Purgative applications to the navel were much trusted to by the ancient physicians as laxatives, but they are now seldom used. The late Dr. Kerr, of Aberdeen, however, sometimes had recourse to them, and spoke highly of their efficacy.
SECT. X.—ON EMETICS, AND THE MODE OF ADMINISTERING HELLEBORE.
Persons in health have recourse to emetics when the system is loaded with too much food or humours, and those in acute diseases, when troubled with phlegm or the like. But neither persons in health nor those in acute diseases should be permitted to use emetics, but only in chronic affections, more especially in cases of indurations, and for such matters as require to be dislodged by forcible means, as in gout, epilepsy from the stomach, elephantiasis, dropsy, melancholy, and the like. They are improper in spittings of blood, weakness of the stomach, and suffocative complaints. The readiest of the emetics is the oil of privet (oleum Cyprinum), the fingers or some feathers being dipped in it and pushed down the throat. And dr. vij of Celtic nard taken in honeyed water evacuate upwards powerfully. In like manner v or vj dr. of betony drunk in honeyed water, and three green leaves of the daphnoides pounded and eaten. And an obolus of elaterium taken in a draught of water, purges phlegm and bile upwards; and fifteen grains of stavesacre with thick honeyed water. Of plants with bulbous roots, those usually eaten if taken raw, and the boiled roots of narcissus purge upwards. And the upper part of the root of parsley, namely, that which is exposed to the air, when eaten, purges upwards. Some call it chamæraphanum. The under part of the root purges downwards. When the whole is eaten it purges both upwards and downwards. Radishes purge less than the aforementioned, but more usefully. They are to be taken when very acrid and fresh, and cut into small parts; and having allowed them to soak in oxymel for two or three hours, as many of the pieces as possible are to be swallowed, so that one may vomit three or four times after supper, and once if fasting. But after, large draughts of oxymel are to be swallowed; and after walking about for two hours, and drinking tepid water, one may compel one’s self to vomit by inserting the fingers or some feathers into the throat.
Modes of administering hellebore. Hellebore is to be given in protracted and severe complaints, and when all hope from other remedies is precluded, because the disease has proved stronger than them all. It is to be given in continued diseases, as dropsy, elephantiasis, cachexia, paralysis, and the like; and in certain complaints which attack at intervals, as epilepsy and gout. There being many modes of administering hellebore, the simplest, and rather the preparative for a course of hellebore, is this method: having perforated radishes with a reed, pieces of the dried roots of the finest white hellebore are to be inserted into the perforations, and having been allowed to remain for one night they are to be removed. Having cut the radishes in pieces they are to be given with oxymel, in the manner described, to the patient who has been accustomed before to emetics, and after an interval of the number of hours mentioned, he is to be forced to vomit. The established mode of administering hellebore is as follows: having allowed two ounces of the best hellebore to macerate in a hemina of water for five days, boil until only a third part of the water remain, and having expressed the hellebore, mix with the water an equal quantity of honey, and boil it until it thicken; and after the patient has been exercised with vomits in the manner described, give it to him when fasting, and after digestion has been performed, and the contents of the bowels evacuated, either spontaneously or by one or two injections, according to his strength. But the most efficacious mode is this: having cut the roots of the hellebore into pieces resembling the seeds of Indian corn (for when reduced to a downy powder it occasions suffocation by its powerful action), give to those who are of a weaker constitution dr. ij, at most, or, at least, dr. j of the hellebore, in the juice of ptisan, of halica, or the like; but to those who are stronger, it is to be given in hot water or honeyed water. The purging begins after three or four hours; but when it is longer of commencing, it operates more effectually. When the vomiting is slow of beginning, give honeyed water to drink, and let the patient be compelled to vomit by inserting feathers dipped in oil into the throat. If even thus he will not vomit, let him be put into the bath. When vomiting commences, if it go on properly, we need not interfere; but if lancinating pains or convulsions supervene, we must give a mixture of water and oil to drink. For thus is an evacuation downwards occasioned (which otherwise sometimes takes place when hellebore has been administered), and they bear the concentration of the medicine better. When the patient falls into deliquium animi he is to be resuscitated by strong-smelling things and the like. Any other symptoms which may happen to occur are to be treated in a suitable manner. When the purging is excessive, they are to be allowed to take food and sleep, and do otherwise as mentioned in describing the treatment of hypercatharsis. But if it continue, cupping-instruments are to be applied over the stomach, and ligatures tied round the limbs. When the evacuation proceeds properly we must give to drink a moderate quantity of honeyed water, in order to wash away the superfluous particles of the medicine. After a little while, give some food of easy digestion. When apprehensions are entertained of the administration of hellebore by the mouth, and the medicine is by all means required, Antyllus uses the following injection: having allowed two drachms of white hellebore to macerate in a sextarius of water for a day and a night, on the day following we are to boil the hellebore in the water until but a half remain. Then we are to inject it by the anus so as to produce vomiting. It purges upwards somewhat more feebly than when the medicine is drank. After sufficient purging, an acrid suppository is to be introduced so as to occasion the discharge of the injection and stop the vomiting. After the discharge of it, an injection of honeyed water is to be given once or twice in order to wash out the gut. The same person says: A suppository is made of white hellebore, pounded and strained, and mixed with boiled honey, which purges like the injection of hellebore. But the following is a better method; for we have it in our power to regulate the purging: The quantity is to be dr. ij of hellebore, and the suppository is to be wrapped round, or bound with some flocks of wool firmly. The head of this ball of wool is to be allowed to hang out of the anus, in order that after sufficient purging it may be in our power to remove the suppository. This method purges effectually, and neither occasions convulsive suffocation nor any other dangerous symptom.
Commentary. The gentle emetics used by the ancients on ordinary occasions have been treated of in [Book I]. We have now to give some account of the more drastic emetics.
Galen and Oribasius recommend, as effectual emetics, the bulb of the narcissus, the seed of the anagyrus, and the fleshy part of nut ben. The Unguentum irinum and the U. cyprinum are stated by Aëtius and most of the other authorities to be safe and effectual emetics. Aëtius also commends the decoctions of hyssop and of thyme, the seed of bastard saffron pounded with oily grain, the oils of sesame, radishes, and narcissus, and the leaves of the daphnoides. Nitre or an impure carbonate of soda was also a medicine in general use as an emetic. The Lemnian earth was often given as an emetic, being a sort of red ochre. Avicenna and Rhases make mention of a species of black turbith, called gilbenec, which they describe as an effectual emetic, but somewhat unsafe. See the [Appendix]. Avicenna says that tickling the throat with a feather, smeared in the oil of sesame, readily excites vomiting. He remarks that vomiting is promoted by motion and stopped by rest. The bulbus emeticus was in general use to produce vomiting. Serapion directs us to give it boiled along with honey. He also commends the nux vomica as an emetic when given along with a small quantity of salt. We need scarcely say that it is now seldom or never given for this purpose, although it still holds a place in some of the continental systems of Materia Medica. The earlier modern writers on medicine recommend it freely as an emetic. See Guido de Cauliaco. (vii, 1.)
But of all the medicines of this class the white hellebore was undoubtedly the most powerful, and in important cases was the most generally used. We must, therefore, take this opportunity of describing the forms in which it was administered. Hippocrates appears to have been familiarly acquainted with it as a medicine, and to have administered it very freely. Aretæus concludes his work with a spirited eulogium on hellebore; “But in all inveterate chronic diseases, when other remedies have failed to produce the effect, this alone is to be depended upon for the cure. For, in power, white hellebore resembles fire, and with still greater powers hellebore, by pervading the inward parts, produces freedom of respiration from obstruction, a healthy colour from paleness, and plumpness of body, in place of emaciation.” But on the modes of administering hellebore, the fullest and most accurate of the ancient authorities is Oribasius, whose interesting account of it we shall now attempt to give in an abridged form. His description is mostly taken from Archigenes, Herodotus, and Antyllus. He sets out, then, with giving directions about preparing the patient for entering upon a course of hellebore. This consists principally in putting him upon a regulated diet, and administering occasionally some of the gentler emetics, especially the one from radishes. He, then, describes at considerable length the marks by which good hellebore may be recognised. When broken, he says, it ought to be white in the inside; and when taken into the mouth it ought to be felt hot and acrid, but at first of a sweetish taste; thereafter gradually becoming more stimulant, and provoking a great flow of saliva, and that frequently attended with vomiting. He recommends the following preparation of hellebore as being efficacious and perfectly safe: A pound of hellebore is to be macerated for three days in six heminæ of water, which we are to boil at a gentle fire until a third part of the water is consumed, when the hellebore is to be expressed; then two heminæ of honey are to be added to the decoction, which is to be again boiled until it no longer stain the finger. Of this preparation, the dose, to those who do not require strong purging, is two cochlearia, but to robust persons, the quantity called a mystrum. Another of his authorities, Antyllus, directs us to allow five drachms of the shavings of hellebore to macerate for three days in half a hemina of rain-water, after which it is to be strained and heated in a double vessel. Oribasius also mentions that the medicine may be given in a coarse powder. He afterwards lays down the rules of treatment when the action of the medicine superinduces dangerous symptoms. We need not go over this part minutely. Suffice it to say that, according to circumstances, he directs us to provoke vomiting by tickling the throat with feathers dipped in one of the emetic oils; to open the bowels with oily clysters; and to rouse the patient when in a state of stupor, by stimulants, restoratives, shaking him, pinching him, or tossing him in a garment. He recommends hellebore in cases of mania, melancholy, inveterate pains of the hip and other joints, epilepsy, catalepsy, vertigo, chronic headache, lethargy, leprosy, and other cutaneous diseases. He also praises it as a remedy in hydrophobia. (Med. Collect. viii.)
Aëtius states that hellebore is given in infusion, in decoction, and in substance, either cut into pieces or pounded and sifted. When administered in pieces it soon begins to act as a purgative, generally within two hours, bringing away bile and phlegm without much trouble, and after four or five hours the medicine itself is generally vomited up, and the purging stops. When given in a fine powder it acts violently but slowly, so that four or five hours have generally elapsed before its operation commences. He adds that in all its forms it evacuates bile and phlegm, but that it is attended with danger of bringing on convulsions or hypercatharsis. On the infusion he remarks, that it suits with old persons and children, to those who have a feeble constitution, and for the cure of elephantiasis. Five drachms of cut hellebore are to be allowed to macerate for three days in half a hemina of rain-water, after which it is to be strained and heated, when the whole of the infusion is to be taken. The decoction he recommends to be given to persons of a firmer habit of body, and in cases of mania and melancholy. It is to be thus prepared: A pound of hellebore, cut into pieces, is to be allowed to macerate for three days in two sext. of rain-water; after which it is to be boiled gently upon the coals until only a third remain; then, having strained it, we add to the decoction two pounds of scummed honey, and boil to the consistence of honey. It may be given as a linctus to the amount of a large spoonful, or mixed with hot water in a draught, when it will not superinduce spasms, contractions, or hypercatharsis. To those who stand in need of more violent concussion, who are of a strong habit of body and possess fortitude, and vomit readily, it is given cut into pieces; and to persons of still greater determination, or who have been accustomed to it, in the form of a sifted powder. It is to be cut into pieces of the size of malt or bran, and taken in ptisan or barley-water, a draught of mead or plain water being swallowed after to wash it away. The maximum close of it is dr. iiss. Hellebore may also be pounded and sifted in a fine sieve, when the larger particles may be given in halica (barley-water?) or pottage; but the smaller particles may be formed into pills with boiled honey. (iii, 131.) Macer Floridus concludes that scr. ij. is a sufficient dose of the white hellebore. (De Herb. vir.)
The Arabians give this medicine in the same forms and under the same circumstances as the Greeks. They estimate the dose of it at from dr. j to dr. ij. Mesue forbids it to be given in the form of a powder. He and Haly Abbas, however, recommend it in pills with hiera, colocynth, agaric, and various aromatics for the cure of elephantiasis and melancholy. Serapion states that there is great danger of its inducing convulsions if improperly administered. Avicenna’s account of the modes of giving it is very interesting.
Upon this subject we shall give the observations of the celebrated Prosper Alpinus: “Elleborus albus inter medicamenta vomitoria perpetuo apud omnes gentes præcipuum locum obtinet, fuitque in usu elleborismus, id est, purgatio per elleborum album, admodum familiaris apud antiquos, ad morbos sanatu difficillimos tollendos, cujus quidem usu complures ab affectibus ferè prorsus insanabilibus sanabantur, atque ita cito, et probè, ut eæ sanationes miracula viderentur; unde olim antiquorum illorum medicorum laus insigniter augebatur. Nunc vero non sine ægrotantium damno, atque magno artis medicæ dedecore, ipsius usus apud omnes ferè medicos obsolevit, qui nunc neque audent, neque sciunt, quomodo veratrum album exhibendum est.” (Med. Meth. iii, 10.) He gives the following prescription for making a preparation of hellebore: “Nonnulli ex recentioribus parant elleborum accipientes, ʒiss; vini dulcis aromatici, lb. j; turis, ʒiss; hyperici, ʒj; sacchari, ʒij; bulliant ad consumptionem mediatatis. Cujus decocti dant uncias tres.” He likewise approves of giving hellebore by boiling it in oil. (Ibid.)