B. Cases with Rapid Development of Symptoms. —Of the patients who are apparently in their ordinary health until there is a violent in vasion of symptoms, we may distinguish those in whom the attack seems to be precipitated by an injury or an intercurrent disease, and those in whom it comes on without discoverable cause. In either case the attack regularly takes the form of cerebral symptoms, or of dyspncea, or of vomiting, or of sudden death. During these attacks the tension of the pulse is high, the urine is diminished in quantity or suppressed and often contains a little albumin.
I. The cerebral symptoms are : general convulsions, coma, hemi plegia, and aphasia. The convulsions come on suddenly, they are re peated several times, between them the patients are unconscious. Many of the patients die with the convulsions, but a few recover. We are apt to see these persons for the first time while the convulsions are going on, and are told by their friends that they were in their ordinary liealth until the convulsions began.
The coma is developed iu the same rapid way. The patient is found in bed, in a room, or in the street, at first stupid and muttering incoherently, then completely comatose. From this coma they do not emerge, but go on and die in a few hours or days.
The hemiplegia is like that with a clot or 'with an obstructed artery. The patient falls to the ground unconscious and hemiplegic.
If the hemiplegia is on the right side there is usually aphasia. The paralyzed side of the body may remain quiet, or become rigid, or be moved involuntarily. The hemiplegia and unconsciousness usually continue up to death. But occasionally we see a patient who re covers both motion and consciousness.
2. The dyspncea often starts with an ordinary bronchitis. The patients cannot lie down, they suffer from the constant feeling of dyspncea, the pulse is full and tense, the drugs which usually dilate the arteries are of little or no effect, the scrotum and legs become oedematous. The patients live only a few weeks.
3. The vomiting may at first resemble that of an acute gastritis, or that caused by some irritating substance in the stomach. But it con tinues, it is exhausting, it does not yield to the ordinary remedies directed to the stomach; the pulse is full and tense. Such vomiting, however, can often be stopped by the drugs which dilate the arteries.
4. The patients after an injury, or a surgical operation, or without discoverable cause become feeble, the heart's action is feeble, the urine is diminished or suppressed, and in a few hours the patient is dead. These cases are not common. They are very disagreeable for the physician, as the patients seem to die without sufficient cause: