chronic sufferers from constipation 
and alimentary toxemia, to which unques- 
tionably their liver troubles are chiefly due. 
Diseases of the gall-bladder are generally 
due to infection and the source of infection is 
usually the colon. Recent observations have 
shown that pernicious bacteria which develop 
in a neglected colon readily ascend to the 
stomach and even to the mouth. It is evident, 
then, that in these cases thorough change of 
the intestinal flora and the application of 
measures necessary for thorough frequent 
evacuation of the colon are of first impor- 
tance. Recent observations made by a French 
physiologist indicate that by the free and 
prolonged use of carbohydrate (lactose or 
lacto-dextrin) a damaged liver may be aided 
to repair its injured cells and recover its ef- 
ficiency. TREATMENT OF RESULTS OF CONSTIPATION 
503 
Insomnia 
One very rarely finds a person suffering 
from insomnia who is not constipated. Not 
infrequently, the constipation is present in 
the latent form, and its existence may not be 
suspected. Examination of the stools and in- 
spection of the tongue give clear evidence of 
the existence of stasis in the colon. The in- 
somnia is due to the irritation of the brain 
cells produced by the poisons with which the 
blood is saturated through absorption from 
the colon. The use of soporifics only secures 
temporary relief with a certainty of making 
the patient worse through disturbing his di- 
gestion, destroying his appetite, and thus 
making his constipation worse. By relief of 
constipation through proper diet, and the 
adoption of other rational measures the in- 
somnia may be made to disappear, and usually 
with very great promptness. 
Most cases of insomnia are accompanied 
by intestinal stasis or some form of constipa- 
tion. Insomnia may be not only a result of 
constipation but a cause of aggravation of this 
condition through spasm of the descending 504 
COLON HYGIENE 
colon which frequently results from the nerv- 
ous conditions which follow loss of sleep. 
The coated tongue and offensive breath 
which usually accompany insomnia indicate 
the presence of auto-intoxication and the nec- 
essity for the application of thoroughgoing 
measures for change of the intestinal flora. 
Fortunately, this may be readily accom- 
plished by the use of lacto-dextrin or acido- 
philus buttermilk, either one alone or in com- 
bination, and this measure should never be 
neglected in cases of insomnia but should be 
used in connection with thoroughgoing means 
for increasing intestinal activity. Hundreds 
of cases of most obstinate insomnia have been 
treated with entire success by these simple 
but efficient methods. 
Headache 
This very common and most distressing 
effect of chronic constipation is due to putre- 
faction poisons absorbed from the colon, and 
constipation quickly disappears when the in- 
testinal flora is changed and the bowels made 
to move well three times a day. Copious 
water drinking, especially drinking two or 505 
TREATMENT OF RESULTS OF CONSTIPATION 
three glasses of hot water two or three times 
a day, ameliorates the symptom by aiding the 
elimination of poisons. Attacks of migraine 
are always preceded by an increase of stasis, 
that is by an accumulation of fecal matters 
which throws into the blood a new flood of 
indican and other toxins. By a thorough 
emptying of the colon through the use of 
the enema the attack may always be miti- 
gated and sometimes averted. If the attack 
has actually begun, however, the result is less 
satisfactory although even then the duration 
of the attack, if not its intensity, may be less- 
ened by emptying the colon by repeated 
enemas. When vomiting or nausea is present, 
the enema should be repeated several times 
a day as a means of introducing much needed 
fluid. An excellent plan is to introduce into 
the colon to be retained and absorbed half a 
pint to a pint of water every hour or two. 
The excruciating pain of migraine may be 
made more endurable by fomentations or al- 
ternate hot and cold applications to the pain- 
ful parts. The use of morphia and other 
narcotic or pain-relieving drugs is most per- 
nicious. The use of drugs merely purchases 506 
COLON HYGIENE 
present relief at the expense of increased 
future suffering. Such drugs increase the 
constipation and so aggravate the toxemia 
and not infrequently a drug habit is formed. 
Most headaches are toxic and the source of 
the toxin with few exceptions is to be found 
in the colon; hence the efficient remedy for 
chronic headache is to be found in change of 
the intestinal flora; that is, the suppression 
of intestinal putrefaction by training the 
colon to normal activity, which is complete 
evacuation of its contents three or four times 
a day. Lacto-dextrin should be used in liberal 
doses as directed for changing the intestinal 
flora until the headaches disappear. As the 
stools become less putrid and as the tongue 
clears and the malodor of the breath disap- 
pears, headaches will lessen in frequency and 
severity and by a persevering effort a perma- 
nent cure may be accomplished. 
Rachitis, Arrest of Growth and Other Dis- 
turbances of Nutrition in Infants 
The researches of Combe and Rouget have 
clearly shown the relation of intestinal intox- 
ication to the arrested growth and other dis- TREATMENT OF RESULTS OF CONSTIPATION 
507 
turbances of nutrition which are frequently 
observed in infants and young children and 
that constipation lies at the foundation in 
most of these cases. One of the most impor- 
tant of all the duties of the nurse is to attend 
carefully to the condition of the infant's 
bowels, as neglect in the first weeks of infancy 
may lay the foundation of troubles which 
years of painstaking efforts will be required 
to relieve, and which may be irreparable. 
Cancer 
The discoveries of Ross respecting the 
cause of cancer show very clearly the reason 
for the special frequency of cancer in the 
pelvic colon and the rectum. According to 
Ross, cancer is due to an abnormal stimula- 
tion of the processes of normal cell growth. 
He has shown by elaborate laboratory re- 
searches that cholin and cadaverin, two of 
the products of the putrefaction of flesh or 
protein, are powerful augmenters of cell ac- 
tion, and in recent-experiments he has been 
able by these poisons to produce in guinea 
pigs growths which have all the character- 
istics of cancer. Certainly no part of the 508 
COLON HYGIENE 
body is more exposed to the influence of these 
putrefactive products than is the lower bowel. 
It is evident, then, that this portion of the 
body should receive prompt attention on the 
occurrence of the slightest symptoms of dis- 
ease, and that as a protective measure putre- 
faction of the feces should be prevented by 
proper regulation of diet and of the bowel 
movement. 
The writer has no doubt that suppression 
of putrefactive changes in the colon, in other 
words, change of the intestinal flora, will ul- 
timately be found the most effective means of 
preventing cancer of this region of the body. 
'The facts of experience certainly point very 
strongly in this direction. 
Cancer is an exceedingly common disease 
in all carnivorous animals and is, on the other 
hand, rare in non-flesh-eating animals. This 
fact is observed in relation to human beings. 
Cancer is practically unknown among people 
who rarely eat flesh. The principal harm 
which results from flesh eating is due to the 
putrefaction in the colon of the undigested 
residues. Putrefaction is encouraged by flesh 
eating not only because of the great facility TREATMENT OF RESULTS OF CONSTIPATION 
509 
with which animal flesh undergoes putrefac- 
tive changes but because of the fact that flesh 
as usually eaten is already in a state of well 
advanced putrefaction and hence becomes an 
active source of infection of the intestine. 
Persons who are predisposed to cancer 
should take great care to maintain a non- 
putrefactive intestinal flora by the free use of 
acidophilus buttermilk or lacto-dextrin or 
both of these protective foods. The same 
should be said of persons who have devel- 
oped cancer in any other part of the body. 
Every person who has been operated upon 
for cancer should give great attention to 
changing the intestinal flora and the main- 
tenance of normal activity of the bowels. The 
bowels should move three or four times a day 
and an enema should be used when there is 
ground for suspicion that the colon is not 
thoroughly emptied. 
Tuberculosis of the Bowels 
Intestinal tuberculosis appears to be in- 
creasing. That this should be the case is not 
surprising, in view of the fact that constipa- 
tion is becoming more and more prevalent 510 
COLON HYGIENE 
each year. The contact of poisonous fecal 
matters with the mucous membrane lowers 
its resistance and renders it susceptible to the 
infectious influence of the tubercle germ. All 
forms of tuberculosis, as the history of cases 
shows, are almost invariably preceded by 
chronic constipation for a prolonged period. 
Change of flora is most important not only 
as a means of combating the local infection, 
but to increase the general resistance. Meats 
of all sorts must be avoided. With these 
helps, under favorable conditions, many cases 
will recover. Rollier has shown the great 
value of sunlight in these cases. 
Backache 
Aside from symptoms which relate to the 
rectum, backache is perhaps the most com- 
mon of all local symptoms arising from con- 
stipation. In women this symptom is usually 
attributed to disease of the womb or ovaries. 
It is safe to say that in by far the larger num- 
ber of cases the pain is due not to disease of 
the organs peculiar to women, but to a dis- 
eased condition of the colon, set up by long 
continued contact with putrefying fecal mat- TREATMENT OF RESULTS OF CONSTIPATION 
511 
ters. In many cases tender points can be felt 
by deep pressure along the iliac or the de- 
scending colon. Sometimes the pelvic colon 
may be located. By the aid of the X-ray and 
the fluoroscope it is possible to locate and 
make pressure upon every part of the colon, 
as well as to note its form and size, and thus 
the presence of disease may now easily be 
located when present. 
The pain is reflex in character, and may 
often be produced by pressure upon a con- 
tracted and tender part of the colon. Pains 
over the sacrum are quite as often due to dis- 
ease of the rectum as to disease of the uterus 
or ovaries. As constipation is so constantly 
associated with disease of the pelvic organs, 
it is a question of interest whether the pain 
usually attributed to pelvic disease, when this 
is present, may not in many cases be really 
due to disease of the colon or rectum. Ten- 
der spots in the lower part of the back are 
usually due to the same cause, and only 
rarely indicate disease of the spine. 
The congestion of the abdominal organs 
which results from chronic constipation is 
the cause of a great variety of reflex pains in 512 
COLON HYGIENE 
the back and sides. Coldness, numbness, 
prickling and creeping sensations, and points 
of tenderness in the abdomen, a sense of 
weight, dragging and pressure, are only a few 
of the distressing symptoms which arise from 
visceral congestion due to the absorption of 
toxins from the intestinal tract, and the infec- 
tion of the intestinal mucous membrane re- 
sulting from chronic constipation. 
Exopthalmic Goiter 
This serious disorder, which is becoming 
constantly more common, is in many cases 
due to chronic intestinal poisoning, and hence 
may be the result of constipation, which in 
some form is always present in cases of 
chronic intestinal autointoxication. To treat 
this malady simply by removal of a part of 
the thyroid gland by a surgical operation, or 
by partial destruction of the gland by the 
X-ray without giving attention to its cause, is 
certainly irrational, since the enlargement and 
activity are the effects, no doubt, of the ab- 
sorption of toxins from the intestinal canal. 
The gland enlarges because of the extraor- 
dinary amount- of work demanded of it, its TREATMENT OF RESULTS OF CONSTIPATION 
513 
special function in the body being to aid in 
the destruction of poisons, especially those 
developed in the intestine by the decomposi- 
tion of protein. Animals whose thyroids have 
been removed soon develop convulsions and 
die when fed on a meat diet, but thrive in- 
definitely on a diet which excludes meat. 
The writer has seen numerous cases of 
hyperthyroidism, or exopthalmic goiter, 
make excellent recoveries without operation 
by rest, a strict antitoxic diet and change of 
the intestinal flora. These measures are pre- 
ventive as well as curative. Every person 
who has undergone an operation for relief of 
exophthalmic goiter should change the intes- 
tinal flora and maintain a thoroughly good 
flora by the use of lacto-dextrin and the avoid- 
ance of meats of all sorts. 
Myxedema 
A disease which is the antithesis of ex- 
ophthalmic goiter, myxedema, is really due 
to the same cause. The thyroid gland be- 
comes worn out by excessive work, and its 
function is lost. In consequence, the whole 
body suffers from peculiar degenerative 514 
COLON HYGIENE 
changes. The skin and hair become dry, pale 
and sodden in appearance, the speech is thick, 
the expression is peculiar and characteristic, 
and the intellect is dulled. The cause of this 
peculiar disease was wholly a mystery until 
the function of the thyroid was discovered. 
It is now known to be due to the failure of 
this important gland to do its work, as the 
result of degeneration, which is in most cases 
the result of the excessive work imposed upon 
it by the autointoxication induced by a high 
protein diet—the free use of meat and eggs, 
especially when associated with constipation. 
Hypothyroidism, incipient myxedema, is 
a very common malady. The thyroid is less 
active than it should be though its function is 
not wholly lost. Dryness of the hair, falling 
of the hair, and dryness of the skin are com- 
mon symptoms of this condition seen asso- 
ciated with chronic constipation, and the 
natural result of long overwork of the thy- 
roid in destroying colon poisons. Change of 
the intestinal flora and the maintenance of a 
non-toxic condition of the intestinal contents 
are equally important measures in cases of 
myxedema as in cases of hyperthyroidism. TREATMENT OF RESULTS OF CONSTIPATION 
515 
Chronic Rheumatism and Rheumatic Gout 
—Osteo-Arthritis 
Both of these diseases are closely associated 
with constipation and alimentary toxemia. 
Herter showed that certain putrefactive or- 
ganisms are always present in great numbers 
in the stools of persons suffering from rheu- 
matic gout. The experience of many physi- 
cians has shown that great improvement often 
follows the adoption of a low protein diet in 
these cases; and the benefit derived from se- 
curing increased activity of the bowels has 
made many a mineral spring famous as a 
cure-all for rheumatics. 
While chronic rheumatism, rheumatic 
gout, or osteo-arthritis, are sometimes due to 
focal infections located in the mouth, there is 
little room for doubt that the dominating fac- 
tor in most of these cases is to be found in the 
colon. The mouth infections are probably in 
many cases secondary to colon conditions 
which have reduced the general resistance of 
the body. The diseased colon is itself the 
most important of all focal infections. Cer- 
tainly, change of the flora and training the 516 
COLON HYGIENE 
bowels to normal activity with a non-toxic diet 
are the measures which accomplish more re- 
lief of chronic rheumatism than any other 
measures or, in fact, all other measures com- 
bined. 
Pigmentation of the Skin and Skin Diseases 
When meat and eggs are eaten freely, ac- 
cording to Combe, there may be produced in 
the intestine a large amount of a brown 
poisonous coloring substance, “brenzcatechin,” 
to destroy which is one of the functions of the 
suprarenal capsules. When these glands be- 
come defective, through overwork, this sub- 
stance accumulates and, being deposited in 
the skin, gives rise to dinginess of the com- 
plexion, brown circles around the eyes, so- 
called ‘diver patches” on the face and other 
parts, brown spots upon the hands, and a 
deepening of the color of parts of the skin 
which are normally pigmented, as the axil- 
lary regions, groins, and in many patients a 
line down the center of the back. 
This pigmentation is commonly seen in 
aged persons, in whom, as in others, its cause 
is the constipation which is usually associated TREATMENT OF RESULTS OF CONSTIPATION 
517 
with old age. The same pigmentation is 
sometimes seen in young persons, and even in 
infants, as the result of intense poisoning 
from intestinal putrefaction. When an anti- 
toxic diet is adopted, and the bowels are 
made to act normally, the pigmentation dis- 
appears with remarkable quickness. 
Eczema 
Eczema, one of the most common and 
most distressing of skin maladies, has long 
been known by skin specialists to be caused 
by constipation. Doctor Bulkley, the emi- 
nent skin specialist of New York City, has 
within the last thirty years many times called 
attention to the fact that eczema is encour- 
aged by the use of flesh food, and that most 
chronic cases are curable by strict adherence 
to a non-flesh dietary. 
A most distressing form of this disease is 
eczema of the anal region, one of the frequent 
results of constipation. This annoying ail- 
ment usually disappears very soon when the 
bowels are made to move three times a day, 
and meat is excluded from the diet. 518 
COLON HYGIENE 
Temporary relief from the horrible itch- 
ing of eczema may be obtained in many cases 
by bathing the parts with very hot water. 
Psoriasis 
This form of skin disease, usually more 
obstinate though less distressing than eczema, 
is generally incurable without the adoption 
of a fleshless diet and restoration of the nor- 
mal function of the colon. In many cases 
nothing else is needed to effect a permanent 
cure. A few applications of the actinic rays 
by means of the arc light or the “mercury 
light” or the X-ray will generally cause the 
eruptions to disappear after the flora has been 
changed. 
Itching Skin without Eruption 
Many constipated persons, especially old 
persons, suffer from intense itching and burn- 
ing of the skin, especially of the back and 
other parts of the arms and legs. The affec- 
tion is generally worse in cold weather and 
when hard water is used for baths. A soap 
and water bath is generally followed by an 
increase of the itching. If the skin is TREATMENT OF RESULTS OF CONSTIPATION 
519 
scratched, an eruption resembling eczema ap- 
pears. 
Besides combating the constipation nearly 
always present, bathe the parts with water as 
hot as can be borne (120° F.) several times 
daily. Avoid rubbing. After bathing, apply 
lanolin cream. The cream should be applied 
to the whole surface of the body after bathing 
and daily or even twice a day. If necessary 
to completely relieve the itching, menthol 
may be added to the cream in the proportion 
of ten grains to the ounce. 
The following is a most excellent prepara- 
tion for use in maintaining a healthy condi- 
tion of the skin and relieving various forms 
of irritation either with or without skin erup- 
tion; the formula was given to the writer by 
Prof. L. D. Bulkley, of New York, who has 
employed it for many years in the Skin and 
Cancer Hospital under his charge. 
Lanolin 2 drams 
Boroglyceride 1 dram 
Cold cream made with 
white vaseline 6 drams 
When itching is intense, ten drops of car- 
bolic acid may be added to the above or ten 520 
COLON HYGIENE 
grains of menthol. When desirable both 
menthol and carbolic acid may be added. 
Vertigo 
This unpleasant symptom is a very com- 
mon result of constipation. Vertigo is a 
common symptom in cases of arteriosclerosis 
caused by constipation, and sometimes results 
from irritation produced by the presence of 
feces in the rectum. In certain nervous 
persons, vertigo, faintness or exhaustion are 
sometimes experienced when the bowels are 
evacuated by a saline laxative or by an enema. 
The cause of this is doubtless the absorption 
of poisons brought into solution by the large 
amount of fluid present in the intestine. So 
long as the feces are hard, little absorption 
can take place. But when they become semi- 
fluid, the poisons present are brought into 
solution and are also made to come in contact 
with the mucous membrane, so that rapid ab- 
sorption occurs. In some instances, the pros- 
tration is such that recovery does not take 
place for several hours. These are probably 
cases in which the liver and kidneys are 
crippled as the result of long-standing disease. TREATMENT OF RESULTS OF CONSTIPATION 
521 
Dr. Case has observed that unpleasant 
symptoms immediately following an enema 
are connected with the entrance of the in- 
jected liquid into the small intestine through 
an incompetent ileocecal valve. This is an 
interesting observation. It suggests that ver- 
tigo at other times may be due to refluxed 
material from the colon, due to antiperistal- 
tic action of the colon. The wretched feel- 
ing which many neurasthenics experience in 
the morning may be due to the same cause. 
Case has noted that although the small intes- 
tine may be entirely empty at night, in the 
morning several feet of the intestine may be 
filled with fecal matters which have returned 
from the colon through an incompetent ileo- 
cecal valve. 
Disorders of the Urinary and Generative 
Organs 
Urinary troubles in both men and women, 
as well as in children, are often traceable to 
constipation. Very foul-smelling urine often 
owes its unnatural odor to the presence of 
putrefaction poisons absorbed from the intes- 
tine. 522 
COLON HYGIENE 
Both inability to urinate and a frequent 
desire to urinate may result from the accumu- 
lation of feces in the rectum. In children 
the escape of urine during sleep is often due 
to constipation. 
Prolapse and retroversion of the uterus is 
a common result of the straining necessitated 
by constipation in women and girls. 
Dysmenorrhoea, leucorrhoea, and a vari- 
cose condition of the broad ligaments, which 
is accompanied by much pain and discom- 
fort, may result from the pressure of feces in 
the rectum and lower colon. Nocturnal sem- 
inal losses and an abnormal irritability of the 
parts, causing erection and also neuralgic 
pains in the testicles, and varicose veins, may 
result from the congestion caused by the 
pressure of feces in the rectum and lower 
colon. 
In all these disorders first attention must 
be given to removal of the exciting or pre- 
disposing cause by changing the intestinal 
flora and training the bowels to move three 
times a day. In many cases an enema of three 
or four pints of water may be used with ad- 
vantage at bedtime to make sure that the TREATMENT OF RESULTS OF CONSTIPATION 
523 
colon is thoroughly emptied at least every 
twenty-four hours. 
Fecal Fever 
Accumulation of feces in the colon is a 
frequent cause of attacks of fever which so 
much resemble malarial paroxsyms that they 
are usually treated by the administration of 
quinine. There is often a distinct chill, fol- 
lowed by fever and sweating. The tongue is 
coated, the breath bad, and there is much 
headache, and sometimes vomiting. The 
fever may last several days, but disappears 
quickly when the bowels have been thor- 
oughly evacuated. 
These attacks are very common in persons 
who are subject to colitis, and much mucus is 
often discharged when the bowels are cleared 
out. 
Neglect to secure complete and regular 
evacuation of the bowels is a frequent cause 
of rise of temperature after confinement and 
in convalescence from acute illness. Accu- 
mulation of feces not infrequently occurs 
when the bowels move daily and even when 
the bowels are quite loose, as shown by the 524 
COLON HYGIENE 
immense quantities of loathsome material 
which may be washed out by means of a 
thorough enema. The writer recalls a case 
in which a woman who had very loose move- 
ments for two or three weeks was found to 
have an enormous mass of hardened fecal 
matter in the rectum, and a very great accu- 
mulation of feces in the lower colon. 
Bed patients should always be made to sit 
up when moving the bowels or urinating, 
when this is at all possible, so as to secure 
complete evacuation of the urine and feces. 
In most cases this may be done without injury 
after the second day. The same remark ap- 
plies with special interest to cases of confine- 
ment. There is so often an accumulation of 
feces in the colon in pregnancy, especially 
within the last two or three weeks before 
confinement, that it is highly important to 
give the matter prompt attention at once after 
the child is born, as well as before confine- 
ment. Very often a great quantity of putre- 
fying material will be removed, the retention 
of which may give rise to autointoxication 
with fever and even worse symptoms. In all 
cases of this sort change of the intestinal flora TREATMENT OF RESULTS OF CONSTIPATION 
525 
and the establishment of a normal intestinal 
rhythm should receive first attention. 
Flatulency 
This symptom may result either from the 
excessive formation of gas in the intestine, or 
from the accumulation of gas. A certain 
amount of gas is natural. The presence of 
gas in the intestine is an aid to peristalsis. 
This is especially true of the large intestine. 
Excessive formation of gas occurs through 
the action of bacteria upon the foodstuffs. 
Gas is most readily formed from cooked 
starch or sugar, but may be formed from 
cellulose and from protein. Odorless gas is 
usually formed from starch or sugar, in- 
flammable gas from cellulose, and gas having 
a foul odor from protein. These different 
elements of the food are acted upon by dif- 
ferent species of bacteria, so that the character 
of the gas formed in the intestine becomes 
something of an index to the sort of bacteria 
present. Bacteria which act upon starch, 
sugar and cellulose are comparatively harm- 
less, while the presence of foul-smelling gases 
indicates the presence of putrefaction and the 526 
COLON HYGIENE 
pernicious bacteria and virulent poisons 
which are always present in this condition. 
The formation of gas in excess is due pri- 
marily not so much to the excessive use of 
starchy food, as many persons suppose, but to 
stasis or stagnation of the food. Bouchard 
showed long ago that if the foodstuffs remain 
in one part of the alimentary canal, even in 
the stomach, fermentation and other bacterial 
changes take place. 
An important remedy for flatulence, then, 
is increased intestinal activity. When the 
gas is confined to the colon an enema, either 
warm or cool, will usually secure relief; for 
permanent relief the causes of the constipa- 
tion must be removed by systematic treatment. 
Flatulence which is not relieved by emp- 
tying the colon is due to incompetency of the 
ileocecal valve. The absence of the check 
valve at the junction of the small intestine 
with the colon permits the gas to pass back 
into the small intestine. This condition is 
generally greatly mitigated by increased ac- 
tivity of the bowels; a radical cure may be 
accomplished by repairs of the ileocecal 
valve. TREATMENT OF RESULTS OF CONSTIPATION 
527 
Flatulence may become dangerous in cases 
of high blood pressure with degeneration of 
the blood vessels. The great accumulation of 
gas in the intestines forces the blood out of 
the abdominal vessels into the general circu- 
lation, and so raises the blood pressure. If 
the blood pressure is already high, and the 
blood vessels are much diseased, the rise of 
pressure may be sufficient to cause a rupture 
and apoplexy with paralysis, if the rupture 
occurs in the brain. 
The wet girdle or moist abdominal band- 
age is often found a most efficient means of 
combating flatulence. The bandage must be 
kept moist, and should not be too warmly 
covered. The mackintosh cover must be 
omitted, the purpose being to promote evap- 
oration and thus maintain a mild stimulant 
action upon the intestine. The bandage will 
dry out in three or four hours, when it should 
be renewed. It may be worn with advantage 
both night and day. The bandage must be 
changed or boiled daily to avoid producing 
skin infection. 
Flatulence in the colon always means stasis, 
that is, delayed feces which need removal. 528 
COLON HYGIENE 
Persons who have been accustomed to a 
hearty meat diet sometimes suffer consider- 
ably from flatulence when a change is made 
from meat to vegetables, but this should not 
be considered as a need to return to a highly 
nitrogenous diet. After a short time the ac- 
tivity of the bowels will be increased to such 
a degree that the constipation will be over- 
come, and the flatulence will disappear. In 
cases in which the free use of cereals or 
starchy food is accompanied by acidity of the 
stomach or heartburn soon after eating, the 
difficulty may be relieved by increasing the 
amount of fat taken with the meals. Usually 
one or two tablespoonfuls of olive oil taken 
at the beginning of the meal will cause the 
disappearance of this unpleasant symptom. 
Flatulence is an evidence of the presence 
of pernicious bacteria, that is, a bad intes- 
tinal flora. Welch’s bacillus, the so-called 
gas bacillus, is the great gas producer. This 
is the organism that produces the fatal gas 
gangrene which is so much dreaded in mili- 
tary hospitals. 
When lacto-dextrin or acidophilus butter- 
milk is given to change the intestinal flora, TREATMENT OF RESULTS OF CONSTIPATION 
529 
not infrequently there is an enormous increase 
in gas production. This indicates that the 
remedy has reached the colon and that the 
change of intestinal flora has begun. By a 
persevering use of large doses of lacto-dextrin 
or the free use of acidophilus buttermilk, the 
pernicious organisms may be driven out and 
within three or four days the amount of gas 
will diminish; and when the flora is changed 
the gas will disappear altogether. This dem- 
onstrates that carbohydrates are not the real 
cause of flatulence; the right carbohydrates 
are, in fact, the one efficient means of curing 
this condition. 
The observations of Griitzner, Boaz and 
others have shown that a coated tongue and 
foul breath are at least, in part, attributable 
to the same bacteria which are present in the 
colon in cases of chronic autointoxication. It 
has been definitely proven that the bacteria 
of the colon may ascend to the stomach and 
the mouth. It is evident, then, that the one 
important thing to be done in these cases is 
to increase the activity of the colon and to 
change the intestinal flora. By the use of 
these measures the tongue can be made clean 530 
COLON HYGIENE 
and kept clean. The writer has demonstrated 
this in many hundreds of cases. 
Foul Tongue and Bad Breath 
These common conditions are more often 
due to constipation than to neglect of the 
mouth. A high protein diet, that is, the free 
use of eggs and meats, together with constipa- 
tion even in very mild degree, will cause 
coating of the tongue and a fecal odor of the 
breath. The general low resistance caused 
by chronic toxemia destroys the ability of the 
saliva to prevent the growth of germs in the 
mouth and the result is coating of the tongue, 
ulceration of the gums and decay of the teeth. 
The cure is not to be found in dentifrices, 
lotions, tooth brushes or dental procedures, 
“mouth treatment,” etc., but in removal of 
the cause by training the bowels through diet 
and other measures, to move thoroughly three 
times daily. Of course the toilet of the 
mouth and “mouth treatment” by a skillful 
dental surgeon must not be neglected. 
A diet consisting exclusively of wheat bran 
and fruit, preferably apples and oranges, 
continued for three or four days, will rapidly 531 
TREATMENT OF RESULTS OF CONSTIPATION 
clear the tongue and sweeten the breath in 
ordinary cases. An ounce or two of cooked 
bran should be eaten daily and apples may 
be eaten in any quantity which does not cause 
inconvenience. Twelve to sixteen apples 
taken at four meals will usually be found 
sufficient. The fruit must be eaten raw and 
should be well chewed. One or two apples 
or other fruit may be eaten whenever a crav- 
ing for food is felt. Fruit imposes little or 
no labor upon the digestive organs. Berries, 
grapes, peaches, oranges, melons, tomatoes, 
lettuce, cucumbers and celery may be added 
to the bill of fare if desired. The greater the 
bulk and the less the actual food value rep- 
resented in the food, the better. 
The addition of bran is necessary for the 
reason that the tender cellulose of fruit is 
often almost completely digested and so furn- 
ishes little residue. 
The “milk regimen” conducted according 
to the author’s method (see Index), for one 
to two weeks rarely fails to clear the tongue 
and to remove the foul odor of the breath. 532 
COLON HYGIENE 
Anal Infections 
Hemorrhoids, fissures and fistulas arising 
from abscesses about the anus, are due to 
infection. The best preventive is thorough 
cleanliness. The anal region should be care- 
fully cleansed with water after each bowel 
movement. It is best to cleanse the parts 
while the anus is still relaxed, so that the 
anal canal as well as the margin of skin about 
the anus may be well cleansed. When fecal 
matter is left behind in the folds of the skin 
or mucous membrane, infection readily oc- 
curs, the results of which may be hemor- 
rhoids, ulcer, fissure, or an abscess which may 
result in a “blind’' fistula or a complete fecal 
fistula. 
A Hindoo regards it as a religious duty to 
cleanse himself with water after every bowel 
movement. A missionary told the writer that 
he was once interrupted while holding service 
in a Bengali village by a native who rose up 
and shouted, “This man isn’t fit to preach. 
He wipes off with paper.” The entire audi- 
ence fled as though from a leper. We have 
much pity for the degraded heathen but may 
learn not a few lessons in self-respect and TREATMENT OF RESULTS OF CONSTIPATION 
533 
personal cleanliness from these benighted 
children of Nature. 
Hemorrhoids 
The pain and inconvenience from hemor- 
rhoids is usually the result of infection. The 
distended veins do little harm unless inflamed. 
The infection results from the retention of 
fecal matter in the folds of the mucous mem- 
brane. Straining at stool distends the veins 
and cracks the mucous membrane, thus open- 
ing up channels for infection. Abrasions are 
also often produced by rough toilet paper and 
by lack of care in the insertion of the enema 
tube. Thorough cleansing of the parts with 
water after bowel movement is an excellent 
preventive measure. This is the universal 
custom in India and is certainly more sani- 
tary, if less convenient, than the method in uni- 
versal use in western countries. The use of 
an antiseptic suppository after each bowel 
movement is a most useful precaution. 
Instead of a suppository, carbolated vase- 
line may be used with equally good results. 
When the hemorrhoids become inflamed, dry 
calomel or a mixture consisting of equal parts 534 
COLON HYGIENE 
of calomel and starch should be applied after 
each bowel movement. Persons who are suf- 
fering from hemorrhoids should apply carbo- 
lated vaseline regularly every time the bowels 
move. In most ordinary cases operations may 
be avoided by the use of these simple meas- 
ures. The flora must be changed and kept 
changed by methods elsewhere indicated (see 
Index). 
When the bowels move freely three or 
four times a day, hemorrhoids are rarely 
troublesome, at least when the,, precautions 
above recommended are employed. In many 
cases they apparently disappear. When per- 
sistent, however, they should be removed. 
This may be done with perfect safety and 
with so little inconvenience that no one who 
suffers from hemorrhoids should hesitate to 
have them removed. Chronic irritation is 
an invitation to cancer. 
Anal Fissure or Ulcer 
This painful affection most generally fol- 
lows hemorrhoids. If it does not speedily 
disappear when the bowels become regular, 
resort to operation is necessary. Operation TREATMENT OF RESULTS OF CONSTIPATION 
535 
is also indicated when the ulcer renders def- 
ecation painful and thus interferes with regu- 
lar bowel action, which is most generally the 
case. 
A cure may be accomplished in many cases 
by the use of the measures suggested for hem- 
orrhoids. The flora must be changed and 
kept changed. 
Anal Fistula 
Anal fistula is the result of an abscess de- 
veloped in the tissues outside of the anal 
canal, the result of penetration of pus-form- 
ing bacteria. If the abscess opens both into 
the bowel internally and through the skin 
externally, a fistula is formed through which 
fecal matters may escape. Cases of this sort 
require the services of a surgeon. The oper- 
ation is not a serious one and may be done 
under local anesthesia. Change of flora is 
highly important in these cases. The bowels 
should move three or four times a day and 
carbolated vaseline or calomel should be ap- 
plied after each bowel movement to promote 
healing and to prevent recurrence of the dif- 
ficulty. Used in the manner directed, calo- 536 
COLON HYGIENE 
inel is entirely harmless, not being absorbed. 
It simply acts as an antiseptic, suppressing 
the development of harmful bacteria. 
Anal Itching 
This is usually a form of eczema which is 
kept up by an irritating discharge from the 
rectum. The measures recommended for ec- 
zema will effect a speedy cure after the 
bowels have been regulated and the rectal 
irritation or proctitis has been cured. The 
X-ray or the actinic ray will easily complete 
the cure when the flora has been changed. 
The most severe itching may be temporarily 
relieved by applications of water at a temper- 
ature of 120° F. At this temperature, the 
duration of the application must be very short, 
a mere touch, repeated at intervals of one or 
two seconds until the itching is relieved. The 
relief usually lasts for several hours. 
Rectal Prolapse 
In cases of prolapse of the rectum frequent 
movements of the bowels are necessarily 
avoided on account of the inconvenience in- 
volved. These cases may be cured by a simple TREATMENT OF RESULTS OF CONSTIPATION 
537 
and safe surgical procedure. Such an oper- 
ation should be the first step in the effort to 
cure the chronic constipation present. After 
the operation, the free use of bran and paraf- 
fin at each meal will prove efficient. 
Anal Incontinence 
Persons whose anal sphincters have been 
paralyzed by disease or by careless surgery 
often keep the bowels constipated to avoid 
annoyance from incontinence. In such cases 
it is of course necessary first of all to rem- 
edy the anal defect. This may usually be 
done by a skillful surgeon and the operation 
is attended by no serious risk. 
Anal Spasm 
Undue contraction of the anal sphincter is 
generally associated with fissure, hemorrhoids 
or rectal irritation. If not speedily relieved 
by removal of the source of irritation, an op- 
eration for stretching the sphincter may be 
necessary. Excessive tension of the sphincter 
appears to be sometimes present without evi- 
dence of local irritation. 
The application of heat is a most efficient 538 
COLON HYGIENE 
means of relieving anal spasm. Heat may be 
applied by means of a fomentation or by 
sitting in very hot water. 
Abdominal Tenderness 
Very hot fomentations applied two or three 
times a day for ten or fifteen minutes are 
almost a sovereign remedy for the abdominal 
tenderness usually found in chronically con- 
stipated persons, especially when colitis is 
present. The moist abdominal bandage used 
at night with a mackintosh cover is a very 
old-fashioned and still unrivalled remedy for 
tenderness, soreness and ill-defined pain in 
the abdomen. These remedies are more than 
merely palliative, but of course are not in 
themselves curative unless the constipation 
which gives rise to the congestion to which the 
pain is due, is also cured. It is of course nec- 
essary to change the intestinal flora. This is 
of first importance for the reason that by far 
the majority of abdominal pains, tenderness 
and other miseries, with accompanying back- 
aches and “dragging” sensations, are due to 
colitis. TREATMENT OF RESULTS OF CONSTIPATION 
539 
Colic Pains 
Apply very hot fomentations to the abdo- 
men and administer a hot enema. Repeat the 
applications both of the fomentations and of 
the hot enema until the pain ceases, as it soon 
will do. Heat is a most excellent antidote for 
pain. It also relaxes muscular spasm; it is 
thus a most appropriate remedy for intes- 
tinal colic. In all cases of colic the hot enema 
should be administered for the purpose of 
relaxing the bowel and removing the fer- 
menting food residues which give rise to the 
gas and hence are the real cause of the colic. 
The flora should be changed to suppress the 
gas-forming germs. 
“Kinks” 
So much is being said about “kinks” in 
current medical literature, it is not remark- 
able that the laity should begin to take an 
interest in the subject. The writer’s chief 
purpose in mentioning this subject here is to 
emphasize the fact that “kinks” are of far less 
consequence than it was at first supposed. X- 
ray evidence has demonstrated that kinks and 540 
COLON HYGIENE 
folds in the colon are seriously obstructive 
only in very rare cases. To advise a surgical 
operation simply because the X-ray shows a 
“kink” or fold in the transverse colon or a 
very pronounced prolapse is most improper. 
It has been proved that the so-called “Lane’s 
kink” of the terminal ileum is seldom a source 
of trouble and very rarely requires surgical 
interference. By the adoption of an atoxic 
diet from which all flesh meats are excluded 
and by the employment of the necessary 
measures for securing three bowel movements 
daily, the troubles supposed to arise from 
“kinks” rarely fail to disappear; and without 
the adoption of these measures surgery af- 
fords only temporary relief, sometimes not 
even that, as a return for the very great risk 
to life and the severe suffering and shock in- 
volved in such operations as “short circuit- 
ing” and removal of the colon. 
In all cases of this sort change of flora is 
the most important measure that can be em- 
ployed. This means should be applied in 
every case before operation is considered. 
Operation is justifiable only in cases in which 
relief cannot be obtained by changing the TREATMENT OF RESULTS OF CONSTIPATION 
541 
intestinal flora and suppressing putrefactions 
and the autointoxication which arises there- 
from. This statement is not made on theo- 
retical grounds but after observing and test- 
ing both methods in many hundreds of cases. 
It is not too much to say that by an efficient 
application of the reliable methods for 
changing the intestinal flora which are now 
available, surgery for relief of crippled con- 
ditions of the colon may be very largely, if 
not altogether, eliminated. Only in very ex- 
ceptional cases are surgical measures neces- 
sary, when the flora is changed and the change 
maintained. Certainly, operations for kinks, 
either “Lane’s kink” or any other so-called 
kinks, or Jackson’s membrane, prolapse of the 
colon, dilatation of the cecum and like condi- 
tions, and Especially removal of the colon 
and the short circuiting operation, are no 
longer justifiable. These operations are 
needed only in cases of malignant disease 
of the colon and cases in which mechanical 
obstruction exists to such a degree that the 
colon cannot be made to functionate properly 
even by the aid of the measures which have 
been outlined in the foregoing pages. BOWEL HABITS OF UNCIVILIZED 
MAN 
Civilized human beings have departed so 
far from natural primitive modes of life, and 
have adopted so many unphysiologic prac- 
tices, that it is quite impossible from the con- 
ventional usages of civilized people, to form 
any just conclusion of what are natural or bio- 
logic modes of life for human beings. This 
is particularly true of customs and habits in 
relation to human alimentation. From a study 
of the modern hotel bill of fare, one could not 
possibly obtain even a suggestion of man’s 
primitive and biologic diet. The natural 
conclusion would be that man is a universal 
feeder, since the average hotel menu presents 
practically everything that any animal eats; 
but biology teaches us that man is naturally 
irugivorous, and science offers no reason why 
he should have departed from his original 
bill of fare, to which his nearest relatives, 
the anthropoid apes, the chimpanzee, the 
orang-utan and the gorilla, living in their 
native forests, still scrupulously adhere. 
542 PRIMITIVE BOWEL HABITS 
543 
Man has not only developed wrong habits 
in relation to the kind of food he eats, but 
has become unbiologic in almost every phase 
of his daily life. Constipation is simply one 
of the natural consequences of these perver- 
sions. It is scarcely too much to say that the 
average civilized man is the victim of chronic 
constipation. If his bowels move once a day, 
or even once in two days, he feels that his 
condition is very satisfactory; whereas Can- 
non, in his work entitled “The Mechanical 
Factors of Digestion,” has shown that prac- 
tically all the digestible food taken at an or- 
dinary meal is digested and absorbed within 
eight or nine hours from the time it is eaten, 
and the unusable residue is at the end of this 
period found deposited in the colon, ready 
for ejection. Since the chief business of the 
colon is to eject wastes from the body, why 
should the performance of its function be so 
long delayed? The colon contents are largely 
made up of bacteria and excretory products, 
the undigestible elements of the food con- 
stituting only about one-half its bulk, while 
starch, fats, and protein are found in only 
very small and negligible quantities. It 544 
COLON HYGIENE 
should be remembered that bowel movement 
is not simply for the purpose of discharging 
the unusable residues of food. An equally 
essential reason for bowel movement is the 
discharge of the bile and other highly poison- 
ous excretions which are discharged into the 
colon from the blood. No possible good, but 
only much harm can come, then, from the pro- 
longed retention of these body wastes and un- 
usable residues. There is, in fact, no physio- 
logic reason why food residues should be re- 
tained in the body more than twelve to eight- 
een hours, or at longest twenty-four. It is 
evident, then, that bowel movements should 
occur at frequent intervals, for the purpose 
of removing these waste and poisonous mate- 
rials. 
The natural intestinal rhythm, as has been 
previously explained, provides for an unload- 
ing of wastes by a bowel movement after 
each meal and sometimes an additional one 
on rising. This requires three or four bowel 
movements daily. Although convinced by 
careful and extended observations in dealing 
with many thousands of invalids, that the 
bowels should be made to move several times PRIMITIVE BOWEL HABITS 
545 
a day, the writer several years ago set about 
collecting from original sources facts con- 
cerning the habits of uncivilized tribes of 
human beings. 
The keeper of the London Zoological 
Gardens informed the writer that the chim- 
panzee, orang, and the other large apes move 
their bowels four times daily with perfect 
regularity. Professor Hornaday, superin- 
tendent of the Bronx Park informs us that 
the large apes in the great collection under 
his supervision move their bowels three times 
a day. 
Extensive inquiries made by means of ques- 
tionnaires sent out to physicians practising 
among primitive people in various parts of 
the world, show that the custom among many 
of those who live in a really primitive state, 
and have been little influenced by contact 
with civilization, is the same as that of the 
higher apes. Replies were received from 
one hundred and forty physicians who have 
had abundant opportunity to become ac- 
quainted with the habits and usages of the 
wild or half-civilized people with whom 
they have been closely associated, and among 546 
COLON HYGIENE 
whom they have practised for years. A 
summary of these replies will be found 
highly interesting, especially in the light of 
the physiological facts which have been pre- 
sented in the previous pages. It is most in- 
structive to find wild and primitive people in 
widely separated portions of the globe fol- 
lowing identical usages to which they have 
been trained by Nature, the universal teacher. 
A common instinct has led to a practical uni- 
formity of habits among wild tribes who have 
not yet been sophisticated and perverted by 
contact with civilization. It is interesting also 
to note the same identity between wild tribes 
and those most remarkable creatures of the 
tropical wilds, the anthropoids, in practices 
connected with eating and bowel action. For 
much valuable and interesting information, 
a small portion of which is summarized in 
this chapter, I am indebted to scores of mis- 
sionary physicians who have devoted their 
labors to the noble work of civilizing and 
Christianizing the people of heathen lands. 
From this original and authentic informa- 
tion the fact appears that among tribes which 
have been uninfluenced by the customs of PRIMITIVE BOWEL HABITS 
547 
civilization, who still adhere to primitive 
habits in diet, and who live a free and active 
life in the wild, the bowels move two or three 
times daily. A single daily movement is re- 
garded by such people as constipation, and 
gives rise to alarm. The one-movement-a-day 
habit appears only among those classes or 
castes who live a sedentary life and have 
adopted unnatural habits in diet, such as the 
use of hot condiments, concentrated food, etc. 
The aristocratic classes of India and China 
afford striking examples of this, suffering 
much from constipation in consequence of 
their idle and luxurious habits, and from the 
use of curries and other unwholesome condi- 
ments, while the working classes, whose diet 
and habits are more nearly normal, are gen- 
erally exempt. 
As regards the frequency of bowel move- 
ments, physicians located in the following 
countries reported the usual custom to be two 
or more daily, usually two, for the very good 
reason that two meals only are eaten, the first 
movement being on rising or after the first 
meal, and the second soon after the second 
meal, or before retiring: 548 
COLON HYGIENE 
Rhodesia, Uganda Protectorate, Nyassa- 
land, Nigeria, Harda (India), Delhi (In 
dia), Punjab (India), Kashmir, Nagpur (In- 
dia), Bawda (India), Persia,—three or four 
times in summer when fruits are plentiful. 
Aintab (Turkey), Harpoot (Turkey), West 
Coast of Africa,—two or three. Portuguese 
Congo,—two or three. Egypt,—children 
four or five. Japan, Arabia,—two or three. 
It is interesting to note that the experience 
of the millions of primitive and half-civilized 
people who inhabit the above named coun- 
tries demonstrates perfectly that an intake of 
food should be soon followed by an output 
of food residues and wastes. 
In all these countries, as among practically 
all primitive people, great attention is given 
to the bowels. The mothers carefully train 
their children to move their bowels at regular 
times, and much pains are taken to make the 
diet such as to promote intestinal activity. 
The virtues of fruits and green vegetables are 
fully appreciated, and where rice is the prin- 
cipal food, as in most of the Orient, large use 
is made of green vegetables. 
It is especially of interest to note the fre- PRIMITIVE BOWEL HABITS 
549 
quency with which some useful feature of 
bowel hygiene is found in vogue among prim- 
itive people who have practised it from time 
immemorial, while among civilized people 
the same practice has only recently become 
known as one of the discoveries of modern 
medical science. It is becoming more and 
more evident that our modern civilization in 
emerging from barbarism has left behind 
much that was not only useful but essential to 
a healthy physical life, and we may therefore 
profit by a careful study of the habits of 
primitive people and even of those wild ani- 
mal species which belong with man in the 
class of primates, and are closely allied to the 
human species in structure and function. 
Here are a few extracts from the replies 
to our questionnaire, which will be found 
most instructive as well as interesting: 
“I am of the opinion that diet has a great 
influence. The Labances eat plenty of figs, 
either alone or mixed with juice of grapes or 
juice of carob beans, brown bread, fruits, veg- 
etables, olive oil, olives, etc., and drink plenty 
of spring water at meal times.”—A. J. Man- 
asseh, M.D., Bruana, Beyrout, Syria. 550 
COLON HYGIENE 
“Laxative foods used are the following: 
Cooked manioc leaves, bananas, pineapples, 
bingondia (a sour-sweet seedy fruit), plan- 
tains, peanuts, palm oil, pumpkin seeds 
mashed and cooked. Raw guava leaves are 
used for diarrhea, also the clay mounds 
built by white ants.”—Mattie and P. Fred- 
erickson, Belgian Congo, West Central Africa. 
It is interesting to note that the most prim- 
itive tribes of savages have recognized the 
importance of regular and frequent bowel 
action and provided for the maintenance of 
this important function by including in their 
dietary special laxative foods such as named 
above. This usage is practically universal 
among wild tribes in all parts of the world. 
“In the Cape Colony the staple food is 
stamped maize and sour milk; the absence of 
the sour milk leads to constipation. In the 
Northern Transvaal the staple food is thick 
maize porridge, sour milk, and, in summer, 
green vegetables. People go more often (i. 
e., say three times a day) when taking both 
vegetables and milk. When these are scarce, 
they may go only once.”—Neil Macvicar, 
M.D., Lorendall, South Africa. PRIMITIVE BOWEL HABITS 
551 
It is especially interesting to note that the 
Cape Colony natives have by experience 
learned to appreciate the value of sour milk 
as a laxative food and corrective of intestinal 
disorders. Several African travelers have 
called attention to the fact that among the 
native tribes of Africa milk is generally used 
in its soured state. The custom is to put the 
milk into a gourd at night which is reserved 
for this particular purpose. In the morning 
the milk is soured and ready for use. At 
night a new supply of milk is put into the 
empty gourd which is never washed and so 
preserves the lactic-acid-forming ferment in 
an active state. 
“The natives are, in Tora, almost entirely 
vegetarians, living on millet or plantains or 
beans. They rarely get meat. In 9642 out- 
patients seen during the last seven months of 
1911, there were 174 cases of constipation, 
one and eight-tenths per cent of the whole.”— 
J. Howard Cook, M.D., Uganda Protecto- 
rate, East Africa. 
In this country the percentage of patients 
in whom constipation is present is just the re- 
verse of that in Uganda. Whereas, in Uganda, 552 
COLON HYGIENE 
there are less than two per cent who are con- 
stipated, in civilized countries among sick 
people, there is scarcely one in a hundred 
who is not constipated. 
“The rather coarse diet, largely grains 
and vegetables, has a favorable influence on 
the bowel movements. The stools are usually 
very large and fairly soft.”—A. H. Norton, 
M. D., Haiju, Korea. 
“The people eat large quantities of rice, 
turnips, peppers, roots, vegetables and little 
meat. The large quantity of residue must act 
as a stimulus to peristalsis.”—W. C. Purvi- 
ance, M. D., Chung Ju, Korea. 
“Cereals, as wheat, barley, oats, millet 
seed, and all kinds of vegetables, are the sta- 
ple food here (extreme north of Korea) ; 
very little fish and less meat is eaten.”—F. 
H. Birdmann, M.D., Dotson, Korea. 
The natives of Korea, like those of China 
and Japan, are generally known as rice eaters. 
It is interesting to note that the natives of 
Korea make large use of turnips and vege- 
tables and little use of meat. Flesh foods are 
unquestionably constipating in their nature, 
not only because they are completely digest- PRIMITIVE BOWEL HABITS 
553 
ible, leaving little residue behind, but because 
the putrefaction to which they give rise re- 
sults in the formation of ammonia and other 
alkaline substances which paralyze the bowel. 
“Meat bacteria,” which swarm in all kinds 
of flesh foods, are also a prolific cause of co- 
litis, which by causing spastic contraction of 
the descending colon and the pelvic colon, 
produces mechanical obstruction to bowel 
movement, and, also, as shown by Dr. J. T. 
Case, induces powerful retro-peristaltic con- 
tractions by which the intestinal contents are 
forced back into the right half of the colon. 
The cecum and ascending colon become 
greatly dilated as a result, and in time the 
cecum becomes movable and prolapsed. The 
stretching of the colon enlarges the ileocolic 
junction until the ileocecal valve becomes 
incompetent, thus establishing the condition 
known as intestinal toxemia with its long train 
of evil consequences. The vegetarian habits 
of the people of Korea are without doubt of 
great service to them in enabling them to suc- 
cessfully combat the highly unsanitary condi- 
tions under which they live. 
“Bowel movement full and frequent among 554 
COLON HYGIENE 
the working people, who eat large quantities 
of vegetables; more disturbed among the 
better classes, who eat more meat.”—J. K. 
Cox, M.D., West China. 
“My experience with patients has been 
that they are not so subject to constipation as 
persons in the U. S. whom I have treated. 
Think probably the free use of greens and 
other vegetables has something to do with the 
difference, as well as not postponing the call 
of Nature, as is done by civilized persons.”— 
Ida M. Scott, M.D., Tak Hink Chan, South 
China. 
“The vast majority of the people live on 
coarse grains and coarse vegetables, which 
are favorable to large bowel movements.”— 
Geo. D. Lowry, M.D., Peking, China. 
“In my own case, going onto a purely local 
diet of rice and coarse vegetables is usually 
accompanied with looser motions.”—George 
Hadden, M.D., Yung-an Fookin Pwo., 
China. 
“Rice is the principal diet, but is usually 
accompanied by considerable quantities of 
vegetables, largely what we call greens. The 
Chinese have a great variety of leaves and PRIMITIVE BOWEL HABITS 
555 
stocks that are used for greens, such as cab- 
bage, lettuce, and many other kinds that we 
do not see in America. With this diet and 
exercise, the healthy Chinaman usually has 
free bowel action. I think the ‘greens’ is a 
very suitable diet for this climate.”—Jean 
McBurney, M.D., Cheung Chow, Hong 
Kong, China. 
Greens are an equally “suitable diet” for 
the United States. As McCollum and other 
investigators have so often found, greens are 
an essential part of a complete bill of fare. 
“Foods coarse, and largely vegetable, es- 
pecially among the country people, which 
means four-fifths of the population. Chinese 
are not meat eaters to a great extent.”—F. F. 
Tucker, M.D., Pangkiachwang, Shantung, 
China. 
“The natives eat much vegetables, which 
regulate the bowels.”—Cecil I. Davenport, 
M.D., Shanghai, China. 
The people of China as well as those of 
Korea are evidently protected from the nat- 
ural constipating tendency of a rice diet by 
the free use of coarse vegetables. The large 
use of vegetables of all sorts which is prac- 556 
COLON HYGIENE 
tised in the Orient is generally forgotten by 
those who call attention to the fact that rice 
is the staple foodstuff in this part of the world. 
It is true that rice is the chief source of nu- 
triment but at the same time Nature has 
taught these people to make ample provision 
for the bulk which is essential to stimulate 
normal peristalsis by the use of greens and 
vegetables of all sorts. Vegetables are used 
not only during the summer months but at 
other seasons also. Turnips and several other 
roots are preserved by pickling in salt brine 
as cucumbers are preserved in this country. 
A very large use is also made of bamboo 
sprouts, of the leaves and roots of certain 
lilies which are preserved by drying and of 
several varieties of seaweed, from some of 
which a gelatinous substance known as Jap- 
anese isinglass or agar-agar is made, while 
others are used in their native state, as Ice- 
land moss and Irish moss are used in this 
country. 
“The natives note that in eating pumpkins 
and prunes they have more bowel move- 
ments. An old man told me that if a person, 
early in the morning before taking any food, PRIMITIVE BOWEL HABITS 
557 
eats ten fresh prunes from the tree, he’ll have 
bowel movements easily.”—G. Yeram, M. 
D., Gumaldjine, Turkey. 
The most primitive people have learned 
by observation the importance of bulk, a 
lesson which has yet to be learned by the 
great majority of people in civilized lands. 
Knowledge of the laxative value of fruits, 
especially of prunes is, however, quite widely 
diffused. The Turkish peasant who told our 
friend Dr. Yeram that ten fresh prunes taken 
“from the tree” would produce a laxative 
effect was perhaps not aware that dried 
prunes may be so freshened by soaking in 
cold water for 24 hours that their laxative 
quality is to a large extent restored. The free 
use of raw soaked prunes is a highly valuable 
food remedy for constipation which has long 
been in use by many European and American 
physicians. 
“The principal food of both city and rural 
population of the region is boolghoor (crack- 
ed wheat which has been cooked, dried, and 
the thin outer skin removed before cracking. 
It is cooked in many ways. The commonest 
is to boil it about ten minutes, and add a little 558 
COLON HYGIENE 
melted butter before serving), and coarse 
bread of wheat or barley, varied by lentils 
and other legumes, and the fermented milk 
of the country (yougurt in Turkish, leven in 
Arabic, or matzoon in Armenian). The vil- 
lage people eat considerable fruit, especially 
grapes in season, but very little meat or vege- 
tables. The city dwellers eat a good deal of 
meat and vegetables, more fruit, and less 
yougurt than the villagers. They also eat 
finer bread and more spices and condiments. 
In general, I may say that constipation is rel- 
atively much less common than in America, 
and much less common among the villagers 
than in the city people; in fact, very seldom 
seen in those who eat boolghoor. The posture 
assumed in defecation may also have some- 
thing to do with it. They never sit on a stool, 
but always use the natural, squatting posture. 
In the city, where they have regular privies, 
the arrangement is a slit or opening in the 
floor, over which the person squats. The uni- 
versal habit is to move the bowels three times 
a day.”—F. D. Shepard, M.D., Aintab, 
Turkey. 
The above interesting account of the die- PRIMITIVE BOWEL HABITS 
559 
tetic habits of the people of Turkey kindly 
sent us by the late Dr. Shepard contains 
enough practical hints about dietetic meth- 
ods of combating constipaion to enable almost 
any practical person to formulate for him- 
self an efficient and laxative dietary. It is 
evident that however much we may be in ad- 
vance of the ignorant Turkish peasant in the 
various forms of culture which together make 
up what we call civilization, we may study 
his methods in diet with great profit. 
The matter of the position in sitting at 
stool to which Dr. Shepard also called atten- 
tion is one of no small importance. We are 
learning more and more the importance of 
making a careful note of the hints which 
Nature gives us in the instinctive leadings of 
animals and human beings living in a wild or 
primitive state which have resulted in the 
formation of customs and habits the essential 
relation of which to our physical welfare has 
been heretofore too much disregarded. 
In all parts of Turkey, it is the custom of 
the people to move the bowels three times a 
day, which is the natural result of the use 
from early childhood of the several laxative 560 
COLON HYGIENE 
foods above mentioned. Of this we are as- 
sured by a personal statement made to the 
writer by the late Dr. Shepard, who was most 
intimately acquainted with the habits of the 
Turkish people through living and practis- 
ing among them -for more than thirty years. 
That the custom of tri-daily bowel movement 
1? common to all classes is shown by an in- 
cident related to the writer by the eminent 
Sir Arbuthnot Lane, of London, England. 
The famous surgeon was one day consulted 
by an official from the Turkish Embassy in 
London who desired relief from constipation. 
When asked for a particular account of his 
symptoms he admitted that his bowels moved 
once a day but declared that he was greatly 
constipated and not half a man, and that when 
his bowels moved three times a day his vital- 
ity and stamina were more than doubled. 
“Yougurt is the form in which milk is 
taken in Persia. We rarely see appendicitis 
in the natives. I often wonder whether the 
yougurt may be the preventive. The common 
people live on yougurt, cheese, bread, and 
fruit. Meat only occasionally. They all con- 
sider milk (not yougurt) a laxative.”—W. S. 
Vannemann, M.D., Labriz, Persia. PRIMITIVE BOWEL HABITS 
561 
It is certainly very interesting to note that 
the custom of using sour milk should be 
nearly universal among the hundreds of dif- 
ferent tribes and nations filling the vast terri- 
tory from the southern tip of the dark conti- 
nent to Persia. It is also interesting to ob- 
serve a verification of the observations made 
some years ago by Dr. Senn, who studied the 
people of the east coast of Africa and noted 
the absence of appendicitis, an observation 
also confirmed by Dr. Lucas-Champonniere, 
of France, who found appendicitis very rare 
among the wheat- and date-eating Arabs of 
Algiers, and among the inmates of prisons 
and insane asylums in France, where meat is 
rarely made a part of the bill of fare. 
“The diet seems to favor looseness, since 
it consists largely of coarse bread from un- 
bolted flour; also in summer of large quanti- 
ties of fruit ingested.”—J. A. Funk, M.D., 
Hamadan, Persia. 
The use of superfine white flour appears to 
be almost wholly confined to civilized nations 
and there can be no doubt that to this practice 
is largely chargeable the almost universal 
prevalence of constipation in countries which. 562 
COLON HYGIENE 
claim to be the most advanced in civilization. 
“It is a common saying among them that 
milk acts as a laxative, especially if freshly 
milked and unboiled.”—P. W. Brigstocke, 
M. D., Jerusalem, Palestine. 
The fact that boiled milk is constipating 
has long been recognized in this and other 
civilized countries. It appears that the same 
fact is known to the uneducated natives of 
Syria. It is only recently that science has of- 
fered the explanation which has been sup- 
plied by the bacteriological laboratory, that 
boiled milk undergoes putrefaction in the in- 
testine because of the destruction of the acid- 
forming bacteria which abound in raw milk 
which has been exposed to the air, and stim- 
ulate bowel action and prevent putrefaction. 
“The diet is largely a vegetable and cereal 
one, meat being eaten only occasionally.”— 
A. F. Grant, M.D., Assiut, Egypt. 
It is instructive to note that the Egyptians 
are still, as in ancient times, practically non- 
flesh eaters. The experience of two or three 
thousand years has not convinced these simple 
tillers of the soil that the natural products of 
the earth are not capable of affording ample PRIMITIVE BOWEL HABITS 
563 
and sufficient nourishment. The fertile val- 
ley of the Nile in centuries far remote from 
the present supported a population perhaps 
more dense than has been maintained in any 
other part of the world. It may be that some 
future time will again see this highly favored 
region teeming with human life and enter- 
prise, supported as of old by the products of 
its marvelously fertile soil. 
“The coarse, simple diet—millet or corn 
porridge or bread, cabbage, soup, etc.—of the 
country seems to favor regularity of the 
bowels.”—Mrs. Estella A. Perkins, M.D., 
Pao Ting, China. 
“The almost exclusive vegetable diet—rice, 
cabbage, etc.,—seems on the whole to be fa- 
vorable, and constipation is not so common 
among the sedentary classes as might be ex- 
pected.”—B. S. Browne, M.D., Ningpo, 
China. 
“Constipation is not common, but the in- 
habitants of Manchuria are mostly vegetari- 
ans. i. e., eat little butcher meat except on 
festive occasions.”—Drs. Christie and Muir, 
Mukden. 
“People suffering from diarrhea fre- 564 
COLON HYGIENE 
quently take rice and “dahi” (curds, sour 
milk), to check it. Ordinary milk they gen- 
erally consider constipating.”—N. C. Hen- 
derson, M.D., India. 
“People eat wheat, Indian corn, and millet 
seed breads. The first named is supposed to 
be constipating, and the last two laxative.”— 
W. L. Pennell, M.D., Bannu, India. 
“The coarse wheat and barley flour used 
for their bread is, without doubt, favorable 
to regularity.”—Edna B. Kuslar, M.D., 
Phalera, India. 
Wheat meal, as well as rice, is very 
largely used in India. England annually ob- 
tains enormous quantities of wheat from her 
Indian provinces the price of which is such 
that the Hindu peasant finds it necessary to 
make rice his staple, although considerable 
quantities of wheat bread are used by the 
wealthier classes. It is interesting to note, 
however, that the wheat thus used by the na- 
tives is chiefly employed in the state of coarse 
meal, rather than the fine bolted flour from 
which two most important elements, cellu- 
lose and vitamins, have been removed by the 
milling process. PRIMITIVE BOWEL HABITS 
565 
“Usual diet of rice with green vegetables, 
lentils or occasionally meat, favors regular 
motions. Boiled radishes favor diarrhea, 
and fish favors constipation.”—Dr. Minnie 
Gomery, Idlamabad, Kashmir. 
“Diet, rice and vegetables, rarely meat. 
Rice is eaten in great excess. People pass 
large stools, as a lot of rice is ejected. Pre- 
sumably nitrogen and salts are used up and 
starch excreted.”—H. E. Rawlence, M.D., 
Srueagai, Kashmir, India. 
Even remote Kashmir, which has been so 
little in touch with modern civilization, ap- 
pears to be really up to date in matters diete- 
tic. Meat is only used occasionally, whereas 
green vegetables and lentils combined with 
rice constitute the regular dietary. 
The passing of quantities of undigested 
rice is doubtless due to the fact that the rice 
is imperfectly cooked, a custom very common 
in rice-eating countries, and perhaps a whole- 
some one. The Scotch highlander eats his 
oatmeal less than half cooked and is wonder- 
lully sturdy. Some undigested starch in the 
feces prevents putrefaction. 
“The diet being chiefly vegetarian (among 566 
COLON HYGIENE 
the Hindus it is so entirely), the large amount 
of vegetables taken seems to act as the nec- 
essary stimulus to the bowel.”—Robert Mad- 
ison, M.D., Rajshalu, India. 
“Diet of the people mostly fruit and vege- 
table. Have found that when fruit and salad 
oil could be added, tongues are clean, moist 
and red. Where the white bread is taken in 
imitation of the foreigner, troubles begin 
similar to those at home. The national cus- 
tom is to eat but two meals a day.”—Belle J. 
Allen, M.D., Baroda Camp, India. 
The observation made by Dr. Allen, that 
the natives of India begin to suffer from con- 
stipation when they adopt the use of white 
bread, though previously free from this curse 
of civilization, is highly instructive. It is in- 
teresting to note that the U. S. Department of 
Agriculture is making a strong effort to bring 
to the notice of the American people the im- 
portance of using the whole grain instead of 
discarding the outer portion, or bran, which 
is now known to contain by far the largest 
share of the lime essential for perfect nutri- 
tion as well as the highly essential vitamins. 
It is also interesting to note that, although the PRIMITIVE BOWEL HABITS 
567 
natives of India as well as of most other coun- 
tries of the globe eat but two meals a day, the 
prevailing bowel habit among these people 
is two or three movements daily. More fre- 
quent meals should give rise to more frequent 
movements and would doubtless produce this 
effect in this* and most civilized countries 
were it not for the highly concentrated and 
highly constipating character of the diet. 
“Motions are large, bulky and not formed, 
but pultaceous. People of these parts eat 
largely of ground wheat and vegetables, not 
much meat. Hindus seldom eat flesh.”—A. 
H. Browne, M. D., Amristsar, India. 
“Meat tends to constipate; vegetables and 
milk tend to loosen.”—M. M. Brown, M. 
D., Sargodha, Punjab, India. 
Dr. Brown, as well as other close observers 
of the relation of diet to health among people 
of simple habits, notes the effects of a meat 
diet in producing constipation. The reason 
for this, as indicated elsewhere, is that a meat 
diet produces colitis and intestinal putrefac- 
tion. 
“People coming from the interior are much 
more regular than those living in Smyrna, 568 
COLON HYGIENE 
where more meat is eaten than in the interior. 
After some time in Smyrna, such people tend 
to become less regular.”—D. McKenzie New- 
ton, M. D., Smyrna. 
“The use of peanuts in all forms, and the 
eating of cooked green leaves of several kinds, 
used daily, keeps their bowels in’ good shape.’' 
—A. Sims Roma, M.D., Ferrovia, Italy. 
“On the ordinary native diet there is 
scarcely ever any constipation. On other 
diet, occasionally.”—E. MacKenzie, M.D., 
Hog Harbor, Santo, New Hebrides. 
Rare Occurrence of Cancer and Appendi- 
citis Among Primitive Tribes 
It is the universal testimony that cancer 
and appendicitis are extremely rare. Doctor 
Shepard, of Aintab, Turkey, who had an 
enormous practice among the Turks for more 
than a quarter century, and was recognized as 
perhaps the leading abdominal surgeon of 
the Orient, wrote to the author;— 
“There is relatively very little appendi- 
citis here. I do from 500 to 600 important 
surgical operations a year, but only six to 
eight appendectomies. Cancer of the intes- PRIMITIVE BOWEL HABITS 
569 
tinal tract is quite rare (as are all forms of 
cancer), although ulcer of the stomach is 
common.” 
Dr. W. W. Peter, of Shanghai, says, “I 
never heard of appendicitis in a Chinaman.” 
The fact that cancer is a disease peculiar to 
advanced civilization is clearly shown by the 
replies received from one hundred and twelve 
physicians located in the following countries: 
Mexico, Palestine, Arabia, Turkey, Egypt, 
South Africa, East Africa, Central Africa, 
Nigeria, Japan, Syria, Korea, Persia, Siam, 
India, Asia Minor, New Hebrides. Forty- 
three of the one hundred and twelve re- 
ported that they had never seen cancer of 
the bowels. Nine physicians from different 
parts of Africa, the West Coast, Tunis, Ni- 
geria, Rhodesia, Uganda, East Africa, Brit- 
ish Central Africa, the Portuguese Congo 
and Belgian Congo all report having never 
seen a case of cancer of the bowels among the 
natives. 570 
COLON HYGIENE 
Primitive Remedies for Constipation 
The following extracts from replies to our 
questionnaire illustrate the habits of people 
in relation to bowel movements and the sim- 
ple but often highly sensible methods em- 
ployed by them for relief: 
“The chief duty of the Indleburds, or 
priestly caste, is the care of such matters (the 
movement of the bowels). A fine is levied in 
case of neglect.”—P. N. Darling, M. D., 
I ndia. 
The observation of Dr. Darling that one of 
the duties of the priest in India is to educate 
the people in reference to the proper care of 
the bowels is highly suggestive. In this coun- 
try, the subject of bowel hygiene has been so 
universally neglected that even parents are 
quite ignorant concerning the bowel habits 
of their children and often allow them to 
drift into diseased conditions, the evil effects 
of which are felt throughout their entire life- 
time. Physical, mental and moral evils re- 
sulting from constipation are so great that it 
is not an exaggeration to say that teachers, as 
well as preachers, could not make a better use PRIMITIVE BOWEL HABITS 
571 
of a portion of their time and talents than by 
the education and training of the children in 
the proper care of the colon. 
“The natives give prompt attention to the 
bowels. I have again and again had it given 
as a reason for not living in Aden, that peo- 
ple had there to go to the closet in order to 
evacuate their bowels, rather than relieve 
themselves any place, as this was only per- 
mitted for children.”—John C. Young, M. D., 
Sheikh Othman, Aden. 
The above observation by Dr. Young af- 
fords powerful testimony to the importance 
attached by the Arabs to the prompt response 
to the call of Nature for evacuation of the 
bowels. 
Dr. Davidson, of Travancore, India, says: 
“Appendicitis very rare here. Only about 
six cases out of at least 1,000 major opera- 
tions.” 
Dr. Davidson's experience in meeting only 
six cases of appendicitis among a thousand 
major operations is striking evidence of the 
rarity with which appendicitis occurs among 
non-flesh-eating people. This observation 
agrees with that of Dr. Senn, who noted the 572 
COLON HYGIENE 
absence of appendicitis among the vegetable- 
eating natives of the east coast of Africa. 
An examination of the annual report of the 
Mayo Clinic shows 19 per cent of all cases 
examined to be suffering from appendicitis, 
and at operation the appendix was found dis- 
eased, requiring removal in 21 per cent of all 
cases operated; whereas, Dr. Davidson found 
in India only six-tenths of one per cent, a 
frequency thirty-five times less. 
“In cases of constipation or obstruction, 
very forcible measures are employed, such as 
massage, kneading the abdominal wall and 
exerting pressure upon the abdomen, and 
even kicking.”—E. Margaret Phillips, M. 
D., Ping Yin, China. 
“Brown sugar is the laxative usually relied 
upon.”—Walter W. Williams, M. D., Yung- 
an Fookin Pwo., China. 
The above observations in China and Tur- 
key show the sagacity of primitive people in 
discovering simple food remedies for consti- 
pation. When taken in large quantities, sugar 
produces laxative effects, not only because of 
its specific stimulating effect upon the intes- 
tine but because of the stimulating effect of 573 
PRIMITIVE BOWEL HABITS 
the lactic acid produced by the fermentation 
of the sugar in the colon. 
“For relief of constipation a sort of large 
rolling pin is freely rolled up and down the 
abdomen while the patient is lying supine/— 
H. G. Barrie, M. D., Kuling, China. 
The use of the rolling pin as a means of re- 
lieving constipation is an original Chinese in- 
vention, although a cannon ball, as well as 
various kinds of apparatus, have been long in 
use in this country as a means of mechanically 
stimulating the bowels to activity. 
“They use a smooth stalk of millet to stim- 
ulate the lower bowel.”—Elizabeth Beatty, 
M. D., Kwangning, Manchuria, China. 
Mechanical stimulation of the rectum has 
long been known to be a powerful means of 
exciting peristalsis, but the method is not to be 
recommended because of the danger of pro- 
ducing inflammation and infection leading to 
hemorrhoids, fissure or abscess. 
“A very crude method for giving an 
enema is to take a small, slender piece of bam- 
boo for a nozzle and a bag made of pig gut, 
and use it as a syringe.”—William M. Berss, 
M. D., Chenchow, South Hunan, China. 574 
COLON HYGIENE 
“They have no instruments, but often use 
honey suppositories.”—W. H. Park, M. D., 
Soochow, China. 
“They have a funnel-shaped enema which 
is being displaced by European bulb syr- 
inges.”—J. Davidson Frazier, M. D., Resht, 
Persia. 
“The people have few or no remedies, save 
the drinking of a large quantity of hot water, 
which they often do when conscious of the 
need, and with quite good effect.”—H. W. 
Schwartz, M. D., Yokohama, Japan. 
“Massage is employed ; drugs very rarely.” 
—Walter Virden, M. D., Rhodesia, South 
Africa. 
“Enemata given in the knee-elbow position 
with a funnel made of a leaf, and a pipe made 
of a gourd or vegetable stump.”—J. Howard 
Cook, M. D., Fort Portal, Uganda Protec- 
torate, East Africa. 
It is interesting to note that even the mem- 
bers of savage tribes are acquainted with the 
value of the enema and have been able to im- 
provise means for the getting of water into the 
bowels. Some of the means employed are, 
like the above, very highly ingenious. It is 575 
PRIMITIVE BOWEL HABITS 
also interesting to learn from the observations 
of Dr. Cook of the employment of the knee- 
elbow position by the natives of Uganda. 
The credit for the invention of the knee- 
elbow position has been given to an American 
physician. It seems, however, that in this 
case, as in many other matters pertaining to 
physical welfare, our discoveries were antici- 
pated by the natives of primitive tribes. 
“Roots are sometimes cooked in water and 
given as an enema by means of an ox horn 
with perforated end—large quantity poured 
in. In the Northern Transvaal purgatives 
are not required. Enema appliances not 
known.”—Neil Macvicar, M. D., Lorendall, 
South Africa. 
“The natives regularly use enemata, intro- 
duced with gourds.”—D. Robertson, M. D., 
Itu, South Nigeria. 
“They have medicines for use as purga- 
tives, and also use enemas, which are admin- 
istered by means of a sort of gourd with long 
neck. The gourd is filled, and the water 
flows in by gravitation. The patient lies 
prone.”—E. C. Sirley, M. D., West Coast of 
Africa. 576 
COLON HYGIENE 
“The use of common soap passed up into 
the anus or some similar substance is often 
used by the natives of this country to over- 
come constipation.”—W. O. Ballantine, M. 
D., Rahuri, Western India. 
“Soap suppositories is a common native 
remedy; enemas are never used; they con- 
sider it shameful. Massage of the abdominal 
wall is practiced, too.”—R. T. Cox, M. D., 
Persawan, Northern India. 
The Hindu mother knows the value of the 
suppository as a remedy for infants as well as 
does the American mother. Experience is a 
wonderful teacher and in this school the most 
ignorant savage mother has just as good an 
opportunity to learn and make advancement 
as the mother in the most civilized land. 
“A smack in the stomach with a colon spade 
is often used, and is invariably productive of 
a profuse and continued motion. Some of 
the hill tribes carry under the left armpit 
finely engraved brass tongs for the purpose of 
extracting in their entirety the masses of fecal 
matter. These are shaped by the women of 
the tribe, and are used in their war catapults 
in tribal warfare.”—P. N. Darling, M. D., 
India. PRIMITIVE BOWEL HABITS 
577 
This drastic method of stimulating bowel 
action may sometimes produce injury, but 
could not possibly be more productive of mis- 
chief than is the common, almost universal, 
use in all civilized countries of laxative min- 
eral waters and drastic cathartic remedies of 
all sorts. 
“The population generally deal largely in 
drastic purgatives. A man will take a 
month’s leave from work for nothing more 
than a course of purgation, often very severe.” 
—F. V. Thomas, M. D., Palwal, near Del- 
phi, India. 
This method of dealing with constipation 
could scarcely be more injurious than the 
continued use of stomach- and colon-irritating 
drugs. As Von Noorden well says, “nothing 
is so bad as the chronic use of laxative drugs.” 
“The native position, squatting at stool, 
with front of thigh against the abdomen, en- 
courages evacuations.”—W. J. Maule, M. D., 
Miraj, India. 
The squatting position in moving the 
bowels appears to be universal among all peo- 
ple with the exception of those who call 
themselves civilized. It is singular, indeed, 578 
COLON HYGIENE 
that in relation to this most important function 
of the body the wildest and most unsophisti- 
cated natives are really in advance of the 
most highly civilized people. The value of 
the squatting position as a means of relieving 
the bowels has been recognized for years but 
the knowledge has had little influence upon 
the habits of the people in this particular. It 
is pointed out elsewhere in this work how the 
objectionable features of the ordinary closet 
seat may be overcome by elevating the feet 
upon a stool eight or ten inches high placed 
in front of the closet seat. 
“The position in which the native helps 
his expulsion of feces from colon and rectum 
is this: he sits on his haunches and presses 
the left side of the lower abdomen with the 
hand or a bunch of cloth.”—T. Davidson, M. 
D., South Travancore, South India. 
The practice above referred to by Doctor 
Davidson is interesting evidence of the East 
Indian's capacity for intelligent observation. 
The descending colon and pelvic colon are 
located in the lower left side of the abdomen 
and pressure just at this point may be of the 
greatest value in aiding evacuation of the PRIMITIVE BOWEL HABITS 
579 
bowels. The writer has for many years rec- 
ommended patients to assist themselves .when 
necessary by pressing firmly with the closed 
fist or with both fists upon the left side of the 
lower abdomen. Deep pressure made at this 
point will often arouse the lower bowel to 
immediate action, causing instantaneous ex- 
pulsion of gas and, in many cases, within a few 
seconds a large evacuation of retained fecal 
matters. The use of a bunch of cloth for the 
purpose of increasing the pressure is an orig- 
inal invention of the East Indian and is highly 
suggestive. A patient recently reported to 
the writer the discovery that a newspaper 
folded into a round mass serves an excellent 
purpose for making compression over the 
pelvic colon. 
“The use of a piece of oiled soap is com- 
mon, which may have been learned from the 
English; and oiled rag is used, too.”—A 
Missionary Physician of India. 
For more than thirty years, the writer has 
made occasional use of an oiled ball of cotton 
or of a cheese cloth pledget saturated with 
oil and placed in the rectum at night in cer- 
tain forms of constipation. 580 
COLON HYGIENE 
“The chief practice is the habit of squat- 
ting at stool. Have had patients leave the 
Hospital because they could not have a nor- 
mal movement without their own kind of 
commode. Complaints ceased with a native 
place provided.”—Belle J. Allen, M. D., 
Baroda Camp, P. O., India. 
An opening in the floor over which the 
user squats is the provision made for bowel 
evacuation in many parts of France, as well 
as in Oriental countries. Even in Paris, as 
recently as thirty years ago, the writer found 
this arrangement in use in the small hotels in 
the suburbs of the city. It is interesting to 
note that Dr. Allen’s patients were willing to 
forego the advantages of hospital care rather 
than suffer the serious consequences of dis- 
turbed bowel action from interference with 
the normal mode of defecation. 
A missionary physician writing us from 
South Africa related the following incident 
as an illustration of the care which the natives 
take to secure free movement of the bowels. 
Said the doctor, “A native called on me yes- 
terday morning and asked for medicine to re- 
lieve a dreadful constipation. I said to him, PRIMITIVE BOWEL HABITS 
581 
“When did your bowels move last?” He re- 
plied, “This morning, Doctor.” “But I un- 
derstood you to say you were constipated.” 
“Yes,’ replied the native, “I am horribly con- 
stipated. My bowels only move once a day.” 
Since the publication of the first edition of 
this work the writer has learned from Doctor 
Wilfred Grenfell, of Labrador, that it is the 
custom in that country to feed reindeer moss 
to the sled dogs. After mixing with oil, the 
moss is eaten by the dogs with great avidity 
and they appear to thrive upon it. It is strange, 
indeed, that civilized man should be about 
the only creature among the members of the 
animal kingdom who neglects to supply his 
alimentary canal with the material necessary 
to furnish to the intestine the normal stimu- 
lus to action. In civilization, domestic ani- 
mals fare better than human beings in this re- 
gard. When the horse, ox, or cow loses appe- 
tite and becomes constipated, bran mash is the 
farmer’s ready and efficient remedy. But, 
strange to say, the farmer never thinks of giv- 
ing himself the benefit of this simple and nat- 
ural remedy, but instead dopes himself with 
purgative pills or mineral waters which ruin 582 
COLON HYGIENE 
his digestion, spoil his kidneys, increase con- 
stipation, and ultimately induce colitis, one of 
the most common and most formidable of all 
the evil effects produced by constipation. 
The Colon Code 
1. Move the bowels three times a day. 
2. Answer the “call,” even the slightest, at 
once. Delay of five or ten minutes may be 
disastrous. 
3. Give the bowels an opportunity for 
evacuation on rising, at bedtime, and after 
each meal, even if there is no call. 
4. Allow sufficient time for complete and 
thorough evacuation of the colon. 
5. If the “call” returns after a movement, 
make a second visit to the toilet. 
6. Place a stool in front of the closet seat 
to raise the feet. 
7. Eat laxative food at every meal. A 
single omission may upset the bowel rhythm 
for several days. 
8. If necessary, to secure three full evacua- 
tions daily, take two tablespoonfuls of bran, or 
one-third of an ounce of agar-agar, and half PRIMITIVE BOWEL HABITS 
583 
an ounce to an ounce of white Russian paraf- 
fin oil at each meal. 
9. Eat regularly and avoid fine flour bread- 
stuffs and other concentrated foods. 
10. Change the intestinal flora by the fruit 
regimen with lacto-dextrin. The constipation 
will not be permanently cured so long as the 
stools are putrescent or very foul smelling. 
11. Drink two or three quarts of water 
daily, one or two glasses of cold water at bed- 
time and the same on rising. 
12. Take deep breathing and abdominal 
exercises daily. (See Index.) 
13. Wear loose clothing and if the abdo- 
men sags wear a spring supporter constantly 
when on the feet. 
Many persons suffer from stasis, that is, 
delay of the food residues in the colon, with- 
out being aware of the fact. The bowels are 
regular, moving daily, or perhaps several 
times a day, and yet it may be shown by suit- 
able tests that decomposing food residues and 
body wastes are retained in the upper portions 
of the colon for two or three days, or even 
longer. Even in so-called cases of diarrhoea, 
stasis, which is even worse than ordinary con- 584 
COLON HYGIENE 
stipation, is nearly always present. In such 
cases, the cecum is dilated or crippled, and 
has become a cesspool which ever overflows, 
but is never emptied without the use of cathar- 
tics or an enema, and even these are not always 
successful. 
14. If the bowels do not move well and feel 
full, take an enema at night of warm water 
(100° F.), three or four pints. This will do 
no harm and will not interfere with the morn- 
ing after-breakfast movement. 
15. A small enema (half pint) of warm 
water at bedtime, retained overnight, often se- 
cures a good morning movement. An enema 
of a few ounces of paraffin oil (four to six) 
may be used to combat dryness of the stool. 
16. In many cases of colitis, with spastic 
contraction of the descending or pelvic colon, 
a complete movement rarely occurs. The 
feces are slowly pushed through the con- 
stricted bowel. In such cases, what may be 
termed supplementary bowel movements are 
necessary. A few minutes after the move- 
ment, or it may be an hour after, a slight 
“call” may be experienced. This should be 
responded to at once, and even if the call is 585 
PRIMITIVE BOWEL HABITS 
repeated. When the bowels do not move sat- 
isfactorily, it is well to wait for several min- 
utes, meantime occupying the mind with 
reading the morning paper, perhaps. This 
affords time for a new instalment of waste ma- 
terial to be pushed down from the upper 
part of the colon. 
17. A very hot sitz bath for two to five 
minutes, or a hot fomentation, taken before 
breakfast, is an excellent means of relaxing 
the contracted colon in cases of colitis, and so 
preparing the bowel for a good after-break- 
fast evacuation. 
18. Fruit on rising, and on going to bed, 
may be taken when necessary as an aid to 
other measures. One or two oranges, an 
apple, a couple of plums, or a dish of berries 
eaten without cream (malt sugar may be 
added), or a bunch of fresh grapes are suit- 
able for this purpose. The fruits named do 
not tax the digestive organs because they con- 
tain no fat, very little protein, and no raw 
starch, the starch having been digested by the 
process of ripening. They are all rich in vi- 
tamins and highly refreshing. When taken 
into the stomach, they induce a lively peri- 586 
COLON HYGIENE 
stalsis; which is continued down the intestine 
and helps to advance the fecal mass toward 
the point of exit. The fruit taken on rising 
helps to secure a full bowel movement after 
breakfast. The fruit at bedtime prepares the 
way for a bowel evacuation on rising. Index 
PAGE 
Abdomen, pain in 202 
Abdominal compression in constipation 92 
massage 434 
supporter !!!!!! 443 
tenderness „• j ’ * 538 
Abscesses 144 
Abstinence 99 
Achylia 298 
Acid, butyric 66 
citric 83 
malic 83 
tartaric 83 
Acidophile organisms 72 
Acidophilus, bacillus 73, 235, 265, 277 
buttermilk, preparation of .'. 278 
Acne 237 
rosacea 254 
Adami, bacteria in vital organs 242 
Adenoids 257 
Adhesions of colon -. 316 
Agar-agar 79, 351 
Agmatine 249 
Albumosuria 256 
Alcohol 169, 230 
Alimentary toxemia 249 
Alopecia 254 
Alvarez, on antiperistalsis 184 
on belching 192 
Ammonia 66, 136, 249 
Anaerobes 236 
Anal canal 22 
disease 219 
fissure 534 
fistula 535 
incontinence 537 
infections 532 
itching 536 
spasm 537 
sphincter 22 
ulcer 534 
587 588 
INDEX 
PAGE 
Anderson, on emotions 203 
Anemia, pernicious 257, 272 
Angina pectoris 217 
Antiperistalsis 36 
Antitoxic diet 287 
foods 338 
laxative diet 345 
value of uncooked foods 340 
Aorta, dilatation of 252 
Appendicitis .... 73, 100, 236, 251, 316 
rare in primitive tribes • 568 
Appendix 20 
Appetite, importance of 137 
loss of 47, 121, 137, 201, 236 
Arab, diet of 81 
Arteries, dilatation of 252 
Arteriosclerosis 252 
Arthritis 255 
deformans 255 
Asthma 245 
Athletes 248 
Atony 201 
Atoxic foods 338 
Autointoxication 222 
in animals 248 
without constipation 225 
types of 262 
Automatic exercise 447 
Backache 510 
Bacillus acidophilus 73, 83, 235, 265, 277 
bifidus 73, 233, 261 
coli 241 
proteus 72 
putrificus 227, 261, 291 
of Welch 67, 72,227, 241 
Bacteria, absorption of 242 
in the intestine 229, 243 
in meat 236 
protective 232 
Bath, cold 55 
hot, effect of 
for constipation 367 
Bayliss and Starling, on intestine 76 
Belching 192 
Bennett, effect of calomel 395 INDEX 
589 
PAGE 
Bernheim, on antiperistalsis 184 
Beta-imidazolethylamin 249 
Bezley, Dr. W 252 
Bifidus bacillus 73, 233, 261 
Bile 29 
Biliousness 47, 121, 196, 236 
Bladder, inflammation of 100 
Blood pressure, high 252 
subnormal 252 
Blood-vessels, disease of 497 
Boas, on antiperistalsis 47 
on constipation 303 
Boils 254 
Boix 498 
Bones, prominence of 255 
Botulin 249 
Bouchard, on bile 29 
exp. with epileptics 270 
on intestinal poisons 222 
Bowel action, normal 48 
irregular action of 236 
habits of uncivilized man 542 
movements, number of 119 
movements in animals 133 
movements, periodic 59 
movements, supplementary 322 
stricture of 218 
Bran, diabetic 366 
recipes for 357 
Sanitarium 364 
sterilized 348 
use of 356 
flakes, Sanitarium 364 
Breakfast foods, laxative 361 
Breast, cancer of 256 
fibrosis of 256 
wasting of •. 256 
Breath, bad 121, 194, 530 
Breathing exercise 417 
incorrect 149 
Breisacher, exp. with dogs 271 
Brenzcatechin 516 
Bright’s disease 121, 202, 237, 499 
Brose 364 
Browne, on Hindus 117 
Brunton, Lauder 62, 197, 245 590 
INDEX 
PAGE 
Bulkley 517 
Buttermilk, effect on colon 84 
acidophilus, preparation of 278 
Butyric acid 66, 230, 249 
intoxication 263 
Butyric, type of toxemia 262 
Cadaver in 249 
Caffein 145 
“Call,” the 51, 155 
lost 56 
Calomel 394 
Calvin, sufferer from constipation 126 
Cancer 218, 507 
of breast 256 
of liver 251 
of pancreas 251 
of stomach 251 
rare in primitive tribes 568 
Cane sugar 83 
Cannon, obs. of 77, 330, 543 
in obstruction 189 
on cats 36 
on emotions 125 
on hunger 190 
on ileocecal sphincter 46 
on mastication 131 
on stomach 191 
X-ray observations 88, 125 
Cannon ball 439 
Carbonic acid gas 85 
Carlson, on stomach 191 
Carmine test for intestinal motility 304 
Case, obs. of 36, 111 
on antiperistalsis 184 
on belching : 192 
on ileocecal valve 221 
laxatives 123 
Cash, exp. on dogs 136 
Castor oil 127 
Cataract 253 
Catarrh, nasal 234 
of intestines 251 
Catarrhal colitis 475 
Cathartics 227 INDEX 
591 
PAGE 
Cecum 20 
delay in 210 
massage of 435 
Cellulose 77 
in foods 347 
Change of flora 114, 200, 235, 275 
Cherry cure 344 
Chinese, diet of 79, 80 
Chittenden, protein requirement 345 
Cholin 249 
Cholera morbus 225 
Christian Science 126 
Cirrhosis of liver 251 
Citric acid 83 
Clothing 329 
Coffee and tea 145 
Cold and hot applications 94 
Cold pour 370 
Colic pains 539 
Colitis Ill, 136, 225, 242, 251, 264, 449 
catarrhal 475 
chronic 72 
muco-membranous 492 
paraffin oil for 402 
Colon adhesions 109 
absorption in 30 
ascending 20 
bacillus 241 
Code 583 
contracted 204 
discharging function 38 
electrical stimulation of 447 
evacuation of 42 
greedy 208 
house-broken 61 
iliac 21 
normal position of 20 
movements of 35, 75 
pelvic 21 
physiology of 25 
poisons and fatigue 246 
poisons and epilepsy 270 
poisons, cause of disease 237 
psychology of 125 
sigmoid 21 592 
INDEX 
PAGE 
time for action 324 
transverse 20 
Coma 253 
Combe 506 
brenzcatechin 516 
Combe and Ewald 271 
Compress, weighted 440 
Confusion, mental 237 
Condiments 143 
Constipation, causes of 104 
cecal 297 
curable 309 
diet in 334 
different forms of 294 
effects of 21, 239 
latent 301 
primitive remedies for 570 
rationale of 106 
rectal 297, 301, 457 
spastic 301 
spastic, treatment 465 
treatment of 307, 328, 450 
treatment of mixed cases 472 
Convulsions, infantile 234 
Cotton, importance of the colon 269 
Coueism 126 
Cresol 249 
Cromwell’s bowels 126 
Cyanosis, microbic 252 
Cystitis 244 
Danysz, anaphylaxis 244 
Defecation 42, 433 
hurried 162 
mechanism of 49 
unnatural posture in 166 
Delirium 253 
Dementia praecox 268 
Depression 227 
Depressing emotions 203 
Dermatitis 254 
Dextrin for B. acidophilus 281 
Dextrose 83 
Diabetes 147 INDEX 
593 
PAGE 
insipidus 209 
mellitus 209 
Diabetic bran 366 
Diaphragm, action in defecation 42 
Diarrhea 225, 227, 236 
of children 251 
caused by Welch’s bacillus 267 
Diathermy 448 
Diet, antitoxic, laxative 345 
bland 136 
in constipation 334, 452 
constipating 141 
low 140 
Digestive organs 250 
time table 39 
tract 32 
tube, disorders of 184 
Distaso, bacteria in feces 67 
Douche, abdominal 370 
cold . 368 
hot and cold . 369 
cold, rectal 389 
Drinks, hot 139 
Drinking, hot, effect of 101 
Drowsiness 196 
Drugs, laxative 123 
narcotic 169 
Duodenal ulcer 244, 250 
Dropsy 237 
Drug laxatives, injury from 391 
Dysmenorrhea 522 
Eating 86 
Eating, hasty 130 
Eczema 237, 245, 254, 517 
Electricity 89 
in constipation 446 
Emaciation 234, 237 
Emotions, depressing 203 
Endocarditis 252 
Enema 376 
acid 84, 95, 388 
how to administer 381 
cold water 385 
glycerine 389 594 
PAGE 
hot, effect of 101 
hot, saline 384 
hot soap 384 
hot water ,. 384 
oil 387 
paraffin oil 389 
sugar and water 387 
Enteritis, acute 251 
Epilepsy and colon poisons 270 
Escherich, obs. on infant intestine 232 
Eskimos, diet of 80 
Excretory products 68 
Exercise 92 
automatic 447 
for constipation 411 
deficient 152 
Exhaustion 227 
Exophthalmic goiter 512 
Eyes 253 
dull 254 
dark circles around 196 
Faith healing 126 
Fallopius, on aloes 393 
Fasting 142 
Fatigue and colon poisons 246 
Fatigue, Lee on 247 
Fats, absorption of 30 
effect on intestine 85 
Fatty degeneration of heart 252 
Fear, influence of 126 
Febrile attacks 236 
Fecal fever 523 
tumors 494 
Feces 62 
constituents of 64 
Feet, sweating of 254 
Fetish, use in Congo 87 
Fever, fecal 523 
Feverishness 234 
Fibrosis of breast 256 
Ficker, obs. of 226 
Fig marmalade 365 
Fissures 112, 144 
INDEX INDEX 
595 
PAGE 
Fistula 112, 144 
rectal 100 
Fitfulness 234 
Flatulence 227, 525 
Fletcher, Horace •. 122, 134 
error of , 176 
Flora, change of 235 
Fluid, insufficient 146 
Foges, constipation in women 105 
Follicles of Horner — 22 
Fomentations to abdomen 373 
Food canal 17 
gates 17 
tube, structure of 18 
Foods, antitoxic 338 
aversion to 189 
effect on bowel action 59 
cellulose in 347 
concentrated 97 
cooked 138 
uncooked, antitoxic value of 340 
hot 139 
effect on intestinal activity 86 
laxative, breakfast 361 
. laxative properties of 336 
liquid 96 
raw 138 
Formic acid 230 
Foul breath 194 
Fruit acids 83 
cure 344 
juices '. 97 
Fulness, sense of 191 
Gall bladder disease .72, 501 
drainage of 199 
inflammation 251 
Gallstones 237 
Gas 193 
intestinal 241 
in the colon 85 
Gastric catarrh 144 
symptoms 184 
ulcer 251 
Gastritis 251 596 
INDEX 
PAGE 
Genital organs, disorders of 521 
Genito-urinary organs 256 
Giddiness 196 
Goiter 271 
exophthalmic ' 512 
Gout, rheumatic 237, 515 
Goodell 128 
Goodhard 208 
Glycerine enema 389 
Globus 194 
Grape cure 344 
Greedy colon 208 
Grief, effects of 127 
Groedel, on ileocecal sphincter 46 
Griitzner, obs. of . 195 
on antiperistalsis 37, 184 
Hands, sweating of 254 
Hasty eating 130 
Headache 121, 196, 204, 215, 227, 230, 237, 252, 504 
nervous 236 
sick 236 
Heart disease 252, 497 
enlargement of 252 
Heat, effect of 101 
Hemorrhage in retina 254 
Hemorrhoids 100, 112, 144, 215, 237, 533 
Hepatic flexures 20 
Herpes 254 
Herter, obs. of 225, 261, 515 
obs. in anemia 274 
bacteria 290 
bacterial infections 265 
exp. on cat 266 
exp. with epileptics 270 
on indol 247 
obs. on intestine 241 
on clean teeth 291 
Hiccough 193 
Hindus 116 
Hippocrates, observations 188 
Histidin 249 
Holzknecht, on ileocecal sphincter 46 
Hookworm 71 
Horner, follicles of 22 INDEX 
597 
PAGE 
Hot and cold applications 94 
Hot sitz t 370 
House-broken colon 61 
Houston’s valves 22 
thickening of 213 
Howland and Richard, exp. with indol 267 
Hunger, cause of 190 
Hunter, William, on liver 258 
Hurst, on immunity 257, 296 
effect of eating on intestine ,..: 86 
on mastication 131 
Hyperacidity 142 
Ileocecal sphincter, action of 46 
Ileocecal valve 31 
function of 45 
incompetency 206 
Imbecility 253 
Indians, Alaska, diet of 80 
Hopi 81 
Orinoco 81 
Indican 249 
Indol 211, 225, 249 
effects on animals 267 
Indolethylamin 250 
Indolic type of toxemia 262 
Insanity 241, 253, 268 
Insomnia 236, 503 
Intestinal bacteria, immunity to 243 
filter 225 
flora, change of 200, 275 
gas 241 
movements, influences on 96 
motility, carmine test for 304 
toxemia 222 
toxemia, cause of senility 266 
toxemia and mental disease 268 
Intestine, bacteria in 229 
microbes in 66 
small, absorption in 30 
Intussusception 219 
Iritis 253 
Iridocyclitis 253 
Itching skin 518 598 
PAGE 
Jacobi, reverse peristalsis 36 
James, William 123 
on Fletcherizing 182 
Japanese, diet of 79, 80 
Jaundice 254 
Keith, on diet 26, 28 
on structure of intestine 32 
Kelp 81 
Kennan, diet of Eskimos 80 
Kidd, bacteria in body 243 
Kidneys, excessive activity 209 
disease of 499 
floating 256 
Kinks 539 
Kneading, mechanical 437 
Kreuznach, tobacco 168 
Lactose 83 
for B. acidophilus 281 
Lacto-dextrin required 283 
time for taking 284 
Lane 106 
colon useless 25 
on intestinal stasis 256 
Lane’s kink 213 
Lanolin cream 519 
Laxa 365 
Laxative diet, antitoxic 345 
drugs 123 
drugs, injury from 391 
properties of foods 336 
Lecithin 249 
Lee on indol 247 
Leukorrhea 522 
Levator ani muscles 23 
Levin, obs. of 231 
effects of aloes 393 
Levulose 83 
Lichen 254 
Lime salts 69 
Linnaeus, cherry cure 344 
Liquid foods 96 
Liver, cirrhosis of 251 
INDEX INDEX 
599 
PACE 
degeneration of 251 
disease of 501 
enlargement 494 
pad .*.... 126 
patches 516 
sclerosis of 237 
Locomotor ataxia 221 
Long, eye disease 254 
Louis XIV ....377 
Lumbago 255 
Lupus erythematosus 254 
Malic acid 83 
Malt Sugar 83, 365 
Massage, abdominal 434 
of cecum 435 
in constipation 90 
Mastitis 256 
McCarrison, on vitamins 98, 139 
exp. with goats 272 
Meals, irregular 144 
number and size 354 
regularity necessary 319 
Meat bacteria 236 
Meat-eating 135 
Mechanical vibration 89 
Mendel exp. with agar 352 
Mental disease 268 
Metchnikoff 498 
colon useless 25 
on old age 236 
wild germs 275 
Methylguanidin 249 
Methylmercaptan 249 
Microbes in intestine 66 
Migraine 73 
Milk regimen 293 
sugar 83 
sour, effect on colon 84 
Mineral oil 395 
effect on intestine 85 
Mineral waters . 123 
Morro 235 
Motility, test for 180, 304 600 
PAGE 
Muscarin 249 
Myocarditis 217, 252 
Mytilocongestin 249 
Mytilotoxin 249 
Myxedema 271, 513 
Nagelschmidt and diathermy 448 
Nausea 47, 121, 189, 230 
Nephritis 256 
Nervous system 252 
Neuralgia 215, 252 
Neurasthenia 73, 237 
Neurin 249 
Neuritis 244 
Night terrors 234 
Nutrition, disorders of 256 
Nuttall and Thierfelder 231 
Obesity 148 
O’Bierne, on antiperistalsis 37 
Obstructions 204 
from pressure 220 
Oil enema 387 
mineral 395 
Old age 236 
Oppenheim 128 
Organs, digestive 250 
Orth, bacteria in blood 244 
Osteoarthritis 72, 515 
Ovaries, inflammation of 100 
Overeating 226 
Oxybetain 249 
Pain 100 
in joints 237 
in legs 204 
in thigh 214 
Pancreas, inflammation of 251 
Paraffin, objections to 406 
oil enema 389 
tablets 407 
Paralysis 241 
INDEX PAGE 
Paramels 365 
Parasitic ameba 72 
Pasteur 231 
bacteria in colon 223 
Pavlov on indigestion 136 
Pelvi-rectal fold 21 
junction, delay at 211 
Pemphigus 254 
Pentamethylendiamin 249 
Peristalsis 394 
reverse 36, 184 
Peritoneum 18 
Phenol 249 
Photophore 375 
Physiology of colon 25 
Pituitrin 76 
Pityriasis 254 
Planus 254 
Pliny 376 
Poisons, colon 236 
Posture 174 
during sleep 331 
effect of 93 
exercises 413 
standing 415 
Pregnancy 220 
Proctitis 113. 490 
Prostate, inflammation of 100 
Proteins, absorption of 30 
Proteus, bacillus 72 
Pruritis 254 
Pseudo-angina pectoris 497 
Psoriasis - 237, 254, 518 
Psychic influences on intestine 87 
Psychology of the colon 125 
Ptomaines 66, 239 
Ptomatropin 249 
Purgatives, use of 170 
Putrescin 249 
Putrificus bacillus 227, 261 
Pyelitis 244 
Pyloric obstruction 250 
spasm 250 
INDEX 
601 602 
INDEX 
PAGE 
Rachitis 506 
Raynaud’s disease 257 
Rectal prolapse 536 
reflex, loss of 220 
Rectum 21 
electrical stimulation of 448 
lubrication of 409 
Regimen, milk 293 
Reproductive organs 256 
Rettger 265 
Reverse peristalsis 36 
Rheumatic gout 237, 515 
pains 255 
Rheumatism 244, 245 
chronic 72, 237, 515 
muscular 255 
Rickets 234, 255 
Richard and Howland, exp. with indol 267 
Robinson, Byron, length of colon 158 
Roger 82 
bacteria in feces 67 
bacteria in intestine 229 
function of mucous membrane 69 
Rollier, sunlight in tuberculosis 510 
Roosevelt, obs. of 248 
Rosenheim, digestive time table 40 
Rouget 506 
Roughage 77 
Roughage, rejection of 134 
Roux .• 231 
Saline laxatives 393 
Saliva, examination of 195 
Salt 148 
Salts 173 
Seborrhea 254 
Senility, premature 73, 498 
caused by toxemia 266 
Sense of fulness 191 
Sepsin 250 
Servius, discoverer of ileocecal valve 45 
Schiff, obs. of 197 
Schmidt 84, 208 
exp. with bran 349 
Sciatica 255 INDEX 
603 
PAGE 
Sclerokeratitis ' , 253 
Sclerosis of liver 237 
Sclerotitis , 253 
Scotchman, diet of 81 
Scurvy 234, 257 
Sherman 346 
Short circuiting of colon 318 
Shot bag 441 
Sinusoidal current 89 
Sitz baths, cold 103, 371 
bath sedative 371 
hot 370 
Skatol 211,249 
Skin 254 
browning of 237 
dingy 121 
dinginess of 196 
diseases 516 
pigmentation of 516 
symptoms 254 
Sleep 102, 330 
irregular 148 
loss of 149 
posture during 331 
Sollman, on aloes 393 
Smith, Dr. Barclay, colon useless 25 
Smokers 217 
Spastic colon 108 
Spleen, enlargement of 251, 494 
Splenic flexure 20 
Sphincter muscles, location of 34 
Starches, absorption of 30 
Starling and Bayliss, on intestine 76 
Stasis, different forms of 294 
in mental disease 269 
effects of 239 
intestinal 199 
Stiffness 237 
Stools, examination of 70 
Stomach, disorders of 496 
Straining, bad effects of 216 
Strassburger, bacteria in feces 64, 67, 298 
Sugars 83 
of fruit 344 
malt 365 604 
INDEX 
PAGE 
Sulphemoglobin ’. 250 
Sulphuretted hydrogen 249 
Surgery, when needed 315 
Swartz, on ileocecal sphincter 46 
Sweating 102 
of feet 254 
of hands 254 
Synovitis " 255 
Tait, Lawson 495 
Tannin 145 
Tapeworm 71 
Tartaric acid 83 
Tea and coffee 145 
Teeth, decay of 234 
Teeth, grinding of 234 
Tetramethylendiamin 249 
Thermophore 375 
Thermo-penetration 448 
Thierfelder and Nuttall 231 
Thyroid, disease of 271 
Time table, digestive 39 
Tissier, bacteria in meat 223 
change of flora 275 
obs. on infant intestine 232 
on B. Bulgaricus 235 
Tobacco, use of 168 
Tongue, coated 47, 194, 227, 236 
foul 121, 530 
Tonsils, large 257 
Toxemia, alimentary 249 
intestinal 222 
universal 245 
Treatments for constipation 367 
of disorders 475 
Tryptophan 250 
Tuberculosis 144 
of the bowels 509 
Tumors 218 
fecal 494 
of thyroid 257 
Tyramin • 249 INDEX 
605 
PAGE 
Ulcers 112, 144, 217 
duodenal 250 
in mouth 251 
in pharynx 251 
rectal 100 
of stomach 142 
Urinary organs, disorders of 521 
Urobilin 249 
Urticaria 237, 245 
Uterus, diseases of 256 
inflammation of 100 
prolapse of 522 
retroversion of 220, 522 
Vegetable acids 83 
Vertigo 215, 520 
Vibration 437 
mechanical 89 
Virchow, on intestine 105 
Visceroptosis 251 
Vitamin B 98 
Vitamins in food 98 
Voltaire 378 
Volvulus 496 
Vomiting 47, 187, 227 
Water-brash 47 
Water drinking 55 
importance of 146 
mineral 123 
Wasting of breast 256 
Welch’s bacillus 67, 72, 227 
effect on red blood cells 262 
in diarrhea 267 
Westphalen, constipation in women 105 
Wet girdle 372 
Wheat bran, sterilized 348 
Women subject to constipation 105 
Worry, effect on colon 325