Opera minora : a collection of essays, articles, lectures and addresses from 1866 to 1882 inclusive / by Edward C. Seguin.

Edward Constant Seguin

Date:: 1884

Credit: Opera minora : a collection of essays, articles, lectures and addresses from 1866 to 1882 inclusive / by Edward C. Seguin. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$the paraplegic, tlie walk of partial paralysis. In clironic trans- verse myelitis the patient walks with a scuffling movement, drag- ging his toes upon the floor. By closing your eyes and listening to the walk of two patients, one ataxic and the other paraplegic, you can tell them apart easily. The former makes a loud stamping sound with his heels; the latter scrapes the floor with his feet. An important walk is the tetanoid, which I first described in 1873.* The patient takes very small steps and turns the toes inward. The feet are approximated, and there is a tendency to crossing of the legs from overaction of the adductors. The legs are rigid and the feet drag. You will find this in many children, occasionally in adults. This v/alk is believed to indi- cate primary or secondary sclerosis of the lateral columns, or want of development of the same parts. In hysterical hemiplegia the walk is psculiar. A woman may seem to have complete paralysis of the arm and partial paralysis of one leg. In walking she moves the leg in the proper vertical line ; there is no sickle movement ; the foot is carried carefully and squarely over the ground, and is dragged. Dr. K. B. Todd,t of London, who was one of the most acute and skilful students of nervous diseases thirty years ago, first described this walk. The walk of patients with cerebellar disease is usually badly denominated in the books. It is spoken of as ataxic, but there is nothing ataxic about it. If you were to test a patient with cerebellar disease as you would one with ataxia, by requesting him to shut his eyes and put the end of his forefinger upon the end of his nose, etc., he would have no difficulty in doing it. The walk of cerebellar disease is inco-ordinate, though not ataxic. It is more like the inco-ordination of intoxication, or, as the French writers call it, titubating. The patient tries to extend his base of support by separating his feet, and his body oscillates from side to side. If the feet be bare, the patient's toes will be seen working abnormally, and apparently digging into the carpet. Nothnagel;]: has written the best account of the cerebellar walk. I will add a few words about reflexes. These are tested usu- * Description of a Peculiar Paraplegiform Affection. Seep. 127. Mso Archives of Scientific and Practical Medicine, No. 2. New York, February, 1873, vol. i., p. 101. \ Clinical Lectures on Paralysis, etc. London, 1856, p. 257. t Topische Diagnostik^er Gehirn-Krankheiten. Berlin, 1879, pp. 59-51,$