From apoplexy to stroke - review of medical literature on stroke over previous 2,000 years, especially sources from 18th and 19th centuries

Age and Ageing, Sept, 1997 by Pandora Pound, Michael Bury, Shah Ebrahim

It is only in the last few years that stroke has begun to receive attention in the UK. In 1988 a major conference recognized the poor quality of service provision for people with stroke and set guidelines for improving the quality of care [35]. In 1991 stroke became one of the key target areas for prevention under the Health of the Nation initiative [36] and in the same year the Stroke Association split from the Chest, Heart and Stroke Association in order to concentrate its efforts on research, prevention and education, as well to provide direct support for people with stroke. Over the same period there has been a move towards establishing dedicated units for people with stroke so that they can be given acute treatment and rehabilitation by people with enthusiasm, expertise and experience in the field.

Conclusion

This paper has outlined some of the theories of stroke in which patients have been implicated during previous centuries. While the person with apoplexy consulted a physician, and the `case' with cerebrovascular disease was treated by hospital doctors, the stroke patient is now, theoretically, regarded as an active member of a multidisciplinary team which is working towards the goal of `rehabilitation'.

What does the adoption of the lay word 'stroke' by the medical profession signify, if anything? A cynical suggestion is that the term w,as adopted at about the same time as initial high hopes for surgical or drug treatments were dashed; in other words, medicine appealed to the lay model in order to place the onus for recovery onto the patient. On a more positive note, however, perhaps we should rejoice that doctors and patients have found a simple word, stroke, which both find meaningful. It is possible that the adoption of a traditional lay word in preference to a medical category symbolizes the re-emergence of the visibility of the person as opposed to the case, and a renewal of interest in the subjective experience of stroke. As noted earlier, within bedside medicine doctors were interested not only in the physical aspects of their patients, but also in the emotional, social and spiritual aspects of their patients' lives.

While it is true that the doctor's appreciation of the patient's subjective experience was crucial to the patronage system in operation at the time [22], there must have been positive and beneficial consequences for the patient, in terms of being treated as a person rather than a disease, and feeling understood and cared about. If the adoption of the word `stroke' signifies a move in this direction, then it is something that people with stroke will undoubtedly appreciate [37]. However, while the terms apoplexy, cerebrovascular disease and stroke can be seen to signify particular approaches to managing the condition, it should be recognized that they are not mutually exclusive. The term cerebrovascular disease (and `cerebrovascular accident') is still in use today among some physicians, suggesting that patients are frequently still regarded as `cases', probably predominantly during the acute phase.