Around 460-377 BC, Hippocrates, who is picture above while dissecting an animal's brain, coined and described the term, "apoplexy"¹. From this moment on, the term apoplexy was used for many centuries after its addition to the field of medicine. At the time, Hippocrates and his followers had many different ideas on what apoplexy was, and apoplexy was associated with numerous medical conditions, symptoms, and beliefs. So, when translating apoplexy, which was referred to as, "apopliktiki" in Ancient Greek, this term essentially means to strike down or stun and comes from the Greek verb, pletto¹. In these Ancient times, Hippocrates and his followers noticed that when a person experienced apoplexy, they quickly lost regular functions and abilities, and they often lied on the ground which made them appear stunned or struck down¹.

From the Hippocratic Doctrine's perspective, blood was one of the four humors of the body, and the blood was the most important because it was believed to carry one's spirit throughout the body; however, in "Corpus Hippocraticum", apoplexy was understood to be a blockage in the blood's ability to circulate throughout the body, which took away the spirit's ability and then caused the body to shut down¹.

Interestingly, when using modern language, the Ancient Greek verb, pletto, closely translates to the word, "stroke", which is commonly used throughout modern medicine today.

Source:

(1)

Tsoucalas, G., Papaioannou, T. G., & Karamanou, M. (2019, February). The Hippocratic Doctrine of “the Acute Brain Suffering” as the Brain Stroke. ScienceDirect. Retrieved January 24, 2024, from https://www.sciencedirect.com/science/article/pii/S1052305718305974#section-cited-by

The image above is a page from Thomas Willis' Cerebri Anatome, which was published in 1664, and the image does an amazing job of depicting how intricate Willis understood the cerebral arteries to be¹. Interestingly, within Cerebri Anatome, Willis not only brought forth the term, "neurology", but he also classified the cerebral nerves, identified the eleventh nerve, and described the complex hexagonal arterial system that can be found at the base of the brain². While other individuals throughout history made note of the complex hexagonal arterial system at the bottom of the brain, Willis was truly the first to fully grasp and illustrate the physiological, anatomical, and pathological importance of them related to apoplexy².

Within the same work, Willis wrote about two specific patients and their clinical presentations and histories, and he suggested that the specific anatomic alignments and configurations of the arteries at the base of the brain could prevent apoplexy and its symptoms².

Extraordinarily, Willis' understanding of the relationship between the cerebral arteries and their roles in apoplexy are still widely accepted to this day. Moreover, Willis' classification of these cerebral arteries are still accepted within modern medicine, and this complex hexagonal arterial system that can be found at the base of the brain is now commonly referred to as, "The Circle of Willis².

Not only were Willis' contributions astounding, but they truly helped other scientists, medical professionals, and anatomists in the past and present have a deeper understanding of the brain's vasculature while granting access to the well-illustrated images to further the understanding of the brain.

Sources:

(1)

Arráez-Aybar, L.-A., Navia-Álvarez , P., Fuentes-Redondo, T., & Bueno-Lopez, J.-L. (2015, February 16). Thomas Willis, a pioneer in translational research in anatomy (on the 350th anniversary of Cerebri Anatome). Wiley Online Library . https://onlinelibrary.wiley.com/doi/full/10.1111/joa.12273

(2)

https://www.ahajournals.org/doi/full/10.1161/01.str.27.8.1427

However, it was Theophile Bonet, a well respected physician from Geneva, who made major contributions within literature regarding apoplexy. In Bonet's 1679 Sepulchretum sive Anatomia Practica, which is pictured above, Bonet reserved an entire section of his book for apoplexy¹. Within Sepulchretum sive Anatomia Practica, Bonet did not provide any specific or definitive causes of apoplexy, but he did discuss numerous autopsy discoveries that helped point towards numerous possibilities that could have caused apoplexy².

For example, Bonet mentioned that conditions such as intracranial hemorrhages, cerebral abscesses, and tumors could likely contribute to the presence of apoplexy. Interestingly, Bonet noted that many of his autopsies contained excess fluid within the head, and this confused him greatly since he observed numerous patients with hydrocephalus live for great deals of time without displaying any signs of apoplexy.

Because of this perplexing observation, Bonet hypothesized that these findings blocked specific pores within the brain, and this blocked the "spirits" from being able to flow properly, thus contributing to apoplexy^2.

Sources:

(1)

https://drouot.com/en/l/15880476-bonet-theophile-sepulchretum-s

(2)

Coupland, A. P., Thapar, A., Qureshi, M. I., Jenkins, H., & Davies, A. H. (2017). The definition of stroke. Journal of the Royal Society of Medicine, 110(1), 9–12. https://doi.org/10.1177/0141076816680121

This was the case until 1689 when William Cole, a well respected English physician and writer, introduced a new term within his book, A physico-medical essay concerning the late frequency of apoplexies, which is pictured above¹. The specific term that Cole introduced was "stroke", and this term is still used every day within the field of modern medicine².

Uniquely, within this specific work of Coles, he discusses that people of all ages have known about apoplexies for a long time and that they greatly feared them due to their unpredictable nature; however, he continued on and discussed that he was observing a great increase in apoplexies, which he referred to as strokes, within the late 17th century

From here on out, A physico-medical essay concerning the late frequency of apoplexies, which is one of the oldest books in English that specifically discusesses strokes, changed medical terminology forever thanks to William Cole's contributions to the history of neuroscience³.

Sources:

(1)

https://gryphoneditions.com/product/a-physico-medical-essay-concerning-the-late-frequency-of-apoplexies/

(2)

https://www.ahajournals.org/doi/full/10.1161/STR.0b013e318296aeca

(3)

https://history.rcplondon.ac.uk/blog/learned-without-ostentation-stroke-medicine-and-rcp-history

That was until Johann Jakob Wepfer, a physician entered the picture. Wepfer is credited as being the first individual to suggest that apoplexy was associated with the vasculature and blood supply of the brain¹. Additionally, Wepfer discussed this within his 1658 work, Historiae apoplecticorum, which is pictured above². Within this specific work of his, Wepfer discusses four autopsy cases where he discovered an occlusive thrombus within the carotid artery. Furthermore, this book of his also hints to the fact that cerebral arterial insufficiency, blood flow to the brain, and carotid pathology cause apoplexy³.

Because of Wepfer's drastic contribution to the vascular and arterial underpinnings of apoplexy, anatomists and doctors were able to take off and begin to observe and understand apoplexy on a much deeper level. Shortly after Wepfer published his previous mentioned work, other scientists, such as Thomas Willis, deeply described and illustrated the structures Wepfer observed, and because of this, they received most of the credit for Wepfer's initial observations and findings.

Sources:

(1)

https://www.healthline.com/health/stroke/history-of-stroke#early-description-of-stroke

(2)

https://www.digitale-sammlungen.de/en/details/bsb11270100

(3)

Munster, A. B., Thapar, A., & Davies, A. H. (2016). History of Carotid Stroke. American Heart Association. https://www.ahajournals.org/

Wepfer had a long standing career as a medical doctor and scientist, and a large majority of his groundbreaking research was focused upon the brain; however, Wepfer made other contributions to the field of toxicological analysis. Wepfer's detailed anatomical observations did not begin until he was granted the ability to perform autopsies in 1648, and from here he continued to perform complex autopsies and animal experiments that greatly contributed to the history of neuroscience. In addition to his work related to the brain's vasculature and apoplexy, Wepfer was also the first person to color cervical vessels by injecting them with dye which helped to further understanding the brain's vasculature.

Thanks to Johann Jakob Wepfer's anatomical and scientific knowledge, Wepfer's work greatly contributed to the early field of neuroscience, and because of his work the world was able to have an increased understanding of strokes.

Sources:

(1)

https://wellcomecollection.org/works/ev5hc5t5

(2)

https://www.medmuseum.siemens-healthineers.com/en/stories-from-the-museum/stroke#:~:text=It%20was%20not%20until%201658,medicine%20still%20distinguishes%20between%20today.

Mechanical thrombectomy consists of making a small incision inside of a patient's grown and inserting a thin device called a catheter into the patient's artery². From here, the catheter is carefully advanced through through the body until it reaches the specific vessel within the brain where the stroke-causing blood clot is located². Once the blood clot is isolated, prongs slide out from the tip of the catheter and grasp the blood clot². Following this, the catheter, which is still grasping the blood clot, is removed from the patient, and this effectively removes the harmful blood clot within the patient's brain and restores blood flow².

This surgical procedure and process is relatively safe, and in 2017, experts proposed that this procedure be done within a 6-24 hour time window after a patient suffers a stroke to attempt to protect the brain from any excess post-stroke trauma³.

Without the historical knowledge surrounding apoplexy and stroke, especially when it comes to the discovery of apoplexy's neuro-vascular roots, significantly more people would die from strokes every single day. Without the historical understanding that the brain's vascular system is compromised by strokes, there would not be effective treatments available, both surgical and nonsurgical, and our world would be left with numerous medical speculations regarding the brain's health and function. Thanks to these historical neuro-scientific discoveries, we live in a world where a stroke is not always a death sentence, and we have the ability to screen, prevent, and treat strokes in timely and effective ways.

Sources

(1)

https://www.safestroke.eu/2017/06/14/clinical-benefit-clot-retrieval-now-proven-24-hours-major-ischemic-stroke/

(2)

https://ufhealth.org/conditions-and-treatments/endovascular-thrombectomy-evt#:~:text=Endovascular%20thrombectomy%2C%20or%20EVT%2C%20is,and%20prevent%20further%20brain%20damage.

(3)

https://www.safestroke.eu/2017/06/14/clinical-benefit-clot-retrieval-now-proven-24-hours-major-ischemic-stroke/