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DOMESTIC MEDICINE

CHAP. XXVI.

OF THE PHRENITIS OR INFLAMMATION OF THE BRAIN.

THIS is sometimes a primary disease, but oftener only a symptom of some other malady; as the inflammatory, eruptive, or spotted fever, &c. It is very common however as a primary disease in warm climates, and is most incident to persons about the prime or vigour of life. The passionate, the studious, and those whose nervous system is irritable in a high degree, are most liable to it.

CAUSES. - This disease is often occasioned by night-watching, especially when joined with hard study: It may likewise proceed from hard drinking, anger, grief, or anxiety. It is often occasioned by the stoppage of usual evacuations; as the bleeding piles in men, the customary discharges of women, &c. Such as imprudently expose themselves to the heat of the sun, especially by sleeping without doors in a hot season with their heads uncovered, are often suddenly seized with an inflammation of the brain, so as to awake quite delirious. When repellents are imprudently used in an erysipelas, an inflammation of the brain is sometimes the consequence. It may likewise be occasioned by external injuries, as blows or bruises upon the head, &c.

SYMPTOMS. - The symptoms which usually precede a true inflammation of the brain are pain of the head, redness of the eyes, a violent flushing of the the face, disturbed sleep or a total want of it, great dryness of the skin, costiveness, a retention of urine, a small dropping of blood from the nose, ringing of the ears, and extreme sensibility of the nervous system.

WHEN the inflammation is formed, the symptoms in general are similar to those of the inflammatory fever. The pulse indeed is often weak, irregular, and trembling; but sometimes it is hard and contracted. When the brain itself is inflamed, the pulse is always soft and low; but when the inflammation only affects the integuments of the brain, viz. the dura and pia matter, it is hard. A remarkable quickness of hearing is a common symptom of this disease; but that seldom continues long. Another usual symptom is a great throbbing or pulsation in the arteries of the neck and temples. Though the tongue is often black and dry, yet the patient seldom complains of thirst, and even refuses drink. The mind chiefly runs upon such objects as have before made a deep impression on it; and sometimes, from a sullen silence, the patient becomes all of a sudden quite outrageous.

A CONSTANT trembling, and starting of the tendons, is an unfavourable symptom, as are also a suppression of urine; a total want of sleep; a constant spitting; a grinding of the teeth, which last may be considered as a kind of convulsion. When a phrenitis succeeds an inflammation of the lungs, of the intestines, or of the throat, &c. it is owing to a translation of the disease from these parts to the brain, and generally proves fatal. This shews the necessity of proper evacuations, and the danger of repellents in all inflammatory diseases.

THE favourable symptoms are, a free perspiration, copious discharge of blood from the nose, the bleeding plies, a plentiful discharge of urine which lets fall a copious sediment. Sometimes the disease is carried off by a looseness and in women by an excessive flow of the menses.

AS this disease often proves fatal in a few days, it requires the most speedy applicatons. When it is prolonged, or improperly treated, it sometimes ends in madness, or a kind of stupidity which continues for life.

IN the cure, two things are chiefly to be attended to, viz. to lessen the quantity of blood in the brain, and to retard the circulation towards the head.

REGIMEN. - The patient ought to be kept very quiet. Company, noise, and every thing that affects the senses, or disturbs the imagination, increases the disease. Even too much light is hurtful; for which reason the patient's chamber ought to be a little darkened, and he should neither be kept too hot nor cold. It is not however necessary to exclude the company of an agreeable friend, as this has a tendency to sooth and quiet the mind. Neither ought the patient to be kept too much in the dark, lest it should occasion a gloomy melancholy, which is too often the consequence of this disease.

THE patient must, as far as possible, be soothed and humoured in every thing. Contradiction will ruffle his mind, and increase his malady. Even when he calls for things which are not to be obtained, or which might prove hurtful, he is not to be positively denied them, but rather put off with the promise of having them as they can be obtained, or by some other excuse. A little of any thing that the mind is set upon, though not quite proper, will hurt the patient less than a positive refusal. In a word, whatever he was fond of, or used to be delighted with when in health, may here be tried, as pleasing stories, soft music, or whatever has a tendency to sooth the passions, and compose the mind. Boerhaave proposes several mechanical experiments for this purpose; as the soft noise of water distilling by drops into a bason, and the patient trying to reckon them, &c. Any uniform sound, if low and continued, has a tendency to procure sleep, and consequently may be of service.

THE aliment ought to be light, consisting chiefly of farinaceous substances; as panado, and water-gruel sharpened with jelly of currants, or juice of lemons, ripe fruits roasted or boiled, jellies, preserves, &c. The drink small, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only render the liquor more palatable, but likewise more beneficial, as they are of an opening nature.

MEDICINES - In all inflammation of the brain, nothing more certainly relieves the patient than a free discharge of blood from the nose. When this comes of its own accord, it is by no means to be stopped, but rather promoted, by applying cloths dipped in warm water to the part. When bleeding at the nose does not happen spontaneously, it may be provoked, by putting a straw, or any other sharp body up the nostril.

BLEEDING in the temporal arteries greatly relieves the head; but as this operation cannot always be performed, we would recommend in its stead bleeding in the jugular veins. When the patient's pulse and spirits are so low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. These not only draw off the blood more gradually, but by being applied nearer to the part affected, generally give more immediate relief.

A DISCHARGE of blood from the haemorrhoidal veins is likewise of great service, and ought by all means to be promoted. if the patient has been subject to the bleeding piles, and that discharge has been stopped, every method must be tried to restore it; as the application of leeches to the parts, sitting over the steams of warm water, sharp clysters or suppositories made of honey, aloes, and rock-salt.

IF the inflammation of the brain be occasioned by the stoppage of evacuations either natural or artificial, as the menses, issues, setons, or such like, all means must be used to restore them as soon as possible, or to substitute others in their stead.

THE patient's body must be kept open by stimulating clysters or smart purges; and small quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the case be dangerous, may be used in the space of twenty-four hours.

THE head should be shaved and frequently rubbed with vinegar and rose-water. Cloths dipped in this mixture may likewise be applied to the temples. The feet ought frequently to be bathed in lukewarm water, and soft poultices of bread and milk may be kept constantiy applied to them.

IF the disease proves obstinate, and does not yield to these medicines, it will be necessary to apply a blistering plaster to the whole head.

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