HISTORY

OF A SINGULAR

NERVOUS OR PARALYTIC AFION,

ATTENDED WrIT

ANOMALOUS MORBID SENSATIONS.

COMMUNICATED BY

DR. MARCET, FOL SEC. &c.

Read Dec. 18, 1810.

THE gentlemn who is te su4ect of the follow.ing singular case is Dr. Vieusseur, an eminent Phy.sean of Geneta, who studied Medicine in Edin.-burgh and London, aboutforty years ago, andagain visited this country in the autumn of 1810.Whdlst in London, he was induced to draw up andcommunicate to the Society the particulars of hisown case, which he has since authorized thle Cou-cil, through Me foreign secretary, to publish inti volme.

HISTORY OF A

A physician *, sixty-two years of age, of activehabits of life, and addicted to no kind of intem-perance, of a healthy though rather bilious con-stitution, and for many years past subject to slightrheumatic pains, which however had not inter-rupted his professional pursuits, was seized on the29th of December, 1807, with a pain in the gum,just under the third double tooth, on the left sideof the lower jaw. The pain continued severe dur-ing 24 hours, then the part swelled, -and but littleuneasiness remained; but he could not eat anyfood that was at all hard, even though he did notchew it with the diseased tooth. He continuedto go out as usual, though the weather was verycold.

On the fourth of January, 1808, he felt, whilstat dinner, rather an acute pain in eating a piece ofmeat; this pain quickly subsided, but was followedby a general sensation of cold, which obliged himto rise from table to warm himself, though the roomwas heated by a stove. He soon returned, how-ever, to finish his dinner. In the evening at sixo'clock, whilst visiting a patient, he suddenly felta slight pain in the swelled gum, and an extremelyacute one in the internal angle of the left eye;this pain lasted a few seconds, then ceased, but

# Dr. Vietusseux's statture is of middle size; his neck is rathershort, and his frame strong, though not corpulent. He is of afair complexion, and of a sanguine habit.

218

SINGULAR NERVOUS AFFECTION.

returned in a short time with increased violence,and attended with the following symptoms: apeculiar and inexpressible perturbation in allhis sensations; a giddiness which made him seeobjects reversed, and occasioned feelings similarto those produced by a ship violently agitated,such as sickness and vomiting. These were fol.lowed by intestinal evacuations, and by a completeloss ofhis voice, which rendered his speech almostunintelligible, though without affecting his power ofarticulation. He also experienced a considerabledifficulty in swallowing liquids, when in small quan-tities, and a sensation of weakness throughout theleft side, with a numbness in the hand and the leg.He was able to walk, however, supported by twopersons, but dragging his left leg; and the motionof the fingers, though benumbed, continued free.In this state he was with some difficulty conveyedhome in a chair. After being put to bed, he foundhimself free from pain, and observed that he couldmove all his limbs, although he continued to ex-perience the same giddiness. His intellectual fa-culties however remained quite unimpaired, so thathe could accurately observe the whole successionofsymptoms. On examining himself he discover-ed, that the whole of his right side was so insensi-ble, that he could be scratched or pricked, with-out experiencing any pain; and that this insensi-bility abruptly terminiated at a line dividing thewhole body in a vertical direction.

2119

0HISTORY OF A

The pulse being neither full nor hard, and notexceeding 90, and the countenance being ratherpale, the patient was not bled, but three leecheswere applied to each temple, a blister to the back ofthe neck, and one to each leg; and a julep withaether and tincture of amber were administered.

The night passed without accident; the nextmorning he took some emetic tartar; but the samedifficulty that he had in swallowing, he seemed toexperience in vomiting, and it was only by assum-ing a particular attitude, and turning himself onhis left side, that he succeeded in vomiting, anoperation which had the effect of considerably di-minishing his giddiness.

In the course of the day, the diseased tooth wasextracted, and about half a spoonful of blackblood was discharged from the gum by that opera-tion. The swelling did not immiediately diminish,but it subsided in the course of a few days. Theroot of the tooth had lost its polish, apparently bythe effect of the suppuration ofthe gum.

The third day a blister was applied to the head.On the same day he began to be effected with aviolent hiccup, which lasted till the seventh day,and for which he desired to have leeches applied tothe fundament, as he had seen this treatment suc-ceed in removing that particular symptom, and

220

SINGULAR NERVOUS AFECTION.

because it appeared to him that the continualirritation of the diaphragm might occasion con-gestions of blood, although such a state might nothave prevailed, in the first instance. He lost about18 ounces of blood by the leeches, contrary to theadvice of his medical friends, who had prescribed,or rather consented, to a much smaller evacuation.The effect of these evacuations was completely tocure the hiccup, which returned no more, andyet the patient was not weaikened by this treat-ment. A number of antispasmodics had been pre-viously tried without success.

The disorder went on afterwards for -about threeweeks, in the form of a bilious fever, that is,nausea, want of appetite, and foul tongue, withan apththous state ofits surface. The patient wasput under the usual plan of gentle evacuatiEigremedies. The appetite returned, and by slowdegrees he regained his strength without anyparalytic relapse, but without any diminution ofthe peculiar sensations which had taken place atthe moment of the attack.

These symptoms, which constituted the sihgu-larity of the case, we shall describe such as theywere at the beginning of April, which was aboutthree months after the first attack.

Left side. The left half of the head was in'

221-1

HISTORY OF A

sensible either to pricking or scratching; thisinsensibility prevailed over the left half of theforehead, of the nose, of the upper and underlip, of the chin and over the left ear. Theeye on this side was partly shut, and the cornerof the mouth slightly drawn downwards; thetongue, when put out, was turned rather to theleft than the right side, but to a very triflingextent. The hand and fingers had a sensationof numbness, as after having struck a violent blowon a hard body, particularly the thumb andthe first and middle fingers. In the whole ofthis side there was a sensation of weakness ; theleg dragged a little in walking; but it hadniot the feeling of numbness of the hand; andindeed except the peculiar affection of theface just described, the whole of the left sideof the body preserved its usual degree of sensi-bility.

Right side. The right side of the head pos-sessed the same sensibility as befbre the attack.It had experienced at first a very slight degree ofinsensibility, but in the course of three or four dayshad returned to its natural state. With respect tothe other parts ofthe body, ifa line ofdivision weredrawn in a vertical-direction from the lower part ofthe neck or upper part of the sternum, descendingforwards all the way between the lower extremities,and rising backwards up to the nape of the neck,

i-222

SINGULAR NERVOUS AFFECTION.

every part of the body on the right side of thatline was insensible either to scratching or pricking,and even to the pain that inflammation usuallyproduces; for the vesication on the right leg,which lasted and suppurated much more than thaton the other side, occasioned merely a sensationof heat, and no pain whatever, and even a boilor furuncle, which appeared after the blister, onthe right leg, wi-fh A contiderable swelling andredtiess, produced only a sense of heat and ten-sion, though under other circumstances it wouldhave proved very- painftil. A blstering plaisterWhich had been applied to the pit of the stomachfor the hiccup, gave pain only on the left side,and none whatever on the, right. zAnd in thesame manner a gathering at the root of a nail ofthe right hand, (which arose from the patient hav-ing torn off the skin without being aware of it, andwhich occasioned the loss of the nail,) producedfever and strong pulsations in the affected part,but no sense of' pain.

The sensations of heat and cold were in this(the right) side, totally different from what theynaturally are. When the patient put his right armout ofbed, the air of the room felt extremely hot.One day when he was getting better, an attendantbrought him an etherized julep, which he tookwith his right hand, and the bottle felt lukewarm;but on taking hold of it with the left hand, hefound it cold, as it really was. A new-laid egg

24HISTORY OF A

having been brought to him for his dinner, on tak.ing it with the right hand, he did not.-4it hot ibut with the left it actually burned him.

He then distinctly perceived that, to the rightside, cold bodies appeared hot, and hot bodiesappeared cold, or only lukewarm. This is to beunderstood of liquids and of polished bodies, asglass, stones or metals, or even wood with apolished surface. Thus on putting his right handinto cold wtrit .seqmd *1uke arm, and onputting it into boilinig water it appeared so farfrom hot, that -he would have kept it immers-ed without being; sgnpible .Q its scalding him,had not a disagreeable sensation, diff&ent fromthat of burning, at length warued him to with-draw it.'

But when he touched bodies that were not hardor polished, as tl{e hand of another person, hecould not judge of its degree of warmth, it ap-peared neither hot nor cold, and he was obliged totouch it with the left hand, in order to ascertainits temperature.

Nevertheless he had in no degree lost the senseof touch, and he could perfectly feel the pulse ofa patient with his right hand, and judge of itsfrequency and of its strength; but in order toknow the heat of the skin, he was obliged to haverecourse to his left hand. This depraved sensation

224

SINGULAR N1R'votJg APFECTION2

extended over all the right side; and consequentlyon putting him into a cold bed, it appeared hotto the -right side, and cold to the left. In gettinginto a hot bath, it felt hot to the left side, andneither hot nor cold to the right ; and in plunginginto very cold water, which he did at a subsequentperiod, the water appeared almost warm to his rightside, but very cold to the other.

He had often a sensation of cold water all overhis face, especially when in the open air, which in*duced him to wipe himself as if he had been wet.

His sleep was good, and he generally rose inthe morning with a clear head; but in about anhiour it became somewhat confused; it was neitherhieadach nor vertigo, but something approachingto the feeling experienced after looking steadfastlyat the sun, or after drinking mnineral waters whichdo not pass away, btit affect the head. This state,however, generally went off after dinner, parti-cularly after drinking wine, and though he wasaccustomed t,o sleep in the afternoon, he arosefrom this sleep with his head clear, and continuedwell all the rest of the day. He felt no uneasiness even in hot rooms at night: in a numerousassembly, indeed, it happened to him as to others,to feel his head somewhat affected; but this wentoff of itself, even whilst remaining in the hotcrowded room. His voice was very faint, so asto render his speech often unintelligible. lThere

VoL. .Q

'04

2IISTORY OF A

was also some derangement in the functions of thecesophagus; solid or liquid food--passed with ease,but that of an intermediate consistence, as pud.ding, thick soup, or soaked bread, descended withconsiderable difficulty.; and frequently, particularlyat night, the food returned into the mouth by akind ofrumination.

It would be tedious to relate all the remedies hetook during thisi llness; they were chiefly of theantispasmodic and tonic kind, such as bark, va-lerian, assafoetida, camphor, volatile tincture ofguaiacum, compound spirit of lavender, variouschalybeates, stimulating frictions, &c. &c. Theseremedies, which he used in considerable doses, andduring a length of time, did not afford him any cri-tical relief; but yet whilst taking them, his healthgradually improved.

He used electricity during three months in theform of sparks. This remedy having been re-sorted to on rather} vague indications, and notappearing to afford any distinct relief, he inter-rupted it for a fortnight; but he then felt weaker,and having returned to it, he found himself bene-fited by it. The sensations produced by the sparkswere much less vivid on the right side than on theleft.

The winter of 1808 was extremely severe; andthe snow remained on the ground till the end of

226

SINGULAR NERVOUS AFFECTION.

march, which prevented his going out on foot, andrendered evending in a carriage cult. It wasnot tiUl he could go out in the air every day, thathis general health sensibly improved.

In the middle of June 1808, he went to thebaths ofAix, in Savoy, and took hydrosulphuratdAdouches at the temperature of 1060 or 108° ofFabrenheit. He returned thither in September,and daring the interval, that is to say, in Julyand August, he bathed in the Are, a river formedby the melting of the snow on the summits ofthe Alps, the temperature of which is not abovefrom 520 to 560, even when the atmosphere is be-tween 80° and 9. Both times, previous to goingto Aix, he took the precaution of applying leechesto the anus, in order to prevent the head frombeing affected by the heat and vapour of thewater.

The bot douclhes and the cold bathing thus usedalternately, appeared to have little effect on theimmediate symptoms of the disease; but the pa.tient's strength and general health improved con-siderably, so much so that he had every appear.ance of health, and could act and walk as usual,but was unable to run.

Prom this time his health continued constantlyto improve, and though the peculiar symptomsstill remain, yet the digestive and muscular powers

Q2~~P

227

HISTORY OF A

being restored, the patient bears these with muchless inconvenience, so much so indeed, that hesrcely perceives them when he is not directighis attention to the subject, and particularly duringthe latter part of the day.

He has continued to bathe in the river duringall the hot and temperate season, and has discon-tinued it only in the winter; and even then, whenthe weather has been relaxing, he has used thecold bath at home, and has been always carefulto wash his head with cold water. He has occa-sionally taken aloetic pills, and has found themusefiL

In 1809, being still subject to the peculiarsensations in the head formerly described, espe.aialy about an hour after rising, it occurred to

him that, as this symptom was nervous, if hecould, previous to its coming on, excite by arti-ficial means an analogous state, he might pro-bably avoid the recurrence of the morning pa.roxysm. l?or this purpose he tried smoking, whichhe had never been accustomed to. He smokedabout halfa pipe, the effect ofwhich was to producethe peculiar giddiness which usually takes place onsmoking for the first time; at the same time agrateful warmth pervaded all his limbs on both sides.This state gradually subsided, and he actually gotrid of his giddiness that day sooner than usual.He therefore continued to smoke almost every

228

SNGULAR NERVOUS AFFECTIoN.

morning, and has persevered in the practice to thisday with apparent benefit. The affection of thehead has been diminished, and the voice manifestlyimproved, from the very first trials.

It is now three years since this illness began, andthe following is an exact description of the state inwhich the patient finds himself at present.

The insensibility of the eft side of the face hasgradually diminished; it has ceased in the underlip, in the chin, in halfofthe cheek, and in the ear ;it remains in half of the nose and of the forehead,with a slight sense of tension and numbness;the affection of the inner angle of the eye, and ofthe corner ofthe mouth, have entirely disappeared.There is still a slight sense of numbness in thethree first fingers of the left hand, but scarcelyworth noticing. When the patient is not so wellas usual, it is in the left, and not in the right side,that he feels weakness.

Tle right side is as it was at first; the insensi-bility and depraved sensation continue as before.There is constantly a sense of heat throughoutthat side, often as if by puffs, or as if hot clothswere suddenly applied to the parts. At first thepatient thought that this portended some improve-ment, but he has found no effects to result fromit either good or bad. Cold bodies still appear tohim lukewarm; it is not merely the absence ofcold, but a positive- sensation of warmth; and hot

229

HISTORY OF A

bodies feel almost cold, at least neither hot norcold. This side appears to have more vital actionthan the left side; it perspires more easily; theear on the right side secretes double or triple thequantity of wax that the other does; and in gene-ral there is in that side a greater sense of energyand vigour.

This side does not appear to be susceptible ofpain. It has been already stated that the inflam-mation and suppuration occasioned by the blisters,by the boil, and by the whitlow, produced only asensation of heat and tension, without any pain.It is the same with every kind of injury, whetherby a blow, or by solution of continuity. A scratch-on the little toe, followed by inflammation, swell-ing and suppuration, produced only a sense ofheatand tension. The prick of a thorn in the bone ofthe leg, which bled a good deal, produced onlythe sensation ofan obtuse body.

The patient continues to be occasionally afflictedwith rheumatism, but the pain is felt only in theleft side. In the right it occasions only a sensationof local weakness, attended with an undefinablefeeling of heart and itching, but without pain. Alumbago, to which he is frequently subject all overthe region ofthe sacrum, is painful only on the leftside, though he is very sensible that it exists also onthe right side. When the cramp seizes him inthe calf of the right leg, the sensation producedis widely different from the acute pain which he

2s0

SINGULAR NERVOUS AFFECTION.

experiences when the left leg is affected by thesame cause. He has no longer a sensation of coldwater over his face. He walks with tolerablefirmness, but would not be able to run. A slighttendency which he had to oedema, in both legs,but more particularly in the right, has entirelyceased, though the patient has lately taken a longjourney in a post-chaise. The voice, though muchimproved, is still hoarse. The deglutition ofbodiesof soft consistence is not perfect. The peculiarsensations in the head return almost every morn-ing, and generally continue throughout the day;but in a much less degree than formerly, and theygo off after eating, particularly after drinkingwine. Sometimes it has appeared to him thatthe right side of the head was most affected: butthis so indistinctly, that he cannot draw any posi.tive inference from that remark. The cloudyatmosphere and damp weather of England, andperhaps the smoke of coal fires, appear to beunfavourable to the clearness of his head, thoughthey have by no, means impaired his powers ofattention in reading, writing, and the pursuit ofhis usual studies. Seasons more decidedly hot orcold are those which agree with him best.

On reflecting on all the circumstances of thecase, the following is the opinion which the patienthas formed of his situation.

The principle appears to have been catarrhal,and to have originated in the diseased tooth. The

aM

HISTORY OF A

disease in many respects may be compared to aparalytic attack, but it differs from it, 1st, becausethe motion of the affected parts has always beenfree, notwithstanding their diminution of power,and depraved sensations; 2dly, because therehas been no paralytic affection of the tongue;sdly, because there has been no affection what-ever either of the intellect or of the memory, andthat the patient has never articulated one word foranother; 4thly, because there has been no in-clination to depression of spirits or effusion ofsensibility, such as commonly occur in this disease;5thly, because the complaint still exists, and thatso slight a paralytic attack either would have beencompletely cured, by such a general amendmentof health, or there would have been a relapseduring the three years that the illness has lasted.

From all these considerations he is inclined tobelieve, that his disorder is only a peculiar nervousaffection; and that the brain was not originallyaffected as is the case in paralytic attacks. Hewell recollects having seen a patient labouring un-der hemiplegia, who retained his power ofsensationin the palsied side, and not in the other; but itwas a complete case of hemiplegia, in which thebrain was visibly affected, and which terifiinatedin death,

In this case there seems to have existed, as itwere, two distinct kinds of paralytic affections:onbe on the left side, the other on the right.

232

SINGULAR NERVOUS AFFECTION.

That of the left side bears the most resemblanceto hemiplegia, and appears to have attackedthe muscles. The face, on that side, had, fromthe beginning, a sensation of stiffness and tensionwhich it still preserves, though to a smaller ex-tent. Although the motion of the fingers isfree, there is, however, either in bending orextending them, a sense of numbness, which isstill perceptible in the three first fingers. Inshort, the patient has constantly a feeling of com-parative weakness in the left side, and if he isthreatened with hemiplegia, he thinks it is rather-in that side than in the other.

The affection of the right side is merely cuta-neous, and does not seem to extend to the muscles;for there is no kind ofnumbness or stiffness in theirfunctions. These differences, however, are notstrictly confined to each side; for the muscles-onthe right side participate in some degree in theinsensibility which pervades the cutis; as appearsfrom the absence of pain when they are affectedwith spasm or rheumatic inflammation. This con-dition of the muscles appears to be limited tothose that are superficial; it does not extend, forinstance, to the fibres of the intestines or bladder.On the left side, too, the paralytic affection of theforehead and^ neighbourhood of the eye, is notmerely muscular; since the eye and forehead onthat side are insensible to the impression of ice.There is, no doubt, some muscular fibre palsied inthe cesophagus,' and in the larynx, as deglutition

23-

HISTORY OF A

is not perfectly free, and the voice is still hoarse.The patient does not attempt to explain the de.praved sensations of the right side; he is satisfiedwith relating the facts, and leaves it to moreskilful anatomists to explain which are the nervesaffected on either side.

He believes that the peculiar sensations of thehead arise from a derangement of equilibrium inthe distribution of the nervous influence , sinceevery circumstance which- contributes to the im-provement of his general health, tends to restorethe natural state.

Thus he feels well at night when in bed, and inthe morning after sleeping. He is worse afterbeing up some time. He is better after his meals,particularly after having drank a moderate quan-tity of good wine. He feels well in a carriage;it has the effect of carrying off the uneasiness ofthe head; and owing to this circumstance he hassuffered little from the fatigue of his journey.These uneasy sensations in the head which areproduced by a hot or crowded room, subside afterhaving remained in it some time; and this atmo-sphere which incommodes others, ultimately does-him rather good than harm. This circumstanceseems to shew that there is no organic affectionof the brain. But the patient is well aware, thatalthough this state of the head may not arise fromany local cause in the brain, yet the frequent re-currence of this symptom, might in the end prow

234

SINGULAR NERVOUS AFFECTION.

duce a local congestion, which he ought to useevery precaution to prevent.

These details may, perhaps, be deemed to haveextended to too great a length; but the case ap-peared to the narrator sufficiently singular to inducehim to comply with the request of his friend Dr.Marcet, that it might be presented to this learnedSociety; and he will be happy to satisfy theinquiries ofany ofthe members present, who shouldwish for further information with regard to thefacts he has related.

Postscript to tMe 3d Edition; by Dr. Marcet, May, 1816.

Dr. Vieusseux continued nearly in the state above describedtill April 1813, when he was suddenly seized with great debility,especially in his left side (all the motions of which however re-mained free), with giddiness, and palsy of the mouth and tongue.He soon recovered from the paralytic affection ; but a greatdebility remained, and a sense of lassitude in his head, which wasalways greatly relieved by taking food. About this period, hebad a severe ophthalmia in his left eye, which however occasioneduo pain; for the insensibility of that side, and all the peculiaritiesdescribed in the case, continued to prevail to the last day of hislife. In September 1814, he was suddenly seized with severesymptoms of fever, attended with extreme weakness, and with asensation of beat in the brain, but without the least diminution ofhis intellectual power, and without any cbange in the singularcircumstances of his original disorder. On the 20th of the fol-lowing month, he died in a state of complete exhaustion, aftertwo days of a lethargic sleep. It is much to be regretted thathis head was not opened. (Extraced from the BibliothAgucBrita que, 1815.)

6

235