but to the stagnation at some point in the alimentary tract – in the stomach or in the intestine. Flatulence in the colon always indicates the presence of decayed feces; and if not relievable by enema, indicates incompetency of the ileocæcal valve (c) a condition that one cannot afford to further neglect.

KINDS OF CONSTIPATION

Simple Constipation which every one has as the result of wrong eating and wrong habits. The bowels move daily, perhaps, but the colon is far from being completely evacuated. There is as yet no disturbance of the mechanism of the colon; poisons are, however, retained and nervous and other symptoms develop sooner or later. Even simple constipation should not be neglected when we consider that a normal peristalsis should pass along the entire intestinal tract every time the stomach end is stimulated to action by the intake of food.

Accumulative Constipation as its name implies OCcurs when masses of feces accumulate. This accumulation occurs at the lower sagging part of the colon (d) and shows that the mechanism of the rectum is beginning to be disturbed that sensibility is lessening. If neglected, complete loss of reflex - call

follows.

or

Latent Constipation the bowels still move daily-or regularly the "call" or reflex is still active; fecal matter is not accumulated in the rectum; nevertheless somewhere along. the tract there is delay and the feces are dark and ill-smelling. An incompetent ileocæcal valve (c) is most frequently the cause; and the presence of intestinal gas from which relief is not attainable by enema is a keynote in diagnosis, since in these cases, the gas escapes backward, as it were, into the small intestine a condition which obviously should never occur and which never could occur were the guard the ileocæcal valve -alert.

Of the chronic cases that present themselves at the doctor's office, there are two classes First: those that do not "believe in auto-intoxication," or at least do not recognize it in themselves. These it is the doctor's privilege to convince if he can. Patients will say that they are never constipated; will report a daily movement; but on closer questioning, their movement will prove to be far from sufficient to clear the colon, especially in consideration of Dr. Kellogg's statement that with every intake of food at the stomach end of the alimentary tract, peristalsis is set up the whole length of the tract and that in a normal savage, this peristalsis would end in evacuation. These patients are the despair of the earnest physician; and by the

superficial physician are labelled hysterical or neuræsthenic; or that overworked scapegoat, the climacteric, is held responsible, - all terms of scorn as used by the physician who has neither time nor scientific zeal to search for causes. The suffering of these patients, except when auto-intoxication has made deep inroads upon health, are not sufficiently acute to put the superficial physician on his mettle; but to the patient they spell defeat and misery. These are the "chronics" who come to the doctor patiently, on and on, seldom if ever suffering intensely, not in danger of immediate dissolution, but never knowing the joy of living because of the various depressions, physical and mental, which accompany a condition of auto-intoxication.

The other class admit that they are constipated; they recognize it and are worried about it; they have tried every known cathartic, and cathartics are failing them. The cathartic habituè is most difficult to cure; but, barring out organic complications or old age, the specialists along this line tell us that very few cases are incurable.

It may take time and it will require something more than pills on the part of the doctor as well as persistence and patience on the part of the patient. But with special diet, special massage, hydrotherapy, vibration, the sinusoidal current and thermo-penetration, much can be done for these cases. Much is being done for them in hydropathic institutions, and the methods of these institutions are open to any physician who wishes to investigate.

Wisely or unwisely, there is today a reaction in the minds of the laity against drugs; and it is the discouraged chronic who is turning to "drugless healing" of all kinds for help; but it is the superficial doctor who considers his duty towards his patient finished when he passes out the bottle of pellets who is largely responsible for the disaffection of the laity. Pellets have their function, and nothing can fill their true, legitimate field, but the field has its boundaries, and it is the modern doctor's privilege to recognize those boundaries and look over into the abutting provinces. We submit the following suggestion for

THE SUPPLEMENTAL TREATMENT OF CONSTIPATION

First, the patient must be made to appreciate the chemistry of digestion in order that he may do his part; he must live hygienically, avoid tobacco, alcohol, rich food, high proteid diet, irregular or hasty eating, etc.

Diet is most important of all measures; not only must it afford moisture and bulk to the feces; but foods must be rightly

combined. All gases in a chemical laboratory may be excellent so long as rightly combined, but they become most destructive when wrongly combined. Many a patient will outline to her physician a perfectly normal, wholesome, dietary regime; but on investigation one finds that she makes most atrocious combinations; sugar and milk with her cereal; fruits with vegetables, etc., etc.

TREATMENT FOR CUMULATIVE CONSTIPATION

The chief cause of this having been neglect of call until the reflex is more or less lost, this reflex must be restored by establishing regular habits. First of all, the rectum and sigmoid must be thoroughly evacuated by enema. This is repeated day after day until no hardened fecal matter comes away. The bowel must then be kept clean by systematic use of enema until it regains its normal size and activity. Temporary dilation with water does not weaken the intestinal wall; permanent distension with feces does.

The use of the sinusoidal current aids greatly in this restoration. In obstinate cases it may be necessary to use the proctoscope in order to introduce the electrode into or beyond. the sigmoid. Often the proctoscope reveals tiny abrasions which, naturally, favor quick absorption of poisonous feces.

Paraffin treatment, (oil per se) when once the intestine has been cleared, is excellent if not kept up too long. The laity are in danger of using the paraffin preparations now SO widely advertised too freely, until the lining of the intestine becomes so "oiled" that the lighter fluids, the natural secretions of the glands of both intestines, large and small, are unable to penetrate the oil and perform their normal functions.

Often hemorrhoids or sphinctor spasms exist in cases of accumulative constipation. Hot fomentations or sitting over boiling hot water will often relieve the spasm as well as the pain.

A special paraffin which melts at not less than 102 degrees F. introduced into the rectum with a piston syringe is excellent the patient then taking a knee chest position for three or four moments, breathing deeply. This special paraffin cools at the body temperature and forms a soothing lubricating ointment. This treatment is useful, since in these accumulative cases the mucus membrane of the rectum and sigmoid is dry and often sore.

TREATMENT FOR ILEOCÆCAL CONSTIPATION

In this form there may be diarrhoea as well as constipation, and mucus is often found in the stools.

It is best in these cases to give a bismuth test meal and examine with X-ray in order to locate the exact point of stasis, since ileocæcal insufficiency may not, in advanced cases, be the only trouble.

Hot fomentations to the spine and abdomen are useful; they allay pain at once. The wet girdle (cold) worn at night is most effective.

High enemas are at first necessary to wash out the accumulated toxins, but the point of disturbance in ileocæcal constipation is beyond the reach of water. (If one doubts that the intestinal wall has capacity for absorption, let him note the copious discharge of urine, which usually follows a high enema.)

The sinusoidal current is, of course, indicated here as well as in other constipations. Diathermy too is particularly useful in this, as in all disturbances of the colon, in that its heat reaches the deep tissues - an advantage over all other heat application. There is also a special massage movement for this disturbance. This is usually corrected by a few high flushings followed by laxative diet.

SIMPLE CONSTIPATION

Food is nature's laxative. The laxative qualities are due to the flavor and taste, to bulk, to moisture and to chemical properties. Proteids are toxic; therefore proteid should be kept at a minimum; uncooked foods are antitoxic, therefore should be encouraged; fruits are the most antitoxic of all foods, therefore should be used abundantly.

In order to obtain bulk, food containing cellulose should be eaten; the concentrated foods of civilized life furnish far too little bulk; and without bulk, the intestinal muscles have little to exercise upon. Sterilized wheat bran, mingled with morning cereal, forms the two ounces of cellulose which should be eaten daily.

Agar-agar, especially that manufactured under the name of Regulin, is a most effective stimulant to the intestine, and it provides bulk as well. Also its affinity for water is great; therefore sufficient moisture to the intestine is assured by it. These agar-agar preparations provide bulk where the cellulose of green vegetables fails, for the reason that agar-agar is not digested by any of the digestive fluids. Two ounces a day will, under any ordinary condition, produce two large, long, consistent stools a day; a larger amount may be taken, however, as it requires no work of the digestive apparatus other than the intestinal exertion to move it along, which is an advantage rather than disadvantage in all cases of intestinal torpidity.

THE CHEMICAL COMPOSITION OF SOME COMMON

FOODS*

BY WILLIAM A. PEARSON, PH. C., PH. D., M. D., Professor of Chemistry, Hahnemann Medical College of Philadelphia

It is the purpose of this paper to give the analytic results obtained by students of The Hahnemann Medical College, Class 1919, upon the chemical analysis of some common foods.

Not only are the percentages of fat, carbohydrate and protein given, but the number of calories in definite amounts of food, and the amount of each food constituent obtained for ten

cents.

All foods analyzed were purchased on the open market in Philadelphia in January, 1916.

The prepared foods were obtained from Horn and Hardart's Automat Restaurant, Market Street and City Hall Plaza.

(Geckler)

CORN MEAL Purchased at Acme Tea Company Stores, at 24c per lb.

FRUIT JELLY (Heinz)

--

0.7

5.7

0.2

8.43

1.65

16.3

484.39

218.59

882.41

Weight of Jelly 344.2 gms., price 30c

Weight of jelly on label 11 ozs., amount for 10c 114.7 gms.

Gms. per lb. Cal. per lb.

(Taggart)

Cal. for 10c

*Read before the Bureau of Clinical Research, A. I. H. 1916. Published in the Journal of the A. I. H. Repl., 1916. Printed in current number of Journal of American Institute of Homeopathy.