Idiopathic Constipation

- BERNARD H,
Many authors absolutely deny the existence of this form of constipation. Although admitting the difficulty of establishing ex cathedra the clinical reality of this division, yet we believe it can be admitted by analogy. However that may be, we range in this category the cases, numerous enough, of constipation, the pathogenetic origin of which is either not appreciable, or is obscure, and which cannot be better classified in the other sections.
 Two important remedies dispute here the pre-eminence : Nux vomica and Hydrastis canadensis. It is difficult to draw the differential indications of these two substances. We believe, however, that Nux vomica ought to be employed in those subjects who are still vigorous, while that Hydrastis suits rather those persons who are debilitated and enfeebled, with a sickly appearance, or when there are active, persistent pains in the whole extent of the intestinal tract and at the same time fainting after each evacuation. It seems to us, moreover, that we can imitate here the method recommended by Hahnemann for all chronic diseases and especially advised for chronic constipation by Dr. Hughes : that is to say, to commence the treatment by one or more doses of
 In case of failure by these medicines, recourse may be had to Plumbum or Opium, either singly or in alternation. We prefer Opium if there is an entire absence of desire for stool; when the evacuations are of an enormous size, black and rounded; when constipation alternates with a very painful, choleraic form of diarrhoea; it there is a feeling of occlusion of the anus; if anorexia, weight in the stomach and retention of urine are present; principally in cases of lead poisoning or in aged persons, and those of lymphatic or even plethoric constitutions.
 Plumbum is rather to be chosen if the obstinate constipation, with or without tenesmus, is accompanied with intense colic, nausea and vomiting, if the abdomen is hard and retracted, if the stools instead of being large, are composed of small, dark balls, sometimes enveloped in a light, greasy pellicle.
 Other medicines may have to be consulted and notably : Bryonia, Lachesis, Lycopodium, Iris vers., etc. 

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