BOOK I.

OF COMATA, OR, OF THE LOSS OF VOLUNTARY MOTION.

1993. UNDER this title are comprehended those affections which have been commonly called the Soporose diseases; but they are most properly distinguished by their consisting in some interruption or suppression of the powers of sense and voluntary motion, or of what are called the animal functions. These are indeed usually suspended in the time of natural sleep: but, of all the diseases to be comprehended under our title, sleep, or even the appearance of it, is not constantly a symptom. Of such diseases I can mark and properly explain two genera only, which come under the titles of Apoplexy and Palsy.

VOL. II.

CHAP. I.

OF APOPLEXY.

1094. APOPLEXY is that disease in which the whole of the external and internal senses, and the whole of the voluntary motions, are in some degree abolished; while respiration, and the action of the heart, continue to be performed. By its being an affection of the whole of the powers of sense and of voluntary motion, we distinguish it from Palsy ; and by its being with the continuance of respiration and the action of the heart, it is distinguished from Syncope. I have further added to the ordinary definition of apoplexy, that the abolition of the powers of sense and motion, is in some degree only; meaning by this to imply, that, under the title of apoplexy are here comprehended those diseases which, as differing from it in degree only, cannot, with a view either to pathology or practice, be properly distinguished from it: such are the diseases sometimes treated of under the names of Carus, Cataphora, Coma, and Lethargus.

1095. Apoplexy, in all its different degrees, most commonly affects persons advanced in life, and especially those above sixty years of age. It most usually affects persons of large heads and short

necks; persons of a corpulent habit; persons who have passed an indolent life, and used a full diet, and especially those who have indulged in frequent` intoxication. Men who have long laboured under a frequent and copious discharge of blood from the hæmorrhoidal vessels, upon either the suppression or spontaneous ceasing of that discharge, are particularly liable to be affected with apoplexy.

1096. This disease frequently comes on very suddenly but, in many cases, it is preceded by various symptoms, such as frequent fits of giddiness, frequent headachs, a hæmorrhagy from the nose, some transitory interruptions of seeing and hearing, some false vision and hearing, some transitory degree of numbness or loss of motion in the extremities, some faultering of the tongue in speaking, a loss of memory, a frequent drowsiness, and frequent fits of incubus.

1097. An attention to these symptoms, and to the predisponent circumstances (1095), will often enable us to foresee the more violent attacks of this disease.

1098. When the disease comes on suddenly to a considerable degree, it has been frequently observed to have been immediately induced by violent exercise; by full and long-continued inspiration; by a fit of anger; by much external heat, especially

that arising from a crowded assembly of people; by warm bathing; by intoxication; by long stooping with the head down; and by a tight ligature about the neck. The disease has been remarked to make its attacks most frequently in the spring season, and especially when the vernal heat suddenly succeeds to the winter cold.

1099. The symptoms denoting the presence of this disease will be sufficiently known from the definition given 1094. Although the whole of the body is affected with the loss of sense and motion, it sometimes takes place more upon one side of the body than the other; and, in that case, the side least affected with palsy is sometimes affected with convulsions. In this disease there is often a stertorous breathing; and this has been said to be a mark of the most violent state of the disease but it is not always present, even in the most complete form, or most violent degree of the disease.

1100 The proximate cause of this disease may be, in general, whatever interrupts the motion of the nervous power from the brain to the muscles of voluntary motion; or, in so far as sense is affected, whatever interrupts the motion of the nervous power from the sentient extremities of the nerves to the brain.

1101. Such an interruption of the motions of the

nervous power may be occasioned, either by some compression of the origin of the nerves, or by something destroying the mobility of the nervous power. Both these causes we must treat of more particularly; and, first, of that of compression, seemingly the most frequent occasion of apoplexy, and perhaps the occasion of all those apoplexies arising from internal causes.

1102. The loss of sense and motion, in particular parts of the body, may be occasioned by a compression, either of the origin of certain nerves only, or of the same nerves in some part of their course from the brain to the organs of sense and motion. Such cases of partial compression will be more properly considered hereafter; and the affection I am now to treat of being general, it must depend upon a very general compression of the origin of the nerves, or medullary portion of the brain; and, therefore, this more general compression only is to be considered here.

1103. This compression of the origin of the nerves, or medullary portion of the brain, may be produced in different ways: as.

1, By external violence fracturing and pressing in a part of the cranium.

2, By tumours, sometimes soft, sometimes bony, formed in different parts of the brain, or in its membranes, and becoming of such a bulk as to compress the medullary substance of the brain.