APOPLEXY. 109 



down again when you leave it, like a dead limb. Sometimes they are stiff and 

 rigid, or they may be convulsed. The bowels are usually torpid ; or, if they act, 

 the motions are passed in bed, without the patient's knowledge or concern. The 

 urine flows involuntarily, or is retained in the distended bladder until it overflows 

 and dribbles away perpetually. 



It is often a very difficult matter to say whether a person is suffering from 

 apoplexy, or is stupefied by a large dose of opium, or is merely dead drunk. It is 

 very important to make the distinction, as much depends on the treatment, but it is 

 far from easy. In many cases a personal knowledge of the general habits of the 

 sufferer will at once solve the question, but with a stranger it is sometimes almost 

 impossible to decide. The insensibility is profound in each case, although arising 

 from so different a cause. If any one-sided symptoms are noticed if, for instance, 

 one pupil is larger than the other, or if there are twitchings of the arms or legs on 

 one side only it is to be feared that it is apoplexy. If the patient can be roused 

 even for a moment or two, so as to give intelligent replies to questions, he is pro* 

 bably suffering from opium-poisoning or is drunk. His general appearance and age 

 may assist you in solving your doubts. You must inquire whether he is known to 

 have been drinking ; you must try if you can perceive the odour of wine or spirit in 

 the breath ; and you should endeavour to make out from his friends whether he has 

 been low-spirited, or in difficulties, or is a likely person to have taken poison. Even 

 when the odour of drink is distinctly appreciable too much reliance must not be 

 placed on it, because a man who has been drinking may be seized with apoplexy. 

 A story is told which illustrates forcibly the curious circumstances under which one 

 may be called upon to distinguish between apoplexy and drunkenness, and the 

 difficulties that may be experienced in making the diagnosis. Some years ago a 

 doctor living in Edinburgh was called out late one evening to visit an old gentleman 

 of that city. He found him completely insensible, his wife crying, and the whole 

 family plunged in grief and distress. He was told that the patient whom he now 

 saw in a fit had come home, and upon the servant's opening the door to him, had 

 fallen into the passage on his back in a state of insensibility. The doctor learned, 

 however, that he had been at the club, and he knew well enough that the club was 

 composed of choice spirits, fond of their cups, although the gentleman's wife did not 

 know so much. He therefore ventured to express a hope to the wife that her 

 husband was only drunk, a view of the case at which she was extremely affronted 

 and indignant. He persisted in his opinion, and not long afterwards the patient 

 began to recover his senses. It turned out that he had partaken more liberally than 

 the rest of the club, and was the first to be intoxicated. Two of his companions 

 carried him home quite incapable of motion, but not liking to introduce themselves 

 to his wife in that predicament, they placed him with his back against the door, 

 rang the bell, and decamped. Of course, when the servant came to open the door 

 his master tumbled senseless on the floor. The doctor certainly deserved some 

 credit for the cleverness of his diagnosis, for much harm might have resulted if the 

 patient had been treated energetically for apoplexy. 



On the other hand, so many cases of apoplexy occurring in the streets have been 

 mistaken for intoxication, that it should be a strict rule that no person found insen- 



