CHAPTER II. CURE OF CEPHALÆA.
THE head, inasmuch as it is necessary towards life, so is it
also very dangerous in disease. And the onset of diseases
about it is quite tolerable, being attended with slight pain,
noises in the ears, and heaviness; but if they acquire increase,
they become fatal at last. Wherefore even slight pains should
not be overlooked, and, in certain cases, they have been cured
by slight remedies. But if prolonged for a longer space, as
greater sufferings supervene, we must open the vein at the
elbow. But, for two days previous, the patient must get wine
to drink, and the quantity of blood abstracted must be regulated
by the strength; and it is best not to make the whole
evacuation at once, so that the strength may bear the amount
thereof; and the disease is rather removed by the repetition of
the means. The same rule applies to all chronic diseases.
During an interval of three or four days, a fuller diet is to be
given, and then the purgative hiera is to be taken in a
draught; for it, in an especial manner, draws the pabulum of
the disease from the head. The quantity of the medicine
given is to be to the amount of four or five drams. And if
well purged, we are to administer the bath, give wine, and
improve the strength. Then again we are to open the straight
vein (
temporal?) on the forehead, for abstraction by it is most
efficacious; the amount, about a hemina (
half-pint?) or a little
more. But we must not evacuate further, for we must avoid
emptying the vessels. Then, having removed the hair with a
razor, we are first to apply one cupping-instrument to the
vertex, and another between the scapulæ, without drawing
blood; but along with the instrument applied to the vertex,
we are to scarify unsparingly, for the purpose of attracting the
redundant fluid and of making an incision in the deep-seated
parts. For remedial means applied even to the bones are beneficial
in cephalæa. When the wounds are cicatrised, we are to
excise a portion of the arteries;
1 (of these there are two, one
behind the ears, at a little distance from them, being obvious
from their pulsations; the others in front of the ear, and close
to it, for they lie close to the antitragus; and these also are
discovered by their pulsations); we are to incise the larger
ones at the bones, for they afford relief. Adjacent to them are
others, very slender, which there is no benefit from excising.
The mode of operating has been described under operative
surgery. This is the great remedy in cephalæa, epilepsy,
vertigo, and, in fine, in all the diseases of the head.
In all cases we are to bring off phlegm, first evacuating the
bowels, either by a purgative draught, or by a clyster; and
sometimes from the nostrils by sternutatories; and sometimes
from the mouth by sialogogues. Among the kinds of sternutatories
are pepper, the root of soapwort, and the testicle of
the beaver; these may all be used together; having levigated
and sifted them, we are to blow the powder in, either with a
reed or the thick stalk of a goose quill. Euphorbium is more
active and stronger than these when mixed with any of them.
It is also mixed up with the oils, such as
gleucinum, the
Sicyonian, or the ointment from storax. It is made into a
liquid form as an injection, and it is injected by means of a
nasal pipe; the instrument consists of two pipes united
together by one outlet, so that we can inject by both at the
same time. For to dilate each nostril separately is a thing
which could not be borne, as the head gets quickly filled, and
thus contracts a sharp pain. The medicines which evacuate
phlegm from the mouth are, mustard, the
granum cnidium,
pepper, stavesacre, these either together or separately; and
one may masticate these substances and spit out constantly;
and give them mixed up with water or honeyed-water, rinse
the mouth, and press them back to the tonsils with stretching
of the neck, thus wash out along with the breath in expiration;
2
and when you have evacuated phlegm as much as you
think proper, you must bathe and foment the head with a
very large quantity of hot water to promote perspiration, for
the obstructions become strong.
Supper should be spare; but wine also is to be given, to
restore the tone of the stomach, for it also suffers in this
complaint. When, in the meantime, you have re-established
the strength, you will require to give a common clyster having
sprinkled upon it much natron, or dissolving it in two drams
of the resin of the turpentine tree. On the next day we are
to abstract blood from the inside of the nostrils, and for this
purpose push into them the long instrument named
Katidion,
or the one named
Toryne, or, in want of these, we must take
the thick quill of a goose, and having scooped the nervous
part of it into teeth like a saw, we are to push it down the
nostrils as far as the ethmoid cells, then shake it with both
hands so that the part may be scarified by its teeth. Thus we
shall have a ready and copious flow of blood; for slender
veins terminate there, and the parts are soft and easily cut.
The common people have many modes of scarification, by
rough herbs, and the dried leaves of the bay, which they
introduce with the fingers and move strongly.
3 Having
evacuated to a sufficient amount--say to the amount of half a
hemina--we are to wipe the parts with sponges and oxycrate,
or blow in some styptic powder, gall, fissil alum, or the
flower of the wild pomegranate.
Whether the pain remain, or cease after these things, we
must go on to the conclusion of the system of treatment;
for the mischief is apt to return, and frequently lurks in the
seat of the disease. Wherefore, having removed the hair
with a razor (and this also is beneficial to the head), we are to
burn with heated cauteries, superficially, down to the muscles;
or if you wish to carry the burning to the bone, you must
avoid the muscles, for the muscles when burnt occasion convulsions.
And if you burn superficially you must foment the
part with plenty of fragrant sweet wine, along with rose-oil;
a linen cloth wetted with this is to be spread over the eschars
until the third day. But, if the eschars be deep, having
pounded the hairy leaves of leeks with salt, and spread upon
a linen rag, we are to apply it. On the third day, we are to
put the cerate from rose-oil upon the superficial eschars, and
lentil with honey upon the deeper. The medicinal applications
to be made to the wound will be described in another place.
Some have made an incision in the skin above the forehead,
at the coronal suture, down to the bone, and having scraped it,
or cut out a portion down to the diploe, have afterwards
brought the part to incarnation. Some have perforated
the bone, even to the meningx. These are bold remedies,
but are to be used, if, after all, the cephalæa continue,
and the patient be courageous, and the tone of the body
good.
4
But, if they progress gradually, they are to take exercises
in the erect state of the body for the benefit of the chest and
shoulders; the
chironomy,
5 the throwing of the
halteres;
leaping,
and the well-regulated contortions of the body accompanying
it; friction, first and last of the limbs, of the head
in the middle of the process.
The process of pitching
6 is to be frequently applied to the
head; and also rubefacients, sometimes rubbing in mustard
with double quantity of bread, so that the heat may not be
intolerable; and sometimes other medicines are to be so used,
like the compound from lemnestis, euphorbium, and pellitory.
The juice of thapsia, and the medicines made with it which
produce swelling of the skin, and an eruption resembling vari,
are beneficial both for allaying present pain and contributing
to eradicate the evil.
The diet in both kinds of the complaint should be light;
little drink, water for drink, especially before giving any
medicine; complete abstinence from acrid things, such as
onions, garlic, the juice of silphium, but not altogether from
mustard, for its acrimony, in addition to its being stomachic,
is not unpleasant to the head, dissolving phlegm, and exhaling
or discharging downwards. Of pulse, the worst is the common
bean and its species, the common peas, and the species
called
ochrys,
7 and the common
kidney-beans; next to them
are the lentils, which have indeed certain good properties for
promoting digestion and secretion, but induce fulness of the
head and occasion pain; only when boiled with pepper they
are not to be rejected. Granulated spelt (
alica) when washed,
is pleasant along with wine and honey, so as to sweeten, and,
in like manner, their soups, and with plain broths. The seeds
of carui, coriander, anise, and parsley, in the Lydian sauce
8
are excellent. But, of these articles, the best are the herbs
mint and penny-royal, with the fragrant things which have
some diuretic and carminative properties. Of fleshes, all such
as are old are bad; of the recently killed, that of the hen is
good; of birds, the wood pigeon, the common pigeon, and
such others as are not very fat; the extremities of the swine;
the roasted hare; that of the ox and of the sheep is incrassant
and fills the head; the kid is not altogether bad. Milk and
cheese occasion headache. Of fishes, those found among
rocks, and those things that are best in each particular
country. Of potherbs, such as promote the urinary and alvine
discharges, the mallow, the blite, the beet, and asparagus; but
the kale is also acrid. Among raw articles, the lettuce is the
best of all. Roots are bad, even when boiled, such as radishes,
navews, and parsnips, which are diuretic, but occasion repletion;
the garden parsnip indeed is flatulent and swells up
the stomach. Wine which is white, thin, and sweet, is to be
admitted, if it have some astringency, so as not to bind the
bowels. All articles of the dessert occasion headache, except
dates of every species. In autumn the fig and grape are
wholesome, and whatever other fruit is very good at any
particular season. Repletion of all things, even of such as are
proper, is bad; and so, also, indigestion is bad. Lassitude is
less injurious than indigestion, but still it is hurtful. The
morning walk after evacuation of the bowels, but so as not to
affect the breathing nor induce weariness; and it is also very
good after supper. Prolonged gestation, not exposed to wind
or sun, is good for the head; but the dog-star is bad for it.
Sexual intercourse is a self-inflicted evil to the head and
nerves. A journey from a cold to a warmer climate, or from
a humid to a drier, is proper; also a sea-voyage, and passing
one's life at sea; and if one lives by the sea-side it is a good
thing to bathe in the sea-water, to tumble on the sands, and to
reside close by the sea.
The remedies for
heterocrania are the same; for it is well to
apply to a portion of the head the same remedies as are proper
for the whole of it. In all cases in which the disease is not
removed by these means, we are to use hellebore, as being the last and most potent of all methods of treatment.
