720D 
heart, oppressed by some disease affecting its 
own structure, fails to propel the blood with its 
proper force to the brain. The delirium which 
comes on in rheumatic fever, when pericarditis 
or endocarditis commences, is indicative of an 
anemic state of the brain; and in some in- 
stances in which I have had the opportunity of 
examining the brain, when the patient died in 
this delirium, I have found marked and obvious 
anemia of this organ. 
Anemia of the brain, according to my ob- 
servation, is of two kinds, general and partial. 
In the former, pallor prevails throughout the 
brain. This is met with, as before mentioned, 
in ill-nourished children ; and it is also present 
to a remarkable degree in persons, house- 
painters and others, who have largely imbibed 
the poison of lead, as if the presence of that 
= interfered greatly with the process of 
wematosis. Partial anemia is where the defi- 
ciency of blood is observed chiefly in the grey 
matter. I have frequently seen the grey matter 
of the convolutions perfectly bloodless, and the 
white matter of the hemisphere covered with 
bloody points of congested veins. This is the 
condition generally met with after death from 
rheumatic or gouty delirium. 
When the brain is very anemic a consider- 
able quantity of fluid is generally found beneath 
the arachnoid membrane, with or without a 
small quantity in the ventricles ; or more rarely, 
a good deal of fluid in the ventricles, with 
little or no subarachnoid fluid. 
Of cerebral hemorrhage. — Effused blood 
from one or more ruptured bloodvessels is 
found upon the surface, in the substance, or in 
the ventricles of the brain. Effusion of blood 
in any or all of these situations constitutes the 
most common form of cerebral apoplexy. 
The blood is sometimes effused simply upon 
the surface of the brain; it is diffused beneath 
the arachnoid membrane, and even under the 
pia mater, raising up that membrane and sepa- 
rating it from its connection with the cerebral 
substance. Not unfrequently such a diffusion 
of blood beneath the pia mater is connected 
with an internal extravasation which has made 
its way to the surface either through broken down 
cerebral substance or from the ventricles. 
A recent apoplexy in the substance of the 
brain is no more than a dark clot of blood, like 
a mass of black currant jelly, filling a cavity 
which it has formed for itself in the cerebral 
substance. Such is the appearance when the 
examination has been made a few hours or even 
a few days after the qa fit. If the 
patient survive this period, we find evidence of 
changes in the clot and in the surrounding 
cerebral substance. These changes vary ac- 
cording to the condition of the brain prior to 
the apoplectic effusion. 
If the brain has been quite healthy up to the 
occurrence of the rupture, a condition which is 
extremely rare, then the changes towards cica- 
trization take place quickly; the serum of the 
clot becomes absorbed ; the torn brain-substance 
around the clot contracts; the solid matter of 
the clot assumes a reddish instead of a black 
hue; it gradually diminishes in quantity, and 
‘ 
NERVOUS SYSTEM. (Nervous Centres. AsnonmaL Anatomy.) 
the brain-substance, not contracting to the same 
extent as the clot has done, a cavity remains, 
which contains serum, and more or of the 
remnant of the clot. The cerebral substance — 
forming the wall of this cavity has a yellowish — 
colour, somewhat of the same hue as that which — 
is seen after extravasated blood in the subcuta~— 
neous tissue, and it is denser than is natural. 
After the lapse of more time the cavity con- 
tracts, and nothing remains but a spot of dis- 
coloured and somewhat indurated cerebral 
substance. When the apoplectic clot has been 
of large size, and has occasioned an extensiv 
solution of continuity, the contraction of the 
surrounding substance is not sufficient to ¢ 
terate the cavity, which in such instances 
occupied by a soft, loose, areolar tissue, infil- 
trated with fluid. In other cases the cavity is 
lined by a distinct membrane and is filled with 
fluid, forming a true cyst. Cruveilhier affirm 
that the most frequent sequel to the apoplecti 
clot is the indurated and discoloured 
cerebral substance; next in frequency is t 
cavity with the loose areolar tissue ; and last, the 
cavity lined by a membrane or the serous cyst. 
The morbid condition which surrounds the 
apoplectic effusion is generally that of cole 
less softening. This state doubtless precede 
the rupture which gave rise to the hemo 
Sometimes, however, red softening exten 
around it more or less; this generally follor 
the effusion. The existence of either of the 
morbid states is very unfavourable to the 
traction and cicatrisation of the pte ans cy 
It frequently happens that in the cereb 
substance around an apoplectic clot we 
very numerous small points of effused blo 
sometimes accompanied by minute streaks 
lowing the direction of the cerebral f 
This constitutes what is called capillary 
plery. Sometimes this is the only mark 
appearance present, and no large clot has b 
formed. This occurs not uncommonly in 
plexy affecting the medulla oblongata and + 
mesocephale. When many such minute ef 
sions take place very near to each other, il 
easy to understand how by their coalition t 
may form a large apoplectic clot; and — 
most probable that large effusions gen 
arise in this way, not from the ru of 
or even of a few vessels, but 
numerous minute ones. 
The size of the pata clot varies e¢ 
derably (excluding the cases of capillary 
lexy in which no coalition has taken 7 
rom the size of a millet seed to that of 
fist, the clot sometimes breaking up the 
nervous matter of the hemisphere with 1 
rounding grey layer, and completely ocet 
its interior. There is no part of the 
so favourable for the occurrence of a” 
apoplectic clot as the hemisphere, beea 
sofiness and magnitude afford the least resis 
to the flux of blood. : 
Apoplectic effusions occur most frequt 
in the hemispheres of the brain, affecting 
the corpora striata or optic thalami, and sf 
ing from them into the white substance ¢ 
hemisphere, or sometimes breaking up 
rh4 
