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Fundamentals of Anatomy and Physiology, 11e (Martini)
Chapter 10 Muscle Tissue
Multiple Choice Questions
1) Muscle tissue, one of the four basic tissue groups, consists chiefly of cells that are highly
specialized for
A) conduction.
B) contraction.
C) peristalsis.
D) cushioning.
E) secretion.
Answer: B
Learning Outcome: 10-1
Bloom's Taxonomy: Remembering
2) Which of the following is a recognized function of skeletal muscle?

A) produce movement
B) maintain posture
C) maintain body temperature
D) guard body entrances and exits
E) All of the answers are correct.
Answer: E
3) At each end of the muscle, the collagen fibers of the epimysium, perimysium, and
endomysium, come together to form a
A) tendon.
B) satellite cell.
C) ligament.
D) tenosynovium.
E) sheath.
Answer: A
4) The dense layer of connective tissue that surrounds an entire skeletal muscle is the
A) tendon.
B) epimysium.
C) endomysium.
D) perimysium.
E) fascicle.
Answer: B
1
Copyright © 2018 Pearson Education, Inc.
5) Nerves and blood vessels that service a muscle fiber are located in the connective tissues of its
A) endomysium.
B) perimysium.
C) sarcolemma.
D) sarcomere.
E) myofibrils.
Answer: A
6) A fascicle is a
A) group of muscle fibers that are encased in the perimysium.
B) layer of connective tissue that separates muscle from skin.
C) group of muscle fibers that are all part of the same motor unit.
D) group of muscle fibers and motor neurons.
E) collection of myofibrils in a muscle fiber.
Answer: A
7) The delicate connective tissue that surrounds the skeletal muscle fibers and ties adjacent
muscle fibers together is the
A) endomysium.
B) perimysium.
C) epimysium.
D) superficial fascia.
E) periosteum.
Answer: A
8) The bundle of collagen fibers at the end of a skeletal muscle that attaches the muscle to bone
is called a(n)
A) fascicle.
B) tendon.
C) ligament.
D) epimysium.
E) myofibril.
Answer: B
2
9) Put the following structures in order from superficial to deep.
1. muscle fiber
2. perimysium
3. myofibril
4. fascicle
5. endomysium
6. epimysium
A) 1, 5, 4, 3, 2, 6
B) 6, 2, 5, 4, 1, 3
C) 6, 2, 4, 5, 1, 3
D) 1, 3, 5, 6, 4, 2
E) 2, 3, 1, 4, 6, 5
Answer: C
Bloom's Taxonomy: Understanding
10) A(n) ________ can be described as a broad tendinous sheet.

A) fasciae
B) retinaculum
C) aponeurosis
D) interstitium
E) tympanum
Answer: C
11) Interactions between actin and myosin filaments of the sarcomere are responsible for
A) muscle fatigue.
B) the conduction of neural stimulation to the muscle fiber.
C) muscle contraction.
D) muscle relaxation.
E) the striped appearance of skeletal muscle.
Answer: C
12) In a sarcomere, the central portion of thick filaments are linked laterally by proteins of the
A) Z line.
B) M line.
C) H band.
D) A band.
E) I band.
Answer: B
3
13) The advantage of having many nuclei in a skeletal muscle fiber is the ability to
A) contract much more forcefully.
B) produce more ATP with little oxygen.
C) store extra DNA for metabolism.
D) produce large amounts of muscle proteins.
E) produce nutrients for muscle contraction.
Answer: D
14) Skeletal muscle fibers are formed from embryonic cells called
A) sarcomeres.
B) myofibrils.
C) myoblasts.
D) fascicles.
E) myomeres.
Answer: C
15) The repeating unit of a skeletal muscle fiber is the

A) sarcolemma.
B) sarcomere.
C) sarcoplasmic reticulum.
D) myofibril.
E) myofilament.
Answer: B
16) The plasma membrane of a skeletal muscle fiber is called the

A) sarcolemma.
B) sarcomere.
C) sarcosome.
D) sarcoplasmic reticulum.
E) sarcoplasm.
Answer: A
4
17) Which of the following best describes the term sarcomere?
A) protein that accounts for elasticity of resting muscle
B) repeating unit of striated myofibrils
C) storage site for calcium ions
D) thin filaments are anchored here
E) largely made of myosin molecules
Answer: B
18) Muscle fibers differ from "typical cells" in that muscle fibers
A) lack a plasma membrane.
B) have many nuclei.
C) are very small.
D) lack mitochondria.
E) have large gaps in the cell membrane.
Answer: B
19) Which of the following best describes the term sarcoplasmic reticulum?
C) storage and release site for calcium ions
Answer: C
20) Which of the following best describes the term Z line?

C) storage site for calcium ions
Answer: D
5
21) The region of the sarcomere containing the thick filaments is the
A) Z line.
B) M line.
C) H band.
D) A band.
E) I band.
Answer: D
22) The skeletal muscle complex known as the triad consists of

A) actin, myosin, and titin filaments.
B) a transverse tubule and two terminal cisternae.
C) filaments, myofibrils, and sarcomeres.
D) A bands, H bands, and I bands.
E) actin, myosin, and sarcomeres.
Answer: B
23) The area in the center of the A band that contains no thin filaments is the
A) Z line.
B) M line.
C) H band.
D) I band.
E) zone of overlap.
Answer: C
24) At rest, the tropomyosin molecule is held in place by

A) actin molecules.
B) myosin molecules.
C) troponin molecules.
D) ATP molecules.
E) calcium ions.
Answer: C
6
25) Each thin filament consists of
A) two actin protein strands coiled helically around each other.
B) chains of myosin molecules.
C) six molecules coiled into a helical structure.
D) a rod-shaped structure with "heads" projecting from each end.
E) a double strand of myosin molecules.
Answer: A
26) The region of the sarcomere that always contains thin filaments is the
A) Z line.
B) M line.
C) H band.
D) A band.
E) I band.
Answer: E
27) At rest, active sites on the actin are blocked by

A) myosin molecules.
B) troponin molecules.
C) tropomyosin molecules.
D) calcium ions.
E) ATP molecules.
Answer: C
28) The series of membranous channels that surround each myofibril is the
A) sarcoplasmic reticulum.
B) sarcoplasm.
C) sarcomere.
D) sarcolemma.
E) endomysium.
Answer: A
7
29) All of the following proteins are part of the thin filaments except
A) actin.
B) tropomyosin.
C) troponin.
D) titin.
E) None of the answers is correct; there are no exceptions.
Answer: D
30) When a skeletal muscle fiber contracts, the

A) H bands and I bands get larger.
B) zones of overlap get larger.
C) Z lines move further apart.
D) width of the A band increases.
Answer: B
31) Since each myofibril is attached at either end of the muscle fiber, when sarcomeres shorten,
the muscle fiber
A) lengthens.
B) shortens.
C) strengthens.
D) weakens.
E) pulls from the middle.
Answer: B
8
Figure 10-1 Skeletal Muscle Fiber
Use Figure 10-1 to answer the following questions:
32) Identify the structure labeled "1."

A) mitochondria
B) glycogen
C) ATP
D) myofibril
E) synaptic vesicle
Answer: A
Bloom's Taxonomy: Applying
33) Which of the following are found in the structure labeled "3"?
A) actin
B) myosin
C) titin
D) tropomyosin
Answer: E
9
34) What physiological process occurs in the structure labeled "7"?
A) release of neurotransmitter
B) conduction of the action potential into the cell interior
C) activity of acetylcholinesterase
D) release of protein and calcium ions into the muscle fiber
E) opening of sodium channels and subsequent influx of sodium
Answer: B
35) What is released from the structure labeled "9"?

A) sarcoplasm
B) acetylcholine
C) protein
D) calcium ions
E) acetylcholinesterase
Answer: D
36) Where would calcium ions be predominately found?

A) 1
B) 2
C) 4
D) 8
E) 9
Answer: E
37) Which structure has pumps to remove calcium ions from the sarcoplasm to produce
relaxation?
A) 6
B) 7
C) 1
D) 3
E) 2
Answer: A
10
38) Where are the myosin molecules located?
A) 4
B) 5
C) 6
D) 7
E) 8
Answer: B
39) Which structure contains the motor end plate?

A) 1
B) 2
C) 3
D) 5
E) 8
Answer: B
40) Identify the structure where ATP is produced.

A) 6
B) 7
C) 1
D) 3
E) 2
Answer: C
41) Identify the structure(s) where ATP is consumed?

A) 3
B) 6
C) 3 and 6
D) 7
E) 3 and 7
Answer: C
11
42) Active sites on the actin become available for binding after
A) actin binds to troponin.
B) troponin binds to tropomyosin.
C) calcium binds to troponin.
D) calcium binds to tropomyosin.
E) myosin binds to troponin.
Answer: C
43) The action potential is conducted into a skeletal muscle fiber by

A) motor end plates.
B) neuromuscular junctions.
C) transverse tubules.
D) triads.
E) sarcoplasmic reticulum.
Answer: C
44) The most important factor in decreasing the intracellular concentration of calcium ion after
contraction is
A) active transport of calcium across the sarcolemma.
B) active transport of calcium into the sarcoplasmic reticulum.
C) active transport of calcium into the synaptic cleft.
D) diffusion of calcium out of the cell.
E) diffusion of calcium into the sarcoplasmic reticulum.
Answer: B
45) When calcium ion binds to troponin,

A) tropomyosin rolls away from the active site.
B) active sites on the myosin are exposed.
C) actin heads will bind to myosin.
D) muscle relaxation occurs.
E) myosin shortens.
Answer: A
12
46) Physical evidence that supports the sliding filament theory of muscle contraction includes
A) constant distance between Z lines during contraction.
B) decreased width of the H band during contraction.
C) increased width of the I band during contraction.
D) decreased width of the A band during contraction.
E) the I band + H band distance is constant during contraction.
Answer: B
47) The protein that is found in the Z line of a sarcomere is called

A) actinin.
B) titin.
C) nebulin.
D) myosin.
E) actin.
Answer: A
48) The protein that regulates muscle contraction by controlling the availability of active sites on
actin is called
A) actin.
B) titin.
C) myosin.
D) tropomyosin.
E) nebulin.
Answer: D
49) Thin filaments are mostly made of the protein

A) actin.
B) titin.
C) myosin.
D) tropomyosin.
E) nebulin.
Answer: A
13
50) Thick filaments are made of the protein
A) actin.
B) titin.
C) myosin.
D) tropomyosin.
E) nebulin.
Answer: C
51) Stem cells located between the endomysium and sarcolemma that function in the repair of
damaged muscle tissue are called
A) myocytes.
B) satellite cells.
C) endocytes.
D) sarcocytes.
E) creatinocytes.
Answer: B
52) The complex of a transverse tubule and two adjacent terminal cisternae is known as a
A) trimer.
B) triad.
C) triptych.
D) trisome.
E) trilogy.
Answer: B
53) The structural theory that explains how a muscle fiber contracts is called the ________
theory.
A) sliding filament
B) excitation-contraction coupling
C) neuromuscular
D) muscle contraction
E) action-myosin interaction
Answer: A
14
54) The region of sarcomere where thin and thick filaments are located is called the
A) I band.
B) A band.
C) Z line.
D) M line.
E) zone of overlap.
Answer: E
55) In the sarcomere which elastic protein attaches the thick filament to the Z line?
A) titin
B) actin
C) G actin
D) nebulin
E) myosin
Answer: A
56) In the sarcomere the protein that forms two twisted strands around a central rod-like protein
is called
A) titin.
B) actin.
C) G actin.
D) nebulin.
E) myosin.
Answer: B
57) In the myofibril the protein that possesses the active site for myosin heads to bind is called
A) titin.
B) actin.
C) G actin.
D) nebulin.
E) myosin.
Answer: C
15
58) In the myofibril the thin filament is organized around a rod-like core protein called
A) titin.
B) actin.
C) G actin.
D) nebulin.
E) myosin.
Answer: D
59) In response to action potentials arriving along the transverse tubules, the sarcoplasmic
reticulum releases
A) acetylcholine.
B) sodium ions.
C) potassium ions.
D) calcium ions.
E) hydrogen ions.
Answer: D
60) Each skeletal muscle fiber is controlled by a motor neuron at a single

A) synaptic knob.
B) sarcomere.
C) neuromuscular junction.
D) synaptic cleft.
E) transverse tubule.
Answer: C
61) The narrow space between the synaptic terminal and the muscle fiber is the
A) synaptic knob.
B) motor end plate.
C) motor unit.
D) synaptic cleft.
E) M line.
Answer: D
16
62) Which of the following become connected by myosin cross-bridges during muscle
contraction?
A) thin filaments and thick filaments
B) thick filaments and titin filaments
C) z disks and actin filaments
D) thick filaments and t-tubules
E) thin filaments and t-tubules
Answer: A
63) After death, muscle fibers run out of ATP and calcium begins to leak from the sarcoplasmic
reticulum into the sarcoplasm. This results in a condition known as
A) tetany.
B) treppe.
C) depolarization.
D) rigor mortis.
E) oxygen debt.
Answer: D
64) In rigor mortis

A) the myosin heads are attached to actin.
B) ATP is depleted.
C) calcium ions keep binding to troponin.
D) sustained contractions occur.
Answer: E
65) In a sarcomere, cross-bridge attachment occurs specifically in the

A) zone of overlap.
B) A band.
C) I band.
D) M line.
E) H band.
Answer: A
17
66) Triggering of the muscle action potential occurs after
A) acetylcholine binds to chemically-gated channels in the motor end plate.
B) acetylcholinesterase is released from synaptic vesicles into the synaptic cleft.
C) calcium ion binds to channels on the motor end plate.
D) the action potential jumps across the neuromuscular junction.
E) Any of these can produce an action potential in the muscle cell.
Answer: A
67) The following is a list of the events that occur during a muscle contraction. What is the
correct sequence of these events?
1. Myosin cross-bridges bind to the actin.
2. The free myosin head splits ATP.
3. Calcium ion is released from the sarcoplasmic reticulum.
4. The myosin head pivots toward the center of the sarcomere.
5. Calcium ion binds to troponin.
6. The myosin head binds an ATP molecule and detaches from the actin.
A) 1, 3, 5, 4, 6, 2
B) 5, 1, 4, 6, 2, 3
C) 3, 5, 1, 2, 4, 6
D) 3, 5, 1, 4, 6, 2
E) 1, 4, 6, 2, 3, 5
Answer: D
68) How would the loss of acetylcholinesterase from the motor end plate affect skeletal muscle?
A) It would make the muscles less excitable.
B) It would produce muscle weakness.
C) It would cause muscles to stay contracted.
D) It would cause muscles to stay relaxed.
E) It would have little effect on skeletal muscles.
Answer: C
69) When acetylcholine binds to receptors at the motor end plate, the sarcolemma becomes
A) more permeable to sodium ions.
B) less permeable to sodium ions.
C) more permeable to calcium ions.
D) less permeable to potassium ions.
E) less permeable to potassium and sodium ions.
Answer: A
18
70) The cytoplasm of the neuromuscular terminal contains vesicles filled with molecules of the
neurotransmitter
A) epinephrine.
B) norepinephrine.
C) acetylcholine.
D) antidiuretic hormone.
E) adrenaline.
Answer: C
71) At what point during excitation contraction coupling does exocytosis play a role?
A) during calcium ion reuptake into the sarcoplasmic reticulum
B) when sodium channels open up on the motor end plate
C) during acetylcholine release from the synaptic terminal
D) when the action potential surges through the T-tubules
E) when ATP splits into ADP and P on the free myosin head
Answer: C
72) Which of the following statements about excitation-contraction coupling is incorrect?

A) Calcium ions travel through the transverse tubule.
B) Calcium ion is released from the sarcoplasmic reticulum.
C) Tropomyosin moves to expose myosin binding sites on actin.
D) Troponin binds calcium ion and signals tropomyosin to move.
E) Relaxation requires uptake of calcium ion by the sarcoplasmic reticulum.
Answer: A
73) Synaptic vesicles contain neurotransmitters that are released by ________ when the action
potential arrives.
A) endocytosis
B) apoptosis
C) exocytosis
D) hydrolysis
E) sodium
Answer: C
19
74) A patient takes a medication that blocks ACh receptors of skeletal muscle fibers. What is this
drug's effect on skeletal muscle contraction?
A) increases tone in the muscle
B) causes a strong contraction similar to a "charlie horse" cramp
C) increases the muscle's excitability
D) produces a strong, continuous state of contraction
E) reduces the muscle's ability for contraction
Answer: E
75) Communication between axons and muscle fibers occurs at specialized synapses called
A) nervous units.
B) synaptic terminals.
C) motor end plates.
D) motor units.
E) neuromuscular junctions.
Answer: E
76) Active sites become exposed when calcium ions bind to

A) tropomyosin.
B) actin.
C) myosin.
D) troponin.
E) calcium channels.
Answer: D
77) Cross bridge detachment is caused by ________ binding to the myosin head.
A) ATP
B) calcium
C) magnesium
D) acetylcholine
E) acetylcholinesterase
Answer: A
20
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been no paralysis, and the hemorrhages were probably not the
immediate cause of death.
Durand-Fardel gives a table of supposed causes in 21 cases of

persons over fifty: 8 of these were connected with either habitual use
of liquor or a debauch; 9 had an attack immediately after a meal.
After naming all these causes, it must be said that in many cases it is
impossible to find any reason for the occurrence of the hemorrhage
at the particular moment it comes. A person may go to bed in
apparent health, and be found some hours afterward unconscious
and comatose, or unable to stir hand or foot on one side, or to
speak. Gendrin, as quoted by Aitken, states that of 176 cases, 97
were attacked during sleep. The attack may come on when the
patient is making no special muscular effort and under no special
excitement. It is simply the gradual progress of the lesion, which has
reached its limit.
SYMPTOMATOLOGY.—If we take as a point of departure the fully-

developed attack, such as most frequently is found with a large and
rapid hemorrhage into the cerebral hemispheres, pons, or
cerebellum, the symptoms are those usually spoken of as an
apoplectic attack, shock, or stroke, or, as the Germans say,
Hemorrhagische Insult. Trousseau quotes as a satisfactory definition
the words of Boerhaave: “Apoplexia dicitur adesse, quando repente
actio quinque sensuum externorum, tum internorum, omnesque
motus voluntarii abolentur, superstite pulsu plerumque forti, et
respiratione difficili, magna, stertente, una cum imagine profundi
perpetuique somni.”
Loss of consciousness, abolition of voluntary motion and sensation,

and usually stertor, the appearance of the patient being that of one in
deep sleep, are found in the extreme cases. In others the loss of
consciousness and sensation are not complete; the patient can be
aroused enough to utter a grunt or raise a hand to his face in order
to brush away a fly or the hand of the physician who is trying to raise
his eyelids, or can make a grimace to show that he is hurt, the face
returning to its indifferent expression as soon as the cause of
irritation is removed. Although the grade of action, both sensitive and
motor, seems to be a little above the purely reflex, it is but very
slightly so, and probably is not sufficient to remain an instant in the
memory.
The rapidity with which this condition comes on varies widely, from a
very few minutes, or even seconds, to some hours. It may even
diminish for a time and return. The cases in which unconsciousness
is most rapidly produced are apt to be meningeal and ventricular,
and presumably depend upon the rupture of vessels of considerable
size, although the location among the deeper ganglia, where the
conductors of a large number of nervous impulses are gathered into
a small space, will, of course, make the presence of a smaller clot
more widely felt. Even in these, however, the onset is not absolutely
instantaneous, and the very sudden attack is rather among the
exceptions. Trousseau denies having seen, during fifteen years of
hospital and consulting practice, a single case in which a patient was
suddenly attacked as if knocked down with a hammer, and that since
he had been giving lectures at the Hotel Dieu he had seen but two
men and one woman in whom cerebral hemorrhage presented itself
from the beginning with apoplectiform phenomena. In each of these
the hemorrhage had taken place largely into the ventricles.
Lidell gives the following case: A colored woman, aged forty-nine,

was engaged in rinsing clothes, and while in a stooping posture
suddenly fell down upon her left side as if she had been struck down
by a powerful blow. She was picked up insensible, and died in ten or
fifteen minutes. The hemorrhage was chiefly meningeal, and
especially abundant about her pons and medulla oblongata. The
fourth ventricle was full of blood, and there were clots in the lateral
ventricles.
A woman, aged about forty, had been hanging out clothes in an

August sun. She was observed to run out of the house screaming,
and fell to the ground unconscious. This was at 1 P.M., and she died
at 3.30 P.M. Her temperature just after death was 107.2°. The
neighborhood of the posterior surface of the pons Varolii was
occupied by a broken-down-looking mass, appearing like an
aggregation of small apoplexies (hemorrhages), involving and
breaking down the middle crura of the cerebellum. There was no
fatty degeneration nor any miliary aneurism. (I do not know upon
how thorough an examination this last statement rests.)
In a large number of cases it is difficult to say, in the absence of any

observation, intelligent or otherwise, exactly how rapid the onset of
the symptoms may have been, but in those which occur where the
patient is watched or is in the company of observant persons it is
almost invariable to meet with symptoms less than unconsciousness
which denote the actual beginning of the hemorrhage. From the
nature of the lesion it can rarely give rise to symptoms which justify
the epithet of fulminating in the sense of struck with a thunderbolt.
The unconsciousness, so far as can be known, does not depend on
the injury of any one special small point of the brain in which
consciousness resides, but upon the compression of a considerable
portion, which must necessarily take place gradually, but with a
rapidity proportioned to the size of the current which issues from the
ruptured vessel and the ease with which pressure can diffuse itself
over a large area. It is undoubtedly the greater facility offered to such
diffusion by the communication of the hemorrhage with the so-called
cavity of the arachnoid and the ventricles which gives to these forms
a peculiar severity. The difference between a hemorrhage spreading
through all the ventricles or over a large surface of the brain, and
one which is limited to a focus in the substance of one hemisphere,
being restrained by more or less firm tissue, may be illustrated by the
gain in power in the hydraulic press from the transfer of the stream of
water from a small cylinder to a larger one.
Vomiting is a symptom of some importance in diagnosis, being not

very common in cerebral hemorrhage, but very frequent in
cerebellar.
Whether of sudden, rapid, or slow development, the apoplectic

attack is, in its main features, described in the aphorism of
Boerhaave given above. The muscular relaxation of the face imparts
to it an expressionless, mask-like character; the limbs lie motionless
by the side, unless they can be excited to some slight movement by
some painful irritation or are agitated by convulsions, or in a
condition of rigid spasm; the face may be pale or flushed; the cheeks
flap nervelessly—le malade fume la pipe.
Swallowing, in the deepest coma, is not attempted. The fluid poured

into the mouth remains, and distributes itself according to the laws of
gravity without exciting reflex movements of the pharynx. When the
depression is less profound, it may excite coughing or be swallowed.
An attempt to swallow when the spoon touches the lips indicates a
considerably higher degree of nervous activity. Respiration may be
slow, but when the case is to terminate fatally rises with the pulse
and temperature. It is often stertorous and difficult, the obstruction
consisting partly in the gravitation backward of the soft palate and
tongue, and partly in the accumulation of fluids in the pharynx.
Hence stertor is in some cases only an accidental phenomenon,
depending upon the position of the patient on the back, and can be
relieved by turning him on his side and wiping out the mouth as far
back as can be reached. Cheyne-Stokes respiration occurs in severe
cases, though not confined to necessarily fatal ones.
The general temperature in cerebral hemorrhage has been studied

enough to make it of considerable value, especially in prognosis. In a
case which extends over a sufficiently long time several stages can
be distinguished which in shorter ones may be wanting. An initial
period of depression is described by Bourneville17 as occurring
immediately after an attack, in which the temperature falls a degree
or two below the normal, and, according to his view, continues
depressed if death takes place rapidly. He gives the case of a man
who died very shortly after an attack (his second one), where the
temperature, taken in the rectum at the moment of death, was 35.8°.
In cases which survive longer this initial fall passes either into a
stage where it oscillates within the neighborhood of the normal or
immediately begins to rise; the latter occurrence indicates an
impending fatal termination (unless, of course, something else can
be found to account for it). In the former condition we find patients
whose life may be indefinitely prolonged for days or weeks, when, if
a fatal termination is to result, the thermometer again indicates a
rise.
17 Études cliniques et thermométriques sur les Maladies du Système nerveux, 1872.
The initial fall of temperature is not so likely to be observed except in

institutions like the Salpêtrière, where large numbers of old persons
are collected and under close medical surveillance; and, indeed, it
may be doubted, even from Bourneville's own table, whether the rule
is one without exceptions. At any rate, the rise is a more important
phenomenon than the fall. When the rise of temperature is
interrupted by a fall, and then continues again, it is due, according to
the author already quoted, to a renewal of the hemorrhage.
These changes of temperature may be noted with various locations

of the lesion, but it seems probable that further study might make
them useful in diagnosis as well as prognosis. Hale White reports the
case of a boy aged six and a half years, who was found unconscious
with right hemiplegia, and who afterward had many and various
paralyses with hyperpyrexia, the highest temperature being 107°. He
lived long enough for secondary degeneration to extend down the
crura and into the anterior cornua. A small soft patch a quarter of an
inch in diameter existed at the anterior part of each corpus
striatum.18
18 Guy's Hosp. Rep., 1882.
FIG. 37.
The chart W. H. (Fig. 37) is from a man aged fifty who fell in the
street while returning from work at noon, and whose axillary
temperature was taken at 5 P.M. and every two hours thereafter until
death. The hemiplegia was not very marked, but the hemorrhage
was extensive, involving the pons and left crus cerebri, the external
capsule, left crus cerebelli, and medulla, bursting through into the
fourth ventricle.
FIG. 38.
The chart M. M. (Fig. 38), as taken from Bourneville, represents the
course of the temperature in a rapid case: each perpendicular line
denotes an hour.
The difference in the temperature of the two sides has been

variously stated, and probably depends on a number of factors
besides the length of time that has elapsed since the first attack.
There is probably, however, a tendency to excess of heat on the
paralyzed side soon after the attack, owing to vaso-motor paralysis;
and this difference will be more marked in the hands than in the
axillæ. After a length of time which may be from days to months the
temperature becomes equalized, or more frequently the relation is
reversed, the paralyzed side being colder as atrophy takes place.
Lepine19 gives a case where the axillary temperatures of the two
sides continued the same within a small fraction of a degree for three
days, and then separated very slowly, until at death the paralyzed
side was six-tenths of a degree (Cent.) hotter than the other, in both
being inferior to the rectal (107° Cent.).20
19 Mémoires de Société de Biol., 1867.
20 The chart in the original, and as reproduced by Bourneville, is wrongly lettered. The
text says that the left side was the hotter.
FIG. 39.
The chart C. M. (Fig. 39) shows the excess of temperature in a case

of meningeal hemorrhage. The dotted line is from the paralyzed side.
The first observation was made two and a half hours after the attack.
A very interesting case is reported by Johnson21 of crossed
hemiplegia, where the temperature was about a degree higher on
the paralyzed side of the body, and, corresponding to this, the
sphygmograph showed a great diminution of tension; the lesion is
supposed to have been a hemorrhage in the pons. Johnson, in
commenting on the statement of Lorain that in all cases of
hemiplegia the pulse is more full on the paralyzed side, says that it is
incorrect for ordinary cases of hemorrhage into the corpus striatum,
though true in his own case.
21 Brit. Med. Journ., Jan. 6, 1877.
The most marked differences of temperature have been observed

where the lesion has been in the neighborhood of the pons, crus
cerebri, or medulla oblongata. In a case reported by Allbutt there
was a difference of 1.6°; the radial pulse was softer and fuller on the
paralyzed side, and the cheek upon that side was flushed.22 The
pulmonary hemorrhages which have been noticed by Brown-
Séquard and others in animals after cerebral lesions, and the
extravasation, congestion, subpleural ecchymoses noted by Ollivier23
in cerebral apoplexy, are probably to be referred to vaso-motor
disturbances.
22 Med. Times and Gaz., Dec. 4, 1869.
23 Archives générales, 1873, 167.
Much more attention has been paid to the pulse than to the
temperature, but it is less easy to lay down definite rules in regard to
it. It may vary in either direction. When the case is approaching a
fatal termination the pulse is apt to accompany the temperature in a
general way in its rise, though not necessarily following exactly, as is
seen in the chart in Fig. 38.
The throbbing or bounding of the arteries often described may

indicate increased activity of heart, but means at the same time
vaso-motor relaxation. The urine and feces are often passed
involuntarily.
In some rare cases symptoms closely resembling those produced in
animals by section of the sympathetic have been seen. These are
false ptosis, narrowing of the palpebral opening and sinking of the
globe of the eye into the orbit, diminution in the size of the pupil,
higher temperature on the paralyzed side of the face and the
corresponding ear, abnormal secretion of the eye, nose, and mouth
on the same side.24 They are supposed to indicate a paralysis of the
sympathetic.
24 Nothnagel, quoted by Grasset.
The condition of general relaxation may be so profound as to cover

up everything else, but in many cases true paralytic symptoms may
be discovered or provoked, which even at an early period give us
information as to the locality and nature of the lesion.
A greater degree of muscular relaxation may be manifest on one

side of the face than the other; the forehead may be a little smoother
on one side, the corner of the mouth drooping, the downward line
from the ala of the nose flattened, and the cheek flapping. There
may be a little greater resistance to passive motion of the limbs on
one side; one hand on being raised may drop helplessly back to the
bed, while the other is laid slowly down; the right hand when pinched
lies motionless and without power to escape the pain until the left
comes to its assistance. Irregularity of the pupils, if present, is an
important sign, but its absence signifies nothing.
One of the most significant signs is the conjugate deviation of the

eyes, both eyes and the head being turned strongly to one side or
the other. When the lesion is above the pons and is irritative, as in
the early stage of hemorrhage, the deviation is toward the side of the
body affected and away from the lesion; when paralysis is
established, away from the paralysis and toward the lesion. Below
the pons the rule is reversed. The spastic stage of conjugate
deviation may coincide with stiffness (early rigidity) of the paralyzed
limbs. This deviation must not be mistaken for an accidental position
of the head. The patient should be addressed from the side away
from which he is looking. Sometimes the eyes can be brought to the
median line, and not beyond. An attempt to turn the head forcibly
beyond the median line occasionally causes pain. The value of this
symptom in diagnosis has been denied, but a part at least of the
apparent contradictions have arisen from the neglect to notice
whether it were of a paralytic or spastic character.
As the condition of unconsciousness gradually passes off, the face

regaining, at least in part, its natural and more intelligent expression,
the eyes trying to follow the movements of surrounding persons, an
attempt being made, perhaps only by an unintelligible sound or by a
nod, to answer questions, the tongue being protruded, or at least an
attempt toward it made, and some motions being made with the
limbs,—the exact extent and intensity of the paralysis become more
apparent. Conjugate deviation, if it have existed, may disappear
before the other symptoms, or, if it has been of the rigid form
depending on an irritative lesion, it may become paralytic, and is
then in the opposite direction. The patient is then usually found to be
in a condition of hemiplegia, and at this point the history of
hemorrhagic apoplexy becomes identical with that of paralysis from
hemorrhage where no truly apoplectic condition has been present.
Lidell states that in more than one-third of all cases of cerebral

hemorrhage hemiplegia is developed without loss of consciousness
or coma. In some, the paralysis precedes unconsciousness, which
then slowly supervenes.
Hemiplegia (ἥμι, half, πληγη blow) is a paralysis or paresis of a part

of the voluntary muscles of one side of the body, and a few, in some
cases, on the other, and is undoubtedly to be referred to a lesion
interrupting the nervous communication between the cortical centres
of motion and the nuclei of the motor nerves, cerebral and spinal; the
conductors passing through the corpora striata, the internal capsule,
the peduncles, and crossing in great part to the other side above or
at the lower border of the medulla oblongata, and passing down the
crossed pyramidal tracts of the cord, to be finally connected with the
anterior gray columns of the cord. The portion which does not
decussate passes down the inner border of the anterior columns
under the name of columns of Türck. The amount of decussation
which takes place varies somewhat, and the suggestion has been
made, in order to explain certain cases of paralysis occurring on the
same side with the lesion, that possibly in some rare cases there
may be no decussation. It has never been shown, however, that this
condition, highly exceptional if even it ever occurs, is present in such
cases.
It may be said in a general way, although exceptions to the rule can

be found, that it is those muscles trained to separate, specialized, or
non-associated movements which are chiefly affected, while those
which are habitually associated in function with those of the other
side are less or not at all so. It would not, however, be in the least
correct to say that specialized or educated movements of any set of
muscles are alone paralyzed, since the fingers, which are trained to
the most independent movements, are often just as incapable of
making the slightest movement of simple flexion as of writing or
sewing.
We have in ordinary hemiplegia more or less paralysis of the upper

facial, the patient not being able to close his eye or to wink quite so
well as on the paralyzed side. The forehead may be smoother on the
paralyzed side. This condition is usually slight and of short duration,
but varies in different cases. Paralysis of the lower facial angle of the
mouth and cheek is usually better marked, but not absolute. The
corner of the mouth droops, perhaps permits the saliva to escape;
the naso-labial fold is less deep, and the glabella deviated away from
the paralyzed side. The cheek flaps with respiration. The difference
between this facial paralysis connected with hemiplegia and that
dependent upon a lesion of the trunk or distribution of the nerve
(Bell's), as in caries of the temporal bone or the so-called rheumatic
paralysis, is very striking, the latter being so much more complete,
and, by affecting the orbicularis palpebrarum so as to prevent
closure of the eye, giving a very peculiar expression to the
countenance. This distinction between the two portions of the facial
seems to make an exception to the rule stated above, since in most
persons the movements of the corner of the mouth and of the cheek
are quite as closely bilaterally associated as those of the eyelids.
Paralyses of the third, fourth, and sixth pairs upon one side of the
body are comparatively rare in hemiplegia, and when present are
usually referable to localized lesions in the pons. They are to be
looked upon as something superadded to the ordinary hemiplegia.
These nerves, however, are affected in the peculiar way already
spoken of as conjugate deviation, which phenomenon would seem to
denote that muscles accomplishing combined movements in either
lateral direction of both eyes, rather than all the muscles of each, are
innervated from opposite sides—i.e. that the right rectus externus
and the left rectus internus are innervated from the left motor
centres, and vice versâ. Exactly the same remark will apply to the
muscles of the neck which cause the rotation of the head seen
together with the deviation of the eyes. The muscles controlling
deviation to one side, although situated upon both sides of the
median line, are apparently innervated from the side of the brain
toward which the head is turned in paralysis.
The tongue is usually protruded with its point toward the paralyzed
side; and this is simply for the reason that it is pushed out instead of
pulled, and the stronger muscle thrusts the tongue away from it. The
motor portion of the fifth is, according to Broadbent, affected to a
certain extent, the bite upon the paralyzed side being less strong.
The hand and the foot are the parts most frequently and most
completely affected, but one or the other may be partially or wholly
spared, though the latter is rare. The muscles of the limbs nearer the
trunk may be less affected, so that the patient may make shoulder or
pelvis movements when asked to move hand or foot. In severe
cases even the scapular movements may be paralyzed. The
muscles of the trunk are but slightly affected, though Broadbent
states that a difference in the abdominal muscles on the two sides
may be perceived as the patient rises from a chair. The respiratory
movements are alike on the two sides. A woman in the hospital
service of the writer had a quite complete left hemiplegia at about the
seventh month of pregnancy. There was some return of motion at
the time of her confinement. None of the attendants could perceive
any difference in the action of the abdominal muscles of the two
sides, although, of course, the usual bracing of the hand and foot
upon the left side was wanting. The pains were, however, generally
inefficient, and she was delivered by turning. Muscular weakness
often exists, and in some cases the non-paralyzed side shows a
diminution of power.
The sphincters of the bladder and rectum frequently, and in severe

cases almost invariably, lose their activity for a time. It is possible,
however, that in some cases of alleged inability to retain urine and
feces the defect is really mental, and akin to the dirty habits of the
demented. The involuntary muscles probably take no part in
hemiplegia, with the very important exception of the muscular coats
of the arteries, which apparently share to a certain extent, and
sometimes the iris.
Speech may be attempted, and the words be correct, so far as they

can be understood, though the patient is apt to confine his remarks
to the shortest possible answering of questions. It is, however, thick
and indistinct, since the muscles of the tongue and lips are but
imperfectly under the control of the will. This condition may be
connected with paralysis of either side, and is to be sharply
distinguished from aphasia or mental inability to select the proper
word or to determine the necessary movements for its pronunciation.
Aphasia is almost invariably connected with paralysis of the right
side, and will be minutely spoken of hereafter. There is, of course,
nothing to prevent the coexistence of the two conditions, but aphasia
cannot well be shown to exist until we have reason to suppose, first,
that the patient has ideas to express, and secondly, that the
paralysis of the muscles of the lips and tongue has more or less
completely disappeared. The patient may indistinctly mumble a word
which, however, can be understood to be appropriate to the occasion
(defective articulation, glosso-labial paralysis), or, on the other hand,
pronounce with distinctness an entire wrong word or a number of
sounds without meaning (aphasia).
Sensibility—that is, ordinary cutaneous sensation—and, so far as we
can judge, the special senses, are not greatly affected after the deep
coma has passed off, but exceptions to this rule will be noted later.
Having described this most typical but not most common form of
cerebral hemorrhage—that is, the form in which both lesion and
symptoms are most distinct and can be most clearly connected—we
have a point of departure for conditions less clearly marked and less
easily explained.
It is probable that cerebral hemorrhage is much less likely than

cerebral embolism to take place without any disturbance of
consciousness or abnormal sensations; but there can also be little
doubt that a certain amount of paralysis is often accompanied by no
other symptoms, and post-mortem appearances often show the
remains of small hemorrhages which have passed unnoticed or are
lightly estimated. It is highly probable that small hemorrhages may
give rise to symptoms which pass for only a little accidental vertigo
or a slight feeling of faintness, until a later and more serious attack
gives a more definite explanation.
On the other hand, we have a set of cases in which all the symptoms
of cerebral hemorrhage may be present without the lesion. Many of
these are of course due to embolism, which will be considered later;
but besides this condition, recognized as softening for many years,
we find described under the head of simple, congestive, serous, and
nervous apoplexy cases where sudden or rapid loss of
consciousness occurs with general muscular relaxation, which, when
fatal, show nothing beyond changes in the circulation—i.e. in the
amount of blood in the cerebral vessels or of serum in the meshes of
the pia or at the base of the brain.
Besides these, there are cases of temporary unconsciousness with

complete recovery—the coup de sang of the French, or rush of blood
to the head, which are attributed to congestion of the brain—a theory
difficult to prove or disprove, but not in itself unreasonable.
Trousseau, without denying the possibility, or even probability, of
such a condition, says that which has been called apoplectiform
cerebral congestion is in the greater number of cases an epileptic or
eclamptic accident, sometimes a syncope. Simple epileptic
vertigoes, vertigoes connected with a bad condition of the stomach
or diseases of the ear, are wrongly considered as congestions of the
brain. He speaks of various conditions, such as violent attacks of
whooping cough, the expulsive efforts of women in labor, the
congested faces of laborers under heavy burdens, to show that
cerebral congestion does not give rise to an apoplectiform attack;
and it is undoubtedly true that, as a rule, no long-continued attack is
the result; but it must be within the personal experience of almost
every one that decided cerebral disturbance is produced for a few
moments by such efforts, as, for instance, blowing a fire with the
head down. Besides this, a laborer under a heavy load is
presumably healthy and accustomed to his work, so that his arteries
may be supposed capable of maintaining a due balance between
arterial and venous blood in the brain; and, again, although the
ordinary efforts of women in labor do not cause unconsciousness,
puerperal convulsions, involving a longer period of violent muscular
action, may do so, and even give rise to hemiplegia.
Whatever name we may adopt for the temporary cases which

recover, there are others, and fatal ones, which are not explained by
any change in nomenclature. Epilepsy may, it is true, occur under
such circumstances that no convulsion is observed, but, on the other
hand, convulsions may accompany not only an attack of
unconsciousness, but actual cerebral hemorrhage.
Cases of sudden death with no discoverable lesion furnish abundant

opportunity and temptation for conjecture, and it is well known that
too much dependence must not be placed upon the post-mortem
appearances as to the amount of blood in the brain before death,
and probably just as little upon the amount of serum, except as
indicating a condition of atrophy.
Syncope, either from over-stimulation of the pneumogastric or from

simple failure of the heart, may be put forward to explain some cases
of sudden death, but seems to have no advantage as a universal
theory over the older one, which meets with so little favor. Lidell
gives no less than seventeen cases which he classifies as
congestive or serous apoplexy. They are not all equally conclusive,
and were almost all of alcoholics. In some of these there were
absolutely no appearances which could account for death. The two
most characteristic of congestive apoplexy were, first, a young
negress who experienced a violent fit of passion, became
unconscious, with stertorous breathing, and died, having had some
tonic spasms. The brain contained a large amount of blood in the
vessels, but no effusion. Second, a semi-intoxicated woman, aged
thirty, became very angry, fell insensible, and expired almost
immediately. The brain contained an excess of blood, with no
effusion. In both these cases the patients were subject to fits under
the influence of strong excitement, but in both the author took pains
to inquire into and negative the probability of epilepsy of the ordinary
kind; and a change of name does not go far toward clearing up the
pathology.
Lidell's case (XXII.) was that of a man accustomed to alcohol, thin

and pale, who had an apoplectic fit with coma and hemiplegia. He
regained consciousness on the second day, and the hemiplegia
disappeared in a fortnight. This rapid and complete recovery,
exceptional to be sure, cannot be regarded as proof of the absence
of hemorrhage or embolism. In fact, the latter is highly probable. It is
possible that the clot may have been partially dislodged, so as to
allow some blood to pass by it, or that an exceptionally favorable
anastomosis allowed a better collateral circulation than usual to be
established.
The following case occurred in the service of the writer: An elderly

negress, who had extensive anasarca and signs of enfeebled action
of the heart without any valvular lesion being detected, after washing
her face was heard to groan, and found speechless and unable to
swallow, with complete right hemiplegia. There was a slight
improvement in a few hours, but she died two days later. The
autopsy disclosed some hypertrophy and dilatation of the heart
without valvular lesion. A careful search failed to discover any
change in the brain or obstruction in its vessels, although there was
chronic endarteritis.
The relations between epilepsy, apoplexy, and syncope are

interesting and important, but are certainly far from clear. Little is
gained by shifting obscure cases from one category to the other. If
sudden deaths be synonymous with apoplexy, we shall certainly
have to admit that apoplexy does not always demand for its cause
cerebral changes sufficiently marked to be recognizable after death.
If, on the other hand, we refer them to heart disease, we shall have
to admit that a heart without valvular disease or extensive changes
in its muscular substance may cease to beat under influences as yet
not well understood.
Since the paralysis arising from hemorrhage resembles so closely in

its progress that dependent upon occlusion of the cerebral vessels, a
further description will be deferred until the latter lesion has been
described; but this remark does not apply to the premonitory and
initiative symptoms, which may be of great importance, and which
are not always the same with the two or three sets of lesions. There
are many of them, but, unfortunately, no one among them taken
alone can be considered of high significance, unless we except what
are sometimes called premonitory attacks, which are in all probability
frequently genuine hemorrhages of so slight extent that they produce
no unconsciousness, and but slight paralysis easily overlooked. A
little indistinctness of speech or a forgetfulness of words, a droop of
one angle of the mouth, or heaviness in the movement of a foot or
hand, lasting but a few moments, may be real but slight attacks,
which may be followed either by a much more severe one, by others
of the same kind, or by nothing at all for a long time. They are
sufficient to awaken apprehension, and to show in what direction
danger lies, but they give little information as to the time of any future
attack.
Retinal hemorrhage is admitted by all modern authors to be

connected with disease of the vascular system, and hence also with
renal inflammation and cerebral lesions. The writer is greatly
indebted to Hasket Derby for the following facts: Out of 21 patients
who had retinal hemorrhage, and of whose subsequent career he
had information, 9 had some sort of apoplectic or paralytic attack; 1
had had such an attack before she was examined; 3 died of heart
disease, 1 suddenly, the cause being variously assigned to heart
disease or apoplexy; and 6 were alive when heard from, one of
these, a man of forty-eight, being alive and well fourteen years after.
Bull25 describes four cases of his own where retinal hemorrhage was
followed by cerebral hemorrhage, demonstrated or supposed in
three, while in the fourth other symptoms rendered a similar
termination by no means improbable. He quotes others of a similar
character. The total number of cases which were kept under
observation for some years is, unfortunately, not given. In a case
under the observation of the writer a female patient, aged fifty-seven,
who had irregularity of the pulse with some cardiac hypertrophy, was
found to have a retinal hemorrhage two and a half years before an
attack of hemiplegia. The hemorrhage was not accompanied by the
white spots which often accompany retinitis albuminuria.
25 Am. Journ. Med. Sci., July, 1879.
In a case reported by Amidon26 retinal and cerebral hemorrhages

seem to have been nearly simultaneous a few hours before death.
There was diffuse neuro-retinitis and old hemorrhages besides the
recent one.
26 N. Y. Med. Rec., 1878, xiv. 13.
The highly interesting observation has been made by Lionville27 that

when miliary aneurisms are present in the brain, they may often be
found in the retina also. In one case where they were very numerous
in the cerebrum, cerebellum, pons, and meninges, aneurismal
dilatations were found also in the pericardium, mesentery, cervical
region, and carotids (the latter not being more minutely described).
There was very general atheroma and numerous points of arteritis.
The retinal aneurisms varied in size from those requiring a power of
ten or twenty diameters to be examined up to the size of a pin's head
or a millet-seed. He thinks they might have been recognized by the
ophthalmoscope.
27 Comptes Rendus de l'Acad. des Sci., 1870.
The hemorrhages accompanying idiopathic anæmia and other

diseases with a similar tendency are not to be taken into this
account. Hemorrhage accompanying optic neuritis is likely to be due
to some disease of the brain other than the one under consideration.
Mental disturbances of various kinds have been considered as

significant, and Forbes Winslow gives a great many instances of
different forms, but they are to be looked upon rather as indicating
chronic cerebral changes which may result in various conditions, of
which hemorrhage may be one, than as furnishing any definite
indication of what is to be expected. Loss of memory should be
regarded in this way. Some acute or temporary conditions of
depression may affect the nutrition of the brain in such a way, without
having anything to do with hemorrhage actual or anticipated.
Aberrations of the special senses are often observed, such as noises

in the ears more or less definite, the sight of colors (red), or being
unable to see more than a portion of an object. The fact to which
these testify is probably a localized disturbance of the circulation
which may not precede rupture of the vessels.
Distinct hallucinations of hearing, followed by those of smell and

succeeding irritability, sleeplessness, were observed by Savage28 in
a case which terminated soon after in apoplexy.
28 Journ. Ment. Sci., 1883, xxix. 90.
There are few symptoms which are more likely to excite alarm and
apprehension of a stroke of paralysis than vertigo or attacks of
dizziness, but it is too common under a great variety of
circumstances to have much value, and is, as a matter of fact, rarely
a distant precursor of intracranial hemorrhage, although it frequently
appears among the almost initiatory symptoms, especially when the

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Multiple Choice Questions

2) Which of the following is a recognized function of skeletal muscle?

10) A(n) ________ can be described as a broad tendinous sheet.

15) The repeating unit of a skeletal muscle fiber is the

16) The plasma membrane of a skeletal muscle fiber is called the

20) Which of the following best describes the term Z line?

22) The skeletal muscle complex known as the triad consists of

24) At rest, the tropomyosin molecule is held in place by

27) At rest, active sites on the actin are blocked by

30) When a skeletal muscle fiber contracts, the

Use Figure 10-1 to answer the following questions:

32) Identify the structure labeled "1."

35) What is released from the structure labeled "9"?

36) Where would calcium ions be predominately found?

39) Which structure contains the motor end plate?

40) Identify the structure where ATP is produced.

41) Identify the structure(s) where ATP is consumed?

43) The action potential is conducted into a skeletal muscle fiber by

45) When calcium ion binds to troponin,

47) The protein that is found in the Z line of a sarcomere is called

49) Thin filaments are mostly made of the protein

60) Each skeletal muscle fiber is controlled by a motor neuron at a single

64) In rigor mortis

65) In a sarcomere, cross-bridge attachment occurs specifically in the

72) Which of the following statements about excitation-contraction coupling is incorrect?

76) Active sites become exposed when calcium ions bind to

Durand-Fardel gives a table of supposed causes in 21 cases of

SYMPTOMATOLOGY.—If we take as a point of departure the fully-

Loss of consciousness, abolition of voluntary motion and sensation,

Lidell gives the following case: A colored woman, aged forty-nine,

A woman, aged about forty, had been hanging out clothes in an

In a large number of cases it is difficult to say, in the absence of any

Vomiting is a symptom of some importance in diagnosis, being not

Whether of sudden, rapid, or slow development, the apoplectic

Swallowing, in the deepest coma, is not attempted. The fluid poured

The general temperature in cerebral hemorrhage has been studied

The initial fall of temperature is not so likely to be observed except in

These changes of temperature may be noted with various locations

The difference in the temperature of the two sides has been

The chart C. M. (Fig. 39) shows the excess of temperature in a case

The most marked differences of temperature have been observed

23 Archives générales, 1873, 167.

The throbbing or bounding of the arteries often described may

The condition of general relaxation may be so profound as to cover

A greater degree of muscular relaxation may be manifest on one

One of the most significant signs is the conjugate deviation of the

As the condition of unconsciousness gradually passes off, the face

Lidell states that in more than one-third of all cases of cerebral

Hemiplegia (ἥμι, half, πληγη blow) is a paralysis or paresis of a part

It may be said in a general way, although exceptions to the rule can

We have in ordinary hemiplegia more or less paralysis of the upper

The sphincters of the bladder and rectum frequently, and in severe

Speech may be attempted, and the words be correct, so far as they

It is probable that cerebral hemorrhage is much less likely than