SECT. I.—ON AFFECTIONS OF THE HAIR, ALOPECIA, OPHIASIS, AND BALDNESS.
As some plants die from dryness for want of sap, and some from the sap being unsuitable to them, so it happens, in like manner, with the hairs; for baldness is occasioned by want of the natural juices, and alopecia and ophiasis by the badness of them. These complaints differ only in figure; for, in the latter, the affected part has the appearance of a serpent; and alopecia derives its appellation from the circumstance of foxes being frequently subject to the affection. Judging of the prevailing humour, then, from the colour of the skin, we are first to evacuate it by purging, and then to have recourse to local applications. If, therefore, the colour incline to black or white, we purge with the medicine called hiera, which evacuates both phlegm and the melancholic humour; but if it is palish, we give pills of aloes. An account of these medicines will be found in that part of our work which treats of Compound Medicines. After general depletion, we are to use masticatories composed of vinegar, mustard, and honey, and not once only, but frequently. It will be better, too, if marjoram, pennyroyal, thyme, or hyssop be infused in the vinegar. In all the other complaints of the head, the same method is to be observed, first evacuating the prevailing humour, either by purging, or by phlebotomy if there be also a fulness of blood, and then proceeding to the topical treatment.
On alopecia. Having first cleansed the part with nitre (soda), and scrubbed it with a rough cloth, more particularly a woollen cloth, and continued the friction until it become red, anoint it with vervain pounded with vinegar in the sun. Or, rub in the roughest alcyonium burnt and pounded with lamp-oil. Or, burn the root of the club-rush, or the rind of the bitter almond, and rub them in with oil or bears’ grease. These are moderate remedies. But stronger applications may be prepared from euphorbium, thapsia, and adarce, pounded with oil of bays, or liquid pitch.—Another: Having burnt the shells of sea-urchins, mix them with bears’ grease, and anoint with them, having first cleansed the part with nitre.—Another: Of pepper, of dried sheep’s dung, of hedge mustard, of rocket seeds, of each dr. iv; of white hellebore, dr. iij; of mouse-dung, dr. j: add to the gall of a bull, of a goat, or of a hog.—Another tried remedy for alopecia: Of the root of mandragora, of birthwort, of the root of wake-robin, of wax, of liquid pitch, oz. viij; of swine’s seam not salted, of the heart or inner part of the herb nerium a little: boil the seam and the nerium until the herb be softened; then strain and throw away the herb, and add to the axunge the other ingredients, and boil. Add the wax and the liquid pitch, and use boldly in the sun. When the ulcers are cicatrized, burn the head of a fox, take alcyonium, the leaves of the black alkanet, and, having pounded all together, sprinkle upon the ointment, in order to promote the growth of the hair.—Another: Of a mouse’s head burnt, one part; of the shells of the sea-urchin, one part; boil in a pot with swine’s seam, and use. They may also be sprinkled in powder.
A medicament from Thapsia, for all chronic affections. Of euphorbium, of thapsia, of bay-berries, of each, oz. j; of native sulphur, oz. ss.; of hellebore, oz. ss; of wax, oz. viij; of oil of bays, or old castor oil, q. s. When stronger applications are required, add of cardamom, oz. j; of burnt alcyonium, oz. j; and it will be applicable not only for alopecia, but for all cases of chronic coldness. But in every case of alopecia have recourse in the first place to the process of cleansing with nitre, then friction, and frequent shaving. I have seen many have their hair reproduced by friction alone, and frequent shaving.
For baldness, and to promote the growth of the hair, from Crito. Take the dried stomachs of five hares, roast carefully in an earthen vessel, add to them the third part of myrtle tops, of the fruit of acacia, of the juice of acacia, of sweetbriar, an equal part, of maiden hair, oz. iij; pound all these things together, and sift through a small sieve. Then adding of bears’ grease, lb. iv, of that of a seal the same quantity, pound and preserve in a leaden vessel. At the time of using add to any fragrant ointment.
Preservatives of the hair. Of maiden-hair, one part; of ladanum, two parts; add to wine and myrtle oil, and use.—Another: Pound the flower of anemone, and rub it in with oil. The same will blacken the hair.—Another: Pound the straight vervain dried with its roots, sift through a narrow sieve, and, having mixed with oil, so as to have the thickness of the bath-sordes, lay it up in a copper vessel, and, when softened, use instead of oil in like manner.
A watery infusion for increasing the growth of the hairs, and for blackening them. Of rain water, six sextarii; of Alexandrian sumach, three sextarii; of maiden-hair, oz. iv; of savin, oz. iv; of ladanum, oz. j; of dried gourd, oz. j; of myrtle, oz. j; allow to macerate in a glass vessel for twenty days, stirring it twice a day with a pine spatula. On the following day plunge the comb into the infusion, and use once a day. And the seed of marshmallows, when rubbed in while in a bath, preserves the hair and promotes its growth. And, in like manner, oil may be rubbed in that has had the seed of marsh-mallows boiled in it, or added to it.
For thinning the hair. Of the leaves of the fig-tree, of the rind of the white wild vine, of pumice-stone, of the shells of buccinæ, of Cimolian earth, of each one mina. Put them into a new crude pot, and having covered it with clay, burn in a furnace, and pound, adding of aphronitrum half a mina, of the galls called omphacitæ thirty in number, pulverize and use.—Another: Of aphronitrum, half a mina; of roasted pumice-stone, four minæ; of fissile alum (alumen scissile), of dried iris, of the black wild myrtle, of gum, of the root of bryony, of each dr. iv; of unripe lupines pounded, the fourth part of a gallon; use without tallow.
For falling out of the hair. Rub in aloes, with black austere wine; or, the cover of the purpura boiled with oil; or, myrrh and ladanum, with wine and myrtle oil; or, pound burnt sheep’s dung on a shell, and rub it in with oil, having first shaved the head.
Commentary. See Galen (de Med. sec. Loc. i, Parat. Facil., and Meth. Med. xiv, 18); Celsus (vi, 4); Aëtius (vi, 65); Alexander (1); Pliny (H. N. xxviii, 46); Octavius Horatianus (i, 7); Marcellus (de Med.); Isidorus (Orig. iv, 8); Oribasius (Synops. viii, 22, and Meth. Med. iv, 5); Nonnus (8); Heliodorus (ap. Nicetam); Incertus auctor. (Frag. ap. Moschionem in Gynæc. 21); Pollux (Onomast.); Myrepsus (38); Actuarius (Meth. Med. ii, 5); Psellus (op. Med.); Serapion (i, 1); Mesue (ii, 1); Avicenna (iv, 7, 1); Avenzoar (i, 1, 3); Haly Abbas (Theor. viii, 8, Pract. iv, 12); Alsaharavius (Pract. i, 2); Rhases (ad Mansor. vi, 1, Contin. xxxvi.) See also Callimachus (Hymn. ad Dianam, l. 79); with the learned Notes of Tytler and Spanheim.
Our author copies closely from Galen, who explains at considerable length his principles of treatment; which consists of purging with warm cathartics, shaving the part frequently, rubbing it, and using calefacient applications. He says that the disease is occasioned either by the deficiency or depravity of the nutritive juices. Drs. Willan and Bateman describe this complaint by the name of porrigo decalvans. Bateman justly remarks, that, “all that can be prescribed respecting the treatment of this affection has been expressed by Celsus with his usual terseness: “Quidam hæc genera arearum scalpello exasperant; quidam illinunt adurentia ex oleo, maximèque chartam combustam; quidam resinam terebinthinam cum thapsia inducunt. Sed nihil melius est quam novaculâ quotidie radere, quia, cum paulatim summa pellicula excisa est, adaperiuntur pilorum radiculæ. Neque ante oportet desistere, quam frequentem pilum nasci apparuerit. Id autem quod subinde raditur, illini atramento sutorio satis est.”
The modes of treatment recommended by the other authorities are in principle the same as our author’s and that of Celsus. Octavius Horatianus, after directing pills containing colocynth, aloes, scammony, and wormwood, recommends nearly the same external treatment as Celsus: “Omnes confectiones quæ mediocriter calefacere possunt, mediocribus et delicatioribus corporibus adhibendæ sunt. Prius ergo loca linteolo usque ad ruborem ante curam confricentur mediocriter, ne vulnerentur. Quæ si vulnerabuntur, oleo roseo, vel adipibus anserinis recuranda sunt.”
Dioscorides recommends tar-water and other preparations of pitch for alopecia.
In a Fragment of an anonymous author, published along with ‘Moschion’ in the ‘Gynæcia,’ very sensible rules of treatment are given; namely, to shave the part frequently, to rub it with compositions containing mustard, adarce, wormwood, alcyonium, &c., and to purge with aloes, scammony, colocynth, and the like. Similar directions are given by Heliodorus. Even Alexander, who in general controverts freely the opinions of Galen, does not differ from him at all in this case. He lays down the treatment of baldness very systematically, according as the falling off of the hairs arises from preternatural dryness of the part, or from contraction or expansion of the pores, or whether it proceed from the purging of the system from depraved humours. In the first of these cases he recommends baths, and a moistening diet, but forbids the use of astringent applications. For preternatural openness or relaxation of the pores he recommends applications of an astringent and bracing nature, and strongly nourishing food. For preternatural contraction of the pores he advises the opposite class of remedies. When the hairs fall out owing to the cleansing of the system from depraved humours, as happens after diseases, he cautions against a too meddlesome interference with the process of nature. Aëtius and Oribasius are the servile copyists of Galen. Marcellus gives a long list of compound medicines for the cure of alopecia. Pliny recommends bull’s gall with Egyptian nitre. The ancients were in the practice of using nitre for cleaning linen, as is remarked by Bernard (ad Nonnum, u. s.) On the ancient practice of scrubbing the head with nitre or soda, see Salmasius (ad Tertull. de Pallio, 432.)
The Pseudo-Dioscorides recommends shaving, rubbing with nitre, and stimulant applications containing arsenic. (Euporist.)
The Arabians treat the disease exactly as the Greeks. Avenzoar recommends purging, a regulated diet, and friction with oil of nuts and cherva. Haly Abbas approves of general evacuants, friction, and stimulant applications containing cantharides, nitre, &c. Alsaharavius recommends emetics after food, purging with hiera picra, friction with compositions containing mustard, euphorbium, pellitory, nettle-seed, with oil of sesame, or with liquid pitch. Ophiasis, he says, is to be treated upon the same principles. Among the ingredients of Mesue’s compositions, we remark cantharides, musk, and amber. Serapion, like Galen and some of the others, makes mention of red arsenic as an ingredient in these applications. Rhases, in his ‘Continens,’ collects the opinions of all preceding authorities on the nature and treatment of these diseases. Most of the local applications recommended by them are stimulants and rubefacients, such as mastich, euphorbium, cantharides, ladanum, St. John’s-wort, &c. which are to be rubbed in with oil or pitch. He mentions that the celebrated Antyllus recommended scarifications, cupping, and leeching. Servitor directs a depilatory, prepared by mixing two parts of quicklime with one of arsenic in a crucible or mortar, and adding a little water to them. Pliny, Samonicus, Marcellus Empericus, and other ancient authorities speak highly of bear’s grease for the cure of baldness.
For the cure of ophiasis the earlier modern surgeons recommended depilatories containing arsenic, quicklime, vitriol, hellebore, and the like. One described by Rolandus consists of quicklime and arsenic boiled in water. (i, 14.) A similar one is described by Plempius.
SECT. II.—FOR MAKING THE HAIR CURLED, AND FOR DYEING IT. FROM CLEOPATRA.
Having first scrubbed the head, anoint the hair with the root of cow-parsnip in undiluted wine.—Another: Having shaved the head, and scrubbed it, take a young pine kernel, and burn it until it be reduced to ashes, put it into a mortar and pulverize it, adding myrtle ointment, until it be of the thickness of honey, and thus anoint the head with it.—Another: Rub in equal parts of myrtles and beet, with oil.—Another: Twenty galls; of maiden-hair, oz. ij; pound with sea-water until they attain the thickness of honey. Having rubbed the hair with urine, or lixivial ashes, and cleaned it with warm water, anoint it with this medicine for two days, then stopping, on the third day clean it, and, having shaved, anoint with myrtle oil. This will render the hair smooth, and curled, and black; but it will be more curled if you shave before using it.
Preservatives of hoary hairs, and other compositions for dyeing them black. Of the oil of unripe olives, three sextarii; of spikenard, dr. j; of unguis aromaticus (sweet-hoof?), dr. iv; of schænanth, dr. iv. Boil with oil, and separately pound and dissolve carefully one ounce of the juice of acacia in wine. When only a third part of the oil remains, strain it, and mixing with the acacia, lay it up in a vessel, and anoint with it every day.—Another: Of the bark of green walnuts, oz. iij; of the root of the ilex, oz. iij; of dark-coloured wine, three sextarii; boil to a third part, and, having strained, pound the remainder with one sextarius of myrtle oil. To be used every day.
An infusion for dyeing the hair black. Of galls, one sextarius, of elm-leaved sumach (rhus coriaria), two sextarii; of the leaves of privet, an equal quantity; of black myrtle leaves, the same; of cinnaris a handful; of poppy-heads the same; of lake water, twelve sextarii. Macerate for many days, boil to a third, then rub and anoint the head. When the hairs are dry anoint with an acetabulum of Cimolian earth, and an equal quantity of quicklime. Dissolving these things in the juice of boiled beet, anoint with it, and then, for the sake of protection, put over it the leaves of beet, and, when they adhere properly, wash in the bath with it.
For dyeing tawny hairs, and making them of a bright yellow colour. Take of myrrh, one part; of the flower of salt, one part; pulverize carefully, and, having made it of the thickness of the sordes of a bath, scrub the head, anoint it with the ointment, and allow it to remain a night and a day, and then order it to be wiped off.—Another: Rub in unripe lupines with water.—Another: Of litharge, dr. j; of Cretan earth, dr. iv; of quicklime, dr. j; with water make to the thickness of bath sordes, and anoint. Apply the leaves of beet for two or three days, and then clean.
For making black hairs yellow. Add the lees of wine to the sordes of a bath, and, having made it to the consistence of cerate, use it when you are going to sleep, and in the morning the hairs will be yellow.—Another: Macerate the leaves of privet in the juice of Fuller’s herb (struthium), and use the infusion.
A gold-coloured dye. Of alum, dr. vj; of red arsenic, dr. vj; of saffron, dr. ij; of the thapsus used by dyers, called herba rubia by the Romans, dr. viij; of the lixivial ashes used by the bonnet-makers, four sextarii; boil the ashes and the thapsus pounded together, and, when but one half remains, squeeze out the juice, and dissolve in it the alum, red arsenic, and saffron; put it into a glass vessel, and, at the time of using, first scrub the head, and then anoint with it. When it is all drunk up, clean with the decoction of fenugreek, barley, and cumin, having previously washed them with a sufficiency of tepid water, and add as much soap as is required.—Another: Mixing together the burnt lees of wine and the oil used in the baths, anoint the hairs.—Another: Scrub with Gallic soap and water at each bath.—Another very fine: Of red sumach, one sextarius; of galls, lb. iss; of sheep’s dung, oz. ij; of the golden-coloured herb, called rubia by the Romans, oz. ij; of maiden-hair, two bunches (fasciculi); of wormwood, one bunch; of lupines stripped of their outer coat, two cyathi; of water, six sextarii; put all into a glass vessel, and allow to macerate for nine days, stirring it twice a day. At the time of using, strain out what is required, and, soaking a sponge in it, rub the hairs, and when they are moistened allow them to drink it up. When dried, wash with a solution of soap in warm water.
For making the hairs white. Burn the flowers of the white petty-mullein, moisten with vinegar, and mix for a detergent ointment.—Another: Of the fruit of petty-mullein, dr. j; of alum, dr. j; of the rind of radishes, dr. j; pound, and mix of bull’s glue, dr. iv.
Commentary. Galen, when about to treat of compositions for the hair, remarks that the application of these does not belong properly to the physician, but that he may sometimes be obliged to furnish them to royal ladies, whom, under certain circumstances, he cannot venture to disobey. That the ladies, in ancient times, were in the practice of painting their hair, is evident from Achilles Tatius (ii, 149), and Juvenal (vi, 354.) Eustathius mentions that antimony was very much used for painting the eyebrows black. (Comment. in Iliad, viii, versus finem.)
For further information upon this subject, with which we must confess ourselves wholly unacquainted, we refer the reader to the following works: Alexander (i, 3); Oribasius (iv, 7, 8); Aëtius (vi, 58); Nonnus (2, 3); Octavius Horatianus (i, 1); Avicenna (iv, 7, 1); Alsaharavius (Pract. xvii, 7); Rhases (ad Mansor. v, and Contin. xxxvi.) Vegetius, the great authority on Veterinary Surgery, gives prescriptions for dyeing the hair of cattle. (Mulom. ii.)
The thapsus mentioned in this Section occurs in Theocritus (Idyl. ii, 88,) and is said by the scholiast to be a Scythian wood for dyeing the hair. It also occurs in Nicander (Ther. l, 529). His metaphrasist, Eutecnius, says that it grows in Sicily. Lucan, in like manner, calls it Erycina thapsus, i. e. Sicilian thapsus. (Pharsal. ix, 916.) It is impossible to determine exactly what tree it was.
The opinions of the philosophers regarding the hair may be learned from Aristotle (H. A. iii), and Pliny (H. N. xi, 94.) Both state that the hair and also the nails grow after death; and Philoponus mentions this circumstance as a well-known fact. See Comment. in Aristot. de Anima, Præfat. It may be proper to mention that Bichat and other modern physiologists have been of the same opinion.
SECT. III.—ON PITYRIASIS.
Pityriasis is an eruption of small furfuraceous substances on the skin of the head, or the rest of the body, without ulceration. It is occasioned, either by depraved humours which have been determined to the head, or by a saltish phlegm, or by bilious or melancholic blood. After the general system has been evacuated, as formerly described, we must use some of the under-mentioned remedies. Having first macerated Cimolian earth in water, mix with the juice of beet, and anoint it, allowing it to remain until dry, then wash it away, and, having pounded frankincense with wine and oil, anoint with them. Next day, rub in stavesacre with oil.—Another: Of nitre, of the burnt lees of wine, of ben-nut, of each, lb. j; of stavesacre, lb. iss. Dissolve in wine, and rub the head; or, if the rest of the body be affected with tingling, it may be used dry. When the pityriasis is more humid, wash with brine or the decoction of lupines. Of this remedy I have had ample experience.
On psydracia and exanthemata of the head. The psydracia are small protuberances, like blisters, elevated above the skin. The exanthemata are superficial ulcerations, somewhat red and rough. Both are to be cured by the under-mentioned remedies: Of litharge, dr. ij; of ceruse, dr. iv; of alum dr. ij: of the green leaves of rue, dr. ij; pound with vinegar and myrtle-oil, and anoint.—Another: Pounding rue and alum with honey, anoint with this the head, after having first shaved it. If the head is excoriated, apply olive leaves boiled with honey.—Another: Of litharge and ceruse, of each, dr. xij; of native sulphur, dr. viij; mix with myrtle cerate.
For the thick and red ulcers of the head, resembling papulæ, or small nipples, from which ichor is discharged. Having first shaved the head and scrubbed it with water and nitre, use native sulphur livigated with human urine; or anoint with melanteria and vinegar.
For achores and favi. The complaint called achor is one of those which affect the skin of the head, corroding the skin by very small perforations, from which a discharge of viscid humour takes place. The complaint called favus is nearly allied to it in appearance, since it consists of larger perforations resembling the combs of bees, containing a honey-like fluid. They are occasioned by a nitrous and saltish phlegm. In such cases, the diet should consist of wholesome food; and everything that is acrid and saltish should be avoided, more particularly if the attack be inflammatory. After the proper evacuation of the prevailing humour, having shaved the hairs, foment twice, thrice, or oftener, with warm water, in which has been boiled myrtle, bramble, or lentil, or bitter lupines, or the root of asparagus. When the ichorous discharge is greater, apply a cataplasm of the leaves of willow, with water, or of lentil. The ointments used should consist of Cimolian, Cretan, or Samian earth, or pompholyx, or spodium, or litharge, or cadmia, or burnt paper, or the powder from pepper. All these are to be applied with vinegar. We may use the following smegma: Of sulphur, of the herb perdicias, and soap, of each equal parts. The following are compound applications: Of litharge, dr. xvj; of the leaves of rue, dr. viij; of the stavesacre, dr. iv; of copperas, dr. ij; with vinegar and myrtle oil; make to the consistence of bath-sordes, and anoint with it.—Another: Of sandyx (calcined ceruse?), dr. iv; of myrrh, dr. iv; of native sulphur, dr. ij; of manna, dr. iv; rub into the part with old oil.
For achores. When they discharge ichor, triturate the dross of silver, or yellow ore of lead (molybdœna), and sprinkle upon them.—Another, for achores and humid psora: Of the roses of the rhododaphne, oz. iv; of native sulphur, oz. iv; of liquid pitch, oz. iij; of dry pitch, oz. iij; of wax, oz. vj; of myrtle oil, q. s. For children, dissolve in milk, and anoint.
For fici. We give the name of fici to ulcerous excrescences which are round, somewhat hard, red, and accompanied with pain. They arise for the most part on the head, but also sometimes on the other parts of the body. The best application for this complaint consists of fissile alum, of the calcined flowers of copper, of taurocolla, of each equal parts, with double the quantity of the flakes of copper; triturate with vinegar, and anoint. A proper application is also prepared from the burnt heads of the cackrel fish, the bulbi boiled, and their ashes mixed with vinegar.
A dry application for ficose eruptions of the head and chin. Of misy, dr. iss; of chalcitis, dr. iiss; of squama æris, dr. j; of fissile alum, dr. j. Having washed, apply this powder in a dry state unsparingly, and allow it to remain. Next day, having again washed, wipe the part with a sponge, and apply it again. A thick scab will then fall from the ulcer. Repeat the same application the following days. The cure will be effected in a few days without leaving a cicatrix; but this medicine operates strongly.
For lice in the head. Direct the head to be scrubbed with the decoction of lupines; or pound together stavesacre and sandarach, and rub them in along with oil or vinegar; or a small quantity of pepper may be added to old oil, so as not to occasion ulceration; or the juice of ivy with honey may be used; or mustard and vinegar; or the gum vernix, or liquid pitch with alum; or the expressed juice of the bay berries; or oil of radishes. I have always succeeded by pounding stavesacre with vinegar and oil, and anointing with this.
Commentary. Drs. Willan and Bateman agree with all the best medical writers of antiquity in describing, by the name of pityriasis, a disease consisting of slight, scaly, and branny exfoliations without ulceration. See Galen (Sec. Loc. i); Alexander (i, 3); Oribasius (Synops. vi, 25); Aëtius (vi, 66); Actuarius (de Sig. Morb. ii, 5); Nonnus (4.) Actuarius, who gives a very distinct account of the disease, states in strong terms the danger of repressing the cutaneous eruption. (l. c.)
It is the porrigo sicca of Celsus (vi, 2), who recommends for it shaving the head, and using slightly repressing applications, “quale est nitrum cum aceto, vel ladanum cum myrteo et vino, vel myrobalanum cum vino.” Marcellus distinguishes the pityriasis from porrigo. (De Med. 4.)
The Arabians, especially Serapion, direct very active general treatment, such as venesection, masticatories, cathartics, and the like. (i, 4.) It is described under the name of furfures capitis by the translator of Haly Abbas. (Theor. viii, 18.) Like the Greeks, he represents it as consisting of small furfuraceous scales without ulceration. Alsaharavius uses the same name, and recommends bleeding, cupping, purging, and external applications of a detergent nature, such as flour of vetches, with vinegar and the like. Avenzoar recommends pills of drastic purgatives, and the ordinary lotions. (i, 1, 10.) See also Avicenna (iv, 7, 1, 24); and Rhases (ad Mansor. v, 1; Contin. xxxvi.) In the ‘Continens,’ the disease is described by the names of furfures and impetigo, for which Rhases recommends liniments containing nitre, sulphur, hellebore, vinegar, &c.
Willan and Bateman describe the psydracia as being small pustules irregularly circumscribed and terminating in a laminated scab. Most of the above-mentioned writers treat of them in the same terms as our author. They seem to be the balchie of Avicenna (iv, 7, 6, 1) who calls them a malignant species of achor. See Galen (l. c.)
Galen, Alexander, Aëtius, and our author describe the exanthemata as being small superficial ulcerations. Drs. Willan and Bateman use it as a generic term for rashes. The exanthemata seem to be the alraba or pustulæ dulces of Alsaharavius (i, 10.) See Book First, Sect. VI, and Book Fourth, Sect. VIII, of this Work.
Willan and Bateman apply the terms achor and favus in the same sense as Paulus and the other ancient authors. Octavius Horatianus uses the terms acora and cerio. He says, “Acoræ et ceriones distant, quod ceriones plures cavernas egestionis habent et humorem multo pinguiorem emittunt; acora autem unam cavernam habet, et humorem egerit aquatiorem.” (i, 5.) Galen has treated of these complaints very fully, and his applications are similar to those of our author. See also most of the authorities on pityriasis. The favus is the first species of tinea described by Haly Abbas. It consists, he says, of cells, and discharges a fluid-like honey. The achor is his amada, or third species of tinea, consisting of smaller cells than the former. Alsaharavius describes the favus by the name of alsahara. It contains, he says, a viscid fluid like honey. He recommends for it purgatives, and detergent applications containing nitre, lees of wine, &c. (Pract. i, 9.) The achor is called alsahafa by him. The description which Actuarius gives of papulæ, favus, and ficus is sufficiently distinct, but not different from our author’s. (De Diagnos. ii, 5.)
The other authorities gives the same account of ficus as Paulus. It is Haly Abbas’ second species of tinea, and is described by him as consisting of hard round protuberances. Haly’s fourth species of tinea consists of small ulcers of a mammiform appearance. They are mentioned by our author. Fabricius ab Aquapendente defines the ficus thus: “Tumeur qui est rouge, ronde, quelque peu dure, et de laquelle (etant ulcérée et pressée) sort une matière sanieuse, semblable aux grains de figues.” (Œuv. Chir. i, 1, 13.) He says that Hippocrates and Galen give a different account of it from our author’s; but we can see very little difference between them. Most of the ancient authors recommend the same remedies for ficus as Paulus. The most active of these are stavesacre, and sandarach or red sulphuret of arsenic. They do not appear to have apprehended danger from the free use of arsenic in this way. Galen recommends equal parts of white hellebore, stavesacre, and nitre with oil. (De Med. Sec. Loc. i.) Octavius Horatianus mentions equal parts of pellitory and galls. The same medicines are recommended by Serapion, (i, 5.) See also Oribasius (de Loc. Affect. iv, 11); Celsus (xi, 3); Cælius Aurelianus (de Morb. Tard. iv, 2.) Haly’s remedies consist of galls, litharge, mercury killed (sublimed?), sulphur, and so forth. Among those of Rhases we remark squills, assafœtida, quicklime, mercury, &c. However, he prefers excision. (Continens. xxxvi).
For pediculi in the head, the Arabians recommend nearly the same compositions as our author. They contain arsenic, stavesacre, hellebore, nitre, and the like. See Alsaharavius (Pract. i, 16), and Phases (Cont. xxxvi, 6.) Among the ingredients mentioned by the latter, we remark quicksilver, sulphur, red arsenic, mustard, stavesacre, the oil of oleander, vinegar, &c. These medicines form the ingredients in the compositions recommended by modern writers on this complaint. See Plempius (de Morbis Pilorum), and Amatus Lusitanus (Curat. 58.)
SECT. IV.—ON HEADACH.
Headach, which is one of the most serious complaints, is sometimes occasioned by an intemperament solely; sometimes by a redundance of humours, and sometimes by both; and sometimes it is occasioned by a procatarctic cause, such as external heat, or cold, or drunkenness, or a blow. The most vehement pains of the head are excited by the active qualities, particularly heat. Those occasioned by dryness are not equally vehement; but a humid quality excites no pain of itself, unless it happens to be joined to heat, cold, or a fulness of humours. Headachs occurring in a fever having been treated of in the preceding Book on Fevers, we will now treat of the others.
On headach from heat. When headach proceeds from exposure to heat, the skin feels hotter and drier than natural at the first application of the hand, and the eyes of such persons are red. They delight in cold affusions and ointments, and are benefited by them. The method of cure will correspond with that described as applicable for cases of headach in fevers. When the pain becomes chronic, we must have recourse to some of the under-mentioned applications. The following applications to the forehead and temples will also be proper, namely, bread soaked in oxycrate and rose-oil, to which may sometimes be joined almonds; or roses either dried or fresh, or mixed with mint and pennyroyal; or bread with the leaves of the peach tree. Benefit may also be derived from basil, pounded with vinegar and rose-oil; or from ivy berries boiled in vinegar, and pounded with rose-oil; or from wheaten flour mixed with the watery decoction of wild thyme; or from cardamom toasted and triturated in vinegar and rose-oil; or from leaven with rose-oil; or from dried iris with vinegar. These applications must be changed frequently; for if allowed to remain long, they have no effect.
Trochisks for headach connected with a warm intemperament. Of saffron, dr. v; of copperas, dr. x; of alum, dr. xvj; of myrrh, dr. vij; of the oil of unripe olives, dr. iij; of chalcitis, dr. iij; of gum, dr. iij; of austere wine, q. s. Use with oxycrate, and, if watchfulness accompany it, add some of the soporifics.
On headachs from a cold intemperament. In cases of headachs from coldness, the symptoms are just the reverse of those proceeding from heat; for the face is pale and not contracted, and the patients do not delight in cold things, nor are benefited by them. The diagnosis will also be confirmed by adverting to their diet, and the like. The ointments applied should contain rue, or the oil of bay, or of iris, or of nard, or the juice of balsam, more particularly if the excrementitious humours be thick and viscid. This must be rubbed into the forehead, and likewise preparations containing pepper and euphorbium. Also give thin wines and recommend exercise, hot baths, and occasionally an emetic from radishes. When the exciting cause is a chronic quality without plethora, use the following application: Of white pepper, dr. ij; of crocomagma, dr. ij; of fresh euphorbium, dr. viiiss; of pigeon’s dung, dr. iss; of the strongest vinegar, q. s. Having first rubbed the affected part, anoint with this.
On headachs from a bilious humour. The symptoms resemble those occasioned by heat, only there are more gnawing pains at the stomach, paleness of the countenance, and sometimes a bitter taste in the mouth. This affection occurs most frequently in adults who are of a hot temperament, lead an anxious life, and are subject to collections of yellow bile. They must use tepid baths, and mild ointments, with a watery drink; and their whole diet should be moistening, and consist of good juices. The bilious humours must be evacuated with the decoction of wormwood, or with aloes, or the antidote called hiera picra, either alone, or in combination with a little scammony, or the aloetic pills. The forehead is to be rubbed with the saffron trochisk, or with that called trigonos, or the like.
On headach from sympathy. If the head be affected sympathetically with the general system, this must be our first care, by attending to the intemperament and the prevailing matter. If it proceed from plethora, more especially a venous one, we will bleed; but, if it be only an offending quality, we will use a purgative medicine. If the head sympathise with some particular part, such as the liver, belly, or stomach, we must apply remedies to these organs. If a hot intemperament accompany, we give bread which has been steeped in a watery wine, or spoon-meats from chondrus. Moderately cooling and tonic applications are likewise to be used externally, as formerly described. But if the headach be occasioned by viscid and thick humours contained in the stomach, these must be dislodged by drinking oxymel, either alone or that preparation called the Julian. We must also use decoctions of hyssop and marjoram, and other things still hotter and more incisive, and likewise the emetic from radishes, hot embrocations, and cataplasms.
On headach from wine. If the wine remain undigested, we must procure vomiting, by drinking tepid water; but if the headach remain after digestion, we must use cooling and repellent applications, such as rose-oil alone and with vinegar, or the juice of ivy, or of cabbage. And the leaves of cabbage infused in warm water, and applied to and bound to the head, naturally counteract intoxication. They must also eat boiled cabbage. Dried lentil is also beneficial, particularly to those who have a loose belly. They ought likewise to eat alica, pomegranates, apples and pears, and drink water.
On headach from a blow. We must immediately bleed those who have headach from a blow (unless the injury be superficial), and use suitable embrocations to the head; bathe it with sweet oil; cover it with wool; and make the patients abstain from wine and a rich diet, more especially if they have fever; and, upon the whole, we are to accommodate our treatment as for the inflammation of nervous parts, and especially of the membranes of the brain. If there be a wound it must be treated accordingly.
An emollient application for headach. Of wax, dr. vij; of almond-oil, oz. iij; of turpentine, dr. viij; of scraped verdigris, of Cimolian earth, and of chalcitis, of each, dr. iv; of pumice-stone, dr. iij; of burnt copper and scales of steel (squamæ stomomatis), of each dr. ij; and, if appear to be too hard, soften it with almond-oil.
Commentary. By cephalalgia, as Aretæus remarks, is to be understood an acute pain of the head, and by cephalæa a chronic one. Our author does little more than abridge the contents of the second book of Galen’s work ‘De Med. sec. Loc.’, where this subject is treated of with unrivalled precision. See also Aretæus (de Morb. Chron. i, 2); Oribasius (de Loc. Affect. iv, 1); Celsus (iv, 2); Cælius Aurelianus (de Morb. Chron. i, 1); Octavius Horatianus, (ii, 1); Alexander (i, 10); Pseudo-Dioscorides (Euporist. i, 6); Actuarius (Meth. Med. vi, 2); Aëtius (vi, 40); Leo (Synops. ii, 1); Nonnus (10); Serapion (i, 6); Avicenna (iii, 1, 2); Avenzoar (i, 3); Mesue (de Ægr. Capitis, ii, 1); Haly Abbas (Theor. ix, 3, Pract. v); Alsaharavius (Pract. i, 2, 1); Rhases (ad Mansor. ix, 1, Contin. i, 21.)
In headach from heat, Galen and Alexander concur in condemning the use of poppies, hemlock, and mandragora, unless when compelled to have recourse to them by the continued watchfulness of the patient. Galen directs the application of snow to the head. Avenzoar recommends the affusion of cold liquids from a height upon the head. Serapion mentions oil cooled with ice. When the pain is obstinate, Rhases approves of opening the temporal artery. When the pain is violent, the author of the ‘Euporista’ recommends us to shave the head and bathe it with a decoction of narcotic vegetables. Galen expresses himself very clearly with regard to the sympathy between the head and the stomach, from nervous communication. (Loc. affect. iii, 9.)
For headachs arising from a hot or cold intemperament, Galen recommends the remedies called metasyncritica by the Methodists, for an account of which see Le Clerc. (Hist. de la Méd. ii, iv, 1, 3.) He says, “Ce que Thessalus appelloit metasyncrise etoit un changement qu’ il prétendoit faire dans tout le corps, ou dans quelque partie seulement.” Such rubefacients as mustard, thapsia, &c. belonged to this class. See also Prosper Alpinus (de Med. Method. iii, 15.) The term signifies “altering the system;” and, therefore, we have generally rendered it “alteratives” in the course of this translation. The treatment followed by Philagrius in the hot and fiery intemperament of the head deserves to be noticed. In a case of this description having used many other cooling remedies in vain, he says he shaved the head and applied snow to it, by which means he extinguished the intemperament. (Theophilus, Sch. in Hipp. t. ii, 457, ed. Dietz.) This practice is borrowed from Galen, as above.
Our author borrows his treatment of bilious headach from Galen and Alexander. To his judicious account of headach from wine or a blow, nothing need be added from any other author. Alexander justly remarks that, when it arises from the latter cause, it is very dangerous. He is fuller than our author in treating of headach from sympathy with the liver, for which he recommends local applications of a cooling nature and a generous diet. Similar treatment, he adds, is to be pursued when it arises from a hot intemperament of the stomach, bowels, or spleen.
According to Avicenna and Actuarius, frothy urine, that is to say, urine having bubbles on the surface, is characteristic of cephalalgia.
The Arabians generally treat of the disease by the name of soda.
Headach, says Haly Abbas, is either seated in the head, or arises from sympathy. When seated in the head, it either arises from an intemperament, or organic disease, or flatus, or a blow. One of the most common causes of sympathetic headach is the presence of bilious matters in the stomach, which case is generally relieved by vomiting. Protracted watchfulness induces headach, by occasioning a corruption of the food in the stomach; and protracted sleep in like manner fills the brain with vapours. Excessive evacuation, by producing a dry intemperament, proves a cause of headach. It is in this manner that epistaxis and menorrhagia occasion headach. Haly Abbas, like Galen, mentions as a cause of headach an excessive sensibility of the nerves which connect the brain and stomach. Haly further states that headach will arise from sympathy with the uterus, as after abortions, obstructions of the lochial or menstrual discharge, and the like causes. He remarks that violent headach will sometimes occasion loss of speech, owing to an affection of the nerve which is distributed upon the muscles of speech. His treatment, like our author’s, is varied according to the nature of the exciting causes; and his account of it is so full and judicious, that we regret our limits do not permit us to give a more ample detail of it. His remedies are, general bleeding, cupping the extremities or back part of the neck, anodyne or cold applications to the head, drastic or gentle purgatives, and so forth.
Alsaharavius treats the complaint upon similar principles. When it arises from heat, he recommends the affusion of tepid water over the head, and afterwards applies oils cooled in snow. When connected with bile, he directs the belly to be opened. When it is occasioned by a sanguineous plethora, he recommends general bleeding and the application of cupping-instruments to the nape of the neck.
Rhases, as usual, treats fully of soda and all its varieties. When of an inflammatory nature, he recommends bleeding, purging, and the application of vinegar and rose-oil to the head. When connected with bile, he directs first vomiting by drinking tepid water, and then to take purgatives, and afterwards wormwood. When the disease is protracted, he approves of opening the temporal vessels, and of using sternutatories. When it arises from a blow, he recommends bleeding, and purging with colocynth, &c. He states that Ruffus recommended the affusion of cold water, or of oils congealed in snow, over the head. In obstinate cases, he directs the use of the actual cautery.
SECT. V.—ON CEPHALÆA AND HEMICRANIA.
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.
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.
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.
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.
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.
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.