Acute Inflammation of the Brain and its Membranes requires to be treated on the general principles laid down in Inflammation. Blood-letting is only applicable to the early stage of the disease, occurring in robust plethoric individuals, and the extent to which it should be carried must be left to the judgment of the physician and the circumstances of the case. In Subacute and Chronic Diseases of the Brain, Dr. Holland * justly condemns the indiscriminate and general use of blood-letting, especially in the different forms of Paralysis. He prefers the abstraction of blood by leeches, from the hAemorrhoidal vessels. Dr. Griffin also cautions the practitioner against large bleedings in diseases of the brain, for the following reasons: - 1. Because symptoms are no certain tests of the amount of disease, and we may produce a degree of debility which cannot be contended with. 2. Because in all cases in which extensive diseases of the brain are suspected or known to exist, besides the immediate danger, they produce a degree of debility which would interfere with the process of reparation. 3. Because in all cases of disease of the brain, attended with severe and protracted pain, the patients usually die, not from any mechanical effect of an existing inflammation, but from the exhaustion produced by the pain that accompanies it Under these circumstances, he prefers taking blood away in moderate quantities, watching the progress and symptoms of the case, and being guided entirely by them. In Delirium, attended by high vascular action, a hot dry skin, a flushed countenance, a full bounding pulse, particularly if it occur in a young and robust subject, blood-letting is indicated. It is inadmissible in all cases when there is much prostration of the vital powers; Camphor, Musk, and sedatives being then required.
* Med. Notes and Reflections. Med. Problems.
3005. In Insolation, Coup de Soleil, blood-letting was formerly much employed; but, from the mortality which attended this treatment, in the hands of Dr. Russell and others, it has fallen into comparative disuse. Dr. Morehead,* indeed, goes so far as to say, that he " should have no hesitation in altogether interdicting this proceeding in the treatment of sun-stroke." This is, perhaps, rather too sweeping a direction; but it is certain, that except in young plethoric constitutions, and where vascular action runs high, by far the most successful treatment consists in cold affusion to the head, throat, chest, spine, and epigastrium, the application of ice to the spine, stimulants internally (Ammonia, Ether, weak Brandy and water), and frictions of the surface. In the stage of reaction, leeches to the temples or cupping at the nape of the neck may be required.
3006. In Apoplexy, it was formerly the routine practice to bleed copiously; indeed, such treatment was considered the only one which afforded a chance of recovery. The error of this opinion and practice has been fully shown by Drs. Copland, Holland, Watson, Burrows, Marshall Hughes, Copeman, &c; and it is now generally admitted that this treatment is far from applicable to a large portion of apoplectic seizures. To Mr. Cope-man the profession is indebted for much valuable information on this subject The contra-indications of bleeding in Apoplexy, he observes, are - "when the patient is sixty years of age and upwards; when the pulse is feeble, very frequent, intermitting, slow, or large, and inclined to double beat; when the respiration is laboured, and accompanied with cold perspiration; when there is great mobility of the nervous system, with weak muscles, whether the body be thin or corpulent; when the attack comes on soon after a full meal, or after great mental or bodily fatigue. Whenever the pulse has a double beat, the case is best relieved by diffusible stimulants. In all these cases bleeding is unnecessary or prejudicial, generally." The indications for bleeding are a quick, wiry, resisting pulse, flushed countenance, warm perspirations, noisy breathing, and a tendency to spasmodic, muscular contraction, occurring in persons of an earlier age than sixty. These circumstances seem to point out the necessity for resorting to the abstraction of blood; but Mr. Copeman adds, "that there will be less danger in not bleeding in any case, than in always having recourse to it, where there are some of the circumstances indicative of the propriety of its employment."
* Diseases of India, p. 621.
On Apoplexy, p. 198,