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far as it is produced by the ophthalmia membranarum, the same remedies may be necessary. As, however, the ophthalmia tarsi may often depend upon an acrimony deposited in the sebaceous glands of the part, so it may require various internal remedies according to the nature of the acrimony in fault ; for which I must refer to the considera. tion of scrofula, syphilis, or other diseases with which this ophthalmia may be connected : and, when the nature of the acrimony is not ascertained, certain remedies, more generally adapted to the evacuation of acrimony, such, for instance, as mercury, may be employed.
289. In the ophthalmia tarsi, it almost constant. ly happens that some ulcerations are formed on the tarsus. These require the application of mercury or copper, either of which may by itself sometimes entirely cure the affection ; and these may even be useful when the disease depends upon a fault of the whole system.
290. Both in the Ophthalmia membranarum, and in the Ophthalmia tarsi, it is necessary to obviate that gluing or sticking together of the eye-lids which commonly happens in sleep; and this may be done by insinuating a little of any mild unctous medicine, of some tenacity, between the eye-lids before the patient shall go to sleep.'
OF PHRENSY OR, PHRENITIS.
291. This disease is an inflammation of the parts contained in the cavity of the cranium ; and may affect either the membranes of the brain, or the substance of the brain itself. Nosologists have apprehended, that these two cases might be distinguished by different symptoms, and therefore by different appellations : but this does not seem to be confirmed by observation and dissection; and therefore I shall treat of both cases under the title of Phrensy, or Phrenitis.
292. An idiopathic phrensy is a rare occurrence, a sympathic more frequent; and the ascertaining either the one or the other is, upon many occasions, difficult. Many of the symptoms by which the disease is most commonly judged to be present, have appeared, when, from certain considerations, it was presumed, and even from dissection it appeared, that there had been no internal inflammation; and, on the other hand, dissections have shewn, that the brain had been inflamed, when few of the peculiar symptoms of phrensy had before appeared.
293. The symptoms, by which this disease may
be most certainly known, are, a vehement pyrexia, a violent deep-seated headach, a redness and turgescence of the face and eyes, an impatience of light or noise, a constant watching and a deliriumi impetuous and furious. Some nosologists have thought these symptoms peculiar to an inflammation of the membranes, and that the inflammation of the substance of the brain was to be distinguished by some degree of coma attending it. It was for this reason, thats in the Nosology, I added the Typhomania to the character of Phrenitis : but, upon farther reflection, I find no proper foundation for this; and, if we pass from the characters above delivered, there will be no means of fixing the variety that occurs.
I am here, as in other analogous cases, of opinion, that the symptoms above mentioned of an acute inflammation always mark inflammations of membranous parts; and that an inflammation of the paronchyma or substance of viscera, exhibits, at least commonly, a more chronic affection.
294. The remote causes of phrensy are all those which directly stimulate the membranes or substance of the brain ; and particularly all those which increase the impetus of the blood in the vessels of the brain. Among these; the exposure of the naked head to the direct rays of a very warm sun, is a frequent cause. The passions of the mind, and certain poisons, are amongst the
remote causes of phrensy ; but, in what männer they operate, is not well understood.
295. The cure of phrensy is the same with that of inflammation in general ; but, in phrensy, the most powerful remedies are to be immediately employed. Large and repeated blood-letting is especially necessary; and the blood should be drawn from vessels as near as possible to the part affected. The opening of the temporal artery has been recommended, and with some reason : but the practice is attended with inconvenience; and I apprehend that opening the jugular veins may prove more effectual; but, at the same time, it will be generally proper to draw blood from the temples, by cupping and scarifying.
296. It is probable, that purging, as it may operate by revulsion, may be of more use in this than in some other inflammatory affections.
For the same purpose of revulsion, warm pediluvia are a remedy; but, at the same time, somewhat ambiguous. The taking off the force of the blood in the vessels of the head by an erect posture, is generally useful.
297. Shaving of the head is always proper and necessary for the admission of other remedies. Blistering is commonly useful in this disease, but chiefly when applied near to the part affected,
298. Every part of the antiphlogistic regimen is here necessary, and particularly the admission of cold air. Even cold substances, applied close to the head, have been found safe, and highly use. ful; and the application of such refrigerants as
299. It appears to me certain, that opiates are hurtful in every inflammatory state of the brain; and it is to be observed, that, from the ambiguity mentioned in 292, the accounts of practitioners, with regard to the juvantia and lædentia in this disease, are of very uncertain application.
300. This name is applied to every inflammation of the internal fauces; but these inflammations are different, according to the part of the fauces which may be affected, and according to the nature of the inflammation. In the Nosology, therefore, after giving the character of the Cynanche as a genus, I have distinguished five different species, which must here likewise be separately considered,