The Remedial Process is difficult and complicated proportionately to the amount of blood extravasated, to the resulting destruction of texture, and to the solidity of the coagulated fibrin as a central or a peripheral secretion from the fluid thrown out. It is a process of slow gradation, involving the changes produced not only in the effused blood with its red pigment and its fibrin, but also in the surrounding textures. These changes occur simultaneously, and we have frequent opportunities of observing them in areolar tissue, in muscle, and especially in the brain.

The crushed and disorganized texture within the walls of the foyer, together with the extravasate itself, undergoes liquefaction, at the same time that hyperaemia and stasis become developed in the adjacent texture-layer. The medium is probably almost exclusively supplied by the blood serum of the extravasated fluid which undergoes many changes in composition adapting it for the liquefaction of the different substances; namely, the solidified fibrin and the remaining elements proper to the effusion - blood-globules, nucleated and cell-formations, debris of tissues. How important a part the liberation of adipose, and of saline substances out of their primitive combinations herein plays, is sufficiently attested by microscopic analysis. The blood-pigment incurs a special change. It is converted, partly within the blood-corpuscles, partly extraneously to them, into a brown, rusty yellow, or into a blackish-brown, or a black pigment. This is shown as well in the form of spherical corpuscles, which resemble blood-globules and are frequently seen accumulated in compact congeries, as also in the shape of elementary granules (granulated pigment), either discrete or in circular groups. These are commonly free, but now and then inclosed within cells, or suspended from little prismatic crystals of ammonio-phosphate of magnesia. Together with them is found, at the part involved, fat in a free state, fat in the form of little black-edged, discrete or aggregate molecules, of limpid drops, of cholesterine crystals. Again, there are found elementary molecules down to the minutest pulverulent molecular mass, consisting of minutely subdivided, suspended fibrin, albumen, and fat, with calcareous salts. Finally, we have amorphous, membranaceous, stratiform coagula, nuclei, and blood-disks (the as yet integral elements of the effusion), and amongst them all detritus of the involved texture.

In this manner the greater portion of the hemorrhagic effusion would have become fitted for resorption. The process is, however, impeded at this juncture, by the inflamed condition, and at a later period by the hardened character of surrounding textures.

Hence the ulterior metamorphosis of the effused mass, namely, its progressive thinning and clarifying into a mere pale buff, or, it may be, colorless liquid.

"What, amongst other things, has become of the pigment? Partially it may have perished amid the unknown, final conversions of the fluid above characterized. To some extent, however, it is preliminarily taken up into a formation which, - derived from the coagulable contents of the effused fluid - invests the walls of the foyer.

This colored, soft, jelly-like, loosely adherent lining, eventually becomes endowed with a minutely fibrillated structure, and even with bloodvessels, and is at length converted into a delicate, and, if the pigment be destroyed, into a colorless membrane, resembling a serous tunic.

Meanwhile, the inflammatory process has engendered in the walls of the foyer products which serve, in the shape of a nucleated blastema (to be afterwards developed into fibrin texture of various kinds, and, into areolar tissue), to condense and harden the textures. Thus, the original hemorrhagic foyer is changed into a capsule or cyst, which, when it occurs in the cerebrum, is termed apoplectic cyst.

This cyst is susceptible of diminution, and eventual closure, through resorption of its contents, - of closure to a cicatrix which often contains a certain kernel consisting of the aforesaid residuary pigment.

It must be confessed, however, that the complete closure of the cyst is a work of time and difficulty. This is intelligible from the slender absorbent faculty of the surrounding textures in their condensed and hardened condition. Occasionally, special obstacles stand in the way of this process of reduction; for example -

1. Great extent of the hemorrhagic foyer, and of the resulting cyst. 2. A vacuum, created either through original retraction, or through subsequent wasting of the texture involved, in muscles and especially in the cerebrum. In the brain, indeed, a later supplementary enlargement may take place in the apoplectic cyst, as an expletive of the vacuum created within the skull by consecutive atrophy of the cerebral organ; for the internal capsular membrane is, by reason of its vascularity, adapted alike for secretion and for absorption.

3. A very remarkable obstacle to the collapse and closure of the cyst consists in the secretion of fibrin in the shape either of central bulky, or else of peripheral isolating coagula, for the most part tinged by no inconsiderable proportion of embodied blood-corpuscles. These coagula, being originally very dense, and retaining their solidity even when converted into a fibrous texture, resist, when central, the liquefaction, when peripheral and encysting, the resorption of their contents.

Certain cases offer various exceptions to the processes hitherto described. Thus, some cysts having, in spite of the peripheral encysting coagula, parted with their blood-serum by early resorption, are found replete with a dark-colored, inspissated, dry blood-plug; or else with fibrinous, stratiform, villous masses, developed out of the partially absorbed vehicle.

The frequency of hemorrhage varies greatly in the different textures of the organs. A scale of frequency is indeed but of very limited use, since hemorrhage is the result of various disturbances, and, in most instances, of the concurrence of several. Generally speaking, hemorrhages of the brain and of the bronchial mucous membrane are distinguished by their frequency; those of serous membranes are very rare, if we except the cerebral arachnoid sac.

It was signified at the outset, that the mere exudation of colored (red) serum, devoid of blood-corpusles, is perfectly distinct from hemorrhage. It is found as so called petechiae (ecchymoses) in all textures, and in serous and mucous cavities as colored effusion. It is due to decomposition of the blood.