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PA RA LYSIS,
• FROM DISEASE OF THE CERVICAL MEDULLA.
BY JOHN WEBSTER, M.D.,
CONSULTING PHYSICIAN TO ST. GEORGE'S AND ST. JAMES'S DISPENSARY, ETC.
READ NOVEMBER 8th, 1842.
CONSIDERABLE attention has recently been directed by medical practitioners to affections of the nervous system, especially since the physiological experiments and discoveries of the late Sir Charles Bell were made known to the profession. Besides the investigations of that celebrated anatomist, Dr. Marshall Hall, Mr. John Shaw, M. Foville, Sig. Bellingeri, and other physiologists, have by their labours thrown so much light upon these important subjects, that many hitherto intricate questions connected with the functions and diseases of nerves are now much better understood, and are more successfully treated than previously. Nevertheless, believing that any additional facts respecting inquiries of
the above description will prove acceptable to the Fellows of this learned Society, I am induced to bring under their notice the following history of an interesting case of disease in the cervical medulla, occurring in a gentleman, a patient of mine, who died in July last, after suffering from an illness of several years continuance; and as an opportunity was then afforded of ascertaining the actual pathological changes of structure, by which the symptoms characterising the patient's malady during life were produced, the present narrative is consequently more complete, than it would have been otherwise.
This individual, although he was for many months totally unable to move, even in the slightest degree, any muscle situated lower than the neck, still retained the capability of feeling, quite perfect throughout the entire surface of the body; whilst the other senses and intellectual faculties remained unimpaired to the last moment of his existence. Indeed, the patient's cuticular sensibility continued not only unaffected, but it even appeared, in the latter stages of the case, to be more acute than natural; at the same time, that all power of effecting voluntary motion was entirely suspended in the trunk and extremities. This inability of making the slightest movement was so remarkable, that a bystander, ignorant of the patient's real condition, might have readily believed, from merely looking at him as he lay upon a couch, without noticing the movements of the head or countenance, that the inanimate body then before him was a corpse, rather than a
human being, endowed with mental faculties the same as in health, and possessing feelings even more acute than ordinary.
History.-W.H.G., Esq., æt. 36. Before describing the symptoms characterising the disease affecting this gentleman, it should be mentioned that he was endued with a strong muscular frame, was able lo undergo a great deal of bodily exertion without fatigue; and, until a few years before his death, had usually enjoyed excellent health, excepting that he suffered occasionally from severe headaches, which were, however, generally relieved by active purging. It is also of importance to mention, that this patient always perspired very freely in warm weather, or even after much exercise in cold ; nevertheless, from the commencement of his protracted illness, and throughout its continuance, the cuticular secretion became very scanty, and latterly it was entirely suppressed.
In the year 1836, Mr. G., whose health had hitherto been excellent, was annoyed for some months by a phagedenic ulcer on the left leg, from which he suffered much pain and inconvenience ; and although the sore afterwards got well, a similar ulceration on the leg again broke out in 1838, when it was followed, in the same year, by a large chronic ulcer on the posterior part of the pharynx. It is right however to state, that this local affection did not appear to be of a syphilitic character, and the patient, I was assured, never had any complaint of that nature. The ulceration in
the throat continued for some time without undergoing much alteration in appearance ; until, both from it, and from the sore leg, the patient's constitution was considerably deteriorated ; and as Mr. G. afterwards met with a severe domestic affliction, he also suffered much from mental depression.
Towards the end of autumn in 1839, Mr. G. again began to suffer materially in health; he now complained of almost constant pains in the head, which occasionally became so severe, as even to oblige him to stop in the street, and to lean against the rails for support. These symptoms were also frequently accompanied by sickness and considerable prostration of strength; the bowels being generally costive, the tongue much furred, and the appetite at the same time impaired. In January 1840, slight epileptic attacks now supervened, which were attended with an exceedingly slow pulse, varying generally from 35 to 40 in a minute. From this distressing state, Mr. G., however, recovered so much, as to be able to leave home about the end of February, and soon afterwards to resume, in some degree, his ordinary professional avocations.
In the following March, notwithstanding the above improvement, he was again attacked by several epileptic fits, but of a much more marked character than any of those noticed previously. These convulsive seizures occurred repeatedly; and after some weeks, they were followed by severe