134

CALOMEL AND COLOCYNTH.

intestinal canal, but which will also gripe him very severely, and make him for a time very weak and miserable; while a dose which you might perhaps hardly believe would have any purgative action at all, would have been quite sufficient to effect the desired end, and without producing the slightest pain or discomfort. You must vary the doses of the drugs you prescribe, according to the state of the patient, and according to the sort of organism you have to treat. If you are prescribing for a highly nervous, anxious, excitable person, who thinks he has got all sorts of ailments of a very serious character, you must, as a rule, not give very violent purgatives, for, if you do, you may bring on pain and sickness, and much increase the intensity of the suffering you have been asked to alleviate. On the other hand, if you are treating a robust laboring man, accustomed to work hard and feed well, and in the habit of drinking three or four pints of beer a day, and more when he can get it-who has a florid complexion and great muscular vigor, it would be foolish to order him a gentle pill or mild draught. To such a person two or three grains of Colocynth pill would be perfectly useless, and ten grains might be required to act at all, and if you were to add to these two or three grains of Calomel, the patient would probably feel the more grateful to you. Many of the chemists, in town and country, sell good strong pills, and which are most useful for those for whom they are prepared, though they would not suit many of your patients. This necessity for varying the doses of medicines according to the individual patient, ought to convince all of the importance of each practitioner learning how to prescribe, and mix, and combine medicines, instead of exclusively relying upon the pills and mixtures prepared for the profession in enormous quantities by large firms, and to be purchased by the gross and by the gallon, but which cannot be altered to suit individual patients, and combined so as to agree with peculiar temperaments. Moreover, there is no doubt that many extracts and pill constituents lose much of their virtue by being kept for a considerable time. Practitioners have, from time to time, discovered certain combinations of things which are very valuable, and the receipt for many a useful pill or mixture has been handed down from generation to generation. In these days, not only do we neglect to use many of the old prescriptions, but we no longer suggest new ones, and many combinations of drugs of tried value and in frequent use in former days, will soon be altogether forgotten. The old system of teaching such elementary but practically important matters has been entirely abandoned, and many a wrinkle of the greatest importance in practice, instead of being preserved and transmitted as formerly from master to pupil, has been lost. Let me advise you never to neglect an opportunity of picking up from old practitioners any receipts for medicines they are willing to give you, and not to

CASTOR-OIL AND RHUBARB.

135

despise their teaching, especially as regards the treatment of many slight ailments difficult to manage and to cure. Do not receive with contemptuous indifference their suggestions for the treatment of functional disorders, the exact nature of which they may be unable to adequately explain.

Castor-Oil, Oleum Ricini, which is the oily substance expressed from the seeds of the Ricinus communis, is one of the best and most frequently used of purgative medicines, and were it not for its nauseous flavor would be yet more popular. It is at the same time one of the mildest and most certain of purgatives, and is suitable to persons of all ages. You may give it to the infant as well as to the most infirm and delicate. It is usually given by the mouth. But Castor-oil may also be employed in enemata. It is one of the few purgatives that act upon every part of the intestinal canal, from the stomach downwards, but its action commences in the upper part, and it is efficient in driving down imperfectly digested and other matters that may be irritating the mucous membrane and causing pain. The dose varies from a few drops to half an ounce or more, but most persons take more Castor-oil than is really necessary to produce the required effect. One teaspoonful is often sufficient for an adult, and sometimes acts as well as a larger dose. Not the least advantage of prescribing the smallest dose that will be useful is that it is so much easier to take. There are many receipts for taking Castor-oil so as to avoid tasting it. Upon the whole I think you will find the following one of the most efficient plans. You direct that a teaspoonful or more of "black coffee," that is, coffee without milk, be poured into a wineglass, the whole of the interior of which, including the lip, has been well wetted with the coffee. A teaspoonful or a little more of the oil is then to be steadily poured on the surface of the coffee, when it will form a large globule lying perfectly free and not in actual contact with any part of the glass, because the latter has been well wetted with the adhering coffee. The patient then opens his mouth wide and pours the oil and coffee down his throat, swallowing the whole in one gulp. If the operation has been successfully conducted, he will not have tasted the oil in the slightest degree. Tea, a little Ginger or Orange Wine and water, or Peppermint, Camphor or Orange-flower water, or Brandy and water may be used instead, but strong spirit being lighter than the oil will not do. Some strongly recommend that the dose of Castor-oil should be well shaken up in a bottle with twice its quantity of milk, and when well incorporated poured into a cup or glass and quickly swallowed.

Rhubarb, Rhei Radix, Pulvis Rhei is one of the best of purgatives, and its virtues are very widely known. It has been a popular remedy for more than two centuries, and is one of the best purgatives for children. Mixed with Carbonate of Soda, Soda. Bicarbonas, it is very

136

COMPOUND RHUBARB PILL.

useful in derangements of digestion. From five to twenty grains of Rhubarb with twice as much Bicarbonate of Soda, will often give great relief. The dose may be repeated once every other day after food for a week or two in cases of constipation or imperfect action of the bowels. See also pp. 139, 141.

Pulvis Rhei Compositus, formerly known as Gregory's Powder, consists of Rhubarb, 2, Light Magnesia, 6, and powdered Ginger, 1. It is an excellent and safe remedy and may be given in doses of from ten grains to a drachm, in water.

Ordinary Compound Rhubarb Pill, Pilula Rhei Composita, and Compound Colocynth Pill, Pilula Colocynthidis Composita, suit most persons very well. You may order three to eight grains of either of these pills, and it is better to combine with them a grain or two of the Extract of Hyoscyamus or Henbane, Extractum Hyoscyami, which will prevent any griping or discomfort. Three or four grains of either of the above pills with a grain of Extract of Henbane may be made into a pill, and one may be taken every night or every other night for a week or two, in many cases with great advantage. In this way the bowels may be thoroughly relieved and got into the way of working regularly.

One of the great advantages of giving purgative medicines in the form of pills is that the particles of the drug are thoroughly comminuted and diluted, as it were, by less active ingredients. The importance of the minute division of active substances was known even to the ancients. A smaller quantity of the active material is sufficient, and it is far less likely to do harm, while its action is sure to be more moderate and equable, if intimately mixed with a quantity of inert or slightly active material, than if administered in a pure state. have been compounded on this principle. powder, Pulvis Ipecacuanha Compositus, Compound Jalap powder, Pulvis Jalapa Compositus, and Compound Rhubarb powder, Pulvis Rhei Compositus, are examples. If there be much flatulence, or if you desire to give a little stimulus to the secretion of the gastric juice, you may add to the pill or pills half a grain or a grain of Capsicum, Capsici Fructus, or ordinary Cayenne Pepper, with advantage.

Many pills and powders Compound Ipecacuanha

You must recollect in administering pills not to order more than five, or at the most six grains in one pill, or you will astonish your patient by the size of the bolus you have ordered him to take. Five grains form a moderate-sized pill, but if blue pill or calomel should be one of the ingredients, the pill will be small, because a grain of these mercurial preparations occupies very little space. This matter of the size of pills must be borne in mind, for some people think it an insult to receive a large pill, and many will tell you they cannot swallow one of even moderate size. The professed inability to swallow a pill is often

COMPOUND LICORICE POWDER.

137

mere affectation or determination on the part of the patient not to attempt to do so; but some persons have a real difficulty. For them the pill may be silvered or gilt, or covered with a tasteless starch coating, and if neither of these plans will please, tell them to pack the pill up in a small piece of moistened "pastry-cooks' paper," when the whole will slip down whether the patient will swallow it or not. This pastry-cooks' paper can now be obtained at many of the large chemists, and is an excellent thing in which to give powders to children. Little capsules of this material have been prepared and made in separate halves. The powder or pill is placed in one and the cover applied, the edges being slightly moistened, the two halves adhere, and the little parcel with the included medicine can be swallowed without any difficulty.

Nux Vomica is another remedy which may be given, by itself or combined with a purgative, in cases of imperfect action of the bowels. It is useful by giving tone to the bowel and stimulating, probably through its action on the nerves, the muscular coat of the intestine. It is now frequently prescribed. It comes from the plant which yields Strychnine, Strychnos Nux Vomica. You may give of the Extract of Nux Vomica, Extractum Nucis Vomicæ, from a quarter of a grain to a grain. If added to a purgative pill, it helps the action of the large bowel. The Tincture of Nux Vomica, Tinctura Nucis Vomicæ, may be prescribed in doses of from five to twenty minims with some Compound Tincture of Bark or other tonic. Decoction of Aloes, Decoctum Aloes Compositum, Tincture of Senna, Tincture of Rhubarb, are simple remedies which are often prescribed in doses of from a drachm to half an ounce.

Scammony, Scammonium, a gum resin from the root of Convolvulus Scammonia, is a component of many purgative pills, and is a very active purgative. For children suffering from intestinal worms, Scammony is one of the best remedies. It may be given in doses of one or two grains, or from three to five grains of the Compound Scammony Powder, Pulvis Scammonia Compositus, which consists of Scammony, 4; Jalap, 3; and Ginger, 1, may be ordered instead of the pure drug. It may be taken in a little milk. Probably many patent purgative medicines contain Scammony. It is a rather searching purgative, which clears out the bowel well, expelling any hardened fæces and wind that may have collected.

Compound Licorice Powder is now in the Pharmacopoeia. The preparation is much used in Germany and Russia, and is certainly one of the best and safest of ordinary purgative medicines. The Pulvis Glycyrrhiza Compositus of the British Pharmacopoeia contains two ounces of finely powdered Senna and the same quantity of powdered Licorice root, with six ounces of powdered sugar; but the German preparation is made as follows:-" Powdered Senna, powdered Licorice, of each 2; powdered Fennel, Sulphur, of each 1; white sugar, 6: mix."

138

OF THE USE OF ALOES.

The dose of the powder is a teaspoonful, carefully mixed in a little

water.

Aloes is another purgative which has the property of acting upon the large bowel. It probably irritates the mucous membrane, and excites its glands to secrete; but also, by reflex nervous action, it stimulates the action of the muscular coat of the intestine, and excites vigorous contraction both of the circular and longitudinal muscular fibres. It is a very good purgative to give in cases of torpid bowels, but it is important for you to bear in mind that aloes has the effect in some cases of encouraging the formation or increase of hæmorrhoids or piles, see p.120. It seems to irritate the mucous membrane of the lower bowel, and those who suffer from an irritable state of this part sometimes find their sufferings much increased if they take any of the ordinary preparations of Aloes. There is the Socotrine Aloes, Aloe Socotrina, and Barbadoes Aloes, Aloe Barbadensis. The Compound Decoction of Aloes, Decoctum Aloes Compositum, is ordered to be made of Socotrine Aloes, and contains besides, Myrrh, Saffron, Carbonate of Potash, Licorice, Compound Tincture of Cardamoms, and Distilled Water. This is a very valuable preparation, and enters into the composition of many favorite draughts which used to be prescribed in former days, and which brought gain to the apothecaries of old. That once very fashionable but rather nasty dose called a Black Draught was composed of Decoction of Aloes, with Sulphate of Magnesia, Senna, and Licorice. Its composition was modified by different authorities, and some improvements, more nasty still, were made by ingenious physicmongers; but the reputation of the black draught is gone, and, though an excellent purgative, it is seldom prescribed in these days. Forty years ago Dr. Chambers, who was then the fashionable physician in London, and other physicians only a little less fashionable, prescribed blue pills and black draughts for most ailments. It would not be easy now to persuade people to swallow a black draught. However, with a little ingenuity you may make something less nauseous and equally efficacious. Decoction itself may be taken in doses of from two drachms to an ounce and a half or more.

The

Probably the best preparation of aloes, to prescribe in the form of pills, is the Watery Extract of Aloes (Extractum Aloes Socotrina). This watery extract does not irritate the bowels, and acts very effectually. It may be given in doses varying from the one-sixth of a grain up to a grain or more, but it is better not to order a larger dose than is abso lutely requisite, and in prescribing, it is well to bear in mind that Aloes, as well as many other drugs, have their purgative action much improved by being reduced to a state of very minute division, and mixed with other things. If small pieces of Aloes should stick in the mucous membrane of the large bowel, that particular part might be severely