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bowels, passage, action, undigested, sluggishness, bowel, condition and deficiency

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of all ages are subject to constipation. Usually, it is a temporary derangement, which quickly subsides under suitable treatment. In other cases it amounts to a positive infirmity, and is exceedingly obstinate and difficult of cure. The term constipation is a relative one. In itself, it im plies injury to the health from retention in the alimentary canal of matters which ought to be discharged. The condition is therefore compatible with a daily evacuation, if the relief afforded to the system is incomplete. In infants who require the bowels to be emptied several times in the day, a single stool in the twenty-four hours is a sign of costiveness which should not be neglected.

All forms of mechanical obstruction to the passage of the intestinal con tents give rise to arrested or imperfect evacuation as a prominent symptom. This variety of constipation is not here referred to. The form under con sideration in this chapter is clue to deficiency of expulsive action, and not to narrowing of the channel, or other kind of mechanical hindrance.

of the commonest causes of constipation is an unsuit able dietary. This is especially the case in infants. A child brought up by hand, and fed with excess of farinaceous food, is often troubled with an obstinate form of costiveness which is a source of continual discomfort. The frequent passage along the bowels of undigested starchy matter keeps the mucous membrane iu a state of constant hyper-secretion. A slimy mu cus is thrown out which coats the lumps of undigested food so that the muscular coat of the bowel in its contractions can have little hold upon their slippery surface, and they are forced forwards with difficulty.

Still, all cases of constipation occurring in hand-fed babies cannot be attributed to this cause. Often, the most careful examination of the stools can detect no excess of mucus. On the contrary, the motions are hard and lumpy, and seem to be drier than natural. This very dryness of the evacu ations appears in many cases to constitute a cause of infrequent relief to the bowels. We know from cases of diabetes iu the adult, where the ex cessive drain of water from the kidneys diminishes intestinal secretion, how commonly constipation results from this want of moisture. In the young child, a similar deficiency of secretion, however induced, may cause dryness of the fiecal contents and diminish the facility of their passage. Special articles of diet have a constipating effect upon certain children. In some, rice interferes with the regular action of the bowels. In others, eggs may induce a like sluggishness. I have known troublesome costiveness continue

as long as the yolk of an egg was allowed every clay, and disappear at once when the number of eggs was reduced to two in the week.

Atony of the bowel, or actual deficiency of expulsive power, is a not un common Cause of constipation even iu young subjects. In badly-nourished children, the muscular coat of the intestine must share in the general mai nutrition ; and as, in this condition, the lower part of the colon and rectum are apt to be over-distended by accumulation of undigested food, the diffi culty of carrying forwards the flees.' masses is increased. In some cases, the difficulty is added to by a peculiarity of infancy upon which Dr. Jacobi has laid much stress as a cause of constipation in very early life. In the new born infant, the length of the large gut is proportionately greater by about one-third than it is in the adult. This excess of length is due, not to the ascending and transverse colon, which are rather shorter at this age than they become in after years, but to the descending colon and sigrnoid flexure. Consequently, the flexure is thrown into many curves, and is often bent upon itself so repeatedly as seriously to retard the passage of its contents.

Sluggishness of peristaltic action, if not complete stony of the bowel, may be a sequence of certain diseases. After chronic diarrhoea, a state of constipation commonly prevails which is very difficult of cure. Typhoid fever often leaves a similar condition behind it, and after an attack of acute rheumatism the same inactivity of the bowels is often noticed. Again, ul ceration of the intestinal mucous membrane, when not accompanied by ca tarrh, almost invariably induces deficient faecal excretion, and sometimes, in these cases, excrementitial matters may be long retained. In typhoid fever, constipation of a week or longer is frequently met with, and indeed, in many cases, no effort at expulsion appears to be made until the bowels are excited to contract by a copious enema. In these cases, no doubt, the normal pe ristaltic action of the bowels at the seat of ulceration is paralysed by the inflammatory process there existing ; but a similar sluggishness of the in testinal mucous membrane may be induced by disease in a distant part of the body. Thus, disease of the brain or its membranes is usually accom panied by constipation as a prominent symptom, and in another 'part of this volume reasons are given for supposing that Bright's disease in the young child may produce the same result.

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