Paralysis or Palsy

The muscular dystrophies may be divided into two groups ac cording to the period of life in which the malady manifests itself : (I) Those occurring in childhood ; (2) those occurring in youth or adult life. In the first group the muscles may be atrophied or apparently hypertrophied. In the latter instance the child looks like an infant Hercules, with abnormally large calves and but tocks, yet it stands with its feet widely separated; waddles along rather than walks; 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, there is little hope of the patient reaching adult life.

Paralysis Agitans,

otherwise known as Shaking Palsy or Par kinson's Disease, this is a chronic progressive disease of the nervous system occurring late in life, and characterized by weak ness, tremors and stiffness of the muscles associated with a peculiar attitude and gait. The first sign of the disease is weakness fol lowed by tremor of one hand ; this consists of continuous move ments of the thumb and forefinger as in rolling a pill, or of move ments 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. 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.

are certain principles in the treatment of all forms of paralysis which may be summarized as follows.

I. Rest in bed and attention to the vital functions of the body, the heart's action, the respiratory functions, nutrition and ex cretion. 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 un avoidable, 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 pro tective 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 move ment 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 connection of the brain with the muscles through the point of interruption or by a new path if that is not possible.

(F. W. Mo.) For bibliography see Thomas L. Houlton, "General Paralysis" (Archives of Neurology and Psychiatry), 1927.