The development and health of children suffering from chronic constipation may remain for a long time undisturbed, until, quite un forsecn, sudden high fever, pronounced symptoms on the part of the nervous system, particularly somnolence, even convulsions, arrhythmia of the pulse, and the like set in giving rise to the suspicion of a serious illness. I have seen one case of this kind which, after several hours of clonic contractions, profound unconsciousness, taches c6rebrales, irregu larity of pulse, loss of pupillary reflex,—in short, one which presented all the symptoms of tuberculous meningitis,—recovcred promptly after a few doses of calomel.
Other patients exhibit ansemia of various degrees of severity, loss of appetite, different skin affections, particularly lichen urticatus, of great persistence. They complain of heajdache, do poor mental work, are easily fatigued, sleep restlessly, and show nervous irritability.
Indican, in considerable quantities, is found in the urine, which is often scanty and of high salt content.
The diagnosis of this condition usually. presents no great difficulty. Hirschsprung's disease appears in earlier life and leads to the character istic balloon-like distention of the abdomen. Chronic peritonitis is also accompanied by much more considerable nieteorism, and has after wards a fluid exudate in the abdominal cavity. Occlusion of the intes tine runs its course with much more violent symptoms.
The treatment must first of all be directed to the cause. When the condition is due to food too rich in proteid and an oversupply- of milk, a mixed diet should be given in which suitable room is reserved for carbohydrates and fats as well as for vegetables. Graham bread with butter is well taken and is of definite value, and in addition fruit cut finely or scrapecl, strained vegetables, preserves not too sweet (apple jelly, plum jelly), etc.
In the case of older children, who go to the closet, one must insist that this is clone at an hour when they can devote sufficient time to this duty, it may be best in the evening. A moist compress to the abdomen,
applied before going to sleep, assists the intestinal function. Likewise, also, massage either in the manner recommended by lleubner, in which the skin of the abdomen is taken between the index fingers and thumbs, and the abdominal wall kneaded by pinching the rceti and lateral muscles of the abdomen between the fingers from above downward and from below upm-ards, circular movements being then made with the finger-tips between the navel and symphysis, and, filially, shoving movements, beginning at the cecum and extending along the course of the colon (each manipulation lasting two to three niinutes); or in the Thure-Brand method, in which tapping movements are made with the flat of the hands in the direction of the colon, beginning at the left iliac fossa, and the rectum is kneaded between the fingers along its course, and finally the abdomen is shaken thoroughly between the hands laid on laterally (every movement takes five minutes). Intestinal irriga tions, constantly reducing the temperature of the water (to about 59° F.), suppositories cocoa-butter, soap), small glycerin enemata t.5 to 10 c.c. given with a metal syringe), etc., are all to be considered as accessory manipulations. Purgative medicines are better avoided as they do not aid the intestinal tonus and a dependence on them is easily acquired. In single cases I have had success in giving one to several tablespoonfuls of fresh butter, as suggested by Dorfler. In other instances it was not helpful. Alorecver, a solution of a heaping teaspoonful of milk-sugar in a glass of water (prepared in the evening and drunk early just after awaking), is of service. Whcm this does not suffice, mild laxatives can be employed such as syrup of figs. Seidlitz powder and similar medicines, while the drastic purges are to be avoided.
When symptoms of intestinal intoxication set in, high irrigations and the energetic use of calomel are quickly followed by improvement in the condition.