Suppositories are valuable for administration when through any change of diet or other cause the curative drug fails to produce a motion at the hour after breakfast. They then can be employed to cause prompt action of the bowel so that the rhythm of the colon and rectum may be kept up without a break.
If there be accumulations of fieces in the rectum and colon for some time they must be removed, and for this purpose ordinary purgation by the mouth is not to be thought of. A tepid-water enema should be given when the patient is lying upon the left side, with the view of getting the fluid beyond the accumulation; 3 or 4 pints may be thrown up with safety.
Olive or Castor Oil may be administered along with the water with great advantage. It is useless to pour the oil into the water, where it floats, and is not injected into the bowel till the very last. The nurse should lift the end of the enema pipe (lying in the water) and put it into a cupful of the oil, and continue the operation as before without removal of the other end from the rectum. After pumping up 3 or 4 oz. or more in this way the end of the pipe is taken out of time oil and dropped into the warm water again, and the pumping gently continued till the patient cannot tolerate the introduction of any more fluid, when the motion will occur. To remove lodgments from the colon several enemata may be required, and should the mass be above the reach of the finger, lvecks may be spent in pumping it out, though this is decidedlyexceptional. Should the mass be low down it may be broken up with the handle of a spoon or scoop, and removed piecemeal. Injections of Oils, Gruel, White of Eggs, Linseed Infusion, and various other emollients are used. Brewer's Yeast, when injected, breaks up and causes the rapid disintegration of the impaction, and it is harmless.
When the intestinal tract has been cleared in a case of chronic constipa tion, the physician's next attempt is to assist the patient in having a daily evacuation of the bowels, or if an evacuation every second day has been the patient's life-long habit when in health, the effort should be to restore this habit, and not to attempt to improve upon nature.
Good can be done, as already suggested, by urging the patient to take a brisk morning open-air walk or ride if his habits have been sedentary.
Unfortunately, in many instances, the class of patients to whom this would be valuable have little opportunity for walking, and the haste to reach their offices in the city only permits them to indulge in their usual omnibus or railway trip. To such, a half-hours' cycle ride will be followed by splendid results.
Diet is of vital importance; it is generally the small eater who is the victim of chronic constipation, or the individual who takes his food in a concentrated soluble form, and often if such a one, from any cause, begins to eat almost any sort of food in larger quantity than is necessary for the maintenance of health, the constipation disappears. In prescribing a dietary, foods which leave a bulky residue should have the preference. Brown bread, whole-meal bread, or any bran breadstuffs are of great use. White bread made with fine flour and hard-boiled eggs should be entirely given up till the constipation has been conquered. Oaten meal made into porridge, and taken at bed-time or before the ordinary breakfast, is the remedy which keeps many folk in health for years.
Vegetables and fruit should be taken freely, and an orange or apple eaten early in the morning or orange marmalade at breakfast answers well in some cases. There is nothing better than a good supper of boiled Spanish Onion, and the writer has treated obstinate cases of constipation by this means alone with very satisfactory results. Agar-agar in coarse powder in teaspoonful doses used with stewed fruit makes a valuable laxative addition to the ordinary food.
Salad or Olive Oil every morning after breakfast is a. valuable laxative and food, and when freely partaken of with salad at the evening meal it is a very efficient laxative. The writer has noticed that it is not well borne by the plethoric, or lv lean folk with dark skins. The pale, washy-looking, blue-eyed, sedentary, thin subject gets much benefit from it or from Cod Liver Oil when taken once a day in one large dose. Pure Paraffin often acts well, as none of it is absorbed; in passing down the bowel it acts as a lubricant and corrects dryness in the Pieces.