as yet unknown to us which may have a similar influence and which explain the cases where no changes are recognisable in the vessels and especially such as take place during the earlier periods of life. One point however deserves notice; viz that the rupture seldom takes place in the larger arteries but frequently affects those only one degree removed from the capillaries in size; and that these are much less frequently the seat of true atheroma than of simple fatty degeneration. This distinction is not unimportant; as it may explain the comparative absence of prodromata in some cases of haemorrhage since fatty degeneration of the smaller vessels may be found unattended by such a degree of atheroma as is sufficient to diminish the supply of blood by narrowing the calibre of the larger trunks. Such prodromata in cases of Oakley Canada haemorrhage are I believe generally due either to this cause or to previous attacks of determination of blood arising from nervous excitement.The effect of the extravasation of the blood into the brainsubstance differs however markedly from the softening arising from the obstruction of an artery. We have here an element introduced which is entirely absent in softening; viz pressure. The braintissue is pressed aside; and the effect of the pressure is the production of anxmia in the surrounding tissue. Hence though the interruption of the circulation in the vessel which has given way would otherwise lead to collateral hypenemia similar to that which occurs from the obstruction which precedes softening this is prevented in cases of haemorrhage by the pressure exercised by the bloodclot. We find as a consequence that North Face Clearance the parts surrounding the clot are pale that the convolutions above it are flattened and that the pia mater over these is comparatively anaemic. I believe North Face Outlet Store that it is this condition of anaemia from pressure on the surrounding brainsubstance caused by the clot as contrasted with the collateral hyperaemia in cases of softening which mainly explains the differences observable in the phenomena of the two affections. Both may arise from very similar conditions of the arterial system ; but softening acutely induced is usually attended by signs of The North Face Outlet Store excitement mental motor and sensory while the phenomena of haemorrhage are more commonly those of simple paralysis.The diagnosis of haemorrhage preceded by or attended with softening is a question of greater difficulty and may in many cases be impossible though the mixed class of the phenomena observed may in some cases suffice as a guide. The distinction of haemorrhage from the first form of senile softening is chiefly made by the more gradual invasion and by the comparative incompleteness both of the coma and of the paralysis in the latter and also by the signs of determination commonly present in haemorrhage.If we compare these data with the phenomena observed in our North Face Outlet two patients we may I think conclude that Hines has had an attack of softening from obstruction by atheroma of the vessels and that Antills attack has been one of cerebral haemorrhage. We find however that in neither was the attack preceded by any The North Face Outlet very distinct prodromata; but possibly the headache to which Hines was subject may be viewed in this light.The attack however presented very distinct differences. In Hines it was Oakley Sunglasses slowly developed; and the paralysis was only fully produced after fortyeight hours or even after a longer period. In Antill although there was some slight increase of the paralysis subsequently North Face Coat to the attack yet this was not nearly so marked as in the former case; and his loss