Chapter XXIV: Part 24

_For iliac affections of the stomach, that is, strong and spasmodic pains._ The trochisk of the Amazonians is the best medicine in this case. An account of it, and of the ingredients which enter into the composition of other compound remedies for the stomach, you will find in the last Book, where Compound Medicines are treated of.

* * * * *

COMMENTARY. See Aretæus (Morb. Chron. ii, 8); Cælius Aurelianus (Pass. Tard. iii, 2); Celsus (iv, 5); Galen (de Med. sec. loc. vi); Oribasius (Synop. ix, 10); Aëtius (ix, 1); Alexander (vii, 5); Actuarius (Meth. Med. iv, 5); Octavius Horatianus (ii, 16); Marcellus (de Med. 20); Avicenna (iii, 13, 1, 2, 3); Serapion (i, 1); Avenzoar (i, 15); Averrhoes (Collig. v, 54); Haly Abbas (Pract. vii, 2, Theor. ix, 24); Alsaharavius (Pract. 16); Rhases (Divis. 59, Contin. xi.)

To all these authors, almost every one of whom has treated of these complaints more fully than Paulus, or upon a different plan, it is quite impossible for us to do justice within the narrow limits to which we confine ourselves in these annotations. We shall, therefore, direct our attention principally to Celsus, and merely add a few remarks from the others. The stomach, he says, is affected by great heat, inflation, inflammation, and ulceration; by phlegm or bile; and by resolution, which is a common and fatal complaint. Heat is to be cured by cold external applications, such as vinegar and roses, along with cold drink. Inflation we shall see treated of in the next Section. Inflammation which is attended with pain is to be treated by rest, abstinence, sulphurated wool, and wormwood, when fasting. If attended with ardor, he prescribes cold and repellent applications, occasionally exercise, and a fuller diet. Ulceration is to be cured by exercise, friction of the extremities, smooth and glutinous food, and avoiding every thing that is acid and acrid. Redundance of phlegm is to be treated by emetics, exercise, friction, hot drink, and hot food. When bile prevails he recommends laxatives, potions of wormwood, gestation, or a sea-voyage; emetics, if they can be conveniently borne, and suitable food, so as to avoid indigestion. Resolution, he says, is a severe affection of the stomach, when it cannot retain the food, and the body wastes. The bath, he says, is useless, but exercise of the upper parts of the body peculiarly proper. He recommends pouring cold water on the stomach, swimming in the same, and living on cold food, rather such as is difficult to digest than what will readily spoil on the stomach. Hence, he says, some digest beef. Undiluted austere wine, either cold or very hot, is proper. If there is vomiting with pain, he directs us to apply over the stomach, wool or sponge soaked in vinegar, or cold cataplasms; or, if the pain be more severe, a cupping-instrument; then bread which has been steeped in cold diluted wine is to be given. If this is not retained, some smooth article of food not disagreeable to the stomach is to be administered; and, if this be not retained, a cupful of wine is to be taken every hour until the stomach becomes settled. He also praises an acid mixture, containing pomegranate, endive, &c.

Aretæus gives a lively description of the feelings of a dyspeptic. The student who, heedless of the allurements of the senses and of the ties of nature, follows his divine pursuits with indiscreet ardour, and neglects to take proper food and exercise, is said to be particularly liable to affection of the stomach. The cure, he says, is to be effected by gestation, vociferation, a suitable diet, and indulgence of the patient’s caprices as far as possible. Wormwood, ginger, aloes, and mastich are also proper.

Alexander properly remarks that disorder of the stomach affects sympathetically the heart and brain. He treats fully of inflammation of the stomach, for which he directs us to give relaxants and tonics, such as wormwood and mastich. He further recommends the application of a plaster, composed of emollient and stimulant ingredients, such as wax, turpentine, ginger, opopanax, &c. It is singular that he and most of the ancient authorities have omitted to mention venesection for this complaint. We therefore entertain some doubts whether they meant by it the gastritis of modern Nosologists, which, by the by, is of so rare occurrence, that some late writers of high name are of opinion that it never occurs spontaneously. (See Christison on Poisons.) Some of the ancient authors, however, do recommend venesection in this complaint, as for example, Serapion, Rhases, Avicenna, and Haly Abbas. Horatianus recommends the same for sudden pains of the stomach. Cælius Aurelianus, while treating in general terms of stomach complaints, recommends bleeding, “si in vehementiam passio venerit.” He also prescribes cupping and leeching. His account of these affections is highly interesting, but so circumstantial that we dare not venture even upon an abridgment of it. Haly Abbas speaks of the inflammation ending in suppuration. To Alsaharavius we particularly invite attention. Rhases gives a copious statement of the opinions of all preceding authorities on this subject.

SECT. XXXVIII.—ON INFLATION OF THE STOMACH.

The formation of flatus in the stomach arises from the juices or food being dissolved into vapours by a gentle heat. For cold, as it is not of an attenuating and dissolving nature, does not engender flatulence; whilst a violent heat not only attenuates, but likewise dissipates, and thus prevents the formation of flatulence. But a lesser degree of heat dissolves and changes the food, but not sufficiently, and hence flatus is gendered. Wherefore we must attenuate them by calefacient medicines—boiling in oil the seed of cumin, of parsley, of cow-parsnip, and of carrot. When the affection partakes of cold, you may boil rue, bay-berries, gith, and fennel in the oil, and mix bitumen and oil of bays. But if the pain be attended with inflammation, instead of calefacients, you may use relaxants, making a decoction of dill, and mixing with it the fat of a cock and of a goose. Those who have flatulence may be relieved by the decoction of a fasciculus of poley, or a decoction of calamint, having a small quantity of honey and a drachm of pepper mixed with it. These remedies must be applied when the pain is violent; but if it is moderate, fomentations from millet will be sufficient. But a large cupping-instrument that will comprehend the navel often removes the symptom at once. Castor also is of use to them, when taken in a draught with oxycrate, and when applied externally with Sicyonian oil; and it also cures flatulence when attended with tormina. But the ankles of a swine burnt, and taken in a draught, cure tormina and flatulence; and the round birthwort does the same. Pains from obstructions of the bowels, or flatulence arising from thickness of the humours, or from cold, are relieved by drinking undiluted wine after food; and, if sleep follow, it completely removes these complaints.

* * * * *

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

Our author’s treatment, which consists of dry cupping, dry fomentations, and the internal use of calefacients and wine, is what Celsus also recommends. He likewise speaks favorably of exercising the upper parts of the body, of friction, and of using purgatives occasionally, and sometimes, though rarely, the bath. Serapion, Rhases, and Avicenna, recommend similar treatment, namely, purgatives and aromatics, such as aloes, anise, calamint, cumin, and the like. Haly Abbas forbids all flatulent food, such as pulse, milk, and grapes; recommends the bath after much exercise, and before dinner, and the stomach to be rubbed, and a cataplasm of salt and cumin applied to it. He also prescribes many calefacient and carminative articles, such as anise, rue, castor with old wine, also the peppers, theriac, mithridate, hiera picra, &c. Alsaharavius recommends aromatics and carminatives, and afterwards that the pit of the stomach should be rubbed with calefacient oils. Averrhoes directs us to give all solid food, as flesh, puddings, &c. quite cold; but spoon-meats may be eaten as warm as the blood or somewhat warmer. This method, he adds, will clear the head and stomach of wind, beget finer blood, brisker spirits, and cause a lively circulation of all the humours.

Rhases and Avicenna describe _ulceration_ of the stomach very accurately, and also thickening of its coats.

Avicenna mentions _rupture_ of the stomach, but does not say whether he alludes to spontaneous rupture or rupture from accident.

Actuarius has given a more distinct account of _hæmatemesis_ than any other of the ancient authorities. He says the blood may be brought up either pure or of a dark colour, and it may be occasioned either by external injuries or proceed from constitutional causes. The constitutional causes are commonly either general plethora or atony of the liver. In certain cases, he says, it proceeds from rupture of the vessels, and in others from relaxation of them, in others again from corrosion. In _melæna_, he says, the skin is pale. (De Diagnos. i, 39.)

SECT. XXXIX.—ON CHOLERA.

Cholera is an immoderate disorder of the belly, with discharges upwards and downwards, arising from continued indigestion of the food. Persons are affected with indigestion sometimes from the badness of their food, and sometimes owing to a redundance of depraved humours. Wherefore, if the patient be seized with nausea and lancinating pains, while the food remains in the stomach undigested, we must order him to drink tepid water, and to produce vomiting by putting his fingers or feathers down the throat. We must also encourage the discharge by the bowels. After the evacuation of the superfluities, he must take rest, and apply warmth to the hypochondrium, by means of sweet oil, with some wine; or by the oil of mastich, or of spikenard, if it is winter: and he must be allowed to sleep. After digestion has been accomplished, let him have recourse to baths and wholesome food. When the discharge is immoderate, it will be sufficient at first to try those things which are mentioned in the Second Book for disorder of the belly. But when the discharge continues, and the belly loses its tone, and the pulse gets small and dense, we must apply a cataplasm of dates, with flowers of wild vine, acacia, the juice of hypocistis, and pomegranate rind. For drink, give a cupful of moderately cold water to swallow; or, what is still better, a decoction of roses, of the flowers of wild vine, of sumach, or of vine-shoots; or we may give the juice of an acid-sweet pomegranate, sprinkling upon it a little mint. When the excretions are more acrid, and heat and thirst come on, we must give the seed of cucumber, with three cupfuls of water; and succory and lettuces boiled in oxycrate are to be used for food. When the discharge cannot be stopped, we must administer some of the austere wines; if the patient be free of fever, the Palmatian, the Aminæan, or palm wine, or that from unripe grapes, with honey; but when he has fever, pomegranate wine, or myrtle wine, or Cibyratic hydromel for drink, and along with crumbs of bread, alica, or chondrus. If he loathes food from grain, he may chew some summer fruit, or medlars, pears, quinces, or pomegranates, but he must spit out the fleshy and hard parts. When he cannot retain the food, let a large dry-cupping instrument be fastened over the stomach, and while it is on let some of the afore-mentioned food be taken. For the spasmodic contractions apply to the muscles hot rags dipped in oil, and liquid cerates, containing some castor and Sicyonian oil; but before applying them let hot water be poured upon the legs. If he cannot get sleep, we must have recourse to the remedies recommended for watchfulness; and if his strength permit, he may take a potion from poppy-heads. When the disease is on the decline, he may be put into a bath, and recruited with chickens, pigeons, the feet of swine, or the like. Diarrhœa, being a corruption of the food, for the most part ceases spontaneously, if no more food be taken until after the complete digestion and evacuation of the corrupted matters; but if it continue, we must use the remedies applicable to cholera.

* * * * *

COMMENTARY. Consult Hippocrates (Epidem. v, 4, et alibi); Galen (Comment., de Fac. Part., de Rat. Vict., de Med. sec. loc. viii); Aretæus (Morb. Acut. ii, 5; de Curat. M. A. ii, 4); Celsus (iv, 11); Alexander (vii, 16); Aëtius (ix, 12); Oribasius (Morb. Curat, iii, 11); Leo (v, 5); Actuarius (Meth. Med. iv, 5); Nonnus (164); Cassius Medicus (Problem.); Scribonius Largus; Cælius Aurelianus (Morb. Acut. iii, 19); Octavius Horatianus (ii, 16); Marcellus (30); Avicenna (iii, 16, 1); Serapion (iii, 14); Avenzoar (ii, 1); Alsaharavius (xvi, 20); Haly Abbas (Pract. vii, 14; Theor. ix, 25); Rhases (Divis. 60, Contin. xi; ad Mansor. ix.)

Hippocrates in his ‘Epidemics’ has given several well-detailed cases of cholera. In one, the patient drank hellebore in the juice of lentils, and vomited; he became cold, and was put into the hot hip-bath, where he regained his heat and recovered. In another place, he says that the disease is, for the most part, occasioned by unwholesome food, such as pork improperly boiled, pot-herbs, summer fruits, &c.

Aretæus defines cholera to be a retrograde movement of the matters in the body upon the stomach and intestines, consisting of a discharge upwards and downwards of bile, which, if the disease proves fatal, becomes black; and, at the same time, the extremities are cold, with profuse sweats, pulse small and dense, constant straining to vomit, and tenesmus. He also makes mention, among the symptoms, of spasms and contractions of the muscles in the legs and arms, borborygmi, tormina, and syncope. The complaint, he says, is occasioned by continued indigestion, and proves fatal by superinducing convulsions, suffocation, and retching. With regard to the treatment, he cautions us not to stop the discharge at first, but to encourage it by giving frequently some tepid water; and when attended with tormina and coldness of the feet, to apply to the belly hot oil of rue, and rub the legs to restore heat. When the fæces are all evacuated, he recommends some cold water to compose the stomach; and when the pulse sinks and becomes frequent, while at the same time there are profuse sweats and deliquium, he approves of adding a small quantity of wine to the water. It is to be of a fragrant and astringent kind, so as to strengthen the powers of the system. When all the symptoms get worse, when spasms of the legs occur, and the pulse becomes insensible, he advises us to give more wine and water. Should the vomiting continue, we must return to very hot drink and hot food, for, he remarks, the transition often proves beneficial. When all these fail, a cupping-instrument is to be put on between the shoulders or below the navel. He afterwards speaks of such applications as those recommended by our author, namely, calefacients applied to the belly, chest, and legs. He concludes with saying, that, if the symptoms, instead of improving, should get worse after this treatment, it will be proper for the physician to accelerate his retreat.

When cholera is not attended with fever, Galen approves of giving a piece of bread soaked in diluted wine, of cold drink, and of applying cupping-instruments to the belly. When the patient is strong, he even recommends the cold bath. He directs afterwards astringent food, and also speaks of clysters, old wine, and asses’ milk. He mentions with seeming approbation that Asclepiades gave tepid water at the commencement.

Celsus depends most upon tepid water, dry cupping, and sinapisms to the belly. In extreme cases, he prescribes a light fragrant wine diluted with water.

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.

* * * * *

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.

* * * * *

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.

Dysentery is an ulceration of the intestines, sometimes arising from the translation of tenesmus, or some of the disorders of the bowels formerly mentioned, and sometimes being itself the primary affection; and it is attended with evacuations, at first bilious, and of various colours, then, accordingly, bloody, and at last ichorous, like that which runs from dead bodies. Dysentery, arising from black bile, is necessarily fatal, as indicating an ulcerated cancer. If, therefore, the appearances of ulceration be discharged, mixed with the fæces, and attended with pains and tormina, you may be sure that the ulceration is seated in the small intestines, and is to be remedied by medicines swallowed by the mouth; but if the fæces be passed unmixed with the blood, it is an affection of the large intestines, and will yield rather to clysters. When there is a great discharge of blood by itself, the disease is called the bloody dysentery. Sometimes the blood which is discharged is blacker than natural and shining, owing to the liver’s not digesting properly the food which is sent to it; and owing to an atony of the retentive or of the alterative faculty of the stomach, it is discharged from it like the washings of newly-killed flesh. This is called hepatic dysentery, and will be treated of along with the affections of the liver.

In general, therefore, we must use those things which were recommended for cæliac and other preternatural evacuations; but, in particular, the Lemnian earth cures a spreading dysentery when drunk or injected, the intestine being previously washed out with honied water, and afterwards with salt water; and the juice of purslain is proper for dysenteric affections when drunk, or the purslain itself when boiled in oxycrate and eaten. Plantain also is proper, and the fruit and leaves of the bramble, the decoction of the root of marshmallows, the herb horsetail drunk in water or wine, and the juice of it, the unripe fruit of the mulberry dried, and, still more, bramble-berries when similarly dried. Eggs boiled with vinegar and eaten, dry up fluxes of the belly; but it will answer better if, mixing with them some of the articles which are good for dysentery, you fry them, and give to eat. The wine of unripe grapes is most useful in these cases, and the red sumach, and the juice of it, the rind of pomegranate, galls, grape-stones, medlars, myrtles, cornels, the ashes of snails roasted whole. The following is a compound medicine: Of the ashes of snails, p. iv; of galls, p. ij; of pepper, p. j; reduce to a fine powder, and sprinkle upon the condiments, or give to drink in water, or a white watery wine. It greatly helps dysenteric patients, when the ulcers are not putrid. But the dried dung of dogs who have eaten bones, when drank in milk which has been curdled by having heated pebbles put into it, is of great service. The following are compound remedies: The trochisk from Egyptian thorn, that of Philip, that from hartshorn, that from seeds, and the Trigonus. The pills from macer are excellent remedies. The following is an admirable one: Of opium, of saffron, of Indian Lycium (_catechu?_), of acacia, of sumach, of frankincense, of galls, of hypocistis, of pomegranate-rind, of myrrh, of aloes, equal parts; give in water to the amount of three oboli.—_Another_: Of sumach, dr. viij; of galls, of pomegranate rind, of each, dr. iv; give in a spoonful of wine.—_Another_: Of sumach, dr. viij; of galls, of acacia, of gum, of each, dr. ij; of opium, dr. j; give one drachm in diluted wine. This linctus will suit with them: Of black myrtles, one sextarius; of Syriac sumach, one sextarius; of Theban dates, lb. ij; of the flesh of quinces, lb. j; ten sour pomegranates with their rind; of astringent wine, one sextarius: boil to a third, and, having strained, add of honey, lb. vj; and, having boiled to a proper consistence, give for a linctus. It is clear, that the cataplasms should be made from astringents the materials of which you are acquainted with. On account of the tenesmus, which proves a troublesome symptom in dysentery, injections made from the juice of rice, chondrus, or the like, with the tallow of goats, and likewise those recommended in the section on Tenesmus will prove serviceable. But, if there is a discharge of blood, we must inject the juice of knotgrass, or of plantain, with acacia, hypocistis, or the like. But, if this symptom be urgent, we may inject some styptic, such as the ashes of unwashed wool, or of new sponge, which has been soaked in liquid pitch, or the blood of an ox, or liquid alum; or it may be soaked in the juice of asses’ dung in like manner, and burnt. And the trochisk of Andron is an excellent remedy, and that of Musa, and the like. But suppositories of collyria are among the most effectual remedies, more particularly when the discharges are attended with pain. When there is a spreading ulcer in the intestines, which you may ascertain from the fetid smell and putridity of the discharges, and from its not having occurred at the commencement, but after some interval, we must use escharotic injections, such as the trochisks called Faustiani, that from paper, the Bithynian, the Thronian, and that from cork, injected in the decoction of dried lentils, or of some of the other astringents. And the following enema is of approved efficacy: Of burnt omphacis (it is the cavity from which grows the acorn which the tanners use), of arsenic, of comfrey, of Syriac sumach, equal parts. Mix about two spoonfuls of these when pounded together with the juice of rice, and the juice of alkanet that has the thorny, broad, and black leaf (which they call _chærospelethron_), and with the white of eggs, to the amount of two or three ounces; and give for an injection. Those epithemes apply which were mentioned for cæliac affection. And, in like manner, those liniments to the belly which are composed of astringent and desiccative materials, with some of the glutinous substances, gum, frankincense, taurocolla, fine flour, may have place with the corresponding cataplasms. The food at first should be eggs mixed with milk, and the spoon-meats made from frumentaceous substances, either alone or boiled with milk. And milk itself moderately boiled is an excellent thing. The use of pot-herbs is not necessary; however, we may allow the patients to taste of boiled endive, of succory, of plantain, of cabbage twice boiled, and of the autumnal fruits, such as are astringent, spitting out the fleshy parts, and whatever else will irritate the intestines. When the intemperament is very hot, we must give raw succory, and make the patients drink of cold water. The other drink should be rain-water; and, when the stomach is languid, wine may be taken. Afterwards they may take the drier and more digestible parts of fowls, and use baths of sweet water. But if the flux is brought on by the use of them, soak a large sponge or pieces of bread made from fine flour in wine of Ascalon, or some of the hot astringents, apply to the whole abdomen, bind it on, and order them to bathe in this state.

* * * * *

COMMENTARY. Consult Hippocrates (Aphoris., de Affect. Epidem.); Galen (Comment. de Med. sec. loc. ix); Aretæus (Morb. Chron. ii, 9); Celsus (iv, 15); Cælius Aurelianus (Pass. Tard. iv, 6); Alexander (vii, 21 and x, 1); Aëtius (ix, 43); Oribasius (Synops. ix, 14, and Loc. Affect. iv, 88); Actuarius (Meth. Med. i, 41); Nonnus (167); Leo (v, 9); Octavius Horatianus (ii, 31); Marcellus (27); Scribonius Largus (xi); Averrhoes (Collig. iv, 59); Avicenna (iii, 16, 2, 7); Serapion (iii, 26); Avenzoar (ii, 1, 5); Haly Abbas (Theor. ix, 26; Pract. vii, 22); Alsaharavius (Pract. xvii, 1); Rhases (ad Mansor. ix, 72; Divis. 67; Cont. xiii.)

Hippocrates briefly describes dysentery as being a complaint attended with pain throughout the whole belly, tormina, and discharges of bile, phlegm, and blood. The disease, he says, is occasioned by an overflow of phlegm and bile to the veins of the belly, producing erosion and ulceration of the intestines. His treatment consists of purging the head, emetics, opening the belly, emollient clysters, and a regulated diet. In one of his aphorisms he states that a spontaneous vomiting cures dysentery. Another of his aphorisms is that a dysentery commencing from black bile is mortal. Another is, that when substances resembling flesh are discharged by a person affected with dysentery it is a mortal symptom. (iv.) His commentator Theophilus says, in explanation, that it is because the intestines are ulcerated and do not readily heal. (Ed. Dietz, 401.)

Galen treats separately of hepatic dysentery and of dysentery connected with ulceration of the mucous membrane of the intestines. Of his remedies some are astringents, such as galls, alum, dried roses, and hypocistis; some anodyne, such as opium and henbane; some are detergents, such as myrrh, pepper, spikenard, &c.; and some escharotics, such as arsenic, sandarach, the scales of copper, and the like. These last are to be given only in clysters. Modern physicians will be disposed to condemn them without a trial; and yet, as arsenic may be given by the mouth in properly-regulated doses, there appears no good reason why it may not be safely administered in injections. Rogerius, one of the earlier modern writers, speaks favorably of trochisks of arsenic. (i, 37.) Sprengel, however, decidedly condemns the practice. He says of Athenæus: “Il recommandait dans la dyssenterie un lavement dont un _mélange affreux_ d’orpiment et de realgar formait la base.” (Hist. de la Méd.) See Sect. xxix of this Book.

Aretæus gives a very circumstantial description of the symptoms of dysentery, but unfortunately his chapter on the treatment is entirely wanting. He describes all the varieties of ulcers, the superficial, the deep-seated, the irritable, the callous, and the like; and the discharges from them, whether thin, bilious, fetid, devoid of smell, high-seated, or otherwise. Of the other authorities, Alexander may be mentioned as the one who has most correctly pointed out the importance of attending to the part of the intestines in which the ulceration is seated. The large intestines, he says, are most commonly affected. He approves of bleeding in certain cases. His treatment is judiciously regulated according to the exciting causes; and, in many cases, he prescribes gentle laxatives. One of the varieties of dysentery described by him is said to proceed from disorder of the liver, which is impaired in its attractive faculty. This variety he calls hepatic dysentery, which, instead of attempting to cure, as he says many do empirically, by a combination of aloes with astringents, he recommends to be treated according to the nature of the affection and the humour which produces it. His views of the treatment are given at great length.

Celsus gives a very distinct account of the treatment. He enjoins rest, as all motion proves injurious to the ulcers; recommends astringent cataplasms, frequent washing with warm water in which vervain has been boiled, astringent food, injections of ptisan, milk, oil, the decoction of linseed, the yelks of eggs with rose-water, &c. For drink he directs tepid water to be given, either alone or with an austere wine; or, if these things fail, a draught of cold water to stop the discharges from the bowels. When the disease is seated high up, the belly is to be opened.

Aëtius allows the abstraction of a small quantity of blood from the arm when inflammation is present. He says it allays heat, produces revulsion, and induces sleep. His internal remedies are much the same as those of Galen.

Much of our author’s treatment is borrowed from Oribasius.

Octavius Horatianus, like the others, recommends, when the ulcers are attended with putridity, a powder containing arsenic, quicklime, and burnt paper, administered in an astringent wine, or in a decoction of astringent herbs. Marcellus makes mention of a similar application, which he directs to be used only when symptoms of malignity appear.

Cælius Aurelianus gives a very comprehensive description of dysentery, the principal symptoms of which are fever, anxiety, rumbling of the belly, sometimes retention of urine; tongue rough, furred, and black; tenesmus and pungent pains of the intestines and anus. The disease, he says, consists of a defluxion from the belly with ulceration, and is preceded by diarrhœa, cholera, or inflammation. He animadverts upon the treatment of others with his usual freedom. Thus he blames Erasistratus for using nothing but astringents, whereas many cases of dysentery require laxatives. His treatment is minutely detailed, but is not very different from our author’s.

Leo, for bloody dysentery, like our author, recommends pills of macer, the troche of corals, and the decoction of rhubarb.

According to Sprengel, Nonnus is the first author who distinguishes the white dysentery from the red. It is obvious, however, that the distinction between the two varieties had been made by earlier authorities. We may add that Actuarius treats of the bloody dysentery very fully.

The Arabians follow closely the treatment of the Greeks. Injections containing arsenic are recommended by Serapion, Avicenna, and Haly Abbas. Rhases, like Aëtius, admits of venesection in certain cases. He refers the disease, in general, to debility of the retentive faculty of the liver and derangement of the bile. Haly treats separately and minutely first of intestinal dysentery and next of hepatic. The intestinal, he says, is occasioned by ulceration of the intestines. He also describes the bloody dysentery, like our author. His treatment is directed upon general principles. He recommends various clysters; and, when the ulcers are in the rectum, he directs us, among other remedies, to introduce a tent, soaked in a solution of arsenic, quicklime, hypocistis, &c. Some of his stimulant applications, however, are merely detergents, and do not contain septics. The ingredients of his ordinary injections are either emollients or astringents, according to circumstances. The account given by Alsaharavius is valuable, but too long for our limits. Rhases, in cases of protracted dysentery, directs snow to be applied to the belly. In fact most of the ancient authorities recommend cold applications in cases of chronic dysentery.

SECT. XLIII.—ON COLIC AFFECTION.