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Spasmodic Spinal Paralysis

legs, joints, child, cord, columns and limbs

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spinal paralysis, sometimes called spastic paraplegia, appears from the researches of Charcot and of Erb to be due to a sclerosis of the lateral columns of the cord. The disease, which consists in a gradually advancing weakness or paralysis of the limbs—generally the legs—is some times seen in children and even in young babies ; indeed in many cases it ap pears to be congenital. Like infantile spinal paralysis the lesion is accom panied by no disturbance of the cerebral functions, no affection of sensation, and no loss of control over the bladder and rectum ; but, unlike infantile paralysis, the affected muscles seldom waste, there is excessive rigidity of the joints, and the tendinous reflexes, instead of being abolished, are in creased in activity.

Causation.—The lesion may develop itself in the earliest childhood. Its causes are unknown. Seligmueller has recorded an instance in which four children of the same family suffered from a form of the affection.

llforbid Anatomy.—No cases of death from this disease have been no ticed in children ; but in adults the symptoms have been connected by Charcot with degeneration of the lateral columns of the cord. On section of the cord the gray degeneration is seen to be symmetrical and to occupy the lateral columns on each side of the cord. The diseased region, as seen on the surface of the section, is triangular in shape, and reaches in wards to the anterior gray cornua, outwards to the pia water ; in front it passes gradually into the healthy substance of the columns. The degen eration is not in patches, but appears to be diffused over the greater por tion of the length of the cord, and may reach up to the medulla or even beyond it. In some spots the process is more intense than it is in others. On microscopical examination of the degenerated portions, the neuroglia is found to be thickened, the nerve fibres to be degenerated and wasted, and the ganglion cells to be cloudy and swollen, or atrophied, pigmented, and finally almost destroyed.

may be the age of the child when he first comes under observation, we shall generally find that the symptoms date back to the period of infancy, and that they were first noticed only a few weeks or months after birth. On questioning the mother we commonly hear that when quite a baby the child's legs were stiff, and that on this account and dressing him was a troublesome matter ; that although able to move his legs when lying down, he could never stand, and that any at tempt to do so increased the stiffness. If he did succeed in walking at an age long after that at which a healthy child can run alone, be was never firm on his legs, and soon became weaker and tumbled about. Then the power deserted him altogether, and when placed on his feet his legs be came• stiff and crossed, the toes touching the ground but the heels being raised. As there is no fever, pain, or evident impairment of nutrition, and as in many cases the mental development is satisfactory, the weakness is looked upon as a personal peculiarity which the child will " grow out of," and he seldom comes under observation until the disease is fully devel oped.

In a child so afflicted two phenomena are at once noticed: there is weakness of the lower limbs, and the joints are stiff, and become stiffer when handled.

On examination we find that the legs are moved awkwardly and with As the child lies in his cc.t the limbs are extended and only slightly flexed, and the patient may have some power of bending his joints, although some are moved with greater facility than others. The muscles feel rigid to the touch, and when the joints are forcibly flexed—which can be done without inflicting pain upon the child—they straighten again ab ruptly, as if moved by a spring. Handling the limbs increases the rigidity of the joints, and often the mere approach of the physician appears to have the same effect. Movement, whether active or passive, produces no tremors in the affected limbs. It only increases the rigidity of the muscles.

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