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Early care for patients affected by strokes (800 CE - 14th Century)

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Early care for patients affected by strokes (800 CE - 14th Century)

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The concept of the stroke first came about during the time period of 460 to 370 before the Common Era by Hippocrates. The symptoms associated with what we now know is a stroke, was referred to as apoplexy.

During the middle ages, when I say this I'm referring to the time period before the 14th century and after 800 CE, physicians didn't treat patients they thought were incurable or terminally ill. The physicians at this time also didn't want to treat a patient if they believed the case would end fatally. They would not treat all cases pertaining to strokes, but in cases they believed would be successful there were a few methods they would use to "treat" the apoplexy.

Some of the methods used were blood letting and purging/vomiting. This methods were used in order to combat the symptoms of apoplexy because they believed that the abundance of blood and the consumption of excess food/strained bowel movement contributed to the conditions of a stroke.

Sources: (1)

https://journals.lww.com/jnnonline/fulltext/2010/02000/a_historical_account_of_stroke_and_the_evolution.4.aspx

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This photo depicts the way we currently can identify if an individual is having a stroke, but how did they do it hundreds of years ago? The causes of a stroke were identified in the 16oos by J.J. Wepfer (my docent) and James Coplan, but

Hippocrates and Galen were the first two scholars to note symptoms and indicators of strokes way before. They discovered that the symptoms usually showed in the opposite side of the body with the injury.

Sources: (1)

https://journals.lww.com/jnnonline/fulltext/2010/02000/a_historical_account_of_stroke_and_the_evolution.4.aspx

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Strokes are something that is very much understood in our modern day society, but they weren't always this understood. As discussed in the map artifact, there were very high mortality and morbidity rates at certain points in time and in certain regions of the world. Although the #1 leading cause of death during the American Civil War was due to battle wounds, there was over 7,000 cases of stroke recorded during the war - resulting over 300 deaths. Since the soldiers had to march nearly 15 miles a day, the heat became something that truly affected all parties on the battlefield. This is important because the types of strokes these soldiers were having were called "sunstrokes", they could pass out and have conversions.

Sources: (1)

https://www.civilwarmed.org/sunstroke-in-the-civil-war/#:~:text=Since%20most%20military%20campaigns%20occurred,cases%20occurred%20on%20the%20march.

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This photo depicts the burden of a stroke across the world, measuring the "burden" in terms of mortality rate in percentages and DALYs lost per 100,000. There seems to be higher mortality rates due to stroke in developing countries. In fact, in the past stroke has been considered a "disease of the developing world".

Stroke is ranked as the second leading cause of death globally, as well as a high morbidity rate rendering 50% of survivors chronically disabled. From 1975 to 2005 there was a noticeable declination of mortality rates in several countries, but when further research it looks like these rates are just shifting more towards the current developing countries.

A lot of the issues regarding mortality rate due to stroke can be attributed to the lack of information and education on the topic at hand. For example, there were poor recognition of stroke risk factors and warning signs has been reported in Nigeria, Ghana, an Benin.

This is important because it shows the relevance of strokes and the effect it has on society as a whole.

Sources: (1)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288566/#:~:text=At%20this%20time%2C%20stroke%20symptoms,brain%20%5B4%E2%80%936%5D.

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Johann Jakob Webfer will be the best to guide you through this exhibit. He was a Swiss Physician in the 1600s probably best known for the discovery about apoplexy resulting from brain hemorrhage or occlusive diseases of the vessels.

J. J. Webfer has 222 neurological cases that were published after he passed away, these reports have information that is vital to understand neurological diseases that we deal with today. Researchers focus on the reports that contain evidence and presence of aphasia, memory and neglect disorders, among other areas of brain damage and impairments. He was also recognized for language lateralization in the late 19th century.

J. J. Webfer's medical knowledge and findings set the groundwork for neuropsychology. He appears to be one of the first medical scientists to explore the essence of cognitive functions, like language and memory, utilizing the lesion method. This method involves correlating focal brain damage with distinct cognitive dysfunction and is now widely recognized within the scientific community.

Source:(1)

https://www.tandfonline.com/doi/full/10.1080/0964704X.2020.1831338?scroll=top&needAccess=true

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Apoplexy refers to the sudden loss of the ability to feel or move caused by an injury in the brain. Apoplexy was what a stroke was referred to in historical times. During the Renaissance, between the 14th and 17th century, there was a rise of interest in the ancient Greco-Roman ideas.

These ideas allowed for and promoted the human dissection, more commonly referred to as autopsy, that lead to the emergence for new knowledge and evolution of modern medicine.

This is important because many of the medical findings that helped to diagnosis and treat strokes were based off of the autopsies and reports done by prior scientists and researchers. This artifact is an example of an autopsy report done by an examiner.

Sources: (1)

https://www.oxfordlearnersdictionaries.com/us/definition/american_english/apoplexy#:~:text=%2F%CB%88%C3%A6p%C9%99%CB%8Cpl%C9%9Bksi%2F,the%20brain%20synonym%20a%20stroke

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770005/

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The term "stroke" was coined in 1689 by William Cole in a Pysico-Medical essay regarding the frequencies of apoplexies, but the term wasn't fully adopted and used until several years later.

Giovanni Battista Morgagni, known as the father of pathologic anatomy, distinguished a “sanguineous” [intracranial hemorrhage], a “serous” [non-hemorrhagic], and a “neither sanguineous nor serous” apoplexy. These terms later on contributed to the different types and categories of strokes, some being intracranial (within the skull) and some strokes where not even related to hemorrhage at all.

This artifact is a video showing what a "sanguineous" apoplexy looks like which can help readers better understand what the difference between categories of stroke are.

Sources: (1)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770005/