11 
POST-DIPHTHERITIC PARALYSIS IX MAX. 
Paralysis probably follows in one-fourth of all cases of diphtheria 
that recover. The palsies are frequently so shght in degree and 
extent that they may readily be overlooked. Of 50, Sol cases 
observed from 1S95 to 1902 in the hospitals of the Metropohtan 
Asyhuns Board 19.54 per cent developed post-diphtheritic paralysis. 
Post-diphtheritic paralysis follows both mild and severe cases; 
even fatal paralysis may follow an ambulatory case.® Both sexes 
are equally affected. While the palsies follow the attacks of diph- 
theria in all ages, clinicians differ radically as to the relative fre- 
quency of the sequel at different ages. 
The paralysis may affect the heart, palate, ciliary muscle ffoss of 
accommodation), ocular muscles (strabismus), the pharynx, lips, dia- 
phragm, or any of the skeletal muscles. It is sometimes localized, 
sometimes general. 
The paralysis may more properly be described as a palsy or paresis, 
as the loss of power is seldom complete. It usually appears about the 
second or third week, sometimes as late as the eighth week. Accord- 
ing to RoUeston, early paralysis indicates a profound mtoxication of 
the nervous system and is a bad prognosis, early involvement of the 
palate being often associated with cardiac paralysis. This corre- 
sponds precisely vdth our observations upon the guinea pig. Paraly- 
sis appearing early in the guinea pig — between the tbiiTeenth and 
eighteenth days following infection — is almost invariably severe and 
fatal: paralysis appearing later is commonly benign. 
The tendency of diphtheritic palsy is to recover. Alien death 
occurs it is usually vlthin the first three weeks, and is commonly due 
to cardiac paralysis. The figures indicate that from 2 to 4 per cent 
of the total number of cases of diphtheria die as a result of post- 
diphtheritic paralysis. 
A precocious form of palatal palsy occurring about the fifth day 
of the disease or earlier has been described. Deguy^ believes these 
early palsies of the palate to result from the local effect of infiam- 
matory reactions other than diphtheria. The presence of large num- 
bers of diplococci, both in the leucocytes and in the tlnombosed 
capillaries of the part, adds weight to the belief that the action is a 
diplococcsemia superadded to a diphtheritic intoxication. 
Rolleston believes that precocious palatal palsy in diphtheria is 
almost invariably associated with malignant forms, as is shown by 
a This corresponds to our work upon guinea pigs. Mixtures containing large doses 
of toxin partially saturated with antitoxin, when injected into guinea pigs, may clause 
little or no acute s^Tuptoms, but there may be enough uncombined “toxon” to cause 
severe or fatal post-diphtheritic paralysis. 
&Rev. neurology* and ps^'chia., vol. 4, Sept., 1906, p. 614. 
