350 . PRACTICE OF PHYSIC. 



upon a compression preventing the flow of the nervous power 

 from the brain into the organs of motion, or upon the application 

 of narcotic or other powers (MCXV.), rendering the nervous 

 power unfit to flow in the usual and proper manner. 



" I have endeavoured to establish that there are two kinds of 

 palsy, one from compression, the other from collapse, which it 

 is absolutely necessary to distinguish, because the remedies to 

 be applied are often of an opposite nature. I have not been 

 able in a number of cases to satisfy myself, whether to consider 

 them as of one kind or as of the other : but I propose to give you 

 the following considerations, which may often assist in distin- 

 guishing a palsy from collapse. 



" 1. We are more inclined to admit the supposition of collapse, 

 when there are no symptoms of previous plethora, when the dis- 

 ease happens at a time of life when neither arterial nor venous 

 plethora is to be suspected, or in a temperament not disposed to 

 that state, where there is neither short neck, large head, nor obes- 

 ity, nor suppression of usual evacuations. Still from the absence 

 of these symptoms we cannot conclude that it is not a case of com- 

 pression ; for it may arise from tumours in the cranium without 

 any signs of plethora. The only means of judging which we have 

 in such cases, is observing the effects which these tumours gener- 

 ally have before they produce apoplexy and palsy, such as vertigo 

 epilepsy, or maniacal symptoms, and partial topical palsies, be- 

 fore the more general affection comes on. 



" 2. In order to exclude compression, there must be an en- 

 tire absence of the hydropic diathesis ; for where that is pre- 

 sent, where we see anasarca of the lower extremities, or symp- 

 toms of ascites or hydrothorax, and at the same time symptoms 

 of palsy, we presume pretty confidently, that the latter arises 

 from a similar affusion into the brain. 



" 3. Even where plethoric symptoms and marks of congestion 

 have preceded the disease, if the latter has existed for a great 

 length of time, there is a suspicion that the compression which 

 existed at first, has induced a collapse. Certainly plethoric 

 congestions, and still more causes of effusion, may subsist for 

 a length of time ; but I think the congestions cannot do so with- 

 out shewing a considerable change and vicissitude in the appear- 

 ance of the disease ; and serous effusions also must either go 



