Irregular or disturbed peristalsis is one of the difficult problems we have to deal with. It will be impossible to touch upon all the points, even the practical ones, in regard to this very common disorder; nor will it be possible to even mention some of the very important accessories in its successful management. Is it a wonder, when we consider the abuse to which the digestive tract is subjected, that disturbances result? In rapid succession hot, cold, fried, baked, boiled, solids and fluids, mineral matters, proteids, carbohydrates, hydro-carbons, spirits and malt liquors, oftentimes in excess, are put into this much abused channel; in other words, “the eating, drinking, planting, counting man, does not, as we know him, represent himself, but misrepresents himself.” Man fortunately, or unfortunately, has inherited a capacious and seemingly large intestine in which a most abundant flora seems to flourish. Erroneous diet undoubtedly shortens life in many instances, though Brawn, the Irish landowner, who lived to the age of 120, had an inscription put upon his tombstone that he was always drunk, and when in that condition he was so terrible that even death had been afraid of him. Others who drank wine, whiskey and coffee excessively became centenarians.
Doubtless the accumulation of waste matter retained in the large intestine for considerable periods becomes a nidus for microbes, which produce fermentations and putrefactions harmful to the organism. It is certain, though our knowledge is limited on the subject, that the intestinal flora contains some microbes which damage the health, either by multiplying in the organism or by poisoning it with their secretions. Persons have been known who do not evacuate their intestinal tract for several days, who, none the less, do not suffer in health; but the opposite result is likely more common.
It has been contended that the retention of faecal matter for several days very often brings harmful consequences. Organisms which are in a feeble state from some other cause are especially susceptible to damage of the kind referred to. Cases are on record where constipation of infants caused serious illness, such as high fever, insomnia, convulsions and other serious symptoms due to poisoning by toxins.
The exciting causes of disturbed peristalsis are so numerous that routine treatment is out of the question; usually, however, the real cause is one, viz., that the propelling force is not sufficiently great to expel the faeces. This cause may be due to diminished muscular contraction, or it is insufficient to overcome some resisting obstacle. In the greater number of cases it is doubtless due to diminished muscular activity, including the whole muscular mechanism of defecation. In a large number the trouble will be found in the colon, in others in the rectum.
The modern method of treating constipation consists justly in the restriction of drugs. The injury done in the past by too much drugging has become well recognized, even by the regular school, but in many cases drugs must be used as aids to other methods, and they give very satisfactory results. We should remember that all purgatives are irritants. A non-irritant cathartic does not exist, even castor oil, it has been shown, does not act merely by its fatty nature, but by being split up with the production of a gently irritating acid principle. It would then appear that diminished peristalsis must be overcome by irritation of the intestinal tract. As a substitute for active cathartics, other irritants mixed up with the food are employed, such as salted articles, raw fruit, fruit juice, preserves, etc., also have this irritant action. The use of these may be carried too far, because it is supposed to be nature’s method. It is a question, then, which is more injurious, the gentle irritation of a small purgative, or the irritation of a large quantity of raw fruit, such as figs, prunes, and the like? Any irritant that will bring about an explosive outbreak is injurious, as reaction in the opposite direction follows. The pendulum must swing the other way. To establish regular, persistent peristalsis should be the object of treatment. As previously stated, the object of this paper is not to consider the many adjuvants, as electro- and psycho-therapeutics, vibration, exercise, proper diet and environment, surgical methods, but simply to give the indications of a few remedies based on the law of similars, that have helped me to overcome this very troublesome disorder.
If the rectum in particular is inactive and relaxed, there prevail the well known symptoms, “Sensation as if the faeces would pass, but suddenly recede into the rectum.” If, now, a physical examination be made, this organ will be found relaxed and full of large faeces. The symptom just named can be explained from the fact that the upper bowel is active and thereby the faeces are forced into the lower bowel which is inactive and there retained. The atonic condition of the lower bowel is so great that the faeces can only be removed by artificial means. The propelling force is so feeble that the rectum cannot be spontaneously evacuated. For this condition Silicea is specific. Relaxation, want of power and grit of the muscular coat of the rectum as well as a lax condition of the abdominal muscles are indications for Silicea. A Silicea patient is suffering from deficient nutrition; there is imperfect assimilation. Should the patient be suffering with local sweats, Silicea is still more strongly indicated.
Kali carb. should be carefully compared with Silicea in atony of the lower bowel. Large faeces are also characteristic of Kali carb., but instead of the sensation of “slipping back” we find a feeling of weakness and a want of power to expel the contents. The mental condition of Kali carb. will help us to decide, viz., irritability, anxiety and sadness which characterize Kali carb. In constipation of nursing infants with unnaturally large faeces expelled with great difficulty, Kali carb. should be kept in mind.
In anaemia and chlorosis by which the mechanism is interfered with, either by diminished nutrition, or by changes in the quality of the blood supplied, Kali carb. will benefit.
To illustrate the applicability of Silicea, I will relate a clinical case. An old nervous and poorly nourished anaemic woman, who has been suffering from constipation for many years, with the Silicea symptoms just mentioned, plus great dislike for meat, and aggravation and distress after an evacuation, was completely cured with Silicea and liberal mixed diet, she having been a vegetarian.
We will now consider Opium, which is one of the most complicated substances in the materia medica. It contains mucilage, albumen, fat, sugar, and salts of ammonia, calcium and magnesia. It also contains about seventeen alkaloids, and two neutral substances, as well as a peculiar acid – meconic acid (Brunton). In old school practice, it is the prince of pain killing palliatives. Hahnemann says: “It is more difficult to estimate the action of Opium than of almost any other drug.” That Opium in appreciable dose constipates is well known; that in refracted dose it opens the bowels has been admitted, hence it must be homoeopathic to some form of constipation. In other words, it has been proved that large doses of Opium retard or hold in check peristalsis, and that small doses increase it.
In regular practice this drug is used in rather appreciable doses to diminish active peristalsis, in diarrhoea, for instance, as well as in certain forms of constipation in which increased and painful peristalsis induces an ineffectual effort; for this, smaller doses are administered, thereby quieting the disorder and relieving the constipation.
According to the law of similars it doubtless acts as a stimulus in certain forms of diminished peristalsis.
What class of cases brings Opium to our minds? First, we think of it when there is a want of susceptibility to remedies, a lack of vital reaction. The seemingly well chosen remedy makes no impression. The digestive organs are inactive; peristaltic motion is reversed or paralyzed. There seems to be an insensibility of the nervous system depression.
The mental condition of the Opium patient has from some cause or other been disturbed, possibly from fright, which has led to decreased intestinal action.
Torpor characterizes the Opium canal. There is absolutely no desire to evacuate the bowels, and instead of large stools, as we find in the remedies just mentioned, the Opium stool is very small.
While in the Opium condition intestinal peristalsis is lowered, the muscular coat is nevertheless in a moderately spastic state, which accounts for the unusually small faeces.
Here seemingly exists a combined or dual action atony and spasm. Here undoubtedly atony is the foundation from which is evolved the spasmodic condition.
Generally active peristalsis results in frequent evacuations – not in all cases, however. There prevails oftentimes active peristalsis, accompanied with pain, rumbling and ineffectual effort to expel the faeces. Instead of relaxation of the muscular coat there is contraction, and in consequence stenosis, which prevents the progress of the faeces. Such conditions call for Nux vomica. Toxic doses of Nux vom. increase peristalsis to a high degree, and small doses diminish a similar condition. In gastric and intestinal disorders Nux vom. has a very wide range of action. In fact, the entire gastro-intestinal canal is affected by this drug.
Nux vom. is of value in gastric, as well as in rectal irritability. It meets conditions entirely different from the remedies previously mentioned. The constipation of Nux vom. is not due to atony. The functions of the Nux patient are performed fitfully, spasmodically and inharmoniously, hence it may be of benefit in diarrhoea as well as in constipation; or there may be alternate diarrhoea and constipation. Again, in spite of a daily evacuation, only a part of the faecal mass is removed; from the colon faecal matter may pass by or through the faecal mass that is left, in this case the patient may not be aware that he does not empty his bowels completely. This old matter by its constant presence, may prevent the normal reflex that results in peristalsis, and may eventually produce anatomical lesions. This trouble is found in the flexures, most commonly in the sigmoid. In this condition, after the bowels have been cleansed out by high injections of sweet oil, Nux vom. will aid in establishing a normal peristalsis.
In order to illustrate the action of this drug, I will recite the case of a nervous, irritable, fitful, over-sensitive, constipated individual. After a meal his clothing feels uncomfortable; retching predominates over actual vomiting. In addition he has frequent but ineffectual urging to stool, not inertia of the rectum as in the remedies already considered. This patient has been the rounds and now wants relief or death. I told him the latter would be much easier matter for me than the former. He also complains of a sensation in the rectum as though obstructed, and as if much of the faeces still remain there, and he cannot sleep after 4 A. M. The faeces were small but flattened. Examination revealed nothing more than a very hyperaesthetic condition of the rectal walls. Small, tepid water injections for a short time as an adjuvant and Nux vom. persistently administered completely removed the disorder.
Antimony, a drug much used a century ago, has fallen into undeserved neglect. Antimonium crudum has its center of action in the gastro-intestinal mucous membrane.
The white tongue has generally been recognized as a salient symptom; if, however, the intestinal mucosa is alone involved, the tongue may be perfectly clean; in this case Antimonium crudum is equally the similimum and curative drug. In old people we often find obstinate constipation due to a thickened mucosa and paresis of the bowel.
For gastric derangements with hepatic disorders and chronic constipation with very hard, dry round stools, sometimes covered with mucus, Antimonium crudum will demand attention. Instead or atony we have a catarrhal condition present. In this drug the stools are similar to those of Opium, small, round and hard, which imbed themselves in the congested mucous membrane of the large intestine, and whose pressure induce watery evacuations in order to expel them. Here we have a combination of constipation and diarrhoea, or a constipation causing a diarrhoea, and Antimonium crudum will be the curative remedy. Additional symptoms will likely be a snarling temper, haemorrhoids, rheumatic, gouty symptoms, all depending upon an overworked, sluggish intestinal tract.
Lincoln Phillips, M. D., Cincinnati, O.: I want to commend these clear cut remedy indications, by Dr. Geiser. He is one of our able, painstaking homoeopathic prescribers. It seems to me the cure of constipation should be commenced very early in life. We are getting to be a constipated nation at the present time because the bill boards, newspapers and medical journals are plastered over with advertisements for somebody’s pills to act on the liver or regulate the bowels while we sleep and we are doping ourselves – we are made to feel that a clean-up is absolutely essential to life. Now I believe this: There is as much difference in individuals as to how often and how much the bowels should move as there is as to every other function of the body. You know very well, if you will take healthful children, you will find that one child goes on gaining its normal weight and its bowels will move four or five times a day; perhaps another child will do quite as well in gaining weight and be equally as healthful and have one movement every day or every other day. So I believe it is wrong to assume the bowels must move every day in order that we be healthful.
Another point is the establishment of time, for instance, for a movement of the bowels. Everything that we do is the result of persistent training, no matter what it be – it is persistent training. Now, then, this function of movement of the bowels is cycle in its nature, just the same as is every other function in the body and this desire for a movement of the bowels, if brought about normally, we will say at one time of the day, and again the same time the next day, since nature works in cycles, will at that time next day set up in man a desire for a movement of the bowels. Yet we oftentimes do neglect it, the cycle time passes; next day when it comes along perhaps the notion won’t be quite so strong. What do we do? We take somebody’s “little liver pills,” and as a result, we get these cyclic times broken up and in a little time nature ceases to try to do things in a normal way and she must be whipped and spurred in order to do it. So, I say, in the first place, I believe that people differ as to time and frequency of movement of the bowel, just as they do in every other function and that it is not absolutely necessary that the bowels should move every day in order for each separate individual to be healthful.
The slogan “clean out, clean up, and keep clean,” is being overworked to the glory and profit of sundry pill rollers.
H. W. Champlin, M. D., Walter’s Park, Pa.: I had, Mr. Chairman, for some years, as a patient, a very intelligent man, a professor in a normal school, who thanks the doctors to let his bowels alone. They move once a week, which answers his purpose and he does not wish to disturb them oftener, which, he thinks, would cause trouble without any compensation whatever.
Some years ago I read a paper in the Pennsylvania Society on the treatment of typhoid, in which I advocated movement of the bowels by enema frequently, particularly in the early stage of the disease, cleaning them out very thoroughly and, perhaps, continuously, throughout the disease. That brought out statements from physicians there, men older than myself, who told of their early experience in practicing strict Homoeopathy, in which they refrained entirely from cathartics and mechanical methods of clearing the bowels. They recited numerous cases in which the bowels went even twenty-one days without a movement and the patients recovered, showing a better percentage in recoveries in what was believed to be typhoid fever than many of us can show to-day. I fully believe the truth of their statements. However, these may have been cases of constipation with infection, auto-intoxication, rather than true typhoid – at least a certain percentage.
I want to emphasize a most excellent statement in the doctor’s paper, advising us to refrain from permitting the patient to have irritating foods and things that are used to promote peristalsis, such as graham bread or, as I find some of my patients using, “hull of wheat” – I suppose it is bran, because of the mechanical irritation of the lining of intestinal tract. For patients under my treatment, I do not advocate the use of graham bread or such indigestible things, or castor oil. Patients say castor oil is so soothing. It is a mistake. It proves to be curative in some cases of enteritis because I think it is homoeopathic to the condition. That is where it gets its reputation for being so healing, as people say.