Cerebral Hemorrhage

child, quantities and patient

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Prognosis.-In all cases of cerebral the prognosis is very serious ; and it is especially so if the patient in whom the extravasation occur be the subject of diathetic disease, or be weakened by recent acute illness. The occurrence of paralysis is not in itself a necessarily unfavour able sign. Of greater importance is the degree of heaviness remaining after the convulsions have ceased, or the frequency of return of the spas modic movements themselves. As long as the child continues to take liquid food we may hope for improvement. If he refuse his bottle, or cease to drink when the feeding-cup is held to his lips, the sign is a very unfavourable one. The condition of the pupils should be always noticed. If they are dilated and insensible to light the prognosis is bad ; if they are unequal in size death may be considered certain.

Treatment.—Cases of intracranial hmorrhage require much the same treatment as has been already recommended for congestion of the brain. If the child be strong an ice-bag should be applied to his head, and the bowels should be freely acted upon by a dose of calomel and jalap. If

the heart's action be violent, and the arteries of the neck are seen to pul sate strongly, digitalis may be given to control the energy of the cardiac contractions. Three drops of the tincture of digitalis, or twenty of the infusion, may be given every two or three hours to a child of twelve months of age. The patient should lie with his head raised ; and if the feet are cold, a hot bottle can be placed at the bottom of the cot. If the pulse flag or the fontanelle become depressed, stimulants should be given in such quantities as may seem desirable.

The food should consist of milk, freely diluted with barley water, or of whey and barley water. It is better in these cases to feed the child with a spoon, or at any rate to give him fluid only in small quantities at a time, so as not to increase the strain upon the vessels by a rapid introduction of large quantities of liquid into the circulation.

In the after-paralysis little can be done. Our efforts must be re stricted to ordinary measures for improving the general health and pro moting nutrition.

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