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symptoms proceeded from hepatic and gastric disorder, and nothing was done for the relief of the cerebral symptoms beyond giving him occasional doses of blue pill in combination with extract of rhubarb, mineral acids, and bitter infusions. In a few months from the appearance of the numbness he became parayltic, and died in this state eight weeks subsequently. An encysted abscess was found after death in the left hemisphere of the brain.
A boy received a violent blow on the head from a cricket bat. He did not appear to suffer any inconveniences from the injury until ten or eleven years afterwards, when he became subject to paroxysmal attacks of headache, associated with extreme vertigo, clearly of an epileptic character. He eventually had a succession of severe attacks of epilepsy, which continued for a period of five years. He ultimately died in a violent epileptic paroxysm. An encysted abscess, of the size of an egg, was found in the cerebellum.
What course of treatment would I advise under these circumstances? In severe blows upon the head it is important to keep in check all tendency to cerebral congestion and inflammation in the portion of the brain immediately under the part of the scalp and skull that has been injured. By closely watching for local cerebral disorder, we may prevent those states of chronic irritation, congestion, and inflammation that so frequently induce disorganization of structure in the form of tumours, softening, and abscesses. In the days of Pott, veneseetion was almost universally practised afizer the head had received a mechanical injury. This mode of treatment has, in modern times, been altogether exploded. In these cases the local abstraction of blood by means of leeches applied over, or in the immediate neighbourhood of the injury is decidedly advantageous in preventing the development of organic alterations in the brain. It
TREATMENT AFTER INJURIES TO THE HEAD.
will often be necessary also to give mercurials, and to apply cold evaporating lotions to the head.
I have, in some cases of severe cranial injury, applied a seton to the nape of the neck, as well as issues in Me scalp near file siluafz'on 0f l'lm blow, when I have had reason to believe that local, cerebral, and meningeal mischief existed. It may often be necessary, in particular diatheses, to sustain the vital powers by means of iron, quinine, stimulants, and generous diet, whilst the cerebral irritation and congestion is being attacked by the means suggested. I am satisfied that it is in our power to arrest the progress of the fatal cerebral disorganization that so often follows, after the lapse of years, injuries to the head, if we do not sleep at our posts, and are on the look-out for the first scintillations of brain disorder. It is our duty, under such circumstances, to watch for head symptoms. “ It is not enough,” as Dr. Graves remarks, when referring to the obscure cerebral affections observed in some cases of fever, “ to treat them when they come, they MUST BE SEEN and MET COMING.” \Vise and sagacious counsel !
I have paid anxious attention to this subject, and, as the result of much experience, I am fully convinced that in many instances the advance of softening, tumours, and abscesses of the brain has been checked by means of the local head, combined with the constitutional treatment previously referred to.
I have spoken of impairment of attention, the effect of certain morbid conditions of the cerebral health. Such cases of psychical debility are generally associated with a depressed state of the nerve and vital force, impoverished condition of the blood, and impaired state of the nutrition of the brain. A stimulating plan of treatment, generous diet, cod-liver oil, combined with the sulphate and valeria
nate of zinc, quinine, iron, and other blood tonics, are valuable remedies in these cases. In instances of impaired intelligence, associated with active head symptoms, vertigo, headache, &c., such as to justify the belief that capillary congestion exists, judicious local depletion and counter-irritation are often of much service. The abstraction of blood, however, is rarely necessary in these cerebro-psychical afl'ections, and yet I have known patients to be greatly relieved by a modified course of antiphlogistic treatment. Minute doses of strychnine are occasionally indicated, and the various preparations of arsenic, with and without iron, and ammoniated solution of copper, I have found to afford considerable tone to the brain and mind, if judiciously administered. I am of opinion that the therapeutic value of arsenic and copper are not sufficiently appreciated in the affections of the brain and nervous system, particularly if associated with states of vital depression.
The faculty of attention, like that of memory, is susceptible of being greatly cultivated and strengthened by a regular and continuous exercise of its powers. Habits of slovenly thought and careless attention are easily formed, and when once contracted not easily combated. The effort to subject the attention to the controlling influences of the will may at first be difficult, but all obstacles will vanish before a steady and unrelaxed determination to conquer and bring into a state of subjugation the restive faculty. “ When we turn," says Sir \V. Hamilton, “ for the first time, our view on any given object, a hundred other things still retain possession of our thoughts. Even when we are able, by an arduous exertion, to break loose from the matters which have previously engrossed us, or which every moment force themselves on our consideration, even when a resolute determination, or the attraction of the new object,
ON THE CULTIVATION or THE FACULTY or ATTENTION. 67 7
has smoothed the way on which we are to travel, still the mind is continually perplexed by the glimmer of intrusive and distracting thoughts, which prevent it from placing that which should exclusively occupy its view in the full clearness of an undivided light. How great soever may be the interests which we take in the new object, it will, however, only be fully established as a favourite, when it has been fused into an integral part of the system of our previous knowledge, and of our established associations of thoughts, feelings, and desires. But this can only be accomplished by time and custom. Our imagination and our memory, to which we must - resort for materials with which to illustrate and enliven our new study, accord us their aid unwillingly, and indeed only by compulsion. But if we are vigorous enough to pursue our course in spite of obstacles, every step as we advance will be found easier; the mind becomes more animated and energetic, the distractions gradually diminish, the attention is more exclusively concentrated upon its object, the kindred ideas flow with greater freedom and abundance, and afford an easier selection of what is suitable for illustration. At length our system of thought harmonizes with our pursuit. The whole man becomes, as it may be, philosopher, historian, or poet ; he lives only in the trains of thought relating to this character. He now energises freely, and consequently with pleasure, for pleasure is the reflex of unforced and unimpeded energy. All that is produced in this state of mind bears the stamp of excellence and perfection.“ I have yet to address myself to the treatment, medical and moral, of impairment and loss of memory. In such cases, clearly the effect of physical disease or irri
' “Lectures on Metaphysics," by Sir W. Hamilton, Burt. Vol. i. p. 255.
tation established in the brain, or in seme part of the body closely sympathising with this organ, no good will result from an attempt to strengthen or revivify this mental power, apart from a careful pathological investigation of the cerebral state of the patient, and the adoption of a mode of p/lj/sz'cal and psychical treatment suggested by such examination. In all acute affections of the brain damaging the memory, it is useless to battle with a aymlvlom, to treat an qfiecf, without carefully considering the cause. Great benefit occasionally results from the exhibition of stimulants in certain cases of impaired memory consequent upon an exhausted condition of the nerve and vital force.
In less acute conditions of defective memory, advantage undoubtedly accrues from judicious attempts on the part of the patient to revivify the faculty, but if these efforts should he succeeded (as is occasionally the case) by vertigo, headache, or other corporeal symptoms of distress, the mind should be left in a passive state, until the cerebral condition is such as to justify a repetition of the experiment. It occasionally occurs that a language, apparently forgotten, has been suddenly revived during the effort made to seize hold of and resuscitate past impressions. \Vhen making these efforts we should be careful not to strain the faculty beyond justifiable limits. How often the attempt to recall ideas to the mind is abortive? Under these circumstances, if the brain is permitted to be in a quiescent state, the ideas will frequently recur to the mind spontaneously. If I were permitted to theorise on the subject, I should be inclined to suggest, that the endeavour thus made to remember past impressions establishes a cerebral and psychical oscillating movement, which continues in the vesicular neurine of the brain after we cease to make any conscious effort to resuscitate apparently obliterated ideas.