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.
SECT. XIII.—ON EPILEPSY.
Epilepsy, being a convulsion of the whole body with impairment of the leading energies, has its cause seated sometimes in the brain itself, and sometimes in its cavities. This is sometimes a pituitous and sometimes a melancholic humour. The disease also sometimes arises from sympathy with the orifice of the stomach (as happens in colic affections, as will be stated when treating of them); and sometimes it is propagated from other parts, when a cold aura ascends to the brain, either from the leg or the fingers of the hand. It has also been seen to proceed from the uterus in females, at the time they were pregnant, for after delivery it ceased. This disorder attacks mostly the young, more especially infants, and after them boys and adults; but least of all elderly persons and the old. Its precursors are, an involuntary commotion, both of mind and body, despondency, oblivion of accustomed things, terrifying visions in dreams, headach, continued fulness of the head (especially from acute anger), paleness of countenance, and a distorted motion of the tongue, so that some even bite it. When it proceeds from the stomach, palpitation thereof goes before, with rumbling and aching pain; and when fasting, or during a delayed meal, they fall into a paroxysm. When the attack comes on they suddenly fall down, are convulsed, and sometimes utter inarticulate cries. The characteristic mark of these cases is foaming at the mouth, all the other symptoms being common to other diseases. In certain instances the urine and fæces are evacuated involuntarily, and in some the semen also. In some cases, when the disease is very acute, it proves fatal speedily, by the continuance of the paroxysms, or the violence of the attack; but it is most frequently protracted, so that, if it be not removed by the attainment of manhood, by purging, or pregnancy, or if it invade after this period of life, it for the most part does not leave a man until death, unless removed by a suitable cure. The following substances are used to prove epilepsy, namely, the fumes of bitumen, or gagate-stone, or goats’ horn, or the liver of a buck-goat when eaten, or the smell of the roasted liver.
The cure. When the patient is an infant, we need not be particularly solicitous about it; for when its age changes to a more bilious and drier constitution, and the diet is more prudently regulated, the affection most commonly goes off spontaneously. But we must attend to the diet not only of the infants, but likewise of their wet-nurses. After boyhood, those that fall into the disease ought to have the convulsed and distorted parts freely anointed, and ligatures applied to them, when they are to be stretched out; and then the mouth is to be opened, and one must introduce a finger or a feather, smeared with oil of iris, in order to bring away the phlegm. We must also rouse the senses by strong-smelling things, such as hog’s fennel, Cyrenaic juice, bitumen, and the pitch of cedar. But after the paroxysms, if nothing prevent, we must bleed from the arm; and when the paroxysm does not abate, we must apply a sinapism to the extremities, and a cupping-instrument to the hypochondria. When after these things no remission takes place, there can be but little hope, and yet the physician ought boldly to force castor into the mouth, and Cyrenaic juice, with honey and vinegar; and the decoction of centaury, or of colocynth, must be injected by the anus. Those that are recovering from an epileptic attack are to be evacuated after recovery by purging with hiera. This is the cure of a recent and acute attack of epilepsy. We will next deliver the treatment of the disease when it is in a chronic state. Wherefore the patients are to be made to persevere for a long time in drinking cold water; and when setting about the cure, it will be proper to bleed if nothing prevent; and after an interval of four or five days to recruit the body, and thus evacuate with a purgative, more especially black hellebore, colocynth, or scammony. The hellebore, without its medullary part, is to be pounded and strained, and sprinkled on five or six cyathi of honied water, or it may be taken in boiled honey with some pepper. Rejecting the seeds of the colocynth, fill it, still retaining the medullary part, with must, and allow to remain for a whole night; in the morning dilute the must, and give to drink. Or we may use the cathartic from white hellebore. It is this: Of cleansed bay berries, dr. viij; of white pepper, dr. viij; of alypias, dr. viij; of euphorbium, dr. viij; of white hellebore, dr. viij. Give these things at one dose, with the must in the colocynth, and it will evacuate well by vomiting. After proper purgation let them be put into the bath, and on the third day cup the hypochondria and back with scarifications; and then, stopping for a sufficient number of days and recruiting the body, give the hiera from colocynth; and afterwards apply the cupping instrument to the head and nape of the neck, and the day following a cataplasm consisting of bread boiled in honied water, and pounded with bitter almonds, wild thyme, mint, calamint, or rue. This must be done for three days. Afterwards the head is to be shaven and rubbed with the juice of hog’s fennel dissolved in vinegar, wherein cow-parsnip has been boiled; then, after stopping and recruiting the body, nine oboli of the antidote from colocynth are to be given in honied water; and, again, after an interval of some days, the antidote is to be repeated, and sternutatories used. After five or six days give castor in honied water; then stopping again administer a clyster of centaury and colocynth; and afterwards give the hiera again, and use masticatories and errhines in order, and apply a sinapism to the head. Acrid food must be seasonably given. Benefit may be obtained from oxymel of squills drunk every day, and honey in which the squill has been softened, to the amount of a spoonful. The diet should be of an incisive and attenuant nature; and therefore capers may be frequently taken with pickle. But they ought to abstain from flesh, pulse, and much wine, likewise from frequent venery, baths, mustard, and from drinking immediately after the bath, more especially of undiluted wine. Let them have recourse to gymnastic exercises and friction, and the last part that is rubbed should be the head.
On the cure of epilepsy from the stomach. If the disorder is occasioned by the stomach’s being primarily affected, the patient must attend to his digestion, taking about the third hour some carefully-baked bread that has been soaked in some diluted wine, slightly astringent, and of a white colour. Give to such persons the medicine from aloes twice or thrice every year. “I once knew a boy,” says Galen, “who was never seized with epilepsy after he carried a large piece of fresh peony appended from his neck.” Agaric is beneficial to epileptics, also hartwort, the fruit and root of cow-parsnip, and the round birthwort drunk with water. Scarification of the legs frequently repeated is also of great use.
On epilepsy proceeding from some of the members. When the attack is threatened, and they feel a sensation in the part, whether the hand or foot, a tight ligature ought to be applied above it, and the cure attempted during the remissions, by applying some caustic substance to the part, such as the garden cresses (lepidium), preparations from cantharides, and the like. The Julian oxymel is also of great use to epileptics, by expelling the offending matter from the part. After those things which have been mentioned, the theriac and natural baths have place. During their whole life, they must particularly guard against indigestion, and be careful not to take food before digestion has been performed; avoid all incrassating food, too long abstinence from food, all vehement venereal impulse, much wine, and drinking, after the bath, more especially of undiluted wine, as formerly mentioned, and likewise of old and thick wines. They must avoid, also, all aromatics of an acrid smell, and such as fill the head; must abstain from looking down steadfastly from a high situation, from remaining long in the bath, and exposing the head to the heat of the sun.