*** [Constipation, its Theory and Cure; embracing the Physiology of Digestion, and the injuries inflicted by the employment of purgatives: by JOHN EPPS, M. D., London-pp. 440.]

The presence, within the sphere of the personality, of a morbid influence manifests itself through external symptoms. Whatever may be the ultimate character of these symptoms, -whether they eventually result in blood congestions or organic lesions-they nevertheless have their primary movements and manifestations in a disturbance in the normal, i.e. in the usual distribution of the vital nervous currents. The currents of nervo-vital energy which, for instance, in health, are continually flowing through the nerves of the lower extremities, giving life, strength and movement, are under certain diseased impressions, diverted from their natural channels: and instead of the natural temperature of the feet, we find coldness and discomfort there. Under these circumstances, the head may be the portion of the system which correspondingly suffers, though in a precisely opposite direction, the state of that organ being one of repletion instead of deficiency. It would certainly be improper to say, either that the cold feet were the cause of the hot head, or that the hot head was a cause of the cold feet. Both these phenomena should be considered as caused by a third which is primary, and which has its material, external manifestation through these and other symptoms, if others there are connected with the case. The primary cause is the morbid element-the disease itself-which lies behind all the symptoms, in the personality of the patient.

Now in a state of health, there are, constantly flowing through that portion of the nervous apparatus which influences the process of digestion, nervo-vital fluids, whose peculiar function is to preside over and carry on that process. Through these nervo-vital fluids, the organs concerned in the work are endowed with the vital affinities requisite for the proper performance of their respective parts. The liver secretes its bile-the stomach, its gastric juice-the pancreas, its peculiar fluid-the intestinal lining, its mucus. The absorbents, under the impulsion of their nervo-vital forces take up the results of the action of these various secretions upon the ingesta, and peristaltic action removes the debris. Thus all the processes go on normally and well. But if a divergence from the natural channel occurs in the fluids which carry on the process described, the whole action is interrupted, and certain very unwelcome phenomena make their appearance, to the great discomfort of the party concerned. One of the least of these is Constipation, magnified as it has been into awful importance by the ignorant physicians of past ages.

The profound regard with which we consider every symptom occurring in the course of any disease must naturally prevent us, as Homoeopathists, from assigning any such undue importance to any one, as is given to constipation, by the popular or allopathic mind.*[The term allopathic mind may strike some of our readers as a singular and perhaps improper expression. The human intellect may be expected, from its innate qualities, to have other thoughts and affections than those bounded by so small an expletive. Our own recent observations, however, have convinced us that the Creator, for some wise purpose of his own, has permitted such things to be; and that a degree of littleness has been attained, under the influence of a fine allopathic education, which completely and thoroughly incapacitates the intellect for the reception of any idea outside an allopathic college or publication.]

We therefore put it down as an incident occurring in the course of a destroyed nervous equilibrium, and consider it simply one of a series of phenomena among which, perhaps, will be the cold feet and hot head above referred to; furred tongue; loss of appetite; irritation of the organs of special sense; passive hemorrhages; urinary difficulties; mental derangements; and even warts on the fingers and corns on the feet. We repeat again that the simple constipation of the bowels has nothing whatever to do with the rest of the phenomena presented in a case. It is by no means a cause of the hot head, any more than the corns on the feet. All the phenomena have a common cause, which is the morbid element itself, behind them all, in the personality of the patient.

The faulty nosology which names a diseased condition after one of its symptoms has contributed a good deal toward giving its present importance to this symptom of costiveness. Inasmuch as a distinct individualization, “a local habitation and a name,” so to speak, has been given it-since the unevacuated rectum has been elevated to the dignity of a place in the nosology-constipation has been considered almost a specific disease, and many are under the impression that it should be treated as such; and hence the old-school practice of purging takes its rise.

In this place perhaps, as well as any other, we may be permitted to inveigh against the fancied necessity of giving a name to disease. A man is sick-very sick, it may be-in a manner which indicates Belladonna. He recovers under the use of it. The patient may have had sore throat, or inflammation of the brain; Belladonna has cured him. If it is deemed proper to report the case, it should be done in full, with all the symptoms in detail; but no name need be given to the disease. There are reasons for this which may not appear at first sight. For suppose the above case to be called an inflammation of the brain (because the determination of the nervo-vital forces was toward the cerebrum, to the extent of producing irritation); then, a case of this disease has been cured with Belladonna; and forthwith, many, who depend on clinical experience, prescribe Bell, in every case of inflammation of the brain, and of course in many cases in which it is by no means indicated.

Again this custom of naming diseases causes the very severe cases to be confounded with the very slight ones, and false mortuary ratios are drawn between different systems of practice, or the practice of different physicians in the same school.

But to return to the matter in hand: in that condition of the system to which the name of Constipation has been given because constipation is a troublesome symptom, the nervovital fluids have been diverted from their usual channels into other directions. Most commonly we find disturbance in the skin, the kidneys, the mucous membranes of the respiratory organs, and the brain and organs of special sense. No careful observer can fail to have noticed how frequently patients complain of a troublesome perspiration on the slightest movement. In the cases of chronic constipation (so called) which present themselves at the Central Homoeopathic Dispensary, in this city, this symptom is perhaps more constant than any other. Cures are almost always effected in these cases with Nat. Mur. 12 or 30, three doses a week, or perhaps six doses in three weeks. When the sweats are nocturnal most benefit has been derived from Kali Carb. in the same potencies, administered in much the same manner. This experience corresponds precisely with that of Dr. Epps in the book recently published by him.

In those cases where an opposite condition of the skin exists, i.e. when the skin is dry and manifestly inactive, Sulphur has proved in our hands of essential service, though the experience of Dr. Epps seems to point in favor of Graphites. In illustration of the value of Sulph. in this condition, we will here cite the case of a young woman, whose skin was exceedingly inactive. She had an eruption (eczema) upon the hands, of five years standing; chronic constipation, bowels moving hardly once in a week; and a remarkable dryness of the skin, involving entire absence of perspiration. She had endeavored by continued and violent physical exertion to bring on a natural perspiration, convinced if once this event occurred she must experience some relief from her unpleasant sensations. During these attempts she spared no pains, but took every means in her power to accomplish the desired result, but all in vain. She took three doses of Sulph.30, at intervals of six hours, and had Sac. Lact. for a week after, with some very slight effect upon her general feelings, and upon the palms of her hands, which seemed to be a little moist. She then had one dose of Sulph. 200, and in a fortnight came back to the institution, glorying in the remarkable improvement in the eruption, in the fact of her regular evacuations, and in the complete cure of the dry skin which had troubled her so much, but which had now become soft and moist over her whole person. It was a matter of some doubt whether Graph. or Sulph. should be given, and Graph, might have effected a like satisfactory cure; but Sulph. was chosen in consequence of a nocturnal aggravation marked with febrile symptoms.

In cases of chronic constipation, where the diverted nervovital fluids are directed toward the organs of special sense and the cerebrum generally, Nux and Belladonna have been found of most service, in the institution above referred to. Belladonna does not seem to be a favorite remedy with Dr. Epps, though Nux stands very high in his repertory. Nux is doubtless of inestimable value in cases of chronic constipation, but it will not cure more than a third of the cases we meet with, though Homoeopathists have fallen into the habit of prescribing it almost as a matter of course, for this form of diseased manifestation. We are fully satisfied that we have never thoroughly and radically cured a case of chronic constipation with Nux alone. In the cases where this would seem to be the best remedy, Sulph. has been almost always required to complete the cure. Nux 30, administered at night, with one dose of Sulphur on the following morning, and the Nux repeated for the two succeeding nights, accomplishes very satisfactory results in cases where Nux is called for.

It is well known that Allopathists are of late years much in the habit of prescribing Nux and Strychnia in chronic constipation, and patients who have failed of a cure at their hands often come under the care of Homoeopathists with Nux symptoms, which have been superinduced by the large doses of the drug previously administered. These symptoms are increased if the drug is repeated through ignorance of the previous treatment, and patients expecting immediate relief, may perhaps become disheartened at the aggravation. Three doses of Sulph. 30, under these circumstances, are of great service, especially if followed, at the end of ten days, by a single dose of Nux 100, or Nux 200. Sulphur and Nux are well understood to be almost specifics in cases of hemorrhoids.

Bryonia has been found to afford perfect relief, when given in the 12th potency, in cases of constipation, complicated with great flatulence, and with furred tongue and disordered stomach. We consider Opium as, in most cases, merely palliative. In cases of recent origin, in which there is dryness and heat of the Anus, with sensations as if the orifice were, closed, it is often sufficient. There has, however, occurred to us one case, in the person of a very old patient, in which Opium 100, in solution, a dose every morning for a week, seemed to keep the evacuations regular, for two or three months. Lachesis has since seemed to be better indicated, and is perhaps more to be relied on, for old people, who are very apt to have “abortive eructations.”

Dr. Epps gives us many cases of cures, in which the complication of prolapsus ani was present. Sepia, Graphites, Sulphur and Nux, are his favorites. The success which has attended his administration of these remedies is extremely gratifying.

In chest complications, he inclines to use Bryonia, Lycopodium and Hepar. Arsenic and Kali are also employed.

One of the most interesting points made by Dr. Epps, in this work, is the frequency with which the concomitant symptoms become very much relieved, and sometimes in fact entirely removed, while the constipation, supposed by the patient to be the cause of all the trouble, remains the same, or but very slightly improved.

We are reminded, in this connection, of a case of Insanity occurring in a young girl, who had the concomitant symptom of Amenorrhoea. All her previous physicians, considering the Amenorrhoea as the cause of the mental derangement, had administered the most violent emmenagogues with no result. The poor creature was very crazy, and much weakened by her violent treatment. Air, exercise, wholesome diet, and careful medication cured the mental derangement and general weakness in a few weeks, but the Amenorrhoea remained several months after her complete recovery from, the other symptoms. At last the menses became regular, as the diseased influence which caused all the unpleasant manifestations was gradually driven from the system by the power of the vitality, and the return of the nervo-vital fluid into its proper channels.

In Dr. Epps' book similar instances are multiplied. Affections of the head, eyes, ears, chest, stomach, uterus, and even of the rectum, are reported as not only ameliorated, but sometimes as cured, while the bowels are still costive. We are much pleased to see the prominence given to these facts by Dr. Epps, though they are well understood by our school. This is the more proper, inasmuch as the book is intended for intelligent and educated laymen as well as for physicians. Such demonstrations will of course go far toward convincing his readers of the folly-certainly of the uselessness-of forced purgation in any disease. Let us be thankful that the time has at length arrived, when the drastic purges of the old school are falling into absolute disrepute among “all sorts and classes of men.” It is, however, perhaps advisable for us, Homoeopathists, not to raise our paeans too high. To be sure, typhus fever, dysentery, diarrhea and consumption possess a certain immunity from the purging pill box: but such is the horror of many Allopathic physicians of anything which savors in the least of the practice of “sugar pillism,” that there may be found some severely orthodox Doctors, in some far off rural districts, who, at the sound of our rejoicing, will straightway give repeated purges to their patients; intending in this vicarious manner to purge themselves of all suspected Homoeopathic heresies.

A part of Dr. Epps' plan, as set forth in the title of his work, is to notice, and prove the actual injuries inflicted by the use of evacuants. This forms one of the finest chapters in the book, if not the very best. Cases are here cited of epilepsy, gastritis, piles, inflammation of the intestines, hernia, prolapsus ani, prolapsus uteri, etc., etc., distinctly traceable to the habitual employment of purgatives. It is proper in this connection to remark that Dr. Epps seems to have passed too lightly over the injurious effects of the habitual use of enemas. Nothing is so common among the better classes, whose habits are productive of inactivity of the bowels, as cold or warm enemas on rising in the morning: and we are convinced few things are more detrimental in their final effects on the condition of the intestinal canal. Repeated injections must produce a congestion of the rectum. Their effect is necessarily injurious, inasmuch as it is unnatural. If there are impacted feces in the rectum, the condition is owing to the want of proper innervation, and the only proper remedy is the medicine, which, by equalizing the circulation of the nervo-vital fluids, shall radically cure the diseased condition. Palliation is well enough for those who do not wish for a cure; but for those who do, habitual enemas are almost as bad as habitual purgatives.

That part of Dr. Epps' book which treats of the adjuvants toward keeping the evacuations regular is of very great service both to laymen and physicians. It contains many valuable suggestions, which, as the book has not yet been published in America, we shall mention here.

As first in importance, he mentions the immediate obedience of any call to relieve the bowels by stool; next, the habitual solicitation of the bowels, after breakfast; third, moderation in the use of food; fourth, sponging the body, especially the belly, with cold water; fifth, drinking a tumbler of cold water in the morning; sixth, friction of the spine from above downward; and seventh, the exercise of walking. To this we may add, placing the arms akimbo and performing a twisting movement of the body, the hips being the fixed point on which the upper part of the trunk turns; thus bringing into action the abdominal muscles. An eighth means mentioned by Dr. Epps. is the avoidance of late suppers; and he also recommends lathering the abdomen, with soap and brush, on rising in the morning. These various expedients must strike every reader as appropriate, and are beyond all doubt efficient in many cases.

In conclusion we have to say that no case of chronic constipation can possibly resist homoeopathic remedies, when properly applied, unless the diseased condition is complicated with intersusceptive malignant disease, or stricture of some part of the intestinal canal.*[We have not brought the physiological portion of the work into any prominence, as it is simply a repetition of facts well known to our readers.]

Before laying aside the pen, we should fail to do justice to Dr. Epps; as well as to our own feelings, did we fail to speak in the highest terms of his work. Those who write monographs on individual remedies, and those who write monographs on individual symptoms, are to be classed among the greatest benefactors of our science. Dr. Epps has accomplished his purpose in the best possible manner, and the profession and those laymen who employ Homoeopathy cannot feel their obligations to him too deeply.

We are well satisfied that such books as this are of more service to the profession than those of any other character, excepting perhaps those upon individual drugs. Moreover there is as we have said above, a popular element in it, which not only insures its success, but its enlarged usefulness. The various publications of the Author have all of them this characteristic, and are in reality more valuable on that account. There are many invalids who are certain to be induced to make a trial of our system by the perusal of such popular monographs.