These are so named because their action is harsh. In overdoses they tend to produce violent inflammations. Their active principles are chiefly resinous glucosides, such as colocynthin in colocynth and jalapin in jalap, or acids, such as cambogic in gamboge and crotonic in croton oil.

Action And Uses

The drastics are strong local irritants, acting to increase both peristalsis and secretion. If one of them is placed in a loop of intestine tied off without injury to the vessels (a Moreau's loop), the wall of the loop soon becomes congested and shows signs of inflammation, and the contents of the loop contain inflammatory products. Their cathartic action is often accompanied by violent cramps and abdominal soreness, and in this event may result in stools containing blood or serum-albumin. After the larger doses in man, if catharsis does not result in a reasonable time, the drugs accumulate in the cecum and colon, and may cause serious inflammation. In such case, too, they may be slowly absorbed and passed out by the kidneys, and these they irritate severely, even to the production of an acute nephritis.

The writer saw a case of hysteria which had been treated for obstinate constipation by the administration, in a period of twenty-four hours, of a seidlitz powder, three compound cathartic pills, 2 drams (8 gm.) of compound jalap powder, and 3 minims (0.2 c.c.) of croton oil. These resulted in no movement of the bowels until shortly after the last dose. Then there was a violent diarrhea, with blood in the stools, severe abdominal cramps, bloody urine, and later suppression of urine. The patient went into collapse and died in twenty-four hours. At postmortem examination there was an intense inflammation of the last few inches of the ileum and the whole cecum, in which region some brown drug was visible clinging to the wall of the bowel. There was also an acute hemorrhagic nephritis. The drastics had caused these lesions.

On Dr. Theodore Janeway's service at St. Luke's Hospital a girl of nineteen was admitted with similar but less severe poisoning from "bitter apple" (colocynth), given to her by a druggist. She had vomited six hours after the dose, and repeatedly for twenty-four hours, with almost constant diarrhea and a dull ache across the lower abdomen. She was admitted the following day to the hospital, the temperature being 99.8° F., the pulse 116, and the leukocytes 27,200, with 82.5 per cent. of polymorphonuclears. She still had the gastro-enteritis, and vomited twice after admission; but the kidneys were apparently unaffected, probably owing to the free diarrhea. The patient made an uneventful recovery in four days.

In poisoning, the immediate indications for treatment are: (1) To remove the poison by a saline cathartic or castor oil or by colon irrigation, and (2) to check collapse. After the immediate clearing out, bland oils or bismuth salts in large amounts may be given. The subsequent treatment is that for acute colitis, as by bland diet and bismuth salts by mouth, warm oil by rectum, etc. If the kidneys are affected, the treatment for acute nephritis is called for.

Therapeutics

It will be seen that these drugs are not suitable for daily administration. Their repeated use tends to produce ultimate constipation by accustoming the bowel to excessive stimulation, and so lessening its sensitiveness. Their employment should be occasional only, and then only when a thorough cleaning out of stagnating intestinal contents is desired. On account of their tendency to gripe, which is very great, they should also be given with correctives, such as the extract of belladonna and aromatics. In a number of instances a serious drop in blood-pressure has been noted during their action.

Of the individuals, podophyllum, euonymus, and leptandra are rather mild and slow in action. Elaterin tends to produce such copious watery stools that it is a favorite in dropsy. Croton oil is a fixed oil which contains as its active principle crotonic acid, a substance so irritant that a drop of the oil in contact with the skin for an hour or two results in the formation of a pustule. A drop applied to the tongue will sometimes move the bowels, even if the patient is comatose. If the oil is previously freed from crotonic acid, it has an action similar to that of castor oil, and a large dose is necessary to move the bowels. But in the oil as we employ it this action is entirely overshadowed by the action of the crotonic acid; hence the drug as used is not of the castor oil type, but is a powerful drastic. Croton oil is employed only occasionally, and then only in rebellious or comatose cases. It was formerly employed as a pustulant in pleurisy, pneumonia, etc., but this use of it has been abandoned. Its dose is 2 minims (0.13 c.c.), and each drop measures practically 1 minim (0.06 c.c.).

Cautions

As the drastics are emmenagogue and abortifacient, they must be used with great caution, if at all, during menstruation and pregnancy. As they are irritant and decidedly depressing, they should not be employed in nephritis, bowel inflammations, hemorrhoids, and low conditions of vitality or in old age.

Preparations And Doses

Elaterin, 1/10 grain (0.006 gm.); resin of podophyllum, 1/6 grain (0.01 gm.); colocynth (bitter apple), 1 grain (0.06 gm.); croton oil (oleum tiglii), 2 minims (0.13 c.c.); gamboge, resin of jalap, and resin of scammony, each, 2 grains (0.13 gm.); podophyllum and compound extract of colocynth, each, 7 1/2 grains (0.5 gm.); jalap, 15 grains (1 gm.). Euonymus and leptandra are unofficial, dose, 7 1/2 grains (0.5 gm.).

There are official, one drastic powder and one drastic pill, viz., compound jalap powder (pulvis jalapae compositus), composed of jalap, 35 parts, and potassium bitartrate, 65 parts; dose, 30 grains (2 gm.); and compound cathartic pills (pilulae catharticae composite), containing calomel and compound extract of colocynth, each, 1 grain (0.06 gm.), resin of jalap, 3/10 grain (0.02 gm.), and gamboge, 1/4 grain (0.015 gm.) in each pill. They have not sufficient corrective and may gripe severely. Dose, 3 pills. The compound extract of colocynth is composed of purified aloes, 50 per cent.; extract of colocynth, 16 per cent.; and resin of scammony, 14 per cent., with cardamom and Castile soap.

Vegetable cathartic pills (pilulae catharticae vegetabiles), containing compound extract of colocynth, 1 grain (0.06 gm.); resin of jalap, 3/10 grain (0.02 gm.); resin of podophyllum, 1/4 grain (0.015 gm.); extract of leptandra, 1/4 grain (0.015 gm.); extract of hyoscyamus, 1/2 grain (0.03 gm.), and oil of peppermint, 1/8 minim (0.008 c.c.), in each pill, were official in the U. S. P. 1900. They contain sufficient corrective, and the griping is slight or absent. Dose, 3 pills.

Subcutaneous Purgatives

A number of active principles will cause purgation when administered hypodermatically, but most of them, such as aloin, cascarin, cathartinic acid, colocyn-thin, and podophyllotoxin (the active principle of podophyllin) are too irritant locally for such use in medicine. (See "Cathartics Acting by Selective Affinity.")