For him, therefore, puerperal paraplegia does not belong among reflex paralyses. Making a careful distinction between the paralysis of pregnancy and puerperal or post-puerperal paralysis, he places the former among the paraplegias due to antemia, attributing it to chloro-antemia and to a nervous state, and the second class of cases among organic paraplegias, from compression of peripheral nerves, thus attributing a predominating influence to traumatism. Jaccoud, disputing the propriety of the term reflex paralysis, insists that the paraplegia is not reflex, but due to the contraction of the medullary vessels, and that we should designate the paralysis as paraplegia by reflex vascular contraction or reflex ischzemia. But he does not even admit this contraction, for then it should be per manent, or ought, at least, to last as long as the paraplegia, i.e., weeks or months, which is contrary to all the principles of nervous action, for pas sive dilatation tends always and everywhere to active contraction of the vessels. If there really existed a permanent ischtemia of the medulla, the organ ought, after a time, to present the material lesions characteristic of ischtemic degeneration. Rejecting, therefore, the opinion of Willis, Whyth, Prochaska, and Brown-Sequard, he formulates the following theory: " An abnormal excitation is transmitted to the medulla by the sensitive nerves of the uterus, the kidneys, the bladder, the bowel, etc. It exhausts, at the end of a variable time, the peculiar excitability of the corresponding region of the organ, and the inertia of these nervous ele ments under encephalic stimulation, interrupts the channels of the motor impulses. The paralysis of all the parts situated below the affected point is the necessary result." Frog6, thesis 1868, admits that, in certain cases, the gravid uterus may react upon the nervous centres by the physiological phenomena located in it, to such an extent as to precipitate disturbances of innervation, among which is reflex paralysis. Hervieux adopts the theory of reflex paraplegia outright, and the observations cited in our own monograph seem to leave no loubt on the subject.
4. ChM; o-ancemie and posi-Itemorrhag ic Paralyses. —These two forms of paralysis may, we think, be arranged under one heading, the anEemic paraplegias. They embrace what Jaccoud describes under the title dys erasic and ischtemic paraplegias. Some paraplegias from dyscrasix de pend on a qualitative alteration of the blood, i.e., are produced by modi fications in the normal elements of the blood, as regards proportions and quality. Some are due to the presence, in the blood, of some foreign substance. Now, the composition of the blood is changed during preg nancy, and hemorrhages occurring during or after labor, and even during pregnancy, alter the blood by reducing its quantity, and thus themselves sometimes cause paraplegia& 5. Paraplegias from Blood-poisoning, in puerperal Septiccemia.—These a.re admitted by Hervieux, but we think that they should be included among paraplegias due to organic lesions. They are usually secondary to inflammatory lesions, of *hich they are only the results.
6. Traumatic Paraplegias.—These will be separately stud*, and will serve as transitional forms between complete and partial paraplegias.
Preguency.—Paraplegias seem less frequent than hemiplegias, since we found only twenty-five among our one hundred and forty-nine cases. They therefore bear to hemiplegias the approximate relation of one to two.
Age.—They are encountered, most frequently, between nineteen and thirty years, but we have noted six eases between thirty-one and fifty years. The number of pregnancies is indicated in only a few of the cases: In four cases, a paraplegia which existed before pregnancy, or during a preceding pregnancy, relapsed owing to conception. In the cases of Riviere and of Etcheveria, paraplegia followed abortions.
Time of Appearance.—Like hemiplegias, they may appear before or dur ing pregnancy and during or after labor.
Paraplegias are thus much more frequent after labor than during preg nancy.
Symptoms and Course.—These paraplegias do not differ from those not dependent upon the puerperal state, and may be either complete or in complete. There are three types of the latter variety: " 1. The patient cannot take a step, nor even stand upright, but, when she is lying down, she can either move the whole limbs or execute partial movements. 2. The patient can stand without support, and can even take a few tottering stepS, but walks without raising the feet. She executes this kind of progression by the alternate gliding of the whole sole upon the ground, or the heel being lifted, it is only the anterior extremity of the foot which glides along the ground. 3. The patient znay sometimes walk quite a long time without support, except that of a cane, but she feels early and unusual fatigue, which is, most frequently, not in accord with the devel opment of the muscular system." (Jaccoud.) These three types genendly succeed each other, the disease rarely sud denly rea.ing its maximum intensity. It iB, at first, an awkwardness and an enfeeblement of the limbs, or of one limb, succeeded by complete paralysis after a variable time. Paraplegia shows another peculiarity in some cases. It oscillates, as it were, in such a way that if, for example, the left leg were first attacked, the right leg would be in turn affected after a few hours or days. In the meantime the left leg might have partly or entirely recovered. A few days later the latter would be again attacked, and from this time on the affection, being equally or unequally developed in the two legs, would pursue its regular course. Solnetimes paraplegias, limited to the lower extremities, seem to have no effect upon the general system. Sometimes, however, they prostrate the patients considerably, and are attended by bladder and rectal disturbances, par ticularly the former. Sometimes the urine is slowly expelled, and some times there is complete retention, followed by incontinence from paralysis, with erythema and eruptions. The rectum is more or less paretic, which occasions constipation, or, if diarrhcea exist, involuntary defecation. Again, the paralysis involves even the abdominal muscles, and the women, not feeling fcetal movements, and thinking the child dead, can only per suade themselves that it is alive by seeing the movements.