1391. Diseases Of The Head

In Acute Inflammation of the Brain and its Membranes, local or general abstraction of blood should precede the use of Calomel, which should be given in full and repeated doses (gr. ij. - iv. every three or four hours), in order to bring the system as rapidly as possible under its influence. It is, however, a matter of the greatest difficulty to establish salivation in this disease; but Drs. Crawford, Abercrombie, and others consider that Calomel acts most beneficially when we can obtain its full purgative effect. Opium should not be given in combination with the Calomel, as it is likely to aggravate the severity of the symptoms. Blisters to the nape of the neck, or to the extremities, ice to the head, and a strict antiphlogistic regimen, form the other principal points of treatment. The establishment of salivation is generally attended with a marked amelioration of the symptoms.

* Clin. Lect., vol. ii. p. 108, et seq. Obstetric Medicine, p. 497.

Lib. of Med., vol. iii. p. 44. § Op. cit.

1392. In Insanity, the administration of mercurials is occasionally productive of benefit, but much discrimination is required in their use. Dr. Copland's* observations on this point are well worthy of attention. Mercurials, he remarks, are employed for mental disorders, with three intentions, - 1st, to evacuate biliary and fAecal accumulations; 2nd, to improve the secretions, particularly that of the liver; and 3rd, to produce a copious flow of saliva. To fulfil the first of these intentions, Calomel is particularly useful, especially in melancholia and in mania; but should be conjoined with or followed by other purgatives. To produce the second effect, any of the mercurial preparations may be employed, either alone, or with Tartar Emetic, Digitalis, Camphor, &c. To accomplish the third end, Calomel, or Corrosive Sublimate, or Blue Pill, may be given, either combined as above, or alone. The employment of mercurials to an extent likely to produce salivation is of very doubtful propriety, although recommended by some writers. Dr. Prichard remarks, that it is by no means a general remedy for maniacal diseases; but in cases of torpor, with suppression, or a very scanty state of any of the secretions, it is frequently advantageous " Several instances of cure effected by salivation," continues Dr. Copland, "have been recorded by authors; still I believe," he adds, " that Mercury exhibited to the extent necessary to produce the effect, and especially when it fails of causing it, is quite as likely to be as injurious as beneficial - to cause partial insanity, melancholia, and mania, particularly in weak, susceptible, and irritable constitutions. Unfortunately, we know nothing of the symptoms of insanity which indicate probable advantage from mercurial salivation. The most likely conditions are mania or melancholia consequent upon apoplexy, or complicated with hepatic disease. Mercurials, and particularly salivation, are most likely to prove injurious in every form of insanity which has been occasioned by depressing moral, or by exhausting physical causes, and especially by prolonged anxiety or by masturbation. Corrosive Sublimate, however, in minute doses, as an alterative in conjunction with tonics, is sometimes of service in several forms of mental disorder, and particularly in scrofulous constitutions."

* Dict. Pract. Med , vol. ii. pp. 528-9.

1393. In Acute Hydrocephalus, Calomel, for above half a century, has been a standard remedy; but great doubts as to its real utility exist. Dr. Bennett* observes, that, although some cases have appeared to owe their recovery to its administration, yet, in numerous cases, no benefit has resulted, although Mercury has been given in the most judicious manner; whilst in others, recovery has taken place, although it has not been employed at all. Dr. H. Kennedy, indeed, remarks that out of twenty cases of Hydrocephalus of which he has notes, in which the specific effects of Mercury were produced, in not one of them was the result favourable. It is, however, a remedy highly thought of by the German and French physicians. They give it in doses of gr. 1/2 every three or four hours, till it produce green, slimy stools, when they direct it to be suspended for a short time. Ril-liet thinks favourably of it, and advises its persevering use. At the same time he directs cold to the head, sinapisms to the feet, and turpentine glysters. Cathartics should never be omitted.

1394. In Chronic Hydrocephalus, Calomel is strongly advised by Golis and many other eminent authorities. Golis advises it in doses of gr. 1/2, twice or thrice daily, until it purges; and at the same time inunction with Ung. Hydrarg. Fort. The mercurial treatment, however, has been generally superseded by Iodine, Cod Liver Oil, and the external use of Tartar Emetic. When a mercurial treatment is resolved upon, the Hyd. c. Cret. is a good form for internal use.