Remarks on Functional Hemiplegia in Child-Bearing Women
Authors: T. C. Allbutt
Journal: BMJ (1870)

A NUMBER of cases, which may be included under some one name like the above, have occurred in my practice of late.As they seem to con- stitute an uniform clinical group, to have a serious aspect and yet to be curable by appropriate means, I have thought it well to bring these cases together for the consideration of this meeting.I shall best introduce the subject by reading a few brief notes of one of the cases, in order that the group of symptoms of which they consist may be distinctly set forth.Mrs. G. E., aged about 2;, came first under my care on the 12th of November, I869.She was a patient of Mr. Cumberbatch, of Cadogan Place, and had been confined under his care in the previous June.It was, I believe, her first confinement, but was in every way normal, and, as Mr. Cumberbatch informed me, was followed by no ill consequences.A short time after her recovery, she came into Yorkshire, supposing herself to be in good health.Almost unperceived by herself, however, some weakness began to appear in the left arm and leg, and became slowly worse.This weakness or weight she preferred to call numbness, and it was associated with much tingling; there did not seem, however, to be any decided loss of tactile sensibility.The tingling was severe and annoying, and frequently was associated with neuralgic pains or shocks, which were very sharp.These pains were chiefly confined to the left arm and leg, but were sometimes felt also in the left inframam- mary region.She could walk perhaps a mile, or even more, but this exertion is followed by a " dead aching" in the arm and leg.The arm was always decidedly weak, and she avoided the use of it.There were no other nervous symptoms, unless it were that she con- fesses to a good deal of "nervous irritability."Her aspect and manner were, however, cheerful, and there was no emotional peculiarity.Her general health did not seem satisfactory ; she ate badly, and there was some loss of weight.The tongue was pale, flabby, and rather tremulous; there was a good deal of " distension", and the bovels were confined.There were no symptoms of local disease in the lungs, nor was there any hectic.As this was not by any means the first case of the kind I had seen, I was able to assure Mrs. E. and her friends that there was no cause for alarm, and that I fully hoped to relieve her symptoms in a few weeks.The baby had, I think, been weaned a short time previously.I or- dered a liberal diet, with pepsine, mineral acids, and strychnine, and a frequent pill of aloes, belladonna, and capsicum.Under this treatment, with little variation, she completely recovered in the course of a few weeks.The principal features, then, of this case, which is a good instance of the class, were left hemiplegia, neuralgia and other disorders of the sensation in the same parts and in the inframammary region, general debility, flatulence, and constipation.The worst case of the kind wlsich I have seen was that of Mrs. S., who was under the care of Dr. Bronner, of Bradford, when I saw her early in 1869.To relate the whole of her history in detail would be tedious and unnecessary.Suffice it to say that symptoms of the same kind-left hemiplegia with disordered sensation, disordered bowels, inframammary pain, and general debility-were present, with absence of any symptoms directly referable to the head.These had followed a previous confinement, and had shown themselves most rebellious to treatment.She was now some six or seven months advanced again in pregnancy, and since its commencement the symptoms had become worse.When I saw her, walking was a labour and sorrow, and her gait was quite unsteady.She complained much of the " numbness and weight" in the limbs, and was much depressed in spirits.On reviewing the whole circumstances, I informed her that, although her state was one to give rise to much anxiety and apprehension, nevertheless I was prepared to take the responsibility of assuming that there was no organic disease, and of hoping that, her confinement once over, she might be restored to health.Some weeks afterwards, a very eminent physician saw Mrs.