TREATMENT OF CONSTIPATION. 435 



Severe and protracted constipation, in which the bowels are 

 heavily loaded with faeces, as in load-poisoning or spinal 

 paralysis, or as the result of indolent and careless habits, may 

 demand a cathartic. The officinal preparations of Colocynth 

 are suitable in such cases, containing as they do Aloes and 

 Scammony, so that if they be followed by a saline draught, the 

 entire length of the bowel will be evacuated. Sometimes even 

 Croton Oil is required, and a large purgative enema may be 

 preferable to repeated purgation by the mouth in weak subjects. 

 This is an absolute rule in the constipation of typhoid fever. 



The treatment of constipation constitutes but a small part 

 of the use of purgatives. In a considerable proportion of the 

 cases in which purgation is practised, the indication is to 

 hasten or increase the natural activity of the bowels, in order to 

 obtain some or all of the other effects of considerable evacuation, 

 which we have already studied. The practical question then 

 comes to be what degree of activity of purgation is desirable. 

 The activity of a purgative may be estimated by the rapidity of 

 its effect, by the number of the evacuations, by the amount of 

 water in the stools, and by the degree of constitutional disturb- 

 ance which it produces ; these results, as a rule, varying directly 

 with each other. 



When there exists an urgent indication for the reduction of 

 the general blood pressure, for instance, in cerebral haemorrhage, 

 with enlarged heart, the most active purgatives are employed. 

 A drastic must then be given, such as Croton Oil, which has the 

 further advantage of being very easily administered to an 

 unconscious patient. When the portal system, heart, or systemic 

 veins are overloaded, and the fluids of the blood are finding 

 their way out of the vessels so as to constitute dropsy, hydragogue 

 cathartics and salines are given, to establish a free flow of water 

 from the bowel, and thus relieve the circulation. Jalap in the 

 form of the Compound Powder, Colocynth, and most powerful 

 of all Elaterium, are commonly employed, less frequently 

 Scammony. Frequent saline draughts, either alone or after a 

 purgative pill, have the same effect, such as the Sulphates of 

 Soda and Magnesia, Cream of Tartar, and Rochelle salt. 



At the commencement of inflammatory affections, for instance, 

 acute bronchitis or local abscess, it is usual to unload .the bowels 

 and relieve the liver, heart, vascular tension, and respiration, 

 by means of a simple purgative. The Colocynth and Ilyos- 

 cyamus pill, with or without Calomel or Bfue Pill, is well 

 adapted for these cases, being given at night and followed in 

 the morning by a Seidlitz powder. 



Chronic congestion of the pelvic organs, bowels, and liver, a 

 form of disorder not uncommon with sedentary persons, espe- 



