Digestive Diseases


THE head of the department of medicine in a large university medical school said to me the other day, “Do you ever hear of constipation any more? It seems to me almost a thing of the past. I have not myself, personally, taken a cathartic for ten years. And I do not believe there has been more than one dose a year given to any member of my family—and those all to the children.”

Well, if my correspondence is any criterion, he will seem to many to have reached a paradise of bliss. There is still plenty of constipation in the world. But there is a great deal in what he says. Constipation is no longer regarded as a serious disease entity.

There are, I believe, two reasons for this. One, and perhaps the most important, is the changing diet of people—at least, the American people. Within the memory of many of us who are not yet entirely in our dotage, the standard American meal was meat and potatoes. Somewhere in the late nineties the “extra vegetable” began to appear as a regular or frequent addition to the average (I emphasize that) American meal. Before that the prune, which bore the brunt of dietetic humor in the old days as spinach does now, was about the only form of roughage that was evident. Except perhaps the midnight apple. And let no one sneer at the apple as a constipation preventative.

But gradually the preponderance of meat went down, and the percentage of vegetables and fruits went up. Potatoes are now, in most households at least, a minor feature of a meal. Think of all the vegetables and fruits with which we escape monotony most of them of quite contemporary introduction. Broccoli, asparagus, tomatoes, carrots, celery, endive, grapefruit—in many quarters they were considered poisonous when I was young. Cabbage, sauerkraut, slaw, cauliflower and dandelion have risen in the world—they belonged once only on humbler tables. Now they are the delicacies of the season.

Salad has become a regular part of a meal. Indeed, for some business men and business women, it is the meal in itself. And with its watercress and lettuce, celery, fruit slices and tomatoes, it makes up a good load of bulk to act as a cleanser. And if one uses mineral oil instead of olive oil (I defy anyone to tell the difference by taste if a little olive oil is put in and the whole skillfully mixed) in the dressing, it leaves out the fattening part and puts in the best laxative for chronic use.

The amount of fruits we use now in comparison to other days is simply overwhelming.

All of these articles are healthy and furnish the roughage or bulk that constitute a gentle but effective stimulus to the intestinal movements.

Furthermore, they are now produced and distributed so inexpensively that they are available to all.

The second reason that constipation is heard of less is that fewer people take it seriously. It is no longer regarded as a health menace. But that is another story.


The question of the advisability of giving roughage to help elimination has been hotly debated during the last few years. When roughage in the form of bran or other fibrousy vegetables, or in the more artificial form of agar-agar, mineral oil or psyllium seed—when the idea of the value of these materials first became known, there was nothing but praise for them. Then there came some mildly expressed doubts as to whether they did any good or not. Agar-agar, for instance, was reinforced by active cathartics like cascara, and phenolphthalein, in order to make it effective. Finally reports came out from clinics and physicians specializing in stomach and intestinal work, that the use of roughage was actually harmful; that they had seen many patients who had so irritated their intestinal surfaces with continued onslaughts of roughage that they were sicker from the treatment than from the disease.

This was not allowed to go without some objection, and the repercussion showed that bran, etc., was not as bad as the indictment read.

The truth probably lies somewhere between the two extreme points of view. The type of person who uses roughage must be considered. People with naturally sensitive intestines, who feel that they must have one or two evacuations a day, are liable to make themselves extremely uncomfortable. Too much dosage and regular daily dosing is always bad—and is a very distinct danger when anyone starts in the habit of self-dosing, regulating the amount and time by their own judgment. Certainly the more you have of these substances, the more you feel you need.

But that roughage has real value in more ways than one is undoubted, and has been well shown in a recent study on the use of regenerated cellulose. Regenerated cellulose is as nearly pure cellulose as can be obtained, is free of calcium, phosphorus and nitrogen, and looks something like chopped up cellophane. Being treated to remove all chemicals but the fibre, its action is due purely to its bulk.

Measured amounts of this substance were found to be definitely laxative, increased the weight, water content and number of the evacuations. Another result was that there was an increase in the loss of nitrogen, calcium, phosphorus and other minerals from the body, so that the wisdom of giving a high roughage diet to children is questionable.