Puerperal Paralyses.
Paralysis may supervene during pregnancy or after delivery, as is the case with eclampsia. Hence their designation by the generic term, puer peral paralyses. As the older writers especially noticed these paralyses after labor, they referred them to the two great theories then dominating puerperal pathology, retention and suppression of the lochia, and milk metastases. These paralyses are now better studied, and, having ascer tained that they occur during pregnancy, we have been forced to attribute them' to another source. These paralyses are very varied in their mani festations, although they affect, particularly, three leading forms. There may be hemiplegias or paraplegias, which are complete or incomplet,e, local or general, i.e., affecting one limb or both limbs, on the same or on op posite sides. The paralysis may be limited to the face, or affect the face and the limbs; it may particularly involve some one organ of sense or one part of the ,muscular or nervous system, but there is always a marked tendency toward hemiplegia or paraplegia.
By complete paralysis we understand the forms in which, if the case be one of hemiplegia, the upper and lower limbs of the same side aro both involved, or, if paraplegia be present, both lower extremities are impli cated. The term partial paralysis is reserved for the cases in which a sin gle limb is attacked. Among these paralyses there is one special variety observed only after labor. This is the traumatic paralysis seen after diffi cult labors, with or without surgical intervention, and to which we com pare the palsies of newborn children extracted by the forceps or by version.
not extremely frequent, paralysis is not very rare for, in our monograph of 1872, we had already collected 149 cases, thus classified: Ilemiplegias, 57; paraplegias, 25; traumatic paralyses, 12; partial paralyses, 21; paralyses of the senses, 34; total 149. We will now study these different varieties.
Hetniplegia.
The first and by far the most frequent form of puerperal paralysis is hemiplegia. Out of one hundred and forty-nine cases of paralysis, we found, in 1872, fifty-seven hemiplegias. Five years later, Darcy quoted ten new examples, and since then, all authors who have paid attention to this question have published new cases.
The causes are numerous. Aside from the two old theories,retention and suppression of the lochia, and milk metastases,which could, at the best, only be applied to the explanation of paralyses occurring after labor,we mention : 1. Cerebral hemorrhage, cited in 1848, by Menii!re, who particularly insists upon the hypertrophy of the left ventricle and plethora. Darcy admits three forms: a. Apoplectic, in which the apoplexy is often so pro found that the existence of hemiplegia can not be ascertained. b. Mixed form. Consciousness lost, but only for a short time, and eclampsia may or may not have preceded. This is not genuine apoplexy. c. Paralytic form. In these cases there is hemiplegia lasting at least several months, and un dergoing a gradual cure. d. Pregnancy occurring in hemiplegic women.
2. Cerebral angestion.—This is particularly induced by the efforts of labor or by eclampsia. It produces torpor, slight or well-marked, after which more or less complete hemiplegia remains and disappears, ordina rily, quite rapidly.
3. Cardiac Affections.—Endocarditis.—This may be the acute, ulcera tive, typhoid or pyohmmic form of Senhouses Kirke, Simpson, Hardy, Charcot, Peter, Bucquoy, Martineau, and Decorniere, or the subacute and chronic form of 011ivier, to which recent researches on puerperal car diac troubles lend new importance. Attacking by preference the mitral valve, as does rheumatic endocarditis, it advances progressively and in creases with the number of pregnancies. Causing the growth of valvular vegetations, it may give rise to cerebral embolism. In this connection we should mention the arterial thromboses reported by Oke, Risdon, Ben net, Turner and Simpson. This last author divides them into five kinds caused by: a. The detachment of old or organized cardiac concretions and their transportation into arterial channels. b. Entrance into the circulation of recent coagula formed in the heart or in the great arteries. e. Local arteritis. d. A lesion of the tunica intim. of the arteries. e. Foreign bodies coming from the veins and lodged in the pulmonary artery or its divisions.