INFANTILE PALSY. 375 



tractility of the muscles was retained ; whereas, in recent cases of tho 

 permanent form, a few only of the muscles of the paralyzed limb 

 maintained their electric contractility, while in the others it was lost. 

 These observations may be summed up as follows : that the prognosis 

 of an essential palsy is favorable, and that a cure is to be hoped for, 

 when the affected muscles preserve their contractility ; but that it is 

 unfavorable, and that degeneration and atrophy ensue, when the elec- 

 tric contractility is extinct. 



When the disease passes into the so-called second stage, the re- 

 laxed flexible soft limbs, which may readily be placed in any required 

 position, gradually lose their original plumpness. They suffer an 

 atrophy which involves the skin, fat, muscles, and even the bones. In 

 the course of a year the circumference of the limb, and even its length, 

 is far smaller upon the crippled than upon the sound side. The pulse 

 is small, corresponding to the deficient nutritive condition and marked 

 depression of temperature of the paralyzed limb. It has a livid hue, 

 and is liable to bed-sores, chilblains, and ulceration. As the disease 

 progresses, deformity and contractions of the crippled limb are added 

 to the atrophy. The wasted deltoid muscle is often no longer able tc 

 hold the head of the arm-bone in its socket on the shoulder-blade ; sc 

 that the arm sinks, stretching the capsule of the joint by its Weight. 

 We then find a depression immediately beneath the acromion, the 

 head of the bone lying farther downward and backward. It is easy 

 to replace the bone ; but, as soon as the arm is permitted to hang 

 down, it is immediately redislocated by its own weight. When the 

 lower extremities are attacked, particularly if it be at the period when 

 children try to move themselves about by shuffling, permanent short- 

 ening takes place in the muscles which still retain some degree of con- 

 tractile power and encounter no resistance from their antagonists. 

 This is the mode of origin of a variety of forms of clubfoot, flexions of 

 the hip, and the deformities of the knee-joint known as genu valgus. 

 In advanced periods of the disease, the electrical contractility of the 

 degenerated and wasted muscles is extinct. No conclusion as to the 

 origin of the affection can be drawn from this condition, as it occurs in 

 all forms of paralysis (even in the cerebral form) after it has lasted 

 long enough for the nerves and muscles to degenerate. 



The general health usually remains unimpaired in essential paraly- 

 sis. Many patients attain a great age, and, when they belong to the 

 lower classes of society, are often seen as mendicant cripples on the 

 high-roads. 



TREATMENT. It is only in very recent cases of essential palsy that 

 any benefit is to be expected from local blood-letting, or from deriva- 

 tives by the side of the spine. In old cases we have as little reason 

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