Therapeutic Application

Aloes was used as a purgative by the ancient Greek and Roman physicians, and is among those most employed by the moderns. it is indeed a highly important remedy, producing effects which, taken together, can be obtained from no other single medicine. The indications which it would seem calculated to fulfil are to evacuate the contents of the lower bowels, without weakening the patient; to stimulate the digestive function when impaired; to excite the torpid liver; to direct blood and nervous energy to the rectum and lower colon, the urinary and genital organs in the pelvis, and especially the uterus; and to act as a gentle warming stimulus to the system generally.

It is an admirable laxative in habitual costiveness, dependent on an inheritable state of the colon and rectum, and especially when associated with want of due hepatic action. if dyspepsia or torpor of stomach coexists with the other symptoms, the indication is still stronger. in these cases, it is much used, either alone, or associated with rhubarb. it should usually be employed in small doses, and given either at bedtime, or about an hour before a meal, especially before dinner. it usually operates on the following day, producing one easy evacuation.

if, to the above indications, that afforded by the existence of amenorrhoea is added, aloes is perhaps the most efficient remedy to which we can have recourse. Of its emmenagogue operation, however, I shall have occasion to treat in another place.

In jaundice, aloes sometimes operates with great effect. Perhaps it may not be so efficient, as a general rule, in restoring the action of the liver in this disease, as the mercurials; but it will sometimes prove even more successful; and I have known jaundice, which had obstinately resisted calomel and other remedies, yield promptly to active aloetic purgation. it is proper, in this affection, not to depend on small laxative doses, but to administer the full purgative dose at once. it probably proves useful, not only by a direct influence on the liver, but by moderately irritating the stomach and duodenum, and thus secondarily operating on that organ.

Another special application of aloes is to the treatment of chronic splenitis, in which it operates favourably by a revulsive influence upon the lower bowels, situated at the further extremity of the portal circulation, with which the spleen also is connected. it is probably among the most efficient remedies in enlargements of the spleen, dependent on a sustained irritative action in that organ.

It may also be used in all cases, in which serious disease in any organ or part of the body may be supposed to depend on checked hemorrhoidal discharge, the cure of hemorrhoidal tumours, or the healing of fistulous ulcers near the anus. The indication is here to induce a return of the rectal affection; and nothing is so efficient for this purpose as aloes, which, under these circumstances, should be given in large doses, so as to act promptly, or in small and repeated doses, according as the complaint to be relieved is acute or chronic. Hepatic and splenic disease, hemorrhage or other disease of the lungs, congestion of the brain, apoplexy, hemiplegia, and insanity are among the affections which may sometimes be advantageously treated in this way. Even when there has been no antecedent disease of the rectum, a strong direction of the blood and nervous power to the pelvic viscera, such as aloes is capable of producing, may prove useful, on the principle of revulsion, in cephalic and pectoral diseases. Esquirol found advantage from this therapeutic measure in the treatment of certain cases of insanity; and it might sometimes be used advantageously, as a prophylactic measure, in cases where a strong tendency to pulmonary tuberculosis is suspected, especially in young women in whom the menstrual function has not been established, or may have been suppressed.

Aloes has also been employed as a vermifuge, under the supposition that, through its intense bitterness, it might prove noxious or poisonous to the worms. But it has been of little or no service, except in the case of ascarides, upon which it can be brought to bear very effectually by injection into the rectum. For this purpose, the British Pharmacopoeia directs a special preparation, under the name of Enema of Aloes (Enema Aloes, Br.), made by rubbing together forty grains of aloes, fifteen grains of carbonate of potassa, and ten fluidounces of mucilage of starch. The same mixture may be used in amenorrhoea attended with constipation.

Besides the above special uses, aloes is also very frequently employed as an ingredient of compound purgative preparations, in which it answers a useful purpose by adding its peculiar mode and seat of action to those of the other cathartics used, and thus increasing their purgative effect, while their disposition to irritate is lessened, according to principles explained under the general head of cathartics. Thus, it enters into the composition of the compound extract of colocynth, the compound pills of gamboge of the late London Pharmacopoeia, and our own officinal compound cathartic pills.

The contraindications to the use of aloes are the existence of acute febrile inflammation, and a sthenic state of idiopathic fever, acute inflammation of the rectum, colon, bladder, uterus or other parts of the genital apparatus, and hemorrhoidal disease, or a strong tendency towards it. Very frequently, during its administration in habitual costiveness, amenorrhoea, etc., considerable irritation of the rectum comes on; or an old tendency to hemorrhoidal disease is renewed; or the womb, already perhaps phlogosed, becomes the seat of a high irritative action, or of hemorrhage. In such cases, the medicine must be suspended, unless the induced condition may itself be a part of the curative agency in the case. Aloes should not be given to pregnant women, when there is any reason to fear the production of abortion from pelvic irritation. But, in that debilitated state of the organs seated in the pelvis, which sometimes attends long-continued chronic inflammation, it has occasionally proved serviceable, as in piles with relaxation.