A few months later this same woman had to undergo a much more serious operation for multiple fibroids of the uterus and removal of the appendix.  This time I advised the surgeon against the use of any purgative, and he took my remarks so seriously that he did not even allow an enema to be given.  This time the patient showed no signs of exhaustion and had very few gas pains.  I firmly believe that the day will soon come when a patient under operation, or a patient after childbirth, will no longer be depleted by a weakening and dehydrating cathartic and by a period of starvation, at a time when he needs all the energy he can summon.

=Cathartics and Childbirth.= The article referred to in the “Journal of the American Medical Association” cites the experiences of Dr. R. McPherson of the Lying-in Hospital of New York, “who showed that the routine purgation after confinement is not only useless but harmful.  Of 322 women who were not purged, only three had fever (and one of them a mammary abscess); most of them had normal bowel movements and those who did not were given an enema every third day.  Of 322 women who were delivered by the same technique and the same operators but were purged in the usual routine manner, twenty-eight had some fever.”  This experience of one physician is corroborated by that of others who find that the more we tamper with the natural functions in time of stress the harder do we make the recuperative process.  There are certainly times when catharsis is necessary but “one thing is certain, the day for routine purgation is past."[54] Even in emergencies we need to know why we administer cathartics and in chronic cases we may be sure that they are always a mistake.

[Footnote 54:  Ibid, p. 1286.]

="An Old Trick."= Before we make a practice of interfering with Nature’s processes, it is well to remember how old and stable those processes are.  As long as there has been the taking in of food, there has been also the casting out of waste matter.  The sea-anemone closes in on the little mollusk that floats against its waving petals, assimilates what it can and rejects the rest.  In the long line from sea-anemone to man, this automatic process of elimination has gone on without a hitch, adapting itself with perfect success to the changing habits of the varying types of life.  So old a process is not easily upset.  And, be it noted, in the human body this automatic, involuntary process still goes on with very little trouble until it reaches a point in the body where man, the thinking animal, tries to control it by conscious thought.

=A Question of Evacuation.= Much of the misconception about constipation arises from the mistaken idea that this is a disorder of the whole intestine or at least of the whole colon.  As a matter of fact, the trouble is almost wholly in the rectum.  There is no trouble with the general traffic movement, but only with the unloading at the terminus.  In my experience, the patient reports that he feels the fecal mass in the lower part of the rectum, but that he is unable to expel it.  Examination by finger or by X-ray reveals a mass in the rectal pouch.  If there is a piling up of freight further back on the line, it is only because the unloading process has been delayed at the terminus.