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atrophy observed of those muscles which are extended, but also of those which are contracted.

During infancy, paralysis frequently occurs without evident cerebral disturbance. Loss of power is occasioned of a limb, or of a group of muscles during sleep, or whilst a child is at play, without previous indication of the formidable result, and whilst it is apparently in its usual state of health. Florid, robust children are often the subjects of this form of paralysis, as well as the weak and puny.

Congestion and loss of power, or effusion and its consequences, are often traceable in children to over excitement, or to negligence and poverty.

Fractures of the skull may give rise to paralysis, either as an immediate consequence of lesion of the brain (or spinal cord when the vertebral canal is injured), or through consecutive inflammation of the meninges and brain substance.

I lately watched the following case, and cite it as an example to show the mode in which paralysis and distortion

occur.

A child, three years of age, met with a severe contusion of the head and fracture of the skull from a blow: blood was effused beneath the scalp, which concealed the depressed bone, but having been absorbed, and the thickening, which had resulted having been removed, the fractured bone could be readily traced. No cerebral disturbance resulted immediately, consequent on the fracture, and the child had entirely recovered from the concussion when I saw it. Three days after the accident symptoms of inflammation ensued. The muscles of the face were spasmodically affected, and the thumb was flexed into the palm. Some few hours later, the hand was clenched and prone; and, on the following day, the forearm was flexed, the leg was flexed upon the thigh, and the thigh upon the trunk, and the extensors of the foot were in a state of clonic spasm. Hemiplegia succeeded. Finally, the spinal column became curved, the concavity being, of course, towards the paralysed side, and the flexor muscles

of the leg and the extensors of the foot became permanently retracted. The fingers, also, were folded into the palm, the flexor muscles being retracted.

11. Myogenic Paralysis.-This form of paralysis occurs without appreciable nervous lesion, excepting atrophy of the anterior roots of the muscular nerves, which occurs probably subsequent to and is consequent on this paralytic muscular atrophy. This paralysis rarely occurs except during infancy, and is, therefore, termed, essential paralysis of infants.

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According to MM. Rilliet and Barthez, two thirds of the children thus affected are under two years of age. As far as my experience will enable me to speak, I believe it to occur comparatively rarely earlier than the ninth month, or later than the eighteenth. It is probable that, as is suggested by Bouchut, its character is rheumatic, and, also, that it is occasioned by the too rapid cooling of the body. It is sudden in its access, and is induced by exposure to cold; such as draughts of cold air during the day, or the cold night air during sleep, on throwing off the bedclothes. not unfrequently occurs during recovery from febrile and other debilitating diseases, when the child is particularly sensitive to the impression of cold. Often, the attack is preceded by more or less acute pain, which lasts two or three days; "the sensibility of the part is," then, in the words of Dr. Henry Kennedy, "wonderfully increased, and the child does not allow the limb to be touched." The subsidence of pain is accompanied by partial or complete loss of motor power in the affected muscles.

Associated muscles are affected in this form of paralysis, and the lower extremity more frequently than the upper. This form of paralysis is very variable, both in extent,

and degree, and in duration. A single muscle may suffer loss of power, or a group of muscles, or a limb, or the extremities of one side may be affected. Motor power may not be entirely lost, and sensation remains for the most part unaffected, or but little impaired. Power may be regained in the course of some few weeks, or months may pass before it is regained, or it may be only partially restored. It is rare that power is not in part restored to the paralysed limb, but this generally takes place within two or three years from the period of the attack.

In 1853, I saw a gentleman's child, who, at the age of eighteen months, on recovering from fever, suddenly lost in part the use of the extremities of the right side. The deltoid was entirely paralysed, as well as the extensors of the leg; and the muscles of the calf were in part paralysed. The child could drag itself along the floor very slowly, and its efforts caused considerable fatigue. This state had existed during three years, without alteration. By the use of baths, frictions, cod-liver oil, galvanism, and support to the weakened limbs, power was almost perfectly restored to the lower extremity; the deltoid, however, remained weak.

Contraction, in consequence of this form of paralysis, takes place slowly; and the child's health not being impaired, the attack may probably be overlooked until contraction has taken place.

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III. Solution of Continuity of the Nerve-trunk is a rare occasion of paralysis. I had occasion to see, some months since, a severe form of calcaneus, which had been occasioned by the removal of a portion of the posterior tibial nerve together with a tumour from the back of the leg extending into the popliteal space. And in a similar manner, paralysis of the various groups of muscles, abductors, adductors, or flexors of the foot, and corresponding distortions, may be

induced.

This is necessarily a rare cause of distortion, and needs only passing allusion.

Paralysis is by far the most common cause of non-congenital talipes. Every form of talipes occurs from this cause, but those which most commonly arise are equinus and equino-varus.

Paralysis of M. tibialis anticus, extensores, longus et brevis, digitorum, and peroneus tertius occasions talipes equinus, through retraction of M. gastrocnemius, soleus, plantaris, and flexores, longus et brevis, digitorum.

Again, the reverse of this, or paralysis of the extensors of the foot occasions retraction of M. tibialis anticus, peroneus tertius, and the long and short extensors of the toes, or talipes calcaneus.

And paralysis of M. peronei, longus, brevis, et tertius, and extensores digitorum, longus et brevis, causes retraction of M. gastrocnemius, soleus, plantaris, tibiales, anticus et posticus, flexores digitorum, longus et brevis, flexor longus pollicis, extensor proprius pollicis, &c., or talipes varus.

And paralysis of the adductors of the foot, or of the adductors and flexors, occasions retraction of the peronei, or of the abductors and extensors of the foot, or talipes valgus.

It will be at once understood, however, that paralysis and distortion are found in every degree, and vary exceedingly ; a single muscle, or several muscles, being paralysed, and this depending entirely on the nature and amount of the disturbing influence; but, when the balance of power is destroyed, by which antagonistic muscles are regulated, distortion inevitably succeeds.

Females appear to be more frequently affected with

paralytic and other forms of non-congenital talipes than males. Duval gives the following numbers to show the relative frequency of non-congenital talipes in the two sexes, and also that the left foot is more frequently affected than the right.1 Double non-congenital talipes is comparatively rare.

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In all cases of non-congenital talipes, from whatever cause, the temperature of the limb is reduced below the standard of health; but this is especially the case with paralytic distortions. The free motion of the limb is rendered impossible, and the movements of the tibio-tarsal joint are at best greatly impaired. Heine records several observations showing the relative heat of several parts of the body, to contrast the temperature of the paralysed lower extremities with the heat of the trunk and mouth. The following is one of several, which do not essentially differ. The patient was a girl, eight years of age, who had suffered from convulsions at fifteen months. These attacks were immediately followed by paralysis of the lower extremities.

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