This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
A glass of cold water taken, fasting, in the early morning, will assist in securing a regular action of the bowels. If taken, also, the last thing at night, it has a still better effect. Cold hip-baths are useful for the same purpose.
Dr. Graves says, "In constipated habits I have occasionally derived very remarkable benefit from the use of nitric acid given in sufficient doses. It seems, like the carbonate of iron, to possess the advantage of combining tonic with aperient qualities" ("Clinical Medicine," ii., p. 215). I think that this different action of the medicine depends upon dose, and perhaps combination, and is not contradictory to that mentioned in the last section. Nitric acid in small or moderate doses is astringent, especially if prescribed with opium; but nitric acid in full doses has an aperient effect, especially in combination with bitter infusion, such as gentian; this may be traced either to direct intestinal irritation or to hepatic stimulation.
Otorrhoea occurring in scrofulous children or in syphilitic patients, is often quickly controlled by a course of this acid.
Purulent Ophthalmia, with extensive ulceration of the cornea, whether of a gonorrhoeal or scrofulous form, is much benefited by a course of 5 to 10 min. of the dilute acid three or four times a day, together with local treatment.
Besides the astringent power exerted by 5 to 10-gr. doses of alum, we must notice the irritant effect of larger quantities, by which probably they become useful in constipation. Alum is seldom to be preferred to other remedies for this disorder, though it may act favorably in atonic cases, when the muscular coat of the bowel is deficient in power, and when mucous secretion is scanty. Mr. Aldridge has published reports illustrating the good effect of 20 to 40 gr. daily in producing copious and solid evacuations; he also associated it with sulphate of magnesia (Braithwaite, vol. xii.). Such treatment, however, is rarely worth trial, and my own experience with it is not favorable; it either in--creased constipation or caused dysenteric symptoms.
In obstinate cases connected, in part at least, with deficient intestinal secretion, and occurring especially in old people, small doses of tartar emetic will assist the action of saline purgatives such as sulphate of magnesia. Dr. Nevins has recorded a good illustration of this, and finds that less than 1/4-gr. doses will usually suffice ("Comment., Lond. Pharm.").
It has been maintained by some distinguished writers (Gubler, Chomel, Rayer, etc.), that not only the above-described but all other therapeutical effects of antimony are dependent upon, or connected with, its emetic, or at least its nauseant action, and are explained either by an elimination of morbid material, or by the profound disturbance and subsequent reaction induced in the economy; but - not to speak of the older cases in which benefit was conferred during "tolerance," i.e., when there was little or no vomiting - I am satisfied that most maladies are better treated by small and frequent doses, which do not cause vomiting, and that only a few cases require the production of nausea.
In the constipation of delicate persons, especially of pregnant women, also of those subject to gout or rheumatism, hemorrhoids, or other rectal affections, magnesia is a valuable mild laxative; if required frequently, it should be taken in solution (fluid magnesia), and with lemon-juice, if the system be free from acidity. The citrate or two preparations are mixed only at the time of their being required: hydrated peroxide of iron is precipitated, and sulphate of magnesia remains in solution - 4 to 6 dr. of this should be given every quarter of an hour in warm water (Binz).
The sulphate are useful aperients at the commencement of a febrile attack of almost any kind, their action being rapid and more or less depletory; the former may be given effervescing in mild cases, but when a full and decided effect is desired, 1 or 2 dr. or more of the sulphate should be used; sometimes it is given in lemonade or acid infusion of roses, but general experience has proved that it acts best with tincture and infusion of senna. In habitual constipation 1/2 to 1 dr. given in a glass of lemonade or aromatic water, in the early morning, will often answer every purpose. Dr. Fleming found the addition of small quantities of atropia advantageous (British Medical Journal, ii., 1865): it is more usual now, and I believe better, to make use of the magnesian salts in combination with others, as they are found in many natural mineral waters, such as Seidlitz, Pullna, Friedrichshall, or Hunyadi Janos, half a glass or a glass of such waters being ordered with warm water in the early morning. To obviate constipation and headache during the use of astringent tonics, moderate doses of the sulphate may be usefully added to medicines containing sulphate of quinine, iron, acids, etc.
The sulphate of potash acts as a mild aperient, and is suitable for cases of dyspepsia with deficient biliary secretion, or hemorrhoids; it is often combined with rhubarb, especially for children (West, Hillier). Dr. Dickinson recommends it in doses of 10 to 20 gr. as a good laxative in albuminuria (Lancet, i., 1876, p. 628); in larger doses it is apt to cause griping. The acid tartrate is also used as an aperient, especially in cases of hemorrhoids and of dropsy, since it produces a copious watery secretion into the intestinal canal, but it should be combined with some more active agent to secure efficient expulsive effect; thus it is ordered with sulphur in the confectio sulphuris, and with jalap in the pulvis ja-lapae compositus.
On the other hand, the same remedy (soda sulphate), when given in larger doses of 1/2 oz., is a useful saline purge in inflammatory conditions, and is an ingredient in several natural aperient waters: if given with sulphate of magnesia or acid tartrate of potash, smaller doses (1 to 2 dr.) may be used. The phosphate of soda acts in the same manner on the intestinal tract, and has a more decided diuretic action; it renders the urine alkaline. Tartarated soda is an ingredient of Seid-litz powders.