One of the oldest and certainly the most valuable remedy in the treatment of constipation is ordinary wheat-bran. Bran consists almost entirely or very largely of cellulose in an indigestible form. While wheatmeal contains 2.5% of cellulose, bran contains 18%, and in some cases even more. In the form of bran, cellulose is well broken up, and hence can be passed through the intestine without difficulty. The apprehension which some authors have expressed concerning the irritating effects of bran are wholly without basis, except, of course, that one would not think of using bran in a case of gastric ulcer or acute inflammation of the stomach or intestines: As a matter of fact, when well softened with water, bran is no longer irritating, but is an emollient. The thin films of cellulose become as soft and pliable as wet paper, and excite the bowel, not by scratching or irritating it, but by a gentle titillation, so to speak, and by giving to the food sufficient mass to distend the intestine and stimulate it to vigorous activity.
In its ordinary commercial form, bran is scarcely fit for use, on account of the large amount of dirt which it contains, including multitudes of bacteria. For intestinal use as a laxative, it should be carefully prepared by thorough cleaning and washing of the wheat before grinding and sterilization of the bran. Sterilized bran, first introduced by the writer several years ago, is now prepared by various manufacturers, and is put up in convenient packages. One or two rounded tablespoonfuls should be taken at each meal, the amount depending upon the character of other foods taken. The writer has never seen any ill effects from the use of sterilized bran which he has prescribed for many years, although there are cases in which it fails to produce the desired effect and has to be supplemented by the use of paraffin oil as a lubricant.
This is particularly true in cases in which the cecum is greatly dilated or crippled by adhesions and in cases in which there is obstruction of other parts of the colon, especially the pelvic colon as the result of adhesions.
The combination of paraffin oil with bran or agar-agar in some form is also useful in cases of spastic contraction due to colitis.
Experience shows that from an ounce to two ounces of cellulose must be taken with the food daily, to insure sufficient bulk to stimulate the intestine to action. In cases in which the colon is very redundant or is crippled by adhesions, even double this amount may sometimes be needed, at least until the bowel has been trained to normal action. This amount of cellulose is provided by two rounded tablespoonfuls of sterilized bran in addition to other laxative foods.
The amount of food required to furnish an ounce of cellulose may be ascertained by reference to the foregoing tables.
It should further be mentioned that in the use of cellulose in concentrated form as in sterilized bran, the whole amount used at a meal should not be taken at once, as at the beginning or end of the meal, but should be well mixed with the food by taking small portions at frequent intervals during the meal.
The use of agar-agar, a Japanese sea-weed of a nature similar to Iceland moss, is to be most highly recommended as a means of giving the necessary bulk to stimulate the intestine to prompt action.
It may be used without any possible injury in all cases of sluggish bowel action. When properly prepared it is wholly free from unpleasant flavor, and it manifests such astonishing avidity for water . that when it is present in the feces they cannot possibly become dry and hard.
Agar-Agar in Edible Form.
In cases in which constipation is due to "greedy colon," agar-agar or bran is indispensable. In such cases the colon has acquired the power to eat up enormous quantities of the cellulose of the food, so that it is very difficult to increase the bulk of the feces by the use of green vegetables. This is the reason for the disappointment experienced by many who hope to find in the free use of lettuce and like green foods a panacea for their intestinal ills. Agar-agar is hemi-cellulose, and has been shown by the experiments of Mendel and others to be indigestible by any of the digestive fluids with which it comes in contact in the human body. Agar-agar must be taken in sufficient quantity to accomplish the object sought. Two-thirds of an ounce to an ounce is the quantity usually required for adults. For young children a quarter to a half of this quantity is sufficient.
This remedy should be taken at meals in order that it may be well intermingled with the food, and so prevent the formation of hardened residues in the intestine.
Agar-agar may be used with advantage as a substitute for a meal, when food cannot be taken, and when there is no appetite for food, and when so used it maintains the intestinal rhythm which would otherwise be lost, resulting in constipation. It should in such cases be taken with fruit juice or fresh or stewed fruit. When one finds at night that the usual amount of food has not been taken, an extra dose of agar-agar with a little fruit may be taken before going to bed. No digestive work is required by either the fruit or the agar-agar except to move it along the digestive canal. It is important to take fruit or fruit juice with the agar-agar to excite the necessary peristalsis.