Case was called to a patient a short time ago, affected at that moment with bron chitis. lie was forty-three years of age, and at the age of twenty-four had been seized with hemiplegia. Recovering from the immediate danger of the attack, he remained hemiplegic, scarcely regaining the use of the hand and arm at all, and only partially that of the leg.
Whenever this patient is excited by meeting an acquaintance, or in any similar way, he has a little strabismus, and the hand and arm are contracted and convulsed in the most extraor dinary manner: whenever he coughs, the leg is thrown involuntarily upwards. The arm is severed, as it were, from volition, but affected by emotion.
Similar facts have been observed in regard to the influence of certain respiratory acts, but especially those of yawning, sneezing, &c.
Dr. Abercrombie details the following inte resting case in a note to the late Mr. Shaw.
" I think the following case will be interest ing to you and Mr. Bell. I had some time ago under my care, a man affected with heart plegia of the left side ; the palsy complete, with out the least attempt at motion, except under the following circumstances: he was very, much affected with yawning, and every time lie yawned the paralytic arm was raised up, with a firm steady motion, until it was at right angles with his body (as he lay in bed on his back), the fore-arm a little bent inwards, so that his hand was above his forehead at its greatest elevation. The arm was raised steadily during the inspiration, and when the expiration began seemed to drop down by its own weight, with considerable force. lie continued liable to the affection for a considerable time, and it ceased gradually as he began to recover the natural motion of the limb."—That is, as I conclude, as the state of augmented irritability was re moved by the returning acts of volition.
Not less interesting are the effects of the tonic power. In cases of hemiplegia of long duration, the paralytic limbs, but especially the arms and hands, are drawn into a state of chronic, rigid, contraction. This phenomenon is owing to the principle of tone constantly acting upon muscles now possessing augmented irntability, whilst they are never, or rarely, relaxed by acts of volition.
A similar effect is seen in idiots born with atrophied cerebrum : the influence of volition is wanting; that of the spinal marrow, the source, at once, of the tone and of the irrita bility of the muscular system, is in constant action, and induces chronic contraction, an effect which must, however, be distinguished from that of spasm, which is excited imme diately by some disease of the spinal marrow itself.
I may now resume the subject of the action of strychnine on paralytic limbs. It is obvious that the generalization of M. Fouquier, M. SC galas, and others, that the strychnine attacks the paralytic rather than the healthy limbs, was too hasty. This is only true in those cases of paralysis in which the muscles still remain in nervous connexion with the spinal marrow ; the opposite result is observed in those other cases in which such connection between the muscles and the spinal marrow is intercepted.
I would here make another observation. The arms and hands, generally speaking, are more under the influence of the cerebrum than the lower extremities ; and these, on the other hand, are more under the influence of the spinal marrow than the arms and hands. The superior extremities are more and more fre quently affected by hemiplegia than the inferior; these are more influenced by tetanus, by strychnine, &c. than the former, a fact which I have obserVed, in regard to strychnine, in some cases of hemiplegia. These facts must be borne in mind in making our observations.
Another circumstance must also be noticed. The more perfect the paralysis, generally speaking, the more the irritability of the mus cular fibre is augmented. In hemiplegia, the arm is generally at once more paralytic and more irritable than the leg. In chronic cases, however, the irritability becomes impaired, together with the nutrition.
I will now adduce a few cases which, how ever succinctly detailed, will exemplify and substantiate the preceding observations.
Case 2.—On January the 16th, 1839, I visited a patient who had been seized with hemiplegia nine months before: the arm was perfectly paralytic, the leg less so, the face less so still. On passing the galvanic influence through the arms, the left or paralytic arm was much more affected than the right, and dis tinctly affected by a force which induced no effect whatever on the right, the tendons start ing on each completion of the galvanic circle; the contraction of the muscles of the left side of the face was seen in its effect on the features; and that of the left gastrocnemius, in its effect on the tendo Achillis, when no effect was per ceptible on the right side of the face, or in the right leg.