192 DISEASES Of THE BRAIN. 



the correctness of this hypothesis ; it has something seducing about it, 

 but opposed to it is the fact that, if it be true, the same pathological 

 change (compression of the capillaries by serous exudation) has a par- 

 alyzing effect on the greater hemispheres and an irritant effect on the 

 medulla oblongata. 



TREATMENT. Although, in the treatment of hypersemia of the 

 brain, general and local blood-letting, cold to the head, and derivation 

 to the skin and bowels justly enjoy a good reputation, we must not 

 use one or the other indifferently, or employ all at the same time, in 

 any case that arises. In fact, there is no disease where it is more im- 

 portant to fulfil the causal indications, and to attend to the causes of 

 the disease when prescribing the remedies required by the indications. 



In those forms where increased action of the heart and a coincident 

 diminution of resistance in the vessels of the brain have induced fluxion 

 to that organ, the same regimen must be observed as was recom- 

 mended in the first volume, in the treatment of habitual fluxions to the 

 lungs. If danger threatens, we should bleed ; in such cases venesec- 

 tion cannot be replaced by ice-compresses to the head, or by leeching 

 oehind the ears. 



If there be collateral fluxion to the brain, we must first of all 

 attempt to remove the obstructions to the circulation by which the 

 pressure of blood in the carotids is increased. Evacuating the intes- 

 tines, by laxatives or by enemata of water and vinegar, often has a 

 marvellous effect, which is induced by nothing else, both in adults who 

 are constipated and suffering from headache, tinnitus, dizziness, etc., 

 and especially in children where constipation is accompanied by con- 

 vulsions, etc. If these remedies are insufficient and symptoms of de- 

 pression occur, from which we fear danger, it is proper to draw blood 

 here also, in adults by venesection, in children by leeches to the head. 



The treatment must be quite different when the cerebral hyper- 

 aemia has resulted from the continued misuse of alcohol or of narcotics, 

 or from excessive mental excitement. In such cases nothing is to be 

 expected from general bleeding, and large venesections are often in- 

 jurious ; on the other hand, the indications are, to apply a bladder of 

 ice to the head, or else moist compresses, that have laid under a tin 

 vessel filled with ice and salt, till they were frozen. In some cases of 

 this variety derivatives are good ; by these we attempt to remove the 

 fluxion from the brain by inducing fluxion to the skin, intestines, geni- 

 tals, or rectum. The most common remedies used with this object are 

 irritant foot-baths, among which those of ice-water, in which the patient 

 only passes a short time, are better than those of hot water, with mus- 

 tard or salt, and wood-ashes. In acute cases, blisters to the nape of 

 Ihe neck, and in chronic ones the establishment of an issue in the arm 



