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General result.

Gen. VIIL same effect more speedily, and with more facility of re

Spec. V.
Carus Apo- straint when a sufficiency of blood has been taken away.
plexia. What seems to be the fair result the author will give
Treatment in the words of Dr. Cooke. “General opinion, then, as

well as reasoning, appears to be very much in favour of
free and repeated evacuations of blood, both general and
topical, in the strong apoplexy; and I am persuaded
that greater advantage may be reasonably expected from
this than from any other practice: yet I am very much
inclined to think that it may be, and actually sometimes
has been, carried too far. I have seen several cases, and
heard of many others, in which very large quantities of
blood have been drawn without the smallest perceptible
advantage, and with an evident and considerable diminu-

tion of the strength of the patient."* Purgatives. The next important means to be pursued is that of ex

citing the bowels by active purgatives, and thus endeavouring to lessen the pressure on the brain by revulsion. The particular purgative is of no importance: whatever will operate most speedily and most effectively is what should be preferred in the first instance : and hence a combination of calomel and extract of jalap will be found among the best : though a free action may afterwards be more conveniently maintained by colocynth or sulphate of magnesia. Dolæus employed calomel so as to excite salivation, from an opinion that all evacuations are useful; and he gives an account of several cures he was hereby enabled to effect, and particularly relates the case of a woman who was in this manner considerably

relieved, and died on the cessation of the ptyalismt. Emetics, in The collateral remedies are of less importance though entonic

some of them may add to the general effect. Emetics of a doubtful are of a very doubtful character in the form of the discharacter :

ease before us, though often highly useful in atonic apoplexy. They have been given upon the principle of their producing a sudden prostration of strength, and faintness : but this is a result of nausea rather than of vomit

* Ut suprà, p. 311.

+ Dolæus, p. 149.


ing: and the languor hereby occasioned is not exactly Gen. VIII.

Spec. V. of the kind we stand in need of; regard being had to the Carles: disease as a nervous affection, and the danger of inducing plexia. hemiplegia. Full vomiting may, indeed, determine from


Ips the head to the surface of the body, but we cannot answer that the straining will not renew the extravasation, or even rupture a vessel where no rupture has existed. :. It is true the same plan has at times been employed in and why hæmoptysis, apparently with success ; but it has in other doubtful instances been so decidedly productive of mischief, as to urge those who have made choice of it to abandon it abruptly, with a determination never to return to it in any other case, as we have already observed when treating of hæmoptysis under Class II1. Order iv. in the preceding volume. The only instance in which it may be prudent to prescribe an emetic, is where the disease has evidently proceeded from a surcharged stomach.

Blisters and sinapisms promise but little in this form Blisters and of the disease : they tease and irritate to no purpose when applied to the extremities, and are still more injurious when they are made to cover the scalp; for they effectually prevent the use of epithems of cold water, or vinegar, or pounded ice, which afford a rational chance of producing benefit.

Cordials were in high reputation among the Greek prac- Cordials and titioners, from a belief that apoplexy is in almost every case all stimu

lants misthe result of a debilitated and pituitous habit: and the chievous. custom has too generally descended to the present day, even where the ground on which it was founded has been relinquished. Stimulants and cordials of all kinds should be sedulously abstained from : and the neutral salts with small doses of the antimonial powder, or any other cutaneous relaxant be employed in their stead : cooling dilute drinks should be freely recommended; and if we should hereby be enabled to excite a gentle moisture on the skin, it may prove of incalculable advantage.

The curative process under our SECOND VARIETY of Particular the diseasc, or ATONIC APOPLEXY, must vary in many of atonic

treatment apoplexy.




Gen. VIII. points from the preceding. It is here, if at any time, we
Spec. V.
Carus Apo- should pause, before we employ bleeding. Yet as dissec-
plexia. tions show us that even here also compression, and that

too from an efflux of blood, is very general, and either Bleeding from blood or serum, almost constant, whatever be the demands a degree of constitutional debility, I can hardly conceive of pause : but may in any case in which we should be justified in withholding

the lancet or the use of cupping-glasses. The argument be imperatively called stands precisely upon the ground of the expediency of

bleeding in typhus accompanied with congestion : it is in Illustrated.

itself an evil; but it is only employed as a less evil to fight against a greater. With it we may succeed : with

out it, in either instance, the case is often hopeless. Local bleed- Generally speaking, however, local bleeding will here ing mostly to be preferred be preferable to that of the lancet; but cupping should to general. always be preferred to leeches whose operation is far too

slow for the urgency of the occasion. The last, however, are recommended by Burserius, and Forestus quotes an instance in which they succeeded by a formidable application over the entire body *. Aretæus, after abstracting blood by cupping-glasses, recommends also the use of dry-cupping between the shoulders, and the recommenda

tion is highly ingenious and worth attending tot. Purgatives Purgatives, though less violent than in entonic apomay be used with plexy, should in like manner be had recourse to: and as less doubt.

we have less danger to apprehend from the use of emetics, they may be given more freely. They are strongly recommended by Sauvages, and were regarded by Grubelius almost as a specific. They have the triple advantage of freeing the stomach from morbid acrimony, rousing the system generally, and determining from the head

to the surface of the body. As may ex- Here also we may use both external and internal sti

mulants in many cases with considerable success. Of the stimulants. former, volatile alkali, rubefacients, and blisters may be

made choice of in succession, and applied alternately to

ternal and internal

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t De Cur. Morb. Acut. 1. 4.

different parts of the body. Of the latter we should GEN.

Spec. V. chiefly confine ourselves to the warmer verticillate plants, Carus Apoas lavender, marjoram, and peppermint, or the warmer plexia..

Apoplexy. siliquose, as horse-radish and mustard, or the different Treatment. forms of ammonia ; yet even of these we are debarred by Dr. Cullen, at least in that particular modification of atonic apoplexy, which we have described under the name of serous, though he does not enter into a consideration of any other. In that peculiar kind of apoplexy which is sometimes Treatment

of apoplexy produced by taking immoderate doses of spirits or some from excess narcotic, and especially opium, in which we meet with an of drinking,

or of naralmost instantaneous exhaustion of the nervous power, or cotics. an instantaneous stop put to its secretion or flow, making a near approach to asphyxy, though with a heavy drowsiness and stertorous breathing, the patient should first have his stomach thoroughly emptied by an emetic of sulphate of copper; he should be generally stimulated by · blisters, and kept in a state of perpetual motion by walking or other exercise, so as to prevent sleep till the narcotic effect is over. An interesting case of this kind will be found related by Dr. Marcet in the Medico-Chirurgical Transactions*. After all it should not be forgotten that apoplexy is in The interval

of great immost, perhaps in all cases, not secondarily alone, but pri

portance, marily a nervous affection, and dependent upon a predis- and demands

minute atposition to this disorder in the sensorium itself, if not upon a morbid condition of it: and that hence the patient, though we should recover him from the actual fit, will be subject to a recurrence of it. In this view the interval becomes a period of great importance, and should be as much submitted to a course of remedial treatment as the paroxysm itself.

After entonic apoplexy, the patient should habitually Intermediaccustom himself to a plain diet, regular exercise, early, hours of meals and retirement, and uniform tranquillity of entenic mind : and the state of his bowels should particularly ap


ate treatment of

• Vol. 1. p. 77.

Spec. V.


Gen. VIII. claim his attention. After the atonic variety the same

general plan may be followed with a like good effect, but Carus Apoplexia. the diet may be upon a more liberal allowance; and a Apoplexy.

course of tonic medicines should form a part of the remeTreatment. of atonic

dial system. If it were true, as suspected by Dr. Cullen, apoplexy. that all bitters contain in the bitter principle itself a nar

cotic and mischievous power, these ought to be carefully abstained from, but we have already observed that this does not seem to be the fact. And hence much of the treatment laid down under Limosis Dyspepsia * may be pursued here: together with the use of the waters of Bath, Buxton, and Leamington.




nervous affecton.


U MORE OR LESS GENERAL, BUT WITHOUT SOMNOLENCY. Spec. VI. Relation to Palsy is a disease which makes a near approach to apo apoplexy.

plexy in its general nature and symptoms, and is very stric:ly a frequently a result of it. It is, however, still more strictly

a nervous affection, and less connected with a morbid Someimes state of the sanguiferous or the respiratory organs. In exists principall, in

examining it more in detail, we shall find that sometimes the motory the motory fibres alone are affected in any considerable fibres sometines degree, while the sentient are only rendered a little more

obtuse; sometimes both kinds are equally torpid, and motory and

I sometimes several of the faculties of the mind participate and sone- in the debility, though they are never so completely lost times intlu. ences as in apoplexy. several of the mental faculties,

in the

» Vol. 1. p. 164.


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