Epidemic Paralysis
166 Art. XVI.? :Author: DR. Bockhammer. (Translated from the Annates Medico-Psychologiques, September 1876.)
Tiie village of Aryannon, situated upon the Tage, in the Spanish province of Guadelayara, contains about 120 inhabitants, who are described as generally healthy, but subject to pelagra, which is endemic. Here originated the singular epidemic which bears the name of the village, but which has appeared with great severity in other localities, attacking all ages and both sexes, but chiefly those of robust constitution. The lower limbs become first feeble, and then paralysed to such a degree as to render walking impossible, accompanied by formications, cramps, tremor, and pain, which in bad cases ascend to the lumbar region. The paralysis is never complete, but compre- hends all the muscles from the articulation of the femur with the pelvis to the foot; the flexors, supplied with nerves from the sacral plexus, are more affected than the extensors, which are supplied from the lumbar plexus. The paralysis includes the sphincter of the bladder, but not that of the rectum. Muscular co-ordination and contractility, as tested by electricity, remain intact. The cutaneous sensibility is normal, but the lumbar vertebrae are painful on pressure, and there is often a sensation of cold extending even to the sole of the foot. In certain cases the affection reaches almost to the upper part of the spinal marrow, and even the arms and tongue are paralysed. The progress of the disease may be acute or chronic, and develops itself, it may be in days, it may be in months. The nature of this disease is still very obscure ; some of the medical men in Spain who have especially devoted themselves ?
to the subject, conceive that it consists in an alteration in the anterior columns of the spinal marrow, while others regard it as similar to the acrodypia which appeared in Paris in 1828 and 1829, in Belgium in 1845, and at Constantinople during the Crimean War. Neither Pelagra, Trichinosis, Berebere, nor Ergotism, are present, and the symptoms closely approach epi- demic chronic cerebro-spinal meningitis. The symptoms and progress of the two affections are identical up to this point, that cerebro-spinal meningitis attacks principally the medulla oblongata and the upper part of the spinal marrow, while the epidemic of Aryannon is limited, except in a few rare cases, to the lower part of the spinal marrow, so that paraplegia is the most characteristic feature. The resistance of both of these maladies to medical treatment is unfortunately another point of resemblance. (The author, in the Corres- pondenz Blatt, fails to supply information as to the mental condition and pathological appearance in patients affected with the epidemic.)
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