Commentary. Hippocrates treats cursorily of phrenitis in several of his works, particularly ‘de Morb.’ (iii, 9,) and ‘Epid.’ See Galen (Meth. Med. xiii, de Loc. Affec. v, 4); Aretæus (de Morb. Acut. i, 1); Alexander (i, 13); Aëtius (vi, 2); Actuarius (Meth. Med. iv, 2); Nonnus (c. 25); Pseudo-Dioscorides (Euporist. i, 13); Cælius Aurelianus (Morb. Acut. i, 1, &c.); Celsus (iii, 18); Serenus Samonicus; Octavius Horatianus (ii, 2); Serapion (i, 20); Mesue (de Ægr. Capit. c. 19); Avenzoar (i, 4, c. 6); Haly Abbas (Theor. ix, 4, and Pract. v, 13); Alsaharavius (Pract. i, 2, c. 8); Rhases (ad Mansor. ix, 3, and Contin. i, 28.)
Hippocrates, in his ‘Epidemics,’ details several cases of phrenitis, which would appear to be remittent fevers, complicated with determination to the brain, rather than inflammation of the brain.
Galen gives a very circumstantial detail of the symptoms, which is well worth consulting. (Loc. Affec. l. c.) Our author’s description is very complete, considering its brevity. He closely follows Alexander, who agrees with him in recommending the most questionable part of our author’s treatment; we mean the administration of wine. Of course, however, it must have been a weak light wine. He insists that when the strength is much reduced, it does more good than harm, by improving the powers of the constitution. Cælius, however, says that wine is nothing less than a poison. Alexander, Aretæus, and Aëtius agree that cold drink should be given with caution. Most of the authorities have correctly described the pulse as being small and dense. Our author’s practice, in regard to bleeding from the temporal vein, is derived from Alexander, who gives a very interesting case, in which he applied it with great success. He recommends great caution in the administration of narcotics. Upon the whole he is favorable to the tepid bath, as serving to procure sleep, but he condemns the hot. Among the minutiæ of practice, we may mention that Aretæus and Celsus, like our author, recommend all pictures and such like gaudy objects to be removed from the apartment of the sick. Celsus directs us, in pointed terms, after bleeding and purging, to get the head shaved, and fomented with a decoction of emollient herbs. To procure sleep, he recommends us to give draughts containing poppies and hyoscyamus; or to apply the apples of the mandragora below the pillow of the patient; or, to rub his forehead with amomum, or with the tears of mulberry. He informs us, however, that Asclepiades condemns soporifics, as inducing lethargy. For the sake of procuring sleep he recommends gestation performed at night, and of swinging the patient in a suspended couch. For the same purpose, the Pseudo-Dioscorides recommends us to introduce the juice of poppies or mandragora upon wool into the rectum.
Cælius Aurelianus gives an admirable account of the symptoms and treatment of this disease; and his views are, in this case, not very different from those of Hippocrates and Galen. He informs us that Asclepiades condemned venesection, which, he said was nothing less than murder; that he disapproved of keeping the patients in a dark place; and that he allowed them plenty of strong wine. Both Cælius and Celsus properly animadvert upon his treatment. Cælius also blames Diocles for admitting of venesection after the seventh day, and for approving of too acrid clysters. He finds fault with Themison for allowing too much food and wine at the commencement, and for using the bath indiscriminately. He condemns the practice of Heraclides, because he applied the treatment of the Empirics injudiciously, and admitted of bleeding from the frontal vein, which, Cælius says, is most prejudicial.
The treatment recommended by Octavius Horatianus is little different from that of the others.
The Arabians call the disease karabitus. The symptoms, according to Haly, are heat not much increased, but the head warmer than the rest of the body; alienation of the mind; watchfulness, but sometimes somnolency, from which state the patient wakes with starting; blackness of the tongue; picking at the bed-clothes; pulse in all cases weak, small, and hard. He is very minute on the treatment, recommending bleeding from the cephalic vein ad deliquium; cupping; gentle laxatives, such as prunes and tamarinds; vessels filled with cold water or snow applied to the head; in certain cases sinapisms to the feet; and, when watchfulness is protracted, applications to the head, containing poppies, mandragora, lettuce, &c. Alsaharavius particularly mentions general bleeding, bleeding from the temporal vein or the angular vein of the nose, pouring decoctions of refrigerant herbs over the head, and, when the insomnolency is obstinate, washing the temples with infusions of hyoscyamus, poppies, lettuce, &c. Avenzoar speaks of opening the artery in the head, an operation mentioned by Galen. Rhases directs us to pour vinegar and rose-oil from a height upon the head. His general remedies are similar to those of the others, namely, general and local bleeding, with gentle laxatives, such as myrobalans, prunes, and tamarinds. Serapion and Avicenna direct much the same treatment as our author.
SECT. VII.—ON PHLEGMON OF THE BRAIN.
When the brain is inflamed, it is often so swelled that the sutures of the skull are separated. The pain is very strong and permanent; there is much anxiety, and much redness of the countenance, with swelling; the eyes protrude, and the head swells. We must let blood from the arm, and also detract by the nose, and from the vessels below the tongue. We are also to use the fomentations suitable for inflammations of the head, and cataplasms of a moistening and concocting nature.
Commentary. This Section is taken from Aëtius (vi, 25), or Oribasius (Synops. viii, 11.) See also Avicenna (iii, i, 3, c. 4); Haly Abbas (Theor. ix, 4, and Pract. v, 14); Alsaharavius (Pract. i, 2, 9.)