Diathermy Or Thermopenetration

This new application of electricity which we owe to Dr. Nagelschmidt, of Berlin, is a most interesting medical use of the so-called wireless electrical current. In the body the high frequency waves of electrical energy are wholly converted into heat so that no electrical sensation or other sensation except heat is felt. The special advantage of diathermy over other forms of heat applications is that the heat may be applied to the deepest parts as easily as to superficial parts. This is due to the wonderful penetrating power of this current.

Diathermy is a valuable means for employment in the treatment of colitis. The application of the current to the spastic colon causes it to relax, and likewise relieves the pain in the colon as well as the back and other reflexly related parts.

Special Treatment Of Different Types Of Constipation

The practical management of cases of constipation is in its main features the same irrespective of the type or form which the disease may assume. However, there are certain special features of each of the several characteristic phases of this diseased condition, which require special consideration.

Without recapitulating the details of what has been said in the preceding chapters respecting the hygiene and preventive methods, the next few pages will be devoted to a summary of the methods which have proved most effective in dealing "with several forms of constipation.

Treatment Of Simple Constipation

The patient must set himself resolutely to improve his general health in every possible way. He must avoid all habits known to be injurious, such as the use of tobacco, alcohol, tea or coffee. Indulging in late hours; irregular meals; use of rich and highly seasoned foods; unwholesome dress; worry; and every unnecessary expenditure of vital energy which does not bring with it a compensating addition to vital resources, must be resolutely abandoned. The general rules and principles which have been set forth in the preceding chapters respecting the regularity of bowel movement and the use of laxative foods in sufficient quantity must be scrupulously followed.

The special exercises recommended for strengthening the abdominal muscles, correcting wrong attitudes in sitting and standing, must be taken systematically twice a day. Feeble persons will, of course, begin with lighter exercises, increasing their vigor as they improve. No less than thirty minutes should be devoted to exercise daily.

The exercise bath is especially recommended because it economizes time by combining the tonic cold bath with vigorous exercise of the most helpful sort.

In all cases in which the colon is prolapsed, and when there is a flabby state of the abdominal muscles, a carefully fitted abdominal supporter must be worn.

Diet

The most important of all measures is the careful regulation of the diet, not only with a general view to a laxative effect, but to suit the needs of the individual patient. It must be remembered that, above all things, the food must be attractive and it should be eaten at such times and in such quantity that it will always be taken with keen relish. When the mouth waters at the sight and smell of food, it is a good sign that the whole digestive apparatus is ready to undertake the work of digestion with promptness and vigor.

The bill of fare must as far as possible be made up of food stuffs which leave a residue of cellulose. Fine flour bread should be wholly discarded from the dietary. Bread or biscuit made from coarse graham meal or rye meal should replace other bread stuffs. It is in many cases advantageous to increase the amount of cellulose in the bread, by the addition to graham flour of bran to the amount of about one-tenth the weight of the flour. The bran and graham flour should be prepared from well washed wheat. If such flour cannot be readily procured, wheat may be purchased, washed, dried and ground in a hand mill. A few bacteria introduced into a slice of bread prepared from unwashed wheat might not in itself be capable of doing any great amount of injury, but it must be remembered that under the favorable conditions presented by stag-nating fecal matters in the colon, poison-forming bacteria develop with extraordinary rapidity.

All green vegetables should be freely used at the principal meals. Potatoes may be eaten in moderation, but should not constitute the chief vegetable food, for the reason that they are almost completely digested, containing a minimum amount of cellulose, as will be seen by reference to the table of vegetable foods. It is well to select those vegetables which are richest in cellulose. When the digestion is fairly good, such vegetables as beetroot, spinach, squash, asparagus, cabbage, carrots, turnips, and cauliflower should be very freely used.

Two or three of these vegetables may be taken at each meal. Uncooked vegetables of some sort should be taken at least twice a day at the principal meals. Lettuce, celery, cucumber and cabbage may always be taken with the greatest advantage, when the digestion is fairly good. There are very few who cannot take one or more of these green vegetables if care is taken to observe that they are fresh and crisp, and pains are taken to masticate thoroughly. Even radishes may be eaten in moderation, if the irritating skin is removed.

Fruit, both stewed and fresh, should constitute a part of each meal. Fruit is especially valuable for the last meal of the day, and fresh fruit may be taken with advantage just before retiring at night, and as an early meal by those who rise, early and breakfast late. The acids and sugars in fruits stimulate bowel action, but to secure this effect they must be taken in considerable quantity. Those who take two meals a day may often take with advantage two or three oranges or as many apples just before going to bed at night. Juicy fruit requires no work of the digestive organs, except to move it along and absorb the predigested nutrient which it contains. This remark, of course, does not apply to such fruits as dates, which contain a considerable amount of cane sugar, nor to the banana, which is really quite a hearty food, but relates only to such juicy fruits as oranges, apples, peaches, apricots, berries, pears and grapes.

When the bill of fare consists largely of such food stuffs as fruits and vegetables, it is necessary to give careful attention to the actual food content of the meal. There is a wide variation in the amount of nutriment contained in different fruits and vegetables. For example, an ordinary serving of potatoes represents 100 calories of food, while a serving of cauliflower represents 25, and is mostly wood and water. A serving of beetroot represents 25 calories, while a serving of cabbage or lettuce contains only 7 calories.

Many persons suffering from constipation find it better to take two meals a day rather than a larger number. A full meal is a much stronger stimulus to the stomach and to the intestine than a mere "bite" of food or a half meal. By taking two good sized meals a day, a good bowel movement may usually be secured after each meal, while the same quantity of food taken at three or four meals might produce but one thorough movement, the stimulus of the smaller meals being only sufficient to produce a partial emptying of the intestine. The question as to the number of meals is one that should receive careful consideration, and often requires the exercise of the best skill and judgment. Stomachs which empty slowly require a longer interval between meals.

It is especially important that care should be taken to include in the bill of fare a sufficient amount of fat Fat is not only a nutrient of the very highest value, but it is a laxative food element, partly because by its use the secretion of the bile and other intestinal juices is promoted, so that the intestine is benefited by their laxative influence, and also because a portion of the fat remains be-hind unabsorbed, acting as a lubricant and also as a stimulant to the colon.

Most cases of simple constipation are promptly relieved by the adoption of the measures above recommended. The amount of bran may be increased almost ad libitum when necessary. In addition to the bran taken in the food, one or even two heaping tablespoonfuls of cooked and sterilized bran may be taken at each meal Palatable prep-arations of bran are now available which makes possible the free use of this most important aid to bowel action without inconvenience.

If any further assistance is needed it is to be found in the use of white Russian paraffin oil, the details concerning which having been given in a preceding chapter. (See pages 260-270.)