Paralyses of the Senses.
These paralyses are almost always dependent, it is true, upon albumin uria, but they may, in rare instances, be attributed to hysteria, aiammia or dyscraske. The fact of their persistence shows that albuminuria is not their only cause. Rarely isolated, they are often accompanied by paralyses of several other special senses, particularly of hearing and sight. Again, they may coexist with paralyses of the face or of the limbs. Disturbances of vision are by far the most frequent. These troubles may present various degrees. Sometimes the sight is, at first, clear and only grows dim after use. Sometimes there is complete loss of vision. Some patients become color-blind, others become myopic, and others present, at the same time, exophthalmos, strabismus and prolapse of the lids. The cornea and the sclerotic are healthy, the pupils are not very contrac tile and'are often dilated. The retina and the choroid may present nu merous and varied alterations, but often are in a normal state. In cer tain cases, the amaurosis coexists with lesions of motility and of sensi bility in the limbs. Besides these visual troubles, referable to albumin uria, we must mention those following large puerperal hemorrhages, those due to toxic closes of lead or quinine, (we have seen one such case which lasted four months) and those referable to syphilis or to other es, chexia3. We, finally, see these impairments of sight accompanying the dis eases of the post-partum state, whether inflammatory or not. Lastly, in Lebreton's, Boulley's and Landry's cases of hysterical pamlyses, there were marked visual difficulties. We believe albuminuria is the chief path ological agent. The same applies to deafness, although it may be more generally connected with general depression of the system. Although, indeed, deafness sometimes depends upon albuminuria, it is oftener due to the adynamia attending puerperal septimmia, and, in one of our own cases, we found albuminuria to be wanting. The observations of Capu ron, of Liegey and of Prestat regarding paralyses of smell, of taste and of the voice, seem to us at least doubtful.
Must puetTeral mania, which Imbert Gourbeyre considers to be a paralysis of the intellect, be classed with these ? We do not think so, and we hold that the following resume, from our monograph states the essen tial points regarding puerperal paralysis: 1. Puerperal women are subjected to the same causes of paralysis as
non-puerperal subjects.
2. The puerperal state, nevertheless, constitutes with them a predis posing and, in certain cases, even an exciting cause.
3. These palsies may occur at any period of the puerperal state, whether during pregnancy, labor or the puerperium, but are much more frequent in the first and the last named periods.
4. There are three forms of these paralyses: hemiplegia, paraplegia and paralysis of the special senses. Each of the first two may be accom panied by the third, particularly the first.
5. These paralyses may be complete or incomplete, partial or general, i.e., they may affect one side (hemiplegia) or only the lower limbs (pant plegia), and involve either one member or both simultaneously.
6. These palsies may exist in clearly distinct forras by themselves, or may be accompanied by paralysis of the special senses, as of sight and hear ing, which latter may, of themselves, constitute the sum total of paraly tic symptoms.
T. The hemiplegias and the disorders of special senses are often ac companied by facial paralyses, which are rarely isolated, but generally combined with either partial paralysis of the limbs or with paralysis of the special senses.
8. These palsies, of whatever form, affect both motility and sensibilitv. and present every possible variety from simple paresis to complete paralysis.
9. The,se paralyses may be separated into two chief groups: A. Paraly ses from organic lesions; B. Paralyses from reflex action. The paralyses from organic lesions may be subdivided into two classes: a. Primitive organic lesions ; congestions, hemorrhages, meningitis, and lesions of the cranial bones or of the vertebrae; b. Secondary or consecutive organic lesions; congestion, hemorrhage, meningitis, heart affections, cerebral thromboses, albuminuria, uterine affections and compressions of the nerves. Reflex paralyses are due to peripheral irritation.