'Muscular torpidity is also rationally treated with chola-gogues, and Rhubarb and Aloes act partly in this way. The saline cholagogues, such as Sulphate of Soda, and the many bitter mineral waters now sold (such as Friedrichshall and Hunyadi Janos) are highly popular habitual purgatives, but are apt to lose their effect if given for a length of time, and then to increase rather than relieve constipation. In anaemic subjects the Pilula Aloes et Ferri, and in uterine inactivity the Pilula Aloes et Myrrhae, are specially indicated. Purgative or simple enemata must occasionally be ordered, but the practice must not be continued lest it become habitual. It may be necessary to keep up the action of nervo-muscular intestinal stimulants for an indefinite period; and Senna is the best drug for this purpose, especially in the form of the compound Liquorice Powder.

Severe and protracted constipation, in which the bowels are heavily loaded with faeces, as in lead-poisoning or spinal paralysis, or as the result of indolent and careless habits, may demand a cathartic. The officinal preparations of Colocynth are suitable in such cases, containing as they do Aloes and Scammony, so that if they be followed by a saline draught, the entire length of the bowel will be evacuated. Sometimes even Croton Oil is required, and a large purgative enema may be preferable to repeated purgation by the mouth in weak subjects. This is an absolute rule in the constipation of typhoid fever.

The treatment of constipation constitutes but a small part of the use of purgatives. In a considerable proportion of the cases in which purgation is practised, the indication is to hasten or increase the natural activity of the bowels, in order to obtain some or all of the other effects of considerable evacuation, which we have already studied. The practical question then comes to be what degree of activity of purgation is desirable. The activity of a purgative may be estimated by the rapidity of its effect, by the number of the evacuations, by the amount of water in the stools, and by the degree of constitutional disturbance which it produces; these results, as a rule, varying directly with each other.

When there exists an urgent indication for the reduction of the general blood pressure, for instance, in cerebral haemorrhage, with enlarged heart, the most active purgatives are employed. A drastic must then be given, such as Croton Oil, which has the further advantage of being very easily administered to an unconscious patient. When the portal system, heart, or systemic veins are overloaded, and the fluids of the blood are finding their way out of the vessels so as to constitute dropsy, hydragogue cathartics and salines are given, to establish a free flow of water from the bowel, and thus relieve the circulation. Jalap in the form of the Compound Powder, Colocynth, and-most powerful of all-Elaterium, are commonly employed, less frequently Scammony. Frequent saline draughts, either alone or after a purgative pill, have the same effect, such as the Sulphates of Soda and Magnesia, Cream of Tartar, and Rochelle salt.

At the commencement of inflammatory affections, for instance, acute bronchitis or local abscess, it is usual to unload the bowels and relieve the liver, heart, vascular tension, and respiration, by means of a simple purgative. The Colocynth and Hyos-cyamus pill, with or without Calomel or Blue Pill, is well adapted for these cases, being given at night and followed in the morning by a Seidlitz powder.

Chronic congestion of the pelvic organs, bowels, and liver, a form of disorder not uncommon with sedentary persons, espe436 Materia Medic a and Therapeutics.

cially women, may call for a course of treatment by aperient mineral waters, usually containing Sulphates of Soda and Magnesia, at some watering place, or systematically at home.

Contra-indications and abuses of purgatives. - Purgatives must be used with special caution in delicate subjects, such as infants and the aged; in persons weakened by disease; in inflamed ulcerated conditions of the bowels; when there is a tendency to haemorrhoids and other affections of the rectum; in pregnancy, and during menstruation. In such subjects and conditions, constipation should be relieved if possible by enemata or mild aperients, such as Castor Oil, Sulphur, Senna, and dietetio laxatives. Aged persons do not bear saline purgatives well unless they be given warm or combined with a carminative. The evil effects of the habitual use of purgatives has been already referred to.

Anthelmintics.-In connection with the remedies directed to the intestine, must be discussed the anthelmintics (The Intestine Part 5 8 , against, and The Intestine Part 5 9 a worm), or medicines which expel or kill worms. These belong to two classes, namely (1) vermifuges, which simply expel the parasites {vermis, a worm, and fugo, I drive out); and (2) vermicides, which destroy them {vermis, a worm, and coedo, I kill). The vermifuges belong to the cathartic purgatives, such as Scammony and Jalap: they may be given either alone, combined with, or several hours after a dose of a vermicide. The principal vermicides are Male-Fern, Turpentine, Kamala, Kusso, Pomegranate Root, and Areca, Santonica and Santonin. The last named drugs act specially on the lumbicus, the others kill the tape-worm. The thread-worm (oxyuris) which infests the rectum is best reached by anthelmintic enemata of Turpentine, Aloes, or Salt and water, preceded by injections of a bitter infusion, such as Calumba or Quassia, with or without iron, to remove the mucus in which they flourish.