504 ON ANTIPHLOGISTIC TREATMENT IN TETANUS. 
ture of the disease and the course pursued, it seems to accord with 
axioms of science. 
Morbid anatomy points out change, — the effects of inflammation, 
chiefly in the dorsal portion of the medulla spinalis and its tunics ; 
yet the symptoms attest that the brain is, at all events, functionally 
implicated, a fact familiar to my preceptor, the late W. Wilkinson, 
Y. S., and acknowledged in his work, and supported by the ob- 
servations of our best modern authors. 
It is the opinion of able pathologists, that what we call inflam- 
mation may occur in the circulatory, the nutritive, or in the inner- 
vating organs of a part, separately or conjointly; and that it is 
chiefly confined to the last mentioned, in the instance of tetanus, 
is probable. This granted, it seems somewhat strange that a 
disease confessedly consisting of an inflammation of certain parts 
should have produced so arduous a search for a specific remedy, 
often to the exclusion of a rational antiphlogistic treatment. 
I am perfectly aware that depletion and sedatives have been 
directed, and that many cases are recorded where these and other 
means succeeded ; yet, when we see bleeding to faintness recom- 
mended, cold water ablutions, and warm water injections into the 
bloodvessels, and many other such means, we cannot but think 
they are intended to act by a specific shock to the system rather 
than by removing congestion and tranquillizing the irritable nerves: 
indeed, Mr. Wilkinson’s practice turns too much upon the anti- 
spasmodic power of opium, although a glance at the cases shews 
that improvement was generally most evident after evacuating the 
prima via. 
It is scarcely necessary to allude to the fact, that, in the treat- 
ment of encephalonic affections, we should always bear in mind 
that a certain amount of arterial force is essential to the due per- 
formance of the functions of the brain, and that these may be de- 
ranged by the two opposite conditions of an increased or a depressed 
circulation. When the condition of the patient, the pulse, and other 
symptoms warrant venesection, it may be beneficially adopted to 
a moderate extent; and cases will occur where a repetition, either 
from the jugular vein or temporal artery, is required. 
Next in importance stands purging ; and the agents I prefer are 
aloes and linseed oil, putting the animal, at the same time, under 
the influence of hydrocyanic acid, which, by its sedative action 
on the brain and nervous system, may possibly abate inflam- 
mation ; and in this case it evidently accelerated the action of the 
cathartic. 
This influence may be carefully kept up previous to and during 
the operation of the purge, and afterwards aided or superseded 
