GEN. VIII. Sauvages and Cullen, and to distinguish the disease unCarus Para- der the three following varieties founded upon the line or SPEC. VI. locality of affection: a Hemiplegia. 3 Paraplegia. Paraplegic Palsy. y Particularis. The disease affecting and confined to one side of the body. The disease affecting and confined to the lower part of the body on both sides, or any part below the head. The disease affecting and confined to particular limbs. Some nosologists have transferred to this division the local insensibilities and atonies of the external senses or parts of them, as though they were idiopathic affections. It is rarely, however, or never, as Aretæus has justly remarked, that they are not connected with other symptoms and other derangements of such organs and their respective functions: and hence, they rather belong to the second order of the present class, than to paralysis in the strict sense of the term. They are anesthesiæ, νόσοι παραλύτικοι, οι παρέτικοι, rather than παράλυσεις ; and in the system before us are arranged accordingly. HEMIPLEGIA, the first of the above varieties of palsy, is far most frequently met with as a sequel of apoplexy, and especially of atonic apoplexy, or that in which the energy of the nervous system is peculiarly diminished, and irregular. The usual exciting causes of apoplexy are in consequence those of palsy, and need not be enumerated in the present place. In a few instances, however, hemiplegia occurs without preceding apoplexy; and hence, distinctly proves that pressure, or at least such a pressure as is demanded to produce somnolency, is not essentially necessary. Mr. John Hunter, as we have already observed, was inclined to think that pressure from effused blood, was, in every instance, the cause both of this SPEC. VI. a C. Para J. Hunter. A debilita sometimes a disease and of apoplexy; but in allowing, as he has done, GEN. VIII. that on one occasion at least he was called to a patient who died of a gouty affection of the brain" with sym- lysis Hemiplegia. ptoms similar to apoplexy", and without any extravasation Hemiplegic whatever, he directly yields the point of compression palsy. as an universal cause: for if atonic or retrocedent gout evidence may produce apoplexy or palsy without pressure on the admission of brain, so may many other atonic powers, operating as effectively on the sensorium. One of the most frequent ted and parof these powers is a debilitated and paretic state of the etic state of the liver, liver; and hence those persons are peculiarly subject to this variety of palsy, who have spent the earlier part of cause. their lives in an habitual course of intemperance. Hoff- Illustrated. man has particularly noticed this cause; and Morgagni At times describes the case of a man advanced in years who was attacked with jaundice and hemiplegia simultaneously; the jaundice affecting the hemiplegic side alone, which was the right, and that with so much precision, that the nose was of a deep yellow on the one side, and of its proper colour on the other, which were divided from each other as by a ruled line. Other causes are exposure to the rays of the sun, drinking cold water and bathing in it when heated, repelled eruptions, and chronic rheumatism. accompanied with a jaun dice of the hemiplegic side alone. Other causes. symptoms of As apoplexy has its percursive symptoms occasionally, Precursive so also has hemiplegia, and particularly when it is connect- hemiplegia. ed with a plethoric habit: for in this case, the veins of the neck and face often appear turgid, there is an obtuse pain in the head, the tongue moves with some difficulty, and particularly on one side, the perception and memory become impaired, and the patient feels a tendency to drivel at one corner of the mouth rather than at the other. The Attack. onset, like that of apoplexy, is at last sudden; and if the patient be standing he drops down abruptly on the affected side. the disease. The progress of the disease is uncertain; and depends Progress of very much upon the state of the nervous system at the time of the attack. If there be no chronic debility, or other morbid condition of the sensorium, the patient will Duration. SPEC. VI. & C. Para lysis Hemiplegia. Hemiplegic GEN. VIII. Sometimes recover entirely in a week or even less; but if this system, or some particular part of it, be in an infirm state, he recovers only imperfectly; and obtains, perhaps, a thorough or a limited use of the lower limb, while the upper remains immoveable; or he is compelled to pass through the remainder of a wretched and precarious existence with only one half of his body subservient to his will, the other half being more dead than alive, and withering, perhaps, with a mildew-mortification*. palsy. Result. Proofs of ir and distribu tion of the sensorial fluid. We have stated that in this disease, as, indeed, in all regular flow others accompanied with an atonic disturbance of the nervous energy, there is not only a great irregularity in its flow, but a great and confused disproportion in its distribution to different parts of the body; so that the stock, whether of sensific or motific fluid, which is altogether deficient in some parts, seems to be sent in a hurried and tumultuous accumulation to others, which are in consequence irritated with an undue degree of sensation or motivity, in the most capricious manner. Dr. Cooket and Dr. Abercrombie have collected numerous and highly interesting examples of these curious anomalies, and may be consulted with great advantage by those who are desirous of following up the subject more minutely. Transverse hemiplegia Sauvages gives a case from Conrad Fabricius, of what of Sauvages he calls transverse hemiplegia, in which the disease was confined to the arm on one side, and the foot on the what. Other singu lar examples. other§: and Ramazzini speaks of a patient whose leg, on one side, had lost its feeling, but retained its power of motion, while the other leg had lost its power of motion but retained its feeling. In some instances, indeed, the entire feeling of one side is said to have been lost, and the entire motivity on the other side¶¶; and in a few rare examples persons during the paroxysms, and even for some and of cold time afterwards, have felt, on the affected side, a sensation Sense of pungent heat from cold bodies on the affected side: See Vol. 11. Cl. III. Ord. Iv. Gen. XII. Spec. II. + On Nervous Diseases, Vol. 11. Part 1. § Spec. Gen. xix. Ord. 111. Cl. vi. Treatise on Apoplexy and Palsy. De Morb. Artif. 286. See also Helster, Wahrnemungen. 1. 205. GEN. VIII. SPEC. VI. as C. Para lysis Hemiplegia. Hemiplegic palsy. of pungent heat from cold, and especially polished bodies, and of painful cold from an application of hot bodies. It is not, perhaps, very difficult to account for this last singularity. Where the sensibility is morbidly accumulated in a weak limb, as it often is in hemiplegia, sometimes so much as to give a painful sense of formication, bodies. cold not only excites action but becomes almost as pungent This singuan irritant as an actual cautery; in the correct language explained. lar feeling of the poet -Boreæ penetrabile frigus adurat*. from hot And hence in climbing lofty mountains, as the Alps and the Andes, the traveller frequently finds his skin more completely blistered from the sharp cold by which he is surrounded than by an exposure to an equinoctial sun. On the contrary, the morbid halitus or perspiration into which the application of hot bodies often throws a limb, in the same relaxed and debilitated state, produces an unusual sense of coldness in consequence of the evaporation. And we may hence explain the singular case recorded by Dr. Falconer, of a gentleman who after a paralytic attack, felt Singular exhis shoes very hot when he first put them on, and gradual- ample. ly become cool as they acquired the warmth of his feet; the re-action, and consequent increase of moisture thrown forth from the surface of the feet producing the difference of sensation. illustration. In the Transactions of the Medico-Chirurgical Society+ Additional there is a very singular case of Dr. Viesseux, who was gradually attacked with an imperfect hemiplegia which at first showed its approach by perturbed sensations, and vertigo, with a feeling of sea-sickness, a sight of objects reversed, a difficulty in swallowing liquids, and a total loss of voice, while the powers of the mind remained unimpaired, so that he could watch all his symptoms. Shortly after this the whole of the right side became utterly insensible, the insensible part being divided from the sensible by a geometrical line running down the body in a vertical di SPEC. VI. a C. Para palsy. GEN. VIII. rection: and in about three months more the insensibility of the right side of the head, accompanied with a debility lysis Hemi- of all the voluntary muscles was transferred to the left, the plegia. Hemiplegic right re-acquiring its antecedent powers; but all the right side below the head still continuing to possess its former torpitude. Here, also, there was a very different sense of heat and cold on the opposite sides; for whilst the left was influenced naturally, the right had the falsified sensation just noticed in Dr. Falconer's case, so that in getting into a cold bath or a cold bed, the right side had a feeling of heat, while the left side felt cold, as it should do. Hot bodies, in like manner, felt cold to the diseased side, apparently from the cause just stated. And that this was the real cause seems manifest from the patient's having often a feeling of a cold dew, or of cold water on the surface, and especially over his face, which induced him to wipe himself as if he had been wet. It is, perhaps, more singular that, though plunging his right or affected hand into cold water gave him a sense of lukewarmness, plunging it into boiling water gave him a disagreeable sensation, but very different from that of either heat or cold. This sensation seems to have been that of numbness, and was probably produced in consequence of the accumulated sensibility being rapidly carried off by the extreme heat of the water, as a like torpitude is produced by the opposite effect of extreme cold, and the rapid exhaustion of sensibility which is so well known to follow on its application. This irregular distribution of sen sorial power dangerous. sometimes This morbid disturbance and irregular distribution of sensorial power is sometimes productive of the most alarming consequence; for in a hemiplegic state of the bowels some parts are, in certain cases, so acutely sensible, and others so utterly insensible, that while ordinary purgatives are incapable of exciting evacuations from the torpitude and irresponsibility of the palsied parts, they are sufficient Explained, to occasion inflammation, and have actually occasioned it in the parts exacerbated by accumulated sensibility, as certain experiments of M. Magendie have sufficiently established. It is owing to the same irregular distribution of senso |