A poor appetite is a common cause of constipation. It is an almost constant symptom of neurasthenia (a group of symptoms resulting from debility or exhaustion of nerve centers) so that an insufficient quantity of food is generally an important factor in the stasis which is so frequently present in this condition. The patient diets himself because he thinks the dyspepsia, which is often present, is a cause instead of an effect. He gives up one thing after another without obtaining relief. This voluntary starvation, in which the quantity of food taken is only gradually reduced, always results in a corresponding diminution of appetite. The patient subsists on extremely small quantities of food without experiencing any desire for more. As a result the body weight diminishes considerably until a point is reached where the reduced weight and the intake of food balance each other, the metabolism (conversion of foodstuffs into tissue elements) being now on a very low plane. “It is no exaggeration to say that the number of women who are ill because they eat too little is as great as the number of men who are ill because they eat too much.”
A case set out in detail by Hurst is of a man of 35 who reached the conclusion that there must be some-thing seriously wrong with his intestines to produce such insufficient motions. He consequently decreased the amount of food, eating mostly gruels-precisely the wrong thingwith the natural result that he lost weight and became weaker. The cause of the condition, which had become progressively severer, was clear enough. His food was so insufficient in quantity and so uinirritating in quality that the stimulus to bowel movement and to intestinal secretion became very feeble, and the size of the stools very small. On examination, although the patient’s bowels had not been opened for several days, the rectum was found empty and the descending and iliac colon contracted, there being clearly no fecal accumulation in spite of the apparently insufficient amount of bowel action. The patient was told there was no cause for worry, as he had no organic disease, and his condition was easily curable. He was directed to eat a proper amount of mixed diet. No drugs were given. When seen in February, 1909, he had put on weight and all his abdominal symptoms had disappeared.
The underlying error in the above case was the same as in Fletcherism. Horace Fletcher died prematurely in Copenhagen of bronchitis. The underlying cause was believed by a prominent American physician, who treated him, to be intestinal intoxication.* One of his favorite self-felicitations was that by chewing the food into a condition of fluidity, the bowel refuse was so small that defecation need not be performed oftener than once in several days. He is believed to have left the most important element, putrefaction, out of account.