SECT. I.
Of Diseases of the Head,
Of the Apoplexy.
The apoplexy is a disease, wherein the patient falls down motionless, void of sense and sensation, and is, in fact, a temporary death. It will scarce however admit of a strict definition; for there are not only various degrees of this disorder, but even different disorders under the same denomination, that have quite distinct different causes for their effect. Many indeed may be accounted for, but many more cannot.
The brain is the root of the nerves, and consequently the fountain of all sensation, and life itself. That part of the human fabric is extremely delicate, and blood vessels plentifully distributed. When therefore these vessels become either so distended with blood, so as to press the substance of the brain, that it is hindered from its motion, confusion to the animal œconomy must naturally ensue; thence an apoplexy in its various gradations is liable to be the consequence; but as the vessels in such a distention are liable to break, and the extravasated blood pressing the brain more forcibly without a chance of dispersing, we plainly see one reason, why such a malady is apt to turn out fatal, as we find it sometimes does.
Such causes may either proceed from external, or internal injuries; thence we see that a heavy fall, or contusion on the head, may occasion an apoplexy, or at other times, a congestion of blood to the head may produce the same malady.
Sometimes the patient is motionless; and to all appearance dead, and nothing but a faint pulsation remains; at other times there is indeed more signs of life, but more terrible in appearance,—namely a convulsive breathing and foaming at the mouth, without the least signs of sensation or perception; in which case there is much to be feared, that vessels in the brain are burst.
However in all these extremities, nothing can contradict the indication of bleeding, except extreme weakness, and debility of the system; which here is very rarely the case.—After bleeding, a large blister between the shoulders should immediately be applied, and treated as directed in the second lecture, page 75.—A draught like No. [XXX]. will also be of singular service, till the patient comes to; after which he will require such treatment as is directed under fevers; for that disorder will always attend the shock that the apoplexy gives to the animal system.
Of the Frenzy and Delirium.
When the root of the nerves are stimulated by acrimony, so as to heighten their sensibility, or set their regulated perception in confusion, the ideas become bewildered, and the sensations act at random. This is generally the case with patients in acute and malignant fevers; and this conception differs from dreaming in this respect, that the phantoms of the confused imagination may be somewhat guided by the objects around them; as they may be said to dream with their eyes open and full awake.
When the frenzy attends acute fevers, the blood is generally in a great confusion, and the pulse high and fluctuating. Yet bleeding should by all means be avoided, unless indeed the disorder has come on remarkably sudden. Blisters here are requisite; and in order to take off the stimulus of the nerves, give the patient the following draught.
No. XXXI
Take Fever Powder (L) one Scruple; Liquid Laudanum, (T) ten Drops; Spirit of Wine and Camphor (A) twenty Drops; Essential Oil of Peppermint (U), four Drops upon a lump of Sugar; Water half a Tea Cup full.
This draught may be taken every fourth or sixth hour; and now and then a grain of calomel may with great success be added to it. Cooling clysters in this case are also of singular service; for example:
No. XXXII
Take cold water, eight ounces; Nitre, or instead of this[[16]] Fever Powder (L) two drachms; spirits of Camphor (A) thirty drops, mix them.
[16]. The fever powder may be steept in a little water before hand, and the clear poured off, because nothing but the nitre here is useful.
If the patient is very costive, a little honey and soap may be added, previously dissolved; which will both open the body, and promote urine.
For the rest, every method must be taken as is already observed in fevers.
Of a Stupor, and Lethargy.
This is a symptomatic affliction, that attends acute and malignant fevers, in its nature quite opposite to the former; in which the nervous system is benumbed, and have lost their sensation; this is very apt to succeed, but seldom precede the Frenzy. When a patient lays in that kind of stupefaction in a continual dosing, there is in general little hopes of recovery; nevertheless remedies must be applied.
Blisters here are very proper, and these should be pretty large. Horse radish should be frequently held to the nose, which has a reviving quality, and is very innocent with respect of adding acrimony to the system.
A vomit has often in this extremity proved very beneficial; which the patient’s weakness should not retard, unless very weak and near the end indeed. The following draught may also prove highly beneficial.
No. XXXIII
Take Sweet Spirit of Nitre (D) one drachm; Essential Oil of Peppermint (U) ten drops upon a lump of sugar; water one ounce, mix them.
Let the patient take this every four or six hours, till he comes to himself again:
But care should be taken that a good sound sleep, is not mistaken for a stupor; for it frequently happens that a patient upon a favourable crisis will fall into a long sound deep, that terminates all his danger; if therefore the patient breathes freely, and has a moistness all over the body, together with a tolerable regular pulse, disturb him not; but let nature finish her gracious work.—This kind of sleep is materially different from the stupor, wherein the patient neither sleeps nor wakes, but is equally insensible when the eyes are open, as when they are shut.
Of a Violent Head-Ach.
A Violent head-ach often attends fevers, or comes spontaneously without; it generally precedes a delirium, as the irritation of the nerves is the principal cause thereof.
The first intention must be to draw the humours from the head. A compress with vinegar, in which is dropt a little spirits of wine and camphor, is of great service, and will often have the defined effect to carry it off. Warm foot-baths also is of great use; a blister may be applied, and the draught No. [XXXIV]. will also prove of great service.
The head-ach may proceed from many other different causes, and in the general is only a symptomatic affection; therefore particular attention should be had to the primitive seat of the disorder.—Frequently a foul stomach will occasion the head-ach, and a vomit most times prove the best application.