A purgative pap, useful in cases of œdema and aggravated elephantiasis, and when one wishes to dislodge a thick and viscid humour. Having cut up two colocynths, evacuate the seed, and allowing the medullary part to remain, fill them with sweet oil, and covering them up with their proper covers allow them to remain a night and a day. On the following day, having evacuated the oil, boil the colocynths in water until they are reduced to a soft consistence; then throw them away, and the oil being mixed with water, add to it three oboli of black hellebore, and of scammony, dr. j; but boiling along with them a pap of similago, or dried bread pounded, and then give of it to the patient, who has been formerly restricted to a simple diet, to the size of eight, ten, or at most fourteen filberts; and let him drink hot water.
Commentary. It may be proper in this place to apprize the reader of the reason why he will not find the remainder of the work so copiously illustrated by notes as the preceding parts of it. The combination of simple medicines in pharmaceutical preparations is so arbitrary, and so little regulated by any fixed principle, that it is seldom we can find any two authors exactly agreeing as to the ingredients which enter into any one preparation. Now to follow all the ancient writers on pharmacy through all their complex formulæ, and point out every little difference which prevails among them, would be a very wearisome task, and one which would scarcely recompense us or our readers for the time and attention which such an undertaking would necessarily demand; and neither is it much required, since, as will be seen, our author’s system of pharmacy is sufficiently copious and accurate for all practical purposes. We shall therefore be content with giving a general explanation of each class of these medicinal preparations, and only offer some occasional remarks on a few of the more important articles.
Under this head we shall give some account of the Halatia Cathartica, or Purgative Salts of the ancients. The ἅλες κοινὰι πεφρυγμέναι are the same as the sal commune frictum of Apicius. Humelbergius thus explains it: “fricti, id est cremati et torrefacti.” The following is Apicius’s receipt for the “Sales conditi ad multa:” Of common salt roasted, lb. j; of sal ammoniac roasted, lb. ij; of white pepper, oz. iij; of ginger, oz. ij; of bishop’s weed, oz. iss; of thyme, oz. iss; of parsley-seed, oz. iss. The purgative salts of Aëtius contain sal ammoniac mixed up with many purgative and cordial medicines, such as scammony, laserwort, parsley-seed, ginger, pennyroyal, spikenard, and pepper. (iii, 109.) These are the ingredients of a sal purgatorius recommended by Actuarius. (Meth. Med. v, 10.) Myrepsus gives prescriptions for various purgative and stomachic salts. They all consist of sal ammoniac, or common salt mixed with scammony and aromatics in different proportions. (Sect. ii.) See also Haly Abbas. (Pract. x, 10.)
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.)