The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 7. Of Tenesmus.

TEnesmus, is a continual desire to go to stool, and voiding of nothing but Slime or bloody Matter.

The immediate Cause of this Disease, is an Ulcer in the streight Gut called Intestinum rectum; from which, Quittor or filthy Matter continually floweth, and stirreth up the expulsive Faculty, by which means there is a continual desire of going to stool. Moreover, there is voided a slimy Matter mixed with blood, from the depravation of the Homoiosis (or quality that converts things into its likeness) of the ulcerated part, because it cannot wel concoct its proper Nourishment, and make it like it self, but turns it into another slimy substance; as we shewed more at large in Dysenteries, and other Ulcers of the Guts.

But in regard we said in the Chapter of Dysentery, That al the Intestines might be ulcerated in that disease; thence it seems to follow, That the Ulcers of the straight Gut called Rectum belong to a Dysentery. Yet Custom hath so prevailed, that when the Rectum is only hurt, it is called by the name of Tenesmus: And because when other Guts are affected, if the Rectum suffer, there is also Tenesmus or needing, although the disease be then called a Dysentery; therefore Dysentery and Tenesmus are of the same Nature, and have the same Cause, and differ only in respect of the part af∣fected: And therefore we need not repeat the Causes, because they are the same with those that pro∣duce a Dysentery.

For the Knowledg of this Disease, there is no more required but to distinguish it from a Dysen∣tery, which you may learn from the definition. For in a Tenesmus, there is a continual needing; but in a Dysentery it is by fits: besides, in that, after great straining, there is voided only a little slime, bloody or mattery; but in a Dysentery, both Excrements and Humors are continually voided.

The Signs of the Causes are the same with a Dysentery.

As for the Prognostick, Celsus Lib. 4. Cap. 19. saith that a Tenesmus is easily cured, and that of it self it never kils any, yet Galen, 5. de usu partium, cap. 4. reckons it among the chiefest Diseases of the Belly; and truly it may very wel be accounted grievous in respect of its troublesomness and long continuance; yet it is not dangerous except it come of Melancholly, for then it tends to a Can∣cer ulcerated: besides, it brings great inconveniences, as Miscarriage or Abortion to Women. So Hipp. Aph. 27. Sect. 7. saith, If a Woman with Child have a Tenesmus, she wil miscarry. For the continual straining at stool doth much disturb the Womb, which is so neer to the straight Gut. Be∣sides, the same Muscles which serve to throw out the Excrements, are imployed for delivery; there∣fore when they daily compress the lower Belly, they cause Abortion. Lastly, the Ulcers of the Rectum Intestinum being neer the Anus or Fundament, if they contitue long, turn to an incurable Fistula.

The Cure of a Tenesmus, little differs from the Cure of a Dysentery. And therefore first, the sharp Humors that come from the Liver and other parts, are to be purged with Medicines that leave an Astringent quality, as chiefly Rhubarb, which must be so often given till the Humor seem to be spent.

If there be an Inflamation (which is chiefly known by a Feaver) or if much blood, you must open a Vein. And in case it continue after bleeding, and cause a strangury or difficulty of Urine (as it often doth) it is very good to open the Hemorrhoids with Hors-leeches.

Also you must use asswaging Clysters when there is much pain; and clensing, glutinating, and astringent, according as the Ulcer requireth; the Forms whereof are to be found in the Cure of Dysentery.

But in the use of Clysters, observe first, that you give them often, and in a smal quantity, only half a pint, because they wil be hardly kept any time, by reason of the continual needing. And the pipe must be warily conveyed in, lest the pain be encreased.

And you must diligently apply Fomentations, Insessions or Baths to sit in, Fumigations, Sup∣positories, and Oyntments.

You may make a Fomentation thus,

Take of Mullein & Wormwood, of each six handfuls: boyl them in new Milk and put them into two Bags, which apply to the Anus and whol belly one after another very warm. Or,

Take of Chamomel Flowers, and Roses, of each one handful: Red Wine two Pints: infuse them two hours upon hot Embers: Foment the Fundament as hot as can be suffered with four times doubled cloathes: After let the Patient sit upon a spunge dipped and stra••ned from the same Liquor.

Or, Fill two Bags with Barley Bran and boyl them in Vinegar: Let the Patient sit one while up∣on one, another while upon another as hot as he can.

If he void much Blood, make the Fomentation thus,

Take of Mullein Leaves and Roots two handfuls: Red Roses one pugil: Pomegranate peels, and Galls, of each half an ounce: boyl them in two parts of Iron-Water, and one of Red Wine for a Fomentation: which you may make stronger if you ad half an ounce of Allum.

Insessus, or Baths to sit in to asswage Pain, are made of Emollients boyled in Water, or Broth of Sheeps Heads and Feet, to which you may ad Violets, Nightshade, Gourds, and Mellons sliced, but for healing of Ulcers you must make them of Astringents afore-mentioned.

Fumigations are good to dry the Ulcer made of Frankinsence burnt, or the Decoction of Savin made in Oxycrate, or other things mentioned in the Cure of a Dysentery, the Fume whereof must be taken sitting in a hollow Chair. But this following is Commended by Forestus.

Take of Mastich one dram: Frankinsence one scruple: Myrtles one dram and an half: Red Roses two scruples: make a Pouder for a Fumigation.

Suppositories are good in this Disease, they must be gentle and mild, least they exasperate the part which is so sensible: They are fitly made of Goats Suet cut into the form of a Suppository; for they appease the pain & heal the Ulcer: but they wil be better against Pain if you mix the seed finely poudered of Poppies or Henbane, & tye them in a knot in Paper like a Suppository: But far best if you instead of these things put three drops of the Oyl pressed out of these Seeds to every Supposi∣tory: or one grain of Opium dissolved in half a scruple of Oyl of sweet Almonds.

The Ulcer wil be sooner healed, if you first dissolve the Suet, either alone, or with white Starch, Gum Tragacanth beaten, and first steeped in Plantane Water, or else with some Narcoticks: Or, thus,

Take of Gum Tragacanth as much as is sufficient, sprinkle it with Plantane Water that it may only swel and not dissolve; then ad as much of the mucilage of Fleabane seeds, or Quince seeds, and mix them with the white of an Egg roasted; then with melted Wax make them into a Supposi∣tory: You may also ad Narcoticks: as likewise to Cure the Ʋcer better, the Pouders of Ceruss, Tutty, Bole, Pomegranate Flowers, and the like which dry without Acrimony, and sharp∣ness; And these must be very finely Poudered and sifted, least the Part be Exasperated.

You may apply Oyls and Oyntments as in a Dysentery, to the Belly and Fundament: As Oynt∣ment of Roses, Populeon, or of the Mucilages, of the whites of Eggs, Oyl of Roses, and the like, to take away Pain and Inflamation: and other things that shal be mentioned in the Chapter of Hae∣morrhoids, or to Cure the Ulcer, the white Oyntment of Rhasis or Pompholygos, melted in Hydro∣mel, or in Honey and Water.

Lastly, In a more desperate Condition, use Narcoticks both inwardly and outwardly; but three or four grains of Laudanum is best given with Mastich and Terra Sigillata, or mixed in a Clyster made or a Decoction of the Flowers of Chamomel.