While the constipation of **Nux is due to irregularity of intestinal action, that of **Opium is due to absolute inaction of the intestines, a regular paralysis of the peristaltic movement. There is an absence of desire, absolutely no urging to stool whatever, and so the faeces become impacted in the bowels; and when passed at all come in little, hard, dry, black balls, here resembling the stool of **Plumbum, but with Plumbum there is some activity. Another drug which has no urging to stool is Bryonia, but here the lack of urging is rather due to dryness of the mucous membrane than to intestinal inactivity; with **Opium there is a want of sensibility throughout the intestinal tract, and consequently the constipation is not apt to inconvenience the patient, hence it is apt to go on getting worse until the attention is called to it by the flatus accumulating in the upper part of the intestines. Where the faeces require artificial means for their removal, this remedy should be thought of, though **Selenium, Alumina, Plumbum or Bryonia may be used in this condition. Diminished secretions are also characteristic of **Opium, so that dryness intestinal inactivity, is one of the causes of constipation of old people; the patient is drowsy and dizzy.
As we have already seen, with **Plumbum there is some intestinal action; in fact, at times there is considerable. Lead colic is one of the effects of the drug. So we have urging to stool, and accompanying this urging is a colic with a marked retraction of the abdominal walls. The stool is passed with the greatest difficulty and consists of little round balls, which are black, dry and hard, and there is accompanying, a marked spasm of the sphincter ani which is apt to be painful. The anus feels as if drawn upward. With this drug there is loss of muscular activity and diminished secretion of intestinal glands. Thus we see that the indications for **Plumbum in constipation are concise and precise.
Chief among remedies for constipation due to dryness of the intestinal tract stands **Alumina. There is diminished peristaltic movement and complete inertia of the rectum, so that we have the symptom, soft stool expelled with difficulty, explained. There is little or no urging to stool. The stools may be hard and knotty like sheep dung, or may be soft. It is one of our most useful remedies in constipation of children where the rectum is dry, inflamed and bleeding about the orifice. **Alumina differs from **Bryonia chiefly in the state of rectal inactivity. A dry mouth and an irritated looking tongue may lead to the selection of **Alumina. There is much straining with the remedy and the stool is passed in very small quantities, piecemeal, so to speak. If the characteristics of Alumina are prominent in a given case, they may be due to the use of aluminum ware in cooking. Even Spring water boiled in an aluminum pot will deposit a white sediment on cooling.
The large-hard-dry-stool-as-if-burnt of **Bryonia is familiar to all of our Medical School. The constipation of the drug is due to dryness and there is no urging. **Alumina is similar; its constipation is also due to dryness, but it has such complete inactivity of the rectum that even a soft stool is expelled with difficulty. With **Bryonia the stools are passed with a great deal of difficulty, owing to an atony of the intestines similar to **Veratrum album and **Opium. **Nux vomica, as we have seen, produces and cures constipation due to fitful, irregular, peristaltic action. **Bryonia cures constipation where not only the intestinal secretions are diminished, but the muscular action as well. Constipation in young children, according to Hughes, is frequently cured by Bryonia 30th. It is said to act better in rheumatic subjects and in summer. The mental condition of irritability and ill-humor will often be present as a concomitant of the **Bryonia constipation. Older writers alternated **Bryonia and **Nux vomica with success in very obstinate cases.
Natrum muriaticum. [Nat-m]
All the muriates have crumbly stools, and so we find that the characteristic constipated stool of **Natrum muriaticum is a hard and crumbly one; the rectum is dry, the stool is hard to expel and causes bleeding, smarting and soreness in the rectum. There is ineffectual urging to stool, with stitches in the rectum. It sometimes comes in the most obstinate cases, which are accompanied by hypochondriasis. **Magnesia muriatica, another of the muriates, has characteristically a constipation in which the stools are passed with great difficulty, being composed of hard lumps like sheep dung, which are so dry that they crumble as they pass the anus. **Ammonium muriaticum has this same symptom of dry and crumbly stools, they may also be coated externally with mucus. In constipation of young people who are subjected to acne and comedons, **Natrum muriaticum should be thought of.