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.
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.
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.
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.
The cure. When the patient is an infant, we need not be particularly solicitous about it; for when its age changes to a more bilious and drier constitution, and the diet is more prudently regulated, the affection most commonly goes off spontaneously. But we must attend to the diet not only of the infants, but likewise of their wet-nurses. After boyhood, those that fall into the disease ought to have the convulsed and distorted parts freely anointed, and ligatures applied to them, when they are to be stretched out; and then the mouth is to be opened, and one must introduce a finger or a feather, smeared with oil of iris, in order to bring away the phlegm. We must also rouse the senses by strong-smelling things, such as hog’s fennel, Cyrenaic juice, bitumen, and the pitch of cedar. But after the paroxysms, if nothing prevent, we must bleed from the arm; and when the paroxysm does not abate, we must apply a sinapism to the extremities, and a cupping-instrument to the hypochondria. When after these things no remission takes place, there can be but little hope, and yet the physician ought boldly to force castor into the mouth, and Cyrenaic juice, with honey and vinegar; and the decoction of centaury, or of colocynth, must be injected by the anus. Those that are recovering from an epileptic attack are to be evacuated after recovery by purging with hiera. This is the cure of a recent and acute attack of epilepsy. We will next deliver the treatment of the disease when it is in a chronic state. Wherefore the patients are to be made to persevere for a long time in drinking cold water; and when setting about the cure, it will be proper to bleed if nothing prevent; and after an interval of four or five days to recruit the body, and thus evacuate with a purgative, more especially black hellebore, colocynth, or scammony. The hellebore, without its medullary part, is to be pounded and strained, and sprinkled on five or six cyathi of honied water, or it may be taken in boiled honey with some pepper. Rejecting the seeds of the colocynth, fill it, still retaining the medullary part, with must, and allow to remain for a whole night; in the morning dilute the must, and give to drink. Or we may use the cathartic from white hellebore. It is this: Of cleansed bay berries, dr. viij; of white pepper, dr. viij; of alypias, dr. viij; of euphorbium, dr. viij; of white hellebore, dr. viij. Give these things at one dose, with the must in the colocynth, and it will evacuate well by vomiting. After proper purgation let them be put into the bath, and on the third day cup the hypochondria and back with scarifications; and then, stopping for a sufficient number of days and recruiting the body, give the hiera from colocynth; and afterwards apply the cupping instrument to the head and nape of the neck, and the day following a cataplasm consisting of bread boiled in honied water, and pounded with bitter almonds, wild thyme, mint, calamint, or rue. This must be done for three days. Afterwards the head is to be shaven and rubbed with the juice of hog’s fennel dissolved in vinegar, wherein cow-parsnip has been boiled; then, after stopping and recruiting the body, nine oboli of the antidote from colocynth are to be given in honied water; and, again, after an interval of some days, the antidote is to be repeated, and sternutatories used. After five or six days give castor in honied water; then stopping again administer a clyster of centaury and colocynth; and afterwards give the hiera again, and use masticatories and errhines in order, and apply a sinapism to the head. Acrid food must be seasonably given. Benefit may be obtained from oxymel of squills drunk every day, and honey in which the squill has been softened, to the amount of a spoonful. The diet should be of an incisive and attenuant nature; and therefore capers may be frequently taken with pickle. But they ought to abstain from flesh, pulse, and much wine, likewise from frequent venery, baths, mustard, and from drinking immediately after the bath, more especially of undiluted wine. Let them have recourse to gymnastic exercises and friction, and the last part that is rubbed should be the head.
On the cure of epilepsy from the stomach. If the disorder is occasioned by the stomach’s being primarily affected, the patient must attend to his digestion, taking about the third hour some carefully-baked bread that has been soaked in some diluted wine, slightly astringent, and of a white colour. Give to such persons the medicine from aloes twice or thrice every year. “I once knew a boy,” says Galen, “who was never seized with epilepsy after he carried a large piece of fresh peony appended from his neck.” Agaric is beneficial to epileptics, also hartwort, the fruit and root of cow-parsnip, and the round birthwort drunk with water. Scarification of the legs frequently repeated is also of great use.
On epilepsy proceeding from some of the members. When the attack is threatened, and they feel a sensation in the part, whether the hand or foot, a tight ligature ought to be applied above it, and the cure attempted during the remissions, by applying some caustic substance to the part, such as the garden cresses (lepidium), preparations from cantharides, and the like. The Julian oxymel is also of great use to epileptics, by expelling the offending matter from the part. After those things which have been mentioned, the theriac and natural baths have place. During their whole life, they must particularly guard against indigestion, and be careful not to take food before digestion has been performed; avoid all incrassating food, too long abstinence from food, all vehement venereal impulse, much wine, and drinking, after the bath, more especially of undiluted wine, as formerly mentioned, and likewise of old and thick wines. They must avoid, also, all aromatics of an acrid smell, and such as fill the head; must abstain from looking down steadfastly from a high situation, from remaining long in the bath, and exposing the head to the heat of the sun.
Commentary. Consult Hippocrates (de Morbo Sacro); Galen (de Sympt. Diff. 3; De Loc. Affect. iii, 11; De Puero Epileptico); Oribasius (Synops. viii, 3); Aëtius (vi, 13); Aretæus (Morb. Acut. i, 5; Morb. Chron. i, 4); Pseudo-Dioscorides (Euporist. i, 21); Alexander (i, 15); Leo (6); Actuarius (Meth. Med. i, 16); Nonnus (36); Serenus Samonicus; Scribonius Largus (12); Apuleius (Apologia); Celsus (iii, 23); Octavius Horatianus (ii, 2); Isidorus (Orig. iv, 8); Pliny (H. N. xxv, 5); Avicenna (iii, i, 5, 9); Serapion (i, 23); Haly Abbas (Theor. ix, 6; Pract. v, 21); Alsaharavius (Pract. i, 2, 36); Avenzoar (i, 9); Mesue (de Ægr. Cap. 26); Rhases (Div. 7, alibique.)
Our author derives his principles of treatment, more especially with respect to regimen and diet, from Galen’s directions for the management of an epileptic boy. Part seems also to be borrowed from Oribasius.
Hippocrates with great good sense rebuts the popular belief of his own times, that the epileptic paroxysm is produced by demoniacal influence. He justly remarks, that the inferior animals, such as goats, are subject to this complaint; and that in them it is found to be occasioned by water in the brain. It is almost certain that the morbus sacer of the ancients, and the disease under which the demoniacs laboured was epilepsy. See Athenæus (Deipnos. vii, 33), with the notes of Casaubon and Schweigh.; also Coray (ad Hippocrat. de Aq. &c. 12.) Leo, in fact, says expressly, when treating of epilepsy, that the vulgar call the disease the demon and lunacy; and in like manner Aretæus mentions that some refer the disease to the moon. See further Galen (Introductio); Dietz (ad Hippocrat. de Morbo Sacro); and Greenhill (Adnot. ad Theophil. v. 30, p. 340.)
Celsus lays down his rules of treatment with his usual judgment and elegance. His practice is very similar to our author’s. He recommends bleeding; purging with black or white hellebore; shaving the head and applying cupping-instruments to it, and, in desperate cases, even the actual cautery; also friction of the extremities, and bleeding in the foot, along with attention to exercise and diet. The use of hellebore in epilepsy is mentioned by Pliny, and by Aulus Gellius (Noct. Attic. xvii, 15.)
The poet Lucretius gives a very glowing and accurate description of the symptoms and causes of epilepsy. (De Rerum Natura, iii, 485.)
Aretæus delivers separately the treatment of an acute attack and of the disease when in a chronic state. For the former he recommends the general remedies (we mean bleeding, clysters, and emetics.) Among the medicines enumerated by him for the cure of epilepsy, he mentions copper, which, he says, when given with cardamon, will act either upwards or downwards. We need scarcely say that copper has been strongly eulogised in modern practice. In the treatment of chronic cases he pays particular attention to the head, opening the veins and arteries of it, boring the bone down to the diploe, and applying the actual cautery to it. A more rational and less dangerous procedure was the application of embrocations containing cantharides and other such rubefacients to the scalp; in that case he recommends milk to be drunk beforehand, to prevent the bladder from being affected.
Aretæus and most of the authorities mention the gagate stone or jet as a test of epilepsy. The smell of it was said to bring on an attack. He exclaims in affecting terms against the abominable means often had recourse to for the cure of this disease. And so also Pliny (H. N. xxviii, 2.)
Aëtius, Oribasius, Actuarius, and Alexander treat the disease upon the same principles as our author. Alexander, although otherwise a most judicious and original writer, expresses great confidence in the use of amulets, for the preparation of which he gives very minute directions. Jasper is particularly commended as an efficacious amulet. One of his amulets is the nail taken from the arm of a malefactor who had been crucified! In his general treatment he particularly approves of giving drastic purgatives and emetics.
Isidorus thus defines epilepsy: “Epilepsia vocabulum sumpsit quod mentem apprehendens pariter etiam corpus possideat. Fit autem ex melancholico humore quoties exuberaverit, et ad cerebrum adversus fuerit.”
No ancient author has treated of epilepsy more accurately than the great Methodist Cælius; but his account is so long and minute, that it is impossible for us to do justice to it in an abridgment. The causes of the complaint which he enumerates are drinking too much wine, indigestion, compression of the brain, and frights. He says that the whole nervous system is affected, but especially the part seated in the head. When the patient is an infant, he properly directs us either to change the nurse, or to pay particular attention to her diet. Bloodletting he approves of on a first attack, unless the stomach be loaded with crudities; and if there be pain in any part of the head, he directs leeches to be applied to it. He recommends gargles, and rubbing the skin with substances which occasion an eruption of pustules. He enjoins great caution in the use of hellebore. He approves of gentle exercise, a light diet, abstinence from wine, change of scene, or a sea-voyage. With respect to the modes of treatment pursued by the other sects, he greatly disapproves of the application of fire and other hot things to the head, and of strong sinapisms to the other parts of the body. Escharotics applied to the head, he says, only increase the disorder; and the use of bull’s blood, or that of a man recently killed, and other such ridiculous remedies, he properly treats with contempt. He disapproves of diuretics, and of hellebore, scammony, and the like, when administered indiscriminately. He speaks unfavorably of chalybeates.
The Arabians follow closely the views of their Grecian masters, without suggesting any material improvement. Haly Abbas says that epilepsy is a convulsion which either comes on periodically, or at no stated times; and that it either arises from the brain itself, or from sympathy with the stomach, or with some other parts of the body. It is occasioned, he says, either by a gross humour collected in the ventricles of the brain, or from compression produced by fracture. He makes mention of the epileptic aura, and, like our author, states that the disease is distinguished by foam at the patient’s mouth. He joins Hippocrates in pronouncing such cases as occur before puberty to be not difficult to cure, but those which supervene after that age to be most intractable. When the complaint occurs in an infant, he properly directs us to attend both to the nurse’s and the infant’s diet. In cases attended with plethora he approves of general bleeding, cupping the limbs, and opening the saphena. When the disease is protracted he advises to apply cupping-instruments to the neck, and to give drastic purgatives, such as black hellebore, colocynth, &c. When it appears to proceed from the stomach he approves of emetics. He commends peony applied as an amulet. It is worthy of remark that Andreas Laurentius, in the 17th century, speaks confidently of this remedy. So inveterate is the dominion of superstition and ignorance! Alsaharavius gives a curious account of epilepsy, but mixed with some superstitious notions. He says he had had ocular proof that epileptics are possessed with demons; for that he had known many of them who had a knowledge of things which he was sure they had never learned. Like the others, he speaks of amulets; but his general treatment is sufficiently rational and scientific.
Rhases gives the theories and practice of preceding authors along with his own remarks, which, however, contain no very original opinions. One of his Arabian authorities recommends bleeding at the arm, and also by cupping and opening the occipital arteries, rubbing the head with mustard, purging with hiera, sternutatories, &c. The application of mustard to the head is approved of by most of his authorities.
Like our author, most of the ancient writers approve of Cyrenaic juice, or assafœtida, in cases of epilepsy.
SECT. XIV.—ON MELANCHOLY, MANIA, AND DEMONIACS.
Melancholy is a disorder of the intellect without fever, occasioned mostly by a melancholic humour seizing the understanding; sometimes the brain being primarily affected, and sometimes it being altered by sympathy with the rest of the body. And there is a third species called the flatulent and hypochondriac, occasioned by inflammation of the parts in the hypochondria adjoining to the stomach, by which sometimes noxious vapours or auræ are transmitted to the brain, and sometimes part of the substance of the humour. The common symptoms of them all are fear, despondency, and misanthropy; and that they fancy themselves to be, some, brute animals, and imitate their cries; and others, earthen-vessels, and are frightened lest they be broken. Some desire death, and others are afraid of dying; some laugh constantly, and others weep; and some believe themselves impelled by higher powers, and foretell what is to come, as if under divine influence; and these are, therefore, properly called demoniacs, or possessed persons. The peculiar symptoms of melancholy, from sympathy with the general system, are leanness, darkness, and shagginess; the whole appearance melancholic, either by nature, or acquired by anxiety, want of sleep, the administration of noxious food, or stoppage of the hemorrhoidal, or menstrual discharge. Melancholy, from affection of the hypochondria, is indicated by indigestion, acid eructations, heat and heaviness of them, retraction of the hypochondria, and sometimes inflammation, especially in the beginning; and then, when they increase, melancholic symptoms supervene. These are relieved by digestion, or copious discharges, or flatus, or vomiting, or eructations. When none of these symptoms, or very few of them, are present, melancholic symptoms appearing indicate that the brain is primarily affected, and for the most part from a melancholic humour. When the complaint is occasioned by yellow bile, which, by too much heat, has been turned into black, it will bring on the disease called mania, which occasions ungovernable madness, so that those affected with it will destroy persons who come near them unguardedly.
The cure of melancholy. Those who are subject to melancholy from a primary affection of the brain are to be treated with frequent baths, and a wholesome and humid diet, together with suitable exhilaration of mind, without any other remedy, unless when, from its long continuance, the offending humour is difficult to evacuate, in which case we must have recourse to more powerful and complicated plans of treatment. These cases are to be purged from the first with dodder of thyme (epithymus), or aloes; for if a small quantity of these be taken every day, it will be of the greatest service, and open the bowels gently. After purging, as we have mentioned, give wormwood, sometimes macerating and boiling the herb in water to the amount of two cyathi, and sometimes diluting the juice with water, to the amount of half a drachm, and giving it frequently. Let them drink of the most acrid vinegar before going to sleep, and dip, for the most part, their condiments in it before eating them. But it will be better if to the vinegar be added squills, poley, or the slender birthwort. When you meet with an incipient case of the complaint, from sympathy with the general system (as described above), and the body is firm, you must, by all means, begin with phlebotomy, and after phlebotomy, when the strength is recruited, purge downwards, with the wild cucumber, and the composition from the black hellebore, and promote the hemorrhoidal and menstrual discharges, if the affection be occasioned by retention of them. Diuretic remedies are likewise proper, as also evacuations by perspiration. But if the complaint arise from disorder of the hypochondria, we must attend to them, and foment them with a decoction of rue, dill, wormwood, pennyroyal, the seed of the chaste-tree, and of the fruit of the bay-tree; for these soothe the pains and diminish flatulence. They may be boiled in oil and applied; and the cataplasms of them ought to contain the remedies for flatulence, namely, parsley, or anise, or cumin; and it will not be improper to add cyperus, iris, and frankincense, to the cataplasms. These things are to be allowed to remain in general, even during the day, and whether the patient eat or fast; and, when taken away, apply some other protection, such as a broad piece of wool. Use dry-cupping for flatulence, and cupping with scarifications for pains and inflammations. While directing your attention to the cure, you must not forget mustard, and apply acrid smegmata and calefacient plasters to the back and belly. In chronic cases, the most powerful remedy is evacuation, by vomiting with hellebore. The diet for all melancholics should be wholesome, and moderately moistening; abstaining from beef, roe’s flesh, dried lentil, cabbages, snails, thick and dark-coloured wines, and, in a word, from whatever things engender black bile.
The cure of mania. Persons affected with mania are to be treated like melancholics; and, in particular, we must apply to the head rose-oil, or rose-oil with vinegar, and purge with the bitter antidote called hiera, having previously bled them; and we must use leeches to the head. But nothing is of such service as horse-fennel, either the root or seed drunk in water. A drachm of the root of bryony with water may be taken every day. If the maniacs will not be persuaded to take the purgative medicines, they must be mixed with their food, in a concealed manner, such as with mouthfuls of meat, or dried figs, or dates, or else with their drink. But, above all things, they must be secured in bed, so that they may not be able to injure themselves, or those who approach them; or swung within a wicker-basket in a small couch suspended from on high.
Commentary. Consult Hippocrates (Aphor.); Galen (Comment. in Aphor., de Morb. Vulg.); Celsus (iii, 18); Aretæus (de Morb. Chron. i, 6, and de Curat. Morb. i, 5); Aëtius (vi, 8); Nonnus (32); Oribasius (Synops. viii, 17); Alexander (i, 16); Actuarius (de Dig. Morb. ii, 34); Octavius Horatianus (ii, 2, 5); Mesue (de Ægr. Cap. 34); Serapion (i, 22); Avicenna (iii, 1, 4); Avenzoar (i, 9, 16); Haly Abbas (Theor. ix, 7; Pract. v, 23); Alsaharavius (Pract. i, 2, 27); Rhases (ad Mansor. ix, 13; Contin. 1).
Hippocrates, in his Aphorisms, points out the lower intestines as the seat of melancholy, and directs us to cure the complaint by purging. Galen, in his Commentary, agrees with his principles and practice. Galen states correctly that melancholy sometimes changes to epilepsy, and vice versa, that epilepsy is often succeeded by melancholy. (De Loc. Aff. iii, 10.) He gives a curious extract from the works of Diocles, with remarks upon the same.
Aretæus considers melancholy as an incipient mania. He gives a masterly sketch of the different modes in which mania makes its attack, and relates an interesting case of a joiner, who was perfectly sound while engaged at his work, but no sooner left the place where he was occupied than he became mad. For the cure of melancholy he advises blood to be abstracted at the commencement, according to the patient’s strength and condition. He approves then of giving black hellebore, and of applying cupping-instruments over the liver, stomach, or to the head, according as these may happen to be affected. He recommends then wormwood and aloes. When the menstrual or hemorrhoidal discharges are stopped, they are, if possible, to be restored; and for this purpose blood may be abstracted from the ancle, or even from the arm. He also approves very much of the natural hot baths.
Celsus, in cases of melancholy and mania, recommends in particular vomiting and pinging by hellebore; with the black species, if the patient is affected with grief; but with the white, if with gladness. He also approves of bleeding.
Aëtius gives an interesting account of the treatment of melancholy, principally extracted from the works of Galen, Ruffus, Posidonius, Archigenes, and Justus. The remedies which all of them seem to have reposed most confidence in are drastic purgatives combined with bitters and carminatives. They approve, however, of general bleeding and cupping, when indicated by the symptoms of the complaint, and the state of the patient. Nonnus in like manner prescribes bleeding in the forehead, purging with hiera picra, acrid clysters, and bitters, such as gentian and stæchas (lavendula stæchas.)
Alexander’s plan of treatment is very circumstantially detailed; but it differs very little from our author’s, except that he recommends Armenian bole instead of white hellebore. Like Aretæus, he strongly commends the use of the hot bath for the cure of melancholy. He speaks highly of a well-regulated diet, consisting principally of rock fishes, domestic fowls, and emollient pot-herbs, such as lettuces, mallows, and the like. He forbids cabbages, beef, the flesh of stags and of all other wild animals. Instead of hellebore, Serapion and Avicenna particularly praise the lapis lazuli. Haly Abbas gives a graphic delineation of the bizarre fancies, absurd fears, hopes, and vain imaginations of melancholics and maniacs. Like the other authorities, he attributes the disease to the prevalence of black bile. Without doubt, as has been often remarked, the alvine discharges in such cases are dark-coloured; and this, no doubt, gave rise to the ancient opinion that the disease originates in black bile. When the patient is young, and of a hot temperament, Haly abstracts blood from the arm or temples. He approves particularly of hot drastic purgatives, such as black hellebore, scammony, agaric, and the like. He also gives poppies, lettuces, &c. to compose the patient. He recommends cholagogues, such as the decoction of wormwood, and the like. But his treatment is too minutely and circumstantially detailed to admit of its being done justice to within our narrow limits. The same may be said of the account given by Alsaharavius. Rhases in certain cases approves of venesection for the cure of melancholy. When connected with dyspepsia, he recommends emetics and purgatives, especially black hellebore. He also approves of the tepid bath.
We must now mention the opinions of the Methodists. In cases of melancholy Cælius Aurelianus disapproves of aloes and wormwood, as acting too violently; and also forbids venesection and purging with hellebore. On the contrary, he recommends astringent articles of food, and astringent applications containing galls, alum, hypocistis, &c. to be laid over the stomach. Of mania he gives a fuller account, replete with much valuable matter, that does not readily admit of abridgment. He enumerates many existing causes of the complaint, such as intoxication, inordinate passions, indigestion, exposure to the sun, suppression of the hemorrhoidal and menstrual discharges, and the like. Maniacal persons, he says, are differently affected, one believing himself a cock, another a tile, another a god, another an orator, and such like ridiculous fancies. He then inculcates the important fact that the affection of the mind is always secondary, and not primary, as some had supposed. His moral and medical treatment is of the most emollient kind; and he enjoins retirement and quietude. When the patient’s strength will permit, he approves of venesection, the application of cupping-instruments to the head, and leeches to any other parts of the body which may be particularly affected. He commends strongly the bath of oil and the natural hot baths. He also approves of hellebore. He condemns the practice of the other sects in many respects. He does not approve of abstracting blood from both arms, so as to produce deliquium, nor of keeping the patient constantly in a dark place, nor of opening the temporal artery. He disapproves of applying narcotic fomentations to the head. He properly forbids all corporal punishment, although he approves of contradicting the whims of the maniac, and of reasoning him into a better train of thought.
Isidorus thus distinguishes epilepsy, melancholy, and mania: “Epilepsia autem in phantasia fit, melancholia in ratione, mania in memoria.” (Orig.)
The use of hellebore in mania and melancholy is often alluded to in the works of the Latin Classics. See, in particular, Horace (Sat. ii, 3); Perseus (Sat. iv, 16.) We are inclined to think that it was the black hellebore which was given in Anticyra. See Dioscorides (iv, 146.)
Cicero makes some pertinent remarks on the distinction between mania and melancholy. (Tusc. Disp. iii, 5.)
SECT. XV.—ON INCUBUS, OR NIGHTMARE.
Some say that this disorder is called ephialtes in Greek, from the name of a man, or from those in it fancying as if one leaped upon them. But Themison, in the tenth book of his Epistles, calls it pnigaleon, from a Greek word signifying suffocation. It attacks persons after a surfeit, and who are labouring under protracted indigestion. Persons suffering an attack experience incapability of motion, a torpid sensation in their sleep, a sense of suffocation, and oppression, as if from one pressing them down, with inability to cry out, or they utter inarticulate sounds. Some imagine often that they even hear the person who is going to press them down, that he offers lustful violence to them, but flies when they attempt to grasp him with their fingers. The evil must be guarded against at the commencement; for when it continues long, and attacks every night, it is the forerunner of some serious disease, such as apoplexy, mania, or epilepsy, when the exciting cause is determined to the head; for such as persons affected with epilepsy are, during the day, those labouring under nightmare are in their sleep. We must evacuate the patient’s general system by opening a vein and administering purgatives. Black hellebore is especially serviceable to such persons when given to the amount of a drachm, if three oboli of scammony, and some of the aromatics, such as anise, wild carrot, and Macedonian parsley, be mixed with it. The composition called hiera, from wild gourd, is also of great service; it is the hiera of Ruffus. The diet should be light, and they ought to avoid everything that is flatulent. They are benefited also by the fruit of peony: fifteen of the black grains of which may be pounded with water and drunk frequently.
Commentary. See Aëtius (vi, 12); Oribasius (Synops. viii, 2); Actuarius (i, 16); Cælius Aurelianus (Tard. Pass. i, 3); Psellus (Opus Medicum); Avicenna (iii, 1, 5, 7); Alsaharavius (Pract. i, 33); Rhases (ad Mansor. ix, 12, Contin. i.)
The other ancient authors treat the complaint, like our author, by evacuants. Bleeding (Rhases recommends this to be done at the ancle), drastic purgatives, and friction of the extremities are the common remedies. Alsaharavius says that, if not cured by bleeding, it is to be treated, as epilepsy, with hiera and the like. Even Cælius in this case nearly agrees with the others, recommending restricted diet, and, if the disorder is great, venesection. He also approves of applying cupping-instruments with scarifications on the side of the throat, and, when the disease is protracted, of emetics, and shaving the head. For the cure of incubus, Mesue and Rhases recommend bleeding and an attenuant diet. Ruffus, as quoted by the latter, recommends vomiting, purging, an attenuant diet, sternutatories, masticatories, and ointments to the head, containing castor and the like.
Psellus gives a very graphic description of incubus. (Op. Med.)
SECT. XVI.—ON LYCAON, OR LYCANTHROPIA.
Those labouring under lycanthropia go out during the night imitating wolves in all things, and lingering about sepulchres until morning. You may recognize such persons by these marks: they are pale, their vision feeble, their eyes dry, tongue very dry, and the flow of the saliva stopped; but they are thirsty, and their legs have incurable ulcerations from frequent falls. Such are the marks of the disease. You must know that lycanthropia is a species of melancholy which you may cure at the time of the attack, by opening a vein and abstracting blood to fainting, and giving the patient a diet of wholesome food. Let him use baths of sweet water, and then milk-whey for three days, and purging with the hiera from colocynth twice or thrice. After the purgings, use the theriac of vipers, and administer those things mentioned for the cure of melancholy. When the disease is already formed, use soporific embrocations, and rub the nostrils with opium when going to rest.
Commentary. See Aëtius (vi, 11); Oribasius (Synops. viii, 10); Actuarius (Meth. Med. i, 16); Anonymus (de Lycanth. ap. Phys. et Med. Min.); Psellus (Carm. de Re Med. ibid.); Avicenna (iii, i, 5, 22); Haly Abbas (Theor. ix, 7, Pract. v, 24); Alsaharavius (Pract. i, 2, 28); Rhases (Divis. 10, Cont. i.)
All the other authorities give much the same account of this species of melancholy as Paulus. If we adopt Dr. Mead’s theory respecting the dæmoniacs mentioned in Scripture, we may conclude that the man, whose state is described in Luke (viii, 27), was affected with this disease. Dr. Mead is farther of opinion that Nebuchadnezzar was seized with lycanthropia. The reader will find much curious information on this head in Burton’s ‘Anatomy of Melancholy,’ from which all Mead’s opinions are borrowed.
The Arabian term is cutubut.
Avicenna recommends the application of the actual cautery to the sinciput, when the other remedies fail. Haly Abbas describes the disease by the name of melancholia canina. He says the patient delights to wander among tombs, imitating the cries of dogs; that his colour is pale; his eyes misty (tenebricosi), dry, and hollow; his mouth parched; and that he has marks on his limbs of injuries which he has sustained from falls. He recommends the same treatment as our author: indeed he evidently merely translates this section of Paulus. Alsaharavius seems also to allude to this disease by the name of melancholia canina. Rhases’ account of it is quite similar to our author’s.
Schneider has given some interesting critical remarks upon this section of Paulus at the end of his edition of Nicander’s ‘Theriacs.’
SECT. XVII.—ON LOVE-SICK PERSONS.
It will not be out of place here to join love to the affections of the brain, since it consists of certain cares. For care is a passion of the soul occasioned by the reason’s being in a state of laborious emotion. The following symptoms attend lovers: Their eyes are hollow, and do not shed tears, but appear as if overflowing with gladness, their eyelids move rapidly; and even, when none of the other parts of the body are affected, these parts are always so affected in lovers. There is no pulse peculiar to lovers, as some have supposed, but it is the same as that of persons labouring under care. When they call to recollection the beloved object, either from seeing or hearing, and more especially if this occur suddenly, then the pulse undergoes a change from the disorder of the soul, and, therefore, it does not preserve its natural equability or order. Such persons, therefore, being desponding and sleepless, some physicians, mistaking their affection, have wasted them by prohibiting baths, and enjoining quietude, and a spare diet; but wiser ones, recognizing the lover, direct his attention to baths, the drinking of wine, gestation, spectacles, and amusing stories. Some must also be attacked with fear; for, while they think of nothing but love, the affection is difficult to remove. Wherefore, they ought also to be roused to emulation with regard to the objects of their peculiar interest in life; and, upon the whole, their understanding should be diverted to other concerns.
Commentary. See Oribasius (Synops. viii, 9); Haly Abbas (Theor. ix, 7, Pract. v, 25); Avicenna (iii, i, 5, 23); Alsaharavius (Pract. i, 2, 17); Rhases (Divis. 11.)
Although Theocritus had declared that neither ointment nor powder is of any efficacy for the cure of love, several of the ancient writers on medicine have given directions for the treatment of desponding lovers.
Rhases, with unusual brevity, merely recommends, in general terms, repeated enjoyment, fasting, walking, and frequent intoxication. Avicenna, Haly Abbas, and Alsaharavius direct nearly the same treatment; and also mention hunting and sports.
SECT. XVIII.—ON APOPLEXY, AND HEMIPLEGIA OR PARALYSIS.
When the common origin of the nerves is affected, and from it all the other parts of the body have lost their motion and sensibility, the affection is called apoplexy, by which the leading energies are impaired; but if the obstruction is in either side, it is called hemiplegia and paralysis; and if the injury is seated in any one part, it is called an affection of that part, and hence Hippocrates says, “His leg was seized with apoplexy.”
Wherefore, in apoplectics, the respiration remains small. When, then, it is greatly perverted from its natural energy, it will induce a strong affection, and when but little, a weak one. Respiration is of the worst kind when it intermits, or is performed with great exertion. The affection arises suddenly from a cold phlegm obstructing the most important cavities of the brain. Whenever the whole origin of the spinal marrow is affected, all the parts below the face become paralysed, whilst it remains unaffected, because the parts there derive sensibility and motion from the brain; but, if one half only be affected, then is there a paraplegia of these parts, that is to say, a partial paralysis. If the sense of smell is affected, this arises from the anterior cavities of the brain having contracted the intemperament, or from the pores of the ethmoid bones being obstructed. Wherefore, apoplectics lie speechless, motionless, and insensible, without fever. The precursors of this affection are sudden and acute pain of the head, distension of the jugular veins, vertigo, flashes, as it were, of light in the eyes, an inordinate coldness of the extremities, palpitation and difficult motion of the whole body, and grinding of the teeth in sleep. Their urine is in small quantity, of a verdigris-green or a black colour, and containing a branny sediment. The affection occurs in old age to those of a phlegmatic temperament, and who use a diet of this nature. If it occur in youth and in the season of summer, it indicates a strong exciting cause.
The cure of apoplexy, and hemiplegia or paralysis. Apoplexy is an affection which is never or but rarely cured, for it threatens instant death; and if it be relieved, it commonly leaves a paralysis of some part of the body. Wherefore, those persons who admit of being cured should be immediately bled, and if there be any remission of the disorder, the operation should be repeated on the same or the following day. The belly should be opened by a stimulating clyster, made by mixing salt water and honey. Then let the whole body be rubbed with plenty of sulphurated oil, but the head with the oil of chamomile, or of dill in which cow-parsnip or calamint has been boiled. Inject honied water, and apply strong-scented things, such as opopanax, sagapene, galbanum, or castor, to the nose. It may be necessary to open the mouth forcibly, and introduce a finger or feather dipped in oil to remove the matters sticking there. Anoint the anus with applications for promoting the discharge of flatus. Give honied water and oxymel to drink, and use masticatories prepared by boiling thyme, or marjoram, in vinegar. When there is a remission of the complaint, we are to have recourse to tender, diffusible, and succulent food. When loss of speech continues, if the strength permit, we are to apply to the back part of the head a cupping-instrument with scarificators, and, if admissible, it should be applied to the hypochondria also. Let them afterwards be carried about in a chair, or couch, or suspended bed, and have recourse frequently to sternutatories and masticatories. After the fourteenth day, we may bring them back to the other kinds of gestation, attend to their speech, give old apomel with pieces of bread or alica, and afterwards a small quantity of hiera. After the twenty-first day, we may lead them to the bath, give them old wine to drink; and otherwise we must promote recovery by sprinkling them with warm water, by baths, and rubbing with unguents. If possible, let them reside in places by the sea-coast.
The cure of paresis, or resolution. If there be paralysis of all or of certain members, without injury of the primary energies, we must first evacuate the offending humour, whatever it be, and then give hiera, and a certain portion of castor, beginning with half a drachm, along with some honey and warm water in which it has been dissolved, either alone, or with the addition of half a scruple of pepper; then, after an interval of four days, we may give a whole drachm, and afterwards one and a half, then two and three. After an interval of the same number of days, we may give four drachms, if the patient be able to take so much, adding one spoonful of honey. To the part we may apply some of the discutient remedies, along with rubefacients, adding to them some castor, or pepper, or pellitory, or rosemary, or euphorbium; and, in addition to these, we may have recourse to embrocations with oil of rue, or Sicyonian or old oil. The food ought to be farinaceous, taken in a slop, of easy digestion, and not excrementitious. Let cupping-instruments be applied to the affected parts separately, if there be many of them, but to one if there be few. After cupping, apply cataplasms containing pitch, rosin, or manna. A most suitable application consists of calamint, fleabane, and nitre boiled along with mugwort, and some water is to be added, which is to be evaporated during the boiling. The belly is to be again opened by means of aloes, polypody, scammony, or the colocynth pottage. Fatty inunctions are to be made with old oil in which squill has been kept for forty days in the sun; or, if it be not at hand, you may boil in oil two ounces of squill, and anoint with it; or the seed of rosemary may be prepared in like manner, but an ounce of wax must be added, that it may not be too liquid. But, if you add of galbanum, of castor, of euphorbium, of adarce, and of nitre, of each, oz. ss, it will be a more potent remedy. The herb crowfoot, boiled in the oil, and preserved in the sun, is also an excellent application. Castor to the amount of a drachm, and opopanax swallowed to the size of a bean, will make suitable potions. But sagapene taken to the size of a tare in honied water, and castor with opopanax, and the Cyrenaic juice to the size of a millet, are admirable remedies. The antidote from the three peppers is also beneficial. We may likewise use beating restoratives (acapa), and masticatories. After the fourteenth day, we may give more copious food; and, when much benefit is derived, we may lead to the bath. After the thirtieth, it will be necessary to apply a dropax, use the bath, and afterwards put on a cataplasm of mustard, taking care in those cases in which both motion and sensibility are lost, lest from want of feeling they be allowed to burn too much. Where sensibility remains, rubefacients only are to be used. After it swells, we ought to lead to the bath, and cure with simple cerates. They ought to take the emetic after a meal, and that from radishes. They should be carried about in a chair, or in a car drawn by the hand, or in one drawn with a yoke. Otherwise, let them be put into one of the natural baths. A desiccative diet, spare drink, and friction will be proper. Let them, therefore, eat dry food, and struggle against thirst as much as possible.
On paralysis with relaxation or distension. Since paralysed parts are either contracted or relaxed, and this proceeds either from plethora or emptiness, it will be necessary to attend to this, and sometimes abstract blood, and sometimes not. Again, to relaxed parts we must mix astringents with the relaxing remedies, and use intense friction; but for the contrary state we must use relaxing remedies only, along with gentle friction. For the relaxed limbs, let the oil used for friction have a little nitre and dried lees of wine pounded on it. Let hot water also be strongly poured upon them, especially sea-water, in which have been boiled bay-berries, or the shoots of the chaste-tree, or marjoram, or the like. If it is in the summer season, let them also swim in the sea. But rubefacients are particularly applicable to them, and therefore the parts may be whipped with rods, or nettle branches; but if the paralysis remain, the relaxed skin between the joints is to be drawn up, and transfixed with small and slender burning-irons. To contracted limbs it is proper to apply constantly a calefacient plaster.
On paralysis in particular parts. Paralysis occasioned by the division of a nerve is incurable; but when occasioned by an intemperament, or a certain humour, it is relieved by the common remedies already mentioned; but there are certain particular remedies applicable to each of them, which we shall describe below. Wherefore, in cynic spasms, the jaw is to be reduced to the opposite side by means of a muzzle. Detraction of blood from the vessels below the tongue will likewise be proper, as also cupping-instruments applied along the first vertebra, with masticatories, and purgatives administered by an instrument inserted into the nose. It is necessary to know that the jaw which appears to be distorted is not the one which is paralysed, but the opposite one. When the organ of deglutition is paralysed, cupping-instruments must be applied to the chin, and we must use the liniments made of castor, sagapene, and the Parthic juice. Acrid gargles are also beneficial. When the tongue is paralysed, we must open its veins, apply a cupping-instrument to the chin, and use masticatories of mustard, and exercise the tongue. When the organs of speech are paralysed, apply the remedies to the chest, enjoin retention of the breath, and have recourse to vociferation. When the eyebrows are affected, anointing of the eyelids in like manner is of great use, and, at last, the operation by suture called anarrhaphé. When the bladder is paralysed, there is either retention of urine or an involuntary discharge of it. The remedies are to be applied to the bottom of the belly and perinæum, and clysters injected by the anus, consisting of oil of rue, or Sicyonian oil, with butter and castor, galbanum, opopanax, or the juice of laserwort. And these things, if injected into the bladder by the penis, will be of great service, or prove sufficient of themselves. Clysters of centaury and colocynth, along with Sicyonian oil, are also beneficial; and diuretics may be drunk with advantage, and castor taken in like manner. But, above all things, we must have recourse to the catheter when the patients cannot make water, and get them to sit in hot baths of a relaxing nature, and use emollient cataplasms. When the urine flows involuntarily, we must treat them upon the astringent plan with tonic remedies, and make them use dry food and cold drink. During convalescence they ought to use rubefacients, and natural baths in a cold state. Cases occurring from a wound of the spine, from a fall and dislocation of a vertebra, if there be a concurrence of fatal symptoms, it is impossible to remedy. If the penis is paralysed, we must apply the remedies recommended for the bladder to the same parts, and also to the groin; and medicines which excite to erections ought also to be used. Milk, cheese, and the other cakes are improper, likewise lettuces and the other pot-herbs. When the rectum is paralysed, in which case the fæces are either discharged involuntarily, or retained, the same remedies must be used, and clysters are to be administered, sometimes of an astringent nature, such as the decoction of cypress, of rush, or of bramble; and sometimes emollient; such as the fat of swine and geese, and the oil of mallows; and sometimes stimulating, such as salt water, the decoction of colocynth, or the like. Nothing contributes so much to motion as variety of exercise with the lever. If they complain of a sense of cold, the restorative plaster of euphorbium, dissolved in oil, may be used for a clyster. But, along with the ordinary treatment, the paralysed limbs should be bent, rubbed, and stretched in the manner described; for our greatest dependence is upon friction.
On paralysis supervening upon colic disease. In our times a colic complaint has prevailed, in which convalescents are seized with complete loss of motion in their limbs, but the sense of touch remains uninjured, there being a critical translation of the disease from the internal parts. Hence, in many cases, the motion has returned spontaneously in process of time. Those of more difficult cure were remedied by using the more simple liniments formerly described. The acopa made of poplar and of the fir were found to be excellent applications; and many were greatly benefited by tonic and moderately cooling applications.
Commentary. Consult Hippocrates (Aphoris. ii, 42, de Glandulis, et alibi); Galen (Comment. de Loc. Aff. iii, 11); Aretæus (Morb. Chron. i, 7; Cur. Morb. Acut. i, 4); Aëtius (vi, 26); Oribasius (Synops. viii, 14); Theophrastus (ap. Photii Bibliothecam); Alexander (x, 2); Actuarius (Meth. Med. iv, 2); Cælius Aurelianus (Morb. Acut. iii, 5); Octavius Horatianus (ii, 7); Leo (ii, 5); Nonnus (37); Avicenna (iii, i, 5, 12); Avenzoar (i, 9, 12); Serapion (i, 24); Mesue (de Ægr. Cap. 27; de Ægr. Nerv. 2); Haly Abbas (Theor. ix, 6, Pract. v, 22); Alsaharavius (Pract. i, 2, 18); Rhases (ad Mansor. ix, 3.)
To so many excellent works on apoplexy, wherein the subject is treated of fully and correctly, it is difficult to do justice within our narrow limits. We shall give, however, a brief, though imperfect outline of their opinions.
Hippocrates pronounces a slight attack of apoplexy to be difficult to cure, and a severe one to be utterly incurable. He says that an apoplectic attack is brought on by turgidity of the veins. When a person has suddenly lost his powers Hippocrates directs that he should be bled. (Aphor.) Apoplexy, he says, occurs most frequently between the age of forty and sixty. (Ibid.) He says, in allusion to apoplexy (as his commentator Theophilus remarks), that when persons in good health are suddenly seized with pains in the head, with loss of speech, and stertorous breathing, they die in seven days, unless fever supervene. (Ibid.)
Galen states that apoplexy arises from a cold, thick, and viscid humour obstructing the ventricles of the brain. He remarks that, in severe cases, all voluntary motion is lost while respiration is performed as in persons asleep. The reason which he assigns for this is, that the nerves which are distributed upon the respiratory muscles are all derived from the brain itself, and these often escape being injured, unless the attack be of a particularly serious nature. His account of cases of partial paralysis is highly interesting. (Loc. Affect. iii, 14.)
Celsus’ brief account deserves to be given in his own words: “Attonitos quoque raro videmus, quorum et corpus et mens stupet. Fit interdum ictu fulminis, interdum morbo ἀποπληξιαν hunc Græci appellant. His sanguis mittendus est: veratro quoque albo, vel alvi ductione utendum. Tum adhibendæ frictiones, et ex mediâ materiâ minimè pingues cibi, quidam etiam acres; et a vino abstinendum.” Respecting the treatment of paralysis he delivers the following aphorism: “Si omnia membra vehementer resoluta sunt, sanguinis detractio vel occidit vel liberat: aliud curationis genus vix unquam sanitatem restituit, sæpe mortem tantum differt, vitam interdum infestat.” His other remedial measures are such as our author’s, namely gestation, the application of cupping-instruments or rubefacients to the affected part, the warm salt-water bath, and a restricted diet.
According to Theophrastus, paralysis is occasioned by a deficiency or loss of the pneuma, i. e. vital heat.
It is impossible to admire too much the brief but comprehensive account of apoplexy and paralysis given by Aretæus. He states decidedly, that there is sometimes a loss of motion alone, and sometimes of sensibility; the reason of which he supposes to be, that the sensatory and motory nerves are distinct from one another. This is the germ of the theory fully expanded afterwards by Galen. It appears, indeed, from the anatomical works of Ruffus, that the famous Erasistratus had attempted a similar classification of the nerves. Galen, however, has the merit of fully establishing the truth of the theory; and all subsequent writers on physiology stated it in nearly the same terms that he does, until ancient authority in medicine and its cognate sciences came to be despised. Aretæus states it as a general rule, that when one side of the brain is affected the opposite side of the body is paralysed; but, when the disorder is in the spinal marrow, that the affection of the spine and the paralysis are on the same side. This arises, he supposes, from the decussation of the cerebral nerves; and this explanation must be admitted even now to be tolerably correct. The causes of paralysis, as stated by him, are falls, blows, cold, indigestion, debauchery, intoxication, and violent emotions of the mind. His treatment is as follows: He inculcates, in the strongest terms, that the great remedy for apoplexy is venesection; and that the only difficulty, in general, is to determine the extent to which it is to be carried. He forbids the operation, however, when the senses are oppressed with much cold and torpor. When venesection is contra-indicated the belly is to be evacuated, in order to relieve congestion there, and to produce revulsion from the head. For this purpose acrid clysters are to be given, containing nitre, euphorbium, colocynth, turpentine-rosin, and the like. He also recommends hiera as a purgative; and if nausea be present, he advises us to encourage vomiting. He praises castor strongly as a remedy for the nervous affections. The food is to be light and of easy digestion. When the disease is protracted, cupping-instruments are to be applied to the back part of the head. When the parts concerned in deglutition, namely, the fauces and œsophagus, are paralysed, food is to be conveyed into the stomach by a suitable instrument. (By the way, Dr. Friend is mistaken in stating that Avenzoar is the only ancient author who recommends this practice. It will be remarked that our author makes mention of introducing food into the stomach by means of an instrument passed by the nostrils.) When the bladder is affected, he recommends injections, but forbids the use of the catheter, for fear of occasioning convulsions or gangrene. He approves greatly of the bath of oil in this case.
Aëtius, Oribasius, Alexander, Actuarius, and Nonnus treat of the disease in much the same terms as our author. Alexander, in particular, properly recommends moderate purging with the hiera and such like medicines. He restricts venesection to those cases in which the disease is occasioned by fulness of blood.
Cælius Aurelianus enumerates nearly the same causes of apoplexy and paralysis as Aretæus, namely, excessive heat, cold, indigestion, debauchery, and injuries of the brain. The season of winter is justly said to predispose to the disease. It is seated, he says, principally in the head. His treatment is nearly the same as that of the followers of Hippocrates and Galen, namely, emollient applications to the head and limbs, venesection, abstinence, clysters, cupping the back part of the head, and the bath of oil. Of paralysis he treats at greater length, and with much precision and judgment. He mentions nearly the same causes of it as of apoplexy; and remarks that it produces loss of sensibility, or of motion, or of both. He observes, in particular, of the tongue, that it may retain the power of deglutition although that of speech be lost. He details all the phenomena of partial paralysis with surprising accuracy; and, at the present day, we do not know a work on the subject that contains so much information. He distinctly and accurately describes paralysis of the œsophagus and fauces. His treatment is, upon the whole, not very different from our author’s; but his directions for the application of his remedies are exceedingly minute and judicious. In the first place, he approves generally of venesection, calefacient applications to the extremities, a spare diet, and afterwards of cupping with scarifications. When the tongue is affected, hot gargles of mustard and vinegar are to be given; and, when there is paralysis of the bladder, the catheter is to be used. When the disease is obstinate, he approves of hellebore as an emetic, and of calefacient plasters, depilatories, cupping with much heat, embrocations of mustard, and such things as will produce a papular eruption, namely, flour of salt, nitre, and the like. He blames Praxagoras for recommending emetics indiscriminately, and Erasistratus for omitting venesection. He finds fault with Themison for being in too great haste to apply stimulants to the affected parts, and for having recourse to cupping before the disease had begun to subside. Though he permits the occasional use of hellebore, he disapproves of purgative medicines in general. For paralysis of the œsophagus he recommends us to apply a cupping-instrument, leeches, or cataplasms to the neck.