In persons who are fairly normal these changes may be brought about very quickly by regulation of the diet and a voluntary effort to move the bowels after each meal; but in persons who have been chronically constipated for years, other measures are necessary. Means must be employed to combat chronic constipation systematically and continuously. It is not proper, how-ever, to resort to the habitual use of laxative drugs, such as castor oil, cascara sagrada, senna, etc. Salines and even laxative mineral waters must be avoided. All of these things do harm. They invariably aggravate the spastic condition of the descending colon almost always present.

Laxative drugs also produce an exaggeration of the anti-peristaltic movements, which begin in the transverse colon and travel backward toward the cecum. These movements are natural during digestion but do not interfere with the periodical movement of the intestinal contents. Colitis, rectal constipation and especially the use of laxative drugs greatly exaggerate this anti-peristaltic action and so increase the tendency to stasis in the cecum and the ascending part of the colon. It appears to be more than probable that this exaggerated anti-peristalsis set up by mechanical obstacles to normal bowel function existing in the distal colon is the chief cause of dilatation of the cecum and incompetency of the ileocecal valve, which is brought about by the over-distention of the cecum.

Bran and Paraffin

In the great majority of cases of constipation, even very obstinate cases, in which a natural movement of the bowels has not occurred in many years, the difficulty may be quickly over-come by increasing the bulk of the food intake and by adding a lubricant in the form of paraffin oil. The modern diet in civilized countries is by far too highly concentrated. The human intestine is adapted to a bulky diet. The average bill of fare leaves practically no residue after the digestive process is completed. This fault may be easily corrected by the addition of sterilized wheat bran in sufficient amount and by the free use of fresh fruits and green vegetables.

For normal persons living on a biologic diet bran would not be necessary, but persons who have been for years constipated have crippled colons, the colon is dilated and elongated, its muscular walls are weakened by long continued over-distention, and the mechanical stimulus furnished by a very bulky dietary is essential,

Such colons are also crippled by degeneration of the glands that normally furnish an abundance of lubricating mucus. This is particularly true in cases in which the appendix is diseased or has been removed but is also true in practically all cases of chronic constipation. This permanent deficiency may be compensated for by the use of paraffin oil which acts purely in a mechanical way, lubricating the intestinal wall so as to facilitate the onward movement of the colon contents. One or two tablespoonfuls of bran and one-half ounce to two ounces of paraffin oil taken at every meal will usually secure three or four bowel movements daily. The bran should be mixed through the meal. The paraffin oil should be taken a short time before the meal. Neither the oil nor the bran act as laxatives in the ordinary sense. They do not irritate the bowel. The bran stimulates the bowel not by irritation but by a sort of titillation, hastening peristalsis in both the small intestine and the colon, and by hurrying on the unused residues of each meal leaving no opportunity for the development of putrefactive changes. Bran also excites the intestine to action by distending it, and by the same means stimulates the activity of the glands which furnish the digestive fluids.