Etiology

Those conditions of the body that pervert the blood vessels--a plethoric state of the body, rheumatism, gout, acidosis or scurvy--when known to exist, will account for any symptoms there may be of cerebral hemorrhage. Anything that produces a degeneration of the vessels is liable to bring on this affection. Men who abuse themselves with alcohol are predisposed to this trouble. Men are more subject to this disease than women--in all probability due to the fact that they are more licentious and indulgent in the line of stimulation. There is no such thing as inheriting a disease, but there is a tendency to take on this affection which may be called predisposition. It is a disease that is more liable to develop in the gouty subjects than in any other class of people. It is very liable to develop in the course of rheumatism and fevers of various kinds, Apoplexy may develop, caused by embolism.

Symptoms

The patient is seized in apparent good health, while in the performance of some duty--occasionally an action requiring strain. There may be a sensation of numbness, or tingling, or pain, in the limbs; or there may be choreic movements of the muscles of the side opposite to that in which the affection is most intense. The onset of the hemorrhage may be sudden loss of consciousness and complete relaxation of the extremities. The disease is liable to occur at the close of a meal, or after excitement, or after a speech that has brought up the arterial pressure. It is not infrequent that a speaker will fall forward and down unconscious with apoplexy before he has gone very far with his address.

Anything that will temporarily increase the arterial pressure is liable to precipitate hemorrhage. Those cases that do not die will have more or less paralysis following. It is called a stroke. If the hemorrhage is not very large, the blood-clot may be absorbed, and the patient may gradually regain the use of a hand or leg, or both arm and leg of the side paralyzed. A paralysis is more often that of hemiplegia--half the body--than confined to the lower limbs. In severe cases the unconsciousness is very profound; the patient cannot be roused; the face is turgid; the skin has a cyanotic (bluish) appearance, The pupils of the eye are dilated, and sometimes unequal. The patient may remain in a state of coma for several hours before dying; or the coma may last for from several hours to one or two days before consciousness will return. Where the paralysis is not great--where the hemorrhage has not been profound--the symptoms will not be so profound; but there is no assurance that the patient will not have another attack before he has fully recovered from the first and second strokes. Often, however, the strokes are months apart. The location of the hemorrhage varies very widely. Necessarily symptoms coming from this disease must vary a very great deal. The sort of paralysis brought on must depend entirely upon the location of the blood-clot. For example, pressure on the speech center will cause word-deafness.

Treatment

The treatment should begin months and years before the disease manifests. Those who are heavy eaters, continually carrying a large quantity of blood in the brain, evidenced by flushed face and enlarged veins over the forehead, and other signs of too much blood, such as ringing in the ears, head swimming, etc., should take a hint and reform their manner of living. The time to cure this disease is several years before it manifests. No one can be fooled into knowing he is headed in that direction; for all he needs to do is to look at himself in the glass, and he will find he is altogether too stout and too plethoric-looking, and the face is usually quite flushed. He should know what his habits are. A man who uses stimulants to excess must know, or should know, that he is bringing upon himself degeneration of the blood vessels and that the time must come when apoplexy will result. It does not necessarily need to be found in the brain. Apoplexy may take place in the kidneys, or any other vital organ of the body. It means a ruptured blood vessel from a distention of the vessel. So far as the treatment is concerned, it should be preventive. However, when the disease has developed, the patient must be fed very little, so as to reduce the quantity of blood; also the weight must be gradually reduced, and he must consent to live with a reduced arterial pressure and a largely reduced weight. The food should be principally fruit and salads. Very little meat may be taken once or twice a week, but no bread, or anything made from grain, until the weight is brought down to a point where the patient is made safe. Then two or three times a week a little toast bread or baked potato may be given. Sugar in all forms must be tabooed.