PARALYSIS. 143 



When blood is effused into the substance of the brain, its colour 

 gradually changes from red to black, and in successive transitions 

 to brown, dull green, orange, pale yellow, or yellowish white. 

 When the clot has undergone the latter changes of colour, and the 

 fibrine, separated from the other constituents of the blood has as- 

 sumed a fibrous or laminated appearance, the blood-vessels are ob- 

 served to form it. The fibrine may retain its distinctive characters 

 for some time, and then become converted into firm fibrous tissue, 

 which, gradually diminishing in bulk, forms eventually a small 

 cicatrix ; or, the organized fibrinous substance may be converted 

 into a loose cellular tissue, filled with a serous fluid, (the apoplectic 

 serous cyst,) and traversed by a considerable number of blood-vessels. 

 Should the case, under these circumstances, proceed favourably, the 

 serum of the cyst becomes absorbed, the walls approximate, and a 

 cicatrix is formed. Finally, if a complete cure of the paralysis is 

 effected, the cicatrix, whether formed by the first or last process de- 

 scribed, disappears. 



Treatment. — The treatment of paralysis dependent on cerebral 

 hemorrhage consists at first in the treatment proper for the different 

 varieties of apoplexy ; and afterwards in the use of derivatives, and 

 finally, general and local stimulants. The patient should be restricted 

 in his diet, and all causes of cerebral excitement, whether physical 

 or moral, should be avoided ; the chief object in the first part of the 

 treatment being to promote the absorption of the clot, which is best 

 effected by moderately lowering the cerebral circulation. Much ad- 

 vantage is derived from the insertion of a seton, or an issue, in the 

 neck, which establishes a kind of drain in the vicinity of the disease. 

 The bowels should be well acted upon, and the condition of the 

 bladder attended to. When the organic disease of the brain is re- 

 moved, and all symptoms of vascular excitement or congestion have 

 disappeared, we may have recourse to strychnia. This substance, 

 being a powerful medicine, should be given in doses of one-sixteenth 

 of a grain at first; however, it may be gradually increased to half 

 a grain, or even a grain in a day. Whenever it produces headache, 

 vertigo, sickness of Llie stomach, and violent spasmodic twitchings, 

 it must be discontinued. 



The local treatment consists in rubbing the parts with stimulating 

 liniments, applying blisters to the spine, or along the course of the 

 nerves, sprinkling the abraded surface with strychnia, and, finally, 

 in using electricity. The use of the moxa has been strongly recom- 

 mended ; if the paralysis exists in the lower extremity, it may be 

 applied in the course of the great sciatic nerve; if in the upper ex- 

 tremity it may be applied to the back of the neck, corresponding to 

 the junction of the brachial nerves with the spinal cord. 



