CHAPTER VII. ON PARALYSIS
Apoplexy, Paraplegia, Paresis, Paralysis, are all generically the
same. For they are all a defect of motion, or of touch, or
of both; sometimes also of understanding, and sometimes of
other sense. But apoplexy is a paralysis of the whole body,
of sensation, of understanding and of motion; wherefore to
get rid of a strong attack of apoplexy is impossible, and of a
weak, not easy. But paraplegia is a remission of touch and motion,
but of a part, either of the hand or of the leg. Paralysis
for the most part is the remission (
paresis) of motion only, and
of energy.
1 But if the touch alone is wanting--(but such a
case is rare)--the disease is called Anæsthesia rather than paresis.
And when Hippocrates says, "the leg on the same side was
apoplectic," he means to say that it was in a death-like, useless,
and incurable state; for what is strong apoplexy in the whole
body, that he calls paraplegia in the limb.
Paresis, properly
speaking, is applied to suppression or incontinence of urine in
the bladder. But distortion of the eye-brows, and of the
cheeks, and of the muscles about the jaws and chin to the
other side, if attended with spasm, has got the appellation of
Cynic spasm. Loss of tone in the knees, and of sensibility
for a time, with torpor, fainting, and collapse, we call
lipothymia.
Wherefore, the parts are sometimes paralysed singly, as one
eye-brow, or a finger, or still larger, a hand, or a leg; and
sometimes more together; and sometimes the right or the left
only, or each by itself, or all together, either entirely or in a
less degree; and the parts only which are distant, homonymous,
and in pairs--the eyes, hands, and legs; and also the parts
which cohere, as the nose on one side, the tongue to the
middle line of separation, and the one tonsil, the isthmus
faucium, and the parts concerned in deglutition to one half.
I fancy, also, that sometimes the stomach, the bladder, and the
rectum, as far as its extremity, suffers in like manner; but the
internal parts, when in a paralytic state, are concealed from the
sight. Their functions, however, are but half performed; and
from this I conclude, that these parts are half affected, as being
cut in twain by the disease. And, indeed, this thing teaches
us a lesson in respect to the diversity of power and discrimination
between the right side and the left. For the inherent
cause is equal; and means which occasion the affection are
common in both cases, whether cold or indigestion, and yet
both do not suffer equally. For Nature is of equal power in
that which is equally paired; but it is impossible that the same
thing should happen where there is an inequality. If, therefore,
the commencement of the affection be below the head, such as
the membrane of the spinal marrow, the parts which are
homonymous and connected with it are paralysed: the right on
the right side, and the left on the left side. But if the head
be primarily affected on the right side, the left side of the body
will be paralysed; and the right, if on the left side. The cause
of this is the interchange in the origins of the nerves, for they
do not pass along on the same side, the right on the right side,
until their terminations; but each of them passes over to the
other side from that of its origin, decussating each other in the
form of the letter X. To say all at once, whether all together
or separate parts be affected with paralysis ..... or of both;
sometimes the nerves from the head suffer (these, generally,
induce loss of sensibility, but, in a word, they do not readily
occasion loss of sensibility; but if they sympathise with the
parts which are moved, they may undergo, in a small degree,
the loss of motion); and sometimes those which pass from
muscle to muscle (
from the spinal marrow to the muscles),
2 these
have the power of motion, and impart it to those from the
head; for the latter possess the greater part of their motory
power from them, but yet have it, to a small extent, of themselves:
the former, too, principally suffer loss of motion, but
rarely of themselves experience anæsthesia; indeed, as appears
to me, not at all. And if the ligaments of nerves, which
derive their origin from certain of the bones, and terminate in
others, be loosened or torn, the parts become powerless, and
are impeded in their movements, but do not become insensible.
3
The varieties of paralysis are these: sometimes the limbs
lose their faculties while in a state of extension, nor can they be
brought back into the state of flexion, when they appear very
much lengthened; and sometimes they are flexed and cannot
be extended; or if forcibly extended, like a piece of wood on
a rule, they become shorter than natural. The pupil of the
eye is subject to both these varieties, for sometimes it is much
expanded in magnitude, when we call it
Platycoria; but the
pupil is also contracted to a small size, when I call it
Phthisis
and
Mydriasis. The bladder, also, is paralysed in respect to
its peculiar functions; for either it loses its powers as regards
distension, or it loses its retentive powers, or it becomes contracted
in itself, when being filled with urine, it cannot expel
the same. There are six causes of paralytic disorders; for they
arise from a wound, a blow, exposure to cold, indigestion,
venery, intoxication. But so likewise the vehement affections
of the soul, such as astonishment, fear, dejection of spirits, and,
in children, frights. Great and unexpected joy has also occasioned
paralysis, as, likewise, unrestrained laughter, even unto
death. These, indeed, are the primary causes; but the ultimate
and vital cause is refrigeration of the innate heat. It
suffers from humidity, or dryness, and is more incurable than
the other; but if also in connection with a wound, and complete
cutting asunder of a nerve, it is incurable. In respect to
age, the old are peculiarly subject, and difficult to cure; in
children, the cases are easily restored. As to seasons, the
winter; next, the spring; afterwards, the autumn; least of all,
the summer. Of habits, those naturally gross, the humid,
indolent, brutish.
When the affections are confirmed, they are made manifest
by loss of motion, insensibility of heat and cold; and also of
plucking the hair, of tickling, and of touching. It is rare
indeed when in them the extremities are painful; but insensibility
to pain is not worse as regards recovery. Wherefore
the disease occurs suddenly; but if at any time it have prolonged
onsets, there supervene heaviness, difficulty of motion,
torpor, a sensation of cold, sometimes an excess of heat,
short sleeps, greater phantasies, when they become suddenly
paralytic.
But in the Cynic spasm, it is not usual for all parts of the
face to be cramped; but those of the left side are turned to
the right, and those of the right to the left, when there is a
considerable distortion of the jaw to this side or to that, as if
the jawbone were dislocated. And in certain of these cases,
also, there is luxation at the joint, when in yawning the jaw is
displaced to the opposite side: strabismus of the affected eye,
and palpitation in the under eyelid; the upper eyelid also palpitates,
sometimes along with the eye, and at other times alone.
The lips are distended, each on its own side; but sometimes
both being collapsed, they splutter; in others, they are closely
compressed, and are suddenly separated so as to expel the
common spittle with a noise.
The tongue, also, is drawn aside; for it consists of a muscle
and nerves, and at certain times, along its whole extent, it
starts up to the palate, and makes an unusual sound. The
uvula, also, is drawn aside; and if the mouth is shut, there is
an unexpected noise within. And if you separate the mouth,
you will perceive the uvula sometimes attached to the palate
through its whole surface, and sometimes swiftly palpitating
with force, like a bag-fish, when likewise a sound is produced.
But there is apt to be deception in cynic spasms; for to the spectator
it appears as if the parts unaffected were those possessed
by the disease; for owing to the tension and colour of the
affected parts, and the enlargement of the eye, they appear as
if they were diseased. But in laughter, speaking, or winking,
the true state of matters becomes manifest; for the parts affected
are all drawn aside with a smack; the lip expresses no
smile, and is motionless in talking; the eyelid is immoveable,
the eye fixed, and the sense of touch is lost; while the sound
parts speak, wink, feel, laugh.
