On the Causes and Symptoms of Chronic Diseases (1.7)

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.[*] 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),[*] 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.[*]

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.