The account of this subject, given by Oribasius, is taken from the works of Galen and Ruffus. It is too lengthy for our limits. Ruffus directs the surgeon to consider well the patient’s constitution, and regulate the dose of the medicine accordingly, as there is a great difference in the susceptibility of persons to be acted upon by purgatives. The following is a list of the purgatives described by Ruffus in this fragment: Polypody, iris, colocynth, phacoides (a species of spurge olive?), peplos, peplium, aloe, hippophaes, hippophæstum, clematis, pycnocomon, vines, thyme, epithyme, marjoram, Greek savory, poppies, cucumber, the smaller heliotrope, the lesser sesamoides, the tithymalli or spurges, the chamelæa, lathyris, agaric, and euphorbium. His description of the operation of each medicine bespeaks a good acquaintance with the subject. (Med. Collect. vii, 26.) See also Actuarius (Meth. Med. iii, 7.)
Haly Abbas makes some acute remarks on the action of Cathartics. Every purgative, he says, attracts the humour, to which it is allied. Different opinions, he adds, have been entertained regarding the modus operandi in this case. Some maintain that, when such a medicine is swallowed, it goes to the members where its cognate humour is lodged, from which both are expelled by the expulsive faculty of the part, and return to the bowels together. This theory, however, he rejects. He mentions further that others maintain that the medicine attracts its peculiar fluid, as a magnet does iron; and of this theory he adopts a modification. He states it as his opinion that, when such a medicine has been swallowed, it attracts its cognate fluid from the surrounding parts, to which all the similar fluids in the body are afterwards determined, being conveyed thither by the veins. He gives a full account of all the purgatives known in his time. (Pract. iii, 53, 54.) Much the same theory is advocated, and fully explained by Serapion. (De Antidot. vii, 10.)
Avicenna and Rhases object to the doctrine of Galen that he appears to have maintained that there is a peculiar alliance between a purgative medicine of a certain class and the fluid or humour which it attracts, whereas they argue that, as there is no alliance between the magnet and the iron which it attracts, so is it in like manner with purgatives and the peculiar fluids which they evacuate. This, however, is only a more precise exposition of the theory advanced by Galen. Rhases (Cont. xii, 1); Avicenna (i, 4, 4.) The ancient theory is very acutely stated by Averrhoes (Collig. v, 21.) See also Mesue (Canones universales.) There appears to be some originality in the theory of Mesue. He says that a purgative medicine operates by occasioning a preternatural increase of the vital, or, as it is now called, animal heat of the part to which it is applied, whereby its attractive powers are increased. He maintains very ingeniously that purgation is an act of Nature, that is to say, an operation of the vis medicatrix naturæ, and that the medicine is merely the instrument of Nature in this case, for, he adds (as Hippocrates says), it is Nature, and not the physician, that cures diseases. A purgative medicine, then, he argues, acts by rousing the expulsive power of Nature. He joins the preceding authorities, however, in illustrating the attractive power of purgatives, by comparing it to the property which the magnet has of attracting iron, and amber of attracting straws. Purgative medicines, he says, have the faculty of clearing away the humours from the different parts of the body; from the stomach and intestines they do so readily; from the meseraic veins less easily; still more difficultly from the liver, and with the greatest possible difficulty from the joints, especially when the humours are impacted there. He forbids purgatives to be given in the extremes, either of hot or cold; in this practice observing the rule of Hippocrates. In hot weather, he says, emetics, and not purgatives, are indicated. The directions which he gives for correcting the noxious qualities of purgative medicines are highly important, but they are too lengthy for our limits. Aromatics added to purgatives, he says, dispel flatus; bitters do the same, and strengthen the stomach; saltish things increase their purgative powers; unctuous, by lubricating the intestines, accelerate their operation, and render it easier; and sweet substances render them less nauseous, and diminish their acrimony.
On the ancient arrangement of purgative medicines Dr. Paris makes the following pertinent remark: “It is impossible to concede to the opinion of Dr. Hamilton, that the different species of purgative medicines do not possess distinct powers over the different species of matter to be evacuated; on the contrary, there is reason for reviving the ancient theory, too inconsiderately abandoned, and which acknowledged these different distinctions in the operations of cathartic medicines under the appropriate names of hydragogues, cholagogues, &c.” (Pharmacop.) Dr. Alston likewise writes thus: “We have a very learned essay in confirmation of the ancient doctrine of the specific operation of purgatives by Dr. G. Martyn (Lond. 1740, in 8vo.) I shall not enter into the controversy, but only observe that there is nothing impossible, yea, nor improbable in the theory.” (Lectures.) See a learned dissertation on the action of purgatives in Mangeti ‘Bibliotheca Anatomica,’ i, 159. We may mention further that Dr. Murray in his Materia Medica inclines to the Galenic theory of the specific operation of purgatives. (c. viii.)
On Cholagogues. Most of these medicines are sufficiently well known, and therefore do not require to be treated of at greater length. See also Aëtius (iii) and Oribasius (M. Col. vii.)
The Arabian author Mesue gives the following table of Cholagogues:
| Clementer. | Valenter. | ||||||
|---|---|---|---|---|---|---|---|
| Cholagoga | { | Aloe | } | Trahendo et astringendo, flavæ: nam aliæ aliud vacuant. | Radices | { | Agaricus. |
| { | Absinthium | } | { | Asarum. | |||
| { | Rosa | } | { | Aristolochia. | |||
| { | Rhabarbarum | } | { | Bryonia. | |||
| { | Myrobalani | } | { | Cyclaminus. | |||
| { | Pruna. | { | Cucumer agrestis. | ||||
| { | Tamar Indi | } | Astringendo. | { | Dracunculus et arum. | ||
| { | Cassia | } | { | Elleborus. | |||
| { | Manna. | { | Esula. | ||||
| { | Viola nigra | } | Lubricando. | { | Hermodactylus. | ||
| { | Psyllium | } | { | Iris. | |||
| { | Adiantum etiam phl. | { | Scilla. | ||||
| { | Turbith. | ||||||
It will be perceived that this list contains several articles with which the Greeks were unacquainted, namely, myrobalani, tamarindi, manna, and turbith. Of all these substances we have already given some account in the [Appendix to the Third Section]. Mesue calls the tamarinds, the fruit of an Indian palm-tree, the word tamur signifying a date. He says, that they are excellent medicines for repressing the acrimony of the humours, purging bile, cooling the heat of the blood; that they prove useful in hot fevers, jaundice, inflammation of the stomach and liver, and that they stop vomiting. He calls them refrigerants and desiccants of the second order. To prevent them from hurting the stomach by their coldness, he recommends to give them with spikenard, mace, mastich, wormwood, fennel, or any such calefacients. Avicenna states their medicinal characters in the same terms. Serapion says, that they are desiccants and refrigerants in the third degree. Averrhoes ranks them among the refrigerants of the third, and desiccants of the second order. We have already mentioned, that the earlier commentators are decidedly of opinion, that the tripolium of the Greeks was turbith, but this is now generally acknowledged to have been a mistake. Mesue calls it the root of a milky herb, having leaves like a ferula, but smaller. Probably, however, as his commentator Manardus remarks, there is some mistake in the comparison of it to the ferula, as there is no resemblance between them. An accurate modern author, Moses Charras, calls it the bark of a milky root, which is chosen by its weight, dark-coloured without, white within, and clear from its pith, which is hard and fibrous. Mesue represents it to be a hot, nauseous purgative. It is given in powder, he says, to the amount of from one to two drachms.
Serapion recommends Cholagogues particularly in jaundice, inflammatory affections of the brain, mania, epilepsy, erysipelas, herpes, and tertian fever. He describes the following medicines as cholagogues: aloes, southernwood, black hellebore, scammony, colocynth, agaric, claterium, two species of mezereon, lathyris, the root of the lily, centaury, polypody, birthwort, myrobalaus (the yellow, the black, and the chebulic), pomegranate, cassia fistula, violet, ivy, and two Arabian substances anabac and alterariabin. We are unable to determine what the last two were.