As regard the frequency of bowel movements, physicians located in the following countries, reported the usual custom to be two or more daily, usually two, for the very good reason that two meals only are eaten, the first movement being on rising, or after the first meal, and the second soon after the second meal, or before retiring:
Rhodesia, Uganda Protectorate, Nyassaland, Nigeria, Harda (India), Delhi (India), Punjab (India), Kashmir, Nagpur (India), Bawda (India), Persia (three or four times in summer when fruits are plentiful), Aintab (Turkey), Harpoot (Turkey), West Coast of Africa (two or three), Portuguese Corigo (two or three), Egypt (Children four or five), Japan, Arabia (two or three).
It is interesting to note that the experience of the millions of primitive and half-civilized people who inhabit the above named countries demonstrates perfectly that an intake of food should be soon followed by an output of food residues and wastes.
In all these countries, as among practically all primitive people, great attention is given to the bowels. The mothers carefully train their children to move their bowels at regular times, and much pains is taken to make the diet such as to promote intestinal activity. The virtues of fruits and green vegetables are fully appreciated, and where rice is the principal food, as in most of the Orient, large use is made of green vegetables.
It is especially of interest to note the frequency with which some custom in relation to bowel hygiene is found in vogue among primitive people who have practiced it from time immemorial, while among civilized people the same practice has only recently become known as one of the discoveries of modern medical science. It is becoming more and more evident that our modern civilization in emerging from barbarism has left behind much that was not only useful but essential to a healthy physical life, and we may therefore profit by a careful study of the habits of primitive people and even of those wild animal species which belong with man in the class of primates, and are closely allied to the human species in structure and function.
Here are a few extracts from the replies to our questionaire, which will be found most instructive as well as interesting:
"I am of the opinion that diet has a great influence. The Labances eat plenty of figs, either alone or mixed with juice of grapes or juice of carob beans, brown bread, fruits, vegetables, olive oil, olives, etc, and drink plenty of spring water at meal times." - A. J. Manasseh, Bruana, Beyrout, Syria.
"Laxative foods used are the following: Cooked manioc leaves, bananas, pineapples, bingondia (a sour-sweet seedy fruit), plantains, peanuts, palm oil, pumpkin seeds mashed and cooked. Raw guava leaves are used for diarrhoea, also the clay mounds built by white ants." - Mattie and P. Frederickson, Belgian Congo, West Central Africa.
"In the Cape Colony the staple food is stamped maize and sour milk; the absence of the sour milk leads to constipation. In the Northern Transvaal the staple food is thick maize porridge, sour milk, and, in summer, green vegetables. People go more often, (i. e. say three times a day) when taking both vegetables and milk. When these are scarce, they may go only once." - Neil Macvicar, Loren-dall, South Africa.
"The natives are, in Toro, almost entirely vegetarians, living on millet or plantains or beans. They rarely get meat. In 9642 out-patients seen during the last seven months of 1911, there were 174 cases of constipation, one and eight-tenths per cent of the whole." - J. Howard Cook, Uganda Protectorate, East Africa.
In this country the percentage of patients in whom constipation is present is just the reverse of that in Uganda. Whereas in Uganda there are less than two per cent who are constipated, in civilized countries among sick people there is scarcely one in a hundred who is not constipated.
"The rather coarse diet, largely grains and vegetables, has a favorable influence on the bowel movements. The stools are usually very large and fairly soft." - A. H. Norton, Haiju, Korea.
"The people eat large quantities of rice, turnips, peppers, roots, vegetables and little meat. The large quantity of residue must act as a stimulus to peristalsis." - W. C. Purviance, Chung Ju, Korea.
"Cereals, as wheat, barley, oats, millet seed, and all kinds of vegetables, are the staple food here (extreme north of Korea); very little fish and less meat is eaten." - F. H. Birdmann, Dotson, Korea.
"Bowel movement full and frequent among the working people, who eat large quantities of vegetables; more disturbed among the better classes, who eat more meat" - -J. K. Cox, West China.
"My experience with patients has been that they are not so subject to constipation as persons in the U. S. whom I have treated. Think probably the free use of greens and other vegetables has something to do with the difference, as well as not postponing the call of Nature, as is done by civilized persons." - Ida M. Scott, Tak Hink Chan, South China.
"The vast majority of the people live on coarse grains and coarse vegetables, which are favorable to large bowel movements." - Geo. D. Lowry, Peking, China.
"In my own case, going onto a purely local diet of rice and coarse vegetables is usually accompanied with looser motions." - George Hadden, Yung-an Fookin Pwo., China.
"Rice is the principal diet, but is usually accompanied by considerable quantities of vegetables, largely what we call greens. The Chinese have a great variety of leaves and stocks that are used for greens, such as cabbage, lettuce, and many other kinds that we do not see in America. With this diet and exercise, the healthy Chinaman usually has free bowel action. I think the 'greens' is a very suitable diet for this climate." - Jean Mc-Burney, Cheung Chow, Hong Kong, China.