SPEC. VI. a C. Para hence hypochon rial power, where every department of the nervous sys- GEN. VIII. tem participates in the diseased state of the sensorium, that we sometimes behold hemiplegia, and particularly imper- lysis Hemifect hemiplegia united with other affections of the same Hemiplegic plegia. system. The symptoms of hypochondrism are peculiarly palsy. apt to associate with it, in which case the bravest hero Hemiplegia will often lose all his magnanimity and sit down and weep sometimes like a child and in the celebrated geologist M. de Saus- united with sure, we find a still more complicated instance of hemi- drism and plegia, hypochondrism, and chorea. The disorder crept other affece on by imperceptible degrees, and was accompanied with nervous various anomalies. Both sides were weakened, but the system. Exemplified left suffered chiefly; yet, by the aid of a stick, he could in Saussure. still drag forward the left leg. By some unknown means he had taken up a morbid notion, very common to hypochondriac patients, of the difficulty of passing through a door-way when wide open without being squeezed to death; and hence, at the very time in which he could cross his room with a tolerably firm step, the moment he reached. the door, which was of capacious breadth and thrown open for his passage, he tottered and precipitated his motions with the jerk of a St. Vitus's dance, as though he were preparing for the most perilous leap: yet as soon as he had accomplished the arduous undertaking, he again became collected, and passed on with comparative ease till he had to encounter another adventure of the same kind which was sure to try him in the same manner *. Tulpius gives Sometimes a somewhat similar case in which hemiplegia was united beribery. with beribery +. The hemitraying not only hypo plegia be chondrism, but some symptoms of chorea. united with plegia. PARAPLEGIA or the SECOND VARIETY of palsy, has gene- 6 C. Pararally been conceived to depend altogether upon a diseased lysis Paraaffection of the spine in its bones, ligaments, or interior, Paraplegic Palsy. most frequently in the region of the loins; in consequence Chiefly of which the spinal marrow becomes pressed upon, or dependent otherwise injured, independently of any complaint of the upon a disbrain. That this is a common cause is unquestionable, eased spine. * Medico-Chir. Trans. Vol. vII. p. 214. + Lib. iv. Cap. 5. SPEC. VI. B C. Paralysis Paraplegia. Paraplegic palsy. Produced in various ways: but oftenest GEN. VIII. and a cause that often operates long without external signs: for the vertebral extension of the dura mater may be thickened, or a serous fluid effused, or blood be extravasated within the vertebral cavity; or a tumour may be formed in some part of it, or the spinal marrow itself may undergo some morbid change. But the best practical observers of the present day concur in opinion that paraplegia, like hemiplegia, is produced still more frequently by causes operating on the brain than confined to the spine. Of this opinion is Dr. Baillie, who ascribes it chiefly to pressure on the brain *, Sir Henry Halford, Sir James Earle, and Mr. Copeland +. Some kind of affection of the head, indeed, will commonly be discovered from the first, if we accurately attend to all the symptoms; some degree of pain, or giddiness, or sense of weight or undue drowsiness, or imperfection in the sight. And hence, many of the causes of paraplegia are evidently those of hemiplegia, operating probably upon a different part of the brain. by causes the first au thorities of causes of paraplegia. May occur at any age, but chiefly after the middle of life. Occurs often insidiously. Progress of the disease. Termination. This form of paralysis may take place at any age, but it is more frequent as we advance beyond the middle of life; and Dr. Baillie has observed that it occurs oftener in men than in women; for which it is by no means difficult to account, considering the greater hurry and activity of life pursued by the former. The disease, in many instances, makes an insidious approach. There is at first nothing more than a slight numbness in the lower limbs with an appearance of stiffness or awkwardness in the motion of the muscles: these symptoms increase by degrees; there is great difficulty in walking, and an inability in preserving a balance; the aid of a staff or the arm of an assistant is next demanded: and the urine is found to flow in a feeble stream, or perhaps involuntarily. The bowels are at first always costive; but as the sphincter loses its power of constriction, the motions at length pass off involuntarily. The disease may continue for years, and ✦ Trans. Med. Vol. vi. Art. II. + Treatise upon the Symptoms and Treatment of the diseased Spine. the patient at last sink from general exhaustion. It some- GEN. VIII. times, but rarely, terminates in a recovery SPEC. VI. B C. Para plegia. duced by an injured or diseased spine, as described by state of the When an injured or diseased state of the spine is the lysis Paraorigin of paraplegia, the complaint shows itself suddenly, Paraplegic or makes its advances insidiously according to the nature palsy. Origin and of the cause and for a knowledge of this form of the progress malady we are chiefly indebted to Mr. Pott †, who, how- when proever does not think that it properly belongs to the species paralysis, though there seems no sufficient reason why it should not be so arranged, as in truth it has been by most pathologists from the time of Galen, who seems not only to have understood its nature, but to have contemplated it in this view 1. The disease, however, must not be. confounded with RHACHYBIA, or distortion of the spine, from debility of muscular power, of which we have already treated § in the present volume. Pott. It sometimes happens in hemiplegia, that one or more vertebræ have been pushed, by sudden force, a little way out of their proper position; and in this case a considerable degree of numbness, together with less motion in one or both the lower limbs, is almost sure to follow, too often succeeded by a paralysis of the sphincters of the rectum and bladder, and consequently an involuntary discharge of feces and urine: and if the luxation should take place in the dorsal or cervical vertebræ, the organs of digestion may all, more or less, suffer, the respiration become affected, and the spine itself exhibit a considerable degree Curvature of curvature. And the same effects are still more likely to follow, and even to a greater extent and with still more serious mischief, from an idiopathic affection of some part of the spinal chain, arising from inflammation, scrophula, rickets, mollifaction, or caries; from compression by some effused fluid, or a thickening of its external tunic, or even Practical Essay on the Diseases and Injuries of the Bladder. By Robert Bingham. 1822. + Remarks on that kind of Palsy of the lower limbs which is frequently found to accompany a curvature of the spine, 8vo. 1788. De Locis affectis, Lib. iv. cap. vi. § Cl. iv. Ord. 111. Gen. 1. Spec. 3. of the spine. GEN. VIII. SPEC. VI. BC. Para of the substance of the spine itself; of which last M. Portal has given a singular example *. lysis ParaIn the last case the disease, for the most part, makes plegia. Paraplegic its approach slowly, and is often found in weakly and illpalsy. nursed infants. Its precursive symptoms are commonly in ill-nursed languor, listlessness, weakness in the knees, and a pale and infants. shrivelled skin. As it advances, there is a difficulty in Often found Connected like hemi plegia occa a morbid where the fected. Instructive from Cooke. directing the feet aright when walking, the legs involuntarily cross each other, and the little patient is perpetually stumbling upon level ground, till at length he is incapable of walking at all. In adults the progress of the disease is more rapid than in childhood. Like hemiplegia, this variety is sometimes connected with a morbid state of the mental powers, and particularly sionally with with hypochondrism, and this too where the disease prostate of the ceeds from an organic lesion of the spine. Dr. Cooke has mental pow. an instructive case in illustration of this, in an officer of ers, and even the army, aged forty-five, who had for many years been spine is pri- exposed to the hardships of a military life, particularly to marily afextremes of heat and cold in various climates. "For two or three years previous to the paralytic attack, he had comillustration plained that his state of health was deteriorated, although no precise symptoms of disease could be pointed out either by himself or by his medical friends. His appetite was good, his bowels regular, though inclined to costiveness, and his usual robust appearance was not diminished. He entertained some fanciful notions respecting the state of his health and from some uneasy sensations about the sacrum he supposed that he had internal hemorrhoids, though no evidence of their existence could be perceived by his physicians, by whom he was considered as hypochondriacal." After having suffered for two or three years he gradually lost the power of walking without some support for one of his hands. He went to Bath and had the hot water pumped upon his loins: soon after which he complained of pain in the lumbar region, which was followed by a collection of fluid behind the great trochanter of the left * Anatomie Medicale, p. 117. SPEC. VI. Sensibility and mobility most injured where the the spine is upper part of Singular case from Rullier. side, which burst externally, and was discharged daily, in GEN. VIII. considerable quantity. The paraplegia was now complete: 6 C. Parathe lower extremities being quite useless: the feces and lysis Paraplegia. urine, which, for a considerable time, the patient had with Paraplegic some difficulty retained, came away involuntarily: his palsy. strength rapidly wasted; he became much emaciated; and, at the end of three months after his return from Bath he died; retaining the use of his senses and his intellectual faculties to almost the last instant of his life *. Where the upper part of the spine is affected, the superior limbs are usually divested of mobility or sensibility, or both, while but little disturbance, in a few rare instances, takes place in the inferior. The most singular example of this sort that has occurred to the present affected, writer, is contained in a case related by M. Rullier, of Parist. The subject was forty-five years of age, and had evinced a slight rhachetic tendency from infancy, accompanied, as is often the case, with a considerable precocity of intellectual powers; the dorsal portion of the vertebral column evincing a little distortion, so as to give some degree of elevation to the right shoulder; but which did not proceed further. The patient, from early youth, had indulged himself in every concupiscent indiscretion, and especially in an unbounded and extravagant intercourse with females, which frequently reduced him to a state of exhaustion amounting almost to deliquium. It was not, however, till the age of thirty-four, that he first began to perceive any serious difficulty in the movement of his arms, which was soon connected with some degree of pain and swelling in the distorted part of the vertebral chain. The complaint made a rapid progress, and the patient in a short time lost the entire use of these limbs, though their sensibility continued to the last, and appeared to grow morbidly acute, as he would not suffer any one to touch them, on account of the pain produced by such He became indeed highly irritable in his tem contact. On Nervous Diseases, Vol. II. Part. I. p. 43. + London Medical and Physical Journal. July, 1822. p. 80. |