2635. 1. The strong kind.—These cases mostly occur in stout, strong, short-necked, bloated-faced people, who are in the habit of living well.—Symptoms. The patient may or may not have had headache, sparks before his eyes, with confusion of ideas and giddiness, for a day or two before the attack. When it takes place, he falls down insensible; the body becomes paralyzed, generally more so on one side than the other; the face and head are hot, and the blood-vessels about them swollen; the pupils of the eyes are larger than natural, and the eyes themselves are fixed; the mouth is mostly drawn down at one corner; the breathing is like loud snoring; the pulse full and hard.—Treatment. Place the patient immediately in bed, with his head well raised; take off everything that he has round his neck, and bleed freely and at once from the arm. If you have not got a lancet, use a penknife or anything suitable that may be at hand. Apply warm mustard poultices to the soles of the feet and the insides of the thighs and legs; put two drops of castor oil, mixed up with eight grains of calomel, on the top of the tongue, as far back as possible; a most important part of the treatment being to open the bowels as quickly and freely as possible. The patient cannot swallow; but these medicines, especially the oil, will be absorbed into the stomach altogether independent of any voluntary action. If possible, throw up a warm turpentine clyster (two tablespoonfuls of oil of turpentine in a pint of warm gruel), or, if this cannot be obtained, one composed of about a quart of warm salt-and-water and soap. Cut off the hair, and apply rags dipped in weak vinegar-and-water, or weak gin-and-water, or even simple cold water, to the head. If the blood-vessels about the head and neck are much swollen, put from eight to ten leeches on the temple opposite to the paralyzed side of the body. Always send for a surgeon immediately, and act according to the above rules, doing more or less, according to the means at hand, and the length of time that must necessarily elapse until he arrives. A pint, or even a quart of blood in a very strong person, may be taken away. When the patient is able to swallow, give him the No. 1 pills, and the No. 1 mixture directly. [The No. 1 pills are made as follows:—Mix 5 grains of calomel and the same quantity of antimonial powder with a little bread-crumb: make into two pills, the dose for a full-grown person. For the No. 1 mixture, dissolve on ounce of Epsom salts in half a pint of senna tea: take a quarter of the mixture as a dose] Repeat these remedies if the bowels are not well opened. Keep the patient's head well raised, and cool as above. Give very low diet indeed: gruel, arrowroot, and the like. When a person is recovering, he should have blisters applied to the nape of the neck, his bowels should be kept well open, light diet given, and fatigue, worry, and excess of all kinds avoided.
2636. 2. The weak kind.—Symptoms. These attacks are more frequently preceded by warning symptoms than the first kind. The face is pale, the pulse weak, and the body, especially the hands and legs, cold. After a little while, these symptoms sometimes alter to those of the first class in a mild degree.—Treatment. At first, if the pulse is very feeble indeed, a little brandy-and-water or sal-volatile must be given. Mustard poultices are to be put, as before, to the soles of the foot and the insides of the thighs and legs. Warm bricks, or bottles filled with warm water, are also to be placed under the armpits. When the strength has returned, the body become warmer, and the pulse fuller and harder, the head should be shaved, and wet rags applied to it, as before described. Leeches should be put, as before, to the temple opposite the side paralyzed; and the bowels should be opened as freely and as quickly as possible. Bleeding from the arm is often necessary in these cases, but a non-professional person should never have recourse to it. Blisters may be applied to the nape of the neck at once. The diet in those cases should not be so low as in the former—indeed, it is often necessary, in a day or so after one of these attacks, to give wine, strong beef-tea, &c., according to the condition of the patient's strength.
2637. Distinctions between Apoplexy and Epilepsy.—1. Apoplexy mostly happens in people over thirty, whereas epilepsy generally occurs under that ago; at any rate for the first time. A person who has epileptic fits over thirty, has generally suffered from them for some years. 2. Again, in apoplexy, the body is paralyzed; and, therefore, has not the convulsions which take place in epilepsy. 3. The peculiar snoring will also distinguish apoplexy from epilepsy.
2638. Distinctions between Apoplexy and Drunkeness.—1. The known habits of the person. 2. The fact of a person who was perfectly sober and sensible a little time before, being found in a state of insensibility. 3. The absence, in apoplexy, of the smell of drink on applying the nose to the mouth. 4. A person in a fit of apoplexy cannot be roused at all; in drunkenness he mostly can, to a certain extent.
2639. Distinction between Apoplexy and Hysteria.—Hysterics mostly happen in young, nervous, unmarried women; and are attended with convulsions, sobbing, laughter, throwing about of the body, &c. &c.
2640. Distinction between Apoplexy and Poisoning by Opium.—It is exceedingly difficult to distinguish between these two cases. In poisoning by opium, however, we find the particular smell of the drug in the patient's breath. We should also, in forming our opinion, take into consideration the person's previous conduct—whether he has been low and desponding for some time before, or has ever talked about committing suicide.
2641. EPILEPSY.—Falling Sickness.—Those fits mostly happen, at any rate for the first time, to young people, and are more common in boys than girls. They are produced by numerous causes.—Symptoms. The fit may be preceded by pains in the head, palpitations, &c. &c.; but it mostly happens that the person falls down insensible suddenly, and without any warning whatever. The eyes are distorted, so that only their whites can be seen; there is mostly foaming from the mouth; the fingers are clinched; and the body, especially on one side, is much agitated; the tongue is often thrust out of the mouth. When the fit goes off, the patient feels drowsy and faint, and often sleeps soundly for some time.—Treatment. During the fit, keep the patient flat on his back, with his head slightly raised, and prevent him from doing any harm to himself; dash cold water into his face, and apply smelling-salts to his nose; loosen his shirt collar, &c.; hold a piece of wood about as thick as a finger—the handle of a tooth-brush or knife will do as well—between the two rows of teeth, at the back part of the mouth. This will prevent the tongue from being injured. A teaspoonful of common salt thrust into the patient's mouth, during the fit, is of much service. The after-treatment of these fits is various, and depends entirely upon their causes. A good general rule, however, is always to keep the bowels well open, and the patient quiet, and free from fatigue, worry, and excess of all kinds.
2642. Fainting Fits are sometimes very dangerous, and at others perfectly harmless; the question of danger depending altogether upon the causes which have produced them, and which are exceedingly various. For instance, fainting produced by disease of the heart is a very serious symptom indeed; whereas, that arising from some slight cause, such as the sight of blood, &c., need cause no alarm whatever. The symptoms of simple fainting are so well known that it would be quite superfluous to enumerate them here. The treatment consists in laying the patient at full length upon his back, with his head upon a level with the rest of his body, loosening everything about the neck, dashing cold water into the face, and sprinkling vinegar and water about the mouth; applying smelling-salts to the nose; and, when the patient is able to swallow, in giving a little warm brandy-and-water, or about 20 drops of sal-volatile in water.
2643. Hysterics.—These fits take place, for the most part, in young, nervous, unmarried women. They happen much less often in married women; and even (in some rare cases indeed) in men. Young women, who are subject to these fits, are apt to think that they are suffering from "all the ills that flesh is heir to;" and the false symptoms of disease which they show are so like the true ones, that it is often exceedingly difficult to detect the difference. The fits themselves are mostly preceded by great depression of spirits, shedding of tears, sickness, palpitation of the heart, &c. A pain, as if a nail were being driven in, is also often felt at one particular part of the head. In almost all cases, when a fit is coming on, pain is felt on the left side. This pain rises gradually until it reaches the throat, and then gives the patient a sensation as if she had a pellet there, which prevents her from breathing properly, and, in fact, seems to threaten actual suffocation. The patient now generally becomes insensible, and faints; the body is thrown about in all directions, froth issues from the mouth, incoherent expressions are uttered, and fits of laughter, crying, or screaming, take place. When the fit is going off, the patient mostly cries bitterly, sometimes knowing all, and at others nothing, of what has taken place, and feeling general soreness all over the body. Treatment during the fit. Place the body in the same position as for simple fainting, and treat, in other respects, as directed in the article on Epilepsy. Always well loosen the patient's stays; and, when she is recovering, and able to swallow, give 20 drops of sal volatile in a little water. The after-treatment of these cases is very various. If the patient is of a strong constitution, she should live on plain diet, take plenty of exercise, and take occasional doses of castor oil, or an aperient mixture, such as that described as "No. 1," in previous numbers. If, as is mostly the case, the patient is weak and delicate, she will require a different mode of treatment altogether. Good nourishing diet, gentle exercise, cold baths, occasionally a dose of No. 3 myrrh and aloes pills at night, and a dose of compound iron pills twice a day. [As to the myrrh and aloes pills (No. 3), 10 grains made into two pills are a dose for a full-grown person. Of the compound iron pills (No. 4), the dose for a full grown person is also 10 grains, made into two pills.] In every case, amusing the mind, and avoiding all causes of over-excitement, are of great service in bringing about a permanent cure.
2644. LIVER COMPLAINT AND SPASMS.—A very obliging correspondent recommends the following, from personal experience:—Take 4 oz. of dried dandelion root, 1 oz. of the best ginger, 1/4 oz. of Columba root; braise and boil all together in 3 pints of water till it is reduced to a quart: strain, and take a wine-glassful every four hours. Our correspondent says it is a "safe and simple medicine for both liver complaint and spasms."