INFANTILE PALSY. 373 



when offered to drink, rejects a large portion of the liquid with violent 

 expiratory motions, so that at last it often becomes necessary to feed 

 him by means of the oesophagus tube. The choking-fits thus pro- 

 voked by attempting to drink, and the rejection of the liquid amid 

 spasmodic coughing, might awaken the suspicion that a communication 

 exists between the larynx and pharynx, or oesophagus. In one case 

 of this kind, my colleague JBrims demonstrated, by means of the la- 

 ryngoscope, that, " if the patient merely was fed with small spoonfuls 

 of milk or porridge, the swallowed portion only passed as far as the 

 pouch which lies behind the larynx. If, by further swallowing, the 

 level of the liquid rises so as to pass the bottom of the notch between 

 the arytenoid cartilages, the so-called rima glottidis posterior, the soft 

 liquid mass immediately flows forward through this opening into the 

 larynx, and instantly gives rise to a fit of coughing." 



This disease is generally a tedious one. Death is the usual result, 

 either from impairment of the general nutrition of the patient, owing 

 to the difficulty with which he obtains nourishment, or else from vio- 

 lent bronchitis, or pneumonia, in consequence of the repeated intru- 

 sion of liquid into the air-passages. Hitherto no authentic case of im- 

 provement or cure has been reported. Benedikt is the only one who 

 claims that, by galvanization of the sympathetic, and at the mastoid 

 process, he has obtained important success and even a cure, and in 

 advanced cases has relieved dangerous symptoms, such as difficulty 

 in swallowing. For this purpose he applied the copper-pole to the 

 spinal column, and strokes with the zinc-pole upon the pomum adami 

 and neighboring parts, so that in each sitting he is able to induce some 

 twenty or thirty acts of deglutition. May there not have been some 

 confusion with hysterical dysphagia in these almost miraculous cures ? 

 T have cured a hysterical patient by a treatment almost purely psychi- 

 cal, who for months previously had been fed through a tube, and had 

 carried a canula in her trachea for an equally long period of time. 



CHAPTER XXIII. 



ESSENTIAL PALSY OF CHILDREN SPINAL INFANTILE PALSY (Heine). 



ETIOLOGY. Whether the essential palsy of children be a disease 

 of the brain, of the spinal marrow, or of the peripheral nerves, or 

 whether it proceed from all or any of them in turn, as Vogt supposes, 

 ..s a matter which, in our present ignorance of its post mortem lesions, 

 cannot be positively decided. The name " essential palsy " I hold to 

 oe a most appropriate one. Although the paralysis originally may 

 have been due to an inflammation or effusion in the spinal marrow, 



