Part 23

COMMENTARY. Oribasius treats fully of purgatives towards the end of the 8th book of ‘Med. Collect.’ He gives a list of gentle laxatives. (Euporist. i, 45.)

Hippocrates frequently recommends gentle purgatives for the preservation of the health. Of this class, the herb mercury appears to have been his favourite.

Galen has given two distinct treatises on purgatives, and the cases in which they are applicable. He dissuades those who are in good health from taking them, but says that they may often be used so as to prevent the recurrence of diseases. Hence, he says, that he had often prevented gout and rheumatism from relapsing, by the seasonable administration of purgatives. He forbids purgatives when the hypochondria are distended with flatulence.

Aëtius gives a very lengthy account of the preparation of purgative medicines, which will be noticed more properly in the Seventh Book. He states that all medicines of a cutting or penetrative nature are diuretic. He mentions plantain, fennel, parsley, seseli, anise, valerian, bitter almonds, &c. (iii.)

Celsus gives the following list of gentle diuretics: “Urinam movent quæcunque in horto nascentia boni odoris sunt, ut apium, ruta, anethum, ocimum, mentha, hyssopum, anisum, coriandrum, nasturtium, eruca, feniculum: præter hæc, asparagus, capparis, nepeta, thymum, saturcia, lapsana, pastinaca, magisque agrestis, radicula, siser, cepa; ex venatione, maximè lepus; vinum tenue, piper et rotundum et longum, sinapi, absinthium, nuclei pinei.” He also gives a long list of laxative articles, such as cabbage, mallows, sorrel, gourds, cherries, all ripe apples, green figs, cockles, oysters, muscles, milk, crude honey, and all fatty and salty substances. (ii, 29.) Horace makes mention of the laxative properties of oysters, cockles, dock, and white wine—

“Si dura morabitur alvus Mitulus et viles pellent obstantia conchæ, Et lapathi brevis herba; sed albo non sine Coo.”

(Sat. ii, 4.)

Avicenna gives very minute directions respecting the use of purgatives. He very properly recommends us when a purgative medicine has been taken, and instead of operating, has occasioned heat, vertigo, and headach, to administer an injection. (i, 4.)

Haly Abbas treats of these medicines in pretty much the same terms as our author. He remarks that obstruction of the bowels leads to colic, flatulence, difficult respiration, and vertigo. Retention of urine, he says, leads to ulcers in the bladder. He states that diuretics are useful in diseases of the joints and spine, dropsy, and various complaints, but are apt to render the body dry. (Pract. i, 12.) Diuretic medicines, he remarks in another place, are of a hot and sharp nature, so that they heat the kidneys, and thereby increase their attractive power. (ii, 27.)

Alsaharavius cautions against the indiscriminate use of purgatives, which, he says, in a dry temperament disposes to phthisis, and to dropsy when the stomach is weak. When a purgative medicine has induced hypercatharsis, he prescribes astringent powders, containing sumach, pomegranate, and the like. (Theor. x. 1.)

Rhases gives some very sensible observations on the use and abuse of purgatives. He says that persons who lead an indolent life, are of a gross habit, and live freely, are most benefited by them. To those of a dry temperament, on the other hand, they prove prejudicial, by predisposing to hectic fever. He recommends fat food and the warm bath before taking a purgative. (Ad. Mansor. iv, 15.)

See a full account of these laxative medicines, in Serapion (De Antidotis.)

SECT. XLIV.—ON CLYSTERS.

In constipation of the bowels, when the stomach is naturally weak, and cannot bear purgatives, recourse must be had to clysters. When phlegm is contained in the intestines, the clyster may be composed of the decoctions of dried figs, and of beet, nitre, the root of the wild cucumber, honey, and the oil of chamomile or dill. But when the complaint proceeds from dryness they may be composed of those of marsh-mallows, fenugreek, chamomile, oil, and a small quantity of honey. And sometimes oil alone, injected to the amount of half a hemina, will produce the desired effect; but even this must not be repeated constantly, lest nature, becoming accustomed to these things, should forget to perform the evacuation spontaneously.

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COMMENTARY. Hippocrates frequently recommends the administration of clysters. Herodotus mentions that the ancient Egyptians had recourse to clysters at stated periods every month. (ii, 77.)

Oribasius has treated of the composition of clysters, and the cases in which they are to be applied so fully in the eighth book of his ‘Medica Collectanea,’ that he may be said to have exhausted the subject. It appears, from his account, that the ancients used a syringe for throwing up injections. A large clyster, he says, amounts to three heminæ, a small one to one hemina, and a moderate one to two heminæ (two pints). (Synops. i, 19.)

Celsus, after some very appropriate observations on the cases which are benefited by clysters, concludes with the following directions for the composition of them: Plain water may be injected, if the case be slight; or honied water, if stronger means be required; if emollients be indicated, the decoction of mallows, of fenugreek, or ptisan may be used; or if astringents be proper, vervain. Acrid clysters may be formed of sea-water, or with the addition of some salt, and their strength may be increased by boiling. Such a clyster may be rendered still more acrid by the addition of oil, nitre, or honey. He remarks that the more acrid a clyster is, the greater will be its purgative effect, but the more difficult will it be to bear. He says it ought to be neither hot nor cold. After the injection has been thrown up, he recommends the person to remain quiet, and to resist the first desire to go to stool. (ii, 12.)

Aëtius treats of clysters very fully. He prefaces his account of the mode of administering them, with a correct detail of the evils arising from constipation, which, he justly remarks, is the precursor of most of the ills which break out in the human frame. (iii, 159.)

See a long list of prescriptions for clysters in Serapion. (De Antidotis, tr. vii, 26.) Rhases and Avicenna give a full account of the nature of clysters, but supply no additional information on the subject.

SECT. XLV.—ON SUPPOSITORIES.

We often use suppositories for the discharge of scybalæ, or when injections are not properly evacuated. Suppositories are formed of roasted salt, honey, and nitre; or thyme may be mixed with boiled honey. They are also formed of turpentine rosin, and nitre, and sometimes with a moderate quantity of the seeds of the thymelæa (granum cnidium); but it irritates the parts, which, therefore, ought to be rubbed with oil. Pellitory and pepper are also added, and are particularly fitted for paralytics, and for the relief of flatulence from cold. Centaury is also mixed with pitch and cerate, and is very applicable for paralysis of the genital organs. For infants a lump of salt is applied. Figs also are mixed up with nitre.

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COMMENTARY. This Section is entirely taken from Oribasius. (Synops. i, 20.) See a fuller account in his ‘Med. Collect.’ (viii, 39), and Aëtius (iii, 160.) Aëtius, after mentioning the composition of certain suppositories similar to those of our author, speaks also of using for this purpose, figs mixed with nitre (soda?) and grapes deprived of their stones, with the addition of nitre and cumin.

Actuarius states that it is when the obstruction is seated in the rectum that suppositories are particularly applicable. (Meth. Med. iii, 5.)

See also Avicenna (iii, 20, 1), and Rhases (Contin. xxiv.)

The use of suppositories in the practice of medicine might be traced back to the earliest times. Mention of them occurs frequently in the works of Hippocrates.

SECT. XLVI.—ON MEDICINES WHICH EVACUATE PHLEGM FROM THE HEAD, MASTICATORIES, ERRHINES AND LINIMENTS TO THE NOSE.