dr. iv; of natron, dr. iij; of black and white hellebore, of each,
dr. ij; of colocynth, dr. iij; of scammony, dr. ij; of the juice of
elaterium, dr. iv; of granum Cnidium, dr. iv; of fatty dried figs,
oz. ij; of the gall of bulls, oz. j. _Another_ very excellent one: of
elaterium, of lathyrides, of galbanum, of sowbread, of black hellebore,
of each, dr. iv; of the medullary parts of colocynth, dr. viij; of fresh
wild cucumber, of scammony, of granum Cnidium, of each, dr. ij; of
spurge, dr. ij; of turpentine, dr. iij; mix these with the gall of bulls,
and use as a liniment. Some, by mixing with them of wax, oz. vij, and of
Sicyonian oil, q. s., make it of the form of a plaster.
* * * * *
COMMENTARY. It is clear that the liniments applied to the anus were a
sort of suppositories. The _Chezananche_ is described in much the same
terms as our author’s by Myrepsus. The rest of his compositions of this
class are also very similar to our author’s. (xxvi, 2.) Actuarius gives a
full account of them. (Meth. Med. v, 9.)
Purgative applications to the navel were much trusted to by the ancient
physicians as laxatives, but they are now seldom used. The late Dr. Kerr,
of Aberdeen, however, sometimes had recourse to them, and spoke highly of
their efficacy.
SECT. X.—ON EMETICS, AND THE MODE OF ADMINISTERING HELLEBORE.
Persons in health have recourse to emetics when the system is loaded with
too much food or humours, and those in acute diseases, when troubled
with phlegm or the like. But neither persons in health nor those in
acute diseases should be permitted to use emetics, but only in chronic
affections, more especially in cases of indurations, and for such matters
as require to be dislodged by forcible means, as in gout, epilepsy from
the stomach, elephantiasis, dropsy, melancholy, and the like. They are
improper in spittings of blood, weakness of the stomach, and suffocative
complaints. The readiest of the emetics is the oil of privet (oleum
Cyprinum), the fingers or some feathers being dipped in it and pushed
down the throat. And dr. vij of Celtic nard taken in honeyed water
evacuate upwards powerfully. In like manner v or vj dr. of betony drunk
in honeyed water, and three green leaves of the daphnoides pounded and
eaten. And an obolus of elaterium taken in a draught of water, purges
phlegm and bile upwards; and fifteen grains of stavesacre with thick
honeyed water. Of plants with bulbous roots, those usually eaten if taken
raw, and the boiled roots of narcissus purge upwards. And the upper part
of the root of parsley, namely, that which is exposed to the air, when
eaten, purges upwards. Some call it chamæraphanum. The under part of the
root purges downwards. When the whole is eaten it purges both upwards
and downwards. Radishes purge less than the aforementioned, but more
usefully. They are to be taken when very acrid and fresh, and cut into
small parts; and having allowed them to soak in oxymel for two or three
hours, as many of the pieces as possible are to be swallowed, so that
one may vomit three or four times after supper, and once if fasting. But
after, large draughts of oxymel are to be swallowed; and after walking
about for two hours, and drinking tepid water, one may compel one’s self
to vomit by inserting the fingers or some feathers into the throat.
_Modes of administering hellebore._ Hellebore is to be given in
protracted and severe complaints, and when all hope from other remedies
is precluded, because the disease has proved stronger than them all. It
is to be given in continued diseases, as dropsy, elephantiasis, cachexia,
paralysis, and the like; and in certain complaints which attack at
intervals, as epilepsy and gout. There being many modes of administering
hellebore, the simplest, and rather the preparative for a course of
hellebore, is this method: having perforated radishes with a reed, pieces
of the dried roots of the finest white hellebore are to be inserted
into the perforations, and having been allowed to remain for one night
they are to be removed. Having cut the radishes in pieces they are to
be given with oxymel, in the manner described, to the patient who has
been accustomed before to emetics, and after an interval of the number
of hours mentioned, he is to be forced to vomit. The established mode
of administering hellebore is as follows: having allowed two ounces of
the best hellebore to macerate in a hemina of water for five days, boil
until only a third part of the water remain, and having expressed the
hellebore, mix with the water an equal quantity of honey, and boil it
until it thicken; and after the patient has been exercised with vomits in
the manner described, give it to him when fasting, and after digestion
has been performed, and the contents of the bowels evacuated, either
spontaneously or by one or two injections, according to his strength. But
the most efficacious mode is this: having cut the roots of the hellebore
into pieces resembling the seeds of Indian corn (for when reduced to a
downy powder it occasions suffocation by its powerful action), give to
those who are of a weaker constitution dr. ij, at most, or, at least,
dr. j of the hellebore, in the juice of ptisan, of halica, or the like;
but to those who are stronger, it is to be given in hot water or honeyed
water. The purging begins after three or four hours; but when it is
longer of commencing, it operates more effectually. When the vomiting
is slow of beginning, give honeyed water to drink, and let the patient
be compelled to vomit by inserting feathers dipped in oil into the
throat. If even thus he will not vomit, let him be put into the bath.
When vomiting commences, if it go on properly, we need not interfere;
but if lancinating pains or convulsions supervene, we must give a
mixture of water and oil to drink. For thus is an evacuation downwards
occasioned (which otherwise sometimes takes place when hellebore has been
administered), and they bear the concentration of the medicine better.
When the patient falls into deliquium animi he is to be resuscitated
by strong-smelling things and the like. Any other symptoms which may
happen to occur are to be treated in a suitable manner. When the purging
is excessive, they are to be allowed to take food and sleep, and do
otherwise as mentioned in describing the treatment of hypercatharsis.
But if it continue, cupping-instruments are to be applied over the
stomach, and ligatures tied round the limbs. When the evacuation proceeds
properly we must give to drink a moderate quantity of honeyed water, in
order to wash away the superfluous particles of the medicine. After a
little while, give some food of easy digestion. When apprehensions are
entertained of the administration of hellebore by the mouth, and the
medicine is by all means required, Antyllus uses the following injection:
having allowed two drachms of white hellebore to macerate in a sextarius
of water for a day and a night, on the day following we are to boil the
hellebore in the water until but a half remain. Then we are to inject it
by the anus so as to produce vomiting. It purges upwards somewhat more
feebly than when the medicine is drank. After sufficient purging, an
acrid suppository is to be introduced so as to occasion the discharge
of the injection and stop the vomiting. After the discharge of it, an
injection of honeyed water is to be given once or twice in order to
wash out the gut. The same person says: A suppository is made of white
hellebore, pounded and strained, and mixed with boiled honey, which
purges like the injection of hellebore. But the following is a better
method; for we have it in our power to regulate the purging: The quantity
is to be dr. ij of hellebore, and the suppository is to be wrapped round,
or bound with some flocks of wool firmly. The head of this ball of wool
is to be allowed to hang out of the anus, in order that after sufficient
purging it may be in our power to remove the suppository. This method
purges effectually, and neither occasions convulsive suffocation nor any
other dangerous symptom.
* * * * *
COMMENTARY. The gentle emetics used by the ancients on ordinary occasions
have been treated of in Book I. We have now to give some account of the
more drastic emetics.
Galen and Oribasius recommend, as effectual emetics, the bulb of the
narcissus, the seed of the anagyrus, and the fleshy part of nut ben. The
Unguentum irinum and the U. cyprinum are stated by Aëtius and most of the
other authorities to be safe and effectual emetics. Aëtius also commends
the decoctions of hyssop and of thyme, the seed of bastard saffron
pounded with oily grain, the oils of sesame, radishes, and narcissus,
and the leaves of the daphnoides. Nitre or an impure carbonate of soda
was also a medicine in general use as an emetic. The Lemnian earth was
often given as an emetic, being a sort of red ochre. Avicenna and Rhases
make mention of a species of black turbith, called _gilbenec_, which they
describe as an effectual emetic, but somewhat unsafe. See the Appendix.
Avicenna says that tickling the throat with a feather, smeared in the oil
of sesame, readily excites vomiting. He remarks that vomiting is promoted
by motion and stopped by rest. The bulbus emeticus was in general use
to produce vomiting. Serapion directs us to give it boiled along with
honey. He also commends the nux vomica as an emetic when given along with
a small quantity of salt. We need scarcely say that it is now seldom or
never given for this purpose, although it still holds a place in some of
the continental systems of Materia Medica. The earlier modern writers on
medicine recommend it freely as an emetic. See Guido de Cauliaco. (vii,
1.)
But of all the medicines of this class the _white hellebore_ was
undoubtedly the most powerful, and in important cases was the most
generally used. We must, therefore, take this opportunity of describing
the forms in which it was administered. Hippocrates appears to have been
familiarly acquainted with it as a medicine, and to have administered
it very freely. Aretæus concludes his work with a spirited eulogium on
hellebore; “But in all inveterate chronic diseases, when other remedies
have failed to produce the effect, this alone is to be depended upon
for the cure. For, in power, white hellebore resembles fire, and with
still greater powers hellebore, by pervading the inward parts, produces
freedom of respiration from obstruction, a healthy colour from paleness,
and plumpness of body, in place of emaciation.” But on the modes of
administering hellebore, the fullest and most accurate of the ancient
authorities is Oribasius, whose interesting account of it we shall now
attempt to give in an abridged form. His description is mostly taken
from Archigenes, Herodotus, and Antyllus. He sets out, then, with giving
directions about preparing the patient for entering upon a course of
hellebore. This consists principally in putting him upon a regulated
diet, and administering occasionally some of the gentler emetics,
especially the one from radishes. He, then, describes at considerable
length the marks by which good hellebore may be recognised. When broken,
he says, it ought to be white in the inside; and when taken into the
mouth it ought to be felt hot and acrid, but at first of a sweetish
taste; thereafter gradually becoming more stimulant, and provoking a
great flow of saliva, and that frequently attended with vomiting. He
recommends the following preparation of hellebore as being efficacious
and perfectly safe: A pound of hellebore is to be macerated for three
days in six heminæ of water, which we are to boil at a gentle fire until
a third part of the water is consumed, when the hellebore is to be
expressed; then two heminæ of honey are to be added to the decoction,
which is to be again boiled until it no longer stain the finger. Of this
preparation, the dose, to those who do not require strong purging, is
two cochlearia, but to robust persons, the quantity called a mystrum.
Another of his authorities, Antyllus, directs us to allow five drachms
of the shavings of hellebore to macerate for three days in half a
hemina of rain-water, after which it is to be strained and heated in a
double vessel. Oribasius also mentions that the medicine may be given
in a coarse powder. He afterwards lays down the rules of treatment when
the action of the medicine superinduces dangerous symptoms. We need
not go over this part minutely. Suffice it to say that, according to
circumstances, he directs us to provoke vomiting by tickling the throat
with feathers dipped in one of the emetic oils; to open the bowels with
oily clysters; and to rouse the patient when in a state of stupor, by
stimulants, restoratives, shaking him, pinching him, or tossing him
in a garment. He recommends hellebore in cases of mania, melancholy,
inveterate pains of the hip and other joints, epilepsy, catalepsy,
vertigo, chronic headache, lethargy, leprosy, and other cutaneous
diseases. He also praises it as a remedy in hydrophobia. (Med. Collect.
viii.)
Aëtius states that hellebore is given in infusion, in decoction, and
in substance, either cut into pieces or pounded and sifted. When
administered in pieces it soon begins to act as a purgative, generally
within two hours, bringing away bile and phlegm without much trouble,
and after four or five hours the medicine itself is generally vomited
up, and the purging stops. When given in a fine powder it acts violently
but slowly, so that four or five hours have generally elapsed before its
operation commences. He adds that in all its forms it evacuates bile and
phlegm, but that it is attended with danger of bringing on convulsions
or hypercatharsis. On the infusion he remarks, that it suits with old
persons and children, to those who have a feeble constitution, and for
the cure of elephantiasis. Five drachms of cut hellebore are to be
allowed to macerate for three days in half a hemina of rain-water, after
which it is to be strained and heated, when the whole of the infusion
is to be taken. The decoction he recommends to be given to persons of a
firmer habit of body, and in cases of mania and melancholy. It is to be
thus prepared: A pound of hellebore, cut into pieces, is to be allowed
to macerate for three days in two sext. of rain-water; after which it
is to be boiled gently upon the coals until only a third remain; then,
having strained it, we add to the decoction two pounds of scummed honey,
and boil to the consistence of honey. It may be given as a linctus to the
amount of a large spoonful, or mixed with hot water in a draught, when it
will not superinduce spasms, contractions, or hypercatharsis. To those
who stand in need of more violent concussion, who are of a strong habit
of body and possess fortitude, and vomit readily, it is given cut into
pieces; and to persons of still greater determination, or who have been
accustomed to it, in the form of a sifted powder. It is to be cut into
pieces of the size of malt or bran, and taken in ptisan or barley-water,
a draught of mead or plain water being swallowed after to wash it away.
The maximum close of it is dr. iiss. Hellebore may also be pounded and
sifted in a fine sieve, when the larger particles may be given in halica
(barley-water?) or pottage; but the smaller particles may be formed into
pills with boiled honey. (iii, 131.) Macer Floridus concludes that scr.
ij. is a sufficient dose of the white hellebore. (De Herb. vir.)
The Arabians give this medicine in the same forms and under the same
circumstances as the Greeks. They estimate the dose of it at from dr. j
to dr. ij. Mesue forbids it to be given in the form of a powder. He and
Haly Abbas, however, recommend it in pills with hiera, colocynth, agaric,
and various aromatics for the cure of elephantiasis and melancholy.
Serapion states that there is great danger of its inducing convulsions if
improperly administered. Avicenna’s account of the modes of giving it is
very interesting.
Upon this subject we shall give the observations of the celebrated
Prosper Alpinus: “Elleborus albus inter medicamenta vomitoria perpetuo
apud omnes gentes præcipuum locum obtinet, fuitque in usu elleborismus,
id est, purgatio per elleborum album, admodum familiaris apud antiquos,
ad morbos sanatu difficillimos tollendos, cujus quidem usu complures ab
affectibus ferè prorsus insanabilibus sanabantur, atque ita cito, et
probè, ut eæ sanationes miracula viderentur; unde olim antiquorum illorum
medicorum laus insigniter augebatur. Nunc vero non sine ægrotantium
damno, atque magno artis medicæ dedecore, ipsius usus apud omnes
ferè medicos obsolevit, qui nunc neque audent, neque sciunt, quomodo
veratrum album exhibendum est.” (Med. Meth. iii, 10.) He gives the
following prescription for making a preparation of hellebore: “Nonnulli
ex recentioribus parant elleborum accipientes, ʒiss; vini dulcis
aromatici, lb. j; turis, ʒiss; hyperici, ʒj; sacchari, ʒij; bulliant ad
consumptionem mediatatis. Cujus decocti dant uncias tres.” He likewise
approves of giving hellebore by boiling it in oil. (Ibid.)
The following is a very simple receipt for the preparation of the
mel helleboratum or honey of hellebore: “Take of the roots of white
hellebore, dried and sliced, one pound; of clarified honey, three pounds;
of water four pints. After steeping the roots three days in the water,
boil them a little while, then boil the liquor, well pressed out and
strained, with the honey to a due consistence.” Dr. Pemberton (London
Dispensatory, A. D. 1746.) By due consistence is meant the consistence of
honey.
SECT. XI.—ON THE DIFFERENT KINDS OF ANTIDOTES.
The Preface of Galen’s work on Antidotes. Those compositions which
cure affections not when they are applied externally, but when taken
internally, are named antidotes by the ancients. There are three
different kinds of them. The first are those which are administered for
deleterious substances; the second, for those animals called venomous;
and the third are the remedies for affections occasioned by bad articles
of food. Some antidotes profess to fulfil all these three purposes, such
as the one called theriac.
_The preparation of the hedychroum, which forms an ingredient of the
theriac._ Of the bark of the root of aspalathus, of calamus aromaticus,
of costus, of asarabacca, of xylobalsam, of valerian, of amaracus, of
mastich, of each, dr. vj; of carpobalsam, dr. ij; of marum, dr. xvj; of
the flower of the rush, dr. ij; of cinnamon, dr. xxiv; of amomum, of
cassia, of rheum, of each, dr. viij; of Indian nard, of the cassia leaf
(malabathrum), dr. xij; of myrrh, dr. xxiv; of saffron, dr. xij; mix
with fine wine, and form into trochisks, having smeared the finger with
opobalsam.
_The preparation of trochisks of squills._ Having covered over the
squills with clay or dough, roast it moderately, and taking of the
inner parts of it, p. ij; and of the flour of tares, p. j; and having
triturated in like manner, form trochisks.
_The preparation of the theriac trochisks._ Having chosen four or five
vipers of a tawny colour, and recently taken, cut off their heads, and
four fingers’ breadth of the part next the tail, and having removed the
skins and entrails, boil the rest in a new pot, with dill and a moderate
quantity of salts, until the spines be separated from the flesh. Then
removing and cleaning away properly the flesh from the spines, and having
mixed with them an equal quantity of clean bread, and triturated them
in like manner, form into small balls, having your fingers smeared with
opobalsam, and cool in the shade.
_The preparation of the theriac antidote._ Of the trochisks of squills,
dr. lxviij; of the theriac trochisks, dr. xxiv; of hedychroum, dr.
xxiv; of cinnamon, dr. xxiv; of common pepper, dr. xxiv; of the juice
of poppies, dr. xxiv; of dried roses, dr. xv; of water-germander, of
rape-seed, of Illyrian iris, of agaric, of liquorice, of opobalsam,
of each, dr. xij; of myrrh, of saffron, of ginger, of rhaponticum, of
the root of cinquefoil, of calamint, of horehound, of stone-parsley,
of cassidony, of costus, of white and long pepper, of dittany, of the
flower of sweet rush, of male frankincense, of turpentine, of mastich,
of black cassia, of spikenard, of each, dr. vj; of the flower of poley,
of storax, of parsley-seed, of seseli, of shepherd’s pouch, of bishop’s
weed, of germander, of ground pine, of the juice of hypocistis, of Indian
leaf (malabathrum), of Celtic nard, of spignel, of gentian, of anise,
of fennel-seed, of Lemnian earth, of roasted chalcitis, of amomum,
of sweet-flag, of balsamum, of Pontic valerian, of St. John’s wort,
of acacia, of gum, of cardamom, of each, dr. iv; of carrot-seed, of
galbanum, of sagapen, of bitumen, of opoponax, of castor, of centaury,
of the species of birthwort called clematis, of each, dr. ij; of Attic
honey, lb. x; of Falernian wine, oz. ij. Put into a mortar the opium,
hypocistis, myrrh, sagapen, liquorice, storax, acacia, and opoponax, and
having poured in some honey pound and dissolve: then pouring in wine
so as to cover them, macerate for three days; then having pounded the
others, unite them, and scum the honey. It is to be laid up in vessels
of silver or glass, not quite full, and the covers taken off every day.
In case of need it may be used for persons bitten by venomous animals,
and those who have taken anything poisonous, after seven years, a
quantity of it, to the size of a filbert, being drunk twice a day, in
three cyathi of wine. In like manner, to those who are in a dangerous
state from some obscure cause, when the disorder in the body imitates the
quality of a mortal poison, as is the case particularly in pestilential
diseases, it is to be given once a day. But in all other affections, it
is to be used from the tenth to the twentieth year. For coughs, pains
of the chest or side, it is to be given at night, if free from fever,
with wine and honey; but if feverish, with hydromel, to the extent of an
Egyptian bean. In all cases of hæmoptysis, it is to be given morning and
evening, to the size of an Egyptian bean; if recent, in oxycrate; or, if
chronic, in the decoction of comfrey. In cases of flatulence, tormina, or
cæliac affections, it is to be taken in the morning, to the size of an
Egyptian bean, in hot water. It excites an intense appetite, and removes
rigors, coldness, and vomiting of bile when drunk before the attack. It
promotes menstruation, and expels the fœtus when dead, if drunk to the
size of an Egyptian nut with honeyed water, or sweet wine, in which rue
or dittany has been boiled. In the case of loss of voice, it is drunk
alone, and with double the quantity of tragacanth in wine and honey, or
sweet wine, being retained under the tongue and allowed to melt. For
diseases of the spleen or liver, it is given with oxycrate; but if they
are in a scirrhous state, with a cyathus and a half of oxymel, or vinegar
of squills. For nephritic complaints, it is given with oxymel to the
size of an Egyptian bean. In dysenteric cases it is given to the same
amount, with the decoction of sumach, morning and evening. For dimness
of vision it answers excellently thus: Mix oz. ij of the antidote, and
of opobalsam, with one cyathus of honey, and after a little anoint with
it. It is also used as a dentifrice. Many, for the sake of prophylaxis,
take it at new moon to the size of a Grecian bean, after digestion, with
a cochleare of honey and two cyathi of water. In like manner they use it
when upon a journey they suspect that the air or water is bad.