670 PRACTICE OF PHYSIC. 



experience ; since De Haen, and some others, inculcated this 

 practice, I have had more courage to employ it, and not only 

 with safety, but with remarkable success in some cases. 



" 6. I have now but one other case to state, and that is, 

 where, in the advanced stages of the disease, there come on 

 more considerable symptoms of a great irritation of the brain, 

 where the delirium, which had hitherto been of the low kind, is 

 more of the phrenitic, when the patient talks louder and with 

 more rapidity, when he becomes heedless of what is about him, 

 and insensible to his most accustomed impressions, when he is 

 easily provoked, particularly when he is more restless and im- 

 patient, and desires to get out of bed, or becomes remarkably 

 enraged and furious. In these circumstances, I have often seen 

 patients from the lowest state of debility seemingly recover their 

 strength ; at the same time, in their exertions of strength, most 

 considerable tremor, subsultus, and even convulsions occur ; if, 

 with these, the face is flushed and the eyes have an uncommon 

 redness, we suppose that a phrenitic affection of the brain has 

 taken place. One circumstance gives a greater degree of diffi- 

 culty here, viz. that the inflammation is topical, and not re- 

 markably communicated to the arterial system, so that there is 

 little hope from the common remedies in inflammation, and the 

 state of debility makes them inadmissible. In such circum- 

 stances, therefore, it is extremely difficult to determine what is 

 to be done : one remedy we attempt, is topical bleeding, the ap- 

 plying leeches to the temples, or cupping-glasses, which is likely 

 to have more effect upon a topical affection without consider- 

 ably weakening the system. But even this can do mischief: it 

 may induce a greater degree of debility ; and I have to add, 

 that all the symptoms I have mentioned, I now know, from fre- 

 quent experience, not to be inflammatory. What other kinds 

 of irritations can be applied to the brain, I do not pretend to ex- 

 plain ; but from their transient state, from their yielding without 

 any antiphlogistic remedies employed, and the disease, after all, 

 taking a salutary issue, I entertain no doubt that they may 

 occur without any inflammation. Under this ambiguity, 

 the remedies to be employed are chiefly blisters and warm- 

 bathing ; but further, the antispasmodics of the least doubtful 

 kind are proper in these circumstances, such as large doses of 



