W. Grant Hague

Chief Cause of Constipation in Women—Constipation a Cause of Domestic Unhappiness—The Requirements of Good Health—The Cost of Constipation—Constipation and Social Exigencies—One of the Important Duties of Mothers—Constipation and Diseases of Women—Constipation is Always Harmful—Constipation and Pregnancy—Explanation of Incomplete Constipation—Causes of Constipation—Negligence—Lack of Exercise—Lack of Water—Lack of Bulk in the Food Taken—Abuse of Cathartic Drugs and Aperient Waters—Overeating—Treatment of Constipation in Women.

It has been stated that constipation is almost universal among the women of America. It is a fact that very few American women enjoy, to a reasonable degree, a permanently satisfactory bowel condition. Constipation is an acquired habit and unquestionably negligence is the primary and the chief cause of it. The negligence, no doubt, begins at a very early age; it is at least an established habit before any intelligent, consecutive effort is made to remedy it. Inasmuch as women are the mothers of the race, and as their part in the scheme of life is the supreme one; and as constipation has been shown to be a serious, far-reaching, significant disease, a very sincere and persistent crusade should be made to educate women as to its importance. For a less altruistic purpose, tremendous popular movements have been carried to success. For a less service rendered to the race names have achieved renown. In addition to the symptoms stated in the preceding paper, the condition which we now desire to emphasize is the effect of the constant self-poisoning on the general health and its effect upon a woman's reproductive efficiency.

The poison being constantly absorbed, means general bad health, bad health to a degree depending upon the degree of constipation which is the cause of the poisoning. It may be simply that the woman does not wholly enjoy good health, or that she is completely incapacitated because of chronic bad health, or any degree of indifferent health between these two extremes.

If the degree of poison is sufficient to cause habitual poor health, its effect upon the blood must be bad, and the effect of the bad blood upon the nervous system and the other vital organs cannot be good. Now if this process has been going on for many years, the condition of the woman, who is its victim, as an efficient machine, compared with the woman in whom this condition never did exist, must be very different indeed. This condition of affairs—inasmuch as constipation is so common in women—must have a tremendous significance when estimating the vitality and efficiency of the coming generation.

We might go much further and yet be sure of our position, and maintain that it is this national autotoxemia, this scourge of womanhood, that is to a great extent responsible for the characteristic American "vice of neurasthenia," and of the domestic infelicity and unhappiness which are so common in the large cities of this country. If we add to the intestinal autotoxemia of constipation, the tendency to, or vice of, indiscriminate eating and drinking—of which the American people are particularly guilty—we would be on firmer ground. In fact we would feel that we had pointed out the one underlying cause of most of the domestic irritability prevalent to-day, which is of serious importance, and which is, fortunately, capable of correction. It is a matter of everlasting and continuous education.

The Requirements of Good Health.—There are certain fundamental basic requirements which are essential to good health: fresh air, good water, a reasonable amount of physical and mental exercise, nutritious food, freedom from unnecessary and unreasonable worry, frequent bathing, and a daily movement of the bowels. The reason why constipation is of such serious importance is because it is the only basic requirement of good health that afflicts a large majority of the race at the same time. The health of so many is being undermined by this one affliction, that it dominates all other factors that have any bearing upon posterity. A woman may enjoy all the essential conditions necessary to good health, yet she may be constipated, and the presence of this condition will undermine, in her constitution, all the benefits she derives from her advantageous environments. It will do more; it will be responsible for the disposition,—the temperament,—of that woman. The natural disposition of that woman may be an amicable one; if it were allowed to express itself naturally it would be kind, gentle, considerate, affectionate. No woman, however, the victim of chronic constipation, can preserve an equable temperament or an amicable disposition. It is impossible—with her nerves being constantly poisoned—that she can hold the symptoms of that condition in abeyance. She must be irritable and nervous and sick of herself and everything and everybody. The home as a direct result suffers; its atmosphere is not one of contentment and peace and affection. Constipation, therefore, blights the home and the influence of one blighted home may have a far-reaching effect on the story of the human race. It is responsible also for that woman's mental attitude outside the home. Instead of exerting an optimistic influence, her whole existence is a message of pessimism and discouragement. Multiply these influences and messages to correspond with the prevalence of the disease and we have a condition that is tremendously significant, a condition that is really a pressing economic issue. A constipated woman is an anti-eugenist—a eugenic atrocity.

We have no desire to create a false impression or to build up a foolish fear. Are we justified in regarding this as one of the most important, if not the most important, disease condition; the most menacing physical vice, which the human race has to combat? Let us offer the following brief facts in witness of our stand:

The Cost of Constipation.—It has been estimated that consumption (the great white plague) kills one-tenth of all the human race. Cancer kills half as many, or one in every twenty. Constipation, and the diseases which are caused directly by it, kills one in every three of all the people on the civilized globe.

Constipation has been responsible for the expenditure of millions of dollars in advertising in the newspapers alone,—more, probably, than has been spent in advertising remedies for all other diseases combined. Do you suppose this money was a donation? Do you suppose these keen, alert interpreters of the spirit of the times, the up-to-date business men, were not and are not aware that constipation is the "universal disease"?

Every drug store, in every civilized spot on earth, has its shelves loaded down with constipation remedies; dinner pills, liver pills, cathartic pills, tablets in all possible coatings and combinations, mineral waters from a multitude of springs, aperient drinks by the dozen, laxative teas and cordials, cathartic oils and emulsions. If the demand for these articles should cease most of the drug stores would close up.

Many millions of dollars have been made and are being made by various men and concerns, who have devised ingenious mechanical agencies which are supposed to cure, and in curing renew the lost health caused by constipation. We have in mind in this connection, a man who conceived the ingenious plan of putting the opening of an ordinary fountain syringe in the middle instead of at the end and made a fortune out of it. In this opening he places an upright nozzle, and instead of hanging the bag up and allowing the water to run into the bowel, he has the patient sit on the bag and thereby the water is forced into the bowel. He has written a two-hundred page book on the advantages of this idea, and his "literature" contains the names of famous men and women in all walks of life who use his device. The name of one of the famous judges of the Supreme Court of the United States was there; another was the name of a popular operatic beauty who writes for the daily press little essays on "How to be beautiful!" and "How to keep well!" He deserves his success. He is an emancipator and has doubtless done a great deal of good. His success demonstrates, beyond contradiction, the prevalence of the malady under discussion, and it must be remembered that he is only one of hundreds who garner from the same ample harvest.

If we could estimate in value the economic loss sustained by the race because of the inefficiency of the victims of intestinal intoxication, due to constipation, the sum would be colossal. Even then it would only represent the direct economic deficiency—it would not express, nor could any figure adequately represent, the indirect loss sustained by the race because of the temperamental characteristics, which are the products of intestinal poisoning, and which produce domestic tragedies and economic failures.

Has this array of evidence any meaning, or does it just happen to be so? We leave it to the reader; if it stimulates thought, or pricks a conscience it will have done its duty.

Constipation and Social Exigencies.—The cause of constipation in women, whose social station commands every sanitary, hygienic, and dietary luxury, is their method of living, the food they eat, and the negligence which is almost obligatory because of social exactions. If constipation did not so frequently accompany "good" living (which is the modern name for overeating and drinking) we would have thousands and thousands of healthy, robust, contented women, fit and willing to assume the onerous duties concomitant with motherhood. All their enthusiasm, however, is expended in the effort to keep "in the ring," to overcome the effects of the poison of constipation, to preserve their youth and freshness, to undo what neglect has accomplished. It is because of the failure of this simple function that my lady seeks the masseur, the facial artist, the society doctor, the beauty expert, and the thousand and one agencies, which an extravagant and profligate age has made necessary to foster the efficiency of its votaries.

I am optimistic, however, regarding the future. I believe the human race is improving, despite the disadvantageous surroundings and conditions which hamper honest effort and stultify truth. A higher efficiency is the goal, and the intention is to obtain this desideratum by fair and by just means. There is an awakening, an unrest, a groping for knowledge in almost every field of human endeavor, and there is none in which the yearning for fact, for truth, for instruction, is stronger and keener, than in the world-wide movement in the interest of a better motherhood, and in a more serious study of child life. It is an encouraging sign, a hopeful promise, of what the future has in store.

One of the Important Duties of Mothers.—The immediate lesson to be learnt from the facts just recounted is to instruct mothers in their duty toward their daughters. If each mother would retain the confidence of her daughter sufficient to instruct her in the duties which are important, how much needless suffering would be saved. To know as a matter of fact whether the daughter's bowels are in good condition will appeal to all who read this as being of very great importance. It is not only necessary to know if they have a movement every day, it is necessary to know the character of the daily movement; whether it is hard and dry and necessitates straining,—the evil consequences of which, in young girls, is very serious indeed,—or if it is habitually loose and suggestive of what has been described as incomplete constipation.

If the mothers of America would consecrate themselves to this simple task, who could tell in mere words the effect it would have on the race yet unborn? There are problems of scientific intent, and of fancy names, that engage the attention of philanthropically inclined ladies, and which are emblazoned on the society columns of the daily press, of much less importance to the human family than the homely duty we ask mothers to devote themselves to.

Constipation and Diseases of Women.—Constipation is present in a very large majority of the cases of diseases of women. It may be caused by disease of the womb, or it may cause disease of the womb. There is no question about the bad effect constipation has upon all diseases of this type. In many cases it is absolutely impossible to effect a cure without first curing the accompanying constipation.

We seldom appreciate how severe a degree of constipation a growing girl will submit to without seeking relief. Some of the worst cases of constipation that have been known, have been in girls between the ages of sixteen and twenty. The mechanical effects of such a condition can well be imagined. The constant, severe straining, necessary to evacuate the bowel, has, in very many instances, produced congestion and displacement of the womb and ovaries. It is not observed at this time, or if observed it is not understood, and thus is laid the foundation for years of neurasthenia, helplessness, and disease.

The more we investigate the ramifications of constipation the more we learn of its seriousness and of its significance.

Constipation is Always Harmful.—There is no period in life when constipation can be borne with impunity. Youth, with its virility and vitality, will endure its consequences with an apparent negation, so far as positive or specific results are concerned, but it is only an apparent impunity. There is always a certain amount of strength built up, held in reserve as a heritage of youth, which will withstand a certain amount of physical license, but if this reserve is assailed by an unnecessary imposition, and is successfully undermined, there will be infinitely less reserve to call upon in the legitimate battle of life. Life is too real, too concentrated, too strenuous, and health is too precious to be wilfully wasted in any form of self-abuse.

Constipation and Pregnancy.—Mothers will appreciate from the foregoing explanation why constipation is eugenically a crime during pregnancy. The evils which result from constipation mechanically, frequently have serious consequences by interfering with the circulation of the blood to the womb, by forcing the womb to assume wrong positions, by straining at stool, and by preventing the kidneys from functionating properly; these may render the life of the pregnant woman miserable, and may be the direct cause of a painful, prolonged, difficult labor. The evils which result from constipation because of the absorption of poisons by the bowel are of the gravest importance during pregnancy. These poisons affect the general health; the victim is tired, listless, and apathetic, and is thereby disinclined to exercise adequately; the appetite is poor; there are headaches, neuralgias, insomnia, nervousness, melancholia, and general mental and physical inertness. What hope may a pregnant woman entertain of having "an easy confinement," or of bringing a healthy child into the world under these circumstances? Who is to blame? Sometimes it is necessary to tell the unadorned truth,—the woman is to blame. No woman has a right to assume the responsibilities of maternity who has not had enough respect for herself to discontinue habits which caused this failing, or who has not had strength of will enough to begin its successful cure. Get busy,—do something,—it is never "too late," but do it now.

Before we take up the treatment of constipation in women, it is necessary to explain more fully the type of constipation which we referred to as "incomplete" constipation. There is a condition of the bowel, in which we find its wall coated with hard fecal matter. The size of the bowel may be dilated as a consequence. This condition may occupy part, or most, of the entire length of the large intestine. In the middle of this hard mass there is a small channel through which semi-liquid matter passes. When the bowel moves, it is this semi-liquid matter that passes out, and this constitutes the daily movement. We have consequently a condition in which we have a daily movement but not a complete emptying of the bowel. The character of the stools from such a bowel must necessarily be more or less of a semi-liquid consistency, because the intestine, being coated with a hard dried out layer of old fecal substance, is prevented from absorbing the liquid part of the fresh fecal mass passing through it. This condition may exist for a considerable time, but it will slowly undermine the health and vitality of any person in whom it exists. The symptoms which a patient in this condition complains of are,—a feeling of being tired and languid, no energy or vim, headache, loss of appetite, loss of flesh, neuralgic pains, nausea, vertigo (dizziness), insomnia, frequent colds, cold hands and feet, biliousness, sallow skin and muddy complexion, liver spots, coated tongue and a "bad breath," nervousness, melancholia, various abnormal conditions and diseases of the skin, pimples, blackheads, eruptions, eczema, piles, appendicitis, diseases of the intestinal wall as a result of the constipation, Bright's disease of the kidney, and many other morbid conditions. Any physician could name many symptoms, which were never properly understood but which are now known to be caused by the absorption of poisons resulting from inactivity of the bowels. Patients may not necessarily have all of the above symptoms; they may have a number of them, or they may have all of them, and they may have others not mentioned at all.

Treatment of Constipation in Women.—To effect a movement of the bowels in a patient who is a victim of constipation is not a cure. We can indefinitely cause bowel action by drugs, etc., but the condition will remain the same or worse. When habitual constipation exists there is an underlying condition affecting the entire system which indicates that something is radically wrong. It may be necessary to change the whole routine of the patient's life. It will certainly be necessary at the very beginning to inquire into the daily diet, exercise, and surroundings.

During the past ten years there has been born every few days a new medical "ism," a new religious cult. Why? Because human nature is an unstable equation. We are never satisfied with the old order of things and there will always be a following wherever there is a leader. These "isms" and cults do not survive. Some seem to thrive, others die a natural death. There is a law, as old as the hills, that you cannot get something for nothing in this world. We learn its bitter truth as the years pass, and when we get over the day dreams and the sentiment of youth we settle down to real work. If we desire to retain good health, or regain lost health, we must do something. No one can hand it to us on a silver plate, nor can anyone work a miracle in our behalf. We cannot buy health, we must deserve it.

This is the secret of the success of all schemes to cure disease. The human family will not knuckle down and swallow the truth. The man or woman in poor health is looking for Aladdin's lamp everywhere and always. A new bait, dressed up in lubricated, oily words, promising impossible results, will be accepted as the simple unadorned truth, and will be bought and paid for, in the end forgotten. The royal road, the easy road, which they are looking for is impossible. There is no way by which any one of us may continue to break the laws of nature and retain or regain our lost health. Miracles are impossible. Prayers without deeds are empty mouthings and a waste of time. Let us see how this works out in the treatment of constipation. We must find the cause of the constipation. I will name the causes in their order of frequency.

Negligence.—This is unquestionably the primary cause of almost all cases of bowel inactivity. As has been already noted, the exigencies of modern life are of such a strenuous nature that we do not find the time to devote to this function the degree of systematic attention which it demands in order to preserve a healthy condition of intestinal regularity. The bowel is simply a complex muscle controlled by an elaborate system of nerves of an involuntary type. In order to preserve the highest degree of efficiency of this complicated mechanism, it must be permitted to obey the laws nature endowed it with and which it must obey. When the fecal mass reaches the rectum the nerve centers, acting through the spinal cord, send a message to the rectum something like this: "Empty yourself of your contents, we have made all preparations and everything is ready." The rectum obeys to the extent of notifying you that it wants to be relieved; you feel the desire to evacuate the bowels. If you obey, all is well, nature is appeased, you encourage the systematic regularity necessary to good health. If you do not obey, you upset the delicate mechanism, and frequent negligence of this character will result in the complete disarrangement of this complex machinery so that it will fail to warn you that a bowel movement is necessary and constipation is established. We must therefore retrace our steps and re-educate the bowel systematically to empty itself at a certain time every day. This can be done in nearly every case without artificial assistance. It may take time but it is worth a little methodical persistence. The point is, you must do it; no "ism" or esoteric agency can do it for you.

Mothers will recognize from this explanation the necessity of establishing the habit in children at the earliest possible moment.

Lack of Exercise.—What does the word exercise imply? It implies movement, better circulation of the blood, better health and tone to every part of the body, more oxygen, and a richer, better quality of blood, and because of a better quality of blood, which is the fuel of the body machine, we have a better, smoother working machine. Every human being requires a certain amount of exercise; otherwise the machine will not run smoothly. If this exercise is not obtained, things begin to go wrong. One of the very first signs to indicate that the machine is not running as it ought to run, is a sluggish condition of the whole digestive apparatus and a certain degree of bowel inactivity (constipation) follows. There is no substitute for this need. Drugs will not help you, mechanical devices will not do the work for you, though they may aid you. You must do the work yourself. If you fail or hesitate to recognize the truth, if you temporize or procrastinate, you are only deferring the issue. The argument that you have not the time, that your work will not permit you, is no argument at all. You must do it or reap the consequences; you certainly cannot escape them. The wise woman accepts the situation, the fool goes to an early grave.

Lack of Water.—Constipation may be due to a deficiency of water in the system. Women who suffer from this type do not drink enough water. The bowel may be willing and able to do its duty, but is handicapped because a certain amount of liquid is essential to proper digestion and natural bowel activity. At least six glasses of water should be taken by every healthy adult human being in each twenty-four hours. The best time to take this water is as follows: one glass on arising, two between breakfast and lunch, two between lunch and dinner, and one on retiring. Between meals means one hour after a meal and at least one-half hour before the following meal. No liquid should be taken during a meal, or immediately after, or before a meal. All water taken may be hot or cold, according to the fancy of the taker. It is of advantage to squeeze the juice of half a lemon into the water taken on arising if there is any tendency to constipation or if the liver is lazy or torpid. It is also good for the complexion.

Lack of Bulk in the Food Taken.—Sometimes the character of the food taken is such that there is no body to it. The process of digestion so completely liquefies it that the bowel has no solid matter to manipulate. To excite the peculiar movements of the intestinal wall there must be substance in the contents. The variety of the daily food must be so arranged as to provide this. A list of these foods is provided elsewhere in this book. Certain other foods stimulate intestinal activity, not because of their bulk, but because of the chemical elements they contain. All forms of sugar, the sugars of fruits, the acids of fruits and vegetables, are excellent natural laxatives. Sour milk and buttermilk, oils and fats, are also of distinct value in this respect.

On the other hand, soups, gruels, porridges, and purÉes are constipating because the digestive process reduces them to liquids and leaves no bulk for the bowel to act upon. New bread, hot biscuits, "noodles," and doughy foods are also objectionable, especially to children. Hot baths, hot drinks, hot enemas, and sweating are also constipating because they extract so much liquid from the bowel leaving the contents excessively dry.

Abuse of Cathartic Drugs and Aperient Waters.—This is a widespread evil; it may justly be regarded as a national curse. The victims of this custom do not realize that they are addicted to a habit which must be rightly regarded as equally as bad as the drink habit, so far as its ultimate effect on the general health and the prospect of longevity is concerned. Its popularity is a product of our national vice of indiscriminate eating and drinking. It is more common among the class who live in restaurants, hotels, and boarding houses, who keep late hours, eat late suppers and who do not exercise enough. These individuals eat too much and live too high. After a time the liver becomes sluggish, the stomach fails to digest properly, the bowels lose their tone, and flatulent indigestion or some other more or less serious condition follows; to maintain the pace, to feel and keep fit, they discover that a glass of some advertised aperient or laxative water before breakfast works wonders, tides them over for the time being and keeps them "in the ring." They compliment themselves and push the specter of age aside.

The thought that they were not "as young as they once were," or that they must go slow, was not a very pleasing suggestion, so having found a "cure" by adding another bad habit on top of an existence which is composed of nothing but bad habits, they start all over again. The suggestion that their trouble is a warning that "things are going wrong" and that the whole plan of living must be radically and promptly changed does not meet with their approval, and so the Department of Health statistics heap up the records of deaths due to heart disease, hardening of the arteries, Bright's disease of the kidneys and apoplexy. It is not a happy tale, but the truth is often tragic.

When a woman finds that her physical efficiency depends upon the habitual use of cathartic drugs or laxative waters, she must regard the knowledge with respect, she must give it serious consideration, and she must adopt means to so change her method of living, that nature will be given a chance to work in her interest—not against her. Better to find out exactly where the trouble is now, and go after it than to travel too far along the wrong road. Many die from the "disease" of procrastination.

Overeating.—Overeating may be included in this classification because it so overworks the digestive apparatus that it is impossible for it satisfactorily to complete its function. Any reader desirous of understanding the full significance of overeating in this connection should carefully read the article on this subject on pages 289 and 290.

There are, of course, a great many other causes for constipation but these are the important ones. When we find the cause of any particular case it will suggest the remedy and we must employ it faithfully if we hope to effect a cure. If it is negligence, we must correct that fault and compel our daily routine to accommodate itself to a regular observance of this function. If it is lack of exercise, we must get more exercise, or if it is lack of bulk in our food, we must change our method of living and select with more care the foods we eat. If it is lack of water, we can correct the constipation by adding the proper amount of water at the proper time.

A patient who has been a victim of chronic constipation for some time must live a life somewhat after the following general plan:

She should increase the vegetables, fruits, and fats in her diet and she should drink enough water. It is a good plan to sip slowly one-half pint of hot or cold water morning and evening. Daily exercise in the open air is advisable; exercise of some kind, even if taken indoors, is imperative. Walking, riding, bicycling, tennis, golf, swimming, are the best forms of exercise for women. Indoor gymnastics can be made a satisfactory substitute. After the exercise a hot shower bath and a cold sponge bath or cold plunge or a swim should follow.

Women in very moderate circumstances may walk briskly a distance of three or four miles, and on returning can take a warm bath followed by a brisk rub-off with a coarse towel wrung out of cold water, or they can use a hose with a spray nozzle and allow the cold water to run over them for a few seconds after the warm dip in the bath tub. After the adoption of these measures the bowels may tend to regulate themselves. If so, this is the proper time to cultivate the habit of regularity, by selecting a certain time each morning or before retiring for this function. The patient should go to the toilet at the regular time even if the desire is not present. By straining slightly, and by encouraging the voluntary desire, the bowel may receive the necessary stimulation and an evacuation may result. If there should seem to be no disposition on the part of the bowel to become accustomed to this procedure, we must aid it for the time being. A glycerine or soap suppository, a glass of aperient water, Pluto, Hunyadi, Apenta, or the imported Carlsbad salt in warm water, or the effervescent Citrate of Magnesium, will result in a prompt emptying of the bowel. There are a great many other cathartic drugs and many well-known laxative pills, etc., but these are not necessary if a systematic effort is being made to cure the constipation, because success will come within a reasonable time if the patient will not become unduly discouraged. Many victims are deficient in fat; the bowel needs lubrication; we therefore recommend a good quality of olive oil, one tablespoonful after each meal. Frequently it is of advantage to inject, high up in the bowel, two or three ounces of sweet oil at night, as is done in children, and which is fully described in the previous chapter.

If the constipation is due to deranged nerves, in which the reflexes of the intestinal wall seem to share, we advise massage of the abdomen, and an occasional hot or cold rectal injection. The proper quantity to use for this purpose is from two to three quarts. The solution to use is the normal salt solution. See page 627.

In that form of incomplete constipation in which we stated that there was a layer of hard, impacted feces covering the bowel wall, a special method of treatment is necessary. In these cases nothing will succeed as satisfactorily as very hot, high rectal injections. The object of course is to rid the bowel of the old, hard, dry mass, which has collected there, before we can hope to get the bowel into condition to perform its own work. It is almost incredible that the human bowel can hold so much old dried-out, nasty stuff as is stored up in these constipated bowels. Hot salt water, as hot as can be tolerated, two or three quarts at a time, is the correct way to dislodge this mass. It will not be done at once; it frequently takes two or three weeks before the bowel is fairly clean. The irrigations should be given every second night until the bowel is clean. The method of giving these washings is fully described on page 312. While these irrigations are being given the patient should take olive oil by the mouth, one tablespoonful after each meal. The proper food, open-air exercise, sanitary living, plenty of water, and regular attention to the bowel movements will in the end cure the affliction.