Chapter 5 - Diseases of the Brain and Nerves
A Picture of Perfect Health - Diagram
Muscles of the Neck and Face - Diagram 1
Muscles of the Neck and Face - Diagram 2
Internal View of Base of Cranium - Diagram
Cross-section of Head - Diagram
Base of the Brain - Diagram
Cross-section of Head - Diagram
View of Skull - Diagram
Introduction to Diseases of the Brain and Nerves
Inflammation of the Dura Mater
Inflammation of the Arachnoid and Pia Mater
Brain Fever
Softening of the Brain
Abscess of the Brain
Induration of the Brain
Tumors of the Brain
Delirium Tremens
Effects of Alcohol on Stomach and Kidneys - Diagram
Effects of Alcohol on Stomach and Kidneys
Enlargement of the Brain
Shrinking of the Brain
Water in the Head
Dropsy of the Brain
CerebroSpinal Fever
Diseases of the Spinal Cord
Inflammation of the Spinal Cord
Paralysis of One Side of the Body
Paralysis of Lower Part of the Body
Local Palsy
Shaking Palsy
Lead Palsy
Muscular and Nervous Derangements from Wounds
Locked Jaw
St. Vitus' Dance
Chronic Chorea
Pains of Nerves
Tic Douloureux
Dizziness of the Head
Locomotor Ataxia

5.28 Apoplexy

APOPLEXY is that condition in which all the functions of animal life are suddenly stopped, except the pulse and the breathing; in which there is neither thought, nor feeling, nor voluntary motion; in which the person falls clown suddenly, and lies as if in a deep sleep.

Modes of Attack; There are at least three ways in which this terrible disease may make its assault.

The First form of attack is a sudden falling down into a state of insensibility and apparently profound sleep, the face being generally flushed, the breathing stertorous or snoring, the pulse full and not frequent, with occasional convulsions.
From this mode of attack some die immediately, others get entirely well, and others get off with the exception of paralysis on one side, or the loss of speech, or some one of the senses.

The Second form of attack begins with sudden pain in the head. The patient becomes pale, faint, sick, and vomits, has a cold skin and feeble pulse, and occasionally some convulsions. He may fall down, or may be only a little confused, but will soon recover from all the symptoms, except the headache, this will continue, and the patient will sooner or later become heavy, forgetful, unable to connect ideas, and finally sink into insensibility, from which he never rises.
This mode of invasion, though not appearing so frightful as the first, is of much more serious import.

In the Third form of attack there is sudden loss of power on one side of the body, and also of speech, but not of consciousness. The patient retains his mind, and answers questions either by words or signs. This may be called paralytic apoplexy. The patient may either die soon, or get well, or live for years with imperfect speech. or a leg dragging after him, or an arm hanging useless at his side.

The Persons Attacked are apt to have large heads, red faces, short and thick necks, and a short, stout, square build, though it occurs often among those who are thin, pale, and tall. The tendency to it increases in advanced life.

The Forerunners of apoplexy are headache, vertigo, slight attacks of palsy, double vision or seeing two objects when there is but one, faltering speech, inability to remember certain words, sometimes a sudden forgetfulness of one's own name, a frequent losing of the thread of ideas attempted to be pursued, and occasionally an unaccountable dread, for which no reason can be given.

Exciting Causes. Whatever hurries the circulation of the blood, as strong bodily exercise, is an exciting cause. So are all those things which cause the blood to flow towards the head, as coughing, sneezing, laughing and crying, straining at stool when costive, lifting heavy weights, singing, and playing on wind instruments. To these may be added, exposure to the sun, the bad air of crowded rooms, holding the head clown, or turning it around to look backward, tight cravats worn about the neck, and exposure to severe cold.

Treatment. If the patient have the appearance of suffering from fullness of blood in the head, as evinced by redness and turgeseence of the face and throbbing of the temporal arteries, and if the pulse be full and hard, feeling like a tense vibrating rope under the finger, place him in a half recumbent posture, with his head raised; loosen his clothes, particularly his neck cloth and shirt collar, and whatever may press upon the neck, and then as quickly as possible apply cold wet cloths to his head, changing them often. lee is still better, if it may be had. Lay the patient sufficiently on his side so that the tongue and saliva will fall forward instead of back into the pharynx. Apply mustard and friction to the soles of the feet. If the pulse, is feeble and the face pallid, or if the patient is aged, give stimulants and tincture digitalis (five drops every hour or two), put ice behind the ears, and give purgative injection (246). For the subsequent fever 4 drops of tincture of veratrum viride or tincture of aconite may be given 3 times daily; for the headache and delirium 5 grain doses of bromide of camphor every 2 or 3 hours is useful.
To promote absorption of the blood clot the kidneys and bowels should be kept active, and a thorough course of iodide of potash in 5 or 10 grain doses three times daily should be given.
To prevent future attacks, gentle tonics should be used, and the skin should be kept healthy by daily bathing and friction. The bowels must not be permitted to become costive. The diet should be light, chiefly vegetable, and almost entirely so in hot weather. The food should be well chewed. The mind should be kept cheerful and hopeful, and free from great excitement. The sexual passion should be restrained, and very rarely indulged. Intoxicating drinks should be abandoned, if used, and all tight cravats be discarded from the neck. Direct rays of the hot sun in summer should be carefully shunned. No food should be taken for three hours before retiring, and a mattress only, of some degree of hardness, should be slept upon, the head being always well elevated. To these precautions, I would add dipping the feet every night before retiring in hot water; and, if any tendency to cold feet be experienced, dusting pulverized cayenne in the bottoms of the Stockings.

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