On the mechanism of the physiological action of the cathartics

by John Bruce MacCallum

[89] MacCallum, J. B.: University of California Publications, Physiology, Vol. II, 1905, p. 65.

[90] MacCallum, J. B.: University of California Publications, Physiology, Vol. I, 1904, p. 115.

[91] MacCallum, J. B.: University of California Publications, Physiology, Vol. II, 1905, p. 93.

CHAPTER X.
Possible Therapeutic Value of These Experiments.

It at once suggests itself to the physician that some clinical use might be made of the facts outlined above. If such striking results can be obtained in a rabbit it is possible that some modifications of the use of these saline purgatives might be made in the human being.

If in the first place it is found that subcutaneous or intravenous injections of saline purgatives are effective in man, there arise in both medical and surgical practice occasions in which these methods of administration would be of the greatest advantage. It is to be remembered in this connection that the administration by these methods of MgSO₄ is especially dangerous. This salt when rapidly absorbed seems to be very poisonous. Rabbits frequently die in a few minutes after an intravenous injection of a quantity relatively small as compared with the amount of Na₂SO₄ which can be given in this way. Barium chloride is extremely active as a subcutaneous purgative, but should be used with the greatest caution and in very minute quantities on account of its very poisonous character. I can give no idea of the dose that might be given to a human being without danger. A rabbit usually does not recover from a subcutaneous injection of 3 c.c. m/8 BaCl solution.

The fact that saline purgative solutions applied to the peritoneal surfaces of the intestine act very rapidly may suggest some use in abdominal surgery for this method. If it were desirable to have evacuation of the bowel rapidly follow an abdominal operation this procedure might be resorted to. An isotonic solution (m/6) of sodium sulphate or sodium citrate would be most favorable for this purpose.

The possible uses to which our knowledge of the action of calcium may be put has aroused some discussion. The fact that it suppresses muscular and nervous irritability (Loeb), and as shown in the experiments above, inhibits the muscular and glandular activity of the intestine, as well as the secretory activity of the kidney, makes it seem probable that some practical use may be made of it in certain conditions in the human being. The most important of these conditions is perhaps the persistent diarrhœa which sometimes accompanies disorders of an hysterical or neurasthenic sort. There have already come under my notice several cases of diarrhœa of nervous origin which were quite uncontrolled by morphine preparations. These cases were apparently entirely relieved by calcium chloride given for only a few days. (grs XX t.i.d.) Whether a large number of similar patients will show the same results remains to be seen. The treatment is evidently to be applied to only a small class of patients, roughly those cases of persistent diarrhœa of apparently nervous origin, which cannot be influenced by opiates.

When rectal infusions of NaCl are not retained it is possible by adding CaCl₂ to the solution to stop the movements of the rectum which cause their expulsion. Enemata of NaCl containing CaCl₂ are retained much better than those of pure NaCl.

The marked action of calcium on the kidney suggests that certain conditions might arise where it could be made use of. In nervous polyuria it can be given with benefit; and although we know practically nothing as to the etiology of diabetes insipidus, it is possible that calcium might be employed with advantage to stop the abnormal flow of urine.