Albucasis says that he had only known hydrocephalus internus in infancy, and in every case it had proved fatal. However, he describes the operation of evacuating the collection in much the same terms as the Greeks. He warns the operator to avoid wounding an artery, lest the evacuation of blood should occasion immediate death. Alsaharavius mentions the frequent occurrence of the disease in sheep. Haly’s treatment is the same as our author’s.
The hydrocephalus externus is now scarcely mentioned, and the existence of such a case has been even questioned. Van Swieten allows the reality of it, but says that it is of rare occurrence. (Comment. 1217.) We are disposed to think that the cases described by our author must have been collections of lymph, or pus occasioned by external injuries forming between the integuments and the bone. Modern pathologists admit the reality of collections of serum and pus between the bone and the dura mater. We may further mention that the earlier modern authorities approve of the cautery in the present case. See Guido de Cauliaco (ii, 2, 10.)
The late Baron Larrey was a decided advocate for the application of moxa in this complaint. Henricus Regius directs us to evacuate the water slowly by making a small incision and introducing a silver canula. (Animad. Medic. 13.) Though recent experience does not give much encouragement to the operation, it sometimes happens that it is attended with success.
Fabricius gives the same account of these cases as the ancients. (Œuv. Chir. ii. 22.)
SECT. IV.—ON ARTERIOTOMY.
In chronic defluxions of the eyes, and in the affection of vertigo, we are in the practice of dividing the arteries behind the ears. Having, therefore, shaven the hind part of the head, and marked with the fingers the position of the artery, which is easily discovered by its pulsation, and then having marked out the line of an incision two fingers in length with black ink, we cut down to the bone. When this does not succeed we must measure a distance of three fingers’ breadth from the ears, and then operate by making a transverse division of the artery until blood flow per saltum, and the instrument strike the bone. After a moderate evacuation of blood, the pericranium is to be divided, lest it become inflamed from the distension; and having scraped the bone we apply a wedge-like tent of linen to the wounds, and accomplish the cure by pledgets. But if, after all, the bone remain bare, we must have recourse to scraping it in like manner.
Commentary. Our author’s description is mostly abridged from Aëtius (vi, 90), who copies from Severus.
This operation is minutely described by Albucasis. (Chirurg. ii, 2.) He directs us to shave the head, and rub the parts behind the ears with a rough cloth until the arteries become visible. The course of the vessels is to be marked with ink, and they are to be divided with a sharp scalpel, the incision penetrating down to the bone. He says, however, that if the surgeon choose, he may introduce the scalpel below the vessel, and cut upwards. The length of the incision is to be two fingers’ breadth. Blood, he remarks, springs from an artery per saltum. About six ounces, more or less, may be taken.
The operation is likewise mentioned by Avicenna (Cantic. iv,) and Averrhoes (in Cantic.); by Rhases (ad Mansor. vii, 21); and is described in exactly the same terms as our author’s by Haly Abbas. (Pract. ix, 4.)