Volume 2
Elements of the theory and practice of physic, designed for the use of students / By George Gregory.
- George Gregory
- Date:
- 1829
Licence: Public Domain Mark
Credit: Elements of the theory and practice of physic, designed for the use of students / By George Gregory. Source: Wellcome Collection.
34/572 page 30
![. es tl 7 80 Be. *.. APOPLEXY: «4 Jeno i ‘ a ah ie, Ma ele m ] nad es tion of those cases which have fallen 1 peer my own observation. Instances, indeed, are on record of wall en death from apoplexy ; but in many of these there is reason to suspect, that the immediate cause of death was rather to be found in some affection of the. | heart, or large vessels in its neighbourhood, than in injury to the ~~ brain. (Genuine apoplexy, commencing in the manner I have de- * scribed, and attended with all the symptoms just enumerated, almost -* always ends fatally. When a recovery, either perfect, tempo- ‘rary, or partial takes place, it will usually be found that some of the’more decided evidences of: perfect coma have been wanting: the patient has given evidence of feeling when his limb is grasped, | or the lancet used ; the pupil has obeyed in a certain degree the stimulus of light; the mouth has not been firmly closed, or the power of swallowing wholly lost; there has been no stertor, or foaming at the mouth; nor were the premonitory symptoms strongly marked. Under such circumstances our prognosis may ‘be somewhat more favourable; though it should even then be _ guarded by the reflection, that if reeovery does take place, we must. seldoim expect it to be perfect. An incurable palsy may remain; or the memory may wholly or partially fail; oran imbe- cility of mind, approaching to mania, may be left. But besides this, in all cases where @ decided apoplectic fit has been experi- enced, a relapse is to be dreaded, and a recovery from a second attack is seldom if ever witnessed. . : ry The cases which commence with violent headach, falling down senseless, with a slight convulsion, have been considered as fatal; uniform and extensive extrava- sation of blood in the brain distinguish it: It is probable, that the apoplectic effort, _ which appears in pain in the head, in fainting and convulsion, is produced by the distension of the blood-vessels; and that it is relieved by the b ‘sting of the vessels which produce a temporary resuscitation, but which soon ends in apoplexy and death, from the extravasation of the blood being continued on the surface; the patient often gets better on drawing blood, and the bleeding ceases; but, dutiin returns; Dr. Cheyne states, that he never saw a case of apoplexy, which began with a sudden headach, that recovered: In these cases, it has been supposed that the artery is diseased, with an earthy brittleness, or a weak ossification, which admits of an easy rupturé. We must not, however, despair: recovery takes place after extravasation. Dr. Baillie, Astley Cooper, Mr. Wilson, all state, that they have seen persons who had recovered from apoplexy, and in whom there were evident marks of effusion of blood afterwards found in the brain. Cooper says, that the blood is seldom absorbed, but that the brain in time acquires the power of bearing its pressure; and thus the symptoms are relieved. Portal also relates cases, in which hemiplegia had occurred, after a most violent apoplexy, and yet the patient recovered:* The difficulty in curing this disease, consists partly in removing the exciting causes; long habits are with difficulty relinquished: The glutton, the drunkard, the inveterate student, and the indolent, who can cure? — The pulse. after being slow, strong and full, becoming small, frequent and intermitting, is a dangerous symptom. Also, the dilated or obstinately contracted pupil; cold and profuse sweats are unfavourable. . In proportion to the degree ~ of stertor, foaming at the mouth, and intermissions in the breathing, is the danger from the malady. An attack, moderate in all its symptoms, bleeding from the nose, the hemorrhoidal vessels, or any eral evacuation appearing, as the ig ie ” ryt * Cooke, London, 1820. vol. i. 274-6. ~~ ' . 2 > rn ‘](https://iiif.wellcomecollection.org/image/b3328975x_0002_0034.jp2/full/800%2C/0/default.jpg)
