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THE seat of the Apoplexy seems to be within the same inward portion of the Brain, viz. The Corpus Callosum, as that of the Vertigo; to wit, in as much as in both affects the Imagina∣tion, common Sense, tho in a far differing degree, are affected, viz. in the former the irradiation of the Spirits, is wont to be obscur'd in
some places, and to be inetrrupted with little Clouds, as it were, scattered here and there, but in the latter, the same is forthwith wholly darkned, and undergoes a total Eclips.
The Apoplexy, according to the import of the Word, denotes a striking, and by reason of the stupendous Nature of the affect, as tho it contain'd somewhat Divine, it is called a sideration: for those that are seized with it, as tho they were Planet-struck, or smitten by an invisible Deity, fall on the Ground on a sudden, and being deprived of Sense and Mo∣tion, and the whole animal function (unless that they breath) ceasing, they lye dead as it were for some time, and sometimes dye out-right: and if they revive again, they are oftentimes affected with a general Palsie or an Hemiplegia.
Tho it may seem a Paradox, it is not disagreeing with Reason to say that the Apoplexy is two-fold, and that one of them belongs to the Cere∣bellum, and that the other has its seat in the midst of the Brain: the former happens by reason of the animal Spirits design'd for the vital function, being supprest in their very source, viz. within the Cerebellum, the motion of the Heart being often thereby letted or supprest, as we have intimated before that this happens in some sort in the Incubus: and doubtless to this cause ought to be attributed what I have observed in some, that after a great heaviness in the Occiput, a Swooning with a sudden privation of all the animal function ensues: in which the disea∣sed lye without Motion or Sense, with a Pulse and Respiration greatly diminish'd, and scarce perceivable, and being all over cold for many Hours, nay, often a Day or two, more resembling Persons dead, than living: We have sometimes known Persons so affected, who have grown cold and stiff, their Pulse and Respiration seeming wholly to be ceased, and who have been really taken for dead, and put in their Cof∣fins, yet after two or three dayes to have come to life again.
To enquire into the causes of the other, and the wayes of its coming to pass, we must first distinguish concerning the various Invasion of this Disease; to wit, how sometimes being raised from a sudden, solemn, and invincible cause, without any previous Disposition or Procatarxis, it is for the most part mortal; against this no Procatarctick or preservatory Method can be ordered; and the method of curing it, which is ordina∣rily entred upon, for the most part becomes ineffications: or secondly an Apoplectick Fit, having an antecedent Cause, or a previous Procatarxis is brought into act through various Occasions or evident Causes.
As to the seisure of the former kind, viz. being sudden and unawares, its conjunct, and immediate cause is either a great Solution of Continu∣ity hapning some where within or near the middle of the Brain; through which its Pores and Passages being obstructed, or comprest, all ema∣nation of the Spirits is supprest, or it is a great and sudden putting to flight, or extinction of the Spirits residing in the Brain.
The things which are wont to cause a great solution of Continuity within the Brain, are, Blood extravasated, an Abscess suppurated and broken, and an inundation of a serous humour; and tho this latter sel∣dom or never happens of it self, yet sometimes, by reason of strong evident causes, such a glut of serous filth rushes into the Brain, that pre∣sently filling and stuffing all its medullary Pores, it renders the Person speechless, which I have known to have hapned to some upon sleeping presently after having drank too largely of small Wine and Spaw Waters; I have observed the like affect upon a total and long continued sup∣pression of Urine. And in malignant Fevers the serous recrements by a critical Metastasis being conveyed to the Brain have often caused a loss of Speech with Death.
Of the evident Causes by which an extemporary Apoplexy is wont to be procured, the other kind consists in a sudden profligation, or extincti∣on of the Spirits: which strong Narcoticks, and an immoderate drinking of hot-Waters often effect.
Thus much concerning the Causes of the accidental and extemporary Apoplexy, which bring a fit of it on all Persons indifferently, tho not predispos'd; and wherefore there can be no Prophylaxis ordered, and it is seldom that a Cure succeeds. But we observe besides, that this Disease sometimes is habitual, viz. That there remains in certain men a constant Disposition, by reason of which first slight Bickerings trouble them, afterward by short intervals greater accesses come upon them: of which for the most part they dye at last.
As to the conjunct cause of this Disease, it consists in the sudden fil∣ling of the Pores of the Corpus Callosum, and the destroying of the Spi∣rits by the approach of a malignant matter.
Its procatarctick Causes are the like as in most other affects of the Brain, viz. both the Blood is in fault, that either engendring of it self, or ta∣king from elsewhere extraneous Particles, and such as are very adverse to the texture, or constitution of the animal Spirits, and as it were ex∣tinctory of them, it sends them to the Brain: and moreover, the fault of the Brain is, that being weak in its Crasis, and too lax and loosned in its Pores and Passages, it always admits so easily and without resistance the morbifick matter obtruded from the Blood.
The Subject of this Disease being the Brain, or the Cerebellum, or both together; the Brain is shewn to be most obnoxious to it, by pre∣vious and frequent Scotomias, and vertiginous Affects: the Cerebellum is argued to be ill-disposed by a frequent Incubus, an intermitting Pulse, a Swooning, and frequent Fainting.
The Prognostick of this Disease is never declar'd but fatal and dubious: for an Apoplexy is never without danger either present, or to come, but the worst is, in which, besides all the spontaneous Functions being abo∣lish'd, the Pulse also and Respiration either fail, or are carried on with much adoe, and then for the most part it happens with a foaming at
Mouth, and a Swooning, to which at length a sweat (which most com∣monly is colliquative) supervening, foreshews that Death will happen very suddenly.
Those who being seized with the Apoplexy are deprived of Pulse and Respiration, and a little after growing cold, seem to be dead, ought not presently to be taken forth of Bed, or to be left without Physi∣cal Administrations: moreover, tho no hope of Life appears, let them not be buried till after three or four dayes: for such, either of their own accord, or by the use of Remedies sometimes revive: which hap∣pens not by reason of the vital heat being raised up again in the Heart, (for it was not wholly destroyed here) but for that the morbifick mat∣ter being discuss'd, or evaporated from the Cerebellum, the motion of the Heart is renewed, as that of a Clock upon hanging on Weights.
In an Apoplectick Fit, if after letting Blood relief follows, some hope of well-doing appears: but if after this and other Remedies the affect continues above four and twenty hours without remitting, or grows worse, all hope is over concerning the diseased.
If after the first seisure of a speechlesness being well over, the dis∣eased afterward becoming more drowsie and dull, is affected with a Scotomia, and a frequent Vertigo, it is a sign that he will be obnoxious to other accesses of the Apoplexy: for the foresaid affects proceed from the morbifick matter at that time deposed in the circumference of the Brain, and there floating here and there, and now and then descend∣ing by small parts only, into the midst of it, which matter, whether it be Vitriolick or Narcotick, after that it is gathered together to a ful∣ness, brings the Apoplexy.
The Therapeutick method either is curatory, for removing the fit, after it has seized, or preservatory for preventing it from returning: the former regards every Apoplexy, the other only that which is habi∣tual.
A fit of the Disease hapning (if it does not proceed from an outward or violent hurt of the Head) tho it be unknown whether it be raised by an invisible cause (such as are an extravasating of the Blood in the Brain, or an Abscess broken) or not: however we ought diligently to endeavour its cure. And because the Blood being too turgid is wont to induce the morbifick cause, or at leastwise to increase it, and when it subsides and becomes more calm is wont sometimes to remove the same: therefore in the first place we ought to deliberate concern∣ing the moderating of its course. And here a question arises con∣cerning the site of the diseased, viz. Whether he ought not presently to be put to bed, or rather to be kept out of it for some time? some religiously observe the latter, nor is it without reason, because in Bed there is a greater propension to sleep, and the Blood boyling more, and burning more freely by reason of the ambient hear of the Bed, sends more of the recrementitious matter into the head affected: on
the contrary, when the diseased being thinly cloathed, is plac'd in a Chair, the Blood flows more slowly, and the subsiding Vessels seem more fit rather for drinking up humours sent from the Brain, then for sending them thither. Wherefore, if the Patient be strong enough, it may haply be better for him to stay out of Bed for six or eight Hours, till the Fluxion of the morbifick Matter be past, and the course of the Blood be made more calm by blooding, and other Re∣medies carefully administred. But let those that are weak, and of a tender Constitution, be put presently to Bed as soon as they are seiz'd. Let the site of the diseased, whether he be in Bed, or out of it, not be on his Back, but the Head somewhat raised, and learning sometimes to one side, sometimes to the other.
Blooding, being necessary almost in all Apoplectical Persons, may not be delayed: but a smart Clyster being injected, let Blood be taken in a plentiful quantity. In the Clyster let there be dissolved Species Hierae Diacolycinth: and a thick infusion of Crocus Metallorum: let a large Vesicatory be applyed to the Neck, and others to the Leggs, and drawing Cataplasmes to the feet: let the Temples and Nostrils be anointed with appropriate Oyles and Balsoms, and let painful Frictions be used to the Limbs, nay to the whole Body: meanwhile let those things be now and then given, which raise up the animal Spirits, and free them from their Fetters, viz. Spirit of Harts-horn, Soot, and the like, with a Cephalick Julep.
Afterward, the diseased being put to Bed (if he seems easie and able enough to bear a Vomit) let a vomitory of Salt of Vitriol, Oxymel of Squils, or an infusion of Crocus Metallorum be given: and now and then a Quill being thrust into his Throat, let a vomiting be raised four or five times, Posset-drink by intervals being poured into him.
The vomiting being over, let comforting things, as Quercitans Elixir of Life, Spirit of Lavender, or of Treacle camphorated, Tincture of Peony, or of Amber, or Coral, be given in a fit dose, with Apoplectick and other appropriate Waters, and as occasion requires let them be repeated.
On the second day the same Remedies being still continued, let dry Cupping-glasses or with a scarification, also be applyed about the Shoul∣der-blades, or in the Neck: or if more Blood ought to be drawn, let the Jugular Vein be opened; let the Clyster be repeated; Let Spirit of Sal Armoniack, or a steam of Galbanum boyled in sharp Vinegar be held to the Nostrils: Moreover, let Errhins, and Apophlegmatisms be used: afterward in the Evening let a purge of Pilulae Rudii, or the Electuary of Roses so∣lutive dissolved in some Liquour be given.
These things doing no good, tho there be small or no hope, let either a burning hot Iron, or a large Vesicatory be applyed to the Crown of the Head shaved; let the remaining part of it, and chiefly the Forehead, and Sinciput be somented with Bezoardick Vinegar:
Let Leeches be applyed to the Temples, or behind the Ears; Let Spi∣rit of Harts-horn, or of Soot be given him in a large dose, and often; we must insist on these and other ways of adminstrations till death seems to be at hand, which (as Celsus has it) those kind of Remedies often only delay, and in the mean while prove troublesome to life.
The Prophylactick Method regards both those, who have been for∣merly set upon with one or more Invasions, and those who seem prone to them, as being born from Apoplectick Parents, or being obnoxious to the Vertigo, Incubus, or frequent Faintings, and such as have the Neck short and thick grown.
Spring and Fall let purging and blooding (where it is proper) be used; as to the former let those that are easie to vomit, take first a vomitory of the Infusion of Crocus Metallorum, with Salt of Vitriol, or of Sulphur of Antimony, and then after three or four dayes, let a dose of Pilulae Rudii, or of Amber be given; and afterward by due intervals let it is be repeated three or four times: let two large Issues be raised near the Shoulder-blades, or if those Places do not please some, let them have one in the Arm, and another in the opposite Leg.
On other dayes free from purging, let altering and cephalick Me∣dicines be taken twice a day.
Take Conserve of the Flowers of Lillies of the valley (or of male Peo∣ny) six ounces, powder of the roots of male Peony half an ounce, mans skull prepar'd three drams, seeds and flowers of male Peony powdered, of each two drams, red Coral prepar'd, Pearl and white Amber of each a dram, Salt of Coral four scruples, syrup of the flowers of male Peony what suffices, make an Electuary: the dose is two drams morning and evening, drinking after it of the following water two or three ounces.
Take roots of male Peony, Angelica, Master-wort, of each half a pound, roots of Zedoary, the lesser Galingal, of each an ounce, leaves of Mistletoe of Apple-trees, Rue, Sage, Betony, of each four handfuls, the outward coats of ten Oranges and eight Lemmons, Cardamums, Cloves, Nutmegs, of each half an ounce; all being slic'd and bruised, pour to them of White-wine (in which two pounds of Peacocks dung hath been infused for a day) ten pounds: let there be a close infusion for three dayes, then distill it according to art, let the whole Liquor be mixt.
Take species Diambroe two drams, powder of the roots of male Peony, choice Zedoary of each a dram and a half, Pearl a dram, Oyle of pure Amber half a dram, double refined Sugar dissolved in Peony Water, and boyled to a Consistency, for Tablets, six ounces, make Tablets according to art, weighing half a dram; let the Patient eat one or two often in a day at pleasure.
Within fifteen or twenty dayes, the Remedies, that they may be less loathsome and more advantageous ought to be changed; therefore instead of the Electuary, give for a fortnight or three weeks sometimes Spirit of Sal Armoniack saccinated, or coralliated, or impregnated with Mans
Scull, or Castoreum; sometimes the Elixir of Peony, or the tincture of Amber, or Coral, or Quercitans Elixir of Life, mixtura simplex: Also, instead of the compound Waters let them take either the Water of black Cherries, or of Walnuts, or of Rosemary, or of Lavender simple, sometimes a draught of Posset-drink with the Flowers of male Peony, or of Lillies of the Vallies boyled in it, or a draught of Tea or Coffee, in the Morning (those Ingre∣dients being first boyled in the Water of which it is prepared) or let a Confection of Chocolate be made after this manner.
Take powder of the Roots of male Peony, mans Scull prepared of each half an ounce, Species Diambrae two drams, make a Powder, to every paper of which add Cocao-nut-Kernels a pound, Sugar what suffices, make a Confection, let half an ounce or six drams of this be taken every Morning in a draught of a decoction of Sage, of Peony Flowers, or the like.
Take Powder of the Roots of male Peony, mans Scull prepared of each an ounce and a half, Roots of choice Zedoary, bastard Dittany, Angelica, Contrayerva of each two drams, make a subtle Powder of all of them, add the yellow Coats of Oranges and Limons preserv'd of each two ounces, let them be bruised together to a Powder, let about half a dram, or a dram be taken an Hour before and after meals.
For ordinary Drink, let a Vessel of four Gallons be filled with midling Ale, in which boyle the Leaves of white sweet-smelling Hore-hound dryed six handfuls, Anacardiums, Cardamums, of each an ounce and a half, be∣ing slic'd and bruised, make a Bag.
But especially, let an exact form of Dyet be observ'd: Let a tempe∣rate, dry, and well ventilated Air be chosen; let food only of an easie concoction, and light, be eaten; let the Supper be spare, or none at all; let sleeping at noon, drinkings, and other ill accustomances about nonnatural things be shunned.
I might here instance several stories of Apoplectical persons, viz. of some, who, tho seiz'd once or twice, are still living; and of others kill'd by the first, or second, or afterward at the third Invasion. The Right Reverend Father in Christ, Gilbert Lord Arch-bishop of Canter∣bury, lives still, who escap'd above six years since from a severe Apo∣plectick fit, (God, to whom ever be praise, giving success to Physical endeavours,) and from that time, tho he has now and then under∣gone light touches of the Disease, yet he has never been so prostrated by it as to become speechless, or insensible: But it's to no purpose to dwell long in setting forth this and other examples, in regard they contain nothing very rare, whence the Aetiology of the Disease may be illustrated. I have dissected some dead Bodies, but they were in a manner only of such Persons as were seiz'd Apoplectical after the Head being greatly hurt, as by a stroke, or a fall, in all which the Blood extravasated, or an Abscess was the cause of Death: As to the opening of Persons dead of an habitual Apoplexy, we are most com∣monly hindred by Friends, who expecting their revival, both delay
the Interrment, and wholly forbid Anatomy. But I shall give you here one notable Anatomical Observation made about five years since at Oxford.
An ancient Divine, an honest and pious man, of a gross Body, and ha∣ving a short and full grown Neck, being long ill-dispos'd in his health, and leading a sedentary life, had contracted a very Scorbutick Cacochymia; being affected with a difficult and pursy breathing, and with an unwonted heaviness and drowsiness of his Head, he was scarce able to perform any thing of labour or exercise, but to go and come daily from his Chamber to the Chappel, and Refectory: On a certain morning, entring the Chap∣pel a little before Prayers, as he set himself on his knees, being struck on a sudden, and presently becoming speechless and insensible, he fell on the ground; but being forthwith rais'd up, and his Cloaths taken off, he was put into a warm Bed: My self and other Physicians being call'd, and coming as quick as might be, we found him not only with∣out Sence, Pulse and Respiration, but cold and absolutely stift through∣out his whole Body: Nor could he be brought to life, or to a heat by any Remedies, or ways of administration, tho applied with all dili∣gence for some time: Whence we imagin'd, that from his first be∣ing struck, the beat of the Heart was wholly stopp'd, and its flame being extinct, that presently all motion of the Blood was sup∣pressed.
The next day after we opened the Body, it appearing to be quite dead and stiff; nothing doubting but very clear footstepts of an affect so suddenly mortal, left within the Brain, would shew themselves to the eye; but neither there, or in any other part, was there remain∣ing so much as any shadow of the Disease, tho very violent: the ves∣sels irrigating the Meninges were indifferently fill'd with blood, but without any inflammation or extravasation: the Brain, Cerebellum, and medulla oblongata, with all their processes and prominences, ap∣pear'd every where firm and well-coloured throughout, both within and without: neither was there Serum nor extravasated Blood heapt together any where within their Pores and Passages, nor also within the greater Ventricles: nay, and the plexus choroeides plac'd both within the Cavity of the Brain, and behind the Cerebellum, seemed free from all fault, so that the morbifick matter being as fine and subtle as the Spirits which it affected, remained wholly inconspicuous, and we could only argue its presence there from the effect.
Nevertheless, lest it should lye hid elsewhere without the Head, after having accurately inspected all the Contents of the Brain, we came to the Thorax, where the Lungs being discoloured, and stufft throughout with a frothy Ichor, shew'd manifestly enough the cause of the difficult and pursy breathing; but the Heart being sound and firm enough, was wholly free from any obstructions, or polipous con∣cretions. Moreover, neither near it, nor in other adjacent Viscera
was any Abscess or Impostume found, by whose contact or ill favour the Heart could so be opprest, or the Vital Spirit (in case this be possi∣ble) on a sudden be suffocated.
Wherefore in this case we could imagine nothing else, but that the Animal Spirits residing within the middle of the Brain were on a sud∣den put to flight, and extinguished as it were by certain malignant, or narcotick, or otherwise infesting Particles; so that the motion of the Heart, as of the first mover in a machine, failing on a sudden, pre∣sently all the other Functions, their impulses being taken away, whol∣ly ceas'd.