The.few unpleasant effects attending the use of paraffin are really so slight in character that they are generally easily overcome. Sometimes, however, they constitute a real obstacle to the use of this most valuable remedy. The chief objections which are met are the following:
1. An unpleasant oily taste which to some people is so disagreeable as to produce nausea and loss of appetite.
2. A disposition to separate from the other intestinal contents. It usually appears as a brown oily liquid separated from the rest of the stool and sometimes the separation is so marked that the stools are very ragged, or consist of hard lumps smeared with brown oil.
3. Paraffin oil is so limpid that it readily finds its way to the rectum ahead of the other bowel contents, and very easily escapes, either with or without the expulsion of flatus. The patient is often unconscious of the escape until it is noted that the clothing is badly soiled.
The difficulty of taking paraffin the writer succeeded in overcoming almost entirely by preparing a very heavy emulsion through the assistance of gum acacia. This emulsion is easily taken in hot or cold weather, but is open to the objections raised under two and three.
All objections are removed by the use of paraffin in solid form. Paraffin tablets which are solid at or-nary temperatures, but melt at the temperature of the inside of the body, are easily taken with the food. Paraffin in this form mixes with the feces thoroughly and does not separate. A single tablet (one-half ounce) is sufficient for a dose. One tablet is taken with each meal Two or more tablets may be taken without injury.
In many cases of chronic constipation the lower colon and the rectum become dry, the result of atrophy of the lubricating mucous glands which have been destroyed by colitis or chronic proctitis. This condition may extend up into the pelvic colon. As a result, the feces adhere to the walls of the bowel and so accumulate, forming impactions and cumulative constipation, one of the most frequent forms of constipation. In many such cases only partial relief is obtained by a laxative diet. By the use of paraffin oil, one or two tablespoonfuls before each meal, the colon and rectum may be lubricated artificially. In some cases, further lubrication is needed. For this purpose there is nothing so useful as a specially prepared paraffin which melts at a temperature of 102° F., or just above the body temperature. This is heated until it is nearly all melted, by placing the container in hot water. Then with a piston syringe three or four ounces of the warm melted paraffin is introduced into the rectum.
To enable the paraffin to reach the pelvic colon the patient should assume the knee chest position for two or three minutes after the paraffin is introduced and should take deep breaths to encourage the distribution of the melted oil.
The temperature of the body being about 100° F., or less than that of the paraffin, the latter will be cooled below its melting point, and so will acquire the consistency of a soft ointment which adheres to the surface of the bowel, and serves as a most efficient lubricant.
The exercises that are of the greatest value in cases of constipation are those which bring into strong action the muscles of the abdomen. The abdominal muscles are generally weak and relaxed, and the intra-abdominal pressure is consequently low.
By appropriate exercises the weak muscles may be strengthened; the intra-abdominal pressure may be raised, and the colon may be thus enabled to contract with sufficient impetus to expel its contents.
Hill climbing is a more valuable exercise than walking on the level, because the abdominal muscles are brought into more active play. When mountain climbing is not an available form of exercise, nearly the same results may be obtained by climbing a ladder or by walking up and down stairs. The writer has also made use of the treadmill as the means of securing muscular exercise similar to that required in hill climbing.
Horseback exercise is especially indicated as an exercise for constipation. Riding a considerable distance, however, is necessary to produce any decided effect, as, on the whole, horseback riding to a person accustomed to it, is not very active exercise, except when riding a hard trotting horse.
Rowing is one of the very best exercises to combat constipation, provided the chest is held high during the exercise, and especially if care is taken to give the trunk as strong a backward movement as possible; but care must be taken to avoid holding the trunk forward with the shoulders rounded and the chest depressed.