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

by Aegineta Paulus

SECT. XXXVII.—ON AFFECTIONS OF THE STOMACH, OF THE HYPOCHONDRIA, AND OF THE BELLY.

Those complaints which occur in fevers, such as loathing of food, bulimia, the canine appetite, atony of the stomach, deliquium animi, thirst, hiccough, nausea, and syncope, have been treated of sufficiently in the [Second Book], and it would be out of place to say more about them. But inflammations of the orifice of the stomach and of the liver require the admixture of astringents; for, if treated by the relaxant method alone, it will prove dangerous. It will be necessary, then, whether oil be affused on the part or a cataplasm be applied, to add some of the astringents to it, such as wormwood or the nard ointment; or that of apples, or of quinces may be boiled in it. The following is a cerate which we frequently use: Of white wax, oz. j, (but if in summer, dr. vij); of aloes and mastich, of each, dr. j; add of the oil of unripe olives, or of apples and of nard, when going to use it, as much as will be sufficient to give it consistence. Or, if the stomach require greater astringency, as not being able to retain the food, mix also of oil of unripe olives, dr. j; or of the juice of wormwood an equal quantity; and, thirdly, of the juice of hypocistis, of wild vine, and of sumach. We must make the quantity of the cerate proportionate to the number of the other medicines. When the inflammation becomes protracted and hard, we must apply more complicated remedies, containing aromatic, emollient, and discutient ingredients, such as that prepared from melilot, the philagrianum, and the fragrant. And a necklace of green jasper appended from the neck, so as to touch the stomach, is of great use. In hot intemperaments of the stomach, or ardent affections of it with prostration or deliquium animi, or anorexia from any other cause than fever, give cold water with the juice of unripe grapes, or the decoction of quinces, or of vine shoots, or the powdered seed of cucumber with cold water. Apply to the stomach a bladder filled with cold water, or the shavings of gourd. And the pills called Adipsa are to be given, as described when treating of thirst. The following medicine is proper for cooling and strengthening a watery stomach: Of green rose-leaves, dr. vj; of liquorice juice, dr. iv, mix with sweet wine, and make into an electuary, to be allowed to melt under the tongue. When, on account of a gross phlegm, medicines are required to heat and incise it, the following one will be useful: Of the rind of fennel-root, oz. ij; of vinegar, a sextarius and a half; of aloes, oz. iij; of honey, lb. iv; the roots being boiled in the vinegar, are to be squeezed out and thrown away, and honey being added, it is to be boiled to a proper consistence, and then powdered aloes sprinkled upon it. Give three spoonfuls of it with water. Some prepare it without the aloes. The composition from calamint is also proper for such cases. When the food turns acid on the stomach, give in water for drink a drachm of coriander seed sprinkled upon it like polenta, or one spoonful of mastich, or two spoonfuls of the seed of the white lettuce. The following is a compound medicine: Of pepper, dr. j; of the seeds of dill, dr. iij; of cumin, dr. iv; triturate, and give at bedtime one spoonful in diluted wine. Those who form black bile, and have the stomach inflated, may, during the exacerbations, apply to it sponges soaked in the strongest vinegar, after which, if the complaints continue, alum with pulverized copper may be added to honey, and applied. Let them drink the juice of endive, or let mint be sprinkled upon the draught. When the stomach is inflated and distended, mix a moderate quantity of honey and pepper with the decoction of calamint, and give. For subversion of the stomach, take of the juice of the kernels of the unripe pomegranate, p. iij; of the juice of mint, p. j; boil until it thicken, and give a mystrum (two spoonfuls?) of it before a meal.

For salivation of the stomach. Rinse the mouth with vinegar of squills, the sauce of pickled olives, or the decoction of the green leaves. Or a very small quantity of the same may be swallowed. A still more effectual remedy is aloes dissolved in water. For those who cannot retain their food (who were particularly called stomachics by the ancients), mix with honey the flour of fenugreek and the dried seed of mallows in powder, and apply. The cerate consisting of wax, the lees of oil of iris, and castor, is also proper.

On anorexia. Anorexia is a loathing of food, either from the prevalence of an intemperament in the stomach, or a collection of humours. You may know a hot intemperament by the thirst, by the fetid and feculent eructations if compelled to take food, and from the circumstance that cold and intractable substances are most easily digested; and a cold by the opposite, for they neither have thirst, nor can they endure cold things, and they have sometimes acid eructations. Of those who have anorexia from humours, they who suffer from thin and sharp humours, have gnawing pain at the stomach, and are more affected with nausea and thirst. When the humours become putrid, they sometimes have fever. When they suffer from thick and viscid humours, these for the most part neither occasion acute pain nor thirst, but the common symptom of all these cases is nausea. Wherefore, if the humours are contained in the cavity of the stomach, they vomit them up; but, if they are absorbed and infarcted in its coats, they have nausea only, but do not vomit, unless it be when they have taken food. Those, therefore, who have anorexia from a hot intemperament, should take cooling things for diet, more especially such as are prepared from vinegar. Wherefore give them bread that has been soaked in oxycrate, or oxycrate itself to drink, and oxygal (vinegar and milk), and that which is called melca by the Romans (it is a condiment from milk), endive, lettuces, and sometimes cold water: all these moderately, according to the degree of the prevailing intemperament; for the immoderate use of them is not only not beneficial, but often renders the complaint utterly incurable. When the affection is connected with coldness, it is to be cured by the opposite remedies; wherefore give to drink old wine and prepared wine, hydrogarum, and the decoction of anise, rue, and Macedonian parsley, and pepper, in hot common water; or the composition from the three peppers, or that from calamint. You may give also the theriac from vipers, which is also not inapplicable to those who loathe food from a collection of humours. Garlic, both as food and as medicine, is applicable to them. When the anorexia proceeds from a collection of humours, you may evacuate such as are thin and sharp, either by vomiting or purging downwards, and they may readily be made to vomit, by drinking beforehand tepid water, or hydromel diluted with a large quantity of water. But it will be better to give previously some moistening food, such as the juice of ptisan, or the yelks of eggs. How to produce easy vomiting has been explained in the [First Book]. But if the patient be hard to make vomit, it will be better to determine the matter downwards, having previously diluted their system by means of plenty of mild food. The cathartic medicine may either be the picra from aloes, that from quinces, which also admits of scammony, or that from rhodomel. If it be possible without the scammony to evacuate by a large dose of aloes, it will be better, because the scammony is bad for the stomach. When the anorexia proceeds from thick and viscid humours, you may cure them by attenuating and incisive remedies, such as oxymel, and the preparations from it and brine, as capers, olives, mustard, and the like. The remedies recommended for anorexia from a cold intemperament are not inapplicable to these, and more particularly after evacuation. You may evacuate them by the oxymel called Julian. Externally you must use those unguents and emollient ointments which have power to warm and strengthen the stomach, such in particular as that from the unripe grape, that called Marciatum, and all the common ointments; also such epithemes as the Baium, the fragrant, and the like. They ought particularly to have recourse to exercises and friction. When dyspepsia and anorexia arise from a cold and liquid humour, or such an intemperament, the medicines composed from quinces will be applicable to them, I mean that called meloplacuntion, that from the juice of apples, and that from the flesh of them, and that which is prepared from the citron. Also the malagmata or emollient unguents, such as the Marciatum, that from the juice of the unripe grape, the Baium, Polyarchium, and such like. When there is an ulcer in the stomach or bowels, the patient must abstain from all acrid food and drink, and use remedies of a soothing nature, such as draughts without oil, and those from starch, Samian earth, Lemnian earth, and milk, or a small quantity of honey, so as to purge without griping. A convenient epitheme is prepared from dates, the flour of quinces, and a cerate from quince-ointment, or rose-oil with ammoniac and frankincense; and also the epitheme of Nileus, the plaster from willows, and the Icesian may be used. You may know that an ulcer exists by blood, pus, or the scabs of a sore being vomited up.

For those whose stomachs are enervated and in a state of atony, and who, for that reason, do not digest their food, or vomit it up. Of aloes, of masucha, of mastich, of storax, of each, oz. ij; of wormwood, oz. iv; of the flowers of the wild vine, oz. iij; of Gleucine oil, oz. vj; of quince-ointment, oz. iij; of wine, q. s. Some also add of cyphi and roses, of each, oz. ij. These things, being powdered, are received upon purple or wool, and applied to the stomach. But some, by adding of wax, oz. vj, make an epitheme of it.

For iliac affections of the stomach, that is, strong and spasmodic pains. The trochisk of the Amazonians is the best medicine in this case. An account of it, and of the ingredients which enter into the composition of other compound remedies for the stomach, you will find in the [last Book], where Compound Medicines are treated of.

Commentary. See Aretæus (Morb. Chron. ii, 8); Cælius Aurelianus (Pass. Tard. iii, 2); Celsus (iv, 5); Galen (de Med. sec. loc. vi); Oribasius (Synop. ix, 10); Aëtius (ix, 1); Alexander (vii, 5); Actuarius (Meth. Med. iv, 5); Octavius Horatianus (ii, 16); Marcellus (de Med. 20); Avicenna (iii, 13, 1, 2, 3); Serapion (i, 1); Avenzoar (i, 15); Averrhoes (Collig. v, 54); Haly Abbas (Pract. vii, 2, Theor. ix, 24); Alsaharavius (Pract. 16); Rhases (Divis. 59, Contin. xi.)

To all these authors, almost every one of whom has treated of these complaints more fully than Paulus, or upon a different plan, it is quite impossible for us to do justice within the narrow limits to which we confine ourselves in these annotations. We shall, therefore, direct our attention principally to Celsus, and merely add a few remarks from the others. The stomach, he says, is affected by great heat, inflation, inflammation, and ulceration; by phlegm or bile; and by resolution, which is a common and fatal complaint. Heat is to be cured by cold external applications, such as vinegar and roses, along with cold drink. Inflation we shall see treated of in [the next Section]. Inflammation which is attended with pain is to be treated by rest, abstinence, sulphurated wool, and wormwood, when fasting. If attended with ardor, he prescribes cold and repellent applications, occasionally exercise, and a fuller diet. Ulceration is to be cured by exercise, friction of the extremities, smooth and glutinous food, and avoiding every thing that is acid and acrid. Redundance of phlegm is to be treated by emetics, exercise, friction, hot drink, and hot food. When bile prevails he recommends laxatives, potions of wormwood, gestation, or a sea-voyage; emetics, if they can be conveniently borne, and suitable food, so as to avoid indigestion. Resolution, he says, is a severe affection of the stomach, when it cannot retain the food, and the body wastes. The bath, he says, is useless, but exercise of the upper parts of the body peculiarly proper. He recommends pouring cold water on the stomach, swimming in the same, and living on cold food, rather such as is difficult to digest than what will readily spoil on the stomach. Hence, he says, some digest beef. Undiluted austere wine, either cold or very hot, is proper. If there is vomiting with pain, he directs us to apply over the stomach, wool or sponge soaked in vinegar, or cold cataplasms; or, if the pain be more severe, a cupping-instrument; then bread which has been steeped in cold diluted wine is to be given. If this is not retained, some smooth article of food not disagreeable to the stomach is to be administered; and, if this be not retained, a cupful of wine is to be taken every hour until the stomach becomes settled. He also praises an acid mixture, containing pomegranate, endive, &c.

Aretæus gives a lively description of the feelings of a dyspeptic. The student who, heedless of the allurements of the senses and of the ties of nature, follows his divine pursuits with indiscreet ardour, and neglects to take proper food and exercise, is said to be particularly liable to affection of the stomach. The cure, he says, is to be effected by gestation, vociferation, a suitable diet, and indulgence of the patient’s caprices as far as possible. Wormwood, ginger, aloes, and mastich are also proper.

Alexander properly remarks that disorder of the stomach affects sympathetically the heart and brain. He treats fully of inflammation of the stomach, for which he directs us to give relaxants and tonics, such as wormwood and mastich. He further recommends the application of a plaster, composed of emollient and stimulant ingredients, such as wax, turpentine, ginger, opopanax, &c. It is singular that he and most of the ancient authorities have omitted to mention venesection for this complaint. We therefore entertain some doubts whether they meant by it the gastritis of modern Nosologists, which, by the by, is of so rare occurrence, that some late writers of high name are of opinion that it never occurs spontaneously. (See Christison on Poisons.) Some of the ancient authors, however, do recommend venesection in this complaint, as for example, Serapion, Rhases, Avicenna, and Haly Abbas. Horatianus recommends the same for sudden pains of the stomach. Cælius Aurelianus, while treating in general terms of stomach complaints, recommends bleeding, “si in vehementiam passio venerit.” He also prescribes cupping and leeching. His account of these affections is highly interesting, but so circumstantial that we dare not venture even upon an abridgment of it. Haly Abbas speaks of the inflammation ending in suppuration. To Alsaharavius we particularly invite attention. Rhases gives a copious statement of the opinions of all preceding authorities on this subject.