SUBACUTE OBSTRUCTION OF THE DOUBLE COLON loi 



dose to be always necessary, and have seen doses of 



1 grain do all that the most fastidious would require. 

 That dose is sufficient to incite the bowels to action in 

 most cases, and that without an exhausting and painful 

 evacuation of large volumes of fagces. If it fails, it may 

 safely be repeated later in an increased quantity — say, 



2 grains, beyond which it is not wise to push its ad- 

 ministration. 



(/) Pilocarpine- — In this drug we have a most useful 

 adjunct to eserine. Possessing as it does the property of 

 promptly and energetically stimulating glandular secre- 

 tions, including the salivary and intestinal, it a^ once 

 recommends itself for use in the disorder we are con- 

 sidering. While in eserine we have an agent which in 

 large measure confines itself to exciting to action the 

 muscular coat of the bowel, we possess in pilocarpine a 

 drug whose administration will cause the various gastric 

 and intestinal juices to be secreted in large quantities and 

 poured into the bowel. It is plain, therefore, from a 

 physiological point of view, that the exhibition of a com- 

 bination of these two will be an ideal method of dealing 

 with obstruction caused by accumulated faecal matter, 

 and accompanied with torpidity of the bowel wall. 



Practice quite bears this out. It is true that it is only 

 since 1904 that I have been in the habit of using it. I 

 have given it a sufficiently long trial, however, to prove 

 its usefulness. This, combined with eserine, I am now 

 convinced is far preferable to the exhibition of eserine 

 alone. As to the dose, I have found that i grain of 

 eserine in conjunction with 2 grains of the pilocarpine is 

 satisfactory and efficient. 



(g) Arecoline- — Of late years the use of arecoline 

 hydrobromide as an intestinal stimulant has crept to 

 the front. Its action is said to be allied to that of pilo- 

 carpine, but of somewhat shorter duration. Although I 



