140 



PRACTICE OF MEDICINE. 



A summary of Hie result of 386 cases of apoplexy, from the Precis 

 (T Anatomic Patlwlogique of Andral, 



Seats of the Effusion, 



386 



On reference to this table, it will at once be observed the vast 

 preponderance of cases in which effusion has occurred into the hemi- 

 spheres of the brain, the corpora striata, and the optic thalami. 



Treatment. — In the treatment of apoplexy, with active determi- 

 nation to the head, full labouring pulse, carotids beating strongly, 

 &c., the first indications are to relieve the head from the accumula- 

 tion of blood, to prevent further congestion, and to obviate inflam- 

 matory action : and for these purposes the only efficient means is 

 bleeding. A full bleeding, then, must be immediately employed ; 

 the head should be shaved and freely leeched, and the patient may 

 be cupped on the temples or the back of the neck. The adminis- 

 tration of brisk drastic cathartics is attended with the best results, 

 their derivative action being a powerful means of relieving the coma. 

 Croton oil is the purgative generally used in these cases ; but where 

 the patient can swallow, other drastic cathartics may be given. Where 

 the patient has completely lost the power of deglutition, the croton 

 oil should be mixed with a little castor oil or mucilage, and passed 

 into the cesophagus by means of an elastic tube. Drastic enemata 

 will also be found beneficial. The head must be kept cool by means 

 of cold lotions, iced waters, or by pouring a small stream of cold 

 water on the scalp occasionally. When the coma is persistent, 

 blisters should be applied to the nape of the neck, or to the head ; 

 sinapisms to the feet are also indicated. But it must yet be remem- 

 bered that there is a certain injury done to the brain ; that a portion 

 of its substance has been torn up, and compressed by a clot of blood; 

 and that a certain amount of injury has to be repaired. Hence a 

 butcherly, indiscriminate use of the lancet, draining the patient's 

 veins after all active congestion has ceased, is much to be repro- 



