Each of these affections is a permanent pain of the head, liable to be
increased by noises, cries, a brilliant light, drinking of wine, and
strong-smelling things which fill the head. Some feel as if the whole
head were struck, and some as if one half, in which case the complaint
is called hemicrania. When the affection is seated within the skull, the
pain extends to the roots of the eyes, and when externally it spreads
around the skull. Pain then, accompanied with heaviness, indicates
plethora; if with pungency, acrimony of the humours or spirits; if with
throbbing, inflammation; if with tightness and without heaviness and
throbbing, a fulness of a thin and flatulent spirit (_gas?_); but if
it be attended with throbbing, it is indicative of inflammation of a
membrane; if with heaviness, of a fulness contained within the membrane.
If the putrid humour acquire heat, the headach will be attended with
fever; and, in general, those in whom headach proceeds from inflammation
have fever. When, therefore, the whole body is in a plethoric state,
we must bleed (attention being paid to the strength), and use the more
acrid clysters. Should there still appear to be a fulness of blood, we
must open the veins of the nose, and endeavour to evacuate thereby to a
sufficient amount. We must then give hiera sharpened with vinegar, and
use masticatories, or medicines for evacuating the phlegm by the mouth;
also procure evacuations from the nose by means of errhines, such as the
juice of elaterium, which may be poured in with milk; or the elaterium
may be snuffed up dry, or else the juice of sow-bread or of leeks. The
following are compound medicines:
_An errhine for chronic headachs, ophthalmy, and epilepsy._ Of gith
(_nigella sativa_), dr. viij; of sal ammoniac, dr. iv; of elaterium, dr.
iv; pound and mix with Sicyonian oil, or that of iris, or of privet, so
as to have the thickness of cerate, and apply to the nostrils.
_An errhine to be snuffed up._ Of dried sow bread, dr. viij.; of red
nitre, dr. iv; or if, instead of the nitre, you will use elaterium, it
will be still better. Snuff it through a reed. In more chronic cases use
epithemes to the head and unguents, as the following:
_An epitheme for cephalæa._ Of the ointment of iris, of hog’s fennel and
castor, of each, dr. j; of bay-berries, dr. ij; of the tops of rue, dr.
iv; mix with rose-cerate, and having shaved the head, apply to the whole
of it. A certain woman, by using the following application in cases of
hemicrania, acquired wonderful celebrity: Having cut down the green root
of the wild cucumber into small pieces, she boiled it and wormwood in oil
and water until they were softened; and with the warm oil and water she
fomented moderately the affected part; and, pounding the root and the
wormwood, she made a cataplasm of them. And with this application she
cured cases of hemicrania, both with fever and without. When a strong
paroxysm takes place, so that the pain is insupportable, use paregoric
and alterative applications like the following:
_An unguent for cephalæa._ Of the juice of hog’s fennel, dr. xvj; of the
juice of poppy, of anise, of henbane, of saffron, of myrrh, of scammony,
of each, dr. ij. Add to vinegar and make trochisks. When using it, anoint
those who have pain of the head from thick humours or a flatulent spirit
with it, along with vinegar or oxycrate. We must, likewise, use a dropax
and sinapism, and the trochisk from thapsia. That, too, from writing ink
is much approved of for the same cause, and is to be used, as will be
described in the Book on Compound Medicines.
The following one is possessed of wonderful efficacy for hemicrania
proceeding from a thick and viscid humour: Of euphorbium, one part; of
castor, an equal quantity; mixing with water, insert into the ear of the
affected side, and order the patient to go into a bath, and, when he
has remained a short time, take it out, and bathe as usual. Thus it is
of tried efficacy. It will not be improper also to add them to oil, and
inject into the ear. The application described for ischiatics is likewise
a successful remedy for chronic headach and hemicrania.
_For chronic hemicrania._ Of garlic, dr. iv; of wax, dr. ij; of old
axunge, dr. ij; of cantharides, dr. ij. Apply this in the evening, and
having allowed it to remain all night, break the blister in the morning,
and cure with the plaster called panygrus.—_Another_: Of bay-berries,
stripped of their skins, dr. ij; of the leaves of rue, dr. ij; of
mustard, dr. j; moisten with water, and apply. It is most beneficial to
those whose complaints arise from cold causes, so that frequently, when
applied before going into the bath, it immediately cures the affection,
and after the bath they become perfectly well.—_Another_: Of Sabine oil,
lb. j; of wax, oz. iij; of euphorbium, oz. j; with this anoint the half
of the forehead, namely, along the temporal muscle. If the cold is not
great, pound an equal quantity of galls and crocomagma with wine, and
anoint. In cases from hot fumes or humours, do not use the applications
with euphorbium.
_An apophlegmatism, or masticatory, for cephalæa and hemicrania._ Of
mustard pulverized and dissolved in vinegar and honey, oz. xiv; of
stavesacre, dr. iv; of pellitory, dr. iv; having pounded, strained, and
mixed in the sun, gargle with it. When the cephalæa becomes permanent,
owing to a bilious humour or some intemperament, use the remedies
formerly described for headach. If after all this the pain continue,
even after cupping and leeching, and there is reason to suspect that the
distribution by the arteries is affected, it will not be improper to
open the arteries behind the ears. In those of a humid intemperament the
natural baths may be tried with good effect.—_Another, for hemicrania_:
Mix euphorbium and earthworms with vinegar, and anoint the affected part,
or the whole forehead.
* * * * *
COMMENTARY. Our author’s account of cephalæa is mostly abridged from
Galen (See. Loc. iii), where the treatment is detailed at considerable
length. Alexander, Aëtius, Oribasius, and the Arabians follow the views
of Galen; and, as they are similar to our author’s, we need not dwell
upon the exposition of them. General and topical bleeding, cooling or
stimulant applications to the head, purgatives, masticatories, and
errhines, applied according to circumstances, constitute the sum of
their treatment. One rule laid down by Oribasius deserves attention;
when the pain is acute, he recommends general bleeding; and, when it is
protracted, local. When cephalæa is connected with constipation of the
bowels, Alexander advises that they should be opened with laxative food
and gentle purgatives, such as sal ammoniac (a fossil salt procured from
Africa), scammony, and euphorbium. When it is connected with a loose
state of the bowels, he recommends such means as will stop it; and when
it is produced by insomnolency he recommends things of a paregoric and
soporific nature. (i, 11.)
Aretæus, who probably was prior to Galen, delivers an admirable account
both of the symptoms and treatment of this complaint. He recommends
bleeding at the arm, and by opening the temporal arteries, or those
behind the ears, or the vessels of the lining membrane of the nostrils,
or cupping the back part of the head; purging with drastic cathartics,
such as hellebore; errhines, masticatories, a restricted diet; and,
in obstinate cases, he approves of applying the actual cautery to the
cranium. (De Curat. Morb. Chron. ii.) Most of the ancient authorities
recommend the cautery in this case. (See the notes on Sect. I of the
Sixth Book.) Aretæus allows a small quantity of a light wine on account
of the stomach, which is apt to be affected. (Ibid.)
Cælius Aurelianus has given a most minute account of the doctrines of
the Methodists respecting cephalæa. (De Morb. Tar. i, 1.) He enumerates
many causes of the disease, among which we may mention too much attention
paid to the hair by females. The following is an outline of his practice:
Friction of the extremities, emollient fomentations and soft applications
to the head, such as wool, or bladders half filled with warm oil, are
to be used at the commencement. When the pain is violent, he recommends
venesection from the arm opposite the side affected. The head is to be
shaven with a razor, and a cataplasm, or a cupping-instrument without
scarificators, or leeches, are to be applied; and these are to be
followed by sponging with hot water. If the belly be constipated, we
are to give clysters of the oil of rue with honey, or the like. In the
decline of the complaint, emollient plasters (malagmata) are to be
applied. Gentle gestation before food is particularly recommended, and
walking afterwards. Exposure to heat, indigestion, strong drink, hot
baths, violent passions, constipation of the belly, and so forth, are
to be avoided. His directions respecting diet are extremely minute, but
judicious. With regard to topical applications, he recommends after
the head is shaven mild ones at first, and afterwards rubefacients and
stimulants, and cupping with much heat. Masticatories and gargles are
mentioned. He recommends affusion of water, at first hot and afterwards
cold. When the disease does not yield to these remedies, he directs a
course of hellebore. The methodist oppugns freely the practice of the
other sects. Refrigerant applications, containing vinegar, rose-oil, and
the like, he says, are very prejudicial; purgatives injure the stomach;
cauteries excite a dangerous disturbance; the cold bath produces rigidity
of the nerves; and hot masticatories do not answer well.
Scribonius Largus mentions a black torpedo applied alive to the head as a
remedy for headach. (De Comp. Med. c. 1.) The same prescription occurs in
the collection of Marcellus Empiricus. See further Galen (de Simpl. Med.
facult. in voce ναρκὴ) and Aëtius (ii, 185.) Is not this an application
of the principle of galvanism in medicine?
Rhases insists, with becoming earnestness, on the propriety of
administering purgatives, especially cholagogues, in cephalæa. His
commentator Leonardus Jacchinus blames modern physicians for having
substituted weak and ineffectual cathartics for the powerful medicines of
this class used by the ancients.
Galen states correctly that cephalæa often arises from disease of the
pericranium. (De Loc. Affect. l. c.)