Acute Infantile Spinal Paralysis

current, muscles, child, faradic, power, recovery, affected, limb, complete and hot

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The course of infantile paralysis is also very characteristic. The rapid restoration of power in the larger number of muscles affected and the complete paralysis of others is very peculiar ; also the arrest of growth, which embraces the whole of the region first affected, is a very striking phenomenon. At a later period, when contractions occur jib. the limb, the resulting deformity may be distinguished from congenital distortion by the very partial atrophy of muscles, the striking looseness of the liga ments of the joint, and the permanent coldness of the part.

Prognosis.—As infantile paralysis is not a fatal form of illness, our chief anxiety must be to estimate the chances of complete recovery in the par alysed muscles. For our owu comfort and that of the friends we may re member that complete recovery, or at any rate vast improvement, is the rule and not the exception. Careful testing with the faradic current will give us very accurate means of determining in which muscles speedy res toration of power may be anticipated, and in which of them persistent paralysis is to be feared. The muscles which have lost all physiological connection with the spinal cord no longer respond to the induced current, while they react to slow interruptions of the constant current (reaction of degeneration). This change takes place very rapidly. Faradic irritability is enfeebled as early as the third or fifth day, and is lost by the seventh or eighth.

In testing the irritability of the muscles at this period a weak current should be used—one just sufficient to cause contraction in healthy mus cles. Every muscle which does not react to the faradic current after the lapse of a fortnight from the beginning of the illness is likely to be per manently disabled. Still, according to G. Sigerson, muscles which have long ceased to contract may sometimes regain their faradic contractility and recover their power more or less completely. On the other hand, in the muscles which retain some amount of faradic irritability, however faintly they may react to the current, return of power may be confidently predicted. Even when recovery from the paralysis is complete, the child is still liable to some arrest of growth in the affected limb ; and it is well to warn the friends of the patient of this possible consequence of his ill ness.

Treatment.—If we have the opportunity of seeing the child immediately after the occurrence of the paralysis, we should keep him perfectly quiet in bed, clear out his bowels with a brisk aperient, and employ counter irritation to the region of the spine. By the repeated application of mus tard poultices, first to one part, then to another, of the spine, a derivative action may be kept up as long as the skin will bear it. During the early days of the disease it is well to insist upon a prone position, varied occa sionally by laying the patient on his side. The dorsal position, which favours congestion of the vessels within the spinal canal, should, if possi ble, be avoided. The child should be put upon a diet of milk and broth, and care should be taken that his bowels act regularly once a day. While

there is any fever Dr. Althaus recommends a daily subcutaneous injection of a solution of Bonjean's ergotine—a quarter of a grain for a child of twelve months. At first no local treatment is admissible to the paralysed muscles ; and the faradic current should be used only for diagnostic pur poses and not as a therapeutic agent. But immediately any recovery of power begins to be noticed, we should employ the faradic current daily, so as to aid the restoration of the affected muscles. If there is at first no ke sponse to the induced current, the continuous current, with slow inter ruptions may be employed. It is advisable to use a current of sufficient strength to cause a visible contraction of the muscles. . This, however, is often impossible with children. Even a weak application may cause such agitation and alarm that its employment has to be discontinued. We should not in any case use a strong current at first. Probably a weak current, in its influence upon the nutrition of the muscle, is preferable to none at all. Dr. Gowers recommends that in the beginning such a strength should be employed as the child will bear without much emotional disturb ance, and if care be taken not to alarm the child at the first, a current of con siderable strength can be perhaps made use of afterwards.

Besides electricity other means should be used. The paralysed limb must be kept warm with cotton wadding. This is a matter the impor tance of which has been very properly insisted upon by Dr. R. J. Lee. If the affected parts are very cold, they may be rubbed several times a day before the fire ; and hot applications of any kind—bags of hot salt, bran, hot flannel, etc., may be kept in contact with the limb to maintain its tem perature. Great assistance will also be derived from vigorous shampooing. It is advisable to order stimulating liniments for this purpose, as frictions are always employed with more energy if something is given " to be rubbed into the skin." The child should be also encouraged to use the weakened limb as much as possible ; and Volkmann insists strongly upon the worse than uselessness in these cases of crutches or other forms of mechanical support.

It is usual to give strychnia to these patients, either internally or by subcutaneous injection. The remedy has probably little influence in re storing power to the disabled muscles, but as a general tonic its use may be not without value during the stage of recovery. It may be combined with iron and quinine.

In most cases of infantile paralysis, when recovery does not take place within the first two months, the course of the disease is long and tedious, and improvement goes on but slowly. Still, our efforts are eventually re warded by a striking return of power even in cases which at first had ap peared almost hopeless.

The cure of the deformities resulting from atrophy and contraction of muscle come under the department of the surgeon.

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