The treatment of infantile spastic paralysis / by Robert Jones.

  • Robert Jones
Date:
[1902?]
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of infantile spastic paralysis / by Robert Jones. Source: Wellcome Collection.

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    effort he may make to improve the condition of the limb. Clinically, we may divide this group into— (a) Cases with and cases without severe mental complica- tion. (0) Complete and partial disability of hands. (c) Complete or partial disability of limbs. (d@) Cases complicated by athetotic movements. In a number of cases the spasm is confined to the limbs, and this is a group to which we give the name of Little’s Disease, or Spastic Paraplegia. Of the vast majority of cases even in this last group a varying degree of mental derangement will be noted, and in many, athetotic movements are present. A typical case of spastic paraplegia brought to the surgeon at the age, say, of 12 months is characteristic; usually no contractions have occurred at the hip or knee; the child’s legs are rigid; the toes are pointed; there is usually no in- ternal rotation, and adduction is not sufficiently severe to cause a crossing of the limbs. The reflexes are exaggerated, the patellar reflex not usually causing a knee-jerk but a leg-jerk. If the little patient be held by its arms there is no endeavour made to separate the limbs; and should the toes be brought to the ground, and an effort made by the child to walk, both limbs move synchronously and in parallel lines. When passive separation of the limb is made, although it is easily effected, one can see and feel the antagonistic efforts of the powerful adductors. If at a later stage the patient 1s able to walk, several changes will be noted. The adduction will be more marked; the scissors walk will have developed, and a character- istic dragging of one knee round the other will be noted, which becomes more pronounced when any attempt at running be made, The body pressure is mainly transmitted to the ball of the toe. These contractures, however, at this stage, are generally spasmodic, and there is no appreciable shortening in muscle length. This shortening occurs at a still later stage, and is known as contracture. In quite a number of cases the patients are in a hopeless
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