APOPLEXY is a disease in which the patient is suddenly deprived of sensation, and incapable of voluntary motion. Although nosologists have included several other affections of the head, under this denomination, yet it is usually divided only into two kinds, the sanguineous and the serous. The symptoms which distinguish the former are, a sound sleep, preceded by giddiness, and attended with snorting, noise in the ears, corruscations before the eyes, and redness of the face. If any thing be put into the mouth, it is immediately returned through the nose; nor can it be swallowed unless the nostrils be closed, in which case there is danger of suffocation. If the patient appear insensible, there is but little hope of his recovery. Sometimes the consequence of this attack is hemiphlegia, or palsy of one side of the whole frame, which is evident from a distortion of the mouth towards the sound side, a contraction of the tongue, and stammering of speech.
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. In many instances, it proves fatal on the first attack; and few survive a repetition of the fit. Those who apparently recover, are frequently carried off, without being warned of its approach.
The usual method of treatment consists in placing the body in an erect posture, and supporting the head in that situation; in copious and repeated bleedings from the jugular veins and temporal arteries, cupping, and the application of blisters to the head, or between the shoulders.
In the serous, or watery apoplexy, the pulse is small and feeble, the complexion pale, and there is a diminution of natural heat.—Upon dissection, the ventricles of the brain have been found to contain a larger quantity of fluid than they ought in a natural state. This species is equally fatal as the other, and may arise from any cause which induces a debilitated state, such as mental depression, excessive study, long watching, &c. It may also be occasioned by too plentiful an use of acidulated drinks. In this alarming complaint, bleeding cannot be attempted with safety: acrid, stimulating purgatives, and emetics, have been employed with a view to carry off the superabundant serum; but, in debilitated habits, they are liable to strong objections. Volatile salts, cephalic elixirs, and cordials, are usually prescribed; which, if a hemiphlegia supervene, may be aided by aperient ptisans, cathartics, and sudorifics, gentle exercise, especially in a carriage; blisters, and such other stimulating medicines, as are proper in paralytic affections.
The opinion, that the immediate cause of apoplexy is an extravasation of fluids, or a preternatural fulness of the vessels, has afforded a subject of much controversy among medical writers. To refute this conjecture, they have quoted an instance of the hydrocephalus, or dropsy of the brain, where the head was increased to more than double its natural size, without producing one apoplectic symptom. Le Cat, in his ingenious Reflection, published in the Philosophical Transactions, relates, that, when he opened the head of M. de Frequienne, late president of the Parliament of Paris, who died of an apoplexy, he found about a tea-spoonful of blood extravasated between the third and fourth ventricles of the brain: hence Le Cat deduces the impossibility of so trifling a quantity being capable of pressing on the origin of the nerves, so as totally to intercept the course of the animal spirits. According to this writer, the extravasated blood, usually found in the brain of a person dying of an apoplexy, so far from being the cause of death, is an accident owing to the convulsive motions of the dura mater (a strong membrane, covering all the cavity of the cranium) as well as the vessels of the whole basis of the scull; and that, in general, it is occasioned by the matter of gout, or rheumatism, settling on this source of the nerves. The swelling and distension of the dura mater, causes a stagnation of the blood vessels of the brain, some of the weakest of which burst, while all the canals of the nerves become constricted and closed; a circumstance which sufficiently accounts for the consequent fatal event. It will not surely be contended, that these ruptured vessels concur in the production of those spirits which impart motion to the heart, as it is well known that this organ receives the influence of numerous nerves at a time, all which ought to share in an accident consisting merely in the rupture of a capillary vessel.
These reflections are here offered, to repress that hypothetical confidence which many practitioners profess for their theories; and to discountenance the precipitate and excessive use of the lancet. This practice is plausibly suggested by an idea, that it is too great a proportion of blood which destroys the patient; but, besides that so ill-founded an opinion may prove fatal to those persons who are liable to apoplectic attacks, a prejudice in favour of the theory may prevent others from inquiring into the true cause, and discovering the remedies adequate to the cure of that fatal disorder.
In Heister's Medical Observations, a case is related, of a person who died of an apoplexy, in consequence of his being constantly exposed to the scent of three or four flower-pots of white lillies, which were kept in his chamber. This melancholy fact should deter those to whom such odours are sensibly prejudicial, from continuing long within the sphere of their deleterious influence.—See Dropsy of the Brain, and Epilepsy.