HEMIPLEGIA.
The treatment is in its first stage that of Apoplexy, which has been detailed under its own heading. The management of the case after the symptoms of shock or coma have passed away consists in a judicious remedying of such complications as constipation, rentention of urine, tendency to bedsores, insomnia or restlessness. Mental as well as physi cal repose is essential as long as the danger of a second seizure is probable, and it is a wise precaution to restrict the diet, as in cases of head injuries, to farinaceous food and milk, avoiding alcohol in every form and strong tea and coffee.
The period of absolute rest in bed is liable to be unduly prolonged, and though no routine rule can be laid down for the guidance of the physician on this point it will be advisable to get the patient to a sofa or couch within a fortnight after his seizure has occurred when this is possible.
Drugs at this stage are usually administered with the view of absorbing the clot in the cerebral tissue or in the occluded artery, but there is little evidence of their utility; no harm, however, is liable to arise from a mild course of Iodides, and since more or less restlessness or cerebral irrita bility may be present, Bromides may be combined with them. Strych nine must be avoided; any action which it exercises in the early stages is an injurious one. Organic Phosphorus or Glycerophosphates may prove useful as a restorative to impaired cerebral tissue, hut even this drug had better be avoided during the first few weeks.
The treatment of the palsy consists of measures for the preservation or restoration of the nutrition of the wasted muscles and neurons, for the prevention of articular adhesions, faulty position of the affected limbs or joints due to contraction of unantagonised muscles and fur the remedying of ataxic or disordered muscular movements.
The first stage of the treatment should be directed to the correction of the faulty position of the affected limb, which shows itself as soon as early rigidity sets in; the tendency of the arm to be drawn towards the trunk and of the forearm to be flexed at the elbow must be counteracted by placing a large pad, small pillow or sandbag in the axilla and keeping the elbow-joint extended. In a similar manner the lower extremity
should be mechanically treated by outward rotation and abduction, with flexion of the ankle and eversion of the foot.
This early rigidity or spasticity may not show itself for several weeks after the original seizure; in the meantime serious impairment of the joint and muscular movements may become established by the gluing together of the arthritic surfaces and surrounding nerve and muscular tissues. It is therefore necessary as a simple precautionary measure to begin gentle passive movements within a week after recovery from the so-called stroke. By this treatment neuritis may be prevented and the tone of the impaired muscles and their nutrition may be improved, so that wasting is reduced to a minimum.
As the early rigidity advances much may be done by the skilful appli cation of loosely bandaged splints or sandbags to counteract the abnormal attitude of the affected limbs due to excessive action of the flexors. When these are resorted to early, before marked flexion of the joints sets in, the appliances can he usually borne without discomfort, and late rigidity may be entirely prevented. (Late rigidity being always struc tural, the permanent shortening of the muscles cannot be remedied by the application of splints, which can only further increase the mischief.) The treatment of early rigidity by mechanical appliances is liable to be overdone, and unless rationally carried out had better be omitted. Thus if it prevents the employment of massage and passive movements more harm than good will result. The bandages should be removed several times a day and gentle passive movements with light massage carried out whilst the patient is still confined to his room.