Among other remedies for ileus, Hippocrates recommends inflating the bowels by means of a bellows. (De Morb. iii, 15.)
Aretæus gives an excellent account of the disease, the causes of which, as enumerated by him, are protracted indigestion of multifarious and unwonted food, a blow, exposure to cold, cold drink, and prolapsus of the intestine into the scrotum, or intestinal hernia. Some, he says, die from the violence of the pain, some from the conversion of the disease into suppuration, and some from blackening and mortification of the bowels. The symptoms are most accurately described. There is at first vomiting of phlegm and bile, but latterly of fæces; the pulse at first is rare and small, but before death it becomes very small, very dense, and intermittent. When inflammation is the cause of the disease, he approves of immediate venesection, so as to induce deliquium animi, which, he says, will, at all events, bring some respite to the patient’s sufferings. If inflammation is not present, venesection may be omitted, and an emetic of oil and water may be given; and afterwards applications are to be used for promoting the discharge of flatus, consisting of sow-bread, nitre, salts, and turpentine, which last medicine is also to be administered in a clyster with oil, honey, hyssop, and colocynth; and afterwards another injection of hot oil and rue is to be given. Externally he applies various fomentations and dry cupping. He gives carminatives with anodynes and the theriac. When the bowels cannot be got opened otherwise, he recommends the purgative hiera. The food is to consist of soups made from domestic fowls, with cumin, nitre, &c.; and, when there is no fever, he permits the use of hot wine.
Celsus forbids wine, but his treatment otherwise is like that of Aretæus. He directs immediate venesection and cupping; and, if the pain be seated above the navel, he approves of emetics, but, if below, he agrees with Erasistratus in preferring purgatives, such as ptisan, with oil and honey. He directs us to apply cataplasms from the breast to the loins, to put the patient into a bath of oil, to inject hot oil per anum, and to use friction of the extremities.
Our author follows Aëtius and Oribasius closely, who, in their turn, are indebted to Galen.
Nonnus seems merely to abridge our author. The causes of ileus are said by him to be obstruction of the bowels, inflammation, indigestion, and colic affections. His remedies for children are embrocations, cataplasms, and fomentations; and for adults, also venesection, cupping, clysters, and the oily bath. When the food is rejected, he recommends sumach and cumin in oxymel, and also purgatives.
It appears from Cælius Aurelianus that Diocles had been in the practice of giving a leaden bullet to swallow in this disease, no doubt with the same intention that quicksilver is now sometimes administered. In [the preceding Section], we have mentioned that Alexander gave pills of lead for colic. Cælius, however, disapproves of this practice. He finds fault with Hippocrates for recommending to inflate the bowels with smoke; for giving emetics; and for cooling the upper parts of the body. He himself approves of bleeding, oily clysters, baths of oil, and the like.
The Arabians, like the Greeks, treat ileus by venesection, clysters, and so forth. They mention cooling plasters as an external application; but we believe it was the practice of the ancients rather to use hot fomentations than cold in this disease. Haly Abbas in general approves of venesection, but, in certain cases arising from a cold cause, he joins Hippocrates in permitting the use of wine. When the disease is occasioned by obstruction, he recommends laxatives; when connected with descent of the gut, he directs us to return it, but says nothing of the operation for strangulated hernia. According to Rhases, the causes of ileus are inflammation of the bowels, debility of the expulsive faculty, and indurated fæces.
Vegetius, the veterinary surgeon, gives an excellent account of the symptoms and treatment of colic and ileus in cattle. (Mulomedicina, i, 41, 42.)
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.