SUBSECTION 3 Preparatives and purgatives

After bloodletting we must proceed to other medicines: first prepare, then purge—“clean out Augeas’ stable”—make the body clean before we can hope to do any good. Gualter Bruel would have a practitioner begin with an enema of his own, which he prescribes before bloodletting. Most, such as Mercurialis, Montaltus in chapter 30, and others, proceed from gentle laxatives to preparatives, and then to purgatives. The gentle laxatives are well known: the lenitive electuary, Diaphenicum, Diacatholicon and others.

Preparatives are usually syrups of borage, bugloss, apples, fumitory, thyme and epithyme, with twice as much of the corresponding decoction or distilled water; or waters of bugloss, balm, hops, endive, scolopendry, fumitory and the like; or these boiled in whey. They must be repeatedly administered for many days in succession.

Purgatives come last, and “must not be used at all if the disease can be relieved otherwise,” because they weaken nature and dry the body so much. In administering them, “we must begin with the gentlest.” Some, including Alexander and Salvianus, forbid all hot medicines “lest the patients become more deranged through them”: hot medicines increase the disease “by excessive drying.”

Purge downwards rather than upwards, use potions rather than pills, and once you begin medicinal treatment, persevere with a course of it. For, as one writer observes, “to stir up without drawing out is harmful in every case”: to stir up the humour, as a single purge commonly does, and then fail to follow through does more harm than good. Patients must continue a course of treatment, yet without exhausting and overburdening nature. “Nature must be given rest”: treatment must sometimes be relaxed so that nature can rest.

The gentlest purgatives with which to begin are senna, cassia, epithyme, myrobalans and Catholicon. If these do not succeed, we may proceed to stronger ones, such as Hamech’s confection, Indian pills, fumitory pills, pills of Assaieret, Armenian stone and lapis lazuli, and Diasena. Or, if pills are too dry, some prescribe both hellebores as a last resort, among them Aretaeus, “because this disease will resist a gentle medicine.”

Laurentius and Hercules de Saxonia would have antimony tried last, provided the patient is strong and it is given cautiously. Trincavelli prefers Hierologodium, and Francis Alexander agrees in his Apology, rad. 5: they regard it as an excellent medicine. But Crato, in a consultation for the Duke of Bavaria’s chancellor, rejects it entirely.

Among writers I find a vast chaos of medicines, a confusion of recipes and special formulations intended for this disease. I shall recount some of the principal ones. To begin with, being seasick is very beneficial at suitable times.

Mattioli’s hellebore treatment, with which he boasts of having performed so many different cures: “I never administered it,” he says, “without their being successfully cured, with God’s help, after one or two doses.” He describes its preparation at length in his third book of Letters, to the physician George Hankshius. Gualter Bruel and Heurnius mention it with strong approval, as does Skenkius in his Memorable Cures and Experimental Medicines, century 6, observation 37.

Then there is Montanus’ famous hellebore treatment, so often repeated in his consultations and counsels, such as number 28, for a melancholic priest, and consultation 148, for a hypochondriacal patient. He boasts that it is “a most sovereign remedy for all melancholic people, which he has often administered without harm and found effective through long experience and observation.”

Quercetan prefers a syrup of hellebore in his Spagyric Pharmacopoeia, and an extract of hellebore, chapter 5, likewise of his own invention, to every other remedy: “a very safe medicine, and not unsuitable for children.”

Paracelsus, in his book on black hellebore, accepts this medicine, but only as he prepares it. “It is quite certain,” he says, “that this herb has great powers and remarkable effects, differing little from balsam itself. Anyone who knows how to use it properly possesses more skill than all their books contain or all the doctors in Germany can display.”

Ælianus Montaltus, in his excellent work On Diseases of the Head, chapter 31, On Melancholy, gives a particular recipe of his own for hellebore, which he used successfully in his practice. Since it is short, I shall set it down.

Take two ounces of apple syrup, four ounces of borage water, and six or eight grains of black hellebore, infused overnight in a tied packet. Strain it in the morning and administer it.

You will find other recipes for it, serving the same purpose, in his work. Valescus admires Hali’s powder, and Jason Pratensis follows him. Our new London Pharmacopoeia has recently revived its preparation. “Suppose,” he says, “that all other medicines fail: with God’s help this alone will succeed. It is a crowned medicine that must be kept secret.”

Take half an ounce of epithyme, two ounces each of lapis lazuli and agaric, one drachm of scammony, and twenty cloves. Reduce everything to powder; let the patient take four scruples of the powder each week.