Prunes and Figs are serviceable, but even children grow weary of their lusciousness. Stewed prunes do well for a short time. It is often a good thing to advise the patient to become a vegetarian or fruitarian for a time, and if he takes to the practice and makes a fad of it, his constipation, as a rule, disappears.
Massage or deep kneading of the abdominal muscles over the entire course of the large intestine may he tried in very sluggish subjects, or even a smart friction over the abdominal walls with a coarse, warm towel for five minutes on rising, or a cold-water compress, followed by a large drink of cold water and a smart cold shower or plunge bath, may do more good than medicines. Brunton recommended rolling a cannon-ball (7 lbs.) over the abdominal walls, following the direction of the colon.
Electricity—a weak continuous current, with one pole on the spine and a large wash-leather or sponge electrode moved about over the lumbar and hypochondriac regions or a smart interrupted current— may be used with advantage in the same way.
The physician will thus find that most of the cases of chronic constipa tion may be successfully combated without having to resort to the long list of purgatives in daily use. As a rule, active purgation should not be permitted, and, in many of the cases seeking relief, continual purgation indulged in for fancied ills will be found to be the cause of the constipa tion.
The physician should aim at increasing the muscular and nervous tone of the bowel, and, at the same time, increasing the intestinal secretion so as to bring the motions to a healthy state of consistence.
Though the number of purgative drugs is almost endless, those useful in chronic constipation should be only such as in regulated doses will produce a laxative effect, and hence the selection is practically confined to Cascara and Aloes.
Cascara comes first in value, and when all the dietetic and previously mentioned plans have failed, the patient should be placed upon small doses of the liquid extract. It may be given in various ways. One moderate dose in the evening or before bed-time, the treatment not to be commenced till the existing constipation is for the moment corrected by some brisk purgative, is the most successful plan. Beginning with an
evening dose of 3o mins., in a few days knowledge of the dose suitable to the individual case will be obtained, and the initial quantity is increased or diminished accordingly. The object to be clearly aimed at is to avoid purgation, and to give the remedy in such a dose as will secure one soft, natural motion every morning. The amount and the interval necessary to produce this result varies widely in different individuals, and in the same individual under the use of various dietaries. If the moderate dose necessary to produce a laxative effect takes a long time to act the patient must shift the time from bed hour till immediately after or before the evening meal, so as to produce evacuation after breakfast hour.
There is difficulty in getting patients to graduate the dose themselves, and after a few weeks they stop the cascara altogether, through careless I2 ncss, or a belief that they are cured of the constipation, and when the bowels return to their old habit, a large dose of cascara is taken as a purge. This is certain to be followed by more obstinate constipation, and thus the remedy is set down as useless. The physician should insist upon a two months' course at the very beginning of the treatment. Capsules containing any requisite amount may he had readily from chemists, but, though elegant and effective, the dose cannot be easily regulated when the capsular form is used. The pilular extract may be given, but the fluid is more certain and uniform in its action.
some give the cascara three times a day, after or before meals, in a dose equivalent to about one-third of the nightly dose. Thus, ro ruins. may be given immediately after breakfast, luncheon and dinner, but the evening dose is more rational and effective.
Whatever plan be adopted, after a few weeks the dose should be gradually diminished, still, however, taking enough to produce the healthy, natural morning motion, as if no purgative had been administered. At the end of a period, varying much in different cases, the remedy may be occasionally suspended for ore day, and finally, in a few months in some cases, it may be permanently stopped.