Chapter XVII: Part 17

Each of these affections is a permanent pain of the head, liable to be increased by noises, cries, a brilliant light, drinking of wine, and strong-smelling things which fill the head. Some feel as if the whole head were struck, and some as if one half, in which case the complaint is called hemicrania. When the affection is seated within the skull, the pain extends to the roots of the eyes, and when externally it spreads around the skull. Pain then, accompanied with heaviness, indicates plethora; if with pungency, acrimony of the humours or spirits; if with throbbing, inflammation; if with tightness and without heaviness and throbbing, a fulness of a thin and flatulent spirit (_gas?_); but if it be attended with throbbing, it is indicative of inflammation of a membrane; if with heaviness, of a fulness contained within the membrane. If the putrid humour acquire heat, the headach will be attended with fever; and, in general, those in whom headach proceeds from inflammation have fever. When, therefore, the whole body is in a plethoric state, we must bleed (attention being paid to the strength), and use the more acrid clysters. Should there still appear to be a fulness of blood, we must open the veins of the nose, and endeavour to evacuate thereby to a sufficient amount. We must then give hiera sharpened with vinegar, and use masticatories, or medicines for evacuating the phlegm by the mouth; also procure evacuations from the nose by means of errhines, such as the juice of elaterium, which may be poured in with milk; or the elaterium may be snuffed up dry, or else the juice of sow-bread or of leeks. The following are compound medicines:

_An errhine for chronic headachs, ophthalmy, and epilepsy._ Of gith (_nigella sativa_), dr. viij; of sal ammoniac, dr. iv; of elaterium, dr. iv; pound and mix with Sicyonian oil, or that of iris, or of privet, so as to have the thickness of cerate, and apply to the nostrils.

_An errhine to be snuffed up._ Of dried sow bread, dr. viij.; of red nitre, dr. iv; or if, instead of the nitre, you will use elaterium, it will be still better. Snuff it through a reed. In more chronic cases use epithemes to the head and unguents, as the following:

_An epitheme for cephalæa._ Of the ointment of iris, of hog’s fennel and castor, of each, dr. j; of bay-berries, dr. ij; of the tops of rue, dr. iv; mix with rose-cerate, and having shaved the head, apply to the whole of it. A certain woman, by using the following application in cases of hemicrania, acquired wonderful celebrity: Having cut down the green root of the wild cucumber into small pieces, she boiled it and wormwood in oil and water until they were softened; and with the warm oil and water she fomented moderately the affected part; and, pounding the root and the wormwood, she made a cataplasm of them. And with this application she cured cases of hemicrania, both with fever and without. When a strong paroxysm takes place, so that the pain is insupportable, use paregoric and alterative applications like the following:

_An unguent for cephalæa._ Of the juice of hog’s fennel, dr. xvj; of the juice of poppy, of anise, of henbane, of saffron, of myrrh, of scammony, of each, dr. ij. Add to vinegar and make trochisks. When using it, anoint those who have pain of the head from thick humours or a flatulent spirit with it, along with vinegar or oxycrate. We must, likewise, use a dropax and sinapism, and the trochisk from thapsia. That, too, from writing ink is much approved of for the same cause, and is to be used, as will be described in the Book on Compound Medicines.

The following one is possessed of wonderful efficacy for hemicrania proceeding from a thick and viscid humour: Of euphorbium, one part; of castor, an equal quantity; mixing with water, insert into the ear of the affected side, and order the patient to go into a bath, and, when he has remained a short time, take it out, and bathe as usual. Thus it is of tried efficacy. It will not be improper also to add them to oil, and inject into the ear. The application described for ischiatics is likewise a successful remedy for chronic headach and hemicrania.

_For chronic hemicrania._ Of garlic, dr. iv; of wax, dr. ij; of old axunge, dr. ij; of cantharides, dr. ij. Apply this in the evening, and having allowed it to remain all night, break the blister in the morning, and cure with the plaster called panygrus.—_Another_: Of bay-berries, stripped of their skins, dr. ij; of the leaves of rue, dr. ij; of mustard, dr. j; moisten with water, and apply. It is most beneficial to those whose complaints arise from cold causes, so that frequently, when applied before going into the bath, it immediately cures the affection, and after the bath they become perfectly well.—_Another_: Of Sabine oil, lb. j; of wax, oz. iij; of euphorbium, oz. j; with this anoint the half of the forehead, namely, along the temporal muscle. If the cold is not great, pound an equal quantity of galls and crocomagma with wine, and anoint. In cases from hot fumes or humours, do not use the applications with euphorbium.

_An apophlegmatism, or masticatory, for cephalæa and hemicrania._ Of mustard pulverized and dissolved in vinegar and honey, oz. xiv; of stavesacre, dr. iv; of pellitory, dr. iv; having pounded, strained, and mixed in the sun, gargle with it. When the cephalæa becomes permanent, owing to a bilious humour or some intemperament, use the remedies formerly described for headach. If after all this the pain continue, even after cupping and leeching, and there is reason to suspect that the distribution by the arteries is affected, it will not be improper to open the arteries behind the ears. In those of a humid intemperament the natural baths may be tried with good effect.—_Another, for hemicrania_: Mix euphorbium and earthworms with vinegar, and anoint the affected part, or the whole forehead.

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COMMENTARY. Our author’s account of cephalæa is mostly abridged from Galen (See. Loc. iii), where the treatment is detailed at considerable length. Alexander, Aëtius, Oribasius, and the Arabians follow the views of Galen; and, as they are similar to our author’s, we need not dwell upon the exposition of them. General and topical bleeding, cooling or stimulant applications to the head, purgatives, masticatories, and errhines, applied according to circumstances, constitute the sum of their treatment. One rule laid down by Oribasius deserves attention; when the pain is acute, he recommends general bleeding; and, when it is protracted, local. When cephalæa is connected with constipation of the bowels, Alexander advises that they should be opened with laxative food and gentle purgatives, such as sal ammoniac (a fossil salt procured from Africa), scammony, and euphorbium. When it is connected with a loose state of the bowels, he recommends such means as will stop it; and when it is produced by insomnolency he recommends things of a paregoric and soporific nature. (i, 11.)

Aretæus, who probably was prior to Galen, delivers an admirable account both of the symptoms and treatment of this complaint. He recommends bleeding at the arm, and by opening the temporal arteries, or those behind the ears, or the vessels of the lining membrane of the nostrils, or cupping the back part of the head; purging with drastic cathartics, such as hellebore; errhines, masticatories, a restricted diet; and, in obstinate cases, he approves of applying the actual cautery to the cranium. (De Curat. Morb. Chron. ii.) Most of the ancient authorities recommend the cautery in this case. (See the notes on Sect. I of the Sixth Book.) Aretæus allows a small quantity of a light wine on account of the stomach, which is apt to be affected. (Ibid.)

Cælius Aurelianus has given a most minute account of the doctrines of the Methodists respecting cephalæa. (De Morb. Tar. i, 1.) He enumerates many causes of the disease, among which we may mention too much attention paid to the hair by females. The following is an outline of his practice: Friction of the extremities, emollient fomentations and soft applications to the head, such as wool, or bladders half filled with warm oil, are to be used at the commencement. When the pain is violent, he recommends venesection from the arm opposite the side affected. The head is to be shaven with a razor, and a cataplasm, or a cupping-instrument without scarificators, or leeches, are to be applied; and these are to be followed by sponging with hot water. If the belly be constipated, we are to give clysters of the oil of rue with honey, or the like. In the decline of the complaint, emollient plasters (malagmata) are to be applied. Gentle gestation before food is particularly recommended, and walking afterwards. Exposure to heat, indigestion, strong drink, hot baths, violent passions, constipation of the belly, and so forth, are to be avoided. His directions respecting diet are extremely minute, but judicious. With regard to topical applications, he recommends after the head is shaven mild ones at first, and afterwards rubefacients and stimulants, and cupping with much heat. Masticatories and gargles are mentioned. He recommends affusion of water, at first hot and afterwards cold. When the disease does not yield to these remedies, he directs a course of hellebore. The methodist oppugns freely the practice of the other sects. Refrigerant applications, containing vinegar, rose-oil, and the like, he says, are very prejudicial; purgatives injure the stomach; cauteries excite a dangerous disturbance; the cold bath produces rigidity of the nerves; and hot masticatories do not answer well.

Scribonius Largus mentions a black torpedo applied alive to the head as a remedy for headach. (De Comp. Med. c. 1.) The same prescription occurs in the collection of Marcellus Empiricus. See further Galen (de Simpl. Med. facult. in voce ναρκὴ) and Aëtius (ii, 185.) Is not this an application of the principle of galvanism in medicine?

Rhases insists, with becoming earnestness, on the propriety of administering purgatives, especially cholagogues, in cephalæa. His commentator Leonardus Jacchinus blames modern physicians for having substituted weak and ineffectual cathartics for the powerful medicines of this class used by the ancients.

Galen states correctly that cephalæa often arises from disease of the pericranium. (De Loc. Affect. l. c.)

SECT. VI.—ON PHRENITIS.

Phrenitis is an inflammation of the membranes, the brain also being sometimes inflamed along with them, and sometimes a preternatural heat fixes originally in the brain itself. The cause of this disorder is either a fulness of blood, or of a yellow bilious humour; and sometimes the yellow bile, being excessively heated and converted into the black, becomes the cause of the worst species of phrenitis. And sometimes the affection arises from the brain’s sympathizing with the diaphragm by means of the nerves distributed upon it. But the aberration of intellect which occurs at the acme of very hot fevers, and that which is occasioned by sympathy with the stomach, is not called frenzy but delirium. Cases of true phrenitis are, for the most part, attended with watchfulness, but sometimes with disturbed sleep, so that the patients start, leap up, and cry out furiously; when the complaint is occasioned by a sanguineous humour, with laughter; but when by yellow bile, with ferocity; and when by a black, with unrestrainable madness. They forget what is said and done by them, their eyes are bloodshot, and they rub them; they are sometimes squalid, sometimes filled with tears, or loaded with rheums. The tongue is rough, there is a trickling of blood from the nose, they pick at flocks of wool and gather bits of straw, and have acute fever during the whole continuance of the disorder. When a fever of a bad character is seated deeply, they have the pulse small and indistinct, with a certain degree of hardness. The respiration is large and rare when the brain is primarily affected. And, if the phrenitis be occasioned by sympathy with the diaphragm, the respiration is irregular, the hypochondria are retracted and have considerable heat; but, when it arises from sympathy with the brain itself, the parts about the face are hot and suffused with blood, and the veins are full. When a pituitous humour is mixed with the bilious, as the cause of the disease is compound, so also is its appellation; for it is called coma vigil. When a bilious humour prevails, persons so affected are troubled with watchfulness; and, when a pituitous is the cause, they lie in a state of coma. The elder writers before Galen called this disease catochus, but since then it has been called catoche and catalepsy.

_The cure of phrenitis._ If the strength admit of bloodletting, we are to abstract blood from the arm immediately and freely; but, if the patient be delirious and will not present his arm, or if there be apprehension of hemorrhage after the bleeding from the patient tearing his arm during the agitation of his delirium, we must open the straight vein in the forehead, and take away at once a sufficient quantity of blood. We are to use clysters and injections of oil, or rose-oil with the juice of ptisan. When watchfulness prevails, we anoint the head with rose-oil, or with vinegar and rose-oil; in some cases fomenting it with hot water; and we must give the medicine from the heads of poppy, unless prevented by the weakness of the patient’s powers; and must have recourse to the other remedies for insomnolency formerly mentioned. Let the patient be laid in a place which is in a moderate state as to light and temperature, and let there be no paintings in it, for these are apt to excite emotions in such cases. Let some of his most beloved friends come in and converse with him in a suitable manner, sometimes gently soothing him, and at other times chiding him more harshly. His food at first should consist of honied water, and afterwards of the juice of ptisan, or spoon-meats formed from chondrus, with some sweet potion, such as apomel, or hydrorosatum, or rhodomel, or the sweet hydromel. But the vinous hydromel which is brought from Cebyra in small vessels must be rejected, as it produces more mischief than wine itself, especially in affections of the head and before concoction. We are also to administer bread that has been soaked in water, and succory, and boiled lettuces. Or, if there be much effervescence, they may be given raw, and also the medullary part of the cucumber, of the pompion, of apricots, and the like. They must be kept from cold water, more especially if the affection be found to proceed from sympathy with the diaphragm. If their urine (as is likely) be retained, owing to their delirium, we must foment the lower part of the belly and bladder with warm oil and water, and then, by applying the fingers of the hand to the part, we must try to incite them to make water. We must also anoint the rest of the body with warm oil; and the patients are to be kept in a recumbent posture, for a state of quietude is to be maintained as much as possible; and, if they be rich, they are to be restrained by their servants; but, if not, they are to be bound with ligatures. For irregular motion is apt to produce prostration of the strength. And for another reason, too, the feet ought to be bound with ligatures after having been bathed, and friction applied to them, namely, for the sake of revulsion. But, if the attack be more protracted and difficult to remove, we must abstain from all narcotics; and to the fomentations of the head are to be added things of a discutient nature, such as the juice of mint, or of wild thyme, or of calamint, or of rue; and then we must use errhines. After the seventh day, if the viscera be inflamed, we are to soothe them by cataplasms of linseed and raw barley-flour in oil and water. We are then to apply dry cupping or cupping with scarifications to the parts, and to the back part of the head and the spine. But, if the body be observed to be very squalid and hot, even if the fever remain, we must use baths of fresh water, and plentiful anointing, and give some thin and weak wine, in order to rouse the strength; we need not apprehend any mental alienation that will thereby be produced; for, either it will not take place at all, as the disease is on the decline, or, if it do, it may be easily removed. When the disease further abates, we must have recourse to gestation and suitable restoratives. Recovery may be promoted by avoiding intoxication, anger, indigestion of the food, and more especially exposure to the heat of the sun.

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COMMENTARY. Hippocrates treats cursorily of phrenitis in several of his works, particularly ‘de Morb.’ (iii, 9,) and ‘Epid.’ See Galen (Meth. Med. xiii, de Loc. Affec. v, 4); Aretæus (de Morb. Acut. i, 1); Alexander (i, 13); Aëtius (vi, 2); Actuarius (Meth. Med. iv, 2); Nonnus (c. 25); Pseudo-Dioscorides (Euporist. i, 13); Cælius Aurelianus (Morb. Acut. i, 1, &c.); Celsus (iii, 18); Serenus Samonicus; Octavius Horatianus (ii, 2); Serapion (i, 20); Mesue (de Ægr. Capit. c. 19); Avenzoar (i, 4, c. 6); Haly Abbas (Theor. ix, 4, and Pract. v, 13); Alsaharavius (Pract. i, 2, c. 8); Rhases (ad Mansor. ix, 3, and Contin. i, 28.)

Hippocrates, in his ‘Epidemics,’ details several cases of phrenitis, which would appear to be remittent fevers, complicated with determination to the brain, rather than inflammation of the brain.

Galen gives a very circumstantial detail of the symptoms, which is well worth consulting. (Loc. Affec. l. c.) Our author’s description is very complete, considering its brevity. He closely follows Alexander, who agrees with him in recommending the most questionable part of our author’s treatment; we mean the administration of wine. Of course, however, it must have been a weak light wine. He insists that when the strength is much reduced, it does more good than harm, by improving the powers of the constitution. Cælius, however, says that wine is nothing less than a poison. Alexander, Aretæus, and Aëtius agree that cold drink should be given with caution. Most of the authorities have correctly described the pulse as being small and dense. Our author’s practice, in regard to bleeding from the temporal vein, is derived from Alexander, who gives a very interesting case, in which he applied it with great success. He recommends great caution in the administration of narcotics. Upon the whole he is favorable to the tepid bath, as serving to procure sleep, but he condemns the hot. Among the minutiæ of practice, we may mention that Aretæus and Celsus, like our author, recommend all pictures and such like gaudy objects to be removed from the apartment of the sick. Celsus directs us, in pointed terms, after bleeding and purging, to get the head shaved, and fomented with a decoction of emollient herbs. To procure sleep, he recommends us to give draughts containing poppies and hyoscyamus; or to apply the apples of the mandragora below the pillow of the patient; or, to rub his forehead with amomum, or with the tears of mulberry. He informs us, however, that Asclepiades condemns soporifics, as inducing lethargy. For the sake of procuring sleep he recommends gestation performed at night, and of swinging the patient in a suspended couch. For the same purpose, the Pseudo-Dioscorides recommends us to introduce the juice of poppies or mandragora upon wool into the rectum.

Cælius Aurelianus gives an admirable account of the symptoms and treatment of this disease; and his views are, in this case, not very different from those of Hippocrates and Galen. He informs us that Asclepiades condemned venesection, which, he said was nothing less than murder; that he disapproved of keeping the patients in a dark place; and that he allowed them plenty of strong wine. Both Cælius and Celsus properly animadvert upon his treatment. Cælius also blames Diocles for admitting of venesection after the seventh day, and for approving of too acrid clysters. He finds fault with Themison for allowing too much food and wine at the commencement, and for using the bath indiscriminately. He condemns the practice of Heraclides, because he applied the treatment of the Empirics injudiciously, and admitted of bleeding from the frontal vein, which, Cælius says, is most prejudicial.

The treatment recommended by Octavius Horatianus is little different from that of the others.

The Arabians call the disease _karabitus_. The symptoms, according to Haly, are heat not much increased, but the head warmer than the rest of the body; alienation of the mind; watchfulness, but sometimes somnolency, from which state the patient wakes with starting; blackness of the tongue; picking at the bed-clothes; pulse in all cases weak, small, and hard. He is very minute on the treatment, recommending bleeding from the cephalic vein _ad deliquium_; cupping; gentle laxatives, such as prunes and tamarinds; vessels filled with cold water or snow applied to the head; in certain cases sinapisms to the feet; and, when watchfulness is protracted, applications to the head, containing poppies, mandragora, lettuce, &c. Alsaharavius particularly mentions general bleeding, bleeding from the temporal vein or the angular vein of the nose, pouring decoctions of refrigerant herbs over the head, and, when the insomnolency is obstinate, washing the temples with infusions of hyoscyamus, poppies, lettuce, &c. Avenzoar speaks of opening the artery in the head, an operation mentioned by Galen. Rhases directs us to pour vinegar and rose-oil from a height upon the head. His general remedies are similar to those of the others, namely, general and local bleeding, with gentle laxatives, such as myrobalans, prunes, and tamarinds. Serapion and Avicenna direct much the same treatment as our author.

SECT. VII.—ON PHLEGMON OF THE BRAIN.

When the brain is inflamed, it is often so swelled that the sutures of the skull are separated. The pain is very strong and permanent; there is much anxiety, and much redness of the countenance, with swelling; the eyes protrude, and the head swells. We must let blood from the arm, and also detract by the nose, and from the vessels below the tongue. We are also to use the fomentations suitable for inflammations of the head, and cataplasms of a moistening and concocting nature.

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COMMENTARY. This Section is taken from Aëtius (vi, 25), or Oribasius (Synops. viii, 11.) See also Avicenna (iii, i, 3, c. 4); Haly Abbas (Theor. ix, 4, and Pract. v, 14); Alsaharavius (Pract. i, 2, 9.)

The Arabians call it _massera_. Phlegmon of the brain, according to Haly Abbas, is attended with swelling of the brain, so as to occasion a separation at the sutures, redness of the face, acuteness of vision, and sympathetic affection of the stomach. He recommends bleeding at the arm, cooling laxatives, applications of cold things to the head, and so forth. The translator of Alsaharavius calls it ‘flegmon’ and ‘apostema in cerebro;’ says it is occasioned by a collection of corrupted blood in the vessels of the brain; and directs general bleeding, opening of the nasal vein, or of the sublingual. Avicenna’s account is nowise different from our author’s.

Hippocrates makes mention of _sphacelus_ of the brain, which, he says, generally proves fatal in three days. (Aphor. vii, 48.) From the Commentary of Galen it would appear that by sphacelus he meant that state which is the result of an extreme degree of inflammation. Another of his commentators, Theophilus, states that by sphacelus was meant incipient mortification. (Ed. Dietz, ii, 537.) It was therefore a species of _ramollissement_. See an elaborate disquisition into the nature of the sphacelus of Hippocrates by Dr. Coray. (Ad Hippocrat. de Aer. &c. 64.)

SECT. VIII.—ON ERYSIPELAS OF THE BRAIN.

Erysipelas occurs also in the brain, and the patient suffers in the following manner: he has pain of the whole head, and feels as if there were fire in it; his face is cold and somewhat pale, and his mouth dry. Wherefore, bleed such a patient, and more particularly abstract blood from the veins under the tongue, and apply cooling things, such as we use in other kinds of erysipelas.

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COMMENTARY. Aëtius, Oribasius, Avicenna, Haly Abbas, and Alsaharavius treat of this disease in much the same terms as our author. Haly says there is less heat of the face than in phlegmon, nay, that the face even feels cold. Alsaharavius describes it as being accompanied with violent pain, much inflammation, and blackness of the face. He approves of the depletory treatment in general.

SECT. IX.—ON LETHARGY.

Lethargy, which is a lesion of the rational part, has the same seat as frenzy, I mean the brain, but the matter which causes it is of an opposite nature; for it is occasioned by a humid and cold phlegm irrigating the brain. It is attended with an obscure fever, which is not very pungent, and with somnolency. The pulse is large, rare, and undulatory; the respiration is very rare and weak. Lethargies are altogether disposed to sleep; are roused with difficulty; can scarcely be made to answer questions; are forgetful and delirious; they yawn frequently, and remain sometimes with their jaws distended, as forgetting to shut their mouths; their evacuations by the belly are generally watery, but sometimes, on the contrary, the belly is dry; their urine is like that of cattle. Some have tremblings and sweatings. Carus being occasioned by the same matter as lethargy differs from it in this, that fever precedes carus and is more violent, whereas it is subsequent in lethargy; and in this respect also, that carus often supervenes upon other complaints, for it often follows paroxysms of fevers, epilepsy, and compression of the brain, as from the bone in fractures, or from the meningophylax pressing upon the anterior ventricle of the brain; whereas lethargy has a certain peculiar formation.

_The cure of lethargy._ When the strength permits, we must open a vein; but, when it does not, we must use acrid clysters. We must also lay the patient in an apartment of large size, and having a moderate degree of light, and apply to the head an embrocation of oil to which castor has been added. Some, instead of the oil, use vinegar and rose-oil with the castor, by which they strengthen and warm the head at the same time. And, having anointed the rest of the body, particularly the extremities, with old oil, they stimulate them with calcined nitre, pellitory, pepper, or the granum cnidium. It is also possible, by making them into cerate with castor, to use them in this way. We must likewise apply strong-scented things, triturating thyme, marjoram, and pennyroyal, with vinegar. We may smear the mouth and palate with mustard pounded in a small quantity of honey, and we may even remove with the fingers the phlegm which adheres to it. And, if they will admit it, it is proper to use a masticatory consisting of oxymel with hyssop, pennyroyal, marjoram, or mustard itself. We may give also in their drink things of a diffusible nature, more particularly the diospolites, to the amount of a spoonful, with oxycrate. When there is chronic trembling, we must give two or three scruples of castor; or, if there be a redundance of humours, and there be nothing to contra-indicate the use of it, we may add a scruple of scammony to the castor. When the disease is protracted, the head must be shaved and fomented with salt, millet, and the like, in small bags; and sinapisms are to be applied to the whole head, and medicines used to excite sneezing. Afterwards we may apply dry cupping, with much heat, or cupping with scarifications, to the back part of the head. It will be necessary to attend to the natural evacuations by means of clysters and diuretics. Apply to the lower part of the belly an embrocation with oil of rue, or Sicyonian oil with some castor. We must also attend particularly to the deglutition, injecting, by means of a vessel with a narrow mouth, warm water, to which has been added some sweet potion, more especially apomel. And, if there be inflammation in the intermediate parts, we must cure it with embrocations and cataplasms. To the nose is to be applied mustard triturated with vinegar, or burnt castor. Their food should consist of ptisan, or the decoction of oats, or that of alica, with oxymel, salt, or pennyroyal, sometimes giving of it every day, and sometimes only every alternate day. After food, ligatures are to be applied to the extremities, which may also be bent back; and the limbs are to be pinched; and sometimes we may even tear the hair violently in order to rouse them. Rubefacients to the thighs and legs are also proper. When the affection is in the decline, we may enjoin suitable gestation, direct the bath to be taken, and a restorative regimen to be used properly.

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COMMENTARY. See Hippocrates (de Morbis, iii, 5); Celsus (iii, 20); Galen (Meth. Med. xiii); Aretæus (Cur. Morb. Acut. i, 2); Oribasius (Synops. viii, 1); Aëtius (vi, 3); Alexander (i, 14); Actuarius (Meth. Med. iv, 2); Nonnus (c. 22); Octavius Horatianus (ii, 2); Cælius Aurelianus (de Morb. Acut. i, 2); Avicenna (iii, i, 3, 7); Serapion (i, 17); Mesne (de Ægrit. Cap. 22); Haly Abbas (Theor. ix. 5, and Pract. v, 15); Rhases (Divis. c. 6, Contin. 1.)

The ancients, it will be remarked, ascribe the disease to serious congestion, which is a very plausible theory. All the other authorities recommend nearly the same treatment as our author.

There can be no doubt that by lethargus Hippocrates meant a remittent fever, resembling the causus. The other authorities on this subject also describe the disease as a febrile affection.

Aëtius, as usual, is minute and judicious. He remarks that purging is not only useful, by producing evacuation of the bowels, but also by occasioning revulsion. When the disease comes on after frenzy, he forbids venesection, but otherwise approves of it. He and Alexander strongly commend castor. Alexander directs venesection, if the patient’s strength permit; the application of vinegar and rose-oil to the head; and, when the disease is on the decline, applications containing castor and other such stimulants. It is to be remarked, by the way, that Haly Abbas states this as the mode of treatment directed by Alexander Aphrodisiensis, from which it may be inferred that A. Trallian and A. Aphrodisiensis were the same person.

Celsus speaks favorably of the affusion of cold water.

Aretæus gives the plan of treatment very circumstantially, but his chapter on the symptoms of lethargy is lost. He lays it down that the disease is the counterpart to phrenitis, being occasioned by a cold humour oppressing the brain. The principle of his treatment seems to be to produce revulsion; for which purpose he recommends drastic purgatives and stimulant applications of all kinds to the skin. He is guarded in speaking of bleeding.

The methodical treatment recommended by Cælius Aurelianus is not much different from that of the other sects. He approves of bleeding, of shaving the head, and applying cupping-instruments to it, or else leeches; of making the patient lie in a bright light; of using gentle means to rouse him; but he justly condemns Diocles for recommending measures of great severity, which, he says, will but increase the disorder of the brain. He also disapproves of the practice of Praxagoras, who gave wine and hot stimulants; and further ridicules him for neglecting the head, and merely applying fomentations to the feet. He does not approve of Asclepiades’ practice of treating the disease with strong sternutatories, sinapisms to the head, and analeptics. He finds fault with Themison for making his patient lie in a dark place. He also condemns Themison’s practice of giving aloes by the mouth before food, as it will make the food in the stomach spoil, that is to say, will interrupt the digestive process, or, in case of its not operating downwards, will be absorbed, and increase the constitutional disorder. He further disapproves of Themison’s practice of carrying gestation to an inconsiderate length. He likewise condemns the use of the cold bath, which had been recommended by Themison. He then gives an account of the practice enjoined by Heraclides Tarentinus, the empiric, which, of course, he does not approve of; although, judging of it from modern views, we do not think it particularly objectionable. We dare not enter upon the detail of it, owing to its length.

The Arabians generally treat of it by the name of _sirsen frigidum_. Like the other authorities, Haly Abbas states the causes of the disease to be a cold and humid intemperament of the brain, or a collection of pituitous humours. As stated above, he quotes the practice of Alexander with approbation. He particularly recommends acrid clysters, drastic purgatives, shaving the head, applying stimulants to it, rubbing the feet, and in certain cases sternutatories. Rhases does not mention venesection; but Avicenna and most of his countrymen do. Avicenna and Mesue recommend emetics. Their treatment otherwise, like our author’s, consists of acrid clysters, friction of the extremities, masticatories, calefacient and repellent applications to the head. With regard to the last, Mesue may be consulted with advantage. Rhases, in his ‘Continens,’ recommends bleeding, fetid pills, leeches, cupping, and afterwards sternutatories, friction of the extremities, and so forth.

SECT. X.—ON CATOCHUS, OR COMA VIGIL.

We have already, in treating of phrenitis, mentioned the formation of this disease, the symptoms whereof in general are the same as those of phrenitis and lethargy, being modified according to the prevailing matter. The peculiar symptoms are these: The patients remain fixedly stretched in a supine posture, having sometimes their countenance somewhat swelled and livid like those in lethargy, and sometimes with a florid redness in it; the upper eyelid seems drawn upwards and projecting, so that they cannot wink. They seem also not to breathe, but to be as dead. The pulse is small, indistinct, and very dense. The discharges from the bowels and bladder are suppressed, or in small quantities. When the attack is moderate, they drink whatever fluid is poured into the mouth; but those who are overpowered by it reject the same by the nose. Those, therefore, in whom the phlegm prevails over the bile, we distinguish from those affected with lethargy by this, that there is no swelling present, nor is the colour livid like lethargics, except to a very small degree; and that they perspire moderately. The cases are dangerous in which there is much watchfulness, the urine is suppressed, the difficulty of breathing is intense, when they have sweats, and the drink regurgitates by the nose. If it be a woman that is affected, the complaint may be distinguished from uterine suffocation by the circumstance that she lies in a natural state, is sensible when spoken to, can be roused, but sinks again into a state of sopor. Some say that catochus is a different complaint from the coma vigil, for that it has not a compound, but a simple cause; namely, a cold and dry matter which obstructs the posterior ventricles of the brain, and occasions the disease; in which case, the patient being suddenly seized with it, remains in the same posture as when taken with it, that is to say, standing or lying, with his eyes open or shut. The ancients, therefore, called such patients _catochi_, which signifies _detained_, but the moderns call the complaint catoche and catalepsy. The cure resembles that which is already described, but is to be varied according to the difference of the symptoms.

_The cure of catochus._ Wherefore we must have recourse to venesection, more especially when the face is ruddy, or if the strength does not contra-indicate, we must use clysters, sometimes stimulant, when phlegm prevails; and sometimes emollient when bile prevails. In like manner we are to apply other remedies, and give food sometimes every day, and sometimes only every alternate one. The affection is very dangerous when produced by an error of the food or drink, in which case the patient is to be made to vomit without delay, and kept upon a restricted diet; and the bowels are to be stimulated, and an embrocation with cumin or rue applied to the belly. They who have been seized with the complaint from intoxication, after their surfeit has passed off, must be cured by using a more liquid diet, such as the juice of ptisan. And the head is to be smeared with suitable ointments, which, if in summer, may be cold, but tepid, if in winter. If the surfeit do not pass off, nor the patient recover his senses, it will be time to give up the case as hopeless, and pack off.

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COMMENTARY. Most of the authors referred to in the preceding Section may be consulted on catochus, or catalepsy. It is called by the Arabians _subet alsari_. On the characters of the pulse in catochus, see Galen (de Causis Puls. iv, 16.) Nonnus and other authorities remark that it is accompanied with fever. Their general treatment consists of venesection; clysters of the decoctions of rue and cumin, with nitre and honey; epithemes applied to the belly; and fomentations of water and oil to the head. Haly says that the disease arises from a collection of phlegm on the brain; from pressure in cases of fracture of the skull; or from the projection of the internal plate of the cranium. His treatment is judiciously modified according to the nature of the exciting cause. He approves of sinapisms to the head, friction of the feet, and so forth. Alsaharavius recommends venesection when the exciting cause is a bilious humour, but forbids it when the disease arises from a collection of phlegm. His treatment is judicious, but not much different from our author’s. (Pract. i, 2, 13.) Rhases’ general remedies are clysters, purgatives, restricted diet, and, if indicated, bleeding at the arm or ancles.

Cælius Aurelianus describes the disease with his usual accuracy. He says it occurs in cases of continual, intermittent, and ephemeral fevers. The symptoms, as detailed by him, are acute fever, loss of speech, dulness of the senses, pulse large, strong, and full, and the eyes fixed. With regard to his treatment, he says nothing of venesection, but approves of fomentations to the head of sweet tepid oil; and mentions common clysters, cataplasms to the loins, in order to relieve the retention of urine; shaving the head, and applying cupping-instruments to it, scarifications along the occiput, baths, fomentations of oil, &c. He disapproves of the practice of Chrysippus and Themison, who recommended stimulant ointments to the head, shaving the head, and applying sinapisms to it with sternutatories and acrid clysters.

SECT. XI.—ON THE LOSS OF MEMORY AND OF REASON; ON CARUS AND FATUITY.

The loss of memory sometimes occurs by itself, and sometimes along with impairment of the reason, as an impairment of the reason sometimes happens first by itself, and is then followed by that of the memory. When both suffer, the affection called fatuity is formed. These complaints have for a cause the exciting intemperament; but, if it is humid only, it will occasion impairment of the memory and reason, torpidity, drowsiness, long and deep sleep; but if complicated with coldness, it will produce carus and lethargy. In like manner, dryness alone brings on watchfulness, but when joined with heat, delirium and frenzy. These intemperaments are seated sometimes in the fluids, sometimes in the cavities of the brain, or in its vessels; or in the chyle diffused over the system, or in the substance of the brain; or else the temporal muscles may be affected. If the humours are mixed together, they will produce this affection. Whether the exciting intemperament be simple or compound may be learned from the appearance of the excretions. That the loss of memory and of reason springs from cold we readily ascertain; but whether it be accompanied with humidity or dryness, we judge of from the discharges, the habit and temperament of the patient, his mode of life, the season, and the country.

_The cure._ If the intemperament be cold, we must warm, but if accompanied with humidity, we must also dry; but if with dryness, we must, at the same time, moisten and warm. In like manner, when the intemperament is warm, we must cool; but if dryness also prevail, we must likewise moisten; or if humidity, we must both cool and dry. Where we find a sanguineous humour prevailing, we must bleed or use acrid clysters, then give hiera, and use masticatories; anoint the head, by mixing with oil things of a cooling and desiccative nature, we mean roses, myrtles, lentisk, and the like; and we must attend to the general system. But, if it proceed from an over-heat and fatigue, we must apply to the head the embrocation of vinegar and rose-oil; and otherwise use a cooling and moistening regimen in all respects, and with regard to food and drink. If carus supervene upon fatuity or oblivion, it also is to be attended to as formerly mentioned under the head of lethargy, where we also stated the discrimination between these complaints.

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COMMENTARY. See most of the authors on lethargy and catalepsy.

Nonnus says that carus resembles apoplexy, only that in the latter disease the posterior ventricle of the brain is more especially loaded with serum, whereas in carus the anterior is affected. It differs also, he says, from lethargy, in this respect, that fever precedes carus, but is subsequent to an attack of lethargy. Carus, he adds, is occasioned by a blow, pain of the head, and fracture of the bone compressing the brain. Alexander also says that, in carus, the anterior part of the brain is most affected; and hence the sensorial powers are much impaired. It is occasioned, he says, by violent pains which dissipate the vital spirits. On the cure of loss of memory, see Galen (de Loc. Affect. iii, 5.)

Avicenna has treated at great length of the subjects of this Section. Among other things he recommends the celebrated theriac, which contained a very diffusible stimulant oil. His treatment otherwise resembles our author’s. The same may be said of Haly Abbas. For loss of memory, Alsaharavius recommends the application of fragrant and stimulant oils to the head, along with general treatment.

Cælius Aurelianus and Octavius have not treated of carus by name; but, according to Prosper Alpinus, the Methodists entertained similar opinions of the disease to the other sects. (De Med. Meth. x, 5.)

Procopius states that carus was a common symptom of the fatal plague which prevailed in the reign of Justinian. (Persic. ii.)

The philosophers, as well as the physicians, taught that loss of memory is often connected with disease of the posterior portion of the brain. See, in particular, the Commentary of Philoponus on Aristotle (de Anima, i.)

SECT. XII.—ON VERTIGO.

Vertigo is occasioned by a cold and viscid humour seizing upon the brain, whence the patients are ready to fall down from a very slight cause, such as sometimes from looking at any external object which turns round, as a wheel or top, or when they themselves are whirled round, or when their head has been heated, by which means the humours or spirit in it are set in motion. And sometimes it is occasioned by the anterior cavities of the brain being compressed in perforations of the skull for fractures, in which cases there are violent pains. When it is a primary affection of the head, it is preceded by strong pain in the part, by drowsiness, and noises in the ears; and some have either the sense of smell or of taste impaired. But in those cases which arise from sympathy with the orifice of the stomach, heartburn accompanies and nausea follows.

_The cure._ Those affected with vertigo are to be roused at the onset, by using strong-scented things of a suitable nature, by frictions, and such like; and, during the remission, for the recovery of the complaint, they ought first to be bled, and then purged with hiera. And after an interval we must use an acrid clyster of centaury, or the decoction of colocynth. After such evacuations, we are to apply to the back part of the head cupping-instruments with scarifications, and afterwards use masticatories and sternutatories. When there is heat in the head and noises in the ears, inasmuch as they are occasioned by hot vapours diffused in the arteries, we must have recourse to anteriotomy behind the ears, as will be described when treating of surgical matters.

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COMMENTARY. See Galen (de Loc. Affect. iii, 12); Aretæus (Morb. Chron. Curat, i, 3); Aëtius (vi, 7); Oribasius (Synops. vi, 5); Actuarius (Meth. Med. vi, 2); Nonnus (35); Cælius Aurelianus (Morb. Chron. i, 2); Octavius Horatianus (ii, 2, 3); Serapion (i, 3); Avicenna (iii, 1, 5); Mesue (ii, 13); Haly Abbas (Theor. ix, 5; Pract. v, 20); Alsaharavius (Pract. i, 2, 6, 7); Rhases (Divis. 5; Contin. 1.)

Galen agrees with Archigenes that vertigo may either be a primary affection of the brain, or may proceed from sympathy with the mouth of the stomach. Archigenes pretended to distinguish between the two cases in the manner described by our author, that is to say, when the disease is preceded by noises in the head, stupor, loss of the sense of smell, or of any other sense, he concluded that the disease was a primary affection of the brain; whereas, if preceded by nausea and heartburn, he believed that it had its origin in the stomach.

Aretæus details the treatment with great minuteness. He recommends restoring any suppressed secretion, bleeding at the arm, cupping, opening the frontal or nasal veins, sternutatories, emetics of hellebore and the like; cold applications to the head, friction of the extremities, gestation, walking, restricted diet, the cold bath, but not the hot. Aëtius, in an extract from Posidonius, treats of the disease in much the same terms.

Cælius Aurelianus recommends the same treatment as for cephalæa. Octavius approves particularly of hellebore.

Serapion directs us to open the arteries behind the ears, which practice, however, Galen had pronounced to be less useful than some had represented. Mesue makes mention of leeches to the nose, and medicines for renewing the menstrual and hemorrhoidal discharges when suppressed. Avicenna speaks of the actual cautery. (See Book Sixth, Sect. I, of this Work.) Vertigo, according to Haly Abbas, may arise from a pituitous or sanguineous plethora of the cerebral vessels, or from compression occasioned by fracture. He approves of general and local bleeding only when there is a plethora of blood. In other cases he recommends drastic purgatives, aromatic stimulants, masticatories, and sternutatories. His treatment is judiciously modified according to the nature of the exciting cause. Alsaharavius recommends opening the arteries behind the ears, strong purgatives, clysters, gargles, and hot plasters, containing mustard, and the like. Aaron, one of Rhases’ authorities, decidedly inculcates that vertigo may either be connected with disease of the brain or of the stomach. He principally recommends bleeding and purging, and also speaks favorably of cupping the nape of the neck.

SECT. XIII.—ON EPILEPSY.

Epilepsy, being a convulsion of the whole body with impairment of the leading energies, has its cause seated sometimes in the brain itself, and sometimes in its cavities. This is sometimes a pituitous and sometimes a melancholic humour. The disease also sometimes arises from sympathy with the orifice of the stomach (as happens in colic affections, as will be stated when treating of them); and sometimes it is propagated from other parts, when a cold aura ascends to the brain, either from the leg or the fingers of the hand. It has also been seen to proceed from the uterus in females, at the time they were pregnant, for after delivery it ceased. This disorder attacks mostly the young, more especially infants, and after them boys and adults; but least of all elderly persons and the old. Its precursors are, an involuntary commotion, both of mind and body, despondency, oblivion of accustomed things, terrifying visions in dreams, headach, continued fulness of the head (especially from acute anger), paleness of countenance, and a distorted motion of the tongue, so that some even bite it. When it proceeds from the stomach, palpitation thereof goes before, with rumbling and aching pain; and when fasting, or during a delayed meal, they fall into a paroxysm. When the attack comes on they suddenly fall down, are convulsed, and sometimes utter inarticulate cries. The characteristic mark of these cases is foaming at the mouth, all the other symptoms being common to other diseases. In certain instances the urine and fæces are evacuated involuntarily, and in some the semen also. In some cases, when the disease is very acute, it proves fatal speedily, by the continuance of the paroxysms, or the violence of the attack; but it is most frequently protracted, so that, if it be not removed by the attainment of manhood, by purging, or pregnancy, or if it invade after this period of life, it for the most part does not leave a man until death, unless removed by a suitable cure. The following substances are used to prove epilepsy, namely, the fumes of bitumen, or gagate-stone, or goats’ horn, or the liver of a buck-goat when eaten, or the smell of the roasted liver.