Earlier human history brought some strange theories on what causes stroke (then known as apoplexy) and with that came ineffective and downright dangerous ‘cures’. This started to change around the 19th century. Temperance: Truth and Delusion The rising Temperance movements across Europe and America came up with a different theory: apoplexy was caused by an immoderate lifestyle. Apoplexy was blamed on a number of causes:
- A diet of rich heavily seasoned meats, rich cream sauces, and red wine.
- Tobacco use.
- Emotional overexcitement.
- Too much hard labor.
- Daily flatulence.
- Too much sex, or sex for reasons other than procreation.
- The temperance movement believed all of these things ‘inflamed the blood’, which in turn irritated the nerves, especially those in the brain, until the tissues gave way.
- Eat a plain, simple diet and avoid foods that cause flatulence.
- Don’t touch alcohol or tobacco.
- Remain calm and avoid emotional outbursts.
- Stay warm.
- On the other hand, wrap scarves loosely, not tightly, around the neck.
- Don’t ‘strain at the stool’.
A New Strategy of Medical Care The 19th century ushered in a new way of viewing health and disease. Dissection became more popular and widely accepted, which allowed physicians to see what was going on in the body instead of guessing at it from the visible symptoms. Thanks to this, there arose a new theory of what caused apoplexy: the artery walls had visibly degenerated. The discovery of an observable, physical cause stripped away the mystery of apoplexy. The word itself faded from use, replaced with ‘cardiovascular disease’. Before this point, doctors flailed around to explain the unexplainable. They blamed everything from a patient’s spiritual life to their social circle to mysterious diseases. After the discovery of artery failure, physicians narrowed their focus down to what was happening in the patient’s own body. This helped them deliver more effective care. Stroke survival and recovery rates began to rise. The Modern Era The 1950s was an exciting decade in stroke research and treatment. It brought us lifesaving anticoagulants, cardiovascular surgery with a moderate survival rate, and angiography, which allowed doctors to view within the patient’s body without dissection – quite an improvement! These advances weren’t a miracle cure. Anticoagulants that saved lives by breaking up the clots in ischemic strokes also took lives when improperly given to hemorrhagic strokes. Some of the new surgeries proved to be temporary fixes at best. However, with ever more sophisticated technology, advances in surgery, and more advanced drugs available, every decade since the 1950s has improved patient outcomes. All of our modern stroke treatments - antiplatelet and anticoagulant drugs that break up clots indirectly, surgeries that treat clots and brain bleeds directly, and advances in technology that allow accurate images of the inside of the body – all of these spring from the curiosity and critical thinking of doctors throughout history.