The objective phenomena are much more trustworthy than the subjective. Alterations in manner, in character, or in memory—partial paralysis. whether limited to one or more of the cranial nerves, or extending in a modified man ner to all the spinal nerves, or to those on one side of the body, as well as 'muscular irritability or spasm similarly distributed, are symptoms which can be more readily brought to the test of experiment than mere complaints of pain or uneasiness. Mental phenomena, in chronic cases, musi be assumed to be dependent upon some cause of pretty general action. because we know that, in the absence of delirium, the intellectual faculties are frequently undis turbed by lesions of very considerable extent, especially when they are limited to one hemisphere ; we have also reason to believe that the gray matter of the convolutions is particularly involved in the production of such phenomena, and therefore we may be justified in regarding them as evidence of chronic meningitis. When the cause of the affection is central, and acting secondarily on the gray matter, we shall probably find as its accompaniments stupor or paralysis, which are more closely connected with disease of the fibrous element.
Local paralysis, when slight, may be but the commencement of more general paralysis ; when complete, it rather points to the pressure of a tumor. or to some other form of disease of local character. • More extended paralysis, if caused by pressure, is generally accompanied by more or less stupor and con fusion of thought; when standing alone, it is probably dependent on disor ganization of the central structures and tubular nerve substance. In cases in which it is less pronounced, it would seem sometimes to be caused by chronic inflammation of the membranes especially about the base of the brain. Paralysis, coma, and convulsion, with reference to all forms of chronic disease of the brain, are symptoms of very unfavorable omen; spasm, or imperfect control of movement, hold out more hope of possible amelioration, as they rather show some inflammatoty action or irritation of nerve matt,er, Convul sion is not often seen in chronic disease till towards its termination ; it gene rally indicates some degree of inflammation extending to the ventricles or the base of the brain.
Not unfrequently cases of long-standing disease put on, at some period of their history, the aspect of active inflammation. The acute symptoms in such circumstances may be somewhat modified by the previous disease, but their diagnosis is much facilitated by a knowledge of the foregoing state. Unfortu nately, the prognosis is almost hopeless, the chances of modifying the course of the inflammatory action being so mach the smaller in proportion to the severity of the organic lesion out of which they have sprung.
Symptoms of chronic disease are sometimes due to the degeneration of the coats of the arteries of the brain, and a hint of this possible contingency may be obtained from the presence of valvular disease of the heart, which cannot be traced to an inflammatory origin.
§ 4. Apoplexy.—No condition of disease is probably more marked or more easily recognized than a pure case of apoplectic seizure. Suddenly, while to appearance in perfect health, the patient loses recollection, and falls to the ground in a state of un consciousness ; his face is turgid ; his temples throb ; his eyeballs turn upwards ; his features are drawn to one side ; slight convul sive tremor agitates his frame, usually on one side ; and he lies dead to all around him. When examined, probably one side of his body, or even the whole of his limbs, have become flaccid and useless, remain in any posture in which they are 'Aced, and drop'as lifeless things when lifted from the couch ; his breathing is slow and labored ; his pulse oppressed, small, and yet resisting; if one side only be paralyzed, be makes meaningless, purposeless efforts, and struggles with the limbs of the other, when any at tempt to move him is made ; in course of time his breathing be comes stertorous ; his urine is retained in the bladder, or dribbles away in the bed; his feces are passed involuntarily. Without another conscious movement, without any knowledge of what has transpired, the coma deepens, the breathing becomes a succession of interrupted sighs, and he passes away without a struggle.
Clear and unmistakable as such a case is, we find in practice that all the symptoms may be so shaded off by imperceptible differences, that at length scarcely any portion of the original picture remains, by which to give an exact definition of an attack of apoplexy ; and in common parlance, a "fit," followed by loss of consciousness, is called apoplexy. This is not the place to discuss whether anything be rightly called apoplexy which is not distinctly traceable to turgidity of vessels, with or without their rupture, and the consequent extravasation of blood ; but, as a matter of 'diagnosis, it is essential to distinguish sanguineous apoplexy froln all other sorts of " fit," whether these be followed by loss of consciousness or not.
When a history can be obtained in a case of apoplexy it is not unusual to find that there have been for some days or weeks, occasional warnings, which are spoken of as "tendency of blood to the head," consisting of headache, giddiness on sudden change of posture, throbbing of the temples, &c. ; and the occasion of the fit itself has been some strain or prolonged muscular effort, or some mental excitement. The fit itself may not be the first step in the actual progress of the malady, but may be preceded for some hours by an accession of violent pain, or by some form of paralysis of the cerebral or even of the spinal nerves. The oc currence of apoplexy is generally, to a certain extent, limited by • age; a full habit of body, luxurious living, turgescence of the face, and the cessation of habitual discharges, may each be found among the precursors, or, as they are called, the predisposing causes of apoplexy.