How to Treat a Stroke in the 17th century —- The Treatment of King Charles II of England.
On February 2nd, 1685 King Charles II of England suffered a fit of apoplexy (had a stroke) while being shaved by his barber. He fell into convulsions, at which point the court physician was called immediately. The court physician quickly performed the emergency treatment for a man who had just suffered a stroke. He took out a penknife and bled out 16 ounces of blood from King Charles to “balance his humors”. After the bleeding he was given an enema, which was re-administered 2 hours later. When the King came to he was weak and could not speak. Upon word of his stroke, 14 of the finest physicians in London arrived to treat and cure the kings illness. Each doctor had his own theory of medicine and his own special treatment for stroke. The following treatments of King Charles II are well recorded, and closely details the methods and methodology of 17th century medicine.
- As well as the 16 ounces of bloodletting at first, King Charles was bled another 8 ounces daily.
- "To free his stomach of all impurities", he was made to drink strong emetics (drugs that induce vomiting) containing heavy metals such as antimony and zinc sulphate (both are poisonous).
- His head was shaved, and covered in blistering agents such as mustard and camphor. The theory behind this was that the blisters would force bad humors lower into his body where they could be bled out. A red hot poker was also applied to encourage more blistering.
- He was given daily enemas containing “sacred bitter power, cream of tartar, syrup of buckthorn, rock salt, and orange infusion of the metals supplemented by antispasmodic julep of black cherry water”
- He was made to sniff sneezing powders made of cowslip flowers and spirit of sal ammoniac. It was thought the sneezing would relieve pressure on his brain.
- He was given numerous laxatives.
- A mixture of pigeon droppings and burgundy pitch were applied to his feet.
- He was given a tonic containing 40 drops of the essence (ooze) of a human skull “from a man who had died a most violent death and was never buried.”
- He was fed powder from a crushed stone taken from the stomach of a goat from East India.
On February 6th, 1685 King Charles II of England died of the age of 54.
Medicine was a bit of a joke back then wasn’t it! Sounds like they were trying to kill him rather than treat him…
Lets bleed him, feed him poisons, give him diarrhoea.
Considering the stoke was on the 2/2/1685, and he died by 6/2/1685 they did a pretty good job of it!
- this is pain that is perceived at a location distinct from the origin of the stimulus
- lack of somatic innervation to the viscus and visceral peritoneum
- visceral signals are then wrongly attributed to a physical location distant from the actual stimulus
- this area corresponds to the entry level at the spinal cord and its related dermatome
Example - the diaphragm is innervated by the C3-5 spinal level, irritation of the diaphragm (e.g. cholecystisis [inflammation of gallbladder]), leads to pain felt in the corresponding C3-5 dermatome, causing referred pain to the shoulder
Got London for my first job as a doctor, just need to pass finals now!
Ventilation-Perfusion Scan (V/Q scan)
- high probability scan for R. sided pulmonary embolism
- almost absent perfusion to R. lung, with normal ventilation
Paracetamol Toxicity Normogram
- ~40% of self-inflicted poisoning is due to paracetamol
- can cause severe liver damage if >150mg/kg is taken (>12g or 24 tablets)
- damage is from accumulation of NAPQI (metabolite of paracetamol)—> liver and renal damage
- "High Risk Patients" = alcoholics, malnutrition, HIV, enzyme inducing medications, cystic fibrosis (lower threshold for Rx)
- Symptoms - nausea, vomiting, abdominal pain + hepatic tenderness, jaundice
- Treatment - plot plasma paracetamol on graph, if above treatment line —> N-acetylcysteine, initially rapid infusion 150mg/kg, then 50mg/kg over 4hrs, and 100mg/kg over 16hrs
- INR = most sensitive measure of liver damage
- Monitor U&Es and urine dip as risk of acute tubular necrosis
- ?Transplantation - use the Kings College Criteria (pH, INR, Creatinine, encephalopathy)
This image shows gas embolism and air bubbles inside the meningeal vessels in a drowned diver due to sudden decompression.