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.