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diminish this action also. Foods that contain very little liquid and those that do not leave much residue are liable to accumulate in the bowel and at the same time press upon the rectum hard enough to produce a partial paralysis.

Deficiency of the Secretions.—Many of the causes that hinder worm-like motion are also likely to lessen the normal secretions of the bowel. Some kinds of liver diseases tend to lessen the secretions of the bowel, because the amount of bile emptied into the bowel is lessened. Sometimes the glands of the intestine are rendered less active by disease and other causes.

Sundry Causes.—Diabetes, melancholy, insanity, old age, paralysis, lead poisoning and some troubles of local origin, like fissure of the rectum, ulceration, stricture and polypus.

[DIGESTIVE ORGANS 137]

Symptoms.—Headache, inattention to business, loss of memory, melancholy, sallow complexion, indigestion, loss of appetite, nervous symptoms. Spasmodic muscular contraction of the external sphincter. The bowel contents press upon it; spasm of this sphincter muscle is frequently brought on by the presence of a crack in the mucous membrane, caused by injury inflicted during expulsion of hardened feces. Instead of aiding a bowel movement, the muscles now present an obstruction beyond control of the will and aggravate the condition. The most frequent cause of disease of the rectum is constipation and anyone of the following local diseases of the rectum and anus may be a symptom of constipation. (1) Fissure or crack of the anus. (2) Ulceration. (3) Hemorrhoids (piles). (4) Prolapse (falling). (5) Neuralgia. (6) Proctitis and periproctitis.

Fissure of the anus is a common local symptom of constipation. The feces accumulate when the bowels do not move for a few days, the watery portion is absorbed; they become dry, hard, lumpy, and very difficult to expel, frequently making a rent (tear) in the mucous membrane and resulting eventually in an irritable fissure. Ulceration of the rectum and the sigmoid (part of the bowel) is a symptom of persistent constipation, because the pressure exerted upon the nourishing blood vessels by the fecal mass causes local death of the tissues.

Hemorrhoids (Piles) may be produced by constipation in several ways; first by obstruction to the return of the venous (dark) blood. Second, by venous engorgement (filling up) of the hemorrhoidal veins during violent and prolonged straining at stool. Third, as a result of the general looseness of the tissues in those suffering from constipation.

Prolapse (Falling of the Bowel).—This falling of the rectum may be partial or complete, and may be caused by straining or by the downward pressure exerted by the fecal mass during the emptying movement of the bowel. It may also be the result of a partial paralysis of the bowel caused by pressure of the feces upon the nerves.

Proctitis and Peri-Proctitis.—Inflammation of the rectum and surrounding tissue that may or may not terminate in an abscess and fistula, sometimes follows injury to the very sensitive mucous membrane by the hardened feces.

Neuralgia of the Rectum.—This may sometimes result from the pressure of the fecal mass upon the nearby nerves causing pain in the sacrum coccyx (bones).

MOTHERS' REMEDIES.—1. Constipation, a Good Substitute for Pills and Drugs.—"Two ounces each of figs, dates, raisins, and prunes (without pits) one-half ounce senna leaves. Grind through meat chopper, and mix thoroughly by kneading. Break off pieces (about a level teaspoonful) and form into tablets. Wrap each in a wax paper and keep in covered glass jars, in a cool place. Dose.—One at night to keep the bowels regular. Very pleasant to take."

[138 MOTHERS' REMEDIES]

2. Constipation, Substitute for Castor Oil.—"Take good clean figs, and stew them very slowly in olive oil until plump and tender, then add a little honey and a little lemon juice, and allow the syrup to boil thick. Remarks.—Keep this in a covered glass jar and when a dose of castor oil seems necessary, a single fig will answer every purpose. Not unpleasant to take."

3. Constipation, Hot Water for.—"A cup of hot water, as hot as one can drink it, a half an hour before breakfast." The hot water thoroughly rinses the stomach and helps the bowels to carry off all the impurities.

4. Constipation. Excellent Nourishment for Old People.—"A tablespoonful of olive oil three times a day internally for weak or very old people: it can be injected,—used as an enema." Olive oil will be found very beneficial for young people as well as old. It acts as a food for the whole system and is very nourishing.

5. Constipation, Salt and Water for.—"A pinch of salt in a glass of water taken before breakfast every morning. I have found it a very good remedy." This is a remedy easily obtained in any home and will be found very helpful. Few people seem to realize how valuable salt is as a medicine. It acts as a stimulant and loosens the bowels.

6. Constipation, Water Cure for.—"Drink a quantity of water on retiring and during the day." This simple home remedy has been known to cure stubborn cases of constipation if kept up faithfully.

7. Constipation, Tonic and Standard Remedy for.—"Calomel one ounce, wild cherry bark one ounce, Peruvian bark one ounce, Turkish rhubarb ground one ounce, make this into one quart with water, then put in sufficient alcohol to keep it." Dose:—Take a small teaspoonful each morning when the bowels need regulating, or you need a stimulating tonic.

8. Constipation, Glycerin and Witch-Hazel Remedy Where Castor Oil Failed— "Equal parts of glycerin and witch-hazel." Dose :—One teaspoonful every night at bedtime. In severe cases where you have been unable to get a movement of the bowels by the use of other cathartics, take a teaspoonful every two hours until the bowels move freely. This remedy has been known to cure when castor oil and other remedies have failed.

9. Constipation, Well-known Remedy for.—

    "Fluid Extract Cascara Sagrada 1 ounce
    Syrup Rhubarb 1 ounce
    Simple Syrup 2 ounces

Mix."

One teaspoonful at night or fifteen drops four times a day for an adult.

[DIGESTIVE ORGANS 139]

10. Constipation, Effective Remedy, in the most Stubborn Cases of.—

    "Fluid Extract Cascara Sagrada 1 ounce
    Fluid Extract Wahoo 1 ounce
    Neutralizing Cordial 2 ounces

Mix."

Adults may take a teaspoonful of this mixture before retiring, this will be found very effective in the most stubborn cases of constipation.

11. Constipation, Remedy from a Mother at Lee, Massachusetts.—

    "Senna Leaves 1/2 pound
    English Currants 1/2 pound
    Figs 1/4 pound
    Brown Sugar 1 large cup

Chop all together fine. Dose:—One-fourth to one-half teaspoonful every night. Do not cook. The best remedy I know."

12. Constipation, Fruit and Hot Water Cure for.—"Drink a pint of hot water in the morning before eating. Eat fruit, plenty of apples, eat apples in the evening, and they will loosen the bowels. Chew them fine, mix with saliva."

13. Constipation, Herb Tea for.—"One ounce senna leaves steeped in one-half pint of hot water, with a teaspoonful of ginger powdered; strain. This is a most certain and effective purge, and mild in its action upon the bowels. Dose:—A cupful at bedtime. This is far superior to salts."

14. Constipation, Purshiana Bark Tea Without an Equal for.—"An infusion of one ounce of purshiana bark to one pint of boiling water; infuse for one hour and strain. It stands without an equal in the treatment of constipation in all its varied forms. Dose:—One teaspoonful, morning and evening according to symptoms or until the bowels are thoroughly regulated." This is fine for constipation, especially if of long standing. It may be used in connection with cascara. This will give relief when other remedies fail.

PHYSICIANS' TREATMENT for Constipation.—Too much reliance has been placed upon medicine in the treatment of this disease and too little attention given to diet, and the establishment of regular habits in eating, exercising, sleeping and attending to the calls of Nature. Also, local disease of the rectum has been overlooked until of late years. Remedies of a laxative and cathartic nature soon lose their power and the dose must be repeated or a new remedy must be given. This method of treatment is well recommended and is very good.

1—Stretching of the sphincter.

2—Frequent rectal and abdominal massage.

3—Copious injection of warm water (in the beginning only).

4—Application of electricity over the abdomen and in the rectum.

[140 MOTHERS' REMEDIES]

In addition to this treatment which must be carried out by a physician the patient must observe the following rules: Go to stool daily, and as near the same time as is convenient, correct errors of diet. Drink an abundance of water and eat sufficient fruit. Take plenty of outdoor exercise; take a cold bath every morning followed by a thorough rubbing. Dress warmly in winter and cool in summer. Change of temperature or climate if the case demands it. Be temperate in all things affecting the general health. Stretching the sphincter must be done carefully, but in a thorough manner. It can only be done properly by an experienced person. Stretching of the sphincter closes the opening so that the feces are not passed at all times. It is circular in shape. Sometimes this grows larger, stiffer, or it acts spasmodically. The opening is often so tight in some people that it is difficult to introduce even a finger, and it frequently produces a spasm of pain in the bowels, stomach and head to do so. This kind will produce constipation or make it worse. In such cases it should be stretched thoroughly but carefully so that the muscle will be able to close the opening and the bowel contents will not pass at any time unhindered. There are two methods of stretching the muscle—forcible or gradual. The forcible method is generally done by inserting the two thumbs into the anus and stretching the muscle thoroughly in every direction until there is no resistance. (Dilators are made for this purpose, but unless they are very carefully used they will tear the muscle). The forcible method should be done under an anesthetic. Gradual stretching is done when an anesthetic cannot be used. It is better to do too little than to do too much at the first sitting. The muscle is very stubborn sometimes, and it requires careful handling or the irritability will be increased. An instrument in the hands of a careful man is all right. They can be stretched by the fingers or the Wales' bougie, thus: Patients should come to the office two or three times a week, the instrument (bougies) are introduced and allowed to remain within the bowel until the muscle resistance is overcome, and many times their withdrawal will soon be followed by a copious stool. Forcible stretching is seldom required more than once, if a large sized instrument is used from time to time afterward, just as in gradual stretching; when thorough dilatation has been accomplished, the muscle instead of acting as an impassable barrier to the discharge of the feces, now offers only passive resistance, but sufficiently strong, however, to prevent any unpleasant accidents, yet not strong enough to resist the power of the expulsory muscles when the latter are brought into full play during stool. Large quantities of feces do not now accumulate; consequently the pressure upon the mucous membrane and neighboring nerves is eliminated, and the bowel regains its normal sensibility and strength. There are now sold dilators in sets for self use in almost every drug store. These when used continuously do good and successful work.

[DIGESTIVE ORGANS 141]

Abdominal Massage. (Kneading, Rubbing, etc.).—This is an essential feature in the treatment. It was practiced by Hippocrates hundreds of years ago. Place the patient in the recumbent position upon a table which can be so manipulated that the head may be raised or lowered, the body rolled from side to side. Gentle but firm pressure is then made with the palm of the hand and the ball of the thumb over the large intestine beginning in the lower right groin region. Then go up to the ribs on the right side, then over the body to the same place on the left side and down to the left lower side and

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