Study of the history of three hundred cases, showing that about 60 per cent. of all patients suffer from constipation, the number being proportionately larger among women. While the colon and rectun] have not the digestive functions formerly credited to them, their absorp tive power is great and the quantity ab sorbed is in proportion to the time of contact and concentration of the sub stance. The intestinal system is com plex. Since all functional action in the system is reciprocal, it follows that the functional activity of the chylopoietic system must affect the nutrition of the brain and entire nervous system. The absorption of toxic and excrementitious substances produces retrograde changes in the quality of the blood, diminution of the red corpuscles, and, by supplying an infected or imperfect nutriment to the brain, becomes a prominent factor in the production of cerebral anminia and nervous debility. E. S. Pettyjohn (Med. Rec., May 23, '96).
Prognosis.—When constipation is the result of any form of intestinal obstruc tion the prospect of permanent relief will depend entirely on the nature and curability of the obstruction itself. But when it depends upon the loss of peri staltic action induced by erroneous habits of life, the prognosis is very favorable, provided the erroneous habits of the pa tient can be permanently corrected. All such cases can be temporarily relieved by suitable diet, laxatives, and tonic. Re lapse, however, will soon follow unless all the primary causes are persistently avoided.
Treatment. —In the treatment of all cases of constipation the use of active cathartics should be avoided as far as possible.
As few purgatives as possible should be used. The methods employed should be: dietetic, physico-mechanical, and inedicinal. Such foods should be used as are known to increase peristalsis. Suitable massage is of the greatest value in many cases, but it sometimes fails, and the same may be said of electricity. The usual position taken up in defeca tion is not the one best adapted for emp tying the rectum. In the use of elysters particular attention should be given to the anal parts of the syringe. It should be made of vulcanized caoutehouc, and about 30 to 40 centimetres, long. The disadvantage of clysters is that ulti mately small quantities of water do not suffice, and then large amounts must be used; the large intestine may thus become overdistended and the injections useless. Regular attempts at defecation with slight pressure should be made. An
efficient rhubarb preparation is often very useful, but it may become neces sary for the patient to have constant re course to it. Calomel is especially valu able in children. Castor-oil is not suited for constant use. In some cases, with a certain dia,gnosis of Luca] tunior, good results are bad by combining croton with castor- oil. Large injections of olive oil may very properly be recommended. Sometimes sedative and antispasmodic remedies are required where constipation is of the spastic type. Ewald (Berl. klin. Wroeh., Mar., '97).
Purgatives excite increased secretion to soften the fwcal contents, and excessive peristalsis by which the intestine is evac uated, but leave the natural functions of the intestines more exhausted than be fore. Consequently, while they' afford temporary relief, they never affect a permanent cure. To secure the latter, the actual causes of the constipation must be ascertained and removed.
Sedentary habits must be abandoned; the effects of in-door occupations coun teracted by special open-air exercises mornings and evenings, sufficient to se cure full oxygenation and decarboniza tion of the blood; eating freely of fruit, vegetables, and coarse or brown bread; avoiding all use of alcoholic drinks both fermented and distilled, and instead drinking a glass of natural laxative min eral water each morning, and persistently making an effort to evacuate the bowels directly after breakfast each day.
Reasonable hydrotherapeutics, cold ap plications to the abdomen, and cold sitz baths. are often of use; moderate exer cise helps, but undue exercise, by the loss of moisture by the skin, often in creases the constipation. Rosenheirn (In ter. Clinics, vol. iv, '97).
The bitter salines are very valuable, and particularly Apenta water, as it is especially indicated in atony of the bowels, and has the advantage that it does not tend to subsequent constipation. lts action is more gentle than that of other bitter waters, because it contains less calcimn sulphate and no magnesium chloride; it is probably owed to these circumstances that it does not cause cramps. Bogoslowsky (Trans. Moscow Soc. for the Preservation of Pub. Health, Nov. 6, '97).
The purgatives and alkaline mineral waters are objectionable. In place of them enemata and various disinfectants and drugs intended to strengthen the muscular action of the intestine are em ployed. Strychnine and resorcin are par ticularly effective. Boas (Gaz. Heb. de -.NR,(1. et de Chin, Jan. 13, '9S).