2. Simple purges are more powerful than laxatives, and in addition to stimulating the movements of the bowel increase the secretion. The result is a soft, easy motion. Examples: rhubarb, senna, cascara sagrada.
3. Drastic purgatives or cathartics. The drugs cause a profuse flow of the intestinal secretions, and, occasionally, of the bile, with greatly increased bowel movements. They cause a copious watery evacuation, accompanied by a good deal of griping. Examples: calomel, colocynth, aloes, podophyllin, croton oil, jalap and oil of turpentine; of these, podophyllin and aloes cause an increase in the flow of bile, with increased intestinal movements, so they may be said to act directly upon the liver. The result is a profuse, watery, bile-stained motion.
Calomel does not act directly upon the liver, but stimulates the upper part of the bowel, so that its contents are hurried along before the bile can be reabsorbed, and a loose, watery, bile-stained motion ensues.
The most useful purgative of this class is the pill containing colocynth, calomel, and hyoscyamus, of which five to ten grains should be given when there is a furred tongue, constipation, heaviness or weight over the liver, and dyspepsia and loss of appetite.
4. Saline purgatives. These cause a free secretion of the intestinal juices, and a copious motion, proportionate to the size of the dose, is the result. The principal saline purges are Epsom salts (i.e., sulphate of magnesia), Glauber’s salts (i.e., sulphate of soda), seidlitz powder, the various forms of fruit salts, and the aperient mineral waters, such as Rubinat, Hunyadi Janos, etc.
A saline purgative may be given in the morning, to assist the action of an aperient pill administered the previous night.
Saline purgatives are useful, too, in many cases of habitual constipation, and, if necessary, a small dose may be given every morning in a tumbler of warm water.
Quinine.—Quinine is chiefly used for malarial fever, and the urgency of the case must be the guide as to the amount to be administered. It is seldom necessary to give more than ten grains three times a day; at times enormous doses, such as thirty grains three times a day, have been given with advantage, but such doses are rarely necessary, and in the absence of a medical man should never be given.
The administration of quinine sometimes causes headache, deafness, delirium, and partial or even complete blindness. In such cases the dose should be reduced or the drug withheld until these symptoms have disappeared.
It has been stated that quinine causes blackwater fever; this, I believe, is absolutely untrue. I have seen cases of blackwater fever, apparently resulting from the neglect of malarious attacks, which date the commencement of their recovery from the first administration of quinine.