Paraffin oil will not remedy every defect in the defecating process and hence will not cure every case of constipation, but it comes nearer being a panacea than any remedy which has heretofore been found, and does meet a surprisingly large number of indications. After a careful study of its effects in several thousand cases, the writer feels justified in saying with much confidence that paraffin oil may be relied upon to accomplish the following results in the treatment of chronic constipation:

1. It lubricates the alimentary canal throughout its whole length. In a large number of cases of constipation there is an excessive absorption of water from the colon, leaving the feces dry or pasty and adhesive. An examination of the rectum and pelvic colon in such cases shows the mucous membrane to be deficiently lubricated by mucus, and covered with flakes of adhering feces. The use of half an ounce or an ounce of paraffin oil at bedtime, and half as much an hour before each meal, will in two or three days change the condition completely, as shown by proctoscopic examination.

2. This mechanical lubricating action of paraffin is highly important in overcoming kinks due to redundance or to adhesions resulting from colitis or other causes. When the mucous surface is kept well lubricated, the fecal matter slips along and easily overcomes mechanical obstacles, which otherwise become formidable sources of obstruction.

3. The human alimentary canal, like that of other primates, as illustrated in the diet of the higher apes, is adapted to a moderately coarse bill of fare. The concentrated diet of our modern civilized life contains so little indigestible material that the residue forms a pasty mass which tends to adhere to the intestinal wall, especially when any obstruction is presented by kinks, folds, adhesive bands, or a spastic state of the bowel due to colitis. When delay occurs, the further absorption of water converts these pasty residues into hard masses, scy-bala, which sometimes have almost the density of wood. Fats of all sorts are more or less laxative if taken in sufficient amount, through their effect in modifying the character of the food residues. They render the mass less adhesive and to some extent prevent dryness; but both animal and vegetable fats are digestible and absorbable, and hence are not to any considerable degree effective in changing the character of the stools unless eaten in amounts larger than can be used, so that a considerable portion remains behind in the colon. Such large quantities of fat encourage putrefaction, lessen appetite, diminish the secretion of hydrochloric acid, interfere with the motility of the stomach and the small intestine, and may produce great disturbance of the body metabolism. Paraffin oil is free from these objections, since it is wholly non-absorbable, and a comparatively small amount serves the purpose required, because it all remains in the intestine.

4. Paraffin is useful in all forms of intestinal stasis or stagnation, no matter what the cause, by preventing the abnormal drying out of the food residue which is the necessary result of too long retention in contact with absorbing surfaces.

5. Another remarkably interesting and useful property of paraffin oil is found in the fact that it stimulates activity of the small intestine. Observations, in a large number of cases, made by Dr. J. T. Case, Roentgenologist at the Battle Creek Sanitarium, have shown that paraffin oil greatly accelerates the passage of material through the small as well as the large intestine. This action is exceedingly important in those forms of intestinal toxemia which depend upon iliac stasis, by far the most serious of all forms of stasis. Stagnation in the small intestine is of far greater importance than stasis in the colon, for the reason that both putrefaction and absorption are much more active in this part of the digestive tube than in the large intestine. Even in cases in which iliac stasis is due to the so-called Lane's kink, as shown by X-ray examination, great relief may usually be obtained by the regular use of paraffin. This has been demonstrated in many cases. It is only in the most extreme cases, when adhesions are so extensive that the lumen of the intestine is very greatly reduced, that surgical measures become necessary.

6. One of the most interesting features of the many-sided useful activities of paraffin, is its behavior toward intestinal toxins. These toxins consist, not only of bile acids and alkaline wastes of various sorts excreted by the intestinal mucous membrane, but in addition, of a great variety of ptomaines and toxins produced through bacterial action, especially in the colon, and also in the small intestine in cases of incompetency of the ileocecal valve. Paraffin is a highly active solvent, and readily dissolves these waste and poisonous substances, many of which are more soluble in paraffin oil than in water. The result is that the paraffin oil, itself not absorbable, takes up a very considerable portion of toxins found present in the intestinal tract, and thus prevents their absorption. When paraffin is used, it may always be seen in the stools, showing a brownish or blackish color, due to the substances which it holds in solution. In a laboratory test made by a competent chemist by request of the writer, it was found that when paraffin oil was shaken with a watery solution of indol, more than half the indol was quickly taken up by the paraffin. The use of paraffin thus affords an effective means of hindering the absorption of intestinal toxins, and conveying them out of the body.

7. Paraffin oil serves a useful purpose in protecting the mucous membrane when it is in an irritated state, as in cases of chronic colitis. The value of petrolatum and other neutral petroleum products as a dressing for wounds is well known. Paraffin acts in an equally favorable way upon irritated mucous surfaces. It has long been used for this purpose in the treatment of diseases of the nose and throat.