The treatment of infantile paralysis / by Robert W. Lovett.

  • Lovett, Robert W. (Robert Williamson), 1859-1924.
Date:
[1916], ©1916
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Licence: Public Domain Mark

Credit: The treatment of infantile paralysis / by Robert W. Lovett. Source: Wellcome Collection.

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    not be inferred that any other muscle or muscular group is necessarily paralyzed or not paralyzed in connection with it and no inferences can be drawn. One fact, however, is clear from 13,000 muscular observations made on 177 patients by the muscle test to be spoken of later, namely, that the paralysis is generally more widely distributed than would be supposed from a casual examination. Paralysis of the gastrocnemius muscle, e.g., is frequently spoken of as a clinical condition but really paralysis of this muscle alone occurred only twice in 177 cases carefully measured, other muscles being weakened also. When one leg is involved it is common to find weakening of some of the muscles of the other leg. When both legs are affected it is not uncommon to find some weakening of some of the arm muscles. This fact is of great importance in formu¬ lating treatment. In thirty-two cases of the Vermont series taken consecutively from the files for this analysis the follow¬ ing data were observed: Ten cases had been classed by manual examination as having only one leg affected; by the muscle test nine of these showed weakness of muscle groups in the other leg. In eighteen other cases of paralysis of more than one limb examination showed unsuspected involvement else¬ where in ten (55 per cent.). Deformities develop during the disease in certain cases and will be discussed under three heads later on: (1) the prevention of deformity, page 35; (2) the causes and varieties of deformity, page 53; (3) the mechanical and operative correction of deformity, page 75. Later on the reflexes are diminished or absent in affected muscles, and the reaction of degeneration is present to the electrical current in paralyzed muscles. Sensation is ordinarily stated to be unimpaired but the modern pathology makes this seem unlikely because the posterior root ganglion is generally the first part of the nervous system to be affected and because tenderness is generally present early. In a few cases of infantile paralysis, old and recent, tested by Prof. E. G. Martin1 of the 1 Martin, Porter and Nice: “The Sensory Threshold for Faradic Stimulation in Man,” “Psychological Review,” xx, 1913, p. 194- Martin, Paul, and Welles: “A Comparison of Reflex Thresholds with Sen¬