Volume 1 / Book 3 — BOOK THIRD. (continued 6)

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.)

SECT. XLVI.—ON THE AFFECTIONS OF THE LIVER.

The affections of the liver being various (for it is subject to atony, inflammation, erysipelas, scirrhus, apostemes, ulcers, and obstructions), we shall treat first of atony of it, in which case, particularly those affected with it, are usually called hepatics. If, therefore, it evacuate the excrements in a state of chyle, but more liquid than natural, the distribution of the food to the liver being either diminished or altogether stopped, while the stomach is unaffected, it is to be inferred that the attractive power of the liver is in a weak state. But if they resemble the washings of newly-killed flesh, it is the alterative, and, as it has been called, the sanguificative power that is affected. But if the atony arise from a hot intemperament, in process of time it appears more feculent and very fetid, the bile being high-coloured and thick. Wherefore, the substance of the liver being already melted, the whole body also is melted down; and there is fever, anorexia, and vomiting of bile. When the intemperament is cold, the discharges are neither constant nor many, for the affection is a chronic one; and for several days the discharges from the belly will be more abundant, but less fetid, like the lees of thick blood, approaching to black bile. And many and various colours indicate a cold intemperament; for the fever is obscure, the face not collapsed, and there is rather a desire of food. Whichever of these intemperaments prevails, if complicated with the dry, the excrements appear drier and fewer in number, and there is more thirst; but, if the humid, they are more liquid and abundant, and the patients have less thirst. When the liver is inflamed, there is, in all cases, pain in the right hypochondrium, extending upwards as far as the clavicle, but downwards as far as the false ribs; an acute fever, dry cough, thirst, loathing of food, and difficulty of breathing; the tongue at first appears red, but afterwards black; there is vomiting of bile, and the belly is constipated. These symptoms being like to those of pleurisy, we have stated the difference under the head of pleurisy. When erysipelas is seated in the liver, the inflammatory heat is intense, there is ardent fever, and marasmus supervenes. In particular, when the concave parts of the liver are inflamed, there is nausea and vomitings, anorexia, intense inflammatory heat, deliquium animi; and the parts often become congealed, so that dropsical effusions derive their origin from hence. When the convex parts are inflamed, the other symptoms just now enumerated are present, with a visible swelling along its circumference, which swelling is manifest both to the sight and the touch. These are the symptoms of a strong and great inflammation; but if it is weak, we must order the patient to take in a large inspiration, and, if he says that he has pain in the right hypochondrium, we may conclude that there is moderate inflammation of the liver. But if an oblong tumour of a phlegmonous nature appear in the position of the muscles which lie over it, and none of the aforesaid symptoms be present, we know that the muscles themselves are inflamed. Weight with distension, and a sensation of pain in the right hypochondrium, without swelling or fever, indicate an obstruction of the veins, at the place where those of the porta and concave parts of the liver join those of its convex parts. When the inflammation is converted into an abscess, the pain and distension increase, inordinate rigors come on, and they cannot lie on the left side without increasing the pain in the liver. When the abscess bursts, the matter is discharged freely by the urine or bowels. If the tumour pass into a scirrhous state, the pain is diminished, but there is a manifest swelling, attended with hardness, and the surrounding parts become emaciated. But, in process of time, the diagnosis becomes difficult; for dropsy supervenes, and the whole hypochondrium is concealed by the water. For a hot intemperament of the Liver, we must use those things which have the properties of moderately cooling and strengthening the viscus, such as endive and succory, sometimes eaten raw and sometimes boiled with coriander; and the decoction and juice of them may be drunk; and not only thus, but the plant, when sprinkled dry upon honied water, relieves hot and cold intemperaments of the liver. And the species of those herbs called intybus, and troximus, and the sow-thistle, are possessed of similar properties. And a cupful of the juice of citron added to honied water has the same effect, and that of the brake in like manner. But if the intemperament is moderate and complicated with obstruction, these things may be given in some light wine, or some of the diuretics. And the following pill may be taken: Of succory, dr. iv; of the root of ground-pine, dr. iv; give in boiled honey to the size of a Pontic nut, and let the patient take some warm water, and then let him be made to drink the propomata from opium and the seed of hyoscyamus, and the antidote of Philo. In those cases in which the heat is intense, it may be very proper to give of the oil of roses, or of apples, in a draught. For food, let them take of the juice of ptisan, or chondrus, with hydrorosatum, and bread in like manner out of water, with some of the sweet potions; and, in a word, let them take such food as is moderately cooling without being obstruent; abstaining altogether from wine, unless they require it for some other cause, such as atony of the stomach, and in that case the kind which is given should be thin, weak, and watery. And erysipelas of the liver must be cured in like manner. When the intemperament is cold, we must proceed on the opposite mode; we must give them bread with wine, and cabbage which has been twice or three times boiled. Let them taste lightly of chesnuts, take what is sufficient of grapes, and of the flesh of fowls, and drink wine. Let them get a propoma from eupatorium, asarabacca, or the medicine from pepper; and a selection must be made for them from among the remedies formerly mentioned for colic and dysentery. The medicines called cyphoid do not suit entirely with the hot intemperaments, unless the heat be small and joined to much humidity; but they are excellent remedies for the cold, and more especially if complicated with humidity or obstruction of the liver. When the obstruction is occasioned by thick and viscid humours, we may give the myacantha (wild asparagus?), more especially the fruit of it, and the rind of the root of bay, agrimony in oxymel, or in the decoction of bitter lupines, with rue and pepper. And the flour of lupines in a draught; and of roots of cappers, p. ij; of costus, p. j, with wine; and the medicine from cacanus, are of use for obstructions occasioned by thick and viscid humours; also the iris, the fruit and rind of pistaches, horehound, and bitter almonds, and the trochisks from them, the root of dracunculus, and wakerobin, agaric, vinegar of squills, and oxymel. And the dried liver of a wolf, powdered and given with sweet wine to the amount of a spoonful, is applicable for all affections of the liver. And the antidote Theodoretus is one of the best remedies for obstructions of the liver, scirrhus, chronic inflammation, colics, and jaundice; and in like manner the picra with oxymel. The food which is given should be of a heating and deobstruent nature, such as leeks in oxymel, marsh asparagus, and capers in like manner; and the other articles of food should be boiled with some of the calefacient and deobstruent condiments. They should drink light old wine, avoiding such as are thicker, and also frequent baths, more especially after food. If the affection be protracted, we may have recourse to venesection and purging, if nothing prevent. When the liver is inflamed, we must bleed from the right arm without delay, and take away a great quantity, if the strength permit. And over the viscus we must apply externally a cataplasm made of the flour of barley, of fenugreek, and of linseed, with dates, or quinces and the flower of melilot, wormwood, and oil of chamomile; in a word, we must mix astringents with emollients. The epithemes to be applied are that of Nileus, the fragrant, the Philagrianum, that of Apollophanes, that made of melilots, and the one called Copton. For great inflammations, the following one is of tried efficacy: Of the flowers of wormwood, of Celtic nard, of asarabacca, of saffron, of each, oz. j; of iris, of myrrh, of storax, of bdellium, of ammoniac perfume, of each, oz. ij; of a calf’s marrow, oz. iv; of cerate of lentisk, lb. iv. Oxymel is also to be given to them, and the simple remedies, such as asarabacca, Celtic or Indian nard, bog-rush, and Macedonian parsley. We must stimulate the bowels by nettle, or the herb mercury eaten boiled; and during the decline of the complaint we must give of dodder of thyme (epithymum), and of polypody in honied water; and evacuate the bowels with a clyster, in the beginning by means of honied water with salts or nitre, but in the decline mix with hyssop, marjoram, or bastard saffron, or centaury and colocynth. In a word, the concave parts of the liver are to be purged by the belly, and the convex by the urine. For food, give them the juice of ptisan in which parsley has been boiled. We have already stated the cure of erysipelatous inflammation. When an aposteme is formed, we must promote its rupture, by applying a cataplasm of the composition called trispermus, with rosin, manna, pitch, the roots of marshmallows, pigeon’s dung, and goat’s dung. But let them take the propoma from the decoction of poley, that of the fumitory which grows in hedges, reduced to a third part, the decoction of treacle-mustard or of succory, and of the root of wall-germander. When the rupture takes place, honied water and the other things mentioned for ulcerated kidneys may be given; and externally the plaster of Mnasæus, and the other emollient plasters, and the Icesian, or that from willows may be applied. When the liver is in a scirrhous state, there is little hope of recovery, as the affection will pass into dropsy; and yet it may be attempted by mixing ammoniac, bdellium, marrow, grease, and things of similar properties, with emollients. The patients may take draughts of such things as will act as deobstruents and detergents of the viscus, such as diuretics and lithontriptics, along with those just now mentioned for obstruction of the liver; the diet being regulated accordingly.

Commentary. Consult Hippocrates (de Intern. Affect. 30); Galen (Meth. Med. xiii; Sec. Loc. vii); Aretæus (Morb. Acut. ii, 7; Morb. Chron. i, 13); Celsus (iv. 8); Alexander (vii, 19); Aëtius (x, i); Oribasius (Loc. Affec. iv, 96); Nonnus (182); Cælius Aurelianus (Pass. Tard. iii, 4); Octavius Horatianus (ii, 13); Marcellus (de Med. 22); Scribonius Largus (30); Avicenna (iii, 14, 1); Avenzoar (i, 13); Haly Abbas (Theor. ix, 30; Pract. vii, 31); Alsaharavius (Pract. xviii); Serapion (iv); Rhases (Divis. 62; ad Mansor. ix, 67; Contin. xvi.)

Hippocrates describes three varieties of hepatic disease, which appear to have been bilious fevers. It is not easy to define the principles upon which his practice is directed. He mentions, however, emollient applications, bleeding, purging, and vomiting; and, when the disease is protracted, recommends the side to be burned with spindles of box-wood smeared with oil. He directs abscesses of the liver to be opened by the cautery. (Coac. 457.) He states that abscesses of the liver are least dangerous when they open externally; more so when they open internally; and most of all when they open both internally and externally. (Prognost. 7.) He makes mention of hydatids, and says of them that when they burst into the cavity of the peritoneum, the case proves fatal. (vii, 54; where see the Comment. of Theophilus and Damascius, ed. Dietz, p. 540.)

Galen has laid down the principles upon which inflammation of the liver should be treated in the 13th book of his ‘Methodus Medendi.’ We can only afford room for his conclusions. He approves of venesection with the intention of producing revulsion. Such articles of food and medicine are to be given as will emulge the biliary ducts without occasioning irritation, and everything of the opposite kind is to be abstained from. Wherefore such things as are sweet and viscid are to be avoided, and only such as are detergent without pungency are to be allowed. Of this class are ptisan and oxymel much diluted. Astringents, such as pomegranates, are improper, because they occasion contraction of the vessels; and they are more especially to be avoided when the concave side of the liver is affected. When the convex is affected, these articles, being altered by the action of the liver before they reach the seat of the disease, prove less prejudicial. When the concave side is the seat of the disease, he directs us to evacuate by the bowels, which may be accomplished by mixing with the food cnicus (carthamus tinctorius?) the herb mercury, &c.; but, if stronger medicines are required, black hellebore, colocynth, the small centaury, and the like, may be given. When the convex side is affected, he directs us to give diuretics; at first parsley, but, after the inflammation has subsided, the stronger ones, such as Celtic nard, valerian, spignel, &c. He animadverts in strong terms upon the practice of the Thessalian Asses, so he calls the Methodists.

We regret that our limits prevent us from doing justice to the views of Aretæus. The liver, he states, is the grand seat of sanguification, being itself but a concretion of blood. Hence, he says, diseases of it prove speedily fatal. He accounts for the pain which is felt at the top of the shoulder or clavicle in this way: the liver, being enlarged and becoming heavier than natural, drags down the diaphragm to which it is attached, and thus stretches also the pleura from its upper adhesions, whereby pain in the part is produced. A crisis, he says, may take place by a hemorrhage, a copious discharge of bile, or of urine; or the disease may terminate in suppuration, or in dropsy. When pus is formed, it may be discharged by urine, by the bowels, or it may point outwardly. In this last case, he recommends us to open it with an instrument red hot. When it does not suppurate it is apt to end in scirrhus, which is marked by a dull pain in the part. His treatment of acute hepatitis consists of venesection, refrigerant and discutient applications externally, cupping or leeching the side affected, then applying cerates and emollient ointments, consisting of attenuants and diuretics, such as wormwood, cider, &c. The food is to be light, of easy distribution, and diuretic. His treatment of chronic disease is varied, according as the matter passes by the urine or the bowels; but the chapter on it is incomplete.

Celsus at the commencement recommends bleeding, purging even with black hellebore, cataplasms at first repellent and then calefacient. Diuretics are to be given, such as thyme, hyssop, &c.; and all cold things are to be avoided. When a vomica forms, it is to be opened and burnt.

Alexander’s account is full and judicious. He says that, in cases of obstruction of the liver, when deobstruents are given before the swelling is softened, the juices being overheated become like stones and cannot be discussed. He alludes, of course, to hepatic calculi, or gall-stones. He gives copious directions for emollient ointments to be rubbed into the side to dispel the enlargement of the liver.

In treating of scirrhus, Aëtius recommends the emollient ointments, cupping, leeching, calefacient plasters, sinapisms, burning by medicines or by the actual cautery.

The account given by Actuarius is in so far important, as it shows that the views of practice had not changed in his days. In inflammation, he recommends to bleed two or three times, and to unite emollients with deobstruents in the external applications.

For a full exposition of the doctrines of the Methodists, we must refer to Cælius Aurelianus, of whose opinions we can afford room only for a very brief outline. The symptoms of scirrhus of the liver, as stated by him, are a round circumscribed tumour felt below the ribs, the colour jaundiced, the urine muddy, pain extending to the throat of the affected side, difficulty of lying on the left side, as this posture suspends the enlarged viscus. (By the way, Cassius assigns the same reason why persons labouring under disease of the liver or spleen lie easiest on the affected side. Probl. vi.) At the commencement he recommends fomentations, cataplasms, laxative food, and then cupping, scarifications, and leeching. When the attack is violent, venesection is to be premised. Frequent changes, acrid food, and emetics with vinegar of squills or hellebore are also mentioned. He recommends a sea-voyage, vapour-baths, hot springs, the sand-bath, and various stimulant and rubefacient applications to the side. He delivers his strictures very freely upon the practice of the other sects. Thus he justly condemns as too bold and dangerous a measure the proposal of Erasistratus to lay bare the liver, and apply the remedies direct to the part affected. He thinks Asclepiades improperly rejected gestation, baths, cataplasms, and emollient ointments. He also condemns the free use of cauteries to the affected side.

Serapion, like Alexander, states strongly the danger of using discutients before emollients, lest the juices become indurated. No ancient author has treated of the diseases of the liver so fully as Avicenna. He is most minute in his distinctions of disease, and particular in his application of remedies. Among other diseased states of the viscus, he mentions diminution of bulk. Had not inspectiones cadaverum been common in ancient times, the existence of this state of diseased structure could not have been ascertained. In abscess, he and Serapion make mention of taraxacum or the dandelion, which was recommended by the late Dr. Pemberton in cases of diseased liver, and is still used occasionally. Haly Abbas directs us, when suppuration takes place, to determine to the kidneys by diuretics; and, when the abscess bursts into the cavity of the peritoneum, he advises us to open it. When it makes its way to the stomach or bowels, he recommends us to promote its discharge by purging. He remarks that sometimes an abscess will form externally to the liver and put on the appearance of hepatic abscess. He directs it to be opened with aperient medicines or the lancet. He takes notice of the pain at the top of the shoulder, which, like Aretæus, he attributes to the dragging down of the parts by the heavy liver. In the cold aposteme (chronic inflammation?) he recommends wormwood, fenugreek, hyssop, spikenard, fennel, and the like. One of his favourite remedies for hepatic disease is rhubarb. Alsaharavius gives a long account of these diseases. Inflammation he treats by bleeding, various laxative and cooling medicines, emollient plasters, &c. In obstruction he gives rhubarb, wormwood, fennel, endive, &c.; and bleeds, if there be a sanguineous plethora. He treats fully of a discharge of blood from the liver. When it arises from the bursting of a vein after excessive fatigue, he directs us to bleed; but when it proceeds from relaxation and debility, he recommends astringents externally and internally. The account of hepatic diseases given by Rhases in his ‘Continens’ is particularly excellent, but it is too lengthy for our limits. He explains the pain at the top of the shoulder in the same way as Aretæus. He mentions that gross food produces enlargement of the liver, and hence animals fed on figs have large livers. For inflammation he recommends at first depletion and afterwards refrigerants, such as camphor, fleawort, and even snow-water. He recommends aloes with wormwood as a deobstruent cathartic.

SECT. XLVII.—ON CACHEXIA.

We are accustomed to call the commencement of dropsical affections cachexia. Wherefore we must cure it by bleeding, if nothing prevent, at intervals, and continuing the abstraction until the third or fourth day. But, in an especial manner, we must evacuate those who have fallen into this affection from retention of the hemorrhoidal or menstrual discharge; as in those cases which arise from a copious evacuation, we must abstain from venesection, and by all means purge with the hiera from colocynth. The diet should be light and desiccative; and recourse must be had to natural baths, namely the aluminous, and more especially the nitrous, and then the sulphureous; but the other kind of baths may be taken at greater intervals. Let them be exercised in every way, more especially by those who are called jatraliptæ. At last they must be put under a course of hellebore. They are wonderfully remedied by a propoma of wormwood, and by sinapisms and dropaces. If the affection is converted into dropsy, we must have recourse to the treatment applicable for dropsical cases in the manner about to be explained.

Commentary. Almost all the authors referred to in the preceding Section may be consulted on cachexia and dropsy.

Aretæus gives an accurate account of this affection, which, he says, usually terminates in dropsy, phthisis, or wasting. He mentions many symptoms of it, such as œdema, difficulty of breathing, and so forth; and he correctly remarks that the alvine discharges are dry, white, crude, and without bile. His chapter on the treatment unfortunately is lost.

Cælius Aurelianus says that Themison was the first who explained the treatment of cachexia. He mentions as causes of the disease intemperance, the improper use of medicines, hardness of the liver or spleen, long-continued hemorrhoidal discharge, vomiting, protracted fevers, &c. His treatment is judiciously varied according to the cause of the disease, and is given at great length.

Aëtius gives a very interesting account of the views and practice of Archigenes. He says the disease is generally occasioned by scirrhus of the liver or spleen. Like our author, he recommends bleeding if not contra-indicated, and purging with drastic cathartics, such as the hiera from colocynth, friction, rubefacients, exercise, the bath, and thin white wines. Celsus admits of bleeding, but not until after purging, friction, unction, and exercise have failed to restore the health.

Serapion expresses himself in much the same terms as our author and Aëtius respecting venesection; but Avicenna recommends not to have recourse to it unless there be a sanguineous plethora. He also forbids baths of sweet water, but otherwise he adopts the treatment recommended by the Greeks.

SECT. XLVIII.—ON DROPSY.

When the liver is greatly congealed, sometimes primarily, as when it has been inflamed, indurated, or otherwise affected, or when from sympathy with other parts, the process of sanguification ceases, and the affection is called dropsy. When a great quantity of air is collected with a small quantity of fluid between the peritoneum and intestines, so that the abdomen when struck sounds like a drum, the dropsy in this case gets the name of tympanites, being formed by flatulence about the stomach, belly, and colon, and by chronic fevers. But sometimes from hardness of the peritoneum and of the uterus in women, or from scirrhus, on the contrary, a great collection of fluid with a very small proportion of air is formed in the same parts, being confined as it were in a bladder, when the dropsy is named ascites, and is occasioned by the afore-mentioned causes; but, for the most part, it arises from hardness and scirrhus about the spleen and liver, and from chronic defluxions about the intestines; whereby it happens that the belly is swelled, while the rest of the body is melted owing to its not being nourished. Sometimes throughout the whole body a colder and more pituitous blood is collected, either coming from the liver, or deriving its origin from a melting down of the flesh of the whole body, which is as it were converted into water, so that the whole body appears white and pituitous like a corpse, and then the affection is called leucophlegmatia, dropsy of the flesh, or anasarca, being occasioned by protracted fevers, cachexia of the stomach, suppression of long-continued hemorrhoidal discharges, the female flux, dyspnœa, inordinate insomnolency, and similar causes. In treating these complaints, we commence generally with evacuation; but in ascites and tympanites it is by administering hydrogogue medicines; and in anasarca by bloodletting, more especially when the affection is formed by retention of the hemorrhoidal or menstrual discharges, unless the patients had been previously bled for cachexia; and in this case, as in cachexia, the evacuation must be made at intervals. Then, having carefully triturated the dried dung of an ox of the herd, boil it in oxycrate or oxymel, and sprinkling on it a fourth part of sulphur, apply it over the whole belly; or, apply a cataplasm of goat’s dung with the urine of a child, made of the thickness of bath-sordes. These things purge strongly by the belly; and we may use cataplasms made of leaven, dried figs, calcined lime, nitre, iris, cardamom, native sulphur, ammoniac, bay-berries, stavesacre, the dung of wild pigeons, all or some of these may be used with oxymel. After which the epitheme, called spongium, made of goat’s dung, evacuates the fluids in a wonderful manner, both by the insensible pores and by the belly. Afterwards we must apply desiccative plasters, that from willows, the Icesian, the barber’s, that from bay-berries, the Polyarchium, and that from seeds. And the following one is wonderfully efficacious, for it fetches, as it were, the fluids from the deep-seated parts: Of the stone pyrites, dr. xij; of native sulphur, dr. xij; of ammoniac perfume, dr. xij; of cumin, dr. xvj; of nitre, dr. xij; add to a little wax and turpentine, and spreading it upon a piece of skin, apply to the whole belly. Let them take the propoma (liqueur) made by boiling the root of vervain-mallow in wine, or macerate the wild cucumber in austere wine, and give every three days, adding a cupful every day, until the dose amount to three cupfuls. The following is a very compound mixture: Of balsam, of nard, of cassia, of cumin, of liquorice, of St. John’s-wort, of bog-rush, of asarabacca, of carrot, of amomum, of myrrh, of Macedonian parsley, of sweet hay, of pepper, of hartwort, of cow-parsnip, equal parts. Each of these produces a good effect by itself, and in like manner all the diuretics. Squill baked and triturated with honey, and given as a linctus, provokes urine without trouble; or it may be boiled in the water which is drunk. And the following is an excellent remedy: Boil lb. ij of the inner part of squills in iij sextarii of austere wine until it be reduced to one third; give every day of this wine, beginning with a mystrum, until the dose amount to an ounce. The following is an excellent diuretic: Of moist alum, the size of a bean; dissolve in water; strain through a linen cloth; and give to drink every third day, or every alternate day. Picra given in oxymel, the theodoret, and the trochisk from bitter almonds also suit with them. There are many hydragogues, but the following are of approved efficacy: The seeds of the thymelæa (grana cnidia), xl or l; or lathyrides, xx or xxx; or of euphorbium, v or vj siliquæ; or of flakes of copper, dr. ij or iij; being mixed with crumbs of bread and formed into pills; or the juice of the rind of elder-root, drunk with prepared wine; or of the leaves of mezeron, of burnt copper, and of anise, equal parts; give in water at first to the amount of dr. j; and afterwards of dr. ij, or more. And the following are admirable pills: Of aloes, of euphorbium, of grana cnidia, of each, oz. j; of rhubarb, oz. ss; mix together with the juice of cabbage, and form into pills, and give to the amount of viij or ix siliquæ. And the antidote from cloves evacuates water in a wonderful manner. And we must try the effect of a hydragogue wine. The following makes an excellent one: Of squills, oz. iij; of parsley-seed, of the rind of the root of capers, of pepper, of each, dr. iv; of peeled grana cnidia, dr. j; of the Indian leaf, two balls; of best wine, xij heminæ; of raw honey, dr. xvj; beat together, sift, and macerate in the wine, but triturate the squill. The dose is three cyathi. After the evacuation of the water, we must use the theriac. And ox-dung dried and drunk to the amount of a spoonful every day is of mighty use. We must use the most stimulant clysters, unless the belly be spontaneously very loose, in which case we must rather use things for drying it up. When women are affected with dropsy we must use this pessary: Of anise, of cardamom, of cumin, of nitre, of birthwort, of fenugreek, of pennyroyal, of the inner part of figs, equal parts; mix together in the oil called Susinum, and apply per vaginam. Afterwards we may use the natural baths perseveringly, and the sand-bath, but we must abstain from the others; but if they do ever go into a bath, let them sprinkle the body with powders from nitre, salts, mustard, lime, and the like. These things even without bathing are useful, when rubbed into the belly in a dry state, or with oil. In anasarca they must exercise the other parts as much as possible, and use dry friction in the sun. And a desiccative diet should be taken. Let them, therefore, eat pickle, mustard, garlic, wild and dry fowls, asparagus, picktooth fennel, leeks, wild carrot, and the other wild pot-herbs; and the theriac salts, or those of Iamblichus may be mixed with condiments; and old light diuretic wine may be used, or if it is at hand, the wine prepared with salt water. But the patients must abstain from much drink of any kind, and from water altogether.

When the dropsy is attended with fever, the patient must abstain from the more heating and acrid food or remedies; but we may give them intermixed with other things in case of urgent necessity. In tympanites, purgatives and every medicine which wastes the body must be rejected, and also the more drastic diuretics; and we must use both externally and internally such things as can attenuate and dissipate the flatus; and dry-cupping may be frequently applied over the whole belly. When those who have ascites are not benefited by any of the remedies already described, we must have recourse to paracentesis, which does not apply to any of the other varieties of dropsy.

Commentary. See Hippocrates (de Intern. Affect. 25; de Ratione Victus in Morb. Acut.), and Galen’s Commentary on the same (Prognost.), with the Commentary of Stephanus (ed. Dietz), and almost all the authors who treat of hepatic diseases may be consulted.

Hippocrates gives a tolerably correct account of the causes and treatment of dropsy. The varieties of the disease described by him are dropsy from the drinking of cold water, from disease of the liver, and from disease of the spleen. He further states that it is frequently the consequence of protracted fevers, diarrhœa, dysentery, and quartan fevers (de Aer. &c.) He mentions a species of dropsy which he calls the dry (Aph. iv, 11), which has been generally referred to tympanitis. See Littré (t. iv, 416.) In certain cases attended with dyspnœa he recommends venesection; and Galen in his Commentary states that these cases are, when the disease is preceded by suppression of the hemorrhoidal or menstrual discharges, or is connected with plethora. But no one, he says, ventures to bleed in tympanites or ascites. Hence Avicenna and most of the ancient authorities forbid venesection in dropsy, except under the circumstances mentioned by Galen. Galen says, indeed, in his work (de Venesect. ad Erasistrat.) that he had sometimes cured dropsy by bleeding; but it is not to be understood that he approved of it as a common practice. In short, he was no Sangrado, but had anticipated Blackall. One of his hydragogue potions is composed of cantharides. (De Reg. in Morb. Acut.) Hippocrates recommends us to perform paracentesis thoracis in the side at the third rib from the last. He also approves of paracentesis abdominis in cases of ascites; and directs us to burn the region of the liver, when that viscus is affected. He further approves of free scarifications of the testicles and thighs. He has described hydrops uteri, or hydrometra, a case which, although of rare occurrence, is occasionally met with. See Van Swieten (Comment. 1224); Vesalius (de Fabrica Hum. v, 9); Monro (Works), and Dr. A. T. Thomson (Paper in the Med. Chir. Trans. xiii, 1.)

Galen gives a long list of external and internal remedies for dropsical complaints. (Sec. Loc. ix.) Ox-dung mentioned by our author was a common remedy in ancient times, according to Galen. Diogenes Laertius relates that the celebrated Heraclitus died lying in a bed of it. Upon the authority of Antonius Musa, Galen recommends a cataplasm containing elaterium, stavesacre, and hyssop. He recommends a vinous preparation of elder. Pliny particularly commends this medicine in dropsy, and most of the ancient authorities make mention of its diuretic properties. Galen says that the liver is affected in all cases of dropsy. (De Locis, v, 6.) In like manner Stephanus, the commentator on Hippocrates, states that in all cases of dropsy the liver is affected, either primarily or sympathetically. Hippocrates refers one species of dropsy to disease of the parts situated in the loins, by which Galen and Stephanus agree that he means the jejunum, mesaraic veins and kidneys. (Ed. Dietz. 139.)

Celsus describes three varieties of dropsy, namely, ascites, anasarca, and tympanites. He enjoins restriction as to food and drink, and recommends walking, friction, and sudorifics, such as heated sand and warm baths. He gives a long list of diuretics, as iris, valerian, saffron, cinnamon, &c. In tympanites he recommends emetics, cupping the belly, rubbing it with rubefacients, and applying sinapisms to it, or burning eschars on it with heated irons. In anasarca he recommends scarifications at the inner part of the leg, squills in a linctus, and the like. He approves of tapping in ascites.

Aretæus describes the symptoms of dropsy with great accuracy and elegance. He says it is a most unseemly disease, from which few recover, and those more by the aid of the gods than of art. He treats of the three varieties already mentioned, and also makes mention of hydatids. Hydatids, by the way, are described also by Galen (Comm. ad Aphor. vii, 55), and Rhases (Cont. vii). He remarks that it is wonderful how much the patient in dropsy flatters himself with hopes of recovery, more than in many other diseases far less dangerous. He states that there are partial dropsies, such as of the head, lungs, liver, spleen, and uterus. He mentions among the exciting causes of the disease the drinking of cold water, flatulent food, and the insect buprestis (meloe vesicatoria L.)

From a passage in Plutarch, it would appear that certain forms of dropsy had at one time been thought infectious. (De Serâ Num. Vind.)

Dioscorides and Ruffus praise elaterium as a hydragogue in dropsy. In the ‘Euporista,’ baked squills and oxymel are particularly commended, with various cataplasms externally.

Cælius Aurelianus states fully the causes of dropsy, such as cachexia, protracted fevers, hardness of the liver, spleen, peritoneum, or uterus; dyspnœa, cæliac affection, dysentery, retention of the hemorrhoidal or menstrual discharges, abstinence, an unseasonable draught of water, especially of salt water, the abuse of medicines, and so forth. He maintains, however, that the disease is the same, from whatever cause it arises. The common symptoms of all its varieties are said by him to be swelling, torpor, difficult breathing, disturbed sleep, thirst, diminished urine, and sometimes latent fever. He informs us that Erasistratus in his dissections generally found the liver indurated. His external applications are very similar to those of our author. He particularly commends a vinous tincture of squills as a hydragogue. He approves highly of paracentesis, and has answered all the objections which had been made to the operation. He mentions that Asclepiades practised scarifications at the ankles.

The ordinary cases of dropsy are well stated by Serenus Samonicus in the following lines:

Among his internal remedies he mentions broom-seeds, the wine of squills, elder, and hellebore.

Alexander states that a coldness of the liver is the cause of dropsy, in consequence of which it is no longer able to form blood, but converts the fluids into water, phlegm, or air. Hence the distinction of dropsy into ascites, anasarca, and tympanites. In certain cases of anasarca he permits venesection, in order to relieve the depression of the system. He adds afterwards that, if not only the liver, but also the spleen and stomach appear hard, and especially if combined with plethora of blood, venesection is to be had recourse to before all other remedies. But in ascites and tympanites he agrees with Galen in condemning venesection, and trusts principally to purging and friction. Like our author, he commends copper and the leaves of elder. Exercise, he says, is adapted in an especial manner to dropsical complaints, either by sea, on horseback, or in a couch. Horace, by the way, no doubt, alludes to the established practice of taking exercise for the cure of dropsy in the following passage:

Alexander has stated correctly that the disease sometimes derives its origin from disease of the uterus, kidneys, spleen, liver, colon, heart, or other organ of the body. He remarks that dropsy is apt to come on in phthisical cases.

Our author has merely condensed the account given by Aëtius. His list of diuretics contains squills, spikenard, alum, spurge, burnt copper, &c. Like Hippocrates, he approves highly of scarifications at the inner ankle. Upon the authority of Antyllus, he recommends lying in heated salt. In like manner, Galen and some of the other authorities speak favorably of insolation while the patient lies on sand, wheat, or the like. The sand-bath is mentioned as a remedy for dropsy by the earlier modern writers on medicine. See Theodoricus (iii, 33).

Leo, like preceding authorities, refers all dropsies to a coldness of the liver, and says they are mostly incurable. We do not find that Avicenna, Rhases, Avenzoar, and Serapion make any material alteration on the practice of the Greeks. In certain cases of anasarca they permit venesection, but generally condemn it in ascites. They praise mezereon or the chamelæa strongly as a diuretic; and also make mention of colocynth and scammony. Haly Abbas treats separately of anasarca, ascites, tympanites, and dropsy from a hot cause. When anasarca is connected with an obstructed secretion, he approves of bleeding; and, in general, recommends abstinence from drink, exercise in the sun, friction with sand or hard towels, sulphureous baths and diuretics. He concludes with an advice not to persevere too long in the use of any one medicine. In the treatment of ascites, he recommends mezereon, colocynth, &c., but disapproves in general of paracentesis. For tympanitis he prescribes various carminatives, such as parsley, fennel, spikenard, mastich, southernwood, melilot, &c. Alsaharavius expresses himself strongly in favour of venesection for anasarca; and for all kinds of dropsy recommends the sand-bath, sudorifics, and the common remedies mentioned above. The general causes of dropsy upon which Rhases most insists are induration of the liver and debility of the kidneys, so that they no longer attract the aqueous superfluity of the blood. He approves of paracentesis and scarifications of the feet and testicles when they are much swelled. Among his hydragogues, the most powerful are white hellebore, elaterium, scammony, and euphorbium. He mentions that he had known several dropsical cases cured by a spontaneous diarrhœa, and hence he recommends us not to stop one when it comes on. When dropsy is connected with the retention of a natural evacuation, he approves of bleeding. He speaks favorably of the elder as a diuretic.

SECT. XLIX.—ON THE SPLEEN.

The use of the spleen being to attract from the liver the melancholic humour, which is, as it were, the lees of the blood, if its attractive power be weakened, or the passage obstructed by which this was formerly attracted, the black jaundice is formed, blood in an unpurified state being distributed over the whole body; and if there be weight and distension about the spleen, or if there be also pain, obstruction is indicated; but if there be none of these, it is weakness of the attractive power. But vomiting of black bile taking place without fever, or any other symptom of malignity, indicates a weakness of the retentive faculty of the spleen. A weakness of the expulsive faculty will bring on anorexia, the melancholic superfluity being no longer carried to the orifice of the stomach and exciting the appetite. When the melancholic humour is infarcted in the spleen, in the first place inflammation of it occurs, indicated by heat, pain, and tightness, but afterwards it passes into scirrhus, the heat and pain having ceased, while the swelling and hardness remain. Persons thus affected have fetor of the mouth, their gums are corroded, and ulcers in their legs are difficult to heal. When the liver sympathises, dropsy takes place, as formerly mentioned; wherefore intemperaments of it are to be cured like those of the liver. But when inflammation is present, we must bleed from the left arm at the elbow, or at the extremity of the hand, in order that revulsion may take place from as great a distance as possible, and also because of some natural alliance between these parts. Then we are to apply a cataplasm of attenuants which are not manifestly caleficient, intermixing some of the astringents with them. Such is that natural substance called the flower of salt. And this is an admirable cataplasm: Of fenugreek, oz. iv; of barley-flour, of cresses, of each, oz. j; of fat figs, lb. j; of the herb vervain dried, oz. j; macerate the figs in the most acrid vinegar, and boil with the other things already bruised together, and then boil again; or apply goat’s dung boiled with raw barley-meal in oxycrate; and, if you choose, it may receive also some flower of salt. But having first used a fomentation of oil of privet with a little vinegar, use the emollient ointments; and first the more simple, such as this: Of wax, lb. iss; of the fat of bulls, lb. j; of nitre, oz. iij; of turpentine, of the fruit of the chaste-tree, of the bark of the root of capers, of each, oz. v; having boiled the soluble ingredients, sprinkle the powders above. And the malagma of Nileus is an excellent one. If the inflammation is converted into scirrhus, we must use the most powerful applications so as to stimulate the skin, such as the one from goats’ dung, and that from citrons, also that of Macherion, the barber’s, the one from bay-berries, and that from willows. This one I have found to answer upon trial: Of arsenic, oz. ij; of sandarach, oz. ij; of wax, of turpentine, of each, lib. j; of dry pitch, lb. j; of galbanum, oz. j; of opopanax, oz. j; of the bark of the root of capers, of nut ben, of each, oz. iv; of ammoniac perfume, scr. vj; of the oil of nard, and of privet, oz. v. And ammoniac, when rubbed over the spleen with vinegar, is often of great use, and also, when drunk to the amount of three or four scr. with one scr. of castor, while sitting in the hip-bath, having previously chewed dried figs and spit them out. Or of ammoniac, p. j; of castor, p. j; give one drachm of these things, and it will be of great service for scirrhus; and, in like manner, the bark of capers, triturated with vinegar and applied. The same, when drunk with vinegar or oxymel, evacuates thick and viscid humours, and sometimes blood. And the bark of the willow is rubbed in similarly. And the ashes of the brazier’s shop, when applied with raw barley-meal in oxymel, is of use; and the juice of centaury, when applied externally, and when taken in a draught; and the decoction of bitter lupines, when drunk with rue and pepper; and its flour, when applied as a poultice; and the water in which heated iron has been often extinguished, when given to the amount of three cyathi to such as have fever; and to such as are free from fever, to the amount of one cyathus with wine and vinegar; or the root of the wild dock with squills, to the amount of three oboli; or of wall germander, and of wild thyme, an acetabulum; all these may be given with oxymel; or, give two oboli of the juice of the pimpernel having a blue flower (anagallis cærulea?) with oxycrate; or vinegar of squills, or oxymel. These are compound medicines: Of the root of panacea, of ammoniac perfume, of the rind of the root of capers, of fuller’s herb, of the inner part of baked squills, equal parts; give one drachm. It is also of use in asthmatic and dropsical cases.—Another: Of the fruit of tamarisk, dr. iv; of pepper, dr. iv; of spikenard, dr. ij; of ammoniac perfume, dr. ij; triturate with vinegar of squills, and give one drachm in oxymel.

For scirrhus of the spleen. Of sow-bread, dr. xx; of bryony, dr. iij; of dittany, dr. ij; of baked squills, dr. viij; of fuller’s herb, dr. vj; of the root of capers, dr. vj. Give a trochisk to the amount of three oboli in oxymel. And the trochisk from heath is also applicable. The food should be attenuant, acrid, and dry; little drink should be taken; but exercise, friction, and sinapisms should be had recourse to, and sometimes cupping with scarifications.

Commentary. Hippocrates describes several diseases of the spleen in his work, ‘de Internis Affectionibus.’ He states that in scirrhus the spleen is sometimes larger and sometimes smaller than natural. It is an affection which continues long, but is not fatal. Sometimes, he says, it terminates in dropsy, and sometimes in suppuration, when he approves of burning the side. He also recommends diuretics and purging with hellebore. The description which he gives of the symptoms of enlarged spleen, in his work ‘On Airs, &c.,’ is very curious. Dr. Coray considers that it applies to scurvy. (See Notes, &c. 29.)

Aretæus remarks correctly that the spleen is very subject to scirrhus, but little so to suppuration. Scirrhus, he says, is removed with difficulty.

For scirrhous enlargement of the spleen, Celsus recommends unction, friction, and sudorifics. He forbids all sweet things, milk and cheese. He approves of pickled and salted things, acids, the vinegar of squills, a decoction of wormwood, and water in which a red-hot iron has been extinguished. Emollient ointments are to be applied externally.

Cælius Aurelianus says that some had directed the spleen to be cut out when it is much diseased, but he holds the proposal as mere words of course, and believes that the operation had never been performed.

Octavius Horatianus recommends as general remedies for complaints of the spleen, bleeding, purging, and fomentations with wool soaked in equal parts of oil and vinegar. When it becomes indurated he approves of vinegar of squills, friction, gestation, dropaces, salt baths, &c.

Most of our author’s remedies are taken from Galen, who treats fully and scientifically of diseases of the spleen. He states, as a general principle of treatment, that the proper medicines in cases of indurated spleen are such as are of an incisive and attenuant nature. He, therefore, approves of the mixture of bitter with austere things.

Alexander forbids strong purging in the beginning of an inflammation either of the liver or spleen.

The Arabians treat of these affections similarly to the Greeks. Haly Abbas remarks that the spleen can bear much stronger medicines than the liver, and recommends in the indolent diseases of it various bitter and very acid medicines. In inflammation he very properly bleeds. These are his general principles of treatment, the detail of which he explains at great length. Avicenna and Alsaharavius treat of these diseases more minutely than any other of the ancient authorities. Rhases recommends camel’s milk in cases of indurated spleen. He joins Archigenes in directing the application of sinapisms and leeches to the side.

SECT. L.—ON JAUNDICE.

Jaundice is a diffusion of bile over the whole body, sometimes of black, as we stated when treating of diseases of the spleen, and sometimes of yellow. There are many varieties of this complaint, the causes and diagnosis of which are as follows: If jaundice occurring suddenly in a febrile complaint diminish the fever, it is critical, being occasioned by a metastasis of the matter from the deep-seated parts, and, therefore, stands in no need of medicines, but is soon removed by baths and friction. But if it is attended with fever and bilious evacuations from the bowels, and if there be a sense of weight in the right hypochondrium, a hot inflammation of the liver is indicated, by which the blood, being rendered bilious, is conveyed over the whole body. When there is heat in the part without a sense of weight, the affection is occasioned by a hot intemperament alone of the liver. If it is without fever, and the alvine discharges are white, an affection of the gall-bladder, or of its ducts, is indicated. When there is a sense of heaviness in the right hypochondrium, it indicates that the ducts are obstructed; but when without heaviness, weakness of some of its powers is indicated, either of the attractive, by which it attracts the bile from the liver, or of the expulsive, by which it propels the bile to the intestines. For when the blood is not purged of bile, it is diffused over the whole body (as we stated respecting the black jaundice); in which case the urine is voided very much mixed with bile. But jaundice is also occasioned by a hot intemperament of the solid parts, which convert into bile whatever is brought to them in place of food, in like manner as in anasarcous complaints a conversion to a pituitous fluid takes place. This variety of jaundice is recognized by its not occurring at once but by degrees, none of the afore-mentioned symptoms being present. Moreover jaundice is occasioned also by drinking certain deleterious medicines, and by the external application of poison from some venomous animal. The cure of a hot intemperament of the liver, and of inflammation of it, and of weakness of its powers, we have treated of under the head of the affections of it; and what we said there is to be applied here without alteration, that we may not be obliged to repeat the same thing. When both the ducts of the gall-bladder are obstructed, or either of them only, we must let blood from the right arm. But some, both in this case and in jaundice from inflammation of the liver, open the vessel near the middle finger of the right hand. And we must use anti-inflammatory cataplasms, and purge with hiera. But persons affected with jaundice must take the propomata from a decoction of parsley, maiden-hair, or dock, or of wild thyme, reduced to a third part; or sprinkle wormwood on the potion. Two cyathi of the juice of radish, drunk with a cyathus of wine, is also of great use; also two or three cyathi of succory alone, and with wine. In cases of jaundice from inflammation of the liver, give a draught of mulse, or of a decoction of slender birthwort, or of St. John’s wort, or of maiden-hair, or of fuller’s herb, or of madder, in like manner; or a drachm of the shavings of hartshorn with wine, or the decoction of carrot boiled in wine to one third; or they may take a drachm of native sulphur in eggs. These things are of great use also in obstruction. But viij scruples of the seed of orache, with Chrysattic, or any other must, if drunk when in the bath, effect a proper evacuation. But the picra may be properly given in powder, or with oxymel, and the one called Theodoret; likewise the trochisk from bitter almonds. Give also of cinnamon what can be lifted with three fingers in a cyathus of mulse, or in mixed water; or of myrrh, the bulk of a bean, with twenty seeds of pepper, and the same quantity of cinnamon. Those affected with jaundice, owing to a warm intemperament of the solid parts, are to be treated with gentle friction, moderate exercise, unction and baths, with a moistening and moderately cooling diet, the juice of ptisan, intybus, endive, succory, fish, and light watery wine. The treatment of those who are affected with jaundice from drinking some deleterious substance, or from the bite of some venomous animal, will be laid down in the Fifth Book. When bile is lodged in the vessels of the face and eyes, inject elaterium to the size of a vetch, with a woman’s milk, into the nose while in the bath, and then direct the person to descend immediately into it, but not to immerse his head; and after the bath, having given him a recruiting diet, again inject the errhine in the sun. The juices of sow-bread, of horehound, and of gith act in like manner. But let him draw into his nostrils, while seated in the bath, some acrid vinegar, and compress his nostrils for a short time, and it will produce a wonderful discharge.

Commentary. See Hippocrates (de Locis in Homine, 40); Galen (de Med. sec. loc. ix); Aretæus (Morb. Chron. i, 15); Celsus (iii, 24); Cælius Aurelianus (Tard. Pass. iii, 5); Aëtius (x, 18); Oribasius (Cur. Loc. Affect. iv, 99); Actuarius (Meth. Med. i, 11); Nonnus (188); Pliny (H. N. xi, 37; xxvi, 76; xxviii, 64); Ruffus Ephesius (ii); Palladius (de Feb. 6); Alexander Aphrodisiensis (Probl. i, 90); Octavius Horatianus (ii, 14); Scribonius Largus (31); Marcellus (de Med. 22); Serapion (iv, 9); Avicenna (iii, 15, 1); Avenzoar (i, 14, 6); Haly Abbas (Theor. ix, 33; and Pract. vii, 41); Alsaharavius (Pract. xviii, 11); Rhases (Divis. i, 64; Contin. xvi.)

With regard to the etymology of the term icterus: in the first place, Aretæus derives it from the animal ictis, which the Scholiast on Nicander pronounces to be a wild ferret. On the identity of the mustela and ictis, see further Pliny (H. N. xxix, 16.) Schneider determines it to be the mustela furo. (Ad Aristot. H. A. vi, 30.) Isodorus would seem to agree with Aretæus, in his derivation of the term Orig. Suidas, however, derives the word from ἰκτῖνος, a species of kite, and Pliny from some unknown bird of the imaginary name of icterus (H. N. xxx, 11.) We have no hesitation in saying that we are disposed to follow the authority of Aretæus.

Hippocrates directs us to give at first fatty things, and to use the bath for three days; then to abstain from these things, and purge both the belly and the head, and give diuretics. But he forbids cholagogues, which, he says, only increase the disorder of the system. We have stated in the Second Book, Sect. IV, his views regarding jaundice occurring in fever. His commentator Theophilus explains that jaundice arises from obstruction of the ductus choledochus. Hippocrates lays it down as a rule that in cases of jaundice it is a bad symptom when the liver is hard. (Aphor. vi, 42.)

Our author follows closely the views of Galen. He remarks that, when in fever the bile is suddenly determined to the skin, it proves critical, and is easily removed by baths of sweet water, and friction with a discutient or rarefying oil. When the disease proceeds from obstruction of the vessels of the liver, he directs the administration of hot and detergent things, such as gentian, birthwort, and centaury. When occasioned by inflammation of the liver, the remedies suitable to that disease will be proper. When inflammation and obstruction are combined together, they are to be removed by relaxants and detergents. He gives from Andromachus and Archigenes a long list of compositions for jaundice; but we must be content with explaining his general principles without entering upon the detail of his practice. Galen, in another place, remarks that the poisons of certain reptiles occasion jaundice. (De Loc. Affect. vi, 8.) This fact is confirmed by modern observation. See Van Swieten (Comment. 916); Dr. Simson (paper on Jaundice, vol. i of the Medical Essays and Observations); and Rogerius (i, 47.) By the way, the ancients maintained that the primary action of certain poisons is exerted upon the liver. (See Book Fifth, XLII.)