Excerpt from American Journal of the Medical Sciences, 1912, Vol. 144

Such a thing as natural constipation, in my Opinion, does not exist. Some reason must he looked for as a cause for the deficient evacuation. In childhood such reason is found occasionally in some anatomical malformation, but this is seldom. The common cause is neglect of the habit of evacuation, or, even more commonly, a wrong diet.

When I looked over these boys I found absolutely no anatomical deformity, but on questioning the mother as to their habits and diet, I found that the custom of having stool at a special time of day had never been insisted upon, and the mother told me that she was very careful as to their diet and had always been. I was away on my vacation when consulted as to these boys, so had no means of making careful record of the physical findings, weight, urine, etc. Suffice it to say that the only abnormality found was a condition of inanition in both children. When the mother told me how she was feeding them, into the details of which it is unnecessary to enter, I was not surprised at their physical state. They were being fed on foods which had almost no residue, and they were not receiving enough even of such food.

To the joy of both boys 1 increased their diet considerably, giving both foods which had more food value, and what is just as important, a sufficient amount of the fodder vegetables to produce enough bulk to the residue to stimulate peristalsis. I also pre scribed the amount oi water to be taken daily and the times at which it should be taken. I instructed the mother to have the boys go to stool at the same time each day and try to have a passage. If this did not come without great straining, to give a small enema of soaped water to start it. I also ordered that all laxative medicines be stopped. After the third day the enema was not needed. It is over a year since this advice was given, and the boys have neither of them required a laxative Since. I have several such: cases on record, so I feel sure that we can put down as one of the chief etiological factors in constipation, especially in children, a lack of sufficient bulk to the residue of the food, and, as another, neglect of the habit of evacuation. The former can readily be supplied by the use of a sufficient amount of the fodder vegetables, and the latter by discipline.

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