Bauhaus-Universität Weimar

Titel:
Dictionary of philosophy and psychology including many of the principal conceptions of ethics, logics, aesthetics ... and giving a terminology in English, French, German and Italian, vol. 2 [lead-zwing]
Person:
Baldwin, James Mark
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29448/282/
PARALYSIS 
course/ or a course with the appearance of 
extensive delusional fabrications and the per¬ 
formance of absurd enterprises and even 
criminal actions. Such abnormal conduct is 
due in part to the progressive defect of 
memory and of judgment ; or it is a feature 
of an expansive excitement (in rare cases 
of depression), presenting the well-known 
megalomania in ideas of enormous wealth and 
strength, inventions, schemes, ability to raise 
the dead, &c., or delusions of the most abject 
misery ; or it may begin like a case of paranoia, 
or as epilepsy. A further characteristic possi¬ 
bility is the occurrence of peculiar attacks of 
convulsions, or apoplectiform stupor. Hallu¬ 
cinations and truly depressive episodes are 
rare. 
There is hardly a symptom or symptom- 
complex that will not occur occasionally in 
a case of general paralysis (see the enumera¬ 
tion of symptoms in Mickle’s article in Tube’s 
Dictionary of Psychological Medicine) ; and 
the disease well illustrates the necessity of 
a distinction between the concepts disease- 
process and essential and casual symptoms (cf. 
Psychoses). Occasionally the downward 
course is arrested for some time, and in 
rather rare cases a complete remission occurs, 
leaving hut little or no defect, so that it might 
represent a recovery if it did not end in the 
final fatal relapse with almost absolute cer¬ 
tainty. 
It should be noted that hut few cases of 
syphilis develop into general paralysis. There 
is at present no adequate basis for ex¬ 
plaining the course of the development of the 
disease in individual cases ; why in one case 
of infection no further symptoms ensue, and 
in another, perhaps after six or more years, 
locomotor ataxia or general paralysis ; and in 
the latter case, why the disease takes the 
spinal ataxic form (with early absence of knee- 
jerks) or the cerebral form (with exaggerated 
knee-jerk), or begins with epilepsy or attacks 
of transitory aphasia ; or why it assumes an 
•expansive, pai’anoic, or purely demented type. 
Although pathological histology gives a clear 
picture of decay of nerve elements, and especi¬ 
ally of increase of neuroglia and alteration of 
blood-vessels, there is still great difference of 
opinion as to which one (if any) of these lesions 
is the primary process ; the diffuseness of the 
lesion over the whole nervous system makes it 
also quite difficult to establish even a parallel¬ 
ism between the lesion and the symptoms, 
■except in the most general way. (a.m.) 
Lesions of Paralysis. The causes of paralysis 
vary between wide limits. An inflammation 
of the spinal cord (myelitis) or of the peripheral 
nerves (neuritis) may produce an acute as¬ 
cending (Landry’s) paralysis in which control 
over the muscles of the legs, trunk, arms, and, 
finally, of the head, is progressively lost. In 
cases of sclerosis of the lateral columns of 
the cord a motor paralysis with increase of 
tendinous reflexes, known as spastic spinal 
paralysis, occurs. 
Bulbar paralysis—of the motor centres of 
the medulla—results in interference in articu¬ 
lation, deglutition, and innervation of the face 
and eyelids. Degeneration and atrophy of 
the cells of origin of the glossopharyngeal and 
facial nerves, as well as atrophy of their root- 
fibres, are features. 
Cortical paralysis due to injury or disease 
of the motor areas requires no other explana¬ 
tion. Purely functional motor and sensory 
paralyses in hysteria must be looked upon as 
cases of abnormal central inhibition allied to 
hypnotic disassociation. Lead poisoning and 
other intoxications give rise to localized peri¬ 
pheral paralyses, the aetiology of which is 
obscure. 
General paralysis (dementia paralytica 
progressiva) is primarily a disease of the 
brain, and one in which characteristic lesions 
rarely fail to be developed. Syphilis is 
the most prominent cause. It is still a 
question whether the primary lesion is in the 
nervous, vascular, or sustentative (neuroglia) 
system, as all are affected. In the case of 
alcoholic paralysis the circulating medium 
is thought to form the point of departure. 
The vascular troubles begin with hyperaemia, 
which passes into an inflammatory condition 
of the walls. These are associated with de¬ 
generative changes in the specific nerve-tissue 
and proliferation and swelling (afterwards 
shrinking) of the sustentative apparatus. 
While it seems to be true that the first 
demonstrable alterations in the nervous ap¬ 
paratus consist in destruction of the fine 
gemmules of the dendrites, it may be assumed 
that obscure changes are concomitantly taking 
place in the cell protoplasm. Soon well- 
marked foci of degeneration occur in the cell, 
and nodosities on the processes. The blood¬ 
vessels become distended and the walls thicken, 
and finally the adventiva cells proliferate, 
narrowing the lumen. Great dilation of the 
perivascular and pericellular lymph spaces is 
inaugurated. Inflammatory processes with 
exudation are found in late stages or acute 
cases and the meninges participate and become
        

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