Treatment. When the patient is of a robust and plethoric habit, and the dis ease is attended with acute pain in the bowels, with a strong full pulse, blood. letting will be necessary, but it must be practised with caution, especially in warn. climates, where the employment of pow erful antiphlogistic measures is often suc ceeded by a sudden and dangerous de gree of debility ; gentle emetics should be administered; they are not only useful in emptying the prima viz, but they also determine to the skin ; they will be more efficacious when given in such small and repeated doses as not to excite imme diate vomiting, unless the oppression at the stomach is urgent; the emetics gene rally employed in dysentery are ipecacu anha and tartar emetic, and, at the early periods of the disease, they will be more efficacious when combined : the morbid and noxious contents of the intestines, the most pernicious source of irritation in dysentery, must be expelled by cathar tics; those most generally celebrated are, the ipecacuanha and tartar emetic, the former is, however, most frequently em ployed ; it may be given either alone, or in combination with the crystals of tartar, in such doses as will produce some de gree of nausea, and repeated when the nausea abates ; the calomel is an excel lent remedy where there is a,tendency to inflammation, but it should never be given alone ; its operation is rendered both more easy and certain, by combin ing it with ether cathartics ; the most effectual remedy, however, in general, is a simple solution of Epsom salts, or Glauber's, or it may be given in a diluted infusion of semis, with a considerable proportion of manna ; the cream of tartar with tamarinds, the phosphate of soda, and castor oil, will make an useful variety; sifter the operation of the cathartic is finished, it will be advisable to adminis ter opiates, and they will be more effica cious if given with nauseating doses of emetics ; the pulvis ipecacuanha corn positus is a good medicine ; the byes cyamus, by its anodyne and gently laxa tive qualities, seems eminently to this disease. The warm bath is often used with advantage; fomentation of the abdomen is more frequently serviceable, but the most effectual remedy is a large blister applied over the abdomen; in mild cases, however, so severe a remedy is not necessary ; the addition of strong peppers to the fomentation may, in such cases, answer our intentions ; the pain attending the tenesmus will be allay ed by fomenting the anus with hot water, or with the decoction of chamomile flowers, with some tincture opii sprink led on the stupes : strangury is not an uncommon symptom: independent of can Mendes, it will be effectually relieved by fomenting the pubes and perinzum : me cilaginous demulcent liquids must be given freely, for the purpose of defend ing the intestines against the acrimony of their contents, and mucilaginous and oily elysters should be employed once or twice a day, or more ; they are very ser viceable for the same intention as the mucilaginous liquids, and act also as a fomentation; they should consist of a strong decoction of linseed or starch, or they may be composed of milk and oil, united by means of mucilage. In the ad vanced and chronic stage of the disease, as acidity of the stomach chiefly prevails at that period, absorbents will be useful, as the mistura cretacea, aqua calcis, pul vis cretz comnositus, &c. combined with opiates ; astringments will also, at this period of the disease, be proper, as the. kino, hamatoxylum, catechu, &c. and 2' the powers of the stomach be much weakened, they may be combined with chalybeates. The tone of the bowels will be restored by administering quas sia, bark, angostura, or columbo ; an in fusion of gentian and cinnamon in port wine is recommended : it will always be advisable to join aromatics with bitters a purgative of the calomel and rhubarb should be given from time to time in this form of the disease, and when it remains obstinate, we may always suspect visceral obstruction ; should this, upon examina tion, be the case, mercury, either inter . nally, or by friction, should be employed, until some sensible effect is produced in the mouth. The diet in the first should consist of milk, sago, salep, Indian arrow-root (maranta arundi. nacea), and rice, the quantity being re gulated by the appetite ; the sweet and subacid fruits may be allowed, and they are particularly serviceable when there is much bile in the prima viz. In the more advanced stages, the ripe fruits are condemned, but it does not, however, ap pear, on sufficient grounds, that they should be so; together with the fsrinacea, a small quantity of animal food may be allowed in the chronic state of the dis ease, provided it does not disagree with the patient. The drink at the commence ment should be either barley or rice wa ter, boiling water poured upon toasted bread, or burnt biscuit, whey, or the de coction ofhartshorn, and the like ; in the advanced stage of the disease, port wine or Madeira, or a moderate quantity of spirits diluted with water, will be pro per; the patient should wear flannel next to the skin for some time after the dis ease is gone off, and should take as much exercise as he can bear without fatigue, either on horse-back or in a carnage, carefully avoiding exposure to cold or moisture. The powder or extract of nux vomits is strongly recommended by Dr. Hufeland, in doses of from six to ten grains of the powder, three times a day ; or one or two grains of the extract may be given every two or three hours; three or four grains or more may be given in clysters : children of one year old may take from one to two grains of the ex tract in the twenty-four hours; it is ne. cessary to observe, that the medicine is directed to be administered in some mu cilaginous mixture. It is of consequence to warn the young practitioner, in the most forcible manner, against employ. ing opiates at the beginning of this dia.
ease, unless a free evacuation of the 4owels has been procured by cathartics, arid the excitement much diminished, as they generally aggravate the disease; and It will always' be pernicious to give them without nauseating doses of emetics, while the griping pains remain ; the hyos cyamus, if anodynes be deemed requisite, is preferable to opium, in consequence of its possessing a gently laxative quality.
This of diseases is characterised by an injury of the sense and motion, with an idiopathic pyrexy, or some local affection. It comprises the following or
dent Implying a diminution of voluntary mo tion, with sleep, or insensibility, and in. eluding the following genera: 1. Apo plexia, apoplexy, which is either idiopa thio or symptomatic, and is described thus ; almost all voluntary motion dimi nished, with sleep more or less profound ; the motion of the heart and arteries re, tnaiuing, 2. Paralysis, palsy, only some of the voluntary motions diminished, fre quentlywith sleep. These also are either Idiopathic or symptomatic ; the species are, asthenic, paralytic, convulsive.
Of qmplary, the symptoms are so well known, that they need not be repeated. Dr. Daily remarks very justly, that " When the patient is not cut off at once, but lives for some time after the attack, the hemiplogia.which is almost constantly an effect of this disease, is upon the opposite side of the body from that of the brain in which the effusion of blood has taken place : this, the learned author observes, would seem to shew, that the rightside of the body derives its nervous Influence from the left side of the brain, and the left side of the body, its nervous Influence from the right side of the brain." This disease is observed to make its at tacks most frequently about the period pf the equinoxes.
The predisposing causes are, a declen sion from the meridian of life, a large head, short neck, the sanguine or phleg matic temperament, obesity, an indo. lent life, or one too much devoted to study, too long sleeping, high living, in. dulgence in spirituous liquors, the gout, and the suppression or cessation of the hemorrhoidal, or any other habitual haemorrhoge or evacuation. The exciting causes are, violent exercise, as dancing after too great repletion of the stomach, a full and long continued inspiration, too strong exertions of the mind, every pas sion which agitates the human frame, great external heat, especially from a crowded room, intemperance, warm bath ing, crudities in the prima via, violent emetics, the spring season, rapid alterna tions of heat and cold, too great indul gence in smoaking tobacco, long stooping with the head down, tight ligatures about the neck,over distention of the blood-yes. self of the brain or its membranes, an ef fusion or eztravasation of blood or serum into the substance of the brain or its ven tricles, fractures of the scull or depres sion of it, causing an effusion of blood upon the brain or its meninges, and tu mors within the cranium. The proximate cause is supposed to be whatever inter. rupts the motion of the nervous power, from the brain to the muscles of voluntary motion. Difficulty of swallowing, and the regurgitation of the drink through the nostrils, great difficulty of breathing, and foaming at the mouth, are symptoms of the most imminent danger ; but the prop nosis may be generally collected from the violence of the attack, profoundness of the sleep, stertorous breathing, and the degree of the affection of the respiration, and of the powers of sense and of motion : the first attack of this disease is not com monly fatal, particularly if the patient be pot cut off in the course of the first week ; it frequently terminates favourably either by diarrhcea, hemorrhage, return of the hemorrhoidal, or any other habitual dis. charge, and sometimes by the appearance pf fever.
Treatment. As this disease arises in consequence of an effusion of blood or serum into the ventricles of the brain, or upon its meninges, blood-letting in a mo. derate degree may be of service, but co pious bleedings must be injurious, by weakeningthe patient and preventing the absorption of the effused fluid ; the blood should be taken from the temporal artery, or the jugular vein, and if that Cannot conveniently be done, it may be taken from the arm ; if one aide be more af. fected than the other, the blood should be taken from the side least affected ; cup ping the occiput is often serviceable, and it does not reduce the patient's strength so much as general blood-letting ; warm fomentations of the shaved head, continu ed for a length of time, and frequently repeated, will be of service ; an emetic is recommended to be administered, but, in our opinion, it is at least a doubtful remedy, unless the patient is affected with nausea, in consequence of repletion of the stomach ; acrid cathartics, as aloes, resin of jalap, calomel combined with the acammony, or with the extract of colo rynth, &c. should be given by the mouth, if the power of swallowing remains ; and clysters composed of a solution of some of the above cathartics, and the oleum succini, should be injected; blisters should be applied to the head, spine, and extremities, or a large caustic should be applied to the neck, and mustard cats plasma to the feet : the patient should be kept cool, and as much in an erect pos ture as he can bear without inconveni ence; small electric shocksshould be sent through the head; errhines and acrid vo. latile medicines are recommended, but to us they appear at least doubtful reme. dies : ifthe disease appear to be the con sequence of the suppression of the ha morrhoids, leeches should be applied to the hemorrhoidal veins, fomentati:ms must be employed, and the intestines must be stimulated by means of aloetic cathartics. The strength of the system will be restored by hark, bitters, and eha. lybeates. The return of this disease is to be prevented, by studiously avoiding all the remote causes which are in our power; a plethoric state of the blood-vessels of the brain must be obviated by a low diet, abstinence from fermented or spirituous liquors, moderate exercise, as riding on horse-back, if not affected with frequent fits of giddiness, or by walking ; costive ness must be prevented by gentle cathar tics; and if the disease had arisen from the suppression of the hemorrhoidal flux, aloetic purgatives will be most suitable ; an issue or seton should be made as near ps possible to the head, or, as being less disagreeable, a thin slice of the fresh root of the dapline mezereum, steeped in vine gar for twenty-four hours, may be applied daily, and if the inflammation should be very considerable, and the discharge pro fuse, it may be left off for a few days, and the parts should be kept moistened with a solution of sugar of lead.