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March 3, 1923


JAMA. 1923;80(9):646. doi:10.1001/jama.1923.02640360054029

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To the Editor:  —Constipation is generally considered to be due to sluggish bowels. All our numerous attempts at treatment are based on the notion of sluggish bowels. Has it ever been shown that the bowels are ever unduly sluggish? Is it not a fact that the rectum and not the intestine is loaded in constipation?H. A. Kelly (Medical Gynecology, 1908, p. 191) conceives constipation to be an inertia of the defecation reflex, a conception that is in harmony with all clinical data. It explains the correlation of constipation with neurasthenia, and also the paradox that while we have numerous cathartics we have no cure for constipation. A simple motor function reacts to any change in the environment, while a depressed reflex is out of the range of our materia medica, which contains no analeptics, no sensory stimulants, and no drug or combination of drugs that might affect simultaneously all

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