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value. The trouble in the treatment of kidney lesions or of Bright's disease is that we so often fill up the patient and try to sweat it out of him. In sweating the patient gets rid of non-toxic salts, but in getting rid of the water we rather increase the intoxication by intensifying the salts in the blood. The liver is another organ which is very much abused in the treatment of nephritic conditions by giving calomel, which is not indicated. The proper thing to do is to let the liver rest and let the alimentary canal rest. Put the patient on nothing to eat but small draughts of water, sufficient to quench thirst, and if you give him anything give him salicylate of soda, which is a slight hepatic stimulant and intestinal antiseptic.
TREATMENT OF CONSTIPATION.
BY THEODORE TOEPEL, M.D., ATLANTA.
I was prompted to write this paper by a discussion which took place at a meeting of the Atlanta Medical Society about a year ago, also on account of the wide experience which I have had in prescribing some simple methods of treatment and the good results derived therefrom. Before I enter upon my chosen subject, I ask your indulgence to a few general remarks by way of introduction.
Life, according to Herbert Spencer, is characterized by the power of living beings to preserve a mobile equilibrium within their environments, or, as he phrases it, by "the continuous adjustment of internal relations to external relations."
Natural recuperative power has been developed, not through the intaking of substances foreign to the organism, but by physical, chemical, and, finally, psychic reactions of the cells, tissues, organs, systems, and, a factor not to be ignored, of the organism as a whole.
We must recognize that disease and recovery are alike vital processes in which the organism itself is the most active agent, and that neither morbific nor therapeutic influences endow the organism with new attributes or introduce into its operations new powers, but we must keep in mind that disease and recovery are often, if not (265)
always, one continuous process. A health-preserving and health-restoring tendency exists; that is a natural endowment, and not the gift of art, and that it is dependent upon the inherent properties of cells, tissues, organs and the organism. Some of these qualities are constantly manifested, while others are evoked only in reaction to perturbing influences. Salutary reactions, however, may be delayed, deficient, or excessive; and thus art must come to the assistance of nature, and therapeusis finds its reason for being. All successful treatment, nevertheless, depends upon the evocation, stimulation and control of the recuperative reactions, together with the suppression, diminution, or neutralization of antagonistic reactions likewise occurring automatically as the result of extraneous, morbific influences or of internal failures or disturbances.
I have great faith in the power for good of the right drug, given at the right time in the right dose. Nevertheless, a more restricted use may be made of drugs with less danger of harm-doing by reason of mistake in the election of drug, dose or time, by the physician who familiarizes himself with the powers of the remedial agent falling into the group of natural or physiologic therapeutic.
But all that exists in nature is natural-drug equally with sunlight, microbe equally with antitoxin; and, under all the circumstances, the disordered functions of the paralytic, for example, are equally physiologic with the co-ordinated functions of the athlete. Moreover, any intervention by the physician in a case of illness, be it merely to enforce rest, or to regulate diet, or to open the windows of the sick-room, is an exercise of his art.
Hippocrates, the empiric, was the father of scientific medicine; the dogmatists were his opponents, and dog
matism is still the enemy of medical progress. Rational empiricism in medicine consists in the orderly arrangement and analysis of facts observed not only in the laboratory, but also at the bedside; and in making, from the data thus established, inductions to the principles of science, and deductions to the applications of art. In the experience to which rational physicians look, must be included the whole history of the human organism, and, indeed, so far as these can be learned, a study of the conditions that have affected the living matter before it was human; for in the actions and reactions of living matter with its environment, from the simplest to the most complex, are to be found the influences that have determined, not alone the physiologic, but also the pathologic, development of man, together with the power of the organism to recover from the disturbance that we term disease.
Speculation upon the origin of living matter is enticing, but not profitable. Given the original living matter with its inherent forces and tendencies, and its development into man, and man's coming into his present physical, mental and moral conditions, are the resultants of habit and environment. Under these general heads are to be understood the effects of climate and of weather (including heat and cold, the physical and chemical constitution of the atmosphere, sunlight and other light, electricity, etc.), the use of water, food and methods of feeding, rest and exercise of function, physical and mental, of which last not the least important phase is one commonly overlooked-emotion. These and similar influences having helped to make man what he is, may well be employed to remake him when he departs from the normal.
Hoping that this digression has not been too lengthy, I shall now proceed with the discussion of my subject.
Constipation may result from one or more of the following causes: 1. Insufficient quantity of solid food. 2. Too highly nutritious or concentrated food. 3. Insufficient fluid. 4. Astringent food and drinks. 5. Indigestible food. 6. Lack of digestive fluids. 7. Irregularity in diet. 8. Obstruction from overeating. 9. Lack of peristalsis. 10. Lack of exercise. II. Certain diseases, such as anemia, neurasthenia and hysteria, chronic infectious affections of the liver, stomach and intestines. 12. Habitual drug-taking. 13. Weakness of the abdominal muscles in obesity or from over-distention in repeated pregnancies. 14. The presence of tumors, physiological or pathological, pressing upon the bowel. 15. Atony of the colon, particularly of the muscles of the sigmoid flexure by which the feces are propelled into the rectum,
Before prescribing for constipation, interrogate the patient minutely as to his daily habits of life, such as occupation, hours for meals and for exercise, recreation and sleep, the kinds of food and quantity usually eaten, the amount and kinds of fluids drunk, hour for going to stool, the use of stimulants and tobacco, and presence of mental worry and anxiety.
The principles of diet in the treatment of constipation must be based upon supplying digestible food, which will excite peristalsis either by its bulk or its physical and chemical properties. Vegetable food in general, as distinguished from nitrogenous diet, furnishes a much larger proportion of waste matter. Herbivorous animals have more abundant evacuations than do carnivorous. The