The physiology of digestion considered with relation to the principles of dietetics

by Andrew Combe

Where, however, as most frequently happens, the constipation arises chiefly from the absence of all assistance from the abdominal and respiratory muscles, and in part only from an inappropriate diet, the first step to be taken is again to solicit the aid of the former—first, by removing all impediments to free respiration, such as stays, waistbands, and belts; and, secondly, by resorting to such active exercises as shall call the muscles into full and regular action: and the next is to proportion the quantity of food to the wants of the system, and to the condition of the digestive organs. If we employ these means systematically and perseveringly, we shall rarely fail in at last restoring the healthy action of the bowels with little aid from medicine. But if we set these natural conditions at defiance, we may go on for years, adding pill to pill and dose to dose, without ever attaining the end at which we aim.

How, indeed, can it be otherwise? If the Creator has so constituted us that the free play of the lungs and muscles is indispensable to proper intestinal action, it is in vain for us to struggle against the arrangement, and expect to substitute beneficially the stimulus of purgatives for that of the natural play of the muscles. Either we must give up our own obstinate adherence to sedentary pursuits and conform to the divine laws, or we must submit to the punishment inseparable from disobedience, and merely endeavour to mitigate its severity by such partial remedies as lie within our reach.

Where bodily weakness, or any other cause, absolutely prevents us from engaging in active bodily exertion, corresponding moderation in eating, and continued kneading and rubbing over the region of the bowels, when used daily and persevered in till the strength is restored, are of great service in promoting their healthy action. Where great sluggishness of the bowels exists, and no exercise can be taken, the rubbing generally requires to be continued for an hour or more daily, or even twice a-day.

Sometimes intestinal inaction proceeds from defective mucous secretion on the surface of the internal coat, caused either by errors in diet or by local irritation. When costiveness is excited in this way, a mild diluent regimen will generally remove it. It is in such cases that saline medicines, which act by increasing the mucous secretions, are often very useful; while aloetic and other stimulant purgatives increase the evil by aggravating the irritation.

Such being the mode of action of the bowels, and such the natural agents by which it is carried on, we can now appreciate the folly of seeking to apply the same remedy to every kind of costiveness, no matter from what cause it proceeds. If a clerk who sits motionless all day in an office, who indulges his appetite, and has no bodily exercise to facilitate respiration and give a natural impetus to the bowels, begins after a time to complain of constipation, it is not difficult to tell what is required for his cure. The first step which a knowledge of the animal functions would suggest, is to diminish the food to such a quantity as the stomach can digest; the next, to use such a diet as is calculated to excite the muscular coat of the intestine to healthy activity; the third, to seek the natural aid arising from exercise of the abdominal and respiratory muscles; and the last of all, to have recourse, when necessary, to such medicines as may be required for a time to restore the tone of the bowels, and enable them to act without further assistance. The course usually adopted, however, is widely different from that here described. From ignorance of the laws of organization, the patient is not aware of the extent to which he infringes them in his conduct, and consequently rests satisfied with lamenting his hard fate in possessing such a bad constitution, and resorting to strong medicines to force that action which he feels to be essential to health, but which he will not consent to elicit by the means with which Nature has furnished him.

Among the middle and higher classes, very many females act on the same erroneous plan, and with equally unfortunate results. In them the evil is aggravated by the tightness of their clothing impeding almost entirely the descent of the diaphragm, and the free play of the abdominal muscles, in respiration.

From this view of the nature and causes of costiveness, it will be evident, that, as a general rule, the bowels are perfectly competent to the discharge of their functions, when the conditions essential for their healthy action are duly fulfilled. And hence, whenever they become morbidly inactive, we may rest assured that, in some point or other, our own management is or has been defective; and the surest way to remedy the evil is, not to have instant recourse to medicine, but to begin by discovering and amending the defect. In the rare occurrence of constipation among children and other actively employed persons, we have ample proof of the fundamental principle that the bowels do not naturally stand in need of the stimulus of medicine, but require only to be properly treated to fit them for the office with which they are charged.

While, then, I entirely agree with public opinion in attaching great importance to the proper regulation of the bowels, and in tracing much suffering to their neglect, I am only the more anxious that we should, as far as possible, follow Nature in our arrangements, and reap the benefit of her aid. If we do so, we shall not only be less frequently obliged to have recourse to medicine, but, by our knowledge of the causes of the deficient action, be greatly assisted in our selection of an appropriate kind of laxative, and thus avoid forcing the constitution too far. It sometimes happens, for example, that, from debility of the muscular coat, the peristaltic motion is insufficient to propel the contents of the intestines, even with the aid of proper diet and exercise. In such cases, small doses of aloes or rhubarb, or other laxatives, which act chiefly by exciting the muscular contraction, will be sufficient to clear the bowels, especially when any mild tonic is conjoined with them; while saline laxatives which act chiefly on the mucous coat, may be given freely, and even cause numerous watery evacuations, and yet the real or solid contents of the intestines continue unremoved. In practice this often happens; and hence the frequent mistake of supposing that there is proper passage from the bowels, when in reality there is no such thing.

The period of life at which intestinal inactivity is attended with the most serious consequences, is at and for a few years after puberty. At that age a sudden change is often made from the restless activity of youth to all the stillness of a sedentary profession, without any corresponding alteration being made in the quantity of food consumed. The vigorous appetite, which is perfectly natural during a period of growth and great bodily activity, remains at first unimpaired, and impels the individual to eat an amount of food far beyond the present necessities of the system or the powers of digestion. The consequence is a tendency, not only to fulness from excessive nutrition, but to severe digestive disorder from the stomach and intestines being weakened both by want of exercise and by excess of food. I have known many instances of dyspepsia, constipation, and mental affection, and even of active inflammation, thus produced. In one case, four years of continued bad health in an otherwise sound constitution were the penalty inflicted before the real cause was accidentally discovered. During all that time, too, temporary relief invariably followed the use of purgatives, and seemed in some measure to point to the truth; but from the mind never having been directed to the principles, its practical bearing was overlooked, and now the individual wonders that the cause did not, even at first sight, arrest the attention of his medical advisers.

In cases of this description, however, it ought to be observed, it is not the mere constipation which injures the health and requires to be removed. It is in reality to the mode of life which induces it that we ought to direct our attention; for, unless that be amended, all our efforts to preserve the health by merely removing the effect will prove insufficient.