Field says he is continually surprised at the mistake people make as to the completeness of defecation. This error is frequently practiced regularly by persons who are very particular as to personal cleanliness in all other matters. It is almost a regular experience to find in cases of stasis located in the lower end of the colon (dyschezia) that from one-third to one-half of the contents that should be expelled are left behind.’
No curiosity as to the facts seems to exist. Not the least attempt is made to secure any accurate information on the subject. Nor is it even known that the act of defecation when properly performed should empty the colon as far up as the splenic flexure, (end of the tranverse colon). Whether this has been done or not can be easily and accurately ascertained by a follow-up irrigation of the descending colon as far as this flexure, and the frequent use of charcoal “markers” (discussed later).
As these residues accumulate they become impacted, lose much of their moisture, become dark in color, produce a loss of appetite (nature’s protest against the condition) and, by deranging the delicately adjusted intestinal mechanism of nutrition, bring about a general condition of inefficiency and ill health, fully discussed else-where.
After a patient has suffered from this intermittent or persistent condition, whatever the cause, mucus will promptly make its appearance, usually in jelly-like form > around the scybala (hard masses). Although this is often considered the beginning of the catarrhal stage, there can be no doubt that catarrh will exist long be-fore the mucus becomes visible. For a time the patient may now suffer from alternating constipation and diarrhea, with occasional distension of the bowels and flatulency, the diarrhea, according to Ewald, being produced by fermentation. At this stage scybala are apt to accumulate in the colon, especially at the flexures, and, setting up irritation of the membrane, cause a marked in-crease in the quantity of the mucus secreted.
Gompertz, in order to ascertain the efficiency of bowel movements in healthy young men, developed an important and interesting experiment. He gave 10 grains of lampblack to 30 individuals, all students but two, one of the two being a merchant aged 32 and one a physician aged 36. In ten of the cases selected as being indicative of the whole body the lampblack was identified in the following number of hours after ingestion: 11, 13, 14, 14 1/2, 13 1/2, 14, 14 1/2, 13 1/2, 13 1/2, 14 1/2. In six cases it was taken in the morning and in four in the evening. The average time was a little over 13 1/2 hours.
It would be very instructive had Gompertz carried the investigation into the fourth, fifth, sixth, seventh and eighth decades of age. The results would in all likelihood have shown a progressive lengthening of the time between ingestion and defecation. With the progress of age, the lessening of physical activity, the decline in strength, the decrease in the amount of exercise, the frequent maintenance of the full-sized food ration and, most important of all, the weakening of the abdominal muscles, there develops in a large majority of cases a marked impairment of the intestinal functions.
Hurst says that the majority of cases of stasis, so often associated with visceroptosis (falling of the organs), is due to weakness of the abdominal and pelvic muscles and the ptosis (falling) of the diaphragm, which render the act of defecation inefficient, so that the rectum and pelvic colon are never properly emptied.
What this very frequently means may be best shown perhaps by the citation of a case reported by Stevens.
Mrs. H., beyond middle age, applied for relief from “rheumatism” that is, she complained of pain in her shoulders, arms and legs, and this had continued for about four years. Because of an accident to her husband the burden of family support had fallen on her. For two years she had suffered from cold feet and during this period she lost about twenty pounds. Her throat and teeth were in good condition with no inflammatory skin affection. She had considerable flatulence, her complexion was bad and where she formerly had a clear and ruddy skin her face became sallow and careworn.
She was directed to take three 5 grain charcoal tablets at 9 o’clock in the evening and thereafter to note the color of the stools. She had been habitually using laxatives. Her report follows:
At 14 hours, .the usual color 38 hours,slightly darkened 62 hours,color increased 86 hours quite dark 110 hours,color lighter 134 hours,slight color 158 hours,usual color
It will be noticed that the color persisted for ten hours less than six days, and it probably persisted longer, as there was no observation between 134 and 148.
At a clinic (examination of a patient in the presence of a class) in a western medical college of prominence, duly published, the lecturer observed that four days between ingestion and ejection is about normal. This astonishing statement coming from an instructor is valuable as showing the unreliability of even medical opinions and as also disclosing a condition that is sufficiently widespread to seem to warrant such a generalization. We also have here a probable explanation of the reason many people stop too soon in taking agar and bran.
Numerous authorities of the highest competence have accurately observed and carefully noted the normal time required for the disposal of the dejecta of the human body.
Hurst says the x-ray examination of eighteen normal individuals disclosed that the barium meal reached the cecum in from 3 1/2 to 4 hours (beginning of the colon), the hepatic flexure (the first bend) in from 4 to 8 hours, the splenic flexure (end of the transverse colon) in from 7 to 14 hours and the junction of the descending colon with the iliac colon (at the crest of the pelvis) in from 8 to 16 hours. The average time taken is 4 hours to the cecum, 6 to the hepatic flexure, 9 to the splenic flexure, 11 to the commencement of the iliac colon (sigmoid) and 12 to the pelvic colon 1 (lower part of the sigmoid).
The same author also calls attention to the well-known fact that the rectum should always be empty except at the time when there is a call of nature, at which time it has been supplied with dejecta from the adjoining pelvic colon* (see page 40). The act should then be complete at least as far as the splenic flexure and sometimes beyond that point. There is no more important fact of colon hygiene than this.
The average American citizen, says Kellogg, considers himself a model of regularity if he has one bowel movement daily without the use of drugs. But it is no exaggeration to say that the said average adult is suffering from intestinal toxemia (poisons generated in the intestine). Women suffer more than men. It is difficult to find one who does not show more or less indications of this condition (thus confirming Foges of Vienna, quoted elsewhere). When the bowels move thoroughly three times a day the food residues remain in the colon too short a time to allow for the development of advanced putrefaction. If the diet is low in protein (food derived from animal sources, exclusive of milk), rich in carbohydrates (starches, sugars, preferably other than cane, such as honey and grape sugar), the output soon ceases to show marked evidence of decomposition, the strong ammoniacal, putrid or rancid odors disappear, the odor becomes either faint, sweetish or slightly sour, while the dark brown color gives place to a color nearer the orange.
Constipation is a disease of civilization. Wild men and wild animals do not suffer from this malady which is perhaps responsible for more human misery, mental and moral disaster, than almost any other cause that can be named.
In every case of constipation some particular condition is the immediate cause of the delayed intestinal movement. In practically all cases this can be readily removed by change of the intestinal flora, increase of the bulk of the food or by other available means.
In colitis (inflammation of the colon membrane) bran is of signal benefit. It is most important that the mucous membrane should be kept clean. Paraffin oil is necessary as a lubricant. Long continued inflammation causes degeneration of the mucous membrane that produces the lubricating mucus. The intestinal flora (micro-organisms) should be changed and the membrane kept clean by a laxative diet, if necessary by the daily use of the enema.
When the bowels are once regulated be careful not to interrupt the rhythm. Make no experiments. Keep right on doing the things that succeed.’
Eyre, quoted by Mutch, examined bacteria from the lower end of the small intestine, near its union with the cecum, in 16 constipated patients. In one only there was a failure to find disease-breeding (pathogenic) micro-organisms. When the valve separating the small from the large intestine (ileo-cecal) is passed conditions become much worse. On 14 occasions Mutch attended upon operations by Sir Arbuthnot Lane for removal of parts of the colon and small intestine in bad cases of intestinal stasis and made careful notes. When the small intestine was opened an extremely faint fecal odor was emitted. But when the cecum (beginning of the large intestine) was cut into there was very pronounced, nauseating odor, indicating bad conditions of putrefaction in the large intestine.
What infections under such conditions may mean is set out by Reed who says that the terms “insanity” and “epilepsy” are vague and refer simply to various conditions induced by the poisoning of the blood stream by “focal” infections of one kind or another (meaning sources of infection). He defines these infections as invasions of the body by disease-producing germs which, becoming established in a tissue, organ or cavity, there form a focus from which the germs themselves, or the toxins they generate, or both, are persistently absorbed into the blood stream and thus infect the general system.’
Under this lucid generalization who can say that the common infections of the tonsils and teeth do not frequently originate in the intestinal tract? Reed shies at the definitions of insanity” and “epilepsy.” This re-calls the remark of John Hunter, the great British physiologist and surgeon (1728-1793), that “of all things on the face of the earth definitions are the most cursed,” meaning, no doubt, that they are often allowed to take the place of a rigid investigation of the facts.
For instance, it is not difficult to define the phrase “tobacco heart” as being due to excessive smoking. But Brooks, as is shown in Chapter XXXI herewith, was not content with generalities and made 44 post mortems where death seemed to be associated with excessive use of tobacco, and reached certain definite conclusions that seem to rest on the facts instead of on definitions. Such observations apply, as Hunter points out, with more force to the physician than to the layman, as the public is slowly finding out at its cost.