Part 86

Alexander’s account is very minute, but little different from that of Aretæus. In certain cases, he permits poppies to remove insomnolency and wine to support the strength. Like Hippocrates, he describes correctly dry cholera. In this variety, which he attributes to a bilious humour, he recommends purging with scammony or the picra of aloes. But in particular he approves of friction and the application of strong ligatures to the extremities; to the arms and hands, when the evacuations are by the belly; and to the feet and legs, when by vomiting from the stomach.

Aëtius, Oribasius, Actuarius, and Nonnus treat of the disease in nearly the same terms as our author.

For cholera, Marcellus recommends various astringent remedies, both externally and internally. Myrtle-wine, he says, will stop the vomiting. He also commends opium.

Octavius Horatianus calls cholera “omnibus acutis ægritudinibus velocior.” Like the others, he recommends draughts of tepid water at the commencement, and wine and aromatics in extreme cases.

Cælius Aurelianus, with his accustomed accuracy, gives a complete history of the symptoms of this disease. The bile which is vomited, he says, is at first yellow, afterwards green, and at last black. His treatment is very similar to that of Aretæus, namely, tepid water at the commencement to facilitate vomiting, sponges out of cold water applied over the stomach, or else cupping-instruments with much heat; aromatics, bread soaked in wine, and the like. He condemns Hippocrates for sanctioning the giving of hellebore. He blames Diocles for recommending southernwood, which, he remarks, is a very harsh medicine; and also for allowing milk, which, he says, is apt to grow acid. He finds fault with Heraclides Tarentinus for trusting to opium and henbane.

Cassius Medicus accounts for the coldness of the extremities and contractions thereof upon the supposition that they are occasioned by the vital spirits having left them and been determined to the stomach.

There is nothing very original in the works of the Arabians. Haly remarks that cholera consists of a discharge of bile. He inculcates as a settled principle of treatment, that, when the strength continues good, and the discharge not immoderate, the vomiting is to be encouraged by giving tepid water with oil of sweet almonds to drink. When there is great prostration of strength and tendency to deliquium, he directs us to sprinkle water on the patient’s face, to apply ligatures to his limbs, and to rub his feet and legs with a calefacient oil. When the discharge cannot be got otherwise stopped, he advises us to apply a cupping-instrument over the stomach. Alsaharavius, like the others, directs us to promote the vomiting at first by giving tepid water. Among his other remedies, he recommends an infusion of aloes and wormwood, Rhases recommends draughts of tepid water, the application of snow over the stomach, ligatures to the extremities, wine, and astringents. He, Avicenna, and most of the authorities direct us to encourage sleep. Avicenna’s plan of treatment is exactly the same as that of Rhases.

With respect to diarrhœa, Celsus recommends us to give an emetic; to anoint next day with oil; to give moderate food and undiluted wine; and to apply over the belly a cerate with rue. Cælius Aurelianus enjoins at first rest and abstinence, then astringent applications to the belly, next day astringent food, and then wine and the hath. Haly Abbas remarks that a diarrhœa is not to be rashly stopped unless it become excessive, in which case astringents are to be given, such as galls, roses, pomegranate fruit, &c. Serapion and Rhases mention an emetic as a remedy for diarrhœa.

For the cure of diarrhœa, the veterinary surgeons recommend at first bleeding and hot water, and then astringents, such as sumach and pomegranate rind. (Geopon. xvi, 8.)

SECT. XL.—ON LIENTERY AND CÆLIAC AFFECTION.

There are two varieties of lientery: the one arising from superficial ulceration of the intestines, and (according to some) from a cicatrix occasioned most frequently by dysentery or other defluxions; and the other from an atony of the retentive faculty of the bowels: the second variety being in our opinion connected with the cæliac affection; for in it the stomach being unable to concoct and distribute the food, it is discharged downwards in a smooth, undigested, and liquid state, the stomach in all cases labouring under a defluxion. But in lientery the passage of the food is quick, and the indigestion more intense; so that the appearance of the food which has been taken is preserved, and by these circumstances it is more especially distinguished from cæliac affection. Wherefore we must apply cataplasms of linseed with dates. And lentisk and bramble boiled with oxymel is a very effectual remedy; but, when there is flatulence of the bowels, we must mix some cumin, dill, and rue. If the defluxion increase, we may add quinces, moist alum, acacia, hypocistis, galls, some or all of these. Cerates also made of myrtle-oil with some astringent wine are useful, and the caleficient epithemes from the bay-berries, or from seeds. But that from the flowers of wild vine, that from grape-stones, and that ascribed to Antyllus are more astringent. But the one called Erythrian is wonderfully efficacious. When the disease is protracted, we must have recourse to a dropax (calefacient plaster) along the abdomen, and the cerate from mustard, or mustard itself. The drinks which are taken should be simple, containing plantain-seed, or the seed of dock, or the rind of pomegranate, or dried services, or dried unripe grapes from the Aminæan vine, to the amount of three oboli; which things, when there is no fever, are to be taken in six cupfuls of an austere wine, but when there is fever in rain water. It will injure the stomach less if the dried crop of hens be sprinkled upon the drink. But diuretics, such as parsley, maiden-hair, and the like, occasion a metastasis of the fluid; and, in like manner, the compound ones, as that of Polyides (it is the sigillum), the trochisk from amber, that from Egyptian thorn, the one called clidium, and that from seeds. The following one is most excellent: Of the seed of the wild dock, oz. iss; of plantain-seed, oz. j; of the juice of the hypocistis, dr. vj; of gum or acacia, dr. iij; add to a decoction of the juice of quinces boiled to a third part.—Another: Of cumin, of pepper, of Syriac sumach, of the flowers of the wild pomegranate, of each, oz. iss; of pomegranate-rind, oz. j; of laserwort, oz. ss; either sprinkle a drachm of it dried upon the drink, or mix with oxymel, and give morning and evening.—Another: Of black myrtle, a spoonful and a half; of anise, of dried roses, of the flower of wild vine, of each, half a spoonful; of dates, xx in number; make trochisks, and give a drachm with water or diluted wine. And the theriac from vipers is also an excellent remedy for them. When the discharge is acrid and bilious, the food should be from chondrus, rice, alica, and the like; but some of the astringents should be boiled along with them, such as pears, apples, quinces, medlars, and such like. Boiled milk is also proper. The drink should be either a light watery wine, or some of the sweet potions. If the discharges consist more of phlegm, we may change the diet to the opposite kind, mixing the seeds of some of the stomachic vegetables, anise, cumin, or the seed of parsley. The dried lentil twice boiled is often of use to them, when eaten with a little vinegar or oxymel, and cabbages likewise twice boiled; but it is better to make the second boiling in oxycrate. They should drink some of the older and more heating wines.

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COMMENTARY. Hippocrates (Aphor., de Affect.); Galen (in Hipp. Aphor. Comment. vi, 1; de Med. sec. loc. vii); Aretæus (Morb. Chron. ii, 10); Celsus (iv, 16); Nonnus (166); Theophilus (de Alvi Retrim. 2); Actuarius (Meth. Med. i, 42); Aëtius (ix, 37); Oribasius (Morb. Curat. iv, 88); Leo (v, 5); Psellus (Opus Medicum); Scribonius Largus (xi); Marcellus (de Medicam. 27); Avicenna (iii, 16, 1); Serapion (iii, 18); Haly Abbas (Theor. ix, 25, Pract. vii, 16); Alsaharavius (Pract. xvii, 1); Rhases (ad Mansor. ix, 72; Contin. xiii.)

In lientery, says Hippocrates, the food passes through the bowels in a liquid state and without change. Galen remarks that the affection may be defined to be a loss of digestion, the food having undergone no change in consistence, smell, or quality, while in the bowels. The intestines, he says, are either in a state of ulceration and great tenderness, or they have lost their retentive faculty.

Aretæus calls it a disease arising from broad ulcers of the intestines when the food passes through the bowels not at all altered. With respect to the treatment, he merely says that an emetic after food will remove it.

Celsus recommends astringent food, stimulant and rubefacient applications externally; and afterwards exercise, friction, insolation, and vomiting, which, he says, Hippocrates directed to be produced with white hellebore when other things fail.

Dioscorides states that when the inner membrane of a cock’s stomach has been dried and reduced to powder, it may be given triturated in wine with great advantage in stomach complaints. Our author, it will be remarked, makes mention of this medicinal article.

Archigenes and Aëtius describe cæliac affection as an atony of the intestines, so that the food is not retained until it is digested. They treat of it at great length, their principal remedial measures being purging, vomiting, and astringent applications. According to Psellus it arises from superficial ulceration of the intestines. Psellus defines lientery to be a loss of the retentive faculty of the bowels, so that the food passes undigested in a liquid state.

Serapion for lientery directs us to give astringent decoctions, and to apply to the belly an astringent epitheme containing galls, roses, pomegranate-flowers, &c. the food to consist principally of millet and the like. He also recommends a mixture of goat’s milk and water boiled until the water evaporate. When the stomach is loaded he prescribes an emetic. In cæliac affection he directs us to strengthen the intestines by astringents internally and externally. Haly Abbas defines lientery to be a quick discharge of the food in an unchanged state. It arises, he adds, from immoderate debility of the retentive faculty of the intestines, or from excess of the expulsive. It is said to be generally caused by ulcers which, being irritated by the food, stimulate the intestines to expel it. He recommends a variety of remedies, most of which are either astringents or acids, such as balaustine, rind of acorns, mastich, sumach, galls, roses, &c.

SECT. XLI.—ON TENESMUS.

Tenesmus is sometimes the precursor of dysentery, but often it prevails alone for a short time, and then ceases. The affection is an irresistible desire of evacuation, discharging nothing but some bloody or mucous matter, which is the cause of the whole complaint, being an œdematous inflammation in the rectum, which creates the impression of fæces lodged in the intestine, and a desire of evacuation. And Galen relates that a stone has sometimes been discharged by the anus in attacks of tenesmus. But tenesmus often arises in consequence of fæces being retained in the small intestines, and is increased by astringents and obstruents, but immediately removed by acrid injections, such as honied-water with salts, or by any of the emollients taken by the mouth, such as damascenes, dried figs, the herb mercury, or the whey of milk; for when the fæces are evacuated, the complaint immediately ceases. When the tenesmus occurs without such a cause, it will be proper to allay the inflammation by barley-flour heated, the embrocations from wine, myrtle-oil, rose-oil, or the oil of unripe olives, applied to the loins and lower belly. The mucous matters shut up in the rectum must be cleared away by an injection of honied water. And salt and water when injected often effects the purpose, or six drachms of salts in a hemina of hot water. But we must mitigate the pain and intense sufferings by sitting in a hip-bath of fenugreek, mallows, or linseed. Sometimes the following hip-bath will effect the purpose: Of bramble, of myrtle, of the flowers of the pomegranate, of bays, and of green cypress shoots, mixing these in equal parts, boil in water. It is the Marcellian. When the inflammation and irritation are deep-seated, we must use injections of some of the juices of grain boiled with some of the astringents. And sweet oil injected and retained for several hours has the effect of removing the violent pain. When the desires to go to stool are frequent, we must apply a ball of warm threads to the anus, or warm bran in a bag, or a sponge, or some such thing.

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COMMENTARY. See the authors referred to in the preceding Section.

Celsus recommends the tepid bath, emollient and astringent applications to the rectum, such as butter and roses, or alum wrapped in wool and applied, the remedies for tormina, and an austere wine every alternate day.

Aëtius may be referred to as an author who has treated of this affection in a very accurate manner, although nearly to the same effect as our author. Among other things he mentions the application to the anus of a sponge soaked in a solution of galls in vinegar.

Nonnus defines tenesmus to be an inflammation of the rectum, and says that it is to be benefited by injections of the oil of rue, or of wine and honey with brine; by hip-baths of astringent decoctions, such as myrtles, bays, &c. or by fomentations with a sponge.

Avicenna describes two varieties of tenesmus, the false, which is occasioned by the lodgment of hardened fæces in the intestines, and is to be cured by emollient clysters, &c.; and the true, which, if occasioned by cold, is to be relieved by fomenting the parts with a sponge or the like soaked in hot water; if by hard pressure, a sponge is to be squeezed out of hot oil and applied; if by an aposteme, it is to be treated upon general principles by bleeding and embrocations; if by a flux, remedies suited to that complaint are to be given; and, if by ulcers, the common applications to them are to be used. Haly Abbas treats fully of tenesmus, like Avicenna. In several of his prescriptions poppies and opium occur. When produced by retention of scybalæ, he recommends powerful evacuants, such as colocynth, prunes, turbit, scammony, &c. One of Serapion’s prescriptions contains burnt lead, sumach, myrrh, &c. By a stone, said by our author and Galen to be sometimes discharged in cases of tenesmus, must have been meant an alvine concretion of a hard nature.

SECT. XLII.—ON DYSENTERY.