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STROKE, APOPLEXY
 
The usual popular name for an apoplectic seizure is a stroke, and for the condition which may follow exposure to high temperatures, sunstroke or heat stroke. Apoplexy may also be referred to as a paralytic stroke, and the sudden appearance of disablinig paralysis from some lesion in the spinal cord might also be described.
Few disasters to health are so dramatic and tragic in their suddenness as the paralytic stroke. The nature and cause of the catastrophe are explained, and advice is given as to the emergeney steps to be taken.
INFARCTION.
When a part of the body is suddenly deprived of its blood supply, infarction may seen.
An organ like the kidney, the spleen, the retina and the lung, is supplied with blood by a single artery, which forms a stalk to it. It is true the artery may begin to divide into branches before it actually enters the organ, but the branches so resulting, as well as the veins emerging from the organ, are all attached to it at one area, which is known as the hilum.
The arteries in such an organ divide and subdivide, each branch presiding over the nutrition of a cone;-shaped portion of tissue which has its base towards the surface of the organ and its apex towards the hilum. If one of these branchesis blocked, the conical part of the organ served by it becomes an infarct.
 
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INFARCTION; BY PLUG IN AN ARTERY
Above an embolus plugs an artery: blood passes into the empty vessels from the veins and possibly adjoining arteries and engorges them; but if not, the affected area forms a white infarction.
Infarcts are described as red and white. The former is deep red in colour, and forms a somewhat swollen wedge-shaped mass; the white infarct is smaller but similarly disposed, and is of a pale grey colour and usually shrunken. The difference lies in the amount of blood in the two, and depends largely upon whether or not the affected area can receive blood from elsewhere. Often the infarct is not completely cut off.
The question of infarction is closely related to embolism and thrombosis, for it is by one of these processes that the blood vessel becomes occluded. When embolism has occurred, i.e. when an artery is blocked by a fragment of clot circulating in the blood, the clot may be septic and the resulting infarct will form an abscess in the organ. Infarcts when large or septic are often fatal.

APOPLEXY OR PARALYTIC STROKE
Causes and Effects of Various Seizures

Apoplexy, a Greek word introduced into the English landuage by Chaucer, means "a striking down." It is often replaced by the expression a paralytic stroke and conveys the idea of a man being suddenly felled by an unseen hand.

In modern usage, apoplexy signifies a more or less prolonged period of unconsciousness arising from a sudden disturbance in the blood supply of the brain, this disturbance being occasioned by a local cause situated within the cranial cavity. It will be observed that this definition excludes cases of unconsciousness due to such causes as heart disease, alcohol, head injury or epilepsy. On the other hand, the term heat apoplexy or sunstroke is justifiable, since coma in this case originates from a sudden engorgement of blood in the brain. In most instances however, a stroke signifies that one of the arteries which supply blood to the brain has either broken or become obstructed.
The signs and symptoms associated with apoplexy vary enormously in accordance with the position and extent of the arterial disturbance, but the following brief accouut of a typical case will serve to emphasise the main points. A man of middle age who had shortly before made occasional complaints of dizziness and headache, was hurrying one morning to catch a train when suddenly he raised his hand to his head and fell to the ground. On examination he was found to be quite motionless and senseless. Pinching his hand did not cause it to be drawn away, and a touch of the eyeball did not cause blinking. The pupils were unequal in size. His face was of purple tint and slightly swollen, the pulse was full and regular. Breathing was deep and noisy, like snoring, the reapiration rate beine rather slow. A thick froth soiled the lips.
His condition remained unchanged for about four hours, and then his colour, breathing and pulse became more natural. He lay still and inert, but could be roused sufficiently to tell his name. Further examination showed that the left angle of his mouth was drawn downward and that his left arm and leg, when raised from the bed, dropped limply down, whereas the right members retained a slight degree of rigidity. The right foot was drawn away when touched, and the eyeball also had regained its sensitiveness. It soon became evident that the patient could appreciate his surroundings, and his senses gradually returned but he was confused and perplexed for some hours. The left arm and left leg were at this stage completely paralysed but power of movement steadily improved. When allowed to get up, a fortnight later, weakness of the left side was still present.
Such is a picture of apoplexy in its most frequent form; but great variations occur. The disease is not confined to full-blooded people, the thin and pale are sometimes attacked. It is four times more common in men than in women. No age is exempt, but later middle life provides the largest number of cases. Sometimes the onset of unconsciousness is gradual. Many cases are fatal. Death may occur within a short period from the beginning of an attack, but it is never instantaneous. It must be remembered that until clear consciousness is regained, with normal pulse and temperature, the patient remains in serious danger. ln severe cases the patient passes from unconsciousness to death after a few hours, or it may be some days.
Paralysis does not invariably occur, and in some cases the initial loss of power entirely disappears within a few weeks. The part of the body to be affected depends on the position of the blood vessel which is at fault. Commonly the arm and leg of one side are involved (hemiplegia), with or without one side of the face. If the lesion occurs in the left side of the brain, not only is the right side of the body paralysed, but loss of speech (aphasia) is present. More rarely a single limb is affected (monoplegia) or some of the higher mental faculties, such as memory and judgment, are involved as a rule more or less weakness remains permanently after an attack of apoplexy: the final state may show any degree between inert and useless limbs and a trivial weakness or an awhwardness only shown in finer movements.
Apoplectic seizures are liable to recur, for it is but rarely that the cause of the disaster can be removed. There is a current belief that a third stroke is inevitably fatal, but no rule can be formulated. Some individuals have survived as many as ten strokes.
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APOPLEXY: OBTAINING EVIDENCE OF DEEP UNCONSCIOUSNESS
The front of the eyeball can be gently touched in apoplexy without any attempt to close the eye which would always happen except when unconsciousness is very profound. The pupils will probably be unequal in size. The possibility of mistaking an artificial for a real eye must not be overlooked when making this test.
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