342 
PATHOLOGY. 
if thefe fymptoms are not prefent, the ftate of the alimen¬ 
tary uanal is to be firft attended to. As foon as the 
fymptoms of cephalitis become in the flighted degree ap¬ 
parent, whether it has been preceded by the above ftage, 
or makes its attack in a fudden and unexpected manner, 
bleeding muft be had recourfe to. As all that can be 
done in this difeafe muft be done early, the practitioner 
muft at once decide, not only from the conftitutional ap¬ 
pearance, but from the ftate of the pulfeand of the men¬ 
tal faculties of the patient, the degree to which venefec- 
tion may be carried. He will be chiefly guided in his 
opinion as to this point, by the mode of attack; for, 
when the difeafe comes on fuddenly, it will, caeteris pa¬ 
ribus, require much more ample bleeding than when in- 
difpofitior. has long preceded it. Moft praCfitioners truft 
to leeches to the head ; and in milder cafes thefe may do 
very well; but we are quite fure that in the majority of 
patients the difeafe will be more fuddenly arrelted by the 
ufe of the lancet. Even in the youngeft children, this 
meafureffiould, when the difeafe is violent, always precede 
local bleeding; for, as we have before fliown in this ar¬ 
ticle, the efficacy of bleeding depends much on its aCtion 
on the heart; and this effeCt is notincreafed unlefs by a 
fudden abftraCtion of blood. After the general bleeding, 
the application of leeches will be found of the greateft 
benefit; and, in violent cafes, cold water to the head, 
and counter-irritants, as blifters, &c. to the feet, may alfo 
be ufed with advantage. The bowels are to be freely 
purged by draftic cathartics. We are cautioned by fome 
authors (e. g. by Dr. Golis) not to carry the ufe of thefe 
fubftances too far, left we transfer the inflammation 
from the brain to the inteftines. Of courfe this effeCl 
muft be watched ; but in few cafes of violent Cephalitis 
will it be found to occur; and, even ffiould it take place, 
it will feldom prove of an obftinate character, if the irri¬ 
tating medicines be wfithheld, and local bleedings and 
anodyne injections reforted to. 
When the third ftage, or that in which effufion has 
taken place, comes on, our treatment muft be in a great 
meafure directed by the hiltory of the cafe. If the pa¬ 
tient has been fo far negleCted, that no bleeding, or even 
if not enough of this evacuation has been made, we muft 
(always keeping in view the faCt that aqueous effufion is 
in moft inftances a confequence of vafcular fulnefs) bleed 
until the pulfe is reduced to a fomewhat natural time. 
We may then purge, and counter-irritate. Lowering of 
the pulfe may be produced alfo by the regular exhibition 
of digitalis in minute dofes. In that ftate of aqueous ef¬ 
fufion manifefted by partial paralyfis, large doles of this 
drug afford the only means we know of for palliating the 
fufterings of the patient, and relieving the convulfive 
agonies which attend death. And in thofe cafes in which 
all inflammatory fymptoms have gone off, and the patient 
has become quiet and idiotic, this drug will be found by 
no means ufelefs. We know not whether this medicine 
relieves the malady in queltion by its vicarious a&ion on 
the kidneys, or whether it repreffes the irritative inflam¬ 
mation which all morbid depofits tend to excite in the 
ftruCfure they inhabit, whenever the fyftem happens to 
be fubjeCled to the influence of inflaming caufes, as cold, 
&c. but we have lately feen two very marked cafes of 
chronic hydrocephalus cured by the exhibition of fmall 
defies of digitalis in conjunction w ith a very clofe atten¬ 
tion to the digeftive fyftem, and change of air. It is this 
chronic ftate of hydrocephalus in which fir G. Blane pro- 
pefed to bandage the cranium. 
3. Hydrops fipinte, hydro-rachitis or fpina bifida, is a 
difeafe moftly congenital, though occafionally met with 
in adults. It confifts of a “ foft fluctuating extuberance 
W the fpine, with gaping of the vertebra;.” This gaping 
of the vertebras is lateral to the tumour, and arifes from 
the want of the fpinous proceffes of thefe bones. The 
preffure of the tumour of courfe paralyfes thofe parts 
which have their nerves fupplied from the lower portion 
1 
of the fpinal marrow'. The difeafe is, with a very few ex¬ 
ceptions, incurable ; the patient oftentimes dying in a 
few days after the tumour has begun to make rapid ad¬ 
vances. In the few cafes which have been met with in 
adults, it would appear that the preffure of the water 
caufed abforption of the bone; but this is merely fpecula- 
tion. The little that can be done for Hydrops fpinae 
confifts in applying gentle preffure on the tumour from 
its commencement. If this fails, we muft punCture the 
tumour with a fine inftrument, (as a needle,) evacuate the 
contents, and, clofing it carefully to prevent the admif- 
fion of air and consequent inflammation, re-apply the 
preffure for the purpofe of preventing the return of the 
fluid depofit. It is to be remarked, that, when imperfeCt 
offification of the bones of the head, and hydrocephalus, 
exift, then the cafe is nearly hopelefs; for the preffure 
on the tumour moftly caufes the greater proportion of 
water to prels on the brain. When preffure on the tu¬ 
mour feems to do harm, we may prevent its further en¬ 
largement by a concave trufs. 
9. Hydrops feroti, hydrocele, or dropfy of the ferotum: 
foft femi-tranfparent pyriform intnmelcence of the fero¬ 
tum; progreffively enlarging, without pain. Two varie¬ 
ties. 
a. Vaginalis; the fluid contained in the tunica vagina¬ 
lis, or furrounding (heath of the teftis. 
0 . Cellularis; the fluid contained in the cellular mem¬ 
brane of the ferotum. 
Genus II. Emphyfema, [from <pvca.u, to inflate, to dif- 
tend with air.] Inflation; Wind-dropfy. Generic cha¬ 
racters—Elaftic and fonorous diftention of the body or 
its members, from air accumulated in natural cavities. 
We have before fpoken, under Borborygmus, of the 
fuppofition that air may be generated in the human body 
by fecreting veffels. As far as this relates to the prefent 
genus, it derives lupport from thofe cafes in which, upon 
the authority of John Hunter and other accurate obfervers, 
we are informed, that air has been found in cavities where 
neither its admiffion from without nor its generation from 
the putrefaCHve procefs could have been fufpefted. We 
have three fpecies of this kind of Spontaneous generation 
of air to enumerate. 
1. Emphyfema cellulare : tenfe, glabrous, diffufive in- 
tumefcence of the (kin, crackling beneath the preffure of 
the finger. Two varieties, as proceeding, 
a. A vulnere; from a wound of the thorax. 
Though the form of Emphyfema which affeCts the tho¬ 
rax commonly arifes from a wound, inftan£§£ are not 
wanting to (how, that this difeafe may arife from other 
caufes. Thus violent fits of coughing, or other fudden 
exertions, may rupture the air-cells of the lungs, and give 
the air free accefs into the cellular membrane. This ef¬ 
fect more certainly follows if inflammation exifts in the 
ftruCture of the lungs at the time the exciting caufe is ap¬ 
plied. In addition to the fymptoms above mentioned in 
the definition of Cellular emphyfema in general, a fenfe 
of fuftocation, great dyfpncea coming on in fits, and ex¬ 
pectoration of blood, are met with in Emphyfema from 
wounds of the thorax. In the treatment of the difeafe, 
the practitioner is rather occupied with removing the 
inflammation of the lungs which the wound occafions, 
than with the Emphyfema, which in faCt, if not exceffive 
in quantity, will generally fubfide as the pulmonary 
phlogofis goes off. It is to be recolleCted, however, that 
a large collection of air in the cellular membrane fpreads 
very faft, and threatens that ftruCture with mortification. 
Hence it is femetimes neceffary to evacuate the air by 
punCture, and to prevent as much as poffible its reproduc¬ 
tion by preffure. For the mode of operation, fee Surgery'. 
( 3 . E. cellulare a veneno, “ from fiffi-poifon, or other 
venom.” It feems to us a mere popular error to fuppofe 
that the bodies of poifoned perlons fwell before death. 
That this happens afterwards we have no doubt in cafes 
of 
