CHAPTER IV. THE CURE OF APOPLEXY.
. . . . . should indeed the apoplexy be severe, for by all
means the patients are, as it were, dead men whenever one is
old, to whom this affection is congenial, and they cannot
survive the greatness of the illness, combined with the misery
of advanced life. It has been formerly stated by me, how the
magnitude of the disease is to be estimated. If the patient be
young, and the attack of apoplexy weak, it is still no easy
matter to effect a cure; it must, however, be attempted. The
equivalent remedy, then, as being the great assistance in a
a great disease, is venesection, provided there be no mistake
as to quantity; but the amount is difficult to determine, since
if you take a little too much, you despatch the patient at
once; for to them a little blood is most potent, as being that
which imparts the vital heat to the frame itself, and to the
food. But, if the quantity be inferior to the cause, you do
little good with this the great remedy, for the cause still
remains. But it is better to err on the side of smallness; for,
if it should seem to have been deficient, and the appearance
of the eyes, as seen from below, be favourable, we can open a
vein again. We must open the vein at the hollow of the
elbow, for the blood flows readily from it in the left arm.
But in smaller attacks of apoplexy, it is necessary to consider
whether the paralytic seizure be on the left side or the right.
In a word, the abstraction is to be made from the healthy
parts, for there the blood flows more freely, and thither the
revulsion is made from the parts affected. When, therefore,
the patient is seized with apoplexy without any obvious cause,
we should decide thus concerning the abstraction of the blood.
But if the attack happen from a blow, a fall from a high place,
or compression, there must be no procrastination, for in certain
cases this alone is sufficient for the cure and to save life.
But if it is not thought expedient to open a vein, owing to
the patient's having been seized with much coldness, torpor,
and insensibility, an injection must be given for the evacuation
of the engorgement in the bowels (for very generally persons
are seized with apoplexy from the immoderate use of food and
wine), and for the revulsion of the humours seated in the head.
The clyster should be acrid; and an evacuant of phlegm and
bile, consisting not only of natron, but also of euphorbium, to
the amount of three oboli, added to the usual amount of a
clyster, also the medullary part of the wild cucumber,
or the decoction of the hair (
leaves) of centaury in oil or
water. The following is a very excellent clyster: To the
usual amount of honey add rue boiled with oil and the resin
of the turpentine tree, and some salts, instead of natron, and
the decoction of hyssop.
And if by these means the patient be somewhat aroused,
either from being moved by the supervention of fevers, or
having recovered from his insensibility, or the pulse has
become good, or if the general appearance of the face has
become favourable, one may entertain good hopes, and apply
the remedies more boldly. Wherefore, when the strength is
confirmed, the purgative hiera may be given to the patient
fasting, and particularly a full dose. But, if the strength be an
objection, it is to be given, to the amount of one-half, with
honeyed-water. And we are to move him about, after having
laid him stretched on a couch; and those who carry him must
do so gently, he being allowed to rest frequently, to avoid inducing
lassitude. And if there be a copious evacuation from
the bowels, we are to permit it; but if not, give water, or
honeyed-water, to the amount of two cupfuls, for drink. And
if nausea supervene upon the purging, we are not to interfere
with it; for the exertions of the body have some tendency to
resuscitate the patient, and the vomiting of the bile carries off
the cause of the disease. The medicine hiera is a purger of
the senses, of the head, and of the nerves. Enough, indeed,
has been said respecting evacuation of every kind at the
commencement.
But having wrapped the whole of his person in wool, we
are to soak it with some oil -- the Sicyonian, oil of musk
(
gleucinum), or old oil, either each of these separately, or all
mixed together; but it is best to melt into it a little wax, so
as to bring it to the thickness of ointments; and it is to be rendered
more powerful by adding some natron and pepper: these
are to be reduced to a powder, and strained in a sieve. But
castor has great efficacy in cases of palsy, both in the form of
a liniment with some of the fore-mentioned oils, and it is still
more potent when taken in a draught with honeyed-water, the
quantity being to the amount we have stated under lethargics;
but, at the same time, we must consider the age and disposition
of the patient, whether he be ready to take the drink for several
days. Inunctions are more powerful than fomentations, as
being more easily borne, and also more efficacious; for the
ointment does not run down so as to stain the bed-clothes (for
this is disagreeable to the patient), and adheres to the body
until, being melted by the heat thereof, it is drunk up. Moreover,
the persistence of their effects is beneficial, whereas liquid
applications run off. The ingredients of the ointments are
such as have been stated by me; but along with them castor,
the resin of the turpentine-tree, equal parts of euphorbium, of
lemnestis, and of pellitory; of pepper, and of galbanum one-half,
with triple the amount of Egyptian natron; and of wax,
so as to bring it to a liquid consistence. But a much more
complex mode of preparing these medicines has been described
by me on various occasions, and under a particular head.
Cataplasms are to be applied to the hardened and distended
parts; their ingredients are linseed, fenugreek, barley-meal, oil
in which rue or dill has been boiled, the root of mallows
pounded and boiled in honeyed-water, so as to become of the
consistence of wax. They should be of a soft and agreeable
consistence. These things are to be done if the patient still
remains free of fever, or if the fever be slight, in which case
no regard need be had to the heat.
But if the fevers be of an acute nature, and the remaining
disease appear to be of minor consequence, and if these induce
urgent danger, the diet and the rest of the treatment must be
accommodated to them. Wherefore, the patients must use
food altogether light and of easy digestion; and now, most
especially, attention ought to be paid to the proper season for
eating, and, during the paroxysms, the whole of the remedial
means must be reduced; and, altogether, we must attend to
the fevers.
But if the disease be protracted, and if the head be at fault,
we must apply the cupping-instrument to the back of the head,
and abstract blood unsparingly; for it is more efficacious than
phlebotomy, and does not reduce the strength. But, dry-cupping
is to be first applied between the shoulders, in order
to produce revulsion of the matters in the occiput.
Sometimes, also, the parts concerned in deglutition are
paralysed, which is the sole help and safety of persons in
apoplexy, both for the swallowing of food and for the transmission
of medicines. For not only is there danger of want
of nourishment and hunger, but also of cough, difficulty of
breathing, and suffocation; for if one pour any liquid food
into the mouth it passes into the trachea, neither the tonsils
coming together for the protrusion of the food, nor the epiglottis
occupying its proper seat where it is placed by nature,
as the cover of the windpipe; we must, therefore, pour
honeyed-water or the strained ptisan into a piece of bread resembling
a long spoon, and passing it over the trachea, pour
its contents into the stomach; for in this way deglutition is
still accomplished. But if the patient be in the extremity of
danger, and the neck with the respiration is compressed, we
must rub the neck and chin with heating things and foment.
They effect nothing, and are unskilful in the art, who apply
the cupping-instrument to the throat, in order to dilate the
gullet; for distension, in order to procure the admission of
food, is not what is wanted, but contraction of the parts for
the purposes of deglutition. But the cupping-instrument
distends further; and, if the patient wish to swallow, it prevents
him by its expansion and revulsion, whereas it is necessary
to pass into a state of collapse, in order to accomplish the
contraction of deglutition; and in addition to these, it stuffs
the trachea so as to endanger suffocation. And neither, if
you place it on either side of the windpipe, does it any good;
for muscles and nerves, and tendons and veins, are in front
of it.
The bladder and the loose portion of the rectum are sometimes
paralysed, in regard to their expulsive powers, when the
bowels are constantly filled with the excrements, and the
bladder is swelled to a great size. But sometimes they are
affected as to their retentive powers, for the discharges run
away as if from dead parts. In this case one must not boldly
use the instrument, the catheter, for there is danger of inducing
violent pain of the bladder, and of occasioning a convulsion
in the patient. It is better to inject with no great
amount of strained ptisan; and if the bowel be evacuated of
the fæces, it will be proper to inject castor with oil. But the
sole hope, both of general and partial attacks of paralysis,
consists in the
sitz bath of oil. The manner of it will be described under the chronic diseases.
