SECT. VI.—ON THE MANAGEMENT OF THOSE WHO TAKE PURGATIVE MEDICINES; AND WHAT IS TO BE DONE TO THOSE WHO ARE NOT PURGED BY A PROPER DOSE OF PURGATIVES.
In general when any of the drastic purgatives is to be taken, the medicine is to be given to the patient with an empty stomach, and after digestion has been performed; and he is to be prevented from sleeping until it has been wholly purged off, and if possible he should make moderate motion, and abstain during the time from all food and drink, until the purging is over.
From the works of Philagrius. But if he cannot endure abstinence from food, either because the mouth of the stomach is troubled with bile from long fasting, which has preceded, or any such cause, we must give him bread out of diluted wine, or the juice of ptisan, or of chondrus, not after the evacuation has begun, lest it spoil in the stomach, but straightway after the medicine has been taken; for in this way by its weight it contributes to the speedy evacuation of the medicine. But if, after taking any of the laxative medicines, one does not purge nor evacuate, provided the case be not at all serious, we need not be very solicitous about it; but if the greatness of the disease be urgent, or the patient experiences acute tearing pains with distension of the belly, we must necessarily administer a clyster. But if even thus the belly is not evacuated, and there is a pungent pain and disorder of the body, he is to be bathed and rubbed freely with oil; or if he feels full and heavy, a vein must be opened, more especially if he is of a sanguineous habit of body, and if his eyes be red and prominent, not naturally but incidentally, owing to his having drunk the medicine. When none of these symptoms trouble him, but he experiences a gnawing and lancinating pain, he may take food immediately after the bath, and drink wine freely, and in the meantime he is to receive a clyster, if he does not settle; and again he is to be bathed. The oil used in the clyster, should be that of rue or prepared from some other of the carminative medicines.
Commentary. Hippocrates, as Galen mentions, recommends a draught of ptisan to be swallowed immediately after taking a purgative medicine, in order to facilitate the operation of the medicine and wash away any particles of it which may lodge in the intestines. Both forbid it to be given after the operation has commenced, as it tends only to blunt the powers of the medicine. Galen remarks, that sometimes a purgative does not operate, either from idiosyncrasy of the patient, or from the smallness of the dose, or from the intestines being blocked up by indurated fæces, which must be removed by means of a clyster before the medicine can operate. At other times, he adds, the medicine is determined to the kidneys, or is digested and converted into food. As all purgatives are bad for the stomach, he recommends us to weaken the impression of them by the mixture of aromatic seeds, which possess attenuating and cutting powers—Quosnam oportet purgare, &c.
Oribasius treats fully of this subject in two extracts from the works of Galen and Ruffus. Ruffus directs us, when the bowels are difficult to move, to give beforehand a soup of shell-fish, with mallows, beet, and the like, or to administer a clyster. He forbids us to give purgatives to persons who are apt to vomit. (Med. Collect. vii, 26.)
Mesue has treated more fully of all the circumstances connected with the administration of purgatives than any other ancient author. When the operation of the medicine is retarded by flatus, or the bad state of the humours, he recommends us either to administer a clyster or give an emetic. When this arises from debility of the expulsive faculty of the intestines, he directs us to give, first, a moderate draught of cold water, and then some astringent potion, such as one from quinces, or pears. When the passage is obstructed, he directs a clyster to be administered; and in this case he forbids cold water to be given, as it will increase the contraction of the intestine. When violent pains are excited in the stomach by the medicine, he recommends an emetic, and if in the bowels, a clyster. (Canon. Univers. iii.) See also Avicenna (i, iv, 8), and Rhases (Contin. xii.)