On stertor, apoplexy, and the management of the apoplectic state / Robert L. Bowles.

Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: On stertor, apoplexy, and the management of the apoplectic state / Robert L. Bowles. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    which is pressed against the bed by the weight of the body. An ice-bag should be put on the head, and par- ticularly over that side on which the haemorrhage is sup- posed to be. Bleeding was formerly universally practised, but of late its usefulness is doubted. It is not indicated, unless the deep congestion of the face, the violent pulsation of the carotids, and the full slow pulse show increased arterial tension. In such a case, if the patient seems otherwise robust, we may bleed at the commencement of an attack, in the hope of checking the escape of blood by lowering the intra-arterial pressure. In similar conditions, experience shows that the local abstraction of blood from the temples is sometimes advantageous. The bowels should be well emptied by enemata, and later on by drastic purgatives. If the respiration and pulse fail, we may try stimulants (ether, camphor); but very likely they will be without success. These extracts show that practically Dr. Strumpfel's entire treatment of the apoplectic attack is directed to the relief of arterial tension, and that this tension is believed to have some relation with the deep, noisy, stertorous breathing; but what that relation is, is left to the imagina- tion. It is clear, however, that the means suggested (bleeding) for the relief of the arterial tension is not looked upon as really trustworthy; the writer shows that he has no abiding faith in the means he advises. They are suggestions only ; he evidently is not fully satisfied of their end and object. The following pages will demonstrate the fact that the arterial tension has no direct causal rela- tion with the cerebral haemorrhage ; on the contrary, it is shown to be entirely indirect, and a consequence simply of an easily removable cause, suffocation, indicated by the