Weak Abdominal Muscles. Persons suffering from weak abdominal muscles, the result of diseases which cause muscular atrophy, or that have interfered with a normal growth, have not the power to compress the intestinal contents sufficiently to give the needed aid to expulsion.

Incomplete Membranous Occlusion of the anus and organic stricture of the rectum and anus are malformations, which, while only partly obstructing the rectal and anal canal, may cause constipation.

An Incomplete Imagination of the sigmoid or rectum may be the cause of an insufficient evacuation of the bowel contents, but as it is of such a serious nature it is safer to consider it from a surgical standpoint as an intestinal obstruction. Atreus an vesicles, Atreus an urethral es, Atreus an vaginal is, Atreus an uterine are other malformations which may remain undiscovered for a while causing symptoms of insufficient defecation. Atreus an vaginal is is often not discovered until late in life, and it furnishes fully fifty per cent. (50%) of the cases of malformation of the rectum.

Congenital Idiopathic Dilatation of the colon (Hertzsprung’s disease) may be the cause of an apparent constipation. This rare disease begins probably as a congenital deformity, in which there is a dilatation of from three to four inches in width, beginning at about the lower end of the sigmoid flexible and include all or part of the colon; the small intestine not being affected. The muscular and mucous membrane coats are very much hypertrophied and the mes-colon and peritoneal covering thickened. The dilatation may be enormous and admit of the collection of a great mass of fecal matter.

Obstruction to the normal movement of the bowel occurs from cancer, stricture, tumors within the bowel and pressure from neighboring organs.

Painful Affections such as fissure in anew, thrombotic piles, prolapse of the rectum, congenital narrowing of the rectum or anus, or a stricture the result of a catarrh proctorial, may cause constipation Any of these conditions may cause re tension from fear of pain at defecation, and therefore simulate constipation. Fissure in anew is a very common disease, and without doubt one of the frequent causes of constipation or constipation

Symptoms. Auto-intoxication is the most common result of constipation. Its many reflex symptoms are in the form of irritability of temper, eye defects, disordered stomach, and a lack of a healthy complexion. We may have more serious manifestations in children in the form of infantile convulsions, night terrors, day terrors, teeth grinding, bed wetting or hypochondria sis due to intestinal disturbances.

Prophylaxis. Children suffering from constipation should be taught at the beginning of the sixth week to move the bowels while on a suitable receptacle. Infants at that age, as a rule, have a bowel movement after the second feeding, and the habit encouraged then will prove of great benefit later. Older children should receive strict observation and be forced to attend to a daily evacuation. Adults, likewise, should be taught to understand that the same principles apply to them.

Treatment. Constipation being a term used to indicate the relative slow movement of the fecal contents, the treatment is necessarily indicated by the symptoms of auto-intoxication, digestive disturbances and anemia which accompany this deficient physiological function. Authentic statistics refute the opinion that a daily evacuation of the bowel contents is necessary to perfect health in all adults, as cases are on record in which individuals have had only weekly movements of the bowels, without interfering with the general health in any way. These facts would direct the treatment to relieving the condition only when constipation has interfered with some of the healthy bodily functions and should be governed by individual treatment.

Enema ta and suppositories, consisting wholly or in part of soap, as given children most frequently, are a common cause of proctorial The daily enema, or suppository of soap, should be condemned. In cases due to a kinking of the sigmoid flexible, a daily enema is the best method of emptying the bowel, but care should be exercised to have it consist simply of water. In giving an enema for this purpose an ordinary piston syringe should not be used, as the sudden injection of the fluid into the rectum tends to empty it at once, leaving the mass high up unaffected. A small catheter attached to a fountain syringe will gently carry the water into the rectum and allow it to advance into the sigmoid without expulsion. The fountain syringe should not be held higher than a foot or two above the body so as to avoid too much force.

The use of magnesium sulphate and calcined magnesia are very valuable for temporary use in children, when added to the bottle food. Strong purgatives, such as aloes and the mercurial preparations, are so irritating to the mucous membrane of the intestine that their continuous use for constipation should not be encouraged. Castor oil, owing to its after constipating effect, is only harmful in these cases.

The use of the ordinary drugs for constipation, such as cascara, phylum and senna, are to be recommended as secondary to a general line of treatment relieving the condition if possible, and arising from some definite cause. The combinations of these drugs are so well-known and commonly put up that their special prescription need not be mentioned.

Deficient motor activity is probably dependent upon a constitutional disease and is theoretically classed as such. Persons suffering from febrile diseases for short periods, due to this cause, are best relieved by the well-known and agreeable laxatives. During long periods of illness in which it is fair to presume that the depression due to the disease has caused motor inactivity, a combination of the alkaline laxative treatment with rhubarb, cascara, calorie and muscular tonic treatment is best left to the judgment of the physician in charge.