of the two cases has been however very diverse. Antill has presented us North Face Coat with a gradual return of voluntary power unmarked by any condition of spasm The North Face Outlet Store and his intellectual faculties are unimpaired. Hines on the other hand has frequent fits of excitement attended with a gradual failure of intellectual power; and his paralysis instead of diminishing has remained Oakley Sunglasses stationary.I must here call your attention to the conditions of the muscles which though presenting at first sight an apparent similarity really are essentially different from one another; and this difference is one of great clinical importance. There is rigidity in both; but in Antill it is limited to the biceps and the muscles of the forearm. It appeared late; it was constant in amount; but it has diminished gradually after the affected muscles have been galvanised. In Hines on the other hand it affects some of the muscles of the trunk as well as North Face Outlet Store of the arm; it was comparatively early in its appearance; it varied in intensity at different times; and it has been if anything increased by the galvanic stimulus when this has been applied. This difference is due in Antills case to the commencing atrophy of the muscles which so constantly occurs in paralysed parts and through which the muscular tissue wastes leaving only the fascia and intervening fibrous tissue ; and this being devoid of elasticity undergoes a steadily progressive contraction. The improvement under the galvanic action has been a further proof of this shewing the return of the nutrition of the muscular tissue; and as this has coincided with an improvement in his cerebral state he has in consequence gradually regained his voluntary control over the motor action. The means by which this latter is accomplished is a question of very interesting features but one upon which I cannot now enter. I believe however that in the majority of cases in which late rigidity occurs after hemorrhage it is due to this cause. It is however I must tell you believed to be occasionally due to inflammatory action arising around the clot. In such cases it approximates to the tonic contraction seen in Hines which arises from inflammatory action affecting the meninges and the brainsubstance surrounding the softened portion. It frequently affects also the lower limb though this is not seen in the present instance.Both these cases present certain points of resemblance in respect of the state of the vascular system and this always deserves attention in cases of hemiplegic apoplexy. I have already told you that the states of the vessels giving rise North Face Outlet to softening and to hoemorrhage are in many cases very similar. The state of the heart may however be sometimes a guide in cases where the symptoms are of a doubtful nature. The existence of cardiac hypertrophy or of disease of the tricuspid valve may afford a presumption that the nature of the cerebral lesion is hemorrhagic. Disease North Face Clearance of the aortic or mitral valve especially if originating in rheumatism would raise a well founded suspicion that hemiplegic apoplexy originated in the obstruction of the middle cerebral artery by a fibrinous coagulum carried from the left ventricle. The manner of the attack may also aid you though in both Oakley Canada these cases we could obtain no information on these points. Hsemorrhage is often preceded or accompanied by fulness of the vessels of the head by flushing of the face and heat of head. In softening these signs are usually absent; the face may be pale and the circulation is often depressed. Later however signs of determination The North Face Outlet may