Apoplexy and Softeni7ig of the Brain. 89 



but sometimes slow, of a more or less profound unconsciousness, 

 attended or followed by paralytic troubles. The history of the 

 case may assist, any blow on the head, or sustained by falling, 

 striking a wall or post, or wearing a yoke, is to be noted. Any 

 extraordinary exertion or excitement must be considered. Any 

 sign of injury about the head ; the congestion of the cephalic 

 mucous membranes in contrast with the pallor of shock; the 

 onset of the attack without convulsions (or with them as in epi- 

 lepsy) ; the deep coma indicating cerebral haemorrhage or nar- 

 cotic poisoning; the absence of the odor of alcohol, opium, or 

 other narcotic from the breath ; the turning of the ej'es to one 

 side and the inequality of the pupils on the two .sides ; the turn- 

 ing of the head to the same side as the eyes ; the slow, labored, 

 usually .stertorous breathing ; the slow, full, .soft pulse ; the oc- 

 casionally rigid condition of the mu.scles and finally the paralysis, 

 hemiplegic, and less frequently monoplegic or paraplegic, make 

 up the diagnostic picture. 



UrcEinia and diabetic coma may be excluded by examination of 

 the urine, pulmonary apoplexy or cedema by the predominance of 

 respiratory troubles, and fulminant anthrax by the examination 

 of the blood and by the fact that this disease does not prevail in 

 the localit3'. 



Treatment is very unsatisfactory in the lower animals, as the 

 disease is ver}' fatal, and unless recoveries are complete, they are 

 not pecuniarily desirable. It is only in the slighter cases, there- 

 fore, that treatment can be recommended. At the very outset no- 

 thing is better than a full bleeding in a large stream from the 

 jugular vein or temporal arter5^ Ice, snow, or cold water should 

 meanwhile be applied to the cranial region. Absolute re.st should 

 be given, any harness that would impede circulation or respiration 

 removed, and hot water or stinuilating embrocations applied to 

 the limbs. 



When consciousness returns and the patient can swallow, an 

 active purgative may be administered, or barium chloride or 

 eserine may be given subcutem. Ain' recurring heat of the htad 

 ma}^ be met by renewal of cold applications, and the force of the 

 circulation may be kept in check by small doses of bromides or 

 aconite. In case of the formation of a clot, iodide of potassium 

 and other alkaline agents may be resorted to. Quiet and the 



