ADDITION TO THE REVISED EDITION OF 1880. 287 



cases probably depends upon destructive local disease of the brain, 

 the prognosis should be unfavorable, although improvement may 

 perhaps take place. When there is no paralysis, and when we have 

 reason to ascribe the attack to a transitory derangement of the cir- 

 culation, to a watery exudation, or the like, we may hope that the 

 affection may pass away. 



Treatment of aphasia should be mainly a treatment of its cause. 

 Later in the disease the attempt may be made to develop the speak- 

 ing faculty from the opposite half of the brain, by judicious prac- 

 tice of reading, writing, and elocution. Such vicarious compensa- 

 tion is, however, not to be relied on.] 



ADDITION TO THE REVISED EDITION OF 1880. 



SECTION I. DISEASES OF THE BKAIN. 



1. P. 216. 



The discovery that the bursting of a vessel is preceded by an 

 aneurismal dilatation of its walls is most important in the etiology 

 of apoplexy. It used to be assumed that the fatty degeneration at- 

 tacked only the inner and middle coats, causing an escape of blood 

 into the adventitia, which then bulged out under the blood-pressure 

 (Kolliker's and PestalozzVs spurious aneurism ; Virchow's dissecting 

 ectasy). Char cot and JBouchard take quite a different view of the 

 vascular dilatation which plainly lies at the root of most apoplexies. 

 According to them, a periarteritis, or inflammation of the lymphatic 

 sheath, forms the starting-point of the process, and the morbid 

 changes progress from without the vessel inward (the reverse of 

 what occurs in atheroma), the adventitia thickens more or less, or 

 at least shows a multiplication of its nuclei, while the muscular 

 coat tends to atrophy. At points where the thickening of the ad- 

 ventitia has failed while the muscular coat has atrophied, the vascu- 

 lar wall yields before the blood-pressure ; thus there form small 

 round knots (miliary aneurisms), situated on the vessels, and hav- 

 ing the diameter of -J 1 millimetre. If these little aneurisms con- 

 tain liquid blood, their color will be red ; if the blood be coagulated, 

 they present a brown or blackish appearance. If the thickening of 

 the wall be considerable, the sac may attain the consistence of a 

 grain of sand. 



ZenJcer, while supporting the Frenchmen regarding the fre- 



