PANDORA POUND, MICHAEL BURY1, SHAH EBRAHIM
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, Rowland Hill Street
London NW3 2PF, UK
'Department of Social Policy and Social Science, Royal Holloway College, Egham Hill, Egham, Surrey TW20 OEX, UK
Address correspondence to: R Pound. Department of Public Health Medicine, Block 8 (South Wing), St Thomas'
Hospital, Lambeth Palace Road, London SEI 7EH. Fax: (+44) 171 928 1468. Email: p.pound@umds.ac.uk
http://ageing.oxfordjournals.org/content/26/5/331.full.pdf
Selected lines below;
and bloodletting, vomits, purges and enemas remained
popular responses to apoplexy until the beginning of
the twentieth century.
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Wepfer (1620-95) also believed that apoplexy was caused by
an obstruction in the path to the brain, with the result
that the brain did not receive enough "animal spirits".
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Copland [21] provides an example of the latter, relating the
warning that Napoleon was given by his physician,
Corvisart, with regards to apoplexy: "a first attack,
which is often slight, is a summons without costs; a
second, a summons with costs; but a third is an
execution on the person".
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"Those Persons, above all others, are in danger of
sudden deaths, that are of an unwieldy, corpulent
Body; that have short Necks, strait Chests, and are
subject to hitch in their Breathing; great, large heads,
with a very sanguine or pale Countenance, if they
indulge in a luxurious Manner of Living, seldom
escape a sudden, fatal stroke" [14].
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as Tanner suggested in 1854:
"Where a predisposition to apoplexy is suspected,
the individual should avoid strong bodily exertion;
venereal excitement; the excitement of drunkenness;
violent mental emotion; straining at stool; long
stooping; tight neckcloths; too much indulgence in
sleep; and warm baths" [18].
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Of course the latest is that stroke is the wrong term to use, because it doesn't say anything specific.
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The terminology has seduced us into believing the problem is simple. The term ‘stroke’ should be exorcised from the medical literature. A stroke is defined as an acute neurological event caused either by cerebral infarction or intracerebral haemorrhage in which symptoms persist for longer than 24 hours or which results in death. The WHO has included subarachnoid haemorrhage as a form of stroke,14 15 but many authors do not. From a neuroscientific point of view, the term ‘stroke’ is unsatisfactory in that it includes a number of pathologies whose management and prognosis are different. By using the term there is thus a danger of over simplifying a complex area. Adding qualifiers helps little. Haemorrhagic stroke, which means primary intraparenchymal haemorrhage, is often confused with secondary haemorrhagic transformation of an infarct. The term ischaemic stroke is equivalent to cerebral infarction, but fails to convey the heterogenous nature of the pathology.
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The
term ‘stroke’ is obscurantist, reductionist, and redundant. It has
connotations that are unhelpful to both the general public and the
medical profession. Better terms exist that either do not
pretend to be a diagnosis (eg, ‘brain attack’), or that have some
pathophysiological significance. ‘Stroke’ should be consigned to the dustbin of medical usage.
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Great picture at the end of the 8 pages - Help the Aged; let them sleep
We have improved greatly since then, we don't damage them with noxious treatments but we still have no useful acute or chronic treatments
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