Cases of constipation due to dyspeptic conditions must be treated by first ameliorating the gastric disorder. Cases of constipation secondary to diseases of other organs must be managed by first applying remedies toward the improvement of the original trouble. If these alone are insufficient, they must be managed like typical cases of habitual constipation.

With regard to the prophylaxis of constipation, we should avoid administering cathartics in slight transient disturbances of digestion and rather let nature take its own course. Never put a patient on a one-sided diet for too long a time; the exclusion of vegetables, fruits, and starchy foods in general, from the diet is frequently the cause of marked constipation. A hygienic mode of living, regular habits, less business strain and worry, and more outdoor life and exercise are of the greatest importance in the prevention of constipation.

Generally no purgatives whatever, or as few as possible, should be used. The chief measures in curing constipation are the following:

1. The Moral Treatment

It is of utmost importance to allay the patient's anxiety to have a movement. He should be told to pay as little attention as possible to the condition of his bowels. Absence of a movement for a few days will cause no harm whatever. Avoidance of purgatives and keeping the mind of the patient free from worry over the condition of his bowels is occasionally sufficient to produce spontaneous movements.

Training the patient to have an evacuation at a certain time every day is also of great importance. The patient should be taught to go to the watercloset every morning at the same time and should try to have a passage. In doing this he should not exert himself too hard and should spend only three to five minutes for this purpose. In case the attempt be unsuccessful, he should wait until the following morning, unless there is a strong desire to go to stool. Trousseau was the first to advocate this mode of treatment, and the importance of this maxim has since been generally accepted. My own experience coincides with that of others, and I cannot lay too much stress upon this apparently unimportant piece of advice. Even when using other measures in combating constipation we must not lose sight of the influence in "training " the patient.

2. Dietetic Measures

The dietetic measures have for their object the ingestion of foods which increase the intestinal peristalsis and the avoidance of substances which are of a more or less constipating nature. Advocate the drinking of plain cold water, especially in the fasting condition, the use of buttermilk, cider, grapes, oranges, and other fruits, raw or cooked (apples, prunes, pears, peaches), lemonade, honey; salmon, sardines, herring, plenty of vegetables, spinach, green peas, cauliflower, cabbage, green salads, rye bread, butter. Avoid strong tea, claret, huckleberries, cacao and chocolate.

Some substances have a constipating effect upon one person and a purgative effect upon another, as for instance milk. In treating the patient we must acquaint ourselves with his peculiarities in this respect. In prescribing a diet for patients with constipation we should allow them the usual foods with a predominance of those just enumerated. It is needless to say that some of the articles mentioned will not be permissible in every case. Thus a patient with a very delicate stomach should certainly be told not to take cabbage and cider, etc.

In some instances in which too much vegetable food has been taken and a constipation has developed in consequence of the intestine being overburdened with too much ballast, food articles containing much cellulose will have to be restricted. As a rule, however, a mixed diet with a preponderance of vegetable food is adapted for most cases.