A CASE OF PARALYSIS OF MOTION OF BOTH

UPPER EXTREMITIES,

By J. N. UPSHUR, M.D.,

VIRGINIA.

WAS called on November 4, 1880, to see W. O., colored, male, aged about forty years. The messenger stated that he had been unable to find his regular attendant, and desired that I would visit him, as he had been seized with a convulsion. The distance being great, and the night very inclement, I sent a prescription for an active purge. I was again sent for the next day, when I received the following account of his attack: While sitting at dinner, about 3 P. M., he was seized suddenly with a convulsion, and had a second one about three hours after the first. From the imperfect account given by the man's wife, the convulsions were epileptic in nature. He had always been of robust health, led an active life, being a bricklayer by trade, and had no history of syphilis, had had gonorrhoea in early life and resulting stricture, which had sometimes given trouble, but he had never had any regular treatment for it, and had not at the time of this attack been suffering from it. Two years before he had had a fall from a scaffold, sliding down an inclined plane to the ground, dragging and striking the back of his head all the way. Afterwards felt no inconvenience from the fall except some soreness. The pill ordered the night before had acted freely, he had had no more convulsions, and expressed himself as feeling better, except that some dizziness still remained. Ordered gr. x sulph. quiniæ every four hours till forty grains were taken. Nov. 6th found the patient much better. Told me his urine was usually very scanty. I discontinued my attendance, and early the following week he went to work.

On the 13th was again called to see him; he had had a recurrence of the convulsions, two coming on about the same time of the day, and with the same interval (three hours). Same treat

ment as before, but with only partial relief. Patient complains of intense aching in the back and limbs, and inability to lie down or sleep in any position. Any attempt to lie down brought on agonizing pain in the shoulders. He had now almost complete paralysis of both upper extremities, subsequently becoming complete except in the hands, where slight power of motion remained. He was unable to feed himself, or use his hands in any way, usually sat in a rocking chair with his hands resting on his knees. Appetite good, bowels normal, urinary secretion moderate and high colored, contained no albumen and no tube-casts, no dizziness, mind clear, tongue slightly furred, facial expression very good. The only prominent symptoms were paralysis of motion of both upper extremities except in the hands, intense pain in his shoulders on attempting to lie down, and inability to sleep. Iron, arsenic, and strychnia were orderel, but after fair trial, no good resulting, salicylic acid in full doses was substituted with some benefit which was not continuous. Bromide potass. gr. xx and tinct. gelsemium gtt. vij, three times a day, were next given, with some improvement in the paralysis (began with gtt. iv of the gelsemium and increased it to gtt. vij).

Nov. 26th. Doing pretty well; more power in his arms, and does not suffer quite so much on attempting to lie down. Describes this pain as extending across the back, from the point of one shoulder to the other.

29th. Having ceased to improve on the last prescription, it was discontinued, and potass. iodidi, gr. xv three times a day, ordered.

Dec. 3d. Patient improved, so that with some difficulty he can raise the forearm. Great tenderness over the brachial plexus on both sides; had been able to lie down for an hour the night before, very comfortably; increased the iodide potass. to gr. xx three times a day, with the addition of gtt. xx of the fluid extract of ergot to each dose.

7th. Can move the arms some from the shoulder; complains of the tenderness at the root of the neck, and over the plexus; ordered it to be well painted twice daily with the tinct. iodine.

11th. Patient better; can lie down now nearly all night without pain. Tinct. iodine relieved the soreness at the root of the neck; he can use his arms much better. Complains now chiefly of a pain in the belly of the biceps muscle: continue treatment.

15th. Was placed upon a tonic treatment of hypophosphites, iron, and nux vomica.

22d. On the night of the 20th the patient had another convulsion, while lying quietly in bed. All other treatment was discontinued, and he was put upon potass. bromide, gr. xx, three times a day.

March 2d. Patient has steadily improved up to this date, and has gone to work. Stopped my attendance, but directed the bromide to be steadily kept up for some time.

May 3d. Saw the patient at my office this A. M. The weather damp, and threatening to rain. Still partial paralysis of motion; says that in cloudy or rainy weather he suffers most, and has greater difficulty in using his arms. Is still taking the bromide; complains of having suffered from dizziness for the past week, due I think to a torpid condition of the liver. The increased suffering in cloudy or rainy weather inclines me to the opinion that his attack is of a neuralgic character.

Remarks.-Perhaps the most striking feature in the report of the above case is the frequent change and great diversity in the treatment, indicative, as it truly is, of how much at sea the reporter was for an accurate diagnosis of the cause and existing lesion, in what was to him a most unique case. Had the fall, two years previous, anything to do with this condition, as a predisposing cause to epilepsy? Was it a case of cervico-brachial neuralgia, as would seem to be indicated by the tenderness over the brachial plexus? Was the paralysis due to any circumscribed lesion of the upper part of the dorsal cord? Was it of malarial origin? Did the scanty secretion of urine and the convulsions indicate that it was due to uræmic poisoning? Finally, could it have been due to reflex irritation from the strictured urethra? All of these causes were carefully considered by the writer, without arriving at any (to him) satisfactory explanation of the pathology of the case, or suggesting any rational mode of treatment. The report of the case is now made, because, to the writer, it is most unique, and with the hope that it may provoke discussion and criticism, and some light be evolved thereby.

IS CROUPOUS PNEUMONIA A ZYMOTIC DISEASE?

By D. WEBSTER PRENTISS, A.M., M.D.,

DISTRICT OF COLUMBIA.

Ir is not proposed in this paper to enter into a detailed description of the history, symptoms, and treatment of croupous pneumonia, but rather to present in a condensed form the reasons why it should be classed among the constitutional diseases rather than among the local. The exhaustive article by Juergensen in vol. v. Ziemssen's Cyclopædia leaves but little to be desired in regard to a complete history of this disease.

There exist, however, among general practitioners, in this country at least, very confused ideas upon the subject of inflammations of the lungs. To very many, pneumonia means "inflammation of the lungs" and nothing more, no different forms being recognized. Others, by far the largest number, accept the classification into "lobar" and "lobular" pneumonia, but do not recognize them as distinct diseases, but rather as differing only in the extent of the lung involved. This distinction is such a palpable clinical one, that we find it impressed upon the works of nearly all writers. Under the general heading of "pneumonia," Prof. G. B. Wood, twenty-three years ago, describes "lobar or common pneumonia" and "lobular or catarrhal pneumonia” -the latter being spoken of as a consecutive disease most frequent in children under seven years of age. His "lobar pneumonia" is the croupous pneumonia of the present day, and to his graphic detail of symptoms nothing need now be added to complete the picture. Prof. Wood also describes "vesicular pneumonia," "typhoid pneumonia," and "chronic pneumonia." The disease is considered distinctly local, and the different forms as varieties of each other.

This author is quoted because the views expressed are those entertained by the great majority of the medical profession in this country at the present time.

1 Wood's Pract. of Med., vol. ii., 5th ed.