DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 107 



partly on the stage. In the early stage of partial coma, arising from in- 

 digestion, bleeding may be useful, inasmuch as by reducing the general 

 volume of the blood, it will relieve the fulness of the vessels of the brain. 

 The quantity abstracted should not be large, not over two or three quarts, 

 but the blood must be drawn quickly. If we cause the strength to fail, 

 we shall not be able to bring back the stomach and bowels to their nor- 

 mal action. If the coma arises from concussion of the brain, blood may 

 be freely drawn, say five to six quarts. If, however, it be due to the for- 

 mation of a tumor on the brain or such like cause, bleeding is clearly use- 

 less and so indeed is all treatment. When the comatose state, whatever 

 may have been the cause, has lasted for some time, bleeding is obviously 

 inadmissible. The patient is in far too reduced a state to admit of such 

 a depleting measure. 



In mad staggers the same course of treatment as has been recom- 

 mended for the comatose phase is desirable and should be applied, as far 

 as circumstances may admit in any particular case. But except in the very 

 early stage or in mild attacks it is generally almost impossible to apply 

 those remedies on account of the violence of the animal. 



As boon as decided signs of frenzy appear, whether as a primary symp- 

 tom or supervening on coma, copious bleeding (whatever may have been 

 the cause of the attack) is the appropriate remedy. The blood should be 

 allowed to flow irrespective of quantity. On the authority of Prof. Wil- 

 liams, it may be four, five, six, or even eight quarts, but other writers do 

 not recommend such large quantities. There is often, however, great 

 difficulty and risk to the operator in applying this remedy, and indeed in 

 some cases of frantic delirium it is impossible to approach the patient. 

 If it be not possible to open the jugular vein, it may be possible to cut 

 the temporal artery. This class of affections of the brain yield more 

 readily to the influence of blood-letting than to any other remedy. If we 

 cannot very quickly abate the phrenitic symptoms, the patient will die. 



As topical relief, both in the comatose and also in the mad stages (if 

 possible), cold wet cloths should be constantly applied to the head, and 

 a stream of cold water should be poured on them from above. 



Blisters to the head and neck are not advisable during the acute symp- 

 toms, whether comatose or phrenitic, as they tend to increase the de- 

 rangement. But when the attack seems to become chronic, they may be 

 beneficially applied, or a seton may be inserted. The latter generally 



