Perhaps the largest group of patients who may be said to poison themselves with drugs, are included in the group of habitual cathartic consumers. Most of them little realize how much damage they are doing to themselves, and would bitterly resent the implication that they are poisoning themselves regularly.
Perhaps in this attitude there may be some justification on their part. The poisoning is not of the same sort as that referred to in other drugs mentioned this week, in which bodily changes are evident. But cathartic users unquestionably create an entirely changed physiologic tonus of the bowel, as well as changes in the mucous membrane of the intestines. Furthermore, they actually create the disease, constipation, rather than relieve it.
The psychology of the habitual cathartic user is a good deal like the psychology of the person who gets in the habit of taking sleeping powders. The latter takes the sleeping powder more for fear that he won’t get to sleep than because he is actually sleepless. The habitual cathartic user takes his drug for fear he will not have an evacuation more than because he does not have one. This feeling is augmented by the fact that the cathartic irritates the inside of his intestine, which gives him the sense of being full, or constipated, and hence makes him feel that he should take more of the drug, which actually creates the feeling he is trying to get rid of.
With this in mind, there is one way for the habitual cathartic user to get rid of his habit. Which is to take a cathartic only on the night of the day in which he does not have an evacuation. If the cathartic that he uses works at all, this will reduce his dose to every other night instead of every night. To his surprise, he will usually find that his intestines evacuate themselves quite regularly without the use of drugs, in spite of the fact that he has been convinced for years that he was dependent upon the drugs.
Of all the cathartics to take as a regular thing, I believe the best is the heavy oil, liquid petrolatum. It used to be said that this acted merely as a lubricant and had no stimulating effect upon the intestines. A recent splendid research by two St. Louis physicians has shown that this is not the case. The actual bulk of the petrolatum stimulates the intestines to activity. Of all the drugs used for purposes of evacuation, liquid petrolatum is less likely to form a habit. It is, of all of them, the most amenable to being reduced to dosage, and the least irritating to the delicate mucous membrane of the intestines.