AFOPLEXT. 229 



that we have given of the apoplectic fit, it is evident that, under some 

 circumstances, venesection is a very useful remedy ; under others it is 

 very injurious, and the indications for it may be very exactly given. 

 In order that as much arterial blood as possible may enter the brain, 

 we must try to facilitate the escape of the venous blood, without, how- 

 ever, diminishing the propelling power too much. If the impulse of 

 the heart be strong and its sounds loud, if the pulse be regular, and 

 no signs of commencing oedema of the lungs exist, we should bleed 

 without delay. Local bleeding by leeches, behind the ears, or to the 

 temples, or by cups to the back of the neck, cannot replace general 

 bleeding, but may be used as adjuvants. If, on the contrary, the 

 heart's impulse is weak, the pulse irregular, and rattling in the trachea 

 has already begun, we may be almost certain that bleeding would only 

 do harm, since the action of the heart, which is already weakened, 

 would be still more impaired, and the amount of arterial blood going 

 to the brain would thus be still more decreased. When the latter 

 state occurs, the symptomatic indications require just the contrary 

 treatment, in spite of the original disease being the same, and being 

 due to the same causes. We must strive with all our skill, by the use 

 of stimulants, to prevent paralysis of the heart. If we cannot give 

 wine, ether, musk, etc., internally, we should apply large sinapisms to 

 the chest and calves of the legs, rub the skin vigorously, sprinkle the 

 breast with cold water, or drop melted sealing-wax on it. 



If the patient has recovered consciousness after the apoplectic fit, 

 we simply prescribe a mild, unirritating diet, keep the bowels open, 

 and cover the shaved head with cold compresses, so as to prevent, if 

 possible, too severe inflammatory reaction. According to the severity 

 of the inflammatory symptoms which, nevertheless, occur, we may 

 continue this simple treatment, and at most give a purge, or apply 

 leeches behind the ears, and repeat the application if necessary. In 

 this stage venesection is superfluous and dangerous. On the other 

 hand, especially when the fever-symptoms have moderated, good is 

 done by derivatives to the nape of the neck, such as blisters and pus- 

 tulating ointments, wliich subsequently are no more to be used. 



If the stage of inflammatory reaction has happily passed, and the 

 patient is pretty well, except the paralysis, we should avoid prescribing 

 strychnia and other remedies, which are neither theoretically nor prac- 

 tically useful, but should regulate the diet and bowels, and place the 

 patient under the best possible hygienic influences. Well-to-do pa- 

 tients may be sent to Wildbad, Gastein, PfSfers, or Ragatz. We must 

 not hope that the destroyed filaments of the brain will be restored by 

 the use of these waters, but experience shows that, at these places, 

 both cerebral and spinal paralysis often improve ; probably this im- 





