of narcotic poisoning and alcoholic intoxication. It must be borne in mind that a person smelling strongly of liquor and found lying in the street in a comatose state may be suffering from apoplexy, and the error of sending a dying man to a police cell may be avoided by this knowledge.
If the fit is only moderately severe, the reflexes soon return, and the patient may in a few hours show indications of returning consciousness by making some movements or opening his eyes when spoken to, although later it may be found that he is unable to speak, or may be paralysed or mentally afflicted (see Paralysis). In severe cases the coma deepens and the patient dies, usually from interference with the breathing, or, less commonly, from arrest of the heart’s action.
The mechanism by which apoplexy is produced has been a matter of much dispute; the condition was formerly ascribed to the pressure exerted by the clot on the rest of the brain, but there is no increase of intracranial pressure in an apoplectic fit occurring as a result of the sudden closure of a large vessel by embolism or thrombosis. Suddenness of the lesion appears to be, then, the essential element common to all cases of apoplexy from organic brain disease. It is the sudden shock to the delicate mechanism that produces the unconsciousness; but seeing that the coma is usually deeper and more prolonged in cerebral haemorrhage than when occasioned by vascular occlusion, and that an ingravescent apoplexy coma gradually develops and deepens as the amount of haemorrhage increases, we may presume that increase of intracranial pressure does play an important part in the degree and intensity of the coma caused by the rupture of a vessel. Apoplexy seldom occurs under forty years of age, but owing to the fact that disease of the cerebral vessels may exist at any age, from causes which are fully explained in the article Neuropathology, no period of life is exempt; consequently cases of true apoplexy are not wanting even in very young children. Recognizing that there are two causes of apoplexy in advanced life, viz. (1) sudden rupture of a diseased vessel usually associated with high arterial pressure, enlarged, powerfully acting heart and chronic renal disease, and (2) the sudden clotting of blood in a large diseased vessel favoured by a low arterial pressure due to a weak-acting heart, it is obvious that the character of the pulse forms a good guide to the diagnosis of the cause, the prevention and warding off of an attack, and the treatment of such should it occur.
Anything which tends directly or indirectly to increase arterial pressure within the cerebral blood-vessels may bring on an attack of cerebral haemorrhage; and although the identification of an apoplectic habit of body with a stout build, a short neck and florid complexion is now generally discredited, it being admitted that apoplexy occurs as frequently in thin and spare persons who present no such peculiarity of conformation, yet a plethoric habit of body, occasioned by immoderate eating or drinking associated with the gouty diathesis, leads to a general arterio-sclerosis and high arterial pressure. All conditions which can give rise to a local intracranial or a general bodily increase of the arterial pressure, i.e. severe exertion of body and mind, violent emotions, much stooping, overheated rooms, exposure to the sun, sudden shocks to the body, constipation and straining at stool, may, by suddenly increasing the strain on the wall of a diseased vessel, lead to its rupture.
The outlook of apoplexy is generally unfavourable in cases where the coma is profound; death may take place at different intervals after the onset. If the patient, after recovering from the initial coma, suffers with continual headache and lapses into a drowsy state, the result is likely to be serious; for such a condition probably indicates that an inflammatory change has taken place about the clot or in the area of softening.
Treatment.—The patient should be placed in the recumbent position with the head and shoulders slightly raised. He should be moved as little as possible from the place where the attack occurred. The medical man who is summoned will probably give the following directions: an ice-bag to be applied to the head; a few grains of calomel or a drop of croton oil in butter to be placed on the tongue, or an enema of castor oil to be administered. He may find it necessary to draw off the water with a catheter. The practice of blood-letting, once so common in this disease, is seldom resorted to, although in some cases, where there is very high arterial tension and a general state of plethora, it might be beneficial. Depletives are not employed where there is evidence of failure of the heart’s action; indeed the cautious administration of stimulants may be necessary, either subcutaneously or by the mouth (if there exist a power of swallowing), together with warm applications to the surface of the body; a water-bed may be required, and careful nursing, is essential to prevent complications, especially the formation of bedsores. (F. W. Mo.)
APOROSE (from Gr. ἀ, without, and πόρος, passage), a biological term meaning imperforate, or not porous: there is a group of corals called Aporosa.
APOSIOPESIS (the Greek for “becoming silent”), a rhetorical device by which the speaker or writer stops short and leaves something unexpressed, but yet obvious, to be supplied by the imagination. The classical example is the threat, “Quos ego——!” of Neptune (in Virgil, Aen. i. 135).
APOSTASY (ἀπόστασις, in classical Greek a defection or revolt from a military commander), a term generally employed to describe a complete renunciation of the Christian faith, or even an exchange of one form of it for another, especially if the motive be unworthy. In the first centuries of the Christian era, apostasy was most commonly induced by persecution, and was indicated by some outward act, such as offering incense to a heathen deity or blaspheming the name of Christ.[1] In the Roman Catholic Church the word is also applied to the renunciation of monastic vows (apostasis a monachatu), and to the abandonment of the clerical profession for the life of the world (apostasis a clericatu). Such defection was formerly often punished severely.
APOSTIL, or Apostille (possibly connected with Lat. appositum, placed near), a marginal note made by a commentator.
APOSTLE (ἀπόστολος, one sent forth on a mission, an envoy, as in Is. xviii. 2; Symmachus, ἀποστέλλειν ἀποστόλους; Aquila, πρεσβευτάς), a technical term used in the New Testament and in Christian literature generally for a special envoy of Jesus Christ. How far it had any similar use in Judaism in Christ’s day is uncertain; but in the 4th century A.D., at any rate, it denoted responsible envoys from the central Jewish authority, especially for the collection of religious funds. In its first and simplest Christian form, the idea is present already in Mark iii. 14 f., where from the general circle of his disciples Jesus “made twelve (‘whom he also named apostles,’ Luke vi. 13, but doubtful in Mark), that they should be with him, and that he might from time to time send them forth (ἵνα ἀποστέλλῃ) to preach and to have authority to cast out demons.” Later on (vi. 6 ff.), in connexion with systematic preaching among the villages of Galilee, Jesus begins actually to “send forth” the twelve, two by two; and on their return from this mission (vi. 30) they are for the first time described as “apostles” or missionary envoys. Matthew (x. 1 ff.) blends the calling of the twelve with their actual sending forth, while Luke (vi. 13) makes Jesus himself call them “apostles” (for Luke’s usage cf. xi. 49, “prophets and apostles,” where Matthew, xxiii. 34, has “prophets and wise men and scribes”). But it is doubtful whether Jesus ever used the term for the Twelve, in relation to their temporary missions, any more than for the “seventy others” whom he “sent forth” later (Luke x. 1). Even the Fourth Gospel never so describes them. It simply has “a servant is not greater than his lord, neither an apostle (envoy) greater than he that sent him” (xiii. 16); and applies the idea of “mission” alike to Jesus (cf. Heb. iii. 1, “Jesus, the apostle ... of our profession”) and to his disciples, generally, as represented by the Twelve (xvii. 18, with 3, 6 ff.). But while ideally all Christ’s disciples were “sent” with the Father’s Name in charge, there were different degrees in which this
