Of Simple Apoplexy.—Apoplexy may, in the first place, occasion death without leaving any sign at all in the dead body. Cases of this sort were called nervous apoplexy by the older authors; but for the purpose of avoiding a name that involves a theory as to their nature, they have been more appropriately termed by Dr. Abercrombie simple apoplexy. At one time they were believed to be common. The researches of modern pathologists, however, have shown that they are rare, and that the apparent absence of morbid appearances may be often with justice ascribed to an insufficient examination; for it is not always easy to detect, without minute attention, two disorders little known till in recent times, and sometimes closely allied in their symptoms to apoplexy,—hypertrophy of the brain, and inflammation of its substance. On this account some have even gone so far as to deny altogether the existence of simple or nervous apoplexy; and M. Rostan, who is of this opinion, has supported it by the fact, that in the course of his pathological researches he had examined no less than 4000 heads, and never met with an instance of it.[1] But although this statement, made by so eminent a pathologist, is sufficient to prove the rarity of the disease, it does not establish its non-existence in the face of positive observations, made by others after the phenomena and effects of cerebral inflammation were well known.
Among the modern authorities to whom reference may here be made for examples of simple apoplexy, Dr. Abercrombie, M. Louis, my colleague Dr. Alison, and M. Lobstein, may be particularized. Dr. Abercrombie has seen four cases,[2] M. Louis has recorded three,[3] M. Lobstein one,[4] and Dr. Alison informs me, that he has seen one and got the particulars of another from the late Dr. Gregory. In several of these cases the individuals were at the time of the apoplectic seizure affected with other diseases, such as asthma, anasarca, or slight febrile symptoms; but in four of them the coma commenced during a state of perfect health. I have myself seen two of the former class, one occurring during convalescence from a slight pleurisy, the other terminating a complicated case of pulmonary emphysema and catarrh, diseased kidneys and anasarca. Reference may be also made under this head to several cases of apoplexy described in Corvisart's Journal, as connected with the enormous accumulation of worms in the intestines. Such a connexion is said to be common on the coast of Brittany; and one striking instance is related of a young man, who, after an attack of headache, vomiting, and loss of speech, died comatose in two days, and in whose body no unnatural appearance could be seen except a prodigious mass of worms in the small intestines.[5]
In none of all the cases of apoplexy now under consideration was
