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Paralysis

power, loss, spasm, muscle, resistance, patient and muscular

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PARALYSIS is meant the inability to transmit nervous influ ence, whether in a central or in a peripheral direction ; but the term is more usually applied to that manifestation of it which consists in loss of muscular power : loss of sensation has been called anesthesia, and a corresponding term for muscular paralysis has recently been invented—acinesis : loss of power of motion without diminished sensibility is much more frequently met with than the converse, and when the two are coincident the diminution of mobility is generally much greater than that of sensibility. Taking into consideration the compound nature of most of the nervous tracts, it will rather appear surprising that the two con ditions should ever be apart, than that they should frequently be found associated in the same individual : and in those exceptional cases in which the nerve fibres are wholly sensory, or wholly motor, we find that the very same circumstances which in the one lead to anaesthesia, in the other produce muscular palsy. In prosecuting the diagnosis of nervous diseases there would there fore seem to be no advantage in separating them in a pathological view ; and in semeiology, as has been already observed, objective phenomena are generally more certain and conclusive than sub jective.

The history of the incursion of paralysis and the symptoms which have preceded its development, give us the first clue to discover the cause on which it depends ; but it is also of use in enabling us to determine whether the complaint made by the patient of loss of power or numbness be based on a real alteration of the condition of the parts, or be entirely, or partly imaginary ; a point which is often very difficult to decide when the paralysis of the nerve is not complete. In real paralysis we shall either find that at one time it has been more perfect than it now is, and that it commenced with a comparatively sudden seizure, or that it has come on gradually and has been slowly increasing : its amount, too, is the same at different times of observation.

This may be best measured by power of resistance; but it is necessary to bear in mind that spasm is sometimes associated with paralysis, and while there is little or no voluntary power, the muscle under the influence of spasm may offer great resistance to movement of the limb by another : such an occurrence can only mislead when the observation is very superficial ; one set of mus cles only is affected by the spasm, and that for but a short period, the limb under all other circumstances remaining in a powerless condition: such spasm is only seen when the paralysis is complete; it is referable to some sort of reflex action.

The duration of the affection aids in determining the nature of the lesion ; we discriminate cases according as we can trace an invasion of recent disease on old standing paralysis, or the latter supervening on illness of longer dura tion, or all the symptoms commencing together. Similarly its mode of incur sion may throw light on its cause, as we find it occurring suddenly in apoplexy, or more slowly in chronic diseise; ushered in by a fit or loss of consciousness, or gradually spreading from muscle to muscle ; attaining its maximum in a few hours, or advancing from week to week. Occasionally a fallacy presents itself in the circumstance that some slight paralysis of long standing is only first observed when febrile disturbance is present; such, for instance, as slight strabismus, of which the patient was quite unconscious. This is best corrected by ascertaining whether there be any recent change in function ; double vision necessarily attends recent strabismus unless the sight of one eye be lost. • In all forms of incomplete paralysis, whether the patient complain of ins• bility to walk, of imperfect power of the hand and arm, or of mere feelings of numbness, while yet there is no muscle which cannot be brought to act when he is at rest and no resistance offered, we are beset with difficulties, because, on the one hand, the cause of the affection is exceedingly obscure, and on the other, its main features may be simulated by hysteria or hypochondriasis. It is not only during life that this obscurity prevails, but even after death it may be wholly impossible to point out the lesion on which it depended. Were other instances wanting, very forcible evidence of this fact is derived from instances of what is called the paralysis of the insane.

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