Descriptions of strokes are to be found in the medical literature as far back as the ancient Egyptians, although it’s only in the past 400 years that even a basic understanding of their underlying causes began to emerge, and only in the past 50 years or so that treatment options have become anything approaching effective.

For much of human history, strokes were attributed to other-worldly causes; the severity of symptoms coupled with sudden and inexplicable onset seemed to suggest Divine disfavour. The so-called Edwin Smith papyrus (an ancient Egyptian medical treatise dated to c.1600 BC) correctly identifies a connection between brain injury and paralysis, but cites magical potions and incantations by way of remedy. There’s also some speculation that the Biblical Psalm 137: 5 - 6 is a reference to stroke symptoms afflicting the hand and the tongue, interpreted here as God’s punishment for the faithless.

Around the same time as the composition of the Psalms, Greek medicine was getting closer to the mark with a more naturalistic explanation for illness in general, and strokes in particular. For Hippocrates (born c.460 BC) strokes were a form of apoplexy, which translates as “striking away”, conveying the idea of a sudden, crippling blow, as if the victim had been struck by lightning. Hippocrates believed that the fundamental cause of apoplexy was sluggishness of the blood, which sluggishness in turn led to a lack of “vital spirit” in the brain, a diagnosis seconded a few centuries later by the other great medical authority of antiquity, the Greco-Roman physician Galen (born c.AD 130).

After the fall of the Classical world, knowledge of strokes more or less stagnated (and in some cases even regressed) over the course of the next 1000 years. In Medieval and Early Modern Europe, the belief persisted that a stroke was a consequence of Divine retribution; indeed, the first use of the word “stroke” in a pathological context in English literature dates from a 1599 medical tract recommending cinnamon-infused water as a cure for “the stroke of God’s hand.”

It wasn’t until the 17th Century that any great progress was made in the understanding of brain pathology, kick started by William Harvey’s discovery of the circulation of the blood in 1628. A few decades later, Johann Wepfer correctly distinguished between haemorrhagic stroke (caused by a bleed on the brain) and ischaemic stroke (caused by a lack of blood to the brain), while Thomas Willis demonstrated around the same time that lesions to specific parts of the brain caused weakness and/or paralysis in specific parts of the body.

The recognition of the importance of blood flow in brain injury meant that treatment even into the 19th Century was largely restricted to blood-letting, sometimes by means of the application of leeches, sometimes by direct cutting or drilling into the head or neck. Other equally useless treatments included purging and fasting. In the 18th Century the concept of the “apoplectic habitus” found favour- that is, the idea that a certain body type was particularly prone to strokes (stout, with a thick neck and a large head). This theory lingered into the early 20th Century, even as the role of the arteries in the onset of stroke began to be better understood. The first carotid endarterectomy- removal of plaques in a carotid artery- was performed in 1807, and it was likewise in the early 19th Century that the term “cerebrovascular disease” came to be preferred by doctors in place of apoplexy.

Until the early 1900s, stroke treatment such as the aforementioned endarterectomy was largely preventative in intent, with very little to be done for the patient once a stroke had actually happened. Early- to mid-19th Century medical textbooks are almost unanimous in offering a dismal prognosis to stroke victims. This began to change towards the end of the 19th Century, when clinicians started to appreciate the importance of after-the-event rehabilitation. The 1892 edition of Osler’s Principles and Practice of Medicine recommends regular massage of the limbs of stroke victims so as to maintain circulation and nerve function; 40 years later, the 1935 edition advises a full-blown physiotherapy regime.

This shift in emphasis in stroke treatment from preventative to therapeutic is explicable in terms of the increased incidence of strokes as the 20th Century progressed, a consequence of lengthening lifespans, with a greater demand for effective remedies.

By the 1950s, a suite of recognisably modern treatments for stroke was beginning to emerge, along with a holistic recognition of the link between strokes, lifestyle, and blood pressure. Pharmacological and surgical options for stroke victims have continued to advance, with the emphasis being on rapid diagnosis and acute treatment. Remedial action within 3 hours of onset of symptoms is now understood as being crucial to prospects of recovery, a recovery which typically involves a multi-disciplinary and long-term approach from doctors, physiotherapists, speech therapists, occupational therapists, and specialist nurses.

Stroke is now a fairly well-understood pathological process with well-established treatment and rehabilitation paradigms, a far cry from the sudden, supernatural affliction of yesterday, with its invariably gloomy prognosis.


Freeths Solicitors - How we can help

As clinical negligence lawyers we represent people who have suffered avoidable disability due to failures of medical care and delayed or inappropriate treatment. We know how difficult life can be for those who have suffered a stroke and for their families. We are able to assist by ensuring they have access to the services they require, have the funds to pay for private care allowing them to live their lives as comfortably as they possibly can and are compensated for the harm. We also represent the families of those who have sadly died in such circumstances.

Freeths Clinical Negligence Solicitors have a national reputation for providing first class advice on all medical claims. If you are concerned about the medical care you or a loved one has received, please contact one of our national team free:-

Phillip McGough, Clinical Negligence Executive (Nottingham) on 0845 050 3290/0115 936 9369 or phillip.mcgough@freeths.co.uk

Jane Williams, Partner (Nottingham) on 0845 272 5724 or jane.williams@freeths.co.uk

Carolyn Lowe, Partner (Oxford) 0186 578 1019 or carolyn.lowe@freeths.co.uk

Karen Reynolds, Partner (Derby) on 0845 274 6830 or karen.reynolds@freeths.co.uk

For further information please also visit our website at: http://www.freeths.co.uk/legal-services/individuals/clinical-negligence/