There is one circumstance which is so exceedingly frequent as to form a law-perhaps the most general of any in medicine-that paralysis occurs on the side of the body opposite to that on which the effusion occurs; if the apoplexy attacks the right side of the brain, the left side of the body will be paralysed, and if the left side of the brain is attacked, the right side of the body will be paralysed. It is said, however, that there have been a few exceptions to this rule.

In some cases we find the paralysis affecting the tongue, face and muscles of the eye-lids; in some we have paralysis of the muscle that closes the end of the bowels (the sphincter ani,) or of the muscles of the throat, or of the bladder; but these are rare.

The upper limbs are more frequently paralysed than the lower; and when both upper and lower are affected, the upper are generally worse than the lower. When a person recovers, we find that the lower limbs are the first to regain their lost power and sensibility.

But we may have paralysis without apoplexy. It is sometimes caused by abscess in the brain; sometimes it arises from softening of the brain; sometimes from ossification of some of the arteries. In these cases, however, there is generally some symptom beforehand of mischief. Paralysis may also occur from disease of the spinal cord; sometimes it appears connected with disease of the kidneys or of the bladder; and occasionally persons die with paralybis, in whom, after death, no cause sufficient to produce the paralysis can be detected. Sometimes paralysis is caused by pressure on the nerves without organic disease. There is a ease on record of a person who lost the use of one of his upper limbs from having leaned too long over a bench at a public meeting: and of another who, during a fit of intoxication, fell asleep with his arm thrown over the back of a chair, and awoke with perfect paralysis of the hand. Cases like this are seldom of long duration, and generally yield to the use of stimulants. Permanent paralysis has, however, been caused in this way.

Treatment

"The remedies for apoplexy are few and simple. The great point is to relieve the head from the accumulation of blood, to prevent further congestion, and to obviate inflammatory action; and for these purposes the only efficient means we possess is bleeding. There is no disease in which the efficacy of bold and free depletion by the lancet is more remarkable than in apoplexy." Dr. Abercrombie thinks that, in the commencement of the disease, you may bleed where the pulse is feeble,as well as where it is strong and full, and gives many important cases in which the disease yielded to full bleeding, though the state of the patient's pulse and system at the time were such as would deter many from bleeding. He gives three cases of persons about seventy years of age, on whom bleeding was practised with success, and another of a person of spare habit, aged eighty, whose life was saved by a bold and timely use of the lancet. The first bleeding should be to an extent that will produce some effect on the symptoms. In some cases a second bleeding will be necessary, but in most cases, if a sufficient quantity of blood has been taken at first, more benefit will be derived from the application of a large number of leeches to the head, than from a second bleeding from the arm. Before applying leeches, of course the head must be shaved. If leeches are not to be obtained, the patient may be cupped at the back of the neck.

After bleeding, both general and local, much benefit will be derived from the use of strong purgatives; it is of little consequence what purgatives are employed, as long as they act properly, and if one-or half a dozen-do not operate, others must be tried; and they may be assisted by the use of injections. Many cases in which bleeding has had no apparent effect on the symptoms, have recovered under the use of strong purgatives.

After purgatives, the next thing is to apply cold to the head, by means of cold lotions, ice water, or by pouring a stream of cold water over the head. If all these means have been employed without removing the insensibility, you may apply a blister to the head or the back of the neck; some persons advise the use of emetics in apoplexy, but where congestion of the head exists, vomiting will always increase it; and some cases have occurred in which a fit of vomiting has actually caused apoplexy.

If, after sufficient bleeding, purging, cold applications, and blisters, the patient is still insensible, with a feeble pulse and cold skin; then, and not till then, you may venture on the use of internal stimulants. For this purpose, Camphor, Musk and Carbonate of Ammonia are frequently employed. I recollect a case that occurred some years ago: a gentleman, tall, thin, and of a pale sallow complexion was seized with a fit of apoplexy. After bleeding, his head was shaved, and forty leeches were applied, followed the next day by twenty more; and after the leeches cold applications. In fear of a fatal termination, a brother of the gentleman-a physician-was sent for, and arrived at this stage of the case. He took charge of the case, and commenced giving Port Wine at short intervals. The gentleman's usual medical attendants were rather startled, and were still more surprised when they saw a rapid improvement take place.

Having overcome the attack and restored the patient to consciousness, you must endeavour to prevent a return of the attack; and this is to be effected by carefully restricting the patient in his diet, by avoiding everything likely to excite or irritate the brain or the circulation. It is advisable from time to time to take a little blood from the head, by leeches or cupping; and considerable benefit has been derived from a seton, or an issue at the back of the neck. The bowels must also be kept open, and attention paid to the state of the bladder.

When paralysis remains after the removal of all inflammatory symptoms, it is sometimes necessary to stimulate the action of the brain or the spinal cord. Strychnine has been employed with benefit in cases where the paralysis has remained after the disappearance of organic disease of the brain. It has been given in doses of one-sixteenth of a grain, daily, and gradually increased; but it is a dangerous medicine, and is one of that class that accumulate in the system for some time, without any apparent effect, and then suddenly act with great violence. It should therefore be used with great caution. Friction with strong liniments along the course of the spine, and on the paralysed limbs will sometimes act with advantage.

Considerable benefit has been derived in some cases from the use of electricity and galvanism after inflammation has subsided. I had a case some years ago-a man who had been thrown out of a cart, and fell, with one of his hands doubled under him. He completely lost the use of his hand; had no power to raise it, or to move his fingers. He became an out-patient of St. George's Hospital, (London,) and continued attending there for some weeks. What they did for him I do not know, but, as he got no better, he became tired of going there, and came to me. I applied a mercurial plaster to the wrist, and commenced the use of electricity, increasing the strength with each application. At the end of a week there was a manifest improvement, and in less than two weeks more, the patient was able to return to his work, having regained full power over the muscles of the hand.

In what is called Shaking Palsy, the muscles of one or both of the upper limbs are in a state of continual tremor, and this by degrees and in time extends to both legs, whereby the patient walks with difficulty. The speech at length becomes indistinct, mastication difficult, the saliva dribbles from the mouth, and the body is bent forward. The complaint frequently lasts for some years without impairing the mental faculties. As the muscular weakness Increases, the agitation of the body becomes more violent, continuing even during sleep, and at length drowsiness, delirium, and marks of exhaustion, precede death.

In every species of palsy the diet should be light, nutritive, and of a warm, aromatic nature. If the patient is able to walk, he should take such daily exercise as his strength will permit; but, if deprived of the use of his legs, he ought then to be carried abroad in a carriage or on horseback, and frictions, with strong stimulants, should frequently be applied to the parts affected. Flannel should be worn next to the skin; and all exposures to cold, damp, and moist air, ought carefully to be avoided.

The inhabitants of the East Indies are subject to a peculiar species of Palsy. Those who are seized with it have a tottering in the knees, and a peculiar manner of walking. It attacks both natives and strangers, especially during the rainy season, commencing in November, and terminating in March or April, but is most violent on the Malabar coast. Sometimes only apart of the extremities is affected, and at others the whole of them. The speech is now and then so much obstructed, that the patient can scarcely pronounce a syllable to be understood. The disease is seldom fatal; but the cure is tedious; it is usually effected by change of air, fomentations, baths, frictions, and earth-bathing.