ases. A pill of cascara
sagrada is the best for this purpose. It should not be continued for
more than two weeks. Castor oil, calomel, and other frequently-used
cathartics should never be used in simple constipation.

TREATMENT OF OBSTINATE CONSTIPATION

There are cases that resist treatment of the kind described above. Diet
and drugs do not succeed in establishing the habit of daily bowel
movements. In these cases radical treatment is imperative. The diet
should be the same as that described above, but it will be found
advisable to cut out milk altogether. Cereals can be taken with sugar
and butter instead of milk. The oil injection plan of Professor Kerley
has given me excellent results. I quote his comments upon and method of
giving it:--

"OIL INJECTIONS."--"For this purpose a soft-bulb syringe of four ounces'
capacity is ordered. Over the hard rubber tip is place a small sized
adult rectal tube or a No. 18 American catheter. The catheter or tube is
cut so that but nine inches remain for use. The cut end is forced over
the small, hard rubber tip of the syringe. A fountain syringe is
impracticable for this purpose, as it is soon destroyed by the oil and
rendered unfit for use. Besides, sufficient pressure is not produced to
force the oil into the gut even with a high elevation of the bag. The
child is placed on his back or on his left side. The syringe is filled
with oil, the tube is lubricated, and passed through the rectum as far
as it can go. When it has been passed to the full nine inches, as may
readily be done with a little practice, the syringe is emptied and the
tube withdrawn. The injection should be given after the child has been
placed in bed for the night. It is our object to have the oil retained
during the night. If a passage of the bowels is produced at the time, or
if the oil leaks out during the night, a small quantity should be used.
In some of my patients I have been able to use but one ounce. In very
few, indeed, does it cause an evacuation at the time. If there is a
tendency to leakage a napkin should be worn to avoid soiling the
bed-linen. The following morning after breakfast, the child is placed on
the vessel and kept there until a bowel movement results or until
fifteen minutes have elapsed. In a great many cases if the constipation
has been obstinate for months, the bowel will be at once evacuated. When
this does not occur in fifteen minutes, a glycerine suppository is
inserted, which i