138 PRACTICE OF MEDICINE. 



serious affection, of the brain ; and if the person be in the decline of 

 life, it may safely be said he is in immediate danger of an attack of 

 apoplexy. But it is a serious error to suppose that premonitory 

 symptoms always occur; indeed, if we may trust the experience of 

 M. Rochoux, one of the best authorities on apoplexy, they are by 

 no means common. Of sixty-three cases which came under his 

 notice, 7ii7ie only had distinct precursory symptoms.* 



Symptoms of the attack. — In the mild form of apoplexy (the 

 atonic apoplexy of Dr. Good), the patient, after experiencing some 

 of the premonitory symptoms, is seized with alarming vertigo, lei- 

 pothymia, or feeling of faintness ; nausea and vomiting; disturbance 

 of the senses, particularly of the sense of sight ; loss of memory ; 

 partial loss of sense, consciousness, speech, and voluntary motion ; 

 weak, irregular, and sometimes quick pulse, and more or less of 

 sopor. 



In the more active form (the entonic apoplexy of Dr. Good), the 

 patient is more or less suddenly seized with profound sopor, the 

 eyes being either open or closed ; the breathing deep, slow, sonorous, 

 or stertorous ; and the pulse slow, full, hard, or strong, sometimes 

 irregular. In this form of the disease, the above are often the chief 

 symptoms, there being no paralysis ; but frequently the mouth is 

 drawn to one side, the eyes are distorted, and one eyelid immovable, 

 with relaxation, loss of sensation and of motion of a limb, or of one 

 side of the body ; the arm of the non-paralysed side being often 

 closely applied to the chest or to the genital organs. The patient 

 generally lies on the paralysed side, which is relaxed, incapable of 

 motion, and insensible to the application of irritants. 



In the -most severe and sudden forms of attack, the patient is 

 struck down instantly, sometimes froths at the mouth, has a livid 

 countenance, dilated pupil, complete relaxation and immobility of 

 the voluntary muscles and limbs, and unconscious evacuation of the 

 urine and faeces, and dies very shortly afterwards either with or 

 without stertor, with cold, livid extremities, cold perspiration, and 

 sometimes a cadaverous cast of countenance. This form constitutes 

 the apoiiUxie foudroyante of the French, in which there is generally 

 an immense extravasation of blood. 



Duration of the symptoms in fatal cases of apoplexy. — According 

 to the common opinion, apoplexy may prove fatal instantly or in a 

 fevf minutes. The best modern pathologists deny this, and assert 

 that when death is so sudden the cause is commonly disease of the 

 heart, and never apoplexy.. Although, however, it seldom proves 

 instantaneously fatal, it may undoubtedly cause death in much less 

 than an hour. In some cases, on the other hand, patients remain 

 even for months in a comatose, paralytic state. 



* Loco citato, p. 70. 



