The treatment in a cerebral case of moderate severity has been already
sufficiently explained. Blood must be drawn to the subdual of the
inflammation, and if blood be abstracted early, two, or at most three,
moderate bleedings will be all that will be required.
But when the attack commences with severe cerebral affection, the
bleeding must be proportionally large, and early as it is copious. A
bleeding adequate to subdue a moderate, will be utterly inert in a
severe degree of cerebral disease. I give, as a specimen of what may be
sometimes required, the case of Dr. DILL. I saw my friend at the very
commencement of his attack, and was, therefore, able to carry into
effect what I conceive to be the proper treatment with due promptitude
and vigour. I saw him before there was any pain in the head, or even in
the back, while he was yet only feeble and chilly. The aspect of his
countenance, the state of his pulse, and the answers he returned to two
or three questions, satisfied me of the inordinate, I may say the
ferocious, attack that was at hand. Having taken an emetic without
delay, as soon as its operation was over, blood was taken from the arm
to the extent of twenty ounces. During the night, severe pain in the
limbs, especially in the loins, and intense pain in the head came on.
The blood that was taken on the preceding evening was not inflamed.
Early in the morning he was again bled to the extent of about sixteen
ounces, with great diminution, but not entire removal of the pain: the
pain not lessening, towards the afternoon he was again bled to the same
extent: the pain was now quite gone; the blood from both these bleedings
was intensely inflamed. During the night the pain returned, and, in the
morning, the eyes were dull and beginning to be suffused, while the
pulse continued slow and intermittent, and the respiration suspirious;
but the face was blanched, and the pulse, in addition to its other
characters, was weak. Instead of opening the vein afresh, twelve leeches
were applied to the temples; these very much relieved, but still did not
entirely remove the pain; for this reason, he was cupped to the extent
of sixteen ounces: this operation afforded very great relief, and he
continued easy until the following evening, when the pain returned, and
he was again cupped on the temples to the same extent. Immediate relief
followed this second operation; but, unfortunately, the pain returned
with great violence towards evening, and it was now impossible to carry
the bleeding any farther. Within twenty-four hours, it was plain that
typhoid symptoms in abundance would be present, for the fur on the
tongue was becoming brown, and there was already slight tremor in the
hands. No more blood could be taken with any prospect of advantage, nor
even with safety; yet, without the aid of some powerful remedy the case
was lost.
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