In the Midst of Life

their way, the guide telling them about Bazalgette and his visionary ideas for the construction of a new sewage system for London. He was describing the struggle the engineer had to get his plans approved, when Mrs Doherty muttered, ‘I feel funny,’ and leaned heavily on the woman beside her.
    ‘It’s only the methane,’ called the guide. ‘Please try to keep up at the back there. We don’t want anyone to get lost.’ Mrs Doherty couldn’t keep up. She leaned more heavily. Two women tried to support her, but couldn’t. Her voice was slurred. ‘I’m so sorry. I don’t know what’s happened. I feel fu … fu … fu …’ and she slid to the ground.
    Mrs Doherty had suffered a stroke.
    Thedifficulty of getting the unconscious woman out of the sewer was considerable. Two ladies tried to carry her, but the slippery surface of the tunnel made it impossible. Others said they would go to get help, but the guide assured them they would get lost if they tried. With great courage and strength, he hoisted Mrs Doherty across his shoulders and carried her the half mile to the exit shaft. One of the ladies was supporting her head, and several times the guide slipped and nearly went over, but not quite, and he did not drop Mrs Doherty. ‘It was a nightmare,’ the ladies said afterwards. The journey, the bumping, and the length of time taken probably added to the injury sustained after the initial stroke.

A DANGEROUS SUBJECT
     
    ‘Stroke’ is a good word. It is much better than medical words. There is no warning, no time to prepare when a stroke brings you down. Strokes can vary in severity from mild and transient, to catastrophic with permanent injury. They are caused by one of three things: thrombosis, embolism or haemorrhage, in order of severity.
    Thrombosis is caused by the hardening and narrowing of the cerebral arteries, which can give rise to both chronic and acute changes in the oxygen supply to the brain. Blockages in the tiny cerebral arteries are associated with a slow, progressive disturbance of cerebral functions, punctuated at intervals by seizures or attacks, called transient ischaemic attacks (TIA) or mini-strokes. Stroke due to thrombosis is less common, nowadays, because of the early diagnosis of high blood pressure and hardened arteries, and drug treatments available to rectify these conditions.
    An embolus is something floating freely in the circulatory system. Several things such as air or fat or necrotic material from a tumour are possible emboli, but the most common is a blood clot. Our blood gets thicker, and flows more sluggishly, with an irregular pulse, as we grow older, and clots are liable to form. When an embolus reaches an artery too narrow to allow it to pass, it becomes lodged, and the tissue beyond it is no longer fed with oxygen and will die. These blockages can occur in any part of the body, but if one of the cerebral arteries is blocked, the result will be a stroke. The severity can be mild or severe, and this will depend on the position in the brain and the size of the area affected. The incidence of a stroke due to an embolus has been greatly reduced by preventive measures – drugs such as Warfarin, which thin the blood, and those which reduce high blood pressure.
    Astroke caused by haemorrhage cannot be foreseen and, therefore, cannot be prevented. It is due to the rupture of a weak spot in a cerebral artery. We all have weak patches in our blood vessels and they normally cause no trouble. But just as the strength of a chain is in its weakest link, so it is with blood vessels. Under tension, the weakest link will snap. In certain circumstances, the weak spot of an artery will burst and blood will escape into the surrounding area of the body. This can occur in any artery, in any part of the body, and the site of the haemorrhage will determine the severity of the damage. If it ruptures in the cranium, it causes a stroke. It can occur at any age and is quite unpredictable.
    I was a ward sister at the Elizabeth Garrett Anderson Hospital for Women in London when Mrs Doherty was admitted. She was in a deep coma, and her skin was colourless and cold, although covered with perspiration. Her temperature, blood pressure, pulse and respiration were subnormal. We did not think she would live for long – such a severe stroke was usually terminal. The houseman who attended whilst we admitted the patient, said much the same as I had been thinking: ‘The kindest thing would be to let