COMATA. 345 



when a large branch can be opened, so as suddenly to pour out 

 a considerable quantity of blood, may also be an effectual re- 

 medy ; but, in execution, it is more uncertain, and may be in- 

 convenient. It may be in some measure supplied, by cupping 

 and scarifying on the temples or hind-head. This, indeed, 

 should seldom be omitted ; and these scarifications are always 

 preferable to the application of leeches. 



With respect to every mode of blood-letting, this is to be ob- 

 served, that when, in any case of apoplexy, it can be perceived 

 that one side of the body is more affected with the loss of mo- 

 tion than the other, the blood-letting, if possible, should be made 

 on the side opposite to that most affected. 



DCXXXIII. Another remedy to be employed is purging, 

 to be immediately attempted by acrid glysters ; and, at the same 

 time, if any power of swallowing remain, by drastic purgatives 

 given by the mouth. These, however, lest they may excite 

 vomiting, should be given in divided portions, at proper inter- 

 vals. 



MCXXXIV. Vomiting has been commended by some prac- 

 titioners and writers : but, apprehending that this might impel 

 the blood with too much violence into the vessels of the head, I 

 have never employed it. 



MCXXXV. Another remedy to be immediately employed 

 is blistering ; and I judge that this is more effectual when ap- 

 plied to the head, or near to it, than when it is applied to the 

 lower extremities. This remedy I do not consider as a stimulant, 

 or capable of making any considerable revulsion : but, applied 

 to the head, I suppose it useful in taking off the haemorrhagic 

 disposition so often prevailing there. 



" I have said that the accumulation, upon which the com- 

 pression depends, may be of two kinds, haemorrhagic or hydrop- 

 ic. Now here there must be different managements. Nothing 

 is more obvious than that blood-letting, on which we chiefly de- 

 pend in the case of haemorrhagic, may be truly pernicious in the 

 case of hydropic apoplexy, which generally arises from a loss of 



ic in the whole system, and particularly in the exhalents, de- 

 pending upon an abundance of serum in the sanguiferous sys- 

 tem." 



MCXXXV I. It has been usual with practitioners, together 



