To the Editor: I wish to accept your invitation of comparing my approach with that of Walter Pick, MD (Amer J Dis Child 105:229 [March] 1963) to the problem of fecal soiling and paradoxic obstipation. While Dr. Pick has done us the service of pointing out and emphasizing the fact that many patients with obstipation have fecal soiling secondary to constipation, his method of treatment and his concern for the symptom of fecal soiling itself rather than for the child with this symptom lead me to several comments and questions.
First of all, Dr. Pick says that his two patients were cured of soiling when the cause of the soiling was determined, that is, obstipation. My criticism here is that Dr. Pick did not go far enough in his search for causes. He merely related one symptom to another claiming that one was the cause of the difficulty and the