4. Injections

Injections into the bowels of water alone or of water with the addition of soap, vinegar, common table salt, or castor-oil are often used with advantage. The amount of fluid required for a purging effect varies in different persons. As a rule a pint to a quart or one and a half quarts are necessary. These water injections should be made daily at the same hour for a period of three to four weeks, and then every other day also for the same length of time.

Recently Klemperer 1 has recommended the use of small water injections into the bowels at bed-time. Half a pint of water is injected and the patient is told to retain the fluid. The latter is very soon absorbed by the intestine and the patient has an evacuation on the following morning. Kleniperer cured cases of constipation by giving these small water injections for about three weeks every day, and then every other day for the following two or three weeks.

1 Klemperer: " Therapie der Gegenwart, " 1899, p. 48.

Injections of sweet oil into the rectum, which have been recommended by Kussmaul and Fleiner, are best adapted for the treatment of obstinate cases of constipation, especially if due to spasmodic contraction of the bowel. The injections should be made in the following way: Take about one pint of good olive oil and heat it to the temperature of the body. Then take a fountain syringe provided with a soft-rubber rectal tube, and inject the oil into the rectum. The patient takes the injection while in bed, and it is advisable to have him retain the oil as long as he can. I usually order it to be taken in the evening, so that the patient may fall asleep at once and retain it over night. The following day the oil is passed and an evacuation follows. If the patient is treated for two to three weeks with oil, the spasmodic condition will subside. The oil injections should then be given every other night for a period of two weeks, thereafter twice a week for some time, then once a week for several months.

Injections of glycerin, which were first recommended by Anacker,1 are also beneficial. Two to four grams of glycerin are dissolved in about three to four ounces of water and injected into the rectum. An evacuation of the bowels results in a very short time, ten to twenty minutes. The glycerin may also be given in the form of a suppository, acting the same way. While this mode of treatment is very convenient to produce an evacuation of the bowels, it should not be resorted to daily, as the bowel is thereby greatly irritated.

1 Anacker: "Das Purgativ Oidtmann. " Deutsche med. Wochenscur., 1887, p. 823.

Similar in its action but less harmful is Flatau's 1 method of applying boric acid directly to the rectum. Boric-acid powder, about one to three grams, may be inserted into the rectum with the finger or blown into it by means of a powder-blower through the anus. A movement of the bowels occurs half an hour to three hours later.

5. Purging Medicaments

In many instances of habitual constipation the use of drugs must be resorted to. As a general rule we should administer as mild cathartic remedies as possible, and instead of increasing the dose we should rather try to reduce it gradually, and ultimately relieve the constipation without the help of cathartics.

The various preparations of rhubarb are very serviceable. Vinum rhei and tinctura rhei aromatica or dulcis may be given in doses of from half a teaspoon to one teaspoonful. Rhubarb may also be given as a powder in conjunction with calcined magnesia and bicarbonate of soda, as for instance:

5 Purging Medicaments 49

Pulv. rad. rhei,

Magnes. ustae,

Sod. bicarb................

aa 20.0

(3v.)

M. f. pulv. D. ad scatulam. S. One-half teaspoonful two or three times a day.

Pulvis glycyrrhizae compositus is also a very suitable preparation. It can be given in teaspoonful doses at night or in the morning. It has the following composition:

1Flatau: Berl. klin. Wochenschr., 1891, p. 231.

5 Purging Medicaments 50

Fol. sennae.........

Rad. glycyrrhizae..........

aa, 10.0

(3 iiss.)

Fruct. foeniculi,

Sulph. depur...........

aa 5.0

(3 i 1/4)

Sacch. alb.................

30.0

(5 Purging Medicaments 51 i.)

Aloes is another very efficient and popular remedy. It effects a movement of the bowels in about eight to twelve hours after its ingestion and does not cause any griping. I often give the following prescription:

5 Purging Medicaments 52

Aloes.........

1.0

(gr. xv.)

Extr. belladonnae.......

Extr. strychn............

aa 0.3

(gr. v.)

Extr. et pulv. glycyrrhizae................

q.s.

Ut f. pil. No. xx. S. One pill twice daily.

Of the newer remedies podophyllin and cascara sagrada are very valuable. Podophyllin is given in doses of one-sixth to one-third of a grain twice a day. I use the following prescription:

5 Purging Medicaments 53

Podophyllin...........

0.3

(gr. v.)

Extr. physostigmatis,

Extr. nuc. vomic

aa 0.5

(gr. viiss.)

M. f. cum extr. et pulv. glycyrrhizae q. s. pil. No. xxx. S. One pill twice daily.

Cascara Sagrada may be given in the form of fluid extract, fifteen to twenty-five drops twice daily, or cascara sagrada with maltine, one teaspoonful once or twice daily.

Syrup of figs, one teaspoonful at night time, or tamarind, also one teaspoonful, is often of value.

Jalap and colocynth belong to the stronger drastic remedies, and hardly ever find a place in the treatment of the cases under consideration. Hunyadi Janos water, Fried-richshaller, Homburger or Rakoczy waters, Apenta, Ru-binat and the like are also sometimes of benefit. They should, however, not be used for a long period of time in cases of anaemia and neurasthenia.