The following instructive table by Rubner, professor of Physiology, Berlin University, shows results obtained from equal weights of different foods.
In grams Weight Weight Percentage of of dried of ingested feces feces food Nitrogen
Bread from fine flour…. 132.7 24.8 4.03 2.17
Bread from coarse flour.. 252.8 40.8 6.66 324
Brown Bread 317.8 75.79 1223 3.80
The above table shows clearly, for instance, the small residue from fine white flour bread as compared with brown bread132 to 317 in round numbers. In another table Rubner extends this very useful information by showing the digestive refuse of a meal when made in turn from one only of each of the following substances, the necessary amount being eaten of each to satisfy energy requirements (figures representing weight of dried residue).
Here we have one of the most important points in the physiology of digestion, that if food is capable of almost entire digestion and absorption the amount of residue is greatly lessened in bulk and largely limited to that produced within the intestine itself.
In order to drive home this fact, that a great many of our modern physical ills are due to the popularity of foods that are not adapted to the human digestive tract, Kellogg entered into correspondence with one hundred and forty physiciansmissionaries in remote regions where primitive people can be studied,to find out if such people are free from constipation.
From the replies received we make the following extracts.
Cape Colony, South Africa: The staple food is stamped maize and sour milk; the absence of sour milk leading to constipation. In the Northern Transvaal the staple food is thick maize porridge, sour milk and in the summer green vegetables.
Toro, Uganda Protectorate, East Africa: The natives are almost entirely vegetarians living on millet, plaintain or beans. They rarely get meat. In 9642 out-patients seen during the last seven months of 1911 there was but 1.8 per cent suffering from constipation174 cases. Commenting on this report Kellogg says that whereas in Uganda less than 2 per cent of the ill are constipated, in civilized countries in the same number of sick people there is scarcely one in a hundred who is not.
Dotson, extreme north Korea: Wheat, barley, oats, millet seed and all kinds of vegetables are the staple food. Very little fish and less meat.
West China: Bowel movement full and frequent among the working people, who eat large quantities of vegetables.
Pekin, China: The great majority of the people live on coarse grains and coarse vegetables.
Cheung Chow, Hongkong, China: Rice is the principal diet with quantities of vegetables. With this diet and exercise the healthy Chinaman usually has full bowel action.
Shepard, Anitab, Turkey: The principal food is boolghoor (cracked wheat) which has been cooked, dried, and the thin outer skin removed before cracking. It is usually boiled about ten minutes and a little melted butter added. They also eat coarse bread of wheat or barley, varied by lentils and other legumes (of the pea kind) with fermented milk (curdled) called youghurt. In defecation they never sit but squat.
Tabriz, Persia: Youghurt is the form of milk taken in Persia. Meat only occasionally. Youghurt is considered a laxative. Additional food in common use is cheese, coarse bread and fruit.
Bannu, India: People eat wheat, Indian Corn and mil-let seed breads. The supposed effect of the first is overcome by the last two which are laxative.
Amritsar, India: Motions are large, bulky and not formed. People here eat largely ground wheat and vegetables, not much meat.
Doctor Shepard, of Aintab, Turkey: There is little appendicitis here. I do from 500 to 600 important surgical operations a year with but 6 or 8 cases of appendicitis. All forms of cancer rare. Ulcers of the stomach common.
Forty-three physicians of the hundred and twelve in Mexico, Palestine, Arabia, Turkey, Egypt, South Africa, East Africa, Central Africa, Nigeria, Japan, Syria, Korea, Siam, Indian Asia Minor and the New Hebrides re-ported that they had never seen cancer of the bowels. Nine physicians scattered over Africa also reported that they had never seen a case of cancer of the bowels.
John C. Young, of Sheikh Ottoman, Aden, reports: The natives give prompt attention to the bowels. I have again and again had it given me as a reason for not living in Aden that people are not permitted to evacuate their bowels in public, as this is only permitted for children.
In “Diet and Race” (1920) F. P. Armitage’ assembles from the various memoirs of travelers considerable in-formation on the food of primitive man in various parts of the world.
Thus among the brown peoples of Queensland, Central and Northern Australia, the food is almost entirely vegetable, with occasional eggs, game, lizards and the like, which the husband often keeps for himself. Palmer gives an account of fifty-nine species of fruits, roots and vegetables and seven species of seed, all of which, raw or cooked, are eaten by the natives. Five of the former and three of the latter require the most careful treatment before they are fit for use. In Central and Northern Australia the only food seen in camp was, often, the raw or slightly roasted pods of the acacia. The natives near Sidney consumed as much flesh as any two Englishmen. Of yaws, roots, sour thistles, water grass and various fruits, there was no stint. In a native oven on the banks of Murrumbidgee, Matthew found a half ton of roots, cooked by several days’ heating and beautifully white and palatable.
Hurst makes the observation that big eaters almost always have loose bowels, as a result of the excessive stimulus to intestinal activity produced by the large residue left by the bulky food. Stasis may be due to an insufficient supply of water, excessive loss of water by other channels and excessive absorption of water from the intestines. Many women drink much too little water.
Voluntary restriction results in a lessened desire as is the case with loss of appetite. When the colon becomes impacted it is unwise to give purgatives as the colic, which is generally present, indicates that the intestinal musculature is already contracting very actively. Belladonna is more likely to relieve the pain and cause the contraction to become more orderly. Enemata are generally indicated (fully treated elsewhere). A high enema 1 should be given at a very low pressure. On account of its irritant action glycerine should not be given in suppositories to patients suffering from proctitis (inflammation of the rectum) or hemorrhoids. Sempules (shaped somewhat like a dumb-bellan English article) should be used instead of ordinary suppositories if hemorrhoids are present. They are made with a narrow neck that joins the broader conical end which projects into the rectum while the narrow neck remains in actual contact with the anal canal. The sempule should contain tannic acid or adrenalin if the hemorrhoids have recently bled, and the slight mechanical irritation the sempule produces often suffices to complete evacuation.
Adolf Schmidt, says that feces pressed into small cylinders indicates spastic constipation (contraction of the colon, usually the descending section).
Webster, says the stool is much softer with a purely vegetable diet, of which about 85 per cent is water, than with animal diet, of which only 65 per cent is water (and with a relatively small residuum). Many factors may influence the amount of water present, such as a lessened absorption of water from the canal, intake of a large amount of water and an increased secretion from the intestinal glands. Webster claims that a large intake of drinking water directly influences the water content of the colon .4 As a general rule, continues Webster, it may be stated that the greater the absorption of water from the intestine the more firm the residue. Clay-colored stools are caused by excess of fat sometimes with a deficiency of bile. Strumfell was able to obtain a light brown color by (feeding patients a diet containing a small amount of fat, thus indicating that the fat was more important than the diminution of bile, although this latter is a cause also.
Cammidge makes the observation that as, a rule the longer feces are retained the darker they are. Hurst says that of two actions, one before breakfast and one after, the first is apt to be the darker as having been longer retained. The most prevalent normal color is a light reddish brown. These facts have a wide application.
Cammidge quotes Escherich to the effect that a 10 weeks old child taking One liter of cow’s milk a day (half a gill over a quart) passed nearly ten times as much as a child of the same age fed at the breast. This is largely due to the quantity of food taken. On a vegetable diet Rumpf and Schumm found the output consisted of 370 grams. On a flesh diet Rubner gives 64 grams as the average weight, and Harley and Goodbody 54% grams (nearly 31 grams to the apothecary’s ounce). As a rule maladies beginning abruptly are accompanied by constipation. The time spent by the food in the intestines bears no relation to the frequency of the evacuations, an important fact. Defecation can be regular, yet the retention of the food residue be greatly prolonged. The form and consistency, in health, is mainly determined by the water content. Sometimes this is the result of the amount of intestinal secretion from the blood and the rapidity of the bowel movements pre-venting absorption or defective absorption from disease of the intestinal wall, etc. The consistency of the stools usually varies directly with their number, typical hard masses varying in size from a hazelnut to a walnut, and frequently showing indentations of the tenia of the colon (one of the three muscular bands in which the longitudinal muscle fibers of the colon are collected). Still smaller masses are sometimes seen, resembling the dejecta of sheep. The presence of scybala indicates long delay of the feces in the large intestine. Bilious stools are bright, golden yellow in typical cases, but may have a greenish tint or even a dark green. The presence of unaltered, or but slightly altered, bile pigment in adults is always indicative of conditions of disease unless it is due to calomel, and indicates a hurried passage through the bowel Bloody stools may be scarlet, brownish red, coffee-colored or black. As a rule the higher in the alimentary tract the source of the blood, the darker is the color. Bright red blood, especially when on the surface, has a nearby source. Adherent blood, slightly changed in color, suggests the colon as its source. The black or coffee color has a stomach or duodenal source (first intestinal section below stomach) after hemorrhages. The odor depends partly on the nature of the food and partly on the decomposition changes undergone in the intestine. Both skatol and indol as a rule are present, both products of the putrefaction of proteins by bacteria in the large intestine. The intensity of the odor of these will depend upon the quantity of protein in the diet and the number of putrefactive bacteria in the large intestine 1 (fully discussed elsewhere).
Persons subject to constipation, headaches, so-called bilious attacks, or colitis, and who combat these conditions by an antitoxic dietary, should carefully note the stools from time to time, at least once or twice a week. The appearance of a dark color or putrid odor should lead to a prompt change in the dietary. A continuation of this condition means a constant absorption of poisonous material into the blood and gives rise to hardening of the arteries and increased blood pressure, while contact with the liver, kidneys and other eliminative organs, leads to their degeneration.
Fothergill says (in “Diseases of Sedentary and Advanced Life”) it frequently happens that as bilious persons advance in years they gradually cease to be bilious and become gouty. In both instances the liver is at fault; at first it makes bile acids in excess; later it acquires the vicious practice of forming urates instead (a salt of uric acid), both the outcome of the protein element of the food. In both conditions there are those spots of pain in the back near the shoulder blades, which are so characteristic of nitrogenized (protein) waste in the blood in excess; no matter what its form.
Large masses of mucus in the form of whitish or yellowish shreds or flakes, are due to colitis, a catarrhal condition of the large intestine, believed to be caused often by the free use of cathartics. Such disease may be present even if mucus may not be constantly found. Large masses of clear mucus due to irritation of the rectum sometimes precede or follow the stool. Mucus mixed with pus indicates an ulcerative condition of the lower bowel. When the ulcers are higher up the mucus and pus are apt to disappear through decomposition or digestion
With a coarse vegetable diet the bulk may be twice as great as normal. When the food and bacterial residue find their way through in from twelve to sixteen hours the consistency is never concentrated and hard with dark color. This condition develops only when it re-mains in the lower colon 24 to 48 hours or more. The color varies more or less with the food. Meat produces a dark color, milk yellow or orange-color. Fermenting materials have a generally slight acid odor; if much fat is present, a rancid odor. When putrefaction is well advanced there is a strong ammoniacal odor. Where the offensiveness is pronounced there is often a combination of rancid, ammoniacal and putrid odors.
Muco-membranous colitis is a very chronic disease and there are cases of a duration of 30 years. Early treatment is generally favorable but when there has been delay for years the outlook is very unfavorable. It occurs five times more frequently in women that men. The mucus is excreted as membranous shreds, which, in well marked cases, may form long tubular casts of the colon, sometimes called skins by the patient, the diameter being anything up to 1 ii inches, with very thin walls. Sometimes they are rolled into a ball. The membranes may be passed alone or with dry, hard feces. Occasionally streaks or clots of blood are present owing to hemorrhage from excoriations of the mucus membrane or from anal ulcers or hemorrhoids, all of which may be produced by the hard scybala As they have been found to contain cells they are obviously derived from the epithelial (surface) lining of the mucus membrane. Nearly one-half the women who suffer from muco-membranous colitis have also some pelvic disorder such as uterine displacement, pelvic cellulitis (inflammation of the cellular tissue), uterine disease, or painful menstruation. In many of these cases the muco-membranous colitis is secondary to the constipation, which results from the reflex spasm or delay caused by pelvic disease or partial obstruction due to adhesions involving the pelvic colon. The spasm and accompanying pain is generally worse during menstruation. Fallen abdominal organs, including movable kidney, are frequently present, generally due to weakness of the abdominal muscles. Patients generally rest easier in a horizontal position which ameliorates the abdominal drag .2
Some practical comments by the present authors on the facts in this chapter seem called for. Consider the thousands in large cities who hurry through breakfast and then start immediately for the place of employment, frequently requiring, in the case of commuters, from one to two hours for the trip. Every incident of this morning rush, including the half masticated food, makes for derangement of the digestive tract. And so with countless other complexities of modern business life.
One of the great hygienic advances of the world war among American troops was to do away in some fortunate commands with the closet seat. Round holes were cut in the floor and the men compelled to squat, with excellent results in the improvement of health, especially in the matter of hemorrhoids, which in many cases in-capacitated men from service. In America manufacturing plumbers, with no adequate knowledge of requirements, have sought but one resultcomfort and ease. But Nature does not take kindly to such coddling of muscles, particularly of the abdomen.
An interesting case points the moral. A physician was having trouble with a delayed delivery in child-birth where the patient had been laboring in the hollow of a soft bed in great pain for twelve hours. Another physician was called. He quickly took in the situation and had the patient gently lifted to the floor. She was assisted to a proper position where the muscles involved could perform their natural functions and a quick and safe delivery resulted.
In Pompeii a small cement-floored room, ten feet square, was found in a dwelling (villa) by a visitor, who had made the necessary inquiries, to contain a large stone slab, as thick as a curb, five feet long and four feet wide, which was hollowed out with rounded ends and sides, It was flat on the ‘floor and was supposed to contain sand. Above it a smooth stone seat, a foot wide, five feet long, low in position, was supported by ornamented posts at each end well set back. A person in position on this slab, with feet rather high, would be compelled to bend sharply forward.
So much for twentieth century advances in civilization!