350 PATH 
varieties anfwersno good purpofe. It makes the patho¬ 
logical ftudent expe<ft to find difeafes exa&ly to corref- 
pond with the varieties laid down by his nofologift, while 
every one knows that will never be the cafe; confequent- 
ly it feems better to us to defcribe the various forms of 
apoplexy under one head, when the ftudent eafily per¬ 
ceives their connexion, and the probability of his meet¬ 
ing with many intermediate forms. 
We ufually find the apople£tic patient in a ftate in 
which, as Dr. Cooke accurately fays, “ the animal func¬ 
tions are fufpended, while the vital and natural func¬ 
tions continue; refpiration being generally laborious, 
an,d frequently attended with ftertor.” According to 
Serres, the ftertorous refpiration is often fioweft when the 
pulfe is quickeft ; and this want of correfpondence be¬ 
tween the two functions of circulation and refpiration 
this author considers to be a pathognomonic fign of apo¬ 
plexy. 
Although the attack is often fudden, yet, where pa¬ 
tients have paid attention to their own fenfations, there 
have ufually been fome of the following premonitory 
lymptoms; as, pain in the head, ringing in the ears, ver¬ 
tigo, difpolition to fomnolency, numbnefs of the limbs, 
orfenfe of formication ; dimnefs of fight; flalhes of light 
before the eyes, with fuelling and watering of thofe or¬ 
gans ; fiufhing of the face; turgidity of the jugular 
veins; trembling and faultering of the voice ; failure of 
the memory ; deep breathing, &c. After more'or lefs 
of the foregoing premonitions, the attack is ufhered in, 
according to Dr. Abercrombie, in one of the three fol¬ 
lowing forms. 
“In the firft form, the patient falls down fuddenly, 
deprived of fenfe and motion, and lies like a perfon in a 
deep deep; his face generally flufhed ; his breathing 
ftertorous; his pulfe full, and not frequent, fometimes 
below the natural ftandard ; in fome cafes, convulfions 
occur. In this ftate of profound ftupor, the patient may 
die after various intervals, from a few minutes to feveral 
days, or he may recover perfectly without any bad con- 
fequences of the attack remaining, or he may recover 
with paralyfis of one fide. This paralyfis may difappear 
in a few days, or it may fubfide very gradually, or it may 
be permanent; other functions, as the fpeech, may be af- 
fefted in the fame manner; and, fometimes, recovery 
from the apople&ic ftate is accompanied by lofs of fight. 
“ The fecond form of the difeafe begins with a fudden 
attack of violent pain in the head; the patient becomes 
pale, fick, and faint, generally vomits, and frequently, 
though not always, falls down in a ftate refembling fyn- 
cope; the face very pale, the pulfe very fmall. This is 
fometimes accompanied by flight convulfion. In other 
cafes, he does not fall down, the fudden attack of pain 
being only accompanied by flight and tranfient lofs of 
recollection. In both cafes, he recovers in a few mi¬ 
nutes ; is quite fenfible, and able to walk ; continues to 
complain ofintenfe head-ache; after a confiderable time, 
perhaps fome hours, becomes oppreffed, forgetful, and in¬ 
coherent, and thus gradually finks into coma, from 
which he never recovers. In fome cafes, paralyfis of 
one fide occurs; but in others, and I think the greater 
proportion of this clafs, there is no paralyfis. 
“ In the third form, the patient is fuddenly deprived 
of the power of one fide of the body, and of fpeech, with¬ 
out ftupor ; or, if the firft attack is accompanied by a 
degree of ftupor, this foon goes oft'; he appears fenfible 
of his fituation, and endeavours to exprefs his feelings by 
figns. In the farther progrefs of this form of the difeafe, 
great variety occurs; in fome cafes, it paffes gradually 
into apoplexy, perhaps after a few hours; in others, 
under the proper treatment, the patient recovers per¬ 
fectly in a few days. In many cafes, the recovery is 
gradual, and it is only at the end of feveral weeks or 
months that the complaint is removed. In another va¬ 
riety, the patient recovers fo far as to be able to fpeak 
indiftinCtly, and to walk, dragging his leg by the molt 
O L O G Y. 
painful effort, and after this makes no further improve¬ 
ment. He may continue in this ftate for years, and die 
of fome other difeafe, or he may be cut off' by a frefti at¬ 
tack. In a fifth variety, the patient neither recovers nor 
paffes into apoplexy ; he is confined to bed, fpeechlefs 
and paralytic, but in poffeflion of his other faculties, and 
dies gradually exhaufted, without apoplexy, feveral weeks 
or months after the attack.” Thefe two laft varieties 
belong to palfy, properly fpeaking. 
In the feverer degrees of this difeafe, the function of 
refpiration is generally much embarraffed ; flow and la¬ 
borious at the beginning of the paroxyfrn ; frequent, 
weak, and irregular, towards the fatal termination. 
Stertor, though not always, is very commonly prefent; 
and fome of our ableft phyficians meafure the violence 
and danger of the difeafe by the degree of the ftertor. 
This laft remark is equally applicable to the frothy fa- 
liva, or foam, excreted from the mouth, and fometimes 
blown away from the lips with confiderable force. In 
refpeCt to the pulfe, it is obferved by Dr. Cooke, that it 
is “at firft regular, ftrong, full, and flow, beating from 
fifty-five to lixty-five times in a* minute; but, as the 
difeafe advances, it becomes weaker, and more frequent; 
and, in the end, irregular or intermitting.” Dr. Gre¬ 
gory, in his LeCtures, obferves, that “it is a fatal fign when 
the pulfe is firft fmall, and afterwards becomes very full.” 
Whenapoplexy terminates fatally,as thedifeafe proceeds, 
the abolition of fenfe and voluntary motion feems to be¬ 
come more complete ; the refpiration and pulfe more 
weak and irregular; cold clammy fweats affeCt the face 
and whole body; the features fhrink, and convulfions 
fupervene, which terminate in death. 
The predifpolingcaufesare, age, (few patients fuffering 
apoplexy before the age of 40,) cold and moifture, 
plethora, and intenfe thinking. Any circumftance in¬ 
deed which fills the blood-veffels inordinately, prevents 
their due activity in the general circulation of the body, 
or caufes extraordinary aCtion in the brain, may predif- 
pofe to or actually cau-fe apoplexy. We ftiould alfo men¬ 
tion, among the caufes of apoplexy, difeafe of the heart, 
whether this arife from exceflive aCtion of this organ gene¬ 
rally or from difproportionate aCtion of one of its cavities. 
The connexion between cardiac and apoplectic difeafe, 
■which has recently been much dwelt on by the French, 
is worthy of particular attention. The pathology of 
apoplexy ufually laid down, is that it arifes from concuf- 
fion of the brain, its fatality being caufed by acoagulum 
of blood or an effufion of ferum, forming the comprefling 
body. Many diffeCtions, however, difcovered no kind of 
lefion of the above-mentioned fort; and M. Serres, in his 
experiments on animals, found that compreflion did not 
produce apoplexy ; and in his diffeCtions of the human 
body, he fometimes found coagula of blood in the brain 
without the antecedence of this difeafe. Hence it be¬ 
came allowable to doubt the correCtnefs of the eftablifhed 
doCtrine. M. Serres, from numerous diffeCtions, infers, 
that apoplexy, in all inftances except thofe attended with 
paralyfis, is a difeafe of the membranes of the brain ; 
hence he calls it meningeal apoplexy. That the inflamed, 
and confequently thickened, and generally effufing, ftate 
of the membrane may produce apoplexy by its uniform 
and extenlive preffure over the furface of the cranium, 
cannot be denied; but it may reafonably be queftioned 
whether apoplexy is membranous inflammation, when 
we confider the extreme pain ufually attendant on that 
fort of difeafe; nor do we find that the appearances repre- 
fented by M. Serres are corroborated by the teftimony of 
other authors. It fliould be recolleCted alfo, that we are 
not obliged to admit, that, becaufe preffure from a clot 
of blood does not produce apoplexy, (as ftated in the 
experiments and diffeCtions of M. Serres,) therefore pref¬ 
fure is not the caufe of the difeafe. For the diftention of 
the blood-veffels mutt induce a very great preffure, and 
one which is uniformly exerted through the whole fub- 
ftance of the brain. Of courfe, when we confider the 
compaCi 
