If actual impaction of occur so as to offer an insuperable obstacle at any point of the intestinal canal, symptoms of occlusion of the bowel arise. The distinction between this condition and intussusception is ex plained in the chapter treating of the latter subject.
Treatment.—The regular action of the bowels is at all ages so much a matter of habit that the child as soon as he can walk, or even earlier, should be trained to regularity in this important particular. Every morn ing after breakfast he should be accustomed to go punctually to stool, and nothing should be allowed to interfere with this necessary duty. By this means the bowels become accustomed to regular relief at the same period of the day. The mother should herself see that the rule is enforced, for an inattentive nurse, from ignorance or carelessness, is very apt to neglect it.
In infants, constipation may be combated by careful regimen, by the adoption of special articles of diet, by enemata, and by drugs. In the first place, the dietary should be revised and excess of starchy matter excluded. If the child is eight or ten months old, the first meal in the day may con sist of a teaspoonful of fine oatmeal rubbed up carefully with cold milk into a thin, smooth paste, and then stirred briskly while hot milk is added. Mellin's "Food for Infants," probably on account of the glucose it contains, often has an admirable effect in regulating the bowels of infants who are inclined to costiveness, and is a very useful resource. If the constipation is only temporary and occasional, a small lump of manna dissolved in a dessert-spoonful of warm water, strained and added to the bottle of food, has a ready aperient effect ; or fifteen to twenty drops of the liquid extract of rhamnus frangula will be equally successful. In cases where the consti pation is habitual, I have found a combination of the infusions of senna, and gentian a remedy of unfailing usefulness. I usually combine these with the tinctures of belladonna and nux vomica, as in the following draught. The quantity ordered is suitable to a child between eight and twelve months of age, and can be given at first three times in the day immediately before a meal :— The value of this remedy consists in the fact that the patient does not be come dependent upon the medicine. On the contrary, it has a strength ening effect upon the coats of the bowel, so that after a time it can be given twice in the clay, then only once, and eventually be discontinued altogether.
The extract of malt, on account of its glucose, is also useful in relieving the constipation of infants ; but must be given in sufficient quantity, i.e., a
teaspoonful two or three times a day. It however, very inferior to the senna mixture, and has the disadvantage that in warm weather it is apt to turn acid on the stomach and cause nausea. In all cases of habitual con stipation in infants, the belly should be rubbed firmly with the hand twice a day after the bath, so as to stimulate the peristaltic movement of the bow els. In obstinate cases, Dr. Merriman advises the friction to be made with a liniment composed of half an ounce of the tincture of aloes to one ounce of the compound soap liniment. Professor Stephenson, in an interesting paper, has proposed the use of pepsin, in cases of habitual constipation, for children of all ages. To a child of twelve months old, three grains of the dry powder, or five drops of pepsin wine may be given three times a day. The remedy must be taken for several weeks, and can then be gradually discon tinued. If necessary, an occasional dose of castor-oil can be given during the first few days of taking the pepsin, but this is seldom required to be repeated more than twice.
The above methods of treatment are greatly to be preferred in cases of habitual constipation to the mechanical relief of the bowels obtained by means of enemata, or even by the use of suppositories. Suppositories of Cas tile soap, cocoa butter, or brown gelatine have been strongly advocated by some writers. They are no doubt useful in producing an -immediate effect, but have no further influence, and cannot promote healthy and regular action iu the future. Enemata are of service in unloading the bowels where there is accumulation of fatal matter, especially where irritation and colic have been excited by its retention. They should be composed of thin gruel or soap and water, should be used warm, and if the constipation be obstinate or the pain severe, may contain the addition of a spoonful of castor-oil. Care should be taken to use a sufficient quantity of fluid. An enema to be effectual in such a case should consist of at least two-thirds of a pint for a child of six months old. If enemata are given daily to relieve habitual con stipation, the quantity need not be so considerable. Four or five ounces will usually be sufficient, and plain water of the temperature of 60° Fahr. may De employed. This daily repetition of. enemata is not, however, a plan of treatment to be recommended.