Chapter XXII: Appendix: To the Third Section (3)

Musk, the inspissated secretion of the follicle in the prepuce of the _Moschus moschiferus_ L., would appear to be first mentioned in the works of Aëtius (xvi, 122), who gives formulæ for various fumigations (suffumigia) containing a great many aromatics, and among them musk. But as we have already had occasion to state, we entertain strong suspicions that the concluding chapters of this author may be spurious. Indeed, as this important article is not noticed by authors subsequent to Aëtius, such as Oribasius, it would appear to us that this circumstance is the strongest possible presumption, that the passage in Aëtius had been added after the Arabian period of medicine. There is one notice of it also by our author, but it also has a suspicious appearance. (p. 292, ed. Basil. See also 296.) Serapion gives a long account of it, first upon the authority of Abuhanifa, who calls the animal the musk gazelle, and says its habitat is in the countries of _Tumbasci_ and _Sini_, by which he probably means Thibet and China. Of these the better kind, he says, is that procured from Thibet, as the animal in that country lives on fragrant herbs, and the inhabitants are better acquainted with the process of extracting it from its follicles. And, moreover, he says, the Sinenses (Chinese?) are apt to adulterate their musk. The animal which produces musk, he adds, does not differ in figure, colour, nor horns from other gazelles, and the best musk is procured after it is full grown. He then gives an anatomical description of its canine teeth, and of the modes of catching it by snares, gins, and by shooting it with arrows; and also the manner of extracting the musk from the animal after its death. But the best musk, he says, is procured from the animal when it is in a state of orgasm, and rubs its follicles against a rock until the musk drops out of them. The inhabitants of Thibet (homines de Thebeth) know the places where the animal feeds, and collect the musk thus procured from them. This, he remarks, is the finest musk of all, and is reserved for royal personages and held in high esteem. This authority concludes by saying that in the region of _Thebeth_ there are many cities, but that the one, from which musk is procured, is that city which is properly called _Thebeth_. His next authority is Alcholabama, who calls musk hot in the second degree, and dry in the third. The following one, Aben Mesuai, says of it, that it comforts the heart and internal viscera, both when drunk and when applied externally in plasters. His next authority is Honain, who recommends musk in diseases of the eyes. The others supply little additional information on it, but in general recommend it in diseases of the brain. He says the Persian doctors applied the oil to the member as an aphrodisiac. (De Simpl. 185.) Rhases recommends musk in headache, and all cold affections of the head, and also as a stomachic. (Ad Mansor. iii, 22.) In his ‘Continens’ he quotes from several Arabian authorities, all of whom give it the characters already stated, and recommend it most especially in diseases of the brain and eyes. (l. ult. i, 483.) Avicenna gives an accurate description of it, as far as we can judge from the wretched translation of his works. He recommends it in errhines with saffron, and with a little camphor for vertigo, and other affections of the brain. He also thinks favorably of it as a cordial in affections of the heart, and in melancholy. He concludes by saying of it that it is alexipharmic, especially in cases of poisoning with napellus. (ii, 2, 452.) See also his treatise (de Med. cordial., ii.) There does not appear any distinct mention of it in the works of Mesue the younger. It occurs frequently as an ingredient in the antidotes of Myrepsus. Ebn Baithar gives a very full description of it and its medicinal virtues, but it agrees so well with the description of it by Serapion, that we need not enter much into particulars. He recommends it particularly in diseases of the eyes, and says that the oil of it is a useful application to piles, and when rubbed into the genital member, is strongly aphrodisiac. It is, moreover, said to be an excellent cordial. Of the Greek authorities Symeon Seth is the only one that gives anything like a distinct account of musk. He describes three kinds, of which the best is procured from a city east of Chorasan called _Trepet_ (Thibet?). The next in quality is the Indian, and the worst is that which is procured from the Sines (Chinese?). All the kinds, he says, are formed in the umbilicus of an animal with one horn, resembling the gazelle. Like Serapion he states that it is got from the animal while in a state of sexual orgasm. Musk, he says, is hot and dry in the third degree, and of a volatile nature. As to its medicinal powers, it strengthens weak parts, and is beneficial in cold intemperaments of the head, but injurious in hot. It is adapted for the recovery of persons in a fainting fit, in loss of strength, and in affections of the heart. (De Alimentis.) An antidote of musk occurs in Actuarius. (Meth. Med. v, 6.)

_Volubilis._

This name is loosely applied by the Arabian authorities to several genera of the climbing plants. For example under this head Serapion describes the _lebleb_ or _cussus_, the _acfin_, the _atthin_, and _lebleb maju_. Of these the first is unquestionably the κισσὸς or ivy, and is described in extracts from Dioscorides and Galen. Of the _acfin_ he says that it is laxative, and quotes Dioscorides as saying that it loosens the bowels. He says the _atthin_ is styptic, and quotes Dioscorides and Galen as recommending it in rheums of the eyes, and fluxes of the bowels. The last or _lebleb_ he describes upon the authority of Aben Mesuai, who says it is hot in the middle of the first degree, dry in the beginning of the same, of a cutting nature with some saline properties, and purges adust bile. Afterwards he describes its medicinal powers in the same terms as Dioscorides and Galen describe the _cissus_, that is to say, he represents it as being rather a medicine than an article of food; says it purges bile in doses of from one third to two thirds of a pound, when clarified without boiling, by means of ten drachms of sugar or penidia. His next authority, Isaac ebn Amram, says it is deobstruent. Alkanzi says it is cold and dry, is purgative and useful in indurations. His last authority, Abix, says the _lebleb_ is cold and moistening, cholagogue, and along with cassia fistula and oil of almonds it proves useful in clearing out the bowels, and relieves coughs. (De Simpl. 42.) Avicenna under the head of _Volubilis_, i. e. _hedera_ (ii, 2, 724), and under _Cussus_ (ib. 169), describes the κισσὸς of Dioscorides, but the former of these rather confusedly so as to create suspicions that he used the term in rather a lax manner. Mesue is the ancient author who treats most elaborately of the _volubilis_, applying the term to five distinct species, or rather genera, of which the first is probably the Hedera, the second the Helxine, and the third the Clematis of the Greeks; the fourth, which he calls lupulus, is acknowledged to be the _Humulus lupulus_, and the fifth the _Convolvulus scammonium_. See his learned commentator Costa (c. 24.) As all the others have been already treated of, we shall confine our attention at present to the account which he gives of the medicinal powers of the _hops_. He says the lupulus brings away some yellow bile, clears the blood, allays its inflammation, and that its infusion or whey is of great use for this purpose, and its syrup, he adds, cures jaundice. He says it was little used by the physicians of his time. He recommends it as a deobstruent of the liver, and of other internal viscera, as a remedy in asthma, and protracted fevers; and as a plaster to the head with rose oil or oil of chamomile, &c. (i, 24.) He treats of scammony separately in the next chapter. The character thus drawn of the _lupulus_ does not seem at first sight to agree well with the acknowledged virtues of the _Humulus Lupulus_. But, as Rutty remarks, he probably alludes to the stem and not to the flowers of the plant, as being a medicine which purges yellow bile. (M. M. 296.) The _Humulus Lupulus_ is not noticed by any Greek writer, nor by any Roman, with the exception of Pliny. (H. N. xxi, 50.)

The _lebleb_, noticed above, there is every reason to suppose, was the _dolichos lebleb_. It is also treated of by Avicenna as well as Serapion. They represent it as containing saltish juices which purge adust bile. It is a well-known article in Hindoo Medicine. See Wise (Book of Hindoo Medicine, 104.)

_Abrong_, or _Abrugi_.

Serapion describes it as a round grain, spotted with black and white, which is brought from Seni (China?), having a bitter taste, hot and dry in the second degree, a laxative of the bowels, and vermifuge. (De Simpl. 153.) According to Dodonæus and Parkinson, it is the pea which the latter describes and represents under the name of _pisum cordatum vesicarium_. See Theatre of Plants (1378.)

_Ribes._

This has been supposed the ribes _or_ raspberry, but it is now well ascertained that it is a species of _Rheum_, namely the _Rheum Ribes_. See Sprengel (R. H. H. i, 257.) Serapion gives a full account of it; he represents it to be a cold, astringent plant, and recommends it in various complaints, such as cholera, smallpox, measles, and in hemorrhoids. (De Simpl. 241.) Avicenna briefly recommends it in nearly the same complaints. (ii, 2, 581.) See also Rhases (Cont. l. ult. i, 582.) Ebn Baithar gives a full and very interesting description of it. He says it grows in alpine localities in Syria, and in the northern countries, but not in Spain; that it has large, broad, round leaves, and tender reddish spots. He calls it bitter and astringent, and recommends it in palpitation of the heart, vomiting, and marasmus. He also praises it in hemorrhoids, and the red flux (menorrhagia) of women; and further commends it in measles, smallpox, and plague. Dr. Royle says (M. M. 521) that the _Rheum Ribes_ is “the _Riwas_ of Serapion, who mentions it as making a good sherbet.” Does he allude to the chapter on the _Ribes_ quoted above?

_Aurantium._

When we stated in another place (Vol. I, 134) that no ancient author had noticed the _orange_, we were unacquainted with the works of Ebn Baithar, and of D’Hanvantare, the author of the Susruta. In the latter work the orange is enumerated with acid fruits, of a somewhat indigestible nature. (140 et alibi.) Ebn Baithar says of the orange that it produces an oil which is useful in flatulence and pains of the joints. The rind of the fruit, he says, is carminative and anthelminthic, an antidote to poisons, and removes spots from clothes. The Hindoos have been long familiar with the _Citrus aurantium_. See the Susruta and Wise’s Hindoo Medicine (p. 191.)

_Limon._

We are now inclined to think that we were mistaken in stating (Vol. I. 137) that the lemon was mentioned by Avicenna (ii, 2, 433.) His description is probably to be referred to the _Statice limonium_. However, beyond all doubt, the _Citrus medica Limon_ is fully described by Ebn Baithar. He says the rind is bitter, acid, astringent, and aromatic, excites the appetite, improves digestion, renders the breath fragrant, is cordial, and an antidote to poisons. He recommends it particularly in fevers, exanthemata, palpitation of the heart, vomiting, &c. It appears also to be noticed several times in the Susruta. (See p. 142 et alibi.) Lemons are likewise noticed by the Persian writers on the Materia Medica by the names of _Leemoo_ and _Neemboo_. See Royle (Mat. Med. 297.) They have been long known to the Hindoos. See Wise (Hindoo Med.)

_Margaritæ._

Though the Greeks and Romans were well acquainted with pearl-mussels, as is obvious from several passages in the classical authors, it does not appear that they ever used these articles in the practice of medicine. They were used by the Arabians as an ingredient in their celebrated Electuarium _de Gemmis_, (Mesue _de Elect._) and were reckoned among their cordial medicines. Avicenna says of pearls, that they resemble _karabe_ in medicinal powers, but are more powerful in their operation. (De Med. Cordial.) Serapion gives a fuller account of them upon the authority of several Arabian writers, who describe pearls as being cold, desiccant, and attenuant, and recommend them in diseases of the eyes, and in hemorrhages, as dentifrices in diseases of the teeth, but more especially as cordials in palpitations and other affections of the heart. (De Simpl. 397.) We could have wished to have given in this place, since we have had no convenient opportunity to do so elsewhere, an exposition of the views of the Arabians respecting the operation of _cordial medicines_; but as this subject could not be understood without a fuller explanation of certain parts of the higher philosophy of the ancients than is consistent with our limits, we are reluctantly obliged to dismiss it with a very brief notice. We would beg leave to refer our readers to Avicenna’s elaborate treatise ‘de Medicinis Cordialibus.’ He there gives an ingenious disquisition on medicines which operate upon the animal spirits and dispel vapours, and first advocates views which have formed the basis of many a modern hypothesis on this subject. Among the cordial medicines described by him we would remark amber, gold, silver, citron, coral, cinnamon, camphor, myrobalans, hyacinth (the gem), lapis lazuli, myrtle, musk, mace, frankincense, silk, sandal-wood, tamarinds, zerumbet, zeduary, &c. One important class of cordials consists of medicines which evacuate black bile, namely, melanogogues, which we will have to treat of in a subsequent section of this work.

In imitation of the Arabians, Paracelsus and the modern alchemists have attributed great virtues to the precious metals and stones as cordial medicines. See Schröder (Chemical Dispensatory, pluries.) He says of pearls, that “they are an excellent cordial, that strengthens the balsam of life, resists poison, pestilence, and putrefaction, and clear the spirits.” (167.) Pearls and other precious stones have always been highly esteemed by the Hindoo physicians. See the Susruta and Wise’s Hindoo Medicine (124.)

_Sericum._

We have mentioned above, that silk is one of the cordial medicines treated of by Avicenna. Silk, and especially raw silk, he says, is attenuant and desiccative, acts as a cordial, improves the memory, proves useful in affections of the eyes, in obstructions of the liver and other complaints. (De Med. Cord. ii, 3.) The silkworm (_bombyx mori_) and the uses of silk in medicine, are described with considerable accuracy by Serapion. Like Avicenna he ranks it with the cordial medicines, and recommends it in this capacity along with pearls, karabe, corals, and musk. (De Simpl. c. 28.) Silk forms one of the ingredients in the electuary of Mesue, to which he gives the following imposing title, “Electuarium ex granis tinctoriis ad cordis palpitationem, syncopem, mentis alienationem, seu desipentiam, moerorem sine causa manifesta, facultates enim nostrum corpus dispensantes mirifice roborat.” See f. 89, and the interesting Commentary of Costa. It is also an ingredient in several of the Antidotaria of Avenzoar. Ebn Baithar says, that various Arabian authors had written on the medicinal properties of silk. One of them quoted by him describes the use of it in medicine by burning it, and using its ashes for collyria and other purposes. He remarks, that Ebn Sina (Avicenna) says, that silk as an article of clothing prevents the formation of lice. Raw silk has been used as a medicine in modern times. Moses Charras, in his ‘Royal Pharmacopœia,’ writes thus of it: “Many writers have attributed great virtue to raw silk. But although the use thereof had been at all times unknown in physic, my judgment is that it is too fragrant, that it has too much beauty, that it affords too many conveniences to human life, that there are too many wonders in the first original, progress, labour, and metamorphosis of the worm which produces it, to be despised.” He adds, “that is called raw silk which was never boiled, but is still as it were in the grain, out of which the worm has been but newly taken.” He says further of the composition, whereof raw silk is an ingredient, namely, _Confectio alkermes regia_, “This confection is, without question, one of the best cordials that ever Galenic physic invented. For it repairs and recreates the vital and animal spirits, it ceases palpitations of the heart and swooning-fits; it fortifies the brain, &c.” (R. P. 149.) A still more recent authority on pharmacy, says of raw silk, _Sericum_, that it is “cordial, restorative, one drachm in powder.” Gray (Suppl. to Pharmacop. 215.)

_Hyacinthus._

This is one of the precious stones which often occurs as an ingredient in the Arabian formulæ for antidotes. Ebn Baithar remarks, that it is not described by Dioscorides nor Galen. He mentions three kinds, a yellow, a red, and a black, of which the red is the noblest. Its powers, he says, are increased by fire. It was used as an amulet, and was held to be cordial and alexipharmic; and, in fact, Ebn Baithar says it is possessed of many virtues. From his mentioning of it, that, when rubbed, it attracts straw, there seems every reason to suppose that it was tourmaline. Some have taken the hyacinth of the Greeks and Romans for the same, but Heeren rather supposes it to be the ruby. It is briefly noticed as a cordial by Avicenna, Mesue, and Serapion. The last of these gives nearly the same account of it as Ebn Baithar; that is to say, both had copied from the same authorities. He particularly mentions it as being an excellent phylactery to guard the body during thunder-storms. (De Simpl. 398.) The _Confectio de Hyacintho_ has been very celebrated in modern times. See Moses Charras (Roy. Pharmacop. 147.)

_Hager Albuzedi._

It is thus described by Serapion: “Hager albuzedi is a red stone, but less so than the hyacinth, the redness of which is more agreeable to the eye, as there is no obscurity in it. The mines where this stone is found are in the East. When taken from the mine it is opake; but when divested of its outer coat by a lapidary, its goodness is discovered and it becomes transparent. When this stone has been strongly rubbed against the hair of the head, it attracts chaff, as the magnet does iron.” He speaks of its being useful to the eyes when they are rubbed with it, and says that as a seal it dispels frightsome dreams. (de Mineral. 399.) According to Beckmann this is most probably not the tourmaline, although it bears some resemblance to it in properties, but belongs rather to the hyacinths. (History of Inventions.) In fact, it would appear to us highly probable, that this article like the preceding was a variety of the ruby.

_Hager Salachil_, or _Lapis Corneolus_.

Several species of it are described by Serapion, of which the best he says is the red. They are brought, he adds, from the mines of the Romans, and were used principally as an amulet and dentifrice. It must have been the same as the _Sardion_ of Theophrastus (De Lapidibus), and of Plato (Timæus.) The term would appear to have been used in a general sense for several of the finer kinds of agates. (De Simpl. 400.) A modern authority thus describes it: “The Sarda _or_ Cornelian. It is a gem half transparent, like the water wherein flesh is washed, or like bloody flesh: hence it is called Carneolus or Cornelian. The best cornelians are found in Sardinia.” Schröder (Chemical Dispensatory, p. 160.)

_Tincar_, or _Borax_.

We have treated of this article already under the head of _Chrysocolla_, with which it has been often confounded. It was introduced into medical practice by the Arabians, and there appears to us no doubt that it was the same as our borate of soda. It was very much used for the cure of toothache. See the authorities quoted under _Chrysocolla_. It was used medicinally by the Hindoo physicians. See the Susruta (pluries), Wise (Hindoo System of Medicine, 117); Ainslie (Mat. Ind. 576); Royle (Mat. Med. 97.)

_Hager Alcazaha._

It is difficult to determine precisely what this precious stone was, although it is pretty minutely described by Serapion. He says it is brought from Yemen, and is of divers colours, from white to black, and that it occasions disturbed dreams when worn as an amulet: he recommends it, however, to be thus used by infants, and says a vessel prepared from it, if used for holding any article of food or drink, prevents sleep. (De Simpl. 401.)

_Lapis Lazuli._

We have in so far treated of this substance under _Cyanus_ in the preceding Commentary. It was used, like the other precious stones, as an amulet, but was more particularly celebrated as a melanogogue medicine. It was further said to be useful in asthma, and as an emmenagogue. See Serapion (De Simpl. 369); Avicenna (ii, 256). A modern authority describes it thus: “It is a stone like a sapphire, or the flowers of cyanus adorned with golden stones or flowers, harder than the Armenian stone. It is in virtue like the Armenian stone, but weaker; it purgeth chiefly melancholy. It is worn about the neck for an amulet to drive away frights from children,” &c. Schröder, (Chymic. Dispensat.)

_Berengemish_, or _Ozimum Gariofilatum_.

Serapion, after quoting a description of it from Isaac ebn Amram, says of it, that it is hot and dry in the end of the second degree, is useful in coldness of the stomach, promotes digestion, is a hepatic and cordial medicine, dispels melancholy, renders the eructations fragrant, &c. His other authorities recommend it in similar cases. (De Simpl. 156.) Avicenna gives a similar account of it in all respects. (ii, 2, 254.) We suppose there is no doubt that it is the clove basil, or _Ocimum gariofilatum_ of Miller; or, according to Sprengel, the _O. monachorum_.

_Behen._

Serapion briefly describes two varieties of it consisting of fibrous roots, being brought from Armenia, and having a good smell with some viscidity. Both kinds, he says, are hot and humid, and increase the secretion of semen. (De Simpl. 223.) See also Avicenna (ii, 2, 82), and Rhases (Contin. l. ult. iii, 29.) Avicenna holds that it is also cordial in addition to its power of forming semen. It is the _Centaurea Behen_ L.

_Spinachia._

We have already treated of the spinach (_Spinachia oleracea_) as a dietetical article introduced by the Arabians. (Vol. I, 113.) According to Avicenna it is laxative of the bowels, useful in orthopnœa, and other diseases of the chest. It is noticed in like terms by Serapion (De Simpl. 140); by Rhases (Contin. l. ult. i, 671.) Ebn Baithar says of spinach that it is an excellent potherb, and useful in diseases of the neck and chest, being much used for this purpose by the inhabitants of Nineveh, who are very subject to such complaints.

_Rhabarbarum._

We have stated under _Rheum_ in the preceding Commentary (317), that it was the _rheum rhaponticum_, which is the only species of the _rheum_ described in the regular treatises on the Mat. Med. of the Greeks and Romans. Our author, however, would seem to allude to the _Rheum barbarum_ or purgative rhubarb, at Book I, 43, and VII, 11. Although it is stated by some learned authorities that the rheum of Trallian (viii, 3) was a species of the Rhabarbarum, we are satisfied from a careful examination of the passage, that it was the rhaponticum. There can be no doubt that the general use of the purgative rhubarb was introduced by the Arabians, of whom Ebn Baithar is by far the most copious and instructive under this head. He states decidedly that there are four species of rhubarb, three of which are perfectly distinct. On the first species, by which he evidently means the _R. Rhaponticum_, he gives extracts from Dioscorides, Galen, Oribasius, and Paulus. He says the older physicians knew nothing of the virtues of the purgative kinds of rhubarb until they were discovered near to his time. He says the purgative rhubarb acts as a deobstruent and strengthener of all the internal viscera, is useful in mental diseases, dropsy, jaundice, marasmus connected with obstructions, especially when combined with gum lac. He says it is most useful in chronic diarrhœa when taken in an aromatic wine and with Indian spikenard, and also in uterine fluxes, dyspepsia, and other complaints of a similar nature. He praises it most especially as a stomachic. He states, that of all the kinds of rhubarb, the Turkish possesses the purgative quality in the highest degree. Of the other Arabian authorities, Averrhoes is one who gives a very distinct account of the true purgative rhubarb. (Collig. v, 42.) Mesue describes three species of the Rhabarbarum, _or_ Rhaued, namely, Indianum, Barbarum, and Turcicum, to all of which he ascribes purgative powers, and recommends them as being possessed of hepatic, stomachic, and deobstruent properties, which render them particularly serviceable in dropsy, obstructions of the spleen, and jaundice. The dose of the infusion, he says, is from one to ten drs.; and of the pounded, from one to three. He appears not to have been acquainted with the Rhaponticum (De Simpl. v), whereas Avicenna and Serapion would seem not to have known the other. It may be proper to mention, in conclusion, that the Rheum rhaponticum is the common culinary or tart rhubarb of this country. According to Loudon, it was introduced in 1573, but it is most probable that we owe the introduction of it to the Romans.

* * * * *

But it is time that we should draw this Appendix to a close. And now we trust it will not be thought out of place to conclude with Professor Beckmann’s eloquent eulogy on the Literature of the Arabians in his celebrated work on the ‘History of Inventions and Discoveries.’

“What a noble people were the Arabs! We are indebted to them for much knowledge and for many inventions of great utility; and we should have still more to thank them for were we fully aware of the benefits we have derived from them. What a pity that their works should be suffered to moulder into dust, without being made available! What a shame that those acquainted with this rich language should meet with so little encouragement! The few old translations which exist have been made by persons who were not sufficiently acquainted either with languages or the sciences. On that account they are for the most part unintelligible, uncertain, in many places corrupted, and besides, exceedingly scarce. Even when obtained, the possessors are pretty much in the same state as those who make their way with great trouble to a treasure, which, after all, they are only permitted to see at a distance through a narrow gate. Had I still twenty years to live, and could hope for an abundant supply of Arabic works, I would learn Arabic. But ὁ βίος βραχὺς, ἡ δὲ τέχνη μακρή.”

SECT. IV.—ON SIMPLE PURGATIVE MEDICINES.

Give of aloes one drachm, with honeyed water, in the morning. But they who administer it in the evening or after food occasion mischief, for it makes the food spoil. It evacuates yellow bile, less if given to the extent of three oboli, for in that case it proves solely and entirely eccoprotic. But purgative medicines being generally bad for the stomach, aloes alone is stomachic. Those who cannot endure the bitterness of it may take it formed into pills. It is manifest that purgative medicines do not evacuate by any one simple temperament such as heat (for then all hot things would be evacuants, such as pepper), but by some specific property of their whole substance in like manner as the magnet attracts iron. Of purgative medicines those which are simply laxative have been treated of in the First Book. We are to use drastic purgatives either in order to transfer some matter, or to dislodge and remove an indurated diathesis, or as an alterative to the system, and in order to change the temperament of it, or to displace any offending humour. There are certain mixed modes complicated of the afore-mentioned. Purgative medicines are to be given to those whose powers are firm and their understanding strong; to such as have passed the first stage of life, and have not yet come to the last; to those who have a strong stomach, and have collections of superfluous matters in the body, and are not very sanguineous. The best seasons for purging, if there be no urgent necessity, are the spring and the autumn.

_On those things which evacuate bile._ We may give cholagogue medicines at any season except winter, to persons in the vigour of life and in the decline; to persons of dry and muscular habits, and who are of a dark or ruddy complexion; to men rather than to women; to those whose food is apt to spoil on their stomachs, and whose bellies are constipated; to such as abound in bitter bile, are irascible, pass little urine, and use hot and dry food: in icteric, hepatic, and pleuritic affections; in phrenitis, cynanche, mania, cephalæa, ophthalmy, erysipelas, leprosy, fevers, and to such as are troubled with collections of bile. Aloes is given to such as are troubled with heaviness of the head, with ophthalmy, with thirst, with disturbed dreams without fever; to such as have a sensation of departing rigor; to those who pass acrid flatus, and have gnawing pains of the intestines; to those who are seized with burning heat about the stomach, or nausea producing eversion of it; and to those who being troubled with a collection of excrementitious matters cannot bear evacuations by clysters. For it evacuates the whole body, and does not occasion disorder of it unless given in very great quantity, and brings along with it any bile lying in the intestines, stomach, and gullet.—Hellebore agrees both with those in acute diseases and those in chronic requiring a cholagogue medicine, such as maniacs, those troubled with hemicrania, and such as have defluxions of the eyes and complaints in the chest. But it suits most with such viscera as the uterus and bladder when they require a cholagogue remedy. It is also proper for chronic affections of the trachea, for jaundice, exanthemata, lichen, herpes, erysipelas, and leprosy. Black hellebore evacuates bile, especially yellow, from the whole body and without trouble. Hence it is given to those not affected with heavy fever, and more especially to such as are free from fever, in the quantity of one drachm of the roots triturated in honeyed water or plain water, while fasting, or with honey made into pills. Some mix with it pennyroyal, savoury, or some of the volatile stomachics.—Scammony purges like hellebore, and more especially yellow bile, but of all purgative medicines it is the most prejudicial to the stomach. It is, therefore, to be given to those who are free from fever, and such as have strong stomachs, to the amount of four oboli, with salts, pepper, ginger, or some one of the volatile stomachics, or along with honey. It is also formed into pills with gum.—The medullary part of the fruit of the Colocynth evacuates especially bile and mucous matters, not from the blood like hellebore and scammony, but from the nerves and nervous parts, when given to the amount of one drachm in two cyathi of honeyed water which has rue boiled in it. But it is to be triturated for a long time, because otherwise its rough particles sticking in the internal parts produce ulcerations and nervous affections by sympathy. It is to be given to those who have affections of the head, namely, when the meninx or the pericranium is affected, such as those labouring under vertigo or hemicrania, or those troubled with cephalæa; also in epilepsy, apoplexy, cynic spasms, chronic defluxions on the eyes, orthopnœa, asthma, and chronic coughs; likewise in arthritic cases to those who have affections about the kidneys or bladder.—Elaterium evacuates like scammony. Such as is green like leeks, light, and not older than a year, is to be chosen; and it is to be given to the amount of three oboli, triturated with one hemina of milk.—Tithymallus, _spurge_, evacuates bile like elaterium and scammony. Four or five drops of the juice are given, mixed with polenta and quickly swallowed. For if retained long in the mouth they ulcerate the tongue and surrounding parts.—Lathyrides (a species of spurge) purge bile like hellebore and scammony. They are to be given to the amount of seven, eight, or as many as fifteen grains to such as are robust and require much purging, who are to be directed to chew them. But those who are weaker and have bad stomachs, must swallow them whole.—The dried tops of the Peplium are to be given to the amount of eight oboli in honeyed water. They evacuate bile like hellebore, and occasion the breaking of wind.—Agaric has similar powers to the colocynth, but acts slowly and is not prejudicial to the stomach. It is given to the amount of two drachms with honeyed water. It should be very white, brittle, and not very woody nor carious.—Illyrian Iris purges in like manner when given to the amount of eight oboli in honeyed water. It ought not to be old nor carious.—The small Centaury by purging bile and mucus is particularly adapted for cases of ischiatic disease. The decoction is to be drunk of a drachm and a half of centaury, boiled in a hemina of water until it be reduced to the half.—The flower with the fruit of Tragoriganum is given to the amount of two drachms, in honeyed water, to the same class of persons as the black hellebore. It is more stomachic than the hellebore, but less purgative.—Four drachms of Chamelæa (mezereon?) boiled in two heminæ of honeyed water, until reduced to a fourth part, purge like hellebore. Some administer chamelæa by making it into pills with a double quantity of wormwood.—Aristolochia, _birthwort_, purges like colocynth, one drachm of the species called clematis being given in honeyed water.—The dried root of Polypody when pounded and sprinkled on honeyed water, or triturated along with it, has the same effects as colocynth.

_Medicines which evacuate black bile._ Medicines which evacuate black bile are to be given in an especial manner to melancholic persons, to such as are easily moved to paroxysms, to passionate persons, to misanthropists, to persons of solitary habits, or to such as during convalescence require purging, during the heat of autumn, in dry habits, and to such as are not muscular.—Epithymum, _dodder of thyme_, is the best of those medicines which evacuate black bile. It is to be given to the amount of five drachms triturated with a hemina of milk.

Epithymbrum, or the substance which grows upon savory, evacuates in like manner with the epithymum, but is weaker. Pennyroyal, when taken to the amount of an acetabulum, in honeyed water, evacuates black bile.—The Heracleatic Tragoriganum in the same dose evacuates like pennyroyal. But both must be dried. Alypum, the seeds of it have been said to purge black bile when given in the same quantity as the epithymum with salts and vinegar; but, as Dioscorides says, it occasions slight ulceration of the intestines. It is, I think, that substance which is now called alypias. It is to be given in honeyed water.—Parthenium (matricaria?), _feverfew_, when dried and drunk in like manner, evacuates the same humours. Alypon, _madwort_, drunk with salts, purges in like manner.

_Medicines which evacuate phlegm._ We are to administer phlegmagogues in cold habits; to aged persons, in winter; in paralytic and apoplectic cases; for loose œdematous swellings; to such persons as have great collections of phlegm in the belly, chest, or stomach; and in cases of the female flux. They agree also with those who have a copious running from the nose and thick expectoration, with cases of anorexia and ischiatic disease when the joint becomes mucous or pituitous; but they are particularly adapted for those cases of dropsy which are called anasarca.—One drachm of white Storax, drunk with an equal quantity of turpentine rosin, evacuates phlegm.—The bark of the root of Olive to the amount of one drachm, with wine or water; nine oboli of Pellitory, with water; two drachms of the seed of Lychnis (_campion_); one drachm of the root of Sow-bread, with hydromel; two drachms of Garlic, with honey; ground Pine, triturated and given in the form of pills; half a drachm of the flakes of copper, with an equal quantity of rosin, in pills, purges bile strongly.—A drachm and half of the green leaves of Bay; two oboli of the bark of the root of the wild Cucumber; forty seeds of that species of ricinus called Crotones stripped of their bark and eaten, do the same. A half of that part of Parsley connected with the root (which some call chamæraphanus), when eaten; two drachms of Bdellium, with hydromel; but Gum is particularly adapted for defluxions on the eyes.

_Medicines which evacuate water._ We are to give hydragogues in that variety of dropsical disease called ascites; to women troubled with the whites; and to those who have ulcers accompanied with a copious discharge.—One drachm of the flakes of Copper, when drunk with honeyed water evacuates water; but a little vinegar must also be swallowed lest it be vomited.—The Granum Cnidium when stripped of its bark, triturated, and drunk with boiled honey, that it may not touch the orifice of the stomach, evacuates water. Twenty, twenty-five, or thirty grains are to be given, and to those who are stronger, as many as forty.—One drachm of Euphorbium, drunk with boiled honey, evacuates phlegm, but more especially water.—Eight oboli of the seed of rough Spleenwort, with honeyed water, evacuate water.—Cneorum, in like manner, purges water when drunk with polenta.—Five drachms of the seed of Cnicus, when triturated together in ptisan, are swallowed with a small quantity of salts.—One drachm of Ammoniac perfume, drunk in honeyed water, evacuates water. Some give it in affections of the spleen with oxycrate.—The juice of the bark of the root of the Elder-tree, when drunk to the amount of two ounces with wine, evacuates water.

* * * * *

COMMENTARY. The philosopher Aristotle thus explains his ideas respecting the action of purgatives: “When purgatives are conveyed to the stomach, and are there dissolved, they are carried by the same passages as the food, and when they cannot be digested, but their prevailing power remains unsubdued, they return, and carry with them whatever opposes them, and this is called purging.” (Problem. 43.) See also Alexander Aphrodisiensis (Probl. ii, 58.)

Hippocrates administered purgative medicines freely and boldly, but at the same time he cautions against the unseasonable and rash administration of them in several parts of his works. We do not find any theory, however, of the _modus operandi_ of purgatives, nor any general remarks on the cases in which they are applicable, in any of the Hippocratic treatises which are now acknowledged to be genuine. Some ingenious remarks, however, may be found on this subject in the work ‘De Nat. humana.’

Celsus has a chapter on purgative medicines which contains much curious and valuable matter. He says the more ancient physicians gave various purgative medicines very freely, such as black hellebore, polypody, squama æris, the milky juice of lactuca marina (_euphorbia paralias?_), the milk of asses, with a little salt; but he holds that purgatives hurt the stomach, and are not to be given when any fever is present. The rules, which he lays down for the administration of them, are highly judicious, and deserving of consideration. He approves of them when the head feels heavy, when the eyes are misty, when there is obstruction of the bowels, and when there is pain there or in the hip-joint, when the stomach is oppressed with bile or phlegm, and when there is dyspnœa, when venesection is indicated, but the powers of the system will not admit of it, and in several other cases. (v, 12.) He mentions that Asclepiades totally rejected the use of purgative medicines. (i, 3.)

Galen has devoted a complete treatise to the discussion of the question regarding the _modus operandi_ of purgatives. He decidedly inclines to the theory that every purgative by some specific property attracts, and as it were, sucks to it the humour to which it has a natural alliance, in like manner as the magnet attracts iron. He divides Purgatives into Cholagogues, Melanogogues, Hydragogues, and Phlegmagogues. He rejects the hypothesis of Erasistratus, who maintained that each medicine converts the juices presented to it, into its own specific nature: thus that cholagogues convert them into yellow bile, melanogogues into black bile, and so forth. Although Galen flatters himself that he effectually demolishes this hypothesis, we have long looked upon it as a very plausible one, and believe that at the present time the prevailing opinion in the profession inclines much in that direction. For example, the green and dark discharges which are brought off by mercurial purgatives, are now generally supposed to be occasioned by the fluids in the secretions entering into combination with the medicine administered. It is to be regretted that no ancient author has given us a clear exposition of the hypothesis of Erasistratus. Galen gives a long list of cases, in which purgatives prove beneficial, such as erysipelas, epilepsy, apoplexy, gout, rheumatism, melancholy, and many chronic complaints. He insists strongly on the benefit derived from cholagogues for the cure of jaundice. (De purg. Med. vi.)

Antyllus, in an extract preserved by Aëtius, espouses the theory which maintains the specific operation of purgatives, and that they act by attracting the humours to which they are allied. He recommends them for various complaints, as malignant cutaneous diseases, spontaneous ulceration, and rheumatic affections. (iii, 23.)

The account of this subject, given by Oribasius, is taken from the works of Galen and Ruffus. It is too lengthy for our limits. Ruffus directs the surgeon to consider well the patient’s constitution, and regulate the dose of the medicine accordingly, as there is a great difference in the susceptibility of persons to be acted upon by purgatives. The following is a list of the purgatives described by Ruffus in this fragment: Polypody, iris, colocynth, phacoides (a species of spurge olive?), peplos, peplium, aloe, hippophaes, hippophæstum, clematis, pycnocomon, vines, thyme, epithyme, marjoram, Greek savory, poppies, cucumber, the smaller heliotrope, the lesser sesamoides, the tithymalli or spurges, the chamelæa, lathyris, agaric, and euphorbium. His description of the operation of each medicine bespeaks a good acquaintance with the subject. (Med. Collect. vii, 26.) See also Actuarius (Meth. Med. iii, 7.)

Haly Abbas makes some acute remarks on the action of Cathartics. Every purgative, he says, attracts the humour, to which it is allied. Different opinions, he adds, have been entertained regarding the _modus operandi_ in this case. Some maintain that, when such a medicine is swallowed, it goes to the members where its cognate humour is lodged, from which both are expelled by the expulsive faculty of the part, and return to the bowels together. This theory, however, he rejects. He mentions further that others maintain that the medicine attracts its peculiar fluid, as a magnet does iron; and of this theory he adopts a modification. He states it as his opinion that, when such a medicine has been swallowed, it attracts its cognate fluid from the surrounding parts, to which all the similar fluids in the body are afterwards determined, being conveyed thither by the veins. He gives a full account of all the purgatives known in his time. (Pract. iii, 53, 54.) Much the same theory is advocated, and fully explained by Serapion. (De Antidot. vii, 10.)

Avicenna and Rhases object to the doctrine of Galen that he appears to have maintained that there is a peculiar alliance between a purgative medicine of a certain class and the fluid or humour which it attracts, whereas they argue that, as there is no alliance between the magnet and the iron which it attracts, so is it in like manner with purgatives and the peculiar fluids which they evacuate. This, however, is only a more precise exposition of the theory advanced by Galen. Rhases (Cont. xii, 1); Avicenna (i, 4, 4.) The ancient theory is very acutely stated by Averrhoes (Collig. v, 21.) See also Mesue (Canones universales.) There appears to be some originality in the theory of Mesue. He says that a purgative medicine operates by occasioning a preternatural increase of the vital, or, as it is now called, animal heat of the part to which it is applied, whereby its attractive powers are increased. He maintains very ingeniously that purgation is an act of Nature, that is to say, an operation of the _vis medicatrix naturæ_, and that the medicine is merely the instrument of Nature in this case, for, he adds (as Hippocrates says), it is Nature, and not the physician, that cures diseases. A purgative medicine, then, he argues, acts by rousing the expulsive power of Nature. He joins the preceding authorities, however, in illustrating the attractive power of purgatives, by comparing it to the property which the magnet has of attracting iron, and amber of attracting straws. Purgative medicines, he says, have the faculty of clearing away the humours from the different parts of the body; from the stomach and intestines they do so readily; from the meseraic veins less easily; still more difficultly from the liver, and with the greatest possible difficulty from the joints, especially when the humours are impacted there. He forbids purgatives to be given in the extremes, either of hot or cold; in this practice observing the rule of Hippocrates. In hot weather, he says, emetics, and not purgatives, are indicated. The directions which he gives for correcting the noxious qualities of purgative medicines are highly important, but they are too lengthy for our limits. Aromatics added to purgatives, he says, dispel flatus; bitters do the same, and strengthen the stomach; saltish things increase their purgative powers; unctuous, by lubricating the intestines, accelerate their operation, and render it easier; and sweet substances render them less nauseous, and diminish their acrimony.

On the ancient arrangement of purgative medicines Dr. Paris makes the following pertinent remark: “It is impossible to concede to the opinion of Dr. Hamilton, that the different species of purgative medicines do not possess distinct powers over the different species of matter to be evacuated; on the contrary, there is reason for reviving the ancient theory, too inconsiderately abandoned, and which acknowledged these different distinctions in the operations of cathartic medicines under the appropriate names of hydragogues, cholagogues, &c.” (Pharmacop.) Dr. Alston likewise writes thus: “We have a very learned essay in confirmation of the ancient doctrine of the specific operation of purgatives by Dr. G. Martyn (Lond. 1740, in 8vo.) I shall not enter into the controversy, but only observe that there is nothing impossible, yea, nor improbable in the theory.” (Lectures.) See a learned dissertation on the action of purgatives in Mangeti ‘Bibliotheca Anatomica,’ i, 159. We may mention further that Dr. Murray in his Materia Medica inclines to the Galenic theory of the specific operation of purgatives. (c. viii.)

_On Cholagogues._ Most of these medicines are sufficiently well known, and therefore do not require to be treated of at greater length. See also Aëtius (iii) and Oribasius (M. Col. vii.)

The Arabian author Mesue gives the following table of Cholagogues:

_Clementer._ _Valenter._
{ Aloe { Agaricus.
{ Absinthium } Trahendo et { Asarum.
{ Rosa } astringendo, { Aristolochia.
{ Rhabarbarum } flavæ: nam aliæ { Bryonia.
{ Myrobalani } aliud vacuant. { Cyclaminus.
{ Pruna. { Cucumer agrestis.
Cholagoga { Tamar Indi } Astringendo. Radices { Dracunculus et arum.
{ Cassia } { Elleborus.
{ Manna. { Esula.
{ Viola nigra } Lubricando. { Hermodactylus.
{ Psyllium } { Iris.
{ Adiantum etiam phl. { Scilla.
{ Turbith.

It will be perceived that this list contains several articles with which the Greeks were unacquainted, namely, myrobalani, tamarindi, manna, and turbith. Of all these substances we have already given some account in the Appendix to the Third Section. Mesue calls the _tamarinds_, the fruit of an Indian palm-tree, the word _tamur_ signifying a _date_. He says, that they are excellent medicines for repressing the acrimony of the humours, purging bile, cooling the heat of the blood; that they prove useful in hot fevers, jaundice, inflammation of the stomach and liver, and that they stop vomiting. He calls them refrigerants and desiccants of the second order. To prevent them from hurting the stomach by their coldness, he recommends to give them with spikenard, mace, mastich, wormwood, fennel, or any such calefacients. Avicenna states their medicinal characters in the same terms. Serapion says, that they are desiccants and refrigerants in the third degree. Averrhoes ranks them among the refrigerants of the third, and desiccants of the second order. We have already mentioned, that the earlier commentators are decidedly of opinion, that the tripolium of the Greeks was _turbith_, but this is now generally acknowledged to have been a mistake. Mesue calls it the root of a milky herb, having leaves like a ferula, but smaller. Probably, however, as his commentator Manardus remarks, there is some mistake in the comparison of it to the ferula, as there is no resemblance between them. An accurate modern author, Moses Charras, calls it the bark of a milky root, which is chosen by its weight, dark-coloured without, white within, and clear from its pith, which is hard and fibrous. Mesue represents it to be a hot, nauseous purgative. It is given in powder, he says, to the amount of from one to two drachms.

Serapion recommends Cholagogues particularly in jaundice, inflammatory affections of the brain, mania, epilepsy, erysipelas, herpes, and tertian fever. He describes the following medicines as cholagogues: aloes, southernwood, black hellebore, scammony, colocynth, agaric, claterium, two species of mezereon, lathyris, the root of the lily, centaury, polypody, birthwort, myrobalaus (the yellow, the black, and the chebulic), pomegranate, cassia fistula, violet, ivy, and two Arabian substances _anabac_ and _alterariabin_. We are unable to determine what the last two were.

A modern writer, Christianus Margravius, in his ‘Materia Medica Contracta,’ thus enumerates the cholagogues of his time.

Cholagoga,
Cassia, manna, tamarindi, succusque rosarum,
Scammonium, myrobalani, rhabarbarum, aloe.

Professor Alpinus gives an accurate account of the ancient cholagogues. (Meth. Med. iii, 9.) The following medicines are said to be used as purgatives by the Hindoos; we give the scientific names as given by Dr. Wise: 1. Convolvulus turpethum. 2. Panicum frumentaceum. 3. Croton polyandrum. 4. Anthericum tuberosum. 5. Abrus precatorius. 6. Cessampelos hexandra. 7. Asclepias geminata. 8. Clotoria ternata. 9. A kind of convolvulus. 10. _Shabraba._ 11. Cassia fistula. 12. Plumbago zeylanica. 13. Acheranthes aspera. 14. Poa cynosurides. 15. Saccharum spontaneum. 16. _Jelaka?_. 17. A variety of the convolvulus turpethum. 18. _Ramaka._ 19. Bignonia suaveolens. 20. Terminalia chebula. 21. Indigofera tinctoria. 22. Ricinus communis. 23. Costus speciosus. 24. Euphorbia. 25. _Suptachetta._ 26. Calotropis gigantea. 27. Halicacabum cardiospermum. Of these the turbet, myrobalans, and castor oil, are particularly commended. (On Hindoo Medicine.)

_On Melanogogues._ The other Greek authorities treat of nearly the same number of Melanogogues. They are treated of methodically by Galen, Oribasius, and Aëtius. The _Alypias_ is supposed by Bernard (Nota in Nonni Epit.), and Prosper Alpinus, to have been the turbith; but, as is now maintained, erroneously. See Sprengel’s Notes on Dioscorides (iv, 177) and the preceding _Appendix_.

The following is Mesue’s list of Melanogogues:

_Clementer._ _Valenter._
{ Stæchas. { Balanus Myrepsica.
{ Aqua lactis. { Centaurium.
{ Fumaria. Fructus et { Colocynthis.
{ Epithymus. Flores { Coccum Gnidium.
Melanogoga { Thymus leviter, magis phleg. { Genista.
{ Polypodium. { Ricinus.
{ Jus gallorum phleg. cum phleg. { Senna.
{ melanogogum cum melanogog.
{ Armenus lapis.
{ Cyanus lapis.
Terrea { Nitrum.
{ Salis genera.

Of these medicines, the only one which we owe to the Arabians is _Senna_. 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.