DEUGS ACTING ON THE DIGESTIVE ORGANS 



INDIRECT CHOLAGOGTTES. 



Calomel 

 Mercury 

 Most purgatives in a less degree. 



The bile occurring at any time within the bowels is in 

 part absorbed and then re-secreted. This process may be 

 repeated indefinitely, but is prevented by purgatives, espe- 

 cially those increasing peristalsis in the duodenum and 

 upper part of the jejunum (calomel), because they hurry 

 along and expel the bile in the gut before it has time to be 

 absorbed. 



In this way calomel and purgatives are indirect chola- 

 gogues in removing bile from the body; not by stimulating 

 its secretion, but by hastening its excretion from the bowels. 

 The experiments of Rutherford and Vignal have hitherto 

 been chiefly responsible for the scientific basis of our belief 

 in cholagogues. Their results have been swept aside by the 

 more recent and thorough researches of Stadelmann, on 

 animals, and of Pfaff, on mien, with biliary fistulse. 



These researches show that there is no agent which has 

 any marked influence in increasing the secretion of bile, 

 except bile itself. 



Salicylic acid and its compounds do, however, have a 

 feeble cholagogue action. Moreover, there is no morbid con- 

 dition in which increasing the flow of bile would prove rem- 

 edial. We must regard the existence of cholagogue action 

 then as exceedingly problematical at present. 



Clinically so-called cholagogues are, nevertheless, of 

 great value — as much so as they were ever thought to be. 

 This happens, not because they increase the flow of bile, 

 but because they act as purgatives (calomel)," or as intestinal 

 antiseptics (calomel, salicylic acid), expelling or inhibiting 

 the formation of toxins or in some way improving digestion 

 (nitrohydrochloric acid). The conditions in which they act 



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