APOPLEXY. 25 



The Prognosis of a case of apoplexy holds out little hope of 

 the life of the patient. Should the practitioner be called in early 

 enough, and be, from the promptitude and propriety of his mea- 

 sures, fortunate enough, to restore the lost senses and get the 

 patient on his legs again, he may indeed entertain the most 

 sanguine expectations of recovery ; horses not being the subjects 

 of those hemiplegic affections which are so apt to follow apoplectic 

 attacks in man ; and as for any mental derangement or imbecility, 

 we have, for obvious reasons, no cause for alarm on that score. If 

 the breathing continue or become stertorous, the pupil of the eye 

 remain incontractible to light, and there supervene cold sweats and 

 dilated sphincters, we may consider the scene of life to be all but 

 closed. In fine, to use the language of Dr. Marshall Hall*, '' in 

 an ordinary fit of apoplexy, the prognosis is favourable or un- 

 favourable, according as the symptoms are limited to affections of 

 the cerebral system, or are extended to the true spinal and gan- 

 glionic ^ 



Treatment. — Presuming the fit of apoplexy in which we 

 find the horse, to be, as it commonly is, the result of the pre- 

 sence of too much blood in the encephalon, it is our duty, 

 without a moment's loss of time, to set about to diminish this. 

 And here, the jugular veins, for two reasons, are not near so 

 eligible for blood-letting as the temporal arteries : first, it is 

 awkward and difficult to open and compress them in the recum- 

 bent posture ; and, secondly, we shall probably obtain freer and 

 more speedy evacuation from the arteries. I may repeat here 

 what I said under encephalitis, that both my own practice and 

 that of several others in whose observation I confide, decide very 

 much in favour of arteriotomy in the temples in preference to 

 drawing blood from the jugulars. In regard to the quantity of blood 

 to be drawn, as it hardly ever happens that we can collect it, we 

 must in this, as in all similar cases, be entirely guided by the 

 effects of the loss of blood upon the pulse and by the general state 

 of the patient. Should blood-letting to the fullest extent we durst 

 practise it fail to rouse our patient, stimulants of various kinds may 

 be made trial of — such as the application of ammonia to the 



* On the diseases and derangements of the nervous system. 

 VOL. ni E 



