of the blood; among the most important are lead, arsenic and chronic alcohol poisoning. It also occurs in diabetes, diphtheria, beri-beri and other conditions (see Neuropathology). A short description of the commonest form will be given. It occurs in chronic alcoholism and especially in women, and is most frequently due to a combination of a septic absorption from some internal disease and the abuse of alcohol. In a marked case the patient may suffer from paraplegia, but it is distinguished from the paraplegia of spinal disease by the fact that there is loss of control of the sphincters only when there is associated dementia, and that instead of the limbs being insensible they are extremely painful on deep pressure. There is wasting of the muscles, and electrical changes in them; frequently there is anaesthesia and analgesia of the skin, which takes a stocking-like distribution. In severe cases the upper limbs may be affected, and all the muscles of the body are more or less liable to be paralysed—even the heart may suffer. The mental condition in such a severe case is usually quite characteristic; there is delirium, the patient is the subject of hallucinations and delusions; there is loss of knowledge of time and place, and illusions of personal identity. A constant symptom is the loss of memory of recent events, while those of early life are easily recollected.
Paralyses—termed medically muscular dystrophies—may arise from a primary atrophy of muscle apparently independent of any discoverable change in the nervous system, but due to a congenital developmental defect of the muscles. Heredity plays an important part in the incidence of these diseases, members of the same family being affected with the same type of disease, and at the same period of life. There may be a tendency in a family to the affection of one sex and not the other; on the other hand, children of both sexes may suffer in the same family. It is curious that the majority of cases are males, and that it is transmitted by women who are not themselves its subjects. Many different clinical types have been described based upon the age of onset, the groups of muscles first affected, and the presence or absence of apparent hypertrophy; they are however all varieties of one affection, and in a case where there is an apparent enlargement of muscles there is really atrophy of the contractile muscle, fibres and overgrowth of fat and interstitial fibrous tissue; consequently this form of the disease is called pseudo-kypertrophic paralysis. The muscular dystrophies may be divided into two groups according to the period of life in which the malady manifests itself: (1) Those occurring in childhood; (2) those occurring in youth or adult life. In the first group the muscles may be atrophied or apparently hypertrophied. A progressive atrophy of muscles associated with progressive weakness and various disabilities of movement is soon recognized in the relation of cause and effect; but the parents whose first child looks like an infant Hercules, with abnormally large calves and buttocks, cannot for some time appreciate any connexion of this condition with a muscular weakness which is manifested in various ways. The child stands with its feet widely separated; it waddles along rather than walks; it falls easily and rises with difficulty, having to use the hands to push against the floor; it then rests one hand on the knee, and then the other hand on the other knee, and climbs, as it were, up its own thighs in order to assume the erect posture. In this pseudo-hypertrophic form of paralysis the outlook is very grave, and there is little hope of the patient reaching adult life.
Paralysis agitans, Shaking Palsy or Parkinson’s Disease is a chronic progressive disease of the nervous system occurring late in life, and characterized by weakness, tremors and stiffness of the muscles associated with a peculiar attitude and gait. The first sign of the disease is weakness followed by tremor of one hand; this consists of continuous movements of the thumb and forefinger as in rolling a pill, or of movements of the hand like beating a tom-tom; then the other hand is affected, and later there is tremor at the ankle. In some cases there is a continual nodding movement of the head. These tremors are at the rate of five per second and cease during sleep. The attitude and gait are very characteristic; the head is bent forward, and the patient in beginning to walk takes slow steps, which soon become short and quick as if he were running after his centre of gravity. The intellect is clear and in marked contrast to the mask-like expression. This disease lasts for years, and but little can be done in the way of treatment, except passive movements of the limb to prevent contracture.
Treatment.—There are certain general principles in the treatment of all forms of paralysis which may be summarized as follows.
1. Rest in bed and attention to the vital functions of the body, the heart’s action, the respiratory functions, nutrition and excretion. The pulse is the best guide to the administration of drugs and stimulants. As regards the respiratory function, one of the dangers of paralysis is an intercurrent pneumonia—sometimes unavoidable, often due, however, to attempts to give nourishment to a patient in an insensible state, with the result that some of the fluid enters the bronchial tubes, when either the reflex protective coughing is not excited or is ineffectual. Attention to the bowels and bladder is most important. A purge at the onset of paralysis is indicated when the pulse is full and of high tension, and the regular action of the bowels is necessary in all conditions. Retention of urine should be carefully avoided, if necessary by the passing of a catheter, but too much emphasis cannot be laid upon the importance of adopting aseptic precautions to avoid infection of the bladder. Daily inspection of the back should be made of all paralysed patients, and precautions taken to keep the skin of all parts exposed to pressure clean; the back should be laved with eau-de-Cologne or spirit to harden the skin. Any sign of a red spot on the back or buttock of the paralysed side should be a warning note of the possibility of a bedsore; zinc powder or ointment should be applied and the effect of pressure on the part be removed if possible by change of posture and by the use of a water-bed. It is important to cover all warm bottles with flannel, for owing to insensibility large blisters, which heal with difficulty, may result. In cases of paraplegia the legs should be covered with warm woollen hand-knitted stockings, and a cradle employed to protect the feet from the continuous, weight of the bed-clothes, a fruitful source of foot drop.
2. As soon as the acute symptoms have passed off passive movement and massage may be employed with advantage; in some cases electrical treatment is indicated; but as a rule, especially in children, electrical treatment offers the disadvantage of being painful and not accomplishing more than can be effected by massage and passive movements. When the passive movements are being made the patient should be instructed by the operator to will the movement which he is performing, and thus try to re-establish the connexion of the brain with the muscles through the point of interruption or by a new path if that is not possible. (F. W. Mo.)
PARAMARIBO, the capital of Dutch Guiana or Surinam
(see Guiana), in 5° 44′ 30″ N., 55° 12′ 54″ W., 20 m. from the
sea on the right bank of the Surinam, here a tidal river nearly
a mile broad and 18 ft. deep. Pop. (1905), 33,821. Built on
a plateau about 16 ft. above low-water level, Paramaribo is
well-drained, clean and in general healthy. The straight canals
running at right angles to the river, the broad, straight tree-planted
streets, the spacious squares, and the solid plain public
buildings would not be unworthy of a town in the Netherlands.
The Indian village of Paramaribo became the site of a French settlement probably in 1640, and in 1650 it was made the capital of the colony by Lord Willoughby of Parham. In 1683 it was still only a “cluster of twenty-seven dwellings, more than half of them grog-shops,” but by 1790 it counted more than a thousand houses. The town was partly burned down in 1821, and again in 1832.
PARAMECIUM, O. F. Müller, (often misspelt Paramaecium,
Paramoecium), a genus of aspirotrochous ciliate Infusoria (q.v.),
characterized by its slipper-like shape, common in infusions,
especially when they contain a little animal matter. It has
two dorsal contractile vacuoles, each receiving the mouths
of five radiating canals from the inner layer of the ectosarc, and a
large ovoid meganucleus, and one or two micronuclei. From
its abundance, the ease with which it can be cultivated and
observed, its relatively simple structure and adequately large
size (1125 in.), it is most frequently selected for elementary study
and demonstration, as well as for purposes of research.
PARAMENT (Fr. parement, from Late Lat. paramentum,
adornment, parare, to prepare, equip), a term applied by
ancient writers to the hangings or ornaments of a room of
state.
