434 MATER i A MEDIC A AND THERAPEUTICS. 



thirst, or sips of toast-water; draughts of all kinds must be 

 avoided. Stimulants may he required hy the aged, hy infants, 

 and in all cases of protracted diarrhoea, hrandy and port wine 

 "being the most suitable forms. 



2. Deficient Intestinal Action : The Use of Purgatives. The 

 treatment of constipation consists chiefly in careful regulation 

 of the diet, which should include fruits, green vegetables, meats, 

 and " whole " brown bread, whilst milk and strong tea are to 

 be avoided. As a rule, however, its chronic " habitual " form 

 calls for active interference. 



In the treatment of constipation, the cause must first be 

 removed if it can be discovered. The diet, digestion, and liver 

 must be regulated, and sufficient muscular exercise, mental 

 relaxation, and other hygienic provisions ensured. 



Habitual constipation being generally referable to torpidity 

 of the muscular coat, will be rationally treated by the adminis- 

 tration of nervo-muscular stimulants. But these must be 

 preceded by a free evacuation, since the tone of the intestinal 

 wall cannot be restored until over-distension has been removed. 

 For this purpose a more powerful purgative must be given at 

 first, such as Colocynth and Blue Pill, followed by a saline, to 

 thoroughly empty the gut ; and this practice will be repeated 

 with advantage every few weeks for a time. A regular course 

 of aperient medicine may then be commenced. There is con- 

 siderable choice of drugs which increase peristalsis, the best for 

 habitual use being Aloes, Senna, Rhatnnus Frangula, and 

 Cascara Sagrada. Nux vomica (strychnia) is often added, in 

 cases where the muscular tone has been lost by protracted over- 

 distension ; and Belladonna is a valuable adj uvant of Aloes in 

 particular cases. Rhubarb, which is a popular aperient, is apt 

 t9 produce further constipation. 



"Muscular torpidity is also rationally treated with chola- 

 gogues, and Rhubarb and Aloes act partly in this way. The 

 saline cholagogues, such as Sulphate of Soda, and the many bitter 

 mineral waters now sold (such as Friedrichshall and Hunyadi 

 Janos) are highly popular habitual purgatives, but are apt to 

 lose their effect if given for a length of time, and then to in- 

 crease rather than relieve constipation. In anaemic subjects 

 the Pilula Aloes et Ferri, and in uterine inactivity the Pilula 

 Aloes et Myrrhse, are specially indicated. Purgative or 

 simple enemata must occasionally be ordered, but the prac- 

 tice must not be continued lest it become habitual. It 

 may be necessary to keep up the action of nervo-muscular 

 intestinal stimulants for an indefinite period ; and Senna is the 

 best drug for this purpose, especially in the form of the 

 compound Liquorice Powder. 



