Our term ‘stroke’ comes from the word strike. It implies a sudden and severe event that hits a person with no visibly obvious cause. Long ago, it came with another name – apoplexy. Apoplexy was any illness in which the patient fell to the ground and lay senseless, unable to move voluntarily.
There were many theories of its causes and cures. Ancient Greece Around 400 BC, Hippocrates, father of medicine, came up with the medical theory of blood humors. He believed in imbalances in the ‘four humors’ of the blood, four vital qualities that if one grows dominant can lead to illness. Bloodletting and strange diets were prescribed to fight off whichever humor was causing trouble. Interestingly, Hippocrates believed apoplexy was caused by a ‘stagnation of the blood’, that is, the blood not flowing properly – which is indeed the case for ischemic strokes! In AD 131, Galen, another prominent doctor of that era, expanded on that theory.
For over a thousand years, doctors in the Western world used the theory of blood humor imbalance and obstructed bloodflow to diagnose and treat many illnesses, including stroke. Europe, Medieval era and beyond Apoplexy was a mysterious and frightening illness in those times. In our modern era, we have ways of measuring blood pressure and cholesterol levels, of detecting vein and heart abnormalities, and a host of other silent factors that don’t obviously affect the health until the person suddenly collapses. Back then, these fits seemed to come literally out of thin air. Many believed that apoplexy had a supernatural cause. The person was being literally ‘struck by the wrath of the Divine’ for living a sinful life. It was believed that repentance, prayer, and a sincere effort to amend one’s ways might bring God’s mercy instead of his wrath. Europe, Renaissance Era Wepfer, who lived from 1620-1695, worked in the University of Padua in Italy.
He dissected corpses in the morgue and came up with numerous theories on their causes of death. In the cases of people killed by apoplexy, he pinpointed that it was the blood supply to their brains had been disrupted. In some cases the arteries had been blocked; in others, there had been massive bleeds within the skull. He was the first to clearly differentiate between Ischemic and Hemorrhagic strokes. 18th Century Progress Around this time, people began to understand the concept of blood pressure. There was also a common theory that apoplexy was caused by lack of blood flow, or by too much blood pressure. Thanks to that, doctors continued the practice of bloodletting. It supposedly restored blood flow and dropped pressure, giving the brain relief so it could heal. There was a certain logic to this idea, but it had tragic results. A few decades later, some medical writers noted how many of their patients died from this ‘treatment’ and began cautioning against it. The Victorian era’s interest in phrenology also tied to another interesting way to diagnose who was at risk of apoplexy, which was by the proportions of someone’s body. A person with a large head and thick neck was believed to draw too much blood into the brain, endangering it. All of these theories betrayed a certain basic lack of understanding of the processes that lead to stroke, and what might be needed to recover from one. However, these peoples were doing what they could with the limited knowledge of their times.