Cathartics

Great are the dangers of habitual constipation-leading often to autointoxication, intestinal ulcers and even cancer (TIME, Dec. 7). Great too are the dangers of laxatives, purgatives and cathartics.*On the household medicine shelf is the array of epsom salts, castor oil and compound cathartic pills or their masked coordinates. The housewife has learned from a long chain of gossips to use these whenever any of her progeny complain of stomach ache, and as a rule she is safe in their use, for the really serious stomach and intestinal disorders are comparatively rare.

Yet, as Dr. Charles L. Lockwood of the Gorgas Memorial Institute, explained in Chicago last week, there is ever the possibility of stomach ulcer, of appendicitis, of obstructed intestines, cases in which cathartics are a positive menace, cases in which only a surgeon or skilled physician should intervene. In cases of stomach ulcer the stomach wall is thinned or even already perforated. The carthartic induces the stomach to contract and the partly digested food oozes into the peritoneal cavity. Fatal peritonitis results. In intestinal obstruction the intestines may be blocked by the caked products of digestion or they may be blocked by a band, a twist, a growth or an impaction of partly absorbed food. The cathartic enters and stimulates peristalsis, the evacuating motion of the intestines. There circular muscles contract progressively, and at the same time there is a wavelike motion forward. This activity may be seen in certain very thin persons. It resembles greatly the finger movements in milking a cow’s teats. In intestinal obstruction such cathartic-induced peristalsis pounds the blockade, causing terrific distress and often death. Appendicitis is another situation where cathartics may not be used without discretion. Here the appendix has become infected and the human corporation tries to occlude the spread of germs by forming adhesions and putting the abdomen at rest. Cathartics disturb this equilibrium.

All such cases require the intervention of the surgeon. Sometimes their symptoms elude the casual diagnosis of the doctor. Certainly the family medico, the housewife, cannot recognize them. So Dr. Lockwood urges prudence against too free use of bowel-evacuating agents.

One abdominal condition which he did not mention two of his Chicago colleagues, Dr. N. Lionel Blitzsten and Dr. William A. Brams, have been dealing with. That is, the severe abdominal pain which fluctuates with attacks of migraine (megrim, hemicrania). These men, by brilliant studies, have shown that a certain syndrome of abdominal pain, where syphilitic spoors and exopthalmic goiter do not intrude, shows the symptoms of atypical migraine. The relationship between the brain and the abdominal viscera, in this disease, remains obscure. Four cases out of ten were operated upon, and the doctors found, as they expected, that there was nothing to explain the pains. Cathartics would do no good here.

*Laxatives loosen the bowel contents and allow comfortable expulsion. Purgatives, especially cathartics, irritate the intestinal muscles to more or less violent peristalsis evacuating.