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

  • Oscar Vulpius
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.

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    one, so that it exhibits a relative shortening. Later on, however, the disturbing effect of the paralysis shows itself in the opposite limb, and investi¬ gations in cases which have been followed up for a considerable time have revealed the fact that the difference in length tends to disappear. This explanation is clearly somewhat far-fetched. It fails, too, to account for two cases described by Tubby and Jones, in which both legs were paralyzed, but the less affected limb was the shorter. Here we have a splendid example of the fact that the extent of the paralysis bears no relation to the severity of the trophic disturbance. I myself have frequently seen cases of elongation of the affected leg. But it was only an apparent lengthening, due either to contracture of the abductors and tilting of the pelvis, or to paralytic forward dislocation of the hip-joint. In two patients the elongation appeared to amount to 1-J- or 2 centimetres. Deformity and Contracture.—The most interesting stage to the ortho¬ paedist is that of recovery after the first onset, for it is then that paralytic deformity and contracture begin to appear. The causation of paralytic contracture is not easy to explain. Various theories have been advanced, and the resulting controversy has been keen. The fact is, that none of the explanations offered is sufficient to explain the whole difficulty, but there is an element of truth in all of them. In order to understand them properly, we must go back to the physiology of the muscles. But here we are at once confronted with the difficulty that physiologists themselves are not agreed on the point. There can be no doubt that the normal position of a joint in the living body is determined and maintained by the equilibrium subsisting between the various muscles surrounding the joint. But how is this brought about ? Mainly by the elastic tension of the muscles and tendons—that is to say, by a mechanical force—but also by muscular tone, a factor whose existence has been fre¬ quently denied, but which appears, according to recent work, to come into play. We have proof of its existence every time that we perform tenotomy of a tendon. The muscle retracts as soon as it is divided, and the gap between the two ends of the tendon affords a measure of the previous degree of tension on the muscle. Retraction also occurs in the antagonist, because it cannot extend fully after a contraction, without the help of its opponent. The same thing happens in muscular paralysis, but the causation of the contracture varies according as the paralysis is partial or complete. Total paralysis is followed by relaxation of the joint capsule ; flail-joint ensues, and the position of the peripheral part of the limb is solely controlled by its weight. If one posture is maintained uncorrected for any length of time, shortening occurs in those muscles whose points of attachment have been approximated. In time the bones also become adapted to the new position, and osseous deformity ensues. In the case of partial paralysis, the
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