We are inclined to think that it was the temporal veins and not the arteries which were cut out and burnt by the Greek surgeons in this operation. It will be seen, however, that the Arabians direct us to cut out a portion of the artery; at least this is sufficiently clear in the description of Albucasis, for he states decidedly that the vessel to be secured will be recognized by its pulsation, and he further recommends us to apply beforehand a ligature about the head, and not about the neck as directed by our author, whereby it is obvious that the arteries and not the veins would become distended; these observations apply also to Jesu Haly’s description. As Celsus, like our author, directs the ligature to be applied round the neck (cervix ante modice deliganda est), we may suppose that his operation related to the veins. From his using the word venæ indeed no inference can be drawn, as he applies it indiscriminately to arteries and veins. We are at a loss what to determine respecting the description given by Haly Abbas, for although the vessel that is secured be called arteria, the ligature or strip of cloth is directed to be applied round the collum. Where the mistake lies in this case we cannot venture to conjecture, and leave it to be found out by some person who has access to the MS. of the original. For our part we may exclaim with a celebrated German scholar,—“Felices sæpe prædicavimus Bochartum, Plempium, Celsium, Hydium, Casirium, quibus usus codicum Arabicorum concessus erat.” (Sprengel, Rei Herbariæ Historia, i, 239.)
Fabricius ab Aquapendente describes the operation as relating to the veins (Œuv. Chir. ii, 3.) Tagliacozzi, however, seems to refer it to the arteries. It thus appears that there is a good deal of uncertainty regarding this ancient operation.
SECT. VI.—ON HYPOSPATHISMUS.
This surgical operation derived its name from the kind of instrument used in it. We have recourse to it when a copious and hot defluxion is determined to the eyes. The face is ruddy, and about the forehead there is a sensation as of worms or ants passing along it. Having therefore first shaven the hairs about the forehead, we must permit the lower jaw to move, and avoiding the place where the temporal muscles are seen to act, we are to make three straight and parallel incisions on the forehead, each having the length of two fingers, and descending to the bone, and being at the distance of about three fingers’ breadth from one another. After the incision we apply the instrument called hypospathister, and extend the division from the left temple to the middle incision, dividing all the intermediate substance along with the pericranium; then we push a spatula from the middle one to the rest, and applying the point of a sharp-pointed knife to the first division, so that its sharp side may be turned to the flesh within the skin, and the blunt one to the bone, we push it as far as the middle division, cutting through all the vessels which descend from the head to the eyes, but not comprehending the external skin. And again we push it from the middle to the last incision, cutting through the vessels in like manner. After a moderate evacuation of blood, having squeezed out the coagula, and made three twisted tents, we are to put one into each division, and applying a compress soaked in water, we must secure it with a bandage. Next day we bathe not only the ulcers, but likewise the temporal muscles, and the ears with wine and oil, on account of the inflammation; and on the third day having removed the dressings, we must have recourse to copious affusion, and afterwards complete the cure suitably with tents out of basilicon dissolved in rose-oil.
Commentary. See Aëtius (vii, 92); Albucasis (Chirurg. ii, 4); Haly Abbas (Pract. ix, 7.) This operation is better described by our author than by any of the others. Celsus, although he describes several grave operations for the relief of defluxions on the eyes, makes no mention of it. Aëtius barely alludes to it in general terms. It must have been a very formidable operation, and for that reason perhaps, has been entirely abandoned in moderate times. Even Albucasis speaks of it as being an operation which was performed by the ancients; from which language we may suppose that it had been given up in his time. His description of it is evidently taken from our author. Haly Abbas describes the operation very distinctly. Three longitudinal incisions at the distance of three fingers’ breadth from one another are to be made in the forehead down to the bone, then a knife, or some such instrument, is to be introduced so as to divide the parts between the longitudinal incisions, sparing only the outer skin.
SECT. VII.—ON PERISCYPHISMUS.
When many deep-seated vessels send a copious defluxion to the eyes, we have recourse to the operation called periscyphismus. These cases are attended with such symptoms as these: in the first place you will find the patient’s eyes atrophied and small, weak of sight, the canthi corroded, and the eyelids ulcerated, the hairs falling off, with a discharge of very thin, acrid, and hot tears; there is a deep-seated pain in the head of an acute and violent character, and there is frequent sneezing. Having first shaved the head as aforesaid, and avoiding the place where the temporal muscles play, we make a transverse incision, beginning at the left temple and ending at the other. The incision must have its terminations where there are no muscles, its direction being a little above the forehead, and we must avoid the coronal suture. Leonidas directs the incision to be made along the middle of the forehead. When the bone is laid bare we may keep the parts asunder with tents and plenty of pledgets, and bind the extremities of the division; and, as we formerly stated, bathe with wine and oil. After loosing them, if the inflammation is on the decline, we may scrape the bone until it begin to incarnate, and accomplish the cure by a mode of practice calculated to promote incarnation, using the incarnative powders; among which is that containing of wheaten flour, p. ij; of colophonian rosin, p. j; and that called the cephalic, and those incarnatives prepared from pumice-stone. For, when the skin is thickened by a dense cicatrix, and the mouths of the vessels constricted, the defluxion is prevented from being determined to the eyes as before.
Commentary. See Aëtius (vii, 93); Pseudo Galen (Isagoge); Albucasis (Chirurg. ii, 5); Haly Abbas (Pract. ix, 18.)
It is evident that this operation is neither more nor less than a complete division of the integuments of the head from temple to temple; of course it must even have been more dangerous than the operation treated of in [the last section]. Aëtius, Haly Abbas, and Albucasis describe it in the same terms as our author. The periscyphismus and hypospathismus are briefly noticed in the ‘Isagoge.’