108 THE TREATMENT OP DISEASES. 



stooping; a feeling of weight or fulness in the head, with roaring noises in the 

 ears and temporary deafness ; dimness of sight or double vision ; bleeding from 

 the nose, with fits of nausea and sluggishness of the bowels ; a loss of elasticity 

 in walking, with numbness or a sense of pins and needles in the feet, or a feeling 

 as if there were some foreign body in the boot; loss of memory, great mental 

 depression, and peevishness or irritability of temper, or the use of wrong words 

 in talking; and drowsiness with heavy sleep, and a tendency to dreaming or 

 nightmare. Any one of these symptoms occurring singly would probably be of 

 little significance ; but a combination of them in a person who is a likely subject 

 for apoplexy should be regarded as a warning. 



An apoplectic seizure may commence in several different ways. Sometimes 

 the patient falls down suddenly, deprived of sense and motion, and lies like a 

 person in a deep sleep his face flushed, his breathing laboured, and his pulse full 

 and usually less frequent than natural. There may be convulsions or contraction 

 of the muscles of the limbs, often confined to one side. Sometimes insensibility 

 is not the earliest symptom ; the attack begins with a sudden sharp pain in the 

 head, the patient becomes pale and faint, and usually vomits. He may, perhaps, 

 fall down in a state of insensibility, with a bloodless and cold skin and a fee*ble 

 pulse. This may be accompanied by convulsions. Very often he does not fall 

 down, the sudden attack of pain being accompanied only by slight and transient 

 confusion. In either case he commonly recovers in a short time from these 

 symptoms, and is quite sensible and able to walk, but the headache continues. 

 After a certain interval varying from a few minutes to several hours he becomes 

 heavy, forgetful, and incoherent, and sinks into a state of insensibility, from which 

 he never emerges. Sometimes the seizure begins by an abrupt attack of paralysis 

 of one side of the body, often with loss of speech, but no diminution of conscious- 

 ness. The paralysis may pass gradually into apoplexy, or may remain without 

 further urgent symptoms, or in certain favourable cases may slowly pass off, and 

 the patient recovers. Such are the different modes in which apoplexy makes its 

 appearance. It may be painful to have to consider the details so minutely, but 

 it must be done, or there is danger of overlooking the real nature of the attack. 



When the apoplectic state is fully formed in whatever manner the attack 

 may have commenced the patient lies totally unconscious of all that may be going 

 on about him. He replies to no questions, he is unmoved by the cries and lamen- 

 tations of his family, and, in fact, does not hear them. The pulse is at first slow 

 and almost imperceptible, but becomes quicker and stronger as the system recovers 

 from the prostrating shock, although it usually remains less frequent than natural,- 

 and is sometimes irregular. The breathing is peculiar, being slow and interrupted 

 or irregular, and attended with a snoring noise, and a pufiing out of the cheeks 

 like a person smoking a pipe. There is frothy saliva about the mouth, and the 

 body is covered with a cold clammy sweat. The face is pale, the eyes are dull 

 and glassy, the pupils are commonly neither much contracted nor much dilated, but 

 very often they are unequal in size. The teeth are clenched, all power of swallow- 

 ing is lost, and if you put fluids in the mouth they run out again at the corners. 

 of the lips. The limbs lie motionless, and if you raise one of them it falls passively 



