Paresthesia

“ The Causes of Paralysis are very numerous. Whatever destroys, or impairs the natural structure of nervous matter, or whatever interferes materially with the conducting power of nerve-fibre, or the generating power of the nerve-centres, will produce a paralysis, the extent of which will depend upon the amount of nervous matter affected. Thus paralysis may be due to disease of the brain arising from apoplexy; to abscess, softening, syphilitic or other tumors, or epilepsy; to disease of the spinal cord, or marrow ”

“ Early physical symptoms are headache, sensations of fulness and pressure in the head, followed by a feeling of dizziness, fatigue, exhaustion, debility, etc. Sooner or later, following a seizure of some kind, neurological signs appear—drooping of the mouth, lateral deviation of the tongue, weakness of an arm, dragging of one leg, loss of sensation on one side, ankle clonus, an increase, decrease or inequality of the patellar reflexes, and sometimes a Babinski reflex. The pupils are very likely to be unequal and sluggish in reaction. ”

“ And the cases of paralysis from the motor zone with no accom- panying anaesthesia may be explicable without denying all sensory function to that region. For, as my colleague Dr. James Putnam informs me, sensibility is always harder to kill than motility, even where we know for a certainty that the lesion affects tracts that are both sensory and motor. Persons whose hand is paralyzed in its movements from compression of arm-nerves during sleep, still feel with their fingers ; and they may still feel in their feet when their legs are paralyzed by bruising of the spinal cord. ”

“ Palsy, either consequent to compression of the brain, or dependent on partial exhaustion of the energy of that organ, may, when the palsied limbs become affected with tremulous motions, be confounded with this disease. In those cases the abolition or diminution of voluntary muscular action takes place suddenly, the sense of feeling being sometimes also impaired. But in this disease, the diminution of the influence of the will on the muscles comes on with extreme slowness, is always accompanied, and even preceded, by agitations of the affected parts, and never by a lessened sense of feeling. ”

“ Pressure on brain—pain, spasm, nausea, dullness, blindness, stupor, coma, palsy. Congestion and anæmia synchronous. Lesions of cortex. Encephalic lesions—hemiplegia, with spasms, increased reflexes, spasms follow cranial nerves, vertigo, apoplexy, epilepsy, dementia, coma, little muscular atrophy, or dermal sloughing. Spinal lesions, paraplegia without spasm, reflex reduced or nil, follow spinal nerves, head symptoms less, much muscular atrophy, bed sores. Sensory and motor tracts, in crus cerebri, respiratory centres—inspiratory expiratory, inhibition. ”

“ DEFINITION.—These neural disorders consist of a certain train of nervous symptoms, such as spasm, paralysis, pain, tremor, vaso-motor disturbances, etc., either alone or in more or less complicated combinations, which follow certain muscular acts and are occasionally accompanied by a marked condition of general nervousness; they occur in many of the occupations of every-day life that require for their performance a constant muscular strain combined with more or less delicate movements of co-ordination continued for long periods at a time. ”

“ The nervous symptoms of this stage are chiefly vertigo, headaches, which are usually occipital, and depression of spirits. Insomnia may be a marked feature. Lack of mental concentration is often noted.
Second Stage.—In the second stage we have a continuation and aggravation of the skin and alimentary tract symptoms with pronounced neurological manifestations. Tremors of the tongue and hands appear. There is great muscular weakness of the legs. Paraesthesias in great variety are common. Pain on pressure in the dorsal and lumbar regions of the back is common. ”

“ In mild cases instead of deep coma, there may be only headache, faintness, nausea and vomiting.
Subsequent Symptoms.—When the patient improves, consciousness returns, but there remains a half-side paralysis, hemiplegia, on the side and opposite to that of the seat of the injury in the brain. It may not take in the whole side, only a part. The gait is peculiar. In walking the patient supports the paralyzed arm. In many cases the paralyzed parts gradually regain their functions in a few weeks, but not always complete. The leg improves more than the arm. There is danger of other attacks. ”

“ These are the two opposed symptoms that we produce experimentally by electrization and ablation of the substance of the convolutions. It goes without saying that the symptoms vary with the locality of the lesion: the intellectual region gives delirium; the motor region, spasms; the sensitive region, subjective sensations. The symptoms of functional paralysis are also diversely represented by mental feebleness, motor paralysis, and anæsthesia limited to one sense. A lesion frequently presents both orders of symptoms, which succeed each other, or alternate, according to its nature. ”

“ That analogous changes take place in the vessels supplying the spinal centres is certain; but it is a remarkable fact that these do not very commonly produce motor paralysis. What they do produce is rather a slow enfeeblement both of (spinal) sensation and motion, but where the process of decay has been prematurely forced, or the inheritance of neurotic weakness is very marked, the process of sensorial decay (the decline, that is, of true sensorial function) is apt to be mingled with pain. ”

“ But, secondly, this paralysis may extend to the muscular sense, so that the feeling of muscular tension is wanting as well as that of contact-pressure; and yet none the less can a weight be lifted or sustained by a conscious effort, provided that the deficiency of the guiding sensations ordinarily derived from the muscle itself is supplied by the sight. A woman whose arm is sensorially but not motorially paralyzed can hold up her child as long as she looks at it, and a man affected with the like paralysis of his legs can stand and walk while looking at his feet. ”

“ Symptoms.—The onset is usually sudden; often the child is put to bed at night seemingly well and in the morning is found paralyzed in one or more limbs. High fever or chills, general feeling of illness, pain all over the body, decided brain symptoms, like delirium or convulsions and intermittent contractions of the muscles may usher in the disease. These forerunning symptoms may last a short time or for several weeks, after which the paralysis is noticed, being extensive as a rule, and affecting one, two, or all of the extremities and sometimes the muscles of the trunk. ”

“ Peripheral irritation of a particular sensory nerve may evoke neuralgic pains in nerves connected with that irritated only through the spinal centre. (3) Neuralgia in a sensory nerve may (and almost always does, to some extent) produce secondary vaso-motor paralyses: these paralyses may affect fibres which run in the same branch of the nerve as that which is painful, or fibres that run in another branch of the same nerve, or fibres that run with another sensory nerve, or the ganglionic chain of the sympathetic itself. ”

“ Most persons have experienced a disagreeable sensation and dizziness, caused by falling from a slight elevation, or by jumping from a carriage. This is the result of a moderate concussion of the brain.
844. In injuries of the brain, from blows and falls, the symptoms are usually alarming, and all should possess some information for such contingencies. In general, such accidents are attended by insensibility; the skin and extremities are pale and cold, the pulse is very weak and feeble, and the circulation is less vigorous; the respiration, also, is less frequent and full. ”

“ It is not, as is usually supposed, an affection of the muscles, but of the nerves that control the muscular movements. Sometimes one entire side of the body becomes affected and completely deprived of voluntary motion. Congestion of the brain is a preliminary of paralysis, and congestion of the brain are invariably due to an enlarged transverse colon.
One form of paralysis affects only certain parts of the body, such. as the lower limbs, or the reproductive organs, and is caused by pressure upon some large nerve communicating with the paralyzed portion. ”

“ Prolonged and excessive nervous action is attended with too great a rush of blood to the nerve-centers, which can [pg 917] only be relieved by increasing the flow in the muscles. Congestion, or hyperæmia, in the spinal cord or brain, or both, is a condition ever present in neuralgia. The application of motion through the manipulator causes the blood to flow to the muscles, thus relieving nervous congestion and consequent neuralgia.
CURE OF PARALYSIS.
In no single disease has the transmission of motion through the Manipulator proved more thoroughly efficacious than in paralysis. ”

“ The most prominent symptoms which mark a peripheral paralysis are the implication of all the branches of the nerve, the loss of the reflexes, the development of the degenerative reaction, and atrophy of the muscles. In facial paralysis of cerebral origin the frontal and orbital branches are not at all or but slightly affected, leaving the eye with its natural appearance, in contrast to the lagophthalmos, and the open eye which does not close even in sleep. In cerebral paralysis the reflexes are normal and the muscles retain their natural electric reaction. ”

“ Palsy from pressure, as from sleeping with the head resting upon the arm or with the arm hanging over the back of a chair, is a frequent cause of paresis or paralysis of the muscles supplied by the musculo-spiral. ”

“ When the nerve roots alone are injured, sensory phenomena predominate. Formication, radiating pains, and neuralgia are present in the area of distribution of the nerves implicated. There is motor paresis or paralysis, which may disappear either suddenly or gradually, or may persist and be followed by atrophy of the muscles concerned. ”

“ Another nervous disease, corresponding in some of its features to paresis and indeed sometimes spoken of as a spinal form of paresis, is locomotor ataxia. This affection {321} begins usually with loss of sensation in the soles of the feet so that the patient thinks that he is walking on carpet all the time. Before this there may have been some disturbance of vision. The pupils may fail to react to light. Occasionally the first symptoms are motor, that is, the man notices that he is not able to walk as readily as before. He staggers easily. ”

“ When the paralysis is not complete, the side so affected suffers sometimes from slight convulsive twitches, while well-marked spasms prevail in the other, leading to the belief that, while paralysis is an affection of only half the brain of the opposite side, or of half the spinal marrow of the same side, convulsions are the effect of a more general irritation, capable, however, of being confined to a part; for partial convulsive motions do very frequently occur without any paralysis accompanying them on the opposite side. ”

“ Commencing, for instance in one arm, the [6] wearisome agitation is borne until beyond sufferance, when by suddenly changing the posture it is for a time stopped in that limb, to commence, generally, in less than a minute in one of the legs, or in the arm of the other side. Harassed by this tormenting round, the patient has recourse to walking, a mode of exercise to which the sufferers from this malady are in general partial; owing to their attention being thereby somewhat diverted from their unpleasant feelings, by the care and exertion required to ensure its safe performance. ”

“ In cerebral paralysis of any standing the superficial reflexes, such as the cremaster and abdominal reflexes, are usually diminished or abolished, while the deep or tendon reflexes are exaggerated. In spastic conditions due to spinal disease—say sclerosis of any kind affecting the lateral column and leaving the motor nuclei of the anterior cornua unaffected—the deep reflexes are similarly increased, but the cremaster reflex is increased also.154 This feature of the superficial reflexes is significant in the case of cerebral disease only when unilateral. ”

“ They are preceded by headache and vertigo, or, if these be continuously present, by an aggravation of them; then unconsciousness develops, either accompanied by convulsions or not, and the face is flushed, the pulse full and frequent, and the temperature raised. Consciousness returns in a few hours or a day, the attack rarely lasting more than two days, and it is found that the patient is hemiplegic. But, unlike the hemiplegia found after vascular rupture, embolism, or structural cortical disease, it is rapidly recovered from. ”

“ Symptoms.—May come on suddenly, when it is due to a jar of the brain as well as the cord. Loss of consciousness, complete paralysis, small pulse, collapse, and within a few hours death may follow. In other cases improvement, though very slow, follows. Walking is difficult and the upper extremities are weak in these cases. There are pain and tenderness along the spine. Brain symptoms, such as headache, dizziness and fainting, may be present or absent. ”

“ Spinal Congestion.—This is one of the varieties of disease-pictures that call for a deviation in management, and is, perhaps, as common as any of the special types, and may be recognized by the following symptoms: pain in the back, as if from long stooping, not increased by pressure; also a dull, aching sensation, as after prolonged exercise. This pain is aggravated by the recumbent posture; hence the sleeplessness so common in many of these cases. Fainting sensations are produced by standing long upon the feet: a misstep, or a sudden jolt in a wagon or car, causes much suffering. ”