There was a time when violent cartharsis, emesis and other severe measures of depletion, were considered essential in the treatment of every case of disease. This was followed after a period, by a swinging of the pendulum to the other extreme; and the carthartic agents were seldom used for a while, for their extreme influence.
The consensus of opinion at the present time, is, that carthatics as local irritants, or profound depletive measures, are seldom if ever needed, and that irritability of the gastrointestinal tract from cathartic agents, must be avoided, but that a thorough cleansing of the entire canal, in the mildest and smoothest manner possible, is essential, that the canal may be rid, either of the germs of disease, or of the toxins which the growth, nutrition and development of these germs induces.
There are several objects which should be considered in the administration of cathartics. They may be used (a) with which to unload the bowels. The contents of the intestinal canal become more irritating, or in other ways more dangerous, than the effect of an irritating carthartic, which might, be used for its removal. In plethoric individuals, the lower bowel may become distended, and may become filled with dried feces which may become impacted in the channel for a less or greater portion of its length.
There are other cases in which a channel, imperfect of course, forms by the side of the impacted mass, permitting of a partial bowel movement while the impaction continues. A cathartic, active and sufficient, assisted perhaps by repeated high flushings and external massage, in many instances may also be necessary to remove this mass.
The second use for cathartics, is (b) to relieve the tendency to constipation. In this, active catharsis is contraindicated. The mildest of measures should be used, the laxatives should be of a tonic, usually mildly stimulating character, with the addition of out of door exercise, the taking of an abundance of water, a carefully regulated diet and perhaps simple abdominal massage should be advised.
Another important influence for this class of remedies is (c) for their cleansing and eliminating influence. Intestinal antiseptics, such as the sulphocarbolate, are given in these cases in conjunction with repeated proper doses of epsom salts, or my course has been, after a simple laxative measure, to persist in the use of the peroxide of hydrogen, perhaps both in the drinking water, and used as a high enema. There is no doubt that in both acute and chronic disease sepsis occurs, very frequently, from the intestinal tract.
It is seldom, nowadays, that we find it necessary to use cathartics for (d) the lowering of blood pressure. We have confidence in our remedies, that they will do this in a far more efficient manner than is accomplished by intestinal irritation. At the same time, there is no doubt that there is an occasional case of chronic disease, such as arteriosclerosis, or where there is a tendency to cerebral congestion where atheroma is known to be present, where the use of a sufficiently active cathartic each day will be beneficial.
Finally hydragogue cathartics are essential at times for (e) the removal of dropsical conditions or exudates. Watery stools may be induced with advantage quite actively, in general edema for a number of days without harm. Judgment should always be exercised in the use of remedies for this purpose.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.