See also:

• APOPLEXY (Gr. arov n i.a, from aroaMvvew, to strike down, to stun)

APOPLEXY (Gr. arov n i.a, from aroaMvvew, to strike down, to stun)  , the See also:

• TERM

term employed by See also:

• GALEN (or GALENUS), CLAUDIUS
• GALEN, CHRISTOPH BERNHARD, FREIHERR VON (16o6-1678)

Galen to designate the " sudden loss of feeling and See also:

• MOVEMENT

movement of the whole See also:

• BODY

body, with the exception of respiration," to which, after the See also:

• TIME (0. Eng. Lima, cf. Icel. timi, Swed. timme, hour, Dan. time; from the root also seen in " tide," properly the time of between the flow and ebb of the sea, cf. O. Eng. getidan, to happen, " even-tide," &c.; it is not directly related to Lat. tempus)
• TIME, MEASUREMENT OF
• TIME, STANDARD

time of See also:

• HARVEY
• HARVEY, GABRIEL (c. 1545-1630)
• HARVEY, SIR GEORGE (1806-1876)
• HARVEY, WILLIAM (1578—1657)

Harvey, was added " and with the exception of the circulation." Although the term is occasionally employed in See also:

• MEDICINE

medicine with other significations, yet in its See also:

• GENERAL
• GENERAL (Lat. generalis, of or relating to a genus, kind or class)

general acceptation See also:

• APOPLEXY (Gr. arov n i.a, from aroaMvvew, to strike down, to stun)

apoplexy may be defined as a sudden loss of consciousness, of sensibility, and of movement with-out any essential modification of the See also:

• RESPIRATORY

respiratory and circulatory functions occasioned by some See also:

• BRAIN (A.S. braegen)

brain disease . It was discovered that the See also:

• MAJORITY (Fr. majorite; Med. Lat. majoritas; Lat. major, greater)

majority of the cases of apoplexy were due to cerebral See also:

• HAEMORRHAGE (Gr. atµa, blood, and prryvvvac, to burst)

haemorrhage, and what looked like cerebral haemorrhage, red APOPLEXY 195 softening; and the See also:

• IDEA (Gr. Ibia, connected with i&eiv, to see; cf. Lat. species from specere, to look at)

idea for a See also:

• LONG, GEORGE (1800-1879)
• LONG, JOHN DAVIS (1838– )

long time prevailed that apoplexy and cerebral haemorrhage could be employed as synonymous terms, and that an individual who, in popular parlance, " had an apoplectic stroke," had necessarily suffered from haemorrhage into his brain . A small haemorrhage may not, however, cause an apoplectic See also:

• FIT

fit, nor is an apoplectic fit always caused by haemorrhage; it may be due to sudden blocking of a large See also:

• VESSEL (O. Fr. vaissel, from a rare Lat. vascellum, dim. of vas, vase, urn)

vessel by a See also:

• CLOT, ANTOINE

clot from a distant See also:

• PART

part (embolism), or by a sudden clotting of the See also:

• BLOOD

blood in the vessel itself (thrombosis) . Owing to the prevailing idea in former times that cerebral haemorrhage and apoplexy were synonymous terms, the word apoplexy was applied to haemorrhage into other See also:

• ORGANS

organs than the brain; thus the terms pulmonary apoplexy, retinal apoplexy and splenic apoplexy were used . The term `.` apoplexy " is now used in clinical medicine to denote that See also:

• FORM (Lat. forma)

form of See also:

• COMA (Gr. K(.7)

coma or deep See also:

• STATE
• STATE, GREAT OFFICERS OF

state of unconsciousness which is due to sudden disturbance of the cerebral circulation occasioned by a See also:

• LOCAL

local cause within the See also:

• CRANIAL

cranial cavity, as distinct from the loss of consciousness due to sudden failure of the See also:

• HEART
• HEART, LUNG

heart's See also:

• ACTION

action (See also:

• SYNCOPE (Gr. vvyKO7n , a cutting up or short, from Kbirrew, to cut)

syncope) or the coma of narcotic or alcoholic poisoning, of status epilepticus, of uraemia or of See also:

• HEAD (in 0. Eng. heafad; the word is common to Teutonic languages; cf. Dutch hoofd, Ger. Haupt, generally taken to be in origin connected with Lat. caput, Gr. KerbOvi7)
• HEAD, SIR EDMUND WALKER, BART
• HEAD, SIR FRANCIS BOND, BART

head injury . The sudden coma of See also:

• SUNSTROKE (Heatstroke; Insolation; Thermic Fever; Siriasis)

sunstroke and See also:

• HEAT (0. E. haktu, which like " hot," Old Eng. hat, is from the Teutonic type haita, hit, to be hot; cf. Ger. hitze, heiss; Dutch, hitte, heet, &c.)

heat-stroke might be jncluded, although owing to the suddenness with which a See also:

• PERSON, OFFENCES AGAINST THE

person may be struck down, the term heat apoplexy is frequently used, and, from an etymological point of view, quite justifiably . The older writers use the term See also:

• SIMPLE

simple apoplexy for a sudden attack which could not be explained by any visible disease . Again, congestive apoplexy was applied to those cases of coma where, at the See also:

• AUTOPSY (Gr. aisros, self, and i4'tc, sight, investigation)

autopsy, nothing was found to See also:

• ACCOUNT
• ACCOUNT (through O. Fr. acont, Late Lat. comptum, cornputare, to calculate)

account for the coma and See also:

• DEATH

death except engorgement of the vessels of the brain and its membranes . In senile dementia and in general See also:

• PARALYSIS, or PALSY (from Gr. aapal,6a , to relax; Wycliffe has palesy, and another old form of the word is parlesy)

paralysis the brain is shrunken and the convolutions atrophied, the increased space in the ventricles and between the convolutions being filled up with the cerebro-See also:

• SPINAL

spinal fluid . In these diseases apoplectic states may arise, terminating fatally; the excess of fluid found in such cases was formerly thought to be the cause of the symptoms, consequently the See also:

• CONDITION (Lat. condicio, from condicere, to agree upon, arrange; not connected with conditio, from condere, conditum, to put together)

condition was called serous apoplexy . Such terms are no longer used, owing to the better knowledge of the See also:

• PATHOLOGY (from Gr. raBos, suffering)

pathology of brain disease . Having thus narrowed down the application of the term " apoplexy," we are in a position to consider its See also:

• CHIEF (from Fr. chef, head, Lat. caput)

chief features, and the mechanism by which it is produced .

Apoplexy may be rapidly fatal, but it is very seldom instantly fatal . The onset is usually sudden, and sometimes the individual may be struck down in an instant, senseless and motionless, " warranting those epithets, which the ancients applied to the victims of this disease, of attoniti and siderati, as if they were See also:

• THUNDER

thunder-stricken or See also:

• PLANET (Gr. ssXavirrns, a wanderer)

planet-struck " (See also:

• SIR

Sir See also:

• THOMAS
• THOMAS (c. 1654-1720)
• THOMAS (d. 110o)
• THOMAS, ARTHUR GORING (1850-1892)
• THOMAS, CHARLES LOUIS AMBROISE (1811-1896)
• THOMAS, GEORGE (c. 1756-1802)
• THOMAS, GEORGE HENRY (1816-187o)
• THOMAS, ISAIAH (1749-1831)
• THOMAS, PIERRE (1634-1698)
• THOMAS, SIDNEY GILCHRIST (1850-1885)
• THOMAS, ST
• THOMAS, THEODORE (1835-1905)
• THOMAS, WILLIAM (d. 1554)

Thomas See also:

• WATSON, RICHARD (1737-1816)
• WATSON, THOMAS (c. 1557–1592)
• WATSON, WILLIAM (1858- )
• WATSON, WILLIAM (c. 1559-1603)

Watson) . The attack, however, may be less sudden and, not infrequently, attended by a convulsion; while occasionally, in the condition termed ingravescent apoplexy, the coma is See also:

• GRADUAL (Med. Lat. gradualis, of or belonging to steps or degrees; gradus, step)

gradual in its onset, occupying See also:

• HOURS, CANONICAL

hours in its development . Although unexpected, various warning symptoms, sometimes slight, sometimes pronounced, occur in the majority of cases . Such are, fulness in the head, headache, giddiness, noises in the ears, See also:

• MENTAL

mental confusion, slight lapses of consciousness, numbness or tingling in the limbs . A characteristic apoplectic attack presents the following phenomena: the individual falls down suddenly and lies without sense or See also:

• MOTION (Lat. motio, from movere, to move)
• MOTION, LAWS OF

motion, except that his See also:

• PULSE

pulse keeps beating and his breathing continues . He appears to be in a deep See also:

• SLEEP (0. Eng. slcepan; Ger. schlafen; cf. Lat. labi, to glide, and " slip ")

sleep, from which he cannot be roused; the breathing is laboured and stertorous, and is accompanied with puffing out of the cheeks; the pulse may be beating more strongly than natural, and the See also:

• FACE (from Lat. fades, derived either from facere, to make, or from a root fa-, meaning " appear "; cf. Gr. cbatvstv)

face is often flushed and turgid . The reflexes are abolished . Although apoplexy may occur with-out paralysis, and paralysis without apoplexy, the two, owning the same cause, very frequently co-exist, or happen in immediate sequence and connexion; consequently there is in most cases definite See also:

• EVIDENCE (Lat. evidentia, evideri, to appear clearly)

evidence of paralysis affecting usually one See also:

• SIDE
• SIDE (mod. Eski Adalia)

side of the body in addition to the coma . Thus the pupils are unequal; there may be asymmetry of the face, or the limbs may be more rigid or flaccid on one side than on the other . These signs of localized disease enable a distinction to be made from the coma of narcotic poisoning and alcoholic See also:

• INTOXICATION (Lat. toxicare, intoxicare, to smear with poison, toxicum, an adaptation of Gr. 'r(*uK v, sc. ¢apµasov, a poison smeared on arrows; roEov, bow)

intoxication . It must be See also:

• BORNE, KARL LUDWIG (1786–1837)

borne in mind that a person smelling strongly of liquor and found lying in the See also:

• STREET
• STREET, GEORGE EDMUND (1824-1881)

street in a comatose state may be suffering from apoplexy, and the See also:

• ERROR (Lat. error, from errare, to wander, to err)

error of sending a dying See also:

• MAN
• MAN, ISLE OF (anc. Mona)

man to a See also:

• POLICE (Fr. police, government, civil administration, a police force, Gr. sroXumeia, constitution, condition of a state, roars, city, state)

police See also:

• CELL (from Lat. cella, probably from an Indo-European kal —seen in Lat. celare, to hide; another suggestion connects the word with Lat. cera, wax, taking the original meaning to refer to the honeycomb)

cell may be avoided by this knowledge .

If the fit is only moderately severe, the reflexes soon return; and the patient may in a few hours show indications of returning consciousness by making some movements or opening his eyes when spoken to, although later it may be found that he is unable to speak, or may be paralysed or mentally afflicted (see PARALYSIS) . In severe cases the coma deepens and the patient See also:

• DIES, CHRISTOPH ALBERT (1755-1822)

dies, usually from interference with the breathing, or, less commonly, from See also:

• ARREST (Fr. arrester, arreeter, to stop or stay)

arrest of the heart's action . The mechanism by which apoplexy is produced has been a See also:

• MATTER

matter of much dispute; the condition was formerly ascribed to the pressure exerted by the clot on the See also:

• REST (O. Eng. rest, reste, bed, cognate with other Teutonic forms, e.g. Ger. Rast, Riiste, rest, and probably Gothic Rasta, league, i.e. resting or stopping place)

rest of the brain, but there is no increase of intracranial pressure in an apoplectic fit occurring as a result of the sudden See also:

• CLOSURE (Fr. clooture)

closure of a large vessel by embolism or thrombosis . Suddenness of the See also:

• LESION (through Fr. from Lat. laesio, injury, laedere, to hurt)

lesion appears to be, then, the essential See also:

• ELEMENT (Lat. elementum)

element See also:

• COMMON

common to all cases of apoplexy from organic brain disease . It is the sudden See also:

• SHOCK, or COLLAPSE

shock to the delicate mechanism that produces the unconsciousness; but seeing that the coma is usually deeper and more prolonged in cerebral haemorrhage than when occasioned by vascular occlusion, and that an ingravescent apoplexy coma gradually develops and deepens as the amount of haemorrhage increases, we may presume that increase of intracranial pressure does See also:

• PLAY

play an important part in the degree and intensity of the coma caused by the rupture of a vessel . Apoplexy seldom occurs under See also:

• FORTY

forty years of.See also:

• AGE (Fr. age, through late Lat. aetaticum, from aetas)

age, but owing to the fact that disease of the cerebral vessels may exist at any age, from causes which are fully explained in the See also:

• ARTICLE (from Lat. articulus, a joint)

article See also:

• NEUROPATHOLOGY

NEUROPATHOLOGY, no See also:

• PERIOD
• PERIOD (Gr. irepioSos, a going or way round, circuit, aepi, round, and &Sis, way, road)

period of See also:

• LIFE

life is exempt; consequently cases of true apoplexy are not wanting even in very See also:

• YOUNG
• YOUNG, A
• YOUNG, ARTHUR (1741-1820)
• YOUNG, BRIGHAM (1801-1877)
• YOUNG, CHARLES MAYNE (1777–1856)
• YOUNG, EDWARD (1683–1765)
• YOUNG, JAMES (1811-1883)
• YOUNG, THOMAS (1773-1829)

young See also:

• CHILDREN, LAW RELATING TO

children . Recognizing that there are two causes of apoplexy in advanced life, viz . (I) sudden rupture of a diseased vessel usually associated with high arterial pressure, enlarged, powerfully acting heart and chronic renal disease, and (2) the sudden clotting of blood in a large diseased vessel favoured by a See also:

• LOW, SETH (1850- )
• LOW, WILL HICOK (1853- )

low arterial pressure due to a weak-acting heart, it is obvious that the See also:

• CHARACTER (Gr. xapareri7p, from xap&crew, to scratch)

character of the pulse forms a See also:

• GOOD, JOHN MASON (1764-1827)

good See also:

• GUIDE (in Mid. Eng. gyde, from the Fr. guide; the earlier French form was guie, English " guy," the d was due to the Italian form guida; the ultimate origin is probably Teutonic, the word being connected with the base seen in O. Eng. witan, to know)

guide to the diagnosis of the cause, the prevention and warding off of an attack, and the treatment of such should it occur . Anything which tends directly or indirectly to increase arterial pressure within the cerebral blood-vessels may bring on an attack of cerebral haemorrhage; and although the See also:

• IDENTIFICATION (Lat. idem, the same)

identification of an apoplectic See also:

• HABIT (through the French from Lat. habitus, from habere, to have, hold, or, in a reflective sense, to be in a certain condition; in many of the English senses the French use habitude, not habit)

habit of body with a stout build, a See also:

• SHORT, FRANCIS JOB (1857– )

short See also:

• NECK (O. Eng. hnecca; the word appears in many Teutonic languages; cf. Dutch ride, Ger. Nacken; in O. E. the common word was heals; cf. Ger. Hals)

neck and florid complexion is now generally discredited, it being admitted that apoplexy occurs as frequently in thin and spare persons who See also:

• PRESENT

present no such peculiarity of conformation, yet a plethoric habit of body, occasioned by immoderate eating or drinking associated with the gouty diathesis, leads to a general arterio-sclerosis and high arterial pressure . All conditions which can give rise to a local intracranial or a general bodily increase of the arterial pressure, i.e. severe exertion of body and mind, violent emotions, much stooping, overheated rooms, exposure to the See also:

• SUN
• SUN (0. Eng. sonne, Ger. sonne. Fr. soleil, Lat. sol, Gr. ijXior, from which comes helio- in various English compounds)

sun, sudden shocks to the body, See also:

• CONSTIPATION (from Lat. constipare, to press closely together, whence also the adjective " costive ")

constipation and straining at See also:

• STOOL

stool, may, by suddenly increasing the See also:

• STRAIN (through O. Fr. straindre, estraindre, mod. i treindre, from Lat. stringere, to draw tight, related to stress, stretch, string, &c.)

strain on the See also:

• WALL (O. Eng. weal, weall, Mid. Eng. wal, wane, adapted from Lat. vallum, rampart; the original O. Eng. word for a wall was wag or tenth)
• WALL, RICHARD (1694-1778)

wall of a diseased vessel, See also:

• LEAD
• LEAD (pronounced iced)

lead to its rupture . The outlook of apoplexy' is generally unfavourable in cases where the coma is profound; death may take See also:

• PLACE (through Fr. from Lat. platea, street; Gr. IrAar6s, wide)

place at different intervals after the onset . If the patient, after recovering from the initial coma, suffers with continual headache and lapses into a drowsy state, the result is likely to be serious; for such a condition probably indicates that an inflammatory See also:

• CHANGE (derived through the Fr. from the Late Lat. cambium, cambiare, to barter; the ultimate derivation is probably from the root which appears in the Gr. «a urmu', to bend)

change has taken place about the clot or in the See also:

• AREA

area of softening .

Treatment.—The patient should be placed in the recumbent position with the head and shoulders slightly raised . He should be moved as little as possible from the place where the attack occurred . The medical man who is summoned will probably give the following directions: an See also:

• ICE (a word common to Teutonic languages; cf. Ger. Eis)

ice-bag to be applied to the head; a few grains of See also:

• CALOMEL

calomel or a drop of croton oil in See also:

• BUTTER (Lat. butyrum, Gr. 0obrvpov, apparently connected with $ous, cow, and rvpbs, cheese, but, according to the New English Dictionary, perhaps of Scythian origin)

butter to be placed on the See also:

• TONGUE (O. Eng. lunge)

tongue, or an enema of See also:

• CASTOR

castor oil to beadministered . He may find it necessary to draw off the See also:

• WATER

water with a catheter . The practice of blood-letting, once so common in this disease, is seldom resorted to, although in some cases, where there is very high arterial tension and a general state of plethora, it might be beneficial . Depletives are not employed where there is evidence of failure of the heart's action; indeed the cautious See also:

• ADMINISTRATION (Lat. administrare, to serve)

administration of stimulants may be necessary, either subcutaneously or by the mouth (if there exist a See also:

• POWER [WILLIAM GRATTAN] TYRONE (1797-1841)

power of swallowing), together with warm applications to the See also:

• SURFACE

surface of the body; a water-See also:

• BED
• BED (a common Teutonic word, cf. German Bett, probably connected with the Indo-European root bhodh, seen in the Lat. fodere, to dig; so " a dug-out place " for safe resting, or in the same sense as a garden " bed ")

bed may be required, and careful See also:

• NURSING

nursing, is essential to prevent complications, especially the formation of bedsores . . (F . W .