Chapter XXV: Part 25

The colon, being a part of the large intestine, takes its origin in the right iliac region, and passes across to the left, in the form of a belt. The most violent pains arise in it from various causes, either from a thick and pituitous humour shut up between its coats, or from a thick flatus that cannot find a passage out, or from inflammation of the intestine, or from acrid and sharp humours. Those, therefore, who suffer from a thick and pituitous humour, have a deep-seated pain along the whole abdomen, and especially in the region of the colon; there is a sensation as if it were pierced by a wimble; they are troubled with tormina, eructations, nausea, and vomitings of all kinds, but more especially of phlegm. The belly is greatly constipated, so as not to allow the passage even of wind; and any fæces which are discharged seem like the dung of oxen, light and windy. These symptoms are usually preceded by the continued use of food of a cold and incrassating nature, repletion, indigestion, inactivity, and the like. When the attack proceeds from flatulence, there is rather a sense of distension. When it is from inflammation, there is a sense of heat in the part, and no inconsiderable fever, retention of the urine as well as of the fæces, pulsation in the belly, thirst, and troublesome heat, nausea, and vomitings, more especially of bile, which afford no relief. In short, this is the most severe of the colic affections, and threatens to pass into ileus. When acrid and sharp humours are the cause of the pain, the patients, as in the case of inflammation, have heat, thirst, and sleeplessness; if they have fever, it is less than in the former case; their urine is acrid; the alvine discharges bilious; and often along with the discharge from the bowels the pain is aggravated, and exacerbations thereof take place, more especially after heating food or drink. Pains occasioned by cold, viscid, and thick humours are to be cured by such things as are not violently heating; for by things which are thus heating the humours are dissolved and converted into air. Wherefore we must try to incide and concoct them by carminatives, and such medicines as are attenuant and desiccant, without heating much at the beginning of the complaint. The fæces being evacuated from the bowels by suitable clysters, we must use an injection of oil, in which cumin or rue has been boiled, with the grease of a goose or hen; or of a decoction from the roots of wild cucumber, with a drachm of myrrh and some honey and oil; or from myrrh, honey, and Sicyonian oil. And often, when common oil is injected, the vitreous phlegm is discharged along with it, and instantly removes the pain. If, owing to the violence of the pain, the injection be retained, we must apply a suppository of honey, cumin, nitre, and the dried seeds of rue; or of a stalk of cabbage well shaven down and macerated in salt water; or of the ashes of cabbage mixed with honey; or of colocynth triturated with honey, nitre, and cumin. The suppositories should be six fingers’ breadth in length, so that they may extend beyond the sphincter muscle. The anus is to be anointed with the juice of sow-bread, with honey and nitre, or with centaury along with honey and nitre. When the pain is continued, in addition to the afore-mentioned, these injections are to be used: Of turpentine-rosin, oz. j; or of opopanax, dr. i; or of galbanum, dr. iv; of bitumen, an equal part, with, of nitre, dr. j; and of water, oz. j; of oil of rue, oz. v, or more. Embrocations are to be applied to the affected parts from the oil of cumin, of dill, or Sicyonian oil. Cataplasms are to be applied, composed of the medicine called trispermum with cumin, bay-berries, and parsley-seed. Epithemes are to be applied, namely, that from seeds, that from bay-berries, that from meliot, and the polyarchian. Let the patients sit in a hip-bath of the decoction of fenugreek, marshmallows, chamomile, mugwort, dill, bay, and the like. And they may be made to sit in a hip-bath of warm oil, or in oil and water. They should take potions containing wormwood and cumin, in equal parts, or panacea with water, or of castor, of anise, and of the peppers, dr. j, with oxymel. When the pain does not remit, we must give them a draught, containing the medicine from three peppers, or the theriac; and have recourse to a sinapism and dropax during the remissions, and to the natural baths; but they must abstain from bathing in drinkable water, unless compelled to have recourse to them by the urgency of the pain; when, having previously injected some of the afore-mentioned medicines, we must direct them to bathe, and be fomented within the heated walls of the bath, having been previously rubbed with some of the detergent ointments containing nitre. When the pain is violent, we must use those things which are moderately soothing, such as the trochisk of castor, either injected or taken by the mouth, and such like remedies. But powerful narcotics must be avoided, which allay the pain indeed for a short time, but render the affection more protracted by incrassating the offending matter, and occasioning obstruction of the pores of the intestine. When the phlegm is attenuated, we must purge them with hiera picra, or such pills as these: Of aloes, of euphorbium, of pure granum cnidium, of scammony, equal parts. The dose is two scruples. A heating and desiccant diet will suit with them. At first, indeed, they should abstain from food, but afterwards take acrid food. Wherefore we must give them leeks boiled with prepared wine and parsley, and marsh asparagus, raw garlic, more especially if they do not dislike these things; and they may drink of the prepared wine, and take some bread with it. Afterwards we must give them wholesome and digestible food, avoiding a surfeit and indigestion. If it is a flatulent spirit which causes the pain, after carminative injections and draughts, dry-cupping by means of large cupping-instruments, heated and fixed along the whole abdomen, often effects a cure. When the intestine is in a state of inflammation, we must bleed from the arm; but if dysuria prevails, we must likewise open the vein in the ankle, and use the remedies already mentioned, except those things which are acrid and powerfully cathartic; and we must rather use soothing injections, cataplasms, fomentations, placing the patient in a hip-bath of oil. We may also apply cupping-instruments to them, and lay a cerate upon the abdomen, containing, of wax, oz. v; of chamomile, oz. ij; of rose-oil, oz. ij; of the flour of beans, oz. ss; five yelks of eggs pounded with the juice of linseed. The diet should be light, and such as that applicable in fever, until the inflammation be resolved. But if the pain arise from acrid and sharp humours, we must administer injections of oil, in which has been boiled fenugreek or marshmallows, with plain fresh grease of a goose or hen, or the juice of ptisan with rose-oil, or the juice of linseed. They must take the antidote called picra from aloes in a draught, and use baths of sweet waters, and spoon-meats from chondrus or ptisan, and fishes caught among rocks; and, in a word, the whole regimen should be moistening and cooling. The patient must abstain from all acrid food and medicines, and from hot fomentations, by means of embrocations and cataplasms, and from drinking wine, more especially old. When the pain is strong, we may also use narcotics; for they prove less injurious in this case than in any of the others, incrassating and moderately cooling the thin and sharp humours. I am of opinion that the colic affection which now prevails is occasioned by such humours; the disease having taken its rise in the country of Italy, but raging also in many other regions of the Roman empire, like a pestilential contagion, which in many cases terminates in epilepsy, but in others in paralysis of the extremities, while the sensibility of them is preserved, and sometimes both these affections attacking together. And of those who fell into epilepsy the greater number died; but of the paralytics the most recovered, as their complaint proved a critical metastasis of the cause of the disorder. Those, therefore, who were thus affected, a certain physician in Italy cured, in an incredible way, by putting them boldly upon a refrigerant diet. For he gave them unboiled lettuces previously cooled, and succory, in like manner, to eat until they were more than sated; and also grapes, apples, fish which have hard flesh, and, in short, all the crustacea; also the feet of oxen, the bulbi, and the like, namely, things which were not only cold by their powers, but likewise to the touch. He seldom gave wine, and when he did, he mixed it with cold water. And he gave cold water for drink, or cold oxycrate, and prohibited all warm food and that of the middle kind; and, contrary to all expectation, he cured most people in this way, and even some who had begun to experience a conversion of the disease into epilepsy or paralysis.

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COMMENTARY. See Hippocrates (de Affect. xv); Galen (de Med. sec. loc. ix; de Loc. Affect. vi, 2); Aretæus (Morb. Acut. ii, 6; Chron. ii, 8); Alexander (ix, 1); Celsus (iv, 14); Oribasius (Loc. Affect. Curat. iv, 87); Leo (v, 13); Aëtius (ix, 29); Actuarius (Meth. Med. i, 45); Pliny (H. N. ix, 37); Nonnus (170); Scribonius Largus; Cælius Aurelianus (Tard. Pass. iv, 7); Marcellus (de Med. 29); Serapion (iii, 32); Avicenna (iii, 16, 4); Avenzoar (ii, 1); Haly Abbas (Pract. vii, 28); Alsaharavius (Pract. xvii, 2, 12); Rhases (Divis. 69; Contin. xxi.)

Hippocrates treats very sensibly of the colic pains which occur in summer, recommending for them emetics of tepid mulse and vinegar, warm clysters, the warm bath, fomentations, soporifics, and purgatives, according to circumstances. When the pains are seated in the lower part of the belly, he merely gives clysters and laxatives.

Galen gives a long list of preparations for colic. They consist principally of narcotics, such as opium, henbane, and mandragora, along with carminatives and aromatics, as anise, pepper, valerian, cinnamon, saffron, gentian, and the like.

Aretæus concludes his chapter on ileus with a short account of colic. He remarks that the colon being a larger and more fleshy intestine than the ileum, the pain is less acute, and the complaint in so far less dangerous. The pain, he says, sometimes extends to the side, resembling pleurisy; sometimes to the false ribs, resembling hepatitis or splenitis; and sometimes to the os sacrum, tops of the thighs, and testicles. The complaint is attended with unavailing vomiting; and what is vomited is thin, bilious, and oily. He also describes a more protracted species of colic among the chronic diseases. Among the symptoms he enumerates torpor, loathing of food, watchfulness, and swelling of the face. He says the pain sometimes shoots down to the testicles, whereby ignorant surgeons have been led into the mistake of supposing that the disease was seated there, and have made an incision into the cremasters. Does he allude to the operation for strangulated hernia? or does he mean to say that the disease is confounded with inflammation of the testicle? His treatment of ileus will be given in the next Section.

Alexander insists strongly on the absolute necessity of distinguishing colic from the diseases of the adjoining parts, which, he remarks, is sometimes difficult. He first treats of colic pain arising from a cold humour, and discusses fully the remedies for it. They are nearly such as our author recommends, namely, attenuant food, including white wines in cases of flatulence; avoiding the common bath, which does no good, but using the sulphureous bath if convenient; rubbing the affected parts with calefacient ointments, or applying heated bricks to them; purging with aloes, scammony, and the like; using the hip-bath made with the decoctions of parsley and anise, common oil, and the like; applying epithemes; administering clysters of hot oil, either alone or with some carminative, such as turpentine; giving narcotics, as opium and henbane, when the humours are thin and acrid, but not otherwise; applying sinapisms and calefacient plasters; sometimes giving emetics; and in protracted cases enjoining exercise. When the disease proceeds from flatulence, he applies dry fomentations of millet, calefacient oils, and a cupping-instrument to the belly. When it is occasioned by constipation, he directs us to remove the obstruction by giving water, oil, and mead, and administering the same in clysters. In obstinate cases he directs us to inflate the bowels with a bellows, and afterwards to inject a little nitre and oil and water. He also speaks of pills or pellets of lead. When it proceeds from hot and bilious humours, he gives for food fish, the testacea, the most indigestible parts of quadrupeds; and recommends the common bath, and purging with drastic cathartics, such as hellebore and scammony. When inflammation is the cause, he forbids purgatives, because they only increase the evil, but recommends general bleeding repeated at intervals; and, if the urine is suppressed, bleeding at the ankles; also emollient clysters, external applications of a soothing nature, and baths after venesection, but not before.

Celsus recommends principally dry fomentations, friction of the extremities, and dry cupping. He also mentions a medicine called the colic composition, consisting of poppy tears, pepper, anise, castor, spikenard, myrrh, &c.

The beginning of Cælius Aurelianus’s chapter on colic is unfortunately lost. He approves of venesection, fomentations of sweet oil, and injections of the same; but disapproves of adding rue, anise, or anything calefacient to them; speaks favorably of cupping and leeching, which are to be followed by hot fomentations with sponges squeezed out of warm water, or by the hip-bath. As to the calefacient and acrid things usually given, namely, parsley, cumin, and the like, he properly directs them to be avoided when inflammation is present. In this case he recommends the bath of oil. When the complaint is on the decline, he approves of gestation, of friction of the belly with rubefacients; and of sinapisms, calefacient plasters, and the like. He speaks favorably of a long sea-voyage, and of the use of medicinal springs, especially sulphureous, and directs indigestion and everything of a flatulent nature to be guarded against.

Several of the other Greek and Latin authorities, especially Aëtius, treat of colic with admirable precision; but, as their remedial measures are much the same as those already mentioned, we shall not attempt to give any account of them.

Serapion’s divisions and treatment are nearly the same as our author’s. Avicenna, however, treats of the complaint more fully and circumstantially than any other ancient author, but the length of his description prevents us from giving an abstract of it. We may mention, however, that when the pain is violent he approves of narcotics both by the mouth and in clysters. Among the causes of colic mentioned by Haly Abbas is debility of the intestine, so that it can neither digest the food nor evacuate it. Haly justly remarks that the inflammatory colic is the worst species of the disease, for that in it the patient experiences no relief from evacuations, and the danger is imminent. With regard to the treatment of it, he forbids purgatives, which do but increase the irritation; and recommends bleeding, emollient drinks, plasters, &c. In flatulent colic his remedies are purgatives and carminatives, such as hiera with anise, fenugreek, cucumber, mastich, &c. In all cases he approves much of clysters. Alsaharavius enumerates the following causes of colic: A hot intemperament, hernia, indurated fæces, cold humours impacted in the intestines, and the presence of some poisonous medicine. We dare scarcely venture upon an exposition of the minutiæ of his treatment. When the disease is occasioned by retention of hard fæces, he recommends oily injections, baths, and diluent draughts. When it arises from gross humours, he agrees with Galen in approving of strong wine, clysters of dill, chamomile, fenugreek, and the like, boiled in water. Rhases directs us to give emetics when the disease arises from indigestion. He probably alludes to duodenal disease. He mentions alvine calculi and worms among the causes of colic. He particularly recommends the warm bath and clysters.

Our author’s interesting account of the epidemical colic is copied by Avicenna; but neither he nor any other subsequent authority supplies the smallest additional information. Pliny seems to allude to an epidemical colic which prevailed in the reign of Tiberius, but gives no satisfactory account of it. (H.N. xxvi, 6.) The Jewish physician Moyses Alatinus gives the following description of a pestilential colic resembling that described by Paulus and Avicenna: “Colicam, iliacamque, hujus generis, _contagiosas passiones_, quas hoc in loco refert Avicenna, memini me olim vidisse in civitate Mantuæ anno 1560, mensibus nimirum Augusti et Septembris, quia publicè tunc temporis ejusmodi passiones contagiosæ per universam civitatem grassabantur, cum sævis symptomatibus, assiduo nempe, ac urgente vomitu bilis porraceæ in magna copia, nec non etiam æruginosæ, lipothymia, assiduâ febre malignitatis non experte, ac siti immensâ, ac in eâdem familiâ plurimi eo morbo oppressi inveniebantur,” &c. (Marciæ Prælect. 276.) See Book Second, Sect. XXXVI.

SECT. XLIV.—ON ILEUS.

Iliac passion, being a very acute and painful complaint, has a symptom more grievous even than dangerous; for those who are overpowered by the disease die a most piteous death, vomiting up fæces at last by the mouth. The affection arises from indigestion and obstruction, when the corrupted matters are retained, and from deleterious medicines, and from a falling down of the bowels into the scrotum, and from inflammation of the intestines, commonly supervening upon a colic affection. Wherefore children are to be cured by embrocations, cataplasms, clysters, suppositories, and fomentations, as described when treating of colic. But young persons and adults are to be bled without delay, and the operation repeated; and dry cupping is to be freely applied along the abdomen, and cupping even with scarifications to the affected parts. The extremities are to be rubbed and ligatures applied round them; and we must have recourse to the most drastic clysters and enemata, putting the patients into hip-baths of hot oil, giving antidotes, and purgatives; and simply all things, in short, which are applicable for colics, except when the affection of the colon proceeds from acrid and pungent humours. It has a wonderful effect in this complaint to drink the decoction of dill, even if it should be vomited up; but after drinking it, dip bread in warm water, and give the hot pieces of it to eat. For those who cannot retain their food, triturate sumach and cumin together, and give to drink in oxymel to the amount of six cupfuls. Those who are attacked with ileus from taking deleterious substances are to be compelled to vomit by drinking warm water (the symptoms arising from taking any of the deleterious substances are detailed in the Fifth Book); and then they are to be made to drink warm oil, or fat soups, that they may again vomit; but, after a certain number of days, they must drink the theriac. If the constipation continue, the belly is to be evacuated by curds and whey (_schiston_), with a little scammony, aloes, or some other purgative. If the complaint arise from the falling down of the intestine into the scrotum, we must put the patient into a reclining position with his feet elevated, and then we are to press the prolapsed intestine up to the groin, and retain it with a bandage.

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

Among other remedies for ileus, Hippocrates recommends inflating the bowels by means of a bellows. (De Morb. iii, 15.)

Aretæus gives an excellent account of the disease, the causes of which, as enumerated by him, are protracted indigestion of multifarious and unwonted food, a blow, exposure to cold, cold drink, and prolapsus of the intestine into the scrotum, or intestinal hernia. Some, he says, die from the violence of the pain, some from the conversion of the disease into suppuration, and some from blackening and mortification of the bowels. The symptoms are most accurately described. There is at first vomiting of phlegm and bile, but latterly of fæces; the pulse at first is rare and small, but before death it becomes very small, very dense, and intermittent. When inflammation is the cause of the disease, he approves of immediate venesection, so as to induce deliquium animi, which, he says, will, at all events, bring some respite to the patient’s sufferings. If inflammation is not present, venesection may be omitted, and an emetic of oil and water may be given; and afterwards applications are to be used for promoting the discharge of flatus, consisting of sow-bread, nitre, salts, and turpentine, which last medicine is also to be administered in a clyster with oil, honey, hyssop, and colocynth; and afterwards another injection of hot oil and rue is to be given. Externally he applies various fomentations and dry cupping. He gives carminatives with anodynes and the theriac. When the bowels cannot be got opened otherwise, he recommends the purgative hiera. The food is to consist of soups made from domestic fowls, with cumin, nitre, &c.; and, when there is no fever, he permits the use of hot wine.

Celsus forbids wine, but his treatment otherwise is like that of Aretæus. He directs immediate venesection and cupping; and, if the pain be seated above the navel, he approves of emetics, but, if below, he agrees with Erasistratus in preferring purgatives, such as ptisan, with oil and honey. He directs us to apply cataplasms from the breast to the loins, to put the patient into a bath of oil, to inject hot oil per anum, and to use friction of the extremities.

Our author follows Aëtius and Oribasius closely, who, in their turn, are indebted to Galen.

Nonnus seems merely to abridge our author. The causes of ileus are said by him to be obstruction of the bowels, inflammation, indigestion, and colic affections. His remedies for children are embrocations, cataplasms, and fomentations; and for adults, also venesection, cupping, clysters, and the oily bath. When the food is rejected, he recommends sumach and cumin in oxymel, and also purgatives.

It appears from Cælius Aurelianus that Diocles had been in the practice of giving a leaden bullet to swallow in this disease, no doubt with the same intention that quicksilver is now sometimes administered. In the preceding Section, we have mentioned that Alexander gave pills of lead for colic. Cælius, however, disapproves of this practice. He finds fault with Hippocrates for recommending to inflate the bowels with smoke; for giving emetics; and for cooling the upper parts of the body. He himself approves of bleeding, oily clysters, baths of oil, and the like.

The Arabians, like the Greeks, treat ileus by venesection, clysters, and so forth. They mention cooling plasters as an external application; but we believe it was the practice of the ancients rather to use hot fomentations than cold in this disease. Haly Abbas in general approves of venesection, but, in certain cases arising from a cold cause, he joins Hippocrates in permitting the use of wine. When the disease is occasioned by obstruction, he recommends laxatives; when connected with descent of the gut, he directs us to return it, but says nothing of the operation for strangulated hernia. According to Rhases, the causes of ileus are inflammation of the bowels, debility of the expulsive faculty, and indurated fæces.

Vegetius, the veterinary surgeon, gives an excellent account of the symptoms and treatment of colic and ileus in cattle. (Mulomedicina, i, 41, 42.)

SECT. XLV.—ON AFFECTIONS OF THE KIDNEYS AND BLADDER; AND, FIRST, ON CALCULUS.

The alliance of these diseases obliges us to break through the order of instruction; for it is a common symptom of colic and of calculus in the kidney, that the belly is at first constipated, with violent pain, anorexia, indigestion, and tormina. But it is peculiar to colic affections to have all these symptoms more intense, whereas in nephritic they are less so; and in colics the pain is rather in the right loin, and ascends to the stomach, liver, and spleen; and the passage of the fæces is completely obstructed, so that not even flatus can pass; or, when with difficulty the fæces are evacuated, they are flatulent, and resemble the dung of oxen, or sometimes a vitreous phlegm is discharged, and the urine is voided freely, and is of a pituitous nature: whereas, in nephritic cases, there is a severe fixed pain in the kidneys, as if transfixed with a sharp-pointed instrument, and the corresponding testicle is pained, and there is torpor in the thigh of the same side. They also have sometimes, though rarely, spontaneous evacuations of the belly; but clysters always bring away flatus and bilious fæces; the urine is in small quantity and sandy, and the urinary passage is contracted. These are the symptoms of stones in the kidneys, which occur most frequently in adults, but the stones in the bladder form rather in boys. The symptoms of these are, unconcocted and whitish urine, with a sandy sediment; the patients rub constantly and handle the member, stretch it, and make incessant attempts to pass water, and are troubled with strangury. Wherefore the material cause of the formation of stones is a thick and terrene humour, but the efficient is a fiery heat of the kidneys or bladder. But with regard to the kidneys, we must use lithontriptics of a cutting nature, without being decidedly heating: such are the roots of the royal asparagus and of the bramble, burnt glass, the root of couch-grass, maiden-hair, bdellium, the rind of the root of the bay, the seeds of marshmallows, the black chick-pea, the stones of sponges, vinegar of squills, and valerian, spignel, asarabacca, carpesia, saxifrage, water-parsnip, when eaten or drank, the golden-thistle (_scolymus_), hedge-mustard, and prionitis. Let them use baths constantly; and after the bath take some of the afore-mentioned things; and have recourse to embrocations, cataplasms, fomentations, hip-baths of a soothing nature; in short, applying the remedies for colics. The following are compound draughts: Boil the roots of wild rue, wild mallows, and parsley, with wine; mix the expressed juice with water, and give to the amount of two cyathi. And this is a powder: Of the fruit of balsam, of the stone in sponges, of dried pennyroyal, of the seeds of wild mallows, equal parts. Give a spoonful with two cupfuls of diluted wine. Also, dried goat’s blood, dried cicadæ without the wings and feet, the Jew’s stone, in oxymel. Let these things be given in the warm bath, and the compound medicines prepared from them, the nephritic sour wine (_posca_), and the wines prepared for this intention. And the troglodytes (_wren?_) is a much-commended remedy. It is of all the sparrow tribe the least, except that called the regulus; for it is a little larger than this one alone, and resembles it in colour, which is intermediate between that of ashes and green. It has a slender bill, and lives mostly in walls and hedges. When, therefore, this bird is pickled whole, and frequently eaten in a raw state, it makes the stones which are already formed be passed with the urine, and prevents them from being formed again; and if it be burnt alive entire with its wings, and if the ashes by itself and along with pepper and a moderate quantity of Indian leaf, be drunk out of mulse, it will do the same thing. To relieve the acuteness of the pains and the want of sleep, the medicine called Sotira and that of Philo, are excellent remedies; and frequent venesection, if had recourse to, alleviates the pain, and produces a speedy discharge of the stone. The preservatives from the formation of stones are, first, wholesome and moderate food, exercise, abstinence from the frequent use of all kinds of pulse and food of grain, cheese, milk, and condiments prepared from dark-coloured wine, much flesh, and simply all things which contain thick juices; also from those things which are very hot and acrid, I mean hydrogarum, prepared wines, and the like. And the following things not only prevent stones from forming, but also break down or produce the discharge of those which are already formed. Let them drink oxymel with some of the simpler diuretics, the decoction of maiden-hair, parsley, and couch-grass; and, after the bath, let them drink tepid water before taking food or drinking wine; and in the midst of dinner, let them drink cold water if nothing prevent it. If they feel a collection of vitiated humours, let them evacuate by bleeding or purging. But the most effectual of all remedies is to drink water of a middling temperature after the bath, and before taking food or wine. The stones which form in the bladders of young persons you may destroy by the more powerful remedies, making choice from among the above mentioned. But when the stone gets too large, or becomes impacted at the neck of the bladder, we must have recourse to concussion, catheterism, or even lithotomy, as will be described in the Surgical part of the work.

_On inflammation._ If there be inflammation of the kidneys or bladder, it is to be recognized by the heat in the place, attended with heaviness and pain, fever, delirium, vomiting of pure bile, and inability to make water, more especially if the bladder is inflamed. Wherefore we must have recourse immediately to venesection, and use soothing fomentations and cataplasms from rue, dill, fenugreek, and the root of marshmallows; also emollient clysters and injections consisting of oil, poppies, and the grease of geese; and when the bladder is affected, we may push up the anus half an obolus of opium with myrrh, saffron, and oil. They may take a sweet draught of honied water, but must abstain from the strong diuretics and much drink, unless an acrid and bilious humour prevail, when they must take copious draughts, and plenty of the non-stimulant diuretics. Let them take in water a spoonful of a mixture consisting of two parts of linseed, and one of starch; and likewise let them take the seeds of cucumber and pompion. If there is a sensation of great heat about the kidneys, apply to these parts rags out of wine and rose-oil, water and rose-oil, or oil of apples; or a cerate composed of wax, rose-oil, oil of chamomile; or oil of apples, and the yelks of eggs, with a little vinegar, or the juice of knot-grass. Afterwards they may use the diachylon plaster with oil of chamomile; but must abstain from very hot applications, lest they occasion suppuration; and from very cold, for thereby the kidneys will readily become scirrhous. During the violence of the inflammation they must abstain from baths, and use the regimen called the febrile and anti-inflammatory.

_On abscess and ulceration of the urinary organs._ Pains in the loins, anomalous rigours, and irregular fevers indicate an aposteme in the kidneys; but when it is in the bladder, it is marked by pain in that part in addition to the symptoms we have now mentioned. You may ascertain which kidney is affected from this, that when the person lies upon the sound side he has pain in the opposite one, from the diseased kidney being suspended. In these cases we must place the patients in hip-baths of oil and water, apply cataplasms of fine flour, oil, and rosin, or the flour of tares with honey, or cardamom, or pigeon’s dung with dried figs. Pus freely discharged in the urine indicates a rupture of the abscess and ulceration in the part. But since the urinary organs are ulcerated without an aposteme, from the rupture of a vessel, erosion by acrid matter, or the irritation of a stone, we may distinguish ulceration in the kidneys from that in the bladder or urethra in this way: When the kidneys are ulcerated, the patient experiences a heavy pain in the loins, he makes water freely, and pus is found mixed with the urine, and particles of flesh floating in it. When the bladder is in a state of ulceration, the patient has violent pain in the region of the pubes and hypogastrium, and difficulty of making water; the pus, after the urine is voided, sinks to the bottom, and fetid scales, or else foliaceous ones float in it. Furfuraceous sediments indicate scabies of the bladder. When the ureters are ulcerated, the mixture of the pus is in an intermediate degree, and rather resembles hairs floating in the urine; and the situation of the pain is intermediate between the kidneys and bladder. If blood or pus be discharged without any evacuation of urine, it is to be understood that none of the afore-mentioned parts are ulcerated, but the member itself. Wherefore to those who have ulceration of the urinary organs we must give the sweet draughts of honied water, or of the decoction of fenugreek with honey, or from the seeds of cucumber with must. To those who void pus in their urine we are to give Armenian bole, or the ashes of burnt reeds, as much as can be taken up with three fingers, in must; and drinking milk is an excellent remedy for them. The following are compound remedies: Of linseed, of the seed of cucumber, of tragacanth, of each, dr. ij; form trochisks.—_Another_: Twenty pine-nuts; forty seeds of the garden cucumber; of starch, dr. j; add to two heminæ of the decoction of nard and parsley seed. But Archigenes, in his epistle to Atticus, says that “when the dysuria is urgent, we should take of the powdered seed of toasted poppy, dr. j, which is to be sprinkled upon the decoction of bog-rush, sweet-rush, or liquorice. This medicine removes the pains from ulceration: Of the seeds of purified cucumber, xxx in number; pine-nuts, xij in number; bitter almonds, whitened, xxxv in number; of saffron, what is sufficient to give it colour; give to the patient with an empty stomach every day, along with the wine _protropum_, or milk. It will be milder, if, instead of the pine-nuts, it receive an equal quantity of the seeds of mallows. The cyphi and the cyphoid antidotes are also said to cure ulcerations in the bladder. I, in the more protracted cases, by using this medicine, have not stood in need of more complex remedies: Of wall-germander, of ground pine, of each, dr. xxiv; of asarabacca, of white pepper, of each, dr. vij; of cinnamon, dr. j. Of this medicine, finely powdered, I give two spoonfuls in Cretan sweet wine; but if there is fever, in three cyathi of water; but when the ulceration is attended with pain, by adding two cyathi of starch, and fifteen seeds of cucumber, I accomplish my purpose.” These things are from the works of Archigenes. And the remedies formed from alkekengi, the antidote from the seed of wild mallows, and that from sweet-meats are excellent. We may apply to the perinæum and lower belly cerates made from washed hyssop and butter, and the grease of geese, and storax; and we may inject into the bladder, by means of a small syringe, honied water much diluted, or milk with some honey, or with cucumber seed, or the white of an egg with pompholyx, or some of the remedies formerly mentioned. When the ulcer is spreading, the trochisk from paper must be injected, or the Bithynian; and cataplasms are to be applied, made from dates, dried grapes, with galls, acacia, hypocistis, and alum.

_On hemorrhage of the kidneys._ The kidneys often getting into a relaxed state, cannot retain the urine, but, becoming dilated, they allow the blood and other thick matters to escape from the veins. The kidneys often discharge blood periodically like hemorrhoids; and when evacuated they are relieved, in which cases we must not rashly interfere, if the bleeding immediately stops; but, if it continue, we must bleed in the arm, and use for hemorrhage of the kidneys and bladder those remedies which are recommended for hemoptysis and other hemorrhages; and, more especially, we must give the root of comfrey and tragacanth macerated in wine, the juice of knotgrass and plantain with oxycrate, or bitter almonds with must; or this medicine: Of fissile alum, dr. j; of tragacanth, dr. ij; of gum, oboli, v; with must. And we must apply a cataplasm of raw barley-meal with oxycrate or rose-oil, or that from dates, and bread of siligo with acacia, or hypocistis boiled in an astringent wine or oxycrate. In hemorrhages from the bladder, we must apply cupping instruments to the loins and ischium; and we must ascertain the part from which the blood flows by the pain in the place, and whether the blood be mixed with the urine or no, as was said with regard to pus. If there be coagulated blood in the bladder (which you may know from the flow of urine being suddenly stopped after a discharge of bloody urine, and from certain clots or bloody fluids being probably passed), give the decoction of mugwort to drink, and the seed of shrubby-everlasting, of fleabane, or of radish, or the juice of laserwort, or the Cyrenaic juice, or the juice of parsley, each mixed with vinegar, or the rennet of a hare, or of a hind, or of a kid, in oxymel, or strained lye with oil, and externally sponges out of hot salt water, or strained lye, must be applied. But, if they are not dissolved, we must make an incision in the perineum, as in the cases of calculus; and having removed the clots of blood, accomplish the cure in a proper manner.

_On hardness of the kidneys._ When hardness occurs in the kidneys, it does not occasion pains, but they seem, as it were, to hang from the loins, and the haunches are torpid, and the limbs lose their strength, little urine is passed, and the whole habit resembles that of dropsical persons. Wherefore they are to be softened by cerates, emollient ointments, friction and fomentations; and we must administer diuretics, and clear out the bowels by clysters.

_On diabetes._ Diabetes is a rapid passage of the drink out of the body, liquids being voided by urine as they were drank; and hence it is attended with immoderate thirst; and therefore the affection has been called dipsacus, being occasioned by a weakness of the retentive faculty of the kidneys, while the attractive is increased in strength, and deprives the whole body of its moisture by its immoderate heat. Wherefore with this intention we will give more food, and that of difficult digestion and not humid, such as alica with rose-wine, or rhodomel, or hydromel, or some wine that is not old, or some of the hot wines. We must give of pot-herbs, succory, endive, and lettuces; of fishes, those that abide among rocks; the feet and womb of swine; pears, apples, and pomegranates; and give cold water to drink. They must get to drink propomata, from the juice of knotgrass, and elicampane, in dark-coloured wine, and from the decoction of dates and myrtles. We must apply a cataplasm to the hypochondrium and kidneys of polenta, in vinegar and rose-oil; and of the leaves of the vine and navelwort, pellitory of the wall, and purslain. We must promote sweats, and excite vomiting by drinking cold water; and make them abstain from all sorts of diuretics. There will be nothing improper in letting blood at the commencement.

_On strangury and dysuria._ When neither inflammation, nor a stone, nor any of the afore-mentioned complaints are present, if there is acrimony in the urine, and if the whole habit or the other symptoms indicate bile, the dysuria or strangury is formed by it, and we are to use medicines for altering and diluting it; the juice of ptisan, fishes, baths, and a corresponding diet; avoiding acrid things, wine, baths, anger, and long abstinence from food. If the thinness and whiteness of the urine, and the other symptoms indicate a cold intemperament, hot wine and prepared wines will be proper; also diuretic food and medicines, and hot hip-baths. When, in conjunction with the whiteness, the urine appears thicker than natural, we are to suspect a pituitous humour obstructing the neck of the bladder, and must use oxymel, and the compositions from hyssop and pennyroyal, or marjoram, or thyme, or laserwort, boiled in honied water, and the hotter embrocations. But, if a thick humour, a stone, a thrombus, or some such obstruction stop up the passage of the urine, we must apply the catheter to them, unless inflammation of the part be present. Dysuria in fevers is to be cured by an embrocation with oil of rue, of dill, or old oil. When the bowels are constipated, a decoction of fenugreek or mallows is to be injected, and the patient made to sit in oil and water, or in some of the afore-mentioned decoctions, with oil. And this cerate will be proper for them: The roots of wild mallows are to be boiled in Sicyonian oil, with a little water, until they are dried, and they are to be thrown away; and with the oil is to be mixed of the juice of rue a fourth part, and of wax and castor a sufficient quantity.

_On paralysis of the bladder._ This complaint, which is sometimes accompanied with dysuria, and sometimes with an involuntary discharge of water, has been formerly treated of under the head of Paralysis.

_On incontinence of urine._ Relaxation of the muscle at the neck of the bladder occasions this affection, and therefore it happens most frequently to children. Our general treatment ought to consist especially of tonics, such as hot wine and oil, and the like, abstaining from all things which are powerfully refrigerant, and rather as much as possible using calefacients; for cold produces a resemblance to paralysis. The following things are naturally efficacious: Burn the crop of a cock, and give to the patient to drink in tepid water, when fasting, or the flowers of the white ox-eye (_chrysanthemum_) in like manner; or, shave down the testicle of a hare into fragrant wine, and give to drink; or, give calamint and myrrh in a draught before supper; or, give the toasted seed of the wild rue to drink every third day. Let the privy member be anointed with Cimolian earth, mixed with the juice of perdicias (_pellitory of the wall?_)

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COMMENTARY. On these diseases consult Hippocrates (Aphor. iv, 76; de Morb. Intern. 15, et alibi); Galen (de Med. sec. loc. x; de Affect. Renum; de Loc. Affect.; Isagoge); Celsus (iv, 10); Aretæus (Morb. Acut. ii, 9; Morb. Acut. Curat. ii, 8); Ruffus Ephesius (de Vesicæ Renumque Affectibus); Alexander (viii, 4); Aëtius (xi); Oribasius (de Loc. Affect. Curat. iv, 101); Actuarius (Meth. Med. iv, 8); Pseudo-Dioscor. (Euporist. ii, 112); Nonnus (173); Cælius Aurelianus (Morb. Chron. v, 4); Scribonius Largus (38); Marcellus (de Med. 24); Avicenna (iii, 19, 1); Avenzoar (ii, 2); Serapion (iv); Haly Abbas (Theor. ix, 34; Pract. vii, 12); Alsaharavius (Pract. xx); Rhases (Div. 70, and Contin. xxiii.)

Hippocrates describes four affections of the kidneys, beginning with calculus. According to his theory, stones are formed from phlegm which has been converted into sand. See his theory fully explained (de Morbis, iv, 28, and de Aer. &c. 53.) He states distinctly that the formation of stones is the product of a preternatural heat in the bladder, with a thick and turbid state of the urine. (l. c.) He recommends fomentations with the juice of scammony, purging the whole body, tepid baths, and the like. He intimates, however, that when a stone is fairly formed, the only hopes of recovery are founded upon the operation. It appears that in his days lithotomy was a separate branch of the profession; for in his _Oath_ he inhibits his pupils from performing the operation, and binds them to leave it to those who make it their practice. Doubts, however, are entertained of the genuineness of this piece. He mentions that hairs are sometimes passed in the urine; and the same fact is attested by Galen (Loc. Affect. vi, 3), Cælius Aurelianus, Aëtius, Avicenna, and Alsaharavius, among the ancients, and by recent writers on pathology. Actuarius calls them substances resembling hairs, of a handbreadth or thereabout in length. (De Urinis, i, 16.) He held them to be connected with disease of the kidneys. (Ibid. iv, 20.)

Galen says that all lithontriptics are of a cutting and detergent nature, the most of them being bitters. He makes mention of pepper, galbanum, ammoniac, aphronitrum, asarabacca, spignel, St. John’s wort, &c. He does not hesitate, however, to declare it as his opinion that the only certain remedy for calculus is lithotomy. (Art. Med. 94.)

Aretæus gives an interesting account of the affections of the kidneys and bladder. His remedies are similar to those of our author. For stones in the bladder he recommends, among other things, some quicklime with honied water, and diuretics. When a stone obstructs the passage, he directs us to push it back, or cut the neck of the bladder. He states that navigation and living at sea are beneficial in all affections of the kidneys. We may mention that this accords well with the late statistics of calculous diseases.

Alexander, like our author, ascribes the formation of stones to viscid and thick humours which have been much heated or roasted. He says, in the language of the Peripatetic philosophy, that the material cause of calculus is a thick matter, but the efficient a fiery heat, in like manner as by heat and a suitable matter of such a nature tiles are formed which are insoluble in water. This theory is explained with great logical parade in the ‘Isagoge’ generally ascribed to Galen, but which Albertus Fabricius supposes to be a work of Demetrius Pepagomenos. Alexander’s remedies are mostly the same as our author’s. He speaks with surprising confidence of the efficacy of goats’ blood; and, by the way, there is no lithontriptic which, both in ancient and in modern times, has been so generally cried up as it. His general treatment, which consists of bleeding, baths, emollient and paregoric medicines, is very proper. He remarks that certain lithontriptics, if given unseasonably, increase the disposition to calculus. Like our author, he forbids thick food, and attributes the best effects to drinking water.

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.