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LEFT PARAMARIBO 111 PARANOIA apoplectic attacks, and this usually in its most severe and dangerous form. The prognosis must be looked on as extremely unfavorable when the attack is sudden, the paralysis extensive and complete, and the loss of consciousness protracted; while, on the other hand, when the pa- ralysis advances gradually, there is more reason to hope for prolonged life, if not for a complete restoration of health. Among the other causes that may give rise to paralysis are various injuries and diseases of the brain or spinal cord; as tumors, inflammation, external injuries, etc. When paralysis takes place with- out any previous apoplectic attack, the premonitory symptoms are a general torpor or lassitude, occasional giddiness, or a sense of weight and pain in the head, and loss of memory. When it is the result of injury of the spinal cord, then, of course, the paralysis takes place instantly. Paraplegia sometimes lasts for many years without greatly interfer- ing with any function except locomotion; but when it occurs during fevers and ad- vances rapidly, it is of very sinister au- gury, especially if it involves the sphinc- ter muscles of the anus and bladder. Paralysis is not a disease of itself, but only a sign of some disorder of the ner- vous system, probably at a distance from parts affected. PARAMARIBO, the capital of Dutch Guiana, on the Surinam, about 10 miles from its mouth. It has broad, tree- shaded streets, with clean wooden houses, painted light gi'ay, and numerous canals and churches. There are also a gov- ernor's palace, two forts, a park, etc. The Herrnhuters (Moravian Brethren) are a strong body in the town. Except for the small harbor of Nickerie, all the trade of the colony is at Paramaribo. Pop. (1918) 37,051. PARANA, a city of Argentina, the capital of the province of Entre Rios. It is on the Parana river, 370 feet from its mouth. The town is well built and has a number of handsome public build- ings, including a normal school and handsome college. It has an important trade and steamship connection with Santa Fe. Pop. about 40,000. From 1853 to 1861 Parana was the capital of Argentina. PARANA, a state of Brazil, in S. E. bounded by Atlantic Ocean, Sao Paulo, Paraguay, Matto Grosso, Argentina, and Santa Catharina, Rises from sea-level to a plateau on which elevations further rise to 5,000 feet above the sea. There are dense forests, but on the plains cocoa, coffee, mate, and rice are cultivated. Tributaries of the Parana river irrigate the state. Area 67,570 square miles. Capital, Curitiba. Pop. 480,400. PARANA, a river in South America, the largest except the Amazon, and draining a larger basin than any othei river in the New World except the Amazon and the Mississippi. It is formed by the junction of two streams, the Rio Grande and the Paranahyba, which meet in Brazil, and it discharges itself into the estuary of the La Plata, its course latterly being through the Ar- gentine Republic. Its principal tribu- taries are the Paraguay and the Salado, both from the right. Its length, from its sources to its junction with the Para- guay, is probably 1,500 miles, and thence to the sea 600 miles more. In breadth, current, and volume of water, the Pa- rana has 10 times the magnitude of the Paraguay. PARANOIA, a mental disease of the psychosis type, characterized by marked delusions, tending toward persecutory ideas and apt to terminate in a form of mental degeneration. The progressive psychosis may begin almost from child- hood, with a systematizing of one or sev- eral hallucinations, the symptoms of which are indicated in extravagance of speech or eccentricity of conduct, and easily aroused emotions. An element is the hereditary or acquired predisposition, though physical injury may be a pre- dispcjing cause. The paranoiac is usually a person of fixed ideas, who is not amenable to out- side influences, but whose persistence in a wrong line of conduct springs from emotional conditions that will not yield to rational exposition. The patient is apt to show himself unduly sensitive and suspicious, to imagine conspiracies di- rected against him, and to show an in- disposition to mingle with others. The effects of these ideas and impulses are shown in the patients' inability to get on in the world, a preference for soli- tary pursuits, and a dislike for syste- matic work in any field except in that which leaves them at liberty to indulge in their ideas and delusions. The per- sonal delusion may sometimes take a so- cial or patriotic or religious form, and may display itself in an extreme fervor for which there is no rational basis. Where the hallucinations are strongly developed the paranoiac is apt to show distinct homicidal tendencies. In such cases the only remedy is the removal of the patient to surroundings where he can do no harm, and to improve his con- dition by such diversions and discipline as may suit his individual case.