This description, borrowed from V ulpian,Bastien and Tillaux, is perfectly applicable to traumatic paraplegias. Commencing moderately, the disease progressively reaches its maximum, but is almost always unilateral, which shows that the compression has been more strongly exerted on one of the sacral plexuses. The paralysis is generally incomplete and limited, for, since the compression affects particular nerves, the paralytic symptoms show themselves in the muscles which these nerves supply. Thus, in one of Bianchi's cases, paralysis was especially well marked in the muscles supplied by the external popliteal nerve. Limited to one limb, or to one part of a limb, the paraplegia never invades the rectum or the vagina, which remain intact and preserve the integrity of their functions. Elec • trical excitability is diminished or even abolished.
The only conditions whirl' are liable to be mistaken for these paraple gins, are the pseudo-paraplegias of Jaccoud, and the relaxation of the pel vic symphyses, succeeding a difficult labor, but the differential diagnosis is easy. Schmidt had a curious and rare case, in which paraplegia devel oped in the course of an extra-uterine pregnancy. These paraplegiss always disappear, but sometimes only after months or even years, and in these tedious cases, we find atrophy of the diseased limbs.
Treatment.—This is preventive, consisting in wise intervention, calcu lated to prevent compreAsion of the nerves from prolonged contact with the head, and curative, consisting in efforts to retain the remaining exci tability of the injured nerves, and to prevent or to arrest fatty degenera tion of the muscles. Electricity, locally applied, cutaneous revulsion, dry or wet frictions, mineral waters, baths and sulphur douches are indi cated, besides a tonic and roborant treatment.
These paralyses9 whether hemiPlegic or paraplegic, may affect now an upper and now a lower extremity, and may either simultaneously invade the face and one upper limb or be limited to the face. Again, they may involve a limited muscular area. Although the causative influence of the puerperal state is evident in some cases, yet these paralyses may acciden tally develop in a pregnant woman without there being an evident con nection between the palsy and pregnancy. Aside from traumatic paral yses, we have collected the following twenty-one cases: One striking fact is the comparative frequency of facial paralysis.
Next to this comes paralysis of the arm. The hemiplegic type largely .
predominates over the paraplegic in these cases of partial paralysis, and these palsies are rarely isolated, i.e., they are complicated by impairment of the senses, as of hearing and sight. Amaurosis, most frequently par tial, may exist. Instead of always assuming a typical course, these paral yses tend to develop in one single region, a,s in the muscles of the face, the shoulders, or the neck. They therefore belong to the class desig nated as rheumatic. On the other hand, all authors have noted the relation existing between albuminuria and rheumatism. Among our twenty-one cases, in six albuminuria existed, and in four others, the pa ralysis coincided with a more or less complete amaurosis. These usual impairments are among the most frequent complications of albuminuria. We. thus, believe that partial paralysis are due to three chief causes: 1. Albuminuria; 2. Rheumatism; 3. Reflex action.
Frequency.—Rare as regards absolute frequency, partial paralyses are frequent as compared with complete paralyses. Thus, if we add these twenty-one partial paralyses to the seventeen traumatic paralyses, we ob tain the followingfigures: llemiplegias, 57; Paraplegias, 25; Partial pa ralyses (traumatic or otherwise), 38; total 120.
After hemiplegia, this is, therefore, by far the most frequent form. Partial panilyses may occur as well during pregnancy as after delivery, after an abortion as well as after labors at term, and may be recurrent. This happened once in three, once in four, and once in eight successive pregnancies. Motility and sensibility are alike affected, and we may have all the varieties noted above. Sometimes the palsies begin sud denly, and, sometimes, are preceded by discomfort, head-ache and visual trouble& Occasionally the paralysis has been preceded by weakness, numbness and pains in the limbs, and hus slowly and prpgressively grown more marked until sensation and motion have been entirely lost. Occasion ally, however, it has begun suddenly without premonitions. It may present the same varieties mentioned under the head of complete paralyses, which enable us to make the diagnosis, to which we need not revert at present. Let us only mention hysterical paralyses, which are distinguished by the concomitance of other hysterical phenomena which render the diagnosis clear.