In earliest infancy from two to three daily evacuations from the bowels are considered a normal number, but in childhood, as in adults, one passage is normal. In later infancy constipation is exceedingly common on account of the milk diet, and bottle-fed babies are more subject to it than sucklings. The small intestine is relatively longer than in the adult, the large intestine easily becomes distended, the pelvis is more contracted, and peristalsis is usually less vigorous, owing to a less powerful musculature than obtains in adults.

When constipation is present in an infant at the breast the milk may be too rich in casein and deficient in fat, salts, and sugar. This may be due to a constipated habit of the mother, and laxative foods should be given to her rather than medicines to the child. If the child is nursing a wet nurse, it may be best to change to another in perhaps an earlier stage of lactation, or one whose milk is less rich in proteids.

If the infant's stools consist of dry and brittle scybalae it should be given more water to drink, or a little oatmeal water, which is laxative. Other simple and oftentimes effectual remedies are from half to a teaspoonful of olive oil, molasses, melted sugar, or butter.

In the case of hand-fed babies when the milk forms large and hard curds, and when the proportion of cream is too small, the addition of water and cream will often remedy the evil.

As an occasional, but not habitual, simple remedy for constipation in such cases relief may be obtained by making a mixture of a tablespoonful of whole-meal gluten flour in a pint of water, boiling for three hours to a thick mass, and adding a teaspoonful of the mixture, unstrained, to each feeding bottle.

Artificial foods, "prepared " foods, and condensed milk are more apt to excite diarrhoea than constipation, but it should be remembered that they may cause the latter, and the continued use of coarse food or cathartics, or of large enemata, overstimulates the bowel and results in constipation.

When it is necessary to use enemata they should be small, and not too frequently given. From ten to thirty drops of glycerin in two teaspoonfuls of water is quite sufficient for a young nursing infant. The glycerin, by virtue of its hygroscopic power, abstracts water from the rectal mucous membrane, causing hyperemia, which in time excites peristalsis. A simple injection of two teaspoonfuls of cold water containing a pinch of salt is often successful.

Suppositories may also be used. They should be small, conical in shape, and well oiled before being inserted. They may be made of glycerin, soap, molasses candy (Fruitnight), or gluten.

For older children, from three years up, some one or more of the following articles should be included in the menus. By this means it will be possible to do without castor oil, senna, rhubarb, strong enemata, and other remedies which are constantly abused.

Foods Recommended

Oatmeal, corn bread, cracked wheatf porridge, wheaten bread made of unbolted flour, bran bread soaked in warm milk, gingerbread, bread and molasses (not sirup), brown bread and honey, stewed prunes, baked apples, figs, olive oil and olives, cod-liver oil, fresh green vegetables, orange juice, peaches, and whey.

Foods Forbidden

Certain foods should be absolutely forbidden to older children, such are cheese, dry fruits (except figs and prunes), fruits having small seeds, spices, pickles, nuts, raisins, dried, salted, or preserved foods of all kinds, canned corn, sweets, candies, cakes, and excess of farinaceous foods. All articles likely to produce flatulent dyspepsia must be avoided. Children on a mixed diet do well to avoid starchy foods and take more broths and soups. Variety in the diet is desirable.

Children should be trained to go to stool at regular hours, and should be early taught the evil consequences of neglect to respond to the calls of Nature. School-teachers should not detain them at their lessons when they are inclined to seek the closet. Water-closets or privies are often dark, cold, and otherwise disagreeable, so that children dread going to them.

Abdominal massage is very helpful in overcoming chronic constipation in young children. It may be performed two or three times a day for five minutes. The movements should be made with the fingers of a warm, dry hand, which move the integument and abdominal wall over the intestine. The treatment must be very gentle, and if the muscular wall is tense, it may be conducted while the infant is nursing or feeding, as suggested by Fruitnight.