228 DISEASES OF THE BRAIN. 



In other cases, most probably when the haemorrhage ceases for a 

 time and returns again, and continues moderately, the disease begins 

 with an apoplectic fit, from which the patient arouses after a time. 

 We note the hemiplegia, but hope that this time the patient will es- 

 cape with his life. But, after a few hours, consciousness again begins 

 to disappear, and finally is lost entirely, does not return, and the pa- 

 tient dies comatose. 



A slowly-occurring haemorrhage, which finally becomes very abun- 

 dant, appears to induce the cases where an apoplectic fit does not open 

 the scene, but where there is first hemiplegia, and, later, loss of con- 

 sciousness and general paralysis of the brain. 



It would require too much time to fully describe other appearances, 

 particularly the modifications resulting from the different severity of 

 the reactive inflammation in the vicinity of the clot, and from the 

 varied grades of the consecutive atrophy of the brain. 



TREATMENT. For the prophylaxis of apoplexy, we may refer to 

 Chapters I. and IV. of this section, since the prophylaxis of cerebral 

 haemorrhage demands the same general rules that we gave for the 

 treatment of cerebral hyperaemia, and for the disturbances of circulation 

 resulting from disease of the arteries. If a patient has had one attack 

 of apoplexy, he must be particularly careful to avoid all causes by 

 which the cerebral vessels may be overfilled and distended ; he must 

 especially avoid long, luxurious meals, and must keep his bowels 

 regular. 



If cerebral haemorrhage has occurred, it becomes our object to pre- 

 vent a continuance of the bleeding, to induce reabsorption of the ex- 

 travasation, and the formation of an apoplectic cicatrix. But we must 

 not deceive ourselves as to our power, and must understand that we 

 have no remedy for arresting the haemorrhage, or for hastening the 

 reabsorption and cicatrization. In the treatment of this disease we 

 are restricted to combating the more dangerous symptoms as well as 

 possible. Not a few patients, in apoplectic fits, recover consciousness 

 during venesection, and it seems as if we could, not unfrequently, pre- 

 vent the extension of the paralysis from the cerebrum to the medulla 

 oblongata, which is indispensable to life, and so save the patient by 

 bleeding. On the other hand, there is no doubt that, in many cases, 

 bleeding during an apoplectic fit hastens a fatal result ; collapse occurs 

 immediately after the venesection, and the patient never arouses. We 

 have previously said that bleeding must always prove beneficial, if the 

 symptoms given as signs of pressure on the brain were actually in- 

 duced by the pressure to which the brain is subjected by the extrava- 

 sation ; and we have also said that the want of success in venesection, 

 in many cases, spoke against this explanation. From the explanation 



