Part 16

Sec. 147. When the first kind of this Disease exists in its most violent Degree, it is then sometimes termed, an apoplectic Stroke, or thundering Apoplexy, which kills in a Moment or instantaneously, and admits of no Remedies. When the Assault is less violent, and we find the Patient with a strong, full and raised Pulse, his Visage red and bloated, and his Neck swelled up; with an oppressed and loud hoarse Respiration; being sensible of nothing, and capable of no other Motions, except some Efforts to vomit, the Case is not always equally desperate. We must therefore immediately,

1. Entirely uncover the Patient's Head, covering the rest of his Body but very lightly; procure him instantly very fresh free Air, and leave his Neck quite unbound and open.

2. His Head should be placed as high as may be, with his Feet hanging down.

3. He must lose from twelve to fifteen Ounces of Blood, from a free open Orifice in the Arm: the Strength or Violence with which the Blood sallies out, should determine the Surgeon to take a few Ounces more or less. It should be repeated to the third or fourth Time, within the Space of three or four Hours; if the Symptoms seem to require it, either in the Arm, or in the Foot.

4. A Glyster should be given of a Decoction of the first emollient opening Herbs that can be got, with four Spoonfuls of Oil, one Spoonful of Salt: and this should be repeated every three Hours.

5. If it is possible, he should be made to swallow Water plentifully, in each Pot of which three Drams of Nitre are to be dissolved.

6. As soon as the Height and Violence of the Pulse abates; when his Breathing becomes less oppressed and difficult, and his Countenance less inflamed, he should take the Decoction No. 23; or, if it cannot be got ready in Time, he should take three Quarters of an Ounce of Cream of Tartar, and drink Whey plentifully after it. This Medicine succeeded extremely well with me in a Case, where I could not readily procure any other.

7. He should avoid all strong Liquor, Wine, distilled Spirit, whether inwardly or by outward Application, and should even be prevented from smelling them.

I have been very authentically assured of the Death of a hale Man, which happened in the very Act of pouring out a large Quantity of distilled Spirits, by Gallons or Bucketfulls, from one Vessel into another. K.

8. The Patient should be stirred, moved, or even touched, as little as it is possible: in a Word every Thing must be avoided that can give him the least Agitation. This Advice, I am sensible, is directly contrary to the common Practice; notwithstanding which it is founded in Reason, approved by Experience, and absolutely necessary. In Fact, the whole Evil results from the Blood being forced up with too much Force, and in too great a Quantity, to the Brain; which being thence in a State of Compression, prevents every Movement and every Influence of the Nerves. In Order, therefore, to re-establish these Movements, the Brain must be unloaded, by diminishing the Force of the Blood. But strong Liquors, Wines, Spirits, volatile Salts, all Agitation and Frictions augment it, and by that very Means increase the Load, the Embarrassment of the Brain, and thus heighten the Disease itself. On the contrary, every Thing that calms the Circulation, contributes to recall Sensation and voluntary Motion the sooner.

9. Strong Ligatures should be made about the Thighs under the Ham: By this Means the Blood is prevented in its Ascent from the Legs, and less is carried up to the Head.

If the Patient seems gradually, and in Proportion as he takes proper Medicines, to advance into a less violent State, there may be some Hopes. But if he rather grows worse after his earliest Evacuations, the Case is desperate.

Sec. 148. When Nature and Art effect his Recovery, his Senses return: though there frequently remains a little Delirium or Wandering for some Time; and almost always a paralytic Defect, more or less, of the Tongue, the Arm, the Leg, and the Muscles of the same Side of the Face. This Palsy sometimes goes off gradually, by the Help of cooling Purges from Time to Time, and a Diet that is but very moderately and lightly nourishing. All hot Medicines are extremely hurtful in this Case, and may pave the Way to a repeated Attack. A Vomit might be even fatal, and has been more than once so. It should be absolutely forbidden; nor should we even promote, by Draughts of warm Water, the Efforts of the Patient to vomit. They do not any ways depend on any Humour or Mass in the Stomach; but on the Oppression and Embarrassment of the Brain: and the more considerable such Efforts are, the more such Oppression is increased: by Reason that as long as they continue, the Blood cannot return from the Head, by which Means the Brain remains overcharged.

Sec. 149. The other Species of Apoplexy is attended with the like Symptoms, excepting the Pulse not being so high nor strong; the Countenance being also less red, sometimes even pale; the Breathing seems less oppressed; and sometimes the Sick have a greater Facility to vomit, and discharge more upwards.

As this Kind of the Disease attacks Persons who abound less in Blood; who are less strong, and less heated or inflamed, Bleeding is not often at all necessary: at least the Repetition of it is scarcely ever so: and should the Pulse have but a small Fulness, and not the least unnatural Hardness, Bleeding might even be pernicious.

1. The Patient however should be placed as was directed in the former Mode of this Disease; though it seems not equally necessary here.

2. He should receive a Glyster, but without Oil, with double the Quantity of Salt, and a Bit of Soap of the Size of a small Egg; or with four or five Sprigs of Hedge Hyssop. It may be repeated twice a Day.

3. He should be purged with the Powder No. 4.

Vomits which are so pernicious in the sanguineous Apoplexy, where the Patient's Countenance and Eyes are inflamed; and which are also dangerous or useless, when a Person has been very moderate in his Meals, or is weakened by Age or other Circumstances, and whole Stomach is far from being overloaded with Aliment, are nevertheless very proper for gross Feeders, who are accustomed to exceed at Table, who have Indigestions, and have a Mass of viscid glairy Humours in their Stomachs; more especially, if such a one has a little while before indulged himself excessively, whence he has vomited without any other evident Cause, or at least had very Strong Nauseas, or Loathings. In brief, Vomits are the true Specific for Apoplexies, occasioned by any narcotic or stupifying Poisons, the pernicious Effects of which cease, the Moment the Persons so poisoned vomit them up. An attentive Consideration of what has occurred to the Patient before his Seizure; his small natural Propensity to this Disease, and great and incessant Loathings, render it manifest, whether it has been caused by such Poisons, or such poisonous Excesses. In these two Last Cases a double Dose of Tartar emetic should be dissolved in a Goblet or Cup of Water, of which the Patient should immediately take a large Spoonful; which should be repeated every Quarter of an Hour, till it operates. E. L.

4. His common Drink may be a Strong Infusion of Leaves of Balm.

5. The Purge should be repeated the third Day.

6. Blisters should immediately be applied to the fleshy Part of the Legs, or between the Shoulder Blades.

These Blisters may be preceded by Cupping with Scarification on the Nape of the Neck. This Remedy, often used by the ancient Physicians, but too little practiced in France, is one of the most speedy, and not the least efficacious, Applications in both sanguine and serous Apoplexies. E. L.

7. Should Nature seem disposed to relieve herself by Sweatings, it should be encouraged; and I have often known an Infusion of the Carduus benedictus, or blessed Thistle, produce this Effect very successfully. If this Method be entered upon, the Sweat ought to be kept up (without stirring if possible) for many Days. It has then sometimes happened, that at the End of nine Days, the Patient has been totally freed from the Palsy, which commonly succeeds this Species of the Apoplexy, just as it does the other.

Sec. 150. Persons who have been attacked with either kinds of this Disease are liable to subsequent ones; each of which is more dangerous than that preceding: whence an Endeavour to obviate or prevent such Relapses becomes of the utmost Importance. This is to be effected in each Sort by a very exact, and rather severe Diet, even to diminishing the usual Quantity of the Patient's Food; the most essential Precaution, to be observed by any who have been once assaulted with it, being entirely to leave off Suppers. Indeed those, who have been once attacked with the first, the sanguineous Apoplexies, should be still more exact, more upon their Guard, than the others. They should deny themselves whatever is rich and juicy, hot or aromatic, sharp, Wine, distilled Liquors and Coffee. They should chiefly confine themselves to Garden-Stuff, Fruits and Acids; such should eat but little Flesh, and only those called white; taking every Week two or three Doses of the Powder No. 24, in a Morning fasting, in a Glass of Water. They should be purged twice or thrice a Year with the Draught No. 23; use daily Exercise; avoid very hot Rooms, and the violent Heat of the Sun. They should go to Bed betimes, rise early, never lie in Bed above eight Hours: and if it is observed that their Blood increases considerably, and has a Tendency towards the Head, they should be bled without Hesitation: and for some Days restrain themselves entirely to a thin and low Regimen, without taking any solid Food. In these Circumstances warm Bathings are hurtful. In the other, the serous, Apoplexy, instead of purging with No. 23, the Patient should take the Purge No. 21.

Sec. 151. The same Means, that are proper to prevent a Relapse, might also obviate or keep off a primary or first Assault, if employed in Time: for notwithstanding it may happen very suddenly, yet this Disease foreshews itself many Weeks, sometimes many Months, nay even Years beforehand, by Vertigos, Heaviness of the Head; small Defects of the Tongue or Speech; short and momentary Palsies, sometimes of one, sometimes of another, Part: sometimes by Loathings and Reachings to vomit; without supposing any Obstruction or Load in the first Passages, or any other Cause in the Stomach, or the adjoining Parts. There happens also some particular Change in the Looks and Visage not easy to be described: sharp and short Pains about the Region of the Heart; an Abatement of the Strength, without any discernible Cause of it. Besides there are still some other Signs, which signify the Ascent of the Humours too much to the Head, and shew, that the Functions of the Brain are embarrassed.

Some Persons are liable to certain Symptoms and Appearances, which arise from the same Cause as an Apoplexy; and which indeed may be considered as very light benign Apoplexies, of which they sustain many Attacks, and yet without any considerable Annoyance of their Health. The Blood, all at once as it were, flushes up to their Heads: they appear heedless or blundering; and have sometimes Disgusts and Nauseas, and yet without any Abatement of their Understanding, their Senses, or Motion of any Sort. Tranquillity of Mind and Body, once Bleeding, and a few Glysters usually carry it off soon after its Invasion. The Returns of it may be prevented by the Regimen directed Sec. 150; and especially by a frequent Use of the Powder No. 24. At the long Run however, one of these Attacks commonly degenerates into a mortal Apoplexy: though this may be retarded for a very long Time by an exact Regimen, and by avoiding all strong Commotions of the Mind, but especially that of Anger or violent Rage.

_Chapter X._