Evening star. [volume] (Washington, D.C.) 1854-1972, 1886-04-03
The Case of Secretary Manning.

THE CAUSE OF CEREBRAL APOPLEXY,
The Medical Record, in an article on 1.-THE
Cause and Prognosis of Cerebral Apoplexy,'
says to-day:
The unfortunate illness which has attacked
Secretary Manning calls attention to some ofthe
| facts which the modern pathologist has de
veloped, or is still studying, with regard to the
subject of cerebral hemorrhage One fact which
the pathologist has not perhaps felt called on tc
investigate is the apparent increase relatively
Wales. during the years 1S5O-'54, the average
annual death rate from apopleXy per million
inhabitants was 454.2, while in 1S7O-'74 it was
deaths from brain diseases Increased from 90 a
to 24S.6. In New York city the total deaths
rom apop!exy and hemiplegia in 1S74-'75
amounted to 1.35 per cent of the total death
rate; In 1884 the percentage was 1S. Even
bearing In mind the fact that more persons
reach the apoplectic age now than did thirty
years ago it still remains probable that anoniax
les are on the increase
Modern pathology has shown that the prim.
airy cause Of cerebral hemorrhages is in the
great majority Of cases, the bursting of miliary
aneurisms which have developed on the cere
6ral vessels as the result of local periarterits.
me most important supplemental cause TO this
is an increased arterial tension due to heart lis
ease, plethora with corpulence and disease of
oe kiuneys WIN the arteriai sclerosis often ac-
companylng II. Charcot found hypertrophied
heart In forty per cent of cases of cerebral hem
orrhage, and renal disease in 321a per cent The
cause OF The military aneurisms is naturally the
point that should most interest the phvsician
but here little progress has been made We
know In general that they develop almost
soiely In persons passed forty, while from fifty
10 seventy is the apOplectic age. AS in five
slXths OF the cases atheroma of the arteries
Is present we may attribute the aneurisms to
much the same cause as the atheroma viz de-
generative changes natural to Old age chronic
alcoholism, specific disease and continual ex-
cesses and exposure of almost all kinds They
develop more often in men, and heredity as
shown by Hughlings-JacksOn and Diellafov
ACKNOWLEDGEMENTS its part.
of n
such thing as the "apopIectic habit" exists
Most systematic writer's OF late years deny il
PULLS, put is very EVIDENT that many of these ari-
from a hospital experience among the poor w no
do not suffer from corpulence. We are our
selves much inclined to side with Immermann
who places apoplexy among the prominent
complications and sequelfe" of corpulence a.
pecially if with it there is plethora A CORFU
lent man VINO has passed the age Offifty is more
likely, other things being equal to have de.
generated arteries and higher arterial tension
intracranial hemOrrhage. ~
Braln-workers are not by virtue of their work
made liable TO apopiexy. This is a disease of
nutrition and OF the bloOd-veSses. its causes re
seniity, exposure and intemperate Hvino in
the broadcast sense. Whatever puts off old aoa
delays desenerative changes and lessons also
the tendency 10 apOplexy. The prognosis after
an attack occurs relates to life and to health in
the future. should life be preserved. 49,
Quick onsets, quickly recovered from, are
more favorable than those coming on Slowly
When the attack comes on without loss of con
seriousness, as was the case we are told. with
Secretary Manning, the prognosis 0uond ,,i,nn,
is very good. Ii loss of consciousness is pro
found. and lasts twenty-four or forty-efght
hours, the outlook is most ominous But one of
the worst prognOsticators OF the future is the
clinical thermometer. A progressive rise or n
steady fall OF temperature is a most favorable
sign. Inc extent OF the paralysis, and aphasia,
II that exists, gives fair indication of the ex,
tent OF the lesson, and this, in connection with
a history OF It's progress during the first fort
night after the attack, will tell how much of
mental or physical restoration can take place.