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.