PARALYSIS FROM PROGRESSIVE MUSCULAR ATROPHY.
As this form of wasting palsy is due to a sclerotic degeneration of the entire motor tract, especially of its lower segment, little can be expected from any form of treatment. Nevertheless, by general attention to health laws, careful feeding and judicious nursing the fatal issue may be retarded. Gowers believed that by the hypodermic administration of Strychnine the degenerative process may be arrested for a considerable period, and the writer has satisfied himself of the truth of this statement, though the ultimate fatal issue is always to be counted upon. In the spastic type of the disease massage and passive or resistance movements are sometimes beneficial, though useless in the atrophic form of the disease.
Progressive Bulbar or Glosso-labio-laryngeal Paralysis, showing itself as a primary degenerative process commencing in the bulbar nuclei or appearing as an extension upwards of the disease in the motor tract which afterwards invades these centres, is practically beyond the reach of treat ment. The degeneration attacks the nuclei of the hypoglossal, spinal accessory, vagus, portions of the seventh and sometimes of the fifth nerves. An immediate danger to life is always present owing to the difficulty in deglutition, whereby food may find its way into the air passages. Hence
the necessity of the most careful attention to the feeding of the patient; pultaceous food should be skilfully administered, solids and liquids being more liable to enter the larynx and produce suffocation or aspiration pneumonia. When liquids are necessary they should in the advanced stages of the disease be administered through the nasal tube.
Strychnine hypodermically and a galvanic current applied to the medulla by placing the electrodes over each mastoid process sometimes improves the power of swallowing, or the positive pole may be placed over the nucha and the negative applied to the affected muscles. Atropine or Belladonna checks the secretion of saliva, but generally produces much discomfort from drying the mucous membrane of the mouth and pharynx.
The treatment of Acute Apoplectiform Bulbar Paralysis should be conducted upon the same lines as apoplexy or cerebral haemorrhage. This remark also applies to the treatment of pseudo-bulbar paralysis seen in lesions of a bilateral type attacking the motor path in the cerebral hemi spheres and leaving the medulla intact.