134 PRACTICE OF MEDICINE. 



distinct cavities form, and occasionally we find several small cavi- 

 ties uniting to form a large one. In some instances, the pus is found 

 enclosed in cysts, in which case the purulent matter assumes the 

 same characters as that found in the cellular membrane of the body. 

 The gray substance is the most usual seat of encephalitis ; and the 

 parts most commonly affected are, the corpora striata, optic tha- 

 lami, the convolutions, pons Varolii, and cerebellum. 



Treatment. — In this case, the most active treatment must be had 

 recourse to. The patient should be bled to the approach of syn- 

 cope ; the head should be shaved, and leeches applied to the scalp, 

 or cupping to the nape of the neck. There is great tolerance of the 

 loss of blood in this case, and it is extremely difficult to produce 

 syncope, owing to the excited condition of the brain producing a 

 continued determination of blood to that organ. Cold should be 

 applied to the head, and this treatment is indicated in all cases of 

 meningitis, and meningo-encephalitis, except in the rheumatic or 

 erysipelatous forms. The bowels should be well emptied in the first 

 instance by a large dose of calomel, and compound extract of colo- 

 cynth, followed in about two hours by a brisk cathartic draught, 

 aided in some instances by a purgative enema. Having procured a 

 proper action on the bowels, repeated doses of calomel should be 

 exhibited, either in combination with digitalis, colchicum, or James' 

 powder ; and its action should be established in the system as quickly 

 as possible. During the progress of the disease, enemata and brisk 

 cathartics should occasionally be administered. In the advanced 

 form, should there be deep coma, blisters to the scalp have been 

 recommended. 



Blisters, however, should never be applied in this situation, unless 

 there is profound sopor, weak action of the carotids, and no remark- 

 able increase of temperature of the head. If applied in the earlier 

 stages they seem to add to the excitement. Sinapisms may be 

 applied to the feet, or inner sides of the legs or thighs ; blisters are 

 generally applied to the nape of the neck, or between the scapulas. 



DELIRIUM TREMENS. 



[Delirium c. tremor e.) 



The hrain fever of drunkards (Armstrong) is variously modified, 

 according to the causes in which it originates, and the habits and 

 constitution of the patient. It may, however, be divided into two 

 species — the one being evidently connected with inflammatory irri- 

 tation, or with excited vascular action in the meninges of the brain, 

 and associated with great irritability ; the other consisting chiefly of 

 this last state, attended by exhausted nervous energy. 



Symptoms. — The phenomena of this disease vary remarkably, 

 from the slightest forms of nervous tremor, with spectral illusions 



