This difference in the symptoms, may serve to farther facilitate the diagnosis and often reveals the source of the paralysis. Thus, in paraly sis from cerebral affections, the inception is always sudden, and the pa thological conditions rapidly reaching their maximum, are lasting and fatal. On the other hand, in so-called reflex paralysis, the beginning is insidious. The lesions of motility, at first consisting in weakness and numbness, gradually pass into complete hemiplegia. In the former case all the extremities are almost always simultaneously involved, while, in the latter case, partial paralysis is often seen. Moreover, in the latter ,ease, the lesions of sensibility are various, while, in cerebral lesions, sen sibility is usually just as completely abolished as motility. In the variety due to albuminuria, there are usually prodromal symptoms, viz., headache, visual derangements, eclampsia, convulsions. In these cases constitutional symptoms, fever, peritonitis, phlebitis, and lymphangitis are absent, al though they do occur in paralysis from puerpeml septictemia. These hemiplegias considerably resemble those occurring aside from pregnancy, but the puerperal state impresses a certain stamp upon their course and their termination. Puerperal hemiplegias, commencing often during the later months, increase as pregnancy advances, acquire greater intensity dur ing labor, and subsequently disappear, either completely or by gradual subsidence. In some cases the hemiplegia does not entirely disappear, and if several pregnancies succeed each other, the paralytic symptoms are aggravated either at the time of a new conception, or during utero-gesta tion. In these cases there is sometimes amelioration of the symptoms in the later months, but during parturition, or some days later, there is a real relapse from which the patient does not recover for some time. Again, in rarer instances, hemiplegia begins during labor, but it is then almost always the result of eclampsia, albuminuria having been super added to the influences due to the puerperal state. In a third class of cases, which are, at least, as frequent as the first, the paralysis does not begin until after labor, and, stmngely enough, generally after a natural, easy and short confinement.
Prognosis.—This is very variable, and depends chiefly upon the cause producing the paralysi& Hemiplegia due to organic lesions is quite often fatal, but the other forms of hemiplegia are not. Hemiplegias may be divided into two large classes: those due to extensive, and those due to transient or slight cerebral lesions. In fatal c,asea, death usually occurs very soon, within two or three days, and the autopsy reveals considerable cerebral lacerations and hemorrhages. When death ensues more gradu ally, we find meningitis, or much less important hemorrhages, or a com bination of lesions which suffice of themselves to cause death, inde pendently of the cerebral affection. When recovery occurs, it is gener ally very rapid, taking place in a few hours or days, thus showing the lesion to have been transient. In some cases, if long protracted, the in tellect has been impaired. Death does not occur so frequently as might be expected. We find it to have taken place in twenty of our fifty-seven observations. Another peculiarity of these hemiplegias is that, in some cases, before permanently disabling a limb or a side, they may alternately disappear and reappear. This characteristic feature is not always a proof of benignity, for two such c,ases resulted fatally. These hemiplegiaa exert hardly any influence upon pregnancy and labor. The majority of hemiplegic women almost or quite reach full term. Among fifty-eight
of Darcy's cases, thirty-two reached the full term. In ten cases labor occurred prematurely, but this hardly happens except when albuminnria is present. In the cases referred to, eclampsia preceded labor, and the, paralysis was consecutive to these attacks. In only two or three in stances, has labor been slow and prolonged. In all the others parturition was normal, easy and rapid.
The treatment varies with the cause, the nature and the form of the paralysis. Venesection, friction, mineral baths, strychnia, and electricity have been employed, sometimes with success, and sometimes without any favorable effect upon the patient's condition.
Parapleg las.
These are not less frequent than hemiplegias, and here we find, after labor, the two chief ancient theories regarding suppression of the lochia and milk metastases. The c,auses are numerous, as in hemiplegia, but we find here two new and important causes; reflex action, which we admitted with some reserve as a cause of hemiplegia, and traumatism. We mention, therefore, in the first place: 1. Paraplegia!? from medullary Lesions.—In this c,ase the medullary lesion sometimes exists before conception, and pregnancy only modifies its original action. On the other hand, the lesion may be developed under observation daring 'pregnancy, the physician thus witnessing the series of morbid results terminating in death, and ascertaining the existence of the lesion, past mortem.
2. Paraplegias from Albuminuria.—Some authors admit this cause, without reserve, while others regard it as exceptional, and still others re ject it. We reject it, in common with Lasegue, Fournier, Addison, Si.e and Hervieux. Lasegue, in the Archives de Med., 1852, studying the cerebral disorders which occur in Bright's disease, mentions coma, con vulsions, delirium, and disturbances of the senses, but insists upon the absence of coma, in the following terms: " The absence of paralysis and the peculiar condition of respiration almost suffice to banish doubt. No nuttter at what period of the disease the case is observed, or what the in tensity of the stupor, we do not find the slightest paralysis. Whenever concomitant paralysis is reported, it may be referred to a local cause, and is not due to Bright's dise,ase. Bright himself emphasized this distinction, which experience fully confirms." 3. Paralyses front reflex Action. —These are the functional paraplegias of Jaccoud, which were formerly called peripheral paraplegias. This is the prevailing cause of puerperal paraplegias. The relation between paraplegia and certain morbid conditions of the genital organs was men tioned by Churchill, Romberg, IIunt, Stanley, Lisfranc, Estiaut, thesis 1857, Vallin, thesis 1858, and Nonat. Now, as Hervieux remarks, " if the diseased uterus is capable of producing paraplegias, why may not the gravid uterus or the uterus in its post-partum state, exert the same patho logical influence?" Jaccoud gives the name of functional paraplegias to all those whose distinctive feature is the absence of all material conditions producing paraplegias of his first three classes (spinal lesions, ischa3mia and dyscrasite), and he classifies functional paraplegias as follows. 1. The paralysis results from a more or less prolonged abnormal excitation trans mitted to the medulla by the peripheral nerves, from the genito-urinary organs, the abdominal viscera or the skin. This is peripheral paraplegia. 2. Paraplegia follows pyrexia3 and acute diseases. 3. Paraplegia appears during the coma of a constitutional or cachectic disease. 4. Paraplegia developes from a neurosis.