work, but a few remarks on the most common causes of constipation, depending on torpor of the colon, and the means of obviating that condition, will not be out

of place.

Habitual constipation as a constitutional effect occurs in those whose vital powers are naturally low: thus during the earlier periods of life we most frequently meet with it in delicate females; but as age advances, and the organic functions become enfeebled, we find it prevailing in either sex. The most frequent accidental causes are sedentary. habits, and the very common practice of not attending to the first calls of nature to evacuate the bowels. Fæcal accumulations are thus favoured, the bowel becomes distended, and in some instances to an amazing extent; its vital contractility is diminished, and it is rendered incapable of expelling its contents. Yet, notwithstanding this condition, frequently neither the patient nor medical attendant suspects the real mischief that exists, from the fact that diarrhoea may at the same time be present, consequent on the irritation induced by the overloaded state of the bowel. I have many times been consulted by patients suffering from the effects of fæcal accumulations, who assured me their bowels invariably acted regularly each day; and what they asserted was quite correct; yet they were the subjects of torpor of the colon and fæcal accumulations. On

inquiring more particularly into such cases, it will be discovered, that though the bowels have been moved daily, the evacuations have been scanty, and that a sense of fulness and discomfort in the bowel remains ; the fact being, that accumulations had been gradually increasing, and the softer and more recent excrementitious matter had passed over that which had been retained and become hardened.

The habitual use of large and warm enemata relax and distend the rectum, and enervate its functions; one of the effects of which is to promote the occurrence of a form of intussusception and slight invagination of the bowel, the upper portion descending into the lower, occasioning many distressing symptoms; a dull, heavy pain and fulness is felt in the loins and sacral region, defecation is difficult and painful, and the calls to stool frequent: the evacuations are small, or passed in lumps; or being rendered fluid, from an increased secretion from the mucous surface, the result of irritation, are ejected as if from a syringe. These symptoms often induce a suspicion of the existence of stricture of the rectum, and the suspicion, although entirely groundless, may be apparently confirmed if an endeavour be made to pass a bougie, and it be arrested in the edge or fold of the semi-prolapsed portion of the intestine.

In the treatment of habitual constipation, the ob

ject to be attained is the removal of the cause, to procure fæcal evacuations by the mildest and least irritating means adequate to the purpose, to restore the lost tone, and prevent the recurrence of the torpid condition of the bowels.

It is too frequently the case, the most inappropriate means are adopted to remedy this condition. Many people are in the habit of dosing themselves with calomel or blue pill, and black draught, or saline purgatives, which, besides teasing and tormenting the upper part of the alimentary canal for no fault of its own, is productive of very temporary relief and much permanent harm. I could cite innumerable instances which have come under my own cognizance, of the mischief that has thus been induced, and many practical writers have made the same observation. Dr. Graves,* in his very valuable lectures on Clinical Medicine, remarks, "Various causes have combined to render blue pill and calomel almost popular remedies, to which many have recourse when their bowels are irregular, or the stomach out of order. Indeed, it is quite incredible what a number of persons are in the habit of taking these preparations, either singly, or combined with other purgatives, whenever, to use the common expression, they feel themselves

*Clinical Lectures on the Practice of Medicine,' by Robert J. Graves, M.D., Second Edition, vol. ii., p. 213.

bilious. This habit, sooner or later, induces a state of extreme nervous irritability, and the invalid finally becomes a confirmed and unhappy hypochondriac; he is, in fact, slowly poisoned, without the more obvious symptoms of mercurialization being at the time produced."

Should the rectum and colon be distended by fæcal accumulations, they must be dislodged before we can possibly effect any benefit; for which purpose enemata will be the most efficient means; and the only effectual mode of administering them is by a long elastic tube.

In overcoming habitual constipation, much may be done without medicine. In attaining this object, it is essential that the patient should "solicit nature" at a certain period of the day, immediately after breakfast being the best time. By allowing the mind to be occupied, and, as it were, directing the attention to the subject shortly before visiting the closet, the desire will very probably occur. The influence of the mind is strongly marked in two gentlemen I am acquainted with; both are very regular in their habits, and are accustomed to evacuate their bowels shortly after breakfast: should circumstances occur, obliging the one to take his morning meal at an earlier hour than usual, he is unable to relieve himself, unless the organic functions are roused through

the influence of the mind by thinking on the subject while he is dressing, and invoking as it were, the assistance of nature. The converse is the case in the other gentleman; if anything unusual occupies his attention early in the morning, temporary constipation ensues, which he is unable to overcome by any effort without the assistance of artificial means; headache, flatulence, acid eructations, and pain at the epigastrium ensue, which continue till the rectum is freed, either by an enema or the return of his accustomed time of relieving the bowels, when the symptoms instantly subside.

Exercise is most important to the proper performance of defecation, and no one has a right to expect the enjoyment of health, unless he devote at least one or two hours every day to walking or riding. A glass of cold clear spring water taken early in the morning, and friction of the abdomen with the hand while at the closet, will materially assist in promoting the peristaltic action of the intestines.

However, the simple means suggested will not always be sufficient to accomplish our object, and it may be necessary to have recourse to medicines. Saline aperients afford temporary relief, but they afterwards increase the tendency to constipation, and induce debility of the stomach and small intestines. The combinations that I have found most useful, are