239 
PATHOLOGY. 
other marks of delirium : fometimes, however, delirium 
does not come on till the fifth, fixth, or feventh, day. It 
gradually incr.eafes till it often arrives at a ftate of phren- 
fy. The face becomes turgid, the eyes ftare, and feem as- 
if starting from their fockets ; tears, and (according to 
fome) even blood, flowing from them; and the patient 
fometimes refembles a furious maniac, from whom he is 
principally diftinguilhed by the ftiorter duration of his 
complaint. 
We fliould, d priori, expert in phrenitis confiderable de¬ 
rangement in the different organs of fenfe, which fo im¬ 
mediately depend upon the ftate of the brain ; and fuch 
is the fadl. The eyes are incapable of bearing the light; 
and falfe vifion, particularly that termed mufca volitantes, 
or floating motes and flafhes of light feeming to dart be¬ 
fore the eyes, are frequent fymptoms. The hearing is 
often fo acute, that the leaft noife is intolerable: fome¬ 
times, on the other hand, the patient becomes deaf; and 
it has been even obferved, that the deafnefs and morbid 
acutenefs of hearing fometimes alternate. Affections of 
the fmell, tafte, and touch, are lefs obfervable. 
The rejpiration is generally deep and flow, fometimes 
difficult, now and then interrupted with hiccup, feldom 
humid and frequent, which Iaft is a very unfavourable 
fymptom. The deglutition is often difficult, fometimes 
convulfive. The liver is often affefted ; and complete, 
jaundice, the urine and fkin being tinged yellow, fome¬ 
times fupervenes. Inftead of a fuperabundance of bile, 
however, there is fometimes a deficiency of it, which af¬ 
fords a bad prognofis. The feces being of a white co¬ 
lour, and a black cloud in the urine, have been regarded 
as fatal fymptoms. The black cloud in the urine is owing 
to an admixture of blood; when unmixed with blood, the 
urine is generally pale. 
Among the moft unfavourable fymptoms of cephalitis 
the following may be enumerated ; namely, tremors of 
the joints, convulfions of the mufcles of the face, grind¬ 
ing of the teeth, fudden changes of the colour of the 
face from florid to pale, involuntary tears, a mucous 
dil’charge from the nofe, the urine being of a dark-red 
colour, or yellow^, or black, or covered, with a pellicle; 
the feces being either bilious or white, and very fetid ; 
protule fw'eat of the head, neck, and (houlders ; paralyfis 
of the tongue, general convulfions, much derangement 
of the internal funCIions, and the fupervention of the 
fymptoms of other vifceral inflammations, particularly of 
peripneumony. If the delirium changes to coma, and 
the pulfe at the fame time becomes weak and the deglu¬ 
tition difficult, the approach of death may be generally 
expeffed. 
With refpeCt to the c«i/« of cephalitis, we have already 
obferved that it is a rare difeafe in our temperate climate, 
but is more frequently obferved in warm latitudes. The 
predifpofition feems to confift in the irritability of youth 
and of the fanguine temperament, as u'ell as in a paffionate 
temper of mind. The exciting caufes are fuch circurn-' 
fiances, internal and external, as tend to produce an ac¬ 
cumulation of blood in the head ; among which are the 
direfif influence of a vertical fun in tropical climates, or 
long expolure to it in hot weather in more moderate 
heats, eipecially under great bodily exertions; violent 
fits of anger; intoxication; conculfion, fraCture of the 
flcull, or other mechanical violence ; long and intenfe 
exertion of the mind ; certain narcotic poifons, miafmata, 
and perhaps contagion. 
The cure of cephalitis muft be conducted upon the 
fame general principles as that of other-acute vifceral in¬ 
flammations; and, from the particular importance of the 
organ inflamed, the antiphlogiftic and evacuant plan 
muft be purfued with the utmoft vigour and expedition. 
Blood-letting is to be confidered as the principal depen¬ 
dence of the practitioner, and the more early it is em¬ 
ployed, the more efficacious in general it will prove. It 
fortunately happens, that in this complaint, the advan¬ 
tages of general and local blood-letting may be combined ; 
Vol. XIX, No. 1300. 
inafmuch as a large quantity of blood can ufually be pro¬ 
duced from the veflels immediately connected with the 
inflamed organ. When this advantage can be obtained, 
it fliould never be overlooked. It is advifable, therefore, 
to open the temporal artery, or the jugular vein, and to 
take a large quantity of blood, according to the violence 
of the fymptoms, and to the age and ftrength of the pa¬ 
tient. The blood-letting fliould be carried to the ex¬ 
tent of producing fyncope or fainting 5 and, when that 
effeCt follows, the relief is more often complete. 
We need pay very little attention to the admeafured 
quantity of blood we take. We muft bleed till the vio¬ 
lence of the delirium is much abated, and till the pulfe 
is materially lowered. The eftefts of the blood-letting, 
in diminifliing the morbid determination of blood to the 
head, Ihould be feconded by all other means in our 
power. The application of cold to the fcalp, fuch as waffl¬ 
ing it, after (having, with cold water, vinegar ; and water, 
or fpirits, is often exceedingly beneficial. To affift in 
leflening the flow of blood to the head, the patient 
ihould be kept as near the ereCt pollure as can be borne. 
At the fame time he muft be kept in bed, becaufe the 
mufcular exertion required to fit or ftand accelerates the 
pulfe; but the head and clieft muft be fupported by 
pillows, or by othercontrivances. And at this time, every 
irritation, efpecially thofe of light and noife, of which 
the inflamed fenforium becomes peculiarly fufceptible, 
fliould be carefully withdrawn. 
When the aftion of the heart is fomewhat diminiftied, 
and the brain (till continues opprefled, we (hall find 
great benefit from bliftering the lower extremities; but 
this fliould not be done on the firft invafion of the ma¬ 
lady. I11 addition to thefe direCt means of diminilhing 
the inflammatory aCtion in the head, the indirect efteCt, 
which is produced by copious evacuations from the 
bowels, obtained by the life of purgatives, is of great im¬ 
portance, and fliould be carefully attended to. Even 
fyncope itl'elf has been produced by profufe evacuations 
from the inteftines, which implies the complete influence 
over the circulation in the brain, which Inch operations 
produce. The free ufeof elaterium, fcammony, gamboge, 
&c. therefore, fliould be reforted to in all cafes of phre¬ 
nitis ; and, if a fpontaneous diarrhoea fliould fupervene, 
the pradlitioner will be-careful not to check it. As in 
all other cafes of inflammatory fever, every external 
fource of excitement Ihould be carefully excluded ; the 
apartment ihould be cool and well ventilated ; the bed¬ 
clothes light; the drink aqueous, cold, and acidulated. 
It feems fcarcely neceflary to add, that naufeating dofes 
of antimony, and the frequent exhibition of infulion of 
digitalis, are very appropriate auxiliaries to the treat¬ 
ment of Cephalitis. 
2. Emprefma otitis, (Otalgia, Cullen.) Ear-ache fe- 
vere pain in the ear; tendernefs upon prefiure ; deafnefs 
or confufion of founds. This complaint is accompanied 
by a fenfe of weight or teniion in the internal ear, with 
fome flight degree of fever. The treatment is the fame as 
Phlegmon auris, (which fee p.. 230.) except that, when 
it is accompanied with much fever, we Ihould bleed, left 
the violence of the inflammation fliould diforganize the 
ear. Otitis is often a confequence of inflammation affeft- 
ing the throat and euftachian tube; in which cafe we 
muft ufe meafures which might be confidered fomewhat 
aflive as compared with the fmall extent of the difeafe, 
that we may prevent the clofure of the euftachian tube ; 
an accident productive of ferious inconvenience. 
3. Emprefma parotidis, (Cynanche parotidea, Cull. 
Branks, Scotlice. Mumps, Anglice.) Painful unfuppura- 
tive tumour of the parotid glands, often extending to 
the maxillary ; confpicuous externally ; often accompa¬ 
nied with fwelling of the teftes in males, and of the 
mammae in females. This complaint, which is (aid to 
have proved both epidemic and contagious, comes on 
with the ufual fymptoms of fever, which are foon after 
attended with a confiderable tumour of the external 
3 Q fauces 
