CEREBRAL APOPLEXY. 221 



the extremities, to those muscles of the face going to the angle of the 

 mouth and the nose, and to the muscles that protrude the tongue. 

 The patients can almost always chew normally on the affected side, 

 they can wrinkle the forehead, open and close the eyelids, move the 

 eyes in any direction, etc. On the other hand, the patient frequently 

 cannot lift the paralyzed arm and foot an inch from the bed ; the mouth 

 hangs down on the affected side, and the nostril is contracted, occasion- 

 ally the cheek flaps about like a loose sail at every expiration, wliile, 

 on the sound side, the angle of the mouth is drawn up and the nostril 

 dilated. If the patient protrude the tongue, its point goes toward the 

 paralyzed side, because only the muscles of the opposite side push for- 

 ward the root of the tongue and elongate that organ. In most cases, 

 along with the hemiplegia, there is also anaesthesia of half the body, but 

 after a time this usually passes off partially or entirely. This course 

 of the anaesthesia, as well as the experience that animals have no sensa- 

 tion after destruction of then* corpus striatum and thalamus, and that, 

 after taking them away, the power of feeling peripheral pain continues, 

 appears to indicate that the temporary anaesthesia of the paralyzed 

 half of the body does not depend immediately on destruction of the 

 corpus striatum and thalamus, but on the compression of the capil- 

 laries in the sections of brain lying below them, caused by the effusion 

 of blood. 



The same symptoms as are caused by effusions of blood into the 

 thalamus and corpus striatum, are induced by effusions at other parts 

 of the cerebrum, provided they are extensive enough to compress the 

 capillaries of the thalamus and corpus striatum. After the discussion 

 in the previous chapter concerning partial anaemia of the brain and its 

 influence on the cerebral functions, this similarity cannot appear strange 

 to us, but must rather be regarded as evident and necessary. The 

 only difference is the following : A large apoplectic clot, destroying 

 the corpus striatum or thalamus, leaves a hemiplegia that never dis- 

 appears ; only small clots in these parts, by which the filaments and 

 ganglion-cells are not broken down, but only pressed apart, leave 

 paralysis which is occasionally temporary. Hence we may conclude 

 that the apparatus for exciting the motor nerves, which doubtless exists 

 in the brain, although it may itself be excited by the will, is located in 

 the vicinity of the corpus striatum and thalamus. On the other hand, 

 extensive apoplectic clots at other parts of the cerebrum not unfre- 

 quently leave paralysis, which sooner or later disappears again. From 

 this course we may suppose that the capillaries of the motor centres, 

 being relieved of the pressure by the partial resorption of the extrav- 

 asation, have again become permeable to the blood ; or that the col- 

 lateral oedema in the vicinity of the broken-down part of brain, which 



