Mesue, it is true, quotes Galen as an authority on it, but this is most
probably a mistake, as no mention of it is now to be traced in any part
of his works. Averrhoes, accordingly, ranks it among the newly-discovered
medicines. He says, that it is both phlegmagogue and cholagogue. Serapion
and Rhases give nearly the same account of it. They state the minimum
dose of the powdered leaves at one drachm, and of the decoction at five
drachms. Mesue directs us to prepare a vinous tincture by infusing
the leaves in musk. He recommends us to correct its nauseousness and
unpleasant effects by the addition of ginger, and other cordials. He says
that it cleanses the liver and spleen. Actuarius briefly notices it. He
says it evacuates bile and phlegm. (Meth. Med. v, 8.) See Appendix. The
Arabian authors represent the lapis lazuli to be the same as the lapis
armenus of the Greeks. We have stated what we believe to be the truth of
the matter in the preceding commentary. Margravius, in his enumeration of
melanogogues, makes a distinction between them:
Melanogoga—
Sunt ludiæ balani, lazuli lapis, armenusque,
Senna, polypodium quernum, helleborusque, epithymum.
Averrhoes states that the lapis lazuli is the most potent medicine of
this class. (Collig. v, 43.)
_On Phlegmagogues._ Mesue’s list is as follows:
_Clementer._ _Valenter._
{ Cnicus. { Euphorbium.
Phlegmagoga { Lupulus. Lachryma { Opoponax.
{ Hyssopus. { Scammonium.
{ Eupatorium etiam cholag. { Sagapenum.
{ Sarcocolla.
Serapion directs us to administer these medicines to persons of a cold
habit, in cold seasons of the year, to those affected with anasarca and
apoplexy, in sciatica and hemorrhages. His list is little different from
our author’s. Margravius enumerates the phlegmagogues as follows:
Phlegmagoga—
Carthamus, agaricus, turpeth, mechoaca, jalappa,
Emblica, belliricæ, chebulæ, colocynthis, amara,
Hermodactylus, euphorbium, opoponax, sagapenum.
_On Hydragogues._ The hydragogue properties of the elder-tree are
commended by Boerhaave and Sydenham. See the section on Dropsy in the
Third Book.
There is some difficulty in determining what the cneoros was. We are
inclined to think that it was the _cassia fistula_, the medicinal
characters of which, as stated by Mesue among the Arabian, and Prosper
Alpinus among the modern, authorities, correspond with the account of
cneoros given by our author.
Gum ammoniac is an ingredient of the purgative salt, a receipt for
which is given by Apicius. It also enters into the sales purgatorii of
Myrepsus. (ii, 9 and 10.) See the commentary on the next Section.
Prosper Alpinus says of the coccum gnidium, or fruit of the thymelæa,
that in doses of fifteen grains it is a strong purgative, and evacuates
principally serous humours in dropsy. He reckons the squama æris among
the drastic purgatives.
Serapion’s account of the hydragogues is nearly the same as our author’s.
The following is Margravius’s list of them:
Esula, gratiola, atque ireos succus, mechoaca,
Post ebuli semen, et succus, cortexcque elaterium,
Soldanella virens, et gummi gutta, jalappa.
SECT. V.—ON COMPOUND PURGATIVES.
_Pills from aloes._ Of the medullary part of colocynth, p. j; of the
juice of wormwood, p. j; of aloes, p. j; of scammony, p. ij; make with
water pills of the size of a chick-pea. The dose xj grains.
_The oxymel of Julian._ Of rue, oz. iij; of marjoram, oz. iij; of the
hair (capillary-leaves?) of thyme, oz. iv; of dill, oz. iss; of iris, oz.
j; of the root of mandrake, oz. iss; of agaric, oz. ij; of fatty dead
pines, oz. xij; of the granum Cnidium, oz. iv; of lathyrides, oz. iij; of
alypias, oz. iij; of polypody, oz. ij; of the cassia-leaf (malabathrum),
oz. j; of costus, oz. j; of spikenard, oz. j; of rha Ponticum, oz. iss;
of squills, oz. iij; of the tops of the elder-tree, oz. iij; of canopus,
which is the bark of elder, oz. iij; of asarabacca, oz. j; of pennyroyal,
oz. iij; of dodder of thyme, oz. ij; of hellebore, oz. ij; of sweetflag,
oz. ij; of water-parsnip, oz. j; of amomum, oz. j; of St. John’s wort,
oz. j; of cumin, oz. j; of anise, oz. ij; of vinegar, ten sextarii; of
honey, five sextarii: macerate the herbs in the vinegar for three days;
then, having boiled it until more than one half be consumed, add the
honey, and having strained, add the lathyrides, the costus, the granum
Cnidium, and the spikenard triturated, and, if you please, after it is
fully boiled, the oxymel. The full dose is oz. j; or according to the
patient’s strength. It is useful in gouty affections and epilepsies; and
when we require at the same time to evacuate or dislodge thick humours.
_The purgative hydragogue from cloves._ Of aloes, of dodder of thyme, of
cloves, of granum Cnidium, of stone-parsley, of rha Ponticum, of each,
oz. ss; of euphorbium, scr. iv; of honey, q. s. The dose is one spoonful.
_The purgative medicine from rhodomel, of Alexander._ Of the juice
of roses, two sextarii; of honey, one sextarius; of scammony, oz.
iv. A full dose is five spoonfuls, a small, two, a medium dose three
spoonfuls.—_Otherwise_: of honey, lb. j; of the juice of roses, lb. j; of
pepper, dr. ij; of scammony, dr. viij; of mastich, dr. iv; and of ginger,
dr. ij.—_Otherwise_, one which I use: of spikenard, of asarabacca, of
dodder of thyme, of each, oz. ss; macerate in a hemina of water for three
days; and having boiled it to a moderate degree, mix with the water of
the juice of roses, half a sextarius; of honey, half a sextarius; and
having boiled it until it acquire consistence, add scammony to the amount
of oz. iss.
_A purgative medicine from quinces._ Of roasted quinces, oz. iv; of
pepper, oz. ss; of scammony, dr. j; of honey, oz. v. Having triturated
it, give one spoonful, according to the strength.
_The stomachic purgative from citrons._ Boil of the bark of a citron,
and of the flesh of the same, lb. j, in a sextarius and a half of water,
until a third be left; add half a sextarius of honey, and having boiled
until it acquire the consistence of honey, sprinkle of the powder of long
pepper, oz. j; of scammony roasted in leaven, oz. j.
_The purgative called Buccellatus._ Of baked scammony, oz. j; of pepper
and of parsley-seed, of each, scr. j; of fennel, of anise, of each, oz.
j; of honey, lb. j; having roasted it moderately, give in hippocras to
the amount of one ounce.
_Purgative olives._ Of scammony, oz. j; of pepper, oz. j; of dodder of
thyme, of toasted cumin, of stone-parsley, of rue, of the green leaves of
mint, of each, dr. iv; of laserwort, dr. j; of dates, oz. v; of honey,
oz. v; of vinegar, two heminæ; of pickled olives (namely of schistous),
one sextar. Some add a moderate quantity of fish-sauce. The dose is v,
vij, or ix.
_A purgative trochisk._ Of scammony, dr. iv; of euphorbium, dr. iv; of
the cassia-leaf (malabathrum), dr. ij; of pepper, dr. ij; of honey, lb.
j. The dose is oz. j.
_A purgative and stomachic posca._ Of cumin, of fennel, of each, oz. j;
of pennyroyal, of parsley, of anise, of each, oz. ss; of dodder of thyme,
of scammony, of each, oz. j; of salts, oz. ij. The full dose is two
scruples in the oxycrate. Some add also of euphorbium, scr. iv.
_A purgative wine for dropsical cases._ Of squills, oz. iij; of
parsley-seed, oz. vi; of pepper, dr. j; of the root of capers, dr. iv; of
the granum Cnidium stripped of its bark, dr. j; of the leaf malabathrum,
two balls; of wine, twelve heminæ; of honey, oz. iij. Having pounded the
squills, macerate in wine, and mix the other things when triturated.
_Purgative salts._ Of common salts toasted, dr. vj; of parsley-seed, of
ginger, of dried bread, of each, scr. vj; of anise, of pepper, of each,
oz. ss; of scammony, of dodder of thyme, of each, oz. j. The dose is one
spoonful.
_The podagric purgative from hermodactylus._ Of hermodactylus, oz. iij;
of anise, of Ethiopian cumin, of bishop’s weed, of the clusters of thyme,
of white pepper, of ginger, of each, scr. iij; of dodder of thyme, oz.
ss; the dose is scr. iv; some give scr. vj. It is administered in the
morning with hippocras, honeyed water, or strong wine heated.
_The same purgative otherwise._ Of hermodactylus, oz. j; of Ethiopian
cumin, of anise, of agaric, of ginger, of each, scr. vj; of mastich, scr.
ij; of spikenard, scr. ij; of musk, one siliqua; of cnicus, scr. ij. The
dose is scr. iv with hydromel. We reject scammony, because it is bad for
the stomach. But if more evacuation be required, mix with the dose three
siliquæ of scammony; give after the bath.
_Pills from the lapis Armenicus, given principally in arthritic cases._
Of aloes, oz. iv; of scammony, oz. vj; of agaric, oz. j; of dodder
of thyme, oz. j; of lapis armenicus, scr. xij; of cassia, oz. j; of
spikenard, oz. j; of baked squills, oz. ij; of saffron, scr. xij; add to
rhodomel. The dose is scr. ij.
_The purgative from coronopodium, applicable in the same cases as that
from hermodactylus, a stomachic._ Of ginger, scr. ij; of pepper, scr. j;
of agaric, scr. j; of the internal part of cnicus, scr. iv; of the root
of buckthorn plantain (coronopodium), scr. vj; the dose is scr. iij, but
to those persons whose belly is difficult to move, twenty-three siliquæ,
which make altogether seven oboli, or nearly eight. After evacuation,
having bathed, let them take eggs and bread for food.
_That from Cyrenaic juice, for quartans._ Of Cyrenaic juice, of pepper,
of ginger, of the leaves of rue, of each, dr. j. The dose is the size of
a filbert.
_A purgative pap, useful in cases of œdema and aggravated elephantiasis,
and when one wishes to dislodge a thick and viscid humour._ Having cut
up two colocynths, evacuate the seed, and allowing the medullary part
to remain, fill them with sweet oil, and covering them up with their
proper covers allow them to remain a night and a day. On the following
day, having evacuated the oil, boil the colocynths in water until they
are reduced to a soft consistence; then throw them away, and the oil
being mixed with water, add to it three oboli of black hellebore, and
of scammony, dr. j; but boiling along with them a pap of similago, or
dried bread pounded, and then give of it to the patient, who has been
formerly restricted to a simple diet, to the size of eight, ten, or at
most fourteen filberts; and let him drink hot water.
* * * * *
COMMENTARY. It may be proper in this place to apprize the reader of
the reason why he will not find the remainder of the work so copiously
illustrated by notes as the preceding parts of it. The combination of
simple medicines in pharmaceutical preparations is so arbitrary, and so
little regulated by any fixed principle, that it is seldom we can find
any two authors exactly agreeing as to the ingredients which enter into
any one preparation. Now to follow all the ancient writers on pharmacy
through all their complex formulæ, and point out every little difference
which prevails among them, would be a very wearisome task, and one which
would scarcely recompense us or our readers for the time and attention
which such an undertaking would necessarily demand; and neither is it
much required, since, as will be seen, our author’s system of pharmacy is
sufficiently copious and accurate for all practical purposes. We shall
therefore be content with giving a general explanation of each class of
these medicinal preparations, and only offer some occasional remarks on a
few of the more important articles.
Under this head we shall give some account of the _Halatia Cathartica_,
or _Purgative Salts_ of the ancients. The ἅλες κοινὰι πεφρυγμέναι are the
same as the sal commune frictum of Apicius. Humelbergius thus explains
it: “_fricti_, id est cremati et torrefacti.” The following is Apicius’s
receipt for the “Sales conditi ad multa:” Of common salt roasted, lb. j;
of sal ammoniac roasted, lb. ij; of white pepper, oz. iij; of ginger,
oz. ij; of bishop’s weed, oz. iss; of thyme, oz. iss; of parsley-seed,
oz. iss. The purgative salts of Aëtius contain sal ammoniac mixed up
with many purgative and cordial medicines, such as scammony, laserwort,
parsley-seed, ginger, pennyroyal, spikenard, and pepper. (iii, 109.)
These are the ingredients of a sal purgatorius recommended by Actuarius.
(Meth. Med. v, 10.) Myrepsus gives prescriptions for various purgative
and stomachic salts. They all consist of sal ammoniac, or common salt
mixed with scammony and aromatics in different proportions. (Sect. ii.)
See also Haly Abbas. (Pract. x, 10.)
SECT. VI.—ON THE MANAGEMENT OF THOSE WHO TAKE PURGATIVE MEDICINES; AND
WHAT IS TO BE DONE TO THOSE WHO ARE NOT PURGED BY A PROPER DOSE OF
PURGATIVES.
In general when any of the drastic purgatives is to be taken, the
medicine is to be given to the patient with an empty stomach, and after
digestion has been performed; and he is to be prevented from sleeping
until it has been wholly purged off, and if possible he should make
moderate motion, and abstain during the time from all food and drink,
until the purging is over.
_From the works of Philagrius._ But if he cannot endure abstinence from
food, either because the mouth of the stomach is troubled with bile
from long fasting, which has preceded, or any such cause, we must give
him bread out of diluted wine, or the juice of ptisan, or of chondrus,
not after the evacuation has begun, lest it spoil in the stomach, but
straightway after the medicine has been taken; for in this way by its
weight it contributes to the speedy evacuation of the medicine. But
if, after taking any of the laxative medicines, one does not purge nor
evacuate, provided the case be not at all serious, we need not be very
solicitous about it; but if the greatness of the disease be urgent, or
the patient experiences acute tearing pains with distension of the belly,
we must necessarily administer a clyster. But if even thus the belly is
not evacuated, and there is a pungent pain and disorder of the body,
he is to be bathed and rubbed freely with oil; or if he feels full and
heavy, a vein must be opened, more especially if he is of a sanguineous
habit of body, and if his eyes be red and prominent, not naturally but
incidentally, owing to his having drunk the medicine. When none of these
symptoms trouble him, but he experiences a gnawing and lancinating pain,
he may take food immediately after the bath, and drink wine freely, and
in the meantime he is to receive a clyster, if he does not settle; and
again he is to be bathed. The oil used in the clyster, should be that of
rue or prepared from some other of the carminative medicines.
* * * * *
COMMENTARY. Hippocrates, as Galen mentions, recommends a draught of
ptisan to be swallowed immediately after taking a purgative medicine,
in order to facilitate the operation of the medicine and wash away any
particles of it which may lodge in the intestines. Both forbid it to
be given after the operation has commenced, as it tends only to blunt
the powers of the medicine. Galen remarks, that sometimes a purgative
does not operate, either from idiosyncrasy of the patient, or from
the smallness of the dose, or from the intestines being blocked up by
indurated fæces, which must be removed by means of a clyster before the
medicine can operate. At other times, he adds, the medicine is determined
to the kidneys, or is digested and converted into food. As all purgatives
are bad for the stomach, he recommends us to weaken the impression of
them by the mixture of aromatic seeds, which possess attenuating and
cutting powers—_Quosnam oportet purgare_, &c.
Oribasius treats fully of this subject in two extracts from the works of
Galen and Ruffus. Ruffus directs us, when the bowels are difficult to
move, to give beforehand a soup of shell-fish, with mallows, beet, and
the like, or to administer a clyster. He forbids us to give purgatives to
persons who are apt to vomit. (Med. Collect. vii, 26.)
Mesue has treated more fully of all the circumstances connected with
the administration of purgatives than any other ancient author. When
the operation of the medicine is retarded by flatus, or the bad state
of the humours, he recommends us either to administer a clyster or give
an emetic. When this arises from debility of the expulsive faculty of
the intestines, he directs us to give, first, a moderate draught of
cold water, and then some astringent potion, such as one from quinces,
or pears. When the passage is obstructed, he directs a clyster to be
administered; and in this case he forbids cold water to be given, as it
will increase the contraction of the intestine. When violent pains are
excited in the stomach by the medicine, he recommends an emetic, and if
in the bowels, a clyster. (Canon. Univers. iii.) See also Avicenna (i,
iv, 8), and Rhases (Contin. xii.)
SECT. VII.—ON THE TREATMENT OF HYPERCATHARSIS.
In cases of hypercatharsis the body is to be rubbed and bathed in hot
water, and before the bath a thin, pale-coloured and yellow wine is to be
given (for such is the most speedily distributed), and bread soaked in
it, and pomegranates. But if the evacuation continue, the limbs are to
be bound with ligatures, extending from above downwards, and tightened
so as to intercept the blood and spirits. A moderate quantity of the
theriac from the flesh of vipers is also to be given. For it soon passes
to the skin, and quickly gives a counter-determination to the defluxion
of fluids upon the belly, and blunts the poisonous and deleterious
property as it were of the cathartics. When in want of it we may use the
theriac trochisks, and also that from seeds, and the antidote called
Philonius. Cupping-instruments are also to be applied over the stomach,
and cataplasms from polenta, and wine and honey; after which we must
use the astringent epithemes. But they will derive the most sensible
advantage from frictions of the whole body, and draughts of the aforesaid
medicines. They must abstain from very cold and very hot air; for the
one occasions a determination from without inwards, and increases the
discharge, and the other dissipates and reduces the strength. But if
the evacuation is increased by irritation in the bowels, we must apply
cataplasms of the afore-mentioned things, and injections of emollients,
such as the fat of geese, sweet wine, nard, and the like.
* * * * *
COMMENTARY. Oribasius remarks, that when an overdose of a purgative
medicine has been taken, it purges first yellow bile, then black bile,
and at last blood. He recommends us, in cases of hypercatharsis, to give
a hot draught, to apply tight ligatures and violent friction to the
extremities, and cupping-instruments to the hypochondrium and back. When
the patient can readily be made to vomit, he directs us to produce this
operation by the administration of a copious draught of tepid water,
and by putting a feather or the fingers down the throat. This is in
accordance with Celsus’s rule of practice: “Longas dejectiones supprimit
vomitus.” (ii, 8.)
Hippocrates and Aëtius, in cases of excessive purging from the
administration of medicine, recommend the bath and a light-coloured wine
before and after it.
Avicenna lays down the rules of treatment with great precision, but
they are mostly the same as our author’s. After friction, cupping,
tight ligatures, and restorative draughts have been tried, should the
excessive purging continue he recommends us to administer narcotics. (i,
4, 7.) See, in like manner, Rhases (Contin. xiii, 1, 2), and Serapion
(de Antid.) But Mesue is the author who has treated of all the symptoms
connected with hypercatharsis at the greatest length. He recommends us
to reserve narcotics as an _ultimum remedium_, as from the unseasonable
administration of them much harm might result. He directs us to add
cordials and aromatics to the narcotics. When the tenesmus is severe he
directs us to stop it by suitable enemata and suppositories. For the
debility and lassitude occasioned by too great purgation he recommends
a tepid bath of sweet water, and friction with warm oils. (Canones
Universales.)
SECT. VIII.—ON THE ANTIDOTES CALLED HIERÆ.
_The hiera of Antiochus._ Of germander, of agaric, of the medullary part
of colocynth, of cassidony, of each dr. x; of opoponax, of sagapen, of
stone-parsley, of the species of birthwort called clematis, of white
pepper, of each dr. v; of cinnamon, of spikenard, of troglodytic myrrh,
of the leaves of saffron, of each dr. iv; of honey, q. s.—_Another
hiera._ Of the medullary part of colocynth, dr. xx; of baked squills,
of agaric, of ammoniac perfume, of the bark of black hellebore, of
scammony, of St. John’s wort, of each dr. iij; of dodder of thyme, of
dried polypody, of bdellium, of aloes, of germander, of horehound, of
cassia, of each dr. viij; of troglodytic myrrh, of opoponax, of sagapen,
of stone-parsley, of the common long, and white pepper, of cinnamon, of
saffron, of castor, of the long birthwort, of each dr. iv; of honey, q. s.
_The hiera of Justus._ Of dodder of thyme, dr. xij; of horehound, of
cassidony, of germander, of black hellebore, of scammony, of agaric,
of long pepper, of baked squills, of each dr. xvj; of euphorbium, of
the medullary part of colocynth, of aloes, of saffron, of gentian, of
stone-parsley, of ammoniac perfume, of sagapen, of each dr. viij; of
opoponax, of poley, of cinnamon, of myrrh, of spikenard, of the flower of
the rush, of pennyroyal, of each dr. iv; of long and of round birthwort,
of each dr. ij; of honey, q. s. The dose is two, three, or four scr.,
with honeyed water and salts.
_The hiera of Galen._ Of germander, of long pepper, of white pepper,
of cassidony, of black hellebore, of scammony, of spikenard, of baked
squills (and some of dodder of thyme), of each dr. xvj; of myrrh, of
saffron, of ammoniac perfume, of euphorbium, of each dr. viij. Mix with
honey.
_The hiera of Ruffus._ Of sicyonia, or the medullary part of colocynth,
dr. viij; of germander, dr. x; of sagapen, dr. viij; of stone-parsley,
dr. v; of round birthwort, dr. v; of white pepper, dr. v; of cinnamon,
dr. iv; or of cassia, dr. viij; of base horehound, of saffron, of poley,
of myrrh, of each dr. iv; of honey, q. s.
_The hiera of Archigenes._ Of horehound, of agaric, of germander, of the
medullary part of colocynth, of cassidony, of each dr. x; of opoponax,
of sagapen, of stone-parsley, of round birthwort, of white pepper, of
each dr. v; of cinnamon, of spikenard, of myrrh, of the cassia leaf
(malabathrum), of saffron, of each dr. iv; pound the dry things together,
and strain. The opoponax, sagapen, and myrrh, being bruised, are to be
put into a mortar to macerate with honeyed water for one night; then
triturate and add the dry things; then mixing them with the finest honey
lay them up in a glass or leaden vessel. This is the common method with
all the hieræ. The full dose of them is dr. iv. Add to it also of salts,
dr. j; of honey, two cyathi; of water, q. s. If we wish to make those
compositions of this class which have not scammony more purgative, we
must add to each of them an obolus of it.
* * * * *
COMMENTARY. The hieræ, for the most part, consist of drastic purgatives,
combined with aromatics. There is a great variety of these compositions
described in the works of the ancient winters on pharmacy. Galen makes
mention of an aloetic hiera, which was much used by the celebrated
Archigenes. The following is his prescription for it: “R. Aloes, dr.
c; cinnamomi, nardi, xylobalsami, mastichæ chiæ, asari, croci, ā ā dr.
vj.” Galen remarks, however, that the proportion of aloes is too great,
and recommends us to substitute xc or lxxx dr. instead of the quantity
directed. (De comp. Med. acc. loc.) Mesue describes the composition of 6
hieræ, Haly Abbas of 5, and Serapion of a much greater number. But for
variety, Myrepsus surpasses all the other authorities. He describes the
composition of 30 hieræ. The following is his receipt for the _Hiera
Picra Galeni_: “℞. Aloes flavæ, dr. xivss.; cinnamomi, croci, costi,
floris junci odorati, xylobalsami, cassiæ fistulæ puræ, mastiches, asari,
rosarum, amomi, absinthii, ā ā dr. j; Tere subigendo cum mellis Attici
q. s.” Moses Charras’s receipt for it is very little different. (Royal
Pharm. i, 20.)
SECT. IX.—ON LINIMENTS TO BE APPLIED TO THE ANUS, AND PURGATIVE
APPLICATIONS TO THE NAVEL.
_A liniment to the anus for the discharge of flatulence._ Rue is
triturated with honey so as to form one juice, and the inner parts of the
fundament rubbed with it. It becomes more efficacious if a small quantity
of cumin and natron, or the juice of sowbread be added. It is daubed
upon flocks of wool and introduced; or a suppository is formed with the
addition of honey. For the flatus escapes freely, affording relief.
_A liniment to the anus, evacuating the belly; called Chezananche._ Alum
being triturated with honey is to be boiled until it become yellowish,
and the anus is to be rubbed with it. It forces a free evacuation of many
things, but not without trouble.