MEDICINE. 



II 



r, trti<-. voluntary motion, while the circulation and the 

 "Y"^' nic functions continue to perform their actions. The 

 > is, however, slow and oppressed, and the inspi- 

 ration performed after long intervals, and accompanied 

 by stertor, while the countenance is flushed, and the 

 sensibility so much impaired, that the patient is uncon- 

 scious of the most powerful impressions that can be 

 made upon him The immediate cause of Apoplexy 

 appears to be, almost in every instance, the effusion of 

 blood or serum on the surface of the brain, or into 

 tome of its cavities, which may be supposed to com- 

 press this organ, and thus prevent it from performing 

 its due functions OccaMomlly, however, we observe 

 persons to be attacked with symptoms, which have 

 every claim to be considered as apoplectic, where, from 

 the complete and very speedy recovery that takes place, 

 we are unavoidably led to conclude that no consider- 

 able injury has occurred to the structure of the brain, 

 an opinion which has been confirmed by some cases of 

 dissection, although it is obvious that such opportuni- 

 ties can only be of accidental occurrence, where the 

 patient has died from some other cause soon after hit 

 recovery from the Apoplexy. The state of insensibility 

 which is occasioned by complete intoxication is very 

 similar to Apoplexy, so much so, that except from 

 the previous hutory of the case, from the length of 

 time tiich it continues, and from the odour exhaled 

 by the breath, we have frequently great difficulty 

 in discriminating between these affections, although 

 arising from such very different causes, and producing 

 tuch different ultimate effects upon the system. Per- 

 sons who hare suffered from Apoplexy are observed to 

 be of a peculiar temperament or bodily co ' 



they are generally corpulent, with short necks, and 

 large heads, and exhibit various indications of a torpid 

 state of the blood-vessels, attended, at the same time, 

 with considerable force of the circulation, and firmness 

 in the texture of the components of the body. Ac- 

 cording to the nature of the fluid which is effused, whe- 

 ther it be entire blood or only serum, the disease has 

 beer divided into the two varieties of sanguineous and 

 serous, and it seems that this division has an actual ex- 

 istence, but we doubt much whether we have any cer- 

 tain means of ascertaining them before death from the 

 symptoms of the case. 



The proximate cause of the disease is supposed to be 

 a congestion of blood in the vessels of the brain, gene- 

 rally terminating in effusion ; it has been a controvert- 

 ed question whether a proper Apoplexy can be pro- 

 duced by the mere accumulation of blood in the vesacss, 

 without absolute effusion taking place, a question which 

 we should be disposed to answer in the affirmative, al- 

 though it is difficult to prove the point by a reference 

 to dissection, because when there is no actual rupture 

 of the vessels, recovery may be supposed generally to 

 take place, so as not to admit of our examination. The 

 exciting causes of Apoplexy are various, bat my, for 

 the most part, be referred to those circumstances which 

 increase the impetus of the blood through the arteries of 

 the bead, or retard its egret* from them. Violent exer- 

 cise, sudden fits of pasion, severe mental exertions of 

 all kinds, certain postures of the body, the direct ap. 

 plication of the sun's rays to the head, blows, or me- 

 chanical injuries of the part, and especially intemper- 

 ance in eating or drinking, are among the most frequent 

 caunes assigned for Apoplexy, and may be obviously ac- 

 counted for upon the above principle. There are, how- 



r er, other causes, such as narcotic poisons, metallic 

 i of various kind*, some of the unrespirable gases, 



especially the carbonic acid, and intense cold, which, Practice, 

 although they induce the symptoms of Apoplexy, may *" "Y"~' 

 perhaps be supposed to act upon the nervous system 

 generally, by diminishing the sensibility of all its parts, 

 rather than by producing any local affection upon the 

 brain in particular. After a severe attack of Apoplexy, 

 except it arise from some obvious external cause, the 

 functions, both of the body and the mind, seldom re- 

 gain their former vigour, and, for the most part, 

 either one side of the body is left without motion, con- 

 stituting what has been termed Hemiplegia, or the whole 

 of the voluntary motions and mental powers continue 

 in a very imperfect and enfeebled state. We have 

 sometimes curious instances of the loss of individual 

 faculties, as the memory of names, of dates, or of places, 

 and occasionally of a particular language : such cases 



have given rise to many pathological and metaphysical 

 speculations, but these do not hitherto appear to have 

 been sanctioned by the results of our anatomical exa- 

 minations. 



The cure of Apoplexy consists first in removing the Treatment 

 exciting cause of the disease, should this still remain 

 applied, and afterwards in endeavouring to relieve the 

 congestion of the vessels. This last is attempted by 

 large bleeding*, which are thought to be more effectual, 

 when the vessels near the head are opened, such as the 

 jugular vein or the temporal artery ; we may also take 

 blood from the cutaneous veasels by the scarificator or 

 by leeches, and aft-.-rwardt apply Urge blisters to the 

 neck ; along with these drastic purgatives are to be 

 given, to as to procure a free evacuation from the 

 bowels. Where the disease -appears to have been im- 

 mediately produced by repletion of the t>tomach, or by 

 any noxious substance received into it, an emetic will 

 be proper, but in other cases vomiting is thought to be 

 rather injurious, or at least does not seem to have any 

 claim to be considered as a remedy of general applica- 

 tion. When depletion has been carried as tar ai has 

 been thought necessary, or as the state of the p.aient 

 will justify, little efficient treatment remains to be em- 

 ployed ; stimulants must at first be used with great 

 caution, as any degree of over- excitement might bring 

 back the original complaint ; the longer the disease has 

 continued the more freely they may be given ; but it 

 must, at the same time, be contested that we can have 

 less expectation of benefit from them. Upon the whole, 

 if the complaint be not relieved, either by the efforts of 

 nature, or by the operation of our remedies soon after 

 its first invasion, we arc not to hope for much advan- 

 tage from any thing that can be done in future, but 

 mut coo line ourselvet to relieving particular symptoms, 

 and soothing the helpless condition of the patient, by 

 an attention to a variety of minute circumstances, for 

 which no general rules can be prescribed. 



SlCT. VN. Paralytu. Pal>y. 



Paralysis may be regarded at a partial Apoplexy, and 

 is, in most instances, the sequel of that dieate, when it 

 does not terminate fatally. The two diseases originate 

 from the same causes, and commence nearly with the 

 tame tymptoms in the roost severe kind of Palsy ; but 

 besides these, we have partial Paralysis, sometimes of a 

 single limb, or even of a single muscle, which proceeds 

 entirely from some local injury or the nerves of the part. 

 \\ V have also another variety of Palsy, in which the 

 affection n general, but lest violent, where there is no 

 sudden seizure, and where the lost of sensation and 

 motion U not complete in any one part, but where then 



