It is almost as difficult to prescribe a diet for constipation as it is for dyspepsia, and for the same reason, namely, constipation is not in itself a disease, but a symptom or result of many diseases. As a general rule, however, a certain diet is more or less suitable for any kind of constipation. By the latter term we usually mean a delayed action of the bowels due to a natural weakness of the muscles of the intestines, or to an acquired weakness due to too concentrated a form of nourishment or to a sedentary life. In a certain percentage of cases the delayed action of the bowels is due to temporary spasm of the intestinal muscle, and this may even occur in association with weakness of the muscle, as is seen in hysterical women. There is finally delayed bowel action in a great number and variety of diseases.

The resources employed in treating the diseases which cause constipation include many plans beside diet, yet the latter is indispensable.

A mixed diet is very necessary, for purely animal food products, as meat, fish, eggs, milk, cheese, etc., conduce to constipation because absorption of such foods is so nearly complete that not enough residue remains in the intestines to stimulate peristalsis. On the other hand, a diet of vegetables, involving a large indigestible residue, causes large fecal motions, but these are not promptly expelled unless the intestine is healthy. Much extra work is thrown upon the intestine when a vegetarian diet is used exclusively; and as a result of such excessive work the intestine becomes in time weakened.

Constipation from whatever cause and of whatever nature may be, when sufficiently pronounced, sufficient to render a healthy man or woman sick. Digestion becomes impaired, appetite lost. This fact alone teaches us that in dieting a constipated subject we often have to deal with a sick individual. It has often been stated that a patient or his lifelong companions are better judges as to his diet than a physician hastily consulted.

Ewald, and doubtless most stomach specialists, are opposed to an exclusive calorie plan of feeding in all gastro-intestinal diseases. This is natural because food which is theoretically indicated cannot be managed by the digestive organs. If an attempt is made to feed a patient thus affected with 3000 calories of food, the result will be complete repugnance to all food. The amount of food ingested in these cases, in the most palatable and digestible form, cannot come up to the calorie standard. The quantity ingested in such patients is so low as to be quite beneath the efficient level. The inference is natural that such patients must draw on their reserve fund to make up the calories.

Hence the only course to pursue is to cure the condition which causes the constipation as soon as possible. For mere sluggish action of the bowels, not amounting to disease, many popular dietetic remedies are employed. It is by no means certain that this delayed action in many healthy persons is other than natural or temperamental. Fletcher has shown that as a result of his reduced diet and excessive mastication of food which contains not much indigestible residue, sterile and odorless feces are formed which cause no discomfort, and insists that such people need have no anxiety about their bowels. On the other hand, very many people who have regular daily evacuations suffer from retention of fecal matter; only careful palpation of the sigmoid flexure will inform us as to whether the bowels are actually empty.

Of household dietetic procedures for securing daily evacuations, the most common is the drinking of cold water on rising - one, two or more glasses. To this a little common salt may be added. Many men depend for their morning evacuation on smoking a cigar after breakfast. Women, as already stated, find the morning draught of cold water valuable. The use of fruit at or before breakfast often causes an evacuation during the day. This is true especially of apples, pears, oranges, etc. Buttermilk is also largely used for this purpose. The vegetable acids with the large amount of indigestible residue make certain fruits valuable as laxatives. This is true also of berries, although those which contain tannin (blackberries) may tend to constipate. Dried fruits, such as figs and prunes are especially useful. The use of sweet cider as a marked laxative seems to illustrate again the laxative power of vegetable acids. Very sweet substances in large amounts, chiefly honey and molasses are notably laxative. Oatmeal, among the cereal foods, is noted for its laxative powers. Beans and peas, popularly believed to be laxative, are really constipating; but the fermentation of the large amount of cellulose gives the illusion of impending diarrhoea. Oils and fats are laxative to many people. A word of caution must here be inserted. Many of these substances carelessly spoken of as laxatives, often behave as violent purgatives, especially in individuals who alternate between constipation and diarrhoea. The severe diarrhoea set up at times by sweet cider, molasses and other relatively inert substances should teach us caution in giving such articles to patients.

No more important hygienic regimen can be adopted than the following: 1. Eat fruit before retiring (experiment and find what fruit seems to agree). 2. Three-quarters of an hour before breakfast drink two glasses of cold water and exercise ten minutes in room before open window or take a brisk walk. If this regimen were followed daily by children and grown people there would be less illness.

Diet: Soup

Oyster soup, meat broths, Liquid Peptonoids bouillon.

Fish

Raw oysters, fresh fish of all kinds broiled or boiled.

Meats

Game, poultry, almost any fresh meats.

Farinaceous

Rye bread, brown bread, graham, corn and whole wheat bread, hominy, mush, cereals, Bran Cookies.

Vegetables

Salads with oil, string beans, green peas, green corn, asparagus, potatoes, cauliflower, spinach, brussels sprouts,' onions, boiled.

Desserts

Simple and light-apple and fig puddings, plain pudding, as custards, whips, and gelatin, etc., junkets, ice cream, sherbet, ices, hominy, raisins, cherries, huckleberries (the blue seedless kind), grapes, melons, apples, oranges, pears, ripe peaches, baked apples, with cream, figs, stewed prunes.

Liquid

Unfermented grape juice, plenty of pure water, cold or hot; black coffee, cocoa, new cider, buttermilk, orange juice, malted milk.

Avoid

Spirituous liquors, pineapple, cheese, nuts, tea, sweets, milk, pastry, rich puddings, rice, tapioca, new bread, eggs, liver, pork, salt, smoked, potted or preserved fish or meats.