Sensibility is differently affected. In some cases there is slight, but in others, profound anmsthesia. There are, sometimes, sensations of tick ling, prickling and creeping in the paralyzed limbs. In spinal paraplegias there is, at the seat of the lesion, constant pain, which may radiate either toward the pubes, the thighs, the legs or the loins. or may encircle the body, producing cramps and sensations of heat and mid. But these sen sations have nothing characteristic, and motility may be alone affected.
These paraplegias pursue a special course. Beginning in a gradual fashion, they rapidly become complete, but generally disappear quite rap idly. This is not always true, and sometimes there is a sort of transition in the disease, which Ja,ccoud has well described. Aniemia of the spinal cord may lead to more or less severe organic lesions. Then paralysis persists, or, becoming general, it kills. In these cases other syinptoms appear, which prove that it has changed.
These symptoms are spinal pains, spasms, pains in the paralyzed limbs, which radiate t,o different points, and sometimes give the patients no peace. The muscles are wasted, and even complete atrophy may occur. Under the influence of repeated pregnancies, these paraplegias increase in extent and in gravity.
Prognosis.—This varies with the cause. If the paraplegia is reflex, anwmic or post-hemorrhagic, the cause being transient and capable of en tirely disappearing under proper treatment, the prognosis is favorable, and we may expect a cure, unless a transformation in the type of the disease appears. If the paraplegia be organic, the importance and the gravity of the lesion will decide the prognosis. If the cause is a congestion or a slight hemorrhage, we may hope for a cure, although it may be tardy. If the case involves vertebral caries, myelitis or medullary softening, the lesion will be grave in proportion to the extent of the disease.
Diagnosie.—The chief point in the diagnosis is to decide whether the cause of the paraplegia be organic, or functional and reflex, and this is not, generally, difficult. If the paraplegia is of organic origin, it is gen erally slowly progressive, accompanied by radiating pains in the spine, by formication, numbness in the legs, cramps, spasms, veritable oontrac tures, analgesia and anresthesia, or marked hypenesthesia, vesical and rectal disorders, all of which are persistent. The puerperal state is lost sight of in these cases, and the organic lesion is the dominating pathologi cal feature. When paraplegia begins after labor, and is not due to trau matism, which plays a special role, this paraplegia is only developed after puerperal diseases, and is due to disease of the lumbar and sacral plexuses, dependent on inflammatory changes in the soft or the bony tissues of the pelvis. In this case inflammation is propagated from these tissues to the
nervous plexuses. The resulting paraplegia follows in its development the evolution of the original disease. and, if the patients recover, the par alysis disappears, either at the same time 118 the disease which occasioned it, or at the end of a longer period. In such c,ase, the paraplegia, al though organic, is dependent upon a local condition which owes its origin directly to the puerperal state. Our view is thus quite different from that of Hervieux, who considers these paraplegias to be the result of a real poisoning by what lie calls the puerperal miasm.
Reflex paraplegias are never accompanied by spinal or lumbar pains. Beginning insidiously, i.e., with simple enfeeblement, perhaps ot a single limb, they do not fail to speedily attack the other limb, and to become more or less complete (sometimes in a few hours). The peculiar changes of sensibility noted among the symptoms, are particularly prominent in these cases. The bladder and the rectum are, most frequently, unaffected and the paralysis supervenes, sometimes without known cause, and some times as the result of an exposure to cold, of a hemorrhage, or of preg nancy alone. It occurs just as readily after an easy as after a difficult labor, and is generally of short duration. If it persists, it is because its type has been transformed. Although these paraplegias have no effect upon pregnancy, it is not so with labor, although this influence varies with the cause and the intensity of the paraplegia. If the disease, for exam ple, is slight, and limited to the legs, its influence upon the course of labor is of no moment, but it rather seems to hasten labor by diminishing the susceptibility to pain. The same does not hold when the paraplegia extends to the abdominal muscles. In this case, labor is arrested at the very end, by failure of the expulsive power of the abdominal wall& (Garnet, Depaul, Brachet.) Treatment.—This varies with the nature of the disease. In the former case revulsives and stimulants to the legs, and nux vomica, meet the indi cations. In the second case, a tonic regimen and rest will usually suffice to cure a disease, the natural tendency of which is toward recovery. If the disease, even in the second instance, proves a little rebellious, electri city and baths, particularly sulphur baths, may be useful.