In the cure of Nervous fever, we must refer to the same principles which we have laid down with respect to its pathology ; we require no general depletion, but we begin from the first with stimulants and excitants, exhibited in moderate doses, and proportioned to the effect which they have in rousing the dormant powers of the system. It is obviously of great importance to remove, if possible, the exciting cause, when it still remains applied, and in the later stages of the disease we must have recourse to stimulants and tonics, and shall find the proper management of the diet a most ef fectual part of the medical treatment. It is in fevers of this description that wine becomes a valuable remedy, and it is often found more grateful to the stomach than any stimulating compound which we can procure from the apothecary. It would have been fortunate for man kind if its use had been restricted to this disease, and had not been extended, by a false or imperfect analogy, to other affections which it resembles scarcely in any thing but in name.
The second genus of the Astheni?, Anaesthesia, is divided into complaints which consist in general debility of the nervous system ; defects of the external senses, not depending upon a change in the structure of the organs ; and in debility of the organic functions. The two first of these subdivisions may, almost all of them, be considered as symptomatic of some more general affection ; the latter, under which we include Aphonia, Dysphagia, Anorexia, Dysuria, and Anaphrodisia, are not unfrequently primary, although at other times, like the former, only symptomatic. They depend occasion ally upon an obvious change of mechanical structure, when they properly belong to a different part of the nosological system, and must be removed by mechanical as it frequently the case with Dysphagia and Dysuria. When, however, they are merely nervous af fections, the cure is to be accomplished upon the same general principles which were detailed above, regard being always had to the local situation and specific func tions of the part.
The third genus of Asthenia is formed by the Dysci nesir, those diseases which essentially consist in a loss or diminution of the power of voluntary motion, arising, for the most part, from an organic derangement of the brain ; we include under it the species Apoplexia, Para lysis, Hydrocephalus, and Lethargus.
Apoplexy is characterized by a sudden abolition, or considerable diminution of both the external and the internal senses, and of the power over the muscles of voluntary motion, while the circulation and the orga nic functions continue to perform their actions. The pulse is, however, slow and oppressed, and the inspi ration performed after long intervals, and accompanied by stet tor, while the countenance is flushed, and the sensibility so much impaired, that the patient is uncon scious of the most powerful impressions that can be made upon him. The immediate cause of Apoplexy appears to be, almost in every instance, the effusion of blood or serum on the surface of the brain, or into some of its cavities, which may be supposed to com press this organ, and thus prevent it from performing its due functions. Occasionally, however, we observe persons to be attacked with symptoms which have every claim to be considered as apoplectic, where, from the complete and very speedy recovery that takes place, we are unavoidably led to conclude that no consider able injury has occurred to the structure of the brain, an opinion which has been confirmed by some cases of dissection, although it is obvious that such opportuni ties can only be of accidental occurrence, where the patient has died from some other cause soon after his recovery from the Apoplexy. The state of insensibility
which is occasioned by complete intoxication is very similar to Apoplexy, so much so, that except from the previous history of the case, from the length of time which it continues, and from the ndour exhaled by the breath, we have frequently great difficulty in dis criminating between these affections, although arising from such very different causes, and producing such dif ferent ultimate effects upon the system. Persons who have suffered from Apoplexy are observed to be of a peculiar temperament or bodily conformation; they are generally corpulent, with short necks, and large heads, and exhibit various indications of a torpid state of the blood-vessels, attended, at the same time, with consider able force of the circulation, and firmness in the texture of the components of the body. According to the nature of the fluid which is effused, whether it be entire blood or only serum, the disease has been divided into the two varieties of sanguincous and serous, and it seems that this division has an actual existence, but we doubt much whether we have any certain means of ascertaining them before death from the symptoms of the case.
The proximate cause of the disease is supposed to be a congestion of blood in the vessels of the brain, gene rally terminating in effusion ; it has been a controvert ed question, whether a proper Apoplexy can be pro duced by the mere accumulation of blood in the vessels, without absolute effusion taking place, a question which we should be disposed to answer in the affirmative, al though it is difficult to prove the point by a reference to dissection, because, when there is no actual rupture of the vessels, recovery may be supposed generally to take place, so as not to admit of our examination. The exciting causes of Apoplexy are various, but may, for the most part, be referred to those circumstances which increase the impetus of the blood through the arteries of the head, or retard its egress from them. Violent exer cise, sudden fits of passion, severe mental exertions of all kinds, certain postures of the body, the direct ap plication of the sun's rays to the head, blows, or me chanical injuries of the part, and especially intemper ance in eating or drinking, are among the most frequent causes assigned for Apoplexy, and may be obviously ac counted for upon the above principle. There are, how ever, other causes, such as narcotic poisons, metallic fumes of various kinds, some of the unrespirable gases, especially the carbonic acid, intense cold, which, although they induce the symptoms of Apoplexy, may perhaps be supposed to act upon the nervous system generally, by diminishing the sensibility of all its parts, rather than by producing any local affection upon the brain in particular. After a severe attack of Apoplexy, except it arise from some obvious external cause, the functions, both of the body and the mind, seldom re gain their former vigour, and, for the most part, either one side of the body is left without motion, con stituting what has been termed Hemiplegia, or the whole of the voluntary motions and mental powers continue in a very imperfect and enfeebled state. We have sometimes curious instances of the loss of individual faculties, as the memory of names, of dates, or of places, and occasionally of a particular language : such cases have given rise to many pathological and metaphysical speculations, but these do not hitherto appear to have been sanctioned by the results of our anatomical exa minations.