32 PRACTICE OF PHYSIC. 



when few of the peculiar symptoms of phrensy had before ap- 

 peared. 



CCXCIII. The symptoms by which this disease may be 

 most certainly known, are, a vehement pyrexia, a violent deep- 

 seated headach, a redness and turgescence of the face and eyes, 

 an impatience of light and noise, a constant watching, and a 

 delirium impetuous and furious. Some nosologists have thought 

 these symptoms peculiar to an inflammation of the membranes, 

 and that the inflammation of the substance of the brain was to 

 be distinguished by some degree of coma attending it. It was 

 for this reason that, in the Nosology, I added the Typhomania 

 to the character of Phrenitis ; but, upon farther reflection, I find 

 no proper foundation for this ; and, if we pass from the charac- 

 ters above delivered, there will be no means of fixing the va- 

 riety that occurs. 



I am here, as in other analogous cases, of opinion that the 

 symptoms above mentioned of an acute inflammation always 

 mark inflammations of membranous parts ; and that an inflam- 

 mation of the parenchyma, or substance of viscera, exhibits, at 

 least commonly, a more chronic affection. 



CCXCIV. The remote causes of phrensy are all those which 

 directly stimulate the membranes or substance of the brain ; and 

 particularly all those which increase the impetus of the blood in 

 the vessels of the brain. Among these, the exposure of the 

 naked head to the direct rays of a very warm sun, is a frequent 

 cause. The passions of the mind, and certain poisons, are 

 amongst the remote causes of phrensy ; but in what manner 

 they operate is not well understood. 



CCXCV. The cure of phrensy is the same with that of in- 

 flammation in general ; but in phrensy, the most powerful re- 

 medies are to be immediately employed. Large and repeated 

 blood-letting is especially necessary ; and the blood should be 

 drawn from vessels as near as possible to the part affected. The 

 opening of the temporal artery has been recommended, and 

 with some reason ; but the practice is attended with inconveni- 

 ence ; and I apprehend that opening the jugular veins may 

 prove more effectual ; but, at the same time, it will be general- 

 ly proper to draw blood from the temples by cupping and scari- 

 fying. 



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