Orange juice or a scraped raw apple is allowable at this time. Constipated children should eat plenty of good butter. Olive oil, two or three teaspoonfuls after each meal, is excellent. It can be kept up for months to advantage. Older children may eat raw and cooked fruits, figs, dates, baked potatoes, poultry, and fish. One or two raw apples or a peach or orange may be given daily. A strict observance of the above rules and diet will result in normal movements of the bowel if persisted in for a reasonable time. It may be necessary occasionally to use a suppository or an enema now and again until the habit is established.
In children from five to fifteen years of age the use of bran muffins, with fruit, etc., as described above, will effect a cure of constipation without having to resort to drugs. I have cured many cases of constipation in growing children with these muffins without making any other change in their diet or habits.
RECIPE FOR BRAN MUFFINS
Take one pint of best flour, one quart unsifted bran, one teaspoonful bicarbonate of soda (baking soda), a pinch of salt. Mix these thoroughly together, then add: six to eight tablespoonfuls good, New Orleans molasses, one pint of milk. Mix together very thoroughly. Put in muffin rings and bake in oven. About one ounce should be put in each ring as they raise easily. Eat with plenty of good butter. They should be given to children before each meal, when they are hungry, not after their stomachs are full. Put bran in dish first. Sift in flour, soda and salt. Mix these thoroughly together, then add one pint of milk (two cupfuls) and six to eight tablespoonfuls of New Orleans molasses. The quantity of molasses depends upon the individual taste. They are good for any child or adult whether constipation exists or not.
Drugs may be of temporary service in some cases. A pill of cascara sagrada is the best for this purpose. It should not be continued for more than two weeks. Castor oil, calomel, and other frequently-used cathartics should never be used in simple constipation.
TREATMENT OF OBSTINATE CONSTIPATION
There are cases that resist treatment of the kind described above. Diet and drugs do not succeed in establishing the habit of daily bowel movements. In these cases radical treatment is imperative. The diet should be the same as that described above, but it will be found advisable to cut out milk altogether. Cereals can be taken with sugar and butter instead of milk. The oil injection plan of Professor Kerley has given me excellent results. I quote his comments upon and method of giving it:—
"Oil Injections."—"For this purpose a soft-bulb syringe of four ounces' capacity is ordered. Over the hard rubber tip is place a small sized adult rectal tube or a No. 18 American catheter. The catheter or tube is cut so that but nine inches remain for use. The cut end is forced over the small, hard rubber tip of the syringe. A fountain syringe is impracticable for this purpose, as it is soon destroyed by the oil and rendered unfit for use. Besides, sufficient pressure is not produced to force the oil into the gut even with a high elevation of the bag. The child is placed on his back or on his left side. The syringe is filled with oil, the tube is lubricated, and passed through the rectum as far as it can go. When it has been passed to the full nine inches, as may readily be done with a little practice, the syringe is emptied and the tube withdrawn. The injection should be given after the child has been placed in bed for the night. It is our object to have the oil retained during the night. If a passage of the bowels is produced at the time, or if the oil leaks out during the night, a small quantity should be used. In some of my patients I have been able to use but one ounce. In very few, indeed, does it cause an evacuation at the time. If there is a tendency to leakage a napkin should be worn to avoid soiling the bed-linen. The following morning after breakfast, the child is placed on the vessel and kept there until a bowel movement results or until fifteen minutes have elapsed. In a great many cases if the constipation has been obstinate for months, the bowel will be at once evacuated. When this does not occur in fifteen minutes, a glycerine suppository is inserted, which invariably produces an evacuation. This use of the suppository, according to my observation, can usually be dispensed with in a very few days; the use of the oil, however, may have to be continued for several weeks. When the child has had the oil nightly and an evacuation the next morning without assistance for two weeks, I direct that the oil be omitted for a night and the effect noted. If the usual passage occurs after breakfast, the oil is given for five nights and then omitted. If the case progresses satisfactorily the use of the oil is gradually omitted, being given at first every second night, then every third, fourth, or fifth night, etc. A considerable number of cases have been completely relieved in two months. In the event of no passage following the omission of the oil, its use is continued for two weeks longer, when it is again omitted for a night." To illustrate this point the following case is cited.
"Illustrative Case.—A boy three years of age had never had a bowel evacuation without drugs, soap enemas, or suppositories since birth, and finally these were no longer effective. The mother, thoroughly frightened, brought the child to me. Eight months of diet and the use of the oil were required before he was entirely well. It is now three months since the local treatment was discontinued and the bowel function remains normal.
"The diet with the absence of milk must be continued for months after the patient is apparently well, and he must not be allowed to pass a single morning without an evacuation at the usual time. In assuming the management of one of these cases I explain to the mother or nurse that the treatment is not pleasant for the child or the attendant, and that it may have to be persisted in for weeks, and unless she is willing to carry it out to the end, it would better not be undertaken. I assure her, however, that with her coöperation, which is usually readily given, the child will make a complete recovery. Cases that are slow in responding to treatment, I usually give the additional advantage of abdominal massage from twenty minutes to one-half hour, before the child is placed at stool. The massage should practiced by one skilled in the work.