There is one cause of constipation in infants which must not be for gotten. This is the sluggishness of the bowels which is induced by opium. Hand-fed babies are apt to be very peevish and troublesome at night, and an unscrupulous nurse will often drug the child with " soothing syrup" or other opiate in order that her own sleep may be undisturbed. This prac tice induces a very obstinate form of constipation, and, unless detected, may be a cause of much perplexity to the medical attendant. It is therefore important in obstinate cases to examine the child's pupils.
The causes which have been referred to may influence the state of the bowels at all periods of childhood, but there are other causes which largely prevail after the period of infancy has passed. Habitual neglect of the calls of nature is as common a cause of constipation in young people as it is in their elders. The lower bowel, when it finds its warnings neglected, soon becomes accustomed to the presence of its faecal contents, and requires something more than the ordinary stimulus to excite its action. Whether from necessity or convenience, school-children of both sexes often suppress the natural desire for relief ; but if the favourable moment is allowed to pass, efforts made at another time are often ineffectual, and a habit of con stipation is thus acquired which may be very difficult to overcome. Even during infancy, constipation may be made worse by this means. Children of ten or twelve months old, who have been subjected to much pain from distention of the sphincter by hard fecal masses, will often resist, as long as possible, the desire to empty the bowel, in order to spare themselves un necessary suffering. In such cases, if measures are not taken to enforce due evacuation, serious accumulation may ensue.
Want of exercise is another cause which is often found to prevail amongst young girls, especially if they are much confined to the house and pressed too quickly forward in their studies, and very obstinate constipation may result from their sedentary life.
Symptoms.—In infancy, deficient excretion from the bowels is usually indicated by a pasty, dull complexion, fretfulness, and agitation, especially at night. The child's sleep is not the sound, unbroken sleep of health. He often starts and twitches, and is roused up by the least noise. Flatulence is an early consequence. The child seems to suffer from occasional twinges of pain, for he often cries suddenly without evident cause, and draws up his lower limbs uneasily. His upper lip looks purple ; the muscles of his mouth
twitch, and if the pain is severe, his whole complexion may become ghastly white. If the constipation is obstinate, the stools are voided with great diffi culty ; and in cases where several days pass without any relief, defecation is only effected with much straining and pain. The infant often makes violent efforts to unload his bowel of its accumulated burden, and will strain until his face is purple, his bowel prolapses, and his navel starts. Tinging of the ffecal masses with blood from rupture of small vessels about the anus is often seen, and umbilical hernia not unfrequently owes its origin to this cause.
The belly is generally swollen from flatulence, and sometimes the gas accumulates in such quantity as to cause a fit of violent colic, in which the child gives signs of extreme suffering, screaming and writhing and draw ing up his legs. Actual convulsions may be induced by this cause. In cases where irritation of the bowels is excited by the retention of excremen titial matters, the temperature may become elevated for a time, but it sub sides at once when the accumulation has been removed. In many children, the torpor of the bowel is accompanied by languid circulation, so that the hands and feet are habitually cold. If the state of constipation continue, the general health usually suffers ; the flesh gets flabby, and the child is peevish and fretful, with a tendency to vomit. Palpation of the abdomen will often discover hard masses in the descending colon. These are well-defined lumps, are painless, and can be indented by firm pressure with the finger.
In older children, we see little more than dulness of complexion, a furred tongue, and some want of sprightliness and activity. The child may com plain of discomfort after food and of occasional headaches. His breath is often unpleasant, and there may be aphthie on the tongue and lips, or red patches on the tongue from which the epithelium appears to have been thrown off. Sometimes the bowels act only at rare intervals, and if proper measures are not resorted to, may remain confined for a week together, or even longer. Such children are subject to sick-headaches, and have habit ually a pasty-looking, unhealthy tint of skin.