SPEC. VI. Carus Para Palsy. Apoplexy contem plated as common the Greeks. The Greek writers contemplated the two diseases under GEN. VIII. the same view, considering them as closely related to each other, or, in other words, as species of the same genus. lysis. "The ancients", says Dr. Cooke, who has accurately gone over the entire ground and taken nothing upon and palsy trust, very generally considered apoplexy and palsy con as diseases of the same nature, but different in degree; different apoplexy being an universal palsy, and palsy a partial degrees of a apoplexy. Aretæus says, apoplexy, paraplegia, paresis, disease by and paralysis, are all of the same kind; consisting in a loss of sensation, of mind, and of motion. Apoplexy is a palsy of the whole body, of sensation, of mind, and of motion. And on this subject Galen, Alexander, Trallianus, Ætius, and Paulus Ægineta, agree in opinion with Aretæus. Hippocrates who, in various parts of his works, speaks of apoplexy, no where, as far as I know, mentions paralysis; and when he refers to this disease he employs the term apoplexia. Both Aretæus and Paulus Ægineta represent him as speaking of apoplexy in the leg. Celsus describes palsy and apoplexy by the general terms RESOLUTIO NERVORUM."* It is only necessary to add that paresis and palsy were used sometimes mously; and that, when a distinction was made between from palsy. them, paresis was regarded as only a very slight or imperfect palsy. synony Paresis how far different should be re eases: but distance as they have Palsy and apoplexy, however, are something more than Why the two the same discase merely varied in degree; the one, in- garded as deed may lead to and terminate in the other, but they very distinct disoften exist separately and without any interference; and, not placed at notwithstanding their general resemblance, are distinguish- so great a able by clear and specific symptoms. But if the Greeks approximated them too closely, the greater part of the nosologists of modern times, as Sauvages, Linnéus, Vogel, Sagar, Cullen, and Young, have placed them too remotely, by regarding each as a distinct genus: the proper nosological arrangement seems to be that of co-species, as *Treatise on Nervous Diseases, Vol. 11. p. 1. been by many modern writers. Proper station apparently that of the present work. GEN. VIII. they are ranked by Dr. Parr, as well as under the system SPEC. VI. Carus Para lysis. Palsy. Common causes of apoplexy very frequently those of before us. The common causes of apoplexy are usually asserted to be those of palsy: and considering how frequently palsy occurs as a sequel of apoplexy, the assertion has much to support it: for compression is here also as well as in apoplexy a very frequent cause. Yet as compression does not seem to be the only cause of apoplexy, it is still less so of palsy in all its modifications, and we shall still more frequently have to resolve the disease into some of those causes of general, and especially of nervous, debility, which we have already noticed as occasionally giving rise to apocauses, and plexy, and which we have more particularly illustrated under the genus CLONUS of the preceding order. palsy, espe- ease often produced from other especially those of ner- lity. Nerves chiefly affected those company cipate in a Palsy is often preceded by many of the precursive signs we have already noticed as forewarning us of apoplexy; and it commonly commences slowly and insidiously; a single limb, or a part of the body being at first troubled with an occasional sense of weakness or numbness, which continues for a short time and then disappears. A single finger is often subject to this token, as is one of the eyes, the tongue, or one side of the face. The nerves chiefly affected are those subservient to voluntary motion, but the accompanying nerves of feeling of voluntary in most cases participate in the torpitude though not in an motion: equal degree, and sometimes not at all. “I never”, says but the ac- Dr. Cooke, " saw a case of palsy in which sensation was ing nerves of entirely lost": though such cases seem sometimes to have feeling commonly parti- occurred. The action of the involuntary organs, and especially of the heart and lungs, are but little interfered less degree. with, though in a few instances something more languid than in a state of ordinary health. And in this respect we perceive a considerable difference between paralysis and apoplexy, in which last the heart appears to be always oppressed, and the breathing laborious. The faculties of the mind, however, rarely escape without injury, and especially the memory; insomuch that not only half the vocabulary the patient has been in the habit of using is some greater or Action of the heart and lungs little inter fered with: and hence a material dif ference be tween palsy and apo plexy. [ORD. IV. times forgotten, but the exact meaning of those terms that are remembered; so that a senseless succession of words is made use of instead of intelligible speech, the patient perpetually misusing one word for another, of which we have given various examples under MORIA imbecillis, or MENTAL IMBECILITY*. And it is hence not to be wondered at that palsy should occasionally impair all the mental faculties by degrees, and terminate in fatuity or childishness. We have frequently had occasion to observe and to prove by examples, that where any one of the external senses is peculiarly obtuse or deficient, the rest are often found in a more than ordinary degree of vigour and acuteness," as though the sensorial power were primarily derived from a common source, and the proportions belonging to the organ whose outlet is invalid, were distributed among the other organs". Something of this law seems to operate in many cases of palsy, and is more and more conspicuous in proportion to the extent of the disease for in hemiplegia and paraplegia, the half of the body that is unaffected has not unfrequently evinced a morbid increase of feeling. Dr. Heberden attended a paralytic person whose sense of smell became so exquisite as to furnish perpetual occasions of disgust and uneasiness and he mentions one case in which all the senses were exceedingly acute. GEN. VIII. SPEC. VI. lysis. The mind, and especially the memory rarely escapes injury. General pathological planatory remark ex of many of palsy. symptoms Hence the side sometimes unaffected evinces a morbid in crease of feeling. Illustrated. Hence, too, the sensific affected limb sometimes fibres of the possess excess of feel It is to this principle we are to resolve it that where the disease confines itself to the motory nerves of an organ alone, and the sensific are not interfered with, the feeling of the palsied limb itself is sometimes greatly increased, and sometimes exacerbated into a sense of formication, or some other troublesome itching. "I have seen several ing. instances", says Dr. Cooke," in which paralytic persons have felt very violent pain in the parts affected, particularly in the shoulder and arm;" and the remark, if necessary, might be confirmed from numerous authorities. Palsy, however, is strictly a disease of nervous debi- Sometimes * See Vol. 1, pp. 188, 189. Ut suprà, p. 5. + with compare the whole nervous system manifestly affected: SPEC. VI. lysis. Palsy. and the sensorial turbed in various GEN. VIII. lity, and where it shows itself extensively, the whole nervCarus Para- ous system is affected by it. The consequence of which is, as we have already shown in treating of entastic, and particularly clonic spasm, that the sensorial fluid in all its modifications is secreted or communicated irregularly, and balance dis- its balance perpetually disturbed, so as to operate upon the mind as well as upon the body: whence some parts are too hot and others too cold, and even the affected limb affected limb itself, according to the nature of the affection, and its limitation or extension to different sets of nerves, will be warmer or colder than in its natural temperature, and will waste away, or retain its ordinary bulk; while the passions of the mind will participate in the same morbid irritability, and evince a change from their constitutional wastes away. tenour. Persons of the mildest and most placid tempers Passions of will often discover gusts of peevishness and irascibility; ways. Hence the sometimes warmer, sometimes colder than natural; retains its bulk or the mind affected. Illustrated. Affected limbs com colder than and men of the strongest mental powers have been known to weep like children on the slightest occasions. In a few instances, however, an opposite and far more desirable alteration has been effected. "I had several years ago," says Dr. Cooke, " an opportunity of seeing an illustration of this remark in the case of a much respected friend. The person to whom I allude had always, up to an advanced age, shown an irascible and irritable disposition but after an attack of palsy his temper became perfectly placid and remained so until his death about two years afterwards."* It is the general opinion that paralytic limbs are unimonly supformly colder than in a state of health: and Mr. Henry posed to be Earle has ably supported this opinion upón an extensive in ordinary scale of examination, in an article introduced into the health: Transactions of the Medico-Chirurgical Society +. Dr. especially by Abercrombie, on the contrary, in a correspondence upon this subject with Dr. Cooke, gives it as his opinion that paralytic parts do not become colder than natural; and adds," that he had long ago observed that they are sometimes warmer than sound limbs, but without being able Earle. crombie not to be colder. See Vol. I. p. 12. + Medico-Chirur. Trans. Vol. VII. SPEC. VI. to account for it." The present author has frequently GEN. VIII. made the same remark, though he has more commonly Carus Parafound them below the ordinary temperature. The facts, lysis. therefore, on both sides are correctly stated; and the dis- Palsy. Diversity crepancy is to be resolved into the nature and extent of of opinion the sets of nerves that are immediately affected, whether reconciled. sensific, motific, or both, and into the disturbed and irregular, the hurried or interrupted tenour with which the nervous fluid is secreted or supplied. The learned Pereboom, who has followed Boerhaave Subdivision and Heister in attaching himself to the apparently correct founded on of Pereboom doctrine of the Galenic school, that the nerves issuing a true phyfrom the sensorium are of two distinct sorts, one subser- siology; vient to sensation, and the other to muscular motion, and has so far accorded with the physiology attempted to be established in the commencement of the present volume, has divided palsy, which he describes as a genus, into three species; a nervous, muscular, and nerveo- but not quite cormuscular; by the first meaning that form of the disease in rectly exwhich there is a deprivation of sense without loss of pressed, motion; by the second, loss of motion while the sensibility remains; and by the third, loss both of sense and motion*. The specific names are here at variance with the physiology; for if it be true that muscular motion is as dependent upon the nerves as sensation, then, palsy affecting the moving fibres, is as much entitled to be and unnecessarily called nervous as palsy affecting the sentient. Nor are complicated. the few cases to be met with of privation of feeling without loss of motion, strictly speaking, to be regarded as palsies. They are rather, as Aretaus has correctly observed, examples of anesthesia, or morbid want of the sense of feeling, and as such will be found described in the present system under the name of PARAPSIS EXPERS†. On this account the present author, in his volume of nosology, thought it better to follow up, though with a considerable degree of simplification, the subdivisions of fered in the Acad. Nat. Cur. Soc. De Paralysi, 8vo. Hornæ. † Class. 1v. Ord. 11. Gen. v. see suprà, p. 283. Hence a more sim plified sub division of present system of nosology. |