Part 89

Those who wish to see a full exposition of the ancient views on this subject may consult Aëtius. Like all the others, he says that milk, with the exception of that of asses, contributes to the formation of stones. He also recommends goats’ blood. He gives very proper directions respecting the regimen after extraction of the stone, to prevent a recurrence of the complaint.

Cælius Aurelianus makes no mention of lithontriptics, but he describes very properly the treatment when pain and inflammation of the bladder supervene. It is altogether emollient and relaxant.

The nature and treatment of calculous diseases are treated of in a very practical manner by Palladius in his Commentary on the sixth ‘Epidem. Hippocrat.’ He depends principally upon a restricted diet and light food.

The Arabians treat of calculi at great length, but have the same ideas of the formation of them, and recommend the same remedies as the Greeks. We remark that Avicenna, Rhases, Serapion, and Alsaharavius mention among their lithontriptics barauch, or the nitrum of the Greeks and Romans, which was most probably an impure carbonate of soda. We need scarcely say that this alkali is now given upon chemical principles. Like our author, they make mention of glass as a lithontriptic. Rhases, Avicenna, and some of the others remark, and perhaps justly, that white urine is one of the earliest symptoms of calculus. For stone in the bladder Avenzoar recommends cubebs. Avicenna, Serapion, and Alsaharavius join the Greeks in commending the small sparrow (or, as some suppose it, the wren) as an efficacious remedy for calculus. It is said in the ‘Isagoge’ that its lithontriptic powers were discovered by dreams. We may mention that it has been ingeniously supposed that allusion is here made to magnetic somnambulism, which, it is maintained, was one of the remedial means practised in the ancient temples of health. Haly Abbas ascribes the formation of stones to the concurrence of a viscid humour with heat of the part. Old men, he says, are most subject to renal calculi; for in them the watery part of the urine passes down to the bladder, while the grosser part or sediment is detained in the kidneys, and is converted into stones. Children are said to be most liable to calculi in the bladder, owing to their eating much gross food, and taking exercise after meals, by which means the system is loaded with gross impurities. With regard to the treatment, he enjoins restricted diet, abstinence from gross food, and the use of medicines of an incisive and attenuant nature. The general treatment during a fit of gravel is well laid down by Alsaharavius, consisting of bleeding, cupping, the tepid bath, emollient clysters, &c. Rhases, upon the authority of Antyllus, states that stones are formed either from drinking turbid water or from imperfect digestion, whence the urine deposits a sediment, which is converted into a stony hardness by the heat of the part.

According to Theophilus, a thick and milky state of the urine is characteristic of calculous diathesis. (De Urin. 8.)

Vegetius mentions that cattle, especially young ones, are liable to stones in the bladder, which are apt to fall into the urethra and obstruct the urine. He states correctly that a stone will sometimes make its way into the rectum. (Mulom. i, 46.)

Alexander Aphrodisiensis states that young and old persons are most subject to calculus. (Prob. i.) From the late investigation of Dr. Prout, it appears that children until fourteen years of age are most liable to stone; then persons after forty; while those in the intermediate period are but little subject to the complaint.

With respect to the lithontriptics mentioned above, all we can venture to say is, that, having no experience of them, we do not think ourselves entitled to question or confirm their efficacy decidedly; but, as we repose little confidence in those now in repute, we cannot be supposed to have much in those which have fallen into disuse.

On inflammation, abscess, and ulceration of the urinary organs. Celsus recommends rest; a soft bed; opening the belly; sitting in hot water; avoiding cold food and drink; abstinence from everything that is saltish, acrid, and acid, and from apples; taking copious draughts; adding to the food or drink pepper, leeks, fennel-giant, and white poppy, to promote the urinary discharge, &c.

One may find in Galen many receipts for abscess and ulceration of the urinary passages, but they are similar to our author’s.

Aretæus makes mention of ulcers of the kidney occasioned by stones, which he pronounces to be incurable. He states also that ulcers of the kidneys give rise to consumption. Without doubt he alludes to the morbid condition of the kidneys now known by the name of Bright’s disease. Hippocrates has been supposed to refer to the same in the following Aphorism: “When bubbles appear on the surface of the urine, they indicate that the kidneys are affected, and that the disease will be protracted.” (Aph. vii, 34.) Upon which MM. Lallemand and Pappas remark that frothy urine and albuminous are identical; and it is well known that Bright, Rayer, and Martin Solon have decided that albuminous urine is generally connected with a very obstinate disease of the kidneys. (Littré’s Hippocrates, t. iv, 414.) It seems highly probable that Actuarius alludes to albuminous urine in the following passage: “When substances, the effect of melting, and resembling spiders’ webs, float in the urine, they indicate either that the kidneys are diseased, or that the system is in a state of atrophy from wasting.” (De Urinis, vi, 16.) On frothy urine, see, further ‘De Urin.’ (v, 4.)

Alexander lays down the rules of treatment very properly, recommending venesection, purging, and topical applications of a cooling nature, especially at the commencement. When the abscess forms, he prescribes a variety of things which are detergent without pungency.

When the bladder is ulcerated, Nonnus directs us to inject into it by a syringe honey much diluted with water, or the seed of cucumber with the same.

The treatment prescribed by Cælius Aurelianus scarcely differs at all from that of the others in this case.

One of the oldest writers on diseases of the kidneys is Ruffus, who lived, according to Suidas, in the days of Trajan; so that he was prior to Galen, and perhaps to Aretæus and Cælius Aurelianus. As we have seldom occasion to meet with him in our researches, we shall give a fuller abstract of his opinions on this subject than we would otherwise have done. The symptoms of inflammation of the kidneys, as detailed by him, are pains below the loins, so that the patient cannot stand erect nor walk, but is obliged to lie upon his back, which position affords him most relief; the pains extending to the bladder and testicles; the extremities cold, more especially the legs and feet; frequent and painful desire to make urine, which is at first thin and watery, but afterwards becomes redder. These symptoms are followed by emaciation of the thighs and hips, debility of the limbs, and sometimes suppuration. His treatment is as follows: The patient is to be laid on a soft couch, and must abstain from food for one day, but long abstinence is forbidden. If the bowels require to be opened, this is to be done by means of emollient clysters, such as injections of hot water, decoctions of mallows, of linseed, or of fenugreek, to which may be added some oil. Large injections, however, are forbidden, lest they press upon the kidneys and occasion irritation. When the bowels are evacuated, and yet the pain does not remit, the parts may be wrapped in wool which is smeared with hot oil having rue, marshmallows, dill, or mugwort boiled in it. When the pain is acute, a vein at the elbow is to be opened; after which emollient cataplasms and plasters are to be applied to the back when the kidneys are affected, and to the fore parts when the bladder. When these remedies fail to remove the pain, the loins and groins are to be cupped, and then sponges squeezed out of hot water are to be applied, and the patient put into a hip-bath of hot water in which poppies, chamomile, and the like have been boiled. Then, when the patient is laid in bed, let him be fomented with bladders half-filled with oil and water; and afterwards let cerates of the oil of privet, &c. or fragrant malagmata be applied. When the pain is excruciating, he directs us to give a decoction containing opium and the heads of poppies. In due time diuretics are to be administered, such as the root of acorus, ground-pine, cassia, spignel, parsley, sea urchins, radishes, carrots, and the like. When an abscess is formed, there is a discharge of tawny and more natural urine, there is swelling in the loins, strong heat in the kidneys, and the pain becomes duller with irregular fever. The abscess bursts either into the bladder or intestines. Praxagoras, he says, related a case in which there was pus voided by the anus for twelve years and probably longer. When it bursts into the bladder, pus is voided with the urine. Suppuration is to be promoted by frequent fomentations with sponges, by cataplasms of barley-meal with a decoction of figs in mead or wine, to which may be added pounded wormwood, spurge, &c. For promoting the rupture of the abscess, diuretics are prescribed, such as wild marjoram, mock dittany, and the like. When the abscess does not burst, acrid clysters containing black hellebore, radishes, garlic, and the pulp of colocynth are to be given. To these oil may be added, and when thus taken they will promote the rupture of the abscess. However, fomentations with sponges and plasters are to be applied to alienate the pain. When the ulcers are of a mild nature (which is shown by the abatement of the fever and pain, and from the substances which appear in the urine being white and inodorous), the milder diuretics are to be used for cleansing them, such as the seed of pompion, the decoction of dates, &c.; or, when stronger things are required, galbanum, opopanax, turpentine rosin, and the like may be added to mead or wine. When the ulcers are putrid, Æthiopian cumin with must, rue with honey and wine, and the like may be given internally; while cataplasms of bitter vetches boiled in wine and honey are to be applied externally. It is proper also, he says, to inject some of the medicines for dysentery; to give clysters of strained ptisan; and to place the patient in hot water. If the matter is thick, a decoction of fennel, parsley, or wormwood is to be given. With respect to food, he recommends milk, especially that of mares or asses, along with honey; also cucumbers, lettuces, the flesh of kids, lambs, and goats, almonds, and wine; but vinegar must be avoided. All motion is to be abstained from. When there are symptoms of repletion, emetics are to be given. When the abscess points outwardly, he seems to direct us to open it and apply the cautery; but here unfortunately the text is incomplete.

This account is so full and judicious that we think it unnecessary to give extracts from any more of the Greek and Latin authorities.

From the Arabians little or no additional information is to be derived. Haly Abbas recommends bleeding by opening the basilic vein, and then cataplasms of barley-flour, &c. He then gives a cooling draught containing the seeds of cucumbers, gourds, melons with purslain, mallows, and the syrup of violets. This part of his practice deserves consideration. When the abscess forms he directs us to apply cataplasms containing chamomile, fenugreek, melilot, &c. Alsaharavius, in like manner, recommends bleeding, cooling and demulcent draughts, the tepid bath, and discutient cataplasms. The same plan of treatment is fully laid down by Rhases. When pus is discharged from the bladder, owing to ulceration of it, he directs us to give astringent injections prepared from galls, sumach, purslain, pomegranate leaves, &c.

On hemorrhage of the kidneys. Our author’s treatment is so fully stated that it will be unnecessary to multiply extracts from the others. It is mostly condensed from Aëtius. (xi, 27.) The latter makes mention of injecting into the bladder some astringent infusion by means of an instrument like a catheter, having a bladder attached to one extremity. When the coagulated blood (and the urine generally does coagulate it) cannot be got otherwise discharged, he recommends, like our author, an incision to be made in the perinæum.

Cælius Aurelianus also recommends injecting into the bladder some astringent infusion, such as that of hypocistis, knot-grass, &c. In the case of women astringent pessaries may be used.

Avicenna recommends us to inject the rennet of a hare. Haly Abbas directs us to bleed by opening the basilic vein, and then to give draughts containing various vegetable astringents, such as wild pomegranate flowers, cucumbers, and purslain, with alum, Cyprian earth, &c. According to Rhases, the discharge of blood by urine is often connected with disease of the liver.

The veterinary surgeon Vegetius ascribes the bloody water of cattle to general plethora. This is a very plausible hypothesis.

On hardness of the kidneys. Nearly the same account is given by Aëtius, and also by Avicenna, Rhases, Serapion, and all the medical authorities who have treated of this subject. Haly Abbas and Alsaharavius particularly commend the diachylon plaster. Ruffus, as quoted by Rhases, recommends rest, emollient clysters, the application of cupping-instruments to the back, tepid baths, refrigerant and sedative medicines internally.

On diabetes. Aretæus remarks that diabetes is a wonderful affection, being a melting down of the flesh into urine, occasioned by a cold and humid cause like dropsy. The disease, he says, is of slow formation, but when completely formed speedily proves fatal. His description of the symptoms is very striking: a fiery thirst, a never-ending desire to make water, a parched skin, a dry mouth, and so forth. Diabetes, he justly remarks, is a species of dropsy, the water in the one case being determined to the peritoneum, and in the other to the urinary organs. We have, in fact, known these diseases reciprocate. He recommends by all means attention to the thirst, endeavouring to allay it by means of the medicines called Adipsa; rectifying the stomach by purging with hiera; and applying epithemes of spikenard, mastich, and the like. For drink he directs us to give water in which the autumnal fruits have been boiled; and for food recommends starch, milk, and cold astringent wines. He concludes by saying that the general remedies and regimen proper in dropsical cases will answer in diabetes, and particularly mentions the theriac and mithridate. Among the causes of diabetes he mentions poisoning by the sting of the African viper, called the dipsas. This subject will be found treated of in the Fifth Book.

Celsus recommends exercise, friction, purging, astringent food, and austere wine. Galen states that he only recollected having met with two cases of diabetes. He maintains that it is such an affection of the urinary organs as lientery is of the bowels. He is decidedly of opinion that the kidneys are primarily affected, and not the stomach, as some had supposed. He explains his views of the nature of the disease with great precision. (De Locis Affectis, vi, 3.)

Aëtius has given the fullest account of diabetes. Upon the authority of Archigenes, he recommends at the commencement bleeding and diuretics, the latter being given to clear away the vitiated urine from the kidneys; but if the disease be of long standing, he proscribes both those measures. He recommends also a cooling diet, ruddy wine diluted, cooling applications to the pubes and loins, and, in certain cases, narcotics, such as opium and mandragora.

Alexander’s theory respecting the nature of the disease is the same as our author’s, both having borrowed it from Galen. He recommends food of difficult digestion, such as the feet of oxen, the flesh of pompions, chesnuts, &c. He forbids all saltish, acrid, and diuretic articles. He says nothing of venesection.

Actuarius recommends purgatives, in order to determine to the intestines, and astringent and refrigerant remedies in general.

Avenzoar explains fully his views respecting the nature and treatment of diabetes, in which he follows Galen closely. But the fullest and most accurate of the Arabian authorities on this subject is Avicenna. In certain cases, he admits of venesection at the commencement. The remedies, however, in which he seems to place the greatest reliance, are emetics and sudorifics, which he gives until the intention of altering the determination of the fluids to the kidneys. He particularly directs the patient to avoid taking all diuretic articles, to use exercise on horseback, moderate friction, and, in the decline of the disease, the tepid bath with fragrant wine.