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DOMESTIC MEDICINE

CHAP. XLI.

OF THE APOPLEXY.

THE apoplexy is a sudden loss of sense and motion, wherein the patient is to all appearance dead; the heart and lungs however still continue to move. Though this disease proves often fatal, yet it may sometimes be removed by proper care. It chiefly attacks sedentary persons of a gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in winter, especially in rainy seasons, and very low states of the barometer.

CAUSES. -The immediate cause of an apoplexy is a compression of the brain, occasioned by an excess of blood, or a collection of watery humours. The former is called a sanguine, and the latter a serous apoplexy. It may be occasioned by any thing that increases the circulation towards the brain, or prevents the return of the blood from the head; as intense study; violent passions; viewing objects for a long time obliquely; wearing any thing too tight about the neck, a rich and luxurious diet; suppression of urine; suffering the body to cool suddenly after having been greatly heated; continuing long in a warm bath; the excessive use of spiceries, or high-seasoned food; excess of venery; the sudden striking in of any eruption; suffering issues, setons, &c. suddenly to dry up, or the stoppage of any customary evacuation; a mercurial salivation pushed too far, or suddenly checked by cold; wounds or bruises on the head; long exposure to excessive cold; poisonous exhalations, &c. I knew a woman who in a violent fit of anger was seized with a sanguine apoplexy. She at first complained of extreme pain, as if daggers had been thrust through her head, as she expressed it. Afterwards she became comatose, her pulse sunk very low, and was exceeding slow. By bleeding, blistering, and other evacuations, she was kept alive for about a fortnight. When her head was opened, a large quantity of extravasated blood was found in the left ventricle of the brain.

SYMPTOMS, and method of cure. - The usual forerunners of an apoplexy are giddiness, pain and swimming of the head; loss of memory; drowsiness; noise in the ears; the night-mare; a spontaneous flux of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit, and should endeavour to prevent it by bleeding, a slender diet, and opening medicines.

IN the sanguine apoplexy, if the patient does not die suddenly, the countenance appears florid, the face is swelled or puffed up, and the blood-vessels, especially about the neck and temples, are turgid; the pulse beats strong; the eyes are prominent and fixed, and the breathing is difficult, and performed with a snorting noise. The excrements and urine are often voided spontaneously, and the patient is sometimes seized with vomiting.

IN this species of apoplexy every method must be taken to lessen the force of the circulation towards the head. The patient should be kept perfectly easy and cool. His head should be raised pretty high, and his feet suffered to hang down. His clothes ought to be loosened, especially about the neck, and fresh air admitted into his chamber. His garters should be tied pretty tight, by which means the motion of the blood from the lower extremities will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated in two or three hours. A laxative clyster, with plenty of sweet oil, or fresh butter, and a spoonful or two of common salt in it, may be administered every two hours; and blistering-plasters applied betwixt the shoulders, and to the calves of the legs.

AS soon as the symptoms are a little abated, and the patient is able to swallow, he ought to drink freely of some diluting opening liquor, as a decoction of tamarinds and liquorice, cream-tartar-whey, or common whey with cream of tartar dissolved in it. Or he may take any cooling purge, as Glauber's salts, manna dissolved in an infusion of senna, or the like. All spirits and other strong liquors are to be avoided. Even volatile salts held to the nose do mischief. Vomits, for the same reason, ought not to be given, nor any thing that may increase the motion of the blood towards the head.

IN the serous apoplexy, the symptoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breathing less difficult. Bleeding is not so necessary here, as in the former case. It may, however, generally be performed once with safety and advantage, but should not be repeated. The patient should be placed in the same posture as directed above, and should have blistering-plasters applied, and receive opening clysters in the same manner. Purges here are likewise necessary, and the patient may drink strong balm-tea. If he be inclined to sweat, it ought to be promoted by drinking small wine-whey, or an infusion of carduus benedictus. A plentiful sweat kept up for a considerable time, has often carried off a serous apoplexy.

WHEN apoplectic symptoms proceed from opium, or other narcotic substances taken into the stomach, vomits are necessary. The patient is generally relieved as soon as he has discharged the poison in this way.

PERSONS of an apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong liquors, spiceries, and high-seasoned food. They ought likewise to guard against all violent passions, and to avoid the extremes of heat and cold. The head should be shaved, and daily washed with cold water. The feet ought to be kept warm, and never suffered to continue long wet. The body must be kept open either by food or medicine, and a little blood may be let every spring and fall. Exercise should by no means be neglected; but it ought to be taken in moderation. Nothing has a more happy effect in preventing an apoplexy than perpetual issues or setons; great care however must be taken not to suffer them to dry up, without opening others in their stead. Apoplectic persons ought never to go to rest with a full stomach, or to lie with their heads low, or wear any thing too tight about their necks.

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