What History Can Teach Us About Constipation and the Gut

The early 20th century was constipation’s belle époque. Sales of purgatives, tonics, syrups and patent medicines like Carter’s Little Liver Pills went through the roof as ordinary people were encouraged to closely monitor the frequency and quality of their bowel movements.

In Britain, the campaign against costiveness was spearheaded by a man named William Arbuthnot Lane, who spent much of his medical career popularising the idea that bodily health depended on the regular elimination of its waste. A highly regarded surgeon, he undertook pioneering work in the field of orthopaedics and neo-natal care before becoming interested in the mysteries of the gastrointestinal tract. Lane spent most of his career at Guy’s Hospital in London, where he distinguished himself as an expert in numerous medical fields, mastering the rigors of ear, nose and throat surgery and designing several surgical instruments—bone-holding forceps, a periosteal elevator and an osteotome, a bone-cutting device— which are still in use today. After World War One he was honored with a knighthood in recognition of his military service and his remarkable contribution to modern medicine.  

And yet, by 1920, Lane found himself embroiled in a bitter dispute with the British Medical Association, which would eventually see him struck off the medical register, forced to give up his lucrative private practice and ostracised by the wider professional community.

This dramatic fall from grace was the consequence of Lane’s long-standing, almost monomaniacal preoccupation with constipation. More than a discomfort or an embarrassment, costiveness was, he claimed, “the cause of all chronic diseases of civilization”and the most serious public health crisis facing the developed world. The danger came from the threat of autointoxication, a medical theory which held that half-digested matter sitting in the gut for too long would begin leaking toxins into the rest of the body. Chronic intestinal stasis occurred, according to Lane, when “the passage of contents of the intestinal canal is delayed sufficiently long to result in the production of an excess of toxic material, and in the absorption into the circulation of a greater quantity of poisonous products than the organs which convert and excrete them are able to deal with.” These “poisonous products” were the cause of a whole host of seemingly unrelated health problems: from stomach pain and sallow complexion to muscle pain, cold hands, baldness, excessive perspiration, a compromised immune system, rheumatoid arthritis and even cancer.

Less quantifiable, but just as worrisome, were the mental and emotional problems that could arise from irregular bowel movements. Writing in 1916, Frank Crane, an American physician and another proponent of the theory of autointoxication, observed that most “domestic friction”—misbehaving children, fractious spouses and cantankerous relations—could be attributed to the malignant influence of unhealthy bacteria lurking the gut. What the religiously minded might be tempted to label “sin” was, he insisted, often due to “what the physician calls stasis.” Beyond family squabbles, incomplete digestion could, in extreme cases, cause full-blown insanity. One of the founding members of modern psychiatry, the German physician Emil Kraepelin, was particularly adamant that many diseases of the mind originated deep in the viscera. Dementia praecox, what we would now define as schizophrenia, was caused by “an endogenous process of chronic autointoxication which led to a self-poisoning of the body and, eventually, its brain.”

As these fretting physicians reveal, through the early decades of the 20th century, a particular narrative around the gut began to take shape which pictured it as a storehouse for dirt and danger in the body, a leaky vessel always threatening to spill its contents. Characterized as a vestige of the distant past lingering on in the present, the belly was viewed as dangerously out of time with the pace of modernity. Today, the gut has again become the locus for a bundle of concerns ranging from the increasing incidence of chronic illness to worries about processed foods, from rising levels of depression to concerns over the West’s growing “sleep deficit.” Looking back to the digestive troubles of an earlier era may shed some light on the origins of our present-day anxieties—and how we have escalated them.

Read More: The Truth About Common Digestive Health Fears

Recent research has explored possible connections between the microbiome, cognitive function and the symptoms associated with schizophrenia. Having compared stool samples from sufferers and non-sufferers, a team from the University of Wollongong in Australia found dramatic differences in their microbial make-up and they have posited that this may impact the neuronal functioning of the brain. While today scientists tend to view the gut–mind relationship as a fundamentally friendly one, sometimes set off course by miscommunication, doctors working at the beginning of the 20^th century took a much dimmer view of this alliance. The theory of autointoxication elevated digestion as the primary determinant of physical and mental wellbeing, but it also recast the bowel as the primary site of pollution in the body.

The human digestive tract was, by Lane’s estimation, the biological equivalent of the household drainage system: with the stomach as the toilet bowl, the small intestine the drainpipe and the large bowel the septic tank. Just as no one would allow “the discharge of offensive and poisonous gases” into the rest of the house and would instead “have the cesspool cleared of the material stagnating in it,” so too with the guts. Like the vast sewage networks lying underneath the streets of cities like London and Paris, the intestines are responsible for channelling and processing the putrid wastes of the body. In Lane’s view, ill health can, therefore, usually be attributed to “defective drainage.” The trouble with the digestive system, he contended, was that it had not evolved at the same pace as the rest of the human body. The colon was, he insisted, essentially useless. Once needed to regulate elimination during fight or flight situations, now that much of humanity had developed beyond a minute-to-minute battle for survival, the organ no longer had a function.

Worse than simply useless, it was also hazardous. Having originated in our four-footed ancestors, the colon had failed to adapt sufficiently when we evolved into homo erectus, with the result that unnatural kinks had developed in the organ where toxic material lodged and festered. Walking upright slowed the transit of food through the system, meaning that waste material became lodged in the bands of the large intestine, setting the flora of the gut off balance and seeping poison into the rest of the body. As this imagery of toxicity, filth and corruption suggests, Lane had an almost adversarial attitude towards the gut; a myopic suspicion of the digestive system that came to govern his approach to treating patients and which would eventually lead to professional disgrace.

He was, however, not alone in his mistrust of the colon and throughout the early decades of the twentieth century many physicians and health reformers also warned of the dangers posed by autointoxication. John Harvey Kellogg, the nutritionist, diet reformer, and anti-masturbation campaigner, was similarly invested in bowel health. Indeed, the invention for which he is now best remembered, the cornflake, was developed with the aim of introducing more fibre into the American diet and thus stave off the epidemic of intestinal stasis that threatened the wellbeing of the nation. Kellogg’s thinking on constipation, that anything less than three bowel movements a day risked dangerous intestinal putrefaction, was shaped by the emerging germ theory of disease and the ascent of bacteriology as a discipline through the closing decades of the 19th century. This new medical paradigm impacted not only how external threats were imagined—the hordes of viruses, spores and prions who now appeared to be always threatening to break through our defences—but also how the internal world of the body was envisioned. From the beginning attention was directed to the presence of microbes in the digestive system and questions raised as to their possibly malignant influence on health. Physicians like Robert Bell, credited with having first coined the term “autointoxication,” and Charles Bouchard, a French doctor who was a well-known authority on the gut, warned that hostile microbes lurking in the intestines might slowly, through processes of fermentation and putrefaction, poison their host.

Constipation could usually be resolved by a change of diet, but in persistent cases of intestinal stasis, Lane proposed a more extreme solution. Between 1908 and 1925, he performed hundreds of colectomies, involving the partial or complete removal of the colon. Having begun by experimenting with colon bypasses and finding them largely ineffective, Lane began recommending that the whole large intestine be taken out in cases of chronic constipation. He performed hundreds of these operations and quoted frequently from satisfied patients whose lives had been transformed by it, but there was a great deal of debate within the medical community as to the efficacy of the colectomy. Lane was too extraordinary a surgeon to be shrugged off as a crank, but before long reports of worryingly high mortality rates began to circulate and several damning exposés appeared in prominent medical journals. Elsewhere, in America where the theory of autointoxication had spawned a thriving consumer market for tonics, pills and other cure-alls, moves had already been made by the government to stem the tide of misinformation: in 1906 when the American Medical Association set up a Propaganda Department its first action was to denounce it as quackery.

In 1913, after Lane had been removing his patients’ colons for five years, a panel of the Royal Society of Medicine was finally convened to interrogate the wisdom of resorting to surgery to combat chronic constipation. Working under the title ‘A Discussion on Alimentary Toxaemia’, speakers from surgery, medicine, anatomy and bacteriology spent nearly two months deliberating over the validity of autointoxication as a theory and the value of the colectomy as a practice. Interrogating the idea of intestinal kinks, one participant suggested, tongue in cheek, that a giraffe be dissected to determine whether it, as a similarly vertical animal, suffers from the same crimped intestines as humans, while another challenged the idea that the colon was a useless organ and claimed that all Lane had demonstrated with his surgeries was that”‘no colon was better than a diseased one.” These questions opened up the very real possibility that a venerated surgeon had performed hundreds of pointless, dangerous procedures on his patients and the tide of opinion began to turn against him.

Yet even after his public fall from grace, Lane remained convinced of the dangers that constipation posed to health. Despite committing his life to the profession, in 1933 he cut ties with the British Medical Association so that he could continue to see private patients and publish on the topic of autointoxication.

While it might be tempting to dismiss him as a fanatic whose all-consuming obsession with the frequency of his family’s bowel movements tarnished an otherwise glittering career in surgery, that would involve ignoring not only the countless patients who sought his advice, but also the other physicians, popular health reformers and prominent scientists who were similarly committed to the theory of autointoxication.

Part of what this history reveals is that the belly has long been the subject of anxious fascination. Digestion may appear to be among the more mundane bodily processes, but in truth it plays an essential role in shaping both our physical and emotional health. Lane, though dangerously misguided, was ahead of time in recognizing the power of the gut.

Adapted from Rumbles: A Curious History of the Gut: The Secret Story of the Body's Most Fascinating Organ by Elsa Richardson. Published by Pegasus Books, October 1^st 2024.