APOPLEXY. 137 



vasation on its surface, forming the " meningeal apoplea:!/'' of 

 Serres. 3. Hemorrhage into the substance of the brain, with lesion 

 of its structure. 4. A serous etfusion on the external surface, and 

 into the ventricles of the brain, constituting what is defined, " serous 

 apoplexy /" but this is more frequently the termination of an inflam- 

 matory or congestive disorder of the brain, than of that deranged 

 state which constitutes the apoplectic attack. 5. Apoplexy may 

 occasion death without leaving any sign at all in the dead body. To 

 this variety, to which the older writers gave the names nervous, 

 convulsive, and hysteric. Dr. Abercrombie has applied the term 

 simple apophx^j. 



Causes. — Apoplexy is said to be hereditary. It may occur at an 

 early period of life, but in the majority of cases the age is above 

 fifty. Among the causes of apoplexy are — ossification, or aneurism 

 of the arteries of the brain ; obstruction, thickening, induration, or 

 obliteration of the canals of the sinuses ; diseases of the heart, espe- 

 cially hypertrophy of its left ventricle ; diseases of the kidney, par- 

 ticularly the granular degeneration described by Dr. Bright ; torpor 

 of the liver, or other excreting glands ; diseases of the air-tubes and 

 lungs, especially those attended with violent fits of coughing ; the 

 coup de soleil ; suppressed hemorrhages, particularly epistaxis and 

 hasmorrhoids ; suppression of the menstrual discharge ; metastatic 

 gout and rheumatism ; suppression of any vicarious discharge ; de- 

 pressed and anxious states of the mind ; excessive tise of wine or 

 malt liquors ; too great sexual indulgence ; frequent indulgence in 

 sleep after a full meal ; the use of neckcloths worn too tightly round 

 the neck, &c., are among the predisposing causes to apoplexy. 

 Gastric disease, narcotics, and mephitic gases may also be enume- 

 rated. Overloading the stomach and neglecting the bowels are 

 often enough to cause an attack in the predisposed. 



Apoplexy is said to occur chiefly in persons of a full habit of 

 body. Upon this point, M. Rochoux's cases afford important data 

 Of his sixty-three patients, thirty were of an ordinary habit of body 

 twenty -three were of a thin, meagre habit, and ten only were large 

 plethoric, and fat.* 



Symptoms, (premoiiitory.) — Apoplexy is sometimes preceded at 

 considerable intervals by precursory or warning symptoms, such as 

 vertigo, headache, ringing in the ears, loss of memory, a feeling of 

 drowsiness and lethargy, depraved vision, or partial palsy. In some 

 cases, there is a sense of great fulness in the head, the veins of the 

 head and forehead become turgid, the countenance is sufflised and 

 occasionally livid, and there are slight attacks of epistaxis. If any 

 individual were to complain of several, of these symptoms at any 

 period of life, he might be regarded as on the very brink of some 



* Recherches sur I'Apoplexie, p. 214. 

 12* 



