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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 Katidion, 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 pitching6 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 sauce8 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.

1 See Paulus Ægineta, b. vi. 5.

2 This is rather an obscure description of the simple process of gargling. See the note of Petit.

3 On this practice, see Paulus Ægineta, tom. i. p. 326, Syd. Soc. Edit.

4 On this heroic method of treating diseases of the head, see Paulus Ægineta, t.ii. pp. 248-250, and 258, Syd. Soc. Edit. Before making trial of it, I would recommend the reader to consult the part of De Haen's works there referred to.

5 See Oribasius, vi. 30, and p.663, ed. Bussemaker and Daremberg.

6 See Paulus Ægineta, t.i. p. 82, Syd. Soc. Edit.

7 The pisum ochrys.

8 See Hesychius, under κηρυκεία and -- κη, Athen. Deip. p. 516, Ed. Casaub.

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