Women should note that certain misplace ments of the womb occasion great obstacles to the passage of the fmces, simply by pressing against and blocking the bowel, and the con sequent costiveness seriously aggravates the uterine trouble.
Symptoms.—The main symptom is evident, but others attend it, such as indigestion, want of appetite, headache, dulness, lowness of spirits, and uneasiness about the region of the stomach and bowels. A bad complexion and foul breath are also results.
Treatment.—If what has been said about the causes of constipation has been understood, the treatment will, in many cases, be evident. First of all, the habit many busy men have of delaying going to stool till it suits their busi ness must be stopped. The habit of going to the water-closet at a certain time every day should be adopted. The best time is perhaps after breakfast, at any rate after a considerable meal. This may be vain at first, but, if per sisted in, will in the end be beneficial. If this is not effectual it may be assisted by means which rouse the contractions of the bowel. Of these one very successful is the injection, by means of an elastic ball, of a quantity of tepid water and then of cold water. This, repeated for two or three days at the same hour, will in very many cases be sufficient. This form of treat ment may be aided in various ways by the use of vegetables and fruits at meals, provided they otherwise agree, and ripe fruits in the morning, figs, prunes, &c., the use of bran bread instead of fine white bread, the drinking of a tumbler of fresh water on rising, or on going to bed, &c. &c. Many men find that if they do not smoke a pipe or cigar after a meal constipation results. Along with the use of such means exercise must be regularly taken.
Should these measures fail Trousseau recom mends the use of a pill of nth grain of bella donna taken daily before breakfast. Two may be taken together at the beginning of their use, if necessary, but they are to be discontinued as soon as possible. In many cases where the liver is slow a pill of Atli grain of the resin of podophyllin and ith grain of extract of flux vomica is effectual when taken before break fast. Brisk purgatives should be avoided as long as possible. If necessary, however, the best purgative is castor-oil, which may now be obtained in gelatine capsules for those who could not otherwise take it. Sometimes purga tive medicines fail to give relief because har dened faeces have been allowed to accumulate in the rectum. The proper treatment for this
is the injection of a strong stream of soapy water by means of an enema (see Plate XXXII, and p. 407, Vol. II.) till the hardened mass becomes softened and loosened. Finally, a drug has lately been introduced for obstinate consti pation, the Cascara sagrada, the bark of Rh,am uus Purshiana from the North Pacific coast. It may be taken as extract, 2 to 8 grains in pill, or as fluid extract, of which the dose is 10 to 60 drops. It has a very disagreeable taste, and a cordial has now been made to disguise the taste, of which 15 drops to one tea-spoonful is a dose. The quantity that is found neces sary in each case should be taken and gradually reduced till it can be stopped altogether. It may also be obtained in tabloid form, alone or in combination with aloes and other stimulants of bile.
In women during pregnancy constipation is often very troublesome/ for this nothing is better than a wine-glaisful of Hunyadi 4nos mineral water every morning before rising.
Colic is another symptom of intestinal de rangement which requires special mention. Pain, as•has been seen is a frequent symptom in dyspeptic conditio40. In colic the pain is experienced across the belly about the region of the navel. It is due generally to irregular and spasmodic contractions of the large bowel —the colon, hence the word colic. The pain is of a severe twisting character, and comes on in paroxysms, occasionally so severe that the patient rolls and twists about, usually doubled up and grasping his belly, crying and groaning like one bereft of reason. Constipation of the bowels is usually present, and the pain may occasion vomiting. Often, however, severe colicky pains are the forerunner of looseness of the bowels, caused by some food which has disagreed. The pain may be caused by wind, the discharge of which greatly relieves. There is no fever with the attack, indeed the pulse is usually lowered, and the face pale and anxious looking. This helps to distinguish colic from an inflammatory attack. Another great distinction is that pre,* sure on the belly relieves, while, if the pain were due to inflammation, pressure could not be endured. The attitude of the person and the pressure he himself exerts with every renewal of the attack show that it is not an inflammatory affection that is the cause of the disturbance.
The passage of a gall-stone or a stone from the kidney—binary or renal colic—is not to be confounded with this affection. (Refer to DIS