Stroke, or Apoplexy.
This disease is caused by the rupture or blocking up of one of the blood-vessels in the brain.
Symptoms.—The person attacked falls down suddenly, and is unable to move one or more of his limbs. He may be quite insensible, or soon become so, or perhaps he is unable to talk. The mouth may be drawn to one side, and the tongue, when protruded, be pushed to the right or left. The condition is serious.
Treatment.—Tight clothing must be removed. Six grains of calomel powder should be placed on the back of the tongue, and the patient kept lying on his back with the head slightly raised. Cold should be applied to the head and a hot-water bottle to the feet, the room darkened, and absolute quiet observed. An enema of hot water may be given, and while the patient is insensible the lips should be moistened only with water. Food may be given by the bowel on the second or third day. Stimulants are absolutely forbidden. If the patient gets over the attack he ought to be sent home.
Note.—It must not be forgotten that many of the above symptoms might be caused by injury or poison.
Sun-Stroke and Heat-Stroke.
These conditions are distinct. Sun-stroke, which is comparatively rare, is due to the direct action of the sun on the brain and spinal cord. Heat-stroke, on the other hand, would appear to be due to the lack of escape of heat from the body, owing to insufficient evaporation from the skin, and to the effect of muscular fatigue. As a result, poisonous substances accumulate and act detrimentally upon the nerve cells. There is also a deficient supply of oxygen to the blood. High relative humidity plays a very important part in producing attacks of heat-stroke. The milder forms are known as Heat exhaustion and Heat prostration; the severe form is often associated with true sun-stroke.
Symptoms.—Heat exhaustion is really a form of faintness, and recovery soon takes place after a rest. The symptoms of heat prostration are giddiness, often associated with nausea. The patient is bathed in a clammy sweat, his pulse is thready, his breathing shallow, and, it may be, sighing. The condition may pass into unconsciousness, but the temperature is not raised, and death rarely results.
There are two kinds of true Heat-stroke; one a form with high temperature, the other what is called Heat cramp, which is common amongst ships’ firemen in the tropics. An early warning sign of heat-stroke is a desire for frequent micturition, and other premonitory symptoms are a dry skin, giddiness, drowsiness, headache, and intolerance of light. The pulse becomes quick and irregular, the skin is hot and dry, and the temperature elevated. The patient may become comatose, or exhibit delirium or convulsions. There is an asphyxial type, in which the face becomes cyanosed and the breathing is in abeyance.
Prophylaxis.—Avoid severe exercise in a hot sun. Wear suitable clothing, which should be loose and easy, and protect the head, and especially the nape of the neck, from the sun’s rays. Dark or tinted glasses are useful. Water should be taken freely, and the bowels kept open; but alcohol must be avoided. Sniffing a mixture of water and vinegar and damping the face are helpful measures.