Recent Apoplexy is followed by numerous changes in the cavity itself, in the cerebral substance around it, and even in the whole brain; and the description of the recent cell may now be followed by some account of them. They include, in a word, the terminations and consequences of apoplexy, provided a fatal result has not ensued suddenly, or after some short period, such as a few days. I will speak first of the changes which attend a favorable result, and constitute the reparative process in apoplexy. A representation of this process can be obtained only by numerous observations on persons who have died at various periods after an attack of apoplexy. The parts in which these changes occur, are the extravasated blood, and the surrounding cerebral substance, or wall of the cell.

Numerous changes of color gradually take place in the extravasation; it becomes blackish-red, then brown, of the color of plum-sauce, rusty brown, and yellow, like yeast: at last this color also fades completely, or nearly so; and there remains only a clear and colorless, or a turbid white fluid. Corresponding alterations take place also in the consistence of the extravasation, and in its general composition. They are manifested on the whole in the extravasation becoming fluid, the fibrin and blood-disks being absorbed, and in the progressive changes in the pigment which have been mentioned.

The shreds of cerebral substance contained in the extravasation are also absorbed, and disappear entirely.

Whilst these changes are going on in the contents of the cell, we observe others also in its walls.

In the first place that portion of the wall of cerebral tissue which is suffused, torn, and disorganized, and which hangs into the cavity in the form of pulpy shreds, becomes partly absorbed, and partly fluid, so that the inner surface of the wall acquires a polished appearance, and the cavity itself a more regular rounded form. A reactionary inflammatory process then commences in the neighboring uninjured cerebral substance: it is moderate in degree, and its products partly undergo a change of structure, and partly both they, and the cerebral tissue, which is the seat of the process, become reduced to a fine molecular mass, and are gradually absorbed. In its general appearance, therefore, this layer seems to consist of fibrils like cellular tissue, of numerous nucleated structures, some rounded and others elongated into fibrils, of delicate nucleated fibres, of elementary neucleoli, partly separate, and partly conglomerate, and forming the so-called exudation-corpuscles, and of a certain quantity of yellow, or yellowish-red, amorphous pigment. And, according to the amount of one, or the other, the density of the layer varies: if the formation of new tissue predominate, its density is considerable, while in many cases we find it to be made up of honeycombed compartments, the partition-walls consisting of these fibrillated structures, and the intervals being filled up by a thick, white fluid, like lime-water, which is composed of the molecular matter already spoken of. After the absorption of the latter, the layer always increases in density, and appears like a cicatrix surrounding the apoplectic cavity.

Meanwhile the extravasation within the cavity has undergone the changes already generally described. The fluid contains a quantity, varying according to circumstances, of separate or confluent elementary corpuscles, and is dotted with more or less, brown, yellowish-red, or yellow pigment, which may be either amorphous, or in the form of very small prismatic crystals. Moreover the cell is either traversed by a delicate network of varying firmness, which contains this fluid in its intervening spaces, or it forms a simple cavity with its walls lined by a similar network. Minute examination proves this to be a gelatinous blastema, which is gradually resolved into exceedingly fine fibrils, and contains many of the elementary granules, separate or conglomerate, and a greater or less quantity of pigment. It constitutes what is looked upon as the characteristic lining of the cavity when changed to the so-called Apoplectic cyst.

In this lining membrane and the equivalent network, just as in the fluid that fills its cells, the pigment sometimes gradually disappears, at least from the naked eye; an exceedingly small quantity remaining perceptible with the aid of the microscope. Indeed, the presence of pigment has less weight in the diagnosis than is ascribed to it, as similar pigments remain after many other processes, which are attended with extravasation, though it be only in the form of the smallest ecchymoses. I may instance, especially, inflammation.

This lining membrane is found at later periods gradually to change into a finely fibrillated cellular tissue: it becomes more compact and smooth on its inner surface, the lining of the apoplectic cyst looking, in fact, like a serous membrane. Sometimes new vessels are formed in it.