Inflammation of the Brain may be chronic or acute; the Brain itself may be attacked, or merely the investing membranes; and usually the pain is greater in the latter than in the former case. But pain in the head is sometimes sympathetic; the consequence of disease in other parts of the body; and pains in other parts of the body may be the result of disease of the Brain. Dr. Stokes relates some curious cases illustrative of these points. "A lady got a pain in the lower part of the Tendo Achillis, (the large tendon of the heel), which was considered to be rheumatic, and very little notice taken of it. There was no swelling, heat, or tenderness on pressure, in the painful part, and the nature of the disease was so imperfectly understood that all the efforts of her medical attendants were directed to the heel, but without any benefit whatever. Matters remained in this state for some time, when she was suddenly attacked with convulsions and coma, and died. On opening the head some hours after, a large abscess, together with an apoplectic effusion, was found to exist in the brain." "A gentleman, labouring under a painful affection of the face, which was supposed to be tic douloureux, had been subjected to a great variety of treatment without success; but, it has been since proved that the tic douloureux was a mistake, as the complaint was successfully treated by shaving the head, and applying leeches and an iced cap over the seat of the suspected irritation. Since then, whenever an attack comes on, he immediately gets a bladder containing a quantity of pounded ice, applies it to his head, and in this way obtains relief."

In acute inflammation of the Brain, commonly called Brain fever, there is generally "high fever, a strong bounding pulse, throbbing of the carotid arteries, intense pain of the head, great brilliancy of the eye, with intolerance of light, vivid redness of the face, a ferocious countenance, and furious delirium."

But, although pain usually accompanies acute inflammation of the Brain and its membranes, pain in the head is not always to be considered as evidence that inflammation exists, Dr. Stokes says:"In many cases of hysteria, the headache and determination of blood to the head are violent, and yet unconnected with inflammatory action. I know a young lady who is frequently attacked with most agonising headache, accompanied by violent throbbing of the carotids, and great heat of the face and scalp. Yet, in this case it is plain that the pain cannot be inflammatory, for she has been subject to the;e attacks once or twice a week for the last six years, and yet continues otherwise in a state of good health. If her disease were to be measured by the violence of the pain and determination of blood to the head, it would be natural to expect that death would have long ago put a period to her sufferings."

Although, in a general way, the more the intellect is disturbed the greater is the mischief going on in the brain, still, we may have extensive and fatal disease of the brain without delirium; and we may have delirium without any actual disease of the brain.

Acute inflammation of the Brain is a very dangerous complaint, and requires very prompt and active treatment. "The patient may die of the inflammation, or, if you subdue this, of the chronic disorganisation which frequently follows, terminating in apoplexy, paralysis and other consequences. On the other hand, it is consolatory to reflect that experience has proved the possibility of curing both general and local inflammation of the Brain."

In acute inflammation of the Brain, or Brain fever, active measures must be adopted. Bleeding, and that in sufficient quantity to make an impression upon the system,-must be resorted to. It will often happen that, from the uncontrollable state the patient is in, it is dangerous and almost impossible to bleed him. Here you must endeavour to moderate the delirium, and there is no way in which you can do this so fully as by dashing cold water over the head. Where there is much delirium it is always a good plan to throw a few basins of cold water over the patient's head before bleeding. In this way you may procure an interval of comparative tranquility, during which you can open a vein or an artery with convenience and safety. There has been a difference of opinion amongst medical men, as to whether it was better to bleed from the arm or to open an artery in these cases. On the whole, bleeding from the arm is considered the safest, as, should the patient-after the opening of an artery-tear off the bandage while in a fit of delirium, he may bleed to death before assistance can be obtained. Accidents of this kind have occurred. The quantity of blood to be taken away must be regulated by the age, strength and constitution of the patient, as also by the intensity of the disease. From the excited condition of the Brain, it is difficult to produce fainting.

The next step is to get the head shaved: this should never be neglected. After shaving the head, a number of leeches (if they can be obtained) should be applied. I have known as many as forty leeches applied to the head at one time; and half that number the following day, and with the best effect.

After the leeches, the head should be kept as cool as possible with cold lotions or affusions. One of the best modes of applying cold is to put pounded ice in a long flannel bag, pointed at one end, like a jelly-bag; this should be hung up at the head of the bed, with the point of the bag about 9 or 10 inches above the patient's head. The warmth of the room will cause the ice to dissolve gradually, and it will fall, drop by drop, upon the patient's head. Of course, care must be taken, by means of cloths properly placed, to prevent the water soaking into the bed. A vessel of ice and water may also be kept at the bedside, and cloths squeezed out of the same applied to the head. But, if this mode is adopted, the cloths should be changed every two or three minutes, and the cloths, after being taken off the head, should be wrung out in cold water before being put into the iced water, and in this way the ice will be so much longer before it is dissolved.

Dr. Stokes says: "But one of the best modes of applying cold to the head is that recommended by Dr. Abercrombie, and, as far as my experience goes, I can safely affirm that there is scarcely any remedy of such unequivocal value in acute inflammation of the Brain or its membranes. Dr. Abercrombie's mode is this-the scalp being first shaved, you direct the patient's head to be held over a basin, and then taking a jug of cold water, pour its contents over the head from some height in a small continuous stream. This measure, simple as it may appear, is one of extraordinary efficacy. In fact, so great and so instantaneous is the depression of the vital power produced by this mode that it must be used with caution. There are numerous cases of persons in the highest state of maniacal excitement,reduced in a few moments to a low and weak state by this powerful remedy. In acute inflammation this form of cold affusion should be employed every hour or half hour, according to circumstances, and if you wish to increase its efficacy you can do it by placing the patient's feet in warm water at the same time.

If a sufficient quantity of blood has been taken from the arm at once, followed by leeches, it may not be necessary to repeat the bleeding; but, it may be necessary to repeat the leeches, in severe oases, even several times.

Blisters to the head are apt to cause considerable irritation, and are therefore not advisable, except when the patient is in a state of coma (insensibility), with a cool skin; in this case the stimulus of a blister is frequently found to be useful. Blisters may, however, sometimes be applied to the nape of the neck with advantage.

The bowels must be kept open by means of purgatives, which may be frequently repeated. Much benefit has been derived from the use of brisk cathartics, even after insensibility has set in. Any of the cathartics previously ordered in this work,-Nos. 3 or 4; or a mixture of Epsom Salts and Senna Tea; or, if the bowels are very sluggish, the following pills may be taken:-

Compound Extract of Colocynth........... 40 Grains.

Extract of Rhubarb............................ 20 Grains.

Oil of Cloves..................................... 12 Drops.

Mix and divide into twelve Pills, of which two may be taken every three or four hours till they operate. Or the following:-

Croton Oil........................................ 6 Drops.

Oil of Cloves..................................... 13 Drops.

Crumb of Bread, sufficient to make twenty-four pills. Two to be taken every three or four hours till they operate.

If the above should fail to give relief, their action may be assisted by enemas of Castor Oil, mixed up with yolk of egg, and afterwards with water; or half a pint of Linseed Oil, warmed, may be used.

In addition to medical treatment, the patient must be kept perfectly quiet; the room should be kept cool and well aired; and rather dark; the bed covering should he light, the attendants few.

In all cases of disease of the Brain, attention must be given to the state of the bladder, as in these cases there is very often retention of urine; when this is the case, the bladder must be emptied by means of a catheter, two or three times a day.

Emetics should never be given in Brain fever.

In all cases where there is congestion of the Brain, Opium is likely to be injurious, "but when all the symptoms of active inflammation have passed away, and when there remains a peculiar nervous condition of the Brain, characterised by symptoms of mental excitement and watchfulness, somewhat resembling delirium tremens, here I believe you may have recourse to Opium with much benefit."

It sometimes happens, in cases of Brain fever, that the patient is quite unmanageable, and it is absolutely necessary, for the patient's own safety, to put on a "straight-waistcoat;" this, however, should never be done unless it is absolutely necessary, and the patient so violent as to be likely to do mischief to himself or others; as the frequent effect of restraint is that the patient becomes irritated by the confinement, and makes the most violent efforts to free himself; his struggles increase the excitement of the Brain, and prevent the measures you employ from taking proper effect. Therefore, although coercion is sometimes necessary, it must be used with great caution, and no longer than is absolutely necessary.