The seven books of Paulus Ægineta, volume 1 (of 3)

by Aegineta Paulus

SECT. XLV.—ON AFFECTIONS OF THE KIDNEYS AND BLADDER; AND, FIRST, ON CALCULUS.

The alliance of these diseases obliges us to break through the order of instruction; for it is a common symptom of colic and of calculus in the kidney, that the belly is at first constipated, with violent pain, anorexia, indigestion, and tormina. But it is peculiar to colic affections to have all these symptoms more intense, whereas in nephritic they are less so; and in colics the pain is rather in the right loin, and ascends to the stomach, liver, and spleen; and the passage of the fæces is completely obstructed, so that not even flatus can pass; or, when with difficulty the fæces are evacuated, they are flatulent, and resemble the dung of oxen, or sometimes a vitreous phlegm is discharged, and the urine is voided freely, and is of a pituitous nature: whereas, in nephritic cases, there is a severe fixed pain in the kidneys, as if transfixed with a sharp-pointed instrument, and the corresponding testicle is pained, and there is torpor in the thigh of the same side. They also have sometimes, though rarely, spontaneous evacuations of the belly; but clysters always bring away flatus and bilious fæces; the urine is in small quantity and sandy, and the urinary passage is contracted. These are the symptoms of stones in the kidneys, which occur most frequently in adults, but the stones in the bladder form rather in boys. The symptoms of these are, unconcocted and whitish urine, with a sandy sediment; the patients rub constantly and handle the member, stretch it, and make incessant attempts to pass water, and are troubled with strangury. Wherefore the material cause of the formation of stones is a thick and terrene humour, but the efficient is a fiery heat of the kidneys or bladder. But with regard to the kidneys, we must use lithontriptics of a cutting nature, without being decidedly heating: such are the roots of the royal asparagus and of the bramble, burnt glass, the root of couch-grass, maiden-hair, bdellium, the rind of the root of the bay, the seeds of marshmallows, the black chick-pea, the stones of sponges, vinegar of squills, and valerian, spignel, asarabacca, carpesia, saxifrage, water-parsnip, when eaten or drank, the golden-thistle (scolymus), hedge-mustard, and prionitis. Let them use baths constantly; and after the bath take some of the afore-mentioned things; and have recourse to embrocations, cataplasms, fomentations, hip-baths of a soothing nature; in short, applying the remedies for colics. The following are compound draughts: Boil the roots of wild rue, wild mallows, and parsley, with wine; mix the expressed juice with water, and give to the amount of two cyathi. And this is a powder: Of the fruit of balsam, of the stone in sponges, of dried pennyroyal, of the seeds of wild mallows, equal parts. Give a spoonful with two cupfuls of diluted wine. Also, dried goat’s blood, dried cicadæ without the wings and feet, the Jew’s stone, in oxymel. Let these things be given in the warm bath, and the compound medicines prepared from them, the nephritic sour wine (posca), and the wines prepared for this intention. And the troglodytes (wren?) is a much-commended remedy. It is of all the sparrow tribe the least, except that called the regulus; for it is a little larger than this one alone, and resembles it in colour, which is intermediate between that of ashes and green. It has a slender bill, and lives mostly in walls and hedges. When, therefore, this bird is pickled whole, and frequently eaten in a raw state, it makes the stones which are already formed be passed with the urine, and prevents them from being formed again; and if it be burnt alive entire with its wings, and if the ashes by itself and along with pepper and a moderate quantity of Indian leaf, be drunk out of mulse, it will do the same thing. To relieve the acuteness of the pains and the want of sleep, the medicine called Sotira and that of Philo, are excellent remedies; and frequent venesection, if had recourse to, alleviates the pain, and produces a speedy discharge of the stone. The preservatives from the formation of stones are, first, wholesome and moderate food, exercise, abstinence from the frequent use of all kinds of pulse and food of grain, cheese, milk, and condiments prepared from dark-coloured wine, much flesh, and simply all things which contain thick juices; also from those things which are very hot and acrid, I mean hydrogarum, prepared wines, and the like. And the following things not only prevent stones from forming, but also break down or produce the discharge of those which are already formed. Let them drink oxymel with some of the simpler diuretics, the decoction of maiden-hair, parsley, and couch-grass; and, after the bath, let them drink tepid water before taking food or drinking wine; and in the midst of dinner, let them drink cold water if nothing prevent it. If they feel a collection of vitiated humours, let them evacuate by bleeding or purging. But the most effectual of all remedies is to drink water of a middling temperature after the bath, and before taking food or wine. The stones which form in the bladders of young persons you may destroy by the more powerful remedies, making choice from among the above mentioned. But when the stone gets too large, or becomes impacted at the neck of the bladder, we must have recourse to concussion, catheterism, or even lithotomy, as will be described in the Surgical part of the work.

On inflammation. If there be inflammation of the kidneys or bladder, it is to be recognized by the heat in the place, attended with heaviness and pain, fever, delirium, vomiting of pure bile, and inability to make water, more especially if the bladder is inflamed. Wherefore we must have recourse immediately to venesection, and use soothing fomentations and cataplasms from rue, dill, fenugreek, and the root of marshmallows; also emollient clysters and injections consisting of oil, poppies, and the grease of geese; and when the bladder is affected, we may push up the anus half an obolus of opium with myrrh, saffron, and oil. They may take a sweet draught of honied water, but must abstain from the strong diuretics and much drink, unless an acrid and bilious humour prevail, when they must take copious draughts, and plenty of the non-stimulant diuretics. Let them take in water a spoonful of a mixture consisting of two parts of linseed, and one of starch; and likewise let them take the seeds of cucumber and pompion. If there is a sensation of great heat about the kidneys, apply to these parts rags out of wine and rose-oil, water and rose-oil, or oil of apples; or a cerate composed of wax, rose-oil, oil of chamomile; or oil of apples, and the yelks of eggs, with a little vinegar, or the juice of knot-grass. Afterwards they may use the diachylon plaster with oil of chamomile; but must abstain from very hot applications, lest they occasion suppuration; and from very cold, for thereby the kidneys will readily become scirrhous. During the violence of the inflammation they must abstain from baths, and use the regimen called the febrile and anti-inflammatory.

On abscess and ulceration of the urinary organs. Pains in the loins, anomalous rigours, and irregular fevers indicate an aposteme in the kidneys; but when it is in the bladder, it is marked by pain in that part in addition to the symptoms we have now mentioned. You may ascertain which kidney is affected from this, that when the person lies upon the sound side he has pain in the opposite one, from the diseased kidney being suspended. In these cases we must place the patients in hip-baths of oil and water, apply cataplasms of fine flour, oil, and rosin, or the flour of tares with honey, or cardamom, or pigeon’s dung with dried figs. Pus freely discharged in the urine indicates a rupture of the abscess and ulceration in the part. But since the urinary organs are ulcerated without an aposteme, from the rupture of a vessel, erosion by acrid matter, or the irritation of a stone, we may distinguish ulceration in the kidneys from that in the bladder or urethra in this way: When the kidneys are ulcerated, the patient experiences a heavy pain in the loins, he makes water freely, and pus is found mixed with the urine, and particles of flesh floating in it. When the bladder is in a state of ulceration, the patient has violent pain in the region of the pubes and hypogastrium, and difficulty of making water; the pus, after the urine is voided, sinks to the bottom, and fetid scales, or else foliaceous ones float in it. Furfuraceous sediments indicate scabies of the bladder. When the ureters are ulcerated, the mixture of the pus is in an intermediate degree, and rather resembles hairs floating in the urine; and the situation of the pain is intermediate between the kidneys and bladder. If blood or pus be discharged without any evacuation of urine, it is to be understood that none of the afore-mentioned parts are ulcerated, but the member itself. Wherefore to those who have ulceration of the urinary organs we must give the sweet draughts of honied water, or of the decoction of fenugreek with honey, or from the seeds of cucumber with must. To those who void pus in their urine we are to give Armenian bole, or the ashes of burnt reeds, as much as can be taken up with three fingers, in must; and drinking milk is an excellent remedy for them. The following are compound remedies: Of linseed, of the seed of cucumber, of tragacanth, of each, dr. ij; form trochisks.—Another: Twenty pine-nuts; forty seeds of the garden cucumber; of starch, dr. j; add to two heminæ of the decoction of nard and parsley seed. But Archigenes, in his epistle to Atticus, says that “when the dysuria is urgent, we should take of the powdered seed of toasted poppy, dr. j, which is to be sprinkled upon the decoction of bog-rush, sweet-rush, or liquorice. This medicine removes the pains from ulceration: Of the seeds of purified cucumber, xxx in number; pine-nuts, xij in number; bitter almonds, whitened, xxxv in number; of saffron, what is sufficient to give it colour; give to the patient with an empty stomach every day, along with the wine protropum, or milk. It will be milder, if, instead of the pine-nuts, it receive an equal quantity of the seeds of mallows. The cyphi and the cyphoid antidotes are also said to cure ulcerations in the bladder. I, in the more protracted cases, by using this medicine, have not stood in need of more complex remedies: Of wall-germander, of ground pine, of each, dr. xxiv; of asarabacca, of white pepper, of each, dr. vij; of cinnamon, dr. j. Of this medicine, finely powdered, I give two spoonfuls in Cretan sweet wine; but if there is fever, in three cyathi of water; but when the ulceration is attended with pain, by adding two cyathi of starch, and fifteen seeds of cucumber, I accomplish my purpose.” These things are from the works of Archigenes. And the remedies formed from alkekengi, the antidote from the seed of wild mallows, and that from sweet-meats are excellent. We may apply to the perinæum and lower belly cerates made from washed hyssop and butter, and the grease of geese, and storax; and we may inject into the bladder, by means of a small syringe, honied water much diluted, or milk with some honey, or with cucumber seed, or the white of an egg with pompholyx, or some of the remedies formerly mentioned. When the ulcer is spreading, the trochisk from paper must be injected, or the Bithynian; and cataplasms are to be applied, made from dates, dried grapes, with galls, acacia, hypocistis, and alum.

On hemorrhage of the kidneys. The kidneys often getting into a relaxed state, cannot retain the urine, but, becoming dilated, they allow the blood and other thick matters to escape from the veins. The kidneys often discharge blood periodically like hemorrhoids; and when evacuated they are relieved, in which cases we must not rashly interfere, if the bleeding immediately stops; but, if it continue, we must bleed in the arm, and use for hemorrhage of the kidneys and bladder those remedies which are recommended for hemoptysis and other hemorrhages; and, more especially, we must give the root of comfrey and tragacanth macerated in wine, the juice of knotgrass and plantain with oxycrate, or bitter almonds with must; or this medicine: Of fissile alum, dr. j; of tragacanth, dr. ij; of gum, oboli, v; with must. And we must apply a cataplasm of raw barley-meal with oxycrate or rose-oil, or that from dates, and bread of siligo with acacia, or hypocistis boiled in an astringent wine or oxycrate. In hemorrhages from the bladder, we must apply cupping instruments to the loins and ischium; and we must ascertain the part from which the blood flows by the pain in the place, and whether the blood be mixed with the urine or no, as was said with regard to pus. If there be coagulated blood in the bladder (which you may know from the flow of urine being suddenly stopped after a discharge of bloody urine, and from certain clots or bloody fluids being probably passed), give the decoction of mugwort to drink, and the seed of shrubby-everlasting, of fleabane, or of radish, or the juice of laserwort, or the Cyrenaic juice, or the juice of parsley, each mixed with vinegar, or the rennet of a hare, or of a hind, or of a kid, in oxymel, or strained lye with oil, and externally sponges out of hot salt water, or strained lye, must be applied. But, if they are not dissolved, we must make an incision in the perineum, as in the cases of calculus; and having removed the clots of blood, accomplish the cure in a proper manner.

On hardness of the kidneys. When hardness occurs in the kidneys, it does not occasion pains, but they seem, as it were, to hang from the loins, and the haunches are torpid, and the limbs lose their strength, little urine is passed, and the whole habit resembles that of dropsical persons. Wherefore they are to be softened by cerates, emollient ointments, friction and fomentations; and we must administer diuretics, and clear out the bowels by clysters.

On diabetes. Diabetes is a rapid passage of the drink out of the body, liquids being voided by urine as they were drank; and hence it is attended with immoderate thirst; and therefore the affection has been called dipsacus, being occasioned by a weakness of the retentive faculty of the kidneys, while the attractive is increased in strength, and deprives the whole body of its moisture by its immoderate heat. Wherefore with this intention we will give more food, and that of difficult digestion and not humid, such as alica with rose-wine, or rhodomel, or hydromel, or some wine that is not old, or some of the hot wines. We must give of pot-herbs, succory, endive, and lettuces; of fishes, those that abide among rocks; the feet and womb of swine; pears, apples, and pomegranates; and give cold water to drink. They must get to drink propomata, from the juice of knotgrass, and elicampane, in dark-coloured wine, and from the decoction of dates and myrtles. We must apply a cataplasm to the hypochondrium and kidneys of polenta, in vinegar and rose-oil; and of the leaves of the vine and navelwort, pellitory of the wall, and purslain. We must promote sweats, and excite vomiting by drinking cold water; and make them abstain from all sorts of diuretics. There will be nothing improper in letting blood at the commencement.

On strangury and dysuria. When neither inflammation, nor a stone, nor any of the afore-mentioned complaints are present, if there is acrimony in the urine, and if the whole habit or the other symptoms indicate bile, the dysuria or strangury is formed by it, and we are to use medicines for altering and diluting it; the juice of ptisan, fishes, baths, and a corresponding diet; avoiding acrid things, wine, baths, anger, and long abstinence from food. If the thinness and whiteness of the urine, and the other symptoms indicate a cold intemperament, hot wine and prepared wines will be proper; also diuretic food and medicines, and hot hip-baths. When, in conjunction with the whiteness, the urine appears thicker than natural, we are to suspect a pituitous humour obstructing the neck of the bladder, and must use oxymel, and the compositions from hyssop and pennyroyal, or marjoram, or thyme, or laserwort, boiled in honied water, and the hotter embrocations. But, if a thick humour, a stone, a thrombus, or some such obstruction stop up the passage of the urine, we must apply the catheter to them, unless inflammation of the part be present. Dysuria in fevers is to be cured by an embrocation with oil of rue, of dill, or old oil. When the bowels are constipated, a decoction of fenugreek or mallows is to be injected, and the patient made to sit in oil and water, or in some of the afore-mentioned decoctions, with oil. And this cerate will be proper for them: The roots of wild mallows are to be boiled in Sicyonian oil, with a little water, until they are dried, and they are to be thrown away; and with the oil is to be mixed of the juice of rue a fourth part, and of wax and castor a sufficient quantity.

On paralysis of the bladder. This complaint, which is sometimes accompanied with dysuria, and sometimes with an involuntary discharge of water, has been formerly treated of under the head of Paralysis.

On incontinence of urine. Relaxation of the muscle at the neck of the bladder occasions this affection, and therefore it happens most frequently to children. Our general treatment ought to consist especially of tonics, such as hot wine and oil, and the like, abstaining from all things which are powerfully refrigerant, and rather as much as possible using calefacients; for cold produces a resemblance to paralysis. The following things are naturally efficacious: Burn the crop of a cock, and give to the patient to drink in tepid water, when fasting, or the flowers of the white ox-eye (chrysanthemum) in like manner; or, shave down the testicle of a hare into fragrant wine, and give to drink; or, give calamint and myrrh in a draught before supper; or, give the toasted seed of the wild rue to drink every third day. Let the privy member be anointed with Cimolian earth, mixed with the juice of perdicias (pellitory of the wall?)

Commentary. On these diseases consult Hippocrates (Aphor. iv, 76; de Morb. Intern. 15, et alibi); Galen (de Med. sec. loc. x; de Affect. Renum; de Loc. Affect.; Isagoge); Celsus (iv, 10); Aretæus (Morb. Acut. ii, 9; Morb. Acut. Curat. ii, 8); Ruffus Ephesius (de Vesicæ Renumque Affectibus); Alexander (viii, 4); Aëtius (xi); Oribasius (de Loc. Affect. Curat. iv, 101); Actuarius (Meth. Med. iv, 8); Pseudo-Dioscor. (Euporist. ii, 112); Nonnus (173); Cælius Aurelianus (Morb. Chron. v, 4); Scribonius Largus (38); Marcellus (de Med. 24); Avicenna (iii, 19, 1); Avenzoar (ii, 2); Serapion (iv); Haly Abbas (Theor. ix, 34; Pract. vii, 12); Alsaharavius (Pract. xx); Rhases (Div. 70, and Contin. xxiii.)

Hippocrates describes four affections of the kidneys, beginning with calculus. According to his theory, stones are formed from phlegm which has been converted into sand. See his theory fully explained (de Morbis, iv, 28, and de Aer. &c. 53.) He states distinctly that the formation of stones is the product of a preternatural heat in the bladder, with a thick and turbid state of the urine. (l. c.) He recommends fomentations with the juice of scammony, purging the whole body, tepid baths, and the like. He intimates, however, that when a stone is fairly formed, the only hopes of recovery are founded upon the operation. It appears that in his days lithotomy was a separate branch of the profession; for in his Oath he inhibits his pupils from performing the operation, and binds them to leave it to those who make it their practice. Doubts, however, are entertained of the genuineness of this piece. He mentions that hairs are sometimes passed in the urine; and the same fact is attested by Galen (Loc. Affect. vi, 3), Cælius Aurelianus, Aëtius, Avicenna, and Alsaharavius, among the ancients, and by recent writers on pathology. Actuarius calls them substances resembling hairs, of a handbreadth or thereabout in length. (De Urinis, i, 16.) He held them to be connected with disease of the kidneys. (Ibid. iv, 20.)

Galen says that all lithontriptics are of a cutting and detergent nature, the most of them being bitters. He makes mention of pepper, galbanum, ammoniac, aphronitrum, asarabacca, spignel, St. John’s wort, &c. He does not hesitate, however, to declare it as his opinion that the only certain remedy for calculus is lithotomy. (Art. Med. 94.)

Aretæus gives an interesting account of the affections of the kidneys and bladder. His remedies are similar to those of our author. For stones in the bladder he recommends, among other things, some quicklime with honied water, and diuretics. When a stone obstructs the passage, he directs us to push it back, or cut the neck of the bladder. He states that navigation and living at sea are beneficial in all affections of the kidneys. We may mention that this accords well with the late statistics of calculous diseases.

Alexander, like our author, ascribes the formation of stones to viscid and thick humours which have been much heated or roasted. He says, in the language of the Peripatetic philosophy, that the material cause of calculus is a thick matter, but the efficient a fiery heat, in like manner as by heat and a suitable matter of such a nature tiles are formed which are insoluble in water. This theory is explained with great logical parade in the ‘Isagoge’ generally ascribed to Galen, but which Albertus Fabricius supposes to be a work of Demetrius Pepagomenos. Alexander’s remedies are mostly the same as our author’s. He speaks with surprising confidence of the efficacy of goats’ blood; and, by the way, there is no lithontriptic which, both in ancient and in modern times, has been so generally cried up as it. His general treatment, which consists of bleeding, baths, emollient and paregoric medicines, is very proper. He remarks that certain lithontriptics, if given unseasonably, increase the disposition to calculus. Like our author, he forbids thick food, and attributes the best effects to drinking water.

Those who wish to see a full exposition of the ancient views on this subject may consult Aëtius. Like all the others, he says that milk, with the exception of that of asses, contributes to the formation of stones. He also recommends goats’ blood. He gives very proper directions respecting the regimen after extraction of the stone, to prevent a recurrence of the complaint.

Cælius Aurelianus makes no mention of lithontriptics, but he describes very properly the treatment when pain and inflammation of the bladder supervene. It is altogether emollient and relaxant.

The nature and treatment of calculous diseases are treated of in a very practical manner by Palladius in his Commentary on the sixth ‘Epidem. Hippocrat.’ He depends principally upon a restricted diet and light food.

The Arabians treat of calculi at great length, but have the same ideas of the formation of them, and recommend the same remedies as the Greeks. We remark that Avicenna, Rhases, Serapion, and Alsaharavius mention among their lithontriptics barauch, or the nitrum of the Greeks and Romans, which was most probably an impure carbonate of soda. We need scarcely say that this alkali is now given upon chemical principles. Like our author, they make mention of glass as a lithontriptic. Rhases, Avicenna, and some of the others remark, and perhaps justly, that white urine is one of the earliest symptoms of calculus. For stone in the bladder Avenzoar recommends cubebs. Avicenna, Serapion, and Alsaharavius join the Greeks in commending the small sparrow (or, as some suppose it, the wren) as an efficacious remedy for calculus. It is said in the ‘Isagoge’ that its lithontriptic powers were discovered by dreams. We may mention that it has been ingeniously supposed that allusion is here made to magnetic somnambulism, which, it is maintained, was one of the remedial means practised in the ancient temples of health. Haly Abbas ascribes the formation of stones to the concurrence of a viscid humour with heat of the part. Old men, he says, are most subject to renal calculi; for in them the watery part of the urine passes down to the bladder, while the grosser part or sediment is detained in the kidneys, and is converted into stones. Children are said to be most liable to calculi in the bladder, owing to their eating much gross food, and taking exercise after meals, by which means the system is loaded with gross impurities. With regard to the treatment, he enjoins restricted diet, abstinence from gross food, and the use of medicines of an incisive and attenuant nature. The general treatment during a fit of gravel is well laid down by Alsaharavius, consisting of bleeding, cupping, the tepid bath, emollient clysters, &c. Rhases, upon the authority of Antyllus, states that stones are formed either from drinking turbid water or from imperfect digestion, whence the urine deposits a sediment, which is converted into a stony hardness by the heat of the part.

According to Theophilus, a thick and milky state of the urine is characteristic of calculous diathesis. (De Urin. 8.)

Vegetius mentions that cattle, especially young ones, are liable to stones in the bladder, which are apt to fall into the urethra and obstruct the urine. He states correctly that a stone will sometimes make its way into the rectum. (Mulom. i, 46.)

Alexander Aphrodisiensis states that young and old persons are most subject to calculus. (Prob. i.) From the late investigation of Dr. Prout, it appears that children until fourteen years of age are most liable to stone; then persons after forty; while those in the intermediate period are but little subject to the complaint.

With respect to the lithontriptics mentioned above, all we can venture to say is, that, having no experience of them, we do not think ourselves entitled to question or confirm their efficacy decidedly; but, as we repose little confidence in those now in repute, we cannot be supposed to have much in those which have fallen into disuse.

On inflammation, abscess, and ulceration of the urinary organs. Celsus recommends rest; a soft bed; opening the belly; sitting in hot water; avoiding cold food and drink; abstinence from everything that is saltish, acrid, and acid, and from apples; taking copious draughts; adding to the food or drink pepper, leeks, fennel-giant, and white poppy, to promote the urinary discharge, &c.

One may find in Galen many receipts for abscess and ulceration of the urinary passages, but they are similar to our author’s.

Aretæus makes mention of ulcers of the kidney occasioned by stones, which he pronounces to be incurable. He states also that ulcers of the kidneys give rise to consumption. Without doubt he alludes to the morbid condition of the kidneys now known by the name of Bright’s disease. Hippocrates has been supposed to refer to the same in the following Aphorism: “When bubbles appear on the surface of the urine, they indicate that the kidneys are affected, and that the disease will be protracted.” (Aph. vii, 34.) Upon which MM. Lallemand and Pappas remark that frothy urine and albuminous are identical; and it is well known that Bright, Rayer, and Martin Solon have decided that albuminous urine is generally connected with a very obstinate disease of the kidneys. (Littré’s Hippocrates, t. iv, 414.) It seems highly probable that Actuarius alludes to albuminous urine in the following passage: “When substances, the effect of melting, and resembling spiders’ webs, float in the urine, they indicate either that the kidneys are diseased, or that the system is in a state of atrophy from wasting.” (De Urinis, vi, 16.) On frothy urine, see, further ‘De Urin.’ (v, 4.)

Alexander lays down the rules of treatment very properly, recommending venesection, purging, and topical applications of a cooling nature, especially at the commencement. When the abscess forms, he prescribes a variety of things which are detergent without pungency.

When the bladder is ulcerated, Nonnus directs us to inject into it by a syringe honey much diluted with water, or the seed of cucumber with the same.

The treatment prescribed by Cælius Aurelianus scarcely differs at all from that of the others in this case.

One of the oldest writers on diseases of the kidneys is Ruffus, who lived, according to Suidas, in the days of Trajan; so that he was prior to Galen, and perhaps to Aretæus and Cælius Aurelianus. As we have seldom occasion to meet with him in our researches, we shall give a fuller abstract of his opinions on this subject than we would otherwise have done. The symptoms of inflammation of the kidneys, as detailed by him, are pains below the loins, so that the patient cannot stand erect nor walk, but is obliged to lie upon his back, which position affords him most relief; the pains extending to the bladder and testicles; the extremities cold, more especially the legs and feet; frequent and painful desire to make urine, which is at first thin and watery, but afterwards becomes redder. These symptoms are followed by emaciation of the thighs and hips, debility of the limbs, and sometimes suppuration. His treatment is as follows: The patient is to be laid on a soft couch, and must abstain from food for one day, but long abstinence is forbidden. If the bowels require to be opened, this is to be done by means of emollient clysters, such as injections of hot water, decoctions of mallows, of linseed, or of fenugreek, to which may be added some oil. Large injections, however, are forbidden, lest they press upon the kidneys and occasion irritation. When the bowels are evacuated, and yet the pain does not remit, the parts may be wrapped in wool which is smeared with hot oil having rue, marshmallows, dill, or mugwort boiled in it. When the pain is acute, a vein at the elbow is to be opened; after which emollient cataplasms and plasters are to be applied to the back when the kidneys are affected, and to the fore parts when the bladder. When these remedies fail to remove the pain, the loins and groins are to be cupped, and then sponges squeezed out of hot water are to be applied, and the patient put into a hip-bath of hot water in which poppies, chamomile, and the like have been boiled. Then, when the patient is laid in bed, let him be fomented with bladders half-filled with oil and water; and afterwards let cerates of the oil of privet, &c. or fragrant malagmata be applied. When the pain is excruciating, he directs us to give a decoction containing opium and the heads of poppies. In due time diuretics are to be administered, such as the root of acorus, ground-pine, cassia, spignel, parsley, sea urchins, radishes, carrots, and the like. When an abscess is formed, there is a discharge of tawny and more natural urine, there is swelling in the loins, strong heat in the kidneys, and the pain becomes duller with irregular fever. The abscess bursts either into the bladder or intestines. Praxagoras, he says, related a case in which there was pus voided by the anus for twelve years and probably longer. When it bursts into the bladder, pus is voided with the urine. Suppuration is to be promoted by frequent fomentations with sponges, by cataplasms of barley-meal with a decoction of figs in mead or wine, to which may be added pounded wormwood, spurge, &c. For promoting the rupture of the abscess, diuretics are prescribed, such as wild marjoram, mock dittany, and the like. When the abscess does not burst, acrid clysters containing black hellebore, radishes, garlic, and the pulp of colocynth are to be given. To these oil may be added, and when thus taken they will promote the rupture of the abscess. However, fomentations with sponges and plasters are to be applied to alienate the pain. When the ulcers are of a mild nature (which is shown by the abatement of the fever and pain, and from the substances which appear in the urine being white and inodorous), the milder diuretics are to be used for cleansing them, such as the seed of pompion, the decoction of dates, &c.; or, when stronger things are required, galbanum, opopanax, turpentine rosin, and the like may be added to mead or wine. When the ulcers are putrid, Æthiopian cumin with must, rue with honey and wine, and the like may be given internally; while cataplasms of bitter vetches boiled in wine and honey are to be applied externally. It is proper also, he says, to inject some of the medicines for dysentery; to give clysters of strained ptisan; and to place the patient in hot water. If the matter is thick, a decoction of fennel, parsley, or wormwood is to be given. With respect to food, he recommends milk, especially that of mares or asses, along with honey; also cucumbers, lettuces, the flesh of kids, lambs, and goats, almonds, and wine; but vinegar must be avoided. All motion is to be abstained from. When there are symptoms of repletion, emetics are to be given. When the abscess points outwardly, he seems to direct us to open it and apply the cautery; but here unfortunately the text is incomplete.

This account is so full and judicious that we think it unnecessary to give extracts from any more of the Greek and Latin authorities.

From the Arabians little or no additional information is to be derived. Haly Abbas recommends bleeding by opening the basilic vein, and then cataplasms of barley-flour, &c. He then gives a cooling draught containing the seeds of cucumbers, gourds, melons with purslain, mallows, and the syrup of violets. This part of his practice deserves consideration. When the abscess forms he directs us to apply cataplasms containing chamomile, fenugreek, melilot, &c. Alsaharavius, in like manner, recommends bleeding, cooling and demulcent draughts, the tepid bath, and discutient cataplasms. The same plan of treatment is fully laid down by Rhases. When pus is discharged from the bladder, owing to ulceration of it, he directs us to give astringent injections prepared from galls, sumach, purslain, pomegranate leaves, &c.

On hemorrhage of the kidneys. Our author’s treatment is so fully stated that it will be unnecessary to multiply extracts from the others. It is mostly condensed from Aëtius. (xi, 27.) The latter makes mention of injecting into the bladder some astringent infusion by means of an instrument like a catheter, having a bladder attached to one extremity. When the coagulated blood (and the urine generally does coagulate it) cannot be got otherwise discharged, he recommends, like our author, an incision to be made in the perinæum.

Cælius Aurelianus also recommends injecting into the bladder some astringent infusion, such as that of hypocistis, knot-grass, &c. In the case of women astringent pessaries may be used.

Avicenna recommends us to inject the rennet of a hare. Haly Abbas directs us to bleed by opening the basilic vein, and then to give draughts containing various vegetable astringents, such as wild pomegranate flowers, cucumbers, and purslain, with alum, Cyprian earth, &c. According to Rhases, the discharge of blood by urine is often connected with disease of the liver.

The veterinary surgeon Vegetius ascribes the bloody water of cattle to general plethora. This is a very plausible hypothesis.

On hardness of the kidneys. Nearly the same account is given by Aëtius, and also by Avicenna, Rhases, Serapion, and all the medical authorities who have treated of this subject. Haly Abbas and Alsaharavius particularly commend the diachylon plaster. Ruffus, as quoted by Rhases, recommends rest, emollient clysters, the application of cupping-instruments to the back, tepid baths, refrigerant and sedative medicines internally.

On diabetes. Aretæus remarks that diabetes is a wonderful affection, being a melting down of the flesh into urine, occasioned by a cold and humid cause like dropsy. The disease, he says, is of slow formation, but when completely formed speedily proves fatal. His description of the symptoms is very striking: a fiery thirst, a never-ending desire to make water, a parched skin, a dry mouth, and so forth. Diabetes, he justly remarks, is a species of dropsy, the water in the one case being determined to the peritoneum, and in the other to the urinary organs. We have, in fact, known these diseases reciprocate. He recommends by all means attention to the thirst, endeavouring to allay it by means of the medicines called Adipsa; rectifying the stomach by purging with hiera; and applying epithemes of spikenard, mastich, and the like. For drink he directs us to give water in which the autumnal fruits have been boiled; and for food recommends starch, milk, and cold astringent wines. He concludes by saying that the general remedies and regimen proper in dropsical cases will answer in diabetes, and particularly mentions the theriac and mithridate. Among the causes of diabetes he mentions poisoning by the sting of the African viper, called the dipsas. This subject will be found treated of in the [Fifth Book].

Celsus recommends exercise, friction, purging, astringent food, and austere wine. Galen states that he only recollected having met with two cases of diabetes. He maintains that it is such an affection of the urinary organs as lientery is of the bowels. He is decidedly of opinion that the kidneys are primarily affected, and not the stomach, as some had supposed. He explains his views of the nature of the disease with great precision. (De Locis Affectis, vi, 3.)

Aëtius has given the fullest account of diabetes. Upon the authority of Archigenes, he recommends at the commencement bleeding and diuretics, the latter being given to clear away the vitiated urine from the kidneys; but if the disease be of long standing, he proscribes both those measures. He recommends also a cooling diet, ruddy wine diluted, cooling applications to the pubes and loins, and, in certain cases, narcotics, such as opium and mandragora.

Alexander’s theory respecting the nature of the disease is the same as our author’s, both having borrowed it from Galen. He recommends food of difficult digestion, such as the feet of oxen, the flesh of pompions, chesnuts, &c. He forbids all saltish, acrid, and diuretic articles. He says nothing of venesection.

Actuarius recommends purgatives, in order to determine to the intestines, and astringent and refrigerant remedies in general.

Avenzoar explains fully his views respecting the nature and treatment of diabetes, in which he follows Galen closely. But the fullest and most accurate of the Arabian authorities on this subject is Avicenna. In certain cases, he admits of venesection at the commencement. The remedies, however, in which he seems to place the greatest reliance, are emetics and sudorifics, which he gives until the intention of altering the determination of the fluids to the kidneys. He particularly directs the patient to avoid taking all diuretic articles, to use exercise on horseback, moderate friction, and, in the decline of the disease, the tepid bath with fragrant wine.

Serapion gives nearly the same account as Aëtius, only he says nothing of venesection. Haly Abbas states, with his usual precision, the theory of Galen and the other Greek authorities, namely, that the disease is occasioned by a preternatural increase of the attractive faculty of the kidneys, arising from heat of the viscus. Agreeably to this theory of the disease, his remedies are refrigerants and astringents. Alsaharavius advocates similar views of the nature and treatment of the disease. When the urine is thick, with some appearances of blood, he recommends venesection. According to Rhases, the affection is connected with preternatural heat of the kidneys and debility of their retentive faculty. He says it resembles lientery of the intestines.

To those who are conversant with the principles of ancient physiology, the theory advanced by Galen, and advocated by all subsequent authorities, will appear very plausible and ingenious. The ancients appear not to have known that the urine some times possesses saccharine properties.

Rogerius, like the ancient authorities, refers diabetes to a hot intemperament of the kidneys, whereby their attractive faculty is increased. (Tr. i, 54.) All the earlier writers on medicine appear to have held the same hypothesis.

On strangury and dysuria. As these diseases arise from a variety of causes, our author has properly treated of them accordingly. We do not find that the other authorities supply much additional information.

Hippocrates mentions that there are many varieties of strangury. His remedies are the tepid bath, diluent drinks, diuretics, and anodynes.

Aëtius states that the disease is called dysuria when the patient has a desire and passes his urine with difficulty, and strangury when it is passed in drops. It is occasioned, he says, by acrimony of the urine, ulceration, or debility of the bladder. It may also arise from affections of the kidneys and liver, or from an intemperament. The treatment is to be varied accordingly.

When dysuria is connected with weakness of the bladder Leo recommends that pressure should be made with the hands on the hypogastric region.

Avicenna is particularly full upon these affections. For ardor urinæ Haly Abbas recommends various emollient and cooling articles, such as mallows, the seeds of cucumbers, pompions, and the hot bath, &c. When it proceeds from an inflammatory cause, he recommends the treatment directed in the beginning of this Section. When these remedies prove ineffectual, the catheter is to be used. He says that one of the most common causes of the complaint is debility of the expulsive faculty of the bladder. Alsaharavius treats fully of these complaints in much the same terms. When dysuria is connected with inflammation, he recommends bleeding, diluent drinks, and the warm bath. When it proceeds from a clot of blood he directs us to inject into the bladder the water of ashes. (Aqua cinerum, perhaps it should be aqua cicerum.) Rhases states that the complaint generally arises in old men from heat or ulceration at the neck of the bladder. He justly remarks that when retention arises from inflammation, no urine at all is passed, and the pain is constant; and that, when connected with obstruction, the bladder gets distended.

For inflammation, pain, and ulceration of the bladder, Scribonius Largus recommends water into which a heated iron had been plunged. He adds that he had known the chalybeate waters of Tuscany do much good in diseases of the bladder. This may be said to be an anticipation of the modern practice, introduced, we believe, by the late Mr. Cline, of giving the tincture of muriated iron in such cases.

On incontinence of urine. Galen properly remarks that incontinence of urine is often occasioned by injury of the spinal marrow either through violence, or the application of cold. (De Loc. Affect. iv, 7.)

According to Avicenna it is occasioned by excessive cold, by relaxation of the muscles (sphincter vesicæ?) or weakness of the bladder, as happens at the end of certain diseases, or by the immoderate use of diuretics. Rhases says briefly, that the complaint is occasioned by excessive heat or coldness. When it proceeds from the former cause, he recommends a composition of coriander, vinegar, Armenian bole, acorns, &c. When from cold, he prescribes the following: Of dried acorns, of frankincense, q. s. to be rubbed into the pubes with oil of ben, or oil of rue. Haly Abbas attributes the complaint to enervation of the sphincter vesicæ and loss of the retentive faculty of the bladder. He also mentions its connexion with disease of the spine. Alsaharavius recommends various stimulant liniments externally, and galls, vinegar, and the like internally.

Ruffus briefly describes a disease of the urinary organs, by the name of scabies vesicæ, attended with furfuraceous sediments and pains in the hypogastric regions, and ending, for the most part, in ulcerations of the bladder. The disease is said to be of a very intractable nature. It is alluded to by Hippocrates. (Aph. iv, 77; where see the Comment. of Theophilus, ed. Dietz.) It is further stated in one of the aphorisms that blood, pus, and scales in the urine, accompanied with deep pain, indicate ulceration of the bladder. (Ed. Dietz., t. ii, 437.) Theophilus says, blood, pus, and scales in the urine, with a heavy smell, indicate ulceration of the kidneys or bladder. (De Urinis, 15.)