The anaesthesias that are so frequently present in the early or acute stage rarely prove lasting. The occasional develop ment of chorea in the affected extremi ties is in so far a good sign as it indi cates returning conductivity of the mo tor tracts.
Three important prognostic indiea tions: 1. llenal disease the most im portant. 2. Cheyne-Stokes respiration. 3. Hyperpyrexia. lf one, two, or all three be present, patient will, in all prob ability, not recover. Diabetes, chronic alcoholism, typhoid. fever, idiopathic amnmia will also exert fatal influence. A. G. I3arrs (Brit. Med. Jour., May IS, '95).
Treatment.—It cannot be too strongly urged that the first desideratum is a rect diagnosis. Upon this must our treatment primarily depend to be cacious, since the affections that most closely simulate cerebral hinorrhage demand directly opposite treatment.
As the therapeutic indications in cere bral hwmorrhage vary considerably ac cording to the stage of the trouble, they can best be considered under four heads:— Prevention.—In general the prophy lactic management is indicated by the etiological factors. If there are any sus picions of prodromata, the patient must be warned against all lifting and strain ing, the bowels be kept free (calomel or salines), any overtension of the pulse be eased by mild depressants, and the patient kept in a warm atmosphere well protected from all chilling. Digitalis and cardiac stimulants of every sort should be carefully avoided. Any nerv ous overtension can advantageously be remedied with bromides, and their use here is regularly in order.
During the Attacle.—Some cases are promptly fatal, meningeal and ventric ular forms being usually of this kind. Nearly always, however, the effusion progresses for some time. It is here that the physician can be of great serv ice, and as there is rarely time to call for consultants it is important that every practitioner understand the methods fully.
The first and main object is to stop further hicmorrhage. 0 Ur efforts should be directed to a loicering of the arterial pressure, and to a derivation of the blood current to other parts ; i.e., in general to a reduction of the supply to the brain. For this purpose a variety of means are available and when promptly applied are successful.
:Management of cerebral linlorrhage and its abortive treatment: 1. Do not
give stimulants. Their use in such cases is most reprehensible. The patient is prostrated, and the lay mind naturally turns to tonics and bracers: about the worst thing that can be done. 2. Do not resort to saline injections. During the acute stage a limitation of fluids is in order. 3. Do not use the depressant diaphoretics, such as ipecac, pilocarpine, or apomorphine. They t,end to nauseate: an inclination otherwise too common. and, in the degree of attempts at vomit ing, most undesirable. 4. Do not pre scribe digitalis. It is a dangerous drug in any individual with a liability to apoplexy, and for this, if for no other reason, of unquestionable utility in nephritis. lf anything of this sort must be used, strophanthus, in the author's experience, is by far the safest. 5. Do not resort to opiates. 6. Do not try nitrites. 7. Do not permit any ntuscular exertion on the patient's part; and mov ing by others should be limited as nutch as possible.
In the subacute stage the important question is: when should the patient be encouraged to sit up? He should be kept as quiet as possible for the first few days, lest further effusion occur from the same vascular rupture. In about a week sitting up should be en couraged. Give vascular depressants in lesser dose at this time. Care should be taken that the patients should not be allowed to remain listless abed and thus a secondary dementia be favored.
In the chronic stage, which is often hopeless enough, the nse of mix vomica, massage, electricity, etc., is to be tried. The chief benefit will be derived from cultivating in the patient whatever power remains. William Browning (New York Med. Jour.. Feb. 15, 1902).
Position of the Patient.—The main essential is a sufficiently prone attitude to insure complete relaxation of all the muscles, since we know that muscular effort tends to increase arterial tension. On the other hand, dropping the head too low favors the flow of the blood to the brain: a principle that we apply in cases of fainting, anmmic exhaustion, chloroform syncope, etc. The best posi tion, then, for a patient with progressing cerebral hmrnorrhage, is to have the body sufficiently reclining to be fully relaxed and the head considerably elevated.