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GEN. VIII.
SPEC. V.

Carus Apo

plexia. Apoplexy.

General

result.

same effect more speedily, and with more facility of restraint when a sufficiency of blood has been taken away. 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 diminution of the strength of the patient."*

Purgatives.

Emetics, in
entonic
apoplexy,
of a doubtful

character:

The next important means to be pursued is that of exciting 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 ptyalism +.

The collateral remedies are of less importance though some of them may add to the general effect. Emetics are of a very doubtful character in the form of the disease 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

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:

SPEC. V.

ing and the languor hereby occasioned is not exactly GEN. VIII. of the kind we stand in need of; regard being had to the Carus Apodisease as a nervous affection, and the danger of inducing plexia. Apoplexy. hemiplegia. Full vomiting may, indeed, determine from Treatment. 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 III. 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.

sinapisms.

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.

all stimulants mis

Cordials were in high reputation among the Greek prac- Cordials and titioners, from a belief that apoplexy is in almost every case the 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 disease, or ATONIC APOPLEXY, must vary in many of atonic

treatment

apoplexy.

GEN. VIII. Carus Apoplexia. Apoplexy.

SPEC. V.

Treatment.
Bleeding

points from the preceding. It is here, if at any time, we should pause, before we employ bleeding. Yet as dissections show us that even here also compression, and that too from an efflux of blood, is very general, and either from blood or serum, almost constant,-whatever be the degree of constitutional debility, I can hardly conceive of 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 itself an evil; but it is only employed as a less evil to fight against a greater. With it we may succeed: without it, in either instance, the case is often hopeless.

demands a pause: but may in

some cases

for. Illustrated.

Local bleed

ing mostly to

Generally speaking, however, local bleeding will here 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 recommendation is highly ingenious and worth attending to†.

Purgatives

may be

used with less doubt.

As may external and internal

Purgatives, though less violent than in entonic apoplexy, should in like manner be had recourse to: and as 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.

Here also we may use both external and internal stimulants 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

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SPEC. V.

different parts of the body. Of the latter we should GEN. VIII. chiefly confine ourselves to the warmer verticillate plants, Carus Apoas lavender, marjoram, and peppermint, or the warmer 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.

of drinking,

or of nar

cotics.

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 almost instantaneous exhaustion of the nervous power, or 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 most, perhaps in all cases, not secondarily alone, but primarily a nervous affection, and dependent upon a predisposition 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.

The interval
portance,
of great im-

and demands
tention.

minute at

ate treat

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

* Vol. I. p. 77.

SPEC. V.

plexia. Apoplexy. Treatment.

of atonic apoplexy.

GEN. VIII. claim his attention. After the atonic variety the same general plan may be followed with a like good effect, but the diet may be upon a more liberal allowance; and a course of tonic medicines should form a part of the remedial system. If it were true, as suspected by Dr. Cullen, that all bitters contain in the bitter principle itself a narcotic 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.

GEN. VIII. SPEC. VI. Relation to apoplexy. Still more strictly a

nervous

affection.

Sometimes exists principally in

CORPOREAL

SPECIES VI.

CARUS PARALYSIS.

Palsy.

TORPITUDE AND MUSCULAR IMMOBILITY MORE OR LESS GENERAL, BUT WITHOUT SOMNOLENCY.

PALSY is a disease which makes a near approach to apoplexy in its general nature and symptoms, and is very frequently a result of it. It is, however, still more strictly a nervous affection, and less connected with a morbid state of the sanguiferous or the respiratory organs. In examining it more in detail, we shall find that sometimes the motory fibres alone are affected in any considerable sometines degree, while the sentient are only rendered a little more obtuse; sometimes both kinds are equally torpid, and sometimes several of the faculties of the mind participate in the debility, though they are never so completely lost as in apoplexy.

the motory

fibres.

in the motory and

sentient : and some

times influ

ences several of

the mental

faculties.

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