After the heart, the head is the most important factor in sudden death. The most frequent form of death from intra-cranial causes is apoplexy. Apoplexy, as the name indicates--a breaking out--is due to a rupture of one of the arteries of the brain, and a consequent flowing out of blood into the brain tissue. The presence of the exuded blood causes pressure upon important nerve tracts, and so gives rise to unconsciousness, to paralysis, and to the other symptoms which are {144} noted in apoplexy. There are a number of symptoms that act as warnings of the approach of apoplexy. First, it occurs only in those beyond middle life, that is, in individuals over forty-five, and in these only where there is marked degeneration of arteries. The degeneration of the arteries can be easily noted, as a rule, in other parts of the body. The condition known as arterio-sclerosis, that is, arterial hardening, can be detected by the finger at the wrist, or by the eye in the branch of the temporal artery, which can so frequently be seen to take its sinuous course on the forehead behind and above the eye. At the wrist the thickened artery is felt as a cord that can be rolled under the finger. It is not straight as in health, but is tortuous, because the overgrowth in the walls, which makes it thick, has also made it longer than normal, thus producing tortuosity. Besides these objective signs, as they are called, there are certain subjective signs, that is, signs easily recognised by the patient himself, which should put him on his guard, and at the same time serve as a warning to the clergyman, should he hear of their presence. These signs are recurring dizziness, or vertigo, not clearly associated with gastric disturbance; tendency of the limbs, and especially the fingers and toes, to go to sleep easily, and when there is no external cause for this condition; tendency to faintness and to dizziness when the patient rises in the morning, especially if he assumes the erect position suddenly; tendency to vertigo when the patient stoops, as to tie a shoe, or pick up something from the floor, and the like; finally, certain changes in the patient's disposition, with a loss of memory for things that are recent, though the memory may be retained for the happenings of years before. When several of these symptoms occur, patients who are well on in years should take warning of the fact that they are liable at any time to have a stroke. Needless to say, this has no reference to the cases of young nervous persons who may readily imagine that they have some or all of these symptoms. Apoplexy is typically the disease of those over fifty years of age. There may even occasionally be slight losses of power in the hand or foot that point to the occurrence of small hemorrhages in the brain, that is, slight preliminary "strokes." {145}