146 PRACTICE OF MEDICINE. 



his being injured by the violence of his muscular exertions. One of 

 the first things to be done is to put something between the teeth, to 

 prevent injury to the tongue, and the dress must be loosened, parti- 

 cularly stays and neckcloths. Bloodletti7ig has been recommended 

 in the paroxysm ; but unless the fits are attended by marked plethora 

 or cerebral congestion, or in the first attack, especially when pro- 

 duced by the suppression of some sanguineous evacuation, it should 

 be deferred. It is in the convulsive stage of the paroxysm that 

 bleeding is particularly indicated : it cannot, however, be easily per- 

 formed in this stage. Cold affusion to the head has been recom- 

 mended by Brera ; it is not very efficacious, except in those cases 

 complicated either with hysteria or uterine disease. Antispasmodic 

 and p)urgaiiveenemata are perhaps the most efficacious means during 

 the fit ; if there be not much determination to the head, assafoetida 

 injections and castor oil may be employed ; but when this symptom 

 is present, turpentine should be preferred. 



After the paroxysm is over, the patient should be kept quiet, the 

 bowels opened as quickly as possible, and light nourishing diet in 

 moderate quantity is to be used ; the abuse of stimulants is to be ab- 

 stained from ; and every cause, corporeal as well as mental, which 

 can possibly have the effect of disturbing the balance of the circula- 

 tion, or exciting the nervous system, is to be avoided. If there be 

 evidence of much disturbance in the cerebral circulation, the treat- 

 ment must be more active; if the patient's strength will admit of it, 

 general bleeding from the arm may be useful, or occasional cupping 

 may be had recourse to, together with keeping the head shaved, ap- 

 plying cold lotions, acting briskly on the bowels, and placing moxas 

 or blisters behind the ears, or setons in the neck. In this form of 

 the affection, Dr. Cheyne recommends James'' powder to be taken at 

 bedtime, beginning with two or three grains, and increasing the 

 dose every night, until a sensible effect is produced on the skin, 

 stomach, or bowels. When chronic inflammatory action is sus- 

 pected, \\\Q potassio-tartrate of a^itimony ointment should be applied 

 along the spine, or over the nape of the neck, until it produces a 

 copious eruption of pustules. Where this disease arises from an 

 affection of the spinal cord or its membranes, it will necessarily re- 

 quire either vascular depletions or tonics, or both, according to the 

 degree in w^hich plethora, increased action, or deficient power, is in- 

 ferred to be present. Where incited action exists, cupping, the ap- 

 plication of leeches, and dry cupping in the course of the spine, the 

 insertion of setons or issues a little below the seat of the pain, or 

 application of moxas, are the most efficient means. The effects of 

 these means are increased by absolute rest, the antiphlogistic regi- 

 men, and active purges. In some cases, associated with deficient 

 power, whilst moderate local depletion, dry cupping, external deriva- 



