A. SPASTIC FAMILY AFFECTIONS' 1. SPINAL SYMPTOM-COMPLEXES Family spastic paralysis of the spinal type ("hereditary form of spastic spinal paralysis," Erb) is a distinctly hereditary disease which does not always begin in childhood, its first appearance being sometimes delayed until a more mature age. Males seem to be more frequently affected with this disease than females. The symptoms are as follows: after the powe.r of walking is fully established (rarely when the child first attempts to walk) there are noticed a tendency' to become easily tired, awkwardness in going up stairs, in getting up from a sitting posture and other similar movements. Gradually the child begins to drag its feet; the feet slip along the floor and the legs are dragged after. The stride is shortened and every step is taken with great caution. I,ater on, the spasticity becomes more and more distinct, the legs more rigid, tonic tension of the muscles persists, the foot assumes the position of pcs equinus, the trunk is bent over forward, and locomotion is possible only with the aid of a cane. Although walking becomes more and more difficult, paresis is not marked in the legs, and the test for gross muscular strength yields a satisfactory: result. All the muscles of the legs are in persistent spasm (tension) and do not relax even during rest. The
patellar and Achilles tendon reflexes are greatly exaggerated and often of a clonie character; the Babinski reflex is usually positive, Hyper extension of the big toe is often present even without reflex irritation. As a rule the spastieity does not involve the arms. Sensation of every kind is intact; muscle sense and sphincter control are not affected. There is often some diminution of intelligence from the very beginning, and almost regularly later in the course of the patient's life.
The course of hereditary spastic spinal paralysis is extremely tedious. The patients do not become bedridden, or only very late, and the disease does not shorten the duration of life.
The few cases that have come to autopsy show the pathological picture of a sinrple systern-disease, with sclerosis of the pyramidal tracts. The lateral cerebellar tract and the columns of Go11 showed slight changes. The brain is intact.
A form, which, although somewhat different, nevertheless belongs to this group, was described by Jendrassick, who w-as able to demon strate as the cause of the spastic phenomena in the legs a shortening of the muscles and tendons.