The treatment of infantile paralysis / by Oskar Vulpius ; translated by A. H. Todd.

  • Vulpius, Oscar, 1867-1936.
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of infantile paralysis / by Oskar Vulpius ; translated by A. H. Todd. Source: Wellcome Collection.

    22/336 (page 8)
    Age. Axilla. Back. Loin. Thigh. Leg. Dorsum of foot. Sole of foot. 93° F. 90 90 86 76 75 72 6 97° F. 93 90 84 77 74 70 8 — 95 93 80 65 — 64 12 97° F. 92 90 74 70 — 65 The coldness and cyanosis are, of course, due to the defective circulation This, in turn, is partly due to the loss of movement in the limb, but chiefly to the vasomotor system being involved in the paralysis. Chilblains and chronic ulceration of the skin frequently result from the impairment of the blood-supply. It is not improbable that other structures besides the skin suffer from loss of nutrition, and that this is the explanation of the deficient growth of the bones. Affection of Bones.—The alterations in the growth in length and thickness of the long bones have not yet been studied in sufficient detail, although the X rays have proved a great advance on the methods of palpation and measurement. It is certain, however, that the condition is not solelv caused by defective circulation and insufficient use, but is an actual disuse- atrophy. Volkmann showed that there is often a relationship between the severity of the paralysis and that of the impairment of development. In paralysis of the lower leg the femur may show considerable shortening, so that marked disability may persist in patients who have recovered from a so-called “ transitory ” paralysis. Nonne reports the case of a girl of sixteen, who was ill for four years with infantile paralysis, which left her with a complete palsy of one arm. The skiagram showed translucency and rare¬ faction of the bones of the hand and forearm, especially of the epiphyses. The greater part of the diaphyses, especially of the humerus, was unaffected. It must be recognized, therefore, that trophic disturbances of nervous origin may occur in the skeleton, in addition to the muscles, and that these are particularly liable to take the form of Sudeck’s atrophy. Careful and pro¬ tracted observation and measurement of paralyzed limbs will be necessary in order to learn something of the origin and course of the disorder of growth. Quite recently a remarkable phenomenon has been observed, in the shape of an elongation of paralytic limbs. Von Seligmüller and Neurath had already written on the subject, and later on von Kalischer added some further observations. It has been suggested that rickets, which was noted in the majority of the cases, may be the cause of the apparent lengthening. The effect of this disease is to inhibit growth, and it may chiefly affect the good leg, being the one upon which the weight of the body is chiefly borne. Consequently, this leg may have its growth more impaired than the paralyzed