Apoplexy

“ Adolphus.—Forming my opinion as to the best of my judgment and experience, I would say that the teeth were removed within two or three hours after death. I have never seen a person die of apoplexy, in which the brain [Pg 125] was not injured, but I believe that such cases have occurred in what is called serous apoplexy. There was no serum effused on the boy's brain, nor did it present any unhealthy appearance whatever. He was apparently about fourteen years old, and in no respect did he seem inclined to apoplexy. ”

“ When a person has suddenly lost his powers Hippocrates directs that he should be bled. (Aphor.) Apoplexy, he says, occurs most frequently between the age of forty and sixty. (Ibid.) He says, in allusion to apoplexy (as his commentator Theophilus remarks) , that when persons in good health are suddenly seized with pains in the head, with loss of speech, and stertorous breathing, they die in seven days, unless fever supervene. (Ibid.)
Galen states that apoplexy arises from a cold, thick, and viscid humour obstructing the ventricles of the brain. ”

“ Its operation was quick yet not sudden: it produced no pain,—it left on the form no grim convulsion, on the skin no purpling spot, to arouse suspicion; you might have cut and carved every membrane and fibre of the corpse, but the sharpest eyes of the leech would not have detected the presence of the subtle life-queller. For twelve hours the victim felt nothing save a joyous and elated exhilaration of the blood; a delicious languor followed, the sure forerunner of apoplexy. No lancet then could save! Apoplexy had run much in the families of the enemies of the Visconti! ”

“ Apoplexy can be distinguished from syncope by the pulse, which beats perhaps with unnatural force; the face instead of being pale is generally flushed, and turgid, and the respiration goes on though it may be labored and stertorous. The condition of the sensorial functions is much the same as it is in narcotic poisoning, or when a man is dead drunk. The nurse should make all necessary enquiries so that she can furnish the physician with a full history of the case to help him in his diagnosis. In apoplexy the pulse is rather slow though full, and the pupils of the eyes, one or both, dilated. ”

“ Apoplexy.—In some cases apoplexy is preceded by warning symptoms—headache and giddiness. As a rule apoplexy is a disease of old age, and of stout, plethoric people. If the symptoms do not come on for some hours after food or drink has been taken, this disease is to be suspected; but it may occur at or immediately after a meal, too soon to be the result of the action of narcotics—ten to thirty minutes always elapsing before these poisons act. Apoplexy generally comes on suddenly, coma at once present. It is seldom possible to rouse the person when the sopor of apoplexy is fully developed. ”

“ Paralysis and apoplexy are often, through ignorance, used synonymously, but they really mean very different conditions. Paralysis is a loss of power of contracting a muscle, due to disease or injury of the nervous system; it frequently follows or is associated with apoplexy.
In the case of apoplexy, and most conditions of coma, there is generally little for the attendant to do. The patient should be put to bed, with light coverings, and the head raised on pillows. Do not annoy the patient by trying to rouse him, and do not give stimulants. ”

“ Kirkland speaking of apoplexy, in which there is an instantaneous extinction of the vital principle, relates the case of a mantua-maker, who being at work, was talking cheerfully with some of her friends about her, when her hands dropped down upon her lap, and she was perfectly dead. Forestus relates several similar cases, but hesitates in pronouncing them apoplexy. We have no doubt but that the greater proportion of sudden deaths depend upon diseases of the heart. ”

“ The general cause of sanguineous apoplexy, is a plethoric habit, with a peculiar determination of blood towards the head. Whatever tends to accelerate the circulation, such as surfeits, intoxication, immoderate exercise, and violent passions of the mind, may sooner or later occasion this disease. It seldom, however, occurs till persons have passed the age of sixty, and after a fulness of the veins has for a long time prevailed in the system. ”

“ The most frequent predisposing cause of apoplexy is a general debility of the system, produced by intemperance in eating and drinking. The phenomena of the disease are produced by an effusion of blood or serum, in consequence of a morbid distension, or of a rupture of the vessels of the brain. The pulmonary consumption begins and ends in the same way, allowing only for the difference of [69] situation and structure of the brain and lungs. ”

“ Apoplexy:— "There is a popular idea that whenever a person is taken ill with giddiness, fainting or insensibility, brandy should be at once procured and poured down his throat. Nothing can be more dangerous in apoplexy. This disease is due to the bursting of some blood-vessel in the head, and the poured-out blood presses on the brain and leads to more or less insensibility. If fainting occurs, it may possibly save the patient's life, because then the blood-vessels contract, and the flow of blood ceases immediately ”

“ Next to apoplexy, injuries of the head are most important. The symptoms presented by the patient will often be nearly the same as those of apoplexy. If the skull is fractured, and the depressed bone is exerting pressure upon the brain substance, there is a similar state of affairs to that which exists in apoplexy. Any return to consciousness must be taken advantage of for the administration of the Sacraments. ”

“ APOPLEXY. —A ruptured blood vessel in the brain; usually causes unconsciousness, at least for a time. The control of certain muscles is lost and a general dullness prevails over the animal. In case the apoplectic attack runs a favorable course, the muscles come more or less under control again and the patient in time may recover. It is in rare cases only, however, that animals recover to an extent to be worth much after being affected with apoplexy. Fortunately the disease in animals is rare. ”

“ The instances of individuals who have died of apoplexy, either of the cerebrum or cerebellum, during coition, are by no means rare. We can readily imagine, that if there be a marked disposition to this disease, and that if it be disposed to come on, the derangement in the respiration and circulation produced by the venereal action might hurry it. This has happened more than once during the digestion of a full meal. Most old men who have died during coition, have been affected with apoplexy. Hence, authors have generally placed venereal excesses among the causes of this affection. ”

“ In epilepsy the patient always loses consciousness. Apoplexy never produces tetanic convulsions. Perhaps I might be allowed to say that when there is effusion of blood upon the brain, and a portion of the brain is involved, the muscles may be thrown into short tetanic convulsions. In such case the consciousness would be destroyed. Having heard described the symptoms attending the death of the deceased, and the post-mortem examination, I am of opinion that in this case there was neither apoplexy nor epilepsy. ”

“ Where, however, the apoplexy does not destroy its victim in a short space of time, it may be subdued and the animal temporarily cured; but only for awhile; it invariably dies soon afterwards of inflammation of the brain. Sometimes apoplexy will run, like an epidemic, through a whole piggery, and where this is the case the causes of it must be diligently sought out and carefully removed. ”

“ The whole Difference between these two Species consists in this, that the sanguineous Apoplexy prevails among strong robust Persons, who have a rich, heavy, thick and inflammable Blood, and that in a large Quantity; in which Circumstance it becomes a genuine inflammatory Distemper. The serous, or humoral Apoplexy invades Persons of a less robust Constitution; whose Blood is more dilute or watery; and rather viscid, or lightly gelatinous, than heavy or rich; whole Vessels are in a more relaxed State; and who abound more in other Humours than in red Blood. ”

“ Mr. Palmer said he was of the same opinion as myself with respect to the death of the deceased. I never knew apoplexy produce rigidity of the limbs. Drowsiness is a prelude to apoplexy. I attributed the sickness of the first two days to a disordered stomach. Mr. Cook never sent for me himself.”
The examination of Dr. Todd by the Attorney-General was then proceeded with, as follows: Having heard the deposition of Dr. Bamford read, I do not believe that the deceased died from apoplexy, or from epilepsy. ”

“ When these are combined with headache patients often become seriously disturbed and begin to dread the occurrence of apoplexy. While these are premonitory symptoms of cerebral hemorrhage in those whose arteries are degenerated, patients must be made to understand that just because the fingers or hand or arm go to sleep occasionally, even though there may be complaint of headache, these are not indications of impending apoplexy unless other objective symptoms are present. Subjective symptoms alone can never mean much as regards organic disease. ”

“ There is really no doubt that the morbus sacer of the ancients and the cases of demoniacal possession of which we read were cases of epilepsy (Hippoc. de Morbo Sacro) . Concerning apoplexy he says that a slight attack is difficult to cure, and a severe one utterly incurable. The cause of the attack he considered was turgidity of the182 veins. We know it to be often associated with cerebral hæmorrhage or sanguineous apoplexy and sometimes with effusion of serum = serous apoplexy. Hippocrates therefore came very near the truth. ”

“ Q. Did you never hear of any person dying of an epilepsy or of an apoplexy with symptoms like those, being in convulsions?
A. I do not think the symptoms described as having taken place in Sir Theodosius Boughton are like to an epilepsy.
Q. Nor an apoplexy?
A. They were entirely in my opinion the effects of the draught.
Q. Might not an epilepsy or an apoplexy be accompanied with those symptoms?
A. I never saw either of them attended with an heaving at the stomach.
Q. When respiration grows feeble; is it not a common case that the muscles of the throat are very much relaxed? ”

“ Any peculiar feeling, such as that of the hand or foot going to sleep, is set down at once as a symptom of a serious nervous disease, or if the patient has heard that in old people numbness of the extremities is a forerunner of apoplexy, he is sure to conclude that apoplexy is threatening in his own case. ”

“ A number of neurotic symptoms are always added to whatever manifestations of mind and the somatic system may develop as a consequence of the cerebral apoplexy, and these are treated more effectually by mental reassurance than in any other way. Besides, apoplexy confines people to the house who have often been vigorous and active before, and this confinement with deprivation of exercise and air and consequent disturbance of appetite and digestive functions, acts as a serious factor in the production of neurotic symptoms. ”

“ Well, then, Sir Gervaise, as commander-in-chief, you'll be obeyed, I think. Sir Wycherly Wychecombe is suffering under an attack of apoplexy—or [Greek: apoplêxis] , as the Greeks had it. The diagnosis of the disease is not easily mistaken, though it has its affinities as well as other maladies. The applications for gout, or arthritis—sometimes produce apoplexy; though one disease is seated in the head, while the other usually takes refuge in the feet. ”

“ ETIOLOGY.—The causes of meningeal apoplexy are predisposing and immediate. The most important predisposing cause consists in disease of the cerebral vessels, especially the arteries, which favors the formation of so-called miliary aneurisms, as demonstrated by Charcot and Bouchard in the case of cerebral apoplexy. Disease of the vessels in its turn arises from various conditions, among which alcoholism in adults holds a prominent place from its tendency to favor a fatty degeneration of the vascular walls. ”

“ Thus in persons affected with apoplexy an ordinary dose of opium may accelerate death; and in people even with a mere tendency to apoplexy, if it is strongly marked, or appears from what are called warning symptoms to be on the point of developing itself, a common dose of such narcotics as occasion determination to the brain may excite the apoplectic attack. Thus, too, in cases of inflammatory disorders of the alimentary canal, irritating substances, in doses not otherwise injurious, may produce dangerous impressions on the tender membrane with which they come in contact. ”

“ Cerebral apoplexy is an extremely serious organic disease that seems surely to be an affection for which psychotherapeutics can mean little or nothing. When an artery has burst in the brain and blood is either actually flowing out or has flowed out in damaging quantities into the delicate brain tissues, seriously injuring and perhaps destroying some of them forever, no amount of mental assurance will do any good for the organic lesions that have been produced. ”

“ In true apoplexy certain peculiar changes in pulse, respiration, and temperature can always be expected, and these differ from those noted in catalepsy. The stertorous breathing, the one-sided helplessness, the usually flushed face, the conjugate deviation of the eyes and head, the loss of control over bowels and bladder, are among the phenomena which can be looked for in most cases of apoplexy, and are not present in catalepsy.
It is hardly probable that a cataleptic will often be supposed to be drunk, or a man intoxicated to be a cataleptic ”