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.
* * * * *
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?_)
* * * * *
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.
One of the oldest writers on diseases of the kidneys is Ruffus, who
lived, according to Suidas, in the days of Trajan; so that he was prior
to Galen, and perhaps to Aretæus and Cælius Aurelianus. As we have
seldom occasion to meet with him in our researches, we shall give a
fuller abstract of his opinions on this subject than we would otherwise
have done. The symptoms of inflammation of the kidneys, as detailed by
him, are pains below the loins, so that the patient cannot stand erect
nor walk, but is obliged to lie upon his back, which position affords
him most relief; the pains extending to the bladder and testicles; the
extremities cold, more especially the legs and feet; frequent and painful
desire to make urine, which is at first thin and watery, but afterwards
becomes redder. These symptoms are followed by emaciation of the thighs
and hips, debility of the limbs, and sometimes suppuration. His treatment
is as follows: The patient is to be laid on a soft couch, and must
abstain from food for one day, but long abstinence is forbidden. If the
bowels require to be opened, this is to be done by means of emollient
clysters, such as injections of hot water, decoctions of mallows,
of linseed, or of fenugreek, to which may be added some oil. Large
injections, however, are forbidden, lest they press upon the kidneys and
occasion irritation. When the bowels are evacuated, and yet the pain
does not remit, the parts may be wrapped in wool which is smeared with
hot oil having rue, marshmallows, dill, or mugwort boiled in it. When
the pain is acute, a vein at the elbow is to be opened; after which
emollient cataplasms and plasters are to be applied to the back when the
kidneys are affected, and to the fore parts when the bladder. When these
remedies fail to remove the pain, the loins and groins are to be cupped,
and then sponges squeezed out of hot water are to be applied, and the
patient put into a hip-bath of hot water in which poppies, chamomile,
and the like have been boiled. Then, when the patient is laid in bed,
let him be fomented with bladders half-filled with oil and water; and
afterwards let cerates of the oil of privet, &c. or fragrant malagmata be
applied. When the pain is excruciating, he directs us to give a decoction
containing opium and the heads of poppies. In due time diuretics are
to be administered, such as the root of acorus, ground-pine, cassia,
spignel, parsley, sea urchins, radishes, carrots, and the like. When an
abscess is formed, there is a discharge of tawny and more natural urine,
there is swelling in the loins, strong heat in the kidneys, and the pain
becomes duller with irregular fever. The abscess bursts either into the
bladder or intestines. Praxagoras, he says, related a case in which there
was pus voided by the anus for twelve years and probably longer. When
it bursts into the bladder, pus is voided with the urine. Suppuration
is to be promoted by frequent fomentations with sponges, by cataplasms
of barley-meal with a decoction of figs in mead or wine, to which may
be added pounded wormwood, spurge, &c. For promoting the rupture of the
abscess, diuretics are prescribed, such as wild marjoram, mock dittany,
and the like. When the abscess does not burst, acrid clysters containing
black hellebore, radishes, garlic, and the pulp of colocynth are to be
given. To these oil may be added, and when thus taken they will promote
the rupture of the abscess. However, fomentations with sponges and
plasters are to be applied to alienate the pain. When the ulcers are of a
mild nature (which is shown by the abatement of the fever and pain, and
from the substances which appear in the urine being white and inodorous),
the milder diuretics are to be used for cleansing them, such as the
seed of pompion, the decoction of dates, &c.; or, when stronger things
are required, galbanum, opopanax, turpentine rosin, and the like may be
added to mead or wine. When the ulcers are putrid, Æthiopian cumin with
must, rue with honey and wine, and the like may be given internally;
while cataplasms of bitter vetches boiled in wine and honey are to be
applied externally. It is proper also, he says, to inject some of the
medicines for dysentery; to give clysters of strained ptisan; and to
place the patient in hot water. If the matter is thick, a decoction of
fennel, parsley, or wormwood is to be given. With respect to food, he
recommends milk, especially that of mares or asses, along with honey;
also cucumbers, lettuces, the flesh of kids, lambs, and goats, almonds,
and wine; but vinegar must be avoided. All motion is to be abstained
from. When there are symptoms of repletion, emetics are to be given. When
the abscess points outwardly, he seems to direct us to open it and apply
the cautery; but here unfortunately the text is incomplete.
This account is so full and judicious that we think it unnecessary to
give extracts from any more of the Greek and Latin authorities.
From the Arabians little or no additional information is to be derived.
Haly Abbas recommends bleeding by opening the basilic vein, and then
cataplasms of barley-flour, &c. He then gives a cooling draught
containing the seeds of cucumbers, gourds, melons with purslain,
mallows, and the syrup of violets. This part of his practice deserves
consideration. When the abscess forms he directs us to apply cataplasms
containing chamomile, fenugreek, melilot, &c. Alsaharavius, in like
manner, recommends bleeding, cooling and demulcent draughts, the tepid
bath, and discutient cataplasms. The same plan of treatment is fully
laid down by Rhases. When pus is discharged from the bladder, owing to
ulceration of it, he directs us to give astringent injections prepared
from galls, sumach, purslain, pomegranate leaves, &c.
_On hemorrhage of the kidneys._ Our author’s treatment is so fully
stated that it will be unnecessary to multiply extracts from the others.
It is mostly condensed from Aëtius. (xi, 27.) The latter makes mention
of injecting into the bladder some astringent infusion by means of an
instrument like a catheter, having a bladder attached to one extremity.
When the coagulated blood (and the urine generally does coagulate it)
cannot be got otherwise discharged, he recommends, like our author, an
incision to be made in the perinæum.
Cælius Aurelianus also recommends injecting into the bladder some
astringent infusion, such as that of hypocistis, knot-grass, &c. In the
case of women astringent pessaries may be used.
Avicenna recommends us to inject the rennet of a hare. Haly Abbas directs
us to bleed by opening the basilic vein, and then to give draughts
containing various vegetable astringents, such as wild pomegranate
flowers, cucumbers, and purslain, with alum, Cyprian earth, &c. According
to Rhases, the discharge of blood by urine is often connected with
disease of the liver.
The veterinary surgeon Vegetius ascribes the bloody water of cattle to
general plethora. This is a very plausible hypothesis.
_On hardness of the kidneys._ Nearly the same account is given by
Aëtius, and also by Avicenna, Rhases, Serapion, and all the medical
authorities who have treated of this subject. Haly Abbas and Alsaharavius
particularly commend the diachylon plaster. Ruffus, as quoted by
Rhases, recommends rest, emollient clysters, the application of
cupping-instruments to the back, tepid baths, refrigerant and sedative
medicines internally.
_On diabetes._ Aretæus remarks that diabetes is a wonderful affection,
being a melting down of the flesh into urine, occasioned by a cold and
humid cause like dropsy. The disease, he says, is of slow formation,
but when completely formed speedily proves fatal. His description of
the symptoms is very striking: a fiery thirst, a never-ending desire
to make water, a parched skin, a dry mouth, and so forth. Diabetes, he
justly remarks, is a species of dropsy, the water in the one case being
determined to the peritoneum, and in the other to the urinary organs.
We have, in fact, known these diseases reciprocate. He recommends by
all means attention to the thirst, endeavouring to allay it by means
of the medicines called Adipsa; rectifying the stomach by purging with
hiera; and applying epithemes of spikenard, mastich, and the like. For
drink he directs us to give water in which the autumnal fruits have been
boiled; and for food recommends starch, milk, and cold astringent wines.
He concludes by saying that the general remedies and regimen proper
in dropsical cases will answer in diabetes, and particularly mentions
the theriac and mithridate. Among the causes of diabetes he mentions
poisoning by the sting of the African viper, called the _dipsas_. This
subject will be found treated of in the Fifth Book.
Celsus recommends exercise, friction, purging, astringent food, and
austere wine. Galen states that he only recollected having met with two
cases of diabetes. He maintains that it is such an affection of the
urinary organs as lientery is of the bowels. He is decidedly of opinion
that the kidneys are primarily affected, and not the stomach, as some had
supposed. He explains his views of the nature of the disease with great
precision. (De Locis Affectis, vi, 3.)
Aëtius has given the fullest account of diabetes. Upon the authority of
Archigenes, he recommends at the commencement bleeding and diuretics,
the latter being given to clear away the vitiated urine from the
kidneys; but if the disease be of long standing, he proscribes both those
measures. He recommends also a cooling diet, ruddy wine diluted, cooling
applications to the pubes and loins, and, in certain cases, narcotics,
such as opium and mandragora.
Alexander’s theory respecting the nature of the disease is the same as
our author’s, both having borrowed it from Galen. He recommends food of
difficult digestion, such as the feet of oxen, the flesh of pompions,
chesnuts, &c. He forbids all saltish, acrid, and diuretic articles. He
says nothing of venesection.
Actuarius recommends purgatives, in order to determine to the intestines,
and astringent and refrigerant remedies in general.
Avenzoar explains fully his views respecting the nature and treatment
of diabetes, in which he follows Galen closely. But the fullest and
most accurate of the Arabian authorities on this subject is Avicenna.
In certain cases, he admits of venesection at the commencement. The
remedies, however, in which he seems to place the greatest reliance, are
emetics and sudorifics, which he gives until the intention of altering
the determination of the fluids to the kidneys. He particularly directs
the patient to avoid taking all diuretic articles, to use exercise on
horseback, moderate friction, and, in the decline of the disease, the
tepid bath with fragrant wine.
Serapion gives nearly the same account as Aëtius, only he says nothing
of venesection. Haly Abbas states, with his usual precision, the theory
of Galen and the other Greek authorities, namely, that the disease
is occasioned by a preternatural increase of the attractive faculty
of the kidneys, arising from heat of the viscus. Agreeably to this
theory of the disease, his remedies are refrigerants and astringents.
Alsaharavius advocates similar views of the nature and treatment of the
disease. When the urine is thick, with some appearances of blood, he
recommends venesection. According to Rhases, the affection is connected
with preternatural heat of the kidneys and debility of their retentive
faculty. He says it resembles lientery of the intestines.
To those who are conversant with the principles of ancient physiology,
the theory advanced by Galen, and advocated by all subsequent
authorities, will appear very plausible and ingenious. The ancients
appear not to have known that the urine some times possesses saccharine
properties.
Rogerius, like the ancient authorities, refers diabetes to a hot
intemperament of the kidneys, whereby their attractive faculty is
increased. (Tr. i, 54.) All the earlier writers on medicine appear to
have held the same hypothesis.
_On strangury and dysuria._ As these diseases arise from a variety of
causes, our author has properly treated of them accordingly. We do not
find that the other authorities supply much additional information.
Hippocrates mentions that there are many varieties of strangury. His
remedies are the tepid bath, diluent drinks, diuretics, and anodynes.
Aëtius states that the disease is called dysuria when the patient has a
desire and passes his urine with difficulty, and strangury when it is
passed in drops. It is occasioned, he says, by acrimony of the urine,
ulceration, or debility of the bladder. It may also arise from affections
of the kidneys and liver, or from an intemperament. The treatment is to
be varied accordingly.
When dysuria is connected with weakness of the bladder Leo recommends
that pressure should be made with the hands on the hypogastric region.
Avicenna is particularly full upon these affections. For _ardor urinæ_
Haly Abbas recommends various emollient and cooling articles, such as
mallows, the seeds of cucumbers, pompions, and the hot bath, &c. When
it proceeds from an inflammatory cause, he recommends the treatment
directed in the beginning of this Section. When these remedies prove
ineffectual, the catheter is to be used. He says that one of the most
common causes of the complaint is debility of the expulsive faculty of
the bladder. Alsaharavius treats fully of these complaints in much the
same terms. When dysuria is connected with inflammation, he recommends
bleeding, diluent drinks, and the warm bath. When it proceeds from a clot
of blood he directs us to inject into the bladder the water of ashes.
(_Aqua cinerum_, perhaps it should be _aqua cicerum_.) Rhases states that
the complaint generally arises in old men from heat or ulceration at the
neck of the bladder. He justly remarks that when retention arises from
inflammation, no urine at all is passed, and the pain is constant; and
that, when connected with obstruction, the bladder gets distended.
For inflammation, pain, and ulceration of the bladder, Scribonius Largus
recommends water into which a heated iron had been plunged. He adds that
he had known the chalybeate waters of Tuscany do much good in diseases
of the bladder. This may be said to be an anticipation of the modern
practice, introduced, we believe, by the late Mr. Cline, of giving the
tincture of muriated iron in such cases.
_On incontinence of urine._ Galen properly remarks that incontinence of
urine is often occasioned by injury of the spinal marrow either through
violence, or the application of cold. (De Loc. Affect. iv, 7.)
According to Avicenna it is occasioned by excessive cold, by relaxation
of the muscles (_sphincter vesicæ?_) or weakness of the bladder, as
happens at the end of certain diseases, or by the immoderate use of
diuretics. Rhases says briefly, that the complaint is occasioned by
excessive heat or coldness. When it proceeds from the former cause, he
recommends a composition of coriander, vinegar, Armenian bole, acorns,
&c. When from cold, he prescribes the following: Of dried acorns, of
frankincense, q. s. to be rubbed into the pubes with oil of ben, or
oil of rue. Haly Abbas attributes the complaint to enervation of the
sphincter vesicæ and loss of the retentive faculty of the bladder. He
also mentions its connexion with disease of the spine. Alsaharavius
recommends various stimulant liniments externally, and galls, vinegar,
and the like internally.
Ruffus briefly describes a disease of the urinary organs, by the name
of _scabies vesicæ_, attended with furfuraceous sediments and pains in
the hypogastric regions, and ending, for the most part, in ulcerations
of the bladder. The disease is said to be of a very intractable nature.
It is alluded to by Hippocrates. (Aph. iv, 77; where see the Comment.
of Theophilus, ed. Dietz.) It is further stated in one of the aphorisms
that blood, pus, and scales in the urine, accompanied with deep pain,
indicate ulceration of the bladder. (Ed. Dietz., t. ii, 437.) Theophilus
says, blood, pus, and scales in the urine, with a heavy smell, indicate
ulceration of the kidneys or bladder. (De Urinis, 15.)