We will consider the treatment of this affection under four separate heads as follows:

1. Preventive Treatment of Apoplexy

This consists chiefly in the careful avoidance of all the known exciting causes of the affection. The predisposing causes should also be avoided as far as possible. A person who has an hereditary tendency to the disease should exercise especial care, and avoid every exciting cause, and should especially abstain from the use of all kinds of stimulating food. Flesh diet is especially injurious for such persons. The diet should consist almost wholly of fruits and grains. Milk may be used freely, but eggs and fish should be used only in moderation. Tobacco, alcohol, tea, and coffee should be utterly discarded.

2. Treatment of Apoplexy During the Attack

When a. patient falls in an apoplectic attack, or is found in a state of unconsciousness exhibiting symptoms of such an attack, energetic measures should be employed at once. To relieve the pressure of blood in the head, ice should be freely applied all about the head, the head being first thoroughly wetted with ice water so as to secure an immediate effect. The shirt collar should be unbuttoned and all clothing about the neck loosened. The head should be raised and the extremities and other parts of the body thoroughly warmed by the application of artificial heat by means of hot bottles, jugs or rubber bags filled with hot water, heated bricks, bags of heated sand or salt, etc.

If the attack is the result of overeating, having followed a heavy meal, an emetic should be given with a large quantity of warm water, so as to prevent violent efforts in vomiting. If the patient does not vomit readily, vomiting may often be induced by tickling the throat with the finger or a feather. Bleeding, a measure so often practiced in apoplexy, is of very doubtful necessity. Trousseau remarks with refer ence to bleeding, "No physician, however, thinks of bleeding for the extravasation of blood under the skin, for he knows how perfectly absurd such a practice would be, and would excite an adverse reaction. There is no difference between it and the cerebral clot."

Dr, Hammond says, "I have never bled a patient for cerebral hemorrhage since 1849, and I am sure that I have had no reason to regret the abandonment of the practice." If the bowels are constipated, they should be relieved by a large, warm-water enema. If water alone is not effective, strong soap-suds may be employed, or a little extract of senna may be added to the water used The routine prattice of giving a cathartic at once is to be condemned.

3. Apoplexy Treatment Immediately After the Attack

Put the patient in a quiet room. Give him a good nurse and exclude all visitors. Continue the application of cold compresses or ice to the head until the danger of inflammation is past, which will be after seven or eight days; keep the extremities well warmed; relieve the bowels daily or every other day by the use of the enema. If the bladder is paralyzed, the urine should be drawn with a catheter two or three times a day. It should be recollected that in some cases when the bladder is paralyzed there will be continual dribbling of urine. The patient's diet should consist of simple, easily digested food, as milk, oatmeal porridge, simple soups, etc. Rich, stimulating food, especially meat and fats of all kinds, should be strictly prohibited. In case the patient is unconscious and unable to swallow food, he should be nourished by means of nutritive solutions injected into the bowels.

If the fever rises quite high, sponge baths or cool compresses about the trunk of the body should be used as in fever from any other cause. A cool enema taken at a temperature of 65 to 80 is a very excellent means of reducing the temperature in these cases. These measures should be employed whenever marked evidences of fever make their appearance. The use of blisters applied to the wrists, ankles, and calves of the legs, are in the highest degree absurd. The application of the blister to the back of the neck is also of very questionable propriety. Bed-sores should be treated by means of alternate hot and cold sponging applied for 20 or 30 minutes twice a day. They should be covered during the intervals with oiled silk or gutta-percha tissue, smeared with vaseline containing ten drops of carbolic acid to the ounce. See also "Bed-Sores" in section devoted to surgery.