Ext. Cascarce gr. j.
Ext. Nucis V. gr. ss.
Ext. BeIlad. gr. ss.
Ferri Su1ph. Ex. gr. j. Misce.
Gregory's Powder or Rhubarb, though much used for many years by chronically constipated patients, is not a good remedy. In the writer's experience its tendency in chronic constipation is not curative; aged patients employ it continually because they cannot do without it.
Colocynth is more active, but it is most difficult to graduate.the dose so As to get a laxative effect. It may, however, be combined with rhubarb As in Brunton's Pill.
Podophvllin is much more valuable in the treatment of acute consti pation where a satisfactory brisk purge is required, nevertheless it is use ful in the chronic form in bilious subjects. It may be given in combina tion with Belladonna.
R. Tinctura Podothylli 3j.
Tincturce Belladonnre 3iv.
Tincharee Zingiberis Fort. 3iv. Misce.
Smntal plias xx. multi nocle ex paululo sacchari.
Nothnagel recommended Podophylli Resime, gr. ivss.; Ext. Aloes, ;r. xlv.; Ext. Rhei, gr. xlv.; Ext. Taraxaci, q.s.; misce. Divide in pilulas Signa.—" One, two, or three at bed-time.'' Euonymin in pilular acts much in the same way, but it is feebler.
Castor Oil in small doses has been given for long periods with advantage. Thus in the chronic constipation of pregnancy it is the best remedy in morning doses not exceeding i dr., and may be taken with impunity all ;hruugh.
Senna in the form of Tamar Indien is an excellent remedy, and when administered with care to regulate the dose, is a very successful method of .reating chronic constipation in indoor patients. It produces very large, almost solid motions, and its action is not followed by any tendency to :onstipation; the dose can be easily diminished by the patient. Some tatients can manage to keep their bowels regular with small doses of Senna Pods made into an infusion.
Purgatin (anthrapurpurin diacetate) and Purgen (phenolphthalein) are valuable aids in the treatment of constipation, but they cannot be employed for long periods with safety. Purgatin in 13 gr. doses produces one semisolid motion after about so hours, but it colours the urine red.
Purgen in i to . gr. doses acts in halt this time.
Sulphur is of much value, and may be given in the morning before break fast mixed with a spoonful of Orange Marmalade, and the Compound Powder of Liquorice is a palatable laxative and one of the best routine drugs for occasional constipation in childhood. Two or three Compound Sulphur Lozenges may be given at bed-time.
Rubinat, Friedrichshall, Carlsbad, Hunyadi Janos, Pullna and other natural purgative waters are useful as occasional adjuncts to the aloes or cascara treatment, and they are invaluable in the management of occa sional constipation, hut it will be found impossible to obtain a laxative effect by their administration. Hence upon the whole they are not to be depended upon as curative agents, and the same remark applies to the treatment at spas like Harrogate, Cheltenham and other places where saline aperients are freely administered. Often the good effects are but temporary, and the habit afterwards is aggravated.
Jalap, Scammonv, Croton Oil, Epsom Salt, and 1Nfercurials are not avail able for the treatment of chronic, though valuable for the relief of acute or occasional constipation.
There is little to he said for surgical interference which can only be justifiable under very exceptional circumstances.
Constipation in infants, the cause of constipation is usually a deficiency in sugar or fats. The former may be remedied by the administration of a. teaspoonful of brown or Demerara sugar, and the latter by a similar dose of cream. When the constipation is due to scarcity of water, as in cases where artificial food is administered of the consistency of a thick cream or paste, water should be freely supplied. The constipa tion caused by the presence of firm curds, if not relieved, is liable to end in acute diarrhoea. The dilution of the cow's milk with barley water, or beef tea, or peptonisation should be resorted to. Manna is a safe laxative, though now seldom employed; it may be given for long periods to infants and young children till the constipated habit disappears.