Apoplexy

Apoplexy (Greek apoplexia) is sometimes also called paraplexia or paralysis. The name apoplexia, according to Caelius Aurelianus, is derived "from the fact that it involves a sudden collapse, as if from a deadly blow. It is a sudden seizure (oppressio), in general without fever, and it deprives the body of all sensation; it is always acute and never chronic."

The etiology of apoplexy was stated in different ways by the ancient medical authors. The earliest account is from the Hippocratic corpus: It is caused by winds or breaths (qpuoag), "so, if copious breaths rush through the whole body, the whole patient is affected with apoplexy. If the breaths go away, the disease comes to an end; if they remain, the disease also remains." Centuries later, Celsus wrote that the relaxation of the sinews (resolutio nervorum) was a common disease everywhere. "It attacks at times the whole body, at times part of it. Ancient writers named the former, apoplexia, the latter, paralysis."

Elsewhere a humoralistic etiology was advanced: black bile (melancholy) by Hippocrates, or cold, vis cous phlegm by Paul of Aegina (see also Galen). Finally, a solidist etiology was proposed by the Methodist sect — for example, by Soranus, whose last work was translated into Latin by Caelius Aurelianus. The latter states that apoplexy is a disease caused by strictures (passio stricturae) of the tube and pore structure of the human body. Isidore of Seville suggests quite a different theory, but offers no evidence or source. In fact, Isidore's entire entry for apoplexy consists of one sentence: "Apoplexia is a sudden effusion of blood, by which those who die are suffocated."

In addition to the clinical relationship between apoplexy and paralysis, there is evidence of a more primitive distinction between apoplexy and temporary mental confusion (e.g., the state of being dumbfounded, astounded, speechless), which is translated as 'ajioJiX-Yxog and/or ajtim^yxTixog in the nonmedical literature, such as that by Herodotus, Aristophanes, and Sophocles.

It is difficult to separate neatly the classical beliefs regarding the incidence and epidemiology of apoplexy because of the ignorance surrounding its etiology. A few brief passages, here and there, suggest, however, that its incidence in particular must have been a subject of some discussion. Thus, there are two Hippocratic aphorisms concerned with age incidence: The first contains a short list of complaints common to old men, including apoplexy. The meaning of old is specific in another: "Apoplexy occurs chiefly between the ages of forty and sixty." (See also Caelius Aurelianus, who notes that old women have special therapeutic problems.) Data on seasonal incidence are also scarce. Hippocrates simply stated that apoplexy was one of several diseases that frequently occurred in rainy weather. Caelius Aurelianus, however, thought it most prevalent at the end of autumn or in the winter.

With regard to the pathology of apoplexy, detailed, clinical descriptions are provided by Celsus, Caelius Aurelianus, Galen, and Paul of Aegina. Though their descriptions do not agree verbatim, we can summarize them by noting the major areas of consensus:

1. Sudden onset (with no or few antecedent indications)

2. Lack of fever

3. Feeble pulse and shallow respiration following the stroke

4. Lack of sensation

5. Impairment of muscular control, sometimes accompanied by tremors

6. Comatose state

If there is recovery, the victim may show evidence of mental impairment, especially in his or her speech and uncontrolled muscular action. This catalogue of signs was important to the physician not only for making a diagnosis but also for differentiating apoplexy from other diseases, especially epilepsy, lethargy, and some forms of paralysis.

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