In hemicrania and in chronic or acute defluxions, when the eyes are affected with a hot and acrid defluxion, so as to occasion heat of the temporal muscles with swelling, every one approves of angiology for the cure of them. Having, therefore, first shaven the hairs of the temples, and noted the part with our fingers, we must use warm fomentations, and apply a bandage round the neck; and, when the vessels become visible, having marked their course with ink, we must draw the skin aside with our left hand or the fingers of an assistant, and make a superficial incision along the vessel; then cutting quite through, and stretching the parts with hooks, and exposing the vessel by means of the instruments used in operations on membranous parts, we must raise it up when it is separated all around. If it be small, having stretched and twisted it with a blind hook, we may divide it through, so as to be able to seize upon part of it. But if it be large, we must apply a double ligature under it with a needle, either a piece of raw flax, or some other strong thing; and, in the first place, making a straight opening into the vessel with a scalpel used in venesection, and taking away a moderate quantity of blood, we must tie the ligatures at both extremities of the exposed vessel, and cutting the intermediate part, we may remove it either immediately, or at the time of loosing the dressings. Some, without dividing the vessels at all, burn them to a sufficient depth with burning-irons shaped like olive-kernels. After the operation we must use pledgets of dry charpie, and put on an oblong compress (splenium) with a bandage. After the removal of these dressings, we must accomplish the cure by incarnating powders, applications on pledgets, and cicatrizing remedies; the threads and ligatures having previously dropped out from putrefaction.
Commentary. The author of the Hippocratic treatise (de Morbis in Homine, c. 49) recommends us to open the temporal veins for obstinate headaches; and, if this does not effect a cure, he directs us to burn them.
Celsus describes both operations very distinctly. He directs us to apply a ligature round the neck, so as to make the vessels swell, and then, having marked the course of the vessels with ink, to remove the ligature, and open the veins. When a sufficient quantity of blood is discharged, the part is to be burnt with slender irons cautiously about the temples, for fear of wounding the temporal muscles, but more boldly between the forehead and the vertex, so as to produce exfoliation of a scale of the bone. He also speaks favorably of cutting the vessels in the temples and upper part of the head. (vii, 7.)
Aëtius gives nearly the same description as our author. The part which relates to the burning is taken from Leonidas (vii, 93.)
Angiology is briefly described in the ‘Isagoge’ of Galen. A minute description is given by Albucasis. He recommends the operation as a remedy for inveterate cases of hemicrania, catarrh, and cephalæa. He directs us to shave the hairs about the temples, and to continue to do so until the artery appears. It is known, he remarks, by its pulsation. When it does not readily make its appearance, he recommends us to apply a cloth round the patient’s head, and to rub the place with a rough towel. Then, he says, take a scalpel, and make an incision so as to lay bare the artery, which seize with a hook, and separate from the surrounding parts, and if the vessel is small, cut out a proper piece of it, and allow from three to six ounces of blood to flow. But if the vessel is large, bind it in two places with strong silk threads, or strips of raw cloth (alhohod), so that it may not drop out before the wound is consolidated. Then cut out the part between the two ligatures. He directs us to dress the wound as recommended by our author. He also mentions the operation of burning the temporal veins as being one that is less serious than angiology. (Chirurg. ii, 3.)
Jesu Haly’s account of the operations of tying and burning the temporal arteries is very distinct. (iii, 25.)
Haly Abbas describes the operations of cutting out and burning the temporal vessels in nearly the same terms as our author. (Pract. ix, 70.)
Rhases mentions that the celebrated Archigenes recommended the temporal veins to be burnt for epilepsy. (Contin. i.)
The veterinary surgeons burnt the temporal veins in diseases of cattle. See Vegetius (Mulomed. ii, 16.)