The drug may be given alone, or combined with some of the remedies about to be mentioned.
Extracti Cascara Sagradce Liquidi 3ij. Tincturee Nucis Vomicce 3v.
Tinctitree BeIladwina 3iij.
Glycerini q.s. ad Siv. Misce.
Fiat mistura, cujus capiat cochlearium minimum omni vespere et mane ad.qaatuor vicem, deinde omni. vespere.
_ Cascara jelly madewith agar agar is a favourite form for administration; the agar adds to the hulk of the faeces by absorbing water. Regulin—a patented combination of cascara and agar in the dried form—is also a valuable laxative. Both may be given in doses of i to 4 drs. with stewed fruit.
Aloes comes next to cascara in value in the treatment of chronic consti pation, and often both laxatives may be combined with advantage. If judiciously administered, the dose of aloes need not be increased, whilst, in many cases, it may be diminished, and finally withdrawn as the consti pated habit becomes cured. It is best given in combination with other laxatives or cathartics, as it is slow in its action, and, when given in small doses, does not soften the motions much, but stimulates the peristaltic movement. Like cascara, it is a tonic, and markedly increases the quan tity of the biliary secretion. It must never be forgotten that a moderate dose of aloes requires for its action to 15 hours or more, and hence the importance of administering it at a time when the normal morning hour for evacuation should not he interfered with it should usually be given before the evening meal, and noi at bed-time.
Its action in chronic constipation is very materially increased by com bining with it Sulphate of Iron, as in Spender's pill.
7. Extracti Aloes gr. j.
Ferri Salphatis gr. ij. Misce. Fiat pit:the. Mute tales xxiv.
Sigma.—" Take one 3 times a day for 7 (lays, then one twice a day for a fortnight, then one every night." When amenorrhoea accompanies the constipation the combination of aloes with iron is the best possible treatment.
Aloes in hannorrhoidal cases requires caution, since large purgative doses often seriously aggravate hmmorrhoids when present, but small laxative doses generally relieve and produce decided curative effects; and good results have been obtained by treating haemorrhoids exclu sively by small doses (r gr.) of the extract of aloes given night and
morning.
The Compound Decoction is a most unsatisfactory laxative in chronic constipation, and though of the greatest value in other intestinal dis orders, it is not to be depended upon, as it is almost impossible to regulate the dose so as to produce uniform results, and frequently it actually consti pates.
A dinner pill, in which a small dose of aloes combined with Iron, Ipecac uanha, Capsicum„ Nux Vomica, Myrrh, and Belladonna or Hvoscvamus, given immediately before or after dinner, is a most suitable method of treatment. The following is one of the best: . Extracti Aloes gr. j.
Extracti Nitcis Voinice gr. ss. Pulveris Ipecacuanha gr. j. Pulveris Capsici gr, j. Misce.
Fiat pilula. Mille tales xxiv. Sumat unain omni die ante prandium.
Brunton recommended Pil. Rhei Co. and Pil. Colocynth. Co. 55 gr. i.; Ext. Hyoscy., gr. ss.
Sir A. Clarke used this formula :—Ext. Nuc. Vain., Ferri Sulph.. Pulv. Myrrke, Pulv. Saponis, Aloin ana, s gr. The quantity of aloin is to be increased or diminished according to the effect produced upon the bowel.
Belladonna was used by Trousseau. The extract in doses of to or. given at bed-time, alone or with as much Extract of Nux Vomica, may be tried, or may be given with any laxative in a dinner pill, when it will not only strengthen the muscular contractions of the bowel, but to some extent prevent griping. The tincture, in small doses, is a very excellent treatment for the constipation of infants and children. Belladonna is also the best remedy for the spastic form of constipation sometimes met with in neurotic and usually associated with much spasm and pain. Alvarez combines atropine -, gr. with gr. Apocodein.
Strychnine or Nux \'omica is of the greatest value as an adjunct to other drugs, and occasionally alone it meets every requirement. The following formula combines the most valuable of agents, and by modifying the dose of the different ingredients nearly every case of chronic constipation can be treated with success: R. loin gr. j.