On those things which evacuate bile. We may give cholagogue medicines at any season except winter, to persons in the vigour of life and in the decline; to persons of dry and muscular habits, and who are of a dark or ruddy complexion; to men rather than to women; to those whose food is apt to spoil on their stomachs, and whose bellies are constipated; to such as abound in bitter bile, are irascible, pass little urine, and use hot and dry food: in icteric, hepatic, and pleuritic affections; in phrenitis, cynanche, mania, cephalæa, ophthalmy, erysipelas, leprosy, fevers, and to such as are troubled with collections of bile. Aloes is given to such as are troubled with heaviness of the head, with ophthalmy, with thirst, with disturbed dreams without fever; to such as have a sensation of departing rigor; to those who pass acrid flatus, and have gnawing pains of the intestines; to those who are seized with burning heat about the stomach, or nausea producing eversion of it; and to those who being troubled with a collection of excrementitious matters cannot bear evacuations by clysters. For it evacuates the whole body, and does not occasion disorder of it unless given in very great quantity, and brings along with it any bile lying in the intestines, stomach, and gullet.—Hellebore agrees both with those in acute diseases and those in chronic requiring a cholagogue medicine, such as maniacs, those troubled with hemicrania, and such as have defluxions of the eyes and complaints in the chest. But it suits most with such viscera as the uterus and bladder when they require a cholagogue remedy. It is also proper for chronic affections of the trachea, for jaundice, exanthemata, lichen, herpes, erysipelas, and leprosy. Black hellebore evacuates bile, especially yellow, from the whole body and without trouble. Hence it is given to those not affected with heavy fever, and more especially to such as are free from fever, in the quantity of one drachm of the roots triturated in honeyed water or plain water, while fasting, or with honey made into pills. Some mix with it pennyroyal, savoury, or some of the volatile stomachics.—Scammony purges like hellebore, and more especially yellow bile, but of all purgative medicines it is the most prejudicial to the stomach. It is, therefore, to be given to those who are free from fever, and such as have strong stomachs, to the amount of four oboli, with salts, pepper, ginger, or some one of the volatile stomachics, or along with honey. It is also formed into pills with gum.—The medullary part of the fruit of the Colocynth evacuates especially bile and mucous matters, not from the blood like hellebore and scammony, but from the nerves and nervous parts, when given to the amount of one drachm in two cyathi of honeyed water which has rue boiled in it. But it is to be triturated for a long time, because otherwise its rough particles sticking in the internal parts produce ulcerations and nervous affections by sympathy. It is to be given to those who have affections of the head, namely, when the meninx or the pericranium is affected, such as those labouring under vertigo or hemicrania, or those troubled with cephalæa; also in epilepsy, apoplexy, cynic spasms, chronic defluxions on the eyes, orthopnœa, asthma, and chronic coughs; likewise in arthritic cases to those who have affections about the kidneys or bladder.—Elaterium evacuates like scammony. Such as is green like leeks, light, and not older than a year, is to be chosen; and it is to be given to the amount of three oboli, triturated with one hemina of milk.—Tithymallus, spurge, evacuates bile like elaterium and scammony. Four or five drops of the juice are given, mixed with polenta and quickly swallowed. For if retained long in the mouth they ulcerate the tongue and surrounding parts.—Lathyrides (a species of spurge) purge bile like hellebore and scammony. They are to be given to the amount of seven, eight, or as many as fifteen grains to such as are robust and require much purging, who are to be directed to chew them. But those who are weaker and have bad stomachs, must swallow them whole.—The dried tops of the Peplium are to be given to the amount of eight oboli in honeyed water. They evacuate bile like hellebore, and occasion the breaking of wind.—Agaric has similar powers to the colocynth, but acts slowly and is not prejudicial to the stomach. It is given to the amount of two drachms with honeyed water. It should be very white, brittle, and not very woody nor carious.—Illyrian Iris purges in like manner when given to the amount of eight oboli in honeyed water. It ought not to be old nor carious.—The small Centaury by purging bile and mucus is particularly adapted for cases of ischiatic disease. The decoction is to be drunk of a drachm and a half of centaury, boiled in a hemina of water until it be reduced to the half.—The flower with the fruit of Tragoriganum is given to the amount of two drachms, in honeyed water, to the same class of persons as the black hellebore. It is more stomachic than the hellebore, but less purgative.—Four drachms of Chamelæa (mezereon?) boiled in two heminæ of honeyed water, until reduced to a fourth part, purge like hellebore. Some administer chamelæa by making it into pills with a double quantity of wormwood.—Aristolochia, birthwort, purges like colocynth, one drachm of the species called clematis being given in honeyed water.—The dried root of Polypody when pounded and sprinkled on honeyed water, or triturated along with it, has the same effects as colocynth.
Medicines which evacuate black bile. Medicines which evacuate black bile are to be given in an especial manner to melancholic persons, to such as are easily moved to paroxysms, to passionate persons, to misanthropists, to persons of solitary habits, or to such as during convalescence require purging, during the heat of autumn, in dry habits, and to such as are not muscular.—Epithymum, dodder of thyme, is the best of those medicines which evacuate black bile. It is to be given to the amount of five drachms triturated with a hemina of milk.
Epithymbrum, or the substance which grows upon savory, evacuates in like manner with the epithymum, but is weaker. Pennyroyal, when taken to the amount of an acetabulum, in honeyed water, evacuates black bile.—The Heracleatic Tragoriganum in the same dose evacuates like pennyroyal. But both must be dried. Alypum, the seeds of it have been said to purge black bile when given in the same quantity as the epithymum with salts and vinegar; but, as Dioscorides says, it occasions slight ulceration of the intestines. It is, I think, that substance which is now called alypias. It is to be given in honeyed water.—Parthenium (matricaria?), feverfew, when dried and drunk in like manner, evacuates the same humours. Alypon, madwort, drunk with salts, purges in like manner.
Medicines which evacuate phlegm. We are to administer phlegmagogues in cold habits; to aged persons, in winter; in paralytic and apoplectic cases; for loose œdematous swellings; to such persons as have great collections of phlegm in the belly, chest, or stomach; and in cases of the female flux. They agree also with those who have a copious running from the nose and thick expectoration, with cases of anorexia and ischiatic disease when the joint becomes mucous or pituitous; but they are particularly adapted for those cases of dropsy which are called anasarca.—One drachm of white Storax, drunk with an equal quantity of turpentine rosin, evacuates phlegm.—The bark of the root of Olive to the amount of one drachm, with wine or water; nine oboli of Pellitory, with water; two drachms of the seed of Lychnis (campion); one drachm of the root of Sow-bread, with hydromel; two drachms of Garlic, with honey; ground Pine, triturated and given in the form of pills; half a drachm of the flakes of copper, with an equal quantity of rosin, in pills, purges bile strongly.—A drachm and half of the green leaves of Bay; two oboli of the bark of the root of the wild Cucumber; forty seeds of that species of ricinus called Crotones stripped of their bark and eaten, do the same. A half of that part of Parsley connected with the root (which some call chamæraphanus), when eaten; two drachms of Bdellium, with hydromel; but Gum is particularly adapted for defluxions on the eyes.
Medicines which evacuate water. We are to give hydragogues in that variety of dropsical disease called ascites; to women troubled with the whites; and to those who have ulcers accompanied with a copious discharge.—One drachm of the flakes of Copper, when drunk with honeyed water evacuates water; but a little vinegar must also be swallowed lest it be vomited.—The Granum Cnidium when stripped of its bark, triturated, and drunk with boiled honey, that it may not touch the orifice of the stomach, evacuates water. Twenty, twenty-five, or thirty grains are to be given, and to those who are stronger, as many as forty.—One drachm of Euphorbium, drunk with boiled honey, evacuates phlegm, but more especially water.—Eight oboli of the seed of rough Spleenwort, with honeyed water, evacuate water.—Cneorum, in like manner, purges water when drunk with polenta.—Five drachms of the seed of Cnicus, when triturated together in ptisan, are swallowed with a small quantity of salts.—One drachm of Ammoniac perfume, drunk in honeyed water, evacuates water. Some give it in affections of the spleen with oxycrate.—The juice of the bark of the root of the Elder-tree, when drunk to the amount of two ounces with wine, evacuates water.
Commentary. The philosopher Aristotle thus explains his ideas respecting the action of purgatives: “When purgatives are conveyed to the stomach, and are there dissolved, they are carried by the same passages as the food, and when they cannot be digested, but their prevailing power remains unsubdued, they return, and carry with them whatever opposes them, and this is called purging.” (Problem. 43.) See also Alexander Aphrodisiensis (Probl. ii, 58.)
Hippocrates administered purgative medicines freely and boldly, but at the same time he cautions against the unseasonable and rash administration of them in several parts of his works. We do not find any theory, however, of the modus operandi of purgatives, nor any general remarks on the cases in which they are applicable, in any of the Hippocratic treatises which are now acknowledged to be genuine. Some ingenious remarks, however, may be found on this subject in the work ‘De Nat. humana.’
Celsus has a chapter on purgative medicines which contains much curious and valuable matter. He says the more ancient physicians gave various purgative medicines very freely, such as black hellebore, polypody, squama æris, the milky juice of lactuca marina (euphorbia paralias?), the milk of asses, with a little salt; but he holds that purgatives hurt the stomach, and are not to be given when any fever is present. The rules, which he lays down for the administration of them, are highly judicious, and deserving of consideration. He approves of them when the head feels heavy, when the eyes are misty, when there is obstruction of the bowels, and when there is pain there or in the hip-joint, when the stomach is oppressed with bile or phlegm, and when there is dyspnœa, when venesection is indicated, but the powers of the system will not admit of it, and in several other cases. (v, 12.) He mentions that Asclepiades totally rejected the use of purgative medicines. (i, 3.)
Galen has devoted a complete treatise to the discussion of the question regarding the modus operandi of purgatives. He decidedly inclines to the theory that every purgative by some specific property attracts, and as it were, sucks to it the humour to which it has a natural alliance, in like manner as the magnet attracts iron. He divides Purgatives into Cholagogues, Melanogogues, Hydragogues, and Phlegmagogues. He rejects the hypothesis of Erasistratus, who maintained that each medicine converts the juices presented to it, into its own specific nature: thus that cholagogues convert them into yellow bile, melanogogues into black bile, and so forth. Although Galen flatters himself that he effectually demolishes this hypothesis, we have long looked upon it as a very plausible one, and believe that at the present time the prevailing opinion in the profession inclines much in that direction. For example, the green and dark discharges which are brought off by mercurial purgatives, are now generally supposed to be occasioned by the fluids in the secretions entering into combination with the medicine administered. It is to be regretted that no ancient author has given us a clear exposition of the hypothesis of Erasistratus. Galen gives a long list of cases, in which purgatives prove beneficial, such as erysipelas, epilepsy, apoplexy, gout, rheumatism, melancholy, and many chronic complaints. He insists strongly on the benefit derived from cholagogues for the cure of jaundice. (De purg. Med. vi.)
Antyllus, in an extract preserved by Aëtius, espouses the theory which maintains the specific operation of purgatives, and that they act by attracting the humours to which they are allied. He recommends them for various complaints, as malignant cutaneous diseases, spontaneous ulceration, and rheumatic affections. (iii, 23.)