In the eighteenth century, most diseases were still ill-defined and explained by local or remote causes. The diagnosis of ‘apoplexy’ was applied in a broad sense, with unresponsiveness as the cardinal symptom and overfilling of the skull or its vessels as the key event. Its purported causes included not only primary changes in or around the brain (Boerhaave), but also the general constitution and external circumstances. Thus, two doctrines of attributing causality more or less coexisted in the ‘long eighteenth century’, up to the 1820s. One was the morphological approach, practised in Vienna (de Haen) and Bologna (Valsalva), and especially in Padua (Morgagni distinguished three kinds of apoplexy: haemorrhagic, serous, and ‘other’). The other doctrine, related to Galen’s ‘fluidism’ and only slowly losing ground, implicated mainly external factors as the cause of fullness in the head (Portal).