The Toledo chronicle. [volume] (Toledo, Tama County, Iowa) 1873-1924, 1875-12-30
Errors About Ap0plexy.

A REcEN medical writer makes the
following suggestions, which correctsome
prevalent notions regarding apoplexy;
In conversing with several persons
about Vice-Presidcnt Wilson's death and
its cause, l have noticed that few have a
right conception Of the symptoms of apo
plexy. The conditions constituting an
attack are the rupture Of a cerebral blood
Vessel, and consequent hemorrhage or ex-
travasation of blood into the brain. The
effect of an extravasation of blood into
the brain substance is the same as COM
preston by a depressed portion of the
skull, because the brain is inclosed in a
hard, unyielding, bony case. Under these
circumstances the pressure caused by the
~extravasatcd blood interrupts the circula-
ton in the substance of the brain, and the
apoplectic phenomena, such as stupor, in
sensibility, etc., are in fact due to q de-
f~iciency of a proper supply of blood to
the nervous mass. The mechanism is
practically the same when apoplexy de.
ponds on sudden and intense congestion,
or the plugging of a cerebral artery by a
blood-clot.
The symptoms of the disease and imme-
diate cause of death are, therefore, due to
a lack of proper supply of blood to the
brain, and not, as is generally supposed,
to an accumulation OF crush of blood to
the head" 1t may appear paradoxical
that a superfluous quantity of blood within
the Uranium should destroy life by depriv-
ing the mass of brain of a sufficient sup
ply Of arterial blood, yet the fact is suffi-
ciently clear. The rupture of the cerebral
blood-vessel is due to the weakness of its
coats, which is he result of general debil,
ity or previous ill-health. In the great
majority Of cases there are no premonitory
symptoms. The attack may be preceded
in certain instances by a sense of weight
or ~fullncss, vertigo, flushing of the face,
ETC., but these symptoms are never of sutii
cient significance to warrant the predic-
ton of an attack Statistics show that of
sixty-three cases analysed with reference
to premonitory symptoms by Rocheaux,
they were present in only nine, less than
10 per cent. of the whole number.
The liability to an attack increases pro-
gressively from the age of twenty years
upward, occurring most frequently after
sixty years of age, which is due to the
increased weakness of the coats of the
blood vessels in old age, and hence their
liability to rupture.
1t is generally supposed that an attack
is usually preceded by strong mental ex-
citement or violent physical exertion.
This does not seem to be the case. AL
though attacks sometimes follow severe
muscular exercise or mental excitement,
in the large proportion of cases the atfec-
ton is not induced by any obvious excit-
ing cause. Gendrin analysed 176 cases,
and found that ninety-seven lover So per
cent? occurred during sleep, and a large
share of the others when the patients were
comparatively quiet. Another popular
error is the supposition that a certain
class of persons who have short nccks,
tlorld faces, with what is known as a fuH
habit, with considerable e~mbonpotnt, are
peculiarly liable to a so-called apoplectic
constitution. Recent researches and anal
Uses OF large numbers of cases have de-
veloped the facts that no reliance is to be
placed on these or any other external
characters as denoting a predisposition to
apoplexy, and that the majority of per-
sons attacked are either spare or of ordi-
nary habit of body. After a patient has
suffered n attack and partially recov-
cred, the conditions which induced it are
likely to remain or to return, and hence
there is considerable liability to a rccur-
renee. Physicians therefore conclude
that unless one attack has occurred there
are but few if any physical signs or pre-
monitory symptoms which will warrant
the prediction of an attack in any case.