Ene Such a diet was maintained for one or two weeks. mata were used when necessary at the start. If at the end of the period the diet worked without aid from enemata, as was frequently the case, the patient was instructed to continue in it, gradually cutting down the prunes and possibly to some extent the proportion of fruits or green vegetables. In this way after a time an ordinary diet with plenty of green vegetables and fruit and an occasional prune dessert was approximated in many cases as a permanent habit. In cases which were very much the victim of drug habit for their constipation, or in all cases which did not improve after ten days to two weeks of the above diet with the prunes, prunes stewed with a certain quantity of senna were prescribed (one ounce of senna leaves placed in a cheese cloth bag and stewed with three or four dozen prunes). The patient was told to take a saucer of this dish for dessert once to thrice a day, according to need, in addition to his special diet. After one to three weeks the senna was omitted from the prunes (it was best to have this omitted without the knowledge of the patient if possible) and the patient continued on the regular constipation diet. It was frequently necessary to use the senna at the start in cases which had depended much upon drugs. Given in the above way it was very easy to gradually lessen the dose while the general effect of the laxative diet was establishing itself, and the mental effect on the patient of the dosage given in this way was not at all the effect of giving a drug for laxative purposes. In some special cases other methods, as the inclusion of fat excess in the diet were tried. As a rule, however, the above plan was given and adhered to in all cases. The treatment has now been tried upon 126 cases taken in routine with no selection of cases excepting that cases with obvious pathological lesion as a próbable cause of the condition as tumor or definite disease of the alimentary tract were sometimes excluded. Of these 126 cases 100 were hospital cases and 26 private. The plan was stated one year ago and all the cases inIcluded in the record have been under observation for six months or more. The result of the experiment up to date may be seen from the following table. TABLE 3. Total number of cases not heard from 68. (All hospital cases.) Total number of cases under observation 58. Number relieved by treatment 54. Of the 58 cases 40 were relieved by the diet alone, including prunes. The remaining 18 necessitated senna with the prunes at the start, but all save four of these have finally become able to continue on the diet alone without the senna. In In most cases the relief came at once and continued. a few it was a matter of one to several months before the result was accomplished, and frequently slight adaptation of the diet varying on the routine plan had to be made for the special individual, as the inclusion of excess of fat or of more organic acid in the diet. These results indicate two facts very emphatically. First, that in a very large majority of the cases of constipation which occur in the routine of practice, the chief if not the only cause or underlying condition is a failure of the individual to follow a normal physiological manner of life. Second, that in a large majority of all cases of constipation taken without reference to the cause or underlying condition, a complete cure, so that the patient can get along without the regular use of drugs or other artificial aids, can be established by a proper direction of general regime and diet. These results are the more encouraging since a large proportion of them were obtained in out-patient hospital patients whose facility for carrying out the directions was limited. One can not but feel that a treatment which could be so successful under these conditions is one thoroughly adapted to routine practice. On the whole, when we consider that all the patients treated already had the drug habit to some extent, the quick response to dietary regime is quite remarkable and was a great surprise to me as also to the patients. It must be borne in mind, however, that these results were obtained under a method which included extreme attention to and study of the patient, much more than is accorded in the rule where a simple diet list is made out and the patient sent away to follow this indefinitely. This was, it is true, all that was done at the start and the number of cures with this simple procedure alone was large. With many of the cases, however, very intimate study of the condition as to gastric digestion and motility investigated by study of the gastric contents, general metabolism as studied by quantitative analyses of the urine, intestinal digestion and absorption studied by examination of the fæces, and adaptation of the treatment to the findings in these regards was neces sary before success was forthcoming. Taken all in all, however, the record is such as to confirm us in the surety that we have a method of treating constipation in a large majority of our cases which is effective and also ideal in that it follows the natural physiological method of accomplishing the function in question and does away with extraneous or drug stimulation. |