302 
PALSY. 
the ordinary bdfinefs of life. If, as the difeafe continues, 
the paralyfed limbs gradually lofe their fenl'e of feeling, 
or if they are affefiled with coldnefs, and the flefh wades, 
the profpefil is moll unfavourable. But, if there is a fre¬ 
quent prickling fenfation, or even fome degree of pain, 
in the parts; if they are occafionally affefiled with flufti- 
ings of heat, or with fpafmodic twitchings ; or if rheu¬ 
matic or inflammatory fwelling take place in them; thefe 
appearances are to be deemed favourable, inafmuch as 
they imply a lefs-complete interruption of the nervous 
power, or its returning influence. 
The treatment of hemiplegia will necefliirily be fome- 
what different in different inftances, according to the 
age and conftitution of the patient, and to the obvious 
exciting caufe of the difeafe. It is a practice, but too 
generally adopted by routine-prafilitioners, to begin im¬ 
mediately with the exhibition of flrong ftimulants, upon 
the fuperficial inference, it fhould feem, of a torpor of the 
nervous power. But, if they were to penetrate a little 
below the furface of things, it would be evident that this 
torpor of the nerves depends entirely upon an opprelTed 
Hate of their origin, the brain, in confequence of an over- 
adiion and turgefcence of its veffels ; and, therefore, that 
every meafure, which tends to augment vafcular afilion, 
mull nectffariiy be a fource of aggravation to the difeafe. 
Upon the plained principles, the very oppofite objefiv is 
to be purfued; and, until the fymptoms of plethora and 
the atlive ftate of the difeafe be fubdued, the beneficial 
aid of flimulants is more than problematical. In a word, 
it appears, that Jtimulants arc perhaps never advijab'e in 
true hemiplegia; and that the benefit of thefe remedies is 
limited to thofe fpecies of general palfy which arife from 
th.e influence’ of cold or narcotic poifons on the brain and 
nerves, or to thofe local varieties of palfy w hich feem to 
depend upon difeafe a ffe filing the branches and extremi¬ 
ties of the nerves, while the brain remains uninjured. 
For the purpofes, therefore, of aiding recovery from an 
attack of hemiplegia, the principal indication will be, to 
avoid every fpecies of intemperance; to reftrifil the diet 
to light and cooling articles, and to take thefe with great 
moderation; to employ regular, but always gentle, exercife, 
avoiding every extraordinary hurry of the circulation ; 
to preferve a regular, and rather free, fiate of the bowels; 
and to manage the clothing fo as to preferve a regular 
ltate of the cutaneous exhalation, and to avoid the im- 
prefiions of viciffitudes of heat and cold; In a word, the 
objedf will be to free the■ conllitution from all embarraff- 
ment, in which condition it will be the beft enabled to 
relume its healthy afitions. We may liberate and aflift, 
but we cannot command, the powers of the vis medicalrix 
natures. It may be obferved, hov/ever, that where the 
attack has been flight, and the tendency to recovery ob¬ 
vious, the return of power in the paralyfed mufcles-feems 
to be confiderably accelerated by a conftant exertion of 
them, or at leaft by conftant attempts at exertion by di- 
redling the volition to them. The advantages of this 
voluntary exertion are commonly obvious in the more 
fpeedy and complete recovery of the motion of the leg, 
w hen compared to that vaf the arm, in perfons who have 
fuffered hemiplegia; a circumftance to be aferibed folely 
to the neceli'ity of nfing the leg in moving from place to 
place, while the arm is too commonly hung in a fling, and 
no attempt is made to employ it. 
2. Paraplegia, or Palfy of the lower Extremities.— 
A palfy of the lower extremities may perhaps fometimes 
arife from injury or difeafe in fome part of the brain itleif; 
but of this the evidence appears to he invperfefil ; and, at 
ail events, the occurrence is rare. The ordinary in¬ 
ftances of this palfy obvioufly originate from preflure on 
Tome part of the vertebral nerve, orfpinal marrow, below 
which the palfy (hows itfelf, while the parts fupplied with 
nerves, that branch off above the feat of th.e preflure, con¬ 
tinue to poflefs their power of motion unimpaired. 
The paraplegia may occur at all ages, and in either 
fex, and is 'always prcdutdlive of much diftreis: for, if 
4 
the patient be a child, it becomes an objefit of conftant 
and unavailing anxiety to its parents ; and, if an adult, 
he is rendered perfectly helplefs to himfelf, and ufelefs 
to all others, which of all pofiible ftates is furely the 
worft. 
When this palfy attacks an infant of only a year or two 
old, the true caufe of it is feldom difcovered until fome 
time after the efFefit has taken place, at leaft by parents and 
nurfes, u'ho know not where to look for it. The child is 
faid to be uncommonly backward in the life of its legs, or 
it is thought to have received fome hurt in its birth. When 
it affefils a child who is old enough to have already walked, 
and who has been able to walk, the lofs of the ufe of the 
legs is gradual, though not very flow. He at firft com¬ 
plains of being very loon tired; is languid, liftlefs, and un¬ 
willing to move much, or at all brilkly : in afliort time after 
this he may be obferved frequently to trip, and (tumble, 
although there be no impediment in his way ; and, when¬ 
ever he attempts to move brilkly, he finds that his legs 
involuntarily crofs each other, by which he is frequently 
thrown down, and that without (tumbling; upon endea¬ 
vouring to (tand (till and erefl, without fuppoft, even for 
a few minutes, bis knees give way, and bend forward. 
When the diftemper is a little farther advanced, it will he 
found that he cannot, without much difficulty and de¬ 
liberation, direfit either of his feet precifely to any exafit 
point; and, very foon after this, both legs and thighs lo!e 
a good deal pf their natural fenfibility, and become per- 
fefitly ufelefs for all the purpofes of locomotion. 
When the difeafe occurs in an adult perfon, its progrefs 
is much the fame, but rather quicker. He complains alio, 
in the early part of its courfe, of a fenfe ofnumbnefs in 
th.e affefiled limbs, with tranlitory tremblings and twitch¬ 
ings, and fometimes of rigors : and he finds, as the blad¬ 
der and lower portion of the bowels are included in the 
difeafe, that the (tools pafs off unconfcioufly, and the urine 
flows without his content, at the lame time that he has a 
difficulty of emptying the bladder. Ultimately the legs 
become rigid, the knees and ankles ftiIf, and the feet 
extended fo that they cannot be placed flat on the ground. 
The la ft circumftance is likewile obferved in children. 
When the back is examined, fome prominency or cur¬ 
vature of the fpine is always found. The curvature varies 
in fituation, extent, and degree, being in the neck or back, 
and fometimes, though very rarely, in the upper part of 
the loins; fometimes comprehending two vertebrae only, 
fometimes three or more, by which the extent.of the cure 
becomes necefliirily more or lefs; but, whatever may be 
the number of the vertebrae concerned, or whatever the 
degree or extent of the curvature, the lower limbs only 
feel the efrefil, the arms never being aifefihed. The efFefit 
is alfo different in different fubjefifs: fome are rendered 
totally and abfolutely incapableof walking in any manner,, 
or with any help, ami that very early in the courfe of the 
diftemper; others can make a fhift to move about with 
the help of crutches, or by grafping their own thighs 
with their hands; fome can lit in an erefih pollute, in a 
chair, without much trouble or fatigue, which others are 
incapable of, at leaft for any length of time: fome have 
fuel) a degree of motion in their legs and thighs, as to 
enable them to turn and move, for their own convenience, 
in bed ; others have not that benefit, and are obliged to 
lie till moved by another. 
The difeafe is commonly aferibed to fome injury, fuch 
as a blow, fall, or violent ltrain, which had affected the 
fpine ; and probably this is afituaily the origin of it in 
many inftances. But there is no doubt that the fpine 
and its ligaments often become dileafed, fo a:, to-produce 
paraplegia, independently of fuch violence. For it is not 
the mere diftortion or curvature of the fpine which gives 
rife to the palfy, (lince the moll extenllve crookednefs 
often occurs where no paralyfis exills;) but afitual preflure 
upon the vertebral nerve, by the concomitant difeafe or 
the fpine. 
The cure of paraplegia was feldom effefited till the 
proper* 
