MODES OF ATTACK AND WARNINGS-Apoplexy may come on suddenly or gradually. the patient may be suddenly struck-falling at once bereft of motion and consciousness. such a case termed Primary Apoplexy., More frequently, however, apoplexy is indicated by well-marked premonitions, whip are, chiefly, Headache; giddiness, particularly on stooping;fullness and pulsation of the blood- vessels of the head; Epistaxis; retinal Haemorrhage; sleepiness, with heavy or snoring breathing; transient blindness; considerable different in the sizes of the pupils; deafness, nor noises in. the ears; momentary loss of consciousness, with or without indistinctness of speech or incoherent talking; flashes, motes, etc., before the eyes;vomiting, numbness or tingling of the hands or feet; unsteady gait partial paralysis, sometimes involving the muscles of the face. sometimes those of a limb; the patient becomes comatose, and drowsiness gradually increases to perfect Coma. This is called Ingravescent Apoplexy, because the symptoms become worse gradually. the sudden attack is due to the extravasation of the large quantity of blood. the Ingravescent for is caused by a more gradual leakage and subsequent softening an destruction of brain tissue and its symptoms may be paralleled by those due to brain abscess or tumour. Different areas in. the brain were and muscular movements and the nerves that govern muscles groups follow definite paths. the local symptoms therefore, of brain injury from haemorrhage or tumour vary with the site of the lesion, and the site can often be Haemorrhage affecting he convolution of of the brain in the left frontal area are generally accompanied with more or less interference with the functions of speech and writing, and degrees of what is called aphasia or agraphia result. Symptoms of this order in the case of haemorrhage follow the recovery from the attack.
SYMPTOMS DURING A FIT-These vary according to the seat and amount of the haemorrhage, and are sometimes so vague that cerebral haemorrhage can only be suspected. Pain in the head, giddiness, faintness, sickness, laboring pulse, succeeded by some reaction, may only be present. In the early stage of an Ingravescent cases before tea patient becomes comatose, where is great depression in. the circulation from the shock to the nervous system;l the surface is cold, pale, and clammy, and the pulse frequent, small and weak. As Coma comes other pulse becomes full, slow and labored (passes slowly under the fingers0; the surface warm, sometimes preternatural so, that perspiring;l the countenance has a peculiar bloated appearance, and is often congested; the pupils are insensible to light, m and usually dilate, although one or both away be contracted;l the breathing is starters from inaction of the bladder; and the bowels are sluggish.
One or several of he above symptoms may, however, occur as the consequence of indigestion Vomiting and Headache are more important as indications when they come on suddenly without any obvious cause, and to not on first rising in the morning; and the mo the vomiting, or efforts at vomiting;a nd the vomiting, or efforts at vomiting re continued beyond the emptying of the stomach;if these symptoms are associated with degeneration of the arteries, and Albuminuria, we may suspect the existence of haemorrhage into the brain.
PREDISPOSITION-(I) Age. After fifty, Apoplexy is one of the most frequent causes of death. This arises not so much from the year’s of death. This arises not so much from the year’s of a man’s life, as from a bad constitution and tissue-depravation, not often present in early life. After the middle period of life the capillaries become impaired and as a consequence the veins. Congested. The cerebral arteries also are often diseased; the heart has often acquired an abnormal power, driving the blood with great violence, and with an increased momentum, towards the brain, while the lungs have their function so impaired that the blood is only imperfectly oxygenated; and all these are causes of Congestion, a done of tendency to repeater of the vessels of the brain (Aitken). (2) Intemperance, excessive eating or drinking. in controlled passion, pressure about the neck, to close mental labour, or other habits of life that lead to cerebral Congestion. (3) Disease affecting the heat, kidneys, or blood-vessels of the brain.
APOPLEXY NOT OFTEN SUDDENLY FATAL-A popular opinion k, to some extent shared by the profession, is current that an effusion of blood in the brain is a frequent cause of sudden death. In stories and therapeutical representations the characters are made to die suddenly of Apoplexy;l in news paper, s too, accounts r often given of sudden deaths attribute do it. this error has also been of fostered by another equally common, namely, that persons with short thick beck and red face are most liable suddenly, but the suddenness of the death is generally due to heat-disease. A man with a red face had not necessarily roe blood in his head than another with a pale face; and if blood is poured out into the brain it is pale face; and if blood is pored out into the brain it s because the diseased blood vessel gave way under stress. It is then, a person with diseased arteries in whom Apoplexy is likely to occur, and this may exist in those states that he once knew a gentleman who had such an extraordinary red face that some young friends disliked to walk the streets with him, lest he should die of Apoplexy. This gentleman, whose face was a deeply purple hue. died of heart- disease. Although cerebral Haemorrhage sometimes kills rapidly, it does not kill instantly, as rupture of the aorta, or heart disease, sometimes doses (Jackson).
CAUSES-The main cause of Apoplexy is disease of blood vessels; hence the increasing liability to it with advancing age. The gradual generation or calcification of arteries common to old age renders them in them inelastic, and as the blood is forced on them by the action of he heart, they give way.( For a fuller account see the Section of Old Age and Senile decay) Haemorrhage within the cranium is sometimes caused by the bursting of Aneurysms involving the arteries of the brain. The idea that increased pressure on the blood-vessels of the brain, as during exertion or rapid movement of the body, is n originating cause of apoplexy is incorrect; there must be actual degeneration of the arteries, the products probably of years, before they cold give way. the predisposing cause of Apoplexy is generally bodily unsoundness, which may be especially due to glandular disease of he kidney, or Hypertrophy of the left ventricle of the heart. Apoplexy is almost always the local expression of the general constitutional failure; hence it is classed as a constitutional failure; hence it is classed as a constitutional disease.
DIAGNOSIS.-Apoplexy is distinguished from Epilepsy in that the latter sometimes begins with a cream, is always attended by Convulsions and much frothing at the mouth symptoms which do not occur in Apoplexy., In distinguishing it from intoxication of poisoning with opium, the history and circumstances of the patient must be considered. Is he likely to have been drinking? Is there an odour of spirits in the breath? Has he been low- spirited or in any difficulties likely to had led him to swallow poison? It is from such circumstances, considered in connection with the entire history of he case, that we must make our diagnosis; the condition of the brain, especially in the advanced stages, being newly the same in all these cases. The importance of promptly recognizing Apoplexy from alcoholic or narcotic poisons arises from the difference in the immediate measure that would be taken in the one or the other case. An emetic, or a stomach-pump, might remove in one case, what if suffered to remain might lead to serious or even fatal results; while in. the other case wholly different measure should be necessary. It is obviously far better to mistake drunkenness for apoplexy than Apoplexy for drunkenness and when any one is found deeply insensible be should be carefully attended under the direction of a medical man. Even if death could not possibly be averted it is sad that a human being should die of cerebral haemorrhage in a police cell. Under many circumstances, then, an unconscious person needs our care, for he may be so from a combination of causes; a drunken man may have had his blood-vessels ruptured by a blow on the head; or a drunken debauch may coincide with the breaking of a cerebral artery.
EPITOME OF TREATMENT.-
1. For the promontory symptoms-Nux V., Aconite, Belladonna
2. Cerebral Haemorrhage-A on. (strong tinct), Belladonna, Opi.
3. sequelae (Paralysis, etc.)-Aconite, Belladonna, Phosphorus, Cocc., Rhus.
LEADING INDICATIONS-
Aconitum-Full, rapid, and strong pulse; dry, hot skin. This remedy is suitable for the promontory symptoms, and for an actual attack, and both immediately and remotely is infinitely superior to the abstraction often, sixteen, or twenty ounces or blood.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."