Hemorrhage in the Brain.
So suddenly does an attack of apoplexy[1] come upon a person that the ancients not inappropriately called it attonitus (thunder-struck). The difficulty always is the result of pressure upon the brain caused by an excessive amount of blood in the vessels or the rupturing of a blood vessel in the brain. Persons of any age may be affected, but those over fifty are the most frequent victims, and certain individuals are more liable than others to be stricken.[1] Apoplexy here refers to what we now call a stroke. Apoplexy now refers generally to bleeding within a non-specific internal organ.
Persons with a florid complexion, short neck and large abdomen and a tendency to rapidly accumulate flesh have cause to fear apoplexy, especially if they live high and take little exercise. Indulgence in alcoholic liquors by such persons is highly dangerous. Excessive mental labor, sudden great excitement and continued exhaustive physical labor may bring on a stroke of apoplexy in anyone. Again, there are peculiar organizations whose blood vessels seem liable to become brittle, and prone to burst readily. Even very thin persons and those who live most carefully may thus suffer from apoplexy.
Warning Symptoms. — While a stroke of apoplexy comes on with great suddenness, still there are certain premonitory symptoms usually manifested which should be recognized and heeded as warnings by those who are especially inclined to the disease, and should cause them to be careful in their habits. These warning symptoms are: Headache, dizziness, especially when stooping, blurred vision, throbbing sensations in the neck or head, ringing in the ears, flushing of the face, especially after eating or slight exertion, bleeding of the nose. No one of the symptoms alone would indicate apoplexy, but many of them together, occurring in persons predisposed to the disease, should give occasion for great concern.
Peculiar Symptoms. — A stroke of apoplexy may come on in one of three ways. First, the victim experiences a sudden pain, darting through the head; he then becomes extremely pale, sick and faint, and perhaps vomits freely; his memory rapidly leaves him and his countenance appears deathly and his eyes have a vacant stare. He sinks into a most profound stupor and dies. These cases are almost hopeless, for there is little vitality to be aroused.
Second. — There may be a sudden paralysis upon one side of the body, loss of speech and apparent agony of mind. Such cases are slow in developing stupors and full recovery from the paralysis is highly improbable.
Third. — Usually the victim falls suddenly as though struck and lies in a stupid sleep, having no power of speech or thought, the face is flushed, the teeth clenched, the veins of the neck large and distended, the breathing slow and heavy and snoring, and the pulse slow and full and its stroke hard or violent beneath the fingers; the cheeks are distended and often the breath passes through them with a puffing sound. The pupils of the eyes remain unchanged as light is brought near.
Occasionally there are involuntary discharges from the bowels and bladder, though as a rule obstinate constipation follows an attack. In mild cases the patient endeavors to speak but seems to forget certain words necessary to convey his meaning. Swallowing in severe cases is extremely difficult.
Apoplexy from the bursting of a blood vessel gives sudden and complete unconsciousness, and is usually fatal, some patients dying in four or six hours, most living from three to nine days and a very small number recovering with the exception of more or less paralysis. But no person after a stroke of apoplexy can be considered out of danger until ten days after the attack. A third attack usually proves fatal; unless manifestly brought on by excessive eating. The. older the patient the less chance for recovery.
Treatment.— This depends upon the immediate cause of the attack. If from over-eating, the distended stomach is pressing upon the large blood vessels and causing an excessive amount of blood to go to the brain[2]. Manifestly in such cases the patient must sit upright, and not be allowed to lie down — that would increase the pressure. Next, the stomach must be unloaded at once — warm water with salt and mustard is most useful. The hands and feet will usually be found cold; bathe them in hot water containing mustard or ginger. Always loosen the clothing about the neck and body and allow abundance of fresh air.
When it is known that the attack is not caused by over-eating, the patient may lie down with the head raised. Enforce quietude and bathe the extremities in hot water containing stimulation. The bowels must be moved — injections of warm water containing salt and ginger being excellent. Days may elapse before improvement is noticed. But the means of relief must be persisted in, and the patient sustained by frequent administration of broths or other soft or liquid nourishing foods. If swallowing is too difficult sustenance by injections must be resorted to. Feeble heart action may be sustained by small doses of an infusion of goldenseal and scullcap or cactus.
The rules to be observed by persons predisposed to apoplexy may be stated as follows: Avoid excessive labor, mental strain, anxiety and excitement. Eat plain food, and that very moderately; subsist mainly on fruits and vegetables. Leave all alcoholic liquors alone. Keep the bowels open, exercise moderately and keep a cheerful disposition— do not quarrel. Never lie down soon after eating, and don't retire at night with a full stomach. Avoid exercise before breakfast and immediately after meals. Avoid hard water, which often makes brittle the blood vessels in some persons; and do not indulge in foods or habits liable to produce fat.
[2] I did not find any evidence that a stroke could be caused by the immediate effects of over-eating (though obesity is a risk factor). Abdominal blood flow accounts for 25% of cardiac output after eating a meal, and interruptions to the blood supply in that area could cause distension.