at any season except winter, to persons in the vigour of life and in the
decline; to persons of dry and muscular habits, and who are of a dark
or ruddy complexion; to men rather than to women; to those whose food
is apt to spoil on their stomachs, and whose bellies are constipated;
to such as abound in bitter bile, are irascible, pass little urine, and
use hot and dry food: in icteric, hepatic, and pleuritic affections; in
phrenitis, cynanche, mania, cephalæa, ophthalmy, erysipelas, leprosy,
fevers, and to such as are troubled with collections of bile. Aloes
is given to such as are troubled with heaviness of the head, with
ophthalmy, with thirst, with disturbed dreams without fever; to such as
have a sensation of departing rigor; to those who pass acrid flatus,
and have gnawing pains of the intestines; to those who are seized with
burning heat about the stomach, or nausea producing eversion of it;
and to those who being troubled with a collection of excrementitious
matters cannot bear evacuations by clysters. For it evacuates the whole
body, and does not occasion disorder of it unless given in very great
quantity, and brings along with it any bile lying in the intestines,
stomach, and gullet.—Hellebore agrees both with those in acute diseases
and those in chronic requiring a cholagogue medicine, such as maniacs,
those troubled with hemicrania, and such as have defluxions of the eyes
and complaints in the chest. But it suits most with such viscera as the
uterus and bladder when they require a cholagogue remedy. It is also
proper for chronic affections of the trachea, for jaundice, exanthemata,
lichen, herpes, erysipelas, and leprosy. Black hellebore evacuates bile,
especially yellow, from the whole body and without trouble. Hence it
is given to those not affected with heavy fever, and more especially
to such as are free from fever, in the quantity of one drachm of the
roots triturated in honeyed water or plain water, while fasting, or
with honey made into pills. Some mix with it pennyroyal, savoury, or
some of the volatile stomachics.—Scammony purges like hellebore, and
more especially yellow bile, but of all purgative medicines it is the
most prejudicial to the stomach. It is, therefore, to be given to those
who are free from fever, and such as have strong stomachs, to the
amount of four oboli, with salts, pepper, ginger, or some one of the
volatile stomachics, or along with honey. It is also formed into pills
with gum.—The medullary part of the fruit of the Colocynth evacuates
especially bile and mucous matters, not from the blood like hellebore
and scammony, but from the nerves and nervous parts, when given to the
amount of one drachm in two cyathi of honeyed water which has rue boiled
in it. But it is to be triturated for a long time, because otherwise
its rough particles sticking in the internal parts produce ulcerations
and nervous affections by sympathy. It is to be given to those who have
affections of the head, namely, when the meninx or the pericranium
is affected, such as those labouring under vertigo or hemicrania, or
those troubled with cephalæa; also in epilepsy, apoplexy, cynic spasms,
chronic defluxions on the eyes, orthopnœa, asthma, and chronic coughs;
likewise in arthritic cases to those who have affections about the
kidneys or bladder.—Elaterium evacuates like scammony. Such as is green
like leeks, light, and not older than a year, is to be chosen; and it is
to be given to the amount of three oboli, triturated with one hemina of
milk.—Tithymallus, _spurge_, evacuates bile like elaterium and scammony.
Four or five drops of the juice are given, mixed with polenta and quickly
swallowed. For if retained long in the mouth they ulcerate the tongue
and surrounding parts.—Lathyrides (a species of spurge) purge bile like
hellebore and scammony. They are to be given to the amount of seven,
eight, or as many as fifteen grains to such as are robust and require
much purging, who are to be directed to chew them. But those who are
weaker and have bad stomachs, must swallow them whole.—The dried tops
of the Peplium are to be given to the amount of eight oboli in honeyed
water. They evacuate bile like hellebore, and occasion the breaking of
wind.—Agaric has similar powers to the colocynth, but acts slowly and is
not prejudicial to the stomach. It is given to the amount of two drachms
with honeyed water. It should be very white, brittle, and not very woody
nor carious.—Illyrian Iris purges in like manner when given to the amount
of eight oboli in honeyed water. It ought not to be old nor carious.—The
small Centaury by purging bile and mucus is particularly adapted for
cases of ischiatic disease. The decoction is to be drunk of a drachm
and a half of centaury, boiled in a hemina of water until it be reduced
to the half.—The flower with the fruit of Tragoriganum is given to the
amount of two drachms, in honeyed water, to the same class of persons as
the black hellebore. It is more stomachic than the hellebore, but less
purgative.—Four drachms of Chamelæa (mezereon?) boiled in two heminæ of
honeyed water, until reduced to a fourth part, purge like hellebore. Some
administer chamelæa by making it into pills with a double quantity of
wormwood.—Aristolochia, _birthwort_, purges like colocynth, one drachm of
the species called clematis being given in honeyed water.—The dried root
of Polypody when pounded and sprinkled on honeyed water, or triturated
along with it, has the same effects as colocynth.
_Medicines which evacuate black bile._ Medicines which evacuate black
bile are to be given in an especial manner to melancholic persons,
to such as are easily moved to paroxysms, to passionate persons, to
misanthropists, to persons of solitary habits, or to such as during
convalescence require purging, during the heat of autumn, in dry habits,
and to such as are not muscular.—Epithymum, _dodder of thyme_, is the
best of those medicines which evacuate black bile. It is to be given to
the amount of five drachms triturated with a hemina of milk.
Epithymbrum, or the substance which grows upon savory, evacuates in like
manner with the epithymum, but is weaker. Pennyroyal, when taken to the
amount of an acetabulum, in honeyed water, evacuates black bile.—The
Heracleatic Tragoriganum in the same dose evacuates like pennyroyal. But
both must be dried. Alypum, the seeds of it have been said to purge black
bile when given in the same quantity as the epithymum with salts and
vinegar; but, as Dioscorides says, it occasions slight ulceration of the
intestines. It is, I think, that substance which is now called alypias.
It is to be given in honeyed water.—Parthenium (matricaria?), _feverfew_,
when dried and drunk in like manner, evacuates the same humours. Alypon,
_madwort_, drunk with salts, purges in like manner.
_Medicines which evacuate phlegm._ We are to administer phlegmagogues
in cold habits; to aged persons, in winter; in paralytic and apoplectic
cases; for loose œdematous swellings; to such persons as have great
collections of phlegm in the belly, chest, or stomach; and in cases of
the female flux. They agree also with those who have a copious running
from the nose and thick expectoration, with cases of anorexia and
ischiatic disease when the joint becomes mucous or pituitous; but they
are particularly adapted for those cases of dropsy which are called
anasarca.—One drachm of white Storax, drunk with an equal quantity of
turpentine rosin, evacuates phlegm.—The bark of the root of Olive to the
amount of one drachm, with wine or water; nine oboli of Pellitory, with
water; two drachms of the seed of Lychnis (_campion_); one drachm of the
root of Sow-bread, with hydromel; two drachms of Garlic, with honey;
ground Pine, triturated and given in the form of pills; half a drachm of
the flakes of copper, with an equal quantity of rosin, in pills, purges
bile strongly.—A drachm and half of the green leaves of Bay; two oboli of
the bark of the root of the wild Cucumber; forty seeds of that species of
ricinus called Crotones stripped of their bark and eaten, do the same.
A half of that part of Parsley connected with the root (which some call
chamæraphanus), when eaten; two drachms of Bdellium, with hydromel; but
Gum is particularly adapted for defluxions on the eyes.
_Medicines which evacuate water._ We are to give hydragogues in that
variety of dropsical disease called ascites; to women troubled with
the whites; and to those who have ulcers accompanied with a copious
discharge.—One drachm of the flakes of Copper, when drunk with honeyed
water evacuates water; but a little vinegar must also be swallowed lest
it be vomited.—The Granum Cnidium when stripped of its bark, triturated,
and drunk with boiled honey, that it may not touch the orifice of the
stomach, evacuates water. Twenty, twenty-five, or thirty grains are to
be given, and to those who are stronger, as many as forty.—One drachm
of Euphorbium, drunk with boiled honey, evacuates phlegm, but more
especially water.—Eight oboli of the seed of rough Spleenwort, with
honeyed water, evacuate water.—Cneorum, in like manner, purges water when
drunk with polenta.—Five drachms of the seed of Cnicus, when triturated
together in ptisan, are swallowed with a small quantity of salts.—One
drachm of Ammoniac perfume, drunk in honeyed water, evacuates water. Some
give it in affections of the spleen with oxycrate.—The juice of the bark
of the root of the Elder-tree, when drunk to the amount of two ounces
with wine, evacuates water.
* * * * *
COMMENTARY. The philosopher Aristotle thus explains his ideas respecting
the action of purgatives: “When purgatives are conveyed to the stomach,
and are there dissolved, they are carried by the same passages as the
food, and when they cannot be digested, but their prevailing power
remains unsubdued, they return, and carry with them whatever opposes
them, and this is called purging.” (Problem. 43.) See also Alexander
Aphrodisiensis (Probl. ii, 58.)
Hippocrates administered purgative medicines freely and boldly,
but at the same time he cautions against the unseasonable and rash
administration of them in several parts of his works. We do not find
any theory, however, of the _modus operandi_ of purgatives, nor any
general remarks on the cases in which they are applicable, in any of the
Hippocratic treatises which are now acknowledged to be genuine. Some
ingenious remarks, however, may be found on this subject in the work ‘De
Nat. humana.’
Celsus has a chapter on purgative medicines which contains much curious
and valuable matter. He says the more ancient physicians gave various
purgative medicines very freely, such as black hellebore, polypody,
squama æris, the milky juice of lactuca marina (_euphorbia paralias?_),
the milk of asses, with a little salt; but he holds that purgatives hurt
the stomach, and are not to be given when any fever is present. The
rules, which he lays down for the administration of them, are highly
judicious, and deserving of consideration. He approves of them when the
head feels heavy, when the eyes are misty, when there is obstruction of
the bowels, and when there is pain there or in the hip-joint, when the
stomach is oppressed with bile or phlegm, and when there is dyspnœa, when
venesection is indicated, but the powers of the system will not admit of
it, and in several other cases. (v, 12.) He mentions that Asclepiades
totally rejected the use of purgative medicines. (i, 3.)
Galen has devoted a complete treatise to the discussion of the question
regarding the _modus operandi_ of purgatives. He decidedly inclines to
the theory that every purgative by some specific property attracts, and
as it were, sucks to it the humour to which it has a natural alliance,
in like manner as the magnet attracts iron. He divides Purgatives into
Cholagogues, Melanogogues, Hydragogues, and Phlegmagogues. He rejects
the hypothesis of Erasistratus, who maintained that each medicine
converts the juices presented to it, into its own specific nature:
thus that cholagogues convert them into yellow bile, melanogogues
into black bile, and so forth. Although Galen flatters himself that
he effectually demolishes this hypothesis, we have long looked upon
it as a very plausible one, and believe that at the present time the
prevailing opinion in the profession inclines much in that direction.
For example, the green and dark discharges which are brought off by
mercurial purgatives, are now generally supposed to be occasioned by the
fluids in the secretions entering into combination with the medicine
administered. It is to be regretted that no ancient author has given us
a clear exposition of the hypothesis of Erasistratus. Galen gives a long
list of cases, in which purgatives prove beneficial, such as erysipelas,
epilepsy, apoplexy, gout, rheumatism, melancholy, and many chronic
complaints. He insists strongly on the benefit derived from cholagogues
for the cure of jaundice. (De purg. Med. vi.)
Antyllus, in an extract preserved by Aëtius, espouses the theory which
maintains the specific operation of purgatives, and that they act by
attracting the humours to which they are allied. He recommends them
for various complaints, as malignant cutaneous diseases, spontaneous
ulceration, and rheumatic affections. (iii, 23.)
The account of this subject, given by Oribasius, is taken from the works
of Galen and Ruffus. It is too lengthy for our limits. Ruffus directs the
surgeon to consider well the patient’s constitution, and regulate the
dose of the medicine accordingly, as there is a great difference in the
susceptibility of persons to be acted upon by purgatives. The following
is a list of the purgatives described by Ruffus in this fragment:
Polypody, iris, colocynth, phacoides (a species of spurge olive?),
peplos, peplium, aloe, hippophaes, hippophæstum, clematis, pycnocomon,
vines, thyme, epithyme, marjoram, Greek savory, poppies, cucumber, the
smaller heliotrope, the lesser sesamoides, the tithymalli or spurges,
the chamelæa, lathyris, agaric, and euphorbium. His description of the
operation of each medicine bespeaks a good acquaintance with the subject.
(Med. Collect. vii, 26.) See also Actuarius (Meth. Med. iii, 7.)
Haly Abbas makes some acute remarks on the action of Cathartics. Every
purgative, he says, attracts the humour, to which it is allied. Different
opinions, he adds, have been entertained regarding the _modus operandi_
in this case. Some maintain that, when such a medicine is swallowed, it
goes to the members where its cognate humour is lodged, from which both
are expelled by the expulsive faculty of the part, and return to the
bowels together. This theory, however, he rejects. He mentions further
that others maintain that the medicine attracts its peculiar fluid, as
a magnet does iron; and of this theory he adopts a modification. He
states it as his opinion that, when such a medicine has been swallowed,
it attracts its cognate fluid from the surrounding parts, to which all
the similar fluids in the body are afterwards determined, being conveyed
thither by the veins. He gives a full account of all the purgatives known
in his time. (Pract. iii, 53, 54.) Much the same theory is advocated, and
fully explained by Serapion. (De Antidot. vii, 10.)
Avicenna and Rhases object to the doctrine of Galen that he appears to
have maintained that there is a peculiar alliance between a purgative
medicine of a certain class and the fluid or humour which it attracts,
whereas they argue that, as there is no alliance between the magnet and
the iron which it attracts, so is it in like manner with purgatives and
the peculiar fluids which they evacuate. This, however, is only a more
precise exposition of the theory advanced by Galen. Rhases (Cont. xii,
1); Avicenna (i, 4, 4.) The ancient theory is very acutely stated by
Averrhoes (Collig. v, 21.) See also Mesue (Canones universales.) There
appears to be some originality in the theory of Mesue. He says that a
purgative medicine operates by occasioning a preternatural increase
of the vital, or, as it is now called, animal heat of the part to
which it is applied, whereby its attractive powers are increased. He
maintains very ingeniously that purgation is an act of Nature, that
is to say, an operation of the _vis medicatrix naturæ_, and that the
medicine is merely the instrument of Nature in this case, for, he adds
(as Hippocrates says), it is Nature, and not the physician, that cures
diseases. A purgative medicine, then, he argues, acts by rousing the
expulsive power of Nature. He joins the preceding authorities, however,
in illustrating the attractive power of purgatives, by comparing it
to the property which the magnet has of attracting iron, and amber
of attracting straws. Purgative medicines, he says, have the faculty
of clearing away the humours from the different parts of the body;
from the stomach and intestines they do so readily; from the meseraic
veins less easily; still more difficultly from the liver, and with
the greatest possible difficulty from the joints, especially when the
humours are impacted there. He forbids purgatives to be given in the
extremes, either of hot or cold; in this practice observing the rule
of Hippocrates. In hot weather, he says, emetics, and not purgatives,
are indicated. The directions which he gives for correcting the noxious
qualities of purgative medicines are highly important, but they are too
lengthy for our limits. Aromatics added to purgatives, he says, dispel
flatus; bitters do the same, and strengthen the stomach; saltish things
increase their purgative powers; unctuous, by lubricating the intestines,
accelerate their operation, and render it easier; and sweet substances
render them less nauseous, and diminish their acrimony.
On the ancient arrangement of purgative medicines Dr. Paris makes the
following pertinent remark: “It is impossible to concede to the opinion
of Dr. Hamilton, that the different species of purgative medicines do
not possess distinct powers over the different species of matter to be
evacuated; on the contrary, there is reason for reviving the ancient
theory, too inconsiderately abandoned, and which acknowledged these
different distinctions in the operations of cathartic medicines under
the appropriate names of hydragogues, cholagogues, &c.” (Pharmacop.)
Dr. Alston likewise writes thus: “We have a very learned essay in
confirmation of the ancient doctrine of the specific operation of
purgatives by Dr. G. Martyn (Lond. 1740, in 8vo.) I shall not enter into
the controversy, but only observe that there is nothing impossible, yea,
nor improbable in the theory.” (Lectures.) See a learned dissertation on
the action of purgatives in Mangeti ‘Bibliotheca Anatomica,’ i, 159. We
may mention further that Dr. Murray in his Materia Medica inclines to the
Galenic theory of the specific operation of purgatives. (c. viii.)
_On Cholagogues._ Most of these medicines are sufficiently well known,
and therefore do not require to be treated of at greater length. See also
Aëtius (iii) and Oribasius (M. Col. vii.)
The Arabian author Mesue gives the following table of Cholagogues:
_Clementer._ _Valenter._
{ Aloe { Agaricus.
{ Absinthium } Trahendo et { Asarum.
{ Rosa } astringendo, { Aristolochia.
{ Rhabarbarum } flavæ: nam aliæ { Bryonia.
{ Myrobalani } aliud vacuant. { Cyclaminus.
{ Pruna. { Cucumer agrestis.
Cholagoga { Tamar Indi } Astringendo. Radices { Dracunculus et arum.
{ Cassia } { Elleborus.
{ Manna. { Esula.
{ Viola nigra } Lubricando. { Hermodactylus.
{ Psyllium } { Iris.
{ Adiantum etiam phl. { Scilla.
{ Turbith.
It will be perceived that this list contains several articles with which
the Greeks were unacquainted, namely, myrobalani, tamarindi, manna, and
turbith. Of all these substances we have already given some account in
the Appendix to the Third Section. Mesue calls the _tamarinds_, the fruit
of an Indian palm-tree, the word _tamur_ signifying a _date_. He says,
that they are excellent medicines for repressing the acrimony of the
humours, purging bile, cooling the heat of the blood; that they prove
useful in hot fevers, jaundice, inflammation of the stomach and liver,
and that they stop vomiting. He calls them refrigerants and desiccants
of the second order. To prevent them from hurting the stomach by their
coldness, he recommends to give them with spikenard, mace, mastich,
wormwood, fennel, or any such calefacients. Avicenna states their
medicinal characters in the same terms. Serapion says, that they are
desiccants and refrigerants in the third degree. Averrhoes ranks them
among the refrigerants of the third, and desiccants of the second order.
We have already mentioned, that the earlier commentators are decidedly
of opinion, that the tripolium of the Greeks was _turbith_, but this is
now generally acknowledged to have been a mistake. Mesue calls it the
root of a milky herb, having leaves like a ferula, but smaller. Probably,
however, as his commentator Manardus remarks, there is some mistake in
the comparison of it to the ferula, as there is no resemblance between
them. An accurate modern author, Moses Charras, calls it the bark of
a milky root, which is chosen by its weight, dark-coloured without,
white within, and clear from its pith, which is hard and fibrous. Mesue
represents it to be a hot, nauseous purgative. It is given in powder, he
says, to the amount of from one to two drachms.
Serapion recommends Cholagogues particularly in jaundice, inflammatory
affections of the brain, mania, epilepsy, erysipelas, herpes, and
tertian fever. He describes the following medicines as cholagogues:
aloes, southernwood, black hellebore, scammony, colocynth, agaric,
claterium, two species of mezereon, lathyris, the root of the lily,
centaury, polypody, birthwort, myrobalaus (the yellow, the black, and
the chebulic), pomegranate, cassia fistula, violet, ivy, and two Arabian
substances _anabac_ and _alterariabin_. We are unable to determine what
the last two were.
A modern writer, Christianus Margravius, in his ‘Materia Medica
Contracta,’ thus enumerates the cholagogues of his time.
Cholagoga,
Cassia, manna, tamarindi, succusque rosarum,
Scammonium, myrobalani, rhabarbarum, aloe.
Professor Alpinus gives an accurate account of the ancient cholagogues.
(Meth. Med. iii, 9.) The following medicines are said to be used as
purgatives by the Hindoos; we give the scientific names as given by
Dr. Wise: 1. Convolvulus turpethum. 2. Panicum frumentaceum. 3. Croton
polyandrum. 4. Anthericum tuberosum. 5. Abrus precatorius. 6. Cessampelos
hexandra. 7. Asclepias geminata. 8. Clotoria ternata. 9. A kind of
convolvulus. 10. _Shabraba._ 11. Cassia fistula. 12. Plumbago zeylanica.
13. Acheranthes aspera. 14. Poa cynosurides. 15. Saccharum spontaneum.
16. _Jelaka?_. 17. A variety of the convolvulus turpethum. 18. _Ramaka._
19. Bignonia suaveolens. 20. Terminalia chebula. 21. Indigofera
tinctoria. 22. Ricinus communis. 23. Costus speciosus. 24. Euphorbia. 25.
_Suptachetta._ 26. Calotropis gigantea. 27. Halicacabum cardiospermum. Of
these the turbet, myrobalans, and castor oil, are particularly commended.
(On Hindoo Medicine.)
_On Melanogogues._ The other Greek authorities treat of nearly the same
number of Melanogogues. They are treated of methodically by Galen,
Oribasius, and Aëtius. The _Alypias_ is supposed by Bernard (Nota in
Nonni Epit.), and Prosper Alpinus, to have been the turbith; but, as is
now maintained, erroneously. See Sprengel’s Notes on Dioscorides (iv,
177) and the preceding _Appendix_.
The following is Mesue’s list of Melanogogues:
_Clementer._ _Valenter._
{ Stæchas. { Balanus Myrepsica.
{ Aqua lactis. { Centaurium.
{ Fumaria. Fructus et { Colocynthis.
{ Epithymus. Flores { Coccum Gnidium.
Melanogoga { Thymus leviter, magis phleg. { Genista.
{ Polypodium. { Ricinus.
{ Jus gallorum phleg. cum phleg. { Senna.
{ melanogogum cum melanogog.
{ Armenus lapis.
{ Cyanus lapis.
Terrea { Nitrum.
{ Salis genera.