Paiturition Fever, etc. 313 



Treatmoit. With the state of plethora and congestion about 

 the head in the early stages the question of bleeding at once arises. 

 If early enough while there is a full bounding pulse, and as 

 yet no sign of great loss of muscular control it is often very bene- 

 ficial, as^much as 6 quarts or more being withdrawn. It is well 

 however to avoid cording the neck, which must increase the vas- 

 cular tension in the brain, and to trust rather to digital com- 

 pression of the vein. The blood should be drawn from a large 

 opening in a full free stream, and may be stopped when the pulse 

 softens. In the more advanced condition, with paralysis and more 

 or less dulling of the senses, or coma, bleeding may be dangerous 

 rather than useful. There is then serious pressure on the brain, 

 with serous effusion, and perhaps blood extravasation, and in any 

 case anaemia, and this latter may be dangerously or even fatally in- 

 creased by the lessening of the blood pressiu"e, without an}' com- 

 pensating advantage in the way of reabsorption of the effusion. 

 In such cases eliminating agents are a safer resort. 



/'/<r^rt/'/z'6'5-conunend themselves, but with the drawback of a 

 too tardy action. Now however with the peristaltic stimulants 

 given hj'podermically this objection is largeh' obviated. Pilocar- 

 pin \]A gr., and eserine 3 grs. will often secure a noticeable 

 movement of the bowels in the course of fifteen minutes, imply- 

 ing a corresponding motion onward in the bowels more anteriorly, 

 and even of the contents of the gastric cavities. If there is al- 

 ready palsy of the muscles of deglutition, this may be repeated 

 several times at intervals of four or five hours. If however de- 

 glutition is still well performed a purgative of one or two pounds 

 Epsom salts, with 10 drops croton oil, and i oz. oil of turpentine 

 may be given by the mouth. Should this operate, it will supple- 

 ment and carry on even more effectively the work of the hypo- 

 dermic agents, and even lessen the density, plasticity and ten- 

 sion of the blood and act as a potent derivative from the brain. 



A compromise may be made by giving aloes 2 ozs., croton oil 

 20 drops in bolus ; or i to 2 ozs. sulphate of soda in solution 

 may be injected subcutem. 



In any case oil of turpentine or other antiseptic is of great 

 value in the stomach in preventing fermentation and tympany, 

 and thereby obviating a whole series of troubles such as : cerebral 

 disturbance by nervous shock and blood pressure ; impaired res- 



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